Neuropathy Practice Test — Questions and Answers

Question 1: Which symptom suggests autonomic involvement rather than purely sensory neuropathy?

Numbness in the toes
Burning foot pain
Loss of vibration sense
Orthostatic dizziness on standing (Correct answer)

Correct answer: Orthostatic dizziness on standing

Orthostatic dizziness reflects autonomic dysfunction affecting blood pressure regulation.

Question 2: Genetic testing may be appropriate when neuropathy presents with what feature?

Resolution within one day
No symptoms at all
A strong family history and early onset (Correct answer)
Sudden onset after surgery only

Correct answer: A strong family history and early onset

Hereditary neuropathies like Charcot-Marie-Tooth are suspected with family history and early onset, warranting genetic testing.

Question 3: Which symptom pattern best describes a small-fiber neuropathy?

Burning pain and temperature loss with preserved strength and reflexes (Correct answer)
Loss of vibration with brisk reflexes
Pure muscle wasting
Profound weakness with normal sensation

Correct answer: Burning pain and temperature loss with preserved strength and reflexes

Small-fiber neuropathy causes burning pain and thermal loss while strength and reflexes stay intact.

Question 4: A patient reports that their hand symptoms are worst at night and improve with shaking the wrist. This is most characteristic of:

Carpal tunnel syndrome (median neuropathy) (Correct answer)
Generalized autonomic neuropathy
Foot drop
Optic neuropathy

Correct answer: Carpal tunnel syndrome (median neuropathy)

Nocturnal hand tingling relieved by shaking ('flick sign') is classic for carpal tunnel syndrome.

Question 5: For neuropathy caused by alcohol use, which intervention is essential to treatment?

Reducing water intake
Adding more sugar
Alcohol cessation (Correct answer)
Increasing alcohol intake

Correct answer: Alcohol cessation

Stopping alcohol removes the toxic cause and is essential to managing alcoholic neuropathy.

Question 6: The stocking-glove pattern of sensory loss in diabetic neuropathy reflects damage to which fiber types first?

Large myelinated fibers only
Cranial nerve fibers
Small unmyelinated C fibers and Aδ fibers first (Correct answer)
Motor fibers only

Correct answer: Small unmyelinated C fibers and Aδ fibers first

Small nerve fibers (C and Aδ) are damaged early in diabetic neuropathy, causing pain and temperature loss before large-fiber signs appear.

Question 7: A lumbar puncture may be used in diagnosing neuropathy when which condition is suspected?

Common cold
Mild dehydration
Simple muscle strain
Inflammatory or autoimmune neuropathy (e.g., Guillain-Barré) (Correct answer)

Correct answer: Inflammatory or autoimmune neuropathy (e.g., Guillain-Barré)

Cerebrospinal fluid analysis helps diagnose inflammatory neuropathies like Guillain-Barré syndrome.

Question 8: Which systemic disease is the most common cause of peripheral neuropathy in the United States?

Hypothyroidism
Lupus
Rheumatoid arthritis
Diabetes mellitus (Correct answer)

Correct answer: Diabetes mellitus

Diabetes mellitus is the leading cause of peripheral neuropathy in the US, affecting up to 50% of people with diabetes.

Question 9: The monofilament test is used in neuropathy screening to assess:

Lung capacity
Protective sensation in the feet (Correct answer)
Color vision
Hearing thresholds

Correct answer: Protective sensation in the feet

The 10-gram monofilament test checks whether a patient can feel light touch, indicating protective sensation.

Question 10: Which symptom would suggest motor nerve involvement rather than sensory?

Burning pain
Numbness
Tingling
Muscle weakness and wasting (Correct answer)

Correct answer: Muscle weakness and wasting

Motor nerve damage causes muscle weakness and atrophy, while sensory damage causes numbness and tingling.

Question 11: Uremia-associated neuropathy occurs as a complication of which condition?

Liver failure
Pulmonary fibrosis
Chronic kidney disease (Correct answer)
Heart failure

Correct answer: Chronic kidney disease

Chronic kidney disease leads to uremic neuropathy due to accumulation of toxins that damage peripheral nerves.

Question 12: Which diagnostic test is considered the gold standard for confirming gastroparesis?

Hydrogen breath test
Abdominal ultrasound
Gastric emptying scintigraphy (nuclear scan) (Correct answer)
Upper endoscopy

Correct answer: Gastric emptying scintigraphy (nuclear scan)

Gastric emptying scintigraphy using a radiolabeled meal is the gold standard for diagnosing gastroparesis.

Question 13: According to ADA guidelines, at what point after type 2 diabetes diagnosis should peripheral neuropathy screening begin?

5 years after diagnosis
Only when symptoms develop
At the time of diagnosis (Correct answer)
10 years after diagnosis

Correct answer: At the time of diagnosis

ADA recommends screening for diabetic peripheral neuropathy at the time of type 2 diabetes diagnosis because neuropathy may already be present.

Question 14: Which blood test is commonly ordered to rule out a reversible cause of neuropathy?

Vitamin B12 level (Correct answer)
Pulmonary function test
Bone density scan
Liver ultrasound

Correct answer: Vitamin B12 level

Vitamin B12 deficiency is a common, treatable cause of peripheral neuropathy.

Question 15: What is the medical term for the burning, tingling 'pins and needles' sensation common in neuropathy?

Ataxia
Paresthesia (Correct answer)
Aphasia
Apnea

Correct answer: Paresthesia

Paresthesia refers to abnormal sensations such as tingling, prickling, or burning.

Question 16: Which skin biopsy finding confirms small fiber neuropathy in diabetes?

