clinical relevance / extra pbl

Question 1

what information is carried in the spinothalamic tract

Answer 1

temperature ad pain sensation

Question 2

what information is carried in the dorsal column

Answer 2

conscious appreciation of fine touch, two-point discrimination, conscious proprioception, and vibration sensations from the entire body except for the head

Question 3

where does the spinothalamic tract decussate

Answer 3

Spinal chord- dorsal horn

Question 4

where do the dorsal column fibres decussate

Answer 4

medulla - cuneate nucleus (upper body) and gracile nucleus (lower body)

Question 5

why might a lesion at one level of the spinothalamic tract result in pathology of a different level

Answer 5

the fibers decussate at an angle e.g. fibers from S1 might decusate at L4

Question 6

red flag features suggesting a secondary headache

Answer 6

1. change in pattern of habitual headache (frequency, severity etc.);
2. headache with fever, weight loss, known cancer, thrombotic risk factors etc.;
3. headache w seizures;
4. headache w confusion, personality change, impaired alertness or persistent focal symptoms lasting >1hr;
5. headache w raised ICP symptoms

Question 7

4 signs of raised ICP headache

Answer 7

1. aggravated by lying/bending/coughing
2. present on waking/ wakes person from sleep
3. associated vomiting, visual obsurations, impaired conscious levels
4. papilloedema

Question 8

what is kernig’s sign

Answer 8

elicitation of pain or resistance with passive extension of the patient’s knees past 135 degrees in the setting of meningeal irritation

Question 9

what is Brudzinski’s sign

Answer 9

reflexive flexion of the knees and hips following passive neck flexion

Question 10

what is another name for thiamine

Answer 10

vitamin B1

Question 11

what can a deficency in B1/thiamine cause

Answer 11

Wernicke’s encephalopathy

Question 12

features of wernicke’s encephalopathy (3)

Answer 12

1. oculomotor dysfunction - nystagmus (the most common ocular sign), ophthalmoplegia: lateral rectus palsy, conjugate gaze palsy
2. gait ataxia;
3. encephalopathy: confusion, disorientation, indifference, and inattentiveness
   peripheral sensory neuropathy