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OSCE > Neurology > Flashcards

Neurology Flashcards

1
Q

Causes of Peripheral Neuropathy

A

Diabetes Drugs; (Phenytoin, Isoniazod, Nitrofurantoin) Autoimmune; Gullian Barre, SLE CKD Alcohol/B12 deficiency

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2
Q

Features of neuropathic ulcers

A

Slouchy Bloody Not painful

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3
Q

Features of diabetic neuropathy

A

Sensory affected>motor

light touch and vibration go first - loss of protection

Glove stocking distribution - can be painful

Length dependant - feet affected first

Loss of ankle reflexes, then knees etc

Can cause neuritis

Loss of autonomic function later

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4
Q

Ulnar nerve palsy

A

Weakness/wasting first dorsal interosseous - loss of thumb adduction

Partial claw hand (loss of lumbricals) looks like Dupetryns

Weakness of pincer grip (Frommets)

Sensory loss of fifth and ulnar half of fourth digit

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5
Q

Positive prayer sign

A

Fixed flexion deformity e.g RA, scleroderma, diabetes, ulnar nerve palsy, dupuytrens

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6
Q

Causes of Carpal Tunnel

A

RA DM Pregnancy Trauma Hypothyroid

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7
Q

Shoulder Abduction Nerve Root

A

C5

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8
Q

Elbow Flexion Nerve Root

A

C6

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9
Q

Wrist Extension Nerve Root

A

C7

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10
Q

Finger Extension Nerve Root

A

C8

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11
Q

Finger Abduction Nerve Root

A

T1

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12
Q

Median Nerve Palsy

A

e.g carpal tunnel can’t abduct thumb (thenar./APB) sensory loss 3.5 fingers Tinels and Phalens positive Pain in night relieved by shaking

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13
Q

Radial Nerve Palsy

A

Wrist drop e.g fractured head of humerus loss of sensation dorsum forearm and first 3 fingers dorsum

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14
Q

Hip Flexion Nerve Root

A

L2

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15
Q

Knee Extension Nerve Root

A

L3

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16
Q

Inversion and Dorsiflexion of Foot Nerve Root

A

L4

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17
Q

Dorsiflexion Big Toe Nerve Root

A

L5

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18
Q

Eversion of Foot Nerve Root

A

S1

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19
Q

T1 Nerve Supply

A

Pupil Dilation Axilla and upper inner sensation Intrinsic muscles of hand

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20
Q

T1 Nerve Root Lesion Features

A

e.g Pancoasts tumour (partial ptosis, small pupil) pain/sensory loss axilla complete claw hand wasting of small muscles hand

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21
Q

Facial paralysis with contralateral body weakness

A

Brainstem lesion

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22
Q

Isolated hemianopia - where is the lesion/vessel?

A

Posterior Communicating Artery

Contralateral

(occipital lobe)

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23
Q
A
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24
Q

Hemianopia plus hemiplegia on same side -

Where is the lesion/vessel?

A

Middle cerebral artery on contralateral side

(optic radiation temporal and parietal lobes)

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25
Q

Where is the lesion if central scotoma (middle missing)?

A

Optic Nerve

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26
Q

Where is the lesion if bitemporal hemianopia (outside halves gone)?

A

Optic Chiasm

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27
Q

Where is the lesion if homonymous hemianopia (left/right half of both gone)

A

Lobe lesion

28
Q

Why do you sometimes macular sparing?

A

Small part of optical lobe supplied by MCA rather than (PCA)

29
Q

Why do you get forehead sparing in UMNL?

A

“bilateral cortical representation of upper part of the face”

30
Q

What are the Parkisons Plus Syndromes?

A

Multiple system atrophy

Progressive supranuclear palsy

Parkinsonism-dementia-amyotrophic lateral sclerosis complex

Corticobasal ganglionic degeneration

Dementia with Lewy bodies

31
Q

CNIII Palsy

A

Partial ptosis

down and out

dilated pupil

32
Q

Causes of a CNVII LMNL

A

Acoustic Neuroma

Bells Palsy

Trauma to petrous temporal bone

Ramsay Hunt

33
Q

Dopamine Agonists

A

Less effective than Ldopa+inhib

Less motor complications - useful for young

Or in addition in adv disease

34
Q

Ldopa + dopa decarboxylase inhibitor

A

Main tx

Good for bradykinesia an rigid but less for tremor

Balance of benefit vs dyskinesias

Useful for 5 years before wearing off - delay start

35
Q

Side effects of levodopa

A

End-of-dose effect = wears off earlier and earlier

On-Off effect = unpredicatable fluctuation

Dyskinesias = unwanted movements

36
Q

Seligiline

A

Can be used to delay ldopa

Autonomic side effects

37
Q

COMT inhibitors

A

inhibit peripheral breakdown

helps w/ end-of-dose

38
Q

Features of a TACI

A

Severe, poor recovery

All three of:

