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MVU Adult 2 > Exam 4 > Flashcards

Exam 4 Flashcards

1
Q

What is paresthesia?

A

The sensation of numbness, prickling, or tinglng experienced in central and peripheral nerve lesions

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2
Q

What are the potential causes of paresthesias?

A

anatomical or mechanical peripheral nerve injuries; more common to occur at sites that undergo increased pressure or mechanical forces (wrist)

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3
Q

What is the difference between paresthesia and paresis?

A

Paresthesia- change in sensation
Paresis- change in movement

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4
Q

Where is the associated location of paresthesia for a patient with cervical injury?

A

arms and hands

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5
Q

Where is the associated location of paresthesia for a patient with a lumbar injury?

A

buttocks, legs, and feet

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6
Q

Spurling’s sign

A

radicular pain reproduced when the examiner exerts downward pressure on the vertex while tilting the head toward the symptomatic side

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7
Q

Differentiate between acute and chronic back pain- how will presentations differ?

A

Acute- presents with localized discomfort that occurs after mechanical stress; may have trouble standing erect; pain may radiate to buttox and thigh
Chronic- hallmark symptom is radiation to one or both buttocks, pain aggravated by activity

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8
Q

What is the straight leg test?

A

With the patient supine and relaxed, elevate the leg until it begins to bend or the patient reports severe pain in buttock or back; considered positive when the pain is elicited below the level of the knee when the leg is raised less than 60 degrees; would be positive if herniated disc

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9
Q

S&S of epicondylitis

A

S: stiffness at the elbow, especially at night; difficulty extending the arm in the morning; pain that is worse with gripping or shaking hands
O: inability to fully extend arm at elbow

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10
Q

Describe the Phalen’s test

A

Test for carpal tunnel: Patient engages in full flexion of wrists by placing back of hands touching in front of them; positive if tingling sensation of the median nerve

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11
Q

Describe Tinel’s sign

A

Test for carpal tunnel: Examiner taps anterior wrist briskly; positive if this illicits pins and needles sensation of the median nerve over the hand

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12
Q

Describe Finkelstein’s test

A

Test for De Quervain’s tenosynovitis: patient should flex thumb toward the palm and make a fist (holding thumb under fingers) and deviate wrist towards the ulna; positive if pain on the wrist on the thumb side

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13
Q

Describe McMurray’s test

A

Test for medial meniscus injury: positive if there is a click sound upon manipulation of the knee

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14
Q

What is the standard diagnostic test for osteoporosis?

A

Dual energy x-ray absorptiometry (DXA)

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15
Q

Treatment/Management for osteoporosis

A

Non-pharm: gait training, activity, eliminate hazards in home, prevent fractures
Pharm: Calcium & Vitamin D, estrogen, biphosphonates, testosterone supplements, fluoride

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16
Q

Hormone replacement with estrogen for osteoporosis causes increased risk for what?

A

breast CA, CAD, stroke, DVT

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17
Q

What is the most common entrapment neuropathy?

A

carpal tunnel syndrome

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18
Q

What is the clinical presentation for carpal tunnel syndrome?

A

S: aching sensation that radiates to thenar area; pain at night and in the morning with numbness/paresthesia at thumb & 4th metatarsal, frequently drops objects and can’t open jars
O: Possible swelling, redness, nodules, deformity, muscle atrophy; tests are Allen’s sign, PHalen’s maneuver, Tinel’s sign

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19
Q

Management for carpal tunnel syndrome

A

Non-Pharm: prevent flection/extension by using a splint
Pharm: NSAIDs, corticosteroid injections, Vitamin B6

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20
Q

What are the red flags when assessing a patient with low back pain?

A

Hx of trauma, fever, incontinence, unexplained weight loss, a cancer history, long term steroids, parenteral drug use, intense localized pain and an inability to get into a comfortable position

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21
Q

What are the special tests for assessing lower back pain?

A

-Straight-leg raise: places the L5 & S1 nerve roots and the sciatic nerve under tension
-Reverse straight-leg raise: Places the L1-L4 nerve roots under tension
-Prone rectus femoris test: places the L1-L4 nerve roots under tension

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22
Q

Treatment for low back pain (non-radiating)

A

Non-pharm: exercise, CBT, electromyography, Tai chi/yoga, relaxation, heat, massage, acupuncture, spinal manipulations
Pharm: NSAIDs, tylenol, muscle relaxers

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23
Q

Clinical presentation of Cauda Equina Syndrome

A

S: acute or insidious onset, pain in both legs that may be more severe in one, numbness in lower extremities, difficulty voiding, loss of bowel/bladder control
O: Stumbling gait, quadricep or hip extensor weakness, difficulty rising from chair, unable to walk on heels or toes, bilateral footdrop

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24
Q

Why is it so important to recognize cauda Equina?

