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UNIT 9- Neurology > 9-5 Clinical Care of the Nervous System > Flashcards

9-5 Clinical Care of the Nervous System Flashcards

1
Q

What is one of the most common medical complaints?

A

headache

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2
Q

How many workdays are lost each year due to headaches?

A

150 million

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3
Q

A headache of sudden onset or “thunderclap” headache could be?

A

subarachnoid hemorrhage

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4
Q

Absence of prior headache(s) similar to the present one could be?

A

CNS infection

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5
Q

Headaches:

focal neurological signs other than auras?

A

stroke or tumor

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6
Q

Headaches:

other physical sx like fevers could be?

A

meningitis

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7
Q

Headaches:

rapid onset with exercise could be?

A

intercranial hemorrhage associated with brain aneurysm

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8
Q

Headache:

associated with congestion could be?

A

sinusitis

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9
Q

Headache:

associated with papilledema(optical disc swelling) could be?

A

increased cranial pressure

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10
Q

What are some reasons to refer patients for imaging when complaining of a headache?

A
  • recent change in sx
  • progressively worse
  • focal neurological deficits
  • scalp tenderness
  • onset of headache with exertion, cough, sex
  • visual changes, auras
  • after age 40
  • history of trauma, hypertension, fever
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11
Q

What are the 5 types of headaches?

A
  • tension
  • cluster
  • migraine
  • post traumatic
  • medication overuse headache
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12
Q

What is the most prevalent type of headache?

A

tension

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13
Q
  • bilateral headaches
  • occurs daily
  • “vice-like”
  • exacerbated by emotional stress, fatigue, noise, glare
  • hypertonicity of neck muscles
A

tension headache

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14
Q

What is the treatment for tension headaches?

A
  • NSAIDs

- Tylenol

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15
Q

What is the specific NSAID treatment for a tension headache?

A
  • Ibuprofen 400-800 mg PO q 4-6 hours

- naproxen 25-500 mg PO q 12 hours

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16
Q

What is the specific Tylenol treatment for tension headaches

A

-325-1000 mg PO q 4-6 hours

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17
Q
  • intense unilateral pain
  • starts around the temple or eye
  • pt is restless/agitated
  • episodes are 15 mins to 3 hours, occur seasonally
  • ipsilateral congestion/rhinorrhea
  • lacrimation/redness of eye
  • horner syndrome
A

cluster headache

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17
Q
  • intense unilateral pain
  • starts around the temple or eye
  • pt is restless/agitated
  • episodes are 15 mins to 3 hours, occur seasonally
  • ipsilateral congestion/rhinorrhea
  • lacrimation/redness of eye
  • horner syndrome
A

cluster headache

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18
Q

What is the initial treatment of choice for cluster headaches?

A

-inhaled 100% O2 for 15 mins

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19
Q

What is the medication treatment for cluster headaches?

A
  • sumatriptan (subQ 6 mg)

- zolmitriptan (PO 2.5mg)

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20
Q
  • gradual buildup of a throbbing headache
  • unilateral or bilateral
  • duration=several hours
  • aura may or may not be present
  • family hx usually + for headaches
  • may have N/V
A

migraine

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21
Q

What is the initial management of a migraine?

-during acute attacks?

A
  • avoid of precipitating factors

- during acute attacks: rest in a quite, dark room

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22
Q

What is the migraine abortive treatment?

A
  • simple analgesics/NSAIDs
  • sumatriptan
  • zolmitriptan
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23
Q

Preventative treatment is indicated when migraines occur more than how many times per month?

A

2-3 times per month

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24
Q

What is the treatment for migraine prophylaxis for these classes:

  • anti hypertensives
  • antidepressants
  • anticonvulsants
A
  • beta blocksers, propranolol
  • amitryptyline
  • topiramate
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25
Q

What is the treatment for concurring symptoms of migraines?

A

antiemetics: promethazine

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26
Q
  • sx occur within 1-2 days of injury
  • subside within 7-10 days
  • accompanied by impaired memory, poor concentration, emotional instability, increased irritability
A

post traumatic headaches

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27
Q

What is the treatment for post traumatic headaches?

A
  • no special tx

- simple analgesics

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28
Q
  • present in about 50% of pt’s with chronic daily headaches
  • present with chronic px or with complaints of headache unresponsive to medication
  • heavy use of analgesics
A

medication overuse headache

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29
Q

What is the treatment for medication overuse headache?

A

withdrawal medication

improvement in months not days

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30
Q

What is characterized by recurrent unprovoked seizures?

A

epilepsy

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31
Q

An abnormal, excessive, hypersynchronous discharge from an aggregate of CNS neurons

A

seizure

32
Q

What are the 3 etiologies of seizures in young adults?

A
  • trauma
  • metabolic disorders
  • CNS infection
33
Q

What are the 5 etiologies of seizures in older adults (>35)?

A
  • cerebrovascular disease
  • brain tumor
  • metabolic disorders
  • degenerative disorders
  • CNS infection
34
Q
  • only one part of the brain is affected
  • presentation depends on focal area
  • formerly known as simple partial seizure
A

focal seizure with retained awareness

35
Q
  • only one part of brain is affected
  • patient appears to be awake, not in contact w/ environment, do not normally respond to questions
  • often have no memory of what occurred
  • may exhibit automatisms
A

focal seizure with impaired awareness

36
Q
  • involves the entire brain

- may or not may not lead to alteration of consciousness

A

generalized seizure

37
Q

What is the most common type of generalized seizure?

