Neurology

Question 1

What are the motor functions of the median nerve?

Answer 1

Thumb flexion and opposition
Digits 2 + 3 flexion
Wrist flexion and abduction
Forearm pronation

Question 2

What are the motor functions of the ulnar nerve?

Answer 2

Thumb + finger abduction
finger adduction
Digits 4-5 flexion
Wrist flexion and adduction

Question 3

What are the motor functions of the radial nerve?
What are the 4 sensory branches?

Answer 3

Extension - elbow, wrist, PIPs
Forearm supination
Thumb abduction (posterior interosseus nerve)

Lower lateral cutaneous nerve of arm
Posterior cutaneous nerve of arm
Posterior cutaneous nerve of forarm
Superficial branch (dorsal digital nerves)

Question 4

What are the motor functions of the axillary nerve?

Answer 4

Shoulder abduction of arm beyond first 15 degrees

Question 5

What are the motor functions of the musculocutaneous nerve?
What is the sensory branch called?

Answer 5

Elbow flexion
Forearm supination

Lateral cutaneous nerve of forearm

Question 6

What are the motor functions of the femoral nerve?
What are the sensory branches?

Answer 6

Hip flexion
Knee extension

Femoral nerve - anterior thigh
Sapehenous nerve - medial calf/foot

Question 7

What is the motor function of the obturator nerve?
Where is the sensory innervation?

Answer 7

Hip adduction

Proximal medial thigh

Question 8

What are the branches of the sciatic nerve? What are there motor and sensory function?

Answer 8

Common peroneal:
Superficial peroneal - foot eversion; lateral foot + calf
Deep peronal - foot DF, toe extension; patch between toes 1 and 2

Tibial nerve: foot PF, inversion, toe flexion; lateral aspect of foot

Question 9

What nerves are branches of the lumbar plexus?
What nerves are branches of the sacral plexus?

Answer 9

Lumbar - femoral, obtural, lateral femoral cutaneous nerve (sensation to lateral thigh)

Sacral - sciatic nerve, posterior femoral cutaneous nerve (posterior thigh sensation)

Question 10

What feature differentiates ulnar neuropathy at the wrist from ulnar neuropathy at the elbow?

Answer 10

Both will cause cause motor weakness with clawing of digits 4 + 5

Compression at the elbow cause sensory loss of both dorsal + palmar ulnar surfaces however at the wrist sensory loss will be limited to palm + digits 3 + 4

Question 11

List the genes associated with early onset dementia

Which gene is associated with late onset dementia. What chromosome?

Answer 11

Early onset AD:
- APP gene (amylid precursor protein)
- PSEN 1/2

Also trisomy 21

Late onset AD:
- APOE4 (homozygous). Chromosome 19.

Question 12

Gene affected in CADASIL

Answer 12

NOTCH3 gene pathogenic variant (ch. 19)

Question 13

Upper trunk plexopathy
- signs
- spinal levels

Answer 13

C5,C6

• loss of shoulder movements and elbow flexion
• sensory loss over lateral aspect of arm AND forearm

Question 14

Lower trunk plexopathy
- signs
- spinal levels

Answer 14

C8, T1
- Claw hand
- Horners
- senosry loss of ulnar side of hand AND forearm

Question 15

Foot drop with absent ankle jerk.
Where is the lesion?

Answer 15

Sciatic neuropathy.

NOTE - peroneal nerve often more affected than tibial; may have sparing of PF despite weak AJ

Question 16

Which antibiotic significantly reduces therapeutic levels of valproate?

Answer 16

Carbapenems

Question 17

Which nerve root supplies brachioradialis reflex?

Answer 17

C5, C6

Question 18

Which 2 conditions are Anti-GAD65 antibodies associated with?

Answer 18

Stiff person syndrome
T1DM

Question 19

List the alpha synucleinopathies

Answer 19

MSA
Parkinsons disease
Lewy body dementia

Question 20

Signs of gerstmanns syndrome

Where is the lesion?

Answer 20

Dominant (left) inferior parietal lobe (left angular gyrus)

Acalculia - can’t do math
Agraphia - can’t write
Agnosia (of the fingers) - can’t name fingers
Right-left disorientation

Question 21

Key features of Parinauds syndrome

Where is the lesion?

Answer 21

Dorsal midrain lesion
Commonly caused by pineal tumors, hydrocephalus

Results in:
- dilated pupils sluggishly responsive to light (EWN)
- impaired upgaze (dorsal vertical centre)
- convergance-retraction nystagmus
- retracted eye lids (sub-oculomotor nucelus)
- intact accomodation

Question 22

Ipsilateral CNIII palsy
Contralateral hemiataxia

Where is the lesion? What is this syndrome?

Answer 22

Claude sundrome

Dorsomedial midbrain (PCA and baslar branches)

Question 23

Poor prognostic features in bells

Answer 23

severe (complete) paralysis - MAJOR prognostic factor
older age; patients with moderately severe dysfunction should have valaciclovir + steroids

Other poor features - hyperacusis, altered taste, electromyographic evidence of axonal degeneration.

Question 24

Pure motor stroke (hemiparesis) - where is the lesion?

Answer 24

Posterior limb of internal capsule

Question 25

EEG findings in alzheimers dementia

Answer 25

Frontal slowing
Increased delta and theta activity
Decreased alpha and beta activity

Question 26

EEG in depression

Answer 26

Frontal alpa asymmetry
No slowing (unlike in dementia)

Question 27

Mechanism of Atogepant and indication

Answer 27

CGRP antagonist (calcitonin gene related pepetide)

Used in migraine

Question 28

Treatment of JME.
What AED exacerbates it?

Answer 28

Valproate

Exacerbated by lamotrogine

Question 29

Two parkinsons plus syndromes that are tauopathies

Answer 29

PSP
Corticobasal degeneration

Question 30

Knee jerk reflex spinal cord level, muscle and nerve

Answer 30

L2, 3, 4
Quardriceps
Femoral

Question 31

Ankle jerk reflex spinal cord level, muscle and nerve

Answer 31

S1-2
Tibial nerve (branch of sciatic)
Triceps surae

Question 32

Triceps jerk reflex spinal cord level, muscle and nerve

Answer 32

C7
Radial nerve
Triceps muscle

Question 33

Biceps jerk reflex spinal cord level, muscle and nerve

Answer 33

C5/6
Biceps
Musculocutaneous

Question 34

L) facial weakness
L) abducens weakness
R) hemiplegia

Where is the lesion?

Answer 34

Left ventral pons - “Millard-Gubler syndrome”

Affecting CNVI/VIII + corticospinal tracts

Basily artery