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peripheral nerve d/o Flashcards

1
Q

Neuropathy

A

peripheral nerve dysfunction

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2
Q

What is polyneuropathy?

A

dysfunction of multiple diffuse nerves causing SYMMETRIC distal LMN weakness and/or somatosensory loss
stockings and gloves
typically length-dependent (down-up)

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3
Q

what is radiculopathy?

A

nerve root damage causing LMN weakness and/or somatosensory loss AT & BELOW LEVEL of damage

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4
Q

what are symptoms of motor nerve damage?

A

weakness
cramps
fasciculations
muscle wasting

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5
Q

what sensations are affected w/ Large sensory nerve damage?

A

vibrations and touch especially in hands and feet causing stocking glove numbness, no reflexes or position sensations

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6
Q

what sensations are affected w/ small sensory nerve w/o myelin damage

A

pain and temp which can cause neuropathic pain

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7
Q

what is affected with autonomic nerve damage?

A

small fiber axons causing excess sweating, heat intolerance, BP fluctuations, GI sx

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8
Q

what is the subacute time frame?

A

4-8 weeks

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9
Q

How to rule out stroke and spinal cord problem

A

stroke– BE FAST; progresses faster than PNS d/o
spinal cord– you’d see LMN signs @ level of damage but UMN signs below level of damage

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10
Q

UMN vs LMN lesions

A

UMN– hyper-reflexia, clonus/hypertonicity, babinski, muscle mass maintains (stroke, cord section)
LMN– hyporeflexia, hypotonicity, muscle wasting
they both would have weakness/paralysis!!

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11
Q

name 5 compressive mononeuropathy

A

ulnar neuropathy
carpal tunnel
radial nerve palsy
meralgia paresthetica
common peroneal nerve

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12
Q

which nerve is affected w/ carpal tunnel and where is sensation affected?

A

median nerve
first 3.5 fingers on palmar side

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13
Q

how do you evaluate for carpal tunnel

A

phalens test and tinnels sign

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14
Q

what is ulnar neuropathy and where is sensation affected?

A

when ulnar nerve is caught in cubital tunnel
1/2 of the fourth finger and pinky finger

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15
Q

what is radial nerve palsy and what is affected?

A

when radial nerve is compressed at any point
affects extensor forearm muscles, causing wrist drop

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16
Q

what is meralgia paresthetica and what region is affected?

A

entrapment of the lateral femoral cutaneous nerve causing burning pain, tinging and numbness in lateral thigh

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17
Q

what are some causes and consequences of common peroneal nerve compression?

A

causes– crossing legs, short leg casts, trauma
consequences– foot drop

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18
Q

compressive radiculopathy vs compressive mononeuropathy

A

mononeuropathy involves a single nerve while radiculopathy involves a nerve root

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19
Q

name two compressive radiculopathies

A

cervical and lumbar
they follow dermatomal patterns & reflexes

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20
Q

what would a C5 radiculopathy look like?

A

absent/reduced biceps and brachioradialis reflex
decreased sensation from shoulder

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21
Q

what would a C6 radiculopathy look like?

A

absent/reduced biceps and brachioradialis reflex
decreased sensation in thumb, index finger and lateral forearm

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22
Q

what would a C7 radiculopathy look like?

A

absent/reduced triceps reflex
decreased sensation to middle finger

23
Q

how do you manage cervical radiculopathies

A

injections
PT
meds
steroids

24
Q

what to expect if L4 is affected in L3-4 disc herniation?

A

pain in lower back and anterior leg
numbness in anteromedial thigh and knee
weakness & atrophy of quads
diminished knee jerk reflex

