Neurological System

Question 1

What is the best continuous sedative drip for intubated neuro patients

Answer 1

Propofol ( diprivan)

Question 2

What part of the neuro exam is the best indicator of neurological deterioration

Answer 2

Changes in LOC

Question 3

What are late signs of deteriorating neurological status

Answer 3

Fixed and dilated pupils

Decerebrate posturing

Question 4

Cranial nerve 3

Answer 4

Oculomotor
EOM pupil constriction
Raises lowers eyelid

Question 5

Cranial nerve 4

Answer 5

Trochlear
EOM
Down and in

Question 6

Cranial nerve 6

Answer 6

Abducens
EOM
Lateral gazes

Question 7

Cranial nerve V

Answer 7

Trigeminal

Sensory of face and mastication and corneals

Question 8

Cranial nerve 9

Answer 8

Glossopharangeal

Posterior taste buds and innervates pharyngeal sensation

Question 9

Cranial nerve 12

Answer 9

Hypoglossal

Tongue movements

Question 10

What is the cerebellar responsible for

Answer 10

Gait and posture

Question 11

What does the cerebellar exam consist of

Answer 11

Gait and posture
Heel to shin ( drag heel of one foot down the shin of opposite leg looking for uninterrupted contact)
Ataxia ( staggering, unsteady wide gait)
Dysmetria ( inability to control the range of movement in muscle action { past pointing}

Question 12

Where is c4

Answer 12

At the clavicle

Innervates the diaphragm

Question 13

Where is t4

Answer 13

At the nipple

Question 14

Where is t10

Answer 14

At the umbilicus

Question 15

Brain death testing

Answer 15

Dolls eyes
+ dolls eye is a good sign ( the eyes moves in the opposite direction the head was turned)
If the reflex is negative severe brain stem damage is indicated

Question 16

Oculovestibular reflex

Answer 16

Infusion of ice cold water into the ear canal of a comatose patient
A intact brain stem will turn the eyes outward and downward from affected ear

Question 17

A GCS 8 or less indicates what

Answer 17

Comatose

Question 18

A GCS of 3 indicates what

Answer 18

Unresponsive

Question 19

Central pain

Answer 19

Tells examiner what level the brain is functioning

Question 20

Peripheral pain

Answer 20

Tells the examiner what level the cord is functioning

Question 21

What’s normal ICP

Answer 21

0-15

Question 22

What is ICP

Answer 22

Pressure within the cranial volt

Question 23

What is CCP

Answer 23

Cerebral perfusion pressure

Question 24

What is normal CCP

Answer 24

60-80

Question 25

How do u calculate CCP

Answer 25

MAP-ICP=CCP

Question 26

What drain can calculate ICP

Answer 26

EVD

Question 27

What is Cushing triad

Answer 27

HTN Bradycardia Widened pulse pressure

Question 28

What is criteria for brain death

Answer 28

1. Pupils nonreactive ( usually dilated) 2. No protective reflexes ( cough, gag, corneals) 3. No respirations above what the vent provides 4. Core temp 36 degrees Celsius or above 5. PACO2 greater than 60 6. No movement of any kind to central pain 7. On no sedatives, paralytics, or barbiturates

Question 29

Brain facts

Answer 29

Brain is totally dependent on oxygen and glucose for its metabolism Receives 750 ml/min blood Recieves 15-20% of resting cardiac output Brain is supplied by 2 major arteries

Question 30

What is a ischemic stroke

Answer 30

Occlusion of a blood vessel

Question 31

What is a hemmorhagic stroke

Answer 31

Rupture of a blood vessel

Question 32

What is penumbra

Answer 32

Zone of hypoperfused neuronal cells that are unable to function but remain viable Located around the injury

Question 33

What's a embolic stroke

Answer 33

Clots form elsewhere and travels to brain | Accounts for 15-20% of all ischemic strokes

Question 34

Where's the origin of a embolic stroke

Answer 34

Cardiac origin | A fib, decreased heart valves, infectious endocarditis, cardiomyopathy

Question 35

What's a thrombotic stroke

Answer 35

Atherosclerosis vessels narrow, the plaque may dislodge | TIAs may precede

Question 36

What's the origin of a thrombotic stroke

Answer 36

HTN Smoking Diabetes

Question 37

How do you diagnose a stroke

Answer 37

A CT to rule out hemmorhage is the gold standard ( should be done within 25 min) CTA to identify acute vascular occlusion Perfusion CT shows areas of perfusion and penumbra

Question 38

What's the gold standard on examining cerebral circulation

Answer 38

Angiography

Question 39

What may patients with a intercerebral hemmorhagic present with

Answer 39

Lateralized weakness, sensory symptoms, aphasia, visual field cuts Headaches, vomiting, Elevated systolic pressure Coma and / or decreases in LOC

Question 40

What is care of the intercerebral hemmorhage

Answer 40

Medical priorities to prevent hematoma expansion Reverse anti coagulants ( vit k, FFP, Factor VIIa BP management Maintain CCP above 60 if monitoring ICP

Question 41

What's a subarachnoid hemmorhage

Answer 41

``` Presentation of classic severe headache May have loss of consciousness Unchallenged rigidity or stiff neck Photophobic, photophonic N/V Focal neurologic deficits ```

Question 42

How do you diagnose SAH

Answer 42

``` Cerebral angiography do the gold standard Non contrast CT lumbar puncture MRA CTA to detect aneurysm ```

Question 43

What are complications of SAH

Answer 43

Cerebral vasospasm | Hydrocephalus

Question 44

What med is riven q4 hr to every SAH patient

Answer 44

PO CCB

Question 45

What are strategies for ICP management

Answer 45

``` Bed 30 degrees Suctioning 3% NS OR 1.5% NSS if peripheral line Osmotic diuretic Paralytic, sedation Temp control, seizure control hypothermia ```