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neuro Flashcards

1
Q

CN I

A

olfactory - smell

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2
Q

CN II

A

optic - vision

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3
Q

CN III

A

oculomotor (most EOMs, eyelid opening, pupil constriction)

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4
Q

CN IV

A

trochlear - down/inward eye movement

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5
Q

CN V

A

trigeminal (mastication, sensation: face, scalp, cornea, mucus membranes, nose)

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6
Q

CN VI

A

abducens - lateral eye movement

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7
Q

CN VII

A

facial (move face, close mouth/eyes, taste (anterior 2/3), saliva/tear secretion)

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8
Q

CN VIII

A

acoustic - hearing/equilibrium

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9
Q

CN IX

A

glossopharyngeal (phonation, gag reflex, carotid reflex, swallowing, posterior taste)

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10
Q

CN X

A

vagus (talking, swallowing, carotid body sensation, carotid reflex)

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11
Q

CN XI

A

spinal accessory (trapezius & sternomastoid movement ie shrugging)

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12
Q

CN XII

A

hypoglossal - tongue movement

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13
Q

which CN: gag reflex

A

IX - glossopharyngeal

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14
Q

which CN: pupil constriction

A

III - oculomotor

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15
Q

which CN: shoulder shrug

A

XI - spinal accessory

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16
Q

CN type mnemonic

A

Some Say Marry Money But My Brother Says Big Boobs Matter More

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17
Q

CN name mnemonic

A

On Old Olympus’ Towering Tops A Fin And German Viewed Some Hops

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18
Q

which CN: make eyes do tricks

A

III, IV, VI

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19
Q

which CN: pure sensory

A

I, II, VII

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20
Q

which CN: puff cheeks

A

VII

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21
Q

which CN: hearing

A

VIII

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22
Q

which CN: seeing

A

II

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23
Q

which CN: smelling

A

I

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24
Q

which CN: raspberry

A

XII

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25
Q

Mental Status Assessment (or MMSE): scoring x4

A

30 max
24-30 (no cognitive impairment, 27 avg)
18-23 (delirium/dementia)
0-7 (severe impairment)

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26
Q

TIA definition *

A

transient ischemic attack

  • acute cerebral insufficiency
  • resolves in 3 hours
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27
Q

purpose of Mental Status Assessment

A

discern cognitive impairments

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28
Q

TIA causes x2

A
  • ischemia d/t atherosclerosis, thrombus, arterial occlusion, embolus, intracerebral hemorrhage
  • cardio-embolic events: a fib, acute MI, endocarditis, valve disease
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29
Q

TIA indicative of

A

impending stroke

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30
Q

? TIA pts will experience cerebral infarction w/in 5 years

A

1/3

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31
Q

TIA: 2 classic sx *

A

altered vision: amaurosis fugax (ipsilateral monocular blindness)

motor impairment: paresthesia in CONTRALATERAL arm, leg, face

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32
Q

TIA: s/s x8

A
  • altered vision (amaurosis fugax)
  • motor impairment (contralateral paresthesia)
  • aphasia
  • dysphagia
  • vertigo
  • nystagmus
  • sensory deficits
  • cognitive/behavioral abnormalities
    (and more)
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33
Q

amaurosis fugax is

A

painless, transient, monocular loss of vision d/t retinal ischemia

  • think: TIA
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34
Q

aphasia *

A

loss of language comprehension/production d/t data processing deficit

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35
Q

agnosia

A

failure to recognize form/nature of objects (pattern recognition defect)

agnOsia - Objects

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36
Q

apraxia

A

impaired performance of skilled/purposeful movement

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37
Q

agraphia

A

inability to write

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38
Q

dysarthria *

A

difficulty articulating words r/t motor impairment

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39
Q

hemianopia

A

defective vision in half of visual field

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40
Q

hemiparesis *

A

partial paralysis with incomplete loss of muscle power on ONE (entire) side - WEAKNESS

