Chapter 17 #2 - Neurology - AI Powered Flashcards
(140 cards)
1
Q
Cards coming…I reached my AI summarization limit for the day. HAHA
A
:)
2
Q
What is dementia?
A
Dementia can affect multiple functions in the brain, leading to a variety of symptoms and signs.
3
Q
What are common manifestations of dementia?
A
- Difficulty with learning and retaining information
- Problems with handling complex tasks
- Impaired reasoning
- Spatial disorientation
- Language problems
- Behavioral symptoms
4
Q
What are early-stage symptoms of dementia?
A
- Memory loss for recent events
- Changes in behavior and personality
- Impairment in work/skills performance
5
Q
What symptoms characterize middle-stage dementia?
A
- Significant decline in skills
- Difficulty identifying objects
- Confusion and disorientation
- Worsening personality changes
6
Q
What are late-stage dementia symptoms?
A
- Loss of basic skills (e.g., eating and drinking)
- Weight loss
- Loss of ability to ambulate independently
- Loss of recognition of familiar people and environments
7
Q
What is mild cognitive impairment (MCI)?
A
A condition of memory loss beyond what is expected with normal aging, but minimal or no loss in daily work or routines.
8
Q
What is the significance of establishing an accurate diagnosis of dementia?
A
To determine whether cognitive decline is related to an irreversible illness or reversible causes.
9
Q
What are some examples of reversible causes of cognitive decline?
A
- Depression
- Chronic renal insufficiency
- Thyroid disease
- Vitamin deficiencies
10
Q
What are the main types of stroke?
A
- Ischemic stroke
- Hemorrhagic stroke
11
Q
What is an ischemic stroke?
A
Occurs when a blood vessel that supplies blood to the brain is clogged.
12
Q
What are the two ways ischemic strokes can occur?
A
- Thrombotic stroke (clot forms in a narrow artery)
- Embolic stroke (clot travels to the brain)
13
Q
What are modifiable risk factors for ischemic stroke?
A
- High blood pressure
- Dyslipidemia
- Atrial fibrillation
- Coronary artery disease
- Diabetes mellitus
- Overweight and obesity
- Excessive alcohol consumption
- Tobacco use
- Illicit drugs
14
Q
What are common symptoms of an ischemic stroke?
A
- Contralateral weakness and/or sensory loss
- Aphasia
- Confusion
- Visual perceptual problems
- Dysphagia
15
Q
What are the seven Ds in the management of ischemic stroke?
A
- Detect
- Dispatch: call 911
- Door: immediate triage
- Data: obtain evaluations
- Decision: establish thrombolytic therapy
- Drug: administer t-PA
- Disposition: transfer to appropriate unit
16
Q
What is the primary goal of symptomatic therapy for Alzheimer’s disease?
A
To enhance cognitive function using cholinesterase inhibitors and NMDA receptor blockers.
17
Q
True or False: Antipsychotics and sedatives should be used regularly in dementia treatment.
A
False
18
Q
What complications can arise from Alzheimer’s disease?
A
- Injury and trauma
- Malnutrition
- Incontinence
- Aspiration pneumonia
- Pressure ulcers
- Seizures
19
Q
What is a transient ischemic attack (TIA)?
A
A warning sign of future strokes, characterized by transient neurologic events lasting up to 24 hours.
20
Q
What is the best management setting for a patient with acute ischemic stroke?
A
A special care unit (e.g., stroke unit)
Continuous neurologic and cardiovascular monitoring by skilled medical personnel is essential.
21
Q
What are some general measures used in caring for acute ischemic stroke patients?
A
- Optimal blood pressure control
- Control of fluid and/or electrolyte balance
- Adequate oxygenation
- Maintenance of euglycemia
Normal blood sugar levels are crucial for patient care.
22
Q
What precaution should be taken for patients with significant aphasia or drowsiness after a stroke?
A
Keep them without food per mouth until safe to eat
This helps avoid aspiration pneumonia.
