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Flashcards in Revisin Deck (186):
1

what are 2 possible side effects of a statin

muscle pain and weakness

2

what do you worry about with night pain

cancer

3

what are spinal red flags

back pain (worse at night, new pain in old patient)
bilateral sciatica, urinary incontinence
impotence
saddle anaesthesia

4

what is cauda equina syndrome

Compression/ irritation of lumbosacral nerve roots below conus medullaris

5

what are the common causes of cauda equina syndrome

herniated disc, spinal stenosis, vertebral fracture, tumour

6

what are the clinical features of cauda equina syndrome

usually acute (<24hrs), rarely subacute or chronic.
Motor signs - LMN signs → weakness in multiple root distribution, reduced tendon reflexes
Sensory signs - low back pain radiating to legs aggravated by sitting, relieved by lying down. Saddle anaesthesia (S2-5)
Autonomic signs - urinary retention/ overflow incontinence, loss of anal tone (faecal incontinence).

7

treatment for cauda equina

PR
MRI of lumbar spine
decompression within 48 hrs

8

what reflexes are usually absent in cauda equina

ankle

9

where does the conus medullaris end

L1/2

10

what is degenerative cervical myelopathy

spinal cord dysfunction from compression in the neck.1 Patients report neurological symptoms such as pain and numbness in limbs, poor coordination, imbalance, and bladder problems. Owing to its mobility, the vertebral column of the neck is particularly prone to degenerative changes such as disc herniation, ligament hypertrophy or ossification, and osteophyte formation

11

what are the common symptoms of degernative cervical myelopathy

Neck pain/stiffness
Unilateral or bilateral limb/body pain
Upper limb weakness, numbness, or loss of dexterity
Lower limb stiffness, weakness, or sensory loss
Paraesthesia (tingling or pins and needles sensations)
Autonomic symptoms such as bowel or bladder incontinence, erectile dysfunction, or difficulty passing urine
Imbalance/unsteadiness
Falls

12

what are the motor signs of degenerative cervical myelopathy

o Pyramidal weakness (Upper limb; extensors more than flexors. Lower limb: flexors more than extensors)
o Limb hyperreflexia
o Spasticity (eg, clasp knife sign)
o Clonus, especially Achilles tendon
o Hoffman’s sign (thumb adduction/flexion +/− finger flexion after forced flexion and sudden release of a finger, distally)
o Babinski’s sign (upgoing plantar)
o Segmental weakness (corresponding to the level of compression)

13

what are the features of an upper motor neurone lesion

paralyses affects movement rather than muscles
slight muscle wasting
spasticity
hyperreflexia
hypertonia
normal power

14

what are the features of a lower motor neurone lesion

flaccid paralysis (of muscle or muscle group)
severe atrophy
hypotonia
absent reflexes
may have fasciculation and fibrillation

15

what is the most likely benign tumour of the brain

meningioma

16

what is foster kennedy syndrome

when a slow growing frontal lobe tumour compresses optic nerve causing it to atrophy

17

what level in spinal cord do sensory afferent from bladder enter

S2-4

18

what is danish

how to examine to cerebellum
-dyskensia
-ataxia
-nystagmus
-intention tremor
-staccato speech
-hypotonia

19

what tract will an upper motor neurone be in

pyramidal tracts

20

is parkinsons an UMN lesion

no as not within the pyramidal tract

21

are tremors pyramidal or extrapyramidal

extra pyramidal (involuntary movements)

22

where are LMNs

anywhere below L1/2 or out with the CNS

23

what is a tremor

involuntary movement in which there is rhythmicity, is a regular movement

24

what movements tend to develop in extrapyramidal disorders

involuntary- tremors

25

what are the types of tremors

resting- when sitting and relaxed
postural- holding arms in certain postitions
intention- when trying to complete an action

26

where must a lesion be if it affects the leg and arm

cervical spin or above

27

weakness is a symptoms of a lesion affecting which tract

pyramidal

28

why is there not weakness in parkinsons

as extrapyramidal

29

what are the hallmarks of parkinsons

SLOWNESS (bradykinesia- only symptoms seen in everyone)
tremor
tone (stiffness and rigidity)

