Nonentrapment Peripheral Neuropathies

Question 1

What is the most common cause for peripheral neuropathy?
● A. Diabetes
● B. Arteritis
● C. Monoclonal gammopathy
● D. Acute idiopathic polyneuritis
● E. Sjogren syndrome

Answer 1

A. Diabetes

Question 2

In critical illness polyneuropathy (CIP), CPK levels are normal or mildly elevated while EMG shows what?
● A. Decrease in amplitudes of compound muscle action potentials
● B. Increase in amplitudes of compound muscle action potentials
● C. Amplitudes of compound muscle action potentials remain unchanged
● D. Two spikes per second
● E. Nonlocalizing changes

Answer 2

A. Decrease in amplitudes of compound muscle action potentials

Question 3

Idiopathic brachial plexitis usually starts to show some improvement by when?
● A. 3rd day
● B. 2nd week
● C. 4th week
● D. 2nd month
● E. 3rd month

Answer 3

C. 4th week

Question 4

EMG changes can be appreciated in neuralgic amyotrophy of the upper extremity after how long?
● A. 24 hours
● B. 48 hours
● C. 72 hours
● D. 2 weeks
● E. 3 weeks

Answer 4

E. 3 weeks

Question 5

A diabetic patient presents with abrupt onset of asymmetric pain in back, hip, buttocks, thigh, and leg usually deep aching/burning with superimposed lancinating paroxysms, severe at night. Progressive weakness in proximal and distal muscles was preceded by weight loss. Patellar reflexes are absent. Sensory loss is minimal. EMG findings consistent with demyelination are invariably accompanied by axonal degeneration, with involvement of paraspinals and no evidence of myopathy. These findings are consistent with what?
● A. Guillain Barre syndrome
● B. Bruns-Garland syndrome
● C. Ramsay Hunt syndrome
● D. Tolosa Hunt syndrome
● E. Brachial plexitis

Answer 5

B. Bruns-Garland syndrome

Question 6

Which of the following is not associated with drug-induced neuropathy?
● A. Metronidazole
● B. Ciprofloxacin
● C. Phenytoin
● D. Thallium
● E. Cisplatin

Question 7

What is the most common cause of femoral neuropathy?
● A. Diabetes
● B. Nerve entrapment
● C. Intra-abdominal tumor
● D. Femoral artery catheterization
● E. Retroperitoneal hematoma

Question 8

Peripheral nerves regeneration rate in mm/d is about how
much?
● A. 1
● B. 2
● C. 3
● D. 5
● E. 10

Answer 8

B. 2

Question 9

According to the Sunderland system for classification of peripheral nerve injury what is neurotmesis?
● A. First degree
● B. Second degree
● C. Third degree
● D. Fourth degree
● E. Fifth degree

Question 10

In which of the following complete interruption of axons and myelin sheaths takes place and Wallerian degeneration occurs whereas supporting structures including endoneurium remain intact?
● A. Neuropraxia
● B. Axonotmesis
● C. Neurotmesis
● D. Axonolysis
● E. First degree injury of Sunderland system

Question 11

Lesions of peripheral nerves can produce somatic findings (combination of weakness, sensory disturbance, and reflex changes) and/or autonomic disturbances. Etiologies of nonentrapment peripheral neuropathies include which of the follow-
ing?
● A. Diabetes
● B. Alcoholism
● C. Guillain-Barre syndrome
● D. Vasculitis/arteritis
● E. All of the above

Answer 11

E. All of the above

Question 12

A patient admitted in ICU developed critical illness neuropathy (CIP) also known as neuropathy of critical illness or ICU neuropathy. For evaluation of the patient, blood work with fasting electrolytes, Hgb-A1C, CBC, ESR, CRP, vitamin B12, methylmalonic acid, serum protein electrophoresis with serum
immunofixation, and electrodiagnostics (EMG/NCV) are done to rule out the cause of neuropathy. Following are the diagnostic criteria of CIP except?
● A. Presence of sepsis, multiorgan failure, septic inflammatory response syndrome, or respiratory failure
● B. Difficulty weaning from ventilator or extremity weakness
● C. EMG showing increased amplitudes of compound muscle action potentials
● D. Widespread muscle denervation potentials
● E. Normal or only mild increase in serum CPK levels

Question 13

A male patient 30 years of age develops acute onset of intense pain in right upper extremity some days after a viral illness. Weakness of the same limb developed acutely after 2 weeks of pain onset. Arm movements exacerbated the pain. EMG/NCV showed the portion of brachial plexus involved.
What is the most probable diagnosis in this patient?
● A. Parsonage Turner syndrome
● B. Immune-mediated brachial plexus neuropathy
● C. Neuralgic amyotrophy of the upper extremity
● D. Brachial plexitis
● E. All of the above

Question 14

A patient presents to neurosurgical OPD with history of sudden onset of pain in lower extremity with weakness of quadriceps femoris muscle, SLR positive. EMG/NCV was done which showed patchy denervation involving at least two segmental
levels with sparing of the paraspinal muscles. What is the most likely diagnosis in this case?
● A. L4 and L5 acute rupture of intervertebral disk
● B. Lumbosacral plexus neuropathy
● C. Rupture of AVM at L4 and L5 level
● D. Sudden compression of lumbosacral plexus
● E. None of the above

Question 15

About 50% of patients with diabetes mellitus develop neuropathic symptoms or show slowing of nerve conduction velocities on electrodiagnostic studies. What is the most appropriate treatment of diabetic amyotrophy?
● A. Mexiletine started at 150 mg every 8 hours
● B. Gabapentin 1800 to 3600 mg every day
● C. Pregabalin up to a maximum of 100 mg TID
● D. Amitriptyline and fluphenazine
● E. All of the above

Answer 15

E. All of the above

Question 16

Drugs that are most notorious for peripheral neuropathy include all of the following except?
● A. Thalidomide
● B. Macrolides
● C. Phenytoin
● D. Amitriptyline
● E. Metronidazole

Question 17

AIDS patients can develop vague numbness, tingling, and sometimes painful feet. There may be reduction of light touch and vibratory sense. What is this condition called?
● A. Distal symmetric polyneuropathy
● B. Mononeuropathy multiplex
● C. Meralgia paresthetica
● D. Lumbar polyradiculopathy
● E. All of the above

Answer 17

A. Distal symmetric polyneuropathy

Question 18

Following are most common nerves that can be involved in perioperative neuropathy except?
● A. Ulnar nerve
● B. Brachial plexus
● C. Median nerve
● D. Radial nerve
● E. Common peroneal nerve

Question 19

Which of the following statements is incorrect regarding the Sunderland system of peripheral nerve injury classification?
● A. First degree is physiologic transection with local conduction block with usually complete recovery in 2 to 3 weeks and is also called neuropraxia
● B. Second degree is complete interruption of axons and myelin sheath, with supporting structures including endoneurium intact with recovery at 1 mm/d and is also called axonotmesis
● C. Third degree is endoneurium disrupted with intact epineurium and perineurium and is also called axonotmesis
● D. Fourth degree is interruption of all neural and supporting elements with only epineurium intact and is also called neurotmesis
● E. Fifth degree is complete transection with loss of continuity