Peripheral neuropathies (Hon)

Question 1

Dermatome

Answer 1

SKIN are supplied by a single spinal root

Question 2

Myotome

Answer 2

MUSCLE group supplied by a single spinal root

Question 3

Sclerotome

Answer 3

Area of BONE supplied by a single spinal root

Question 4

Radiculopathy definition

Answer 4

nerve root dysfunction

Question 5

What are the most common levels involved in radiculopathy?

Answer 5

Cervical
C5-6 = C6 nerve compression
**C6-7 = C7 nerve compression

Lumbar
L4-5 = L5 nerve compression
L5-S1 = S1 nerve compression

Question 6

Which nerve root is compressed if a patient is experiencing symptoms across the C6 and C7 dermatomes?

Answer 6

C7

Question 7

Which nerve root is compressed if a patient is experiencing symptoms across the L5 and S1 dermatomes?

Answer 7

S1

Question 8

the C5 spinal nerve root innervates which DTR?

Answer 8

biceps

Question 9

the C7 spinal nerve root innervates which DTR?

Answer 9

triceps

Question 10

the L4 spinal nerve root innervates which DTR?

Answer 10

patella

Question 11

the S1 spinal nerve root innervates which DTR?

Answer 11

achilles

Question 12

Suprascapular nerve

Answer 12

comes off early on the brachial plexus; pure C5 to the supraspinatus and infraspinatus muscles

Question 13

Parsonage-Turner Syndrome

Answer 13

a brachial plexopathy syndrome of unknown etiology; patient will present with severe pain in the shoulder and days later have weakness and atrophy of muscles of the shoulder girdle (pain subsides); spontaneous recovery in 6-18 months but steroids are helpful

Question 14

diffuse, symmetrical disease involving motor, sensory or both neurons

Answer 14

definition of peripheral neuropathy (polyneuropathy)

Question 15

Mononeuropathy

Answer 15

a type of peripheral neuropathy where there is only a single nerve affected; there is a specific pattern of sensory loss and weakness only in specific muscle(s)

Question 16

Polyneuropathy

Answer 16

a type of peripheral neuropathy where there is diffuse symmetrical motor, sensory or both deficit; there is a stocking/glove sensory loss; distal weakness and possible atrophy; with decreased reflexes

Question 17

Dysesthesia

Answer 17

pain upon gentle touch

Question 18

Hyperalgesia

Answer 18

lowered threshold of pain

Question 19

Hyperpathia

Answer 19

pain threshold is elevated, but pain is excessively felt

Question 20

paresthesias

Answer 20

pins and needles sensation

Question 21

What are the typical lower motor neuron symptoms?

Answer 21

distal weakness, cramps, fasciculations (twitches), atrophy, decreased DTRs and hypotonia

Question 22

What are the typical symptoms of sensory large fiber lesion?

Answer 22

positive: tingling, pins and needles and numbness

Negative: decreased vibration, decreased joint position sense, areflexia, ataxia and hypotonia

Question 23

What are the typical symptoms of sensory small fiber lesion?

Answer 23

positive: burning and jabbing sensation

negative: decreased pain (pin prick) and temp

Question 24

Compression of the median nerve presents with what major clinical features?

Answer 24

sensory loss, thenar atrophy with an abnormal pinch sign

Question 25

Compression of the ulnar nerve presents with what major clinical features?

Answer 25

clawing of 4th and 5th fingers, hypothenar atrophy and variable sensory loss

Question 26

Compression of the radial nerve presents with that major clinical features?

Answer 26

wrist drop, triceps involved and sensory loss

Question 27

Carpal tunnel syndrome

Answer 27

compression of the median nerve at the wrist; presents with sensory loss, thenar atrophy with an abnormal pinch sign

Question 28

Cubital tunnel syndrome

Answer 28

compression of the ulnar nerve at the elbow; presents with clawing of 4th and 5th fingers, hypothenar atrophy and variable sensory loss

Question 29

Saturday night palsy

Answer 29

compression of the radial nerve at the spiral groove; commonly due to abnormal sleep postures; presents with wrist drop, triceps involved and sensory loss

Question 30

Answer 30

the median nerve sensory distribution; medial palmar surface of lower forearm and palm, thenar eminence, thumb and adjacent two fingers

Question 31

Pronator Syndrome

Answer 31

median nerve mononeuropathy; diffuse/dull ache at the proximal forearm; pain is exacerbated in the forced forearm pronation; absence of nocturnal awakening because of pain or numbness

Question 32

Anterior Interosseous Syndrome

Answer 32

a median nerve mononeuropathy; inability to make the "ok" sign with your hand

Question 33

What test would you suspect to be positive in a patient with an ulnar neuropathy?

