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Primary Care III > Module 4 > Flashcards

Module 4 Flashcards

1
Q

term “seizure” refers to a

A

sudden change in behavior caused by abnormal, synonymous electrical activity within the brain. Seizures can be provoked by an underlying medical condition or unprovoked.

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2
Q

Causes of provoked seizures include

A

febrile-related seizure in infancy, trauma, hypoglycemia, hyponatremia, hypocalcemia, drug abuse, and alcohol withdrawal. Provoked seizures are most often generalized tonic-clonic seizures

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3
Q

Epilepsy, by definition, is

A

a condition in which an individual is predisposed to seizures and has had two or more unprovoked seizures during their lifetime

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4
Q

Status epilepticus is defined as a

A

seizure lasting longer than 30 minutes or multiple seizures without return to baseline in a 30-minute period. This is a medical emergency

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5
Q

seizure body changes

A

Motor activity—jerking or stiffening of a limb

*Autonomic function—tachycardia or sweating

*Vision—seeing colored shapes

*Olfaction—smelling strange odors

*Language—aphasia

*Psychological feeling—déjà vu

*Sensation—paresthesias in one area of the body

*Consciousness

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6
Q

focal seizure definition

A

affects only one part of brain

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7
Q

generalized seizure

A

affects entire brain

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8
Q

Focal onset seizures are typically caused by

A

an underlying focal lesion or abnormality in the brain that acts as an epileptogenic seizure focus. A seizure focus can lie in any area of the cerebral cortex and thus, different patients’ seizures can vary quite dramatically from one another, depending on the area of brain affected

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9
Q

focal onset seizure is further classified on the basis of whether

A

consciousness is impaired during the attack

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10
Q

most common seizure in adults with epilepsy

A

focal seizure with impaired awareness (previously called partial seizures)

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11
Q

focal seizure, impaired awareness

A

pts appear awake, not aware of their surroundings

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12
Q

automatisms examples

A

, such as chewing, lip smacking, repeating words, or gestures

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13
Q

generalized onset seizures

A

associated with childhood onset generalized epilepsy syndromes

both hemispheres involved

consciousness briefly impaired

motor manifestations bilateral

EEG shows bilat hemisphere activity

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14
Q

absence seizure is a

A

nonmotor seizure that causes a sudden interruption of ongoing activities, typically with a blank stare. If the patient is speaking, speech will be slowed or interrupted; if the patient is walking, he or she will stand transfixed; if eating, the food will be stopped on the way to the mouth. The attack typically lasts a few seconds

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15
Q

most frequently encountered generalized seizures

A

tonic-clonic (Previously called grand mal)

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16
Q

tonic-clonic seizures

A

sudden, tonic stiffening of muscles, often associated with stridor or an ictal cry, and the patient falls to the ground in the tonic state. The patient lies rigid; during this state, tonic contraction inhibits respiration and cyanosis may occur. The tongue may be bitten, and urine may be voided involuntarily. The tonic stage then leads to clonic convulsive movements lasting a variable period of time. At the end of this stage, deep respiration will occur and all muscles will relax.

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17
Q

in the postictal period (the stage following a tonic-clonic seizure), the patient will have

A

a depressed level of conscious. The individual frequently goes into a deep sleep and may have a significant headache when awakened

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18
Q

Myoclonic jerks are

A

sudden, brief, shock-like contractions, which may be generalized or confined to the face and trunk or to one or more extremities. They may occur predominantly during sleep and are associated with certain generalized epilepsy syndromes.

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19
Q

Atonic seizures cause

A

a sudden loss of muscle control

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20
Q

Tonic seizures cause

A

sudden muscle stiffening.

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21
Q

drop attacks

A

associated with atonic and tonic seizure, causes sudden falls without warning

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22
Q

PNES

A

paroxysmal seizure-like events that arise from psychological disturbances rather than abnormal electrical brain activity.

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23
Q

Up to 80% of PNES are associated with

A

early sexual abuse, especially in females.

