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NPTE-PT > Neuromuscular > Flashcards

Neuromuscular Flashcards

1
Q

What is the etiology of Parkinson’s disease?

A

loss of inhibitory dopamine results in an excessive excitatory output from cholinergic system (acetylcholine) of basal ganglia

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2
Q

What are the stages of Parkinson’s disease? (Hoehn and Yahr)

A

I.) minimal or absent disability, unilateral symptoms

II.) minimal bilateral or midline involvement, no balance involvement

III.) impaired balance, some restrictions in activity

IV.) all symptoms present and severe; stands and walks only with assistance

V.) confinement of bed or wheelchair

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3
Q

What is the etiology of Myasthenia gravis?

A

an autoimmune antibody-mediated attack on acetylcholine receptors at the neuromuscular junction

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4
Q

What are the four types of myasthenia gravis?

A
  • ocular myasthenia
  • mild generalized myasthenia
  • severe generalized myasthenia
  • crisis
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5
Q

What electrolyte imbalances can cause seizures?

A
  • hyponatremia
  • hypernatremia
  • hypoglycemia
  • hypomagnesia
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6
Q

Lesions of the archicerebellum

A

central vestibular symptoms: ocular dysmetria, poor eye pursuit, dysfunctional vestibular ocular reflex (VOR), impaired eye-hand coordination

gait and trunk ataxia

little change in tone or dyssynergia or extremity movements

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7
Q

Lesions of paleocerebellum

A

hypotonia

truncal ataxia

ataxic gait

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8
Q

Lesions of neocerebellum

A
  • intention tremor
  • dysdiadochokinesia
  • dysmetria
  • dyssynergia
  • errors in timing related to perceptual tasks
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9
Q

What visual changes can occur in patients with vestibular dysfunction?

A
  • nystagmus

- blurred vision: gaze instability secondary to VOR dysfunction

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10
Q

Vestibular neuritis, labyrinthitis

A

an acute infection with prolonged attack of symptoms, persisting for several days or several weeks; caused by viral or bacterial infection

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11
Q

Ménière’s disease

A

recurrent and usually progressive vestibular disease; episodic attacks may last from minutes to several hours with severe symptoms; usually associated with tinnitus, deafness, sensation of pressure/fullness within ear; etiology unknown, edema of membranous labyrinth is a consistent finding

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12
Q

Tumors involving the inner ear

A
  • acoustic neuroma
  • gliomas/brainstem
  • cerebellar medulloblastoma
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13
Q

What conditions case bilateral vestibular disorders (BVD)?

A
  • toxicity: ototoxic drugs
  • bilateral infection: neuritis, meningitis
  • vestibular neuropathy, otosclerosis (Paget’s disease)
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14
Q

What is the difference between axonotmesis and neurotmesis?

A

interruption of the endoneurium

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15
Q

Trigeminal neuralgia

A

results from degeneration or compression (tortuous basilar artery or cerebellopontine tumor)

  • brief paroxysms of neurogenic pain; frequently reoccurring
  • occurs along the distribution of the trigeminal nerve, mandibular and maxillary divisions; ocular division is rare
  • pain restricted to one side of the face
  • autonomic instability: exacerbated by stress, cold; relieved by relaxation
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16
Q

Bulbar palsy

A
  • weakness or paralysis of the muscles innervated by the motor nuclei of the lower brainstem, affecting the muscles of the face, tongie, larynx, and pharynx
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17
Q

(T/F) Amyotrophic lateral sclerosis (ALS) is an autosomal dominant condition

A

True

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18
Q

What are the stages of ALS?

A

Stage 1: early disease, mild focal weakness, asymmetrical distribution, sx of hand cramping and fasciculations

Stage 2: moderate weakness in groups of muscles, some wasting (atrophy) of muscles; modified independence with assistive devices

Stage 3: severe weakness of specific muscles, increasing fatigue; mild to moderate functional limitations, ambulatory

Stage 4: severe weakness and wasting of LEs, mild weakness of UEs; moderate assistance and assistive devices required; wheelchair user

Stage 5: progressive weakness with deterioration of mobility and endurance, increased fatigue, moderate to severe weakness of whole limbs and trunk; spasticitiy, hyperreflexia; loss of head control; maximal assist

Stage 6: bedridden, dependent ADLs, FMS; progressive respiratory distress

19
Q

Acute Stage of CRPS

A

diffuse, severe burning or aching pain; increases with emotional stress; allodynia and hyperpathia; vasomotor instability with dusky mottling, cool skin, swelling and edema

20
Q

Dystrophic Stage of CRPS

A

skin changes with thin, pale, cyanotic skin; cessation of hair and nail growth; hyperhidrosis; muscle atrophy and osteoporosis

21
Q

Atrophic Stage of CRPS

A

decreased hypersensitivity; normal blood flow and temperature; smooth; glossy skin; severe muscles atrophy; periscapular fibrosis; diffuse osteoporosis; development of claw hand deformity

22
Q

What are the components of the basal ganglia?

