4th Year NMJ Flashcards
what is the DN4 questionnaire used for?
neuropathic pain
management of neuropathic pain
amitriptyline duloxetine gabapentin pregabalin tramadol, capsaicin cream, physiotherapy and psychology
what should UMN facial nerve make you think?
stroke
can LMN facial nerve be managed in the community
yes
does each side of the forehead have UMN innervation?
yes
when is there forehead sparing?
UMN lesion of CNVII
what does Bells’ palsy affect?
LMN of CNVII
management of Bell’s palsy
prednisolone and lubricating eye drops + tape at night
what increases the risk of Bell’s palsy?
pregnancy
diabetes
presentation of Bell’s palsy
abrupt onset unilateral face weakness pain around ear reduced taste hypersensitivity to sound unable to wrinkle forehead dry eyes speech difficulty drooling
what causes bilateral face weakness?
Lyme disease
GBS
management of Bell’s palsy
steroids
what does bulbar palsy denote?
disease of the nuclei of cranial nerves IX-XII in the medulla
management of myasthenia crisis
mechanical ventilation and plasmapheresis
what order are muscles affected in myasthenia gravis?
extraocular bulbar face neck limb girdle trunk
what exacerbates myasthenia gravis symptoms?
pregnancy low K+ infection temperature changes emotion exercise
diagnosis of myasthenia gravis
examination
EMG
CT to exclude thymoma
clinical examination points to do if myasthenia gravis suspected
fixed upgaze for 20 seconds (ptosis) fixed horizontal gaze for 20s (diplopia) sustained counting (dysarthria) shoulder abduction facial weakness
classification of myasthenia gravis
ocular
generalised
management of myasthenia gravis
relapses= prednisolone long-term= pyridostigmine
management of LEMS
amifampridine blocks K+ channels prolonging depolarisation
what are 50% of cases of LEMS associated with?
malignancy
what is McArdle’s disease?
metabolic myopathy - muscle pain and weakness after exercise due to glycogen storage disorder
causes of peripheral neuropathy
ABCDE alcohol B12 deficiency cancer and CKD diabetes and drugs (isoniazid, amiodarone and cisplatin) every vasculitis
criteria for diagnosing GBS
Brighton criteria
antibody in GBS
anti-ganglioside Ab
what are the muscular dystrophies?
group of genetic diseases with progressive degeneration and weakness
examples of muscular dystrophies
Duchenne’s
Becker’s
fascioscapulohumeral muscular dystrophy
examples of inflammatory myopathies
inclusion body myositis
polymyositis
dermatomyositis
clinical examination muscle testing techniques
stand up with arms crossed (pelvic girdle)
raise arms above head (shoulder girdle)
