Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Neuro II > coma and brain death > Flashcards

coma and brain death Flashcards

1
Q

2 most common causes of comma

A
  • cardiac or pulmonary failure >5min

- drug/alcohol overdose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

other causes of coma

A 
severe organ failure 
stroke or hemorrhage in CNS
cranial trauma
infections
psychiatric pseudo-coma or catatonia (rare)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

oculocephalic reflex

A

‘dolls eyes’

eyes go in opposite direction of head turn

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

oculovesticular reflex

A

cold water on ear drum- eye moves towards the stimulus with a nastagmus away

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

2 most important prognostic indicators of coma

A

-pupillary rxns to light
-spontaneous mvmts
if these are absent for 72 hours and no known reversible cause, pt has <5% chance of survival

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

requirements for brain death

A

no known reversible cause
no evidence of cerebral fnx
no evidence of brain stem fnx (loss of CN reflexes)
APNEA test
can do EEG or cerebral arteriography or radionuclide brain scans

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

persistent vegetative state

A

vegetative state >1month

still have brainstem fnx, but NO Cx fnx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

alzheimers

A

most apparent in temporal and parietal lobes

drugs which lower amyloid do not help

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

risks fo alzheimers

A 
almost all cases >65yrs
W>M
poorly educated, mentally inactive
head trauma
homozygous for e4 allele of ApoE
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

symptoms of alzheimers

A

almost always present w/loss of memory first
speech becomes restricted
visuspatial decline (get lost in familiar places)
depression
gait disorder
sundowning

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

CSF in alzheimers

A

soluble beta amyloid low

tau high

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Tx of alzheimers

A

cholinesterase inhibitors
memantidine (blocks NMDAR)
anti-depressents
mentally and physically active

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

cholinesterase inhibitors for alzheimers

A 
relief of memory impairment, agitated behavior, poor concentration
do not work for very long
-donepexil
-rivastigmine
-galantamine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

mild cognitive impariment

A

pt who have limited problems w/memory or cognition

50% go on to develop alzheimers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

lewy body dementia

A 
fluctuating dementia w/agitated behavior
decreased facial animation
slowness and imbalance 
mild or no tremor
visiual hallucinations
BAD response to antipsychotic drugs
live 5-7yrs
like parkinsons except early onset  of dementia and agitations
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

lewy bodies

A

contain alpha-synuclein

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

multi-infarct disease

A

dementia d/t known Hx of strokes
seizures more common then w/other dementias
often have concurrent vascular disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

fronto-temporal dementias

A

family of multiple disorders
increased Tau, TDP-43, Ubiquitin
typical onset 50-60
pick bodies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

fronto-temporal dementia behavior dominant form

A 
most common 
major personality changes
obsessions
overeating/overdrinking
occasional weakness, ataxia, clumsiness
no auditory/visual hallucinations
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

fronto-temporal dementia language predominante form

A

primary progressive expressive aphasia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

CJD

A 
transmissible spongiform encephalopathy
prominent myoclonic jerks
loss of balance and coordination
EEG triphasic waves
high 14-3-3 in CSF
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

normal pressure hydrocephalus symptoms

A

gait disturbances (wide)
incontinence (wet)
dementia (weird)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

normal pressure hydrocephalus Dx

A

removal of 30cc of CSF provides symptom relief

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

normal pressure hydrocephalus Tx

A

ventriculo-peritoneal shunting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

CV syncope

A 
decreased CO
cardiac arrhythmias
aortic stenosis (elderly)
idiopathic subaortic hypertrophic cardiomyopathy (HS kids)
mitral valve prolapse (young women)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

tonic phase of tonic-clonic seizure

A

clenching/tightening of mm in fixed position
arms flexed, legs extended
close mouth, open eyes
loss of urinary and sometimes bowel continence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

clonic phase of tonic-clonic seizure

A

repetitive synchronous mvmts of arms and legs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

physiologic changes during seizure

A 
HR increases immediately
O2 saturation drops
BP increase
pupils dilate and do not react to light
metabolic acidosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

todds paralysis

A

rare

pt remains weak on one side for a day after seizure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Imaging for HA

A

recurrent migraine do not need image unless: recent change in HA pattern, focal neuro signs
MRI more likely to show cause

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Dx of migraines

A

> = 5 attacks lasting 4-72hrs
= 2 of (u/l, pulsating, moderate/severe intensity, aggravation by physical activity)
=1 of (nausea, photophobia, phonophobia)
no evidence of secondary HA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

idiopathic intracranial HTN

A 
aka pseudotumor cerebri
progressive diffuse HA w/intermittent loss of vision in 1 or both eyes
obese young women
papilledema
often have extraoccular palsy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Tx of idiopathic intracranial HTN

A

weight loss
steroids
carbonic anhydrase inhibitors
defenestration of optic nn sheath or lumbar-periotoneal shunt

