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FRACP CLINICAL SS > Neurology > Flashcards

Neurology Flashcards

1
Q

Cranial nerve exam

A

General inspection - look and feel for scars/shunts

Close eyes, tell me what you smell?

Acuity

Fields

Movements

Sacades

Pupils

Fundoscopy

Face sensation

Masseter

Forehead, eyes, smile

Corneal reflex

Stick tongue out, test power, Examine tongue - fasciculations

Say AH

Gag reflex

Shrug shoulders, turn your head against my hand

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2
Q

Ptosis

A

General Inspection

One eye closed, other normal - MG or CN III palsy

Ptosis + large pupil + down and out - CNIII

Ptosis + small pupil - Horners

Bilateral - myopathy or MG

Proptosis and ptosis in one eye - orbital tumour or vascular anomaly

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3
Q

Differentials for complex opthalmoplegia

A

Multiple nerve lesions:

MS / demyelination

Mononeuritis multiplex

Cavenous sinus syndrome

Muscles:

Throid eye disease

NM Junction: MG

Miller fisher, Kearns-Sayer, botulism

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4
Q

Causes of anosmia

A

Upper respiratory tract infection

Meningioma of olfactory groove

Ethmoid tumours

Head trauma - cribiform plate fracture

Meningitis

Hydrocephalus

Congenital - Kallmann’s syndrome (hypogonadatrophic hypogonadism)

Dementia

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5
Q

Causes of absent light reflex but intact accomodation

and

intact light with loss of convergence

A
  1. Midbrain lesions
  2. Ciliary ganglion lesion (Adies)
  3. Parinaud Syndrome
  4. Bilateral anterior visual pathway lesions (bilat RAPDs)

and

  1. Cortical blindness
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6
Q

Causes of pupillary constriction

A
  1. Horners
  2. Argyll Robertson
  3. Pontine lesion
  4. Narcotics, pilocarpine drops
  5. Old age
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7
Q

Causes of pupillary dilatation

A

Mydriatics, atropine, cocaine

CNIII lesion

Adie’s pupil

Iridectomy, lens implant, iritis

Post trauma, deep coma, cerebral death

Congenital

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8
Q

Adie’s syndrome

A

Dilated pupil

Loss of direct and consentual light reflex

Slow accomodation

Decreased tendon reflexes

lesion in the efferent parasympathetic pathway

young women

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9
Q

Argyll Robertson Pupil

A

Signs:

small irregular, unequal pupil

no reaction to light

prompt reaction to accomodation

+/- decreased reflexes with Tabes

Cause:

Syphilis

Diabetes

Alchoholic or other midbrain degenerartion/lesion

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10
Q

Papilloedema vs papililitis

A

Papiloedema

usually bilateral

Swollen optic disc no venous pulsation

Normal acuity and colour vision

Large blind spot & concentric constriction of peripheral fields

Papillitis

sudden onset unilaterl

swollen optic disc

poor acuity with red desaturation

large central scottoma

pain on eyemovement

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11
Q

Causes of papillloedema

A
  1. Space occupying lesion
  2. Hydrocephalous
  3. IIH
  4. HTN grade IV
  5. Central retinal vein thrombus, or venous sinus thrombus
  6. Elevated CSF protein (ie GBS)
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12
Q

Causes of optic atrophy

A
  1. Chronic papilloedema
  2. Optic nerve compressions/divission
  3. Glaucoma
  4. Ischaemia
  5. Familial - retinitis pigmentosa, Leber’s, Frederich’s ataxia
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13
Q

Causes of optic neuropathy

A
  1. MS
  2. Toxic - EtoH, ethambutol
  3. Metabolic - vit B12 deficiency
  4. Ischaemia - DM, temporal arteritis, atheroma
  5. Familial - Leber’s disease
  6. Infective - EBV
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14
Q

Causes of cateract

A

Age

Endocrine - DM, steroids

Hereditary / congenital - dystophia myotonica

Occular disease - glaucoma

Irradiation

Trauma

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15
Q

Causes of ptosis (normal pupils)

A

Senile

Myotonic dystrophy

Fascioscapulohumeral dystrophy

Occular myopathy ie mitochondrial

Thyrotoxic myopathy

Myesthenia gravis

Botulism, snake bite

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16
Q

Ptosis + contricted pupil

Ptosis + dilated pupil

A

Horner’s

Tabes dorsalis

CNIII lesion

17
Q

Clinical features of a third nerve palsy

A

Ptosis

Divergent strabismus (down and out)

Dilated pupil, unreactive to direct or consentual light with no accomodation reflex

rule out 4th nerve lesion by tilting head to the side of the lesion and looking for intorsion if intact

18
Q

Causes of CNIII lesion

A

Compressive lesion - PCOM

infarction - DM, arteritis (pupil spared)

tumour causing raised ICP (pupil early)

demyelination

naropharyngeal carcinoma

cavernous sinus lesions

19
Q

Clinical features of a CNVI palsy

A

Failure of abduction

Diplopia - maximal on looking to the affected side

examine fundus for papillodema

20
Q

Causes of CNVI palsy

A

Raised ICP

tumour

trauma

vascular lesions

diabetes/other vascular

mononeuritis multiplex

inflammatory - MS

infective - subacute meningitis

Wernicke’s

21
Q

Which muscle does CNIV supply?

