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Peripheral Nervous System - Sachen Flashcards

1
Q

3 layers of peripheral nerve connective tissue

A
  • Epineurium - whole nerve
    • Supplied by vasa nervorum
  • Perineurium - fascicles
  • Endoneurium - fibers
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2
Q

A-alpha fibers

A

Large, proprioception and somatic motor

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3
Q

A-beta fibers

A

Large-ish, touch and pressure

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4
Q

A-gamma fibers

A

Medium, muscle spindle motor

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5
Q

A-delta fibers

A

Small-ish, pain/cold/touch

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6
Q

B fibers

A

Small-ish, pre-ganglionic autonomics

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7
Q

C fibers

A

Tiny, UNMYELINATED, pain/temp/reflexes, post-ganglionic sympathetics

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8
Q

2 main fiber types in peripheral neuropathies (NOT including DM)

A

A-alpha

C fibers

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9
Q

Parts of a peripheral nerve that can be affected (6)

A
  • Cell body
  • Nerve root
  • Axon
  • Myelin sheath
  • Connective tissue
  • Blood supply
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10
Q

Wallerian degeneration

A

Sever a nerve –> distal degeneration

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11
Q

Most common cervical nerve roots affected by a radiculopathy (w/ percentages)

Most common lumbosacral nerve roots affected (w/ percentages)

A 
C7 = 60%
C6 = 25%

L5 = 50%
S1 = 45%
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12
Q

Causes of radiculopathy

A

Structural - discs, osteophytes, tumors, etc

Non-structural - DM, infections (ex. WNV), etc

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13
Q

Pain in shoulder
Loss of sensation in lateral arm
Weak shoulder abduction
Loss of biceps reflex

A

C5 radiculopathy

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14
Q

Pain in shoulder
Loss of sensation in lateral arm and digits 1, 2
Weak shoulder abduction and elbow flexion
Loss of biceps +/- brachioradialis reflexes

A

C6 radiculopathy

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15
Q

Shoulder/arm/forearm pain
Loss of sensation in 3rd digit
Weak UE extension muscles
Loss of triceps reflex

A

C7 radiculopathy

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16
Q

Shoulder/arm/forearm pain
Loss of sensation in digits 4, 5
Weak finger abduction and flexion

A

C8 radiculopathy

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17
Q

Pain in knee, anterior lateral thigh, medial calf
Loss of sensation in medial calf
Weak hip flexion, knee extension

A

L4 radiculopathy

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18
Q

Pain in dorsal thigh, lateral calf
Loss of sensation in lat calf, dorsal foot
Weak hamstrings, anterior leg mm

A

L5 radiculopathy

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19
Q

Pain in posterior thigh and calf
Loss of sensation in lateral calf and lateral foot
Weak hamstrings and posterior leg muscles

A

S1 radiculopathy

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20
Q

Cervical nerve roots exit (above/below) the numbered vertebra

A

Above (C5 root btwn C4 & C5)

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21
Q

Thumb/index finger

A

C6

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22
Q

Middle finger

A

C7

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23
Q

4th/5th finger

A

C8

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24
Q

Medial forearm

A

T1

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25
Q

Nipple line

A

T4

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26
Q

Umbilicus

A

T10

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27
Q

Inguinal area

A

L1

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28
Q

Medial calf

A

L4

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29
Q

Lateral calf

A

L5

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30
Q

Lateral foot and posterior calf

31
Q

Medial thigh

32
Q

Paresthesias and motor/reflex symptoms (pins and needles, numbness) are secondary to what fibers?

A

Large myelinated fibers

33
Q

Pain and temp symptoms are secondary to what fibers?

A

Small unmyelinated fibers

34
Q

4 types of pain symptoms w/ peripheral neuropathy (w/ definitions)

A
  • Burning
  • Dysesthesia (pain on gentle touch)
  • Hyperalgesia (lower threshold to pain)
  • Hyperpathia (elevated threshold, but excessively felt)
35
Q

6 motor symptoms w/ peripheral neuropathy

A
  • Weakness
  • Cramps
  • Fasciculations
  • Atrophy
  • Decreased DTRs
  • Reduced tone
36
Q

Paresthesia of half of 4th finger

Paresthesia of ALL of 4th finger

A

Median nerve issue

C8 radiculopathy

37
Q

4 places for ulnar neuropathy

A
  • Axilla (crutches)
  • Elbow (behind medial epicondyle)
  • Cubital tunnel
  • Guyon’s canal (wrist)
38
Q

Froment sign

A

Ulnar neuropathy - grabs piece of paper w/ flexed thumb IP joint

39
Q

Wrist drop, can’t extend fingers

A

Radial neuropathy - compression as it winds around humerus (saturday night palsy)

40
Q

Most common entrapment neuropathy of LE

Most common causes?

A

Peroneal (fibular) nerve – at fibular head

  • Sick patient lying on side for long period of time
  • Sitting legs crossed
41
Q

Distinguishing L5 radiculopathy and peroneal nerve neuropathy

Other tip-offs to radiculopathy

A

Ankle inversion (post. tib. m)

  • Normal = Peroneal nerve
  • Abnormal = L5

Hip pain, back pain, thigh pain

42
Q

Patient gets IM injection in butt…most common neuropathy?

