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Clinical Prep > Neurology > Flashcards

Neurology Flashcards

1
Q

Parietal lobe signs (dominant)

A

AALF
Acalculia - serial 7s
Agraphia - writing
Left-right disorientation - “show left hand”
Finger agnosia - name fingers

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2
Q

Parietal lobe signs (non-dominant)

A

Agraphaesthesia - draw number on hand
Inattention - visual and sensory
Astereognosis - identify object in hand
Dressing apraxia
Constructional apraxia
Spatial neglect

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3
Q

Temporal lobe signs

A

Short term memory loss
Long term memory loss
Dysphasia, receptive (in dominant lobe lesions)

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4
Q

Frontal lobe signs

A

Grasp reflex
Palmomental reflex
Pout reflex
Gait apraxia
Anosmia
Interpret a proverb

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5
Q

Shoulder ABduction
nerve root
Muscles

A

C5 / C6
Deltoid and supraspinatus

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6
Q

Shoulder ADduction
Nerve root
Muscles

A

C6 / C7 / C8
Pectoralis major, latissimus dorsi

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7
Q

Elbow flexion
Nerve root
Muscles

A

C5 / C6
Biceps and brachialis

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8
Q

Elbow extension
Nerve roots
Muscles

A

C7 / C8
Triceps

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9
Q

Wrist flexion
Nerve root
Muscles

A

C6 / C7
Flexor carpi ulnaris and radialis

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10
Q

Wrist extension
Nerve root
Muscles

A

C7 /C8
Extensor carpi group

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11
Q

Finger extension
Nerve root
Muscles

A

C7/C8
Extensor: indicis, digiti minimi, digitorum communis

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12
Q

Finger flexion
Nerve root
Muscles

A

C7/C8
Flexor digitorum profundus

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13
Q

Finger ABduction
Nerve root
Muscles

A

C8/T1
Dorsal interossei

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14
Q

Finger ADduction
Nerve root
Muscles

A

C8/T1
Palmar interossei

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15
Q

Biceps reflex

A

C5/6

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16
Q

Triceps reflex

A

C7/8

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17
Q

Brachioradialis reflex

A

C5/C6

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18
Q

Radial nerve
Root
Motor and sensory functions

A

C5-8
Triceps, brachioradialis, wrist extension
If lesion in upper third of nerve it will cause triceps weakness
Sensation in anatomical snuff box

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19
Q

Median nerve
Nerve roots
Motor and sensory function

A

C6-T1
LOAF
Lateral two lumbricals
Opponens pollicis
Abductor pollicis brevis
Flexor pollicis brevis
(All muscles of the front of the forearm except the flexor carpi ulnaris and half of the flexor digitorum profundus)

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20
Q

Which nerves / nerve roots supply the intrinsic muscles of the hand?

A

Ulna and median nerve
C8-T1

21
Q

Clawing of the ring and small fingers - what does this signify?

A

ulnar lesion

22
Q

Wasting of 1st dorsal interossei - cause

A

ulnar lesion

23
Q

Wasting of abductor digiti minimi - cause

A

ulnar lesion

24
Q

Wasting of abductor digiti minimi - cause

A

ulnar lesion

25
Q

Wasting of abductor policis brevis (thenar eminance, thumb abduction) - cause

A

median nerve lesion

26
Q

Iliopsoas
function
nerve root
peripheral nerve

A

hip flexion
L1/2/3
Femoral

27
Q

Quadriceps
function
nerve root
peripheral nerve

A

knee extension
L2/3/4
femoral

28
Q

Gluteus maximus
function
nerve root
peripheral nerve

A

hip extension
L5 S1/2
inferior gluteal nerve

29
Q

Hamstrings
function
nerve root
peripheral nerve

A

knee flexion
sciatic nerve
L5 S1/2

30
Q

Hip adductors
function
nerve root
peripheral nerve

A

obturator nerve
L2/3/4

31
Q

Myotonic dystrophy
Types
Mutations
Inheritance pattern

A

DM1 and DM2 (milder)
Repeat expansion in DMPK (DM1) or ZNF9 (DM2)
Autosomal dominant inheritance

32
Q

Myotonic dystrophy manifestations

A

Weakness - facial muscles, distal forearms, hands
Muscle pain
Myotonia
Cardiac conduction disease
LVH
Pharyngoesophageal weakness and respiratory muscle weakness
Sleep disorder
Hypogonadism
Cataracts

33
Q

Wasted hand
- only abductor pollicis brevis (thumb abduction)

A

median nerve lesion

34
Q

Wasted hand
- only abductor digiti minimi and first dorsal interosseous

A

Ulnar lesion

35
Q

How does median nerve lesion and the wrist differ to median nerve lesion at the elbow?

