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MSK 2 Post Midterm > Sachen > Flashcards

Sachen Flashcards

1
Q

What radiculopathy?

scapular pain,​ “tight band around elbow feeling”, 3rd digit numb, absent triceps jerk

A

C7 nerve root compression (C6-C7) - most common cervical radiculopathy

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2
Q

Hand sensory mnemonic

A 
C6 = "six shooter"
C7 = middle finger
C8 = ring/pinky finger
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3
Q

What radiculopathy?
dorsal thigh and lateral calf pain, lateral calf numb, weak hip E and loss of all foot movements EXCEPT can still plantarflex

A

L5 nerve root compression (L4-L5) - most common lumbar radiculopathy

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4
Q

What radiculopathy?

post thigh/post calf pain. Postlat calf and lat food numb. Weakness of hip E and foot plantarflexion.

A

S1 nerve root compression (L5-S1) - most common lumbar radiculopathy

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5
Q

Triceps reflex

A

C7

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6
Q

Biceps reflex

A

C5/C6

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7
Q

Finger flex reflex

A

C8

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8
Q

Patellar reflex

A

L4

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9
Q

Achilles reflex

A

S1

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10
Q

what is mononeuropathy multiplex?

A

multiple mononeuropathies - focal involvement of two or more nerves.

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11
Q

CNS (UMN) v. PNS (LMN)

  • Paresis
  • Tone (flaccid/spastic)
  • Bulk (atrophic or normal)
  • Fasciculations (Y/N)
  • DTRs (hyper/hypo)
  • Plantar reflex
A
  • Paresis: patterns v. distal
  • Tone: spastic v. flaccid
  • Bulk: normal v. atrophic
  • Fasciculations: no v. sometimes
  • DTRs: hypERactive v. hypoactive
  • Plantar reflex: Babinski v. absent
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12
Q

What type of neuropathy is this:

symmetric, LMN sx stocking/glove sensory loss ­ distal numb/weak (foot/hand) instead of calf

A

polyneuropathy

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13
Q

What type of fiber results in this sensory peripheral neuropathy:

  • Negative: ↓vibration, ↓proprioception, ataxia, ↓2pt. discrim.
  • Positive: Tingling, pins and needles
A

large myelinated fiber sensory

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14
Q

What type of fiber results in this sensory peripheral neuropathy:

  • Negative: ↓p/t impairment
  • Positive: burning/jabbing
A

small unmyelinated fiber sensory

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15
Q

Do nerve roots and peripheral nerves:

-split digits (Y/N)

A

● Nerve roots DO NOT split digits: ​Pure C8 root lesion​ → 4th + 5th finger sensory defects
● Peripheral nerves SPLIT digits: Median N lesion (Carpal tunnel​ involving lgmts of palmaris longis + pronator teres) → 1st ­- 3rd finger + lateral 1⁄2 of ring finger defects

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16
Q

Froment sign = what nerve and what mm?

A

adductor pollicus weakness; ulnar nerve palsy

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17
Q

Saturday night palsy -midshaft humerus fracture, axilla compression.

What nerve? What clinical signs?

A

WRIST DROP due to paresis of extensor muscles of wrist, finger, thumb.

Radial nerve compression in the spiral groove

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18
Q

Fibular head/neck compression from sitting cross legged - what nerve and what clinical features?

A

PERONEAL N ENTRAPMENT - Motor weakness of dorsiflexion, eversion, toe extension. Sensory loss dorsum of foot.

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19
Q

What nerve causes: lateral thigh pain, foot drop, absent ankle jerk

A

sciatic compression (i.e. injection in buttocks in wrong location)

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20
Q

What Hereditary Polyneuropathy and what type of dysfunction/etiology?
● weakness in walking/running is 1st symptom (1st­-2nd​ decade). ​“Doc, I can’t keep up during sports”
● INVERTED CHAMPAGNE BOTTLE LEGS (severe distal SYMMETRIC ATROPHY; LEGS​>arms), HAMMER TOES (chronic), pes cavus, skeletal deformities

A

Charcot­-Marie-­Tooth 1 Neuropathies (hereditary motor sensory neuropathies)

DEMYELINATING

21
Q

What Hereditary Polyneuropathy and what type of dysfunction/etiology?
● onset: adulthood; AD
● Distal symmetric atrophy (legs>arms)

A

Charcot­-Marie-­Tooth 1 Neuropathies (hereditary motor sensory neuropathies)

neuronal/axon LOSS

22
Q

Difference between HMSN1 and HMSN2 EMG

A
  • HMSN 1 EMG: slow motor N. conduction (demyelination)

- HMSN 2 EMG: EMG: almost nml motor N. conduction velocities (axonal loss)

23
Q

Low back/leg pain is first sign, then ascending symmetric motor paralysis (no­minimal sensory)​; self resolving (after 6w).

A

Acute Inflammatory Demyelinating Polyneuropathy (GBS)

24
Q

Etiology/triggering event in Acute Inflammatory Demyelinating Polyneuropathy

A

prior infection with Campylobacter JEJUNI, Mycoplasma pneumonia, EBV

25
Q

Indicative of what Dz?

