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Year 4 > Neurology > Flashcards

Neurology Flashcards

1
Q

Name the parts of an upper limb neuro examination

A 
WIPE
Observation: wasting, fasciculation, tremor, asymmetry
Tone
Power (and pronator drift)
Sensation
Reflexes 
Coordination
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2
Q

What is added in a lower limb neuro exam?

A

Tone includes leg roll, ankle drag and clonus
Reflexes include plantar
Coodination includes gait

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3
Q

What is part of a baby’s neuro exam?

A 
Anterior fontanelle protrusion/indent (ICP)
Head circumference (Hydrocephalus)
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4
Q

What 3 things is it key to understand in speech/language disorders?

A

Is it a difficulty in:
Articulation
Expression
Understanding

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5
Q

Name the sections of the Glasgow coma scale (GCS) and total

A

/15
Eye opening/4
Verbal reponse/5
Motor response/6

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6
Q

What are the different categories in GCS within eye opening?

A

Spontaneous
To sound
To pressure (supraorbital nerve)
None

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7
Q

What are the different categories in GCS within verbal response?

A 
Orientated
Confused (but sentences)
Words
Sounds (groans/grunts)
None
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8
Q

What are the different categories in GCS within motor response?

A 
Obey commands
Localising to pain
Normal flexion to pain
Abnormal flexion to pain
Extension to pain
None
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9
Q

How do you test CNII?

A 
Visual acuity
Visual fields
Visual inattention
Fundoscopy
Pupillary reflexes
Accommodation
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10
Q

How do you test CNV?

A

Sensation (pain/temp/light touch)
Corneal reflex
Jaw jerk
Mastication muscles

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11
Q

Muscle power is defined how?

A

Scale 0-5

0: no contraction
1: flicker
2: Active movement without gravity
3: Active movement against gravity
4: Active movement against gravity and resistance
5: Normal power

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12
Q

What movement involves C5 myotome?

A 
Shoulder abduction (deltoid) C5
Elbow flexion (biceps) C5/6
Scapula winging (serratus anterior) C5/6/7
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13
Q

Which myotome does the biceps reflex test?

A

C5/6

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14
Q

What movement involves C6 myotome?

A 
Elbow flexion (biceps) C5/6
Elbow flexion (brachioradialis) and supintation (supinator) C6
Scapula winging (serratus anterior) C5/6/7
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15
Q

Which myotome does the supinator reflex test?

A

C6

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16
Q

Which myotome does the triceps reflex test?

A

C7/8

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17
Q

What movements involve C7?

A 
Elbow extension (triceps) C7/8
Finger flexion (FDS and FDP) Radial and median C7/8
Finger extension (EDc, radial) C7
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18
Q

What movements involve C8?

A 
Elbow extension (triceps) C7/8
Flexor digiti minimi, palmar and dorsal interossei, aductor policis (Ulnar nerve) C8/T1
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19
Q

What movements involve T1?

A

All intrinsic hand muscles

Ulnar + Median (LOAF)

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20
Q

What does LOAF stand for?

A

Median 2 lumbricals
Opponens policis
Abductor pollicis brevis
Flexor pollicis brevis

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21
Q

Knee reflex nerve roots?

A

L3/4

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22
Q

Ankle reflex nerve roots?

A

S1/2

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23
Q

Optic nerve compression leads to what visual field defect? Eg

A

Central scotoma

eg optic neuritis

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24
Q

Optic chiasm pathology leads to what visual field defect? eg

A

Bitemporal hemianopia

Pituitary tumour

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25
Q

Optic tract pathology leads to what visual field defect? eg?

A

Incongruous homonymous hemianopia

Meningioma

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26
Q

Optic radiation pathology leads to what visual field defect? eg?

A

Complete homonymous hemianopia

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27
Q

Temporal lobe pathology leads to what visual field defect? eg?

A

Superior quadrantic hemianopia

Space occupying lesion

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28
Q

Parietal lobe pathology leads to what visual field defect? eg?

