peripheral neuropathy

Question 1

What is motor nerve damage associated with

Answer 1

muscle weakness
-fasiculations
-muscle atrophy
-painful cramps

Question 2

What symptoms will you have with sensory nerve damage

Answer 2

Loss of vibratory sense
stocking glove sensation
loss of reflexes
loss of position sense
loss of temp sense

Question 3

What is another name for autonomic nerve damage

Answer 3

small fiber neuropathies

Question 4

What symptoms will you have with autonomic nerve damage

Answer 4

excess sweating
heat intolerance
inability to expand

Question 5

What is neuropathy of several discrete nerves known as

Answer 5

multiple mononeuropathy

Question 6

What is polyneuropathy

Answer 6

multiple nerves diffusely

Question 7

What are some acquired sources of neuropathy

Answer 7

trauma (physical injury)
Diabetes
Vascular / blood problems (CAD)
systemic autoimmune diseases (SLE)
triggered autoimmune disease (Guillian-barre)

Question 8

What is the leading cause of polyneuropathy in the US

Answer 8

Diabetes

Question 9

Where does Guillian-Barre neuropathy generally present first

Answer 9

trunk

Question 10

What is the most common cause of single nerve injury

Answer 10

Physical injury

Question 11

What are some genetic sources of neuropathy

Answer 11

Charcot-Marie-Tooth

Question 12

What is the most common inherited nerve disorder

Answer 12

Charcot-Marie-Tooth

Question 13

What is a common infection that can cause neuropathy

Answer 13

HIV

Question 14

What are the physiologic tests for nerve function

Answer 14

Nerve conduction velocity (NCV)
Electromyography (EMG)

Question 15

What does NCV measure

Answer 15

signal strength and speed

Question 16

What does EMG measure

Answer 16

Electrical activity rest/contraction

Question 17

What are some neuropathology tests for nerve appearance

Answer 17

Nerve bx (usu. from lower leg)
Neurodiagnostic skin bx

Question 18

What is the gold standard for dx small fiber neuropathies

Answer 18

Neurodiagnostic skin biopsy

Question 19

What does MRI for neuropathy look for

Answer 19

Compression
mass
soft tissue structures

Question 20

What does CT for neuropathy look for

Answer 20

Mass
Solid tissue structure (spinal stenosis)

Question 21

What are some therapies than can help improve some peripheral neuropathies

Answer 21

orthotics
acupuncture
CBT
Behavioral strategies

Question 22

What are some surgeries that can be done to help peripheral neuropathy

Answer 22

decompress a nerve
severing the nerve and replace w/ stimulation

Question 23

What is the best treatment for peripheral neuropathy

Answer 23

Prevention

Question 24

If a patient presents with profound motor weakness with minimal atrophy and reflexia, what dx should you consider

Answer 24

Acquired demyelinating polyneuropathy

Question 25

If a patient presents with chronic progressive muscle weakness, fasciculation, muscle atrophy, and no sensory deficits, what dx should you consider?

Answer 25

Motor neuron disease

Question 26

What is an autonomic testing for peripheral neuropathy

Answer 26

QSART testing

Question 27

What are the symptoms someone with vascular / ischemic neuropathy may present with

Answer 27

Abnormal pain / temperature sensation Atrophy in proportion to weakness disproportionate preservation of reflexes

Question 28

What is complex regional pain syndrome

Answer 28

Chronic pain condition (>6mo) that most often affects one limb.. usually after injury

Question 29

If someone presents with prolonged or excessive pain and changes in skin color, temperature, and/or swelling in affected area, what might their dx be

Answer 29

CRPS

Question 30

What are the types of CRPS

Answer 30

CRPS 1 CRPS 2

Question 31

What is CRPS 1

Answer 31

No confirmed injury *reflex sympathetic dystrophy syndrome

Question 32

What is CRPS 2

Answer 32

Associated and confirmed injury *causalgia

Question 33

Which gender is more apt to get CRPS

Answer 33

Women (roughy age 40)

Question 34

Who is CRPS more common in

Answer 34

Patients with other inflammatory disorders

Question 35

What are the most common triggers for CRPS

Answer 35

Fx, strains, limb immobilization Soft tissue injury Surgery

Question 36

What is the benefit of nerve conduction studies and EMGs

Answer 36

Helps distinguish between demyelinating disorders from axonal disorders

Question 37

What are some vascular effects that may occur from CRPS

Answer 37

Possible ischemia of deeper tissue, causing muscle and joint pain/damage may dilate/leak fluid into surrounding tissue causing red/swollen skin May over constrict causing old, white, bluish skin

Question 38

What are some immune system effects of CRPS

Answer 38

High levels of cytokines *redness, swelling, and warmth

Question 39

What is the key symptom of chronic regional pain syndrome

Answer 39

Prolonged severe pain that may be constant

Question 40

What is the best treatment for CRPS

Answer 40

Rehab or PT

Question 41

What is the most common cause of Vitamin B12 deficiency

Answer 41

Lack of intrinsic factor (common in elderly) *pernicious anemia

Question 42

What are some reasons a person may develop vitamin B12 neuropathy

Answer 42

Autoimmune malabsorption Dietary insufficiency

Question 43

Which ancestry is most likely to have pernicious anemia

Answer 43

Northern European ancestry

Question 44

What is the H&P focused on with workup for Vitamin B12 neuropathy

Answer 44

GI and Neuro findings

Question 45

What signs are consistent with macrocytic anemia

Answer 45

Pallor fatigue

Question 46

What blood work will be done to dx Vitamin B12

Answer 46

CBC with peripheral smear serum B12 Folate *MMA *homocysteine

Question 47

What differentials should be ruled out with vitamin B12 neuropathy

Answer 47

Lead toxicity Syphillis MS

Question 48

What are some complications if Vitamin B12 deficiency goes undiagnosed

Answer 48

Heart failure Severe neurologic deficits Increased risk for gastric cancer Increased risk for autoimmune diseases

Question 49

What is Guillian-Barre syndrome

Answer 49

Rare neurologic disorder in which the body's immune system mistakenly attack peripheral nervous system

Question 50

Who are more frequently effected by Guillian-Barre syndrome

Answer 50

Most common in adults and older people

Question 51

How can Guillian-Barre be life threatening

Answer 51

Potentially interferes with breathing, BP, and HR

Question 52

When do most cases of Guillian-Barre present

Answer 52

A few days or weeks following a respiratory or GI viral infection

Question 53

What virus caused an increase incidence of GBS

Answer 53

ZIKA

Question 54

How will GBS present

Answer 54

Symmetric weakness is the most characteristic Symptoms can increase in intensity over a period of hours, days, weeks until certain muscles cannot be used at all

Question 55

What are the key diagnostic findings with GBS

Answer 55

Recent onset abnormal sensations Absent / diminished deep tendon reflex Recent viral infection / diarrhea

Question 56

What is the most common type of GBS in the US

Answer 56

Acute inflammatory demyelinating polyneuropathy

Question 57

What are the 2 types of GBS

Answer 57

Acute inflammatory demyelinating polyneuropathy Acute motor axonal neuropathy Millie-Fisher syndrome Chronic inflammatory demyelinating polyneuropathy multifocal motor neuropathy

Question 58

What is the acute treatment of Guillian-Barre

Answer 58

Admit and treat in ICU -Plasmapheresis -IVIG