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MSK 2 > Clinical Approach to Peripheral Neuropathies (Hon) > Flashcards

Clinical Approach to Peripheral Neuropathies (Hon) Flashcards

1
Q

What is a dermatome?

What is a myotome?

What is a sclerotome?

A

1) Skin are supplied by a single spinal root
2) Muscle group supplied by a single spinal root
3) Area of bone supplied by a single spinal root

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2
Q

What is radiculopathy?

What can it be caused by?

A

Nerve root dysfunction

-Structural (discs, osteophytes, tumors, etc)
or
-non structural (DM, infections, etc) conditions

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3
Q

What are the most common cervical levels involved with radiculopathy?

Which is more common?

A

1) C5-6

2) C6-7 (more common)

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4
Q

What does a C5-6 radiculopathy lead to?

What does a C6-7 radiculopathy lead to?

A

1) C6 nerve root compression

2) C7 nerve root compression

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5
Q

What are the most common Lumbar levels involved with radiculopathy?

What does each lead to?

A

1) L4-L5 = L5 nerve root compression

2) L5-S1 = S1 nerve root compression

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6
Q

A C6 nerve root compression leads to:

1) Pain where?
2) Sensory loss where?
3) Weakness in what movement?
4) DTR loss where?

A

1) Scapula, shoulder, proximal arm
2) 1st and 2nd digit, lateral arm
3) Shoulder abduction, elbow flexion
4) Biceps

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7
Q

A C7 nerve root compression leads to:

1) Pain where?
2) Sensory loss where?
3) Weakness in what movement?
4) DTR loss where?

A

1) Scapula, shoulder, elbow
2) 3rd digit
3) Elbow and wrist extension
4) Triceps

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8
Q

A L5 nerve root compression leads to:

1) Pain where?
2) Sensory loss where?
3) Weakness in what movement?
4) DTR loss where?

A

1) Dorsal thigh and lateral calf
2) Lateral calf and dorsum of foot
3) Hamstrings and foot dorsiflexion, inversion, eversion
4) None

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9
Q

A S1 nerve root compression leads to:

1) Pain where?
2) Sensory loss where?
3) Weakness in what movement?
4) DTR loss where?

A

1) Posterior thigh and posterior calf
2) Posterolateral calf and lateral foot
3) Hamstrings and foot plantarflexion
4) Achilles

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10
Q

Match the dermatome level to the area it supplies:

1) C6
2) C7
3) C8
4) T1
5) T4
6) T10
7) L1
8) L4
9) L5

A

1) Thumb/Index Finger
2) Middle Finger
3) Fourth/Fifth Finger

4) Medial forearm
5) Nipple line
6) Umbilicus

7) Inguinal
8) Medial calf
9) Lateral calf

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11
Q

Parsonage-Turner Syndrome is a form of?

A

Brachial plexopathy

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12
Q

What is the clinical presentation of Parsonage-Turner Syndrome?

A

Severe pain in shoulder area

followed within a few days by weakness and atrophy

usually involving muscles of the shoulder girdle

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13
Q

What does the course look like for Parsonage-Turner Syndrome?

What can be given to help?

A

1) Spontaneous recovery in 6 – 18 months

2) Steroids

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14
Q

What are the different classifications of peripheral neuropathy?

A

1) Mononeuropathy
2) Polyneuropathy
3) Mononeuropathy Multiplex

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15
Q

What is Mononeuropathy Multiplex?

It may occur in some systemic disorders such as?

A
  • Focal involvement of 2 or more nerves

- DM and Vasculitis

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16
Q

What are some sensory findings seen with Peripheral nerve disease?

A

1) Loss of sensation
2) Paresthesia (pins & needles)
3) Pain (Burning sensations)

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17
Q

What are some motor findings seen with Peripheral nerve disease?

A

1) Muscle fasciculations (twitching)
2) Cramps

3) Distal weakness
4) Atrophy
5) Decreased DTRs

MC DAD

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18
Q

Large myelinated sensory fibers can be impaired due to peripheral nerve disease and is tested with what exams?

A

1) Light-touch (cotton swab)
2) Two-point discrimination
3) Vibration (128 Hz tuning fork)
4) Joint position sense

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19
Q

Small unmyelinated sensory fibers can be impaired due to peripheral nerve disease and is tested with what exams?