23
Q
What is the only proven and effective pharmacologic treatment for acute ischemic stroke?
A
t-PA (tissue plasminogen activator)
Administered within 4.5 hours of symptom onset.
24
Q
What are major contraindications to t-PA?
A
Systemic or cerebral bleeding risks
These contraindications are critical to minimize t-PA-associated risks.
25
What is mechanical thrombectomy?
Angiographic removal of a demonstrated clot in a large artery of the cerebral circulation
## Footnote
It is beneficial for acute ischemic strokes with specific clot locations.
26
What is the recommended management for patients with acute cerebral infarction at high risk of recurrence?
Anticoagulant therapy
## Footnote
This includes heparin and vitamin K antagonists like warfarin.
27
What should patients not at high risk of cerebral cardioembolism receive to prevent ischemic stroke recurrence?
Long-term antiplatelet therapy
## Footnote
Options include aspirin, clopidogrel, and ticlopidine.
28
What lifestyle changes should patients with ischemic stroke be educated about?
* Stop smoking
* Comply with antihypertensive and/or blood sugar medications
* Exercise
* Avoid excess alcohol use
## Footnote
These changes help minimize stroke risk factors.
29
What surgical procedure is indicated for symptomatic carotid artery stenosis?
Carotid endarterectomy
## Footnote
This procedure is performed in addition to medical therapy if surgical risk is low.
30
What complications can arise from massive cerebral infarction?
* Hydrocephalus
* Brain herniation
## Footnote
Hydrocephalus may require shunt insertion, while brain herniation may necessitate lobectomy or hemispherectomy.
31
What are some long-term complications associated with stroke?
* Recurrent aspiration
* Infections (e.g., pneumonia, urinary tract infections)
* Pressure sores
* Poor nutrition
* Chronic pain
* Cognitive difficulties
## Footnote
These complications contribute to the disability associated with stroke.
32
What is multiple sclerosis (MS)?
The most common immune-mediated demyelinating disease of the CNS
## Footnote
MS incidence varies geographically, with higher rates in Europe and North America.
33
What is the mean age of onset for multiple sclerosis?
Approximately 30 years
## Footnote
Women are slightly more prone to MS than men.
34
What are the pathological hallmarks of MS?
Inflammatory patches or plaques with multifocal demyelination
## Footnote
Axonal destruction occurs early and becomes prominent as the disease progresses.
35
What are the two main forms of MS?
* Relapsing-remitting disease (RR-MS)
* Primary progressive MS (PP-MS)
## Footnote
RR-MS is characterized by recurrent spells of neurologic signs and symptoms.
36
What are common clinical manifestations of multiple sclerosis?
* Unilateral visual loss
* Sensory loss or paresthesias
* Motor weakness and spasticity
* Bladder dysfunction
* Fatigue
* Cognitive impairment
## Footnote
Symptoms vary widely due to the demyelination of myelinated pathways.
37
What are the primary goals of management for relapsing-remitting MS?
* Reducing recurrence rates and disease modification
* Hastening recovery during a recurrence
* Treatment of symptoms and complications
## Footnote
These goals guide the management strategies for RR-MS.
38
What are some pharmacotherapy options for disease modification in MS?
* Interferon β–1a
* Interferon β–1b
* Glatiramer
* Fingolimod
* Dimethyl fumarate
* Natalizumab
* Teriflunamide
## Footnote
These medications are used primarily for relapsing-remitting MS.
39
What is a common treatment for bladder dysfunction in MS patients?
Tolterodine
## Footnote
Several medications are available to manage symptoms associated with MS.
40
What are potential complications of steroid use in MS treatment?
* Bone mineral density loss
* Aseptic necrosis of the hips
## Footnote
Long-term steroid use can lead to significant complications.
41
What is the prevalence of multiple sclerosis in the United States?
0.1%
## Footnote
MS prevalence varies globally, with higher rates in certain geographic locations.
