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CCRN > Neurology > Flashcards

Neurology Flashcards

1
Q

What are the 2 “holes” in the skull?

A
  1. Transtentorial notch (small)

2. Foreamen magnum (large)

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2
Q

Supplies blood to lower areas of the brain stem

A

Basal vertebral

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3
Q

Supplies blood to upper areas of the brain

A

Carotids

*Left internal carotid is dominant for most people

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4
Q

Personality, abstract thought, long-term memory

A

Frontal lobe

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5
Q

Hearing, sense of taste and smell, interpretations.

A

Temporal lobe

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6
Q

Vision, visual recognition, reading comprehension.

A

Occipital lobe

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7
Q

Object recognition by size, weight, shape, body part awareness.

A

Parietal lobe

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8
Q

Coordination, balance, gait.

A

Cerebellum

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9
Q

Is a circulatory anastomosis comprised f various arteries that supply blood to the brain. When well-developed, is allows collateral blood flow to one area from another area in the event of an occlusion.

A

Circle of Willis

*Less than 50% have a well developed one

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10
Q

What arteries are apart of circle of willis?

A
  1. Anterior cerebral artery (L & R)
  2. Anterior communicating artery
  3. Internal carotid artery (L & R)
  4. Posterior cerebral artery (L & R)
  5. Posterior communicating artery (L & R)
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11
Q

What artery is not part of the circle of willis?

A
  1. Basilar artery

2. Middle cerebral arteries (MCA)

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12
Q

What is the first sign of a neuro change?

A

Change in LOC.

  • EXCEPT a epidural hematoma that may cause pupil changes before LOC
  • Sometimes personality can change first with brain tumors
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13
Q

In what order does orientation become hindered?

A

Time -> place -> person

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14
Q

A network of neurons connecting the brain stem to the cortex.

A

RAS

  • The upper is responsible for awareness and the lower is responsible for the sleep-wake cycle.
  • If the lower is damaged, coma occurs. If upper, the patient loses awareness but still wakes and sleeps.
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15
Q

Responsible for speech.

-Expressive aphasia & receptive aphasia

A

Broca’s

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16
Q

What is consciousness dependent on?

A

Depends on an intact cerebral cortex and reticular activating system (RAS)

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17
Q

Where do motor neurons cross (decussation)?

A

The medulla

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18
Q

If someone is flaccid, where is damage?

A

Medulla dysfunction

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19
Q

Decorticate dysfunction =

A

Hemispheric dysfunction

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20
Q

Decerebrate dysfunction =

A

Midbrain, pons dysfunction

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21
Q

What is sympathetic effect of pupils?

A

Dilate

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22
Q

What is parasympathetic effect of pupils?

A

Constrict

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23
Q

Where do pupil changes occur?

A

Side of injury

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24
Q

Is abnormal in adults and occurs due to pressure on pyramidal/motor tracts in cerebrum, found on opposite side of damage.

A

Babinski reflex

25
Q

Reflex when the patient’s eyes are held open while ice id injected slowly into the ear canal and the eye response of observed

  • Positive: eyes move toward side of ice water injection
  • Positive is good
A

Occulovestibular reflex

26
Q

What are the 3 components of cushing’s triad?

A
  1. Increase in SBP, widening pulse pressure
  2. Decrease HR
  3. Decrease respirations
27
Q

Midbrain problem causes what breathing problem?

A

Hyperventilation

28
Q

Pontine problem causes what breathing problem?

29
Q

Medulla problem problem causes what breathing problem?

A

Ataxic, ARREST

30
Q

What does obtunded mean?

A

Can speak but mumbles

*Better than stuporous

31
Q

Loss of vision in half the field of each eye.

  • Caused by damage to the optic nerve
  • Contralateral problem
  • Usually results in neglect of the affected side
A

Homonymous

32
Q

What ways do eye tend to deviate?

-Also will see pupil changes

A

TOWARD the pathology

33
Q

Displacement of temporal lobe against the brain stem and 3rd cranial nerve.

  • Lateral shift
  • No initial change in LOC (pupil changes first)
  • Most often caused by epidural hematoma that occurs int he temporal lobe
A

Uncal Herniation

34
Q

Swelling on both sides of the brain causing downward placement of hemispheres.

  • Pupils started small then both dilate
  • May be caused by cerebral edema secondary to encephalopathy or stroke
A

Central Herniation

35
Q

What is the hunt and hess scale used for?

