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FRACP Clinical > Neurology > Flashcards

Neurology Flashcards

1
Q

CN 3 palsy features

A
  • eye down and out, pupil dilated

- failure of addiction, elevation, depression, and ptosis of eyelid

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2
Q

CN IV palsy features

A
  • head tilt
  • can’t intort eye
  • on adduction, eye elevates
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3
Q

Causes of CN IV palsy

A
  • head injury

- DM

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4
Q

Causes of CN VI palsy

A

Location: CN6 nucleus in pons

  • HTN
  • DM
  • raised ICP
  • pontine stroke or bleed
  • nasopharyngeal cancer
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5
Q

Features of INO

A
  • one eye fails to adduct, the other eye: nystagmus
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6
Q

Causes of INO

A
  • lesion of median longitudinal fasciculus
  • unilateral INO: stroke
  • bilateral INO: MS
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7
Q

Decreased visual acuity, with RAPD

A

Lesion at anterior visual system: eye or retina or optic nerve

  • optic neuropathy:
    - inflammatory: optic neuritis
    - infiltrative: sarcoidosis, lymphoma
    - trauma
    - compression
    - ischemia: GCA
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8
Q

Cause of bitemporal hemianopia

A

Optic chasm lesion

- pituitary tumor; look for signs of hypopituitarism or acromegaly

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9
Q

Causes of homonymous hemianopia

A

Location of lesion: behind optic chiasm

  • stroke
  • tumor
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10
Q

Homonymous hemianopia with sparing of central vision. Where is the lesion?

A

Occipital lobe

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11
Q

Upper homonymous quadrantanopia: where is the lesion?

A

Temporal lobe optic radiation

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12
Q

Lower homonymous hemianopia: where is the lesion?

A

Parietal love optic radiation

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13
Q

Peripheral nystagmus beats away or towards lesion?

A

Away from side of lesion

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14
Q

Vertical nystagmus central or peripheral?

A

Central duh

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15
Q

Horner syndrome causes:

A

1st order: tumor, stroke: brain stem, hypothalamus
2nd order: apical lung tumor, mediastinal tumor
3rd order: skull base lesions, trauma

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16
Q

Causes of 3rd nerve palsy

A
  • posterior communicating artery aneurysm
  • chronic meningitis
  • raised ICP
  • cavernous sinus lesion (would involve CN V)
  • DM
  • HTN
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17
Q

How to test median nerve function?

A
  • thumb abduction
  • thumb flexion
  • index finger flexion
  • median nerve distribution sensation
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18
Q

What are features of ulnar nerve lesion?

A

Loss of:

  • finger abduction
  • little finger flexion
  • ulnar nerve distribution sensation
  • claw hand 4th, 5th fingers
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19
Q

What are features of radial nerve lesion?

A

Loss of:

  • finger extension
  • wrist extension
  • elbow E (triceps), if lesion above spiral groove
  • brachioradialis
  • sensation anatomical snuff box
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20
Q

How to test C5-C6 nerve root?

A
  • deltoid: shoulder abduction
  • biceps and brachioradialis
  • biceps and supinator jerks
  • C5/C6 dermatome
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21
Q

How to test C7-C8 nerve root?

A

Finger flexion and extension
Triceps: elbow extension
Triceps jerk
C7-C8 dermatome

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22
Q

What are differentials for mainly motor neuropathy?

A
  • GBS / CIDP
  • hereditary: CMT
  • DM
  • lead poisoning
  • polio
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23
Q

What are differentials for sensory neuropathy?

A
  • DM
  • malignancy ?paraneoplastic
  • b12 deficiency
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24
Q

What are causes of peripheral neuropathy?

A
  • metabolic: DM, hypothyroidism
  • hereditary
  • alcohol
  • GBS
  • drugs/toxins: isoniazid, cisplatin, phenytoin
  • rheum: RA, SLE, Vasculitis
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25
Q

What are causes of mononeuritis multiplex?

