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Lectures final revision > Neuro > Flashcards

Neuro Flashcards

1
Q

Where can the problem be?

A

Central or peripheral

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2
Q

What is included in central

A

Brain (hemisphere, brainstem, cerebellar, L or R)

Spinal Cord (level, which tracts)

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3
Q

what is included in peripheral

A

nerve (mono/poly, sensory, motor or mixed)

Neuro-muscular junction

Muscle

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4
Q

Clusters of cranial nerve

A

1 nose

2346 Eyes

57 Face

8 Ears

9 10 12 Mouth

11 Neck

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5
Q

CN 1 test

A

have you noticed change in smell (and taste)

You would test each nostril one at a time with two different scents

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6
Q

CN2 tests

A

Acuity - change in vision/problems

Colour vision - Plates - can’t do in exam

Blind spot - unlikely to test

Pupillary reflexes

Fundoscopy

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7
Q

Visual Fields

How

A

Confrontational

one eye closed

1m aprt hand in middle

tell me when my finger is moving x4 for each eye

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8
Q

causes of enlarged blind spot

A

papilledema

optic neuritis

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9
Q

short cases - fundoscopy

if pale disk or papilloedema what to ask for

A

gross assessment of their Blind spot

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10
Q

Pupillary reflexes - how to examine?

A

Inspection - size, shape and symmetry

Direct reflex

Consensual Reflex

Swinging for RAPD

Accomodation (constricts on near vision)

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11
Q

RAPD on pupillary reflexes ddx

A

MS

(optic nerve two problem)

One eye is sluggishly getting bigger every time you go back to shine the light on it.

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12
Q

What are the common pupil abnormalities

A

3rd nerve (down and out)

Holmes Aide pupil

Drugs

Horners Syndrome

Argly Robertson Pupil

Drugs

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13
Q

What is Homes Aide pupil

A

The Holmes-Adie pupil is large and irregular.

Pupillary constriction:

to light is slow and incomplete

to accomodation is relatively normal

once the pupil has constricted it remains small for an abnormally long time (tonic pupil)

The Holmes-Adie pupil is considered a variation of normal but is rarely the result of a lesion in the efferent parasympathetic pathway.

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14
Q

Horners Syndrome signs in eye

A

Mild ptosis

Miosis (constriction of eye)

Anhydrosis

Enophalmus (inset eyeball)

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15
Q

Fundoscopy shorts examinatoin

A

Inspection

Pupils

Nystagmus

ptosis

aligned

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16
Q

If there is no diplopia what does that indicate?

A

left LR/6th CN

and

Right MR/3rd

(or vice versa)

Is intact

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17
Q

If only one Medial Rectus is not working and other eye has lateral nystagmus what is happening?

on looking to centre it will move.

A

if third nerve would be down and out

3rd nerve and 6nerve communicate at Medial longitudinal fasciculus in pons

Lesion where they connect

Causes: MS or stroke

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18
Q

Inspect Trigeminal V

A

Motor

Masseter/temporalis wasting. Ask to clench.

Open jaw against resistence for pterygoid power (jaw deviation towards side of lesion)

Snesory

V1 V2 V3

Reflex

Corneal reflex (afferent V1 and efferent Facial nerve)

Jaw jerk (afferent V3 and efferent motor of V)

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19
Q

Facial nerve examination

A

Motor

Facial expression

Sensory

Change in taste to anterior 2/3 tongue

Hyperacusis due to LMN loss of innervation to muscle of stapedius

Reflex

Efferent part of corneal reflex

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20
Q

In Facial nerve UMN forehead is

A

Sparing

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21
Q

Causes of unilateral LMN VII

A

Bells Palsy

Ramsey Hunt Syndrome

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22
Q

Vetibulocochlear test

A

Whisper for crude hearing

Rinne test

Webers

Otoscopy and audiometry to formally hearing loss

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23
Q

Nerves 9 Glossopharyngeal and 10 Vagus

Assessment

A

Inspection (NG or PEG)

Assess speech quality and volume

Palatal asymmetry and uvular deviation away from side of lesion

Offer to test left and right gag reflex seperately

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24
Q

Hypoglossal X12

A

Tongue

Deviated towards side of lesion as poor muscle tone on that side

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25
Q

Nerve 11

Spinal Accessory

A

Supplies sternocleidomastoid and trapezius

Trapezius - shrug up

Sternocleidomastoid - turn your head against my hand

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26
Q

MG special test

A

Fatiguiability

hold upper gaze

will get better after 5 mins

count to 20 for their voice

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27
Q

Complex Opthalmoplegia

A

More than one nerve

Lots going on

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28
Q

What is the order of motor structures

A

Cerebral Coretx

Pyramidal dessuciation

Spinal Cord

Anteriror Horn Cell

Nerve

Neuromuscular junction

Muscle

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29
Q

UMN lesion signs

A

Increased Tone

Weakness (pyramidal pattern)

