Muscle and nerve Flashcards
MG associated with which EMG finding?
Decreased amplitude with repetitive motor nerve stimulation
36 yo pt with pain behind L ear progressing to numbness of l side of face, tearing of L eye, discomfort with low frequency sounds, left facial weakness on exam. Dx?
Idiopathic Bell’s palsy
Tx of trigeminal neuralgia?
Gabapentin (most effective carbamazepine)
37 yo truck driver with numbness of L hand, increased severity in past 2 years. Reduced pinprick sensation on L little/ring fingers, atrophy of hypothenar muscle
Ulnar nerve lesion
22 yo with pain in the R hand that radiates into the forearm and bicep muscle. Parasthesia in the palm of the hand, thumb, index, middle ring finger. Sensory systems in the ring finger split the ringer finger longitudinally. Dx?
Median nerve entrapment at the wrist
Atrophy of the intrinsic muscles of the R arm and forearm. Reflexes are generally brisk, plantar reflexes are extensor. Electrophysiology shows widespread fasciculations, fibrillation, and sharp waves, normal sensation, muscle spasticity. Positive sharp waves on EMG
AMS
Stiffness of legs while walking and spasms of LE while sleeping. Stiff-legged gait, adducts legs while walking. Increased LE tone/ spastic catch, hyperactive knee jerks, ankle jerk clonus. Increased Romberg sway.
Cervical spondylosis
Persistet numbness in the L hand, decreased sensation in 4th/5th digits (palmar/dorsal), weak finger abduction/adduction especially 5th digit.
Ulnar entrapment at the elbow
Right neck pain, tends to rotate neck to the L- touching the chin prevents deviation- prominent R SCM spasm. Tx
Botulinum toxin
Progressive weakness over several days-absent reflexes worse in lower extremities- slow conduction velocity, conduction block. A 54 yo pt had a viral URT 2 weeks ago and now presents with a 3 day episode of progressive, symmetric weakness in the legs, and tingling in the toes and fingers. On exam, achilles and patellar deep tendon reflexes are diminished. Nerve conduction studies demonstrate decreased conduction velocity and decreased amplitude of action potentials. Dx?
Acute inflammatory demyelinating polyneuropathy
14 yo pt after a demanding physical test becomes extremely weak and unable to stand. PE is + for depressed DTRs. Labs= K= 2.8. Hx of similar episodes. EKG: minimally prolonged PR, QRD, QT interval. Father and grandfather had similar episodes. Dx?
Periodic paralysis
26 yo pt with sudden onset back pain. Spasms in R paraspinal muscles in the lumbar region. Straight leg raising on the R is limited by sharp pain at 45 degrees. Ankle jerk on L is diminished. No muscle weakness, no sensory deficit. Next step?
Order MRI of lumbar spine.
MG can be dx in 80-90% of cases by ID of serum antibodies against what?
Ach R
MOA of botulinum toxin at neuromuscular junction
Inhibition of Ach from presynaptic terminals
During 2nd trimester, a pregnant 38 yo F has numbness n both hands, particularly the thumb, forefinger, middle finger bilaterally. Dorsal part of hand unaffected. Arms ache in the morning from shoulders to hands. Dx?
Median neuropathy at the wrist
An IV meth user develops severe back pain, followed after several days by bilateral lower extremity weakness/ sensory loss, bladder incontinence, low grade fever, tenderness to percussion over the 2nd and 3rd lumbar vertebrae, paraparesis and loss of sensation to light touch and pinprick in both legs, buttocks, and sacral region
Spinal epidural abscess.
What chemo agent is MC associated with distal sensory polyneuropathy?
Cisplatin
Pt with episodes of severe, intermittent, lancinating pain involving the posterior tongue and pharynx, w/ radiation to deep ear structures. Triggered by swallowing of cold liquids and talking. Workup normal. Dx?
Glossopharyngeal neuralgia
Contralateral loss of pain and T sensation with motor paralysis and proprioception loss on the other. Dx?
Brown-sequard syndrome (hemisection)
Subacute combined degeneration of the posterior column of the spinal cord is associated with a deficiency of
Vitamin B12 deficiency
Which of the following is the most effective tx of blephorospasm?
Botulinum toxin
Pt complains of progressive weakness of several days Exam + for generalized weakness and absent reflexes. Nerve conduction studies show slowing of velocities. Dx?
