Degenerative Disorders Flashcards
What’s the etiology of MS?
unknown, likely viral/autoimmune
T/F: MS is a demyelinating disease.
true
- plaques impair neural transmission , causing nerves to fatigue rapidly
What are the hallmarks of MS? (4)
1) demyelinating plaques cause nerves to rapidly fatigue
2) variable symptoms (cerebellar, pyramidal)
3) exacerbating factors like stress, infections
4) transient worsening of symptoms: adverse reactions to heat, hyperventilation, fatigue
Which type of MS is the most common?
relapse/remit
What’s the difference between primary progressive MS and secondary progressive MS?
primary progressive = no acute attacks, just continued deterioration in function from onset
secondary progressive = initial relapse/remit, followed by progressive deterioration, with or without acute attacks
Progressive-relapsing MS - describe.
similar to primary progressive in that it has steady deterioration, but with occasional acute attacks
-intervals between attacks are characterized by continued disease progression
If there is an episode of inflammatory demyelination in the CNS that could become MS if additional activity occurs, what is this called?
clinically isolated syndrome (CIS)
- could progress to RRMS
Your patient comes in with RRMS; describe the cognitive/affect issues she may have.
euphoria, mild-mod cognitive impairment, emotional dysregulation
T/F: Lhermitte’s sign can be positive in these patients with MS.
true - electric shock-like sensation through body produced with neck flexion
Do patients with MS experience sensory deficits?
yes, often hyper sensitive to sensory stimuli (hyperpathia), parasthesias common, abnormal sensations common (dysthesias)
T/F: DTRs are often hyporeflexic.
false, this is UMN issue (pyramidal lesions)
also see spasticity
What type of gait is most common with patients with MS?
ataxic
The MS functional composite tests what subtests?
25 foot walk, 9 hole peg test, and paced auditory serial addition test
What types of drugs do MS patients often take?
interferon (to slow progression, decrease symptoms)
immunosuppressants to treat acute flare ups (ACTH and steroids like prednisone, dexamethazone)
drugs to treat spasticity (baclofen, diazepam, datrolene)
What are two things you should be looking out for with MS during treatment episode, as they are common causes of death?
respiratory infection and UTI
What parts of the brain are undergoing degeneration in Parkinson’s Disease?
substantia nigra and nigrostriatal pathways
Parkinsons involves the deficiency of what neurotransmitter?
dopamine (within basal ganglia system)
What are hallmarks of PD? (4)
1) rigidity, lead pipe or cogwheel tone
2) bradykinesia
3) resting tremor
4) impaired postural reflexes
If you have a patient who is in the third Hoen and Yahr stage, what does this indicate about symptom presentation?
III = impaired balance, some restrictions in activity
Recall that it’s scored I-V, with the big split being from 2 to 3: 2 has no balance impairment, 3 does
If a patient with PD has bilateral symptoms, what stage would they automatically be given?
II
I = unilateral involvement II = minimal bilateral involvement, no balance issues III = balance issues, some activity restrictions IV = all symptoms present and severe, stands and walks only with assistance V = confined to bed/wc
What communication deficits are common with PD?
hypophonia
hypographia
mutism in advanced stages
blank facial expressions
T/F: Parkinson’s causes wasting of muscles.
false, atrophy is due to disuse and is a secondary issue
T/F: Parkinson’s causes poor balance.
true, poor postural reactions = balance
What gait deficits do those with PD tend to have?
festinating, freezing, generalized lack of extension
What is Sinemet? What kind of drugs enhance it’s action?
levadopa/carbidopa: provides dopamine and crosses blood-brain barrier
Dopamine agonist drugs enhance effects of sinemet therapy
Side effect of prolonged levadopa use?
dyskinesia (think michael j fox)
Why would a patient with PD take an anticholinergic drug?
to control resting tremor
What is myasthenia gravis? What causes it?
neuromuscular jxn disorder in which there is progressive muscular weakness and fatigue upon exertion
- caused by auntoimmune antibody-mediated attack on ACH (acetylcholine) receptors at NMJ
Does myasthenia gravis affect more distal or more proximal muscles?
proximal limb girdle muscles
AS WELL AS muscles of eyes, face, and mastication
What is a myasthenic crisis?
myasthenia gravis with respiratory failure - a medial emergency
What’s important in your education for these patients?
energy conservation techniques (activity pacing, optimal activity with rest as needed)
What are common functional mobility skills that are difficult for patients with myasthenia gravis?
stair climbing, lifting, rising from chair (similar to myopathies)
What are common functional mobility skills that are difficult for patients with myasthenia gravis?
stair climbing, lifting, rising from chair (similar to myopathies)
What is occular myasthenia gravis?
the least involved version of the disease; only restricted to extraoccular muscles
2) mild generalized myasthenia
3) severe generalized myasthenia
4) crisis
What is a seizure?
repetitive abnormal electrical charges in the brain
Compare tonic vs clonic activity.
tonic = stiffening/rigidity of muscles clonic = rhythmic jerking of extremities
What could be the reason why your kid with CP has seizures?
low oxygen at birth can cause seizure activity
What areas of the brain are involved in a grand mal seizure?
all of them; entire cortex
Which of the following can cause a seizure?
a) hyperthermia
b) drug overdose
c) drug withdrawal
d) electrolyte imbalance
e) degenerative brain disease (alzheimers)
f) all of the above
all can cause seizures
Is it common for people with a seizure to pee themselves?
yes, esp. in grand mal seizure
T/F: A person after a grand mal seizure wakes up conscious and able to return to function, just may not be able to recollect what just happened.
false, they may be amnesiac for hours after the event, as well as confused and drowsy
Posture is maintained in what kind of seizures? What else do you see in these types of seizures
absence or petit mal seizures
- here you see repetitive blinking, maybe other smaller movements
- may happen many times a day since they’re so brief
What parts of the brain are involved in a focal seizure?
not the entire cortex, only a certain region
- also called partial seizure
What is a complex focal seizure?
focal = only one area of the brain
- person appears dazed or confused; not fully alert nor unconscious
A patient has complex halucinations, automatisms (lip smacking, pulling on clothing) altered cognitive/emotional function (sexual arousal, violent, depressive), and also was preceeded by an aura. What type of seizure could be occuring?
temporal lobe seizure
- this would be a focal seizure
What is a life-threatening situation called with epilepsy, and how is it characterised?
status epilepticus = prolonged seizure for >30min with little rest in between attacks
When seeing a pt in the clinic, they report they’ve had a seizure since seeing you. What is important information to get about this event?
- time of onset and duration
- type of seizure
- sequence of events leading up to it and after
- frequency if occurring more than once
- incontinence/respiratory stress during event?
What is tegretol used for?
seizures (so is dilantin)
If a patient is having a seizure during your treatment, what should you do (discuss priorities)?
1) make sure pt is safe in environment (loosen restrictive clothing, don’t restrain limbs)
2) establish airway via sidelying positioning
Do you want to hold down a patient having a grandmal seizure?
no, clear enviro so they don’t hit anything and just establish airway
TIME it
