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DDX Flashcards

1
Q

-how many people complain about being tired?
- what does fatigue rank?
- what are causes of fatigue divided into?
- what percent goes unidentified?

A
  • 1 out of 4 or 5 patients have a complaint of tiredness
  • ranks 7th out of primary complaints
  • causes of fatigue are divided into organic or psychogenic
  • 10-30% of cases go unidentified
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2
Q

what kind of things would you look for to get to the bottom of hx of fatigue?

A
  • is complaint more tired or fatigued?
  • is it disabling?
  • review daily eating, work, and sleep habits
  • is it fatigue or prolonged stress- lack of mental peace and well-being?
  • signs of infection
  • medication hx
  • any past dx
  • endocrine problems
  • depression?
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3
Q

why is knowing “timing” of fatigue important?

A
  • morning fatigue is generally more functional
  • fatigue that increases as day progresses is more indicative of psychological
  • fatigue with exertion is more physiological
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4
Q

what is chronic fatigue syndrome known as?

A
  • myalgic encephalomyelitis
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5
Q

what are some characteristics of myalgic encephalomyelitis?

A
  • pt complains of fatigue that has persisted for several months- rest is good but does not relieve symptoms
  • there is no single cause- but may be a dysfunction in immune - acute illness
  • confusing dx, commonly coexists with fibromyalgia 50% of time, depression and other illnesses
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6
Q

what is ME or CFS dx criteria?

A
  • new-er onset of fatigue- not lifelong
  • fatigue neither results from ongoing exertion nor is relieved substantially by rest
  • sense of fatigue causes a significant reduction in previous levels of occupational, educational, social, and personal activities.
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7
Q

what are some other symptoms for ME or CFS?

A
  • sleep that is not refreshing
  • difficulties with memory, focus and concentration
  • dizziness that worsens with moving from lying down or sitting to standing
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8
Q

what lab tests would you conduct to exclude other causes for fatigue?

A
  • thyroid, cortisol and hormone panel- hypothalamus pituitary glands or adrenal glands
  • check for mono spot
  • CBC
  • ELISA for lyme disease
  • functional med. lab tests to consider like candida, celiac and food sensitivity test
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9
Q

what are some risk factors for ME- myalgic encephalomyelitis? CFS that you can watch out for ?

A
  • Age- CFS can occur at any age, but most commonly affects young to middle aged adults
  • sex- women are dx with CFS much more often than men, but it may be that women are simply more likely to report their symptoms to a doctor.
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10
Q

what is ME/CFS prognosis?

A
  • there is no single test to confirm a dx of chronic fatigue syndrome. variety of tests needed-
  • treatment for CFS focuses on improving symptoms.
  • 50% will recover in 2 years
  • severe cases of CFS only 4% recovered in 4 years.
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11
Q

when patient complains of weakness- what do you look for?

A
  • determine what patient means by weakness
  • is it general sense of fatigue or tiredness
  • is it in a specific region or joint weakness
  • has there been trauma
  • is this a sudden onset with diffuse areas of neurologic weakness - difficulty with speech, cognition, consciousness or affect.
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12
Q

what does insidious onset of weakness suggest?

A
  • with persistence or progression of symptoms suggest lesions such as tumors
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13
Q

what does improvement of neurologic signs but recurrence of weakness suggest?

A

vascular process

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14
Q

what does period of immobilization from weakness suggest?

A
  • a need for strengthening
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15
Q

what would specific regional weakness associated sensory complaints such as pain or numbness suggest?

A

nerve involvment

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16
Q

regarding weakness-
- attempt to localize regional weakness by?

A
  • MRI or electrodiagnostic studies may be indicated
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17
Q

regarding weakness-
- if UMNL is located what does this look like and what does this include and what do you do?

A
  • UMNL may present with increased relfexes, an increase in muscle tone, spastic paralysis and pathologic reflexes such as babinskis
  • should be referred out
  • includes cerebral hemispheres, brain stem, and spinal cord.
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18
Q

regarding weakness-
- if LMNL is located, how does this present, what is included and what should you do?

