Peripheral neuropathies

Question 1

What is the MC hereditary disease of the PNS?

Answer 1

Charcot Marie Tooth

Question 2

Presentation of Charcot Marie Tooth

Answer 2

Progressive loss of motor and sensory function of UE/LE

Question 3

Physical exam findings in Charcot Marie Tooth

Answer 3

Pes cavus with:

1. Hammer toes
2. Foot drop
3. Stork leg

Question 4

What is a positive stocking-glove distribution in diabetic neuropathy?

Answer 4

Burning, prickling pain, tingling

Question 5

What is a negative stocking-glove distribution in diabetic neuropathy?

Answer 5

Feelings of numbness or deadness, “stocking glove” pattern

Question 6

What is an early symptom of foot weakness/motor issues in diabetic neuropathy?

Answer 6

Foot slapping and toe scuffling

Question 7

List some autonomic sx’s in diabetic neuropathy

Answer 7

1. CV: Orthostatic hypotension
2. GI: Gastoparesis, N/V/D, constipation
3. GU: Incontinence

Question 8

What dos the inability to perceive a tuning fork in a diabetic patient indicate?

Answer 8

increased risk for a foot ulcer

Question 9

DTR physical exam findings in diabetic neuropathy

Answer 9

Hypoactive or absent DTRs

Question 10

Nerve pain treatment in diabetic neuropathy

Answer 10

1. Gabapentin, Pregabalin
2. Tricyclic antidepressant
3. NSAIDs

Question 11

Orthostatic hypotension treatment diabetic neuropathy

Answer 11

Alpha 1 agonist

Question 12

Bladder dysfunction treatment in diabetic neuropathy

Answer 12

Oxybutnin

Question 13

What causes Vitamin B12 deficiency?

Answer 13

1. Inadequate absorption=MC: Celiac dz, IBS
2. Inadequate intake: Vegans
3. Inadequate utilization: Liver d/o, enzyme deficiencies
4. Drugs: Metformin, NO,antacids

Question 14

What is the classic triad of sx’s in Vitamin B12 deficiency?

Answer 14

1. Weakness
2. Sore tongue
3. Paresthesia

Question 15

Early stages of Vitamin B12 deficiency PN?

Answer 15

1. Decreased position and vibratory sense in extremities
2. Weakness
3. Hyporeflexia

Question 16

Late stages of Vitamin B12 deficiency PN?

Answer 16

1. Spasticity, ataxia
2. Irritable/depressed
3. Paranoia: “Megaloblastic madness”

Question 17

What is the initial test for diagnostic work-up in Vitamin B12 deficiency

Answer 17

Serum B12 (Cobalamin)

Question 18

CBC findings in Vitamin B12 deficiency

Answer 18

Megaloblastic anemia

Question 19

Why do we want to order folate in Vitamin B12 deficiency?

Answer 19

R/O Folate deficiency as these both cause Megaloblastic anemia

Question 20

Schilling test

Answer 20

Dx intrinsic factor deficiency

Question 21

Define “Wet” Thiamine B1 deficiency

Answer 21

Cardiovascular:

1. Peripheral edema
2. Tachycardia
3. JVD
4. SOB

Question 22

Define “Dry” Thiamine B1 deficiency

Answer 22

Nerves:

1. Paralysis
2. Weakness
3. Confusion
4. Eye movements
5. Pain

Question 23

Thiamine B1 Deficiency treatment

Answer 23

1. Thiamine Replacement: 50 Imx several days, followed by 2.5-5 mg/day for maintenance
2. Brown rice