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Neuro > Medical Diagnosis & Treatment > Flashcards

Medical Diagnosis & Treatment Flashcards

1
Q

One of the most common medical complaints

Effects 12-16% if the North American population

A

Headache

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2
Q

How many work days are lost each year from headaches?

A

150 million

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3
Q

Headaches are rarely caused from what kind of strain?

A

Rarely caused by refractive error (eyestrain) alone

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4
Q

“Thunderclap” Headache indicates what?

A

Subarachnoid hemorrhage (SAH)

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5
Q

Absence of headaches similar to the present headache indicates:

A

CNS Infection

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6
Q

Headache with a fever could indicate:

A

Meningitis

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7
Q

Headache with rapid onset with exercise

A

Intracranial hemorrhage associated with a brain aneurysm

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8
Q

Headache with nasal congestion

A

Could be Sinusitis

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9
Q

Headache with papilledema

A

Increased intracranial pressure

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10
Q

What are the reasons for imaging a headache

A
  1. Recent change in pattern, frequency, or severity of headaches
  2. Progressive worsening despite therapy
  3. Focal neurological deficits or scalp tenderness
  4. Onset of headache with exertion, cough, or sexual activity
  5. Visual changes, auras, or orbital bruits
  6. Onset of headache after age 40
  7. History of trauma, hypertension, fever
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11
Q

Most prevalent headache

“Vice-Like”

Often exacerbated by emotional stress, fatigue, noise, glare

May be associated with neck muscles

A

Tension headache

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12
Q

Treatment for tension headaches

A

Ibuprofen 400-800mg PO q 4-6 hrs - Max 2400mg daily
Naproxen 250-500mg PO q 12 hrs

Tylenol 325-1000mg PO q 4-6 hrs, max 4g/24 hours

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13
Q

Intense unilateral pain that starts around the temple or eye

Duration: 15 minutes to 3 hours

Usually occurs “seasonly”

A

Cluster Headaches

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14
Q

Patient presents with ipsilateral congestion or rhinorrhea, lacrimation, redness of the eye, Horner Syndrome

A

Associated symptoms of a Cluster Headache

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15
Q

Initial treatment of choice for a Cluster Headache

A

Inhaled 100% O2 for 15 minutes

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16
Q

Treatment medications for Cluster Headaches

A

Sumatriptan: 6mg SubQ, repeat 6mg >1 after initial dose

Zolmitriptan: 2.5mg Oral, 2.5 mg >2 hour after dose

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17
Q

Gradual build-up of a throbbing headache

Duration: Several hours

Possible Aura

Family history is often positive

May have associated nausea and vomiting

A

Migraine

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18
Q

Treatment for acute migraine attacks

A

Rest in a quiet, darkened room until symptoms subside

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19
Q

Migraine abortive treatment

A

SubQ Sumatriptan: 6mg
Oral Sumatriptan 25, 50, or 100mg
*50mg has been shown to be the most effective

Oral Zolmitriptan: 2.5mg

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20
Q

When would you prescribe beta blockers, antidepressants, anticonvulsants to treat migraines?

A

When migraines occur more than 2-3 times a month or associated significant disability

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21
Q

Treatment for concurring migraine symptoms

A

Promethazine (antiemetic/antihistamine)

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22
Q

Symptoms occur 1-2 days of injury, subside within 7-10 days

Often accompanied by impaired memory, poor concentration, emotional instability, and increased irritability

A

Post-traumatic Headache

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23
Q

Treatment for Post-traumatic headache

A

No special treatment required

Simple analgesics are appropriate first line therapy

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24
Q

Present in 50% of patients with chronic daily headaches

Chronic pain or complaints of headache unresponsive to medication

History reveals heavy use of analgesics

A

Medication Overuse headache

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25
Q

Treatment for Medication overuse headache

A

Withdraw medication (improvement in MONTHS, not days)

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26
Q

Percentage of the population will have at least one seizure

A

5-10%

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27
Q

What age is the highest occurrence for seizures?

