neuropathy

Question 1

what is carpal tunnel

Answer 1

median nerve entrapment. hypothyroid, pregnancy, rheumatoid, acromegaly

Question 2

what are the symptoms in carpal tunnel

Answer 2

nocturnal painful tingling in hand and or foream not confined to anatomical sensory territory of the nerve. weakness and wasting is a late sign

Question 3

what is Tinels test

Answer 3

tap on the flexor aspect of the wrist get tingling and pain

Question 4

what is Phalens test

Answer 4

symptoms on maximal wrist flexion

Question 5

what symptoms do you get with lesions median nerve at the wrist

Answer 5

sensory loss over radial 3 1/2 fingers and palm, weakness abductor pollicis brevis

Question 6

what is the ulnar nerve vulnerable to

Answer 6

elbow trauma. in the cubital tunnel.

Question 7

signs of ulnar nerve damage

Answer 7

weakness/wasting of medial side wrist flexors, interossei (cant cross fingers), medial 2 lumbricals (claw hand), hypothenar wasting (weak little finger abduction), sensory loss over medial 1 1/2 fingers

Question 8

treatment carpal tunnel

Answer 8

wrist splint at night or local steroid injections

Question 9

treatment ulnar cubital tunnel

Answer 9

night time soft elbow splinting

Question 10

what does the radial nerve do

Answer 10

opens the fist

Question 11

why can radial damage take place

Answer 11

against the humerus, eg when arm draped over hard chair for several hours

Question 12

signs radial damage

Answer 12

wrist and finger drop. sensory loss variable but can affect anatomical snuff box.

Question 13

what is lateral cutaneous nerve of the thigh compression called

Answer 13

meralgia paraesthetica

Question 14

lateral cutaneous nerve of the thigh compression signs

Answer 14

anterolateral burning thigh pain from entrapment under the inguinal ligament

Question 15

lateral cutaneous nerve of the thigh roots

Answer 15

L2-L3

Question 16

what is common peroneal nerve palsy

Answer 16

originates from sciatic nerve just above the knee. often damaged as winds around the fibular head due to trauma, cross legged sitting, yoga, in a cast

Question 17

signs common peroneal nerve palsy

Answer 17

foot drop, weak ankle dorsiflexion/eversion. sensory loss over dorsum of the foot

Question 18

causes of mononeuritis multiplex

Answer 18

occurs in DM, leprosy, vasculitis, amyloidosis,l malignancy, neurofibromatosis, HIV and hep C

Question 19

causes of polyneuropathies- metabolic

Answer 19

hypothyroid, DM, hypoglycaemia

Question 20

inflammatory causes of polyneuropathies

Answer 20

GBS, CIDP, sarcoidosis

Question 21

nutritional causes of polyneuropathies

Answer 21

low B1, B12, high B6, low folate

Question 22

causes of polyneuropathies malignancy

Answer 22

polycythaemia rubra ve ra, paraneoplastic syndromes

Question 23

causes of polyneuropathies infection

Answer 23

HIV, lyme disease, syphilis, leprosy

Question 24

causes of polyneuropathies vasculitides

Answer 24

RA, PAN, wegeners

Question 25

causes of polyneuropathies drugs

Answer 25

alcohol, cisplatin, vincristine, isoniazid, phenytoin, metronidazole

Question 26

what is guillain barre

Answer 26

immune mediated , symmetrical ascending muscle weakness. acute inflammatory demyelinating polyradiculopathy (AIDP)

Question 27

what can GBS follow

Answer 27

campylobacter jejuni and CMV around 1-3 weeks after

Question 28

what are the symptoms GBS

Answer 28

weakness distal limb muscles, and or distal numbness, low back pain can be an early feature. progresses proximally. loss of tendon reflexes and some autonomic

Question 29

what % GBS get facial and respiratory weakness

Answer 29

20%

Question 30

how is GBS diagnosed

Answer 30

clinically, nerve conduction studies- slowed conduction. CSF- protein increased

Question 31

what can be a variant of GBS

Answer 31

Miller Fisher Syndrome- proximal muscles- ocular motor palsy and ataxia, antibodies against GQ1b (ganglioside). CIDP- slower onset and recovery. AMAN (acute motor axonal neuropathy)- no sensory loss

Question 32

features required for diagnosis GBS

Answer 32

progressive weakness all 4 limbs, areflexia

Question 33

features excluding diagnosis GBS

Answer 33

purely sensory symptoms, diagnosis of MG, botulinism, poliomyelitis, diphtheria, porphyria, toxic neuropathy

Question 34

management GBS

Answer 34

IV Ig. plasma exchange. monitor ventilaiton (vital capacity) to see whether needs ventilatory support

Question 35

what tests can be done in polyneuropathies

Answer 35

FBC, ESR, glucose, U&E, LFT, TSH, B12, electrophoresis, ANA and ANCA, CXR, urinalysis, lead level, antiganglioside antibodies, nerve conduction- distinguish between demyelinating and axonal causes

Question 36

what neuropathies can you get in diabetes

Answer 36

distal symmetrical sensory (glove and stocking), acute painful sensory, mononeuropathy and mononeuritis multiplex, diabetic amyotrophy, autonomic neuropathy

Question 37

what can deficiency of B1 cause

Answer 37

thiamine. Wernicke-Korsakoffs. alcohol main cause is West

Question 38

signs in Wernicke Korsakoffs

Answer 38

eye signs-nystagmuc, conjugate gaze palsy; ataxia- broad based gait, cerebellar signs; cognitive- stupor and coma, confabulation and amnesia

Question 39

how to treat Wernickes Korsakoffs

Answer 39

thiamine

Question 40

genetic example of neuropathy

Answer 40

Charcot Marie Tooth

Question 41

what happens in Charcot Marie Tooth

Answer 41

distal limb wasting and weakness progresses slowly over years, mostly in legs. severe foot drop. pes cavus (high arch) and toe clawing

Question 42

what signs can be seen in autonomic neuropathy

Answer 42

postural hypotension, urinary retention, erectile dysfunction, nocturnal diarrhoea, diminished sweating

Question 43

in what can autonomic neuropathy be seen

Answer 43

diabetes, amyloidosis, GBS