Oxford Clinicals III

Question 1

What is the dermatome region of the umbilicus?

Answer 1

T10

Question 2

What is the dermatome region of the nipple?

Answer 2

T4

Question 3

What is the dermatome region of the inguinal ligament?

Answer 3

L1

Question 4

What is Multiple Sclerosis

Answer 4

MS occurs when there are discrete plaques of demyelination occurring at multiple CNS sites, from T-cell mediated immune response.

Question 5

What is the mean age of onset of Multiple Sclerosis?

Answer 5

Age 30

Question 6

Are females or males more at risk of having MS?

Answer 6

Females.

Question 7

How is Vitamin D related to MS?

Answer 7

Early exposure to sunlight and vitamin D status relates to prevention of MS, and fewer symptoms and fewer new lesions on MRI in established MS.

Question 8

What is the characteristic presentation of MS?

Answer 8

In Multiple Sclerosis, there is usually monosymptomatic presentation such as unilateral optic neuritis (pain on eye movement and rapid central vision loss).
Numbness or tingling in the limbs
leg weakness
Brainstem or cerebellar symptoms such as diplopia or ataxia.

Question 9

What is ageusia?

Answer 9

decreased taste

Question 10

Who are at risk of Bell’s Palsy?

Answer 10

Risk of Bell’s palsy increases with pregnancy and diabetes

Question 11

What is Bell’s Palsy?

Answer 11

Bell’s Palsy is a diagnosis of exclusion.

It is VII’s nerve palsy.

Question 12

Give the symptoms of Bell’s Palsy

Answer 12

• Abrupt onset (overnight or after a nap)
• Complete unilateral facial weakness at 24-72 hours (2-3 days)
• ipsilateral numbness or pain around the ear
• Reduced taste (ageusia)
• Hypersensitivity to sound (Hyperacusis from stapedius palsy)
• Decrease in gland production: Dry eyes and dry mouth, reduced secretio

Question 13

What tests can be done to check the function of the facial nerve?

Answer 13

Ask patient to raise their eyebrows and wrinkle their forehead. Or to blow out their cheeks (buccinator muscle).
Patient will be unable to do these as the facial nerve controls facial expression.

Question 14

Besides Bell’s Palsy, what are the 2 other conditions that can cause facial nerve VII palsy? How are these 2 conditions ruled out?

Answer 14

Ramsay Hunt Syndrome (when latent VZV reactivates in the geniculate ganglion of the VII’s cranial nerve.

Lyme disease: Borrelia sp.

Rule these out by doing a blood test to look for Borrelia antibodies and VZV antibodies.

Question 15

What is the treatment of Bell’s Palsy?

Answer 15

If it is within 72 hours of onset, giving Prednisolone will speed up recovery.
Protect the eyes: dark glasses and artificial tears if there is drying of eyes

Question 16

When are clonus seen?

Answer 16

Clonus is typically seen in patients with cerebral palsy, stroke, multiple sclerosis, spinal cord damage and hepatic encephalopathy.

Question 17

Headache is relieved when lying flat and gets much worse within 10mins of standing or sitting. What is a possible cause of such a headache?

Answer 17

Decrease in intracranial pressure due to CSF depletion.

Question 18

What is a non-communicating hydrocephalus and a communicating hydrocephalus?

Answer 18

A non-communicating hydrocephalus is one where there is a blockage to the cerebral aqueduct, resulting in dilatation of the lateral and third ventricles.
A communicating hydrocephalus is one where there is an obstruction to the arachnoid granulations (from a subarachnoid haemorrhage or by bacterial and inflammatory cells following meningitis) . All ventricles are dilated in the communicating hydrocephalus.

Question 19

When is Lumbar puncture contraindicated?

Answer 19

1. Non-communicating hydrocephalus
2. Suspicion of meningitis
3. Suspected intracranial mass
4. Signs of raised intracranial pressure such as unequal or unreactive pupillary response, papilloedema, drowsy, high BP with bradycardia, GCS <9, abnormal ‘Doll’s eye’ movement, or extensor-flexor posturing

Question 20

What is bleeding diathesis?

Answer 20

Bleeding diathesis is the an unusual susceptibility to bleed, mostly due to hypocoagulability which is in turn caused by a coagulopathy (a defect in the system of coagulation)