Nervous system Exam #2 Flashcards
1
Q
What is biofeedback?
A
conservative form of Tx for ppl who suffer from chronic HA. Learn to control body functions that are usually involuntary (ie HR, BP, body temp)
2
Q
How do nerve blocks work?
A
local anesthetic is injected to inhibit neural pathways
3
Q
What is neuroablation?
A
permanent nerve destruction to stop nerve impulse transmission permanently
4
Q
What is chemical ablation?
A
destruction of nerves after admin of chemical agent
5
Q
What is thermal ablation?
A
use of extreme temps to ablate nerves, cryoablation (cold) or radiofrequency (hot)
6
Q
What is a cordotomy?
A
sever the spinothalmic tract
7
Q
What is a tractectomy?
A
sever the spinal tract at the level of the brain stem, dorsal route (sensory) affected only, not ventral (motor)
8
Q
What is deep brain stimulation?
A
electrodes in brain are connected to implant in chest wall sends impulses to target location to block nerve impulses
9
Q
What kind of neuroaugmentation is used to Tx seizure disorders?
A
vagal nerve stimulation
10
Q
Where do inflammatory brain conditions most often originate from?
A
the bloodstream
11
Q
What is meningitis?
A
inflammation of the meninges
12
Q
Pathophysiology of meningitis?
A
organism travels to CNS via blood, damages BBB, infects CSF which leads to an increased production of CSF (IICP), protein spills in, less glucose enters
13
Q
How is bacterial meningitis spread?
A
URI
14
Q
What is the primary difference between viral & bacterial meningitis?
A
viral is self-limiting, bacterial = medical emergency
15
Q
What are S/Sx of bacterial meningitis?
A
HEADACHE (earliest sign)
fever, N/V, stiff neck, photophobia
16
Q
What are 3 classic signs of bacterial meningitis?
A
- nuchal rigidity
- Positive brudzinski’s sign
- Positive Kernig
17
Q
What is nuchal rigidity?
A
stiff & painful neck, forced flexion = pain & muscle spasms
18
Q
What is a + Brudzinski’s sign?
A
when examiner flexes pts neck, involuntary knee & hip flexion
19
Q
What is a + Kernig sign?
A
when pt laying supine with hip flexed, examiner cannot straighten knee
20
Q
What are S/Sx of IICP?
A
altered mental state
seizures, BP RR HR changes, coma, death
21
Q
How do you Dx bacterial meningitis?
A
most significant Dx = LP for CSF analysis: cloudy, purulent, increased protein & WBC’s, low glucose
22
Q
How do you Tx bacterial meningitis?
A
large doses of IV ABX STAT (after cultures drawn), isolation & symptomatic Tx
23
Q
What is waterhourse-friderichsen syndrome?
A
severe vascular dysfunction
24
Q
What is the rationale for using decadron for meningitis?
A
decrease cerebral edema = reduces mortality & hearing loss
25
What is encephalitis?
acute inflammation of brain tissue caused by a virus, can be transmitted from mosquitos & ticks
26
Pathophysiology of encephalitis?
virus enters host and accesses CNS, via circulation, where it causes diffuse cortex inflammation
27
S/Sx of encephalitis?
mild to severe, flu-like Sx + IICP Sx (mental changes from minimal to coma, seizures, memory less, motor disturbances)
28
Which virus should you suspect for adults over 50 with encephalitis or meningitis in summer or early fall?
west nile virus
29
How do you Dx encephalitis?
Hx of recent travel or viruses, MRI, CT, PET looking for inflamed tissue, PCR test & Ig M
30
Tx for encephalitis?
antivirals & dexamethasone (decadron) to reduce inflammation
31
What is a brain abscess?
localized collections of pus within brain tissue
32
Pathophysiology of brain abscess?
localized infection causes tissue necrosis & pus formation causes liquidification, becomes encapsulated in a thick fibrous wall
33
How do brain abscesses reach the brain?
infection by direct extension: most common (from ear, tooth, mastoid or sinus infections)
trauma or neurosurgery
bloodstream
34
Which organisms are usually responsible for brain abscesses?
staph & strep
35
S/Sx of brain abscess:
HA, fever, chills, LOC changes + Focal S/Sx depending on location of abscess
36
How do you Dx & Tx brain abscess?
WBC & ESR, cultures, CT/MRI
| large doses ABX, craniotomy if ABX not effective
37
What is prognosis for unTx'ed brain abscess?
100% mortality
38
What is neurosyphilis?
inadequately Tx'ed syphillis, not contagious!
39
Dx for neurosyphilis?
RPR (rapid plasma regain) often tested when anyone presents with neuro S/Sx
40
S/Sx of neurosyphilis?
progressive ataxia, lightening pain, slapping gait, Charcot's joints, loss of DTR
41
What is Tx for neurosyphilis?
Penicillin (neurodeficits will remain!)
42
What is diff between primary (functional) & secondary (organic) HA?
