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POTH 455 > Clincal cases > Flashcards

Clincal cases Flashcards

1
Q

what is fibromyalgia characterized as?

A

Disease characterized by widespread MSK pain.

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2
Q

what causes fibromyalgia?

A

deficit in the way the brain processes pain. CNS is affected . pain modulatior pathways are altered leading to hypersensitivity

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3
Q

who is most at risk of Fibromyalgia?

A
  • family history
  • women
  • middle aged
  • people of low socioeconomic classes
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4
Q

what are some risk factors associated to fibromyalgia?

A
  • psychiatric problems
  • traumatic physical or emotional event
  • bacterial or viral infection
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5
Q

what disease is characterized by the following symptoms?

diffuse, burning-like bilateral and axial pain, stiffness, sleep disturbances and headaches?

A

fibromyalgia

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6
Q

what are some of the secondary effects caused by fibromyalgia?

A
  • irritable bowel
  • chronic fatigue
  • fibrofog
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7
Q

what disease is diagnosed with 11/18 pain points and ongoing pain for the past 3 months?

A

fibromyalgia

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8
Q

what treatments can be used for fibromyalgia?

A
  • pain meds and muscle relaxants

- antidepressants and anti epileptic drugs

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9
Q

is there a cure for fibromyalgia?

A

no since the cause is unknown

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10
Q

what is the implication of a PT and OT on fibromyalgia?

A

PT: flexibility and strength
OT: ADLs with minimal stress on body

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11
Q

what are life changes that may help reduce pain in patients with fibromyalgia?

A

meditation, sleep, exercise, reduced caffeine, smoking an alcohol

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12
Q

what are the different types of strokes?

A
  • ischemic (thromboic and embolic) where a clot is formed

- hemorrhagic where a vessel breaks

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13
Q

what happens in the case of a stoke to the brain tissue?

A

lack of o2 and nutrients leads to its death

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14
Q

who is most at risk of stoke?

A

men
>55
indigenous, african & south asian

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15
Q

what are risk factors associated to stoke?

A 
HTN
Smoking
WHR
sedentary
diabetic
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16
Q

what does FAST stand for?

A 
primary signs of stoke
Face drooping
arm weakness
slurred speach
time
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17
Q

what are other signs associated with stoke?

A
  • weakness on one side of the body
  • blurred or double vision
  • headaches
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18
Q

what are some common impairments after stoke?

A

depression & mood changes
low energy
cognitive deficits
dysphagia

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19
Q

how is stoke diagnosed?

A

using CT/MRI to identify location and type

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20
Q

what are the common treatments for stoke?

A

ischemic: tissue plasminogen ~4.5H after stoke to break down the clot or surgical removal via stent clipping
hemorrhagic: reduce bleeding and BP by clipping, endovascular embolization and high beam radiation

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21
Q

what is often used after stoke to reduce spasticity?

A

balcofen or

FES

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22
Q

what is the role of PT/OT for stoke?

A

PT: recover motor losses, endurance, ROM & strength
OT: fine motor skills, adaptive techniques & technologies

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23
Q

what is affected by addiction?

A

mesolimbic dopamine pathway by increasing the [dopamine] in the synapses which induces the production of cAMP and increases CREB production.

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24
Q

what is the result on dopamine caused by addiction?

A

natural endogenous dopamine production is reduced and hence increases the body’s demand for with

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25
Q

what cortical organs are involved in addiction?

A

amygdala
hippocampus
cortex

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26
Q

who is most at risk of addiction? of intoxication?

A

addiciton: men
intoxication: women

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27
Q

what are the common risk factors associated to addiciton?

A 
poor familial status
peer pressure
easy access to drugs
impulsive personality
mental health issue
abuse
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28
Q

what are signs and symptoms often associated to addiction?

A

craving
tolerance
nelect of responsibilities
development of mental illnesses

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29
Q

what are the common symptoms associated to withdrawal?

A 
sweating
vomiting and nausea
increased HR
irritability
hallucinations
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30
Q

what are the common treatments used for addiciton?

A

self help groups as they are empowering
medications to help prevent withdrawl
CBT

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31
Q

what is alzheimer?

A

neurogenerative disease which causes cortical cell death

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32
Q

what causes alzheimer?

A
  • development of amyloid plate which disrupt synaptic communication, and increase cell death and excitotoxicity
  • neurofibrillary tangles which impede communication
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33
Q

what NTs seem to be decreased in Alzheimer?

A

NE
ACh
serotonin

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34
Q

what part of the brain shows atrophy in Alzheimer

A

medial temporal lobe and hippocampus

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35
Q

what causes Alzheimer?

A

unknown cause

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36
Q

what are the risk factors associated to Alzheimer

A
  • genetic (APOE 4 or trisomy 21 gene)
  • environmental
  • lifestyle
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37
Q

who is most at risk of Alzheimer

A

women
> 60
african americans, causians , and hispanics

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38
Q

what symptoms are associated with mild AD?

A

short term memory loss

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39
Q

what symptoms are associated with moderate AD?

A 
short term memory loss
inappropriate behavior
redundancy
apraxias
damage to cortical areas involved in reasoning, conciousness, language and information processing
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40
Q

what symptoms are associated with severe AD?

A 
brain atrophy
communciation impairments
dysphagia
seizures
gait abnormalities
bladder and bowel impairments
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41
Q

how can Alzheimer be diagnosed?

A

no explicit test

use medical history, imaging techniques, lab tests and neurological exams

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42
Q

what medication can be given to treat Alzheimer?

A

-cholinesterase inhibitor which allows to maintain ACh and thus increase communication between cells
anti-psychotic drugs

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43
Q

how can PT OT help patients with Alzheimer?

A

-improve gait and balance and promote PA and cognitive health
educate patient and caregiver on AD and help with communication strategies

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44
Q

what is Parkinsons disease?

A

neurological motor disorder that is due to the loss of dopaminergic neurons in the substancia nigra

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45
Q

what is the role of lewy body formation in PD?

A

Believed to prevent neuronal functionning

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46
Q

when is PD generally diagnosed?

A

~60-65 years old

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47
Q

what is the greatest risk factor associated to PD?

A

age

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48
Q

who is most at risk of PD?

A

men

western countries

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49
Q

what are some risk factors associated to PD?

A

genetics

environmental (pesticides)

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50
Q

what is the effect of coffee and cigarets on PD?

A

recuces risk, considered to be negative risk factors

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51
Q

what disease are the following symptoms associated with?

  • tremors
  • rigitidy
  • bradykinesia
  • dysphagia, incontinence/cosntripation
  • dementia
  • depression
  • day time sleepiness
A

-parkinson disease

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52
Q

what are the most common treatments for pd?

A
  • Levodopa which increases Dopamine availibility
  • deep brain stimulation which inhibits the inhiitory pathway by inhibiting the STN and allows to take smaller medications
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53
Q

what is paranoid schizophrenia?

A

mental disorder characterized by debilitating symptoms such as hallucinations, dellusions and constant suspiciousness

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54
Q

what is the cause of schizophrenia?

A

assumed to be caused by environmental and genetic factors which alter brain

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55
Q

what NT appear to be in excess in schizoprenia?

A

dopamine

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56
Q

what are risk factors associated with schizophrenia?

A
  • positve family history
  • drug abuse
  • pregnancy complicaitons
  • low family income
  • childhood trauma
  • social isolation
  • living in rural area
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57
Q

who is more at risk of schizophrenia?

A

men and women are at equal risk, but men seem to show symptoms at a younger age
18-30 years old

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58
Q

how is schizophrenia diagnosed?

A

-2 symptoms have been consistently present for the past 6 months (delusion, hallucinations, disorganized speech and behavior, negative symptoms)
CT/MRI: enlarged lateral and 3rd ventricle, loss of grey matter and smaller frontal and temporal lobes
-psychosocial evaluation
urine and blood tests

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59
Q

what are some positive symptoms associated to schizophrenia?

A

unhealthy cognitive and sensory processes that are in addition to what is expected in a healthy individual (these are in addition to healthy perceptions)
such as Hallucinations, delusion

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60
Q

what are some negative symptoms associated to schizophrenia?

A

-avolition
-decreased motivation
neglect of personal hygiene
-reduced eye contract
-child-like behaviors

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61
Q

what are some cognitive deficits associated with schizophrenia?

A

speech memory and attention deficit

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62
Q

what is used to treat schizophrenia?

A

antipsychotic drugs can be good to restore dopamine balance (clozapine) –> multiple secondary effects

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63
Q

what is diabetic peripheral neuropathy

A

uncontrolled blood glucose levels which leads to nerve destruction in the PNS and narrows down the blood vessels thus increases susceptibiltiy to hypoxia, apoptosis and myelin degeneration.

64
Q

what are the risk factors associated with DPN?

