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primary 3 chronic conditions final exam > neuro > Flashcards

neuro Flashcards

1
Q

what is Parkinson’s disease?

A

due to a depletion of dopamine and its a progressive neuro disorder

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2
Q

What are the three main symptoms of Parkinson’s?

A

bradykinesia- slowing of pts movement- most debilitating- see it in shuffling of steps
rigidity- muscle becomes inflexible, stiff, and tight over time
resting tremor- a tremor that occurs even when the pt is at ease

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3
Q

essential tremors vs. parkinsons (resting) tremors

A

essential tremors- pts go to reach for an item and they tremor
parkinsons occurs at rest
essential can use beta blockers to control tremors
regular physical activity and alcohol- can make damage tremors
sexual activity and caffeine can make it worse

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4
Q

1st treatment of parkinsons

A

no cure
we try to slow progression
tackles motor symptoms such as tremor and rigidity
dopamine agonist- ropinerole- use it before carbidopa and levodopa or in conjunction

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5
Q

2nd treatment of parkinsons

A

levodopa/ carbidopa
tries to control bradykinesia
like to delay taking levo/carbo
eventually “wearing off phenomenon”- symptoms worsen before next dose of med
usually happens after 3-5 years of med

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6
Q

multiple sclerosis

A

disease process where demyelination in the CNS (brain and spinal cord)- very unpredictable
remissions and exacerbations of symptoms

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7
Q

multiple sclerosis symptoms

A

muscle weakness
balance concerns
bladder or bowel incontinence
immense fatigue
vision complaints

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8
Q

age of onset of multiple sclerosis

A

20-40 years

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9
Q

first sign of multiple sclerosis

A

blurry vision- leads to dx

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10
Q

once you have MS

A

going to put you at a higher risk of other conditions such as trigeminal neuralgia

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11
Q

managment in primary care

A

refer to rheumatology to handle treatment such as steroids and DMARDS (which will delay the prgressions)
so important to recognize the symptoms and refer them out to get the proper treatment

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12
Q

Absence seizures

A

commonly diagnosed in childhood
can last 20-30 seconds
may appear as if the child is daydreaming
could cause fluttering of eyelids
no recollection
Most will outgrow absence seizures
can be started on xerontin, valproic acid, lamictal

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13
Q

Diagnosis of seizures can be difficult

A

diagnoses with EEG but seizure has to be captured on EEFG- will try to capture seizure with sleep deprivation or flashing lights

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14
Q

managment in primary care

A

refer to rheumatology to handle treatment such as steroids and DMARDS (which will delay the progression)
so important to recognize the symptoms and refer them out to get the proper treatment

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15
Q

tonic-clonic seizures

A

tonic stiffening
clonic- jerking
pt loses LOC
be acutely aware of pts safety- often fall to floor can bite tongue

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16
Q

The biggest concern with seizures?

A

safety: get pt lying down, turn on side to prevent aspiration.
dont put anything in mouth
last 3 minutes
call 911 if > 5 minutes
common no recollection

17
Q

treatent of seizures

A

lamictal
valproic acid
keppra
topamax
key is to work with neurology
Biggest key safety concerns and education points

18
Q
  • Multiple sclerosis characteristics Symptoms
    *
A

Fatigue (95% of patients)
* Episodes of visual loss, diplopia, nystagmus, and optic neuritis
* Vertigo
* Walking/balance problems/Ataxic gait
* Weakness of the legs/Foot drop
* Paresthesias of extremities
* Bowel or urinary dysfunction
* Electric shock-like sensation runs down the back when bending neck forward
* Muscle spasms, stiffness/weakness

19
Q

Multiple sclerosis characteristics Tests

A
  • Tests
  • Get a good H&P (key)
  • For the dx to be made, 2 or more areas of the CNS must be involved at 2 different periods of time (Vision, speech, strength, coordination, balance, position)
  • MRI of brain, spine may show lesions
  • LP-eval for lymphocytes and IgG bands)
  • McDonald criteria (H&P, lesions or lab tests, MRI)
20
Q

Multiple sclerosis characteristics treatment

A
  • Treatment
  • 3 major goals: delay progression, manage symptoms, treat acute flares)
  • Glucocorticoids are the mainstay of treatment for acute exacerbations
     Can also use IV Depomedrol and/or oral prednisone
  • Refer to neurology
  • Disease-modifying therapies (B-Interferon)
21
Q

Parkinson’s symptoms

A

tremor.
rigidity (stiffness)
slowness of movement.
mild memory and thinking problems.
sleep problems.
pain.
mental health problems, including anxiety and depression.

