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Neuro Flashcards

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1
Q

Lesion to CN iiii

A

Diplopia when looks down and away from affected side

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2
Q

Usual causes of CN vi lesions

A

Trauma , wernikes encephalopathy

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3
Q

Features of CN vi lesions

A

Failure of lateral movement

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4
Q

LMN lesion of facial

Usual cause

A

Ipsilateral weakness of muscles of facial expression

Bell’s palsy

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5
Q

UMN of facial

Usual cause

A

Insulate real weakness of muscles of facial expression but SPARES FOREHEAD
Tumours / vascular events

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6
Q

Facial nerve involvement in hearing?

Damage ->

A

Motor supply to stapedius

Hyperacusis (loud distortion of sounds)

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7
Q

Hip flexion nerve

A

L1,2

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8
Q

Knee flexion / hip extension nerve

A

L5 s1,2

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9
Q

Knee extension nerve

A

L2,3,4

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10
Q

Knee jerk nerve

A

L3,4

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11
Q

Ankle jerk nerve

A

S1,2

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12
Q

Plantar reflex nerve

A

L5 s1,2

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13
Q

Dermatomes of legs

A 
Upper thigh l2
Anterior knee l3
Inner calf l4
Outer calf l5
Lateral foot s1
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14
Q

Heel to toe walking tests for

A

Midline cerebellar lesion

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15
Q

Difficulty walking on toes

A

S1 lesion

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16
Q

Difficulty walking on heels ? (Foot drop )

A

L4/5 lesion

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17
Q

Parkinson’s gait

A 
Hesitation in starting
Shuffling
Freezing
Diminished swinging of arms 
Propulsion
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18
Q

Cerebellar ataxia gait

A

Broad based
Unstable
Tremulous

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19
Q

Sensory ataxia gait

A

Broad based and high stepping

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20
Q

Distal vs proximal weakness gait

A

Distal - affected leg raised high and foot slaps ground

Proximal - waddling

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21
Q 
Never supply:
Deltoid 
Pec major / lats
Biceps 
Triceps
Wrist flexion 
Wrist extension 
Finger flexion 
Finger extension. 
Dorsal interrossi (splay fingers) 
Palmar interrossi
A 
Deltoid c5,6
Pec major / lats c6,7,8
Biceps c5,6
Triceps c7
Wrist flexion c6,7,8
Wrist extension 
Finger flexion 
Finger extension. 
Dorsal interrossi (splay fingers) 
Palmar interrossi
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22
Q

Lesion of CN III

A

Eye pointing down and out with a fixed dilated pupil

Pstosis

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23
Q 
Never supply:
Deltoid 
Pec major / lats
Biceps 
Triceps
Wrist flexion 
Wrist extension 
Finger flexion 
Finger extension. 
Dorsal interrossi (splay fingers) 
Palmar interrossi
A 
Deltoid c5,6
Pec major / lats c6,7,8
Biceps c5,6
Triceps c7
Wrist flexion c 6,7,8
Wrist extension c7,8
Finger flexion c7,8
Finger extension. C7,8
Dorsal interrossi (splay fingers) c8,t1
Palmar interrossi c8, t1
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24
Q

