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Pass Medicine notes > neuro SBAs > Flashcards

neuro SBAs Flashcards

1
Q

66 y/o female, stiffness and weakness climbing stairs. history of hypertension. diet controlled type 2 diabetes.

mild upper arm weakness, 4/5 hip flexion bilaterally. bilateral wasting, flickers of fasciculations in right quads.

knee extension, dorsiflexion and plantarflexion are strong.

positive babinski sign.

likely diagnosis

A
  • Motor neuron disease
  • Patient presents with both UMNL and LMNL signs

Upper
- brisk flexes, upgoing plantar

Lower
- fasciculations

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2
Q

Myositis

A
  • affects muscle

- resulting in tenderness, wastng and fasciculations

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3
Q

23 y/o stabbed in neck. MRI shows hemisection of cord at C6.

expected result of this injury?

A
  • Brown-sequard syndrome
  • ipsilateral paralysis
  • ipsilateral loss of light touch and vibration sensation
  • contralteral loss of pain and temp
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4
Q

78 y/o RHS male collapses, can follow clear one step commands, gets frustrated cannot answer questions ,cannot lift RHS hand or leg.

irregular pulse and high 149/87 bp.

only takes aspirin and frusemide.

likely diagnosis

A

Left cortical infarct

- probs cuz of embolus secondary to AF.

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5
Q

Patient with expressive dysphasia implies involvement of what area of brain….

A

BROCA’S AREA

cortical

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6
Q

most significant risk factor for stroke

A

hypertension

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7
Q

71 y/o male with atrial fibrillation. presented following syncope episode. poor sleep, got out of bed, felt dizzy before lights dimmed around him and he fell.

he went pale, arms and legs jerked. but he was okay after.

most likely diagnosis

A

ORTHOSTATIC HYPOTENSION

  • syncope as a result of reduced cerebral perfusion
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8
Q

41 y/o male terrible headache. affects RHS of head. 11/10 pain. Light bothers him a little. Similar episodes over past 6 months. resolved spontanesouly over 2 weeks.

very distressed. prefers to pace up and down, unable to sit still.

indicative of:

A

Cluster headache

  • excruciating
  • unilateral
  • miosis, ptosis, tearing ///
  • resolve spontaneously then reoccur
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9
Q

Headache feeling as if a tight band is around the head

A

Tension headache

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10
Q

headache heralded by an aura associated with nausea and vomiting with smell, sound and photophobia.

patients prefer to curl up in dark rooms.

A

Migraine

like Dr House in that one episode hahaa

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11
Q

49 y/o sudden onset, painless, unilateral visual loss lasting about a minute. describes it like a black curtain coming down.

audible bruit on auscultation, PMH of DVT on RHS leg.

most likely diagnosis?

A

Amaurosis Fugax

- painless, unilateral, visual loss

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12
Q

69 y/o male, 6 month history of progressive lower back pain radiating down to his buttock.

pain exacerbated on morning walk. better going uphill but worse doing downhill.

stopped walking unless if necessary.

has history of hypertension. diabetes and prostatic hyperplasia.

diagnosis likely

A

Spinal stenosis
- narrowing of spinal canal as a result of spondylosis (degenerative disease)

History:

  • spinal claudication
  • lower back pain
  • sciatica on walking
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13
Q

Sharp shooting pain down posterior leg:

A

Sciatica

- impingement of the nerve roots

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14
Q

Multiple sclerosis

A
  • inflammatory disorder of CNS

- resulting in UMN signs

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15
Q

Infective neuropathies commonly include

A
  • Lyme disease (Ticks)

- Leprosy

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16
Q

Guillain Baree

A
  • inflammatory disorder of peripheral nerves
  • often preceded by infection
  • e.g. campylobacter gastroenteritis
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17
Q

Left handed, 79 y/o male.

  • resting tremor
  • writing smaller than it used to be
  • difficulty turning inbed
  • feels woozy after getting out of bed

likely diagnosis

A

Parkinsons

  • bradykinesia
  • rigidity
  • tremor
  • (postural instability)

associated with narrow based gait.

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18
Q

complex partial seizures

A
  • start focally and result in reduced awareness

- don’t remember seizure unlike in simple partial seizures where consciousness is maintained

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19
Q

dermatome for medial lower leg

A

L4

20
Q

dermatome for lateral side of lower leg down to dorsum of great toe

A

L5

21
Q

on examination patient has 5/5 power in all muscle groups of his upper limbs/.