How to avoid?

A

Sciatic

Inject in UPPER-OUTER quad.

43
Q

Posterior dislocation of the hip…possible neuropathy?

44
Q

Pregnant woman giving delivery in lithotomy position…possible neuropathy?

A

Femoral (inguinal ligament)

45
Q

Patient has numbness and tingling along anterolateral thigh…neuropathy?

Cause?

A

Lateral femoral cutaneous

Tight clothing or weight gain around waist

46
Q

Pain down lateral thigh, foot-drop, absent S1 reflex

A

Sciatic neuropathy

47
Q

Foot drop, weak eversion, lost sensation to dorsum of foot

A

Peroneal (fibular) neuropathy

48
Q

Weak knee extension, absent patellar reflex

A

Femoral neuropathy

49
Q

Sensory loss in sole of foot

A

Posterior tibial neuropathy (tarsal tunnel syndrome)

50
Q

Peripheral neuropathies can involve ___, ___, ___, and ___

A

Motor
Sensory
Cranial nerves
Autonomics

51
Q

Peripheral polyneuropathy presents where?

A

Symmetric stocking-glove distribution of symptoms

52
Q

3 big categories of KNOWN causes of peripheral neuropathies

A
  • Hereditary
  • Toxins/meds
  • DM
53
Q

4 metabolic/endocrine causes of peripheral neuropathy

A

DM, hypothyroid, uremia, porphyria

54
Q

Patient w/ severe abdominal pain, can’t find abdominal cause or psychiatric cause. Diagnosed by neurologist.

55
Q

Infectious causes of peripheral neuropathy (7)

A

Mono, hepatitis, Lyme disease

HIV, leprosy, syphilis, VZV

56
Q

Immune-mediated causes of peripheral neuropathy (4)

A

Guillan-Barre
Chronic inflam. demyel. poly.
Multifocal motor neuropathy
Paraproteins (monoclonal gam)

57
Q

Vitamin deficiency causes of peripheral neuropathy (5)

A

B1, B6, **B12, E, Copper

58
Q

Toxic causes of peripheral neuropathy

A

Alcohol
Heavy metals
Organic compounds

59
Q

Vasculitic causes of peripheral neuropathy

A

RA, SLE, PAN

60
Q 
Child/teenager
Difficulty walking/running
Lower leg atrophy and foot deformities
Skeletal deformities
Arreflexia, mild sensory loss

Inheritance?

A

Charcot-Marie-Tooth type 1

Autosomal dominant

61
Q

How does CMT type 2 differ from type 1? (2)

A
  • Adult onset

- Axonal loss, but normal nerve velocities

62
Q

Acute/subacute ascending motor paralysis, recent illness or surgery or immunization

Infectious causes? (5)

A

Guillan-Barre

EBV, Mycoplasma pneumonia, C. jejuni, HIV, Hodgkin’s

63
Q

Treating Guillan-Barre

A

Supportive (swallowing, respiratory, infection, DVT)

Plasmapheresis, IVIg

64
Q

Bad symptoms of G-B that must be watched for and treated

A

Respiratory difficulty, sudden drops in BP

65
Q

Poor prognosis in G-B

A

Axonal damage

66
Q

Miller-Fisher Syndrome – what is it?

  • Symptoms?
  • Labs?
A

5% variant of G-B

  • Ophthalmoplegia, ataxia, arreflexia
  • GQ1b antibody
67
Q

G-B that persists for 2+ months, symmetric distal involvement, progressive

Treatment?

A

CIDP

**IVIg, steroids, plasma exchange

68
Q

Adult w/ slowly progressive distal weakness of hand, no sensory or UMN symptoms. Slowly involves other nerves. GM-1 antibody.

Treatment?

A

Multifocal motor neuropathy

IVIg

69
Q

Possible presentations of DM neuropathy (7)

A
  • Distal sensorimotor
  • Cranial nerve (3, 6, other)
  • Mononeuropathy (ex. CT)
  • Mono multiplex
  • Autonomic
  • Lumbosacral plexopathy
  • Radiculopathy
70
Q

DM CN3 palsy vs. Compression CN3 palsy

A 
DM = normal light reflex
Comp = bad light reflex
71
Q

HIV neuropathy presentations (3)

A
  • Distal symmetric poly
  • Guillan-Barre
  • CIDP
72
Q 
aANCA
Anti-MAG antibodies
Anti-GM1 antibodies
Anti-GQ1b antibodies
Hu antibody
A
  • Systemic vasculitis
  • MGUS
  • Multifocal motor neuropathy
  • Miller Fisher syndrome
  • Carcinoma sensory neurop
73
Q

Important blood tests to get in peripheral neuropathy

A

CBC, chemistry, Glc, ESR, antibodies
SPEP – looking for spikes
B12/Folate

74
Q

EMG/NCV can be used to distinguish what?

Specific diagnoses with this?

A

Axonal vs. demyelinating neuropathy

GBS, CMT, MMN

MSK 2 (20 decks)

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