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;
57 Cards in this Set
- Front
- Back
|
What is the definition of Multiple Sclerosis? |
Autoimmune degenerative disease that targets the myelin of the brain and spinal cord --multiple lesions are seen in multiple locations |
|
|
What is the typical age of onset for multiple sclerosis and the prevalent population affected? |
Age: 20 -50 Females > males Caucasians: Europe, North America, Australia Theory: lack of vitamin D exposure |
|
|
What are the MS subtypes? |
RRMS, Primary progressive, Secondary progressive, PRMS |
|
|
What defines the MS subtype of RRMS?
|
Relapsing -remitting (85%) Episodes resolve with good neurologic function between exacerbations and minimal to no cumulative defects |
|
|
What defines the MS subtype of Primary Progressive?
|
Episodes do not fully resolve and there are cumulative defects
|
|
|
What defines the MS subtype of Secondary Progressive?
|
Accumulating disability after a period of relapsing-remitting
|
|
|
What defines the MS subtype of PRMS?
|
Progressive - relapsing (5%) steadily progressive from onset; also with acute attacks |
|
|
What defines a first clinical episode, clinically isolated episode (CIS) of MS?
|
90% focal neurologic event indicative of demyelination; often associated with clinically silent lesions on MRI |
|
|
What is the hallmark of the MS disease?
|
inflammatory attack on myelin sheath of nerve axon ***plaque formation and scarring *** with each attack, lesser degree of recovery |
|
|
What can be found in a MS clinical presentation?
|
--fatigue (70%) --sensory loss: paresthesias --Visual disturbances: diplopia (on lateral gaze), blurred vison, nystagmus, loss of vision --gait disturbance --weakness in one or more limb --urinary incontinence, frequency, hesitancy, urgency |
|
|
What are MS associated symptoms?
|
Temperature or heat sensitivity H/O: band like sensation around waist Dysarthria: difficulty with speaking Muscle spasm Cognitive difficulties: memory, attention span Sexual dysfunction Trigeminal Neuralgia |
|
|
What are abnormal elements of the physical exam for MS?
|
Neuro: EOM - nystagmus Reflexes - brisk, up going toes Limbs - weakness, decreased hand dexterity, altered gait, drags foot Re-assess baseline |
|
|
What is the definition of Parkinson's disease?
|
slowly progressing movement disorder DOPAMINE normally secreted in the brain is no longer available insidious asymmetric symptoms |
|
|
Who gets Parkinson's disease?
|
Age >65 Mean age at diagnosis 70 men > women risk doubled if 1st relative has it |
|
|
What is the pathophysiology of Parkinson's?
|
Unknown cause Degenerative changes in the basal ganglia Depletion of dopaminergic neurons in substantia nigra Large numbers of acetylcholine secreting neurons Loss of dopamine receptors sites affects refinement of voluntary movement |
|
|
What are Parkinson's cardinal features?
|
Tremor at rest [disappears w/ action], rigidity, bradykinesia[slow to start & continue movements, impaired adjustment of body], hypokinesia, flexed posture, loss of postural reflex, gait disturbance [small shuffling steps], freezing phenomenon
|
|
|
What is the common presentation of Parkinson's?
|
Masklike faces [decreased blinking], lateral lifting of trunk, head bowed, trunk bent forward, hands in front of body, flexion of elbows, hips, knees, soft speech with monotonous tone, cog wheeling and freezing, resting tremor [pill rolling]
|
|
|
How is Parkinson's disease diagnosed?
|
clinical evaluation presentation of cardinal features trial of levodopa with response to symptoms |
|
|
What are complications noted with Parkinson's disease? |
--Psychosis / visual hallucinations (dose reduction of medication) --Depression --Dementia --Increased fall risk --Choking concerns |
|
|
What is a seizure? |
Isolated event in whihc group of neurons produce excessive electrical discharges in the brain |
|
|
What is a seizure disorder? |
Abnormally altered balance between excitation and inhibition of brain's electrical activity in favor of excitation |
|
|
What is epilepsy? |
--More than one seizure secondary to an unerlying condition in the brain --a functional disorder of the brain |
|
|
What is status epilepticus in epilepsy? |
--More than 30 minutes of continous seizure activity or two or more seizures without recovery of baseline consciousness --Efforts to change this to 10 minutes of continuous seizure activity |
|
|
What is a partial seizure? |
focus in ONE hemisphere of brain |
|
|
What is a simple partial seizure? |
Usually has aura Usually awake, NO LOC (e.g. Jacksonian: motor one arm or leg) |
|
|
What is a complex partial seizure? |
Impaired conciousness |
|
|
What is a generalized seizure? |
BOTH hemispheres of brain involved usually with EEG changes |
|
|
What are nonconvulsive seizures? |
Absence = petit mal Atonic = drop attacks |
|
|
What is a petit mal seizure? |
Blank staring lasting 3-50 seconds impaired level of consciousness |
|
|
What is generalized convulsive myoclonic seizure? |
Usually awake with abrupt muscle jerks |
|
|
What is generalized convulsive tonic-clonic seizure? |
AKA GRAND MAL --rigid extension of arms and legs, followed by sudden jerking movements --LOC --bowel & bladder incontinence common --post-ictal confusion |
|
|
What is generalized tonic seizure?
