neuro problems - PP

Question 1

migraines - scotomas

(blind on the scooter)

Answer 1

partial vision loss

Question 2

cluster ha - treatment

Answer 2

100% O2 - nonrebreather

Question 3

seizure causes

Answer 3

acidosis, electrolyte imbalance, hypoglycemia, barbiturate withdrawals, etc, heart, lung, liver disease, SLE, DM, HTN, septicemia

Question 4

Primary Generalized Seizures

Answer 4

Primary Generalized Seizures (non-focal)
Involves both sides of the brain
Most people lose consciousness

Question 5

Focal Seizures

Answer 5

Focal Seizures (Partial or Partial focal)
Begins in one hemisphere of the brain in a specific region of the cortex
Produces sensory, motor, cognitive or emotional disturbances based on the area of brain involved

Question 6

Absence Seizure

Answer 6

Typical Absence Seizure (petit mal)
Usually occurs in children and rarely extend beyond adolescence
Simple absence seizure – blank stare “day dreaming” for 10 sec
Complex absence seizure – blank stare accompanied by some form of body movement (chewing, blinking, etc) for up to 20 sec
Atypical absence sz – similar to complex absence seizure but continue into adulthood
May occur >100x a day; easy to overlook
*Very important to diagnose and treat these as they may progress to tonic-clonic grand mal seizures

Question 7

Generalized: Tonic-Clonic Seizure “Grand mal”

Answer 7

Most common of the generalized seizures
Loss of consciousness followed by stiffening of the body (tonic phase lasting 10-20 sec)
Then jerking of extremities (clonic phase for 30-40 secs)
Cyanosis, excessive salivation, incontinence, biting of tongue/cheek common
No memory of seizure
Postictal: fatigue, confusion, amnesia, muscle soreness

Question 8

Atonic seizure (aka “akinetic”, “astatic”, “drop”)

Answer 8

Involves a tonic episode or an acute loss of muscle tone → person falls to ground
Person usually remains conscious. High risk for head injury
Lasts <15 secs

Question 9

PARTIAL SEIZURES: SIMPLE FOCAL SEIZURE

Answer 9

Person remains conscious and alert
Sudden unexplained emotions: joy, anger, sadness or nausea
May hear or smell things that aren’t real

Question 10

PARTIAL SEIZURES: COMPLES FOCAL SEIZURE

Answer 10

Person has loss of consciousness or alteration in awareness
Their eyes are open but unaware of their actions “dreamlike”. Can be dangerous or embarrassing as people may walk onto oncoming traffic or remove their clothes
May spread across the brain and evolve to become tonic-clonic type

Question 11

STATUS EPILEPTICUS (SE)

Answer 11

Any seizure lasting >5 min or a series of separate seizures in rapid successions in which the person does not regain consciousness.
Neurons become exhausted and stop functioning → anoxic brain injury

Question 12

STATUS EPILEPTICUS (SE) - complications

Answer 12

respiratory distress, cardiac dysrrhythmias, acidosis, hyperthermia

Question 13

Do’s and Don’ts during a seizure

Answer 13

Observe:
Time seizure and characteristics
Safety:
Do remove objects around patient to prevent injury
Do not stick your finger in mouth to clear airway
Do not attempt to start an IV (you may harm yourself or patient)
Don’t use padded tongue blades
can chip teeth and obstruct airway or get aspirated

Question 14

MS

Answer 14

A chronic progressive degenerative disorder of the CNS
Characterized by disseminated autoimmune demyelination of the myelin sheath of the brain and spinal cord.
Affects women more than men. Onset between 20s to 50s. Avg life expectancy is 25 years from onset
African American and Asians have lower incidence

Question 15

ms - Three pathological processes

Answer 15

chronic inflammation
demyelination
gliosis (scarring) in the CNS

Question 16

Positive MS dx requires:

Answer 16

At least 2 inflammatory demyelination lesions in MRI
Sx attacks occurring at different times > a month apart
All other possible dx ruled out

Question 17

MS: PSEUEDO-EXACERBATION - on exam

Answer 17

Temporary worsening of symptoms without actual myelin inflammation or damage
Brought on by triggers such as UTI (most common), infection, stress, exercise
Uhthoff’s phenomenon (extreme heat that worsen’s MS symptoms
Once trigger resolves symptoms usually subside within 24 hrs

Question 18

MS - avoid what?

Answer 18

heat, saunas

Question 19

parkinsons symptoms - TRAP

Answer 19

tremor, rigidity, akenisia, postural instability

Question 20

parkinsons meds - on exam

Answer 20

Dopaminergic: Levodopa/carbidopa (Sinemet)

Question 21

MYASTHENIA GRAVIS (MG)

Answer 21

Auto-antibodies attack acetylcholine receptors (AChR). Prevents Ach from binding and stimulating muscle contraction.

Question 22

MYASTHENIA GRAVIS (MG) - symptoms

Answer 22

Initial mild Sx: MAIN one = ocular palsie (can’t open eyelids), ptosis, diplopia, incomplete eye closure. In 20% of people, MG does not progress beyond ocular muscle involvement

Question 23

MYASTHENIA GRAVIS (MG) - diagnosis

Answer 23

Ice pack test: Ptosis improves when cold applied to eye. (Colddecreases Ach breakdown)
Tensilon (Edrophonium) test – an IV Acetyl cholinesterase inhibitor that improves muscle contractility after administration
Serology test to identify for specific antibodies
CT to evaluate for thymoma

Question 24

on exam - Myasthenic vs Cholinergic Crisis,

Answer 24

Myasthenic crisis: exacerbation of Sx caused by under-medication with anti-cholinesterase leading to decreased ACh at the receptor site. Sx: ↑ skeletal muscle weakness, ptosis, bulbar signs, dyspnea, respiratory failure requiring intubation
Sx improve after IV anticholinesterase. Pt needs a Medic Alert bracelet. Myasthenic crisis requires admission to the ICU: anticholinesterases, steroids, plasmapheresis, IVIG. Cholinergic crisis: acute. exacerbation of muscle weakness due to over medication with anticholinesterase d/t remission or after thymectomy leading to ↑ Ach activity at the receptor sites. flaccid paralsysis, resp. failure, increased salivation and broch secretions, pupillary misosi. others - defication, urination, GI stress, muscle spasm, lacrimation.
sx wores after IV antiochinesterase. have atropine on standby.

Question 25

AKA LOU GEHRIGS DISEASE

Answer 25

Patient remains cognitively intact while the body is wasting away

Question 26

als death

Answer 26

*Death usually results from respiratory tract infection 2/2 respiratory dysfunction

Question 27

HUNTINGTON’S DISEASE

Answer 27

Involves the basal ganglia and extrapyramidal motor system
Results in: Excessive dopamine, deficiency of Ach and GABA

Question 28

HUNTINGTON’S DISEASE - symptoms

Answer 28

Abnormal and excessive involuntary movement (chorea). Writhing, twisting movements of limbs, face and body

Question 30

depression meds for older adults

Answer 30

sertraline (Zoloft), citalopram (Celexa), fluoxetine (Prozac)