Neurology

Question 1

What kind of aura would you expect for epilepsy?

Answer 1

Dizziness
Deja vu/Jamais vu
Unusual smell/taste/vision

Question 2

Which cranial nerves may be affected by a cavernous sinus thrombosis?

Answer 2

3, 4, 5, 6

5 is particularly associated with pain and loss of corneal reflex

Question 3

Give 5 causes of any cranial nerve palsy.

Answer 3

Diabetes
Stroke
MS
Tumour
Vasculitis

Question 4

Give 3 causes of a unilateral Ptosis. Will they be partial or complete?

Answer 4

Horner’s - partial
CN 3 palsy - complete
Congenital

Question 5

Give 3 causes of a bilateral Ptosis.

Answer 5

Myaesthenia gravis
Myotonic dystrophy
Congenital

Question 6

What are the features of a cranial nerve 3 palsy?

Answer 6

Eye down and out
Complete Ptosis
Dilated pupil

Question 7

What are the signs of Horner’s syndrome?

Answer 7

Unilateral:

Partial Ptosis
Miosis (constricted pupil)
Anhydrosis

Question 8

How would you differentiate between Bell’s palsy and a umn facial nerve palsy?

Answer 8

If frontalis is spared then it is umn stroke.

Due to bilateral innervation of this muscle.

Question 9

What are the bulbar signs? What are they indicative of?

Answer 9

Slurred speech, dysphagia, absent gag reflex.

LMN damage to CN9-12 in medulla
Polio
MND
Myaesthenia gravis

Question 10

What is your differential for a CN1 problem?

Answer 10

Trauma
Viral infection
Meningitis

Question 11

What is your differential for monocular blindness?

Answer 11

Retinal detachment
Ophthalmic artery thrombus
Giant cell arteritis

Question 12

What is your differential for bitemporal hemianopia?

Answer 12

Pituitary adenoma

Aneurysm in the circle of Willis

Question 13

What is your differential for a homonymous hemianopia?

Answer 13

Anything behind the chiasm:

Stroke
Tumour
Abcess

Question 14

What is your differential for a CN5 problem?

Answer 14

Trigeminal neuralgia

Herpes zoster

Question 15

What is your differential for a CN8 problem?

Answer 15

Furosemide
Gentamicin
Age

Question 16

What kind of aura would you expect for a simple vasovagal faint?

Answer 16

Nausea
Sweating
Dizziness

Question 17

What are the myotomal roots of the reflexes?

Answer 17

Ankle - S1/2
Knee - L3/4
Biceps and brachioradialis - C5/6
Tricep - C7/8

Question 18

What are the cardinal signs of Parkinson’s?

Answer 18

Bradykinesia
Rigidity (cog wheel)
Resting tremor (pill rolling)

May also have masked fascies and slurred speech.

Question 19

What are the signs of a cerebellar lesion?

Answer 19

DANISH

Disdiadokinesis
Ataxia
Nystagmus 
Intention tremor
Speech - slurred
Hypotonia

Question 20

What are the signs of an ulnar nerve lesion?

Answer 20

LMN signs in fourth and fifth fingers

Question 21

What are the signs of a median nerve lesion?

Answer 21

LMN signs in the thenar muscles and palmar surface

Question 22

What are the signs of a radial nerve lesion?

Answer 22

Wrist drop and weakness of extension of the elbow

Question 23

What are the signs of an upper motor neuron lesion?

Answer 23

Hypertonia
Hyperreflexia
Spastic muscle weakness
Babinski's 
Clonus

Question 24

What are the signs of a lower motor neuron lesion?

Answer 24

Hypotonia
Hyporeflexia
Flaccid weakness
Muscle wasting
Fasciculations

Question 25

How would you grade muscle weakness?

Answer 25

``` 0 - no movement 1 - flicker 2 - unable to move against gravity 3 - unable to move against resistance 4 - reduced power, able to move against resistance 5 - normal ```

Question 26

What birth injury causes damage to the upper brachial plexus? How does it present?

Answer 26

Erbs = waiters tip Shoulder adducted Arm internally rotated Forearm pronated

Question 27

What birth injury causes damage to the lower brachial plexus? How does it present?

Answer 27

Klumpke's Wasting of small muscles in hand - claw Flexion of the elbow and wrist Horner's may accompany

Question 28

Give 5 causes of peripheral neuropathy?

Answer 28

``` Diabetes Uraemia (kidney failure) Vasculitis Anaemia Alcohol ```

Question 29

Give 4 causes of foot drop.

Answer 29

Common peroneal nerve palsy Stroke L4/5 lesion Motor neurone disease

Question 30

What is syringomyelia? How does it present?

Answer 30

Blockage of CSF in spinal canal - syrinx Affects spinothalamic tracts as they cross Loss of pain and temperature on both sides in a cape like pattern.

Question 31

What is brown squared syndrome and how does it present?

Answer 31

Lateral hemi section of the spinal cord Lose vibration and proprioception on same side Lose pain and temperature and crude touch on opposite side.

Question 32

What is cauda equina? How does it present?

Answer 32

Damage to the lumbar region L1-5 can also damage the sacral nerve roots. Leads to saddle anaesthesia, urinary incontinence, sexual dysfunction, motor and sensory deficits.

Question 33

What is the differential for a positive Romberg test?

Answer 33

NOT cerebellar, they will not balance with eyes open. Lesion to dorsal columns (proprioception) eg Neurosyphilis Alcohol B12/thiamine deficiency MS

Question 34

Give three types of gait and what causes them.

Answer 34

Festinating - Parkinson's Trendelenberg - superior gluteal nerve palsy or fractured neck of femur Antalgic - arthritis

Question 35

Give four types of tremor and what causes them.

Answer 35

Intention tremor - cerebellar lesion Resting tremor - Parkinson's Flapping - metabolic Drug induced - anti psychotics

Question 36

What are the main causes of carpal tunnel syndrome?

Answer 36

``` Idiopathic Pregnancy Repetitive strain injury Arthritis Diabetes Hypothyroid ```

Question 37

Give three causes of nystagmus

Answer 37

Alcohol Cerebellar lesion CN8 lesion