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Role 3 > Neuro > Flashcards

Neuro Flashcards

1
Q

leading cause of neurological disability in young adults and in whom

A

MS, women

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2
Q

clinical symptoms of MS

A

hand cramps, double vision, slurred speech, ataxia, depression, cog dysfunction, blurry vision

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3
Q

Lhermittes phenomenon

A

tingling in extremities with neck flexion d/t cervical cord lesion in MS

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4
Q

Internuclear ophthalmoplegia (INO)

A

lesion in brainstem, patient will have lack of adduction of one eye with nystagmus in the other eye (eyes don’t align)

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5
Q

white matter lesions are present in which illness

A

MS

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6
Q

4 Core features of PD

A

Tremor, Rigidity, Akinesia/bradykinesia, Postural instability associated with flexed posture

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7
Q

non-motor signs of PD

A 
Constipation
sleep disorders
depression
olfactory impairment (happens early-10 yrs prior)
Dysphagia 
Autotomic dermatitis (late)
Orthostatic hypotension
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8
Q

motor signs of PD

A 
freezing
dyskinesia
micrographia (small handwriting)
shuffling gait
hypophonia (soft speech)
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9
Q

micrographia

A

small cramped handwriting

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10
Q

Bradykinesia

A

slowness of movement

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11
Q

Hypophonia

A

soft speech

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12
Q

DaTSCAN

A

measures dopamine in the brain

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13
Q

PD is the loss or gain of what?

A

dopamine

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14
Q

usual age onset of PD?

A

45-65 years old

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15
Q

second most common neurodegenerative disorder?

A

PD

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16
Q

first most common neurodegenerative disorder?

A

Alzheimers

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17
Q

what meds can induce parkinsonism?

A

Haldol, high doses of CCB, SSRIs

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18
Q

Myersons sign

A

repetitive tapping over the bridge of the nose may cause blinking

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19
Q

when is an MRI done in PD?

A

to rule out other causes of symptoms

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20
Q

what symptoms indicate vascular parkinsonism?

A

isolated shuffling gait and step-wise progression of symptoms

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21
Q

does PD have early difficulties with falls?

A

no

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22
Q

Stages of PD

A

1- one side affected, no impairment
2-Both sides affected, no impairment

3- Both sides affected, mild posture and balances affected, still independent

4-Both sides affected, disabling instability, can’t live alone

5-Both sides affected, restricted to bed

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23
Q

what are you at greater risk for with Carbidopa/levodopa?

A

long-term motor complications like dyskinesia

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24
Q

what are you at greater risk for with Dopamine Agonists (Requip, Permax)?

A

impulse disorders (sex, gambling)

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25
Q

Dopamine Agonists (Requip, Permax) side effects

A

hallucinations, delusions, nightmares, leg edema, daytime somnolence

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26
Q

Amantadine is added for problems with what symptom of PD

A

good for motor symptoms and dyskinesia

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27
Q

Dyskinesia vs bradykinesia

A

bradykinesia=slow movements

Dyskinesia=uncontrolled, involuntary movements

28
Q

What 4 meds are mostly use in PD?

A

MAO inhibitors, Dopamine agonists and carbidopa/levodopa, amantadine

29
Q

If PD patient has constipation, what meds should you assess?

A

anticholinergic (antihistamines, trycyclic antidepressants, CCB)

30
Q

can MOI inhibitors be give alone or needed to be given with another med for PD?

A

either

31
Q

MOI inhibitor examples for PD

A

Seligiline, Eldepryl

32
Q

Seligiline, Eldepryl

A

MAO inhibitor examples for PD

33
Q

Dopamine agonist examples

A

Requip, Permax

34
Q

Carbidopa/levodopa med doses

A

10/100, 25/100, 25/250

35
Q

usual starting dose for Carbidopa/levodopa

A

1/2 tab-1 tab TID, can go up to 2 tabs QID

36
Q

Before a referral to neuro, should you try a therapeutic trial before hand?

