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EM Final Study Guide > Neuro > Flashcards

Neuro Flashcards

1
Q

3 most common classifications AMS?

A
  1. Delerium
  2. Dementia
  3. Psychosis
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2
Q

In which class are vital signs irregular?

A

Delirium

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3
Q

In which class are visual and audial hallucinations seen?

A

Visual: delirium
Audial: Psychosis

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4
Q

What part of brain manages arousal? Cognition?

A

Arousal: Brainstem nuclei (RAS)
Cognition: Cortical functioning

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5
Q

Most common causes delirium?

A

Almost always caused by underlying medical problem that has toxic or metabolic effects on the brain

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6
Q

How to test pronator drift?

A
  1. Hold arms outstretched with palms facing upward
  2. Eyes closed: w/o vision, patient relies on proprioception alone to maintain position
  3. UMN lesion, supinator muscles in upper limb are weaker than pronator muscles, and arm drifts downward and palm turns toward floor
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7
Q

Definition stroke?

A

Acute onset of neurologic deficit caused by disruption of cerebral blood flow to a localized region of the brain

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8
Q

Majority of strokes ischemic or hemorrhagic?

A

87% ischemic

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9
Q

Risk factors stroke?

A
  1. Hypertension / diabetes / hyperlipidemia
  2. Smoking
  3. Advanced age
  4. A fib / prosthetic heart valve
  5. Prior stroke
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10
Q

Timeframe for giving TPA?

A

Door to decision to give: 45 minutes

Door to drug administration: 60 minutes (and less than 3 hours from onset)

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11
Q

Imaging in suspected stroke?

A

Head CT w/o contrast on all patients to exclude hemorrhage

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12
Q

Contradiction to tPA in head imaging?

A

Frank hypodensity on CT is indicative of completed stroke and may be a contraindication to thrombolytic therapy

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13
Q

Inclusion criteria for tPA?

A
  1. Diagnosis of ischemic stroke causing measurable neurological deficit
  2. Onset of symptoms less than 3 hours
  3. Aged ≥18 years
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14
Q

Blood pressure goal after tPA?

A

Below 180/105 in first 24 hours

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15
Q

Use of aspirin in stroke?

A

Aspirin within 24 – 48 hours of stroke onset is recommended

- Aspirin should not be administered for at least 24 hours after administration of rtPA

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16
Q

Classic meningitis presentation?

A
  1. Fever
  2. Neck Stiffness
  3. AMS
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17
Q

What is papilledema?

A

Condition in which increased pressure in or around the brain causes optic nerve inside eye to swell. Symptoms may be fleeting disturbances in vision, headache, vomiting, or a combination

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18
Q

Glucose in bacterial meningitis?

A

Less than 40 or ratio of CSF/blood glucose less than 0.40

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19
Q

Rx HSV encephalitis?

A

Acyclovir

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20
Q

Class presentation SAH?

A
  1. Acute onset “thunderclap” HA
  2. LOC
  3. Vomiting
  4. Neck stiffness
  5. Seizure
21
Q

RFs intracerebral bleeds?

A
  • ***FH 3 - 5x risk
    1. Recent exertion
    2. Hypertension
    3. Excessive alcohol consumption
    4. Sympathomimetic use
    5. Smoking
22
Q

What is an epidural hematoma?

A

Accumulations of blood between the skull and dura

- Typically occur after significant blunt head trauma

23
Q

Presentation EDH?

A

Brief LOC after blow to head, followed by a lucid period. - Soon after, level of consciousness deteriorates again

24
Q

What is a subdural hemorrhage?

A

Extra axial blood collections between the dura and the arachnoid mater

25
Q

What is cushings Triad?

A

Physiologic response to rapidly increasing ICP and imminent brain herniation. Its features are:

  1. Hypertension
  2. Bradycardia
  3. Abnormal respiratory patterns
26
Q

How does bleeding appear on head CT?

A

Hyperdense (whiter) relative to the surrounding tissues

27
Q

How to control rising ICP?

A
  1. Monitoring/lowering BP
  2. Elevating head of bed to 30 degrees
  3. Providing adequate sedation and analgesia
  4. Mannitol
  5. Mild hyperventilation
28
Q

Two categories seizure?

A
  1. Generalized: involving both hemispheres of brain with loss of consciousness
  2. Focal (partial): only one hemisphere is involved
29
Q

Two types focal seizures?

A
  1. Simple partial: cognition is not impaired

2. Complex partial: when cognition is impaired

30
Q

Evidence of seizure if not witnessed?

A
  1. Tongue trauma from biting

2. Urinary or bowel incontinence

31
Q

What is Todd’s Paralysis?

A

Focal neurologic deficit mimicking a stroke which can be seen with seizure

32
Q

Secondary causes of seizure?

A
  1. Alcohol withdrawal
  2. Drug use
  3. HYPOglycemia
  4. HYPOnatremia
33
Q

Definition status epilepticus?

A

Seizure of greater than 5 minutes duration, or 2 or more seizures in a row without a return to baseline

34
Q

When are patients with primary seizures prone to seize?

A
  1. Medical noncompliance: #1
  2. Sleep deprivation
  3. Emotional or physical stress
35
Q

Labs for first seizure?

A
  1. CMP

2. Pregnancy test

36
Q

Additional test in status?

A

LP, CT must be done first

37
Q

When to CT seizure?

A
  1. First time
  2. New type of seizure
  3. Trauma
  4. Fever
  5. Prolonged post ictal
  6. Status
38
Q

When to MRI seizure?

A

First time but as outpatient

39
Q

When is EEG need?

A
  1. First seizure as o/p

2. Status to make sure seizure has stopped

40
Q

Vitals in etoh withdrawal?

A

tachycardia, hypertension, hyperthermia and tachypnea

41
Q

Meds known to cause seizure?

A
  1. Tricyclics

2. Isoniazid

42
Q

Signs of PNES?

A

Rhythmic, controlled shaking activity, ability to talk or follow commands during the seizure, recall of a seizure that involves both sides of the body, or lack of a postictal period

43
Q

Can you place something in mouth in seizure?

A

Bite block or oropharyngeal airway to protect the tongue.

44
Q

Lines of therapy in status?

A

First line: benzodiazepines (usually lorazepam)
Second line: fosphenytoin/phenobarbital/valproic acid
Third line: versed/pentobarbital/propofol infusions

45
Q

Seizure meds that can be given IM?

A

Lorazepam, midazolam, and diazepam can all be given intramuscularly

46
Q

Rx secondary seizures?

A

Eclampsia – Magnesium sulfate
Hyponatremia – Hypertonic saline
Isoniazid – Pyroxidine
Hypoglycemia – Dextrose

47
Q

When not to use NIPPV?

A 
Respiratory arrest/absent respiratory drive
Hemodynamic instability
Aspiration Risk
Airway obstruction
Unable to tolerate mask
Mask does not fit
Altered mental status
48
Q

When to use NIPPV?

A 
Moderate to severe dyspnea
Accessory muscle use
Paradoxical abdominal movement
Fatigue
RR > 25 bpm
pH < 7.35, pCO2 >45
49
Q

DDx for slow and rapid onset respiratory distress?

A 
Rapid:
1. PE
2. Spontaneous pneumothorax
Gradual:
1. COPD
2. Pneumonia
3. CHF

EM Final Study Guide (29 decks)

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