Pattern Recognition (revision) Flashcards by Joanna Mitchell

Describe hyperkinetic movement disorders

Dystonia
Tics
Myoclonus
Chorea
Tremor

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Describe hypokinetic movement disorders

Parkinsons; rigidity and bradykinesia

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What is the pattern of weakness in MND?

UMN and LMN signs
Absence of sensory symptoms
+/- frontotemporal dementia

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Inflammatory muscle disorders

Poly/deramatomyositis
Inclusion body myositis
Vasculitis
RA
Sjogren's

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Endocrine muscle disorders

Hypothyroidism
Cushing's 
Electrolyte disturbances
Hypophosphatemia
Hypocalcemia
Hypernatraemia/ hyponatraemia

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Drugs/toxins causing muscle disorders

Illicit drugs; cocaine, heroin
Alcohol
Corticosteroids
Colchicine
Antimalarial drugs
Stains
Penicillamine

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Infections causing muscle disorders

Viral; influenza, parainfluenza, coxsackie, HIB, CMG, echovirus, adenovirus, EBV
Bacteria
Fungal
Parasitis

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Rhabdomyolysis causing muscle disorders

Crush trauma
Seizures
Alcohol absuse; hyperkinetic state with delirium tremens
Exertion 
Vascular surgery 
Malignant hyperthermia

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Which muscle, nerve and nerve root are responsible for shoulder abduction?

M: deltoid
N: axillary
NR: C5

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Which muscle, nerve and nerve root are responsible for elbow extension?

M: triceps
N: radial
NR: C7

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Which muscle, nerve and nerve root are responsible for finger extension?

M: extensor digitorum
N: radial
NR: C7

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Which muscle, nerve and nerve root are responsible for index finger abduction?

M: 1st dorsal interosseous
N: Ulnar
NR: T1

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Which muscle, nerve and nerve root are responsible for hip flexion?

M: iliopsoas
N: femoral
NR: L1,2

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Which muscle, nerve and nerve root are responsible for knee flexion?

M: hamstrings
N: sciatic
NR: S1

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Which muscle, nerve and nerve root are responsible for ankle dorsiflexion?

M: tibialis anterior
N: common fibular and sciatic
NR: L4,5

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Which muscle, nerve and nerve root are responsible for great toe dorsiflexion?

M: EHL
N: common fibular
NR: L5

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Main deep tendon reflexes and oot innervation

Biceps/ supinator: C5,6
Triceps: C7,8
Knee: L3,4
Ankle: S1,2

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What does a glove and stocking sensory loss indicate?

Length dependent neuropathy

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What does a sensory level sensory loss indicate?

Spinal cord lesion

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What does a hemianesthesia sensory loss indicate?

Contralateral cerebral lesion

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What is a dissociated sensory loss indicate?

Loss of spinothalamic but preserved DCML; anterior spinal artery syndrome, brown sequard or syringomyelia

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Extrapyramidal symptoms

Bradykinesia
Rigidity
Resting tremor
Shuffling gait
Stooped posture
Hypomimia
Hypophonia
Reduced arm swing 
Impaired postural reflexes
Asymmetry in PD, symmetry in DI

Main function of frontal lobe

Executive function

Prefrontal cortex connects to the basal ganglia, limbic system, thalamus and hippocampus

Frontal lobe dysfunction

Personality disorder
Disinhibition 
Paraparesis
Paratonia
Frontal gait dysfunction 
Cortical hand
Seizures
Incontinence
Visual field defects - homonymous hemianopia
Expressive dysphagia  - broca's area
Anosmia

Temporal lobe dysfunction

``` Episodic memory dysfunction Agnosia Receptive aphasia; wernicke's area Superior quadrantanopia Auditory dysfunction; as hearing is bilateral deafness is NOT a cerebral feature Limbic dysfunction Temporal lobe epilepsy ```

Parietal lobe dysfunction

``` Inferior homonymous quadrantanopia Visuospatial dysfunction Gerstmann's syndrome Dyspraxia Inattention Denial ```

What is gerstmann's syndrome?

