Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
157 Cards in this Set
- Front
- Back
|
Hypercalcemia causes weakness and fatigue and is caused by the following
|
1) Malignancies
2) Hypoparatyroidism 3) Prolonged bedrest/inactivity 4) Excessive dietary intake/absorption NOTE: Diuretic use is not one of them |
|
|
What are the causes of Hyperkalemia?
|
1) Renal failure (not peeing enough out)
2) Addisons Dz (aldosterone fx to increase K+ secretion while facilitating Na+ absorption. A decrease in this system can result from adrenal insufficiency - aka Addison's Dz). 3) Seizures NOTE: Cushings is NOT a cause. pg. 772 |
|
|
The triad of fever, flank pain and ileus most consistently characterizes:
|
e) uretero-lithaiasis (KI stones)
|
|
|
What type of incontinence is seen in Parkinson's Dz and MS?
|
Urge incontinence
|
|
|
What type of incontinence is seen due to loss of the posterior urethrovesical angle from childbirth?
|
Stress urinary incontinence
|
|
|
What type of incontinence is seen in spinal cord injuries?
|
Overflow incontinence
|
|
|
What are the causes of hypokalemia?
|
1) Diarrhea
2) Diuretic intake 3) Hyperaldosteronism (check this out) 4) Excessive Na intake NOTE: NOT Cushings Dz. |
|
|
What is typically associated with diarrhea?
|
1) Celiac Dz
2) Intestinal Infection 3) Inflammatory bowel Dz 4) Food intolerance NOTE: Colon cancer is not typically associated with diarrhea |
|
|
A 49 y/o man with a temp of 102.6 has perineal pain, dysuria and shaking chills, however his urine is stale. What is his likely Dx?
|
Prostatitis
|
|
|
What is Cushing's caused by?
|
Excess cortisol production, typically produced by pituitary tumor.
|
|
|
What's the diff btween Cushing's Dz and Cushing's syndrome?
|
Cushing's Dz is caused by a pituitary tumor.
|
|
|
What is Cushing's syndrome caused by?
|
1) Pituitary
2) Adrenal 3) Ectopic ACTH 4) Iatrogenic |
|
|
What causes the Buffalo Hump?
|
Cushing's syndrome; it's the only thing that causes that
|
|
|
What are the manifestations of Cushing's Sx?
ON TEST 3-5 features |
Related to cortisol excess
1) altered fat metabolism (protruding abdomen, buffalo hump, moon face) 2) Thin skin - striae on abdomen, thighs breasts [easily to get stretch marks] 3) Protein catabolism (thin legs and arms) 4) Osteoporosis 5) Immune dysfunction, infection |
|
|
What are some additional manifestations of Cushings Sx?
ON TEST 3-5 features |
1) Derangements of glucose metabolism, diabetes from effects of cortisol
2) ***hypokalemia, hypernatremia***, water retention, hypertension, from mineralcorticoid properties of cortisol as well as from aldosterone 3) Hyperandrogenism |
|
|
How to Dx Cushings Sx?
|
see slides
|
|
|
What promote glucose utilization?
|
Insulin, catecholemines, growth hormone, glucocortioids, glucagon (p. 988-992)
|
|
|
In the absence of insulin, what do you see?
|
Elevated glucose; once it is high enough to spill into the urine, technically it's caused diabetes.
Since this depends on the renal threshold of your KI, this varies per person. NORMAL glucose: 70-120 (ballpark) |
|
|
What does diabetes mean?
FACTOID |
Making tons of urine. Mellitus - means honey or something.
So the term means sweet urine maker. |
|
|
T/F Glucose, like sodium, is hydrophillic.
|
TRUE - Glucose is like salt in that it will take free water with it.
|
|
|
What's the diff btween Cushing's Dz and Cushing's syndrome?
|
Cushing's Dz is caused by a pituitary tumor.
|
|
|
What is Cushing's syndrome caused by?
|
1) Pituitary
2) Adrenal 3) Ectopic ACTH 4) Iatrogenic |
|
|
What causes the Buffalo Hump?
|
Cushing's syndrome; it's the only thing that causes that
|
|
|
What are the manifestations of Cushing's Sx?
