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Nervous System, Psych & Head & Neck > Conditions of the Nervous System > Flashcards

Conditions of the Nervous System Flashcards

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1
Q

What are common signs and symptoms of brain neoplasms?

A

1) Onset is usually gradual
2) Focal neurologic deficits: dependent on the location of the lesion
3) Seizures
4) *Headache, wakes patient at night
5) Signs of increase intracranial pressure: nausea, vomiting, headach, papilledema

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2
Q

What is in the ddx for someone presenting with symptoms of a brain neoplasm?

A

CVA, intracranial hemorrhage, meningitis, multiple sclerosis

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3
Q

What percentage of brain neoplasms are a result of metastasis from other primary sites?

A

About 50%

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4
Q

What primary cancer sites metastasize to the brain?

A

Lung
Breast
Melanoma
Colon

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5
Q

Which inherited diseases increase the risk for developing brain tumors?

A

Neurofibromatosis, tuberous, sclerosis, multiple endocrine neoplasia type 1 and retinoblastoma

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6
Q

What is the most common type of primary brain neoplasm?

A

Meningioma

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7
Q

Are most meningioma tumors typically malignant or benign

A

Benign

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8
Q

What is the most malignant type of astrocytoma?

A

Glioblastoma multiforme

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9
Q

What is the diagnostic study of choice for diagnosis of brain neoplasms?

A

MRI with contrast

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10
Q

What are the common signs and symptoms of acoustic neuromas?

A

Unilateral hearing loss
Tinnitus
Headache
Balance disturbance and/or vertigo
Facial weakness or parasthesia

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11
Q

What is the diagnostic imaging of choice to detect acoustic neuromas?

A

MRI with gadolinium enhancement

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12
Q

What disease is categorized as a rapidly progressive inflammatory demyelinating polyneuropathy?

A

Guillain-Barre

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13
Q

What are some of the common causes of Guillain-Barre Syndrome GBS?

A

1) 2-4 weeks post viral or bacterial illness (2/3 of cases): respiratory most common, followed by gastrointestinal
2) Recent vaccination
3) Medication use: penicillin and anti-motility drugs

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14
Q

What bacteria has been associated with development of GBS?

A

C.jejuni

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15
Q

What are the common signs and symptoms of GBS?

A

1) Progressive ASCENDING symmetric muscle weakness starting in the fingers and lower extremities
2) Mild sensory symptoms: paresthesias, numbness
3) Pain: shoulder girdle, back, buttock and thighs
4) Autonomic changes
5) Dyspnea, SOB, respiratory failure
6) Bowel or bladder dysfunction

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16
Q

What would find on CSF analysis in patient with GBS?

A

1) Increased protein
2) Normal WBC

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17
Q

What are the stages of progression in a patient with GBS?

A

1) Reach stage of greatest weakness by the 3rd week
2) Recovery usually within 2-4 weeks after progression ceases
3) 30% will have symptoms up to 3 years later

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18
Q

What is in the ddx for Guillain Barr’e?

A

1) Meningitis or encephalitis
2) Poliomyelitis
3) Rabies
4) Botulism
5) CVA
6) ALS

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19
Q

What causes botulism?

A

Ingestion of the neurotoxin of Clostridium botulinum

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20
Q

What are the 2 routes to be infected with botulism?

A

1) Food borne: Consumption of improperly canned food or raw honey in infants
2) Wound contamination: traumatic injury, intravenous drug use

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21
Q

What are the adult prodromal signs and symptoms of foodborne botulism?

A

1) Gastrointestinal Symptoms: Nausea/vomiting, abdominal pain and diarrhea, dysphagia, extremely dry mouth
2) Neurological symptoms: Sudden onset diplopia, dilated and fixed pupils

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22
Q

How does wound- borne botulism differ from foodborn botulism?

A

There are no gastrointestinal symptoms in wound botulism

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23
Q

How fast does botulism progress?

A

Symptoms typically start within 12-36 hours after consumption of contaminated food. After onset of symptoms, progresses quickly over 1-2 days.

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24
Q

How would you describe the paralysis in botulism?

A

Bilateral descending flaccid paralysis

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25
Q

What are the sensory deficits associated with botulism?

A

None typically found except for blurred vision

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26
Q

How high is the fever in botulism?

A

There is no fever

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27
Q

What is likely a sequelae of botulism?

A

Respiratory arrest and/or death if antitoxin is not received

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28
Q

If you have recovered from botulism, will you have future immunity?

A

NO

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29
Q

What is an inflammation of the brain called?

A

Encephalitis

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30
Q

What usually causes encephalitis?

A

1) Most commonly secondary to viral infections: HSV, West Nile Virsu
2) Bacterial: Mycoplasma pneumoniae
3) Fungal
4) Autoimmune: SLE or Hashimoto’s
5) Trauma

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31
Q

What are some of the signs and symptoms of encephalitis?

