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Foundations II Exam 4 > Neurology Potpourri - 2 > Flashcards

Neurology Potpourri - 2 Flashcards

1
Q

T/F: Carpal tunnel is MC in women.

A

TRUE

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2
Q

What are the risk factors of carpal tunnel?

A

Obesity

Pregnancy

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3
Q

What disease involves the following structures:

  • flexor retinaculum (transverse carpal ligament)
  • carpal bones
  • 9 flexor tendons
  • Median nerve
A

Carpal Tunnel Syndrome

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4
Q

What sensory and motor deficits would a patient with Carpal Tunnel Syndrome present with?

A

Motor:

  • ABductor pollicis brevis
  • Flexor pollicis brevis (SF head)
  • Opponens pollicis
  • 1st & 2nd lumbricals
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5
Q

What disease does this describe?

Median nerve compression –> inflammation –> ischemia –> nerve damage

A

CTS (carpal tunnel syndrome)

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6
Q

What disease?

Extrinsic:

Compression is work related (typing on a keyboard)

Recreation related (cycling)

Positional (sleeping)

Intrinsic:

small anatomical space

fluid retention during pregnancy

tendon inflammation due to overuse or connective tissue disorder

A

CTS

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7
Q

Clinical presentation of what disease?

  • aching radiating to the thenar area
  • pain + numbness
  • dropping objects, cannot open jars or twist off lids
  • pain worsened by repetitive motion/ remaining stationary
A

CTS

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8
Q

Clinical Px of what dz?

  • sx worse @ night
  • pt awakens at night with pain or numbness & needs to “shake out” involved hand/wrist (flick sign)
A

CTS

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9
Q

What dz is this?

Physical Exam:

  • Inspect for thenar atrophy
  • thumb opposition against resistance
  • sensation over median nerve (Phalens & Tinnels)
A

CTS

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10
Q

What is the Dx & Tx of CTS

A

Clinical Dx

+/- nerve conduction testing

Treatment:

1. NSAIDS

2. PT

3. Wrist Splint @ night

+/- ergonomic modifications

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11
Q

How do you treat CTS if initial treatments didnt work?

A

Ortho surgery consultation

steroid injection

carpal tunnel release

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12
Q

Describe anatomy of ulnar nerve

A

passes through condylar groove b/w medial epicondyle & olecrenan

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13
Q

Clinical Px for which disease?

  • Paresthesias, tingling, numbness in medial hand, 1/2 of 4th finger, entire 5th finger.
  • pain @ elbow/forearm
  • Dec. sensation in ulnar distribution
  • Tinel’s sign @ elbow.
A

Ulnar neuropathy (cubital tunnel syndrome)

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14
Q

Tx for ulnar neuropathy

A
  • elbow pads
  • surgical tx performed IF:
    1. no improvement after 6-12 wks conservative tx
    2. progressive palsy or paralysis
    3. muscle wasting, clawing
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15
Q

Clinical Px of what?

  • wrist drop
  • cannot extend finger or abduct thumb
  • sensory loss in dorsal web b/w thumb and index finger
  • normal tricepts & brachioradialis strength
  • triceps reflex intact
  • spontaneously recovers in 6-8 weeks
A

Radial neuropathy

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16
Q

Tx of radial neuropathy

A

cock-up wrist & finger splints

PT

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17
Q

Clinical Px of what?

  • paresthesias, numbness, occasionally pain in lateral thigh
  • Sx increased with standing/walking
  • sx relieved by sitting
  • knee reflexes intact
A

Lateral cutaneous femoral neuropathy

“Meralgia paresthetica”

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18
Q

What is another name of lateral cutaneous femoral neuropathy?

A

meralgia paresthetica

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19
Q

T/F: meralgia paresthetica (lateral cutaneous femoral neuropathy) resolves spontaneously over wks-mos but CANNOT have permanent numbness

A

False: you CAN have permanent numbness

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20
Q

Tx of lateral cutaneous femoral neuropathy (meralgia paresthetica)

A

weight loss

avoid tight belts

analgesics (lidocaine patch)

NSAIDS

neuropathic pain meds

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21
Q

What is another name of Lateral cutaneous femoral neuropathy?

