Return to Scenario ListShow Learning Points most relevant to Phase 1:

Neuromuscular disease / generalised muscle weakness

Clinical Discipline(s)/Organ System(s)
Nervous System, Neurology, Palliative Medicine
Progress Test Topic(s)
A 36 year old NZ European woman presents to her GP with generalised fatigue, weakness and dysarthria. She has no significant past medical history.
Progress Test-Type Questions:   Question 1
Applied Science for Medicine 
   - Anatomy of the neural motor pathways
   - Physiology of neuromuscular control
   - Pathophysiology of neurodegenerative and neuro-inflammatory disorders including myasthenia gravis, multiple sclerosis and motor neuron disease
   - Cellular and molecular basis of autoimmunity
   - Pharmacology of neuromuscular blockers
Clinical and Communication Skills 
   - History from a patient with neuromuscular symptoms
   - Perform a focused neurological examination to localise the lesion within the nervous system and identify characteristic features
   - Indications for lumbar puncture, visual evoked responses, nerve conduction studies, CT and MRI
   - Interpret lumbar puncture, visual evoked responses, nerve conduction studies, CT and MRI results
   - Outline the management of myasthenia gravis and multiple sclerosis
   - Role of rehabilitation programmes and physiotherapy in neurodegenerative disorders
   - Palliative care in neurodegenerative disorders
Personal and Professional Skills 
   - Helping a patient to deal with uncertainty; importance of family involvement and support
   - Impact of chronic disease in a young patients with regards to employment, social life and body image
   - Developing palliative care skills
   - Discussion with patient and family regarding resuscitaiton status and the role of advance directives
Hauora Māori 
   - Acknowledgement of disproportionate impact of illness of whānau employment/income and therefore availability and models of caregiving
   - Knowledge that multiple sclerosis is less common in Māori than other patient groups
   - Consideration of access to cultural and spiritual support for patient/whānau
Population Health 
   - Epidemiology of multiple sclerosis, myasthenia gravis and motor neuron disease
Conditions to be considered relating to this scenario
myasthenia gravis, multiple sclerosis, motor neuron disease, transverse myelitis, Guillain–Barré syndrome
Less common but 'important not to miss'
acquired myopathies (Cushing's syndrome, hyperthyroidism, cancer, hypo/hypercalcaemia)
chronic inflammatory demyelinating polyneuropathy, lead poisoning, arsenic poisoning, vasculitis, inclusion body myositis, botulism, porphyria, arbovirus diseases, late-onset muscular dystrophies