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Short case clinical skills > Neurology > Flashcards

Neurology Flashcards

1
Q

Differentials for anosmia

A 
URTI
smoking
Increasing age
Parkinson's disease
Ethmoidal tumours
Basal skull fracture
Meningioma of olfactory groove
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2
Q

Differentials for rapid onset bilateral blindness

A

Bilateral occipital lobe infarction or trauma

Bilateral optic nerve damage - methyl alcohol poisoning

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3
Q

Differentials for unilateral rapid onset blindness

A 
Retinal artery or venous occlusion of optic vessels
Temporal arteritis
Non-arteritic ischaemic optic neuropathy
Optic neuritis
Migraine
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4
Q

Differentials for bilateral blindness gradual onset

A 
Cataracts
Glaucoma
Age related macular degeneration
Diabetic retinopathy
Bilateral optic nerve chiasmal compression
Tobacco amblyopia
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5
Q

Differentials for concentric diminution of visual field

A

glaucoma
Papilloedema
Chorioretinitis
Retinitis pigmentosa

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6
Q

Differentials central scotomata/loss of macular vision

A 
Demyelination of optic nerve
Methyl alcohol poisoning
Tobacco amblyopia
Vascular lesions
Optic nerve gliomas
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7
Q

Differentials for bitemporal hemianopia

A

Pituitary tumour
Craniopharyngioma
Suprasellar meningioma

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8
Q

Differentials for binasal hemianopia

A

Atheroma of internal carotid siphon

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9
Q

Differentials for homonymous hemianopia

A

Contralateral optic radiation infarct (both parietal and temporal lobes)
Contralateral occipital lobe lesions

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10
Q

Cause upper quadrantanopia

A

Contralateral temporal lobe lesion

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11
Q

Cause of lower quadrantanopia

A

Contralateral parietal lobe lesion

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12
Q

Differentials for absent pupillary reflex with intact accommodation

A

Midbrain lesion - Argyll Robertson pupil of Syphilis
Ciliary ganglion lesion - Adie’s pupil
Parinaud syndrome

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13
Q

Incominant squint/strabismus

A

Eye alignment changes depending on direction of gaze

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14
Q

Concominant squint/strabismus

A

Stable eye alignment independent of gaze

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15
Q

Features of third nerve palsy

A

Complete or incomplete ptosis of ipsilateral eye
Divergent ipsilateral strabismus “eye down and out”
Ipsilateral dilated, unreactive pupil on direct light stimulation
(Reactive on consensual stimulation)
Unreactive to accomodation

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16
Q

Differentials for third nerve palsy

A 
Posterior communicating artery aneurysmal compression
Ischaemia or infarction (T2DM)
Superior orbital fissure syndrome
Tumour
Basal meningitis
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17
Q

Features of superior orbital fissure syndrome

A

Painful lesion of ipsilateral CNIII, CNVI, CNVI and ophthalmic division of CNV

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18
Q

Features of fourth nerve palsy

A

Superior oblique weakness - unable to move eye downwards when in medial position
Rectified by tilting head in the contralateral direction

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19
Q

Differentials for fourth nerve palsy

A

Isolated CNV ischaemia, infarct or trauma

Isolated midbrain infarcts

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20
Q

Features of sixth nerve palsy

A

Unable to look laterally on ipsilateral side

Double vision on lateral gaze

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21
Q

Differentials for unilateral sixth nerve palsy

A

Ischaemia or infarct of nerve
Isolated pontine infarct
Raised intracranial pressure
Wernike’s encephalopathy (bilateral)

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22
Q

Features of conjugate gaze or supranuclear palsy

A

Inability to coordinate movement of both eyes in particular direction (loss of ipsilateral and contralateral eye movement)

Loss of right deviation is caused by a right brainstem lesion or left frontal cortical lesion (or right frontal epileptic focus)

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23
Q

Distinguishing of supranuclear palsy from CN palsy

A

Both eyes affected
Fixed and unequal pupils
Intact reflex eye movements

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24
Q

Features of supranuclear palsy

A

Loss of vertical (downward) and later horizontal gaze
Preserved reflex eye movements on neck flexion/extension
Extrapyramidal signs
Neck rigidity
Dementia

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25
Q

Features of Parinaud’s syndrome

A

Loss of vertical gaze
Nystagmus on attempted convergence
(pseudo-) Argyll- Robinson pupils

26
Q

Differentials for Parinaud’s syndrome

A

Pinealoma
Multiple sclerosis
Vascular lesions

27
Q

Features of one-and-a-half syndrome

A

Unilateral horizontal gaze palsy
impaired adduction on looking to the other side (ipsilateral)
Contralateral turning out of eye

28
Q

Differentials for one and a half syndrome

A

Demyelination

Tumour or infarct dorsal pons

29
Q

Differentials for jerky horizontal nystagmus

A 
Vestibular lesion (away from lesion acutely)
Cerebellar lesion (toward lesion)
Werneke's syndrome
Phenytoin toxicity
Intranuclear ophthalmoplegia
30
Q

