Exam 3 main points Flashcards
- One sided
- Episodic (days, weeks, or months)
Trigeminal Neuralgia
- Unilateral
- More common in men
- “alarm clock headache”
Cluster Headaches
- NSAIDS can help
- Bilateral
Tension headach
- Vasodilation/vasospasm and stretch of nerves: inflammation
- Unilateral (70%), women
Migraine headach
Meningococcal meningitis caused by?
Meningococcal meningitis (caused by Neisseria meningitidis) usually causes a petechial rash
CSF for Meningitis & Encephalitis
- Bacterial
- Viral
CSF:
Bacterial> cloudy, ↑neutrophil and protein levels, ↓ glucose levels
Viral> ↑ Lymphocyte count, mild to mod. protein elevation, normal glucose levels
Encephalitis is most commonly caused by?
most commonly viral
Tx for temporal arteritis (AKA Giant Cell Arteritis)
Corticosteroids (1-2 years)
- Epidural/Extradural- bleeding in epidural space >
- Subdural- bleeding in subdural space >
- Epidural/Extradural- bleeding in epidural space > fast
- Subdural- bleeding in subdural space > fast/slow
Epidural Hematoma almost always results from?
Underlying brain usually minimally damaged; neurological deficits & HA begin within?
- Almost always results from skull fracture (temporal bone) & middle meningeal artery laceration & bleeding
Underlying brain usually minimally damaged; neurological deficits & HA begin within hours
Subdural Hematoma Effects begin?
Effects begin 48 hrs post trauma: HA, confusion
Rupture: “Worst HA of my life” with or without LOC, neurological S/S
Aneurysm
Mostly benign tumors
Pituitary Adenoma
Sensation that YOU ARE spinning =
subjective vertigo
Sensation that the room is spinning =
objective vertigo
Triad > Vertigo, Tinnitus, Hearing loss
Meniere’s Disease
- Testing TSH, T3/4, radioactive thyroid uptake scan -Goiter -pretibial myxedema -exophthalmos
Grave’s disease
(protrusion of eyes)
Graves’ ophthalmopathy
Cause :Extra stress: infection, emotional distress, etc..
Thyroid Crisis (Storm)
NO exophthalamos or pretibial myxedema
Toxic Nodular Goiter (TNG)
Classic triad: diaphoresis, episodic HA, tachycardia
Pheochromocytoma
Agoraphobia
Panic Disorders (PD)
Cognitive-Behavioral Therapy
Anxiety Disorder Treatment
SSRI (Serotonin Specific Reuptake Inhibitor
Neurotransmitter Reuptake
Start around 30 years of age
Life expectancy is about 60 yrs old
Hereditary
Dementia is early stage, with chorea
Huntington’s Disease
Antiproliferative factor prevents new cell growth in lining of bladder. Can lead to Hunner Ulcers
- w/o bacteria
Interstitial Cystitis
Patient is not in photo
She keeps coming up with excuses to her friends for not going to trampoline world
The real reason is she gets embarrassed
Every time she jumps or laughs she can’t hold it! -Patient learns that she just has weak pelvic floor muscles, and its not her fault!
Stress Incontinence
Patient presents confused and easily disoriented
Has been in pain lately and noticed some blood in her urine
At least, she thought she saw blood but can’t remember. She is having a hard time remembering anything lately
Patient recently had catheter removed after surgical procedure After finding bacteria in a UA, craziness can be helped with antibiotics & Granny can get back to feeling herself again
Dementia from Urinary Tract Infection
This is the patient.
Has urgency to go, but only dribbles
Pt says this happens frequently.
None of the women he knows has this problem
Feels it is ruining his rep Common in men over 40
Causes frequency and urgency
Men need to start getting tested at age 40 for BPH
BPH
Mary is afraid to go to work
She has had this job for years
Now she is afraid of getting eaten by a shark
Mary works at the beach, but has never actually seen a shark before Mary sells ice cream by the beach and never even gets near the water
Generalized Anxiety Disorder
He hit his head about two weeks ago
Now he is suffering from severe headaches
Starting to get dizzy and eyes are blurry Took weeks to notice, slow bleeding. Sometimes patient doesn’t even remember exact trauma that caused it
Chronic Subdural Hemotoma
Patient has noticed weird symptoms lately
Not only has she had desire to shave head and act irrational
She also has noticed she is lactating but not pregnant
Pituitary Adenoma
Pituitary gland controls prolactin. A pituitary tumor could cause stimulation of prolactin when not needed in body
Could also affect HGH – Acromegaly, or cortisol levels – Cushings Syndrome
This is the patient
Feels like he is getting sweaty all of a sudden
Feels his heart rate rapidly increasing
Remembers something doctor said about taking medication for Grave’s Disease – now feels maybe he should have filled the prescription
Thyroid Crisis
Medical emergency if not treated with PTU
Thyroid gland instantly goes into overdrive
Will also cause delirium with N/V and diarrhea
Death likely if not treated immediately!
bilateral cerebral hemisphere involvement or RAS dysfunction
Coma
- Not normal part of aging
- Progressive failure of cerebral functions
Dementia
- Signs and Symptoms Amyloid plaques Neurofibrillary tangles - chromosome 21 - Beta Amyloid plaques between cells - Neurofibrillary Tangles of twisted strands of protein
Alzheimer’s Disease
- Cortex shrinks
- Hippocampus shrinks
- Ventricles enlarge
Alzheimer’s Disease
- Genetic- Autosomal dominant (Chromosome 4)loss of
- GABA neurons (inhibitory) within basal ganglia
- HD gene - CAG repeats indicates HD risk
Huntington’s Disease
Early in the disease, the D2 receptors involved in the INDIRECT pathway get destroyed – chorea (jerky, writhing, involuntary movements affecting especially the shoulders, hips, and face) results
Later in the disease the D1 receptors in the DIRECT pathway get destroyed as well – bradykinesia (diminished movement results
Basal Ganglia’s Role in Huntington’s Disease
- Post-ictal period, that may last minutes to hours - ALOC
- involves both brain hemispheres
Tonic - Clonic Seizures
Often accompanied by automatism
person may make chewing, lip smacking, picking or other non-purposeful involuntary motions
Complex Partial Seizure
thiamine (Vitamin B1) deficiency
- Confabulations
Wernicke - Korsakoff Syndrome
- depletion of dopamine
- Loss of substantia nigra dopamine-producing neurons; excess cholinergic activity in basal ganglia
Parkinson’s disease
- (bronchogenic cancer *most common)
- ↓Serum osmolarity vs.↑Urine osmolarity
SIADH Syndrome Of Inappropriate ADH Secretion
Polyuria and polydipsia
↑Serum osmolarity vs. ↓Urine osmolarity
Diabetes Insipidus
More common at rectum and sigmoid colon
- Left sided pain more common
-Risk of colon cancer increases if patient has UC for >10 yrs
Pseudopolyps due to continued healing of ulcers
Ulcerative Colitis (UC)
both small and large intestines
Rectum is seldom involved
Ascending and transverse colon main sites
- “Skip” lesions, transmural inflammation
- Ileum involved: Malabsorption of Vit B12
- cobblestoning
Crohn’s disease
Anticholinergic medications – cause lack of bowel motility and urine retention
Ileus (Intestinal Obstruction)
Maternal age 35 – 1/385 40 – 1/106 45 – 1/30 - leukemia (ALL)
Down Syndrome
XXY
Klinefelter’s syndrome
X only
Turner’s syndrome, 45x
autosomal recessive
Primordial dwarfism
autosomal dominant
Achondroplasia
