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Clinical Neuro > Final > Flashcards

Final Flashcards

1
Q

Herpes Simplex and Varicella remain dormant

A

In sensory ganglia

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2
Q

Post Herpetic Neuralgia

A

Severe pain along nerve pathway
Condition seen especially in people >60 y/o
Rarely is also motor paralysis

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3
Q

PT role in management of person with varicella zoster

A

Keep track of strength

Possibly manage pain

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4
Q

Stages of HIV infection

A 
Early stage (Asymptomatic): CD4 count >500. No need for retroviral txt
Middle stage (symptomatic): CD4 count 200-500. Retroviral probably needed
Late stage (advanced disease): CD4 count
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5
Q

Goal of txt of HIV

A

Minimize viral load
More load = more rapid disease progression
Viral load is prognostic indicator

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6
Q

Opportunistic infections for HIV pt

A

ADC = HIV Encephalopathy or Dementia Complex
Cryptococcal Meningitis
Viral Encephalitis
Progressive multi focal leukoencephalopathy
Toxoplasmosis
Herpes
Cytalomegavirus

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7
Q

AIDS Dementia Complex

A

The most common neurological complication of AIDS; major cause of dementia in the young
“HIV encephalopathy”
1/4 ppl with HIV

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8
Q

Symptoms of ADC

A 
Apathy
Social withdrawal
Difficulty concentrating
Difficulty with complex mental tasks
May be mistaken for depression

All changes in affect

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9
Q

Patient with HIV walks into your clinic. The patient exhibits these behaviors upon your examination that make you think ADC

A

Slowing of verbal and motor tasks
Unsteady gait
Decreased ability to perform repetitive movements (not dysdiakinesia)

Needs txt because pt will eventually be mute, bedridden, paraplegic, and incontinent.

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10
Q

What is the link between Cerebral Toxoplasmosis and HIV patients?

A

CATS!

Patients should be using gloves and masks when cleaning litterbox

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11
Q

Inflammatory Demyelinating Polyneuropathy (IDP)

A

Asymptomatic patients present with weakness but without sensory loss

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12
Q

Primary CNS tumors

A

Develop/start in the brain, SC or supporting tissues
Do not typically metastasize from the brain to other parts of the body due to the lack of a Lymphatic system in the brain

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13
Q

Metastatic Tumors

A

Travel to the CNS from other sites (lungs, breast, GI tract, GU tract, Melanomas)

Can spread from one part of the CNS to another via the CSF

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14
Q

Effects of a Space Occupying Lesion

A

Mechanical displacement of brain and SC. Will damage and destroy brain tissue
Blockage of CSF circulation. In young -> hydrocephalus. In adult -> increased ICP

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15
Q

What is a focal neurological deficit?

A

A problem in nerve, spinal cord, or brain function that affects a specific location. Ie: left arm, right arm

Also refers to any problem with a specific nervous system function

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16
Q

Clinical signs of Elevated ICP

A

Headache

Seizures

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17
Q

Headache associated with increased ICP

A

Worse with straining activities (coughing, lifting, etc)
Awakens person from sleep
Worse in AM; may get better during the day d/t erect position causing drainage
Often accompanied by nausea, vomiting and papilledema

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18
Q

Seizures are more likely to accompany

A

Slow growing tumors

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19
Q

Differentiation

A

The extent to which parenchyma like cells resemble their normal forbearers morphologically and functionally

The more differentiated the cell, the more similar it is to its original cell type, both morphologically and functionally. Is better than poorly differentiated

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20
Q

Anaplasia

A

Hallmark of malignancy

When malignant cells are composed of undifferentiated cells; Do not have specialized functional activity

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21
Q

The less differentiated the cell

A

The less similar it is to its original cell type, both morphologically and functionally
The tumor cell cannot perform the originally intended/needed functions

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22
Q

“Cells are well differentiated” is this good or bad? What does it mean?