A

Early childhood and late adulthood

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28
Q

Recurrent UNPROVOKED seizures

A

Epilepsy

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29
Q

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

A

Seizure

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30
Q

Seizures happen in young adults (18-35) from:

A

1) Trauma
2) Metabolic disorders
3) CNS infection

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31
Q

Seizures are commonly found in older adults (>35) from:

A

1) Cerebrovascular disease
2) Brain tumor
3) Metabolic disorders
4) Degenerative disorders
5) CNS Infection

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32
Q

Preictal phase can have an aura

Focal seizures with retained awareness

One side of the brain is affected

A

Partial seizures

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33
Q

One part of the brain is affected

Appears to be awake but not in contact with environment, does not respond normally

Patients will have no memory of what occurred during seizure

A

Focal Seizure with impaired awareness

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34
Q

Involves the entire brain

May or may not lead to alteration of consciousness

Most common type is Tonic-Clonic seizure (grand mal)

A

Generalized seizure

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35
Q

Seizure phase characterized by sudden muscle stiffening

A

Tonic

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36
Q

Seizure phase characterized by rhythmic jerking

A

Clonic

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37
Q

What phase of a seizure will tongue biting occur

A

Clonic

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38
Q

“Todd paralysis”

A

Weakness of the limbs

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39
Q

What phase of the seizure will patients have somnolence, confusion or headache that may occur for several hours

May present with “Todd Paralysis”

A

Postictal phase

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40
Q

What is used to diagnose a seizure?

A

Video EEG monitoring

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41
Q

What labs are needed after a seizure has occurred?

A

Electrolytes, LFT, CBC, Finger stick glucose

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42
Q

Treatment for active seizure

A

Diazepam 5mg IV/IM Q5-10 minutes (do no exceed 30mg)

MEDEVAC Immediately

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43
Q

Seizure lasting more than or equal to 5 minutes or 2+ seizures without recovery in-between is classified as?

A

Status Epilepticus (EMERGENCY)

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44
Q

Status Epilepticus treatment

A
  • Diazepam 5mg IV/IM
  • Valproic Acid 30mg/kg
  • Intubation
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45
Q

Not associated with abnormally excessive neuronal activity

Usually there is no postictal phase

Eyes are closed, usually episodes last longer than 2 minutes

A

Psychogenic nonepileptic seizure (PNES)

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46
Q

Treatment for Psychogenic nonepileptic seizure

A

Psychotherapy with cognitive behavioral therapy or interpersonal therapy

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47
Q

What are the two major branches from the carotid artery?

A

Anterior cerebral artery (ACA)

Middle cerebral artery (MCA)

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48
Q

Two vertebral arteries fuse to become what artery?

A

Basilar Artery

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49
Q

What are the branches of the Basilar artery?

A

Right and Left Posterior Cerebral Arteries (PCA)

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50
Q

What supplies the Cerebellum and Brainstem with blood?

A

Basilar Artery

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51
Q

What interconnects the internal carotid and vertebral basilar arteries?

A

Circle of Willis

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52
Q

An acute neurologic injury that occurs as the result of the interrupted blood flow to the brain

A

Stroke

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53
Q

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

A

Hemorrhagic stroke

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54
Q

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

A

Ischemic stroke

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55
Q

TIA and CVA are subtypes for what kind of stroke?

A

Ischemic stroke subtypes

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56
Q

What percentage of strokes are ischemic?

A

80%

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57
Q

The 3rd leading medical cause of death & 2nd most frequent cause of neurological morbidity

A

Stroke

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58
Q

Risk factors of stroke

A

HTN, atherosclerosis and age

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59
Q

Obstruction of an artery due to a blockage that forms in the vessel; often due to atherosclerosis

A

Thrombotic

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60
Q

Obstruction of an artery due to a blockage from DEBRIS that has broken off from a distal area

A

Embolic

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61
Q

Lack of brain blood flow from decreased systemic blood flow

A

Systemic Hypoperfusion

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62
Q

What lobe is affected when a patient is having a seizure with VISUAL phenomenons (colors, flashes, scotoma)?

A

Occipital lobe

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63
Q

What lobe is affected when a patient is having a seizure with PARESTHESIA (tingling, pain, temperature)?

A

Parietal lobe

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64
Q

What lobe is affected when a patient is having a seizure with hallucinations, epigastric rising, emotions, automatisms, Deja vu?

A

Temporal lobe

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65
Q

What lobe is affected when a patient is having a seizure with head and neck movements, Jacksonian march, posturing?

