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Finals OSCEs > Neuro Exam > Flashcards

Neuro Exam Flashcards

1
Q

LL Myotomes

A
  1. Hip flexion [iliopsoas L1/2]
  2. Hip adduction[adductors L2/3]
  3. Knee extension [quadriceps L3/4]
    position, “kick your leg out”
  4. Ankle dorsiflexion [tibialisanterior L4]
  5. Great toe dorsiflexion [extensor hallucis longus L5]
  6. Ankle plantarflexion [gastrocnemius S1/2]
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2
Q

Define the terms 1. hemiplegia 2. diplegia 3. paraplegia 4. quadriplegia

A
  • Hemiplegia: Paralysis on one side of the body
  • Diplegia: paralysis of corresponding parts on both sides of the body, typically affecting the legs more severely than the arms
  • Paraplegia: Complete or incomplete paralysis affecting the legs and possibly also the trunk, but not the arms.
  • Quadriplegia: Paralysis caused by illness or injury that results in the partial or total loss of use of all four limbs and torso
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3
Q

Cause of pyramidal gait?

A

UMN lesion leading to increased tone of leg

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4
Q

MRC scale of muscle strength

A
  1. No movement
  2. Flicker is perceptible in the muscle
  3. Movement only if gravity eliminated
  4. Can move limb against gravity
  5. Can move against gravity and some resistance exerted by examiner
  6. Normal power
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5
Q

LL reflexes

A

Knee jerk = L3/4

Ankle jerk = S1/2

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6
Q

Define the term clonus. In what conditions might you be able to elicit clonus?

A
  • Clonus definition: muscular spasm involving repeated, often rhythmic, contractions. Sign of UMN lesions
  • Causes: MS, Huntington disease, damage to the spinal cord, meningitis
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7
Q

Reflex grading system

A 
0: Absent
1+: Hypoactive
2+: normal
3+: Hyperactive, without clonus
4+ : Hyperactive, with clonus
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8
Q

Babinski’s sign

A

The reflex is normal in infants when the sole of the foot is firmly stroked and the hallux moves upwards whilst the remaining toes fan out

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9
Q

2 main sensory pathways

A

Dorsal column: Vibration and proprioception

Spinothalamic tract: Pain and temp

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10
Q

Name 2 conditions which would give a mixture of upper motor neurone and lower motor neurone signs.

A
  • ALS (amyotrophic lateral sclerosis)

- Paralytic Poliomyelitis

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11
Q

Gait problems??

Ataxic:
Trendelenburg:
Arthralgic:
Pyramidal:
Extrapyramidal:
Foot drop:
Apraxic:
A

Ataxic: Poor control (due to peripheral nerve injury, cerebellar injury, vestibular apparatus injury)

Trendelenburg: Dropping hip / waddling (due to weak proximal muscle

Arthralgic:

Pyramidal:

Extrapyramidal:

Foot drop:

Apraxic:

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12
Q

Gait problems??

Ataxic:
Trendelenburg:
Arthralgic:
Pyramidal:
Extrapyramidal:
Foot drop:
Apraxic:
A

Ataxic: Poor control (due to peripheral nerve injury, cerebellar injury, vestibular apparatus injury)

Trendelenburg: Dropping hip / waddling (due to weak proximal muscle

Arthralgic: Painful

Pyramidal: Circumduction of the legs (due to UMN lesion)

Extrapyramidal: Shuffling, unstable (due to basal ganglia lesion)

Foot drop: High stepping gait due to LMN lesion (i.e. common peroneal nerve)

Apraxic: Unable to perform purposeful tasks (due to frontal lobe lesions in e.g. hydrocephalus, stroke)

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13
Q

Myotomes of UL

A 
Shoulder - C5
Elbow flexion - C6
Elbow ext - C7
Wrist flex - C6
Wrist flexion - C7 
Finger flexion - C8
Finger abduction/ adduction - T1
Thumb abduction - T1
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14
Q