A

Because it is a medical emergency and the patient would need an immediate surgical nerve decompression to prevent further injury

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25
Q

What are the complementary therapies for osteoarthritis and musculoskeletal problems?

A

acupuncture, massage, yoga/tai chi, supplements, aromatherapy

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26
Q

Clinical presentation of plantar fasciitis

A

subcalcaneal pain that sometimes radiates to the arch of the foot while the person is running or walking; pain is worse in the morning

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27
Q

What is the treatment for plantar fasciitis?

A

-Heel lifts, padded heel cups, orthotic devices
-For acute phase: rest, ice, NSAIDs, local corticosteroid injections
-Heel-cord stretching exercises and a nighttime splint
-Surgery decompression of the plantar fascia are a last resort

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28
Q

Which musculoskeletal diagnosis are more common in the elderly?

A

Osteoporosis, osteoarthritis, fractures, falls

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29
Q

What diagnosis would X-ray confirm?

A

-OA
-Erosions
-Calcifications/cysts
-Osteopenia
-Narrowing of joint spaces
-deformity of bones (fractures, dislocation)

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30
Q

When is a CT ordered for a musculoskeletal complaint?

A

for axial skeletion evalution because of the ability of the CT to visualize the axial plane; examples are for herniated disc, spinal trauma; also bone fractures that may not show on Xray, blood clots, and organ damage

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31
Q

When is an MRI indicated for a musculoskeletal complaint?

A

When suspecting soft-tissue disorders such as muscle and tendon tears and intra-articular disorders such as labrum tears and meniscus tears, as well as spine disorders; also nerve compression, rotator cuff tears, achilles tendon rupture

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32
Q

What is an EMG and when is it indicated?

A

A nerve conduction study, is indicated when neurologic abnormalities or paresthesia are present in disorders such as carpal tunnel

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33
Q

How do you define an acute musculoskeletal injury?

A

acute pain less than 6 weeks’ duration; damage to muscle, tendons, ligaments, nerves & bursae

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34
Q

Strain vs. Sprain

A

Strain- muscle injury caused by excessive tensile stress placed on a muscle resulting in stiffness & decreased function; affect muscles or tendons that connect muscle-bone
Sprain- stretching or tearing of ligaments that occurs when a joint is forced beyond its normal anatomical range

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35
Q

Describe the degree of sprains

A

1st degree: stretching of ligamentous fibers
2nd degree: tear or part of the ligament with pain & swelling
3rd degree: complete ligamentous separation

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36
Q

Management for acute musculoskeletal injury

A

-PRICE: Protect, Rest, Ice, compression, elevation
-Pharm: NSAIDS
-Referral to orthopedic if no relief with conventional methods after 6 weeks

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37
Q

Differential diagnosis for knee pain

A

Acute: Fracture, meniscal injury, ligamentous injury, musculotendinous strain, extensor mechanism injury, contusions
Chronic: arthritis, tumors, sepsis, overuse

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38
Q

S&S of cervical muscle sprain/strain

A

S- pain, mid to lower posterior neck; dull/aching exacerbated by movement; occipital headache
O- Decreased ROM w/ poor quality of movement; negative Spurling’s sign; reproducible tenderness

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39
Q

Management of cervical muscle sprain/strain

A

-Reassurance and time
-NSAIDs & Non-narcotics
-Short-term muscle relaxants
-Physiotherapy: Ice, heat, therapies, cervical traction

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40
Q

What should patients be aware of when taking muscle relaxants?

A

Cause drowsiness; don’t drink alcohol, don’t drive or operate heavy machinery

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41
Q

S&S of cervical spondylosis

A

S: Recurring neck stiffness with mild aching, limited ROM with lateral rotation/flexion toward affected side
O: Shoulder abduction weakness, Biceps/Triceps weakness

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42
Q

How does treatment of cervical sprains differ from cervical spondylosis?

A

-For cervical spondylosis, all of the interventions for a sprain in addition to these:
-Steroids might be indicated if there is radicular pain (pain that radiates down back and into legs or arms)
-Surgery may be indicated if myelopathy/intractable pain/severe disabilities

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43
Q

Is cervical spondylosis acute or chronic?

