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Patient Care > Neurology > Flashcards

Neurology Flashcards

1
Q

Divisions of the Brain

A

Cerebellum
Cerebrum
Brain Stem

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2
Q

Cerebrum

A

Divided into left + right hemispheres
Connected by corpus callosum
Interprets sensory impulses, controls voluntary muscles, memory, thought, reasoning

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3
Q

Cerebral Cortex

A

Outer layer of grey matter

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4
Q

Cerebral Medulla

A

White matter

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5
Q

Lobes of cerebrum

A

Frontal, parietal, temporal, occipital

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6
Q

Cerebellum

A

Controls posture and fine motor control

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7
Q

Meninges

A

Dura mater
Arachnoid mater
Pia mater

Supports structures and vasculature

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8
Q

Brainstem

A

Midbrain
Pons
Medulla oblongata

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9
Q

Midbrain

A

Just below cerebellum
Connects cerebrum to lower centers

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10
Q

Pons

A

Between mid brain and medulla
Conduction network between spinal cord and brain
Respiratory centre

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11
Q

Medulla Oblongata

A

Enlargement of cord as it enters cranial nerve through foramen magnum
Cardiac Centre
Vasomotor centre
Respiratory centre
Vomiting

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12
Q

Spinal Cord

A

From medulla to L1
Same coverings as brain

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13
Q

Reticular Activating System

A

Small portion of brain stem
Collection of neurons responsible for wakefulness and behaviour

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14
Q

Blood Supply to Brain

A

16% CO and 20% of total oxygen consumption
Supplied from carotid arteries
10s reserve
Constant supply of glucose
Drainage by jugular veins

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15
Q

Somatic Nervous System

A

Conscious control
Spinal + cranial nerves

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16
Q

Autonomic

A

Sympathetic
Parasympathetic

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17
Q

Spinal nerves #

A

31 pairs

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18
Q

Cranial nerves #

A

12

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19
Q

Nervous Tissue Function

A

Transmit nerve impulses
Interpretation
Storage (memory)

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20
Q

Nervous System Function

A

Receptors
Sensory Input
Integration center
Motor output
Effectors

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21
Q

Neurons

A

Relay impulse from body to spinal cord and brain
Messages from brain to all compartments of the body

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22
Q

Afferent

A

Sensory
Carry impulses toward brain and spinal cord from tissues and organs

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23
Q

Efferent

A

Motor
Carry away from brain and spinal cord

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24
Q

Interneurons

A

Connection between neurons
Exclusively in brain + spinal cord

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25
Q

3 Parts of Neurons

A

Dendrite
Cell body
Axon

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26
Q

Nervous Tissue Properties

A

Excitability
Conductivity

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27
Q

Cranial Nerve Names

A

I. Olfactory
II. Optic
III. Occulomotor
IV. Trochlear
V. Trigeminal
VI. Abducens
VII. Facial
VIII. Vestibulocochlear/auditory
IX. Glossopharyngeal
X. Vagus
XI. Spinal accessory
XII. Hypoglossal

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28
Q

Breakdown of Spinal Nerves

A

8 Cervical
12 Thoracic
5 Lumbar
5 Sacral
1 Coccygeal

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29
Q

Cervical Plexus

A

C1-C4
Skin and muscles of shoulder and neck
Diaphragm

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30
Q

Phrenic Nerve

A

Innervates diaphragm
C3,4,5

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31
Q

Brachial Plexus

A

C5-C8, T1
Skin and muscles of arm

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32
Q

Axillary nerve

A

Muscles of shoulder

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33
Q

Radial nerve

A

Back of arm, forearm, hand, thumb, 2 fingers (wrist drop)

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34
Q

Medial Nerve

A

Forearm, hand
Carpal tunnel

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35
Q

Ulnar Nerve

A

Wrist and hand muscles (claw hand)

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36
Q

Lumbosacral Plexus

A

T12, L1-5, S1-4
Lower torso + legs

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37
Q

Sciatic Nerve

A

Back of leg, buttocks

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38
Q

Femoral Nerve

A

Lower abdomen, front of thigh, medial leg and foot

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39
Q

Peroneal Nerve

A

Lateral leg, foot

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40
Q

Tibial Nerve

A

Back of leg, foot

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41
Q

Autonomic Neurotransmitters

A

Acetylcholine + Epinephrine

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42
Q

Cholinergic

A

Neurons releasing ACh (PNS)
Parasympathetic pre + post ganglionic neurons
Sympathetic preganglionic

