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neuromuscular II > final exam intro to actue inflammatory demyelinating polyneuropathy (AIDP) > Flashcards

final exam intro to actue inflammatory demyelinating polyneuropathy (AIDP) Flashcards

1
Q

UMN and/or CNS: (8)

A

Dementia
Stroke
TBI (including concussion)
Multiple Sclerosis
Cerebellar Disorders
SCI above T10
Parkinson’s Disease
Huntington Disease

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2
Q

Mixed (2)

A

ALS
SCI between T10-L2

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3
Q

LMN and/or PNS: (6)

A

SCI below L2
Vestibular hypofunctions
AIDP
CIDP
Post-Polio
Polyneuropathies

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4
Q

What is AIDP:
-the main subtype of
-acute _______ ______ that is initially ascending and progressive
-commonly related to recent _______ or _______ infections (vestibular neuritis/labyrinthitis)
occurs via demyelination of PNS at the ___________

A

GBS
acute flaccid paralysis
viral or bacterial
node of ranvier

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5
Q

Prevalence of AIDP:
men___women
race?
ages?
3-7% mortality rate due to?
20% have lasting deficits, which require?

A

> white
all ages: peak is in young adults or people in the 5th/8th decades
mechanical ventilation
bilateral AFOs

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6
Q

Etiology of AIDP:
common __________________ bacterial infection
—most common cause of the subtypes involving _______damage
common after ___________ and also common Sx and vaccinations
______% of patients who got GBS had a viral or bacterial infection in the 30 days preceding

A

post-campylobacter jejuni (c-jejuni)
axonal
influenza
90%

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7
Q

Pathophysiology of AIDP:
—typically attacks ________ nerves
—can attack sensory and motor but mainly _______
—in AIDP specifically, there is ________ sensory involvement

A

peripheral
motor
minimal

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8
Q

Pathophysiology of AIDP:
—in subtypes, there is more sensory or motor involvement?
—anti-inflammatory process involving T-cells and macrophages resulting in _______
—Node of Ranvier is partially affected leading to decreased ________ ________

A

sensory
demyelination
nerve conduction

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9
Q

Pathophysiology of AIDP:
Can have damage all the way to axons, especially in subtypes like AMAN, which can lead to lack of _______

A

sweating (involvement of autonomic nerves that control sweat gland function)

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10
Q

Symptoms of AIDP

A

bilateral ascending weakness
rapid and progressive initially
absence of DTRs

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11
Q

AMAN: Acute Motor Axonal Neuropathy:
–more or less severe
—more likely to have ________ involvement and _____ dependence
–significant residual symptoms

A

more severe
respiratory; vent

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12
Q

ASAN: Acute Sensory Ascending Neuropathy
–_________ changes more prominent than weakness

A

sensory

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13
Q

AMSAN: Acute Motor and Sensory Axonal Neuropathy:
–autonomic dysfunction is worse
–may have: (3)

A

postural hypotension, impaired sweating, bowel and bladder changes

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14
Q

CIDP: Chronic Inflammatory Demeneylanting Polyneuropathy
–onset?
–relapses/readmissions likely or unlikely?

A

slow onset
likely

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15
Q

Can facial nerve be affected by AIDP?

A

yes, CNs are peripheral nerves
—AIDP, patients may experience facial weakness or paralysis on one or both sides of the face.

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16
Q

What are the three phases of AIDP

A

Progressive
Plateau
Recovery

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17
Q

AIDP Progression:
rapid progression up to:
plateaus:
heal:

A

4 weeks
2-4 weeks similar to SCI
heal proximal –> distal but begins on distal –> proximal

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18
Q

The progressive phase of AIDP ends in _______________ of cases by 2 weeks and in 90% by ______ weeks.

A

50% ; 4 weeks

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19
Q

On average, peak impairment in AIDP occurs around _______________.
The progressive phase of AIDP involves ascending demyelination that can last from _______________.

A

4 weeks
2-6 weeks

20
Q

Approximately _______________ of patients in the progressive phase of AIDP require mechanical ventilation.
AIDP can also attack the autonomic nervous system, leading to _______________.

A

30%
arrhythmia, tachycardia, BP changes, ileus

21
Q

AIDP progressive phase pts. are usually kept in what setting due to possible need of ventilation?