A

Chronic: caused by cumulative stress over time but is exacerbated by trauma, poor body mechanics, postural changes, or a disc injury

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44
Q

F/U for cervical spondylosis

A

6 weeks; if no improvement can refer to an orthopedic surgeon

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45
Q

How long would acute low back pain persist?

A

less than 6 weeks

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46
Q

Chronic low back pain duration

A

Lasts longer than 3 months

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47
Q

Causes of low back pain

A

-Lumbar strain/sprain
-Spinal stenosis
-Osteoarthritis
-scoliosis
-spondylosis
-Lesion or fracture

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48
Q

S&S of low back pain

A

S: Pain radiates to buttocks, muscle spasms, history of lifting/twisting with heavy object, prolonged sitting, trauma
O: Diffuse tenderness to lower back; ROM elicits pain, Negative straight-leg to rule out disc herniation

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49
Q

Differential diagnosis for chronic low back pain

A

Depression
Arthritis
Infection
Mets/tumors
Osteoporosis

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50
Q

What is the most common cause of radicular pain to the lower extremities?

A

A herniated lumbar disc

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51
Q

S&S of herniated lumbar disc

A

S: Onset most likely insidious; exaggerated by sitting, walking, standing, coughing, sneezing; radiates from buttock to posterior leg, ankle, foot, paresthesias, weakness
O: Positive straight leg raise; pain & spinal extension when sitting with leg raised (flip sign), possible loss of DTRs

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52
Q

Non-pharmacological management for herniated disc

A

-Pain relief/improve mobility
-Limit sitting, prolonged standing, or walking; take frequent rest breaks when resuming activity
-Surgery if symptoms persist for > 3 months or significant neurological compromise

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53
Q

Pharmacological management for herniated disc

A

-NSAIDS
-Short course of muscle relaxants/opioids
-Short course of steroids or epidural steroid injection

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54
Q

Follow up and referral for herniated disc

A

F/U 7-10 days and every 2 weeks to monitor progress
-Referral for neuro deficits: ankle jerk, bladder/rectal sphincter weakness (incontinence), foot drop

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55
Q

Pharmacological management for lumbar spinal stenosis

A

-NSAIDS
-Folic acid and Vitamin B12 supplements

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56
Q

S&S of lumbar spinal stenosis

A

S: Sx progress from proximal to distal; sitting/walking causes pain and weakness in legs
O: Impaired proprioception, possible + romberg, diminished reflexes, lumbar scoliosis

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57
Q

Which part of the spine is the most common injured?

A

C-spine

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58
Q

S&S of vertebral fracture

A

S: C/O pain after injury; pain is at a specific pinpoint and described as aching or stabbing
O: possible ecchymosis or swelling

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59
Q

Patient education for vertebral fracture

A

-Avoid bending, stooping, twisting, or lifting anything over 10 pounds; exercise, fall-prevention

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60
Q

S&S of bursitis

A

S: pain or swelling of bursal sacs; warmth, possible fever, chills, arthalgias if due to RA or gout
O: Pain may be referred to other structures, induration, erythema, and effusion

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61
Q

When to make a referral for bursitis

A

Refer to ortho if no improvement w/ conservative therapy after 6 weeks

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62
Q

What is the most common cause of tendinitis or tenosynovitis?

A

Overuse

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63
Q

S&S of De quervain’s tenosynovitis

A

S: Pain at radial side of wrist especially with lifting
O: Possible creptis over radial styloid; Allen’s, Phalen’s, Tinel’s are negative; Finkelstein’s test is +

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64
Q

What is Dupuytren’s contracture?

A

palmar fibromatosis most often in the 4th and 5th fingers
S&S: thumb-index finger web space, difficulty grasping objects, normal sensation
Management: injections/surgery

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65
Q

S&S of rotator cuff syndrome

A

S: gradual onset, A/L shoulder pain exacerbated by overhead activity, pain radiates to elbow
O: Pain/crepitus with shoulder motion/palpation; Positive Neer & Hawkins signs

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66
Q

When to refer to an orthopedic surgeon for ankle sprain

A

-If no improvement in 6-8 weeks; would need MRI

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67
Q

Diagnostics for ankle sprain

A

Anterior drawer test
X-ray ankle & foot

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68
Q

What is the most common articular disease in adults greater than 45 years of age?

