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Adult health 2 > Exam 2: Neurology > Flashcards

Exam 2: Neurology Flashcards

1
Q

Degenerative disorders are progressive in nature, we must focus on…

A

symptom management, promoting independence, acceptance of loss of function

multi interdisciplinary approach

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2
Q

e.g. of degenerative disorders

A

dementias
Parkinson disease
MS
ALS

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3
Q

__________ progressive neurodegenerative disease characterized by a cognitive decline that causes impairment in daily functioning

A

Dementia

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4
Q

What are the subtypes of dementias

A
  1. Alzheimer’s (most popular)
  2. Vascular dementia
  3. Lewy body dementia
  4. Frontotemporal dementia (least popular)
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5
Q

What are risk factors of dementia

A

age > 65 years old
female gender – females live longer than men

Dementia is NOT a normal physiologic change of aging

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6
Q

Alzheimer’s will cause

A

memory loss, confusion, and cognitive declines

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7
Q

What is the patho of alzheimer’s

A

buildup of beta-amyloid plaques and TAU (neurofibrillary) tangles in the brain, which disrupts communication between neurons and leads to their eventual death

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8
Q

What are the early symptoms of alzheimer’s

A

difficulty remembering recent events, followed by language issues, disorientation, mood changes, and eventually the inability to perform daily tasks –> no cure

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9
Q

Vascular dementia patho

A

occurs when the brain’s blood supply is reduced due to stroke, small vessel disease, or other conditions affecting blood vessels

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10
Q

Vascular dementia leads to

A

cognitive decline because brain cells are deprived of oxygen and nutrients

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11
Q

What are symptoms of vascular dementia

A

difficulties with problem-solving, focus, organization, and slower thinking

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12
Q

What is the difference with vascular vs alzheimers dementia

A

Unlike alzheimer’s, memory loss may not be the initial symptom

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13
Q

With vascular dementia the progression can be

A

stepwise, worsening after each stroke or vascular event

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14
Q

What is LBD caused by

A

accumulation of abnormal protein deposits called Lewy bodies in the brain

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15
Q

What will LBD affect

A

memory, movement, and mental abilities

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16
Q

People with LBD often experience

A

visual hallucinations, fluctuations in cognitive abilities, Parkinsonism (stiffness, tremors, and slow movement), and sleep disturbances

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17
Q

T/F LBD has symptoms like Alzheimer’s and is often misdiagnosed

A

True

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18
Q

FTD is a group of disorders caused by damage to

A

frontal and temporal lobes of the brain

–personality, behavior, and language

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19
Q

FTD results in

A

personality changes, emotional problems, and difficulty with speech (aphasia)

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20
Q

FTD typically occurs in which age group

A

younger 50s or 60s

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21
Q

Unlike Alzheimer’s, FTD memory is usually

A

preserved in the early stages, but people may show socially inappropriate behaviors, poor decision making, or lack of empathy

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22
Q

What are diagnostic exams for dementia

A

CT/MRI, LP, biopsy post mortem most definitive

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23
Q

What MRI finding’s do we see with alzheimer’s

A

loss in volume of the brain but hypertrophy of the ventricles

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24
Q

Early stage of AD

A

independent in ADL’s

may deny presence of symptoms

forgets names; misplaces household items

has short term memory loss, difficulty recalling new info

shows changes in personality and behavior subtly

loses initiative and is less engaged in social relationships

has mild impaired cognition and problems with judgement

unable to travel alone to new destinations

often has decreased sense of smell

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25
Q

Mild stages of AD

A

has impairment of all cognitive functions

demonstrates problems with handling or is unable to handle money and finances

is possibly depressed or agitated

no longer AAOx3/4

has visuospatial deficits –> gets lost

has speech and language deficits: less talkative, decreased use of vocabulary, increasingly non fluent, and aphasic

incontinent of urine and stool

psychotic behaviors

wandering, trouble sleeping

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26
Q

Late stages of AD

A

completely incapacitated; BR

totally dependent ADLs

has loss of mobility and verbal skills

possibly has seizures and tremors

has agnosia

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27
Q

The priority collaborative problems for patients with AD include

A

memory and cognition

injury

elder abuse

symptom management at end of life

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28
Q

What is the priority for inter-professional care with AD

A

safety

prevent injury or accidents; prevent elder abuse

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29
Q

Pharmacological therapy for AD

A

AchE inhibitors: donepezil, galantamine, rivastigmine

NMDA antagonist: memantine

Antidepressants: SSRI

Psychotropic drugs: chemical restraints

Ginkgo, vitamin E

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30
Q

How do we help cope with restlessness and wandering

A

ensuring the patient is wearing identification bracelet

registering the patient for safe return program

providing frequent walk and structured activities

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31
Q

Interventions to mitigate risk for injury with AD

A

ensuring safety by removing all potentially dangerous objects, particularly in case seizures occur

