Medicine Notes Medical Finals & OSCEs Notes
This is my collection of typed notes and diagrams made for my Finals in Medicine, both the written exams and the Objective Structured Clinical Examinations, OSCEs, which we all dread. I found that making not only academic notes, but also notes of practical use for the OSCEs was very valuable.
This pack includes OSCE notes of clinical examination walkthroughs and clinical signs, examination interpretation, presentation and summaries for various OSCE subjects, as well as chest x-ray Interpretati...
The following is a more accessible plain text extract of the PDF sample above, taken from our Medical Finals & OSCEs Notes. Due to the challenges of extracting text from PDFs, it will have odd formatting:
Optic Nerve Palsies
Cranial Nerve III: Oculomotor nerve
Functions of oculomotor:
The efferent for the pupillary reflex (i.e. constricts) since it carries parasympathetic fibres
Innervates all extraocular muscles except lateral rectus and superior oblique:
Medial rectus adduction (move medially)
Superior rectus up
Inferior rectus down
Inferior obliqueup and out
Levator palpebraelift eyelid
A lesion therefore produces:
Levator palpebrae damageptosis
Parasympathetic efferent damagefixed dilated pupil
Unopposed lateral rectusabducted eye
Unopposed superior obliquedown
Muscle damageeye fixed down and out
Pathway:
Originates in midbrain
Travels near the posterior communicating artery near the Circle of Willis
Travels through the cavernous sinus (below the pituitary gland)
Travels through the superior orbital fissure
Anatomy:
Parasympathetic fibres carried on the outside
The muscle nerves are in the middle
There are small arteries that supply the middle nerve
Mechanisms of damage:
Iatrogenic CNIII palsycomplete palsy d/t severing during an operation (e.g. to fix a posterior communicating artery aneurysm)
Surgical CNIII palsy:
Aneurysm of posterior communicating artery or internal carotid artery in the cavernous sinuscompress CNIIIouter parasympathetic fibres firstpupil dilated first
Increased ICP compressing CNIIIouter parasympathetic fibres firstpupil dilated first
Uncal herniation down into the midbrain compresses CNIII nucleus almost before anything elseevolving CNIII palsy
Uncal herniation may be unilateral but give bilateral CNIII palsies as it pushes across
Unilateral pressure (e.g. haematoma)unilateral uncal herniation
Bilateral pressure (e.g. hydrocephalus)bilateral uncal herniation
Medical CNIII palsy:
Oculomotor middle nerve blood supply damaged d/t:
Small ischaemic episodes
Vasculitides
Oculomotor nerve damaged d/t:
Mononeuritis multiplex
MS
Diabetic polyneuropathy
Cavernous Sinus Syndrome
Patterns of damage:
A surgical CNIII palsy will theoretically compress the outer parasympathetic fibres first and cause a dilated pupil without motor involvement.
A medical CNIII palsy will theoretically damage the inner motor fibres first and cause a ptosis and ophthalmoplegia without a dilated pupil.
Practically, all features (lid ptosis, pupil dilation, eye down-and-out) occur simultaneously.
Cranial Nerve IV: Trochlear nerve
Functions of trochlear:
Innervation of superior oblique muscle
pulls the eye nasally
pulls the eye down when it is facing inwards
makes the eye look at the nose
the gaze for going downstairs or reading the newspaper
cannot turn nasally when the oculomotor muscles are paralysed
when the oculomotor muscles are paralysed it can only turn downwards
when the oculomotor muscles are paralysed it cannot counteract the lateral rectuseye moves down and out
A lesion therefore produces:
An inability to turn the eye nasally when it is turned downwards
Difficulties with going downstairs or reading the newspaper
Double vision on looking down, especially on looking down and nasally
Impaired ability to turn the eye downwards
The resting position of the affected eye is slightly higher than the unaffected eye
Affected eye ‘stuck’ higher up than the unaffected eye, especially on downgazevertical diplopia
A compensatory position of tilting the chin down and turning the head towards the affected eye so that the unaffected eye is now at the same level as the affected eyepatient appears to have torticollis
Pathway:
Originates in the dorsal midbrain
Travels up the dorsum of the midbrain
Decussates! under the inferior colliculi
Travels through cavernous sinus
Travels through the superior orbital fissure
Mechanisms of damage:
Isolated lesions are rare
Neuropathies: MS, diabetic neuropathy, etc.
Acute head trauma
Compression pathologies (e.g. haematoma, haemorrhage, oedema, hydrocephalus, space-occupying lesion) usually affect CNVI abducens first, thus producing a horizontal diplopia not a vertical diplopia!
Infection: meningitis, herpes zoster virus
Cavernous Sinus Syndrome
Patterns of damage:
The lesion is ipsilateral if after the decussation i.e. after passing above the midbrain
The lesion is contralateral if before the decussation i.e. in the nucleus
Lesions will almost always be in association with other neurological pathology
Cranial Nerve VI: Abducens nerve
Functions of abducens:
Innervation of lateral rectus muscleeye abduction i.e. looking outwards away from the nose
Turns to see the surrounding environment
A lesion therefore produces:
An inability to abduct the affected eye
An eye that ‘sticks’ when it tries to look outwards past the midpoint
A diplopia on turning the eye towards the affected eye
A compensatory mechanism of moving the head to look towards the environment on the affected eye’s side, to avoid diplopia and gain visual field
Pathway:
It has a very long coursefalse localising sign!
It emerges at the...
Buy the full version of these notes or essay plans and more in our Medical Finals & OSCEs Notes.
This is my collection of typed notes and diagrams made for my Finals in Medicine, both the written exams and the Objective Structured Clinical Examinations, OSCEs, which we all dread. I found that making not only academic notes, but also notes of practical use for the OSCEs was very valuable.
This pack includes OSCE notes of clinical examination walkthroughs and clinical signs, examination interpretation, presentation and summaries for various OSCE subjects, as well as chest x-ray Interpretati...
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