Neuro, Ears, and Eyes Flashcards
what is the patho of MS?
Chronic, progressive, degenerative, demyelinating neurologic disorder
what are the classifications of MS?
1) relapsing-remitting (most common); 2) primary progressive; 3) secondary progressive; 4) progressive-relapsing
MS is more common in…..
women
what are some DX tests for MS?
MRI, evoked potential response; CSF
what are some tx for MS?
disease modifying therapies (DMT’s)
immunomodulators, monoclonal antibodies, Corticosteroids, immunosuppressive agents, muscle relaxants, tricyclic antidepressants, anticholinergics.
what is the patho of PD?
-Progressive, degenerative neurologic disease, affecting voluntary motor functions.
-Failure of dopamine to inhibit acetylcholine
what are some TX for PD?
1) enhance release or supply of dopamine or
2) antagonize the effects of overactive cholinergic neurons:
- levodopa/carbidopa, dopamine agonists, anticholinergics, monoamine oxidase inhibitors, antidepressants, propranolol & botulism toxin.
what is a surgical option for PD?
deep brain stimulation (electrodes implanted into the brain and connected to a pulse generator)
what is the patho of huntington’s disease?
A single gene disorder – genetic autosomal. Progressive, degenerative, inherited neurologic disease → dementia and chorea. ↓ gamma-aminobutyric acid and acetylcholine levels. Excess of dopamine.
Tx for huntington’s disease:
There is no known cure or treatment for HD. Collaborative palliative care:
RX: tetrabenzine to treat the chorea; to decrease dopamine at the synapses; Others: haloperidol and risperidone; benzos, SSRI’s.
what is the patho for ALS?
rapidly progressive and fatal degenerative neurologic disease characterized by weakness and wasting of muscles under voluntary control.
PD is more common in…..
men
what is the patho of myasthenia gravis?
Chronic autoimmune neuromuscular disorder → fatigue & severe weakness of skeletal muscles with periods of remission. Antibodies destroy or block neuromuscular junction receptor sites ↓ acetylcholine receptors. Strength usually restored after period of rest.
what are some Dx tests for myasthenia Gravis?
Anticholinesterase test, nerve stimulation studies, anti-acetylcholine receptor antibodies and Tensilon tests.
what are some TX for myasthenia Gravis?
Thymectomy (40% remission with this surgery) for pt’s < 60; plasmapheresis; IV IgG. RX: anticholinesterase drugs (Mestinon), corticosteroids, immunosuppressants.
what is the patho for GBS?
Acute inflammatory demyelinating disorder of the peripheral nervous system → acute onset of ascending motor paralysis.
what are some DX tests for GBS?
↑ CSF protein, Electromyographic (EMG) studies that reflect ↓ nerve conduction.
what is some TX for GBS?
Plasmapheresis. IV immunoglobulin. Prolonged rehab. Recovery is slow.
what are some TX for trigeminal neuralgia?
phenytoin, rhizotomy: caution with applying any chemicals to face.
what are some TX for Bell’s Palsy
antivirals and steroids
do patients with bell’s palsy recover?
80% of patient’s recover within 2 weeks to a few months
pink eye or acute conjunctivitis is caused by?
staphylococcus, haemophilus, chlamydia or gonococcus.
what are some tx for acute conjunctivitis?
proper handwashing is imperative; RX: antibiotics (eye-drops), antivirals, anti-inflammatories and antihistamines
what is blepharitis?
Inflammation of the glands and lash follicles on the margins of the eyelid.
what is TX for blepharitis?
gentle cleansing with baby shampoo.
what is hordeolum (stye)?
Infection of one or more of the sebaceous glands of the eyelid
-staphylococcus aureus
what are tx for hordeolum (stye)?
warm moist compresses QID; antibiotics (possibly) and/or incision and drainage (I&D)
what is a chalazion?
Chronic inflammation of meibomian glands
what are some tx for chalazion?
warm moist compresses QID; antibiotics (possibly) and/or incision and drainage (I&D)
what is entropion?
Inversion of eyelid margin that may lead to corneal irritation and scarring
-associated w aging or infection
what are tx for entropion?
may need corrective surgery
what is cataracts?
Opacification of the lens; one of the leading causes of blindness
what are some risk factors for cataracts?
age (affects 50% >65; nearly all >70), smoking, ↑ exposure to UV rays, ETOH use, trauma, radiation, DM or congenital.
how do we treat cataracts
Surgery
(HOB ↑ 30 degrees lying on opposite side of surgery); avoid activities that increase IOP; post-op eyedrops (antibiotics and corticosteroids)
what is glaucoma?
Optic neuropathy with ↑ intraocular pressure; optic nerve atrophy; peripheral visual field loss
what are some risk factors for glaucoma?
age, family hx, African American (open angle), Far Eastern, Asian, Inuit (narrow angle).
what are tx for glaucoma?
