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NMR II > Final: Other Diseases > Flashcards

Final: Other Diseases Flashcards

1
Q

What two conditions are under the category of peripheral neuropathies?

A

Guillain Barre Syndrome and Diabetic polyneuropathy

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2
Q

What is GBS?

A

Acute inflammatory demyelinating polyradiculopathy with demyelination of the PNS due to macrophages attacking the myelin sheath impairing nerve conduction ability

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3
Q

After what timeframe will Schwann cells re-proliferate and allow for remyelination with GBS?

A

2-3 weeks

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4
Q

What are three clinical characteristics of GBS?

A
  1. Rapid, ascending, symmetrical weakness and sensory loss
  2. Distal to proximal, 50% with CN involvement
  3. Progresses for 2-4 weeks followed by recovery
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5
Q

Will GBS pt’s present with intact or absent DTRs?

A

Absent

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6
Q

What symptoms of autonomic dysfunction will a pt with GBS present with?

A

Decreased cardiac output, arrhythmias, unstable BP

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7
Q

How is GBS diagnosed?

A

Lumbar puncture or nerve conduction velocity tests

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8
Q

How is GBS medically managed?

A

Intravenous immunoglobulin, plasmapheresis, corticosteroids

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9
Q

What will indicated a poorer prognosis for GBS recovery?

A

Ventilator, older than 60, longer time to peak deficits, failure to show improvement within three weeks of plateau

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10
Q

What is stage 1 of GBS, and how long does it last?

A

Acute infection, lasts 0-3 weeks

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11
Q

What is stage 2 of GBS, and how long does it last?

A

Static phase, 10-14 days post peak. Can last for several months

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12
Q

What is stage 3 of GBS?

A

Rehab phase indicated my slow recovery over a period of months

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13
Q

What interventions are indicated during the acute stage of GBS?

A

Positioning, ROM, splinting, pressure relief, upright tolerance

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14
Q

What muscle should specifically be target when stretching for pt’s with GBS?

A

2 joint muscles

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15
Q

What types of interventions are indicated for GBS?

A

Strengthening, stretching, functional mobility, CV training, pain management, adaptive equipment

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16
Q

What are four considerations during GBS rehab?

A
  1. Adequate rest breaks
  2. Avoid overworking
  3. Bowel and bladder dysfunction
  4. High intensity in later recovery after 1 year
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17
Q

Why should you avoid overworking denervated muscles?

A

Can result in loss of functioning motor units, which can then be linked to central fatigue

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18
Q

What does CIDP stand for?

A

Chronic Inflammatory Demyelinating Polyneuropathy

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19
Q

What is CIDP?

A

Chronic inflammation caused long-term demyelination that developed over weeks/months

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20
Q

What does evidence recommend for treating CIDP?

A

Resistance and aerobic training can improve muscle strength and aerobic capacity

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21
Q

Practice Question: Which of the following is recommended for patients with a diagnosis of GBS?

a. Blood transfusion
b. High intensity gait training in the first week of rehab phase
c. Mechanical ventilation
d. Multi-disciplinary rehab

A

d. Multi-disciplinary rehab

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22
Q

Practice Question: Which of the following clinical symptoms can be found in patients with GBS?

a. Hyperreflexia
b. Confusion
c. Tingling
d. Clonus

A

c. Tingling

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23
Q

What is Myasthenia Gravis

A

Autoimmune disorder that affects NMJ and attacks Ach receptors on the motor end plate

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24
Q

What receptors does Myasthenia Gravis specifically affect?

A

Post-synaptic Ach receptors

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25
Q

Describe post-exercise decrement in MG

A

Fatigable weakness - activity causes fatigue that is worse at the end of the day due to each muscle contraction having less Ach available

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26
Q

What muscle groups are impacted by post-exercise decrement in MG?

A

Asymmetrical, neck and face muscles, bulbar, facial, axial, limb, respiratory, ocular involvement, dysphagia, dysarthria, dyspnea

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27
Q

What are the risk factors for developing MG?

A

Family history, autoimmune disease. Women < 40 and men > 60

28
Q

What is myasthenic crisis?

A

Emergency when respiratory muscles are severely impacted

29
Q

What are the three diagnostic methods for Myasthenia Gravis?

A
  1. Pharmacological
  2. Immunologic
  3. Electrophysiologic
30
Q

What is the Tensilon Test?

A

Confirms MG diagnosis. Tensilon is given and examiner assesses movement before and one minute after injection. If strength improves, it is positive

31
Q

What electrophysiologic testing is used to diagnose MG?

A

Repetitive nerve stimulation shows a rapid decrease in motor action potential amplitude

32
Q

What are four medical interventions for Myasthenia Gravis?

A
  1. AChE inhibitor medication
  2. Thymectomy
  3. Immunosuppressive - corticosteroids
  4. Plasmapheresis and IVIG
33
Q

What does LEMS stand for?

