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Flashcards in 4 - Neuromuscular Dysfunction Deck (23):
1

There are no good diagnostic tests for this disease.  Try and rule out other diseases.  An EMG shows specific changes, loss of nerve supply to muscle (shows muscle movement).

a.) Multiple Sclerosis

b.) Parkinson's Disease

c.) ALS

d.) Myasthenia Gravis

e.) Guillain-Barre Syndrome

ALS

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2

After adminstering a Tensilon Test, if the patient gets worse, they are having a ________.  S/S include SLUDGE.

a.) Myasthenic Crisis

b.) Cholinergic Crisis

Cholinergic Crisis

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3

S/S include progression to descending paralysis; fatigue/muscle weakness (don't use it, you lose it); twitching; spasticity; DTR's brisk; muscle weakness; difficulty talking, swallowing, breathing; and progresses to trunk and legs; drooling; cough and gag reflexes impaired or absent (aspiration pneumonia), emotionally labile (moody).

a.) Multiple Sclerosis

b.) Parkinson's Disease

c.) ALS

d.) Myasthenia Gravis

e.) Guillain-Barre Syndrome

ALS

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4

Pharmacological treatment includes giving interferons, and steroids to treat acute exacerbations.  Overall goal of treatment is to promote physical mobility, reduce exacerbations, bowel/bladder continence, improve cognitive function, self-management, and adapt to sexual dysfunction.

a.) Multiple Sclerosis

b.) Parkinson's Disease

c.) ALS

d.) Myasthenia Gravis

e.) Guillain-Barre Syndrome

Multiple Sclerosis

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5

Diagnostics for this disease include having 2 out of 4 cardinal clinical manifestations.

a.) Multiple Sclerosis

b.) Parkinson's Disease

c.) ALS

d.) Myasthenia Gravis

e.) Guillain-Barre Syndrome

Parkinson's Disease

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6

When planning treatment for this disease, pace activities and have planned rest periods because energy comes back.

a.) Multiple Sclerosis

b.) Parkinson's Disease

c.) ALS

d.) Myasthenia Gravis

e.) Guillain-Barre Syndrome

Myasthenia Gravis

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7

Autoimmune disease of the PNS that causes a decrease in acetylcholine receptors, which causes weakness in voluntary muscles.  This disease gets worse as the day progresses.

a.) Multiple Sclerosis

b.) Parkinson's Disease

c.) ALS

d.) Myasthenia Gravis

e.) Guillain-Barre Syndrome

Myasthenia Gravis

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8

Treatment includes having a Pallidotomy (cauterize global pallidus in basal ganglia) (only works sometimes and is only temporary).

a.) Multiple Sclerosis

b.) Parkinson's Disease

c.) ALS

d.) Myasthenia Gravis

e.) Guillain-Barre Syndrome

Parkinson's Disease

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9

Autoimmune disease of the CNS characterized by destruction of the myelin sheath of the brain and spinal cord.  As the disease progresses, the demyelinated areas re-myelinate and heal over with sclerotic or fibrous tissue.  The nerve fibers eventually degenerate and the disabilities become permanent.

a.) Multiple Sclerosis

b.) Parkinson's Disease

c.) ALS

d.) Myasthenia Gravis

e.) Guillain-Barre Syndrome

Multiple Sclerosis

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10

Treatment includes Levodopa (synthetic dopamine) and Carbidopa/Sinemet (carries dopamine past blood-brain barrier).  Carbidopa prevents Levodopa from converting to dopamine outside of brain.  Side effects include sedation, hallucinations, psychosis, dyskinesia, and unpredictable response.

a.) Multiple Sclerosis

b.) Parkinson's Disease

c.) ALS

d.) Myasthenia Gravis

e.) Guillain-Barre Syndrome

Parkinson's Disease

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11

Pharmacological treatment includes Riluzole / Rilutek (glutamine antagonist) which may help prevent injury to motor neurons.  Goal of treatment is to keep patient as independent as long as possible.  Death usually occurs 3-5 tears because of respiratory failure because the intercostal muscles weaken, and the patient usually ends up on a dependent ventilator.

a.) Multiple Sclerosis

b.) Parkinson's Disease

c.) ALS

d.) Myasthenia Gravis

e.) Guillain-Barre Syndrome

ALS

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12

S/S for this disease include ascending paralysis (bottom up); paresthesias; pain; stiffness; weakness; diminished reflexes.  Very terrifying for patient.

a.) Multiple Sclerosis

b.) Parkinson's Disease

c.) ALS

d.) Myasthenia Gravis

e.) Guillain-Barre Syndrome

Guillain-Barre Syndrome

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13

After adminstering a Tensilon Test, if the patient temporarily gets better, they are having a _________. 

a.) Myasthenic Crisis

b.) Cholinergic Crisis

Myasthenic Crisis

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14

S/S include resting tremor (not intentional tremor) ; rigid, muscle stiffness (high fall risk); akinesia (slowness of movement); postural instability (stooped posture); mask-like face; shuffling gait; turns like a statue; slow and slurred speech; "pill rolling"; and dementia.

a.) Multiple Sclerosis

b.) Parkinson's Disease

c.) ALS

d.) Myasthenia Gravis

e.) Guillain-Barre Syndrome

Parkinson's Disease

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15

Classic S/S is fluctuating weakness.  Other S/S include ptosis / diplopia, a flat facial expression and open mouth, dysphonia (voice fades with talking), difficulty chewing and swallowing (risk for aspiration), affects upper extremities before lower, proximal extremities more than distal, and usually no sensory loss.  Disease is characterized by remissions and exacerbations.  

a.) Multiple Sclerosis

b.) Parkinson's Disease

c.) ALS

d.) Myasthenia Gravis

e.) Guillain-Barre Syndrome

Myasthenia Gravis

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16

Diagnostics for this disease include (1) performing a thorough history and physical exam, (2) performing a spinal tap to test CSF (cerebral spinal fluid) to check for increased T lymphocytes and IgG (oligoclonal banding), and (3) an MRI test to see if there are any visualized plaques and lesions.

a.) Multiple Sclerosis

b.) Parkinson's Disease

c.) ALS

d.) Myasthenia Gravis

e.) Guillain-Barre Syndrome

Multiple Sclerosis

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17

The diagnostic test for this disease is the Tensilon Test.  Give a short acting anticholinesterase drug (cholinergic drug) that inactivates cholinesterase.  Need to stay with patient because within 5-10 minutes you can tell if the test is positive.

If the patient temporarily gets better, they are having a Myasthenic Crisis (disease is acting up).  If the patient gets worse, they are having a Cholinergic crisis (too much medication).  S/S include SLUDGE.

a.) Multiple Sclerosis

b.) Parkinson's Disease

c.) ALS

d.) Myasthenia Gravis

e.) Guillain-Barre Syndrome

Myasthenia Gravis

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18

Pharmacological treatment includes Pyridostigmine bromide (mestinon), which is the 1st line of therapy.  This med increases ACH at receptor sites, and needs to be taken on time and with food.  A thymectomy can also be performed, but may take up to 3 years to benefit because of circulating T cells.

IVIG (intravenous immune globulin) and plasmapheresis are used to treat exacerbations.

a.) Multiple Sclerosis

b.) Parkinson's Disease

c.) ALS

d.) Myasthenia Gravis

e.) Guillain-Barre Syndrome

Myasthenia Gravis

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19

Recovery for this disease usually occurs after 6 months to 2 years.  Any residual after is permanent.  You do not want to give an influenza vaccine.  Prevent complications from immobility.

a.) Multiple Sclerosis

b.) Parkinson's Disease

c.) ALS

d.) Myasthenia Gravis

e.) Guillain-Barre Syndrome

Guillain-Barre Syndrome

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20

Neurodegenerative disease of CNS characterized by an imbalance of acetylcholine (excitatory) and dopamine (inhibitory) that affects voluntary movement.

a.) Multiple Sclerosis

b.) Parkinson's Disease

c.) ALS

d.) Myasthenia Gravis

e.) Guillain-Barre Syndrome

Parkinson's Disease

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21

Progressive, neurodegenerative disease of CNS characterized by loss of motor neurons (nerves that control muscles) in the brain and spinal cord), but the mind is still fully intact.

a.) Multiple Sclerosis

b.) Parkinson's Disease

c.) ALS

d.) Myasthenia Gravis

e.) Guillain-Barre Syndrome

ALS

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22

An autoimmune disease of the PNS that is not chronic.  There is an inflammatory disease process that causes demyelination of peripheral nerves, and is usually stimulated by viral illness.

a.) Multiple Sclerosis

b.) Parkinson's Disease

c.) ALS

d.) Myasthenia Gravis

e.) Guillain-Barre Syndrome

Guillain-Barre Syndrome

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23

S/S include: ataxia (walking like a drunk), muscular incoordination, spasticity; slow and slurred speech; intentional tremors; mood swings, emotional, and depressed; incontinence and/or retention problems.

a.) Multiple Sclerosis

b.) Parkinson's Disease

c.) ALS

d.) Myasthenia Gravis

e.) Guillain-Barre Syndrome

Multiple Sclerosis

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