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Lectures final revision > Zul's Revision lecture > Flashcards

Zul's Revision lecture Flashcards

1
Q

eye is down and out, ptosis and DILATED pupil

A

Compression of 3rd nerve.

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2
Q

Causes of 3rd nerve palsy

A

Pupil sparing and non pupil sparing

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3
Q

Does pupil dilate early or late in surgical 3rd nerve palsy and why?

A

Early because parasympathetic fibre are on the outside so compress first.

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4
Q

Why look at eyes in emergencies?

A

LOOK THIS UP

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5
Q

Easy things to also measure

A

BM and BP

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6
Q

how can the causes of ptosis be seperated?

A

Unilateral and Bilateral

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7
Q

Unilateral ptosis - causes

A

Horners
3rd nerve palsy
MG

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8
Q

Bilateral ptosis - causes

A

Myasthenia
Dystrophia Myotonica
Bilateral horner

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9
Q

Ptosis and small pupil

A

Horners

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10
Q

Ptosis and large pupil

A

3rd nerve palsy

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11
Q

Ptosis and normal pupil

A

MG

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12
Q

Causes of 6th nerve palsy

A

DM
HTN
MS
Raised ICP

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13
Q

When would someone with 4th nerve palsy complain of double vision

A

Looking down stairs

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14
Q

in double vision which is the ‘bad eye’

A

one that projects the outer image

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15
Q

Early signs of raised ICP

A

Loss of retinal vein pulsation

Late - papilloedema

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16
Q

What is cushings triad?

A

Bradycardia,
increased blood pressure,
irregular breathing (pressure on resp centre)

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17
Q

Why is the 6th nerve affected first in raised ICP

A

Has the longest intra-cranial course. Compression over the Petras Temple

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18
Q

What is spastic paraperesis

A

Increased tone and reflexes
Decreased power bilaterally
ankle clonus

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19
Q

Causes of spastic parapersis

A 
Cerebral Palsy
Stroke
Cord compression
Cervical spondylosis
MS
MND
CVA
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20
Q

How is spasticity described

A

Clasp knife

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21
Q

Rigidity

A

Same tension throughout

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22
Q

When a patient has spastic paraperesis in neuro exam what else might you think to do?

A

Sensory levels
Upper limb reflexes
cranial nerves

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23
Q

Recall the sites of the dermatones

A

The dance

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24
Q

If a patient has back pain what questions should you ask

A 
anal numbness
urinary symptoms
faecal incontinence
change in sensation when passing urine
sexual dysfunction
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25
Q

Causes of wasting of the small muscles of the hands

A

bilateral and unilateral

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26
Q

Bilateral wasting of small muscles of hands - causes

A

RA
Cervical Spondylitis
MND

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27
Q

Unilateral wasting of small muscles of hands - causes

A

Pancosts tumour
Brachial plexus trauma
Cervical rib

28
Q

What is Neurofibromatosis

A

Neurofibromatosis is a genetic disorder that causes tumors to form on nerve tissue.
Auto Dom Chrom 17

29
Q

What will you see on the patient with NF

A

freckling in axilla

dermal and neuronal fibroma

30
Q

How many and what size of cafe au laits spots

A

> 5 and >15mm in size

31
Q

Complications of T1 NF

A

Renal Artery Stenosis - HTN
Thoracic Kyphosis
Malignant change in 10%

32
Q

What triad is seen in NF T1

A

Lisch nodules
Neurofibromas
Cafe au lait spots

33
Q

Crowe’s signs

A

Axilla freckling in NF T1

34
Q

In facial palsy what are the ddx

A

Bells
Stroke
Ramsay Hunt
Lymes disease

35
Q

What is Ramsay Hunt Syndrome

A

reactivation of herpes zoster in the geniculate ganglion. It is sometimes called herpes zoster oticus, and has variable presentation which may include a lower motor neuron lesion of the facial nerve, deafness, vertigo, and pain

36
Q

Where to look for Ramsay hunt

A

around the ear - herpes Zoster

37
Q

What questions may be needed in facial palsy?

A

Change in taste sensation

Any loud exaggerated sounds (Horners)

38
Q

What is the earliest sign of a cerebellar pontine angle lesion?

