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Flashcards in Neurology Deck (252):
1

What nerve roots make up the brachial plexus

C5 - T1

2

What is an erb's palsy

Upper brachial plexus injury
Arm extended
Internally rotated - pronated
Hand extended backwards

3

Which nerve roots are involved in an erb's palsy

C5 + 6 - upper brachial plexus

4

Common causes of an erb's palsy

Traction injuries - e.g. Motorcycle accident, shoulder dystopia at birth.

5

What is a Klumpke's palsy

Lower brachial plexus injury
Claw hand - all digits
Sensory loss over ulnar border of forearm + hand

6

Nerve roots involved in a Klumpke's palsy

C8 + T1 - lower brachial plexus

7

Causes of Klumpke's palsy

Breech birth injury (arm extension)
Pulling on the arm during delivery
Motorcycle accidents

(Klumpke the monkey hung from the tree)

8

Winging of the scapula is caused by injury to which nerve

Long thoracic nerve to serratus anterior

9

When may the long thoracic nerve be damaged

Breast surgery
Axillary surgery
Breast / axillary radiotherapy
Axillary trauma

10

What nerve runs in the spiral groove of the humerus

Radial nerve

11

Common causes of radial nerve palsies

Humeral shaft fracture
Elbow dislocation
Monteggia fractures
Compression of neve by prolonged use of ill fitting crutches
Falling asleep with arm hanging over Chair = Saturday night palsy

12

What nerve is involved in a Saturday night palsy

Radial

13

What causes wrist drop

Radial nerve palsy

14

Nerve supply of the anatomical snuffbox

Radial nerve

15

What does the accessory nerve supply

Trapezius
Sternocleidomastoid

16

Syx / signs of accessory nerve palsy

Weak shoulder shrug
Inability to turn head against pressure

17

What does the axillary nerve supply

Motor to deltoid
Sensory to regimental badge area

18

What nerve is compressed in carpal tunnel syndrome

Distal median nerve

19

Compression of the medial nerve by the flexor retinaculum is called what.....

Carpal tunnel syndrome

20

In whom is carpal tunnel syndrome more common

Women
Pregnancy
RA
acromegally
Hypothyroidism

21

Syx of carpal tunnel syndrome

Tingling + numbness in radial 3 1/2 digits
Wasting thenar eminence

22

Features of 6th CN lesion

Eyes appear conjugate in primary position
Failure of abduction of affected eye
Horizontal diplopia when looking at affected side

23

Features of 4th CN palsy

Diplopia on downward gaze
Sit with head tilted
Failure to aduct on downward gaze
Eyes conjugate in primary position

24

Features of 3rd CN palsy

Eye down and out
Ptosis
Pupil dilation

25

What is convgent strabismus

1or both eyes turn in
Will turn out to focus when other eye is covered

26

What is ramsay hunt syndrome

Herpes zoster (shingles) of the geniculate ganglion.
+ external auditory meatus

27

What is Ménière's disease

Recurrent vertigo + deafness, tinnitus, aural fullness.

28

Benign paroxysmal vertigo symptoms

Short episodes of vertigo triggered by head movement.
Due to free floating particles in the endolymph

29

What is hallpikes manoeuvre used to diagnose

To confirm benign paroxysmal vertigo.
Move pt from sitting to lying with head below vertical to reproduce vertigo and nystagmus.

30

Most common cause of subarachnoid haemorrhage

Rupture of berry aneurysm on circle of willis.

31

Features predisposing to berry aneurysm formation

Defective collagen synthesis
- Polycystic kidney disease
- Ehlers Danlos
High blood pressure conditions
- coarctation of the aorta
-

32

Investigations for suspected subarachnoid haemorrhage

CT head.
LP for xanthochromia after 12hr

33

Symptoms of trigeminal neuralgia

Mandibular, maxillary or ophthalmic division - unilateral stabbing pain.
Precipitated by touch.
More common in F

34

Early morning headache,worse on lying down and coughing suggests...

