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FRACP > Neurology > Flashcards

Neurology Flashcards

1
Q

Foster Kennedy-Syndrome

A

Tumour of the frontal lobe - optic nerve compression - personality change

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2
Q

Gerstmann Syndrome

A

Dominant, angular gyrus Acalculia, agraphia, L-R disorientation, fingeragnosia (AALF)

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3
Q

Frontal Lobe

A

MOTOR personality primitive reflexes expressive dysphasia (dominant) anosmia optic nerve compression gait apraxia *Foster-Kennedy syndrome

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4
Q

Parietal lobe

A

SENSORY Sensory, visual spatial inattention Construction, dressing apraxia Lower quadrantanopia *Gerstamann’s syndrome

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5
Q

Temporal lobe

A

AUDITORY Receptive dysphasia upper quadrantanopia memory loss *Alzheimers

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6
Q

Occipital lobe

A

HOMONOMOUS HEMIANOPIA Alexia (without agraphia) *Anton’s syndrome

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7
Q

Anton’s Syndrome

A

bilateral occipital lobe infarcts from occlusion of the basilar arterial occlusion - Cortical blindness with confabulation

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8
Q

non-fluent, expressive, Broca’s aphasia

A

Dominant frontal lobe able to comprehend, paucity of words, know that they want to say Frustrated Transcortical motor*

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9
Q

fluent, receptive, Wernickes

A

Dominant temporal lobe incomprehensible fluent speech not frustrated Transcortical sensory*

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10
Q

Able to repeat a phrase but not to create a phrase..

A

Conduction aphasia arcuate fasiculus

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11
Q

Horner’s syndrome

A

Ptosis myosis (constriction) anhydrosis

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12
Q

Brainstem rules of 4

A
  1. 4 CNs in each location: I-IV above the pons; V-IIIX Pons, IX-XII Medulla 2. 4 Medial structures begin with M 3. 4 Side structures that begin with S 4. 4 medial motor nuclei dive into 12: 3, 4, 6, 12
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13
Q

4 medial brain stem structures

A
  1. Motor pathway 2. Medial lemniscus 3. Medial longitudinal fasicularis (MLF) 4. Motor nucleus
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14
Q

4 side brainstem structures

A
  1. Spinocerebellar tract 2. Spinothalamic tract 3. Sensory nucleus of CNV 4. Sympathetic tract
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15
Q

CNI

A

Olfactory

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16
Q

CNII

A

Optic Afferent pupil

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17
Q

CNIII

A

Occular motor Efferent pupil Levator palperbrae Superior, inferior, medial rectus Inferior oblique *Medial midbrain

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18
Q

CNIV

A

Trochlear Superior oblique (depression and intorsion) *Medial midbrain

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19
Q

CNV

A

Trigeminal - face sensation - muscles of mastication *Lateral Pons

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20
Q

CNVI

A

Abducens Lateral rectus *

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21
Q

CNVII

A

Facial - muscles of facial expression - stapedius - sensation of anterior 2/3 of tongue

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22
Q

CNVIII

A

Vestibulocochlear hearing and balance

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23
Q

CNIX

A

Glossopharyngeal middle ear, 1/3 tongue some swallowing

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24
Q

CNX

A

Vagus - Sensation of pharynx, larynx, oesophagus, thoracic, abdominal viscera - Motor of soft palate, pharynx, larynx

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25
Q

CNXI

A

Accessory SCM and traps

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26
Q

CNXII

A

Hypoglossal Tongue movement

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27
Q

Arm & leg weakness on R Loss of vibration on R Tongue weakness and atrophy on L ? lesion

A

Anterior Medial Medulla Supplied by the vertebral artery Dejerine Syndome - Ipsilateral hypoglossal palsy - Contralateral hemiparesis - Contralateral lemniscal loss

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28
Q

Ipsilateral CN lesion + Contralateral hemiparesis what level is the lesion?

