Reference no: EM132011030

Scott, a 37-year-old elementary teacher, is seeing his general practitioner for complaints of general weakness, especially in his lower extremities. He has also been feeling very fatigued lately and has trouble keeping up with his students throughout his work day. His physician notes that he has lost a significant amount of weight in the last 6 months. Scott reports that even simple tasks, such as brushing his hair and getting dressed, can seem like a chore. He has trouble climbing stairs because of his weakness and notices that his speech is slurred, especially at the end of the day.

Scott's physician uses a tongue depressor during his physical examination and Scott begins to gag and has difficulty swallowing. His physician notes muscle wasting and abnormal spasticity in upper and lower extremities bilaterally. All reflexes are normal except the Babinski reflex. Scott's toes fan out when the sole of his feet are stroked with the reflex hammer.

1. Scott's symptoms are primarily related to problems with:

a. Both sensory and motor neurons

b. Sensory neurons

c. Neurons of the autonomic nervous system only

d. Motor neurons

2. Because Scott's symptoms are progressively getting worse over a period of several months, we can rule out which of the following diagnoses?

a. Muscular dystrophy

b. Amyotrophic Lateral Sclerosis

c. Multiple Sclerosis

d. Traumatic spinal cord hemisection

Which of the following is NOT an early symptom of ALS?

a. Difficulty swallowing

b. Fatigue

c. Leg weakness

d. Loss of balance

3. ALS stands for Amyotrophic Lateral Sclerosis. What is the word "lateral" referring to in this case?

a. The disease only affects the lateral part of the body.

b. The neurodegeneration affects the lateral portion of the cerebrum.

c. The neurodegeneration affects the lateral columns of the spinal cord.

d. The symptoms only affect one side of the body.

4. Which of the following statements regarding ALS is true?

a. Diagnosing ALS can involve a spinal tap, electromyography, X-rays, MRI, muscle and nerve biopsies, and blood tests.

b. The familial type of ALS is the most common and accounts for 80% of all ALS cases in the U.S.

c. ALS cannot be cured, but medication can stop the progression and sometimes reverse the effects of ALS.

d. The average survival time for a patient diagnosed with ALS is 20-25 years post-diagnosis.

5. True or False? The motor neurons affected by ALS are found in the spinal nerves and peripheral branches of those spinal nerves only.

CASE STUDY 2

Russell is 72 years old and is still working part-time as a professor. He has noticed some arm and hand shaking in the past year, but assumed it must be related to low or high blood sugar levels because he has had some issues with that in the past. However, the shaking/twitching has become more consistent lately and does not seem to be correlated with his diet. Russell's doctor said that the stress of his job could be the problem, so he took the entire summer off from teaching.

When he returned to work in the fall, Russell and his students noticed that his handwriting has become nearly illegible. Drinking a cup of coffee without spilling had also become a challenge. Russell returned to his doctor, who performed a physical exam and a few tests. Here are the notable results: shuffling gait, mild bradykinesia, mild voice tremor, intermittent rigidity of the limbs, and normal EEG.

1. If Russell is having symptoms in his upper extremities, lower extremities, and his speech is slurred, which of the following body regions is most likely experiencing a pathology?

a. Spinal nerves

b. Brain and spinal cord

c. Peripheral nerves

d. Cranial nerves

2. Shuffling gait is often associated with Parkinson's disease. Which of these symptoms is NOT another common sign of Parkinson's disease?

a. Bradykinesia

b. Rigidity

c. Babinski reflex

d. Facial masking

3. Russell's physician decides to follow-up with an MRI. If he does have Parkinson's disease, his MRI may show degeneration in which part of the brain?

a. Corpus callosum

b. Substantia nigra

c. Wernicke's area

d. Frontal lobe

4. Which of the following is NOT a treatment option for Parkinson's disease?

a. Deep brain stimulation

b. Radiation

c. Levodopa

d. Antidepressant medications

5. Which of the following statements is true regarding Parkinson's disease?

a. Brain imaging typically shows degeneration of neurons in the temporal lobe.

b. The loss of neurons is often accompanied by the necrosis of astrocytes and an increase in microglia.

c. It is possible to reverse the effects of Parkinson's disease.

d. Parkinson's disease is typically diagnosed before 40 years of age.