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41
Q

vertebrobasilar TIA cause *

A

inadequate blood flow from vertebral arteries

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42
Q

carotid TIA cause *

A

carotid stenosis

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43
Q

vertebrobasilar TIA: presentation x6 *

A 
vertigo, dizziness
ataxia
confusion
visual field deficits
weakness
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44
Q

ataxia *

A

uncoordinated voluntary movements

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45
Q

carotid TIA: presentation x5 *

A

aphasia
dysarthria
altered LOC
weakness, numbness

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46
Q

priority diagnostic test to order in suspected TIA

A

CT - distinguishes between ischemia, hemorrhage, tumor

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47
Q

TIA: labs + diagnostics x5

A 
CT
MRI
echo
carotid doppler/US
CTA
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48
Q

CT or MRI: superior for detecting ischemic infarcts

A

MRI

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49
Q

TIA mgmt x5

A
  • aspirin
  • clopidogrel/Plavix 75 mg qd PO
  • ticlopidine (Ticlid)
  • hypertension assessment
  • carotid endarterectomy
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50
Q

why aspirin in TIA?

A

reduces CVA incidence, death

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51
Q

ticlopidine (Ticlid) AE considerations

A

associated with agranulocytosis, thrombotic thrombocytopenia purpura, GI intolerance

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52
Q

why hypertension assessment in TIA?

A

1 cause of heart failure

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53
Q

why carotid endarterectomy in TIA?

A

decreases risk of stroke, death in pt with recent TIA

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54
Q

when is carotid endarterectomy indicated? *

A

> 70 - 80% vascular stenosis in symptomatic patients

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55
Q

What is the strongest indicator of functional impairment at discharge? *

A

Cognitive impairment

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56
Q

Most important aspect in assessing mental status

A

orientation

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57
Q

Gold standard diagnostic for TIA

A

non-contrast head CT

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58
Q

Patient is asymptomatic but a carotid bruit is present on physical examination. What is the next step in the plan of care?

A

Order carotid doppler/ultrasound

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59
Q

Patient presents with L hand tingling and carotid Doppler revealed 90% occlusion of both carotids. What is the next step in the plan of care?

A

Carotid endarectomy of the right carotid first

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60
Q

What is the number one cause of heart failure

A

HTN

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61
Q

When do most TIAs resolve

A

around 3 hours

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62
Q

CVA

A

Rapid onset of neurological deficits lasting longer than 24 hrs

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63
Q

CVA causes

A 
aneurysm
atherosclerosis
AVM
HTN (chronic)
trauma
tumor
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64
Q

describe the progression of CVA infarct presentation

A

subtle progressive or sudden neurological deficits

ischemic - gt 80% of CVAs

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65
Q

ischemic CVA s/s

A 
LOC changes
motor weakness
paralysis
visual changes
vital sign changes
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66
Q

describe the progression of hemorrhagic CVA presentation

A

acute onset of focal neurological deficits

15-20% of CVAs

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67
Q

hemorrhagic CVA s/s x11

A

headache, sudden ↑ ICP, AMS, vomiting (when hemorrhage extensive)

L (dominant) hemisphere: R hemiparesis, aphasia, dysarthria, difficulty reading/writing

R (nondominant) hemisphere: L hemiparesis, R visual changes, spatial disorientation

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68
Q

What s/s do you see with an MCA infarct?

A

hemiplegia

deviation of eyes towards the lesion

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69
Q

s/s specific to hemorrhagic CVA in L hemisphere

A

R hemiparesis
aphasia
dysarthria
difficulty reading/writing

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70
Q

s/s specific to hemorrhagic CVA in R hemisphere

A

L hemiparesis
spatial disorientation
right visual field changes

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71
Q

In which hemisphere would a CVA be occurring if patient presented with right visual changes; left hemiparesis and spatial disorientation?

A

R (nondominant) hemisphere

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72
Q

In a L hemisphere CVA is aphasia an expected finding? What else?

A

yes
R hemiparesis
dysarthria
difficulty reading/writing

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73
Q

A 54 yo F suddenly falls out at church. What CVA do you expect?

