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49 Cards in this Set
- Front
- Back
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The motor system originates in the motor area of the ______, output from here moves caudally in the _______ tract and _____ ganglia and the ____ have additional influences.
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-frontal lobe cortex
-corticospinal -basal -cerebellum |
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What do the basal ganglia and cerebellum have influence over?
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Integrating, Posture, Reinforcing, Coordinating
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What level of the motor system can diseases affect?
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Every level from the brain to the muscle
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What are some signs and symptoms of motor system disease of the CNS?
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-Difficulty w/ coordination, balance, and rapid movements
-NORMAL muscle strength, NO wasting! -Muscle tone increased w/ spasticity or rigidity |
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What are some signs and symptoms of motor system disease of the PNS?
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"Difficulty w/ Tasks"
-If weakness proximal: impairment in climbing or descending stairs, rising from a chair, or lifting heavy objects overhead -If weakness distal: stumbling and tripping, problems fastening buttons and opening locks or doors |
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PD is a ___kinetic disorder with increased muscle tone throughout the ROM.
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hypo
(not enough movement) |
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PD will not vary with ____ ROM and _____ rigidity is seen with a superimposed tremor.
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-Passive
-Cogwheel |
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PD begins most commonly b/w the ages ___&___ and is the leading cause of neuro dz in people over ____.
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45 & 65
65 |
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What is the "triad" of PD symptoms and what symptom was added later?
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-Tremor, Bradykinesia, Postural Instability
-Muscle Rigidity |
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PD is caused by premature death of _____ neurons in the _______.
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-Dopaminergic
-Substantia Nigra |
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Since dopamine depletion leads to an imbalance of dopamine and Ach, treatment is aimed at blocking the affect of Ach with ______ or administration of ______.
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-Anticholinergics
-Levodopa (dopamine precursor) |
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The tremor of PD is noticed more at ____, worsened by ____, less severe during ____ activity, and is mostly combined to ____ limb/s for years before becoming generalized.
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-Rest
-Stress -Voluntary -1 |
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There is a characteristically _____ posture in PD.
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Flexed
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What is the most diasabling feature of PD?
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Bradykinesia
(Slowness in voluntary and involuntary movements such as swinging arms when walking) |
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In PD, voluntary movements may be temporarily regain during _____.
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Emergencies
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Other Signs/Findings of PD?
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-Immobile face w/ widened palpebral fissure
-Infrequent blinking and fixed facial expression -Seborrhea of scalp and face -Blepharoclonus -Tremor of mouth and face -Myerson's sign (forehead tap) -Drooling -Soft, quiet voice -Micrographia -Shuffled gait, loss of arm swing, difficulty stopping, propensity to fall |
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In cases where ___ is absent, dx of PD is difficult.
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Tremor
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What are the DDX of PD?
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-Old Age
-Depression (may require trial of antidepressants to differentiate) -Wilson's dz (early age of onset, keyser-fleischer rings, hepatitis) -Huntington's dz (Fam hx, accomanying dementia) |
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Is drug treatment required early in PD?
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No, but should discuss w/ pt
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What are the medications used to treat PD?
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-Amantadine: helpful if mild sx w/o disability and improves all clinical features of PD
-Anticholinergics (Cogentin): relieves tremors and rigidity -Levodopa/Carbidopa: result is fewer SE's w/ exception of the "off and on" phenomenon or dyskinesias -Dopamine agonists (Permax, Parlodel, Requip, Mirapex): lower incidence of "off and on" phenomenon and dyskinesias -COMT inhibitors: leads to longer plasma levels of levodopa when administered together; Entalcopone is preferred to Tolcapone b/c no liver toxicity & no need to monitor LFTs |
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What are the aids to daily living in PD pts?
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-Rails
-Banisters -Large handle table utensils -Non slip table mats -Non slip bathroom surfaces -Voice amplification devices |
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What are the surgical treatments for PD pts who are unresponsive to medical treatment or have intolerable SE's to medications?