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32
Q

T/F it’s important to make caregivers and family aware of their own health and stress resulting from new responsibility in AD care

A

True

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33
Q

Patho of Parkinson’s

A

loss of dopamine resulting in loss of tone, loss of inhibition of gross movement

atrophy and neuronal loss

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34
Q

Majority of parkinsons is _______

A

primary (idiopathic)

secondary is from something such as tumor or meds

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35
Q

Risk factors of Parkinson’s

A

genetic and environmental factors, affects more men over 40

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36
Q

PD is separated into stages…

A

Stage 1 is mild progressing to stage 5 which is completely dependent

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37
Q

TRAP for PD

A

tremor
rigidity
akinesia/bradykinesia
postural instability (late)

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38
Q

Rigidity assessment includes

A

cogwheel: rhythmic interruptions of movement

plastic: mildly restricted movement

lead pipe: total resistance to movement

39
Q

Stages of parkinson’s with the characteristics include

A

1: unilateral limb involvement, minimal weakness, hand and arm trembling
2: bilateral limb involvement, mask-like face, slow shuffled gait
3: postural instability, increased gait disturbance
4: akinesia, rigidity
5: completely dependent

40
Q

What are the priority problems with PD

A

decreased mobility and possible self care deficit

impaired cognition due to NT and neuronal changes

41
Q

When giving a patient with PD monoamine oxidase B inhibitors such as selegiline (eldepryl) what must we watch for

A

tyramine food interactions

can cause severe HTN and very bad headaches

42
Q

MS patho

A

autoimmune disorder: chronic disease characterized by demyelination and axonal nerve damage

43
Q

MS affects ______ more than _____

A

women more than men (3:1)

44
Q

What are the types of MS

A

relapsing-remitting
primary
secondary
progressive-relapsing

45
Q

What are the priority problems with MS patients

A

decreased immunity
decreased mobility
decreased cognition

46
Q

What must be watch for with natalizumab for MS

A

hepatotoxicity and progressive leukocephalopathy (PML) –> opportunistic viral infection

47
Q

What must we watch for with novantrone-mitoxantrone-chemo for MS

A

cardiac toxicity, leukemia

48
Q

What must we watch for with fingolimod (gilenya) for MS

A

monitor pulse for bradycardia first 6 hours after taking

49
Q

What is ALS

A

progressive degeneration of both upper and lower motor neurons

lou gehrig’s disease

50
Q

Is there a diagnostic test for ALS

A

no

51
Q

What are s/s of ALS

A

muscle weakness, atrophy, decreased DTR’s, fatique

52
Q

What is the focus of ALS care

A

supporting self care and coping strategies

53
Q

What is Myasthenia gravis

A

acquired progressive autoimmune disease characterized by muscle weakness

54
Q

What are the two main types of MG

A

ocular
generalized

55
Q

Patho of MG

A

destruction of Ach receptors–antibodies attached to AChR’s

56
Q

MG is sometimes associated with

A

thymoma

57
Q

What are diagnostic tests for MG

A

+AChR antibody, MuSK titers, RNS, Tensilon test

58
Q

Diagnostics tests for MG will also differentiate

A

cholinergic to myasthenic crisis

59
Q

What is the main medication we give patients with MG

A

mestinon (pyridostigmine)

60
Q

With Cholinesterase inhibitor drugs what must we remember when admin

A

admin 45 min to 1 hour before meals

observe drug interactions

enhance neuromuscular impulse transmission by preventing decrease of Ach by the enzyme ChE

61
Q

Crisis situations in MG include

A

myasthenic crisis: acute exacerbation of disease process often due to infections

Cholinergic crisis: toxic response to medication

62
Q

How do we differentiate crisis in MG

A

A tensilon test is definitive in identifying the type of crisis the patient is experiencing

