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4th year OSCE > Neuro > Flashcards

Neuro Flashcards

1
Q

Causes of peripheral neuropathy

A

Alcohol, Autoimmune (GB, Lupus), Diabetes, Infection, Charcot Marie, Amyloid, Trauma, Tumour, Kidney/Liver disease, Hypothyroid, Vitamin B deficiency

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2
Q

Upper motor neuron lesions are above the…

A

anterior horn cell

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3
Q

Interruption of UMN have greatest effect on which type of muscles?

A

antigravity muscles (flexors)

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4
Q

UMN lesions increase…

A

tone and reflexes

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5
Q

Fasciculations are seen in UMN or LMN?

A

LMN

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6
Q

Distinguish between LMN and myasthenia?

A

Myasthenia will have normal tone and reflex, only weakness which is worse with repitition

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7
Q

Footdrop DDx

A

L4, L5 lesion, sciatic nerve palsy, common peroneal palsy, distal myopathy, motor neuron disease, peripheral neuropathy,

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8
Q

Describe hemiplegic gait…

A

foot is plantar flexed and leg swung in lateral arc

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9
Q

Parkinsonian gait description

A

hesitation in starting (bradykinisea), shuffling, freezing, festination (hurrying), propulsion, retropulsion,

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10
Q

Waddling gait suggests…

A

myopathy

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11
Q

Cerebellar gait description

A

wide base and staggering

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12
Q

High stepping gait usually means… UMN or LMN

A

Lower motor neuron

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13
Q

Posterior column lesion= what gait?

A

clumsy slapping down of foot on broad base

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14
Q

First comment to make about gait…

A

symmetrical or assymetrical

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15
Q

Upper motor neuron lesion causes which resting positions for upper limb?

A

adductioxtn at shoulder, flexion at elbow, pronation wrist and fist made

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16
Q

When asked about specific location of a lesion…

A

Further testing would be required. Do upper and lower limb and cranial nerve testing. Frontal and temporal lobe too.

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17
Q

Thalamic strokes can have different presentations due to what??

A

4 different vascular supplies (3 vertebrobasilar, 1 PCA)

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18
Q

Lacunar infarcts are…

A

small subcortical infarcts in brainstem, thalamus, internal capsule, basal ganglia

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19
Q

Key features of internal capsule stroke

A

sensory and motor deficits, cranial nerve involvement

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20
Q

define site of stroke by blood supply

A

ACA: frontal affected. leg weakness
MCA: face and arm>leg, gaze preference, speech difficulty if in dominant hemisphere
PCA: heminaopia, if thalamus involved sensory loss too

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21
Q

Temporal lobe testing

A

short and long term memory, upper quad hemianopia, dysphasia

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22
Q

Frontal lobe testing

A

emotional disinhibition, gait apraxia, grasp reflex, anosmia

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23
Q

Parietal lobe testing (dominant)

A

AALF- acalculia, agraphia, left right disorientation, finger agnosia

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24
Q

Brainstem stroke vs internal capsule

A

brainstem will affect ipsilateral (LMN) cranial nerve but contralateral limbs

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25
Q

Basal ganglia stroke symptoms

A

swallowing, tremor, ataxia

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26
Q

Violent frequent hiccups=

A

Wallenburg syndrome- PICA artery. Contralateral pain and temp. Ipsilateral cranial nerve

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27
Q

Ddx of LMN

A

Peripheral nerve lesion, nerve root lesion (radiculopathy), Spinal Cord lesion

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28
Q

DDx of UMN

A

Cerebral cortex, basal ganglia, brainstem, cerebellum, spinal cord

29
Q

Radial nerve lesion=

A

wrist drop, loss of sensation over snuff box

30
Q

Median nerve lesion=

A

weakness of APB, loss of sensation in distribution

31
Q

Ulnar nerve lesion=

A

4th and 5th claw finger, loss of sensation in distribution

32
Q

Upper brachial plexus=

A

waiters tip, sensory over lateral arm

33
Q

Lower brachial plexus=

A

claw hand, sensory over ulnar side of hand and forearm

34
Q

Lateral cutaneous nerve of thigh=

A

loss of sensation only!

