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General Medicine > Neurology > Flashcards

Neurology Flashcards

1
Q

What nerve roots make up the brachial plexus

A

C5 - T1

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2
Q

What is an erb’s palsy

A

Upper brachial plexus injury
Arm extended
Internally rotated - pronated
Hand extended backwards

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3
Q

Which nerve roots are involved in an erb’s palsy

A

C5 + 6 - upper brachial plexus

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4
Q

Common causes of an erb’s palsy

A

Traction injuries - e.g. Motorcycle accident, shoulder dystopia at birth.

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5
Q

What is a Klumpke’s palsy

A

Lower brachial plexus injury
Claw hand - all digits
Sensory loss over ulnar border of forearm + hand

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6
Q

Nerve roots involved in a Klumpke’s palsy

A

C8 + T1 - lower brachial plexus

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7
Q

Causes of Klumpke’s palsy

A

Breech birth injury (arm extension)
Pulling on the arm during delivery
Motorcycle accidents

(Klumpke the monkey hung from the tree)

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8
Q

Winging of the scapula is caused by injury to which nerve

A

Long thoracic nerve to serratus anterior

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9
Q

When may the long thoracic nerve be damaged

A

Breast surgery
Axillary surgery
Breast / axillary radiotherapy
Axillary trauma

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10
Q

What nerve runs in the spiral groove of the humerus

A

Radial nerve

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11
Q

Common causes of radial nerve palsies

A

Humeral shaft fracture
Elbow dislocation
Monteggia fractures
Compression of neve by prolonged use of ill fitting crutches
Falling asleep with arm hanging over Chair = Saturday night palsy

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12
Q

What nerve is involved in a Saturday night palsy

A

Radial

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13
Q

What causes wrist drop

A

Radial nerve palsy

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14
Q

Nerve supply of the anatomical snuffbox

A

Radial nerve

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15
Q

What does the accessory nerve supply

A

Trapezius

Sternocleidomastoid

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16
Q

Syx / signs of accessory nerve palsy

A

Weak shoulder shrug

Inability to turn head against pressure

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17
Q

What does the axillary nerve supply

A

Motor to deltoid

Sensory to regimental badge area

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18
Q

What nerve is compressed in carpal tunnel syndrome

A

Distal median nerve

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19
Q

Compression of the medial nerve by the flexor retinaculum is called what…..

A

Carpal tunnel syndrome

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20
Q

In whom is carpal tunnel syndrome more common

A 
Women 
Pregnancy
RA
acromegally
Hypothyroidism
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21
Q

Syx of carpal tunnel syndrome

A

Tingling + numbness in radial 3 1/2 digits

Wasting thenar eminence

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22
Q

Features of 6th CN lesion

A

Eyes appear conjugate in primary position
Failure of abduction of affected eye
Horizontal diplopia when looking at affected side

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23
Q

Features of 4th CN palsy

A

Diplopia on downward gaze
Sit with head tilted
Failure to aduct on downward gaze
Eyes conjugate in primary position

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24
Q

Features of 3rd CN palsy

A

Eye down and out
Ptosis
Pupil dilation

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25
Q

What is convgent strabismus

A

1or both eyes turn in

Will turn out to focus when other eye is covered

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26
Q

What is ramsay hunt syndrome

A 
Herpes zoster (shingles) of the geniculate ganglion. 
\+ external auditory meatus
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27
Q

What is Ménière’s disease

A

Recurrent vertigo + deafness, tinnitus, aural fullness.

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28
Q

Benign paroxysmal vertigo symptoms

A

Short episodes of vertigo triggered by head movement.

Due to free floating particles in the endolymph

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29
Q

What is hallpikes manoeuvre used to diagnose

A

To confirm benign paroxysmal vertigo.

Move pt from sitting to lying with head below vertical to reproduce vertigo and nystagmus.

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30
Q

Most common cause of subarachnoid haemorrhage

A

Rupture of berry aneurysm on circle of willis.

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31
Q

Features predisposing to berry aneurysm formation

A 
Defective collagen synthesis 
        - Polycystic kidney disease
        - Ehlers Danlos 
High blood pressure conditions
        - coarctation of the aorta 
        -
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32
Q

Investigations for suspected subarachnoid haemorrhage

A

CT head.

LP for xanthochromia after 12hr

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33
Q

Symptoms of trigeminal neuralgia

A

Mandibular, maxillary or ophthalmic division - unilateral stabbing pain.
Precipitated by touch.
More common in F

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34
Q

Early morning headache,worse on lying down and coughing suggests…

A

Raised intracranial pressure.