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

triptans

A

serotonin agonists
rizatriptan
eletriptan
CI in known coronary artery or cerebral vascular disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

ergotamines

A

DHE
causes significant vasoconstriction and can increase BP
given w/caffeine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

great prophylaxis of migraine

A

amitriptyline
propanolol
topiramate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

amitriptypline

A 
tricyclic antidepressent
low doses in evening
may cause tachyarrythmias
weight gain
have to worry about suicide potential
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

propanolol

A

long acting once daily

relative CI in asthma, CHF, or bradycardia d/t heart block

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

topiramate

A

anticonvulsant
take at bedtime
may cause difficulties w/speech and cognition- nickname dopamax
weight loss, anorexia, loss of sensation in arms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

good prophylaxis

A

gabapentin

zonaisamide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

fair prophylaxis

A

valproic acid

verapamil

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

valproic acid

A 
bad side effects
weight gain
lowering platelet count
tremor
hair loss
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

abortive Tx of cluster HA

A

sumatriptan injection or nasal spray
high dose O2
nasal lidocaine

44
Q

preventative Tx of cluster HA

A 
must use
verapamil
lithium
prednisone
deep brain stimulation
45
Q

verapamil

A

CaCh blocker
may need high doses
ADR: hypotension and constipation

46
Q

lithium

A

unclear effects on postsynpatic transmission
suicide potential
ADRs: renal and thyroid disease

47
Q

prednisone

A

limited use d/t side effects

48
Q

Tx of trigeminal neuraliga

A

carbamazepine

surgical

49
Q

MS epidemiology

A

mean onset 29
rare 55
70% women, men worse prognosis
north of equator

50
Q

pathology of MS

A 
T-cell mediated
do not know subtype of T cell
do not know Ag
do not know how T cells cross BBB
macros, cytokines, and chemokines are involved
51
Q

benign MS

A

have infrequent minor attacks and always return to normal basline

52
Q

relapsing remitting MS

A

most common
intermittent attacks that progressively get worse and more frequent
baseline progressively gets worse after each attack

53
Q

secondary chronic progressive MS

A

second most common

starts out like relapsing intermittent, but then just takes off as continuously degenerating disease

54
Q

primary progressive MS

A

rare
never recover from ‘first attack
and just keep getting worse

55
Q

kurtzke’s rule

A

90% of disabilities of MS occurs w/in first 10yrs

56
Q

MS first attack symptoms

A

visual loss or double vision, most common, usually improves
weakness, usually improves
paresthesiaes, usually does not improve
depression can precede Dx by yrs

57
Q

Dx of MS

A

multiple attacks in time and location
MRI
CSF

58
Q

MRI of MS

A

9+ lesions
at least 1 gadolinium enhancing lesion
at least 1 lesion in cerebellum or brainstem
at least 3 periventricular lesions

59
Q

CSF of MS

A

oligoclonal band in 90%
increased myelin basic protein or IgG index
increased WBC, but <100

60
Q

optic neuritis

A

painful, sudden loss of vision usually u/l
pupillary light reflex usually lost -> marcus-gunn pupillary light reflex
50% develop MS
time to recovery shortened w/IV corticosteroids

61
Q

internuclear opthalmoplegia (INO)

A

eyes cannot ADDuct, only ABduct
severe nystagmus
d/t damage of MLF
only two causes: MS or brainstem stoke

62
Q

Tx of MS

A

beta interferons
glatiramer acetate
natalizumab
fingolimos

63
Q

beta interferons

A

limit pathologic activity of MS
acenoz
beatseron
rebif

64
Q

glatiramer acetate

A

only indicated for relapsing remitting MS

may micic meylin protein acting as decoy

65
Q

natalizumab

A

possibly most effective

at risk for PML d/t JC virus

66
Q

fingolimos

A

PO
limits circulation of lymphocytes fewer cross BBB
ADR: cardiac effects, coronary artery diseae

67
Q

symptomatic Tx of MS

A

corticosteriods- during attack
antispasmoics
antidepressents

68
Q

neuromyetlites optica/NMO

A 
devics disease
optic neuritis (usually b/l) and spinal cord demyelination w/o brain demyelination
distinct from MS
seldom have oligoclonal bands
at risk for respiratory crisis 
infants-90s
69
Q

NMO MRI

A

show spinal cord lesions at 3+ levels

usually severe w/cavitation and hemorrhage

70
Q

pathology of NMO

A

Abs to aquaphorin 4 Chs

can follow infection

71
Q

Miller fishcer variant of GBS

A

limited leg and arm weakness

opthalmoplegia and cerebellar deficits predominate

72
Q

Dx of GBS

A

nerve conduction and electromyograms

LP abnormal, but takes a week significant elevated protein

73
Q

chronic inflammatory demyelinating polyneuropathy (CIPD)

