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becky: neuro MSK > REVIEW 2: CNS PNS, SCI > Flashcards

REVIEW 2: CNS PNS, SCI Flashcards

1
Q

ALS MEDS

A

riluzole
edaravone
tofersen

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2
Q

sialorrhea meds

A

Amitriptyline/nortriptyline, atropine drops
levsin
scopalamine patch
ALS treatment of excess drooling

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2
Q

pseudobulbar palsy treatment

A

neudexta
ALS, MS

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3
Q

ALS meds for fatigue

A

BIPAP, Modafinil
stimulant!!!

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4
Q

ALS meds for pain/cramps

A

Mexiletine
Quinine
gabapentin (mm relaxant)
baclofen
opioids
PT/OT

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5
Q

how can you tell its a radiculopathy? and not LMN lesion?

A
  1. mm weakness
  2. radicular pain in dermatome
  3. atrophy
  4. decrease reflexes

(reflex, myotome, dermatome)

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6
Q

how can you tell its a plexopathy?

A

1 limb, painful, symptoms in more than 1 nerve/1 root
(from trauma, tumor, thoracic outlet)

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7
Q

autonomic neuropathy symptoms

A
  • Orthostatic hypotension
  • Arrhythmias
  • Severe constipation, urinary retention, erectile dysfunction
  • Abnormal sweating
  • Early satiety, lightheadedness with meals (gastroparesis)
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8
Q

demyelinating polyneuropathy

A

weak, not atrophy
length doesnt matter
patchy
asymmetric

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9
Q

axonal polyneuropathy

A

distal, LE, weak AND ATROPHY EARLY

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10
Q

AIDP symptoms

A
  1. tingling/parasthesias
  2. severe radicular back pain
  3. weakness! (mild/complete)
    -mostly legs, face, swallowing

SYMMETRIC, AREFLEXIC, varying sensory loss

CSF and EMG/NCS

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11
Q

AIDP/GBS treatment

A

NOT STEROIDS
plasma and IVIG
*watch for RR and ANS dysfunction

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12
Q

CIDP presents as

A

MOTOR
SYMMETRIC weakness prox and distal
decreased reflees
*sensory loss mainly in legs

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13
Q

what meds to treat neuropathic pain?

A

– Tricyclic antidepressants -> Cymbalta
– Gabapentin -> Lyrica – -Tramadol (messy opioid)
– Topical capsacin

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14
Q

DM neuropathy presents as

A

distal, symmetric, sensory
stocking, glove
then autonomic changes
NO WEAKNESS

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15
Q

DLRPN or diabetic amyotrophy

A

ACUTE
sharp/aching pain, hip/thigh, then leg/foot (prox to distal)
pain, then weak, then distal weak.
*weight loss!

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16
Q

charcot marie tooth is a

A

motor and sensory neuropathy
hereditary
LD sensory loss
distal weakness/atrophy
foot deformities
decreased reflexes
CHRONIC

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17
Q

which drugs are worse for myasthenia gravis

A

penicillamine
IFN alpha
botox
succinylcholine
magnesium salts

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18
Q

how do you treat MG

A

pyridostigmine (mestinon) Ach esterase inhib
-acute: IVIG/PLEX
-STEROIDS
-thymectomy

19
Q

signs of MG

A

weak, fatigue, atrophy
myalgia (mm PAIN), cramp, contractures, PSEUDOHYPERTROPHY, stiffness, myoglobinuria

20
Q

how do myopathies present?

A

GOWERS prox weakness
sensation intact
DTRs normal or slightly reduced

21
Q

are polymyositis/dermatomyositis acute or subacute/chronic?

A

subacute/chronic onset of PROX WEAKNESS
(pulm or cardiac involvement)
malignancy**
autoimmune or HIV

22
Q

inclusion body myositis

A

males over 50!
slow, prog weakness (prox leg, distal arm)
asymmetric, atrophy, dysphagia

23
Q

acute transverse myelitis symptoms

A

back pain
sensory level
sphincter disturbance
paraparesis
(SC!)

24
Q

optic neuritis symptoms

A

pain with eye mvmt
loss of color (RED)
poor acuity
afferent pupillary defect

25
Q

you have increased risk of MS if you are

A

female
young
multiple MRI lesions!
previous sensory symptoms

26
Q

risk factors (environmental) for MS

A

EBV, low sun, obesity, smoking

27
Q

4 types of MS

A
  1. relapsing-remitting
  2. secondary progressive
  3. primary progressive
  4. progressive-relapsing
28
Q

main symptoms of MS

A

fatigue, cognition, depression
eyes: nystagmus, diplopia, optic neuritis
speech: dysarthria
throat: dysphagia
MSK: UMN weak/spasticity, ataxia
SENSORY: pain, hypo/paraesthesias
BOWEL: incontinence, diarrhea or constipation
URINARY: incont/freq/retention

29
Q

what are the motor symptoms of MS

A

UMN spastic weakness (corticospinal and corticobulbar)
ataxia, tremor, scanning speech, incoordination (cerebellar)

30
Q

what is main sensory symptom of MS?

A

ALST! pain/temp
*Lhermitte’s

31
Q

what are brainstem symptoms of MS?

A

nystagmus, diplopia, face weakness, vertigo, dysphagia
TRIGEMINAL NEURALGIA
*can’t adduct ipsi eye (INO)

32
Q

intranuclear ophthalmoplegia is seen in

A

MS
*cant adduct ipsi eye, contra eye has nystagmus

33
Q

what do you use to diagnose MS

A

Uhthoff’s phenomenon
MRI*
Evoked potentials
CSF: high protein or WBC but for sure oligoclonal bands

34
Q

what do you use to treat acute RRMS?

A

steroids or plasma ex

35
Q

PML

A

severe demyelinating CNS disease-fatal
JC virus

36
Q

treatment of spasticity (meds)
MS

A

MM RELAXANT
Baclofen (oral, intrathecal) – Tizanidine (Zanaflex)
Dantrolene
Botox injections
PT-stretching!

37
Q

spastic bladder in MS: meds

A

– oxybutynin (Ditropan),
tolterodine (Detrol), botox
– Limit fluids at night
– Schedule voiding

38
Q

flaccid bladder in MS

A

terazosin (Hytrin),
doxazosin (Cardura)
– Chronic intermittent catheterization

39
Q

tremors meds (FOR MS)

A

Propranolol: B blocker
– Primidone: barbituate
– Gabapentin: pain
– wrist weights, assistive devices

40
Q

meds for neuropathic pain in MS

A

– gabapentin
(Neurontin)
– pregabalin (Lyrica)
– duloxetine (Cymbalta): pain
– amitriptyline (Elavil)

41
Q

med for ataxia in MS

A

PT :)

42
Q

Ampyra is what

A

med for walking speed for MS

43
Q

symptoms of NMO

A

area postrema syndrome (hiccups, nausea, vomiting)
-acute brainstem syndrome (vomit, hiccups, pruritus, hearing loss, CN3)
narcolepsy
cerebral lesions

44
Q

MOG is what

A

all ages (usually young adults/children)
optic neuritis
TM
ADEM like CNS lesions

becky: neuro MSK (14 decks)

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