Neuro CIS Case 2 Flashcards
etiology for weakness/fatigue/tremor and falls
neurologic
cardiac
metabolic
MSK
neurologic etiology
parkinsons, AZD, lewy body dementia, benign familial tremor
cardiac etiology
arrhythmia, valvular
metabolic etiology
anemia, electrolyte disturbance, thyroid,EtOH use
MSK etiology
DJD, OA, joint laxity
tremor that goes away with voluntary muscle contraction
resting tremor
tremor that occurs when extending upper limbs horizontal, pointing at objects, sitting erect without support for the upper body
postural tremor
tremor that occurs during any voluntary contraction of skeletal muscle
finger to nose test, heel to shin test, reaching, writing, drawing, pouring a glass, eating etc
action tremor including kinetic and isometric tremor
PD tremor
age of onset gender fam history asymmetry freq character distribution assocaited features
AOS: 50 males 25% family history assymetry 4-6 hz at rest, supination and pronation hands, legs, chin, tongue bradykinesia, rigidity, gait difficulty, postural instability, micrographia
Essential tremor (differentiation from PD tremor)
age of onset gender fam history asymmetry freq character distribution assocaited features
20s and 60s M=F >50% family history little asymmetry 4-10 hz postural, kinetic hands, head, voice deafness, dystonia, parkinsonism
is parkinsons disease progressive
yes
3 main features of parkinsons (triad)
tremor (pill rolling)
bradykinesia
rigidity
non motor symptoms with parkinosns
depression, anxiety, psychosis
clinical diagnosis of parkinsons
triad plus response to L-Dopa (only way to really confirm would be at autopsy)
masked facies and micrographia associated with what and explain what each is
associated with PD
masket facies = flat facial expression
micrographia = tiny handwriting
treament for PD
levodopa
dopamine agonist: bromocriptine, and pramipexole
warfarin indicatred use and INR target
A fib- 2-3
VT/PE 2-3
bioprostehtic valve 2-3
mechanical valve 2.5-3.5
most common cause of supratherapeutic INR
interaction with warfarin and its metabolism
if INR is above 5 then what to do
lower warfarin dose or omit dose until range goes back to normal
-no reduction needed if INR only minimally prolonged
if INR is 5-9 then what
omit next 1-2 doses, monitor and resume at lower dose when INR in therpeutic range
-or omit dose and administer 1-2.5 mg oral vitamin K1
INR over 9 then what
hold warfarin
administer 2.5-5 mg oral vitamin K (administer more prn)
resume warfarin at lower dose
when INR is life threatening what to do
hold warfarin and administer 10 mg of vitamin K by slow IV infusion
supplement with 4-factor PCC or FFP
why non-contrasted CT head
contrast will obscure blood
mini mental exam questions category
orientation
registration
attention and calculation
recall
language
(go over handout)
