FTT & Movement Disorders (Exam 2) Flashcards
A syndrome of weight loss, decreased appetite and poor nutrition, and inactivity, often accompanied by dehydration, depressive symptoms, impaired immune function, and low cholesterol
Adult failure to thrive
A person must be considered __________ ___________ in order to be diagnosed with Adult Failure to Thrive.
Physically Frail
If a pt had malnutrition or weight loss and impaired physical function, how would you describe their condition?
Frailty
True or False? Unintentional weight loss is a significant predictor of death in nursing homes
True
_______ is a catabolic state often seen in end-stage diseases like cancer, ESRD, lung disease, and heart failure.
Cachexia
________ describes a loss of muscle mass that occurs with aging. This condition is associated with functional decline, disability, and falls.
Sarcopenia
True or false? If a patient has cachexia- nutrition therapy will not alter the progression.
True. Cachexia is a progressive disorder in which nutrition therapy does not alter the course.
True or False? A disability is not an independent risk factor for mortality, hospitalization, and need for long term care.
FALSE.
A disability is an Independent risk factor for mortality, hospitalization, and need for long term care
__________ is an acute cognitive decline, different from a patient’s baseline, that results from a number of factors; such as meds, ETOH, hospitalization, etc, and is reversible.
Delirium
What should be on your differential Dx of an elderly pt who has unexplained injuries, isnt getting/taking their meds, or whose caregiver has changed behaviors?
Elder abuse and neglect
What is a clinical test used to check if a pt is at a greater fall risk?
“get up and go” test
(have pt sit in chair and stand up on their own, then walk 10 ft- should take 8-10 secs, if takes longer they are at a greater risk for a fall)
Urine analysis’ are not always needed for elderly pt’s who are “confused”. Why is this true?
Because most elderly pt’s will always have bacteria in urine, due to colonization/age.
Abx not indicated unless pt has urinary s/sx, fever and/or leukocytosis.
Which two labs are the most definitive markers of
malnutrition and should be considered when evaluating an elderly patient who is potentially “failure to thrive”?
Albumin and total cholesterol
The _____ Criteria is a list of meds that have worse side effects for older adults and can be used in helping you eliminate unnecessary or marginally beneficial drugs from a pt who is failure to thrive.
The BEERS criteria
True or False? Tube feeding does not have a survival benefit compared to hand feeding in those with severe cognitive impairment.
TRUE
aspiration is still possible with a feeding tube
What 4 interventions have been proven to treat FRAILTY?
- Exercise
- Protein/ Calorie support
- Vitamin D supplementation
- reduce polypharmacy
Which medication is frequently used to treat depression in elderly pt’s with failure to thrive, because it also helps increase appetite and promote weight gain?
Mirtazapine (Remeron)
A _________ is the most common type of movement disorder and is caused by contractions of antagonistic muscles.
Tremor
In a _________ tremor, the body part is supported and relaxed. The tremor can come and go depending on patient’s stress level, if they feel observed. Often better during movement.
Resting tremor
A/an __________ tremor occurs during a voluntary movement
Action tremor
A ____________tremor occurs when a person maintains a position against gravity, such as holding the arms outstretched
Postural tremor (type of action tremor)
A ____________ tremor is a type of action tremor associated with any voluntary movement, such as moving the wrists up and down or closing and opening the eyes.
Kinetic
A _____________ tremor worsens during goal-directed movement. Pt’s with this tremor would have trouble completing the finger to nose test.
Intention
A __________ tremor would occur during muscle contraction against stationary objects, such as holding a heavy book or dumbbell.
Isometric tremor
This Movement Disorder/ Tremor disorder is usually a postural-action tremor. Pt might complain of trouble writing or drinking from a cup. It frequently affects the hands, forearms, head, and/or voice. Emotional stress usually exacerbates the tremor. Alcohol provides relief in many and can be diagnostic of this condition.
Benign Essential Tremor (AKA Familial Tremor)
Which medication would be used to treat essential tremor causing intermittent disability? What med would be used for essential tremor causing persistent disability?
Intermittent: Propranolol or Alcohol
Persistent: Propranolol or Primidone
Does an essential tremor cause a decline in the patient’s overall survival rate?
No
A _________ tremor occurs in all people and is not caused by any neurologic disease. This tremor can be heightened by anxiety, exhaustion, hypoglycemia, caffeine,etc.
Physiologic tremor
A ___________ tremor is a low-frequency, intention tremor that can be unilateral or bilateral. This type of tremor is typically not a benign situation and should be investigated with neural imaging.
Cerebellar tremor
A/an __________ tremor occurs in the legs and/or trunk immediately after standing. It is typically not visible, but causes the pt to feel unsteady.
