Station 3: Neurological

Question 1

Causes of mononeuritis multiplex

Answer 1

Wegners
AIDS and Amyloidosis
Rheumatoid arthritis
Diabetes
Sarcoidosis

Polyarteritis nodosa
Leprosy
Carcinomatosis

Question 2

Causes of median nerve neuropathy

Answer 2

Myxoedema (hypothyroidism)
Enforced flexion 
Diabetes
Idiopathic
Acromegaly
Neoplasms

Tumours
Rheumatoid arthritis
Amyloidosis
Pregnancy
Sarcoidosis

Question 3

Features of ulnar nerve palsy

Answer 3

Loss of sensation over 4th / 5th finger
Hypothenar wasting
Loss of abduction and adduction of the fingers

Nb. Lesions at the wrist have a more pronounced claw hand due to retained function of flexor digitorum profundus

Question 4

Radial nerve palsy

Answer 4

Loss of function of
Brachioradialis
Extensors
Supinator
Triceps

Question 5

Causes of lower motor neurone facial nerve palsy

Answer 5

Idiopathic (Bells)
Ramsay Hunt
Lyme disease
Diabetes
Sarcoidosis
Parotid tumours
Otitis media

Question 6

Argyll Robertson pupil

Answer 6

Constricted
Accommodates
Irregular
Atrophied iris

Look for sensory ataxia
Usually caused by neurosyphillis

Other: Lyme, HIV, sarcoidosis, VZV, MS, paraneoplastic

Question 7

Holmes Adie pupil

Answer 7

Dilated pupil
Slow to accommodate
Sluggish reaction to light

Usually benign

Other: Lyme, syphilis, parvovirus, HSV, autoimmune

Question 8

Marcus Gunn pupil

Answer 8

Swinging flashlight test: paradoxical dilatation of pupil as a light is shone into it

Causes by optic nerve damage and retinal disease

Question 9

Horners syndrome

Answer 9

Partial ptosis
Reduced sweating
Constructed pupil

Causes:
Carotid artery aneurysm or dissection
Pancoast tumour
Spinal cord tumour
Brainstem lesion e.g. multiple sclerosis, stroke (Wallenbergs)
Syringomyelia

Question 10

CNIII palsy

Answer 10

Eye is down and out
Pupil dilatation
Ptosis

Causes:

Pupil sparing = medical e.g. diabetes, micro vascular disease, demyelination, midbrain infarction, mononeuritis multiplex

Pupil involved = surgical e.g. posterior communicating artery aneurysms, cavernous sinus pathology, cerebral uncus herniation

Question 11

Cavernous sinus lesions affect which cranial nerves

Answer 11

III
IV
V
VI

Question 12

Causes of a predominantly sensory neuropathy

Answer 12

Diabetes
Renal failure
B12 deficiency
Alcohol
Drugs e.g. isoniazid and vincristine

Question 13

Causes of a predominantly motor neuropathy

Answer 13

Hereditary sensorimotor neuropathy
Lead toxicity
Guillian Barre syndrome
Porphyria

Question 14

Causes of predominantly autonomic neuropathy

Answer 14

Diabetes
Connective tissue disease e.g. SLE and RA
Vasculitis
Infections e.g. HIV
Malignancy

Question 15

Causes of testing tremor

Answer 15

Parkinson’s disease
Drug induced parkinsonism e.g. antipsychotics
Multiple systems atrophy
Corticobasilar degeneration
Lewy Body dementia
Vascular parkinsonism
Progressive supranuclear palsy

Question 16

Causes of postural tremor

Answer 16

Thyrotoxicosis
Anxiety
Benign essential tremor
Hypercapnia
Hepatic encephalopathy
Alcohol

Question 17

Causes of intention tremor

Answer 17

Cerebellar disease

E.g. stroke, tumours, paraneoplastic, alcohol