Neurological Disorders
QUESTIONS WITH ANSWERS.
Med Surg Exam 3- Managment of the adult with neurological disorders
agnosia - CORRECT ANSWER✅✅failure to recognize objects perceived by senses
aphasia (expressive, receptive, global) - CORRECT ANSWER✅✅- expressive:
difficulty speaking, understand what is being said to you, recognize that something has
to be said, say wrong words
- receptive aphasia- don't understand what is being said
- global- large legion associated with almost total reduction of written and spoken
language
apraxia - CORRECT ANSWER✅✅inability to carry out purposeful learned motor
activities
Areas assessed for CVA (6) - CORRECT ANSWER✅✅1. motor function
2. communication ability
3. perceptual disturbances
4. bowel impairment
5. bladder impairment
6. mental ability
ASA, Persantine (CVA DRUG) - CORRECT ANSWER✅✅- antiplatelet aggregators
Assessment of IIP (7) - CORRECT ANSWER✅✅1. level of responsiveness
2. change in behavior (early signs)
3. changes in vital signs (late signs)
4. headache
5.vomiting
6. Glascow Coma scale
7. Neuro Assessment
Cerebral Embolism - CORRECT ANSWER✅✅- clot from another site travels to the
brain. M>W
Cerebral Thrombosis - CORRECT ANSWER✅✅- m>w, 30-50% will have history of
TIAs. Represents the most common cause of stroke for those >50
Cerebral Vascular Disease Definition - CORRECT ANSWER✅✅any functional
abnormality of the CNS caused by interruption of the normal blood supply to the brain.
The most common cause of CVD is arteriosclerosis of the internal carotid. CVD is the
,3rd leading cause of death in the USA. Remember that arteriosclerosis refers to a
groups of diseases characterized by thickening of walls and atherosclerosis is deposit of
plaque
- CVD can cause a TIA and/or a CVA
Changes in behavior IIP (early signs) - CORRECT ANSWER✅✅AKA mental acuity
- terms to describe: restlessness, exaggerated breathing, mental cloudiness, confusion
Changes in vital signs (late signs) IIP - CORRECT ANSWER✅✅- increased
temperature
- hypothalamus responsible for vital signs
- HR decrease, swelling hypothalamus, lead to periods of apnea- Cheyne Stokes
- BP go up in response to pulse decrease, widening pulse pressure * S is increased and
D is decreased, distance between them is increased
cholinergic crisis (related to MG) - CORRECT ANSWER✅✅- due to overdose of
cholinesterase inhibitors which results in profound muscle weakness that leads to
respiratory failure. atropine may be administered
- might be difficult to differentiate between 2 crises. the tensilon test is given to
determine which one. the patient who has Myasthenia crisis will improve temporarily
and the one with cholingeric crisis will worsen
Clinical Manifestations CVA - CORRECT ANSWER✅✅- TIAs were formally viewed as
a separate entity from CVAs. Now, no longer viewed that way. TIAs generally produce
produce neurologic dysfunction (loss of motor, sensory or visual function) that are
temporary, last about 24 hours. Considered to be a precursor of CVA
clinical manifestations Guillan-Barre Syndrome (4) - CORRECT ANSWER✅✅1. acute
onset of generalized weakness
2. paralysis starts in legs
3. ascending paralysis
4. respiratory paralysis
Clinical Manifestations MS (3 triad) - CORRECT ANSWER✅✅Cardinal or Classic
Triad:
1) resting tremors: at first are slow and unilateral. hands may have tremors at rest
causing micrographia (writing becomes smaller) and pill rolling (thumb and fingers rub
back and forth). the forearm and hands have supination/pronation. the tongue has
tremors that cause dysarthria (difficulty with speech). eventually the patient will have
difficulty with fine motor movements For ex) holding a newspaper or using a touch
phone. the resting tremors will disappear with slow purposeful movement. Anxiety,
walking and when the patient is concentrating will cause an increase
2. rigidity: muscles become stiff and increasingly resistant to passive movement.