Orthostatic tremor
An orthostatic tremor usually responds to what med?
clonazepam
A ___________ tremor is a variable tremor that can look like any type of tremor movement. Tremor might stop if pt given a task or distraction. Commonly seen with psychiatric disorders.
Psychogenic tremor (AKA Functional Tremor)
A _________ __________ Tremor is a type of Action tremor that occurs only while writing and is limited to the hand
Primary Writing tremor
This is a common movement disorder in which patients have an uncomfortable urge to move their legs, especially when relaxed. These pt’s may also have involuntary movements of their limbs while sleeping.
Restless leg syndrome (AKA Willis-Ekbom Disease/WED)
______ _________ _______ is the most common treatable cause for restless leg syndrome.
Iron deficiency anemia
What 2 medications could be considered to treat restless leg syndrome if non-pharmacological methods and iron trial failed?
Mirapex and Requip
Which 2 meds could be considered to treat CHRONIC/PERSISTENT restless leg syndrome?
Gabapentin or Lyrica
__________ ________ is an inherited, fatal, progressive neurodegenerative disorder characterized by chorea, psychiatric disturbances and dementia
Huntington’s Disease
True or False. 80% of people who inherit the gene that causes Huntington’s Disease will develop the disease.
False- 100% of those who inherit the gene will develop the disease.
________ is the word used to describe rapid, involuntary, nonrepetitive dance-like movements involving the face, trunk, and limbs. It is a hallmark sign of Huntington’s Disease.
Chorea
____________ ________ is a Progressive neurodegenerative disorder characterized by
bradykinesia, tremor, rigidity, & postural instability.
Parkinsons Disease
All of the following are risk factors for Parkinsons Dz except:
a. Depression
b. Fever
c. Constipation
d. Exposure to pesticide
b. fever
Parkinsons Disease is caused by degeneration of __________ neurons in the substantia nigra, which leads to an imbalance of __________ and __________.
Dopaminergic
Dopamine and Ach
Name the 3 essential features/ hallmark signs of Parkinsons Dz
Resting tremor
bradykinesia
rigidity
___________ is a specific type of resting tremor that is commonly seen in PD.
Pill rolling tremor
__________ is a common characteristic of pt’s with PD in which they have reduced blinking & masked facies
hypomimia
_________ ___________ is seen in later stages of PD, in which the pt has a feeling of imbalance and a tendency to fall
Postural instability
The following are motor symptoms that might be seen in a pt with what disease? • Dysarthria • Dysphagia • Sialorrhea • Blurred vision • Micrographia • Freezing gait
Parkinsons Disease
What are some dz’s that might be on your Ddx for a pt who possibly has Parkinsons Disease?
- Essential tremor
- Lewy Body Dementia
- Multiple System Atrophy
- Secondary parkinsonism
- Corticobasal degeneration
- Progressive supranuclear palsy
The following are NON-motor symptoms that might be seen in a pt with what neuro-dengenerative disease? • Depression** • Anxiety • Cognitive dysfunction • Dementia • Sleep disturbance • Autonomic dysfunction • Constipation • Olfactory dysfunction
Parkinson’s Disease
A patient MUST have what two s/sx’s in order to be diagnosed with PD?
- Bradykinesia
2. Tremor or Rigidity
TRUE OR FALSE? If you put a pt who you suspect to have PD on a dopaminergic med and they do not respond, it is highly unlikely that they have PD.
TRUE
What are some factors that would influence your decision to intiate tx for a pt with PD?
degree of functional impairment, patient
values & preferences, amount of interference with work, ADLs, social, or leisure function, and more
_________ is an Antiviral medication that has mild antiparkinsonian activity. It is Best as short-term monotherapy in those with mild, early disease
Amantadine
__________ is the Most effective drug for symptomatic treatment of PD. It is Especially good for symptoms of bradykinesia. In the US, this med is combined with Carbidopa to decrease the negative side effects. The name of the combined med is _________.
Levodopa
Sinemet
This class of meds is also a good choice in treatment of PD, except for pts who did not respond to Levodopa. These meds are Associated with fewer motor fluctuations & dyskinesia’s than levodopa.
Dopamine Agonists
Name two dopamine agonists commonly used in tx of PD. These two meds are also used in tx of restless leg syndrome.
Mirapex
Requip
_______ inhibitors are a type of med used as early monotherapy for PD, but are not as effective as other common classes of meds.
MAO B
___________is a class of meds that reduces the metabolism of levodopa. It is Not effective if given alone, but prolong the levodopa effect when given with a dose of levodopa.
COMT Inhibitors
[Tolcapone (Tasmar) & entacapone (Comtan)]
Hyperkinetic movement disorder with a delayed onset that appears after prolonged use of dopamine receptor blocking agents, mainly antipsychotics (aka neuroleptics) and antiemetics
Tardive dyskinesia
TRUE OR FALSE? Tardive dyskinesia is mainly caused by second generation antipsychotics
False, it is primarily caused by 1st gen antipsychotic meds
If a patient presented with any of the following s/sx’s and has had a recent change in their psych med, you should consider what dz?
