Neurology

Question 1

How would an obtundated patient present themselves?

Answer 1

lethargic, somnolent, responsive to verbal or tactile stimulation, but quickly drifts back to sleep

Question 2

What kind of patient would present generally unresponsive; may be briefly aroused by vigorous, repeated, or painful stimuli; may withdraw (shrink away from) or localize (grab at) the source of stimuli?

Answer 2

a patient presenting with stupor

Question 3

What scale is used to assess changes in arousal?

Answer 3

glascow coma scale

Question 4

What are the three categories assessed in the Glascow Coma Scale?

Answer 4

Eye opening, verbal response, and best motor response

Question 5

What are three examples of central stimulation? What does this address?

Answer 5

Trapezius pinch, sternal rub, supraorbital pressure
This will assess if the brain stem is still intact/functioning

Question 6

What does peripheral stimulation assess?

Answer 6

spinal cord function

Question 7

If a patient is presenting with decorticate posturing, what may this indicate?

Answer 7

cerebral hemispheric dysfunction

Question 8

If a patient is presenting with decerebrate posturing, what may this indicate?

Answer 8

brainstem dysfunction

Question 9

Is decorticate or decerebrate posturing more concerning? Why?

Answer 9

decerebrate, as this means there is brainstem dysfunction

Question 10

What is the inability to understand written or spoken words?

Answer 10

wernicke’s (receptive) aphasia

Question 11

What is the inability to express language through speech or writing?

Answer 11

broca’s (expressive) aphasia

Question 12

What can pupillary reaction provide information on?

Answer 12

the location of the lesions or mass effect from cerebral edema

Question 13

If both pupils are nonreactive, where is damage indicated?

Answer 13

the midbrain

Question 14

If pupils are dilated on a patient, what is important to assess before getting too concerned?

Answer 14

medications.. atropine and epinephrine can cause pupil dilation

Question 15

If a patient has pinpoint pupils, what can this be an indicator of?

Answer 15

pons lesion or opiate drug overdose

Question 16

What are the two oculomotor responses that determine brainstem integrity?

Answer 16

oculovestibular (caloric) and oculocephalic (doll’s eyes) reflexes

Question 17

What kind of drugs can depress oculocephalic/oculovestibular reflexes?

Answer 17

ototoxic drugs, neuromuscular blockers, and ethyl alcohol

Question 18

What kind of respirations are seen in a bilateral lesion in the cerebral hemispheres, cerebellum, midbrain, or, in rare circumstances, upper pons, and it may be caused by cerebral infarction or metabolic disease?

Answer 18

Cheyne-stokes

Question 19

What type of respirations indicate a lesion in the low midbrain or upper pons and may be caused by infarction or ischemia of the midbrain or pons, anoxia, or tumors of the midbrain?

Answer 19

central neurogenic hyperventilation

Question 20

What may an increased pulse be indicative of?

Answer 20

poor cerebral oxygenation

Question 21

In the late stages of ICP, there will be a ____ in heart rate?

Answer 21

decrease

Question 22

What is the reason that widening pulse pressure may occur?

Answer 22

ICP exceeds MAP

Question 23

What do cranial nerve reflexes indicate?

Answer 23

brainstem functioning

Question 24

What are the 4 protective reflexes?

Answer 24

(1) corneal reflex (blink), (2) gag reflex, (3) swallow reflex, and (4) cough reflex

Question 25

What is the gold standard for measuring ICP?

Answer 25

intraventricular monitoring

Question 26

What are the major disadvantages of having an intraventricular drain?

Answer 26

it is very invasive and carries a high risk for hemorrhage and infection

Question 27

Why is a subarachnoid pressure monitoring device not ideal for someone with an increased ICP?

Answer 27

they are unable to drain CSF

Question 28

What is the anatomic landmark for the lateral ventricle?

Answer 28

foramen of Monroe (tragus)

Question 29

Why is the waveform of a subarachnoid bolt/screw easily dampened?

Answer 29

fragments of bone or brain tissue may obstruct the bolt

Question 30

What is the p1 waveform on an ICP monitor?

Answer 30

pulse pressure

Question 31

What does the p2 waveform represent on an ICP monitor?

Answer 31

compliance of brain tissue

Question 32

What is the p3 waveform on an ICP monitor?

Answer 32

dicrotic wave

Question 33

When do A waves typically occur? What do they look like?

Answer 33

When there is an increase in ICP. They are sharp increases that plateau

Question 34

What kind of neurological changes typically accompany A waves?

Answer 34

decreased level of consciousness, pupillary changes, and posturing

Question 35

What are the two types of cerebral oxygenation monitoring?

Answer 35

jugular bulb oximetry and brain tissue oxygen monitoring

Question 36

What does a transcranial doppler measure?

Answer 36

cerebral blood velocity

Question 37

Three primary types of TBIs

Answer 37

Accelerational/decelerational, Rotational, Penetrating

Question 38

What are the 5 trademark signs of a basilar skull fracture?

Answer 38

Battle sign, raccoon eyes, otorrhea, rhinorrhea, positive halo sign.

Question 39

What are three circumstances that may cause an increase in cerebral blood volume?

Answer 39

hypoxemia and/or hypercapnia, cerebral venous outflow obstruction, or loss of cerebral autoregulation

Question 40

Why does hypoxemia/hypercapnia result in an increased CBV?

Answer 40

it causes vasodilation

Question 41

What term describes the process whereby cerebral vessels have the capacity to dilate or constrict in response to changes in perfusion pressures?

Answer 41

Autoregulation

Question 42

A brief loss of consciousness followed by a period of being alert and oriented and then a loss of consciousness again is a typical presentation for which condition?

Answer 42

epidural hematoma

Question 43

What is the term used to describe an accumulation of blood between the dura and the arachnoid layers of the meninges?

Answer 43

Subdural hematoma

Question 44

What should the MAP be maintained at for management of an intraparenchymal hematoma?

Answer 44

70mmHg or less

Question 45

Presence of dizziness, headache, and confusion for long periods of time after concussion is _______.

Answer 45

postconcussive syndrome

Question 46

What are the components of the beside neurological assessment?

Answer 46

LOC, motor function, pupillary response, respiratory function, and VS

Question 47

What interventions are used to manage cerebral metabolism?

Answer 47

sedation, anticonvulsants, antipyretic therapies