PRELIMS: GBS, MS, Bell's Palsy

Question 1

What is Guillain-Barré Syndrome?

Answer 1

Acquired symmetrical polyneuropathy, often beginning in the lower extremities and progressing to total body paresis.

Question 2

What are common initial symptoms of Guillain-Barré Syndrome?

Answer 2

Paresthesias in toes and fingertips, ascending weakness.

Question 3

Which muscles are typically involved in Guillain-Barré Syndrome?

Answer 3

Facial and oropharyngeal muscles.

Question 4

Which muscles are typically spared in Guillain-Barré Syndrome?

Answer 4

Extraocular muscles and sphincters.

Question 4

What type of reflexes are usually affected in Guillain-Barré Syndrome?

Answer 4

Muscle stretch reflexes are absent or severely decreased.

Question 5

What is a common pain symptom in Guillain-Barré Syndrome?

Answer 5

Deep aching pain in the back, buttocks, and posterior thighs

Question 6

What are some common etiological factors for Guillain-Barré Syndrome?

Answer 6

Viral or bacterial infections, immunization, or surgery.

Question 7

What is the common agent associated with Guillain-Barré Syndrome?

Answer 7

Campylobacter jejuni.

Question 8

What are some disorders included in Motor Neuron Disease?

Answer 8

Spinal muscular atrophy (SMA), Amyotrophic lateral sclerosis (ALS), Primary lateral sclerosis (PLS), Progressive muscular atrophy (PMA), Progressive bulbar palsy (PBP).

Question 9

Where do upper motor neurons (UMNs) originate?

Answer 9

Motor cortex, premotor areas, temporal cortex, and sensory cortex.

Question 10

What do upper motor neurons (UMNs) synapse with?

Answer 10

Cells in the brainstem nuclei and the ventral horn of the spinal cord, which are lower motor neurons (LMNs).

Question 11

What are the clinical features of Primary Lateral Sclerosis (PLS)?

Answer 11

Spasticity usually starting in the lower extremities, urinary incontinence, spastic dysphagia.

Question 12

What is the common onset age for Primary Lateral Sclerosis (PLS)?

Answer 12

Between 20 to 60 years old.

Question 13

What is Lathyrism and what causes it?

Answer 13

A condition caused by excessive consumption of chickling pea (Lathyrus sativus), leading to neurotoxic effects.

Question 14

What does “amyotrophy” refer to in ALS?

Answer 14

Atrophy of muscle fibers.

Question 14

What is the gender prevalence for ALS?

Answer 14

Males are affected more than females, with a ratio of approximately 2:1.

Question 14

What are the clinical features of Classic Amyotrophic Lateral Sclerosis (ALS)?

Answer 14

Weakness, atrophy, fasciculations, spasticity, spastic dysarthria, and typically sparing of bowel, bladder, and sensation.

Question 14

What is another name for Amyotrophic Lateral Sclerosis (ALS)?

Answer 14

Lou Gehrig’s Disease or Charcot’s Disease.

Question 15

What is a common cause of death in ALS patients?

Answer 15

Respiratory failure and aspiration.

Question 15

What are some common features of Pseudobulbar Affect in ALS?

Answer 15

Emotional lability, inappropriate laughter or crying, and emotional outbursts.

Question 15

What chromosomal defect is commonly associated with ALS?

Answer 15

A 15% defect in Chromosome 21q12.1.

Question 15

What are the survival rates for ALS based on age of onset?

Answer 15

2.5 years survival for onset at 62 years, vs. 8 years for early onset.

Question 15

Describe the typical progression of weakness in ALS.

Answer 15

Starts as dysfunction or weakness in one part of the body and gradually spreads to other parts.

Question 15

What is a key diagnostic criterion for ALS?

Answer 15

The presence of both upper motor neuron (UMN) and lower motor neuron (LMN) signs in more than two regions.

Question 15

What cognitive impairments are associated with ALS?

Answer 15

: Issues with executive function, visual attention, working memory, cognitive flexibility, problem-solving, and verbal fluency.

Question 15

What are typical treatment strategies for spasticity in ALS?

Answer 15

Stretching, positioning, Baclofen, Tizanidine.

Question 15

What diagnostic tests are used for ALS?

Answer 15

EMG-NCV (fibrillation and fasciculation potentials), CT scan/MRI (degeneration of tracts).

Question 15

How is Bell's Palsy diagnosed?

Answer 15

iagnosis is mainly by exclusion, ruling out other causes of facial paralysis.

Question 16

What are the typical findings in electromyography (EMG) for ALS?