A

slower form of polyneuropathy developing over 3-6months
milder weakness, more sensory complains
responds to corticosteroids (GBS does not)
can also use plasma exchange or IVIG

74
Q

Tx of GBS

A

plasma exchange

IVIG

75
Q

benign paroxysmal postional vertigo (BPPV)

A 
intermittent vertigo lasting <1min associated w/changes in head position
walking impaired, but possible
sometimes follows cold, URI, or trauma
full relief by lying still
lasts 1-2wks
76
Q

pathology of BPPV

A

detachment of otolithic crystals

77
Q

Dx of BPPV

A

clinical
no hearing loss
Dix-hallpike maneuver

78
Q

Tx of BPPV

A 
epley manuver
meclizine
scopolamine patch
promethazine
diazepam
79
Q

Menieres disease

A

recurrent attacks over years/decades of vertigo, tinnitus, decline in hearing, pressure in ear
ultimately have hearing loss
completely immoblize pt
rare cochlear variatn w/prominent hearing loss and mild vertigo

80
Q

pathology of menieres disease

A

increased volume of endolymphatic fluid -> bulges -> ruptures -> attack
mostly sporadic, rarely familial

81
Q

Tx of menieres attack

A

meclizine
promethazine
scopolamine patch

82
Q

prophylaxis of menieres attacks

A

low Na diet
K sparring diuretic
surgical repair
resolves in most pts eventually w/o surgery

83
Q

cerebellar disease

A

ataxia
inability to walk/control direction
fall a lot
intention tremor

84
Q

cerebellar stroke

A 
sometimes few cerebellar symptoms seen
ataxia, dysmetria, nystagmus, dysarthria
vomiting
walking may be impossible
HA, diplopia
if not detected infarct grows -> closes of ventricles -> hydrocephalus -> herniation
85
Q

glasgow coma scale

A

9-13 minor
8-12 moderate
7 and below major

86
Q

cushing reflex

A

after head injury or growth of tumor pts have HTN and bradycardia

87
Q

SDH

A

venous
cresent
acute if 33mm
cohen prefers craniotomy

88
Q

EDH

A 
less common
arterial
middle menigeal a
lucid interval
surgical drainage always required
89
Q

concussions

A

must do CT if LOC, persistent HA, or neuro signs

90
Q

post concussive syndrome

A 
persistent HA
light headedness
depression
poor concentration
irritability
can last for wks-months
resistent to Tx
91
Q

chronic traumatic encephalopathy

A

Tau build up, especially in temporal and frontal lobes
brain atrophy
damaged septum pallicidum and corpus collosum
do not have amyloid plaques

92
Q

four cardinal features of parkinsons

A

resting tremor
bradykinesia
disequillibrium
rigidity

93
Q

other signs and symptoms of parkinsons

A 
sleep disorders
loss of sense of smell
autonomic problems
cramps/pains in back and shoulders
depression, dementia
smaller incomprehensible handwriting
loss of power of voice
94
Q

parkinsons epidemiology

A

55-59yrs, but anywhere from 40-70
smokers, caffeine consumers lower incidence
rural areas
M>W

95
Q

drug induced parkinsonism

A 
usually do not have resting tremor
anti-cholinergics
phenothiazines
metoclopramide
promethazine
96
Q

progressive supranuclear palsy

A

usually no tremor, but severe disequillibrium
falls and choking seen early
progressive loss of extraoccular mvmts
dystonic extension of neck, furrowed brow, look scarred
blink frequently
usually die from aspiration pneumonia or fall
live 5-6yrs

97
Q

essential tremor

A

most common mvmt disorder seen in practice
older onset worse prognosis
rue out huperthyroidism, medication cause, cerebellar disease

98
Q

essential tremor Tx

A

propranolol
primidone
deep brain stimuation

99
Q

tourettes

A

likely associated w/OCD, ADHD, depression

Tx w/haloperiodl or other D2 blockers

100
Q

huntingtons

A

onset 40-50

chorea limited by dompamine blockers

101
Q

resteless leg syndrome

A 
AR inheritence 
Tx:
-pramipexole
-levodopa/carbidopa
-Fe
-benzodiazepines
-gabapentin
-opioids
102
Q

MG

A

thymic tumors or hyperplasia common
nerve conduction studies shows decremental response
tensilon test

103
Q

MG Tx

A

anticholinesterases
corticosteroids
plasmaphoreiss
IVIG

104
Q

ALS

A

may present w/asymmetric weakness
no extraoccular eye mm involved
dysarthria most common early symptom

105
Q

ALS presentatin

A

worsening weakness
frequent fasiculations
loss of speech, inability to move tongue, tongue atrophy
split hand w/ulnar sparing
cognitive decline in 105 (frontal lobe w/personality changes)

106
Q

Dx ALS

A

EMG- denervation of 3+limbs

107
Q

Tx of ALS

A

riluzole

Neuro II (22 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions