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Osce Prep > Neuro > Flashcards

Neuro Flashcards

1
Q

Lesion to CN iiii

A

Diplopia when looks down and away from affected side

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2
Q

Usual causes of CN vi lesions

A

Trauma , wernikes encephalopathy

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3
Q

Features of CN vi lesions

A

Failure of lateral movement

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4
Q

LMN lesion of facial

Usual cause

A

Ipsilateral weakness of muscles of facial expression

Bell’s palsy

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5
Q

UMN of facial

Usual cause

A

Insulate real weakness of muscles of facial expression but SPARES FOREHEAD
Tumours / vascular events

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6
Q

Facial nerve involvement in hearing?

Damage ->

A

Motor supply to stapedius

Hyperacusis (loud distortion of sounds)

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7
Q

Hip flexion nerve

A

L1,2

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8
Q

Knee flexion / hip extension nerve

A

L5 s1,2

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9
Q

Knee extension nerve

A

L2,3,4

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10
Q

Knee jerk nerve

A

L3,4

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11
Q

Ankle jerk nerve

A

S1,2

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12
Q

Plantar reflex nerve

A

L5 s1,2

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13
Q

Dermatomes of legs

A 
Upper thigh l2
Anterior knee l3
Inner calf l4
Outer calf l5
Lateral foot s1
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14
Q

Heel to toe walking tests for

A

Midline cerebellar lesion

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15
Q

Difficulty walking on toes

A

S1 lesion

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16
Q

Difficulty walking on heels ? (Foot drop )

A

L4/5 lesion

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17
Q

Parkinson’s gait

A 
Hesitation in starting
Shuffling
Freezing
Diminished swinging of arms 
Propulsion
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18
Q

Cerebellar ataxia gait

A

Broad based
Unstable
Tremulous

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19
Q

Sensory ataxia gait

A

Broad based and high stepping

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20
Q

Distal vs proximal weakness gait

A

Distal - affected leg raised high and foot slaps ground

Proximal - waddling

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21
Q 
Never supply:
Deltoid 
Pec major / lats
Biceps 
Triceps
Wrist flexion 
Wrist extension 
Finger flexion 
Finger extension. 
Dorsal interrossi (splay fingers) 
Palmar interrossi
A 
Deltoid c5,6
Pec major / lats c6,7,8
Biceps c5,6
Triceps c7
Wrist flexion c6,7,8
Wrist extension 
Finger flexion 
Finger extension. 
Dorsal interrossi (splay fingers) 
Palmar interrossi
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22
Q

Lesion of CN III

A

Eye pointing down and out with a fixed dilated pupil

Pstosis

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23
Q 
Never supply:
Deltoid 
Pec major / lats
Biceps 
Triceps
Wrist flexion 
Wrist extension 
Finger flexion 
Finger extension. 
Dorsal interrossi (splay fingers) 
Palmar interrossi
A 
Deltoid c5,6
Pec major / lats c6,7,8
Biceps c5,6
Triceps c7
Wrist flexion c 6,7,8
Wrist extension c7,8
Finger flexion c7,8
Finger extension. C7,8
Dorsal interrossi (splay fingers) c8,t1
Palmar interrossi c8, t1
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24
Q

Nerves for
Biceps reflex
Triceps
Supinator

A

Biceps c5,6
Triceps c7,8
Supinator c5,6

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25
Q

Dermatomes of arm

A 
Lateral upper arm - c5
Lateral forearm and thumb - c6
Middle finger - c7
Little finger - c8
Medial upper arm - t1
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26
Q

Cerebellar signs

A 
DANISH 
Disdiadokinesis 
Ataxia
Nystagmus
Intension tremor 
Slurred speech 
Hypotonia
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27
Q

Cerebellar function tests

A

Heel to shin
Finger to nose
Finger to nose to finger
Rapid alternating movements

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28
Q

Basic causes of cranial nerve lesions

A

Trauma, diabetes, tumours, MS

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29
Q

Used for visual acuity

A

Snellen chart

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30
Q

Why are muscles of forehead sometimes spared from UMN lesions

A

They have bilateral UMN supply

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31
Q

What does a bovine (non explosive cough suggest)

