Neuromuscular and Nervous System Pathology

Question 1

What areas of the brain does Alzheimer’s affect?

Answer 1

cerebral cortex and subcortical areas

Question 2

What neurons does Alzheimer’s effect? and what else develops?

Answer 2

ones associated with AcH
amyloid plaques
and neurofibrillary tangles show up

Question 3

Higher incidence of Alzheimer’s in men or women?

Answer 3

women

Question 4

Initial signs and symptoms of Alzheimer’s?
As it progresses what happens physically?

Answer 4

higher cortical functions like difficulty learning new things and subtle changes in memory and concentration.

rigidity, bradykinesia, shuffling gait

Question 5

PT treatment of Alzheimer’s?

Answer 5

maximizing patients remaining function and providing family and caregiver education.

Question 6

ALS involves both…
There is significant loss of …. in the spinal cord and motor cranial nerve nuclei in lower brainstem produces….
Demyelination of corticospinal and corticobulbar tracts produce…

Answer 6

UMN and LMN
anterior horn cell
weakness and muscle atrophy
UMN symptoms

Question 7

Higher incidence of ALS in men or women?

Answer 7

men
40-70

Question 8

LMN signs in ALS

Answer 8

asymmetric muscle weakness, fasciculations, cramping and atrophy in the hands. Weakness spreads distal to proximal.

Question 9

UMN signs for ALS

Answer 9

incoordination of movement, spasticity, clonus and positive Babinski

Question 10

Bell’s palsy is secondary to trauma and demyelination of…

Answer 10

facial nerve

Question 11

Is Bell’s palsy common?
And what ages does it show up in?

Answer 11

yes
15-45

Question 12

What is the associated cause of Bell’s?

Answer 12

herpes viral infection
inflammation of auditory canal produces subsequent demyelination and can lead to ischemia which can degenerate the nerve axonally.

Question 13

PT for Bell’s

Answer 13

stimulation of facial nerve
facial massage and/or exercise

Question 14

Carpal tunnel pressure to be considered CTS.
What is normal?

Answer 14

> 30 mmHg

2-10mmHg

Question 15

Symptoms of CTS

Answer 15

may radiate into UE, shoulder and neck
night pain, weakness of hand, muscle atrophy, decreased grip, clumsiness and decreased wrist mobility.

Question 16

Types of cerebellar disorders

Answer 16

congenital malformations
hereditary ataxia
spinocerebellar ataxias
acquired ataxias

Question 17

Hereditary ataxias
most common

Answer 17

recessive
Friedreich’s ataxia
gait unsteadiness begins early in life and followed by UE ataxia, dysarthria and paresis.
Mental function declines and slight tremors may be seen.
Reflexes, vibration, and position senses are impaired.

Question 18

Spinocerebellar ataxias

Answer 18

dominant
commonly present with neuropathy, pyramidal signs, ataxia, restless leg syndrome

Question 19

Acquired ataxias

Answer 19

nonhereditary neurodegenerative systemic disorders
toxin exposure or it can be idiopathic.

Alcoholism, hypothyroidism and vitamin E deficiency.
Toxin causes include carbon monoxide, heavy metals and lithium

Question 20

Diabetic neuropathy most common types

Answer 20

symmetric polyneuropathy and autonomic neuropathy

Question 21

Diabetic neuropathy symptoms

Answer 21

wasting of muscles in feet or hands
stocking glove sensory distribution
orthostatic hypotension
weakness
urinary impairments
significant pain

Question 22

Guillain-Barre Syndrome is aka

Answer 22

acute polyneuropathy

Question 23

GBS is caused by what they think

Answer 23

autoimmune response to previous respiratory infection, flu, immunization or surgery. Viral infections, Epstein-Barr syndrome etc

Question 24

Seizures a prodromal period is …(things preceding the seizure). But can occur…..and include….

Answer 24

rare
days or hours prior
mood changes, lightheadedness, sleep disturbances, irritability, difficulty concentrating
aura minutes before

Question 25

An aura is

Answer 25

simple partial seizure

Question 26

After someone has a seizure how should you lay them?

Answer 26

on their left side until they have fully recovered which is 5-20 min

Question 27

Signs and symptoms of GBS

Answer 27

distal to proximal progression, sensory impairment and possible respiratory paralysis.

Question 28

Initially GBS will present with

Answer 28

distal symmetrical motor weakness, mild distal sensory impairments, and transient paresthesias that progress to head

Question 29

Level of disability with GBS peaks when?

Answer 29

2-4 weeks after onset

Question 30

How can GBS be life threatening?

