Exam 2 Neurologic Conditions

Question 0

Multiple sclerosis

Answer 0

Myelin destruction/scarring in central nerves. Axonal damage.

Genetically predisposed triggered by virus/bacteria.

Question 1

Guillain Barre Syndrome

Answer 1

Demyelination of peripheral nerves.

Exposure to virus/bacterial (resp infection) which produces antibodies that also attack peripheral nerves.

Question 2

Myasthenia Gravis

Answer 2

Autoantibodies block skeletal muscle receptors so ACh cannot bind -> no muscle contraction.

Question 3

Parkinson’s Disease

Answer 3

Reduced levels of dopamine
(Substantia nigra = dopamine maker).
Dopamine cannot attach to ACh -> muscle tremor, rigidity.

Question 5

Amyotrophic Lateral Sclerosis

Answer 5

Lou Gerig’s disease.

Loss of upper and lower motor neurons -> atrophy of voluntary muscles, ex: resp muscles.

Question 6

Treatment: GBS

Answer 6

plasmapheresis (clean blood circulation for antibodies)

IVIG

Question 7

Treatment: MS

Answer 7

corticoid steroids (methylprednisolene, prednisone)
immune suppressants

Question 8

Treatment: MG

Answer 8

anticholinerase drugs
corticoid steroids
immune suppressant
plasmapheresis
IVIG
thymectomy

Question 9

Treatment: ALS

Answer 9

-

Question 10

Treatment: PD

Answer 10

Levodopa/carbidopa

deep brain stimulation (implant 2 electrodes in head, pacemakers on chest)

Question 11

Diagnostic: GBS

Answer 11

lumbar puncture

EMG (electromyography-test nerve conduction)

Question 12

Diagnostic: MS

Answer 12

MRI (for the plaque)

Question 13

Diagnostic: MG

Answer 13

EMG
Tensilon test (give drug)
serum acetylcholine receptor antibodies

Question 14

Diagnostic: ALS

Answer 14

-

Question 15

Diagnositc: PD

Answer 15

no definitive tests
drug challenge (give dopamine)

Question 16

define: paresthesia

Answer 16

tingling

Question 17

define: autonomic dysfunction

Answer 17

Autonomic dysreflexia indicates over-activity of the autonomic nervous system – the part of the system that controls things you don’t have to think about, such as heart rate, breathing and digestion.

(Stimulus below the injury level sends nerve impulses to the spinal cord; they travel upward until blocked at the level of injury. Since these impulses cannot reach the brain, the body doesn’t respond as it would normally. A reflex is activated that increases activity of the sympathetic portion of the autonomic nervous system. This results in a narrowing of the blood vessels, which causes a rise in blood pressure. Nerve receptors in the heart and blood vessels detect this rise in blood pressure and send a message to the brain. The brain then sends a message to the heart, causing the heartbeat to slow down and the blood vessels above the level of injury to dilate. However, since the brain is not able to send messages below the level of injury, blood pressure cannot be regulated. The body is confused and can’t sort out the situation.)

Question 18

define: ptosis

Answer 18

drooping of eyelid

Question 19

define: diplopia

Answer 19

double vision

Question 20

define: dysphagia

Answer 20

difficulty swallowing

Question 21

define: dysarthria

Answer 21

difficulty articulation

Question 22

define: bradykinesia

Answer 22

slowness of movement

Question 23

define: cog wheel

Answer 23

rigidity occurs when there is also a tremor and is characterized by a “stop and go” or jerking effect during a range of motion maneuver

Question 24

define: rigidity

Answer 24

stiffness; decreased ability to move

Question 25

clinical manifestations, incidence: GBS

Answer 25

15-35, 50-75 yo

ascending paralysis, absent DTR, plateau can recover, paresthesia, autonomic dysfunction, respiratory failure

Question 26

clinical manifestations, incidence: MS

Answer 26

20-50yo women colder climates

extreme fatigue, ataxia, vision changes (blurred/diplopia), paresthesia/numberness

RRMS, primary progressive, secondary progressive, progressive relapse

Question 27

clinical manifestations, incidence, nsg management: MG

Answer 27

early 20-30yo women, late >=50 men

ptosis, diplopia, dysphagia, dysarthria, myasthenic snarl, resp insuf/fail, muscle weakness worse with exercise/improve with rest

monitor for dyspnea, ineffective cough, dysphagia
plan activities with rest
educate effects of anticholinerase (SLUDGE, BBCRA) and steroid (increase glucose, glaucoma, poor wound healing, osteoporosis

Question 28

clinical manifestations, incidence: ALS

Answer 28

40-60yo men, 3-5 death

+Babinski’s (foot will dorsiflex toward shin)
maintain senses but cannot move
unexplained paralysis and fasciculation muscles in limb
muscle atrophy with increase tone and hyperrflexia

Question 29

clinical manifestations, incidence, nsg management: PD

Answer 29

> =65 yo

bradykinesia, flexed posture, cogwheel rigidity, shuffling gait, masked-like face, delayed swallowing, rest tremor

monitor for dysphagia (aspiration risk)
education: take meds on time
constipation - increase fluids and fiber
rest tremor - handle coin in pocket
fall precaution - sturdy shoes, remove throw rugs and clutter, install grab bars, consciously pick foot up