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NPTE > Neuro DDx > Flashcards

Neuro DDx Flashcards

PD, MS, ALS, GBS

1
Q

UMN lesion description

A

Structures: cortex, brainstem, spinal cord

Tone: INCREASED - hypertonia, velocity dependent (spasticity)

Reflexes: INCREASED - hyperreflexia, abnormal reflexes (clonus, babinski)

Sensation: DECREASED

Involuntary movements: muscle spasms

Voluntary movements: synergistic patterns

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2
Q

LMN lesion description

A

Structures: peripheral nerves, nerve roots, cranial nerves

Tone: DECREASED - hypotonia

Reflexes: DECREASED - hyporeflexia or absent

Sensation: DECREASED

Involuntary movements: denervation - fasciculations (twitching)

Voluntary movements: weak or absent

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3
Q

Basal ganglia lesion description

A

Structures: basal ganglia

Tone: INCREASED - rigidity

Reflexes: decreased or normal

Sensation: normal

Involuntary movements: resting tremors

Voluntary movements: hypokinesia, bradykinesia, akinesia

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4
Q

Cerebellum lesion description

A

Structure: cerebellum

Tone: decreased or normal

Reflexes: decreased or normal

Sensation: normal

Involuntary movements: none

Voluntary movements: ataxia, intention tremor, dysdiadochokinesia, dysmetria, nystagmus

Balance and coordination

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5
Q

Parkinson’s disease description

A

Basal ganglia
Depletion of dopamine in the substantia nigra
Older adults
Male > females

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6
Q

PD primary symptoms

A

TRAP
- tremors (resting, unilateral)
- rigidity (cogwheel or lead pipe, asymmetrical, proximal)
- akinesia
- postural instability (thoracic kyphosis)

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7
Q

Two types of rigidity

A

Lead-pipe: smooth, consistent, sustained through ROM

cogwheel: ratchet-like, jerky resistance through ROM (tremor + rigidity)

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8
Q

Hoehn and Yahr Stage 1

A

Minimal or absent, unilateral if present

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9
Q

Hoehn and Yahr Stage 2

A

Minimal bilateral or midline involvement. Balance not impaired.

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10
Q

Hoehn and Yahr Stage 3

A

Impaired righting reflex
Unsteadiness when turning or rising from chair
Some activities restricted, but patient can live independently and continue some forms of employment

Balance: B = 3

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11
Q

Hoehn and Yahr Stage 4

A

All symptoms present and severe. Standing and walking possible only with assistance.

Needs AD > 4WW > Stage 4

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12
Q

Hoehn and Yahr Stage 5

A

Confined to bed or wheelchair

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13
Q

PD other symptoms

A

Early: loss of smell (CN1), constipation, sleep disorders

Motor: hypophonia, mask-like face, micrographia

Cardio: orthostatic hypotension, abnormal response to exercise, fatigue, weakness

Respiratory: restrictive lung disease 2/2 posture, decreased lung expansion

Cognition/behavior: difficulty with dual tasking, depression, dementia

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14
Q

PD gait

A

Freezing of gait
Festinating gait
Decreased step width and length (shuffling)
Decreased trunk rotation and arm swing
En bloc turning (whole body)

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15
Q

Freezing of gait

A

Sudden inability to initiate movement
Cognitive overload

intervention: visual targets, distraction, music, wide doorways, mod environment

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16
Q

Festinating gait

A

Compensation for anterior momentum 2/2 kyphosis

Short stride, shuffling, increasing speed, anteropulsive

intervention: add toe wedge or declined heel to move COM posteriorly

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17
Q

PD interventions

A

caregiver education

gait training (metronomes, music, visual cues)

posture (rotation, crossing midline, prone lying)

hypokinesia (big movements and voice, stretching/ROM)

balance

tai chi, yoga, cycling, dance

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18
Q

Gold standard PD pharm treatment

A

Levodopa/carbidopa

Higher level L-dopa delivered to brain

Side effect: on/off phenomenon

Schedule PT 1 hour after dose

High protein diet can block med effectiveness

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19
Q

On/off phenomenon

A

Random fluctuations in motor performance and response. PD med side effect.

