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RACP Clinical Exam > Neurology > Flashcards

Neurology Flashcards

1
Q

What are the causes of pes cavus?

A 
Charcot Marie Tooth Disease 
Fredrick’s Ataxia
Spina Bifida
Muscular dystrophies 
Cerebral palsy 
Spinal muscular atrophy 
Spinal cord tumours
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2
Q

What level is the biceps and brachioradialis reflex?

A

C5/6

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3
Q

What level is the triceps reflex?

A

C7/8

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4
Q

Weakness in big toe extension suggests what?

A

L5 nerve lesion

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5
Q

What are the features of Brown Sequard Syndrome?

A

Ipsilateral spastic paralysis
Ipsilateral loss of vibration and proprioception
Contralateral loss of pinprick sensation

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6
Q

What are the causes of a small stepped gait?

A 
Parkinson’s disease
Vascular Parkinson’s disease 
Normal pressure hydrocephalus 
Multi lacunar state 
(Later three have wide base)
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7
Q

Striata hand deformity description?

A

Flexion of MCP
Extension of PIP
Flexion of DIP

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8
Q

What are the three types of horners syndrome?

A

First order - sympathetic tract
Second order - preganglionic
Third order - internal carotid artery

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9
Q

What are the cardinal signs of horners syndrome?

A

Ptosis
Miosis
Anhidrosis

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10
Q

What is the path of sympathetic fibres to the eye?

A

First order - Hypothalamus to first synapse C8 to T2
Second order - sympathetic trunk through brachial plexus ascending to superior cervical ganglion
Third order - ascends within adventitia of ICA and joins V1

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11
Q

Causes of first order neuron horners syndrome?

A 
Lateral medullary syndrome 
Strokes affecting sympathetic outflow
Tumours 
Demyelination disease 
Syringomyelia 
Cervical cord trauma
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12
Q

Causes of second order neuron horners syndrome?

A

Trauma or surgery of

  1. Spinal cord
  2. Thoracic outlet
  3. Lung apex
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13
Q

Causes of third order neuron horners syndrome?

A

ICA dissection
ICA thrombosis
cavernous sinus aneurysm

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14
Q

What are the causes of Parkinsonism?

A 
Idiopathic Parkinson’s disease 
Parkinson’s plus syndromes
Medications - metoclopramide 
Toxins - manganese
Basal ganglia tumours 
Levy body dementia 
Dementia pugilistica 
Normal pressure hydrocephalus
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15
Q

What are Lewy bodies and what are they found in?

A

Spherical eosinophilia a-synuclein inclusions.

Can be present in

  • Parkinson’s disease
  • Lewy Body Dementia
  • Alzheimer’s Disease
  • Hallervorden Spatz Disease
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16
Q

What is hallervorden spatz Disease?

A

Autosomal recessive disorder characterised by dementia, Parkinsonism and retinitis pigmentosa.

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17
Q

What re the features suggestive of Parkinson plus syndromes?

A 
Symmetrical onset 
Vertical gaze palsy 
Early falls 
Early autonomic failure 
Early onset dementia 
Early onset hallucinations 
Cerebellar signs
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18
Q

What are the features of essential tremor that distinguish it from Parkinson’s?

A 
Symmetrical tremor 
Worse with movement 
Not associated with bradykinesia 
Involves the head 
Writing gets larger not smaller
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19
Q

What are the features and types of MSA?

A

Parkinsonism with early autonomic failure, cerebellar and pyramidal signs.

MSA-P - Parkinson’s predominant
MSA-C - cerebellar
Shy Drager - autonomic failure

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20
Q

What are the features of progressive supranuclear palsy

A 
Symmetrical Parkinson’s
Axial rigidity 
Prominent falls 
Speech and swallowing difficulties 
Frontal symptoms 
Vertical gaze palsies
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21
Q

What are the features of corticobasal degeneration.

A 
Limb apraxia 
Cortical sensory loss 
Alien limb phenomenon 
Myoclonus 
Dementia
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22
Q

What are the findings of a bulbar palsy?

A

Lower motor neuron disorder of cranial nerves 9-12.

Flaccid dysarthria
Reduced gag reflex
Fasciculations of the tongue
Reduced jaw jerk

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23
Q

What are the causes of a bulbar palsy?

