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Rotation 4: FMI > Neuro > Flashcards

Neuro Flashcards

1
Q

Down Syndrome

WHICH CHROMOSOME

A

TRISOMY 21

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2
Q

Down syndrome

6 sxs!!!!!

ONE KEY THING RELATED TO!!

A

SXS:

  1. hypotonia
  2. poor moro reflex
  3. hypermobility of joints
  4. flattened facies
  5. excess skin on back of neck
  6. single transverse palmar crease SIMIAN crease

CAUTION: CARDIAC DISEASEIN 40%, ASD

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3
Q

Klinefelter syndrome (XXY)

4 characteristics

A
  1. initially tall thin become obese with scoliosis
  2. expressive language disorder and developmental delay
  3. male: small penis, scant pubic or facial hair
  4. females: eunich appearance (difficult to tell gender)
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4
Q

what is the chromosome issue with klinefelter syndrome?

A

XXY

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5
Q

Turner Syndrome

what is the issue genitically here?

A

MONOSOMY X

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6
Q

Turner Syndrome

4 characteristics of this

A
  1. webbed neck and short stature
  2. prominent ears with widely spaced nipples
  3. congenital lymphedema
  4. increased carrying angle
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7
Q

Cerebral Palsy

what is this?

3 options of presentation?

SXS

2

1

4

A

involuntary sustained or intermittent muscle contractions cause twisting and repetitive movements, abnormal posture or both

presentaiton:

  1. arm and leg on one side (hemiplegic)

FLOPPY OR SPASTIC HAND

WALKS ON TIP TOE OF EFFECTED SIDE

  1. both legs only (diplegic)

CONTRACTURES OF THE ANKLES AND FEET

  1. both arms and both legs (quadriplegic)
    - ARMS HEAD AND MOUTH MAY TWIST STRANGELY
    - SEVERE BRAIN DAMAGE THEY CAN’T WALK
    - KNEES PRESS TOGETHER
    - LEG AND FEET TURN INWARD
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8
Q
A
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9
Q

migraineurs

8 things that can contribute/spark this and cause the migraine

A
  1. motion sickness with nausea/vomiting
  2. menstrual headaches
  3. headaches the worsen with physical activity including benign sex headaches
  4. post small amount of colored wine or liquor
  5. caffine withdrawal headaches
  6. water diving headaches
  7. altitude headaches
  8. chocolate, peanuts, and caffine
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10
Q

migraine pathophysiology

what is the end pathway that causes this?

what are 2 contributing factors?

A

end pathway: casuses activation of the sensory fibers that innervate the miningeal and cerebral blood vessels** that **arise in the TRIGEMINAL NERVER

inflammatory and vascular components

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11
Q

vasogenic theory

vs

neurogenic theory

what are the 2 theories?

which one is the more commonly believed theory?

A

VASOGENIC THEORY

a. intracranial internal carotid vasoconstriction causes the migriane aura
b. headache occurs from the rebound vasodilation of cranial vessels aka external carotid** which activate the **perivascular pain fibers of the trigeminal nerve

NEUROGENIC THEORY

a. brain activates or sensitizes trigeminal nerve fibers** which **initiates the headache from neurogenic inflammation

***theory believed by most neurologists**

**but keep in mind…we don’t actually know, but neurogenic more commonly believed**

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12
Q

serotonin in migraines

what is the role of serotonin?

what can be used to tx migraines because of this quality?

what does it bind with?

3 things the tx leads to aka why it works?

A

serotonin is a NT that activates pain fibers and contirbutes to both inflammation and vasodialation of the meningeal and dural blood vessels **(basically the same as what happens in a migraine!!)**

serotonin agonists used for migraine abortion:

when the 5-HT1 serotonin receptors on presynaptic terminal are agonized/activated inhibit the release of serotonin** and this leads to **VASOCONSTRICTION** and **PREVENTS ACITVATION OF THE TRIGEMINAL NERVE

  • turn off release of serotonin
  • vasoconstrict the dilated vessels
  • turn off activation of the trigeminal nerve
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13
Q

aura

what is this? when does it occur?

what are 6 possible sxs?

what might it mimic?

A

transient 15-30 mins episodes of focal neurologic dysfunction before the headache phase begins

SXS:

  1. expanding scotoma (blind spot) with scintillating margin

***visual hallucinations, stars, sparks, and zig zags of light***

  1. visual field defects

3. unilateral paresthesias

4. numbness

5. weakness

6. dysphagia

***some may minic TIAs**

(typically wihout vertigo, ataxia, tinnitus, hearing loss)

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14
Q

migraine with aura

what is confusing about this?

what is aura thought to come from and how can you identify this?

A

some are explained with decreased blood flow while others aren’t

aura is contributed to by activation of wave of electrical activity** that spreads through the brain **depressing cortical activity** and results in **visual and other sxs

“spreading depression of Lao seen on PET SCAN*

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15
Q

migraines

what is the age of onset?

5 sxs commonly seen with these in general?

A

peaks 35-45

  1. lateralized to one side or generalized

2. throbbing and worse with physical activity

  1. develops gradually
  2. phonophobia
  3. photophobia
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16
Q

migraine tx

3 tx options

0

2

(what do they bind to, what do they cause/where, two things to remember about admin of these)

2

A
  1. ASA, NSAIDS if taken early
  2. tryptans-5-HT1 receptor agonists with high affinity to trigeminal nerve that cause vasoconstriction
    - sumatriptan
    - zolemitriptan

***autoinjection the most effective route of administration**

***make sure to take continuously untill migraine completely gone***

  1. narcotic ONLY in ED
    - injectable dihydroergotamine
    - merperidine
17
Q

mirgraine prophylaxsis

who do you consider this in?

4 tx options for this?

A

consider if:

1. migraines limit activities 3 or more times a month

2. complex migraines

TX:

  1. BETA BLOCKER-propanolol, metoprolol that cross BBB
  2. tricyclic antidepressant-amitripylene
  3. anticonvulsants- topiramate
  4. botulinum toxin A injected into the scalp
18
Q

tension headache

what to remember about this type of headache?

when does it occur in life?

4 skey sxs?

5 associated findings?

A

most common type of headache

3rd decade, patho poorly understood

sxs:

  1. symmetric tightness/pressure, band like
  2. mild-mod steady aching without throbbing pain mins to days
  3. DO NOT WORSEN WITH PHYSICAL ACTIVITY
  4. NO NAUSEA VOMITING OR OTHER NEURO SXS

aka no photophobia, phonophobia, vision changes

  1. associated findings
    - poor concentration
    - stress
    - fatigue
    - noise
    - depression
19
Q

tension headaches

2 medication tx?

1 prevention strategy?

A
  1. acetominophen
  2. NSAIDS

PREVENTION:

  1. RELAXATION TEHCNIQES
20
Q

cluster headache

what is this called?

who does it occur in?

where does this occur?

what are 4 other sxs that appeare with this?

when and how frequently do they occur?

A

MIGRAINEOUS NEURALGIA

males more than females, 3-6th decade of life

SXS:

  1. intense unilateral, orbital, supraorbital, or temporal head pain along with ipsilateral partial cervical sympathetic paralysis

a. conjunctival injfeciton

b. lacrimation

c.rhinnoreah

d. eyelid edema

  1. 15 mins-2 hours and recur daily for days to weeks
22
Q

cluster headache

what is the best treatment for this?

3 medical tx for acute attacks?

A
  1. 100% O2 for 15 mins- VERY EFFECTIVE for 1-2 hour duration HA

  1. acute attacks

ergotamine tartrate

sumatriptan

butorphanol

23
Q

cluster headache

2 prophylaxsis medication options

A
  1. verapamil
  2. ergotamine
24
Q

what are 3 common triggers for cluster headaches?

A
  1. ETOH
  2. stress
  3. foods
25
Q

substance use activates which system?

