Zul's Revision lecture Flashcards
eye is down and out, ptosis and DILATED pupil
Compression of 3rd nerve.
Causes of 3rd nerve palsy
Pupil sparing and non pupil sparing
Does pupil dilate early or late in surgical 3rd nerve palsy and why?
Early because parasympathetic fibre are on the outside so compress first.
Why look at eyes in emergencies?
LOOK THIS UP
Easy things to also measure
BM and BP
how can the causes of ptosis be seperated?
Unilateral and Bilateral
Unilateral ptosis - causes
Horners
3rd nerve palsy
MG
Bilateral ptosis - causes
Myasthenia
Dystrophia Myotonica
Bilateral horner
Ptosis and small pupil
Horners
Ptosis and large pupil
3rd nerve palsy
Ptosis and normal pupil
MG
Causes of 6th nerve palsy
DM
HTN
MS
Raised ICP
When would someone with 4th nerve palsy complain of double vision
Looking down stairs
in double vision which is the ‘bad eye’
one that projects the outer image
Early signs of raised ICP
Loss of retinal vein pulsation
Late - papilloedema
What is cushings triad?
Bradycardia,
increased blood pressure,
irregular breathing (pressure on resp centre)
Why is the 6th nerve affected first in raised ICP
Has the longest intra-cranial course. Compression over the Petras Temple
What is spastic paraperesis
Increased tone and reflexes
Decreased power bilaterally
ankle clonus
Causes of spastic parapersis
Cerebral Palsy Stroke Cord compression Cervical spondylosis MS MND CVA
How is spasticity described
Clasp knife
Rigidity
Same tension throughout
When a patient has spastic paraperesis in neuro exam what else might you think to do?
Sensory levels
Upper limb reflexes
cranial nerves
Recall the sites of the dermatones
The dance
If a patient has back pain what questions should you ask
anal numbness urinary symptoms faecal incontinence change in sensation when passing urine sexual dysfunction
Causes of wasting of the small muscles of the hands
bilateral and unilateral
Bilateral wasting of small muscles of hands - causes
RA
Cervical Spondylitis
MND
Unilateral wasting of small muscles of hands - causes
Pancosts tumour
Brachial plexus trauma
Cervical rib
What is Neurofibromatosis
Neurofibromatosis is a genetic disorder that causes tumors to form on nerve tissue.
Auto Dom Chrom 17
What will you see on the patient with NF
freckling in axilla
dermal and neuronal fibroma
How many and what size of cafe au laits spots
> 5 and >15mm in size
Complications of T1 NF
Renal Artery Stenosis - HTN
Thoracic Kyphosis
Malignant change in 10%
What triad is seen in NF T1
Lisch nodules
Neurofibromas
Cafe au lait spots
Crowe’s signs
Axilla freckling in NF T1
In facial palsy what are the ddx
Bells
Stroke
Ramsay Hunt
Lymes disease
What is Ramsay Hunt Syndrome
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
Where to look for Ramsay hunt
around the ear - herpes Zoster
What questions may be needed in facial palsy?
Change in taste sensation
Any loud exaggerated sounds (Horners)
What is the earliest sign of a cerebellar pontine angle lesion?
Loss of corneal reflex
cornea is over the iris and is not the sclera
What is charcot marie tooth
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
What shape does a sub dural make on CT
Crescent shape
What shape does an extra dural make
Lens shape
What do you want to know about a rash on an elbow
Itch
Do you have eczema?
Lichenification
Associated with hayfever and asthma
How to describe psoriasis?
Salmon pink discoid patches with silver discoloration on extensor surfaces
What else to examine in Psoriasis?
Joints
Nails for pitting, oncholyisis, subungal hyperkeratosis
Scalp
Koebner Phenomenon is seen in which conditions
Vitiligo
Psoriasis
Lichen Planus
Warts
What is Acanthosis Nigricans?
dark, velvety discoloration in body folds and creases
What is aconthosis nigricans associated with
Cushings and Diabetes
What are the cardiac causes of Syncope?
AS
Arrythmias both fast and slow
Fast - VF and VT
Slow - Bradycardia
What type of MI might cause bradycardia
Inferior MI as the same vessel (RCA) as SAN
Triad seen in Parkinson
Bradykinesia, tremor and rigidity
Describe the cog wheel rigidity
it is a tremor superimposed upon lead pipe rigidity
What is Shy-Drager Syndrome
Multi System Atrophy.
Get Parkinsonism and more pronounced autonomic dysfunction.
Supra Nuclear Palsy
slurring of speech, difficulty swallowing, and difficulty moving the eyes, particularly in the vertical direction. Can’t look up
How would you examine the hands of someone with RA
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
What nerve is affected in Pagets
8th nerve compression
Small bones of the ears fuse
What to patients with pagets disease die of?
High output heart failure from capillary expansion in bone.
Causes of bowed legs
Vit D deficiency
Osteogenesis Imperfecta
Pagets
What is Myotonic Dystrophy
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
Causes of hypoglycaemia
SAILSQ
Sulphonylureas Alcohol Insulin overdose Liver disease Sepsis Q - IV Quinine
What is the classic history of Addisons?
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.
What are the causes of addisonian crisis?
Autoimmune Stopping steroids TB (in adrenals) HIV - CMV associated infeciton Mets to adrenals Amyloidosis
For Addisonian crisis what tests are important?
ABG acutely
Short SYNACTHEN test
Na - goes down
K goes up
Glucose goes down
Urea increases as dehydrated
Rx of addisonian crisis
Iv 200mg hydrocortisone
fluids
Rx cause
Advice should be given to someone with addisons
Double steroids when unwell
Medic alert bracelet
Don’t suddenly stop steroids
lifelong Rx
What are the complications of Mitral Stenosis>
P Hypertension
RHF
What will you find on examination of P hypertension
Loud P2
Left Parasternal heave
Grey Steele Murmur - back flow to pulmonary valve
pulm regurg murmur.