A
  • DM
  • connective tissue disease: SLE, RA
  • compressive neuropathy
  • sarcoidosis
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26
Q

What are the features of CMT?

A
  • pets cavus
  • distal muscle atrophy
  • absent reflexes
  • minimal to no sensory loss
  • thickened nerves
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27
Q

Causes of hand wasting?

A 
Nerve: 
- median, ulnar nerve lesions
- plexus lesion
Anterior horn cell disease:
- MND
- polio
Myopathy:
- myotonic dystrophy
Spinal cord:
- syringomyelia, cervical spondylosis, tumour
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28
Q

How to differentiate the causes of foot drop?

A
  • Peroneal nerve: lose Dorsi F and eversion only
  • L5 radiculopathy: lose Dorsi F, eversion, AND inversion
  • sciatic nerve: foot can’t do anything, loses plantar flexion too
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29
Q

Feature of sciatic nerve lesion?

A

L4/L5/S1/S2

  • weak knee F
  • loss of power below knees
  • absent ankle jerk, no plantar response
  • sensory loss posterior thigh and below knee
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30
Q

Spinal cord lesion causes?

A
  • cord compression: spondylosis, abscess, tumour
  • transverse myelitis
  • MS
  • intrinsic cord lesion: infarction, syrinx
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31
Q

What are features of subacute combined degeneration of cord (B12 deficiency)?

A
  • upper motor neuron signs in lower limbs (increased tone, UMN pattern weakness, upgoing plantar)
  • but absent ankle jerks and sometimes loss of knee jerk.
  • sensory neuropathy: vibration, proprioception
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32
Q

What are the features of cord hemisection (Brown Sequard)?

A

Motor:
- Ipsilateral UMN signs below lesion
- ipsilateral LMN signs AT level of lesion
Sensory:
- ipsilateral loss of vibration, position
- contralateral loss of pain, temperature

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33
Q

What are causes of Brown-Sequard?

A
  • MS
  • glioma
  • trauma
  • myelitis
  • post radiation myelopathy
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34
Q

What are some causes of muscle weakness?

A

Myopathy:
- polymyositis, Dermatomyositis
- endocrine: hypo/hyperthyroidism, Cushings, hypopituitarism
- drugs: steroids
- hereditary: muscular dystrophy (only in males)
NMJ: myasthenia, lambert-eaton
Neurogenic: MND, polyradiculopathy (I.e. spinal stenosis, leptomeningeal disease, tumors, diabetic amyotrophic)

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35
Q

What tests for myopathy?

A
  • CK
  • EMG
  • muscle biopsy
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36
Q

What are side effects of dopamine agonists in Parkinson’s?

A
  • impulsivity: gambling, hyper sexuality, shopping
  • headache
  • nausea/vomiting
  • fatigue
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37
Q

What are some causes of Horner’s syndrome?

A
  • apical lung mass or infection
  • neck: thyroid mass, trauma
  • carotid artery aneurysm
  • brainstem lesions
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38
Q

Clinical features of Horner’s syndrome?

A
  • ptosis
  • pupil constricted
  • loss of sweating forehead
  • hoarse voice
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39
Q

What is lateral medullary syndrome and what are the clinical features?

A

Stroke or lesion at lateral medulla

  • nystagmus to side of lesion
  • ipsilateral pain loss
  • ipsilateral cerebellar signs
  • contralateral pain/sensory loss in limbs
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40
Q

What are causes of optic neuropathy?

A
  • MS
  • metabolic: B12 deficiency
  • DM
  • temporal arteritis
  • infiltrative: lymphoma, sarcoidosis
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41
Q

What causes a 3rd CN Palsy with sparing of the pupil?

A
  • diabeetus
  • arteritis
  • MG - can mimic CN palsy
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42
Q

What are causes of CN3 palsy?

