Clinical Care of the Nervous System

Question 1

If a patient complains about a vice like headache and hypertonicity of neck muscles what are you thinking

Answer 1

Tension headache

Question 2

What is the treatment for tension headaches

Answer 2

NSAIDS
ibuprofen 400-800mg PO q 4-6 hrs
max 2400mg/34hrs

 Napoxen 250-500mg PO q12hrs 

 Acetaminophen 325/1000mg PO 4-6 
 hrs Max 4G/24hrs

Question 3

Middle ages man comes in agitated complaining of a headache with intense unilateral pain that starts around the temple or eye what are you thinking

Answer 3

Cluster headache

Question 4

how long do cluster headaches usually last for 15 - 30 min

Answer 4

cluster headaches

Question 5

if you suspect a cluster headache what should you ask about reassurance about headache

why

Answer 5

when do you have these types of headaches ?

cluster headaches occur seasonally and are grouped together

Question 6

what other type of symptoms are you looking at if you suspect a cluster headache

Answer 6

ipsilateral congestion or rhinorrhea

Laceration and redness of the eye

Horner syndrome
Ptosis- drooping of the eye
Miosis- excessive pupil constriction
Anhidrosis- No sweating

Question 7

how should be your first treatment of choice for a cluster headache

Answer 7

100% O2 for 15 min

Question 8

what is a secondary treatment of choice for a cluster headache

Answer 8

Sumatriptan SubQ -6mg repeat if needed after 1hr max does 12mg/24hrs

or

Oral Zolmitriptan - 2.5mg repeat if needed after 2 hrs max dose 10mg/24hrs

Question 9

a patient comes in complaining about a gradual build up of throbbing headache what are you thinking

Answer 9

migraine

Question 10

if you suspect a migraine headache what questions are you asking

Answer 10

do you have a aura, visual disturbances, or hallucinations

Family Hx

Nausea vomiting

Question 11

how should migraines be treaded

Answer 11

avoidance of precipitating factors, with treatment of Sx and prophylactics treatment

Question 12

what shroud you do for the PT during an acute attack

Answer 12

have them rest in a quite dark room until Sx subside

Question 13

what are abortive treatment for migraines

Answer 13

Simple analgesics and NSAIDS

Ketoralac 30mg IV/IM every 6 hrs or single dose of 60mg IM max 120mg/24hrs

Question 14

what is the dosage of Sumatriptan for migraines

Answer 14

One oral dose of either 25/50/100mg

or

6mg IM

Question 15

what is prophylaxis for migraines

Answer 15

antihypertensive - such as beta blockers

anticonvulsants

Question 16

what should be given sx of migraines

Answer 16

antiemetics promethazine

antihistamines for nausea and vomiting

Question 17

what is common tohave after a head injury

Answer 17

post traumatic headache

Question 18

within how many days may a patient have a post traumatic headache

Answer 18

within 1-2 days and last for 7 10 days

Question 19

what is usually accompanied with a post traumatic headache

Answer 19

impaired Memory

emotional Instability

poor Concentration

Emotional instability

Question 20

what is the treatment for post traumatic headaches

Answer 20

No treatment

Sx management with

Question 21

patient comes in complaining of headaches unresponsive to medications that use to work for their headaches what are you thinking

Answer 21

medication overuse headache

Question 22

how do you treat medication overuse headaches

Answer 22

withdraw abused medication

Question 23

how long should patients expect to recover from medication use headaches

Answer 23

months

Question 24

what patient population are seizures common with

Answer 24

childhood and late adulthood

Question 25

what is a seizure

Answer 25

an abnormal, excessive hypersynchronous discharge from an aggregate of CNS neuros

Question 26

what are the the two types of focal seizures

Answer 26

focal seizure with retained awareness focal seizure with impaired awareness

Question 27

focal seizure with retained awareness were formally known as

Answer 27

simple partial seizure

Question 28

focal seizure with impaired awareness were formally known as

Answer 28

complex partial seizure

Question 29

how does a focal seizure with retained awareness present

Answer 29

depends on the foal area involved

Question 30

what type of focal seizure does the patient appear to be awake but not coherent

Answer 30

focal seizure with impaired awareness

Question 31

what do patients with focal seizure with impaired awareness usually remember

Answer 31

no memory of the event

Question 32

patients with focal seizure with retained awareness or impaired awareness exhibit what automations