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24
Q

PNES are often comorbid with

A

epilepsy and can be considered to be a type of conversion disorder. It can cause significant morbidity including repeated hospitalizations and intensive care unit admissions

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25
highest frequency seizures
young children, persons older than 65
26
disorders that initiate seizures
drug OD drug withdrawal head trauma stroke infection tumor
27
systemic problems that cause hyperexcitable neurons
hypocalcemia hypoglycemia hyponatremia hypoxia
28
antiepileptic drugs reduce
hyperexcitability of neuro cell membranes by slowing activation of sodium channels
29
GABA agonist MOA
counteract person's tendency to have seizures benzos
30
during seizure, brain metabolism
accelerates in affected area increase in o2 use, glucose, lactate levels
31
Todd’s paralysis,
which is a transient hemiparesis following some seizures
32
seizure dx labs
ecg, cbc, cmp, UA, drug screen
33
seizure imaging
1st time- CT or MRI to eval for lesion EEG
34
In adults presenting with a first-time unprovoked seizure, the risk of recurrent seizure is greatest in
the first 2 years after the seizure (21%–45%)
35
1st seizure tx
workup performed, antiepileptic therapy not required unless pt experiences recurrent activity
36
structural lesions associated with recurrent seizures
brain tumor AVM
37
if a patient has uncontrolled epilepsy requiring multiple antiepileptic drugs,
consultation with a neurologist should be considered.
38
antiepileptic drugs have possible increased risk of
suicidality
39
seizure precaution
take showers, not baths swim only with partner cook with microwave or back burners avoid climbing ladders
40
Alzheimer’s disease (AD) is
a progressive, neurodegenerative condition and the most common form of dementia sixth leading cause of death overall, fifth leading cause of death for individuals older than 65 yrs
41
AD is characterized by an
insidious onset; slow, progressive cognitive decline; and an array of emotional and behavioral problems that result from cognitive decline
42
The cognitive decline in AD manifests as an
impaired ability to learn new information or recall previously learned information and one or more additional cognitive disturbances in language (aphasia), function (apraxia), perception (agnosia), or executive function
43
The incidence of the sporadic form of AD in the general population increases rapidly with
age
44
additional alzheimer's risk factors
lower educational and occupational levels, family history, head injury, Down syndrome, and vascular disease
45
For 60- to 70-year-old individuals with AD, the average life expectancy is
7 to 10 years after diagnosis.
46
The rare familial form of AD typically has
an earlier onset. Inheritance is autosomal dominant
47
Neurons that use the neurotransmitter ________ are especially susceptible to the alzheimers
acetylcholine
48
Pathologic changes seen in brains of patients with AD include
neuritic plaques and neurofibrillary tangles
49
Each plaque has a core of
beta-amyloid, an insoluble peptide
50
One major protein in these tangles is an aberrant form of
tau protein (which, in its normal form, stabilizes microtubules), and patients with AD have elevated concentrations of tau proteins in their cerebrospinal fluid.
51
often AD symptoms initially presented by
family members before pt
52
80% of AD pts in nursing homes have
behavioral problems
53
An easily administered bedside test for cognition is
the Montreal Cognitive Assessment
54
refer to memory disorder center
if atypical presentation, severe impairment, complex comorbidities
55
AD diagnostic tests
CBC, CMP, TSH, B12 MRI, CT, PET
56
two categories of serum biomarkers being studied to determine relevance to diagnostic criteria
beta-amyloid accumulation biomarkers indicating level of injury
57
may be the most effective way to prevent the development of excess disability
Maintaining as much normalcy as possible in relationships and everyday activities
58
Treatment with this med for AD should be considered at the time of diagnosis
cholinesterase inhibitors (donepezil, reminyl, exelon) doesn't prevent progression, seems to slow rate of decline
59
Federal regulations require that if antipsychotic agents are used in nursing homes,
an effort should be made to reduce the dosage at least every 6 months.
60
The failure to institute timely pharmacologic management in patients with AD may result in
a more rapid need for institutionalization, an increase in aggression, further difficulty with ADLs, and further cognitive decline.
61
Parkinson’s disease (PD) is a
chronic, progressive, degenerative disorder of the basal ganglia in the CNS. The disease usually begins insidiously and eventually leads to disability.
62
Parkinsonian syndrome is
any disorder that manifests symptoms of parkinsonism, which include rest tremor, rigidity, bradykinesia, postural instability, flexed posture, and freezing
63
Parkinsonism-plus syndromes are caused by
degeneration of multiple systems and are characterized by neurologic signs and symptoms in addition to parkinsonism. Examples in this category include progressive supranuclear palsy, multiple systems atrophy, and corticobasal degeneration.
64
Secondary parkinsonism is parkinsonism that is
