OCC 520 Final Exam

Understand how occupational performance is impacted by substance use disorders

Adversely affects IADLS, health maintenance, socialization Occupation at a population level Strain on medical services Cost of treatment and burials Children needing foster care

progressive/relapsing MS (PRMS)

overlaps PPMS/SPMS 5% pts steady deterioration occasional attacks superimposed upon progressive course

cluster a

paranoid, schizoid, and schizotypal Odd eccentric thinking or behavior Discomfort in interpersonal relationships Emotional distancing, isolation, distrust, suspicion Restricted emotional expression Interpreting others' intentions as negative

general personality disorder

pattern of inner experience and behavior that deviates from expectations of individuals culture Manifested in 2 or more: cognition- ways of perceiving/interpreting self, others, events affectivity- range, intensity, lability, appropriateness interpersonal functioning impulse control pattern is inflexible/pervasive pattern leads to clinically significant distress/impairment in occupation or other areas of functioning stable/long duration- onset in adolescence or early adulthood

rods and cones

photosensitive cells rods- specialized cells for vision in dim light cones- associated with visual acuity/color vision

MS etiology

polygenic- family hist common latitude of residence in childhood is risk factor

end stage

total assistance needed with ADL rigidity, mutism, incontinence, immobility

lymphomas

tumors derived from mature lymphocytes or their progenitors, resulting in neoplastic proliferation of B- or T- lymphocytes most common types of hematologic malignancy tumors may arise anywhere in body where lymphoid elements reside

middle stage

unable to work easily lost/confused requires supervision social graces, routine behavior, superficial conversation may be intact language impairment (first naming them comprehension finally fluency) apraxia emerges visuospatial deficits begin to interfere w/ ADL

OT interventions

understanding defense mechanisms establishing therapeutic relationships addressing occupational dysfunction prevention

ALS clinical manifestations

variable disease course- any muscle group may be first to show signs- w/ time disorder takes on symmetric dist in all regions doesnt typically involve- cognition, tactile sensation, vision, bowel/bladder no cure/effective treatment

Oligodendroglioma

10% gliomas present w/ seizures; calcifications/hemorrhage prognosis better overall that astrocytoma (2-7 yr med)

primary progressive MS (PPMS)

15% cases steady functional decline from disease onset (no acute attacks) begins later in life (mean=40yrs) disability develops faster

binocular vision

2 primary types of movement: vergence- movements where central visual axes of eyes move in parallel convergence- movements where central visual axes converge towards nasal fields to allow near vision

glaucoma

2 variants: Open angle- chronic, progressive optic neuropathy associated w/ chronic elevation of intraocular pressure painless, most common closed angle- acute blockage of aqueous fluid (most often caused by iris) producing severe elevation of introcular pressure both damage retina, w/ peripheral to foveal field progression; fovea acuity is spared until end-stage

Parkinson's disease etiology

2nd most common neurodegenerative disease prevalence = across demographics mean age of onset = 60 yrs frequency increases w/ age

Relapsing-remitting MS (RRMS)

85% cases at onset discrete attacks- evolve over days-wks complete recovery during dormant period btwn attacks pts are neurologically stable

cluster b

Anti-social, borderline, histrionic, narcissistic Dramatic and overly emotional Unpredictable thinking or behavior excessive/unstable expressions of emotions Maladaptive interpersonal relationships Disregarding of others rights/needs

cluster c

Avoidant, dependent, obsessive-compulsive Anxious, fearful thinking or behavior traits related to anxiety may stem from: Fear of rejection or humiliation Need to be taken care of Preoccupation with perfection