A

Brainstem

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29
Q

Ipsilateral occulomotor nerve + contralateral hemiparesis where is the lesion?

A

Midbrain Weber’s syndrome Vessel: PCA

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30
Q

Ipsilateral UMN signs + loss of vibration proprioception Contralateral pain and temp loss

A

Brown-Sequard Syndrome

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31
Q

Foot drop + inversion weakness

A

L5 L5 radiculopathy: Weakness in toe >foot + inverter weakness Loss sensation to medial foot + lateral leg (dermatome) Reflexes intact

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32
Q

Foot drop + eversion weakness

A

Common pEronEal nerve Reflexes and sensation intact

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33
Q

Foot drop + loss of anke jerk

A

Sciatic nerve + loss of sensation to lateral leg, dorsum and sole of foot

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34
Q

Wallenberg’s syndrome + Lateral Medullary

A

Ipsilateral loss of pain and temp face Contralateral los of pain and temp body Ipsilateral cerebellar signs Occasionally hiccups

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35
Q

Sodium valortate and which antibiotic?

A

carbopenums - avoid!! induces +++

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36
Q

Balint Syndrome

A

Bilateral Parietal-Occipital lobe lesions (PCA) Bilateral loss of voluntary but not reflex eye movements

37
Q

Most common side effect of levadopa

A

nausea and vomiting

38
Q

Amantadine

A

enhances dopamine release

39
Q

Symptomatic partial epilepsy

A

Focal onset seizures Normal intellect Lesions of the cortex Rx Carbamazepine +/- neurosurgery TLE 2’ to hippocampal sclerosis Autosomal dominant frontal lobe epilepsy

40
Q

Idiopathic generalised epilepsy

A

Generalised seizures Normal intellect Inherited ion channelopathies Juvenile onset myoclonic epilepsy Na Valproate ist line

41
Q

Symptomatic secondary generalised epilepsy

A

Frequent severe generalised seizures ? mechanism +/- lesion Intellectual disability Lennox-Gastaut syndrome

42
Q

Riluzole

A

sodium channel blocker that inhibits glutamine release disease modifying drug for MND - slows progression

43
Q

Femoral nerve

A

L2,3,4 Quads Inner thigh sensation Knee Jerk

44
Q

Anti-yo

A

cerebellar syndrome breast and ovarian

45
Q

Foot drop L5

A

weakness to eversion and inversion normal NCS neurogenic EMG

46
Q

Foot drop common peronneal nerve compression

A

+ weakness to eversion EMG changes confined to below the knee squatting/surgery fibular neck

47
Q

Foot drop from sciatic nerve compression

A

EMG abnormal above the knee Post surgery / dislocation

48
Q

Lumbar canal stenosis

A

leg and buttock pain worse up hill need to stop and sit down

49
Q

Median nerve

A

sensory latency changes 1st motor changes 2nd axonal loss (reduced amplitude)

50
Q

Ulnar compression

A

elbow deep branch in the palm

51
Q

Radial nerve compression

A

Wrist drop with preserved flexion! ddx radiculopathy => loss of flexion

52
Q

Brachial neuritis (plexopathy)

A

unilat shoulder pain then weakness carrying heavy backpack patchy changes on EMG/NCS winging of scapular (long thoracic nerve)

53
Q

Progressive motor weakness - sensory involvement excludes..

A

MND MG MMN

54
Q

Split hand

A

Wasting of FDIO + thenar eminance preserved hypothenar => cortical wasting => MND

55
Q

Loss of reflexes =

A

neuropathy *Except MMN preserved

56
Q

Involvement of individual peripheral nerves?

A

MMN (motor only) mononeuritis multiplex (pain)

57
Q

Neck flexion / extension weakness

A

Predominantly muscular conditions MG/MND/myopathies

58
Q

Bulbar / respirator involvement?

A

MG MND

59
Q

Proximal predominant weakness?

