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Clinical Exam > Neurology > Flashcards

Neurology Flashcards

1
Q

Emergency Plans: Seizures

A
  • Epilepsy Australia website template
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2
Q

Emergency plans: Migraines

A
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3
Q

Emergency plans: dystonic crisis

A
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4
Q

Emergency plans: respiratory infections for neuromuscular conditions

A
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5
Q

Emergency plans: relapsing demyelinating conditions

A
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6
Q

Why should we NOT give sodium valproate to teenage girls?

A

Due to 30% risk of teratogenicity

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7
Q

Epilepsy long case questions

A
  • Diagnosis:
    • Age of first seizure, doing what, seminology, treatment, investigations
    • Focal vs generalised; structural vs genetic vs metabolic
  • Progress:
    • What types of seizures since?
    • Frequency of seizures
    • Average duration of seizures
    • Triggers
    • Presentations with status
    • Febrile seizures
    • ICU admissions
  • Investigations
    • EEG, MRI, PET, CSF, genetics
  • Management
    • Medications trialed
    • Current medications
    • Other: keto / diet / surgery
    • Goals:
  • Complications
    • SUDEP
    • Water / roads / heights / locked rooms
  • Monitoring
  • Emergency Management
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8
Q

Neuromuscular disease

  • Cardiovascular consequences
A
  • Cardiomyopathies
  • Arrhythmias
  • Increased risk of MI
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9
Q

Localising the lesion in a neuro short case

A
  • Cerebral cortex / cerebellum / brain stem
    • Tumor
    • Stroke
    • Ataxia telangiectasia
  • Cranial nerve
    • Mobius: absence of cranial nerves
  • Spine
    • Tumor
    • Infarct
  • Anterior horn cell
    • SMA
  • Peripheral nerve
    • Hereditatory motor-sensory
      • Charcot Marie Tooth
    • Toxic
    • Guillian Barre
    • Lambert Eaton
    • SLE
    • Fabry
    • Porphyria
  • NMJ
    • Myasthenia gravis
    • Transient myasthenic syndrome
    • Congenital
    • Botulism / tick
  • Muscle
    • Myopathies
      • Congenital
      • Endocrine + toxic
      • Metabolic
    • Muscular dystrophies
      • BMD / DMD
      • Emery-Dreifuss
      • Myotonic
      • Limb girdle
      • Fascioscapulohumeral
      • Congenital
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10
Q

3yr old M, examine the gait

HC: 45cm (microcephalic) Wt: 21kg

Not dysmorphic

Small lump on head: underlying device

Mild hypotonia

Ataxic wide-based gait

Mild dysmetria

Plantars down, normal power

A
  • Lesion: cerebellum
  • Differential diagnosis
    • Battens disease
    • Stroke: posterior circulation
    • Arteriovascular malformation
    • Hereditary ataxia
      • Friederichs ataxia
      • Spinocerebellar
      • Ataxia telangiectasia
      • Glucose transport deficiency
    • Cerebellum tumor: medulloblastoma or pilocytic astrocytoma
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11
Q

8yr old M examine his gait

Ht 105cm, Wt 52kg, HC 54cm

BP 130/80

Increased central adiposity / abdominal striae

Wide based gait + waddling, gower +

Calf hypertrophy

Decreased power especially proximal muscles

Absent knee + ankle jerks

A

Duchenne muscular dystrophy

Complications:

  • Steroid complications: cataracts + glaucoma/ central adiposity / striae / hypertension /
  • Scoliosis
  • Restrictive lung disease
  • Contractures
  • Cardiomyopathy
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12
Q

11yr old F examine gait

HC 52cm, Wt 40kg, Ht 155cm

Hemiparetic gait

Circumduction R) leg, reduced R) arm swing

Power 5/5 in all muscle groups L

Power 4/5 in all muscle groups R (stronger in flexors)

Upgoing plantar R) foot

A

Differential diagnosis

L) MCA infarct

Tumur or dysplasia over the L) central region

Ramussen syndrome

  • Immune mediated response that causes one hemisphere of the brain to become inflamed and deteriorate

Acute:

  • Hemiplegic migraine
  • ADEM
  • Todds paresis
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13
Q

Primitive / Developmental Reflexes

A
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14
Q

Craniosynostosis types + fontanelle closure

A
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15
Q

Causes of macrocephaly

A
  • Hydrocephalus: tense fontanelle, distended scalp veins
  • Vacular malformations: cranial bruit
  • Tumour: abnormal neurology
  • Subdural haematoma : bruising
  • Fragile X: developmental delay, large ears
  • Neurofibromatosis: cafe-au-lait patches, axillary freckles
  • Overgrowth syndromes
    • Sotos : developmental delay, large hands/feet
  • Metabolic
    • Mucopolysaccharidoses : developmental delay, course features
  • Familial macrocephaly
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16
Q

