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neurology > RLS/guillan barre/myasthenia gravis/RSD > Flashcards

RLS/guillan barre/myasthenia gravis/RSD Flashcards

1
Q

RLS

  • gender
  • % of population
A

women usually

3-30%

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2
Q

primary and secondary RLS

A

usually primary.

can be secondary to peripheral neuropathy, uremia, pregnancy, iron deficiency

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3
Q

symptoms of RLS

A

frequent involuntary movements during sleep and rest’ sleep disturbance is common

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4
Q

RLS

  • drug of choice
  • can also add what
  • last choice
A

dopamine agonists(pramipexole, ropinole)
can add benzos
last choice is opiods

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5
Q

Guillain-Barre’s syndrome

  • etiology
  • dangerous?
A

Autoimmune disease that often occurs after an infection or surgical procedure
- assoc with recent campylobacter jejuni infection
May become life threatening if respiratory muscles become involved

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6
Q

Guillain-Barre’s syndrome sx

-progression duration?

A

**Ascending paralysis – weakness in hands and feet and now my whole legs feel weak (rubbery legs)
Muscle pain
Progression is rapid taking hours to days

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7
Q 
Rapidly ascending muscle weakness
Absence of deep tendon reflexes
Change in temperature and pain sensation
No fever
Lumbar puncture shows what
Electromyography shows what
A

guillain barre
Lumbar puncture – elevated protein > 55
Electromyography – slow nerve conduction velocities

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8
Q

guillain barre tx

A

Supportive care
Plasmapheresis to filter antibodies
IV immunoglobulins
In most cases improvement begins at about 4 weeks and they go on to a complete recovery(85%)

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9
Q

Guillain-Barre can be from what preceding infection

A

preceding infection of lungs or GI tract

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10
Q

what organism is the most common precipitant with gullain barre

A

campylobacter jejuni

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11
Q 
tachycardia
cardiac irregularities
labile blood pressure
disturbed sweating
impaired pulmonary function
spinter disturbances
paralytic ileus
A

gullain barre significant autonomic dysfunction

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12
Q

gullain barre recovery %

A

60% make a full recovery within a year; mortality rate in 1 year is 5%

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13
Q

RSD

  • definition
  • begins when
  • affects what systems
  • age
  • gender
A

Chronic disease
Usually begins with a surgery or trauma. It is an inappropriate response of the nervous system to injury
It is a systemic disease affecting both the central and peripheral nervous system
The average age of diagnosis is 42 though it may occur at any age
Females are more likely to be affected than males

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14
Q 
I had surgery/trauma and now I’m having severe pain all the time and even with just light touch.  “Even having a sheet on at night hurts”
Burning
Throbbing
Searing
Muscle spasms
Red or reddish violet skin color
Swelling
A

RSD

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15
Q

Pain out of proportion to injury
Changes in temperature in a limb either warm or cold
Reddish violet skin color
Normal EMG

A

RSD

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16
Q

tx for RSD

A 
Physical therapy
Occupational therapy
Medications(NSAIDS, Steroids, Gabapentin, Beta blockers,
Bisphosphonates)
Local anesthesia and nerve blocks
Amputation
17
Q

what med for RSD can prevent bone resorption

A

calcitonin

18
Q

Clinically you suspect a patient may have RSD based on the severity of their pain 2 months post-op. What simple physical exam finding will help your diagnosis?

A

Check the temperature of the skin

19
Q

Myasthenia Gravis

A

Myasthenia Gravis
Things you should know
An autoimmune disorder where acetylcholine receptors are blocked by antibodies
Acetylcholine normally causes an excitatory effect at the neuromuscular junctions

20
Q

Fatigability – Increasing weakness which improves with rest
Ptosis (Droopy eyelids)
Diplopia (Double vision)
Difficulty chewing and swallowing
Change in the voice
Difficulty breathing, leading to respiratory failure

A

Myasthenia gravis
Fatigability – Increasing weakness which improves with rest
Ptosis (Droopy eyelids)
Diplopia (Double vision)
Difficulty chewing and swallowing
Change in the voice
Difficulty breathing, leading to respiratory failure (myasthenic crisis)

21
Q

Often Normal exam
Easy Fatigability, weakness improving after rest and worsening again on repeat exertion
Normal reflexes and feeling of sensation

A

Myasthenia gravis

22
Q 
Myasthenia gravis tests
-\_\_\_ antibody test
- Ice test why
-Edrophonium is what
CXR / CT / MRI 
Nerve Conduction Studies
Electromyography 
Pulmonary function tests
\_\_\_ biopsy
A

Acetylcholine receptor antibody test
Ice test – applying ice causes an increase in strength
Edrophonium is a short acting anticholinesterase which may aid in the diagnosis
CXR / CT / MRI – to identify a tumor or thymoma
Nerve Conduction Studies
Electromyography – results will present muscle fibers to be unresponsive to stimuli
Pulmonary function tests
Muscle biopsy

23
Q

Treatment

Medication for myasthenia gravis

A
  • Acetylcholinesterase inhibitors
    Neostigmine and pyridostigmine – slows down the natural enzyme cholinesterase that degrades acetylcholine in the motor end plate.
  • Immunosuppressive drugs
    Prednisone, cyclosporine, mycophenolate, and azathioprine
  • Use in combination with an acetylcholinesterase inhibitor.
24
Q

myasthenia gravis

  • emergency tx
  • surgery
A

Plasmapheresis and IVIG – in an emergency to remove antibodies
Surgery
Thymectomy

25
Q

Ascending paralysis
Easy fatigability which improves with rest
Relapsing and remitting symptoms
Has an issue with acetylcholine receptors
Loss of tendon reflexes

A

Ascending paralysis GB
Easy fatigability which improves with rest MG
Relapsing and remitting symptoms MS
Has an issue with acetylcholine receptors MG
Loss of tendon reflexes GB

26
Q

what improves with rest

-onset

A
  • myasthenia gravis

- insidious

27
Q

myasthenia gravis

  • gender
  • age
  • 60% have what
A

young women
any age
ptosis and/or diplopia

28
Q

sensation and reflexes in myasthenia gravis

A

nml

29
Q

edrophonium

A

anticholinesterase to confirm diagnosis of myasthenia gravis

30
Q

what test is 80-90% positive in myasthenia gravis pts

A

serum assay for elevated levels of circulating acetycholine receptor antibodies

neurology (10 decks)

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