Muscle and nerve Flashcards
(47 cards)
MG associated with which EMG finding?
Decreased amplitude with repetitive motor nerve stimulation
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?
Idiopathic Bell’s palsy
Tx of trigeminal neuralgia?
Gabapentin (most effective carbamazepine)
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
Ulnar nerve lesion
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?
Median nerve entrapment at the wrist
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
AMS
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.
Cervical spondylosis
Persistet numbness in the L hand, decreased sensation in 4th/5th digits (palmar/dorsal), weak finger abduction/adduction especially 5th digit.
Ulnar entrapment at the elbow
Right neck pain, tends to rotate neck to the L- touching the chin prevents deviation- prominent R SCM spasm. Tx
Botulinum toxin
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?
Acute inflammatory demyelinating polyneuropathy
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?
Periodic paralysis
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?
Order MRI of lumbar spine.
MG can be dx in 80-90% of cases by ID of serum antibodies against what?
Ach R
MOA of botulinum toxin at neuromuscular junction
Inhibition of Ach from presynaptic terminals
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?
Median neuropathy at the wrist
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
Spinal epidural abscess.
What chemo agent is MC associated with distal sensory polyneuropathy?
Cisplatin
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?
Glossopharyngeal neuralgia
Contralateral loss of pain and T sensation with motor paralysis and proprioception loss on the other. Dx?
Brown-sequard syndrome (hemisection)
Subacute combined degeneration of the posterior column of the spinal cord is associated with a deficiency of
Vitamin B12 deficiency
Which of the following is the most effective tx of blephorospasm?
Botulinum toxin
Pt complains of progressive weakness of several days Exam + for generalized weakness and absent reflexes. Nerve conduction studies show slowing of velocities. Dx?
Acute polyneuropathy
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?
Myotonic dystrophy
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?
Idiopathic Bell’s palsy
