Nervous System

Question 1

Winging of the scapula indicates damage to which nerve?

Answer 1

Long thoracic nerve

Question 2

Define Hoffman’s reflex

Answer 2

Thumb flexion in response to tapping the distal third/fourth finger - indicates an UMN lesion

Question 3

Outline the 4 main risk factors for a CVA

Answer 3

1. Smoking
2. Hypertension
3. Diabetes
4. Hyperlipidaemia

Question 4

What are the 3 important aspects of HPC to ask patients presenting with a CVA?

Answer 4

1. Previous TIAs/CVAs
2. Amaurosis fugax
3. Transient sensory/ motor problems

Question 5

Suggest 3 cranial nerve findings that may be seen with a patient presenting with CVA

Answer 5

1. Homonymous hemianopia
2. UMN facial weakness
3. Pseudobulbar palsy

Question 6

What are the immediate investigations required for someone presenting with a CVA?

Answer 6

1. BM - rule out hypoglycaemia
2. ECG - rule out AF
3. CT brain

Question 7

Which 3 clinical sequelae are required as part of the Bamford classification to diagnose a total anterior circulation stroke?

Answer 7

1. Motor and sensory deficits in 2/3 of face/arm/leg
2. Homonymous hemianopia
3. Disturbance of higher function e.g. dysphasia/ neglect

Question 8

What are the clinical characteristics of a lacunar stroke ?

Answer 8

Pure motor or sensory/ ataxic hemiparesis

Question 9

Marcus Gunn pupil is associated with which medical condition?

Answer 9

Multiple sclerosis

Question 10

Define Marcus Gunn Pupil

Answer 10

Optic atrophy with a relevant afferent pupillary defect

Question 11

What findings on the examination of CSF can be associated with MS? (3)

Answer 11

1. Oligoclonal bands (immunoglobulins) - seen in around 90% of patients
2. Slight increase in protein concentration
3. Slight increase in mononuclear cells

Question 12

What are the treatment options for acute symptomatic MS?

Answer 12

1. 3-5 day course of high dose corticosteroids

2. Specialist supervision of immunosuppressant therapies e.g. azathioprine or intravenous immunoglobulins

Question 13

Name a potential treatment for long term relapsing-remitting MS

Answer 13

Interferon Beta

Question 14

Name the 3 patterns/ types of MS seen

Answer 14

1. Relapsing-remitting
2. Secondary progressive
3. Primary progressive

Question 15

Name the 2 characteristic symptoms associated with multiple sclerosis

Answer 15

1. Uhthoff’s phenomenon

2. Lhermitte’s sign

Question 16

Suggest 5 expected clinical findings in a patient with Freiderick’s Ataxia

Answer 16

1. Pes cavus
2. Kyphoscoliosis
3. Diabetic finger prick marks
4. Nystagmus
5. Hearing aids

Question 17

Give 4 clinical findings associated with myotonic dystrophy

Answer 17

1. Temporalis muscle wasting
2. Frontal balding
3. Ptosis
4. Cataracts