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Clincial Medicine > Neuromuscular > Flashcards

Neuromuscular Flashcards

1
Q

The percentage of multiple sclerosis patients that are women:

A

70%

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2
Q

MC locations for MS lesions:

A

optic nerves, periventricular white matter, cerebral cortex, brain stem, cerebellum, spinal cord

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3
Q

Which cells are mainly responsible for the demyelination reaction in multiple sclerosis?

A

CD4+ Th1 cells

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4
Q

Three main cytokines responsible for the inflammatory reaction in MS

A

TNF-alpha, IFN-gamma, IL-2

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5
Q

In MS, a patient who experiences one flare up followed by complete remission and then another flare up followed by a progressive increase in disability has which MS classification?

A

Secondary progressive

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6
Q

In MS, a patient who experiences a steady increase in disability over time with occasional flare ups has which MS classification?

A

Progressive-relapsing

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7
Q

The natural history of MS tends to go from relapsing-remitting classification at the time of diagnosis to which classification 11-15 years down the road?

A

Secondary-progressive

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8
Q

An MS patient according to the Expanded Disability Status Scale is given a score of 6.0-6.5 based on what degree of disability? (What are they having trouble doing?)

A

Patient now needs walking assistance

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9
Q

About how much time does it take for an MS patient to reach an EDSS score of 6?

A

About 15 years on average

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10
Q

Top three MC presenting symptoms with MS:

A

Sensory symptoms in arms and legs, unilateral vision loss, and multiple symptoms at onset

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11
Q

Name an infection, and inflammatory syndrome, and one other condition that could mimic MS

A

Infections: Lyme, neurosyphilis, PML/HIV/HTLV-1

Inflammatory: SLE, Sjogren’s, CNS vasculitis, sarcoidosis, Behcet’s disease

Other: B12 or E deficiency, CADASIL, CNS lymphoma, cervical spondylosis, motor neuron disease, myasthenia gravis

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12
Q

The following antibiotics would be suitable for which general type of bacterial infection? Vancomycin, daptomycin, linezolid, clindamycin, B-lactams, fluoroquinolones, sulfa drugs, and glycylcycline.

A

Gram positive organisms.

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13
Q

The following antibiotics would be suitable for which general type of bacterial infection? B-lactams, fluoroquinolones, gentamicin, polymyxins, tigecycline

A

Gram negative organisms

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14
Q

The following antibiotics would be suitable for which general type of bacterial infection? Clindamycin, metronidazole, penicillins, fluoroquinolones, glycylcycline.

A

Anaerobic organisms.

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15
Q

Which three antibiotics are the only ones indicated for MRSA?

A

Vancomycin, daptomycin, and Synercid

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16
Q

Bacteremia with this multi-drug resistant gram negative rod usually occurs in patients with co-morbidities and who have been in hospital settings. It has a mortality of 39%.

A

Pseudomonas aeruginosa.

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17
Q

Studies have shown that nonmotor features such as sleep disturbances and constipation can predate which disease by years?

A

Parkinson disease

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18
Q

What are some autonomic effects seen with Parkinson disease?

A

Drenching sweats, dyspnea, orthostatic hypotension, sexual dysfunction, seborrhea, constipation

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19
Q

What are some cognitive or psychiatric effects seen with Parkinson disease?

A

Anxiety, depression, fatigue, slow thinking, hallucinations, sleep dysfunction (apnea, REM behavior disorder)

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20
Q

What are some sensory or nociceptive effects seen with Parkinson disease?

A

Tingling sensations, akasthisia, olfactory deficit, diffuse pain

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21
Q

In parkinson Disease, is it common or uncommon for symptoms to begin unilaterally?

A

Common

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22
Q

How long is the incubation period for Lyme disease?

A

3 - 32 days

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23
Q

In stage 1 of Lyme disesase, the infection is:

A

Localized, erythema migrans (EM)

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24
Q

In stage 2 of Lyme disease, the infection is:

A

Disseminated and occurs within several days of EM.

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25
Q

Some features of stage 2 Lyme disease are:

A

Secondary annular lesions, malaise, fatigue, fever, chills, headache, lymphadenopathy, hepatitis, neurologic signs, cardiac signs, migratory arthritis

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26
Q

In stage 3 of Lyme disease, teh infection is:

A

Persistent, continuing months after illness onset with 60% of patients developing intermittent joint pain and swelling

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27
Q

Medications acceptable for treating early Lyme infection (stage 1 or 2)

A

Doxycycline
Amoxicillin
Cefuroxime
2 - 4 weeks

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28
Q

Medications acceptable for treating Lyme arthritis:

A

Doxycycline or amoxicillin,

2 - 4 weeks of ceftriaxone

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29
Q

Medications for treating neurologic Lyme effects (except isolated Bell’s Palsy):

A

Ceftriaxone 2g IV daily for 2 - 4 wks

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30
Q

Medications for cardiac Lyme disease :

A

First degree HB- oral regimens

Second degree HB - ceftriaxone

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31
Q

Diagnose ehrlichiosis via what microscopic test? What will you see?

