OME - Weakness

Question 1

Pathology of MS?

Answer 1

Demyelinating autoimmune disease usually affecting women in 20s - 40s

Question 2

Where can MS impact?

Answer 2

Literally anywhere in the brain / NS

Question 3

Presenting MS?

Answer 3

1. Women 20-40s
2. Any neuro symptoms
3. Separated by time: (relapsing, remitting)
4. And space: one neurologic symptom, and another at later point related to different structures
5. Optic neuritis - blurry painful vission

Question 4

What to think in optic neuritis?

Answer 4

MS

Question 5

How to work up MSI?

Answer 5

1. MRI - periventricular white matter

• Shiny white plaques next to ventricle wall
• Only the first time
  2. LP - Oligoclonal bands

Question 6

What to think oligoclonal bands on LP?

Answer 6

MS

Question 7

What to think shiny white plaques around ventricles on MRI?

Answer 7

MS

Question 8

Treatment MS?

Answer 8

Flare:
1. High dose, IV steroids
2. Rule out infection
Chronic:
1. Interferon
2. Glatiramer
3. Fingolanol

Question 9

How to treat urinary retention caused in MS?

Answer 9

Bethanechol

Question 10

How to treat urinary incontinence in MS?

Answer 10

Amitriptyline

Question 11

How to treat spasm in MS?

Answer 11

Baclofen

Question 12

How to treat neuropathic pain in MS?

Answer 12

Gabapentin

Question 13

What is guillain Barre?

Answer 13

• Autoimmune demyelinating disease

- Distal ascending paralysis up to diaphragm which can kill y a

Question 14

What to think if watery diarrhea / flu shot then ascending paralysis?

Answer 14

1. Diarrhea then ascending paralysis

2. Flu shot then ascending with HYPOreflexia

Question 15

Organism often causing GBD?

Answer 15

Campylobacter

Question 16

Diagnosis GBD?

Answer 16

1. Lp with lots of protein with very few cells

Question 17

Rx GBD?

Answer 17

1. Intubation
2. IVIG or Plasmapheresis
   * Never Give Steroids

Question 18

2 Demyelinating disorders?

Answer 18

1. MS

2. GBD

Question 19

How does the signaling work at NMJ?

Answer 19

1. ACH stored in presynaptic neuron
2. ACH receptors at the postsynaptic
3. Nerve conduction cause pre Ca channels to open
4. ACH spills from presynaptic

Question 20

Pathology Myasthenia Gravis?

Answer 20

1. Autoimmune disease against postsynaptic ACH receptors
2. Block AcH binding so harder to transmit the signal
3. More ACh needed to over come
4. Pre synaptic usually runs out of Ach
5. Signals no longer transmitted

Question 21

Presentation MG?

Answer 21

Fatigability in:

1. Eyes
2. Throat
3. Fine movement distal extremities
   - Due to Ach depletion at end plate

Question 22

Diagnosis MG?

Answer 22

1. Anti Ach receptor Ig
2. EMG with great amplitudes that fall off
3. CT scan looking for thymoma

Question 23

When is thymoma often seen?

Answer 23

MG

Question 24

Rx MG?

Answer 24

1. Cholinesterase inhibitors “stigmines”
2. Steroids
3. Remove Thymoma

Question 25

Rx myasthenic crisis?

Answer 25

Can't swallow of breathe: | 1. IVIg = plasmapheresis

Question 26

Pathophys Eaton Lambert?

Answer 26

- Often paraneoplastic syndrome - Ig against presynaptic Ca channels - Harders to release ACh

Question 27

Stander person with Eaton Lambert?

Answer 27

1. 50 or older 2. Improvement with use 3. Least used muscles are worst: proximal muscles

Question 28

What to think if cant rise out of chair, trouble combing hair, gettings things from high shelf?

Answer 28

Eaton Lambert

Question 29

Diagnosis Eaton?

Answer 29

1. Antibodies 2. EEG with amplitude increasing with use 3. CT looking for small cell cancer

Question 30

When will you see small cell lung cancer?

Answer 30

Eaton Lambert

Question 31

Treatment Eaton Lambert?

Answer 31

1. Treat cancer

Question 32

Presentation ALS?

Answer 32

1. Combined UMN and LMN lesions AT SAME TIME at different levels - Different limbs with different presentation 2. Sensation spared

Question 33

What happen in LMN lesion?

Answer 33

1. Areflexia 2. Weakness 3. Fasciculations

Question 34

What happens in UMN lesion?

Answer 34

1. Hyperreflexia | 2. Weakness

Question 35

How to diagnose ALS?

Answer 35

EMG

Question 36

Treatment ALS?

Answer 36

1. Supportive - will die of respiratory failure | 2. Riluzole - can add three weeks to life