Term
| What is the pathophys of parkinson's disease? |
|
Definition
| idiopathic depletion of dopamine in the substantia nigra and nigrostriatal tract |
|
|
Term
| What is the usual age of onset of Parkinson's disease? |
|
Definition
|
|
Term
| What is the life expectancy from time of diagnosis of parkinson's? |
|
Definition
|
|
Term
| What insults can cause a parkinsonian like syndrome? |
|
Definition
| neuroleptic and metoclopramide use, post encephalitis, toxic exposures (manganese, MPTP, carbon disulfide), bihemispheric ischemia, and trauma |
|
|
Term
| What is the parkinson's tetrad? |
|
Definition
| resting tremor, rigidity, bradykinesia, postural instability |
|
|
Term
| What are one of the earliest signs of parkinson's? |
|
Definition
|
|
Term
| What parts of the body are affected by the resting tremor of Parkinson's? |
|
Definition
|
|
Term
| Name some Parkinson's plus syndromes? |
|
Definition
| progressive supranuclear palsy, corticobasal ganglionic degeneration, Shy-Drager syndrome |
|
|
Term
| What other diseases besides Parkinson's presents with tremors, psychomotor slowing and instability? |
|
Definition
| Wilson's disease, essential tremor, depression, normal pressure hydrocephalus |
|
|
Term
| What are teh different types of therapy used to treat parkinson's? |
|
Definition
| dopamine analogs (levodopa and carbidopa), catechol-O-methyltransferase (COMT) inhibitors such as entacapone, dopamine agonists (bromocriptine and pramipexole), benztropine (an anticholinergic) and amantadine (a dopamine agonist) are useful for tremor symptoms |
|
|
Term
| What is the MOA of COMT inhibitors? |
|
Definition
| increase the availability of levodopa to the brain and may decrease motor fluctuations |
|
|
Term
| name some parkinson drugs useful in treating tremors? |
|
Definition
| amantidine (dopamine agonist), benztropine (anticholinergics) |
|
|
Term
| How do you surgically treat parkinson's? |
|
Definition
| surgical pallidotomy or chronic deep brain stimulation |
|
|
Term
| What is the pathophys of huntington's disease? |
|
Definition
| hyperkinetic autosomal dominant disorder involving multiple abnormal CAG triplet repeats (<29 is normal) in the huntingtin gene on chromosome 4p |
|
|
Term
| What is the life expectancy for pts with Huntington's after diagnosis? |
|
Definition
|
|
Term
| What are the characteristics of essential tremor? |
|
Definition
| a postural/intention tremor; 1/2 of pts have + family history; alcohol reduces the tremor; tremor can affect the voice |
|
|
Term
| How can you treat essential tremor? |
|
Definition
|
|
Term
| At what age do pts present with Huntington's? |
|
Definition
|
|
Term
| What are the symptoms of Huntington's? |
|
Definition
| early motor symptoms of stiffness and rigidity give way to prominent choreiform activity. Pts are highly aware of their movements. Irritability, moodiness, antisocial behavior, schizophreniform illness, depression, suicidality; dementia |
|
|
Term
| Whatkind of workup can you do for pts whom you suspect have Huntingtons? |
|
Definition
| its a clinical diagnosis but CT/MRI may show cerebral atrophy esp of the caudate and putamen; genetic testing to determine the number of CAG repeats |
|
|
Term
| What kind of treatment can you offer pts with Huntington's? |
|
Definition
| reserpine to minimize unwanted movements; haloperidol for treatment of psychosis, antidepressants for depression; benzodiazepines for anxiety; offer genetic counseling for offspring |
|
|
Term
| What's the difference between simple and complex seizures? |
|
Definition
| simple has intact consciousness; complex seizures cause a loss of consciousness |
|
|
Term
| A seizure is very easily confused with what type of syncopal event? |
|
Definition
| syncope with postsyncopal convulsions |
|
|
Term
| What lab value can help you distinguish psuedoseizures from true seizures? |
|
Definition
| serum prolactin levels are usually increased after true tonic-clonic siezures (prolactin levels can also increase after a syncopal event) |
|
|
Term
| T/F Tonic clonic movements exclude syncope. |
|
Definition
|
|
Term
|
Definition
| predisposition to recurrent unprovoked seizures |
|
|
Term
| Name some non-neurologic etiologies of seizure? |
|
Definition
| hypoglycemia or hyperglycemia, hyponatremia, hypocalcemia, hyperosmolar states, hepatic encephalopathy, uremia, porphyria, drug overdose (esp cocaine, antidepressants, neuroleptics, methylxanthines, and lidocaine), drug withdrawal (esp alcohol and other sedatives), eclampsia, hyperthermi, hypertensive encephalopathy and cerebral hypoperfusion |