A 
Motor neurone disease
Syringobulbia 
Poliomyelitis
Myasthenia Gravis 
Guillain Barre Syndrome
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24
Q

What are the features of a pseudobulbar palsy?

A

UMN lesion of cranial nerves 5,7,9,10,11,12.

Features include: 
Spastic dysarthria 
Exaggerated gag reflex
Shrunken and stiff tongue
Exaggerated jaw jerk 
Emotional lability 
Expressionless face
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25
Q

What are the causes of pseudobulbar palsy?

A

Motor neuron disease
Bihemispheric vascular disease
Brainstem tumour
Multiple sclerosis

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26
Q

What are the causes of myasthenic bulbar palsy?

A

Botulism

Myasthenia gravis

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27
Q

What causes myopathic bulbar palsy?

A

Muscular dystrophy

Polymyositis

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28
Q

What is the most common phenotype of musk positive myasthenia gravis?

A 
Female 
Ocular Disease 
Respiratory muscle weakness
Bulbar myasthenia 
Neck weakness
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29
Q

What medications can worsen myasthenia?

A 
Penicillamine 
Aminoglycosides 
Fluoroquinolones 
Macrolides 
B-blockers 
Quinidine 
Lithium
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30
Q

In myasthenia, what other features would you examine for?

A
  1. Immunosuppression (steroids)
  2. Thymectomy scar
  3. Autoimmune disease
    - T1DM (skin pricks, neuropathy)
    - hyperthyroidism (tachycardia, tremor, graves)
    - rheumatoid or SLE
    - hypothyroidism (slow ankle jerk, bradycardia)
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31
Q

What are differentials for myasthenia gravis?

A 
Botulism 
Lambert Eaton Myasthenic Syndrome 
Mitochondrial myopathy 
Miller Fisher Syndrome 
Snake bite (cobra)
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32
Q

What are the features of Lambert Eaton Myasthenic SYndrome?

A

Antibodies against voltage gated calcium channels most commonly associated with SCLC.

Proximal muscle weakness with post exercise facilitation.
Reduced tendon reflexes
Incremental improvement with RNS

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33
Q

What are the indications for thymectomy in a patient with myasthenia?

A
  1. Thymoma

2. Generalised myasthenia and <60 years of age

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34
Q

What are the different types of CMT disease?

A

CMT 1 - demyelination PNS disease

CMT2 - axonal PNS Disease

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35
Q

What are the features clinically of CMT1?

A

Peripheral motor and sensory neuropathy

Classical presenting with sprained ankles, reduced reflexes, Pes cavus and reduced vibration and proprioception.

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36
Q

What are the features clinically of CMT2?

A

The classic features of CMT2 include distal weakness, atrophy, sensory loss, decreased deep tendon reflexes and variable foot deformity.

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37
Q

What is the most common genetic defect in Charcot Marie tooth?

A

Peripheral myelin protein 22 on chromosome 17

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38
Q

What is hereditary neuropathy with liability to pressure palsy?

A

Autosomal dominant disorder related to PMP22 deletion resulting in isolated nerve palsies in areas liable to compression.

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39
Q

What are the causes of a positive rombergs test?

A 
Inherited 
- Fredricks ataxia
- ataxic neuropathies 
Metabolic and Toxic
- B 12 deficiency 
- vitamin E deficiency 
- medication related (cisplatins, vincristine) 
- pyridoxine excess 
Immunologic 
- Gillian barre 
- CIDP
Infective 
- Tabes dorsalis
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40
Q

What are the causes of unilateral pes cavus?

A 
Malunion of calaneal fracture 
Burns 
Poliomyelitis 
Spinal trauma
Spinal cord tumours 
Compartment syndrome 
Stroke
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41
Q

What are the causes of bilateral pes cavus?

A 
Friedrichs ataxia 
Muscular dystrophy 
Spinal muscular atrophy 
Cerebral palsy 
Syringomyelia
Hereditary Spastic Paraparesis
Spinal cord tumours 
Charcot Marie tooth
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42
Q

What are the differential diagnosis for MND?

A 
Syringomyelia 
Cervical Myelopathy 
Multifocal motor neuropathy
Inflammatory myopathies 
Hyperthyroidism
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43
Q

What are the differentials for MND presenting with only UMN signs?

A

HIV related myelopathy
Spinal Cord Tumour
Syringomyelia
Cervical myelopathy

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44
Q

What are the differentials for MND presenting with only LMN signs?

