Ipad Questions Flashcards by Helen Nightingale

3rd nerve palsy

Ptosis
Down and out at rest

Big pupil - if damage to PNS via Edinger-Westfall nucleus or external compression

PCOM aneurysm
Uncal herniation
Diabetic infarct (pupil sparing)
Nuclear (brainstem) lesions - often bilateral

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Benign Essential Tremor

Autosomal dominant
Both upper limbs
Worse with outstretched arms (postural)
Improves with alcohol
Improves with rest

Commonest cause of head tremor (“titubation”)

Management:

Propranolol
Primidone

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6th nerve palsy

Failure of abduction (lateral gaze)

Or just double vision looking one wayw

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4th nerve palsy

Commoner in children (head trauma at birth)
Double vision on reading
Fall over walking downstairs
Down and in is the problem - Vertical diplopia
Long term –> head tilt to compensate (bielschowsky tilt)

Usually traumatic
Longest nerve as comes out back of brainstem and around

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Congenital Horner’s

Associated with heterochromia (different coloured eyes)

Prob with development pf something in cord

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Causes of horners

Brain, stem down to T1 - stroke, MS, tumour

Cervical chain from t1 up - tumour in lung or thyroid, goitre

Carotid dissection
Cavernous sinus
Superior orbital fissure??

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Painful, pupil involving 3rd nerve palsy

Aneurysm of PCA pressing on occulomotor nerve

If bleed –> SAH (xanthochromia on LP)
Refer to neurosurgeons

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Holmes Adie pupil

Dilated pupil
Anisocoria
Changes with ambient light but no acute light response - “tonic pupil”
Accomodation occurs but may be slow

Idiopathic problem with post ganglionic Parasympathetic NS
Can occur secondary to trauma, inflammation, infection, tumour

Holmes-Adie syndrome = with hyporeflexia and diaphoresis (sweating)

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Ulnar Nerve Palsy

Bent little and ring fingers = ulnar claw (loss of medial lumbricals) when asked to straighten hand
Small muscle wasting of hand but NOT thenar eminence
Sensory change in palmar little and half of ring finger

?Froment’s sign - opposing thumb the index finger flattens

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Radial Nerve Palsy

Wrist and finger drop - long extensors of the hand and fingers
No wasting in the hand

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Median Nerve Palsy

Thenar wasting
High median lesion –> median claw when asked to make a fist = hand of benediction - can’t bend index and middle in due to loss of long flexors of the lateral fingers and the lateral lumbricals

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Causes of spastic paraparesis

Cord compression - emergency!

Cervical spondylosis
MS
Motor neuron disease
Stroke

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Right eye deviated medially
Can’t look laterally
Diplopia maximal on looking right

6th nerve palsy

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Causes of a 6th nerve palsy

Diabetes, hypertension

MS
Raised ICP

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Earliest sign of raised ICP in fundi

Loss of retinal vein pulsation

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Cushing’s Triad

Hypertension
Bradycardia
Abnormal respiration

Signs of raised ICP

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Signs of raise ICP

Cushing's triad
Loss of retinal vein pulsation, then papilloedema
Vomiting, especially in the morning
Headache
6th nerve palsy
3rd nerve palsy

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Wasting of the small muscles of the hand - causes

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Bilateral

rheumatoid
cervical spondylosis
motor neuron disease
charcot marie tooth
syringomielia
bilateral cervical ribs

Unilateral causes

pancoasts
brachial plexus trauma
cervical rib

Neurofibromatosis Type 1

Von Recklinghausen

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AD on chr 17

Neurocutaneous: Cafe au lait spots (6 or more, over 15mm), axillary /neck/groin freckling,
Lisch nodules in the iris (hamartomas seen with slit lamp)
More than 2 dermal NFs
Nodular NF (nerves)
Optic glioma
Fundal changes

Neurofibromas on nerve tissue which may cause compression

Associated with:
Hypertension
Scoliosis
10% malignant transformation
Behavioural abnormalities, learning difficulties

Rare associations:
phaeo
Renal artery stenosis

Neurofibromatosis Type 2

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AD on chr 22

Bilateral 8th nerve palsy
Acoustic neuromas

Crowe’s sign

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Axillary freckling

As seen in neurofibromatosis type 1

What is Fredrich’s ataxia?