Schwannoma

Benign tumor of Schwann cells of cranial/spinal n roots vestibular schwannomas or acoustic neuromas are most common variant; arise from vest portion of 8th cranial n- present w/ progressive unilateral hearing loss, dizziness, tinnitus

presbycusis

age associated hearing loss most common cause of sensorineural hearing loss in adults characterized by symmetric, high freq hearing loss; progressing to hearing loss of all freq produces significant loss in clarity- hearing aids helpful in enhancing signal to noise ratio by amplifying sounds close to listener

macular degeneration

Damage of the choroid plexus; either extracellular deposits accumulate under retinal layer of eye or neuro vascularization both Produce inflammation, damaging central retina macula Progressive, painless, most typically bilateral central vision loss peripheral vision spared

antisocial personality disorder

Disregard or violation of rights of others, occurring since age 15 as indicated by 3 or more: Failure to conform to social norms w/ respect to lawful behavior (repeatedly performing acts that are grounds for arrest) Deceitfulness (repeated lying, use of aliases, conning others for profit/pleasure) impulsivity (failure to plan ahead) reckless disregard for safety Consistent irresponsibility (repeated failure to sustain consistent work behavior/honor financial obligations) Lack of remorse (being indifferent to/rationalizing having hurt/mistreated/stolen) Must be 18 → childhood diagnoses of conduct disorder

Etiology: Environmental Factors

Early life events Sexual abuse for over 70% of people with personality disorders Childhood trauma linked to borderline personality disorder Narcissistic linked to parental interaction styles Being overly praised Lack of tending to emotional needs Personality development: Coping style is linked to personality disorder Relationship to the world

histrionic personality disorder

Excessive emotionality and attn seeking indicated by 5 or more: Uncomfortable when not center of attn Inappropriate sexually seductive/provocative behavior Use physical appearance to draw attn speech is excessively impressionistic/lacking detail self-dramatization, theatricality, exaggerated expression of emotion Suggestible (easily influenced by others/circumstance) Considered relationships to be more intimate than they are

factitious disorder (Munchausen's)

Falsification of physical or psychological signs or symptoms, or induction of injury or disease, associated with identified deception. individual presents self to others as ill, impaired, or injured deceptive behavior is evident even in absence of obvious external rewards

cataract

Ossification or clouding of the lens sufficient to reduce vision develops slowly as result of aging leading to gradual impairment of vision Can be surgically corrected

Frontotemporal Dementia

group of clinical syndromes that produce frontotemporal degeneration ant insular, frontal, temporal regions, basal ganglia, motor neurons autosoma dominant inheritance seen in 10% cases begings 5-7th decade

Down Syndrome

Genetic disorder caused when abnormal cell division results in an extra full or partial copy of chromosome 21 mild to mod cognitive impairment language delayed short/long term memory affected Trisomy 21 → 95% of cases → three copies of 21- Abnormal cell vision during sperm and egg cell development Mosaic → only some cells with extra 21- Abnormal cell division after fertilization Translocation → 21 translocated on other chromosomes Risk Factors: adv maternal age, carriers of genetic translocation for down syndrome, having child w/ DS Complications: heart defects, GI defects, immune disorders, sleep apnea, obesity, spinal problems, leukemia, dementia Strengths: social understanding, empathy, social interaction, visual memory (visual learners), may read at age level, sensitive to failure

PD trajectory

I- unilateral involvement only- min/no functional impairment II- bilateral/midline involvement w/o impairment of balance III- 1st sign of impaired righting reflex mild-mod disability IV- fully developed- severely disabling/requires assistance w/ ambulation/cognitive decline V- confinement to bed/wheelchair unless aided

occupational performance affect

Paranoid Personality Disorder: Maintain close relationship Strong sense of autonomy, may blame others for their shortcoming Avoidant Personality Disorder: Avoids occupational activities that involve significant interpersonal contact Due to fears of criticism, disapproval, or rejection Difficult to get a job or go to school Obsessive-Compulsive Personality: Preoccupied with details so much that may not be able to finish job Hard to do group project Schizoid Personality: Socialization is minimal> neither desires or enjoys close relationships Difficulty making friends . shows emotional coldness, detachment No desire to have sex due to reduced sense of pleasure

