EMQs in Clinical Medicine.pdf - Peshawar Medical College

110 Neurology
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• Paralysis of intrinsic muscles of the hand Klumpke’s palsy [32]
Loss of sensation in ulnar
distribution (C8, T1)
Horner’s syndrome sometimes present
• Loss of shoulder abduction and elbow flexion Erb’s palsy (C5, C6)
Arm held internally rotated
‘Waiter’s tip’ sign if arm adducted behind back
An EMQ may require you to establish the area of the brain that has been
affected/vessels involved in a stroke (Box 10).
Box 10 Stroke: symptoms and signs
Symptoms/signs
• Unilateral weakness/sensory deficit
Homonymous hemianopia
Higher cerebral dysfunction, e.g.
dysphasia, neglect
• Cranial nerve palsies/cerebellar
signs, e.g. vertigo, dysarthria,
ataxia, choking
Isolated homonymous hemianopia
• Patient can understand you but
replies in non-fluent speech
Site of stroke
Anterior circulation stroke
Posterior circulation stroke
Site: dominant frontal lobe
(Broca’s area)
Broca’s (expressive) dysphasia
• Patient has impaired comprehension Site: dominant temporoparietal lobe
Speech is fluent with jargon Wernicke’s (receptive) dysphasia [38]
• Patient has symptoms of:
Site: PICA thrombosis
– vertigo Lateral medullary syndrome [28]
– vomiting
– dysphagia
• Ipsilateral signs can include:
– ataxia
– Horner’s syndrome
– nerve V, VI palsy
• Contralateral signs can include
loss of pain, temperature and
sensation in face