30

what are the other symptoms of parkinsons

can 'freeze' and struggle to initiate and stop movements
shuffling gate
stooped posture
changes in mood
handwriting gets smaller (micrographia)
balance problems
depression and anxiety
sleeping problems
loose paralysis in dreams so cant act out what they are dreaming
REM sleep disorder
loose sense of smell and taste (before motor symptoms)
memory changes
voice gets quieter
constipation
bladder problems

31

where is the lesion in parkinsons

substantia nigra in the basal ganglia (produces dopamine)

32

why is cerebrovascular pmhx important in parkinsons

as type of vascular parkinsons

33

what diseases are related to parkinsons

cerebrovascular disease, psychiatric problems (anti dopamine drugs)

34

what drugs are related to parkinsons

antihistamines, anti emetics (block dopamine), some anti psychotics

35

what are the risk factor for parkinsons

family Hx
risk factors for cardiovascular disease- alcohol, diet etc
NOT SMOKING - smoking protects you from parkinsons

36

what occupations have increased risk of parkinsons

agriculture, manganese minors, general exposure to chemicals

37

what is the commonest form of parkinsons

idiopathic

38

what type of movement do you loose in parkinsons

spontaneous
-facial
-adjusting position
-rolling over in bed

39

are cranial nerves affected in parkinsons

no

40

how is tone affected in parkinsons

increased (not in same way as UMN lesion)
= rigidity (high tone but velocity independant)
also get cog wheel rigidity

41

what type of tone changes in UMN lesion

velocity dependent
spactity
hypertonic

42

what type of tone changes in LMN lesion

hypotonia
flaccidity

43

does parkinsons affect one or both sides

affects both sides of the brain but to different degrees so usually have one side affected in early stages then becomes more symmetrical

44

how is power affected in parkinsons

isnt as extrapyramidal

45

are reflexes affected in parkinsons

no as reflexes are pyramidal

46

is coordination affected in parkinsons

no as cerebellum fine

47

what do yuo get a resting tremor in

parkinsons

48

what do you get a postural tremor in

drugs, dystolic tremor, anxiety

49

what do you get an intention tremor in

cerebellar disease

50

what is a holmes tremor

a resting, postural and intentional tremor all at the same time

51

what is bradykinesia

slowness with decrement and degradation of repetitive movements (“fatigue”)

52

what are is affected in a central nervous system lesion

hemiplegia/ paraplegia/ whole limb

53

what type of weakness in a central nervous system lesion

heaviness

54

what are the additional features of a central nervous system lesion

spasms/ jerks
cognitive/ sphincter involvement

55

can you get sensory symptoms in a central nervous system lesion

yes

56

what area will be affected in a peripheral nervous system lesion

may be peripheral or localised areas
can be whole limb if affects plexus

57

what type of weakness in a peripheral nervous system lesion

positional/ with sleep
ascending

58

what additional features can exists in a peripheral nervous system lesion

cramp
twitching (fasciculations)
loss of grip
tripping up
unsteady with eyes closed

59

can you get sensory symptoms in a peripheral nervous system lesion

yes
pain may be prominent

60

where might be affected in NMJ lesion

ocular/ bulbar/ proximal limb

61

what is the weakness like in a NMJ lesion

fatiguable - worse after use
diurnal variations- worse towards end of day

62

what additional features can be seen in a NMJ lesion

bulbar- swallowing, speaking, loss of chewing/ talking
ocular- diplopia, ptosis, prolonged gaze hard
resp- orthopnoea

63

can you get sensory symption in a NMJ lesion

no

64

where might be affected in muscular lesion

proximal
symmetrical

65

what is the weakness like in a muscle lesion

may be aching
may be insidious
proximal weakness
symmetrical

66

what additional features can you get in a muscle lesion

myalgia
cramping
hard to get up from low chairs/ hang out washing

67

can you get sensory symptoms in a muscle lesion

no

68

what might be seen on inspection in a CNS lesion

abnormal limb posture

69

what might be seen on inspection in a PNS lesion

wasting/ fasciculations
pes cavus

70

what might be seen on inspection in a NMJ lesion

ptosis
ophthalmoplegia

71

what might be seen on inspection in a muscle lesion

proximal wasting

72

what happens to tone in a CNS lesion

increased
spacticity/ clonus

73

what happens to tone in a PNS lesion

decreased

74

what happens to tone in a NMJ lesion

normal or decreased

75

what happens to tone in a muscle lesion

normal or decreased

76

what is the pattern of weakness like in peripheral neuropathy

distal weakness

77

what is a pyramidal pattern of weakness

arm: extensors weaker than flexors
leg: flexors weaker than extensors
if brain affected= contralaterla
if cord affected= ipsilateral side