Answer 16

Fibrillations, fasciculations, unstable motor units, increased duration/amplitudes in slowly progressing ALS, low-amplitude polyphasic motor unit potentials.

Question 16

What is a common issue with muscle biopsy in ALS?

Answer 16

Denervation atrophy.

Question 16

What are some commonly affected muscles in ALS?

Answer 16

Weakest: wrist extensor, finger extensor, hand intrinsics. Spared: wrist & finger flexor, elbow extensors.

Question 17

Name a medication used to decrease glutamate and extend life in ALS patients.

Answer 17

Rilutek (Riluzole).

Question 17

What are some adaptive strategies for feeding in ALS?

Answer 17

Soft solids > liquids, using adaptive utensils, and feeding tubes if necessary.

Question 17

What are the levels of injury in Bell's Palsy and their effects?

Answer 17

Stylomastoid Foramen: Facial Muscles Chorda Tympani: Salivation & taste loss Stapedius: Hyperacusis Geniculate Ganglion: Lacrimation Internal Auditory Meatus: Deafness, tinnitus, balance loss Pons: Marcus Gunn phenomenon, marin Amat, and CN V, VI, IX, X involvement

Question 17

What are some special considerations for communication in ALS?

Answer 17

Dysarthria, sialorrhea, and the use of communication aids or devices.

Question 17

What are some common medications used to manage ALS symptoms?

Answer 17

What are some common medications used to manage ALS symptoms?

Question 17

What is Bell's Palsy?

Answer 17

Bell's Palsy is a common neurologic disorder characterized by abrupt, unilateral, peripheral facial paresis or paralysis without a detectable cause.

Question 17

What is Ramsay Hunt Syndrome?

Answer 17

It is a type of facial paralysis associated with herpes zoster virus infection, presenting with severe otalgia, facial paralysis, and vesicular eruption.

Question 17

What are some common physical therapy interventions for ALS?

Answer 17

Maintenance of range of motion, prevention of contractures, low-impact aerobic exercise, use of splints & gait aids.

Question 17

What are the main symptoms of Bell's Palsy?

Answer 17

Sudden onset facial weakness, hyperacusis, decreased tear production, altered taste, facial or retro-auricular pain, and potential hearing loss.

Question 17

What are common risk factors for Bell's Palsy?

Answer 17

Increased risk in pregnancy, diabetes, and a history of upper respiratory infections.

Question 17

What is the typical age of onset for Multiple Sclerosis?

Answer 17

The mean age of onset is 32 to 34 years old.

Question 18

What are the main treatments for Bell's Palsy?

Answer 18

Treatments include corticosteroids, antiviral medications, eye care, physical therapy, and psychological support.

Question 18

What is Multiple Sclerosis (MS)?

Answer 18

MS is an inflammatory disease of the CNS characterized by areas of demyelination leading to functional and cognitive impairments.

Question 18

What factors are associated with poor prognosis in MS?

Answer 18

Progressive course of onset, male gender, onset before age 40, cerebellar involvement at onset, and multiple system involvement.

Question 18

What are some bad prognosis factors for Bell's Palsy?

Answer 18

Complete facial palsy, no recovery by three weeks, age over 60 years, severe pain, Ramsay Hunt syndrome, and severe facial nerve degeneration.

Question 18

What are common clinical presentations of MS?

Answer 18

Weakness, paresthesias, gait difficulty, visual disturbances, diplopia, ataxia, vertigo, and urinary bladder dysfunction.

Question 18

What are the types of MS?

Answer 18

Relapsing-Remitting MS Secondary Progressive MS Primary Progressive MS Plateaued MS Benign MS Malignant MS

Question 18

What are the primary diagnostic tools for MS?

Answer 18

Cerebrospinal Fluid Examination, Magnetic Resonance Imaging (MRI), and Evoked Potential Recordings.

Question 18

What are the major types of MS treatment?

Answer 18

Steroids Immunosuppressive drugs Disease-modifying treatments (e.g., Interferon, Copaxone) 4-Aminopyridine

Question 18

What is the role of 4-Aminopyridine in MS treatment?

Answer 18

It blocks K+ channels, prolonging nerve action potentials and restoring conduction in demyelinated fibers.

Question 18

What are some emerging therapies for MS?

Answer 18

Alemtuzumab, Cladribine, Fingolimod, and Teriflunomide.

Question 18

What are some common problems and challenges faced by MS patients?

Answer 18

Cognitive and psychiatric problems, neurogenic bladder and bowel, spasticity, ataxia, sexual dysfunction, and difficulties with ADLs.