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Medecine - As PACES > Neuro > Flashcards

Neuro Flashcards

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1
Q

Features of cauda equina

A

Pain in back and radicular pain down legs
Weakness: bilateral flaccid, arefleixa
Saddle anaesthesia
Poor anal tone

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2
Q

Features of beck syndrome

A

Paresis
Impaired pain and temp
Preserved touch and proprioception

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3
Q

Signs of syringomyelia

A 
Dissociated sensory loss 
- loss of pain and temp - scars from burns 
- preserved dorsal columns 
- cape distribution 
Wasting/weakness of hands +/- claw hand 
Loss of reflexes in upper limb 
Charcot joints 
UMN weakness in lower limbs with extensor plantars
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4
Q

Syrinx the expansion affects…

A

Deccusatating spinothalmic neurone
Anterior horn cells
Corticospinal tracts

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5
Q

Feature of Parkinson

A

Tremor- ⬆️stress⬇️by sleep
Rigidity - lead pipe, cog wheeling
Akinesia- difficulty with repatitive movement, slow imitation, mask like face
Postural instability- stopped gait with festination
Postural hypotension, constipation, ED, ⬆️saliva
Sleep disorders: EDS, OSA, RBD, dopamine SE
Psychosis - Visual hallucination
Depression/ dementia/ drug SE

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6
Q

Causes of tremor

A 
Resting: Parkinsonism 
Intention: cerebellar 
Postural (worse with arms outstretched) 
- benign essential tremor 
- endocrine: ⬆️T4 
- alcohol withdrawal 
- toxins: b-agonist 
- sympathetic: anxiety
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7
Q

Side effects of l-dopa

A 
Dyskinesia 
On-off phenomena 
Psychosis 
ABP - decreased 
Mouth dryness 
Insomnia 
Nausea and vommiting 
Excessive daytime sleepiness
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8
Q

Cerebellar signs

A 
DANISH 
Dysdiadochokinesia 
Ataxia 
Nystagmus 
Intention tremor 
Slurred speech 
Hypotonia
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9
Q

Cause of cerebellar signs

A

DASIES
Demyelination
Infarct- brain stem stroke
Space occupying lesion - schwannoma and CPA Tumour
Inherited: Wilson, Friedrich ataxia, VHL
Epilepsy medication: phenytoin
System atrophy - multiple

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10
Q

Cerebellar vermis lesion

A

Ataxic trunk and gait

Normal arms

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11
Q

Feature of cord compression

A

Pain: at level and anaesthesia below
Weakness: LMN at level and UMN below level
Sphincter disturbance

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12
Q

Features of lateral medullary syndrome

A 
DANVAH 
Dysphagia 
Ataxia 
Nystagmus 
Vertigo 
Anaesthesia - ipislateral face, contralateral body 
Horner syndrome
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13
Q

Presentation of vestibular schwannoma

A 
Unilateral SNLH, Tinitus and vertigo 
Increased ICP - headache 
Ipislateral CN 5,6,7, 8 palsied and cerebellar signs 
- facial anaesthesia and absent corneal reflex 
- lateral rectus palsy 
- LMN facial nerve palsy 
- SNLH 
-DAMISH
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14
Q

Cause of cerebellopointine angle syndrome

A 
Vestibular schwannoma - 80% 
Meningioma 
Cerebellar astrocytoma
Metastase 
Epidermoid cyst
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15
Q

Von hippel Lindau

A 
Renal cyst 
Bilateral renal cell carcinoma 
Haemangioblastoma - often in cerebellum 
Phaeochromctyome 
Islet cell rumours
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16
Q

Features of Friedrich ataxia

A

Pes cavus
Bilateral cerebellar ataxia
Leg wasting + arefleixa but extensor plantars
Loss of vibration and proprioception

Other: HOCM, high arched palate, optic atrophy

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17
Q

Detention of a stroke

A

Rapid onset focal neurological defecit of vascular origin lasting >24hrs

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18
Q

Features of TACS - total anterior circulation stroke

A

All 3 of the following

  1. contralateral hemiparesis +/- hemisensory defecit
  2. Homonymous heminsopia
  3. Higher cortical dysfunction - domiant - dysphagia, nondominant - confusion and constructional apraxia
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19
Q