• Protruding, twisting movements of the tongue
• Smacking of the lips
• Retraction of the corners of the mouth
• Puffing out of the cheeks
• Chewing movements
• Puckering the lips
Tardive dyskinesia
What dz/ disorders might be on your Ddx for a pt who potentially has TD?
- Tourette syndrome
- Schizophrenia, autism, severe mental retardation
- Huntington disease (especially early-stage)
- Wilson disease
- Tremor
- Levodopa-induced dyskinesia
- Hyperthyroidism
- Improperly fitted dentures
Progressive neurodegenerative disorder of motor neurons at all levels of the CNS, that causes muscle
weakness, disability, and death.
Amyotrophic Lateral Sclerosis (ALS)
aka Lou Gehrigs dz or motor neuron dz
What dz’s/disorders might be on your Ddx when you are considering ALS as a dx?
- Post-polio syndrome
- Benign fasiculations
- Multifocal motor neuropathy
- Cervical radiculomyelopathy
- Inflammatory myopathy
_______________ is the only FDA-approved medication known to extend tracheostomy-free survival in pt’s with ALS. This med can prolong survival for ______ months.
Riluzole (Rilutek)
2-3
______________ __________ is a common symptom of ALS, in which the pt might have uncontrollable crying or laughing. It can be treated with ___________.
Pseudobulbar affect
Nuedexta
The average survival period for a pt diagnosed with ALS is _____ years
3-5 years
Relatively uncommon autoimmune disorder characterized by dysfunction at the neuromuscular junction, causing weakness and fatigability of skeletal muscles
Myasthenia Gravis
In myasthenia gravis, Autoantibodies act against ___________ Receptors in the postsynaptic
neuromuscular junction
Acetylcholine
Majority of patients with Myasthenia Gravis have _________ abnormalities
Thymic
True or false? Ptosis and/or diplopia are common clinical findings in pts with myasthenia gravis
Most present with ocular symptoms (>50%)
Weakness of eyelid leads to ptosis
Extraocular muscles produce diplopia
Pupils are always spared
What is the Ice Pack Test and which dz is it used to test for?
Ice pack placed on pts affected eyelid (with ptosis) for 2 mins, remove, eyelid will improve.
Tests for Myasthenia Gravis
________________________ is the most sensitive test for Myasthenia Gravis
Single-fiber electromyography
_______________ is a blood test that can help diagnose MG.
Serum AChR antibodies test
Positive antibodies diagnostic- positive in 85-90%
What class of meds is the 1st line treatment for pts with myasthenia gravis? Name a commonly used med in this class and its dose for MG.
Acetylcholinesterase inhibitors
Pyridostigmine (Mestinon) 30 mg PO q6-8 hrs
True or false? Immunotherapy cannot be used with Acetylcholinesterase inhibitors when treating MG.
FALSE- pts with MG may require immunotherapy in addition to other meds (corticosteroids,etc)
What type of surgery can be performed on pt’s with MG?
Thymectomy (improves survivability in 85%)
There are several classes of medications that should be avoided in pts with MG. What are some?
Quinolones Macrolides Beta blockers Anesthetics Botox quinine magnesium
A neurological disorder manifested by multiple motor and phonic tics. Thought to be a disturbance in the striatal-thalamic-cortical (mesolimbic) system,
which leads to disinhibition of the motor and limbic system.
Tourette Syndrome
_____ are Sudden, brief intermittent movements or utterances. Considered involuntary, but can be suppressed at times
Tics
Sometimes individuals with certain disorders, display _____________, meaning they imitate the movement of others, or _____________ meaning they repeat/mimic others’ speech.
Echopraxia
Echolalia
True or false? Tourette Syndrome typically develops in childhood and resolves on its own before age 18.
True
50% resolve before 18 yrs old. May go into adulthood, but still usually decreases in severity over time.
If a patient had Tourette’s Syndrome and OCD, how would you treat them?
Behavioral therapy and an SSRI (Prozac)
If pt doesnt respond to that, try a 2nd gen antipsychotic (Seroquel, Abilify, Zyprexa)
What med would you choose for a pt with Tourette’s Syndrome and ADHD?
Clonidine
2 drugs to treat dementia in FTT
Aricept and Namenda
Best anti-depressant to treat FTT depression due to appetite stimulation
Mirtazipine (Remeron)
3 Bad anti-depressants to treat depression in FTT due to weight loss S/E
Sertraline (Zoloft), Fluoxetine (Zoloft), Buproprion (Wellbutrin)
