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Spring ER > Neurologic > Flashcards

Neurologic Flashcards

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1
Q

What is coma

A

– state of reduced alertness and responsiveness; patient cannot be aroused

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2
Q

MCC AMS in ED

A

hypoglycemia

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3
Q

Causes of miosis

A 
COPS
clonidine & cholinergics
opiates & organophosphates
pilocarpine & phenothiazines & pontine bleed/lesion
sedative hypnotics (benzos)

+ Horner Syndrome

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4
Q

Causes of mydriasis

A

anticholinergics

sympathomimetics

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5
Q

fixed dilated pupil

A

temporal lobe herniation on same side or if alert, could be from drops or compression of CN III

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6
Q

apneustic breathing

A

prolonged pause after inspiration –

pontine infarct

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7
Q

ataxic breathing

A

irregular, no pattern,

preterminal

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8
Q

MC location of HA in SAH

A

occipitonuchal

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9
Q

Life threatening causes of HA

A 
Subarachnoid Hemorrhage
Meningitis
Intraparenchymal Hemorrhage and Cerebral Ischemia
Subdural Hematoma
Brain Tumor
Cerebral Venous Thrombosis
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10
Q

Risk Factors for SAH

A 
HTN
smoking
excessive EtOH
fhx
polycystic kidney dis
coartaction of aorta
Marfan Syndrome
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11
Q

T or F:

uncomplicated syncompe w/out trauma or other sxs should persue SAH

A

False

every syncope does not need CT

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12
Q

Remote trauma with HA
+anticoag/alcohol/elderly

suspected dx & how to dx

A

Subdural hematoma
Noncontrast Ct
- may need contrast if subacute or chronic

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13
Q

HA worse in AM think

A

Brain tumor

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14
Q

Hypercoaguable state:
oral contraceptives, postpartum/post op, etc
+
HA, vomiting, seizures

A

Cerebral Venous Thrombosis

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15
Q

60 yo F HA and jaw claudication

A

Temporal Arteritis

Start on prednisone

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16
Q

Tx for benign intracranial htn (pseudotumor cerebri)

A

Acetazolamide

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17
Q

– young patient with chronic HAs. N/V, visual problems, papilledema, normal CT, elevated CSF pressure

A

Benign Intracranial Hypertension

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18
Q

DHE in contraindicated for migraine treatment in

A

pregnancy,
uncontrolled HTN,
CAD

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19
Q

Tx tension HA

A

analgesics or NSAIDs

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20
Q

Tx cluster HA

A

high flow oxygen

DHE, triptans, analgesics

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21
Q

Tx trigeminal neuralgia

A

Carbamazepine

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22
Q

Contralateral hemiparesis, facial plegia, and sensory loss. Homonymous hemianopsia and gaze preference toward side of infarct (away from the deficit). Face and upper extremity affected more than lower. If dominant hemisphere involved, aphasia (receptive, expressive, or both) present. If nondominant hemisphere involved, inattention, neglect, often present.

A

Middle Cerebral Artery Stroke

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23
Q

Contralateral sensory and motor symptoms in lower extremity, sparing of hands and face. May have aphasia neglect, incontinence

A

Anterior Cerebral Artery stroke

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24
Q

unilateral headache, contralateral homonymous hemianopsia and unilateral cortical blindness.

A

Posterior Cerebral Artery stroke

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25
Q

vertigo (with cerebellar or brainstem signs), HA, nausea, visual disturbances, oculomotor palsies, ataxia, sensory disturbance, bilateral limb weakness

A

Vertebrobasilar stroke

26
Q

MC artery affected in ischemic stroke

A

middle cerebral artery

27
Q

Stroke pt who is a candidate for thrombolytics. Lower BP to___ via which drugs___

A

SBP <110

labetalol, nicardipine, esmolol

28
Q

tPA must be given within

A

3hrs of onset sxs
(some places 4.5-6)

must know last baseline!

29
Q

ED tx of TIA

A

antiplatelet therapy – aspirin alone
clopidogrel
or aspirin plus dipyridamole

30
Q

Dx cervical artery dissection

A

MRI/MRA and CT/CTA

31
Q

ED tx cervical artery dissection

A

heparin followed by Coumadin

admit for monitoring

32
Q

Nystagmus with ataxia suggests

A

pathology is central, not in the cord or periphery

33
Q

Apraxic gait is

A

lost ability to initiate walking – seen with nondominant hemispheric lesions

34
Q

Festinating gait is

A

narrow based shuffling steps - Parkinson’s

35
Q

Worsening (+) Romberg suggests

A

sensory ataxia with problem in posterior column, vestibular dysfunction, or peripheral neuropathy

36
Q

perception of movement when none exists

A

Vertigo

37
Q

transient loss of consciousness due to loss of postural tone with spontaneous recovery

A

Syncope

38
Q

light-headedness with concern for syncope

A

Near Syncope

39
Q

– feeling of unsteadiness, imbalance, or sensation of floating while walking

A

Disequilibrium

40
Q

MCC vertigo in elderly

A

Benign paroxysmal positional vertigo

41
Q

Hallpike maneuver diagnoses

A (+) result=

A

Benign paroxysmal positional vertigo

(+) nystagmus toward AFFECTED ear

42
Q

Treatment for BPPV

A

antihistamines

43
Q

Acoustic schwannoma affects cranial nerve

A

VIII (8)

44
Q

Vertigo with head movement and accompanied nausea.

NO hearing loss or tinnitus

A

BPPV

45
Q

status epilepticus lasts more than ____ minutes

A

5

46
Q

initial treatment of status epilepticus

A

IV Lorazepam or Diazepam

not working:
Phenytoin or Fosphenytoin

47
Q

If a neuromuscular blocker (Vecuronium) is used in status epilepticus, what must you do?

A

EEG monitoring
drug does not affect neuronal activity.
Body will not demonstrate seizure even though they are still experiencing it

48
Q

Pt complains of lateralized weakness and on exam is hyper-reflexive with a + Babinski.
What kind of lesion is most likely?

A

Central lesion

49
Q

“floppy infant” with poor feeding and lethargy

A

Botulism

50
Q

Gi sxs- n,v,d, cramps
+ descending symmetric paralysis
diplopia, dilated pupils

A

Botulism

51
Q

Sub acute ascending symmetric weakness or paralysis and loss of DTR’s

A

Guillain-Barre Syndrome

52
Q

Most common plexopathy and nerve roots involved

A

Brachial plexopathy

C5-T1 nerve roots

53
Q

best way to dx MS

A

MRI T2 weighted showing multiple lesions in white matter, ventricles, or spinal cord

54
Q

acute treatment for MS flare-up

A

IV steroids

55
Q

Urine dipstick says + for blood but no RBCs found on microscopic exam

A

Rhabdomyolisis

56
Q

MC presenting symptoms of myasthenia gravis

what kind of weakness does this symptom have?

A

ptosis and diplopia

also see proximal weakness relieved by rest

57
Q

What cholinergic inhibitor drug used in myasthenia gravis?

A

pyridostigmine

neostigmine

58
Q

Dx myasthenic crisis/ myasthenia gravis?

A

Edrophonium IV push

if muscle weakness improves then myasthenic crisis

59
Q

Pt presents with hyperthermia, rigidity, and AMS

exam shows “lead pipe” rigidity

A

neuroleptic malignant syndrome

60
Q

what causes neuroleptic malignant syndrome

A

dopamine antagonism/depletion

61
Q

Treatment for neuroleptic malignant syndrome

A 
ABCs
Cooling measures
Fluids & alkaline diuresis
Bromocriptine- dopamine agonist
Dantrolene- prevents muscle contraction
Nipride of CCB for HTN
Paralyze and intubate pt with nondepolarizing neuromuscular blockers

Spring ER (10 decks)

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