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Lectures final revision > Neuro > Flashcards

Neuro Flashcards

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1
Q

Where can the problem be?

A

Central or peripheral

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2
Q

What is included in central

A

Brain (hemisphere, brainstem, cerebellar, L or R)

Spinal Cord (level, which tracts)

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3
Q

what is included in peripheral

A

nerve (mono/poly, sensory, motor or mixed)

Neuro-muscular junction

Muscle

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4
Q

Clusters of cranial nerve

A

1 nose

2346 Eyes

57 Face

8 Ears

9 10 12 Mouth

11 Neck

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5
Q

CN 1 test

A

have you noticed change in smell (and taste)

You would test each nostril one at a time with two different scents

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6
Q

CN2 tests

A

Acuity - change in vision/problems

Colour vision - Plates - can’t do in exam

Blind spot - unlikely to test

Pupillary reflexes

Fundoscopy

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7
Q

Visual Fields

How

A

Confrontational

one eye closed

1m aprt hand in middle

tell me when my finger is moving x4 for each eye

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8
Q

causes of enlarged blind spot

A

papilledema

optic neuritis

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9
Q

short cases - fundoscopy

if pale disk or papilloedema what to ask for

A

gross assessment of their Blind spot

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10
Q

Pupillary reflexes - how to examine?

A

Inspection - size, shape and symmetry

Direct reflex

Consensual Reflex

Swinging for RAPD

Accomodation (constricts on near vision)

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11
Q

RAPD on pupillary reflexes ddx

A

MS

(optic nerve two problem)

One eye is sluggishly getting bigger every time you go back to shine the light on it.

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12
Q

What are the common pupil abnormalities

A

3rd nerve (down and out)

Holmes Aide pupil

Drugs

Horners Syndrome

Argly Robertson Pupil

Drugs

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13
Q

What is Homes Aide pupil

A

The Holmes-Adie pupil is large and irregular.

Pupillary constriction:

to light is slow and incomplete

to accomodation is relatively normal

once the pupil has constricted it remains small for an abnormally long time (tonic pupil)

The Holmes-Adie pupil is considered a variation of normal but is rarely the result of a lesion in the efferent parasympathetic pathway.

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14
Q

Horners Syndrome signs in eye

A

Mild ptosis

Miosis (constriction of eye)

Anhydrosis

Enophalmus (inset eyeball)

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15
Q

Fundoscopy shorts examinatoin

A

Inspection

Pupils

Nystagmus

ptosis

aligned

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16
Q

If there is no diplopia what does that indicate?

A

left LR/6th CN

and

Right MR/3rd

(or vice versa)

Is intact

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17
Q

If only one Medial Rectus is not working and other eye has lateral nystagmus what is happening?

on looking to centre it will move.

A

if third nerve would be down and out

3rd nerve and 6nerve communicate at Medial longitudinal fasciculus in pons

Lesion where they connect

Causes: MS or stroke

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18
Q

Inspect Trigeminal V

A

Motor

Masseter/temporalis wasting. Ask to clench.

Open jaw against resistence for pterygoid power (jaw deviation towards side of lesion)

Snesory

V1 V2 V3

Reflex

Corneal reflex (afferent V1 and efferent Facial nerve)

Jaw jerk (afferent V3 and efferent motor of V)

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19
Q

Facial nerve examination

A

Motor

Facial expression

Sensory

Change in taste to anterior 2/3 tongue

Hyperacusis due to LMN loss of innervation to muscle of stapedius

Reflex

Efferent part of corneal reflex

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20
Q

In Facial nerve UMN forehead is

A

Sparing

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21
Q

Causes of unilateral LMN VII

A

Bells Palsy

Ramsey Hunt Syndrome

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22
Q

Vetibulocochlear test

A

Whisper for crude hearing

Rinne test

Webers

Otoscopy and audiometry to formally hearing loss

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23
Q

Nerves 9 Glossopharyngeal and 10 Vagus

Assessment

A

Inspection (NG or PEG)