|
|
Term
| What is the difference between the time frame of seizures vs. syncope? |
|
Definition
| seizures may last 1-2 minutes; syncope rarely lasts >14 seconds |
|
|
Term
| What types of focal neurological pathology can cause seizures? |
|
Definition
| tumor, stroke, AVM, infection or hemorrhage |
|
|
Term
| What percent of idiopathic seizures will recur? |
|
Definition
|
|
Term
| What findings make an idiopathic seizure more likely to recur? |
|
Definition
| abnormal EEGs or MRIs, with focal exams or with irreversible predisposing factors |
|
|
Term
| What is another name for a focal seizure? |
|
Definition
|
|
Term
|
Definition
| a seizure that arises from a discrete region in one cerebral hemisphere |
|
|
Term
| In a patient with a known seizure disorder and on medication who has a breakthrough seizure, what are some possible causes of the seizure? |
|
Definition
| subtherapeutic levels of medication or a new factor such as infection or trauma |
|
|
Term
| How can you tell the difference between Todd's paralysis and acute stroke? |
|
Definition
|
|
Term
| Face twitching before seizure means that the seizure probably originated in the... |
|
Definition
|
|
Term
| hand tingling before seizure means that seizure foci is probably in the... |
|
Definition
|
|
Term
| ALterations in BP, changes in heart rate and bronchoconstriction before seizure means it probably originated where? |
|
Definition
|
|
Term
| What are the most common parts of the cortex from which complex partial seizures arise in order of decreasing frequency? |
|
Definition
| temporal lobe, frontal lobe, then occipital lobe |
|
|
Term
| What types of auras might be seen in partial complex seizures that arise in the temporal lobe or medial frontal lobes? |
|
Definition
| memories (deja vu), feelings of fear, and "complex" actions such as lip smacking or walking; involves an impaired level of consciousness |
|
|
Term
| Describe the characteristics of Todd;s paralysis? |
|
Definition
| weakness or paralysis, often unilateral, that resolves over 24 hrs |
|
|
Term
| Name some common etiologies of seizures in infants? |
|
Definition
| congenital/genetic disorders, infection, perinatal ischemia/injury, metabolic disturbance |
|
|
Term
| Name some common etiologies of seizures in children ages 2-10? |
|
Definition
| idiopathic, infection, trauma, febrile seizure |
|
|
Term
| Name some common causes of seizures in adolescents (ages 11-17)? |
|
Definition
| idiopathic, traumatic, drug withdrawal, AVM |
|
|
Term
| What are some common causes of seizures in adults ages 18-35? |
|
Definition
| trauma, alcoholism, brain tumor, or drug withdrawal |
|
|
Term
| What are some common causes of seizures in adults 35+ |
|
Definition
| trauma, stroke, metabolic disorders, alcoholism |
|
|
Term
| What kind of workup should you do for seizures? |
|
Definition
| cbc, bmp, LFTs, ABGs, renal panel, RPR, esr, and tox screen; EEG; r/o a mass by CT or MRI (MRI is better) |
|
|
Term
| Why are EEGs ordered after a seizure? |
|
Definition
| to look for epileptiform waveforms and to confirm epileptiform waveforms |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| Name some common anticonvulsants used to treat epilepsy? |
|
Definition
| phenytoin, carbamazepine, phenobarbital, valproate, lamotrigine, gabapentin, and levetiracetam |
|
|
Term
| What is the first line anticonvulsant for children? |
|
Definition
|
|
Term
| What are some side effects of phenytoin? |
|
Definition
| gingival hyperplasia, hirsutism, and decreased vitamin B 12 levels |
|
|
Term
| What are the two most common types of generalized seizures? |
|
Definition
| absence (petit mal) and tonic-clonic (grand mal) |
|
|
Term
| T/F Absence seizures are familial. |
|
Definition
|
|
Term
| T/F Absence seizures typically resolve before adulthood. |
|
Definition
|
|
Term
| How long do absence seizures last? |
|
Definition
|
|
Term
| What does an absence seizure look like to an observer? |
|
Definition
| lasts only seconds, no loss of msucle tone, may see eye fluttering or lip smacking |
|
|
Term
| What is the classic EEG finding associated with absence seizures? |
|
Definition
| three-per-second spike and wave tracing |
|
|
Term
| What drugs can be used for absence seizures? |
|
Definition
| ethosuximide is first line but valproic acid or zonisamide may also be used |