A

Vagal palsy

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32
Q

Key parts of Cerebellar exam

A 
DANISH 
Disdiadokinesis 
Ataxia (gait and posture)
Nystagmus 
Intention tremor 
Slurred, sticato speech
Hypotonia / heel shin test
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33
Q

What does innatention suggest

A

Damage to frontal / parietal lobes (stroke/trauma etc)

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34
Q

Lack of consensual pupillary response could indicate ?

A

Damage to one or both optic nerves

Damage to edinger westphal nucleus

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35
Q

Swinging light test can detect?
What does it look like?
Caused by?
Eg?

A

Relative afferent pupillary defect (RAPD) (marcus-gunn pupil)
Dilation of the affected pupil when light shines into it (should constrict)
Damage to tract between optic nerve and chiasm
Eg optic neuritis in MS

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36
Q

What is a squint called

A

Strabismus

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37
Q

What is a saccade

A

Rapid jerky movement that corrects the gaze after a slower deviation

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38
Q

What is the red reflex?

Absent means?

A

Light reflecting back from the retina (30cm away)

Cataracts

39
Q

In unilateral Cerebellar disease which way is the deviation?
Why?

A

Towards the side of lesion due to hypotonia

40
Q

Why do you use the heel to toe walking for Cerebellar disease?
What does it assess?

A

Exaggerates any unsteadiness

Assesses function of Cerebellar vermis

41
Q

What is the first function to be lost in alcoholic Cerebellar cortical degeneration

A

Heel to toe walking

42
Q

In a Cerebellar exam what would a positive rombergs test indicate

A

Unsteadiness is due to sensory ataxia (damage to dorsal columns of spinal cord) rather then Cerebellar ataxia

43
Q

What would a slow upward pronator drift indicate

A

Lesion in the contralateral cerbellum

44
Q

What does a positive rebound phenomenon suggest

A

Cerebellar disease

45
Q

What is a pendular reflex mean ?

When do you get it?

A

Leg keeps swinging after you elict the knee reflex

Cerebellar disease

46
Q

Reflexes in Cerebellar disease

A

Mild hypo reflexes

47
Q

What is an intention tremor

A

Gets worse at endpoint of a deliberate movement

48
Q

Failure of Disdiadokinesis suggests

A

Cerebellar ataxia

49
Q

Things to look for in lower limb inspection

A 
SWIFT
Scars
Wasting 
Involuntary movements 
Fasiculations 
Tremor
50
Q

Possible causes for abnormal heel to toe gait

A

Weakness
Impaired proprioception
Cerebellar disorder

51
Q

What does heel walking test

A

Dorsiflexion power

52
Q

Positive rombergs test suggests

A

Sensory ataxia (defective proprioception / vestibular system)

53
Q 
Hip nerve roots 
Flexion
Extension
Abduction 
Addiction
A

Flexion L1/2
Extension L5/s1
Abduction L4/5
Adduction L2/3

54
Q

Knee nerve roots
Flexion
Extension

A

Flexion - S1

Extension - L3/4

55
Q

Big toe extension nerve root

56
Q

Reflexes
Knee jerk
Ankle jerk
Plantar response

A

Knee jerk L3/4
Ankle jerk l5/s1
Plantar response S1

57
Q

What is an abnormal plantar response ?

Indicative of?

