Extra Neuro

Question 1

Where is CSF made?

Answer 1

in the choroid plexus

Question 2

Define hydrocephalus?

Answer 2

Excessive volume of CSF in ventricular system

Question 3

Define the 2 main groups of hydrocephalus?

Answer 3

obstructive (non-communicating) - physical blockage to the flow of CSF

non obstructive (communicating) - imbalance in resorption or production of CSF

Question 4

Describe examples of obstructive (non-communicating) hydrocephalus?

Answer 4

congenital anomalies:
congenital stenosis or atresia of the Sylvian aqueduct
atresia of the foramen of luschka or magendie
arnold chiari malformation (may be associated with spina bifida)

acquired:
posterior fossa and brainstem tumours
3rd ventricle colloid cyst
choroid plexus papilloma (rare)

Question 5

What is Arnold Chiari malformation?

Answer 5

part of the cerebellum and medulla bulges through the foramen magnum

Question 6

Describe examples of non-obstructive (communicating) hydrocephalus?

Answer 6

Descreased resorption e.g. meningitis or post haemorrhage
increased production - choroid plexus tumour (very rare)

Question 7

Presentation of hydrocephalus in infants?

Answer 7

since sutures are not fused there is an increase in head circumference, failure of upward gaze and sunsetting eyes

Question 8

Presentation of hydrocephalus in adults?

Answer 8

causes raised ICP so presents with headache with red flags, papilloedema, nausea and vomiting, coma

Question 9

Investigations for hydrocephalus?

Answer 9

CT head
MRI
Lumbar puncture can be both diagnostic and therapeutic since it allows sampling of the CSF, measuring of opening pressure but also to drain and reduce some of the pressure

Question 10

Management of hydrocephalus?

Answer 10

treat underlying cause
external ventricular drains
ventriculoperitoneal shunting

Question 11

Cause of normal pressure hydrocephalus?

Answer 11

mainly unknown

Question 12

Define normal pressure hydrocephalus?

Answer 12

non obstructive hydrocephalus characterised by large ventricles with normal intracranial pressure

Question 13

Presentation of normal pressure hydrocephalus?

Answer 13

triad of gait disturbance, dementia and urinary incontinence

Question 14

Management of normal pressure hydrocephalus?

Answer 14

ventriculoperitoneal shunt

Question 15

What is syringomyelia / syringobulbia?

Answer 15

can be called syrinx for shot
collection of CSF in the spinal cord
if in the medulla it is called synrigobulbia

Question 16

Causes of syringomyelia?

Answer 16

strong association with arnold chiari malformation
trauma, tumours, idiopathic

Question 17

Presentation of syringomyelia?

Answer 17

cape like loss of temperature sensations, spastic weakness, in LL
upgoing planters

Question 18

Investigations for syringomyelia?

Answer 18

MRI whole spine and brain (to rule out arnold chiari malformation)

Question 19

Investigations for syringomyelia?

Answer 19

MRI whole spine and brain (to rule out arnold chiari malformation)

Question 20

Management of syringomyelia?

Answer 20

may need a shunt

Question 21

C5 Dermatome?

Answer 21

Badge patch

Question 22

C6 Dermatome?

Answer 22

Thumb

Question 23

C7 Dermatome?

Answer 23

middle finger

Question 24

C8 Dermatome?

Answer 24

pinky

Question 25

T1 Dermatome?

Answer 25

above and below elbow on anterior arm

Question 26

T2 Dermatome?

Answer 26

medial top of arm

Question 27

T3 Dermatome?

Answer 27

Just above the nipple

Question 28

T4 Dermatome?

Answer 28

in line with the nipple

Question 29

T10 Dermatome?

Answer 29

At the umbilicus

Question 30

L1 dermatome?

Answer 30

at the groin

Question 31

L2 Dermatome?

Answer 31

upper anterior thigh

Question 32

L3 dermatome?

Answer 32

Knee

Question 33

L4 Dermatome?

Answer 33

Medial leg

Question 34

L5 Dermatome?

Answer 34

Lateral leg and big toe

Question 35

S1 Dermatome?

Answer 35

pinky toe

Question 36

Femoral nerve roots?

