Neurology Flashcards
1
Q
What nerve roots make up the brachial plexus
A
C5 - T1
2
Q
What is an erb’s palsy
A
Upper brachial plexus injury
Arm extended
Internally rotated - pronated
Hand extended backwards
3
Q
Which nerve roots are involved in an erb’s palsy
A
C5 + 6 - upper brachial plexus
4
Q
Common causes of an erb’s palsy
A
Traction injuries - e.g. Motorcycle accident, shoulder dystopia at birth.
5
Q
What is a Klumpke’s palsy
A
Lower brachial plexus injury
Claw hand - all digits
Sensory loss over ulnar border of forearm + hand
6
Q
Nerve roots involved in a Klumpke’s palsy
A
C8 + T1 - lower brachial plexus
7
Q
Causes of Klumpke’s palsy
A
Breech birth injury (arm extension)
Pulling on the arm during delivery
Motorcycle accidents
(Klumpke the monkey hung from the tree)
8
Q
Winging of the scapula is caused by injury to which nerve
A
Long thoracic nerve to serratus anterior
9
Q
When may the long thoracic nerve be damaged
A
Breast surgery
Axillary surgery
Breast / axillary radiotherapy
Axillary trauma
10
Q
What nerve runs in the spiral groove of the humerus
A
Radial nerve
11
Q
Common causes of radial nerve palsies
A
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
Q
What nerve is involved in a Saturday night palsy
A
Radial
13
Q
What causes wrist drop
A
Radial nerve palsy
14
Q
Nerve supply of the anatomical snuffbox
A
Radial nerve
15
Q
What does the accessory nerve supply
A
Trapezius
Sternocleidomastoid
16
Q
Syx / signs of accessory nerve palsy
A
Weak shoulder shrug
Inability to turn head against pressure
17
Q
What does the axillary nerve supply
A
Motor to deltoid
Sensory to regimental badge area
18
Q
What nerve is compressed in carpal tunnel syndrome
A
Distal median nerve
19
Q
Compression of the medial nerve by the flexor retinaculum is called what…..
A
Carpal tunnel syndrome
20
Q
In whom is carpal tunnel syndrome more common
A
Women Pregnancy RA acromegally Hypothyroidism
21
Q
Syx of carpal tunnel syndrome
A
Tingling + numbness in radial 3 1/2 digits
Wasting thenar eminence
22
Q
Features of 6th CN lesion
A
Eyes appear conjugate in primary position
Failure of abduction of affected eye
Horizontal diplopia when looking at affected side
23
Q
Features of 4th CN palsy
A
Diplopia on downward gaze
Sit with head tilted
Failure to aduct on downward gaze
Eyes conjugate in primary position
24
Q
Features of 3rd CN palsy
A
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
234
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
236
What is cataplexy
Sudden loss of postural tone
Patient crumples
Remains conscious
237
Tetrad of symptoms in narcolepsy
Excessive daytime sleepiness
Cataplexy
Sleep paralysis
Hypnagogic hallucinations
238
What is retrograde amnesia
Impaired memory of events before injury / illness
239
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
```
241
Characteristics of a cerebellar tremor
Absent at rest
Maximal on approaching target
Slow + coarse
242
Symptoms and signs of cebellar disease
```
Ataxia
Dysmetria
Dysdiadochokinesia
Intention tremor
Rebound phenomenon
Titubation
Pendular reflexes
Nystagmus
Altered speech
Vermis lesion --> truncal ataxia
```
243
What bacteria causes meningitis In adults / elderly
Adults - N. meningitidis, strep penumoniae, TB
elderly - strep penumoniae, listeria
244
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
245
What area is affected in expressive dysphasia
Broca's area
246
What area is affected in a receptive dysphasia
Wernickes area
247
Symptoms of trigeminal neuralgia
Episodic intense facial pain
Trigeminal nerve distribution
Lasts secs-mins
100s x per day
248
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
253
What conditions pre-dispose to cerebral abscesses
Acute endocarditis
Bronchiectasis
Cyanotic congenital heart disease
Otitis media
254
Features of freidrichs ataxia
```
Gait disturbance
Ataxia
Dysarthria
Scoliosis
DM
Heart disorders
```
255
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
256
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