63
Q

What is the priority when a MG emergency crisis occurs

A

maintain adequate respiratory function and promote gas exchange

ICU monitoring may be needed due to mechanical ventilation

Cholinesterase inhibiting drugs are withheld because they increase respiratory secretions and are usually ineffective for the first few days after crisis occurs

64
Q

What can we give when there is a cholinergic emergency crisis

A

atropine

65
Q

What is GBS

A

acute inflammatory polyneuropathy

immune mediated response triggers destruction of myelin sheath

66
Q

What is GBS associated with (microbiology-wise)

A

Camplylobacter jejuni, Epstein barr virus, Cytomegalovirus

67
Q

What is the most common GBS

A

4 types: ascending GBS is the most common

68
Q

GBS can cause respiratory

A

depression

69
Q

Diagnosis of GBS

A

clinical presentation with history or viral or bacterial infection, EMG, CSF, MRI-no single test

70
Q

Main management for patient with GBS

A

airway compromise

plasmapheresis: removing circulating antibodies assumed to cause disease

IVIG

71
Q

Primary vs secondary headaches

A

Primary: migraine, tension, cluster

secondary: caused by unknown

72
Q

Migraine pattern

A

pulsatile and unilateral; progress slow-severe

73
Q

Migraine phase

A

prodromal
aura
headache
postdromal

74
Q

Migraine frequency

A

episodic, increase with stress, hormones

75
Q

Cluster headaches onset

A

young men, ETOH or nitrate use

76
Q

Cluster headache frequency

A

episodic–lasts days or weeks

77
Q

Cluster headache pattern

A

Intense (most painful of primary H/A), unilateral, severe, begin infraorbital, sweating, flushing, tearing

78
Q

Is there a prodromal phase of cluster

A

no

79
Q

tension headache onset

A

most common–associated with anxiety

80
Q

tension headache frequency

A

episodic or chronic

81
Q

tension headach pattern

A

dull, constant, bilateral, neck to shoulders

82
Q

Seizure vs epilepsy vs status epilepticus

A

Seizure: abnormal paroxysmal electrical discharge from the cerebral cortex (partial or generalized)

Epilepsy: recurrent or chronic seizure

Status epilepticus: seizure lasting over 30 minutes or two or more sequential seizures without recovery between them
THIS IS A MEDICAL EMERGENCY

83
Q

Partial Seizure: simple-focal

A

consciousness is preserved

motor: focal twitching that spreads to other body parts in a sequential fashion

sensory: pins and needles sensation or visual hallucinations

84
Q

Partial Seizure: complex

A

consciousness is impaired

cognitive disruptions (deja vu)

affective symptoms (fear, anxiety)

automatisms: repetitive involuntary activity such as lip smacking

usually no recall of the event

can progress to generalized tonic-clonic

85
Q

Generalized seizures are characterized by

A

Sudden LOC and immediate symmetric abnormal motor acitivity

86
Q

Generalized seizures: tonic clonic

A

formerly called grand mal or convulsion

LOC usually under 2 minutes
stiffness of the body then jerking of the limbs

87
Q

Generalized seizures: absence

A

formerly called petit mal

sudden onset with interruption of activity

momentary LOC lasts a few seconds

seen in children (stare into space)

misdiagnosed often as ADD or daydreaming

88
Q

Generalized seizures: myoclonic

A

sudden brief contractions

large jerking movements of a major muscle group, such as an arm

falling from a sitting position or dropping what is heal

frequently occur when awaking or when falling asleep

89
Q

Generalized seizures: Tonic or Atonic

A

Abrupt fall either with stiffening (tonic) or with loss of muscle tone (atonic)

90
Q

What is the patho of trigeminal neuralgia

A

impaired inhibition mechanism in the brainstem caused by excessive firing of irritated fibers in the trigeminal nerve CN V

91
Q

Trigeminal neuralgia clinical manifestation

A

very severe pain, triggers

92
Q

Bells palsy patho

A

paralysis of cranial nerve 7

93
Q

Clinical manifestation of bell’s palsy

A

facial paralysis, with forehead involvement, alterest taste and pre auricular pain 48 hours prior to event

94
Q
A

Adult health 2 (10 decks)

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