PD medical/surgical management

Med: levo-dopa- synthetic compound- converts (breaks down) to dopamine in CNS surgical: deep brain stimulator- high frequency stimulation of STN or GPI to reduce neuronal over activity/improve PD features

errors of refraction

Most common cause of defects in visual acuity hyperopia (farsightedness): eyeball too short; intrinsic focal point is behind retina eye accommodation (ciliary contraction) allows for dist focus, though not enough capacity for near tasks Myopia (nearsightedness): eyeball too long; intrinsic focal point in front of retina obj nearby are in focus; those at dist are blurred bc relaxed lens cant flatten any further corrected w/ biconcave lens presbyopia: natural loss of accommodation capacity w/ age

somatic symptom disorder diagnostic criteria

One or more somatic symptoms that are distressing or result in significant disruption to daily life Excessive thoughts, feeling, behavior related to the symptoms/associated health concerns as manifested by at least 1 of the following: Disproportionate thoughts about the seriousness of symptoms Excessive time or energy put toward symptoms/health concern persistently high anxiety about health/symptoms Persistent state of being symptomatic, though symptoms can change (>6 mo)

diabetic retinopathy

Pathological neovascularization causes vitreous hemorrhage, retinal detachment, and glaucoma occurs as secondary cond of diabetes after yrs; in nearly all cases pattern of visual loss is presence of irregualr scotoma leading cause of blindness in US

Etiology: Biological Factors

People with impulsive behaviors (borderline and histrionic) Higher levels of testosterone Low levels of serotonin Overactive amygdala (fight or flight)

etiology: genetic factors

People with relatives with personality disorders are more likely to get them However, no specific gene has been discovered

dependent personality disorder

Pervasive and excessive need to be taken care of that leads to submissive or clinging behavior and fears of separation as indicated by 5 or more of the following: Difficulty in making everyday decisions without advice/reassurance Others need to assume responsibility for major areas of life Difficulty expressing disagreement with others bc fear of loss of support/approval Difficulty initiating projects, doing things on their own goes to excessive lengths to obtain nurturance and support from others to the point of volunteering to do things that are unpleasant Feel uncomfortable/helpless when left alone urgently seeks another relationship as a source of care/support when close relationship ends unrealistically preoccupied with fears of being left to care for self

epilepsy

group of disorders characterized by recurrent seizures

avoidant personality disorder

Social inhibition, feelings of inadequacy, hypersensitive to negative evaluation as indicated by 4 or more: Avoids occupational activities that involve significant interpersonal contact bc fears of criticism, disapproval, rejection unwilling to get involved with people w/o certainty of being liked Restraint w intimate relationships bc of fear of being shamed/ridiculed Preoccupied with being criticized or rejected in social situations inhibited in new interpersonal situations bc of feelings of inadequacy Feel social inept, personally unappealing, inferior Reluctant to take risks or engage in new activity bc they may prove embarrassing

staging

TNM (tumor, node, metastasis) system: anatomically based categorizes tumor on basis of: size of primary tumor lesion (T) presence of nodal involvement (N) presence of metastatic disease (M) T, N, M scores are broken into stages, usually designated by roman numerals I-IV tumor burden increased/curability decreased w/ increasing stage

AD treatment

addresses degeneration of cholinergic network pharmacologic action includes inhibition of cholinesterases correlates w/ maintaining MMSE score for close to a yr (placebo declines 2-3 pts)

visual accommodation

adj eyes lens shape to focus visual targets on retina (near vs far) distant vision- light rays are parallel/need min refraction to bring into focus (ciliary muscle relaxes) near vision- light rays from close obj diverge/require more refraction to focus (ciliary muscle sustains contraction)

late stages

ambulatory but unstable to navigate familiar environments impaired judgement/reasoning delusions are common (theft, infidelity, misidentification) 10% develop capgrass syndrome loss of inhibitions/aggression and/or passivity/withdrawal sleep-wake patterns disrupted w/ night time wandering

generalized

arise when tumor/edema cause hydrocephalus general/nonspecific symptoms (headache, cog def, balance dis, personality changes)

vasucular neurocognitive disorder

associated w/ cerebrovascular disease

Meniere's disease

attacks consist of vertigo, hearing loss, pain, pressure, fullness in affected ear low freq hearing loss due to excess fluid (endolymph) in inner ear

Secondary Progressive MS (SPMS)

begins as RRMS steady deterioration in function unassociated w/ acute attacks produces greater amount of fixed neurologic disability than RRMS

lesions of chiasm

bitemporal hemianopia- blindness in half of visual fields, impacting both temporal fields

absence seizure

brief lapses in consciousness lasting several sec w/o loss of posture eyelid blinking, slight head movement, brief jerks of limb muscles immediately after- pt fully alert begin in childhood/remit by adulthood disorder transmitted as autosomal dominant trait

PD Clinical Manifestations

cardinal features: rest tremor rigidity bradykinesia gait impairment

Vestibular Schwannoma

cause slow progressive unilateral sensorineural hearing loss/vest hypofunction typically dont have acute vertigo

sensorineural hearing loss

caused by damage to mechanotransduction apparatus of cochlea or subsequent neural transmission injury to hair cells damage to central auditory pathway

conductive hearing loss

caused by factors that obstruct transmission of sound/acoustical energy obstruction by cerumen (earwax), tumors, foreign bodies inflammation of canal tears to tympanic membrane disruption of ossicular chain ootosclerosis

partial seizure

caused by focal brain disease producing motor, sensory, visual, psychic, autonomic phenomena consciousness preserved unless seizure discharge spreads to other areas producing tonic-clonic seizure following seizure- ind typically confused/may demonstrated anterograde amnesia/todds paralysis

Fragile X Syndrome

changes in FMR1 gene both m/f (f more mild sympt) leading cause of intellectual dis highly associated w/ autism/ADHD delayed devel speech/language by 2 anxiety/hyperactivity intellectual dis (more m than f) affects communication/social interactions seizures long narrow face, large ears, prominent jaw/forehead, flexible fingers, flat feet strengths: independence in ADLs, visual learners, motivated by function/purpose (get things done)

limb girdle

child/adult onset adult- slowly progresses/not alway symm/not assoc w/ cog impairment- cardiopulmonary comp common in later stages

diffuse white matter disease pathology/manifestations

chronic cog def due to subcortical disease (ischemia/hypertension) insidious/progressive course cog sympt are global: early sympt include conf, apathy, anxiety, psychosis, memory/spatial/exec def later symptoms= diff judgement/orientation, euphoria, elation, depression, aggression, dependence for daily activities

multi-infarct dementia pathology/manifestations

chronic cognitive deficits due to mult infarctions produces acute onset cog changes w/ stepwise progression as subsequent infarctions occur location/size will present variable course across ind

MS pathology

chronic disease T-cell driven inflammation of CNS: demyelination (targeting glia) gliosis (scarring) neuronal loss (produces irreversible damage) lesions vary w/ timing/location

parkinsonian/lewy body dementia

cog impairment due to presence of lewy bodies throughout brainstem nuclei, substantia nigra, amygdala, cingulate gyrus, neocortex diagnostic criteria includes presence of neurocognitive symptoms w/: history of PD- considered to have parkinsonian dementia no PD diagnosis or later develop PD- considered to have dementia w/ lewy bodies

FTD clinical manifestations

cog symp are affective/behavioral: apathy, loss of empaty disinhibition, weight gain, food fixations, compulsions anosagnosia no management slows progression treatment is symptomatic

Benign Paroxysmal Positional Vertigo (BPPV)

common type produced by calcium carbonate crystals w/in semicircular canals brief episodes (<1min)/always provoked by changes in head position produces vertigo/nystagmus PTs focus on relocation of crystals w/in canals to be benignly located

Tay-Sachs disease

defects in gene on chromosome 15 that codes for production of Hex a 50% passing to children babies appear typically devel until 6 mo 2 yrs- recurrent seizures/diminishing mental funct infant grad regresses- unable to crawl, turn over, sit, reach out becomes blind, cog impaired, paralyzed, non resp 3-4 yrs- nervous system so affected death results by 5 yrs

ALS pathology

degeneration of motor neurons at all levels of CNS (motor cortex, brainstem motor nuclei, corticospinal tracts, ant horns of spinal cord)

comitant

degree of misalignment is same in all directions of gaze affects 1% of pop, fusion disrupted in infancy or early childhood

