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Term 3 > PTMMD Unit 2 > Flashcards

PTMMD Unit 2 Flashcards

1
Q

What is Amyotrophic Lateral Sclerosis (ALS)?

Ch.5 pg. 217 (Dutton)

A

Commonly referred to as Lou Gehrig Disease

  • A progressive neurodegenerative disorder that causes rapid loss of motor neurons in the brain and spinal cord, leading to paralysis and death.
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2
Q

What data is required to diagnose ALS?

Ch.5 pg. 217 (Dutton)

A

Upper Motor Neuron (UMN) and Lower Motor Neuron (LMN) signs in bulbar and two spinal regions or three spinal regions are required.

The LMN weakness and muscle atrophy involve both peripheral nerve and myotomal distributions

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3
Q

What are the Clinical Hallmarks of ALS?

Ch.5 pg. 217 (Dutton)

A

The clinical hallmark of ALS is the co- existence of muscle atrophy, weakness, fasciculations (muscle twitches/involuntary movement), and cramps (caused by LMN degeneration), together with hyperactivity or inappropriately brisk muscle stretch reflexes, pyramidal tract signs, and increased muscle tone (due to corticospinal tract involvement)

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4
Q

How do patients present with ALS? How do symptoms progress?

Ch.5 pg. 217 (Dutton)

A

Most patients present with asymmetrical, distal weakness of the arm or leg.
- Symptoms usually progress in the affected extremity and gradually spread to adjacent muscle groups and remote ipsilateral or contralateral regions.
Although disability is usually limited in early stages, ALS progresses relentlessly, most patients are ultimately unable to walk, care for themselves, speak or swallow

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5
Q

Does ALS involve the CNS?

Ch.5 pg. 217 (Dutton)

A

ALS usually has no clinical involvement of parts of the CNS other than the motor pathways

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6
Q

What is the most common cause of death in ALS?

Ch.5 pg. 217 (Dutton)

A

Respiratory weakness due to high cervical (phrenic nerves, C4) and thoracic spinal cord involvement in conjunction with aspiration pneumonia

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7
Q

What is Guillain-Barré Syndrome (GBS)?

Ch.5 pg. 217 (Dutton)

A

May be defined as a post-infectious, acute, paralytic peripheral neuropathy and can affect any age group, although there is a peak incidence in young adults

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8
Q

How is GBS described?

Ch.5 pg. 217 (Dutton)

A
  • The majority of Pt. describe an antecedent febrile illness.
  • GBS is usually an acute respiratory or gastrointestinal condition that last for several days and then resolves, followed in 1-2 weeks by a gradual or rapid progressive ascending weakness or paralysis, usually symmetric.
  • Upper respiratory infection are seen in about 50% of cases and are caused by other various viruses
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9
Q

What might a Pt. report with GBS?

Ch.5 pg. 217 (Dutton)

A
  • Difficulty or instability with walking, rising from a chair, and ascending or descending stairs
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10
Q

What are associated signs and symptoms of GBS?

Ch.5 pg. 217 (Dutton)

A
  • Cranial nerve involvement (facial weakness), paresthesias (abnormal sensation), sensory deficits, difficulty breathing, diminished muscle stretch reflex, autonomic dysfunction (tachycardia and vasomotor symptoms), oropharyngeal weakness and ocular involvement
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11
Q

What is the Differential Diagnosis of GBS?

Ch.5 pg. 217 (Dutton)

A

The differential diagnosis is quite large and includes the spectrum of illnesses causing acute or subacute paralysis.
These include spinal cord compression (myelopathy), UMN disorders, poliomyelitis, transverse myelitis, polyneuropathy, systemic lupus erythematosus (SLE), polyarteritis nodosa (inflammatory BV disease), myasthenia gravis, and sarcoidosis

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12
Q

Why are Pt. suspected with GBS typically hospitalized with vigilant monitoring?

