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BS VIII, Module II > 6B. Neurologic Disorders > Flashcards

6B. Neurologic Disorders Flashcards

1
Q

Parkinson’s Disease
► Degenerative CNS disorder characterized by ____ deficiency
► Affects approximately 500,000 people
► 1 % over age 50 have the disease
►2.5 % over the age of 70 have the disease
► ____x increase in frequency is predicted in the next 50 years

A

dopamine

3-4

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2
Q

Etiology / Pathophysiology
► Primary
– Degeneration of dopaminergic neurons of the
____

► Secondary
– Loss of or interference with the action of ____ 20 to other CNS diseases

► Associated factors 
– \_\_\_\_ mutation
– Stroke
– \_\_\_\_ tumor
– Head injury
– Exposure to \_\_\_\_
A 
substantia nigra
dopamine
genetic
brain
chemicals
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3
Q

Signs / Symptoms

►Resting tremors
– ____
– Seen in extremities at ____ – “Pill – rolling“

►Muscle rigidity
– ____ arm swing with walking
– ____ posture
– ____ instability

►Pain

►\_\_\_\_ dysfunction
►Slow movements
►Facial \_\_\_\_
►“Restlessness”
►Impairment of \_\_\_\_ and concentration
►Mood disturbances ►\_\_\_\_
A 
rhythmic
rest
decreased
bent
gait

bladder/bowel
impassiveness
memory
dementia

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4
Q 
Diagnosis 
►Physical signs and symptoms
►No reliable \_\_\_\_ or biochemical markers for PD
►Neuroimaging
– Evaluate \_\_\_\_ production 
– Rule out other CNS pathology
►Positive clinical response to \_\_\_\_

Rest means more acitivity, ____ is less activity.
This is substantia nigra section of the brain translating to dopramine activity

A

histological
dopamine
carbidopa/levodopa
blue

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5
Q 
Medical Management
►Mainstay of treatment has been replacement of \_\_\_\_ 
►Sinemet® (Carbidopa / Levodopa)
– Levodopa (L-dopa)
►Metabolic precursor of \_\_\_\_ 
►Crosses \_\_\_\_

– Carbidopa
►Inhibits ____ of peripheral levodopa
– May induce ____
– Medication must be ____ carefully to diminish dyskinesia

A

dopamine
dopamine
BBB

decarboxylation
dyskinesia
titrated

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6
Q 
Oral considerations
►Oral motor and sensory impairment
►\_\_\_\_
►Xerostomia
►\_\_\_\_
►Burning mouth syndrome
A

dysphagia

candidiasis

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7
Q 
►Preventive strategies ►Consider patient’s physical and cognitive deficiencies 
– Electric toothbrushes
– Modification of oral hygiene aids 
– \_\_\_\_ rinses
– Topical fluoride
– \_\_\_\_
►Therapeutic strategies
– Venue for dental treatment
– Orthostatic \_\_\_\_
– Facial / oral muscle tremor
– Increased salivation
– Basic vs. complex dental treatment
– Choice of dental restorative \_\_\_\_
– Drug interactions
A

chlorhexidine
sialogogues

hypotension
materials

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8
Q

Alzheimer’s Disease
►Neurodegenerative disease characterized by ____
►Gradual ____ in cognitive processes
►May lead to total ____ disability

A

dementia
decline
mental and physical

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9
Q

Epidemiology (AD)
►> 5 million people in the U.S. affected by dementia / AD
– 18.5 million cases in the U.S. by the year 2050
►Incidence
– 11% over age 65
– 50% over age 85
►____ are at greater risk than men for development of AD
►Genetic predisposition
– Early onset AD
►More ____
►Progresses more ____

A

women
severe
rapidly

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10
Q

Etiology (AD)

►Primary pathophysiologic 
mechanism of AD
– Excessive \_\_\_\_ deposition 
– \_\_\_\_ plaques
– \_\_\_\_ tangles

►Loss of ____ input into the cortex

►Age
►\_\_\_\_ sex 
►Prior head injury 
►Family history 
►\_\_\_\_ genotype 
►\_\_\_\_ mutation 
►Trisomy \_\_\_\_
A

beta amyloid
neuritic
neurofibrillary

cholinergic

female
ApoE4
SORL1
21

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11
Q

AD Brain

Macro and both micro changes in brain. This picture is for macro changes:
• Decrease in amount of brain tissue in areas
• ____ of ventricles
• ____ of sulcus
• Pronounced ____ in language and memory cortices.

