Neurology

Question 1

Jugular foramen syndrome includes which cranial nerve defects

Answer 1

9,10,11

Question 2

Nerves that can be affected by acoustic neuroma

Answer 2

cochlear, vestibular, trigeminal, facial

Question 3

Grade Power from 0-5 neuro examination

Answer 3

0: No visible muscle contraction

1: Visible muscle contraction with no or trace movement

2: Limb movement, but not against gravity

3: Movement against gravity but not resistance

4: Movement against at least some resistance supplied by the examiner

5: Full strength

Question 4

How to test cranial nerve 1

Answer 4

1.Test each nostril with smelling salts if available

2.If not, ask patient if they have noticed any change in smell

Question 5

How to test cranial nerve 2 AFRO(Acuity, fields,reflexes,opthalmoscopy-Acuity

Start with inspection (visual aids; pupil size and symmetry; screening test – ask if they can see your whole face clearly).

Answer 5

1. Distant vision (visual acuity): test with Snellen chart (the result is recorded as distance/smallest font size read, e.g. 6/9)
2. Near vision: read a line of a letter/magazine
3. Assess for blind spot
4. ‘I would also like to test colour vision using Ishihara plates.’

Question 6

Visual Field defect: mono-ocular visual loss site of lesion

Answer 6

Ipsilateral retinal/optic nerve lesion

Unilateral vision field loss indicates a disorder of a structure anterior to the optic chiasm, whilst bilateral visual loss at or posterior to the optic chiasma

Retinal Causes: central retinal artery/vein occlusion, retinal detachment, disorders of the retina

Optic Nerve Causes: optic neuritis, optic atrophy, glaucoma, optic nerve transection

Question 7

Visual Field defect: bitemporal hemi-anopia visual loss site of lesion

Answer 7

Optic Chiasma

most commonly associated with pituitary tumours also occurs with craniopharyngiomas, meningiomas, anterior communicating artery aneurysms

Question 8

Visual Field defect: homonymous hemianopia visual loss site of lesion

Answer 8

Optic Tract

Homonymous hemianopia refers to a visual field defect involving either the two right or the two left halves of the visual fields of both eyes. Vascular causes such as cerebral infarction or cerebral haemorrhage are the most commonly identified causes. In children, this visual field defect is commonly the result of a tumour.

Right homonymous hemianopia is due to a lesion on the left side of the brain and vice versa.

Causes: MCA infarction. Tumour less commonly, aneurysm or trauma); migraine (which may cause transient homonymous hemianopia)

Question 9

Visual Field defect: Homonymous Superior Quadrantopia visual loss site of lesion

A visual field defect involving the two right or two left upper quadrants of the visual fields in both eyes.

Answer 9

Contralateral temporal (lower) optic radiation

‘Pie in the Sky’

A left superior homonymous quadrantanopia is due to a lesion on the right side of the brain (e.g. right temporal lobe)

Causes: temporal lobe tumour or middle cerebral artery SUPERIOR branch occlusion

MCA Infarction:
-upper quadrantopia indicates a temporal lesion
-lower quadrantopia indicates a parietal lobe lesion

Question 10

Visual Field defect: Homonymous Inferior Quadrantopia visual loss site of lesion

Answer 10

Contralateral parietal (upper) optic radiation

‘Pie on the Floor’

A left inferior homonymous quadrantanopia is due to a lesion on the right side of the brain (e.g. right parietal lobe)

Causes: parietal tumour or middle cerebral artery INFERIOR

Question 11

Classic tetrad Narcolepsy symptoms

Answer 11

• daytime sleepiness
  -cataplexy
  -sleep paralysis
  -hypnagogic/
  hypnopompic hallucinations

Question 13

GCS- Verbal Response

Answer 13

Best verbal response
Oriented 5
Confused 4
Inappropriate words 3

Incomprehensible sounds 2
No verbal response 1

Question 14

GCS Motor Response

Answer 14

Obeys commands 6
Localizing response to pain 5
Withdrawal response to pain 4
Flexion to pain 3
Extension to pain 2
No motor response 1

Question 15

GCS- Eyes

Answer 15

Spontaneous 4
Response to verbal command 3
Response to pain 2
No eye opening 1