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NMR II > Final: Other Diseases > Flashcards

Final: Other Diseases Flashcards

(65 cards)

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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
Describe post-exercise decrement in MG
Fatigable weakness - activity causes fatigue that is worse at the end of the day due to each muscle contraction having less Ach available
26
What muscle groups are impacted by post-exercise decrement in MG?
Asymmetrical, neck and face muscles, bulbar, facial, axial, limb, respiratory, ocular involvement, dysphagia, dysarthria, dyspnea
27
What are the risk factors for developing MG?
Family history, autoimmune disease. Women < 40 and men > 60
28
What is myasthenic crisis?
Emergency when respiratory muscles are severely impacted
29
What are the three diagnostic methods for Myasthenia Gravis?
1. Pharmacological 2. Immunologic 3. Electrophysiologic
30
What is the Tensilon Test?
Confirms MG diagnosis. Tensilon is given and examiner assesses movement before and one minute after injection. If strength improves, it is positive
31
What electrophysiologic testing is used to diagnose MG?
Repetitive nerve stimulation shows a rapid decrease in motor action potential amplitude
32
What are four medical interventions for Myasthenia Gravis?
1. AChE inhibitor medication 2. Thymectomy 3. Immunosuppressive - corticosteroids 4. Plasmapheresis and IVIG
33
What does LEMS stand for?
Lamber-Eaton Myasthenic Syndrome
34
What is LEMS?
Autoimmune disease impacting pre-synaptic NMJ by attacking calcium channels impacting the release of Ach
35
60% of LEMS pt's also have what condition?
Cancer
36
What are the three primary symptoms of LEMS?
1. Proximal weakness 2. Hyporeflexia/Areflexia 3. ANS dysfunction
37
Describe the presentation of weakness with LEMS
Proximal, symmetrical, weakness will get better with use, repeated contractions enhances reflexes and strength due to increased influx of calcium in presynaptic membrane
38
Describe reflexed with LEMS
Reflexed absent prior to exercises, but will occur immediately post exercise
39
What ANS symptoms are associated with LEMS?
Orthostatic hypotension, dry mouth, excess sweating, ptosis
40
How is LEMS managed?
1. Treat cancer 2. Plasmapheresis
41
What are similarities between MS and LEMS?
1. Proximal muscles 2. Ptosis 3. Bulbar signs 4. Ach 5. Autoimmune 6. LMN 7. Sensation not affected
42
What are the primary differences between MG and LEMS?
1. pre vs post synaptic receptors 2. CN vs ANS involvement 3. Etiology 4. Worse vs better with exercise
43
What should PT intervention look like for NMJ dysfunction conditons?
Pt education for energy conservation, time of day, strengthen large muscle group, mod-low intensity aerobic and strengthening
44
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
c. MG
45
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. Cancer
46
What type of disease is Huntington's?
Neurodegenerative
47
What is the etiology of Huntington's?
Autosomal dominant with genetic marker on chromosome 4. Results in brain degeneration
48
What movement disorder characteristics are associated with Huntington's?
Chorea, gaze fixation abnormalities, dysarthria, dysphagia, sleep disorders, urinary incontinence, gait and balance
49
What psychiatric symptoms are associated with Huntington's?
Personality changes and depression
50
What cognitive symptoms are associated with Huntington's?
Memory deficits and executive dysfunction
51
What is the life expectancy of Huntington's?
15-20 years after the onset
52
What medication is used to manage chorea symptoms with Huntington's?
Tetrabenazine
53
What STOM is used for Huntington's?
Unified Huntington Disease Rating Scale
54
What 4 domains of function are included in the UHDRS?
1. Motor function 2. Cognitive function 3. Behavioral abnormalities 4. Functional capacity
55
What other outcome measures can be used with Huntington's?
10MWT, TUG, 6MWT, Berg, SF36, 4 square step test
56
What are possible benefits of exercise in pt's with Huntington's?
Improved motor function, gait speed and endurance, balance, VO2 max, BMI, pulmonary function
57
What should PT focus on in the early-mid stages of Huntington's?
1. Aerobic 2. Resistance exercises 3. Balance and gait 4. Compensatory training 5. External cues 6. Caregiver education
58
What should PT focus on in mid-late stage Huntington's?
1. Fall risk assessment 2. Wheelchair assessment 3. Functional exercise 4. Aerobic capacity, pulmonary training 5. ROM
59
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
d. mod-high intensity
60
What diagnoses cause damage to the basal ganglia?
HD and PD
61
What diagnoses cause damage to the pyramidal cells?
ALS
62
What diagnoses cause damage to the corticospinal tract?
ALS
63
What diagnoses cause damage to the anterior horn cells?
ALS and Post-Polio
64
What diagnoses cause damage to peripheral nerves?
GBS
65
What diagnoses cause damage to the NMJ?
MG and Lambert Eaton

NMR II (27 decks)

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