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Quarter 4 finals > clin med- ALS lecture > Flashcards

clin med- ALS lecture Flashcards

1
Q

EMG shows slowing of the velocity

A

Demyelinating neuropathy

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2
Q

EMG shows denervation changes

A

Axonal neuropathy

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3
Q

EMG shows slowing of a segment of ONE nerve

A

Mononeuropathy i.e. Carpal tunnel

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4
Q

Peroneal nerve damage

A

Foot drop

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5
Q

Radial nerve damage

A

Wrist drop

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6
Q

Mono neuropathy multiplex

A

Thoracic neuropathy; both Radial and Ulnar problems

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7
Q

Demyelinating conditions (2)

A

Acute acquired: Guillian Barre

Chronic inherited: Charcot Marie

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8
Q

Guillan Barre

A

Distal (feet) –> Proximal

after URI

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9
Q

Charcot Marie

A

“foot drop”
Distal muscle wasting
Freq ankle sprains

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10
Q

“Neuropraxia”

A

mechanical compression

“Saturday night palsy”

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11
Q

Vascular ischemia to nerves

A

Rheumatoid Arthritis

Multiple nerve distributions

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12
Q

Axonal damage to nerves

A

Diabetic Neuropathy

“stocking glove”

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13
Q

Neuronal damage

A

ALS

pure Motor

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14
Q

Diabetic neuropathy is what type of damage?

A

Axonal

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15
Q

ALS is what type of nerve damage?

A

Neuronal

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16
Q

Guillian barre and

Charcot marie are what type of damage?

A

Demyelinating

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17
Q

Will see what in Demyelinating pathologies

  • guillian barre
  • charcot marie
A

elevated protein in CSF

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18
Q

B12 deficiency is unique, why?

A

Proximal MOTOR
Distal SENSORY

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

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19
Q

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

A

Nerve biopsy

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20
Q

TCAs are good to treat

A

Diabetic Neuropathy

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21
Q

Tx for Guillian Barre

A

Only supportive,

steroids don’t work

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22
Q

Classic Lower motor neuron sx

A

Weak, atrophy, HYPOreflexia, tongue fasciculations

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23
Q

Classic Upper motor neuron sx

A

hyperreflexia
“Babinski”
spastic
clonus

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24
Q

EMG may show what with ALS?

A

Widespread involvement of proximal and distal muscles

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25
Q

ALS starts where usually?

A

Hands and arms, spreads down to legs

26
Q

Hallmark of ALS

A
  • Presence of UMN and LMN sx in the same limb

- Tongue fasciculations

27
Q

Peripheral causes of vertigo

A

HEARING LOSS

acute onset

28
Q

Central causes of vertigo

A

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

29
Q

Caloric Testing

“COWS”

A

Cold, opposite
Warm, same

referring to which side the Nystagmus goes to with an intact, normal brainstem

30
Q

BPPV

A 
Most comm cause of Vertigo
Calcium particles dislodged
vertigo <1 min
Trigger: change in head position
"Dix Hallpike" maneuver positive: nystagmus fatigues
31
Q

Tx for BPPV

A

Reassurance

meds don’t really help

32
Q

Vestibular Neuritis

A

Vestib Neuronitis: just the Vestibular

Labyrinthitis: BOTH Vestibular and Cochlear (hearing loss)

33
Q

Vestibular Neuritis

A

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

34
Q

Vestibular Neuritis

A

“Falling to one side”

Two tests:
+ Head thrust
Caloric testing: Vestibular paresis

35
Q

Tx for Vestibular Neuritis

A

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

36
Q

1st line tx for Vestibular suppressing

A

Anti-cholinergics (Scopolamine)

Anti-Histamines (Dramanine)

37
Q

Meniere Dz

A

Endolymph Hydrops

38
Q

Meniere Dz

A

> 40 YO

BAD NEWS BEARS damage:

  • Paralysis of nerve fibers
  • Degen of cochlear hair cells
39
Q

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

A

Triad of Meniere

40
Q

Meniere

A

Attack onset suddenly
lasting 20 min-1 day

eventually, hearing loss is irreversible

41
Q

Tx of Meniere

A

Rest, anti-emetic, vest suppressant

42
Q

Prophylaxis for Meniere

A

Low salt diet
Limit caffeine, nicotine
Diuretics

43
Q

Tx for Refractory sx d/t Meniere

A

Surgery

  • steroid inj
  • sac decompress
  • vestibular ablation
44
Q

Perilymphatic Fistula

A

LEAKAGE b/w perilymph and middle ear

Trauma, Scuba diving, weight lifting

45
Q

Confirm dx of Perilymphatic Fistula with

A 
Pneumatic Otoscopy
(+) if: abnormal eye movements with change in pressure of TM
46
Q

Tx for Perilymphatic Fistula

A

Bedrest
Hydration
Symptomatic
Surgery (if refractory)

47
Q

Red flags of Vertigo!

A

Neuro def
Hearing loss
Gait abn
Nystagmus

48
Q

Neurally mediated syncope includes

A

Vasovagal and Situational

49
Q

Cardiac syncope

A

Obstructive vs Arrhythmia

50
Q

How to take Orthostatic BP

A

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

51
Q

Abn result of taking Orthostatic BP

A

Drop >20 in sys
Drop >10 in diast

Rise in HR of >20

52
Q

CONTRA to doing Carotid sinus massage

A

Stroke or TIA within past 3 months

Carotid bruits present

53
Q

Most common obstructive cause of Cardiac syncope

A

Aortic stenosis

54
Q

3 types of Neurally mediated/Reflex syncope

A

Vasovagal
Carotid sinus
Situational

55
Q

Carotid sinus syncope

A

Carotid sinus is hypersensitive
Atherosclerotic
Tight collar shirt

56
Q

Tx for Carotid sinus syncope

A

Cardiac pacemaker

57
Q

Situational syncope

A

Peeing

Coughing (post-tussive)

58
Q

Orthostatic (postural) hypotensions yncope

A

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

59
Q

Associated conditions with Orthostatic syncope

A

Diabetic neuropathy

Parkinsons

60
Q

Tx of Orthostatic Hypotension syncope

A

Avoid volume depletion
Med adjust
Behavior mod- wear socks

61
Q

Subclavian Steal Synd

A

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)

62
Q

Tx for Subclavian Steal Synd

A

AVR
Cardiac defibrillator
Pacemaker

Quarter 4 finals (11 decks)

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