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Clin med neurology > Misc Neurologic behaviors > Flashcards

Misc Neurologic behaviors Flashcards

1
Q

What is Tourettes

A

Repetitive stereotyped, involuntary movements and vocalizations

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2
Q

What is a simple tic in Tourettes

A

Sudden, brief, repetitive movement involving limited muscle groups

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3
Q

What is a complex tic in Tourettes

A

Distinct, coordinated patterns of movement involving several muscle groups and may appear purposeful

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4
Q

Which type of tic are you concerned for self harm

A

complex

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5
Q

What is echolalia

A

Repeating others words

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6
Q

What is coprolalia

A

Inappropriate swearing

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7
Q

What is a premonitory urge in Tourettes

A

Urge/sensation in muscle prior to onset of tic…could make tic more complex than it is

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8
Q

Which gender and age group are most commonly diagnosed with Tourettes

A

Boys
pediatrics.. around age 6

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9
Q

What type of inherited disease is Tourettes

A

autosomal dominant

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10
Q

At what age do tics increase in frequency and severity

A

8-12y/o

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11
Q

When will improvement in tics be seen

A

adolescents.. could be tic free

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12
Q

Can tics change over time

A

yes

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13
Q

What are the three main tic disorders

A

tourettes
persistent
provisional

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14
Q

What type of tics do Tourettes patients have and roughly how long will they last

A

both motor and vocal tics
present for at least a year

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15
Q

What type of tics do persistent tic disorder patients present with and how long do they last

A

motor OR vocal
Present for at least 1 year

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16
Q

What type of tics do provisional tic patients have and for how long

A

motor or vocal or both
Present for LESS than a year

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17
Q

What are the dx requirements for Tourettes

A

2+ motor tics
1+ vocal tic
Tics present for at least a year
Onset prior to 18y/o
Sx are not a result of medications

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18
Q

What else are Tourettes patients often diagnosed with

A

at least 1 mental health, behavioral, or developmental disorder
-OCD
-ADHD

Asthma

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19
Q

What is the focus for treatment of Tourettes

A

tic suppression

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20
Q

What are common drugs used to treat Tourettes (only approved drugs)

A

Neuroleptics
-haloperidole
-pimozide
-aripiprazole

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21
Q

Which type of treatment will be utilized before medications

A

Therapy
-biofeedback (for 2nd emotional problems)
-habit reversal
-CBT

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22
Q

What is another name for ALS

A

Lou Gehrig’s disease

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23
Q

What is ALS

A

Neurological disease affecting control of voluntary muscle movement

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24
Q

What pattern does ALS effect your body

A

Starts distally and works centrally until you are no longer able to breathe or speak

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25
Q

At what age is ALS most common

A

55-75y/o (most common in men)

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26
Q

Which type of patients are at a higher risk of developing ALS

A

Military vets

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27
Q

How long from onset of symptoms will patients die and what do they die from

A

3-5yrs from onset
respiratory failure

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28
Q

What is the most common type of ALS

A

Sporadic

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29
Q

What are some known factors with ALS development

A

poor protein recycling
changes in RNA

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30
Q

If you develop familial ALS, how many genes need to be mutated

A

more than 12
-autosomal dominant
-dementia will be in the family

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31
Q

What are some common signs/symptoms of ALS

A

Fasiculation in arm, leg,shoulder, tongue
Muscle cramps
spasticity
difficulty chewing/swallowing
painless, progressive muscle weakness

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32
Q

What is limb onset of ALS

A

Sxs in arms or legs (younger patients)

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33
Q

What is bulbar onset of ALS

A

Sxs onset with speech/ swallowing concerns or changes (older patients)

34
Q

What in a physical exam strongly suggests ALS

A

Presence of upper and lower motor neuron involvement

35
Q

What two diseases need to be ruled out before diagnosing someone with ALS

A

Polio
MS

36
Q

What medications can be used to try to control the symptoms of ALS

A

Riluzole
Edaravone

37
Q

What non-medicine treatments can help control the symptoms of ALS

A

PT
OT
Speech therapy
Nutritional support

38
Q

What is multiple sclerosis

A

Auto immune process directed at the CNS

39
Q

What occurs in the body with MS

A

Inflammation damages myelin and myelin producing cells

damaged areas scar

40
Q

What type of immunologic response is MS

A

T-cell mediated
-T-regulatory cells fail to shut off
-Cytotoxic T cells target the myelin and myelin producing cells