Reduced intraepidermal nerve fiber density (IENFD) (Correct answer)
Demyelinated large axons
Inflammatory infiltrate around vessels
Amyloid deposits in dermis

Correct answer: Reduced intraepidermal nerve fiber density (IENFD)

Skin punch biopsy showing reduced IENFD is the gold standard for diagnosing small fiber neuropathy in diabetic patients.

Question 17: A patient on gabapentin should be monitored for which common side effect?

Improved night vision
Increased height
Hair growth
Drowsiness and dizziness (Correct answer)

Correct answer: Drowsiness and dizziness

Gabapentin commonly causes sedation and dizziness, especially when starting therapy.

Question 18: Which nerve conduction study finding is most characteristic of diabetic polyneuropathy?

Reduced sural nerve sensory amplitude with slowed conduction velocity (Correct answer)
Conduction block in proximal segments
Normal sensory responses with abnormal F-waves only
Fibrillation potentials in proximal muscles

Correct answer: Reduced sural nerve sensory amplitude with slowed conduction velocity

The sural nerve sensory nerve action potential amplitude reduction with slowed velocity is the earliest and most sensitive NCS finding in diabetic polyneuropathy.

Question 19: A patient reports electric, shooting pains down the limb. This type of neuropathic pain is best described as:

Dull aching
Lancinating (Correct answer)
Throbbing
Cramping only

Correct answer: Lancinating

Lancinating pain is sharp, sudden, and shooting, typical of neuropathic pain.

Question 20: Charcot neuroarthropathy (Charcot foot) is a catastrophic complication of diabetic neuropathy affecting which structure?

Joints and bones of the foot (Correct answer)
Peripheral blood vessels
Spinal cord
Skin of the foot

Correct answer: Joints and bones of the foot

Charcot neuroarthropathy causes progressive destruction of joints and bones of the foot due to loss of protective sensation.

Question 21: Orthostatic hypotension in autonomic neuropathy is defined as a systolic blood pressure drop of at least how many mmHg upon standing?

20 mmHg (Correct answer)
40 mmHg
30 mmHg
10 mmHg

Correct answer: 20 mmHg

Orthostatic hypotension is defined as a drop of ≥20 mmHg systolic or ≥10 mmHg diastolic within 3 minutes of standing.

Question 22: Mononeuropathy differs from polyneuropathy in that mononeuropathy:

Affects only autonomic nerves
Affects a single nerve (Correct answer)
Affects nerves symmetrically
Affects the brain only

Correct answer: Affects a single nerve

Mononeuropathy involves damage to one specific nerve, while polyneuropathy affects many nerves.

Question 23: Exposure to which heavy metal is a known toxic cause of peripheral neuropathy?

Lead (Correct answer)
Calcium
Sodium
Potassium

Correct answer: Lead

Lead and other heavy metals are neurotoxic and can cause peripheral neuropathy.

Question 24: What is the classic cerebrospinal fluid (CSF) finding in Guillain-Barré Syndrome?

Elevated protein with normal white blood cell count (albuminocytologic dissociation) (Correct answer)
Elevated white blood cells with normal protein
Normal protein and normal white blood cell count
Decreased glucose with elevated protein

Correct answer: Elevated protein with normal white blood cell count (albuminocytologic dissociation)

Albuminocytologic dissociation — elevated CSF protein without a corresponding increase in white blood cells — is the hallmark CSF finding in GBS.

Question 25: A patient suddenly develops weakness and numbness confined to the distribution of a single nerve, such as wrist drop. This pattern is called:

Mononeuropathy (Correct answer)
Autonomic neuropathy
Radiculopathy of all roots
Symmetric polyneuropathy

Correct answer: Mononeuropathy

Mononeuropathy involves damage to a single peripheral nerve, producing localized signs.

Question 26: Colchicine toxicity causing neuromuscular complications presents as which pattern?

Acute demyelinating polyneuropathy
Mononeuritis multiplex
Pure sensory neuropathy with paresthesias
Neuromyopathy with proximal weakness and elevated CK (Correct answer)

Correct answer: Neuromyopathy with proximal weakness and elevated CK

Colchicine toxicity typically causes a combined neuromyopathy with proximal muscle weakness and elevated creatine kinase, especially in renal failure.

Question 27: A patient describes a sensation of walking on cushions or thick socks despite being barefoot. This altered perception is best classified as which neuropathy symptom?

Paresthesia (Correct answer)
Hyperalgesia
Allodynia
Anhidrosis

Correct answer: Paresthesia

Paresthesia is an abnormal sensation such as tingling, prickling, or the feeling of padding under the feet.

Question 28: Which first-line medication is FDA-approved for painful diabetic peripheral neuropathy?

Pregabalin (Correct answer)
Carbamazepine
Gabapentin
Amitriptyline

Correct answer: Pregabalin

Pregabalin (Lyrica) is FDA-approved for painful diabetic peripheral neuropathy and has strong clinical trial evidence.

Question 29: Diabetic amyotrophy (proximal neuropathy) most characteristically presents with which symptom?

Bilateral foot tingling
Foot drop
Loss of ankle reflexes only
Severe unilateral thigh pain and weakness (Correct answer)

Correct answer: Severe unilateral thigh pain and weakness

Diabetic amyotrophy presents with acute, severe, often unilateral pain and weakness in the proximal leg muscles.

Question 30: Autonomic neuropathy causing diarrhea in diabetic patients is thought to involve dysfunction of which autonomic process?

Excessive gastric acid production
Abnormal intestinal motility and reduced sphincter tone (Correct answer)
Reduced bile acid secretion
Pancreatic exocrine dysfunction

Correct answer: Abnormal intestinal motility and reduced sphincter tone

Diabetic autonomic diarrhea results from abnormal gut motility, impaired sphincter control, and sometimes bacterial overgrowth due to reduced gut peristalsis.

Question 31: Insulin neuritis is a paradoxical worsening of neuropathic pain that occurs in which clinical situation?