Raised intracranial pressure.
Investigate to exclude SOL.

35

Features of tension headache

Band-like pain around head
Stress

36

Features of UMN lesion

Increased tone
Hyper-reflexia
Spasticity
Clonus
Pronator drift
Extensor plantar response

37

Features of LMN lesion

Fasciculation
Wasting
Loss of reflexes
Hypotonia

38

What neurological condition is worse with heat

MS

39

In what condition does lead-pipe / cog-wheel rigidity occur

Parkinson's disease

40

In what condition does a pill-rolling tremor occur

Parkinson's tremor

41

In what condition does a festinant gait with reduced arm swing occur

Parkinson's disease

42

Decreased muscle action potentials after continuous stimulation suggests what neurological condition

Myasthenia gravis

43

Features of cauda equina syndrome

Saddle anaesthesia
Bladder and bowel disturbance
Bilateral leg pain

44

Features of brown sequard syndrome

Ipsilateral loss of vibration and proprioception
Contralateral loss of pain and temperature

45

Features of Gillian-Barre syndrome

Ascending symmetrical flaccid muscle weakness.
Loss of tendon reflexes.
+/- distal paraesthesia or pain.
20% develop respiratory muscle involvement
Preceding recent respiratory / GI infection (esp campylobacter jejuni)

46

What is shy-drager syndrome also known as

Multi-system atrophy

47

Features of multi-system atrophy

autonomic dysfunction
parkinsonism (muscle rigidity +/ tremor and slow movement)
ataxia (Poor coordination / unsteady walking)

48

Features of wernicke's encephalopathy

Confusion
Nystagmus
Opthalmoplegia
Ataxia

49

Features of korsakoff's syndrome

Memory problems
Confabulation
Irreversible

50

Cause of a bilateral high-stripping gait

Sensory ataxia
E.g. Peripheral neuropathy

51

Cause of a scissoring gait

Spastic paraplegia

52

Cause of a wide-based gait

Cerebellar lesion

53

Cause of bilateral pin-point pupils

Opiate overdose

54

Features of a 3rd nerve lesion

Dilated pupil
Ptosis
Eye deviated down and out

55

Features of horners syndrome

Unilateral ptosis
Facial anhydrosis

56

Features of an anterior circulation stroke

Unilateral weakness
Unilateral sensory deficit
Homonymous hemianopia
Dysphagia
Sensory neglect

57

Investigations for suspected MS?

Neuro referral - mainly clinical diagnosis
EEG
MRI - demyelinating plaques
LP - oligoclonal bands
Immunoassay for myelin antibodies

59

What cancers metastasise to the brain

Lung
Kidney
Breast
Melanoma
Colon

60

What is a todd's paresis?

Post-ictal temporary paralysis

61

Features of a radial nerve palsy?

Wrist drop
Loss of sensation in the anatomical snuffbox
Inability to extend metacarpophalangeal joints

62

When may the accessory Nerve (CN XI) be damaged?

Surgery to the neck

63

What nerve wraps around the surgical Neck of the humerus?

Axillary nerve

64

What nerve is damaged by anterior dislocation of the shoulder?

Axillary nerve

65

Features of axillary nerve lesion?

Absent sensation to the upper outer arm (Regimental badge patch)
Deltoid muscle paralysis
Limited arm Abduction (0-90. Above 90 = suprasipinatus)

66

Is clawing of the 4th and 5th digits more marked in a proximal or distal ulnar nerve lesion?