A

Frontal lobe

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66
Q

Episode of neurologic dysfunction caused by focal brain, spinal cord, or retinal ischemia, WITHOUT acute infarction?

A

Transient Ischemia Attack (TIA)

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67
Q

Episode of neurologic dysfunction caused by focal brain, spinal cord, or retinal ischemia, WITH acute infarction of central nervous system tissue?

A

Cerebral Vascular Accident (CVA)

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68
Q

What is the only way to determine the difference between a TIA and a CVA?

A

MRI

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69
Q

What clinical mnemonic is used for clinical manifestations of stroke?

A

FASTER

FACE drooping or numbness on one side of the face
ARMS - one limb being weaker or more numb than the other side
STABILITY - steadiness on feet
TALKING - slurring, garbled, nonsensical words, inability to respond normally
EYES - Visual changes
REACT - MEDEVAC immediately and note time of symptom onset

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70
Q

What intracranial hemorrhage generally has a gradual onset?

A

Intracerebral hemorrhage

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71
Q

What intracranial hemorrhage has a rapid response to pain, usually “the worst headache of my life”?

A

Subarachnoid hemorrhage

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72
Q

What number of patients with ICH have headache, vomiting, decreased level of consciousness?

A

About Half

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73
Q

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

A

Aneurysm

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74
Q

Imaging used for a stroke

A

Non-contrast CT

MRI

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75
Q

Labs/interventions needed for a suspected stroke patient

A
  • EKG
  • O2 Saturation
  • Fingerstick blood glucose (FBG)
  • CBC

MEDEVAC Immediately

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76
Q

At what Blood pressure levels would you think about lowering a stroke patients BP?

A

Systolic >220
Diastolic >120

In this case lower the blood pressure by 15% with a Beta Blocker

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77
Q

When can you give Aspirin to a suspected TIA patient?

A

Thorough Neuro exam reveals no abnormalities and with MO guidance

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78
Q

Where can you find the disposition “Cerebrovascular disease including stroke, transient ischemic attack, and vascular malformation is disqualifying”?

A

MANMED 15-106

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79
Q

Uncomfortable “creeping, crawling” sensation or “pins and needles feeling” in the limbs, especially the legs

Occurs during periods of inactivity (Evening)

A

Restless Leg Syndrome (RLS)

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80
Q

Patients with RLS will experience what symptom that may or may not awake them?

A

Periodic Limb Movements of Sleep (PLMS)

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81
Q

Causes of Restless Leg Syndrome

A

1) CNS and PNS abnormalities
2) Reduced iron stores
3) Alterations in dopaminergic systems
4) Circadian physiology
5) Neurotransmitter imbalances of glutamate and GABA

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82
Q

PNS abnormality in patients with restless leg syndrome

A

Hyperalgesia (Increased sensitivity of pain)

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83
Q

What level of sensation do patients with RLS experience?

A

Deep sensation

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84
Q

What can exacerbate RLS?

A

Antihistamines

Dopamine receptor antagonists (antinausea - metoclopramide)

Antidepressants like SSRIs and SNRIs

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85
Q

What can be the cause of a patients volitional movements like foot tapping, bouncing, leg rocking?

A

Lack of circadian rhythm pattern

86
Q

Definition of Akathisia

A

Intense desire to move

87
Q

How can you tell the difference between patients with RLS and nocturnal leg cramps?

A

Nocturnal leg cramps would have disorganized spasms of muscles associated with PALPABLE muscle contraction

88
Q

What levels or Serum Ferritin indicate low iron etiology?

A

<45 to 50mcg/L

89
Q

Treatment for RLS caused by low iron

A

Ferrous Sulfate 325mg three times daily for 3-6 months

Turns stool black & Very constipating, use a stool softener/laxative

90
Q

Patients that respond only to repeated vigorous stimuli

A

Stuporous patients

91
Q

Causes of a coma

A
  1. Seizures
  2. Hypothermia
  3. Metabolic disturbances
  4. Bilateral cerebral hemispheric dysfunction
  5. Disturbance of the brainstem reticular activating system
  6. Mass lesion involving one cerebral hemisphere that compresses the brainstem
92
Q

ABRUPT onset of coma could suggest

A

Subarachnoid hemorrhage

Brainstem stroke

Intracerebral hemorrhage

93
Q

Slow onset and progression of a comatose patient would suggest?

