Neuro

Question 1

Horners syndrome - proceed

Answer 1

Corneal reflex - orbital or retroorbital lesion
Ipsilateral facial pain+temp - brainstem lesion
Ipsilateral brachial plexus

Question 2

Ix for Myaesthenia gravis

Answer 2

Resp function tests
Modified Ba swallow
Single fibre EMG - jitter
Repetetive nerve stimulation
Anti AChR Ab, anti MUSK
Edrophonium test
CT chest for thymoma

Question 3

Ddx for bilateral ptosis

Answer 3

Myaesthenia gravis
Dystrophica myotonica
Ocular myopathy eg.Kearns-sayre - ask for ECG
Senile ptosis
-with dilated pupils - Miller-Fischer syndrome

Question 4

Ddx for optic nerve atrophy

Answer 4

Subfrontal meningioma
Pituitary tumour
Optic neuropathy
Carotid aneurysm
MS
trauma
Syphilis

Question 5

Vestibular nystagmus (beats away from affected side) - proceed

Answer 5

Test cranial nerves 5, 7, 8 (cerebellopontine angle tumour)
Test hearing
Test cerebellar signs
Look for hemiparesis

Question 6

Vertical nystagmus causes

Answer 6

Upbeat - stroke, MS, tumour, Wernickes, bilateral INO
Downbeat - Arnold chiari
Convergence retraction nystagmus - tectal midbrain lesion

Question 7

Optic neuritis vs papilloedema

Answer 7

Optic neuritis - central scotoma, colour vision, acuity

Papilloedema - enlarged blind spot

Question 8

Causes of chorea

Answer 8

Hungtingtons
SLE
APLS
Sydenhams
PRV
Hyperthyroidism