Dominant lobe; dysgraphia, left-right disorientation, finger agnosia, acalculia

Treatment protocol for PD

Symptomatic; levodopa or dopamine agonist MDT including speech and language, OT, PT, exercise Deep brain stimulation

Drugs used in PD

``` Levodopa; crosses BBB Dopamine agonists; acts on D2 receptors MAO-B inhibitors; improve symptoms in those with mild disease Anticholinergics for tremor Amantadine; blocks NMDA receptors ```

Imaging in stroke

MRI T1/T2 and FLAIR for old lesions and lesions of non-vascular origin T2 to identify bleeds and microbleeds CT: hyperintense; bleed. Ischaemic; loss of lentiform nucleus, poor grey white matter differentiation, loss of insular ribbon

Corticospinal tract origin and parts

Origin: primary motor cortex of precentral gyrus Lateral (primary decussation) = voluntary motor control of limbs and digits Anterior corticospinal (segmental decussation) = voluntary motor control of trunk and maintains posture

Corticobulbar tracts origin and function

Origin: primary motor cortex in precentral gyrus Function: muscles of face, head and neck

Which CN do NOT have a bilateral innervation to their nuclei?

CN 12 | Lower part of 7; if there is forehead sparing this is an UMN lesion of facial nerve

Rubrospinal tract origin and function

Origin: red nucleus of midbrain Function: excites flexors and inhibits extensors of upper body

Reticulospinal tract origin and function

Origin: pons/medulla Function: excites extensors

Which motor tract is in charge in decorticate rigidity?

Lesion above midbrain | Rubrospinal tract; flexion of upper limbs

Which motor tract is in charge in decerebrate rigidity?

Lesion below midbrain | Reticulospinal tract; extension

DCML function and route

Function; fine touch, pressure and vibration Decussates in medulla to contralateral medial lemniscus to reach the primary somatosensory cortex in the postcentral gyrus of the parietal lobe

Difference between gracile fasciculus and cuneate fasiculus

Gracile; legs, below T6 Cuneatus; arms; above T6 Gracile medial to cuneate in spinal cord

Spinothalamic tract function and pathway

Function: pain and temp | Decussates segmentally in spinal cord to reach opposite primary somatosensory cortex

``` Extradural haemorrhage: Location Origin Presentation Symptoms Ix Imaging findings ```

L: skull and dura O: middle meningeal artery Px: injury to pterion Sy: unconscious then lucid interval then unconscious Ix: CT Findings: hyperdense biconvex lens appearance

``` Chronic subdural haemorrhage Location Origin Presentation Symptoms Ix Imaging findings ```

L: dura and arachnoid Origin: cerebral bridging veins Px: older patients due to low impact trauma Sy: progressive headache and confusion Ix; CT Findings: hypodense crescent shaped appearance

``` SAH Location Origin Presentation Symptoms Ix Imaging findings ```

L: arachnoid and pia Origin: arterial; commonly berry aneurysm Px: severe head injuries or ruptured berry Sy: thunderclap headache, meningeal irritation (neck stiffness, photophobia), loss of consciousness Ix: CT initially. Definitive diagnosis is CTA Findings; hyperdense in SA space. Commonly star shaped

Symptoms of cerebral herniation

Extensor response Cushing's triad; hypertx, brady, agonal breathing Uncal herniation = blown pupil

Where can you find the dual venous sinuses?

Outer and inner dura

Expressive dysphasia

Brocas area

Receptive dysphasia

Wernicke's area

Nystagmus, intention tremor and dysarthria

Cerebellum

Temperature control

Hypothalamus

Oculomotor nucleus

Midbrain

Most common cause of hydrocephalus in children

Aqueduct stenosis - non-communicating hydrocephlus

Sy of aqueduct stenosis?

Growth in head circumference Eyelids retracted; sunsetting eyes Upward gaze impaired Failure to thrive

What GCS indicates comatomse?

8 or less