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CPD III > Quiz 3- Neurological Disorders Part 2 > Flashcards

Quiz 3- Neurological Disorders Part 2 Flashcards

1
Q

a seizure typically causes

A

altered awareness, abnormal sensations, focal involuntary movements or convulsions (widespread violent involuntary contractions of muscles)

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2
Q

definition of types of seizures

A

epilepsy (recurrent unprovoked seizure. often idiopathic)
nonepileptic (seizure provoked by a temp disorder)
symptomatic (due to a known cause)
psychogenic (no electrical discharge in the brain)

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3
Q

what are a few etiologies for seizures emphasized during class?

A

CNS infxn
brain trauma
metabolic disturbances

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4
Q

generalized seizure
involves which parts of brain?
LOC?
from?

A

involves entire cortex of both hemispheres
complete LOC
from metabolic disturbances

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5
Q

partial seizure
involves which parts of brain?
LOC?
from?

A

involve one cerebral cortex
either no LOC (simple partial) or partial LOC (complex partial)
from structural abnormalities

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6
Q 
absence seizures (aka Petit Mal)
what population does it affect?
what type of seizure is it?
A

children

generalized

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7
Q

what does an absence seizure look like?

A 
occurs many times throughout the day 
5-30 sec LOC 
eyelid fluttering 
no falling or convulsing 
occurs when patient is sitting quietly, pt stares vacantly, may abruptly stop activity and just as abruptly resume it 
neuro and cognitive exams are normal
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8
Q

Tonic clonic seizures (aka Gran Mal)
who does it affect?
what type of seizure is it?

A

doesn’t say, think adults

general seizure

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9
Q

Tonic clonic seizure is characterized by?

A
  1. begin with outcry
  2. LOC and falling
  3. tonic contraction then clonic motion of muscles
    sometimes: urinary or fecal incontinence, tongue biting, frothing at the mouth
    NO AURA
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10
Q

Simple partial (a type of partial seizure) is characterized by?

A

cause motor, sensory, or psychomotor sxs without LOC

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11
Q

the types of simple partial

A

MOTOR - INDICATE STRUCTURAL BRAIN DZ
SENSORY - INDICATE STRUCTURAL BRAIN DZ
the focal onset localizing the lesion- full investigation is mandatory

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12
Q

motor (a simple partial seizure)

A 
arise in the frontal motor cortex with movements in the contralateral face, trunk and limbs 
jacksonian march (involuntary muscle movement from one muscle group to the next)
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13
Q

sensory (a simple partial seizure)

A

arise in the sensory cortex

parasthesias or tingling in an extremity or face sometimes associated with a distortion of body image

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14
Q

complex partial (a type of partial seizure) is characterized by?
LOC?
Originates where?
preceded by what?

A 
reduced but not complete LOC 
originate in temporal lobe
often preceded by an aura
during seizure patients may stare 
automatsims (oral or limbs)
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15
Q

what are some risk factors for seizures?

A 
prior head trauma or CNS infxn
known neurological disorders
drug/alcohol withdrawal
nonadherence to anticonvulsants 
family hx of seizures or neurological disorders
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16
Q

rare triggers of seizures

A 
repetitive sounds
flashing lights
video games
touching certain body parts
sleep deprivation
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17
Q

imaging to dx seizure?

A

EEG - critical for DX but normal EEG cannot necessarily r/o seizure disorder

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18
Q

what 3 common ssx (vomiting, fever, h/a) might be something more serious, for instance ______?

A

brain abscess

might also present with focal neurologic deficits and seizures

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19
Q

what common infections can turn into a potential brain abscess?

A

mastoiditis and sinusitis

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20
Q

encephalitis is inflammation of which part of the brain?

what viruses cause it?

A

parenchyma
mosquito-borne arboviral encephalitides
HSV
HIV

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21
Q

SSX of encephalitis?

sounds similar to which other condition?

A

fever, h/a, altered mental status, seizures, focal neurological deficits
sounds a lot like brain abscess, minus vomiting

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22
Q

rabies is a type of encephalitis transmitted by

A

saliva of infected bats or mammals

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23
Q

SSX of rabies

A 
depression
fever
agitation
excessive salivation
hydrophobia
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24
Q

when should you suspect rabies?