A
  • LMNL may present with absent or decreased deep tendon reflexes, atrophy and fasciculation- twitches- muscle tone may be normal or decreased.
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19
Q

regarding Bell’s Palsy
- what percent recover without treatment
- what can be used to help patient recover if needed.
- what does patient need for eyes
- what are some natural options

A
  • 60% recover without treatment
  • corticosteroids can be used to help recover
  • eye patch and drops may be needed
  • natural antivirals, acupuncture and time
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20
Q
  • what is parkinsons dz
  • when/how do symptoms start
  • what “movement” is most common?
  • what is going on in the brain?
  • what happens when dopamine levels decrease?
A
  • progressive NS disorder that affect movements.
  • gradually, barely noticeable tremor in one hand.
  • tremors are most common- but the disorder also commonly causes stiffness or slowing of movement.
  • neurons in the brain that produce dopamine gradually break down or die.
  • it causes abnormal brain activity, leading to impaired movement and other symptoms.
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21
Q

-what is the cause of parkinsons dz ?
- how do genes play a role?
- what kind of environmental triggers may have a role?
- age?
- heredity?
- sex?
- exposure to toxins?

A
  • the cause of parkinsons is unknown
  • specific genetic mutations can cause parkinsons dz. - certain gene variations appear to increase the risk of parkinsons dz with small risk of genetic markers.
  • exposure to certain toxins or environmental factors can increase the risk of later park. dz
  • young adults are rare- begins in mid/late life and risk increases with age- develp around 60 or older
  • close relatives with park. dz increases chances- risk is small
  • men are more likely to dev. park. dz than women
  • ## ongoing exposure to herbicides and pesticides may slightly increase risk of park dz.
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22
Q

what are some signs/symptoms of parkinsons dz?

A
  • tremors: shaking begins in hands or limbs- or pill rolling tremor- or tremor at rest.
  • bradykinesia: slow movement- time consuming, steps become shorter and difficult to get out of chair- drag feet when walking.
  • rigid muscles: stiffness in any part of body, painful and limit ROM
  • impaired posture and balance: stooped, balance problems as result
  • loss of automatic movements: decreased ability to perform unconscious movements- including blinking, smiling or swinging arms when walking.
  • speech changes: speak softly- quickly slur or hesitate. monotone no inflections
  • writing changes: hard to write and writing may appear small
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23
Q

what are some complications of parkinsons?

A
  • thinking difficulties: dementia occurs later stages- cognitive problems are not responsive to meds.
  • depression and emotional changes: include fear, anxiety or loss of motivation
  • swallowing: saliva accumulate in mouth- leads to drooling
  • chewing and eating problems
  • sleep problems and sleep disorders: REM sleep disorder, acting out dreams
  • bladder problems: not controlled
  • constipation
  • blood pressure changes: dizzy when standing position due to orthostatic hypotension
  • smell dysfunction
  • fatigue
  • pain
  • sexual dysfunction: decrease sexual desire/performance
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24
Q

-what would you see on MRI with parkinsons?
- what lab tests can be done?
- what treatment ?

A
  • MRI narrowing of substantia nigra para compacta on heavily weighted T2 MRI
  • no lab test for parkinson- but to rule out thyroid dz or liver damage can be done
  • treatment is aimed at blocking effects of acetylcholine with anticholinergic drugs or boosting dopamine with levodopa - all patients need co-managing and counseling
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25
Q

-what are characteristics of MS

A
  • patient is younger less than 55
  • hx of dizziness, weakness, numbness or tingling that resolved over the course of days- recurrent episodes
  • genetic relationship due to association of MS and HLA-DR2
  • decreased risk with higher levels of Vit D
  • Ebstein Barr Virus- (Mono) 9and Hx of smoking increase risk
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26
Q

-what is seen when evaluating MS?
- what is seen in the lab evaluation?

A
  • episodic attaches of regional numbness, tingling, weakness, diplopia, dizziness, urinary frequency dysfunction, neurologic deficits
  • reveal mild lymphocytosis or increased protein in CSF
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27
Q

what are some early signs of MS?

A
  • vision problems
  • tingling and numbness
  • pains and spasms
  • weakness or fatigue
  • balance problems
  • bladder issues
  • sexual dysfunction
  • cognitive difficulty- brain fog
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28
Q

regarding MS-
- what is CIS
- define CIS
- what does CIS involve
- what are symptoms of CIS

A
  • clinically isolated syndrome CIS - early sign of MS
  • neurologic symptoms that last 24 hours and cant be assoc. with another cause.
  • involves demyelination
  • symptoms include- optic neuritis, lhermittes sign ( tingling or shock down the back of neck) , transverse myelitis
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29
Q

regarding MS: evaluation and managment:
- what can an MRI indicate
- what can be taken for treatment
- what supplements can be given for nutritional therapy
- what kind of labs can be taken

A
  • if there is only been one episode of CIS or multiple episodes which may indicate MS
  • corticosteroids and immunosuppressive therapy
  • omega 3 fatty acids, vitamin D therapy and antioxidants
  • labs for food sensitivities, candidiasis, celiac and abnormal microflora- fungal infections
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30
Q
  • how does guillain barre syndrome present?
  • what is common complaint
  • what are motor signs
  • what is the % of self resolving
A
  • presents with bilateral leg weakness following either a viral infection or immunization
  • complain of distal paresthesia mostly in LE but can affect UE.
  • loss deep tendon reflexes, fluctuations in blood pressure, abnorm in sweating and sphincter dysfunction.
  • condition is self resolving in 80-90% within mnths- 10% may have residual disablity and 30% will have relapses
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31
Q
  • how does myasthenia gravis present?
  • what could it be associated with?
  • what part of presentation is mc in older men?
  • more frequently seen in what age and sex?
  • can involve difficulty doing what functions?
  • what is the cause?
A
  • may be idiopathic or assoc. with thymoma thyrotoxicosis, RA or SLE- weakness in arm, jaw muscles or chewing difficulty swallowing and double vision.
  • Thymomas mc in older men
  • most freq. seen in young women 20-30 and men 50+
  • can involve difficulty swallowing or breathing
  • cause is unknown- there is no cure
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32
Q

-what is myasthenia gravis?
- is it inherited or contagious?
- what do the antibodies attack?
- what could develop in the fetus?

A
  • a chronic autoimmune disorder in which antibodies destroy the communication between nerves and muscle- resulting in weakness of skeletal muscles. Affects the voluntary muscles of the body- control the eyes, mouth, throat and limbs.
  • it is not inherited or contangious
  • antibodies attach normal receptors on muscle
  • a temp form could develop in the fetus- mom passes the antibodies to the fetus- it resolves in 2 to 3 months.
33
Q

what are some signs and symptoms of myasthenia gravis?

A
  • visual problems, drooping eyelids PTOSIS and double vision DIPLOPIA
  • muscle weakness and fatigue- intensity over days or hours
  • facial muscle involvement causing a mask
    like appearance- a smile may appear more like a sharl- droopy mouth
  • trouble swallowing or pronouncing words
  • weakness of the neck or limbs- can result in unsteady gait- myasthenia gravis may look like other conditions.
34
Q

-what are diagnostics for myasthenia gravis?
- what do you look at when doing a blood test?
- what other tests do you conduct?