A
  • type 2 diabetes
  • poor control of blood sugars
  • kidney damage
  • smokers due to narrowing and hardening of arteries
65
Q

at what age does risk for DPN increase?

A

~60-80

66
Q

what are the common symptoms associated with DPN?

A

feeling of numbness, tingling and pins/needles
muscle weakness and low muscle tone
dry and cracked feet due to inactive sweat glands

67
Q

how can we diagnose for DPN?

A
  • reduced amplitude of AP
  • slow sensory and motor nerve conduction velocity
  • lab tests for FBG and HB A1c
  • blisters and sores
68
Q

how can DPN be prevented?

A
  • diet changes
  • stop smoking
  • PA
  • proper footcare
  • regulation of BG levels
69
Q

what medication can be used to reduce pain associated to DPN?

A
  • antidepressant
  • anticonvulsants
  • opiods
  • topical cream capsaicin
  • transcutaneous nerve stimulation
70
Q

what is GBS?

A

immune attack of the myelin sheaths on the peripheral nerve axons

71
Q

what are the different types of GBS based on ?

A

based on the different part of the peripheral nerve that is involved

72
Q

when is the actute phase of GBS reached? when is the peak?

A

lasts 4 weeks

peak is reached after 2 weeks

73
Q

what happens during the second phase of GBS?

A

symptoms stabilize

74
Q

does a GBS patient fully recover?

A

no

75
Q

how many people are affected by GBS annually

A

100K

76
Q

who is most at risk of GBS

A

males
between 15-35 and 50-75
military personnel

77
Q

whta is a common risk factor associated with GBS?

A

GIT or respiratory infection

78
Q

what disease is the symptoms associated with?
tingling and symetrical weakness in LL which progresses in UL.
muscular weakness
CN damage
pain in the back, thighs, butt and shoulders
VNS complications

A

GBS

79
Q

how can GBS be diagnosed?

A 
bilateral symptoms
rapidity of symptom onset
conduction velocity
tendon reflex
electromyography and ct/mri
80
Q

how can GBS be treated

A

intravenous immunoglobulin treatment to provide healthy antibodies and plasmapharesis to clean out harmful antibodies from plasma

81
Q

what medications are be prescribed to patients with GBS

A

pain meds and anticoagulants

82
Q

what is the role of PT in GBS

A

pain
help with strength and fatigue
use of EMS, Heat packs and exercise

83
Q

what is the cause of TBI?

A

exernal force to the head with penetrating and non-penetrating injury

84
Q

what leads to a primary injury?

A

bruising, bleeding and tearing side the skull.

85
Q

what is the secondary injury ?

A

inflammation, ICP reduced blood flow

86
Q

what is the most common cause of TBI?

A

Falls, MVA, sports, violenece or assults

87
Q

who is most

A

young adults between 15-24 MVA
males
and then >60 years old due to falls

88
Q

what symptoms are associated to mild TBI?

A 
vomiting
dizziness
lethargy
memory loss
brief loss of conciousness
89
Q

what symptoms are associated to moderate/severe TBI?

A 
visible trauma on neuroimagine
extended loss of conciousness
bleeding
confusion
lack of sleep
90
Q

how can TBI be diagnosed?

A

CT/MRI/Xrays and EEGs

15 point gasglow coma sclae

91
Q

what are some long term complications associated with TBI?

A

physical and sensory impairments
intellectual deficits
communication deficits
behavioural and emotional issues

92
Q

how can TBI be treated?

A

emergency care
medication including diuretics to decrease ICP, anti-siezure meds and coma inducing drugs
surgery to remove blood clots, repair fractures and prevent further bleeding

93
Q

how can PTOT help with TBI

A

-relearn motor skills
help with ADLs
movement patterns
balance

94
Q

what is huntington’s disease?

A

autosomal dominant disease that leads to hyperkinetic movements

95
Q

what causes HD?

A

unknown cause but believed to be due to the breakdown and degeneration of nerve cells in the striatum

96
Q

what changes may the patient of HD undergo?

A

personality, cognitive and motor impairments

97
Q

what is the life expectancy of HD?

A

15-20 years after onset of HD?

98
Q

what are the risk factors associated to HD?

A

-family incidence (genetics)

99
Q

what is the average age of incidence for HD? from what region?

A

35-44 years old

western europeans

100
Q

what are symptoms observed in early phases of HD?

A

Irritability
Difficulty making memories, decisions and learning
Involuntary jerky movements
Gait impairment

101
Q

what are symptoms observed in later phases of HD?