ON TEST 3-5 features |
Related to cortisol excess
1) altered fat metabolism (protruding abdomen, buffalo hump, moon face) 2) Thin skin - striae on abdomen, thighs breasts [easily to get stretch marks] 3) Protein catabolism (thin legs and arms) 4) Osteoporosis 5) Immune dysfunction, infection |
|
|
What are some additional manifestations of Cushings Sx?
ON TEST 3-5 features |
1) Diabetes and/or derangements of glucose metabolism (diabetes from effects of cortisol)
2) ***hypokalemia, hypernatremia***, water retention, hypertension, from mineralcorticoid properties of cortisol as well as from aldosterone 3) Hyperandrogenism |
|
|
How to Dx Cushings Sx?
|
see slides
|
|
|
What promote glucose utilization?
|
Insulin, catecholemines, growth hormone, glucocortioids, glucagon (p. 988-992)
|
|
|
In the absence of insulin, what do you see?
|
Elevated glucose; once it is high enough to spill into the urine, technically it's caused diabetes.
Since this depends on the renal threshold of your KI, this varies per person. NORMAL glucose: 70-120 (ballpark) |
|
|
What does diabetes mean?
FACTOID |
Making tons of urine. Mellitus - means honey or something.
So the term means sweet urine maker. |
|
|
T/F Glucose, like sodium, is hydrophillic.
|
TRUE - Glucose is like salt in that it will take free water with it.
|
|
|
What do catecholamines do?
|
They are chemicals like epinephrine (classic example)...it makes glucose readily available for rapid metaobolism. [check book]
|
|
|
Why do people taking exogenous growth hormone need to be careful?
|
They can drive themselves into hypoglycemia.
|
|
|
What is the balancer of insulin?
|
Cortisol - it runs counter to insulin. So pt with Cushing's Sx, tend to develop diabetes and tend to drive their glucose up.
|
|
|
What is glucagon?
|
It's a hormone produced by the pancreas, and modifies/dampens the affects of insulin. [see book]
|
|
|
What is the primary point of distinction btwn the two types of diabetes?
|
In insulin receptivity.
The ideal situation, is limited amount of work (hormone production) with little fluxuation in blood glucose. NOTE: Dramatic fluxuations in blood glucose promote negative effects of diabetes as much as steady high blood glucose levels do. |
|
|
T/F We have insulin receptors on literally every part of the body (blood cells, endothelial cells, muscle cells...).
|
TRUE
|
|
|
What is Type I Diabetes?
|
IDDM= Insulin Dependent Diabetes Mel.
a) Destruction of pancreatice beta cells b) Characterized by lack of insulin c) Type 1A=autoimmune 90% [formerly juvenile] d) Type 1B=idiopathic (10%) e) All require insulin replacement f) Prone to diabetic ketoacidosis (DKA) |
|
|
Which type of diabetes develop ketoacidosis?
TEST QUESTION |
Diabetes TYPE 1
There glucose levels get higher and higher...usu by the time glucose is 500-600 people start to metabolize ketones. Diabetic ketoacidosis, high blood glucose setting, it's the acidosis that does them in. Their pH will drop to 6.9 and 6.8 and will cause them to go into a coma and they can die. Brain injury impairs breathing and that's how they die. |
|
|
What is Type II Diabetes?
|
A heterogeneous Ds associated with:
1) Disordered beta cell function - diminished insulin levels and/or 2) Disordered insulin fx - insulin resistance 3) Increased hepatic production of glucose [gluconeogenisis; LIV produces glucose out of amino acids] We'd like to stay away from insulin adminstration in this situation unless it's due to 1) above. |
|
|
T/F Type II Diabetes can be associated with high, low or normal levels of insulin.
|
TRUE - most often though, it's associated with insulin resistance.
|
|
|
What is really the only risk factor for type II diabetes?
|
Obesity; fat cells are poorly responsive to insulin. The pancreas doesn't know your fat, so it keeps churning out insulin.
|
|
|
What is the Metabolic Sx?
|
It's a spiraling effect whereby fat, decreases ability of insulin metabolism, making so the pancreas churns out more insulin, so you get fatter, and cycle repeats.
Develop Htn and ....[see book] |
|
|
What are primary clinical manifestations of diabetes?