Ch.5 pg. 217 (Dutton)

A

Because of the high risk of respiratory failure, which occurs in approximately one-third of patients

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13
Q

What is Rheumatoid Arthritis (RA)?

Ch.5 pg. 218 (Dutton)

A

A chronic, progressive, systemic, inflammatory disease of connective tissue, characterized by spontaneous remissions and exacerbations (flare-ups)

The second-most rheumatic disease after osteoarthritis (OA), but its the most destructive to synovial joints

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14
Q

What is the difference between OA and RA?

Ch.5 pg. 218 (Dutton)

A

RA involves primary tissue inflammation rather than joint degeneration

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15
Q

What population of individuals develop RA?

Ch.5 pg. 218 (Dutton)

A

Although most individual who develop RA do so in their early-to-middle adulthood, some experience it earlier (Juvenile) or later

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16
Q

How is RA diagnosed?

Ch.5 pg. 218 (Dutton)

A

No single test or group of laboratory test can confirm a diagnosis of RA, but they can support the patient’s history and physical findings.
- Several immunologic test, such as the rheumatoid factor and antinuclear antibody titer are available to aid diagnosis
- A complete musculoskeletal examination helps diagnose the disease.

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17
Q

What are the 2 associated syndromes with RA?

Ch.5 pg. 218 (Dutton)

A
  • Sjogren syndrome
  • Felty syndrome
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18
Q

With RA, how are Sjogren syndrome characterized?

Ch.5 pg. 218 (Dutton)

A

Characterized by dryness of eyes (keratoconjunctivitis), mouth (xerostomia), and other mucous membranes

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19
Q

With RA, how are Felty syndrome characterized?

Ch.5 pg. 218 (Dutton)

A

Characterized by leukopenia and hepatosplenomegaly (swelling and enlargement of liver and spleen), often leading to recurrent infections. It encompasses a diverse group of pathogenic mechanisms in RA, resulting in decreased levels of circulating neutrophils

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20
Q

How does RA typically begin?

Ch.5 pg. 218 (Dutton)

A

Typically begins in the joints of the arm and hand. The individual complains of joint stiffness lasting longer than 30 minutes on awakening, pain, swelling, and heat (synovitis). Unlike with OA, the distal interphalangeal joints of the fingers usually are not involved in RA.

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21
Q

What are the signs and symptoms of RA? What other symptoms are associated with RA?

Ch.5 pg. 218 (Dutton)

A

RA vary among individuals depending on its rate of progression.
- Clinical manifestations include joint involvement and systemic problems; some are associated with RA’s early stages, where as others are seen later in advanced disease.

  • Complaints of fatigue, anorexia, low grade fever and mild weight loss are commonly associated with RA.
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22
Q

What are the signs/symptoms and clinical manifestations of later/advanced stages of RA?

Ch.5 pg. 218 (Dutton)

A

As the disease worsens, joints become deformed, and secondary osteoporosis can result in fractures, especially in older adults. Hand and finger deformities are typical in the advanced stages of the disease

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23
Q

What happens with RA progresses over the years?

Ch.5 pg. 218 (Dutton)

A
  • Systemic manifestations increase and potentially life-threatening organ involvement begins. Cardiac problems, such as pericarditis and myocarditis and respiratory complications, such as pleurisy, pulmonary fibrosis and pneumonitis are common.
  • The people with RA loses control over body changes, is chronically tired, and eventually may lose independence in performing activities of daily living (ADLs). Some people may become depressed, feeling hopeless/helpless because there is no cure presently for the condition.
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24
Q

What does the Physical Therapy examination of the patient with RA involve?

Ch.5 pg. 218 (Dutton)

A
  • Measurement of independence with functional activities
  • Measurement of joint inflammation
  • Measurement of joint ROM
  • Determination of limiting factors, including pain, weakness, and fatigue
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25
Q

Since RA affects multiple body symptoms, how can this affect the patient?