|
increased muscle tone |
|
|
What is generalized clonic seizure?
|
muscle contraction and relaxation movements |
|
|
For new onset seizures, what should be included in the subjective assessment? |
--Recent headache? --Illness/fever? --Trauma? --Aura? Warning? --Description of seizure? Bowel/Bladder incontinence? --Post-ictal duration? symptoms? |
|
|
For new onset seizures, what should be included in the objective assessment? |
Physical Exam: focal neurological deficits Injury Tongue biting |
|
|
What is the likely etiology if seizures manifest by age 18? |
generalized idiopathic epilepsy |
|
|
What is the likely etiology if seizures manifest after age 18? |
focal etiology |
|
|
What is the likely etiology if seizures manifest in older adults? |
stroke etiology --------- vascular disease new mass lesion withdrawal from alcohol or medication |
|
|
What is the most likely secondary cause for a generalized seizure? |
Alcohol, drug withdrawal |
|
|
What maybe metabolic causes for generalized seizure? |
Hypercalcemia Hyponatremia Hypoglycemia |
|
|
What maybe cardiac causes for a generalized seizure? |
Syncope - cerebral ischemia cardiac arrhythmia - heart block |
|
|
What maybe secondary neurological causes for a generalized seizure? |
Migraine ACVS (TIA) Cerebrovascular event Brain tumor AV malformation Infection |
|
|
Can a generalized seizure happen secondary to hyperventilation? |
Yes |
|
|
What is NJ law regarding seizures? |
Physician must report: --recurrent convulsive seizures --recurrent episodes of unconsciousness or impairment --epilepsy CAN DRIVE IF SEIZURE FREE FOR 6 MONTHS |
|
|
What is the definition of dementia? |
Cognitive impairment Memory disturbance Interferes with ADLs, social & occupational functioning No decrease in level of consciousness Insidious onset |
|
|
What are the types of dementias? |
Alzheimer's Vascular |
|
|
What is the pathophysiology behind alzheimer's disease? |
amyloid plaques - protein deposits outside the neuron neurofibrillary triangles - protein deposits inside the neuron diffuse cerebral cortex atrophy in frontal, temporal, and parietal lobes |
|
|
What biochemical transmission are disrupted cortical pathways in alzheimers disease? |
catecholamine serotonergic cholinergic |
|
|
What is the pathophysiology behind vascular dementia? |
multi-infarct multiple areas of focal ischemic change lacunar infarct |
|
|
What occurs in the EARLY alzheimer's disease? |
Memory loss Time and spatial disorientation Poor judgement Personality change Withdrawal depression Perceptual disturbances |
|
|
What occurs in the MODERATE alzheimer's disease? |
Recent & remote memory worsens Increased aphasia (slowed speech & understanding) Apraxia - inabilty to execute voluntary motor movement despite normal muscle function Hyperorality Disorientation to time & place Restlessness (pacing) Irritability Loss of impulse control |
|
|
What occurs in the LATE / SEVERE alzheimer's disease? |
incontinence of urine or feces, loss of self-care loss of motor skills, motor rigidity decreased appetite or dysphagia Agnosia: inability to recognize and identify objects or persons (family, self) Apraxia: inability to execute voluntary motor movement despite normal muscle function Severe impaired communication decreased immune system |
|
|
What should be included in a physical examination for Dementia? |
Neuro: check for focal deficits Cardio: Check for bruits Psych: Mini Mental Status exam, Depression screening |
|
|
What is the definition of Delirium? |
acute confusion state symptom of underlying problem |
|
|
What occurs during delirium state? |
Disturbance in attention, consciousness, and cognition inability to focus, sustain, or shift attention short-term memory loss, disorientation, language disturbance, perceptual disturbance develops over short period of time |
|
|
What is sundowning? |
Delirium state |
|
|
When trying to identify an underlying cause for delirium, what conditions should be considered? |
infection: UTI, pneumonia cardiac: MI, PE, CHF cerebral: CVA, TIA, seizure metabolic: dehydration, electrolyte imbalance, intoxication: medication, withdrawal |
