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Primary Care 3 > Neuro > Flashcards

Neuro Flashcards

1
Q

Shock

A

cellular and tissue hypoxia due to reduced oxygen delivery or increased oxygen consumption or inadequate oxygen utilization

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2
Q

4 types of shock

A

Distributive, Cardiogenic, Hypovolemic, Obstructive

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3
Q

Distributive shock

A

has many causes including septic, SIRS, neurogenic shock, anaphylactic, toxic and endocrine like through addisons disease. A reduced systemic vascular resistence leads to a compensatory increase in cardiac output. All other forms of shock have an increased SVR and decrease cardiac output.

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4
Q

Cardiogenic shock

A

cardiomyopathic through MI, arrythmia like sustained VTach, or mechanical abnormality like valvular rupture

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5
Q

Hypovolemic shock

A

hemorrhagic from trauma or nonhemorrhagic fluid loss from vomiting

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6
Q

Obstructive shock

A

Pulmonary embolism or pulmonary vascular related, due to mechanical causes like tension pneumo, pericardial tamponade (obstructing oxygen flow –> shock)

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7
Q

Anaphylaxis

A

serious allergic or hypersensitivity reaction that is rapid in onset and may cause death

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8
Q

Criteria for anaphylaxis

A

acute onset of illness involving the skin or mucosal tissue and at least one of the following: resp compromise (wheeze, stridor) or reduced BP or s/s end organ malperfusion (hypotonia, syncope) can be after a likely allergen with two of the following: skin issue, resp compromise, reduced BP, GI symptoms. Known allergen: reduced bp systolic

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9
Q

Children and those with food induced anaphylaxis do not usually have this symptom

A

hypotension

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10
Q

Anaphylaxis results from this

A

igE mediated allergic reaction from foods, insects, medications or anything really including allergen immunotherapy, chemotherapy, vaccines, food additives, spices, cat dander, human seminal fluid, latex

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11
Q

Anaphylaxis blood work

A

within 15 minutes to 3 hours obtain total tryptase in serum or plasma or plasma histamine in excluding other disorders which do not involve mast cells. Histamine between 2 and 15 minutes no vacuum tube manually pul blood both on ice

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12
Q

Symptoms of anaphylaxis

A

Warm, flushing, itching, urticaria, angioedema, hair standing on end, tingling lips, edema of lips, tongue, metallic taste, congestion, sneezing, sob, tightness, cough, nausea, abd pain, diarrhea, syncope, ams, incontinence, anxious, headaches, sudden behavior change, tearing, eye itching, uterine cramps

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13
Q

Increased risk for stroke with those who have this type of migraine

A

migraine with aura

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14
Q

Stroke risk most increased in women with these risk factors

A

child bearing age, migraine with aura, smoking, taking the pill

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15
Q

migraine with aura causing strokes describes as

A

silent infarct-like lesions in posterior circulation of the white matter or cerebellum

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16
Q

patho of migraine leading to stroke

A

vasospams and changes in blood flow

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17
Q

patients with vascular disease are not allowed to take these medications

A

vasoconstrictive meds that treat migraines including triptans and ergots and seratonin agonists

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18
Q

women with migraine with aura who are smoking need to do these two things to control their risk factor of stroke

A

control blood pressure, use another form of birth control other than the pill

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19
Q

Biggest priorities in managing a patient with a traumatic brain injury

A

prevent hypoxia (Pa02

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20
Q

First thing to order with a TBI

A

CT Head

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21
Q

Treatment for impending herniation following a TBI from increased ICP

A

Head of bed elevation and IV Mannitol osmotic therapy

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22
Q

Treatment with a severe TBI causing mass hamatoma, contusions and swelling

A

ventriculostomy placement with ICP monitoring

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23
Q

target ICP pressure number

A

20 mmHg

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24
Q

prevention og early seizures post TBI

A

only one week of antiepileptic drugs (valproic acid,m phenytoin)

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25
Q

exacerbates secondary neurological injury

A

fever and hyperglycemia both need to be avoided

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26
Q

glasgow coma scale meaures

A

eye opening, verbal response, motor response. 3-15. 3 is the worst.

