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BOARDS: Neuromuscular > Degenerative Disorders > Flashcards

Degenerative Disorders Flashcards

1
Q

What’s the etiology of MS?

A

unknown, likely viral/autoimmune

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2
Q

T/F: MS is a demyelinating disease.

A

true

- plaques impair neural transmission , causing nerves to fatigue rapidly

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3
Q

What are the hallmarks of MS? (4)

A

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

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4
Q

Which type of MS is the most common?

A

relapse/remit

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5
Q

What’s the difference between primary progressive MS and secondary progressive MS?

A

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

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6
Q

Progressive-relapsing MS - describe.

A

similar to primary progressive in that it has steady deterioration, but with occasional acute attacks

-intervals between attacks are characterized by continued disease progression

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7
Q

If there is an episode of inflammatory demyelination in the CNS that could become MS if additional activity occurs, what is this called?

A

clinically isolated syndrome (CIS)

- could progress to RRMS

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8
Q

Your patient comes in with RRMS; describe the cognitive/affect issues she may have.

A

euphoria, mild-mod cognitive impairment, emotional dysregulation

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9
Q

T/F: Lhermitte’s sign can be positive in these patients with MS.

A

true - electric shock-like sensation through body produced with neck flexion

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10
Q

Do patients with MS experience sensory deficits?

A

yes, often hyper sensitive to sensory stimuli (hyperpathia), parasthesias common, abnormal sensations common (dysthesias)

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11
Q

T/F: DTRs are often hyporeflexic.

A

false, this is UMN issue (pyramidal lesions)

also see spasticity

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12
Q

What type of gait is most common with patients with MS?

A

ataxic

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13
Q

The MS functional composite tests what subtests?

A

25 foot walk, 9 hole peg test, and paced auditory serial addition test

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14
Q

What types of drugs do MS patients often take?

A

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)

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15
Q

What are two things you should be looking out for with MS during treatment episode, as they are common causes of death?

A

respiratory infection and UTI

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16
Q

What parts of the brain are undergoing degeneration in Parkinson’s Disease?

A

substantia nigra and nigrostriatal pathways

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17
Q

Parkinsons involves the deficiency of what neurotransmitter?

A

dopamine (within basal ganglia system)

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18
Q

What are hallmarks of PD? (4)

A

1) rigidity, lead pipe or cogwheel tone
2) bradykinesia
3) resting tremor
4) impaired postural reflexes

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19
Q

If you have a patient who is in the third Hoen and Yahr stage, what does this indicate about symptom presentation?

A

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

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20
Q

If a patient with PD has bilateral symptoms, what stage would they automatically be given?

A

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
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21
Q

What communication deficits are common with PD?

A

hypophonia
hypographia
mutism in advanced stages
blank facial expressions

22
Q

T/F: Parkinson’s causes wasting of muscles.

A

false, atrophy is due to disuse and is a secondary issue

23
Q

T/F: Parkinson’s causes poor balance.

A

true, poor postural reactions = balance

24
Q

What gait deficits do those with PD tend to have?

A

festinating, freezing, generalized lack of extension

25
Q

What is Sinemet? What kind of drugs enhance it’s action?

A

levadopa/carbidopa: provides dopamine and crosses blood-brain barrier

Dopamine agonist drugs enhance effects of sinemet therapy

26
Q

Side effect of prolonged levadopa use?

A

dyskinesia (think michael j fox)

27
Q

Why would a patient with PD take an anticholinergic drug?

A

to control resting tremor

28
Q

What is myasthenia gravis? What causes it?

A

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
29
Q

Does myasthenia gravis affect more distal or more proximal muscles?

A

proximal limb girdle muscles

AS WELL AS muscles of eyes, face, and mastication

30
Q

What is a myasthenic crisis?

A

myasthenia gravis with respiratory failure - a medial emergency

31
Q

What’s important in your education for these patients?

A

energy conservation techniques (activity pacing, optimal activity with rest as needed)

32
Q

What are common functional mobility skills that are difficult for patients with myasthenia gravis?

A

stair climbing, lifting, rising from chair (similar to myopathies)

33
Q

What are common functional mobility skills that are difficult for patients with myasthenia gravis?

A

stair climbing, lifting, rising from chair (similar to myopathies)

34
Q

What is occular myasthenia gravis?

A

the least involved version of the disease; only restricted to extraoccular muscles

2) mild generalized myasthenia
3) severe generalized myasthenia
4) crisis

35
Q

What is a seizure?

A

repetitive abnormal electrical charges in the brain

36
Q

Compare tonic vs clonic activity.

A 
tonic = stiffening/rigidity of muscles
clonic = rhythmic jerking of extremities
37
Q

What could be the reason why your kid with CP has seizures?

A

low oxygen at birth can cause seizure activity

38
Q

What areas of the brain are involved in a grand mal seizure?

A

all of them; entire cortex

39
Q

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

A

all can cause seizures

40
Q

Is it common for people with a seizure to pee themselves?

A

yes, esp. in grand mal seizure

41
Q

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.

A

false, they may be amnesiac for hours after the event, as well as confused and drowsy

42
Q

Posture is maintained in what kind of seizures? What else do you see in these types of seizures

A

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
43
Q

What parts of the brain are involved in a focal seizure?

A

not the entire cortex, only a certain region

- also called partial seizure

44
Q

What is a complex focal seizure?

A

focal = only one area of the brain

- person appears dazed or confused; not fully alert nor unconscious

45
Q

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?

A

temporal lobe seizure

- this would be a focal seizure

46
Q

What is a life-threatening situation called with epilepsy, and how is it characterised?

A

status epilepticus = prolonged seizure for >30min with little rest in between attacks

47
Q

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?

A
  • 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?
48
Q

What is tegretol used for?

A

seizures (so is dilantin)

49
Q

If a patient is having a seizure during your treatment, what should you do (discuss priorities)?

A

1) make sure pt is safe in environment (loosen restrictive clothing, don’t restrain limbs)
2) establish airway via sidelying positioning

50
Q

Do you want to hold down a patient having a grandmal seizure?

A

no, clear enviro so they don’t hit anything and just establish airway

TIME it

BOARDS: Neuromuscular (16 decks)

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