A

widening
deepening
decrease

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12
Q 
Signs / Symptoms (AD)
►Gradual deterioration 
– \_\_\_\_
– Orientation
– \_\_\_\_ stability 
– Language capacity 
– \_\_\_\_ thinking 
– Motor skills
– Self \_\_\_\_
A

memory
emotional
abstract
care

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13
Q

Diagnosis (AD)
► Dementia established by clinical examination and documented with testing (MMSE)
► Deficits in two or more areas of ____
► Progressive worsening of memory and other cognitive functions
► No disturbance of ____
► Onset between ages 40 and 90
► Absence of systemic disorders or other brain diseases that could account for the progressive memory and cognitive changes

A

cognition

consciousness

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14
Q 
►Three stages of disease
– Progress though stages variable
►\_\_\_\_ AD
►Mild cognitive impairment (MCI)
– \_\_\_\_ loss (most prominent feature)
– Time disorientation
– \_\_\_\_ errors
– Notable decline in personal appearance / hygiene
A

preclinical
memory
judgement

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15
Q 
►Dementia due to AD
– Rapid decline in \_\_\_\_
capacity
– Inability to
►Recognize \_\_\_\_ ►Understand speech ►Recognize \_\_\_\_ objects
►Dementia due to AD
– Advanced disease 
►\_\_\_\_
►Unable to walk 
►Body \_\_\_\_ 
►Seizures 
►Hyperorality 
►\_\_\_\_ behavior

• Death from ____, secondary infection, or ____ disease

A

intellectual
self
familiar

disoriented
wasting
aggressive
malnutrition

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16
Q

Medical Management (AD)

►No definitive cure
►Use of acetylcholinesterase
inhibitors
– ____ (Aricept®)

►Use of NMDA receptor antagonist
►____ (Namenda®)

►Improve cognition 
– NSAID’s
– Antioxidants (\_\_\_\_ 
– \_\_\_\_ biloba
►\_\_\_\_ 
►Symptom-specific medication
A 
donepezil
memnatine
vitamin E
ginkgo
antipsychotics
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17
Q

Dental Management
► Dental treatment planning, oral care, and behavioral management for persons with AD must be designed with consideration of the severity of the disease and must involve family members

►AD patients at increased risk for: 
– Coronal and root \_\_\_\_
– Periodontal diseases
– \_\_\_\_ disorders
– Orofacial pain
A

caries

TMJ

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18
Q

AD

►Aggressive preventive measures 
– Topical \_\_\_\_
– Chlorhexidine
– Frequent recall visits
►Maintain updated medical and medication records ►Dental appointments / instructions may be \_\_\_\_ ►Dentures are frequently \_\_\_\_ / lost
A

fluoride
forgotten
broken

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19
Q

AD

►Oral dysfunction limit dental treatment
– ____ function
– Involuntary oral movements
►Changes in oral environment may be ____ for AD patients

►Progressive neglect of oral health
– ____ plaque / calculus

►Consider IV ____ / GA for advanced AD patients ►Avoid complex / time – consuming treatment

A

reflexive
disturbing
increased
sedation

20
Q

Multiple Sclerosis
►Most common ____ disease of nervous system
►Chronic, intermittent ____ of neurons within the CNS

A

autoimmune

demyelination

21
Q 
Epidemiology (MS)
►Incidence
– 1 / 1,000 in the U.K.
– 1 / 10,000 in the \_\_\_\_
►\_\_\_\_ adults
– Between 20 and 45 years old
►\_\_\_\_ affected more than men – 3:2
A

US
young
women

22
Q

Etiology (MS)

►Autoimmune disease triggered by infectious agent
– \_\_\_\_ 
– Mumps
– \_\_\_\_
– Chlamydia pneumoniae 
– \_\_\_\_
– Epstein 
– Barr virus
– \_\_\_\_

►____ factors
– 20 – 40x greater chance of child developing MS if parent has MS

►Geographical distribution
– Countries at greater distance from the ____ have higher incidence of MS

A

rabies
measles
HSV-1 and -2
HHV-6

genetic
equator

23
Q

Pathophysiology (MS)
►____ of axons
►Impaired ____

A

demyelination

axonal conduction

24
Q

MS

►Affected regions are called “plaques”
– \_\_\_\_
– B / T lymphocytes
– \_\_\_\_ cells
– Inflammatory cytokines 
– \_\_\_\_

