UL and LL Vivas Flashcards
Differentials for proximal myopathy
Endo: Hypothyroidism, Cushings, Osteomalacia
Inflammatory: Dermatomyositis, polymyositis
Drugs: Statins, Steroids
Becker muscular dystrophy
Define proximal myopathy
symmetrical weakness of proximal upper +/or lower limbs
Ix for proximal myopathy
TFT: hypothyroidism
Vit D/ bone profile: osteomalacia
CK: poly-/ dermatomyositis
Differentials causing weakness (not proximal myopathy)
MS
MND
Myasthenia gravis
Lambert Eaton myasthenic syndrome
Peripheral neuropathies with predominantly motor loss
GBS
Porphyria
Lead poisoning
Hereditary sensorimotor neuropathies: Charcot-Marie-Tooth
Chronic inflammatory demyelinating polyneuropathy
Diptheria
Peripheral neuropathies with predominantly sensory loss
Diabetes
Alcoholism
B12 deficiency
HIV
Syphilis
Uraemia
Leprosy
Amyloidosis
What causes subacute combined degeneration of the spinal cord? What does this result in?
B12 deficiency
Results in impairment of dorsal columns, lateral corticospinal tract + spinocerebellar tracts
Give 2 features of dorsal column involvement in subacute combined degeneration of the spinal cord
Symmetrical dstal tingling/ burning/ sensory loss, tends to affect legs > arms
Impaired proprioception + vibration sense
Give 5 features of lateral corticospinal tract involvement in subacute combined degeneration of the spinal cord
Muscle weakness, hyper-reflexia, spasticity
UMN signs (legs 1st)
Brisk knee reflexes
Absent ankle jerks
Extensor plantars
2 features of spinocerebellar tract involvement in subacute combined degeneration of the spinal cord
Sensory ataxia: gait abnormalities
+ve Romberg’s sign
Define peripheral neuropathy
Damage to peripheral nerves (not brain/ spinal cord)
Symmetrical glove + stocking loss to all modalities
Define mononeuropathy. Give 2 examples
Damage to a single peripheral nerve
Carpal tunnel syndrome (median nerve at wrist)
Cubital tunnel syndrome (ulnar nerve in elbow)
Ix for peripheral neuropathy
FBC
ESR, CRP
LFTs, GGT: alcoholism
Glucose: DM
Creatinine: end stage renal disease
B12 + folate: B12 deficiency
Nerve conduction studies + EMG
What is polio?
Viral disease, largely affects <5s
Faeco-oral transmission
How does polio manifest?
Majority asymptomatic/ mild Sx + disease usually goes unrecognized.
Sx: fever, fatigue, headache, vomiting, stiffness in neck + pain in limbs.
Sx usually last 2–10 days + recovery is complete in almost all cases.
Rarely: can cause paralysis, usually of legs, which is most often permanent. Paralysis can occur rapidly (within hours of infection)
Mx of polio
No cure
Vaccination to prevent
Mx: limiting + alleviating Sx. Heat + physical therapy to stimulate muscles + antispasmodic drugs to relax effected muscles. Can improve mobility but does not reverse permanent polio paralysis.
UMN defects
LMN defects
Rigidity ddx
PD
Multiple system atrophy
Lewy body dementia
NMS
Tremor ddx
Resting tremor: PD
Action tremor: idiopathic, anxiety, thyrotoxicosis
Postural: Essential (most common action tremor)
Intention tremor: cerebellar disease
Charcot marie tooth
Hereditary peripheral neuropathy
Predominant motor loss
No cure
Mx: PT + OT
Features of Charcot Marie tooth
Foot drop
High-arched feet (pes cavus)
Hammer toes
Hx of frequently sprained ankles
Distal muscle weakness
Distal muscle atrophy
Hyporeflexia
Stork leg deformity
Charcot joint
neuropathic joint
joint disrupted + damaged secondary to a loss of sensation
S/S: swollen, red, warm
Causes: DM, Syphilis
McDonald’s criteria
diagnostic criteria for MS
Foot drop ddx
Common peroneal nerve damage
Trauma: fibula fracture
Why examine eyes in PD?
Impaired vertical gaze in progressive supranuclear palsy (Parkinson’s plus syndrome)
Progressive supranuclear palsy
Postural instability + falls
Impairment of vertical gaze
Parkinsonism: bradykinesia
Multiple system atrophy
Parkinsonism
Autonomic disturbance: ED, postural hypotension, atonic bladder
