Nov. 27, 2019 Flashcards
1
Q
What does ALS stand for (be able to spell this shit)
A
Amyotrophic Lateral Sclerosis
2
Q
What does MYOTROPHIC indicate?
A
Atrophy of muscle fibers
3
Q
Does ALS affect SENSORY or MOTOR neurons more?
A
MOTOR exclusively
4
Q
In what people group is ALS more common?
A
Middle age men
5
Q
How long does ALS typically last?
A
2-5 years
6
Q
What is usually the cause of death in ALS?
A
Respiratory complications
7
Q
What is the Et of ALS?
A
- Genetic
- Sporadic (90-95%)
- Familial (5-10%)
- Autoimmune
- Viral?
8
Q
What gene is often affected in ALS that results in the accumulation of FREE RADICALS?
A
SOD1 gene on Ch 21
9
Q
What happens to MOTOR NEURONS in ALS?
A
They degenerate
10
Q
The MOTOR NEURONS in what 3 areas are most affected?
A
- The brain stem
- The anterior horn in the spinal cord
- Upper MOTOR NEURONS in the cerebral cortex
11
Q
What is the difference between UPPER MOTOR NEURONS ans LOWER ones
A
UPPER go from the brain to the spinal cord, LOWER go from spinal cord to periphery
12
Q
How do FREE RADICALS contribute to the patho of ALS?
A
They cause damage to the MOTOR NEURONS when they accum
13
Q
How does GLUTAMATE contribute to the patho of ALS?
A
They cause damage to the MOTOR NEURONS when they accum. NEURO-toxic
14
Q
Is GLUTAMATE a stim or inhib NEUROTRANSMITTER?
A
Stim
15
Q
What are the mnfts of ALS?
A
- Muscle atrophy
- Fasciulations
- Weakness
- Dysarthria
16
Q
What are fasciulations?
A
Twitching
17
Q
What is dysarthria?
A
Difficulty speaking d/t resp muscle atrophy
18
Q
What kind of eating precautions do ALS patients need? Why?
A
Swallowing precautions d/t high aspiration risk r/t dysphagia
19
Q
What affect does ALS have on cognition and sensation?
A
None
20
Q
How is someone diagnosed w ALS?
A
- Hx
- Presence of mnfts
- Electromyography (ELECRTO
21
Q
What is ELECRTO?
A
Stim nerve and observe its action
22
Q
What is the cure for ALS?
A
There isn’t one
23
Q
What is the Tx for ALS?
A
- Mostly supportive
- Symptom management
- Prevent resp infct
- Riluzole
24
Q
What kind of drug is Riluzole?
A
An antiGLUTAMATE
25
How does Riluzole help Tx ALS?
By suppressing GLUTA-toxicity it helps prevent damage to MOTOR NEURONS
26
What is BACTERIAL MENINNGITIS?
Inflm of the MENINGES
27
Is BAC M dangerous?
Yes, life-threatening
28
What 2 flora are most commonly associated with BAC M?
- NEISSERIA MENINGITDIS (NEISS M)
| - STREPTOCOCCUS PNEUMONIA (STREP PNEU)
29
What age is most affect by NEISS M?
Youth
30
What age is most affected by STREP PNEU?
Adults
31
Where can you find NEISS M and STREP PNEU most in the body?
In small numbers w/in the nasopharnynx
32
How do congruent infcts relate to the Et of BAC M?
A congruent infct (eg sinusitis) could cause the normal flora in the nasopharynx to make contact with the MEINGES and result in BAC M?
33
Why can BAC M occur after a neural Sx?
Because the cranium is compromised, this creates a perfect portal of entry for bacteria to reach the meninges. Head trauma can result in this problem too
34
Why do chronic diseases and steroid use also put someone at risk for BAC M?
Because these cause dec immunity
35
A quick overview of the patho for BAC M?
Bacteria make contact with the MENINGES -> they prolif -> inflm -> purulent exudate
36
Why does inc INTRACRANIAL PRESSURE become a problem during BAC M?
because the inflm and exudate take up a lot of room, increasing the pressure to dangerous levels if not relieved
37
Vascular _________ is a risk of BAC M
Congestion
38
Can infarction become of complication of BAC M?
Yes
39
What could happen as the MENINGES swell?
They could become fused
40
What is HYDRCEPHALUS and how does it occur in BAC M?
HYDROCEPH is caused when CSF flow is disrupted and begins to accum
41
Mnfts of BAC M?
- Nuchal rigidity
- Back pain
- BRUDINSKI'S SIGN (BRUDS)
- KERNIG'S SIGN (KERNS)
- Fever
- Nausea/vomiting (from the pain)
42
How does BRUDS present?
Flexation of the neck causes lifting of knees
43
How does KERNS present?
Knee is resistant to flexation
44
What is done to diagnose BAC M?
- Hx and Px
- C+S of CSF
- CBC
- Serology
- CSF content evaluated
45
What contents w/in CSF could indicate BAC M?
- Pus
- WBCs
- Protein
- Dec glucose
46
Why is there dec glucose in CSF w BAC M?
Because the bacteria are using the glucose as an energy source
47
What are the Tx for BAC M?
- Abx
| - Steroids
48
What is another name for VIRAL MENINGITIS (VIR M)?
