deck_3350254 Flashcards
1
Q
four cardinal features of nacrolepsy
A
- excessive day time sleepiness with sleep attacks”
2
Q
what does polysomnogram of narcolepsy show?
A
short sleep latency with REM onset(REM sleep occuring during wakefulness)
3
Q
obstructive sleep apneasymptoms? risk factors? tx?
A
obstruction of upper airway during sleep with preservation of respiratory effort risk factors: age, obesity, ethanol usesymptoms: excessive daytime sleepiness, snoring, cessation of breathing during night, mornng headaches, cognitive complaints tx: CPAP, weight loss
4
Q
insomnia
A
difficulty getting to sleep or staying asleep, or non refreshing sleep at least 1 month
5
Q
restless leg syndrome
A
urge to move legs, usually during periods of rest or inactivity, typically in the evening (crawling sensation that gets worse when legs remain still and are relieved by moving them)
6
Q
what is RLS associated with?
A
iron deficiency anemia
7
Q
what is restless leg syndrome treated with?
A
dopamine agonists
8
Q
REM sleep behavior disorder
A
loss of normal skeletal muscle atonia during REM sleep, associated with acting out dreams
9
Q
night terrors
A
sudden unexplained bouts of terror/fear occurring in stage 3 or 4 sleep. common amongst chidlren who often can neither be awakened or consoledlast for 10 minutesonset usually in first cycle of sleep
10
Q
sleepwalking
A
common, more frequent in childrenno memory of doing it, difficult to arouse
11
Q
bruxism
A
common sleep disorder where you grind your teeth, can lead to dental erosion
12
Q
syncope
A
transient loss of conscoiusness and postural tone that results from brain hypoperfusion, lasts seconds
13
Q
pre?syncope
A
light headedness, visual changes, buckling of knees, cognitive slowing, neck pain, headache
14
Q
cardiogenic syncope
A
MI, arrhythmias, valvular outflow obstruction
15
Q
orthostatic syncope
A
autononomic failture (SC injury or diabetic neuropathy)volume depletion (blood loss, dehydration)medications (anti?hypertensives and antidepressants)
16
Q
vasovagal syncope
A
normal variant, most commoncna be caused by pee/poop/coughcarotid sinus hypertesensitivitycan be triggered by noxious stimuli (hearing bad news, seeing blood, strong emotionits a PARASYMPATHETIC response
17
Q
which kind of syncope is most common?
A
vasovagal?? exaggeration of normal reflex
18
Q
tx of vasovagal syncope
A
avoidance of triggers
19
Q
tx of orthostatic syncope
A
if due to orthostatic hypotension, discontinue BP meds, tight stockings, blocks under head of bed, hydrate, more salt, avoid prolonged standing or fast transitions
20
Q
seizure
A
symptom?? pathological discharge of of neurons that results in stereotypical behavior or sensation (the symptoms depend on where seizure is)
21
Q
epilepsy
A
chronic condition of recurent UNPROVOKED epileptic seizures? if your seizure happens everytime after a certain stimulus, it is not epilepsy
22
Q
status epilepticus
A
rare emergency where someone has seizures for more than 30 minutes?? great morbidity and mortality
23
Q
simple partial motor seizure
A
recurrent stereotypic motor event (lift your hand over your head)focal onsetconsciousness intact
24
Q
simple partial sensory seizure
A
weird vision, smells, numbness in one armfocal onsetconsciousness intact
25
complex partial seizure
focal onsetinvolves limbic or cognitive structuresaffects cognition, speech, memory impairment (others notice it, bu you dont remember bc of impaired hippocampus)
26
can a partial onset seizure become a generalized seizure?
yes, partial onset seizure can secondarily spread and become a generalized tonic clonic seizure
27
generalized onset seizures:absencetonic?clonicinfantile spasmsatonic
absence: subtle? kids stare into space, fine afterwards (no postictal confusion)tonic?clonic: typical seizures you think ofinfantile spasms: baby does weird thing with arms, you see if on EEGatonic: drop attacks (usually have to wear headaches bc when you fall out you can harm head)
28
how can you tell if its generalized onset seizure?
