final exam peripheral neuropathies Flashcards

1
Q

Characteristics of Peripheral Nerves:
can affect ________ or _______ nerves
can affect both ______ and ______

A

one or many
sensory and motor

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2
Q

Two types of peripheral neuropathies

A

mononeuropathies and polyneuropathies

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3
Q

What is the MOST common type of nerve injury affecting the general population?

A

mononeuropathies

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4
Q

________ have many types of etiologies and DM is the MOST common cause in the USA

A

polyneuropathies

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5
Q

________ is usually caused by some kind of nerve entrapment

A

mononeuropathies

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6
Q

What is the MOST common type of mononeuropathy?

A

Median nerve entrapment

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7
Q

Leprosy is the most common cause world-wide of which neuropathy _______________

A

polyneuropathies

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8
Q

neuronal degeneration:

A

degeneration of motor and sensory cell bodies and their subsequent axons

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9
Q

damage to the axon at a specific point below the cell body w/degeneration distal to injury

A

Wallerian degeneration:

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10
Q

diffuse axonal damage is known as _______________

A

axonal degeneration

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11
Q

injury to the myelin sheath without injury to the axon

A

segmental demyelination

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12
Q

What are the 4 ways a nerve is classified when damaged:

A

neuronal degeneration
Wallerian degeneration
axonal degeneration
segmental demyelination

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13
Q

mononeuropathies:
compressive injuries of the following nerves:

A

* median C5-T1
* ulnar C8- T1
* radial C5-T1
* femoral L2-L5
* sciatic L4-S3
* fibular L4-S2
* tibial L4-S3

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14
Q

mononeuropathies: common CNs injured -

A

trigeminal neuralgia (V), bells palsy (VII), ramsay hunt syndrome (VIII)

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15
Q

types of acquired polyneuropathies:
1) autoimmune
2) infectious
3) toxic and metabolic neuropathies

A
  1. GBS, CIDP, paraneoplastic neuropathy
  2. HIV-related polyneuropathies, lyme disease, leprosy
  3. alcoholic neuropathies, B12, B6 deficiency
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16
Q

types of acquired polyneuropathies associated w/ systematic disease:

A

diabetic neuropathy, hypothyroidism, RA, sarcoidosis, idiopathic polyneuropathy, critical illness polyneuropathy

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17
Q

heredity polyneuropathies:

A

Charcot Marie Tooth

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18
Q

__________ nerve implicated in carpal tunnel syndrome, however, can get impinged where along the path
-medical diagnostic test:
-medical management:

A

median
EMG
carpal tunnel release

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19
Q

PT exam/eval of Median Nerve Pathology:
—test along its entire path: (6)

A

myotomes
dermatomes
first rib elevated
scalenes compressing
carpal tunnel: phalen’s, tinnels signs
ULNT

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20
Q

PT Intervention: Median Nerve Pathology
–create _______,______,and _______

A

space, movement, and blood flow

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21
Q

PT Intervention: Median Nerve Pathology
–treat anything that is compressing it (rib, muscle) =
–nerve glides/flossing =
–cardio/aerobic training, bring nutrients to the injured area =
–once the nerve is ready you should strengthen and work on ________

A

space
movement
blood flow
functional tasks

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22
Q

Piriformis common trap area for which nerve?

A

sciatic nerve

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23
Q

Sciatic Nerve -medical diagnosis:

A

physical exam, EMG, MRI

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24
Q

Sciatic Nerve:
-nerve roots
-splits in two separate nerves:

A

L4-S3
tibial, common fibular

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25
Q

These test should be performed for diagnosis of sciatic nerve pathology:

A

palpation of piriformis
slump or SLR
PA’s

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26
Q

PT intervention of Sciatic Nerve Deficits
–create _______,______,and _______

A

space, movement and blood flow

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27
Q

PT intervention: Sciatic Nerve Deficits
–compression: (2)
–movement =
–blood flow =
–once the nerve is ready you should strengthen and work on ________

A

lumbar spine/piriformis
nerve glides/flossing
cardio/aerobic training
functional tasks

28
Q

Bell’s palsy is _________ dysfunction

A

CN VII

29
Q

Bells Palsy: can be preceded w/

A

exposure to cold
facial numbness and stiffness
jaw P!
decrease hearing and hyperacusis

30
Q

Idiopathic acute unilateral facial paralysis is known as

A

bells palsy

31
Q

Bell’s Palsy: medical management
________ for a week
_______ protection because _____ don’t work
can try to ____________ it but the data is mixed and there is a high risk of damaging hearing

A

corticosteroids
eye; eyelids
surgically decompress

32
Q

Bell’s Palsy: Prognosis
____-_____% improve without treatment and 90% get better w/ __________

A

70-90%
corticosteroids

33
Q

PT role in Bells Palsy:
retrain ______ muscles for function + dry needling
PT should maintain _____ of the eye

A

facial
protection

34
Q

Most common cause of neuropathy in the United States:

A

diabetic neuropathy

35
Q

1). Most common presentation of diabetic neuropathy is
2). Often one of the 1st signs of __________