Increased reflexes

No wasting

No fasciculation

Hoffmans Sign

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30
Q

LMN lesion signs

A

Decreased tone

Weakness and wasting

Areflexia

Fasciculations

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31
Q

SWIFT inspection

A

Scars

Wasting

Involunatry

Fasciculation

Tremor

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32
Q

MND signs

A

UMN and LMN for all limbs

No sensory signs

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33
Q

fasciculations have to be seen

A

at rest (no tone)

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34
Q

Order of examining power

A

Shoulders - ab and ad

Elbow - flex and ext

Wrist - ext and flex

Small muscles of hand for grip

Interossei - spread fingers apart DAB

Paler PAD paper between fingers

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35
Q

Coordination how to test

A

Finger to nose

Dysdiadokinesia

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36
Q

Finger to nose tests can reveal

A

Pass pointing and intention tremor

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37
Q

co-ordination remember

A

BOTH HANDS

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38
Q

Biceps

A

C5 C6

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39
Q

Supinator

A

C5 C6 C7

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40
Q

Triceps

A

C6 C7 C8

41
Q

Reinforcement

A

on three grit your teeth

42
Q

Median nerve palsy

A

Exam

Sensory loss to lateral border of hand

Loss of LOAF muscles

Wasting of thenar eminence

CTS - phalens and tinels test

43
Q

What are causes of Caral tunnel syndrome

A

Rheumatoid

Acromegaly

Hypothyroidism

44
Q

What is phalens?

A

used to diagnose CTS

arms flexed and wrist flexed push dorsal of hand together for 60 seconds.

Increases pressure of CT and illicit signs

45
Q

What are the signs in carpel tunnel?

A

pain and tingling of hands and fingers

numbness in fingers

pain in or near the wrist

pain extending into the arm

skin lesions in the terrirotry of the median nerve due to compression of blood vessels

46
Q

Ulner Nerve Palsy

A

Exam

Claw hand in 4th and 5th finger

Hypothenar eminence wasting

Weakness of muscles

Sensory loss of ulnar border of the hand

Causesd by injury to elbow

47
Q

Radial Palsy

A

Exam

sensory loss to dorsum of hand

Weakness of wrist flexion and finger extension

48
Q

Causes of radial palsy

A

Humerus fracture

Prlonged pressure

lipoma/fibroma

Systemic causes of mono-neuritis multiplex

49
Q

Myotonic Dystrophy features

A

weakness in facial nerve

frontal balding

cataracts

bilateral ptosis

wasting of sternoclydoid muscle

hatchet facies due to atrophy of temporal muscle

50
Q

Examination of Myotonic Dystrophy

A

Myo-pathic facies

balding

cataracts

decreased power in face and bulbar muscles

Wasting of face, neck, distal arms

distal weakness

asbent reflexes

hand grip myotonia

percussion myotonia

51
Q

What is the inheritance of Myotonic Dystrophy

A

Trinucleaotide repeat,

AD

Anticipation

52
Q

Differentials in Myotonic Dystrophy

A

Could be motor neurone problem but given that I can see that the face involved this would be less likely.

This could be a motor nerve problem - isolated motor nerve rare

nMJ like MG

muscular problem could be acquired or congenital

53
Q

How to conclude an examination in Myotonic dystrophy

A

Cognitive

CVS

Urine dip for glucose as get diabetes

54
Q

Diagnose and investigate Myotonic Dystrophy

A

Serum CK

EMG

MD Type 1 - genetic

ECG and Echo for Cardiomyopathy and conduction block

hBA1c - diabetes

Opthal RV - cataracts

Formal cognitive testing - cognitive impairment

55
Q

UMN in lower limb

A

include clonus

plantars

56
Q

Lower limb

inspection look for what?

A

Muscle groups

Fasciculation

Wasting

Any bony deformity or scar

Pes Cavus (CMT/ F Ataxia)

57
Q

Lower limb tone examination

A

Ask for pain

then roll leg

brisk lift of knee joint

Clonus: knee flexed, check tone of ankle, rotate it around and flex the joint

58
Q

Clonus examination

A

Clonus is present if foot moves up and down

Present bilaterally in MS

59
Q

Examining power

A

Hip

Knee

Dorsi and ankle plantar

Eversion and inversion

60
Q

Plantar response

A

from heel up

isolate anke

stop after first movement of big toe

61
Q

Spastic Paraparesis

A

Exam

Hypertonia, clonus, hyperflexia, weakness, up-going plantars

no or mild wasting without fasciculations

62
Q

In spastic paraparesis

what are the additonal clues to look for the cause?

A

Sensory involvement/level

Scars from tendon release

Cerebellar signs (Friedreichs)

Upper limb signs (LMN Cervical myelopathy, UMN Cranial cause)

Eye signs (MS)

63
Q

What is the relationship between UMN and LMN signs in Cervical Myelopathy?

