Flashcards in Pattern Recognition (revision) Deck (53):
1
Describe hyperkinetic movement disorders
Dystonia
Tics
Myoclonus
Chorea
Tremor
2
Describe hypokinetic movement disorders
Parkinsons; rigidity and bradykinesia
3
What is the pattern of weakness in MND?
UMN and LMN signs
Absence of sensory symptoms
+/- frontotemporal dementia
4
Inflammatory muscle disorders
Poly/deramatomyositis
Inclusion body myositis
Vasculitis
RA
Sjogren's
5
Endocrine muscle disorders
Hypothyroidism
Cushing's
Electrolyte disturbances
Hypophosphatemia
Hypocalcemia
Hypernatraemia/ hyponatraemia
6
Drugs/toxins causing muscle disorders
Illicit drugs; cocaine, heroin
Alcohol
Corticosteroids
Colchicine
Antimalarial drugs
Stains
Penicillamine
7
Infections causing muscle disorders
Viral; influenza, parainfluenza, coxsackie, HIB, CMG, echovirus, adenovirus, EBV
Bacteria
Fungal
Parasitis
8
Rhabdomyolysis causing muscle disorders
Crush trauma
Seizures
Alcohol absuse; hyperkinetic state with delirium tremens
Exertion
Vascular surgery
Malignant hyperthermia
9
Which muscle, nerve and nerve root are responsible for shoulder abduction?
M: deltoid
N: axillary
NR: C5
10
Which muscle, nerve and nerve root are responsible for elbow extension?
M: triceps
N: radial
NR: C7
11
Which muscle, nerve and nerve root are responsible for finger extension?
M: extensor digitorum
N: radial
NR: C7
12
Which muscle, nerve and nerve root are responsible for index finger abduction?
M: 1st dorsal interosseous
N: Ulnar
NR: T1
13
Which muscle, nerve and nerve root are responsible for hip flexion?
M: iliopsoas
N: femoral
NR: L1,2
14
Which muscle, nerve and nerve root are responsible for knee flexion?
M: hamstrings
N: sciatic
NR: S1
15
Which muscle, nerve and nerve root are responsible for ankle dorsiflexion?
M: tibialis anterior
N: common fibular and sciatic
NR: L4,5
16
Which muscle, nerve and nerve root are responsible for great toe dorsiflexion?
M: EHL
N: common fibular
NR: L5
17
Main deep tendon reflexes and oot innervation
Biceps/ supinator: C5,6
Triceps: C7,8
Knee: L3,4
Ankle: S1,2
18
What does a glove and stocking sensory loss indicate?
Length dependent neuropathy
19
What does a sensory level sensory loss indicate?
Spinal cord lesion
20
What does a hemianesthesia sensory loss indicate?
Contralateral cerebral lesion
21
What is a dissociated sensory loss indicate?
Loss of spinothalamic but preserved DCML; anterior spinal artery syndrome, brown sequard or syringomyelia
22
Extrapyramidal symptoms
Bradykinesia
Rigidity
Resting tremor
Shuffling gait
Stooped posture
Hypomimia
Hypophonia
Reduced arm swing
Impaired postural reflexes
Asymmetry in PD, symmetry in DI
23
Main function of frontal lobe
Executive function
Prefrontal cortex connects to the basal ganglia, limbic system, thalamus and hippocampus
24
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
25
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
26
Parietal lobe dysfunction
Inferior homonymous quadrantanopia
Visuospatial dysfunction
Gerstmann's syndrome
Dyspraxia
Inattention
Denial
27
What is gerstmann's syndrome?
Dominant lobe; dysgraphia, left-right disorientation, finger agnosia, acalculia
28
Treatment protocol for PD
Symptomatic; levodopa or dopamine agonist
MDT including speech and language, OT, PT, exercise
Deep brain stimulation
29
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
30
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
31
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
32
Corticobulbar tracts origin and function
Origin: primary motor cortex in precentral gyrus
Function: muscles of face, head and neck
33
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
34
Rubrospinal tract origin and function
Origin: red nucleus of midbrain
Function: excites flexors and inhibits extensors of upper body
35
Reticulospinal tract origin and function
Origin: pons/medulla
Function: excites extensors
36
Which motor tract is in charge in decorticate rigidity?
Lesion above midbrain
Rubrospinal tract; flexion of upper limbs
37
Which motor tract is in charge in decerebrate rigidity?
Lesion below midbrain
Reticulospinal tract; extension
38
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
39
Difference between gracile fasciculus and cuneate fasiculus
Gracile; legs, below T6
Cuneatus; arms; above T6
Gracile medial to cuneate in spinal cord
40
Spinothalamic tract function and pathway
Function: pain and temp
Decussates segmentally in spinal cord to reach opposite primary somatosensory cortex
41
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
42
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
43
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
44
Symptoms of cerebral herniation
Extensor response
Cushing's triad; hypertx, brady, agonal breathing
Uncal herniation = blown pupil
45
Where can you find the dual venous sinuses?
Outer and inner dura
46
Expressive dysphasia
Brocas area
47
Receptive dysphasia
Wernicke's area
48
Nystagmus, intention tremor and dysarthria
Cerebellum
49
Temperature control
Hypothalamus
50
Oculomotor nucleus
Midbrain
51
Most common cause of hydrocephalus in children
Aqueduct stenosis - non-communicating hydrocephlus
52
Sy of aqueduct stenosis?
Growth in head circumference
Eyelids retracted; sunsetting eyes
Upward gaze impaired
Failure to thrive
53