A

It’s good bc cells are able to do their specialized function

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23
Q

“Cells have high degree of Anaplasia” is this good or bad? What does it mean?

A

It’s bad. Means they’re malignant, undifferentiated. Have no specialized function

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24
Q

“Cells in sample are undifferentiated” is this good or bad? What does this mean?

A

Bad. Cells are different from what they were originally

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25
Q

Tumor grading

A

G1: well-differentiated (low grade)
G2: moderately differentiated (intermediate grade)
G3: poorly differentiated (high grade)
G4: undifferentiated (high grade)

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26
Q

TMN staging system

A

T - tumor size
M - metastasis
N - nodes

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27
Q

I-IV staging system of CNS tumors

A

I - no spread beyond structure of origin
II - spread into adjacent tissue
III - spread beyond own region, but not distant
IV - involves another organ or distant site

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28
Q

Neurinomas

A

Slow growing benign tumors that originate from Schwann cells
Typically develop in vestibular portion
Clinical presentation is sensorineural hearing loss, tinnitus, and vertigo

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29
Q

CD4 Count

A

Normal T cell count = 500-1500

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30
Q

LMN lesion signs

A 
Hyporeflexia or Areflexia
Hypotonia
Fasciculations and Fibrillations
Muscle weakness
Atrophy
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31
Q

LSN lesion signs

A

Hyporeflexia/Areflexia

Dermatomal pattern of paraesthesia/anesthesia, hypoesthesia, hyperesthesia

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32
Q

Neuropathy

A

Disorder of the nerve

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33
Q

Myelinopathy

A

Disorder of the myelin; due to disease state

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34
Q

Dying Back Neuropathy

A

Progression of disease state and signs/symptoms distally to proximally. Starts at the most distal parts of the nerve fiber and progresses proximally approaching the cell body.

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35
Q

Guillan-Barre Syndrome (GBS)

A

Acute Inflammatory Demyelinating Polyneuropathy (AIDP)
Most common in 5th-8th decades of life. Females > Males. White > Black
Is idiopathic
Possible autoimmune response that damages peripheral nerves

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36
Q

Risk Factors linked to Guillan-Barre Syndrome

A

Most cases are preceeded by cases of:
Infections: Bacterial (Campylobacter jejuni)
Viral (Haemophilus influenza), Epstein-Barr, CMV
Surgery
Vaccination (H1N1)

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37
Q

Pathogenesis of Guillan-Barre Syndrome (GBS)

A

Believed to be autoimmune attack on PNS myelin
Affects PNS from spinal nerve roots to distal termination of motor and sensory fibers
Inflammatory response results in macrophages and lymphocytes that strip myelin from PNS nerves
*Affects nerve roots and peripheral nerves
*Damages myelin sheath

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38
Q

Remyelination

A

Mediated by Schwann cells

Recovery results in shorter internodal distances

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39
Q

Clinical Presentation of GBS

A

Rapidly evolving
Ascending symmetrical motor and sensory deficits with sparing of extraocular muscles
Usual progression of bilateral paralysis/paresis is from distal to proximal
Weakness may be only in extremities or may result in tetraplegia along w/ involvement of respiratory muscles and cranial nerves. Dysphagia often present
Areflexia
Paraesthesias and hypersthesias. Pain often present. “Stocking-glove presentation”
Some ANS involvement: Decreased cardiac output, tachycardia, BP fluctuations, cardiac rhythm changes, possible sudden death

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40
Q

Most common cause of mortality in GBS

A

Respiratory failure, so mechanical ventilation required ~30% of patients

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41
Q

Recovery from GBS

A

Can last months to years, occurs in a proximal to distal manner

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42
Q

GBS Phases

A 
Actue phase (Onset to about 2-4 weeks)
Static phase (weeks 3-5, about a 4 week period w/ stable conditions but sxs still present)
Gradual Recovery (months to years)
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43
Q