A
  • anticholinesterase medications are used to assess the dx based off the patients response to the medication-
  • when doing a blood test you look for antibodies that may be present in people with myasthenia gravis
  • other tests include genetic tests- nerve conduction studies and electomyogram EMG
35
Q

what is treatment for MG

A
  • anticholinesterase medications
  • thymectomy (surgery) is dramatically effective and is often recommended to patients under 60 years of age
36
Q
  • what is amyotrophic lateral sclerosis?
  • how does it present?
  • what is the age range?
A
  • muscle atrophy and fasciculations often brisk deep tendon reflexes- ALS- sensory exam is normal and sphincters are not affected- muscle weakness and cramping in the hand.
  • s/s multiply, including difficulty in swallowing, chewing, coughing or breathing. / abnormal spontaneous activity in resting muscle and a decrease in recruitment ability
  • adult between 30 and 60 years of age.
37
Q

what is the treatment for ALS?

A
  • there is no treatment-
  • progresses to death over a period of 2-2.5 years- 5 years survival rate is 20%
38
Q
  • what is syringomelia
  • what is the demographic of patient
  • what is it associated with?
A
  • a disorder with fluid filled cyst called syrinx forms within the spinal cord- over time it gets bigger and can damage the spinal cord and compress and injure the nerve fibers that carry info to the brain and from the brain to entire body. / DO NOT FEEL PAIN - could also be caused by spinal cord injuries- inflammation around the spinal cord- some idiopathic
  • patient is usually young pediatric
  • could be due to developmental problems- secondary to trauma or intramedullary tumor
  • many cases associated with ARNOLD CHIARI MALFORMATION
39
Q

what are some signs and symptoms of syringomyelia?

A
  • symptoms vary according to where the syrinx forms and the size and how long it extends. They develop slowly and may occur on one or both sides of the body.
  • pain, progressive weakness in the arms and legs- stiffness in the back, shoulders, neck arms or legs- headaches- loss of sensitivity to pain or hot and cold- numbness or tingling- imbalance- LOSS OF BOWELS AND BLADDER CONTROL- sexual function- *** scoliosis may be the only symptom in children
40
Q

syringomyelia has two major forms what are they?

A
  • congenital
  • acquired
41
Q

-what is congenital syringomyelia also called
- what is it most often caused by
- age
- what may patients also have

A
  • also called communicating syringomyelia
  • caused by a chiari malformation and resulting syrinx- usually in cervical region.
  • 25-40
  • may also have hydrocephalus/ straining cough valsalva increases pressure in head causing headache or consciousness
  • they may also have arachnoiditis
42
Q
  • what is acquired syringomyelia called?
  • what might these patients also have?
A
  • primary spinal syringomyelia or non communicating syringomyelia
  • patients might also have spinal cord injury, meningitis, arachnoiditis, tethered cord syndrome or spinal cord tumor
43
Q
  • how do you evaluate and manage syringomyelia?
  • what about treatment?
A
  • MRI is the most reliable way to dx syringomyelia- multiple MRI images can be taken- this is called dynamic MRI- dye contrast injected to enhance
  • depends on the severity and progression of symptoms.
44
Q
  • how is asymptomatic syringomyelia treated?
  • how is progressive syringomyelia treated?
A
  • monitoring, by neurosurgeon- patients should avoid activities that involve straining
  • surgery for progressive- restoration of normal CSF flow and / or direct drainage of the syrinx
45
Q

regarding neurofibromatosis:
- who is usually the patient?
- what are the different types
- how do they present?
- what is treatment?

A
  • children usually the patient
  • present with multiple skin lesions and cafe-au-lait macules on the trunk (type 1) or difficulties with hearing or eyesight (type 2)
  • present as tumors formed in the brain, spinal cord, and nerves- usually not cancerous
  • type 2 is characterized by benign tumors of both acoustic nerves leading to hearing loss
  • no treatment besides surgery to remove tumors
46
Q

regarding NF
- there may be _______ trait that shows changes in the skin, nervous system, bones, and endocrine glands
- ________ autosomal dom. condition that may present as mild or extremely disfiguring with pedunculated tumors and skeletal abnormalities.
- _______ macules may/may not be present at birth- but occur within 3 years and always by 10 years of age.

A
  • genetic trait
  • inherited autosomal
  • cafe-au-lait macules
47
Q

regarding NF
- what are other names for NF type 1?
- at what age does type 1 appear?
- how does it present
- what other symptoms might the patient have
- which nerve (s) does it affect

A
  • von recklinghausens/ fibroma molluscum
  • late adolescence
  • papules, nodular tumors skin colored, pink or brown- flat dome shaped or pedunculated- soft-firm tender and painful when pressure applies- BUTTON HOLE SIGN
  • pt may have hypertensive headaches, bone cysts and fractures, also mental retardation and a short stature- precocious puberty
  • affects the OPTIC NERVE OR SPINAL NERVES
48
Q
  • what is the prognosis of type 1 NF
  • what is prognosis of type 2 NF
A
  • type 1- if they are mild pt can live normal lives- can be debilitating due to cosmetic and psychological issues
  • type 2- damage to vital structures, cranial nerves and brain stem- schwannomatosis very painful-disabling.
49
Q

regarding muscular dystrophy
- what is another name
- age
- what do kids have a hard time doing
- what is elevated finding
- what age of death
- how does it present

A
  • duchenne type
  • 1-5 of age- average dx around 4
  • child has difficulty rising from a bent over position- waddling gait and falls a lot
  • elevated CK levels (CPK) creatine kinase
  • death by 20
  • delays in early dev. milestones such as sitting, walking, and talking. speech delay and inability to keep up with peers/
50
Q

what are some signs and symptoms of DMD
(muscular dystrophy duchenne)

A
  • gowers maneuver (walk hands up legs when getting up from floor)
  • has a hard time lifting head- weak neck
  • not walking at 15 months
  • has a hard time walking, running or climbing stairs
  • is not speaking as well
  • has calves that look bigger than normal (pseudohypertrophy)
  • walks with legs apart
  • walks on toes or waddles
  • has swayback with chest pointing out
51
Q
  • regarding MD duchenne-
    what kind of tests can be used?
A
  • genetic testing- blood cells or muscles cells- can be conclusive- very expensive
  • muscle biopsy- muscle cells are spaced out.
52
Q
  • what is fibromyalgia?
A
  • disorder characterized by widespread musculoskeletal pain accompanied by fatigue, sleep, memory and mood issues.
  • it amplifies painful sensations by affecting the way you brain and spinal cord process painful and non painful signals
  • dx of exclusion
53
Q

regarding fibromyalgia
- what is age range
- what is the population
- what type of labs would you consider

A
  • middle aged women
  • approx 2% of general population
  • CMP CBC ESR- food allergy and sensitivity testing hair biopsy, UA, thyroid panel and vitamin D hydroxy. nothing conclusive
54
Q

regarding fibromyaligia:
what is dx criteria according to american college of rheumatology?

A
  • severe pain in 3-6 different areas of the body or milder pain in 7 + different areas.
  • symptoms have stayed at a similar level for at least 3 months
  • no other reason for symptoms has been found.
55
Q

regarding fibromyaligia
- what are some signs and symptoms

A
  • they vary from person to person
  • main symptom is WIDESPREAD PAIN
  • symptoms get better or worse depending on stress levels, changes in the weather, and how active someone it.
  • widespread pain
  • hyperalgesia and allodynia
  • muscle stiffness
  • fatigue
  • poor sleep quality
  • cognitive diffculties “fibro-fog”
  • headaches
  • IBS
  • dizziness, clumsiness anxiety and depression- cold/hot flashes, paresthesia and RESTLESS LEGS SYNDROMe
  • exercise in flames
  • changes in weather make it worse
56
Q

regarding fibromyalgia
- what conditions must be ruled out?

A
  • chronic fatigue syndrome- ME
  • rheumatoid arthritis- causes pain and swelling in the joints
  • MS- condition of CNS and affects movement and balance
57
Q

regarding fibromyalgia
- treatment?
- management?

A
  • there is no single treatment- may need variety- medications and lifestyle changes- meds are tricyclic antidepressants- malate, Mg, Vit E. L-carnitine, exercise, physical manipulation
  • 75% will recover in one year
  • none have large studies with sig. improvement over control groups
  • 1 hour of exercise 2x per week had 35% of pt improvement
58
Q
  • what is mononucleosis- what age range
  • what is it caused by
  • what happens in 15% of patients
  • what type of testing is done
  • what type of treatment
  • what are some natural options?
A
  • sharing drinks- eating off of people forks etc. causes infection.
  • young patients 10-35 years- complaining of fever, fatigue and sore throat
  • caused by ebstein Barr virus - 5-15 days
  • in 15% enlargement of post. cervical lymph nodes and SPLENOMEGALY- gentle palpate
  • confirmed with Monospot test
  • treatment is palliative - like bad cold unless pt is immunosuppressed
  • natural options- vit c, lauric acid, zinc, milk thistle, rich in fruits and veg. low in processed foods
  • no contact sports or chiropractic adjustment
59
Q

-what is lyme diseased caused by
- how is it transmuted to humans
- how does initial stage present- what does it form.

A
  • complex multi system dz caused by the SPIROCHETE BORRELLA BURGORDORFI
  • by a bite of an infected deer tick
  • annular erythema at the site of the tick bite- red papule spreads outward and forms a plaque with the center clearing. - looks like bullseye- ERYTHEMA MIGRANS
60
Q

regarding lyme disease
- what are the 3 stages

A
  • stage 1- localized infection with flu like symptoms- interleukins flare up
  • stage 2- month after bite pt may show mult. smaller annular lesions as well as heart irregularities- heart palpatations- headaches and arthralgia- joint pain
  • stage 3- indiv. may display gen. erythema, chronic joint pain and possible neurologic symptoms- mood memory sleep changes.
61
Q

regarding lyme disease
- how do you manage it.

A
  • doxycycline or amoxicillin for 21 days or longer if caught early
  • probenocid- increases uric acid elimination by kidneys and boosts antibiotic fx, - added if later in dz and joints affected and treatment is extended to 30 days.
  • colloidal silver has little research behind its efficacy
62
Q

describe hep A

A
  • bad hand washing techniques - or touched surface infected.
    -pts are ASYMPTOMATIC
  • some may present with anorexia and malaise
  • may develop fever prior to jaundice
  • transmission is through fecal oral
  • mc in daycare centers, homosexual men and institutionalized people. also contaminated food
  • 20 to 80% have immunity
  • incubation is 15-45 days
63
Q

regarding hep A
- what is presentation
- what is seen on tests
- what should hep a pts avoid
- is it self resolving
- what are some natural treatments

A
  • may have hepatomegaly with upper right quadrant tenderness
  • dark urine
  • jaundice - usually occurs as pt begins to feel better
  • WBC and ESR are normal
  • ALT and AST are elevated 8X
  • elevated bilirubin and alkalinephosphatase
  • confirmation is NAV IgM - first Ab to increase in hep A
  • avoid tylenol- due to hepatic metabolization
  • encourage caloric intake increase to fight infection
  • self resolving
  • antiviral and liver support such as milk thistle, vit. c and lauric acid
64
Q
  • how does hep b present
A
  • chronic malaise or fatigue
  • if during prodrome may present with urticaria, rash and arthralgias
  • hepatomegaly with upper rt quad tenderness
  • dark urine
65
Q

regarding hep b
- what would you see on WBC and ESR?
- what would ALT and AST levels be?
- what other things would be elevated
- what would dx
- what antibody present with chronic flareups

A
  • gen. normal
  • elevated 8x normal
  • bilirubin and alkaline phosphatase elevated
  • IgM anti-hep b core antibody
  • IgG antibody present with chronic flareups= chronic tired and itchy with joint pain
66
Q

regarding hep b
- it is generally self resolving if it is ______
- pt dx with chronic hep b need treatment for how long
- what do treatments help reduce
- what type of liver support natural
- what kind of drugs would you avoid
- what about alcohol
- Hep B positive pts have higher risk for?

A
  • acute- lasts approx 6 weeks with the poss. of 2 or 3 relapses
  • for the rest of their lives
  • treatment helps reduce the risk of liver disease and prevents transmitting the infection to others/ antiviral meds, interferon injections, liver transplant.
  • risk of liver dz and prevents transmitting infection to others.
  • vit. c, milk thistle, monolauric acid
  • hepatotoxic and hepatically metabolized drugs
  • limit alcohol
  • ## HBV positive pts. have much higher risk of liver cancer.
67
Q

-what is CML?
- how present
- signs
- tests
- treatment

A
  • chronic myelogenous leukemia
  • middle aged - complains of fatigue, night sweats and low grad fever
  • splenomegaly
  • WBC elevated- uric acid level elevated
  • stem cell or bone marrow transplant- standard treatment for chronic is TYROSINE KINASE INHIBITOR
68
Q
  • is dizziness a dx?
  • what rank in presentation is dizziness?
  • what % report dizziness
A
  • it is NOT a dx - could be a component of a larger diffuse problem
  • 3rd mc presentation
  • 42% report dizziness
69
Q

what are the 5 types of dizziness

A
  • vertigo
  • disequilibrium
  • lightheadedness
  • near-syncope
  • unsteadiness
70
Q

-what is vertigo
- what is objective vertigo
- what is subjective vertigo
- what is the most common cause of dizziness

A
  • described as spinning, twisting or turning
  • objective vertigo- the pt feels still but objects appear to be moving around them
  • subjective vertigo- the patient feels that they are spinning
  • MCC of dizziness is vertigo- may arise from dz of inner ear- alcohol- food poisoning- cardiovascular diseases- VBI, cerebellar or brain stroke cerebellar hemorrhage- vertebral artery dissection
71
Q

Vertigo is presenting symptom of?

A

MS- onset is abrupt and examination of the eyes may reveal the in ability of the eyes to move past the midline toward the nose.

72
Q

what is the most appropriate for dx vascular causes of vertigo

A

MRI- because it visualizes the posterior fossa

73
Q

regarding dizziness
what is disequilibrium?
what are the causes?

A
  • sensation of imbalance and unsteadiness when standing or walking- room feels tilted
  • causes include- cerebellar dz- degeneration, tumor infarction, drugs- parkinson- dorsal column lesion- B12 def. syphilis, multiple sensory def. and peripheral neuropathy
74
Q

what is lightheadedness
what are the causes

A
  • sensation of impending loss of consciousness- floating- wooziness
  • causes include recently corrected vision- psychological anxiety or depression- physiological influences, changes in homeostasis
75
Q

what is near syncope
what is presyncope
what is syncope
what is the cause?

A
  • near syncope is the cause of dizziness in 6% of cases and up to 28% in elderly patients with sever dizziness
  • presyncope is a more extreme form of lightheadedness- it may or may not precede syncope. it may accompany tachycardia and palpitations or excessive sweating diaphoresis
  • syncope is the transient complete loss of comsciousness
76
Q

what is near syncope caused by?

A
  • decreased total peripheral resistance- think vasokilation- drugs- exercise, orthostatic hypotension. hypoglycemia, inadequate BP and dehydration- SUBCLAVIAN STEAL
77
Q

what is BPPV

A
  • debris in the ear
  • brief but recurrent- moderate to severe
  • associated with head position
  • gradually diminshes over a month or two- no hearing loss
  • latency or delayed onset of signs or symptoms
  • caused by OTOCONIA DEBRIS FLOATING IN PSC POSTERIOR SEMICIRCULAR CANAL
78
Q

what is dix hall pike maneuver

A

Tri 7 (12 decks)

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