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PACES > Neurology > Flashcards

Neurology Flashcards

1
Q

Distrobution of peripheral sensory nerves hand

A

Radial nerve - snuff box
Median nerve - lateral first finger
Ulnar nerve - medial hand

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2
Q

Upper limb dermatomes/peripheral nerves

A

Lateral biceps - C5 musculocutaneous
Lateral forearm - C6 lateral cutaneous (from MC)
Snuff box - C6/radial
Radial first finger - C6/median
Middle finger - C7, variable nerve
Ulnar hand - C8/ulnar
Medial forearm - C8, medial cutaneous nerve
Medial biceps - T1

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3
Q

Upper limb reflex nerves/roots

A

Biceps - Musculocutaneous. C5/6
Brachioradialis - radial. C6(5)
Triceps - Radial. C7 (C6-8)

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4
Q

Differentiating ulnar from C8/T1 lesion

A

Abductor pollicis brevis C8/T1, median nerve
Medial forearm C8 not ulnar

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5
Q

Ulnar neuropathy signs

A

Inspection: flexion 4th/5th fingers. First dorsal and hypothenar wasting.
Power: Weak finger abduction
Altered sensation little finger/half ring palmar

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6
Q

Ulnar nerve nerve injury sites

A
  • At elbow in ulnar groove from repetitive flexion/extension
  • Wrist fracture/surgery
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7
Q

Parkinsonism definition

A

Triad:
- Tremor - resting, low freq
- Hypertonia - rigidity>spasticity, cogwheel
- Bradykinesia - slow initiation, reduced amplitude with repetition, micrographia

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8
Q

Parkinson’s plus syndromes

A

Progressive supranuclear palsy - early postural instability, vertical gaze palsy, trunkal rigidity, speech/swallow issues
Multisystem atrophy - early autonomic features, cerebellar signs
Cortico-basal degeneration - akinetic rigidity of one limb, alien limb, sensory loss/change
LBD

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9
Q

Parkinson’s investigations

A

Bedside
- OBS /postural BP
- DHx
- MOCA/cognitive assessment for dementia
Imaging:
- Consider MRI to exclude structural pathology
- Consider DaT scan

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10
Q

Parkinson’s treatment

A
  • L- Dopa with Dopa carboxylase inhibitor (madopar/co-beneldopa). SEs - Nausea, dyskinesia, on/off, waning over years. Inhibitor prevents peripheral metab from prodrug to dopamine -> fewer peripheral SEs
  • Dopamine agonists (rotigotine) - less waning, more SEs inc disinhibition
  • MAOB inhibition (selegiline) - prevents dopamine breakdown
    Others:
  • COMT inhibition - prevents L dopa breakdown to reduce off periods
  • Apomorphine - SC for severe off rescue
  • DBS
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11
Q

30 year old woman
Visual loss with pain on movement
Worse in bath
Episodes urinary incontinence 2 months ago

A

MS

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12
Q

Explain INO

A

Lésion in médian longitudinal fasciculus in pons causes ipsilateral failure of adduction with contralateral nystagmus on abduction
Causes
- MS
- Vascular
(Lyme’s, HIV, syphilis)

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13
Q

MS pathophysiology/prognosis

A

Inflammatory plaques leading to demyelination disseminated in space and time. Episodes >1h, >30/7 between.
Poor healing leads to secondary progression in >80%
10% no improvement between relapses - primary progressive
Small no - no progression

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14
Q

MS management

A

Lifestyle: stop smoking, exercise, avoid stress
DMDs: demethyl fumarate, anti t cell MAbs
Methylpred for relapses 3-5/7 affects duration but not freq/prog, use <2 per year
Symptomatic: spasticity- baclofen/gabapentin. Botox for tremor.

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15
Q

MS Signs

A

CNs: INO (often bilateral), optic atrophy, reduced acuity, other CN palsy
PNS: UMN lesions - spasticity, weakness, brisk reflexes, altered sensation
Cerebellar lesions
Lhermittes sign - electric shock sensation on cervical flexion

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16
Q

MS investigations

A

Bedside:
Bloods:
Imaging:
MRI for spatially disseminated lesions - >2 over > 2 attacks sufficient for diagnosis
Special tests:
CSF - IgG oligoclonal bands on electrophoresis, not seen in plasma
Evoked potentials - e.g. visual, sensory, auditory - evidence of e.g. optic neuritis

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17
Q

MS investigations

A

Bedside:
Bloods:
Imaging:
MRI for spatially disseminated lesions - >2 over > 2 attacks sufficient for diagnosis
Special tests:
CSF - IgG oligoclonal bands on electrophoresis, not seen in plasma
Evoked potentials - e.g. visual, sensory, auditory - evidence of e.g. optic neuritis

18
Q

Peripheral primarily sensory neuropathy causes

A

Metabolic:
- Diabetes
- B12 deficiency
- Uraemia
- Hypothyroidism
Toxic:
- Alcohol
- Chemotherapy (vincristine)
Inflammatory:
- CIPD (chronic inflammatory )
- Sarcoidosis, RA
- Amyloidosis
Paraneoplastic:
- Solid cancer, e.g. lung
- Paraproteinaemia

