Neuromuscular Flashcards

1
Q

hereditary Inclusion Body Myopathy (IBM).

A

Hereditary IBM is most commonly autosomal recessive, affects DISTAL lower extremity muscles first, and spares the quadriceps even in advanced disease (fingers difficulty pinching, buttoning)

Interestingly, not responsive to steroids.

IBM clinically presents with asymmetric, slowly progressive, painless weakness in proximal and distal muscles. It is associated with a polyneuropathy. It is not responsive to pharmacologic intervention, such as steroids and immunosuppressive agents. Treatment choices primarily involve appropriate rehabilitation interventions, which include provision of assistive device

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2
Q

Myotonic dystrophy

A

Myotonic Dystrophy (DM) typically follows an autosomal dominant inheritance pattern and is associated with multiple psychological disorders, including obsessive compulsive disorder, depression, and avoidant personality disorder. Testicular atrophy and cardiac abnormalities are common in DM.

Cataracts are common in myotonic muscular dystrophy (MMD). The heart is also frequently involved, particularly the electrical conduction system. MMD patients rarely get significant scoliosis. Excessive fatigue and daytime sleepiness, not insomnia, are common in both MMD1 and MMD2. Blood pressure is typically low in MMD, particularly MMD1.

Myotonic muscular dystrophy (MMD) is characterized clinically by progressive, predomi-nantly distal, muscle weakness and myotonia. Associated findings include frontal bald-ness, gonadal atrophy, cataracts, and cardiac dysrhythmias. Most persons affected with MMD will maintain the ability to ambulate throughout their lives, although gait patterns will be abnormal. However, fine motor function in the hands may be severely impaired because of difficulty with muscle relaxation (myotonia) and weakness.

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3
Q

Axontemesis vs Neurapraxia , how many days afteR?

A

Wallerian degeneration takes 9 days to occur typically, and neurapraxia should be distinguishable from axonotmesis after this time. While compound muscle action potential can still be elicited distal to the lesion in a neurapraxic injury, it will not be present if axonotmesis has occurred due to Wallerian degeneration.

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4
Q

CSF in AIDP and CIDP

A

elevated protein; also In both AIDP and CIDP, both conduction slowing and conduction block are typical on electrodiagnostic testing.

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5
Q

Miller Fisher Syndrome

A

areflexia, external ophthalmoparesis, and ataxia

Anti-GQ1b antibodies are present in about 95% of patients with MFS.

motor conduction velocities and amplitudes may be nearly normal, there is usually a marked reduction in sensory nerve conduction amplitudes (more so in the upper limbs as compared with the lower limbs).

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6
Q

Anti-GM1 antibodies are typically associated with

A

Multifocal Motor Neuropathy

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7
Q

Multifocal motor neuropathy vs ALS

A

Both ALS and MMN present with asymmetric, progressive weakness in the absence of sensory loss. On initial evaluation, it may be difficult to distinguish the two based on clinical presentation. Anti-GM1 antibodies are present in MMN, but not in ALS. The combination of both Upper and Lower Motor Neuron findings is seen in ALS, where MMN usually involves only Lower Motor Neuron findings on physical examination. Conduction block on nerve conduction studies is a hallmark of MMN due to its demyelinating pathology. In contrast, ALS involves motor neuron degeneration, and conduction block should not be present. Unlike ALS, MMN is responsive to IVIG.

FYI : if ALS runs in family then inheritance pattern is Autosomal DOMINANT

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8
Q

Which of the following is most useful in determining the prognosis of patients with Guillain-Barré syndrome (GBS)?

A

In GBS, some factors have been shown to have prognostic value, including CMAP amplitudes of < 20% of the lower limit of normal on nerve conduction studies, the magnitude of increase in serum IgG levels 2 weeks after IVIG treatment, nerve root enhancement on MRI, and elevated CSF levels of axonal neurofilament (NfH).

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9
Q

Spinal cord injury in HIV

A

Vacuolar myelopathy is the most common cause of spinal cord dysfunction in HIV. It occurs in 11-22% of AIDS cases. Presentation involves paraparesis, ataxia, posterior column sensory loss, spasticity, and neurogenic bowel and bladder.

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10
Q

Pompe’s disease

A

Pompe’s disease is an ACID MALTASE DEFICIENCY. The resultant accumulation of glycogen leads to irreversible damage of skeletal, respiratory, and cardiac muscle tissue resulting in permanent disability and death.