Assess speech quality and volume

Palatal asymmetry and uvular deviation away from side of lesion

Offer to test left and right gag reflex seperately

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24
Q

Hypoglossal X12

A

Tongue

Deviated towards side of lesion as poor muscle tone on that side

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25
Nerve 11 Spinal Accessory
Supplies sternocleidomastoid and trapezius Trapezius - shrug up Sternocleidomastoid - turn your head against my hand
26
MG special test
Fatiguiability hold upper gaze will get better after 5 mins count to 20 for their voice
27
Complex Opthalmoplegia
More than one nerve Lots going on
28
What is the order of motor structures
Cerebral Coretx Pyramidal dessuciation Spinal Cord Anteriror Horn Cell Nerve Neuromuscular junction Muscle
29
UMN lesion signs
Increased Tone Weakness (pyramidal pattern) Increased reflexes No wasting No fasciculation Hoffmans Sign
30
LMN lesion signs
Decreased tone Weakness and wasting Areflexia Fasciculations
31
SWIFT inspection
Scars Wasting Involunatry Fasciculation Tremor
32
MND signs
UMN and LMN for all limbs No sensory signs
33
fasciculations have to be seen
at rest (no tone)
34
Order of examining power
Shoulders - ab and ad Elbow - flex and ext Wrist - ext and flex Small muscles of hand for grip Interossei - spread fingers apart DAB Paler PAD paper between fingers
35
Coordination how to test
Finger to nose Dysdiadokinesia
36
Finger to nose tests can reveal
Pass pointing and intention tremor
37
co-ordination remember
BOTH HANDS
38
Biceps
C5 C6
39
Supinator
C5 C6 C7
40
Triceps
C6 C7 C8
41
Reinforcement
on three grit your teeth
42
Median nerve palsy
Exam Sensory loss to lateral border of hand Loss of LOAF muscles Wasting of thenar eminence CTS - phalens and tinels test
43
What are causes of Caral tunnel syndrome
Rheumatoid Acromegaly Hypothyroidism
44
What is phalens?
used to diagnose CTS arms flexed and wrist flexed push dorsal of hand together for 60 seconds. Increases pressure of CT and illicit signs
45
What are the signs in carpel tunnel?
pain and tingling of hands and fingers numbness in fingers pain in or near the wrist pain extending into the arm skin lesions in the terrirotry of the median nerve due to compression of blood vessels
46
Ulner Nerve Palsy
Exam Claw hand in 4th and 5th finger Hypothenar eminence wasting Weakness of muscles Sensory loss of ulnar border of the hand Causesd by injury to elbow
47
Radial Palsy
Exam sensory loss to dorsum of hand Weakness of wrist flexion and finger extension
48
Causes of radial palsy
Humerus fracture Prlonged pressure lipoma/fibroma Systemic causes of mono-neuritis multiplex
49
Myotonic Dystrophy features
weakness in facial nerve frontal balding cataracts bilateral ptosis wasting of sternoclydoid muscle hatchet facies due to atrophy of temporal muscle
50
Examination of Myotonic Dystrophy
Myo-pathic facies balding cataracts decreased power in face and bulbar muscles Wasting of face, neck, distal arms distal weakness asbent reflexes hand grip myotonia percussion myotonia
51
What is the inheritance of Myotonic Dystrophy
Trinucleaotide repeat, AD Anticipation
52
Differentials in Myotonic Dystrophy
Could be motor neurone problem but given that I can see that the face involved this would be less likely. This could be a motor nerve problem - isolated motor nerve rare nMJ like MG muscular problem could be acquired or congenital
53
How to conclude an examination in Myotonic dystrophy
Cognitive CVS Urine dip for glucose as get diabetes
54
Diagnose and investigate Myotonic Dystrophy
Serum CK EMG MD Type 1 - genetic ECG and Echo for Cardiomyopathy and conduction block hBA1c - diabetes Opthal RV - cataracts Formal cognitive testing - cognitive impairment
55
UMN in lower limb
include clonus plantars
56
Lower limb inspection look for what?
Muscle groups Fasciculation Wasting Any bony deformity or scar Pes Cavus (CMT/ F Ataxia)
57
Lower limb tone examination
Ask for pain then roll leg brisk lift of knee joint Clonus: knee flexed, check tone of ankle, rotate it around and flex the joint
58
Clonus examination
Clonus is present if foot moves up and down Present bilaterally in MS
59
Examining power
Hip Knee Dorsi and ankle plantar Eversion and inversion
60
Plantar response
