Peripheral Neuropathies

Question 1

There is involvement with the CNS (brain and spinal cord). True or false?

Answer 1

False

- no involvement with CNS

Question 2

Where does the PNS start?

Answer 2

Spinal nerve root

Question 3

Large motor fibre neuropathy - symptoms
Power - increased/normal/reduced
Sensation - normal/abnormal
Reflexes - present/absent

Answer 3

Symptoms: weakness, unsteadiness, wasting, lack of muscle control

Power: Reduced

Sensation: Normal

Reflexes: Absent

Question 4

Large sensory fibre neuropathy - symptoms
Power - increased/normal/reduced
Sensation - normal/abnormal
Reflexes - present/absent

Answer 4

Symptoms: Numbness, paraesthesia

Power - Normal

Sensation: Vibration and JPS reduced

Reflexes: Absent

Question 5

Small fibre neuropathy - 
symptoms 
Power - increased/normal/reduced
Sensation - normal/abnormal 
Reflexes - present/absent

Answer 5

Symptoms: pain, dyesthesia

Power: Normal

Sensation: pin prick and temperature reduced

Reflexes: Present

Question 6

The term “radiculopathy” is used if the damage is where?

Answer 6

Nerve root is damaged

Question 7

The term “plexopathy” is used if the damage is where?

Answer 7

Nerve plexus is damaged

Question 8

Plexopathy - presentation

Answer 8

Unilaterally paralysed but often recover

Question 9

There term “peripheral neuropathy” is used if the damage is where?

Answer 9

Peripheral nerve is damaged

Question 10

What are the 3 main types of peripheral neuropathy

Answer 10

Mononeuropathy
Mononeuritis multiplex
Length dependent peripheral neuropathy

Question 11

Carpal tunnel syndrome is an example of:
Mononeuropathy
Mononeuritis multiplex
Length dependent peripheral neuropathy

Answer 11

Mononeuropathy

Question 12

Mononeuritis multiplex - clinical features

Answer 12

Asymmetrical
painful
Isolated damage to at least 2 separate nerve areas

Question 13

Wrist drop + foot drop is an example of:
Mononeuropathy
Mononeuritis multiplex
Length dependent peripheral neuropathy

Answer 13

Mononeuritis multiplex

- as there is isolated damage to at least 2 separate nerve areas

Question 14

Length dependent peripheral neuropathy may have which type of distribution?

Answer 14

Glove and stocking distribution

Question 15

Mononeuritis multiplex is asymetrical/symetrical?

Answer 15

Asymmetrical

Question 16

Length dependent peripheral neuropathy has symmetrical/asymmatrical distribution?

Answer 16

Symmetrical

Question 17

Name 2 ways in which peripheral nerves can be damaged?

Answer 17

Axonal loss

Demyelination

Question 18

Nerve damage: axonal loss is treatable. True or false?

Answer 18

False

- untreatable

Question 19

Nerve damage: demyelination. name 2 acute demyelination disorders

Answer 19

Guillaine Barre Syndrome

Acute inflammatory demyelinating polyradiculopathy

Question 20

Management of demyelinating neuropathies

Answer 20

IV Ig
Steroids
Immunosuppressants

Question 21

Patient presents with rapidly progressive paraplegia, pain, weakness, unsteadiness, paraesthesia and dysphagia. What is the likely diagnosis?

Answer 21

Guylaine barre syndrome (GBS)

Question 22

GBS - is the most common form of neuromuscular paralysis. True or false?

Answer 22

True

Question 23

GBS - definition

Answer 23

There is acute demyelination of the PNS

Question 24

GBS - who gets it

Answer 24

Young adults mainly

Question 25

GBS - examination findings

Answer 25

Findings may be normal in the initial phase Reduced reflexes -> absent Reduced tone

Question 26

GBS - management

Answer 26

IV Ig Plasma exchange Steroids Physiotherapy

Question 27

What was "hereditary neuropathy" formerly known as?

Answer 27

Charcot marie tooth

Question 28

Patient presents with clawed hands, high arched for and champagne bottle deformity of the calves. What is the likely diagnosis?

Answer 28

Hereditary neuropathy

Question 29

Pseudoathetosis - definition

Answer 29

Abnormal writing movements of the fingers caused by loss of proprioception

Question 30

GBS - clinical features

Answer 30

Acute onset ascending weakness of all 4 limbs Loss of reflexes Sensory symptoms

Question 31

A 50yo man presents complaining of pain in both his feet. He describes the pain as burning. O/E he has 5/5 power in both legs and feet however has reduced sensation up to his mid shins. What is the likely diagnosis?

Answer 31

Diabetic neuropathy - Glove and stocking sensory disturbance with no motor involvement is indicative of diabetic neuropahty. Check for ulcers

Question 32

``` Foot drop is caused by a mononeuropathy affecting which nerve? Obturator nerve Common fibulae nerve Tibial nerve Sciatic nerve Femoral nerve ```

Answer 32

Common fibulae nerve

Question 33

``` Wrist drop is caused by a mononeuropathy affecting which nerve? Radial Axillary Ulnar Median Musculocutaneous ```

Answer 33

Radial nerve

Question 34

``` Which of the following (multiple) would be caused by a mononeuropathy affecting 5e sciatic nerve? Weakness of knee extension Weakness of knee flexion Weakness of ankle Doris/plantar flexion Weakness of hip flexion Loss of ankle jerk reflex ```

Answer 34

Weakness of ankle Dorsi/plantar flexion Loss of ankle jerk reflex Weakness of knee flexion

Question 35

``` Which of the following would be caused by a mononeuropathy affecting the femoral nerve? Weakness of knee flexion Weakness of knee extension Loss of ankle jerk reflex Loss of patellar reflex Weakness of hip flexion ```

Answer 35

Loss of patellar reflex Weakness of hip flexion Weakness of knee extension