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56 Cards in this Set
- Front
- Back
What are the signs of a LMN lesion?
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inspection: wasting and fasciculations
tone: reduced power: reduced reflexes: reduced/absent sensation: reduced co-ordination: reduced |
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What are the signs of an UMN lesion?
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inspection: cerebral posturing, pronator drift
tone: increased power: reduced reflexes: brisk/increased sensation: reduced co-ordination: reduced |
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what muscles are supplied by the occulomotor, trochlear and abducens nerves?
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occulomotor:
trochlear: superior oblique abducens: lateral rectus |
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What visual field defects correlate to a lesion in front of the chiasm, at the chiasm and behind the chiasm?
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in front of chiasm: central scotoma (optic nerve)
at chiasm: bitemporal hemianopia behind chiasm: homonymous hemianopia |
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what blood vessel is likely to be affected if there is a homonymous hemianopia?
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without hemiparesis: posterial cerebral artery, as it supplies the occipital lobe may also have macular sparing.
with hemiparesis on same side: middle cerebral artery, as it supplies the optic radiation in the temporal and parietal lobes. |
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What is Internuclear opthalmoplegia and what type of disease usually causes it?
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f
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what are some common causes of IIIrd nerve palsy?
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Causes include diabetes (pupil often spared), posterior communicating artery aneurysm (surgical 3rd – often painful), raised ICP (false localising sign
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why is the pupil spared in a IIIrd nerve palsy caused by diabetes?
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the PNS fibres have a separate blood supply from the nerve sheath vessels.
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What is horner's syndrome?
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slight ptosis
constricted pupil reduced sweating over forehead eye may be slightly bloodshot early on (loss of alpha vasocontrictor tone) |
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Common causes of facial nerve palsy?
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UMN: lacunar infarct, infarct of pontine arteries supplying facial nucleus
LMN: Bell's palsy, Ramsay Hunt Syndrome, Trauma (temporal bone fractures), otitis media, tumours (acoustic neuroma, parotid gland tumours) |
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What is Ramsay hunt syndrome?
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Herpes Zoster infection of facial and vestibulocholear nerves. Causes facial parylsis, sensorineural hearing loss, ear pain, vesicles in ear and vertigo.
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How can you differentiate between and UMN and LMN defect of the facial nerve?
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UMN lesions have relative sparing of the upper face, because of bilateral cortical representation of the upper part of the face.
this means that the part of the facial nerve nucleus responsible for the upper part of the face has an upper motor neurone input from both cerebral hemispheres. |
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Describe the course of the facial nerve.
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Begins in the motor cortex, travels down in the corticobulbar tracts through the internal capsule to the facial nucleus in the lower pons. travels in the cerebello pontine angle in the internal auditory meatus to enter the facial canal which exits the skull via the stylo-mastoid foramen then travels through the parotid gland to supply the facial muscles. it then spreads as 5 branches of the pes anserinus.
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describe the nerve supply to the pupil?
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sphincter pupillae - constricts the pupil and is under PNS control (pilocarpine enhances this by promoting PNS activity)
dilator pupillae - dilates the pupil and is under SNS control (atropine enhances this by blocking PNS) |
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what fibres run in the occulomotor nerve?
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motor fibres for controlling eye movements (superior, medial and inferior rectus)
levator palpebrae for elevating eyelid PNS supply to pupil (pupillary contrictor via cillary ganglion) |
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the SNS supply to the eye
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from superior cervical ganglion.
blood vessels, sweat glands and 4 eye muscles: 1. dilator pupillae 2.superior tarsal muscle (elevates eyelid -involuntary control) 3.inferior tarsal muscle (vestigal in humans) 4. orbitalis (vestigal in humas) |
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what are the symptoms of horner's syndrome?
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ptosis
miosis anhidrosis redness of conjunctiva |
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features of a third nerve palsy?
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ptosis - loss of levator palpebrae
mydriasis (dilated pupil) - PSN loss of sphincter pupillae diplopia and down and out position - motor loss of IR,MR and SR. ischaemic events affect somatic before PNS. DM does not usually affect the pupil. |
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diagnostic criteria of a migrane without aura?
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>5 headaches lasting 4-72 hours with either nausea or vomiting or photophobia/phonophobia AND more than one of:
unilateral pulsating interfers with normal life worsed by normal activity |
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what are some contraindications to triptans?
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IHD
coronary spasm uncontrolled BP lithium SSRIs |
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colour changes which help distinguish syncope from seizure?
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cyanosis suggests seizure
white/red suggests arrythmia |
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brugada syndrome!
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genetic SCN5A channelopathy predisposing to VT. treat with a pacemaker.
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what are the test and treatments for BPPV?
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Hallpike's - what the hell is it?
Epley to better it |
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triad of meniere's disease?
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1. vertigo
2. hearing loss 3. tinnitus (+aural fullness) |
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what are some ototoxic drugs?
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aminoglycosides, loop diuretics and cisplatin
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presentation of acoustic neuroma?
