Neurology Neuropathies
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| Neurological exam consists of: | motor (strength, bulk, tone), sensation (vibration, position, temperature, pin prick), reflexes
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| mononeuropathy | single nerve involved; such as the median nerve in carpal tunnel syndrome
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| Polyneuropathy | multiple diffuse; such as metabolic neuropathies like diabetic or uremic neuropathy
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| Many isolated single nerves | mononeuritis multiplex
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| Motor involvement signs | Atrophy, fasiculations, weakness, cramps
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| Signs of sensory involvement | numbness, pain
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| Signs of autonomic involvement | dizziness, tachycardia, gastroparesis, impotence, loss of sweating
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| Tinnel's and Phalen's signs in Carpel Tunnel | Percussion over median nerve at wrist (tinnel's), flexion of the wrist for 30-60 seconds (Phalen's).
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| Location of sx in Carpel Tunnel | Fingers supplied by the median nerve: thumb, index, middle and medial half of the ring finger
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| Hypothyroidism, DM, RA, Pregnancy, Obesity and repetitive use are associated with higher risk of | Carpal tunnel syndrome
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| Areas of entrapment in ulnar nerve lesions | cubital tunnel, elbow, wrist. Injury may occur years after a malunited suprabondylar fracture of the humerus with bony overgrowth.
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| Signs of ulnar nerve palsy | Contrary to findings in carpal tunnel syndrome, muscle weakness and atrophy characteristically predominate over sensory sx. Atrophy of first dorsal interosseus muscle and difficulty with fine manipulations
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| Wrist drop and finger drop are motor deficits seen in | radial mononeuropathy
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| Reflexes to test radial nerve | triceps and brachioradialis
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| Humerus fx, crutches, and lead toxicity are all causes of | radial nerve lesions
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| _______ is the most common pure sensory mononeuropathy | Meralgia paresthetica; compression of the lateral cutaneous nerve of the thigh as it passes under or through the inguinal ligament. Pain on lateral thigh
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| Weakness of hip flexion and knee extension may suggest | femoral neuropathy. Sensory loss on the anterior thigh and medial suface of the lower leg
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| Habitual leg crossing can damage | the common peroneal nerve.
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| For motor deficit caused by sciatic neuroapathy, what must be affected? | Peroneal AND Tibial muscles
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| Numbness of 4th and 5th finger | Ulnar mononeuropathy
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| Obese, diabetic with prickly pain on anterior thigh | Meralgia Paresthetica (lateral femoral cutaneous)
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| Guillain-Barre Syndrome AIDP Pneumonic | Acute, Inflammatory, Demyelinating, Polyradiculoneuropathy
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| Which neuropathy is frequently associated with antecedent GI illness or URI? | Buillain-Barre Syndrome
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| Characteristics of GBS: | Rapidly ascending weakness, motor affected more than sensory, may start with deep achy pain, hypo or areflexia, facial droop, dipolopia, dysphagia
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| Diagnostic testing for GBS | Lumbar puncture (cytoalbuminological dissociation), Nerve conduction studies
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| What is the recovery time for GBS? | Recovery is generally complete in month to 1-2 years. Tx: plasmapheresis and infusion of high doses of human Ig
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| cytoalbuminological dissociation on an LP is associated with | GBS
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| Which fibers (A or C) are associated with burning, cold, sharp, shooting pain? | C- small fibers: discomfort
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| Which fibers (A or C) are associated with tingling and decreased position sensation | A- large fibers
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| Onset of polyneuropathies | insidious (sudden and asymmetric pain may suggest non-neuropathic origin)
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| In a polyneuropathy were motor deficit is greater than sensory, and there is rarely burning, or tingling, it is more likely | genetic. Most genetic neuropathies are autosomal dominant
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| In which CMT do you find: demyelination, NCS=slow velocity, and areflexia? | CMT I
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| In which CMT do you find: axon loss, NCS=low amplitude and reflexes are less affected? | CMT II
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| Foot deformity with high arches (pes cavus ) and hammer toes, reflecting long-standing muscle imbalance in the feet typically is present in | CMT
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| What percentage of Diabetics will have peripheral neuropathy after 20 years of diabetes? | 15%. Primary axonal with secondary demyelination
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| _______ is the most frequent cause of peripheral neuropathy worldwide | Diabetes
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| Signs of diabetic polyneuropathy | symmetric, usually begins distally with sensory loss in the feet
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| Pain and atrophy of proximal leg muscles in diabetics | Diabetic Amyotrophy; Tx with high dose IVIg
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| What is the screening tool for monoclonal gammopathies? | SPEP
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| What percentage of patients with idiopathic PN have monoclonal gammopathy? | 10%
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| POEMS pneumonic in Osteosclerotic Myeloma | Polyneuropathy, Organomegaly (spleen, liver), Endocrinopathy (thyroid, DM, hirsutism, testicular atrophy, M protein, Skin (hyperpigmentation).
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| Distal symmetric sensorimotor polyneuropathy (with primaily axonal features). Burning, numb feet with atrophy = | Alcohol-Nutritional Neuropathy (diabetic is symmetric, distal and SENSORY)
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| Differential Diagnosis for Common Peroneal MonoNeuropathy | L5 radiculopathy, ALS
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| distal muscle atrophy and weakness indicate | Motor impairment
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| If you see hammer toes and pes cavus in a 20 year old, think | hereditary neuropathy
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