Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

ACPNP Review > Neurology > Flashcards

Neurology Flashcards

1
Q

Seizures

A

Abnormal electrical discharge and change in patient’s usual function can include ALOC, incontinence of bowel and bladder, apnea, cyanosis followed by post-ictal state.

Common causes include fever, toxins, infections, solid mass or tumor.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Simple Partial Seizures

A

Motor signs, somatosensory or special sensory, autonomic symptoms and signs, psychic signs.

Dx: Most important aspect of diagnosis is history of event and resulting disability.

  • i.e., hypoxia, family history of seizures and type is also important.
  • Labs: (none needed for simple febrile seizure), CBC, electrolytes, toxicology screen, glucose, calcium, magnesium.
  • Imaging: CT or MRI depending on type and focal deficit.

Tx: Based on situation, consult neurology. Seizure therapies have some significant side effects.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Complex Partial Seizures

A

Simple partial onset followed by impairment of consciousness or with impairment of consciousness at onset.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Febrile Seizures

A

Occur on onset and rise of fever, usually between ages 6 months and five years.
- Short, resolve spontaneously.

Tx: Treat in regards to use of antipyretics.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Status Epilepticus

A

A single seizure lasting longer than 30 minutes or two or more consecutive seizures without returning to baseline LOC.

Tx: (First Line Therapy) ABC, benzodiazepines PR, IM, IV.
- (Second Line Therapy) Dilantin or phenobarbital load.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Lumbar Puncture

A

Should be performed when a child with a seizure and fever also has symptoms that suggest meningitis.
- Neck stiffness, + kernig and/or + Brudzinski signs.

Is an option if an infant aged 6 to 12 months has a seizure and fever but has not received recommended immunizations for Hib or Strep pneumoniae or if immunization status cannot be determined.

When a child with a seizure and fever has been pretreated with antibiotics, because antibiotics can mask the signs and symptoms of meningitis but may not be sufficient to eradicate it.

Blood culture and serum glucose testing should be conducted concurrently to determine whether the hypoglycorrhachia characteristic of bacterial meningitis is present.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Spinal Cord Injury

A

Age Specific Considerations:

  • Infants have poorly developed cervical musculature, head is disproportionately large.
  • Children < 9 years have wedge shaped vertebral bodies, angled horizontally.
  • Young children have cartilaginous endplates with lax interspinous ligaments, so they are more prone to SCIWORA (spinal cord injury without radiological abnormality).
  • Children with Down’s syndrome are prone to atlanto-axial subluxation as a result of acute flexion injuries (sports activities).
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

SCIWORA

A

Spinal cord injury without radiological abnormality

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Mechanism of Spinal Cord Injury

A

Divided into complete and incomplete lesions.

  • Incomplete leaves residual motor or sensory function more than three segments below the level of the injury.
  • Complete lesion is defined as having no preserved motor or sensory function more than three levels below the injury.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Teraplegia

A

(Formerly quadriplegia) Is an injury of the eight cervical segments. Paraplegia is an injury in the thoracic, lumbar, or sacral segments.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Spinal Cord Injury: Evaluation

A

Description of injury, mechanism of injury, medical problems, timing of onset of symptoms, motor and sensory assessment, muscle strength and motor weakness evaluation.
- Typical trauma incident includes fall from height, head, neck, or spinal trauma, MVC, diving, contact sports, abusive head trauma.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Spinal Cord Impairment Scale

A

A: (Complete) No sensory or motor function preserved below S4-S5

B: (Incomplete) Sensory function present; no motor function preserved below the neurologic level extending through S4-S5.

C: (Incomplete) Motor function preserved below the neurologic level with muscle grade < 3.

D: (Incomplete) Motor function preserved below the neurologic level with muscle grade of 3 or greater.

E: (Normal) Sensory and motor function preserved.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Spinal Cord Injury: Diagnostics

A

Radiographs - head and neck films with lateral views and odontoid views.

CT and MRI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Spinal Cord Injury: Management

A

Initial management is to manage airway, immobilize C-spine, high dose IV steroids (30mg/kg), manage neurogenic shock with fluids, alpha-adrenergic agents, continuous monitoring. Spinal shock follows some spinal cord injuries and can last several days, causing paralysis and loss of tone with hypovolemia.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Traumatic Brain Injury

A

Trauma to the head and brain occurring in two distinct phases.

  • Primary occurs with the moment of impact with disruption of the brain parenchyma.
  • Secondary occurs from systemic (hypotension, hypoxia, anemia) or intracranial problems (tumor, cerebral edema, seizures, infection.

