Neuromuscular Dysfunction Flashcards

1
Q

What is myasthenia gravis?

A

Antibody to post-synaptic AcH receptors - autoimmune, and type 2 hypersensitivity. So not able to bind AcH - weakness in often used muscles, eyes, jaw, vocal, facial, worse throughout the day.

Crisis - respiratory weakness!!

R/out thymoma and do a Tensilon test

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2
Q

What is inflammatory myositis?

A

Is a systemic autoimmune disease - T-cell mediated, cellular damage and atrophy of muscles, multiple variants, large and proximal muscles - high CK - polymyositis

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3
Q

To help augment prednisone - what can be used to help taper

A

Methotrexate, Imuran, and tacrolimus

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4
Q

What is MS?

A

Demyelination of neurons = leads to slowing of the nerve impulses, higher in areas away from the equator and might be related to the HLADR

Only effects the CNS, one or more clinically distinct CNS dysfunction with some resolution

Lesions spaced in time and space - and do and MRI - needed 2 different things

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5
Q

Weakness due to LMN vs UMN vs neuro-motor unit

A

LMN - the peripheral nerve, anterior ventral horn, etc. Looking for a localized disease, hyporeflexia, atrophy, flaccid paralysis, and fasciculations

UMN - spinal cord, cerebral cortex, hyperflexia , increased tone, consider B12 deficiency (rare)
- forehead spared

NEURO-motor unit - where the nerve connects to the muscle - will follow anatomical distribution, fatiguable weakness, functional loss of muscle fibres.

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6
Q

How does lead effect neuromuscular disease?

A

Damages the axon in the anterior horn cells

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7
Q

Gullain-Barre presentation

A

Ascending paralysis - can do a CSF analysis - watch for respiratory failure, post-viral, weak and tired

Don’t treat with steroids tx with IVIG or plasma exchange, fine to vaccinate but avoid vaccinations that may have triggered the initial event

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8
Q

Weakness questions?

A

Figure out function - ADLs, what is effected
Progressive or sudden, and onset vs recognition
Is there associated sensory loss, vision changes, mental changes
What worsens it - use, heat?

Along with regular full interview and exam

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9
Q

Muscle strength grading?

A

5 - muscle contracts against full resistance
4 - reduced but still against resistance
3- reduced but against gravity only
2 - movement against gravity
1- flicker of movement
0- nothing

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10
Q

Generalized vs Localized weakness

A

Generalized - look for cachexia, periodic paralysis
Localized - look for asymmetry, then for LMN disorders, if symmetric then look for other causes as well - not neuro disorders

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11
Q

Lambert- Eaton

A

Pre-synaptic AcH inhibition

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12
Q

What is dermatomyositis

A

Dermatomyositis - this is the one that you need to know - has a rash WITH symmetric muscle weakness, heliotrope rash, serious

Dermatomyositis - screen for cancer (everything) from 40s onwards
Polymyositis - screen for cancer (everything) from 60s onwards

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13
Q

Sx of B12 deficiency

A

Peripheral neuropathy, fatigue, parasthesias, glossitis, confusion, delirium, dementia

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14
Q

Wernicke’s encephalopathy

A

Ataxia, confusion, nystagmus (thiamine deficiency)

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15
Q

Korsakoff encephalopathy

A

Anterograde amnesia, problems with learning things, confabulation

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