Final Exam Flashcards
(128 cards)
1
Q
biomechanical cascade for concussion
A
increased glutamate
increased intracellular K
need ATP to pump out K
need glucose to make ATP
(HIGH GLUCOSE NEED, LOW GLUCOSE DELIVERY)
2
Q
concussion pathophysiology
A
mitochondrial dysfx 2/2 excessive Ca
axonal damage
neuro mechanical imbalance
unmyelinated nerve fibers more vulnerable to damage
upregulationof inflammatory cells
3
Q
adult concussion recovery
A
7-14 days
4
Q
children concussion recvoery
A
4 weeks
5
Q
concussion education
A
expectation is recovery
6
Q
BCTT
A
20 min/day, 80% of threshold, 2 wks
increase target HR by 5-10
repeat until at 85-90% for 20min w/out Sx exacerbation
7
Q
stage 1 return to school
A
short phase of physical and cognitive rest with symptom guided activity (24-48 hours)
8
Q
stage 2 return to school
A
getting ready to go back to school, begin cog activity for max of 30 min w/o S/E
9
Q
stage 3 return to school
A
back to school with environmental accommodations and modified academics
may last days to months depending on rate of recovery
10
Q
stage 4 return to school
A
normal routines with some restrictions
back to full days of school (student NOT required to catch up on missed work)
11
Q
stage 5 return to school
A
fully back to school
12
Q
stage 1 return to activity
A
short phase of physical and cognitive rest with symptom guided activity 24-48 hours
13
Q
symptom group A
A
Sx decrease within an hour after injury
take at least 24 hours for each stage as you complete the rest of guidelines
14
Q
symptom group B
A
Sx free/decr within 1-4 weeks
take at least 2 days for each stage
15
Q
symptom group C
A
Sx for more than 4 weeks
take at least 1 week for each stage
16
Q
stage 2 return to activity
A
light exercise (no contact)
17
Q
stage 3 return to activity
A
individual sport-specific activity (no contact)
18
Q
stage 4 return to activity
A
sport specific practice with team (no contact)
19
Q
stage 5 return to activity
A
sport specific practice with team (contact)
20
Q
stage 6 return to activity
A
return to full sport, activity, game play
21
Q
goals of early PD
A
prevention of inactivity
prevention of fear to move or fall
preserve of improve physical capacity
22
Q
early PD H&Y
A
1-2.5
23
Q
middle PD H&Y
A
2-4
24
Q
late PD H&Y
A
5
25
middle PD goals
preserve or improve activities (function)
address function through compensatory strategies
26
late PD goals
preserve vital functions and prevent complications such as pressure sores and contractures
27
what parts of the brain are involved in tremor production
GPi, SubThN, ventral intermediate nucleus of thalamus
28
physiology of rigidity
combination of spinal reflex and brainstem dysfunction including non-dopaminergic NT systems
29
physiology of bradykinesia
"network" dysfunction in circuitry of BG, motor cortex, and cerebellum
30
what does bradykinesia look like during a discrete movement
decreased size of initial agonist burst
series of small agonist bursts
31
PD muscle activation
more- co-contract ag/antag
less- show sequential muscle activation
32
H&Y 1
unilateral involvement
33
H&Y 1.5
unilateral and axial involvement
34
H&Y 2
bilateral w/o balance impairment
35
H&Y 2.5
mild bilateral dx with recovery on pull test
36
H&Y 3
mild to moderate bilateral disease, some postural instability, physically independent
37
H&Y 4
severe disability, still able to walk or stand unassisted
38
H&Y 5
wheelchair bound or bedridden unless aided
39
define GBS
autoimmune disorder of PNS 2/2 rapid loss of myelin: progressive weakness and diminished reflexes
40
etiology of GBS
macrophages attack Schwann cells- affects sensory, motor, and autonomic systems
41
S/S of GBS
sensory loss, paresthesias, pain
motor paresis or paralysis
dysarthria, dysphasia, diplopia, facial weakness
42
interventions for GBS in acute phase
respiratory care
passive movement
positioning
splinting
gentle strengthening
43
progression of Sx GBS
progresses usually over a few days ot weeks, usually ascending symptoms
most regain function
44
management of physical deconditioning GBS
-avoidance of overwork
-avoidance of ECCENTRIC contractions
-wait until antigravity strength achieved to start stressing
45
disease of LMN
loss of anterior horn cells in SC and motor cranial nuclei in brainstem
46
disease of UMN
demyelination and gliosis of corticospinal and corticobulbar tracts in motor cortex
47
bulbar signs
dysarthria, dysphagia
48
respiratory signs
nocturnal respiratory difficulty, exertional dyspnea, accessory msucle use, paradoxical breathing
49
ALS most frequent initial symptoms
focal weakness beginning in the arm, leg, or bulbar muscles
50
relapsing remitting
specific attack of deficits
full or partial recovery
periods between relapses characterized by lack of disease progression