Features of intranuclear ophthalmoplegia

A

Nystagmus of abducting eye
unilateral horizontal gaze palsy of contralateral eye

Lesion of medial longitudinal fasciculus

31
Q

Differentials for jerky vertical nystagmus - upbeat

A

Midbrain lesion (upbeat)
Lesion in floor of fourth ventricle (upbeat)
Phenytoin or alcohol

32
Q

Differentials for jerky verticle nystagmus - downbeat

A

Foramen magnum lesion

Phenytoin or alcohol

33
Q

Cause of dissociated sensory loss of pain and temperature of face

A

Medullary or upper spinal cord lesion.

Pain and temperature fibres terminate in the medulla and upper cervical cord, whilst touch and proprioception terminate in pons and upper medulla

34
Q

Corneal reflex - loss of bilateral blinking

A

Ipsilateral CNV1 nerve or nucleus lesion

35
Q

Corneal reflex - loss of ipsilateral blinking

A

Ipsilateral CNVII nerve or nucleus lesion

36
Q

Corneal reflex - loss of contralateral blinking

A

Contralateral CNVII nerve or nucleus lesion

37
Q

Unilateral jaw deviation

A

Ipsilateral CNVI3 nerve or nucleus lesion

38
Q

Central CNV sensory deficit differentials

A

Vascular lesion
Tumour
Syringobulbia

39
Q

Peripheral CNV sensory deficit differentials

A

Middle fossa aneurysm
Tumour
Chronic meningitis

40
Q

Loss of single CNV segment

A

Post ganglionic lesion

41
Q

Loss of 3 CNV segments

A

Preganglionic or nucleus lesion

42
Q

Differentials for CNV pre-ganglionic lesion

A

Trigeminal neuroma
Meningioma
Acoustic neuroma
Fracture of middle fossa

43
Q

Differentials for cavernous sinus lesion

A

Aneurysm
Tumour
Thrombosis

44
Q

Differentials for dissociated facial sensory loss

i.e. loss of pain and temp, with light touch preserved

A

Syringobulbia
Foramen magnum tumour
Posterior inferior cerebellar artery

45
Q

Features of unilateral lower motor neuron CNVII lesion

A

Loss of lower and upper hemiface
Incomplete closure of eyelid
Upward movement of eyeball on closure
Loss of taste sensation of anterior two thirds

46
Q

Differentials for LMN CNVII lesion

A 
Bell's palsy
Posterior fossa lesion (acoustic neuroma, meningioma, chronic meningitis)
Pontine nuclear lesion
Ramsay Hunt syndrome
Temporal bone fracture
Parotid lesion
47
Q

Differentials for bilateral facial weakness

A 
Guillain-Barre syndrome (Miller-Fisher variant)
Bilateral parotid disease
Sarcoidosis
Myasthenia gravis
Mononeuritis multiplex
48
Q

Features of Rinne positive test

A

Hearing no different comparing bony and air conduction

49
Q

Features of Rinne negative test

A

Hearing better with bony conduction

Indicates conductive deafness

50
Q

Features of abnormal Weber test

A

Hearing is better on one side compared to another

51
Q

Cause of abnormal Weber and negative Rinne test

A

Conductive deafness of affected side

52
Q

Cause of abnormal Weber and positive Rinne test

A

Sensorineural deafness of affected side

53
Q

Differentials of unilateral deafness

A

Posterior fossa tumours
Fracture of petrous temporal bone
Vascular disease of internal auditory artery

54
Q

Differentials of bilateral nerve deafness

A 
Environmental noise exposure
Presbyacusis
Drug - aminoglycoside, aspirin or alcohol
Congenital infection - rubella, syphilis
Meniere's disease
Genetic syndrome
55
Q

Differentials of conductive nerve deafness

A 
Wax
Otitis media
Tympanic perforation
Otosclerosis
Paget's disease of bone
56
Q

Features of positive Hallpike manoeuvre

A

Brief torsional horizontal nystagmus toward affected tilted side after sudden lying down
This is followed by a cessation of nystagmus

Ongoing nystagmus suggests cerebellar or brainstem infarct

57
Q

Cause of uvular deviation

A

contralateral CNX lesion (uvula deviates toward normal side)

58
Q

Cause of abnormal gag reflex with absent sensation

A

CNIX nerve or nucleus lesion

59
Q

Cause of abnormal gag reflexe with sensation present

A

Reduced gag reflex of age

CNX nucleus or nerve lesion

60
Q

Features of cerebellopontine angle syndrome

A

Loss of CNV, CNVII and CNVIII ipsilaterally

61
Q

Features of jugular foramen syndrome

A

Loss of ipsilateral CNIX,X and XI

Short case clinical skills (5 decks)

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