Investigate to exclude SOL.

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35
Q

Features of tension headache

A

Band-like pain around head

Stress

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36
Q

Features of UMN lesion

A 
Increased tone
Hyper-reflexia
Spasticity
Clonus
Pronator drift
Extensor plantar response
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37
Q

Features of LMN lesion

A

Fasciculation
Wasting
Loss of reflexes
Hypotonia

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38
Q

What neurological condition is worse with heat

A

MS

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39
Q

In what condition does lead-pipe / cog-wheel rigidity occur

A

Parkinson’s disease

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40
Q

In what condition does a pill-rolling tremor occur

A

Parkinson’s tremor

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41
Q

In what condition does a festinant gait with reduced arm swing occur

A

Parkinson’s disease

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42
Q

Decreased muscle action potentials after continuous stimulation suggests what neurological condition

A

Myasthenia gravis

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43
Q

Features of cauda equina syndrome

A

Saddle anaesthesia
Bladder and bowel disturbance
Bilateral leg pain

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44
Q

Features of brown sequard syndrome

A

Ipsilateral loss of vibration and proprioception

Contralateral loss of pain and temperature

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45
Q

Features of Gillian-Barre syndrome

A

Ascending symmetrical flaccid muscle weakness.
Loss of tendon reflexes.
+/- distal paraesthesia or pain.
20% develop respiratory muscle involvement
Preceding recent respiratory / GI infection (esp campylobacter jejuni)

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46
Q

What is shy-drager syndrome also known as

A

Multi-system atrophy

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47
Q

Features of multi-system atrophy

A

autonomic dysfunction
parkinsonism (muscle rigidity +/ tremor and slow movement)
ataxia (Poor coordination / unsteady walking)

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48
Q

Features of wernicke’s encephalopathy

A

Confusion
Nystagmus
Opthalmoplegia
Ataxia

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49
Q

Features of korsakoff’s syndrome

A

Memory problems
Confabulation
Irreversible

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50
Q

Cause of a bilateral high-stripping gait

A

Sensory ataxia

E.g. Peripheral neuropathy

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51
Q

Cause of a scissoring gait

A

Spastic paraplegia

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52
Q

Cause of a wide-based gait

A

Cerebellar lesion

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53
Q

Cause of bilateral pin-point pupils

A

Opiate overdose

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54
Q

Features of a 3rd nerve lesion

A

Dilated pupil
Ptosis
Eye deviated down and out

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55
Q

Features of horners syndrome

A

Unilateral ptosis

Facial anhydrosis

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56
Q

Features of an anterior circulation stroke

A 
Unilateral weakness
Unilateral sensory deficit
Homonymous hemianopia 
Dysphagia 
Sensory neglect
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57
Q

Investigations for suspected MS?

A 
Neuro referral - mainly clinical diagnosis
EEG
MRI - demyelinating plaques 
LP - oligoclonal bands
Immunoassay for myelin antibodies
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59
Q

What cancers metastasise to the brain

A 
Lung
Kidney
Breast
Melanoma
Colon
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60
Q

What is a todd’s paresis?

A

Post-ictal temporary paralysis

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61
Q

Features of a radial nerve palsy?

A

Wrist drop
Loss of sensation in the anatomical snuffbox
Inability to extend metacarpophalangeal joints

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62
Q

When may the accessory Nerve (CN XI) be damaged?

A

Surgery to the neck

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63
Q

What nerve wraps around the surgical Neck of the humerus?

A

Axillary nerve

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64
Q

What nerve is damaged by anterior dislocation of the shoulder?

A

Axillary nerve

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65
Q

Features of axillary nerve lesion?

A

Absent sensation to the upper outer arm (Regimental badge patch)
Deltoid muscle paralysis
Limited arm Abduction (0-90. Above 90 = suprasipinatus)

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66
Q

Is clawing of the 4th and 5th digits more marked in a proximal or distal ulnar nerve lesion?