A

Structural or mass intracranial lesions

94
Q

Purposeful limb withdrawal to painful stimuli suggests that:

A

Sensory and motor pathways are intact

95
Q

Unilateral absence of responses to painful stimuli despite application of stimuli to both side of the body suggests:

A

Corticospinal lesion

96
Q

Bilateral absence of painful stimuli responses suggests:

A

Brainstem involvement

Bilateral pyramidal tract lesions

Psychogenic unresponsiveness

97
Q

Posturing may occur with lesions of the internal capsule and rostral cerebral peduncle

A

Decorticate (flexor)

98
Q

Posturing may occur with dysfunction or destruction of the midbrain and rostral pons

A

Decerebrate (extensor)

99
Q

Unilateral absence of corneal reflex implies damage to?

A

Ipsilateral Pons or a trigeminal nerve deficit

100
Q

Bilateral absence of corneal reflex can be seen with:

A

Large Pontine lesions or in deep pharmacologic coma

101
Q

Ipsilateral hemispheric lesion, contralateral pontine lesion, or ongoing seizures from the contralateral hemisphere could cause what kind of eye movements?

A

Conjugate deviation

102
Q

Deep breathing with alternate periods of apnea

Found in bi-hemispheric, diencephalic disease, or metabolic disease

A

Cheyne-Strokes Respiration

103
Q

Central neurogenic hyperventilation occurs with lesions in what part of the CNS?

A

Brainstem tegmentum

104
Q

Prominent end-inspiratory pauses

Suggest damage at the pontine level

A

Apneustic breathing

105
Q

Completely irregular pattern of breathing

Associated with lesions of lower pontine tegmentum and medulla

A

Atactic breathing

106
Q

Max score of GCS

A

15

107
Q

Lowest score of GCS

A

3

108
Q

What is the GCS verbal response graded for an intubated patient?

A

1T

109
Q

What GCS range suggests a minor brain injury?

A

13-15

110
Q

What GCS range suggests moderate brain injury?

A

9-12

111
Q

What GCS range suggests severe brain injury?

A

3-8

112
Q

Naloxone dosage

A

IV/IM/SubQ: 0.4 to 2mg (repeat doses every 2-3 minutes as needed)

113
Q

What should be considered when administering Naloxone to an opioid dependent patient?

A

Avoid acute withdrawal syndrome

Use lower doses like 0.1 to 0.2mg

114
Q

Sudden deceleration or acceleration of the head that leads to impact of the brain against the cranium

A

Concussion

115
Q

Mildest subset of traumatic brain injury (TBI)

May or may not lose consciousness

A

Concussion

116
Q

According to the CDC how many concussion cases were there in 2013?

A

2.8 million

117
Q

Leading cause of concussions

A

Falls (47%)

118
Q

Most accident prone to concussion

A

Young (15-34), male, and drunk

119
Q

How long would you observe and awaken a concussed patient?

A

Direct observation for 24 hours

Awaken every 2 hours

120
Q

Occurs when patient is symptomatic from the 1st concussion and sustains a 2nd concussion

A

Second Impact Syndrome (FATAL)

121
Q

Repeated concussions lead to cumulative neuropsychologic deficits.

-Behavior changes, personality changes, depressions, increased suicidality, Parkinsonism, speech and gait abnormalities

A

Chronic Traumatic Encephalopathy (CTE)

122
Q

Thin areas of the skull

A

1) Temporal region

2) Nasal Sinuses

123
Q

Battle sign, Raccoon eyes, hemotympanum, CSF rhinorrhea/otorrhea, cranial nerve deficits would indicate what type of skull fracture?

A

Basilar skull fracture

base of the skull fracture

124
Q

Bradycardia + Hypertension + Respiratory irregularity

A

Cushing’s Triad

125
Q

Suspected signs of increased ICP or brain herniation you should:

A

1) Secure and maintain an open airway
2) Elevate the head of the bed by 25-30 degrees
3) Ventilate for oxygenation and avoid hypercarbia

126
Q

What types of IV solutions do you NOT want to use when treating a patient with increased ICP?