►Most common demyelinated regions
– ____ nerve
– Periventricular cerebral white matter
– ____ cord

A

macrophages
plasma
immunoglobulins

optic
cervical spinal

25
Q

Signs/symptoms (MS)

► Clinical signs are ____ of CNS location involved

► Most common symptoms
– Disturbance in ____ acuity
– Abnormal ____ movements
– ____ sign

► Motor disturbances
– ____
– Spasticity
– Tremor/paralysis

► Sensory disturbances
– Loss of ____, pain, temperature, proprioception

► Fatigue

► Attack / relapse pattern over several years

► Course is unpredictable
– 50% of patients will need help walking within ____ years of onset of disease

A

dependent
visual
eye
uhthoff’s

incoordination

touch

15

26
Q

Laboratory Findings (MS)
►Evaluation of CSF
– Shows elevated ____ levels in 80% - 90% of patients
– ____ protein

►MRI
– Visualize ____ demyelinated regions

A

immunoglobulin
myelin
hypodense

27
Q

Medical Management (MS)

►Anti-inflammatories
– IV \_\_\_\_
– Interferon – β drugs 
– \_\_\_\_ 
– Natalizumab

►Complications managed via medications
– Spasticity – ____, BDZ’s
– Poor bladder control – ____ – Fatigue
– ____

A 
corticosteroids
chemotherapeutics
baclofen
anticholinergics
stimulants
28
Q

Oral / dental considerations (MS)

►Facial pain symptoms can mimic ____
– V2 and V3 sensory neuropathy
– Facial paralysis

► Higher incidence of ____ and headache

► Oral symptoms ►Myokymia
►Dysarthria
►“____ Speech”

► Patients undergoing relapse
– \_\_\_\_ dental treatment only
► Optimal time for treatment is during \_\_\_\_
► Evaluate level of motor impairment
► Drug interactions / ADR’s
A 
trigeminal neuralgia
TMD
scanning
emergency
remission
29
Q

Anxiety Disorders

• anxiety
• Sense of psychological distress that may not have a focus
• Foci may include:
– Internal \_\_\_\_ conflict 
– Environmental stress
– Physical disease state
– Medicine / drug effect
• May be purely \_\_\_\_ or physical experience

Physical effects are widespread
Very often ____ upset
Muscle tightness that feels like ____ pain

A

psychological
psychological

GI
chest

30
Q

Epidemiology (Anxiety)
• Most frequently found psychiatric problem in the general population
• ____ disorder is the most common anxiety disorder in people seeking medical treatment
– Sudden, unexpected, overwhelming feeling of ____ accompanied by physical symptoms
– Peaks in ____ minutes, may last 20 to 30 minutes

A

panic
terror
10

31
Q

Etiology (Anxiety)
• Combination of psychosocial and biological processes
– May be associated with dysregulated firing of neurons in ____ in the brainstem
– Dysfunction of ____ receptors

A

locus coeruleus

benzodiazepine

32
Q 
Post-traumatic Stress Disorder (PTSD)
• Syndrome of psychophysiologic signs / symptoms that develop after exposure to a traumatic event outside the range of human experience
• Men
– \_\_\_\_-induced PTSD
• Women
– \_\_\_\_-induced PTSD
A

combat

sexual/physical

33
Q

3 cardinal features of PTSD •

• \_\_\_\_
– Startle responses, inability to sleep
• \_\_\_\_ of the initial trauma
• Psychic \_\_\_\_
– Detachment from others, reduced capacity for intimacy

• Acute and chronic forms
– Based on ____ of symptoms
• ____ – onset PTSD

A

hyperarousal
flashbacks
numbing

duration
delayed

34
Q 
Treatment 
• Psychological treatment
– \_\_\_\_
• Behavioral treatment
– \_\_\_\_, desensitization
• Drugtreatment
– \_\_\_\_,  SSRI’s,  BDZ’s
A

psychotherapy
hypnosis
TCAs

35
Q

Mood Disorders

• ____ group of disorders characterized by extreme exaggeration and disturbance of mood and affect

A

heterogeneous

36
Q

Depression
Depression is a common but serious affect
Affect all areas of life, there are lots of types,
Persistent depressive disorder, post partum depression, psychotic, seasonal, major depressive disorder

