Muscle Disorders and Reflexes Quiz

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Questions and Answers

What should be ensured if a teratogenic medication is prescribed to a female of childbearing age?

  • She must be monitored every week.
  • She must be fully informed of potential risks. (correct)
  • She must stop all contraception.
  • She should increase her medication dose.

Muscle weakness and fatigability are common symptoms of muscle disorders.

True (A)

What condition is suggested by spontaneous, irregular, and brief contractions of a muscle?

Lower Motor Neuron disease (LMN disease)

Dystrophia myotonica is characterized by weakness and __________, particularly in the face and neck.

<p>myotonia</p> Signup and view all the answers

Match the symptoms of muscle disorders with their descriptions:

<p>Muscle weakness = Generalized decrease in muscle strength Fasciculation = Brief contractions suggesting LMN disease Myotonia = Delayed relaxation after muscle contraction Local muscular tenderness = Pain indicating possible infiltration</p> Signup and view all the answers

What is the role of the reflex arc in the reflex action?

<p>It transmits the stimulus via sensory nerves to create muscle contraction. (B)</p> Signup and view all the answers

Clonus is associated with lower motor neuron lesions.

<p>False (B)</p> Signup and view all the answers

What does the presence of a brisk reflex indicate?

<p>An upper motor neuron lesion.</p> Signup and view all the answers

A reflex that is absent could imply a breach in the reflex arc at the __________ nerve or root.

<p>sensory</p> Signup and view all the answers

Match each type of reflex response with its implication:

<p>Absent reflex = Breach at sensory nerve or root Brisk reflex = Upper motor neuron lesion Clonus = Rhythmic involuntary muscle contraction Reinforcement = Method to enhance absent reflex</p> Signup and view all the answers

Which method is used to accentuate a reflex that seems absent?

<p>Asking the patient to clench their teeth. (C)</p> Signup and view all the answers

Reinforcement of reflexes lasts indefinitely until the reflex is observed.

<p>False (B)</p> Signup and view all the answers

What type of problems might an absent reflex indicate?

<p>Neuropathy or myopathy.</p> Signup and view all the answers

Which of the following cranial nerves is tested for the ability to differentiate smells?

<p>Olfactory nerve (D)</p> Signup and view all the answers

Monocular blindness indicates a lesion in the optic chiasm.

<p>False (B)</p> Signup and view all the answers

What is one potential cause of lesions affecting cranial nerves?

<p>Diabetes Mellitus (DM)</p> Signup and view all the answers

The cranial nerve responsible for vision is the ______.

<p>Optic nerve</p> Signup and view all the answers

Match the cranial nerves with their clinical tests:

<p>I = Smell test II = Visual acuity and fields III = Pupillary reaction IV = Eye movement</p> Signup and view all the answers

Which of the following conditions can affect cranial nerves?

<p>Meningitis (A)</p> Signup and view all the answers

Bitemporal hemianopia is a result of a lesion beyond the optic chiasm.

<p>False (B)</p> Signup and view all the answers

Name one type of visual field loss that can occur due to lesions affecting cranial nerves.

<p>Homonymous hemianopia</p> Signup and view all the answers

What is a common cause of diplopia when looking outwards?

<p>Brainstem CVA (B)</p> Signup and view all the answers

A normal-sized pupil indicates a IIIrd nerve lesion.

<p>False (B)</p> Signup and view all the answers

What are the symptoms of a VII nerve (facial nerve) lesion?

<p>Facial weakness and droop</p> Signup and view all the answers

The __________ nerve is responsible for hearing and balance.

<p>Vestibulo-cochlear</p> Signup and view all the answers

Match the cranial nerve with its associated symptoms:

<p>III = Ptosis and diplopia IV = Diplopia on looking down and in V = Jaw deviation and corneal reflex loss VII = Facial droop and weakness</p> Signup and view all the answers

Which of the following conditions is NOT related to facial nerve (VII) damage?

<p>Trigeminal neuralgia (C)</p> Signup and view all the answers

The function of cranial nerve VIII includes only auditory capabilities.

<p>False (B)</p> Signup and view all the answers

What is the potential cause of a unilateral corneal reflex loss?

<p>Trigeminal nerve lesion</p> Signup and view all the answers

Which drug class is NOT commonly associated with exacerbating neurological symptoms according to the content?

<p>Corticosteroids (A)</p> Signup and view all the answers

Iron deficiency is associated with 50% of sufferers in the context provided.

<p>False (B)</p> Signup and view all the answers

What is the recommended management for Wernicke's encephalopathy?

<p>Start thiamine 200–300mg od po.</p> Signup and view all the answers

The most common inherited ataxia is __________.