A

More marked in a distal lesion

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67
Q

Normal pressure on LP

A

50-180 mm H2O

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68
Q

Normal values and colour of CSF on LP

A 
Clear
RBC 0-4
WBC 0-4
Glucose >60% of blood value
Protein <4.5 g/L
Microbiology - sterile
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69
Q

CSF values suggesting bacterial meningitis on LP

A 
Normal / raised pressure
Cloudy 
RBC 0-4 (normal)
WBC >1000 -neutrophils
Glucose 0.45g/L
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70
Q

CSF values suggesting viral meningitis on LP

A 
Normal pressure
Clear 
RBC 0-4 (normal)
WBC 60% blood value
Protein - Normal <0.45g/L
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71
Q

CSF values suggesting TB meningitis on LP

A 
Normal / raised pressure
Clear / cloudy
RBC 0-4 (normal)
WBC >1000 - Lymphocytes
Glucose 0.45g/L
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72
Q

CSF values suggesting fungal meningitis on LP

A 
Normal pressure
Clear
RBC 0-4 (normal)
WBC 0-50 - Lymphocytes
Glucose 0.45g/L
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73
Q

What does India ink stain

A

Cryptococcus neoformans (fungi)

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74
Q

What Do oligoclonal bands on CSF indicate?

A

MS

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75
Q

When is xanthochromia seen in the CSF?

A 
Subarachnoid haemorrhage
(Due to erythrocyte breakdown products --> Yellow colour)
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76
Q

Neurological manifestations of Wilson’s disease

A

Dementia
Tremor
Dyskinesia

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77
Q

What are the MRC grades of power. And what does each one mean

A

Grade 5 = normal power
Grade 4 = movement against gravity and mild resistance
Grade 3= active movement against gravity
Grade 2 = active movement when gravity eliminated
Grade 1 = flicker of contraction
Grade 0 = no contraction

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78
Q

What is Gillian-Barre syndrome

A

Post-infective demyelination polyneuropathy.

Immune-mediated demyelination of spinal roots or peripheral nerves.

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79
Q

Management of Gillian-Barre syndrome

A

Supportive

Ventilatory support if respiratory involvement

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80
Q

What is miller-fisher syndrome

A

Rare variant of GBS.
Descending paralysis, (reverse order of normal GBS.)
Triad of ophthalmoplegia, ataxia, and areflexia.

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81
Q

Features of a Bell’s palsy

A 
Unilateral loss of facial movement
Normal facial sensation 
Pain around ear
Hyperacusis
Loss of salivation / tear secretion
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82
Q

What is a Bell’s palsy

A

LMN lesion of the facial nerve
CN 7
Cause unknown

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83
Q

What is / what causes myasthenia gravis

A

Autoimmune destruction of post-synaptic acetylcholine receptors in neuromuscular junction

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84
Q

What is a typical patient with myasthenia gravis

A

Female

20-40yo

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85
Q

Features of myasthenia gravis

A 
(Inability to sustain a maintained or repeated contraction of striated muscle) 
Diplopia
Ptosis
Fatiguability 
Syx worse after exercise
Syx worse at end of day
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86
Q

What is a myasthenic crisis

A

Sudden onset paralysis of the respiratory muscles.
Necessitating assisted ventilation

Crises may be triggered by infection, fever, an adverse drug reaction or emotional stress.

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87
Q

What is the tension test and what is it used for

A

AKA edrophonium test
IV edrophonium bromide administered to a patient with suspected MG.
MG confirmed if weakness transiently improves.

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88
Q

Why do all patients with myasthenia gravis need a CT

A

To rule out thymoma

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89
Q

Management of myasthenia gravis

A

Anticholinergics (pyridostigmine)

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90
Q

What does an overdose of anticholinergics do

A 
Cholinergic crisis
Muscle fasciculation
Paralysis
Pallor
Sweating
Excessive salivation
Small pupils
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91
Q

What is motor neuron disease

A

Progressive degeneration of motor neurons within the spinal cord, motor cortex and cranial nerve nuclei.

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92
Q

Features of motor neuron disease

A 
Combination of upper and lower motor neuron signs
Limb weakness
Fasciculation
Spasticity
Exaggerated reflexes
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93
Q

Types of motor neuron disease

A

Progressive muscular atrophy (weakness of distal limb muscles 1st)
Progressive bulbar palsy (early involvement of tongue and pharyngeal muscles)
Amyotrophic lateral sclerosis ( combination of distal and proximal muscle wasting)

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94
Q

Management of motor neuron disease

A

Supportive

Riluzole improves life expectancy

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95
Q

What is lambert eaton syndrome

A

Impaired neurotransmitter release due to autoantibodies to pre-synaptic voltage gated calcium channels

