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Clinical Medicine Lecture - Professor Kramer > Neuro: Autonomic disorders & Childhood disorders > Flashcards

Neuro: Autonomic disorders & Childhood disorders Flashcards

1
Q

Autonomic disorders ?

A

Neurogenic syncope

Postural orthostatic tachycardia syndrome

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2
Q

Neurogenic syncope Pathophysiology ?

A

Afferent trigger creates reflex vasodilation and bradycardia

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3
Q

Neurogenic syncope common types ?

A

Vasovagal (covered previous)

Pulmonary - bronchiolavage

Urogenital - foley in

Gastrointestinal - bowel movement with C

Carotid - new PA student,
massage carotid

Ocular - face in cold water

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4
Q

Neurogenic syncope demographic ?

A

F>M

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5
Q

Neurogenic syncope RF ?

A

Family history positive

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6
Q

Neurogenic syncope H and P: Predominant features ?

A

diaphoresis, pallor, palpitations, nausea, hyperventilation, and yawning

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7
Q

Neurogenic syncope Diagnostic Studies ?

A

CBC
CMP
EKG

Consider
CT head

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8
Q

Neurogenic syncope Treatment ?

A

Avoid stimuli

Fludrocortisone

steroid - CCS help with Increasing BP and they might have some mineralocortico capability - aldosterone - Na retention = expanding blood volume

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9
Q

Neurogenic syncope H and P ?

A

Premonitory features
diaphoresis, pallor, palpitations, nausea, hyperventilation, and yawning

Dizziness/ lightheadedness

Loss of postural tone, LOC
-May have proximal and distal myoclonus

eyes typically remain open and usually deviate upward

**they sense it coming **

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10
Q

Postural orthostatic tachycardia syndrome (POTS) pathophysiology ?

A

Unclear

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11
Q

Postural orthostatic tachycardia syndrome (POTS) possible etiology ?

A

Hypovolemia

Deconditioning

venous pooling

impaired brainstem regulation

β-receptor supersensitivity

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12
Q

POTS demographic ?

A

Age 15-50

Female to male 5:1

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13
Q

POTS History ?

A

Symptomatic when moving from sitting or lying to standing

  • Lightheadedness
  • Weakness
  • blurred vision
  • Palpitations
  • Tremulousness
  • nausea
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14
Q

POTS Physical ?

A

increase in heart rate with standing

to >120 beats/min or an increase of 30 beats/min

  • *usually around 140 increase of 30 is really dx
  • *
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15
Q

POTS Diagnostic studies ?

A

Clinical diagnosis

Consider

  • CBC
  • CMP
  • EKG
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16
Q

POTS complications ?

A

Limitation of daily activities

17
Q

POTS Treatment ?

A

Fluid expansion

Postural training - don’t suddenly stand up

18
Q

POTS tx considered ?

A

Midodrine - alpha stimlant - vasoconstriction to maintain BP

Fludrocortisone - expanding BV

Phenobarbital

beta blockers - help HR

19
Q

Childhood disorders types ?

A

Cerebral palsy

20
Q

Cerebral palsy pathophysiology ?

A

Cerebral injury before birth, during delivery, or in the perinatal period

chronic impairment of muscle tone, strength, coordination, or movements

21
Q

Cerebral palsy prevalence ?

A

Some degree in 0.2% of births

22
Q

Cerebral palsy demographic ?

A

Birth and early childhood identified

23
Q

Cerebral palsy RF ?

A

Intrauterine hypoxia
Birth hypoxia

Intrauterine bleeding
Infections (CMV)
Toxins
congenital brain malformations
Kernicterus
neonatal hypoglycemia
metabolic disorders
genetic syndromes
24
Q

Cerebral palsy PE: motor ?

A

spasticity (75% of patients)
unintentional

lack of coordination

fine motor difficulties

Ataxia
Lethargy
Hypotonia
Dystonia

25
Q

Cerebral palsy PE: sensory ?

A

Hearing

Vision

Sensation

26
Q

Cerebral palsy Diagnostic Studies ?

A

MRI

May show lesion, infarct, or infection

**loss of brain tissue **

27
Q

Cerebral palsy complications ?

A

Seizures (50%)

mental retardation (50%)

Cataracts
Retinopathy
congenital heart defects

28
Q

Cerebral palsy Treatment typical patient ?

A

Therapy

29
Q

Cerebral palsy tx. if spasticity ?

A

Skeletal muscle relaxants

**Baclofen - centrally acting muscle relaxant **

30
Q

Cerebral palsy’ tx. If seizures ?

A

anticonvulsants

31
Q

Cerebral palsy patient education ?

A

PT / OT / ST

32
Q

Cerebral palsy pharmacology ?

A

Anticonvulsants

  1. Carbamazepine (Tegretol)
  2. Phenytoin (Dilantin) - older
  3. Valproic acid (Depakote)

Skeletal muscle relaxants
Centrally acting preferred (baclofen)

33
Q

Cerebral palsy Kramer story ?

A

difficulty child birth

cord was wrapped around neck and he was blue and he survived and he has seizures and hemiparesis and significant developmental delays = debilitating
main drive why people dont want to go into obstetrics anymore ( very high risk stuff) 18 years

its like a stroke for babies - hypoxia for the brain and cord around neck cutting off supply , ingestion of placental fluid and now they cant breathe

Clinical Medicine Lecture - Professor Kramer (28 decks)

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