Exam 4 Final Concepts Flashcards
Periodic Limb Movement Disorder (PLMD)
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.
Restless Leg Syndrome
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.
Obstructive Sleep Apnea (OSA)
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.
Seizure activity in the brain
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.
Generalized seizures
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
Generalized motor seizures
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.
Generalized nonmotor seizures
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.
Status Epilepticus
**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.
Parkison Disease pathophysiology, Clinical Manifestations
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.
Cerebral Palsy pathophysiology
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.
Cerebral Palsy pathophysiology: classification
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
Multiple Sclerosis (MS) pathophysiology
central nervous system (CNS) deficiency
Process of demyelination, MS Clinical Manifestations, MC Clinical Course, MS Diagnostic Criteria, MS treatment
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
Stroke
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.
Disorders of the Middle Ear
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.
