pastest 2 Flashcards
where does the saphenous nerve supple
anetriomedial aspect of the knee, leg and medial malleolus
when can saphenous nerve be damaged
during femoral vein catheterisation
ankle reflex
L1/L2
knee reflex
L3/L4
biceps reflex
C5/C6
triceps reflex
C7/C8
femoral nerve give rise to what nerve
anterior cutaneous and saphenous
where does femoral nerve bifurcate
inch below inguinal ligament
lateral cuteness of thigh arises from
branch of lumbar plexus
posterior cutaneous nerve of thigh arises from
sacral plexus
what nerve supplies dorsum of foot
peroneal nerve
peroneal nerve splits into superficial and deep, which does each innervate
superficial innervates all of dorsum except web space between 1st and 2nd toe which is innervated by deep peroneal
sural nerve supplies where
posterolateral lower leg, lateral heel, lateral aspect of foot and pinky
what is the thenar eminence
muscles at base of thumb
wasting of thenar eminence indicates what pathology
carpal tunnel syndrome (usually chronic in wasting)
wrist drop: what nerve
radial nerve
radial nerve supplies sensory to where
dorsal aspect of hand
what pathology causes a non-communicating hydrocephalus
pineal gland tumour
why do you get hydrocephalus with a pineal gland tumour
blocked CSF from lateral and 3rd ventricle flowing into 4th ventricle and subarachnoid space
how do you treat non communicating hydrocephalus
shunt between 3rd and 4th ventricle
wrist drop =
radial nerve
radia lnerev is what part of brachial plexus
terminal branch of posterior cord
radial nerve carries fibres from which levels
C5-C8
radial nerve sensory is from which level
T1
what muscles do radial nerve innervate
muscles of dorsal arm: anconuos and triceps bracii
extrinsic extensors of the wrist and hand
where does radial provide sensory
back of hand
axillary nerve originates in ____ cord of the brachial plexus
posterior cord
axillary nerve carries fibre from which levels
C5 and C6
axillary nerve innervates what muscles (3)
deltoids
long head of triceps brace
teres minor
median nerve is formed from which brachial plexus cords
lateral and median cords
median cord originated from which roots
C8 and T1
lateral cord originate from what levels
C5, C6, C7
brachial plexus made up of
C5, C6, C7, C8 and T1
sensory loss to lateral side of forearm
musculocutaneous nerve
what nerve if weak supination and flexion at elbow
musculocutaneous nerve
ulnar nerve comes from which cord of brachial plexus
medial cord
ulnar nerve originates from which nerve roots
C8 and T1
nerve impingement in elbow called
cubital tunnel syndrom: ulnar nerve
ulnar nerve sensory to where
pinky and lateral half of 4th digit
the main descending motor pathway
cortical spinal pathway
corticospinal tract fine details
motor cortex to alpha motor neurones in ventral horn of spinal cord
signs of upper motor neurone lesions
weakness, wasting, hyperflexia and fasciculations
ash leaf, cafe olay
tuberous sclerosis
cluster headache: uni or bi lateral
unilateral
migraine: uni or bilateral
unilateral
tension: uni or bilateral
bilateral
treatment for cluster head aches
high flow oxygen and sumatriptan
cluster headache prophylaxis
verapamil (calcium channel blocker)
what type of dementia has fluctuations
lewy body
dementia that has hallucinations
lewy body
eye looking in and down
4th nerve palsy
nerve palsy where the person may tilt their head
4th
how many CAG repeats result in fully penetrant huntingtons
41+
huntingtons inheritance
autosomal dominant
essential tremor inheritance
autosomal dominant
how many CAG repeats result in partial penetrance in huntingtons
36-40
what drug can help in huntingtons
tetrabenazine
neurofibromatosis 1 will have:
peripheral involvement
- cafe aule
- axillary and inguinal freckles
- skin neurifibromas
neurofibromatosis 2 will get:
central:
- bilateral acoustic neuromas
- cranial nerve and CNS tumours
what is ramsay hunt syndrome
herpes zoster of external acoustic meatus
bells palsy symptoms + facial spasm =
MS
parkinsons is
reduced dopamine production from the substantial nigra of the basal ganglia
in parkinsons, why can’t we just replace dopamine
it doesn’t cross BBB
treatment for parkinson
L-dopa (levodopa)
what is levodopa
dopamine precursor (that can cross BBB)
what other drug must be given along with levodopa
a dopa decarboxylase inhibitor (can’t cross BBB) such as carbidopa
what does carbidopa do?
