neuro

Question 1

Difference between dementia and delirium

Answer 1

Chronic vs. acute

Delirium cannot shift focus

Question 2

3 most common causes of dementia

Answer 2

Alzheimer’s disease, vascular dementia (infarcts/HTN/tobacco), Lewy body dementia

Question 3

Treatment for cluster headaches

Answer 3

Oxygen; prevention with oral glucocorticoids

Question 4

Treatment for tension headaches

Answer 4

ASA, Tylenol, NSAID, behavioral changes

Question 5

Danger symptoms with headaches

Answer 5

SNOOP
Systemic symptoms (fever, wt. loss, immunosuppressed, bleed)
Neurologic S/S (impaired LOC, nuchal rigidity, papiledema)
Onset (thunderclap, during exertion i.e. inc ICP)
Onset- age (if 1st HA >50 or < 5 = secondary cause)
Previous HA history

Question 6

Hyperactive delirium example

Answer 6

delirium tremens

Question 7

Hypoactive delirium example

Answer 7

opiate intoxication

Question 8

If suspected seizure, what lab show you draw?

Answer 8

Serum Prolactin - rises 2-3 times above normal for 10-60 minutes following seizure

Question 9

Medications regimen during Status Epilepticus

Answer 9

Lorazepam .1-.15 mg/kg over 1-2 minutes
Valproate 25 mg/kg (in patients taking valproate who are possibly sub therapeutic)
Fosphenytoin 20 mg/kg over 150 mg/min
Phenytoin 20 mg/kg over 50 mg/min
Phenobarbital 20 mg/kg over 60 mg/min
Last - propofol, midazolam, or pentobarbital

Question 10

Brudzinski’s sign

Answer 10

Sign for bacterial meningitis
Pt lay supine, flex neck so chin to chest
Positive if knees raise and flex upwards

Question 11

Kernig’s sign

Answer 11

Sign for bacterial meningitis
Pt lay supine, take one leg, one hand on heel and one on knee. Raise straight up
Positive if causing spasm/pain in hamstring

Question 12

Guillain barre is most commonly associated with..

Answer 12

Campulobacter jejuni enteritis (water contaminated by animals or unpasterized milk)

Question 13

Most common manifestation with Myasthenia Gravis

Answer 13

Ptosis (Ocular weakness)
Can do Tensilon test (edrophonium) medication that decreases ocular/facial twitching when lightly tapped around the eye or
ice pack test - motor nerve function increases with cold

Question 14

Most common cause of delirium in the hospital

Answer 14

Infection

Question 15

Tension HA definition

Answer 15

Last 30 min-7 days
pressing, nonpulsatile pain
usually bilateral, mild to moderate pain
Female: male 5:4

Question 16

Migraine without aura

Answer 16

4-72 hours
unilateral
pulsating, mod to severe pain
female: male 3:1
first line abortive therapy is triptans (contraindicated in CAD and uncontrolled HTN)

Question 17

Cluster HA

Answer 17

usually brief, several times a day and occur several weeks to months then disappear for months to years
Pain behind the eye, lacrimation, conjunctival injection, ptosis and nasal stuffiness

Question 18

Most important component of an ischemic CVA

Answer 18

Time, >3 hours prior to presentation, patient is unable to receive thrombolytics

Question 19

Gullain-Barre Syndrome

Answer 19

caused by demyleniation of ascending peripheral nerves resulting in progressive, symmetrical paralysis
Begins in lower extremities and progresses upward

Question 20

Autonomic dyreflexia

Answer 20

cause: traumatic injury above T6
Symptoms: exaggerated autonomic responses to stimulus; diaphoresis and flushing above the injury, chills and vasoconstriction below injury, HTN, bradycardia, HA, nausea

Question 21

Brown-Sequard’s Syndrome

Answer 21

Cause: penetrating trauma to spinal cord
Symptoms: ipsalateral motor disturbance and proprioception; contralateral loss of pain and temp appreciation