Answer 36

L2, L3, L4

Question 37

Sciatic nerve roots?

Answer 37

L4-S3

Question 38

Sciatic nerve divides into what 2 nerves?

Answer 38

tibial and common peroneal

Question 39

Anterior compartment of the thigh is supplied by and does what?

Answer 39

Femoral nerve, flexion at the hip, extension at the knee

Question 40

Posterior compartment of the thigh is supplied by and does what?

Answer 40

tibial nerve, extension at the hip, flexion at the knee

Question 41

The medial thigh is supplied by what and does what?

Answer 41

obturator nerve, adduction of the thigh

Question 42

The lateral leg is supplied by what and does what?

Answer 42

superficial peroneal nerve, eversion

Question 43

Anterior leg is suppled by what and does what?

Answer 43

deep peroneal nerve, dorsiflexion, extend toes, inversion and eversion

Question 44

Posterior leg is suppled by what and does what?

Answer 44

tibial nerve, plantar flexion of ankle and flexion of toes

Question 45

Lesion of the femoral nerve means?

Answer 45

won't be able to flex hip or extend knee

Question 46

Lesion of sciatic nerve?

Answer 46

lose full leg extension, will get a foot drop

Question 47

Lesion of common peroneal nerve?

Answer 47

associated with fibula neck fractures, will get a foot drop

Question 48

lesion of obturator nerve?

Answer 48

loss of adduction

Question 49

Cutaneous nerve supply to the hand?

Answer 49

ulnar - pinky plus half the ring both sides radial - dorsal side of hand (dorsal web spaces!) - thumb plus two and half fingers median nerve - palmar side of hand - thumb plus two and half fingers

Question 50

Axillary nerve lesion?

Answer 50

dislocation of shoulder loss of sensation to the badge patch loss of shoulder abduction

Question 51

Radial nerve lesion?

Answer 51

wrist drop - humeral shaft fractures (loss of wrist extension)

Question 52

Median nerve lesions?

Answer 52

carpal tunnel syndrome

Question 53

Ulnar nerve lesions?

Answer 53

weakness of hand - loss of sensation in digits 4 and 5

Question 54

Ankle jerk reflex?

Answer 54

S1, S2 (buckle my shoe)

Question 55

Knee jerk reflex?

Answer 55

L3, L4 (kick the door)

Question 56

Biceps reflex?

Answer 56

C5, C6 (pick up sticks)

Question 57

Triceps reflex?

Answer 57

C7, C8 (lay them straight)

Question 58

Loss of sensation in big toe and no reflexes affected ?

Answer 58

L5

Question 59

L5 root damage?

Answer 59

loss of big toe sensation and big toe extension

Question 60

S1 root damage?

Answer 60

loss of ankle plantar flexion, ankle reflex may be affected, loss of sensation in little toe and potentially heel

Question 61

Hip replacement can damage?

Answer 61

The sciatic nerve

Question 62

Stenosis

Answer 62

narrowing of canal lumbar spinal stenosis is the most common cause of neurogenic claudication

Question 63

Spondylosis

Answer 63

age related wear and tear of the intervertebral discs can cause a myelopathy or a radiculopathy

Question 64

Spondylolithesis

Answer 64

vertebra falls forward and pushes on the spinal cord (anterior direction)

Question 65

Disc prolapse

Answer 65

= disc herniation = slipped disc IV disc protrudes posteriorly and can compress the spinal cord

Question 66

Cauda equina syndrome?

Answer 66

syndrome from compression of cauda equine most commonly caused by disc prolapse but could be trauma, tumours, infections, etc

Question 67

Myelopathy

Answer 67

compression of spinal cord, UMN signs

Question 68

Radiculopathy

Answer 68

compression of spinal roots LMN signs

Question 69

What is raised 10-20 minutes after a true seizure?

Answer 69

raised serum prolactin

Question 70

What is a rare but serious side effect of lamotrigine?

Answer 70

Steven Johnson syndrome patients must look out for the rash - seek medical help

Question 71

T1 myotome?

Answer 71

thumb adduction - T1 bring in the thumb

Question 72

Klumpkes palsy is what type of injurY?

Answer 72

a traction injury

Question 73

First line for absence seizures?

Answer 73

ethosuximide