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Neuro Flashcards

1
Q

What are the red flag/warning signs for neuro?

A

-“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

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2
Q

What is vertigo?

A

a “spinning sensation”
Vestibular disease from peripheral causes in inner ear
-Labyrinthitis, Meniere’s Disease, benign positional vertigo

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3
Q

What are vertigo associated sx?

A

double vision, problems with gait/balance

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4
Q

What are the causes of transient loc?

A

-neurocardiogenic or vasovagal syncope
-orthostatic hypertension
-cardiac disease ( v tach, sinus brady)
-stroke
-subarachnoid hemorrhage

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5
Q

What are the 5 components of the mental status exam?

A
  1. appearance and behavior
  2. speech and language
  3. mood
  4. thoughts and perceptions
  5. cognitive function
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6
Q

How do you escalate the stimulus in a patient that is not awake and alert?

A

speak to the patient by name and in a loud voice
shake patient gently

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7
Q

Define alert

A

opens eyes, looks at you, responds fully and appropriatley to stimulu

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8
Q

Lethargy

A

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

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9
Q

Obtunded

A

Shake the patient gently

Opens eyes, looks at you, but responds slowly and is somewhat confused.

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10
Q

Stupor

A

Apply painful stimuli
Arouses only after painful stimuli, verbal responses slow or absent, lapse into states when stimuli ceases

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11
Q

Coma

A

Apply repeated painful stimuli
Remains unarousable with eyes closed

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12
Q

Dysarthria

A

defective articulation (slurring)

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13
Q

Aphasia

A

disorder of pronouncing or understanding speech

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14
Q

Broca’s (expressive) Aphasia

A

Nonfluent, slow, few words, laborious effort. Inflection, articulation impaired.
post inferior frontal lobe

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15
Q

Wernicke’s (receptive) Aphasia

A

Fluent, rapid, voluble, effortless. Inflection, tone good; lack meaning
W=WORDS
post sup temporal lobe

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16
Q

How do you test for aphasia?

A

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)

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17
Q

Fluency

A

Rate, flow, melody of speech and the content and use of words

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18
Q

Paraphasias

A

: malformed “I write with a den”, wrong “I write with a bar”, or invented “ I write with a dar”

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19
Q

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.

A

same two week period. acute

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20
Q

What characterizes a major depressive episode?

A
  1. *Depressed mood most of the day, nearly every day
  2. *Markedly diminished interest or pleasure in almost all activities most of the day, nearly every day
  3. Significant weight gain/loss
  4. Insomnia/hypersomnia
  5. Psychomotor agitation or retardation
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21
Q

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

A

one week, 3

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22
Q

What characterizes a manic episode?

A
  1. Inflated self esteem or grandiosity
  2. Decreased need for sleep
  3. More talkative than usual/pressure to keep talking
  4. Flight of ideas/racing thoughts
  5. Distractibility
  6. Increased goal directed activity (professionally, socially, scholastically, sexually…)
  7. Excessive involvement in pleasurable high risk activities (shopping sprees, foolish business ventures, sexual indiscretions)
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23
Q

A mixed episode meets criteria of both ________ and _____ episodes. These must last at least ______ week.

A

major depressive, manic
1

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24
Q

Hypomanic Episode

A

Resemble those of manic episode but are less impairing, shorter duration (~4 days)

25
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
26
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
27
Define circumstantiality
characterized by indirections and delay in reaching the point
28
Define derailment
shifting between unrelated subjects without knowing they are unrelated
29
Define flight of ideas
continuous flow of accelerated speech with abrupt topic changes
30
Define incoherence
speech is incomprehensible because of illogic
31
Define blocking
sudden interruptions of speech in midsentence before idea completed
32
Define neoologisms
invented or distorted words with idiosyncratic meaning
33
Define confabulation
fabrications of facts or events
34
Define perservation
persistent repetition of words or ideas
35
Define echolalia
repetition of words or phrases of others
36
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"
37
Compulsions
repetitive behaviors or mental acts that drive pt to prevent future unrealistic act
38
Obsession
recurrent, uncontrollable thoughts, images, impulses
39
Phobias
persistent irrational fears accompanied by desire to avoid the stimulus
40
Feelings of unreality
a sense that things in the environment are strange, unreal, or remote
41
Anxieties
apprehensions, fears, tensions, or uneasiness that may be focused or free floating
42
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
43
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
44
illusions
misinterpretation of real external stimuli
45
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
46
Insight
Looking in. Awareness that symptoms or behaviors are normal or abnormal “What brings you to the hospital?”
47
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?”
48
Orientation
awareness of personal identity, place and time which requires both memory and attention 1. Time: time of day, day of the week, month, season, date and year 2. Place: patient’s current location, city, state 3. Person: patients own name, names of relatives
49
Attention
ability to focus or concentrate over time on a particular stimulus or activity
50
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
51
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
52
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
53
Remote Memory
Inquire about patient’s birthday, anniversaries, names of schools attended, career, or past historical events Preserved in early dementia
54
Abstract Thinking: Test in 2 ways
1. Proverbs: Ask patient what they mean Don’t count your chickens before they are hatched The squeaky wheel gets the grease 2. Similarities: ask how the following are alike An orange and an apple A piano and a violin
55
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
56
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
57
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)
58
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

PCA (17 decks)

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