NPLEX 2010 - Neurology Flashcards -
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&&&NPLEX 2010 - Neurology
Nplex 2010 - Neurology
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109 Cards in this Set
Why does Lithium have a blood dose and what are signs of toxicity
The systemic level is too close to the toxic level.
Neuro signs
Renal toxicity
What type of diet is CI in Lithium use
Low Sodium diet
What conditions can Gabepentin be used for
What do fever, HA, neck stiffness or nuchal rigidity suggest in an adults
What sign of meningitis is not seen in infants that is seen in adults and what sign is seen in infants that is not seen in adults typically
nuchal regidity
infants will often have GI complaints
What is seen more often in encephalitis than in meningitis.
focal neurallogical deficit
What is the hallmark of encephalitis
Persistent HA, had flu like sx that resolved by HA won't go away
What can cause meningitis
0-4 wks - Group B strep, E. Coli, L. Monocytogenase
4-12 wks - add Step pneumonea
3mo - 18 yrs - Step pneumonea, N. Meningitidis, H. Influen
18-50 yrs - Step pneumonea, N. Meningitidis
& 50 yrs - Step pneumonea, N. Meningitidis, L. Monocytogenes, arobic gram neg. bacilli
What can cause encephalitis
EEE, (Togaviridae, genus Alphavirus) birds reservoir not horses
Measles, mumps, chicken pox, rubella can cause autoimmune encephalitis
HSV I & II (why C-section for positive mothers in the past)
What type of parastesias are seen in MS
glove and stocking parastesias that comes and goes
What are some sx in MS that can come and go
Weakness, numbness, tingling, unsteadiness, spasticity, diplopia, sphincter disturbance
Person who has recovered from a viral infection then wakes and can't stand up d/t a paralysis that is moving from their feet up their body
Guillain-Barre Syndrom
What is Wernicke-Korsakoff syndrome
Thiamine (B1) def d/t alcoholism - EtOH uses up B1
Confabulations (no short term memory) IV B1 reverses many Sn/Sx
What is Pallegra?
Niacin def
Dementia, Dermatitis, Diarrhea (death)
What vit def is suggested in a macrocytic anemia that resolves with
Folate supplementation
However the pt's neuro sx do not resolve
Multi infarct dementia - describe
Common in rhythm disturbances in the heart (chronic)
Slowly progressing dementia
Smokers, proinflammatory conditions, DM, HTN and hyperlipidemia
Why should an MRI be done on all migraine pts at some point
migraines can be d/t vascular abnormalities in the brain.
What is at the top of a DDX when a pt has
a sudden very severe HA or the worst HA of their life
Barry Aneurysm or other vascular problem in the head
What is seen in Hypertensive Encephalopathy?
-Diastolic pressure over 120
-Grade 4 retinal changes
-Confusion, drowsiness, h/a, nausea.
Will act very crazy.
-May lead to rupture and hemorrhage
How is Bell's palsy dx
by clinical evaluation of sx - only 7th CN involved
May see hyper lacrimation and salivation prior to the development of the paralysis
How long does RIND last
&24 hrs and sx resolve completely
How does a TIA present
Often will be an older person brought in by care giver saying person is not thereselves
A last 2-30 abate with no permanent sequelae
90% affect carotid ipsilateral blindness/contralateral hemiparesis that are temporary
Neurological exam is normal when seen
How are Gillion Berret differ from Botulism
Botulism is from the top down vs GB is from the bottom down
Describe a Stroke
Infarction of brain tissue manifested by neurologic deficits of varying severity
Atherothrombotic: sudden, gradual, stepwise or fluctuating.
Cardiac embolus: sudden onset. High Risk-atrial fibrillation, prosthetic valve, mural thrombus, dilated cardiomyopathy, M I in previous 4 wks
Waking in the morning with a global HA suggests what?
CO poisoning
Pt with sx of
of ring finger and 5th finger on palm surface suggests the involvement of what nerve
What sx are seen in Botulism
Dry mouth, diplopia, ptosis, loss of accommodation and pupillary light reflex
G.I. Sx precede neuro sx and include n/v, cramps and diarrhea
How can a migraine and a cluster HA be differentiated from each other
Cluster HA - gremlin beats you on the side of the head at specific times throughout the day. Big pain burst that causes them to be violent. M&F young&old. May see autonomic stuff - stuffy nose
Migraines - Giant bear that you see coming and you know what is coming (big long crescendo) so you want to hibernate
What is CI in the use of sumatriptan
Basilar artery abnormalties - can cause vessel rupture!!!
