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Neuromuscular Physical Therapy > Exam Pt 4 > Flashcards

Exam Pt 4 Flashcards

1
Q

If a patient w PD has impaired balance, they are stage..

A

III

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2
Q

Brandyphrenia is.. & is a symptom of ..

A

Slowed thinking ; PD

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3
Q

What is the pharm intervention of UI in MS?

A

Anticholinergic drugs

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4
Q

What are the two common causes of death in pts w MS you should be on the alert to look out for?

A

UTIs and respiratory infection

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5
Q

What is a reasonable intervention for DiplopiA?

A

Eye patching

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6
Q

What neurotransmitter is deficient in PD?

A

Dopamine within the BG corpus striatum

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7
Q

What issues of perception/sensation occur in PD?

A

1 cramp-like sensation,

  1. Spatial organization deficit
  2. Perception of the vertical
  3. Extreme restlessness (akathisia)
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8
Q

What is festinating gait?

A

Abnormal involuntary increase in the speed of walking (occurs in PD)

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9
Q

What is the main medical mgmt for PD? How is its effect prolonged?

A

Sinemet (levodopa/carbidopa) or sustained release sinemet

  • -provides dopamine
  • -prolonged effect via LOW PROTEIN DIET & dopamine agonist drugs
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10
Q

In patients with PD, what are anticholinergic drugs used for?

A

Control of tremor

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11
Q

What does Amantadine do?

A

Enhances dopamine release

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12
Q

DBS for PD is used in what area of the brain?

A

Thalamus or subthalamus

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13
Q

Myasthenia gravis is an autoimmune attack on what receptors ? Where?

A

ACh receptors at NMJ

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14
Q

How do people with myasthenia gravis respond to continual contraction?

A

Muscular strength gets worse with continuing contraction , improved with rest

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15
Q

What is myasthenic crisis?

A

Myasthenia gravis w respiratory failure (MEDICAL EMERGENCY)

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16
Q

What ms are the most effected in myasthenia gravis?

A

Proximal ms

-ie getting out of a chair & going up stairs the most difficult functional activities

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17
Q

If a pt w PD has unilateral symptoms, they are H&Y stage ..

A

I

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18
Q

what are the 3 main pharmacological interventions used for Myasthenia Gravis? `

A
  1. ACh inhibitors
  2. Corticosteroids
  3. Immunosuppressants (ie IVIG)
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19
Q

what is the autonomic phenomenon associated with epilepsy?

A

sudden attack of : anxiety, tachycardia, sweating, piloerection, abnormal sensation in upper abdomen/chest

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20
Q

the cognitive phenomenon in epilepsy involves affective disturbances, such as..

A

intense feelings of hate, fear and anger

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21
Q

What is a possible cause of seizures if you are pregnant?

A

eclampsia (seizure caused by HTN, mother can subsequently become comatose)

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22
Q

grand mal seizures aka ..

A

tonic clonic seizures

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23
Q

a partial focal motor seizure involves..

A

clonic activity involving a specific area of the body

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24
Q

a temporal lobe seizure is characterized by ..