42
What are common complications associated with β–interferons?
Menstrual abnormalities, skin reactions at injection sites, precipitation or exacerbation of depression, thrombotic thrombocytopenic purpura.
## Footnote
Rarely, β–interferons can cause thrombotic thrombocytopenic purpura.
43
What liver abnormalities are associated with teriflunamide and fingolimod?
Liver abnormalities.
## Footnote
Fingolimod treatment has been linked to severe MS relapses, although rarely.
44
What serious CNS condition can natalizumab increase the risk of?
Progressive multifocal leukoencephalopathy (PML).
## Footnote
This is a serious CNS condition associated with natalizumab treatment.
45
What are non-drug-related complications of MS?
Recurrent urinary tract infections, chronic pain, fatigue, depression, dementia, sensory and motor deficits.
## Footnote
These complications can lead to physical disability and reduced ambulation.
46
What percentage of patients with RR-MS may develop secondary progressive MS each year?
2 to 3% per year.
47
What is classified as a head injury?
Any trauma that leads to injury of the scalp, skull, or brain.
48
What are the two classifications of head injuries?
Closed and open (penetrating).
49
What is the most common type of traumatic brain injury?
Concussion.
50
What are common causes of head injury?
Traffic accidents, falls, physical assault, self-inflicted injury, recreation-related injuries, work-related injuries.
51
What are risk factors for traumatic brain injury (TBI)?
Age, male gender, occupation type.
52
What symptoms can occur as a result of a head injury?
Severe headaches, changes in alertness, irritability, memory loss, mood changes, clumsiness, fluid drainage, fractures, pupil changes, sensory loss, speech problems, changes in vital signs, motor paralysis, seizures, neck stiffness, vomiting.
53
What characterizes mild TBI?
Loss of consciousness for a few seconds or minutes, headache, confusion, dizziness, memory issues.
54
What is the management approach for head trauma?
Supportive care and pharmacologic therapy.
55
What are some complications of head injury?
Posttraumatic seizures, headaches, cognitive impairment, mental health issues, persistent nausea, bladder dysfunction.
56
What is Guillain-Barré syndrome (GBS)?
A peripheral, predominantly demyelinating disorder that is typically monophasic.
57
What are the subtypes of Guillain-Barré syndrome?
Acute inflammatory demyelinating polyneuropathy (AIDP), acute motor axonal neuropathy (AMAN), Miller Fischer syndrome.
58
What is the annual incidence of GBS?
1 to 2 per 100,000.
59
What are common antecedent infections that may lead to GBS?
Influenza, cytomegalovirus, Campylobacter.
60
What are common symptoms of AIDP?
Paresthesia, ascending muscle weakness, possible paralysis, bulbar and respiratory muscle weakness.
61
How is classic GBS or AIDP diagnosed?
Clinically suspected with ascending numbness and weakness, absent reflexes, and characteristic LP findings.
62
What is the primary treatment for GBS?
Plasma exchange (plasmapheresis) or intravenous immunoglobulin (IVIG).
63
What are potential complications of GBS?
Residual weakness, cardiac dysfunction, prolonged mechanical ventilation, respiratory failure, sepsis.
64
What is the annual incidence of Amyotrophic Lateral Sclerosis (ALS)?
1.5 to 3.7/100,000
## Footnote
The prevalence of ALS ranges from 2.7 to 7.4/100,000.
65
What is the median age of onset for ALS?
Mid to late fifties
## Footnote
This is observed in most populations studied.
66
What percentage of ALS cases are familial?
5 to 10%
## Footnote
Familial ALS almost always represents an autosomal dominant disorder.
67
What gene mutation is associated with X-linked dominant ALS?
UBQLN2 gene on Xp11.21
68
Which mutations are commonly linked to familial ALS?
* SOD1 gene missense mutations
* C9ORF72 gene repeat expansions
## Footnote
The latter has been found in some sporadic cases as well.
