Exam 4 Final Concepts Flashcards

1
Q

Periodic Limb Movement Disorder (PLMD)

A

Episodes or repetitive large toe movement with flexion of the ankle, knee, and hip during sleep.

Cause if PLMD is largely known. A person must experience both periodic leg movements in sleep and a disruption in daytime functioning for diagnosis.

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2
Q

Restless Leg Syndrome

A

Approximately 7 out of 10 people may experience. RLS can occur as a primary or secondary disorder. There is a high familial incidence of primary RLS, suggesting a genetic disorder.

Secondary causes of RLS include iron deficiency, neurologic disorders, pregnancy, uremia, and medications.

Diagnosis of RLS is based on a history of a compelling urge to move the legs, usually associated with unpleasant sensations; motor restlessness, as seen by activities such as pacing, tossing and turning in bed, or rubbing the legs; symptoms that become worse at rest are relieved by activity; and symptoms that are worse in the evening or night.

Because RLS may be a symptom of iron deficiency, serum ferritin and iron saturation should be addressed.

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3
Q

Obstructive Sleep Apnea (OSA)

A

Apnea = cessation of airflow for a period of time (10 secs or longer)

A critical pathophysiologic feature of OSA is sleep-related partial or full collapse of the upper airway at the pharynx level.

Risk factors include increasing age, family history, obesity. Alcohol and other drugs can make it worse but not give the cause.
Large neck girth (greater than 40 cm) correlates with OSA, more telling than body mass index.

Noisy snoring, insomnia, abnormal movements during sleep, systemic hypertension.

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4
Q

Seizure activity in the brain

A

seizure is a single event of abnormal electrical discharge from neurons in the brain that results in an abrupt, altered state of function.

seizures are classified into two broad categories:
focal onset
generalized onset

epilepsy is a chronic disorder of recurrent seizures.

seizures resulting from identifiable causes, such as substance withdrawal or fever, are not considered epilepsy.

the aura represents a focal seizure without impaired consciousness. the aura is perceived as a warning sign of impending seizures.

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5
Q

Generalized seizures

A

generalized seizure are the most common type of seizure.

symptoms include unconsciousness and involve varying degrees of symmetric motor response.

divided into two categories:
motor
nonmotor

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6
Q

Generalized motor seizures

A

tonic-clonic seizure: formerly called grand mal seizures
person has a vague warning and experiences a sharp tonic contraction of muscles with extension of muscles and loss of consciousness. incontinence is common.
tonic phase followed by clonic phase - rhythmic bilateral contraction and relaxation of extremities.
at end of clonic phase, the person remains unconscious until RAS (reticular activating system) begins to function again (postictal phase). tonic-clonic phases last approx 60-90 seconds.

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7
Q

Generalized nonmotor seizures

A

also known as absence seizures or petit mal seizures.

characterized by blank stare, motionlessness, and unresponsiveness.

if motion occurs, it is in the form of automatism - lip smacking, mild clonic seizures (usually eyelids), changed postural tone.

often brief loss of contact with environment.

usually last a couple seconds without post-ictal state.

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8
Q

Status Epilepticus

A

**Medical emergency

seizures that do not stop spontaneously or occur w/out recovery.

1/3 of patients have no history w/ seizures.

maybe the initial manifestation of epilepsy.

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9
Q

Parkison Disease pathophysiology, Clinical Manifestations

A

Chronic, progressive neurologic condition.
Impaired transport of dopamine.
Presence of Lewy bodies (protein).

Tremor: most visible manifestation - mainly affects hands and feet, head, neck, face, lips, tongue, and jaw. Characterized by rhythmic alternating flexion & contraction movements (4-6 beats per min) that resembles rolling a pill between thumb and forefinger. occurs at rest and disappears w/ movement and sleep

Rigidity - resistance to movement of flexors and extensors throughout full ROM. Most evident during passive joint movement and involved a jerky, ratchet-like movement.

Bradykinesia-slowness in initiating and performing movements and difficulty with sudden, unexpected stopping of voluntary movements - lean forward and take small shuffling steps w/out arm swing.

Loss of postural reflexes - predispose to falling, often backwards.

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10
Q

Cerebral Palsy pathophysiology

A

cause: event during the antenatal or postnatal periods damaging upper motor neurons

etiology not completely understood but cerebral anoxia, hemorrhage, and other neurologic insults involved.

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11
Q

Cerebral Palsy pathophysiology: classification

A

motor dysfunctions type:
spastic = inability of muscles to relax
athetoid/dyskinetic = inability to control muscle movement
ataxic = inability to control balance and coordination

anatomic involvement:
hemiplegia = involving one arm and one leg on same side of body
diplegia = involving both legs
quadriplegia = involving all four extremities, the trunk and neck muscles

clinical manifestations: variable severity

no known cure

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12
Q

Multiple Sclerosis (MS) pathophysiology

A

central nervous system (CNS) deficiency

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13
Q

Process of demyelination, MS Clinical Manifestations, MC Clinical Course, MS Diagnostic Criteria, MS treatment

A

disease of multifactorial origin & chronic degeneration.
axon injury and formation of demyelinated plagues.