Associated with underlying malignancy - often lung

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96
Q

Features of lambert eaton syndrome

A

Muscle weakness - improves with sustained contraction
Autonomic dysfunction - dry mouth, blurred vision, impotence
Absent tendon reflexes

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97
Q

Presentation of a subarachnoid haemorrhage

A 
Severe
Sudden onset 
Occipital headache 
Vomiting
Irritability 
Photophobia
Neck stiffness
Reduced consciousness
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98
Q

Presentation of a cluster headache

A 
Unilateral
Severe 
Peri orbital pain 
Conjunctival injection
Lacrimation
Nasal congestion
30-90min 
Same time every day
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99
Q

Typical patient with cluster headaches

A

Male
Heavy smoking
Excess alcohol

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100
Q

Prophylaxis against cluster headaches

A

Verapamil (CCB)

Ergotamine

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101
Q

Presentation of trigeminal neuralgia

A

Sharp stabbing pain
Severe, brief, repetitive
Trigeminal nerve distribution - most commonly mandibular or maxillary

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102
Q

Management of trigeminal neuralgia

A

Carbamazepine
Phenytoin
Gabapentin

103
Q

Features of migraine

A 
Unilateral throbbing headache
Severe
Photophobia
Vomiting
\+/- aura
104
Q

Migraine triggers / exacerbants

A 
Poor sleep
Dehydration
Alcohol - esp red wine
COCP
Chocolate
Cheese
105
Q

Options for migraine prophylaxis

A 
Beta blockers (commonly propranolol) 
Pizotifen
Amitryptilline
106
Q

Features of idiopathic intracranial hypertension

A

Raised intracranial hypertension in the absence of a SOL, ventricular dilation or impaired consciousness.

Intermittent headaches
Transient diplopia / blurred vision
Papilloedema

107
Q

Typical patient with idiopathic intracranial hypertension

A

Female
Younger
Obese

Can be triggered by COCP, tetracyckines, steroid withdrawal

108
Q

Management of idiopathic intracranial hypertension

A

Weight loss
Remove trigger
Acetazolamide
Repeated LP

(Untreated can lead to blindness. Hence no longer called ‘benign’)

109
Q

Dermatome supply of the back of the head

A

C2

110
Q

Dermatome supply of the neck

A

C3

111
Q

Dermatome supply of the thumb

A

C6

112
Q

Dermatome supply of the middle finger

A

C7

113
Q

Dermatome supply of the little finger

A

C8

114
Q

Dermatome supply of the axilla

A

T2

115
Q

Dermatome supply of the nipple line

A

T4

116
Q

Dermatome supply of the level of the xiphoid process

A

T6

117
Q

Dermatome supply of the level of the umbilicus

A

T10

118
Q

Dermatome supply of the inguinal ligament

A

T12 / L1

119
Q

Dermatome supply of the medial thigh

A

L2

120
Q

Dermatome supply of the big toe

A

L4

121
Q

Dermatome supply of the dorsum of the foot

A

L5

122
Q

Dermatome supply of the sole of the foot

A

S1

123
Q

Dermatome supply of the popliteal fossa

A

S2

124
Q

Dermatome supply of the bottom (ischial tuberosity)

A

S3

125
Q

Dermatome supply of the perianal area

A

S4/5

126
Q

Dermatome supply of the penis

A

S3

127
Q

What is multiple sclerosis

A

Autoimmune destruction of the myelin producing oligodendrocytes
Myelin loss in CNS causes slow nerve conduction

128
Q

Symptoms of multiple sclerosis

A 
Optic neuritis
Unilateral dorsal column loss
Coarse tremor 
trigeminal neuralgia 
recurrent facial nerve palsy 
sixth cranial nerve palsy 
lhermitte phenomenon = Tingling in spine or limbs in neck flexion
129
Q

Diagnosis of MS requires all of the following

A

> Age less than 60
Deficit in two or more anatomically distinct sites
Abnormity present on examination
- Two episodes lasting >24 hours and >1 month apart
- OR Slow progression over six months
No other explanation for symptoms

130
Q

Types of MS

A 
Relapsing and remitting 80%
Primary progressive 15%
Secondary Progressive
Benign
Childhood MS
131
Q

What are the muscular dystrophies

A 
Group of inherited disorders with progressive degeneration of groups of muscles
No involvement of the nervous system
Symmetrical wasting and weakness
No fasciculations 
no sensory loss
132
Q