|
|
Term
| Describe tonic-cloinc seizures? |
|
Definition
| begin suddenly with loss of consciousness and tonic extension of the back and extremities; then ontinuing with 1 to 2 minutes of repetitive symmetric clonic movements; seizurs are marked by incontinence and tongue bitting |
|
|
Term
| What are some common post ictal complaints? |
|
Definition
| muscle aches and headaches |
|
|
Term
| What are first line anticonvulsant therapies for grand mal (tonic clonic) seizures and how do you decide which ones to use? |
|
Definition
| valproate, phenytoin and carbamazepine are first line; choice depends on EEG, MRI and careful history |
|
|
Term
| What part of the immune system mediates MS? |
|
Definition
|
|
Term
| What is the male: female ratio of MS? |
|
Definition
|
|
Term
| When is MS typically diagnosed? |
|
Definition
|
|
Term
| T/F MS has a genetic component. |
|
Definition
|
|
Term
| What geographic location correlates with MS and what is the significance of this? |
|
Definition
| there is an increase in MS the further away from the equator you are; these geographic differences have led to the hypothesis that MS may be the result of a genetic predisposition coupled with a heretofore uncharacterized viral infection |
|
|
Term
| What are the different types of MS in decreasing frequency? |
|
Definition
| relapsing/remitting; secondary progressive, primary progressive and progressive-relapsing |
|
|
Term
| What are some common ocular symptoms associated with MS? |
|
Definition
| optic pallor or atrophy; medial longitudinal fasciculus lesions leading to internuclear ophtalmoplegia and diplopia; and optical enuropathy involving painful vision loss |
|
|
Term
| What are some bulbar symptoms associated with MS? |
|
Definition
|
|
Term
| What is the classic traid of MS? |
|
Definition
| scanning speech, intention tremor, and nystagmus |
|
|
Term
| What are some spinal cord symptoms? |
|
Definition
| hyperreflexia, spasticity, limb weakness, paresthesias and pain, patients will often present with a sensory level (e.g. numbness/tingling) below a given dermatome) due to the organization of the spinal cord; urinary retention, Lhermitte's sign |
|
|
Term
| What kind of infections are patients with MS predisposed to? |
|
Definition
| UTIs because of urinary retention |
|
|
Term
| What is Lhermitte's sign? |
|
Definition
| appears in some MS patients and presents as electrical sensation running down the spine an dinto the lower extremities with neck flesion |
|
|
Term
| What are some factors exacerbating MS? |
|
Definition
| infection, heat, trauma, the post partum period |
|
|
Term
| What common condition can decrease severity of MS symptoms? |
|
Definition
|
|
Term
| MS being exacerbated by heat is often referred to as... |
|
Definition
|
|
Term
| What should be in the differential when considering diagnosing MS? |
|
Definition
| CNS tumors or trama, CVAs, vasculitis, vitamin B12 deficiency, CNS infections (lyme disease, neurosympilis), sarcoidosis, atypical prsentation of other autoimmune diseases ( SLE and Sjogren's syndrome) |
|
|
Term
| How can you diagnose MS clinically? |
|
Definition
| history of multiple, separate neurologic attacks consisting of two attacks and clinical evidence of two separate lesions, or two attacks with clinical evidence of one lesion and laboratory evidence of another lesion |
|
|
Term
| What does MRI of MS show? |
|
Definition
| multiple, asymmetric, often periventricular lesions in white matter, called plaques |
|
|
Term
| What are plaques extending as long spindles away from the ventricles called? |
|
Definition
|
|
Term
| What MRI finding is almost pathognomonic for MS? |
|
Definition
|
|
Term
| How can you tell the difference between active and old lesions on MRI of MS? |
|
Definition
| active lesions will enhance with gadolinium |
|
|
Term
| What would CSF analysis of MS show? |
|
Definition
| mononuclear pleocytosis (>5 cells/uL) in 25% of cases, elevated free kappa light chains in 60% of cases, increased IgG in 80% of cases and oligoclonal bands in 90% of cases (nonspecific); typically no mroe than 50 WBCs in CSF |
|
|
Term
| What are some ways to treat MS? |
|
Definition
| avonex, betaseron, copaxone |
|
|
Term
| How efective are immunomodulatory and immunosupressive treatments in treating MS? |
|
Definition
| they can decrease the number of relapses by 30% and also can reduce the severity of relapses in relapsing-remitting disease |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| What is the treatment for an acute MS exacerbation? |