69
What are the nonmodifiable risk factors for ALS?
* Advancing age
* Male gender
* Caucasian race
70
What are the two types of motor neuron dysfunction in ALS?
* Upper Motor Neuron (UMN)
* Lower Motor Neuron (LMN)
71
What are common clinical manifestations of UMN in ALS?
* Spasticity
* Hyperreflexia
* Impaired rapid alternating movements
* Spastic gait
* Muscle spasms
72
What are common clinical manifestations of LMN in ALS?
* Muscle atrophy
* Fasciculations
* Impaired heel/toe walking
* Foot drop
* Impaired dexterity
* Cramps
73
What is a common respiratory symptom in ALS?
Dyspnea
## Footnote
Dyspnea is common with ALS and can lead to anxiety.
74
What is the only FDA-approved drug for ALS?
Riluzole
75
What should be the focus of symptom management in ALS?
* Shortness of breath
* Aches and pains
* Muscle spasms
* Spasticity
* Fatigue
* Drooling
76
What is the recommended timing for gastrostomy in ALS patients?
Before forced vital capacity (FVC) falls below 50% of predicted FVC
77
What is the mean survival time from symptom onset in ALS?
Less than 3 years
78
What is Myasthenia Gravis (MG)?
A disorder of the neuromuscular junction
79
What is the peak incidence age for MG in women?
Twenties and thirties
80
What is the peak incidence age for MG in men?
60 to 70 years
81
What are the five severity-based classifications of MG?
* Purely ocular
* Mild generalized
* Moderate generalized
* Severe generalized
* Requiring intubation
82
What is a myasthenic crisis?
A sudden severe decline in strength with respiratory failure
83
What are common autoantibody targets in MG?
* Acetylcholine receptors (AChR)
* MuSK (muscle-specific tyrosine kinase)
* LRP4 (lipoprotein receptor-related protein 4)
84
What is the clinical hallmark of MG?
Fatigable weakness of striated muscles
85
How does symptom variation present in MG?
Normal or near-normal function early in the day, with progressive weakness later
86
What is myasthenia gravis (MG)?
An autoimmune disorder characterized by weakness in the skeletal muscles.
87
What are common symptoms of myasthenia gravis?
Ptosis, diplopia, facial weakness, dysphagia, dysphonia, drooling, head drop.
88
What is the mainstay treatment for mild myasthenia gravis?
Anticholinesterase inhibitors, such as pyridostigmine.
89
What are the therapeutic strategies for managing myasthenia gravis?
Improving neuromuscular function, immune modulation, thymectomy, supportive care.
90
What is the role of thymectomy in myasthenia gravis?
It may increase the probability of remission, even in patients without thymoma.
91
What are some complications of myasthenia gravis?
Respiratory insufficiency, aspiration pneumonia, prolonged hospitalization, immobility.
92
What is Duchenne's muscular dystrophy (DMD)?
An X-linked recessive disorder affecting mostly boys, leading to muscle weakness.
93
What is the incidence of Duchenne's muscular dystrophy?
Approximately 1 in 3,500 live male births.
94
What is the typical progression of Duchenne's muscular dystrophy?
Affected boys become wheelchair-bound by age 12.
95
What is oculopharyngeal muscular dystrophy (OMD)?
A rare, late-onset autosomal dominant disorder manifesting with ptosis and dysphagia.
96
What is the primary treatment for OMD?
Supportive care; cricopharyngeal myotomy or gastrostomy for dysphagia.
97
What is myotonic dystrophy (MyoD)?
A multisystem disease affecting swallowing and speaking muscles.
98
What are the characteristics of myotonic dystrophy?
Involves weakness in small muscles, facial and pharyngeal muscle involvement.
99
What is Parkinson's disease (PD)?
A neurodegenerative disorder affecting the extrapyramidal system.
100
What are the common symptoms of Parkinson's disease?
Bradykinesia, rigidity, tremor, loss of postural reflexes.
101
What is the male to female ratio in Parkinson's disease prevalence?
Approximately 2:1.
102
What are the main strategies for pharmacotherapy in Parkinson's disease?
Early symptom relief, advanced symptom management, neuroprotection.
103
What complications are associated with Parkinson's disease?
Cognitive impairment, hallucinations, dysphagia, malnutrition, repeated falls.
104
What is dystonia?
A movement disorder characterized by repetitive, twisting movements or abnormal posture.
105
What are the classifications of dystonia based on age at onset?
Early-onset and late-onset (after age 26 years).
106
What is the typical outcome for untreated myasthenia gravis?
10% mortality over 10-75 years.
107
What are common supportive care measures for myasthenia gravis?
Respiratory toiletry, prevention of aspiration, chest physiotherapy, physical therapy.
108
What is the typical age of onset for Duchenne's muscular dystrophy?
Normal at birth, subtle signs of weakness appear when standing and walking.
109
What is the genetic basis of Duchenne's muscular dystrophy?
Mutations in the dystrophin gene.
110
What is a common treatment for myotonic dystrophy?
Supportive care focusing on speech and swallowing difficulties.
111
What are the classification schemes for dystonia based on?
Age at onset, anatomy, and etiology
## Footnote
These classifications include early vs. late-onset, focal vs. segmental vs. generalized, and primary vs. secondary dystonias.
112
Which types of dystonias are particularly relevant to SLPs?
Oromandibular dystonia, lingual dystonia, and pharyngeal dystonia
## Footnote
These dystonias are associated with symptoms like dysphagia, dysphonia, and dysarthria.
113
What are the symptoms of Oromandibular dystonia (OMD)?
Sustained spasms, involuntary jaw opening or closing, pain, difficulties with articulation, and excessive drooling
## Footnote
Symptoms can be triggered by swallowing, speaking, or eating.
114
What are the causes of primary Oromandibular and lingual dystonia?
Unknown
## Footnote
Dysfunction at several levels of the neuraxis has been implicated.
115
List some conditions associated with secondary Oromandibular and lingual dystonia.
* Wilson’s disease
* Choreoacanthocytosis
* Lesch-Nyhan syndrome
## Footnote
These conditions can lead to OMD and lingual dystonia.
116
What is the primary treatment for Oromandibular dystonia?
Botulinum toxin
## Footnote
It may be superior to oral therapy, especially when long-term side effects of oral medications are concerning.
117
True or False: Botulinum toxin is recommended for lingual dystonia.
False
## Footnote
Experts caution against its use due to potential complications.
118
What are some pharmacologic treatment options for Oromandibular dystonia?
* Tetrabenazine
* Antiepileptic drugs (e.g., benzodiazepines)
* Carbidopa + levodopa
* Anticholinergic drugs
## Footnote
These options can alleviate associated spasms and symptoms.
119
What complications can arise from Oromandibular and lingual dystonia?
Difficulties with swallowing, communication, nutrition, pain, discomfort, and emotional instability
## Footnote
These complications require an interprofessional management approach.
120
What is diabetic autonomic neuropathy (DAN)?
A complication of long-term diabetes mellitus affecting various systems
## Footnote
It can be asymptomatic or present with gastrointestinal, cardiovascular, or neuroendocrine symptoms.
121
What gastrointestinal symptoms can be associated with diabetic autonomic neuropathy?
* Constipation
* Nocturnal diarrhea
* Dysphagia
* Gastroparesis-related symptoms
## Footnote
Symptoms may include postprandial fullness, indigestion, and nutritional deficiencies.
122
What are the risk factors for gastrointestinal dysfunction in patients with diabetes mellitus?
* Poor glycemic control
* Duration of illness
* Presence of other complications (e.g., peripheral neuropathy)
## Footnote
These factors increase the likelihood of GI dysfunction.
123
What management strategies are recommended for gastroparesis in diabetic patients?
