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NP 612- Family Theory Adult > Musk/Neuro/Endocrine > Flashcards

Musk/Neuro/Endocrine Flashcards

1
Q
  • Pathophysiology
    o Cervical sprain- nonradiating pain in neck associated with loss of neck motion and stiffness
    o When abnormal forward posture of the head occurs consistently- looking at computer, faulty sitting position, stress
A

Cervical sprain

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2
Q

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

A

Spurling’s sign- cervical neck pain

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3
Q
  • Pathophysiology
    o Can compress spinal nerves as they exit the foramina, leading to cervical radiculopathy- mostly C6 and C7- pain/parethesias in lower lateral arm, thumb, and middle finger
    o Degeneration may cause narrowing of spinal canal- can cause myelopathy- can cause shoulder or arm pain and numbness/tingling (pins and needles)- not as common (less than 5%)- usually a result of soft-disc herniation
A

Cervical spondylosis

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4
Q
  • Management
    o Cervical traction if radiculopathy is present
    o PT
    o NSAIDs
    o Oral steroids if nothing else works
    o Steroid epidural injection for radiculopathy
    o Surgery for myelopathy, intractable pain, severe disability
A

Cervical spondylosis

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5
Q

 Hallmark for _______ is recurrent pain that radiates to one or both buttocks- exacerbated by bending, stooping, twisting- there may be intermittent sciatica
• May be relieved with lying down or sleeping but may also keep the paitent awake at night

A

Chronic lower back pain

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6
Q
  • Management
    o Usually mild and self-limited- most resolve in 1-6 weeks
     Symptom control
    o Nonpharm
     Exercise, motor control exercise, CBT, tai chi, yoga, progressive relaxation, heat, massage, acupuncture, spinal manipulation, rehab
    o Pharm
     Tylenol, NSAIDs, and skeletal muscle relaxants
    • NSAIDs- increase risk of GI bleed/ulcers, renal problems, fluid retention, edema
    • Muscle relaxants- short-term- can be addicting and cause drowsiness/dizziness, avoid alcohol (CNS depressant)
    o Activity
     Rest does not help- so weight loss, PA, exercise is important
A

chronic low back pain

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7
Q
  • Most common cause of radicular pain to lower extremities- can cause pain, numbness, or weakness in one or both extremities- from compression of nerve root and chemical irritation of nerve root by substances in nucleus pulposus
A

Herniated lumbar disc

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8
Q

Which lumbar level for radicular pain: produces symptoms extending to the dorsum of the foot with weakened dorsiflexion of large toe and weakened heel walking

A

L5

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9
Q

Which lumbar level for radicular pain:lateral and posterior calf, gastrocnemius weakness, impaired toe walking, reduces or absent ankle reflex

A

L5 and S1 together

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10
Q

What kind of low back pain:• Pain worse with sitting, walking, standing, coughing, sneezing- hard to find a comfortable position
o Helps when lying in fetal position or on back with pillow under knees

A

Herniated disc

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11
Q

What sign for herniated disc: when sitting, patient may have pain and spinal extension (leaning back) when leg is raised

A

Flip sign

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12
Q

two tests for low back pain to assess for radicular pain

A

straight-leg-raise and crossed straight-leg-raise

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13
Q

Better for visualizing conditions of soft-tissue structure

A

MRI

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14
Q

pain with abduction from 45-120 degrees- supraspinatus tendonitis and subacromial bursitits

A

Early rotator cuff injuries

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15
Q
  • Idiopathic loss of both active and passive ROM with no clear predisposition
A

Adhesive capsulitis- frozen shoulder

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16
Q

tests to diagnose meniscal tears (2)

A

McMurray and Apley

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17
Q

Test that helps diagnose ACL injury

A

Lachman test

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18
Q

Test to identify patella dislocation

A

Fairbank test (Apprehension test)

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19
Q

test for ACL- positive can diagnose, negative may be false…

A

Anterior drawer test

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20
Q

test to diagnose posterior cruciate ligament injury

A

Posterior drawer test

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21
Q

inflammation of tendon- usually at point of insertion into bone or at muscular origin

A

Tendinitis

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22
Q

inflammation involving synovial sheaths surrounding the tendon in addition to the tendons

A

Tenosynovitis

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23
Q

Diagnostic imaging for tendinitis/tenosynovitis

A

MRI

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24
Q

Joint condition in which loss of articular cartilage and degeneration occur, leading to pain and deformity

