Multiple Sclerosis & Movement DO & Next step questions

Question 1

NMO tx

Answer 1

Long term immunosuppresive therapy like azathioprine or mycophenolate or rituximab.
Short term Iv mthylprednisolone.
Natalizumab can aggravate NMO.

Question 2

Cardinal signs of parkinson’s

Answer 2

Tremor, Bradykinesia, Rigidity, Postural Instability (late finding)

Don’t forget about the autonomic sx

Question 3

Non motor sx of parkinson’s

Answer 3

●Cognitive dysfunction and dementia
●Psychosis and hallucinations
●Mood disorders including depression, anxiety, and apathy/abulia
●Sleep disturbances
●Fatigue
●Autonomic dysfunction
●Olfactory dysfunction
●Gastrointestinal dysfunction

Question 4

postanoxic myoclonus treatment

Answer 4

VPA, klonopin, keppra

Question 5

Copper myelopathy

Answer 5

optic neuropathy and may resemble clinically and by MRI vit B12 deficiency. Other nutritional deficiencies Vit E and B12 deficiency or intoxication with pyridoxine.

Question 6

Drug given to Decrease ICP

Answer 6

dexamethasone (decreases cerebral edema)

Question 7

Trigeminal neuralgia tx

Answer 7

Carbamazepine

Worry about MS in younger patient

Question 8

EMG Findings of myopathy

Answer 8

1) no insertional fibrillations. 2)low amplitude small motor units with 3) early recruitment of motor units but normal interference pattern.

Question 9

EMG findings of neuropathy

Answer 9

1) fibrillation potentials on needle insertion. 2) large motor units with 3) reduced interference pattern when patient asked to contract muscle more strongly.

Question 10

MG tx

Answer 10

Acetylcholine esterase inhibitor - pyridostigmine