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Urgent Care Guide > Neuro 1 > Flashcards

Neuro 1 Flashcards

1
Q

ischemic stroke - clinical pres
5

A
  1. lateralized weakness
  2. +/- numbness of face or extremity
  3. aphasia
  4. dysarthria
  5. hemianopia
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2
Q

hemorrhagic stroke - clinical pres
4

A
  1. sudden onset of severe HA
  2. NV
  3. elevated BP
  4. neuro deficits
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3
Q

consider posterior circulation stroke if patient presents with
3

A
  1. dizziness
  2. NV
  3. ataxia
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4
Q

stroke - assess for patients what

A

LNW time

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5
Q

stroke - tPA window

A

3-4.5 hours of LNW

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6
Q

stroke - assess for what additional history findings and symptom
3 (sign, use, dx)

A
  1. fever
  2. IV drug use
  3. infective endocarditis
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7
Q

stroke - PE
1

A

comprehensive neuro exam

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8
Q

stroke - img/testing
2

A

do not delay transfer in favor of imaging or testing
POC glucose

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9
Q

stroke - DD
6

A
  1. vertigo
  2. migraine
  3. seizures
  4. electrolyte abnormalities
  5. medication or drug toxicity
  6. infection
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10
Q

stroke - tx and disposition
3 (obtain, call, do not)

A
  1. obtain hx and perform exam rapidly
  2. call EMS to transfer to nearest stroke center
  3. do not lower BP in OP setting
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11
Q

tension headache - clinical pres
6

A
  1. mild to moderate intensity
  2. non pulsating
  3. non exertional
  4. “pressure” or “tightening”
  5. bilateral
  6. neck pain
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12
Q

cluster headache - clinical pres
8

A
  1. unilateral
  2. severe HA
  3. may radiate to jaw or neck
  4. concomitant lacrimation
  5. recurring
  6. typically in young adult males
  7. typically resolves in about 2 hours
  8. no aura or NA
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13
Q

migraine headache - clinical pres
10

A
  1. often unilateral
  2. nausea
  3. photosensitivity/noise sensitivity
  4. pulsatile in nature
  5. exacerbated by physical activity
  6. prodrome/aura
  7. flashing lights
  8. depression/anhedonia
  9. fatigue
  10. irritability
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14
Q

headache - non pulsating, bilateral, pressure, neck pain

A

tension

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15
Q

headache - unilateral, radiates, lacrimation

A

cluster

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16
Q

headache - unilateral, photosensitivity, irritable

A

migraine

17
Q

tension HA - PE findings
2

A
  1. normal neuro exam
  2. neck tenderness/spasm
18
Q

cluster HA - PE findings
4

A
  1. unilateral lacrimation and injection
  2. nasal congestion
  3. pallor or flushing may be present
  4. restlessness/pacing
19
Q

migraine HA - PE findings
1

A

neuro exam normal although some may cause neurological sx

20
Q

headache - img/testing

A

none usually if presentation is consistent w/ prior HAs

21
Q

headache - can’t miss DD
6

A
  1. subarachnoid hemorrhage - worst HA of your life, sudden onset
  2. stroke - new neuro sx
  3. meningitis - fever and nuchal rigidity
  4. cavernous sinus thrombosis (severe HA, bulging eyes, vision changes, drooping eyelid, fever and more - recent sinusitis or surgery)
  5. giant cell arteritis - older patients, usually female, jaw claudication (jaw pain or fatigue when chewing) and visual symptoms
  6. malignancy - new neuro sx, new onset sz
22
Q

general HA/migraine tx
1 first line always

A
  1. analgesics
23
Q

HA - NSAIDs should be use in what frequency a month

A

14 days of less a month

24
Q

migraine tx

A

1st line - NSAIDs then Acetaminophen
If not helping - triptans I.e eletriptan 40 mg PO. If symptoms persist or return, may repeat dose after ≥2 hours. Maximum: 40 mg/dose; 80 mg per 24 hours

25
Q

general HA/migraine - analgesic options
3

A
  1. acetaminophen 975 mg PO
  2. ibuprofen 400 mg PO
  3. ketoralac 15 mg IM or IV (off label)
26
Q

cluster headache - tx
2

A
  1. oxygen first line tx - non rebreather mask for 15 mins
  2. sumatriptan 6 mg SQ (6 mg is max dose in one sitting; can repeat dose in 1 hour, usually same mg as first dose; max dose is 12 mg/24 hours
27
Q

cluster HA - sumatriptan, caution use in who
2

A

those with CAD or HTN

28
Q

headache - when to refer to ER
2

A
  1. any can’t miss dx
  2. HA associated with change in mental status
29
Q

Tension type HA tx

A

First line is nsaids
For those unresponsive to or unable to take initial options, diclofenac (25 to 100 mg) and ketoprofen (25 to 50 mg) are potential alternatives. More data Available on ketoprofen, try 25 mg q6h, max dose 300 mg/ day. Both NSAIDs. Caution use in CABG, cardia, patients

Urgent Care Guide (38 decks)

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