<p>Friedreich’s ataxia</p> Signup and view all the answers

Match the neurological conditions with their associated symptoms or characteristics:

<p>Wernicke’s encephalopathy = Thiamine deficiency leading to nystagmus, ophthalmoplegia Friedreich’s ataxia = Progressive gait and limb ataxia, hypertrophic cardiomyopathy Korsakoff syndrome = Confabulation and memory acquisition issues Huntington’s disease = Movement abnormalities and dementia</p> Signup and view all the answers

Which of the following management strategies is prioritized before drug therapies?

<p>Reassurance and information (D)</p> Signup and view all the answers

Korsakoff syndrome can occur without a history of alcohol misuse.

<p>False (B)</p> Signup and view all the answers

What are two common symptoms of Huntington’s disease?

<p>Chorea and dementia</p> Signup and view all the answers

What percentage of patients is affected by relapsing-remitting MS (RRMS)?

<p>85% (D)</p> Signup and view all the answers

Secondary progressive MS (SPMS) develops in 65% of patients after 15 years of relapsing-remitting MS.

<p>True (A)</p> Signup and view all the answers

What is the first-line treatment for acute relapses of MS?

<p>oral methylprednisolone</p> Signup and view all the answers

Primary progressive MS (PPMS) affects ___% of patients.

<p>10</p> Signup and view all the answers

Match the following types of MS with their characteristics:

<p>Relapsing-remitting MS = 85% of patients with episodes and full recovery Secondary progressive MS = Continuous downward progression after initial period Primary progressive MS = Steady progression from the outset Management = Referral and testing to confirm diagnosis</p> Signup and view all the answers

Which of the following is NOT a disease-modifying drug for MS?

<p>Ibuprofen (A)</p> Signup and view all the answers

All disease-modifying drugs for MS are prescribed without monitoring.

<p>False (B)</p> Signup and view all the answers

What is the Expanded Disability Status Scale (EDSS) threshold for starting treatment immediately?

<p>7</p> Signup and view all the answers

Flashcards

Reflexes

Automatic responses, typically involving a stimulus, sensory nerve, spinal cord, motor nerve, and muscle contraction, without brain involvement.

Reflex arc

The pathway a reflex travels from stimulus to response.

Absent or Decreased Reflex

A reflex that is absent or diminished, indicating a possible issue with the nerve pathway, such as a nerve injury or disease.

Hyperactive Reflex

An exaggerated reflex, often indicating an upper motor neuron lesion, like a stroke.

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Clonus

Rhythmic, involuntary muscle contractions due to sudden tendon stretching, often seen with an upper motor neuron lesion.

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Reinforcement

A technique used to enhance a reflex by asking the patient to clench their teeth or pull on their arms, increasing muscle tension.

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Neuropathy

A nerve disorder affecting peripheral nerves, often causing weakness, numbness, and tingling.

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Polyneuropathy

A nerve disorder affecting multiple peripheral nerves, often causing widespread symptoms like weakness, numbness, and tingling.

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Primary Progressive MS (PPMS)

A type of MS where symptoms worsen steadily from the beginning, with increasing disability.

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Secondary Progressive MS (SPMS)

A type of MS where symptoms worsen gradually over time after an initial period of relapses and remissions.

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Relapsing-Remitting MS (RRMS)

A type of MS where symptoms come and go, with periods of complete or near-complete recovery.

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Disease-Modifying Drugs (DMDs)

Drugs that modify the course of MS by reducing the frequency and severity of relapses and slowing disease progression.

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Expanded Disability Status Scale (EDSS)

A scale used to assess disability in MS patients, ranging from 0 (no disability) to 10 (death).

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Oral Methylprednisolone

A short-term treatment for acute relapses of MS, involving high doses of methylprednisolone.

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Multiple Sclerosis (MS)

A neurological condition that affects the central nervous system, causing inflammation and damage to the myelin sheath that protects nerve fibers.

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Eligibility Criteria for DMTs

The criteria that determine whether a patient is eligible for DMD treatment. It typically includes factors like diagnosis, disability level, and other health considerations.

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Third Nerve Palsy

A condition where the third cranial nerve is affected, resulting in weakness of the eye muscles, causing drooping eyelid (ptosis), dilated pupil, and the eye looking down and outwards. Other potential causes include diabetes, giant cell arteritis, syphilis, and posterior communicating artery aneurysm.

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Fourth Nerve Palsy

A condition where the fourth cranial nerve is affected, resulting in double vision when looking down and inwards. The affected individual may tilt their head to compensate.

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Trigeminal Nerve Palsy

A condition affecting the fifth cranial nerve, responsible for facial sensation and jaw movement. Sensory symptoms include facial pain, numbness, and loss of corneal reflex. Motor symptoms include jaw weakness and deviation.