A

Inferior quadrantic hemianopia

Space occupying lesion

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29
Q

Occipital lobe pathology leads to what visual field defect? eg?

A

Homonymous hemianopia +/- macular sparing

Occipital lobe infarct

30
Q

Inferior and superior obliques operate the eye in…

A

Adduction

31
Q

Causes and features of a IIIrd nerve palsy

A

Fixed down and out gaze with fixed dilated pupil, complete ptosis
Aneurysm, diabetes,
cavernous sinus lesion,
tentorial herniation

32
Q

If a pt has unequal pupils, how do you know which is the abnormal one?

A

The side with ptosis

33
Q

Where do you never see complete ptosis?

A

Horner’s syndrome

Only the smooth muscle is affected, skeletal muscle intact

34
Q

How do you test CNVII?

What branches are involved?

A

Facial expression
Change in hearing (nerve to stapedius)
Change in taste (chorda tympani)

35
Q

What symptoms involving sensation would show that the lesion is central/peripheral?

A

Dissociated sensory loss of 2 different sensory modalities: central rather than peripheral.

36
Q

Describe what happens to motor and sensory modalities in a complete spinal lesion

A

Motor: LMN at site of lesion, UMN below lesion
Sensory: Sensory level
Bladder involvement

37
Q

Describe what happens to motor and sensory modalities in Brown Sequard syndome

A

Motor: ipsilateral UMN below lesion
Sensory: Contralateral loss of pain temp (spinothalamic)
Ipsilateral loss of vibration and proprioception (dorsal column)

38
Q

Whats different between complete spinal lesion and central spinal lesion?

A

Motor same
Sensory: spinothalamic same
Dorsal column preserved

39
Q

What does radial nerve pathology present with?

A

Wrist drop
Makes hand muscles appear weak (so examine on flat surface)
Loss of triceps reflex

40
Q

What is seen with the pupil in Horner’s? Cause?

A 
Small constricted pupil
Normal light response and accommodation
Fails to dilate with cocaine
Mild ptosis
Damage to sypathetics
41
Q

What is seen with the pupil in Adie’s? Cause?

A

Dilated pupil with absent light reflex, slow accommodation
Pilocarpine constricts
No ptosis
Damage to parasympathetic fibres

42
Q

How can you tell is a facial nerve palsy is UMN or LMN?

A

UMN has forehead sparing due to bilateral innervation

43
Q

What is the difference between a bulbar palsy and a pseudobulbar palsy?

A

Bulbar: LMN (eg MND, Myasthenia gravis)
Nasal dysarthria, dysphonia, dysphagia, wasting and fasciculations of tongue
Wasting and fascilculations of masticatory muscles, fatiguable dysarthria, facial weakness

Psudobulbar: UMN (eg MS, cerebrovascular)
Strained voice, dysphagia, small tongue, emotional lability, brisk jaw jerk

44
Q

Which side does the tongue go in a right sided hypoglossal dysfunction?

A

Right

Towards lesion

45
Q

2 causes of myasthenia

A

Thymoma

Idiopathic

46
Q

What is seen in IVth nerve palsy?

A

Failure of depression in adduction

Usually due to head injury

47
Q

What is parinaud?

A

Failure of vergence (con/divergence when focusing)
And failure of vertical gaze
Due to a dorsal midbrain lesion (eg pineal tumour)

48
Q

What does a RAPD show?

A

An optic nerve disease (eg MS or optic neuritis)

49
Q

What pathways are involved in the corneal reflex?

A

Afferent Va (sensory), efferent VII (orbicularis oculi)

50
Q

What does hypotonia signify?

A

LMN lesions and cerebellar disease

51
Q

Hemisection of the spinal cord leads to…

A

Brown-sequard syndrome
Ipsilateral paralysis and loss of proprioception and vibration sense
Contralateral loss of pain and temp (as spinothalamic crosses at spinal level)

52
Q

What pathways are involved in coordination?