Open angle medications i.e., topical beta-adrenergic blockers; topical adrenergics (mydriatics); topical prostaglandin analogs; topical carbonic anhydrase inhibitors and surgery. These medications are life-long therapies. Narrow angle medications include diuretics for rapid decrease in intraocular pressure or surgery. Avoid any medication or positioning (bending over) that ↑ eye pressure.
what is Age Related Macular Degeneration?
-drusen deposits beneath the pigment epithelium of the retina which causes atrophy and interferes with macular function.
-formation of new, weak blood vessels in the potential space between the choroid
what are some tx for age related macular degeneration?
Dry AMD: RX include high-dose antioxidants, vitamins, minerals.
Wet AMD: medications injected into vitreous cavity (inhibit endothelial growth factor), laser surgery or photodynamic therapy (destroys abnormal blood vessels)
what are the 4 stages of retinopathy?
- Mild non-proliferative
- Moderate non-proliferative
- Severe non-proliferative: retinal edema (from leakage) → small hemorrhage (from rupture).
- Proliferative: large areas of retinal ischemia; formation of new blood vessels; spread to over inner surface of retina and into the vitreous body;
what are tx for retinopathy?
Photocoagulation or vitrectomy (reduces risk of retinal hemorrhage, detachment, and edema).
how do we treat retina displacment?
Usually urgent surgery (which includes the use of a bubble and correct positioning), cyrotherapy, photocoagulation.
what is otitis externa?
inflammation of external ear canal
-swimmers ear
what are some tx for otitis externa?
thorough cleansing and medication i.e., topical antibiotics, pain relief and/or anti-itch
what are some treatments for otitis media and OM effusion?
: medications i.e., anti-inflammatory, decongestant and/or antihistamine, antibiotics, analgesics, antipyretics; application of heat; surgery which includes myringotomy (avoid getting water into ears).
-OME: valsalva manuever
how do we treat Meniere’s disease Chronic “attacks” of vertigo
-meds: diuretics, scopolamine, antivertigo/antiemetic (meclizine hydrochloride), and sedatives; supportive therapy, i.e., dark, quiet room, IV fluids if needed, low sodium diet, avoidance of caffeine, tobacco, and ETOH; avoid sudden movements.
-Surgery; endolymphatic decompression or labyrinthectomy as a last resort.
how do we describe conductive hearing loss?
disruption of sound via obstruction (impacted cerumen, edema, neoplasm, perforated TM, fixed ossicles, scarring, or middle ear fluid
how do we describe sensorineural hearing loss?
affects auditory nerve and pathway
what % of the population over 85 experience dementia in some form?
nearly 50%
what is commonly the first symptom of alzheimers that is normally looked over?
subtle memory loss
what frequently is a cause of death for alzheimers?
aspiration pneumonia
what is the definitive diagnosis for alzheimers disease?
post mortem examination of brain tissue that identifies plaques and tangles
name 3 interventions that should be used to avoid increasing intra ocular pressure?
-do not lay on affected side
-do not bend over
-elevate HOB at least 30 degrees
-avoid meds that can increase IOP
list 5 latent symptoms of alzheimers
-difficulty performing familiar tasks
-lang/comm problems
-disorientation
-poor judgement
-misplacing things
-loss of initiative
-sundowning
what causes MS?
an autoimmune response to a prior viral infection or immunologic or genetic factor
what is the most common classification of MS?
relaspsing-remitting course
describe the affect that climate has on the prevalence of MS in particular regions?
increased prevalence in temperate climates vs less prevalence in tropical climates near the equator
what usually is the COD for someone with MS?
usually due to infectious complications of immobility or an unrelated disease
list 3 pharmacologic classes used to treat MS?
immunomodulators
monoclonial antibodies
corticosteriods
immunosuppresants
muscle relaxants
tricyclic antidepressants
anticholinergics
what is chorea?
movements that are the involuntary, rapid jerky movements of limbs trunk and face
how long does one with ALS usually live after diagnosis?
usually 2-6 years
what is the characteristic symp of GBS?
acute onset of ascending motor paralysis
what is a tensilon test, what does it diagnose?
myasthenia gravis
-injected IV, marked improvement in muscle tone that lasts 4-5 minutes
a pt has increased pain when her auricle is manipulated and a feeling of fullness with purulent discharge. What diagnosis do you suspect?
otitis eterna
pt complains of decreased hearing, frequent popping sensation, pain with pressure changes. What diagnosis do you suspect?
serous otitis media (middle ear infection)
what is a myringotomy and what does it treat?
-the sugical creation of a hole in the eardrum
-to drain middle-ear fluids and relieve pain in a pt with otitis media
what sugical intervention treats otosclerosis, what pt teaching is most important post-procedure?
stapedectomy
-sneezing, coughing with mouth open
what disease presents with chronic attacks of vertigo, tinnitus, and progressive unilateral hearing loss? what are three treatments?
meniere’s disease
-avoid sudden movements
-dark quite room
-low na diet
-IVF if needed
avoid caffine
-avoid tobacco
-avoid alc
someone with glaucoma would experience what visual change?
loss of peripheral vision field