A

hemorrhagic

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74
Q

gold standard CVA diagnostic

A

non-contrast head CT

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75
Q

CVA diagnostics

A

non-contrast head CT
CTA
LP (only if grade I or II aneurysm)

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76
Q

What must be obtained before LP?

A

non-contrast head CT

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77
Q

LP: contraindication + why?

A

large brain bleed

- brain stem herniation can be induced d/t rapid decompression of subarachnoid space

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78
Q

CVA: mgmt x8

A
  • thrombotic: fibrinolytics lt 3 - 4.5 hrs of sx onset
  • surgical evacuation
  • ↓ BP (monitor for cerebral ischemia) + avoid hypotension (exacerbates ischemic deficits)
  • ↓ ICP
  • MAP 110-130 (tx cerebral vasospasm)
  • intravascular vol replacement + hypertensive tx (↑ CPP, blood flow, O2 delivery)
  • nimodipine (Nimotop)

OVERALL GOALS: maintain CPP + limit ↑ ICP

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79
Q

CVA mgmt: goal MAP & why

A

110 - 130 mmHg

- treat cerebral vasospasm

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80
Q

CVA mgmt: cerebral vasospasms x2

A

MAP 110 - 130 mmHg

nimodipine (Nimotop) calcium channel blocker

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81
Q

CVA mgmt: how to ↑ CPP x2

A

intravascular volume replacement
hypertensive therapy

(also increases blood flow & O2 delivery)

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82
Q

window for tPA in CVA management

A

less than 3-4.5 hrs since onset of symptoms

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83
Q

What increases ICP in CVA?

A

hypotension
hypoxemia
hypercapnia

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84
Q

45 yo. M s/p CVA is intubated on the ventilator. Most recent ABGs read: pH 7.48/pCO2 35/pO2 60 with FiO2 40%. What is your next step?

A

leave pCO2 at 35

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85
Q

What is the function of the lateral rectus muscle?

A

Moves eyes sideways and back

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86
Q

MOA of nimodipine (Nimotop) *

A

prevent calcium from entering smooth muscles cells and causing contraction

(use for CVA

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87
Q

seizure

A

paroxysmal event resulting from abnormal electrical activity in cerebral neurons

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88
Q

simple partial seizure: presentation x 6

A

rarely gt 1 minute
** no LOC **
parasthesia, flashing lights, hallucinations
motor symptoms start in one muscle group and spread to entire side of body

note: common with cerebral lesions

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89
Q

complex partial seizure: what & presentation x3

A

simple partial seizure followed by ** impaired LOC **
automatisms
aura
staring into space

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90
Q

generalized seizure: absence

  • aka
  • presentation x 3
A

aka petite mal

sudden arrest of motor activity + blank stare + begin/end suddenly

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91
Q

generalized seizure: tonic clonic

  • aka
  • presentation x 5
A

aka grand mal

tonic contractions + LOC, then…
clonic contractions
incontinence possible

lasts 2 - 5 min,
followed by postictal

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92
Q

status epilepticus is…

A

series of tonic clonic (grand mal) seizures 10+ min duration
- can occur when awake or asleep BUT consciousness not regained between attacks

MEDICAL EMERGENCY
- most uncommon & most life-threatening

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93
Q

seizure assessment: most important questions x3

A

loss of consciousness
duration
neuro changes after?

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94
Q

seizures: diagnostics

A 
assessment (seven dimensions + description)
EEG (most important test)
CT head (indicated for all new onset seizures)
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95
Q

seizure classification: most important diagnostic

A

EEG

96
Q

new onset seizure s/s indicating STAT non-con CT head? x3

A

headache
vertigo
personality change

97
Q

Order what if pt complains of any of the following? What are you ruling out?
- new onset seizure, headache, vertigo, personality changes

A

non-con CT head

r/o brain tumor

98
Q

seizure mgmt: initial

A

supportive (seizures self-limiting)

  • maintain open airway
  • protect from injury
  • admin O2

DO NOT FORCE ARTIFICIAL AIRWAYS OR OBJECTS BETWEEN TEETH

99
Q

seizure mgmt: drug indicated if unresponsive to phenytoin (Dilantin)

A

phenobarbital (Luminal)

100
Q

status epilepticus: drug of choice + secondary

A

diazepam (Valium) 5-10 mg IV

phenytoin (Dilantin) = secondary

101
Q

immediate seizure control: drug of choice

A

lorazepam (Ativan) 1-2 mg/minute IV @ 1 - 2 mg/min

102
Q

Patient education in long-term seizure control

A

must taper down drugs due to risk for withdrawal seizures

103
Q

most commonly prescribed maintenance (longterm) anticonvulsant?

