Week 4 - Neurological and Peripheral Nerve problems

Question 1

What is multiple sclerosis

Answer 1

-Autoimmune disorder that affects nerve cells in brain and spinal cord
-Demyelination of nerve fibers of brain and spinal cord

Question 2

Initial symptoms of MS

Answer 2

-Blurred/double vision (usually first symptom)
-Red-green color distribution
-Blindness in one eye

Question 3

Motor manifestations of MS

Answer 3

-Spasticity of muscles
-Tremors
-Scanning speech
Weakness/paralysis of:
Head, trunk, lumbs

Question 4

Sensory Manisfestations of MS

Answer 4

-Numbness (Paresthesia)
-Pain
- Decrease hearing
-Vertigo and tinnitus
-Lhermitte’s sign
-Chronic neuropathic pain

Question 5

Cerebellar manisfesation of MS

Answer 5

Nystagmus
Ataxia - lack of muscle control
Dysarthria - speech disorder
Dysphagia - difficulty swallowing
Severe fatigue caused by heat and medications

Question 6

Diagnostic Studies for MS

Answer 6

-No definitive diagnostic test
-Primarily based on:
1) MRI of brain and spinal cord (plaques, inflammation, atrophy, tissue breakdown)
2) Cerebral spinal fluid analysis (increase immunoglobin G)

Question 7

Drug Therapy for MS

Answer 7

-Corticosteroids (methylprednisolone, prednisone)
-immunomodulators
(interferon B-1a - Avonex, Rebif)
(Interferon B-1b - Betaseron)

Question 8

AST levels

Answer 8

0 - 35

Question 9

ALT ranges

Answer 9

4 - 36

Question 10

Billirubin

Answer 10

0.1 - 1.0

Question 11

Albumin

Answer 11

3.5 - 5

Question 12

What is Guillain-Barre Syndrome?

Answer 12

Acute destruction of the myelin sheath of peripheral nerves

GBS is acute illness, MS is chronic

autoimmune disorder

Question 13

Diagnostic studies for GBS

Answer 13

• Progressive weakness of more than one limb
• Absent/diminished reflexes
• CSF
• EMG/Nerve conduction

Question 14

Clinical manisfestations of GBS

Answer 14

• Ascending muscle weakness
• Respiratory compromise
• Muscle flaccidity –> muscle atrophy
• Paresthesia
• Double vision, facial weakness, dysarthria, dysphagia

Question 15

GBS management

Answer 15

• Plasmapheresis: removes antibodies
• High-dose IV IG: interferes with antigen presentation

Question 16

What is myasthenia gravis?

Answer 16

-Autoimmune disease affecting neuromuscular junction (antibodies attack ACH receptors)
-Causes fluctuating muscle weakness that increase with muscle use

Question 17

Clinical manifestations of myasthenia gravis?

Answer 17

-THINK FACIAL
-Fluctuating weakness of skeletal muscles
-Facial immobility
-Bilateral ptosis (drooping of upper eyelid) and diplopia (double vision)
-Dysarthria (speech), dysphagia(swallow), chewing
-Difficulty w/speech, chewing, swalling

Question 18

Diagnostic studies for Myasthenia Gravis

Answer 18

-EMG
-Labs: 90% of pts have anti-AchR antibodies
-Tensilon test

Question 19

What is Bell’s Palsy

Answer 19

-Inflammation of cranial nerve 7, unilateral
-Unilateral facial drooping

Question 20

Manifestations of Bell’s Palsy (think stroke)

Answer 20

-Unilateral
-Affects ears, eyes and mouth
-Pain around ears
-Drooping, drooling on affected side
-Inability to smile, frown, whistle
-Excessive tearing

Question 21

Diagnostics for BP

Answer 21

No definitive test
MRI and CT to rule out stroke

Question 22

What is Amyotrophic Lateral Sclerosis

Answer 22

-Degeneration of motor neurons
-Progressive paralysis –> respiratory paralysis and death

Question 23

Manifestations of amyotrophic lateral sclerosis

Answer 23

-Muscle weakness
-Muscle atrophy
-Dysarthria, dysphagie
-Twitching/cramping muscles –> pain

Question 24

Nursing management for ALS

Answer 24

Reduce risk of aspiration
Assess respiratory
Pain control due to twitching muscles

Question 25

What is Parkinson’s Disease

Answer 25

Slowness in initiation/execution of movement
-Decreased dopamine, excessive acetylcholine

Question 26

Clinical Manifestations for Parkinson’s: TRAP

Answer 26

Tremor
Rigidity
Akinesia (loss/impairment of voluntary movement)
Postural Instability