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-Pallidotomy (destroy the globus pallidus to relieve involuntary movements or muscular rigidity)
-Thalamotomy (ablation of selected portion of the thalamus to relieve tremors) |
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High frequency electrical _____ stimulation suppresses the rest tremor of PD.
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Thalamic
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Bilateral stimulation of the _____ nuclei or _______ may benifit ALL the features of PD.
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-Subthalamic
-Globus Pallidus Internus |
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What are the adavantages of electrical Deep Brain Stimulation?
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-Is Reversible
-Causes minimal or no damage to the brain -Is the prefered surgical approach to tx |
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What are the secondary causes of PD?
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-Drug Induced PD
-Lewy-body dz -Vascular PD -Toxic PD |
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Drug induced PD is mostly due to ______ medications such as phenytoin and phenothiazine, and provokes a _________ syndrome.
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-Neuroleptic
-Bradykinetic/Rigid |
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When lewy-bodies are found in the _____ there is no difference b/w Lewy-body dz and PD.
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Brainstem
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Vascular PD is caused by microangiopathic changes in the _____.
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Basal ganglia
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What are some causes of toxic PD?
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-CO poisoning (causes bilateral necrosis of the basal ganglia)
-Chronic manganese exposure -Street drug MPPP contaminated w/ MPTP |
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Huntington's dz is an AD neurodegenerative disorder affecting ______, ______, and _____.
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Motor Fxn
Cognition Behavior |
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What 2 symps characterized Huntington's dz?
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1. Chorea
2. Dementia |
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When is the clinical onset of Huntington's dz and how many years after onset is it fatal?
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-30-50 yo
-15-20 yrs |
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Initial symptoms and earliest mental changes in Huntington's dz?
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-Initial symps: Abnormal movements (dyskinesias, fidgety, restlessness; eventually choreiform movements and dystonic posturing) or Intellectual changes
-Earliest mental changes are behavioral: Irritablity, Moodiness, Antisocial behavior, Psychiatric disturbances. |
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What 2 things sometimes occur in those w/ Huntington's dz who have dementia?
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1. Progressive rigidity
2. Akinesia |
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What does CT demonstrate in Huntington's dz?
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Cerebral atrophy of the caudate nucleus
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What does PET demonstrate in Huntington's dz?
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Reduced glucose utilization in an anatomically normal caudate nucleus.
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Chorea with NO ______________ should not be attributed to Huntington's dz.
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Fam hx of Huntington's
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What are the non-genetic causes of chorea?
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-Stroke
-SLE -Paraneoplastic syndromes -HIV -Meds -In younger pts w/ strep infection, called Sydenham chorea (self limiting) |
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What is the cure for Huntington's dz?
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NO CURE and cannot halt progression! Treatment is symptomatic.
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What drugs may control the dyskinesia or behavior probs in Huntington's dz?
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Dopamine Receptor Blocking Agents (phenothiazines, haloperidol)
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What antipsychotic can be used for behavioral disturbances in Huntington's dz?
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Clozapine
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In Tourette Syndrome, 80% of the pts have ____ tics and 20% have _____ tics.
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-Motor
-Phonic *Usually all pts develop a combo of the 2. |
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When are the tics of Tourette Syndrome 1st noticed?
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In childhood b/c 2-15 yrs old
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What areas of the body do motor tics occur and what do they entail?
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-Face, Head, Shoulders
-Sniffing, Blinking, Frowning, Shoulder Shrugging, Head thrusting (can be self mutilating) |
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What are some phonic tics in Tourette Syndrome?
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Grunts, Barks, Hisses, Throat clearing, Cough
*Coprolalia-obscene speech *Echolalia-repitition of speech of others |
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What behaviors may be more disabling that the tics in Tourette Syndrome?
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Obsessive-Compulsive
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Is the PE normal in Tourette Syndrome?
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Normal except for Tics
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How do we treat Tourette Syndrome?
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-Haloperidol is DOC!!!
-Clonazepam may be helpful and avoids the long term effects of haloperidol -Pimozide (dopamine blocking drug) may be helpful in pts who haven't responded to the DOC. |
