neuro abnormalities

Question 1

multiple sclerosis patho

Answer 1

progressive autoimmune disorder
- combo of inflammation and degeneration of the myelin of the brain’s white matter, leading to decreased brain mass and obstructed transmission of nerve impulses

Question 2

multiple sclerosis subjective

Answer 2

fatigue
urinary freq, urgency, or hesitancy
sexual dysfunction
vertigo, weakness, numbness
blurred vision, diplopia, loss of vision
emotional changes
relapse symptoms develop rapidly over hours or days

Question 3

multiple sclerosis objective

Answer 3

muscle weakness, ataxia 
hyperactive DTR
paresthesia, sensory loss
intention tremor
optic neuritis
cognitive changes
MRI: brain lesions

Question 4

intracranial tumor patho

Answer 4

abnormal growth within the cranial cavity that may be a primary or metastatic cancer

Question 5

intracranial tumor subjective

Answer 5

persistent HA
nausea, early morning vomiting
unsteady gait, impaired coordination 
memory loss and confusion 
reduced vision acuity, visual loss, diplopia
behavior or personality change
seizure

Question 6

intracranial tumor objective

Answer 6

s/s vary by location of tumor 
altered consciousness, confusion 
papilledema
cranial nerve impairment
aphasia, language disorder
vision loss- hemianopia, nystagmus 
gait disturbances, ataxia

Question 7

pseudotumor cerebri patho

Answer 7

clinical syndrome of intracranial HTN that mimics brain tumors

Question 8

pseudotumor cerebri subjective

Answer 8

severe daily HA, throbbing
pain behind eye
vomiting
short episodes of blurred vision, double vision 
whooshing in ears

Question 9

pseudotumor cerebri objective

Answer 9

papilledema, retinal hemorrhages on fundoscopic 
inferior nasal vision field defect
dec. visual acuity 
alert, unimpaired consciousness 
absence of focal neurologic signs

Question 10

Sz disorder (epilepsy) patho

Answer 10

chronic disorder characterized by recurrent, unprovoked seizures secondary to an underlying brain abnormality
- episodic abnormal electrical discharges

Question 11

Sz disorder subjective

Answer 11

hx of prior sz 
premonition or aura
body is stiff and rigid, followed by rhythmic jerking movements 
eyes roll upward
drooling
loss of bladder or bowel control

Question 12

sz disorder objective

Answer 12

tonic phase:

• brief flexion and characteristic cry with contraction of abdominal muscles, followed by generalized extension for 10-15 minutes; loss of consciousness for 1-2minutes, eyes deviated upward, dilated pupils
• Clonic phase: contractions alternate with muscle relaxation
• postictal state: coma followed by confusion and lethargy

Question 13

encephalitis patho

Answer 13

acute inflammation of the brain and spinal cord involving the meninges, often due to a virus

Question 14

encephalitis subjective

Answer 14

mild viral illness with fever

recovery and quiet stage followed by onset of lethargy, restlessness, and mental confusion

Question 15

encephalitis objective

Answer 15

altered mental status, confusion, stupor, coma
photophobia
stiff neck
muscle weakness, paralysis, ataxia

Question 16

meningitis patho

Answer 16

inflammation of the meninges of the brain or spinal cord

- bacterial, viral, or fungal infection crosses the BBB

Question 17

meningitis subjective

Answer 17

fever, chills
HA, stiff neck
lethargy, malaise
vomiting
irritability
sz

Question 18

meningitis objective

Answer 18

altered mental status, confusion 
nuchal rigidity
fever
brudzinski and kernig signs
petechiae and purpura with meningococcal meningitis

Question 19

myasthenia gravis patho

Answer 19

autoimmune disorder of neuromuscular junction involved with muscle activation
- autoantibodies directed against the acetylcholine Rc in the neuromuscular junction -> destruction and inflammatory changes in the postsynaptic membranes -> muscle dysfunction

Question 20

myasthenia gravis subjective

Answer 20

drooping eyelids
double vision
diff. swallowing or speaking
fluctuating fatigue or weakness; worse with exercise
inability to work with arms raised above head
difficulty walking
s/s worse later in the day and improve with rest

Question 21

myasthenia gravis objective

Answer 21

ptosis that develops within 2 minutes of upward gaze
facial weakness w/ puffing out cheeks
hypophonia
difficulty managing secretions
resp. compromise or failure
weakness of skeletal muscles without reflex, sensory, or coordination abnormalities

Question 22

guillain-barre syndrome patho

Answer 22

postinfectious disorder following a nonspecific GI or respiratory infection that causes an acute neuromuscular paralysis
- autoimmune disorder triggered by bacterial or viral infection -> peripheral nerve denervation and atrophy

Question 23

guillain-barre syndrome subjective

Answer 23

hx of recent illness and recovery
progressive weakness, more in legs than arms
difficulty walking
paresthesia
pain in the shoulder, back, or posterior thigh
double vision

Question 24

guillain-barre syndrome objective

Answer 24

distal weakness, usually bilateral and symmetric
diminished rerlexes in ascending pattern
ataxia, progressing to flaccid paralysis
facial nerve weakness, diplopia
dysphagia, difficulty handling secretions
resp. distress

Question 25

trigeminal neuralgia (tic douloureux) patho

Answer 25

recurrent paroxysmal sharp pain that radiates into one or more branches of CN V - compression the nerve -> demyelination

Question 26

trigeminal neuralgia subjective

Answer 26

- sharp pain episodes on one side of the face that lasts seconds to minutes; rarely bilateral - potential pain triggers: chewing, swallowing, talking, washing face, brushing teeth, exposure to cold - episodes may occur several times a day to several times a month followed by a pain free period

