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4. MSK exam > Sachen: Peripheral Neuropathies > Flashcards

Sachen: Peripheral Neuropathies Flashcards

1
Q

How can radiation injury vs. neoplastic etiology be differentiated on the basis of involvement and pain in terms of brachial plexopathy?

A
  • Radiation injury: upper trunk, lateral cord, painless
  • Neoplastic: medial cord, painful (breast and lung)
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2
Q

What are 6 motor signs/sx’s of peripheral nerve disease?

A
  • Distal weakness
  • Cramps
  • Muscle fasciculations (twitching)
  • Atrophy
  • ↓ DTRs
  • Reduced tone
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3
Q

What are sx’s of a small unmyelinated fiber neuropathy?

A
  • Pain
  • “Burning” dysesthesias
  • Paresthesias
  • Temperature sensation abnormalities
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4
Q

What will be seen on skin biopsy in a small (unmyelinated) fiber polyneuropathy?

A

↓ epidermal nerve fiber density

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5
Q

Weakness in shoulder abduction with loss of sensation in the lateral arm is seen with lesion of what nerve root?

A

C5

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6
Q

Weakness in shoulder abduction + elbow flexion with sensory loss in the 1st and 2nd digit is due to lesion of what nerve root?

A

C6

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7
Q

Sensory loss in the medial calf + weakness in hip flexion and knee extension is due to lesion of which nerve root?

A

L4

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8
Q

Sensory loss in the lateral calf/dorsum of foot + weakness in hamstrings + foot dorsiflexion, inversion, and eversion is due to lesion of what nerve root?

A

L5

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9
Q

What is the dermatomal distribution for T1?

A

Medial forearm

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10
Q

When diagnosing a plexopathy which 2 muscle can help identify proximal lesions?

A
  • Rhomboids (Dorsal Scapular n. - C5)
  • Serratus Anterior (Long thoracic n. - C5)
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11
Q

What are the negative vs. positive sx’s associated with a large (myelinated) fiber peripheral neuropathy?

A
  • Negative: ↓ vibration + ↓ joint position sense + arreflexia + ataxia + hypotonia
  • Positive: tingling + pins and needles + numbness
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12
Q

Which median mononeuropathy is associated with an insidious onset of diffuse/dull ache about th proximal forearm (rarely acute or sharp)?

A

Pronator Syndrome

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13
Q

Pronator syndrome will have associated sensory loss where in the hand?

A

Diffuse numbness of hand, mostly 2nd-3rd fingers (median n)

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14
Q

Which mononeuropathy is associated with an abnormal pinch (ok) sign w/ normal sensation?

A

Anterior Interosseous Syndrome (median n)

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15
Q

What is a common site in the elbow and wrist contributing to ulnar mononeuropathy?

A
  • Elbow: cubital tunnel (medial epicondyle and olecranon)
  • Wrist: Guyon’s canal
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16
Q

Which muscle and motion of the thumb will be impaired in ulnar mononeuropathy?

A

ADductor policis = weak thumb ADduction = Froment Sign

17
Q

What is the most common site for radial mononeuropathy to develop; presents with what deficit?

A
  • Spiral groove of the humerus == Saturday night palsy
  • Presents with wrist drop due to paresis of extensor ms. of the wrist, finger, and thumb
  • Elbow extension is SPARED!
18
Q

What is Parsonage-Turner syndrome?

A

Autoimmune with severe shoulder pain for days that leads to weakness and atrophy

Spontaneous recovery in 6-18mo

19
Q

3rd digit sensory loss, elbow/wrist/finger ext, and tricep reflex loss describes compression of which nerve root?

A

C7

20
Q

Sensory loss to the 4/5th digit & loss of finger abd/flexion describes which nerve root loss?

A

C8

21
Q

Sensory loss of the post/lat calf & loss of hamstrings/planterflexion describes loss of which nerve root?

A

S1

22
Q

What nerves does the posterior cord give off? Lateral?

A

Posterior cord = axillary & radial

Lateral cord = musculocutaneous & median

23
Q

What are the 3 locations assc w radial n neuropathy?

What are the motor/sensory impairments?

A

Motor = wrist drop; Sensoey = dorsum of hand

Locations

  1. Axilla: crutches
  2. Spiral groove: saturday night palsy
  3. Posterior interosseous: elbow synovitis
24
Q

Which neuropathy is assc w thenar atrophy?

A
25
Q

Which nerve entrapment presents with clawing of the 4th/5th digit and hypothenar atrophy?

A

Ulnar n

26
Q

What procedure is assc with sciatic nerve palsy? What are some s/s?

A

Intramuscular injection == sciatic neuropathy

S/s: foot drop, weak eversion, sensory loss to dorsum of foot

27
Q

What is the MC location for peroneal nerve compression? S/s?

A

Location: fibular neck

S/s: foot drop, weak eversion, weak dorsiflexion, sensory loss to dorsum

“PED” peroneal-evert-dorsi

28
Q

What are the s/s of tibial n neuropathy?

A

Weak inversion and plantarflexion

“TIP” tibial-invert-plant

29
Q

What should we consider with pure sensory neuropathy?

A

Consider sensory ganglionopathy

  • RO cause is paraneoplastic – from malignancy**
  • Maybe from toxin

Consider small-fiber disease

  • If pain and temp affected
30
Q

What are the characteristics of Charcot-Marie-Tooth type 1?

A

CMT 1 = HMSN 1

  • Most common type of CMT
  • Auto dom
  • S/s: walking issues, distal sym atrophy, pes cavus, scoliosis
  • EMG shows slowing of motor nerve conduction
31
Q

What are the characteristics of Charcot-Marie-Tooth type 2?

A

CMT2 = HMSA 2

  • AD, but onset as adult
  • Distal sym atrophy
  • Mild sensory loss
  • Nml EMG and near nml motor nerves
32
Q

What are 2 key lab findings in GBS?

A
  1. CSF = albumino-cytologic dissociation (inc protein, nml cell count, nml glucose)
  2. NCVs = slow conduction velocity, long F waves
    1. Low amplitude responses indicates poor prognosis
33
Q

What is the MC variant of GBS?

A

Miller-Fischer syndrome

  • ophthalmoplegia, ataxia, arreflexia
  • facial weak, dysarthria, dysphagia
  • GQ1b and GT1a ab
34
Q

Which disease is similar to GBS but slower to evolve and more persistent?

A

CIDP = chronic inflamm demyelinating polyneuropathy

  • may occur w gbs
  • 15% have IgM/IgG ab
35
Q

What are the char of HIV neuropathies?

A
  • might be AIDP or CIDP
  • CD4 <200
  • 30-50% of AIDS pt’s
36
Q

How does the MC cause of aquired neuropathy present?

A

DM – symmetrical distal polyneuropathy

4. MSK exam (21 decks)

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