ON TEST |
1) polyurina
2) polydipsia 3) polyphagia |
|
|
T/F Type II Diabetes can go away with a weight loss program.
|
TRUE - but not always
|
|
|
What are other clinical manifestations of diabetes?
|
1) Blurred vision (form hyperosmolar changes of the lens and retina)
2) Chronic skin infections 3) Yeast infections - vaginal, foreskin |
|
|
Wounds that don't heal or get easily infection, what might you think?
|
Diabetes. This is one of the manifestations.
|
|
|
What are the complications of insulin dependent diabetes?
|
1) DKA
2) Hyperosmolar hyperglycemic state (they can present in a coma; b/c their brain swells) 3) Hypoglycemia [PROFOUND INSULT TO THE BRAIN, if the brain is deprived of glucose for a minute; cells will die; the brain dies from the outside in - from the cerebral cortex] |
|
|
Insulin dependent diabetes is which type?
|
Type I, IDDM
|
|
|
DKA
|
See slides, read about it (diabetes ketoacidosis?)
|
|
|
What is the most common cause of DKA?
|
Someone not taking insulin. But it can also be rigged by infection (common), stress, anxiety, inadequate dosing of insulin.
|
|
|
What do catecholamines do?
|
They are chemicals like epinephrine (classic example)...it makes glucose readily available for rapid metaobolism. [check book]
|
|
|
Why do people taking exogenous growth hormone need to be careful?
|
They can drive themselves into hypoglycemia.
|
|
|
What is the balancer of insulin?
|
Cortisol - it runs counter to insulin. So pt with Cushing's Sx, tend to develop diabetes and tend to drive their glucose up.
|
|
|
What is glucagon?
|
It's a hormone produced by the pancreas, and modifies/dampens the affects of insulin. [see book]
|
|
|
What is the primary point of distinction btwn the two types of diabetes?
|
In insulin receptivity.
The ideal situation, is limited amount of work (hormone production) with little fluxuation in blood glucose. NOTE: Dramatic fluxuations in blood glucose promote negative effects of diabetes as much as steady high blood glucose levels do. |
|
|
T/F We have insulin receptors on literally every part of the body (blood cells, endothelial cells, muscle cells...).
|
TRUE
|
|
|
What is Type I Diabetes?
|
IDDM= Insulin Dependent Diabetes Mel.
a) Destruction of pancreatice beta cells b) Characterized by lack of insulin c) Type 1A=autoimmune 90% [formerly juvenile] d) Type 1B=idiopathic (10%) e) All require insulin replacement f) Prone to diabetic ketoacidosis (DKA) |
|
|
Which type of diabetes develop ketoacidosis?
TEST QUESTION |
Diabetes TYPE 1
There glucose levels get higher and higher...usu by the time glucose is 500-600 people start to metabolize ketones. Diabetic ketoacidosis, high blood glucose setting, it's the acidosis that does them in. Their pH will drop to 6.9 and 6.8 and will cause them to go into a coma and they can die. Brain injury impairs breathing and that's how they die. |
|
|
What is Type II Diabetes?
|
A heterogeneous Ds associated with:
1) Disordered beta cell function - diminished insulin levels and/or 2) Disordered insulin fx - insulin resistance 3) Increased hepatic production of glucose [gluconeogenisis; LIV produces glucose out of amino acids] We'd like to stay away from insulin adminstration in this situation unless it's due to 1) above. |
|
|
T/F Type II Diabetes can be associated with high, low or normal levels of insulin.
|
TRUE - most often though, it's associated with insulin resistance.
|
|
|
What is really the only risk factor for type II diabetes?
|
Obesity; fat cells are poorly responsive to insulin. The pancreas doesn't know your fat, so it keeps churning out insulin.
|
|
|
What is the Metabolic Sx of Diabetes?
|
It's a spiraling effect whereby fat, decreases ability of insulin metabolism, making so the pancreas churns out more insulin, so you get fatter, and cycle repeats.
Develop Htn and ....[see book] |
|
|
What are primary clinical manifestations of diabetes?