Switching from insulin to oral medications
Developing renal failure
Starting a high-fat diet
Rapid improvement of blood glucose control (Correct answer)

Correct answer: Rapid improvement of blood glucose control

Insulin neuritis occurs when rapid normalization of blood sugar triggers a painful neuropathy, possibly due to epineural arteriovenous shunting.

Question 32: Sudomotor function testing using the quantitative sudomotor axon reflex test (QSART) evaluates the function of which nerve fiber type?

Large myelinated sensory fibers
Parasympathetic preganglionic fibers
Motor fibers to skeletal muscle
Postganglionic sympathetic cholinergic small fibers (Correct answer)

Correct answer: Postganglionic sympathetic cholinergic small fibers

QSART measures sweat output to assess postganglionic sympathetic cholinergic small fiber integrity, providing an indirect measure of sudomotor autonomic function.

Question 33: Which symptom combination suggests pandysautonomia rather than isolated sensory neuropathy?

Burning feet only
Orthostatic hypotension, gastroparesis, and bladder dysfunction together (Correct answer)
Pure foot weakness
Numb toes only

Correct answer: Orthostatic hypotension, gastroparesis, and bladder dysfunction together

Widespread autonomic features across multiple systems indicate pandysautonomia.

Question 34: Which patient behavior most significantly increases ulceration risk in a patient with established sensory neuropathy?

Walking barefoot indoors (Correct answer)
Using emollient cream on the feet
Taking daily walks in well-fitted shoes
Trimming toenails regularly

Correct answer: Walking barefoot indoors

Walking barefoot exposes insensate feet to injury from floors, debris, and temperature extremes that the patient cannot feel, dramatically increasing ulcer risk.

Question 35: What is a key reason to identify the underlying cause before starting neuropathy treatment?

It speeds up nerve conduction tests
Treating the cause may halt or reverse nerve damage (Correct answer)
Causes never affect treatment
It is required for insurance only

Correct answer: Treating the cause may halt or reverse nerve damage

Addressing the root cause, such as diabetes or B12 deficiency, can stop progression and sometimes reverse symptoms.

Question 36: Celiac disease-associated neuropathy is thought to be triggered by which mechanism?

Pancreatic enzyme deficiency
Malabsorption of sodium and potassium
Immune-mediated attack triggered by gluten sensitivity (Correct answer)
Direct gluten toxicity to axons

Correct answer: Immune-mediated attack triggered by gluten sensitivity

Gluten sensitivity triggers immune responses that can attack peripheral nerves even without gastrointestinal symptoms.

Question 37: Which test is most commonly used to evaluate the function of peripheral nerves?

Chest X-ray
Nerve conduction study (NCS) (Correct answer)
Colonoscopy
Echocardiogram

Correct answer: Nerve conduction study (NCS)

Nerve conduction studies measure how quickly and strongly electrical signals travel through nerves.

Question 38: Which of the following is an early motor sign of peripheral neuropathy affecting the feet?

Increased muscle bulk in the calves
Resting tremor of the hands
Exaggerated knee reflexes
Difficulty with fine toe movements and foot weakness (Correct answer)

Correct answer: Difficulty with fine toe movements and foot weakness

Motor neuropathy causes distal weakness, making fine foot and toe movements difficult.

Question 39: Linezolid, an antibiotic for resistant gram-positive infections, causes peripheral neuropathy through which toxic mechanism?

Folate antagonism in Schwann cells
Mitochondrial protein synthesis inhibition (Correct answer)
Autoimmune mimicry
Blocking nerve sodium channels

Correct answer: Mitochondrial protein synthesis inhibition

Linezolid inhibits mitochondrial ribosomal protein synthesis, leading to peripheral neuropathy with prolonged use.

Question 40: Which complication makes early diagnosis of foot neuropathy critical?

Unnoticed ulcers leading to infection or amputation (Correct answer)
Faster healing of all wounds
Spontaneous full recovery
Improved sensation over time

Correct answer: Unnoticed ulcers leading to infection or amputation

Loss of sensation allows injuries to go unnoticed, increasing risk of ulcers, infection, and amputation.

Question 41: Which test is used to assess large fiber function in diabetic neuropathy screening?

10-g Semmes-Weinstein monofilament test (Correct answer)
Nerve biopsy
Warm/cold temperature discrimination
Pinprick sensation test

Correct answer: 10-g Semmes-Weinstein monofilament test

The 10-g Semmes-Weinstein monofilament detects loss of protective sensation by assessing large myelinated fiber function.

Question 42: Which symptom is a hallmark of genitourinary autonomic neuropathy in male diabetic patients?

Erectile dysfunction
Testicular pain
Urinary retention and overflow incontinence
Both erectile dysfunction and urinary dysfunction (Correct answer)

Correct answer: Both erectile dysfunction and urinary dysfunction

Genitourinary autonomic neuropathy in men causes both erectile dysfunction (parasympathetic) and bladder dysfunction with overflow incontinence.

Question 43: Which pathophysiological mechanism is central to hyperglycemia-induced nerve damage in diabetes?

Hypocalcemia-induced demyelination
Elevated LDL depositing in nerves
Polyol pathway activation and oxidative stress (Correct answer)
Excess insulin signaling

Correct answer: Polyol pathway activation and oxidative stress

Excess glucose enters the polyol pathway, depleting NADPH and increasing oxidative stress, which damages axons and Schwann cells.

Question 44: Which symptom would be UNUSUAL for a typical length-dependent sensory neuropathy and should prompt evaluation for an alternative diagnosis?

Tingling that slowly ascends the legs
Symmetric burning in both feet
Gradual numbness starting in the toes
Sudden severe weakness of one arm only (Correct answer)

Correct answer: Sudden severe weakness of one arm only

Sudden focal weakness of one limb is atypical for symmetric length-dependent neuropathy and suggests another cause.