A

with ascending paralysis and recent hx of animal bit or exposure to bats

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25
Q

subdural empyema is what

A

a collection of pus between dura mate and arachnoid

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26
Q

what’s the etiology for subdural empyema?

A

usu a complication of sinusitis

ear infxn

27
Q

prion disease aka

A

transmissible spongioform encephalopathies

28
Q

transmission of prion disease

A

person to person as in kuru

animal to person as in CJD

29
Q

Creutzfeldt-Jakob Disease (CJD)- types

A

Sporadice (sCJD) accounts for 85% of cases

Variant (vCJD) comes from people eating meat from cattle with bovine spongioform encephalopathy

30
Q

SSX for CJD

A

memory loss (similar to dementia in terms of loss of volume of brain)
confusion
incoordination and ataxia
startle mycoclonus (jerky muscle movements brought on by sudden noise or other stimuli)
onset >40 YO

31
Q

when should you suspect CJD?

A

suspect in elderly patients with rapidly progressing dementia esp. if accompanied by ataxia or myoclonus

32
Q

what to know about Kuru?

A

disorder of TSE (transient spongiform encephalopathy) that has been extensively studied in Papua New Guinea and is spread from man to man through cannibalism

33
Q

all types of meningitis share some of the same ssx. which ones?

A

h/a
fever
nuchal rigidity

34
Q

PE’s for meninigitis

A

(+) Kernig
(+) Brudzinski
difficulty touching chin to chest with mouth closed

35
Q

DX for meningitis

A

CSF

36
Q

Acute bacterial meningitis
pathophysiology
ssx
dx

A

-hematogenous spread or nearby infected structures: sinuses, middle ear
-feeling unwell for 3-5 days (malaise, fever, irritability, vomiting)
then meningeal sxs may develop (h/a, fever, photophobia, changes in mental status- lethargy, obtundation, nuchal rigidity, seizures)
DX
-CSF: Incr WBCs (PMNs), incr protein, dec glucose
-CBC with diff: shift to the left
-Blood culture

37
Q

Viral Meningitis
causes
ssx
dx

A 
*less severe than bacterial meningitis 
enteroviruses (most common), HSV
- begin with: h/a, fever, GI or Resp sxs
-follow by: h/a, fever, nuchal rigidity)
DX:
-CSF: Inc WBCs (lymphcytes), protein slightly incr (less than bacterial meningitis), glucose normal
38
Q

what causes recurrent meningitis?

A

HSV
would see: ≥3 episodes of fever, nuchal rigidity, and CSF with inc. lymph; episodes last 2-5 days and resolve spontaneously

39
Q

what might cause subacute meningitis?

A

fungi

develops over days to a few weeks - hard to eradicate

40
Q

how to dx subacute meningitis?

A

clinical findings are non-specific

CSF may not provide indicative info and may need more invasive testing like brain bx

41
Q

compare physiologic tremor to pathologic tremor

A

physiologic - fast in rate, occurs while maintaining a posture
pathologic - slow in rate, occurs while at rest or with movment

42
Q

essential tremor

A

action tremor (occurs with movement)
20X more common than Parkinson dz (good to keep in mind)
alchohol alleviates sxs (reduces the overactivity of the cerebellum)

43
Q

what things should you cover in hx in someone with a tremor?

A

onset of tremor? body parts affected?
ROS: wt loss? dec appetite, diarrhea, palpitations, heat intolerance (hyperthyroidism)
muscle rigidity, gait and postural problems, slowness of movement (Parkinson dz or other forms of Parkinsonism)
sudden onset of motor weakness, difficulty with speech (stroke)

44
Q

PE for tremor

A

Vitals
HEENT- any signs of exopthalmus or eyelid lag?
Thyroid - enlarged thyroid gland?
Cardio - tachycardia?
Extensive neuro exam - extend arms out in front of them to look for tremor, spiral hand drawings (with action tremor will have difficulty, not with Parkinsonian tremor)

45
Q

What are the red flags for someone with a tremor?

know these

A
  • abrupt onset

- onset in ppl

46
Q

what’s the most common form of intellectual disability in males?