More marked in a distal lesion

67

Normal pressure on LP

50-180 mm H2O

68

Normal values and colour of CSF on LP

Clear
RBC 0-4
WBC 0-4
Glucose >60% of blood value
Protein <4.5 g/L
Microbiology - sterile

69

CSF values suggesting bacterial meningitis on LP

Normal / raised pressure
Cloudy
RBC 0-4 (normal)
WBC >1000 -neutrophils
Glucose 0.45g/L

70

CSF values suggesting viral meningitis on LP

Normal pressure
Clear
RBC 0-4 (normal)
WBC 60% blood value
Protein - Normal <0.45g/L

71

CSF values suggesting TB meningitis on LP

Normal / raised pressure
Clear / cloudy
RBC 0-4 (normal)
WBC >1000 - Lymphocytes
Glucose 0.45g/L

72

CSF values suggesting fungal meningitis on LP

Normal pressure
Clear
RBC 0-4 (normal)
WBC 0-50 - Lymphocytes
Glucose 0.45g/L

73

What does India ink stain

Cryptococcus neoformans (fungi)

74

What Do oligoclonal bands on CSF indicate?

MS

75

When is xanthochromia seen in the CSF?

Subarachnoid haemorrhage
(Due to erythrocyte breakdown products --> Yellow colour)

76

Neurological manifestations of Wilson's disease

Dementia
Tremor
Dyskinesia

77

What are the MRC grades of power. And what does each one mean

Grade 5 = normal power
Grade 4 = movement against gravity and mild resistance
Grade 3= active movement against gravity
Grade 2 = active movement when gravity eliminated
Grade 1 = flicker of contraction
Grade 0 = no contraction

78

What is Gillian-Barre syndrome

Post-infective demyelination polyneuropathy.
Immune-mediated demyelination of spinal roots or peripheral nerves.

79

Management of Gillian-Barre syndrome

Supportive
Ventilatory support if respiratory involvement

80

What is miller-fisher syndrome

Rare variant of GBS.
Descending paralysis, (reverse order of normal GBS.)
Triad of ophthalmoplegia, ataxia, and areflexia.

81

Features of a Bell's palsy

Unilateral loss of facial movement
Normal facial sensation
Pain around ear
Hyperacusis
Loss of salivation / tear secretion

82

What is a Bell's palsy

LMN lesion of the facial nerve
CN 7
Cause unknown

83

What is / what causes myasthenia gravis

Autoimmune destruction of post-synaptic acetylcholine receptors in neuromuscular junction

84

What is a typical patient with myasthenia gravis

Female
20-40yo

85

Features of myasthenia gravis

(Inability to sustain a maintained or repeated contraction of striated muscle)
Diplopia
Ptosis
Fatiguability
Syx worse after exercise
Syx worse at end of day

86

What is a myasthenic crisis

Sudden onset paralysis of the respiratory muscles.
Necessitating assisted ventilation

Crises may be triggered by infection, fever, an adverse drug reaction or emotional stress.

87

What is the tension test and what is it used for

AKA edrophonium test
IV edrophonium bromide administered to a patient with suspected MG.
MG confirmed if weakness transiently improves.

88

Why do all patients with myasthenia gravis need a CT

To rule out thymoma

89

Management of myasthenia gravis

Anticholinergics (pyridostigmine)

90

What does an overdose of anticholinergics do

Cholinergic crisis
Muscle fasciculation
Paralysis
Pallor
Sweating
Excessive salivation
Small pupils

91

What is motor neuron disease

Progressive degeneration of motor neurons within the spinal cord, motor cortex and cranial nerve nuclei.

92

Features of motor neuron disease

Combination of upper and lower motor neuron signs
Limb weakness
Fasciculation
Spasticity
Exaggerated reflexes

93

Types of motor neuron disease

Progressive muscular atrophy (weakness of distal limb muscles 1st)
Progressive bulbar palsy (early involvement of tongue and pharyngeal muscles)
Amyotrophic lateral sclerosis ( combination of distal and proximal muscle wasting)

94

Management of motor neuron disease

Supportive
Riluzole improves life expectancy

95

What is lambert eaton syndrome

Impaired neurotransmitter release due to autoantibodies to pre-synaptic voltage gated calcium channels

Associated with underlying malignancy - often lung

96

Features of lambert eaton syndrome

Muscle weakness - improves with sustained contraction
Autonomic dysfunction - dry mouth, blurred vision, impotence
Absent tendon reflexes