|
Definition
|
|
Term
| Besides pharmacologic therapy pts with MS may also benefit from? |
|
Definition
| PT and symptomatic treatment of spasticity, pain, fatigue and depression |
|
|
Term
| What are the characteristics of MS pts with the best prognosis? |
|
Definition
| relapsing-remitting course with discrete exacerbations, full recovery of function after each episode and an early age of onset of the initial attack |
|
|
Term
| What is the Kurtzke five year rule? |
|
Definition
| the absence of significant motor or cerebellar dysfunction 5 yrs after diagnosis correlates with limited disability at 15 years |
|
|
Term
| What is the prognosis 15 yrs after diagnosis of MS? |
|
Definition
| fifteen years after diagnosis, approximately 20% of MS patients ahve no functional limitation; 70% are limited or unable to perform major activities of daily living and 75% are not employed |
|
|
Term
| What is the prognosis 15 yrs after diagnosis of MS? |
|
Definition
| fifteen years after diagnosis, approximately 20% of MS patients ahve no functional limitation; 70% are limited or unable to perform major activities of daily living and 75% are not employed |
|
|
Term
| What causes guillain Barre syndrome? |
|
Definition
| believed to be autoimmune in nature and is often associated with a ivral URI prodrome or campylobacter jejuni infection |
|
|
Term
| How may cases of GBS are diagnosed each year? |
|
Definition
|
|
Term
| What percent of patients with guillain barre completely recover? die? |
|
Definition
| 85% completely recover; 5% die |
|
|
Term
| What are some key distinctions between MS and GBS? |
|
Definition
| GBS produces no sensory level, whereas spinal cord demyelination does produce a sensory level; GBS produces hypo- or areflexia, whereas chronic MS often leads to hyperreflexia. HOwever, an acute MS exacerbation can lead to areflexia for several days |
|
|
Term
| What does EMG and nerve conduction studies show for GBS? |
|
Definition
|
|
Term
| What does LP of GBS reveal? |
|
Definition
| LP reveals a CSF protein level >55 mg/dL with little or no pelocytosis (albuminocytologic dissociation) |
|
|
Term
| What study should you get on suspected GBS patients? |
|
Definition
| MRI of the spinal cord to exclude cord compression |
|
|
Term
| T/F Steroids can be used to treat GBS. |
|
Definition
|
|
Term
|
Definition
| plasmapheresis and IVIG are first line treatments |
|
|
Term
| Do you admit pts with GBS? |
|
Definition
| yes; they need to go to the ICU |
|
|
Term
| What is a major cause of morbidity of GBS? |
|
Definition
| autonomic instability, including cardiac arrhythmias and gastroparesis |
|
|
Term
| What lab value should you follow to monitor recover of GBS? |
|
Definition
|
|
Term
| How long does it take for pts to recover from GBS? |
|
Definition
| aggressive rehab is imperative and severe cases may take up to a year to recover |
|
|
Term
|
Definition
| a chronic, progressive degenerative disease of unknown etiology characterized by the loss of upper and lower motor neurons withOUT associated sensory symptoms |
|
|
Term
| How do you workup suspected ALS? |
|
Definition
| the clinical presentation is often diagnostic; rule out systemic causes; EMG/nerveconduction studies, CT/MRI of th hespine to exclude structural lesions that might account for UMN signs |
|
|
Term
| What do EMG/nerve conduction studies show for patients with ALS? |
|
Definition
| widespread denervation and fibrillation potentials |
|
|
Term
|
Definition
| supportive measures and patient education; riluzole, a glutamate inhibitor may prolong survival time |
|
|
Term
| What is the pathophys of myasthenia gravis? |
|
Definition
| an autoimmune disease caused by circulating antibodies to postsynaptic acetylcholine receptors |
|
|
Term
| Myasthenia Gravis can be associated with what other diseases? |
|
Definition
| thymoma, thyrotoxicosis and autoimmune diseases such as RA and SLE |
|
|
Term
| What kind of weakness is present in myasthenia gravis? |
|
Definition
| fluctuating ptosis, double vision, proximal muscle weakness, difficulty swallowing; weakness worsens with activity and throughout the day |
|
|
Term
| What is a myasthenic crisis? |
|
Definition
| respiratory compromise and aspiration that are rare but potentially lethal complications |
|
|
Term
| What can you do to examine pt's with myasthenia gravis? |
|
Definition