0/5 power in all muscle groups of his lower limbs.

cranial nerves are intact.

wheres teh lesion

A

Spinal cord

22
Q

for a brain lesion to affect both legs where would the lesion have to be:

A
  • lesion would have to be in midline of frontal cortex

- thus sparing upper limbs

23
Q

a patient is unable to move his right arm of leg. when asked to smile, the LHS of his mouth droops.

where is the lesion?

A
  • left motor cortex
24
Q

which nerve is the afferent limb that detects light

A

CN II

OPTIC NERVE

25
Q

what is the efferent limb nerve which results in pupillary constriction

A

CN III

Occulomotor

26
Q

what is a key clinical feature that differentiates patients with myopathies with patients with myasthenia gravis ?

A
  • fatigability

- as MG patients use muscles, they exhaust their ACH supply thus resulting in increasing weakness

27
Q

Contrast Myasthenia Gravis patients with Lambert-Eaton patients

A
  • patients with LE increase strenght upon repitition
28
Q

Lambert-Eaton syndrome caused by:

A
  • autoantibodies against the vollage gated calcium channels
  • on presynaptic motor nerve terminal
  • paraneoplastic associated with small cell lung cancer
29
Q

Forehead sparing indicates what motor neuron lesion type?

A

Upper motor neuron lesion

30
Q

female patient with diplopia. when asked to look right her left eye stays in the midline but her right eye moves right and starts jerking.

what is the diagnosis?

A
  • intranuclear opthalmoplegia
  • problem between communication of abducens of RHS eye and occulomotor nerve of left eye.
  • Multiple Sclerosis
31
Q

Normally, how do the nuclei of the abducens and occulomotor nerve communicate to maintain conjugate gaze.

e.g. keep the eyes aligned on the same spot

A
  • nuclei communicate via the medial longitudinal fasciculus
32
Q

Neurologist takes patient middle finger and flicks the distal phalanx. her thumb contracts in response.

what sign has been elicited

A

Hoffman’s reflex
- suggestive of upper motor neuron disease

  • positive in this patient
33
Q

Chvosteks sign

A

contraction of face.

on stimulation of facial nerve over the masseter.

seen in hypocalcaemia

34
Q

Test for parkinsonism where doctor taps above the bridge of nose and patient continues to blink

A

Glabellar tap

normal response would be to stop blinking

35
Q

Babinski reflex

A
  • extension and outward fanning of toes in response to firm stimulus of outer soles
  • suggestive of upper motor neurone disease
36
Q

What occurs in Friedrich’s ataxia

A
  • both cord and peripheral nerve involvement accompany cerebellar degeneration
37
Q

Patient struggles to walk. gait is unsteady. has difficulty raising his right leg and swings it round in an arc as he walks

holds his RHS arm and wrist flexed.

what type of gait does he have?

A
  • hemiplegic

- assymetrical weakness involving right upper and lower limbs

38
Q

What type of gait is seen in patients with sensory peripheral neuropathy e.g. in diabetics?

A
  • stomping gaits
  • by banging their foot down
  • vibrations travel up leg where they can be detected by intact nerves
39
Q

a patient is admitted with a stroke. on examination of her visual fields she can’t see in right lower quadrant of her field.

where is the lesion:

A
  • lesion in left parietal lobe
40
Q

lesions at optic chiasm such as pituitary tumours and craniopharyngeomas result in:

A
  • bitemporal hemianopia
41
Q

43 y.o female. dizziness when she sat up in bed. room spinning for a couple minutes. settles if she keeps still but returns on movement.

no tinnitus or deafness

some nausea and no vomiting

likely diagnosis

A

bening paroxysmal positional vertigo

42
Q

convex haematomas are seen in

A

extradural haemorrhages

blood trapped between dura and skull

43
Q

extradural haematomas commonly occur due to

A
  • trauma

- rupture of middle meningeal artery

44
Q

crescent shaped haematomas indicate

A

blood between the dura and arachnoid

45
Q

blood between the dura and arachnoid will present with

A

crescent shaped haematomas

46
Q

subdural haemorrhages commonly occur due to bleeding from

A
  • bridging veins
  • more common in elderly and alcoholics
  • bridging veins are stretched from cerebral atrophy
47
Q

which meningitis is less severe

A
  • viral meningitis less severe

- bacterial meningitis can progress rapdily to septicaemia

Pass Medicine notes (34 decks)

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