A

Osteoarthritis

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69
Q

Principle sites for osteoarthritis

A

-Distal interphalangeal joint (DIP)- Herberden’s nodes
-Proximal interphalangeal joint (PIP)- Bouchard’s nodes
-Carpometacarpal joint (CMC)
-Great toe, hips, knees, C/L spines

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70
Q

S&S of osteoarthritis

A

S: slowly developing localized pain in affected joint, subtle onset, weight-bearing joints with early morning stiffness or stiffness after inactivity that subsides after 30 minutes
O: minimal or no swelling in affected joints; tenderness on direct palpation, crepitus, reduces passive and active ROM

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71
Q

Pharmacological treatments for osteoarthritis

A

-NSAIDS (topical/PO), tylenol, tramadol, steroid injections (knee or hip joints)

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72
Q

What will an X-ray of a patient with osteoarthritis show?

A

Asymmetrical joint space narrowing, bony cysts & osteophytes, subchondral sclerosis (for worsening disease)

73
Q

Risk factors for osteoporosis

A

low body weight, smoking, excessive alcohol, low calcium intake, vitamin D deficiency, chronic use of glucocorticoids, thyroxine, long-term phenytoin

74
Q

S&S of osteoporosis

A

S: often no symptoms until fracture occurs; gradual onset of back pain
O: Compression fracture with acute point tenderness, kyphosis

75
Q

When should a patient with osteoporosis be referred to endocrinology?

A

If you suspect secondary causes are present such as hormone imbalances

76
Q

Follow up for patients with osteoporosis

A

Repeat bone density scans every 2 years

77
Q

DDX for osteoporosis

A

Neoplasm, osteomalacia, skeletal hyperparathyroidism, hyperthyroidism

78
Q

Causes of confusion in the elderly

A

-Depression, delirium, dementia, Alzheimer’s, metabolic disturbances, infections, tissue hypoxia & ischemia

79
Q

Difference between dizziness and vertigo

A

Dizziness- feeling unsteady or off balance, faint, light-headed, often is brief with abrupt or gradual onset
Vertigo- false sensation of rotation or movement of patient or their surroundings

80
Q

S&S of tension headache

A

Bilateral, bandlike pain that is non-pulsating; possible N/V but usually no photophobia

81
Q

S&S of migraine headache

A

Unilateral, Pulsating; N/V often present; photophobia, phonophonia, may or may not have an aura

82
Q

S&S of cluster headache

A

Night-time, unilateral, non-pulsating; causes tearing, sweating, congestion, rhinorrhea, red eyes, ptosis

83
Q

Non-pharm treatments for different types of headaches

A

Tension: stress management, massage
Migraine: Avoid triggers
Cluster: 100% O2 mask

84
Q

Pharm treatments for different types of headaches

A

Tension: ASA, tylenol, NSAIDs, muscle relaxers
Migraine: Triptans, NSAIDs, antiemetics, propanolol, nortriptyline, topiramate
Cluster: Sumatriptan, indomethacin

85
Q

What is temporal arteritis and what labs should be tested if suspecting?

A

local swelling, tenderness/pulselessness over temporal artery; causes fever, anorexia, weight loss, chills
-CHECK ESR & CRP

86
Q

What is a thunderclap headache?

A

Abrupt, severe, sudden onset reaching maximum intensity in 1 minute- this is an EMERGENCY because it is likely a subarachnoid hemorrhage aneurysm rupture

87
Q

When to refer someone with headaches to neurology?

A

Neurological deficits, increased frequency and severity of unilateral headaches, atypical auras, changes in personality, excessive sleepiness and new onset of progressive deficits

88
Q

Women with migraines have a higher risk of what emergent diagnosis if they are taking estrogen-containing contraceptives?

A

Stroke

89
Q

DDx for paresthesias/paresis

A

Arterial occlusion, arteriosclerosis, nerve entrapment syndrome (Carpal tunnel), neuropathy, TIAs, herpes zoster

90
Q

Difference between resting and intentional tremor

A

Resting- occurs in relaxed & supported extremity and ends with purposeful movement
Intentional- occurs with attempted voluntary movement

91
Q

Difference between focal and generalized seizures

A

Focal- affecting one part of the brain and often due to a focal lesion
Generalized- affecting the entire brain; tonic-clonic, absence, myoclonic, tonic, and atonic; often associated with childhood onset

92
Q

Describe absence seizures

A

Nonmotor; sudden interruption of ongoing activities- blank stare; lasts for a few seconds

93
Q

Describe tonic-clonic (grand mal) seizures

A

Tonic stiffening of muscles, fall to ground, rigidity, may inhibit respiration, tongue may be bitten; loss of bladder control; clonic convulsive movements; postictal period- depressed LOC followed by deep sleep and possible headache