78

what are reflexes like in a CNS lesion

increased

79

what are reflexes like in a PNS lesion

decreased

80

what are reflexes like in a NMJ lesion

normal or decreased

81

what are reflexes like in a muscle lesion

normal or decreased

82

what are reflexes like in a CNS lesion

extensor

83

what are reflexes like in a PNS lesion

flexor/ mute

84

what are reflexes like in a NMJ lesion

flexor

85

what are reflexes like in a muscle lesion

flexor

86

what distribution of sensory symptoms in a CNS lesion

brain- hemi sensory (one side for body, other side for face (trigeminal nerve))
cord- at sensory level

87

what distribution of sensory symptoms the PNS lesion: sensory neuropathy

glove and stocking

88

what distribution of sensory symptoms the PNS lesion: root/ plexus/ mononeuropathy lesion

depends on dermatome/ nerve

89

what does velocity dependant increased tone mean

involves pyramidal tract

90

where will see the effects of a lesion in the internal capsule

leg, arm, face and trunk

91

what is the general pattern of an inflammatory lesion in the brain

relapsing and remitting

92

what are the types of NMJ pathology and how can you differentiate them

lambert eaton= diminshed/ adbscence deep tendon reflex, autonomic features (is a pre synaptic problem)

myaestenia gravis - has ocular problems (post synaptic problem)

93

how do you demonstrate NMJ pathologies

bulbar- counting out loud
ocular- fixed horizontal gaze
ptosis- fixed upward gaze
limb- repetitive movements
(fatiguing weakness)

94

what results from an L4/5 L5 impingement

weak toe dorsiflexion

95

what results from an L5/S1 S1 impingement

weak knee flexion
decreased knee jerk

96

what happens in a lesion on the brachial plexus

extensive arm weakness

97

what happens in a lesion on the lumbosacral plexus

extensive leg weakness

98

what results from a median nerve neuropathy

weak thumb abduction

99

what results from a ulnar nerve neuropathy

weak finger abduction

100

what are 2 features and common causes of peripheral neuropathy

is distal and sensory more than weakness

if acute- guillane barre syndrome
if chronic- diabetes/ alcohol

101

what test do you always do in epilepsy

ECG!!!!!

102

what does rigidity occur in

extrapyramidal conditions affecting the basal ganglia (e.g. parkinsons)

103

is rigidity associated with weakness

no
but can have slow developing muscle contractions (bradykinesia)

104

is there usually a change in tendon reflexes in rigidity

no

105

what is spasticity dependent on

(velocity)
input to the spinal cord produced by the passive movement of the limb

106

which muscles is spasticity predominantly found in

flexor muscles and forearm pronators inarm
extensor muscles in the legs
(think opposite to pyramidal weakness)

107

what is the clasp knife phenomonenum

where spasticity builds up soon after the start of the passive movement, then melts away

108

how is spasticity most easily elicited in the arm and leg

rapid extension of the elbow or supination of
the forearm

in the leg by rapid flexion of the knee

109

will a slow movement meet resistance in spasticity

no

110

what are the features of rigidity that distinguish it from spasticity

not velocity dependent
present equally in flexors and extensors
present throughout the range of movement
can have cog wheel or led pipe quality

111

how is rigidity best elicited

relatively slow passive movements
In the arm by flexion-extension of the wrist and elbow, and by supination-pronation of
the elbow.

In the lower limb flexion-extension of the knee and ankle are tested

112

what is the MRC power scale

0= No contraction
1= Flicker of contraction without movement
2= Slight movement with gravity eliminated*
3= Movement against gravity only
4= Movement against resistance
(can expand grade 4 to: 4+, 4 and 4-)
5= Normal power

113

why do tendon reflexes change

Reflexes are very sensitive to pathology affecting the afferent side of the reflex arc. If
conduction is blocked in only a few muscle spindle primary afferents, then the
compound action potential elicited in all the motorneurones will be smaller, and the
reflex will be less brisk or absent.
Reflexes are also sensitive to “upper motorneurone lesions” affecting the descending
motor pathways in the cerebral hemispheres, brainstem and spinal cord. The
excitability of the alpha motorneurones increases and the reflexes become brisker.