A

difficulties swallowing
weight loss
slurred speach
extreme rigidity

102
Q

what are some psychological symptoms of HD?

A

ocd
depression
mood changes

103
Q

how can HD be diagnosed?

A

genetic testing

neurological exam

104
Q

how can PTOT help with HD?

A

PT: improving strength, balance, gait, maintain respiratory functions, fall prevention techniques, imitating deterioration of ROM, posture
OT: enhance safety in independence in doing ADLs, recommending equipment and modifications

105
Q

how can a speech pathologist help a HD patient?

A
  • Assesses dysphagia & communication
  • Provides eating techniques to prevent choking
  • Techniques for speech and communication problems
106
Q

what medicine can be used for HD?

A

dopamine depleating agent

107
Q

what is bacterial meningitis?

A

acute infection that causes swelling of the meninges and leads to apoptosis, increased ICP and arterial blockage

108
Q

what is the most important risk factor for bacterial menigitis?

A

weakened immune system

109
Q

who si most at risk for bacterial meningitis?

A

people wioth weaker immine system

sub-saharan africa

110
Q

what is the incidence rate for bacterial meningitis?

A

went from 15 motnhs to 39 years old due to the introduction of conjugate vaccine

111
Q

what are common symptoms of bacterial meningits

A 
Neck stiffness
Headaches
Fever, nausea, vomiting
Muscle and joint pain
Difficulty concentrating
Photophobia & hearing loss due to compression of cranial nerves
irritability
swelling of fontanelles and high pitched cries
112
Q

what are some complications associated with bacterial meningitis?

A 
lack of coordination
weakness
concentration deficits
long term hearing loss
behvaioral changes
113
Q

how to diagnose bacteial meningitis?

A

Lumbar puncture
Blood sample with gram stain
Imaging to identify swelling or inflammation

114
Q

treatment for bacterial meningitis?

A
  • corticosteroids to reduce inflammation
  • antibiotics
  • intravenous fluids
  • o2 therapy
115
Q

how cna PTOT help with bacterial meningitis?

A

PT: evaluate and monitor improvement/regressions in patient’s level of balance and coordination & ensure proper positioning to avoid bed sores and muscle contractures
OT: proper environment for patient’s recovery & provide patient with adaptive techniques
o Provide patient education about disease and possible complications

116
Q

what is autonomic dysreflexia?

A

Over reactivity of the SNS due to loss of SNS inhibition which results in an acute episode of peripheral hypertension accompanied with bradycardia. This further results in peripheral vasoconstriction.

117
Q

what can trigger autonomic dysreflexia?

A

noxious/non-noxious stimuli
bladder distention/obstruction
occluded catheter
fecal impaction

118
Q

what can be some complications of autonomic dysreflexia?

A

Cerebral hemorrhage
Neurogenic pulmonary edema
Coma
Myocardial infarction

119
Q

what is the common risk associated to autonomic dysreflexia?

A
  • people with lesion above T6
  • complete SCI
  • MS patients
  • return of sacral reflexes after spinal shock
120
Q

what are the general symptoms associated with autonomic dysreflexia?

A 
overexcitation PSNS above, SNS  below leads to 
o	Flushing of the face
o	Profuse sweating above the lesion
o	Pale, cold skin below the lesion
o	Blurred vision & dyspnea
o	Pounding headaches
o	Nasal congestions  vasodilation (above the lesion PSNS)
o	Nausea  PSNS vagal effect
o	Chills and increased spasms
o	Increased SBP BY >20%
121
Q

how can autonomic disreflexia be treated?

A

-patient needs to sit up right
-monitor BP
-removal of noxious stimuli or cause of AD
pharmacological meds (nifedipine)
topical nitroglycerine ointment above the lesion

122
Q

what is the role of PT/OT in autonomic dysreflexia?

A

be aware of the symptoms and how to respond to them during a session
educate about ADLs and various emptying techniques

123
Q

what is MJD

A

spinocerebellar ataxia type 3 which is an autosomal dominant neurodegenerative disease that arises due to ingreated CAG codon repetetions

124
Q

what is the function of the ATXN gene?

A

regulation of transcription of certain aa and removing damaged excess proteins thus mutations leads to degeneration and cell death

125
Q

what areas of the brain are affected by MJD?

A

BS, basal ganglia, SC, peripheral nerve, cerebellar cortex

126
Q

what is the most prominent subtype of MJD?

