Bells Palsy/Carpal Tunnel Syndrome/Lambert-Eaton Myasthenic Syndrome/Muscular dystrophy

Question 1

What infection is Bells Palsy associated with?

Answer 1

Herpes simplex virus

Question 2

What are two risk factors for Bells palsy?

Answer 2

1. Diabetes

2. Pregnancy (3rd trimester)

Question 3

Subjective clinical features of Bells palsy?

Answer 3

• posterior auricular pain
• Hyperacusis: pain with loud noises
• Decreased taste on the anterior 2/3 of the tongue
• Eye dryness

Question 4

Tx for Bells palsy

Answer 4

1. Prednisone 60mg for 7 days (then taper)
2. Valacyclovir (if severe nerve palsy or herpes zoster)
3. Artificial tears (drops and ointment - since pt. can’t fully close eye)

Question 5

Clinical manifestation of carpal tunnel syndrome

Answer 5

• thenar muscle wasting
• Flick sign ** (wake up at night due to pain and weakness in hand- shake it out)
• Drop objects, can’t open jars
• Decreased thumb opposition against resistance

Question 6

What must be done before ortho surgery consult in carpal tunnel?

Answer 6

nerve conduction testing

Question 7

What are the 3 treatments for carpal tunnel?

Answer 7

1. NSAIDs (short term)
2. Physical therapy
3. Volar splint (esp. at night)

Question 8

To what do antibodies form in Lambert-Eaton Myasthenic syndrome?

Answer 8

calcium-gated channels at the neuromuscular junction

Question 9

What malignancy is Lambert-Eaton Myasthenic syndrome associated with?

Answer 9

Small cell lung cancer

Question 10

Will DTRs be affected by LEMS?

Answer 10

Yes, they will be decreased

Question 11

What are the clinical manifestations of LEMS?

Answer 11

1. Proximal limb weakness
   
   • Bilateral
   • Symmetrical
   • Slowly progressive
2. Alterations in gait (difficulty going up the stairs, getting out of chair)
3. DTRs recover with exercise (MG will not)
4. Dry mouth
5. Sluggish pupillary light response

Question 12

Tx for LEMS?

Answer 12

-remove lung tumor

-Acetylcholinesterase inhibitors: Pyridostigmine
-3,4- diaminopyridine
(improved calcium entry)
-Prednisone + Azathioprine
-Immunotherapy to remove antibodies (VGCC antibodies)

Question 13

How is muscular distrophy inherited?

Answer 13

X-linked (so very rare for females to develop)

Xp21

Question 14

Describe the difference in dystrophin levels between Duchenne muscular dystrophy and Becker muscular dystrophy

Answer 14

Duchenne: very low/absent dystrophin level

Becker: normal dystrophin level

Question 15

Describe the difference in cognition and growth between DMD and BMD

Answer 15

Duchenne: growth and cognitive impairment

Becker: normal growth and cognition

Question 16

What are some clinical manifestations of Duchenne muscular dystrophy?

Answer 16

1. Gower’s Sign - hand support to stand up
2. Lordosis
3. Gradual weakening of respiratory muscles
4. Primary dilated cardiomyopathy
5. INCREASED ALT, AST

Question 17

What is the most significant clinical manifestation of Becker muscular dystrophy?

Answer 17

Severe cardiac involvement

Question 18

Before obtaining a muscle biopsy for a patient you suspect may have muscular dystrophy, what lab might you do?

Answer 18

Serum creatinine levels.

DMD: VERY HIGH
BMD: slightly high

Question 19

Tx for muscular dystrophy

Answer 19

Prednisone daily or alternating days