A

skinny jeans syndrome

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22
Q

Causes of skinny jean syndrome (lateral cutaneous femoral neuropathy OR meralgia paresthetica)

A

obesity

belts w/stuff hanging off

skinny jeans & heels

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23
Q

Clinical Px for what dz?

  • Foot drop
  • sensory loss
  • onset upon wakening
  • NO pain
A

Peroneal neuropathy

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24
Q

Which dz must you differentiate from L5 radiculopathy?

A

Peroneal neuropathy

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25
Q

What dz is this?

acute idiopathic facial nerve (CN VII) mononeuropathy

Lower motor neuron “lesion”

weakness –> paralysis

caused by HSV

A

Bell Palsy

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26
Q

What are risk factors of Bell Palsy?

A

DM

pregnancy in 3rd trimester

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27
Q

Clinical px of what dz?

  • sudden onset, peaks by 3 days
  • forehead unfurrows
  • facial creases & nasolabial fold disappear
  • corner of the mouth droops
  • sagging of the lower eyelid
  • tearing from the eye
  • loss of corneal reflex
A

Bell Palsy

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28
Q

What is the main difference between Bell Palsy vs. Stroke?

A

Stroke spares the forehead

Bell Palsy does not

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29
Q

Bell’s palsy is a _______ lesion.

Stroke is a _______ lesion.

A

Peripheral

Central

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30
Q

How do you dx Bell Palsy (main dx)?

A

Dx based on history & physical exam

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31
Q

What other diagnostic tests (+/-) can you do for Bell Palsy?

A

electrodiagnostic testing for complete paralysis

High resolution CT/ Gadolinium enhanced MRI : slow progression beyond 3wks, no improvement after 4 mos or when hx/physical exam suggest an alternate diagnosis

Serologic testing: Borrelia Burgdorferi

Audiometry: if hx/PE suggest an alternate diagnosis

32
Q

What is 1st line of treatment of Bell Palsy?

A

Prednisone: start within 3 days of sx onset

33
Q

When would you use Valacyclovir in Bell Palsy?

A

reserved for pts with severe nerve palsy or HZV presentation

34
Q

Additional therapeutic interventions for Bell Palsy

A

Eye protection

Acupuncture

PT

35
Q

What is CRPS (complex regional pain syndrome) AKA “reflex sympathetic dystrophy”?

A

rare disorder of extremities characterized by autonomic & vasomotor instability

36
Q

What dz?

  • Burning pain
  • autonomic dysfunction
  • vasomotor instability

Preceded by surgery or trauma

A

Complex Regional Pain Syndrome (CRPS)

OR

“reflex sympathetic dystrophy”

37
Q

inflammation, neurogenic inflammation, maladaptive changes in pain perception @ CNS

What dz?

A

CRPS

38
Q

Clinical Px for what dz?

  • Most commonly involves findings localized to the hand (not a single peripheral nerve)
  • burning/aching, allodynia that is aggravated by changes in environment or emotional stress
  • color & temp changes
  • physical changes in skin & nails
  • Limited ROM
A

CRPS (complex regional pain syndrome)

“reflex sympathetic dystrophy”

39
Q

Clinical Px for what dz?

  • cutaneous vasomotor changes (vasodilation & vasoconstriction)
    • red, mottled ashen color
    • inc or dec temp
    • dry or hyperhidrotic skin (excessive sweating)
    • edema
  • Motor abnormalities
    • Psychological distress
A

CRPS

“Reflex sympathetic dystrophy”

40
Q

Affected limb px within weeks of injury:

  • swollen, red, burning
  • diaphoresis
  • sx near site of injury

What stage of CRPS Type 1?

A

Acute Stage

41
Q

Affected limb sx within mos of injury:

  • skin cool & diaphoretic
  • sudek’s atrophy of bone on x-ray
  • pain occurs throughout entire limb

What stage of CRPS Type 1?

A

dystrophic stage

42
Q

affected limb sx yrs after injury:

  • skin pale & shiny
  • atrophy of muscle & bone
  • pain constant w/tx

What stage of CRPS Type 1 is this?

A

Atrophic Stage

43
Q

Dx of CRPS?

