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48 Cards in this Set
- Front
- Back
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UMNL Upper motor Neuron loss
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1st order neurons
Central nervous system Fine rapid movements most affected Increased tone Increased reflexes Babinski (extensor) No muscle atrophy No fasciculations |
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LMNL Lower motor neuron lloss
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2nd order neurons
Nerve roots or nerves (peripheral) All movements equally affected Decreased tone Decreased reflexes No Babinski (flexor) Muscle atrophy fasciculations |
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Pain – Chronic Definition:
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Pain that persists after healing has occurred, results from long-term illness, or has no apparent cause .
Chronic pain may persist for weeks, months, or years and may not respond to treatment. |
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According to the Centers for Disease Control and Prevention,what is the leading cause of disability in the US?
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chronic pain
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Chronic pain - causes
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Cancer
Degenerative disease (i.e. osteoporosis, osteoarthritis) Fibromyalgia Inflammatory disease (i.e. rheumatoid arthritis) “Neurogenic pain” syndromes, both central (MS, stroke) and peripheral (neuropathy) |
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Pain treatment
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Definition:
Goal is pain CONTROL and not pain RELIEF. A decrease of 30% in either intensity or frequency of pain is considered success. |
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Dizziness, history
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Description (vertigo, lightheadedness, etc.)
Position (sitting, standing, valsalva) Any visual changes. Any previous such episodes Associations (tinnitus, hearing loss) |
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Dizziness- exam
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Orthostatics.
Nystagmus. Coordination (Finger-to-nose, heel-to-shin) Nylan-Barany (=Hallpike-Dix) maneuver Any motor/sensory deficit (Neuropathy) Rhomberg, may be sensitive, but not specific |
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Signs suggesting imaging in dizziness
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Progressively worsening vertigo over weeks to months
Progressive Tinnitus and deafness unilaterally Accompanying sensory or motor deficit in the face or body |
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Evaluation of vestibular function
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Cold calorics
VOR (Vestibulo-ocular reflex), “head thrust” Nystagmography |
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Syncope evaluation
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History: Your best friend
Check for signs of dehydration or poor nutrition Event monitor for an extended period Tilt table Autonomic testing. Cardiology referral 65 % are due to cardigenic events |
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Partial Seizures I
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Simple: Without change of conciousness
Sensory Motor Autonomic Psychic |
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Partial Seizures II
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Complex: With change of level of conciousness (“temporal lobe epilepsy”)
Automatisms Stereotypy. “aura” |
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Generalized Seizures
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I. Absence (“petit mal”)
II. Tonic-Clonic (“grand mal”) III. Myoclonic IV. Tonic V. Clonic VI. Atonic (“drop attacks”) |
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Most common neurologic disorder
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Seizures
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Bimodal peaks of seizures
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childhood and after age 50
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Causes of Neuropathy
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1. DM
2. ETOH 3. Hereditary. 4. Idiopathic |
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Labs for neuropathy
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ESR, RPR, B12, Folate.
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Meralgia Paresthetica
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numbness of anterior thigh.
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Frequently associated with Restless leg syndrome (RLS) and Periodic Limb Movement of Sleep (PLMS),
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Meralgia Paresthetica, numbness of anterior thigh.
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Rest tremor
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Parkinson’s disease
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Not affected by ETOH
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Parkinson’s disease
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Hypertonicity
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Parkinson’s disease
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Bradykinesia
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Parkinson’s disease
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Usually begins on one side
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Parkinson’s disease
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Action tremor
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Essential tremor
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Ameliorated by ETOH
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Essential tremor
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Normal tone
Normal movement |
Essential tremor
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Bilateral
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Essential tremor
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Familial
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Essential tremor
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Parkinson’s Disease, treatment
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Dopamine agonists Amantadine, Trihexphenidyl, Pergolide (ECHO at onset and ?annually).
Selegeline, Rasigiline Carbidopa/Levodopa (Sinemet) COMT inhibitors (Tolcapone, Entacapone) |
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Essential tremor, treatment
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Primidone
Propranolol Mirtazipine (Remeron) Topiramate Diamox Deep Brain Stimulation (DBS) Assistive devices: Weighted utensils and writing tablet with a magnet and wrist strap |
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predisposing factors of sleep apnea
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predisposing factors include family history, obesity, short neck, head injury, or stroke
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Second most frequent pain syndrome and the most expensive.
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Low Back Pain
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the most common cause of low back pain
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Myofascial or discogenic pain syndrome
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What are fasciculations ?
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Fine muscle movements or flutterings under the skin
Signals denervation |
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What does the pyramidal system control?
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Voluntary movements
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What doe sthe extrpyramidal system control ?
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Involuntary movements
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Is Parkinsons pyramidal or extrapyramidal?
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extrapyramidal
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What is Opioid-Induced Hyperalgesia Syndrome ?
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A heightened sensitivity to pain can be caused by the very medications used to treat chronic pain
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Most common seizure onset in adults
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Partial seizure II- complex with a change in the level of consciouness (temporal lobe epilepsy),repetitive motions and lip smacking
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Simple: Without change of conciousness
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Partial Seizures I
one focal point in brain |
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Complex: With change of level of conciousness (“temporal lobe epilepsy”)
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Partial Seizures II
generalized seizures involve the entire brain |
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When do you need to do blood levels for seizure meds?
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Blood levels only if seizing or showing signs of toxicity (Nystagmus, incoordination)
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How long is the driving restrictions for seizures?
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The driving restriction applies to 3-6 months after last event.
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When do you dc seizure meds?
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If one time GTC seizure, negative EEG and patient willing to forgo driving for 3-6 months (based on Arizona and California law as there is none in Ohio)
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What is Neuroleptic malignant syndrome ?
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a life-threatening neurological disorder most often caused by an adverse reaction to neuroleptic or antipsychotic drugs. Can also be caused by abuptly stopping meds. Rare but mortality can be 80%
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Drugs that can cause disinhibition syndrome
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Dopamine agonists Mirapex
Requip |
