Neurology > Neuropathies > Flashcards

Neuropathies Flashcards

(78 cards)

Study These Flashcards
1
Q

Neuropathy list

A
  • Peripheral Neuropathy
  • Compressive Neuropathy
  • Bell’s Palsy
  • Trigeminal Neuralgia
  • Herpes Zoster/Post-herpetic neuralgia
  • herpes zoster/post - HN
  • Motor neuron dz/ AML
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

History

Pain

A
  • location
  • character
  • pain elsewhere? (Back neck)
  • pattern / time course of progression
  • better/worse ?
  • meds?
  • ADL changes
  • Bothered by touching, sheets
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

History

Causes

A
  • DM, HIV, EtOH, Autoimmune, cancer, ?
  • Healthy lifestyle
  • Med use
  • social hx (etoh)
  • ‘Do elders in family always complain about feet?”
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

MC etiologies

A
  • DM
  • HIV/HepC
  • Meds = Chemo,HIV,FQ
  • vit deficiencies/excess (B)
  • inherited neuropathies
  • autoimmune dz
  • cancer (weight loss?)
  • idiopathic
  • leprosy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Differential Dx

Painful feet

A
  • Peripheral Neuro (both legs, whole leg)
  • Radiculopathy (dermatomes - strip down leg)
  • Claudication/Vascular dz - insuff blood
  • Plantar fasciitis
  • Gout
  • Rheumatoid Arthritis
  • Morton’s neuroma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Physical exam

A
  • CN
  • Motor exam
  • reflexes
  • sensory exam
  • gait/romberg
  • PSN
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Strength testing

A

Weakness/symptoms worse distally than proximal

Pain limits strength test

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Sensory testing

A

Stocking glove sensory loss

Also down mid chest (distal part of spinal offshoots)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Sensory testing

Modalities

A
  • **Pinprick
  • **Temperature

**Vibration
**Proprioception
DIFFERENT NERVE TRACTS, but these often go together

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Small fibers

A

Unmyelinated fibers innervating skin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Large fibers

A

Macroscopic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Which impaired in small fiber neuropathy?

A

temperature

Pinprkc

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Which impaired in large fiber neuropathy?

A

Vibration

Proprioception

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Labs

A
  • help with UNDERLYING CAUSE
  • Glucose test/ A1C
  • Hepatitis serologies
  • Autoimmune
  • Testing for B12
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Labs

Extra tests

A

Serum protein electrophoresis (MM)

B6 levels

HIV testing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Electrical Studies

A

Measure speed of conduction / amplitude of transfer - LARGE FIBER, KNOWN PATHWAY

Problem with axon /myelin/both

Acute problem/ chronic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Genetic testing

A
  • Charcot-Marie-Tooth syndrome
  • only helpful if known mutation
  • avoid unnecessary back surgery
  • genetic non-discrimination concerns
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

PSN Tx

Anticonvulsants

A

1st line
Gabapentin

*NOT PAIN PILLS, PAIN PREVENTERS, need a week or two of regular dosing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

PCN Tx

Anti-depressants

A

TCA - sleep difficulties

SNRI - depression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

PSN Tx

Weak mu-opiod ag

A

Tramadol
S.E. - toxic metabolite = seizures
Give 10 for “bad days”

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

PSN Tx

Opiates

A

not effective for neuro pain

*NOT 1st line

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

PSN Tx

Lidocaine

A

for small focal areas

Wear gloves!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

PSN Tx

Supplements

A

Alpha-lipoic acid

*Buy from german pharmacy (UNREGULATED in USA)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Tx