```
Primary = HA is primary problem (migraine, cluster or tension HA)
Secondary = results from a medical condition (Sx of another problem)
```
43
What causes tension HA?
stress/tension
44
Which is the most common type of HA?
tension
45
What are S/Sx of tension HA?
bilateral pain, c/o pressure/tightness, photo/phonosensitivty
46
How do you Tx tension HA?
```
Abortive = OTC NSAIDS, muscle relaxers, sedatives, tranquilizers or narcotics (severe)
preventative = antidepressants, Beta-blockers, selective serotonin uptake inhibitors
```
47
What is pathophysiology of migraine?
neurovascular events cause vessel dilation, constriction & spasm. hyperexcitable neurons in cerebral cortex (particularly occipital lobe)
48
S/Sx of migraine:
unilateral mod-severe pain, usually over 1 eye or ear, throbbing synchronized to pulse accompanied by photo/phonosensitivity & N/V
49
What triggers migraines?
foods containing tyramine, some medications (nitro & estrogen) & bright lights, smells or menses
50
What is an aura?
a sensation that precedes HA & signals onset (often visual)
51
What are phases of migraines?
Prodromal = experiences consistent Sx that often precede HA (food cravings, mood swings) Diff from aura
Second Phase = time pt experiences HA
Third phase = HA termination phase, pain subsiding
52
What are Tx for migraines?
OTC NSAIDS for mild
| for severe = triptans
53
How do triptans work? & what are S/Es?
affects serotonin receptors to inhibit neurogenic inflammation & cause cranial vasoconstriction
S/E = flushing, tingling or hot sensation
54
What are cluster HA?
severe HA caused by hypothalmic dysfunction
55
What are S/Sx of cluster HA?
unilateral pain focused around 1 eye, burning sharp severe stabbing pain, occur in rhythmic pattern (same time, same season for wks-months)
56
What is an abortive Tx for cluster HA
100% O2 by face mask
57
What is a seizure?
paroxysmal, uncontrolled electrical d/c of neurons that interrupts normal function and causes abnormal motor, sensory and autonomic activity
58
How are seizures Dx?
Hx of head trauma, illness, birth injury etc
EEG (not definitive)
CT, MRI, cerebral angiogroaphy, MRA
59
What are 2 major classes of seizures?
partial & generalized
60
What is the most common type of seizure?
generalized tonic-clonic seizure
61
What does tonic mean? clonic?
```
tonic = muscle stiffness
clonic = abrupt jerky movements & loss of muscle tone
```
62
Where do generalized seizures occur?
| partial?
```
generalized = always involve abnormal firing on both sides of brain
partial = unliateral manifestations due to localized focal abnormality (can spread into generalized seizure)
```
63
What is the ictal phase?
seizure phase
64
what is the aural phase?
sensory warning
65
What is an absence seizure?
childhood seizure - brief staring spell lasting just a few seconds. Can be precipitated by blinking/flashing lights (video games!!)
66
What is an atonic seizure?
sudden loss of muscle tone, person drops to the floor unconscious, but will usually regain consciousness before they hit the ground
67
What is an atypical absence seizure?
staring spell with peculiar behavior and post-seizure confusion
68
What are 2 subdivisions of partial seizures?
simple partial seizures (alert) & complex partial seizures (altered LOC)
69
Describe simple partial seizure
no loss of consciousness
last < 1 min
Sx are uniliateral: may be sensory (olfactory hallucinations), motor (involuntary movements) or autonomic (increased HR or flushing)
70
Describe complex partial seizure
last longer than 1 min, changes in LOC, occur in temporal lobe, may have automatisms (repetitive movements)
71
Describe generalized tonic-clonic seizures
Loss OC, tonic, clonic, last 2-5 min, may experience cyanosis, excess salivation, tongue/cheek biting, incontinence
72
What is TODS?
transient period of paralysis after a seizure
73
What are 3 criteria for surgery to Tx seizure? and what do they do remove during surgery?
3 criteria = confirm Dx, Failed drug trial, identify type of seizure
Surgery = remove epileptic focus to prevent spread
74
What is status epilepticus?
continuous seizure w o return to consciousness between. medical emergency b/c neurons become exhausted, leads to permanent brain damage
75
What are 2 primary interventions during status epilepticus?
maintain airway & gain IV access
76
Tx for status epilepticus?
IV antiepileptics
77
What is Parkinson's?
slowly progressive neurologic movement disorder
78
Patho of parkinson's:
decreased dopamine levels due to destruction of dopamine producing cells, leads to imbalance between dopamine & Ach
79
What are 3 cardinal signs of Parkinson's?
Tremors, rigidity, bradykinesia
80
Dx Parkinson's:
2 out of 3 cardinal signs & trial with anti-parkinson's meds to look for improvements
81
What is Tx medication for Parkinson's?
Levodopa, dopamine agonists, anticholinergics
82
How does deep brain stimulation help with Parkinson's?
delivers electrical stimulation to inhibit neuronal activity.
83
What is Huntington's disease?
Disease of nervous system that results in involuntary choreiform movements and mental status changes
84
Which gender does Huntington's affect more?