Medical Management of GBS

A

Plasmapheresis

High does IV administration of immunoglobulin

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44
Q

Interventions for Management of GBS

A 
Pulmonary PT
Position and ROM
Motor Learning
Strengthening
Functional Training
Education
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45
Q

More is better w/ a GBS patient RIGHT?! No Pain no gain

A

No it’s a possible contraindication to exercise
Avoid muscle fatigue; it can lead to significant loss of strength
Provide freq rest periods
Only GENTLE stretches
Return to bedrest if decrease in function or strength occurs
Overwork of respiratory muscles may lead to profound decrease in respiratory function

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46
Q

Acute Poliomyelitis

A

Viral in origin
Affects the anterior horn cell
Presentation is asymmetrical: Effects proximal > distal; including trunk. LE > UE

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47
Q

SxS of Acute Poliomyelitis

A

1st 2 weeks: fever, malaise, myalgia, sore throat, GI upset
Flaccid paralysis
Hyporeflexia or areflexia
Sensation intact. Myalgia can be intense
Bulbar symptoms: Dysarthria, Dysphagia, Extraocular sparing, Death d/t respiratory involvement

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48
Q

Recovery from Acute Poliomyelitis

A

Restoration of neurons not irreversibly damaged. Collateral sprouting from surviving axons
Compensation via hypertrophy of undamaged muscles = “denervation hypertrophy”
Many individuals use muscle substitution to achieve functional goals
Often ligaments are used for stability -> ligamentous hypermobility and eventually malalignment of trunk and limbs

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49
Q

Polio is long gone right?

A

NOO!

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50
Q

Diabetic Neuropathy presents

A

Distal symmetrical presentation, occasional focal pattern

51
Q

Most common findings in Diabetic Neuropathy

A 
Painless distal paraesthesia
Loss of vibration and proprioception
Diminished DTRs
Sensory Ataxia gait
"Dysvascular Symptoms", usually arterial disorders
Person may have had MI w/o knowing it
52
Q

Vertigo

A

The characteristic symptom is a false sense of spinning or rotation. Has 2 types of true vertigo: Central and peripheral

53
Q

Central Vertigo

A 
Structures involved include the cerebellum, brainstem, medulla, and pons
 Vertebro-basilar insufficiency
 Cerebellar hemorrhage
 Brainstem ischemia
 MS
 Migraines
 Neurolabyrinthitis
 TIAs
54
Q

Peripheral Vertigo

A

Results from abnormalities in the vestibular end organs (semicircular canals and the utricle), the vestibular nerve, and the vestibular nuclei
Benign Paroxysmal Positional Vertigo (BPPV)
Labyrinthitis
Vestibular Neuritis
Otitis Media
Meniere’s disease

55
Q

Central vs Peripheral Vertigo

A

Central: Purely vertical, horizontal, or torsional; not inhibited by fixation of eyes onto object. Rarely hearing loss. Severe unable to stand still or walk

Peripheral: combined horizontal and torsional; inhibited by fixation of eyes onto object; fades after a few days; does not change direction w/ gaze to either side; Commonly hearing loss; Mild to moderate imbalance when walking

56
Q

Benign Paroxysmal Positional Vertigo

A

Most common cause of sudden onset vertigo. Easily treated. Remove otoconia from semicircular canal
Positional testing may include Dix Hallpike (posterior and anterior canals)
Roll test (for horizontal canals)

57
Q

Selective Brain Atrophy in Elderly

A

More cell loss in the hippocampus and cortex than in the cerebellum and brainstem

58
Q

Changes in NT activity w/ Elderly

A

Decrease especially in dopamine, epinephrine, and norepinephrine. Decrease in receptor
Serotonin appears to be reduced; involved in central regulatory activities like thermoregulation, sleep, respiration, and memory

59
Q

Muscle strength in Elderly

A

Muscle strength is fairly well maintained in adults thru 50 y/o
10-20% decrease in strength between ages 60-70
30-50% decrease in strength between ages 70-80