Question 27

trigeminal neuralgia objective

Answer 27

may be normal neurologic findings may have slight sensory impairment in the regions of pain pain occurs in the distribution of one or more divisions of the facial nerve

Question 28

peripheral neuropathy patho

Answer 28

disorder of the peripheral nervous system that results in motor and sensory loss in the distribution of one or more nerves

Question 29

peripheral neuropathy subjective

Answer 29

- gradual onset of numbness, tingling, burning, and cramping, most commonly in the hands and feet - night pain in one or both feet - early s/s: may be unusual sensations of walking on cotton, floors feeling strange, or inability to distinguish between coins by feel. - sensations of burning accompanied by hyperalgesia and allodynia: all sensation painful

Question 30

peripheral neuropathy objective

Answer 30

- reduced sensation in the foot with the monofilament, dec. sensation of pain or touch sensation. - distal pulses may be present or diminished - diminish or absent ankle and knee reflexes - dec. or no vibratory sensation below the knees temperature sensation may be less impaired - distal muscle weakness, inability to stand on toes or heels - skin ulceration or injuries to extremities the pt does not feel

Question 31

cerebral palsy patho

Answer 31

group of permanent disorders of movement and posture development associated with nonprogressive disturbances that occurred in the developing fetal or infant brain. - infection, trauma, anoxia in perinatal period, intracranial hemorrhage in fetus or premature infant

Question 32

cerebral palsy subjective

Answer 32

- delays in gross motor development that become more obvious as the infant ages - activity limitation, stiff joints and positioning - may have hearing, speech, and language disorders - feeding diff., poor sucking and swallowing coordination - sz

Question 33

cerebral palsy objective

Answer 33

- cognitive impairment or learning disabilities - spastic - dyskinetic - ataxic

Question 34

spastic CP

Answer 34

``` hypertonicity tremors scissor gait toe walking persistent primitive reflexes exaggerated DTR ```

Question 35

dyskinetic CP

Answer 35

involuntary slow writhing movements of the extremities, tremors may be present - exaggerated posturing - inconsistent muscle tone that varies during the day

Question 36

ataxic CP

Answer 36

abnormalities of movement involving balance and position of trunk and extremities - intention tremors, past pointing - inc. or dec. muscle tone, may have hypotonia as infant - instability, wide-based gait.

Question 37

myelomeningocele (spina bifida) patho

Answer 37

congenital vertebral defect that allows spinal cord content to protrude

Question 38

myelomeningocele subjective

Answer 38

may have loss of bowel control or constipation may have loos of bladder control mobility problems

Question 39

myelomeningocele objective

Answer 39

exposed meningeal sac filled with fluid and nerves is apparent at birth - sensory deficit and paralysis or weakness are dependent on level of defect (higher = greater) - rapidly inc. head circumference (hydrocephalus) - may have hip or foot abnormalities - learning disability and perceptual motor skills

Question 40

shaken baby syndrome patho

Answer 40

severe form of child abuse resulting form the violent shaking of infants younger than 1 year old

Question 41

shaken baby syndrome subjective

Answer 41

``` fever irritability or lethargy dec. food intake breathing difficulty or apnea sz loss of consciousness ```

Question 42

shaken baby syndrome objective

Answer 42

reported HPI does not match nature and severity of findings altered LOC sz bilateral retinal hemorrhages with retinal detachments absence of visible trauma to head possible fingerprints on arms and body bruising, bite marks, or burns possible

Question 43

parkinsons disease patho

Answer 43

slowly progressive, degeneration neurologic disorder in which motor function is primarily affected along with behavioral and cognitive problems - destruction of neurons that transmit dopamine -> poor communication between parts of the brain that coordinate and control movement and balance

Question 44

parkinson's disease subjective

Answer 44

- tremors occur initially at rest and with fatigue, disappearing with intended movement and sleep, progress to pill-rolling movement of fingers bilaterally and tremor of head - slowing of voluntary and automatic movements, "feel wooden" freezing or unable to continue movements - numbness, aching, tingling, and muscle soreness - difficulty swallowing, drooling

Question 45

parkinson disease objective

Answer 45

tremors muscular rigidity, cogwheel rigidity with jerks stooped posture, balance and postural instability short steps, shuffling, freezing gait, gait may accelerate to maintain upright posture slow, slurred, monotonous speech, voice softening impaired cognition, dementia

Question 46

normal pressure hydrocephalus patho

Answer 46

syndrome simulating degenerative disease that is cuased by noncommunicating hydrocephalus (dilated ventricles with ICP nml)

Question 47

normal pressure hydrocephalus subjective

Answer 47

gait impairment is 1st s/s unsteady and difficulty turning forgetfulness, cognitive impairment urinary freq. that progresses to urgency and incontinence over time

Question 48

normal pressure hydrocephalus objective

Answer 48

gait impairment, wide-based stance, short, small-steps no tremor no sensory impairment cognitive impairment, attention and executive function impaired impaired memory recall for recent events

Question 49

postpolio syndrome patho

Answer 49

reappearance of neurologic signs 10 or more years after an acute poliomyelitis infection

Question 50

postpolio syndrome subjective

Answer 50

``` hx of paralytic or nonparalytic polio new onset muscle weakness, muscle cramps inc. pain sensitivity fatigue cold intolerance difficulty with swallowing or speaking SOB difficulty sleeping ```

Question 51

postpolio syndrome objective

Answer 51

focal and asymmetric muscle weakness and atrophy fasciculations dysphagia, dysarthria sleep apnea, hypoventilation