Chapter 4 #2 - Differential Diagnosis - AI Powered Flashcards
(123 cards)
1
Q
What is the fourth most common cause of death in the U.S.?
A
Stroke
A stroke-related death occurs every 4 minutes
2
Q
How many people are afflicted by stroke annually in the U.S.?
A
750,000 to 800,000 people
3
Q
What percentage of all strokes occur in individuals with a prior cerebral ischemic event?
A
25%
4
Q
What is the estimated annual cost of stroke in the U.S.?
A
$40 billion
5
Q
What are the two major types of stroke?
A
- Ischemic stroke
- Hemorrhagic stroke
6
Q
What percentage of all strokes are hemorrhagic strokes?
A
15 to 20%
7
Q
What causes hemorrhagic strokes?
A
Blood bursting into the substance of the brain
8
Q
What is a thrombotic stroke?
A
A stroke caused by a clot forming in an artery that is already very narrow
9
Q
What is an embolic stroke?
A
A stroke caused by a clot that breaks off from another place in the blood vessels and travels to the brain
10
Q
List some substances that can clog arteries to the brain.
A
- Fat
- Cholesterol
- Blood products (e.g., platelets, white cells)
- Debris from infected heart valves
- Tumor products
11
Q
What is the number one risk factor for ischemic stroke?
A
High blood pressure
12
Q
Identify two modifiable risk factors for ischemic stroke.
A
- Dyslipidemia (e.g., hypercholesterolemia)
- Atrial fibrillation
13
Q
What are some clinical manifestations of a stroke?
A
- Motor deficits
- Speech deficits
- Sensory deficits
14
Q
What symptoms are commonly associated with a middle cerebral artery (MCA) stroke?
A
- Contralateral weakness and/or sensory loss (face and arm more than leg)
- Aphasia (dominant MCA)
- Neglect
- Apraxia
- Dysprosody (nondominant MCA)
15
Q
What is a transient ischemic attack (TIA)?
A
A transient neurologic event lasting up to 24 hours, with full recovery
16
Q
What are the seven Ds of early intervention for ischemic stroke?
A
- Detect
- Dispatch
- Door
- Data
- Decision
- Drug
- Disposition
17
Q
What is the recommended time frame to administer t-PA for acute ischemic stroke?
A
Within 4.5 hours of symptom onset
18
Q
What is mechanical thrombectomy?
A
The angiographic removal of a demonstrated clot in a large artery of the cerebral circulation
19
Q
What is the primary pharmacologic treatment for acute ischemic stroke?
A
t-PA (tissue plasminogen activator)
20
Q
List some long-term antiplatelet therapy options to prevent ischemic stroke recurrence.
A
- Aspirin
- Clopidogrel
- Ticlopidine
- Aspirin combined with dipyridamole
21
Q
What is carotid endarterectomy?
A
A vascular surgery aimed at dissecting out plaque from the diseased carotid artery
22
Q
What complications can arise from a massive cerebral infarction?
A
- Hydrocephalus
- Brain herniation
- Need for lobectomy or hemispherectomy
23
Q
True or False: Stroke is the most disabling condition among the U.S. population.
A
True
24
Q
What are some common long-term complications associated with stroke?
A
- Recurrent aspiration
- Silent aspiration
- Overt aspiration (with symptoms like gagging)
25
What is a cerebellar ischemic stroke?
A type of stroke that may require a cerebellectomy if the infarcted cerebellar hemisphere is surgically removed.
26
What are common long-term complications associated with stroke?
* Recurrent aspiration
* Predisposition to infections
* Pressure sores and ulcers
* Poor nutrition
* Chronic pain
* Cognitive difficulties
27
What is the prevalence of Multiple Sclerosis (MS) in the United States?
Approximately 0.1%.
28
What demographic factors influence the prevalence of MS?
* More prevalent in women than men
* More prevalent among Caucasians than African-Americans
* Higher incidence in Europe and North America
29
What are the pathological hallmarks of MS?
Inflammatory patches or plaques with multifocal demyelination in the brain, spinal cord, and optic nerves.
30
What are the two main forms of MS?
* Relapsing-remitting disease (RR-MS)
* Primary progressive MS (PP-MS)
31
Fill in the blank: The mean age of MS onset is approximately ______.
30 years.
32
What are common clinical manifestations of MS?
* Unilateral visual loss
* Sensory loss or paresthesias
* Motor weakness and spasticity
* Bladder dysfunction
* Fatigue
* Depression
33
What are the primary treatment goals in managing RR-MS?
* Reducing recurrence rates and disease modification
* Hastening recovery during a recurrence
* Treatment of symptoms and complications
34
Name three disease-modifying agents used for MS.
* Interferon β–1a
* Glatiramer
* Fingolimod
35
True or False: High-dose glucocorticoids change the ultimate course of MS.
False.
36
What are common complications associated with MS treatments?
* Bone mineral density loss
* Aseptic necrosis of hips
* Flulike symptoms from β–interferons
* Liver abnormalities from teriflunamide
37
What is a traumatic brain injury (TBI)?
A form of acquired head injury that occurs when a sudden trauma causes damage to the brain.
38
What are the classifications of head injuries?
* Closed head injury
* Open (penetrating) head injury
39
What are some common causes of head injury?
* Traffic accidents
* Falls
* Physical assault
* Sports injuries
* Work-related injuries
40
List two symptoms of a head injury.
* Severe headaches
* Changes in degree of alertness
41
Fill in the blank: Concussion is the most common type of ______.
traumatic brain injury (TBI).
42
What are potential symptoms of TBI?
* Memory loss
* Mood changes
* Fluid draining from nose or ears
* Changes in pupil size
* Motor paralysis
43
What risk factors are associated with TBI?
* Age (children, young adults, elderly)
* Male gender
* Occupation type (e.g., athletes, military personnel)
44
What are some signs of changes in pupil size?
Changes in, or unequal size of pupils.
## Footnote
This can indicate neurological issues.
45
What symptoms may indicate a loss of sensation in TBI?
Loss of, or change in, sensation such as hearing, vision, taste, or smell.
## Footnote
Examples include blurred vision or double vision.
46
What speech or language problems can occur with TBI?
Dysarthria, expressive or receptive aphasia.
## Footnote
These affect the ability to speak or understand language.
47
What changes in vital signs may be observed in TBI?
Slow and shallow breathing, drop in blood pressure, bradycardia or tachycardia.
## Footnote
Vital signs can indicate severity of injury.
48
What are common symptoms of mild TBI?
* Headache
* Confusion
* Lightheadedness
* Dizziness
* Blurred vision
* Tinnitus
* Fatigue
* Sleep pattern changes
* Behavioral changes
* Memory issues
## Footnote
Symptoms can vary based on individual cases.
49
What symptoms may indicate moderate or severe TBI?
* Worsening headache
* Repeated vomiting
* Convulsions
* Inability to awaken
* Dilation of pupils
* Slurred speech
* Weakness or numbness
* Loss of coordination
* Increased confusion
## Footnote
These symptoms require immediate medical attention.
50
What is the management approach for head trauma?
Depends on severity and areas injured; supportive care and pharmacologic therapy are used.
## Footnote
Medications may include analgesics and antidepressants.
51
What are common complications of head injury?
* Posttraumatic seizures
* Posttraumatic headache
* Spasticity
* Cognitive impairment
* Dizziness
* Tinnitus
## Footnote
Severity of complications often correlates with injury severity.
52
What is Guillain-Barré syndrome (GBS)?
A peripheral, predominantly demyelinating disorder that is typically monophasic.
## Footnote
GBS has several subtypes including AIDP and AMAN.
53
What are common causes and risk factors for GBS?
* Antecedent infections
* Male gender
* Advancing age
* Viral infections (e.g., influenza)
* Bacterial infections (e.g., Campylobacter)
## Footnote
The influenza vaccine is rarely implicated.
54
What are the clinical manifestations of AIDP?
* Symptom onset 1-3 weeks after illness
* Ascending muscle weakness
* Severe cases may require mechanical ventilation
## Footnote
Symptoms can progress rapidly.
55
What are some common symptoms of GBS?
* Ascending weakness
* Dysarthria
* Diplopia
* Respiratory insufficiency
## Footnote
These symptoms indicate varying severity of the syndrome.
56
What is the management strategy for GBS?
Interdisciplinary management focusing on respiratory compromise, pain control, and rehabilitation.
## Footnote
SLP plays a critical role in managing dysphagia.
57
What disease-modifying treatments are used for GBS?
* Plasma exchange
* Intravenous immunoglobulin (IVIG)
## Footnote
Glucocorticoids have proven ineffective.
58
What is Amyotrophic Lateral Sclerosis (ALS)?
A degenerative disease affecting upper and lower motor neurons.
## Footnote
Also known as Lou Gehrig’s disease.
59
What are the typical onset age ranges for ALS?
Mid to late fifties.
## Footnote
The annual incidence is 1.5 to 3.7 per 100,000.
60
What are the risk factors associated with ALS?
* Male gender
* Advancing age
* Caucasian race
## Footnote
Most cases are sporadic with few familial occurrences.
61
What are the common symptoms of ALS related to upper motor neuron dysfunction?
* Spasticity
* Hyperreflexia
* Impaired rapid alternating movements
## Footnote
These symptoms reflect damage to the UMNs.
62
What are the clinical manifestations of ALS?
Symptoms vary based on subtype; often include both UMN and LMN dysfunction.
## Footnote
Patients may present with weakness in extremities or bulbar muscles.
63
What is the only FDA-approved drug for ALS?
Riluzole.
## Footnote
It helps slow disease progression.
64
What is the only FDA-approved drug for the treatment of ALS?
Riluzole
## Footnote
Riluzole is recognized for its safety and effectiveness in slowing the progression of ALS.
65
What are the recommended management strategies for dyspnea in ALS?
* Supportive measures (chest physiotherapy, home oxygen supplementation)
* Pharmacologic measures (benzodiazepines, opioids)
## Footnote
Early recognition and management of dyspnea improve quality of life.
66
How should pain, muscle spasms, and spasticity be managed in ALS?
Aggressively with pharmacotherapy
## Footnote
Dependence on opioids and narcotics is uncommon, allowing for early treatment.
67
What medications can be used for muscle spasms in ALS?
* α-adrenergic blockers (e.g., tizanidine)
* Antiepileptic drugs (e.g., levetiracetam)
## Footnote
Tizanidine and baclofen are also used for spasticity management.
68
What is a common symptom of ALS that can be treated with modafinil?
Fatigue
## Footnote
Fatigue can also be a complication of riluzole.
69
What alternative treatments exist for drooling in ALS?
* Anticholinergic drugs
* Intrasalivary botulinum toxin injections
* Salivary gland radiotherapy
## Footnote
Anticholinergics have systemic and neurologic side effects.
70
What are examples of supportive measures for ALS patients?
* Respiratory toiletry
* Illness counseling and discussions of end-of-life care
* Improving sleep hygiene
* Maintaining adequate nutrition
* Managing symptoms and complications of dysphagia
* Timely immunization
* Ambulatory assistive devices
* Assistive communication devices
* Physical therapy
## Footnote
Supportive care can reduce morbidity and improve quality of life.
71
What is the main challenge for SLPs when managing ALS patients?
Management of dysphagia and dysarthria
## Footnote
A fluoroscopic swallowing study can provide anatomical information for safe swallowing strategies.
72
What is recommended regarding the timing of gastrostomy in ALS?
Before forced vital capacity (FVC) falls below 50% of predicted FVC
## Footnote
The procedure may improve quality of life.
73
What is the goal of late-stage management of ALS?
Providing comfort and maximizing quality of life
## Footnote
Hospice care is recommended when life expectancy is 6 months or less.
74
What is the mean survival time from symptom onset in ALS?
Less than 3 years
## Footnote
ALS mortality typically results from respiratory failure or severe pneumonias.
75
What role does an interdisciplinary team play in ALS management?
Critical in supporting the individual and improving quality of life
## Footnote
Team approaches may improve survival and reduce morbidity.
76
What are neuropsychiatric complications of ALS?
* Depression
* Dementia
* Pseudobulbar affect
* Anxiety
## Footnote
Management should be both pharmacologic and nonpharmacologic.
77
What is Myasthenia Gravis (MG)?
A rare disorder of the neuromuscular junction (NMJ)
## Footnote
Incidence ranges from 3 to 30 per million.
78
What is the peak incidence age for MG in women?
Twenties and thirties
## Footnote
In men, peak incidence occurs at ages 60 to 70.
79
How is MG classified?
* Age of onset
* Presence or absence of acetylcholine receptor (AChR) antibodies
* Disease severity
* Etiology
## Footnote
Neonatal MG relates to maternal antibodies.
80
What are the five severity-based categories of MG?
* Purely ocular
* Mild generalized
* Moderate generalized
* Severe generalized
* Requiring intubation
## Footnote
Myasthenic crisis is a life-threatening emergency.
81
What is a myasthenic crisis?
A sudden severe decline in strength, often with respiratory failure
## Footnote
Requires intubation and mechanical ventilation.
82
What are the autoimmune targets in MG?
* Acetylcholine receptors (AChR)
* Muscle-specific tyrosine kinase (MuSK)
* Lipoprotein receptor-related protein 4 (LRP4)
## Footnote
MuSK antibodies are found in about 40% of seronegative patients.
83
What is the clinical hallmark of MG?
Fatigable weakness of striated muscles
## Footnote
Symptoms worsen with activity and improve with rest.
84
What are common symptoms of MG?
* Ptosis
* Diplopia
* Facial weakness
* Dysphagia
* Dysphonia
* Drooling
* Head drop
* Proximal limb weakness
* Breathlessness
## Footnote
Myasthenic involvement of swallowing and respiratory function is life-threatening.
85
What is the mainstay treatment for mild MG?
Anticholinesterase inhibitors (e.g., pyridostigmine)
## Footnote
These improve neuromuscular transmission.
86
What are the therapeutic strategies for MG?
* Improving neuromuscular function
* Immune modulation during acute exacerbation
* Thymectomy
* Supportive care
## Footnote
Severe cases may require immunosuppression.
87
What is the long-term mortality of untreated MG?
10% over 10 years
## Footnote
Most patients lead near-normal lives if properly managed.
88
What is Duchenne’s Muscular Dystrophy (DMD)?
The most common muscular dystrophy in the U.S., an X-linked recessive disorder
## Footnote
Occurs primarily in boys with an incidence of approximately 1 in 3,500 live male births.
89
What causes DMD?
Mutations in the dystrophin gene
## Footnote
Dystrophin is a membrane-associated structural protein.
90
What is the typical outcome for boys with DMD?
Most become wheelchair-bound by age 12
## Footnote
Death usually occurs from respiratory failure or pneumonia.
91
What is Oculopharyngeal Muscular Dystrophy (OMD)?
A progressive, late-onset, autosomal dominant disorder
## Footnote
Primarily seen in families of French-Canadian descent.
92
What are the symptoms of OMD?
Ptosis and dysphagia
## Footnote
Treatment is only supportive as no effective pharmacotherapy is currently available.
93
What is Myotonic Dystrophy (MyoD)?
The form of muscular dystrophy most likely to involve swallowing and speaking muscles
## Footnote
It is a multisystem disease affecting various tissues.
94
What is myotonic dystrophy (MyoD)?
A multisystem disease that involves muscle weakness, particularly in swallowing and speaking, and affects other tissues like the eye lens and cardiac muscles.
## Footnote
MyoD involves genetic mutations, specifically in the myotonin protein kinase gene.
95
What are the common clinical features of myotonic dystrophy?
Weakness and wasting of small muscles of the hands and forearm, facial muscle weakness, ptosis, and a weak, hypernasal voice.
## Footnote
There is currently no effective pharmacotherapy for MyoD.
96
What is Parkinson's disease (PD)?
A neurodegenerative disorder affecting the extrapyramidal system, specifically the depletion of pigmented cells in the substantia nigra.
## Footnote
PD is the second most common neurodegenerative disease.
97
What is the incidence of Parkinson's disease across ages?
Approximately 14/100,000, with a significantly higher rate of 160/100,000 in people over 65 years old.
## Footnote
The prevalence of PD is about 1%.
98
What are the subtypes of Parkinson's disease?
1. Old age at onset and rapid progression
2. Young-onset PD (YOPD) and slow progression
3. Tremor-predominant PD
4. Postural instability and gait difficulty PD (PIGD)
99
What are some risk factors for Parkinson's disease?
Advancing age, male gender, family history of PD, traumatic brain injury, prolonged exposure to certain environmental factors.
## Footnote
Factors like caffeine consumption and physical exercise may offer protection.
100
What are the hallmark motor symptoms of Parkinson's disease?
Bradykinesia or akinesia, rigidity, tremor, and loss of postural reflexes.
## Footnote
Patients may exhibit a masked face and reduced blinking.
101
What is the management approach for Parkinson's disease?
Focus on improving mobility, preventing falls, controlling pain, and supportive care; pharmacotherapy includes early symptom relief and advanced management strategies.
## Footnote
Dysarthria in PD is typically hypokinetic, monotonous, and monopitched.
102
What complications are associated with the progression of Parkinson's disease?
Cognitive impairment, behavioral problems, hallucinations, speech difficulties, dysphagia, weight loss, sleep disturbances, falls, and reduced pharmacotherapy effectiveness.
103
What is dystonia?
An uncommon movement disorder characterized by repetitive, twisting movements or abnormal postures due to involuntary muscle contractions.
104
What are oromandibular dystonia (OMD) and lingual dystonia?