60
Q

Muscle atrophy in Elderly

A

Postural muscles (Quads, soleus) show greater atrophy than non-postural muscles

61
Q

Age-Related Changes in Muscle Tissue

A

Decrease in both type I and II. Greater loss proportionately of type II fibers (fast twitch)

62
Q

The 2 most important elements needed to maintain balance are

A

Center of Gravity

Base of Support

63
Q

Postural stability is the ability to

A

Maintain Center of Gravity within Base of Support

64
Q

Postural orientation

A

Maintenance of correct alignment of body segments

Normally utilizes input from visual, somatosensory and vestibular systems

65
Q

Limits of stability (LOS)

A

The farthest distance in any direction a person can lean (away from midline) w/o altering the original BOS by stepping, reaching or falling

66
Q

Quiet Stance

A

Attain and maintain steady state

67
Q

Reactive/Adaptive Stance

A

Modifying postural responses to changing demands

Ex: boat, gust of wind, subway

68
Q

Proactive/Anticipatory Stance

A

Pre-tuning to meet expected postural demands

Ex: moving couch on stairs, lifting child, being thrown their groceries

69
Q

Balance Coordination in Elderly Change in Strategies

A

Dominated by hip and stepping strategies

D/t decreased muscle strength and vibration and proprioception sense

70
Q

Multiple Systems Involved in Balance

A 
Motor System
Peripheral Sensory (Somato, vestib, visual)
Higher level systems - Cb and BG for Feedback and feedforward functions
71
Q

Ambulation in the Elderly

A

Decrease gait speed, decrease vertical head movement, increase in lateral head movement
Increase in stride width and toe-out
Decrease in hip, knee, and ankle flexion
Decreased stride length
Longer double support stance time
Decrease plantarflexion force at pushoff
More flat-food landings (decrease force absorbed by quads at beginning of stance phase)

All of these a strategy to increase stability

72
Q

Arndt-Schultz Principle

A

The elderly need a longer period of stimulation and a higher threshold for stimulation
The elderly have a smaller response to stimulus, less visible response and less consistent response
The elderly have a narrower range of safe, therapeutic stimulation

73
Q

Balance in the elderly is

A

decreased

74
Q

The ability to register, retain, recall recent experiences in the elderly is

A

decreased

75
Q

The rate of learning new material in the elderly is

A

decreased

76
Q

Performing motor tasks requiring speed in the elderly is

A

decreased

77
Q

Fine motor coordination in the elderly is

A

decreased

78
Q

Difference between seizures and epillepsy

A 
Seizures = finite event caused by sudden, excessive electrical discharge of cerebral neurons
Epilepsy = family of disorders characterized by recurrent seizures
79
Q

Ictal refers to

A

Seizure

80
Q

Prodrome

A

Early SxS or set of SxS that may indicate the start of a disease - Premonition.
Includes headache, mood alterations, lethargy, myoclonic jerking (sudden rapid twitching)
Last from 30 mins to several hours
Prodromes are pre-ictal

81
Q

Aura

A

Changes in subjective sensations:
Bodily sensations, e.g., strange taste in mouth
Ability to interact w. things happening around you
How familiar outside world is – e.g., deja vu
May occur right before seizure (sz)/at start of seizure. Lasts up to 15 mins.

82
Q

What kind of generalized seizure is characterized by stare, fluttering eyes, and lasts 2-15 seconds?

A

Absence (Petite Mal)

83
Q

Call 911 if a patient is having a seizure and

A

Prolong duration >5 minutes
Pregnant pt (this could be a sign of preclampsia)
>1 seizure occurs w/in 24 hours
Pt does not respond normally w/in 1 hour post sz
Seizure accompany by CVA, TBI, DM, severe HA, post ingestion of poison or breathing fumes
Pt c/o severe pain after waking up or develops fever w/in 24 hrs post seizure

84
Q

A PT should educate the family of an individual who has seizures to position her in a (blank) position during/after a seizure.

