General neuro PACES

Question 1

What is the first question you ask yourself in a neuro station?

Answer 1

Where is the lesion
-> Is it UMN or LMN
-> Is it sensorimotor or purely motor

Question 2

How do you remember the pattern of weakness in an UMN lesion?

Answer 2

Flexors stronger than extensors in upper limb
Extensors stronger than flexors in lower limb

FUEL

Question 3

What are the six main locations from a nerve leaving the spinal cord?

Answer 3

Anterior horn
Nerve root
Plexus
Nerve
NMJ
Muscle

Question 4

What are the three locations that can cause a purely motor neuro issue

Answer 4

Anterior horn
NMJ
Muscle

Question 5

What are the three locations where you can get a sensorimotor issue?

Answer 5

Nerve root
Nerve plexus
The nerve itself

Question 6

What is the usual difference between causes of a proximal vs distal weakness?

Answer 6

Proximal = muscle weakness
Distal = neuropathy

Question 7

When do you get spasticity vs rigidity?

Answer 7

Spasticity = pyramidal issues
Rigidity = extra-pyramidal issues

Question 8

What is one of the main things you must describe about any neurological issue?

Answer 8

Is it symmetrical?

Question 9

What direction should you assess for sensation in limb neuro exams?

Answer 9

Distal to proximal

Question 10

What questions should you ask when you’re assessing sensation in limb neuro exams?

Answer 10

Can you feel this? Does it feel normal?

Question 11

What will you see on limb examination for someone who has a spinal cord issue?

Answer 11

LMN signs at the level of the lesion
UMN signs below that level

Question 12

What side are the signs for a cerebellar problem?

Answer 12

Ipsilateral

Question 13

How can you classify cerebellar issues?

Answer 13

Acute (stroke, demyelination)
Subacute (infection, paraneoplastic or inflammation)
Chronic (slow things)

Question 14

What are the 4 different types of tremors?

Answer 14

Resting tremor (gravity not acting)
Postural tremor (gravity acting)
Action tremor (throughout action)
Intention tremor (at end of action)

Question 15

What are the three cerebellar things you need to screen for in an UL exam?

Answer 15

Pronator drift, Rebound phenomena, Closed fist test (see if it opens slowly)

Question 16

How do you screen for cerebellar issues in a LL exam?

Answer 16

Gait + Heel shin

Question 17

What is romberg’s test a sign for?

Answer 17

Sensory ataxia (typically joint position) -> NOT CEREBELLAR

Question 18

What are the 4 cardinal features of parkinsonism

Answer 18

Postural instability
Bradykinesia -> finger to thumb touching (necessary)
Rigidity (amplified by distraction)
Resting tremor

Question 19

What are the four broad types of investigations used in neuro?

Answer 19

Imaging
Neurophysiology
CSF
Bloods

Question 20

What are the features of a Broca’s aphasia?

Answer 20

Expressive aphasia
-> Able to understand questions but can’t formulate speech
-> Only can say a few words
-> Have awareness

Question 21

Where are Broca’s and Wernicke’s areas located?

Answer 21

Broca’s = dominant hemisphere frontal lobe
Wernicke’s = dominant hemisphere superior temporal gyrus

Question 22

What are the features of a Wernicke’s aphasia?

Answer 22

Receptive aphasia
-> Issue in language comprehension
-> Difficulty understanding speech
-> ‘word-salad’ / neologisms used with no insight

Question 23

What are the cardinal features of vestibular neuronitis? What two symptoms are not present?

Answer 23

-> Nausea + Vomiting
-> Balance problems

No TINNITUS OR HEARING LOSS

Question 24

What should you consider if a patient presents with N+V, balance issues, tinnitus and hearing loss?

Answer 24

Meniere’s or Labrynthitis

(Vestibulocochlear nerve affected)

Question 25

What test detects peripheral causes of vertigo?

Answer 25

The head impulse test involves the patient sitting upright and fixing their gaze on the examiner’s nose. The examiner holds the patient’s head and rapidly jerks it 10-20 degrees in one direction while the patient continues looking at the examiner’s nose. The head is slowly moved back to the centre before repeating in the opposite direction. Ensure they have no neck pain or pathology before performing the test.

A patient with a normally functioning vestibular system will keep their eyes fixed on the examiner’s nose.

In a patient with an abnormally functioning vestibular system (e.g., vestibular neuronitis or labyrinthitis), the eyes will saccade (rapidly move back and forth) as they eventually fix back on the examiner.

Question 26

What causes a double vision that disappears when shutting one eye?

Answer 26

Ophthalmological problem (NOT NEUROLOGY)

Question 27

What does a chronic subdural haemorrhage look like on CT?

Answer 27

On CT imaging, a chronic subdural haematoma will appear as a hypodense (dark), crescentic collection around the convexity of the brain

Question 28

best ways of examining for fasciculations in the arms?

Answer 28

best seen in the deltoid
-> may be elicited by gently flicking the muscle if there’s a clinical suspicion

Question 29

MRC scale for muscle power

Answer 29

5: Full Strength
4: Movement against partial resistance
3 – Movement against gravity (e.g. can lift heel off bed)
2: Movement with gravity eliminated (i.e. can move horizontally on the bed)
1: Feeble contractions (e.g. twitch)
0: Absent voluntary contraction

Question 30

how is the strength of reflexes scored?

Answer 30

absent, hyporeflexic, normal or brisk