Neuro

Question 1

Signs of lower motor neurone lesion

Answer 1

Weakness
Wasting
Decreased or absent reflexes
Fasciculation

Question 2

Signs of a upper motor neurone lesion

Answer 2

Weakness in “upper motor neurone pattern”
Spasticity
Clonus
Increased reflexes and extensor plantar response

Question 3

Causes of peripheral neuropathy

Answer 3

Diabetes
Hereditary
Idiopathic

Drugs - isoniazid, vincristine, phenytoin, amiodarone
Metabolic - diabetes, uraemia, hypothyroidism
Alcohol
Immune mediated - GBS
Vitamin B12 or B1 deficiency
Tumour - lung carcinoma
Connective tissue disease or vasculitis

Question 4

Causes of motor neuropathy

Answer 4

Guillain Barre Syndrome
CIDP
Hereditary motor and sensory neuropathy - CMT
Acute intermittent porphyria
Diabetes mellitus
Lead poisoning 
Multi focal motor neuropathy

Question 5

Causes of a sensory neuropathy

Answer 5

Diabetes
Carcinoma
Paraproteinaemia 
Vitamin B6 intoxication 
Sjögren’s syndrome
Syphilis
Vitamin B12 deficiency

Question 6

Causes of painful peripheral neuropathy

Answer 6

Diabetes mellitus
Alcohol 
Vitamin B12 and B1 deficiency 
Carcinoma
Porphyria
Arsenic or thallium poisoning

Question 7

Causes of mononeuritis multiplex

Answer 7

Acute:

Diabetes
Polyarteritis nodosa or connective tissue disease

Chronic:

Multiple compressive neuropathies - joint deforming arthritis 
Sarcoidosis
Acromegaly
Leprosy 
Lyme disease 
Carcinoma

Question 8

Causes of thickened nerves

Answer 8

Hereditary motor and sensory neuropathy 
Acromegaly
CIDP
amyloidosis 
Leprosy

Question 9

Causes of fasciculation

Answer 9

Motor neurone disease
Benign idiopathic fasciculation 
Motor root compression 
Malignant neuropathy
Spinal muscle atrophy

Question 10

Features of hereditary motor and sensory neuropathy

Answer 10

Pes cavus 
Distal muscle atrophy due to peripheral nerve degeneration 
Absent reflexes 
Slight to no sensory loss in the limbs 
Thickened nerves 
Optic atrophy: Argyll Roberton pupil

Question 11

Causes of foot drop

Answer 11

Common peroneal nerve palsy 
Sciatic nerve palsy
Lumbosacral plexus lesion 
L4 / L5 root lesion 
Peripheral motor neuropathy 
Distal myopathy
Motor neurone disease

Question 12

Signs of complete brachial plexus lesion

Answer 12

Lower motor neurone signs affecting the whole arm
Sensory loss (whole limb)
Horner’s syndrome

Question 13

Signs of upper brachial plexus lesion - C5,C6

Answer 13

Loss of shoulder movement and elbow flexion

Sensory loss over the lateral aspect of the arm and forearm and over the thumb

Question 14

Signs of a lower brachial trunk lesion C8 T1

Answer 14

True claw hand with paralysis of all intrinsic muscles

Sensory loss along the ulnar side of the hand and forearm

Horner’s syndrome

Question 15

Signs of a radial nerve lesion

Answer 15

Wrist and finger drop
Triceps loss (elbow extension loss)
Sensory loss over the anatomical snuff box
Finger abduction APPEARS to be weak

Question 16

Signs of a median nerve lesion

Answer 16

Loss of abductor pollicis brevis with a lesion at or above the wrist

Loss of flexor digitorium sublimis with a lesion in or above the cubit fossa

Sensory loss over the thumb, index, middle and lateral half of the ring finger

Weakness of muscles of the hands - LOAF

Question 17

Signs of an ulnar nerve lesion

Answer 17

Wasting of the intrinsic muscles of the hand
Weak finger abduction and addiction - loss of interosseous muscles
Ulnar claw like hand
Froment’s sign
Sensory loss over the little and medial half of the ring finger (both palmar and dorsal aspects)

Question 18

Causes of wasting of the muscles of the hand

Answer 18

Nerve lesion

• median and ulnar nerve lesions
• brachial plexus lesions
• peripheral motor neuropathy

Anterior horn cell

• motor neurone disease
• polio
• spinal muscular atrophy

Myopathy

• dystrophia myotonica
• distal myopathy

Spinal cord lesions

• syringomyelia
• cervical spondylosis with C8 compression

Trophic disorders

• arthopathies (disuse)
• ischaemia inc vasculitis