PACS - partial anterior circuition stroke

A

2/3 of TACS criteria

Defecit is less dense or incomplete

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20
Q

5 syndrome with lacunar strokes

A
  1. Pure Motor - posterior limb of internal capsule
  2. Pure sensory - posterior thalamus
  3. Mixed sensimotor - internal capsule
  4. Dysathria - clumsy hand
  5. Ataxic hemiparesis - anterior limb of internal capsule
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21
Q

Milland gubler syndrome

A

Pontine infarct

Features: diplopia, LMN facial nerve palsy, loss of corneal reflex and contralateral hemiplegia

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22
Q

ABCD2 score

A 
Predict stroke risk following TIA 
Age >60
BP>or equal : 140/90
Clincal features: unilateral weakness(2) speech disturbance without weakness (1) 
Duration: >1hr(2) 10-59 (1) 
Diabetes melitus

Score - 6 or more - high risk of Stoke admit
Score - above 4 - specialist clinic within 24hrs

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23
Q

Definition of MS

A

Chronic inflammatory condition of the CNS characterised by multiple plaques of demyelination disseminated in time and space

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24
Q

Differential of mixed UMN and LMN signs

A

Motor neurone disease
Friedrich ataxia
Subacute combined degeneration of the cord
Taboparesis

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25
Features of a radial nerve palsy
Inspection: wrist drop Power: triceps, brachioradailis, extensors in wrist, finger, MCP, thumb Absent or weak triceps reflex Loss of sensation over dorsal aspect of the hand at the anatomical snuff box
26
Features of a medial nerve palsy
Inspection: sign of benediction, thenar wasting Weakness of LOAF muscles - thenar: abduction, flexion and oppisiotion of the thumb - index: flexion of DIP Median nerve sensation loss
27
Feature of an ulnar nerve palsy
Inspection: wasting of dorsal interossei and hypothenar emminance, claw hand Weakness of all muscle of the hand except LOAF Loss of sensation over medial aspect of hand
28
LOAF muscles
Lateral two lumbricals Oppens pollicis Abductor policis Flexor policis brevis
29
Sensory polyneuropathy
``` Diabetes melitus Alcohol B12 defficancy Chronic renal failure and cancer - paraneoplastic Vasculitis Drugs: isonizid, vincristine ```
30
Mainly motor polyneuropathy
Hereditary motor sensory neuropathy/ Charcot Marie tooth Parenoplastic - lung cancer, renal cell cancer Lead posising Acute: GBS and botulinism
31
Femoral neuropathy/amyotrophy
Painful asymmetric weakeness and wasting of the quads with loss of knee jerks
32
Differential of muscle fatiguabilty
Myasthenia Polymyositis SLE Botulinism
33
Investigation in myasthenia
Bedside: spirometery Bloods -Abs: anti-Achr, anti- musk - Tft EMG: decreased response to continuous stimulus Tensilon test: improvement with edrophonium CT mediastinum- thyoma in 10%
34
Miller fisher
Subtype of GBS | Opthalmoplegia, ataxia and arefleixa
35
Bells sign
Eye ball roll back on closure
36
Cause of bilateral facial nerve palsy
``` Bilateral bells Sarcoidosis GBS Lyme Pseudo palsy: MG, Myotonic dystrophy ```
37
Cause of facial palsy
``` 75% idiopathic Bell's palsy Supranuculear: vascular, MS, SOL pontine: vascular, MS, SOL CPA: Vestibular schwannoma, Intra-temporal: Ramsay hunt, cholesteoma Infra-temporal: parotid tumour, trauma Systemic : - neuropathy - DM, Lyme, sarcoid - pseudopalsy: myasthenia gravis ```
38
Features of Horners syndrome
Ptosis - partial - superior tarsal muscle Enopthalmos Anhydrosis Small pupil
39
Causes of an occulomotor palsy
``` Medical - mononeuritis - diabetes - MS - midbrain infarction - Webers - migraine Surgical - increased ICP - car venous sinus thrombosis - posterior communicating artery anneyeursm ```
