definitive diagnosis for MS
clinical, but at least one lesion in white matter on MRI + oligoclonal bands on MRI
lesion in MLF gives IPS medial rectus palsy on lateral gaze and horizontal nystagmus of abd eye (contralat side)
treatment of MS?
IV high dose corticosteroids for ACUTE attacks
disease modifying= interferon, cyclophosphamide if really bad
symptomatic therapy for MS:
- muscle spasticity
- neuropathic pain
GBS affect with nerves?
motor, not usually sensory
treatment of GBS?
do NOT give steroids
- antibodies to postsynaptic Ach(N) receptors in NMJ
- Symptomatic tx= AchE inhibitors (pyridostigmine)
do you need to intubate MG patients?
low threshold, intubate at FVC of 15ml/kg
reflex pattern in MG vs lambert eaton?
in MG, reflexes are preseved
In LE, patients have hyporeflexia
- CT scan for thymoma (10%)
- edrophonium (tensilon) test- AchE
patient with DMD pulls himself from floor because of weak proximal lower etremeity muscles
character of enlarged calves in DMD
hypertrophy at first, becomes pseudohypertrophy as fat replaces muscle
proximal muscle weakness, elevated CK, ESR, etc
dx with muscle bx showing infravesicular infilatrates
shortness of breath in suspected AS?
they can develop restrictive lung dz from decreased movement of their spine
myalgias, rhabdo, myoglobinuria and “second wind phenomenon”
mcardle’s dz= glycogen stroage do 2/2 myphosphorylase deficiency
giant cell tumor (aka osteoclastoma):
- appearance on xray
- soap bubble at distal femur or proximal tibia
- over active osteoclasts due to over expression of RANK-L
- boys age 20-40
*consider local excision or tx with dinosumab
on hip or femur
“moth eaten” appearance on xray + periosteal reaction
first line for sx pagets
*can cause flu like reaction, osteonecrosis of the jaw
what should you check after finding a calcaneal fracture from a fall? (think about compression)
empiric against GNR in septic arhtritis?
who gets osteosarcoma?
bimodal: 10-20, >65
- pain worse at night and with activity
- metaphysis of long bones
- sunburt + codman’s triangle
whats at risk in mid/proximal humerus break?
distal humerus break?
differentiate bony lesions in metastatic prostate cancer vs MM
prostate= osteoblastic aka sclerotic lesions
MM= punched out
morning stiffness as an indicator of OA or RA?
OA <30 mins
RA > 30 mins
role of entanercept in AS?
it helps with spinal mobility but DOES NOT prevent disease progression
calcification of hylaine cartilage on XRAY?