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Clin med exam 2 > Peripheral > Flashcards

Peripheral Flashcards

1
Q

Major types of peripheral neuropathy

A

Depends on which nerves are affected

Large fiber nerves and Small fiber nerves

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2
Q

Peripheral neuropathy- Large fiber nerves

A

pins and needles
lost of joint position (proprioception)
loss of vibration
loss of reflexes

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3
Q

Peripheral neuropathy- Small fiber nerves

A

burning pain
can have normal reflexes
can affect autonomic function (BP, pulse)

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4
Q

Peripheral neuropathy- Cause

A

often idiopathic

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5
Q

metabolic and nutritional issues that causes peripheral neuropathies

A

diabetic mellitus- most common cause

alcohol abuse

hypothyroidism

uremia (renal disease)

vitamin deficiencies
- b12

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6
Q

Non celiac gluten sensitivity

A

can’t handle but do not have celiac markers

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7
Q

Gluten

A

can cause peripheral neuropathies

linked to a number of idiopathic axonal neuropathies

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8
Q

Most common cause of peripheral neuropathy in US

A

Diabetes mellitus

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9
Q

Diabetes mellitus

A

affects all nerves in the body

GI issues

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10
Q

All patients with peripheral n. should be offered ___?

A

Physical therapy for balance

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11
Q

Hypothyroidism

A

can cause peripheral neuropathies

associated with upper weakness

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12
Q

What is associated with carpal tunnel

A

hypothyroidism

causes tingling/pain in palms
PE: tinel test and phalens maneuver

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13
Q

Kidney disease

A

can cause peripheral neuropathies

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14
Q

Diet- vitamins

A

B-12- pernicious anemia, gastric bypass, veganism, prolonged antacids

copper- zinc supplements (denture cream)
zinc

vitamin E- fat malabsorption

vitamin B6- deficiency and excess

vitamin B1- mal nourishment

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15
Q

B12 deficiency

A

eating disorders

bariatric surgeries

catch early ! takes months to improve symptoms

check for loss of proprioception

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16
Q

Sepsis

A

can cause critical illness polyneuropathy (nerve damage)

unclear pathophysiology

tx is supportive care

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17
Q

Alcoholism

A

can cause toxic neuropathy and myopathy

tx: thiamine

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18
Q

Infectious cause

A

HIV/AIDS

Leprosy- most common cause worldwide

Herpes Zoster (varicella)

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19
Q

Herpes zoster tx

A

acyclovir, valacyclovir

vaccine available

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20
Q

Chemotherapy

A

can cause peripheral neuropathy

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21
Q

Medications

A

can cause peripheral neuropathy

chemotherapy

antiarrhythmic

antiepileptic

antihypertensive

abx

cholesterol lowering agents

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22
Q

Immune axonal neuropathies

A

cause joint pain, fevers

hep b/c
RA
SLE

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23
Q

Toxins

A

can cause neuropathies

arsenic
thallium

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24
Q

Genetic disorders

A

can cause peripheral neuropathy

foot deformities (rocker bottom) 
classic sign- inverted champagne bottle

charcot marie tooth

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25
Q

most common inherited neurological disorder

A

charcot marie tooth

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26
Q

charcot marie tooth diagnosed with ____?

A

with EMG/ NCS

show decrease in velocity (abnormal myelin problem)

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27
Q

What do we order for peripheral neuropathy?

A

EMG/NCS for lower extremities

Labs- hba1c, tsh, vit d, glucose tolerance test, poss ana, sed rate

gabapentin

physical therapy for balance

education on skin care/fall precautions

28
Q

What is good for nerve pain?

A

Gabapentin

29
Q

Side effects of gabapentin

A

foot w edema

30
Q

What can you use instead of gabapentin

A

Lyrica (pregabalin)- fewer side effects than gaba

31
Q

Gaba and lyrica are ___ meds?