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Sixth Nerve Palsy

A condition affecting the sixth cranial nerve, responsible for controlling the lateral rectus eye muscle, resulting in double vision when looking outwards.

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Facial Nerve Palsy

A condition affecting the seventh cranial nerve, responsible for facial expression control. Symptoms include facial weakness, drooping, and inability to raise eyebrows, show teeth, or puff out cheeks.

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Vestibulocochlear Nerve Palsy

A condition affecting the eighth cranial nerve, responsible for hearing and balance. Symptoms include hearing loss, tinnitus (ringing in the ears), and dizziness.

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Glossopharyngeal Nerve Palsy

A condition affecting the ninth cranial nerve, responsible for taste, swallowing, and salivary gland function. Symptoms include difficulty swallowing, dry mouth, and taste alterations.

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Vagus Nerve Palsy

A condition affecting the tenth cranial nerve, responsible for controlling the heart, lungs, and digestive system. Symptoms include difficulty swallowing, voice changes, and gastrointestinal disturbances.

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Olfactory Nerve Damage (CN I)

Loss of smell, often due to trauma, tumors in the frontal lobe, or meningitis.

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Monocular Blindness

Loss of vision in one eye due to damage to the optic nerve. Can result from conditions like MS or giant cell arteritis.

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Bitemporal Hemianopia

Loss of vision in both the right and left halves of the visual fields. Often caused by compression of the optic chiasm from a pituitary adenoma, craniopharyngioma, or internal carotid artery aneurysm.

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Homonymous Hemianopia

Loss of vision in half of the visual field on one side of the body. It occurs when the optic tract is damaged and is often caused by a stroke or tumor.

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Multiple Sclerosis (MS) and Demyelinating Diseases (DM)

A group of diseases that affect the central nervous system (brain and spinal cord). Common symptoms include muscle weakness, fatigue, vision problems, and numbness. MS is an autoimmune disease. DM is a progressive neurodegenerative disease.

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Sarcoidosis

A chronic inflammatory disease affecting various organs, including the lungs, eyes, skin, and lymph nodes. Often affects the nervous system, potentially causing cranial nerve damage.

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Vasculitis

Inflammation of blood vessels, potentially affecting the nervous system. This leads to damage to the vessel walls and narrowing of blood vessels, affecting blood flow to the brain.

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Syphilis

A sexually transmitted infection that can cause damage to the nervous system. If left untreated, it can affect many organs and systems, including the brain and nerves leading to vision problems.

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Teratogenic Drugs

Drugs that can cause birth defects if taken during pregnancy.

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Myotonia

A condition where muscles relax slowly after contraction, like difficulty letting go of a grip.

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Muscular Dystrophies

A group of genetic disorders causing progressive muscle weakness and degeneration.

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Dystrophia Myotonica

An autosomal dominant genetic disorder with variable symptoms including muscle weakness and myotonia.

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Dystrophia Myotonica

A genetic disorder causing muscle weakness and myotonia, particularly affecting the face, eyelids, jaw, neck, forearms, hands, lower legs, and feet.

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Restless Leg Syndrome (RLS)

A condition characterized by an irresistible urge to move the legs, often accompanied by uncomfortable sensations, particularly at night. It occurs in about 1 in 10 people and can be caused by several factors, including iron deficiency, pregnancy, medications, and underlying medical conditions.

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Wernicke's Encephalopathy

An acute neurological condition caused by severe thiamine (vitamin B1) deficiency. Symptoms include nystagmus (involuntary eye movements), ophthalmoplegia (eye muscle paralysis), and ataxia (lack of coordination). This condition is often a serious complication of alcohol misuse.

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Korsakoff Syndrome

A neurological condition that can occur after Wernicke's Encephalopathy. It is characterized by a severe anterograde amnesia, difficulty forming new memories. Individuals with Korsakoff syndrome often invent stories to fill in gaps in their memory.

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Huntington's Disease

An inherited neurological disorder characterized by involuntary movements, particularly chorea (rapid, jerky movements), and dementia. The condition is caused by a faulty gene and can be identified before symptoms appear. It primarily affects adults but can also affect children.

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Friedreich's Ataxia

An inherited neurological disorder that affects the nervous system and heart muscle. It causes progressive ataxia (lack of coordination), muscle weakness, and speech difficulties. It also affects the heart, often leading to hypertrophic cardiomyopathy, a condition where the heart muscle thickens. This disorder is usually diagnosed in adolescence and progresses over time, causing significant disability.

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Gilles de la Tourette Syndrome

A rare neurological condition that causes involuntary muscle contractions called tics. These tics can range from simple movements like blinking to complex movements, and may include vocalizations. The condition is often diagnosed in childhood and can be accompanied by behavioral issues and anxiety.