Bipolar disorder
Bipolar is shift in mood, energy and ability to ____ normal task

A

fulfill

37
Q

Epidemiology (mood disorders)
• 5% of adults in the U.S.
• More common among ____

• Major depression may begin at any ____ – 20 – 25% of adult women
– 7 – 12% of adult men

• Bipolar disorder – 0.4 – 1.6%
– Equal frequency between ____

A

women
age
sexes

38
Q

Etiology (mood disorders)

• Decreased levels of neurotransmitters

• Depression
– ____
– Serotonin
– ____

• Bipolar Disorder
– ____
– Norepinephrine
– ____

A

norepinephrine
dopamine

GABA
dopamine

39
Q

Pathogenesis (mood disorders)

• Abnormality in function / quantity of receptors

• Chronic release of ____
– “Long term stress reaction

• Genetic studies
– Family hx of depression
– Stronger genetic link with ____ disorder

• Psychosocial theory
– Focuses on ____ stressor as the
cause for depression

• Cognitive hypothesis
– ____ thinking which leads to pessimistic / negative views of self and others

A

TSH and cortisol
bipolar
emotional
distorted

40
Q

Clinical Presentation

• Major depressive disorder
– Feeling ____ / blue / helpless / hopeless most of the day (dysphoria)
– Decrease in ____ / pleasure from most activities (anhedonia) – Impaired cognition
– ____
– Psychomotor retardation
– Marked ____ change (+/- 5%)
– Sleep disorders
– Symptoms must be present for at least ____ weeks

A 
sad
interest
agitation
weight
2
41
Q

Bipolar Disorder

• AKA Manic – Depressive Disorder
• Manic episodes
– Distinct period in which mood is either markedly \_\_\_\_ or irritable / anger
– Excessive \_\_\_\_ in multiple activities 
– Little to no \_\_\_\_ for days
• Depressive episodes
• Extreme \_\_\_\_ of moods 
– Unpredictable
– Variable duration
A

elevated
participation
sleep
cycling

42
Q 
MDD Treatment
• Anti – depressants
– \_\_\_\_ antidepressants
– \_\_\_\_ inhibitors 
– \_\_\_\_ inhibitors

• ____ behavioral therapy – Psychotherapy

A

tricyclic
selective serotonin re-uptake
monoamine oxidase

cognitive

43
Q

MDD Treatment

• Electroconvulsive therapy (ECT)
– \_\_\_\_ cases of depression
– Non-responsive to medication 
– Refusal to eat
– Multiple \_\_\_\_ attempts

• Massive neuronal electrical discharge
– Akin to ____ / convulsion

  • Neuronal membranes become more responsive to ____
  • Medical complications rare
A

severe
suicide
seizure
serotonin

44
Q

BD Treatment

• Rapid control of acute manic episodes
– ____ (Lithium) +
– ____ (Risperidone) +
– ____ (Lorazepam)

• Prevention and / or reduction of severity of future episodes
– ____(+/- antipsychotic, benzodiazepine)

  • Psychotherapy
  • ECT
A

mood-stabilizer
anti-psychotic
benzodiazepine

lithium + SSRI

45
Q

Medical History

• Provide empathy and reassurance

• HPI
– ____ each patient-reported complaint
– Physical or psychological causes of complaint?

• Past psychiatric hx
– Utilization of ____ services?
– Treatment received?

• Family hx
– ____ of psychiatric illness?

• Social hx
– ____?
– Relationships?
– Substance use / abuse?

A

clarify
psychiatric
FH
employment

46
Q

Dental / Oral Findings

  • Dental caries
  • Periodontal disease
  • Tooth loss
  • Facial pain complaints
• Medication – induced effects 
– \_\_\_\_
–Candidiasis
– \_\_\_\_
–Stomatitis 
– \_\_\_\_ 
–Sialadenitis 
– \_\_\_\_
A

xerostomia
dysgeusia
glossitis
bruxism

47
Q

Provision of Dental Care
• Assess ____ of condition
• Ensure compliance with medications
• Medical ____, if appropriate
• Laboratory evaluation(s), if appropriate
• Determine appropriate ____ for dental care
• Aggressive preventive measures
• ____ education
• Drug interactions
• ____ substitutes
• Surveillance for oral and maxillofacial pathology

A 
stability
consultation
environment/venue
oral hygiene
salivary

BS VIII, Module II (11 decks)

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