Common Neuro Osce Questions

Front 1

What are the signs of a LMN lesion?

Back 1

inspection: wasting and fasciculations
tone: reduced
power: reduced
reflexes: reduced/absent
sensation: reduced
co-ordination: reduced

Front 2

What are the signs of an UMN lesion?

Back 2

inspection: cerebral posturing, pronator drift
tone: increased
power: reduced
reflexes: brisk/increased
sensation: reduced
co-ordination: reduced

Front 3

what muscles are supplied by the occulomotor, trochlear and abducens nerves?

Back 3

occulomotor:
trochlear: superior oblique
abducens: lateral rectus

Front 4

What visual field defects correlate to a lesion in front of the chiasm, at the chiasm and behind the chiasm?

Back 4

in front of chiasm: central scotoma (optic nerve)
at chiasm: bitemporal hemianopia
behind chiasm: homonymous hemianopia

Front 5

what blood vessel is likely to be affected if there is a homonymous hemianopia?

Back 5

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.

Front 6

What is Internuclear opthalmoplegia and what type of disease usually causes it?

Back 6

f

Front 7

what are some common causes of IIIrd nerve palsy?

Back 7

Causes include diabetes (pupil often spared), posterior communicating artery aneurysm (surgical 3rd – often painful), raised ICP (false localising sign

Front 8

why is the pupil spared in a IIIrd nerve palsy caused by diabetes?

Back 8

the PNS fibres have a separate blood supply from the nerve sheath vessels.

Front 9

What is horner's syndrome?

Back 9

slight ptosis
constricted pupil
reduced sweating over forehead
eye may be slightly bloodshot early on (loss of alpha vasocontrictor tone)

Front 10

Common causes of facial nerve palsy?

Back 10

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)

Front 11

What is Ramsay hunt syndrome?

Back 11

Herpes Zoster infection of facial and vestibulocholear nerves. Causes facial parylsis, sensorineural hearing loss, ear pain, vesicles in ear and vertigo.

Front 12

How can you differentiate between and UMN and LMN defect of the facial nerve?

Back 12

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.

Front 13

Describe the course of the facial nerve.

Back 13

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.

Front 14

describe the nerve supply to the pupil?

Back 14

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)

Front 15

what fibres run in the occulomotor nerve?

Back 15

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)

Front 16

the SNS supply to the eye

Back 16

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)

Front 17

what are the symptoms of horner's syndrome?

Back 17

ptosis
miosis
anhidrosis
redness of conjunctiva

Front 18

features of a third nerve palsy?

Back 18

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.

Front 19

diagnostic criteria of a migrane without aura?

Back 19

>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

Front 20

what are some contraindications to triptans?

Back 20

IHD
coronary spasm
uncontrolled BP
lithium
SSRIs

Front 21

colour changes which help distinguish syncope from seizure?

Back 21

cyanosis suggests seizure
white/red suggests arrythmia

Front 22

brugada syndrome!

Back 22

genetic SCN5A channelopathy predisposing to VT. treat with a pacemaker.

Front 23

what are the test and treatments for BPPV?

Back 23

Hallpike's - what the hell is it?
Epley to better it

Front 24

triad of meniere's disease?

Back 24

1. vertigo
2. hearing loss
3. tinnitus
(+aural fullness)

Front 25

what are some ototoxic drugs?

Back 25

aminoglycosides, loop diuretics and cisplatin

Front 26

presentation of acoustic neuroma?

Back 26

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

Front 27

causes of pulsatile tinnitus?

Back 27

carotid artery stenosis or dissection
AV fistula
glomus jugulare tumours

Front 28

HAS BLED SCORE?

Back 28

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

Front 29

by how much does warfarin reduce your risk of stroke?

Back 29

68%

Front 30

grading mortality in SAH

Back 30

1: none : 0
2: neck stiffness & CN palsies: 11
3: drowsiness : 37
4: drowsiness with hemiplegia : 71
5: prolonged coma :100

Front 31

where does the bleeding happen in subdural haematoma?

Back 31

bridging veins between the cortex and venous sinuses (frequently occurs in a deceleration injury and in the elderly atrophic brain)

Front 32

where does a extradural (epidural) haemorrhage occur?

Back 32

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

Front 33

what are Madopar/sinemet and what are they used for?

Back 33

are dopa-decarboxylase inhibitors used with levodopa

Front 34

what are ropinirole & pramipexole and what are they used for?

Back 34

dopamine agonists used to delay L dopa treatment. also allow lower doses of L-dopa to be used as disease progressed.

Front 35

what are benzhexol and phenadrine?

Back 35

anticholinergics used to help the tremor in parkinson's disease

Front 36

what are rasagiline and selegiline?

Back 36

MOA-B inhibitors used an as alternative to dopamine agonists in early PD.
S/E postural hypotension and AF

Front 37

what are entacapone and tolcapone?

Back 37

COMT inhibitors used to lessen the "off" time in Parkinsons disease

Front 38

Progressive supranuclear palsy features?

Back 38

early POSTURAL INSTABILITY & FALLS
verticle gaze palsy
rigidity of trunk
speech and swallowing problems
tremor is unusual

Front 39

Multisystems atrophy features?

Back 39

early AUTONOMIC features
cerebellar and pyrimidal signs
rigidity is worse than tremor

Front 40

Cortico-basal degeneration features?

Back 40

akinetic rigidity involving ONE LIMB
cortical SENSORY LOSS
APRAXIA (alien limb)

Front 41

causes of mononeuritis multiplex?
WARDSPLC

Back 41

wegner's
aids/amyloid
rheumatoid
diabetes
sarcoiditis
PAN
leprosy
carcinomatosis

Front 42

most common false localising sign?

Back 42

6th nerve palsy - had the longest intracranial route

Front 43

treatment for bell's palsy?

Back 43

give prednisolone if present within 72 hours (60mg for 5 days)

Front 44

treatment for ramsay hunt syndrome?

Back 44

give prednisolone and aciclovir
1/3 1/3 1/3 prognosis

Front 45

what does MND never do?

Back 45

affect eye movements
affect sensation
affect sphincters

Front 46

lhetmitte's symptom?

Back 46

neck flexion causing tingling down the spine

Front 47

signs of radiculopathies?

Back 47

reduced reflexes, dermatomal sensory loss, LMN weakness and wasting, UMN signs below the lesion with cord compression

Front 48

dystrophia myotonica

Back 48

AD Cl channelopathy
onset around 25 years old with distal onset weakness (hand/foot drop)
weak sternomastoids
myotonica

Front 49

pattern of affected muscles in MG?

Back 49

eyes - bulbar - face - neck - limb girdle - trunk

Front 50

antibodies in MG?

Back 50

anti AChR in 90%, only positive in 70% with occular confined disease
if negative try anti McSK antibodies

Front 51

treatments in MG?

Back 51

pyridostigmine (anticholinesterase)
prednisolone for relapses
IvIg/ plasmaphoresis for myasthenic crises

consider thyectomy

Front 52

diagnosis of NF1?

Back 52

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

Front 53

diagnosis of NF2?

Back 53

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

Front 54

complications of NF1?

Back 54

nerve root compression
GI bleeds/obstruction
cystic lesions, scoliosis, pseudoarthorisis
high BP
plexiform neurofibroma
malignancy (change to sarcoma)
high risk of epilepsy

Front 55

syringomyelia

Back 55

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)

Front 56

signs of syringomyelia?

Back 56

dissociative sensory loss (loss of spinothalamic, preserved dorsal columns) as presses on anterolateral pathways
horners syndrome
UMN leg signs
body assymetry
limb hemihypertrophy