Neurology

Question 1

What is tone?

Answer 1

The resistance of the resting muscle to stretch
Required for maintaining posture and movements

Question 2

What’s the difference between spasticity and rigidity

Answer 2

Spasticity is force dependent
Rigidity fixed hypertonia
Dystonia - sustained muscle contraction and is often basal ganglia insult or genetic condition

Question 3

What is hypotonia a sign of

Answer 3

Lower motor neuron lesions
Can be benign - benign congenital hypotonia

Question 4

What are the types of hypertonia

Answer 4

Spasticity
Rigidity
Dystonia

Question 5

What is Spasticity

Answer 5

An UMN lesion in descending motor pathways (pyramidal tracts) and is force dependent
Most common form of hypertonia in children

Question 6

What is rigidity

Answer 6

Basal ganglia/deep nuclei insult
Parkinsonism
Fixed hypertonia - not force dependent

Question 7

How should power be assessed?

Answer 7

Work proximally to distal

Question 8

Describe the MCR power assessment

Answer 8

0 - no observable contraction
1 - slight contraction
2 -
3 -
4 -
5 -

Question 9

What is distal weakness a sign of?

Answer 9

Neuropathy - nerve problems

Question 10

What is proximal weakness typically a sign of?

Answer 10

Myopathy - muscle

Question 11

How are reflexes affected in UMN conditions?

Answer 11

Brisk reflexes - slowed inhibition of contralateral muscle group

Question 12

How are reflexes affected in LMN conditions?

Question 13

What is Babinski’s Signs?

Answer 13

Plantar reflex
Upgoing in a UMN lesion
White matter tracts

Question 14

What is the Spinothalamic tract responsible for?

Question 15

How is coordination tested in the upper limb?

Answer 15

finger-nose co-ordination - looking for past pointing and intention tremor
Fast movements - disdiadokinesis
Pronator drift - UMN sign of contralateral corticospinal tract

Question 16

How is co-ordination tested in the lower limb?

Answer 16

Heel-Shin (not alone)
Gait - looking for broad based? tandem walking? tip-toe and heel walking

Question 17

What is an Acoustic Neuroma?

Answer 17

A benign tumour of the Schwann cells surrounding the vestibulocochlear nerve that innervates the inner ear

Question 18

What is another name for an Acoustic Neuroma?

Answer 18

Vestibular Schwannoma

Question 19

What are Schwann cells?

Answer 19

Provide the myelin sheath in the peripheral nervous system

Question 20

Where do Acoustic Neuromas occur?

Answer 20

Cerebellopontine angle
Therefore they are sometimes known as cerebellopontine angle tumours

Question 21

What other conditions can acoustic neuromas be associated with?

Answer 21

Can be associated with facial nerve palsy if the tumour grows large enough to compress the facial nerve
Bilateral tumours almost certainly indicate Neurofibromatosis type II

Question 22

Describe the symptoms of an Acoustic Neuroma

Answer 22

The typical patient is aged 40-60 years and presents with gradual onset
-Unilateral sensorineural hearing loss (often the first symptom)
-Unilateral tinnitus
-Dizziness or imbalance
-Sensation of fullness in the ear

Question 23

What investigations are indicated in a suspected acoustic neuroma?

Answer 23

Audiometry - pattern of sensorineural hearing loss
Brain imaging - CT or MRI

Question 24

Describe the types of management for Vestibular Schwannoma

Answer 24

Conservative - monitoring if there are no symptoms or treatment is inappropriate
Surgery - partial or total removal
Radiotherapy - reduce growth

Question 25

What risks are associated with the treatment of a Cerebellopontine Angle Tumour?

Answer 25

Vestibulocochlear nerve injury - permanent hearing loss of dizziness
Facial nerve injury - facial weakness