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AR inheritence
Spinocerebellar degeneration

Spine –> upper and lower MN signs = weakness and wasting

Cerebellar signs

Motor Neuron Disease

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Degeneration of the anterior horn cells

Commonly presents with fasciulations

Joints affected in psoriatic arthritis

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Hands
Hips (sacroilitis)
Knees

Oligoarthritis

Also arthritis mutilans - erodes joint, pencil in cup appearance?

Lichen Planus

Purple papules Inside of wrists White patch on buccal mucosa Demonstrates Koebener phenomenon

What is the Koebener phenomenon?

Rash occurs at site of trauma Vitiligo Psoriasis Lichen planus Warts

Complications Post MI

``` Failure Arrhythmias - AF, heart block (inferior MI), VT/VF and sudden death Murmurs -- Mitral regurgitation -- VSD -- tricuspid regurg ``` Ventricular aneurysm Pericarditis Dressler's syndrome

Cardiac causes of syncope

Aortic stenosis Arrhythmias - AF, SVT, heart block, VT/VF Tamponade

Chest pain + systolic murmur | Mirza

Aortic stenosis

Palpitations and murmur | Mirza

Mitral regurg??

Complications of a prosthetic valve

``` Failure Infection Bleeding - warfarin Anaemia - haemolysis Thromboembolic ```

Causes of an irregularly irregular pulse

AF Atrial flutter with a variable block Multiple ventricular ectopics

Poor prognostic factors in rheumatoid

Young at onset Female Rheumatoid factor positive (More on Mirza's slide)

Can't see a red reflex

Tumour Opacified lens Retinal detachment Vitreous haemorrhage (False eye)

Causes of a pigmented retina

``` Retinitis pigmentosa Racial variation Choroido retinitis (toxoplasmosis) Laser burns (diabetic retinopathy treatment) Melanoma ```

Indications for Pulmonary Lobectomy

Cancer and benign tumours Bronchiectasis Congenital abnormalities Infection - Chronic lung abscess - TB - Fungal infection (life threatening haemoptysis in Aspergillosis)

Causes of Bronchiectasis

Genetic - CF, Kartagener's (Marfan's) Chronic lung disease - COPD Chronic systemic disease - Rheumatoid (1/3 pts), IBD Secondary to obstruction - foreign body, tumour, lymph nodes Secondary to infection - TB, pertussis, measles Secondary to damage - recurrent aspiration Hypogammaglobulinaemia (this is the treatble cause!!) Allergic bronchopulmonary aspergillosis

Allergic Bronchopulmonary Aspergillosis

Aspergillus triggering ++immune response - mucus plugging - serum eosinophilia - raised IgE and IgG (precipitins) Usually presents as loss of symptom control in an asthmatic Management: long term steroids and antifungals

Lobectomy or Pneumonectomy?

Thoracotomy + chest drain below OR 3 port VATS Lobectomy = local flattening of ribs, locally reduced expansion and air entry. Otherwise hyper-resonant as remaining lung expands to fill the cavity. Pneumonectomy = this side fills with fluid, so like a giant effusion - stony dull with decreased expansion, air entry and vocal resonance. Trachea and apex beat displaced.

Causes of a Thoracotomy Scar

Lungs: pneumonectomy, lobectomy Heart: valve repair, thoracic aorta Oesophageal procedures Diaphragmatic repair Anterior spinal tumour excision Latissimus dorsi flaps

Dark skinned Persistent dark brown bruise-like lesion Palms, soles, under nails, buccal mucosa (hairless areas)

Acral lentiginous melanoma 5% of all malignant melanoma BUT 50% of mm in dark skinned people Poor prognosis as goes unnoticed

Dark, flat, irregular lesion Itching, bleeding and growing Caucasian woman Sun exposed areas

Superficial spreading melanoma Commonest malignant melanoma Usually in pre-existing mole, can be de novo

Nodular pigmented lesion De novo (not in an existing mole) Grow rapidly Extend deep

Nodular melanoma Most aggressive type of malignant melanoma

Pigmented sun-damaged skin | Progress over years into lesion with nodules or irregular border

Lentigo maligna melanoma

Ipad Questions Flashcards

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