Dermatomes of UL

A 
Deltoid - C5
Thumb - C6
Middle finger - C7
little finger - C8
Inner arm - T1
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15
Q

Dermatomes of LL

A 
Groin - L1
Thigh - L2
Inner knee - L3
Medial malleolus - L4
Web space of big toe - L5
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16
Q

Reflexes of UL

A

Biceps - C5/6
Triceps - C7-8
Brachioradialis - C6

17
Q

Absolute contraindications to thrombolysis

A 
Haemorrhage stroke on CT
S/S of SAH
Neurosurgery, head trauma or stroke in past 3 months
LP in last week
GI bleed in last 3 weeks
Uncontrolled HTN >185/110
Hx of intracranial haemorrhage
Known intracranial AV malformation, neoplasm or aneurysm
Active internal bleeding
Suspected or confirmed endocarditis
Known bleeding diathesis
BM <5
18
Q

Contraindications of LP

A

signs suggesting raised intracranial pressure or reduced or fluctuating level of
consciousness (Glasgow Coma Scale score less than 9 or a drop of 3 points or more)
relative bradycardia and hypertension
focal neurological signs
abnormal posture or posturing
unequal, dilated or poorly responsive pupils
papilloedema
abnormal ‘doll’s eye’ movements
shock
extensive or spreading purpura
after convulsions until stabilised
coagulation abnormalities or coagulation results outside the normal range or platelet
count below 100x109/litre or receiving anticoagulant therapy
local superficial infection at the lumbar puncture site
respiratory insufficiency in children.

19
Q

Signs of RICP

A 
headache
drowsiness
anorexia
visual disturbances e.g. 
- blurred vision: often the first manifestation noted by patients
- visual field loss: early finding
- visual acuity is usually preserved
- double vision
- "greying out of vision" a.k.a. transient visual obscurations. Commonly occur with changes in posture
- papilloedema
neck/back pain
nausea and/or vomiting
convulsions
pulsatile tinnitus
blackouts
decreased GCS/coma
20
Q

Signs of cerebellar dysfunction

A 
Dysdiadochokinesia
Ataxia
Nystagmus
Intension tremor
Slurred speech
Hypotonia
21
Q

DDx for cerebellar disorder

A

STEAM

Stroke
Trauma
Ethanol
Anti-epileptics
MS
22
Q

Name the cranial nerves

A 
I - Olfactory
II- Optic
III- Occulomotor
IV- Trochlear
V- Trigeminal
VI- abducens
VII - Facial
VIII - Vestibulocochlear
IX - Glossopharyngeal
X - Vagus
XI - Spinal accessory
XII - Hypoglossal
23
Q

Signs of horners syndrome

A

Miosis (Small pupil)
Ptosis
Anhydrosis
Enophthalmos (eyeball recession)

24
Q

Meaning of 6/x vision?

A

6/x vision means what patient can see at 6m what a person with normal vision can see at x metres.

25
Q

Function of MLF?

A

MLF (medial longitudinal fasciculus) connect abducens nucleus to contralateral oculomotor nucleus to perform horizontal CONJUGATE LATERAL GAZE

26
Q

Extraoccular muscles innervation and signs of palsy

A

CN III: Levator palpebrae superioris, Medial + superior and inferior rectus and inferior oblique

CN IV: Superior oblique

CN VI: Lateral rectus

PALSY:
CN III: Ptosis, “down and out”, pupil dilated and unresponsive
CN IV: “up and in” Impaired depression to adducted eye, contralateral head tilt
CN VI: Impaired abduction

27
Q

Control of taste and salvation?

A

CN VII (Sensory and PS efferent)

28
Q

Light reflex

A

Afferent: CN II
Efferent: CN III

29
Q

Speech innervation

A

CN X (Vagus) and CN XII (hypoglossal)

30
Q

Nerve control of pharynx, and larynx motor, sensory and PS function

A 
CN IX (glossopharyngeal)
CN X (vagus)
31
Q

Corneal reflex

A

Afferent: CN V
Efferent: CN VII

Finals OSCEs (4 decks)

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