Peripheral Neuropathy

Question 1

The peripheral nervous system includes…

Answer 1

cranial nerves
spinal nerves
peripheral nerves (sensory and motor)

Question 2

peripheral neuropathy affects ____ million people in the US

Answer 2

20

Question 3

what is the most common cause of peripheral neuropathy

Answer 3

diabetes

Question 4

polyneuropathy

Answer 4

pathology affecting multiple peripheral nerves (cell body, axon and myelin sheath)

Question 5

demyelination

Answer 5

damage to the protective covering that surrounds nerve fibers

Question 6

axonal (wallerian) degeneration

Answer 6

axontmesis
neurotmesis

Question 7

what are the 3 grades of nerve injury

Answer 7

1 - neurapraxia
2 - axonotmesis
3 - neurotmesis

Question 8

neurapraxia

Answer 8

• mild injury to a nerve caused by transient compression or stretch
• loss of motor function but sensation and autonomic may be preserved

Question 9

axonotmesis

Answer 9

• more severe blunt injury to a nerve
• axons divided
• connective tissue layers intact
• loss of motor, sensory, and autonomic functions

Question 10

neurotmesis

Answer 10

nerve is completely divided and all connective tissue layers of the axon are disrupted
- loss of motor, sensory, and autonomic function

Question 11

can peripheral nerves regenerate?

Answer 11

yes

Question 12

what supports peripheral nerve regeneration

Answer 12

schwann cells

Question 13

in humans, nerves regenerate by _____ a day

Answer 13

1mm

Question 14

3 types of physical injury to a peripheral nerve

Answer 14

• trauma
• mechanical
• compression

Question 15

what are common areas of physical nerve injuries

Answer 15

brachial plexus, TOS, ulnar, median, disc herniation, piriformis, common peroneal

Question 16

double crush syndrome

Answer 16

serial constraints predispose the nerve to enhanced dysfunction
ex: cervical entrapments conbined with carpal tunnel

Question 17

what are some acquired neuropathies?

Answer 17

• metabolic
• toxins (alcohol)
• AIDS/hep C
• chemotherapy-induced (CIPN)

Question 18

what system does CIPN usually affect the most? is it reversible?

Answer 18

• sensory
• yes, it may be once chemo is stopped

Question 19

T or F: the mechanism for alcohol related peripheral neuropathy remains unclear

Answer 19

T

Question 20

is diabetic peripheral neuropathy more prevalent in type 1 or 2 diabetes

Answer 20

type 2

Question 21

are females or males with type 2 diabetes more at risk for DPN?

Answer 21

females
*also high prevalence in minority populations

Question 22

T or F: many people with diabetes report vestibular dysfunction

Answer 22

T: 70%

Question 23

diabetic neuropathy classification

Answer 23

• subclinical
• diffuse clinical with distal symmetric sensorimotor and autonomic syndromes
• focal syndromes

Question 24

what is the clinical presentation of large fiber neuropathy

Answer 24

• impairments in motor, vibration, position sense, touch/pressure
• interferes with QOL and ADLs

Question 25

what is the clinical presentation of small fiber neuropathy

Answer 25

- pain and impairments with autonomic system and thermal - leads to morbidity and mortality

Question 26

does mononeuritis come on suddenly or gradual? what about nerve entrapment

Answer 26

mononeuritis - sudden entrapment - gradual

Question 27

2 types of focal syndromes

Answer 27

- mononeuritis - entrapment syndromes

Question 28

what are some common nerves involved with mononeuritis

Answer 28

CN 3, 6, 7, ulnar, median, peroneal

Question 29

what are some common nerves involved with entrapment

Answer 29

median, ulnar, peroneal, medial/lateral plantar

Question 30

T or F: mononeuritis is not progressive and resolves spontaneously

Answer 30

T: treat the symptoms

Question 31

T or F: nerve entrapment is not progressive

Answer 31

F: it is! - treat with rest, splints, diuretics, injections, surgery

Question 32

diabetic neuropathy is nerve damage due to ______

Answer 32

hyperglycemia

Question 33

pathophysiology of diabetic neuropathy

Answer 33

- metabolic derangement causes microvessel dysfunction which then causes fiber alterations - metabolic derangement also causes injury to schwann cells and nerve fibers

Question 34

hyperglycemia = greater than ______

Answer 34

225 mg/dl

Question 35

what are some physical symptoms of diabetic peripheral neuropathy

Answer 35

- nocturnal foot and leg pain - hypersensitive dysthesias - numbness/burning pain

Question 36

what monofilament for protective sensation

Answer 36

5.07

Question 37

what turning fork do you use for diabetic peripheral neuropathy

Answer 37

128 Hz

Question 38

what are clubbed fingers a sign of

Answer 38

COPD, lung problems

Question 39

sign of heavy metal poisoning in nails

Answer 39

white lines

Question 40

your pt nails are rough and have straight lines across them. what may they have?

Answer 40

RA

Question 41

what kind of electrodiagnostic study can you get for diabetic peripheral neuropathy

Answer 41

nerve conduction velocity

Question 42

TUG cut off for diabetic peripheral neuropathy

Answer 42

10.7 seconds

Question 43

DGI cut off for diabetic peripheral neuropathy

Answer 43

22/24

Question 44

berg balance cut off for diabetic peripheral neuropathy

Answer 44

52/56

Question 45

functional reach test cut off for diabetic peripheral neuropathy

Answer 45

31.7cm

Question 46

if your pt's blood glucose is less than _______ or greater than ______ you should stop exercise

Answer 46

100 mm/dl 300 mm/dl