Peripheral Neuropathies

Question 1

symmetric distal sensory loss with burning or weakness

Answer 1

polyneuropathy

Question 2

Disease usually provoked by preceding infection, acute inflammatory demyelinating polyneuropathy

Answer 2

Guillain-Barre Syndrome (GBS)‏

Question 3

Sx include symmetric muscle weakness w/ absent or decreased DTRs, respiratory muscle weakness requiring ventilatory support, severe back pain, Dysautonia***

Answer 3

Guillain-Barre Syndrome

Question 4

Tx for Guillain-Barre Syndrome

Answer 4

plasmapheresis or IV immune globulin

Question 5

Diagnostic test of choice for Guillain-Barre and its results

Answer 5

Lumbar puncture- elevated protein w/normal WBC count

Glycolipid antibodies to gangliosides

Question 6

Likely cause of Bell’s Palsy

Answer 6

Herpes simplex activation

Question 7

Sx include: unilateral facial paralysis, Decreased tearing, Eyebrow sagging

Answer 7

Bell’s Palsy

Question 8

TImeline of progression and resolution of Bell’s Palsy

Answer 8

Progressive w/ maximal paralysis within three wks of onset. Recovery of some degree by 6 months

Question 9

Pharm tx for Bell’s palsy

Answer 9

short term glucocorticoid. if severe add valacyclovir

Question 10

Autoimmune disorder characterized by weakness and fatiguability of skeletal muscle. Autoantibodies against acetylcholine receptors

Answer 10

Myasthenia Gravis

Question 11

Key symptom of Myasthenia Gravis

Answer 11

Fluctuating skeletal muscle weakness

Question 12

Sign seen in myasthenia gravis characterized by unilateral ptosis

Answer 12

Curtain Sign

Question 13

Mainstay of tx for myasthenia gravis in symptomatic patients

Answer 13

Anticholinesterase agents-Pyridostgigmine (Mestinon)

Question 14

Tx for a myasthenia crisis

Answer 14

Plasmapheresis, IV immunoglobulin, removal of thymus

Question 15

Most common etiology of polyneuropathy

Answer 15

DM

Question 16

pattern of weakness in polyneuropathy

Answer 16

stocking and glove distribution

Question 17

Results of electrodiagnostic tests for polyneuropathies

Answer 17

Reduced amplitude of evoked compound actions potentials. Preservation of nerve conduction studies

Question 18

Neuropathy pathogenesis that results in length-dependent “dying back” axonapathy and Involves the distal portions of the longest mylenated and unmylenated sensory axons

Answer 18

DM polyneuropathy

Question 19

late findings of DM polyneuropathy

Answer 19

widespread loss of reflexes and motor weakness

Question 20

4 Factors needed for adequate absorption of B12 (cobalamin)

Answer 20

pepsin, pancreatic proteases, intrinsic factor, and Ileum w/ Cbl-IF receptors

Question 21

Cause of polyneuropathy that leads to a defect in myelin formation and subacute degeneration of dorsal (posterior) and lateral spinal columns

Answer 21

Vitamin B12 deficiency

Question 22

Axonal neuropathy complicated by demyelination when there is coexisting nutritional deficiency

Answer 22

Alcoholic Polyneuropathy

Question 23

An example of a common direct neurotoxin

Answer 23

ETOH

Question 24

Sx include: Pareshesias, ataxia w/ loss of vibration and position sense, can progress to severe weakness, spasticity, clonus and paraplegia

Answer 24

Vitamin B12 deficiency polyneuropathy

Question 25

Tx for vitamin B12 deficiency polyneuropathy

Answer 25

IM B12 injections 1000microgms twice weekly for 2 weeks followed by weekly for 2 months and then monthly

Question 26

Spinocerebellar syndrome with variable peripheral nerve involvement

Answer 26

vitamin E deficiency

Question 27

Most common etiologies of vitamin E deficiency

Answer 27

cholestasis and pancreatic insufficiency

Question 28

Tx of vitamin E deficiency

Answer 28

large doses of alpha-tocopherol then daily oral vitamin E

Question 29

neuropathy associated w/ calf cramps, muscle tenderness, and burning feet, autonomic neuropathy may be present

Answer 29

Dry Beriberi

Question 30

high-output CHF + neuropathy

Answer 30

Wet beriberi

Question 31

Bugs commonly responsible for Guillan-Barre

Answer 31

Campylobacter jejuni, CMV, and EBV

Question 32

has the advantage of being an antidepressant as well as helping control pain

Answer 32

Duloxetine (Cymbalta)

Question 33

medication that is targeted for diabetic polyneuropathy

Answer 33

Pregabalin (Lyrica)

Question 34

medication that reduces pain associated with polyneuropathies

Answer 34

Gabapentin (Neurontin)

Question 35

Has NO abnormalities beyond motor function of CNVII

Answer 35

Bells Palsy

Question 36

In Myasthenia Gravis what happens to sensation and DTRs

Answer 36

Sensation is normal and there are no reflex changes

Question 37

More common in pregnancy and DM

Answer 37

Bell's Palsy