94
Q

Describe atonic seizure

A

Sudden loss of muscle control

95
Q

Describe psychogenic nonepileptic seizures (PNES)

A

Paroxysmal seizure-like events arising from psychological disturbances rather than abnormal electrical brain activity

96
Q

Possible causes of seizures

A

Epilepsy, drug overdose, drug withdrawal, head trauma, strokes, degenerative brain disease, infections, tumors

97
Q

Management for patients with seizures

A

-Prevent recurrence with medications
-Identify type of seizure before treatment
-Baseline CBC, CMP, LFT before starting therapies and monitor throughout
-Serum drug levels to assess therapeutic
-Referral to neurologist early
-Wean meds slowly if wanting to discontinue

98
Q

S&S of Alzheimer’s disease

A

S: Initial complaints of memory problems usually from a family member; changes in behavior, decreased ability to complete normal tasks
O: May not show obvious signs of confusion, but clinician should ask questions like “What did you do last Sunday?” and perform separate assessments with family and patient; Pertinent information to gather: Family hx, medications, depression, anxiety, sleep issues; Functional Activities Questionnaire (FAQ) given to family, MoCa completed with patient

99
Q

Pharmacological treatments for patients with Alzheimer’s disease

A

-Cholinesterase inhibitors: Donepezil, Galantamine, Rivastigmine, Galantamine
-N-Methyl-D-Aspartate-Receptor-Antagonist: memantine
-Anti-psychotics (use with caution): risperidone, olanzapine, quetiapine

100
Q

Non-pharmacological interventions for Alzheimer’s disease

A

-Protect physical health, emotional support, maintain optimal function to prevent/reduce excess disability
-Good nutrition, exercise, preventive care
-Referral to memory disorder center

101
Q

Difference between Parkinson’s disease and Parkinsonian Syndrome

A

-Parkinsonian syndrome is a general term that refers to any condition that causes the types of movement problems (rest tremor, rigidity, bradykinesia, postural instability, flexed posture, freezing) observed in Parkinson’s disease; Parkinson’s disease is the most common cause of Parkinson’s syndrome

102
Q

What are some secondary causes of Parkinsonism?

A

-CVA
-Infection
-Trauma
-Toxins
-Hereditary (Wilson’s disease- excess copper)

103
Q

6 major symptoms of Parkinson’s

A
  1. Tremor at rest
  2. Rigidity
  3. Bradykinesia
  4. Hypokinesia
  5. Flexed Posture
  6. Loss of postural reflexes
104
Q

What is the freezing phenomenon?

A

transient episodes, usually lasting seconds, in which the motor activity being attempted by an individual is halted

105
Q

Diagnostics for Parkinson’s

A

-Presence of parkinsonism and absence of exclusion criteria (such as cerebellar abnormalities/antidopaminergic medication)
-MRI
-SPECT & PET
-Levodopa trial

106
Q

Non-pharm management for Parkinson’s

A

-Referral to movement disorder neurologist or neurosurgeon to discuss deep brain stimulation
-Speech therapy, dysphagia screening

107
Q

Pharmacological management for Parkinson’s

A

-Levodopa is the most efficacious
-MAO-B Inhibitors: Selegiline
-Dopaminergic- Carbidopa/Levodopa
-Anticholinergics- Trihenyxphenidyl
Antiviral- Amantadine

108
Q

TRAP pneumonic for signs of parkinson’s

A

Tremor: shaking, usually starting on one side
Rigidity: stiffness of the limbs, neck, or trunk
Akinesia: loss or impairment in power or voluntary movement
Posture and Balance

109
Q

S&S of ALS (Lou Gehrig’s)

A

-Starts in one limb or region of spinal cord; bulbar onset poorer prognosis as swallowing and breathing are affected sooner
-Weakness will spread to other areas of the body
-Bowel and bladder control are usually not affected

110
Q

What is the only medication shown to improve survival of ALS?

A

Riluzole

111
Q

Hemorrhagic vs. Ischemic Strokes Vs. TIA

A

Hemorrhagic: bleeding in the brain, often due to weakend vasculature or aneurysm; intracerebral, subarachnoid, epidural, subdural
Ischemic- embolism, thrombosis, hypoperfusion
TIA- temporary episode of focal ischemia which resolves spontaneously

112
Q

Name some modifiable risk factors of stroke

A

-HTN
-Cardiac disease
-Diabetes
-HLD
-Smoking
-Illicit drugs
-Lifestyle

113
Q

What is the most common cause of an intracerebral hemorrhage?

A

Hypertension

114
Q

What is the most common cause, signs, and symptoms of a subarachnoid hemorrhage?