A

1) Fever
2) Altered consciousness
3) Personality changes, confusion
4) Seizures
5) Stiff neck
6) Nausea and vomiting
7) Focal neurologic deficits
8) Rash

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32
Q

What is the most important diagnostic test done in patient suspected of encephalitis?

A

CSF sampling

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33
Q

What is in the DDx for encephalitis?

A

1) Meningitis- can often coexist with encephalitis (meningiocephalitis)
2) Lyme Disease
3) Syphilis
4) CVA
5) Drug or alcohol intoxication
6) Intracranial tumor

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34
Q

How does herpes zoster most commonly present?

A

Painful unilateral eruption of vesicles along a single dermatome

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35
Q

What physical therapy modality is helpful for herpes zoster?

A

UV light treatment

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36
Q

What drugs are use to treat acute herpes zoster?

A

Acyclovir, valacylovir

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37
Q

What is a sequelae of herpes zoster?

A

Post- herpetic neuralgia

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38
Q

What homeopathic remedies could you consider herpes zoster?

A

Rhus tox
Sulphur

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39
Q

What vaccination is used to prevent herpes zoster?

A

Zoster vaccine recombinant, adjuvanted

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40
Q

What are the causative agents of bacterial meningitis?

A

Neisseria meningitides
Haemophilius influenzae type b
Streptococcus pneumoniae 80%

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41
Q

What are some of the signs and symptoms of bacterial meningitis?

A

Rapid onset of fever, chills
Headache
Stiff neck
Photophobia
Confusion
Drowsiness, stupor
Seizures

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42
Q

How rapid is the onset of bacterial meningitis?

A

Very rapid onset (3-7 days after exposure) and progression

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43
Q

What are some of the sequelae of bacterial meningitis?

A

Seizures
Deafness
Death

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44
Q

When do you see petechial rash?

A

Meningococcal meningitis: due to broken blood vessels resulting from meningococcal septicemia

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45
Q

What are some of the viral agents that cause viral meningitis?

A

1) Enteroviruses: Coxsackie virus or echovirus 85%
2) Mumps
3) HSV 1 or 2
4) HIV

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46
Q

What are some of the signs and symptoms of viral meningitis?

A

1) Fever
2) Headache
3) Stiff neck
4) Altered mental status
5) Mild photophopia

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47
Q

Which type of meningitis can have a spontaneous recovery?

A

Viral

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48
Q

What are the 2 physical exam signs that are positive in meningitis?

A

Brudzinski’s sign : Severe neck stiffness causes a patient’s hips and knees to flex when the neck is flexed.

Kernig’s sign: Extension of the knee on a flexed hip at 90° causes restriction and pain Beyond 135°

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49
Q

What diagnostic technique is used to help diagnose meningitis?

A

CSF examination and culture

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50
Q

What type of meningitis has low glucose in 60% of cases?

A

Bacterial meningitis

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51
Q

What type of meningitis has lymphocytes in the CSF?

A

Viral Meningitis

52
Q

What are common etiologies for peripheral neuropathy?

A

1) Diabetes mellitus
2) HIV infection
3) Vitamin deficiencies: B12 , B1, B6 (although too much can cause neuropathy also)
4) Chemotherapy
5) Alcohol induced

53
Q

What physical therapy modality is indicated for neuropathy?

A

Infrared Treatment

54
Q

Which accessory nutrients are useful in treating peripheral neuropathy especially in diabetic patients?

A

Alpha lipoic acid
Benfotiamine (highly absorbable thiamine)

55
Q

What herbs are useful for treating diabetic neuropathy?

A

Borago officinalis oil and Capsicum annuus topically

56
Q

What are the common signs symptoms of acute poliomyelitis?

A

1) Only 5- 10% of people develop symptoms
2) 3 main presentations
-Abortive (flu-like): 2-3 days of fever, malaise, HA, sore throat, N/V, abdominal pain and diarrhea
-Non-paralytic (aseptic meningitis): 3-7 days of abortive poliomyelitis plus stiff neck and back
-Paralytic: all features listed above with asymmetric, flaccid lower motor neuron weakness, intense myalgia

57
Q

What are the common signs and symptoms of tetanus?

A

1) Sore throat with dysphagia
2) Local muscle rigidity at site of entry
3) Headache
4 ) Lockjae and risus sardonicus
5) No fever
6) Muscle spasms and seizures
7) Respiratory compromise

58
Q

What is the treatment for a patient suspected of having tetanus?

A

Tetanus immune globulin immunization, diazepam IV, magnesium sulfate IV and metronidazole in hospital

59
Q

What are some of the risk factors associated with cerebrovascular accidents CVA?

A

1) Advanced age
2) Diabetes
3) HTN
4) Smoking
5) OCP/HRT usage
6) Atrial Fibrillation
7) Atherosclerosis

60
Q

What types of defects are caused by a brain-stem stroke?

A

Respiratory
Heart Rate
Blood pressure
Voice
Eye movement
Gross motor defects
Minimal sensory defects

61
Q

What are the 2 causes of inadequate perfusion of the brain in a stroke?

A

1) Infarction or ischemia
2) Hemorrhage

62
Q

What position do you put a stroke victim in?

A

Head and back elevated 30 degrees to relieve intracranial pressire

63
Q

What effect does smoking have in women on oral contraceptives?

A

It increases the risk of MI and stroke

64
Q

What determines the types of defects seen with TIAs?

A

The location of the ischemia in the brain

65
Q

What are some of the symptoms of a carotid artery deficit?

A

Ipsilateral blindness
Contralateral hemiparesis with paresthesias

66
Q

What are some of the symptoms of a vertebrobasilar deficit?

A

Vertigo
Confusion
Sudden sensorineural deafness
Ataxia (without coordination): falling to the side of the lesion

67
Q

What usually causes an epidural hematoma?

A

Head trauma resulting in a tear in the middle meningeal artery

68
Q

What are the common signs and symptoms of cluster headaches?

A

1) Unilateral , stabbing pain over periorbital or temporal region
2) Occur in clusters: 15-80 minutes, up to 8 times per day
3) Lacrimation, conjunctival injection
4) Rhinorrhea or nasal congestion
5) No aura
6) Patient is usually agitated and extremely restless

69
Q

What is an important condition to rule out in someone you suspect has cluster headaches?

A

Temporal Arteritis

70
Q

What can you consider for acute treatment of cluster headaches?

A

Sumatriptan
100% oxygen for 15 minutes

71
Q

What drug is used prophylactically to prevent recurrence of cluster headaches?

A

Calcium Channel blockers: Verapamil

72
Q

What are the common signs and symptoms of migraine headaches?

A

Unilateral throbbing pain
Nausea and vomiting
Photophobia and phonophobia
Can present with and without aura

73
Q

What types of headaches have an aural prodrome?

A

Classic migraines, common migraines do not have an aura

74
Q

What herb is used prophylactically to prevent recurrence of migraines?

A

Tanecetum parthenium

75
Q

What mineral has been used to treat acute migraines?

A

Magnesium sulfate

76
Q

What drug is used to treat acute migraines?

A

Sumatriptan

77
Q

What is the typical presentation of tension headaches?

A

Midl to moderate intensity, bilateral, non-throbbing, band-like pain

78
Q

What are the symptoms of TMJ syndrome?

A

Bruxism (unconsciously grind or clench teeth)
Masseter or temporalis pain and spasm
Unilateral radiating facial pain
Crepitus on opening jaw
Frequent headaches

79
Q

What kind of headache onset do you usually see with a brain tumor?

A

A gradual onset, new type of headache in a patient who has not previously had headaches is a cause for concern

80
Q

What cranial nerve is affected in Bell’s Palsy? Give name and cranial nerve number

A

CN 7: Facial Nerve

81
Q

What infections are associated with Bell’s palsy?

A

HSV, Herpes zoster, Lyme Disease, CMV, EBV

82
Q

What other condition is associated with Bell’s palsy?

A

Pregnancy or the immediate post-partum state

83
Q

What nutrients are used to treat Bell’s palsy?

A

B6
B12
EFAs
Zinc

84
Q

What is a homeopathic remedy to consider for Bell’s palsy when the patient reports it started after being exposed to cold, dry air?

A

Causticum

85
Q

What are some central causes of vertigo?

A

Vestibular migraine, brainstem ischemia, multiple sclerosis, Chiari malformation

86
Q

What may trigger the onset of trigeminal neuralgia?

A

Brushing the hair or chewing, post-dental procedure

87
Q

What are the symptoms of trigeminal neuralgia?

A

Acute, brief attacks of severe shooting pains along mandibular and maxillary branches of the trigeminal nerve

88
Q

What pharmaceutical medications could be prescribed for trigeminal neuralgia?

A

Carbamazepine, phenytoin

89
Q

What vitamins/minerals may be indicated in trigeminal neuralgia?

A

Vitamins B1, B6, B12

90
Q

What is an herb that can be used topically to reduce the pain of trigeminal neuralgia?

A

Capsicum annuum

91
Q

Describe the sequence of events in a tonic-clonic type (grand mal) seizure

A

The seizure begins with tonic contractions of muscles with loss of control and rigidity followed by clonic phase of bilateral limb jerking

92
Q

Does the patient with a tonic-clonic seizure regain consciousness immediately afterwards?

