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Flashcards in Neurology III Deck (46):
1

Neurons of the CNS are supported by?

oligodendrocytes and astrocytes

2

Neurons of the PNS are associated with?

Schwann cells and ganglionic satellite cells

3

The peripheral nervous system includes all of the cranial nerves except?

CNII

4

The peripheral nervous system excludes the mesh-like system of neurons of the:

gastrointestinal system (the Enteric Nervous System)

5

Peripheral neuropathies have four main patterns:

mononeuropathy, mononeuritis multiplex, polyneuropathy, autonomic neuropathy

6

mononeuropathies involve:

one nerve

7

mononeuritis multiplexes involve:

multiple individual nerves

8

polyneuropathies involve:

multiple nerves

9

most common causes of mononeuropathies are:

compression, ischemia, infection, inflammation

10

the mononeuritis multiplex is what type of neuropathy?

An asymmetric, non-contiguous, multifocal neuropathy

11

Most common causes of mononeuritis multiplexes are:

DM, vaculitis, immune-mediated disease, infection

12

a polyneuropathy is what type of neuropathy?

A symmetric or contiguous multifocal neuropathy, usually starting distally.

13

The most common causes of polyneuropathies are:

DM, metabolic/toxic disturbances, demylination (Guillain Barre), infection (herpes zoster).

14

Autonomic neuropathies usually co-occur with:

polyneuropathies

15

Presenting sxs of autonomic neuropathies include:

GI sxs, disturbances of HR/BP, erectile dysfunction, disturbances of sweat regulation

16

Peripheral neuropathy can be caused by:

DM, hypothyroidism, tobacco use, systemic lupus, deficiency in vitamin B1, B12, A, E or an excess of B6.

17

Drugs that can cause peripheral neuropathies are :

fluoroquinolones (permanent), phenytoin, vincristine, metronidazole, statins, isoniazid, nitrofurantoin, chemotherapy

18

Shingles, HIV, Lyme disease, hypothyroidism, and lightning strikes can all cause:

peripheral neuropathies

19

peripheral neuropathy treatments include:

tricyclic antidepressants (SNRIs), gabapentin/pregabalin/valproate, cannabinoids, opiates, TENS

20

carpal tunnel syndrome (CTS) is an example of:

entrapment mononeuropathy

21

CTS generally presents with what sxs:

intermittent numbness and parasthesias of the 1st, 2nd, 3rd, and radial half of the 4th digit of an upper extremity.

22

Predisposing factors for CTS include:

heavy manual work, work with vibrating tools, obesity, DM, hypothyroidism, RA, wrist fractures, acromegaly, ganglion cysts, sleep posturing, and pregnancy

23

Tests commonly used to diagnose CTS are:

Phalen's maneuver, Tinel's sign, hand elevation test, NCS/EMG

24

Tx for CTS includes:

wrist brace while sleeping, NSAIDs, Steroids (oral, phonopharesis, injected), surgical release of the transverse ligament (increased risk of trigger thumb)

25

Bell palsy is?

Compressive sensorimotor peripheral neuropathy of CN VII

26

Bell palsy sxs:

weakness to paralysis of the facial muscles, hyperacusis, and loss of taste to the anterior 2/3 of the tongue

27

Bell palsy exam:

Have pt raise eyebrows. If pt has experienced insidious onset of >2wks or they are able to raise eyebrows or wrinkle their forehead then MRI of the brain is indicated.

28

mild Bell palsy tx:

no tx needed

29

Bell palsy tx:

Prednisone is effective if started early. Eye lubrication. Physical therapy, massage, and exercise.

30

Bell palsy prognosis:

sxs usually start improving within 2 weeks of onset with a full recovery within 3-6 months.

31

Guillain-Barre syndrome is diagnosed by:

history and supported by NCS and CSF

32

Guillain-Barre history will show:

progressive, ascending weakness (distal to proximal)

33

Guillain-Barre PE will show:

absent DTRs and no fever

34

Guillain-Barre CSF study will show:

increased protein without an increase in cell count

35

Guillain-Barre CBC study will show:

increased WBC

36

Guillain-Barre NCS study will show:

prolonged distal latency

37

Guillain-Barre tx:

plasmapharesis and/or iv immunoglobulins, breathing support prn, and physical rehab

38

Guillain-Barre recovery:

usually starts after the 4th week and 80% will recover fully within a year

39

Myasthenia gravis (MG) is:

Autoimmune neuromuscular disease causing intermittent/fluctuating weakness and fatiguability

40

Main sx of MG:

fatiguability

41

Most commonly involved muscles of fatiguability for MG:

extraocular, facial, mastication, and pharyngeal muscles

42

MG PE:

ptosis, ophthalmoplegia/nystagmus, fatiguability with upward gaze, slowed speech and counting

43

MG etiology:

MG is usually caused by autoimmune ABs against the nicotinic acetylcholine receptors. MG can also be caused by ABs against muscle specific kinase

44

MG tx:

acetylcholinesterase inhibitors (neostigmine, pyridostigmine) and immunosuppressant (prednisone, cyclosporine, azothiprine)

45

Severe MG tx:

plasmaphoresis and IVIG

46

MG prognosis:

MG is not progressive. Some pts see improvement after 3-5 yrs but most see fluctuating severity over time.