1. Fundamental of Medicine
    2. 1. Clinical decision-making
    2. Clinical therapeutics and good prescribing
    3. Clinical genetics
    4. Population health and epidemiology
    5. Principles of infectious disease
  2. Emergency and Critical care medicine
    3. 6. Poisoning
    7. Envenomation
    8. Environmental medicine
    9. Acute medicine and critical illness
  3. Clinical Medicine
    4. 10. Infectious disease
    11. HIV infection and AIDS
    12. Sexually transmitted infections
    13. Clinical biochemistry and metabolic medicine
    14. Nephrology and urology
    15. Respiratory medicine
    16. Endocrinology
    17. Nutritional factors in disease
    18. Diabetes mellitus
    19. Gastroenterology
    20. Hepatology
    21. Haematology and transfusion medicine
    22. Rheumatology and bone disease
    23. Neurology
    24. Stroke medicine
    25. Medical ophthalmology
    26. Medical psychiatry
    27. Dermatology
    28. Maternal medicine
    29. Adolescent and transition medicine
    30. Ageing and disease
    31. Oncology
    32. Pain and palliative care
    33. Laboratory reference ranges
Clinical Medicine
23. Neurology
CLINICAL EXAMINATION OF THE NERVOUS SYSTEM
Clinical examination of the nervous system
▢ Stance and gait:
❖ Posture:
❖ Romberg's test:
❖ Arm swing:
❖ Pattern of gait:
❖ Tandem (heel-toe) gait:
▢ Back:
❖ Scoliosis:
❖ Operative scars:
❖ Evidence of spina bifids occulta:
❖ Winging of scapula:
▢ Neck and Skull:
❖ Skull size and shape:
❖ Neck stiffness and Kernig's test:
❖ Carotid bruit:
▢ Cranial nerves:
❖ 3rd nerve palsy:
One eye points 'down and out'
Image 1
Fig. 3rd nerve palsy
Credit. All about vision
❖ 7th nerve palsy:
  1. Drooping mouth
  2. Flattening of nasolabial skin fold
Image 1
Fig. 7th nerve palsy
Credit. Wikipedia
❖ 12th nerve palsy: Wasting of side of tongue
▢ Optic fundi:
❖ Papilloedema:
❖ Optic atrophy:
❖ Cupping of disc (glaucoma):
❖ Hypertensive changes:
❖ Signs of diabetes:
▢ Sensory:
❖ Pin-prick, temperature:
❖ Joint position, vibration:
❖ Two-point discrimination:
▢ Motor:
❖ Wasting:
❖ Fasciculation:
❖ Abnormal posture:
❖ Abnormal movements:
❖ Tone (including clonus):
❖ Strength:
❖ Coordination:
❖ Tendon reflexes:
❖ Abdominal reflexes:
❖ Plantar reflexes:
▢ Higher cerebral function:
❖ Orientation:
❖ Memory:
❖ Speech and Language:
❖ Localised cortical functions:
FUNCTIONAL ANATOMY AND PHYSIOLOGY
▢ Functional anatomy of the nervous system:
▢ Localising lesions in the central nervous system:
INVESTIGATION OF NEUROLOGICAL DISEASE
▢ Neuroimaging:
▢ Neurophysiological testing:
PRESENTING PROBLEMS IN NEUROLOGICAL DISEASE
▢ Headache and facial pain:
▢ Dizziness, blackouts and 'funny turns':
▢ Status epilepticus:
▢ Coma:
▢ Delirium:
▢ Amnesia:
▢ Weakness:
▢ Sensory disturbance:
▢ Abnormal movements:
▢ Abnormal perception:
▢ Altered balance and vertigo:
▢ Abnormal gait:
▢ Abnormal speech and language:
▢ Disturbance of smell:
▢ Visual disturbance and ocular abnormalities:
▢ Hearing disturbance:
▢ Bulbar symptoms – dysphagia and dysarthria:
▢ Bladder, bowel and sexual disturbance:
▢ Personality change:
▢ Sleep disturbance:
▢ Psychiatric disorders:
FUNCTIONAL SYMPTOMS
HEADACHE SYNDROMES
EPILEPSY
VESTIBULAR DISORDERS
DISORDERS OF SLEEP
▢ Excessive daytime sleepiness (hypersomnolence):
▢ Parasomnias:
NEURO-INFLAMMATORY DISEASES
PARANEOPLASTIC NEUROLOGICAL DISORDERS
NEURODEGENERATIVE DISEASES
▢ Movement disorders:
▢ Ataxias:
▢ Tremor disorders:
▢ Dystonia:
▢ Hemifacial spasm:
▢ Motor neuron disease:
▢ Spinal muscular atrophy:
INFECTIONS OF THE NERVOUS SYSTEM
▢ Meningitis:
▢ Parenchymal viral infections:
▢ Parenchymal bacterial infections:
▢ Diseases caused by bacterial toxins:
▢ Prion diseases:
INTRACRANIAL MASS LESIONS AND RAISED INTRACRANIAL PRESSURE
▢ Raised intracranial pressure:
▢ Brain tumours:
▢ Paraneoplastic neurological disease:
▢ Hydrocephalus:
▢ Idiopathic intracranial hypertension:
▢ Head injury:
DISORDERS OF CEREBELLAR FUNCTION
DISORDERS OF THE SPINE AND SPINAL CORD
▢ Cervical spondylosis:
▢ Lumbar spondylosis:
▢ Spinal cord compression:
▢ Intrinsic diseases of the spinal cord:
DISEASES OF PERIPHERAL NERVES
▢ Entrapment neuropathy:
▢ Multifocal neuropathy:
▢ Polyneuropathy:
▢ Guillain–Barré syndrome:
▢ Chronic polyneuropathy:
▢ Brachial plexopathy:
▢ Lumbosacral plexopathy:
▢ Spinal root lesions:
DISEASES OF THE NEUROMUSCULAR JUNCTION
▢ Common things between Myasthenia Gravis and Lambert-Eaton myasthenic gravis:
  1. Both presents with painless weakness of muscle
  2. Both are autoimmune disease
  3. Both of them have autoantibodies present in circulation
  4. Both affect Neuromuscular junction
▢ Differences between Myasthenia Gravis and Lambert-Eaton myasthenic gravis:
Myasthenia gravis
Lambert-Eaton myasthenic gravis
Pathogenesis
  1. Antibodies directed against Acetylcholine receptor in the post-junctional membrane of the neuromuscular junction -> Complement-mediated inflammatory responses -> Reduces the number of acetylcholine receptors -> Damages the end-plate
  2. Other autoantibodies against Muscle-specific kinase (MuSK) which is involved in the regulation adn maintenance of acetylchoine receptors.
  1. Antibodies directed against Voltage-gated calcium channel
C/F
  1. Muscle weakness
    1. Intermittent ptosis or Diplopia -> Oculomotor muscle weakness
    2. Weakness of Chewing
    3. Swallowing
    4. Speaking
    5. Limb muscles -> Limb movement difficulty
    6. Respiratory muscles -> Respiration failure
    7. Ineffective cough -> Aspiration
    8. Progressive
  2. Cogan's lid twitch sign
  3. Thymoma (15%) or Thymic follicular hyperplasia
  4. Organ-specific autoimmune diseases
  5. Exacerbating drugs
    1. Penicillamine
    2. Aminoglycosides
    3. Quinolones
Investiagion
  1. Tensilon test (IV injection of the short-acting anticholinesterase Edrophonium bromide)
Management
▢ Myasthenia gravis:
▢ Lambert–Eaton myasthenic syndrome:
DISEASES OF MUSCLE
▢ Muscular dystrophies:
▢ Inherited metabolic myopathies:
▢ Acquired myopathis: