Nervous System

Question 1

damage to wernicke’s area results in…

Answer 1

word salad

Question 2

damage to wernicke’s results in…

Answer 2

wouldn’t be able to understand what someone is saying to you

Question 3

levels of the meninges (outer to inner)

Answer 3

dura mater
arachnoid mater
pia mater

Question 4

what should MAP be over to ensure good cerebral perfusion

Answer 4

MAP > 60 (for adults)

Question 5

normal ICP

Answer 5

5-15

Question 6

symptoms of increased ICP

Answer 6

headache
vomiting
mental status
posturing
eyes (pupillary changes, nystagmus)
speech
vital signs

Question 7

cushing’s triad

Answer 7

increased systolic, decreased diastolic
decreased heart rate
altered respirations

Question 8

what does cushing’s triad show

Answer 8

increased ICP, could lead to herniation

Question 9

what does decorticate posturing indicate

Answer 9

lesion above midbrain

Question 10

what does decebrate posturing indicate

Answer 10

can indicate brain herniation
*more serious!

Question 11

what is paresis

Answer 11

weakness in muscles
“incomplete paralysis”

Question 12

ataxia

Answer 12

poor muscle coordination

Question 13

dyspraxica

Answer 13

partial inability to perform purposeful or skilled motor acts

Question 14

apraxia

Answer 14

inability to perform purposeful or skilled motor acts

Question 15

what medication is rapid acting and will stop a seizure

Answer 15

lorazepam

Question 16

which benzo is short acting with rapid onset and 1-2 duration

Answer 16

midazolam

Question 17

which benzos are intermediate acting

Answer 17

alprazolam (6-12 hours)
clonazepam (18-50)
lorazepam (2-6 hours)

Question 18

long acting benzo

Answer 18

diazepam
onset is rapid, duration 20-50 hours

Question 19

therapeutic levels for phenytoin?

Answer 19

10-20 mcg/ml

Question 20

max daily dose of acetaminophen?

Answer 20

4g per day
for longer term use - 3g per day

Question 21

antidote for acetaminophen

Answer 21

acetylcysteine

Question 22

why is aspirin used in caution with peds patients

Answer 22

can cause reye’s syndrome if they have viral illness

Question 23

what is a open skull fracture

Answer 23

torn dura

Question 24

when is a closed skull fracture

Answer 24

dura is intact

Question 25

what is a basilar skull fracture

Answer 25

skull fracture at base of skull, where brain connects to spinal cord

Question 26

what are three signs of a basilar skull fracture

Answer 26

battle’s sign - bruising over mastoid process
raccoon eyes
CSF rhinorrhea - test with halo test

Question 27

should you insert an ng tube in a patient with a basilar skull fracture

Answer 27

no

Question 28

will CSF be positive or negative for glucose

Answer 28

positive

Question 29

are epidural hematomas arterial or venous bleeds

Answer 29

arterial which means they will be rapid
b/w dura mater and skull

Question 30

are subdural hematomas arterial or venous bleeds

Answer 30

venous which means they will be slower
b/w arachnoid and dura mater

Question 31

if injuries occur above T6, what should we monitor for

Answer 31

autonomic dysreflexia

Question 32

s/s of autonomic dysreflexia

Answer 32

sudden and severe hypertension
bradycardia
headache
nasal stuffiness
flushing
sweating
blurred vision
anxiety

Question 33

triggers for autonomic dysreflexia

Answer 33

restrictive clothing
dehydration
anxiety
broken bone
pressure ulcer
uti
blister
bladder
fecal impaction

Question 34

tx for autonomic dysreflexia

Answer 34

antihypertensive med
find cause and treat

Question 35

if a patient says they have the worst headache of their life, what might they have

Answer 35

hemorrhagic stroke

Question 36

what is a hemorrhagic stroke

Answer 36

vessel ruptures and bleeds into the brain
blood accumulates and increases pressure on the brain

Question 37

what is an ischemic stroke

Answer 37

blood flow to the brain is blocked by a blood clot

Question 38

difference between thrombotic and embolic stroke

Answer 38

thrombotic - blood clot in an artery going to the brain

embolic - clot that is formed elsewhere and travels in the bloodstream and clogs a blood vessel in or leading to the brain, sudden onset

Question 39

symptoms of stroke BEFAST

Answer 39

balance - dizziness, headache, loss of balance
eyes - blurry vision
face - face drooping
arms - arm or leg weakness
speech difficulty
time to call 911

Question 40

door to TPA

Answer 40

60 minutes

Question 41

4 signs of meningitis

Answer 41

nuchal rigidity
photophobia
kernig’s sign
brudzinski’s sign

Question 42

kernig’s sign

Answer 42

with patient place supine and hip flexed at 90 degrees, knee cannot be completely extended due to pain

Question 43

brudzinski’s sign

Answer 43

patient placed supine, passive flexion of neck causes involuntary flexion of knee and toes

Question 44

s/s of MS (two danishes)

Answer 44

tingling & numbnes
weakness
optic neuritis
dysdiadochokinesia - cannot perform rapid alternative movements
ataxia
nystagmus
intentional tremor
scanning speech
hypotonia
epilepsy, seizures
spasticity (muscle, bladder)

Question 45

what has descending vs ascending paralysis

Answer 45

ascending = guillain barre
descending = botulism toxin

Question 46

tensilon test

Answer 46

give patient tensilon (basically Ach that body is blocking)
if muscle strength is improved –> patient has myasthenia gravis
key assessment finding: eye lids perk up (usually ptosis)

Question 47

s/s of parkinsons’s TRAP

Answer 47

tremor
rigidity
akinesia (absence of movement)/ataxia (poor muscle control)
postural instability