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FRACP Short Case Nosh > Neuro Exam > Flashcards

Neuro Exam Flashcards

1
Q

What deficits would you find in a dominant parietal lobe lesion?

A

AALF

Acalculia
Agraphia
Left-right disorientation
Finger agnosia

Inattention
Contralateral Inferior quadrantanopia

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2
Q

What deficits would you find in a non-dominant parietal lobe lesion?

A

Dressing apraxia
Inattention
Contralateral Inferior quadrantanopia

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3
Q

Causes of papilloedema?

A 
Space-occupying lesions
Hydrocephalus
IIH
Severe systemic HTN
Venous sinus thrombosis / retinal vein thrombosis
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4
Q

What deficits would you find in a temporal lobe lesion?

A

Receptive aphasia
Memory deficits
Contralateral Superior quadrantanopia

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5
Q

What are frontal release signs?

A

Palmar-mental reflex
Grasp reflex
Pout reflex

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6
Q

What area is involved in expressive aphasia?

A

Dominant frontal lobe

Motor = expressive = Broca’s aphasia

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7
Q

What area is involved in receptive aphasia?

A

Dominant temporal lobe
Sensory = receptive = Wernicke’s aphasia:
Impaired comprehension

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8
Q

Parkinson’s exam findings?

A

General

  • mask-like facies
  • tremor
  • paucity of movement

Gait

  • shuffling
  • festinating
  • difficulty starting
  • freezing

ULs

  • rigidity
  • postural BPs
  • palmar-mental reflex

Face

  • eyes -> gaze palsy of PSP
  • speech -> soft, monotonous

Functional:

  • handwriting
  • dressing
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9
Q

Cerebellar lesion findings?

A

Gait

  • wide-based
  • heel-toe
  • Rhomberg’s (neg)

ULs

  • tremor, drift, bounce
  • tone
  • rapid alternating movements
  • finger-nose (intention tremor / past pointing)

Face

  • nystagmus, broken pursuit
  • speech -> dysarthria

LLs

  • tone
  • coordination -> heel-shin, toe-finger, heel-tapping
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10
Q

What is Rhomberg’s test?

A

A test of proprioception

Description = Patients are asked to stand upright with feet together and then close the eyes

Positive if patient is markedly more unsteady with eyes closed compared with open.
Occurs because patients are using their eyes to compensate for the lack of sensory feedback they are receiving from their lower extremities.

Causes of positive test =

  • peripheral neuropathy with loss of joint position sense
  • posterior column dysfunction e.g. tabes dorsalis
  • uncompensated acute unilateral or bilateral vestibular impairment (controversial)
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11
Q

Causes of unilateral cerebellar lesion?

A 
SOL
Ischaemia
Trauma
MS
Paraneoplastic syndrome
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12
Q

Causes of bilat cerebellar lesion?

A 
ETOH
Hypothyroidism
Drugs
Trauma
MS
Drugs
Freidrich's ataxia
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13
Q

How to differentiate foot drop causes?

A

All cause weakness of dorsi/eversion

Common peroneal -> dorsi + eversion affected
L5 root -> also weakness of INVERSION
Sciatic nerve -> reflex reduced, all movements weak

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14
Q

Peripheral Neuropathy DDx: predominantly sensory

A 
DM
ETOH
Drugs (chemo)
CKD
B12
Paraneoplastic
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15
Q

Peripheral Neuropathy DDx: predominantly motor

A 
CIDP / AIDP 
ETOH
CMT
Syphilis
DM
Critical illness
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16
Q

Spinal cord syndromes:
Ipsilateral weakness + loss of proprioception
Contralateral loss of pain + temperature

A

Brown-Sequard

17
Q 
Spinal cord syndromes: 
LMN signs at level
UMN signs below
Loss of sensation below
Loss of anal tone / bladder / bowel
A

Complete cord transection

18
Q

Spinal cord syndromes:
Loss of proprioception
UMN weakness

A

Subacute combined degeneration

19
Q

Spinal cord syndromes:
Loss of pain/temp sensation cape distribution
Weakness follows, LMN in ULs, UMN in LLs

A

Central cord syndrome / syringomyelia

20
Q

How do you test median nerve function?

C6-T1

A

Motor:

  • LOAF of hand =
  • > lateral 2 lumbricals
  • > opponens pollicis brevis
  • > abductor pollicis brevis
  • > flexor pollicis brevis
  • PIP flexion
  • 2nd / 3rd finger DIP flexion

Sensory:
- lateral 3.5 fingers

21
Q

How do you test radial nerve function?

A

Motor:

  • elbow / wrist extension
  • finger / thumb extension

Sensory:
- dorsal 1.5 fingers / anatomical snuff box

22
Q

How do you test ulnar nerve function?

A

Motor:

  • Finger abduction / adduction
  • 4th/5th DIP flexion

Sensory:
- medial 1.5 fingers

23
Q

How do you test musculocutaneous function?

A

Motor
- Elbow flexion (biceps)

Sensory
- lateral forearm

24
Q

Gait exam -> hemiparetic / unilateral spasticity ?

A

CVA / central lesion

25
Q

Gait exam -> paraparetic gait ?

A 
Spinal cord lesion
MS
Hereditary spastic paraparesis
Cerebral palsy
Bilateral stroke
26
Q

Gait exam -> unilateral high stepping ?

A

Foot drop ->

  • L5 lesion
  • common peroneal lesion
  • sciatic lesion
27
Q

Gait exam -> bilateral high stepping gait ?

A

Distal polyneuropathy / CIDP
MND
Lumbosacral radiculopathy

  • may be sensory ataxia, will be Rhomberg’s positive
  • > peripheral sensory neuropathy
  • > syphilis
  • > subacute combined degeneration of the cord
28
Q

Gait exam -> Trendelenberg / Waddling ?

A

Proximal myopathy

NMJ disease e.g. myasthenia

29
Q

Gait exam -> Parkinsonian ?

A

Parkinson’s
PSP
MSA
Medications

30
Q

What is Gerstmann’s syndrome?

A

Dominant parietal lobe lesion

Acalculia
Agraphia
Finger agnosia
Right-left disorientation

31
Q

Bilateral UMN findings + sensory involvement

DDx?

A 
Spinal cord 
MS
B12 deficiency 
Multiple strokes
Arnold Chiari malformation
32
Q

DDx for absent ankle jerk but upgoing plantar?

A

MND
Dual pathology -> UMN + peripheral neuropathy
Friedrich’s ataxia
Subacute combined degeneration of the cord

33
Q

Classic presentation of inclusion body myositis?

A

Proximal leg weakness + distal finger flexor weakness
Scalloping of the medial forearm flexor compartment.
Facial muscles may be involved + dysphagia

*decrease in reflexes in parallel with weakness

34
Q

Function of sciatic nerve?

A

Motor

  • knee flexion (hamstrings)
  • all muscles below knee

Sensory
- foot sensation + lateral calf

35
Q

Function of femoral nerve?

A

Motor

  • hip flexion (iliopsoas)
  • knee extension (quads)

Sensory
- over knee and medial thigh/calf

36
Q

Common peroneal nerve function?

A

Motor
- ankle dorsiflexion / eversion

Sensory
- dorsum of foot + lateral calf

37
Q

What does standing on heels test?

What does standing on toes test?

A

Heels -> dorsiflexion -> L4/L5 (mainly L5)

Toes -> plantarflexion -> S1

FRACP Short Case Nosh (5 decks)

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