A
  • posterior communicating artery aneurysm
  • tumour: raised ICP
  • DM
  • Trauma
  • cavernous sinus lesion
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43
Q

What nerve lesion causes Abductor Pollicus Brevis (APB) wasting?

A

Median nerve

44
Q

What nerve lesion causes Abductor Digiti Minimi (ADM) and 1st dorsal interosseous wasting?

A

Ulnar nerve

45
Q

What lesion causes thumb abductor weakness?

A

Median nerve at carpal tunnel

46
Q

What lesion causes thumb abductor, thumb flexion, and index finger weakness?

A

Median nerve at elbow

47
Q

What lesion causes isolated finger abduction weakness

A

Ulnar nerve at elbow

48
Q

What causes wasting, weak finger extensors, finger flexors, and triceps?

A

C7, C8, T1 root or plexus lesion

49
Q

What causes flaccid paralysis of entire arm, with wasting, areflexia, sensory loss to one arm?

A

Avulsion of all roots of brachial plexus (i.e. trauma)

50
Q

What causes wasting of one hand, loss of reflexes in arm, and dissociated sensory loss (loss of pinprick, but normal light touch) in half cape distribution?

A

Lesion of cervical and upper thoracic cord (syringomyelia, tumours)

51
Q

What causes wasting of both hands, and spastic weakness in legs?

A

C8-T1 cord lesion: trauma, tumour

52
Q

What causes generalised muscle weakness and wasting, fasiculations, hyper-reflexia, and normal sensation?

A

Motor neuron disease

53
Q

What causes distal wasting and weakness of all 4 limbs, areflexia, and a glove/stocking sensation loss?

A

Peripheral neuropathy i.e. DM, inherited

54
Q

What causes distal wasting, weakness of all four limbs, hyporeflexia, baldness, ptosis and cataracts

A

Myotonic dystrophy

55
Q

What causes weakness of brachioradialis, wrist extension, finger extension? Normal triceps power. With loss of brachioradialis reflex, and sensory loss of snuff box?

A

Radial nerve lesion at spiral groove

56
Q

What causes weak triceps, finger extensors, and finger flexors? Loss of triceps reflex?

A

C7-C8 root or plexus lesion

57
Q

What causes increased tone, generalised weakness of muscles of upper limb in deltoid, triceps, wrist E, finger E? Hypereflexia of UL?

A

Corticospinal lesion

58
Q

What causes weakness of detloid only? Biceps and brachioradialis power normal. Sensation loss over deltoid.

A

Axillary nerve lesion.

59
Q

What causes :

  • weakness of deltoid, biceps, and brachioradialis? Absent biceps and brachioradialis reflex.
  • Triceps reflex increased
  • Increased lower limb reflexes
A

C5-C6 cord lesion

60
Q

What causes:

  • weakness of deltoid, biceps, and brachioradialis
  • absent biceps and brachioradialis reflex
  • normal triceps and leg reflexes
A

C5-C6 root or plexus lesion

61
Q

What causes:

  • weakness of all muscles in one arm
  • absent reflexes
  • C5 to T1 sensory loss
A

Brachial plexus lesion

62
Q

What causes:

  • weakness of all muscles in one arm
  • hyperreflexia
A

UMN/hemiparesis

63
Q

What causes:

  • proximal weakness both arms and both legs
  • normal or reduced reflexes
  • normal sensation
A
  • polymyositis/dermatomyositis

- Myasthenia Gravis

64
Q

What causes:

- selective proximal weakness of arms and legs

A
  • muscular dystrophy
  • spinal muscular atrophy
  • inclusion body myositis
65
Q

Where is the lesion:

  • weakness hip F, knee E
  • normal hip add
  • absent knee jerk
A
  • femoral nerve lesion
66
Q

Where is the lesion:

  • weakness hip F, knee E, hip adduction
  • absent knee jerk
A

L2/3/4 root or plexus lesion: tumour, amyotrophy

67
Q

Where is the lesion:

  • unilateral weakness Hip F, Knee F, Dorsi F, eversion
  • increased tone and reflexes
A

