Localization

Question 1

1) Innervation of interosseous muscles of the hand?

Answer 1

Essentially all ulnar nerve

Question 2

2) Patient with positive straight leg raise and leg and back pain that gets better as patient leans forward. Diagnosis? Mechanism of pain?

Answer 2

Spinal stenosis caused by hypertrophy of ligamentum flavum

Question 3

5) What is anterior interosseous syndrome? Manifestation? How do you test for it in the office?

Answer 3

Entrapment of the anterior interosseous nerve (branch of median nerve). Supplies radial half of flexor digitorum profundus and flexor polilicis longus
Test by asking patient to make an O with thumb and index finger. No sensory loss

Question 4

6) Difference between Myasthenia Gravis and Eaton-Lambert syndrome? (Clinically and pathophysiology)

Answer 4

MG: Weakness occurs with repeated exertion. Ab to post-synaptic ACh receptors and neuromuscular junction
Eaton-Lambert: Weakness improves with repeated exertion. Ab to pre-synaptic calcium channels

Question 5

9) Lower motor neuron signs?

Answer 5

Loss of deep tendon reflexes, fasciculations, more focal area of atrophy than upper motor neuron signs.

Question 6

9) Hallmark signs in ALS?

Answer 6

Both upper and lower motor neuron signs, not easily localizable

Question 7

10) Patients with tetralogy of fallot at increased risk for what dangerous neurological issue?

Answer 7

Brain abscess!! Holy shit!

Question 8

13) Patient presents after an abdominal aortic aneurysm repair with absent lower extremity reflexes, absent pinprick sensation, but relatively intact vibratory & position sense. Diagnosis? Treatment?

Answer 8

Anterior spinal artery occlusion (spares the posterior columns)
Rx: high dose steroids!