97

Presentation of a subarachnoid haemorrhage

Severe
Sudden onset
Occipital headache
Vomiting
Irritability
Photophobia
Neck stiffness
Reduced consciousness

98

Presentation of a cluster headache

Unilateral
Severe
Peri orbital pain
Conjunctival injection
Lacrimation
Nasal congestion
30-90min
Same time every day

99

Typical patient with cluster headaches

Male
Heavy smoking
Excess alcohol

100

Prophylaxis against cluster headaches

Verapamil (CCB)
Ergotamine

101

Presentation of trigeminal neuralgia

Sharp stabbing pain
Severe, brief, repetitive
Trigeminal nerve distribution - most commonly mandibular or maxillary

102

Management of trigeminal neuralgia

Carbamazepine
Phenytoin
Gabapentin

103

Features of migraine

Unilateral throbbing headache
Severe
Photophobia
Vomiting
+/- aura

104

Migraine triggers / exacerbants

Poor sleep
Dehydration
Alcohol - esp red wine
COCP
Chocolate
Cheese

105

Options for migraine prophylaxis

Beta blockers (commonly propranolol)
Pizotifen
Amitryptilline

106

Features of idiopathic intracranial hypertension

Raised intracranial hypertension in the absence of a SOL, ventricular dilation or impaired consciousness.

Intermittent headaches
Transient diplopia / blurred vision
Papilloedema

107

Typical patient with idiopathic intracranial hypertension

Female
Younger
Obese

Can be triggered by COCP, tetracyckines, steroid withdrawal

108

Management of idiopathic intracranial hypertension

Weight loss
Remove trigger
Acetazolamide
Repeated LP

(Untreated can lead to blindness. Hence no longer called 'benign')

109

Dermatome supply of the back of the head

C2

110

Dermatome supply of the neck

C3

111

Dermatome supply of the thumb

C6

112

Dermatome supply of the middle finger

C7

113

Dermatome supply of the little finger

C8

114

Dermatome supply of the axilla

T2

115

Dermatome supply of the nipple line

T4

116

Dermatome supply of the level of the xiphoid process

T6

117

Dermatome supply of the level of the umbilicus

T10

118

Dermatome supply of the inguinal ligament

T12 / L1

119

Dermatome supply of the medial thigh

L2

120

Dermatome supply of the big toe

L4

121

Dermatome supply of the dorsum of the foot

L5

122

Dermatome supply of the sole of the foot

S1

123

Dermatome supply of the popliteal fossa

S2

124

Dermatome supply of the bottom (ischial tuberosity)

S3

125

Dermatome supply of the perianal area

S4/5

126

Dermatome supply of the penis

S3

127

What is multiple sclerosis

Autoimmune destruction of the myelin producing oligodendrocytes
Myelin loss in CNS causes slow nerve conduction

128

Symptoms of multiple sclerosis

Optic neuritis
Unilateral dorsal column loss
Coarse tremor
trigeminal neuralgia
recurrent facial nerve palsy
sixth cranial nerve palsy
lhermitte phenomenon = Tingling in spine or limbs in neck flexion

129

Diagnosis of MS requires all of the following

> Age less than 60
> Deficit in two or more anatomically distinct sites
> Abnormity present on examination
- Two episodes lasting >24 hours and >1 month apart
- OR Slow progression over six months
> No other explanation for symptoms

130

Types of MS

Relapsing and remitting 80%
Primary progressive 15%
Secondary Progressive
Benign
Childhood MS

131

What are the muscular dystrophies

Group of inherited disorders with progressive degeneration of groups of muscles
No involvement of the nervous system
Symmetrical wasting and weakness
No fasciculations
no sensory loss

132

How is duchenne muscular dystrophy inherited

X linked recessive

133

Presentation of duchenne muscular dystrophy

Onset in childhood
Effects proximal arms and legs
Pseudohypertrophy of the calves - replacement of muscle by fat and fibrosis.
Waddling gait
Difficulty standing (gowers sign-walk hands up legs)