A

1) Glucose containing
2) Hypotonic

(Avoid overhydration; more hydration = more pressure)

127
Q

What osmotic therapies can be used to reduce brain volume by drawing free water out of tissue and into circulation where it can then be excreted by the kidneys?

A
  1. Mannitol (osmotic diuretic) 1g/kg IV 15-20% solution

2. Hypertonic NaCl 7.5% 250 cc open bolus

128
Q

What should you consider as a last resort in an increased ICP patient?

A

Hyperventilation

129
Q

What are the types of Intracranial Hemorrhage (ICH) locations?

A

1) Epidural
2) Subdural
3) Subarachnoid
4) Intracerebral bleed

130
Q

ICH Classification:

  • 1-4% of head trauma cases
  • Highest among adolescents
  • Usually caused by traffic accidents, falls, and assaults
  • 75-95% have a skull fracture
A

Epidural hematoma

131
Q

What artery is commonly affected in an epidural hematoma?

A

Middle Meningeal Artery

132
Q

Treatment for epidural hematoma

A

Immediate neurosurgical consultation

-Operation likely required: Trephination, Burr hole

133
Q

ICH Classification:

  • 20% of severe head injuries
  • Elderly, ETOH abusers, people on anticoagulants
  • Can occur WITHOUT impact
  • 60% mortality rate
A

Subdural Hematoma

134
Q

Cranial Hematoma that:

  • Tears binding veins, drain from the brain to the Dural sinuses
  • May tamponade, GRADUAL progression
  • May be CHRONIC
A

Subdural Hematoma

135
Q

Acute subdural hematoma usually presents itself how many days after onset?

A

1 to 2 days

136
Q

Chronic subdural hematoma usually presents itself how many days after onset?

A

15 days

137
Q

ICH Classification:

  • Usually a rupture of a blood vessel (aneurysm) is involved
  • Trauma or a congenital anomaly
  • Bleeding is high pressure, combines with CSF causing severe pain
A

Subarachnoid Hematoma (SAH)

138
Q

What are some activities that increase risk for a SAH?

A

Drug use (cocaine, amphetamines), smoking, hypertension, alcohol use

139
Q

Checklist by MACE, used as soon as possible on a patient with suspected head injuries

A

IED

Injury

Evaluation 
   H:  Headaches or vomiting?
   E:  Ear ringing
   A:  Amnesia/loss of consciousness
   D:  Double vision or dizziness
   S:  Something feels wrong?

Distance: Service member within 50 meters of blast?

140
Q

Concussion that impacts the opposite side from rebound motion

A

Coup-Contrecoup

141
Q

Red flags for a concussion

A

Lack of recall or repetitious questioning

142
Q

Early symptoms of a concussion (minutes to hours)

A

Headache, dizziness, vertigo, imbalance, nausea, vomiting

143
Q

Delayed symptoms of a concussion (hours to days)

A

Mood/cognitive disturbance, light/noise sensitivity, sleep disturbance

144
Q

If seizures occur within what time frame it’s more related to TBI than epilepsy?

A

One week of head injury

145
Q

Complete a MACE exam within how many hours?

A

48 hours

146
Q

First concussion results in how many hours of rest or limited duty?

A

24 hours

147
Q

Second diagnosed concussion within a 12-month period results in how much rest?

A

7 days

148
Q

Three concussions in a 12-month period would result in:

A

Return to duty delayed until a RECURRENT concussion evaluation has been conducted

149
Q

1) Comprehensive Neurological Evaluation
2) Neuroimaging
3) Neuropsychological Assessment
4) Functional Assessment
5) Duty Status Determination

A

Recurrent Concussion Evaluation

150
Q
  • 40 million persons affected each year
  • MVA (47%), Falls (23%), Violence (14%). Sports (9%)
  • Largely affects young males
A

Spinal cord injuries

151
Q

What is the pathophysiology for severe spinal cord injuries?

A

Injury to vertebral column which leads to mechanical compression of the spinal cord

152
Q

What part of the spine would indicate poor respiratory function and may require intubation if necessary?

A

Cervical

153
Q

What medications could reduce spinal cord swelling?

A

Steroid use: Methylprednisolone 125mg IM/IV 4-6 hours prn

Consult with MO

154
Q

What mnemonic is used for C-spine X-ray?