classified as plastic-mildly restrictive movement where trying shoes and rising from an
armed chair is difficult. cogwheel rigidity: rhythmic interruption of muscle movement
, when joint is moved inhibiting spontaneous movement (will have problems pivoting-lose
balance)
- lead pipe rigidity: total resistance to movement leading to akenesia called freezing
phenomena (joint locks and patient will be unable to move)
- truncal rigidity: causes the need to move the body as a unit when getting out of bed
and chair. should sit in chair that has arms. rigidity of neck and back muscle-results in
old man posture (stooped, flexed trunk, flexed elbows and abducted shoulders) stiffness
of facial muscles also occurs. hypomimia- mask of P's (decreased facial expression)
- the rigidity may affect muscles of speech- resulting in slurring, stuttering, raspy voice
and inability to speak. patient may also develop rigidity of voluntary muscles of the
throat- dysphagia- leads to pooling of food which could cause choking- aspiration
pneumonia
- also possible for chest wall and intercostals muscle rigidity leading to difficulty
breathing
3. bradykenesia- reduced movemen
clinical manifestations MS (6) and (7) secondary symptoms - CORRECT
ANSWER✅✅- depends on the area of demyelination in brain
- early symptoms are due to a single or small number of lesions (plaques). Poses a
problem in dx as the symptom may disappear with remission of 10 years
1. visual disturbance: common early sign that over 50% experience. Due to damage
and inflammation of the optic nerve. Patient may c/o: diplopia (double vision),
nystagmus (invol. jerky eye movement) which leads to blurred vision and oscillopsia
(objects jump into the field of vision)
2. intentional tremors (when performing voluntary actions- opposite of resting tremors),
weakness, paresthesia and pain around the trunk form spasm in spinal cord, and ataxia
(uncoordinated movements)
3. sensitivity to heat occurs in 50% of cases. heat triggers symptoms and they may not
realize how hot something is because of the numbness (environmental heat, being 90
outside)
4. 75% cases c/o fatigue. not related to muscle problem but due to effects of MS on
CNS. comes on without a warning. Patients complain that they feel as though they have
hit a brick wall after being normal all day. MS fatigue is called idiopathic lassitude
5. many patients will develop urinary retention from bladder spasticity and bowel
spasticity
6. secondary symptoms
- UTI: from urinary retention
- Constipation: from bowel spasticity
- decubiti: from immobility
- contracture deformities: from immobility
- dependent peda; edema (swelling below knees)
- pneumonia (many die from)
- reactive depressions: patients who have MS often have social and psychological
problems such as depression and mood swings. vocational problems such as job loss
and job changes and redefining personal relationships. these must be addressed as
QUESTIONS WITH ANSWERS.
Med Surg Exam 3- Managment of the adult with neurological disorders
agnosia - CORRECT ANSWER✅✅failure to recognize objects perceived by senses
aphasia (expressive, receptive, global) - CORRECT ANSWER✅✅- expressive:
difficulty speaking, understand what is being said to you, recognize that something has
to be said, say wrong words
- receptive aphasia- don't understand what is being said
- global- large legion associated with almost total reduction of written and spoken
language
apraxia - CORRECT ANSWER✅✅inability to carry out purposeful learned motor
activities
Areas assessed for CVA (6) - CORRECT ANSWER✅✅1. motor function
2. communication ability
3. perceptual disturbances
4. bowel impairment
5. bladder impairment
6. mental ability
ASA, Persantine (CVA DRUG) - CORRECT ANSWER✅✅- antiplatelet aggregators
Assessment of IIP (7) - CORRECT ANSWER✅✅1. level of responsiveness
2. change in behavior (early signs)
3. changes in vital signs (late signs)
4. headache
5.vomiting
6. Glascow Coma scale
7. Neuro Assessment
Cerebral Embolism - CORRECT ANSWER✅✅- clot from another site travels to the
brain. M>W
Cerebral Thrombosis - CORRECT ANSWER✅✅- m>w, 30-50% will have history of
TIAs. Represents the most common cause of stroke for those >50
Cerebral Vascular Disease Definition - CORRECT ANSWER✅✅any functional
abnormality of the CNS caused by interruption of the normal blood supply to the brain.