A

Sidelying

85
Q

You are a PT working with a person who suddenly has a seizure. What are appropriate actions to take?

A

Move objects away to prevent injury to person with seizure
Time the seizure
Do not place anything in the patient’s mouth

86
Q

Signs of tardive dyskinesia are

A

Stereotypical facial movements, e.g., facial grimacing, chewing movements, tongue writhing &/or protrusions

Choreiform (dancelike) movements of extremities: “piano-playing” of fingers, larger choreiform movements of limbs

Can have respiratory dyskinesias

When severe, can be dysarthria and dysphagia leading to need for feeding tube

Condition worsens when patient does dexterity tasks, walking and doing cognitive task at same time, is fatigued or anxious

87
Q

PTs role in management of Tardive Dyskinesia

A

Early recognition

Communication w/ the health care team

88
Q

Medications associated w/ an increased incidence of Tardive Dyskinesia?

A

antiepileptic, antiemetic and antipsychotic medications

89
Q

Why is early recognition of Tardive Dyskinesia important?

A

The effects can be irreversible

90
Q

Lewey Body Dementia

A

Every person with LBD is different
Progressive dementia - deficits in attention and executive function are typical. Prominent memory impairment may not be evident in the early stages.
Fluctuating cognition with pronounced variations in attention and alertness.
Recurrent complex visual hallucinations, typically well formed and detailed.
Spontaneous features of parkinsonism.
Severe sensitivity to neuroleptics occurs in up to 50% of LBD patients who take them.
Repeated falls and syncope (fainting).
Transient, unexplained loss of consciousness.
Autonomic dysfunction.
Hallucinations of other modalities.
Visuospatial abnormalities.
Other psychiatric disturbance

91
Q

Lewey Body Dementia Diagnosis requires

A

Dementia plus two or more core features, or
Dementia plus one core feature and one or more suggestive features. AND THIS JUST FOR A PROBABLE DIAGNOSIS
Dementia plus one core feature, or
Dementia plus one or more suggestive features.
FOR POSSIBLE DIAGNOSIS

92
Q

The most common form of demyelinating disease

A

Multiple Sclerosis

93
Q

Multiple Sclerosis

A

A demyelinating disease characterized by a course of demyelination-mediated relapses and remissions, superimposed upon gradual neurologic deterioration. The demyelinating lesions are called plaques

94
Q

Origin of the Name MS

A 
Multiple = Multiple CNS sites
Sclerosis = Hardening = the plaques that result
95
Q

MS Incidence is most prominent in

A

20-50 y/o
Caucasians
“Temperate Climates”: Northern US; There is an environmental trigger in where a person spends their first 15 years of life
Genetic link

96
Q

MS is considered a (blank) disease

A

Autoimmune

97
Q

Primary Impairments and Conditions of Multiple Sclerosis

A 
Fatigue
Sensory Impairments
Weakness
Optic neuritis
Spasticity (UMN)
Heat sensitivity (for some the humidity is worse than actual heat)
Cerebellar signs [typically bilateral] (dizziness, vertigo, ataxia, other cerebellar signs)
Pain
Psychiatric issues
Bladder dysfunction
Bowel dysfunction
Sexual dysfunction
98
Q

PT considerations w/ working w/ an MS patient

A

Careful in prescribing exercise. They are prone to fatigue so want to be mindful of that. Fatigue is one of the biggest complaints from an MS patient.

99
Q

Uthoff’s Phenomena

A

Related to MS patients

Worsening of fatigue and weakness w/ elevation of body temperature

100
Q

Psychiatric issues in patients w/ MS

A

Most common cognitive changes are memory loss and impaired safety awareness
Euphoria is often seen in late stages
Possible Depression

101
Q

Secondary Conditions from MS

A

Overuse/Tendonitis secondary to spasticity
Progressive weakness d/t inactivity
Osteoporosis - from disuse and steroids
UTIs, respiratory infections, skin breakdown

102
Q

1 problem for MS patients that is commonly seen d/t steroid use (she underlined this multiple times)

A

OSTEOPOROSIS from steroids. The steroids are supposed to suppress immune function and limit the inflammatory response but the side effect is the osteoporosis.

