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Finals PACES > Neuro > Flashcards

Neuro Flashcards

1
Q

Median nerve palsy (carpal tunnel is common cause)

A 
Thenar eminence wasting
Thumb ABduction (reduced power)
LOAF = motor innervation of median nerve
Lateral 2 lumbricals
Opponens pollicis
Abductor pollicis brevis
Flexor pollicis brevis
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2
Q

Phalen test

A

Wrist held in flexion for 60 seconds causing parasthesia

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3
Q

Tinel test

A

Repeatedly percuss over carpal tunnel

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4
Q

Ulnar nerve palsy

A

Hypothenar eminence wasting
Partial claw hand of little and ring finger
Finger ABduction (reduced power)
Usually caused by damage to elbow (funny bone)

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5
Q

Froment’s sign

A

Straight thumb and index finger pinching paper and try and keep hold as you pull away; would flex DIP if positive showing weak ADductor pollicis

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6
Q

Radial nerve palsy (or C7 radiculopathy)

A

Wrist drop
Reduced power extending wrist and fingers
NB C7 sensation though is index and middle fingers so would had motor deficit of radial nerve and median nerve sensation loss

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7
Q

Carpal tunnel syndrome causes

A 
Idiopathic
Pregnancy
RA
Hypothyroidism
Diabetes
Acromegaly
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8
Q

Radial nerve palsy causes

A

Humeral shaft #

Saturday night palsy (compression of radial nerve when sleeping causing dead arm)

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9
Q

T1 lesion causes

A

Causes:
Cervical spondylosis
Pancoast tumour
Plexus trauma/birth trauma (Klumpke’s)

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10
Q

T1 lesion features

A

Total claw hand
Wasting of small muscles in hand
Sensory loss in medial forearm
Horner’s syndrome may co-exist

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11
Q

Supinator catch

A

Early sign of hypertonia in upper limb, difficulty pronating/supinating

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12
Q

Erb’s palsy

A

Lesion of C5-6
Atrophy of the deltoid, biceps, and brachialis muscles
Medially rotated arm with extended and pronated forearm with flexed wrist

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13
Q

Klumpke’s palsy

A

C8-T1 lesion
Claw hand occurs
Wasting on small muscles in hand

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14
Q

Shoulder ABduction

A

C5 (axillary)

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15
Q

Elbow flexion

A

C5/C6 (musculocutaneous)

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16
Q

Elbow and finger extension

A

C7 (radial)

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17
Q

Wrist extension

A

C6 (radial)

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18
Q

Finger flexion

A

C8 (medial + ulnar)

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19
Q

Thumb ABduction

A

T1 (median)

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20
Q

Finger ABduction

A

T1 (ulnar)

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21
Q

Biceps jerk

A

C5/6 (same as elbow flexion)

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22
Q

Triceps jerk

A

C7 (same as elbow extension)

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23
Q

Supinator jerk

A

C5/6 (biceps does so same as elbow flexion)

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24
Q

Extrapyramidal lesion

A 
Rigid tone
Normal power
Normal reflexes
Plantars down
Co-ordination down
(THINK PARKINSON'S)
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25
Q

Spinothalamic pathology

A

Syringomyelia = expansion of spinal cord central canal due to CSF blockage
Anterior spinal artery occlusion
MS

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26
Q

Dorsal columns pathology

A

Tabes dorsalis
Folate/B12 deficiency (SDSC)
MS

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27
Q

Spinothalamic

A

Pain
Temp
Crude touch

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28
Q

Dorsal columns

A

Vibration
Propriaception
Fine touch

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29
Q

Syringomyelia

A

Loss of pain and temp in cape-like distribution over arm and shoulder
LMN signs in upper limbs and spastic paraparesis of lower limbs
Dorsal column signs develop in late syringomyelia
If affects brainstem called syringobulbia

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30
Q

Flexion of upper limb

A

C5 - elbow flexion (musculocutaneous = makes sense as biceps innervated by this)
C8 - finger flexion (median and ulnar)

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31
Q

Extension of upper limb

A

C6 - wrist extension (radial)

C7 - elbow extension and finger extension (radial)

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32
Q

Hip flexion

A

L1/2

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33
Q

Hip extension and knee flexion

A

L5/S1

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34
Q

Knee extension

A

L3/4

35
Q

Ankle dorsiflexion

A

L4 (peroneal)

36
Q

Hallux extension

A

L5 (peroneal)

37
Q

Ankle plantarflexion

A

S1 (tibial)

38
Q

Knee jerk

A

L3/4 (same as knee extension)

39
Q

Ankle jerk

A

S1 (same as ankle plantarflexion)

40
Q

Peripheral neuropathy DDx

A 
DM (sensory mainly)
B12/folate deficiency (called subacute degeneration of spinal cord)
Alcohol
Thiamine deficiency (Wernicke's)
Uraemia (sensory mainly)
SLE
Guillain-Barre (motor mainly)
Charcot-Maries-Tooth
Lead poisoning (motor mainly)
Amyloidosis
Paraneoplastic
41
Q

Unilateral leg weakness DDx

A

UMN: stroke, tumour, MS
LMN: root lesion, nerve lesion

42
Q

Subacute degeneration of spinal cord

A 
B12/folate deficiency
Features:
UMN - Spastic paraparesis & upgoing plantars
LMN - reduced reflexes
\+ dorsal columns loss
43
Q

Mixed LMN and UMN

A

MND (e.g. ALS Amyotrophic lateral sclerosis)

SDSC

44
Q

Bilateral leg weakness DDx

A

UMN (spastic) - bilateral strokes; acute spinal cord compression (eg disc prolapse, trauma, tumor, MS); syringomyelia (LMN signs in upper limb)
LMN (flaccid) - Guillain Barre; lead poisoning; Charcot-Marie-Tooth

45
Q

Positive Romberg’s (dizziness when eyes shut)

A

Dorsal columns loss: tabes dorsalis; SCDC; MS

Sensory peripheral neuropathy

46
Q

MND features

A

UMN: spasticity, brisk reflexes
LMN: weakness, wasting, fasciculation

47
Q

Foot drop

A 
Common peroneal nerve palsy
Stroke
L4/L5 nerve root lesion
MND
Charcot-Marie-Tooth
48
Q

Olfactory lesion

A

Trauma
Frontal lobe tumour
Meningitis

49
Q

Bitemporal hemianopia

A

Pituitary adenoma

Internal carotid artery aneurysm

50
Q

Homonymous hemianopia

A

Anything behind chiasm

Stroke/tumour/abscess

51
Q

Trigeminal lesion

A

Trigeminal neuralgia (idiopathic)
Acoustic neuroma
Herpes zoster

52
Q

Facial lesion

A

LMN: Bell’s, malignant parotid tumour, Ramsay Hunt (herpes), sarcoid (usually bilateral)
UMN: stroke, tumour

53
Q

Hearing loss

A 
Excessive noise
Conductive loss
Meniere's
Furosemide
Gentamicin
54
Q

Bulbar balsy (LMN)

A 
MND
Diptheria
Polio
Myasthenia gravis
Guillain Barre syndrome
Syringobulbia
55
Q

Pseudobulbar palsy (UMN)

A

MND
Bilateral stroke
MS

56
Q

Cavernous sinus thrombosis

A

III, IV, VI lesion (mainly VI)
V - pain (ophthalmic)
Corneal reflex lost
Headache, periorbital oedema, proptosis (exopthalmus)

57
Q

CN III palsy

A

Down and out eye
Ptosis
Dilated pupil if complete (not diabetes)

58
Q

Opthalmoplegia

A 
Myasthenia gravis
Cranial nerve palsy (III, IV, VI)
Grave's
Wernicke's
Progressive supranuclear palsy
59
Q

Internuclear opthalmoplegia (INO)

A

Disorder of conjugate lateral gaze due to lesion in medial longitudinal fasciculus (MLF), which ADducts that eye
Means that if you have LEFT LESION, your LEFT EYE cannot ADduct and so you cannot look to the RIGHT

60
Q

Causes of INO

A

MS (esp in young pt)
Stroke
Lyme disease and TCA overdose

61
Q

Bulbar palsy (LMN) features

A

Tongue appearance:
Flaccid
Wasted
Fasciculating

Tremulous lips as well as drooling and dysphonia

62
Q

Pseudobulbar palsy (UMN) features

A

Tongue appearance:
Spastic
Contracted

Emotionally labile as well as drooling and dysphonia

63
Q

Parkinson’s

A 
TRAP
Tremor
Rigidity
Akinesia (bradykinesia initially)
Postural instability
64
Q