  • Scale is scored 1-5 (5 is the worse)
  • Try to do surgery within 48 hours for grade 1-3
A

Severity of SAH

36
Q

What is the greatest cause of death in SAH?

A

Rebleed

  • Possible 7-10 days after initial bleed with peak incidence on days 4-8
  • Amicr, antifibrinolytic agents help prevent this
37
Q

When are vasospasm most likely to occur?

A
  • Usually occur 5-7 days post-bleed
  • Are associated with hyponatremia
  • Triple H therapy may be used to treat (now controversial)
38
Q

What are early manifestations of a brain tumor?

39
Q

What is the first sign of increase in ICP?

A

Decrease LOC

40
Q

How do you measure cerebral perfusion pressure (CCP)?

A

MAP-ICP

  • Average is 80-100
  • Minimum is 50
  • Brain death is <30
  • When ICP elevated, maintain CPP ~70
41
Q

What is the external auditory meatus level too?

A

The foramen of Monro

42
Q

ICP waves:

A

A wave = awful, B wave = bad, C wave =common

43
Q

What are the two types of TBI?

A
  1. Diffuse: concussion, diffuse axonal injury (DAI)

2. Focal: contusion, intracranial hematomas, skull fracture, open injuries

44
Q

Usually due to meningeal artery bleed secondary to temporal bone trauma with bleeding between skull and dura.

  • Rapidly developing symptoms
  • More common in younger populations
A

Epidural hematoma

Clinical presentation:
-Ipsilateral pupil dilation, often before decreased LOC.

45
Q

May occur due to trauma or spontaneously with bleeding between dura and arachnoid membrane.

  • More common in elderly
  • Can be acute (within 24h), subacute (within 2 weeks), chronic (>2 weeks).
A

Subdural hematoma

-Symptoms develop more slowly

46
Q

Is a linear fracture that occurs int he floor of the cranial vault (skull base), which results in meningeal tear.

A

Basilar skull fracture

S/S:

  • Raccoon eyes
  • Battle’s sign
  • Otorrhea: fluid from ear
  • Rhinorrhea (no nose blowing)- check if spinal fluid by testing sugar (sugar = spinal fluid)
  • Lose of sense of smell

Treatment:

  • Surgery only if CSF fluid persistent
  • Give ABX only if sign of infection
47
Q

What if dilantin levels are therapeutic and patient seizes?

A

Give lorazepam

48
Q

How are benzos reversed?

49
Q

Time to call it status epilepticus?

50
Q

GBS treatment:

A
  • IV immunoglobulin instead of plasma exchange

- Plasmapheresis: will get ride of anti-bodies causing disease

51
Q

Autoimmune attack in neuromuscular junction

A

Myasthenia Gravis

S/S

  • Progressive skeletal muscle weakness
  • Early: easily fatigued
  • 70% have ocular dysfunction
52
Q

Due to undiagnosed/under-treatment or acute exacerbation. Deficiency of acetylcholine.

A

Myasthenic Crisis

53
Q

Due to over-treatment, excess of acetylcholine.

A

Cholinergic Crisis

54
Q

What is the tension test?

A

The patient is given 2 mg IV tension. If symptoms improve then it is myasthenia crisis.
-Patient is asked to hold arms out during administration

55
Q

What happens if tension is given for cholinergic crisis?

A 
S: salivation
L: lacrimation
U: urination
D: defecation
D: defecation
G: GI distress
E: emesis
56
Q

Treatment for MG?

A
  • Pyridostigmine (mestinon, cholinesterase inhibitor) - it prevents the breakdown of acetylcholine.
  • Steroids
  • Immunosuppressants
  • Removal of thyroid gland
  • Plasmapheresis
  • IVg
57
Q

Inherited group of progressive myopathic disorders resulting from defects in a number of genes required for normal muscle function.

  • Causes progressive muscle weakness and atrophy due to defects in one or more genes required for normal muscle function
  • Weakness usually starts in the trunk and extends to the extremities (legs before arms)
A

Muscular dystrophy

*More prone to malignant hyperthermia

58
Q
  • Onset very young, wheelchair bound by 12yrs.

- Most patients die in their early teens or twenties a result of respiratory infection or CM

A

Duchenne muscular dystrophy

59
Q
  • Onset is usually later and symptoms are milder
  • Children can usually walk until they are ~15yrs or even adults
  • Usually survive into their mid-40s usually from heart failure
A

Becker muscular dystrophy

CCRN (8 decks)

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