a) List four causes and four clinical features of pseudo-bulbar palsy. (60% marks)
b) With regard to injury of the cervical spine, what are the key clinical findings that would differentiate a complete C3/4 injury from a complete C6/7 injury? (40% marks)
a)
Causes: (any four) (2 Marks)
Clinical Features: (any four) (4 Marks)
b)
What are the key clinical findings that would differentiate a complete C3/4 injury from a complete C6/7 injury? (4 marks)
C3/4 |
C6/7 |
|
Motor function |
|
|
Reflexes |
o Absence of all reflexes in upper and lower limbs |
|
Sensation |
|
and medial aspect of forearm |
Respiratory |
o Phrenic nerve affected with weak diaphragm and reduced vital capacity |
o Phrenic nerve preserved, maybe mild or no reduction in VC depending on effect on other respiratory mechanics |
Examiners Comments:
Answers generally lacked enough detail and were poorly structured.
It was something of a surprise to the author, when he discovered that the words "spastic", "spasticity" and "jaw" were hyperlinked to amboss.com in the college answer. This easter egg is of course unintentional, because the content of the answer was a lazy cut-and-paste from this article, and Word preserves hyperlinks.
a) The best article to cover this briefly turned out to be the pseudobulbar palsy chapter from StatPearls (NIH)
Causes:
Clinical features:
b)
C3/C4:
C67/C7:
Saleem, Fatima, and Sunil Munakomi. "Pseudobulbar Palsy." (2020).