Parkinson’s DDx

A

Benign essential tremor

Wilson’s (with psych illness, hepatotoxicity and Kayser-fleischer rings)

65
Q

Parkinson-plus syndromes

A

Multi-system atrophy (autonomic failure)
Corticobasal degeneration (alien hand syndrome and apraxia)
Progressive supranuclear palsy (ocular features including vertical gaze failure)
Lewy-body dementia

66
Q

Parkinson’s Rx

A 
L-dopa
Dopamine agonist - ropinerole
Anticholinergics - procyclidine
COMTi - entacapone
MAO-Bi - selegiline
Glutamate antagonists - amantadine
Sleep commonly affected and mirtazapine works best
67
Q

Causes of cerebellar disease

A 
Stroke: vertebrobasilar
Tumour at cerebello-pontine angle
MS
Congenital (e.g. Arnold-Chiari)
Friedrich's ataxia
Alcohol abuse
Thiamine deficiency
Anti-epileptic medication (phenytoin)
68
Q

Wernicke’s triad

A

Acute confusion
Ataxia
Ophthalmaplegia (especially upgaze)

69
Q

Dysarthria Differentials

A 
Facial nerve palsy CNVII
Bulbar palsy eg MND
Pseudobulbar palsy eg MS
MG
Cerebellar disease
70
Q

Lateral Medullary syndrome

A

posterior inferior cerebellar artery (PICA) infarct
DANVAH = dysphagia, ataxia, nystagmus, vertigo, anaesthesia, Horner’s

[] ipsilateral: ataxia, nystagmus, dysphagia, facial numbness, cranial nerve palsy e.g. Horner’s

[] contralateral: limb sensory loss

71
Q

Weber’s syndrome

A

ipsilateral III palsy

contralateral weakness

72
Q

Abulia

A

Pathological laziness, seen with anterior cerebral artery infarct (with this face spared usually)

73
Q

Cerebellopontine angle syndrome

A

Causes: acoustic neuroma, meningioma, astrocytoma and mets (e.g. breast)

Effect: ipsilateral CN 5, 6, 7, 8 palsies (pons) and cerebellar signs

74
Q

Subclavian steal syndrome

A

subclavian artery stenosis proximal to origin of vertebral artery leading to syncope/headache raising arms and BP difference >20 between arms

75
Q

Anterior spinal artery/Beck’s syndrome

A

Supplies ventral 2/3 spinal cord caused usually by aortic aneurysm or dissection / surgery

Symptoms: paresis with impaired pain and temperature sensation but preserved dorsal columns as these antero-lateral

76
Q

Locked-in syndrome

A

Everything paralysed but eye muscles

Causes = ventral pons infarct from basilar artery or central pontine demyelination

77
Q

Millard-Gulber syndrome

A

Pontine infarct

6 and 7 CN palsy and contralateral hemiplegia

78
Q

Parkinson’s plus

A

Progressive supranuclear palsy
Corticobasal degeneration
Multi system atrophy (shy drager)
Lewy body dementia

79
Q

Hearing loss conductive causes

A 
WIDENING
  Wax or foreign body
  Infection: otitis media, OME
  Drum perforation
  Extra: ossicle discontinuity – otosclerosis, trauma   
  Neoplasia: carcinoma
  INjury: e.g. barotrauma
  Granulomatous: Wegener’s, Sarcoid
80
Q

Hearing loss sensorineural causes

A 
DDIVINITY
Developmental - Alport's; TORCH
Degenerative - Presbyacusis
Infection - VZV, measles
Vascular - internal auditory artery
Inflammation - vasculitis, sarcoid
Neoplasm - cerebellopontine angle tumour
Injury - trauma / noise
Toxins - gentamicin, frusemide
LYmph - Perilymphatic fistula
81
Q

Action tremor causes

A

BEATS

 Benign essential tremor
 Endocrine: thyroxicosis, ↓glucose, phaeo
 Alcohol withdrawal (or caffeine, opioids…)
 Toxins: β-agonists, theophylline, valproate, PHE
 Sympathetic: physiological tremor may be
enhanced: e.g. in anxiety

82
Q

Bell’s sign

A

Eyes move up on trying to close eyelid in bell’s palsy

83
Q

Miller Fisher sydrome

A

Variant of GBS
Triad of:
Ophthalmoplegia + sensory ataxia + areflexia

Finals PACES (12 decks)

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