S/S: Classified as mild, moderate, or severe based on neurologic assessment. Headache, irritability, changes in neuro status, vomiting, transient neuro symptoms such as cortical blindness.
- LOC, AMS, vomiting, increased head circumference in young infant.

Dx: To scan or not to scan?? Use PECARN or CHALICE.

Tx: Acute monitoring - ICP monitor, cerebral perfusion pressure monitoring (CPP).

  • Goal of TBI management is to lower ICP, optimize CPP, oxygenation and ventilation with appropriate cardiac output, surgical evacuation of of mass or blood.
  • Rapid sequence intubation, minimize increased ICP.
  • Continued evaluation of symptoms is extremely important in children with moderate to severe brain injuries, but children with mild injury should also be monitored for changes in status.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Primary Brain Trauma

A

Injury:

  • Intracranial contusion
  • Extra-axial hemorrhage - epidural, subdural and subarachnoid
  • Diffuse axonal injury

Results:

  • Epidural hemorrhage - injury to the middle meningeal artery or vein.
  • Subdural hemorrhage - bridging vein rupture.
  • Subarachnoid hemorrhage - tearing of small vessels in the pia mater.
17
Q

Secondary Brain Trauma

A

Injury:
- Sequelae of local and systemic events.

Results:

  • Ischemia
  • Energy failure
  • Cell death and secondary brain injury
  • Axonal injury and death
  • Cerebral edema
  • Intracranial pressure increases or changes
18
Q

CHALICE

A

Historical Features:

  • No LOC > 5 min
  • No abnormal drowsiness
  • No vomiting > 3 times
  • No suspicion of inflicted head trauma
  • No seizures

Physical Exam Findings:

  • GCS > 14 in a child older than 1yr
  • GCS > 15 in a child younger than 1yr
  • No suspicion of penetration injury
  • No suspicion of depressed skull fracture
  • No Suspicion of basilar skull fracture
  • No focal neurological deficit
  • No swelling or laceration of more than 5cm in a child younger than 1yr

Mechanism of Injury:

  • Not a high speed accident
  • No fall from height > 3 meters
  • Injury not due to a fast-moving projectile or object
19
Q

PECARN

A

Pediatric Emergency Care Applied Research Network
- Used for pediatric patients who are not likely to have clinically important traumatic brain injury and who may not require head CT. If any of the criteria are present, the GCS , 14, or the patient is acting abnormally, a CT scan is required.

Less than 2yrs old:

  • GCS > 14
  • No altered LOC
  • No nonfrontal scalp hematoma
  • No LOC > 5 sec
  • No severe injury mechanism
  • No palpable skull fracture
  • Acting normally according to parents

Older than 2yrs:

  • GCS > 14
  • No AMS
  • No LOC of any duration
  • No history of vomiting
  • No severe injury mechanism
  • No clinical signs of basilar skull fracture
  • No severe headache
20
Q

Epidural Bleed/Hematoma

A

Does not cross suture line, typically on side of direct impact, rapid accumulation of blood, often with fracture.

21
Q

Subdural Bleed/Hematoma

A

Crescent shape, may cross suture line, but not midline, contrecoup injury.

22
Q

Intraparenchymal Hemorrhage

A

Bleeding within brain tissue.

23
Q

Intraventricular Hemorrhage

A

Bleeding inside or around the ventricles of the brain.

24
Q

Hypoxic-Ischemic Injury

A

Initial CT may be normal, occurs and progresses over 24-48 hours, CT appears hyper dense.

25
Q

Cerebral Palsy

A

Motor impairment resulting from neurological insult, typically classified by type of movement problem.
- Can involve spasticity (failure of muscle to relax), athetoid (inability to control the movement of a muscle), hemiplegic (involves one arm and leg on the same side of the body), diplegia (both legs), quadriplegia (all four extremities).

S/S: Delay in development, abnormal muscle tone, abnormal movements, abnormal reflexes, persistent infantile reflexes, permanent appearance of specific motor problems.

Dx: MRI/CT scan, EEG monitoring, metabolic lab testing.

Tx: Neurology, orthopaedic, and physical therapy consults are usually necessary for children with CP on a regular basis.
- Chronic care of a child with TBI or CP includes collaboration with services such as PT, speech and language, school services, neurology.

26
Q

Encephalitis

A

Acute inflammatory process of the brain parenchyma, often caused by a viral process, but can be bacterial, autoimmune, or fungal.

