Question 14.1

Created on Tue, 05/12/2015 - 19:36
Last updated on Thu, 09/24/2015 - 00:32
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Other SAQs in this paper

Other SAQs on this topic

In each part of this question, list clinical examination findings for each of the two underlined conditions that would help you to distinguish between them:

  • A myopathy or a neuropathy as being the cause of weakness in all limbs of a patient

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College Answer


  • Wasting is late sign
  • Usually proximal weakness
  • Reflexes preserved until late
  • Normal sensory exam
  • May be muscle tenderness


  • Wasting earlier
  • May be fasciculations
  • Often peripheral distribution
  • Loss of reflexes
  • May be abnormal sensory exam


This comes down to basic common sense.

If the nerves are healthy, and the muscles are to blame,

  • The sensory supply should be preserved
  • The reflexes should be preserved
  • Weakness should be proximal - that is where the bigger muscles are, and the weakness there will be more obvious.
  • There should be no fasciculations


  • There may be myocardial involvement (skeletal myopathies tend to be associated with cadiomyopathy)
  • The muscles involved may be painful and tender(as in myositis)

This question has been repeated. Its doppelganger, Question 3.1 from the first paper of 2010, has a much better-organised college answer.


Chapter   57   (pp. 617)  Neuromuscular  diseases  in  intensive  care by George  Skowronski  and  Manoj  K  Saxena

UpToDate: An approach to the patient with muscle weakness

Young, G. Bryan, and Robert R. Hammond. "A stronger approach to weakness in the intensive care unit." Critical care 8.6 (2004): 416.

Dhand, Upinder K. "Clinical approach to the weak patient in the intensive care unit." Respiratory care 51.9 (2006): 1024-1041.