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Old DOOS > Neuro Lecture 2 > Flashcards

Neuro Lecture 2 Flashcards

1
Q

What cells support the CNS?

A

Oligodendrocytes

astrocytes

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2
Q

What cells support the PNS?

A

Schwann cells

Ganglionic satellite cells

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3
Q

Damage to the peripheral neurons and their supporting structures

A

Peripheral neuropathies

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4
Q

What are the four main patterns of peripheral neuropathies?

A

Mononeuropathy
Mononeuritis multiplex
Polyneuropathy
autonomic neuropathy

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5
Q

Affects isolated nerves but they are in single places.

A

Mononeuritis multiplex

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6
Q

Most common causes of a mononeuropathy (4)

A

compression
ischemia
infection
inflammation

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7
Q

Why are peripheral nerves often affected?

A

tiny artieries supplying area

far away from cell body

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8
Q

Most common causes of mononeuritis multiplex?

A

Diabetes
vasculitis
immune-medicated dseases
Infection

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9
Q

What is a symmetric or contiguous multifocal neuropathy, usually starting distally?

A

Polyneuropathy

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10
Q

Most common causes of polyneuropathy?

A

DM
other metabolic/ toxic disturbances
demyelination
infection

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11
Q

A type of polyneuropathy, affecting the autonomic nervous system.

A

Autnonomic neuropathy

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12
Q

What are some manifestations of autonomic neuropathy?

A

bladder incontinence, urine retention
GI symptoms
disturbances of heart rate

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13
Q

How does diabetes mellitus cause peripheral neuropathy?

A

DM affects the blood supply and has toxic effects

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14
Q

List 3 other conditions besides diabetes mellitus for peripheral neuropathy.

A

Hypothyroidism
Tobacco use
Systemic lupus erythematosis

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15
Q

Too much ____ can cause peripheral neuropathy.

A

Vitamin B6

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16
Q

__________ cause permanent peripheral neuropathies.

A

Fluoroquinolones

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17
Q

What are some other not as common diseases that cause neuropathy.

A 
Shingles
HIV
Lyme disease
Leprosy
Lightning strikes
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18
Q

What are some treatments for peripheral neuropathy?

A 
Tricyclic antidepressatns
SNRIs 
Gabapentin/ Pregabalin/ Valproate 
Cannabinoids 
Opiates (will turn off sensation, not 1st choice) 
TENS
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19
Q

Carpal tunnel syndrome is a ________ mononeuropathy.

A

Entrapment

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20
Q

CTS results in Intermittent numbness & paræsthesias of the _______________

A

1st, 2nd, 3rd and radial half of the 4th digit of an upper extremity.

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21
Q

What can chronic CTS lead to?

A

Permanent nerve damage and denervation and atrophy of the thenar muscles

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22
Q

Can light repetitive tasks cause CTS?

A

No

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23
Q

What is first line treatment of CTS?

A

Put an arm in a splint at night so they are extended

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24
Q

What is the hand elevation test?

A

Raise hands above head for at least 30 seconds

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25
Q

What meds can be used for CTS?

A

NSAIDs

steroids (oral, phonopharesis, injected)

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26
Q

What is done surgically for curing CTS?

A

Surgical release of the transverse carpal ligament

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27
Q

What will you be at risk for after having a transverse carpal ligament?

A

Trigger thumb

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28
Q

Who is more likely to have CTS?

A

Women

>30 years old

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29
Q

What nerve does cubital tunnel syndrome affect?

A

Ulnar nerve

Will fell in 5th finger and ulnar part of 4th

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30
Q

What is believed to cause Bells palsy?

A

Inflammation

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31
Q

Where will you lose taste with Bells Palsy?

A

anterior 2/3 of the tongue

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32
Q

For Bells Palsy if the insidious onset (>2 weeks) or forehead sparing what do you need to get?

A

A MRI

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33
Q

How do you treat Bell Palsy?

A

Mild- don’t do anything
Prednisone effective when started early
Acyclovir may be effect if caused by herpes virus

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34
Q

What do you need to protect with Bell palsy?

A

The eye

Lubricating eye drops and ointments

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35
Q

How long does it take to improve with bell palsy?

A

Usually improve within 2 weeks

Full recovery usually within 3-6 months

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36
Q

Who are more likely to have Bell Palsy?

A

Pregnant women

Diabetics

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37
Q

Peripheral neuropathy that ascends, rapid onset, autoimmune disorder.

A

Guillain-Barre syndrome

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38
Q

What will a demylinating disease look like on CSF?

A

Ton of protein in CSF but not many cells.

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39
Q

Guillian-Barre is immune response to foreign antigens, creating antibodies to

A

gangliosides

40
Q

What will be absent with Guillian Barre?

A

DTRs

No fever

41
Q

What will NCS show with Guillain-Barre

A

Prolonged distal latencies

42
Q

Will the CBC show increased WBCs in Guillain Barre?

A

No

43
Q

How do you treat Guillain Barre?

A

Plasmapharesis and/or IV immunoglobulins
breathing support
physical rehabilitation

44
Q

When does recovery usually start with Guillain-Barre?

A

After the 4th week.

45
Q

80% of peoplw ill recover from Guillain-Barre within how long?

A

A year

46
Q

Autoimmune neuromuscular disease causing intermittent/fluctuating weakness and fatiguability.

A

Myasthenia gravis

47
Q

What muscles are most commonly affected with myasthenia gravis?

A

Extraocular
Facial
Mastication
Pharyngeal muscles

48
Q

When does a myasthenic crisis occur?

A

Respiratory muscles are affected

49
Q

What will a person with MG look like on physical exam?

