Peirpheral neuropathy

Question 1

what is peripheral nervous system

Answer 1

• originates and ends in the spinal cord

- motor and sense system involved in invountary reflex arc and voluntary control/awareness

Question 2

7 possible localizations in peripheral system

Answer 2

1. myopathy
2. NMJ
3. mononeuropathy
4. plexopathy
5. radiculopathy
6. motor/sensory neuropathy
7. polyneuropathy

Question 3

3 principles of nerve conduction

Answer 3

1. propagation is analagous to transmission in CNS
2. depol. hyperpol. dependednt on Na/K
3. strength and speed depend on type of nerve fiber

Question 4

what is saltatory conduction

Answer 4

myelin covering means you can jump

- autonomic is much slower due to lack of myelin

Question 5

4 mechs of nerve injury

Answer 5

1. disrupted axonal transport (most common)
2. nerve infarct
3. nerve inflammation
4. compression/direct injury

Question 6

what are 2 types of axonal transport and what do they transport?

Answer 6

1. anterograde - essential nutrients to the nerve

2. retrograde - returns debris to cell body for recycling

Question 7

what nerves oare most likely to be disrupted

Answer 7

longest (toes) and thickest (sensory)

Question 8

what is polyneuropathy

Answer 8

most common

- lenght dependent due to disruption in axonal transport

Question 9

5 sensory Sx of polyneropathy

Answer 9

1. itch
2. burning
3. freezing
4. tingling
5. numbness

Question 10

3 motor Sx of polyneuropathy

Answer 10

1. cramps
2. weakness
3. gait diff./falls

Question 11

7 autonominc features of polyneuropathy

Answer 11

1. syncope
2. arrythmia
3. incr./decr. perspirtation
4. diarrhea/constipation
5. bladder dysfunciton
6. visual blurring
7. sexual dys

Question 12

6 general causes of symetrical distal polyneuropathy

Answer 12

1. metabolic - endo, organ dysfunction
2. nutritional
3. toxic - env and meds
4. infection
5. CA
6. CT diseases

Question 13

most common cause

Answer 13

diabetes

- in world used to be leprosy

Question 14

what does EMG tell us

Answer 14

• if and where there is dysfunction
• extent of injury
• duration
• type of damage
  NOT
• etiology
• central involvement

Question 15

what is nerve conduction

Answer 15

evaluates sense and motor nerves in the limbs

Question 16

what is EMG

Answer 16

can tell us about nerve and muscle function in any accessible muscle

Question 17

5 screening lab tests

Answer 17

1. CBC
2. ESR
3. metabolic screen (luc, TSH, LIVER)
4. B12
5. serum protein electorphoresis

Question 18

what is highest yeild lab test

Answer 18

B12

Question 19

5 patterns of peripheral nerve dys.

Answer 19

1. polyneuropathy
2. plexopathy
3. radiculopathy
4. mononeuropathy
5. mononeuropathy multiplex

Question 20

7 red flag on neuro

Answer 20

1. early/simultaneous upper limb Sx
2. cranial nerve involvment
3. rapid progression
4. focality/multifocality
5. pure motor movement
6. bowel/bladder involvment
7. associated Sx

Question 21

3 etiologies of atypical neuopathy

Answer 21

1. radiculopathy
2. mononeuropathy mulitplex (vasculitis, amyloidosis)
3. demyelinating

Question 22

what is general treatment strategy

Answer 22

remove the insult

- no DMARDs for polyneupathy

Question 23

what is important other Sx in polyneuropathy

Answer 23

pain

Question 24

what is treamtent of neuropathic pain

Answer 24

• anticonvulsants
• anti-deps
• opiods

Question 25

what is treatment for cramping

Answer 25

- stretch - hydrate - Ca blockers - baclofen