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43
Q

Adrenergic

A

Neurons releasing epi (SNS)
Sympathetic post ganglionic

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44
Q

Sympathetic Chain Ganglia

A

Sympathetic axon collaterals bridge adjacent ganglia
In same side of vertebral column

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45
Q

Breakdown of Sympathetic Chain Ganglia

A

3 Cervical
11 Thoracic
4 Lumbar
4 Sacral

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46
Q

Alpha 1 receptors

A

Blood vessel vasoconstriction

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47
Q

Alpha 2 Receptors

A

Presynaptic neuron, eliminates release of NE

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48
Q

Beta 1

A

Heart, increases contractility and heart rate

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49
Q

Beta 2

A

Lungs, skeletal muscle, dilation

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50
Q

Norepinephrine

A

2 main receptors (alpha + beta)

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51
Q

NE Deactivation

A

2 enzymes MAO and COMT
Slower than ACh deactivation

52
Q

Parasympathetic Neurons

A

Cell bodies in ganglion near effector organ
Synapse with one postganglionic neuron

53
Q

Parasympathetic Effect

A

Restores vegetative function
Slows body function
Speeds up body functions (GI motility)

54
Q

ACh deactivation

A

Acetylcholinesterase in synaptic cleft

55
Q

2 Components of Consciousness

A

Content
Arousal

56
Q

Anisocoria

A

Unequal pupils

57
Q

Doll’s Eye Test

A

Move head side to side or up and down slow then quick
Should focus on fixed point
Abnormal is eyes fixed and move with head
Indicates brainstem dysfunction

58
Q

Nystagmus

A

Involuntary but rhythmic oscillation of eyes

59
Q

Hoover’s Sign

A

Flex contralateral leg against resistance
Involuntary extension of opposite leg won’t occur in cases of paresis with psychiatric etiology

60
Q

Chair Test

A

Pts with gait disturbances
Propel self forward while seated, then walk same distance
Functional gait disturbance can ambulate chair but not standing

61
Q

Scalp acronym

A

Skin
SubCutaneous tissue
Adipose
Ligament
Pericranium

62
Q

Syncope

A

Transient complete LOC due to cerebral ischemia followed by recovery to mental status
Rapid onset
Short duration
Spontaneous complete recovery

63
Q

Neually mediated syncope

A

Vasovagal
Carotid sinus sickness
Situational

64
Q

Cardiac Syncope

A

Dysrhythmias
Structural disease

65
Q

Cerebrovascular/neurologic syncope

A

Migraine
Subclavian steal
TIA
Carotid artery disease

66
Q

Orthostatic Syncope

A

Autonomic failure
Drug-induced
Volume depletion

67
Q

Patho Neurally Mediated Syncope

A

Autonomic reflex
Vasodilation + bradycardia
Systemic hypotension + cerebral hypo perfusion
LOC

68
Q

Carotid Sinus Sickness

A

Over-activity or over-stimulation of carotid sinus
Quick head movement
Tight collar
Shaving over sinus area
Tumor or other growth
Emotional stress

69
Q

Orthostatic Syncope Patho

A

Upright position causes hypotension and cerebral hypoperfusion without bradycardia
Standing up with exertion or with prolonged standing in crowds
Hypovolemia/faulty ANS

70
Q

Medications affecting Orthostatic Syncope

A

Diuretics
B-adrenergic blockers
Anti-hypertensives
NTG

71
Q

Common Dysrhythmias causing syncope

A

Transient VT
AV block
Sinus bradycardia
SVT, VF
Sick sinus syndrome
Pacemaker malfunction
Long QT

72
Q

Structural Cardiac Syncope

A

Cardiac Ischemia
Outflow obstruction
Restrictive cardiomyopathy
Pericardial tamponade
PE
Aortic dissection
Congenital

73
Q

Subclavian Steal

A

Occlusion/stenosis of subclavian artery or innominate artery

Causes retrograde flow in ipsilateral vertebral artery

Collateral pathway takes blood from contralateral vertebral artery and basilar artery to supply blood to arm