UMN/corticospinal lesion

68
Q

Where is the lesion:

  • bilateral weakness hip F, knee F, ankle dorsi F, eversion
  • increased tone and reflexes
A

spinal cord lesion

69
Q

Where is the lesion:

  • proximal weakness
  • normal or reduced reflexes
A
  • myopathy: muscular dystrophy/polymositis

- myasthenia gravis

70
Q

Where is the lesion:

  • proximal weakness
  • absent reflexes
A
  • spinal muscular atrophy

- GBS

71
Q

Where is the lesion:

- weak dorsi F and eversion

A
  • common peroneal nerve lesion (with lateral lower leg sensation loss)
72
Q

Where is the lesion:

- weak dorsi F, eversion, inversion

A
  • L4/5 root or plexus lesion
73
Q

Where is the lesion:

- weak dorsi F, eversion, inversion, and plantar F

A
  • sciatic nerve lesion

DDx: trauma, vasculitis, tumour

74
Q

Where is the lesion:

  • distal weakness both legs
  • areflexia
  • glove/stocking sensory loss
A 
- peripheral neuropathy
(DDx:
- metabolic: DM, hypothyroidism 
- hereditary
- alcohol
- GBS
- drugs/toxins: isoniazid, cisplatin, phenytoin
- rheum: RA, SLE, Vasculitis)
75
Q

Where is the lesion:

  • wasting, fasiculations
  • hyper-reflexia
  • normal sensation
A
  • MND
76
Q

Where is the lesion:

  • weak hip F, knee F, dorsi F, eversion
  • tone increased
  • brisk reflexes
A
  • UMN/corticospinal
77
Q

Where is the lesion:

  • bilateral weakness hip F, knee F, dorsi F, eversion
  • tone increased
  • brisk reflexes
A
  • spinal cord lesion
78
Q

What does a positive Romberg’s mean?

A
  • ataxia from loss of proprioception/sensation, such as: diabetic neuropathy, sensory neuropathy, spinocerebellar degenration, subacute combined degeneration of cord, MS
  • NOT cerebellar ataxia
79
Q

What does unilateral high stepping gait suggest?

A
  • unilateral foot drop
80
Q

What does bilateral high stepping gait suggest?

A
  • bilateral foot drop:
    DDX:
    1) peripheral neuropathy i.e. CMT
    2) MND
81
Q

What does wide based and high stepping gait suggest?

A

sensory ataxia

DDx: diabetic neuropathy, sensory neuropathy, spinocerebellar degenration, subacute combined

82
Q

Causes of waddling gait

A
  • weakness of hip abduction
  • DDx: myopathy, OA hips
  • Trendelenberg “sound side sags”
83
Q

DDx of circumduction gait

A
  • hemiparesis: stroke
84
Q

DDx of bilateral circumducting gait

A
  • spastic paraparesis/scissoring gait

DDx: cerebral palsy, hereditary spastic paraplegia, MS, cervical spondylosis

85
Q

What does a Parkinson’s gait look like?

A
  • small shuffling steps
  • turning takes several steps
  • normal/narrow based gait
  • decreased arm swing
  • positive pull test
86
Q

Shuffling small steps, several steps to turn, broad based gait

A
  • NPH

- dementia

87
Q

What causes broad based irregular/ataxic gait?

A
  • cerebellar disturbance

- stagger to side of lesion

88
Q

What causes facial weakness, with sparing of frontalis and eyelid closure?

A

UMN/stroke contralateral cerebral hemisphere

89
Q

What causes weakness of all muscles on one side of face?

A 
LMN
DDx:
- Bell's Palsy (sensation normal)
- lesion of facial nucleus (has CN VI palsy as well)
- acoustic neuroma
- infection within facial nerve canal
90
Q

Bilateral facial weakness

A
  • GBS
  • myotonic dystrophy
  • MG
  • Bilat UMN: multi-lacunar stroke or MND
91
Q

In facial weakness, if pupils spared, usually means muscle or NMJ problem

A

…

92
Q

What are the features of CMT?