Non-comitant

degree of misalignment varies with direction of gaze when acute in onset, restrictive or neurological etiology

neurocognitive disorders according to DSM-V

delirium minor neurocognitive disorder major neurocognitive disorder

Ependymoma

derived from ependymal cells that line ventricular surface 5% pediatric tumors (frequently 4th ventricle) more common in spine for adults

schizoid personality disorder

detachment from social relationships and Restricted range of expression of emotions in interpersonal settings as indicated by 4 or more of the following: Neither desires/enjoys close relationships almost always chooses Solitary activities little if any interest in sex takes pleasure in few if any activities lacks close friends other than first degree relatives appears Indifferent to praise or criticism Emotionally cold/detached/flattened affectivity

schizotypical personality

discomfort/reduced capacity for close relationships and cognitive/perceptual distortions and eccentricities of behavior as indicated by 5 or more: ideas of reference (excluding delusions of reference) Odd beliefs or magical thinking that influences behavior/is inconsistent with sub cultural norms Unusual perceptual experience (bodily illusions) Odd thinking and speech (vague, circumstantial, metaphorical, elaborate, stereotyped) Suspiciousness, paranoid ideation Lack of close friends Excessive social anxiety that doesn't diminish with familiarity

delirium

dist in awareness/attn (reduced ability to direct, focus, sustain, shift attn) change in cognition (memory def, disorientation, lang dist, perceptual dis) dist develops over short period (hrs/days)/tends to fluctuated during course of day dist caused by direct physiological consequence of general med cond, intoxicating sub, med use

paranoid personality disorder

distrust/suspiciousness of others - motives are interpreted as malevolent, in variety of contexts suspects, w/o sufficient basis that others are exploiting, harming, deceiving them preoccupation with unjustified doubts about loyalty or trustworthiness of friends/associates reluctant to confide in others bc of fear that info will be used against them reads hidden demeaning or threatening meaning into benign rumors/events persistently bears grudges perceives attacks on their character/reputation that arent apparent to others and is quick to react angrily or to counter attack has recurrent suspicions w/o justification, regarding fidelity of spouse/sexual partner

seizures

disturbance in cerebral function caused by atypical synchronous discharge of cortical neurons

neuroplasia/cancer etiology

embryogenesis, tissue growth, repair involve typical stages of cell growth/maturation- disordered regulation of processes can result in loss of control over cell growth, differentiation, spatial confinement neoplasia- spectrum of diseases characterized by abnormal growth/invasion of cells

risk factors of primary brain tumors

exposure to radiation immunosuppression family history

somatic disorder etiology

genetic biological vulnerability- increased sensitivity to pain early traumatic exp learning- attn gained from illness, lack of reinforcement of nonsomatic exp of distress stigma related to psychological suffering as compared to physical suffering neg thought patterns

etiology

genetics- family patterns environmental- trauma, social env (living w/ someone w/ psychiatric disorder) Co-morbid condition- dual diagnosis (schizophrenia/depression)

narcissistic personality disorder

grandiosity, need for admiration, lack of empathy indicated by 5 or more: Grandiose sense of self importance (exaggerates achievements/talents, expects to be recognized as superior w/o commensurate achievements) Preoccupied with fantasies of unlimited success, power, brilliance, beauty Belief they are special/unique and can only be understood by or should associate with other special or high status people/institutions Require excessive admiration Sense of entitlement (unreasonable exp of favorable treatment/automatic compliance with expectations) interpersonally exploitative (takes adv of others to achieve) Lack empathy (unwilling to recognize/identify with feelings/needs of others) Envious of others/believes others are envious of them Arrogant or haughty behaviors/attitudes

focal

hemiparesis aphasia visual field defect focal partial seizures

Huntington's disease etiology

hereditary disorder of nervous system gradual onset/subsequent progression of chorea/dementia autosomal dominant disorder- offspring have 50% chance of development prevalence rate= 5/100,000 pts have often started fams of own by diagnosis (4-5 decade)

Post-Chiasmal Lesions

homonymous hemianopia- blindness in half visual fields, impacting both L or R visual fields (visual loss contralateral to site of lesion)

OT treatment

identify functional deficits/treat as you would w/ other clients holistic approach work closely w/ treatment team treat symptoms combine w/ behavioral approach- reward desired behaviors address psychological conflict as appropriate

initial stage

impaired IADL (tracking finances, following instructions on job, driving, shopping, housekeeping) anosognosia (lack of ability to perceive the realities of one's own condition) environmental changes are disorienting become lost on walks/driving

abducens nerve (CN VI)

innervates lat rectus muscle palsy produces horiz diplopia- worsens w/ gaze towards side of lesion