symptomatic of an underlying cause of the disorder, such as cerebrovascular disease, drugs, infections, trauma, or exposure to toxins. Common causes of secondary parkinsonism include exposure to dopamine-blocking medications, such as antipsychotics or certain antiemetics
65
hereditary causes of parkinsonism
wilsons dx
66
parkinson age
mean age- 57 middle to later life
67
greatest risk factor PD
age
68
persons with PD die from
secondary complications (pneumonia, injury from fall), not PD
69
neuro effects PD
tremor at rest, muscular rigidity, slow movements, difficulty maintaining steady posture
70
PD causes abnormal accumulation of
Lewy bodies and degenerated of pigmented dopaminergic cells of substantia nigra
71
six cardinal features of PD
tremor at rest rigidity bradykinesia flexed posture loss of postural reflexes freezing phenomenon
72
TRAP
tremor rigidity akinesia postural disturbance
73
may be reason pt first seeks care for PD
tremor
74
classic rest tremor of PD is
a low-frequency tremor that appears distally in the extremities when the extremity is motionless and at rest. It can mimic the motion of rolling an object between the thumb and forefinger fingers and because of this is also called a “pill-rolling tremor.” This resting tremor disappears with action but reemerges as the limbs maintain a posture. A resting tremor is most common in the hands but can also be present in the jaw and feet.
75
bradykinesia can be evaluated by
assessing finger and toe tapping
76
although postural instability is a feature of parkinsonism, it is
not part of the diagnostic criteria for PD because it is typically a later manifestation and its presence early in the disease process suggests a parkinsonism-plus disorder
77
pull test
examiner stands behind the patient; gives a sudden, firm pull on the patient’s shoulders; and checks for retropulsion.
78
camptocormia
extreme truncal flexion
79
freezing
typically occurs when pt starts to walk attempts to turn when walking approaches destination
80
other common manifestations of PD
drooling dysphagia excessive perspiration constipation urinary urgency "masklike" face
81
Parkinson disease diagnosis
requires the presence of parkinsonism (bradykinesia plus rigidity and/or rest tremor) and absence of exclusion criteria,
82
Red flags for PD that indicate an alternative diagnosis include
rapid progression of gait impairment, absence of progression over years, severe early bulbar dysfunction, severe early autonomic failure, recurrent early falls, and symmetric signs
83
Patients with PD usually have improvement in rigidity, bradykinesia, and tremor with
levodopa, whereas patients with other forms of parkinsonism are less likely to respond
84
wilsons disease signs
gray-green Kayser-Fleischer rings in the cornea, chronic hepatitis, and increased concentrations of copper.
85
In early PD when symptoms are mild and not disrupting daily activity,
treatment may be deferred
86
most efficacious med for PD
levodopa
87
Once levodopa therapy is started, the rule of thumb is to administer the
lowest dosage that controls symptoms.
88
"on-off" phenomenon
2 to 5 years of treatment, more than 50% of patients experience fluctuations in their response to levodopa with dyskinesia (extra hyperkinetic choreiform movements) at peak doses and recurrence of parkinsonism as the medication wears off
89
anticholinergic agents for PD
usually prescribed for those under 70 tremor is dominant clinical feature cognitive function preserved
90
UPDRS
he UPDRS is a comprehensive evaluation tool that assesses mental, historical, and motor features and the complications of dopaminergic therapy
91
ALS
Amyotrophic lateral sclerosis (ALS) is a progressive neurologic disorder that involves destruction of motor neurons
92
ALS risk factors
age, family history, tobacco use
93
ALS mortality
universally fatal, median survival of 2-5 years
94
ALS symptom presents
typically start in one limb or region in the spinal cord
95
diagnostic criteria ALS
*  Signs of degeneration of lower motor neurons (spinal cord and brainstem) *  Signs of degeneration of upper motor neurons (brain) *  Progressive spread of signs *  Other disease processes excluded
96
The only medication that has been shown to improve survival in ALS is
riluzole
97
Stroke, also referred to as a cerebrovascular accident (CVA), causes
acute onset of neurologic deficits caused by decreased blood flow or bleeding in a localized area of brain tissue
98
two types of strokes
hemorrhagic (20%) ischemic (80%)
99
TIA
A transient ischemic attack (TIA) is a temporary episode of focal cerebral ischemia that resolves spontaneously and does not leave permanent damage. People who have had a TIA are at higher risk for future stroke.
100
fifth leading cause of death in USA
stroke
101
nonmodifiable risk factors for stroke
age, sex, race, ethnic origin
102
young African americans have
2-3x greater risk of stroke than white
103
For people older than age 55 years, the incidence of stroke more than
doubles in each successive decade
104
modifiable risk factors for stroke
htn cardiac disease dm hypercholesterolemia smoking illcit drug use lifestyle factors
105
stroke risk increases by ____x if BP over 160/95
4
106
stroke risk increases by ____x if a. fib
3-5x
107
Neurons will stop functioning after less than