A

carbamazepine (Tegretol)

104
Q

new onset seizure: #1 ddx

A

brain tumor

105
Q

35 yo. M s/p aneurysmal clipping. What is the initial action in the plan of care?

A

Place patient in a quiet room

106
Q

Which serum abnormality increases the risk for pheyntoin (Dilantin) toxicity?

A

hypoalbuminemia

107
Q

60 yo. M on Norvasc for HTN management. You find out he likely had an ischemic CVA four hours ago. What about this patient excludes the use of tPA?

A

time of onset of symptoms (lt3 hrs)

108
Q

29 yo. F admitted to MSICU for ETOH abuse. You notice tremors during the physical exam. What is the next intervention?

A

administer vitamin B1 for tremors in ETOH

109
Q

myasthenia gravis is…

A

autoimmune disorder: reduced ACH receptor sites at neuromuscular junction
= weakness that worsens with exercise

110
Q

autoimmune destruction of ACh receptor sites at neuromuscular junction

A

myasthenia gravis

111
Q

myasthenia gravis: s/s x9

A 
ptosis (#1)
diplopia, dysarthria, dysphagia
extremity weakness (bilateral), fatigue
- worse after exercise, better w rest
respiratory difficulty
senses & DTRs --normal--
112
Q

myasthenia gravis: diagnostics

A

antibodies to ACh receptors (AChR-ab) - 85%

edrophonium (Tensilon) test

113
Q

myasthenia gravis: mgmt

A 
neurology referral (!)
pyridostigmine bromide (Prostigmin) 
immunosuppressants
plasmapheresis
vent during crisis
114
Q

myasthenia gravis: drug of choice + MOA

A 
pyridostigmine bromide (Prostigmin)
anticholinesterase: blocks hydrolysis of ACh
115
Q

multiple sclerosis is…

A

autoimmune disease: attack of myelin

= weakness + loss of muscular coordination

116
Q

multiple sclerosis: s/s

A

numbness, weakness, loss of muscle coordination

problems: vision, speech, bladder control

117
Q

myelin: function

A

nerve insulator, helps with nerve signal transmission

118
Q

multiple sclerosis: s/s x10s

A
  • weakness, numbness, tingling, limb unsteadiness (may progress to all)
    disequilibrium
    diplopia, optic atrophy, nystagmus
    urinary urgency/hesitancy
119
Q

multiple sclerosis: diagnostics

A
  • definitive diagnosis never based solely on labs! *
brain MRI
LP
CSF elevated protein (slight)
Elevated CSF IgG
lymphocytosis (slight)

THINK CSF

120
Q

What is abnormal in multiple sclerosis CSF?

A

elevated CSF protein & IgG

121
Q

multiple sclerosis: management

A 
* NO CURE - no tx for dz progression *
neurology referral
steroids: recovery from acute relapse ONLY
plasmapheresis
immunosuppressants

classic:

  • antispasmodics
  • interferon therapy
122
Q

The most common site of intracranial thrombosis is:

A

middle cerebral artery

123
Q

Differentials for syncope

A

anxiety
aortic stenosis
hypoglycemia

124
Q

What is the most common sign of vertebrobasilar insufficiency?

A

Vertigo

125
Q

75 yo. F is diagnosed with a SAH after falling down a flight of steps. She has developed obstructive hydrocephalus. What would be the first sign of increased ICP?

A

altered LOC

126
Q

50 yo. F is in the neuro ICU POD #1 s/p craniotomy. She develops Cushing’s Response. What is the criteria for Cushing’s Response and what is it a sign of?

