Monday, June 22, 2009

Plantar Response - Other than Babinski


Other than Babinski sign, what other signs do you know ?

In upper motor neuron lesion, the big toe will dorsiflex with the following :

Gordon reflex – On applying pressure to the muscle of the calf

Oppenheim sign – on applying heavy pressure with thumb and index finger to the shin, stroking downwords from below the knee down to the ankle

Bing reflex – when the dorsum of the toe is pricked with a pin

Schaefer reflex – pinching the Achilles tendon sufficiently to cause pain

Chadock reflex – on stroking the lateral side of the foot, beginning below the malleolus and extending anteriorly along the dorsum of the foot to the base of the big toe

Gonda reflex – grasping the small toes between the fingers, slowly and forcibly flexing the toe and then suddenly releasing the toe

I know an MRCP examiner who likes to ask this question. Try practicing it !  Physical examination is the most crucial step in Neurology.

Saturday, June 6, 2009

Infectious Disease for MRCP Part 2a

39 years old 39 years old Malay Man presented with fever for 1 week associated with cough, yellowish sputum, pleuritic chest pain. No haemoptysis, loss of weight or night sweats. Chronic smoker. Also has diarrhoea for 1 week. 

Examination reveals clubbing, bibasal crepitations, hepatosplenomegaly. Multiple L/N enlargement.

Hb 10

WBC 4.1

Plt 43

Na 112 K3.2 U 3.8 Cr 69


pH 7.43 pCO2 2.4 pO2 9.8 HCO3 12 BE -10 SpO2 95%

What is your choice of treatment ?

A. IV Ceftazidime 2 g stat and 8H

B. IV (sulfamethoxazole and trimethoprim)Bactrim 3 ampules stat & qid

C. Isoniazid, Rifampicin, Ethambutol and Pyrazinamide

D. IV Acyclovir 500 mg stat and 8H

E. IV Amphotericin B