Neuromuscular diagnoses - Gold,Silver, Bronze

Question 1

Alzheimer’s Disease

Answer 1

progressive neurological disorder that results in deterioration & irreversible damage within cerebral cortex and subcortical areas

• initially noted by change in memory, impaired concentration and difficulty with new learning
• typical course of the disease averages between 7-11 years with death resulting from infection or dehydration

Question 2

amyotrophic lateral sclerosis

Answer 2

• risk is higher in males than females
• 40-70 years of age
• clinical presentation may include upper and lower motor neuron involvement with weakness occurring in a distal to proximal progression
• average course of the diagnosis is two to 5 years with 20-30% of patients surviving longer than five years

Question 3

carpal tunnel syndrome

Answer 3

• incidence is higher in females than males with the most common age being from 35-55 years of age
• muscle atrophy is often noted in the abductor pollicis brevis muscle and later in the thenar muscles
• electromyography studies, tinel sign and phalen’s test can bbe used to assist with confirming the diagnosis

Question 4

central cord syndrome

Answer 4

• an incomplete SC lesion that most often results from a cervical hyperextension injury
• clinical presentation involves motor loss that is greater in the upper extremities than the lower extremities
• most common incomplete SC lesion accounting for approximately 30% of all incomplete forms tetraplegia

Question 5

cerebral palsy

Answer 5

• spastic cerebral palsy involves upper motor neuron damage; athetoid cerebral palsy involves damage to the basal ganglia
• clinical presentation:motor delays, abnormal muscle tone and motor control, reflex abnormalities, poor postural control, and balance imapirments
• intellectual disability and epilepsy are present in 50-60% of children diagnosed with cerebral palsy

Question 6

cerebralvascular accident

Answer 6

• types of CVA include ischemic stroke and hemorrhagic stroke
• left CVA may represent with weakness or paralysis to the right side,, impaire processing, heightened frsutration, aphasia, dysphagia, and motor apraxia
• right CVA: weakness or paralysis to the left side, poor attention span, impaired awareness and judgement, spatial deficits, memory deficits, emotional lability, and impulsive behavior

Question 7

Down Syndrome

Answer 7

• clinical manifestaation include hypotonia, flattened nasal bridge, Simian line(palmar crease), epicanthal folds, elargement of the tongue and developmental delay
• detection occurs in approximately 60-70% of women tested that are carrying a baby with down syndrome
• exercise is essential for a child with DS in order to avoid inactivity and obesity

Question 8

Duchenne Muscular Dystrophy

Answer 8

• x-linked recessive trait manifesting in only male offspring while female offspring become carriers
• clinical presentation: waddling gair, proximal muscle weakness, toe walking, pseudohypertrophy of the calf, and difficulty climbing stairs
• there is usually rapid progression of this disease with the inability to ambulate by ten to twelve years of age with death occurring as a teenager or less frequently in the 20’s

Question 9

Erb’s Palsy

Answer 9

• muslces affected are supplied by cervical roots C5 & c6 which result in a loss of function of teh rotator cuff, deltoid brachialis, corachobrachialis, and biceps brachii
• brachial plexus injury in a newborn usually occurs during a difficult delivery, due to a large baby, a breech presentation with a prolonged labor or with the use of forceps
• results in a flacci paralysis nicknamed the “waiter’s tip deformity”

Question 10

Guillain-Barre Syndrome

Answer 10

• results in motor weakness in a distal to proximal progression, sensory impairment, and possible respiratory paralysis
• etiology of teh disease is unknown, however, it is hypothesized to be an autoimmune response to a previous respiratory infection, influenza, immunization or surgery
• majority of patient’s experience full recovery, 20% have remaining neurologic deficits and 3-5% of patients die from respiratory complications

Question 11

Huntington’s disease

Answer 11

Chronic progressive genetic disorder that is fatal within 15- 20 years after clinical manifestation

• characterized by degeneration and atrophy of teh basal ganglia and cerebral cortex within the brain
• clinical presentation includes enlarged ventricles secondary to atrophy of teh basal ganglia, mental deterioration, speech disturbances, and ataxic gait

Question 12

Multiple sclerosis

Answer 12

• characterized by demylination of the myelin sheaths that surround nerves within the brain and SC resulting in plaque development, decreased nerve conduction velocity, and eventual failure of impulse transmission
• clinical symptoms may include visual problems, paresthesias, sensory changes, clumsiness, weakness, ataxia, blance dysfunction and fatigue
• intervention includes regulation of activity level, relaxation and energy conservation techniques, normalization of tone, balance activities, gait training and core stabilization

Question 13

Parkinson’s disease

Answer 13

• degenerative disorder characterized by a decrease in production of dopamine within the substantia nigra of teh basal ganglia
• clinical presentation may include hypokinesia, difficulty initiating and stopping movement, festinating and shuffling gait, bradykinesia, poor posture, and cogwheel or lead pipe rigidity
• medical management includes dopamine replacement therapy which is designed to minimize bradykinesia, rigidity, and tremor

Question 14

Sciatica Secondary to a herniated Disk

Answer 14

• the sciatic nerve experiences an inflammatory response and subsequent damage secondary o compression from the herniated disk
• sciatica is characterized by low back and gluteal pain that typically radiates down the back of teh thigh along the sciatic nerve distribution
• pain will increase in sitting position or when lifting forward bending or twisting

