Passmed Notes

Question 1

What movements test for the C5 myotome?

Answer 1

Elbow flexion

Question 2

What movements test for the C6 myotome?

Answer 2

Wrist extension

Question 3

What movement tests for the C7 myotome?

Answer 3

Elbow extension

Question 4

What movements test for the C8 myotome?

Answer 4

Finger flexion

Question 5

What movements test for the T1 myotome?

Answer 5

Finger abduction

Question 6

What movements test for L2 myotome?

Answer 6

Hip flexion

Question 7

What movements test for the L3 myotome?

Answer 7

Knee extension

Question 8

What movements test for L4 myotome?

Answer 8

Ankle dorsiflexion

Question 9

What movements test for the L5 myotome?

Answer 9

Long toe extension

Question 10

What movement tests for the S1 myotome?

Answer 10

Ankle plantar flexion

Question 11

What pathology arises when there is damage to the common peroneal nerve?

Answer 11

Weakness in dorsiflexion and eversion. This results in the patients having a footdrop.

Question 12

How do you differentiate between L5 radiculopathy and common peroneal nerve palsy?

Answer 12

L5 radiculopathy results in weakness in dorsiflexion, inversion and hip abduction.

Question 13

What is the first line treatment for neuropathic pain?

Answer 13

Amitryptyline, Gabapentin, Duloxetine, Pregabalin

Question 14

What happens if one neuropathic painkiller doesn’t work e.g. gabapentin?

Answer 14

You swap it with another neuropathic pain killer. You do not add neuropathic pain killers together!!
E.g. swap gabapentin for pregabalin/amitryptyline/duloxetine

Question 15

What drug can be used as rescue therapy if first line neuropathic painkillers do not work?

Answer 15

Tramadol

Question 16

What drug can be used for localised neuropathic pain e.g. post-herpetic neuralgia?

Answer 16

Topical capsacin

Question 17

What is acute disseminated encephalomyelitis?

Answer 17

Acute disseminated encephalomyelitis is a condition where the autoimmune system attacks the myelin sheath of the CNS, often following a bacterial/viral infection.

Question 18

What MRI features are characteristic of acute disseminated encephalomyelitis?

Answer 18

Demyelination in supra and infra-tentorial regions.

Question 19

How quickly do patients with acute disseminated encepholomyelitis develop symptoms following a viral/bacterial infection?

Answer 19

Patients with acute disseminated encephalomyelitis develop neurological symptoms between few days to 2 months after onset of infection.

Question 20

How do we treat acute disseminated encephalomyelitis?

Answer 20

Glucocorticoids & IVIG if glucocorticoids fail

Question 21

What is the single most important blood marker for restless leg syndrome?

Answer 21

Serum ferritin

Question 22

What are the clinical features of restless leg syndrome?

Answer 22

1) An uncontrollable urge to move legs (akathisia). This uncontrollable urge typically occurs at night, but as the condition progresses, patient may develop symptoms during the day.
2) This uncontrollable urge to move legs tends to be at its worst when the patient is at rest.
3) The patient may also have parasthesia –> crawling/throbbing sensations.
4) Periods of movements whilst patient is asleep may be noted by partner.

Question 23

What are the main causes of restless leg syndrome?

Answer 23

In 50% of the cases, the cause is unknown –> idiopathic in nature.
However, other known causes of restless leg syndrome include:
1) Iron deficiency anaemia –> this is why knowing the ferritin level is really key blood marker for this condition.
2) Uraemia
3) Diabetes mellitus
4) Pregnancy

Question 24

How do we treat restless leg syndrome?

Answer 24

1) Simple measures such as walking / stretching/ massaging affected limbs
2) Treating the iron deficiency anaemia
3) Dopamine agonists (such as pramipexole or ropinirole) are usually first line drug treatments
4) Benzodiazipines
5) Gabapentin

Question 25

What are the clinical features of an essential tremor?

Answer 25

Tremor that is worse when the arms are outstretched.

Question 26

What can make an essential tremor better?

Answer 26

Resting and alcohol

Question 26

What is the first line treatment for essential tremor? Aside from first line treatment, what can sometimes be used?

Answer 26

Propranolol is first line ; primidone can sometimes be used.