Phase 3a (GP oxford handbook notes) Flashcards
what types of lesions are indicated by absent or decreased reflexes?
sensory nerve or root (e.g neuropathy, spondylosis)
anterior horn cell (MND, polio)
motor nerve or root (neuropathy, spondylosis)
nerve endin e.g myasthenia gravis
or muscle (myopathy)
type of lesion indicated by increased reflexes
upper motor neurone lesion - lack of higher control e.g post stroke
what does clonus normally indicate?
UMN lesion
what rhyme can help to remind you which nerve roots innervate which reflexes?
give answers for ankle jerk, knee jerk, biceps and triceps
One, two– buckle my shoe (S)
Three, four– kick the door. (L)
Five, six– pick up sticks. (C)
Seven, eight– shut the gate. (C)
S1,2 = ankle jerk (plantar flexion) L3,4 = knee jerk (knee extension) C5,6 = biceps and brachioradialis (elbow flexion) C7,8 = triceps (elbow extension)
what mneumonic is used to help name all the cranial nerves in order?
what is used to help remember if they are sensory, motor or both?
Oh - olfactory (sensory) Oh - optic (sensory) Oh - oculomotor (motor) to - trochlear (motor) touch - trigeminal (both) and - abducens (motor) feel - facial (both) virgin - vestibulochoclear (sensory) girls - glossopharyngeal (both) vaginas - vagus (both) and - accessory (motor) hymens - hypoglossal (motor)
some say money matter but my brother says big boobs matter more
when testing the optic nerve three possible findings are
monocular blindness
bitemporal hemianopia
homonymous hemianopia
what are the common cause for these three presentations?
mono - MS, giant cell arteritis
bitemp hemi - pressure on optic chiasm (pituitary adenoma)
homonymous hemi - affects half the visual field on the side OPPOSITE to the lesion - stroke, abscess, tumour
what nerve is effected if the eye is pointing ‘down and out’ and what are the possible causes?
3rd nerve = down and out (tramps palsy)
+/- pupil being large
DM, giant cell arteritis, syphilis, PCA aneurysm, idiopathic
if pupil is NORMAL size, DM or other vascular cause
a lesion in the 7th nerve causes what presentation?
whats the difference between and upper motor neuron lesion or a lower motor neurone lesion in this nerve?
facial nerve: causes unilateral facial weakness and drooping
upper motor neuron - e.g from a stroke (or tumour). You get forehead sparing so only affects lower 2/3rd of the face
lower motor neurone - e.g Bell’s palsy, (also otitis media, polio, skull fracture, pontine angle tumour, parotid tumour, herpes zoster
affects whole side of face
describe how bells palsy presents?
cause?
unilateral facial weakness and drooping, WITHOUT any other neurological signs, usually sudden onset
idiopathic, ?viral
management of bells palsy
give prednisolone if <72 hours onset
self limiting normally, reassure.
85% should begin to improve within 3 weeks - refer if not, and most will be fully recovered by 3-4 months
conservative measures - eye drops to lubricate, tape eye shut at night if won’t close, avoid things which might irritate eye such as swimming.
what is ramsay hunt syndrome?
basically bells palsy caused by herpes zoster virus, preceded by severe pain in ear and companied by zoster rash. if <24 hours after rash appears, can give antivirals (acyclovir)
how does carpal tunnel present?
what nerves are involved?
loss of sensation over lateral 3 and 1/2 fingers and palm +/- wasting of thenar eminence and inability to flex thumb.
median nerve - roots C5-T1
how does gillian barre polyneuritis present? and what is it?
ascending motor neuropathy - may advance fast. proximal worse than distal - so trunk, resp and cranial nerves can also be involved.
develops within few weeks of infection (campylobacter - GI, but also URTI, flu) or afters surgery or vaccination.
prognosis good - 85% make complete or near complete recovery
what should you do if you suspect someone with gillian barre syndrome presents and why?
resp invovlement is the danger due to possible requirement of ventilation of ITU- admit to hosp immediately if suspected.
whats the main cause of an antalgic gait?
gait adjusted to minimise pain in a joint - most often OA of the hip
compare a drunken gait to a sensory ataxic gait and what causes them?
what test should you do to tell the difference?
how can you use it to localise the possible location of a lesion?
wide based gait with patient looking forwards and placing feet down carefully is drunken
wide based gait with patient watching their feet is sensory ataxic and stamping feet down clumsily
test rombergs - if romburg positive more suggestive of sensory ataxic
alcohol or cerebellar lesion –> they will fall to the side of the lesion for drunken gait
sensory ataxic = peripheral neuropathy pr spinal cord disease (cervical spondylsosis, MS, syphilis,
how might foot drop present?
what test should you do to narrow down the cause?
patient tripping frequently or a high stepping gait. unable to walk on heels and cannot dorsiflex the foot
check the ankle reflex!
what are the possible causes of foot drop? and how does the ankle jerk help to narrow this down?
common peroneal palsy - trauma, normal ankle jerk
sciatica - absent ankle jerk
L4,5, root lesion - ankle jerk may be absent
peripheral motor neuropathy - weak or absent
distal myopathy - weak or absent
MND - increased ankle jerk!
describe hemiplegic gait and who it presents in?
arm adducted and internally rotates, elbow flexed +/- finger flexion with foot plantar flexes and leg swings around in a lateral arc
UMN lesions - stroke often
describe a parkinsonian gait?
shuffling - short steps with feet barely leaving ground (audible)
turning ‘en bloc’ - multiple small steps required to turn
gait freezing - inability to move feet and may worsen in tight spaces (through a door) or when initiating walking (so hesitant to start/walk through door)
lack of normal arm swing (normally unilateral in parkinsons)
describe a scissor gait and who it might present in ?
patient walks on tiptoe and knees rub together/cross during the walking cycle which may be accompanied by complex arm movements to assist walking
spastic paraplegia
who do you classically see a waddling gait in?
proximal myopathy e.g MD
but other causes are pregnancy/congenital dislocation of the hip
describe the two main types of tremor and what they are commonly assocaited with?
resting tremor - present at rest but stops when doing voluntary movement: PD (pill rolling, rhythmic)
intention tremour - irregular, large amplitude tremour, worse on movement particularly like pointing: cerebellar disease
what is chorea and what conditions are assocaited with it?
non rhythmic, jerky, purposeless movements with volunarty movements possible in between.
dyskinetic cerebral palsy or huntingtons disease