A

acute care

22
Q

Plateau or Stable Phase:
–around _____ weeks when progression stops but__________ has not fully occurred yet
–usually lasts 2-4 weeks

A

4; remyelination

23
Q

Recovery Phase of AIDP:

A
  1. nerves start remyelinating and repairing
  2. process takes months to years depending on level of damage (heals 1 mm/day)
  3. recovery happens proximal to distal
24
Q

Diagnosis for AIDP:
clinical features:

A

—bilateral and flaccid weakness of limbs
—decreased or absent DTRs
—absences of alternative diagnosis

25
Q

Diagnosis for AIDP- additional features:
severe or mild sensory symptoms?
progress after 2-4 week of _______?
CN involvement or involvement?
Autonomic Dysfunction
Absence of __________?*

A

mild
plateau
involvement
fever

26
Q

Diagnosis for AIDP: CSF Analysis
_______ CSF protein levels after 1 week
continued increase with _______ testing
less than _____ leukocytes/mm

A

increased
repeat
10

27
Q

Diagnosis for AIDP: nerve conduction velocity studies
_________ at 2 weeks
________ across the entire nerve
_________ potential present in case of axonal damage

A

slowest
decreased
fibrillation

28
Q

How do you check CSF, what diagnostic test is used?

A

Lumbar puncture/spinal tap

29
Q

AIDP: medical management
In an acute situation, you should _____ the patient. Monitor changes, and be prepared to _______ if necessary.

The two main treatments are:

A

admit; intubate
high dose IVIG
plasmapheresis
*don’t have to do both, each is individually effective

30
Q

IVIG: immunoglobin treatment
a _________ that attacks foreign mechanisms
need ______ dose
_____ day course via IV
best for __________ adults in the first two weeks of onset

A

protein
high
5
non-ambulatory

31
Q

Plasmapheresis: plasma exchange
–filter blood plasma and remove ____
–most effective within ____ weeks of onset

A

antibodies
2

32
Q

AIDP medical management: plateau phase
_______ off vent
get into _______

A

wean/get off
therapy

33
Q

AIDP medical management: recovery phase
EMG to _______ nerve conduction recovery over time
refer to ______

A

track
PT

34
Q

AIDP worse prognosis w/

A

age >40
delay in diagnosis
delay in treatment
C-jejuni infection causing it
if mechanically ventilated at any point

35
Q

AIDP better prognosis w/

A

younger age
no diarrhea preceding the diagnosis
lower level of disability symptoms and admission
longer interval between symptom onset and admission (non-rapid progression)
no need for mechanical ventilation

36
Q

MOST AIDP pts. recover in ______ years?
AIDP pts. still see changes up to ______ years?
About _____% do not reach full recover

A

first year
3 years
20%

37
Q

AIDP settings: usually begins in _______ specifically, may not have tolerance for _________

A

acute care (ICU), acute rehab

38
Q

PT exam/eval: early/progressive stage
-acute care (ICU)
-integ
-msk
-neuro
-cardiopulm: ABG –> PO2 cannot be less than 70mmg or that would be indicative of ________ ________

A

range of motion
positioning and pressure injuries (roll, prone)
MMT
DTRs, sensation (likely intact)
respiratory failure (tachypnea/confusion)

39
Q

PT interventions: early/progressive stage

A
  1. positioning (prevent wounds)
  2. PROM (maintain jt. mobility)
  3. respiratory treatments - prone better ability to breathe, clearing secretions, assisted coughing, spirometry,
40
Q

PT interventions: early/progressive stage - high intensity exercise at this phase results in ________ functional status

A

worsened

41
Q

PT exam/eval: plateau stage
-neuro
-msk
-integ
-cardiopulm: begin to _____ off vent, vitals, respiratory ability, upright positioning

A

DTRs, Sensory
ROM, muscle function
pressure injuries
wean

42
Q

PT interventions: plateau stage
PROM:
INTEG:
Cardiopulm:
Functinal mobility such as:

A

PROM: progress to AAROM, and AROM as able

INTEG: edu, self management

Cardiopulm: incentive spirometry, cough physiotherapy, breathing techniques

upright in chair, STS, transfers

43
Q

PT exam/eval: recovery phase
-neuro
-msk
-integ
-cardiopulm:

A

DTRs, sensory
ROM, muscle function
pressure injuries
vitals, respiratory ability

44
Q

PT intervention: recovery phase
-PROM
-Strengthing
-Integ:
-Cardiopulm:
-Functional mobility

A

PROM: progress to AAROM/AROM as able

Strength: eccentrics not contraindicated but use your judgement

-Integ: edu, self management (mirrors) , wound care from earlier phases

-Cardiopulm: incentive spirometry, cough physiotherapy, breathing techniques, aerobic training (cycle ergometer is good) 30-60 min 3x/weerk at 70-90% HR Max

-Functional mobility: make salient and applicable

45
Q

AIDP POC: discharge planning at each phase depends on:

if vent need –> great for ______ setting

A

severity and disability in ea.
how long ea phase last
insurance coverage
functional mobility
psychosocial/environmental factors

LTACH

neuromuscular II (18 decks)

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