Neuro Flashcards
What are the red flag/warning signs for neuro?
-“thunderclap” headache: age 50, “worst HA of my life> subarachnoid hemorrhage
-atypical presentation of patients unusual headache> stroke
-fever, stiff neck, > meningitis
-exacerbated by sneezing, coughing, tumor
What is vertigo?
a “spinning sensation”
Vestibular disease from peripheral causes in inner ear
-Labyrinthitis, Meniere’s Disease, benign positional vertigo
What are vertigo associated sx?
double vision, problems with gait/balance
What are the causes of transient loc?
-neurocardiogenic or vasovagal syncope
-orthostatic hypertension
-cardiac disease ( v tach, sinus brady)
-stroke
-subarachnoid hemorrhage
What are the 5 components of the mental status exam?
- appearance and behavior
- speech and language
- mood
- thoughts and perceptions
- cognitive function
How do you escalate the stimulus in a patient that is not awake and alert?
speak to the patient by name and in a loud voice
shake patient gently
Define alert
opens eyes, looks at you, responds fully and appropriatley to stimulu
Lethargy
Speak to the patient in a loud voice
Will appear drowsy, but will open eyes, look at you, respond to questions then fall back to sleep
Obtunded
Shake the patient gently
Opens eyes, looks at you, but responds slowly and is somewhat confused.
Stupor
Apply painful stimuli
Arouses only after painful stimuli, verbal responses slow or absent, lapse into states when stimuli ceases
Coma
Apply repeated painful stimuli
Remains unarousable with eyes closed
Dysarthria
defective articulation (slurring)
Aphasia
disorder of pronouncing or understanding speech
Broca’s (expressive) Aphasia
Nonfluent, slow, few words, laborious effort. Inflection, articulation impaired.
post inferior frontal lobe
Wernicke’s (receptive) Aphasia
Fluent, rapid, voluble, effortless. Inflection, tone good; lack meaning
W=WORDS
post sup temporal lobe
How do you test for aphasia?
Word comprehension (point to your nose)
Repetition (repeat after me…)
Naming (ask pt to name objects)
Reading comprehension (read paragraph out loud)
Writing (write a sentence)
Fluency
Rate, flow, melody of speech and the content and use of words
Paraphasias
: malformed “I write with a den”, wrong “I write with a bar”, or invented “ I write with a dar”
In major depressive episode, at least 5 of the symptoms (including one of the first two) must be present in the _________. The patient must present _______ change in persons behavior.
same two week period. acute
What characterizes a major depressive episode?
- *Depressed mood most of the day, nearly every day
- *Markedly diminished interest or pleasure in almost all activities most of the day, nearly every day
- Significant weight gain/loss
- Insomnia/hypersomnia
- Psychomotor agitation or retardation
In a manic episode, a distinct period of abnormality and persistently elevated, expansive or irritable mood must be present for at least ______. During that one week, _____ symptoms msut be demonstrated persistently
one week, 3
What characterizes a manic episode?
- Inflated self esteem or grandiosity
- Decreased need for sleep
- More talkative than usual/pressure to keep talking
- Flight of ideas/racing thoughts
- Distractibility
- Increased goal directed activity (professionally, socially, scholastically, sexually…)
- Excessive involvement in pleasurable high risk activities (shopping sprees, foolish business ventures, sexual indiscretions)
A mixed episode meets criteria of both ________ and _____ episodes. These must last at least ______ week.