A
  • Pes cavus (high arches, hammer toes)
  • Distal muscle atrophy (champagne bottle legs)
  • Absent reflexes
  • No or only slight snesory loss
  • Thickened nerves
  • optic atrophy (RAPD)
93
Q

What are some causes of foot drop?

A
  • common peroneal nerve palsy
  • sciatic nerve palsy
  • Lumbosaccral plexus lesion
  • L4/5 nerve root lesion
  • peripheral motor neuropathy
  • distal myopathy
  • MND
94
Q

Shoulder abduction:

  • Muscle: ??
  • Nerve root: ??
  • Peripheral nerve: ??
A

Muscle: deltoid
Nerve Root: C5/C6
Peripheral Nerve: axillary nerve

95
Q 
Elbow E:
Which:
- Muscle
- Nerve Root
- Peripheral Nerve
A

Muscle: Triceps
Nerve Root: C7/C8
Peripheral Nerve: radial

96
Q 
Elbow F:
Which:
- Muscle
- Nerve Root
- Peripheral Nerve
A

Muscle: Biceps
Nerve Root: C5/C6
Peripheral Nerve: musculocutaneous

97
Q 
Wrist E:
Which:
- Muscle
- Nerve Root
- Peripheral Nerve
A

Muscle: extensor carpi ulnaris
Nerve Root: C7/C8
Peripheral Nerve: branch of radial

98
Q 
Wrist F:
Which:
- Muscle
- Nerve Root
- Peripheral Nerve
A

Muscle: flexor carpi radialis
Nerve Root: C6/C7
Peripheral Nerve: median

99
Q 
Finger E:
Which:
- Muscle
- Nerve Root
- Peripheral Nerve
A

Muscle: extensor digitorum
Root: C7/C8
Nerve: Radial

100
Q 
Finger abduction:
Which:
- Muscle
- Nerve Root
- Peripheral Nerve
A

Muscle: dorsal interossei
Root: C8/T1
Nerve: Ulnar

101
Q

What are the features of myotonic dystrophy?

A 
Inspection:
- frontal baldness
- triangular facies
- wasting of temporalis, masseter, sternomastoid
- partial ptosis
Neck:
- weak neck flexion
Upper limbs:
- grip myotonia (shake hands)
- percussion myotonia (tap over thenar eminence)
- wasting and weakness (esp. forearm)
- usually only mild sensory loss
Chest:
- gynecomastia
Testicular atrophy
Urinalysis: glycosuria
Cardiomyopathy
102
Q

What are the features of lateral medullary syndrome?

A

Occlusion of PICA or branches of vertebral artery; lateral medulla infarcts:

  • vomiting/vertigo/nystagmus
  • ipsilateral cerebellar signs
  • ipsilateral dimished gag reflex
  • ipsilateral Horner’s
  • ipsilateral face loss of pain/temp
  • contralateral loss of pain/temperature
103
Q

What are some causes of Parkinsonism?

A
  • idiopathic PD
  • drugs drugs drugs (metopclopramide, antipsychotics)
  • Wilson’s disease
  • Parkinson’s Plus: PSP, MSA
104
Q

What are causes of UMN facial weakness?

A
  • brain: infarct, tumour, bleed

- pons: MS, MND, infarct, tumour

105
Q

What are causes of LMN facial weakness?

A 
Most common: Bell's palsy
Cerebello-pontine angle:
- acoustic neuroma
- meningioma 
- tumour, mets
Facial nerve canal:
- Bell's
- zoster (Ramsay Hunt)
- tumour, trauma
Parotid: sarcoidosis
106
Q

What is the differential for bilateral proximal muscle weakness?

A
  • neuropathy
  • myopathy
  • MND
  • MG/Lambert Eaton

FRACP Clinical (11 decks)

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