A

-Ruptured arterial aneurysms
-Severe headache (thunderclap), vomiting, drowsiness

115
Q

Risk factors for ischemic stroke

A

AFib, prosthetic heart valves, valve vegetation, MI, atherosclerosis

116
Q

Diagnostics for stroke

A

-First CT to determine if hemorrhage
-MRI
-Glucose (rule out hyper/hypoglycemia)
-NIHSS- stroke scale

117
Q

Describe Kernig’s test for meningitis

A

-Patient is supine or in a chair
-Hip and knee are flexed to 90 degrees and attempt is made to extend the knee
-The test is positive if the maneuver causes pain in the neck or back

118
Q

Describe Brudzinki’s sign for meningitis

A

-Patient is supine
-Flexion of the neck causes flexion of the hips and knees

119
Q

S&S of meningitis

A

S: headache, photophobia, neck pain/stiffness (nuchal rigidity)
O: Fever, tachycardia, tachypnea, pain with eye movement, Kernig’s and Bruzinksi, seizures, altered LOC

120
Q

Management for meningitis

A

-Immediate hospitilization- refer to ER if suspected

121
Q

Causes of encephalitis

A

-Virus- most common
-Bacteria
-Parasites
-Chemical & autoimmune reactions (syphilis, Rocky Mountain spotted fever, mycoplasma, Lyme disease, tuberculosis)

122
Q

S&S of encephalitis

A

S: Confusion, altered LOC, headache, photophobia, personality changes, amnesia
O: Fever, systemic infection, nuchal rigidity, rash, hemiparesis, CN palsy, focal seizures, ataxia, movement disorder

123
Q

Management of Encephalitis

A

-If suspicious, referr for hospitilization
-Identify/Treat cause

124
Q

Diagnosis for encephalitis/Meningitis

A

-LP
-CBC, CMP, blood cultures, sputum cultures
-CT/MRI
-EEG (encephalitis)

125
Q

S&S of Herpes Zoster

A

S: Unexplained pain along a dermatome for 48-72 hours before rash appears; rash- later
O: Unilateral vesicular rash along dermatome

126
Q

Tx for herpes zoster

A

-Antivirals- famciclovir, acyclovir, valacyclovir
-Corticosteroids for pain- prednisone
-Calamine lotion, Burrow’s solution dressing

127
Q

Tx for postherpetic neuralgia (PHN) related to herpes zoster

A

-Alagesics (tylenol/NSAIDS)
-tricyclic antidepressants
-Gabapentin
-Lidocaine patch

128
Q

When should a patient with herpes zoster be referred to a specialist?

A

-Refer to ophthalmologist if ophthalmic lesions
-Refer to neurologist if lesions become infected or PHN is present for >3 months after

129
Q

Patient education for herpes zoster

A

-Lesions are contagious until they crust
-Take medications with food, complete entire course
-Shingles vaccine for >60yrs

130
Q

S&S of trigeminal neuralgia

A

S: Severe paroxysmal pain on one side of face; onset after trigger point is stimulated; lasts a few seconds & stops with no pain between episodes
O: Cranial nerves have normal motor function; no residual ache/pain

131
Q

Pharmacological management for trigeminal neuralgia

A

-Carbamazepine, gabapentin, possible TCAs, topical capsaicin

132
Q

Non-pharm management for trigeminal neuralgia

A

Acupuncture, TENS; microvascular decompression if no relief from other treatments, trigger avoidance, nutritional counseling

133
Q

What is Bell’s Palsy?

A

Idiopathic CN7 palsy- lower motor neuron facial paralysis; self-limiting and possible for complete recovery in a few weeks; cause is often viral, HSV

134
Q

S&S of Bell’s palsy

A

S: Acute onset partial or total paralysis 1 side of face; May worsen over 2-3 days; loss of taste on ipsilateral tongue, postauricular pain, sensitivity to sound
O: Acute onset, no other CNS symptoms, absence of forehead wrinkles on affected side, Bell’s phenomenon, flattened nasolabial fold, unclear pronunciation

135
Q

What is bell’s phenomenon?

