Knowledge Check

Home » MEDCLIN530 » Virtual Neurology Clinical Case Studies: MEDCLIN530 » 6. Peripheral Neuropathy » Knowledge Check
Headshot of Dawn Elise DeWitt, MD, MSc, CMedEd, MACP, FRACP, FRCP-London · Senior Associate Dean, Collaboration for InterProfessional Health Education Research & Scholarship (CIPHERS)
Dawn Elise DeWitt
MD, MSc, CMedEd, MACP, FRACP, FRCP-London · Senior Associate Dean, Collaboration for InterProfessional Health Education Research & Scholarship (CIPHERS)
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Table of Contents

This quiz deliberately has both peripheral neuropathy items and central neurological lesion items to help you test your knowledge in distinguishing between the two.

question

Which of the following are associated with the patients below? (Not all items will be associated with a patient.)

  1. Median nerve/Carpal tunnel
  2. Ulnar neuropathy
  3. Mononeuritis multiplex
  4. Radiculopathy
  5. Vitamin B12 deficiency
  6. Thiamine deficiency
  7. Bell’s palsy
  8. Meralgia paresthetica
  9. Toxic exposure
  10. Guillain-Barré Syndrome
  11. Multiple Sclerosis
  12. Psychogenic pain
  13. Medication side effect

Patient 1: Bob—Hip pain and numbness

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A 49-year-old truck driver with T2DM, hypertension, and obesity (BMI 38) has left hip pain and numbness. Exam shows a casually dressed man in tight jeans, wearing a wide leather belt. He has an area of decreased sensation to light touch and cold on his lateral thigh. Reflexes are symmetrical, and there is no weakness. Straight leg raise causes “pulling” in his L posterior leg, but does not reproduce his symptoms. 

Meralgia paresthetica.

 

Patient 2: Cherie—Facial droop and drooling

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51-year-old patient with T2DM develops drooling and has facial droop on the left. Left eyebrow does not elevate. PERRLA, extraocular movements are normal. Tongue protrusion, gag, and shoulder shrug are normal. Grip is symmetrical and power in her upper/lower extremities is symmetrical.

Bell’s palsy.

 

Patient 3: Sadia—Finger numbness

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32-year-old medical student with numbness of the left 4th–5th fingers. Weakness with pincer grip of thumb and 5th fingers and of 5th finger when testing intrinsic muscle strength.

Ulnar neuropathy.

 

Patient 4: Elle—Hands are asleep

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A 40-year-old surgeon and avid cyclist wakes up at night with her hands asleep. She develops symptoms when she rides her bike. Despite wearing a brace at night, she now has increasing numbness in the fingers of her dominant hand.

Carpal tunnel.

 

Patient 5: Jay—My hair is falling out

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A 19-year-old student returns from a semester abroad in Italy and presents because he has developed numbness and weakness in his extremities. He is also “freaked out” because his hair is falling out. The weakness developed over the last month but has stopped progressing. He also has numbness in a stocking-glove distribution. He also had some nausea that improved when he arrived home and notes some trouble with his balance and some blurry vision. When asked about exposures he says only that they had an exterminator come to deal with rats in their apartment.

Toxic exposure (thallium—see reference link below).

 

Patient 6: J.R.—Shooting pain in right leg

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A 72-year-old avid hiker and cyclist, who is still working as a lawyer, develops R leg pain that “shoots” down to his knee. Raising his L leg causes pain in the R leg.

Radiculopathy (positive “crossed straight-leg raise” is highly suggestive of sciatica).

 

Patient 7: James—Can't feel the computer keys

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A 64-year-old family physician who has early T2DM on metformin (x 1 year) and hypertension on nifedipine (3 years) has had 4 cycles of chemotherapy for colon cancer with 5-FU and vincristine. He says he can’t feel the keys anymore when he types on his computer. His symptoms became noticeable 2 months ago.

Medication side effect from vincristine is most likely (depending on the timing here, B12 deficiency related to metformin would also be possible).

 

Patient 8: Catherine—Sharp wrist pain

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A 39-year-old woman with known SLE presents with bilateral shooting/sharp pains in the wrist. She has a classic “butterfly” rash on her face and chronic swelling of her left knee with some purpura on her lower legs bilaterally. Examination shows no warmth or swelling of any of the wrist, hand or finger joints. Wrist extension is ⅘ on the right and ⅗ on the left.

Mononeuritis multiplex (multilpe vasculitic or ischemic mononeuropathies).

 

References

  1. Kemnic TR, Coleman M. Thallium Toxicity. [Updated 2023 Jul 10]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan—. 
  2. Editors: Busti, A.J., Kellogg, D. Stroke vs. Bell’s Palsy. Evidence-Based Medicine Consult. Last updated: 2015.

Image credits

Unless otherwise noted, images are from Adobe Stock.

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