Neuropathy Signs and Symptoms 3 — Questions and Answers
Question 1: A patient reports symptoms that are worse at night and improve slightly with walking. This nocturnal worsening is most characteristic of:
- Cluster headache
- Painful peripheral neuropathy (Correct answer)
- Carpal tunnel resolved
- Acute stroke
Correct answer: Painful peripheral neuropathy
Neuropathic pain, especially diabetic, classically intensifies at night.
Question 2: Which symptom pattern best describes a small-fiber neuropathy?
- Profound weakness with normal sensation
- Burning pain and temperature loss with preserved strength and reflexes (Correct answer)
- Loss of vibration with brisk reflexes
- Pure muscle wasting
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 3: A patient with neuropathy frequently trips and reports a 'slapping' gait. This is most consistent with weakness of which movement?
- Plantarflexion (pointing toes down)
- Dorsiflexion (lifting the foot) (Correct answer)
- Knee extension
- Hip flexion
Correct answer: Dorsiflexion (lifting the foot)
Foot drop from dorsiflexion weakness causes a slapping, high-stepping gait.
Question 4: Which finding indicates large-fiber involvement on examination?
- Loss of vibration and proprioception (Correct answer)
- Loss of pinprick only
- Excessive sweating
- Burning pain only
Correct answer: Loss of vibration and proprioception
Large fibers carry vibration and position sense, so their loss reflects large-fiber damage.
Question 5: 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 6: Reduced or absent ankle reflexes in a length-dependent neuropathy occur because:
- The brain is damaged
- The reflex arc's sensory and motor nerves are affected distally (Correct answer)
- The muscle is hypertrophied
- Reflexes are normally absent in adults
Correct answer: The reflex arc's sensory and motor nerves are affected distally
Damage to the distal reflex arc reduces or abolishes the ankle jerk.
Question 7: 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)
- Immediate full recovery
- Acute spinal cord transection
Correct answer: Gradual, progressive nerve dysfunction
Many neuropathies progress from intermittent to constant symptoms as nerve damage advances.
Neuropathy Signs and Symptoms 3
A patient reports symptoms that are worse at night and improve slightly with walking.
This nocturnal worsening is most characteristic of: