EMQs in Clinical Medicine.pdf - Peshawar Medical College

106 Neurology
Box 3 summarizes some features of neurological disease that you may find in the
scenarios of EMQs.
Box 3 Neurological disease
Signs
Disease
• Mixed UMN and LMN signs Motor neuron disease [31]
NO sensory loss
• Optic neuritis is a common finding Multiple sclerosis [31]
in EMQs
Non-specific signs, e.g. leg weakness,
ataxia
May mention heat worsens symptoms
↑↑ CSF protein, oligoclonal IgG bands
on electrophoresis
Delayed visual/somatosensory evoked
potentials
• Lead-pipe rigidity, cog-wheel rigidity Parkinson’s disease [36, 41]
(if tremor)
Pill rolling tremor
Festinant gait with poor arm swing
• Young woman presents with weakness Myasthenia gravis [35]
muscles
On examination: bilateral ptosis,
proximal muscle weakness
Electromyography (EMG): decreased
muscle action potential after continuous
stimulation
Serum acetylcholine receptor antibodies
• Onset of chorea in middle age, Huntington’s disease [34, 38]
dementia later
Positive family history (autosomal
dominant)
• Triad of: gait apraxia
Normal pressure hydrocephalus
plus confusion
plus incontinence
Box 4 describes features of various neurological eponymous syndromes that may
help you when answering EMQs.