A

Fragile X-Associated Tremor/Ataxia Syndrome (FXTAS)

47
Q

Huntington Disease
pathology
ssx
dx

A

-neuronal loss in basal ganglia
SSX
-dementia or psych disturbances may precede movement disorders
-chorea (uncontrolled twisting and writhing movements)
-tics
DX
-clinical eval confirmed by genetic testing
-neuro imaging

48
Q 
Parkinson Disease
pathophysiology 
etiology
ssx
dx
A

-loss of neurons mainly in the stubstantia nigra and the presence of Lewy bodies
-genetic and/or environmental factors (smoking, herbicides, carbon dioxide)
SSX
-mask-like facies (little to no expression on face because of muscle rigidity)
-coarse tremor (occurs at rest and improves with movement and sleep)
-rigidity (of flexors of neck and trunks resulting in flexed posture)
-bradykinesia
-shuffling gate
-dementia (in 30%)
DX
- unilateral resting tremor that disappears during finger to nose coordination test

49
Q

MS

SSX

A

paresthesias in one or more extremity, in the trunk, or on one side of face
weakness or clumsiness of a leg or hand
visual disturbances
urinary incontinence (neurogenic bladder)

50
Q

whats the clinical course for MS?

A
  1. Relapsing-Remitting Pattern
    usu occurs in early course
    exacerbations alternate with remissions
  2. Primary Progression Pattern
    disease progresses rapidly without remission
  3. Secondary Progression Pattern
    initially begins with relapsing-remitting course, but later evolves into progressive course
  4. Progressive Relapsing Pattern
    disease progresses gradually with sudden relapses (rare)
51
Q

MS
PE
DX

A

reflexes- exaggerated repetitie knee jerk

MRI- most sensitive test for MS, reveals many plaques (# of plaques does not correlate with sx/dz severity)

52
Q

myasthenia gravis definition

A

condition that causes episodic muscle weakness and easy fatigability cause by immune destruction of acetylcholine receptors

53
Q

myasthenia gravis

SSX

A

fatigability (muscle weakness after use of the affected muscle), weakness resolves with rest
eyes - ptosis and diplopia
resp - recurrent pneumonia (can’t cough things out)

54
Q

myasthenia gravis

DX

A

Bedside test- tensilon (should see dramatic improvement in muscle weakness) & Ice-pack tests (improved neuromuscular transmission at lower temps, effect on ptosis immediately observed)
Confirmed by - Serum Anti-AchR Abs & EMG

55
Q

Guillain-Barre Syndrome (GBS)

A

antibody and cell-mediated rxns to peripheral nerve myelin involved

56
Q

SSX of Guillain-Barre Syndrome

A

motor impairment is > sensory
a. sensory sx to begin: parasthesia of feet then hands
b. then, rapid onset of severe muscle weakness (after a surgery, infection, or vaccination)
- usu weakness is symmetric and begins with legs and progresses to arms
-respiratory paralysis may occur
-at its worst: total flaccid quadriplegia
Prognosis:
50-90% complete recovery

57
Q

PE for GBS

A

DTRs are lost completely

58
Q

What’s the DDX for GBS?

A

-Myasthenia Gravis: weakness, early ptosis, opthalmoplegia; DTRS are retained
-MS: doesn’t resolve, hyperreflexia
Diabetes: glove and stocking parasthesia but DTRs retained

59
Q

ssx of a brain tumor

A

h/a (esp new onset, worsened by sleep

60
Q

What’s a primary tumor (glioma) that develops in younger patients?

A

Astrocytomas

61
Q

What’s a benign tumor of the meninges that can compress the adjacent brain tissue?

A

Meningiomas

62
Q

A patient with a pituitary tumor will manifest which sx?

A

h/a

visual manifestations

63
Q

Spinal cord tumors - what’s the sx you’ll see all the time that you should be thinking “is the a spinal cord tumor?”

A

progressive back pain that’s unrelated to activity and worsened by recumbency (highly unusual)

CPD III (7 decks)

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