Neurology

Question 1

Comatose state

Answer 1

diffuse cortical disturbance

Question 2

Seizure

Answer 2

paradoxical discharge of cerebral neurones which is apparent to an external observer or as an abnormal perceptual experience by the subject

Question 3

Epilepsy

Answer 3

recurrent tendency to have seizures

Question 4

Diplopia

Answer 4

Double vision

Question 5

Dysmetria (eyes)

Answer 5

Overshooting of eyes during scanning movements. Sign of a cerebellar lesion

Question 6

Dysmetria (fingers)

Answer 6

Past pointing

Question 7

Dysphagia

Answer 7

Difficulty swallowing

Question 8

Dysphonia

Answer 8

Definition - difficulty producing sound (low in volume, speech in terms of quality is completely normal)

Question 9

Dysarthria

Answer 9

difficulty in articulating, can include slurring

Question 10

Dysphagia - definition, difference between Receptive and Expressive

Answer 10

Dysphagia - difficulty of language

Receptive (cannot understand what someone else is saying. Problem is in Wernicke’s area. e.g. Unable to follow commands)

Expressive (cannot find the word, non fluent. Problem is in Broca’s area. e.g. Unable to name objects)

NB: Both areas are supplied by MCA therefore most people will have a mixed picture

Question 11

Aphemia

Answer 11

Complete lack of ability to make a sense

Question 12

Bradykinesia

Answer 12

slowing of movement

Question 13

Akinesia

Answer 13

loss of voluntary movement

Question 14

Tremor

* Resting 
* Postural 
* Intention

Answer 14

Tremor - oscillation of a body part, usually involuntary

* Resting - tremor at rest 
* Postural - tremor when arms are held out 
* Intention - tremor when patient attempts to do something, e.g. Going towards a target

Question 15

Myoclonus

Answer 15

rapid, lighting fast muscle jerks (can be a form of focal epilepsy, sign of vCJD etc)

Question 16

Chorea

Answer 16

random and involuntary movements of the limbs and trunk (“dance like jerks”)

Question 17

Dystonia

Answer 17

co-activation of muscles causing cramping and seizing of muscle groups (spasms and contractions)

Question 18

Stereotyped movements

Answer 18

itching, pulling, rocking, tics etc are all signs of potential neurological disturbance

Question 19

Tic

Answer 19

single or complex motor or vocal expression with partial control. A type of stereotyped movement

Question 20

Spasticity

Answer 20

velocity dependent resistance to passive muscle stretch

Question 21

Decerebrate

Answer 21

Type of posture - lack of cerebral function therefore there is a loss of brain stem, presents as extension to pain (very serious)

1/5 on the motor portion of the GCS

Question 22

Decorticate

Answer 22

Type of posture - lack of cortical function, presents as flexion to pain (UMN presentation to pain)

3/5 on GCS scale for motor

Question 23

What are the signs of cerebellar disease? (HINT: think DANISH)

Answer 23

Dysmetria (past-pointing)
Ataxia
Nystagmus
Intention tremor
Slurred speech
Hypotonia

Question 24

List the “5 As” of complex, partial seizures

Answer 24

Aura
Autonomic change
Awareness lost
Automatisms
Amnesia

Question 25

What are the potential causes of collapse/blackout?

Answer 25

CARDIAC - stoke-adams, vagal overactivity (eg: vasovagal), sympathetic underactivity (eg: postural hypotension), vertebrobasilar insufficiency (eg: migraine), shock NEUROLOGICAL - epilepsy, TIA, stroke OTHER - metabolic (eg: hypoglycaemic episode), respiratroy (eg: hypoxia)

Question 26

What is a "resting tremor"? - Describe what you would see and when - What causes it (i.e. ddx)

Answer 26

Pill rolling tremor Improves (absent) on voluntary movement Worse on distraction Cause - parkinsonism

Question 27

What is an "action tremor"? (aka: essential tremor) - Describe what you would see and when - What causes it (i.e. ddx)

Answer 27

Absent at rest Worse on movement Cause - essential tremor, thyrotoxicosis, withdrawal, anxiety

Question 28

What is an "intention tremor"? - Describe what you would see and when - What causes it (i.e. ddx)

Answer 28

Irregular Worse towards the end of movement Cause - cerebellar damage

Question 29

Define myoclonus and list some causes

Answer 29

Sudden involuntary jerks | Causes - metabolic, neurodegenerative diseases, epilepsy

Question 30

Define chorea and list some causes

Answer 30

Non-rhythmic, purposeless, jerking movements | Causes - huntington's, sydenham's chorea, wilson's, L-DOPA

Question 31

List some of the triggers for migraine (HINT: think CHOCOLATE)

Answer 31

``` Chocolate cHeese OCP Caffeine alcohOL Anxiety Travel Exercise ```

Question 32

What are the (3) cardinal features of parkinson's disease?

Answer 32

Rigidity Tremor (resting / pill rolling) Bradykinesia

Question 33

In addition to the cardinal features, list some of the other symptoms of Parkinson's disease

Answer 33

``` Akinesia Postural instability Slow shuffling gait Postural hypotension Depression Dementia Mask-like facial expression Psychosis Sleep disturbance ```

Question 34

List the common presenting features of MS (HINT: think TEAM)

Answer 34

Tingling Eyes: optic neuritis Ataxia Motor disturbance - commonly spastic paresis

Question 35

What is the difference between a medical and a surgical third (occulomotor) nerve palsy?

Answer 35

Medical 3rd nerve palsy is pupil sparing Surgical 3rd nerve palsy involves the pupil - it is fixed and dilated. This is a SURGICAL EMERGENCY to save the eye

Question 36

Describe the symptoms of Bell's Palsy. Which cranial nerve is affected?

Answer 36

Sudden onset of - unilateral facial weakness, failure to close eye, eye dryness, bell's sign, drooling, decreased taste, hyperacusis Facial nerve (CN VII)

Question 37

List the three classical symptoms of Horner's Syndrome

Answer 37

Miosis - pupil constriction (due to paralysis of papillae muscles) Ptosis - eyelid droop Anhydrosis - absence of sweating (on affected side of face)

Question 38

How can you differentiate between Horner's Syndrome and 3rd nerve palsy on examination? How are they similar?

Answer 38

In both pathologies there is ptosis In Horner's syndrome - there is miosis (pupil constriction) In 3rd nerve palsy - there is a dilated pupil AND it points DOWN and OUT