Pattern Recognition (revision)

Question 1

Describe hyperkinetic movement disorders

Answer 1

Dystonia
Tics
Myoclonus
Chorea
Tremor

Question 2

Describe hypokinetic movement disorders

Answer 2

Parkinsons; rigidity and bradykinesia

Question 3

What is the pattern of weakness in MND?

Answer 3

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

Question 4

Inflammatory muscle disorders

Answer 4

Poly/deramatomyositis
Inclusion body myositis
Vasculitis
RA
Sjogren's

Question 5

Endocrine muscle disorders

Answer 5

Hypothyroidism
Cushing's 
Electrolyte disturbances
Hypophosphatemia
Hypocalcemia
Hypernatraemia/ hyponatraemia

Question 6

Drugs/toxins causing muscle disorders

Answer 6

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

Question 7

Infections causing muscle disorders

Answer 7

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

Question 8

Rhabdomyolysis causing muscle disorders

Answer 8

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

Question 9

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

Answer 9

M: deltoid
N: axillary
NR: C5

Question 10

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

Answer 10

M: triceps
N: radial
NR: C7

Question 11

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

Answer 11

M: extensor digitorum
N: radial
NR: C7

Question 12

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

Answer 12

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

Question 13

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

Answer 13

M: iliopsoas
N: femoral
NR: L1,2

Question 14

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

Answer 14

M: hamstrings
N: sciatic
NR: S1

Question 15

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

Answer 15

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

Question 16

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

Answer 16

M: EHL
N: common fibular
NR: L5

Question 17

Main deep tendon reflexes and oot innervation

Answer 17

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

Question 18

What does a glove and stocking sensory loss indicate?

Answer 18

Length dependent neuropathy

Question 19

What does a sensory level sensory loss indicate?

Answer 19

Spinal cord lesion

Question 20

What does a hemianesthesia sensory loss indicate?

Answer 20

Contralateral cerebral lesion

Question 21

What is a dissociated sensory loss indicate?

Answer 21

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

Question 22

Extrapyramidal symptoms

Answer 22

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

Question 23

Main function of frontal lobe

Answer 23

Executive function

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

Question 24

Frontal lobe dysfunction

Answer 24

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

Question 25

Temporal lobe dysfunction

Answer 25

``` 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 ```

Question 26

Parietal lobe dysfunction

Answer 26

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

Question 27

What is gerstmann's syndrome?

Answer 27

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

Question 28

Treatment protocol for PD

Answer 28

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

Question 29

Drugs used in PD

Answer 29

``` 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 ```

Question 30

Imaging in stroke

Answer 30

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

Question 31

Corticospinal tract origin and parts

Answer 31

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

Question 32

Corticobulbar tracts origin and function

Answer 32

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

Question 33

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

Answer 33

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

Question 34

Rubrospinal tract origin and function

Answer 34

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

Question 35

Reticulospinal tract origin and function

Answer 35

Origin: pons/medulla Function: excites extensors

Question 36

Which motor tract is in charge in decorticate rigidity?

Answer 36

Lesion above midbrain | Rubrospinal tract; flexion of upper limbs

Question 37

Which motor tract is in charge in decerebrate rigidity?

Answer 37

Lesion below midbrain | Reticulospinal tract; extension

Question 38

DCML function and route

Answer 38

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

Question 39

Difference between gracile fasciculus and cuneate fasiculus

Answer 39

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

Question 40

Spinothalamic tract function and pathway

Answer 40

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

Question 41

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

Answer 41

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

Question 42

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

Answer 42

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

Question 43

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

Answer 43

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

Question 44

Symptoms of cerebral herniation

Answer 44

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

Question 45

Where can you find the dual venous sinuses?

Answer 45

Outer and inner dura

Question 46

Expressive dysphasia

Answer 46

Brocas area

Question 47

Receptive dysphasia

Answer 47

Wernicke's area

Question 48

Nystagmus, intention tremor and dysarthria

Answer 48

Cerebellum

Question 49

Temperature control

Answer 49

Hypothalamus

Question 50

Oculomotor nucleus

Answer 50

Midbrain

Question 51

Most common cause of hydrocephalus in children

Answer 51

Aqueduct stenosis - non-communicating hydrocephlus

Question 52

Sy of aqueduct stenosis?

Answer 52

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

Question 53

What GCS indicates comatomse?

Answer 53

8 or less