Men & women equally
85
Which gene is responsible for Huntington's disease?
HD gene: IT 15
86
What is patho of Huntington's?
HD gene causes a deficiency in GABA and Ach which = excess dopamine.
87
What are clinical manifestations of Huntington's disease?
chorea & intellectual decline
88
How is Huntington's Dx?
presentation of characteristics, family Hx & genetic testing
89
How do you Tx Huntington's?
No cure or Tx to halt or reverse disease, only symptomatic Tx
Xenazine decreases dopamine availability
Neuroepieptics = calming effect
90
What is MS?
chronic, degenerative autoimmune disorder that affects the myelin sheath & conduction pathways of CNS
91
Patho of MS:
chronic inflammation leads to myelin sheath damage & gliosis which inhibits impulses in CNS. 1st T cells activated, disrupt BBB barrier, later inflammation within CNS causes demylenation, scarring & axon damage
92
What is the most common & severe Sx of MS?
fatigue.
93
What are other Sx of MS:
impaired movement, stiffness, gait problems, tremors w activity, hyperactive DTR, poor balance, visual disturbances, parasthesias, vertigo, tinnitus, Pain, ST memory loss
94
What are classifications of MS?
relapsing remitting, Secondary progressive, primary progressive, progressive relapsing
95
what happens to people w MS during pregnancy?
most will see remission, or at least improvement, of Sx during pregnancy, but high risk for exacerbation postpartum
96
What is the primary tool for Dxing MS?
MRI to visualize plaques and scarring
97
What do MS meds do?
reduce plaques (# & size) & reduce frequency & duration of relapses
98
What is primary MS med?
interferon injections
99
What is Tx for acute exacerbation of MS?
ACTH (adrenocorticotropic hormone) IV
| solu-medrol IV for 1-2 weeks
100
What is ALS?
Amyotrophic Lateral Sclerosis is a rapidly progressive neurologic disorder that causes degeneration of UMN & LMN. leads to progressive debilitating muscle weakness
101
ALS does not affect:
Senses, function, or intellect
102
What is the most widely accepted theory behind ALS?
Protein mishandling. mishandled proteins build up & caused nerve cell damage
103
Clinical manifestations of ALS:
initially muscle weakness & fatigue
then muscle twitching, spasticity & hyperreflexia
dysarthria, dysphagia, pain & resp difficulties
104
What is the cause of death with ALS most often?
Respiratory failure
105
What is the only med approved to Tx ALS?
glutamate antagonists (rilutek or riluzole)
106
What is myasthenia gravis?
autoimmune, muscle fatigue & weakness caused by inadequate Ach receptor site stimulation due to Ach receptor antibodies
107
Patho of MG:
Antibodies are produced that block Ach receptor sites, decreased available sites = not enough Ach stimulation to cause muscle contraction
108
What is definitive Dx for MG?
tensilon test: assess muscle stength, IV admin of tensilon, reassess muscle strength. improved muscle strength = +MG
109
Primary manifestation of MG?
muscle fatigue, worse at the end of the day
110
which muscles are most affected w MG?
eyes, eyelids, & facial muscles
111
What is a Simpson eye test?
when pt looks up for a few min eyelid will begin to droop bc of muscle fatigue
112
What is 1st line of therapy for MG? 2nd line?
anticholinesterase drugs: Mestinon = most successful.
| 2nd = immunoglobulin G
113
What are 2 complications of MG?
myasthenic crisis & cholinergic crisis
114
What is Myasthenic crisis?
insufficient medication- under stimulation of Ach receptor sites by Ach
115
What is cholinergic crisis?
excessive medication- excess stimulation of Ach receptor sites by Ach
116
What are S/Sx of myasthenic & cholinergic crisis? What are primary concerns
ptosis, dyspnea, dysarthria & dysphagia. primary concerns = aspiration & resp insufficiency
117
How do you Tx myasthenia crisis?
IV tensilon
118
How do you Tx cholinergic crisis?
Atropine
119
What is trigeminal neuralgia?
disease affecting the 5th cranial nerve (trigeminal)
120
What are the 3 branches of the trigemnial nerve?
ophthalmic, maxillary & mandibular
121
What are clinical manifestations of trigeminal neuralgia?
sudden, unilateral excruciating pain of the face
122
What are trigger zones?
zones that will initiate pain with benign event
| can be a draft, brushing teeth, touching face etc
123
What is Dx for trigeminal neuralgia?
imaging to r/o other causes of pain
124
What is Tx for trigeminal neuralgia?
anti-epileptics
125
What is guillain barre syndrome?
acute autoimmune attack on myelin sheath of peripheral nerves, characterized by symmetrical ascending muscle weakness
126
patho of guillain barre:
edema, inflammation & demyelination of nerves by antibodies
127
in which direction does remyelination occur?
proximal to distal
128
what is #1 complication of guillain barre?
respiratory failure
129
what is therapy of choice for guillain barre?
IV immunoglobulin
