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Limb weakness Flashcards

1
Q

The technical term for a ‘clumsy’ limb

A

Ataxia

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2
Q

2 key things to establish with acute limb weakness

A

Time course

Location of the lesion

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3
Q

Sudden onset of limb weakness =>

A

CVA
Trauma (e.g. displaced cervical fracture)
Could also be in various parts of the nerve pathway -> acute limb ischaemia, Todd’s palsy, spinal cord prolapse!

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4
Q

Chronic onset limb weakness =>

A

Slow growing tumour

MND

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5
Q

Slow onset limb weakness (hours -> days) =>

A

Gillian-Barre
MS
Subdural haematoma

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6
Q

Spinal cord disease

A

Prolapse
Infarction
Spinal canal stenosis

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7
Q

Altered sensation and paralysis peripheral -> central =>

A

GBS

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8
Q

Where does GBS affect in the nerve pathway?

A

Nerve root

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9
Q

Causes of gradual onset limb weakness (chronic)

A

Diabetes
Myasthenia
Vit B12 deficiency
Tumour

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10
Q

Window for thrombolysis

A

4.5hr

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11
Q

How can you tell the lesion is in the brain?

A

Cognitive signs such as speech or vision issues

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12
Q

Gradual onset headache =>

A

Slow growing tumour

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13
Q

Seizure or LOC with limb weakness =>

A

Haemorrhage
Todd’s paresis
Hypoglycaemia

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14
Q

Hemiparesis with back pain =>

A

Disc prolapse

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15
Q

Unilateral headache and limb weakness =>

A

Hemiplegic migraine

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16
Q

3 main RF for stroke

A

Previous stroke/TIA
AF
Atherosclerotic RF e.g. obesity, HTN, diabetes smoking

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17
Q

UMN signs

A

Increased tone
Brisk reflexes
Upgoing plantars (Babinski sign)
Clonus

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18
Q

LMN signs

A

Reduced tone
Absent reflexes
Fasciculations
WASTING

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19
Q

Broca’s area affects…

A

Articulation of speech

Know what to say but can’t say it

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20
Q

Wernicke’s area affects….

A

Comprehension of speech

Can speak fluently but its nonsense

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21
Q

Complete blindness in one eye suggests…

A

Lesion in optic nerve

Optic neuritis

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22
Q

Homonymous hemianopia suggests…

A

Lesion in the optic chiasm (if bitemporal)

One side => in the cortex (localising sign)

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23
Q

Eye deviating TOWARDS the weak side =>

A

Brain stem lesion

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24
Q

Eye deviating away from the weak side =>

A

Cortical lesion

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25
Non-forehead sparing weakness =>
Problem with facial nerve itself (Bell's palsy)
26
If the weakness is greater in the arm than the leg, which bit of the motor cortex is it affecting?
Lateral homunculus
27
Which artery supplies the lateral part of the primary motor cortex?
Middle cerebral artery
28
Which artery supplies the medial primary motor cortex?
Anterior cerebral artery
29
How long do TIA usually last?
<1 hour
30
Definition of TIA
Symptoms and signs of stroke that resolve in <24hr
31
First-line investigations of stroke
``` CT head FBC Blood glucose (hypoglycaemia) Blood clotting (emboli) ECG (AF) ```
32
Which metabolic abnormality can mimic stroke?
Hypoglycaemia
33
Main treatment for haemorrhagic stroke
Supportive therapy to aid rehabilitation
34
What is the management of an ischaemic stroke outside of the 4.5hr thrombolysis window
Anti-platelet drugs (ASPIRIN!) Given as soon as haemorrhagic stroke is excluded Stroke ward admission VTE prophylaxis
35
Ix to do for patients after initial stroke management
ECG for AF/arrhythmia causing emboli | Carotid artery doppler looking for any stenosis
36
Complications of stroke
Aspiration pneumonia Pressure sores VTE and recurrent stroke
37
Which type of therapist should review stroke patients?
SALT
38
What is the cut off for carotid endarterectomy?
>70%!
39
Who performs carotid endarterectomy?
Vascular surgeons
40
Acronym for stroke drug prophylaxis
ASA Antiplatelet (e.g. clopidogrel) (if you start this, no need for the aspirin aswell) Statin ACEi
41
Which drug should be prescribed for ALL TIA patients?
300mg aspirin
42
Which scoring system is used in TIA?
ABCD2
43
Drug to control rate in AF
Bisoprolol
44
Drug to reduce clotting risk in AF
Warfarin or modern drugs such as rivoroxaban
45
Aspirin and clopidogrel affect which part of the clotting pathway
Platelet aggregation
46
Name for clots that form due to stasis are called ....
Red clots | Rich in RBC and fibrin
47
Prophylaxis of red clots from stasis is through use of
Fibrin mesh inhibitors = clotting cascade | = rivoroxaban and warfarin!
48
Name of clots from ruptured plaques...
White clots | Rich in platelets!!!!!
49
Prophylaxis of white clots from ruptured plaques is through use of...
Platelet aggregation inhibitors Clopidogrel Aspirin
50
What do rivoroxaban and warfarin prevent?
Formation of fibrin mesh | Help to prevent VTE and atrial clots
51
What do clopidogrel and aspirin prevent?
Platelet aggregation after ruptured atherosclerotic plaques | Help to prevent myocardial infarction and ischaemic stroke
52
What is the 300mg aspirin prescribed for in stroke patients?
To prevent emboli
53
What do you compare the CHADsVASc score against to determine if anticoagulation is wise?
HAS BLED
54
Presentation of cord compression
Bilateral sensory loss Weakness UMN signs Presentation building over a few days (subacute)
55
Causes of cord compression
Disc herniation Spondylolisthesis SOL (abscess, tumour, haematoma)
56
Investigation of cord compression
Spinal MRI
57
Ix for MS
Spinal MRI looking for plaques | Lumbar puncture looking for oligoclonal bands
58
Humerus fracture can cause damage to which nerve?
Ulnar nerve
59
Which scale is used to grade limb weakness?
MRC scale
60
Hemiparesis means...
Half body weakness
61
Quadraplegic means
Complete paralysis of all 4 limbs
62
Nerve root responsible for ankle jerk
S1/S2
63
Nerve root responsible for knee jerk
L3/L4
64
Nerve root for biceps
C5/C6
65
Nerve root for triceps
C7/C8
66
Nerve that innervates the bicep
Musculocutaneous nerve
67
Nerve that innervates the badge area of the arm and teres minor
Axillary nerve

Oxford Clinical Cases (11 decks)

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