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#DOOS Neuro > Lect 11 & 12 > Flashcards

Lect 11 & 12 Flashcards

1
Q

what is syncope

A

transient, self-limiting LOC d/t hypoxia, 2dry to redusction in cerebral perfusion pressure

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2
Q

most syncope is _______mediated

A

neurally

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3
Q

what’s the most important thing to r/o with syncope

A

structural heart dz, this has a much poorer prognosis (left or right vent obstruction)

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4
Q

order ____ on every pt with syncope and look for other signs of ____________

A

ECG

structural heart dz

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5
Q

what is neurocardiogenic aka ________ syncope

A

vasovagal
barroreceptors in aorta and carotid sinus sense a change of pressure and inc sympathetic activity (pain/fright may induce symp activity)

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6
Q

3 categories of tx for syncope

A
  • INCREASED FLUID intake (and salt(fludrocortisone to retain salt))
  • Avoid triggers such as DEHYDRATION, prolonged standing, ETOH, and extreme heat
  • Beta-blockers (propanolol), alpha 2 agonist, SSRI, or pacemaker
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7
Q

postural syncope aka ________ affects ~20% of pts >65yo, this is caused by….

A

orthostatic hypotension

gravity induced pooling of blood in LE with delayed compensatory vasoconstriction

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8
Q

5 categorical etiologies of orthostatic hypotension

A 
hypovolemia
autonomic insuff
meds/toxins
metabolic/endocrine
vascular insuff
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9
Q

what is presyncope (6 sx)

A

prodrome of lightheadedness, weakness, nausea, unease, vertigo, and visual changes
–can occur w/o syncopal episodes

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10
Q

syncope with shaking is called _______ or _________ phenomenon which is secondarily due to _______

A

syncopal myoclonus
brainstem release phenomenon
d/t hypoxia
(normally short lasting as long as pt DOES NOT remain upright)

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11
Q

__________ is the most common reason fro seeking medical care

A

pain

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12
Q

acute pain typically lasts _______ days /months

A

<30days

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13
Q

subacute pain typically lasts _______ days/months

A

1-6 months

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14
Q

chronic pain typically lasts _______ days /months

A

> 6months

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15
Q

with nociceptive pain the CNS and PNS are functioning ________(correctly/incorrectly)

A

incorrectly

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16
Q

describe visceral pain

A

vauge radiates in common patterns

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17
Q

describe deep somatic pain

A

in bones, ligaments, tendons, muscles.

poorly localized and intense

18
Q

superficial pain is

A

relatively well defined and easy to locate

19
Q

With neuropathic pain the CNS and PNS are functioning ________(correctly/incorrectly)

A

PNS is malfucntioning

CNS is ok

20
Q

neuropathic pain feels like

A

tingling burning electrical, pins and needles

d/t periph neuropathy of DM, postherpetic neuralgia, CA

21
Q

psychogenic pain is freq d/t

A

greif, social rejection, emotions, occasionally mental illness

22
Q

fibromyalgia is a well defined syndrome without an unknown cause and therefore should NOT be called __________ pain

A

psychogenic

this is idiopathic

23
Q

__________ extends beyond the expected period of healing, this seems to change the diencephalon and dorsal horns of spinal cord

A

chronic pain

24
Q

what is the goal in treating chronic pain

A

NOT to be pain free
need to have pt specific goals, what is important, what do they want to do (ROM and participation)
GOAL is to build a life you can be proud of

25
Q

what is the “gateway theory”

A

topical stimuli can override deeper pain

capsaicin and menthol topicals

26
Q

opiates are useful in tx of (4)

A

acute
sharp
moderate/severe
visceral/deep-somatic

27
Q

No evidence for opiates as long term tx for chronic _______ or ________

A

HA or OA

28
Q

_____________ is aka reflex sympathetic dystrophy, causalgia, reflex neurovascular dystrophy. amplified musculoskeletal pain syndrome

A

complex regional pain syndrome

29
Q

what is complex regional pain syndrome (CRPS)?

A

chronic pain often affecting one of the extremities (looks edematous)
can occur after injury- type I, or w/o injury - type II

30
Q

CRPS affects _____(f/m) ore freq and will NOT affect ______

A

females

will not affect those >5yo (>10 rare)

31
Q

CRPS affects ___% of people who _____

A

68%

ppl who smoke tobacco

32
Q

CRPS causes prolonged _______type pain, often pts will injure finger and feel pain ______ (disproportinate to inciting event)

A

neuropathic
in entire arm
(pain may bilateralize)

33
Q

what does skin temp change mean in CRPS

A

Hot type -common

Cold type - POOR prognosis

34
Q

what is tolerance

A

dec effectiveness of a drug as a result of chronic administration (need higher dose for same effect)

35
Q

what is dependence

A

phys adaptation to presence of medication; this induces withdrawal sxs when discontinued
meds must be tapered slowly

36
Q

what is addiction

A

COMPULSIVE use of medication for nonmedical reasons (craving for mood altering affects, not pain relief)
involves DYSFXNL behaviors

37
Q

what is pseudo-addiction

A

pain relief seeking behavior
this is an iatrogenic condition, and requires education of health care provider (look at half life of drug and dosing schedule)

38
Q

random drug screens are good for ______

trough drug screens are good for ______

A

rando: drug screen, is the drug in their system
trough: for treatment plan, what’s the dose needed for therapeudic effect without dipping too low

39
Q

there are 3 different tests you can run for opiates, you must use the most sensitive 100 ng/ml to capture __________ (drug); but beware as poppy seeds (muffins) and dextromethorphan (cough syrup) will also be detected in this test

A

oxycodone

40
Q

if you’re going to prescribe a controlled substance for chronic pain you will be required by law to ______

A

do a through physical exam (psych and pain status)

41
Q

4 rules for chronic pain tx made by NMMB

A
  • written tx plan (w/stated objectives)
  • discuss risk/bene of controlled subst
  • written agreement of pt responsibility
  • documentation of care provided

#DOOS Neuro (6 decks)

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