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MSK 2 Post Midterm > Sachen > Flashcards

Flashcards in Sachen Deck (49):
1

What radiculopathy?
scapular pain,​ “tight band around elbow feeling”, 3rd digit numb, absent triceps jerk

C7 nerve root compression (C6-C7) - most common cervical radiculopathy

2

Hand sensory mnemonic

C6 = "six shooter"
C7 = middle finger
C8 = ring/pinky finger

3

What radiculopathy?
dorsal thigh and lateral calf pain, lateral calf numb, weak hip E and loss of all foot movements EXCEPT can still plantarflex

L5 nerve root compression (L4-L5) - most common lumbar radiculopathy

4

What radiculopathy?
post thigh/post calf pain. Postlat calf and lat food numb. Weakness of hip E and foot plantarflexion.

S1 nerve root compression (L5-S1) - most common lumbar radiculopathy

5

Triceps reflex

C7

6

Biceps reflex

C5/C6

7

Finger flex reflex

C8

8

Patellar reflex

L4

9

Achilles reflex

S1

10

what is mononeuropathy multiplex?

multiple mononeuropathies - focal involvement of two or more nerves.

11

CNS (UMN) v. PNS (LMN)
-Paresis
-Tone (flaccid/spastic)
-Bulk (atrophic or normal)
-Fasciculations (Y/N)
-DTRs (hyper/hypo)
-Plantar reflex

-Paresis: patterns v. distal
-Tone: spastic v. flaccid
-Bulk: normal v. atrophic
-Fasciculations: no v. sometimes
-DTRs: hypERactive v. hypoactive
-Plantar reflex: Babinski v. absent

12

What type of neuropathy is this:
symmetric, LMN sx stocking/glove sensory loss ­ distal numb/weak (foot/hand) instead of calf

polyneuropathy

13

What type of fiber results in this sensory peripheral neuropathy:
-Negative: ↓vibration, ↓proprioception, ataxia, ↓2pt. discrim.
-Positive: Tingling, pins and needles

large myelinated fiber sensory

14

What type of fiber results in this sensory peripheral neuropathy:
-Negative: ↓p/t impairment
-Positive: burning/jabbing

small unmyelinated fiber sensory

15

Do nerve roots and peripheral nerves:
-split digits (Y/N)

● Nerve roots DO NOT split digits: ​Pure C8 root lesion​ → 4th + 5th finger sensory defects
● Peripheral nerves SPLIT digits: Median N lesion (Carpal tunnel​ involving lgmts of palmaris longis + pronator teres) → 1st ­- 3rd finger + lateral 1⁄2 of ring finger defects

16

Froment sign = what nerve and what mm?

adductor pollicus weakness; ulnar nerve palsy

17

Saturday night palsy -midshaft humerus fracture, axilla compression.

What nerve? What clinical signs?

WRIST DROP due to paresis of extensor muscles of wrist, finger, thumb.

Radial nerve compression in the spiral groove

18

Fibular head/neck compression from sitting cross legged - what nerve and what clinical features?

PERONEAL N ENTRAPMENT - Motor weakness of dorsiflexion, eversion, toe extension. Sensory loss dorsum of foot.

19

What nerve causes: lateral thigh pain, foot drop, absent ankle jerk

sciatic compression (i.e. injection in buttocks in wrong location)

20

What Hereditary Polyneuropathy and what type of dysfunction/etiology?
● weakness in walking/running is 1st symptom (1st­-2nd​ decade). ​“Doc, I can’t keep up during sports”
● INVERTED CHAMPAGNE BOTTLE LEGS (severe distal SYMMETRIC ATROPHY; LEGS​>arms), HAMMER TOES (chronic), pes cavus, skeletal deformities

Charcot­-Marie-­Tooth 1 Neuropathies (hereditary motor sensory neuropathies)

DEMYELINATING

21

What Hereditary Polyneuropathy and what type of dysfunction/etiology?
● onset: adulthood; AD
● Distal symmetric atrophy (legs>arms)

Charcot­-Marie-­Tooth 1 Neuropathies (hereditary motor sensory neuropathies)

neuronal/axon LOSS

22

Difference between HMSN1 and HMSN2 EMG

- HMSN 1 EMG: slow motor N. conduction (demyelination)
- HMSN 2 EMG: EMG: almost nml motor N. conduction velocities (axonal loss)

23

Low back/leg pain is first sign, then ascending symmetric motor paralysis (no­minimal sensory)​; self resolving (after 6w).

