Chp. 59 - Chronic Neurologic Problems

Question 1

Tension-type headache

Answer 1

characterized by its bilateral location and pressing/tightening quality. They are usually of mild or moderate intensity and not aggravated by physical activity

Question 2

Migraine headache

Answer 2

recurring headache characterized by unilateral or bilateral throbbing pain, a triggering event or factor, strong family history, and manifestations associated with neurologic and autonomic nervous system dysfunction

Question 3

Migraines may be preceded by…

Answer 3

prodrome - something happens before a migraine (about 24 hrs) that warns a person that it is coming aura - immediately precedes migraine (not common)

Question 4

What medication to take at onset of migraine (abortive)

Answer 4

Triptan (sumatriptan) Abortive medication Shrinks blood vessels that are causing pain

Question 5

Example of prophylactic medication for migraine

Answer 5

Topamax

Question 6

Cluster headache

Answer 6

rare form of headache with a sharp stabbing pain. They involve repeated headaches that can occur for weeks to months at a time, followed by periods of remission

Question 7

Tension headache Site Quality Frequency Duration Associated Symptoms

Answer 7

Site: bilateral, bandlike pressure at base of skull Quality: constant, squeezing tightness Frequency: cycles for many years Duration: 30 min - 7 days Associated symptoms: stiff neck/shoulders, tenderness

Question 8

Migraine headache Site Quality Frequency Duration Time/mode of onset Associated symptoms

Answer 8

Site: unilateral (60%), commonly anterior Quality: throbbing, synchronous with pulse Frequency: periodic; cycles of several mos to yrs Duration: 4-72 hours Time/mode of onset: may be prodrome; onset after wake; improves w/ sleep Associated symptoms: N/V irritability, sweating, photo/phonophobia, family Hx

Question 9

Cluster headache Site Quality Frequency Duration Time/mode of onset Assoicated symptoms

Answer 9

Site: unilateral, radiating from 1 eye Quality: severe, bone-crushing Frequency: may have mos or yrs between attacks Duration: 5 min - 3 hrs Time/mode of onset: nocturnal; commonly awakens pt from sleep Associated symptoms: facial flushing or pallor, unilateral lacrimation, ptosis, rhinitis

Question 10

Seizure

Answer 10

A paroxyxmal, uncoltrolled electrical discharge of neurons in the brain that interrupts normal function

Question 11

4 phases of seizure

Answer 11

1. Prodromal - signs/activity that precede sz 2. Aural - sensory warning of impending sz 3. Ictal - full sz 4. Postical - period of recovery after sz

Question 12

Generalized seizure

Answer 12

involve both sides of the brain and are characterized by bilateral synchronous epileptic discharges in the brain from the onset of the seizure (no warning or aura)

Question 13

Tonic-clonic seizure

Answer 13

sz characterized by loss of consciousness and falling followed by stiffening of the body (tonic) and subsequent jerking of the extremities (clonic) Generalized

Question 14

Absence (petit mal) seizure

Answer 14

sz w/ brief starting spell lasting only a few seconds (many go unnoticed); rarely continues beyond adolescence Generalized

Question 15

Myoclonic seizure

Answer 15

sz characterized by a sudden, excessive jerk of the body or extremities Generalized

Question 16

atonic seizure

Answer 16

sz characterized by loss of muscle tone and begins suddenly with the person falling to the ground Generalized

Question 17

Tonic seizure

Answer 17

sz involves a sudden onset of maintained increased tone in extensor muscles (increased tone in muscles) Generalized

Question 18

Clonic seizure

Answer 18

sz begins with loss of consciousness and sudden loss of muscle tone, followed by limb jerking Generalized

Question 19

Simple partial seizure

Answer 19

sz do not involve loss of consciousness and rarely last longer than 1 minute

Question 20

Complex partial seizure

Answer 20

sz usually last longer than 1 minute, frequently followed by a period of postictal confusion (amnesia of event), involve alteration in consciousness

Question 21

Status epilepticus

Answer 21

a state of continuous seizure activity or a condition in which seizures recur in rapid succession without return to consciousness between seizures

Question 22

Primary drugs to treat generalized tonic-clonic and partial seizures

Answer 22

phenytoin (Dilantin) ***** carbamazepine (Tegretol) phenobarbital divalproex (Depakote)

Question 23

Drugs used to treat absence and myoclonic sz

Answer 23

divalproex (Depakote) clonazepam (Klonopin)

