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Adult Part II > Nuero Part 1 > Flashcards

Nuero Part 1 Flashcards

1
Q

MS def

A

Inflammation of and destruction of myelin sheath of neurons

Onset 15-45
W>M
Increases with distance from equator

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2
Q

Relapsing - remitting MS

A

Most common, acute exacerbations followed by full, partial or no revolver of function. Recovery from an attack takes weeks —> months

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3
Q

Primary progressive MS

A

Characterized by a gradual but steady progression of disability. Common in people who develop the disease after the age of 40

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4
Q

Secondary - progressive MS

A

Initially begins with replacing remitting MS then evolves into a progressive disease. The progressive part may begin shortly after onset of MS or later

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5
Q

Progressive - relapsing MS

A

Least common form of disease and is characterizes by steady progressive of disease with acute attacks that may or may not be followed by some recovery. These people have primary progressive initially

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6
Q

Clinical impression of MS

A

Blurred or double vision , limb weakness, paresthesia, clumsiness, lack of coordination/balance difficulty thinking/ concentrating,

Dizziness, bowel and bladder dysfunction, tremors, speech difficulty

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7
Q

Biggest organs affected of MS

A

Involves immune attack against the central nervous system .. targeting the brain, spinal cord and optic nerve at the back of the eye

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8
Q

Lab work for MS

A

CSF - increased immunoglobulins, separation into oliochlonal bands

Evoked Potentials - how long stimuli take to get to the optic nerve

MRI - lesions found in white matter of brain, spinal cord and optic nerves, 1-4 cm in diameter

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9
Q

Management of MS

A

Treat relapses - IV corticosteroids at onset followed by tapering oral corticosteroids

Manage symptoms

Delay progression to disability

Emotional support

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10
Q

Factors that influence treatment decisions

A

Stage of disease and amount of recent disease activity

MRI leasion burden and activity

Safety and tolerability profiles of immunomodulating agents

Efficacy of the immunomodulating agents

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11
Q

Tremor - def

A

Involuntary visible, rhythmic and oscillatory movements of a body part

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12
Q

Physiological or non pathological

A

Essential - familial tremor - action tremor

Usually undetectable, and to some degree present in everyone

Can involve any muscle group but arm and hand most common

Nuero exam - normal

Enhanced physiological

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13
Q

Characteristics of essential tremor / familial tremor

A

Head, jaw, throat, fingers

Increases with - fear, fright, anxiety

  • caffeine / SSRI, adderall
  • nicotine, steroid use
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14
Q

Medications that increase physiologic tremors

A

Antiarrythmics, antidepressants, antiepileptic, beta agonist, glucocorticoids, mood stabilizers, thyroid hormone ( hypothyroidism), toxins

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15
Q

Essential tremor / FT unique characteristics

A

Appearance only during movement- ceases up in relaxation

  • tremor will slightly increase as target approached
  • bilateral
  • alcohol can improve the tremor
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16
Q

Enhanced physiological tremors caused by

A

Steroids, alcohol, hyperthyroidism, hypoglycemia

Treat aimed at correcting underlying problem

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17
Q

Pathological tremors : Cerebellar tremor

A

Also known as intention tremor
Characteristics
- absent when limbs are inactive ( no resting tremor)
- tremor present with action or movement and increases when closer to target
- abnormal nuero exam
- problems with coordination, cant correct tremor, present along with swinging arms and clumsiness

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18
Q

Cerebellar Tremor - caused by

A

MS, Stroke, other Cerebellar injury

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19
Q

Parkinsonian tremor

A

Resting tremor and is coarser , most often unlilateral

Involving fingers, hands, arms, jaw, lips and tongue

Pill rolling tremor

Tremor present when limb is at rest and diminishes with voluntary movement

Excitement and stress will increase tremor

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20
Q

Parkinson Disease - def

A

Chronic progressive disease

Treatment is aimed at improving function and mobility

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21
Q

PD - cardinal features

A

Tremors - rest in distal extremities, usually unilateral and tremor disappears with action

Rigidity - increases in muscle tone that can be elicited wen one moved the patient limbs

Bradykinesia - loss of automatic movement and difficulty initiating movement

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22
Q

Levy body dementia

A

Progressive type of dementia associated with PD

Characterized by fluctuations in concentration, attention, alertness and wakefulness from day to day

Depression, apathy, anxiety and agitation

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23
Q

DX Parkinson’s disease

A

Looking for sings
- loss of sing of arms when walking, shuffling gait with small septs, flexed posture, masked facial appearance, decrease blinking, overall - depressed look

Hyposmia - inability to smell ( early sign)