Causes of acute stroke in childhood

A
  • Haematological
    • Sickle cell disease (most common)
    • Polycythaemia
    • Leukaemia
    • Disorders of coagulation
  • Cardiac
    • Confenital (cyanotic)
    • Endocarditis
    • Embolic
  • Infection
    • Meningitis
    • Local infections or bacteraemia
  • Intracerebral vascular
    • AVM
    • Aneurysm
  • Autoimmune
    • SLE
    • Sarcoidosis
    • JIA
  • Metabolic
    • Homocystinuria
    • Mitochondial
  • Trauma
17
Q

Causes of developmental regression

A
  • Acquired brain injury
    • Hypoxia
    • Meningitis
  • Seizure disorders
    • West syndrome
    • Landau-Kleffner
  • Neurometabolic/degenerative
    • Mitochondrial disorders
    • Tay-Sachs
  • Toxic substances
    • Lead
  • Infections
    • Panencephalitis
    • Prion
  • Developmental disorder
    • Autism
    • Retts
18
Q

Complete 3rd nerve palsy findings

A
  • Ptosis
  • “Down and out” position of the involved eye
  • Paralysis of most eye movements (sparing only lateral rectus and superior oblique function)
  • Dilated pupil
  • Lack of direct and consensual pupillary light response
19
Q

Dwayne Syndrome

A
  • Isolated cranial nerve 6 palsy
20
Q

Senoforis

Heterochromia

A

Senoforis = monobrow

Heterochromia = multi-colour iris

21
Q

Horners Syndrome

A
  • Ptosis, meiosis, anhydrosios

Causes

Thoracic surgery

Neuroblastoma

Birth trauma

Congenital horners

22
Q

Causes of glaucoma

A

Sturge Weber

Marfans

Homocystinuria

23
Q

Causes of coloboma

A
24
Q

Clinical findings in 4th nerve palsy

A
  • Diplopia on looking down and in
25
Q

6th nerve palsy findings

A
  • Lack of lateral movement with diplopia most marked on looking towards the affected side
26
Q

Bells Palsy Differential Diagnosis

A
  • Herpes zoster (Ramsay Hunt)
  • Otitis media
  • Guillain Barre Syndrome
  • HIV infection
  • Sarcoidosis
  • Sjogren syndrome
  • Tumour syndrome
  • Stroke
27
Q

Ptosis

  • Nerve involved + causes
A

Nerve: cranial nerve 3

Causes

  • Congenital (most common)
  • Myopathies
  • 3rd cranial nerve palsy
  • Haemangioma
  • Orbital cellulitis

*Bilateral ptosis = neuromuscular or myasthenia gravis

*Horner’s causes a partial ptosis*

28
Q

Aniridia

  • What is it?
  • Causes
A

Hypoplasia of the iris (coloured part): pupil looks markedly dilated

Causes

  • Inherited: autosomal dominant
  • WAGR syndrome (Wilms Aniridia Genitourinary abnormalities Retardation-ID)
  • Can cause: cataracts, glaucoma, corneal opacification
29
Q

Causes of cataracts

A

Cataracts: = opacity of the lens

Causes

  • Hereditary: autosomal dominant
  • Chromocomal disorders (T21, Noonan)
  • TORCH infections
  • Metabolis: galactosaemia, diabetes
  • Steroids
30
Q

Ectopia lentis causes

A

Displacement of the lens

Upward

  • Marfan

Downward

  • Homocystinuria
31
Q

Squit (stabismus)

Non-paralytic

Paralytic

A

Non-paralytic

  • Convergent (esotropia)
  • Divergent (exotropia); intermittent + constant

Paralytic

  • 3rd nerve palsy; frequently congenital, divergent squint + downward deviation of eye + ptosis
  • 4th nerve palsy; congenital or acquired from head trauma, head tild towards opposite shoulder to eliminate vertical deviation
  • 6th nerve palsy; convergent squit
32
Q

What is the normal visual acuity at 18 months + 2 years

A

18 months = 6/9

2 years = 6/6

33
Q

At what age is strabismus abnormal

A

From 6 months of age

34
Q

Common cause of horizontal conjugate nystagmus

A

Most common- anticonvulsant medications

If NOT an anticonvulsants then most common cause = cerebellar

35
Q

Horizontal nystagmus causes

A
  • Cerebellar
  • Vestibular
  • Visual
36
Q

Causes of vertical nystagmus

A
  • Visual causes
  • Brainstem causes
37
Q

Causes of bilateral proptosis

A
  • Thyroid eye disease
  • Neuroblastoma
  • Leukaemia
  • Craniofacial conditions
    • Craniosynotoses
      • Apert
      • Crouzon
  • Thrombosis
  • Glaucoma (includes in SWS)
  • Harmangioma
38
Q
A

Clinical Exam (14 decks)

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