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year 3 OSCE > Neuro > Flashcards

Neuro Flashcards

1
Q

What would a damage to cranial nerve 3 cause?

A

Complete unilateral ptsosis
Pupil dilated and fixed
eye faces down and lateral

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2
Q

What is the condition where the eye reacts normal to accommodation but not to light?

A

Argyll robertson pupil

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3
Q

What is the cause of Argyll robertson pupil?

A

Seen in diabetics but also a characteristic of neurosyphilis

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4
Q

What is Bells palsy?

A

Damage to the 7th cranial nerve

Lower motor neuron lesion leading unilateral paralysis of the face

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5
Q

If there is a lesion in cranial nerve 12, does the tongue point away or towards the lesion?

A

Towards

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6
Q

If there is a lesion in cranial nerve 9 or 10, does the uvula point away or towards the lesion?

A

away

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7
Q

What do you look for in general inspection of cranial nerves?

A 
The face for
Asymmetry
Atrophy
Random eye movement
Paralysis of the face
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8
Q

What is horners syndrome?

A

Results from an interruption of the sympathetic nerve supply to the eye

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9
Q

What is the triad symptoms of Horners syndrome?

A

Miosis (constricted pupil)
Partial ptsosis
Unilateral anihydrous

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10
Q

What muscle does cranial nerve 4(trochlear ) control?

What movement does that control?

A

Superior oblique and movement of down

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11
Q

What muscle does cranial nerve 6(abducen) control?

What movement does that control?

A

Lateral rectus

Movement of the eyes right –> laterally

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12
Q

If there is a jaw jerk reflex is it UMN or LMN lesion?

A

UMN

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13
Q

What is conductive deafness?

A

Defect of sound transmission to the spiral ganglion

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14
Q

What is Sensorineural deafness?

A

Defect of the spiral ganglion and/or cochlear nerve

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15
Q

In Sensorineural deafness will sound be louder in air or via bone in rines test?

A

Bone

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16
Q

Give two diseases that cause constriction of pupil?

A

Argyll robertson pupil

Horners syndrome

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17
Q

Give a diseases that cause dilation of the pupil?

A

holmes adie pupil

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18
Q

What are you looking for in general observation of lower and upper exam?

A 
Scars
Wasting of muscles
Involuntary movement
Fasciculations 
Tremor
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19
Q

What is a cause of decreased tone

A

LMN lesion or cerebellar lesion

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20
Q

What is a cause of increased tone?

A

UMN lesion

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21
Q

What is felt in UMN lesion in tone?

A

spasticity–> initial increase in resistance then decrease

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22
Q

What is felt in basal gaglia lesion in tone?

A

Led pipe rigidity

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23
Q

In parkinsons what is the type of tremor?

A

Cog wheel rigidity which is tremor superimposing led pipe rigidity

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24
Q

What does babinski sign indicate?

A

UMN lesion if the toes extend

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25
Q

What nerve roots for patella reflex?

A

L3/4

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26
Q

What nerve roots for ankle jerk reflex?

A

S1/2

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27
Q

What nerve roots for babinski sign?

A

S1

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28
Q

What are the end pieces of lower neuro exam?

A

Romberg and Gait

29
Q

What does a positive romberg test indicate?

A

Cerebellar lesion if you wobble when eyes open

30
Q

In romberg test if positive once eyes closed what is the indication?

A

Sensory ataxia

31
Q

What is positive pronator drift sign a indication of?

A

UMN lesion–> the arm will pronate and fall

32
Q

What lesion causes lose of rebound phenomenon?

A

Cerebellar lesion

33
Q

What does clonus indicate?

A

UMN lesion

34
Q

What is the cerebellar symptoms?

A 
Dysdiadochokinesis
Ataxia
Nystagmus
Intentional tremor and past pointing
Slurred speech
Hypotonic
35
Q

What causes UMN lesion?

A

Blunt trauma, stroke and tumour

36
Q

If you have a UMN lesion is extension or flexion weaker in

a) arm
b) leg

A

A) Extension weaker than flexion

B) Flexion weaker than extension

37
Q

Explain the grading power?

A

5= normal
4= slight weakness of power
3=movement possible against gravity but not resistance
2= movement possible if eliminate gravity
1= slight movement
0= no movement

38
Q

Describe the reflex ladder?

A 
0= absent
\+= present with reinforcement needed
1= present but dappended
2= normal
3= increased
4= clonus
39
Q

What is the SNOOP mnemonic for red flag of headache symptoms?

A

Systemic symptoms–> fever , neck stiffness
Neurological symptoms–> ataxia, pralysis
Onset recent or recurrent–> important for <40
Other associated symptoms–> with trauma,
Past headaches –> different or same

40
Q

What fingers are abducted in the upper neuro examination?