Question 24

Drug to treat status epilepticus

Answer 24

diazepam (Valium)

Question 25

SE for antiseizure drugs

Answer 25

involve the CNS and include diplopia, drowsiness, ataxia, and mental slowing

Question 26

Multiple Sclerosis (MS)

Answer 26

a chronic, progressive, degenerative disorder of the CNS characterized by disseminated demyelination of nerve fibers of the brain and spinal cord

Question 27

Parkinson's Disease

Answer 27

a chronic, progressive neurodegenerative disorder characterized by slowness in the initiation and execution of movement (bradykinesia), increased muscle tone (rigidity), tremor at rest, and gait disturbance

Question 28

Parkinson's Triad

Answer 28

1) bradykinesia - slowness in the initiation of movement 2) rigidity - increased muscle tone 3) tremor at rest

Question 29

Priority Pt teaching for Parkinsons \*

Answer 29

Avoid taking other drugs without HCP approval Take meds ON TIME!

Question 30

Myasthenia Gravis (MG)

Answer 30

an autoimmune disease of the neuromuscular junction characterized by the fluctuating weakness of certain muscle groups

Question 31

Myasthenic crisis

Answer 31

an acute exacerbation of muscle weakness triggered by infection, surgery, emotional distress, drug overdose, or inadequate drugs

Question 32

#1 NDx for pt with Myashtenia Gravis

Answer 32

Activity intolerance ( get more tired as the day goes on)

Question 33

Restless legs syndrome (RLS)

Answer 33

a relatively common condition characterized by unpleasant sensory (paresthesias) and motor abnormalities of one or both legs

Question 34

Amyotrophic Lateral Sclerosis (ALS)

Answer 34

a rare progressive neurologic disorder characterized by loss of motor neurons

Question 35

What happens with ALS? (progress of disease)

Answer 35

motor neurons in the brainstem gradually degenerate -\> electrical and chemical messages from the brain do not reach muscles; 'cognitively intact, trapped inside a dying body'

Question 36

True or False: A person with Huntington's Disease is hyperactive.

Answer 36

True

Question 37

# reverse characterized by its bilateral location and pressing/tightening quality. They are usually of mild or moderate intensity and not aggravated by physical activity

Answer 37

Tension-type headache

Question 38

# reverse recurring headache characterized by unilateral or bilateral throbbing pain, a triggering event or factor, strong family history, and manifestations associated with neurologic and autonomic nervous system dysfunction

Answer 38

Migraine headache

Question 39

# reverse prodrome - something happens before a migraine (about 24 hrs) that warns a person that it is coming aura - immediately precedes migraine (not common)

Answer 39

Migraines may be preceded by...

Question 40

# reverse Triptan (sumatriptan) Abortive medication Shrinks blood vessels that are causing pain

Answer 40

What medication to take at onset of migraine (abortive)

Question 41

# reverse Topamax

Answer 41

Example of prophylactic medication for migraine

Question 42

# reverse rare form of headache with a sharp stabbing pain. They involve repeated headaches that can occur for weeks to months at a time, followed by periods of remission

Answer 42

Cluster headache

Question 43

# reverse Site: bilateral, bandlike pressure at base of skull Quality: constant, squeezing tightness Frequency: cycles for many years Duration: 30 min - 7 days Associated symptoms: stiff neck/shoulders, tenderness

Answer 43

Tension headache Site Quality Frequency Duration Associated Symptoms

Question 44

# reverse Site: unilateral (60%), commonly anterior Quality: throbbing, synchronous with pulse Frequency: periodic; cycles of several mos to yrs Duration: 4-72 hours Time/mode of onset: may be prodrome; onset after wake; improves w/ sleep Associated symptoms: N/V irritability, sweating, photo/phonophobia, family Hx

Answer 44

Migraine headache Site Quality Frequency Duration Time/mode of onset Associated symptoms

Question 45

# reverse Site: unilateral, radiating from 1 eye Quality: severe, bone-crushing Frequency: may have mos or yrs between attacks Duration: 5 min - 3 hrs Time/mode of onset: nocturnal; commonly awakens pt from sleep Associated symptoms: facial flushing or pallor, unilateral lacrimation, ptosis, rhinitis

Answer 45

Cluster headache Site Quality Frequency Duration Time/mode of onset Assoicated symptoms