A

no because it can mask diagnostic findings

37
Q

options for levodopa dyskinesia?

A
  1. ) decrease levodopa dose and give more frequently and/or increase dopamine agonist
  2. ) reduce dose of any MAO inhibitor
  3. ) add amantadine
38
Q

what are anticholinergic meds used for with PD

A

in younger patients with tremor. (Not used often)

39
Q

off time vs wearing off in PD

A

off time are periods during the the day when the medication is not working well, causing worsening of Parkinsonian symptoms.

wearing off may occur predictably and gradually. Need to change med regime

40
Q

AD hallmark signs on MRI

A
  • Amyloid plaques and neurofibrillary tangles (NFTs)
  • Oxidative stress
  • Sytsemic inflammation
41
Q

typical screening test for AD

A

montreal cog assessment

42
Q

medication classes for AD

A

Cholinesterase inhibitors, NMDA receptor antagonist

43
Q

Cholinesterase inhibitors

A

used for AD; Rivastigmine (exelon) and Galantamine (Razadyne)

44
Q

Rivastigmine (exelon) and Galantamine (Razadyne) are used for which illness and what drug class

A

AD; Cholinesterase inhibitors

45
Q

Galantamine (Razadyne) what problem should you avoid this in? give with food or without food? side effects?

A

avoid if patient has hx of syncope; give with food;

side effects: GI, bronchonstriction, wt loss, anorexia

46
Q

Rivastigmine (exelon) side effects

A

syncope, wt loss

47
Q

NMDA receptor agonist medication

A

Memamantine (Namenda)

48
Q

Memamantine (Namenda) side efects

A

steven johnson, wt gain, aggression, somnolence

49
Q

AD typical age

A

> 65

50
Q

who is more at risk for AD?

A

first degree relative, depression, APOE42 gene, patients with cardiovascular risk factors

51
Q

what meds are used with AD when patient has behavioral probs?

A

SSRIs

52
Q

what meds should not be used with aggressive behaviors of AD?

A

anticonvulsant unless they have a hx of bipolar

53
Q

what is an independent risk factor for delirium?

A

Dementia

54
Q

Treatment of acute relapse of MS

A

IV methylprednisolone 1g IVx3-5 days, no oral steroid taper

55
Q

AD stages

A

Stage 1-no changes
Stage 2-Very mild- minor forgetting

Stage 3-Mild-forgetting names, not retaining reading material, losing objects, can be diagnosed, cog changes seen in office

Stage 4-moderate-cant preform complex tasks, reduced personal hx, can’t remember recent occasions

Stage 5-moderate severe-major gaps in memory, confused about location, date, need help choosing clothing

Stage 6 and 7-dependent care

56
Q

6 Cognitive domains of dementia

A

Complex attention, executive function, Learning and memory, language, perceptual motor, social cognition

57
Q

executive function (one of the cognitive domains of dementia)

A

can’t do multiple tasks, they put shoes in fridge

58
Q

Perceptual motor (one of the cognitive domains of dementia)

A

visual issue-readings different, they can’t interpret things

59
Q

Social cognition (one of the cognitive domains of dementia)

A

react inappropriately in a social situation ex: funeral and laugh

60
Q

Relapsing remitting MS

A

symptoms get worse then recover, found in early diagnoses, disease does not get worse

61
Q

secondary progressive MS

A

you don’t get symptoms that come and go like in RRM, symptoms just get gradually worse

62
Q

primary progressive MS

A

no obvious relapsing, symptoms just get worse

63
Q

primary progressive MS vs secondary progressive MS

A

primary progressive MS does not experience the relapsing remitting phase of MS like secondary progressive MS people did

64
Q

Pseudo-Relapse in MS

A

something causes you to flare like getting a fever, infection, hot weather.

65
Q

MS remission

A

you return to the previous phase before the relapse

Role 3 (10 decks)

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