Spine and Nerve Injuries

Question 1

What is cauda equina syndrome?

Answer 1

Nerve roots at the base of the spine are compressed

Question 2

What is the most common cause of cauda equina syndrome?

Answer 2

Herniated disc L4/5 or L5/S1

Question 3

What is the presentation of cauda equina?

Answer 3

Saddle anaesthesia
Bilateral sciatica
Incontinence
Bilateral motor weakness in legs
Reduced anal tone on PR exam

Question 4

What is the gold standard diagnosis for cauda equina?

Answer 4

MRI whole spine to localise lesion

Question 5

What test indicates a problem at L4?

Answer 5

Femoral stretch test

Question 6

What is the gold standard management of cauda equina?

Answer 6

Lumbar decompression surgery

Question 7

What does HORSETAIL stand for in cauda equina?

Answer 7

Orgasm changes
Retention
Sciatica
Erectile dysfunction
Tone changes
Altered sensation
Inability to stop
Leakage

Question 8

What is carpal tunnel syndrome?

Answer 8

Compression of the median nerve in the carpal tunnel

Question 9

What is the median nerve roots?

Answer 9

C5-T1

Question 10

What are some risk factors for carpal tunnel syndrome?

Answer 10

Obesity
Pregnancy
RSI
DM
Acromegaly

Question 11

What fingers are affected in carpal tunnel?

Answer 11

Thumb
Index
Middle fingers

Question 12

What muscles can waste in cauda equina?

Answer 12

Thenar

Question 13

What are some tests for cauda equina?

Answer 13

Phalens - reverse prayer sign causes symptoms
Tinels - tapping over median nerve causes symptoms
Flick sign - patient makes flicking movement of wrist to alleviate symptoms

Question 14

What is the gold standard test for diagnosis of carpal tunnel?

Answer 14

EMG shows slowed conduction over the median nerve

Question 15

What is the management of carpal tunnel?

Answer 15

Stretching and wrist splints
Oral prednisolone
Resect transverse carpal ligament

Question 16

What is damaged in foot drop?

Answer 16

Common peroneal nerve

Question 17

What is there weakness of in foot drop?

Answer 17

Ankle dorsiflexion

Question 18

What are the nerve roots of the sciatic nerve?

Answer 18

L4-S3

Question 19

What does the sciatic nerve split into at the knee?

Answer 19

Tibial and common peroneal

Question 20

What is charcot marie tooth syndrome?

Answer 20

A group of inherited diseases which affect peripheral motor and sensory nerves

Question 21

What is the ABCDE aetiology of CMT?

Answer 21

Alcohol
B12 deficiency
Cancer and CKD
Diabetes and drugs
Every vasculitis

Question 22

What are some presentations of CMT?

Answer 22

High foot arches - pes cavus
Hammer toes
Inverted champagne bottle legs
Claw hand and foot drop

Question 23

What is anterior cord syndrome?

Answer 23

Damage to the anterior 2/3rd of the spinal cord and posterior part is spared

Question 24

What is the most common cause of anterior cord syndrome?

Answer 24

Ischaemia of the anterior spinal artery

Question 25

What is the presentation of anterior cord syndrome?

Answer 25

Bilateral weakness - quadriplegia or paraplegia Bilateral loss of pain and temperature Autonomic dysfunction

Question 26

What are some investigations for anterior cord syndrome?

Answer 26

MRI LP ECHO

Question 27

What are the nerve roots of the radial nerve?

Answer 27

C5-T1

Question 28

What are the most common causes of radial nerve injuries?

Answer 28

Humerus fractures or excessive pressure on the nerve

Question 29

What nerve is damaged in claw hand?

Answer 29

Ulnar nerve

Question 30

What nerve is damaged for winged scapula?

Answer 30

Long thoracic nerve

Question 31

What are the defects of Brown Sequard?

Answer 31

Ipsilateral loss of position, light touch and vibration at the level of the lesion Contralateral loss of pain and temperature below the level of the lesion

Question 32

What is GBS?

Answer 32

Ascending acute demyelinating polyneuropathy following GI/ URT infection, most commonly C. jejuni

Question 33

What are targeted in GBS?

Answer 33

PNS schwann cells

Question 34

What are some symptoms of GBS?

Answer 34

Ascending weakness - lower limbs first Loss of knee jerk Flaccid paralysis Facial weakness and droop Hypotonia

Question 35

What is the diagnosis for GBS?

Answer 35

Nerve conduction studies show reduced velocity LP - isolated finding of raised protein Brighton criteria

Question 36

What is the management for GBS?

Answer 36

IV immunoglobulins Plasma exchange Monitor vital capacity and breathing rate

Question 37

How does diabetic neuropathy present?

Answer 37

Glove and stocking sensory and/ or pain loss Proximal weakness

Question 38

What is the most common type of diabetic neuropathy?

Answer 38

Distal symmetrical sensory neuropathy

Question 39

What can be offered for pain relief in diabetic neuropathy?

Answer 39

Gabapentin or Pregabalin

Question 40

What nerve roots are the brachial plexus?

Answer 40

C5-C8 and T1

Question 41

What is Erb's palsy?

Answer 41

dermatomal sensory loss in C5-C6 showing waiters tip sign

Question 42

What is Klumpke's palsy?

Answer 42

Dermatomal sensory loss in C8-T1 distribution

Question 43

What is neurofibromatosis?

Answer 43

Loss of function of tumour suppressor genes causing benign tumour growth

Question 44

What is the inheritance of neurofibromatosis?

Answer 44

Autosomal dominant

Question 45

What are some presentations of neurofibromatosis?

Answer 45

Cafe au lait spots Lisch nodules Scoliosis HTN Learning difficulty Epilepsy Meningiomas Posterior lens opacities Astrocytomas