103
Q

Besides for maintaining strength and preventing secondary problems of infection or skin breakdown a big part of PT should include what when working w/ MS patients

A

Energy Conservation Techniques (they’re fatigued)

104
Q

If you see degeneration of substantia nigra and decrease in dopamine you think

A

Parkinson’s

105
Q

If you see decrease in synaptic connections, amyloid plaques, decrease in ACTH, neuronal death, decrease in number of axons you think

A

Alzheimers

106
Q

If you see atrophy of basal ganglia, corpus striatum, and autosomal dominant gene you think

A

Huntington’s disease

107
Q

Diagnosis of Parkinson’s

A

Asymmetrical onset
Resting Tremor
Positive initial response to L-Dopa

108
Q

Diagnosis of Alzheimer’s

A

Definitive only made by Biopsy or

Autopsy finding of Amyloid Plaque formations.

109
Q

Diagnosis of Huntington’s

A

Genetic Marker; All individuals w/ gene will get HD

110
Q

Between Parkinson’s Alzheimer’s and Huntington’s which impacts younger typically?

A

Huntington 30-50 y/o. The others are usually 65+

111
Q

Risk factors for Parkinson’s

A

Age is the greatest risk factor
Possible family history
Damage to BG
Idiopathic

112
Q

Risk factors for Alzheimer’s

A

Idiopathic
15% have fam hx
Chromosome 21 mutation, esp.
Down Syndrome have high risk.

113
Q

Risk factors for Huntington’s

A

Inheriting gene; 50% chance of inheriting HD if one parent has gene

114
Q

Onset of disease in Parkinson’s Alzheimers and Huntingtons

A

Parkinsons is asymetrical

The others are insiduous and huntington’s is progressive

115
Q

Loss of ability to do math computations (e.g., handling money), sleeping & eating disorders, word-finding difficulty, loss of orientation, lost in familiar environments, subtle personality changes, (irritability, impulsiveness, indifference, paranoia, hoarding). You might be thinking?

A

Early Alzheimer’s

116
Q

Choreic mvmts (reported as “restlessness”), Personality/Behavioral/ Cognitive Changes. You’re thinking?

A

Huntington’s

117
Q

Parkinson’s TRAP

A 
T= Tremor (Resting tremor)
R = Rigidity (Lead pipe, Cogwheel)
A= Akinesia, Bradykinesia (both are considered motor planning deficits)
P = Postural Instability: FALLS RISK!!
118
Q

Cell loss in DRG with secondary degeneration in the posterior columns & spinocerebellar tracts

A

Friedrich Ataxia (Spinocerebellar Degeneration)

119
Q

Demyelination autoimmune in CNS. Scarring is caused by inflammatory process at multiple CNS sites = plaques. As disease progresses, myelin is replaced by Gliosis = fibrous scarring

A

Multiple Sclerosis

120
Q

Degenrerative scarring or sclerosis in lateral aspects of the SC, Brainstem & Cortex,
Peripheral nerve involvement leads to atrophy (amyotrophy)
= Combination of UMN and LMN

A

ALS or Amoyotrophic Lateral Sclerosis

121
Q

Diagnosis of Friedrich Ataxia

A

Absent DTR’s with Positive Babinski
Normal tone w/ flexor spasm
Motor Restlessness

122
Q

MMT of a patients w/ ALS

A

They won’t realize how weak they are, not until 80% of their motor neurons are gone

123
Q

Huntington’s disease is a disorder characterized by

A

Movement abnormalities
Dementia
Personality changes (disturbances)

124
Q

Huntington’s disease is a disorder characterized by

A

Movement abnormalities
Dementia
Personality changes (disturbances)

Clinical Neuro (5 decks)

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