Question 45: A patient feels lightheaded and their heart rate fails to rise appropriately when standing. This points to dysfunction of which system?

Somatic motor system
Visual system
Cerebellar system
Cardiovascular autonomic system (Correct answer)

Correct answer: Cardiovascular autonomic system

Cardiovascular autonomic neuropathy impairs heart rate and blood pressure responses to position change.

Question 46: What is the most common form of diabetic neuropathy?

Autonomic neuropathy
Focal mononeuropathy
Proximal neuropathy
Distal symmetric polyneuropathy (Correct answer)

Correct answer: Distal symmetric polyneuropathy

Distal symmetric polyneuropathy is the most prevalent form, affecting the feet and hands in a stocking-glove pattern.

Question 47: Why is a thorough medication review part of neuropathy diagnosis?

It replaces all blood testing
It is only for billing purposes
Medications never affect nerves
Certain drugs, such as some chemotherapies, can cause neuropathy (Correct answer)

Correct answer: Certain drugs, such as some chemotherapies, can cause neuropathy

Drug-induced neuropathy from agents like chemotherapy can be identified and addressed by reviewing medications.

Question 48: Which finding on examination suggests large-fiber sensory neuropathy?

Loss of vibration sense and proprioception (Correct answer)
Increased muscle bulk
Normal reflexes and full strength
Improved fine touch

Correct answer: Loss of vibration sense and proprioception

Large-fiber involvement typically reduces vibration sense, proprioception, and deep tendon reflexes.

Question 49: Which autonomic reflex is tested by the Valsalva maneuver in the evaluation of autonomic neuropathy?

Cardiovagal and adrenergic baroreflex response (Correct answer)
Pupillary light reflex
Vasovagal syncope threshold
Sudomotor reflex

Correct answer: Cardiovagal and adrenergic baroreflex response

The Valsalva maneuver tests both cardiovagal function (heart rate response) and adrenergic function (blood pressure recovery) during forced expiration.

Question 50: Duloxetine is FDA-approved for painful diabetic neuropathy and works primarily through which mechanism?

Opioid receptor agonism
GABA-A receptor modulation
Sodium channel blockade
Serotonin-norepinephrine reuptake inhibition (Correct answer)

Correct answer: Serotonin-norepinephrine reuptake inhibition

Duloxetine inhibits reuptake of serotonin and norepinephrine, enhancing descending pain inhibitory pathways.

Question 51: Cardiac autonomic neuropathy (CAN) is associated with which serious cardiac risk?

Aortic stenosis
Pericardial effusion
Sudden cardiac death due to arrhythmia (Correct answer)
Mitral valve prolapse

Correct answer: Sudden cardiac death due to arrhythmia

CAN is associated with a significantly increased risk of sudden cardiac death due to QT prolongation and cardiac arrhythmias.

Question 52: Which screening tool is validated for assessing neuropathic pain quality and intensity in clinical practice?

McGill Pain Questionnaire only
Visual analogue scale alone
Beck Depression Inventory
Douleur Neuropathique 4 (DN4) questionnaire (Correct answer)

Correct answer: Douleur Neuropathique 4 (DN4) questionnaire

The DN4 questionnaire discriminates neuropathic from non-neuropathic pain using 10 items about pain quality and associated sensory symptoms, with a cutoff score of 4.

Question 53: Diabetic neuropathic cachexia is characterized by which combination of features?

Proximal weakness, fever, and elevated CRP
Foot drop, ankle weakness, and insomnia
Cranial nerve palsies and hypertension
Severe weight loss, depression, and painful neuropathy (Correct answer)

Correct answer: Severe weight loss, depression, and painful neuropathy

Diabetic neuropathic cachexia presents with profound weight loss, severe neuropathic pain, and depression, predominantly in older men.

Question 54: Why is regular foot care especially important for neuropathy patients?

To detect injuries early since pain warning is reduced (Correct answer)
Because their feet grow faster
Because shoes cause neuropathy
To improve nerve conduction speed

Correct answer: To detect injuries early since pain warning is reduced

Reduced sensation means daily foot inspection is needed to catch wounds before they worsen.

Question 55: Neuropathy-related gait abnormalities most commonly manifest as which pattern?

Scissor gait
Antalgic gait
Waddling gait
High-stepping (steppage) gait due to foot drop (Correct answer)

Correct answer: High-stepping (steppage) gait due to foot drop

Foot drop from peroneal nerve or anterior compartment weakness causes a steppage gait where the patient lifts the foot high to avoid tripping on a dropped toe.

Question 56: What is the primary mechanism by which IVIG benefits patients with inflammatory neuropathies?

Direct regeneration of damaged myelin sheaths
Immune modulation through Fc receptor blockade, complement inhibition, and idiotype interactions (Correct answer)
Direct antibacterial action against triggering pathogens
Replacement of antibodies depleted by autoimmune attack

Correct answer: Immune modulation through Fc receptor blockade, complement inhibition, and idiotype interactions

IVIG exerts multiple immunomodulatory effects including Fc receptor blockade on macrophages, complement activation inhibition, and neutralization of pathogenic antibodies.

Question 57: Approximately what percentage of GBS patients recover the ability to walk independently within 6 months?

Nearly 100%
About 50%
About 85% (Correct answer)
About 20-30%

Correct answer: About 85%

Approximately 85% of GBS patients regain independent ambulation within 6 months, though some may have persistent fatigue, pain, or mild weakness.

Question 58: Which medication used for tuberculosis is a well-known cause of isoniazid-induced neuropathy?