Acute Inflammatory Demyelinating Polyneuropathy (GBS)

24

Etiology/triggering event in Acute Inflammatory Demyelinating Polyneuropathy

prior infection with Campylobacter JEJUNI, Mycoplasma pneumonia, EBV

25

Indicative of what Dz?
- ***​↑protein, nml cell count, nml glucose ***= albumin-­cytological dissociation
- NCVS​: slow conduction, prolonged F waves

Acute Inflammatory Demyelinating Polyneuropathy

26

Tx of GBS

plasma exchange or IVIg,

NEVER USE STEROIDS

27

Sudden ANS changes to look for in Acute Inflammatory Demyelinating Polyneuropathy

arrhythmias (brady/tachy), HTN/hypoT, Resp failure

28

How is the Variant of GBS, Miller-­Fisher Syndrome, different than normal GBS?

-Children
-***Ophthalmoplegia, ataxia, arreflexia***
-dysphagia, dysarthria
-***GQ1b and GT1a ab’s***

29

Difference between Acute Inflammatory Demyelinating polyneuropathy and Chronic Inflammatory Demyelinating Polyneuropathy

CIDP lasts longer than AIDP and is REPLAPSING.

30

Treatment for Chronic Inflammatory Demyelinating polyneuropathy

Tx: IVIg, steroids, plasma exchange, immunosuppression [Cyclophosphamide (Cytoxan); Azathioprine (Imuran)]

31

M>F. Single n. to start → progressive distal weakness (upper extremity/HANDS>feet)

GM-1ab

● No sensory sx, no UMN findings

Multifocal Motor Neuropathy

32

Serum GM-1 ab titer in Multifocal Motor Neuropathy: what makes a worse prognosis.

Tx of Multifocal Motor Neuropathy

Increased titer means worse prognosis.

Tx: IVIg

33

Eyes "down and out" with complete ptosis and DILATED-UNREACTIVE v. REACTIVE pupil. What cranial nerve is compressed and what etiologies?

Dilated/unreactive: PCA aneurysm - compressive CN3 neuropathy

Reactive: DM neuropathy - inflammatory neuropathy (#1 MCC)

34

- Initial complaints: gait disorder, limb weakness, speech or swallowing.
- Unexplained wt loss, DIFFICULTY SWALLOWING/tongue atrophy and mm cramps/fasciculations

Amyotrophic Lateral Sclerosis

35

○ Degeneration of any or combo of the following leads to ___?
Pyramidal Betz cells, **ANTERIOR HORN CELLS and LATERAL/VENTRAL CORTICOSPINAL TRACTS** and Corticobulbar Tract, brainstem lower CN motor nuclei

ALS

*Hallmark: UMN and LMN denervation in one limb

36

EMG in ALS shows:

widespread innervation and denervation

37

What are the important "rule of thumb" Diagnostic Negatives in ALS?

■ No sensory or extraocular loss
■ Nml mentation
■ No bowel or bladder issues
■ Decubiti (pressure ulcer) rare

38

Death in ALS due to...

rspiratory failure.

39

While tx for ALS is supportive, what glutamate inhibitor prolongs life by a few months?

Riluzol

40

What is this:
○ 20% of MND, ***brainstem lower CN motor nuclei***

○ Dysarthria, dysphagia, chewing issues, respiratory difficulty, dysphonia (nasal tone)

○ Progresses to ALS

Progressive Bulbar Palsy

41

What is this?
○ 10% of MND, M more than F, ***mean onset 64, AH cells, LMN deficits,*** rarely progresses to ALS (better prognosis than ALS)

Progressive Spinal Muscular Atrophy

42

What is this?
○ 2­4% of MND, 50­55yo, UMN, CST deficit

○ Weakness, spasticity, hyperreflexia,+ Babinski

○ Slow progression but can evolve to ALS

○ Better prognosis than ALS

Primary Lateral Sclerosis

43

What childhood motor neuron disease is this?
­​Hypotonia, areflexia, poor suck, breathing issues, death in 6-­12mo

Infantile SMA (Werdnig-Hoffmann Dz)


Kugelberg-Welander Dz is milder than WH

44

Two presynaptic disorders of NMJ.

LEMS (VGCaC), Botulism (blocks presynaptic ACh release)

45

One postsynaptic disorder of NMJ.

Myasthenia Gravis (postsynaptic nAChRs)

46

What NMJ disorder has ocular weakness with ptosis, diplopia/double vision and NORMAL reflexes?

Myasthenia gravis

tx with ACHEi (mestinon), predinosne (aminoglycosides have sig drug interaction with MG)

47

What NMJ disorder has association with Small Cell Lung Cancer. Strength improves with exercise. ARREFLEXIA.

LEMS

tx Guanidine hydrochloride

48

Don't give LEMS pts with heartburn what?

Mg2+. because inc Mg = dec Ca influx = LEMS exacerbation

49

What NMJ disorder has Descending: dry mouth, blurred vision, resp/limb paralysis

Botulism