A

bradycardia
hypertension
irregular RR
late sign of increased ICP

127
Q

guillain-barré syndrome

what + involves + results

A

acute, rapidly progressing inflammatory polyneuropathy
- characterized by: peripheral nerve demyelination
- results: progressive symmetrical ascending paralysis
M/F incidence equal

128
Q

guillain-barré syndrome: progression

A
  • viral infection + fever 1 - 3 wks before onset weakness in LE
  • acute bilateral symmetrical ascending paralysis
  • flaccid paralysis w/in 48 - 72 hrs
129
Q

guillain-barré syndrome: s/s

A

rapidly progressing ascending paralysis

  • cranial nerve impairment: difficulty in speech, swallow, mastication
  • reflexes: hypo or absent
  • respiratory muscle paralysis
130
Q

guillain-barré syndrome: diagnostics

A

↑ CSF protein (esp IgG)
CBC: early leukocytosis w left shift
LP, MRI, CT: can aid dx

131
Q

guillain-barré syndrome: management + recovery

A
  • neuro consult
  • supportive tx: allow myelin to regenerate
  • sx improvement ~2 wks
  • recovery ~2 years
132
Q

meningitis is…

A

infection: pia mater & arachnoid mater membranes of brain or spinal cord

acute bacterial meningitis = medical emergency

133
Q
  • fever + neuro symptoms in ANY pt should = concern for what? *
A

meningitis

- esp w hx infection or head trauma

134
Q

cause of 80-90% meningitis cases

A
  • Streptococcus pneumoniae *
    Hemophilius influenzae
    Neisseria meningitidis
135
Q

meningitis: s/s

A 
fever (101 - 103F)
nuchal rigidity
\+ Kernig & Brudzinski
photophobia, seizures, severe HA
n/v
136
Q

Kernig sign is?

A

hamstring pain, spasms

137
Q

Brudzinski sign is?

A

flexion: head to chest = flexion: hips & knees

138
Q

Spasms and pain of the hamstring muscle is…

A

+ Kernigs

139
Q

Flexion of head and neck to chest causes flexion of hips and knees is…

A

+ Brudzinski

140
Q

meningitis: diagnostics

A

LP – ASAP dx is suspected
CT head

CSF: cloudy/xanthrochromic
+/- ↑ pressure, protein
+/- WBCs present
+/- ↓ glucose

141
Q

bacterial meningitis: CSF findings

A 
cloudy or xanthrochromic 
↑ opening pressure
↑ protein
↑ glucose
WBCs
142
Q

meningitis: mgmt

A
  • control sx + maintain lyte balance
  • high dose parenteral abx ASAP if bacterial suspected; one of the following:
    • Pcn G
    • vanc + 3rd gen cephalosporin (until C&S available)
    • fluroquinolones
143
Q

most common demyelinating central nervous system disease

A

multiple sclerosis

144
Q

40 yo. F presents to ED with complaints of bilateral weakness in lower extremities ptosis and diplopia. You suspect myasthenia gravis. What is the diagnostic test that should be done?

A

antibody ACh

Tensilon

145
Q

CCP: what + normal range

A

cerebral perfusion pressure
CPP = MAP - ICP
normal: 50 - 130 mmHg

146
Q

viral meningitis: CSF findings

A

clear

normal glucose & protein

147
Q

chief cause of death in males under 35

A

accidents (chiefly MVCs)

- 70% involve head trauma

148
Q

which brain bleed is characterized by a lucid interval?

A

epidural hematoma

149
Q

major complication of head trauma

A

CUSHING’S TRIAD: increased ICP

  • widening pulse pressure (SBP ↑ to maintain CPP - often seen first)
  • ↓ RR
  • ↓ HR
150
Q

24 yo. F s/p procedure for hematoma. She is currently agitated and combative and the priority intervention is for her to be still. What is next in your plan of care?

A

sedation with holidays to assess neuro status

151
Q

4 P’s of Spinal Cord Injury

A

paralysis, paraesthesia, pain, position

152
Q

cervical spine injuries result in x3

A

quadriplegia

problems in arms through hands

153
Q

respiratory center of spinal cord located where?

A

C3

154
Q

thoracic spine injuries result in x2

A

paraplegia

no trunk control

155
Q

muscle strength: 5/5

A

normal movement against gravity & resistance

156
Q

muscle strength: 3/5

A

full ROM against gravity but NOT resistance

157
Q

muscle strength: 0/5

A

no visible/palpable muscle contraction or extremity movement

158
Q

spinal cord injury: drug given + why

A

methylprednisolone 30 mg/kg IV bolus
- followed by 5.4 mg/kg/hr gtts for 23 hrs

admin w/in 8 hrs of injury = improves neurological recovery

159
Q

When to administer methylprednisolone in spinal injury

A

within 8 hours

160
Q

injury @ C4 or above: major resulting complication

A

respiratory compromise

161
Q

T4 - T6 injury: resulting complication

A

autonomic dysreflexia

162
Q

autonomic dysreflexia

A

T4 - T6 injury - EMERGENCY

exaggerated autonomic response caused by stimulus (bladder/bowel distension, hot/cold, restrictive clothing)

163
Q

autonomic dysreflexia: s/s x8

A
  • flushing + diaphoresis (above level of injury) *
  • chills + severe vasoconstriction (below level of injury) *
    hypertension, bradycardia
    headache, nausea
164
Q

autonomic dysreflexia: treatment x2

A

first, stimulus removal

then, antihypertensives

165
Q

injury @ T6 or above: complication

A

neurogenic shock

166
Q

neurogenic shock is…

A

d/t T6 or above SCI

  • disruption of transmission of sympathetic impulses that cause unopposed parasympathetic stimulation
  • leads to loss of vasomotor tone → massive vasodilation
    • results in: hypovol, ↓ venous return & CO
167
Q

neurogenic shock: treatment & why

A

sympathomimetic vasopressors to maintain BP

168
Q

Parkinson’s Disease

A

degenerative disorder d/t insufficient amount of DOPAMINE

169
Q

degenerative disorder d/t insufficient amount of dopamine

A

Parkinson’s

170
Q

Parkinson’s Disease: s/s

A

(3 most common)

  • tremor / at rest
  • rigidity
  • bradykinesia

impaired swallowing
mask-like facies
drooling, less blinking, Myerson’s sign

171
Q
  • Parkinson’s Disease: mgmt *
A

increase dopamine
- carbidopa-levodopa (Sinemet), amantadine (Symmetryl), pramipexole (Mirapex), ropinirole (Requip)

anticholinergics (alleviate tremor, rigidity)
- benztropine (Cogentin), trihexyphenydyl (Artane)

172
Q

Parkinson’s Disease: why anticholinergics & which x2

A

reduce tremors, rigidity

  • benztropine (Cogentin)
  • rihexyphenydyl (Artane)
173
Q

65 yo. M diagnosed with Parkinson’s complains of increasing tremor. What medication is indicated?

A

anticholinergic (alleviate tremor and rigidity)

- benztropine (Cogentin), trihexyphenydyl (Artane)

174
Q

delirium is…

A

sudden, transient onset: clouded sensorium assoc with physical stressor

175
Q

delirium: causes x7

A

toxins, alcohol/drugs
trauma
anesthesia
impactions in elderly, poor nutrition, electrolyte imbalances

176
Q

dementia is…

A

NEUROCOGNITIVE DISORDER
gradual memory loss w decreased intellectual functioning
usually in 60+

177
Q

dementia: causes top 4 + 3 more

A
  • neurotransmitter deficits
  • atherosclerosis
  • alzheimers disease
  • cortical atrophy

ventricular dilation, loss of brain cells, virus

178
Q

most common cause of dementia

A

Alzheimer’s disease

179
Q

DEMENTIA mnemonic

r/o other diseases

A 
D rugs
E motional disorder
M etabolic disorder
E ar/eye disorder
N utritional imbalance
T umor
I nfection
A rteriosclerosis
180
Q
  • Alzheimer’s Disease x5
A

multiple cognitive defects including
- memory impairment (impaired ability to learn new info and recall previously learned)

PLUS, 1+ of…
aphasia, apraxia, agnosia, inability to plan/organize/sequence/abstract differences

181
Q
  • Alzheimer’s Disease: hallmark signs
A 
memory impairment
cannot learn new info
cannot recall old info
aphasia
apraxia
agnosia
inability to plan organize make abstract decisions
182
Q

Alzheimer’s patient cannot recognize a spoon. This is an example of what?

