Neurology

Question 1

Parietal lobe signs (dominant)

Answer 1

AALF
Acalculia - serial 7s
Agraphia - writing
Left-right disorientation - “show left hand”
Finger agnosia - name fingers

Question 2

Parietal lobe signs (non-dominant)

Answer 2

Agraphaesthesia - draw number on hand
Inattention - visual and sensory
Astereognosis - identify object in hand
Dressing apraxia
Constructional apraxia
Spatial neglect

Question 3

Temporal lobe signs

Answer 3

Short term memory loss
Long term memory loss
Dysphasia, receptive (in dominant lobe lesions)

Question 4

Frontal lobe signs

Answer 4

Grasp reflex
Palmomental reflex
Pout reflex
Gait apraxia
Anosmia
Interpret a proverb

Question 5

Shoulder ABduction
nerve root
Muscles

Answer 5

C5 / C6
Deltoid and supraspinatus

Question 6

Shoulder ADduction
Nerve root
Muscles

Answer 6

C6 / C7 / C8
Pectoralis major, latissimus dorsi

Question 7

Elbow flexion
Nerve root
Muscles

Answer 7

C5 / C6
Biceps and brachialis

Question 8

Elbow extension
Nerve roots
Muscles

Answer 8

C7 / C8
Triceps

Question 9

Wrist flexion
Nerve root
Muscles

Answer 9

C6 / C7
Flexor carpi ulnaris and radialis

Question 10

Wrist extension
Nerve root
Muscles

Answer 10

C7 /C8
Extensor carpi group

Question 11

Finger extension
Nerve root
Muscles

Answer 11

C7/C8
Extensor: indicis, digiti minimi, digitorum communis

Question 12

Finger flexion
Nerve root
Muscles

Answer 12

C7/C8
Flexor digitorum profundus

Question 13

Finger ABduction
Nerve root
Muscles

Answer 13

C8/T1
Dorsal interossei

Question 14

Finger ADduction
Nerve root
Muscles

Answer 14

C8/T1
Palmar interossei

Question 15

Biceps reflex

Answer 15

C5/6

Question 16

Triceps reflex

Answer 16

C7/8

Question 17

Brachioradialis reflex

Answer 17

C5/C6

Question 18

Radial nerve
Root
Motor and sensory functions

Answer 18

C5-8
Triceps, brachioradialis, wrist extension
If lesion in upper third of nerve it will cause triceps weakness
Sensation in anatomical snuff box

Question 19

Median nerve
Nerve roots
Motor and sensory function

Answer 19

C6-T1
LOAF
Lateral two lumbricals
Opponens pollicis
Abductor pollicis brevis
Flexor pollicis brevis
(All muscles of the front of the forearm except the flexor carpi ulnaris and half of the flexor digitorum profundus)

Question 20

Which nerves / nerve roots supply the intrinsic muscles of the hand?

Answer 20

Ulna and median nerve
C8-T1

Question 21

Clawing of the ring and small fingers - what does this signify?

Answer 21

ulnar lesion

Question 22

Wasting of 1st dorsal interossei - cause

Answer 22

ulnar lesion

Question 23

Wasting of abductor digiti minimi - cause

Answer 23

ulnar lesion

Question 24

Wasting of abductor digiti minimi - cause

Answer 24

ulnar lesion

Question 25

Wasting of abductor policis brevis (thenar eminance, thumb abduction) - cause

Answer 25

median nerve lesion

Question 26

Iliopsoas function nerve root peripheral nerve

Answer 26

hip flexion L1/2/3 Femoral

Question 27

Quadriceps function nerve root peripheral nerve

Answer 27

knee extension L2/3/4 femoral

Question 28

Gluteus maximus function nerve root peripheral nerve

Answer 28

hip extension L5 S1/2 inferior gluteal nerve

Question 29

Hamstrings function nerve root peripheral nerve

Answer 29

knee flexion sciatic nerve L5 S1/2

Question 30

Hip adductors function nerve root peripheral nerve

Answer 30

obturator nerve L2/3/4

Question 31

Myotonic dystrophy Types Mutations Inheritance pattern

Answer 31

DM1 and DM2 (milder) Repeat expansion in DMPK (DM1) or ZNF9 (DM2) Autosomal dominant inheritance

Question 32

Myotonic dystrophy manifestations

Answer 32

Weakness - facial muscles, distal forearms, hands Muscle pain Myotonia Cardiac conduction disease LVH Pharyngoesophageal weakness and respiratory muscle weakness Sleep disorder Hypogonadism Cataracts

Question 33

Wasted hand - only abductor pollicis brevis (thumb abduction)

Answer 33

median nerve lesion

Question 34

Wasted hand - only abductor digiti minimi and first dorsal interosseous

Answer 34

Ulnar lesion

Question 35

How does median nerve lesion and the wrist differ to median nerve lesion at the elbow?