Oculomotor (CN III)

innervates muscles for: eye add/elevation eyelid opening iris sphincter total palsy causes ptosis (eyelid droop) results in dilated pupil/leaves eye down/out partial palsy includes any combo of ptosis, pupil dilation, weakness of associated eye muscles

Trochlear Nerve (CN IV)

innervates muscles that depress/abd eye (w/ depression) palsy results in affected eye having resting sup dev (hypertropia)- worsens when tilting head toward effected side (produces diagonal double vision)/alleviated by tilting away

treatment

inpatient: detox, rehab centers outpatient: drug/alc rehab centers mental health centers self help groups- 12 step programs Cognitive behavioral therapy peer based group therapy (AA/NA) family therapy psycho education motivational interviewing harm reduction med- reduce positive effects of substance, reduce cravings, produce neg side effects when using meds for alc use disorder- reduce pos effects/produce neg side effects meds for opioids- supress cravings, reduce pos effects, prevent overdose use in comb w/ other therapies

clinical manifestations

insidious onset of memory loss, followed by progressive neurocognitive decline med survival is 8-10 yrs death most often results from aspiration pneumonia can also occur from malnutrition, secondary infections, PE, CAD

spinal bifida occulta

mild form small separation or gap in 1 or more of bones (vert) of spine no s/s

strabismus

misalignment of eyes due to impaired oculomotor control or orbital trauma will produce diplopia (double vision)

borderline personality disorder

instability of interpersonal relationships, self-image, affect, marked impulsivity 5 or more: frantic efforts to avoid real/imagined abandonment pattern of unstable/intense interpersonal relationships characterized by alternating between extremes of idealization/devaluation identity disturbance: markedly/persistently unstable self-image/sense of self impulsivity in at least 2 areas that are potentially self-damaging (speeding, sex, substance abuse, reckless driving, binge eating) recurrent suicidal behavior, gestures, threats, self mutilating affective instability due to marked reactivity of mood (intense episodic dysphoria, irritability, anxiety) chronic feelings of emptiness inappropriate, intense anger/diff controlling anger (frequent displays of temper, constant anger, recurrent physical fights) transient, stress-related paranoid ideation or severe dissociative symptoms

Supranuclear disorders of gaze

lesion at level of gaze brainstem nuclei or cerebrum will affect movement in both eyes frontal eye fields of cerebrum generate saccades to contralat side parietal lobe lesions disrupt smooth visual pursuit of targets moving toward side of lesion

Pre-Chiasmal Lesion

lesions of macula, retina, or optic n cause scotoma (island of impaired vision surrounded by normal vision)

leukemia

liquid neoplasia where malignant myeloid or lymphoid precursor cells accumulate in bone marrow/spill into peripheral blood/infiltrate other tissues malignant cells are immature/nonfunctional; displace or suppress production of normal elements in marrow symptoms: circulating blasts cause vascular obstruction- results in strokes, retinal vein occlusion, pulmonary infarction susceptibility to infections as result of depressed granulocyte number/function abnormal bleeding as result of low platelet counts

regions of retina

macula- post fovea- central point of visual fixation, contains only cones optic disc- physiological blind spot, region w/ no photoreceptors due to exiting gangionic cell axons

hematological neoplasia

malignancies of cells from hematopoietic precursors myeloid cells lymphocyte cells

mealnoma

malignant neoplasm derived from melanocytes

carcinoma

malignant neoplasm from epithelial cells (lung, colon, breast, prostate cancers)

germ cell tumor

malignant neoplasm from germ cells

sarcoma

malignant neoplasm from mesenchymal cells (fat, muscle, CT)

pituitary tumors

microadenomas (<1cm diameter) secrete hormones/produce specific endocrine syndromes macroadenomas (>1cm) produce symptoms by mass effect, giving rise to headaches, visual impairments, hypopituitarism