A

tonic-clonic

38
Q

Which phase is:

-characterized by sudden muscle stiffening

A

tonic phase

39
Q

Which phase is characterized by rhythmic jerking?

A

-clonic phase

40
Q

Which phase is tongue biting common in?

A

clonic phase

41
Q
  • somnolence, confusion or headache that may occur for several hours
  • no recollection of event
  • weakness of limbs may occur (todd paralysis)
A

postictal phase

42
Q

What is the method of diagnosis of a seizure?

A

video EEG monitoring

43
Q

What are the 4 aspects of first aid for seizures?

A
  • maintain airway
  • redirect gently (partial seizures)
  • start IV
  • blood work
44
Q

What are the labs you should get for patients with seizures?

A
  • electrolytes
  • LFT
  • CBC
  • finger stick glucose
45
Q

What is the treatment for active seizures?

A
  • diazepam 5mg IM/IV q5-10 minutes, no more than 30mg

- medevac

46
Q

Single seizure lasting more than or equal to 5 minutes or 2 or more seizures between which there is an incomplete recovery of consciousness

A

status epilepticus

47
Q

What is a complication of a seizure that is considered a medical emergency?

A

status epilepticus

48
Q

What is the treatment for status epilepticus?

A
  • diazepam 5mg
  • valproic acid 30 mg/kg
  • correct underlying problem
  • intubate
49
Q
  • not associated with abnormally excessive neuronal activity
  • usually last longer than 2 mins
  • eyes are closed during event
  • incontinence is less common
  • usually no postictal phase
A

psychogenic nonepileptic seizure

50
Q

What are the two major branches of the internal carotid arteries?

A
  • anterior cerebral artery

- middle cerebral artery

51
Q

What supplies blood to the cerebellum and brainstem?

A

-basilar arteries

52
Q

The basilar artery branches to become the?

A

-left and right posterior cerebral arteries (PCA)

53
Q

What interconnects the internal carotid and vertebral basilar arteries?

A

circle of willis

54
Q

Which blood vessel connects internal carotid artery and the vertebral basilar arteries?

A

posterior cerebral arteries

55
Q

Acute neurological injury that occurs as the result of the interrupted blood flow to the brain

A

stroke

56
Q

Rupture of a blood vessel causing bleeding into the brain and lack of cerebral blood flow leading to ischemia

A

hemorrhagic stroke

57
Q

Blockage of a blood vessel causing lack of cerebral blood flow leading to ischemia

A

ischemic stroke

58
Q

What are subtypes of ischemic stroke?

A
  • TIA

- CVA

59
Q

What are the 3 risk factors of stroke?

A
  • HTN
  • age
  • atherosclerosis
60
Q

obstruction of an artery due to a blockage that forms in the vessel
-often due to atherosclerosis

A

thrombotic

61
Q

obstruction of an artery due to a blockage from debris that has broken off from a distal area

A

embolic

62
Q

lack of brain blood flow to decreased systemic blood flow

A

systemic hypoperfusion

63
Q

a transient episode of neurologic dysfunction caused by focal brain, spinal cord, or retinal ischemia, without acute infarction

A

TIA

64
Q

neurological dysfunction caused by focal brain, spinal cord, or retinal ischemia with infarction (tissue death) of central nervous system tissue.

A

CVA

65
Q

The only way to determine between a TIA and CVA is?

A

MRI

66
Q

What is the mnemonic for strokes?

A 
Face- face drooping/numb on one side
Arms-one limb weaker/numb
Stability-steadiness on feet
Talking-slurring, garbled
Eyes-visual changes
React-MEDEVAC
67
Q

These are risk factors for what?

  • hx of vascular disease
  • a fib
  • atrial septal defect
  • ventricular septal defect with DVT
  • recent MI
  • atherosclerosis
  • clotting disorder
A

ischemic stroke

68
Q

What are the two subtypes of hemorrhagic stroke?

A
  • intracerebral hemorrhage

- subarachnoid hemorrhage

69
Q

Which type of hemorrhagic stroke

-bleeds directly into the brain tissue

A

intracerebral hemorrhage

70
Q

Which type of hemorrhagic stroke:

-bleeds into the subarachnoid space?

A

subarachnoid hemorrhage

71
Q

Usually has gradual onset as blood builds

A

intracerebral hemorrhage

72
Q

maximum impact right away usually with intense “worse headache of my life” headache

A

subarachnoid hemorrhage

73
Q

headache, vomiting, decreased level of consciousness occurs in about of the patients with what type of hemorrhagic stroke?

A

intracerebral stroke

74
Q

These are risk factors for what?

  • HTN
  • trauma
  • bleeding disorder
  • drug use (cocaine, methamphetamines)
  • vascular formations (aneurysms)
A

hemorrhagic stroke

75
Q

Outpouchings and ballooning of artery due to weakness in the vascular wall

A

aneurysm

76
Q

Differential blood pressure readings between upper extremities may indicate?

A

an aortic dissection

77
Q

Acute management for strokes:

-fundoscopic exam for papilledema, which may indicate?

A

ICP

78
Q

initial interventions for ischemic stroke

A
  • maintain o2 at 94%
  • elevate head of bed 30 degrees
  • labs
  • imaging
  • medication
  • medevac

UNIT 9- Neurology (4 decks)

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