What are the sx of Giant cell arteritis
Half sided HA often triggered by pressing on the temporal artery.
Needs to be tx b/c can lead to blindness.
Labs show ESR &100+ need to do biopsy to dx
What type of tremor is seen in Parkinson's dzs
resting tremor
Pill rolling
What are the movements that are characteristic of Huntington's
How is the dx of Alzheimer's made
it is a dx of exclusion - dementia w/o any other known cause - tumor, strokes, cardiovascular, meds ect.
How is Muscular Dystrophy dx
Mytonic dystrophy
Stiffness, unable to release a grasp, thick speech, muscle atrophy in face and neck ? swan neck deformity
A slowly progressive
Onset in 20’s
Cataract, frontal baldness, testes atrophy, diabetes, cardiac and intellectual changes.
Cerebral palsy
Motor manifestations of nonprogressive brain damage sustained during prenatal/postnatal life.
Lower motor neuron involvement—atrophy, weakness of arms/legs, normal sensation, ? DTR’s, fasciculations of muscles, dorsal interosseous spaces become hollow
Upper motor neuron involvement—spasticity, clonus, ? DTR’s, + Babinski
Bulbar involvement—dysarthria, dysphagia, tongue atrophy
Sensation and gait are maintained
Muscle biopsy will show neurogenic process
CK may be very high (&1000)
Myasthenia gravis
Autoantibodies to Ach receptors
weakness, particularly of ocular, bulbar, pharyngeal, respiratory, proximal extremities
Weakness on exertion!
No sensory loss
What meds are CI with cyclobenzapine
MAO inhibitors
What effect do opiods have on pain sensation
Doesn't stop the pain, only causes a disassociation from the pain - you don't care about the pain
Most common side effects of opiates and what is the most concerning side effect
Constipation
Most concerning - too high of dose stop breathing
What meds are opiates
codeine, morphine, oxycodone, hydrocodone
What is the #1 overdose medication in the world and what dose is considered the toxic dose. Why is it toxic
Tylenol/Acetaminophen - should not exceed 4 g in 24 hours or 7-10 g in one dose!!! It is hepatotoxic
What is a possible side effect of people who do long term chronic NSAIDs use (even w/in) the recommended dose
Renal failure
What is the concern for celecoxib (Cox 2 inhibitor)
Heart and Liver failure
What strength difference of prednisone to hydrocortisone
hydrocortisone is 1/4 the strength of prednisone
What are the CI in colchicine
CV, hepatic, renal or GI dz
What is the dose equivalent of prednisone to cortisone
dose from Prednisone to Cortisone conversion is a 4 to 1 ratio.
5 mg. Prednisone = 20 mg Cortisone
Physiologic dose of Cortisone is 25 to 40 mg. orally.
What are the two types of Absence (petit mal) seizures? What are the concrns when seen in childhood
Simple - like a pause button was pushed
Complex - out of it long enough it is noticeable.
If seen in children can develop tonic clonic (grand mal) in adulthood
what is at the top of the ddx when someone has a 1st episode of syncope, what is first test to be done
First episode of heart block
What is most common iatrogenic cause of syncope
Overdose of HTN meds or alcohol consumption
What is the DDX for altered mental status
Endocrine, electrolytes
Oxygen, opiates
Trauma, Temp
Insulin (DM)
Psychiatric, porphryria
Subarachnoid, Space occupying lesion
What image is used to diagnose dementia such as alzhiemers
What NT speed up someone's brain &uppers&
What NT slow down the brain &downers&
Histamines
Neurosteroids
What condition do we want to speed the brain up
Depression
What sort of condition do you want to slow the brain down
Seizure disorders
What are bromocriptine and pramipexole used for and what are the side effects
it is a dopamine agonist and is used for the tx of Parkinson's dz (late stage)
HTN, aggressive behavior, NV
What are the side effects to chatacholomine like drugs
HTN and constipation d/t alpha 1 receptor stimulation
tachycardia and maybe some lung effects
Why do you want to use caution with SAMe and hyperthyroid
It is a stimulant so you can get over stimulated
What are the two amino acids that can be stimulating and what are they precursors for
Phenylalanine and Tyrosine
They are precursors to Dopamine and NE and Thyroid hormones
What are the concerns with giving Phenylalanine and Tyrosine
They can have insomnia, pychotic, can seem similar to ADHD etc
What vitamins need to be closely regulated in the case of Dopamine therapy
B vitamins especially B6
Why can people go hypertensive on SAMe
it is a methyldonor and therefore can push NE to Epi in the periphery
What is phenelzine and what does it do
It is a MAO inhibitor and blocks the break down of catacholomines.