| test how long patients can keep their eyes open |
|
|
Term
| How do you diagnose myasthenia gravis? |
|
Definition
| give edrophonium (tensilon; a short acting cholinesterase inhibitor) and it should lead to a rapid and temporary improvement of clinical symptoms |
|
|
Term
| What serologies can you get on pts with myasthenia gravis and how useful are they? |
|
Definition
| AChR antibodies are positive in 85-90% of patients; 20% are negative for anti-AChR antibodies will have anti-muscle-specific kinase (anti-MuSK); antistriatal antibodies are present in 85% of patients with thymoma |
|
|
Term
| Name some long-acting anticholinesterase inhibitors used in the treatment of myasthenia gravis? |
|
Definition
| neostigmine and pyridostigmine (mestinon) |
|
|
Term
| Besides long acting cholinesterase inhibitors, what other types of medications are the mainstays of treatment for myasthenia gravis? |
|
Definition
| prednisone, other immunosuppressive agents; but pts must be closely monitored because symptoms can worsen with prednisone |
|
|
Term
| What is the treatment for myastehnic crisis? |
|
Definition
| plasmapheresis or IVIG may provide temoporary relief (days to weeks) |
|
|
Term
| When is thymectomy beneficial to pts with myasthenia gravis? |
|
Definition
| it is associated with an increased rate of clinical remission and a better clinical outcome esp in younger pts and regardless of the presence of a thymoma |
|
|
Term
| What is the pathophys of Lambert-Eaton Myasthenic syndrome? |
|
Definition
| paraneoplastic disorder in which autoantibodies to presynaptic calcium channels cause muscle weakness that improves with repetitive contraction of the muscle |
|
|
Term
| What percent of lambert eaton is paraneoplastic? |
|
Definition
| 90% are associated with small cell lung cancer |
|
|
Term
| Describe the characteristics of weakness associated with lambert eaton? |
|
Definition
| weakness of the proximal muscles with sparing of the extraocular or bulbar muscles |
|
|
Term
| How do you treat lambert eaton syndrome? |
|
Definition
| guanidine hydrochloride; anticholinesterases may also mitigate symptoms; tumor resection can cure symptoms |
|
|
Term
| What pt poptulation has the highest rates of carpal tunnel? |
|
Definition
| most commonly in women 30-55 yoa |
|
|
Term
| What are some risk factors to developing carpal tunnel syndrome? |
|
Definition
| repetitive use injury, pregnancy, diabetes, hypothyroidism, acromegaly, RA and obesity |
|
|
Term
| What is teh term for pathology of the spinal cord? |
|
Definition
|
|
Term
| What types of diseases cause problems with the anterior horn cells? |
|
Definition
| ALS, spinal muscular atrophy, poliomyelitis |
|
|
Term
|
Definition
|
|
Term
| Pathology of a nerve plexus= |
|
Definition
|
|
Term
| pathology of periphearl nerve= |
|
Definition
|
|
Term
| Anterior horn cell damage causes what kind of weakness pattern? |
|
Definition
|
|
Term
| What kind of weakness is caused by myopathies? |
|
Definition
|
|
Term
| What does an EEG look like if there has been damage of the spinal cord, anterior horn cell or peripheral nerve plexus? |
|
Definition
| with lesions causing axonal degeneration there may be abnormal spontaneous activity (fasciculations/fibrillations); if sufficient time has elapsed after onset; with reinnervation, motor units may be large, long and polyphasic |
|
|
Term
| What does EEG show if there is pathology with the neruomuscular junction? |
|
Definition
| often normal but individual motor units may show abnormal variability in size |
|
|
Term
| What does electromyography show if there is a myopathy? |
|
Definition
| small, short, abundant polyphasic motor unit potentials; myositis--abnormal spontaneous activity |
|
|
Term
| What type of pathology shows up on nerve conduction velocity studies? |
|
Definition
| peripheral nerve plexus disorders where they are slowed, especially in demyelinating neuropathies |
|
|
Term
| What types of diseases have abnormal muscle response to repetitive motor nerve stimulation? |
|
Definition
| anterior horn cell disorders have normal muscle response except in teh active stage of disease; neruomuscular junction disorders ahve abnormal decrement or increment depending on stimulus frequency and disease |
|
|
Term
| When is myelography or spinal MRI useful in evaluating weakness? |
|
Definition
| it may be helpful if it is spinal cord disease and may be helpful in excluding other disorders if it is anterior horn cell disease |
|
|
Term
| What kind of symptoms do pts with carpal tunnel syndrome complain of? |
|
Definition
| wrist pain; numbness and tingling of the thumb, index finger, middle finger, and lateral half of the ring finger; weak grip and decreased thumb opposition |
|
|
Term
| What make symptoms of carpal tunnel worse? |
|
Definition
| activities that require wrist flexion (typing, holding a cup of coffee, or opening a jar); symptoms may awaken th epatient at night and are relieved by shaking out the wrists; patients often compain of nocturnal prain and paresthesias |
|
|
Term
| Where is the anatomic location of the carpal tunnel? |
|
Definition
| between the carpal bones and the flexor retinaculum |
|
|
Term
|
Definition
| tapping on the palmaris longus tendon at the wrist over the median nerve to elicit a tingling sensation in the thumb and affected fingers |
|
|
Term
| How useful in Tinel's sign? |
|
Definition
| 60% sensitivity and 65% specificity |
|
|
Term
|
Definition
| requires that the patient appose the dorsal aspects of th ehands with the wrists flexed at 90 degrees for at least 30 seconds; the onset of paresthesias confirms the diagnosis |
|
|
Term
| What is the usefulness of phalen's sign? |
|
Definition
| 75% sensitivity; 35% specificity |
|
|
Term
| What studies can you use to evaluate a pt for carpal tunnel syndrome? |
|
Definition
| EMG and nerv conduction studies to evaluatin the degree of neural and motor compromise esp in pts wh oexhibit persistent symptoms despite conservative management |
|
|
Term
| Pts with carpal tunnel should be evaluated for risk factors such as... |
|
Definition
| diabetes and hypothyroidism |
|
|
Term
| What are some conservative management options of carpal tunnel syndrome? |
|
Definition
| neutral wrist splints to wear both during the day and at night; modification of repetitive actibities and creation of a more ergonomic work environemtn; NSAIDs to control inflammation of the tendons |
|
|
Term
| What kinds of procedures can be done to treat carpal tunnel syndrome? |
|
Definition
| direct injection of corticosteroids into the carpal space to provide temporary relief; surgical division of the transeverse carpal ligament if symptoms persist |
|
|
Term
| What kinds of things cause spinal cord compression? |
|
Definition
| tumor, abscess, ruptured or slipped intervertebral disk, or bone fragments from a vertebral fracture |
|
|
Term
| What are the symptoms of spinal cord compression? |
|
Definition
| back pain and decreased sensation below th elevel of compression and/or paralysis of the limbs below the level of compression; urinary and fecal incontinence and/or urinary retention may also be seen; hyperreflexia and Lhermitte's sign may be present |
|
|
Term
| What are the symptoms of cauda equina syndrome? |
|
Definition
| saddle anesthesia, bowel/bladder dysfunction, low back pain, and lower extremity weaknes |
|
|
Term
| If a patient has suspected spinal cord compression and a pacemaker, what kind of imaging should you get? |
|
Definition
|
|
Term
| What kind of tumors commonly cause spinal cord compression? |
|
Definition
| metastatic nonsmall cell lung cancer, breast cancer, prostate cancer, renal cell carcinoma, lymphoma, and multiple myeloma |
|
|
Term
| What is the treatment for spinal cord compression? |
|
Definition
| IV dexamtheasone (a glucocorticoid) shuold be given to reduce edema around the lesion; urgent surgery is warranted if a localized lesion is identified and some hope of regaining function is predicted; if it is cancer related, emergent radiation tehrapy may decrease tumor bulk and help reduce compression |
|
|
Term
| When do spinal cord compression symptoms become irreversible? |
|
Definition
| chances of recovery are significantly reduced if you've ahd complete paralysis for > 24 hrs |
|
|
Term
| What are the symptoms and signs of closed angle glaucoma? |
|
Definition
| extreme, sudden pain and blurred vision that may be accompanied by nausea and vomiting; presents as a hard red eye that is unilateral and the pupil is dilated and nonreactive to light |
|
|
Term
| What is the pathophys of closed angle glaucoma? |
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Definition
| acute closure of the narrow anterior chamber angle |
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Term
| How do you evaluate some one that you suspect has closed angle glaucoma? |
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Definition