Answer 35

Weakness of abductor pollicis brevis at the wrist lesion At elbow - will have weakness of flexors of the finger and flexor pollicis longus. (okay sign)

Question 36

What is the benediction sign a sign of?

Answer 36

proximal median nerve lesion

Question 37

What muscles are supplied by the ulnar nerve?

Answer 37

Flexor digitorum profundus of the little finger Abductor digiti minimi first dorsal interosseous

Question 38

What causes weakness of all three of: Abductor pollicis brevis Abductor digiti minimi First dorsal interossus

Answer 38

C7/8/T1 root or plexus lesion - finger extensors and triceps C5-T1 - sensory loss of the whole arm, often associated with horners Syringomyelia - wasting, loss of reflexes and loss of pain (light touch preserved) C8/T1 cord lesion - wasting of both hands and spastic weakness of the legs - look for sensory level Motor neurone disease - fasiculations, wasting, hyper-reflexia, No sensory loss Peripheral neuropathy - wasting of all limbs distally Myotonic dystrophy - distal wasting, hyporeflexia, baldness, ptosis, cataracts

Question 39

Wrist drop patterns of weakness

Answer 39

1. radial nerve lesion - weak brachioradialis, wrist extension, finger extension. snuff box sensory loss 2. posterior interosseous nerve lesion - weakness of finger extension, radial deviation of the wrist on extension, no sensory loss, and normal reflexes. 3. C7/8 root or plexus lesion - weak triceps, finger extensors and flexors, triceps reflex absent 4. Corticospinal lesion - teneralised weakness, increased tone and reflexes

Question 40

Lower limb weakness patterns

Answer 40

1. Femoral nerve lesion: weakness of quads and hip flexion, reduced knee jerk. Hip adductors normal. 2. L2/3/4 root or plexus injury; as per femoral nerve plus weakness of hip adduction. 3. Cortical lesion: pyramidal weakness with increased tone and hyperreflexia 4. Paraparesis: bilateral pyramidal pattern weakness plus sensory level 5. Generalised weakness with reflexes increased- MND or quadriparesis

Question 41

Foot drop patterns

Answer 41

1. common peroneal nerve - weakness of dorsiflexion and eversion 2. L4/5 nerve root - as per 1. but add inversion, and may be weakness of hip abduction, ankle jerk preserved 3. Sciatic nerve - loss of all movements plus loss of ankle jerk 4. peripheral neuropathy - associated with sensory loss 5. cauda equina - saddle anaesthesia etc 6. MND 7. Corticospinal tract - brain vs. cord 8. Brown-sequard - one leg weak with loss of all sensation, contralateral leg has loss of pain and temperature

Question 42

Pes cavus causes

Answer 42

long standing neuropathy - CMT - Friedreich's ataxia - spina bifida

Question 43

Gait patterns

Answer 43

High-stepping gait - foot drop Bilateral high-stepping gait - bilat foot drop - think CMT, MND High-stepping with wide base - think sensory ataxia, test rombergs myopathic / waddling gait - weakness of hip abduction - test trendelenburg Circumduction - hemiparesis Scissoring gait - bilateral increased tone - cerebral palsy, hereditary spastic paraplegia, MS, cervical spondylosis Parkinsonian gait Frontal gait - wide base, small steps, upright posture Cerebellar gait - broad base with irregular steps

Question 44

Facial weakness patterns

Answer 44

1. Upper motor neurone lesion; unilateral weakness sparing frontalis and orbicularis oculi. 2. Lower motor neurone lesion; unilateral weakness, usually Bells (loss of taste, hyperacusis), facial nucleus (may also have CN6 nerve palsy) 3. Bilateral facial weakness - GBS, sarcoidosis, myopathies (such as facio-scapulo-humeral dystrophy, mitochondrial myopathy, myotonic dystrophy, parkinson's facies, pseudobulbar palsy / MND 4. isolated weakness to one or two muscles - rare

Question 45

Unilateral ptosis causes

Answer 45

horners - constricted pupil, partial ptosis occulomotor palsy - down and out with dilated pupil

Question 46

Lateral medullary syndrome

Answer 46

Horners, ipsilateral loss of temperature / pain sensation, contralateral pain and temperature loss on trunk and limbs

Question 47

Bilateral ptosis

Answer 47

myaesthenia, myotonic dystrophy

Question 48

Perinaud syndrome

Answer 48

convergence-retraction nystagmus - pupils may be unractive to light but normal accommodation. Usually compression of the mid-brain, hydrocephalus or stroke

Question 49

PSP eye findings

Answer 49

loss of voluntary vertical gaze, but reflex movements intact