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NPTE Final Frontier > Neuro Diff Dx > Flashcards

Neuro Diff Dx Flashcards

1
Q

Parkinsons Disease is depletion of _ from the _

A

Dopamine from the Substantia nigra
Exercise SLOWS the progression!

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2
Q

People w/ PD are TRAPped

CARDINAL SIGNS

A

T:Tremor– shaking, usually starts 1 side; “pill-rolling”
R: Rigidity– stiffness, of limbs, neck, or trunk (1. cogwheel 2. lead pipe)
A: Akinesia– LOSS or impairment in POWER of voluntary mvmt
P: Posture and Balance– Anteropulsion
Bradykinesia also present==> SLOWNESS of mvmt
Shuffling, short-stepped gait pattern
LOSS OF ARM SWING**

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3
Q

PD Sx’s: Resting Tremor

A

Often occurs first in ONE hand, resembles pill-rolling

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4
Q

PD Sx’s: Rigidity

A

Cogwheel (exactly what it sounds like) and Lead Pipe (exactly what it sounds like)

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5
Q

PD Sx’s: Akinesia, BRADYkinesia

A

Hesitation, SLOW mvmt.
Diff rising from a sitting pos is COMMON sign of disordered control over mvmt

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6
Q

PD Sx’s: Postural INstability

A

Lean FORWARD or BACKWARD when upright==impaired balance/coord.

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7
Q

PD Sx’s

A

see pics

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8
Q

This scale stages the SEVERITY of PD:

A

Hoehn and Yahr Stages
Staged 1 (good)-5 (worst)

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9
Q

Hoehn and Yahr Stages of PD
ALL: Stage 1 (best): Stage 5 (worst)

A

see pics

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10
Q

Hoehn and Yahr Stages of PD:
ALL

A
  • Stage 1: Develop MILD sxs but able to go about day-day life (BEST)
  • Stage 2: Sx’s such as tremors and stiffness worsen, may develop POOR posture or have trouble walking
  • Stage 3: Mvmt begins to SLOW DOWN, LOB (uses AD, falls/unbalanced, rollator
  • Stage 4: Sxs are severe and cause significant issues w/ day-day living, UNABLE to live alone and will need care
  • Stage 5: Walking or standing may be IMPOSSIBLE @ this point, people in Stage 5 often confined to WC or bed (WORST)
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11
Q

PD: Gait related impairments:
2 VERY characteristic ones…

A
  1. Festinating gait:progressive INC in speed w/ a shortening of stride–can be anteropulsive (forward festinating)
  2. Freezing of Gait (FOG)– sudden, abrupt INability to initiate ANY mvmt. Ex’s: doorways, turns
    - USE: music, count steps, cognitive tasks
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12
Q

PD related Gait impairments:
ALL

A
  • Festinating
  • Freezing
  • Diff turning: incd steps per turn
  • Reduced stride length; incd step-step variability
  • Reduced speed of walking
  • Incd time in DLS
  • Insuff hip, knee, and ankle flexion–> shuffling steps
  • Insuff heel strike w/ incd FOREFOOT loading
  • Reduced trunk rotation: DECd/absent arm swing**
  • Diff dual tasking–> simultaneous motor/cog
  • Diff w/ attn demands of complex environments
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13
Q

Training ideas for gait related impairments

A

Visual/auditory cueing
ex. ladder for equal step length, count steps

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14
Q

Medical mgmt PD:
GOLD STANDARD DRUG TX

A

LEVODOPA/CARBIDOPA (Sinemet)

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15
Q

Medical mgmt PD:
SEs and **what should you remember about this?? **

A

SEs: Dyskinesias–Dynamic INvoluntary choreoathetotic mvmts occurring @ peak of Levodopa dose–> Initial=facial grimace w/ twitch lips, tongue protrusion–> Severe=involves limbs, trunk, neck

REMEMBER: This is SE of the MEDS (Levodopa) NOT from PD itself!!!!

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16
Q

Practice!
PT working w/ 67yo male. Pt displays rigidity, slowed mvmts, INvoluntary oscillatory mvmts, intsability w/ recent uptick in falls. Based on presentation which neuro dx is likely ?

