Neurology
Quiz yourself by thinking what should be in
each of the black spaces below before clicking
on it to display the answer.
Help!
|
|
||||
|---|---|---|---|---|---|
| ALS: Dx | UMN & LMN sx in 3 regions; UMN: clinical; LMN: EMG; CK nml or high
🗑
|
||||
| ALS Tx | Riluzole; cough assist device, chest PT, BiPAP; PEG feeding tube;
🗑
|
||||
| PLS: path | degeneration of lateral corticospinal tract
🗑
|
||||
| PLS clin findings | usu legs before arms; leg weak/stiff; spasticity; ave duration >8 yrs; many pts develop LMN sx & transition to ALS
🗑
|
||||
| PLS: dx | EMG, MRI (br & spcord), LP, evoked potls; B12, Lyme, RPR, long chain fatty acids
🗑
|
||||
| PMA | pure LMN dz; slower progress than ALS; often spares bulbar mx; CK very high
🗑
|
||||
| Kennedy dz | X-linked rec, TNR; mutation in androgen receptor; sx onset (wide age range); facial fasciculations, weakness mouth/tongue; dysphagia, limb weakness; gynecomastia, DM, oligospermia
🗑
|
||||
| Disorders of neuromuscular transmission (NMJ): | MG (most common), LEMS, botulism
🗑
|
||||
| MG: pathology | Acquired autoimmune: Ach receptor insufficiency & Abs to Ach receptor protein; possibly also thymus hyperplasia
🗑
|
||||
| MG S/S | Insidious; fluctuating mx weakness (worse w/reps); asymmetric ptosis; tired face, difficulty chewing/swallowing; SOB. Normal DTRs. F 20-30 yo, M 70-80
🗑
|
||||
| MG Dx | Tensilon test (or neostigmine); Ach receptor & MuSK Abs; Repetitive nerve stim; Single fiber EMG; CT Chest to exclude thymoma
🗑
|
||||
| MG Tx | Symptomatic (Cholinesterase inhibitors, eg pyridostigmine & neostigmine); Firstline: steroids (alt immunosupp: CellCept, Cyclosporine); thymectomy
🗑
|
||||
| MG exacerbations | d/t infxn, PG, meds; may worsen resp sx; tx w/ plasmapheresis or IVIg, supportive respiratory care
🗑
|
||||
| MG: drugs to avoid | NM blockers; quinine; macrolides, FQ; botox; beta/CCB; IV contrast
🗑
|
||||
| LEMS | usu paraneoplastic (autoimm rare); proximal weakness / autonomic sx (dry mouth); hypo/absent reflexes; voltage gated Ca channel Abs; facilitation w/ RNS
🗑
|
||||
| Botulism MOA | irreversible blockade of Ach release
🗑
|
||||
| Botulism S/S | Diplopia, ptosis, dilated pupils; facial / resp weakness; descending paralysis; Autonomic dysfunction
🗑
|
||||
| Botulism Tx | supportive; horse serum antitoxin? (months to recover)
🗑
|
||||
| MD classified by: | distribution, inheritance and clinical features
🗑
|
||||
| MD: labs/studies | ultrastructural protein abnormalities; mx bx: mx fiber necrosis
🗑
|
||||
| Duchenne | onset at 3-5 yrs; calf pseudohypertrophy; loss of ambulation by teens; cardiomyopathy; death in 20s
🗑
|
||||
| Duchenne/Becker: Dx | Mx bx; genetic testing (need complete sequencing); CK sometimes >10,000; FH
🗑
|
||||
| Duchenne/Becker Tx | Prednisone (age 5) for Duchenne; Supportive (orthotics, resp, cardiac, PT/OT); cardiac TP in Becker
🗑
|
||||
| FSHD | auto dominant; asymmetric; eye or mouth closure weakness: may sleep w/ eyes open; pectoral & biceps/triceps atrophy (but normal deltoid); also scap winging; no fx on life exp; orthotics & counseling
🗑
|
||||
| FSHD Dx | genetic testing (95%); FH; mx bx rarely helpful
🗑
|
||||
| Emery Dreifuss | Humeroperoneal / scapuloperoneal weakness w/ early contractures (ankle neck elbow); teen onset (very thin); scap winging/deltoid sparing; x linked or auto dom; cardiac conduction block/arrhythmia (need pacemaker)
🗑
|
||||
| Most common MD’s | Duchenne/Becker; myotonic; FSHD
🗑
|
||||
| Myotonic dystrophy | auto dom; any age; TNR