134

Inheritance pattern of Becker muscular dystrophy

X-linked recessive

135

Inheritance pattern of myotonic dystrophy

Autosomal dominant

136

Features of myotonic dystrophy

Weakness of temporal, facial, sternocleidomastoid and distal limb muscles
Myotonia - Slow relaxation of muscles
Frontal balding
Cataract
Ptosis
Gonad atrophy

137

What is mononeuritis multiplex

Peripheral neuropathy where there is damage to 2 or more peripheral or spinal nerves

138

Common causes of mononeuritis multiplexed

Diabetes mellitus
Polyarteritis nodosa
Rheumatoid arthritis
Systemic lupus erythematous

139

What is charcot-marie-tooth disease

Hereditary motor and sensory neuropathy
Autosomal dominant inheritance is most common
Autosomal recessive and X-linked forms have been identified

140

Symptoms of Charcot-Marie-Tooth disease

Symmetrical, distal, slowly progressive muscle wasting
Foot drop
Claw toes
Pes cavus
Areflexia
Distal sensory loss
Inverted bottle appearance of legs due to distal muscle wasting

141

Causes of sciatic nerve injury

Fracture dislocation of the hip
Misplaced gluteal injection

142

Presentation of a sciatic nerve palsy

Paralysis of hamstrings
Paralysis of all muscles of foot and leg

Loss of sensation below knee - (except medial leg = saphenous)

143

Causes of tibial nerve injury

Posterior dislocation of knee

144

Features of a tibial nerve palsy

Loss of toe flexion
Loss of Ankle inversion
Loss of ankle jerk

Loss of sensation over sole of foot

145

What is the tibial nerve a branch of

Sciatic nerve

146

Boundaries of the femoral triangle

It is bounded by:
(superiorly) inguinal ligament
(medially) medial border of adductor longus muscle
(laterally) medial border of sartorius muscle

147

Contents of the femoral triangle

from medial to lateral:
> femoral veins and its tributaries
> femoral artery and its branches
> femoral nerve and its branches

148

Presentation of a femoral nerve palsy

Loss of knee extension

Loss of sensation over anterior thigh and medial leg

149

What is meralgia paresthetica

Trapped lateral femoral cutaneous nerve at the inguinal ligament
Esp obese or pregnant patients

Causes pain / burning of lateral thigh
Often caused by prolonged standing

150

What nerve may be injured by ankle plaster casts

Common peroneal nerve (branch of sciatic)

151

When may the saphenous nerve be damaged.
What does this cause

Surgery on long saphenous vein

Causes loss of sensation to medial aspect of calf

152

When may the sural nerve be damaged.
What does this cause

Surgery to the short saphenous vein

Loss of sensation to the lateral side if the foot and little toe

153

When may the obturator nerve be damaged.
What does this cause

Obstetric procedures
Pelvic disease

Loss of hip adduction
Loss of sensation to upper inner thigh

154

What does superior gluteal nerve damage cause

Loss of hip abduction
Pelvic dip in walking = trendelenburg gait

155

What does inferior gluteal nerve damage cause

Loss of hip extension
Buttock wasting

156

Eyes component of GCS

4 - eyes open spontaneously
3 - eyes open to speech
2 - eyes open to pain
1 - no eye opening

157

Verbal component of GCS

5 - Coherent speech
4 - Confused/disorientated speech
3 - Inappropriate words without conversational exchange
2 - Incomprehensible sounds
1 - no verbal response

158

Motor component of GCS

6 - obeys commands
5 - localises to pain
4 - withdraws from pain
3 - abnormal flexion to pain (decorticate)
2 - abnormal extension to pain (decerebrate)
1 - no motor response

159

What is conversion disorder?