A

No specific test**

starts after limb trauma 4-6 wks

not explained by initial trauma

affects distal limb, goes beyond region involved in trauma

44
Q

“pain out of proportion”

what dz?

A

CRPS

45
Q

What is the budapest consensus criteria for clinical dx of CRPS?

A

_Continuing pain, disproportional to inciting event. **_

1 or more sx/sign in 3 of the following 4 categories:

sensory (hyperesthesia, allodynia)

vasomotor (temp, asymmetry, skin color changes)

sudomotor/edema

motor/trophic (dec. ROM, weakness, tremor, dystonia, changes of hair/skin/nails)

46
Q

What dx tools would you utilize for CRPS to determine whether there are bone changes/demineralization present?

A

Bone scan: diffuse increased uptake in affected extremity (early phase)

X-ray: generalixed osteopenia (later stages)

47
Q

Tx for mild cases of CRPS?

A

NSAIDS

48
Q

Tx for severe cases w/edema of CRPS?

A

Prednisone

49
Q

Neuropathic medications for CRPS?

A

tricyclic antidepressants: nortriptyline

anticonvulsatnts: gabapentin + pregabalin

SNRI’s: duloxetine, venlafaxine

50
Q

what meds would you use for bone changes (demineralization) present in CRPS?

A

biphosphonates, calcitonin

51
Q

What dz would you use the following as last line meds?

Topical lidocaine

tramadol, opioids

A

CRPS

52
Q

You can use neuromodulation as a tx for CRPS

T/F?

A

True:

implanted spinal cord stimulators

transcutaneous nerve stimulation (TENS)

brisk rubbing of affected part (counter irritation) & acupuncture

53
Q

You can use PT/OT for CRPS.

T/F?

A

True

54
Q

How can you attempt to prevent CRPS?

A

early mobilization after injury or surgery

55
Q

What disorder?

Neurodevelopmental d/o manifested by motor & phonic tics

M>F

Accompanied by OCD & ADHD.

affects kids aged 6-17 (adolescents)

A

Tourette Syndrome

56
Q

T/F: Fam hx of Tourette syndrome or OC is common

A

True

57
Q

What is the onset age of tics typically?

A

2-15 yrs w/ avg age of onset 6 yrs.

58
Q

Give examples of

Simple & Complex motor tics

A

Simple: blinking, facial grimacing, shoulder shrugging, head jerking

Complex: bizarre gait, kicking, jumping, body gyrations, scrathcing and seductive gestures

59
Q

What is echopraxia and what disorder is this part of?

A

mimicking gestures

TS

60
Q

What is copropraxia and what disorder is this part of?

A

obscene gestures

TS

61
Q

Give examples of simple vocal/phonic tics

A

sniffing, coughing, throat clearing, grunting

62
Q

Define coprolalia

A

obscene words

63
Q

define echolalia

A

repitition of words

64
Q

Define palilalia

A

repeating a phrase/word with inc rapidity

65
Q

Do tics often improve when focused on other tasks in Tourette’s Syndrome?

A

Yes, they do

66
Q

T/F: tics worsen with stress, anxiety or excitement

A

TRUE

67
Q

What are the clinical manifestations of Tourette?

A

motor/vocal/phonic tics

ritualistic behavior–> repeating behavior

PE normal except for presence of tics

68
Q

Dx of Tourettes Syndrome

A

Brain MRI: order only when abnormality detected on neurological exam.

EEG: IF need to evaluate seizure activity

69
Q

Diagnostic criteria for Tourette Syndrome

A

multiple motor + one or more phonic tics must be present (do not need to be concurrent)

tics must occur multiple times a day, nearly everyday

OR

intermittently throughout a period of more than one year

Onset before 18 y/old

tics must be witnessed

70
Q

Tx of Tourette Syndrome

A

Tx psychiatric disorder 1st if present

CIBT (comprehensive behavioral intervention)

71
Q

1st line Mod-severe tics TX

A

clonidine/guanfacine

72
Q

Which tx of TS is favored by specialists?

A

antidopaminergic (tetrabenazine)

73
Q

Tx for severe tics unresponsive to other meds

A

Haloperidol (antipsychotic)

74
Q

Tx for focal motor tics

A

Botox

75
Q
A

Foundations II Exam 4 (2 decks)

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