4th Year NMJ

Question 1

what is the DN4 questionnaire used for?

Answer 1

neuropathic pain

Question 2

management of neuropathic pain

Answer 2

amitriptyline
duloxetine
gabapentin
pregabalin
tramadol, capsaicin cream, physiotherapy and psychology

Question 3

what should UMN facial nerve make you think?

Answer 3

stroke

Question 4

can LMN facial nerve be managed in the community

Answer 4

yes

Question 5

does each side of the forehead have UMN innervation?

Answer 5

yes

Question 6

when is there forehead sparing?

Answer 6

UMN lesion of CNVII

Question 7

what does Bells’ palsy affect?

Answer 7

LMN of CNVII

Question 8

management of Bell’s palsy

Answer 8

prednisolone and lubricating eye drops + tape at night

Question 9

what increases the risk of Bell’s palsy?

Answer 9

pregnancy

diabetes

Question 10

presentation of Bell’s palsy

Answer 10

abrupt onset
unilateral face weakness
pain around ear
reduced taste
hypersensitivity to sound
unable to wrinkle forehead
dry eyes
speech difficulty
drooling

Question 11

what causes bilateral face weakness?

Answer 11

Lyme disease

GBS

Question 12

management of Bell’s palsy

Answer 12

steroids

Question 13

what does bulbar palsy denote?

Answer 13

disease of the nuclei of cranial nerves IX-XII in the medulla

Question 14

management of myasthenia crisis

Answer 14

mechanical ventilation and plasmapheresis

Question 15

what order are muscles affected in myasthenia gravis?

Answer 15

extraocular
bulbar
face
neck
limb girdle
trunk

Question 16

what exacerbates myasthenia gravis symptoms?

Answer 16

pregnancy
low K+
infection
temperature changes
emotion
exercise

Question 17

diagnosis of myasthenia gravis

Answer 17

examination
EMG
CT to exclude thymoma

Question 18

clinical examination points to do if myasthenia gravis suspected

Answer 18

fixed upgaze for 20 seconds (ptosis)
fixed horizontal gaze for 20s (diplopia)
sustained counting (dysarthria)
shoulder abduction 
facial weakness

Question 19

classification of myasthenia gravis

Answer 19

ocular

generalised

Question 20

management of myasthenia gravis

Answer 20

relapses= prednisolone
long-term= pyridostigmine

Question 21

management of LEMS

Answer 21

amifampridine blocks K+ channels prolonging depolarisation

Question 22

what are 50% of cases of LEMS associated with?

Answer 22

malignancy

Question 23

what is McArdle’s disease?

Answer 23

metabolic myopathy - muscle pain and weakness after exercise due to glycogen storage disorder

Question 24

causes of peripheral neuropathy

Answer 24

ABCDE
alcohol
B12 deficiency
cancer and CKD
diabetes and drugs (isoniazid, amiodarone and cisplatin)
every vasculitis

Question 25

criteria for diagnosing GBS

Answer 25

Brighton criteria

Question 26

antibody in GBS

Answer 26

anti-ganglioside Ab

Question 27

what are the muscular dystrophies?

Answer 27

group of genetic diseases with progressive degeneration and weakness

Question 28

examples of muscular dystrophies

Answer 28

Duchenne’s
Becker’s
fascioscapulohumeral muscular dystrophy

Question 29

examples of inflammatory myopathies

Answer 29

inclusion body myositis
polymyositis
dermatomyositis

Question 30

clinical examination muscle testing techniques

Answer 30

stand up with arms crossed (pelvic girdle)

raise arms above head (shoulder girdle)