Question 46

# reverse A paroxyxmal, uncoltrolled electrical discharge of neurons in the brain that interrupts normal function

Answer 46

Seizure

Question 47

# reverse 1. Prodromal - signs/activity that precede sz 2. Aural - sensory warning of impending sz 3. Ictal - full sz 4. Postical - period of recovery after sz

Answer 47

4 phases of seizure

Question 48

# reverse involve both sides of the brain and are characterized by bilateral synchronous epileptic discharges in the brain from the onset of the seizure (no warning or aura)

Answer 48

Generalized seizure

Question 49

# reverse sz characterized by loss of consciousness and falling followed by stiffening of the body (tonic) and subsequent jerking of the extremities (clonic) Generalized

Answer 49

Tonic-clonic seizure

Question 50

# reverse sz w/ brief starting spell lasting only a few seconds (many go unnoticed); rarely continues beyond adolescence Generalized

Answer 50

Absence (petit mal) seizure

Question 51

# reverse sz characterized by a sudden, excessive jerk of the body or extremities Generalized

Answer 51

Myoclonic seizure

Question 52

# reverse sz characterized by loss of muscle tone and begins suddenly with the person falling to the ground Generalized

Answer 52

atonic seizure

Question 53

# reverse sz involves a sudden onset of maintained increased tone in extensor muscles (increased tone in muscles) Generalized

Answer 53

Tonic seizure

Question 54

# reverse sz begins with loss of consciousness and sudden loss of muscle tone, followed by limb jerking Generalized

Answer 54

Clonic seizure

Question 55

# reverse sz do not involve loss of consciousness and rarely last longer than 1 minute

Answer 55

Simple partial seizure

Question 56

# reverse sz usually last longer than 1 minute, frequently followed by a period of postictal confusion (amnesia of event), involve alteration in consciousness

Answer 56

Complex partial seizure

Question 57

# reverse a state of continuous seizure activity or a condition in which seizures recur in rapid succession without return to consciousness between seizures

Answer 57

Status epilepticus

Question 58

# reverse phenytoin (Dilantin) \*\*\*\*\* carbamazepine (Tegretol) phenobarbital divalproex (Depakote)

Answer 58

Primary drugs to treat generalized tonic-clonic and partial seizures

Question 59

# reverse divalproex (Depakote) clonazepam (Klonopin)

Answer 59

Drugs used to treat absence and myoclonic sz

Question 60

# reverse diazepam (Valium)

Answer 60

Drug to treat status epilepticus

Question 61

# reverse involve the CNS and include diplopia, drowsiness, ataxia, and mental slowing

Answer 61

SE for antiseizure drugs

Question 62

# reverse a chronic, progressive, degenerative disorder of the CNS characterized by disseminated demyelination of nerve fibers of the brain and spinal cord

Answer 62

Multiple Sclerosis (MS)

Question 63

# reverse a chronic, progressive neurodegenerative disorder characterized by slowness in the initiation and execution of movement (bradykinesia), increased muscle tone (rigidity), tremor at rest, and gait disturbance

Answer 63

Parkinson's Disease

Question 64

# reverse 1) bradykinesia - slowness in the initiation of movement 2) rigidity - increased muscle tone 3) tremor at rest

Answer 64

Parkinson's Triad

Question 65

# reverse Avoid taking other drugs without HCP approval Take meds ON TIME!

Answer 65

Priority Pt teaching for Parkinsons \*

Question 66

# reverse an autoimmune disease of the neuromuscular junction characterized by the fluctuating weakness of certain muscle groups

Answer 66

Myasthenia Gravis (MG)

Question 67

# reverse an acute exacerbation of muscle weakness triggered by infection, surgery, emotional distress, drug overdose, or inadequate drugs

Answer 67

Myasthenic crisis

Question 68

# reverse Activity intolerance ( get more tired as the day goes on)

Answer 68

#1 NDx for pt with Myashtenia Gravis

Question 69

# reverse a relatively common condition characterized by unpleasant sensory (paresthesias) and motor abnormalities of one or both legs

Answer 69

Restless legs syndrome (RLS)

Question 70

# reverse a rare progressive neurologic disorder characterized by loss of motor neurons

Answer 70

Amyotrophic Lateral Sclerosis (ALS)

Question 71

# reverse motor neurons in the brainstem gradually degenerate -\> electrical and chemical messages from the brain do not reach muscles; 'cognitively intact, trapped inside a dying body'

Answer 71

What happens with ALS? (progress of disease)

Question 72

# reverse True

Answer 72

True or False: A person with Huntington's Disease is hyperactive.