Question 15

spina bifida- myelomeningocele

Answer 15

• classifications include occulta (incomplet fusion of teh posterior arch with no neural tissue protruding), meningocele (incomplete fusion of the posterior arch with neural tissue.meninges protruding outside the neural arch), and myelomeningoccele ( incomplete fusion of teh posterior vertebral arch with both meninges and spinal cord protruding outside teh neural arch)
• aprox 75% of vertebral defects are found in the lumbar/sacral region most often at L5-S1.
• prenatal testing of alpha-fetopreotein (AFP) in the blood will show an elevation in levels that indicate a probable neural tube defect at aprox week 16 of gestation

Question 16

SCI- complete C7 tetraplegia

Answer 16

• clinical presentation: impaired cough and ability to clear secretions altered breathing pattern, and poor endurance
• outcomes at this level include independence with feeding, grooming, dressing, selfROM, independent manual WC mobility, independent transfers, and independent driving with an adapted automobile

-triceps, extensor pollicis longus and brevis, extrinsic finger extensors and flexor carpi radialis will remain the lowest innervated muscles

Question 17

SCI- complete L3 Paraplegia

Answer 17

• patients possess at least partial innervation of teh gracilis, iliopsoas, quadratus lumborum, rectus femoris, and sartorius with full upper extrmeity use,
• additional findings that can exist include secual dysfunction, a nonreflexive bladder, ther need for bowel program, UTI, muscle contractures, pressure sores
• Patients with L# paraplegia should be able to live independently with education regarding the management of their disability

Question 18

Thoracic Outlet Syndrome

Answer 18

• results from compression and damage to brachial plexus nerve trunks, subclavian vascular supply, and/or teh axillary artery
• contributing factors in the development of teh condition include the presence of a cervical rib, an abnormal first rib, postural deviations, hypertophy or spasms of teh scalene muscles, and an elongated cervical transverse process
• females are at two or three times greater risk than males, with the most common age ranging from 30-40 years of age

Question 19

Traumatic Brain Injury

Answer 19

• occurs due to an oopen head injury where there is penetration through the skull or closed head injury where the brain makes contact with the skull secondary to an sudden, violent acceleration or deceleration
• brain injury may include swelling,axonal injury, hypoxia, hematoma, hemorrhage, and changes in intracranial pressure
• high-risk groups include ages 0-4,15-19, and greater than 65

Question 20

vestibular disorders

Answer 20

• occurs when there is a disruption of teh sensory information processed by the inner ear and brain with respect to the bodyls control of balance and eye movements
• classified as either peripheral or central, with the majority of cases diagnosed as peripheral
• effects can be quite diverse ranging from spontaneous recovery to permanent disability

Question 21

anterior Cord Syndrome

Answer 21

an incomplete spinal cord lesion in which the anterior 2/3 of the SC is damaged

• occurs through a traumatic incident that causes compression or damage to the anterior spinal artery, most often associated with fracture or dislocation
• typically presents with complete loss of motor function and loss of pain and temp sensation bilaterally below the level of the lesion due to the damage to the corticospinal and spinothalamic

Question 22

Bell’s Palsy

Answer 22

• refers to an acute onset of sensory and motor deficits in structures supplied by the facial nerve
• primarily affects the muscles associated with facial expression, however, it can also impact saliva and tear production
• self-limiting condition that is not life-threatening with majority of patients experiencing a spontaneous recovery that occurs within weeks to months

Question 23

Cauda Equina Syndrome

Answer 23

• considered to be a peripheral nerve injury and results from damage and loss of function involving two or more nerves of the cauda equina
• may result from compression on th ecauda equina nerve roots, including spinal structure pathology, trauma, infectious conditions, tumor or iatrogenic factors
• self-limiting condition, however, the longer a patient is symptomatic prior to intervention, the less likely the patient is to achieve a complete recovery

Question 24

Myasthenia Gravis

Answer 24

• autoimmune disorder that affects the transmission of neuromuscular signals
• Primary feature is muscle weakness within the skeletal muscles, with other neurologic findings being normal
• muscles affected commonly include the ocular muscles and limb musculature

Question 25

post polio syndrome

Answer 25

• 25-50% of pt with poliomyelitis will eventually develop post-polio syndrome
• symptoms of post-polio syndrome include muscle weakness, atrophy, fatigue and sometimes muscular or joint pain
• tx is generally multidisciplinary and aimed at controlling symptoms and improving daily function

Question 26

epilepsy

Answer 26

injury to the brain can cause abnormal activity of teh brain’s nerve cells in which the electrical discharge of the neurons becomes hyper synchronous, resulting in epileptic seizures

• symptoms vary widely depending onn the type of seizure and may include mood disturbances, staring, loss of consciousness, uncontrollable jerking of teh arms and legs, stiffening of muscles and losss of muscle control
• electroencephalogram measures electrical activity of the brain and is the most common test used to confirm the diagnosis of epilepsy

Question 27

polyneuropathy

Answer 27

• characterized by damage or disease that affects multiple peripheral nerves, which is most commonly caused by diabetes mellitus
• polyneuropathy often starts in the distal lower extremities, generally symmetrically, and may progress to include the hands and more proximal portions of the limbs
• electromyography and nerve conduction testing are often used to determine the location and extent of teh nerve damage

Question 28

trigeminal neuralgia

Answer 28

• result of abnormal pressure or irritation of teh trigeminal nerve
• symptoms typically unilateral and may be either episodic or constant ; sudden ppain described as sharp, jolting, stabbing or shock-like or persistent aching or burning sensations
• diagnostic testing is often inconclusive with a diagnosis typically made based on the patient’s reported symptoms