Isoniazid (Correct answer)
Pyrazinamide
Ethambutol
Rifampin

Correct answer: Isoniazid

Isoniazid causes peripheral neuropathy by interfering with pyridoxine (vitamin B6) metabolism, and supplementation is given prophylactically.

Question 59: What are the central nervous system and the peripheral nervous system?

The brain and spinal cord (Correct answer)
The digestive system and the autonomic nervous system
The brain and the spine
The heart and the peripheral nervous system
The spinal cord and the periphery

Correct answer: The brain and spinal cord

The central nervous system (CNS) consists of the brain and the spinal cord, which act as the main control center for the body. The peripheral nervous system (PNS) comprises all the nerves that branch out from the CNS to the rest of the body, including muscles and organs.

Question 60: Which finding indicates large-fiber involvement on examination?

Loss of pinprick only
Burning pain only
Excessive sweating
Loss of vibration and proprioception (Correct answer)

Correct answer: Loss of vibration and proprioception

Large fibers carry vibration and position sense, so their loss reflects large-fiber damage.

Question 61: Gustatory sweating (Frey's syndrome) after eating is a form of autonomic neuropathy associated with damage to which nerve?

Glossopharyngeal nerve
Auriculotemporal branch of trigeminal nerve (Correct answer)
Hypoglossal nerve
Facial nerve

Correct answer: Auriculotemporal branch of trigeminal nerve

Frey's syndrome results from aberrant reinnervation of the auriculotemporal nerve, causing sweating during eating instead of salivation.

Question 62: Which bedside tool is used to screen for loss of protective sensation in the feet?

Reflex hammer alone
Stethoscope
Tuning fork at 64 Hz only
10-gram monofilament (Correct answer)

Correct answer: 10-gram monofilament

The 10-gram Semmes-Weinstein monofilament test screens for loss of protective sensation, especially in diabetics.

Question 63: Multiple system atrophy (MSA) is distinguished from pure autonomic failure by which feature?

Involvement of the central nervous system with cerebellar or parkinsonian features (Correct answer)
Response to fludrocortisone treatment
Presence of orthostatic hypotension
Onset after age 70

Correct answer: Involvement of the central nervous system with cerebellar or parkinsonian features

MSA involves both autonomic failure and central nervous system degeneration (cerebellar ataxia or parkinsonism), unlike pure autonomic failure.

Question 64: Which type of neuropathy is characteristically associated with IgM monoclonal gammopathy of undetermined significance (MGUS)?

Mononeuropathy multiplex from vasculitis
Anti-GM1-associated pure motor neuropathy
Autonomic neuropathy with orthostatic hypotension
Anti-MAG neuropathy with predominantly large fiber sensory loss (Correct answer)

Correct answer: Anti-MAG neuropathy with predominantly large fiber sensory loss

IgM MGUS frequently produces anti-MAG (myelin-associated glycoprotein) antibodies that cause a demyelinating sensory neuropathy with prominent distal sensory loss and gait ataxia.

Question 65: Which bedside test is used to evaluate cardiovagal autonomic function in cardiac autonomic neuropathy?

Thermoregulatory sweat test
Quantitative sudomotor axon reflex test
Tilt table test
Heart rate variability with deep breathing (E:I ratio) (Correct answer)

Correct answer: Heart rate variability with deep breathing (E:I ratio)

The heart rate response to deep breathing (E:I ratio) is a sensitive, non-invasive test of parasympathetic cardiac function.

Question 66: Which structured educational program is most effective in preventing diabetic foot complications in neuropathy patients?

Therapeutic patient education on foot care (Correct answer)
Carbohydrate counting courses only
Exercise rehabilitation programs
Dietary counseling for weight loss

Correct answer: Therapeutic patient education on foot care

Structured therapeutic patient education on foot inspection, proper footwear, and early wound recognition significantly reduces foot complications.

Question 67: Over time, untreated motor neuropathy can lead to which visible foot deformity due to muscle imbalance?

Increased calf muscle bulk
Hammer toes and high arches (Correct answer)
Webbed toes
Flat reduced arches only with no toe change

Correct answer: Hammer toes and high arches

Intrinsic foot muscle weakness causes clawing/hammer toes and high arches.

Question 68: Which occupational therapy intervention is most beneficial for a patient with hand neuropathy affecting fine motor skills?

Nerve conduction studies monitoring
Adaptive equipment and hand-strengthening exercises (Correct answer)
Transcutaneous electrical nerve stimulation (TENS)
Corticosteroid injections into carpal tunnel

Correct answer: Adaptive equipment and hand-strengthening exercises

Adaptive equipment (button hooks, jar openers) combined with targeted hand exercises helps neuropathy patients maintain independence in daily tasks.

Question 69: What type of cream can cause a burning sensation?

Lidocaine (Correct answer)
Benzocaine
Betadine
Iodine
Caffeine

Correct answer: Lidocaine

While lidocaine is primarily used for numbing and pain relief, some individuals may experience a temporary burning or stinging sensation upon application, especially if they have sensitive skin or if the skin is broken. This is a known potential side effect for some topical anesthetics, including lidocaine.

Question 70: Untreated hypothyroidism can contribute to peripheral neuropathy because it:

Causes fluid buildup and metabolic changes that compress and damage nerves (Correct answer)
Directly infects nerve tissue
Raises blood sugar permanently
Increases nerve regeneration

Correct answer: Causes fluid buildup and metabolic changes that compress and damage nerves

Hypothyroidism can lead to fluid retention and metabolic dysfunction that injure peripheral nerves.

Question 71: Which symptom reflects autonomic neuropathy affecting sweat glands in the feet?

Increased hair growth
Excessively moist, sweaty feet
Bright red painful toes
Dry, cracked skin from reduced sweating (Correct answer)

Correct answer: Dry, cracked skin from reduced sweating

Autonomic damage often reduces sweating distally, causing dry, cracked skin prone to fissures.