A

episodic changes in behavior, with complex hallucinations and automatisms

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25
a complex partial seizure involves..
simple partial seizures followed by an impairment of consciousness
26
"status epilepticus" involves..
prolonged seizure OR series of seizures lasting >30 min, life threatening medical emergency if generalized
27
Dilantin (phenytoin) is used as a ...
antiepileptic medication
28
what is unique about the cerebellar presentation of signs and symptoms?
they typically manifest themselves unilaterally
29
lesions to the archicerebellum lead to what?
1. central vestibular symptoms 2. gait and trunk ataxia 3. little change in tone or dyssynergia of extremity movements
30
what are the central vestibular symptoms produced by a lesion to the archicerebellum?
ocular dysmetria poor eye pursuit dysfunctional VOR impaired hand-eye coordination
31
what are the symptoms after a lesion of the paleocerebellum
1. hypotonia 2. truncal ataxia 3. ataxic gait **normally responsible for equilibrium & ms tone**
32
lesion to what aspect of the cerebellum causes an intention tremor?
neocerebellum (posterior lobe)
33
in general, lesions of the neocerebellum cause..
ataxic limb movements | -dysdiadochokinesia, dysmetria, dyssynergia, errors in timing related to perceptual tasks, intention tremor
34
what dynamic stability exercises should be used for patients with cerebellar ataxia?
promote small range control & smooth reversals of movement movement transitions using carefully graded resistance
35
how do you improve stabilization of VOR in cerebellar lesions?
slow head movements with visual fixations (compensation)
36
what motor learning strategies should be used in patietns with cerebellar ataxia?
1. low stim environment (closed) 2. focus on practice and repetition 3. distributed practice (endurance may be low)
37
what are 3 potential causes of bilateral vestibular disorders?
1. Paget's disease (vestibular neuropathy, otosclerosis) 2. B/L infection : neuritis, meningitis 3. toxicity (ototoxic drugs)
38
what is Meneire's disease?
recurrent and usually progressive vestib disease -episodic attacks minute to severeal hours -assoc w tinnitus, deafness, sensation of pressure/fullness within ear, etiology unknown UNILATERAL vesitbular dysfxn
39
what is the subj assessment rec for vestib dysfxn
DHI
40
when examining VOR fxn, look for..
nystagmus, blurred vision w head & total body mvmt
41
to examine for VSR function..
examine posture & balance | -examine for instability in sitting, standing, during fxnl activities and gait
42
what is the definitive exam performed for BPPV?
Hallpike Dix -check for vertigo or nystagmus + for BPPV on the side that produces symptoms
43
to test for vertebral artery compression..
in supine, ext/lat flex/rotate head , hold 30 sec then test contralat side
44
what are some disorders that you should avoid overwork fatigue when dealing with? & why?
MS, ALS, MD, PPS, GBS; all have degeneration of nerves (cranial or peripheral nerves with ALS, PPS, GBS), so overwork will actually cause the ms to break down
45
canalith repositioning treatment is used for..
horizontal SCC BPPV & posterior SCC BPPV
46
what is Wallerian degeneration?
transection that results in degernation of the axon and myelin sheath
47
what is an example of segmental demyelination?
GBS - axons preserved, remyelination restores fxn
48
what are the 3 classes of traumatic nerve injury
I - neurapraxia (transient loss of fxn) II - axonotmesis (axon interruption, loss of fxn distal to lesion, REGEN POSSIBLE) III - neurotmesis : complete loss of fxn 2/2 severance of nerve
49
what are the characteristics of trigeminal neuralgia?
brief paroxysms of neurogenic pain (stabbing and/or shooting pain) reocurring freq ; 2/2 autonomic instability, this is exacerbated by stress and cold and relieved by relaxation
50
Bell's Palsy affects taste where?
anterior 2/3 of tongue
51
what can you do to protect the cornea in bell's palsy?
eye patching or artificial tears until restore fxn
52
bulbar palsy refers to..
weakness or paralysis of the muscles innervated by the motor nuclei of the lower brainstem, - affects ms of face, tongue, larynx and pharynx - ALS is one type
53
the 2 CNs most typically affected w bulbar palsy are..
Vagus & glossopharyngeal | -phonation, articulation, palatal action, gag reflex, swallowing
54
GBS involves demylination of..
both CNs & peripheral nerves
55
What are the UMN signs of ALS?
Spasticity and hyperreflexia; also demos LMN signs (atrophy, widespread weakness, ms cramping and ms twitching)
56
What are the two main types of ALS ?
Bulbar onset - progressive bulbar palsy | Spinal cord onset - progressive ms atrophy
57
At what stage of ALS are you a w/c user?
Stage IV
58
What CNa tend to be affected in ALS and GBS?
VII , IX-XII
59
What is the only pharm intervention that slows ALS disease progression?
Riluzole
60
At what point should exercise be avoided with ALS?
If less than 1/3 of motor units are functioning
61
Patients with PPS may have difficulty with what cognitive functions?
Concentration, memory and attn | Damage to reticular formation, hypothalamus, dopaminergic neurons
62
What type of sensory deficits should you expect in PPS?
NONE
63
To increase Aerobic capacity in PPS, what machine should you use?
Ergo meter that involves UE&LE
64
What meds decrease fatigue and sleep disorders in PPS?
NT inhibitors ie serotonin, norepinephrine
65
What pathway is fast pain transmitted via?
A delta fibers (poly modal non myelinated) ; for LOCALIZATION, discrimination of pain
66
Slow pain is transmitted via.. And tells cortex ..
Via C fibers | - diffuse arousal (protective/adverse reactions), affective and motivational aspects of pain
67
To be classified as chronic pain, must exist for..
>6 mos
68
Nociceptive pain is response to..
An immediate noxious stimulus signaling impending tissue damage
69
Central neurogenic pain often presents as ..
Burning, aching and prickling (from injury/damage to CNS )
70
What type of stroke produces central post stroke pain?
CVA of central posterolateral thalamus | -continuous intense central pain
71
CRPS is an example of what type of pain?
Peripheral neurogenic pain
72
What is allodynia?
Pain upon light touch
73
What is hyper pathia?
Increased sensitivity to normal stimuli
74
What is shingles ?
Herpes zoster (it's a "peripheral neurogenic pain") - acute painful mononeuropathy - infection can last 10 days to 5 weeks - post therapeutic neuralgia pain may persist for months or years
75
Fibromyalgia vs myofascial pain syndrome :
F- widespread tenderness in ms, MPS - involves deep aching pain w trigger points
76
Where does referred pain for the gallbladder manifest?
Right subscapular pain
77
What is a valid subjective pain questionnaire to use with chronic pain?
McGill Pain Questionnaire
78
what CN controls corneal reflex?
CN V trigeminal
79
when do pts w MS typically have the LEAST amt of fatigue?
early AM

Neuromuscular Physical Therapy (7 decks)

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