🗑
|
||||
| Myotonic dystrophy S/S | tenting upper lip; distal weakness; frontal bald; cataracts; conduction block; DM, infertile; cognitive impairment; percussion myotonia
🗑
|
||||
| MG tx: pyridostigmine dose | 15-90 mg Q6h and 180 mg of long acting version HS
🗑
|
||||
| MG tx: neostigmine dose | 15 mg before excessive physical activity
🗑
|
||||
| Young kid with difficulty standing from seated position. Calf muscle wasting | Muscular dystrophy (weakness begins at pelvic girdle)
🗑
|
||||
| fluctuating weakness/fatigability of voluntary mx (diplopia, blurry vision, ptosis, difficulty swallowing); resp difficulty, limb weakness (worsened w/activity); bulbar sxs (dysarthria, dysphagia, fatigable chewing) | Myasthenia gravis
🗑
|
||||
| MG pathophys | Abs vs acetylcholine receptors
🗑
|
||||
| LEMS pathophys: | defective release of Ach in response to nerve impulse; may be assoc with small cell ca
🗑
|
||||
| MG vs LEMS: S/S | LEMS: power increases w/sustained contraction; MG: fatigability
🗑
|
||||
| Kennedy dz genetics | X-linked rec, TNR; mutation in androgen receptor
🗑
|
||||
| Kennedy dz S/S | facial fasciculations, weakness mouth/tongue; dysphagia, limb weakness; gynecomastia, DM, oligospermia
🗑
|
||||
| Disorders of neuromx transmission (NMJ): | MG, LEMS, botulism
🗑
|
||||
| MG: pathophys | Acquired autoimmune: Ach receptor insufficiency
🗑
|
||||
| MG S/S | fluctuating mx weakness (worse w/reps); asymmetric ptosis; tired face, difficulty chewing/swallowing; SOB
🗑
|
||||
| LEMS S/S | usu paraneoplastic (autoimm rare); proximal weakness / autonomic sx (dry mouth); hypo/absent reflexes; voltage gated Ca channel Abs; facilitation w/ RNS
🗑
|
||||
| Botulism MOA | irreversible blockade of Ach release
🗑
|
||||
| Duchenne MD | onset at 3-5 yrs; calf pseudohypertrophy; loss of ambulation by teens; cardiomyopathy; death in 20s
🗑
|
||||
| Emery Dreifuss | Humeroperoneal / scapuloperoneal weakness w/ early contractures (ankle neck elbow); teen onset (very thin); scap winging/deltoid sparing; x linked or auto dom; cardiac conduction block/arrhythmia (need pacemaker)
🗑
|
||||
| Most common MD’s | Duchenne/Becker; myotonic; Facioscapulohumeral dystrophy
🗑
|
||||
| Myotonic dystrophy | auto dom; any age; TNR
🗑
|
||||
| Myotonic dystrophy S/S | tenting upper lip; distal weakness; frontal bald; cataracts; conduction block; DM, infertile; cognitive impairment; percussion myotonia
🗑
|
Review the information in the table. When you are ready to quiz yourself you can hide individual columns or the entire table. Then you can click on the empty cells to reveal the answer. Try to recall what will be displayed before clicking the empty cell.
To hide a column, click on the column name.
To hide the entire table, click on the "Hide All" button.
You may also shuffle the rows of the table by clicking on the "Shuffle" button.
Or sort by any of the columns using the down arrow next to any column heading.
If you know all the data on any row, you can temporarily remove it by tapping the trash can to the right of the row.
To hide a column, click on the column name.
To hide the entire table, click on the "Hide All" button.
You may also shuffle the rows of the table by clicking on the "Shuffle" button.
Or sort by any of the columns using the down arrow next to any column heading.
If you know all the data on any row, you can temporarily remove it by tapping the trash can to the right of the row.
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
Created by:
Abarnard
Popular Medical sets