CCP 214 - Neurological Emergencies

Question 1

What is the primary function of the thalami?

Answer 1

Transmission of impulses to and from the cerebrum.

Question 2

What is the role of the basal ganglia?

Answer 2

Controls fluidity of movement. Injury to the basal ganglia (such as in Parkinson’s) results in rigid movement.

Question 3

The frontal lobe is responsible for:

Answer 3

Behaviour and executive function.

Question 4

The occipital lobe is responsible for:

Answer 4

Vision.

Question 5

The temporal lobe is responsible for:

Answer 5

Memory.

Question 6

The parietal lobe is responsible for:

Answer 6

Sensation, movement, and speech.

Question 7

The brainstem houses ___ of the 12 cranial nerves.

Answer 7

10.

Question 8

CN III is located in the ___.

Answer 8

Midbrain.

Question 9

CN III is assessed by performing:

Answer 9

Pupil assessment.

Question 10

CN V & VII are located in the ___.

Answer 10

Pons.

Question 11

CN V & VII are assessed by performing:

Answer 11

Corneal reflex.

Question 12

Pons injury can result in:

Answer 12

Abnormal pupil function, and abnormal pupil shape.

Question 13

CN IX and X are located in ___.

Answer 13

The medulla.

Question 14

Medullary function is assessed by assessing:

Answer 14

CN IX and X; which includes gag and cough.

Question 15

How does TBI affect cerebral auto regulation?

Answer 15

TBI narrows the zone of auto regulation.

Question 16

The RAS is located in ___.

Answer 16

The midbrain.

Question 17

The respiratory centre is located in ___.

Answer 17

The medulla.

Question 18

Brain stem exam contains these four components:

Answer 18

1) CN III (Midbrain)
2) CN V and VII (Pons)
3) CN IX and X (Medulla)
4) Respiratory centre (low medulla)

Question 19

Respiratory centre assessment is performed by:

Answer 19

Assessing patients ability to breath independently (ie. breath over the vent setting).

Question 20

The cerebral peduncles can be described as:

Answer 20

Structures at the front of the pons that contain large ascending and descending nerve tracts that from the cerebrum to the pons.

Question 21

Uncal herniation produces:

Answer 21

Ipsilateral pupil dilation, but contralateral hemiparesis.

Question 22

Uncal herniation can also be called:

Answer 22

Transtentorial herniation.

Question 23

T or F:

Uncal herniation is often unilateral.

Answer 23

False.

Question 24

What is the tentorium?

Answer 24

A fibrous layer separating the superior and inferior brain.

Question 25

Cerebellar stroke shouldn’t be sedated unless necessary, why?

Answer 25

Constant assessment of motor ability and respiratory function needs to occur. Cerebellar herniation produces apnea before midbrain injury occurs (because of the caudal movement of cerebellar herniation).

Question 26

Describe the three variations of muscle tone:

Answer 26

1) Flaccid
2) Rigid (ie. arm won’t straighten)
3) Spasticity (ie. arm initially tenses, but eventually straightens and relaxes)

Question 27

Plantar reflex indicates:

Answer 27

Unspecific neurological issue.

Question 28

Describe the approach to a neurological assessment:

Answer 28

1) Brainstem
2) Motor
3) Other (reflex/tone)

Question 29

M5 motor score indicates:

Answer 29

Only some dysfunction of the cerebral cortex.

Question 30

M4 motor score indicates:

Answer 30

Severe dysfunction of the cerebral cortex.

Question 31

M3 motor score indicates:

Answer 31

Severe damage above the brainstem (ie. thalamus).

Question 32

M2 motor score indicates:

Answer 32

Dysfunction below the thalamus.

Question 33

M1 motor score indicates:

Answer 33

Severe dysfunction of cerebral cortex with or without dysfunction of the brainstem.

Question 34

Present the cerebral oxygen delivery equation:

Answer 34

CBrO2 = CBF x CaO2

CBF = CPP/CVR

Question 35

Summarize the approach to ICP management:

Answer 35

1) Parenchymal - Sedation, temperature, Sz prophylaxis, osmotherapy
2) CSF - EVD
3) Blood - Venous return, PaCO2
4) Other - Decompressive craniectomy/otomy, transfusion.

Question 36

Astrocytes are responsible for:

Answer 36

Autoregulation of blood flow in the brain.

Question 37

TBI with a period of lucency is often associated with what type of injury:

Answer 37

Epidural.

Question 38

Almost everybody is __ dominant.

Answer 38

Left.

Question 39

Left-sided MCA stroke produces:

Answer 39

Speech issues from damage to Broca’s and Wernicke’s area.

Question 40

Broca’s area is responsible for:

Answer 40

Expressive speech.

Question 41

Wernicke’s area is responsible for:

Answer 41

Receptive speech.

Question 42

Right-sided MCA stroke produces:

Answer 42

Visual and neglect component.

Question 43

Bell’s Palsy occurs from:

Answer 43

Inflammation of the facial nerve, which affects the frontal muscle.

Question 44

ACA stroke presents:

Answer 44

Contralateral lower extremity paralysis.

Question 45

MCA stroke presents as:

Answer 45

Contralateral arm, as well as speech and L face paralysis (sparing the frontal muscle).

Question 46

Posterior circulation includes which three arteries?

Answer 46

Basilar, vertebral, and posterior cerebral artery.

Question 47

MAP goal of SCI is:

Answer 47

> 85

Question 48

What is the goal of adequate MAP in SCI?

Answer 48

Perfusion of the penumbra of spinal tissue.

Question 49

T or F:

Adequate MAP in SCI can drastically improve ASIA score.

Answer 49

True.

Question 50

Cardioembolic strokes often affect the __.

Answer 50

Right MCA (due to anatomy of the vasculature).

Question 51

Basilar CVA presents as:

Answer 51

Drop attack, due to insult to the RAS.

Question 52

Vertebral CVA presents as:

Answer 52

Respiratory issues, cough/gag absence.

Question 53

PCA CVA presents as:

Answer 53

Contralateral hemianopsia.