Question 72: Oxaliplatin causes a unique acute neuropathy during or immediately after infusion characterized by which symptom?

Proximal muscle weakness
Cold-triggered dysesthesias in hands and throat (Correct answer)
Burning feet and ankle edema
Sudden hearing loss

Correct answer: Cold-triggered dysesthesias in hands and throat

Oxaliplatin causes an acute cold-triggered dysesthesia in the hands and oropharynx immediately after infusion, distinct from its cumulative sensory neuropathy.

Question 73: Which topical treatment is FDA-approved for localized painful diabetic neuropathy of the feet?

Capsaicin 8% patch (Qutenza) (Correct answer)
Topical gabapentin cream
Lidocaine 5% patch
Diclofenac gel

Correct answer: Capsaicin 8% patch (Qutenza)

The capsaicin 8% high-concentration patch is FDA-approved for diabetic neuropathic foot pain and depletes substance P from nociceptors.

Question 74: Fall prevention is critical in neuropathy patients because sensory and proprioceptive loss creates which primary hazard?

Impaired postural stability and increased fall risk (Correct answer)
Cardiovascular instability during exertion
Increased cognitive impairment
Progressive muscle atrophy only

Correct answer: Impaired postural stability and increased fall risk

Loss of proprioception and sensory feedback impairs balance and postural reflexes, making neuropathy patients highly prone to falls and fractures.

Question 75: What kind of tests might particularly be done to determine the location and extent of nerve damage?

CT scans
Laboratory tests
Neurological tests (Correct answer)
Radiological tests
MRI

Correct answer: Neurological tests

Neurological tests, such as nerve conduction studies (NCS) and electromyography (EMG), are specifically designed to assess nerve function and muscle response. These tests can precisely identify the location, type, and extent of nerve damage, which is crucial for diagnosing and managing neuropathy.

Question 76: What type of test looks at your autonomic nerve fibers?

Autonomic reflex screen (Correct answer)
Autonomic function test
Autonomic neuropsychiatric test
Autonomic screening test
Autonomic neurophysiology test

Correct answer: Autonomic reflex screen

An autonomic reflex screen is a specific battery of tests designed to evaluate the function of the autonomic nervous system, which controls involuntary bodily functions. These tests assess various reflexes, such as sudomotor function (sweating), heart rate variability, and blood pressure responses, to determine the health and integrity of autonomic nerve fibers. It directly measures the body's involuntary responses mediated by these nerves.

Question 77: What can you get from a blood test?

Diseases
Cancer
Vitamin deficiencies (Correct answer)
Health risks
Preexisting conditions

Correct answer: Vitamin deficiencies

A blood test is a common diagnostic tool that can reveal a wide range of information about a person's health, including levels of various vitamins and minerals. Significant vitamin deficiencies, such as B12 deficiency, can be a cause or contributing factor to neuropathy, making blood tests crucial for diagnosis.

Question 78: Why are foot ulcers a serious risk for people with peripheral neuropathy?

Nerves cause excessive sweating that softens skin
Increased pain makes patients walk more
Neuropathy thickens the skin protectively
Loss of sensation means injuries go unnoticed (Correct answer)

Correct answer: Loss of sensation means injuries go unnoticed

Reduced sensation lets minor wounds go unnoticed and worsen, sometimes leading to serious infection.

Question 79: Alpha-lipoic acid is a supplement studied mainly for neuropathy related to which condition?

Diabetes (Correct answer)
Glaucoma
Hypertension
Asthma

Correct answer: Diabetes

Alpha-lipoic acid, an antioxidant, has been studied for symptom relief in diabetic neuropathy.

Question 80: Why does peripheral neuropathy often begin in the feet before the hands?

Hands have thicker skin
Feet are closer to the brain
The feet have no nerves
Longest nerves are affected first (Correct answer)

Correct answer: Longest nerves are affected first

Length-dependent neuropathy affects the longest nerves first, which reach the feet.

Question 81: Neuropathic pain that is refractory to first and second-line pharmacological treatments may benefit from which interventional procedure?

Epidural steroid injection
Peripheral nerve biopsy
Spinal cord stimulation (SCS) (Correct answer)
Lumbar sympathetic block

Correct answer: Spinal cord stimulation (SCS)

Spinal cord stimulation is an evidence-based neuromodulation approach for refractory neuropathic pain, particularly in painful diabetic neuropathy.

Question 82: What are the nerves that control muscles and movement in the body?

Pediatric neuropathy
Autonomic neuropathy
Motor neuropathy (Correct answer)
Sensory neuropathy

Correct answer: Motor neuropathy

Motor neuropathy specifically refers to damage to the motor nerves, which are responsible for transmitting signals from the brain and spinal cord to the muscles, controlling voluntary movement. When these nerves are affected, it can lead to muscle weakness, cramps, spasms, and impaired coordination.

Question 83: Which medication class is first-line for symptomatic orthostatic hypotension in autonomic neuropathy?

Diuretics
Midodrine (alpha-1 agonist) (Correct answer)
ACE inhibitors
Beta-blockers

Correct answer: Midodrine (alpha-1 agonist)

Midodrine, an alpha-1 adrenergic agonist, increases peripheral vascular resistance and is first-line for symptomatic orthostatic hypotension.

Question 84: Why are opioids generally not preferred as first-line neuropathic pain treatment?

They have no side effects
They speed nerve regeneration
Risk of dependence and limited long-term benefit (Correct answer)
They cure neuropathy

Correct answer: Risk of dependence and limited long-term benefit

Opioids carry addiction risk and offer limited durable relief, so they are reserved rather than first-line.

Question 85: Which immunosuppressant used in organ transplantation is a recognized cause of peripheral neuropathy?