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27
Q

do not use this to manage TBI as it will lead to increased mortality

A

glucocorticoids

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28
Q

symptoms of elevated ICP

A

Headache from the pain fibers of CN 5, depressed global consciousness, vomiting

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29
Q

papilledema

A

intracranial hypertension leading to a blurred optic disc margin, loss of physiological cupping and fullness in the veins

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30
Q

TIA

A

transient episode of neurological dysfunction by focal brain, spinal cord, or retinal ischemia without an acute infarction. Absent end organ injury. The defined end point is tissue injury and not timed 24 hours

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31
Q

TIA timing

A

Was less than 24 hours caused by decreased blood supply but this is inadequate as even relatively brief ischemia can cause a permanent brain injury so the new TIA definition is absent end organ injury

32
Q

Antithrombotic treatment of TIA

A

4.5 hours after symptom onset for yPa and 6 hours for a mechanical thrombectomy

33
Q

Acute ischemic stroke antithrombotic treatment

A

no urgent anticoagulation, instead do early aspirin therapy 160 or 325 daily, ideally start within 48 hours of stroke onset. beyond the acute phase it should continue with asa plus plavix

34
Q

Antithrombolytic for symptomatic large artery disease

A

aspirin plus plavix for 90 days

35
Q

Options to prevent stroke with large artery disease

A

revascularization with carotid endarterectomy/stenting and multifactoral risk reduction with antiplatelets, antihypertensive drugs, and statins

36
Q

treatment for symptomatic carotid atherosclerosis

A

carotid endarterectomy

37
Q

When is surgical revascularization a viable option

A

when residual flow can be demonstrated in the internal carotid artery. If completely occluded, medical mgmt is the only practical option

38
Q

Aortic arch disease mgmt

A

antiplatelet and statin therapy

39
Q

AF is associated with these types of strokes

A

worsened ischemic strokes and longer TIAs due to embolization of larger particles

40
Q

Confirm absence of intracranial hemorrhage before starting anti-thrombotic therapy by

A

cranial CT and MRI

41
Q

When to initiate TPA (alteplase)

A

4.5 hours, preferably 3, from the onset on symptoms with acute ischemic stroke to reduce long term disability

42
Q

Most effective long term therapy for prevention of recurrent stroke

A

Warfarin. Target INR 2-3

43
Q

Mild versus moderate versus severe TBI

A

13 > mild. 9-12 moderate. less than 8 is severe.q

44
Q

Primary TBI

A

intra- and extra=parenchymal hemorrhages and diffuse axonal injury from shearing mechanisms showed as white matter tracks

45
Q

Secondary TBI

A

Cascade of molecular injury mechanisms that are initiated at the time of initial trauma and continue for hours or days. This can be exaccerbated by hypotension, hypoxia, fever and seizures

46
Q

Leading cause of TBI

A

Falls. Second leading cause is MVA

47
Q

Subdural hematoma

A

between the dura and the arachnoid membrane caused by bleeding. Most commonly caused by tearing of the brdiging veins that drain from the surface of the brain to the dural sinus.

48
Q

Epidural hematoma

A

space between the dura and the skull

49
Q

Subdural hematoma s/s

A

can be from a loss of consciousness to a coma.

