Tuesday [18/4/23]

Question 1

what are lower motor neurone lesions?

Answer 1

lesions anywhere from the anterior horn of the spinal cord, peripheral nerve, NMJ, or muscle. This causes hyporeflexia, flaccid paralysis, atrophy

Question 2

difference between UMN lesions and LMN lesions

Answer 2

difference between LMN and UMN is flaccid paralysis - paraylsis accompanied by loss muscle tone. Contrast to UMN lesion which often presents with spastic paralysis and severe hypertonia

Question 3

What are the most common causes of LMN lesion? [4]

Answer 3

The most common causes of lower motor neuron injuries are trauma to peripheral nerves that serve the axons, and viruses that selectively attack ventral horn cells. Disuse atrophy of the muscle occurs i.e., shrinkage of muscle fibre finally replaced by fibrous tissue (fibrous muscle) Other causes include Guillain–Barré syndrome, West Nile fever, C. botulism, polio, and cauda equina syndrome; another common cause of lower motor neuron degeneration is amyotrophic lateral sclerosis.

Question 4

Pathway and function of corticospinal tract

Answer 4

corticospinal tract from the motor cortex to lower motor neurons in the ventral horn of the spinal cord The major function of this pathway is fine voluntary motor control of the limbs. The pathway also controls voluntary body posture adjustments.

Question 5

Colliculospinal tract pathway and function

Answer 5

corticospinal tract from the motor cortex to lower motor neurons in the ventral horn of the spinal cord The major function of this pathway is fine voluntary motor control of the limbs. The pathway also controls voluntary body posture adjustments.
corticobulbar tract from the motor cortex to several nuclei in the pons and medulla oblongata Involved in control of facial and jaw musculature, swallowing and tongue movements.

Question 6

rubrospinal tract pathway and function

Answer 6

colliculospinal tract (tectospinal tract) from the superior colliculus to lower motor neurons Involved in involuntary adjustment of head position in response to visual information.

Question 7

vesticulospinal tract pathway and function

Answer 7

from vestibular nuclei, which processes stimuli from semicircular canals It is responsible for adjusting posture to maintain balance.

Question 8

reticulospinal tract pathway and function

Answer 8

from reticular formation. Regulates various involuntary motor activities and assists in balance.

Question 9

Sx of UMN lesions

Answer 9

Symptoms can include muscle weakness, decreased motor control including a loss of the ability to perform fine movements, increased vigor (and decreased threshold) of spinal reflexes including spasticity, clonus (involuntary, successive cycles of contraction/relaxation of a muscle), and an extensor plantar response known as the Babinski sign

Question 10

When can UMN lesions arise? [1]

Answer 10

Such lesions can arise as a result of stroke, multiple sclerosis, spinal cord injury or other acquired brain injury.

Question 11

what are extrapyramidal SE

Answer 11

It involves repetitive, involuntary facial movements, such as tongue twisting, chewing motions and lip smacking, cheek puffing, and grimacing. You might also experience changes in gait, jerky limb movements, or shrugging

Question 12

when do extrapyramidal SE usually occur for patient of antipsychotics? [2]

Answer 12

You might also experience changes in gait, jerky limb movements, or shrugging. It usually doesn’t develop until you’ve been taking the drug for six months or longer

Question 13

Mx of IECOPD

Answer 13

antibiotics, nebulisers, chest physio, 88-92% oxygen, corticosteroids, respriatory swab

Question 14

what is a comminuted fracture?

Answer 14

bone breaks several places

Question 15

transverse fracture

Answer 15

A transverse fracture is when the fracture line is perpendicular to the shaft (long part) of the bone.

Question 16

oblique fracture

Answer 16

An oblique fracture is when the break is on an angle through the bone

Question 17

stress vs pathological fracture

Answer 17

A pathologic fracture is caused by a disease that weakens the bone
A stress fracture is a hairline crack

Question 18

Sx and Sx of secondary hyperparathyroidism

Answer 18

Bone and joint pain are common, as are limb deformities. The elevated PTH has also pleiotropic effects on the blood, immune system, and neurological system

Question 19

secondary hyperparathyroidism

Answer 19

higher blood phosphorus, kidneys cannot make active vitamin D, lower calcium levels. Usually seen in cases CKD or defective calcium receptors on the surface parathyroid glands.

Question 20

what is GBS? [1]

Answer 20

rapid-onset muscle weakness

Question 21

what is GBS? [1]

Answer 21

rapid-onset muscle weakness damaging the peripheral nervous system

Question 22

why can GBS be serious? [1]

Answer 22

During the acute phase, the disorder can be life-threatening, with about 15% of people developing weakness of the breathing muscles and, therefore, requiring mechanical ventilation

Question 23

in those with severe weakness, what should be given

Answer 23

In those with severe weakness, prompt treatment with intravenous immunoglobulins or plasmapheresis, together with supportive care, will lead to good recovery in the majority of cases

Question 24

What is transverse myleitis?

Answer 24

Transverse myelitis is a rare neurological condition. It’s caused by inflammation (swelling) of the spinal cord. The swelling damages the nerves and can leave permanent scars or lesions. The scars or lesions interrupt the communication between the nerves in the spinal cord and the rest of the body.

