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Emergency Medical Technician > Neurologic Emergencies > Flashcards

Neurologic Emergencies Flashcards

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USMLE® Step 1 flashcards Royal College: Emergency Medicine flashcards
1
Q

Three major parts of the brain

A
  1. Brainstem
  2. Cerebellum
  3. Cerebrum
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2
Q

Controls basic functions of the body, such as breathing, BP, swallowing, and pupil constriction

A

Brainstem

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3
Q

Located just behind the brainstem

A

Cerebellum

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4
Q

Controls muscle and body coordination

A

Cerebellum

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5
Q

Responsible for coordinating complex tasks that involve many muscles, such as standing on one foot without falling, walking, writing, picking something up, and playing piano

A

Cerebrum

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6
Q

Largest part of the brain

A

Cerebrum

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7
Q

The front part of the cerebrum controls ___

A

Emotion and thought

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8
Q

The middle part of the cerebrum controls ___

A

Sensation and movement

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9
Q

The back part of the cerebrum processes ___

A

Sight

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10
Q

In most people, speech is controlled on the ___

A

Left side of the brain, near the middle of the cerebrum

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11
Q

How many pairs of cranial nerves run from the brain to parts of the body?

A

12

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12
Q

The brain is most sensitive to changes in ___

A

Oxygen, glucose, and temperature levels

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13
Q

A state of profound unconsciousness

A

Coma

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14
Q

The pain from a headache is felt from ___

A

The surrounding areas of the face; scalp; meninges; larger blood vessels; and muscles of the head, neck and face

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15
Q

Caused by muscle contractions in the head and neck and are attributed to stress

A

Tension headaches

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16
Q

Type of pain with a tension headache

A

Squeezing, dull, or an ache

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17
Q

Thought to be caused by changes in blood vessel size in the base of the brain

A

Migraine headaches

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18
Q

Type of pain with a migraine headache

A

Pounding, throbbing, or pulsating

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19
Q

Migraines are usually associated with ___

A

Nausea and vomiting, and may be preceded by visual warning signs such as flashing lights or partial vision loss

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20
Q

Caused by pressure that is the result of fluid accumulation in the sinus cavities

A

Sinus headaches

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21
Q

ICP

A

Intracranial pressure

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22
Q

You should suspect a hemorrhagic stroke in patients with a ___

A

Severe headache, seizures, and altered mental status

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23
Q

Early signs of increased ICP

A

Headache, vomiting, altered mental status, and seizures

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24
Q

An inflammation of the meninges caused by a bacterial infection

A

Bacterial meningitis

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25
Q

Bacterial meningitis is a ___

A

Central nervous system infection in which the patient may complain of a headache, stiff neck, fever, and sensitivity to light

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26
Q

Cerebrovascual accident

A

Stroke

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27
Q

CVA

A

Cereobrovascular accident

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28
Q

An interruption of blood flow to an area within the brain that results in the loss of brain function

A

Stroke

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29
Q

Two main types of stroke

A
  1. Ischemic
  2. Hemorrhagic
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30
Q

Occurs when blood flow through the cerebral arteries is blocked

A

Ischemic stroke

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31
Q

A blood vessel ruptures and the accumulated blood causes increased pressure in the brain

A

Hemorrhagic stroke

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32
Q

Most common type of stroke

A

Ischemic stroke

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33
Q

Ischemic stroke may be due to a ___

A

Thrombosis or an embolus

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34
Q

A clot forms at the site of the blockage

A

Thrombosis

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35
Q

A clot forms in a remote area and then travels to the site of the blockage

A

Embolus

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36
Q

Patients with atrial fibrillation are prone to ischemic strokes caused by ___

A

An embolus

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37
Q

A blood vessel ruptures, and the accumulated blood then forms into a clot, which compresses the brain tissue next to it. The compression prevents oxygenated blood from getting into the area

A

Hemorrhagic stroke

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38
Q

Hemorrhagic stroke commonly occurs in people experiencing ___

A

Stress or exertion

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39
Q

The people at the highest risk of a hemorrhagic stroke

A

With extremely high BP, or long-term untreated elevated BP

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40
Q

A swelling or enlargement of the wall of an artery resulting from a defect or weakening of the arterial wall

A

Aneurysm

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41
Q

Most notable symptom of a ruptured aneurysm

A

A sudden-onset, severe headache, typically described as the worst headache the patient has ever had

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42
Q

The headache from an aneurysm is caused by ___

A

The irritation of blood on the brain tissue after the artery swells and ruptures

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43
Q

A hemorrhagic stroke in an otherwise healthy young person is often caused by a ___

A

Berry aneurysm

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44
Q

This type of aneurysm resembles a tiny balloon (or berry) that juts out from the artery