Answer 32

``` facial grimacing gesturing lip smacking chewing replacing words or phrases ```

Question 33

focal seizure with retained awareness or impaired awareness exhibit what automations affect what part of the brain

Answer 33

only one part of the brain

Question 34

Generalized seizure effect what part of the brain

Answer 34

the entire brain

Question 35

what is the most common type of generalized seizure

Answer 35

tonic clonic seizure AKA grand mal

Question 36

the tonic phase of tonic-clonic seizure is characterized by what

Answer 36

sudden muscle stiffening

Question 37

the clonic phase of tonic-clonic seizure is characterized by what

Answer 37

rhythmic jerking

Question 38

how long do tonic clonic seizure AKA grand mal last for

Answer 38

1-2 min

Question 39

what are the other types of generalized seizures

Answer 39

absence seizure clonic seizure atonic seizure

Question 40

what is the the phase called after a seizure

Answer 40

postictal phase

Question 41

what happens in the postictal phase

Answer 41

somnolence confusion headache that last several hrs

Question 42

in the postictal phase Todd paralysis happens is this

Answer 42

weakness of limbs occur

Question 43

how are seizures diagnosed

Answer 43

video EEG

Question 44

how are seizures treated

Answer 44

``` start IV electrolytes LFT CBC finger stick glucose ```

Question 45

During a seizure what can you give

Answer 45

Diazepam 5mg IM/IV Q5-10min max 30mg

Question 46

what is status epilepticus

Answer 46

single seizure that last 5min or more or 2 or more seizure before the patient recovers from the last episode

Question 47

how do you treat status epilepticus

Answer 47

diazepam valproic acid 30mg/kg intubate

Question 48

what type of seizure is not associated with abnormal excessive neuronal activity

Answer 48

psychogenic nonepileptic seizure

Question 49

psychogenic nonepileptic seizure last how long

Answer 49

more than 2 min

Question 50

are a patients eyes open or closed during a psychogenic nonepileptic seizure

Answer 50

closed

Question 51

is there a postictal phase after psychogenic nonepileptic seizure

Answer 51

no

Question 52

psychogenic nonepileptic seizure are treated how

Answer 52

cognitive behavioral and interpersonal therapy

Question 53

an acute neurological injury that is a result of the interrupted blood flow to the brain is called

Answer 53

Stroke

Question 54

what are the two types of strokes

Answer 54

Hemorrhagic stroke Ischemic stroke

Question 55

what type of stroke is one that is caused by a rupture of a blood vessel causing bleeding into the brain and lack of cerebral blood flow leading to ischemia

Answer 55

Hemorrhagic stroke

Question 56

what type of stroke is cause by blockage of a blood vessel causing lack of cerebra blood flow leading to ischemia

Answer 56

Ischemic stroke

Question 57

what are two subtypes of ischemic strokes

Answer 57

transient ischemic attack (TIA) cerebral vascular accident (CVA)

Question 58

what are the mist common kind of strokes

Answer 58

Ischemic 80% hemorrhagic 20%

Question 59

thrombotic ischemic stoke

Answer 59

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

Question 60

describe a embolic ischemic stroke

Answer 60

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

Question 61

describe a systemic hypoperfusion ischemic stroke

Answer 61

lack of blood flow to the brain due to lack of blood supply

Question 62

what kind of stroke is defined a a episode of neurological dysfunction caused by a focal brain, spinal cord, or retinal ischemia WITHOUT acute infarction

Answer 62

Transient ischemic attack

Question 63

what kind of stroke is defined a a episode of neurological dysfunction caused by a focal brain, spinal cord, or retinal ischemia WITH acute infarction

Answer 63

Cerebral vascular accident

Question 64

what is the onset of stoke sx

Answer 64

sudden

Question 65

what are sx for strokes

Answer 65

Face - drooping or numbness on once side Arms one limb weaker than the other Stability- steadiness on feet talking - slurring garbled, nonsensical words, inability to respond normally eye-visual changes react - MEDEVAC

Question 66

intracerebral hemorrhages strokes bleed where

Answer 66

directly into the the brain tissue

Question 67

subarachnoid hemorrhage strokes bleed where

Answer 67

into the subarachnoid space

Question 68

what type of hemorrhage stroke is associated with "worse headache of my life"

Answer 68

subarachnoid hemorrhage

Question 69

what type of hemorrhage stroke has a gradual onset

Answer 69

intercranial hemorrhage

Question 70

for treatment of ischemic stroke where should o2 be maintained

Answer 70

>94%

Question 71

for treatment of ischemic stroke what position should patients be placed in

Answer 71

reverse Trendelenburg raise head 30 degrees

Question 72

how should BP of a ischemic patient not be lowered

Answer 72

acutely may be only thing maintaining profusion

Question 73

if ischemic stroke patient BP is above 220 systolic and 120 diastolic what should you lower the be by