51
primary progressive
disease progression and a deterioration of function from onset
may have slight fluctuations but specific attacks do not occur
52
secondary progressive
initial relapsing remitting stage
change to a progressive ego curse with steady decline in function and impairments increase with or without specific attacks
53
progressive relapsing
steady deterioration in disease from onset with occassional attacks
time between attacks has continuing progression
54
clinically isolated syndrome
first episode of inflammatory demyelination in the CNS that could become MS if additional activity occurs/progresses
55
roles of the cerebellum
motor learning and skill accquisition
modifying movement based on learning
gaze stabiltiy
postural responses
learning
56
superior peduncle
primary motor efferent effect limb movement
57
middle peduncle
sensory afferent including proprioception, auditory, visual, and somatosensory information
58
inferior peduncle
afferent tracts of proprioception information, efferents affecting axial muscle activity and postural control `
59
spinocerebellum
output focused on axial and limb musculature
procedures adaptive motor coordination- error correction
60
cerebrocerebellum
planning and timing of movements
cognitive functions related to cerebellum/important in visually guided movements
ipsilateral Sx typical
61
flocculonodular lober
central vestibular symptoms- poor eye pursuit, VOR, impaired hand-eye coordination
gait and trunk ataxia, poor postural control, wide based gait
62
AICA cerebellar stroke
hemifacial paralysis, horner syndrome, gait and ipsilateral limb ataxia
vertigo with auditory symptoms such as hearing loss
63
superior cerebellar artery stroke
acute gait or trunk instability with associated dysarthria, nausea, vomiting
64
PICA stroke
isolated acute vestibular syndrome without auditory symptoms (vertigo)
lateropulsion (to ipsilateral side)
65
arnold chiari malformations
neck pain (type 1)
unsteady gait
poor coordination
numbness/tingling
dizziness
swallowing issues
speech and breathing problems
66
dyssynergia
decomposition of movements
67
action tremor
impairment due to alternating contractions of agonists and antagonists
68
postural trmor
seen when trying to maintain a posture
69
intention tremor
seen when moving, oscilaltory movement about a joint
most marked at end range
70
hallmark of PICA stroke
ipsilateral lateropulsion
71
lateropulsion scale- 1
head and body tilt without imbalance
72
lateropulsion scale- 2
head and body tilt with considerable sway/imbalance
73
lateropulsion scale- 3
head and body tilt, falls with only eyes closed
74
lateropulsion scale- 4
head and body tilt- falls with eyes open
75
reduced ability to learn from movement error
- impaired plasticity between purkinje cells and parallel fibers
- simultaneous firing of climbing fiber and parallel fiber causes a long-term depressing of synapses that control that movement
76
meningitis
inflammation of the membranes of the brain or spinal cord, may be caused by an infection
77
meningitis symtpoms
headache, fever, stiff neck, irritiability, confusion, light sensitivity, increase HR and RR, lethargy
78
encephalitis
inflammation of the brain often due to infection
primary cause by virus or mosquito borne
secondary- faulty immune reaction
79
encephalitis symptoms
may be mild such as fever, headaches, achy muscle/joints, fatigue, weakness
80
transverse myelitis
inflammation of one section of the spinal cord
etiology- viral, bacterial, fungal, immune system disorder, autoimmune disorder
81
transverse myelitis symptoms
pain, sharp shooting back pain or down extremities, abnormal sensation, weakness to progressing paralyis, stiffnes to spasticity, fatigue
82
putting on order
gown
mask
goggles
glove
83
taking off order
gloves
goggles
gown
mask
84
most common primary sites for metastatic spread to the brain
lung
breast
melanoma
colon
renal carcinomas
85
arise from precursors of astrocytes or oligodendrocytes
glioma
86
low grade or diffuse astrocytoma
very slow growing
found in cerebrum
progression variable
surgical resection
87
anaplastic astrocytoma
malignant tumor- cerebral hemisphere
surgical resection w/ radiation and chemo
88
presents with seixure, symptoms of increased ICP, focal neurological dysfunction
anaplastic astrocytoma
89
glioblastoma
PRIMARY malignant tumor; undifferentiated
poor prognosis
cerebral hemisphere- "butterfly" appearance
SR, C, R
90
presents with increased ICP, focal neurological dysfunction
glioblastoma
91
oligodendroglioma
arise in frontal lobe or white matter- tend to infiltrate the cortex
not distinguishable from astrocytomas on imaging
over time transform into anaplastic tumors= death
92
meningiomas