A

Loss of corneal reflex

cornea is over the iris and is not the sclera

39
Q

What is charcot marie tooth

A

hereditary motor and sensory neuropathies, a group of varied inherited disorders of the peripheral nervous system characterized by progressive loss of muscle tissue and touch sensation across various parts of the body.

Starts in small muscles of the hands

40
Q

What shape does a sub dural make on CT

A

Crescent shape

41
Q

What shape does an extra dural make

A

Lens shape

42
Q

What do you want to know about a rash on an elbow

A

Itch
Do you have eczema?
Lichenification
Associated with hayfever and asthma

43
Q

How to describe psoriasis?

A

Salmon pink discoid patches with silver discoloration on extensor surfaces

44
Q

What else to examine in Psoriasis?

A

Joints
Nails for pitting, oncholyisis, subungal hyperkeratosis
Scalp

45
Q

Koebner Phenomenon is seen in which conditions

A

Vitiligo
Psoriasis
Lichen Planus
Warts

46
Q

What is Acanthosis Nigricans?

A

dark, velvety discoloration in body folds and creases

47
Q

What is aconthosis nigricans associated with

A

Cushings and Diabetes

48
Q

What are the cardiac causes of Syncope?

A

AS
Arrythmias both fast and slow
Fast - VF and VT
Slow - Bradycardia

49
Q

What type of MI might cause bradycardia

A

Inferior MI as the same vessel (RCA) as SAN

50
Q

Triad seen in Parkinson

A

Bradykinesia, tremor and rigidity

51
Q

Describe the cog wheel rigidity

A

it is a tremor superimposed upon lead pipe rigidity

52
Q

What is Shy-Drager Syndrome

A

Multi System Atrophy.

Get Parkinsonism and more pronounced autonomic dysfunction.

53
Q

Supra Nuclear Palsy

A

slurring of speech, difficulty swallowing, and difficulty moving the eyes, particularly in the vertical direction. Can’t look up

54
Q

How would you examine the hands of someone with RA

A

Any pain

I see - 
bilateral deforming arthropathy
wasting of the small muscles of the hands
swan neck deformity of fingers
Z shape deformity of the thumb

Are they warm to touch - active disease

any rheumatoid nodules

Examine
eyes, neck, heart, lungs, abdo (splenomegaly) and peripheries for peripheral neuropathy

55
Q

What nerve is affected in Pagets

A

8th nerve compression

Small bones of the ears fuse

56
Q

What to patients with pagets disease die of?

A

High output heart failure from capillary expansion in bone.

57
Q

Causes of bowed legs

A

Vit D deficiency
Osteogenesis Imperfecta
Pagets

58
Q

What is Myotonic Dystrophy

A

Long term genetic disorder with gradual worsening muscle loss and weakness of muscles.

Heart conduction problems
Early balding
Long face
Muscle contraction with poor relaxation
Cataracts

No cure.
Pain with TCAs and NSAIDS
Pacing and Ventilation

59
Q

Causes of hypoglycaemia

A

SAILSQ

Sulphonylureas
Alcohol
Insulin overdose
Liver disease
Sepsis
Q - IV Quinine
60
Q

What is the classic history of Addisons?

A

Weight loss
Abdo pain
Ill fitting clothes
Postural hypotension - IMPORTANT TO DO THIS TEST

Pigmentation - hands and points of pressure, lips, mouth, nipples and scars.

61
Q

What are the causes of addisonian crisis?

A 
Autoimmune
Stopping steroids
TB (in adrenals)
HIV - CMV associated infeciton
Mets to adrenals
Amyloidosis
62
Q

For Addisonian crisis what tests are important?

A

ABG acutely
Short SYNACTHEN test

Na - goes down
K goes up
Glucose goes down
Urea increases as dehydrated

63
Q

Rx of addisonian crisis

A

Iv 200mg hydrocortisone
fluids

Rx cause

64
Q

Advice should be given to someone with addisons

A

Double steroids when unwell
Medic alert bracelet
Don’t suddenly stop steroids
lifelong Rx

65
Q

What are the complications of Mitral Stenosis>

A

P Hypertension

RHF

66
Q

What will you find on examination of P hypertension

A

Loud P2
Left Parasternal heave
Grey Steele Murmur - back flow to pulmonary valve
pulm regurg murmur.

Lectures final revision (10 decks)

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