neuro- weakness

Question 1

definitive diagnosis for MS

Answer 1

clinical, but at least one lesion in white matter on MRI + oligoclonal bands on MRI

Question 2

INO

Answer 2

lesion in MLF gives IPS medial rectus palsy on lateral gaze and horizontal nystagmus of abd eye (contralat side)

Question 3

treatment of MS?

Answer 3

IV high dose corticosteroids for ACUTE attacks

disease modifying= interferon, cyclophosphamide if really bad

Question 4

symptomatic therapy for MS:

• muscle spasticity
• neuropathic pain

Answer 4

baclofen, dantrolene

carbamezapine, gabapentin

Question 5

GBS affect with nerves?

Answer 5

motor, not usually sensory

Question 6

treatment of GBS?

Answer 6

IVIG!

do NOT give steroids

Question 7

myasethenia gravis:

• path
• treatment

Answer 7

• antibodies to postsynaptic Ach(N) receptors in NMJ
• Symptomatic tx= AchE inhibitors (pyridostigmine)

Definitive: thymectomy

• IVIG
• immunosuppressants

Question 8

do you need to intubate MG patients?

Answer 8

low threshold, intubate at FVC of 15ml/kg

Question 9

reflex pattern in MG vs lambert eaton?

Answer 9

in MG, reflexes are preseved

In LE, patients have hyporeflexia

Question 10

diagnosing MG

Answer 10

• emg
• CT scan for thymoma (10%)
• edrophonium (tensilon) test- AchE

Question 11

gowers maneuver

Answer 11

patient with DMD pulls himself from floor because of weak proximal lower etremeity muscles

Question 12

character of enlarged calves in DMD

Answer 12

hypertrophy at first, becomes pseudohypertrophy as fat replaces muscle

Question 13

polymyositis

Answer 13

proximal muscle weakness, elevated CK, ESR, etc

dx with muscle bx showing infravesicular infilatrates

Question 14

shortness of breath in suspected AS?

Answer 14

they can develop restrictive lung dz from decreased movement of their spine

Question 15

myalgias, rhabdo, myoglobinuria and “second wind phenomenon”

Answer 15

mcardle’s dz= glycogen stroage do 2/2 myphosphorylase deficiency

Question 16

giant cell tumor (aka osteoclastoma):

• appearance on xray
• pathology
• demographic

Answer 16

• soap bubble at distal femur or proximal tibia
• over active osteoclasts due to over expression of RANK-L
• boys age 20-40
• benign!

*consider local excision or tx with dinosumab

Question 17

chondrosarcoma

Answer 17

age 50-70
on hip or femur
“moth eaten” appearance on xray + periosteal reaction

Question 18

first line for sx pagets

Answer 18

IV zolendronate

*can cause flu like reaction, osteonecrosis of the jaw

Question 19

what should you check after finding a calcaneal fracture from a fall? (think about compression)

Answer 19

spinal xray

Question 20

anti-ro, anti-lo

Answer 20

sjodrens

SLE

Question 21

empiric against GNR in septic arhtritis?

Answer 21

IV ceftriaxone

Question 22

who gets osteosarcoma?

Answer 22

bimodal: 10-20, >65
- pain worse at night and with activity
- metaphysis of long bones
- sunburt + codman’s triangle

Question 23

whats at risk in mid/proximal humerus break?

distal humerus break?

Answer 23

radial nerve

radial artery

Question 24

differentiate bony lesions in metastatic prostate cancer vs MM

Answer 24

prostate= osteoblastic aka sclerotic lesions

MM= punched out

Question 25

morning stiffness as an indicator of OA or RA?

Answer 25

OA <30 mins

RA > 30 mins

Question 26

role of entanercept in AS?

Answer 26

it helps with spinal mobility but DOES NOT prevent disease progression

Question 27

calcification of hylaine cartilage on XRAY?

Answer 27

pseudogout