Sudden appearance of neurological symptoms following acute Psychological distress.
Non-volitional

160

Presentation of common peroneal nerve injury

Foot drop
High stepping gait
Loss of sensation over anterolateral lower leg and dorsum of foot

161

Features of wernickes aphasia

Wernickes is responsible for recognising and analysing spoken language.
Fluent aphasia
Poor comprehension
Poor repetition
(Left temporal lobe)

162

What connects wernickes and Broca's areas

Arcuate fasciculus

163

Features of Broca's aphasia

Broca's area is responsible for producing coherent speech
Non-fluent aphasia
Good comprehension
Poor repetition
(Left frontal lobe)

164

What is fluent aphasia

Normal number of words - but wrong words spoken

165

What is non-fluent aphasia

Reduced verbal output - but correct words

166

What would a lesion in the Arcuate fasciculus (between Broca's and wernickes) do

Patient can comprehend (wernickes)
Patient can speak (Broca's)
But cannot repeat back what is said to them - due to no connection between the 2 areas

167

Is a pseudobulbar palsy upper or lower motor neuron

UMN lesion

168

Is a bulbar palsy UMN or LMN

LMN

169

What nerves are involved in bulbar and pseudobulbar palsies

CN 9 - 12

170

Features of a pseudobulbar palsy

UMN
Small, contracted tongue
Immobile tongue - cannot protrude
Brisk jaw jerk
'Donald Duck' speech.
Palatal movements absent.
Dribbling persistently - Dysphagia
Facial muscles may also be paralysed.
Nasal regurgitation .
Dysphonia
Emotional lability.

171

Causes of a pseudobulbar palsy

MMD
MS
brain stem tumour
Brain stem stroke

172

Features of a bulbar palsy

LMN
Fasciculations of tongue and lips
Weak wasted Tongue
Drooling
dysphagia
Absent palate movements.
Dysphonia
Articulation - difficulty pronouncing r

173

Causes of a bulbar palsy

MND
Syringobulbia
GBS
MG

174

Presentation of venous sinus thrombosis

Sudden onset headache
Seizures
Signs of raised intracranial pressure (papilloedema, hypertension, bradycardia)

175

Symptoms of a cavernous sinus thrombosis

Sudden onset headache / Seizures / Signs of raised ICP
+
Proptosis
Ptosis
Ophthalmoloplegia
Reduced sensation in opthalmic division

176

Symptoms of a transverse sinus thrombosis

Sudden onset headache / Seizures / Signs of raised ICP
+
Hemiparesis

177

Risk factors for venous sinus thrombosis

COCP
Pregnancy
Nephrotic syndrome
Thrombophilia

178

How is venous sinus thrombosis confined

CT / MRI

179

Management of a venous sinus thrombosis

Anticoagulation - s/c enoxaparin
And warfarin for 6m

186

Presentation of anterior cord syndrome

Follows flexion-compression injury
Loss of spinothalmic function (pain and temp)
And cortiocspinal tracts (motor)
Greater motor loss in the legs

187

What is syringomyelia

A longitudinal fluid cavity (syrinx) in the spinal cord

188

Features of syringomyelia

Usually 20-30yo
Disrupt spinothalmic tracts
Segmental loss of pain and temperature

189

What is syringobulbia

A longitudinal cavity of fluid in the brainstem

190

Presentation of a central cord lesion

In older pts with cervical spondylosis who have a hyperextension injury.
Flaccid weakness of arms
Motor and sensory to limb - relatively spared

191

At what level does the spinal cord end

L1 and L2

192

Presentation of posterior cord syndrome

Follows hyperextension of the neck
Dorsal column loss
Gait impaired due to loss of proprioception

193

Features of poliomyelitis

Infects grey matter
Mild fever and headache
Progresses to aseptic meningitis
Weakness

194

Features of rabies

Fever
Paraesthesia at site of bite
Prodrome of anxiety
Refusal to drink water - provokes painful diaphragm spasm
Delusions
Hallucinations
Spitting
Biting
Mania
Hyperpyrexia
Death within 1 week

