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Flashcards in Upper Limb Deck (15)
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1
Q

Features of a UMN lesion

A
Tone - increased (spastic)
Power - reduced
Reflexes - brisk
Plantars - up
Coordination - down
Other - clonus
2
Q

Features of an extrapyramidal lesion

A
Tone - increased (rigid)
Power - normal
Reflexes - normal
Plantars - down
Coordination - reduced 
Other - resting tremor, bradykinesia, postural instability
3
Q

Features of a cerebellar lesion

A
Tone - reduced
Power - normal
Reflexes - normal
Plantars - down
Coordination - reduced +++
Other - intention tremor, nystagmus, cerebellar speech
4
Q

Core features Parkinsonism

A

TRAP

Tremor (resting)
Rigidity (cogwheeling)
Akinesia (Bradykinesia)
Postural instability (hesitancy, shuffling gait, loss of arm swing)

5
Q

Causes of Parkinsonism

A

Idiopathic Parkinson’s disease

Drug induced Parkinsonism (Lithium, antipsychotics, metoclopramide)

Atherosclerotic pseudoparkinsonism (legs only, less tremor)

Dementia pugilistica (Parkinsonism secondary to repeated head trauma eg boxing)

6
Q

Conditions with similar presentation to Parkinsonism

A

Benign essential tremor

Wilson’s disease

7
Q

Treatment for Parkinson’s disease

A
L-Dopa
Dopamine agonists
Anticholinergics
COMT inhibitors
MAO inhibitors
Glutamate agonists
8
Q

Ddx tremor

A

Resting - Parkinsonism

Flapping - hepatic failure, respiratory failure (CO2 retention), renal failure

Intention - cerebellar lesion

Postural - benign essential tremor, physiological tremor (fever, anxiety, medication)

9
Q

Outline the sensory modalities carried in the spinal cord i.e. Which tract for what?

A

Spinothalamic - pain, temperature & crude touch

Dorsal columns - vibration, joint position sense, fine touch

10
Q

Ddx spinal cord pathology

A

Spinothalamic - Syringomyelia , Anterior spinal artery occlusion

Dorsal column - Tabes dorsalis (syphilis)

Any - MS

11
Q

Describe the presentation of syringomyelia

A

Spinothalamic fibres principally affected

Loss of pain and temp in cape-like distribution over arms, shoulders and upper body

LMN in upper limbs, spastic parapesis of lower limbs

Dorsal column signs develop as canal expands

12
Q

Describe Erb’s palsy

A

Upper brachial plexus (C5-C7) - shoulder dystocia during birth

Sensory loss down lateral arm

Waiter’s tip position - shoulder ADducted, arm internally rotated, forearm pronated

13
Q

Describe the cause and presentation of Klumpke’s palsy

A

Lower brachial plexus (C8- T1), excessive arm traction

Sensory loss in medial forearm and hand
Complete claw hand
Wasting of small muscles in hand

Horner’s syndrome may co-exist

14
Q

Concluding remarks

A

I would like to complete a full neurological examination

Investigations: nerve conduction studies, imaging (CT, MRI)

15
Q

Features of a LMN lesion

A
Tone - normal or reduced 
Power - reduced
Reflexes - reduced
Plantars - down
Coordination - normal
Other - wasting & fasciculation