A

distal symmetrical sensorimotor neuropathy
diabetes

36
Q

Diabetic Neuropathy: _______ to ______ ascending numbness, paresthesias, and dysesthesias in feet. Can progress to hands. (glove hands, stockings feet)

A

distal to proximal

37
Q

Diabetic Neuropathy: Usually lose ______ and _____ first followed by _______ then muscle weakness and atrophy

A

pain; temp; proprioception

38
Q

What diagnostic tests are performed for diabetic neuropathy

A

glucose testing, EMG/nerve conduction testing, and stocking-glove presentation

39
Q

Diabetic Neuropathy: medical management

A

optimize glucose control, diabetic foot care education, and medication can be used in the setting of p! (gabapentin)

40
Q

PT exam for Diabetic Neuropathy:
-sensory screen (5)
-balance
-skin
-neuropathic p!
-foot and arch integrity (1)

A

pink prick 1st** –> P!, temp proprioception, light touch
pes planus

41
Q

HIV-related polyneuropathies: there is an HIV-associated axonal sensory neuropathy (HIV-SN). Affects most patients with low _____ counts.

A

CD4 (HIV marker)

42
Q

HIV-related polyneuropathies: MOST common neurologic complication for patients with _____ and/or _____

A

HIV;AIDS

43
Q

HIV-related polyneuropathies causes _______ and _______ in extremities

A

P! and numbness

44
Q

PT implication with HIV-SN;

A

desensitization techniques for P! control
exercise as tolerated
balance training: substitution w/visual + vestibular

45
Q

Alcohol-related polyneuropathy:
gradual onset distal to proximal symmetric _______ loss. Looks similar to ________
_____ is a late complication
begins after _____ to ____ of alcohol abuse
DTRs are _____

A

sensory; CIDP
weakness
months to years
diminished

46
Q

MOST common neurologic disease associated w/chronic alcoholism

A

Alcohol-related polyneuropathy:

47
Q

alcohol-related polyneuropathy is due to alcohol toxicity and ensuing _______ and ______ deficiency

A

thiamine; B12

48
Q

alcohol-related polyneuropathy: diagnosis

A

EMG/nerve conduction
exclusion

49
Q

alcohol-related polyneuropathy: medical management

A

sobriety and vitamin supplementation

50
Q

_______ is found in most animal products

A

B12

51
Q

Low levels of B12 lead to

A

neuropathy, myelopathy (subacute and acute degeneration of corticospinal and dorsal column), dementia, and megaloblastic anemia

52
Q

Low levels of B12 often causes
distal _____ and _____ instability and if not caught early result in distal ______ (late sign)
reduced ________ and ______ sense

A

numbness; gait
proprioception;vibration

53
Q

B12 deficiency: diagnosis + medical management (1)

A

serum B12, nerve conduction test
B12 supplementation

54
Q

PT implications for alcohol-related and B12-related neuropathies

A

MMTs
check sensation
observe/treat gait
support (give resources) rehab
strengthening
functional task
fall risk –> balance, compensation and remediation
bracing as needed (WC)
desensitization techniques

55
Q

About 25% of patients have no other identified reason for their neuropathy therefore have ________ neuropathy
Usually occurs in the ______ decade
Has a _______ progression over the years
Distal ______ or _______ are most common
Degeneration of axons ________ an inflammatory process
No clear ______ treatments

A

idiopathic
6th (60s)
sensory or sensory-motor?
without
medical

56
Q

PT implications: Idiopathic neuropathy

A

desensitization strategies for P! control
balance work
gaiit
skin checks

57
Q

Occurs after week to months of having a critical illness_____________
These pts. are typically seen in _______ setting
High _____rate

A

critical illness polyneuropathy (CIP)
ICU
mortality

58
Q

Patients who have been vented through several rounds of steroids, on potentially neurotoxic drugs and vasopressors while in ICU. This leads to a lack of

A

distal blood flow - nerves can’t get blood flow and lose finger + toes

59
Q

Main Signs and Symptoms of CIP:

A

distal or generalized weakness, distal sensory loss, areflexia
myopathy -motor loss

60
Q

CIP: medical management
nerve conduction test reveals _____
_________ control
treat underlying _____that got them into critical care
prevention and/or treatment of
improves over months if ________
50% _________ completely

A

axonal polyneuropathy
glucose
illness
secondary complications of being bedridden in the ICU for weeks to months
patient survives
recover

61
Q

PT implications for CIP:
PTs will see and treat patients with CIP myopathy a lot in _______ setting
Diagnosis like these are why PTs are needed in the ICU to prevent ________complications

A

ICU
secondary

62
Q

PT implications for CIP:
early mobility in ICU pts are less likely to lose ________ _______

A

overall strength

63
Q

Charcot Marie Tooth:
progressive distal weakness, atrophy, and sensory loss over several years
___________ is MOST common feature
get ________toes and pes cavus deformity
type _______MOST common

A

foot drop
hammer
1A

64
Q

CMT is a __________ syndrome similar to Huntington
Can progress into hands and forearms

A

hereditary

65
Q

patients w/CMT often have a ______ managing and may need _____

A

podiatrist/sx