Question 25

what is a stool elastase done for? [1]

Answer 25

A stool elastase test is used to find out if there is pancreatic insufficiency. This test is better at finding severe pancreatic insufficiency, rather than mild or moderate cases. Pancreatic insufficiency can sometimes be a sign of pancreatic cancer, but this test is not used to screen for or diagnose cancer

Question 26

what is a fit test for?

Answer 26

You will need further tests if there is blood found in your poo. Your doctor might call this FIT positive.

This doesn’t mean that you have cancer. Blood in your poo can be caused by cancer or by other medical conditions.

You usually have a test to look at the inside of your large bowel. This is called a colonoscopy.

Question 27

what is TTG used for?

Answer 27

coeliac screen

Question 28

quetiapine used for?

Answer 28

Quetiapine is indicated for the treatment of schizophrenia and bipolar disorder; however, it is commonly used off-label for the management of psychosis in parkinsonism

Question 29

risperidone for PD

Answer 29

Although in some Parkinson’s disease studies, risperidone has been well tolerated, others have shown that many patients are unable to tolerate the drug due to deterioration of motor function.

Question 30

coming off antipsychotics

Answer 30

It is safest to come off slowly and gradually.
You should do this by reducing your daily dose over a period of weeks or months. The longer you have been taking a drug for, the longer it is likely to take you to safely come off it. Avoid stopping suddenly, if possible.

Answer 31

Meningitis (inflammation of the meninges, the membranes that cover the brain and spinal cord)

Encephalitis (inflammation of the brain)

Brain tumors

Psychosis

Lung diseases

Head trauma

Guillain-Barré syndrome (a reversible condition that affects the nerves in the body. GBS can result in muscle weakness, pain, and even temporary paralysis of the facial, chest, and leg muscles. Paralysis of the chest muscles can lead to breathing problems.)

Certain medications

Damage to the hypothalamus or pituitary gland during surgery

Thyroid or parathyroid hormone deficiencies

HIV

Hereditary causes

Question 32

categories of siadh

Answer 32

The causes of SIADH are grouped into six categories: 1) central nervous system diseases that directly stimulate the hypothalamus, the site of control of ADH secretion; 2) various cancers that synthesize and secrete ectopic ADH; 3) various lung diseases; 4) numerous drugs that chemically stimulate the hypothalamus; 5) inherited mutations; and 6) miscellaneous largely transient conditions

Question 33

siadh

Answer 33

Causes
Causes of SIADH include conditions that dysregulate ADH secretion in the central nervous system, tumors that secrete ADH, drugs that increase ADH secretion, and many others. A list of common causes is below:[2]

Central nervous system-related causes
Infections
Meningitis, encephalitis, brain abscess, rocky mountain spotted fever, AIDS
Perinatal asphyxia
Mass / bleed
Trauma, subarachnoid hemorrhage, subdural hematoma, cavernous sinus thrombosis
Hydrocephalus
Guillain–Barré syndrome
Acute porphyria (acute intermittent porphyria, hereditary coproporphyria, variegate porphyria)
Multiple system atrophy
Multiple sclerosis
Cancers
Carcinomas
Lung cancers (small-cell lung cancer, mesothelioma)
Gastrointestinal cancers (stomach, duodenum, pancreas)
Genitourinary cancers (bladder, urethral, prostate, endometrial)
Lymphoma
Sarcomas (Ewing’s sarcoma)
Pulmonary causes
Infection
Pneumonia
Lung abscess
Asthma
Cystic fibrosis
Drugs
Chlorpropamide
Clofibrate
Phenothiazine
Ifosfamide
Cyclophosphamide
Carbamazepine
Oxcarbazepine
Valproic acid
Selective serotonin reuptake inhibitors (SSRIs, a class of antidepressants)
3,4-Methylenedioxymethamphetamine (MDMA, commonly called Ecstasy. SIADH due to taking ecstasy was cited as a factor in the deaths of Anna Wood and Leah Betts)
Oxytocin
Vincristine
Morphine
Amitriptyline
Transient causes
Endurance exercise
General anesthesia
Hereditary causes
Sarcoidosis

Question 34

spinal ord infarct

Answer 34

What is spinal cord infarction? Spinal cord infarction is a stroke within the spinal cord or the arteries that supply it. It is caused by arteriosclerosis or a thickening or closing of the major arteries to the spinal cord

Question 35

atypical an PP syndrome

Answer 35

Atypical parkinsonism and other Parkinson-plus syndromes are often difficult to differentiate from PD and each other. They include multiple system atrophy (MSA), progressive supranuclear palsy (PSP), and corticobasal degeneration (CBD). Dementia with Lewy bodies (DLB), may or may not be part of the PD spectrum, but it is increasingly recognized as the second-most common type of neurodegenerative dementia after Alzheimer’s disease. These disorders are currently lumped into two groups, the synucleinopathies and the tauopathies.[4][5] They may coexist with other pathologies.

Question 36

additional PP syndromes

Answer 36

Additional Parkinson-plus syndromes include Pick’s disease and olivopontocerebellar atrophy.[7] The latter is characterized by ataxia and dysarthria, and may occur either as an inherited disorder or as a variant of multiple system atrophy. MSA is also characterized by autonomic failure, formerly known as Shy–Drager syndrome.