Neuropathies

Question 1

What nerve stimulates the deltoid?

Answer 1

C5

Question 2

What nerve does the biceps?

Answer 2

C5, 6 (pick up sticks)

Question 3

What nerves do the triceps?

Answer 3

C7, 8 (shut the gate)

Question 4

What nerves do wrist extension?

Answer 4

Radial nerve (7,8) (shut the gate cont.)

Question 5

What nerve does wrist flexion?

Answer 5

C8 (median nerve)

Question 6

What nerves do the thumbs?

Answer 6

C8/ T1

Question 7

Quadriceps innervation

Answer 7

L2,3,4 Kick the door

Question 8

Hip flexion

Answer 8

L1-L3

Question 9

Hip Extension

Answer 9

L5-S2

Question 10

Ankle movement

Answer 10

S1, 2 Buckle my shoe

Question 11

Signs of Lower motor neuropathy

Answer 11

Decreased tone- flaccid
Weakness
Decreased reflexes
Flexor Plantar response
Fasciculations and wasting
IPSILATERAL

Question 12

Signs of Upper Motor Neuropathy

Answer 12

Increased tone- spasticity (clasp knife)
Weakness
Increased reflexes
Extensor plantar response
Pronator drift
Contralateral

Question 13

When is the forehead spared?

Answer 13

UMN

Question 14

Brachial plexus mononeuropathy

Answer 14

Pain, weakness, paraesthesia caused by heavy rucksacks

Question 15

Causes of phrenic nerve palsy

Answer 15

Lung cancer, myeloma, cervical spondylosis,

Question 16

Symptoms of phrenic nerve palsy

Answer 16

Orthopnoea, raised hemidiaphragm on CXR,

Question 17

Symptoms of sciatic nerve palsy (L4- S3)

Answer 17

Foot drop, loss of sensation below knee

Question 18

Common Peroneal Nerve Palsy symptoms (L4-S1)

Answer 18

Foot drop, weal ankle, sensory loss dorsal foot.

caused by sitting cross legged

Question 19

Tibial nerve palsy

Answer 19

L4-S3 Cant stand on tip toe (plantar flexion)

Question 20

Are neuropathies usually proximal or distal?

Answer 20

Distal

Question 21

What are systemic causes of neuropathies?

Answer 21

Wegeners
AIDs
Amyloidosis
Diabetes
Rheumatoid
PAN
Sarcoidosis
Leprosy

Question 22

Local causes of neuropathies

Answer 22

Entrapment or trauma

Question 23

Ulnar Palsy symptoms (C7-T1)

Answer 23

Elbow trauma cause
Wrist flexors
Interossei (cross fingers)
Claw hand (lumbricals)
Sensory loss

Question 24

Radial nerve palsy (C5-T1)

Answer 24

Wrist drop
Finger drop
Variable sensory loss

Question 25

Carpal Nerve is entrapment of which nerve?

Answer 25

Median Nerve

Question 26

What are the characteristics of peripheral neuropathy?

Answer 26

Chronic, slowly progressive deficit in motor and/or sensory usually starting in glove and stocking distribution

Question 27

What are the skin changes in peripheral neuropathy?

Answer 27

Trophic changes- Thin, dry skin, hairless and numb

Question 28

What are the 2 kinds of peripheral sensory nerve fibres?

Answer 28

C fibres- small fibres pain and temp sensation | A fibres- large fibres proprioception and vibration

Question 29

Common causes of peripheral neuropathy

Answer 29

B12/folate deficiency Alcohol/toxins Infection- HIV, Lyme, Leprosy Drugs- chemo, ionazid, phenytoin, amiodarone Idiopathic GBS Endocrine: Diabetes, Hypothyroid, Cushings, Agromegaly CIDP (chronic inflammatory demyelinating polyneuropathy) similar to GBS but chronic Charcot Marie Tooth (children) Multifocal Motor neuropathy (MMN)

Question 30

What investigations would you do for peripheral neuropathy?

Answer 30

``` FBC ESR U + E Glucose TFT CRP B12 Folate Antigliadin ANA ENA ANCA RhF antidsDNA (Vasculitis screen) ```

Question 31

Peripheral Neuropathy Treatment

Answer 31

Gabapentin, Pregabalin, Amytriptyline Remove cause (DM, gluten) If inflammatory: steroids (prednisolone), or azathioprine If vasculitis: Prednisolone and immunosupressant (cyclophosphamide)