How is duchenne muscular dystrophy inherited

A

X linked recessive

133
Q

Presentation of duchenne muscular dystrophy

A

Onset in childhood
Effects proximal arms and legs
Pseudohypertrophy of the calves - replacement of muscle by fat and fibrosis.
Waddling gait
Difficulty standing (gowers sign-walk hands up legs)

134
Q

Inheritance pattern of Becker muscular dystrophy

A

X-linked recessive

135
Q

Inheritance pattern of myotonic dystrophy

A

Autosomal dominant

136
Q

Features of myotonic dystrophy

A 
Weakness of temporal, facial, sternocleidomastoid and distal limb muscles
Myotonia - Slow relaxation of muscles
Frontal balding
Cataract
Ptosis
Gonad atrophy
137
Q

What is mononeuritis multiplex

A

Peripheral neuropathy where there is damage to 2 or more peripheral or spinal nerves

138
Q

Common causes of mononeuritis multiplexed

A

Diabetes mellitus
Polyarteritis nodosa
Rheumatoid arthritis
Systemic lupus erythematous

139
Q

What is charcot-marie-tooth disease

A

Hereditary motor and sensory neuropathy
Autosomal dominant inheritance is most common
Autosomal recessive and X-linked forms have been identified

140
Q

Symptoms of Charcot-Marie-Tooth disease

A

Symmetrical, distal, slowly progressive muscle wasting
Foot drop
Claw toes
Pes cavus
Areflexia
Distal sensory loss
Inverted bottle appearance of legs due to distal muscle wasting

141
Q

Causes of sciatic nerve injury

A

Fracture dislocation of the hip

Misplaced gluteal injection

142
Q

Presentation of a sciatic nerve palsy

A

Paralysis of hamstrings
Paralysis of all muscles of foot and leg

Loss of sensation below knee - (except medial leg = saphenous)

143
Q

Causes of tibial nerve injury

A

Posterior dislocation of knee

144
Q

Features of a tibial nerve palsy

A

Loss of toe flexion
Loss of Ankle inversion
Loss of ankle jerk

Loss of sensation over sole of foot

145
Q

What is the tibial nerve a branch of

A

Sciatic nerve

146
Q

Boundaries of the femoral triangle

A

It is bounded by:

(superiorly) inguinal ligament
(medially) medial border of adductor longus muscle
(laterally) medial border of sartorius muscle

147
Q

Contents of the femoral triangle

A

from medial to lateral:
> femoral veins and its tributaries
> femoral artery and its branches
> femoral nerve and its branches

148
Q

Presentation of a femoral nerve palsy

A

Loss of knee extension

Loss of sensation over anterior thigh and medial leg

149
Q

What is meralgia paresthetica

A

Trapped lateral femoral cutaneous nerve at the inguinal ligament
Esp obese or pregnant patients

Causes pain / burning of lateral thigh
Often caused by prolonged standing

150
Q

What nerve may be injured by ankle plaster casts

A

Common peroneal nerve (branch of sciatic)

151
Q

When may the saphenous nerve be damaged.

What does this cause

A

Surgery on long saphenous vein

Causes loss of sensation to medial aspect of calf

152
Q

When may the sural nerve be damaged.

What does this cause

A

Surgery to the short saphenous vein

Loss of sensation to the lateral side if the foot and little toe

153
Q

When may the obturator nerve be damaged.

What does this cause

A

Obstetric procedures
Pelvic disease

Loss of hip adduction
Loss of sensation to upper inner thigh

154
Q

What does superior gluteal nerve damage cause

A

Loss of hip abduction

Pelvic dip in walking = trendelenburg gait

155
Q

What does inferior gluteal nerve damage cause

A

Loss of hip extension

Buttock wasting

156
Q

Eyes component of GCS

A

4 - eyes open spontaneously
3 - eyes open to speech
2 - eyes open to pain
1 - no eye opening

157
Q

Verbal component of GCS

A 
5 - Coherent speech
4 - Confused/disorientated speech
3 - Inappropriate words without conversational exchange
2 - Incomprehensible sounds
1 - no verbal response
158
Q

Motor component of GCS

A

6 - obeys commands
5 - localises to pain
4 - withdraws from pain
3 - abnormal flexion to pain (decorticate)
2 - abnormal extension to pain (decerebrate)
1 - no motor response

159
Q

What is conversion disorder?

