Medical Conditions

Question 1

What is paresthesia?

Answer 1

Paresthesia is a sensation of tingling, tickling, pricking, or burning of a person’s skin; “limb falling asleep”, “pins and needles”

Question 2

What is proprioception?

Answer 2

Proprioception is a sense of the relative position of neighbouring parts of the body and strength of effort being employed in movement

Question 3

What is Tinel’s sign?

Answer 3

Tinel’s sign is a way to detect irritated nerves. It is performed by lightly tapping (percussing) over the nerve to elicit a sensation of tingling or “pins and needles” in the distribution of the nerve.

Question 4

What is Phalen’s test?

Answer 4

Phalen’s test: patient is asked to hold their wrist in complete and forced flexion (pushing the dorsal surfaces of both hands together) for 30–60 seconds. By compressing the median nerve within the carpal tunnel, characteristic symptoms (such as burning, tingling or numb sensation over the thumb, index, middle and ring fingers) conveys a positive test result and suggests carpal tunnel syndrome, not very specific b/c not everyone’s nerve will be compressed

Question 5

What are some tests for carpal tunnel? What is an example of another mononeuropathy?

Answer 5

mononeuropathy: single nerve deficit ex. Bell’s palsy

Question 6

What is Bell’s palsy?

Answer 6

Bell’s Palsy

Etiology:

Idiopathic,
(HSV) infection
of the facial nerve

Diagnosis of exclusion

P/E:

Paralysis or paresis of all muscle groups on one side of the face

Absence of signs of CNS disease

Absence of signs of ear or CPA diseases

Rx:

Protect the eye to prevent exposure keratitis with patching or tarsorraphy
Systemic steroids may lessen degeneration and hasten recovery

Consider antiviral (acyclovir)

F/U:

Spontaneous remission should begin within 3 wk of onset

Delayed (3 to 6 mo) recovery portends at least some functional loss

Px:

90% recover spontaneously and completely overall; >90% recovery if paralysis was incomplete
Poorer if >60 yr, diabetes, HTN, severe pain

Question 7

What is the difference between paresthesia and ataxia?

Answer 7

ataxia - incoordination or unsteadiness due to brain’s failure ot regulate body’s posture and strength/direction of limb movements

often due to BRAIN, specifically cerebellum, location of lesion in CNS, MOTOR deficit

numbness (paresthesia) - sensation of tingling, burning, prickling, or numbness on person’s skin with no apparent physical effect, known as “pins and needles”, “falling asleep”, lesion in PNS, SENSORY deficit

Question 8

Outline etiology Guillain-Barre?

Answer 8

• acute rapidly evolving polyneuropathy that often starts in the distal lower limbs and ascends
• autoimmune attack and damage to peripheral nerve myelin, often after infection (campylobacter most common)

Question 9

investigations in Guillame Barre? treatment?

Answer 9

investigate:

CSF: high protein, normal WBC

EMG/NCS - electromyelogram (muscle), nerve conduction studies - slow

treat: IvIg or plasmapheresis +/- pain management, monitor vitals and vital capacity (high risk of resp depression due to ANS failure, many patients require intubation), 5% mortality due to ANS depression, up to 15% will develop permanent deficits, some will develop condition chronically

Question 10

S&S of Guillame-Barre?

Answer 10

sensory: distal and symmetric paresthesias (numbness), loss of vibration, proprioception, etc; neuropathic pain
motor: weakness starting distally in legs, areflexia
autonomic: bp dysregulation, respiratory depression (30% require intubation), arrhythmia, bladder/spincter dysfunction