EMQs in Clinical Medicine.pdf - Peshawar Medical College

Neurology – revision boxes 107
Box 4 Features of eponymous syndromes
Feature
Syndrome
• Saddle anaesthesia
Cauda equina syndrome
Bowel/bladder disturbance
Bilateral pain legs
• Ipsilateral pyramidal signs plus
Brown–Séquard syndrome
contralateral loss of pain and
temperature
• Ascending symmetrical flaccid Guillain–Barré syndrome [31, 96]
muscle weakness
Preceding recent respiratory/
gastrointestinal infection
• Combination of parkinsonism plus Shy–Drager syndrome
primary autonomic failure, e.g.
postural hypotension
• Triad of: nystagmus,
Wernicke’s encephalopathy
ophthalmoplegia, ataxia [79, 99]
Caused by thiamine (vitamin B 1 )
deficiency
Reversible but if untreated develops
to Korsakoff’s syndrome
• Signs of gross defect in memory of Korsakoff’s syndrome
recent events
Confabulation may be present
Condition is irreversible
Description of the patient’s gait is often a good clue to a particular option in an
EMQ (Box 5).
Box 5 Gait and different conditions [36]
Gait
Condition
Shuffling, festinant gait Parkinson’s disease
High-stepping/stamping gait Sensory ataxia, e.g. peripheral neuropathy
Scissor gait
Spastic paraplegia
Wide-based gait
Cerebellar lesion
Shuffling small steps Cerebrovascular disease (marche à la petit pas)
You will frequently come across an EMQ that tests knowledge of nerve root
innervation and understanding of the level of a lesion when particular
symptoms/signs are described (Box 6).