500.Neurology

Question 1

Upper motor neurons cause weakness. How does this wekness differ from lower motor neurons?

Answer 1

UMN weakness- Affects groups Affects extensors of the arm and flexors of the leg

LMN- depending what neurone is damaged indicates what individual muscles are weak

Question 2

What are the signs of an UMN lesion aside from weakness?

Answer 2

Spasticity- opposite muscle groups ot weakness (ar, fexors, leg extensors)

Less prominent muscle wasting

Hyperreflexic

Upgoing plantars

Significant loss of fine motor skills

Question 3

What are the signs of a lower motor neuron lesion (besides weakness)?

Answer 3

Muscle wasting and fasiculations

Hypotonia/flaccidity

Reduced or absent reflexes

Question 4

What diseases caused mixed upper motor neurone and lower motor neurone signs?

Answer 4

Motor neuroene disease

Reduced B12

Tertirary syphillis that affects spinal cord (taboparesis)

Question 5

Where do pain and temperature senses travel along?

Answer 5

The spinothalamic tract (anterolateral)

Question 6

What fibres travel along the dorsal columns?

Answer 6

joint position and vibration

Question 7

What is the muscle weakness grading scale?

Answer 7

Grade 0- no muscle contractions

Grade 1- flicker of contraction

Grade 2- some movememnt

Grade 3- against gravity

Grade 4- against resitance

Grade 5- normal power (allows for age)

Question 8

What symptoms do internal capusle and corticospinal lesions cause?

Answer 8

Hemiparesis on the contralteral side

Question 9

If there are cranial nerve palsies contralteral to a hemiplegia what does thi sindicate?

Answer 9

Brain stem lesion

Question 10

What drugs are dopamine antagonsits and shouldnt ve used in parkinsons?

Answer 10

Chlorpromazine

Metoclopramide

Question 11

A patient presents with the following. Which artery is occluded?

Weak numb contralateral leg
Similari/slightly milder arm symptoms
No facial abnormalities

Answer 11

Anterior cerebral artery

Question 12

A patient presents with the following. Which artery is occluded?

Contralateral hemiparesis
Hemisensory loss in face and arm
Contralateral homonymous heminaopia
Dysphasia in dominant hemisphere

Answer 12

Middle cerebral artery or

Internal carotid artery (presents similalrly)

Question 13

A patient presents with the following. Which artery is occluded

Contralateral homonymous heminopia (macular sparing)

Answer 13

Posterior cerebral artery

Question 14

A patient is dizzy. Which arteries could be occluded

Answer 14

Superior cerebellar artery- Just dizzy

Anterior inferior cerebellar artey- deaf and dizzy

Posterior inferior cerebellar artery- diizzy, dysphagic and dysphonic

Question 15

What are the sypmtoms of a vetrobasilar circulation infarct?

Answer 15

Many many sings: Hemianopia, blindess, diplopia, vertigo, nystagmus, ataxia, dysarthria, dysphagia. Hemi or quadraplegia

Horner;s syndrome

Locked-in syndrome- damage to the ventral pons

Question 16

What is the diagnosis is blood pressure is different by 20mmHg in each arm?

Answer 16

Subclavian steal syndrome

Question 17

What are the so called “cheat sheet” movements for upper limb myotomes

Answer 17

Shoulder- Abduction- C5
Adduction- C5-C7

Elbow- Flexion C5-C6
Extension- C7

Wrist-Flexion- C7-8
Extension-C7

Fingers- Flexion- C8
Extension-C7
Abduction- T1

Question 18

What are the so called “cheat sheat” movements for lower limb myotomes

Answer 18

Hip- Flexion L1-L2
Adduction L2-L3
Extnesion- L5-S1

Knee- Flexion- L5-S1
Extension- L3-L4

Ankle- Dorsiflexion- L4
Eversion- L5-S1
Plantarflexion- S1-S2

Toe- Big toe extension- L5

Question 19

Name some imporant dermatomes?

Answer 19

C6/7- Lateral arm/forearm
T1- medial side of arm

C6-Thumb
C7-Middle finger
C8- Little finger

T10- umbilicus

L1- inguinal ligament
L2-L3 anterior and inner leg
L5- medial big toe
S1- lateral foot

S2-S4 perineum

Question 20

What are the signs of a space occupying lesion?

Answer 20

Headahce worse on walking, lying down, bending forward or coughing

Seizures

Focal neurology

Personality change

Question 21

What are the differentials for a space occupying lesion?

Answer 21

Tumour

aneurysm

Abscess

Chronic subdural heamatoma

Granuloma

Cyst

Question 22

What are the various types of cancer that can exist in the brain

Answer 22

Astrocytoma

Glioblastoma- aggressive

Oligodendrogiloma- type of glioma

Ependymoma- tumour of CSF cells

Meningioma, CNS lymphoma, cerbellar heamangiobalstoma

Question 23

Disucss the management of a malignant space occupying lesion?

Answer 23

Surgery

Radiotherapy

Chemo (can be localised through carmustine wafers)

Seizure prophylaxis

Dexmethasone/mannitol- raised ICP

palliative care

Question 24

What are some sings a temporal lobe lesion

Answer 24

Dyphasia

Contralateral homonymous hemianopia

Amnesia

Odd feeling phenomenoms

Question 25

A lesion in the frontal lobe produces what signs

Answer 25

Personality changes Hemiparesis Broca's dysphagia Anosmia

Question 26

Parietal lobe lesions produce what signs?

Answer 26

Hemisensory loss Cant recognise objects without seeing them Sensory innatention

Question 27

The acronym "DANISH" is used for the signs of celebellar lesions. Explain DANISH

Answer 27

D- ysdiadochokinesis/ dysmetria A- taxia N- ystagmus I- ntention tremor S- lurred speech H-yptonia

Question 28

What are the signs of a vestibular schwannoma?

Answer 28

Ipsilateral deafness, Nystagmus Reduced corneal reflex Facial weakness Ipsilateral cerbellar sifns Papilloedema

Question 29

What is the management for idiopathic intracranial hypertension (seen in obese 30 year old woman, associated with neurogical abnormalities)

Answer 29

Weight loss Acetazolamide Loop diuretics Prednisolone (optic nerve seath/ lumbar shunt)