35
Q

Femoral nerve=

A

inner thigh and leg sensation, weakness of knee extension

36
Q

Sciatic nerve=

A

footdrop, loss of sensation on posterior of whole leg

37
Q

Common peroneal nerve=

A

footdrop, sensory loss over dorsum of foot

38
Q

Cause of peripheral nerve lesion DDx

A

DM, entrapment, RA, vasculitis

39
Q

Nerve root damage in cauda equina=

A

saddle distribution

40
Q

Radiculopathies are caused by…

A

disk herniation, narrowing of foramen from spondylysis

41
Q

Spinal cord lesion causes

A

complete loss of sensation below level,or if hemisection depends on column

42
Q

Causes of anterior column spinal cord lesion

A

anterior spinal artery embolism

43
Q

Causes of posterior column spinal cord lesion

A

trauma, tumour, MS, cervical spondylysis

44
Q

Causes of cerebral cortex UMN lesion

A

stroke, seizure, tumour

45
Q

Brainstem stroke to midbrain v pons v medulla. symptoms

A

midbrain: CN3,4= diplopia, ptosis, non reactive pupil
Pons: C6,7: LMN facial weakness
Medulla: CN 8,10: lateral medullary syndrome

46
Q

Cerebellar stroke Sx

A

nystagmus, ataxia

47
Q

Spinal cord injury C1-5

A

UMN in upper and lower limbs

48
Q

Spinal cord injury C6-T2

A

LMN in upper, UMN in lower

49
Q

Spinal injury T3-L3

A

Upper limb normal , UMN in lower

50
Q

Spinal injury L4-S2

A

Upper limb normal, LMN lower

51
Q

Why do UMN and LMN look same initially

A

takes a while for hyperreflexia and spascitiy to develop for UMN

52
Q

LMN Sx

A

wasting, fasciculation, hypotonia, reduced reflex

53
Q

Primary muscle disease vs LMN

A

symmetrical loss and no sensory loss (eg myasthenia)

54
Q

Causes of peripheral neuropathy

A

Idiopathic, alcohol, GBS, DM, vit 12, CT disease, Heavy metal, drugs (eg phenytoin)

55
Q

Ix for peripheral neuropathy

A

nerve conduction, electromyography

56
Q

Rx peirpheral neuropathy

A

anti-depressants, anti-convulsants, opiods

57
Q

Sx of peripheral neuropathy

A

Motor: muscle weakness
Sensory: glove and stocking
Autonomic: BP, constipation, bladder, incontinence, sexual

58
Q

3 key symptoms for Parkinsons

A

Resting tremor, bradykinesia, rigidity

59
Q

Other PD Sx

A

Postural instability, lack of facial expression, micrographia, cognitive, mood

60
Q

Mx PD

A

levodopa frontline

use COMT inhibitors, MAO-B inhibitors as adjunct

61
Q

Causes of ataxia

A

Focal lesion: stroke, tumour, MS

Alcohol, Vit B12 deficiency, Wilsons, idiopathic

62
Q

Mx Cerebral ataxia

A

physio, OT

63
Q

What tract is affected in hemiplegia?

A

corticospinal

64
Q

Causes hemiplegia

A

Stroke, meningitis, neoplastic (glioma), traumatic, congenital (cerebral palsy), MS

65
Q

Causes of fasciculation

A

Motor neuron disease, Motor root compression, peripheral neuropathy, primary dystrophy, thyrotoxicosis

66
Q

Cause of footdroop

A

L4,L5 lesion, peripheral neuropathy, MND, stroke, sciatic nerve palsy, peroneal nerve palsy

67
Q

What is syringiomelia?

A

Fluid filled cavities in spinal cord

68
Q

winging of scapula is paralysis of which muscle and damage to which nerve?

A

serratus anterior, long thoracic nerve

4th year OSCE (7 decks)

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