A

PD!!!
TRAPped

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17
Q

Huntington’s Disease (HD)

A
  • Neurodegen GENETIC (hereditary) disease– degen of BG, cerebral cortex
  • Autosomal-dominant illness– CAG repeats
  • Combo of–> mvmt disorders, COG decline, behavioral changes
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18
Q

NOTE: When you hear Parkinsonism

A

NOT actually PD from DEC in dopamine
Just “PD-like” sx’s

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19
Q

HD Sx’s:
AGE????

A

35-55

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20
Q

HD- Sx’s

A
  • 35-55yo
  • mm coord impairs AND cog decline, psychiatric probs
  • **Huntingtons Chorea–> **INvoluntary jerking or writhing mvmts (ex. unable to sit still)
  • MM probs–> rigidity or mm contracture (dystonia)–think superimposing involuntary mm’s– piano example w/ fingers
  • Slow/abnorm eye mvmts
  • Impaired gait, posture and balance
  • Diff w/ production of speech or swallowing*
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21
Q

Cerebellar disorders
THINK* in terms of tremor*…

A

INTENTION tremors

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22
Q

Three specialized regions of Cerebellum for controlling multiple types of mvmt

A
  1. Vestibulocerebellum
  2. Spinocerebellum
  3. Cerebrocerebellum
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23
Q

Vestibulocerebellum
Input, Output, Deficits as result

A

Input–> Vestibular
Output–> eye mvmts; vestib nuclei; balance/equilib
Deficits–> Nystagmus, TRUNCAL ataxia

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24
Q

Spinocerebellum
Input, Output, Deficits as result

A

Input–> Somatosensory, visual/auditory/vestib
Output–> medial upper motor neurons; lateral upper motor neurons
Deficits–> Ataxic gait, Limb ataxia (dysmetria)

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25
Q

Cerebrocerebellum
Input, Output, Deficits as result

A

Input–> Cerebral cortex
Output–> Motor and premotor cortex
Deficits–> DEC coord of fine finger mvmt

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26
Q

Practice!
Pt w/ NORMAL sensation and reflexes presents w/ DEC mm tone and asthenia (weakness). Which other s/s are MOST likely present?

A

Truncal Ataxia
CB disorders–> HypOtonia, lack energy, weakness (asthenia)

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27
Q

Cerebellar Disorder–> Coordination Testing

A

see pics and note Dx tests
- finger to nose, heel to shin

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28
Q

Finger to nose test– >

A

Cerebellar ataxia
*can also see dysmetria (over/under shooting)

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29
Q

S/S Cerebellar Disorder
Mnemonic to remember?

A

VANISHED

V: Vertigo
A: Ataxia
N: Nystagmus
I: Intention tremor
S: Slurred speech
H: HypOtonia
E: Exxagerated broad based gait
D: Dysdiadochokinesia

CB= intention tremor; BG= resting tremors

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30
Q

Cerebellar disorder:
Gait Ataxia explained…

A

INconsistent step LENGTH: not able to predict proper step length
Diff maint. SLS
Poor balance= INCd gait ataxia and slow gait
Diff predicting amt of wt shift needed

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31
Q

Some more Coord. tests for CB

A

Finger-> nose
RAM
Heel-> shin
Foot to finger

32
Q

NOTE for NPTE answering questions

A

IF 2 answers look SIMILAR to ea. other—-> likely BOTH wrong!!!!

33
Q

MS: main things to remember

A
  1. Autoimmune– inflamm, selective demyelination, gliosis
  2. Chronic demyelinating of CNS
  3. ANY area of CNS affected– cortical, subcort, CB, SC
34
Q

MS: Main characteristics

A
  1. MORE in females (2:1)
  2. Onset 20-40yo, PEAKS 30yo
  3. Occurs more caucasians
35
Q

MS: Etiology

Think… Sclerosis literally means scarring… **Multiple sclerosis*

A

Healthy myelin–> Oligodendrocytes produce myelin in CNS–insulates nerves, speeds conduction, conserves energy
- In MS: Destroyed or damaged myelin (WBCs attack neurons and affects myelin (fatty tissues around nerves in brain/SC)== multiple scarring (sclerosis), nerve signals blocked == MS sx’s

36
Q

HEAT SENSITIVITY in MS…. WHY?