No labs, refer to neuro

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24
Q

PD treatment

A

New options like stem-cells
Standard tx works for 7-10 years

2 main ones

25
Sinemet
Mixture of levodopa and carbidopa - breaks down dopamine so more dopamine is available Syncope is major side effect, start slow
26
Dopamine agonists Requip Mirapex
Side effects Dyskinetic movements, hallucinations, confusion
27
Epilepsy - def
Chronic neurological disorder characterized by recurrent unprovoked seizures
28
Seizure
Caused by discrete, temporary metabolic abnormality or height fever and does not means a dx of epilepsy, unless they reoccur and become a pattern
29
Focal onset
Can start in one area or group of cells in the brain - person can be awake or impolite awareness - may be confused
30
Generalized onset
Affects both sides of the brain at the time time, may be Tonic/clonic or atonic
31
Unknown onset
Onset not witnessed
32
Tonic
Sudden stiffening and contraction of the muscle
33
Clonic
Rhythmic twitching and jerking of one or several muscles
34
Tonic - clonic
Combination fo both types and typical in generalizes seizure
35
Seizure threshold lowering factors
``` Decreased sleep Increased ETOH Physical / emotional stress Flashing lights Fever Hormones Drug use ```
36
Seizure medications
Strive for monotherapy - Consult Neuro - therapeutic ranges of rugs, CBC and LFT’s
37
Dilantin - side effects
Gingival hyperplasia
38
Meningitis
Inflammation of Brian and spine cord meme brain Acute or subacute Viral or bacterial
39
Meningitis - presentation
Fever, headache, stiff neck, n/v/ photophobia, petechiae on torso and with more acute bacterial causes Altered LOC, seizures, and hypotension
40
Meningeal signs
Nuchal rigidity Indicates inflammation of the dura
41
Brudzinski sign
Pt supine , tilt neck forward toward chest , if meningeal irritation = flex of the hips and knees
42
Kernigs sign
Meningeal sign Flex hip and knee on one side and then extending knee with hip still flexed . Hamstring spasm = pain in posterior thigh, back pain or difficulty with knee extension = + meningeal sign Severe meningeal inflammation = opposite knee may flex
43
Bell’s Palsy
Acute, unilateral paresis of facial muscles due to inflammation and subsequent mechanical compression of the 7 th nerve
44
Bell’s palsy - symptoms
Droopy eye lid, dry eye or excessive tears Facial paralysis, twitching or weakness Drooping corner of mouth, dry mouth, impaired taste
45
Bell’s palsy
Viral neuropathy caused by activation of HSV type 1
46
BP clinical presentation n
Sudden onset of facial weakness, loss of voluntary movement of facial and scalp muscles, altered ability to close one eye, loss of taste, hypersensitivity to sounds and excessive tearing May report a URI, discomfort around jaw, ringing in ears
47
BP PE and management
Sagging eyebrow, inability to close affected eye, disappearance of nasolabial fold and drooping at the affected corner of the mouth Protect eye to prevent corneal abrasion, lubricant eye drops 1-2 drops every 2 hours and opthamlmic ointment at night, patch eye air night, wear glasses when outside
48
BP medications
Prednisone 60mg for 3 days and then taper by 20 mg every 3 days for 9 days Valacylvior 1gm TID for 1 wk Doxy if related to Lyme
49
BP follow up
2-3 times during 1st week to eval status of paralysis, condition of eye, response to medications Recovery : usually within a few weeks to months, may never recover If recurrent , work up for tumor
50
Primary headache
Tension, cluster, migraine Results from a biochemical physiologic or electrical dysfunction of the brain No underlying organic cause Does not pose a threat
51
Secondary headaches
Refer to an underlying organic cause that must be specifically treated - hypertension - brain tumor - head trauma - sinusitis - subarachnoid hemorrhage - meningitis
52
Sinus headache
Pain is behind the browbone and / or cheek bones
53
Cluster headache
Pain is in and around one eye ``` Burning, piercing pain, unilateral, hot poker into eye Causes tearing of eye and drainage 30-120 min , 1-8 times a day Usually nocturnal and seasonal Pattern - remission and excerabation Males ```
54
Tension headache
Pain is like a band squeezing the head Pain worsens throughout the day Bilateral - frontal in location More females than males 30 min - 7 days Analgesics Stress reduction, exercise
55
Migraine
Pain, nausea and visual changes are typical Aura - 5-20 min Can be unilateral pain 4-72 hours Increases during menses or menopause BCP or Depakote to prevent headache , taken daily whether or not headache is present
56
Acute abortive treatment
5HT1 agonists - Sumatriptan - Imitrex - concern for CVD - no combine with ERGOTS or MAOI NSAIDS, analgesics Ergotamine / Caffeine - Cafergot - potent vasoconstrictor - SE: nausea Antiemetics - Tigan IM, Suppository or PO
57
Cluster headache medications
Ergots - not effect DHE - IV, IM , intranasal Serotonin agonist - triptans Oxygen therapy - very effective set up at home 100 % via face mask x 10-15 min
58
Trigeminal nueralgia 5th cranial nerve
Severe pain in divisions of trigeminal nerve - unilateral - brief episodes of electric shock like pain Lasting from one to several seconds Triggers - chewing, talking, brushing teeth, dental extractions Rule out - herpes zoster, MS, trauma, tumor, vascular compression Imaging : MRI and CT TX: carbamazepine (tegretol) BID and then titrate , Botox injection
59
Prophalyatic treatment
Beta blockers TCA’s

Adult Part II (6 decks)

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