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Y4/Y5 MBBS > Neurology > Flashcards

Neurology Flashcards

1
Q

Pupillary light reflex - which CN involved?

A

Afferent = optic nerve CN II (senses light) – efferent = occumulator CN III (constricts pupils)

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2
Q

Function of CN III

A

Occulomotor nerve. Controls all eye muscles except LR(6) SO(4). So controls MR, IO, SR and IR. + Pupil constriction + Accomodation + eyelid opening

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3
Q

Important investigaitons in Myasthenia gravis

A

Check FVC in initial presentation or flare, CT Thorax (check for thymoma), check antibodies

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4
Q

Function of CN X

A

Vagus, - innervates viscera + phonation and swallowing

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5
Q

Function of CN IX

A

Glossopharyngael n. - taste to post 1/3 of tongue, salivation, swallowing and mediates input from carotid body and sinus

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6
Q

Lesion in CN XI symptoms

A

weakness turning head to contralateral side

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7
Q

1st line Tx: Myasthenia gravis

A

Pyridostigmine (long acting ACh esterase inhibitor), lasts 3-5 hours, reversible, has cholinergic SEs. + Prednisolone for immunosupression ± thymectomy

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8
Q

Loss of gag reflex, what CN lesion involved?

A

CN X or IX

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9
Q

Causes of CN III palsy

A

Diabetes, vasculitis (e.g. temporal arteritis, SLE), raised ICP, posterior communicating artery aneurysm (dilated pupil, pain), cavernous sinus thrombosis, weber’s syndrome (psilateral third nerve palsy with contralateral hemiplegia -caused by midbrain strokes), amyloid, MS

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10
Q

“Hypersensitive carotid sinus reflex” is lesion in what CN?

A

Lesion in glossopharyngeal n. CN IX

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11
Q

What is: CN I

A

Olfactory nerve - smell sensation

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12
Q

Lacrimation reflex. What CN involved?

A

Afferent = opthalmic nerve (V1) and efferent/response = facial nerve CN VII

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13
Q

Horizontal diplopia - what CN lesion?

A

CN VI abducens. Because this usually controls Lateral rectus (remember LR6 SO4 mnemonic)

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14
Q

Jaw jerk reflex - which CN?

A

Afferent: CN V(3) Efferent: CN V(3) - the mandibular branch of trigeminal

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15
Q

Function of CN II

A

Optic nerve - sight

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16
Q

LMN or UMN: tongue deviates to ipsilateral side of lesion?

A

Tongue movement is CN XII (hypoglossal), if the tongue moves to SAME side = UMN lesion. You’d also have atrophy + fasciulations. So if you see fascilations on tongue = LMN .

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17
Q

Bell’s Palsy : Sx

A

Muscles of face droop on one side (Unilateral!) Abnormal corneal reflex pts. may also have post-auricular pain before the paralysis altered taste dry eyes (facial nerve controls lacrimation) hyperacusis.

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18
Q

Vertical diplopia. what CN lesion?

A

CN IV trochlear. This usually controls Superior oblique (SO) which controls the down and in movement of eye.

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19
Q

Function of CN V

A

Trigeminal n. (v1 - ophatlmic, V2- maxillary, and V3-mandibular), - facial sensation for all three. V3 also does motor for mastication

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20
Q

Trigeminal neuralgia: First line Tx

A

Carbamazepine (an anticonculsant). if don’t respond or atypical features (e.g. <50 y/o) –> prompt referral to neurology (can get surgery- neurovascular decompression)

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21
Q

Cause: Myasthenia gravis

A

Autoimmune disorder causing abnormal functioning acetylcholine receptors in post-synaptic membrane of NMJ. Antibodies to acetylcholine receptors found in 90% of cases . Type 2 hypersensitivity

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22
Q

Aetiology; Myasthenia gravis

A

Young women (20-35) or older men (60-75) = bimodal

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23
Q

Lesion in which CN causes nystagmus?

A

Nystagmus related to balance, seen in lesions of CN VIII (vestibulocochlear)

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24
Q

“Tongue deviates toward left side” is a lesion in which CN?

A

Hypoglossal nerve lesion. The tongue diviates to the side of the lesion . so this would be of left hypoglossal n.

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25
Q

Difference between UMN vs LMN lesion in CN VII?

A

CN VII facial n. lesion will cause flaccid paralysis of facia muscles. If it’s an upper motor neurone UMN , the forehead will be unaffected. If it’s LMN - all muscles will be affected

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26
Q

Lesion in CN IV symptoms

A

Palsy - defective downward gaze and vertical diplopia (double vision)

27
Q

LMN or UMN: tongue deviates to contralateral side of lesion?

A

Tongue movement is CN XII (hypoglossal), if the tongue moves to OPPOSITE side = UMN lesion

28
Q

CN III Palsy symptoms

A

Ptosis , ‘down and out’ eye (since only LR and SO muscles working from other nerves) , Dilated and fixed pupil

29
Q

Lesion in CN V symptoms

A
  • Trigeminal neuralgia, loss of corneal reflex, Loss of facial sensation, paralysis of mastication muscles, deviation of jaw to weak side
30
Q

Function of CN XI

A

Acccesory n. for head and shoulder movement

31
Q

Trigeminal neuralgia Sx

A

Unilateral sensory facial pain of single branch of trigeminal nerve. Brief electric-shock like pains, abrupt in onset and termination. Pain usually evoked by light touch or brushing teeth, talking, even a gust of wind. Pain remits for variable periods. (DDx: rule out TMJ dysfunction and tooth absess)

32
Q

Function of CN VI

A

Abducens n. Controls eye muscle - LR (lateral rectus).

33
Q

Lesion in CN VII symptoms

A

Flaccid paralysis of upper and lower face (if UMN lesion - spares forehead e.g. stroke), loss of corneal reflex, loss of taste and hyperacusis

34
Q

Causes of bilateral facial n palsy?

A

sarcoidosis, Guillain-barre, lyme disease, bilateral acoustic neuroma,

35
Q

Tx of myasthenic crisis

A

this is where there is mucsle weakness in myasthenia gravis. Tx: IV immunoglobulins ± Plasmaphoresis

36
Q

Dx: Myasthenia gravis

A

1st line - single fibre EMG (will show increased jitter) or EMG repetitive stimulation (will show decrementation in muscle APs)

37
Q

Function of CN XII

A

Hypoglossal n. - tongue movement

38
Q

Lesion in which CN causes vertigo?

A

CN VIII vestibulocochlear

39
Q

Function of CN VII

A

Facial n. Mnemonic: “face, ear, taste, tear”. Controls facial movements (but mastication is CN V) + taste to anterior 2/3 of tongue + lacrimation + salivation + Motor control of the stapedius in the ear – needed to dampen down sounds

40
Q

Tx of Bell’s palsy

A

oral prednisolone within 72 hours of onset + consider eye care (artificial tears and eye lubricants)

41
Q

Exacerbation factors of myasthenia gravis

A

Drugs that make MG worse: penicillamine, qunidide, beta blockers, lithium, phenytoin, Abx (gent, macrolides, quinolones ,tetracyclines).

42
Q

What CN control sensory and motor function to tongue?

A

Sensory: Facial nerve CN VII is taste of ant. 2/3 , glossopharyngeal is taste to post. 1/3, and hypoglossal is motor control of tongue muscles).

43
Q

What is bell’s palsy?

A

Facial nerve (CN VII) LMN lesion - all muscles of face are affected. Bell’s palsy is acute, unilateral, idiopathic facial nerve paralysis. Associated with herpes simplex virus (causes inflammation of nerve). Peak incidence = 20-40 y/o (associated highly with pregnancy!).

44
Q

Gag reflex control

A

Sensory through CN IX (Glossopharyngeal) and motor to CN X (Vagus)

45
Q

Causes of unilateral facial n palsy (UMN and LMN)?

A

UMN = stroke, LMN = bell’s palsy (is idiopathic), ramsay-hunt syndrome, acoustic neuroma, parotid tumours, HIV, MS, diabetes

46
Q

Lesions in CN IX symptoms

A

Hypersensitive carotid sinus reflex, loss of gag reflex

47
Q

The Corneal reflex (aka blink reflex)

A

Light touch to cornea - Sensation (afferent) received by CN V1 (trigeminal) -> signal to motor fibres of CN VII (Facial nerve) which responds by contracting the orbicularis oculi muscle.

48
Q

Damage to what nerve causes hoarse voice?

A

Recurrent laryngeal nerve. Which is a branch of the vagus nerve.

49
Q

Lesion in which CN causes hyperacusis?

A

CN VII (facial nerve) – it controls stapedus muscle in ear which dampens sound.

50
Q

Function of CN VIII

A

Vestibulocochlear nerve. For hearing and balance.

51
Q

Pt. develops a head tilt, and when they look straight, the affected eye appears to deviate upwards and rotate outwards. What CN affected?

A

CN IV trochlear n lesion. Causes vertical diploplia (typically noticed when reading or going down stairs), tilting of objects (torsional diplopia), head tild and affected eye deviates upwards and rotates outwards

52
Q

Mnemonic for sensory or motor CN.

A

Some Say Money Matters But By Brother Says Big Boobs Matter More

53
Q

Major complications of myasthenia gravis

A

Respiratory failure, aspiration pneumonia, increased VTE risk

54
Q

Causes of trigeminal neuralgia

A

Most are idiopathic. Other cauess: compression of trigeminal roots by tumours or vascular problems

55
Q

Lesion in CN VI symptoms

A

Palsy results in defective abduction of eye -> horizontal diplopia

56
Q

Sx : Myasthenia gravis

A

Ptosis weakness of eye muscles blurred or double vision. Mainly - Fatiguable weakness - muscles get weaker as they are used. Weakness improves with rest. Can also have ocular and bular involvement = swallowing difficulties, speech disturbance.

57
Q

Lesion in which CN? “Uvual deviates away from site of lesion”

A

CN X (vagus)

58
Q

Function of CN IV

A

Trochlear nearve. Controls the SO muscle of eye

59
Q

What CN controls mastication?

A

CN V (V3 division), remember V3 is sensory + motor.

60
Q

What controls accommodation reflex?

A

Change in distance of an object, is sensed by CN II optic nerve. The response is CN III occulomotor. which adjusts the size of the lense to accommodate

61
Q

Red flag sx of trigeminal neuralgia

A

Sensory changes Deafness or other ear problems History of skin or oral lesions that could spread perineurally Pain only in the ophthalmic division of the trigeminal nerve (eye socket, forehead, and nose), or bilaterally Optic neuritis A family history of multiple sclerosis Age of onset before 40 years

62
Q

What condition has ‘Café au lait’ spots?

A

mostly associated with neurofibromatosis , but also tuberous sclerosis

63
Q

“Lethargy, optic neuritis, paraesthesia, spastic weakness” is typica history for?

A

Multiple sclerosis

64
Q
A

Y4/Y5 MBBS (1 decks)

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