Flashcards in Neurology Deck (280)
periodic limb movementd/o with jerky movements during sleep dx by?
Pt while writing, hand goes into spasm - phalen/tinel's neg, serum Ca 9mg
Acute dystonic rxn
Pt get phenothiazine for n/v - coupel hours later - pt eyes are tuck in particular gaze (left or right) wtd?
Torticollis - fixed flexion of neck
18yo M with twitching of face, grimacing and movements of neck
Tremor best seen at rest
Tremor aggrevated by anxiety
Tremor dec'd by rest
Essential/Kinetic or Cerebellar
Tremor relieved by etoh
Tremor activated by action
Essentiail/kinetic, parkinson, cerebellar
Tremor in head/voice tremors
Essential/Kinetic or parkinsons
Tremor on fexion-extension
Tremor on pronation/supination
Tremor at rest and on movment
Ab to POST-synaptic Ach rct's
Low level of Ach rct
WEAKNESS as day PROGRESSES (repetive acts) reflexes normal
Extraoc/oc muscles-> Ptosis, diplopia
Facial muscles-> diff chewing, dysartria
BUlabar muscles - diff swallowing
Prox limb muscles - wk brushing hair
Intercostal an diaphragmatic wk -> resp failure (Myasthenic crisis)
Edrophonium challenge test (Tensilon test) -> Ptosis should get better
Ach rct ab + in 90% gen MG, 50% ocular MG
+Ptosis+wkness -> MG
+dysarthria+ataxia+dizziness-> Verterobasil TIA
+cauda equina -> Leptomeningial metastaisis
Pt with diplopia, fatigue at end of day difficulty brushing hair, recently while eating regurg thru nose, diplpia, ptosis both eye way to do dx?
Ach rct Ab test
35yo prox muscle wk, ptosis, diplopia, EOMI intact, vision intact, replex intact
Repetive nerve stim studies
MS - gets weaker with repeated stim
Eaton lamburt - stronger with repeated stim
Pt dx with MG wtd next
CT chest r/o thymoma - if present resect
40yo F works on farm lately gets tired - diplopia on exam - pupils ok refelxes ok vision ok - dx?
MG - reponsd to physostigmine
(not organophosphate - pupils would be constricted)
30yo smoker with diplopia - tired at end of day - difficulty swallowing, chewing, nasal regurg - develops progressive wk and goes into resp facilure - dx?
What makes MG wkness worse?
Pt with myasthenic crisis wtd?
Elective intub for VC<20ml/kg
Pt with MG on pyridostigmine now with acute exacerbation wtd?
Eaton Lambert syndrome
Autoimmune/Oat cell CA
Antibody to PRE-synaptic rct's
Weakness BETTER with repetitive action
Pt with wk, inabilit to get up form chair, BETTER with excercise - h/o chronic smoking - DECREASED reflexes, repetive nerve stim with incremental INCREASE with continuing potentials dx?
Eaton Lambert 2/2 small cell lung CA
Better with repetition