on EEG, all cortical neurons begin to fire simultaneously, and if its focal the abnormal discharges start in one place (and may or may not spread)
29
febrile seizures
most common?? 4% of populationseizures only occur with fever (generalized onset seizure)only in small children
30
absence epilepsy
looking like a few second staring spellreturns immediately to normalknow its going on bc of EEG
31
infantile spasms
child has generalized onsetassociated with developmental regressionalso associated with tuberis sclerosis
32
lennox?gasteaux syndrome
presents in first decade, associated with developental regression
33
juvenile myoclonic epilepsy
adolescentsgeneralized onset seizure, suddenly drop tooth brush, knock over drinkin young, healthy people (normal development)threshold lowered by drinking, no sleep, etc
34
temporal lobe epilepsy
seizures are either simple partial (deja vu, transient sense of fear, unpleasant olfactory experience)orcomplex partial?? above sensations followed by confusion and speech problems that last second to minutes, followed by amnesia of event and post ictal cognitive changes (dont feel great)
35
where do temporal lobe seizures arise from?
hippocampus or amygdala (medial temporal lobe)can see changes on MRI
36
who is prone to get temporal lobe epilepsy?
most likely if you had seizures as a kid, hit your head as a kid, had a high fever (usually some factor precedes it)
37
how is epilpesy evaluated?
on EEG to identify type of epilepsy and then MRI to see if there is an underlying cause
38
what are normal brain waves?
beta: consciously alert agitatedalpha: physical and mental relaxation (normal)theta: somnolence with reduced consciousnessdelta: unconciousness or deep sleep
39
what does an abnormal EEG with epileptiform discharges show?
characterizes epilepsy syndrome, guides management with medication
40
abnormal EEG with diffuse slowing
can confirm presence of encepalopathy
41
normal EEG?? what does that help with?
does NOT exclude any diagnosis
42
evoked postentials
derivative of EEG, measure the brain waves teh are evoked by an electrical stimulus in teh limbs?? used for intra?operative monitoring during spine surgery
43
polysomnograms
derivative of EEG in combo with other meausurements, useful in IDing sleep disorders
44
mild cognitive impairment
memory loss noted by patient or family in which detailed tesitng shows abnormal memorypatients have no functional impairment and do not meet criteria for dementiabetween normal age related decline in cog and dementia?? higher rate of progression to dementia
45
delerium
acute mental status disorder characterized by normal and fluctuating attention? disturbance in level of awareness and reduced ability to focus, sustain attention (SYMPTOM, not disease)
46
where is delerium most common?
post surgical and ICU settings
47
key features of delerium
acute onset of mental status change, attentional deficits, confusion(also altered level of consciousness, illusion/halluc, disturbed sleep/wake cycle, disorientation, memory impairment, behavioral changes)
48
predisposing factors to delerium
advanced age, dementia, deyhdration, medical illness, infeciton, polypharmacy, drug/alc abuse, sensory deprivation, depression, surgery, bladder catheterselderly: medication, infection, metabolic disturbanceyoung: drugs, alcohol
49
what investigations to do you for delirium?
electrolytes, renal function, LFTs, blood count, thyroid, B12, drug levels, urine analysis, CXR, pulse oxthen head CTthen lumbar puncture if meningitis/encephEEG if seizuresMRI if stroke or intracranial lesion
50
what do you do with delirium?
STOP all meds!avoid restraints and other predisposing factors
51
dementia
acquired, persistent, usually progressive impairment of intellectual function with compromise in many cognitive domains (usulaly memory)? deficits must be significant decline, must interfere with work or social life
52
what are 3 neurodegenerative pathologic processes we discussed?
alzheimers, lewy body dementia, fronto?temporal
53
how are neurodegenerative diseases characterized clinically?
dementia, loss of movement control, paralysis and pathologically defined by loss of neurons?? progressive
54
what is the most common degenerative disease?
alzheimers (women affected more than men) then parkinsons then ALS, huntingtons, friedrichs ataxia
55
which lobes are affected in alzheimers?
symmetric atrophy of temporal, parietal, frontal lobesoccipital lobes can be sparedw
56
hich protein is accumulated in alzheimers?
neuritic plaques are extracellular accumulations of polymerized beta amyloid centrally with a rim of dystrophic neuritic processesand neurofibrillary tangles?? intracytoplasmic accumulation of tau protein
57
frontotemporal dementia (picks disease)? which lobes are affected??what are the behavioral changes?