Don't use with anything else!!!
Over the counter stimulant is the WORSE thing you can do!!!
like psuedafed
What is buproprion
Can be used for depression or quitting smoking.
The caution is that it lowers the seizure threshold.
Therefore can see seizures with it.
It is a NE & Dopa enhancer can be used with SSRIs
What is VMA, how is it used and how is it measured
It is a biproduct of catacholine metabolism and it is found in the urine.
It is used to screen for a chatecholamine producing tumor.
Dec MAO will dec VMA
What B vitamin does MAO require for activity
What is the amino acid that is a precursor for Serotonin, Melatonin, Niacinamide (B3)
Tryptophan
What is the required B vitamine for B3/Niacinamide production
What is the caution of SSRI use with nutrient use
You can induce serotonin syndrome so you don't want to use too much of one
What are the sx of serotonin syndrome
Hyperflexia
BP changes
How is serotonin syndrome progression stopped?
STOP ALL Serotonin manipulating nutrients and drugs!!!
Wait for all sx to go away then slowly reintroduce the a therapy.
What drugs do you need to be cautious with when someone is on a serotonin augmenting substance
Tryptophan
Niacinamide
What is amitriptyline?
What are the main SE?
It is a tricyclic antidepressant. They inhibit re-uptake of MAO and therefore increase NE and Serotonin.
SE - High dose - suicidal, any dose - insomnia
Use - depression (rarely), modified pn syndromes & sleep
What is the enzyme that makes acetylcholine
choline acetylase
What is the enzyme that breaks acetylcholine down
acetylcholine esterase
What is a mineral that blocks AcH release at the synaps
What is are rivastigmine and donepezil
Cognitive Agent - ach sparing
What is trazodone
Serotonin transport inhibitor used for depression and insomnia (esp insomnia)
What is the generic name of benadryl
diphenhydramine
What is loratadine
H1 receptor antagonist - antihistamine
What are the drugs that effect GABA in most specific to least specific - what is the caution with these?
benzodiazapine
barbituates
booze alcohol
&neural steroids
DON'T Ever MIX these!!!
They can lead to death together!
What effect does GABA receptors have on a cell
Open Cl channels and is therefore inhibitory!
What else does this
Marijuana also opens Cl channels
What is GABA synthesized from
What is given IV in acute seizure?
Diazepam and Calcium Gluconate Given IV in acute seizure!
What amino acid can be given to have a calming effect
glycine (also open's Cl channels)
can help in anxiety, wound healing and mm spacity.
What condition must you use caution when using glycine
Bipolar disorder
What is excitatory at NMDA receptors
Glycine, Zn, Glutamate
What effect does NO have on the nervous system
increases cGMP and therefore -
Photoreception
Vascular Smooth Muscle:
Vasodilatation
AMPA (Excitatory) receptors: probable desensitization
How long must you wait to give a MAO inhibitor after they have come off of reserpine?
Do NOT administer MAO inhibitors and Reserpine within two weeks of each other
What type of diet is CI with Lithium use
Low sodium
What organisms typically cause brain accesses
Staph and strep
What increase risk for bran abscess
Increased risk in orbital infections!!, bacterial endocarditis, bronchiectasis, congenital heart dz.
Describe TB meningitis
Mycobacterium TB,
Well formed granulomas with caseous necrosis & giant cell infiltrates
Seen with acid fast stain
Describe Neurosyphilis:
Paralytic = brain atrophy from cell death
Tabes Dorsalis
spirochete destroys dorsal roots = impaired sensation & ataxia, absent DTR’s
Describe Poliomyelitis
Non-specific gastroenteritis
secondary invasion of lower motor neurons,
flaccid paralysis,
Post polio syndrome
progressive weakness 25-35 yrs later, muscle wasting, virus not found
When does cerebral edema commonly occur
Common after injury, radiation, long term HTN
Describe a benign essential tremor
Most common movement disorder
FH found in 50% of cases
Increased with skilled movements and made worse with tension
Absent at rest
Tremor of head and voice also common
What causes motor, sensory loss, as well as a nystagmus
What are neur dz that involve motor and sensory
Guillen-Barre
How is a grand mal seizure characterized
generalized major motor convulsions, tonic mm contractions, loss of consciousness, possibly followed by aura of giddiness, mood change, confusion or involuntary twitching
What is another name of petit mal
Absence seizures
What is another name for grand mal seizure
Tonic clonic seizure
How can you differentiate an upper motor neuron from a lower motor neuron lesion of the facial n
Lower neuro lesion involves full half of the face
Upper only involves the lower half of the face (on r or l)
What neural deficits are common with B12 deficiency
Paresthesias and ataxia
What is Wernikey's syndrome
B1 Deficiency it can cause memory and cognitive problems
What B vitamin def doesn't cause a neural deficit
Folic acid
What CN are affected by lesions in the following areas
Midbrain lesions affect:
Pons lesions affect
Medulla lesions affect
Midbrain lesions affect: CN 1,2,3,4
Pons lesions affect:
CN 5,6,7,8
Medulla lesions affect:
CN 9,10,11,12
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Take one in morning and one at night.
