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Adult Part II > Nuero Part 1 > Flashcards

Nuero Part 1 Flashcards

1
Q

MS def

A

Inflammation of and destruction of myelin sheath of neurons

Onset 15-45
W>M
Increases with distance from equator

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2
Q

Relapsing - remitting MS

A

Most common, acute exacerbations followed by full, partial or no revolver of function. Recovery from an attack takes weeks —> months

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3
Q

Primary progressive MS

A

Characterized by a gradual but steady progression of disability. Common in people who develop the disease after the age of 40

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4
Q

Secondary - progressive MS

A

Initially begins with replacing remitting MS then evolves into a progressive disease. The progressive part may begin shortly after onset of MS or later

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5
Q

Progressive - relapsing MS

A

Least common form of disease and is characterizes by steady progressive of disease with acute attacks that may or may not be followed by some recovery. These people have primary progressive initially

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6
Q

Clinical impression of MS

A

Blurred or double vision , limb weakness, paresthesia, clumsiness, lack of coordination/balance difficulty thinking/ concentrating,

Dizziness, bowel and bladder dysfunction, tremors, speech difficulty

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7
Q

Biggest organs affected of MS

A

Involves immune attack against the central nervous system .. targeting the brain, spinal cord and optic nerve at the back of the eye

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8
Q

Lab work for MS

A

CSF - increased immunoglobulins, separation into oliochlonal bands

Evoked Potentials - how long stimuli take to get to the optic nerve

MRI - lesions found in white matter of brain, spinal cord and optic nerves, 1-4 cm in diameter

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9
Q

Management of MS

A

Treat relapses - IV corticosteroids at onset followed by tapering oral corticosteroids

Manage symptoms

Delay progression to disability

Emotional support

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10
Q

Factors that influence treatment decisions

A

Stage of disease and amount of recent disease activity

MRI leasion burden and activity

Safety and tolerability profiles of immunomodulating agents

Efficacy of the immunomodulating agents

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11
Q

Tremor - def

A

Involuntary visible, rhythmic and oscillatory movements of a body part

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12
Q

Physiological or non pathological

A

Essential - familial tremor - action tremor

Usually undetectable, and to some degree present in everyone

Can involve any muscle group but arm and hand most common

Nuero exam - normal

Enhanced physiological

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13
Q

Characteristics of essential tremor / familial tremor

A

Head, jaw, throat, fingers

Increases with - fear, fright, anxiety

  • caffeine / SSRI, adderall
  • nicotine, steroid use
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14
Q

Medications that increase physiologic tremors

A

Antiarrythmics, antidepressants, antiepileptic, beta agonist, glucocorticoids, mood stabilizers, thyroid hormone ( hypothyroidism), toxins

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15
Q

Essential tremor / FT unique characteristics

A

Appearance only during movement- ceases up in relaxation

  • tremor will slightly increase as target approached
  • bilateral
  • alcohol can improve the tremor
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16
Q

Enhanced physiological tremors caused by

A

Steroids, alcohol, hyperthyroidism, hypoglycemia

Treat aimed at correcting underlying problem

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17
Q

Pathological tremors : Cerebellar tremor

A

Also known as intention tremor
Characteristics
- absent when limbs are inactive ( no resting tremor)
- tremor present with action or movement and increases when closer to target
- abnormal nuero exam
- problems with coordination, cant correct tremor, present along with swinging arms and clumsiness

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18
Q

Cerebellar Tremor - caused by

A

MS, Stroke, other Cerebellar injury

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19
Q

Parkinsonian tremor

A

Resting tremor and is coarser , most often unlilateral

Involving fingers, hands, arms, jaw, lips and tongue

Pill rolling tremor

Tremor present when limb is at rest and diminishes with voluntary movement

Excitement and stress will increase tremor

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20
Q

Parkinson Disease - def

A

Chronic progressive disease

Treatment is aimed at improving function and mobility

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21
Q

PD - cardinal features

A

Tremors - rest in distal extremities, usually unilateral and tremor disappears with action

Rigidity - increases in muscle tone that can be elicited wen one moved the patient limbs

Bradykinesia - loss of automatic movement and difficulty initiating movement

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22
Q

Levy body dementia

A

Progressive type of dementia associated with PD

Characterized by fluctuations in concentration, attention, alertness and wakefulness from day to day

Depression, apathy, anxiety and agitation

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23
Q

DX Parkinson’s disease

A

Looking for sings
- loss of sing of arms when walking, shuffling gait with small septs, flexed posture, masked facial appearance, decrease blinking, overall - depressed look

Hyposmia - inability to smell ( early sign)

No labs, refer to neuro

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24
Q

PD treatment

A

New options like stem-cells
Standard tx works for 7-10 years

2 main ones

25
Q

Sinemet

A

Mixture of levodopa and carbidopa
- breaks down dopamine so more dopamine is available

Syncope is major side effect, start slow

26
Q

Dopamine agonists

Requip
Mirapex

A

Side effects Dyskinetic movements, hallucinations, confusion

27
Q

Epilepsy - def

A

Chronic neurological disorder characterized by recurrent unprovoked seizures

28
Q

Seizure

A

Caused by discrete, temporary metabolic abnormality or height fever and does not means a dx of epilepsy, unless they reoccur and become a pattern

29
Q

Focal onset

A

Can start in one area or group of cells in the brain - person can be awake or impolite awareness - may be confused

