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)