A

Myopathy *CIDP

60
Q

decr reflexes & weakness > wasting motor > sensory

A

likely demyelinating ie CIDP

61
Q

NCS: decreased amplitude absent sural sensory potential

A

axonal loss

62
Q

NCS: decreased velocity dispersion

A

demelination

63
Q

NCS: peripheral demyelination

A

absent or prolonges F waves

64
Q

NCS: > 50% drop in amplitude

A

= focal block compression vs demyelination

65
Q

EMG: absence of activity

A

normal

66
Q

EMG: Neurogenic

A

Spont: fibrilations & sharp waves, fassiculations

Morph: Large amplitude, increased duration, polyphasic

Recruitment: Decreased, with gaps between the motor units

67
Q

EMG: myopathic

A

Spont: fibillaltions and positive sharp waves

Morph: small amplitude

Recruitment: increased/early recruitment (short thick waves)

68
Q

EMG: dive bomber sound

A

myotonia = myopathic EMG

69
Q

EMG Fassiculations

A

Typically occur in neurogenic conditions in which the axons are sick or dying

  • MND
  • CIDP

-Chronic nerve entrapments

70
Q

Would you see upper or lower MN signs in primary lateral sclerosis?

A

UMN

71
Q

Would you see upper or lower MN signs in primary muscular atrophy?

A

LMN

72
Q

What is anti-MOG disease?

A

Anti-Myelin oligodendracyte glycoprotien MS or ADEM Can cause NMO Rx steroids/plasmapheresis

73
Q

What is anti-AQP4?

A

NMO Optic nerve and spinal cord Rx steroids/plasmapheresis

74
Q

Leber’s hereditary optic neuropathy

A

Hereditary visual loss Mitochondrial inheritance

75
Q

Biceps reflex

A

C5

76
Q

Brachioradialis reflex

A

C6

77
Q

Triceps reflex

A

C7

78
Q

Patellar

A

L4

79
Q

Achillies

A

S1

80
Q

C5 radiculopathy

A

Muscle weakness: shoulder abduction, external rotation, elbow flexion and forearm supination Sensory loss: Lateral arm (axilla) Reflexes: C5, C6 Pain: neck, shoulder, scapular

81
Q

C6 radiculopathy

A

Muscle weakness: shoulder abduction, external rotation, elbow flexion, forearm supination and PRONATION Sensory loss: lateral forearm, thumb and index finger Reflexes: Biceps C5, BR C6 Pain: neck, shoulder, scapula, LATERAL ARM AND HAND

82
Q

C7 radiculopathy

A

Muscle weakness: elbow and wrist extension (radial), forearm pronation and wrist flexion. Sensory loss: index and middle finger palm Reflexes: Triceps C7 Pain: neck, shoulder, MIDDLE FINGER, hand

83
Q

C8 radiculopathy

A

Muscle weakness: finger extension, wrist extension (ulnar), distal finger flexion, extension, abduction and adduction, distal thumb flexion. Sensory loss: Medial forearm, medial hand, 4th and 5th digits Reflexes INTACT Pain: neck, shoulder, MEDIAL forearm and hand, 4th and 5th DIGITS

84
Q

T1 radiculopathy

A

Muscle weakness: thumb abduction, distal thumb flexion, finger abduction and adduction. Sensory loss: Anterior and medial forearm Reflexes INTACT Pain: Neck, medial arm and forearm

85
Q

Highest risk factor for stroke?

A

Age risk doubles each successive decade after 55

86
Q

Highest modifiable risk factor for stroke?

A

HTN Rx 33-44% risk reduction

87
Q

Charcot Mary Tooth

A

Hereditary sensory motor neuropathy Distal weakness > sensory - Peripheral neuropathy (glove and stocking) Pes cavus foot deformity HSMN 1 - hypertrophic myelin, onion bulbs (slow NCV) with secondary axonal degeneration HSMN2 - neuronal type degeneration (normal NCV)

88
Q
A

FRACP (12 decks)

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