A

1) Temperature perception

2) Pain perception (pin prick)

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20
Q

Carpal tunnel syndrome involves entrapment of?

A

Median nerve

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21
Q

The usual sensory distribution of the median nerve is?

A

1) Medial palmar surface of the lower forearm and palm
2) Thenar eminence and thumb
3) Adjacent two and a half fingers.

22
Q

What hand motion is used to test Anterior Interosseous Syndrome (form of median mononeuropathy)?

A

The “ok” hand sign

23
Q

What is the most common site of ulnar mononeuropathy?

A

Cubital tunnel

24
Q

What sign is seen with ulnar neuropathy?

A

Froment sign (bends thumb excessively to grasp)

25
Q

What is the most common site of radial mononeuropathy?

What is it called when in this location?

A

1) Humerus/Spiral groove

2) Saturday Night Palsy

26
Q

What sign is seen with radial nerve damage?

A

Wrist drop

27
Q

What are the clinical features of peroneal mononeuropathy at fibular head?

A

1) Weakness of foot dorsiflexion and eversion
2) Weakness of toe extension
3) Sensory loss dorsum of foot

28
Q

“Large fiber” sensory involves?

“Small fiber” sensory?

A

1) Position/vibratory sense

2) Pain/temperature sense

29
Q

What is the most common autonomic abnormity seen with peripheral (Polyneuropathy) neuropathy?

A

Orthostatic hypotension

30
Q

Polyneuropathy results in what sensory loss pattern?

A

Stocking/glove sensory loss

31
Q

Which vitamin deficiency is most commonly associated with peripheral neuropathy?

Toxin?

Drug induced?

A
  • B12
  • Organophosphate
  • Phenytoin and Amiodirone
32
Q

The Romberg Maneuver tests?

A

Proprioception

33
Q

What signs are seen with Small Fiber Polyneuropathy?

A

1) Decreased pin-prick and temperature sensation

2) Dysesthesia to light touch

34
Q

What is seen on skin biopsy for Small Fiber Polyneuropathy?

A

Decreased epidermal nerve fiber density

*Ultimate test

35
Q

What is the most common identifiable cause of neuropathy?

What is the second most common cause?

A

DM

Alcohol!

36
Q

What CNs can be affected by neuropathy due to DM?

A

1) CN III
2) CN VI
3) CN VII

37
Q

What is the most common form of Hereditary Motor Sensory Neuropathies (Charcot-Marie-Tooth)?

A

HMSN I

38
Q

What is the inheritance pattern of HMSN I?

What is the age of onset?

What is the first symptom seen?

A

1) AD
2) Before age 20
3) Difficulty walking or running

39
Q

What are the classic skeletal deformities seen with HMSN I?

A

1) Pes cavus

2) Hammer toes

40
Q

What does EMG show for HMSN I?

A

Slowing of motor nerve conduction velocities (i.e. Demyelination)

41
Q

HMSN III is a very severe demyelinating neuropathy of?

A

Childhood

42
Q

What is the most common form of Acquired Demyelinating Polyneuropathies?

A

Acute inflammatory demyelinating polyneuropathy (Guillain-Barre)
AIDP

43
Q

Guillain-Barre Syndrome leads to?

A

Acute ascending motor paralysis (starts with legs first)

44
Q

What are some causes of Guillain-Barre?

A

1) EBV
2) Mycoplasma pneumonia
3) Campylobacter jejuni

45
Q

What is the most common cause of death with Guillain-Barre Syndrome?

A

Respiratory failure

46
Q

What is the CSF finding for Guillain-Barre Syndrome?

NCV? (Nerve Conduction Velocity)

A

Albumino-cytologic dissociation (Elevated protein and normal cell count/glucose

Slows conduction velocity

47
Q

What is the direct treatment for Guillain-Barre Syndrome?

A

Plasma exchange or IVIg

48
Q

Poor prognosis of Guillain-Barre Syndrome is assocaited with?

A

1) Low amplitude motor nerve response

2) Axonal involvement

49
Q

What variant of Guillain-Barre Syndrome presents with ophthalmoplegia, ataxia, areflexia, facial weakness?

What are the antibodies found with this variant?

A

1) Miller-Fisher Syndrome

2) GQ1b and GT1a antibodies

50
Q

What antibody is elevated with Multifocal Motor Neuropathy?

A

GM-1 Ab

MSK 2 (9 decks)

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