Hydroxychloroquine
Mycophenolate mofetil
Azathioprine
Tacrolimus (FK506) (Correct answer)

Correct answer: Tacrolimus (FK506)

Tacrolimus can cause peripheral neuropathy in transplant patients, thought to be related to its calcineurin inhibition affecting Schwann cells.

Question 86: What might lidocaine patches offer?

A numbing sensation
Pain relief (Correct answer)
A cooling sensation
Inhibition of nerve impulses
Hearing loss reduction

Correct answer: Pain relief

Lidocaine patches are topical medications that deliver lidocaine, a local anesthetic, directly to the skin. They work by blocking nerve signals in the area where they are applied, thereby providing localized pain relief, particularly useful for neuropathic pain.

Question 87: A patient with neuropathy reports inability to sense a full bladder and incomplete emptying. This bladder dysfunction is due to:

Increased reflexes
Excess muscle strength
Damage to autonomic nerves supplying the bladder (Correct answer)
A urinary tract stone only

Correct answer: Damage to autonomic nerves supplying the bladder

Autonomic neuropathy can impair bladder sensation and emptying, causing retention.

Question 88: Which of the following standard immune therapies is specifically effective for Multifocal Motor Neuropathy (MMN) but NOT corticosteroids or plasmapheresis?

Azathioprine
Mycophenolate mofetil
Rituximab
Intravenous immunoglobulin (IVIG) (Correct answer)

Correct answer: Intravenous immunoglobulin (IVIG)

IVIG is the treatment of choice for MMN; corticosteroids and plasmapheresis are not only ineffective but may worsen the condition, making MMN unique among inflammatory neuropathies.

Question 89: Which lifestyle measure is most important for preventing complications in diabetic foot neuropathy?

Daily foot inspection and proper footwear (Correct answer)
Soaking feet in very hot water
Ignoring small cuts
Walking barefoot outdoors

Correct answer: Daily foot inspection and proper footwear

Daily inspection and protective footwear help prevent unnoticed injuries and ulcers in numb feet.

Question 90: A patient with neuropathy frequently trips and reports a 'slapping' gait. This is most consistent with weakness of which movement?

Plantarflexion (pointing toes down)
Knee extension
Hip flexion
Dorsiflexion (lifting the foot) (Correct answer)

Correct answer: Dorsiflexion (lifting the foot)

Foot drop from dorsiflexion weakness causes a slapping, high-stepping gait.

Question 91: Which autoimmune condition commonly causes a painful sensory neuropathy due to dorsal root ganglion inflammation?

Celiac disease
Psoriasis
Type 1 diabetes
Sjögren's syndrome (Correct answer)

Correct answer: Sjögren's syndrome

Sjögren's syndrome can cause a ganglionopathy by attacking dorsal root ganglia, producing sensory ataxia and pain.

Question 92: What conditions can cause neuropathy from chemotherapy?

Patients receiving radiation therapy
Cancer patients (Correct answer)
Patients who have received radiation therapy
Patients with diabetes
Patients with autoimmune diseases

Correct answer: Cancer patients

Chemotherapy-induced peripheral neuropathy (CIPN) is a common and often debilitating side effect experienced by cancer patients undergoing certain chemotherapy treatments. These powerful drugs, designed to kill cancer cells, can also damage healthy nerve cells, leading to symptoms like pain, numbness, and tingling.

Question 93: A patient describes intermittent numbness that comes and goes early in disease before becoming constant. This progression suggests:

A purely psychiatric cause
Gradual, progressive nerve dysfunction (Correct answer)
Acute spinal cord transection
Immediate full recovery

Correct answer: Gradual, progressive nerve dysfunction

Many neuropathies progress from intermittent to constant symptoms as nerve damage advances.

Question 94: Amiodarone, an antiarrhythmic drug, is associated with which type of neuropathy?

Mononeuritis multiplex
Acute motor axonal neuropathy
Pure autonomic neuropathy
Demyelinating polyneuropathy resembling CIDP (Correct answer)

Correct answer: Demyelinating polyneuropathy resembling CIDP

Amiodarone can cause a demyelinating polyneuropathy similar to CIDP, as the drug and its metabolite accumulate in lysosomes of Schwann cells.

Question 95: Which vitamin deficiency is a well-recognized cause of peripheral neuropathy?

Vitamin B12 (Correct answer)
Vitamin C
Vitamin D
Vitamin A

Correct answer: Vitamin B12

Vitamin B12 deficiency damages the myelin sheath of nerves, causing peripheral neuropathy.

Question 96: Supine hypertension in autonomic failure patients treated with midodrine or fludrocortisone is best managed by which approach?

Reducing fluid intake
Discontinuing all treatment
Elevating the head of the bed at night (Correct answer)
Adding a diuretic to therapy

Correct answer: Elevating the head of the bed at night

Elevating the head of the bed 30-45 degrees at night counteracts supine hypertension by promoting fluid redistribution away from the chest.

Question 97: Which HbA1c target is recommended to slow the progression of diabetic neuropathy in non-elderly adults with type 1 diabetes?

Below 8%
Below 9%
Below 7% (Correct answer)
Below 6%

Correct answer: Below 7%

Maintaining HbA1c below 7% significantly reduces the risk and progression of diabetic peripheral neuropathy.

Question 98: A diabetic patient is unaware of a blister forming on the sole of the foot. This 'silent' injury risk is most directly due to:

Muscle hypertrophy
Loss of protective sensation (Correct answer)
Improved reflexes
Excessive sweating

Correct answer: Loss of protective sensation

Loss of protective sensation means injuries go unnoticed, increasing ulcer risk.

Question 99: Which organ is primarily responsible for producing advanced glycation end-products (AGEs) that contribute to diabetic neuropathy?

