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SU18: Internal med final > Neurologic Disorders > Flashcards

Neurologic Disorders Flashcards

1
Q

epilepsy

A

disorder of brain characterized by predisposition to epileptic seizures

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2
Q

epilepsy is what type of condition

A
  • heterogenous condition

* multiple seizure types and syns, diverse etiologies, variable prognoses

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3
Q

etiology of seizures

A
  • genetic
  • structural (i.e. tumor)
  • metabolic
  • immune
  • infectious
  • unknown (i.e. at end of syncopy, ppl can seize)
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4
Q

what is a big component of pts having seizures?

A

alcohol withdrawal

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5
Q

what are the 3 ways to classify seizure disorders

A
  1. focal seizures with retained awareness
  2. focal seizures with impaired awareness
  3. generalized seizures
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6
Q

what may pts with focal seizures with retained awareness experience?

A

an aura

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7
Q

clinical presentation of focal seizures with retained awareness if occipital cortex is affected?

A

flashing lights

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8
Q

clinical presentation of focal seizures with retained awareness if motor cortex is affected?

A

rhythmic jerking on body opposite affected side

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9
Q

clinical presentation of focal seizures with retained awareness if parietal lobe is affected?

A

distortion of spatial perception

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10
Q

clinical presentation of focal seizures with retained awareness if frontal lobe is affected?

A

sudden speech difficulties

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11
Q

postical state with focal seizures with retained awareness

A
  • may return to pre-event baseline

- may experience worsened neurologic fxn for a period of time

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12
Q

what is the most common type of seizures in adults with epilepsy?

A

focal seizures with impaired awareness

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13
Q

T/F: pts who are having a focal seizure with impaired awareness appear to be asleep

A

false, they appear to be awake

*eyes are open

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14
Q

clinical presentation of person having a focal seizure with impaired awareness

A
  • does not interact with others in their environment

- does not respond normally to instructions/questions

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15
Q

how long does a focal seizure with impaired awareness last?

A

<3 minutes

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16
Q

postical state with focal seizures with impaired awareness

A
  • somnolence (state of strong desire to sleep)
  • confusion
  • headache
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17
Q

which hemisphere does generalized seizures affect?

A

both hemispheres

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18
Q

what is the most common type of generalized seizures?

A

generalized tonic-clonic

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19
Q

characteristic of generalized seizure

A

abrupt loss of consciousness

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20
Q

how many phases are there in a generalized seizure?

A

3

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21
Q

what are the 3 phases of a generalized seizure?

A
  • tonic
  • clonic
  • postictal
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22
Q

tonic phase of generalized seizure

A

muscle stiffness

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23
Q

how long does the tonic phase of a generalized seizure last?

A

~1 min

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24
Q

clonic phase of generalized seizure

A

muscles jerk and twitch

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25
Q

how long does the clonic phase of generalized seizure last?

A

~2 mins

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26
Q

postictal phase of generalized seizure

A
  • initial deep sleep followed by gradual awakening

- confusion and/or agitation

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27
Q

syms of aura phase in tonic-clonic seizure

A
  • light-headedness
  • dizziness
  • confusion
  • hallucinations
  • some pts say they can smell certain things
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28
Q

syms of tonic phase in tonic-clonic seizure

A
  • skeletal mm. tense uo

- usually lose consciousness

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29
Q

syms of clonic phase in tonic-clonic seizure

A
  • jerky movements
  • convulsions
  • violent shaking
  • uncontrollable twitching/rolling
  • sometimes breathing stops
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30
Q

syms of postical phase in tonic-clonic seizure

A
  • confusion
  • amnesia
  • nausea upon regaining consciousness
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31
Q

med management of seizure disorders

A
  • long-term drug therapy
  • reduce frequency over lifetime
  • slow increase in dose to avoid adverse side effects
32
Q

what are the first-line agents for pts with seizure disorders?

A
  • phenytoin
  • carbamazepine
  • valproic acid
33
Q

what percent of pts gain control of seizure disorder within 5 yrs?

A

60-80%

34
Q

status epilepticus

A

repeated seizures over short period of time without a recovery period

35
Q

status epilepticus can cause the brain to be what?

A

gravely hypoxic and acidotic

*may lead to extensive brain injury and possible death

36
Q

status epilepticus is usually observed in what type of pts?

A

more frequently observes in pts who have abrupt withdrawal from anticonvulsant med or abused drug

37
Q

is routine dental care indicated for pts with controlled seizure disorders?

