Hon Review

Question 1

What’s the most common anterior horn cell disease?

Answer 1

ALS

Question 2

What do you expect to see or hear in the patient or in their history if they have ALS?

Answer 2

weakness, gait disturbance, clumsiness

Question 3

what are you going to see on examination of a patient with ALS?

Answer 3

fasciculations (usually later in disease), objective muscle weakness, increased reflexes, babinski response, muscle atrophy

Question 4

do you expect to see numbness or tingling or loss of sensation with ALS? Pain?

Answer 4

no and no

Question 5

primary lateral sclerosis- is this upper or lower motor neuron?

Answer 5

upper

Question 6

spinal muscular atrophy, is this primarily upper or lower motor neuron?

Answer 6

lower

Question 7

what are the 2 basic areas of the spinal cord that are involved in motor neuron diseases-especially ALS?

Answer 7

anterior horn cell and the corticospinal tracts

Question 8

2 important diseases of the NMJ?

Answer 8

myasthenia gravis and LEMS

Question 9

is myasthenia gravis pre-synaptic or post-synaptic?

Answer 9

post synaptic

Question 10

is LEMS pre or post synaptic?

Answer 10

pre synaptic

Question 11

what is the typical presentation of a patient with myasthenia gravis?

Answer 11

ptosis and diplopia, fatigable weakness

Question 12

if you do a nerve conduction on patients with MG what are you expecting?

Answer 12

~10% decrement

Question 13

what is the blood test to look for MG?

Answer 13

AChR antibodies

Question 14

what is the age distribution for MG?

Answer 14

bimodal: younger women and older men

Question 15

What would the nerve conduction studies show in a patient with LEMS?

Answer 15

incremental response to exercise (big time increment)

Question 16

How would a patient with LEMS present?

Answer 16

proximal muscle weakness, complains of getting out of chair, difficulty climbing stairs; they also have muscle pain; worst complaint: dry mouth; diminished DTRs

Question 17

LEMS tends to be classified as what?

Answer 17

a paraneoplastic syndrome

Question 18

what is the antibody that we look for if we are looking for LEMS?

Answer 18

VGCC antibodies

Question 19

LEMS is often discovered when patients are taking exogenous what?

Answer 19

magnesium

Question 20

what does magnesium act as?

Answer 20

a false neurotransmitter

Question 21

what kinds of cancer do we typically see with LEMS?

Answer 21

small cell lung carcinoma or breast cancer

Question 22

what is the classic presentation of a diabetic with peripheral neuropathy?

Answer 22

predominantly sensory: burning, stinging, tingling feeling that usually starts in the toes or the soles/pads of the feet

Question 23

late, late, late in peripheral neuropathy of any kind you can get dysautonomia. What is this?

Answer 23

hypotension, urinary retention, or urinary urgency/frequency

Question 24

remember that generalized sensory motor peripheral neuropathy has the so-called what distribution?

Answer 24

stocking and glove distribution- usually starts in the feet

Question 25

what is the definition of peripheral neuropathy?

Answer 25

weakness, sensory loss, and impairment of reflexes caused by diffuse lesion of peripheral nerves

Question 26

when you have B12 deficiency it can cause what?

Answer 26

subacute combined degeneration

Question 27

what is subacute combined degeneration?

Answer 27

both upper and lower motor neuron issue

Question 28

what is typically affected in B12 deficiency?

Answer 28

the posterior columns

Question 29

what might you see on the exam of a patient with a B12 deficiency? aka how do we check the posterior columns?

Answer 29

an abnormal romberg test -poor balance

Question 30

what is the most common radiculopathy in the upper extremity and at what level?

Answer 30

C7 nerve root; C6-7 is the level

Question 31

what is the most common mononeuropathy in the UE?

Answer 31

carpal tunnel