A

Peripheral blood smear. Morulae (intracytoplasmic inclusion bodies) can be seen with H&E.

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32
Q

What transmits babesia microti?

A

Ixodes scapularis

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33
Q

What is seen in a peripheral smear with babesiosis?

A

Maltese cross: tetrads of merozoites

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34
Q

Babesiosis is not covered by which antibiotic used to treat Lyme?

A

Doxycycline

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35
Q

Treatment options for babesiosis?

A

Clindamycin and quinine
Azithromycin and atovaquone
7 - 10 days

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36
Q

Rocky Mountain Spotted Fever is transmitted by the

A

American dog tick

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37
Q

Difference between relapsing fever and other tick-borne illnesses can include symptoms such as:

A

conjunctival suffusion, diffuse abdominal tenderness

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38
Q

What is the mechanism behind the relapsing fever?

A

Antigentic variants elicit a whole new but decreased response from the body’s immune system.

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39
Q

Two types of tularemia, go!

A

Ulceroglandular tularemia and typhoidal tularemia

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40
Q

Transmission of Tularemia via:

A

Rabbits, hares, ticks

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41
Q

Ulceroglandular tularemia presents with:

A

Enlarged and tender lymphadenopathy, then necrosis

42
Q

Typhoidal tularemia presents with:

A

Fever, chills, headache, myalgias, sore throat, anorexia, nausea, vomiting, diarrhea, abdominal pain, cough. Not associated with prominent lymphadenopathy.

43
Q

Colorado tick fever is diagnosed by the fact that it is:

A

A virus and not a bacterium

44
Q

Manifests as symmetric weakness of the lower extremeities and progresses to an ascending flaccid paralysis over several hours or days. A tick is discovered. This is?

A

Tick paralysis

45
Q

STARI presents with a similar skin rash to Lyme:

A

erythema migrans

46
Q

What consequence of osteoporosis increases mortality the most?

A

Hip fractures

47
Q

What are the genetic risk factors for osteoporotic fractures?

A 
Age
Being female
Being white or asian
Previous fragility fracture
Family history of hip fracture or osteoporosis
Small frame
48
Q

What are some modifiable risk factors for osteoporotic fractures?

A 
Menopause estrogen deficiency,
Low body weight,
Calcium and Vitamin D deficiency,
Inadequate physical activity,
Excessive alcohol intake,
Cigarette smoking,
Long-term glucocorticoids
49
Q

An online tool to calculate risk for fracture:

A

FRAX

50
Q

What is the most important factor in determining fracture risk?

A

Bone density

51
Q

What bone mineral density T-score for a healthy young woman would qualify as osteoporosis?

A

-2.5 or less

52
Q

What is one of the leading cause of falls that Dr. Adelizzi mentioned?

A

Polypharmacy

53
Q

Main indications for treatment of osteoporosis:

A

Postmenopausal women and men age 50+ with the following:

  • previous hip or vertebral fracture
  • T-score of -2.5 or lower at femoral neck or spine
  • T-score btw -1.0 and -2.5 plus a 10-year probability of hip fracture of 3% or greater (or just a 10 year probability of major fracture of 20% or greater based on FRAX)
54
Q

SERMs are best for helping to prevent what possible consequence of osteoporosis?

A

Spine fractures

55
Q

Drug used in osteoporosis that has been very effective:

A

Bisphosphonates

56
Q

Bisphosphonates work by:

A

Causing apoptosis of osteoclasts, preventing bone decomposition

57
Q

How often should treatments for osteoporosis be administered?

A

Many are weekly or monthly

58
Q

What drug for osteoporosis is given intravenously? How often?

A

Reclast (a bisphosphonate), once a year

59
Q

What is a contraindication for treatment with bisphosphonate?

A

Low calcium levels

60
Q

A chronic inflammation of striated muscle and skin that involves painless and symmetrical proximal muscle weakness and presents with elevated serum muscle enzyme levels.

A

Dermatomyositis

61
Q

Systemic symptoms seen with dermatomyositis:

A

fever, weight loss, arthralgias

62
Q

GI symptoms seen with dermatomyositis:

A

dysphagia

63
Q

Cardiac symptoms seen with myositis:

A

AV conduction defects, tachyarrhythmias, dilated cardiomyopathy, CHF

64
Q

Pulmonary symptoms seen with dermatomyositis:

A

Respiratory muscle weakness, interstitial lung disease

65
Q

Skin symptoms seen with dermatomyositis:

A

Heliotrope rash (upper eyelids), Gottron’s papules (over PIP and MCP joints), erythematous rash, Raynaud’s phenomenon

66
Q

For which malignancies is there increased risk wiith dermatomyositis?

A

Ovarian, breast, colon, non-Hodgkin’s, melanoma. Nasopharyngeal cancer in Asians.

67
Q

What distinguishes dermatomyositis from polymyositis?

