Neurology

Finger clubbing is due to overgrowth of soft tissue in the terminal phalanx, which increases the lateral and longitudinal curvature of the nail (see Fig. 3.8), raising the nail bed off the underlying bone. It is palpable as a boggy fluctuation of the nail when pressure is applied just proximal to the nail 

The most common respiratory causes of clubbing are chronic suppurative lung disease (such as bronchiectasis), lung cancer and pulmonary fibrosis. An additional rare complication of lung cancer is hypertrophic pulmonary osteoarthropathy, in which painful, tender swelling of
the wrists and ankles accompanies pronounced finger clubbing. X-rays of the distal forearm and lower legs show subperiosteal
new bone formation overlying the cortex of the long bones.
Other important signs of respiratory disease in the hands include:
•     cyanosis
•     tar staining of fingers from tobacco use (Fig. 5.8)
•     small-muscle wasting (see Fig. 13.22), which may indicate
T1 root damage by an apical lung tumour
•     rarely, yellow–brown discoloration of nails in yellow nail
syndrome

Explanation: SAH typically presents with a sudden, severe, ‘thunderclap’ headache (often occipital), which lasts for hours or even days, often accompanied by vomiting, raised blood pressure and neck stiffness or pain. It commonly occurs on physical exertion, straining and sexual excitement.

Sensory: 1, 2, 8
Motor: 3, 4, 6, 11, 12
Mixed: 5, 7, 9, 10

Reference: Davidson 23rd, Page: 1160
Explanation: most common site of SAH are Anterior communicating artery (30%)

Explanation: Headache, drowsiness, fever and neck stiffness are the usual presenting features. In severe bacterial meningitis the patient may be comatose, later developing focal neurological signs

Reference: Davidson 23rd, Page: 1133
Explanation: The diagnosis may be confirmed by lumbar puncture, which shows raised normal CSF constituents at increased pressure ( usually > 30 cmH2O CSF )

From lateral to medial, the four deep cerebellar nuclei are the dentate, emboliform, globose, and fastigii.

Explanation: Ependymal cells line the cerebral ventricles. Oligodendrocytes are responsible for the formation and maintenance of the myelin sheath. Astrocytes form the structural framework for neurons

Explanation: CT is first line for stroke diagnosis

Lateral horn of spinal cord refers to a lateral sideways extension of the lateral intermediate substance (lamina VII). It can be found only in the thoracic and upper lumbar spinal segments (T1 to L2) and therefore does not extend throughout the length of the spinal cord.

The Circle of Willis is an arterial polygon (heptagon) formed as the internal carotid and vertebral systems anastomose around the optic chiasm and infundibulum of the pituitary stalk in the suprasellar cistern

In SAH the pattern of headache is thunder cap in nature.

Reference: Davidson 23rd , Page : 1145, Box : 25.94

Reference: Davidson 23rd, Page: 760 , Box : 20.41

Explanation: Oculomotor nerve is ithe 3rd Cranial nerve

Davidson 23rd; P-1118

Explanation: Fever with Severe headache and photophobia, neck stiffnss usually suggestive of meningitis

Reference: Davidson 23rd, Page: 1141
Explanation: The most evident symptom is fatigable muscle weakness. Worsening of symptoms towards the end of the day or following exercise is characteristic.

Before doing lumbar puncture, fundoscopy should be done to see papilloedema to exclude raised intracranial pressure.

Davidson 23rd; P-1152

The most evident symptom is fatigable muscle weakness; movement is initially strong but rapidly weakens as muscle use continues.
Worsening of symptoms towards the end of the day or following exercise is characteristic. There are no sensory signs or signs of involvement of the CNS, although weakness of the oculomotor muscles may mimic a central eye movement disorder. The first symptoms are usually intermittent ptosis or diplopia but weakness of chewing, swallowing, speaking or limb movement also occurs. Resting of the eyelids (looking downwards)
may be followed by increased reflex elevation with up-gaze (so-called Cogan's lid twitch sign). Any limb muscle may be affected, most commonly those of the shoulder girdle; the patient is unable to undertake tasks above shoulder level, such as combing the hair, without frequent rests. Respiratory muscles may be involved and respiratory failure is an avoidable cause of death.

Explanation: Fragile X syndrome is the most common inherited cause of intellectual disability. Davidson explains that the condition is caused by an expansion of the CGG trinucleotide repeat in the FMR1 gene on the X chromosome, leading to abnormal brain development. Harrison adds that Fragile X syndrome typically presents with developmental delay, intellectual disability, and characteristic facial features, such as a long face and large ears.