A

o First dorsal interosseous (FDI) (index)

o Abductor digiti minimi (ADM) (small finge)

41
Q

What is the finger nose test assessing?

A

If their is any past pointing or intentional tremors

42
Q

What is rebound phenomenon testing?

A

Your antagonist muscle

If you fail to stop your hand then you have a cerebellar disease

43
Q

What nerves are involved in bicep reflex?

A

C5/6

44
Q

What nerves are involved in supinator reflex?

A

C5/6

45
Q

What nerves are involved in tricep reflex?

A

C6/7

46
Q

What does Proprioception test indicate?

A

Intact joint position sense is intact

47
Q

What is the SOCRATES for migraine?

A 
o	S: unilateral type of headache
o	O: Gradual
o	C: Pulsating/throbbing
o	R:start one side then spread to whole head and neck
o	A: Nausea/vomiting, blurred vision
o	T: 4 to 72 hrs
o	E: Bright light, loud sound, food triggers
o	S: moderate to severe
48
Q

What is the SOCRATES for tension headache?

A 
o	S: Generalized
o	O: gradual
o	C: tight band
o	R: arise from the neck
o	A: stress
o	T: few hours
o	E: Stress
o	S: moderate
49
Q

What is the SOCRATES for cluster headache?

A

o S: unilateral
o O: Gradual
o C: specific to one eye  feel like you want to gouge your eye out key symptom
o R: Lacrimation flow of tears
o A:
o T: 6 to 12-week period of cluster headaches
 Each lasting 30 to 60 minutes
o E: Agitation, they move around and hit there head to try and get rid of the pain
o S: severe

50
Q

What is the characteristics of syncope?

A

o Short duration
o Rapid onset
o Spontaneous complete recovery

51
Q

What questions you ask when patient has lost of consciousness?

A

o Was LOC complete
o Was LOC transient with rapid onset with short duration
o Did patient recover spontaneously, completely without sequel?
o Did patient loose postural tone

52
Q

What is the most common syncope?

A

Vasovagal syncope

53
Q

What does vasovagal syncope occur?

A

o Occurs when you faint because your body overreacts to certain triggers, such as the sight of blood or extreme emotional distress

54
Q

What is key facts you need to get from a syncope history?

A 
o	Position
o	Activity  was it exercise induced, or were you sitting down
o	Predisposing factors
	What happened that day
o	Onset
o	Eye witness
o	Background history
55
Q

What is carotid syncope?

A

o Massage both carotid bodies on your neck together  pass out
o More common in elderly

56
Q

How do you treat carotid syncope?

A

Pace maker

57
Q

What is ictus mean?

A

period of which seizures occur in

58
Q

What does Postictal mean?

A

Period after seizure but before patient has returned to baseline mental state

59
Q

What is key questions to ask in epileptic seizure history?

A
  • The trigger
  • Is it your 1st Seizure
  • Response to treatment
  • Seizure frequency
  • Any warnings or symptoms
  • How many times have you visited ED
  • What follows the seizure
  • What happens during seizure
60
Q

What are the key associated symptoms for headache?

A 
Fever=meningitis
Rash= meningitis
Nausea +Vomiting= ICP
Worse on lying down or coughing=ICP
Neck stiffness =menin
Fits/faints
Loss of consciousness
Blurred vision
Jaw in the temporal region/jaw when moving
Photophobia
Thunderclap= worse after 5 minutes (SAH)
Disrupting the sleep= ICP
Any weakness in the body or face= stroke
61
Q

In a headache history what questions do you ask about associated causes of the headache?

A

Cheese, coffee, bright light
Smack your head
Does sitting in a dark room make it better

62
Q

In radiation of a headache what do you want to ask?

A

Spread to the neck
Behind the eye
Unilateral or bilateral
Tight band?

63
Q

What are the key red flags for acute angle glaucoma with headache history?

A

Blurred vision
N+V
Eye pain
Red eye

64
Q

What are the key red flag questions to distinguish ICP in headache history?

A

Worse when lying down or coughing
wakes you up at night?
Nausea and vomiting

65
Q

How to identify meningitis headache?

A 
Fever with worsening headahce
Neck stiffness
Rash
Photophobia
N+V
Altered mental state ( more confused)
66
Q

What questions do identify temporal arteritis in headahce history?

A

Temporal pain
Pain with jaw movement
unilateral or bilateral

67
Q

Key questions for SAH headachce?

A 
Thunder clap
Worse headache
Occipital region
Blurred vision
Neck stiffness 
Vomiting/blurred vision
68
Q

In all general vague headache history what question should you ask?

A

MOOD!!!!!!!!1

69
Q

In what type of lesion do you get fasciculations and atrophy of the muscles?

A

Lower

year 3 OSCE (14 decks)

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