Intro to Clincal Wk 1 Stream B

Q: What is Motor Neuron Disease (MND)?

A: A group of diseases where neurons controlling mm which enable movement, speaking, breathing, and swallowing degenerate and die. This also leads to de-innervation atrophy of those mm.

Q: What are some early symptoms of MND?

A:

• Stumbling d/t leg weakness
• Difficulty holding objects (weak hand mm)
• Slurred speech or swallowing difficulties d/t weak throat and tongue mm
• Cramping, and mm fasciculations.

Q: What is Parkinson's disease?

A: A progressive, degenerative neurological condition that affects the control of body movements.

Q: What are some key signs and symptoms of Parkinson's disease?

A:

• Tremor
• Bradykinesia
• Rigid muscles, and impaired posture and balance
• Loss of automatic movements, as well as changes to speech and writing.

Q: What type of disease is Multiple Sclerosis (MS)?

A: An autoimmune disease which attacks and destroys the myelin sheath.

Q: Who is most commonly affected by MS?

A: Women > Men (3x more). Often begins 16-55 y/o.

Q: What are the common signs and symptoms of MS?

A:

• Motor control: mm spasm and weakness
• Neurological symptoms: Vertigo, pins and needles
• Continence problems particularly in the bladder
• Neuropsychological Sx like depression & memory loss.

Q: What is Peripheral Neuropathy and its common cause?

A: Damaged or disease peripheral nerves. Often d/t diabetes mellitus.

Q: What is the typical presentation of peripheral neuropathy?

A:

• Weakness, numbness, pain, in the hands/feet
• Pain described as stabbing, burning, or tingling. Often gradual onset.
• May have sensitivity to touch and mm weakness or paralysis if motor N are affected.

Q: What is Guillain-Barre syndrome?

A:

• Rare Autoimmune Neurological disorder where the body's immune system attacks part of the peripheral nervous system.
• Affects anyone, any age. Can range from brief weakness to devastating paralysis.

Q: What is the primary complaint associated with Guillain-Barre syndrome?

A:

• Muscle weakness w associated tingling in hands/feet.

Q: What is Myasthenia Gravis? What is its primary characteristic?

A:

• Breakdown in the normal communication between nerves and muscles.
• Characterised by weakness & rapid fatigue of any mm under voluntary control.

Q: What are some signs and symptoms of Myasthenia Gravis?

A:

• Weakness of arm or leg muscles
• Double vision, Ocular ptosis, Difficulties w speech, chewing, swallowing, and breathing.

Q: A SOL is the most common cause of raised ICP. What are 4 examples of a SOL?

A:

• Neoplasm/ Tumor
• Hemorrhage
• Abscess
• Oedema (brain swelling)

Q: What are risk factors for Cerebrovascular disease?

A:

• Hypertension (60% of untreated → stroke)
• Smokeing, diabetes, obesity, lipid abnormalities (high LDL), OCP

Q: What are the Five clinical syndromes of ischaemic cerebrovascular disease?

A:

• Transient ischaemic attacks (TIA): Transient neurological deficit lasting >24hrs w full recovery. Most last 10-20mins but can be between 2-60mins.
• Stroke in progress: Neuro deficit progressing over 24hrs
• Complete stroke: Neuro deficit lasting <24hrs w persistent residual deficit.
• Subarachnoid haemorrhage
• Arteritis

Q: What is the most common cause of a subarachnoid haemorrhage?

A:
The rupture of a congenital aneurysm.

Q: What is the main Sx a patient complains of with a subarachnoid haemorrhage?

A:
A sudden severe H/A unlike any they have experienced before.

Q: what are the S/S of a subarachnoid haemorrhage?

A:

• Similar to that of raised ICP (incl: papilledema, CN dysfunction).

Q: What are a few "red flags" for a headache?

A:

• Any sudden, severe H/A.
• H/A w convulsions, fever, or mental confusion.
• H/A following a blow to the head
• Onset of new H/A in older person
• Recurring H/A in children
• Long-standing headache with changes in character.