25
what to expect if L5 is affected?
pain in lateral thigh and leg numbness in lateral leg and first 3 toes weakness in dorsiflexion; maybe foot drop
26
what to expect if S1 is affected?
pain posteriolateral thigh, posterior leg down to heel numbness in back of calf, lateral heel, foot and toe weakness in plantarflexion atrophy of gastrocnemius and soleus diminished/absent ankle jerk reflex
27
which nerves are affected w/ Sciatica? what are some causes of sciatica?
L4 to S3 trauma piriformis syndrome lumbar disk herniation
28
why no MRI w/ back?
a lot of people who dont have pain have a herniated disk or bulging disk so getting an MRI can lead to unnecessary surgery
29
when should you get an MRI for back pain?
back pain w/ fever back pain w/ cancer hx extremity weakness loss of bladder control
30
when do you do back surgery from herniated disks?
motor deficits or uncontrolled pain
31
how do you treat back pain?
NSAIDs PT nerve root injections
32
Cauda equina syndrome & sx
URINARY RETENTION--> incontinence can be with or without low back pain leg weakness, saddle anesthesia no reflexes or rectal tone
33
what is diabetic polyneuropathy? most common sx?
it is SLOW progressive, length-dependent most common sx: neuropathic pain and glucose intolerance also paresthesia, pain, motor weakness
34
Differentiate diabetic polyneuropathy from alcoholic neuropathy
alcoholic is associated w/ vitamin & other deficiencies and sensory sx happen first
35
alcoholic neuropathy
has similar presentation to diabetic polyneuropathy gradual onset & length-dependent sensory sx happens first associated w/ vitamin & other deficiencies
36
what is the work-up for polyneuropathies?
labs-- glucose, vitamin B 12, electrolytes, etc.
37
What is Guillan-Barre syndrome? Sx?
autoimmune demyelinating d/o causing loss of sensation, muscle paralysis in limbs; goes from bottom to up so can cause respiratory failure
38
what are sx of guillan-barre? how fast does it progress?
Sx: ascending sensory loss & muscle weakness, areflexia @ affected levels! progression: FAST! (hours to days)
39
how is guillain-barre diagnosed?
get CSF via lumbar puncture results would be high protein with normal WBC count can also do electrophysiologic studies, autoantibody testing, pulmonary function test
40
how is guillain-barre treated?
plasmapheresis IV Ig rehab most recover in months
41
what is Bells palsy? How is it diagnosed?
idiopathetic,UNILATERAL, facial nerve palsy causing hemifacial weakness & paralysis d/t inflammation or compression related to HSV 1 Diagnosis of exclusion
42
how to differentiate stroke from bells palsy
ask patient to raise eye brow, if it wrinkles, its a stroke!
43
how does Bells palsy progress? what is the prognosis?
sudden onset (48-72 hrs) improves in few days and can resolve in months or stay permanent
44
what are Sx of bells palsy? how do you manage bells palsy?
sx include one sided facial weakness, drooping, drooling, can't close one eye or excessive tearing in one eye, taste issues in anterior 2/3 of tongue, pain managed w/ steroids/predinisone to shorten time, eye protection, PT
45
what is myasthenia gravis? how does it progress
autoimmune NMJ d/o caused by antibodies blocking the acetylcholine receptors of skeletal muscles leading to fatiguable weakness can be sudden onset
46
how is myasthenia gravis diagnosed?
CT chest or MRI chest to rule out thymus tumor
47
hallmark signs of myasthenia gravis?
fatiguable weakness or weakness from repeated actions diplopia & ptosis swallowing issues/bulbar weakness
48
how is myasthenia treated?
1) acetylcholinesterase inhibitors 2) immunosuppressants 3) thymectomy in severe cases could maybe do plasmapheresis?
49
Compare Guillain barre vs Myasthenia gravis in pathophys, sx, diagnosis.
pathophys differences--- GB involves demylination & mimicry, MG involves blocking at NMJ Sx-- GB has sensory changes like paresthesia & pain. GB has decreased reflexes Diagnosis-- MG requires imaging.
50
How are sensation & reflexes affected with guillain barre?
paresthesia & pain decreased DTR
51
how are sensation & reflexes affected with myasthenia gravis?
they are not affected. this is because myasthenia is a NMJ d/o so only motor is affected.
52
myasthenic crisis & what triggers it
acute worsening of myasthenia gravis causing respiratory diff./distress triggered by stress, surgery, meds
53
what do you monitor w/ myasthenic crisis
monitor negative inspiratory force, oxygen, swallowing

NEURO MOD (8 decks)

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