Kidney
Throughout the body in hyperglycemic states (Correct answer)
Pancreas
Liver

Correct answer: Throughout the body in hyperglycemic states

AGEs form throughout the body when chronic hyperglycemia causes glucose to bond non-enzymatically to proteins and lipids, damaging nerves.

Question 100: A patient notices they cannot feel the temperature of bathwater accurately with their feet. Which fiber type is most likely affected?

Large myelinated motor fibers
Proprioceptive fibers only
Small unmyelinated/thinly myelinated fibers (Correct answer)
Cranial nerve fibers

Correct answer: Small unmyelinated/thinly myelinated fibers

Small fibers carry temperature and pain sensation, so their damage impairs thermal perception.

Question 101: Which complication of autonomic neuropathy is a recognized cause of silent myocardial infarction in diabetic patients?

Hypertensive crisis from sympathetic overactivity
Orthostatic hypotension masking chest pain
Cardiac denervation eliminating anginal pain perception (Correct answer)
Resting tachycardia increasing oxygen demand

Correct answer: Cardiac denervation eliminating anginal pain perception

Cardiac autonomic neuropathy causes denervation of the heart, eliminating the pain signals that would normally signal a heart attack.

Question 102: Which complication of diabetic neuropathy is most directly responsible for lower limb amputations?

Painful paresthesias
Muscle weakness causing falls
Autonomic dysfunction causing poor circulation only
Loss of protective sensation leading to undetected foot ulcers (Correct answer)

Correct answer: Loss of protective sensation leading to undetected foot ulcers

Loss of protective sensation prevents patients from feeling injury, allowing foot ulcers to progress undetected to infection and gangrene.

Question 103: Compression stockings are recommended for autonomic neuropathy patients with orthostatic hypotension because they achieve which effect?

Prevent paradoxical supine hypertension
Stimulate peripheral alpha receptors
Increase heart rate to compensate for low blood pressure
Reduce venous pooling in the legs during standing (Correct answer)

Correct answer: Reduce venous pooling in the legs during standing

Compression stockings reduce venous pooling in the legs upon standing, increasing venous return and blood pressure in orthostatic hypotension.

Question 104: Which gastrointestinal manifestation is most common in diabetic autonomic neuropathy?

Esophageal varices
Ulcerative colitis
Gastroparesis (Correct answer)
Acute pancreatitis

Correct answer: Gastroparesis

Gastroparesis, delayed gastric emptying due to vagal nerve dysfunction, is the most common GI manifestation of diabetic autonomic neuropathy.

Question 105: In diabetic neuropathy, loss of the Achilles tendon reflex indicates damage to which nerve root level?

L4-L5
L1-L2
S1-S2 (Correct answer)
L2-L3

Correct answer: S1-S2

The Achilles reflex is mediated by the S1 nerve root via the tibial nerve, and its absence is an early sign of diabetic polyneuropathy.

Question 106: Anhidrosis (inability to sweat) from autonomic neuropathy most commonly begins in which body region?

Face and scalp
Hands and arms
Feet and legs (ascending pattern) (Correct answer)
Upper trunk

Correct answer: Feet and legs (ascending pattern)

Autonomic neuropathy-related anhidrosis typically begins in the distal lower extremities and ascends, mirroring the length-dependent nerve damage.

Question 107: What is the most common type of neuropathy?

HIV neuropathy
Diabetic peripheral neuropathy (Correct answer)
Polyneuropathy
Autonomic neuropathy
Charcot-Marie-Tooth disease

Correct answer: Diabetic peripheral neuropathy

Diabetic peripheral neuropathy is the most prevalent form of neuropathy, affecting a significant percentage of individuals with diabetes. High blood sugar levels over time can damage nerves throughout the body, most commonly in the legs and feet, leading to symptoms like numbness, tingling, and pain.

Question 108: Hypoglycemia unawareness in a diabetic patient with neuropathy occurs because autonomic damage blunts:

The adrenergic warning symptoms of low blood sugar (Correct answer)
All pain everywhere
Insulin production entirely
The need to eat

Correct answer: The adrenergic warning symptoms of low blood sugar

Autonomic neuropathy dulls the adrenergic warning signs (tremor, sweating, palpitations) of hypoglycemia.

Question 109: Which gastrointestinal motility drug is commonly used to treat diabetic gastroparesis?

Loperamide
Metoclopramide (Correct answer)
Ondansetron
Cholestyramine

Correct answer: Metoclopramide

Metoclopramide is the only FDA-approved medication for diabetic gastroparesis and works as a dopamine antagonist and prokinetic agent.

Question 110: More than 145 types of peripheral neuropathy have been identified, each with its own symptoms and prognosis.

True (Correct answer)
False

Correct answer: True

This statement is true. Peripheral neuropathy is not a single disease but a broad term encompassing many conditions resulting from damage to the peripheral nervous system. Due to the diverse causes (e.g., diabetes, autoimmune diseases, infections, toxins, genetics) and the various types of nerve fibers that can be affected, there are indeed numerous distinct forms of peripheral neuropathy, each with unique clinical presentations and outcomes.

Neuropathy Practice Test

Comprehensive assessment of neuropathy knowledge covering peripheral, diabetic, and autonomic neuropathy types, their signs and symptoms, pathophysiology, diagnosis, and clinical management — aligned with healthcare professional certification standards such as the CNRN exam.

110

Questions

120 min

Time Limit

70%

To Pass

Checking for saved progress...

Exam Rules

You can skip questions and return to them later
Flag questions for review before submitting
No feedback shown until you submit the entire exam
Unanswered questions count as wrong — answer everything
10 pretest questions are mixed in and don't affect your score
Timer auto-submits when time runs out
Your progress is auto-saved every 30 seconds