Exercise, Diet, Weight loss

A
  • peripheral nerve regeneration

* Painful - try water, bicycle, rowing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
PSN Patient Education
* DAILY foot inspection * Nail cutting at podiatry * Fall prevention * Med titration * Family ed = it's real! * Risk of chemo/fluoroquinolones
26
Compression Neuropathies vs. radiculopathy
Radiculopathy is compression at nerve root, this is anywhere
27
Compression Neuropathies Common sites
Carpal tunnel Thoracic outlet Ulnar entrapment at elbow Tarsal tunnel
28
CTS risk factors
``` Genetic DM Pregnancy Age Repetitive strain ```
29
* Dull aching discomfort * tingling * weakness/clumsiness of hand * sleep provokes * repetitive actions provoke * improve by changing posture S/s
CTS
30
CTS Tx
* night splints * NSAID * PT - muscular imbalance * Rest/activity mods * steroid injections * Surgical decompression = do early
31
+Tinel's test (medial nerve) +Phelen's Test *Wasting/atrophy of hand muscles (late sign) *abnormal nerve conduction tests Signs
Carpal Tunnel CTS
32
Bell's Palsy
Peripheral CN 7 abnormality | *entire nerve after foramen = affected
33
* facial weakness over DAYS - WEAKS * Taste, lacrimation, hyperacusis change * facial tingling pain near ear s/s?
Bell's Palsy
34
Bells Palsy Tx
Early (72 hrs) - steroids +acyclovir Symptomatic = eye patch, pain control Late, just Symptomatic tx
35
Bell's Palsy Prognosis
Worse for older, complete palsy, severe pain
36
* Recurrent severe, lancinating pain - unilateral, * come from slight stimulus - chewing, yawning, touch S/s?
Trigeminal Neuralgia (CN 5) *Trigem distribution
37
Trigeminal Neuralgia Tx
* before tx - high suicide rate * Anti-convulsant meds * Glycerol injections if refractory, remove nerve insult to allow regeneration * Gamma knife radiosurgery * microvascular decompression (most invasive, sometimes no effect)
38
Shingles (herpes zoster) Who
* those primary varicella zoster | * immunocompromised
39
Where does VZV live?
Sensory dorsal root ganglia
40
Grouped vesicles on an erythematous base
Herpes
41
Zoster distribution on body
Can't cross midline | Always on dermatome
42
* Shingles in V1 distribuition | * Vesicles on tip of nose
Herpes Ophthalmicus URGENT REFER OPTHALMALOGIST TODAY
43
Herpes Zoster Tx
W/In 72 hours - Antivirals * Acyclovir * Valacyclovir * Famciclovir Pain Control * Opiates * Anti-convulsants
44
Persistence of electric shock pain and severe itching >3 months after rash
Post-herpetic neuralgia
45
Post-Herpetic Neuralgia development risks
* Old (>50s) * Female > * w/ prodrome * PAIN w/ rash
46
Post-Herpetic Neuralgia Tx
*Anti-convulsants GABAPENTIN ``` *ADD TCA / SNRI *Weak mu-Opioid (TRAMADOL / ZYDOL) *Opiates, Lidocaine patch (GOOD = LOCAL) cream ```
47
ALS Name
Amyotrophic Lateral Sclerosis
48
ALS Causes
* Excess glutamate in brain | * Muscle weakness + atrophy
49
UMN vs. LMN Lesion Weakness
BOTH
50
UMN vs. LMN Lesion Atrophy
LMN Lesion = YES
51
UMN vs. LMN Lesion Fasciculations
LMN Lesion = YES
52
UMN vs. LMN Lesion Reflexes
LMN Lesion = DOWN UMN Lesion = UP
53
UMN vs. LMN Lesion Tone
LMN Lesion = DOWN UMN Lesion = UP
54
* progressive arm/weak weakness, asymmetrick * fasciculations/twitching * Stiffness * Weight loss/ muscle atrophy * Drool * NO PAIN, NO SENSORY, NO BOWEL CONTROL, OCULAR CONTROL S/S
ALS
55
ALS Tx
***RIluzole * Ventilatory Support - (a serious decision) * Symptomatic Speech Therapy * Psyc
56
ALS Assessment
PE: | Weakness, Hyperflexia, fasiculations
57
ALS Prognosis
* 3 years after Dx (median) * come in w/ facial s/s = 1 yr left * Respiratory failure
58
* Pins + Needles * Numbness * Hypersensitiive/burning * Bunched sock feeling General Presentation?
Peripheral Neuropathy
59
Peripheral Neuropathy (PSN) General Tx
* Anti-convulsants * Antidepressants (TCA/SNRI) * Weak u-opioid ags (tramadol) * Opiates * Lidocaine patches/creams * Healthy lifestyle
60
``` Peripheral Neuropathy (PSN) Tx ``` Anti-convulsants
1st LINE | Gabapentin
61
``` Peripheral Neuropathy (PSN) Tx ``` Anti-Depressants
*TCA/SNRI * TCA = sleep * SNRI = depression
62
``` Peripheral Neuropathy (PSN) Tx ``` u-opioid ags
Tramadol * breakthrough pain * NOT daily med
63
``` Peripheral Neuropathy (PSN) Tx ``` LIdocaine patch/cream
focal neuropathies NO 24 hr
64
``` Peripheral Neuropathy (PSN) Tx ``` Supplements
Alpha-lipoic acid
65
``` Peripheral Neuropathy (PSN) Tx ``` Pt needs to be alert and driving?
Anti-convulsants | Gabapentin
66
``` Peripheral Neuropathy (PSN) Tx ``` Pt w/ concurrent depression?
anti-depressants
67
``` Peripheral Neuropathy (PSN) Tx ``` Pt w/ very focal pain?
Lidocaine patches/topical cream
68
``` Peripheral Neuropathy (PSN) Tx ``` Pt w/ insomnia?
TCAs - bedtime
69
``` Peripheral Neuropathy (PSN) Tx ``` Pt w/ chronic constipation?
***NO*** TCAs, Tramadol, Opiates
70
``` Peripheral Neuropathy (PSN) Tx ``` Pt w/ orthostasis/older pt?
***NO*** TCAs
71
Compression Neuropathy vs. Radiculopathy
Radiculopathy = compression neuropathy at nerve root
72
Compression Neuropathies MC sites
* Carpal Tunnel * Thoracic Outlet * Ulnar Entrapment at the Elbow (Cubital Tunnel) * Tarsal Tunnel
73
What is MC compression Neuropathy?
Carpal Tunnel | Median N.
74
Carpal Tunnel Risk Factors
* Genetic * DM * pregnancy * fat * Age * Repetitive strain
75
Facial muscle weakness: Can raise both sides of forehead
CNS problem
76
Facial muscle weakness: One side of forehead completely paralyzed
Peripheral problem | Bell's Palsy (CN 7)
77
Trigeminal Neuralgia vs Bell's Palsy
*Trigeminal Neuralgia = Facial PAIN Bell's Palsy = Facial WEAKNESS
78
Trigeminal Neuralgia Cause?
UNCLEAR - compression - demyelination - inflammation - trauma
Neurology
flashcards
Decks in class (20)
# Cards
Brainscape helps you reach your goals faster, through stronger study habits.
© 2026 Bold Learning Solutions. Terms and Conditions