Minor Neurocognitive Disorder

modest cognitive decline in 1 or more cognitive domains (complex attn, exec funct, learning, mem, lang, perceptual motor, social cog) based on: concern of ind, knowledgable informant, clinician modest impairment in cognitive performance cognitive deficits dont interfere w/ capacity for independence in everyday activities cognitive deficits dont occur exclusively in context of a delirium cognitive deficits arent better explained by another mental disorder

benign tumors: meningioma

most common benign brain tumor small/asymptomatic often require no int larger symp lesions may be resected surgically

amyotrophic lateral sclerosis (ALS)

most common form of progressive motor neuron disease males more frequently affected 5-10% inherited as autosomal dominant trait non responsive to treatment, leading to death from resp paralysis med survival = 3-5 yrs

malignant tumors: astrocytoma

most common primary CNS neoplasm grades I/II (low grade astrocytoma)- med survival rate= 8 yrs grade III (anaplastic astrocytoma)- med survival = 2-3 yrs grade IV (glioblastoma multiform GBM)- med survivial 1 yr- high rate invasion/tissue necrosis

oculomotor control

movements of the eyes carried out by 6 muscles/3 cranial nerves

hematologic neoplasia

myeloma- neoplasia from mature b-cell lymphocytes lymphoma- malignant neoplasm from lymphocytes leukemia- malignant neoplasm from hematopoietic precursors/myeloid stem cells that give rise to granulocytes, monocytes, erythrocytes, platelets

classification of substance use disorder- criteria

negative pattern of behaviors involving 11 symptoms from 4 areas: Impaired control: Larger amounts/longer periods than planned Unsuccessful efforts to cut down/stop Persistent desire to decrease use but mult unsuccessful attempts Spends time obtaining, using or recovering Craving Social impairment: Failure to fulfill roles Continued use despite impairments Reduced social, occupational, or recreational activities Risky use: Using in situations that are hazardous Use despite knowledges of physiological problems (Drinking when you know it is hurting your liver/Needle sharing) Pharmacological: Increased dose due to increased tolerance Withdrawal symptoms

primary brain tumors

neoplasia whose primary origin is CNS cells high rate of mortality (>50%) glial neoplasia are most common variant (60%)

spina bifida

neural tube defects (embryonic structure- develops into brain) portion of neural tube fails to devel/close properly- causing defects in spinal cord/bones of spine neurological impairments (muscle weakness of legs, bowel/bladder prob, seizures, orthopedic prob) etiology- folate def, meds, diabetes, obesity complications- physical/neurological prob, accumulation of fluid in brain (hydorcephalus), most need ventricular shunt (allows brain to drain into abdomen), infection in tissues surrounding brain (meningitis) strengths- perception of categories/faces, vocab/grammar, number facts, sociability

muscular dystrophy (MD)

neuromuscular dis umbrella term for 9 dis- group of hereditary cond that weakens muscles progressive muscle weakness absence of structural protein dystrophin diagnosis age ranges 3-4 yrs

Epilepsy Etiology/pathology

normal neuronal activity- occurs in non-synchronized manner w/ groups of neurons inhibited/excited sequentially during transfer of info btwn diff brain areas seizures- occur when neurons are activated synch in abnormal activity/pattern of spread to diff part of brain

Conversion Disorder (Functional Neurological Symptom Disorder)

one or more symptoms of altered voluntary motor/sensory function clinical findings provide evidence of incompatibility btwn symptoms/recognized neurological/medical conditions symptom/deficit causes clinically significant distress/impairment in social, occupational, or other important areas of functioning/warrant medical evaluation

Turner Syndrome

only affects females 1 x chromosome missing short height, failure of ovaries to devel, heart defects may be diagnosed prenatally, infancy, childhood, sometimes w/ mild symptoms teen/young adult s/s vary complications: heart problems, high BP, hearing loss, vision prob, kidney prob, autoimmune dis, skeletal prob, infertility, preg comp, learning dis, mental health issues strengths: verbal IQ

Myleomeningocele

open spina bifida most severe babys spinal canal remains open along several vert in lower/mid back membranes/spinal cord protrude at birth forming sac on babys back