A

Multifocal motor neuropathy
Chronic Inflammatory Demyelinating Polyneuropathy
Spinal Muscular Atrophy
Occulopharyngeal muscular dystrophy

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45
Q

What are the trinucleotide repeat disorders?

A 
Myotonic Dystrophy
Fragile X syndrome 
Huntington’s Chorea 
Friedrichs Ataxia
Spinocerebellar ataxia
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46
Q

What are the cardiovascular complications of myotonic dystrophy?

A 
Ecg Changes 
Arrhythmias 
Conduction defects 
Mitral valve prolapse 
Cardiomyopathy
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47
Q

What are the endocrine complications of myotonic dystrophy?

A

Diabetes Mellitus
Hypogonadism
Nodular Thyroid Enlargement

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48
Q

What are the gastroenterological complications of myotonic dystrophy?

A 
Dysphagia 
Reflux 
Delayed gastric emptying 
malabsorption 
Megacolon 
Bacterial Overgrowth
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49
Q

What are the respiratory complications of myotonic dystrophy?

A

Weakness of respiratory muscles
Respiratory failure following anaesthesia
Pneumonia

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50
Q

What are the differentials for distal muscle wasting and weakness?

A 
Myotonic dystrophy
Hereditary motor sensory neuropathy
Inclusion body myositis 
Distal spinal muscle atrophy 
Finish distal myopathy 
Markesbury distal myopathy 
Welander distal myopathy
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51
Q

What are the causes of a sensorimotor polyneuropathy?

A

endo - diabetes, hypothyroid
Toxins - Alcohol, Uraemia
Autoimmune - GBS
Inflammatory - mononeuritis multiplex, vasculitis, paraneoplastic
Infiltrative - sarcoidosis
Hereditary - HMSN, CMT
Medications (vincristine, cisplatin, amiodarone)

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52
Q

What are the causes for a motor neuropathy?

A 
Porphyria 
Lead poisoning 
Diphtheria 
CIDP
AIDP
Medications (dapsone)
53
Q

What are the common causes of sensory neuropathies?

A 
Alcohol 
Diabetes 
Hypothyroidism 
Uraemia 
Sarcoidosis 
Vasculitis 
Paraneoplastic 
Amyloidosis 
B12 deficiency 
Medications (isoniazid, colchicine, metronidazole)
54
Q

What are the causes of autonomic neuropathy?

A 
GBS
Botulism 
Porphyria
Paraneoplastic 
Diabetes 
Chagas’ disease
HIV 
Amyloidosis
55
Q

What are the causes of a small fibre neuropathy?

A 
Diabetes 
Alcohol 
Amyloidosis 
Leprosy 
Heavy metals (gold, arsenic)
Hypothyroidism 
Sjogrens Syndrome 
Primary biliary cirrhosis 
HIV
Medications (cisplatin, disulfuram, metro)
56
Q

What are the causes of demyelinating polyneuropathies?

A 
CIDP
Myeloma
MGUS
HSMN
HNPP
POEMS syndrome 
Multifocal motor neuropathy 
HIV
57
Q

What are the three mechanisms of peripheral neuropathy.

A

Wallerian Degeneration
Axonal degeneration
Segmental demyelination

58
Q

What are the causes of mononeuritis multiplex?

A 
Diabetes 
Polyarteritis Nodosa
Churg Strauss Syndrome 
Wegeners granulomatosis 
Rheumatoid 
SLE
Sjögren’s syndrome 
Sarcoidosis 
Lymphoma 
Amyloidosis 
Lyme disease
Leprosy
59
Q

What are the emg findings of myopathies?

A

Small amplitude
Polyphasic
Rapid recruitment

60
Q

What are the features on emg of neuropathy?

A 
Large amplitude
Reduced recruitment
Late recruitment 
Fibrillations
Positive sharp waves
61
Q

What side is the pathology in an INO relative to the eye that cannot Adduct?

A

Ipsilateral

62
Q

What are argyll Robertson pupils?

And what are the causes?

A

Pupils that accomodate but do not construct.

Neurosyphilis 
Diabetes
Midbrain lesion (Tumour, infarct, demyelination)
Lyme disease
Wernickes 
Brainstem encephalitis
63
Q

Causes of Lhermitte’s sign

A

Multiple sclerosis
Cervical myelopathy
Cervical Cord Tumour
Subacute Combined Degeneration of the Cord

64
Q

What is Uhtoffs Phenomenon?

