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Adult health 2 > Exam 2: Neurology > Flashcards

Exam 2: Neurology Flashcards

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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
Mild stages of AD
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
26
Late stages of AD
completely incapacitated; BR totally dependent ADLs has loss of mobility and verbal skills possibly has seizures and tremors has agnosia
27
The priority collaborative problems for patients with AD include
memory and cognition injury elder abuse symptom management at end of life
28
What is the priority for inter-professional care with AD
safety prevent injury or accidents; prevent elder abuse
29
Pharmacological therapy for AD
AchE inhibitors: donepezil, galantamine, rivastigmine NMDA antagonist: memantine Antidepressants: SSRI Psychotropic drugs: chemical restraints Ginkgo, vitamin E
30
How do we help cope with restlessness and wandering
ensuring the patient is wearing identification bracelet registering the patient for safe return program providing frequent walk and structured activities
31
Interventions to mitigate risk for injury with AD
ensuring safety by removing all potentially dangerous objects, particularly in case seizures occur
32
T/F it's important to make caregivers and family aware of their own health and stress resulting from new responsibility in AD care
True
33
Patho of Parkinson's
loss of dopamine resulting in loss of tone, loss of inhibition of gross movement atrophy and neuronal loss
34
Majority of parkinsons is _______
primary (idiopathic) secondary is from something such as tumor or meds
35
Risk factors of Parkinson's
genetic and environmental factors, affects more men over 40
36
PD is separated into stages...
Stage 1 is mild progressing to stage 5 which is completely dependent
37
TRAP for PD
tremor rigidity akinesia/bradykinesia postural instability (late)
38
Rigidity assessment includes
cogwheel: rhythmic interruptions of movement plastic: mildly restricted movement lead pipe: total resistance to movement
39
Stages of parkinson's with the characteristics include
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
What are the priority problems with PD
decreased mobility and possible self care deficit impaired cognition due to NT and neuronal changes
41
When giving a patient with PD monoamine oxidase B inhibitors such as selegiline (eldepryl) what must we watch for
tyramine food interactions can cause severe HTN and very bad headaches
42
MS patho
autoimmune disorder: chronic disease characterized by demyelination and axonal nerve damage
43
MS affects ______ more than _____
women more than men (3:1)
44
What are the types of MS
relapsing-remitting primary secondary progressive-relapsing
45
What are the priority problems with MS patients
decreased immunity decreased mobility decreased cognition
46
What must be watch for with natalizumab for MS
hepatotoxicity and progressive leukocephalopathy (PML) --> opportunistic viral infection
47
What must we watch for with novantrone-mitoxantrone-chemo for MS
cardiac toxicity, leukemia
48
What must we watch for with fingolimod (gilenya) for MS
monitor pulse for bradycardia first 6 hours after taking
49
What is ALS
progressive degeneration of both upper and lower motor neurons lou gehrig's disease
50
Is there a diagnostic test for ALS
no
51
What are s/s of ALS
muscle weakness, atrophy, decreased DTR's, fatique
52
What is the focus of ALS care
supporting self care and coping strategies
53
What is Myasthenia gravis
acquired progressive autoimmune disease characterized by muscle weakness
54
What are the two main types of MG
ocular generalized
55
Patho of MG
destruction of Ach receptors--antibodies attached to AChR's
56
MG is sometimes associated with
thymoma
57
What are diagnostic tests for MG
+AChR antibody, MuSK titers, RNS, Tensilon test
58
Diagnostics tests for MG will also differentiate
cholinergic to myasthenic crisis
59
What is the main medication we give patients with MG
mestinon (pyridostigmine)
60
With Cholinesterase inhibitor drugs what must we remember when admin
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
Crisis situations in MG include
myasthenic crisis: acute exacerbation of disease process often due to infections Cholinergic crisis: toxic response to medication
62
How do we differentiate crisis in MG
A tensilon test is definitive in identifying the type of crisis the patient is experiencing
63
What is the priority when a MG emergency crisis occurs
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
What can we give when there is a cholinergic emergency crisis
atropine
65
What is GBS
acute inflammatory polyneuropathy immune mediated response triggers destruction of myelin sheath
66
What is GBS associated with (microbiology-wise)
Camplylobacter jejuni, Epstein barr virus, Cytomegalovirus
67
What is the most common GBS
4 types: ascending GBS is the most common
68
GBS can cause respiratory
depression
69
Diagnosis of GBS
clinical presentation with history or viral or bacterial infection, EMG, CSF, MRI-no single test
70
Main management for patient with GBS
airway compromise plasmapheresis: removing circulating antibodies assumed to cause disease IVIG
71
Primary vs secondary headaches
Primary: migraine, tension, cluster secondary: caused by unknown
72
Migraine pattern
pulsatile and unilateral; progress slow-severe
73
Migraine phase
prodromal aura headache postdromal
74
Migraine frequency
episodic, increase with stress, hormones
75
Cluster headaches onset
young men, ETOH or nitrate use
76
Cluster headache frequency
episodic--lasts days or weeks
77
Cluster headache pattern
Intense (most painful of primary H/A), unilateral, severe, begin infraorbital, sweating, flushing, tearing
78
Is there a prodromal phase of cluster
no
79
tension headache onset
most common--associated with anxiety
80
tension headache frequency
episodic or chronic
81
tension headach pattern
dull, constant, bilateral, neck to shoulders
82
Seizure vs epilepsy vs status epilepticus
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
Partial Seizure: simple-focal
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
Partial Seizure: complex
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
Generalized seizures are characterized by
Sudden LOC and immediate symmetric abnormal motor acitivity
86
Generalized seizures: tonic clonic
formerly called grand mal or convulsion LOC usually under 2 minutes stiffness of the body then jerking of the limbs
87
Generalized seizures: absence
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
Generalized seizures: myoclonic
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
Generalized seizures: Tonic or Atonic
Abrupt fall either with stiffening (tonic) or with loss of muscle tone (atonic)
90
What is the patho of trigeminal neuralgia
impaired inhibition mechanism in the brainstem caused by excessive firing of irritated fibers in the trigeminal nerve CN V
91
Trigeminal neuralgia clinical manifestation
very severe pain, triggers
92
Bells palsy patho
paralysis of cranial nerve 7
93
Clinical manifestation of bell's palsy
facial paralysis, with forehead involvement, alterest taste and pre auricular pain 48 hours prior to event
94

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