peripheral neuropathy WORKUP

Question 1

peripheral neuropathy symptoms

when is the pain worse?

what happens if it occurs bilaterally vs unilaterally?

Answer 1

tingling, numbness, feet on fire/crawling sensation, and spread proximally to ankle and leg pain worse at night. Pain can lead to numbnmess

unilateral: mechanical distress/entrapment
bilateral: systemic disease (diabetes)

Question 2

patients with peripheral neuropathy will commonly also have what

Answer 2

diabetes

Question 3

causes of PN

Answer 3

Idiopathic, inherited(charcot mariet tooth, familial amyloid polyneuropathy, refsumdis, Roussy Levy)
Metabolic, mechanical (diabetes, radiculopathy, nerve entrapment)
Drugs: chemotherapy
Infection: Leprosy, myasthenia gravis, syphilis, HIV, herpes, hepatitis
Sarcoidosis
Toxins, Thyroid: uremia, exposed to heavy metals, alcohol
Autoimmune, allergy: guillain-barre syndrome, lupus, RA
Lack of vitamins: b12 insufficiency

Question 4

what is the tobacco impact on peripheral neuropathy

Answer 4

it may contribute to vascular disease and delay healing of future ulceration

Question 5

PVD vs neuropathy

Answer 5

does pain at night get better at night in dependent position?

if yes to both, pain likely due to PVD no neuropathy

Question 6

what can diabetic PN cause to muscles

Answer 6

intrinsic muscle wasting and fat pad displacement/atrophy

Question 7

what does clawing of digits and weakness with muscle strength testing may indicate

Answer 7

motor neuropathy

Question 8

what do you typically see with diabetic or systemic neuropathy in Neuro exam

Answer 8

stocking/glove patteern–bilteral sides

Question 9

which fiber has high velocity fibers to test for acute pain, temp, touch, pressure, proprioception, somatic efferent fibers

Answer 9

TYpe A fibers

Question 10

which fibers are visceral afferents, pregnaglionic autonomic?

Answer 10

type B fiber

Question 11

what is the criteria for peripheral neuropathy with monofilament testing (SWM)

Answer 11

loss of 4 of 10 areas to dx
and its also good to check how far the neuropathy goes up–so check up the leg too:
If 0/10: keep testing up leg to kneed to find level of sensation

Question 12

what is the criteria for peripheral neuropathy with vibratory perception?

where is the test done?

which vibratory perception test is more accurate? and what is that criteria?

Answer 12

128 hz tuning fork: physician should be able to feel for 5 sec longer than patient, if more than 10 seconds–Nerve damage

test is applied to 1st and 5th mpj–test malleoli if not felt

biothesiometer: 3 readins over 25 V indicates PN

Question 13

which device can distinguish between motor and sensory and axonal vs demylination probs?

Answer 13

EMG/NCV

Question 14

which device can dx nerve entrapments and level of dysfunction

Answer 14

emg/ncv

Question 15

if nerve degeneration in present, what will be seen on EMG?

Answer 15

nerve degeneration: fibrillation and sharp wave discharges at rest

Question 16

what can nerve conduction velocity determine

Answer 16

ares of demylination and ares of nerve lesion or entrapment

Question 17

where does peripheral neuropathy usually start

what happens if only a few toes are effected?

Answer 17

toes and met heads

few toes: neuroma or neuritis

Question 18

what do you want to test for in vascular PE?

Answer 18

palpable pedal pulses, if not, vascular prob may be a contributing factor

Question 19

which fiber is slow-velocity: postganglionic autonomic involved in chronic pain

Answer 19

type C fibers unmyelinated

Question 20

what device test 1 and 2 point discrimination, static and moving?

what can it test?

Answer 20

Pressure specified sensory device

it can usually test varibale stages of neuropathy and nerve entrapments

Question 21

when is MRI used

Answer 21

when you think prob stems from

spinal stenosis
spinal cord tumor
lumbar disk disease

Question 22

What does nerve biopsy show? which nerve do you usually do biopsy

Answer 22

show nerve damage and demylination.

sural nerve