A 
Babinski sign (extension of great toe)
UMN lesion
58
Q

What tract is light touch

A

Dorsal / posterior columns

59
Q

Pin prick sensation

A

Spinothalamic

60
Q

Vibration sensation tract

A

Dorsal / posterior columns

61
Q

Proprioception tract

A

Dorsal / posterior column

62
Q

Inability of heel to shin test indicated

A

Loss of motor strength / proprioception

Cerebellar disorder

63
Q

Pronator drift indicates

A

UMN pathology

64
Q

Rigidity when assessing tone suggests

A

Parkinson’s

65
Q

Shoulders
Abduction
Adduction

A

Ab - C5

Ad- C6/7

66
Q

Elbow
Flexion
Extension

A

Flex - C5/6

Extension - C7

67
Q

Wrist
Extension
Flexion

A

Extension - C6

Flex - C6/7

68
Q

Finger
Extension
Abduction

69
Q

Muscles for abduction of fingers

A

First dorsal interosseous

Abductor digiti minimi

70
Q

Thumb abduction

71
Q

Reflexes
Biceps
Triceps
Supinator

A

B- c5/6
T - c7
Sup - C6

72
Q

Nose to finger test may indicate

A

Cerebellar pathology

73
Q

Failure of Disdiadokinesis

A

Cerebellar ataxia

74
Q 
Axillary nerve 
Root
Muscle
Action 
Sensation
A

C5
Deltoid
Shoulder abduction
Regimental badge over deltoid

75
Q 
Musculocutaneous
Root
Muscle
Action 
Sensation 
Reflex
A 
C5/6 
Biceps 
Elbow Flexion 
Lateral aspect of forearm 
Biceps
76
Q 
Radial 
Root
Muscle
Action 
Sensation 
Reflex
A 
C7
Extensiors
Wrist / finger extension 
Anatomical snuff box 
Triceps
77
Q 
Ulnar 
Root
Muscle
Action 
Sensation
A

T1
First dorsal interosseous
Index finger abduction
Medial side of palmar hand and medial border of ring finger

78
Q 
Median nerve
Root
Muscle
Action 
Sensation
A

T1
Abductor pollicis brevis
Thumb abduction
Lateral side of hand palmar

79
Q

What is strabismus

A

Eyes don’t quite point the same way

80
Q

How is visual acuity measured

How far should the snellen chart be held away

A 
Chart distance (m) / lowest line read 
6m (can be reduced to 3 then 1 if top line can't be read)
81
Q

How do you test colour Vision

A

Ishihara charts

82
Q

How do you do fundoscopy

A

Dilate pupils with shirt acting mydriatic eye drops
Darken room
Ask patient to fixate on distant object
Assess for red reflex - look through ophthalmoscope and observe for reddish reflection of pupil

83
Q

When might the red reflex be absent

A

Cataract

Rarely - neuroblastoma

84
Q

What else is examined in fundoscopy

A

Begin medialy and assess optic disk (colour, contour, cupping)
Assess retinal vessels ( cotton wool spots, neovascularisation)
Assess macula (ask to look directly into light - drusen noted in degeneration (yellow deposits made of lipid))

85
Q

Ptosis indicates

A

Oculomotor nerve pathology

86
Q

Cover test responses

A

No movement - normal
Eye moves temporally - convergent squint
Eye moves nasally - divergent squint

87
Q

Facial light touch sensation

Branches

A

Forehead - opthalmic v1
Cheek - maxillary - v2
Jaw - mandibular v3

88
Q

Complete closure of jaw when testing jaw jerk indicates

A

UMN lesion

89
Q

Normal corneal reflex

A

Direct and consensual blinking

90
Q

When assessing facial why do you look at external auditory meatus

A

Herpes zoster lesions (Bell’s palsy)

91
Q

Facial nerve supply

A

Muscles of face
Stapedius
Taste to anterior 2/3 of tongue

92
Q

What is normal result in Rinnes test
Neural deafness
Conductive deafness

A

Air conduction > bone conduction
Air > bone (both reduced equally)
Bone > air

93
Q

Webers test
Normal
Neural deafness
Conductive deafness

A

Sound heard equally
Neural - sound heard louder on intact ear
Conductive - sound heard louder on side of affected ear

94
Q

How to test vestibular

A

Ask patient to march on spot with eyes closed

Vestibular lesion - patient will turn to that side

Osce Prep (9 decks)

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