neuro Flashcards
mnemonic for cranial nerves
Oh- olfactory
oh-optic
oh- oculomotor
to - trochlear
touch - trigeminal
and - abducens
feel - facial
a - acoustic
girls - glossopharyngeal
vagina - vagus
so - spinal accessory
heavenly - hypoglossal
what crainal nerve moves the eyes and does pupillary constriction
CN III oculomotor
which cranial nerve opens eyelids and contrails pupils
CN III oculomotor
CN VI does what
abducens
lateral eye movement
which cranial nerve does hearing
CN VIII acoustic
what CN moves the tongue
CN XII hypoglossal
this CN shrugs the shoulders
CN XI spinal accessory
mnemonic for type of cranial nerves
S- some
s - say
M-marry
M-money
B-but
m- my
b-brother
s-says
b- big
b- bras
m- matter
m- most
hemiplegia is associated with what type of CVA
middle cerebral artery CVA
Mini-mental status exam
ORArL 2,3, RWD
O - orientation to place/time
R- recognition
A attention
r- recall
L- language
2- identify names of 2 objects
3 - follow 3 step command
R - reading
W- writing
D- drawing
what is max score of mine mental
30
no impairment 24-30
delirium/dementia 18-23 mild 0-17 severe
what is homonymous hemianopia
half vision on side of stroke
would you want the family in the room when you do the mini mental status exam
no
when is carotid endarterectomy indicated
symptomatic low risk surgical patients with 50-90% stenosis
asymptomatic patients with > 70-99 %
left side stroke may result in what
aphasia
dysarthria
difficulty reading/writing
pt has hip fracture, you note carotid bruit upon assessment with weakness and confusion. what do you order
carotid US
ipsilateral monocular blindness (amaurosis fugal)
on same side of stroke
what happens to motor impairment in a TIA ? CVA ?
paresthesia of contralateral arm, leg or face
hemiplegia on contralateral arm, leg or face
number one cause of heart failure
HTN
what you may see with right hemisphere CVA
right visual field changes
left hemiparesis
spatial disorientation
mtg for thrombotic stroke
fibrinolytic indicated within <3-4.5 hours
why is there an indication for nimodipine in setting where there are increased ICP
CCM - help counter vasospasm
CPP
cerebral perfusion pressure
MAP - ICP = CPP
indication for ICP monitoring
GCS < 8 + abnormal CT
GCS < 8 + normal CT and 2 of following: age >40, BP <90, abnormal motor posturing
why do we keep MAP 110-130 in CVA
to help decrease vasospasm
pt has no loss of consciousness and has tremors of right hand that precedes to entire arm - what do you dx
simple partial seizure
what is difference in simple partial seizure and complex partial
followed by impaired LOC
Types of generalized seizure
absence
tonic-clonic
what happens in absence seizure
sudden arrest of motor activity with a blank stare
Pt has a seizure and BG is <60 what do you order
100mg thiamine IV then 50ml of D50IV
initial therapy phase of seizure (5-20min)
IM midazolam 5-10mg
IV lorazepam may repeat once
IV diazepam may repeat once
Second therapy (20-40 minutes)
IV fosphenytoin
IV valproic acid
IV levetiracetam
Third phase (40-60) min
repeat second line OR
anesthetic doses (thiopental,midazolmpropofol , pentobarbital)
this is a disorder of reduction of the number of acetylcholine receptor sites
myasthenia gravis
when the bodys immune system attacks myelin
multiple sclerosis
30y/o female presents with ptosis *droop eyelid) extremity weakness and fatigue what do you suspect and test
myasthenia graves
antibodies to acetylcholine receptors
tx for MS flare up
steroids
s/s of MS
weakness
numbness
tingling or unsteadiness in a limb , may progress to all limbs
urinary urgency/hesitency
nystagmus
spastic paraparesis
syndrome usually preceded by viral infection and leads to progressive symmetrical ascending paralysis
guillain- barre syndrome
most specific test for MS diagnosis
MRI
CSF with bacterial meningitis
elevated pressure
elevated protein
decreased glucose
presence of WBC
mtg of bacterial meningitis
< 50 - Vanco + ceftriaxone
>50 - Vanco + ampicillin + ceftriaxone
Cushings triad
widening pulse pressure
decreased RR
decreased HR
pt is in and out of consciousness following head trauma; what do you ssupect
epidural hematoma expanding
positive kernels sign
pain and spasms of hamstring muscles in meningitis
postive brudzinskis sign
in meningits
legs flex at both the hips and knees in response to flexion of the head and neck to chest
CSF of viral meningitis
protein normal
glucose normal
Normal CPP
60-80
ICP normal
<20
complication of c4 injury or above
respiratory compromise
complication of t4-t6 injury
autonomic dysreflexia - emergency clinical condition caused by exaggerated autonomic response to stimulus -TX remove stimulus and antihypertensive
brown squared syndrome
damage to one half of sinal cord
ipsilateral upper motor neuron paralysis and loss of proprioception
contralateral loss of pain and temperature
TX MRI & steroids
cauda equina syndrome
compression of nerve roots
numbness in lower legs, feet or saddle region
TX MRI, steroids and sx
t6 or above compilation
neurogenic shock
patio of parkinsons
degenerative disorder or insufficient amounts of dopamine
medication mtg of parkinsons
-carbidopa-levodopa (increases dopamine)
-dopamine agonists -(mimic dopamine)
pramipexole
ropinirole
rotigotine
-MAO-B inhibitors(help prevent breakdown of dopamine)
selegiline
rasagiline
safinamide
tri of findings in all PD patients
parkinsons
-tremor
rigidity
bradykinesia
type of dementia that goes with PD
Lewy body dementia
number one cause of dementia
alzheimers
aphasia
difficulty with speech
raxia
inability to perform a previously learned task
agnosia
inability to recognize an object
medication used for all stages of alzheimers
donepezil (aricept)
mnemonic for alcohol use screening
C-cut down
A- annoyed by criticizing drinking
G- guilty about drinking
E- eye opener drink
drugs used to tx alzhiemrs
cholinesterase inhibitors
donepezil
galantamine
rivastigmine
NMDA - Namenda (mod-severe disease)
Cominationtion memantine and donepezil(moderate to severe disease)