A

No, there may be a prolonged period of unconsciousness

93
Q

A caregiver describes the following pattern if seizures in the patient: sudden brief loss of awareness, but not loss of consciousness. There is no aura. They stare and have mild clonic movements. This may happen 100 times/ day. What type of seizure do they have?

A

Absence seizure (petit mal)

94
Q

What type of seizure has a single or multiple shock-like concentration of face, trunk, or extremities that comes on suddenly with no loss of consciousness?

A

Myoclonic or minor motor seizure

95
Q

What type of seizure causes sudden muscle stiffening, impaired consciousness and often falling?

A

Tonic

96
Q

What type of seizure causes sudden loss of control of muscles, especially in the legs resulting in collapsing to ground?

A

Atonic

97
Q

What nutrients are used to treat epilepsy?

A

Manganese
Taurine
Vitamin E
Choline
Vitamin B12
Vitamin B6
Omega 3 Fatty Acids

98
Q

What type of diet is indicated for epilepsy?

A

Ketogenic Diet

99
Q

What botanical medicine is indicated for epilepsy?

A

Cannabis sativa

100
Q

What are some of the homeopathic remedies to consider for epilepsy?

A

Cuprum
Stramonium

101
Q

What drugs are commonly used to treat seizure disorders?

A

Carbamazepine
Clonazepam
Gabapentin
Phenytoin

102
Q

Which epileptic drugs require therapeutic monitoring?

A

Carbamazepine and Phenytoin

103
Q

What class of drugs are first line treatment for status epilepticus?

A

Benzodiazepines, especially Diazepam

104
Q

What is the proper name for Lou Gehrig’s disease?

A

Amyotrophic lateral sclerosis (ALS)

105
Q

What cells are affected with ALS?

A

Lower motor neurons: anterior horn cells, upper motor neurons: precentral gyrus

106
Q

What are the hallmark changes that occur with ALS?

A

Progressive muscle weakness and atrophy without sensory loss

107
Q

What are common signs and symptoms seen in ALS?

A

1) Upper motor neuron: incoordination, hyperflexia, spasticity
2) Lower motor neuron: Muscle weakness and atrophy, fasiculations, muscle cramps

108
Q

Which muscles are most commonly affected in ALS?

A

Limb, bulbar, axial and respiratory

109
Q

Which muscles are usually spared with ALS?

A

Facial muscles

110
Q

What are the 3 main signs and symptoms of Huntington’s Disease?

A

Chorea
Psychiatric illness
Dementia

111
Q

Does Huntington’s Disease chorea have motor, sensory or both motor and sensory findings?

A

Motor only

112
Q

What is the autoimmune demyelinating disease of CNS?

A

Multiple sclerosis

113
Q

You suspect a patient has multiple sclerosis. What diagnostic imaging technique is indicated?

A

MRI

114
Q

What therapeutic diets are used for treatment of MS?

A

Swank Diet: extremely low fat diet

115
Q

What conditions may exacerbate MS symptoms?

A

Stress
Worse in heat

116
Q

What are the common signs and symptoms of MS?

A

Numbness, tingling in 1 or more limb
Muscle weakness
Vision changes: Optic neuritis
Fatigue
Urinary Retention or Incontinence

117
Q

A deficiency in what neurotransmitter is associated with Parkinson Disease?

A

Dopamine

118
Q

What are some of the signs and symptoms of Parkinson disease?

A

Pill rolling resting tremors of hands
Lack of facial expression
Cannot stop or start movement very well
Shuffling gait
Cogwheel rigidity

119
Q

What mnemonic can you use to remember the s/sx of Parkinson Disease?

A

SMART
Shuffling gait
Mask-like facies
Akinesia
Rigidity
Tremor

120
Q

What is the prototype anti-Parkinsonism drug?

A

Levodopa

121
Q

How does levodopa work as an anti-Parkinsonism drug?

A

It is decarboxylated to dopamine in the brain and improves motor, neurological, & altered mood symptoms of Parkinson’s disease

122
Q

What drug, a selective dopamine agonist in the pituitary, is used to treat Parkinson’s disease?

A

Bromocriptine

123
Q

What are some of the adverse effect of Bromocriptine?

A

N/V
Dizziness
Hallucinations
Nasal Stuffiness

124
Q

What accessory nutrients are used to treat Parkinson’s Disease?

A

Antioxidants:
IV glutathione
Alpha lipoic acid
SAMe
NAC
Vitamines E and C

125
Q

What is post-polio syndrome?

A

Delayed onset of weakness years after recovery

126
Q

What are the common signs and symptoms of acute traumatic brain injury?

A

Altered consciousness
Severe, persistent headache
Repeated vomiting

127
Q

What are the common signs and symptoms of chronic traumatic brain injury?

A

Headaches
Dizziness
Fatigue
Irritability
Memory problems
Difficult focusing

Nervous System, Psych & Head & Neck (3 decks)

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