mahoney

Question 1

Demyelinating disease vs Axonal disease

Answer 1

DEMYELINATING DISEASE

• NCV is SLOWED by 50% normal
• amplitude is NORMAL
• distal latency is PROLONGED

Axonal diseases

• NCV is SLOWED slightly
• Amplitude is LOWERED
• distal latency is NORMAL

Question 2

What is the preferred location of gluteal IM inject

Answer 2

GLUTEAL IM injection is the VENTROGLUTEAL AREA

• NOT the dorsogluteal area

Question 3

Use of NSAIDS in people with asthma

Answer 3

• By blocking cyclo-oxygenase pathway, NSAIDS shift pathway to production of leukotrienes which can cause bronchospasms
• SAFE TO USE ONLY COX-2 inhibitors

Question 4

ACUTE ONSET of peripheral neuropathy

Answer 4

• P = Proximal diabetic neuropathy (diabetic amyotrophy)
• A = Arterial vasculitis
• T = Toxins (thallium, arsenic, mercury, pesticides)
• P = Paraneoplastic syndrome
• A = Acute inflammatory demyelinating polyradiculoneuropathy (AIDP)… Guillain-Barre
• T = Trauma

Question 5

Chronic causes of peripheral neuropathy

Answer 5

occurs over 2 years or more

• Hereditary neuropathies
• Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP)
• DIABETIC POLYNEUROPATHY

Question 6

decreased vibration sensation suggests…

Answer 6

large fiber involvement and “dying-back” phenomenon (distal symmetric axonal damage)

Question 7

Diminished pinprick and light touch suggests…

Answer 7

involvement of small fibers (generally unmyelinated)

Question 8

inability to stand on heels suggests…

Answer 8

peripheral neuropathy

• if most neuropathies are of the distal variety, they will be prone to the “dying-back” phenomenon which affects the longest nerves first

Question 9

Inability to stand on tiptoes sugests…

Answer 9

CNS problem (spinal cord tumor or lesion)

Question 10

what are the two most relevant signs that increase likelihood of distal symmetrical polyneuropathy.,,,

Answer 10

• decreased or absent ankle reflexes
• decreased distal sensation

Question 11

what is the acroymn for causes of neuropathy

Answer 11

• A DUMB
  
  • metabolic
• MedICAL
  
  • Toxic
• BL(mO)G
  
  • Malignancy
• to CHARt
  
  • Charcot-Marie-Tooth
• Infections
  
  • infections (5)

Question 12

A DUMB

Answer 12

• Amyloidosis
• diabetes
• uremia
• myxedema
• B12, B6, B1 (thiamine) deficiencies

Question 13

MedICAL

Answer 13

toxins

• Medications
  
  • Cancer drugs, arthritic drugs, psychotropic drugs, antibiotics/antivirals, cardiac drugs
• Metal (heavy) exposure
• Insecticides
• Alcohol

Question 14

BL(oM)G

Answer 14

Malignancy

• Bronchogenic carcinoma
• lymphoma
• mOnoclonal paraproteinemias
• gastric carcinoma

Question 15

to CHARt

Answer 15

Hereditary

• Charcot-Marie-tooth

Question 16

Infections

Answer 16

2 H and 2 L and 1 B

• HIV
• Lyme
• Borreliosis
• Leprosy
• Hepatitis

Question 17

Gait unsteadiness suggests…

Answer 17

proximal and/or distal muslce weakness or loss of position sense

Question 18

What type of blood tests are useful in PN

Answer 18

• fasting blood glucose
• A1C
• creatinine
• TSH
• B12
• and PLASMA electrophoresis to rule out multiple myeloma in older men

Question 19

NCV vs EMG

Answer 19

• NCV = distinguishes axonal fromd emyelinating
• EMG = distinguishes nerve from muscular disease

Don’t work very well in small fibers neuropathy

gold standar for large fiber

Question 20

what percentage of diabetic with neuropathy have an etiology other than diabetes

Answer 20

10%

Question 21

what is the signficant of a CSF finding which the Protein is elevated in the absence of white cells

Answer 21

Suggests a demyelinating polyneuropathy

so called albumino-cytologic dissociation

Question 22

Guillain barre

Answer 22

• Acute peripheral neruopathy (demyelinating)
• 50% of the time it is preceeded by gastroenteritis
• Prognosis is good (tx with plasmapheresis, IVIg, close medical support)
• Elevated protein with the absence of white cells in the CSF
• ability to stand on heels, hyporeflexia, negative babinksi, distal sensory loss in the stocking-glove distribution –> suggestive of PNS problem
  
  • muscle tone is flaccid