A

DM has the typical rash presentation

68
Q

Individual criteria for Bohan and Peter diagnosis of PM and DM involve:

A

Muscle biopsy, presence of increased serum skeletal muscle enzymes, EMG pattern, symmetric proximal muscle weakness, DM rash

69
Q

Ezymes leaked from injured skeletal muscle that can be used in meeting criteria for PM diagnosis:

A

CK, Aldolase, AST/ALT, myoglobin

70
Q

Major inflammatory causes of myopathy:

A

PM, DM, inclusion body myositis, juvenile DM, vasculitis, overlap syndromes (lupus, scleroderma, RA, sjogren’s)

71
Q

Major endocrine causes of myopathy:

A

Hypothyroidism, Cushing’s syndrome

72
Q

Major electrolyte disorders causing myopathy:

A

Hypokalemia, hypophosphatemia, hypocalcemia, hypernatremia, hyponatremia

73
Q

Myopathies can be caused by metabolic disorders such as:

A

disorders of carbohydrate, lipid, or purine metabolism

74
Q

Myopathies can be caused by drugs and toxins such as:

A

Cocaine, heroin, alcohol, corticosteroids, colchicine, antimalarials, HMG-CoA reductase inhibitors, penicillamine, zidovudine

75
Q

Myopathies can be caused by infections such as:

A

Influenza, parainfluenza, Coxsackie, HIV, CMV, echovirus, adenovirus, EBV
Pyomyositis, lyme, fungal, parasitic (trichinosis, toxoplasmosis)

76
Q

Myopathies can be caused by rhabdomyolysis:

A

Crush trauma, seizures, alcohol abuse, exertion, vascular surgery, malignant hyperthermia

77
Q

An autoimmune disorder that presents with fever, mechanic’s hand, Raynaud’s, inflammatory arthritis, ILD, myositis, and Anti-Jo-1 antibodies is:

A

Antisynthetase syndrome

78
Q

EMG for DM and PM classic triad consists of:

A
  1. increased insertional activity, spontaneous fibrillations
  2. abnormal myopathic low amplitude, short-duration polyphasic motor potentials
  3. complex repetitive discharges
79
Q

Immunopathogenesis for DM:

A

B cells and CD4+ cells, MAC, infiltrates around BVs, micro-infarct muscle fiber damage

80
Q

JDM associated with increase in which antibodies?

A

Coxsackie-B

81
Q

JPM associated with which virus and agammaglobulinemia?

A

Echovirus

82
Q

ADM associated with which sex and is 63% positive for which antibody? How does it present?

A

Females, ANA. 2 year history of DM rash, but normal muscle strength, muscle enzymes, and EMG.

83
Q

Treatment for PM and DM involves:

A

Prednisone and possibly methylprednisone for 4 weeks with slow taper over the course of a year afterwards.

84
Q

Some other measure that can be taken in treatment of DM and PM:

A

Exercise, monitor FVC if very ill, aspiration risk assessment, caution wrt opportunistic infections, avoid sunlight, meds that are safe if pregnant

85
Q

What are poor prognostic factors for DM and PM?

A

Older age at diagnosis, ethnicity, bulbar involveent, delayed treatment, cardiac and pulmonary involvement

86
Q

A systemic autoimmune disease whose characteristics are xerophthalmia, xerostomia, pneumonitis, interstitial nephritis, neurological, and lymphoproliferative features.

A

Primary Sjogren’s

87
Q

A systemic autoimmune disease presenting with xerophthalmia, xerostomia accompanying another primary autoimmune disease

A

Secondary Sjogren’s

88
Q

Sjogren’s predominately affects:

A

Women, 30 - 50 years

89
Q

What is the genetic factor associated with risk for developing Sjogren’s?

A

HLA-DR, correlates closely with ANA and anit-SS-A

90
Q

A test for Sjogren’s that measures whether or not the eye has enough tears to keep moist is:

A

Schirmer’s test

91
Q

ANA testing is: (sensitive/specific)

A

Sensitive

92
Q

What is the gold standard for diagnosis of Sjogren’s?

A

Lip biopsy

93
Q

Medications used in treatment of Sjogren’s:

A

Hydroxychloroquine, corticosteroids, methotrexate, cyclophosphamide (for vasculitis)

94
Q

MC direction of hip dislocation?

A

Posteriorly

95
Q

Which artery is at risk of laceration with femoral neck hip fracture?

A

Medial femoral circumflex artery

96
Q

Letournel classifies pelvic injury in what manner?

A

Anatomical

97
Q

Tile classification of pelvic injury has three types:

A

Type A: stable pelvic ring
Type B: rotationally unstable, vertically stable
Type C: rotationally and vertically unstable

98
Q

Young-Burgess classification of pelvic injury is based on:

A

direction of force causing injury.

Lateral compression, AP compression, vertical shear, combined

99
Q

Which spinal cord injury would produce the following:
Injury to lumbosacral nerve roots, flaccid paralysis of LL, LMN lesion, sensory loss, areflexic bowel and bladder, absent bulbocavernous reflex, impotence.

A

Cauda Equina syndrome

100
Q

Which spinal cord injury would produce the following:
Injury of sacral cord and lumbar nerve roots, areflexic bladder and bowel, normal motor fxn in legs, areflexic legs, saddle sensory loss

A

Conus Medullaris syndrome

Clincial Medicine (10 decks)

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