OnlineMedEd: Neurology - Weakness

Question 1

Multiple sclerosis most commonly occurs in _______________.

Answer 1

young women

Question 2

Blurry vision and ______________ are suggestive of optic neuritis.

Answer 2

painful movements of the eye

Question 3

What tests can help diagnose MS?

Answer 3

• MRI showing periventricular white matter plaques
• LP showing oligoclonal bands
• Evoked potentials showing demyelination

Question 4

Acute MS flares are treated with ____________.

Answer 4

steroids

Question 5

Chronic MS treatment should be with ______________.

Answer 5

a number of MS-specific drugs like interferon beta, fingolimod, or glatiramer

Question 6

MS presents with what urinary symptoms?

Answer 6

Either incontinence or retention (so treat with amitriptyline or bethanechol)

Question 7

What drug is commonly used to treat MS spasms?

Answer 7

Baclofen

Question 8

What drug is used to treat neuropathic pain in MS?

Answer 8

Gabapentin

Question 9

Those with Guillain-Barré often have _______-reflexia.

Answer 9

hypo

Question 10

How can Guillain-Barré be definitively diagnosed?

Answer 10

With an LP looking for protein without cells

Question 11

How does IV IG work?

Answer 11

It binds the body’s native immunoglobulin and effectively removes it.

Question 12

True or false: give steroids to treat Guillain-Barré.

Answer 12

False. Never give steroids to those with Guillain-Barré. Treat with IV IG and intubation (if the diaphragm is affected).

Question 13

What three muscle groups are usually most affected in myasthenia gravis?

Answer 13

• Eyes and eyelids
• Throat
• Hands

Each of these groups moves frequently, which depletes the acetylcholine reserves.

Question 14

An EMG of someone with myasthenia gravis will show ____________________.

Answer 14

initially normal amplitude waves that taper off

Question 15

How can you diagnose myasthenia gravis?

Answer 15

• Acetylcholine receptor antibodies
• EMG
• CT looking for thymoma

Question 16

Why should you carefully monitor myasthenia gravis patients after giving physostigmine?

Answer 16

They might be having trouble swallowing already, and when you give them cholinesterase inhibitors you will cause them to have increased secretions.

Question 17

List four treatments for myasthenia gravis.

Answer 17

• Steroids
• IV IG
• Thymectomy
• Cholinesterase inhibitors

Question 18

Why are the proximal muscles more affected in Lambert-Eaton myasthenic syndrome?

Answer 18

In LEMS, muscle use improves with increased use. The proximal muscles generally get used the least (particularly if you’re sitting most of the day).

Question 19

What three diagnostic tests should you order in a suspected LEMS case?

Answer 19

• Antibodies (diagnostic)
• EMG showing increased amplitude with use (the opposite of myasthenia gravis)
• CT looking for small cell lung carcinoma

Question 20

Differentiate the presentations of upper- and lower-motor neuron injuries.

Answer 20

• UMN: weakness and hyperreflexia

* LMN: weakness, hyporeflexia, and fasciculations

Question 21

______________ can add a couple months of life to those with amyotropic lateral sclerosis.

Answer 21

Riluzole