Q: What does the SNOOPPPP mnemonic stand for in relation to headaches?

A:

• Systemic signs and disorders

• Neurologic symptoms

• Onset new or changed & patient > 50 years old

• Onset in thunderclap presentation

• Papilledema

• Pulsatile tinnitus,

• Positional provocation,

• Precipitated by exercise.

Q: What is the difference between primary and secondary headaches?

A:
Primary H/A are not caused by other conditions (e.g., migraine, cluster and tension headaches), while secondary H/A are caused by problems elsewhere in the head or neck (e.g. Cervicogenic, meningeal).

Q: What is a cervicogenic headache?

A:

• A H/A arising from one of the upper three cervical segments (C0/1, C1/2, C2/3).
• Is often a Hx of upper neck pain w ↘ ROM, may be Hx of MVA

Q: What is the typical pain pattern with a Cervico-genic headache?

A:

• Pain is daily or constant and either Uni or Bilateral.
• Pain refer to Occipital, Occipito-temporo-maxillary, supra-orbital areas

Q: What is a Tension-type headache?

A:

• The most common H/A type. Can be episodic or chronic.
• Is thought to be d/t the Trigemino-vascular system

Q: What are the clinical features of a tension-type headache?

A:

• Symmetrical (bilateral) pain lasting hours, recurring daily. F>M
• Assoc w Cx pain +/- stress or tension (Pt). Pain is non-pulsating and of mild-moderate intensity. Not aggravated by physical activity.
• No nausea/vomiting, photophobia.
• Physical Exam may show mm tension, and scalp may be tender to touch.

Q: What is the difference between the two types of migraines?

A:

• Migraines with Aura: Recurrent disorder which presents as attacks w reversible focal neurological Sx that develop over 5-20mins & last up to 60mins.
• Migraines w/o Aura: most common, most debilitating. Often strong menstrual relationship. Pathogenesis is Neurovascular related.

Q: What are the typical characteristics of a migraine H/A?

A:

• Unilateral location (often fronto-temporal) w pulsating quality @ moderate to severe intensity.
• Aaggravated by normal, routine physical activity.
• Commonly w nausea and/or photophobia and phonophobia.

Q: What are 5 common triggers of a migraine?

A:

• Excess red wine consumption
• Skipping meals
• Sleep deprivation
• Hormonal influence
• Head/ neck pain or trauma

Q: What is the “Aura” referring to regarding migraines?

A:

• Zigzag figure along vision (like looking @ bifrost bridge from thor)
• Scotoma
• Paraesthesia moving from origin site to greater/ lesser part of one side of body+face.
• Speech disturbance (less common)

Q: What is the difference between a migraine w Aura and a TIA?

A:

• TIAs are often shorter (10-20mins) compared to migraines (up to 60mins)
• Migraine Sx develop slower, TIAs are sudden. TIA Sx are also more severe.

Q: What is a cluster headache?

A:

• Pathophys is primarily Neurovascular. Activation of the Cranial ( CNV) parasympathetic reflex with secondary sympathetic impairment. (

• Theres an upregulation of the Para and a downreg of the Sympathetic NS in the Cranial area

Q: What is the presentation of a cluster H/A?

A:

• M>F, 20-40y/o with severe Unilat H/A in orbital region

• Hx of smoking, alcohol abuse.

• Pt is agitated and cant sit still (d/t extreme pain), and an examination is unrevealing unless during an attack.

Q: What is TMJ dysfunction? What are the potential causes?

A:

• Pain and tenderness due to dysfunction of the TMJ or its surrounding musculature
• F> M
• Causes incl: disc derangement, bruxism, mm spasm in jaw mm, MVA, Dental conditions

Q: What are the symptoms of sinusitis?

A:

• Frontal or retro-orbital H/A.
• Pain around 9am, worst at mid-day and subsides around 6pm.
• Common in smokers.