A

LMN at sensory level and UMN below

64
Q

Post polio syndrome

A

Shortened leg if had as a child

lots of scars from surgery

loss tone

loss of reflex

loss of muscle bulk

one sided but can be two

65
Q
A
66
Q

Rombergs Sign

A

Doesn’t really test cerebellar function

Vision

Posterior columns

Vestibular syndrome

Crude test for swaying with eyes open which is excerbated by closing eye. Therefore, compensating with their eyes

67
Q

Diabetic Polyneuropathy signs and features

A

Mostly sensory in feet

decreased pain and temp sensation

Decreased vibration and JPS

decreased reflexes

Ulcers and charcot joints

Neurogenic pain/allodynia

Wasting if severe

68
Q

CMT signs and features

A

Distal wasting

mixed sensory and motor polyneuropathy mainly peripheral

Pes Cavus

high stepping gait, scoliosis

69
Q

inheritance of CMT

A

AD

Commonest neuro disease affecting 1/2500

70
Q

Central lesion tests

A

Imaging is gold standard

Location based on pathology

71
Q

LMN neurone test

A

Motor studies

72
Q

Extra pyramidal examination

A

Rigidity

Bradykinesia

Tremor

Gait - festinate, reduced arm swing)

Head to toe

Mask like face

Hypophonic

Tremor

Lead pipe elbow

cog wheeling wrist

bradykinesia

synkineisa micrographia

dyskinesia on off phenomenon

end dose(?)

73
Q

Cerebellar Syndrome Examination

A

Gait - broad based

Heel to toe walk

Rombergs sign - should be negative (unless vestibular syndrome)

Head to toe

Eye movements

Speech

rebound phenomena

Finger nose past pointing

intention tremor on finger nose

Rapid hand movements - dysdiadokinesia

heel to shin

hypotonia and pendular reflex

74
Q

what neuropathy causes only MOTOR LMN signs

A

Porphyria

Led toxicity

75
Q

LMN Motorneurone causes of motor problem

A

MND

Polio

76
Q

LMN motor only problem at NMJ

A

MG

LEMS

77
Q

Bloods tests in motor problems?

A

B12

folate

TFT

lead toxicity

78
Q

Difference between motor neurone and neuropathy?

A

Motor neurone is the nucleus

Neuropathy is anything affecting the nerve coming out of the spinal cord

79
Q

what used against hep C

A

Interferon and ribavirin

80
Q

used against hep b

A

Lamivudine

81
Q

with PKD what is relevant re

when palpable

cancer

inheritance

A

end stage are palapable due to cysts

no increased risk of cancer

Autosomal Dominant

82
Q

Side effects of NRTI for HIV

A

Lipoatrophy

Lactic Acidosis

Peripheral Neuropathy

Bone Marrow Suppresion

Anaemia Pancreatitis

83
Q

SE of NNRTI in HIV

A

Hepatoxicity

Steven Johnson Snydrome

84
Q

Rx of recurrant UTI

A

IF more than 1 a month then prophylactic can be considered

100mg Trmethorpim OD

85
Q

Wernickes Encephalopathy Triad

A

Ataxia

Confusion

Opthalmoplegia

86
Q

Korsakoffs

A

impairement of memory

87
Q

Triad in Menieres

A

Vertigo

Hearing loss

Tinnitus

88
Q

Treat molloscum contagiosum

A

Cosmetic cryotherapy as take two years to go away

89
Q

drugs that can increase gallbladder stones

A

Fenofibrate - more cholestrol in gb

oestrogen

somatostatin analogues

90
Q

what is seen in the heart with untreated hypertension

A

uniform hypertrophy of left ventricle wall

91
Q

diabetic on meds with symtpoms of delayed gastric emptying

what to do

A

Change medications from GLP-1 agonsits to other

92
Q

Differentials for a morbilliform rash

macular/erythematous/trunk and extremeititieds

A

Measles, rubella, Parvovirus B19

93
Q

signs in Parvovirus B19

A

Slapped Cheek

lacy appearance of rash

94
Q

Difference between L5 and right common peroneal nerve injury

A

L5 - weak dorsiflexion, eversion AND WEAK inversion. Weak hallux longus extension

Common peroneal - weak dorsiflexors, foot evertor (NOT INVERTOR)

therefore a weak inversion shows its L5 lesion

95
Q

Osteonecrosis is a complication of which drug

rare

A

Bisphosphonates

(Alendronate)

96
Q

Characteristics of Churg Strauss

A

Asthma

Peripheral and Central Esoinophilia

Extravascular granuloma

multiple organ vasculitis

97
Q

drugs that cuase psoriasis upset

A

BB

antimalarials

lithium

interferons

98
Q
A

Lectures final revision (10 decks)

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