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Neurology Flashcards

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1
Q

Causes of Peripheral Neuropathy

A

Diabetes Drugs; (Phenytoin, Isoniazod, Nitrofurantoin) Autoimmune; Gullian Barre, SLE CKD Alcohol/B12 deficiency

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2
Q

Features of neuropathic ulcers

A

Slouchy Bloody Not painful

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3
Q

Features of diabetic neuropathy

A

Sensory affected>motor

light touch and vibration go first - loss of protection

Glove stocking distribution - can be painful

Length dependant - feet affected first

Loss of ankle reflexes, then knees etc

Can cause neuritis

Loss of autonomic function later

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4
Q

Ulnar nerve palsy

A

Weakness/wasting first dorsal interosseous - loss of thumb adduction

Partial claw hand (loss of lumbricals) looks like Dupetryns

Weakness of pincer grip (Frommets)

Sensory loss of fifth and ulnar half of fourth digit

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5
Q

Positive prayer sign

A

Fixed flexion deformity e.g RA, scleroderma, diabetes, ulnar nerve palsy, dupuytrens

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6
Q

Causes of Carpal Tunnel

A

RA DM Pregnancy Trauma Hypothyroid

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7
Q

Shoulder Abduction Nerve Root

A

C5

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8
Q

Elbow Flexion Nerve Root

A

C6

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9
Q

Wrist Extension Nerve Root

A

C7

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10
Q

Finger Extension Nerve Root

A

C8

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11
Q

Finger Abduction Nerve Root

A

T1

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12
Q

Median Nerve Palsy

A

e.g carpal tunnel can’t abduct thumb (thenar./APB) sensory loss 3.5 fingers Tinels and Phalens positive Pain in night relieved by shaking

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13
Q

Radial Nerve Palsy

A

Wrist drop e.g fractured head of humerus loss of sensation dorsum forearm and first 3 fingers dorsum

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14
Q

Hip Flexion Nerve Root

A

L2

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15
Q

Knee Extension Nerve Root

A

L3

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16
Q

Inversion and Dorsiflexion of Foot Nerve Root

A

L4

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17
Q

Dorsiflexion Big Toe Nerve Root

A

L5

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18
Q

Eversion of Foot Nerve Root

A

S1

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19
Q

T1 Nerve Supply

A

Pupil Dilation Axilla and upper inner sensation Intrinsic muscles of hand

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20
Q

T1 Nerve Root Lesion Features

A

e.g Pancoasts tumour (partial ptosis, small pupil) pain/sensory loss axilla complete claw hand wasting of small muscles hand

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21
Q

Facial paralysis with contralateral body weakness

A

Brainstem lesion

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22
Q

Isolated hemianopia - where is the lesion/vessel?

A

Posterior Communicating Artery

Contralateral

(occipital lobe)

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23
Q
A
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24
Q

Hemianopia plus hemiplegia on same side -

Where is the lesion/vessel?

A

Middle cerebral artery on contralateral side

(optic radiation temporal and parietal lobes)