74
Q

Pre-syncopal S/Sx

A

Weakness, headache, blurred vision, diaphoresis, n/v

75
Q

Post Syncope S/Sx

A

Persistent drowsiness, headache, dizziness, nausea

76
Q

S/Sx Cardiac Syncope

A

Chest pain
SOB
Palpitations
Supine syncope
Exercise syncope

77
Q

S/Sx Reflex mediated syncope

A

Abdo pain
Nausea
Light-headedness

78
Q

Seizures

A

Sudden change in behaviour due to excessive electrical activity in brain

79
Q

Causes of Seizures

A

Electrolyte imbalances
Idiopathic
Epilepsy
Injury/head trauma
Infection
Brain tumor
Stork
Hypoglycemia
Drug use
Alcohol withdrawal
High fever
Eclampsia

80
Q

Causes of Epilepsy

A

Stroke
Brain tumor
Brain infection
Past head injury
Metabolic problems
Neurological conditions
Genetic factors

81
Q

Status Epilepticus

A

Prolonged seizures/numerous seizures without complete recovery between them (>5 min)

One constant seizure lasting longer than 5 min

82
Q

Febrile Seizures

A

Fever >38
Child younger than 6
No CNS infection
NO metabolic abnormality
No history of previous seizures
Generalized vs focal
Short
Single rather than multiple

83
Q

Benzodiazepine Actions

A

Enhance binding of GABA to GABA receptors in CNS
Opening of Cl channels
Hyperpolarization of cell membrane, decreasing ability to reach action potential

84
Q

Midazolam

A

Short acting water soluble
Rapid administration causes hypotension + respiratory depresison

85
Q

Phenytoin

A

Dilantin
Alters neuronal membrane permeability to sodium
Stabilizes membranes and suppresses firing
Does not act as CNS depressant
Effective in partial seizures + tonic-clonic and status
Worsens petit man
Crosses placental barrier

86
Q

Carbamazepine

A

Tegretol
Blocks neuronal sodium channels
Inhibits repetitive action potentials
Drug for partial seizures
CNS depressant and eventually hepatotoxic
Metabolism inhibited by several drugs

87
Q

Phenobarbital

A

Unknown mechanism but generally CNS depressant
Effective in treatment of recurrent seizures
Acute presentations of tonic-clonic and in adults that don’t respond to diazepam
Risk of rebound seizures

88
Q

Valproic Acid

A

Enhances neuronal inhibitory synapses
Myoclonic seizures

89
Q

Primidone

A

Similar to phenobarbital

90
Q

Benzodiazepine Antidote

A

Flumazenil

91
Q

Adverse effects Midazolam

A

CNS depression
Resp depression
Hypotension
N/v
Paradoxical CNS stimulation

Profound risk in elderly, debilitated, chronic illness

92
Q

IV Pharmacokinetics Midazolam

A

Sedation in 3-5 min
Anterograde amnesia in 1-5 min, persists for 20-40 min
Elimination in 1.8-6.4

93
Q

IM Pharmacokinetics Midazolam

A

Peak concentration in 30 min
Peak sedation 30-60 min
Duration ~1hour

94
Q

Midaz Routes Preferred

A

Adults: IM -> IV
Ped: Buccal -> IN -> IM

95
Q

Ketamine MOA

A

Blocks NMDA of GABA receptors
Antidepressive effects due to blockage of HCN1 receptors
Affect on cholinergic, aminergic and opioid systems

96
Q

Side Effects Ketamine

A

Tachycardia
HTn
Increased ICP
Laryngospasm
Hypersalivation
N/v
Confusion, hallucination, paranoia
Impaired motor coordination

97
Q

Anterior Circulation Stroke

A

Most common
Like typical stroke
MCA, ACA, and anterior choroidal artery

98
Q

Posterior Circulation Stroke

A

Difficult to detect with vague, non-specific symptoms

99
Q

Episodic Vestibular Syndrome

A

Symptoms resolved
Vasovagal/panic attack

100
Q

Triggered Vestibular Syndrom

A

Pt sits up and dizzy, resolves when back down
Trigger causes symptom, removal of trigger resolves symptoms

101
Q

Acute Vestibular Syndrome

A

Persistent Symptoms
Trigger, but no improvement with removal of trigger
Possible posterior circulation stroke

102
Q

Pontine Stroke S/Sx

A

Pinpoint pupils
Bilateral paralysis/weakness
Vertigo
double vision
Locked in syndrome

103
Q

CVA Mimickers

A

Hypoglycemia
Encephalopathy
Metabolic
Infections
Systemic
Mass lesions
Migraines
transient global amnesia

104
Q

Todd’s Paralysis

A

Post-ictal hemiparesis
Focal weakness to one side post seizure lasting 20 min - 48 hours