A

agnosia

183
Q

What is the most common initial complaint from family members with a patient diagnosed with Alzheimer’s?

A

loss of short term memory

184
Q

2 most significant neuro changes in elderly

A

↑ pain tolerance

↓ sense of touch

185
Q

meningitis: priority diagnostics if suspected

A

LP

CT head

186
Q

Initial differential if blood found in CSF after LP?

A

SAH

187
Q

45 yo. M presents to ED with garbled speech and wife reports new onset paralysis of left arm and left leg. The neurologist suspects right middle cerebral artery infarction. If this is so, which of the following physical findings may develop?

a. bradyarrythmias
b. left homonymous hemianopia
c. right hemiplegia
d. spasticity

A

B

188
Q

Rapidly lowering BP given CVA puts the patient at risk for…?

A

cerebral hypoperfusion and worsening of CVA

189
Q

65 yo. M is found lying on the street and is brought to the ED. Pt is lethargic and poor historian. His clothes are dirty and he appears to have poor hygiene. Vital signs: T 99 HR 100 RR 22 BP 100/60. What diagnostic tests should be obtained in this patient?

a. EEG
b. LP
c. BMP and glucose level
d. CT head

A

c. BMP and glucose

190
Q

65 yo. M is found lying on the street and is brought to the ED. Pt is lethargic and poor historian. His clothes are dirty and he appears to have poor hygiene. Vital signs: T 99 HR 100 RR 22 BP 100/60. A bottle of Percocet is found on the patient and you suspect narcotic ingestion. What is the treatment for narcotic overdose?

A

naloxone (Narcan)

191
Q

EtOH patient expected to have withdrawal tremors when?

A

6 - 48 hrs

192
Q

4th leading cause of death in the US

A

CVA

193
Q

s/s specific to extensive hemorrhagic CVA x4

A

headache, sudden ↑ ICP, AMS, vomiting

194
Q

L (dominant) hemisphere

A

R hemiparesis, aphasia, dysarthria, difficulty reading/writing

195
Q

s/s specific to hemorrhagic CVA in R (nondominant) hemisphere

A

L hemiparesis, R visual changes, spatial disorientation

196
Q

LP in CVA patients indicated when/why?

A

grade I or II aneurysm / detect blood in CSF

197
Q

overall goals for CVA mgmt x2

A
  • maintain CPP

- limit ↑ ICP to lt 20 mmHg

198
Q

what is an automatism?

A

seen in complex partial seizures - lip smacking, picking at clothing, etc

199
Q

seizures: priority diagnostic

A

CT head

200
Q

seizure mgmt: all options

A
  • initial: supportive
  • parenteral anticonvulsants (diazepam for status, lorazepam for average)
  • barbiturate coma or general anesthesia w NMB
201
Q

seizure maintenance med: considerations x2

A

(anticonvulsants)
dosages should be titrated
taper to d/c NEVER ABRUPT

202
Q

edrophonium (Tensilon) test is…

A

AChE inhibitor given to distinguish between myasthenia & cholinergic crises

  • myasthenia: weakness improves temporarily
  • cholinergic: weakness becomes more severe (OD!)
203
Q

cholinergic crisis is…

A

can be d/t overdose of anticholinesterase drugs, such as pyridostigmine (Prostigmin)

OVERSTIMULATION

204
Q

similar major symptom between myasthenia & cholinergic crises

A

severe muscle weakness

205
Q

simple difference between MG & MS labs

A

MG: blood vs MS: CSF

206
Q

monroe-kellie doctrine

A

skull contents = blood + brain + CSF

- when one increases another must decrease to compensate and maintain normal ICP

207
Q

leading cause of death in all trauma cases

A

head trauma

208
Q

two-thirds of all MVCs involve what?

