Muscle and nerve

Question 1

MG associated with which EMG finding?

Answer 1

Decreased amplitude with repetitive motor nerve stimulation

Question 2

36 yo pt with pain behind L ear progressing to numbness of l side of face, tearing of L eye, discomfort with low frequency sounds, left facial weakness on exam. Dx?

Answer 2

Idiopathic Bell’s palsy

Question 3

Tx of trigeminal neuralgia?

Answer 3

Gabapentin (most effective carbamazepine)

Question 4

37 yo truck driver with numbness of L hand, increased severity in past 2 years. Reduced pinprick sensation on L little/ring fingers, atrophy of hypothenar muscle

Answer 4

Ulnar nerve lesion

Question 5

22 yo with pain in the R hand that radiates into the forearm and bicep muscle. Parasthesia in the palm of the hand, thumb, index, middle ring finger. Sensory systems in the ring finger split the ringer finger longitudinally. Dx?

Answer 5

Median nerve entrapment at the wrist

Question 6

Atrophy of the intrinsic muscles of the R arm and forearm. Reflexes are generally brisk, plantar reflexes are extensor. Electrophysiology shows widespread fasciculations, fibrillation, and sharp waves, normal sensation, muscle spasticity. Positive sharp waves on EMG

Answer 6

AMS

Question 7

Stiffness of legs while walking and spasms of LE while sleeping. Stiff-legged gait, adducts legs while walking. Increased LE tone/ spastic catch, hyperactive knee jerks, ankle jerk clonus. Increased Romberg sway.

Answer 7

Cervical spondylosis

Question 8

Persistet numbness in the L hand, decreased sensation in 4th/5th digits (palmar/dorsal), weak finger abduction/adduction especially 5th digit.

Answer 8

Ulnar entrapment at the elbow

Question 9

Right neck pain, tends to rotate neck to the L- touching the chin prevents deviation- prominent R SCM spasm. Tx

Answer 9

Botulinum toxin

Question 10

Progressive weakness over several days-absent reflexes worse in lower extremities- slow conduction velocity, conduction block. A 54 yo pt had a viral URT 2 weeks ago and now presents with a 3 day episode of progressive, symmetric weakness in the legs, and tingling in the toes and fingers. On exam, achilles and patellar deep tendon reflexes are diminished. Nerve conduction studies demonstrate decreased conduction velocity and decreased amplitude of action potentials. Dx?

Answer 10

Acute inflammatory demyelinating polyneuropathy

Question 11

14 yo pt after a demanding physical test becomes extremely weak and unable to stand. PE is + for depressed DTRs. Labs= K= 2.8. Hx of similar episodes. EKG: minimally prolonged PR, QRD, QT interval. Father and grandfather had similar episodes. Dx?

Answer 11

Periodic paralysis

Question 12

26 yo pt with sudden onset back pain. Spasms in R paraspinal muscles in the lumbar region. Straight leg raising on the R is limited by sharp pain at 45 degrees. Ankle jerk on L is diminished. No muscle weakness, no sensory deficit. Next step?

Answer 12

Order MRI of lumbar spine.

Question 13

MG can be dx in 80-90% of cases by ID of serum antibodies against what?

Answer 13

Ach R

Question 14

MOA of botulinum toxin at neuromuscular junction

Answer 14

Inhibition of Ach from presynaptic terminals

Question 15

During 2nd trimester, a pregnant 38 yo F has numbness n both hands, particularly the thumb, forefinger, middle finger bilaterally. Dorsal part of hand unaffected. Arms ache in the morning from shoulders to hands. Dx?

Answer 15

Median neuropathy at the wrist

Question 16

An IV meth user develops severe back pain, followed after several days by bilateral lower extremity weakness/ sensory loss, bladder incontinence, low grade fever, tenderness to percussion over the 2nd and 3rd lumbar vertebrae, paraparesis and loss of sensation to light touch and pinprick in both legs, buttocks, and sacral region

Answer 16

Spinal epidural abscess.

Question 17

What chemo agent is MC associated with distal sensory polyneuropathy?

Answer 17

Cisplatin

Question 18

Pt with episodes of severe, intermittent, lancinating pain involving the posterior tongue and pharynx, w/ radiation to deep ear structures. Triggered by swallowing of cold liquids and talking. Workup normal. Dx?

Answer 18

Glossopharyngeal neuralgia

Question 19

Contralateral loss of pain and T sensation with motor paralysis and proprioception loss on the other. Dx?

Answer 19

Brown-sequard syndrome (hemisection)

Question 20

Subacute combined degeneration of the posterior column of the spinal cord is associated with a deficiency of

Answer 20

Vitamin B12 deficiency

Question 21

Which of the following is the most effective tx of blephorospasm?

Answer 21

Botulinum toxin

Question 22

Pt complains of progressive weakness of several days Exam + for generalized weakness and absent reflexes. Nerve conduction studies show slowing of velocities. Dx?