A

Bc myelin sheath damaged **

37
Q

S/S MS:
3 big ones to know**

A
  1. Lhermittes’ Sign–Flex neck=> E-shock t/o extremities
  2. Uthoff’s Phenomenon–HIGH temp exposure=> exxag’d neuro sx’s (make sure they hydrate!!!)
  3. FATIGUE!
38
Q

S/S MS:
NOTE: impairs vary based on lesion location

A
  • Visual impairs (Optic Neuritis), sensory impairs, motor impairs
  • Intention tremor
  • Neuropathic pain
  • FATIGUE
  • Cog impairs
  • B&B dysf.
  • Emo. distrubs
  • Psychosoc probs
  • Lhermittes’
  • Uthoff’s Phenom.
39
Q

MS Dx:
The one to remember

A
  • CSF analysis–> Elevated immunoglobulins and presence of oligoclonal IgG bands, slight PRO elevation

DECd NCV

40
Q

Common types of MS:

A
  • Relapse-Remitting (RRMS)
  • Secondary Progressive (SPMS)– >85% progress to SPMS
  • Primary-Progressive (PPMS)
  • Progressive-Relapsing (PRMS)
41
Q

Types of MS:
Relapse-Remitting (RRMS)

A
  • Episodes of rapid, abrupt deterioration w/ variable degs of recover over time
  • aka Exacerbating-remitting
42
Q

Types of MS:
Progressive-Relapsing

A

Relapses w/ Lg degree of residual impairment
aka Exacerbating-progressive

43
Q

Types of MS:
Primary-Progressive
“Chronic-Progressive”

its in the name!

A
  • STEADY progressive deterioration
  • Pace of deterioration may be steady or varied

Nonetheless, still progressively worse and worse

44
Q

Types of MS:
Secondary-Progressive

In name, think the one that starts as Relapse-Remitting

A
  • BEGINS as relapse-remitting THEN becomes Primary (chronic)-Progressive
45
Q

MS:
Fatigue vs Fatigability

A

They will demo BOTH
Fatigue is symptom
Fatigability is a sign

46
Q

MS- Gait Related impairs
Big ones to know

Remember its **UMN lesion!! **

A
  1. Weakness– Foot drop==toe drag
  2. Spasticity– Velocity-dep, interferes w/ gait
  3. Balance probs–Swaying and “drunken” gait–> Ataxia
  4. Sensory defs– peripheral neuropathy= sensory ataxia
  5. Fatigue– incd gait probs (remember fatigability also! (sign)
47
Q

This is usually FIRST SYMPTOM OF MS

A

Visual impairments!!!

48
Q

Visual impairs: MS
Usually FIRST symptom!

A
  • Optic neuritis!
  • Marcus Gunn– abnorm Pup Lt Reflex (CN II messenger, CN III motor eff.
  • Nystagmus
  • Diplopia
49
Q

Practice!
32yo female has abnorm reflexes. “weird sensations” t/o body. Incd IgG in CSF. Asks PT to dec temp bc heat intol.

A

MS!!!!
- Inc IgG, heat intol, 35 yo (20-40 onset), female (2:1), weird sensations, abnorm reflexes (UMN)

50
Q

Practice!
43yo pmh includes MS. Reports over past 2 yrs sig. flare ups w/ declining mobility. Which subtype MS?

Flare ups W/ declining funcion

A

Relapsing-Progressive
Relapse but stiil progressively getting worse!

51
Q

MS:
Goals of PT interventions

A
  • Exercise and MS:Fatigue + heat intol combo’d w/ weakness/spasticity limits exercise—BUT people w/ MS get same results as normal people– THEY GET MORE FIT!!! DO INTERVAL TRAINING
  • Ex. considerations– AM bc decd temp and fatigue
52
Q

Big one to remember w/ Myasthenia Gravis

A

PTOSIS
- also WEAKNESS (asthenia)

53
Q

Side by side MS vs Myasthenia Gravis

A

see pics

54
Q

MS Clinical Charactristics

A
  • AcquiredDemyelinating disease w/ AI cause
  • weak, parasthesias
  • Charcots triad C in Charcots, C in Cerebellar–> INtention tremor, scannign speech, nystagmusCerebeller involve.
  • spastic, hypertone, hyperreflex, Babinski
  • INcoord, optic neuritis (often first), ataxia, vertigo, dysarthria (speech)
  • diplopia, bladder incont, tremor, balance defs, falls, cog defs
55
Q

Myasthenia Gravis Clinical Characteristics

NOTE that MG RECOVER FASTER FROM FATIGUE VS MS!!!!