Question 22

Central Cord Syndrome

Answer 22

Cause: hyperextension injury of cervical spinal cord
Symptoms: upper and lower extremity weakness (more deficits in uppers) with varying degrees of sensory loss; impaired pain, temp, light touch and position sense below level of injury

Question 23

Myasthenia Gravis

Answer 23

autoimmune disorder characterized by profound muscle weakness
Edrophium (tensilon) administration shows profound improvement in symptoms and is diagnostic

Question 24

Cranial Nerve I-IV

Answer 24

I - Olfactory (S) ability to identify familiar aromatic odors, one naris at a time with eyes closed

II - Optic (S) Test vision with Snellen chart and Rosenbaum chart.

III - Oculomotor (M) visual fields

IV - Trochlear (M) Inspect eyelids for drooping

Question 25

Cranial Nerve V-VIII

Answer 25

V - Trigeminal (B) Inspect face for muscle atrophy and tremors.
Palpate jaw muscles for tone and strength. Test superficial pain and touch sensation in each branch (test temperature sensation if there are unexpected findings to pain or touch). Test corneal reflex.

VI - Abducens (M) Inspect pupils’ size for equality and their direct and consensual response to light and accommodation. Test extraocular eye movements.

VII - Facial (B) Inspect symmetry of facial features with various expressions (e.g., smile, frown, puffed cheeks, wrinkled forehead).
Test ability to identify sweet and salty tastes on each side of tongue.

VIII - Acoustic (S) Test sense of hearing with whisper screening tests or by audiometry. Compare bone and air conduction of sound. Test for lateralization of sound.

Question 26

Cranial Nerve IX-XII

Answer 26

IX - Glossopharyngeal (B) Test ability to identify sour and bitter tastes. Test gag reflex and ability to swallow.

X - Vagus (B) Inspect palate and uvula for symmetry with speech sounds and gag reflex. Observe for swallowing difficulty. Evaluate quality of guttural speech sounds

XI - Spinal accessory (M) Test trapezius muscle strength (shrug shoulders against resistance). Test sternocleidomastoid muscle strength (turn head to each side against resistance).

XII - Hypoglossal (M) nspect tongue in mouth and while protruded for symmetry, tremors, and atrophy. Inspect tongue movement toward nose and chin. Test tongue strength with index finger when tongue is pressed against cheek. Evaluate quality of lingual speech sounds (l, t, d, n).

Question 27

Epidural bleed

Answer 27

arterial bleed within inner table of skull and dura (epidural space); typically caused by damage to middle meningeal artery
Mean age 20-30; unusual > 50
loss of consciousness, followed by a lucid interval, then rapid deterioration
Classic late signs: dilated pupil ipsilateral to EDH and contralateral hemiparesis
Rapid, competent decompression of EDH can make significant difference in outcome

Question 28

Subdural hematome

Answer 28

o Veins coursing through the subdural space can stretch and tear, causing a bleed. Most common type of intracranial bleeding.
o Acute - appears within 14 days of injury
o Subacute - appears within 20 days of injury
o Chronic - after weeks or months of the initial injury. May wall themselves off; occur more often in the elderly
o Mean age is 31-47 and most common cause is MVA for those that initially present comatose
o Overall mortality is 40-60%; this may be high due to the fact that these bleeds are typically associated with other brain injuries.
o Blood itself may also have a toxic effect on the underlying cortex.

Question 29

Subarachnoid hemorrhage

Answer 29

o Bleeding within the CSF-filled subarachnoid space.
o Trauma is the most common cause of SAH; spontaneous SAH is most commonly cause by ruptured aneurysms
o Is commonly associated with other intracranial injuries; can be a marker for severity of primary injury. Amount of blood can predict the development and progression of intraparenchymal contusions

Question 30

Cerebral perfusion pressure

Answer 30

• CPP = MAP-ICP
o MAP = 2(Diastolic BP) + SBP /3
• Normal CPP is 60-80 mm Hg