A

Berry aneurysm

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45
Q

When the aneurysm is overstretched and ruptures, blood spurts into ___

A

An area between two of the coverings of the brain called the subarachnoid space

46
Q

Blood spurts into the subarachnoid space

A

Subarachnoid hemorrhages

47
Q

When stroke-like symptoms resolve on their own in less than 24 hours

A

Transient ischemic attack

48
Q

TIA

A

Transient ischemic attack

49
Q

Signs and symptoms of a stroke

A
  1. Facial drooping
  2. Sudden weakness or numbness in the face, arm, leg, or one side of the body
  3. Decreased or absent movement and sensation on one side of the body
  4. Lack of muscle coordination (ataxia) or loss of balance
  5. Sudden vision loss in one eye; blurred or double vision or abnormal eye movements
  6. Difficulty swallowing
  7. Decreased level of responsiveness
  8. Speech disorders
  9. Aphasia
  10. Dysarthria
  11. Sudden and severe headache
  12. Confusion
  13. Dizziness
  14. Weakness
  15. Combativeness
  16. Restlessness
  17. Tongue deviation
  18. Coma
50
Q

Dysarthria

A

Slurred speech

51
Q

Inability to produce or understand speech

A

Aphasia

52
Q

If the ___ has been affected by a stroke, the patient may exhibit aphasia

A

Left cerebral hemisphere

53
Q

If the ___ is not getting enough blood, the patient will have trouble moving the muscles on the left side of the body

A

Right cerebral hemisphere

54
Q

Patients involuntarily ignore symptoms

A

Neglect

55
Q

Patients with conditions affecting the back part of the cerebrum may neglect ___

A

Certain parts of their vision

56
Q

Patients with bleeding in the brain may have ___ BP

A

Very high

57
Q

Conditions that may appear to be a stroke

A
  1. Hypoglycemia
  2. A postictal state
  3. Subdural or epidural bleeding
58
Q

Period following a seizure that lasts between 5 and 30 minutes, characterized by labored respirations and some degree of altered mental status

A

Postictal state

59
Q

A collection of blood near the skull that presses on the brain

A

Subdural or epidural bleeding

60
Q

The leathery covering of the brain that lies next to the skull

A

Dura

61
Q

Subdural bleeding is ___ than epidural bleeding

A

Slower

62
Q

The period between injury and deterioration from a epidural hemorrhage is called a ___

A

Lucid interval

63
Q

A neurologic episode caused by a surge of electrical activity in the brain

A

Seizure

64
Q

A disorder in which abnormal electrical discharges occur in the brain, causing seizures and possible loss of consciousness

A

Epilepsy

65
Q

Seizures are classified as either ___

A

Generalized or focal, and their underlying cause either known or unknown

66
Q

Results from abnormal electrical discharges from large areas of the brain, involving both hemispheres

A

Generalized seizure

67
Q

Two types of generalized seizures

A
  1. Generalized motor seizure (tonic-clonic)
  2. Generalized-onset absence seizure
68
Q

A focal seizure begins ___

A

In one part of the brain

69
Q

Classifications of focal-onset seizures

A

Aware or impaired-awareness, and can be motor or absence

70
Q

In a focal-onset aware seizure, no change occurs in ___

A

The patient’s LOC

71
Q

Focal-onset impaired awareness seizures result form ___

A

Abnormal discharges from the temporal lobe of the brain

72
Q

Patient’s often experience this warning sign prior to a seizure

A

Aura

73
Q

Phase of a seizure with extreme muscle rigidity

A

Tonic phase

74
Q

Phase of a seizure with constant muscle contraction and tumbling, tongue biting, bladder incontinence, or bowel incontinence

A

Clonic phase

75
Q

Generalized motor seizures typically last less than ___

A

5 minutes

76
Q

The period after a generalized motor seizure

A

Postictal state

77
Q

How long does the postictal state last?

A

5 to 30 min or more

78
Q

The postictal state is over when ___

A

The patient regains a complete return of their normal LOC

79
Q

A generalized absence seizure may last for ___

A

Just a few seconds, after which the patient fully recovers with only a brief lapse of memory of the event

80
Q

Seizures lasting more than 5 minutes are at risk for progressing to ___

A

Status epilepticus

81
Q

Seizures that continue every few minutes without the person regaining consciousness or that last longer than 30 minutes

A

Status epilepticus

82
Q

How to care for status epilepticus

A
  1. Protect from self-harm
  2. Call for ALS backup
  3. Will need advanced airway management and medication to stop the seizure
83
Q