195

Features of cerebral abscess

Fever
Headache
Meningism
Drowsiness
Seziures
Focal neurology

196

What causes subacute sclerosing panencephalitis

Measles virus
Years after measles infection

197

Symptoms of tetanus

Trismus - painless masseter spasm
Facial muscle contraction
Neck and trunk muscle contraction
Death due to asphyxia / exhaustion / aspiration pneumonia

198

Management of tetanus

IV tetanus anti-toxin
IV benzylpenicillin

199

What does the olfactory nerve supply

Sense of smell

200

What does the optic nerve do

Visual acuity
Visual fields
Afferent pupillary reflex
Pupil accommodation

201

What does the oculomotor nerve supply

Eye muscles - inferior oblique, medial/superior/inferior rectus,
Levator palpabrae muscles
Efferent arm of pupil reflex

202

What does the trochlear nerve supply

Superior oblique muscle

203

What does the trigeminal nerve supply

Sensation of face
Corneal reflex
Muscles of mastication
Jaw jerk

204

What does the abducens nerve supply

Lateral rectus muscle

205

What does the facial nerve supply

Muscles of facial expression
Taste to anterior 2/3 tongue
Nerve to stapedius
Sensation around skin of ear

206

What does the vestibulocochlear nerve supply

Hearing
Vestibular system

207

What does the glossopharyngeal nerve supply

Taste to posterior 1/3 tongue
Afferent gag reflex

208

What does the vagus nerve supply

Motor to pharynx and larynx
Efferent arm of gag reflex

209

What does the accessory nerve supply

Trapezius
Sternocleidomastoid muscle

210

What does the hypoglossal nerve supply

Muscles of the tongue

211

Symptoms of essential tremor

Slow tremor
Often familial
May be mad more obvious by certain movements e.g. Writing
Improved by alcohol
Beta-blockers may help

212

Symptoms of physiological tremor

Normal tremor
Exaggerated by anxiety, fatigue, fever, alcohol withdrawal

213

Symptoms of resting tremor

Occurs in Parkinson's
Pill-rolling
Asymmetrical

214

Symptoms of an intention tremor

Cerebellum disease
Broad tremor at end of purposeful movement
Due to breakdown in feedback mechanisms

215

What is chorea

Jerky, small, involuntary movements

216

Causes of chorea

Huntingtons chorea (autosomal dominant)
Wilson's disease
Cerebral trauma
Rheumatic fever

217

What is athetoses

Slow, writhing movements of the limbs

218

What is hemiballismus

Big movements of the limbs unilaterally

219

What is dystonia

Limb or head takes up an abnormal posture
E.g. Torticollis / blepharospasm / oculogyric crisis

220

Features of neurofibromatosis type 1

Cutaneous neurofibromas
Cafe-au-lait spots
Axillary freckling
Iris fibromas (lisch nodules)
Phaeochromocytoma
Acoustic neuroma
Scoliosis

221

Features of neurofibromatosis type 2

No cutaneous features
Bilateral acoustic neuromas
Optic nerve gliomas
Meningiomas

222

What is an Arnold-chiari malformation

Congenital herniation of the cerebellar tonsils

223

Features of von-Hippel-Lindau syndrome

Retinal and intracranial haemangiomas and haemangioblastomas
Renal cysts
Renal cell adenocarcinoma
Pancreatic tumours
Phaeochromocytoma

224

Features of ataxia telangiectasia

Childhood progressive ataxia and athetosis
Conjunctival/cheek/ear Telangiectasia
Immunodeficiency

225

Futures of shy-drager syndrome

Parkinsonian symptom - tremor, bradykinesia, rigidity
Autosomal failure - incontinence, postural hypotension, gastoparesis, ED

226

Features of a total anterior circulation stroke (TACS)

Triad of hemiplegia, hemianopia, higher cortical dysfunction (aphasia etc)

227

Features of a partial anterior circulation stroke (PACS)

2 of - hemiplegia, hemianopia, higher cortical dysfunction (aphasia etc)

228

Features of a posterior circulation stroke (POCS)

Affects the brainstem --> Vertigo, dysphagia, dysarthria, facial weakness

229

Features of a lacunar stroke (LACS)

