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my NPLEX II > Nervous System > Flashcards

Nervous System Flashcards

1
Q

what are common signs and symptoms of brain neoplasms

A
  • gradual onset
  • focal neuro defects
  • seizures
  • headache
  • confusion
  • n/v, papilledema
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2
Q

diagnostic study of choice for brain neoplasm

A

MRI with contrast

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3
Q

% of brain neoplasms that are metastasis from other primary sites

A

1/2

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4
Q

what primary cancer sites metastasis to the brain?

A

lung, breast, melanoma, colon

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5
Q

which inherited disease increase risk of brain tumors?

A

neurofibromatosis, tuberous sclerosis, multiple endocrine neoplasia type 1
retinoblastoma

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6
Q

most common type of brain neoplasm?

A

gliomas in the brain or spinal cord

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7
Q

List the major subtypes of gliomas

A

astrocytoma (35%) oligodendeogliomas, ependymomas (2%)

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8
Q

gliomas are more common in

A

males

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9
Q

what are the most common brain neoplasms in women?

A

Meningiomas (20%) schwannomas

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10
Q

what are the common signs and symptoms of acoustic neuroma? (vestibular schwannoma)

A 
hearing loss (cochlear nerve) 
imbalance ( vestibular nerve)
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11
Q

diagnostic imaging for acoustic neuroma?

A

MRI with gadolinium enhancement

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12
Q

what causes botulism?

A

Clostridium botulinum: neurotoxin

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13
Q

what are the 2 routes to be infected with botulism?

A
  1. foodborne from canned food or raw honey

2. wound from trauma or IV drug use

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14
Q

adult prodromal signs & sxs of foodborne botulism?

A

GI: N/V, dysphagia, dry mouth
neuro: sudden onset diplopia, dilated, and fixed pupils

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15
Q

wound-borne vs foodborne botulism?

A

no GI symptoms in wound botulism

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16
Q

how fast does botulism progress?

A

12-36 hours and progress quickly over 1-2 days

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17
Q

how would you describe the paralysis in botulism?

A

bilateral DESCENDING flaccid paralysis

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18
Q

what are the SENSORY deficits associated with botulism?

A

blurred vision

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19
Q

how high is the fever in botulism?

A

no fever

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20
Q

what is a likely sequelae of botulism?

A

respiratory arrest and/or death

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21
Q

if you have recovered from botulism, will you have future immunity?

A

NO

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22
Q

what is an inflammation of the brain called?

A

encephalitis

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23
Q

what usually causes encephalitis?

A
  1. secondary to virus : HSV or west nile
  2. bacterial: mycoplasma pneumonia
  3. fungal
  4. autoimmune SLE or Hashimotos
  5. trauma
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24
Q

signs and sxs of encephalitis

A 
fever 
altered conciousness 
personality changes, confusion 
seizures 
stiff neck 
n/v
focal neurological deficits 
rash
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25
Q

Diagnostic test for encephalitis

26
Q

ddx for encephalitis

A
  • meningitis (can coexist with encephalitis)
  • lyme
  • syphilis
  • CVA
  • drug or alcohol intoxication
  • intracranial tumor
27
Q

RAPIDLY PROGRESSIVE INFLAMMATORY DEMYELINATING POLYNEUROPATHY

A

guillan-barre

28
Q

what are common causes of Guillan barre syndrome

A
  1. post-viral 2-4 weeks or bacterial illness (2/3 cases) - resp most common and then GI
  2. post vaccination
  3. medication use: penicillin and anti-motility drug
29
Q

bacteria associated with GBS

30
Q

signs and symptoms of GBS

A
    • progressive ASCENDING symmetric muscle weakness starting in the fingers and lower extremities
      2. parasthesias, numbness
      3. pain: shoulder girdle, back, butt, thighs
      4. autonomic changes
      5. SOB, resp
      6. bladder/bowel change
31
Q

what do you find in CSF analysis of GBS?

A

INCREASE CSF protein

normal WBC

32
Q

what are stages of progession with GBS

A

3rd week= greatest weakness
recovery in 3-4 weeks after progression ceases
30% HAVE SXS FOR 3 years

33
Q

Causative agents of bacterial meningitis?