114

when is clonus abnormal

when it is sustained

115

what is reinforcement when testing a reflex

e.g.to link the fingers of each
hand and attempt to pull them apart to test lower limb reflexes

116

what is clonus

the rhythmic contraction of a muscle group elicited by a rapid passive stretch of it

117

what is the triceps surae

pair of muscles located at the calf - the two-headed
gastrocnemius and the soleus- ankle extensors- common to get clonus here

118

what is clonus a sign of

UMN lesions
always associated with brisk ankle jerks

119

when are reflexes abnormal

when they are absent (with reinforcement).
when they are asymmetrical (right v left).
when there is a marked discrepancy between different reflexes (eg between those
in the arms and those in the legs).
when there is sustained clonus.

120

what is a positive babinski response

big toe extends and the other toes fan- sign of UMN lesion

121

what is a spastic gait

due to UMN lesion
affected limbs appear very stiff

122

what causes a parkinonian gait

basal ganglia pathology

123

what causes a truncal ataxia (widebase, unsteady)

cerebellar disease
hydrocephalus
proprioceptive loss (neuropathy/ myelopathy)

124

what causes a high stepping gate

biltaeral= peripheral neuropathy
unilateral= peroneal nerve or L4 root lesion

125

what causes a waddling gait

proximal leg weakness

126

what are the types of tremor

Rest: Present when the subject is relaxed, and decreasing on
maintaining a posture or during movement
Postural/Action: Present on maintaining a posture and during movement, but
disappearing at rest.
Intention: Present towards the end of a movement to a target, causing
overshoot (dysmetria).

127

what are the causes for resting tremor

parkinsons

128

what are the causes for postural/ action tremor

Physiological
Essential tremor, drugs
Anxiety, Thyrotoxicosis

129

what are the causes for intention tremor

cerebellar disease

130

what happens to rapid supination/ pronation movements in parkinsons

In extrapyramidal diseases (Parkinsonian syndromes) there is a reduction in
the amplitude and speed of supination/pronation movements.

131

what happens to rapid supination/ pronation movements in cerebellar disease

irregularity of the movements as well as slowing
and reduction in amplitude.

132

how do different pathologies affect fine finger movement

impaired in upper motor neurone lesions affecting the hand,
particularly with cortical lesions when the hand may be clumsy with little
weakness.

Fine finger movements are also impaired in extrapyramidal
diseases and cervical myelopathy.

133

what type of taste do the CN VII an IX nerves carry

sourness
sweetness
bitterness
saltiness

134

what vision loss in optic neuritis

central scrotoma

135

what causes red vision to be lost

optic nerve dysfunction

136

where is a defect if vision loss is homonymous

behind the chiasm

137

what is a hippus

oscillation in pupillary size

138

what is the pupil like in horners syndrome

miotic (constricted)
(will also have lack of upward gaze)

139

what is bells phenomenon

the upward deviation of the eyes on closure

140

what causes diplopia when only one eye is open

refractive error or cerebellar problem

141

what causes vertical upbeat nystagmus

most commonly seen as a side-effect of anticonvulsants but it may also occur in cerebellar and pontomedullary abnormalities and in Wernicke's encephalopathy

142

what causes down beat vertical nysatgmus (fast downward phase)

abnormality at the craniocervical junction
cerebellar degeneration and drug intoxication
Wernicke's encephalopathy, demyelination, brain stem encephalitis, tumours at the foramen magnum and hydrocephalus.

143

is there diplopia in long standing strabismus

no

144

what does the medial longitudinal fasciculus connect

CN III, IV and VI

145

in the trigeminal nerve, what are the central connection for touch and pain/ temperature afferents

touch = main sensory nucleus
pain/ temp= spinal nucleus

146

where does UMN facial weakness tend to spare

the upper half of the face

147

what nerve supplies taste to the anterior 2/3rds of the tongue

CN VII (facial)

148

what does a corrective saccade in the head thrust test mean

a peripheral cause of vestobular problems

149

does the spinal accessory nerve originate from cord or brain stem

both hehe

150

what s a bulbar palsy

(bulbar= medulla)
caused by diseases affecting the lower cranial nerves e.g. a LMN lesion, NMJ or muscle problem

151

what causes a pseudobulbar palsy

when a UMN lesion affects the lower cranial nerves (a disease of the corticobulbar tracts)

