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Medicine > Upper and lower limb neurology OSCE > Flashcards

Upper and lower limb neurology OSCE Flashcards

1
Q

What is carried through the spinal thalamic tracts?

A
  • Pain
  • Temperature
  • Crude touch
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2
Q

What is carried through the dorsal columes?

A
  • Light touch
  • Vibration
  • Proprioception
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3
Q

What pathology of the spine that would cause disruption to the spinal thalamic tract?

A
  • Syringomyelia
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4
Q

What pathology of the spinal cord would cause pathology of the dorsal columes?

A
  • Tabes dorsalis (syphilis)

- SCDC (subacute degeneration of the cord)

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5
Q

Syringomyelia what are the characteristics?

A
  • Expansion of spinal cord central canal due to CSF blockage. (Chiari malformation)
  • Spinalthalamic fibres principally affected
  • Loss of pain & temnperature sensation in the cape like distribution over arms shoulder and upper body
  • Lower motor neuron signs in upper limb and upper motor neuron signs in lower limb (spastic paraparesis) of lower limb
  • Dorsal column signs develop as canal further expands
  • Syringobulbia if syrinx extends into brainstem
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6
Q

What is erbs palsy?

A

C5 - C7 damaged during birth.

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7
Q

How would a patients arm be held in erbs palsy?

A

Waiters tip position

  • Shoulder ADducted
  • Arm internally rotated
  • Forearm pronated
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8
Q

What is Klumpke’s palsy?

A

C8-T1 damaged during birth

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9
Q

What are findings on a patient with Klumpke’s

A
  • Sensory loss on medial forearm
  • Complete claw hand
  • Wasting of the small muscles of the hand
  • Horners syndrome may co-exist
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10
Q

Causes of Paraparesis (bilateral leg weakness) that is acute and progressive.

A

Acute & Progressive - very unlikely in OSCEs

  • Acute spinal cord progression (UMN)
  • Cauda equina (LMN)
  • Gullian Barre Syndrome (LMN)
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11
Q

Causes of spastic paraparesis. (Bilateral UMN signs)

A
  • Sagittal sinus lesion
    • Parasagital meningioma
  • Bilateral stroke
  • Syringomyelia (with upperlimb involvement)
  • Cord trauma (e.g. Road traffic accident)
  • Cord compression
    • Extradural tumour
    • Disc prolapse
    • Spondylosis
    • Osteophytes
  • Intrinsic cord disease
    • Tumour
    • Vascular myelopathy
    • Multiple sclerosis
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12
Q

Causes of flaccid paraparesis - Bilateral LMN signs

A
  • Polio
  • Mostly motor peripheral neuropathy
    • Gulliane barre
    • Lead poisoning
    • Charcot Marie Tooth
  • Mixed peripheral neuropathy
    • Diabetic
    • Uraemic
    • Vitamin deficiency (B12, folate, thiamine)
    • Paraneoplastic
    • Alcohol
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13
Q

Causes of unilater leg weakness

A 
UMN
   - Stroke
   - Tumour
   - MS
LMN
   - Root lesion
   - Nerve
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14
Q

What is SCDC (B12 / Folate deficiency)?

And how does it present

A 
Subacute combined degenration of the cord
present with
   - Spastic paraparesis
   - Upgoing plantars
   - Reduced knee jerks
   - Loss of ankle jerks
   - Dorsal column loss
      - Loss of vibratory, joint position sense & Sensory ataxia
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15
Q

What is amyotrophic lateral sclerosis and what are the signs?

A

A type of MND and is the most common MND

LMN signs

  • weakness
  • wasting
  • Fasciculation

UMN signs

  • Spasticity
  • Brisk reflexes
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16
Q

What are the causes of foot drop?

A
  • Common peroneal nerve palsy
  • Stroke
  • L4/L5 root lesion
  • MND
  • Charcot-Marie-Tooth syndrome
17
Q

What do you if there is upper motor lesion signs in the lower limbs with unaffected upper limb?

A
  • Sensory assessment of thorax to ascertain level
18
Q

Causes of a T1 lesion

A
  • Cervical spondylosis
  • Pancoast tumour
  • Plexus trauma / Birth injury (klumpke’s palsy)
19
Q

Clinical features of T1 lesion

A
  • Total claw hand (loss of all lumbricals
  • Wasting small muscles of the hand
  • Pain / Sensory loss in the medial forearm
  • Horner’s syndrome may co-exist
20
Q

Causes of carpal tunnel syndrome

A
  • Idiopathic (majority of cases)
  • Pregnancy
  • RA
  • Hypothyroidism
  • Diabets
  • Acromegaly
21
Q

What is saturday night palsy?

A
  • Compression of the radial nerve against the humerus by falling asleep with your arm over the back of the chair.
22
Q

How would a person with saturday night palsy present?

A
  • wrist drop
  • Numbnees on the radial spot on the dorsum of the hand
  • Triceps may be spared and you know why LOL

Medicine (22 decks)

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