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Finals Elliot > PACES - Limbs > Flashcards

PACES - Limbs Flashcards

1
Q

How would you test power of shoulder abduction?

A

‘Lift your arms into a chicken position, don’t let me push down’

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2
Q

How would you test power of arm flexion?

A

Put your arms in front of you like a boxer
Stop me from pulling you arms out

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3
Q

How would you test power of arm extension?

A

‘Put your arms in front of you like a boxer, push against my hand’

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4
Q

How would you test power of wrist flexion?

A

How you arms straight out and make a fist.
Hand under fist, push my hand down towards the ground

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5
Q

How would you test power of wrist extension?

A

Now cock your wrists back
Hold forearm, stop me from pushing your fist down

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6
Q

How would you test power of finger abduction?

A

Spread your fingers
Stop me from pushing your fingers together

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7
Q

How would you test power of thumb abduction?

A

Turn hand palm up, bring the thumb towards the ceiling. Stop me from pushing your thumb down

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8
Q

How would you test power of hip flexion?

A

‘Keeping your knee straight, lift your leg off the bed’
Hold their thigh, ‘stop me from pushing your leg down’

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9
Q

How would you test power of hip extension?

A

Push your leg down, hold underneath their thigh. ‘Push your leg into the bed’

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10
Q

How would you test power of knee flexion?

A

“Bend your leg at the knee and rest your foot flat on the bed.”
Hold their leg around the back of the calf. “Don’t let me straighten your leg/Pull your heel in towards your bottom”

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11
Q

How would you test power of knee extension?

A

Holding their leg on the shin.
“Try to straighten you leg, push against my hand away with your leg”

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12
Q

How would you test power of dorsiflexion?

A

Place leg straight again: point toes toward face. Place your hand on the dorsum of foot.
“Stop me from pulling your foot down”

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13
Q

How would you test plantar flexion?

A

Place your hand on the sole of the foot. “Push down against my hand”

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14
Q

Which anatomy are you testing with hip flexion?

A

1: Psoas
2: L2
3: Femoral

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15
Q

Which anatomy are you testing with hip extension?

A

1: Gluteus Maximus
2: L5/S1
3: Inf. gluteal nerve

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16
Q

Which anatomy are you testing with knee flexion?

A

1: Hamstrings
2: L5
3: Sciatic

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17
Q

Which anatomy are you testing with knee extension?

A

1: Quads
2: L3/4
3: Femoral

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18
Q

Which anatomy are you testing with dorsiflexion?

A

1: Tibialis anterior (and others)
2: L4/5
3: Deep Peroneal

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19
Q

Which anatomy are you testing with plantar flexion?

A

1: Gastronemeus (and others)
2: S1/2
3: Tibial nerve

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20
Q

How would you test for arm fasciculations?

A

Gently flick the deltoid if clinical suspicion

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21
Q

How do spasticity and rigidity differ?

A

Spasticity = velocity dependent (fast = more resistance)

Rigidity = constant resistance

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22
Q

Describe the muscle power grading system

A

0 = Absent contraction
1= Feeble (ie. twitching)
2 = Can move with gravity eliminated (ie. can move leg horizontally when lying on a bed)
3 = Move against gravity (Can lift heel off bed)
4 = Movement against partial resistance
5 = Full strength

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23
Q

What is Jendrassik’s Manoeuvre?

A

Reinforces reflexes

Ask them to clench their teeth or grasp their hands together and pull apart

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24
Q

What does a positive Romberg’s test mean and how would you carry it out?

A

Sensory ataxia (Peripheral neuropathy)
Tabes Dorsalis (Sensory pathways of spinal cord)

Ask them to stand with their feet close together and stretch out their arms.

Ask to close their eyes. If they fall, lack of proprioceptive input.
If cerebellar, unsteady when eyes are pen and closed.

