Localisation of pathology

Question 1

What area will a CNS pathology affect?

Answer 1

Hemiplegia/ paraplegia

Question 2

What are will a PNS lesion affect?

Answer 2

Peripheral or localised area

Can be a whole limb if due to a plexus

Question 3

What area will a NMJ lesion affect?

Answer 3

Ocular or bulbar

Question 4

What are will a muscle lesion affect?

Answer 4

Proximal and symmetrical

Question 5

What will the description of weakness be like in a CNS lesion?

Answer 5

Heaviness

Question 6

What will the description of weakness be like in a PNS lesion?

Answer 6

Positional/ with sleep

Ascending

Question 7

What will the description of weakness be like in a NMJ lesion?

Answer 7

Fatiguable; worse after use of the muscles

Diurnal variation; worse towards the end of the day

Question 8

What will the description of weakness be like in a muscle lesion?

Answer 8

Aching

Insidious

Question 9

What are the additional features of a CNS lesion?

Answer 9

Spasms

Jerks

Question 10

What are the additional features of a PNS lesion?

Answer 10

Cramp

Twitching (fasiculations)

Question 11

What are the additional features of a NMJ lesion?

Answer 11

Bulbar: swallowing, speaking
Ocular: diplopia, ptosis
Resp: orthopnoea, SOBOE

Question 12

What are the additional features of a muscle lesion?

Answer 12

Myalgia

Cramp

Question 13

Are sensory symptoms possible in a CNS lesion?

Answer 13

Yes

Question 14

Are sensory symptoms possible in a PNS lesion?

Answer 14

Yes

Question 15

Are sensory symptoms possible in a NMJ lesion?

Answer 15

No

Question 16

Are sensory symptoms possible in a muscle lesion?

Answer 16

No

Question 17

Are there any specific difficulties associated with a CNS lesion?

Answer 17

Cognitive involvement

Sphincter involvement

Question 18

Are there any specific difficulties associated with a PNS lesion?

Answer 18

Loss of grip
Tripping up
Unsteady with eyes closed

Question 19

Are there any specific difficulties associated with a NMJ lesion?

Answer 19

Lots of chewing/ talking is difficult
Prolonged gaze hard (long drives/ reading)
Later in day

Question 20

Are there any specific difficulties associated with a muscle lesion?

Answer 20

Getting up from low chairs

Hanging up washing

Question 21

What will be seen specifical on inspection of a CNS lesion?

Answer 21

Limb posture

Question 22

What will be seen specifical on inspection of a PNS lesion?

Answer 22

Wasting/ fasciculations

Pes cavus

Question 23

What will be seen specifical on inspection of a NMJ lesion?

Answer 23

Additional ptosis/ opthalmoplegia

Question 24

What will be seen specifical on inspection of a muscle lesion?

Answer 24

Proximal wasting

Question 25

What will be seen specifically on tone of a CNS lesion?

Answer 25

Increased tone | Spasticity/ clonus

Question 26

What will be seen specifically on tone of a PNS lesion?

Answer 26

Decreased tone

Question 27

What will be seen specifically on tone of a NMJ and muscle lesion?

Answer 27

Neutral or decreased

Question 28

What is the pattern of weakness in a CNS lesion?

Answer 28

``` Pyramidal: Arms; extensors weaker than flexors Legs; flexors weaker than extensors Brain; contralateral Spine; ipsilateral ```

Question 29

What is the pattern of weakness in a PNS lesion?

Answer 29

Peripheral neuropathy; distal weakness | Root/ plexus/ mononeuropathy: dependent on innervated muscles

Question 30

What is the pattern of weakness in a NMJ lesion?

Answer 30

Fatigability

Question 31

What is the pattern of weakness in a muscle lesion?

Answer 31

Proximal weakness (symmetrical)

Question 32

What will the reflexes show in a CNS lesion?

Answer 32

Increased; brisk

Question 33

What will the reflexes show in a PNS lesion?

Answer 33

Decreased; hyporreflexic

Question 34

What will the reflexes show in a NMJ or muscle lesion?

Answer 34

Neutral or hyporreflexic

Question 35

What will the plantar response show in a CNS lesion?

Answer 35

Extensor response; positive babinski sign

Question 36

What will the plantar response show in a PNS, NMJ and muscle lesion?

Answer 36

Flexor response; negative babinski sign

Question 37

Are there any specific sensory symptoms associated with a CNS lesion?

Answer 37

Brain: hemisensory | Spinal cord: sensory level

Question 38

Are there any specific sensory symptoms associated with a PNS lesion?

Answer 38

Peripheral neuropathy; glove and stocking | Root etc; dependent on dermatome

Question 39

Are there any specific sensory symptoms associated with a NMJ or muscle lesion?

Answer 39

No

Question 40

What will a L3/4 root entrapment result in?

Answer 40

L4 root: Pain down medial ankle Loss of quads power Reduced knee jerk

Question 41

What will a L4/5 root entrapment result in?

Answer 41

L5 root: Pain down dorsum of foot Reduced big toe dorsiflexion (extensor hallucis longus)

Question 42

What will a L5/S1 root entrapment result in?

Answer 42

S1 root: Pain to sole of foot Reduced plantar flexion power Reduced ankle jerk

Question 43

What is erb's palsy?

Answer 43

Injury to upper brachial plexus (C5/6) Loss of motor innervation to deltoid, supraspinatus, infraspinatus, biceps and brachialis Internal rotation; waiter's tip posture

Question 44

What is klumpke's palsy?

Answer 44

Lower brachial plexus (C8 and T1) injury Paralysis of intrinsic hand muscles +/- finger and wrist flexors Flexed fingers