19
Q

Peripheral neuropathy investigations

A

Bedside:
- Blood glucose
- Urine dip for glucose
- Fundoscopy
Bloods
- U&E (uraemia)
- FBC (macrocytosis)
- Hba1c
- TFTs
- ESR +/- vasculitis screen
Special tests
- Electrophysiology

20
Q

How does electrophysiology aid with differentiating causes of peripheral neuropathy

A
  • Length dependent (metabolic) vs equal/mononeuritis multiplex (inflammatory)
  • Demyelination vs axonal
21
Q

Median neuropathy signs

A

Inspection: Thenar wasting
Sensory: thumb-middle of ring finger palmar
Motor:
- Abductor pollicis brevis weakness
- Poor precision grip

22
Q

Differentiating sites of median neuropathy

A

Carpal tunnel:
- Palm sensation intact
Anterior interosseous nerve (forearm)
- Distal phalanx of thumb and index weakness
- Other muscles intact
Proximal (elbow)
- Combined

23
Q

Caused carpal tunnel syndrome

A

Oedema in carpal tunnel
Arthritis:
- RSI
- RA
Endocrine
- Myxoedema
- Acromegaly
- Diabetes/obesity increases risk
Tumours
- Ganglion/lipoma
- Myeloma -> amyloidosis

24
Q

Radial neuropathy signs

A

Inspection
Motor
- Wrist/finger drop
- Supinator weakness
(BEAST - brachioradialis, extensors, abductor pillicis longus, supinator, triceps)
Sensory
- Most reliably anatomical snuff box

25
Q

Mononeuritis multiplex causes

A

Generally systemic, most commonly vasculitis
Endocrine - diabetes

26
Q

Mononeuritis multiplex definition

A
  • asymmetrical
  • asynchronous
  • sensory and motor
  • peripheral neuropathy
    isolated damage to at least two separate limb or cranial nerves.

Multiple nerves in random areas of the body can be affected simultaneously or sequentially. As the condition worsens, it becomes less multifocal and more symmetrical, mimicking distal dying-back symmetrical polyneuropathy.

27
Q

Nerve conduction demyelinating vs axonal findings

A

Ulnar nerve - axonal >38m/s, demyelinating <38

28
Q

Charcot Marie Tooth epidemiology

A

Most common inherited neurological disorder. No ethnic etc. predisposition
AD and AR inheritance forms exist.

29
Q

Charcot Marie Tooth forms

A

Most commonly demyelinating and AD.
Multiple forms including AR and axonal.
Type 1 - AD, demyelinating
Type 2 - AD/R, axonal degeneration
Type 4 - AR
Type X - X-linked recessive

30
Q

Charcot Marie Tooth examination

A

Inspection:
- Pes cavus
- Pernoeal/peripheral muscle wasting
- Possible palpable nerve thickening

  • Length dependent peripheral neuropathy - peripheral weakness and reduced sensation. Motor > sensory
  • Hypo/arreflexia
  • High-stepping/slapping gait
31
Q

Bells palsy signs

A
  • Unilateral face weakness including failure to raise eyebrow
  • Numbness/pain around the ear
  • Hypersensitivity to sounds (stapedius palsy)
  • Bell’s phenomenon - up/out movement of eye on attempt to close
32
Q

Bells palsy management

A

If withing 72h - High dose prednisolone for 5/7 then wean
No evidence for antivirals (although some evidence of association with HSV1)
Protect the eye - drops, sunglasses, taping at night

33
Q

Facial nerve lesion site localising features

A
  • Pons - VI nerve signs (failure to abduct eye) (e.g. stroke, tumour)
  • Cerebellar-pontine angle - V, VI, VIII, cerebellar signs. (e.g. acoustic neuroma)
  • Auditory canal - VIII signs (e.g. cholesteatoma/abscess)
  • Face/neck - Scars or parotid mass
34
Q

Causes of facial nerve palsy

A
  • Bell’s
    Infective
  • Ramsay Hunt (Herpes Zoster)
  • Lyme
  • Chronic otitis media/abscess/necrotising OE
    Tumour
    MS
    Stroke
    Diabetic mononeuropathy
35
Q

Sciatic neuropathy signs

A

L4-S3
Hamstring weakness
Weakness all muscles below the knee
Lateral sensory loss below the knee

36
Q

Common peroneal neuropathy signs

A

Branch of sciatic nerve above knee, L4-S1
Weakness of anterior muscles:
- Foot drop/weak dorsiflexion
- Weak ankle eversion
Dorsal foot sensory loss

37
Q

Tibial neuropathy signs

A

Branch of sciatic nerve above knee, L4-S3
Weakness of posterior muscles:
- Weak plantarflexion (unable to stand on toes)
- Weak inversion
- Weak toe flexion
Foot sole sensory loss

38
Q

Lower limb reflexes nerves/roots

A

Knee jerk - Femoral, L3/4
Ankle jerk - Tibial, S1/2

39
Q
A
40
Q

Cranial nerve nucleus sites

A

2/2/4/4
I, II - forebrain
III, IV - midbrain
V - VIII - pons
IX - XII - medulla

PACES (4 decks)

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