clin med- ALS lecture

Question 1

EMG shows slowing of the velocity

Answer 1

Demyelinating neuropathy

Question 2

EMG shows denervation changes

Answer 2

Axonal neuropathy

Question 3

EMG shows slowing of a segment of ONE nerve

Answer 3

Mononeuropathy i.e. Carpal tunnel

Question 4

Peroneal nerve damage

Answer 4

Foot drop

Question 5

Radial nerve damage

Answer 5

Wrist drop

Question 6

Mono neuropathy multiplex

Answer 6

Thoracic neuropathy; both Radial and Ulnar problems

Question 7

Demyelinating conditions (2)

Answer 7

Acute acquired: Guillian Barre

Chronic inherited: Charcot Marie

Question 8

Guillan Barre

Answer 8

Distal (feet) –> Proximal

after URI

Question 9

Charcot Marie

Answer 9

“foot drop”
Distal muscle wasting
Freq ankle sprains

Question 10

“Neuropraxia”

Answer 10

mechanical compression

“Saturday night palsy”

Question 11

Vascular ischemia to nerves

Answer 11

Rheumatoid Arthritis

Multiple nerve distributions

Question 12

Axonal damage to nerves

Answer 12

Diabetic Neuropathy

“stocking glove”

Question 13

Neuronal damage

Answer 13

ALS

pure Motor

Question 14

Diabetic neuropathy is what type of damage?

Answer 14

Axonal

Question 15

ALS is what type of nerve damage?

Answer 15

Neuronal

Question 16

Guillian barre and

Charcot marie are what type of damage?

Answer 16

Demyelinating

Question 17

Will see what in Demyelinating pathologies

• guillian barre
• charcot marie

Answer 17

elevated protein in CSF

Question 18

B12 deficiency is unique, why?

Answer 18

Proximal MOTOR
Distal SENSORY

“Can’t feel my toes, and my shoulders are weak”

Question 19

If worried about inflammatory pathology, what study should we consider?

Answer 19

Nerve biopsy

Question 20

TCAs are good to treat

Answer 20

Diabetic Neuropathy

Question 21

Tx for Guillian Barre

Answer 21

Only supportive,

steroids don’t work

Question 22

Classic Lower motor neuron sx

Answer 22

Weak, atrophy, HYPOreflexia, tongue fasciculations

Question 23

Classic Upper motor neuron sx

Answer 23

hyperreflexia
“Babinski”
spastic
clonus

Question 24

EMG may show what with ALS?

Answer 24

Widespread involvement of proximal and distal muscles

Question 25

ALS starts where usually?

Answer 25

Hands and arms, spreads down to legs

Question 26

Hallmark of ALS

Answer 26

- Presence of UMN and LMN sx in the same limb | - Tongue fasciculations

Question 27

Peripheral causes of vertigo

Answer 27

HEARING LOSS | acute onset

Question 28

Central causes of vertigo

Answer 28

More concerning! Gradual, progressive VERTICAL NYSTAGMUS Stroke, MS, Wernicke encephalopathy

Question 29

Caloric Testing | "COWS"

Answer 29

Cold, opposite Warm, same referring to which side the Nystagmus goes to with an intact, normal brainstem

Question 30

BPPV

Answer 30

``` Most comm cause of Vertigo Calcium particles dislodged vertigo <1 min Trigger: change in head position "Dix Hallpike" maneuver positive: nystagmus fatigues ```

Question 31

Tx for BPPV

Answer 31

Reassurance | meds don't really help

Question 32

Vestibular Neuritis

Answer 32

Vestib Neuronitis: just the Vestibular | Labyrinthitis: BOTH Vestibular and Cochlear (hearing loss)

Question 33

Vestibular Neuritis

Answer 33

Young-middle aged Preceded by URI Severe ATTACK! lasting days-week

Question 34

Vestibular Neuritis

Answer 34

"Falling to one side" Two tests: + Head thrust Caloric testing: Vestibular paresis

Question 35

Tx for Vestibular Neuritis

Answer 35

Vestibular Suppressants (Anti-Chol, Anti-Histamines) Prednisone Anti-emetic

Question 36

1st line tx for Vestibular suppressing

Answer 36

Anti-cholinergics (Scopolamine) | Anti-Histamines (Dramanine)

Question 37

Meniere Dz

Answer 37

Endolymph Hydrops

Question 38

Meniere Dz

Answer 38

>40 YO BAD NEWS BEARS damage: - Paralysis of nerve fibers - Degen of cochlear hair cells

Question 39

Episodic vertigo Tinnitus (low, blowing tone) Fluctuating hearing loss

Answer 39

Triad of Meniere

Question 40

Meniere

Answer 40

Attack onset suddenly lasting 20 min-1 day eventually, hearing loss is irreversible

Question 41

Tx of Meniere

Answer 41

Rest, anti-emetic, vest suppressant

Question 42

Prophylaxis for Meniere

Answer 42

Low salt diet Limit caffeine, nicotine Diuretics

Question 43

Tx for Refractory sx d/t Meniere

Answer 43

Surgery - steroid inj - sac decompress - vestibular ablation

Question 44

Perilymphatic Fistula

Answer 44

LEAKAGE b/w perilymph and middle ear Trauma, Scuba diving, weight lifting

Question 45

Confirm dx of Perilymphatic Fistula with

Answer 45

``` Pneumatic Otoscopy (+) if: abnormal eye movements with change in pressure of TM ```

Question 46

Tx for Perilymphatic Fistula

Answer 46

Bedrest Hydration Symptomatic Surgery (if refractory)

Question 47

Red flags of Vertigo!

Answer 47

Neuro def Hearing loss Gait abn Nystagmus

Question 48

Neurally mediated syncope includes

Answer 48

Vasovagal and Situational

Question 49

Cardiac syncope

Answer 49

Obstructive vs Arrhythmia

Question 50

How to take Orthostatic BP

Answer 50

Lie supine for 3-10 min, then take Sit up, take Stand up, repeat within 3 min after standing

Question 51

Abn result of taking Orthostatic BP

Answer 51

Drop >20 in sys Drop >10 in diast Rise in HR of >20

Question 52

CONTRA to doing Carotid sinus massage

Answer 52

Stroke or TIA within past 3 months | Carotid bruits present

Question 53

Most common obstructive cause of Cardiac syncope

Answer 53

Aortic stenosis

Question 54

3 types of Neurally mediated/Reflex syncope

Answer 54

Vasovagal Carotid sinus Situational

Question 55

Carotid sinus syncope

Answer 55

Carotid sinus is hypersensitive Atherosclerotic Tight collar shirt

Question 56

Tx for Carotid sinus syncope

Answer 56

Cardiac pacemaker

Question 57

Situational syncope

Answer 57

Peeing | Coughing (post-tussive)

Question 58

Orthostatic (postural) hypotensions yncope

Answer 58

Autonomic failure Volume depletion Old Meds- diuretics, a-blockers, CCB, TCAs

Question 59

Associated conditions with Orthostatic syncope

Answer 59

Diabetic neuropathy | Parkinsons

Question 60

Tx of Orthostatic Hypotension syncope

Answer 60

Avoid volume depletion Med adjust Behavior mod- wear socks

Question 61

Subclavian Steal Synd

Answer 61

Stenosis of Subclavian artery blood flow shunted away from the brain LOOK FOR SX with Arm exertion (take BP on both sides, often L side affected > R)

Question 62

Tx for Subclavian Steal Synd

Answer 62

AVR Cardiac defibrillator Pacemaker