Disorders of the Peripheral Nervous System

Question 1

NCV

Answer 1

Nerve conduction velocity

Amplitude - number of conducting fibers reduced in axonal loss

Conduction velocity - reflects myelin sheath…decreased in demyelinating process

Question 2

EMG good for

Answer 2

Myopathyic vs. neurologic causes

Question 3

Babinski sign in UMN vs. LMN

Answer 3

May be present in UMN…not in LMN

Question 4

PNS sensory presentation in general

Answer 4

Worse at night
Negative
Positive
Stocking-glove pattern

Question 5

ALS type of dz and what to look for generally

Answer 5

Acquired, chronic, motor neuron disease

UMN and LMN signs and symtoms

Question 6

Diagnosis of ALS

Answer 6

Weakness
No sensory loss of sphincter distrubance
Progressive course
No cause other than genetic

Question 7

ALS symptoms and signs

Answer 7

Mixed UMN and LMN in limbs

Cognitive decline in some cases

Weakness and wasting of muscles

Question 8

Risk factors and pop of ALS…what degenerates

Answer 8

SMoking
30-60
CN motor nuclei, anterior horn cells, corticospinal tracts

Question 9

ALS clinical findings

Answer 9

UMN and LMN
If bulbar - trouble chewing, swallowng, breathing (worse prognosis)
Drooping of palate and fasciculating tongue
Cog change
Motor weakness in limbs or stifness

Question 10

ALS labs

Answer 10

EMG - chronic partial denervation..sponatneous activity in resting muscle

Question 11

Tx of ALS

Answer 11

Riluzole reduces glutamate release

Supportive

Question 12

Course of ALS

Answer 12

Progressive
Fatal in 3-5 years from pulmonary infection
Worse if bulbar

Question 13

Spinal nerve disorders (herniated disc related radiculopathies)

Answer 13

Pain in a dermatomal region

Weakness of muslce in myotome

Question 14

Causes of spinal nerve dz

Answer 14

Herniated disc
Osteo or rehumatoid arthritis
Cancers

Question 15

Signs and symptoms of nerve root disorders

Answer 15

All LMN signs
Diminished reflexes
Shock-like pains may radiate down

Question 16

Grading of reflexes

Answer 16

0 - none 
1 - dimished 
2 - normal
3 - brisker but not necessarily dz 
4 - very bad with clonus

Question 17

Anke reflexx
Knee reflex
Brachioradilais
Biceps
Triceps

Answer 17

Sacral 1 
Lumbar 2-4 
Cervical 5-6
Cervical 5-6
Cervical 6-7

Question 18

Guillain Barre is also

Answer 18

Acute inflammatory demylinating polyneuropathy

Question 19

Guillan barre histo and clinically

Answer 19

Weakness in distal that rapidly advances to proximal (ascending paralysis)…areflexia…can progress to resp failure

Demyelination of spinal nerve roots and peripheral nerves

Question 20

Pathogen of G-B

Answer 20

GI realted often

Acute-onset immune mediated demyelinating neuropathy

Question 21

G-B tx and prognosis

Answer 21

Plasmapheresis and IV Ig
Supportive

May spend weeks in ICU but can survive

Question 22

Diabetes

Answer 22

Most common cause of peripheraly nerupathy

Question 23

Patterns of diabtetes

Answer 23

Ascending distal symmetric sensorimotor polyneuropathy

Auto dysfunction

Question 24

Pathology of diabetic symmetric sensorimotor polyneurpathy

Answer 24

Axonal neuropathy

Question 25

Clinical features of diabetes

Answer 25

Numbness with stocking-glove distribtuion Parethesias or dysethesias Hyporeflexia that may progress to weakness Charcot foot or skin ulcers

Question 26

Varicella Zoster

Answer 26

Latent infection within neurons of sensory ganglion Follows a dermatome Peripheral axonal degeneration

Question 27

Most common dermatomes of zoster

Answer 27

Trigeminal or throacic

Question 28

``` Carpal tunnel Cubital tunnel Saturday night Tarsal tunnel Meralgia paresthetica ```

Answer 28

``` Median nerve Ulnar nerve Radial nerve Posterior tibial nerve Lateral femoal cutaneous ```

Question 29

Carpal tunnel syndrome risk factors and presnetation

Answer 29

Thumb and first two digits numb...thenar atrophy...weakness in opposition Diabetes or excessive wrist motions

Question 30

Ulnar nerve palsy

Answer 30

Cubital tunnel syndrome Guyon's canal or ulnar groove Decreased 4th and 5th sensation with claw hand (hand of benediction) and weakness of finger abduciton

Question 31

Radial nerve palways

Answer 31

Extension of wrist and fingers - drop hand Decreased back of hand sensation

Question 32

Lateral femoral cutaneous neuropathy

Answer 32

Trapped under inguinal ligament Pure sensory over lateral thigh Eliminate the cause Tight belt, pregnant

Question 33

Peroneal neuropathy

Answer 33

Pain in laterla lower leg and foot drop

Question 34

Posterior tibial nerve neuroapthy

Answer 34

Pain in medial ankle and plantar surface...weakned toe flexors

Question 35

CMT type of dz

Answer 35

Herediatry motor and sensory neuropahty

Question 36

CMT symtpoms and findings

Answer 36

Hypertrophic neuropathy with onion bulb formation from schwann cell hyperplasia Distal muscle atrophy with sensory loss and pes cavus