MS exacerbation - demyelinating event of at least 24 hrs duration in absence of fever or infection.
impaired vision - most common symptoms of MS; caused by optic neuritis or impairment of 3 extraocular eye movements

Related to slowed nerve conduction.
Relapsing-remitting: characterized by periods of acute neurologic symptoms alternating w/ periods of symptom relief or return of neurologic function (remission).
Primary progressive: slow, chronic deterioration of neurologic function with occasional plateaus, not associated w/ exacerbations and remissions.
Secondary progressive: initially presenting w/ RR characteristics of exacerbations and remissions, followed by a pattern of slow, chronic deterioration similar to primary progressive.

imaging: MRI - T2 lesions
laboratory: Lumbar puncture and CSF analysis - oligoclonal IGG banding

no cure
high dose steroids - exacerbations (?) but still used for optic neuritis

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14
Q

Stroke

A

also known as cerebrovascular accidents.

classification include:
Hemorrhagic (bleed into brain w/ compression and decreased blood flow - both from bleed and compression)
Ischemic: Thrombotic - plaque breaks loss locally and occludes vessel w/ subsequent decreased blood flow distally. Embolic - clot breaks loss elsewhere and travels to cerebral artery and occludes vessel w/ subsequent decreased blood flow distally.

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15
Q

Disorders of the Middle Ear

A

Acute Otitis Media in Children: acute onset; middle ear effusion; inflammation; recurrent.

Otitis Media (OM): an infection of the middle ear that is associated w/ a collection of fluid.

Otitis Media with Effusion: the presence of fluid in the middle ear w/out signs and symptoms of acute ear infection.

Otosclerosis: the formation of new spongy bone around the stapes and oval window, which results in progressive deafness. Bone increasingly immobilizes the stapes, reducing the transmission of sound.

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16
Q

Conductive hearing loss

A

Localized to the outer or middle ear and can be temporary or permanent.

17
Q

Hearing Screening
Sensorineural hearing loss (presbycusis)

A

Conductive: stimuli are not adequately transmitted.
Sensorineural: disorders that affect the inner ear, auditory nerve, or auditory pathways of the brain.
Mixed

Disorders that affect the inner ear, auditory nerve, or auditory pathways of the brain.

18
Q

Astigmatism

A

due to irregular curvature of the cornea or lens - prevents focusing of images and blurred vision.

19
Q

Amblyopia

A

“Lazy eye” - optic cortex ignores the bad eye; a condition of diminished vision in which no detectable organic lesion of the eye is present

20
Q

Syrabismus

A

Any abnormality of eye coordination or alignment that results in loss of binocular vision

21
Q

Myopia

A

nearsightedness

22
Q

Hyperopia

A

farsightedness

23
Q

Glaucoma

A

An optic neuropathy characterized by optic disk cupping and visual field loss.

Causes:
An increase in intraocular pressure that results from abnormalities in the balance between aqueous production and outflow.
Most common cause is an interference with aqueous outflow from the anterior chamber, rather than overproduction of the aqueous humor.

Primary open angle: gradual, irreversible vision loss.
Blind spots in field of vision.
Initially limited to periphery.
Progresses centrally.

Acute angle closure: induced by increased pupil dilation.
Eye pain, headache, nausea, blurred vision, rainbows around lights at night.
Damage to optic nerve leads to vision loss.

24
Q

Macular degeneration

A

Degenerative changes in the central portion of the retina (the macula) that results primarily in loss of central vision.

25
Q

Retinitis Pigmentosa

A

Slow degenerative changes in the retinal photoreceptors.

Night blindness.

Bilateral symmetric loss of mid-peripheral fields.

26
Q

Understand CKD and Clinical Manifestations

A

CKD defined as either kidney damage of a GFR less than 60 mL/min/1.73 m2 for 3 months or longer.

hypertension and diabetic kidney disease are the two main causes of CKD in the US.

guidelines define kidney failure “as either A GFR of less than 15 or a need to start renal replacement therapy (dialysis or transplantation)”
these guidelines point out that kidney failure is not synonymous with end-stage renal disease (ESRD)

regardless of cause, CKD represents a loss of functioning kidney nephrons with progressive deterioration of glomerular filtration, tubular reabsorptive capacity, and endocrine functions of the kidney

microalbuminuria, which is an early sign of diabetic kidney disease, refers to albumin excretion that is above the normal range

the accumulation of nitrogenous wastes in the blood, or azotemia, is an early sign of kidney failure, usually occurring before other symptoms become evident. urea is one of the first nitrogenous wastes to accumulate in the blood, and the BUN level becomes increasingly elevated as CKD progresses.

uremia, which literally means “urine in the blood,” is the term used to describe the clinical manifestations of kidney failure. uremia differs from azotemia, which merely indicates the accumulation of nitrogenous wastes in the blood and can occur without any symptoms.