arise from meningothelial arachnoid cap cells of the meninges
majority are benign slow-growing
surgery= gold standard
93
can penetrate bone and present as a scalp mass
meningiomas
94
presents with focal seizures, neurological deficitis from brain and spinal cord compression
meningiomas
95
extradural tumors
OUTSIDE the dura mater in the vertebral bodies and arches
lesions may be osteoblastic, osteolytic, or mixed
96
spinal cord compression symtoms: extradural tumors
- localized, mechanical, radicular pain
- motor weakness
- sensory impairments
- autonomic symptoms
- gait and trunk ataxia
97
intradural extramedullary tumors
primary- located within the dura mater but outside of the spinal cord parenchyma
- most commonly benign
98
arise from peripheral nerves, nerve sheaths, and sympathetic ganglion
intradural extramedullary tumors
99
extramedullary metastases common site of involvement
dorsal aspect of spinal cord at level of cauda equina
100
spinal cord compression symtoms: intradural extramedullary tumors
- similar presentation o epidural spinal cord compression BUT with higher incidence of neuro Sx
- pain= initial symptoms
- weakness
- motor deficitis in the absence of pain
- sensory involvement
- bowel, bladder, and sexual dysfx
101
intradural intramedullary tumors
located within spinal cord parenchyma; arise from glial cells, neuronal cells, and other CT
- typically benign
- can be found anywhere but C and T favored
102
spinal cord compression symtoms: intradural intramedullary tumors
- similar to extradural tumors
- pain= most common
- neuro deficits
- sensory deficits
- bowel, bladder, sexual dysfx
103
presenting signs and symptoms; Cx
initial symptoms are often focal- generalized symptoms as the tumor spreads and gets bigger
104
Sx 2/2 increased ICP
tension type HA (4--80%)
migraine (10%)
epileptic seizures
105
steroids
minimize symptom burden due to associated vasogenic edema (edema due to increase in extracellular fluid and plasma)
106
gamma knife radiosurgery
concrentration radiation dose-201 beams of radiation interact to treat a small area of tissue in the brain
107
steroids side effects
steroid induced myopathy, anxiety, insomnia, psychosis, delirium, Cushing's syndrome, steroid-induced hyperglycemia, fractures of the spine and hip, avascular necrosis of the hip
108
acute radiation encephalopathy symptoms
HA, nausea, lethargy, new onset or worsening of symptoms
responds to increase in corticosteroids
109
signs of cerebral edema/herniation
increase in lethargy/unable to arouse, dilated pupils, headache, change in posture, change in relfexes, coma
110
epidural cord compression
d/t hematogenous spread of tumor cells through bone marrow leading to vertebral collapse
111
signs of epidural cord compression
pain precedes other Sx by 1-2 months, weakness (symmetric), ascending numbness, autonomic dysfunction (commonly urinary retention)
112
signs of venous thromboembolism
heat, swelling, pain
113
red flag HA Sx
- change in HA intensity or duration
- association with fever
- occuring wiht new neuro signs
114
paraneoplastic cerebellar degeneration
severe truncal and limb ataxia and dysarthria
115
hydrocephalus Sx
- confusion, disorientation, or both
- lethargy
- HA
- irritability or personality changes
- blurred or double vision
- seizures
- urinary incontinence
- walking/balance difficulties
116
side effects of anemia
fatigue, dyspnea on exertion
117
nociceptive pain
pain triggered by activation of peripheral receptive terminals in response to noxious irritants
118
neuropathic pain
pain that includes sensory abnormalities such as thermal allodynia, paresthesia, hyperalgesia, dysthesia- may be decrobed as bruning, stabbing, pins and needles
119
vincristine
may result in polyneuropahty or buening of hands and feet
120
myofascial
pain that arises from myofascial trigger points
121
thamalmic
pain that is a central pain syndrom characterized by a burning, may be activated by changes in temp
122
funicular
pain that is a central pain syndrome characterized by excruciating pain that does not follow any fixed dermatome pattern and occurs caudal to lesion due to lesion to ascedning spinothalmic tracts
123
parietal lobe common findings
-sensation loss
- tactile localization
- sterognosia
- autopagnosia
- anognosia
- aphasia
124
temporal lobe common findings
- difficulty with recognizing sounds
- memory impairments
- vision impairments
125
basal ganglion common findings
- contralateral choreoathetosis
- contralateral dystonia
- movement disorders
126
corpus collosum common findings
- apraxia
- agrpahia
127
cerebellum common findings
- ataxia
- dysmetria
- nystagmus
128
brainstem common findings
- cranial nerve dysfx
- ataxia
- papillary abnormalities
- nystagmus
- hemiparesis
- autonomic dysfx