A

NSAID

N: Neurological Deficit
S: Spinal Tenderness
A: Altered mental status
I: Intoxicated
D: Distracting injuries
155
Q

What disks are the most commonly affected in patients with Radiculopathy (pinched nerve)?

A

L5-S1 disks (90% of the time)

156
Q

Causes electric shock-like pain radiating down the posterior aspect of the leg often to below the knee

A

Sciatica

157
Q

What spinal herniation causes pain, paresthesia and sensory loss in the inguinal region

A

L1

158
Q

What spinal herniation location is classified as acute back pain that radiates around the anterior aspect of the thigh knee and may have weakness of hip flexion, knee extension and hip adduction?

A

L2, L3, L4

159
Q

What spinal herniation has pain radiating down the lateral aspect of the leg into the foot and decreased strength in foot dorsiflexion, toe extension, foot inversion, foot eversion?

A

L5

160
Q

Spinal herniation resulting in pain radiating down posterior aspect of leg into the foot, weakness in plantar flexion due to gastrocnemius

A

S1

161
Q

Presence or worsening of radicular pain with straight leg testing

A

Lasegue’s Sign

162
Q

Bundle of nerves that spread out from the bottom of the spinal cord

A

Cauda equina

163
Q

Causes of cauda equina syndrome

A

1) Herniated Disk
2) Infection or inflammation
3) Cancer
4) Spinal Stenosis

164
Q

Clinical presentation:

  • Pain, numbness, or tingling in the lower back and spreading down 1 or both legs
  • Leg weakness, “Foot drop” - unable to hold your foot up while walking
  • Problems with bladder or bowel control
  • Problems with sex
A

Cauda Equina Syndrome

165
Q

An entrapment neuropathy caused by compression of the median nerve between the carpal ligament and other structures within the carpal tunnel

A

Carpal Tunnel Syndrome

166
Q

Carpal Tunnel Syndrome is commonly seen in what types of patients?

A

Pregnancy

Diabetes mellitus

Rheumatoid arthritis

167
Q

Nerve that innervates thumb, pointer, middle and half of the ring finger

A

Median Nerve

168
Q

What is used for Carpal tunnel diagnosis?

A

Tinel or Phalen’s sign exacerbates neuropathic symptoms

Diagnosed with ultrasound and nerve conduction studies

169
Q

Carpal tunnel definitive treatment

A

Carpal tunnel release surgery

170
Q

An acute facial paralysis of a specific pattern, lower motor neuron disease affects CN VII

Rare (34 out of 100,000 people)

A

Bell’s Palsy

171
Q

What diseases are associated with Bell’s Palsy?

A

Herpes Simplex Virus

Lyme Disease

HIV

172
Q

Upward rolling of the eye on an attempted lid closure

A

Bell’s Phenomenon

173
Q

How would you differentiate a stroke from Bell’s Palsy?

A

In a stroke there is no forehead paralysis.

Intact forehead muscle tone suggests stroke.

174
Q

Moderate Bell’s Palsy treatment

A

Prednisone (steroid) 60 mg PO daily x 7 days, then 5 day taper

175
Q

Severe Bell’s Palsy treatment

A

Prednisone (steroid) 60 mg PO daily x 7 days, then 5 day taper

AND

Valacyclovir (antiviral) 1000mg 3 times daily for 7 days

176
Q

What percentage of Bell’s Palsy recover completely without treatment?

A

60%

177
Q

What percentage of Bell’s Palsy patients remain disfigured?

A

10%

178
Q

In a Bell’s Palsy, how would you treat them to avoid corneal ulcerations?

A

Artificial tears, lubricating ointment, and possibly an eye shield

179
Q

Inflammation of the coverings of the brain

May be viral or bacterial, spirochete, or fungal etiology

A

Meningitis

180
Q

Common bacterial causes of meningitis

A

1) Streptococcus pneumonia
2) Neisseria meningitides
3) Listeria monocytogenes

181
Q

Viral etiologies for meningitis

A
  • Enterovirus
  • Herpes simplex (13-36% of patients with genital herpes)
  • West Nile Virus
182
Q

Classic triad of acute meningitis

A

1) Fever
2) Nuchal Rigidity
3) Change in mental status

183
Q

Meningitis symptoms with a RASH would come from what etiology?

