EMQs in Clinical Medicine.pdf - Peshawar Medical College

108 Neurology
Box 6 Symptoms/signs of nerve root innervation
Reflexes
Movements
C5–C6 supinator C5 – shoulder abduction
C5–C6 biceps
C5, C6 – elbow flexion
C7 triceps
C7 – elbow extension
L3–L4 knee
T1 – finger abduction
S1 ankle
L1, L2 – hip flexion
L3, L4 – knee extension
L4, L5 – dorsiflex ankle
L5–S1 – hip extension
S1 – knee flexion, plantar flexion and eversion ankle
An EMQ may describe a scenario and give a particular description of the patient’s
pupil(s) (Box 7). It is useful to be familiar with the main causes of such changes.
Box 7 The pupil in neurological problems
Description of pupil
Bilateral dilated pupils:
• plus no vestibulo-ocular reflexes
• plus euphoric
• plus anticholinergic signs, e.g. ↑ pulse,
↓ BP, urinary retention
Bilateral, pinpoint pupils:
• with respiratory depression
Dilated pupil:
• ptosis, eye deviated laterally and downwards
• irregular, reacts poorly to light and
accommodation
• usually young woman may have reduced
tendon reflexes
Constricted pupil:
• irregular pupils, reacts to accommodation but
not light (known as Argyll Robertson pupil)
• unilateral ptosis, loss of sweating on same
side of face (anhidrosis)
Problem
Brain-stem death
Amphetamines, cocaine
Tricyclic antidepressant
overdose
Opiate overdose
Nerve III lesion
Myotonic pupil
(Holmes–Adie pupil)
Neurosyphilis
Horner’s syndrome
Box 8 summarizes areas that are frequently tested in EMQs:
• The features of cranial nerve palsies that affect extraocular muscle movement.
• The likely site of lesion when a particular visual defect is described.