41
Q

What else do t-cells activate in the body

A

B-cells
-produce antibodies and proteins causing more CNS damage

42
Q

What are some infection factors that occur with MS

A

Measles
Canine distemper
EBV
HSV-6
Chlamydia pneumonia

43
Q

What is the geographical gradient with MS

A

The further from the equator, the more likely you are to get MS

44
Q

What are some disproven theories for MS causation

A

Environmental allergies
Household pets
Heavy metals
Aspartame

45
Q

Is MS hereditary

A

no

46
Q

What are the common symptoms of MS

A

Fatigue
Paresthesia
vision problems
bladder problems
cognitive changes

47
Q

What are some less common symptoms for MS

A

Speech problems
swallowing problems
tremor
seizure
breathing problem
hearing loss

48
Q

What is the most common form of MS

A

Relapsing-remitting MS

49
Q

What are the types of MS

A

Clinically isolated syndrome
Relapsing remitting MS
Secondary progressive MS
Primary progressive MS

50
Q

What is often a first sign of MS

A

Spontaneous retinal detachment (see lighting bolts)

51
Q

What generally causes the first episode of symptoms in CNS with MS

A

Inflammation/demyelination of CNS
-Symptoms must last >24hours
-brain lesions need to be seen on MRI

52
Q

Which type of treatments can delay MS

A

DMARDs

53
Q

What symptoms describe RRMS

A

Relapse-clearly defines attacks of new and increasing neuro sxs

Remission periods of partial/complete recovery

No apparent progression during remission

54
Q

What characteristics are seen with SPMS

A

Eventual transition from initial RRMS

Unique to each patient

55
Q

What characteristics are seen with PPMS

A

Worsening accumulation of disability from onset of sxs without early relapse or remission

56
Q

What is the diagnostic criteria for MS

A

Evidence of damage in 2+ areas of CNS

Evidence damage occurred at different points in time

Brain MRI and Spinal MRI

CSF- +oligoclonal bands may sub for DIT

Rule out differentials

57
Q

What type of drugs are used for treatment of MS

A

immunosuppressants

58
Q

What is the most common cause of death in patients with MS

A

Secondary complications, not the MS itself

59
Q

What is normal pressure hydrocephalus

A

Too much CSF in ventricles

60
Q

What may cause normal pressure hydrocephalus

A

head injury
stroke/cerebral bleed
Meningitis
brain tumor/surgery

61
Q

Who generally gets NPH

A

adults >60y/o

62
Q

The brain areas that are affected by NPH generally effect which areas of the body

A

legs (gait similar to parkinsons)
Bladder (incontinence)
Cognitive process (sxs like dementia)

63
Q

What walking symptoms will a patient with NPH

A

Feeling of getting stuck or freezing

trouble initiating first step

64
Q

If a patient comes in with complaints of urinary incontinence, walking difficulty, and dementia, what should you be concerned for

A

NPH

65
Q

What may and LP be helpful with, in NPH

A

May demonstrate the benefit of a surgical shunt

66
Q

What type of surgical treatments can be preformed with NPH

A

Shunt placed to drain excessive CSF

67
Q

is a patient comes in with complaints of feeling weak that worsens with activity and improves with periods of rest, what is this a hallmark sign for

A

myasthenia Gravis

68
Q

What is Myasthenia gravis

A

Chronic autoimmune dx causing weakness in skeletal muscles

69
Q

When will myasthenia gravis generally present in women

A

Before 40

70
Q

When will myasthenia gravis generally present in men

A

greater than 60

71
Q

What cause myasthenia gravis

A

Interruption at the NMJ
-block/alter/destroy ACh

Thymus
-remains large = more T-cell production

72
Q

What is lymphoid hyperplasia

A

Large thymus

73
Q

Which muscles are most frequently effected with myasthenia gravis

A

Eye/eyelid movement (noticed first)
facial expression
swallowing
dysphagia/ slurred speech

74
Q

What is ptosis

A

drooping of eyelid

75
Q

What is dysarthria

A

impaired speech

76
Q

What are the symptoms of myasthenia gravis

A

ptosis
diplopia
dysphagia
SOB
Dysarthria

77
Q

What is the most sensitive test for Myasthenia gravis

A

Single fiber EMG

78
Q

What test may be helpful to diagnose myasthenia gravis

A

Edrophonium test (for ocular muscle weakness)
Blood work (anti-MuSK antibodies)
Single fiber EMG
Imaging for thymus
PFT

79
Q

What are some treatments for Myasthenia gravis

A

Thymectomy (cure for some patients)
Anti-cholinesterase med: pyridostigmine
Immunosuppressive agents
Plasmapheresis
IVIG

80
Q

What is myasthenia crisis

A

Respiratory muscles are so weak they require ventilator support

81
Q

How do you treat myasthenia crisis

A

IVIG
Plasmapheresis

82
Q

What may trigger a myasthenia crisis

A

infection
stress
surgery
adverse drug reactions

Clin med neurology (12 decks)

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