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Study Notes

Chapter 15: Neurology

  • Reflexes and muscle power: Reflexes are automatic responses; the reflex arc goes from stimulus to spinal cord and back to motor nerve. Key reflexes are recorded as absent, present with reinforcement, normal, or brisk ± clonus.
  • Cranial nerve lesions: Cranial nerves can be disrupted anywhere from the brainstem to the point of innervation. Sites of lesions include muscles, neuromuscular junctions, and locations outside/within the brainstem. Multiple nerves can be affected by certain conditions.
  • Neuropathy: Dermatomes and peripheral nerve distribution are included; mononeuropathy is a lesion of individual peripheral nerves (including cranial nerves). Common causes include trauma, compression, diabetes, leprosy, and cancer.
  • Mononeuropathies: Bell's palsy is sudden facial palsy of unknown cause. Ramsay Hunt syndrome is a viral infection causing pain in the ear, facial nerve palsy, and vesicles. Morton's metatarsalgia is a pain in the forefoot. Autonomic neuropathy can present as symptoms including postural hypotension, urinary problems, sweating issues, and vomiting issues.
  • Polyneuropathy: Generalized disorder affecting peripheral nerves including cranial and autonomic nerves. Sensory neuropathy causes numbness, tingling, and burning sensations; motor neuropathy causes weakness in the hands, stumbling, and difficulty in breathing.
  • Speech problems: Hoarseness, stammering, dysarthria, and dysphasia are discussed. Myasthenia gravis is an autoimmune disease causing muscle weakness, often affecting orbital and bulbar muscles. Lambert-Eaton syndrome is similar to myasthenia gravis.
  • Walking problems: Causes of walking difficulties include musculoskeletal issues (osteoarthritis, fractures), psychological issues (depression, fear of falling), neurological issues (stroke, Parkinson's disease), spinal cord compression, and systemic issues (pneumonia, infections).
  • Other movement problems: Cramps are painful muscle spasms, often at night or after exercise. Dystonia is a prolonged muscle contraction resulting in abnormal postures and movements. Myoclonus is sudden involuntary jerks, and may be associated with several conditions. Tremors, athetosis, chorea, and ballism/hemiballism are classified in this chapter.
  • Transient loss of consciousness: Funny turns in young children and causes of transient loss of consciousness in general are discussed.
  • Assessment of headache: History, including specific issues, symptoms, triggers, characteristics and response to medication. Examination should include blood pressure, neurologic examination, and head circumference in children.
  • Raised intracranial pressure (↑ ICP): Symptoms—including headache, drowsiness, vomiting, focal neurology, or seizures—are associated with ↑ ICP. Common causes include tumor, head injury, intracranial hemorrhage, hydrocephalus, meningitis, and cerebral edema.
  • Acute stroke and intracranial bleeds: Causes of acute stroke are cerebral infarction (atherothrombotic/embolic occlusion) and intracranial/subarachnoid hemorrhage. Risk factors include age, hypertension, diabetes, and prior stroke/TIA.
  • Prevention of stroke: Lifestyle measures (diet, exercise, alcohol reduction), primary prevention (treating hyperlipidemia, hypertension), and anticoagulation (for atrial fibrillation, valve disease)
  • Parkinsonism and Parkinson’s disease: Symptoms of Parkinsonism—tremor, rigidity, difficulty initiating movement, and slow movement—are discussed. Parkinson's disease is a neurodegenerative disorder of unknown cause; causes of Parkinsonism include other neurological conditions, drugs (e.g., haloperidol), toxins, trauma, or normal pressure hydrocephalus.
  • Multiple sclerosis (MS): Chronic disabling autoimmune disease. Symptoms depend on the area of the central nervous system affected. Common symptoms include visual symptoms, sensory/motor problems, balance issues, speech difficulties, pain, bladder/bowel problems, fatigue, and cognitive changes.
  • Motor neurone disease and CJD: MND is a progressive neurodegenerative disorder affecting motor neurons. CJD is a rapidly progressive prion disease.
  • Spinal cord conditions: Conditions affecting the spinal cord include quadriplegia, paraplegia, anterior cord syndrome, Brown-Séquard syndrome, and Cauda equina syndrome. Causes - trauma, tumours, abscesses, compression.
  • Muscle Disorders: Causes and symptoms are classified. Toxic myopathies (e.g. due to drugs) and acquired myopathies are presented.
  • Other neurological syndromes: Von Recklinghausen's disease (NF1) is an autosomal dominant trait neurofibromatosis. Neurofibromatosis 2 is much rarer, also autosomal, presenting predominantly with unilateral vestibular schwannoma; causes include drug use, toxins, and infections.

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