Answer 73

15%

Question 74

what type of BP medications should be used for ischemic strokes

Answer 74

non selective beta blocker

Question 75

if a transient ischemic attack patient shows no neuro exam abnormalities what can be given

Answer 75

aspirin with MO guidance

Question 76

what do you think if a patient comes ion complaining of "creeping crawling" or pins and needles feeling" in the limbs

Answer 76

Restless leg syndrome

Question 77

what is a aggravating factor of restless leg syndrome

Answer 77

periods of inactivity especially at night

Question 78

what types of medications make Restless leg syndrome worse

Answer 78

antihistamines dopamine receptor antagonist antidepressant

Question 79

what are Restless leg syndrome diagnosis differentials

Answer 79

Volitional movements - foot taping, bouncing leg rocking Akathisia - intense desire to move Nocturnal le\g cramps

Question 80

what labs should be drawn for restless leg syndrome

Answer 80

iron levels

Question 81

if iron is low in pt diagnosed with restless leg syndrome what should be prescribed

Answer 81

ferrous sulfate

Question 82

what is type of injury is a mild subset of TBI

Answer 82

closed head injury

Question 83

what happens in a closed head injury

Answer 83

force is applied to the brain that creates a shear force at the white/grey matter junction

Question 84

what word is used to describe a injury at the opposite side of the head

Answer 84

Coup-Countercoup

Question 85

what are hallmarks for closed head injuries

Answer 85

confusion and amnesia

Question 86

in additon to confusion and amnesia what are common signs of closed head injuries

Answer 86

vacant stare delayed verbal expression inability to focus disorientation slurred incoherent speech incoordination emotional memory deficits

Question 87

within how many hours must a MACE exam be administered

Answer 87

48 hours

Question 88

during a closed head injury facial fractures are concerning for what

Answer 88

occult injury

Question 89

how are concussions managed

Answer 89

direct observation for 24 hrs low level of activity for 24 hrs no alcohol, sedatives or pain relivers other than NSIAD for 48 hrs

Question 90

what phrase is used to describe an occurrence when a patient is still having sx from the first concussion and suffers a second concussion

Answer 90

second impact syndrome

Question 91

what are the two types of cranial fractures

Answer 91

linear fractures Comminuted/stellate

Question 92

what type of fracture has a less risk for underlying damage

Answer 92

linear fracture

Question 93

what type of head fracture requires significant force and underlying damage is likely

Answer 93

Comminuted/stellate

Question 94

what part of the skull are easiest to break

Answer 94

temporal regions nasal sinuses

Question 95

what is Cushing triad

Answer 95

bradycardia hypertension raspatory irregularity

Question 96

if do you do if there are are rapid signs of ICP herniation

Answer 96

secure/ maintain airway reveres Trendelenburg 25-30 degrees

Question 97

what type of iv solutions do you not use with ICP/ herniation patients

Answer 97

solutions containing glucose or hypotonic

Question 98

hyperventilation should be used how

Answer 98

last resort

Question 99

where does epidural hematoma occur

Answer 99

between the dura matter and the skull

Question 100

where doe subdural hematoma occur

Answer 100

between the dura mater and the arachnoid matter

Question 101

where does a subarachnoid hematoma occur

Answer 101

between arachnoid matter

Question 102

what does a epidural hemorrhage usually affect

Answer 102

middle meningeal artery

Question 103

hw does epidural hemorrhage present

Answer 103

lucid interval with recovery of consciousness

Question 104

when do you intubate epidural hemorrhage patient

Answer 104

GCS <8

Question 105

who does a subdermal hemorrhage affect most

Answer 105

elderly alcohol abusers anticoagulated at risk

Question 106

subdural hemorrhage presents in how many days

Answer 106

1-2 days

Question 107

who as more at risk for subarachnoid hemorrhage

Answer 107

drug users (coke and amphetamines) smokers hypertension alcohol use

Question 108

what are hallmarks for subarachnoid hemorrhage

Answer 108

thunderclap headache worse headache of my life

Question 109

how do you treat subarachnoid hemorrhage

Answer 109

bed rest analgesia avoid anticoagulation

Question 110

all service members diagnosed with their 1st TBI concussion must have a minimum of how many hrs of recovery time

Answer 110

24 hrs

Question 111

all service members diagnosed with their 2st TBI/concussion within 12 months must have a minimum of how much recovery time

Answer 111

7 days

Question 112

all service members diagnosed with their 3rd TBI/concussion within 12 months must have a minimum of how much recovery time

Answer 112

until a recurrent concussion evaluation has been completed