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25
Where is the lesion if central scotoma (middle missing)?
Optic Nerve
26
Where is the lesion if bitemporal hemianopia (outside halves gone)?
Optic Chiasm
27
Where is the lesion if homonymous hemianopia (left/right half of both gone)
Lobe lesion
28
Why do you sometimes macular sparing?
Small part of optical lobe supplied by MCA rather than (PCA)
29
Why do you get forehead sparing in UMNL?
"bilateral cortical representation of upper part of the face"
30
What are the Parkisons Plus Syndromes?
Multiple system atrophy Progressive supranuclear palsy Parkinsonism-dementia-amyotrophic lateral sclerosis complex Corticobasal ganglionic degeneration Dementia with Lewy bodies
31
CNIII Palsy
Partial ptosis down and out dilated pupil
32
Causes of a CNVII LMNL
Acoustic Neuroma Bells Palsy Trauma to petrous temporal bone Ramsay Hunt
33
Dopamine Agonists
Less effective than Ldopa+inhib Less motor complications - useful for young Or in addition in adv disease
34
Ldopa + dopa decarboxylase inhibitor
Main tx Good for bradykinesia an rigid but less for tremor Balance of benefit vs dyskinesias Useful for 5 years before wearing off - delay start
35
Side effects of levodopa
End-of-dose effect = wears off earlier and earlier On-Off effect = unpredicatable fluctuation Dyskinesias = unwanted movements
36
Seligiline
Can be used to delay ldopa Autonomic side effects
37
COMT inhibitors
inhibit peripheral breakdown helps w/ end-of-dose
38
Features of a TACI
Severe, poor recovery **All three** of: 1. Contralateral hemiparesis 2. Contralateral homonymous hemianopia 3. Higher cortical dysfunction (speech, attention etc)
39
Features of a PACI
2 of the 3 TACI features, usually higher cortical dysfunction + contralateral weakness
40
Features of PoCI
1 of the 3: 1. contralateral homonymous hemianopia 2. cerebellar signs 3. brainstem signs
41
Features of Lacunar Infarct
No higher coritcal No homo hemi No drowsiness No brainstem pure motor/pure sensory/sensorimotor/dysarthria+hand/contra hemiballismus
42
Genetics of Charcot Marie Tooth
Most common is autosomal dominant CMT but other phenotypes
43
What the underlying pathophysiology of Charcot Marie Tooth?
gene duplication leading to production of abnormal myelin, which is unstable and spontaneously breaks down --\> demyelination --\> uniform slowing of conduction velocity onion bulb appearance
44
Presentation of Charcot Marie Tooth
usually before 10 yr peripheral muscle weakness and wasting moving distally - inverted champagne legs, claw hands sensory loss in same pattern - vibration touch then proprioceoption painful arreflexia deformity palpable nerves
45
Deformities of Charcot Marie Tooth
pes cavus/pes planus/ hammer toe spinal eg thorcic scoliosis
46
Management of Charcot Marie Tooth
physio orthotics avoid neuropathic meds surgery for deformity analgesia genetic counselling
47
DDx of adult onset spastc parapesis
MS ALS (MND) B12 deficiency Transverse myelitis
48
Investigations of MS
CSF - oligoclonal IgG bands MRI - plaques Evoked potentials EEG but mainly clinical
49
Why do you get deformity like Z thumb, Boutonnieres etc in RA?
Chronic rheumatoid tenosynovitis damages tendons so they eventually wear out, snap, split etc
50
Types of diabetic neuropathy?
Peripheral neuropathy - glove stocking Mononeuropathy Mononeuropathy multiplex Diabetic femoral neuropathy - wasting and weakness of quads, loss of knee jerks Autonomic neuropathy
51
What peripheral neuropathy affects motor before sensory (unlike most)?
Gullian Barre Charcot Marie Tooth
52
How do you manage GCA?
Refer urgently to surgery for temporal artery biopsy Start high dose steroids immediately 40mg pred (60mg if claudication)
53
Marcus Gunn Pupil
No RAPD optic nerve damage retinal disease
54
Adie Pupil
Dilated pupil Slow reactive to light Damage to parasympathic nerves from infection, often w/ absent knee/ankle jerks
55
Argyll-Robertson Pupil
Small pupil Accomodates but doesnt react to bright light Prostitutes Diabetic neuropathy, neurosyphilis
56
Features of NF1
Cafe au lait Axiary or inguinal freckles Neurofibromas Optic nerve gliomas Lisch nodules
57
Which common drugs can induce Parkinsonism
Amiodarone Metocloperamide, Prochlorperazine Lithium Cinnarizine/Stugeron **Atypical antipsychotics** Conventional antipsychotics
58
What are the extra pyradimal side effects?
Tardive Dyskinesia Parkinsonism Dystonia Restlessness
59
Bacterial Meningitis LP Results
Cloudy and turbid **High WCC** (neutrophils) **High protein** Very **low glucose** Normal red cells
60
Viral Meningtis LP Results
**Normal appearance** **Raised WCC** (lymphocytes) Normal red cells Protein normal/high Glucose normal/low
61
TB Meningitis LP Results
Normal or slight cloudy Raised WCC (lymphocytes) Red cells normal **Protein high** **Glucose very low**
62
SAH LP Results
**Yellow/blood** stained appearance WCC normal **Red cells very high** Protein normal or high Glucose normal or low
63
How might you be able to distinguish between bacterial meningitis and TB meningitis on an LP?
TB less cloudy **bacterial** predominantly **neutrophils** **TB** predominantly **lymphocytes**
64
Gullain Barre LP Results
Appearance WCC normal Red cells normal **High protein (after a week)** Glucose normal or low or Low
65
66
MS LP Results
Normal appearance WCC rasied lymphocytes Red cells normal Protein high Glucose normal

OSCE (20 decks)

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