A

Osteoarthritis

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25
Q

Cartilage matrix degradation predominates in

A

Osteoarthritis

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26
Q
  • Clinical Presentation
    o Subjective
     Slowly developing, localized pain in joint- interferes with usual activities
    • Subtle onset
    • Early morning stiffness or after inactivity
    • Later stages- pain is also at rest
    o Objective
     Minimal or no swelling of joints
     Tenderness on direct palpation, crepitus
     Reduced passive and active ROM
     PE exam findings for specific joints on page 853…
    most common symptom is joint pain
    • Worse with activity after a period of rest (stiffness subsides within 30 minutes, RA is 45+ minutes)
     Joint locking or instability
    joints most commonly affected- hands, knees, hips and spine
A

Osteoarthritis

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27
Q

Generalized skeletal disorder characterized by normal bone mineralization but low bone mass (bone mineral density) and disruption of the bone architecture

A

Osteoporosis

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28
Q

Gold standard for osteoporosis diagnosis/measurement

A

Bone mineral density (dual-energy x ray- DXA)

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29
Q

Dose of calcium and vitamin D for women less than 50 years

A

calcium 1000mg QD, vitamin D 800IU QD

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30
Q

First line treatment for osteoporosis

A

Bisphosphonates- alendronate (Fosamax)

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31
Q

Test for lateral cruciate ligament (LCL)of the knee

A

Varus stress test

32
Q

Test for medial cruciate ligament (MCL) of the knee

A

Valgus stress test

33
Q

Acute transient disturbance in thought process

A

Delirium

34
Q

More persistent or severe confusion with or without psychomotor hyperactivity characterized by a significant time span between symptom appearance and death

A

Dementia

35
Q

Muscle contraction headache- mild to moderate bilateral, nonpulsating, tightening pain that is not aggravated by routine physical activity

A

Tension-type headache

36
Q

Usually unilateral, moderate to severe intensity with pulsating quality, aggravated by physical activity

A

Migraine headache

37
Q

Usually occurs at night and can last from 15-180 minutes
• Usually severe, unilateral orbital, supraorbital, and/or temporal pain accompanied on same side of face with sweating, lacrimation, nasal congestion, ptosis, rhinorrhea, eyelid edema, and/or conjunctival injection

A

Cluster headache

38
Q

Most common type of headache

A

Tension-type

39
Q

Thunderclap headache most common with _______

A

Subarachnoid hemorrhage

40
Q

What type of brain hematoma is venous?

A

Subdural hematoma

41
Q

Severe unilateral pain behind eye or temple lasting 30min to 1 hour
 Pain constant, deep, piercing, can radiate to forehead, neck, or shoulder
 Do not pulsate or cause nausea but do worsen with PA
 Triggered by an abnormality in ipsilateral circadian pacemaker- located in ventral hypothalamus
• Pain is caused by hypersentisized ophthalmic nerve
• Autonomic symptoms are caused by concurrent excitation of parasympathetic fibers running with the ophthalmic nerve

A

Cluster headache

42
Q

Seizure from an underlying focal lesion or abnormality in the brain

A

Focal

43
Q

Most common type of generalized seizure- sudden stiffening of muscles followed by convulsions

A

Tonic-clonic

44
Q

Type of seizure: sudden, brief, shock-like contractions that can be generalized or confined to face or trunk or other extremities
• Can occur predominantly during sleep and are associated with generalized epilepsy syndromes

A

Myoclonic

45
Q

Type of seizure: sudden loss of muscle control

A

Atonic

46
Q

Type of seizure: sudden muscle stiffening

A

Tonic

47
Q

What disease as neuritic plaques and neurofibrillary tangles

A

Alzheimer’s Disease

48
Q

3 drugs for treatment of AD

A

Cholinesterase inhibitors (donepezil- Aricept), NMDA receptor antagonist (memantine-Namenda), and atypical antipsychotics (risperidone, olanzapine, quetiapine)

49
Q

Accumulation of Lewy bodies and degeneration of pigmented dopaminergic cells of the substantia nigra (located in the brainstem)

A

Parkinson’s Disease

50
Q

PD- what does TRAP stand for

A

Tremor (resting), rigidity, akinesia (bradykinesia), and postural disturbances (postural instability is not part of diagnostic criteria)

