Neurology

Question 1

O/E Speech - 3D’s

Answer 1

Dysarthria - hard to form words
Dysphasia - slurred speech due to muscle weakness
Dysphonia - change in voice (hoarse -> total loss of voice)

Question 2

Features of carpal tunnel syndrome?

Answer 2

Pain at night (wakes pt), relieved by shaking 
Thenar wasting
Sensory loss over median distribution 
Tinel's sign - TAP 
Phalen - reverse prayer

Question 3

Causes of carpal tunnel syndrome?

Answer 3

Rheumatological: Arthritis, RA
Endo: Hypothyroidism, acromegaly, diabetes
Other: pregnancy, trauma/lacerations

Question 4

Mx carpal tunnel syndrome

Answer 4

Splint hand in extension at NIGHT - to prevent flexion which is painful
Nerve conduction studies?
Operate if conservative measures don’t work

Question 5

Features of cerebellar lesion

Answer 5

Dysdiadochokinesia
Ataxia
Nystagmus
Intention tremor
Scanning speech 
Hypotonia

Question 6

Causes of peripheral neuropathies

Answer 6

Can be sensory,motor,autonomic

Mainly sensory: alcohol, DM, hypothyroid, B12 def., HIV, drugs

Mainly motor: CIDP/GBS, HMSN, lead poisoning, porphyria

Question 7

What is pes cavus?

Answer 7

High foot arch that doesn’t flatten on wt bearing

Question 8

Causes unilateral and bilateral pes cavus

Answer 8

Unilateral - polio, compartment syndrome, spinal trauma/tumour

Bilateral - Friedrich’s, spianl cord tumour, syringomyelia

Question 9

64 y/o man expressive aphasia, rt-sided weakness. O/E increased tone on right hand side. Likely diagnosis?

DDx?

Answer 9

UMN, stroke, LEFT middle cerebral artery occlusion

DDx = SOL (brain tumour, haemorrhage - but often these are slow, progressive symptoms )

Question 10

MRI

T1 vs T2?

Answer 10

T1 = CSF is DARK
tissue w/ high water content = white, low-water content = dark

T2: CSF is BRIGHT
tissue high H2O = white, low H20 = dark

Question 11

Imaging modality in Multiple sclerosis?

Answer 11

MRI T2 image

CSF is BRIGHT + areas of demyelination appear BRIGHT