major depressive, manic
1
Hypomanic Episode
Resemble those of manic episode but are less impairing, shorter duration (~4 days)
Dysthymic Disorder
-Depressed mood/symptoms for most of the day for over at least 2 YEARS
-Freedom from symptoms lasts no longer than 2 months at a time
Cyclothymic Episode
-Numerous periods of hypomanic and depressive symptoms that last for at least 2 YEARS
-Freedom from symptoms lasts no longer than 2 months at a time
Define circumstantiality
characterized by indirections and delay in reaching the point
Define derailment
shifting between unrelated subjects without knowing they are unrelated
Define flight of ideas
continuous flow of accelerated speech with abrupt topic changes
Define incoherence
speech is incomprehensible because of illogic
Define blocking
sudden interruptions of speech in midsentence before idea completed
Define neoologisms
invented or distorted words with idiosyncratic meaning
Define confabulation
fabrications of facts or events
Define perservation
persistent repetition of words or ideas
Define echolalia
repetition of words or phrases of others
Define clanging
speech in which a person chooses a word on the basis of sound rather than meaning. “look at my eyes and nose, wise eyes and rosy nose”
Compulsions
repetitive behaviors or mental acts that drive pt to prevent future unrealistic act
Obsession
recurrent, uncontrollable thoughts, images, impulses
Phobias
persistent irrational fears accompanied by desire to avoid the stimulus
Feelings of unreality
a sense that things in the environment are strange, unreal, or remote
Anxieties
apprehensions, fears, tensions, or uneasiness that may be focused or free floating
Feelings of depersonalization
a sense that ones self is different, changed, or unreal or has lost identity or has become detached from ones mind or body
Delusions
false, fixed personal beliefs that are not shared by other members of the persons culture
1. delusions of persecution
2. of grandeur
3. of jealousy
4. of reference
5. of being controlled
6. somatic delusions- disease
7. systematized delusions- 1 delusion with multiple elaborations
illusions
misinterpretation of real external stimuli
Hallucinations
subjective sensory perceptions in the absence of relevant external stimuli. The person may not recognize them as false, can be auditory, visual, olfactory, guastatory, tactile, somatic
Insight
Looking in.
Awareness that symptoms or behaviors are normal or abnormal
“What brings you to the hospital?”
Judgment
Looking out.
Process of comparing and evaluation alternative when deciding on a course of actions
“How do you plan to get help after leaving the hospital?”
Orientation
awareness of personal identity, place and time which requires both memory and attention
- Time: time of day, day of the week, month, season, date and year
- Place: patient’s current location, city, state
- Person: patients own name, names of relatives
Attention
ability to focus or concentrate over time on a particular stimulus or activity
Digit Span
Recite a series of digits, 2 at a time at the rate of one per second. Ask the patient to repeat them back to you. Then try a series of 3, 4, 5….
Then starting with series of 2, ask them to recall them backwards
Use number patterns that are familiar to you (zip code)
Normal: correctly repeat 5 digits forwards and 4 backwards
Serial 7s
“Starting from 100, subtract 7, and keep subtracting 7”
Note effort and speed
Normal: complete serial 7s in 90 seconds, fewer than 4 errors
If pt cannot do, try serial 3s or just to count backwards
Spelling Backward
Can substitute for serial 7s. Say a 5 letter word, spell it, then and ask the patient to spell it backwards
W-O-R-L-D
Remote Memory
Inquire about patient’s birthday, anniversaries, names of schools attended, career, or past historical events
Preserved in early dementia
Abstract Thinking: Test in 2 ways
- Proverbs: Ask patient what they mean
Don’t count your chickens before they are hatched
The squeaky wheel gets the grease - Similarities: ask how the following are alike
An orange and an apple
A piano and a violin
What are stroke warning signs
“FAST”
1. face drooping
2. arm weakness
3. speech difficulty
4. time to call 911
-numb/ting
-confusion/trouble understanding
-trouble seeing in one or both eyes
-trouble walking, dizziness, loss of balance or coordination
-severe HA with no known cause
What are modifiable risks for strokes?
Hypertension
Smoking
Dyslipidemia
Diabetes
Weight/Diet
Physical Inactivity
Alcohol Use
Control of A.Fib, Carotid Artery Disease, Sleep Apnea
Diabetic Peripheral Neuropathy
Elevated serum glucose damages blood vessels that supply nerves, causing nerve damage
Maintain optimal glycemic control
Examine feet regularly for neuropathy (pinprick sensation, ankle reflex, vibratory perception, and plantar light touch sensation)
Herpes Zoster Vaccine
Reactivation of latent varicella
Shingles
Painful unilateral vesicles along a single dermatome
25% experience complications post infection
Post-herpetic neuralgia
One time vaccination for adults >60 years