A

Sudden appearance of neurological symptoms following acute Psychological distress.
Non-volitional

160
Q

Presentation of common peroneal nerve injury

A

Foot drop
High stepping gait
Loss of sensation over anterolateral lower leg and dorsum of foot

161
Q

Features of wernickes aphasia

A 
Wernickes is responsible for recognising and analysing spoken language. 
Fluent aphasia
Poor comprehension
Poor repetition
(Left temporal lobe)
162
Q

What connects wernickes and Broca’s areas

A

Arcuate fasciculus

163
Q

Features of Broca’s aphasia

A 
Broca's area is responsible for producing coherent speech
Non-fluent aphasia 
Good comprehension
Poor repetition 
(Left frontal lobe)
164
Q

What is fluent aphasia

A

Normal number of words - but wrong words spoken

165
Q

What is non-fluent aphasia

A

Reduced verbal output - but correct words

166
Q

What would a lesion in the Arcuate fasciculus (between Broca’s and wernickes) do

A

Patient can comprehend (wernickes)
Patient can speak (Broca’s)
But cannot repeat back what is said to them - due to no connection between the 2 areas

167
Q

Is a pseudobulbar palsy upper or lower motor neuron

A

UMN lesion

168
Q

Is a bulbar palsy UMN or LMN

A

LMN

169
Q

What nerves are involved in bulbar and pseudobulbar palsies

A

CN 9 - 12

170
Q

Features of a pseudobulbar palsy

A 
UMN 
Small, contracted tongue
Immobile tongue - cannot protrude 
Brisk jaw jerk 
'Donald Duck' speech.
Palatal movements absent.
Dribbling persistently - Dysphagia
Facial muscles may also be paralysed.
Nasal regurgitation .
Dysphonia
Emotional lability.
171
Q

Causes of a pseudobulbar palsy

A

MMD
MS
brain stem tumour
Brain stem stroke

172
Q

Features of a bulbar palsy

A 
LMN
Fasciculations of tongue and lips 
Weak wasted Tongue 
Drooling
dysphagia
Absent palate movements.
Dysphonia
Articulation - difficulty pronouncing r
173
Q

Causes of a bulbar palsy

A

MND
Syringobulbia
GBS
MG

174
Q

Presentation of venous sinus thrombosis

A

Sudden onset headache
Seizures
Signs of raised intracranial pressure (papilloedema, hypertension, bradycardia)

175
Q

Symptoms of a cavernous sinus thrombosis

A 
Sudden onset headache / Seizures / Signs of raised ICP
\+ 
Proptosis
Ptosis
Ophthalmoloplegia
Reduced sensation in opthalmic division
176
Q

Symptoms of a transverse sinus thrombosis

A

Sudden onset headache / Seizures / Signs of raised ICP
+
Hemiparesis

177
Q

Risk factors for venous sinus thrombosis

A

COCP
Pregnancy
Nephrotic syndrome
Thrombophilia

178
Q

How is venous sinus thrombosis confined

A

CT / MRI

179
Q

Management of a venous sinus thrombosis

A

Anticoagulation - s/c enoxaparin

And warfarin for 6m

186
Q

Presentation of anterior cord syndrome

A

Follows flexion-compression injury
Loss of spinothalmic function (pain and temp)
And cortiocspinal tracts (motor)
Greater motor loss in the legs

187
Q

What is syringomyelia

A

A longitudinal fluid cavity (syrinx) in the spinal cord

188
Q

Features of syringomyelia

A

Usually 20-30yo
Disrupt spinothalmic tracts
Segmental loss of pain and temperature

189
Q

What is syringobulbia

A

A longitudinal cavity of fluid in the brainstem

190
Q

Presentation of a central cord lesion

A

In older pts with cervical spondylosis who have a hyperextension injury.
Flaccid weakness of arms
Motor and sensory to limb - relatively spared

191
Q

At what level does the spinal cord end

A

L1 and L2

192
Q

Presentation of posterior cord syndrome

A

Follows hyperextension of the neck
Dorsal column loss
Gait impaired due to loss of proprioception

193
Q

Features of poliomyelitis

A

Infects grey matter
Mild fever and headache
Progresses to aseptic meningitis
Weakness

194
Q

Features of rabies

A 
Fever 
Paraesthesia at site of bite 
Prodrome of anxiety 
Refusal to drink water - provokes painful diaphragm spasm
Delusions
Hallucinations
Spitting
Biting
Mania
Hyperpyrexia
Death within 1 week
195
Q