105
Q

Corticospinal Tract

A

Damage causes ipsilateral weakness, spasticity, increased deep tendon reflexes, babinski’s sign

106
Q

Spinothalamic tract

A

Damage causes loss of pain + temperature sensation

107
Q

Dorsal Column

A

Injury causes ipsilateral loss of vibration and proprioception sensation

108
Q

Neurogenic Shock

A

Loss of vasomotor tone and sympathetic nervous system tone
Hypotension + bradycardia + poikilothermia
Occurs within 30 min of cord injury T5 or above, lasts up to 6 weeks

109
Q

Spinal Shock

A

Acute spinal cord injury
Absence of all voluntary and reflex neurologic activity below site of injury
Lasts days to months

110
Q

Neurogenic Pulmonary Edema

A

Form of ARDS, increase in pulmonary interstitial and alveolar fluid
Caused by seizures, cerebral hemorrhage, head injury

111
Q

S/Sx of Neurogenic Pulmonary Edema

A

Sudden dyspnea, mild hemoptysis
Tachypnea
Tachycardia
Bibasilar crackles
Respiratory distress
Pulmonary edema with normal JV pressure and absence of cardiac gallop
Fever

112
Q

Autonomic Dysreflexia

A

Body’s resolution of effects of spinal shock
Injuries at or above T6
Sudden HTN, bradycardia, headache, blurred vision, sweating + flushing skin

113
Q

Myasthenia Gravis

A

Auto immune neuromuscular disorder
Signs of muscle weakness of voluntary muscles
Reduction in ACh receptors at synaptic cleft

114
Q

S/Sx Myasthenia Gravis

A

Drooping eyelids
Double vision
Slurred speech
Nasal quality to speak
Drooling
Nasal regurgitation
Weak cough
problems chewing + swallowing
Trouble sitting up/holding head erect
Trouble walking
Feeling SOB

115
Q

Complications of Myasthenia Gravis

A

Myasthenia crisis
Cholinergic crisis
Pneumonia
Sepsis
Complications related to immobility
Respiratory distress
Choking

116
Q

Bells Palsy

A

Rapid onset
15-60 yo
7th cranial nerve affected
Unilateral/bilateral facial weakness
Majority have full recovery

117
Q

Causes of Bells Palsy

A

Infection
Hemorrhage
Tumor
Meningitis
Local trauma

118
Q

S/Sx Bells Palsy

A

Unilateral facial weakness
Aching pain around angle of jaw/behind ear
Headache
tearing
Unilateral mouth drooling + drooping
Inability to control facial expression in smiling, squinting, blinking/closing eyelid
Loss of sensation of taste

119
Q

Complications Bell’s Palsy

A

Corneal ulceration + blindness
Impaired nutrition
Long-term psycho social problems

120
Q

Guillan Barre Syndrome

A

Widespread inflammation or demyelination of ascending/descending nerves in peripheral nervous system
Weakness/paralysis
Muscles unable to respond to commands from brain due to decreased conduction

121
Q

Cause of Guillian Barre Syndrom

A

Unknown
>50% non specific infection 10-14 days prior

122
Q

S/Sx Guillian Barre

A

Lower extremity weakness leading to upper extremity and facial weakness
Sensory and motor loss
Complete paralysis with respiratory failure within 48 hours
Paralysis progressing in 2-3 weeks
HTN
Hypotension
Dysrhythmias
Circulatory collapse

123
Q

Complications Guillian Barre

A

Cardiac failure
Respiratory failure
Infection + sepsis
Venous thrombosis
Pulmonary embolus

124
Q

Cause of Parkinson’s

A

Lack of cells producing dopamine
Inability to relay information from cell to cell

125
Q

S/Sx of Parkinsons

A

Muscle rigidity and akinesia
Jerky tremor
Difficulty walking
High pitched monotone voice
Mask like facial expression
Loss of posture control
Difficulty speaking/swallowing
Decreases with purposeful movement and sleep

126
Q

ALS

A

Progressive degeneration of nerve cells in spinal cord and brain
Unknown cause, suspected excess glutamate

127
Q

S/Sx ALS

A

Twitching + cramping muscles
Loss of motor control in hands + arms
Increased weakness in diaphragm and chest muscles
tripping and falling
Fatigue
Slurred/thick speech
Difficulty breathing + swallowing
Paralysis
Cardiac arrhythmia
Pneumonia
Respiratory arrest

Patient Care (11 decks)

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