The most common cause of CVD is arteriosclerosis of the internal carotid. CVD is the
,3rd leading cause of death in the USA. Remember that arteriosclerosis refers to a
groups of diseases characterized by thickening of walls and atherosclerosis is deposit of
plaque
- CVD can cause a TIA and/or a CVA
Changes in behavior IIP (early signs) - CORRECT ANSWER✅✅AKA mental acuity
- terms to describe: restlessness, exaggerated breathing, mental cloudiness, confusion
Changes in vital signs (late signs) IIP - CORRECT ANSWER✅✅- increased
temperature
- hypothalamus responsible for vital signs
- HR decrease, swelling hypothalamus, lead to periods of apnea- Cheyne Stokes
- BP go up in response to pulse decrease, widening pulse pressure * S is increased and
D is decreased, distance between them is increased
cholinergic crisis (related to MG) - CORRECT ANSWER✅✅- due to overdose of
cholinesterase inhibitors which results in profound muscle weakness that leads to
respiratory failure. atropine may be administered
- might be difficult to differentiate between 2 crises. the tensilon test is given to
determine which one. the patient who has Myasthenia crisis will improve temporarily
and the one with cholingeric crisis will worsen
Clinical Manifestations CVA - CORRECT ANSWER✅✅- TIAs were formally viewed as
a separate entity from CVAs. Now, no longer viewed that way. TIAs generally produce
produce neurologic dysfunction (loss of motor, sensory or visual function) that are
temporary, last about 24 hours. Considered to be a precursor of CVA
clinical manifestations Guillan-Barre Syndrome (4) - CORRECT ANSWER✅✅1. acute
onset of generalized weakness
2. paralysis starts in legs
3. ascending paralysis
4. respiratory paralysis
Clinical Manifestations MS (3 triad) - CORRECT ANSWER✅✅Cardinal or Classic
Triad:
1) resting tremors: at first are slow and unilateral. hands may have tremors at rest
causing micrographia (writing becomes smaller) and pill rolling (thumb and fingers rub
back and forth). the forearm and hands have supination/pronation. the tongue has
tremors that cause dysarthria (difficulty with speech). eventually the patient will have
difficulty with fine motor movements For ex) holding a newspaper or using a touch
phone. the resting tremors will disappear with slow purposeful movement. Anxiety,
walking and when the patient is concentrating will cause an increase
2. rigidity: muscles become stiff and increasingly resistant to passive movement.
classified as plastic-mildly restrictive movement where trying shoes and rising from an
armed chair is difficult. cogwheel rigidity: rhythmic interruption of muscle movement
, when joint is moved inhibiting spontaneous movement (will have problems pivoting-lose
balance)
- lead pipe rigidity: total resistance to movement leading to akenesia called freezing
phenomena (joint locks and patient will be unable to move)
- truncal rigidity: causes the need to move the body as a unit when getting out of bed
and chair. should sit in chair that has arms. rigidity of neck and back muscle-results in
old man posture (stooped, flexed trunk, flexed elbows and abducted shoulders) stiffness
of facial muscles also occurs. hypomimia- mask of P's (decreased facial expression)
- the rigidity may affect muscles of speech- resulting in slurring, stuttering, raspy voice
and inability to speak. patient may also develop rigidity of voluntary muscles of the
throat- dysphagia- leads to pooling of food which could cause choking- aspiration
pneumonia
- also possible for chest wall and intercostals muscle rigidity leading to difficulty
breathing
3. bradykenesia- reduced movemen
clinical manifestations MS (6) and (7) secondary symptoms - CORRECT
ANSWER✅✅- depends on the area of demyelination in brain
- early symptoms are due to a single or small number of lesions (plaques). Poses a
problem in dx as the symptom may disappear with remission of 10 years
1. visual disturbance: common early sign that over 50% experience. Due to damage
and inflammation of the optic nerve. Patient may c/o: diplopia (double vision),
nystagmus (invol. jerky eye movement) which leads to blurred vision and oscillopsia
(objects jump into the field of vision)
2. intentional tremors (when performing voluntary actions- opposite of resting tremors),
weakness, paresthesia and pain around the trunk form spasm in spinal cord, and ataxia
(uncoordinated movements)
3. sensitivity to heat occurs in 50% of cases. heat triggers symptoms and they may not
realize how hot something is because of the numbness (environmental heat, being 90
outside)
4. 75% cases c/o fatigue. not related to muscle problem but due to effects of MS on
CNS. comes on without a warning. Patients complain that they feel as though they have
hit a brick wall after being normal all day. MS fatigue is called idiopathic lassitude
5. many patients will develop urinary retention from bladder spasticity and bowel
spasticity
6. secondary symptoms
- UTI: from urinary retention
- Constipation: from bowel spasticity
- decubiti: from immobility
- contracture deformities: from immobility
- dependent peda; edema (swelling below knees)
- pneumonia (many die from)
- reactive depressions: patients who have MS often have social and psychological
problems such as depression and mood swings. vocational problems such as job loss
and job changes and redefining personal relationships. these must be addressed as