50
Q

Acute subdural hematoma

A

coma is usually present at the time of injury,some may have a lucid interval followed by a progressive neurological decline. Headache, vomiting, anisocoria, dysphagia, cranial nerve palsies, nucal rigidity On CT it is a high dense crescent collection

51
Q

Chronic subdural hematoma

A

insidious onset of headache, light headedness, cognitive impairment, somnolence and occasional seizures, on CT it is a hypodense crescent shaped lesion

52
Q

Refer to a neurologist if a child has these symptoms of concussion

A

symptoms > 10 days, those with multiple concussions occuring with progressively less force and or are associated with more intense symptoms, uncertain dx of concussion

53
Q

concussion s/s

A

headache, dizzy, nausea, difficulting concentrating, vision changes, drowsiness, amnesia, sensitivity to noise, tinnitus, irritability, loss of consciousness, hyperexcitability

54
Q

Most SAH caused by

A

ruptured saccular aneurysms

55
Q

s/s SAH

A

sudden, severe headache, worst headache of my life may be a/w LOC, seizures, n/v.

56
Q

dx SAH

A

CT. If negative and still suspicious then do a lumbar puncture which will show elevated RBCs. After CT do an angiography.

57
Q

Migraine s/s

A

unilateral, throbbing, pulsating, nausea, vomiting, photophobia, phonophobia, crescendo pattern, aggravated by activity duration 4-72 hours

58
Q

Migraine triggers

A

stress, menstruation, visual stimuli, weather changes, nitrates, fasting, wine, sleep disturbances, aspartame

59
Q

Tension headache

A

mild to moderate, bilateral, nonthrobbing, no other features, 30min to 7 days, pressure and tightness will wax and wane no other symptoms

60
Q

Cluster headache

A

idiopathic, unilateral, severe with autonomic symptoms. orbital, supraorbital or temporal pain, lacrimation, conjunctival injection, rhinorrhea, nasal congestion

61
Q

Physical exam done with headache complaint

A

blood pressure, pulse, bruit at neck, palpate head, neck and shoulders, check temporal and neck arteries, examine spine and neck muscles. Mental status, cranial nerves, gait

62
Q

Danger signs

A

SNOOP. Systemic symptoms (fever, weight loss, cancer) Neuro symptoms (confusion, papilledema, seizures) Onset is new or sudden (after 40 or thunderclap) Other symptoms (head trauma, drug use, worse with valsalva) Previous headache history with a progression or change in attack.

63
Q

giant cell arteritis

A

chronic vasculitis of large and medium sized vessels. Older than 50. Temporal or frontal. Fever, fatigue, weight loss, visual changes, polymyalgia rheumatica

64
Q

trigeminal neuralgia

A

sudden, unilateral severe brief stabbing pain across trigeminal nerve older than 50 years of age

65
Q

chronic subdural hematoma

A

insidious onset of headaches, light headed, dizzy, apathy, cognitive impairment, tired, possible seizures

66
Q

new onset seizure older than 50 worry about

A

brain tumor

67
Q

anaphylaxis

A

acute, potentially lethal, multi system syndrome resulting from a sudden release of mast cell, basophil and macrophage derived mediators into circulation

68
Q

immunologic anaphylaxis

A

igE and igG mediated reaction with immune complex mediated mechanisms

69
Q

nonimmunologic anaphylaxis

A

caused by agent or event that induces a sudden, massive mast cell or basal cell degranulation without antibodies

70
Q

anaphylaxis is a/w these cardiac issues

A

MI and arrhythmias, due to cardiac hx, exogenous epinephrine and hemodynamic stress

71
Q

anaphylaxis resp s/s

A

bronchospasm, mucus plugging, larygeal edema and asphixiation esp w those w hx asthma

72
Q

meds that make anaphylaxis worse

A

opiods, nsaids, ethanol, beta blockers, ACE inhibitors

73
Q

level that supports diagnosis of anaphy.

A

serum tryptase 15 min to 3 hours after diagnosis

74
Q

diagnosing anaphylaxis

A

acute onset of illness with skin, mucosal tissue (swollen lips/tongue…hives) with at least 1) resp compromise OR 2) decreased BP

75
Q

Exposure to known allergen dx

A

bp less than 90 or a 30 percent decrease from baseline, infants and children are age specific

Primary Care 3 (29 decks)

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