Answer 22

Acute polyneuropathy

Question 23

66 yo pt with progressive weakness, worse when squatting and standing from a chair. Complains of decreased strength in the R hand. On exam, prominent weakness of the quadriceps bilaterally and on opposition of the thumb in the R hand. Atrophy of forearm muscles with normal DTRs. No other weakness noticed. Sensory exam normal. ROS -. Normal CK and no anti-transfer RNA synthase ab (Jo1). Dx?

Answer 23

Myotonic dystrophy

Question 24

30 yo develops pain behind L ear. The following day pt complains of numbness on the L side of the face, tearing from L eye and discomfort with low frequency sounds. Exam shows L facial weakness, but no sensory deficit. Dx?

Answer 24

Idiopathic Bell’s palsy

Question 25

One month after MVA, a 21 yo complains of persistent pain in the L shoulder and arm with sharp pain radiating into the L thumb. Exam shows weakness of the biceps. The biceps reflex on the L is absent. Dx?

Answer 25

C-6 radiculopathy

Question 26

Pt complains of unpleasant aching and drawing sensation in calves and thighs associated with a crawling feeling, forcing him to move legs, bringing transient relief. Sxs worsened by fatigue. Exam normal. Best med tx?

Answer 26

Pergolide (for restless leg syndrome)

Question 27

Severe spasms and rigidity of limbs intermittently and later more persistent/ continuous

Answer 27

Antiglutamic and antidecarboxylase abs (Anti-GAD abs)

Question 28

Weakness in limbs 2 weeks after a viral GE. Weakness in UE/LE, absent DTRs. Spinal fluid shows no cells and elevated protein. EMG shows slow conduction velocity prolonged distal motor latency, and conduction block

Answer 28

Acute inflammatory polyneuropathy

Question 29

2 years after MVA with rear end collision, pt develops BUE weakness with some muscle wasting, loss of DTRs in arms, loss of sensation to pain and T in neck/arms/ shoulders intact sensation to touch. Most likely cause?

Answer 29

Syryngomyelia

Question 30

Which of the following is the most effective treatment of spasmodic torticollis?

Answer 30

Botulinum toxin

Question 31

50 yo M with acute neck pain radiating down Left arm, gait problems, urinary incontinence. What test should be ordered?

Answer 31

MRI of cervical spine to r/o cord compression

Question 32

Disequilibrium with feet together and eyes closed is a disorder of what?

Answer 32

Posterior spinal cords

Question 33

What diagnostic test would best detect the MC cardiac complication associated with myotonic dystrophy?

Answer 33

EKG

Question 34

24 yo presents with delirium; severe HA after starting high protein/low carb diet, hx of slow growth as child; method to establish dx?

Answer 34

Ornithine transcarbamylase sequencing

Question 35

____ it the most sensitive, non-invasive clinical tool for monitoring inflammation in M.S.

Answer 35

MRI

Question 36

____ is characterized by eyelid ptosis worsening throughout the day, double vision, no pain, and otherwise unremarkable eye exam.

Answer 36

MG

Question 37

Which sensory domain most significantly affected in early syringomyelia?

Answer 37

Pain perception

Question 38

What activity enhances hypoactive DTRs in the leg?

Answer 38

Clench a fist

Question 39

72 yo with profound sensory ataxia with loss of vibratory sensation and cognitive issues with irritability and somnolence. Nutritional deficiency?

Answer 39

Cobalamin

Question 40

Source of pain that is primarily central (non-nociceptive)?

Answer 40

Fibromyalgia

Question 41

Exam findings suggest L5 radiculopathy in pt with back pain and foot drop?

Answer 41

Weakness of ankle inversion

Question 42

35 yo gets blurry vision, drooping eyelids, and difficulty swallowing. Weakness of bulbar muscles. What caused this?

Answer 42

Botulinum

Question 43

Which of the following is most likely to reduce pain in postherpetic neuralgia

Answer 43

Capsaicin

Question 44

53 yo with insidious onset of blurred vision, diplopia x 1 day, ptosis, CN 6 palsy, unreactive pupils, hoarse voice, dysarthria, weak neck muscles. EMG- Increase amplitude with repetitive nerve stimulation? Dx?

Answer 44

Botulism

Question 45

Dx for a 45 yo woman with pins and needles feeling in hand at night and upon awakening

Answer 45

Carpal tunnel syndrome

Question 46

Pt with chronic muscle wasting in both UE, loss of light touch, pain, and T sensation in shoulders, upper arms, and back, and painful paresthesias over the same distribution, dx?

Answer 46

Syringomyelia

Question 47

23 yo Caucasian F in office for f/u after an ER visit 2 days earlier for sudden diplopia R leg weakness and shaking, difficulty with speech which resolved after a few hours. Pt had fever 103.1F and was tx for UTI. Exam: minimal R leg weakness, brisk DTR and musculocutaneous reflexes throughout, and equivocal plantar reflex on L. R toe is downing. Hx of several episodes of transient neurological deficits that resolved spontaneously after a few days. Her spinal fluid is most likely to show what?

Answer 47

Protein: 50mg _oligoclonal bands, nucleated cells: 10