22
Q
  • Parkinson’s characteristics, diagnostic tests, and treatment
A
  • s/s: TRIAD (rest tremors, muscular rigidity, bradykinesia); also masked face.
  • > 50 y/o, more common in men
  • Treatment
  • 1st line: Sinemet TID 25/100mg PO TID with meal or snack to avoid nausea
     Start low and titrate slowly
  • For essential tremors: propranolol 60-320mg daily or long-acting (Inderal LA)
  • Tests
  • No specific tests
  • Get a good H&P, look for s/s and red flags
23
Q
  • Myasthenia gravis s/sx*
A

Autoimmune dx caused by an error in the transmission of nerve impulses to muscles
* s/s: muscle fatigue, weakness with use, eye movements and speech are affected
* weakness of the eye muscles, drooping of the eyelid, blurred vision, change in facial expressions, dysphagia, dyspnea, dysarthria
* s/s are usually worse later in the day, may subside with rest

24
Q
  • Myasthenia gravis Tests
  • *
A

Tensilon test: Tensilon drug is injected into the muscles which prevents the breakdown of Ach (neurotransmitter that nerve cells release to stimulate your muscles)
 A positive test for MG if their muscles get stronger after the injection
* EMG (electrymyography)-electrodes used to monitor muscle activity
* Serum antibodies (IgG)

25
Q

Myasthenia gravis Treatment

A
  • Symptomatic and supportive treatment
  • Meds
     Mestinon/pyridostigmine is the drug of choice
     Steroids
     Immunosuppressants
     IVIG
     Plasmapheresis
  • All pts should be screened for thymoma; thymectomy can be curative
26
Q
  • Seizure disorder characteristics
  • *
A

Caused by a sudden burst of electrical activity from a collection of cerebral cortex neurons which affect motor, sensory, and cognition
* Generalized seizures are associated with a complete loss of consciousness, whereas partial seizures preserve wakefulness; involuntary twitching or stiffness in the body
* Focal (affecting just one part of the brain):
* Complex partial-impairs LOC
* Simple partial-LOC not impaired (motorsensory is affected)
* generalized (affecting the entire brain)
* tonic-clonic/”grand mal”-sudden stiffening of muscles/contractions
* absence sz-“blank stare” or brief interruption in activity
* myoclonic-sudden, brief, shock-like contractions, usually during sleep
* tonic-sudden muscle stiffening, sudden without warning and can lead to injury
* atonic-sudden loss of muscle control , sudden without warning and can lead to injury

27
Q

Seizure disorder Treatment:

A
  • No medication recommended for 1st time seizure
  • Choice of med depends on type of sz, comorbities, etc
  • Monotherapy is preferred (achieve best control of sz with least meds possible)
  • Focal Seizures
     1st line: Carbamazepine (Tegretol) or lamotrigine (Lamictal)
  • Generalized
     1st line: valproic acid for all types
  • Status epilepticus
     Be sure to secure airway and assess cardiac/resp function 1st and check BG levels
     1stline: Buccal midazolam
     2nd line: rectal diazepam
28
Q
  • Brain tumor characteristics, differential diagnosis, treatment
A
  • Symptoms: New onset HA (mild-severe), throbbing, progressively worse, unexplained n/v, blurred/double vision, gradual loss of sensation of movement in extremities, off-balance, slurred speech
  • Differential dx: CVA, MS, SAH, meningitis, optic neuritis, AVF, brain abscess, neurosyphilis
  • Treatment: surgery, radiation, chemo, meds/steroids
29
Q
  • Suicide risk factors
A
  • Ages 15-24 and > 60 y/o
  • Older people who have recently lost a spouse (death or divorce)
  • Plan involving a gun or other lethal weapon/firearms in the house
  • Hx of attempted suicide and/or family hx of suicide
  • Mental illnesses (depression or bipolar)
  • Hx of sexual, emotional and/or physical abuse
  • Terminal illness, chronic illness/chronic pain
  • Alcohol/substance abuse
  • Stressful life issues (financial or relationship problems)
  • Medical professionals/public service
  • American Indian and Alaskan native youth/middle age have the highest risk
  • Blacks have the lowest risk

primary 3 chronic conditions final exam (16 decks)

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