Discover and read the best of Twitter Threads about #neuromuscularqanda

Most recents (16)

Q: Doc, doc there’s a patient with sudden onset shoulder pain which worsened precipitously over a couple of hours after recovering from the flu. What should we do?
A: Sounds like a typical history for Parsonage Turner Syndrome. You suspect this when there’s acute onset really severe shoulder pain after an infection, operation, pregnancy or vaccination.
Read 15 tweets
Q: Doc, doc, got a 35 year old chap in for terrible muscle aches after running a race. He says his urine is black. What could it be?
A: Black urine suggests myoglobin. What’s his CK? Is it elevated together with other muscle enzymes (AST, ALT, Aldolase)? If so, think rhabdo. Now the question is whether he’s got a provoked attack or has underlying genetic susceptibility.
Read 22 tweets
Time again for #NeuromuscularQandA? RT. #neurology #medtwitter#MedEd #medstudent#neurologyresident Join me in discussing/learning/educating with #passion and #humor@WNGtweets @MonicaDhakar @MadSattinJ @NinaRiggins @AaronLBerkowitz @RachelSalasMD
@Tracey1milligan @DxRxEdu
Q: Doc, doc. The limb girdle muscular dystrophies (LGMDs) are giving me a headache. Too many, too many, can’t you simplify them pretty please?
A: Your wish is my command. Let’s think about common presentations. Are there early contractures? Is there calf hypertrophy? Is there calf atrophy? Is there cardiomyopathy? Is there scapular winging? Is there facial weakness?
Read 25 tweets
Q: Doc, doc, got a middle-aged patient with subacute onset of proximal muscle weakness and CK of 10K. What could it be?
A: Any cutaneous or joint or respiratory issues? If it’s just muscle, it might be necrotizing autoimmune or toxic myopathy with that level of CK.
Read 19 tweets
Q: Doc, doc, have a patient with subacute weakness and suspected myositis. Why in the world are we considering these humongous panels of autoantibodies? Can’t we just do a muscle biopsy?
A: Just 2 reasons - diagnosis and prognosis. We send myositis specific antibodies (MSA) and myositis associated antibodies (MAA). MSA are antibodies specifically associated with inflammatory myopathies.
Read 16 tweets
Q: Doc, doc, got a patient with acute progression of proximal and distal weakness after the flu 3 weeks ago. Should we get NCS/EMG to confirm GBS?
A: To confirm? What are you looking for? When was the onset of weakness? If within first 2 weeks, you might get the typical demyelinating features in only 50 percent.
Read 15 tweets
Let’s do one on scapular winging. It’s a common neuromuscular condition. Consider it by the company it keeps - a good history and exam will save you time.
Q: Doc doc, my patient got scapular winging after cervical LN biopsy. What’s going on?
Read 15 tweets
Q: Doc doc, a conundrum. Gotta patient with old mets which resolved after RT to the lumbosacral area ages ago. There’s enhancement of the cauda equina on MRI. Is this cancer or RT damage?
A: Aye, an important question which changes management. Now enhancement could mean either or both, that it could. Does it hurt? RT damage is painless whereas cancer invasion is painful.
Read 10 tweets
Let’s have a philosophical discussion today. Q: Doc doc there are fibs and sharps everywhere on the EMG! Arms, legs, thoracic and lumbar paraspinals. NCS normal. What could it be?
A: Ah, widespread muscle membrane instability. Could be neurogenic, could be myopathic. What’s the recruitment like? Remember reduced recruitment in neurogenic and normal or rapid in myopathic.
Read 11 tweets
Q: Doc, doc, got a patient with CIDP. He wants to know when he can be off IVIG. He’s a gambling man, that he is. Wants to take his chances. #MedStudentTwitter #MedEd #AcademicTwitter
A: Game theory time! Naw, let’s see if we can answer it by closely looking at studies. Or just one. Check out the ICE study in 2008 and see if you can spot Wally. #meded
Read 7 tweets
Q: What up doc. This patient’s eyes don’t move right - tell me how to assess and tell me short and sweet.
A: If patient can’t move eyes to command but can reflex when you snap your fingers right and left - that’s supranuclear - think PSP.
Read 8 tweets
Q. What up doc. My #IBM patient doesn’t have #NT51a antibodies and my #SLE patient has #NT51a antibodies. I’m confused.
A: If only life wasn’t messy. 30 percent of #IBM patients don’t have #NT51a and false positives happen with #SLE and #Sjogrens which can cause #overlapmyositis.
Read 13 tweets
#NeuromuscularQandA! Questions you always wanted to ask your friendly #neuromuscular doc. RT. #neurology #medtwitter #MedEd #medstudent #neurologyresident Short answers only. Join me in discussing/learning/educating with #passion and #humor @WNGtweets @somedocs @MedTweetorials
Q: Cor blimey doc. You can tell what sort of vitamin deficiency neuropathy the patient has by looking at the blood? #twilight #bella #MedTwitter #MedStudentTwitter #MedEd @AaronLBerkowitz @MadSattinJ @Tracey1milligan @WNGtweets @NinaRiggins @RachelSalasMD @AlexMuccilli
A: Elementary, my dear Watson. #megaloblastic anemia - think B12 and Folate deficiency. #leukopenia - think copper deficiency. Throw in normocytic anemia - think #dysautonomia and small fiber neuropathy. Treat these and we treat #2birdswithonestone. Sherlock, out. @dysclinic
Read 4 tweets
Is it time for #NeuromuscularQandA? Questions you always wanted to ask your friendly #neuromuscular doc. RT. #neurology #medtwitter #MedEd #medstudent #neurologyresident Short answers only. Join me in discussing/learning/educating with #passion and #humor @WNGtweets @somedocs
A: Judge the tongue by the company it keeps. If it’s weak and wasted it ain’t tremor. #Musk myasthenia gravis and #ALS tongues may be weak and wasted with fasciculations. So try #steriods - If it responds to steroids it ain’t ALS - gotta be #MG. #clinicaldiagnosis
Read 4 tweets
#NeuromuscularQandA! Questions you always wanted to ask your friendly #neuromuscular doc. #neurology #medtwitter #MedEd #medstudent #neurologyresident Short answers only. Join me in discussing/learning/educating with #passion and #humor @WNGtweets @somedocs @ContinuumAAN
Q: What gives doc? Patient took the prednisone for #myastheniagravis and got worse. Is it a wonky batch?
A: Sometimes you get worse before you get better. 20 percent of #myastheniagravis patients get weaker in 2 weeks after starting steroids. Be careful if they have bulbar or respiratory symptoms - you don’t wanna have a #myastheniccrisis on your hands. @MyastheniaOrg
Read 4 tweets
#NeuromuscularQandA! Questions you always wanted to ask your friendly #neuromuscular doc. #neurology #medtwitter #MedEd #medstudent #neurologyresident Short answers only. Join me in discussing/learning/educating with #passion and #humor @WNGtweets @AANEMorg @CambridgeMedsoc
Q: What gives doc. Got a #myastheniagravis patient. The repetitive stimulations are positive but the AchR antibody ain’t. Ain’t MG an #autoimmune thing?
A: AChR Ab ain’t the only fish in the sea.Try Musk antibody -positive in 40% AChR Ab negative patients. If negative, the waiting game - 20% AChR Ab negative patients seroconvert in a year. Still negative? Ab are teeny tiny and sensitivity of lab testing determines what we see.
Read 4 tweets

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