30
Q

Generalized onset

A

Affects both sides of the brain at the time time, may be Tonic/clonic or atonic

31
Q

Unknown onset

A

Onset not witnessed

32
Q

Tonic

A

Sudden stiffening and contraction of the muscle

33
Q

Clonic

A

Rhythmic twitching and jerking of one or several muscles

34
Q

Tonic - clonic

A

Combination fo both types and typical in generalizes seizure

35
Q

Seizure threshold lowering factors

A 
Decreased sleep
Increased ETOH
Physical / emotional stress
Flashing lights
Fever
Hormones
Drug use
36
Q

Seizure medications

A

Strive for monotherapy

  • Consult Neuro
  • therapeutic ranges of rugs, CBC and LFT’s
37
Q

Dilantin - side effects

A

Gingival hyperplasia

38
Q

Meningitis

A

Inflammation of Brian and spine cord meme brain

Acute or subacute

Viral or bacterial

39
Q

Meningitis - presentation

A

Fever, headache, stiff neck, n/v/ photophobia, petechiae on torso and with more acute bacterial causes

Altered LOC, seizures, and hypotension

40
Q

Meningeal signs

A

Nuchal rigidity

Indicates inflammation of the dura

41
Q

Brudzinski sign

A

Pt supine , tilt neck forward toward chest , if meningeal irritation = flex of the hips and knees

42
Q

Kernigs sign

A

Meningeal sign

Flex hip and knee on one side and then extending knee with hip still flexed . Hamstring spasm = pain in posterior thigh, back pain or difficulty with knee extension = + meningeal sign

Severe meningeal inflammation = opposite knee may flex

43
Q

Bell’s Palsy

A

Acute, unilateral paresis of facial muscles due to inflammation and subsequent mechanical compression of the 7 th nerve

44
Q

Bell’s palsy - symptoms

A

Droopy eye lid, dry eye or excessive tears

Facial paralysis, twitching or weakness

Drooping corner of mouth, dry mouth, impaired taste

45
Q

Bell’s palsy

A

Viral neuropathy caused by activation of HSV type 1

46
Q

BP clinical presentation n

A

Sudden onset of facial weakness, loss of voluntary movement of facial and scalp muscles, altered ability to close one eye, loss of taste, hypersensitivity to sounds and excessive tearing

May report a URI, discomfort around jaw, ringing in ears

47
Q

BP PE and management

A

Sagging eyebrow, inability to close affected eye, disappearance of nasolabial fold and drooping at the affected corner of the mouth

Protect eye to prevent corneal abrasion, lubricant eye drops 1-2 drops every 2 hours and opthamlmic ointment at night, patch eye air night, wear glasses when outside

48
Q

BP medications

A

Prednisone 60mg for 3 days and then taper by 20 mg every 3 days for 9 days

Valacylvior 1gm TID for 1 wk

Doxy if related to Lyme

49
Q

BP follow up

A

2-3 times during 1st week to eval status of paralysis, condition of eye, response to medications

Recovery : usually within a few weeks to months, may never recover

If recurrent , work up for tumor

50
Q

Primary headache

A

Tension, cluster, migraine

Results from a biochemical physiologic or electrical dysfunction of the brain

No underlying organic cause

Does not pose a threat

51
Q

Secondary headaches

A

Refer to an underlying organic cause that must be specifically treated

  • hypertension
  • brain tumor
  • head trauma
  • sinusitis
  • subarachnoid hemorrhage
  • meningitis
52
Q

Sinus headache

A

Pain is behind the browbone and / or cheek bones

53
Q

Cluster headache

A

Pain is in and around one eye

Burning, piercing pain, unilateral, hot poker into eye 
Causes tearing of eye and drainage 
30-120 min , 1-8 times a day 
Usually nocturnal and seasonal 
Pattern - remission and excerabation 
Males
54
Q

Tension headache

A

Pain is like a band squeezing the head

Pain worsens throughout the day
Bilateral - frontal in location
More females than males
30 min - 7 days

Analgesics
Stress reduction, exercise

55
Q

Migraine

A

Pain, nausea and visual changes are typical

Aura - 5-20 min
Can be unilateral pain 4-72 hours
Increases during menses or menopause

BCP or Depakote to prevent headache , taken daily whether or not headache is present

56
Q

Acute abortive treatment

A

5HT1 agonists - Sumatriptan - Imitrex

  • concern for CVD
  • no combine with ERGOTS or MAOI

NSAIDS, analgesics

Ergotamine / Caffeine - Cafergot

  • potent vasoconstrictor
  • SE: nausea

Antiemetics
- Tigan IM, Suppository or PO

57
Q

Cluster headache medications

A

Ergots - not effect

DHE - IV, IM , intranasal

Serotonin agonist - triptans

Oxygen therapy - very effective set up at home 100 % via face mask x 10-15 min

58
Q

Trigeminal nueralgia 5th cranial nerve

A

Severe pain in divisions of trigeminal nerve
- unilateral
- brief episodes of electric shock like pain
Lasting from one to several seconds

Triggers - chewing, talking, brushing teeth, dental extractions

Rule out - herpes zoster, MS, trauma, tumor, vascular compression

Imaging : MRI and CT

TX: carbamazepine (tegretol) BID and then titrate , Botox injection

59
Q

Prophalyatic treatment

A

Beta blockers

TCA’s

Adult Part II (6 decks)

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