  1. Contralateral hemiparesis
  2. Contralateral homonymous hemianopia
  3. Higher cortical dysfunction (speech, attention etc)
39
Q

Features of a PACI

A

2 of the 3 TACI features, usually higher cortical dysfunction + contralateral weakness

40
Q

Features of PoCI

A

1 of the 3:

  1. contralateral homonymous hemianopia
  2. cerebellar signs
  3. brainstem signs
41
Q

Features of Lacunar Infarct

A

No higher coritcal

No homo hemi

No drowsiness

No brainstem

pure motor/pure sensory/sensorimotor/dysarthria+hand/contra hemiballismus

42
Q

Genetics of Charcot Marie Tooth

A

Most common is autosomal dominant CMT but other phenotypes

43
Q

What the underlying pathophysiology of Charcot Marie Tooth?

A

gene duplication leading to production of abnormal myelin, which is unstable and spontaneously breaks down –> demyelination –> uniform slowing of conduction velocity

onion bulb appearance

44
Q

Presentation of Charcot Marie Tooth

A

usually before 10 yr

peripheral muscle weakness and wasting moving distally - inverted champagne legs, claw hands

sensory loss in same pattern - vibration touch then proprioceoption

painful

arreflexia

deformity

palpable nerves

45
Q

Deformities of Charcot Marie Tooth

A

pes cavus/pes planus/ hammer toe

spinal eg thorcic scoliosis

46
Q

Management of Charcot Marie Tooth

A

physio

orthotics

avoid neuropathic meds

surgery for deformity

analgesia

genetic counselling

47
Q

DDx of adult onset spastc parapesis

A

MS

ALS (MND)

B12 deficiency

Transverse myelitis

48
Q

Investigations of MS

A

CSF - oligoclonal IgG bands

MRI - plaques

Evoked potentials EEG

but mainly clinical

49
Q

Why do you get deformity like Z thumb, Boutonnieres etc in RA?

A

Chronic rheumatoid tenosynovitis damages tendons so they eventually wear out, snap, split etc

50
Q

Types of diabetic neuropathy?

A

Peripheral neuropathy - glove stocking

Mononeuropathy

Mononeuropathy multiplex

Diabetic femoral neuropathy - wasting and weakness of quads, loss of knee jerks

Autonomic neuropathy

51
Q

What peripheral neuropathy affects motor before sensory (unlike most)?

A

Gullian Barre

Charcot Marie Tooth

52
Q

How do you manage GCA?

A

Refer urgently to surgery for temporal artery biopsy

Start high dose steroids immediately

40mg pred (60mg if claudication)

53
Q

Marcus Gunn Pupil

A

No RAPD

optic nerve damage

retinal disease

54
Q

Adie Pupil

A

Dilated pupil

Slow reactive to light

Damage to parasympathic nerves from infection, often w/ absent knee/ankle jerks

55
Q

Argyll-Robertson Pupil

A

Small pupil

Accomodates but doesnt react to bright light

Prostitutes

Diabetic neuropathy, neurosyphilis

56
Q

Features of NF1

A

Cafe au lait

Axiary or inguinal freckles

Neurofibromas

Optic nerve gliomas

Lisch nodules

57
Q

Which common drugs can induce Parkinsonism

A

Amiodarone

Metocloperamide, Prochlorperazine

Lithium

Cinnarizine/Stugeron

Atypical antipsychotics

Conventional antipsychotics

58
Q

What are the extra pyradimal side effects?

A

Tardive Dyskinesia

Parkinsonism

Dystonia

Restlessness

59
Q

Bacterial Meningitis LP Results

A

Cloudy and turbid

High WCC (neutrophils)

High protein

Very low glucose

Normal red cells

60
Q

Viral Meningtis LP Results

A

Normal appearance

Raised WCC (lymphocytes)

Normal red cells

Protein normal/high

Glucose normal/low

61
Q

TB Meningitis LP Results

A

Normal or slight cloudy

Raised WCC (lymphocytes)

Red cells normal

Protein high

Glucose very low

62
Q

SAH LP Results

A

Yellow/blood stained appearance

WCC normal

Red cells very high

Protein normal or high

Glucose normal or low

63
Q

How might you be able to distinguish between bacterial meningitis and TB meningitis on an LP?

A

TB less cloudy

bacterial predominantly neutrophils

TB predominantly lymphocytes

64
Q

Gullain Barre LP Results

A

Appearance

WCC normal

Red cells normal

High protein (after a week)

Glucose normal or low or Low

65
Q
A
66
Q

MS LP Results

A

Normal appearance

WCC rasied lymphocytes

Red cells normal

Protein high

Glucose normal

OSCE (20 decks)

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