neurology

Question 1

proximal myopathy:

- main symptoms? 2

Answer 1

• symmetric proximal muscle weakness (difficulty rising from chairs, climbing stairs and brush hairs)
• malaise, fatigue

nb sensory complaints/parasthesia or mainly distal weakness point to neuropathy instead

Question 2

causes of proximal myopathy:

• iatrogenic? 2
• toxic? 3
• hormonal? 5
• nutritional? 1
• inflammatory? 5
• hereditary? 4
• infectious? 3

Answer 2

iatrogenic

• statins (esp simvastatin)
• steroids (esp dexamethasone)

toxic

• alcohol
• cocaine
• heroin

hormonal

• hypothyroidism
• hyperthyroidism
• hyperparathyroidism
• cushings
• diabetes

nutritional
- vit D deficiency (osteomalacia)

inflammatory

• polymyositis
• dermatomyositis
• polymyalgia rheumatica
• inclusion body myositis
• sarcoidosis

hereditary

• Beckers
• limb girdle fascioscapulohumeral dystrophy
• proximal myotonic dystrophy
• glycogen and lipid storage disorders

infectious

• HIV
• influenza
• hep B/C

Question 3

investigations for proximal myopathy

• bloods? 7
• others? 5

Answer 3

• U+Es (looking for high creatinine)
• vit D
• TFTs
• ESR/CRP
• cortisol
• PTH
• ANA + other autoimmune screens
• blood glucose (for diabetes)
• urine dipstick (check for rhabdomyolysis)
• MRI muscle
• needle EMG
• muscle biopsy

management depends on underlying cause found

Question 4

MS:

• risk factors?
• mean age of onset?
• definition?
• common presentations? 4
• what worsens symptoms?
• progression of disease?

Answer 4

• caucasian
• low vit D/sunlight levels (esp in childhood)
• female (3:1)
• 30
• 2 clinical cases of demyelination in 2 separate areas of CNS at 2 different times (where no other cause is found)
• optic neuritis (pain on eye movement + rapid loss of central vision)
• numbness/tingling in limbs
• leg weakness
• brainstem or cerebellar lesions (e.g. ataxia, diplopia)

heat (e.g. hot bath, exercise, swimming is best)

early on relapses (often stress induced) may be followed by remission + full recovery
- with time remissions are incomplete -> aggregation of disability

Question 5

MS

• non-pharm management? 3
• pharm treatment? 4

Answer 5

• reduce stress in life
• give vit D + encourage sun exposure
• disability assistance + physiology
• steroids (shortens acute attacks, use sparingly)
• interferons
• monoclonal antibodies (e.g. alemtuzumab)
• azothioprine

nb these drugs are most effective for relapsing/remitting MS, no good drugs for primary progressive MS