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Flashcards in Neurology Deck (280)
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181

periodic limb movementd/o with jerky movements during sleep dx by?

Polysomnography

182

Pt while writing, hand goes into spasm - phalen/tinel's neg, serum Ca 9mg

Acute dystonic rxn

183

Pt get phenothiazine for n/v - coupel hours later - pt eyes are tuck in particular gaze (left or right) wtd?

Diphenhydramine

184

Acute Dystonia

Torticollis - fixed flexion of neck
Blepharospams
Writers cramp

185

18yo M with twitching of face, grimacing and movements of neck

Tourette's syndrome
Tx: neuroleptics

186

Tremor best seen at rest

Parkinson's

187

Tremor aggrevated by anxiety

Essential/kinetic

188

Tremor dec'd by rest

Essential/Kinetic or Cerebellar

189

Tremor relieved by etoh

Essential/Kinetic

190

Tremor activated by action

Essentiail/kinetic, parkinson, cerebellar

191

Tremor in head/voice tremors

Essential/kinetic

192

Chin tremors

Essential/Kinetic or parkinsons

193

Familial tremors

essential/kinetic

194

Tremor on fexion-extension

Essential/kinetic

195

Tremor on pronation/supination

Parkinson's

196

Tremor at rest and on movment

Parkinsons

197

Neuromuscular dz

Myasthenia gravis
Autoimmune
Ab to POST-synaptic Ach rct's
Low level of Ach rct
Cl ft:
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

198

Dipolpia

+Ptosis+wkness -> MG
+INO-> MS
+dysarthria+ataxia+dizziness-> Verterobasil TIA
+cauda equina -> Leptomeningial metastaisis

199

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

200

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

201

Pt dx with MG wtd next

CT chest r/o thymoma - if present resect

202

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)

203

30yo smoker with diplopia - tired at end of day - difficulty swallowing, chewing, nasal regurg - develops progressive wk and goes into resp facilure - dx?

MG

204

What makes MG wkness worse?

aminoglycoside abx
Antiarrythmics
BB
Infxn
Electrolytes d/o

205

Pt with myasthenic crisis wtd?

ICU
Plasma exhange
Immunglob/steroids
Elective intub for VC<20ml/kg

206

Pt with MG on pyridostigmine now with acute exacerbation wtd?

immunoglobulin/steroids

207

Eaton Lambert syndrome

Autoimmune/Oat cell CA
Antibody to PRE-synaptic rct's
Weakness BETTER with repetitive action
HYPO-reflexia
no ptosis
no diplopia

208

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

209

Better with repetition

Eaton labert

210

Worse with repetition

MG