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NEURO MOD > peripheral nerve d/o > Flashcards

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
Q

what to expect if L5 is affected?

A

pain in lateral thigh and leg
numbness in lateral leg and first 3 toes
weakness in dorsiflexion; maybe foot drop

26
Q

what to expect if S1 is affected?

A

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
Q

which nerves are affected w/ Sciatica? what are some causes of sciatica?

A

L4 to S3
trauma
piriformis syndrome
lumbar disk herniation

28
Q

why no MRI w/ back?

A

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
Q

when should you get an MRI for back pain?

A

back pain w/ fever
back pain w/ cancer hx
extremity weakness
loss of bladder control

30
Q

when do you do back surgery from herniated disks?

A

motor deficits or uncontrolled pain

31
Q

how do you treat back pain?

A

NSAIDs
PT
nerve root injections

32
Q

Cauda equina syndrome & sx

A

URINARY RETENTION–> incontinence
can be with or without low back pain
leg weakness, saddle anesthesia
no reflexes or rectal tone

33
Q

what is diabetic polyneuropathy? most common sx?

A

it is SLOW progressive, length-dependent
most common sx: neuropathic pain and glucose intolerance
also paresthesia, pain, motor weakness

34
Q

Differentiate diabetic polyneuropathy from alcoholic neuropathy

A

alcoholic is associated w/ vitamin & other deficiencies and sensory sx happen first

35
Q

alcoholic neuropathy

A

has similar presentation to diabetic polyneuropathy
gradual onset & length-dependent
sensory sx happens first
associated w/ vitamin & other deficiencies

36
Q

what is the work-up for polyneuropathies?

A

labs– glucose, vitamin B 12, electrolytes, etc.

37
Q

What is Guillan-Barre syndrome? Sx?

A

autoimmune demyelinating d/o causing loss of sensation, muscle paralysis in limbs; goes from bottom to up so can cause respiratory failure

38
Q

what are sx of guillan-barre? how fast does it progress?

A

Sx: ascending sensory loss & muscle weakness, areflexia @ affected levels!
progression: FAST! (hours to days)

39
Q

how is guillain-barre diagnosed?

A

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
Q

how is guillain-barre treated?

A

plasmapheresis
IV Ig
rehab
most recover in months

41
Q

what is Bells palsy? How is it diagnosed?

A

idiopathetic,UNILATERAL, facial nerve palsy causing hemifacial weakness & paralysis d/t inflammation or compression
related to HSV 1
Diagnosis of exclusion

42
Q

how to differentiate stroke from bells palsy

A

ask patient to raise eye brow, if it wrinkles, its a stroke!

43
Q

how does Bells palsy progress? what is the prognosis?

A

sudden onset (48-72 hrs)
improves in few days and can resolve in months or stay permanent

44
Q

what are Sx of bells palsy? how do you manage bells palsy?

A

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
Q

what is myasthenia gravis? how does it progress

A

autoimmune NMJ d/o caused by antibodies blocking the acetylcholine receptors of skeletal muscles leading to fatiguable weakness
can be sudden onset

46
Q

how is myasthenia gravis diagnosed?

A

CT chest or MRI chest to rule out thymus tumor

47
Q

hallmark signs of myasthenia gravis?

A

fatiguable weakness or weakness from repeated actions
diplopia & ptosis
swallowing issues/bulbar weakness

48
Q

how is myasthenia treated?

A

1) acetylcholinesterase inhibitors
2) immunosuppressants
3) thymectomy
in severe cases could maybe do plasmapheresis?

49
Q

Compare Guillain barre vs Myasthenia gravis in pathophys, sx, diagnosis.

A

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
Q

How are sensation & reflexes affected with guillain barre?

A

paresthesia & pain
decreased DTR

51
Q

how are sensation & reflexes affected with myasthenia gravis?

A

they are not affected. this is because myasthenia is a NMJ d/o so only motor is affected.

52
Q

myasthenic crisis & what triggers it

A

acute worsening of myasthenia gravis causing respiratory diff./distress
triggered by stress, surgery, meds

53
Q

what do you monitor w/ myasthenic crisis

A

monitor negative inspiratory force, oxygen, swallowing

NEURO MOD (8 decks)

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