A

eyeball turns upward when trying to close eyelid

136
Q

Treatment for Bell’s palsy

A

-Not always necessary
-Steroids generally recommended
-Eye protection (patient generally can’t fully close eyelid): artificial tears to keep eyes moist, eye patch at night

137
Q

S&S of Guillain-Barre syndrome

A

-Ascending paralysis beginning in legs and progressing in ascending fashion
-Extremity tingling, back pain, autonomic dysfunction

138
Q

Common cause of Guillain-Barre

A

Most often Postinfectious following gastric campylobacter infection

139
Q

Management for Guillain-Barre

A

IV gamma globulin/plasmapheresis
-Emergent referral to emergency department due to risk of rapid respiratory failure

140
Q

S&S of myasthenia gravis

A

Muscle fatigue, weakness, eye movement and speech often affected; weakness worse later in the day

141
Q

Diagnostics for MG

A

Tensilon test (tensilon is injected IV and provider assesses muscle strength; considered positive if strength increases after tensilon), Electromyography

142
Q

Describe the pathophysiology of MG

A

Autoimmune process in which antibodies target receptor for acetylcholine at neuromuscular junction

143
Q

Management for MG

A

-Anticholinesterase agents
-Immunosuppressants
-IV immunoglobulins
-Plasmapheresis

144
Q

S&S of multiple sclerosis

A

S: weakness of legs, bladder & bowel dysfunction, ataxic gait, paresthesias, optic neuritis, unilateral blurred vision, dulling colors
O: Diplopia, blurred vision, loss of visual acuity, limb weakness, hyperreflexia, spasticity, dysarthria, tremor, ataxia, mood changes

145
Q

Diagnostics for multiple sclerosis

A

-Through H&P: 2 or more areas of CNS must be involved at 2 different periods of time
-LP: an evaluation of CSF for the presence of lymphocytes and oligoclonal IgG bands
-MRI: a sensitive, objective measure of plaques and is used to measure the outcomes of treatment
-McDonald criteria

146
Q

Describe Mcdonalds criteria

A

A person who has experienced at least two clinical attacks, and has clear-cut evidence of damage in at least two distinct brain areas, can be definitively diagnosed with MS, as that individual fulfills requirements for both dissemination in space and time.

147
Q

Goals of management for MS

A
  1. Delay progression of disease
  2. Manage chronic symptoms
  3. Treat acute exacerbations
148
Q

Pharmaceutical management of MS

A

Relapsing/Remitting: benefit from disease-modifying agents ( can increase risk for opportunistic infection)
-Acute exacerbation- glucocorticoids (methylprednisolone)
-Antispasmodics- baclofen
-If tremors- clonazepam
-Neuropathic pain- gabapentin, duloxetine

149
Q

What are the most common causes of confusion in the elderly?

A

Delirium or dementia

150
Q

What are the most common causes of delirium?

A

Pneumonic DELIRIUM:
Drugs
Electrolyte imbalance
Lack of drugs (withdrawal, uncontrolled pain)
Infection
Reduced sensory input
Intracranial (CVA)
Urinary retention or fecal impaction
Myocardial/pulmonary

151
Q

What are some common triggers of migraine headaches?

A

-Stress
-Hormonal (low estrogen)
-Environmental (excessive sun, bright lights, weather changes)
-PHenylethylamine (cheese, red wine, chocolate)
-Physical activity at high altitudes
-Fatigue
-Cigarettes
-Dehydration

152
Q

What are the U.S. Department of Transportation regulations regarding licensing for interstate trucking for a person with a seizure disorder?

A

Anyone with a history of seizures is unable to be licensed to drive in interstate trucking

153
Q

Describe the Mini-Mental State Examination (MMSE)

A

-set of 11 questions that providers use to check for cognitive impairment; checks orientation to time and place, attention/.concentration, short-term memory, language skills, visuospatial abilities, and ability to understand and follow instructions; score <24 is abnormal

154
Q

Describe the purpose of the Get UP and Go test

A

Purpose is to assess mobility/risk for falls; Provider has the patient sit and identify a line 10 feet away; when the provider says “go” the patient walks to the end of the line and then back to the chair to sit down; an older adult who takes greater than 12 s is at risk for falling

155
Q

Define and describe the purpose of the Montreal Cognitive Assessment (MoCa)

A

-A rapid screening instrument for mild cognitive dysfunction; thought to assess a broader array of cognitive domains compared to the MMSE
-Mild cognitive impairment is 18-25 points
-10-17 is moderate cognitive impairment

156
Q

What are the prescribing considerations for donepezil (cholinesterase inhibitor)?

A

-Indicated for mild to moderate AD
-SE include: nausea, diarrhea, anorexia, weight loss
-Use with caution in patients with mild to moderate hepatic impairment

157
Q

What are the prescribing considerations for memantine?