A
  • NMSK Junction disorder
  • AI mediated AcH receptor damage==> deficit in NMSK transmission
  • WEAKNESS–worse during activities, improves after rest
  • Variable weakness–> ptosis/diplopia to critical resp weak.
  • MMs of speech, facial, mastication, swallowing, breathing, neck and limbs maybe involve.
56
Q

EARLY sx’s Myasthenia Gravis

*Sometimes the ONLY sx’s

A
  • ptosis (droopy eyelid)
  • diplopia (blurry double vision)
57
Q

Practice!
45yo female w/ recent dx of MS. C/O eye pain, visoin loss ONE eye and visual field loss. Which CN?

A

CN II (Optic)
*usually involved in MS, sometimes CN V

58
Q

Guillian-Barre Syndrome (GBS)
UMN or LMN?

A

LMN!!!!
think stocking glove

59
Q

Guillian-Barre Syndrome (GBS)
UMN or LMN?

A

LMN!!!!
think stocking glove

60
Q

Guillian-Barre Syndrome (GBS)
UMN or LMN?

A

LMN!!!!
think stocking glove

61
Q

Guillian-Barre Syndrome (GBS)
UMN or LMN?

A

LMN!!!!
think stocking glove

62
Q

GBS

remember LMN!!!

A
  • Autoimmune response– antibodies attack own PERIPHERAL NERVES
  • usually onset AFTER resp infx, GI infx
63
Q

Guillian-Barre or GBS
What is the B?

A

B stands for BILATERAL

64
Q

GBS–Pathogen

A

LMN disorder
- demyelinating of spinal N. roots AND P. nerves
- rapid onset of weakness (DIST–>PROX (stocking-glove) w/ BIlateral sx’s– peak 2-3wks, no > 4wks
- severity and course vary widely –usually norm fucntion w/in 3-6mos

65
Q

_ and _ usually FIRST SX’Sof GBS

A

Weakness and Tingling in extremities

66
Q

GBS Dx
MUST satisfy this criteria

A
  1. Symmetrical
  2. B for Bilateral
  3. Ascending (dist->prox= stocking-glove)
67
Q

GBS and Lumbar puncture

A

CSF contain more PRO than normal

68
Q

GBS
Sensory Sx’s

A
  • INITIALLY–> B/L and Symmetrical–> Stocking-glove
  • PAIN–> Lg mm’sof body–> back, thighs, butt
  • Stiff, cramping, deep ache–stretch them first 15mins
  • N/T and parasthesias/dysesthesias “ants under skin”
69
Q

GBS
Motor Sx’s

A
  • DECd signal strength of P. nerves
  • MM weak/atrophy
  • DTRs diminished
  • Partial OR full paralysis
  • Resp mm involve—mech. vent maybe
  • ## Facial/oral-motor weak– vision, speech, swallowing
70
Q

Amyotropic Lateral Sclerosis
A stands for_

A

ALL
UMN and LMN Sx’s

71
Q

ALS
“Lou Gehrig’s”
S/S

A
  • LMN patho– mm weak, hypOreflex, hypOtone, atrophy, mm cramps, fasciculations
  • UMN patho– spastic, patho reflexes, hypERreflex, mm weak
  • Bulbar– bulbar mm weak, dysphagia, dysarthria, siolorrhea, pseudobulbar affect (laugh or cry no reason)
  • Resp– insp/exp mm weak, dyspnea, DOE
  • Frontotemporal dementia–COMMON– loss insight, emo. blunting
  • Cog impairs– attn defs, defs in cog flex.
  • Behavioral impairs– irritable, social disinhibit.
72
Q

Dx of ALS= ALL–> UMN + LMN
Weakness HERE very common

A

CS Extensors!!!!!
MOST COMMON AND DEVASTATING FATAL MOTOR NEURON DISEASE AMONG ADULTS

NOTE: you will see head hanging forward

73
Q

ALS vs MS

A

Note the similarities vs diffs
*Note the Sensory issues w/ MS and NOT ALS

74
Q

Practice!
42 yo female c/o Asymmetrical weak of L/UEs. Fasciculations present (LMN) w/ impaired speech, sensations intact. Randomly starts crying or laughing no reason (bulbar)

A

ALS

75
Q

Summary Table: Neuro Diff Dx

MEMORIZE WHOLE TABLE

A

SEE PICS

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