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Clin Med 3 Final Exam > Lecture 2-neuropathies/ALS > Flashcards

Lecture 2-neuropathies/ALS Flashcards

1
Q

Nerve causing foot drop

A

Perineal nerve

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2
Q

Nerve causing weakness of hand muscles

A

Ulnar nerve

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3
Q

Nerve causing wrist drop

A

Radial nerve

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4
Q

Mononeuropathy multiplex examples

A

DM(combo of individual nerves usu in stocking glove distribution) and thoracic neuropathy(ex of brachial plexus)

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5
Q

Poly neuropathic commonly seen in what nerve distribution?

A

Distal nerve distributions

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6
Q

Damage to the axons but NO nerve damage

A

Neuropraxia (ex: Saturday night palsy)

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7
Q

Causes of mechanical pathology

A

Direct trauma, neuropraxia, or entrapment

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8
Q

Ischemia of nerves

A

Vascular neuropathies

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9
Q

Examples of vascular neuropathies

A

DM, poly arthritis nodosa, and RA

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10
Q

Vascular neuropathies will be in ____(multiple or single) nerve distributions

A

Multiple

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11
Q

Most common atonal polyneuropathy

A

DM

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12
Q

Both motor and sensory deficits but SENSORY dominates

A

Axonal polyneuropathies

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13
Q

Diabetic polyneuropathy

A
  • symmetric distal sensory loss in feet
  • loss of thermal and vibratory sense first
  • may complain of pain
  • may see mononeuropathy a/w DM
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14
Q

Most common mononeuropathy a/w diabetes

A

3rd nerve palsy

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15
Q

Neuronal polyneuropathy

A
  • ABSENCE of sensory involvement (Looks like pure motor)
  • involves proximal and distal muscles
  • fasciculations
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16
Q

Most common neuronal polyneuropathy

A

Amyotrophic lateral sclerosis (ALS)

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17
Q

Acute demyelination polyneuropathy

A

GBS

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18
Q

Chronic demyelinating polyneuropathy

A

Charcot-Marie-tooth

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19
Q

What will you see in CSF with all demyelinating polyneuropathies

A

Elevated protein in CSF

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20
Q

Most common mono neuropathy

A

Median nerve causing carpal tunnel syndrome

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21
Q

Guillian-barre pathology starts with

A

pins and needles in feet progression to weakness in legs and moves proximally; DTRs lost early in lower extremities

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22
Q

Guillian-barre can happen after infection 60% of the time with these etiologic agents

A

URI, campylobacter, mono, CMV, herpes

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23
Q

demyelinating disease seen in 2nd and 4th decade

A

charcot-marie-tooth (inherited)

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24
Q

see slowly evolving footdrop, on exam shows distal wasting of intrinsic muscles of feet; may have hx of ankle sprains

A

Charcot marie tooth

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25
Q

acute

A

onset in a few days; think trauma with compression

26
Q

subacute

A

onset within 2-4wks

27
Q

chronic

A

onset >1 month prior; think DM

28
Q

most causes of peripheral neuropathy affect

A

BOTH MOTOR AND SENSORY

29
Q

Motor symptoms

A

weakness, fatigue, cramps, muscle twitches

30
Q

Sensory symptoms

A

numbness, pain (sharp, burning, stabbing, shooting), alteration in sensation, loss of coordination (sensory ataxia)

31
Q

most UNCOMMON complaint in sensory symptoms

A

sensory ataxia

32
Q

Motor signs we observe

A

weakness (usually focal; classify strength/compare sides), fatigue (myasthenia), cramps (must work muscles to see), fasciculations (easier to see in thin pts and more prominent in gastrocnemius)

33
Q

Sensory signs we observe

A

sensory loss (loss of sharp/dull, light touch), sensory ataxia (may look cerebellar), hyporeflexia (loss of sensory feedback from muscles)

34
Q

In polyneuropathies the deficit of sensory lost is seen in

A

distal areas (stocking glove)

35
Q

Myopathy definition

A

inflammation or degeneration of skeletal muscles

36
Q

Differences of myopathy and neuropathy:

A

myopathy has PROXIMAL motor weakness

neuropathies have DISTAL motor weakness if ANY sensory loss and or loss of reflexes think NEUROPATHY

37
Q

Motor neuron disease findings

A

typically produce symptoms of upper and or lower motor neuron dysfunction WITHOUT sensory symptoms

38
Q

B-12 Deficiency findings

A

symmetrical distal sensory involvement and symmetrical proximal motor involvement

39
Q

two CLASSIC studies for neuropathies

A

EMG and nerve conduction studies

40
Q

findings of slowing of nerve conduction velocity suggest

A

DEMYELINATING neuropathy (GB, CMT)

41
Q

findings of denervation changes on EMG

A

AXONAL neuropathy

42
Q

findings of segment of one nerve

A

MONONEUROPATHY

43
Q

findings of slowing of nerve conduction velocity on multiple nerves

A

POLYNEUROPATHY

44
Q

Nerve biopsy indication

A

if you think inflammatory

45
Q

Muscle biopsy indication

A

if you think myopathy

46
Q

Imaging indication

A

if you think TUMOR

47
Q

DM Tx

A

control glucose; maybe try TCAs for neuropathic pain

48
Q

Guillian-Barre Tx

A

supportive care, steroids DONT help

49
Q

Carpul tunnel tx

A

cock-up splint or surgery

50
Q

ALS tx

A

anticonvulsants for fasciculations

51
Q

B-12 Tx

A

replace B-12 (duh)

52
Q

Non-pharmacologic tx

A

PT, TENS, Magnets, relaxation techniques

53
Q

idiopathic disease affecting both upper and lower motor neurons with NO ALTERATION in sensation

A

ALS

54
Q

ALS accounts for what % of acquires motor neuron disease

A

80%

55
Q

ALS weakness usually starts where

A

hands and arms and goes to legs later

56
Q

commonly seen with ALS

A

muscle twitching and cramps

57
Q

Signs and symptoms of ALS

A

PAINLESS progressive weakness of intrinsic muscles of the hand, may even see wasting of the msucles

58
Q

Hallmark of ALS

A

presence of both upper and lower motor neuron signs in the same limb (spastic tone, hyperreflexia, fasciculations, wasting)

59
Q

tongue fasciculations with limb weakness and upper motor neuron signs highly suggest:

A

ALS

60
Q

How is ALS diagnosed?

A

clinically!!!; NCS normal, EMG shows widespread involvement of proximal and distal muscles, imaging is normal

61
Q

ALS prognosis

A

mean duration of time between symptoms and death is 27-43months

Clin Med 3 Final Exam (6 decks)

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