  • **​↑protein, nml cell count, nml glucose **= albumin-­cytological dissociation
  • NCVS​: slow conduction, prolonged F waves
A

Acute Inflammatory Demyelinating Polyneuropathy

26
Q

Tx of GBS

A

plasma exchange or IVIg,

NEVER USE STEROIDS

27
Q

Sudden ANS changes to look for in Acute Inflammatory Demyelinating Polyneuropathy

A

arrhythmias (brady/tachy), HTN/hypoT, Resp failure

28
Q

How is the Variant of GBS, Miller-­Fisher Syndrome, different than normal GBS?

A
  • Children
  • Ophthalmoplegia, ataxia, arreflexia
  • dysphagia, dysarthria
  • GQ1b and GT1a ab’s
29
Q

Difference between Acute Inflammatory Demyelinating polyneuropathy and Chronic Inflammatory Demyelinating Polyneuropathy

A

CIDP lasts longer than AIDP and is REPLAPSING.

30
Q

Treatment for Chronic Inflammatory Demyelinating polyneuropathy

A

Tx: IVIg, steroids, plasma exchange, immunosuppression [Cyclophosphamide (Cytoxan); Azathioprine (Imuran)]

31
Q

M>F. Single n. to start → progressive distal weakness (upper extremity/HANDS>feet)

GM-1ab

● No sensory sx, no UMN findings

A

Multifocal Motor Neuropathy

32
Q

Serum GM-1 ab titer in Multifocal Motor Neuropathy: what makes a worse prognosis.

Tx of Multifocal Motor Neuropathy

A

Increased titer means worse prognosis.

Tx: IVIg

33
Q

Eyes “down and out” with complete ptosis and DILATED-UNREACTIVE v. REACTIVE pupil. What cranial nerve is compressed and what etiologies?

A

Dilated/unreactive: PCA aneurysm - compressive CN3 neuropathy

Reactive: DM neuropathy - inflammatory neuropathy (#1 MCC)

34
Q
  • Initial complaints: gait disorder, limb weakness, speech or swallowing.
  • Unexplained wt loss, DIFFICULTY SWALLOWING/tongue atrophy and mm cramps/fasciculations
A

Amyotrophic Lateral Sclerosis

35
Q

○ Degeneration of any or combo of the following leads to ___?
Pyramidal Betz cells, ANTERIOR HORN CELLS and LATERAL/VENTRAL CORTICOSPINAL TRACTS and Corticobulbar Tract, brainstem lower CN motor nuclei

A

ALS

*Hallmark: UMN and LMN denervation in one limb

36
Q

EMG in ALS shows:

A

widespread innervation and denervation

37
Q

What are the important “rule of thumb” Diagnostic Negatives in ALS?

A

■ No sensory or extraocular loss
■ Nml mentation
■ No bowel or bladder issues
■ Decubiti (pressure ulcer) rare

38
Q

Death in ALS due to…

A

rspiratory failure.

39
Q

While tx for ALS is supportive, what glutamate inhibitor prolongs life by a few months?

A

Riluzol

40
Q

What is this:
○ 20% of MND, brainstem lower CN motor nuclei

○ Dysarthria, dysphagia, chewing issues, respiratory difficulty, dysphonia (nasal tone)

○ Progresses to ALS

A

Progressive Bulbar Palsy

41
Q

What is this?
○ 10% of MND, M more than F, mean onset 64, AH cells, LMN deficits, rarely progresses to ALS (better prognosis than ALS)

A

Progressive Spinal Muscular Atrophy

42
Q

What is this?
○ 2­4% of MND, 50­55yo, UMN, CST deficit

○ Weakness, spasticity, hyperreflexia,+ Babinski

○ Slow progression but can evolve to ALS

○ Better prognosis than ALS

A

Primary Lateral Sclerosis

43
Q

What childhood motor neuron disease is this?

­​Hypotonia, areflexia, poor suck, breathing issues, death in 6-­12mo

A

Infantile SMA (Werdnig-Hoffmann Dz)

Kugelberg-Welander Dz is milder than WH

44
Q

Two presynaptic disorders of NMJ.

A

LEMS (VGCaC), Botulism (blocks presynaptic ACh release)

45
Q

One postsynaptic disorder of NMJ.

A

Myasthenia Gravis (postsynaptic nAChRs)

46
Q

What NMJ disorder has ocular weakness with ptosis, diplopia/double vision and NORMAL reflexes?

A

Myasthenia gravis

tx with ACHEi (mestinon), predinosne (aminoglycosides have sig drug interaction with MG)

47
Q

What NMJ disorder has association with Small Cell Lung Cancer. Strength improves with exercise. ARREFLEXIA.

A

LEMS

tx Guanidine hydrochloride

48
Q

Don’t give LEMS pts with heartburn what?

A

Mg2+. because inc Mg = dec Ca influx = LEMS exacerbation

49
Q

What NMJ disorder has Descending: dry mouth, blurred vision, resp/limb paralysis

A

Botulism

MSK 2 Post Midterm (11 decks)

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