Rare types of focal dystonias affecting mastication muscles and causing symptoms like dysphagia, dysphonia, and dysarthria.
## Footnote
OMD can be primary or secondary to other disorders.
105
What is the primary treatment for oromandibular dystonia (OMD)?
Botulinum toxin injections.
## Footnote
This treatment is preferred over oral medications due to potential long-term side effects.
106
What is diabetic autonomic neuropathy (DAN)?
A complication of long-term diabetes mellitus that can affect various systems, including gastrointestinal function.
107
What are possible causes of dysphagia in diabetic patients?
Esophageal dysmotility, esophageal cancer, or esophageal rings; poor gastric emptying is also a concern.
## Footnote
Gastric emptying issues may be related to neural control damage.
108
What are some risk factors for gastrointestinal dysfunction in diabetes mellitus?
Poor glycemic control and the duration of illness.
## Footnote
Patients with GI symptoms may have other diabetes complications.
109
What is the exact cause of poor gastric emptying or gastroparesis in patients with DM?
The exact cause(s) is unclear, but proposed mechanisms include:
* Impaired neural control of gastric function
* Autonomic ganglia inflammation
* Demyelination of vagus nerve fibers
## Footnote
These mechanisms can lead to various gastrointestinal dysfunctions.
110
What are the risk factors for GI dysfunction in patients with DM?
Risk factors include:
* Poor glycemic control
* Duration of illness
## Footnote
These factors can exacerbate gastrointestinal symptoms.
111
What are some complications associated with DM and GI symptoms?
Complications may include:
* Peripheral neuropathy
* Postural hypotension
* Cardiovascular instability
* Impaired sweating
## Footnote
These complications are manifestations of diabetic autonomic neuropathy (DAN).
112
What symptoms are associated with gastrointestinal dysfunction caused by DAN?
Symptoms include:
* Constipation
* Nocturnal diarrhea
* Esophageal motility-related dysphagia
* Gastroparesis-related symptoms (e.g., postprandial fullness, indigestion, malabsorption, nutritional deficiencies)
## Footnote
Severe gastroparesis can complicate glycemic control.
113
What management strategies are used for gastroparesis in patients with DM?
Management strategies include:
* Dietary modification
* Good glycemic control
* Prokinetics/antiemetics (e.g., metoclopramide, domperidone, erythromycin, cisapride)
## Footnote
Dietary modifications should be based on imaging and motility studies.
114
What can severe gastroparesis predispose patients to?
Severe gastroparesis can predispose patients to:
* Aspiration
* Aspiration pneumonia
## Footnote
This is due to the impaired gastric emptying and potential for food to enter the lungs.
115
What are some adverse effects associated with neurotherapeutic drugs?
Adverse effects can manifest as:
* Speech/language difficulties
* Swallowing difficulties
## Footnote
These effects occur due to modulation of neurotransmitter function.
116
What are the causes of drug-related adverse events affecting communication?
Causes include:
* Direct link to drug mechanisms of action
* Structural damage induced by the drug
* Idiopathic factors
## Footnote
Understanding these causes is critical for managing communication disorders.
117
True or False: Anticholinergic drugs can impair salivary flow.
True
## Footnote
This can lead to mouth dryness and may affect speech and articulation.
118
What types of dysarthria can be caused by neurotherapeutic drugs?
Types of dysarthria may include:
* Ataxic
* Hyperkinetic
* Hypokinetic
* Spastic
## Footnote
Each type has distinct characteristics and implications for treatment.
119
What is the first step in managing potential drug-related adverse effects?
The first step is to establish causality or association.
## Footnote
This involves a comprehensive assessment of the symptom profile and medication history.
120
What are common clinical manifestations of functional speech disorders?
Common manifestations include:
* Stuttering
* Mutism
* Aphonia
* Dysphonia
## Footnote
These symptoms can significantly affect communication abilities.
121
What is functional dysarthria and dysphonia associated with?
Functional dysarthria and dysphonia are associated with:
* Psychogenic factors such as anxiety, depression, conversion reactions, or personality disorders
## Footnote
These disorders can interfere with volitional control over speech production.
122
What is an important aspect of managing functional speech disorders?
Proper diagnosis and ruling out organic causes are crucial.
## Footnote
This ensures that underlying conditions are addressed.
123
What is the significance of a comprehensive understanding of functional neuroanatomy in speech-language pathology?
It provides a useful approach to diagnosing and treating neurogenic communication and swallowing disorders.
## Footnote
Understanding neuroanatomy helps in assessing the impact of various neurological conditions.