Nerves for
Biceps reflex
Triceps
Supinator

A

Biceps c5,6
Triceps c7,8
Supinator c5,6

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25
Dermatomes of arm
``` Lateral upper arm - c5 Lateral forearm and thumb - c6 Middle finger - c7 Little finger - c8 Medial upper arm - t1 ```
26
Cerebellar signs
``` DANISH Disdiadokinesis Ataxia Nystagmus Intension tremor Slurred speech Hypotonia ```
27
Cerebellar function tests
Heel to shin Finger to nose Finger to nose to finger Rapid alternating movements
28
Basic causes of cranial nerve lesions
Trauma, diabetes, tumours, MS
29
Used for visual acuity
Snellen chart
30
Why are muscles of forehead sometimes spared from UMN lesions
They have bilateral UMN supply
31
What does a bovine (non explosive cough suggest)
Vagal palsy
32
Key parts of Cerebellar exam
``` DANISH Disdiadokinesis Ataxia (gait and posture) Nystagmus Intention tremor Slurred, sticato speech Hypotonia / heel shin test ```
33
What does innatention suggest
Damage to frontal / parietal lobes (stroke/trauma etc)
34
Lack of consensual pupillary response could indicate ?
Damage to one or both optic nerves | Damage to edinger westphal nucleus
35
Swinging light test can detect? What does it look like? Caused by? Eg?
Relative afferent pupillary defect (RAPD) (marcus-gunn pupil) Dilation of the affected pupil when light shines into it (should constrict) Damage to tract between optic nerve and chiasm Eg optic neuritis in MS
36
What is a squint called
Strabismus
37
What is a saccade
Rapid jerky movement that corrects the gaze after a slower deviation
38
What is the red reflex? | Absent means?
Light reflecting back from the retina (30cm away) | Cataracts
39
In unilateral Cerebellar disease which way is the deviation? Why?
Towards the side of lesion due to hypotonia
40
Why do you use the heel to toe walking for Cerebellar disease? What does it assess?
Exaggerates any unsteadiness | Assesses function of Cerebellar vermis
41
What is the first function to be lost in alcoholic Cerebellar cortical degeneration
Heel to toe walking
42
In a Cerebellar exam what would a positive rombergs test indicate
Unsteadiness is due to sensory ataxia (damage to dorsal columns of spinal cord) rather then Cerebellar ataxia
43
What would a slow upward pronator drift indicate
Lesion in the contralateral cerbellum
44
What does a positive rebound phenomenon suggest
Cerebellar disease
45
What is a pendular reflex mean ? | When do you get it?
Leg keeps swinging after you elict the knee reflex | Cerebellar disease
46
Reflexes in Cerebellar disease
Mild hypo reflexes
47
What is an intention tremor
Gets worse at endpoint of a deliberate movement
48
Failure of Disdiadokinesis suggests
Cerebellar ataxia
49
Things to look for in lower limb inspection
``` SWIFT Scars Wasting Involuntary movements Fasiculations Tremor ```
50
Possible causes for abnormal heel to toe gait
Weakness Impaired proprioception Cerebellar disorder
51
What does heel walking test
Dorsiflexion power
52
Positive rombergs test suggests
Sensory ataxia (defective proprioception / vestibular system)
53
``` Hip nerve roots Flexion Extension Abduction Addiction ```
Flexion L1/2 Extension L5/s1 Abduction L4/5 Adduction L2/3
54
Knee nerve roots Flexion Extension
Flexion - S1 | Extension - L3/4
55
Big toe extension nerve root
L5
56
Reflexes Knee jerk Ankle jerk Plantar response
Knee jerk L3/4 Ankle jerk l5/s1 Plantar response S1
57
What is an abnormal plantar response ? | Indicative of?
``` Babinski sign (extension of great toe) UMN lesion ```
58
What tract is light touch
Dorsal / posterior columns
59
Pin prick sensation
Spinothalamic
60
Vibration sensation tract
Dorsal / posterior columns
61
Proprioception tract
Dorsal / posterior column
62
Inability of heel to shin test indicated
Loss of motor strength / proprioception | Cerebellar disorder
63
Pronator drift indicates
UMN pathology
64
Rigidity when assessing tone suggests
Parkinson's
65
Shoulders Abduction Adduction
Ab - C5 | Ad- C6/7
66
Elbow Flexion Extension
Flex - C5/6 | Extension - C7
67
Wrist Extension Flexion
Extension - C6 | Flex - C6/7
68
Finger Extension Abduction
C7 | T1
69
Muscles for abduction of fingers
First dorsal interosseous | Abductor digiti minimi
70
Thumb abduction
C8/t1
71
Reflexes Biceps Triceps Supinator
B- c5/6 T - c7 Sup - C6
72
Nose to finger test may indicate
Cerebellar pathology
73
Failure of Disdiadokinesis
Cerebellar ataxia
74
``` Axillary nerve Root Muscle Action Sensation ```
C5 Deltoid Shoulder abduction Regimental badge over deltoid
75
``` Musculocutaneous Root Muscle Action Sensation Reflex ```
``` C5/6 Biceps Elbow Flexion Lateral aspect of forearm Biceps ```
76
``` Radial Root Muscle Action Sensation Reflex ```
``` C7 Extensiors Wrist / finger extension Anatomical snuff box Triceps ```
77
``` Ulnar Root Muscle Action Sensation ```
T1 First dorsal interosseous Index finger abduction Medial side of palmar hand and medial border of ring finger
78
``` Median nerve Root Muscle Action Sensation ```
T1 Abductor pollicis brevis Thumb abduction Lateral side of hand palmar
79
What is strabismus
Eyes don't quite point the same way
80
How is visual acuity measured | How far should the snellen chart be held away
``` Chart distance (m) / lowest line read 6m (can be reduced to 3 then 1 if top line can't be read) ```
81
How do you test colour Vision
Ishihara charts
82
How do you do fundoscopy
Dilate pupils with shirt acting mydriatic eye drops Darken room Ask patient to fixate on distant object Assess for red reflex - look through ophthalmoscope and observe for reddish reflection of pupil
83
When might the red reflex be absent
Cataract | Rarely - neuroblastoma
84
What else is examined in fundoscopy
Begin medialy and assess optic disk (colour, contour, cupping) Assess retinal vessels ( cotton wool spots, neovascularisation) Assess macula (ask to look directly into light - drusen noted in degeneration (yellow deposits made of lipid))
85
Ptosis indicates
Oculomotor nerve pathology
86
Cover test responses
No movement - normal Eye moves temporally - convergent squint Eye moves nasally - divergent squint
87
Facial light touch sensation | Branches
Forehead - opthalmic v1 Cheek - maxillary - v2 Jaw - mandibular v3
88
Complete closure of jaw when testing jaw jerk indicates
UMN lesion
89
Normal corneal reflex
Direct and consensual blinking
90
When assessing facial why do you look at external auditory meatus
Herpes zoster lesions (Bell's palsy)
91
Facial nerve supply
Muscles of face Stapedius Taste to anterior 2/3 of tongue
92
What is normal result in Rinnes test Neural deafness Conductive deafness
Air conduction > bone conduction Air > bone (both reduced equally) Bone > air
93
Webers test Normal Neural deafness Conductive deafness
Sound heard equally Neural - sound heard louder on intact ear Conductive - sound heard louder on side of affected ear
94
How to test vestibular
Ask patient to march on spot with eyes closed | Vestibular lesion - patient will turn to that side

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