A

Heat induced worsening of MS symptoms. Though to be related to heat induced conduction block or partially demyelinated fibres

65
Q

Causes of internuclear opthalmoplegia.

A 
Multiple sclerosis 
Brainstem lesions 
Wernickes encephalopathy 
Miller Fischer Syndrome 
SLE
66
Q

What are the csf findings in MS?

A

Normal Glucose
lymphocytosis
Normal protein
Oligoclonal bands

67
Q

What are the causes of oligoclonal bands?

A 
Multiple sclerosis 
Neurosarcoidosis 
Neurosyphilis 
CNS lymphoma 
Neuromyelitis optica
Acute disseminating encephalomyelitis 
Progressive multifocal leucoencephalopathy 
Guillain Barre Syndrome
68
Q

What are the causes of spastic paraparesis with dorsal column signs?

A 
Multiple sclerosis 
Subacute combined degeneration of the Cord 
Tabes Dorsalis
Friedreichs Ataxia 
Cervical myelopathy
69
Q

What are the causes of transverse myelitis?

A 
Bacterial infections 
Viral infections 
Demyelination 
Radiation myelopathy 
Anterior spinal artery occlusion 
Vasculitis
70
Q

What is the treatment for spasticity?

A 
Non pharm 
- physio (stretching, strengthening)
- orthoses, braces 
- electrical stimulation
Pharm 
- Benzos, baclofen 
- clonidine, gabapentin 
- botulinum injections 
Surgical 
- contracture release 
- tendon transfer 
- osteotomy
71
Q

What are the causes of cervical myelopathy?

A

Cervical degenerative disc disease
Cervical Cord tumours
Ossification of posterior longitudinal ligament
Trauma

72
Q

Where is pathology commonly located in the setting of downbeat nystagmus?

A

Foramen magnum

73
Q

What are the causes of downbeating nystagmus?

A 
Arnold Chiari Malformation 
Tumours 
Syringobulbia 
Platybasia
Spinocerebellar degeneration 
Vertebrobasilar infarction 
Wernickes 
Alcohol related 
Lithium toxicity 
Vitamin b 12 deficiency
74
Q

Where is the pathology in upbeat nystagmus?

A

Anterior vermis of cerebellum

75
Q

What are the causes of upbeat nystagmus?

A 
Organophosphate poisoning
 Anticonvulsants 
Wernickes Encephalopthy 
Encephalitis 
Meningitis
76
Q

What are the structures of the cavernous sinus?

A

Nerves 3,4,5(a/b),6
Sympathetic carotid plexus
Intracavernous carotid artery

77
Q

What are the causes of cavernous sinus syndrome?

A 
Thrombosis 
Aneurysms 
Carotico-cavernous fistula 
Tumours 
Trauma 
Inflammation/infection.
78
Q

What are the features of a cavernous sinus lesion?

A 
Unilateral 3,4,6 nerve palsies 
Sensory loss in Va and Vb 
Loss of corneal reflex 
Painful ophthalmoplegia 
Proptosis 
Conjunctival congestion 
Visual loss 
Papilloedema 
Retinal haemorrhage
79
Q

What are the causes of upgaze palsy?

A 
PSP 
Miller Fischer 
Myasthenia gravis 
Graves ophthalmopathy 
Muscular dystrophy
80
Q

What are the causes of a bitemporal hemianopia?

A 
Pituitary tumour 
Craniopharyngioma
Suprasellar meningioma 
Glioma 
Granuloma 
Metastasis
81
Q

What are the causes of dissociated sensory loss?

A

Syringomyelia
Anterior spinal artery occlusion
Small fibre neuropathies

82
Q

What are the causes of unilateral ptosis?

A

3rd nerve palsy
Horners syndrome
Myasthenia gravis
Congenital

83
Q

What are the causes of bilateral ptosis?

A 
Myasthenia gravis 
Myotonic dystrophy 
Tabes dorsalis 
Bilateral horners syndrome 
Miller Fischer Syndrome 
Chronic progressive external ophthalmoplegia
84
Q

What are the causes of a abducens nerve palsy?