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unilateral hearing loss progressing to vertigo
ipsilateral 5,6,9,10 ipsilateral cerebellar signs facial nerve is rarely involved! accounts for 80% of cerebello-pontine angle tumours ddx: meningioma and NF1 |
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causes of pulsatile tinnitus?
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carotid artery stenosis or dissection
AV fistula glomus jugulare tumours |
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HAS BLED SCORE?
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HTN >160
renal disease liver diease stroke history prior major bleeding/predisposition to bleeding labile INR age >65 medication predisposing to bleeding alcohol useage 5=9.1% 12.5/100 will bleed |
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by how much does warfarin reduce your risk of stroke?
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68%
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grading mortality in SAH
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1: none : 0
2: neck stiffness & CN palsies: 11 3: drowsiness : 37 4: drowsiness with hemiplegia : 71 5: prolonged coma :100 |
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where does the bleeding happen in subdural haematoma?
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bridging veins between the cortex and venous sinuses (frequently occurs in a deceleration injury and in the elderly atrophic brain)
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where does a extradural (epidural) haemorrhage occur?
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usually after head injury to the temporal bone just lateral to the eye.
middle meningeal artery and vein lucid interval pattern occurs, brain stem compression is possible. LP IS CONTRAINDICATED |
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what are Madopar/sinemet and what are they used for?
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are dopa-decarboxylase inhibitors used with levodopa
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what are ropinirole & pramipexole and what are they used for?
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dopamine agonists used to delay L dopa treatment. also allow lower doses of L-dopa to be used as disease progressed.
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what are benzhexol and phenadrine?
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anticholinergics used to help the tremor in parkinson's disease
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what are rasagiline and selegiline?
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MOA-B inhibitors used an as alternative to dopamine agonists in early PD.
S/E postural hypotension and AF |
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what are entacapone and tolcapone?
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COMT inhibitors used to lessen the "off" time in Parkinsons disease
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Progressive supranuclear palsy features?
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early POSTURAL INSTABILITY & FALLS
verticle gaze palsy rigidity of trunk speech and swallowing problems tremor is unusual |
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Multisystems atrophy features?
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early AUTONOMIC features
cerebellar and pyrimidal signs rigidity is worse than tremor |
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Cortico-basal degeneration features?
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akinetic rigidity involving ONE LIMB
cortical SENSORY LOSS APRAXIA (alien limb) |
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causes of mononeuritis multiplex?
WARDSPLC |
wegner's
aids/amyloid rheumatoid diabetes sarcoiditis PAN leprosy carcinomatosis |
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most common false localising sign?
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6th nerve palsy - had the longest intracranial route
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treatment for bell's palsy?
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give prednisolone if present within 72 hours (60mg for 5 days)
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treatment for ramsay hunt syndrome?
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give prednisolone and aciclovir
1/3 1/3 1/3 prognosis |
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what does MND never do?
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affect eye movements
affect sensation affect sphincters |
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lhetmitte's symptom?
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neck flexion causing tingling down the spine
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signs of radiculopathies?
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reduced reflexes, dermatomal sensory loss, LMN weakness and wasting, UMN signs below the lesion with cord compression
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dystrophia myotonica
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AD Cl channelopathy
onset around 25 years old with distal onset weakness (hand/foot drop) weak sternomastoids myotonica |
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pattern of affected muscles in MG?
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eyes - bulbar - face - neck - limb girdle - trunk
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antibodies in MG?
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anti AChR in 90%, only positive in 70% with occular confined disease
if negative try anti McSK antibodies |
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treatments in MG?
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pyridostigmine (anticholinesterase)
prednisolone for relapses IvIg/ plasmaphoresis for myasthenic crises consider thyectomy |
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diagnosis of NF1?
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cafe au lait spots >6 >5mm prepubertal >15mm post pubertal
auxillary/groin freckling >2 neurofibromas or 1 plexiform optic glioma >2 lisch nodules distinctive osseous lesions first degree relative with NF1 |
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diagnosis of NF2?
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50% new mutations
1. bilateral vestibular schwannoma 2. 1st degree relative with NF2 + a) unilateral vestibular schwannoma b) one of - neurofibroma -meningoioma -glioma -schwannoma -juvenile cataract |
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complications of NF1?
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nerve root compression
GI bleeds/obstruction cystic lesions, scoliosis, pseudoarthorisis high BP plexiform neurofibroma malignancy (change to sarcoma) high risk of epilepsy |
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syringomyelia
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tubular cavity in close relation to central canal of cervical cord. due to blocked CSF circulation.
occurs in around 30 year olds. static symptoms then rapidly worsen (couging, sneezing) increased pressure can cause extension into brainstem (syringobulbia) |
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signs of syringomyelia?
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dissociative sensory loss (loss of spinothalamic, preserved dorsal columns) as presses on anterolateral pathways
horners syndrome UMN leg signs body assymetry limb hemihypertrophy |