NEURO

Question 1

What 2 HAs are unilateral? 1 HA that is bilateral?

Answer 1

Unilateral - cluster + migraine

Bilateral - tension

Question 2

What can untreated temporal arteritis lead to? What lab test do we use to help diagnose?

Answer 2

Blindness

Sed rate

Question 3

CSF findings in bacterial meningitis

Intracranial HTN

SAH

Answer 3

BM: elevated cell count, low glucose

IHTN: cell count and protein normal

SAH: +blood

Question 4

How do we treat HAs

Answer 4

Treat cause

Question 5

How do we treat bacterial meningitis?

Answer 5

Rocephin. When in doubt give med!

Question 6

Times for CVA:
Non-con CT
CT read
TPA

Answer 6

CT: 20-25 min
Read: 40-45 min
TPA: 3 hours

Question 7

HOB in stroke pt?

Answer 7

30-40 degrees if not contraindicated

Question 8

CVA BP goals if giving TPA? Treatment?

Answer 8

Goal <185/<110

Treat with labetolol or nicardipine (CCB, drip)

Question 9

This commonly affects memory but not level of consciousness. Dx of exclusion

Answer 9

Dementia

Question 10

VP shunt problem that causes neuro problems is d/t what?

VP shunt problem that causes fever and abd distension is d/t what?

Answer 10

neuro = blockage

fever/abd distension = infection (infected fluid drains into abdomen)

Question 11

What does an XR shunt series consist of?

Answer 11

-skull
-CXR
-KUB

Question 12

This is an emergency bc you are unable to ventilate. Do not give paralytics initially b/c you want to see if patient stops seizing. Neuronal cellular changes/destruction will continue.

Answer 12

Status epilepticus

Question 13

Characteristics of pseudoseizures

Answer 13

Sudden onset, abrupt return to normal

Question 14

How do we calculate cerebral perfusion pressure? What is normal?

Answer 14

CPP = MAP - ICP

Normal = 70-100

Question 15

How do we decrease CPP?

Answer 15

increase MAP, decrease intracranial volume (mannitol, elevate HOB), decrease vasodilation (CO2 causes vasodilation, so increase RR to decrease CO2 - this is only a temporary measure)

Question 16

CUSHINGS TRIAD

(acute elevations in ICP)

Answer 16

1: irregular respirations
2: decreased HR
3: widened pulse pressure

Question 17

This is d/t hemorrhage of meningeal artery r/t temporal skull fracture. Patients have LUCID INTERVAL.

Answer 17

Epidural hemorrhage

Question 18

What do we do for CSF leaking from nose/ears in a skull fracture?

Answer 18

Cover loosely with dressing, DO NOT PACK

Question 19

What is Brown-Sequard syndrome?

Answer 19

Complete damage to half of the spinal cord.

Question 20

Symptoms of Brown-Sequard

Answer 20

Same side of SC damage: paralysis, paresis, loss of touch/pressure/vibration

Other side: loss of pain and temperature sensation

Question 21

What SCI causes you to breathe no more?

Answer 21

C4

Question 22

What is the difference between spinal shock and neurogenic shock?

Answer 22

Spinal shock: TEMPORARY loss of all neuro function

Neurogenic shock: causes decreased HR, vasodilation leading to low BP

Question 23

What 3 things do you need to clear a c-spine?

Answer 23

-negative XR/CT
-NO motor sensory deficits
-no pain/tenderness on exam

Question 24

Cognitive function generally spared, no consistent cause, autonomic control remains so no bowel/bladder involvement, usually have “limb onset” - usually legs so s&s are frequent tripping/stumbling/falls

Answer 24

Lou Gehrigs - amyotrophic lateral sclerosis

Question 25

autoimmune, leads to physical and cognitive disability, normal life expectancy, most common initial symptom is change in sensation of arms, legs, face

Answer 25

MS

Question 26

autoimmune, symptoms improve with rest, muscle weakness increases with activity, diagnosed with tensilion test, treated with cholinesterase inhibitors (neostigmine), immunosuppressants, steroids, thymectomy (increased r/f thymus cancer)

Answer 26

Myasthenia Gravis

Question 27

d/t low dopamine, tremor at rest that improves with use

Answer 27

Parkinsons

Question 28

GCS worse/best score

Answer 28

worse 3, best 15

Eyes 1-4
Verbal 1-5
Motor 1-6