A

Superior oblique - intorts the eye

22
Q

Which muscle does CNVI supply?

A

lateral rectus - abducts

23
Q

Causes of Horner’s syndrome

A

Orbital/retrorbital

Lateral medullary infarct - PICA

Neck - carotid dissection, malignancy

Apical tumour

24
Q

Speech exam

A

Hello my name is Sophie, thank you for agreeing to be examined today.

What’s your full name? Are you left or right handed?

Is English your first language? Do you normally wear glasses to read?

Cookie Jar

Repeat: “No ifs and or butts”

Read command

Name objects - watch, pen

Write a sentence

Verbal command 3 step

Puh Puh Puh

Tah Tah Tah

Kah Kah Kuh

Cough

Either:v isual fields/neglect, look for a hemiparesis, acalculia, fingeragnosia.

->AF, bruits, BP, diabetic

or

Lower cranial nerves

Cerebellar exam

Parkinson’s

Urinalysis - gylcosuria or haematuria

25
Q

Thyroid exam

A

General inspection - thyrotoxic, BMI appears high or low, temperature regulation, skin and hair, cushingoid

SCARS - thyroid and thymectomy

Hands - skin, clamminess, acropatchy

Tremmor with paper

Pulse - AF? rate?

Blood pressure

Proximal strength

Eyes: exopthalmus, proptosis, lid retraction, lid lag

Eye movements - complex opthalmoplegia

Pupils, Fields

Neck - inspect from the front, SCARS, stick tongue out and swallow

Palpate from the back, swallow, lymphnodes

Chest - SCARS - Auscultate, Percuss & Pembertons

Proximal strength, shoulders & hips

Reflexes - delayed relaxation triceps and knees

Peripheral sensation

Pretibial myxoedema

26
Q

Parkinsons exam

A

General inspection:

mask like facies - hypomimia

stooped partly flexed ‘simian’ posture

gait: narrow based, short shuffling gait, reduced arm swing, turn en block, festination, freezing

propulsion and retropulsion

reduced blink rate & blepharoclonus - on gently closed eyes

sialorrhoea

hypophonia

tremulous speech

clasic resting pill rolling tremor - asymetrical, 4-6 hertz, brought out by walking or emotions

cogwheeling and lead pipe rigidity

bradykinesia and diminuity of amplitude of hands/foot taps

if any dystonia, stick tongue out and hold it out

parkingsons plus:

gaze palsies

blood pressure sitting and standing

mini mental

micrographia

seborrhea

27
Q

What are the causes of parkinsonism

A

Idiopathic Parkinson’s disease

Drugs:

chlorpromazine

metoclopramide

prochlorperazine

sodium valporate

methyldopa

tumours of the basal ganglia

lewy body dementia

chronic head injuruy / repetative trauma / anoxic brain injury

normal pressure hydrocephalus

Wilson’s disease

28
Q

Proximal Weakness

A

CMIND

Congenital - mitochondrial

Metabolic - cushings, hypothyroidism

Inflammatory - dermato/polymyositis

Neuromuscular - MG, LAMS

Dystrophies - beckers, FSHD, limb girdle

29
Q
A
30
Q

DDx Proximal limb girdle weakness

A

Most common pattern…

Autoimmune / inflammatory

Toxins

LGmyopathy

POMPE

Myotonic dystrophy

31
Q

Proximal arm / distal leg

A

Look for winging of the scapular!

Fascioscapulohumeral Musculr dystrophy

Consider POME, congeniotal myopathy

32
Q

Distal arm / proximal leg

A

Inclusion body myositis

DDx myotonic dystrophy

33
Q

muscular weakness patterns - Ptosis +/- opthalmoplegia

A

Mitochondrial - CPEO chronic progressive external opthalmoplegia

Oculopharangeal muscular dystrophy

DDx myesthenia

34
Q

Prominent neck wekness

A

head drop pattern:

Myositis (Sjogren’s, IBM)

FSHD

MG

Metabolic - hypothyroid, CPT

Neurogenic - CIDP, ALS

35
Q
A

FRACP CLINICAL SS (6 decks)

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