Dyskinesia (ON) vs dystonia (OFF)

20
Q

Dyskinesia

A

Involuntary, repetitive, smooth, muscle mvmt (snake-like twisting of arm)

Affects large muscle groups

Not usually painful

ON phase

21
Q

Dystonia

A

Prolonged, involuntary muscle contractions; muscle spasms (toe curling)

Affects a specific muscle or group of muscles

Causes pain

OFF phase

22
Q

Multiple sclerosis description

A

UMN
Autoimmune
Progressive demyelination of CNS neurons (brain and spinal cord)
Decreased nerve conduction

23
Q

MS signs and symptoms

A

Motor: spasticity

Sensory: numbness, paresthesias

Cerebellum voluntary movements: nystagmus, coordination, balance, ataxia, intention tremor (MS typically UMN but can sometimes affect cerebellum)

Gait: scissoring, extensor spasticity in LE, ataxia, uneven steps

Bladder: spastic, flaccid

Speech and swallowing: dysphagia, dysphonia

Emotion: pseudobulbar affect

Cognition: diminished attention, concentration

Optic neuritis, trigeminal neuralgia

Fatigue

24
Q

MS unique signs and symptoms

A

Lhermitte’s sign
Uhthoff’s phenomenon
Charcot’s triad
Cranial nerve II

25
Q

Lhermitte’s sign

A

“LAIR-MEES” > “hair messy”

electric shock sensation down spine with neck flexion

26
Q

Uhthoff’s phenomenon

A

Heat worsens symptoms

“U Turn Heat OFF”

27
Q

Charcot’s triad

A

S.I.N. (cerebellum)

Scanning speech
intention tremor
nystagmus

28
Q

MS CN II symptom

A

inflamed, optic neuritis

Marcus Gunn pupil: pupils will dilate w/ light

29
Q

MS types

A

Progressive relapsing
Secondary progressive
Primary progressive
Relapse-remitting

30
Q

Progressive relapsing MS

A

Steady increase in disability with superimposed attacks

Worst kind

31
Q

Secondary progressive MS

A

Initially RRMS, then symptoms increase without periods of remission

32
Q

Primary progressive MS

A

Steady increase in disability without attacks or exacerbations

33
Q

Relapse remitting MS

A

Short duration attacks with full or partial recovery, may or may not leave lasting symptoms/deficits

Most common form of MS (80%)

34
Q

MS interventions

A

Do not overfatigue
Manage overheating/temp
Energy conservation
Exercise best in the morning
Coordination and balance training

35
Q

MS FITT

A

F: 3-5x/wk (alternating days, mornings preferred)
I: Low intensity 3-5 METS, 50-70% VO2max
T: 30 min per session
T: cycle, walk, swim, circuit training

36
Q

Amyotrophic lateral sclerosis (ALS) diagnosis

A

UMN & LMN
Motor neuron disorder (MND), sensation intact

Progressive neurological disorder that damages nerve cells and causes disability

Death of motor neuron

37
Q

ALS signs and symptoms

A

UMN/LMN presentation w/o sensory loss
- muscle atrophy, fasciculations (LMN)
- spasticity, hyperreflexia (UMN)
- dysphagia, dysarthria (bulbar)

Motor neurons affected only

Cognition: dementia, attention deficits

Emotion: pseudobulbar affect, emotional lability

Muscles: cervical spine extensors weakness is common

Respiratory muscle weakness > death

38
Q

ALS management

A

No effective medical management

PT
- ADLs
- energy conservation
- soft foam collar for neck weakness
- breathing exercises
- avoid over fatigue (frequent breaks)
- ROM, positioning

39
Q

Guillain Barre Syndrome diagnosis

A

LMN
autoimmune

occurs commonly after infection

acute inflammatory demyelinating polyradiculoneuropathy

rapid asymmetrical loss of myelin in nerve roots, peripheral nerves, cranial nerves

40
Q

GBS signs and symptoms

A

Motor loss/paralysis
- distal to proximal
- rapid, progressive

Sensory loss
- glove and stocking (B, symmet)
- burning, tingling, numbness

Decreased reflexes/areflexia

Respiratory involvement

CN VII, IX, X, XI, XII involved

Fatigue

41
Q

GBS intervention

A

Respiratory care
Energy conservation techniques
Avoid overuse/fatigue (can prolong recovery)

Recovery: 6-12 mo, may recover fully

42
Q

Which diagnosis?
Increased tone, reflexes, and babinski

A

UMN > MS, stroke

43
Q

Which diagnosis?
Marcus Gunn pupil, trigeminal neuralgia, pain w/ neck flexion

A

MS

44
Q

Which diagnosis?
difficulty w/ neck extension and extreme weakness/fatigue

A

ALS

45
Q

Which diagnosis?
loss of sensation in hands/feet and weakness ascending the limbs

A

GBS

NPTE (10 decks)

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