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11
Q

Most common type of MS

A

relapsing remitting

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12
Q

parkinsons plus syndromes

A

Multiple system atrophy (Shy-Drager syndrome)
Supranuclear palsy
Olivopontocerebellar atrophy
Striatonigral degeneration

All the symptoms involved suggest cerebellar impairment, including the ataxia and dysarthria. Multiple system atrophy has more autonomic involvement, including orthostatic hypotension, thermoregulatory dysfunction, and impotence. Choice (D) is harder to differentiate from primary Parkinson’s, but is noted to have dystonia, with general absence of tremor. Choice (A) is associated with Parkinson’s along with vertical gaze palsy.

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13
Q

poor prognostic factor MS

A

Ataxia and tremor have a poorer prognosis for MS patients. All other choices are good prognostic factors.

Optic neuritis is inflammation of the optic nerve. It may cause sudden, reduced vision in the affected eye and is considered a good prognostic factor when presenting at onset in MS patients.

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14
Q

Ergot deriv

Non ergot deriv

A

bromocriptine

Non-Ergot derivatives include ropinirole (Requip) and pramipexole (Mirapex).

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15
Q

A patient presents to the emergency department with loss of muscle strength in his right upper and lower extremities. He has loss of proprioception and position sense on his right side and has left-side tongue deviation. What does he most likely have?

A

medial medullary syndrome

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16
Q

age of inflammatory myopathies

A

Bimodal

The three primary types of inflammatory myopathy are polymyositis, dermatomyositis, and inclusion body myositis (IBM). All are thought to involve immune-mediated processes, possibly triggered by environmental factors in genetically susceptible individuals. The age of onset for idiopathic inflammatory myopathies is bimodal. Peaks occur between 10 and 15 years of age in children and between 45 and 60 years of age in adults.

17
Q

when does botulinum toxicity shows

A

1 day

18
Q

an autosomal dominant congenital myopathy. Onset is shortly after birth, and the infant is noted to be floppy and attains milestones slowly. Congenital hip dislocation is often noted, and as the child ages, he or she cannot run and jump like their peers. Weakness is more pronounced in the proximal muscles, and patients can show a Gower’s sign.

It is important to note that there is an association with malignant hyperthermia when receiving general anesthesia. This is because central core disease’s gene locus is at 19q13.1, which is the same gene locus as the malignant hyperthermia gene. On light microscopy, the muscle cells have cores that lack mitochondria.

A

Central core disease

19
Q

Myotonic muscular dystrophy vs FSH

A

myotonic usually involves temporal and masseter muscles, whereas FSH spares them….Myotonic MD also affects distal > proximal. FSH has normal IQ and normal heart…myotonic MD has ftonal balding and hatchet face………

FSH has scattered fiber necorsis on muscle bx
Myotonic muscular dystrophy has type I fiber atrophy (no dystrophin involvement)

20
Q

Myotonia congenita

A

myotonia with hand closure eye closure or other sustained movements, normal muscle power and function, dive bomber myotonic discharges, normal muscle biopsyyyyyyy its just myotonia, not myopathy a

21
Q

muscle energy

A

isometric contraction followed by stretching

22
Q

gate control theory

A

light touch and pressure neurons large Ia/A Beta sensory neurons synapse onto the same layer in the substantia gelatinosa as pain fibers do (C), so inhibit the pain signals.

23
Q

HMSN 4

A

autosomal recessive, involves eyes (retinitis pigmentosa), cardiac abnormalities, deafness, onset early adulthood AKA Refsum’s disease…demyelinating neuropathy that has high blood levels of phytanic acid

24
Q

HMSN 1

A

AKA Charcot marie tooth- Autosomal dominant , early onset, demyelinating, leading to sensory loss Lower > upper, bilateral foot drop, pes cavus, hammer toes, stork leg appearance; EMG normal NCS shows abnormalities

25
Q

HMSN 2

A

axonal neuropathy

26
Q

HMSN 3

A

Autosomal recessive disease found in infnancy that tends to have severe progression (Dejerine Sottas disease) presence in infancy or young childhood; sxs include weakness, sensory loss, hypotonia, delayed milestones, pes cavus, and hearing loss

27
Q

What type of collagen in muscle

bone/tendon/ligament

epiphyseal plate

A

III

I

X

28
Q

muscles affected in primary periodic paralysis

A

Cranial and respiratory muscles are spared in disorders of primary periodic paralysis.