ON TEST |
1) polyurina
2) polydipsia 3) polyphagia |
|
|
T/F Type II Diabetes can go away with a weight loss program.
|
TRUE - but not always
|
|
|
What are other clinical manifestations of diabetes?
|
1) Blurred vision (form hyperosmolar changes of the lens and retina)
2) Chronic skin infections 3) Yeast infections - vaginal, foreskin |
|
|
Wounds that don't heal or get easily infection, what might you think?
|
Diabetes. This is one of the manifestations.
|
|
|
What are the complications of insulin dependent diabetes?
|
1) DKA
2) Hyperosmolar hyperglycemic state (they can present in a coma; b/c their brain swells) 3) Hypoglycemia [PROFOUND INSULT TO THE BRAIN, if the brain is deprived of glucose for a minute; cells will die; the brain dies from the outside in - from the cerebral cortex] |
|
|
Insulin dependent diabetes is which type?
|
Type I, IDDM
|
|
|
DKA
|
See slides, read about it (diabetes ketoacidosis?)
|
|
|
What is the most common cause of DKA?
ON THE TEST |
Someone not taking insulin. ****But it can also be rigged by infection (common), stress, anxiety, inadequate dosing of insulin!****
|
|
|
What are the hypoglycemia causes?
|
1) Improper insulin does
2) Failure to eat after insulin [THIS IS A SERIOUS PROBLEM] 3) Increased exercise, resolution of stress |
|
|
What are the complications of diabetes?
|
1) Macro and microangiopathy
2) Reinopathy 3) Nephropathy 4) Neuropathy |
|
|
What is the single most common cause for renal Dz?
|
Diabetes
|
|
|
Which is worse, high fluctuations in blood glucose within a normal range or small fluctuations within a slightly elevated blood glucose level?
|
The ladder
|
|
|
What are the complications of diabetes?
|
1) Long-term diabetic control is the most ....
see slide 2) Neuropathy Somatic and autonomic. Common to have parastalsis impairment and they can develop constipation that evolves into impaction. 3) Somatic Sensation to vibration (tuning fork on the great toe) and if they've lost sensation, they have diabetic neuropathy. -Most common sensory function is "stocking-glove distribution" ...see slide |
|
|
T/F Diabetes compromises the capillaries dramatically!
|
TRUE - the tissues can't access nutrients in the vessels that have become thickened.
|
|
|
What is the #1 cause of end stage renal Dz in the U.S.?
|
Diabetic nephropathy
|
|
|
What is the leading cause of blindness in the U.S.?
|
Diabetic retinopathy (poor capillary permaability)
|
|
|
Describe retinopathy
|
see slides
|
|
|
Describe macrovascular complications of diabetes?
|
1) Coronary artery Dz
2) Cerebrovascular Dz 3) Peripheral vascular Dz |
|
|
What are the risk factors for macrovascular complications?
NOT ON TEST |
obesity, Htn, hyperlipidemia, hyperglycermia, hyperinsulinemia, altered platelet function, endothelial dysfx, inflammation, elevated fibrinogen
|
|
|
What is gestational diabetes?
|
Glucose intolerance 1st detected during pregnancy, as opposed to pre-existing DM.
|
|
|
What are the gestational diabetic risk factors?
|
1) Family Dx DM
2) see slides to add others |
|
|
What is the tx for gestational diabetes?
ON TEST |
1) Aggressive dietary changes (and insulin if needed)
* A diet rich in veggies/fruit is the way to go. You don't want them to avoid all simple sugars but limit it to what they get from fruit. That's it. Avoid fat (just as important as avoiding sugar). It's been shown that if you eat the same amt of calories from a baked potato form as the same as table sugar (as measured in sugar), the blood sugar load is the same. This includes pasta, breads and potatoes. * Fruits should be a celebratory phenomena * Nuts are okay (cashews may be an exception) * Fish and extreme lean cuts of beef (avoid pork and chicken only if range fed...) NOTE: Oral hypoglycemics are not used due to risk of birth defects |
|
|
Where are sperm produced?
|
In the testes
|
|
|
What is the hormonal control of spermatogensis?
|
see slide 59
* negative feedback with sertoli cells * negative feedback with LH |
|
|
If a male is on testosterone supplementation what may result?
ON THE TEST |
Decreased sperm; they will develop testicular atrophy. This is because LH and FSH will be supressed.
|
|
|
Describe 3 androgens.
|
1) Testosterone
2) Dihydrotestosterone 3) Androstenedione |
|
|
What are two sources of androgens?
|
Testes and adrenal cortex (<5%)
|
|
|
Testosterone is necessary for what?