Answer 30

respiratory paralysis, absence of DTRs and inability to speak or swallow

Question 31

PT for GBS?

Answer 31

pulmonary rehab, strengthening, mobility, w/c and orthotic training

Question 32

Huntington's is what? Genetic how? age it affects?

Answer 32

degeneration and atrophy of basal ganglia and cerebral cortex autosomal dominant 35-55

Question 33

MS occurs when? Initial symptoms of MS

Answer 33

20-35 visual problems, paresthesias and sensory changes, clumsiness, weakness, ataxia, balance dysfunction and fatigue

Question 34

Myasthenia Gravis is what? Defect is specifically in the...

Answer 34

autoimmune disease with neuromuscular junction pathology. transmission of nerve impulses to the muscles at the neuromuscular junction. Antibodies block or destroy receptors needed for AcH uptake and this prevents muscle contraction

Question 35

What are some potential causes for myasthenia Gravis?

Answer 35

enlarged thymus diabetes, RA, lupus and other immune disorders

Question 36

Cardinal signs of Myasthenia Gravis?

Answer 36

extreme fatiguability and skeletal muscle weakness that can fluctuate within minutes or over an extended period. Ocular muscles are affected first and approx half of patients experience ptosis and diplopia. Dysphagia, dysarthria and cranial nerve weakness also are common

Question 37

Myasthenia Gravis is cyclical?

Answer 37

yes there are periods of remissions and exacerbations

Question 38

Myasthenia gravis crisis

Answer 38

is a medical emergency where respiratory muscles are affected and ventilator is required.

Question 39

Parkinson's affects what part of the brain

Answer 39

substantia nigra of the basal ganglia

Question 40

Average age of diagnosis with parkinsons

Answer 40

50-79

Question 41

Myasthenia gravis can fluctuate in severity from...

Answer 41

hour to hour

Question 42

Myasthenia gravis proximal or distal muscles affected more?

Answer 42

proximal

Question 43

What do those with myasthenia gravis have difficulty with?

Answer 43

speech, swallowing, and chewing

Question 44

Involvement of cranial nerves in myasthenia gravis results in...

Answer 44

eyelid weakness, diplopia, ptosis

Question 45

Remissions with mysathenia gravis are typically not...

Answer 45

complete or permanent

Question 46

PT for myasthenia gravis

Answer 46

acquire baseline for respiratory and neurological status monitor respiratory function continually positioning to prevent aspiration educate on osteoporosis using corticosteroids strength for those with mild to moderate symptoms using moderate to max isometrics

Question 47

What should you avoid for those with myasthenia gravis?

Answer 47

strenuous exercise and stress excessive hot or cold

Question 48

Pos-polio is a ....disease. Affects.... after polio. PPS occurs when compensated reinnervation from polio... When does PPS show up? Signs? Treatment?

Answer 48

LMN anterior horn cells fails 25 years after initial recovery slow and progressive weakness, fatigue, muscle atrophy, pain and swallowing issues. no pharmacological intervention. Should focus on lifestyle modifications and symptom managment.

Question 49

Agnosia

Answer 49

inability to interpret info

Question 50

Agraphesthesia

Answer 50

inability to recognize symbols, letters, or numbers traced on skin

Question 51

Agraphia

Answer 51

inability to write

Question 52

Aelxia

Answer 52

inability to read or comprehend written language

Question 53

Anosognosia

Answer 53

denial or unawareness of ones illness often associated with unilateral neglect

Question 54

Apraxia

Answer 54

inability to perform purposeful learned movements or activities even though there is no sensory or motor impairment

Question 55

Constructional apraxia

Answer 55

inability to reproduce geometric figures and designs

Question 56

Decerebrate rigidity

Answer 56

corticospinal lesion at brainstem that results in extension of trunk and extremities

Question 57

Decorticate rigidity

Answer 57

corticospinal lesion at diencephalon where trunk and lower extremities are in extension and UE in flexion

Question 58

Dysprosody

Answer 58

impairment and rhythm of speech

Question 59

Fluent aphasia

Answer 59

speech is functional but lacks content

Question 60

Ideational apraxia

Answer 60

inability to formulate an initial motor plan and sequence tasks

Question 61

Ideomotor apraxia

Answer 61

personal plans a movement or task but cannot volitionally perform it. Automatic movement may occur

Question 62

Neologism

Answer 62

substitution within a word that is so severe that it makes the word unrecognizable

Question 63

Non-fluent aphasia

Answer 63

non functional speech