T3 Soriano I

Front 1

What chemical is is in the neurochemical junction for transmission of the motor unit?

Back 1

ACh

Front 2

What is an example of an inherited myopathy?

Back 2

Muscular Dystrophy

Front 3

Whats an example of an acquired myopathy?

Back 3

Polymyositis

Front 4

How does one come up with the majority of the neurological diagnosis?

Back 4

History and PE

Front 5

Describe the reflex arc.

Back 5

Synapse b/w dorsal root ganglia & anterior horn cell, maybe w/ interneurons.
Thus, receptor-->primary sensory neuron-->spinal cord-->spinal cord motor neuron-->muscle

Front 6

What's the difference b/w a lesion at the dorsal root and a lesion distal to the dorsal root ganglia (ex. plexus)?

Back 6

-Lesion of dorsal root (intact DRG): intact sensory N but w/ sensory sx's.
-Lesion distal to DRG (e.g. plexus): abnl sensory nerve.

Front 7

Where do the dorsal root and ventral roots start and go to?

Back 7

Dorsal root: b/w DRG & cord
Ventral root: b/w AHC & foramen

Front 8

What three occurs in neuropathy if the parasympathetic system is affected more?

Back 8

Inc HR, dec gastric motility, erectile dysfunction. Also w/ lack of vasoconstriction & lack of HR/BP response postiion change--orthostatic response.

Front 9

On History & Exam, fatigability would indicate a problem where?

Back 9

NMJ

Front 10

What would difficulty getting out of chairs or climbing stairs indicate?

Back 10

Proximal Lower extremity weakness

Front 11

Where would weakness be if patient said they have difficulty when shampooing?

Back 11

Proximal Upper extremity weakness

Front 12

Hyperreflexia & Babinski sign are an indication of what?

Back 12

UMN lesion

Front 13

What are three characteristics of an acute peripheral neuropathy--"spinal shock"?

Back 13

Ascending weakness, hypotonia, hyporeflexia or arreflexia (babinski sign not reliable)

Front 14

What is the treatment for an acute myelopathy?

Back 14

hi dose steroids IV, emergent neurosurgical consultation, radiation therapy if due to spine mets

Front 15

Is a lumbar puncture indicate in acute myelopathy?

Back 15

Do not do lumbar puncture until absence of compressive cord lesion is proven b/c may convert partial to complete block.

Front 16

In which condition should there be emergent neuroimaging of spinal cord from cervical and thoracic down to conus?

Back 16

Acute myelopathy

Front 17

What is the most common cause of peripheral neuropathy?

Back 17

Diambetes

Front 18

What lab exams should be done for a patient w/ peripheral neuropathy?

Back 18

fasting blood sugar (for DM), CPK (muscle), ESR (inflammation), ANA (CT d/o--Lupus, Sjogrens), Other antibodies, liver & renal fxn tests, thyroid fxn tests, serum + urine protein electrophoresis (looking for M protein)

Front 19

What would you see in albuminocytologic dissocation of CSF?

Back 19

nl CSF WBC, Elevated CSF protein.

Front 20

Which condition should you think of when you get elevated CSF WBC cot in demyelinating polyneuropathy?

Back 20

HIV

Front 21

Distinguish b/w myopathy & neuropathy on Needle EMG examination?

Back 21

Examination activation of motor units (MUP).
-Large MUP: Neuropathy, Small MUP: myopathy;
-Polyphasic: usually Neuropathy due to reinnervation
-Reduced recruitment: neuropathy, increased recruitment: myopathy.

Front 22

What can you use an EMG to see?

Back 22

Lesions of peripheral nervous system: anterior horn cell, N roots & plexus, individual peripheral Nervies or general, NMJ, muscle, includes N injury, CAN'T test small unmyelinated nerves.

Front 23

What can you NOT test w/ electromyography?

Back 23

CNS lesions & small fiber neuropathy

Front 24

How long does it takes for a nerve to degenerate post injury?

Back 24

7-10 days.

Front 25

Describe the motor/sensory pathway for the nervous system beginning w/ the muscle & ending in the brain.

Back 25

Muscle-->NMJ-->Nerve-->Plexus--->Nerve root-->(Anterior Horn Cell)-->Spinal cord-->Brain.

Front 26

Describe myopathy including muscle pain, motor, sensory, reflexes.

Back 26

Muscle pain w/ mvmt, palpation. Sensory-nl
Reflexes: nl or reduced, proportional to degree of wkness.
Motor: nl, hypertonicity, or atrophy, nl or reduced muscle tone, dysphagia possible, eye mvmts nl, face normal.

Front 27

What lab value should be considered in myopathy?

Back 27

CPK--may be elevated or nl-->& elevated sed rate if inflammatory.

Front 28

What will be the results of an EMG in myopathy?

Back 28

NL sensory nerves & NL or reduced amplitude motor nerves.

Front 29

What will be the results of a Needle EMG in myopathy?

Back 29

increased spontaneous activity, small MUP, increased recruitment.

Front 30

What are the results of nerve condution, repetitive nerve conduction, and needle EMG exam w/ neuromusclear junction dis.?

Back 30

-Nerve conduction-NL
-Repetitive N conduction: decremental response;
-Needle EMG examination: NL

Front 31

How does Neuromuscular Junction Dis. affect muscle tone, reflexes, & sensory?

Back 31

Sensory-nl, reflexes-nl or reduced, muscle tone-nl or reduced.

Front 32

How does NJD affect the bulbar musculature?

Back 32

dysphagia, dysarthria--Neuro emergency!

Front 33

What does NJD do to the eyes?

Back 33

variable diplopia & ptosis (test for prolonged-2 minute upgaze or arm elevation)

Front 34

A nerve lesion of which cranial nerve will give you upper & lower face weakness?

Back 34

CN VII

Front 35

How does a nerve lesion (axonal & demyelinating)appear on EMG?

Back 35

Axonal: nl latency, reduced amplitude, nl conduction velocity,
Demyelinating (ex. GBS): prolonged latency, slowed conduction velocity, blocks.

Front 36

How does a Nerve lesion appear on needle EMG?

Back 36

Increased insertional activity,positive waves & fibrillation potentials, reduced recruitment, large polyphasic MUPs