Tumours and Degenerative neuromuscular/neurological disorders Flashcards
Tumour etiology
viruses, chemical agents, physical agents (radiation, asbestos), drugs, hormones, alcohol
Tumour treatment
surgery, radiation, chemotherapy, biotherapy, antiangiogenic therapy, hormonal therapy
Tumour types
Epithelial - Carcinoma Mesenchymal - Sarcoma Glial - glioma Lymphoid - lymphoma Hematopoietic - leukemia Melanocytic - melanoma
Types of lung carcinoma
squamous metaplasia, squamous dysplasia, carcinoma in situ, invasive carcinoma
Colon tumours is the ___ cause of death
2nd
Prostate cancer Rx
surgery, external beam radiation, brachytherapy, androgen deprivation therapy
3 types of skin cancer
- Basal Cell Carcinoma
- Squamous Cell Carcinoma
- Malignant melanoma
What is the most common form of skin cancer
Basal cell Carcinoma
What is the appearance of Basal cell carcinoma?
High risk or low risk of spreading?
Translucent and red in colour
Low risk of spreading
What is the appearance of Squamous cell carcinoma?
High risk or low risk of spreading?
Solid skin tumor, often volcano shaped
High risk for metastasis
What is the most dangerous form of skin cancer?
Malignant melanoma
ABCD rule for melanoma
High risk or low risk of spreading?
Asymmetry, Border, Color, Diameter
High
Mutation in Duchennes muscular dystrophy?
Male or female more?
Maternal or paternal carrier?
X-link mutation of Chromosome 21 - Dystrophin protein is not produced which is a structural component within muscle tissue - tissue now prone to damage and necrosis
M>F
Maternal Carrier
Duchennes muscular dystrophy effects
- muscle cells are replaced by fat and CT
- progressive symmetrical wasting
- in w/c by 10-12 years, die by age 20
Duchennes muscular dystrophy Dx + classic signs
Genetic testing, physical exam, CK levels
Gowers Sign - pushing on thighs to stand up off floor
Calf Psuedohypertrophy - Well defined calves but by fat and CT not muscle
Duchennes muscular dystrophy S&S
- proximal muscle weakness
- waddling gait
- toe walking
- lordosis
- difficulty standing up and climbing stairs, frequent falls
- lower IQ
Duchennes muscular dystrophy Rx
- exercise by maintain strength and balance (avoid eccentric)
- respiratory therapy
- prevention of contractures, seating, equipment
6 other types of muscular dystrophies
Beckers Congenital Facioscapulohumeral MD Myotonic MD Emery-Dreifus Spinal muscle atrophy
What is beckers muscular dystrophy
A slower and progressive form of DMD but not as severe
What is the most common type of muscular dystrophy after DMD
Myotonic MD
What occurs in SPinal muscle atrophy
Skeletal muscles weaken when anterior horn degenerates
Spinal muscle atrophy S&S
hypotonia, decreased function, weakness (symmetrical, proximal > distal), fatigue
What is another name for Amyotrophic lateral sclerosis
Lou Gehrig’s disease
What is Amyotrophic lateral sclerosis
motor neuron disease w/ gradual deterioration of BOTH UMN and LMN
- can have both flaccid and spastic paresis
Amyotrophic lateral sclerosis M or F more common
M
Amyotrophic lateral sclerosis Disease course
2-5 years after Dx - only 10% survive 10 years
Amyotrophic lateral sclerosis S&S
o paresis in a single muscle group
o corresponding muscle groups are asymmetrically affected (patchy distribution)
o fasciculation’s (twitching)
o Metabolic involvement of the skin (papery, fragile, cold)
o gradual involvement of striated muscle (bulbar = major concern)
o progress to permanent paralysis
o Flaccidity + spasticity may co-exist
o selective sparing (no ocular or cardiac, urethral & anal sphincter)
Amyotrophic lateral sclerosis Dx
Physical exam, medical history, muscle biopsy (not needed to confirm Dx)
Amyotrophic lateral sclerosis Rx
Meds, rehab for immobility, symptom relief (spasticity, secretions, psychological)
What is spared in amyotrophic lateral sclerosis
Ocular
Cardiac
Urethral + anal sphincter
What is an essential tremor evoked by? Cause?
- usually evoked by voluntary movement
causes: genetic, Increased thalamus activity
What is dystonia? What is it commonly linked to?
Causes?
- involuntary, sustained muscle contractions, writhing
- commonly linked to a single repetitive action (ie. musicians)
- causes: genetic, originates from different parts of brain
What is Parkinsons Disease (PD)
Chronic neurodegenerative disease in basal ganglia
What is the pathology of PD
- Decreased dopamine produced by substantia nigra
- dopamine normally inhibits ACh
- without dopamine = excessive excitatory output
PD Possible causes
o viral (infection swelling of brain)
o genetic
o toxic (drugs)
o injury or focal ischemia can cause PD-like symptoms
PD S&S
Classic
o bradykinesia: slowness of movement, can result in freezing
o resting tremor
o rigidity: velocity independent resistance to passive stretch
o postural instability
Other
- loss of automatic movement (ie rolling over in bed)
- micrographia
- autonomic abnormalities
- hypokinesia/akinesia
- mask face
- depression, dementia
- postural hypotension
- pain
- sleep disturbance (restless leg)
- fatigue
- Dec. fine motor control
PD Rx
- drugs (L-dopa + anticholinergic) - patient will have movement tremor b/c of meds
- education (protective effects of exercise)
- functional mobility exercise - FOCUS ON BIG MOVEMENTS
- cueing (tactile, verbal, music)
- address postural changes and cardiorespiratory fitness
- transfers, balance and falls prevention - prevention of secondary sequelae
- environment safety and checks
- care giver involvement and training
- equipment
PD outcome measures
UPDRS
Hoens & Yar
What is Huntingtons Chorea?
Key features?
Hereditary disorder - atrophy of basal ganglia structures, personality disorder, dementia
Abnormal movements (they cant stop moving)
Huntingtons Rx
symptom management, antipsychotic drugs, safety, nutrition
What is Multiple Sclerosis (MS)
inflammatory disease : fatty myelin sheaths around brain + spinal cord axons are damaged
A demyelinating disorder
MS leads to ___ and ____
Demyelination and scarring
MS etiology?
Unknown
MS typical onset? F or M?
20-40y F>M
4 types of MS
Relapsing remitting
Primary progressive
Secondary progressive
Progressive relapsing
Key features of relapsing remitting MS
- new/old symptoms resurface or worsen
- full or partial recovery between relapses
- each flare up may cause more loss of function
Key features of primary progressive
- gradual worsening of symptoms overtime
- may stabilize but no remission
key features of secondary progressive
- Begins as relapsing remitting - gets to point where there is no remitting just steady worsening
- does not re-myelinate
Key features of progressive relapsing
Some degree of recovery between flares
More gradual slope than relapsing remitting
Early symptoms of MS
o muscle weakness o optic neuritis, diplopia o sensory changes (paresthesia) o b/b incontinence o vertigo o fatigue o impaired cognition/memory o pain o depression
MS Rx
Pharmaceuticals:
- anti-inflammatories + immunosuppressant’s
- side effects: heat intolerance, photosensitivity
PT Treatment for:
- vestibular dysfunction
- exercise (posture, core, stretches, proprioception, pool therapy, interval training?)
- osteoporosis (?)
Contraindications/precautions to exercise with MS
- Heat
- Fatigue
- pregnancy