A

head trauma

209
Q

which brain bleed is characterized as “worst headache of my life”?

A

subarachnoid hemorrhage

210
Q

What is Cushing’s Triad?

A

INCREASED ICP

  • widening pulse pressure (SBP ↑ to maintain CPP - often seen first)
  • ↓ RR
  • ↓ HR
211
Q

head trauma: important to assess x

A
  • time/place injury
  • how event occurred
  • sx onset
  • LOC
  • associated seizure activity
  • lucid interval?
  • amnesia? (indicative of severity)
212
Q

lucid interval in head trauma can suggest what?

A

expanding/epidural hematoma

213
Q

what aspect of Cushing’s Triad is often seen first?

A

widening pulse pressure (SBP increase to maintain constant CPP)

214
Q

head trauma: s/s

A
  • Cushing’s Triad (decompensation)
  • Basilar skull fracture (Battle’s Sign or Raccoon eyes)
  • Otorrhea or rhinorhea
215
Q

2 signs of basilar skull fracture

A

Battle’s Sign (bruising behind ear @ mastoid process)

Raccoon eyes

216
Q

Battle’s Sign is…

A

a sign of basilar skull fracture - bruising behind ear @ mastoid process

217
Q

head trauma: diagnostics

A

cervical spine films - ALL PTS
skull films
head CT

218
Q

when can you remove C collar from head trauma patient?

A

if cervical spine films are clear

219
Q

head trauma: mgmt

A

ABCs (any pt w altered LOC or significant trauma)
stabilize vitals
ongoing neuro evals
neurosurgery consult

220
Q

tingling fingers = spinal injury likely at…?

A

C7

221
Q

lumbar spinal segments control… x2

A

lower legs + perineum

222
Q

sacral spinal segments control… x3

A

bowel, bladder, sexual function

223
Q

muscle strength: 1/5

A

muscle contracts but extremity can’t move

224
Q

meningitis: abx when & choices (x3)

A

high dose parenteral abx ASAP if bacterial suspected; one of the following:

    • Pcn G
    • vanc + 3rd gen cephalosporin (until C&S available)
    • fluroquinolones
225
Q

spinal cord trauma: diagnostics x3

A

spinal XRay series
CT
MRI
myelography

226
Q

Parkinson’s Disease: 3 most common s/s

A
  • tremor / at rest
  • rigidity
  • bradykinesia
227
Q

Parkinson’s Disease: drugs to increase dopamine x4

A
  • carbidopa-levodopa (Sinemet)
  • amantadine (Symmetryl)
  • pramipexole (Mirapex)
  • ropinirole (Requip)
228
Q

Parkinson’s Disease: diagnostics

A

none - diagnosis of exclusion

229
Q

Lewy Body

A

refers to either Lewy Body Dementia or Parkinson’s Disease

230
Q

Alzheimer’s: deficiency in?

A

acetylcholine

231
Q

Parkinson’s vs Alzheimer’s deficiencies

A

Parkinson’s: dopamine deficiency

Alzheimer’s: acetylcholine deficiency

232
Q

Alzheimer’s: diagnostics x9 (split into 2 categories)

A

use labs to r/o other diseases
CBC, lytes, glucose, BUN/creat, LFT, B12 VDRL, etc

CT or MRI: r/o tumors

233
Q

Alzheimer’s: additional disease findings x5

A 
limb rigidity
flexion posture
disorientation
gait disturbance
impaired memory/judgment
234
Q

Alzheimer’s: mgmt

A
  • neuro consult
  • acetylcholinesterase inhibitors
    • donepezil (Aricept) = memory improvement
    • rivastigmine (Exelon)
    • galantamine (Razadyne)
  • refer pt/family for counseling
235
Q

drug class of choice for Alzheimer’s

A

acetylcholinesterase inhibitors

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