A
  • neisseria meningitides
  • haemophilus influenza B
  • streptococcus pneumonia (*80%)
34
Q

signs and sxs of bacterial meningitis

A 
rapid onset f/c
stiff neck 
headache 
photophobia 
confusion 
seizures
35
Q

how rapid is onset of bacterial meningitis?

A

very rapid

36
Q

sequelae of bacterial meningitis

A

seizures
deafness
death

37
Q

when do you see a petechial rash?

A

MENINGOCOCCAL

meningitis

38
Q

what are the viral agents that cause viral meningitis

A

ENTEROviruses: coxsackie or echovirus (85%)
mumps
hsv 1 and 2
HIV

39
Q

signs and sxs of viral meningitis

A 
fever
headache 
stiff neck 
altered mental status 
milk photophobia
40
Q

which type of meningitis can have spontaneous recovery?

41
Q

2 positive physical exam signs for positive meningitis

A 
Brudzinskis sign (Severe neck stiffness causes a patient's hips and knees to flex when the neck is flexed.)
Kernigs Sign (Severe stiffness of the hamstrings causes an inability to straighten the leg when the hip is flexed to 90 degrees.)
42
Q

diagnostic technique to diagnose meningitis

A

CSF exam and culture

43
Q

what type of meningitis has low glucose in 60% of patients

44
Q

what type of meningitis has lymphocytes in the CSF

45
Q

ddx for meningitis

A 
ecephalitis 
brain abcess 
febrile seizures 
subarachnoid hemmorahge 
toxoplasmosis 
CVA / stroke
46
Q

how does herpes zoster most commonly present

A

painful unilateral vesicle eruption alone a single dermatome

47
Q

physical therapy modality helpful for herpes zoster

48
Q

what drug is primarily used to treat parkinsons disease can be used for herpes zoster

49
Q

sequelae of herpes zoster

A

post-herpatic neuralgia

50
Q

vaccination used to prevent herpes zoster

51
Q

common signs and symptoms of acute poliomyelitis

A

5-10% develop symptoms
3 presentations:
1: abortive- flu like
2. non-paralytic - (aseptic meningitis) 3-7 days of abortive + stiff neck and back
3. paralytic - features above plus ASYMMETRIC, FLACCID LOWER MOTOR NEURON WEAKNESS AND INTENSE MYALGIA

52
Q

common signs and symptoms of tetanus

A
  • sore throat with dysphagia
  • local muscle rigidity at site of entry
  • headache
  • lockjaw and risus sardonicus (sustained spasm of the facial muscles that appears to produce grinning)
    • NO FEVER**
  • muscle spasms and seizures
  • respiratory compromise
53
Q

tx for patient suspected of having tetanus

A

tetanus immunoglobulin immunization: diazepam IV: mag sulfate IV, and metranidazole

54
Q

risk factors associated with strokes

A 
advanced age 
diabetes 
hypertension
smoking 
AFIB 
anti-coagulant therapy
55
Q

defects caused by brainstem stroke

A

respiratory

heart rate

56
Q

what are 2 causes of inadequate perfusion of brain in a stroke

A

infarction or ischemia

hemorrhage

57
Q

what position do you put a stroke victim in

A

head and back 30 degree elevation to relieve intracranial pressure

58
Q

what effect does smoking have in women on oral contraceptives

A

increase risk of MI and hemorrage stroke

59
Q

what are some of side effects of HRT

A 
CV: stroke, MI 
migraine headaches 
breasts; fibrocystic and breast cancer 
GI: cholelithiasis, N/V
Uterus and ovaries : endometrial cancer, worsening of leimyomata
60
Q

what determines the types of defects seen with TIAS

A

the location of ischemia in the brain

61
Q

what are some of the symptoms of carotid artery deficit

A

ipsilateral blindness

contralateral hemiparesis with paresthesias

62
Q

what are some of the symptoms of vertebrobasilar deficit

A

vertigo - main
confusion
sudden sensorineural deafness
ataxia: falling to the side of the lesion

my NPLEX II (28 decks)

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