neuro pt 3 Flashcards

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1
Q

multiple sclerosis

A

autoimmune disease of the CNS

demyelination, chronic inflammation, gliosis, neuronal loss

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2
Q

MS s/s

A

abrupt or insidious onset

sensory symptoms, optic neurosis, extremity weakness, facial weakness, spasticity, visual changes, ataxia, vertigo

bowel/bladder dysfunction, heat sensitivity, mood alterations, fatigue

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3
Q

MS clinical types

A

relapsing - 90%, discrete attacks but improvement btw attacks

secondary progressive - discrete attack, evolves into progressive course

primary-progressive - gradually progressive symptoms

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4
Q

MS diagnosis

A

2 or more relapses (dissemination in time) & MRI brain/spinal cord w contract evidence of damage in 2 CNS regions (dissemination in space)

LP often performed to R/O other cause - Oligoclonal bands indicate CNS inflammation

labs, expert neuro exam

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5
Q

MS flare tx

A

R/O concurrent illness

glucocorticoids - methylprednisolone & prednisone
plasma exchange
DMARDS
injectibles
oral meds

symptom mgmt

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6
Q

guillan-barre

A

autoimmune polyradiculoneuropathy provoked by infection, inoculation, or surgery

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7
Q

guillan-barre s/s

A

ascending, symmetric motor paralysis with or without sensory changes

loss of DTRs

progresses over hours to days

respiratory dysfunction, speech dysfunction, dysphagia, bowel/bladder dysfunction, autonomic dysfunction

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8
Q

guillan-barre diagnostics

A

descriptive diagnosis
Brighton criteria

CSF - high protein concentration with normal cell content

nerve conduction studies and needle electromyography
nerve biopsy

spirometry to determine need for hospitalization

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9
Q

guillan-barre treatment

A

NO steroids!!!!
IVIG x 5 days
plasmapheresis

admit all
monitor respiratory & autonomic status
neuro c/s

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10
Q

myasthenia gravis

A

chronic autoimmune muscle disorder of the postsynaptic membrane in skeletal muscle

weakness and fatigueability of skeletal muscles

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11
Q

myasthenia gravis s/s

A

muscle fatigue - worse w activity and improves w rest, better in morning

fluctuating skeletal muscle weakness

ocular ptosis

respiratory weakness

complications: thyme abnormalities, hyperthyrodism, respiratory impairment

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12
Q

myasthenia gravis diagnostics

A

ice pack test
serum acetylcholine receptor antibodies
electrophysiology/EMG studies
anticholinesterase test

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13
Q

20/30/40 rule

A

assess for ventilation need in guillan-barre and myasthenia gravis if:

vital capacity <20
maximal inspiratory pressure >-30
OR maximal expiratory pressure <40

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14
Q

myasthenia gravis treatment

A

pyridostigmine
steroids
thymectomy
PLEX or IVIG
intubation if needed

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15
Q

amyotrophic lateral sclerosis & presentation

A

upper and lower motor neuron degeneration leading to. muscle weakness, disability, and death

asymmetric limb weakness is most common presentation

cognitive, sensory, and bowel/bladder function maintained until late-stage

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16
Q

ALS treatment

A

break the news, advanced care planning - resp support? artificial nutrition?
Riluzole - improved survival