ON THE TEST |
Maturation of sperm
|
|
|
What are the benefits of testosterone?
|
1) Anabolic, build muscles
2) see book |
|
|
What is a negative effect of testosterone?
|
Thicken the endothelial membrane (raise BP), increase risk of heart Dz
|
|
|
What is fibrocystic breast Dz?
|
It's an estorgen-dependent condition (esp in the luteal phase you get cystic dilation of the lactiferous ducts).
The masses that are caused are granule and small and virtually multiple. You would ask them to get a thermogram (if you can find one) to rule out cancer. |
|
|
Fibrocystic breast Dz
|
Learn about it - we can probably tx it better than western.
|
|
|
What is the most common malignancy in FM?
|
Breast common; 2nd most common cause of death behind LU in FM.
|
|
|
What are the risk factors for breast cancer?
ON THE TEST |
1) Age
2) Family Hx (1st degree relatives) 3) Hx of benign breast Dz (fibrocystic or atypical hyperplasia) 4) Prolonged, "unapposed" estrogen stimulation (early menarche, late menopause, no term pregnancy, 1st child after 30). 5) However, most have no risk factors. NOTE: Some BCP with progesterone can decrease risk of breast cancer. Low dose of estrogen BC may surpress? production of estrogen....and lower the risk. |
|
|
What are the common organisms involved in cervicitis?
|
see slide
* Yeast infection is the most common cause * Chlamydia is the most common STD |
|
|
What are the signs/sx's of cervicitis?
|
1) cervix is red
2) edematous 3) mucopurulent discharge 4) low back pain 5) dysmenorrhea 6) dyspareunia |
|
|
T/F Cervical cancer "always" begins with dysplasia.
|
TRUE
Notice you can have perfectly benign dysplasia. |
|
|
Which virus plays a strong role in cervical cancer?
|
HPV - duh; the type of human papilloma involved determines to what extent there is a risk for developing cancer
|
|
|
What are the risk factors for cervical cancer and dysplasia?
PROBABLY on TEST |
1) Rare in celibate women
2) Multiple sex partners; partners with multiple partners 3) Age at 1st intercourse 4) Smoking 5) Hx of STDs - herpes, HPV, chlamydia, HIV 6) HIV - cervical cancer is one of the 26 conditions listed by the CDC on their "AIDS surveillance case definition" |
|
|
What are the high risk factors for HPV's?
MAY BE a benchmark or board question |
17 or 18 - see the slide to check
|
|
|
What are the 2 types of endometrial cancer?
|
1) Type I - endometrioid, related to prolonged, unopposed estrogen
2) Type II - serous - unrelated to estrogen; some are genetic (worse prognosis) |
|
|
What is pelvic inflammatory Dz?
ON THE TEST |
It's an ascending infection -> uterus -> tubes -> ovaries
Commonly: it's due to gonorrhea and chlamydia (both at the same time). Should a women develop chlamydia alone, she may have discharge and she may have pain but she might not. Chlamydia can cause scaring in the tubes and result in permanent infertility and she doesn't even know she has an infection. Gonorrhea typically causes pain and fever early on and you can get sepsis. |
|
|
What are the risk factors for PIDz?
|
1) multiple partners
2) IUD's 3) ages 16-24 4) unmarried 5) nulliparous |
|
|
T/F Chlamydia is often asymptomatic for men.
|
TRUE - that is why it's rampant.
|
|
|
What are the manifestations of pelvic inflammatory Dz?
|
see slide
NOTE: You can have subclinical inflammatory Dz - no pain, no discharge and no fever. They can still have PID and be damaging their fallopian tubes. |
|
|
What is endometriosis?
|
Presence of endometrial tissue outside of the uterus. These islands of tissues are called implants and are common to occur in the uterus but can occur rarely in their lungs, nostrils....
