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Neuro 2 > Additional CNS Dx > Flashcards

Additional CNS Dx Flashcards

1
Q

Myasthenia Gravis is an NMJ diagnosis described as an autoimmune attack of ____

A

ACh receptors

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2
Q

what are the major risk factors for MG?

A

avg age ~60
females>males
prior immune disorder

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3
Q

MG is a ___ (UMN/LMN) diagnosis that tyically progesses for about 1.5 years. What are the primary deficits? (3)

A

LMN;
1. weakness (improves w/ rest)
2. diplopia and ptosis (about 1/2 pts exp this first)
3. laryngeal irritation (change in tone, projection, choking/aspiration hazard)

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4
Q

What can exacerbate signs and symptoms with MG?

A

** FATIGUE**
* Stress
* Meds (betablockers, Ca-channel blockers, and antibiotics)
*illness
* extreme heat

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5
Q

Of the 3 types of myesthenia gravis, which has the best prognosis?

A

ocular myasthenia

(as opposed to generalized mod or severe myesthenia)

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6
Q

What is a myasthenic crisis? Does it happen to everyone with MG?

A

myasthenia gravis exacerbation + respiratory failure happens to about 15-20% of people with MG, typically in first 8 months

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7
Q

In addition to the exacerbating fx of normal MG, what are 3 additional known precipitating factors for a myasthenic crisis?

A

PMS/pregnancy, surgery, and pain

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8
Q

How are myasthenic crises managed?

hint: just like GBS

A

IVIg and Plasmaphoresis

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9
Q

MG is diagnosed via the ice pack test, PFTs, and__ (3)

A
  • edrophonium tests
  • blood analysis
    *Electro dx tests (NCV)
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10
Q

In addition to the medical treatments for myasthenic crises, other medical management strategies for MG include__ (2)

A

drugs (cholinesterase inhib, corticosteroids, and immunosuppresants)
surgery (tracheostomy, thymectomy)

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11
Q

**

What is involved in a repetitive nerve stimulation test and why does it help diagnosis of MG?

A

analysis of CMAP peak to peak amp. In MG we see a “tanking” contraction strength compared to the normal 5-8% decrease

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12
Q

What needs to be prioritized in an examination of MG? (4)

A

cranial nerves, respiratory fn, muscle strength and funcitonal mobility (esp power)

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13
Q

How is the prognosis for MG? A myesthenic crisis?

life expectancy and QOL

A

MG: normal life expectancy and likely to live/work IND between exacerbation with appropriate treatment

MC: up to 50% require inpt rehab after a crisis

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14
Q

What 4 items will be involved in your POC for a patient with MG?

A
  • functional strengthening,
  • energy conservation,
  • breathing strategies,
  • monitoring vitals/rep/swallowing for complications
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15
Q

Describe the pathophysiology and etiology behind hydrocephalus

A

CSF buildup in ventricles> enlargemnt and pressure on surrounding tissue

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16
Q

T/F: Hydrocephalus is a solely a congenital dx.

A

false. it can also be acquired and is also seen in older adults.

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17
Q

What is the difference beteen the 2 primary tyoes of hydrocephalus?

A

communicating hydrocephalus indicates a disrupted flow of CSF that can still get through a bit while non-communicating is completely blocked along 1 or more ventricle connections.

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18
Q

this subtype of communicating hydrocephalus presents with a clinical triad of s/s that includes: AMS, gait disturbance (magnetic) , and later urinary incontinence

A

normal pressure hydrocephalus

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19
Q

In addition to the MRI pictured below, what are 4 other methods of arriving at a hydrocephalic dx?

A

neurological (clinical) exam
CT
lumbar puncture
ICP monitoring (if app)

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20
Q

Sometimes hydrocephalus is managed by monitoring, but in the case that surgery is warranted, what 2 options are there? Which is NOT used for NPH?

A
  • shunt palcement and endoscopic 3rd ventriculostomy
  • endoscopic 3rd ventriculostomy
21
Q

what is the goal of an endoscopic 3rd ventriculostomy?

A

killing off ependymal cells that are making the excessive CSF

22
Q

T/F: Shunts are meant to be permanent–meaning the first one shouldn’t fail them and this could be a fatal medical emergency.

A

While failure is an emergency, shunts are meant to be be replaced periodically and should be checked roughly every 6 months.

23
Q

In addition to reoccurence of hydrocephalus symptoms and redness/tenderness along the tract, what other 4 s/s would signify shunt dysfunction?