** G-Plex is not for individual sale and is only sold as a kit with Tart Cherry
Why G-Plex ?
Purines are natural substances that are found in all of the body’s cells and in almost all foods. When cells die off, or when food is consumed, purines get broken down to aid in the proper functioning of our body chemistry. However, if the metabolism of these purines is disrupted, by, for example, an extremely high-purine diet, various health problems may occur.
Gout, a form of arthritis, is mainly caused by high levels of uric acid, which accumulate in joint areas and causes
swelling and pain. Kidney and Liver disease are common co-existing conditions that contribute to Gout. Several drugs, steroids, and antibiotics typically prescribed to treat kidney and liver damage, as well as gout symptoms, must typically be taken for life and may cause signifcant side efects.
G-Plex is an alternative, herbal solution that is specially formulated to aid in the metabolism of purines and uric acid levels.
G-Plex may help in the metabolism of purines to aid:
Proper immune system function
Normal blood circulation
Healthy liver and kidney function
Efficient metabolic process
Proper digestion
G-Plex MUST be taken in combination with .
Tart Cherry can help regulate the effects of high uric acid levels by providing nutrients and phytochemicals, like anthocyanins, that have benefcial antioxidant properties.
G-Plex originally included Tart Cherry in its formula, due to its positive effect on uric acid levels. However, because it has a wide range of other benefits on overall health, Tart Cherry has been isolated into its own separate product to accompany our other products (see our
page for more details) to help improve effectiveness.
Suggested Serving
The recommended dosage is one capsule taken twice daily. One in the morning, and one in the evening must be taken with a meal to prevent stomach irritation.
*As with any dietary supplement, consult your health care practitioner before using this product, especially if you experience any allergic reactions, or have an existing condition.
Q:Can I take a variety of dietary supplements at the same time?
A: Yes, this range of products is a source of dietary nut they are similar to food. Two to three kinds can be taken together, only after meals. For more than three kinds, the fourth and/or fifth kind can be separated by two hours for easy absorption.
Supplement Facts
Ingredient
Ingredient
Amount per serving (2 caps)
Ingredient
Amount per serving (1 caps)
Yucca Root Powder
Yucca Root Powder is extracted from Yucca plant, which has a high saponin content that assists in the growth of new cartilage. Yucca root also contains resveratrol, a natural antioxidant, which may aid in suppressing damaging free radicals.
Artichoke Leaf Extract
Artichoke leaf extract is a plant extract that has been used for aiding digestion by stimulating the flow of bile from the liver. In addition, it has been used to boost liver functions by strengthening and regenerating liver cells. Basic scientific studies have also demonstrated artichokes to aid in the natural elimination of uric acid from the system.
Celery Seed
Celery seeds may help support the maintenance of healthy joints and proper digestive functions.
Bromelain Powder
Bromelain is a protein-digesting (proteolytic) enzyme complex found in pineapples. It may help speed up healing time after an injury.
Rutin Powder
Rutin is a plant pigment (flavonoid) found in certain fruits and vegetables that may also help neutralize free radicals in the body. It may also help circulation by strengthening vessels and trypsin.
Tart Cherry Extract
Cherries are an excellent source of antioxidants and has a broad spectrum of benefits towards overall health. It has at least 17 natural ingredients, including: Anthocyanins, which have antioxidant properties that help to maintain cardiovascular health, and has been found to regulat Perillyl alcohol (POH), a naturally occurring monoterpene, may be beneficial in re and Melatonin (from the Montmorency variety of tart cherries) which may be helpful in promoting healthy sleep patterns.
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