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MSPA4023 - Clinical medical & public heath > PNS disease > Flashcards

PNS disease Flashcards

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USMLE® Step 1 flashcards
1
Q

How many pairs of nerves are there in the PNS?

A

31

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2
Q

Explain which of the 31 pairs of spinal nerves are.

A

Cervical nerves (8)
thoracic nerves (12)
lumbar nerves (5)
sacral nerves (5)
coccygeal nerves (1)

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3
Q

What are the afferent and the efferent cells?

A

Afferent cells - sensory nerves that transfer electrical signals from the muscle to the spinal cord

Efferent cells - motor nerves that transfer electrical signals from the spinal cord to the muscle to take actions

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4
Q

What is the peripheral nervous system divided into?

A

somatic system - afferent & efferent nerves

Autonomic system sympathetic & parasympathetic

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5
Q

What is the sympathetic and parasympathetic nervous system?

A

Sympathetic nervous system:
- increase heart rate
- increase blood pressure
- decrease digestion
- maximized blood flow
# Flight or Flight response
Parasympathetic
- decrease heart rate
- increase digestion
# Rest & digest response

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6
Q

define these neuropathies
- mononeuropathy
- multiple mononeuropathy
- polyneuropathy
- plexopathy
- radiculopathy

A
  • mononeuropathy –> affects one nerve
  • multiple mononeuropathy –> affects several discrete nerves
  • polyneuropathy –> affects multiple nerves that spread around
  • plexopathy –> affects a bundle of nerves
  • radiculopathy –> affects the site where the nerves leave (i.e. neck/spine)
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7
Q

types of peripheral neuropathy

A

mononeuropathy
polyneuropathy
mononeuropathy multiplex

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8
Q

acquired demyelinating polyneuropathy causes

A

Demyelination (damage to the myelin sheath), which slows nerve conduction

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9
Q

symptoms of acquired demyelinating polyneuropathy

A

large-fibre sensory dysfunction (buzzing and tingling sensation)
motor weakness
diminished reflexes
severe motor weakness with minimal atrophy

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10
Q

What is small fibre sensory neuropathy (SFSN)

A

Disorder in which only the small sensory cutaneous nerves are affected

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11
Q

symptoms of small fibre sensory neuropathy (SFSN)

A
  • unusual sensations such as pins-and-needles
  • pricks
  • tingling
  • numbness
  • burning pain or coldness and electric shock-like brief painful sensations
  • start in the feet and progress upwards
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12
Q

What sort of damage can nerve cells go through?

A

compressed
sheath loss
disconnection
degeneration

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13
Q

what is Guillan-barre syndrome (GBS)

A

Acute paralytic polyneuropathy that affects the peripheral nervous system

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14
Q

What’s the feature of Guillan-Barre syndrome?

A
  • symmetrical ascending weakness
  • peripheral loss of sensation
  • neuropathic pain
  • Absence reflexes
  • absent/depressed tendon reflexes
  • facial nerve weakness
  • double vision
  • difficult speaking
  • constipation
  • urinary incontinence
  • orthostatic hypotension
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15
Q

How often does it take GBS symptoms to occur?

A

2-4weeks

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16
Q

What to investigate on GBS?

A
  • nerve conduction test & electromyographic studies
  • clinically
  • lumbar puncture
  • check pulmonary function
17
Q

What tool is to use for diagnosing GBS?

A

Brighton criteria

18
Q

management of GBS

A
  • IV immunoglobulins
  • Plasmapheresis
  • supportive care
  • VTE prophylaxis (low-molecular-weight heparin)
19
Q

What is Myasthenia gravis

A

An Autoimmune condition affecting the neuromuscular junction.
It causes muscle weakness that progressively worsens with activity and improves with rest.

20
Q

Clinical presentation of Myasthenia gravis

A
  • muscle weakness
  • worse with increased muscle use
  • improve with rest
  • affects proximal muscle and small of the head and neck
  • Diplopia (double vision)
  • ptosis
  • difficulties swallowing
21
Q

Diagnosis of Myasthenia gravis

A

Blood test to look for:
- ACH-receptor antibodies
- MUSK antibodies
- serial pulmonary function tests
–> CT/MRI scan
–> edrophonium test

22
Q

What is the treatment of myasthenia gravis?

A
  • Pyridostigmine & neostigmine (acetylcholinesterase inhibitors)
  • steroids & azathioprine (immunosuppression)
  • thymectomy
  • Rituximab
  • Eculizumab
    (monoclonal antibodies)
23
Q

What is the treatment for a myasthenic crisis?

A
  • Intubation and mechanical ventilation
  • plasma exchange / intravenous immunoglobulin
  • supportive care
  • corticosteroid
24
Q

What is Charcot-Marie-Tooth Disease?

A

progressive hereditary disorders of the peripheral nervous system. It’s inherited, worsens over time and affects sensory & motor nerve cells

25
Q

Clinical features of Charcot-Marie-Tooth disease

A
  • loss of sensation on the feet, ankles and legs
  • curled toes (hammer toes) and foot deformities
  • difficulties of using hands
26
Q

What is the investigation of Charcot Marie tooth disease?

A
  • nerve conduction studies (NCS)
  • genetic testing
  • Hip X-ray
27
Q

First-line treatment of Charcot-Marie-Tooth disease

A
  • physiotherapy
28
Q

What is Carpal tunnel syndrome?

A

Carpal tunnel syndrome (CTS) is a collection of symptoms and signs caused by compression of the median nerve in the carpal tunnel.

29
Q

Risk factor of Carpal tunnel syndrome

A

Age between 40-60

Female

High BMI

Pregnancy

Diabetes

30
Q

Clinical features of Carpal tunnel syndrome

A
  • worse at night
  • paresthesia
  • numbness in the median nerve distribution
  • muscle weakness
    clumsiness with holding small objects / turning doorknobs
31
Q

Diagnosis and investigation on carpal tunnel syndrome

A

electromyogram (EMG)
ultrasound of the wrist
MRI on the wrist

32
Q

First-line treatment of carpal tunnel syndrome?

A

Wrist splint

33
Q
A

MSPA4023 - Clinical medical & public heath (16 decks)

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