A

anti-seizure meds

nerve pain meds

get ride of overactive nerve

32
Q

Amitriptyline

A

antidepressant

also helps with sleep

33
Q

Amitriptyline side effects

A

dry mouth

34
Q

Natural approaches that help with peripheral neuropathy

A 
alpha lipoic acid 
vit c
fish oil 
coenzyme Q10 
vit d
35
Q

Topamax

A

=seizure med
nerve pain medication
being researched

36
Q

Guillain Barre

A

lose reflexes bottom to top (ascending paralysis)

autoimmune disorder- have stomach bug or URI- causes mimic response

attacks myelin sheath, no insulation means nerve does not fire

37
Q

Guillain Barre dx

A

CSF from LP showing albuminocytologic dissociation

high amounts of proteins (albumin) but no increase in WBC (infection)

38
Q

Guillain Barre tx

A

plan a: IVIg “liquid gold”

plan b: dialysis (plasma exchanges)

39
Q

Myasthenia gravis

A

immune system attacks the muscle receptors (ACH receptors)

= severe muscle weakness

40
Q

Types of myasthenia gravis

A

ocular and generalized

41
Q

PE for myasthenia gravis

A

focuses on strength

EOM exam
counting on 1 breath
squeezing time multiple times (fatigable)

42
Q

Myasthenia gravis tx

A

ice pack

43
Q

Botulism

A

toxic that causes descending paralysis
the dozen D’s in order of manifestation

go downhill fast- no fluctuations

44
Q

Autoimmune diseases tend to damage peripheral nerves and tend to be

A

symmetrical

45
Q

Myasthenia gravis signs and symptoms

A

fatigable and fluctuating weakness

“double vision”

46
Q

Myasthenia gravis occurs where?

A

occurs in voluntary muscles around eyes, skeletal muscles, and diaphragm

sleepy dwarf

47
Q

Myasthenia gravis dx

A

tensilon test- it is a quick acting version of ACh esterase inhibitor

lab draw- ACh receptor antibody panel

48
Q

Myasthenia gravis tx

A

increase ACh levels

pyridostigmine (mestinon) increases ACh by stopping the destruction of ACh neurotransmitter

(acetylcholinesterase is an enzyme that breaks down ACh, this med slows down this enzyme)

Also immunosuppressants

49
Q

Myasthenia gravis- meds to avoid

A

beta blockers

calcium channel blockers

50
Q

What is the only tx for botulism ?

A

HBAT

heptavalent botulism antitoxin

51
Q

What bacteria is thought to be linked to guillain-barre?

A

campylobater jejuni

52
Q

Peripheral neuropathy

A

is a diffuse nerve problem (polyneuropathy)

described as the “dying back” of nerves

53
Q

Paresthesia

A

is a “pins and needles” sensation

54
Q

What PE findings should you focus on for peripheral neuropathy?

A

reflexes
pin prick
turning fork - most sensitive test

55
Q

Leprosy

cause, symptoms, transmission, tx

A

caused by bacteria mycobacterium lyprae
affects skin and peripheral nerves

symptoms include hypopigmentation

transmission via nasal secretions or close contact

tx: abx (MDT)

56
Q

Lyme disease causes peripheral neuropathy

A

ticks

rash, bullseye

knee joint pain

facial palsy

57
Q

Herpes zoster- presents with

A

dermatomal rash

tx: antiviral tx (acyclovir, valacyclovir

58
Q

What should you order to rule out multiple myeloma ?

A

Serum protein electrophoresis

59
Q

Bell’s palsy

A

facial nerve palsy (CN7)

forehead not wrinkled
vs stroke= wrinkled

60
Q

Bell’s palsy tx

A

steroids

underlying cause

61
Q

Mononeuropathies

A

single nerve is affected

pain, weakness, paresthesia in the distribution of the affected nerve

pure motor nerve involvement= painless weakness
pure sensory nerve involvement= sensory disturbances and no weakness

62
Q

Mononeuropathies vs peripheral neuropathy

A

less symmetrical (mono)

63
Q

What is known as saturday night palsy ?

A

radial mononeuropathy- thumb

ulnar= pinky

64
Q

brachial plexus neuritis

A

musculoskeletal cause of arm weakness

associated with over head movement

65
Q

____ palsies typically happens in pregnancy

A

peroneal nerve

66
Q

complex regional pain syndrome

A

after operation, injury, or vascular event

Clin med exam 2 (12 decks)

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