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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
Features of Parinaud's syndrome
Loss of vertical gaze Nystagmus on attempted convergence (pseudo-) Argyll- Robinson pupils
26
Differentials for Parinaud's syndrome
Pinealoma Multiple sclerosis Vascular lesions
27
Features of one-and-a-half syndrome
Unilateral horizontal gaze palsy impaired adduction on looking to the other side (ipsilateral) Contralateral turning out of eye
28
Differentials for one and a half syndrome
Demyelination | Tumour or infarct dorsal pons
29
Differentials for jerky horizontal nystagmus
``` Vestibular lesion (away from lesion acutely) Cerebellar lesion (toward lesion) Werneke's syndrome Phenytoin toxicity Intranuclear ophthalmoplegia ```
30
Features of intranuclear ophthalmoplegia
Nystagmus of abducting eye unilateral horizontal gaze palsy of contralateral eye Lesion of medial longitudinal fasciculus
31
Differentials for jerky vertical nystagmus - upbeat
Midbrain lesion (upbeat) Lesion in floor of fourth ventricle (upbeat) Phenytoin or alcohol
32
Differentials for jerky verticle nystagmus - downbeat
Foramen magnum lesion | Phenytoin or alcohol
33
Cause of dissociated sensory loss of pain and temperature of face
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
Corneal reflex - loss of bilateral blinking
Ipsilateral CNV1 nerve or nucleus lesion
35
Corneal reflex - loss of ipsilateral blinking
Ipsilateral CNVII nerve or nucleus lesion
36
Corneal reflex - loss of contralateral blinking
Contralateral CNVII nerve or nucleus lesion
37
Unilateral jaw deviation
Ipsilateral CNVI3 nerve or nucleus lesion
38
Central CNV sensory deficit differentials
Vascular lesion Tumour Syringobulbia
39
Peripheral CNV sensory deficit differentials
Middle fossa aneurysm Tumour Chronic meningitis
40
Loss of single CNV segment
Post ganglionic lesion
41
Loss of 3 CNV segments
Preganglionic or nucleus lesion
42
Differentials for CNV pre-ganglionic lesion
Trigeminal neuroma Meningioma Acoustic neuroma Fracture of middle fossa
43
Differentials for cavernous sinus lesion
Aneurysm Tumour Thrombosis
44
Differentials for dissociated facial sensory loss | i.e. loss of pain and temp, with light touch preserved
Syringobulbia Foramen magnum tumour Posterior inferior cerebellar artery
45
Features of unilateral lower motor neuron CNVII lesion
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
Differentials for LMN CNVII lesion
``` Bell's palsy Posterior fossa lesion (acoustic neuroma, meningioma, chronic meningitis) Pontine nuclear lesion Ramsay Hunt syndrome Temporal bone fracture Parotid lesion ```
47
Differentials for bilateral facial weakness
``` Guillain-Barre syndrome (Miller-Fisher variant) Bilateral parotid disease Sarcoidosis Myasthenia gravis Mononeuritis multiplex ```
48
Features of Rinne positive test
Hearing no different comparing bony and air conduction
49
Features of Rinne negative test
Hearing better with bony conduction | Indicates conductive deafness
50
Features of abnormal Weber test
Hearing is better on one side compared to another
51
Cause of abnormal Weber and negative Rinne test
Conductive deafness of affected side
52
Cause of abnormal Weber and positive Rinne test
Sensorineural deafness of affected side
53
Differentials of unilateral deafness
Posterior fossa tumours Fracture of petrous temporal bone Vascular disease of internal auditory artery
54
Differentials of bilateral nerve deafness
``` Environmental noise exposure Presbyacusis Drug - aminoglycoside, aspirin or alcohol Congenital infection - rubella, syphilis Meniere's disease Genetic syndrome ```
55
Differentials of conductive nerve deafness
``` Wax Otitis media Tympanic perforation Otosclerosis Paget's disease of bone ```
56
Features of positive Hallpike manoeuvre
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
Cause of uvular deviation
contralateral CNX lesion (uvula deviates toward normal side)
58
Cause of abnormal gag reflex with absent sensation
CNIX nerve or nucleus lesion
59
Cause of abnormal gag reflexe with sensation present
Reduced gag reflex of age | CNX nucleus or nerve lesion
60
Features of cerebellopontine angle syndrome
Loss of CNV, CNVII and CNVIII ipsilaterally
61
Features of jugular foramen syndrome
Loss of ipsilateral CNIX,X and XI

Short case clinical skills (5 decks)

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