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Clin med exam 2 > Peripheral > Flashcards

Peripheral Flashcards

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1
Q

Major types of peripheral neuropathy

A

Depends on which nerves are affected

Large fiber nerves and Small fiber nerves

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2
Q

Peripheral neuropathy- Large fiber nerves

A

pins and needles
lost of joint position (proprioception)
loss of vibration
loss of reflexes

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3
Q

Peripheral neuropathy- Small fiber nerves

A

burning pain
can have normal reflexes
can affect autonomic function (BP, pulse)

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4
Q

Peripheral neuropathy- Cause

A

often idiopathic

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5
Q

metabolic and nutritional issues that causes peripheral neuropathies

A

diabetic mellitus- most common cause

alcohol abuse

hypothyroidism

uremia (renal disease)

vitamin deficiencies
- b12

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6
Q

Non celiac gluten sensitivity

A

can’t handle but do not have celiac markers

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7
Q

Gluten

A

can cause peripheral neuropathies

linked to a number of idiopathic axonal neuropathies

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8
Q

Most common cause of peripheral neuropathy in US

A

Diabetes mellitus

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9
Q

Diabetes mellitus

A

affects all nerves in the body

GI issues

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10
Q

All patients with peripheral n. should be offered ___?

A

Physical therapy for balance

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11
Q

Hypothyroidism

A

can cause peripheral neuropathies

associated with upper weakness

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12
Q

What is associated with carpal tunnel

A

hypothyroidism

causes tingling/pain in palms
PE: tinel test and phalens maneuver

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13
Q

Kidney disease

A

can cause peripheral neuropathies

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14
Q

Diet- vitamins

A

B-12- pernicious anemia, gastric bypass, veganism, prolonged antacids

copper- zinc supplements (denture cream)
zinc

vitamin E- fat malabsorption

vitamin B6- deficiency and excess

vitamin B1- mal nourishment

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15
Q

B12 deficiency

A

eating disorders

bariatric surgeries

catch early ! takes months to improve symptoms

check for loss of proprioception

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16
Q

Sepsis

A

can cause critical illness polyneuropathy (nerve damage)

unclear pathophysiology

tx is supportive care

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17
Q

Alcoholism

A

can cause toxic neuropathy and myopathy

tx: thiamine

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18
Q

Infectious cause

A

HIV/AIDS

Leprosy- most common cause worldwide

Herpes Zoster (varicella)

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19
Q

Herpes zoster tx

A

acyclovir, valacyclovir

vaccine available

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20
Q

Chemotherapy

A

can cause peripheral neuropathy

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21
Q

Medications

A

can cause peripheral neuropathy

chemotherapy

antiarrhythmic

antiepileptic

antihypertensive

abx

cholesterol lowering agents

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22
Q

Immune axonal neuropathies

A

cause joint pain, fevers

hep b/c
RA
SLE

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23
Q

Toxins

A

can cause neuropathies

arsenic
thallium

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24
Q

Genetic disorders

A

can cause peripheral neuropathy

foot deformities (rocker bottom) 
classic sign- inverted champagne bottle

charcot marie tooth

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25
most common inherited neurological disorder
charcot marie tooth
26
charcot marie tooth diagnosed with ____?
with EMG/ NCS show decrease in velocity (abnormal myelin problem)
27
What do we order for peripheral neuropathy?
EMG/NCS for lower extremities Labs- hba1c, tsh, vit d, glucose tolerance test, poss ana, sed rate gabapentin physical therapy for balance education on skin care/fall precautions
28
What is good for nerve pain?
Gabapentin
29
Side effects of gabapentin
foot w edema
30
What can you use instead of gabapentin
Lyrica (pregabalin)- fewer side effects than gaba
31
Gaba and lyrica are ___ meds?
anti-seizure meds nerve pain meds get ride of overactive nerve
32
Amitriptyline
antidepressant also helps with sleep
33
Amitriptyline side effects
dry mouth
34
Natural approaches that help with peripheral neuropathy
``` alpha lipoic acid vit c fish oil coenzyme Q10 vit d ```
35
Topamax
=seizure med nerve pain medication being researched
36
Guillain Barre
lose reflexes bottom to top (ascending paralysis) autoimmune disorder- have stomach bug or URI- causes mimic response attacks myelin sheath, no insulation means nerve does not fire
37
Guillain Barre dx
CSF from LP showing albuminocytologic dissociation high amounts of proteins (albumin) but no increase in WBC (infection)
38
Guillain Barre tx
plan a: IVIg "liquid gold" plan b: dialysis (plasma exchanges)
39
Myasthenia gravis
immune system attacks the muscle receptors (ACH receptors) = severe muscle weakness
40
Types of myasthenia gravis
ocular and generalized
41
PE for myasthenia gravis
focuses on strength EOM exam counting on 1 breath squeezing time multiple times (fatigable)
42
Myasthenia gravis tx
ice pack
43
Botulism
toxic that causes descending paralysis the dozen D's in order of manifestation go downhill fast- no fluctuations
44
Autoimmune diseases tend to damage peripheral nerves and tend to be
symmetrical
45
Myasthenia gravis signs and symptoms
fatigable and fluctuating weakness "double vision"
46
Myasthenia gravis occurs where?
occurs in voluntary muscles around eyes, skeletal muscles, and diaphragm sleepy dwarf
47
Myasthenia gravis dx
tensilon test- it is a quick acting version of ACh esterase inhibitor lab draw- ACh receptor antibody panel
48
Myasthenia gravis tx
increase ACh levels pyridostigmine (mestinon) increases ACh by stopping the destruction of ACh neurotransmitter (acetylcholinesterase is an enzyme that breaks down ACh, this med slows down this enzyme) Also immunosuppressants
49
Myasthenia gravis- meds to avoid
beta blockers | calcium channel blockers
50
What is the only tx for botulism ?
HBAT | heptavalent botulism antitoxin
51
What bacteria is thought to be linked to guillain-barre?
campylobater jejuni
52
Peripheral neuropathy
is a diffuse nerve problem (polyneuropathy) | described as the "dying back" of nerves
53
Paresthesia
is a "pins and needles" sensation
54
What PE findings should you focus on for peripheral neuropathy?
reflexes pin prick turning fork - most sensitive test
55
Leprosy cause, symptoms, transmission, tx
caused by bacteria mycobacterium lyprae affects skin and peripheral nerves symptoms include hypopigmentation transmission via nasal secretions or close contact tx: abx (MDT)
56
Lyme disease causes peripheral neuropathy
ticks rash, bullseye knee joint pain facial palsy
57
Herpes zoster- presents with
dermatomal rash tx: antiviral tx (acyclovir, valacyclovir
58
What should you order to rule out multiple myeloma ?
Serum protein electrophoresis
59
Bell's palsy
facial nerve palsy (CN7) forehead not wrinkled vs stroke= wrinkled
60
Bell's palsy tx
steroids | underlying cause
61
Mononeuropathies
single nerve is affected pain, weakness, paresthesia in the distribution of the affected nerve pure motor nerve involvement= painless weakness pure sensory nerve involvement= sensory disturbances and no weakness
62
Mononeuropathies vs peripheral neuropathy
less symmetrical (mono)
63
What is known as saturday night palsy ?
radial mononeuropathy- thumb ulnar= pinky
64
brachial plexus neuritis
musculoskeletal cause of arm weakness | associated with over head movement
65
____ palsies typically happens in pregnancy
peroneal nerve
66
complex regional pain syndrome
after operation, injury, or vascular event

Clin med exam 2 (12 decks)

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