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25
how would a hemiparesis present?
UMN signs (Increase tone, brisk reflexes, upgoing plantars, Clonus) Hemiparetic Gait Sensory Loss Visual Field defect?
26
What would your differential be in a pt presenting with hemiparesis?
Anterior circulation stroke SOL Cerebral Palsy Stroke Mimic (Sepsis, Hypoglycaemia, Demyelination)
27
How would you manage a patient with a stroke?
A-E approach Thrombolysis if <4.5h Thrombectomy if <6h Admit to Hyperacute stroke unit Regular neuro obs, CT Head Aspirin, Statin SALT, Rehab, Physiotherapy, OH assessment Lifestyle advice DVLA advice (4weeks) Chadvasc/Hasbled anticoag advice
28
how would a spastic paraparesis present?
Bilateral increased tone Pyramidal Weakness bilaterally Increased reflexes Upgoing plantars/clonus Spastic scissoring gait
29
What are the main causes of a spastic paraparesis?
MS Cord Compression Trauma Anterior horn cell MND Cerebral Palsy
30
What is the likely cause if a patient presents with a spastic paraparesis and a clear sensory level?
Cord compression Cord Infarction Transverse Myelitis
31
What is the likely cause if a patient presents with a spastic paraparesis and UMN signs in the upper limbs?
cervical Myelopathy above C5
32
What is pyramidal weakness?
Weakness in upper limb extensors and lower limb flexors
33
What are the key signs of dorsal column pathology?
Loss of vibration Loss of joint position sense
34
What are the key signs of a cerebellar syndrome?
Ataxic wide-based gait Inability to walk heel to toe Rhomberg Negative Dysdiadokinesis, past pointing, intention tremor, Nystagmus Ataxid Dysarthria Should be reduced tone,
35
What can cause a bilateral cerebellar syndrome?
MS Paraneoplastic Syndromes Stroke/SOL of Posterior Circulation
36
How might a peripheral neuropathy present?
Loss of sensation Loss of proprioception Charcot Joint?
37
What can cause a peripheral neuropathy?
B12 def Diabetes Alcohol GBS CMT Amyloidosis
38
How is B12 def managed?
IM Hydroxycobalamin. 3/wk for 2 wks. then 3 monthly
39
What is charcot marie Tooth syndrome?
Peripheral Motor and sensory neuropathy Distal wasting of legs and hands Weakness, mild sensory loss Arreflexia Bilateral foot drop high stepping gait
40
How common is CMT?
Fairly 1 in 2500
41
How does friedrich's ataxia present?
Spastic Paraparesis Absent lower limb reflexes Cerebellar Signs Has spinocerebellar signs, corticospinal tract signs, dorsal column signs
42
How is friedrich's ataxia inherited?
Autosomal Recessive
43
Which investigations should you ask for in most neuro stations?
Bedside: Bloods: B12/Folate, BMs, Syphylis Nerve Conduction Studies MRI/CT Head/Spine AMTS? Full CN screen Gene check if ?inherited
44
How would you manage complex neuro cases?
MDT Approach Involve specialist, SALT, OT, physio, geneticist etc Screen family Manage complications (Cardiac, Ortho, Endo)
45
How does a flacid paraparesis present?
Reduced tone bilaterally Wasting and weakness Reduced/absent reflexes Downgoing plantars
46
What can cause a flaccid paraparesis?
Anterior horn -> Nerve Root -> Plexus -> Peripheral Nerve -> NMJ -> Muscle AH - MND, Polio NR - Compression (disc herniation, abscess, mets) Plexus -> Lumbosacral Plexopathy Nerve - GBS, Infection, CMT, Amyloid etc (Lots for this) NMJ - MG, LE, Botulism Myopathy - Poly/Dermatomyositis Connective tissue disorders Cancer Drugs (Statins) Lots others (Surgical sieve)
47
Pt presents with high stepping gait?
Common peroneal nerve palsy L5 Radiculopathy CMT
48
What can cause a mix of umn and lmn signs?
MND Friedrich's ataxia Subacute combined degeneration of the cord Taboparesis Syringeomyelia
49
Which spinal cord tracts are motor in function?
Pyramidal = voluntary movement (corticospinal) Extrapyradimal = Involuntary movements (reflexes, tics, posture)
50
Which spinal tracts are sensory in function?
Dorsal Column - Fine touch, proprioception, (crosses at medulla) Spinocerebellar - proprioception Spinothalamic - pain and temperature, crosses at level
51
Where would you test C5
Deltoid
52
Where would you test c6?
Thumb
53
Where would you test c7?
Middle finger
54
Where would you test c8?
Little finger
55
Where would you test T1?
Ulnar side of forearm
56
Carpal tunnel scar
57
What is clasp-knife spasticity?
Initial resistance to movement followed by sudden drop in tone (velocity dependent) UMN lesions Either flexors or extensors
58
What is lead pipe rigidity?
Hypertonicity which persists through range of movement (PD)
59
What is cogwheeling?
Start and stop movements (PD if has tremor)
60
What might cause an ataxic gait?
Cerebellar lesion (Veer to one side) Sensory Ataxia (Watch feet, no proprioception)
61
What might cause a waddling gait?
Proximal lower limb weakness (myopathy)
62
How might someone with a unilateral/bilateral spastic paraparesis walk?