A

type 2

127
Q

what are the subtypes of MJD classified as?

A
  • age of onset (1 being the youngest)
  • rate of onset (1= fastest_
  • length of polyq tract (1= longest)
128
Q

what are the risk factors associated to MJD?

A
  • family onset (anticipation leads to worsening conditions)
  • portuguese descent
  • males
129
Q

what illness is characterized by dystonia, spasticity, ataxia and decreased cerebellar functions as disease progresses?

A

MJD

130
Q

what is amyotrophy? what disease is it a symptom of?

A

MJD

loss of feeling and hypoalgesia

131
Q

how can MJD be diagnosed?

A

genetic testing
symptom recognition
imaging (pontocerebellar atrophy and enlargemnt of 4th ventricle)

132
Q

what can be used to treat MJD?

A

levodopa to treat stiffness, slurred speech
antispasmodic meds like balcofen
modafinil to reduce day time sleepiness
prism glasses to help with blurred vision since eye surgery only provides temporary results due to muscle degeneration

133
Q

how are PTOT involed in MJD?

A

improve independence and gait strategies or mobility aids

134
Q

what is whiplash caused by?

A

Caused by traumatic acceleration-deceleration mechanism which affects the neck and results in a cervical strain/sprain due to Rapid hyperextension or hyperflexion
which results in Intense sheering force that can compress the joint capsules

135
Q

what is the major cause of whiplash?

A

MVA and falls

136
Q

why are females more at risk of whiplash?

A

due to lesser neck musculature

137
Q

who is more at risk of whiplash in a MVA?

A

passenger

138
Q

what country has the highest incidence rate for whiplash?

A

europe

139
Q

how to diagnose whiplash?

A

understand the mechanism of injury and imaging techniques

140
Q

what symptoms are associeated to whiplash?

A 
•	Neck and shoulder pain
Decreases ROM of the neck
Arm pain and weakness, jaw pain, back pain
Cognitive symptoms including
o	Fatigue
o	 Dizziness
o	Visual disturbances
o	Tetanus (noise in ear)
141
Q

what are persistent symptoms of whiplash?

A

headaches

stiff neck and pain

142
Q

what are some psychological symptoms associated to whiplash?

A 
anger
frustration
stress
PTSD
sleep disturbances
143
Q

how can whiplash be treated?

A

antidepressant drugs to relieve neuropathic pain
lidocain injections to numb certain areas
antiinflammatory drugs
msucle relaxants
surgery in cases of persistant pain

144
Q

how can PTOT help with whiplash?

A

pain management, restor ROM and return to ADLs

promote healthy life habits including PA, modifications to ADLs to reduce pain

145
Q

what is spastic cerebral palsy?

A

damage to the developing brain leading to motor deficits. can be acquires or congenital

146
Q

what causes spastic hemiplegia?

A

unilateral lesion of the brain which Tends to affect the MCA

147
Q

what is affected by spastic quadriplegia?

A

cavities that communicate with lateral ventricles
diffuse cortical atrophy
hydrocephalus

148
Q

greatest prevalence for spastic cerebral palsy is seen in who?

A

preterm babies
males
low socio economic classes

149
Q

what are the risk factors of SCP?

A

-menstrual cycle
-previous pregnancy loss
-thyroid or epilepsy disorders
congenital malformations
bleeding in 3rd trimester
interuterine growth retardation
treatment for thyroid, estrogen and progesterone
premature baby
asphyxia
infection

150
Q

what are symptoms associated with SCP?

A 
stiff jerk movements
muscle weakness
decreased ROM
movement and coordination problems
fine motor stuggles
hearing impairmeents
delays in speech
intellectual disabilities
urinary incontinence
151
Q

when do symptoms of SCP generally appear?

A

during infancy and preschool year due to development impairments

152
Q

what impairment can be observed in spastic displegia?

A

muscle stiffness primarily in legs

153
Q

what impairment can be observed in spastic hemiplegia?

A

asymmetrical gait

154
Q

what impairment can be observed in spastic quadriplegia?

A

four limbs, trunk and face are affected

Co-occurring disorders including epilepsy

155
Q

how can SCP be treated?

A

botox
surgical interventions to alter the length of spastic tendons to restore balance and avoid excessive pulliung on the bone
rhizotomy: cut nerve roots with excessive activity to reduce spasticity

156
Q

how can PTOT help in SPC?

A

Aim to improve motor development, prevent MSK complications

Correct abnormal patterns of movements

POTH 455 (6 decks)

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