  • Typical types - Herpes simplex encephalitis (HSE), occurs in neonates infected at birth and in other young infants and is potentially lethal if not treated.
  • Varicella zoster virus encephalitis (VZVE) is life-threatening in immune-compromised patients.

S/S: Diffuse and/or focal neuropsychological dysfunction (can be present in meningitis as well). Headache, aphasia, ataxia, visual disturbances, seizures.

Tx: Treatment of known cause and neurology consult with recommended diagnostic work up. Therapy should be initiated with acyclovir in any young infant or child who is suspected of having viral encephalitis, especially in those who appear ill.

27
Q

Botulism

A

Progressive neuromuscular weakness as a result of presence of Clostridium botulinum. Typically infant less than the age of 6 months.

S/S: Hypotonia, constipation, listlessness, poor feeding, weak cry and decreased gag reflex.

Dx: Identification of C. botulinum spores in feces and clinical findings.

Tx: Botulism-specific IVIG (BIG-IV) - obtained only through the CA Department of Health.

28
Q

Guillain-Barre Syndrome

A

Progressive neuromuscular weakness usually follows 4-6 weeks after and viral illness or prior infection.

S/S: Progressive and symmetrical as weakness in the lower extremities with ascending paralysis. Pain, numbness, tingling of the extremities and sensory loss with gait disturbances.

Dx: CSF protein measurement and clinical findings.

Tx: IVIG and supportive care.

29
Q

Muscular Dystrophy

A

Typically diagnosed by age 2. The limb girdle muscular dystrophies are a group of diseases with progressive, symmetrical weakness with both autosomal recessive and autosomal dominant inheritance. Concern for children with MD is the progressive neuromuscular weakness that will eventually involve the respiratory center and require ventilation.

30
Q

Mitochondrial Disorders

A

Presents as metabolic disease - acidemia, respiratory chain disorders, and fatty acid oxidation defects.

S/S: Ptosis, external ophthalmoplegia, proximal myopathy and exercise intolerance, cardiomyopathy, sensorineural deafness optic atrophy, pigmentary retinopathy, diabetes mellitus, fluctuating encephalopathy, seizures, dementia, migraine, stroke-like episodes, ataxia, and spasticity.

31
Q

Spinal Muscular Atrophy

A

Most fatal and most frequently occurring autosomal recessive neuromuscular disease of childhood.

Three Types:

  • Type 1 (Werdnig Hoffman): never sit, usually diagnosed by 6 months.
  • Type 2 (Intermediate): usually can sit, but not stand or ambulate.
  • Type 3 (Kugelberg Welander): presents after age 18 months and children have learned to walk.

S/S: Weakness at birth or within the first year of life, feeding and breathing difficulties.

Dx: Clinical features, Labs (aldolase, CPK, ESR, serum amino acids), genetic testing, EMG, muscle biopsy and nerve conduction testing.

Tx: Support of growing, respiratory decline and palliative care.

32
Q

CT of Brain Without Contrast

A 
Ventricular size
Hemorrhage
Cerebral atrophy
Large space occupying lesions
Congenital malformations of the brain
Intracranial calcifications
Cerebral edema, infarcts, and demyelination
33
Q

CT of Spine

A 
Visualization of bones
Tumors, fractures, deformities, infection or spinal stenosis
Herniated disks
Compression fractures
Congenital problems
Follow up from problems noted on x-ray
Post-op spine surgery
34
Q

MRI of Brain

A 
Ischemic or infarcted areas
Degenerative disease
Cerebral and spinal cord edema
Hemorrhage
Arteriovenous malformations
Small tumours
Congenital abnormalities
35
Q

Key Points

A
  • EEG does not need to be performed when evaluating a neurologically healthy child who presents with a simple febrile seizure.
  • Therapy should be initiated with acyclovir in any young infant or child who is suspected of having viral encephalitis, especially in those who appear ill.
36
Q

BAER Screen

A

Brainstem Auditory Evoked Response

  • Measures brain wave activity that occurs in response to clicks or certain tones.
  • Can be use in those with developmental delay.
37
Q

ABR Screen

A

Auditory Brainstem Response

- When used as a screening test, only one intensity or loudness level is checked.

38
Q

Preauricular Dimple

A

Common congenital malformation characterized by a nodule, dent, or dimple located anywhere adjacent to the external ear.

Congenital ear malformations are associated with renal anomalies.

  • Branchio-Oto-Renal Syndrome
  • Lachiewicz Sibley Syndrome

ACPNP Review (14 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions