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neuro Flashcards

1
Q

mini mental components

A

appearance, behavior, cognition, thought process

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2
Q

mini mental peumonic for 11 components

A

ORArL 2,3,RWD

Oreintatoin to place and time
Rrecognition0 repeat three objects (orange, dog and pencil)
Attnetion - serial 7s
recal - three objects from before 5 mins later
Language
2 names of 2 objects
3 three step commoand,
Read statment aloud, do what it says, dontsay it (close your eyes)
Write a sentance
Design- copy a design

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3
Q

mini mental pneumonic max score

A

max score is 30, no cog impariment is 24-30- average is 27

deleirum or dementia is 18-23 severe impairment is 0-7

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4
Q

TIA- deff

A

periods of acute cerebral insufficiency lasting less than 24 hours without residual effects

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5
Q

TIA causes

A

thrombus vs hemmorage,

cardio embolic event afib etc

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6
Q

TIA is indicative of

A

impending stroke

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7
Q

appro — % of pt wth TIA will experience a cerebral infarct in —-years

A

1/3 within 5 years

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8
Q

Tia class vertebrobasilar

A

innadequate blood flow from vertebral arteries

presentation is vertigo, ataxia, dizzy, visual field defficit, weakness, confusion

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9
Q

TIA class carotid

A

due to carotid stenosis,

presentation is aphasia, dysarthria, altered LOC, weakness, numbness etc.

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10
Q

TIA lab and DX

A

CT is best to distinguish between, tumor, bleed or ischemic stroke

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11
Q

TIA CT vs MRI

A

MRI is superior to CT in detecting ischemic infarcts.

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12
Q

TIA wk up after CT

A

echo, carotid doppler, cerepbral angioagraphy

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13
Q

TIA managemnt

A

asa reduces the risk of stroke and death

plavix 75mg QD

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14
Q

Tia problems with ticlid

A

agranulocytosis, thrombotic thrombocytopenia purpura, and gi intolerance

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15
Q

in TIA assess for hypertension as it is

A

nuber one cause of heart failure

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16
Q

tia and carotid endartoectmoy

A

decreases the risk of strok and death in patients with recent TIA, it is indicated for >70-80% stenosis of vessells for symptomatic patients..

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17
Q

CVA definition

A

rapid onset of neuro deficits lasting longer that 24 hrs (TIA is less than 24 hrs) it remains the 4th leading cause of death in the us

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18
Q

CVA causes

A

atherosclerotic changes, chronic hypertension, trauma, aneurysm, av malformation, tumor

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19
Q

CVA infarct pearl

A

can produce subtle, progressive or sudden neurologic deficits

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20
Q

CVA infarct signs and symptoms

A

change in loc
motor weakness
visual alterations
changes in vitals signs

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21
Q

CVA hemmorage pearl

A

usually presents with sudden onset focal neuro deficits

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22
Q

CVA hemmorhage S and S

A

signs associated with inreased ICP, emisis, altered mentation, HA,

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23
Q

CVA bleed Left dominent hemisphere

A

R hemiparesis, aphasia, dysarthia, difficulty reading or writing

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24
Q

CVA bleed R non dominant hemisphere,

A

left hemiparesis, right visual field changes, spatial disorientation.

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25
Q

CVA labs and diagnostics

A

Head CT
cerebral angiography
LP if the pt has a grade I or II annurysm, to detect blood in CSF but CT should be first

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26
Q

CVA and LP contraindication

A

contra in large bleeds as brain stem herniation can be induced with rapid decompression of the subarachnoid space

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27
Q

more common infarct vs hemmorhage

A

infarct 80/20

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28
Q

thrombotic stroke management

A

fibrinolytic threapy indicated 3 is the answer up to -4.5 from last known well is contrverisal but done

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29
Q

stroke indications for ICP monitoring

A

sever head injury that cant allow for neuro assessment
GCS <8 abnormal CT
GCS

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30
Q

pipils changes are the

A

same

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31
Q

motor changes are

A

opposite

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32
Q

MAP and cerebral vasospasm

A

110-130 to prevent cerebral vasospasm.

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33
Q

door to fibrinolytic strok vs mi

A

3 vs 6 hrs

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34
Q

cpp formula

A

map-icp

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35
Q

nimitop role in cva

A

it si a calcium channel antagonist that helps to counter vasospasm by preventing calcium form entering the smooth muscle cells and causing contraction.

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36
Q

seizure classificaiton is based on

A

mode of seizure onset and spread

37
Q

partial seizure

simple partial

A

(focal local)
no LOC
rarley greater than 1 minute
motor symptoms start in one group and spread to entire side of body
parastethisas, flashing lights, vocalizations, hallucinations common.

38
Q

complex partial seizure

A

any simple seizure followed by impaired level of cociousness

may have aura, staring or automatisms such as lip smacking, and picking at clothing.

39
Q

HHH that increase ICP

A

hypotension]
hypercapnea
hypoxia

40
Q

generalized seizure absence (petite mal)

A

sudden arest of motor activity with blank stare

common discovered in children and adolescents begin and end suddenly

41
Q

tonic clonic sx grand mal

A

may have aura
begins with tonic - repititive contraction of muscles,
loc then clonic contractions involantary contraction of muscles
2-5 mins
incontinece my occure
post ictal after.

42
Q

grand mal seizures are commonly

A

discovered in children

43
Q

status epileptics definition

A

series of grand mal seizures of >10mins in duration
they are a medical emergency
may occur when awake or asleep but pt never regains consciousness between episodes
most uncommon but most life threatening seizure type

44
Q

labs and diagnostics for seizures/assessment

A

presence of aura, onset, spread, type of movement, body parts involved,

45
Q

seizures- eeg and CT

A

eeg is most important test in determining the seizure classifications
CT is indicated for all new onset seizures

46
Q

seizure management-

A

most are self limiting
protect airway

benzos- 2-4mg, at 1-2mg/min
dilantin- 20mg/kg- at 50mg/in continuous
phenobarb is dilantin fails

47
Q

myasthenia gravis definition

A

autoimmune disorder resulting in the reduction of the number of acetycholine receptor sites at the neuromouscular junction

48
Q

durg of choice to break status

A

valum

49
Q

MG weakness

A

better at rest worst after activity

variable clinical course remission and execerbations

50
Q

MG who gets it

A

20-40 but can happen at any age, younger for women men in the 50’s and 60’s more common in woman than man

51
Q

MG s and s

A

PTOSIS
DIPLOPIA
disarthia, dysphagia, visual changes and extremity weakness

52
Q

MG labs

A 
antibody test (to acetycholine) 
tensilin test, edrophonium- if they get wores they had a cholinergic crisis, if they get better then its myasthenic crisis.
53
Q

MG management

A

anticholinesterase drugs to block the hydrolosis of acetylcholine and are used for symptomatic improment- prostigmine.

immunosuppressives
plasmapharesis,
vent

54
Q

Multiple Sclerosis

A

autoimmune disease marked by numbness, weakness, loss of muscle coordination, and problems with VISION SPEECH AND BLADDER CONTROL

immune system attackes nerve insulator
variable clinical course

55
Q

MS

A

young adults between 20-50 mostly western european descent living in temperate zones

56
Q

MS symptoms MRi

A 
weakness, numbness, tingling, or unsteadiness in a limb, may progress to all limbs
spastic paraparesis
diplopia, 
urinary symtoms, 
optic atrophy
nystagmus
57
Q

MS diag

A

MRI of brain, cant base diagnosis solely on labs, slight protien elevation in CSF IgG also elevated.

58
Q

MS treatment

A

neuro refferal, steroids for acute relapses, antispasmodics, interferon therapy, plasmapharesis

59
Q

GB definition

A

acute usually rapidly progressive form of inflammatory polyneuorpathy characterized by demylinaiton of the peripheral nerves resulting in SYMMERICAL ASCENDING PARALYSIS

60
Q

GB causes

A

unknown, usually preceded by a suspected viral infection accompanied by fever, 1-3 weeks before the onset of acute bilateral muscle weakness in the lower extremities
flaccid paralysis can result within 48-72 hours

61
Q

GB incidence

A

male and female are equal,

62
Q

GB S and S

A

typically a rapidly progressive paralysis with cranial nerve involvement.
reflexes are hypoactive or absent

63
Q

GB labs

A

CSF protein is usually elevated (especially Immunogloublin G

64
Q

Meningitis definition

A

infection of the membranes of the pia matter and arachnoid matter of the brain or spinal cord

65
Q

Meningitis pearls

A

should be considerd in any patient with fever adn neuro symptoms especially with history of other infection or head trauma

acute bacterial meningitis is a medical emergency

66
Q

meningitis bacteria

A

in 80-90% of the cases it is caused by Streptococcus pneumoniae, H influenze, or nisseriea meningitidis

67
Q

meningitis symptoms

A

fever 101-103, severe headache, STIFF NECK, KERNIGS SIGN, pain and spasm of hamstring muscles, Brudzinski- legs flex at both the hips and the knees in response to the flexion of the head and neck to the chest, photophobia and seizures

68
Q

meningitis dx

A

LP- CSF will be cloudy or xanthochromic (yellow) with
elevated pressure, protein, decreased glucose, with WBC’s
CT of head is indicated

69
Q

monroe kelly dosctrine,

A

when one pressure in head increases another must decrease.

70
Q

meningitis tx

A

high does IV abx, Penicillin G, vanc with a thrid generation cephalosporin

71
Q

cushings

A

bradycardia hypertention, slow or strange respiration

72
Q

battles sign

A

brusing behind ears at mastoid process

73
Q

labs for head injury

A

everyone gets c spine

ct head and skull films

74
Q

Four p’s of spina cord injuries

A

pain, position, aralysis, paresthesias

75
Q

lucid interval is what type of hematoma

A

epidural

76
Q

C and T

A

C injury = quad

T can move arms parapalegiea

77
Q

spinal cord injury

A

methlprednisolone - 30mg/kg iv bolus followed by 5.4mg/kg infusion per hour for 24 hours withing the first 8 hours of injury

78
Q

5 complications of spinal trauma

A

C4 or above equals respiratory compromise

T4-T6 may lead to autonomic dysreflexia- an emergency medical condition

79
Q

autonomic dysrefleia-

A

exaggerated autonomic response, to a stimulus, bladder or bowel distention, hot or cold stim, restrictive clothing
symptoms include, diaphoresis and flushing aboe the level of the injury
chills and severe vasoconstriction below the level of the injury
HTN
Bradycardica
Headache
nausea
tx is remove stim and BP control

80
Q

brown sequard syndrome

A

caused by damage to one half of the spinal cord
ipsilateral upper motor nuron paralysis and loss of propriaoception
tx is MRI and steroids

81
Q

cauda equina

A

compression of nerve roots at the end of the spinal cord
numbness in lowerlegs, or saddle region,
mri,steroids, surgery for decompresssion.

82
Q

T6 or above-

A

neurogenic schock may occur
disruption of sympathetic impulses causes uninterupted parasympthetic stim leading to massive vasodilation

hypovolemia
low bp
pressors

83
Q

parkinsons definition

A

not enough dopamne 45-65 all groups

84
Q

parkinsons triad

A

TREMOR, BRADYKANESIA, AND RIGIDITY
wooden faces,
myersons sign- repetive tapping produces sustained blinking
impaired swallowng

85
Q

parkisons management

A

up dopaine
carbidopa-levodopa- sinamet
amantadine
mirapex

help with tremor
cogentin, artane,

86
Q

dementia causes

A 
atheosclerosis, 
neurotransmitter deficits
cortical atrophy
ventricular dilation
loss of brain cells
possible viral causes 
alzheimers disease
87
Q

Dementia pneumonic

A 
drug reactions
emotional disorders 
metabolic or endocrine disorders 
emotional disorders
nutritional problems 
tumors 
infection 
ateriosclerosis
88
Q

agnosia

A

cant recognize an object

89
Q

most common alzheimenrrs drug

A

aracept

issues and policy (22 decks)

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