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Clin med neurology > peripheral neuropathy > Flashcards

peripheral neuropathy Flashcards

1
Q

What is motor nerve damage associated with

A

muscle weakness
-fasiculations
-muscle atrophy
-painful cramps

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2
Q

What symptoms will you have with sensory nerve damage

A

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

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3
Q

What is another name for autonomic nerve damage

A

small fiber neuropathies

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4
Q

What symptoms will you have with autonomic nerve damage

A

excess sweating
heat intolerance
inability to expand

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5
Q

What is neuropathy of several discrete nerves known as

A

multiple mononeuropathy

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6
Q

What is polyneuropathy

A

multiple nerves diffusely

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7
Q

What are some acquired sources of neuropathy

A

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

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8
Q

What is the leading cause of polyneuropathy in the US

A

Diabetes

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9
Q

Where does Guillian-Barre neuropathy generally present first

A

trunk

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10
Q

What is the most common cause of single nerve injury

A

Physical injury

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11
Q

What are some genetic sources of neuropathy

A

Charcot-Marie-Tooth

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12
Q

What is the most common inherited nerve disorder

A

Charcot-Marie-Tooth

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13
Q

What is a common infection that can cause neuropathy

A

HIV

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14
Q

What are the physiologic tests for nerve function

A

Nerve conduction velocity (NCV)
Electromyography (EMG)

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15
Q

What does NCV measure

A

signal strength and speed

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16
Q

What does EMG measure

A

Electrical activity rest/contraction

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17
Q

What are some neuropathology tests for nerve appearance

A

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

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18
Q

What is the gold standard for dx small fiber neuropathies

A

Neurodiagnostic skin biopsy

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19
Q

What does MRI for neuropathy look for

A

Compression
mass
soft tissue structures

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20
Q

What does CT for neuropathy look for

A

Mass
Solid tissue structure (spinal stenosis)

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21
Q

What are some therapies than can help improve some peripheral neuropathies

A

orthotics
acupuncture
CBT
Behavioral strategies

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22
Q

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

A

decompress a nerve
severing the nerve and replace w/ stimulation

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23
Q

What is the best treatment for peripheral neuropathy

A

Prevention

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24
Q

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

A

Acquired demyelinating polyneuropathy

25
Q

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

A

Motor neuron disease

26
Q

What is an autonomic testing for peripheral neuropathy

A

QSART testing

27
Q

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

A

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

28
Q

What is complex regional pain syndrome

A

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

29
Q

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

A

CRPS

30
Q

What are the types of CRPS

A

CRPS 1
CRPS 2

31
Q

What is CRPS 1

A

No confirmed injury
*reflex sympathetic dystrophy syndrome

32
Q

What is CRPS 2

A

Associated and confirmed injury
*causalgia

33
Q

Which gender is more apt to get CRPS

A

Women (roughy age 40)

34
Q

Who is CRPS more common in

A

Patients with other inflammatory disorders

35
Q

What are the most common triggers for CRPS

A

Fx, strains, limb immobilization
Soft tissue injury
Surgery

36
Q

What is the benefit of nerve conduction studies and EMGs

A

Helps distinguish between demyelinating disorders from axonal disorders

37
Q

What are some vascular effects that may occur from CRPS

A

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

38
Q

What are some immune system effects of CRPS

A

High levels of cytokines
*redness, swelling, and warmth

39
Q

What is the key symptom of chronic regional pain syndrome

A

Prolonged severe pain that may be constant

40
Q

What is the best treatment for CRPS

A

Rehab or PT

41
Q

What is the most common cause of Vitamin B12 deficiency

A

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

42
Q

What are some reasons a person may develop vitamin B12 neuropathy

A

Autoimmune
malabsorption
Dietary insufficiency

43
Q

Which ancestry is most likely to have pernicious anemia

A

Northern European ancestry

44
Q

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

A

GI and Neuro findings

45
Q

What signs are consistent with macrocytic anemia

A

Pallor
fatigue

46
Q

What blood work will be done to dx Vitamin B12

A

CBC with peripheral smear
serum B12
Folate
*MMA
*homocysteine

47
Q

What differentials should be ruled out with vitamin B12 neuropathy

A

Lead toxicity
Syphillis
MS

48
Q

What are some complications if Vitamin B12 deficiency goes undiagnosed

A

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

49
Q

What is Guillian-Barre syndrome

A

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

50
Q

Who are more frequently effected by Guillian-Barre syndrome

A

Most common in adults and older people

51
Q

How can Guillian-Barre be life threatening

A

Potentially interferes with breathing, BP, and HR

52
Q

When do most cases of Guillian-Barre present

A

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

53
Q

What virus caused an increase incidence of GBS

A

ZIKA

54
Q

How will GBS present

A

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

55
Q

What are the key diagnostic findings with GBS

A

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

56
Q

What is the most common type of GBS in the US

A

Acute inflammatory demyelinating polyneuropathy

57
Q

What are the 2 types of GBS

A

Acute inflammatory demyelinating polyneuropathy

Acute motor axonal neuropathy

Millie-Fisher syndrome

Chronic inflammatory demyelinating polyneuropathy

multifocal motor neuropathy

58
Q

What is the acute treatment of Guillian-Barre

A

Admit and treat in ICU
-Plasmapheresis
-IVIG

Clin med neurology (12 decks)

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