A

Inputs: spinocerebellar (ipsilateral inferior cerebellar peduncle ICP) and pontocerebellar fibres (contralateral cerebreal hemispheres)
Outputs: superior cerebellar peduncle (SCP) eg dento-rubro-thalamic)

53
Q

What does an extensor plantar reflex mean?

A

Abnormal
Babinski sign
UMN pathology
Spasticity, late wasting, exaggerated reflexes

54
Q

How can you tell a lesion is LMN?

A 
Hypotonic
Early wasting and weakness 
Fasciculations
Tendon reflexes may be lost if specific peripheral nerve affected
plantar: normal (flexor) or absent
55
Q

Effect of central cord lesion and mechanism of injury

A 
Motor loss (LMN at site, UMN below site)
Sensory loss of pain/temp, dorsal column preserved
56
Q

When is central cord syndrome seen?

A 
Hyperextension injury
Esp in elderly/stenotic canals
Bilateral motor and sesnroy deficits, arms worse than legs
Preserves proprioception
Poor prognosis
57
Q

Difference between spinal shock and neurogenic shock

A
  • Spinal shock (misleading), reflex activity sometimes stops following spinal injury for about 24 hours
  • Neurogenic shock: disruption of the sympathetic outflow and hence vascular tone. The whole arterial tree therefore dilates causing hypoperfusion. Treat with pressors like Noradrenaline
58
Q

What muscle responsible for depression of the adducted eye?

A

Superior oblique

59
Q

Which spinal cord tracts are involved in motor control?

A

Motor: Corticospinal tracts, lateral tracts cross at medulla, anterior tracts don’t cross. Ipsilateral descending.

60
Q

Which tracts are involved in joint proprioception and vibration?

A

Dorsal columns, crosses at medulla

61
Q

Which tracts are involved in pain and temp?

A

Spinothalamic, crosses at level of spinal cord

62
Q

UMN lesions cause:

A
  • Late wasting
  • No fasciculation
  • Spasticity
  • Extensors weaker in upper limbs, flexors weaker in lower limbs
  • Exaggerated deep tendon reflexes w/clonus
  • Absent superficial reflexes
  • Extensor plantar reflex (abnormal)
63
Q

Name 3 primary intracranial tumours

A

Astrocytic, oligodendroglial, meningothelial

64
Q

What are the most common cancers to cause brain mets?

A

Breast, bronchogenic, colorectal

65
Q

Which cancers commonly cause spinal mets?

A

Lung, breast, GI, prostate

66
Q

Features of right acoustic neuroma (vestibular schwannoma)

A

Ipsilateral hearing loss, if large could affect cerebellum, brainstem and cause hydrocephalus
Facial nerve palsy
Balance problems

67
Q

Which is the worst brain cancer?

A

Glioblastoma multiforme

2% survive beyond 3yrs

68
Q

Whats the best brain cancer?

A

Meningioma

69
Q

Name 6 cauda equina symptoms

A 
Bilateral leg pain/sensory disturbance
Perianal, perineal and saddle anaesthesia
Urinary/faecal incontinence
Lower back pain
Significant bilateral motor deficit
Sexual dysfunction
70
Q

Describe a C7 radiculopathy

A

Weakness in elbow, wrist and finger extensors. Diminished triceps reflex.

71
Q

Define the term spastic paraparesis and list four common causes

A

Progressive and generally severe lower extremity weakness and spasticity. Causes: Hereditary spastic paraparesis, spondylosis, atlanto-axial canal stenosis, AV malformation compressing cord.

72
Q

Which spinalcord tracts are particularly affected by vitamin B12 deficiency?
List five neurological features found in patients with vitamin B12 deficiency?

A

peripheral and optic nerves. Posterior and lateral columns of the spinal cord.
Weakness, ascending paraesthesia and sore tongue. Abnormal evoked potentials, decreased EMG motor nerve conduction velocities.

Year 4 (9 decks)

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