51
Q

Most CVAs are

A

ischemic

52
Q

From severe head injuries- usually along temporal wall and from tears in middle meningeal artery
• Increases ICP, reducing cerebral blood perfusion, causes contralateral hemiparesis
• Then increasing pressure affects diencephalon, causing lethargy and drowsiness
• Once midbrain becomes compressed, patient can have lateral oculomotor nerve palsy and enlarged pupils
• Can eventually cause herniations and compress the PCAs, pressing on brainstem and becoming fatal

A

Epidural hematomas

53
Q

Usually from blunt trauma- knocking brain against the skull
• Venous injuries- veins that drain external cerebral veins
o Bleed expands more slowly
o Can be reabsorbed or can continue to enlarge

A

Subdural hematoma

54
Q

Aka intraparenchymal hemorrhage
 Bleeding within the brain parenchyma
 Common cause is HTN- arteries rupture
• Other causes- trauma, amyloid angiopathy, tumors, clotting disorders, low platelet counts, anticoagulants, vasoconstrictors (and amphetamines or cocaine), eclampsia during pregnancy

A

Intracerebral hemorrhage

55
Q

Tears in the arteries running along the space at surface of the brain
• Usually from ruptured arterial aneurysms
• Usually at branch points of large arteries- especially circle of Willis
 CSF circulates in the subarachnoid space- so RBCs in LP is a diagnostic tool
 Symptoms are sudden increase in ICP, HA, vomiting, drowsiness

A

Subarachnoid hemorrhage

56
Q

Thyroxine

A

T4

57
Q

Triiodothyronine

A

T3

58
Q

Most common spontaneous cause hyperthyroidism
 Autoimmune d/o- autoreactive, agonistic antibodies to TSH receptor
 80-90% of all hyperthyroid cases

A

Graves

59
Q

Glandular inflammation and follicular cell destruction
 Viral etiology- following acute infection
 40-50 years, more in women

A

Subacute thyroiditis

60
Q

In parts of the world where dietary iodine deficiency is prevalent

A

Plummer disease- hyperthyroidism

61
Q

Leads to thyroid hyperplasia (goiter)
 Increases synthesis of T3
 Correlates with DMI, pernicious anemia, myasthenia gravis, and adrenal insufficiency
 Demonstrates excessive uptake of radioactive iodine on diagnostic tests

A

Graves

62
Q

Normal free T4 with elevated TSH

A

Subclinical hypothyroidism

63
Q

Low FT4 and elevated TSH

A

Primary hypothyroid

64
Q

High FT4 and low TSH

A

Hyperthyroid

65
Q

Initial dosing for hypothyroid

A

1.6mcg/kg/day (common dosage is 75-150

66
Q

Target TSH levels for hypothyroid

A

0.3-2.4

67
Q

Most common cause of thyroid CA

A

Papillary

68
Q

Thyroid CA treatment of choice

A

Thyroidectomy

69
Q

Standard treatment for DMI

A

Basal insulin plus prandial insulin

70
Q

Suppresses excessive hepatic glucose production by increasing glucose utilization in peripheral tissues
o Reduces fasting and postprandial hyperglycemia and reduces hepatic gluconeogenesis
o Can also improve glucose levels by reducing intestinal glucose absorption

A

Metformin

71
Q

Stimulate pancreatic insulin secretion
o Pancreatic beta cells must be still producing insulin
o Do not reduce insulin resistance
o Second gen- improved safety profile compared to 1st gen
 But also carry higher risk of hypoglycemia and weight gain than other meds

A

Sulfonylureas- glipizide

72
Q

Slow breakdown of complex carbs into monosaccharides

o Reduces postprandial blood glucose levels

A

Alpha-glucosidase inhibitors- acarbose or miglitol

73
Q

Sensitize peripheral tissues to insulin by activating nuclear glitazone receptor

A

Thiazolidineodiones- pioglitazone and rosiglitazone

74
Q

Prolongs and enhances activity of incretins, which suppress glucagon secretion and modestly reduces A1C

A

DPP4-I’s- sitagliptin (Januvia)

75
Q

Enhances insulin secretion in glucose dependent manner in response to food intake
 Improves insulin sensitivity, increases beta cell mass, and decreases glucagon secretion
 Affect satiety and hunger by decreasing the hedonic value of food (appeal)

A

GLP-1 analogues-dulaglutide (Trulicity)

76
Q

Block activity of SGLT proteins in renal proximal tubule, decreasing glucose reuptake and increasing secretion of glucose in the urine

A

SGLT-2 inhibitors

NP 612- Family Theory Adult (4 decks)

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