Answer 33

Froment sign; inability to bend at PIP joint to hold a piece of paper

Question 34

Answer 34

Anterior Interosseous Syndrome; a median nerve mononeuropathy; inability to make the "ok" sign with your hand

Question 35

Answer 35

a positive Froment sign seen in Ulnar neuropathy; inability to bend at PIP joint to hold a piece of paper

Question 36

Peroneal nerve compression has what major clinical features?

Answer 36

foot drop, weak evertors, sensory loss in dorsum of foot

Question 37

What is the most common cause of acquired peripheral neuropathy?

Answer 37

diabetes mellitus

Question 38

Answer 38

wrist drop seen in compression of the radial nerve at the spiral groove; commonly due to abnormal sleep postures

Question 39

Answer 39

stocking-glove distribution seen in peripheral neuropathy; legs usually affected first and more severely than the arms

Question 40

What vitamin deficiency can cause a polyneuropathy?

Answer 40

Vitamin B12 deficiency seen in subacute combined degeneration

Question 41

Answer 41

spinal cord in B12 deficiency seen in subacute combined degeneration; a peripheral neuropathy

Question 42

Romberg Maneuver test what?

Answer 42

proprioception

Question 43

What do suspect to find on a skin biopsy in a patient with a small fiber polyneuropathy?

Answer 43

decreased epidermal nerve fiber density

Question 44

Which cranial nerves are most at risk in a patient with diabetes mellitus?

Answer 44

**CN III and CN VI and CN VII

Question 45

What is the most common hereditary polyneuropathy?

Answer 45

Charcot-Marie-Tooth 1A (CMT 1A) aka Hereditary Motor & Sensory Neuropathies 1 (HMSN 1)

Question 46

Charcot-Marie-Tooth 1A (CMT 1A) aka Hereditary Motor & Sensory Neuropathies 1 (HMSN 1)

Answer 46

most common hereditary polyneuropathy; demyelinating; AD and onset is typically 1st or 2nd decade; presents with difficulty walking or running (legs>arms); EMG shows slowing of motor nerve conduction velocities

Question 47

What would the EMG show in a patient with CMT 1A/HMSN 1?

Answer 47

slowing of motor nerve conduction velocities; demyelinating

Question 48

Answer 48

Charcot-Marie-Tooth 1A (CMT 1A) aka Hereditary Motor & Sensory Neuropathies 1 (HMSN 1) foot; high arched foot and hammer toes

Question 49

Acute inflammatory demyelinating polyneuropathy (AIDP) aka Guillain-Barré syndrome (GBS)

Answer 49

an acquired demyelinating polyneuropathy; typically follows an illness, surgery or immunization or *** viral syndrome with EBV, mycoplasma pneumonia or campylobacter jejuni; patient will present with ascending motor paralysis; possible respiratory failure in these patients

Question 50

A viral syndrome of which organisms are typically seen before Guillain-Barré syndrome (GBS)?

Answer 50

EBV, mycoplasma pneumonia or campylobacter jejuni

Question 51

What are key laboratory findings in Guillain-Barré syndrome (GBS)?

Answer 51

CSF - albumin-cytologic dissociation (increased protein to normal cell count and normal glucose) NCV's - slow conduction velocity and focal conduction block with prolonged F-waves

Question 52

What is the typical treatment for Guillain-Barré syndrome (GBS)?

Answer 52

Direct treatment with plasma exchange or IVIg (not steroids)

Question 53

Miller-Fisher Syndrome

Answer 53

a variant of Guillain-Barré syndrome (GBS); will find GQ1b/GT1a antibodies; patient will present with ophthalmoplegia, ataxia, arreflexia, facial weakness, dysarthria and dysphagia

Question 54

In which pathology would you find GQ1b/GT1a antibodies in a patients serum?

Answer 54

Miller-Fisher Syndrome; a variant of Guillain-Barré syndrome (GBS)

Question 55

Chronic Inflammatory Demyelinating Polyneuropathy (CIDP)

Answer 55

an acquired demyelinating polyneuropathy similar to GBS but slower and more persistent >2 months; patient will have a history of progressive and relapsing with the typical treatment; 15% of cases will have IgM or IgG present