neurodegenerative disorder that affects the frontal and temporal lobes (asymmetrically)cause personality change?? apathy, disinhibition, loss of insight and emotional control and globcal cognitive declinepresents between 45?65personality change happens first
58
which protein accumulates in frontotemporal dementia?
pick bodies (tau?ositive spherical intracytoplasmic nuronal inclusions)
59
lewy body dementia
dementia with lewy bodies is the second most common cause for dementia?cog impairment, parkinsonism, prominent visual hallucinations, other psych symptoms (sleep disorders too)?? brain has lewy bodies in neocortex, limbic system, and brainstem?? synuclein proteinopathy
60
what are the non?degenerative pathologies that are progressive?
vascular, alcoholic, CJD
61
describe features of vascular dementia
stepwise decline in cognitive function with focal neuro symptoms and signs on exampatho: small microinfarcts or strategic infarcts (ex: affect hippocampus)
62
tx of vascular dementia
treat hypertension to prevent other end?organ diseaseantiplatelet agents can help to reduce further strokes
63
alcoholic dementia
wernicke?korsakoff syndrometraumatic lesions including chronic subdurals (inc risk of falls and trauma in alcoholism)can have alzheimers pathology, vascular disease like vascular dementia
64
wernicke?korsakoff
due to thiamine deficiencyclassic triad: confusion, opthalmoplegia (paralysis of eye movements), and gait ataxiaanatomical distribution: mamillary bodies, hypothalamus, thalamus, periaquaductal gray matter, colliculi, floor of 4th ventricle
65
what is administered to patients at risk for wern?korsakoff?
glucose given with thiamine bc acute thiamine deficiency can be precipitated by IV glucose admin or carb loading(administering thiamine causes rapid reversal of opthalmoplegia within hours, recovery from ataxia and confusion is slower)
66
korsakoff syndrome
follows repeated bouts of encepalopathy?? as it subsides, patient has amnestic disorder?? ANTEROGRADE and RETROGRADE amnesia (cant make new memories?? makes them up (confabulation)altertness, attention, social behavior and cog function are preservedlesions of diencephalon and temporal lobes
67
creutzfeldt?jakob disease (CJD)
prion disease?? proteinaceous infectious particles with no nucleic acidssporadic?? middle aged/old people?? causes dementia, myoclonus, ataxia, etcfamilial: ADvariant: mad cow disease?? consumption of meat products contaminated byiatrogenic: contaminated growth hormone cadaver extractsspongiform encephalopathy
68
which dementias are potentially reversible?
B12 deficiency, hypothyroidism, HIV, syphilis, normal pressure hydrocephalus, treatable mass (subdural hematoma and benign tumor)q
69
define concussionwhat is it called when you get repeated concussions?
continuum of brain injury raising from mild cases where you are dazed to persistant neurological abnromalities and structural changestraumatic encepalopathy
70
pathologically, what happens in a concussion?
loss of neuro function due to axonal dysfunction (axonal distortion or stretching?? eflux of K into extracellular space, influx of Ca, release of glutamade?? excitotoxic cascadereversible neuronal depression to permanent diffuse axonal damage
71
chronic traumatic encepalopathy?? brain changes?
atrophy, dilatation of lateral and 3rd ventricles, thinning of corpus callosum, neuronal loss and tau deposition (neurofibrillary tangles) and in astrocytesinvolves cerebral cortex, white matter, deep nuclei, brainstem
72
what is hippocampus involved in?
memory storagelesion: poor new learning (anterograde amnesia)
73
what are mammilary bodies involved in?