A

Neisseria meningitides

184
Q

How could you tell the difference between meningitis and encephalitis?

A

Encephalitis brain function is abnormal leading to altered mental status, motor and sensory deficits, altered behavior, speech disorders

Meningitis, cerebral function is normal

185
Q

Spontaneous flexion of hips during flexion of neck

A

Brudzinski sign

186
Q

Inability or reluctance to allow full extension of knee when hip is flexed at 90 degrees

A

Kernig sign

187
Q

Treatment for bacterial meningitis

A

Antibiotic that crosses the blood-brain barrier

  • Ceftriaxone (Rocephin) 2g IV Q12Hr
  • Vancomycin

Dexamethasone 0.15mg/kg IV Q6hr (decreases inflammation)

188
Q

Meningitis prophylaxis for exposed crew

A
  • Ciprofloxacin (500mg PO x 1)

- Mask patients and medical personnel in close proximity

189
Q

Three categories of Chronic Pain

A

1) Nociceptive pain
2) Neuropathic pain
3) Centralized pain

190
Q

Pain caused by stimuli that threaten or result in bodily tissue damage

A

Nociceptive pain

191
Q

Pain resulting from maladaptive response to damage or pathology of the somatosensory nervous system

Can occur in absence of active stimuli or as exaggerated response to minor or moderate stimuli

A

Neuropathic pain

192
Q

Reduced ability of the CNS to diminish responses to peripheral stimuli

A

Centralized pain

193
Q

An acutely painful condition that persists beyond the usually expected 6-12 week time course for healing

A

Chronic pain

194
Q

Initial treatment for chronic pain management

A

Non-pharmacologic therapies

  • Home exercise programs
  • Physical therapy
195
Q

Medications that inhibit descending pain modulation (Neuropathic pain treatment)

A

Gabapentin

TCA’s

SNRI’s

196
Q

How many stages are there for NREM?

A

THREE

1) Beginning sleep cycle
2) Become less aware (people spend 50% in this stage)
3) Deepest sleep stage, muscles relax, delta wave sleep

197
Q

Dreams occur in this stage and brain is more active, eyes move rapidly

“Paradoxical sleep”

A

REM

198
Q

How many REM periods are there every night and how long in total?

A

4-5 REM Periods, make up 1.5 to 2 hours

199
Q

When does the first REM period start?

A

80-120 minutes after onset of sleep

200
Q

What is impaired by loss of sleep?

A

Creativity and rapidity of response to unfamiliar situations

201
Q

How do you diagnose insomnia?

A
  1. Chronic diagnoses established by history

2. Sleep history for 1 week

202
Q

Short term insomnia (less than once a month in duration) usually is caused by?

A

Psychologic or physiologic stress

203
Q

How should chronic insomnia be treated?

A

Psychological sleep referral for cognitive behavior therapy

204
Q

What are medications that can help with insomnia?

A

Melatonin

Trazodone

Vistaril (hydroxyzine)

Diphenhydramine

205
Q

Sensation of motion when there is no motion or an exaggerated sense of motion in response to movement

A

Vertigo

206
Q

Etiologies of peripheral vertigo

A

BPPV

Herpes Zoster

Otitis Media

Aminoglycoside toxicity

207
Q

Etiologies of central vertigo

A

Brainstem ischemia

Multiple sclerosis

Vestibular migraine

208
Q

Quickly lowering the patient to the supine position with the head extending over the edge and placed 30 degrees lower than the body, turning the head left or right

A

Dix-Hallpike Testing

209
Q

Patients with benign paroxysmal positioning vertigo (BPPV) will elicit what response after a Dix-Hallpike test?

A

Delayed onset (~10 seconds) of fatigable nystagmus

210
Q

If no nystagmus from a Dix-Hallpike test, indicates what?

A

CNS Disease

211
Q

Treatment of vertigo

A

Anti-vertigo:

  • Meclizine 25-50mg q 6-12 hours
  • Diazepam 1mg PO q 12 hours

Antiemetic:

  • Ondansetron 4mg PO/IV q 8 hours
  • Promethazine 12.5 to 25mg every 4-6 hours

Neuro (7 decks)

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