Oxford Clinicals III Flashcards
What is the dermatome region of the umbilicus?
T10
What is the dermatome region of the nipple?
T4
What is the dermatome region of the inguinal ligament?
L1
What is Multiple Sclerosis
MS occurs when there are discrete plaques of demyelination occurring at multiple CNS sites, from T-cell mediated immune response.
What is the mean age of onset of Multiple Sclerosis?
Age 30
Are females or males more at risk of having MS?
Females.
How is Vitamin D related to MS?
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.
What is the characteristic presentation of MS?
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.
What is ageusia?
decreased taste
Who are at risk of Bell’s Palsy?
Risk of Bell’s palsy increases with pregnancy and diabetes
What is Bell’s Palsy?
Bell’s Palsy is a diagnosis of exclusion.
It is VII’s nerve palsy.
Give the symptoms of Bell’s Palsy
- 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
What tests can be done to check the function of the facial nerve?
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.
Besides Bell’s Palsy, what are the 2 other conditions that can cause facial nerve VII palsy? How are these 2 conditions ruled out?
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.
What is the treatment of Bell’s Palsy?
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
When are clonus seen?
Clonus is typically seen in patients with cerebral palsy, stroke, multiple sclerosis, spinal cord damage and hepatic encephalopathy.
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?
Decrease in intracranial pressure due to CSF depletion.
What is a non-communicating hydrocephalus and a communicating hydrocephalus?
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.
When is Lumbar puncture contraindicated?
- Non-communicating hydrocephalus
- Suspicion of meningitis
- Suspected intracranial mass
- 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
What is bleeding diathesis?
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)