from heel up isolate anke stop after first movement of big toe
61
Spastic Paraparesis
Exam Hypertonia, clonus, hyperflexia, weakness, up-going plantars no or mild wasting without fasciculations
62
In spastic paraparesis what are the additonal clues to look for the cause?
Sensory involvement/level Scars from tendon release Cerebellar signs (Friedreichs) Upper limb signs (LMN Cervical myelopathy, UMN Cranial cause) Eye signs (MS)
63
What is the relationship between UMN and LMN signs in Cervical Myelopathy?
LMN at sensory level and UMN below
64
Post polio syndrome
Shortened leg if had as a child lots of scars from surgery loss tone loss of reflex loss of muscle bulk one sided but can be two
65
66
Rombergs Sign
Doesn't really test cerebellar function Vision Posterior columns Vestibular syndrome Crude test for swaying with eyes open which is excerbated by closing eye. Therefore, compensating with their eyes
67
Diabetic Polyneuropathy signs and features
Mostly sensory in feet decreased pain and temp sensation Decreased vibration and JPS decreased reflexes Ulcers and charcot joints Neurogenic pain/allodynia Wasting if severe
68
CMT signs and features
Distal wasting mixed sensory and motor polyneuropathy mainly peripheral Pes Cavus high stepping gait, scoliosis
69
inheritance of CMT
AD Commonest neuro disease affecting 1/2500
70
Central lesion tests
Imaging is gold standard Location based on pathology
71
LMN neurone test
Motor studies
72
Extra pyramidal examination
Rigidity Bradykinesia Tremor Gait - festinate, reduced arm swing) Head to toe Mask like face Hypophonic Tremor Lead pipe elbow cog wheeling wrist bradykinesia synkineisa micrographia dyskinesia on off phenomenon end dose(?)
73
Cerebellar Syndrome Examination
Gait - broad based Heel to toe walk Rombergs sign - should be negative (unless vestibular syndrome) Head to toe Eye movements Speech rebound phenomena Finger nose past pointing intention tremor on finger nose Rapid hand movements - dysdiadokinesia heel to shin hypotonia and pendular reflex
74
what neuropathy causes only MOTOR LMN signs
Porphyria Led toxicity
75
LMN Motorneurone causes of motor problem
MND Polio
76
LMN motor only problem at NMJ
MG LEMS
77
Bloods tests in motor problems?
B12 folate TFT lead toxicity
78
Difference between motor neurone and neuropathy?
Motor neurone is the nucleus Neuropathy is anything affecting the nerve coming out of the spinal cord
79
what used against hep C
Interferon and ribavirin
80
used against hep b
Lamivudine
81
with PKD what is relevant re when palpable cancer inheritance
end stage are palapable due to cysts no increased risk of cancer Autosomal Dominant
82
Side effects of NRTI for HIV
Lipoatrophy Lactic Acidosis Peripheral Neuropathy Bone Marrow Suppresion Anaemia Pancreatitis
83
SE of NNRTI in HIV
Hepatoxicity Steven Johnson Snydrome
84
Rx of recurrant UTI
IF more than 1 a month then prophylactic can be considered 100mg Trmethorpim OD
85
Wernickes Encephalopathy Triad
Ataxia Confusion Opthalmoplegia
86
Korsakoffs
impairement of memory
87
Triad in Menieres
Vertigo Hearing loss Tinnitus
88
Treat molloscum contagiosum
Cosmetic cryotherapy as take two years to go away
89
drugs that can increase gallbladder stones
Fenofibrate - more cholestrol in gb oestrogen somatostatin analogues
90
what is seen in the heart with untreated hypertension
uniform hypertrophy of left ventricle wall
91
diabetic on meds with symtpoms of delayed gastric emptying what to do
Change medications from GLP-1 agonsits to other
92
Differentials for a morbilliform rash macular/erythematous/trunk and extremeititieds
Measles, rubella, Parvovirus B19
93
signs in Parvovirus B19
Slapped Cheek lacy appearance of rash
94
Difference between L5 and right common peroneal nerve injury
L5 - weak dorsiflexion, eversion AND WEAK inversion. Weak hallux longus extension Common peroneal - weak dorsiflexors, foot evertor (NOT INVERTOR) therefore a weak inversion shows its L5 lesion
95
Osteonecrosis is a complication of which drug rare
Bisphosphonates | (Alendronate)
96
Characteristics of Churg Strauss
Asthma Peripheral and Central Esoinophilia Extravascular granuloma multiple organ vasculitis
97
drugs that cuase psoriasis upset
BB antimalarials lithium interferons
98

Lectures final revision (10 decks)

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