Peripheral Neuropathis

Question 1

Patient presents with motor problems esp below knee, include foot deformities and gait disturbance. Has distinctive walk, and barrel chest. Depressed tendon reflexes. Dx?

Answer 1

Charcot-Marie-Tooth

Question 2

What test would you order for Charcot-Marie-Tooth?

Answer 2

EMG/NCS- show marked reduction in both sensory and motor conduction

Question 3

Heritable Musculoskeletal neuropathis include

Answer 3

charcot-marie-tooth: HMSN I and II. Dejerine-Sottas disease- HMSN II. Refsum disease- HMSN IV.

Question 4

Ataxic gait, clumsy hands, cerebellar dysfunction, depressed DTR’s, upgoing Babinski’s.

Answer 4

Fredreich Ataxis- primary sensory neuropathy

Question 5

Disturbance in phytanic acid metabolism (too much)-

Answer 5

Refsum disease

Question 6

mode of transmission of fredreich ataxia

Answer 6

autosomal recessive

Question 7

mode of transmission of refsum disease

Answer 7

autosomal recessive

Question 8

Types of peripheral neuropathies in diabetes

Answer 8

Distal symmetric polyneuropathy, isolated peripheral neuropathy, painful diabetic neuropathy, diabetic neuropathic cachexia

Question 9

Charcot foot seen in what neuropathy?

Answer 9

Distal symmetric polyneuropathy

Question 10

Nerves involved in isolated peripheral neuropathy-

Answer 10

cranial and femoral nerves

Question 11

Symptoms in isolated peripheral neuropathy-

Answer 11

severe pain in upper thigh (recovery in 6-18 months), then weakness. and diplopia (recovery in 1-3 months)

Question 12

Acute idiopathic polyneuropathy

Answer 12

Guillan-Barre syndrome

Question 13

Do steroids help in Guillan barre?

Answer 13

No- might hurt

Question 14

cause of guillan barre

Answer 14

probably immunologic basis, can follow Campylobacter jejuni infection

Question 15

sx of guillan barre

Answer 15

symmetric weakness proximally. starts in legs, then arms, then respiratory and deglutition. weakness more severe than sensory loss

Question 16

prognosis of guillan barre

Answer 16

20% have persisting disability. remaining will make full recovery

Question 17

Presenting sx of myasthenia gravis

Answer 17

weakness of commonly used voluntary muscles- diplopia, ptosis, difficulty swallowing. respiratory problems, limb weakness. FATIGABILITY of affected muscles, improves with rest.

Question 18

Dx of myasthenia gravis

Answer 18

serological testing will show antibodies to acetylcholine receptor. Electrophysiologic tests show decrementing response to repetitive 2-3 HZ stimulation

Question 19

Myasthenia crisis

Answer 19

severe respiratory weakness

Question 20

tx of myasthenia gravis

Answer 20

anticholinesterase

Question 21

compression of median n. causing numbness, parasthesias, and weakness in hand

Answer 21

carpal tunnel syndrome

Question 22

entrapment of motor branch of median n. dx and sx?

Answer 22

anterior interosseus syndrome- no sensory loss, just motor sx (weakness in pronator quadratus, flexor pollicis longus, and flexor digitorum profundus)- unable to FLEX thumb

Question 23

Ulnar nerve lesions sx

Answer 23

weakness in forearm and hand, sensory disturbance in medial 1.5 digits. Wasting of first dorsal interosseus muscle, hyperextension of thumb (jeanne’s sign)

Question 24

saturday night palsy aka

Answer 24

radial nerve lesion

Question 25

“waiter’s tip”

Answer 25

erb palsy- braxial plexopathy- entire arm will have abnormal features.

Question 26

Which mononeuropathy is associated with diabetes?

Answer 26

femoral neuropathy

Question 27

femoral neuropathy manifestations

Answer 27

weakness and wasting of quadriceps muscle. Sensory impairment over the anteriomedian aspect of the thigh. depressed patellar reflex.

Question 28

meralgia paresthetica- motor or sensory problem?

Answer 28

mostly sensory- numbness, parasthesia, pain.

Question 29

what nerve affected in meralgia paresthetica?

Answer 29

lateral femoral cutaneous nerve

Question 30

in what types of people would you see meralgia paresthetica in?

Answer 30

obese, diabetic, pregnant

Question 31

how is sciatic nerve palsy differentiated from peroneal nerve palsy?

Answer 31

On EMG, sciatic nerve palsy would also involve short head of biceps femoris

Question 32

What mononeuropathy is most commonly caused by misplaced deep IM injection?

Answer 32

Sciatic nerve palsy

Question 33

Caused by compression or injury near head and neck of FIBULA.

Answer 33

Common peroneal nerve palsy

Question 34

“foot drop”- big toe dragging on floor. Internal rotation of feet. weakness in eversion of foot-

Answer 34

common peroneal nerve palsy

Question 35

Parasthesia, pain, and numbness over BOTTOM of foot, esp at night. Heel is spared.

Answer 35

compression of posterior tibial nerve- tarsal tunnel syndrome

Question 36

Facial nerve palsies causes

Answer 36

HIV, HSV, lyme disease, or sarcoidosis. If cause not known, Bell’s palsy

Question 37

nerurological symptoms in bell’s palsy

Answer 37

impaired taste, hyperacusis

Question 38

bell’s palsy more common in..

Answer 38

pregnant women and diabetics

Question 39

how many patients with bell’s palsy will recover

Answer 39

most, only 10% have lasting deficits.

Question 40

tx of bell’s palsy

Answer 40

prednisone- start within 5 days