memory processing, memory of odorslesion: anterograde amnesia, wernicke korsakoff syndrome
74
amygdala
coordination of emotional states, esp anger and aggression, with somatic responseskluver?bucy syndrome (change in aggression, sexuality, hyperorality)decresaed conditioned fear responseinability to receognize facial and vocal expression of anger in others
75
orbitofrontal cortex
front of frontal lobedefer certain immediate gratifications and suppress certain emotions in order to get long term benefitscontrol over biologic drives/reward circuitlesion: disinhibition and inappropriate behaviorpoor judgement, lack of inhibition or remorse
76
lateral prefrontal cortex
choose course of behavior by letting us assess various alternatives mentallyplanning for future actionif lesion: decreased motivation and attention, disorientation, mood disturbances
77
ventromedial cortex
experience emotions and meanings of thingscontrol of movementlesion: apathy, decreased spontaneous movmement, gait disturbance, incontinence
78
global aphasia
cant be fluent, comprehend, or repeat
79
mixed transcortical aphasia
cant be fluent or comprehend, but can repeat
80
transcortical motor aphasia
cannot be fluent, but can comprehend and repeat (like brocas but you can repeat words)
81
transcortical sensory aphasia
like wernickes but can repeat(so they are fluent, cannot comprehend, but can repeat)
82
conduction aphasia
can comprehend, and be fluent, but cannot repeat
83
anomic aphasia
only have trouble naming
84
hemineglect
most often with right parietal or frontal lobe infarcts/lesions?? neglect of contralateral half of world and bodyhappens more often on LEFT side of view bc left world only has 1 hemisphere paying attention to it (language takes up a lot of space in left brain) and right world has 2?? so if you have lesion on right, left will not compensate)
85
what do you need for consciousness?what causes coma?
one of your two cerebral hemispheres AND the reticular activating system (turns on" the brain)
86
what composes the reticular activating system?
locus coeruleus, periaquaductal grey, thalamus
87
what are the treatable causes of a coma?
hypoglycemiadrug intoxicationmeningitissubarachnoid hemorrhagestatus epilepticusincreased ICP (hyperventilation, mannitol, decompressive surgery)
88
what are the top culprits for coma?
drug poisoning, hypoxia after arrest and resuscitation, trauma, non?traumatic bleeding, stroke
89
compare coma and locked in syndrome
in locked in: pt appears unresponsive, but cognition is preservedcoma is unarousable, where as locked in syndome is arousableboth dont have purposeful movements of limb or facewith coma you dont purposefully move eyes and with LI you can look up on command and blinkcoma: no sleep cycle LI: normal sleep cycle
90
what causes locked in syndrome?
lesion of bilateral ventral pons taking out the bilateral cortical spinal and cortical bulbar tracts, but not RAS
91
what does the glasgow coma scale measure? what is the range?
measures eye opening, verbal response, and motor response
92
decorticate? decerebrate?
decorticate is flexion?? less dreadful bc rubrospinal tracts are workingdecerebral is extension?? it means the lesion is below red nucleus
93
how do you check cranial nerves in person with coma?what other things do you check?
funduscopic exampupillary responseeye deviation: left hemipheric lesion affects frontal eye fields, left pontine lesion affects CN 6 and descending corticospinal tract (midline gaze)vestibular ocular reflex: dolls head maneuvercorneal reflex (CN 5 and 7)gag reflex: CN 9 and 10check for abnormal respiratory patterns, abnormal brain stem reflexes, motor posturing
94
what do you do for treatment of coma?
Airway, breathing, ciruclationgive naloxone (opioid overdose)/glucose/thiaminetreat specific cause
95
definition of brain death
coma of KNOWN causeno hypothermia, drug intoxication, electrolyte disturbance, acid base disturbanceno motor response or brainstem reflexapnea
96
how is peristant vegetative state different than a coma?
in PVS, you have sleep/wake cycles, withdrawal from noxcious stimuli and non?purposeful movement you respond to startle auditory and visual(whereas in coma you have only reflex and postural motor function, no auditory or visual function),
97
what evaluation is done for coma?
PE and history, basic labs, head CTif cause still unclear?? LP, EEG, MRI
98
reactive attachment disorder
extreme insufficient care"
99
disinhibited social engagement disorder
extreme insufficient care"
100
acute stress disorder
exposure to trauma3 days?1 month9 symptoms across 5 categories: intrusion, negative mood, dissociative, avoidance, arousal
101
milestone for 2 month old?? motor and speech
hold head up 45 degree and smiles
102
4 month milestone
grasp objects (pull hear, earrings), bear weight on legslaughs and squeals
103
6 mo milestone
pass objects hand to hand, sit with minimal supportimitates speech sounds, single syllables
104
9 mo milestone
pincer grasp, sits without supportda/ma/ba jabbers(also stranger anxiety around here)
105
12 mo milestone
stand alone, dada/mama specific, responds to name
106
15 months milestone
walk alone, follow simple commands such as STOP
107
18 months milestone
walks up steps, 6 word vocab
108
24 months milestone
runs, combines words