Bi - Scissoring, inverted feet, internal rotation of hips Uni - Circumdating, one leg stiff and swings round in an arc with each stride
63
What is brown-sequard syndrome?
Hemisection of spinal cord Complete sensory loss at level Impaired pain and temperature ipsilaterally Impaired fine touch, vibration contralaterally
64
What would be your differential for UMN signs?
Stroke SOL MS
65
What can cause a unilateral lower limb hemiparesis (One side completely spastic, the other side effectively normal)?
Hemisphere - Stroke, MS, SOL, Cerebral Palsy Hemicord - MS, Cord Compression
66
What can cause a spastic paraparesis?
Common = MS, Corc compression (LMN at level, UMN below level), Cervical Myelopathy, Cord trauma, Cerebral Palsy
67
How do you perform Romberg's test
30s with eyes together. Eyes closed Positive = loss of balance = sensory ataxia (proprioceptive deficit)
68
Investigations for UMN lesion?
MRI cord and brain Lumbar Puncture for MS (oligoclonal bands) FBC for infection, CXR for malignancy B12/Folate for subacute combined degeneration
69
What is the supportive management for UMN lesions?
MDT = gpm radiologist, neurosurgeon, physio, OT Motility aids, Catheterisation Baclofen for spasticity
70
What can cause a stroke in a young person?
SLE/APLS/Vasculitis/Carotid artery dissection/SCA
71
What would your ddx for someone with stroke symptoms?
head injury, hypo/hyperglycaemia, Infection
72
Stroke rehab?
MENDS MDT Eating neurorehab DVT Prophylaxis Sore avoidance
73
Most common symptoms of MS?
TEAM Tingling Eye (Optic neuritis) Ataxia (+ Cerebellar signs) Motor (Spastic Paraparesis) Lhermitte's Sign (electric shock down neck)
74
What is the diagnosis criteria for MS called?
McDonald's Sign
75
MS management?
MDTapproach Acute = steroids Disease modifying = IFN-B Biologics = Natalizumab Symptomatic (pain - amitryptiline, spasticity baclofen
76
What can cause bilateral distal symmetrical LMN signs?
Motor peripheral Polyneuropathy - CMT, lead poisoning, paraneoplastic
77
What might cause bilateral symmetrical proximal LMN signs?
Muscular dystrophy Poly/Dermatomyositis Cushing's Thyrotoxicosis Steroids, Statins Paraneoplastic
78
What might cause unilateral LMN signs?
Group of muscles with same supply = Peripheral mononeuropathy or nerve root damage
79
What can cause hand wasting
Anterior Horn: Syringeomyelia, MND, Polio Roots: Spondylosis (C8,T1) Brachial Plexus: Cervical Rib Neuropathy: CMT, Mononeuritis Multiplex Muscle: Myotonic Dystrophy, RA
80
How does a peripheral neuropathy (sensory) present?
DM, Alcohol, B12 bilateral, symmetrical, glove and stocking distribution. Loss of tendon reflexes. Signs of trauma/deformity. Loss of proprioception
81
How does a peripheral neuropathy (motor) present?
CMT, Paraneoplastic, GBS Bilateral, symmetrical LMN weakness Low tone, hyporefllexia
82
How would you investigate peripheral neuropathy?
urine dip FBC (Infection), LFTs with GGT (Alcohol), U&E (CKD), Glucose and HBA1c, TFTs, B12, Folate CXR (Paraneoplastic) Nerve conduction studies Nerve Biopsy MRI if in doubt about location of lesion
83
CMT
84
CMT
85
Pt has: peripheral muscle wasting Stepping Gait Weak dorsiflexion Absent ankle jerk Variable sensory loss
CMT MDT, foot care, orthoses
86
Parkinson's presentation
Inspection: asymmetric resting tremor, mask-like facies, dysphonia Gait: Shuffling, absent arm swing Arms: Cogwheeling/lead pipe rigidity, normal power/reflexes, tremor, bradykinesia, coordination Eyes: Vertical gaze palsy if PSP, nystagmus if MSA Function: Struggles with buttons/tying shoes
87
Mask-Like facies
88
Vertical gaze palsy - PSP
89
Parkinson's Ix
Full history LL/CN Exam - look for PSP/MSA Lying Standing BP MMSE Test for micrographia Drug Chart (Iatrogenic) Bloods - FBC, U&Es, LFTs, Lipids, HBA1c, Copper studies CT/MRI
90
Parkinson's Mx
MDT L-dopa + Carbidopa Dopamine agonists MAO-B Inhibitors
91
Parkinsonism syndrome causes
PD PSP, MSA, LBD Vascular Metoclopramide, Prochlorperazine
92
PSP
PD plus postural instability, vertical gaze palsy
93
MSA
PD plus autonomic failure (cerebellar signs, postural hypotension)
94
Side effects of L-Dopa?
Dyskinesia On/Off Insomnia
95
Cerebellar signs
DANISH Dysdiadochokinesia Ataxia Nystagmus Intention tremor Scanning dysarthria Hypotonia
96
Causes of cerebellar syndrome
DAISIES Demyelination Alcohol Infarct SOL Inherited (ataxia telangiectasia, Friedrich's) Epilepsy meds System Atrophy
97
CN 5,6,7,8 + cerebellar signs
Vestibular Schwannoma
98
Pt presents with: Pes cavus Bilateral Cerebellar Ataxia Leg wasting Arreflexia Loss of vibration and proprioception
Friedrich's Ataxia AR mitochondrial disorder Degeneration of dorsal column, spinocerebellar tracts and corticospinal tracts
99
Cerebellar exam
Inspection Gait Romberg Arms Coordination Eyes Speech
100
What might cause bilateral ptosis?
MG Myotonic Dystrophy

Finals Elliot (12 decks)

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