A 
Increased intracranial pressure
Space occupying lesion
Cavernous sinus pathology 
Trauma or surgery 
Basilar artery aneurysm 
Ischaemic or vasculopathic 
Demyelinating 
Idiopathic
85
Q

What are the causes of proximal muscle weakness?

A

Inherited myopathies - muscular dystrophy, congenital myopathies
Neurologic - spinal muscular atrophy, amyotrophic lateral sclerosis, BGS
Metabolic - hypokalaemia, nutritional deficiencies, glycogen storage disorders
Endocrine - thyroid disease, Cushings disease, calcium disturbance
Drug induced - statins, steroids, amiodarone, zidovudine
Myositis - autoimmune or viral
Rhabdomyolysis - traumatic

86
Q

What are the clinical features of multi focal motor neuropathy?

A

Subacute asymmetric weakness without sensory loss. Fasciculations and atrophy occurs late in the disease.

87
Q

What are the investigation results of multifocal motor neuropathy?

A

Ganglioside antibody positive
Normal CSF
Motor conduction block

88
Q

What is the treatment of multifocal motor neuropathy?

89
Q

What are the MRI features of corticobasal degeneration?

A

Asymmetric atrophy of posterior frontal and parietal lobes.

90
Q

What are the imaging findings in PSP?

A

Hummingbird sign

Mid brain atrophy

91
Q

What are the Imaging findings of MSA?

A

Hot cross bun sign

92
Q

What are the features of myotonic dystrophy?

A 
Myopathies facies 
Frontotemporal Baldness 
Ptosis 
Wasting of facial muscles
Difficulty opening eyes after closure
Distal upper limb wasting and weakness 
Grip myotonia 
Percussion myotonia 
Loss of reflexes
93
Q

What are the extra neurological manifestations of myotonic dystrophy?

A 
Diabetes 
Hypogonadism 
Goitre
Cardiomyopathy 
Valvular heart defect 
Arrhythmia
94
Q

Describe the lateral medullary syndrome.

A

Ipsilateral Horners
Vertigo and diplopia
Ipsilateral sensory facial loss
Contralateral loss of pain and temperature in upper and lower limb

95
Q

Describe the one and half syndrome.

A

Horizontal gaze palsy with impaired adduction on the same side.

96
Q

What causes the one and half syndrome?

A

Dorsal pontine lesion

  • vascular
  • space occupying
  • demyelination
97
Q

Causes of pupillary construction.

A 
Horners syndrome 
Argyll Robertson pupil 
Pontine lesion
Narcotics
Older age
98
Q

Causes of dilated pupil?

A 
Third nerve palsy 
Congenital 
Adies pupil 
Iridectomy 
Traumatic
99
Q

What are the findings in an Adies Syndrome?

A

Dilated pupil
Absent reflexes to light
Poor accomodation
Decreased tendon reflexes

100
Q

What causes Adies syndrome?

A

Lesion of efferent parasympathetic pathway.

101
Q

What are the causes of 6th nerve palsy?

A

Raised intracranial pressure
Mononeuritis multiplex
Traumatic
Wernickes Encephalopathy

102
Q

Describe the Parinaud Syndrome.

A

Vertical gaze impairment
Convergence nystagmus
Pseudo Argyll Robertson Pupils

103
Q

Causes of parinaud syndrome?

A

Central (dorsal midbrain lesion)

  • pineal gland Tumour
  • multiple sclerosis
  • vascular insult
  • traumatic
  • space occupying lesion
  • raised ICP
104
Q

Causes of trigeminal nerve palsy.

A 
Central 
- vascular 
- space occupying 
- demyelination 
Peripheral 
- aneurysm 
- space occupying lesion
- trauma 
- cavernous sinus pathology
105
Q

What are the causes of a cavernous sinus pathology?

A

Aneurysm
Thrombosis
Tumour

106
Q

Causes of 7th nerve palsy?

A 
UMN 
- vascular insult 
- space occupying 
- demyelination 
LMN 
- parotid Disease 
- traumatic/surgical 
- Bell’s palsy 
- Ramsay hunt syndrome 
- space occupying lesion (neuroma)
- pontine insult (same as for UMN)
107
Q

What is Ramsay Hunt Syndrome?

A

Peripheral facial nerve palsy with vesicular rash of the ear canal.

108
Q

What is the treatment of Ramsay Hunt Syndrome?