A

Lamber-Eaton Myasthenic Syndrome

34
Q

What is LEMS?

A

Autoimmune disease impacting pre-synaptic NMJ by attacking calcium channels impacting the release of Ach

35
Q

60% of LEMS pt’s also have what condition?

A

Cancer

36
Q

What are the three primary symptoms of LEMS?

A
  1. Proximal weakness
  2. Hyporeflexia/Areflexia
  3. ANS dysfunction
37
Q

Describe the presentation of weakness with LEMS

A

Proximal, symmetrical, weakness will get better with use, repeated contractions enhances reflexes and strength due to increased influx of calcium in presynaptic membrane

38
Q

Describe reflexed with LEMS

A

Reflexed absent prior to exercises, but will occur immediately post exercise

39
Q

What ANS symptoms are associated with LEMS?

A

Orthostatic hypotension, dry mouth, excess sweating, ptosis

40
Q

How is LEMS managed?

A
  1. Treat cancer
  2. Plasmapheresis
41
Q

What are similarities between MS and LEMS?

A
  1. Proximal muscles
  2. Ptosis
  3. Bulbar signs
  4. Ach
  5. Autoimmune
  6. LMN
  7. Sensation not affected
42
Q

What are the primary differences between MG and LEMS?

A
  1. pre vs post synaptic receptors
  2. CN vs ANS involvement
  3. Etiology
  4. Worse vs better with exercise
43
Q

What should PT intervention look like for NMJ dysfunction conditons?

A

Pt education for energy conservation, time of day, strengthen large muscle group, mod-low intensity aerobic and strengthening

44
Q

Practice Question: 38 y/o female presents with new onset of dyspnea at rest, 3 week history of speaking and swallowing difficulty, and feeling worse by the end of the day. What is the likely diagnosis?

a. ALS
b. GBS
c. MG
d. Lambert Eaton

A

c. MG

45
Q

Practice Question: Pt presents with reports of hip weakness and facial sweating. DTRs are absent on evaluation, and when retested at the end of the session they are a 2+. What underlying condition should you be worried about?

a. Cancer
b. MG
c. ALS
d. MS

A

a. Cancer

46
Q

What type of disease is Huntington’s?

A

Neurodegenerative

47
Q

What is the etiology of Huntington’s?

A

Autosomal dominant with genetic marker on chromosome 4. Results in brain degeneration

48
Q

What movement disorder characteristics are associated with Huntington’s?

A

Chorea, gaze fixation abnormalities, dysarthria, dysphagia, sleep disorders, urinary incontinence, gait and balance

49
Q

What psychiatric symptoms are associated with Huntington’s?

A

Personality changes and depression

50
Q

What cognitive symptoms are associated with Huntington’s?

A

Memory deficits and executive dysfunction

51
Q

What is the life expectancy of Huntington’s?

A

15-20 years after the onset

52
Q

What medication is used to manage chorea symptoms with Huntington’s?

A

Tetrabenazine

53
Q

What STOM is used for Huntington’s?

A

Unified Huntington Disease Rating Scale

54
Q

What 4 domains of function are included in the UHDRS?

A
  1. Motor function
  2. Cognitive function
  3. Behavioral abnormalities
  4. Functional capacity
55
Q

What other outcome measures can be used with Huntington’s?

A

10MWT, TUG, 6MWT, Berg, SF36, 4 square step test

56
Q

What are possible benefits of exercise in pt’s with Huntington’s?

A

Improved motor function, gait speed and endurance, balance, VO2 max, BMI, pulmonary function

57
Q

What should PT focus on in the early-mid stages of Huntington’s?

A
  1. Aerobic
  2. Resistance exercises
  3. Balance and gait
  4. Compensatory training
  5. External cues
  6. Caregiver education
58
Q

What should PT focus on in mid-late stage Huntington’s?

A
  1. Fall risk assessment
  2. Wheelchair assessment
  3. Functional exercise
  4. Aerobic capacity, pulmonary training
  5. ROM
59
Q

Practice Question: Which of the following intensities is appropriate for people with HD in the early to mid stage?

a. low intensity
b. low-mod intensity
c. mod intensity
d. mod-high intensity

A

d. mod-high intensity

60
Q

What diagnoses cause damage to the basal ganglia?

A

HD and PD

61
Q

What diagnoses cause damage to the pyramidal cells?

A

ALS

62
Q

What diagnoses cause damage to the corticospinal tract?

A

ALS

63
Q

What diagnoses cause damage to the anterior horn cells?

A

ALS and Post-Polio

64
Q

What diagnoses cause damage to peripheral nerves?

A

GBS

65
Q

What diagnoses cause damage to the NMJ?

A

MG and Lambert Eaton

NMR II (27 decks)

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