A
  • striatum (caudate nucleus, nucleus accumbens, putamen)
  • putamen and globus palladus (lenticular nucleus)
  • substantia nigra (compact and reticular aspects)
  • subthalamic nucleus
23
Q

What are the functions of the hypothalamus?

A
  • maintains body homeostasis
  • regulates body temperature
  • eating
  • water balance
  • anterior pituitary function/sexual behavior
  • emotions
24
Q

Pineal gland

A

secretes hormones that influence the pituitary gland and several other organs; influences circadian rhythm

25
Q

Medial longitudinal fasciculus

A

originates from the vestibular nuclei and extends throughout the brainstem and upper cervical spinal cord; important for control of head movements and gaze stabilization (VOR reflex)

26
Q

Nerve fiber types

A
  • A-alpha: proprioception, somatic motor
  • A-beta: touch, pressure
  • A-gamma: motor to muscle spindles
  • A-delta: pain, temperature, touch
  • B fibers: small, myelinated, conduct less rapidly, preganglionic autonomic
  • C fibers: smallest, unmyelinated, slowest conducting (dorsal root: pain, reflex responses; sympathetic: postganglionic sympathetic)
27
Q

Persistent vegetative state

A

a period lasting >1 year for traumatic brain injury and >3 months for anoxic brain injury

28
Q

Glasgow Coma Scale

A

relates consciousness to three elements: eye-opening, motor response, and verbal response

severe brain injury - 1-8
moderate brain injury - 9-12
minor brain injury - 13-15

29
Q

Mini-Mental State Examination

A

maximum score is 30; 21-24 indicates mild cognitive impairment; 16-20 indicated moderate impairment; 15 or less indicates severe impairment

30
Q

Rancho Los Amigos Levels of Cognitive Funcion

A
  • No response (I)
  • Decreased response levels (II and III)
  • Confused levels (IV, V, and VI)
  • Appropriate (automatic, purposeful) levels (VII and VIII)
31
Q

Broca’s aphasia is also known as…

A

nonfluent aphasia; expressive aphasia; results from a lesion involving the third frontal convolution of the left hemisphere

32
Q

Verbal apraxia

A

impairment of volitional articulatory control secondary to a cortical, dominant, hemisphere lesion

33
Q

Wernicke’s aphasia is also known as…

A

fluent aphasia; receptive aphasia; results from a lesion in the posterior first temporal gyrus of the left hemisphere

34
Q

Kernig’s sign

A

patient is positioned in supine; flex hip and knee fully to chest and then extend knee; postive when extending the knees due to spasm of the hamstring, suggesting meningeal irritation

35
Q

Brudzinski’s sign

A

patient is positioned in supine; flex neck to chest; positive when causes flexion of the hip and knees, suggesting meningeal irritation

36
Q

Superficial sensation

A
  • pain
  • temperature
  • touch
37
Q

Deep sensation

A
  • proprioception
  • kinesthesia
  • vibration
38
Q

Cortical sensation

A
  • stereognosis
  • barognosis
  • graphesthesia
  • two-point discrimination
  • tactile localization
  • bilateral simultaneous stimulation
39
Q

Ideomotor apraxia

A

a patient cannot perform the task on command but can do the task when left on own

40
Q

Ideational apraxia

A

the patient cannot perform the task at all, either on command or on own

41
Q

Modified Ashworth Scale

A

0 - no increase in muscle tone
1 - a slight increase in muscle tone, minimal resistance at the end range
1+ - a slight increase in muscle tone, minimal resistance through less than half of ROM
2 - more marked increase in muscle tone, through most of ROM, affected part easily moved
3 - a considerable increase in muscle tone, passive movement difficult
4 - affected part rigid in flexion or extension

42
Q

In which patients is decerebrate posturing observed?

A

in comatose patients with brainstem lesions between the superior colliculus and the vestibular nucleus

43
Q

In which patients is decorticate posturing observed?

A

in comatose patients with lesions above the superior colliculus

44
Q

Opisthotonos

A

prolonged, severe spasm of muscles, causing the head, back, and heels to arch backward; arms and hands are held rigidly flexed

seen in severe meningitis, tetanus, epilepsy, and strychnine poisoning

NPTE-PT (9 decks)

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