40
Holmes Addie pupil
Dilated pupil that has no response to light and sluggish response to accomidation
41
Marcus gun pupil
Dilation on moving light from normal to abnormal eye
42
Features of optic atrophy
Decreased visual acuity Decreased colour Vision - paticualry red Central scotoma Pale optic disc RAPD - dilation on moving light from eye from normal to abnormal eye
43
Causes of optic atrophy
``` Congenital - lebers hereditary optic neuropathy - HSMN - Frederich ataxia Toxins: alcohol, ethambutol, lead b12 Compression: neoplasia ( optic glioma, pituitary adenoma) glaucoma, pagets Vascular: DM, GCA Inflammatory: optic neuritis Sarcoid Infection: herpes zoster, TB Odema: papilloma Neoplastic infiltration: lymphoma, leukemia ```
44
Craniopharyngioma
Benign suprasellar tumour originating from rathke pouch | Leads to ascending visual loss - bitemporal hemianopia
45
Cause of a complex opthalmoplegia
DM: mononeuritis multiplex Myasthenia gravis MS Thyrotoxicosis
46
Causes of hearing loss
Conductive: impaired conduction anywhere between auricle and round window - canal obstruction: wax, foreign body - TM perforation: trauma, infection - ossicle defect: otosclerosis, infection - fluid in the middle ear Sensireneural hearing loss: defect of cochlear, nerves or brain - congenital: alports - acquired: presbyacussis, drugs(gentamicin, vancomycin), infection( measles), tumour - vestibular schwannoma
47
Definition of dysphonia
Impaired production of voice and sounds
48
Definition of Dysathria
Impaired articualtion of sounds and words
49
Defenition of dysphagia
Impairment of language
50
Nail changes in psoriasis
Discolouration Pitting Onycholysis Subungual hyperkeratosis
51
5 patterns of psoriatic athritis
1. Asymmetric oligoathrtis 2. Distal athritis 3. Symmetric polyathritis 4. Spondylitis 5. Athritis mutilans
52
Cause of onycholysis
Psoriasis Fungal infection Trauma Thyrotoxicosis
53
Radiologic features of psoriatic athritis
DIP erosions Osteolysis Periarticualr new bone formation Pencil in cup deformity - advanced disease
54
Occulomotor
Motor : superior, inferior and medial rectus, inferior oblique, levator palpebrae Parasympathetic: pupillary constriction and accomidation
55
Trochlear
Superior oblique
56
Trigeminal
Sensation to, face scalp, cornea, nasal and oral cavities and cranial dura matter Muscle of mastication
57
Abducens
Lateral rectus
58
Facial nerve
Muscle of facial expression and stapedius muscle
59
Glossopharyngeal
Sensory: pharynx, posters 1/3 of the tongue, Eustachian tube, middle ear, carotid body and carotid sinus Motor: stylopharygneal muscle - swallowing Salivation
60
Vagus
Sensory: phaynx, larynx, oesophagus and external ear, aortic bodies and aortic arch, thoracic and abdominal viscera Motor: vocal cord, pharynx Parasympathetic: thoracic and abdominal viscera
61
Accessory nerve
Sternicliodmastoid and trapezius
62
Hypoglossal nerve
Intrinsic and extrinsic muscle of the tongue
63
Cause of sleep disorders in Parkinson's
Insomnia and frequent waking ➡️ excessive day time sleepiness - cause by an inability to turn, restless leg syndrome, obstruct sleep apnoea REM behavioural sleep disorder - loss of movement atonia during sleep leading to violent enactment of dreams
64
On- off effect - Parkinson's
Unpredictable fluctuation in motor performance unrelated to timing of dose
65
Cause of proximal myopathy
1. Inflammation: polymyositis, dermatomyositis 2. Inherited: muscular dystrophy 3. Drugs: Alcohol, statins, steroids 4. Pareneoplastic 5. Endocrine: Cushing syndrome, acromegaly, thyrotoxicosis, osteomalacia, diabetic amyotrophy
66
Blood test in peripheral neuropathy
Glucose, HbA1c, FBC, Blood film, LFTS, GGT, U&E, B12, folate, ESR, ANA, ANCA, TFT

Medecine - As PACES (6 decks)

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