inhibits peripheral dopa decarboxylase which converts levodopa to dopamine (stops formation of peripheral dopamine which has bad side effects)
side main effects of levodopa (peripheral dopamine)
low BP
nausea
vomiting
what enzyme in brain breaks down dopamine
MAO-B (monoamine oxidase B)
what drug can you give to inhibit monoamine oxidase B (MAO-B)
selegiline - increases dopamine and increase L-dopa activity
when is MAO-B inhibitors most effective
early and late stages of parkinsons
which enzyme eliminates L-dopa
COMT - acetechol-O-methyltransferase
what drug do you give to inhibit L-dopa clearance by COMT (acetechol-O-methyltransferase)
entacapone
good drug for resting tremor
muscarinic antagonists: benzatropine
in 3rd nerve palsy you will see:
ptosis (drooping eye lid)
mydriasis (big pupil)
horners syndrom you wil see:
ptosis (drooping eye)
mitosis (small pupil)
anhydrosis
what causes horners
lesion of sympathetic truck (if smokes, apical lesion of lung)
age when motor neurone disease occurs
middle age
what is the mainly affected area in motor neurone disease
anterior horn of spinal cord (hence why only motor affected) and motor neurones in motor cortex
UMN or LMN symptoms seen in motor neurone disease
Both
fasciculations in motor neurone disease?
yes, prominent
most common form of motor neurone disease
amyotrophic lateral sclerosis (ALS)
glove and stocking weakness
guillen-barre syndrome
ascending paralysis
guillen-barre syndrome
high protein and lymphocytes in CSF indicates
viral meningits
** can also be TB but viral more common**
anti epileptic drug that causes cerebellar symptoms
phenytoin
phenytoin is a
anti epileptic
risk of taking phenytoin and why
phenytoin toxicity - small therapeutic window
rinies test will normally show what findings
conduction (air) louder than sensoneural (bone)
normal webber test will show
sound central
webber test: louder in left ear following normal rinses indicates what?
loss of neurosensory in right ear
findings in conductive hearing loss
rinnies: bone will be louder than air
weber: sond localises to affected ear
head injury with lucid period
extradural
common complication of subdural haematoma
recurrent bleed
alpha beta amyloid in brain =
familial alzheimers
familial alzheimers is also called
early onset
familial alzheimers is due to mutation in what
amyloid precursor protein (APP)
what is normal processing of amyloid precursor protein (APP) and how does it go wrong in early onset alzheimers
normally cleaved by gamma and alpha secretase, instead cleaved by gamma and bets secretes forming alpha beta -amylase. this accumulates and causes early onset.
young, neurological and psychiatric symptoms
wilsons
how do you diagnose wilsons
24 hour urine collection - will show higher than normal copper content
dementia + hallucinations
lewy body dementia
lewy body dementia: histological findings
alpha-synuclein cytoplasmic inclusions (Lewy bodies) in the substantia nigra, paralimbic and neocortical areas
what part of brain is more pale in parkinsons
substantia nigra
part of brain affected in lewy body (3)
substantia nigra, paralimbic and neocortical
which 2 dementias are strongly interlinked
lewy and alzheimers
what drugs should be avoided in lewy body
neuroleptics (antipsychotics)
what avoid antipsychotics in lewy body
cause irreversible parkinsonism
lewy body diagnosis
- clinical
- single-photon emission computed tomography (SPECT)
