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Pfizer Pharmaceuticals Group
Genitourinary
. I....
m) Impotence (not due to other causes)
1....:
Retrograde ejaculation
Overflow bladder incontinence
P) Urinary dribbling
q) Incomplete bladder emptying
) Increased urinary volume
s)
Decreased urinary frequency
Sudomotor Abnormality
) Diminished sweating of legs
1) Feeling of increasing sweating elsewhere
Hypoglycemic Unawareness
") Decreased adrenergic awareness of hypoglycemia
B.
NEUROLOGICAL AND PERIPHERAL SENSORY EXAMINATION
Your standard neurological examination should be performed. Special attention should be paid to the peripheral nervous system.
Pin Prick: The level at which the pin prick feels normal (compared with the upper thigh or face), and not just "sharp", should be
recorded.
Vibration: Use a 128-Hz tuning fork. The ability to detect the direction of the small upward or downward movements of the great toe
should be determined, as well as the ability to perceive a low amplitude 128-Hz vibration at the first metatarsal-phalangeal joint, using
your personal experience with individuals without neuropathy as a control.
Muscle Strength: For the most part, strength will be normal in this group of patients. To look for evidence of distal weakness, test
great toe dorsiflexion (extensor hallucis longus muscle) and dorsiflexion of small toes (extensor digitorum brevis, EDB). In addition,
look for evidence of atrophy of EDB and other intrinsic foot muscles.
Reflexes should be elicited in your usual way. In this study, we will be especially interested in the knee and ankle jerks. Reflexes
should be graded as increased, normal, decreased, or absent.
1. Based on this examination, are there abnormalities of:
No
Yes
a) Mental status
b)
Cranial nerves
Proximal or distal muscle strength
. .
d)
Sensory function of small fibers (pin prick)
e)
Sensory function of large fibers (vibration)
f) Gait and coordination
0 0 0 0 0:
2.
Reflex pattern (use the number in parentheses to record the reflex pattern)
increased
(3)
Normal
(2)
Decreased (1)
Absent
(0)
- .. .
Protocol ID A945-1008
41
Working Protocol inc. Amendment #2: August 7, 2002
CONFIDENTIAL
Pfizer_MPatel_0203750
e: https://wwwww.industrydocuments.uesf.edu/does/lpjm0223-

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