* Dietary modification
* Good glycemic control
* Prokinetics/antiemetics
* Enteral nutrition if refractory
## Footnote
Management should be based on imaging and motility studies.
124
What are common communication difficulties associated with neurotherapeutic drugs?
* Dysarthria
* Dysphonia
* Stuttering
* Dysnomia
## Footnote
These can result from drug-related adverse events due to their mechanisms of action.
125
What factors can increase the risk of drug-induced communication disorders?
* Age (very old or very young)
* Multiple comorbidities
* Polypharmacy
## Footnote
These factors can exacerbate the likelihood of experiencing adverse effects.
126
What is the first step in managing potential drug-related adverse effects?
Establish causality or association
## Footnote
This involves assessing symptom profiles and reviewing medication history.
127
What is functional dysarthria?
Dysarthria that arises from psychological dysequilibrium rather than neurological impairment
## Footnote
It can be associated with various psychological conditions.
128
List some psychological disorders that may contribute to functional dysarthria.
* Depression
* Anxiety
* Schizophrenia
* Post-traumatic stress
## Footnote
These disorders can interfere with voluntary control over speech production.
129
What do psychogenic speech disorders represent according to Duffy?
Manifestations of one or more types of psychologic dysequilibrium, such as anxiety, depression, conversion reaction, or personality disorders that interfere with volitional control over any component of speech production.
## Footnote
Adaptation from Aronson.
130
Which Axis I and Axis II diagnoses are implicated in the etiology of functional dysarthria and dysphonia?
* Depression
* Anxiety
* Schizophrenia
* Posttraumatic stress
* Postconcussion syndrome
* History of physical or sexual abuse
* Neuroticism
* Somatoform disorders (e.g., somatization, conversion disorders)
## Footnote
These diagnoses can contribute to the development of functional speech disorders.
131
What are the most common presentations of patients with functional speech disorders?
* Stuttering
* Mutism
* Aphonia
* Dysphonia
## Footnote
These symptoms reflect various degrees of speech impairment.
132
Describe the case of Ms. X, a patient with functional speech disorder.
A 62-year-old woman admitted with sudden onset of speech difficulties, denied focal motor or sensory complaints, and had a history of depression and stressful life events.
## Footnote
Her speech was monotonous and dysprosodic, and she stuttered without paraphasic errors.
133
What were the findings from the diagnostic work-up for Ms. X?
Magnetic resonance imaging of the brain and EEG were both normal.
## Footnote
This helped confirm the diagnosis of functional speech disorder.
134
What is the role of interprofessional collaboration in managing functional speech disorders?
Involves neurologists, SLPs, psychiatrists, and counselors.
## Footnote
Collaboration is essential for proper diagnosis and treatment.
135
What are the first steps in managing patients with functional speech disorders?
* Proper diagnosis
* Ruling out organic causes
* Not downplaying symptoms or their impact
* Ascertaining underlying mental illness
## Footnote
Management should address both physical and psychological aspects.
136
What is the prognosis for patients with functional speech disorders?
Relatively good prognosis.
## Footnote
Providing an explanation of the symptoms can help in management.
137
How do diseases of the motor unit affect speech disorders?
Lead to flaccid dysarthria.
## Footnote
This reflects how neurological conditions can impact speech production.
138
What types of disorders affect the quality of movement in speech?
Disorders of the basal ganglia and cerebellum.
## Footnote
These disorders can lead to dysarthria and other speech issues.
139
What types of disorders impact the motor unit via central mechanisms of control?
* Degenerative disorders
* Vascular disorders
* Inflammatory disorders
* Neoplastic disorders
## Footnote
These conditions ultimately affect communication and swallowing abilities.
140
What is the significance of understanding functional neuroanatomy in speech-language pathology?
Provides a useful and rational approach to the diagnosis and treatment of neurogenic communication and swallowing disorders.
## Footnote
It complements the practice of speech-language pathology.