Acute polyneuropathy
66 yo pt with progressive weakness, worse when squatting and standing from a chair. Complains of decreased strength in the R hand. On exam, prominent weakness of the quadriceps bilaterally and on opposition of the thumb in the R hand. Atrophy of forearm muscles with normal DTRs. No other weakness noticed. Sensory exam normal. ROS -. Normal CK and no anti-transfer RNA synthase ab (Jo1). Dx?
Myotonic dystrophy
30 yo develops pain behind L ear. The following day pt complains of numbness on the L side of the face, tearing from L eye and discomfort with low frequency sounds. Exam shows L facial weakness, but no sensory deficit. Dx?
Idiopathic Bell’s palsy
One month after MVA, a 21 yo complains of persistent pain in the L shoulder and arm with sharp pain radiating into the L thumb. Exam shows weakness of the biceps. The biceps reflex on the L is absent. Dx?
C-6 radiculopathy
Pt complains of unpleasant aching and drawing sensation in calves and thighs associated with a crawling feeling, forcing him to move legs, bringing transient relief. Sxs worsened by fatigue. Exam normal. Best med tx?
Pergolide (for restless leg syndrome)
Severe spasms and rigidity of limbs intermittently and later more persistent/ continuous
Antiglutamic and antidecarboxylase abs (Anti-GAD abs)
Weakness in limbs 2 weeks after a viral GE. Weakness in UE/LE, absent DTRs. Spinal fluid shows no cells and elevated protein. EMG shows slow conduction velocity prolonged distal motor latency, and conduction block
Acute inflammatory polyneuropathy
2 years after MVA with rear end collision, pt develops BUE weakness with some muscle wasting, loss of DTRs in arms, loss of sensation to pain and T in neck/arms/ shoulders intact sensation to touch. Most likely cause?
Syryngomyelia
Which of the following is the most effective treatment of spasmodic torticollis?
Botulinum toxin
50 yo M with acute neck pain radiating down Left arm, gait problems, urinary incontinence. What test should be ordered?
MRI of cervical spine to r/o cord compression
Disequilibrium with feet together and eyes closed is a disorder of what?
Posterior spinal cords
What diagnostic test would best detect the MC cardiac complication associated with myotonic dystrophy?
EKG
24 yo presents with delirium; severe HA after starting high protein/low carb diet, hx of slow growth as child; method to establish dx?
Ornithine transcarbamylase sequencing
____ it the most sensitive, non-invasive clinical tool for monitoring inflammation in M.S.
MRI
____ is characterized by eyelid ptosis worsening throughout the day, double vision, no pain, and otherwise unremarkable eye exam.
MG
Which sensory domain most significantly affected in early syringomyelia?
Pain perception
What activity enhances hypoactive DTRs in the leg?
Clench a fist
72 yo with profound sensory ataxia with loss of vibratory sensation and cognitive issues with irritability and somnolence. Nutritional deficiency?
Cobalamin
Source of pain that is primarily central (non-nociceptive)?
Fibromyalgia
Exam findings suggest L5 radiculopathy in pt with back pain and foot drop?
Weakness of ankle inversion
35 yo gets blurry vision, drooping eyelids, and difficulty swallowing. Weakness of bulbar muscles. What caused this?
Botulinum
Which of the following is most likely to reduce pain in postherpetic neuralgia
Capsaicin
53 yo with insidious onset of blurred vision, diplopia x 1 day, ptosis, CN 6 palsy, unreactive pupils, hoarse voice, dysarthria, weak neck muscles. EMG- Increase amplitude with repetitive nerve stimulation? Dx?
Botulism
Dx for a 45 yo woman with pins and needles feeling in hand at night and upon awakening
Carpal tunnel syndrome
Pt with chronic muscle wasting in both UE, loss of light touch, pain, and T sensation in shoulders, upper arms, and back, and painful paresthesias over the same distribution, dx?
Syringomyelia
23 yo Caucasian F in office for f/u after an ER visit 2 days earlier for sudden diplopia R leg weakness and shaking, difficulty with speech which resolved after a few hours. Pt had fever 103.1F and was tx for UTI. Exam: minimal R leg weakness, brisk DTR and musculocutaneous reflexes throughout, and equivocal plantar reflex on L. R toe is downing. Hx of several episodes of transient neurological deficits that resolved spontaneously after a few days. Her spinal fluid is most likely to show what?
Protein: 50mg _oligoclonal bands, nucleated cells: 10