Pure motor - hemiparesis
Or pure sensory
Or a combination
In 2 of - face, leg, arm

No visual defect. No higher cortical dysfunction. No brain stem problems. No impaired consciousness

230

In neurofibromatosis type 1 what would a CT spine show

Benign tumours at nerve root exits
= dumb bell tumours

232

What can lower the seizure threshold

Drugs - tramadol, fluoxetine, clozapine, cocaine, penicillin,
Hormone change - menstruation, menopause
Tiredness
Fasting
Sleep deprivation
Stress
Alcohol
Flashing lights

233

When do febrile convulsions occur, why + what's the prognosis

6m - 3 yr
Response to rapid increase in temperature
Benign but - Increased risk of seizures later in life - esp male

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What is status epilepticus

Continued tonic-colonic seizures, without regaining consciousness in between
Emergency

235

What is serial epilepsy

A succession of tonic clonic seizures but with recovery between

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What is cataplexy

Sudden loss of postural tone
Patient crumples
Remains conscious

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Tetrad of symptoms in narcolepsy

Excessive daytime sleepiness
Cataplexy
Sleep paralysis
Hypnagogic hallucinations

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What is retrograde amnesia

Impaired memory of events before injury / illness

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What is anterograde amnesia

Inability to learn new information after injury / illness

240

Characteristics of a postural tremor

Absent at rest
Present on maintained posture
Rapid
Fine amplitude
Slow, insidious onset
Uppe limbs
+/- titubation

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Characteristics of a cerebellar tremor

Absent at rest
Maximal on approaching target
Slow + coarse

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Symptoms and signs of cebellar disease

Ataxia
Dysmetria
Dysdiadochokinesia
Intention tremor
Rebound phenomenon
Titubation
Pendular reflexes
Nystagmus
Altered speech
Vermis lesion --> truncal ataxia

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What bacteria causes meningitis In adults / elderly

Adults - N. meningitidis, strep penumoniae, TB

elderly - strep penumoniae, listeria

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What is uhtoffs phenomenon

Transient increase or recurrence of symptoms in MS due to an increase in body temperature
E.g. Getting in warm bath

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What area is affected in expressive dysphasia

Broca's area

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What area is affected in a receptive dysphasia

Wernickes area

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Symptoms of trigeminal neuralgia

Episodic intense facial pain
Trigeminal nerve distribution
Lasts secs-mins
100s x per day

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Signs of base of skull fracture

Panda eyes
CSF rhinorhoea
CSF otorrhoea
Battles sign
Haemotympanum

249

What is Ramsay hunt syndrome

Lower motor nerve facial palsy
Associated with herpes zoster infection of the external auditory meatus (shingles)

250

Most common primary CNS tumour

Meningioma
(Benign)

251

What is encephalitis

Inflammation of the brain parenchyma

252

Clinical features of cerebellar tonsilar herniation

Reduced consciousness
Respiratory irregularities
Neck stiffness
Head tilt

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What conditions pre-dispose to cerebral abscesses

Acute endocarditis
Bronchiectasis
Cyanotic congenital heart disease
Otitis media

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Features of freidrichs ataxia

Gait disturbance
Ataxia
Dysarthria
Scoliosis
DM
Heart disorders

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What is lhermittes phenomenon

Electric shock-like sensations in the arms and legs caused by neck flexion.
Due to involvement of dorsal columns
Common in MS

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What is gélineaus syndrome

Narcolepsy

257

Causes of a transudative pleural effusion

Heart failure
Liver failure
Renal failure
(<20g/L protein)

258

Causes of an exudative pleural effusion

Infection
Infarction
Malignancy
Acute pancreatitis
(>30g/L protein)

259

Causes of respiratory acidosis

COPD
Pneumonia
PE
Pulmonary oedema
Sleep apnoea
Respiratory muscle weakness
(Raised CO2)

260

In what condition is serum ace elevated

Sarcoidosis