Ch.5 pg. 218 (Dutton)

A

This lessens the quality of life and affects functional ability, the approach to managing the patient with this condition must be interdisciplinary

26
Q

What does management look like with patient with RA?

Ch.5 pg. 218 (Dutton)

A

Management typically includes drug therapy, physical and/or occupational therapy, and recreational therapy. Some clients also need psychological counseling to help cope with the disease

27
Q

What is Ankylosing Spondylitis (AS)

Ch.5 pg. 220 (Dutton)

A

AKA Bekhterev or Marie-Strümpell disease
- A chronic rheumatoid disorder

28
Q

What population typically has AS?

Ch.5 pg. 220 (Dutton)

A
  • The patient is usually between 15 to 40 years. There is about a 20% risk that offspring of patients with the disease will later develop it . Although males are affected more frequently than females, mild AS courses are more common in the latter.
29
Q

Where does AS occur? What structures are affected?

Ch.5 pg. 220 (Dutton)

A

Thoracic involvement in AS occurs almost universally.
- The disease includes ALL involvement and ossification of the intervertebral disk, thoracic zygopophyseal joint, costovertebral joint, and manubriosternal joints.
- This multiunit involvement of the thoracic spine makes checking chest expansions measurement s a required test in this region.

30
Q

What happens when AS progresses?

Ch.5 pg. 220 (Dutton)

A

In time, AS progresses to involve the whole spine and results in spinal deformities, including flattening of the lumbar lordosis, kyphosis of the thoracic spine, and hyperextension of the cervical spine.
- These in turn result in flexion contractures of the hip and knees, with significant morbidity and disability

31
Q

What is the most characteristic feature of AS?

Ch.5 pg. 220 (Dutton)

A

Pain at night. Patients often awaken in the early morning (between 2 and 5AM) with back pain and stiffness and usually take a shower or exercise before returning to sleep. Backache during the day is typically intermittent, regardless of exertion or rest.

32
Q

What 5 screening question can be asked to differentially diagnose for AS?

A
  • Is there morning stiffness?
  • Is there an improvement in discomfort with exercise?
  • Was the onset of back pain before age 40?
  • Did the problem begin slowly?
  • Has the pain persisted for at least 3 months
33
Q

What is the goal of exercise therapy for AS?

Ch.5 pg. 220 (Dutton)

A

To maintain the mobility of the spine and involved joints for as long as possible and prevent the spine from stiffening in an unacceptable kyphotic posture.

34
Q

What is Osteoporosis?

Ch.5 pg. 221 (Dutton)

A

Osteoporosis or osteopenia can result from insufficient bone formation (low bone mass), excessive bone resorption, or both.

35
Q

On a patient, what is the result of Osteoporosis?

Ch.5 pg. 221 (Dutton)

A

The result is decreased bone mineral density (BMD) and a progressive loss of trabecular connectivity that is irreversible and diminishes the bone quality in terms of its mechanical resistance to deformity under-loading
- In addition to the loss on bone mass, there is a narrowing of the bone shafting and widening of the medullary canal

36
Q

What can Osteoporosis cause?

Ch.5 pg. 221 (Dutton)

A

Osteoporosis causes pathological (fragility) fractures of the vertebrae and other bone fractures such as the ribs, proximal humerus, distal forearm, proximal femur and pelvis

However, with appropriate care, osteoporosis, fractures, and resultant disability can be prevented

37
Q

Osteoporosis can be classified into 2 broad general types, what are they?

Ch.5 pg. 221 (Dutton)

A

Type one (Postmenopausal)
Type two (Involutional)

  • Type 2 osteoporosis is generally seen in the older population and is referred to as senile osteoporosis
38
Q

Why are women more prone to develop osteoporosis?

Ch.5 pg. 222 (Dutton)

A

Because of the loss of estrogen to accelerated bone loss in the postmenopausal female population

39
Q

What are the risk factors that have been identified as contributing likelihood that an individual will develop BONE LOSS?