152

what can a bulbar palsy with a LMN lesion cause

-impaired voluntary palatal movement
 impaired palatal movement on eliciting the gag reflex or loss of the gag reflex
 wasting and fasciculation of the tongue
 slurring dysarthria and dysphagia

153

what does a pseudobulbar palsy cause

 a brisk jaw jerk
 a brisk gag reflex
 a spastic tongue (with difficulty protruding the tongue and impaired rapid tongue
movements)
 a spastic dysarthria and dysphagia

154

how do you test each occular muscle and nerve (movements)

III -superior rectus (looks laterally and upwards), inferior rectus (looks laterally and
downwards), medial rectus (looks medially), inferior oblique (looks medially and
upwards)
 IV -superior oblique (looks medially and downwards)
 VI - lateral rectus (looks laterally)

155

what are the different types of articulation

Palatal articulation – “KA”,
Guttural articulation – “GO”,
Labial articulation – “PA”

156

what level does should abduction test

C5

157

what level does elbow flexion and wrist extension test

C6

158

what level does elbow extension and wrist flexion test

C7

159

what level does thumb extension test

C8

160

what level does finger abduction test

T1

161

what level does hip flexion test

L1,2

162

what level does knee extension test

L3

163

what level does ankle dorsiflexion test

L4

164

what level does great toe extension

L5

165

what level does ankle plantar flexion test

S1

166

what is a glioblastoma

a high grade (grade 4) astrocytoma

167

what is coning

where the brainstem and cerebellum get pushed through the foramen magnum (tonsillar herniation

168

what is cushings triad

reduced respiratory, high BP and bradycardia

happens in coning

169

what can cause too much CSF to be produced

choroid plexus malignancies

170

who gets medulloblastomas

children

171

what is seen pathologically in an acute infarct

oedema
discolouration (grey/ brown)
loss of normal architecture

172

what happens to old strokes

gliosis, liqudification by macrophages

173

what o watershed infarctions look like

wedge shape infarct on the peripheries of the brain

174

what does global hypoxia look like pathologically

mottling
loss of differentiation between grey and white matter

175

what are the RF for a subarachnoid haemorrhage

ADPKD
HPTx
obesity
smoking

176

what increases and decreases in atrophy

increase sulcus (depression- think in a sulc)
decreased gyrus (bumps- think gyrating, bump and grind)

177

what does MS look like pathologically

dark grey spots mainly affecting white matter, periventricular

178

what is the lateral horn of the spinal cord

a triangular projection between the dorsal and ventral horns

it is present only in the thoracic and upper lumbar segment of the spinal cord

contains autonomic neurones (sympathetic system T1-L2)

179

what is the path of the dorsal column medial leminiscus pathway

primary sensory fibres travel via the posterior root ganglion
up spinal cord
synapse with 2ndary order in medulla (nucleus cuneatus if above T6, nucleus gracilis if below T6)

fibres decussate to the contralateral medial leminiscus and travel upwards to synapse in the thalamus

relayed to the ipsilateral somatosensory cortex

180

what is the path of the spinothalamic tract

The primary sensory axons enters the spinal cord, via the posterior root ganglion, then travel upwards for one or two segments at the periphery of the spinal cord through the tract of Lissauer to synapse in the dorsal horn.
They then cross to the contralateral side of the spinal cord to ascend to synapse in the thalamus.
Sensory signal are then relayed from the thalamus to the ipsilateral somatosensory cortex.

181

what is the function of the spinocerebellar pathways

provides unconscious proprioceptive information to the cerebellum, in order to coordinate posture and the movement of the lower limb and upper limb musculature.

182

what are the three spinocerebellar pathways and their functions

Dorsal/posterior spinocerebellar: carries unconscious proprioceptive information (from muscle spindles mainly) from the lower limbs, synapses in the dorsal nucleus of Clarke.

Cuneocerebellar: carries unconscious proprioceptive information from the upper limbs.

Ventral/anterior spinocerebellar: carries unconscious proprioceptive information (golgi tendon organs mainly) from the lower limbs then decussate twice to reach the ipsilateral cerebellum.

183

do the spinocerebellar tracts travel to the contra or ipsilateral cerebellum

ipsilateral

184

what is the role of the corticospinal tract

voluntary movements

185

where do the anterior corticospinal tracts decussate

the anterior white commissure

186

what does the anterior corticospinal tract mainly supply

proximal and axial muscles