Features of cerebral abscess

A 
Fever
Headache
Meningism
Drowsiness
Seziures
Focal neurology
196
Q

What causes subacute sclerosing panencephalitis

A

Measles virus

Years after measles infection

197
Q

Symptoms of tetanus

A

Trismus - painless masseter spasm
Facial muscle contraction
Neck and trunk muscle contraction
Death due to asphyxia / exhaustion / aspiration pneumonia

198
Q

Management of tetanus

A

IV tetanus anti-toxin

IV benzylpenicillin

199
Q

What does the olfactory nerve supply

A

Sense of smell

200
Q

What does the optic nerve do

A

Visual acuity
Visual fields
Afferent pupillary reflex
Pupil accommodation

201
Q

What does the oculomotor nerve supply

A

Eye muscles - inferior oblique, medial/superior/inferior rectus,
Levator palpabrae muscles
Efferent arm of pupil reflex

202
Q

What does the trochlear nerve supply

A

Superior oblique muscle

203
Q

What does the trigeminal nerve supply

A

Sensation of face
Corneal reflex
Muscles of mastication
Jaw jerk

204
Q

What does the abducens nerve supply

A

Lateral rectus muscle

205
Q

What does the facial nerve supply

A

Muscles of facial expression
Taste to anterior 2/3 tongue
Nerve to stapedius
Sensation around skin of ear

206
Q

What does the vestibulocochlear nerve supply

A

Hearing

Vestibular system

207
Q

What does the glossopharyngeal nerve supply

A

Taste to posterior 1/3 tongue

Afferent gag reflex

208
Q

What does the vagus nerve supply

A

Motor to pharynx and larynx

Efferent arm of gag reflex

209
Q

What does the accessory nerve supply

A

Trapezius

Sternocleidomastoid muscle

210
Q

What does the hypoglossal nerve supply

A

Muscles of the tongue

211
Q

Symptoms of essential tremor

A 
Slow tremor
Often familial
May be mad more obvious by certain movements e.g. Writing
Improved by alcohol 
Beta-blockers may help
212
Q

Symptoms of physiological tremor

A

Normal tremor

Exaggerated by anxiety, fatigue, fever, alcohol withdrawal

213
Q

Symptoms of resting tremor

A

Occurs in Parkinson’s
Pill-rolling
Asymmetrical

214
Q

Symptoms of an intention tremor

A

Cerebellum disease
Broad tremor at end of purposeful movement
Due to breakdown in feedback mechanisms

215
Q

What is chorea

A

Jerky, small, involuntary movements

216
Q

Causes of chorea

A

Huntingtons chorea (autosomal dominant)
Wilson’s disease
Cerebral trauma
Rheumatic fever

217
Q

What is athetoses

A

Slow, writhing movements of the limbs

218
Q

What is hemiballismus

A

Big movements of the limbs unilaterally

219
Q

What is dystonia

A

Limb or head takes up an abnormal posture

E.g. Torticollis / blepharospasm / oculogyric crisis

220
Q

Features of neurofibromatosis type 1

A 
Cutaneous neurofibromas 
Cafe-au-lait spots
Axillary freckling 
Iris fibromas (lisch nodules)
Phaeochromocytoma 
Acoustic neuroma
Scoliosis
221
Q

Features of neurofibromatosis type 2

A

No cutaneous features
Bilateral acoustic neuromas
Optic nerve gliomas
Meningiomas

222
Q

What is an Arnold-chiari malformation

A

Congenital herniation of the cerebellar tonsils

223
Q

Features of von-Hippel-Lindau syndrome

A 
Retinal and intracranial haemangiomas and haemangioblastomas
Renal cysts
Renal cell adenocarcinoma 
Pancreatic tumours
Phaeochromocytoma
224
Q

Features of ataxia telangiectasia

A

Childhood progressive ataxia and athetosis
Conjunctival/cheek/ear Telangiectasia
Immunodeficiency

225
Q

Futures of shy-drager syndrome

A

Parkinsonian symptom - tremor, bradykinesia, rigidity

Autosomal failure - incontinence, postural hypotension, gastoparesis, ED

226
Q

Features of a total anterior circulation stroke (TACS)

A

Triad of hemiplegia, hemianopia, higher cortical dysfunction (aphasia etc)

227
Q

Features of a partial anterior circulation stroke (PACS)

A

2 of - hemiplegia, hemianopia, higher cortical dysfunction (aphasia etc)

228
Q

Features of a posterior circulation stroke (POCS)

A

Affects the brainstem –> Vertigo, dysphagia, dysarthria, facial weakness

229
Q

Features of a lacunar stroke (LACS)