Ch.5 pg. 222 (Dutton)

A

Genetics plays a major role, and female gender, positive family history, and racial characteristics associated with Caucasian, Asian, or Hispanic background increase the risk of Osteoporosis. Low body weight has also been correlated with the development of osteoporosis

40
Q

What are the modifiable risk factors associated with osteoporosis?

Ch.5 pg. 222 (Dutton)

A

Early or iatrogenic menopause, pregnancy at an early age, smoking, sedentary lifestyle, alcoholism, low body fat, low calcium intake, high caffeine intake, prolonged bed rest, and anorexia
- Meds such as corticosteroids, diuretics, and thyroid hormone preparations can also significantly increase bone loss and osteoporosis risk.

41
Q

What populations are most vulnerable to developing osteoporosis? (6)

Ch.5 pg. 222 (Dutton)

A
  • Women aged 65 and older
  • Postmenopausal women under age 65 with risk factors for fractures, such as low body weight, prior fracture, or high-risk medication use
  • Women during the menopausal transition with clinical risk factors for fracture
  • Men aged 70 and older
  • Men under age 70 with clinical risk factors for fracture
  • Adults with a fragility fracture
42
Q

In addition to risk factors of osteoporosis, what are the independent risk factors fractures?

Ch.5 pg. 222 (Dutton)

A

The use of medications in elderly patients with adverse CNS side effects, balance problems, poor muscle strength, visual impairment, home environmental factors such as stairs, and medical comorbidites that increase the likelihood of falls

43
Q

How can physical activity affect bone mass/bone mass density?

Ch.5 pg. 222 (Dutton)

A
  • Exercise early in life contributes to higher peak bone mass.
  • Exercise during the middle years of life has numerous health benefits
  • Exercise during the later years, in the adequate calcium and vitamins D intake , probably has a modest effect on slowing the decline on BMD, but its clear that exercise late in life, even beyond age 90 years, can increase muscle mass and strength twofold or more in frail persons
44
Q

What is Multiple Sclerosis (MS)?

Ch.5 pg. 229 (Dutton)

A

A chronic demyelinating disorder with many clinical manifestations reflecting multifocal areas of CNS myelin destruction

45
Q

What are the clinical presentations of MS?

Ch.5 pg. 229 (Dutton)

A

In adults, the clinical presentation of MS at onset is characterized by motor system (26.5%), sensory system (25%), or optic nerve (21%) involvement, or a combination of all three. Cerebellar and sphincter involvement are less frequent (14.1% each)

46
Q

MS patients that present with a motor system impairment may develop what?

Ch.5 pg. 229 (Dutton)

A

May develop paralysis affecting one or more limbs

47
Q

MS patients that present with a sensory system impairment may develop what?

Ch.5 pg. 229 (Dutton)

A

Sensory dysfunction may occur in one modality (light tough, temp., or deep sensation) and may manifest as hypoesthesia/anesthesia or hypersensitivity with numbness, burning sensation, paresthesia, and dysesthesia in various parts of the body)

48
Q

Other than motor and sensory impairments, what other manifestations may a MS patient have?

Ch.5 pg. 229 (Dutton)

A

Fatigue, cognitive loss, and mood disturbances

49
Q

MS patients that have optic nerve impairments may develop what?

Ch.5 pg. 229 (Dutton)

A

Optic Neuritis (inflammation of optic nerve), this is associated with decreased visual acuity, sometimes resulting in blindness, accompanied by orbital pain when the involved eye moves

50
Q

Can MS patient relapse?
What happens if there are additional relapses?

Ch.5 pg. 229 (Dutton)

A

Most patients with MS (85%) have a relapsing-remitting course, with each relapse being associated with new neurologic symptoms or worsening of existing ones.
- With additional relapses, the possibility of complete recovery is reduced, and permanent disability may develop.
- In the remaining 15% of patients, the disease course is primary progressive, with continuous deterioration

51
Q

When do patients typically develop MS?
Is it curable?