A
  • visual changes
  • N/V
  • seizures (if acute)
  • low grade fever or fatigue
24
Q

How is the prognosis for hydrocephalus?

A

with early dx and treatment, prognosis is good with normal life expectancy. However lingering symptoms might persist with inc age and over progression.

25
Q

T/F: for people with NPH, gait disturbance before AMS yields a better prognosis.

A

true.

26
Q
A
27
Q

what are the 2 primary origins of brain abscesses? how are they usually treated?

A
  1. TBI and infection
  2. drainage, antibiotics/antifungals
28
Q

Aside from infection s/s like fever and AMS, what else might we expect in the clinical presentation of a brain abscess? (5)

A

HA, focal weaknesss, seizeures, visual disturbances and neck stiffness

29
Q

encephalitis and meningitis s/s differ in that ____ is characterized by 2-3 weeks of flu symptoms, while NECK sitffness is one of the hallmark sign for ___

A

encephalitis
meningitis

30
Q

how do the origins of encephalitis and meningitis differ?

A

encephalitis: viral
meningitis: bacterial,viral, fungal, injuries, cancer, drugs

31
Q

How is encephalitis diagnosed? (5)

A

neuro exam, CT/MRI, blood test, spinal tap, brain biopsy

32
Q

what is the prognosis like for encephalitis?

A

it can be life threatening if undx and the herpes subtype results in death within 18 mo for up to 75% of people who get it.

33
Q

what long term effect do severe cases of encephalitis and meninhitis have in common?

A

permanent NS damage

34
Q

What are the Kernig and Brudzinski Signs?

A
35
Q

the “postical state” after a seizure usually lasts 5-10 min (potentially longer) and often presents with what kind of s/s? (4)

A

drowsiness and confusion
nausea
HA
HTN

36
Q

what are the 6 types of generalized seizures?

A

absence, tonic, atonic (drop), clonic, myoclonic, tonic-clonic (grand mal w/ LOC)

37
Q

On average, about how long should you wait to treat someone who has had a seizure? What might you educate them on? (2)

A
  1. 24 hours
  2. auras + postical states, triggers
38
Q

what 4 demographic groups currently have the highest prevalence in brain tumors?

A

children<15
adults 60-70 y/o
Caucasian> Black and Hispanic
Males>Female

39
Q

How are tumors graded?

A
40
Q

these are the most common gliomas, often found in the frontal lobe. At stage 4, patient prognosis for 5 year survival is about 94%–unfortunatley beyond this stage it drops to 30%

A

astrocytomas

41
Q

these are the most aggressive form of gliomas with a prognosis of less than 50% survival at 1 year and about 5.5% at 5.

A

glioblastoma

42
Q

You are treating a female patient who is on Keppra and it has been suggested that you take into consideration HA and personality changes when forming your POC. You see a Hx of brain cancer in her chart. Which glioma is her presentation consistent with? What’s her prognosis?

A
  1. oligodendodroglioma
  2. 81% 5 year and 65% 10 year&raquo_space; relatively slow growing!!
43
Q

increased ICP and hydrocephalus (esp near 4th ventricle) are common complications for what types of gliioma?

A

ependymyoma and medulloblastoma

44
Q

What is the difference between RF and prognosis of ependymomas and medullablastomas?

A

Med: M>F, children, 75% survival in 5 yrs vs
Ependymyoma (85%)

45
Q

Like oligodendodrogliomas, ____ can also result in personality change, seizures and HA. However, these have a higher chance of 10 year survival (>80%)

A

meningiomas

46
Q

Even though these are benign, as a result of their location along the optic tract, s/s of these tumors are usually first presented as visual deficits

A

pituitary adenomas

47
Q

A majority (80%) of brain mets occur in the __. About 1/3 orginate from the ___. Prognosis with treatment is ~6months.

A
  1. cerebrum (the rest are in the posterior fossa)
  2. lung

other met origins: breast, skin, GI, kidneys

48
Q

what 4 unusual characteristics would raise concern for a brain tumor?

A
  • interupts sleep or worse w/ waking and improves
  • elicited by posture, pressure or exertion
  • abnormal or severe
  • assoc w/ N/V, papilledema,or focal neurologic signs
49
Q

PT should pay close attention to pulmonary hygeine, ICP and ___ while treating a pt with a brain tumor

A

cognitive status

Neuro 2 (8 decks)

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