CIDP Diagnosis
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Questions and Answers

When should nerve biopsy be considered for diagnosing CIDP?

  • Only when there is little or no response to treatment
  • Both B and C (correct)
  • As a routine procedure
  • Only when other diagnostic methods cannot confirm CIDP

    • What should be observed when performing nerve biopsy?

  • Maximal standards for processing and evaluating nerve biopsies
  • Minimal standards for processing and evaluating nerve biopsies (correct)
  • No specific standards for processing and evaluating nerve biopsies
  • Only the patient's consent

    • Which nerve is most commonly biopsied for CIDP diagnosis?

  • Sural nerve (correct)
  • Peroneal nerve
  • Median nerve
  • Radial nerve

    • What are some findings suggestive of CIDP on nerve biopsy?

    <p>Demyelinated internodes in teased fibers</p> Signup and view all the answers

    What is the success rate of immunomodulating agents in patients diagnosed with CIDP through biopsy?

    <p>High</p> Signup and view all the answers

    What are the limitations of nerve biopsies in CIDP diagnosis?

    <p>Poor sensitivity and specificity</p> Signup and view all the answers

    What type of testing is strongly advised in adult patients with a clinical suspicion of CIDP?

    <p>Monoclonal gammopathy testing</p> Signup and view all the answers

    What should be included in monoclonal gammopathy testing for CIDP diagnosis?

    <p>All of the above</p> Signup and view all the answers

    What should be done if a gammopathy is found during monoclonal gammopathy testing for CIDP diagnosis?

    <p>Haematology-oncology consultation should be strongly considered</p> Signup and view all the answers

    What should be considered in patients with distal CIDP regarding monoclonal gammopathy testing?

    <p>Repeat testing should be considered if no IgM paraprotein is found</p> Signup and view all the answers

    When is VEGF serum level testing indicated in patients with a distal and painful CIDP phenotype?

    <p>When POEMS syndrome is suspected</p> Signup and view all the answers

    What are some complications associated with sural nerve biopsy?

    <p>Numbness and acute or chronic pain</p> Signup and view all the answers

    When should nerve biopsy be performed to diagnose CIDP?

    <p>Only when CIDP cannot be confirmed by other tests</p> Signup and view all the answers

    Who should be available to perform nerve biopsies?

    <p>Specialized pathology laboratory facilities</p> Signup and view all the answers

    What should patients be informed of before undergoing nerve biopsy?

    <p>The accuracy of nerve biopsy is limited</p> Signup and view all the answers

    What type of nerve biopsy is more likely to provide useful information?

    <p>Biopsy of a clinically affected nerve</p> Signup and view all the answers

    What are some findings suggestive of CIDP on nerve biopsy?

    <p>Demyelination on electron microscopy</p> Signup and view all the answers

    What is the purpose of the statement on nerve biopsy?

    <p>To discourage nerve biopsies for suspected CIDP</p> Signup and view all the answers

    What is strongly advised in adult patients with a clinical suspicion of CIDP?

    <p>Testing for serum monoclonal proteins</p> Signup and view all the answers

    What tests should be included when testing for serum monoclonal proteins?

    <p>Serum protein electrophoresis and immunofixation, spot urine immunofixation for light chains, and measurement of serum free light chains</p> Signup and view all the answers

    What should be done if a gammopathy is found during monoclonal gammopathy testing?

    <p>Further evaluation may be required</p> Signup and view all the answers

    What is the potential complication associated with sural nerve biopsy?

    <p>Numbness in the area of innervation</p> Signup and view all the answers

    What is the success rate of treating patients with immunomodulating agents after a biopsy-guided diagnosis of CIDP?

    <p>High</p> Signup and view all the answers

    What is the accuracy of nerve biopsy?

    <p>Limited</p> Signup and view all the answers

    Study Notes

    Good Practice Points for Nerve Biopsy and Monoclonal Gammopathy Testing in CIDP Diagnosis

    Nerve Biopsy:

    • Nerve biopsy should not be performed routinely to diagnose CIDP.
    • It should only be considered in specific circumstances, such as when CIDP cannot be confirmed by other tests or when alternative diagnoses are being considered.
    • Skilled surgeons, neuropathologists, and specialized pathology laboratory facilities should be available to perform nerve biopsies.
    • The accuracy of nerve biopsy is limited, and patients should be informed of this before undergoing the procedure.
    • Minimal standards for processing and evaluating nerve biopsies should be followed.
    • Biopsy of a clinically affected nerve is more likely to provide useful information.
    • Findings suggestive of CIDP on nerve biopsy may include thinly myelinated axons, small onion bulbs, perivascular macrophage clusters, and demyelination on electron microscopy.
    • Clinical outcomes in patients with suspected CIDP who are treated with immunomodulating agents after a biopsy-guided diagnosis of CIDP have been successful.
    • Nerve biopsy may reveal findings suggestive of a different or differential diagnosis, leading to appropriate therapy.
    • Sural nerve biopsy is associated with numbness in the area of innervation and other potential complications.
    • The statement on nerve biopsy is intended to reduce the number of unnecessary biopsies for suspected CIDP.

    Monoclonal Gammopathy Testing:

    • Testing for serum monoclonal proteins is strongly advised in adult patients with a clinical suspicion of CIDP.
    • Testing should include serum protein electrophoresis and immunofixation, spot urine immunofixation for light chains, and measurement of serum free light chains.
    • If a gammopathy is found, further evaluation may be required, and haematology-oncology consultation should be strongly considered.

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    Description

    Think you know the best practices for nerve biopsy and monoclonal gammopathy testing in CIDP diagnosis? Take this quiz to test your knowledge and learn more about when nerve biopsy should be considered, what to look for on a nerve biopsy, and what tests should be done for monoclonal gammopathy. This quiz will help you stay up-to-date on the latest guidelines and best practices for diagnosing CIDP.

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