A

Weakness of abductor pollicis brevis at the wrist lesion

At elbow - will have weakness of flexors of the finger and flexor pollicis longus. (okay sign)

36
Q

What is the benediction sign a sign of?

A

proximal median nerve lesion

37
Q

What muscles are supplied by the ulnar nerve?

A

Flexor digitorum profundus of the little finger
Abductor digiti minimi
first dorsal interosseous

38
Q

What causes weakness of all three of:
Abductor pollicis brevis
Abductor digiti minimi
First dorsal interossus

A

C7/8/T1 root or plexus lesion - finger extensors and triceps

C5-T1 - sensory loss of the whole arm, often associated with horners

Syringomyelia - wasting, loss of reflexes and loss of pain (light touch preserved)

C8/T1 cord lesion - wasting of both hands and spastic weakness of the legs - look for sensory level

Motor neurone disease - fasiculations, wasting, hyper-reflexia, No sensory loss

Peripheral neuropathy - wasting of all limbs distally

Myotonic dystrophy - distal wasting, hyporeflexia, baldness, ptosis, cataracts

39
Q

Wrist drop patterns of weakness

A
  1. radial nerve lesion - weak brachioradialis, wrist extension, finger extension. snuff box sensory loss
  2. posterior interosseous nerve lesion - weakness of finger extension, radial deviation of the wrist on extension, no sensory loss, and normal reflexes.
  3. C7/8 root or plexus lesion - weak triceps, finger extensors and flexors, triceps reflex absent
  4. Corticospinal lesion - teneralised weakness, increased tone and reflexes
40
Q

Lower limb weakness patterns

A
  1. Femoral nerve lesion: weakness of quads and hip flexion, reduced knee jerk. Hip adductors normal.
  2. L2/3/4 root or plexus injury; as per femoral nerve plus weakness of hip adduction.
  3. Cortical lesion: pyramidal weakness with increased tone and hyperreflexia
  4. Paraparesis: bilateral pyramidal pattern weakness plus sensory level
  5. Generalised weakness with reflexes increased- MND or quadriparesis
41
Q

Foot drop patterns

A
  1. common peroneal nerve - weakness of dorsiflexion and eversion
  2. L4/5 nerve root - as per 1. but add inversion, and may be weakness of hip abduction, ankle jerk preserved
  3. Sciatic nerve - loss of all movements plus loss of ankle jerk
  4. peripheral neuropathy - associated with sensory loss
  5. cauda equina - saddle anaesthesia etc
  6. MND
  7. Corticospinal tract - brain vs. cord
  8. Brown-sequard - one leg weak with loss of all sensation, contralateral leg has loss of pain and temperature
42
Q

Pes cavus causes

A

long standing neuropathy
- CMT
- Friedreich’s ataxia
- spina bifida

43
Q

Gait patterns

A

High-stepping gait - foot drop
Bilateral high-stepping gait - bilat foot drop - think CMT, MND
High-stepping with wide base - think sensory ataxia, test rombergs
myopathic / waddling gait - weakness of hip abduction - test trendelenburg
Circumduction - hemiparesis
Scissoring gait - bilateral increased tone - cerebral palsy, hereditary spastic paraplegia, MS, cervical spondylosis
Parkinsonian gait
Frontal gait - wide base, small steps, upright posture
Cerebellar gait - broad base with irregular steps

44
Q

Facial weakness patterns

A
  1. Upper motor neurone lesion; unilateral weakness sparing frontalis and orbicularis oculi.
  2. Lower motor neurone lesion; unilateral weakness, usually Bells (loss of taste, hyperacusis), facial nucleus (may also have CN6 nerve palsy)
  3. Bilateral facial weakness - GBS, sarcoidosis, myopathies (such as facio-scapulo-humeral dystrophy, mitochondrial myopathy, myotonic dystrophy, parkinson’s facies, pseudobulbar palsy / MND
  4. isolated weakness to one or two muscles - rare
45
Q

Unilateral ptosis causes

A

horners - constricted pupil, partial ptosis
occulomotor palsy - down and out with dilated pupil

46
Q

Lateral medullary syndrome

A

Horners, ipsilateral loss of temperature / pain sensation, contralateral pain and temperature loss on trunk and limbs

47
Q

Bilateral ptosis

A

myaesthenia, myotonic dystrophy

48
Q

Perinaud syndrome

A

convergence-retraction nystagmus
- pupils may be unractive to light but normal accommodation. Usually compression of the mid-brain, hydrocephalus or stroke

49
Q

PSP eye findings

A

loss of voluntary vertical gaze, but reflex movements intact

Clinical Prep (7 decks)

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