It's probably multi-factorial. |
|
|
What are some theories on endometriosis?
|
See slide
|
|
|
T/F The endometrial implants respond to hormonal changes as if they were in the uterus.
|
TRUE - most painful tend to be in the bowels.
|
|
|
What is the triad of endometriosis?
|
1) Dysmenorrhea
2) Dyspareunia (pain during sex) 3) Infertility (common) |
|
|
What is the Dx for endometriosis?
|
see slide
|
|
|
What is the Tx for endometriosis?
|
1) Surgical - laser, cauterization of lesions, lysis of adhesions
2) Medical NSAIDS, non-cyclinc OCP's GnRh analogs 3) Combo Definitive: remove the "source" of the problem. Hysterctomy... |
|
|
What are fibroids?
|
Benign tumors of the uterine smooth muscle that tend to regress during menopause?
|
|
|
What are the manifestations of fibroids?
ON TEST |
1) Asymptomatic in many
2) Bleeding, menorrhagia, metrorrhagia, anemic 3) Pelvic pain, heaviness, dysparenunia, dysmennorrhea 4) Pressure on bladder, rectum 5) Outgrow their blood supply -> infarct (pt maybe febrile and have pelvic pain) 6) Occassionally infertility, premature delivery, pregnancy loss |
|
|
What is ectopic pregnancy?
|
Pregnancy outside the uterus, most often in the tube but can be ovarian, cervical and abdominal.
|
|
|
What are the risk factors for ectopic pregnancy?
|
1) Tubal Dz (PID)
2) Prior tubal ligation or reversal 3) Infertility 4).... see slides NOTE: You have to assume ectopic - b/c it may present as a huge drop in BP. |
|
|
If pt presents with ammennorhea and pelvic pain think??
|
Ectopic pregnancy; people can bleed to death. Usu it doesn't cause pain until..... [see slide, tube compromise b/c the pregnancy is large enough]
|
|
|
What are the 2 types of ovarian cysts?
|
1) Neoplasms
2) Functional (follicular) cysts a.k.a. Stein-leventhal syndrome |
|
|
How do PCOS patients commonly physically look?
|
1) Hiersutism
2) Obesity |
|
|
What are the risk factors for ovarian cancer?
|
see slide
|
|
|
T/F There is no reliable screen test?
|
TRUE
|
|
|
What's the first thing you should ask a couple if they been unable to conceive?
|
Has the male been checked yet?
|
|
|
read through the infertility material
|
create f/c
|
|
|
What conditions can HPV result in?
|
1) Condyloma acuminata (genital warts)
2) Cervical intraepithelial neoplasia-cin see slide |
|
|
How to distinguish acute vs chronic pain?
|
Acute is telling you to not do something (usu) or stop doing something and chronic doesn't.
See slide and add details. |
|
|
See the characteristics of chronic pain?
|
FYI - alcohol is a good pain reliever; dulls the senses and makes it so you don't care about the pain.
|
|
|
What is addiction?
|
Continued behavior or use of substance despite of negative consequences.
Even if someone doesn't experience withdrawal....they are still doing it despite it's negative consequences. IRRITABILITY IS THE PRIMARY, CARDINAL Sx of WITHDRAWAL |
|
|
What does dependence mean?
|
You'll have withdrawal sx if you stop. Ex. alcoholic that stops drinking - dysphoria, increased sweating, increased bp, delirium or seizures.
|
|
|
What is neuropathic pain?
KNOW THIS |
Pain arising from damage from peripheral nerves (single or systemic).
|
|
|
What are the causes of neuropathic pain?
|
see slide
|
|
|
T/F - Most pt with neuralgia will suffer allodynia of some sort.
TEST ON THE TEST |
TRUE - Pain can be triggered by a non-injurious stimulus to the skin (touch the skin with a feather - > immense pain)
|
|
|
What is a common type of neuralgia/neuropathy?
[Board, I would put it on the board] |
Trigeminal - intense pain on the 5th cranial nerve. Severe pain, not sure what causes it.
|
|
|
What virus causes postherpetic neuralgia?
|
herpes zoster
See slide |
|
|
Complex Regional Pain Sx?
NOT ON THE TEST |
Read about it; it's interesting
|
|
|
What are the the common types of headaches?
|
see slides
|
|
|
What % of men/women have migraines?
|
18% of women
6% of men FACTOID: hemi (unilateral) + kranion= migraine. If the whole head hurts, it's NOT a migraine it might be a mixed headache (tension + migraine). |
|
|
What % of migraines have an aura?
|
15% and is mostly visual - they might see flashing lights or squiggly lines in there peripheral visions (scotomata); could get other auras (kenesthetic, olfactory, etc.)
|
|
|
What determines a "classic" migraine?
ON THE TEST |
The migraine which has an aura
|
|
|
If a migraine doesn't respond to imitrex (sp?) what should that tell you?
|
That it is a mixed headache.
|
|
|
Why is migraines like a reversed raynoids?
|
The blood vessels rather than spasm they dilate and causes pain.
Dr. Stewart suspects that migraine suffers are diff from the rest b/c sudden dilation doesn't autocorrect. |
|
|
How does imitrex work?
|
Prevents dialation and minimizes it...kind of a vasoconstrictor but not dramatic. So it's contraindicate with people with high BP or poorly tx heart dz.
|
|
|
What are the migraine trigger factors?
|
1) Estrogen - menstrual migraine
2) Dietary triggers - MSG, cured foods (cheese, meats), chocolate, certain wines w/ nitrites and sulfites NOTE: Dietary journals are helpful in determining triggers. |
|
|
What are cluster headaches?
|
Mostly men, 80%
- intense pain - rapid onset - short duration (15min to 3 hours) Often associated with 1) restlessness 2) agitation 3) also conjunctival redness 4) rhinorrhea 5) nasal congestion 6) forehead/facial pain see slide |
|
|
What is one of the tx for cluster headaches?
|
beta blockers
|
|
|
What is the most common type of headache?
|
Tension headache
1) not as severe, typically does not .... [see slide] |
|
|
What is the etiology of a migraine headache?
|
See slide
|
|
|
T/F Seizures are not a disease but a Sx of an underlying CNS dysfunction.
|
TRUE
|
|
|
T/F There is no such thing really as childhood epilepsy.
|
TRUE - b/c epilepsy is discovered in childhood.
|
|
|
What are some Sx of petit mal seizure?
|
Just staring for 15 seconds, no twitching. Associated with temporal lobe.
|
|
|
T/F Absinthe can cause seizures and hallucinatory experiences.
|
TRUE
|
|
|
What can provide a seizure?
|
1) Insult to the CNS (trauma, stroke, hemmorrhage, tumors)
2) Metabolic disturbances (electrolyte disturbances, hypoxia, hypoglycemia, hypocalcemia, uremia, alkalosis, drug withdrawal) 3) Febrile seizures - in kids > 104 degree |
|
|
What is the common thread in seizure meds?
|
Seditives (a clumsy way to do it) or a membrane stabilizer (makes it hard for neuron to trigger another).
Pt often complain about feeling lethargic, slow, depressed or dull. But they will develop tolerance to those feelings and will begin to function more normally. NOTE: This is similar to how you'd treat schizophrenia. B/c in paranoid schizophrenia, you have a large stimulus of brain activity. The seizure meds are also used to treat bipolar, which is a form of psychosis. |
|
|
What is dementia?
|
Primary disfunction in dementia is orientation. The cardinal sign is someone who becomes disoriented. This is orientation to person (you know who you are), orientation to place (where you are), orientation to time (you know when it is), orientation to situation (what's going on around you). This is in reverse order of occurance.
These people are often alarmed b/c they don't know they don't know who they are when you ask them. |
|
|
What's a quick test to find out if someone is demented?
|
Ability to focus attention for any length of time.
Spell C-A-T, then ask them to repeat it without the instructions or count backwards from 100 by 7's. |
|
|
Name different times of dementia
|
1) Alzheimer's Dz
2) Multi-infarct dementia (stroke) 3) Pick's Dz (virus) 4) Creutzfeld-Jacob Dz (prion's - collection of amino acids that is infectious) 5) Wernicke-Korsakoff Syndrome 6) Huntington's Chorea/Dz |
|
|
Why does it piss Dr. Stewart off when they diagnose Multi-infarct dementia as alzheimers?
|
Alzheimers is a debilitating, fatally progressive Dz; multi-infarct dementia if you prevent them from having strokes, they don't progress. Alzheimers progresses towards death.
Multi-infarct pt will have multi-focii. You ask them to button their shirt with their left hand, no problem. With their right, they might have a problem with that. You could ask someone if they have had "fainting spells"....but it could be a TIA - on it can create a multi-infarct. |