A

MS usually manifest between 20 and 40 year olds with a peak onset at around 30 years and a female to male ratio of 2:1.
- At present, MS is regarded as being modifiable but incurable

52
Q

What are Clinical cluster of signs and symptoms to Diagnose Nociceptive Pain?
What is the Sensitivity and Specificity?

Ch. 2 pg. 16 Box 2.1 (Olson)

A

90.9% Sensitivity , 91% Specificity

  • Pain localized to the area
  • Clear, proportionate mechanical/anatomic nature to aggregating and easing factors
  • Pain usually intermittent and sharp with movement
  • May have more constant dull ache or throb at rest
53
Q

What are the Clinical Cluster of signs and symptoms to diagnose Peripheral Neuropathic pain?
What is the Sensitivity and Specificity?

Ch. 2 pg. 16 Box 2.1 (Olson)

A

86.3% Sensitivity , 96% Specificity

  • Pain referred in a dermatomal or cutaneous distribution
  • History of nerve injury, pathology, or mechanical compromise
  • Pain/symptoms provocation with mechanical/movement tests (e.g. active, passive, neurodynamics) that move/load/compress neural tissue
54
Q

What are the Clinical Cluster of signs and symptoms to diagnose Central Sensitization pain?
What is the Sensitivity and Specificity?

Ch. 2 pg. 16 Box 2.1 (Olson)

A

91.8% Sensitivity , 97.7% Specificity

  • Disproportionate, non-mechanical, unpredictable pattern of pain provocation in response to multiple/nonspecific aggravating/easing factors
  • Pain disproportionate to the nature and extent of injury of pathology
  • Strong association with maladaptive psychosocial factors
  • Diffuse/non-anatomic areas of pain/tenderness on palpation
55
Q

During a medical screen for the cervical spine, what are Red Flags for Cervical Myelopathy?
(10)
Ch. 2 pg. 16 Box 2.2 (Olson)

A
  • Sensory disturbances of hand
  • Muscle wasting of hand intrinsics
  • Unsteady gait
  • Hoffman reflex
  • Inverted supinator sign
  • Babinski sign
  • Hyper-reflexia
  • Bowel and bladder disturbances
  • Multi-segmental weakness or sensory changes
  • Age >45 years old
56
Q

When trying to figure out if a patient is appropriate for PT, what medical considerations must be taken to account with Viscerogenic conditions?

A
  • Neoplastic Conditions
  • Inflammatory or Systemic Disease
  • Cardiopulmonary Conditions
  • Cervical Vascular Pathology
57
Q

For Viscerogenic conditions, what are red flags for Neoplastic Conditions? (5)

Ch. 2 pg. 16 Box 2.2 (Olson)

A
  • Age > 50 years
  • History of cancer
  • Unexplained weight loss
  • Constant pain; no relief with bed rest
  • Night pain
58
Q

During a medical screen for the cervical spine, what are red flags for Inflammatory or systemic disease? (5)

Ch. 2 pg. 16 Box 2.2 (Olson)

A
  • Temp >37° C
  • BP > 160/95 mmHG
  • Resting pulse >100 BPM
  • Resting respiration > 25 breaths per minute
  • Fatigue
59
Q

During a medical screen for the cervical spine, what are red flags for Vertebral Artery Pathology? (7)

(5Ds And 3Ns)

Ch. 2 pg. 16 Box 2.2 (Olson)

A
  • Drop attacks
  • Dizziness
  • Dysphagia
  • Dysarthria
  • Diplopia

Ataxia

Numbness
Nystagmus
Nausea

60
Q

During a medical screen for the cervical spine, what are red flags for Upper Cervical Ligamentous Instability? (3)

Ch. 2 pg. 16 Box 2.2 (Olson)

A
  • Occipital headache and numbness
  • Severe limitations during neck active ROM in all directions
  • Signs of cranial myelopathy

Term 3 (13 decks)

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