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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

A

5-30 mins

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
Q

most seizures last how long

A

within 2 mins

26
Q

status epilepticus

A

seizures that last > 5 mins or 2 seizures without return to baseline mental status in between - this is a medical emergency

27
Q

status epilepticus - tx
2

A
  1. transfer to ER
  2. first line rx is benzos
28
Q

seizure - when to refer to ER
4

A
  1. first time seizure
  2. status epilepticus
  3. atypical presentations or prolonged return to baseline
  4. eclampsia
29
Q

trigeminal neuralgia

A

pain in the distribution of a branch of the trigeminal nerve (cranial nerve V)

30
Q

pain in the distribution of a branch of the trigeminal nerve (cranial nerve V)

A

trigeminal neuralgia

31
Q

trigeminal neuralgia - clinical pres
3

A
  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
Q

sudden onset of unilateral intense pain in the face that resolves in seconds

A

trigeminal neuralgia

33
Q

trigeminal neuralgia triggers can include
4

A
  1. chewing
  2. brushing teeth
  3. talking
  4. cold wind
34
Q

trigeminal neuralgia - PE may have sensory abnormalities where

A

in the trigeminal nerve distribution

35
Q

trigeminal neuralgia - should have normal what

A

neuro exam

36
Q

trigeminal neuralgia - img/testing

A

usually none

37
Q

trigeminal neuralgia - consider what type of tx

A

short course of anticonvulsants carbamazepine or oxcarbazepine w/ close neuro f/u

38
Q

trigeminal neuralgia - rx
2

A
  1. oxcarbazepine 300 mg PO BID
  2. carbamazepine 100 mg PO BID
39
Q

trigeminal neuralgia - when to refer to ER
2

A
  1. any neuro exam abnormalities
  2. any hx of trauma - concern for fx or hemorrhage
40
Q

TN - how is it ex

A

ICHD-3 dx tool: clinical dx

Urgent Care Guide (38 decks)

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