Alzheimer's disease pathology

organic plaques disrupt trasport of ach system comprised of tau filaments/amyloid, byproducts of damaged cellular compounds produce atrophy in med temporal lobes, parietal lobes, frontal cortex produces memory impairment, followed by language/visuospatial deficits

obsessive-compulsive disorder

preoccupation with orderliness, perfectionism, mental/interpersonal control, at expense of flexibility, openness, efficiency as indicated by 4 or more: preoccupied with details, rules, lists, order, organization, schedules to extent that the major point of activity is lost shows perfectionism that interferes w/ task completion (unable to complete project bc overly strict standards arent met) excessively devoted to work/productivity to exclusion of leisure activities/friendships over conscientious, scrupulous, inflexible about matters of morality, ethics, values unable to discard worn-out/worthless objects reluctant to delegate tasks or work with others unless they submit to exactly their way adopts miserly spending style towards self/others (money viewed as something to be hoarded for future catastrophes) shows rigidity and stubbornness

pineal region tumors

present w/ headache, visual symptoms, hydrocephalus

visual perception

process of interpreting visual info by cerebrum visual info projected from retina through optic chiasm to occipital lobe

Huntington's disease clinical manifestations

progressive neurocognitive disorder- irritability, moodiness, antisocial behavior global cog impaiment chorea- movement dist of abnormal writhing movements

MS prognosis

progressive neurologic disability 1/3-1/2 progress to SPMS/require assistance w/ ambulation 20% have benign variant of MS/never develop neurologic disability mortality as direct consequence is uncommon- associated w/ shorter life expectancy (mortality often result of secondary condition)

meningocele

protective membranes around spinal cord (meninges) push through opening in vert spinal cord devel normal- membranes can be removed by surgery w/ little/no damage

Opsoclonus

rare disorder of eye movements, produces bursts of consecutive saccades (saccadomania) in all gaze directions

amblyopia

reduced vision of misaligned eye due to uncorrected strabismus

lesions to central auditory pathway

reduction in clarity of hearing/speech comprehension tumors, MS, infarction

nystagmus

rhythmic oscillation of eyes, produced as product of optokinetic stimulation (rotation) or occurring pathologically w/ specific gaze direction

AD epidemiology

risk factors: old age, positive family history increases w/ each decade of adult life reaching 20-40% of population over 85 4 genes associated more common in groups w/ low education attainment

parkinsonian/lewy body dementia clinical manifestations

severe visiospatial/exec def including: visual hallucinations fluctuating alertness sleep dist parkinsonia movement disorder may/may not be present relative preservation of memory

major neurocognitive disorder

significant decline in one or more cognitive domains based on: concern of ind, knowledgable inf, clinician substantial impairment in cognitive performance cognitive def interfere w/ independence in everyday activities cognitive def dont occur exc in context of a delirium cognitive def arent better exp by other mental dis

conversion disorder etiology

somatic symptom represents symbolic resolution of unconscious psychological conflict- serves to keep conflict out of awareness may also allow for evasion of noxious duties/responsibilities symptoms not intentionally produced onset usually late childhood-> early adulthood onset generally acute may be due to onset of stressor may remit w/in 2 wks or last mos recurrence is common

binocular vision

stereopsis (depth perception) requires proper alignment/movement of eyes to allow dually perceived visual sensory input

PD pathology

substantia nigra degeneration leads to decreased dopamine: excessive inhibition of thalamus reduced activation of cortical motor systems/development of parkinsonian features

generalized tonic-clonic seizure

sudden loss of consciousness followed rapidly by tonic contraction of muscles (10-30 sec) causing limb ext/arching back followed by clonic phase of limb jerking- builds in frequency to peak after 15-30 sec then slows grad over 15-30 sec pt remains unconscious for several min postictal confusion lasting several min/hrs

duchenne md

symptoms may not be present until 3-4 yrs delayed motor devel, prox weakness, waddling gait, increased falls, failure to dev running/jumping wheelchair by 12 1/3 show cog impairment muscle weakness= bilateral/symmetrical affects LE then UE prox to dist

MS clinical manifestations

weakness- upper motor neuron weakness w/ spasticity- movement induced muscle spasms ataxia- cerebellar tremors of limbs/trunk tactile sensory deficits- paresthesia/hypothesia bladder dysfunction optic neuritis- diminished visual acuity, color/light contrast sensitivity cognitive dysfunction heat sensitivity adjustment disorder or depression fatigue- exacerbated by elevated temp, exercise-induced exertion, sleep disturbances