A

ye,s can do surgery and any elective dental care

38
Q

should pts with seizure disorders discontinue taking their anticonvulsant meds before their appt?

A

no

39
Q

dental mods for pts with controlled seizure disorders

A

good stress/pain control

40
Q

what should you do if the pt in your chair is having a seizure?

A
  • stop procedure and remove everything from mouth
  • passively support pt to prevent injury
  • should have return of consciousness within few minutes
  • escort home
41
Q

should you hold down a pt who is having a seizure in your chair?

A

no, don’t try to hold pt down

42
Q

why should you check a pt’s blood sugar after they have a seizure?

A

low blood sugar can induce seizure

43
Q

should you send the pt who was having a seizure in your chair to the ER?

A

no

44
Q

stroke

A

sudden interruption of oxygenated blood to brain

45
Q

what determines the morbidity/mortality of stroke pts?

A
  • length and severity of ischemia

- amount of brain that has necroses

46
Q

T/F: having a stroke is not fatal

A

false, can be

47
Q

a stroke can debilitate what?

A
  • motor
  • speech
  • cognition
48
Q

additive risk factors for developing a stroke

A
  • history of stroke or transient ischemic attack (TIA)
  • age >75 yrs
  • smoking
  • hypertension
  • coronary atherosclerosis
  • congestive HF
  • diabetes mellitus
  • hyperchlesterolemia
49
Q

what are the 2 types of stroke?

A
  • ischemic

- hemorrhagic

50
Q

what percent of stokes are ischemic?

A

60-80%

51
Q

what can lead to someone having an ischemic stroke?

A
  • atherosclerosis
  • emboli
  • hypotension
52
Q

ischemic stroke

A

clot stops blood supply to area of brain

53
Q

hemorrhagic stroke

A

bleeding into brain from ruptured vessel

54
Q

what can cause microaneurysms?

A

hypertension

55
Q

transient ischemic attack (TIA)

*mini stroke

A

transient episode of neurologic dysfunction caused by focal ischemia without acute infarction

56
Q

T/F: TIA can cause permanent injury

A

true

57
Q

T/F: TIA is considered a neurologic emergency

A

true

58
Q

why is TIA a bad sign?

A

something pending is about to happen… i.e. MI or bigger stroke

59
Q

if pts syms resolve before medics arrive, do pts still need to go to the ED?

A

yes, need to be evaluated (i.e. determine what type of stroke it was)

60
Q

outcomes of cerebrovascular accident (CVA) aka another name for stroke

A
  • death

- disability

61
Q

what percent of CVA deaths are hemorrhagic?

A

38-47%

62
Q

what percent of CVA deaths are ischemic?

A

8%

63
Q

disability due to CVA depends on what?

A

size and location of injury

64
Q

T/F: return of fxn of CVA pts are predictable

A

false, return of fxn is unpredictable and slow

65
Q

med management of individuals at risk for CVA

A
  • reduce/eliminate risk factors

- drug therapy

66
Q

drug therapy for individuals at risk for CVA

A
  • antihypertensive drugs
  • antiplatelet drugs
  • statis
67
Q

acute med management of CVA

A
  1. sustain life immediately after stroke
  2. emergency effort to prevent further thrombosis or hemorrhage or to lyse the clot
  3. rehabilitation and prevention of future events
68
Q

T/F: once pts have stoke, they’re always going to be at risk for having another stroke

A

true

69
Q

individuals with history of CVA/TIA are at an elevated risk for stroke for how long after the event

A

6 months

70
Q

during the first 6 months after a pt has a stroke, can they have invasive dental work done?

A

no, just preventative like prophys

71
Q

T/F: pts with recent TIA are considered unstable

A

true

72
Q

should you txt pts who has a recent TIA?

A

no, no elective care

73
Q

dental management of individuals with history of CVA/TIA

A
  • timing important

- stress reduction

74
Q

analgesia for individuals with history of CVA/TIA

A

Tylenol

75
Q

why can’t individuals with history of CVA/TIA take NSAIDs?

A

pt on anti-platelet drugs after stroke so can affect platelets

76
Q

should you give a pt Aspirin when they’re having a stroke?

A

NO, don’t know what type of stroke they’re having

77
Q

what will happen if you give Aspirin to a a pt who is having a hemorrhagic stroke?

A

will thin them out even more

SU18: Internal med final (25 decks)

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