Cause cannot be determined

A

Idiopathic

84
Q

Most common medications to treat seizures

A
  1. Levetiracetam (Keppra)
  2. Phenytoin (Dilantin)
  3. Phenobarbital
  4. Carbamazepine (Tegretol)
  5. Valproate (Depakote)
  6. Topiramate (Topamax)
  7. Clonazepam (Klonopin)
85
Q

Cause of epileptic seizures

A

Congenital origin

86
Q

Cause of structural seizures

A
  1. Tumor
  2. Infection (brain abscess)
  3. Scar tissue from injury (within the skull)
  4. Head trauma
  5. Stroke
87
Q

Cause of metabolic seizures

A
  1. Hypoxia
  2. Abnormal blood chemical values
  3. Hypoglycemia
  4. Poisoning
  5. Drug overdose
  6. Sudden withdrawal from alcohol or medications
88
Q

Cause of febrile seizures

A

Sudden high fever (primarily in children)

89
Q

During the postictal state, the patient’s breathing becomes fast and deep to compensate for ___

A

The buildup of acids in the bloodstream

90
Q

Weakness on one side of the body

A

Hemiparesis

91
Q

In some situations, the postictal state may be characterized by ___

A

Hemiparesis

92
Q

Unlike a stroke, hypoxic hemiparesis ___

A

Soon resolves

93
Q

Most commonly the postictal state is characterized by ___

A

Lethargy and confusion to the point that the patient may be combative

94
Q

Geriatric patients with status epileptics are at a higher risk of ___

A

Hypoxia, hypotension, and/or cardiac dysrhythmias

95
Q

Difference between syncope and seizures

A

Fainting typically occurs while standing up, seizures may happen in any position

96
Q

The patient is not thinking clearly or is incapable of being awakened

A

Altered mental status

97
Q

How to tell the difference between hemiparesis from stroke or hypoglycemia

A

Person experiencing stroke typically alter and attempting to communicate normally. Hypoglycemia will have altered mental status

98
Q

Possible causes of altered mental status

A

AEIOU TIPS
A: Alcohol
E: Epilepsy, endocrine, electrolytes
I: Insulin
O: Opiates and other drugs
U: Uremia (kidney failure)
T: Trauma, temperature
I: Infection
P: Poisoning, psychogenic causes
S: Shock, stroke, seizure, syncope, space-occupying elision, subarachnoid hemorrhage

99
Q

A temporary change in mental status characterized by disorganized thoughts, inattention, memory loss, disorientation, striking changes in personality and affect, hallucinations, delusions, or a decreased LOC

A

Delirium

100
Q

BE-FAST stroke assessment

A

Balance
Eyes
Facial droop
Arm drift
Speech
Time

101
Q

Cincinnati Prehospital Stroke Scale

A

Facial droop
Arm drift
Speech

102
Q

Los Angeles Prehospital Stroke Screen

A

Items 1-6 yes, 97% chance of stroke
1. Older than 45
2. History of seizures or epilepsy absent
3. Symptoms <24 h
4. At baseline, not wheelchair bound or bedridden
5. Blood glucose between 60 and 400 mg/dL
6. Obvious asymmetry if any of the following 3 categories:
- Facial smile/grimace
- Grip
- Arm strength

103
Q

Most commonly used stroke assessment in the hospital setting

A

11-step numerical grading system with the NIH Stroke Scale

104
Q

LAG scale

A

3-item Stroke Severity Scale

105
Q

3-item Stroke Severity Scale

A

LOC:
0 - Normal
1 - Mild dysfunction
2 - Severe dysfunction (unconscious)
Arm drift (hemiparesis):
0 - Normal function
1 - Mild dysfunction
2 - Severe dysfunction (flaccid)
Gaze:
0 - Normal gaze (follows pen/finger to left and right sides)
1 - Mild dysfunction
2 - Severe dysfunction (fixed gaze)

106
Q

LAG Scale scores

A

> 4 stroke likely
5-6 high probability

107
Q

LVO stroke

A

Large vessel occlusion stroke, subtype of ischemic stroke. Caused by an occlusion of a large blood vessel in the brain

108
Q

LVO strokes respond well to ___

A

Fibrinolytics or mechanical thrombectomy

109
Q

Los Angeles Motor Scale (LAMS) was developed to identify ___

A

LVO strokes

110
Q

Los Angeles Motor Scale

A

Facial droop:
0 - absent
1 - present
Arm drift:
0 - absent
1 - slow drift
2 - rapid fall
Grip strength:
0 - Normal
1 - weak grip
2 - no grip
Score of 4+ strong indication of LVO stroke

111
Q

Key info to document for a patient with a suspected stroke

A
  1. Time of onset of signs and symptoms
  2. Score on the GCS
  3. Results of the stroke assessment tool
  4. Changes noted on reassessment

Emergency Medical Technician (100 decks)

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