A

Ptosis
Opthalmoplegia/ nystagmus
Fatigability with upward gaze/ blinking
Slowed speech with counting

50
Q

MG is usually caused by autoimmune antibodies against the ____________, but can also be caused by antibodies againt _________/

A

nicotinic acetylcholine receptors,

muscle-specific kinase (MuSK)

51
Q

10% of patient with MG will have a _____

A

thymoma; will be cured with removal of the thymus

52
Q

How do you treat MG?

A 
AchE inhibitor (neostigmine, pyridostigmine)
and an immunosuppressant drugs
53
Q

What can be used in severe cases MG?

A

Plasmaphoresis and IVIG

54
Q

What is the prognosis for MG?

A

Usually a lifelong problem
No progressive though
some patients see improvement in 3-5 years

55
Q

WHat are 5 lifestyle things that can cause secondary headaches?

A 
dehydration
Poor nutrition
Sleep deprivation
Lack of Exercise
Stress
56
Q

What is the most common primary headache?

A

Tension-type headache

57
Q

When do tension-type headache peak?

A

40s

58
Q

What usually precipitates tension-type headaches?

A

Stress or hunger

59
Q

Where do tension-type headaches occur?

A

Occipital, frontal, or both

60
Q

Are muscle relaxants helpful with tension type headaches?

A

No

61
Q

What do you use to treat tensin-type headaches?

A

OTC pain medications

Triptans can be helpful

62
Q

Can you use opiates to treat tension-type headaches?

A

No

63
Q

What antidepressants can be helpful in tension-type headahces?

A

Tricyclic/ tetracyclic antidepressants

as well as SNRIs and anticonvulsants

64
Q

What are repeated episodes of excruciatingly severe unilateral headache lasting 15 minutes to 3 hours?

A

Cluster headache

65
Q

What is pain accompanied with in cluster headaches?

A

Ipsiltareal ptosis, miois, conjunctival injection, lacrimation and rhinorrhea
Sometimes facial flushing, edema, or diaphoresis

66
Q

What may trigger a cluster headahce?

A

Smoking

ETOH use and nitrates

67
Q

During a cluster headache attack what is seen on a PET scan?

A

Increase metabolic activity in the hypothalamus

68
Q

How do you treat cluster headache?

A 
High flow oxygen mask 
Triptans 
Melatonin
Lithium
Anticonvulsants
69
Q

Who are more affected by cluster headaches?

A

men
blue or hazel eyes
rugged “lionized” facial features
heavy smokers/ drinkers

70
Q

Unilateral, thrombbing pressure lasting 1 hour to 3 days.

A

Migraine headache

71
Q

Before puberty, migraines are more common in ____

A

males

72
Q

What are the autonomic synmptoms of a migraine?

A

pallor, sunken eyes
N/V
photophobia, phonophobia
lightheadedness, vertigo

73
Q

LIst the 4 stages of migraine

A

Prodrome
Aura
Pain/headache phase
Postdrome (hours to days after)

74
Q

What happens horu to days before a migraine. Indicated by a change in mood, crvaing for certain foods, pain, etc.

A

Prodrome

75
Q

What is a classic migraine?

A

Migraine with aura

76
Q

Is migrain aura typically black and white or colorful?

A

Black and white (seizure is coloful)

77
Q

What occur during an aura?

A

Scintillating scotoma
Zigzagging lines
Numbness, tingling, pins and needles
Hemianopsia

78
Q

Does a migraine necessarily include a headache?

A

No

79
Q

Stage where patients feel aching where headache was. May feel tired europhoric.

A

Postdrome

80
Q

What is likely the direct cause of pain with migraine?

A

Vasodilation (sense pain in stretch of blood vessels)

81
Q

Migraine where you can’t move your eye

A

ophthalmoplegic migraine

82
Q

migraine where you can’t move 1/2 your body

A

hemiplegic migraine

83
Q

migraine where people have a change in mental status state

A

confusional migraine

84
Q

What is a childhood periodic syndrome with abdominal pain with or without headhace?

A

Abdominal migraine

85
Q

Bouts of severe nausea and vomiting that last for hours to days, alternating with symptom-free intervals. Each episode look identical from day to day.

A

Cyclic vomitting syndrome

86
Q

What are some migraine triggers?

A

MSG, nitrites, aspartame
Aged cheeses (tyramine)
fluroescent lighting
ETOH (red wine), caffeine

87
Q

What is the first set of medication preventitive therapies for migraines?

A

Beta-blockers
Calcium channel blockers
ACE inhibitors

88
Q

What other therapies are there for migraines?

A

tricyclic antidepressants
SNRIs
some anticonvulsants (VPA/ TPM)
rTMS (repetitive transcranial magnetic stimulation)

89
Q

What are some therapies that are vitamins that can prevent migraines?

A 
Riboflavin (B2)
Magnesium supplements (if levels were low)
90
Q

What is a “natural” therapy that can reduce the frequency of migraines?

A

Coenzyme Q-10
rTMS
progesterone-based contraception can be helpful

91
Q

What meds can used to help headaches but can also cause medication overuse therapies.

A

APAP and NSAIDs

92
Q

2 meds that can help migraine but cause vasospams so shouldn’t be used in those with aura (or those with high stroke or CV risk)

A

Triptan and ergots

93
Q

Are opiates used for migraine?

A

No

94
Q

What double the rsk of ischemic stroke, even more in patients with stroke?

A

Migraine with aura

95
Q

A deficiency in what vitamins can cause peripheral neuropathy?

A

B1, B12, A, E

96
Q

What drugs can cause peripheral neuropathy?

A

Fluoroquinolones, phenytoin, vincristine, metronidazole, statins, isoniazid, nitrofurantoin, chemotherapy

97
Q

What are the 2 childhood periodic syndrome migraines?

A

Abdominal migraine

Cyclic vomiting syndrome

Old DOOS (21 decks)

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