A

dopaminergic

26
Q

what screening test do you use to look for alcohol or substance use disorders?

A

CAGE screening

27
Q

what are the stages for alcohol withdrawal and their time frame?

4 things

A
  1. withdrawal 6-18 hours
  2. nausea/vomiting 8-12 hours
  3. HALLUCINATIONS within 2 days
  4. DELERIUM TREMONS 2-3 days after cessation but can be up to a week after
28
Q

what are 4 things you use to treat alcohol addiction?

A
  1. benzos
  2. thiamine
  3. folic acid
  4. multivitamin
  5. haldoperiol for alocholic hallucinosis
29
Q

opioid addiction

what are the 4 sxs of this and the 2 tx options?

A

SXS:

slurred speech, bradycardia, hypotension constricted pupils

TX:

  1. naloxone
  2. slow taper methadone clonidine or buponorphine
30
Q

Attention Deficit Disorder or Attention deficit hyperactivity disorder

5 sxs? 2 key ones

how to dx?

A

1. hyperactivity before 7 y/o

2. impulsitivity/inattentiveness before 7 y/o

3. emotional liability

4. poor social skills

5. explosive at home, don’t follow rules

DX:

teacher and parent rating scales CONNORS SCALE

31
Q

Attention Deficit Disorder or Attention deficit hyperactivity disorder

TX? 2 first like 2 SE

A
  1. CNS STIMULANTS methylphenidate, amphetamine/dextroamphetamine FIRST LINE

caution weight loss and growth retardation

32
Q

Autistic disorder

what is this?

A

imparied social interaction,

communication, and repetitive stereotypes behavior

33
Q

tourette disorder

what is this?

4 dx of criteria?

age of onset?

A

inherited neurobehavioral disorder characterized by sudden involuntary, repetitive muscle movements and vocalizations

DX CRITERIA:

  1. multiple motor or one or more vocal tics at some time during the disorder
  2. tic episodes several times a day, almost every day or periodically during period over a year
  3. change in type, severity, complexity, frequency,
  4. sxs before 18

sxs onset: 2-15 y/o

50% have sxs but age 7

***SXS BEFORE !***

34
Q

tourettes

motor tics

initlal sxs

secondary sxs

A
  1. initially

blinking

face twitch

head jerk

shrug

neck stretch

sniffing

  1. over time

squatting

jumping

repetitive touching

deep knee bends

smelling things

spinning

echopraxia: meaningless repetitiion or imitation of the movements of others

35
Q

tourettes

vocal tics

simple tics

advance tics

A
  1. simple tics

grunts

throat clearing

sigh

bark

hiss

snort

sniff

  1. advanced tics

repeating words or phrases out of context

palilalia-repeating ones own words

echolalia-repeating heard words

coprolalia (common mainstream depictions) “dropping the F bomb”

36
Q

course of tourette progression

4

A

waxing and waning course

usually combination of motor and verbal tics

few to many times a day often in clusters

lifelong but sxs decrease or resolve in adolescence or adulthood

37
Q

what are the associated sxs of tourettes?

4

A

obsessive compulsive behaviors 25%

attention deficit 50-80%

rage/poor impulse control 30%

anxiety 25%

38
Q

tourettes

4 tx options

A

do IF they present a problem

  1. dopamine antagonists/antipsychotic

haloperidol

fluphenazine

risperidone

  1. antianxiety

benzodiazepine

buspirone

  1. antidepressants-ssri
  2. alternatives

botox into involved muscles

habit reversal training

biofeedback relaxation training

39
Q

what are the 3 take homes of tourettes?

A
  1. TX GOAL: FUNCTION PRESERVATION

  1. MANY WILL HAVE OTHER PSYCHIATRIC ISSUES
  2. MEDS CAN BE USEFUL BUT DON’T FORGET BEHAVIOR MODIFICATION THERAPY
40
Q
A

Rotation 4: FMI (11 decks)

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