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Urgent Care Guide > Neuro 3 > Flashcards

Neuro 3 Flashcards

1
Q

concussion definition
2

A
  1. mild TBI
  2. impaired brain function w/o hemorrhage or lesion
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2
Q

concussion - history

A

direct (blunt force) or indirect injury (acceleration/deceleration injury) to the head causing altered consciousness at the time of or after the inciting event

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3
Q

concussion - symptoms
8

A
  1. HA/dizziness/LOC
  2. NV
  3. visual disturbances (seeing stars, blurred vision)
  4. attention and concentration difficulties
  5. memory impairment
  6. sleep disturbances/fatigue
  7. depression/anxiety/irritability
  8. seizure
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4
Q

concussion - PE
3

A
  1. often normal
  2. comprehensive neuro exam - may have subtle impairments in cognitive function or altered gait
  3. consider Canadian CT rules (age >16) or PECARN score (specific to peds)
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5
Q

concussion - Canadian CT rule medium risk qualifications

A
  1. amnesia following injury
  2. dangerous mechanism (fall from >3 ft or >5 stairs; pedestrian struck by motor vehicle; ejected from motor vehicle)
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6
Q

concussion - img/testing

A

none usually needed

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7
Q

concussion - DD
4

A
  1. intracranial hemorrhage
  2. skull fx
  3. c spine injury
  4. migraine
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8
Q

concussion - initial tx

A

initial rest (mental and physical) for at least 24-48 hours, then graded return to routine including school, work and activities as tolerated

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9
Q

concussion - tx, limit what

A

screen time i.e. video games, TV, computer, phone

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10
Q

concussion - rx
2

A
  1. acetaminophen
  2. +/- antiemetics (zofran, metoclopramide/Reglan)
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11
Q

concussion - rx, avoid what meds

A

ASA and NSAIDs - d/t increased risk of bleeding

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12
Q

concussion - monitor for

A

persistent/worsening symptoms - headache, vomiting, seizures

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13
Q

concussion - f/u with who and why

A

PCP for f/u required to resume normal activity

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14
Q

concussion - when to refer to ER

A

CT or prolonged observation indicated

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15
Q

seizure

A

an episode of abnormal neurologic function caused by inappropriate electrical activity (neuronal discharge) within the brain

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16
Q

seizure - two types

A

generalized
partial/focal

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17
Q

seizure - generalized

A

involving major of one or both cerebral cortices

18
Q

seizure - partial/focal

A

involving a localized area of one cortex

19
Q

seizure - postictal phase last how long normally

20
Q

seizure - history of epilepsy, inquire about
8

A
  1. typical seizure patterns
  2. med compliance/changes
  3. recent infection
  4. sleep deprivation
  5. trauma
  6. caffeine intake
  7. decreased alcohol or benzo use
  8. stress
21
Q

seizure - PE
3

A
  1. comprehensive neuro exam
  2. assess for trauma
  3. assess for bladder incontinence
22
Q

seizure - PE assess for trauma locations

A
  1. tongue
  2. head
  3. neck injury
  4. shoulder dislocation
23
Q

first time seizure - inquire about
7

A
  1. trauma
  2. pregnancy
  3. severe HAs
  4. infection
  5. medication i.e. benzos
  6. alcohol or drug use
  7. DM history
24
Q

seizure - img/testing
2

A
  1. poc glucose
  2. ekg
25
most seizures last how long
within 2 mins
26
status epilepticus
seizures that last > 5 mins or 2 seizures without return to baseline mental status in between - this is a medical emergency
27
status epilepticus - tx 2
1. transfer to ER 2. first line rx is benzos
28
seizure - when to refer to ER 4
1. first time seizure 2. status epilepticus 3. atypical presentations or prolonged return to baseline 4. eclampsia
29
trigeminal neuralgia
pain in the distribution of a branch of the trigeminal nerve (cranial nerve V)
30
pain in the distribution of a branch of the trigeminal nerve (cranial nerve V)
trigeminal neuralgia
31
trigeminal neuralgia - clinical pres 3
1. sudden onset of unilateral intense pain in the face that resolves within seconds 2. stabbing, electric shock like, shooting 3. pain that waxes and wanes, may occur in clusters
32
sudden onset of unilateral intense pain in the face that resolves in seconds
trigeminal neuralgia
33
trigeminal neuralgia triggers can include 4
1. chewing 2. brushing teeth 3. talking 4. cold wind
34
trigeminal neuralgia - PE may have sensory abnormalities where
in the trigeminal nerve distribution
35
trigeminal neuralgia - should have normal what
neuro exam
36
trigeminal neuralgia - img/testing
usually none
37
trigeminal neuralgia - consider what type of tx
short course of anticonvulsants carbamazepine or oxcarbazepine w/ close neuro f/u
38
trigeminal neuralgia - rx 2
1. oxcarbazepine 300 mg PO BID 2. carbamazepine 100 mg PO BID
39
trigeminal neuralgia - when to refer to ER 2
1. any neuro exam abnormalities 2. any hx of trauma - concern for fx or hemorrhage
40
TN - how is it ex
ICHD-3 dx tool: clinical dx

Urgent Care Guide (38 decks)

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