10 seconds of insufficient blood flow, but they can recover fully if circulation is restored promptly
108
Ischemia can be subdivided into three subtypes:
thrombosis, embolism, and hypoperfusion.
109
thrombosis
Thrombosis refers to local obstruction of an artery atherosclerosis
110
embolism
Embolism refers to fragments of debris that travel downstream and occlude smaller arteries and arterioles, producing areas of ischemia.
111
The two most common emboli are
cardioembolic and artery to artery.
112
Paradoxical embolism occurs when
a venous thromboembolism passes through a PFO to enter the arterial system.
113
hypoperfusion stroke causes
shock, cardiac arrest cause watershed areas
114
watershed areas
Watershed areas are located at the border between the areas supplied by the anterior cerebral artery and medial cerebral artery (MCA) as well as between the MCA and posterior cerebral artery (PCA) territories. Watershed infarcts are often bilateral and affect the brain more diffusely.
115
epidural hematomas
caused by severe head injuries drowsy, lethargic then nerve palsy, enlarged pupil, hemiplegia
116
subdural hematoma
caused by blunt trauma that knocks brain against skull
117
one of the most common causes of intraparenchymal hemorrhage
HTN
118
subarachnoid hemorrhage
ruptured arterial aneurysms most common source LP shows CSF with RBC
119
A stroke should be suspected when a patient presents with
sudden onset of focal neurologic signs and symptoms
120
Unilateral weakness or numbness in a stroke is caused by damage to
the opposite side of the brain that controls those functions
121
A common cognitive change seen in a stroke affecting the right brain hemisphere, particularly in the territory of the right middle cerebral artery, is
left-sided neglect. With this, patients lose awareness of the left side of their bodies. They may not realize they have weakness or numbness on the left side of their body. In severe cases, they may not be able to recognize their own left hand
122
Lesions in the left middle cerebral artery territory commonly cause
aphasia (language difficulty) in addition to right-sided weakness.
123
strokes in the brainstem tend to cause
cranial nerve (CN) abnormalities (such as double vision from extraocular movement abnormalities) in addition to weakness and/or numbness on one side of the body.
124
Strokes in the PCA territory,
which supplies the occipital lobes, can cause an isolated visual field deficit.
125
a severe headache of abrupt onset (“thunderclap headache”), possibly with a decreased level of consciousness, raises concern for
subarachnoid hemorrhage.
126
The only definite way to differentiate between ischemic and hemorrhagic strokes is with
brain imaging, typically computed tomography (CT) of the head
127
to differentiate TIA from a stroke, the patient should undergo
brain magnetic resonance imaging (MRI), which will indicate whether permanent damage to the brain has occurred
128
Aphasia typically localizes to the
left middle cerebral artery territory.
129
left-sided neglect typically localizes to
the right middle cerebral artery territory.
130
CN affected if difficulties with eye movement
III, IV, VI
131
CN affected if difficulty with facial sensation, chewing
CN V
132
difficulty with facial weakness involving upper and lower face CN
CN VII
133
difficulty with vertigo or impaired hearing CN
CN VIII
134
difficulty with dysphagia and absent gag reflex CN
CN IX and X
135
impaired tongue movement CN
CN XII
136
eval for IV tissue plasminogen activator
ital signs, NIHSS, blood glucose level, head CT, and assessment of contraindications. Ideally, a neurologic consultation should also be available within 30 minutes of the patient’s arrival.
137
Practice guidelines of the American Heart Association Stroke Council recommend the use of
noncontrast CT of the head in patients with suspected acute stroke to exclude a nonvascular lesion as the cause of the signs and symptoms and to assess for an intracranial hemorrhage
138
basic stroke work up for pts with ischemic stroke includes
ECG, brain MRI, vessel imaging, echo
139
vessel imaging test of choice3
angiography
140
in prehospital setting, special attention paid to _____ if stroke occuring
oxygen status via pulse ox
141
Aggressive treatment of hypertension with stroke in the prehospital setting is
not done in patients with known ischemic disease, because lowering the BP may precipitate hypoperfusion and injury
142
thrombolytic therapy carries risk of
intracerebral hemorrhage
143
Contraindications to thrombolytic therapy include
recent head trauma in the last 3 months, previous intracranial hemorrhage, recent intracranial or intraspinal surgery, active internal bleeding, known brain tumor or intracranial vascular malformation, seizure at stroke onset, evidence of intracranial bleed on CT scan, international normalized ratio greater than 1.7, and a platelet count of less than 100,000
144
malignant stroke
Edema in large territory infarcts can lead to herniation and be life-threatening
145
secondary stroke prevention
antiplatelet or anticoag
146
Carotid endarterectomy should not be considered for symptomatic patients with
less than 50% stenosis.
147
The recommended dosage of clopidogrel for stroke prevention is
75 mg daily

Primary Care III (7 decks)

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