| perform a slit-lamp and measure intraocular pressure by tonometry |
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Term
| How do you treat closed angle glaucoma? |
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Definition
| emergently decrease intraocular pressure with acetazolamide, mannitol, pilocarpine, and timolol to prevent damage that can lead to blindness; peripheral laser iridotomy can be curative |
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Term
| What are the sympotms of open-angle glaucoma? |
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Definition
| can be asymptomatic, esp in the early stages; suspect in pts >40 years of age with frequent eyewar prescription changes, visual disturbances, and headaches |
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Term
| Where do visual defects begin in open angle glucoma? |
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Definition
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Term
| How do you workup suspected open angle glaucoma? |
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Definition
| perform visual field testing, fundoscopy, slit lamp exam and tonometry; look for cupping of the optic disk on slit lamp or fundoscopy |
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Term
| How do you treat open angle glaucoma? |
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Definition
| topical beta blockers (timolol) to decrease aqueous humor production or with pilocarpine to increase aqueous humor outflow; laser trabeculoplasty if medications fail |
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Term
| How do you screen patients for open angle glaucoma? |
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Definition
| pts over 40 should have yearly eye exam; those with a family history or diabetes should have more frequent exams |
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Term
| What is the leading cause of bilateral visual loss among the elderly in the united states/ |
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Definition
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Term
| What are the symptoms of macular degeneration? |
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Definition
| painless loss of central vision |
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Term
| Signs on fundoscopic exam of macular degeneration? |
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Definition
| pigment or hemorrhagic changes in the macular region |
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Term
| Is there any treatment for macular degeneration? |
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Definition
| laser photocoagulation may delay the loss of central vision but the disease will often continue to progress |
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Term
| T/F Good glucose control can help prevent diabetic retinopathy. |
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Definition
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Term
| What are the different types of diabetic retinopathy? |
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Definition
| nonproliferative and proliferative |
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Term
| What is the treatment for nonproliferative diabetic retinopathy? |
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Definition
| focal laser photocoagulation to affected areas, especially when the process starts to affect the macula |
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Term
| What is the treatment for proliferative retinopathy? |
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Definition
| treat with panretinal photocoagulation, in which laser burns are applied to the entire periphery of the retina to destroy ischemic aeras (which release the vessel growth signals) |
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Term
| What is the workup for nonproliferative diabetic retinopathy? |
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Definition
| on slit lam pexam, look for dot-blot hemorrhages, microaneurysms, exudates, adn edema |
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Term
| What is the workup for proliferative diabetic retinopathy? |
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Definition
| on slit lamp exam, look for retinal neovascularization |
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