neuro upper limb Flashcards
wrist drop?
Ix?
Mx?
differential
radial nerve injury -
Ix
fbc - wcc, crp for any inflammatory markers GBS
imaging
Xray to ensure
fall asleep by back of arm compressed - compression of nerve
or injury on basis of fracture of humeral shaft
radial nerve injury
how does it present on examination
wrist drop
extension of forearm impacted
extension of fingers and wrist also impacted
Mx radial nerve injury
brace
cockup splint
therapy
emg and nerve studies
extensory digitorum
MCP - 2-5
flexor digitroum profundus
digitorum superficialis
what muscles aid in abducting and adducting the fingers?
lumbricals and interossei
median nerve
flexor digitorum suoerficialis
radial 1/2 flexor digitorum profundus
1/2nd lumbricals
thenar eminence - moves thumb
Ulnar nerve
ulnar 1/2 flexor digitorum profundus
3/4 lumbricals
interosseous muscles
adductor pollicis
Radial
extensor digitorum
claw hand?
injury to ulnar nerve
all interosseus muscle loss - so no abduction/adduction
ape hand and sign of benedicton
high median nerve when attempt to form a fist
ative attempt to flex digits only pinky and ring finger are flexed
which nerve is associated with carpal tunnel?
median nerve
carpal tunnel syndrome
cause?
features
idiopathic
tingling and pain lateral arm / hand
waking up from sleep/worse in morning
tinels sign
tapping nerve in carpal tunnel to elicit pain
hold the wrist in flexion for 60s to elicit pain ?
phalens manouvre
mx of carpal tunnel?
splint
steroid injection
surgical decompression
Indomethacin is what?
eg contraindicated in?
NSAID
chronic heart failure as it can cause sodium and water retention and = worsen hf
candersartan?
angiotensin receptor blocker
carvedilol
beta blocker
hydralazine and isosorbide dinitrite
vasodilators used in HF for afro-caribbean patients
what is the responsibility of a1at?
protease protects against neutrophil elastase
it can mean lungs not protected leading to cirrhosis / emphysema
primary biliary cirrhosis is associated with what antibody?
anti mitochondrial antibodies
what antibody is autoimmune hepatitis associated with?
anti smooth muscle and anti nuclear antibody
what is pagets disease of breast ?
of breast - eczema hardening of skin
2 to breast cancer
acute causes of pancreatitis
gallstone
ethanol
trauma
steroids mumps autoimmune scorpion venom hyperlipidaemia / calcaemia ERCP drugs : aza, sodium valproate
management of SVT stepwise
and if pt is asthmatics?
1- vagal manouveres - valsalva
6mg IV adenosine
6mg
12mg
maybe amioadarone
calcium channel blocker verapamil
loop diuretics work where?
furosemide
thick ascending limb of loop of henle
where do spironolactone work ?
act on collecting ducts
Carbonic anhydrase inhibitors act on
proximal convoluted tubule to increase bicarbonate excretion,
thiazide diuretic which inhibits the Na+/Cl- transporter in the ______
dct
A 70 kg man has a daily sodium and potassium requirement of
140 mmol and 60-70 mmol, respectively.
High CSF protein in a patient with peripheral neuropathy and myopathy is suggestive of what?
GBS
hypercalcaemia
raised ESR and back pain is suggestive of?
multiple myeloma
how can multiple myeloma cause nephrotic syndrome?
IgG light chains . amyloid fibrils so multiple myeloma
. amyloidosis
target cells associated with?
liver disease
hyposplenism
codocyte
Spherocyte
hereditary or autoimmune haemolytic anaemia
