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D Semester > Neuromuscular Problems > Flashcards

Neuromuscular Problems Flashcards

1
Q

What differentiates GBS from ALS and MS?

A

GBS is an acute autoimmune disorder that affects only the peripheral nervous system, causes ascending paralysis, and is usually reversible.

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2
Q

What differentiates ALS from GBS and MS?

A

ALS is a terminal degeneration affecting both the peripheral and central NS, it is usually fatal.

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3
Q

What differentiates MS from GBS and ALS?

A

MS is a chronic autoimmune disorder that affects only the central nervous system. It is is not reversible or curable but can usually be managed.

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4
Q

What sorts of events are known to trigger GBS?

A

Infections and trauma of the GI or respiratory systems

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5
Q

What major cranial nerve is often affected in GBS?

A

The vagus nerve, controlling heart, lungs, and motor larynx

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6
Q

What is preserved in GBS?

A

Cognitive function and LoC.

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7
Q

What are the diagnostic studies for GBS?

A

Lumbar puncture finding high protein in CSF, EMG, spinal MRI, nerve conduction studies

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8
Q

What is plasmapheresis and what does it do?

A

Blood is removed from the body and plasma is separated and replaced with a substitute that does not contain harmful antibodies. Blood is then replaced into the body.

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9
Q

What NMDs is plasmapheresis effective for?

A

GBS and MG

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10
Q

What does IVIG do?

A

It suppresses inflammatory pathways and modulates immune response (basically, it tells the immune system to chill out without stopping it). It can also neutralize autoantibodies.

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11
Q

What are important assessments in GBS?

A

Organ function, respiratory function, gag and swallow ability, skin condition

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12
Q

What parts of the nervous system are affected by ALS?

A

Upper and lower motor neurons.

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13
Q

What are key features of ALS?

A

Progressive muscle weakness, spasticity / fasciculations, atrophy, elevated deep tendon reflexes, elevated CK-BB.

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14
Q

What is the diagnostic criteria for ALS?

A

Signs of progressive UMN and LMN degeneration without other explanation

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15
Q

What is the only drug approved to treat ALS?

A

Edaravone. Slows decline rate by 33%

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16
Q

What should you do with a bed for nearly every patient with an NMD?

A

Elevate the head of the bed.

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17
Q

What type of brain cell does MS attack?

A

Oligodendocytes, which produce myelin sheath.

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18
Q

What populations are more likely to develop MS?

A

Women, those in temperate climates, those with less childhood sun exposure.

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19
Q

What is the classic pattern of MS?

A

Alternating waves of relapse and remission.

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20
Q

What are the most common features of MS?

A

Chronic fatigue, vision and cognitive changes, difficulty with coordination and emotional regulation, parasthesias

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21
Q

How is MS usually diagnosed?

A

Diagnosis by rule-out + MRI + CSF analysis

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22
Q

What types of drugs are used in treating MS?

A

Immunomodulators, immunosuppressants, corticosteroids, muscle relaxants, monoclonal antibodies

23
Q

What exacerbates MS?

A

Heat, stress, infection, toxins, fatigue, sedentation

24
Q

What is Myasthenia Gravis?

A

An autoimmune disorder in which the acetylcholine receptors in the NMJ are destroyed, preventing muscle activation.

25
Q

What is the primary characteristic of MG?

A

Fluctuating muscle weakness that increases after use and is recovered with rest.

26
Q

What gland is implicated in the pathology of MG?

A

Thymus gland, where B and T cells are made

27
Q

What muscle group is most commonly affected in MG?

A

Ocular muscles and eyelids

28
Q

What anticonvulsants can worsen MG?

A

Phenytoin, benzodiazepines

29
Q

What common BP meds can worsen MG?

A

Beta blockers.

30
Q

How is MG diagnosed?

A

Presence of AChR antibodies, Tensilon contraction test, EMG studies

31
Q

What are the three classes of drugs used to treat MG?

A

Anticholinesterase Inhibitors, Immunosuppressants, corticosteroids

32
Q

What surgical treatment for MG is indicated in almost all cases?

A

Thymectomy

33
Q

What is a myasthenic crisis?

A

MG has flared up significantly enough that the muscles of swallowing, breathing, and talking are impaired

34
Q

What is cholinergic crisis?

A

Excessive ACh stimulation from overdose of ACEI drugs. Produces flaccid paralysis while preserving deep tendon reflexes.

35
Q

What is SLUDGE syndrome?

A

Syndrome indicating parasympathetic overstimulation. Excess production of saliva and tears, urination, defecation, N/V/D. Think that everything is leaking out at once, producing sludge.

36
Q

What are all people with high spinal level neurological problems more susceptible to?

A

Respiratory issues

37
Q

What characterizes Parkinson’s Disease?

A

Tremors at rest, rigidity, bradykinesia, blank expression, shuffling gait

38
Q

What is TRAP as it relates to Parkinson’s?

A

Tremor, rigidity, akinesia, postural instability

39
Q

Why is Parkinson’s medication changed frequently?

A

The progressive nature of the disease renders medications ineffective as time goes on.

40
Q

What are the three types of surgical intervention for Parkinson’s?

A

DBS implant

Ablation of affected brain tissue that is causing symptoms

Transplantation of fetal neural tissue into basal ganglia to provide dopamine

41
Q

What is Parkinsonism?

A

Parkinson’s symptoms that are induced by a drug and cease when the drug is discontinued

42
Q

What group of vitamins is important to get for those with Parkinson’s?

A

B vitamins

43
Q

What are common underlying causes of seizures?

A

Electrolyte issues (hydration status), hypoxia, glycemic issues, acidosis, withdrawals

44
Q

What is epilepsy defined as?

A

Recurrent seizures

45
Q

What are the categories of seizures?

A

Generalized and focal

46
Q

What are the 4 phases of seizure?

A

Prodromal - normal state

Aural - sensory changes indicating oncoming seizure

Ictal - proper seizure

Postictal - recovery time, usually involves sleepiness and confusion

47
Q

What are tonic-clonic seizures?

A

Most common generalized seizure, known as grand mal. Involves muscle contraction.

48
Q

What are are typical absence seizures?

A

Frequent, brief staring spells with little awareness. Usually outgrown in adulthood.

49
Q

What are atypical absence seizures?

A

Brief staring spells that include subtle eye movements, pt may remain responsive. Often persists into adulthood.

50
Q

How are seizure disorders diagnosed?

A

EEG, CBC, BMP, fMRI, CT

51
Q

What is status epilepticus?

A

Seizure(s) lasting longer than 5 minutes without full recovery of consciousness

52
Q

Why is status epilepticus so dangerous?

A

Can cause excitotoxicity, rhabdo, ventilatory insufficiency, hyperthermia, acidosis

53
Q

What are common side effects of phenytoin?

A

Dulling of cognition, gingival hypertrophy, hirsuitism, difficulty with coordination and balance

54
Q

When do most EtOH withdrawal seizures start?

A

7-30 hours of last drink. Lasts 48 hours.

D Semester (7 decks)

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