A

Pure motor - hemiparesis
Or pure sensory
Or a combination
In 2 of - face, leg, arm

No visual defect. No higher cortical dysfunction. No brain stem problems. No impaired consciousness

230
Q

In neurofibromatosis type 1 what would a CT spine show

A

Benign tumours at nerve root exits

= dumb bell tumours

232
Q

What can lower the seizure threshold

A 
Drugs - tramadol, fluoxetine, clozapine, cocaine, penicillin,
Hormone change - menstruation, menopause
Tiredness
Fasting
Sleep deprivation
Stress
Alcohol
Flashing lights
233
Q

When do febrile convulsions occur, why + what’s the prognosis

A

6m - 3 yr
Response to rapid increase in temperature
Benign but - Increased risk of seizures later in life - esp male

234
Q

What is status epilepticus

A

Continued tonic-colonic seizures, without regaining consciousness in between
Emergency

235
Q

What is serial epilepsy

A

A succession of tonic clonic seizures but with recovery between

236
Q

What is cataplexy

A

Sudden loss of postural tone
Patient crumples
Remains conscious

237
Q

Tetrad of symptoms in narcolepsy

A

Excessive daytime sleepiness
Cataplexy
Sleep paralysis
Hypnagogic hallucinations

238
Q

What is retrograde amnesia

A

Impaired memory of events before injury / illness

239
Q

What is anterograde amnesia

A

Inability to learn new information after injury / illness

240
Q

Characteristics of a postural tremor

A 
Absent at rest
Present on maintained posture
Rapid
Fine amplitude
Slow, insidious onset 
Uppe limbs 
\+/- titubation
241
Q

Characteristics of a cerebellar tremor

A

Absent at rest
Maximal on approaching target
Slow + coarse

242
Q

Symptoms and signs of cebellar disease

A 
Ataxia
Dysmetria
Dysdiadochokinesia 
Intention tremor
Rebound phenomenon 
Titubation 
Pendular reflexes 
Nystagmus 
Altered speech
Vermis lesion --> truncal ataxia
243
Q

What bacteria causes meningitis In adults / elderly

A

Adults - N. meningitidis, strep penumoniae, TB

elderly - strep penumoniae, listeria

244
Q

What is uhtoffs phenomenon

A

Transient increase or recurrence of symptoms in MS due to an increase in body temperature
E.g. Getting in warm bath

245
Q

What area is affected in expressive dysphasia

A

Broca’s area

246
Q

What area is affected in a receptive dysphasia

A

Wernickes area

247
Q

Symptoms of trigeminal neuralgia

A

Episodic intense facial pain
Trigeminal nerve distribution
Lasts secs-mins
100s x per day

248
Q

Signs of base of skull fracture

A 
Panda eyes
CSF rhinorhoea 
CSF otorrhoea 
Battles sign
Haemotympanum
249
Q

What is Ramsay hunt syndrome

A

Lower motor nerve facial palsy

Associated with herpes zoster infection of the external auditory meatus (shingles)

250
Q

Most common primary CNS tumour

A

Meningioma

Benign

251
Q

What is encephalitis

A

Inflammation of the brain parenchyma

252
Q

Clinical features of cerebellar tonsilar herniation

A

Reduced consciousness
Respiratory irregularities
Neck stiffness
Head tilt

253
Q

What conditions pre-dispose to cerebral abscesses

A

Acute endocarditis
Bronchiectasis
Cyanotic congenital heart disease
Otitis media

254
Q

Features of freidrichs ataxia

A 
Gait disturbance 
Ataxia
Dysarthria
Scoliosis 
DM
Heart disorders
255
Q

What is lhermittes phenomenon

A

Electric shock-like sensations in the arms and legs caused by neck flexion.
Due to involvement of dorsal columns
Common in MS

256
Q

What is gélineaus syndrome

A

Narcolepsy

257
Q

Causes of a transudative pleural effusion

A

Heart failure
Liver failure
Renal failure
(<20g/L protein)

258
Q

Causes of an exudative pleural effusion

A 
Infection
Infarction
Malignancy
Acute pancreatitis  
(>30g/L protein)
259
Q

Causes of respiratory acidosis

A 
COPD
Pneumonia
PE
Pulmonary oedema
Sleep apnoea
Respiratory muscle weakness 
(Raised CO2)
260
Q

In what condition is serum ace elevated

A

Sarcoidosis

General Medicine (25 decks)

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