ASEPTIC MENINGITIS
49
What viral infct is most commonly associated w VIR M?
Mumps
50
What does paramyxovirus cause?
Mumps
51
Which is more dangerous: BAC M or VIR M?
BAC M
52
T or F:
| VIR M will not get better unless aggressively treated, healthcare providers must monitor very closely
F, VIR M is usually self-limiting, although it still requires monitoring to be sure it doesn't continue to get worse
53
What is elevated in the CSF of a pt w VIR M?
Lymphocytes
54
How is glucose affected in VIR M?
It isn't
55
How are proteins affected by VIR M?
There are elevated levels of proteins in the CSF
56
Why should you administer anti-viral meds in VIR M?
You shouldn't, not unless it gets out of hand
57
What is the Tx of VIR M?
Largely supportive and monitoring
58
What is ENCEPHALITIS? (ENCEPH)
Inflm of the brain tissue
59
Specifically what brain tissue is affected in ENCEPH/
Parenchymal tissue
60
T or F:
| ENCEPH is usually VIRAL
T
61
What 2 VIRUSES are associated w ENCEPH?
- Herpes simplex type 1
| - Arbovirus
62
Where does the ARBOVIRUS generally come from?
- Ants
- Crabs
- Lobsters
- Ticks
- Many things like the above
63
ENCEPH is highly _________
Variable
64
What causes the degeneration of cell bodies in ENCEPH?
Virus disrupts the genetic info within the neuron, causing neurons to lyse,
resulting in degeneration of cell bodies and necrosis of healthy neurons
65
What causes hemorrhage in ENCEPH?
BVs are affected through the inflm process and tissue damage, causing hemorrhage
66
What causes edema in the brain d/t ENCEPH?
Inflm causes exudate production resulting in edema in the brain tissue
67
How does the disease differ if pt is infected w the HERPES VIRUS as opposed to the ARBOVIRUS?
```
ARBO = self limiting (~2 weeks)
HERPES = more severe, requiring more aggressive Tx
```
68
Systemic mnfts of ENCEPH?
Lethargy
69
Local mnfts of ENCEPH?
Seizures & coma d/t neurological disturbances, fever, nuchal rigidity, and headache (fever and headache normally considered systemic but because this is an issue within the brain they are local)
70
What is the mortality rate of ENCEPH?
~ 30%
71
What are the Txs for ENCEPH?
- Antiviral drugs for HERPES
- Acyclovir IV
- Symptom management
72
Is a SEIZURE a disease or a mnft?
A mnft
73
What causes SEIZURES?
Excessive, acute, uncontrolled neural stimulation (altered behavior and movements)
74
Is EPILEPSY a disease or a mnfts?
A disease
75
What is EPILEPSY characterized by?
Recurrent, unprovoked, chronic SEIZURES
76
What is the Et of SEIZURES?
Changes to the NEURILEMMA
77
Describe PRIMARY SEIZURES?
- Unprovoked
- Idiopathic
- Genetic??
- Not a mutated gene, but a predisposition
78
Describe SECONDARY SEIZURES?
- CNS injury
- Fever (esp in kids)
- May come right after severe infct
- Hypoxia
- Brain is AEROBIC *only*, cannot use ANAEROBIC as
a last resort
- Hypoglycemia
- 'Lyte imbalance
79
What is the origin of PARTIAL SEIZURES?
Focal (one hemisphere)
80
How do SIMPLE PARTIAL and COMPLEX PARTIAL SEIZURES differ from each other?
```
SIMPLE = No l/o consciousness
COMPLEX = L/o consciousness
```
81
What hemisphere does a GENERALIZED SEIZURE affect?
Both! It is non-focal
82
How does NEURONAL DISCHARGE contribute to SEIZURES?
There is an acute, extreme inc in NEURONAL DISCHARGE that causes SEIZURES to happen
83
Where does the NEURONAL DISCHARGE take place?
In the CEREBRAL CORTEX and HIPPOCAMPUS
84
Where is the EPILEPTOGENIC FOCUS?
In the CORTEX and HIPPO
85
Are the adjacent NEURONS affected by the over-stimulated ones?
Yes
86
How are inhib NEURONS affected during a SEIZURE?
They are overwhelmed. I can totally relate to you inhibitory NEURONS :(
87
When does a SEIZURE end?
When NEURONAL activity is controlled
88
What happens during the intermittent contraction-relaxation phase?
Spastic, rigid movements
89
What is the last phase in a SEIZURE?
The postictal phase
90
What happens during the postictal phase?
The pt appears to be sleeping, drowsy, etc
91
How might LACTIC ACIDOSIS occur during a SEIZURE if the brain is unable to metb anaerobically?
Other muscles throughout the body are also involved during a SEIZURE, and if the SEIZURE requires more o2 and ATP than the body is able to provide, hypoxia will set in, triggering anaerobic metb and as a result - LACTIC ACIDOSIS
92
What is a STATUS EPILEPTICUS?
A prolonged SEIZURE
93
What is the use of an EEG with a person who has had a SEIZURE?
It is used to detect or visualize the damage present
94
Tx for SEIZURES?
- Prevent injury during a SEIZURE
- Anticonvulsants eg Ativan
- Preserve brain Fx eg prevent ACIDOSIS
95
What is a long term Tx for SEIZURES?
- Anticonvulsants
| - Sx??