A

Oral corticosteroids
Oral aciclovir
Neuropathic pain medications

109
Q

Causes of optic neuropathy?

A 
Ischaemic Optic Neuropathy
- arteritic and non arteritic causes 
Optic Neuritis 
- demyelination 
- infections 
- inflammatory 
- genetic 
Neoplasm 
- optic glioma 
- meningioma 
Compression 
- thyroid eye disease 
- abscess
- artery aneurysm 
Metabolic 
- drugs and toxins 
- nutritional deficiency - vit B1, B12, folate 
Hereditary 
- lebers optic neuropathy
110
Q

What are the causes of an Argyll Robertson Pupil?

A 
Neurosyphilis 
Diabetes 
Midbrain lesion 
Wernickes encephalopathy 
Brainstem encephalitis
111
Q

What are the causes of bilateral ptosis?

A 
Myaesthenia Gravis 
Myotonic dystrophy 
Tabes dorsalis 
Bilateral horners 
Bilateral 3rd nerve palsy 
Myopathies (Chronic progressive external ophthalmoplegia)
Miller Fischer Syndrome
112
Q

What are the features of a cerebellar dysarthria?

A

Slurred and indistinct
Jerky and explosive
Slow and scanning

113
Q

What are the features of a pseudobulbar dysarthria

A

Harsh vocal quality
Rigid articulation muscles
Spastic dysarthria

114
Q

What are the features of a bulbar dysarthria?

A

Weak voice
Low volume with nasal quality
Slurring of consonants

115
Q

What are the features of an extrapyramidal dysarthria?

A

Slow and monotonous
Frequent pauses
Hypokinetic

116
Q

What are the causes of Brown Sequard?

A 
Demyelination 
Transverse myelitis 
Trauma 
Vascular insult 
Space occupying lesion (Tumour or infection)
117
Q

What are the features of a Wernickes aphasia and where is the lesion?

A

Fluent aphasia
Impaired comprehension and repetition
Paraphasias

Temporal lobe dominant lesion

118
Q

What are the features of a Brocas aphasia and where is the lesion?

A

Non fluent speech
Intact comprehension
Impaired repetition

Posterior dominant Frontal lobe

119
Q

What are the features of a global aphasia? Where is the lesion?

A

Non fluent aphasia
Impaired comprehension
Impaired repetition

Dominant MCA territory

120
Q

What are the features of a conduction aphasia? Where is the lesion?

A

Fluent aphasia
Intact comprehension
Impaired repetition

Dominant arcuate fasciculus

121
Q

What are the findings in a cerebellopontine angle lesion?

A

Cranial nerve 5,6,7,8 palsy

Unilateral cerebellar signs

122
Q

What are the causes of a cerebellopontine angle lesion?

A 
Acoustic neuroma 
Meningioma 
Medulloblastoma 
Metastasis 
Basilar artery aneurysm
123
Q

Causes of pes planus

A 
Charcots arthropathy 
Arthritis
Ligamentous laxity (marfans/ehlers danlos)
Trauma
Congenital
124
Q

Causes of pes cavus

A 
Charcot Marie tooth 
Fredriechs Ataxia 
Hereditary sensorimotor neuropathy
Poliomyelitis 
Cerebral palsy
Syringomyelia
125
Q

Bulbar palsy

What would you like to do to finish your exam?

A

Spirometry
Sip test
Lying and Standing MEPs

126
Q

What are the causes of oculomotor nerve palsy?

A 
Vascular 
Space occupying lesion 
Demyelination
Posterior com artery aneurysm
Cavernous sinus pathology
127
Q

What are the differentials for lower limb spasticity with hyperelfelxia?

A 
Hereditary spastic paraparesis 
MND 
Syphilis
HIV
Spinocerrebellar ataxia 
Multiple Sclerosis
128
Q

What is the mechanism of small fibre neuropathy?

A

Damage to small myelinated (A delta) and small in myelinated C fibres.

129
Q

What are the causes of small fibre neuropathy?

A 
Endocrine - diabetes
Autoimmune - SLE, Sjogrens, coeliac Disease 
Inflammatory - amyloidosis, sarcoidosis 
Metabolic - Fabrys, B12 deficiency
Infectious - HIV 
Toxic - chemotherapies, ETOH

RACP Clinical Exam (13 decks)

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