A

-Indicated for moderate-severe AD
-Can be used in conjunction with Cholinesterase inhibitors (donepezil)
-C/I in patients with renal and hepatic impairment
-Use with caution in patients with cardiac conduction abnormalities and peptic ulcers

158
Q

The onset of Parkinson’s disease is most common in what age/gender group?

A

Midde-later life, with a mean age of 57 years; more common in men

159
Q

What nerve is affected with trigeminal neuralgia? What are the 3 branches of this nerve?

A

-Trigeminal nerve (cranial nerve V)
-Three main branches: V1 (opthalmic), V2 (maxillary), V3 (mandibular branch)

160
Q

MS is commonly diagnosed in what age group?

A

between 20-50 years old

161
Q

What are the most common early signs of MS?

A

-Weakness of the legs
-Bladder and bowel dysfunction
-Ataxic gait
-Paresthesias in the extremities
-Optic neuritis

162
Q

What is the main principle in the management of stroke prevention?

A

-Modification and reduction in risk factors: control hypertension, ASA for prophylaxis, anticoagulation for patients with Afib

163
Q

Describe how you would educate the patient on the signs of a CVA

A

Acronym BE FAST:
Balance loss
Eyesight changes
Facial drooping
Arm weakness
Speech Difficulties
Time- act fast

164
Q

Compare and contrast different types of meningitis

A

-Bacterial: rapid onset; Tx: cefotaxime/ceftriaxone plus vancomycin or ampicillin
-Chronic: symptoms develop over weeks to months (less acute); treat cause- PCN G for syphilis, ceftriaxone for Lyme disease
-Viral: More benign; self-limited syndrome; Tx with acyclovir if HSV or VZV

165
Q

What are the potential causes of syncopal episodes in the elderly?

A

-Medications/Polypharmacy
-Hypotension

166
Q

Why are the elderly at risk for falls? What are the potential complications for the elderly patient as a result of a fall?

A

-Increasing age, medications, and cognitive deficits
-Falls are the most common cause of a traumatic injury in the elderly
-Most common complications include hip or head fracture

167
Q

Describe the pneumonic RITUAL

A

A guideline for providers to assess and teach fall prevention:
-Review self-assessment from older adults
-Identify risk factors
-Test gait and balance
-Undertake multifactorial assessment
-Apply interventions (canes, walkers, bathroom bars)
-Later follow-up

168
Q

Apley scratch test

A

a rotation test technique used to assess and measure shoulder range and motion in a patient with shoulder pain, shoulder instability, or any other issue in this area

169
Q

Empty can test

A

a clinical test used to test the integrity of the supraspinatus tendon. In this test, the patient is tested at 90° elevation in the scapular plane and full internal rotation (empty can). The patient resists downward pressure exerted by the examiner at the patients elbow or wrist.

170
Q

Allen test

A

Tests collateral blood flow in hand; examiner tests blood flow by compressing the radial artery if blood flow does not return to hand the test is considered negative

171
Q

Patellar Apprehension sign (Fairbank test)

A

Tests for patellar instability; examiner places lateral/medial force on patella while patient bends knee to 90 degrees and then back to straight; positive if patient tries to move their knee away from pressure

172
Q

Lachman test

A

Tests for ACL injury;
1. Patient is supine with leg flexed to 30 degrees and rotated out slightly
2. Provider places one hand on the tibia and one on the lower thigh
3. Provider pulls lower leg forward while maintaining position of thigh
4. Graded on system with normal -severe

173
Q

Valgus/varus stress test

A

Valgus: provider pushes bent knee medially while abducting ankle; tessts for MCL injury
Varus: provider pushes bent knee laterally while adducting foot; knee bent at 30 degrees; tests for LCL injury

174
Q

SNOOP pneumonic for red flag migraines

A

-Systemic symptoms such as fever, vomiting
-Neurologic symptoms- decreased LOC, gait disturbance, slurred speech, seizures
-Onset- abrupt, thunderclap
-Older age at onset >40
-Progression of headache worsening over time: papilledema, position changes, precipitated by valsava maneuver

175
Q

When would you want to order imaging for a patient with a migraine?

A

-If red flag symptoms are present; imaging not needed if no red flags signs are present

176
Q

Treatment for common migraine

A

-Trial 550 mg naproxen daily to start 2 days before onset of menstruation (for menstrual migraine)
-Sumatriptan 100 mg PO at onset of migraine and one more in 2 hours if needed

177
Q

Sumatriptan precautions

A

don’t exceed 300 mg daily; risk of rebound headache if using more than twice weekly

178
Q

F/U for migraine

A

2-4 weeks

MVU Adult 2 (4 decks)

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