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NNSOCM 2023 > NEUROLOGY W4 > Flashcards

NEUROLOGY W4 Flashcards

1
Q

What are the 3 main functions of CNS?

A
  1. Monitor internal/external environment
  2. Integrate sensory input (understanding-creating sensations)
  3. Coordinate voluntary/involuntary responses
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2
Q

What is a neuron?

A

A nerve cell

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3
Q

What are the components of a neuron?

A
  1. Nuclei (core)
  2. Dendrite (receiver/tentacle)
  3. Axon (transmitter/tail)
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4
Q

What is the function of an afferent nerve cell?

A

Transports sensory input towards the brain

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5
Q

The autonomic nerve system consists of what to types of response?

A

Parasymphatic (inhibitor/relaxation)
Symphatetic (Exiter/fight or flight)

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6
Q

Is it true that neurons can divide and renew them selves?

A

No. Dead neutrons cannot be restored, but their function can be somewhat resumes by other neurons close by

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7
Q

Which molecules are mainly involved in creating action potential?

A

Sodium (Na) and a smaller amount of potassium (K)

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8
Q

What does the myelin (coating) of the axons achieve?

A

Nerve impulse travels faster in highly myilated axons

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9
Q

Name 3 types of nerve terminals

A
  1. Nerve to nerve
  2. Nerve to muscle (neuromuscular-terminal)
  3. Nerve to gland (neuroglandular-terminal)
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10
Q

What happens in the synaptic cleft

A

Neurotransmitters interact with potsynaptic receptors and excites or inhibits a process

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11
Q

Name 3 different methods in which the body disposes of a neurotransmitter after it has been used

A
  1. Diffusion out of the synapsis cleft
  2. Inactivation/decomposition by enzymes
  3. Reuptake into the presynaptic knob (reused)
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12
Q

Name the 3 meninges (protective layers) of the brain

A
  1. Dura mater
  2. Arachnoidea
  3. Pia mater
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13
Q

What are the characteristics of arachnoidea?

A

Spiderlike connections between the two other meninges. Containing CSF (cerebrospinal fluid)

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14
Q

What are the characteristics of pia mater?

A

Thin, delicate, highly vascularised layer closest to the brain

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15
Q

What is the normal daily production amount of CSF

A

500ml

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16
Q

What is the normal constant volume of CSF?

A

150ml

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17
Q

What is the characteristics of CSF?

A
  1. Surrounds the brain and spinal cord
  2. Transports nutrients and waste
  3. Acts as shock absorbent
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18
Q

What is a ganglion?

A

A collection of nerve cell bodies (nuclei)

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19
Q

Name, function and type of CN I

A

Name: Olfactory
Function: Smelling
Type: Sensory

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20
Q

Name, function and type of CN II

A

Name: Optic
Function: Vision (sensory)
Type: Sensory

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21
Q

Name, function and type of CN III

A

Name: Oculomotor
Function: Eye movements (motor)
Type: Motory

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22
Q

Name and function of CN IV

A

Name: Trochlear
Function: Voluntary eye movements
Type: Motory

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23
Q

Name, function and type of CN V

A

Name: Trigeminal
Function: Sensation of head and face, movement of mandible
Type: Sensory + Motory

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24
Q

Name, function and type of CN VI

A

Name: Abducent
Function: Eye movement (lat. rectus)
Type: Motory

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25
Q

Name and function of CN VII

A

Name: Facial
Function: Taste, Facial expression
Type: Sensory + Motory

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26
Q

Name and function of CN VIII

A

Name: Vestibulocochlear
Function: Hearing and balance
Type: Sensory

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27
Q

Name, function and type of CN IX

A

Name: Glossopharyngeal
Function: Control swallowing
Type: Sensory + Motory

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28
Q

Name, function and type of CN X

A

Name: Vagus
Function: Pharynx, larynx-control + speech
Type: Sensory + Motory

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29
Q

Name, function and type of CN XI

A

Name: Accessory
Function: Rotation of head, shoulder shrug.
Type: Motory

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30
Q

Name, function and type of CN XII

A

Name: Hypoglossal
Function: Movement of tongue
Type: Motor

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31
Q

How many peripheral nerve pairs do a human body have?

A

31 pairs

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32
Q

What is a dermatome?

A

An area of the skin a given nerve serves. Therefor the nerve can be tested for function at this given area.

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33
Q

What is a myotome?

A

A muscle that is served by a given nerve. Therefor the nerve can be tested for function at this given muscle

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34
Q

What is the plexus?

A

A structure found many places in the body were several efferent and afferent fibres of nerves merge to form peripheral nerves that innervate a specific muscle or skin area

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35
Q

What is a reflex?

A

A rapid and automatic response to a specific stimulus that happens in the spinal cord

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36
Q

What are the most common and easy recognizable signs and symptoms of meningitis?

A

Fever
Stiff neck
Headache

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37
Q

What is brudzinzki’s sign?

A

The “test” were you bend the patients neck upwards. If the patient flexes the hip upwards due to pain and swollen meninges it is a sign of meningitis.

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38
Q

When should you always perform neurological examination?

A
  1. Suspected head or spinal injury
  2. Complaints of neurological deficits
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39
Q

What are the to causes of stroke?

A
  1. Ischemia (85%)
  2. Haemorrhage (15%)
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40
Q

Name some of the signs & symptoms of stroke

A
  1. Sensory deficit
  2. Motory deficit
  3. Aphasia (speech problems)
  4. Blindness
  5. Dizziness
  6. Decreased LOC
  7. Thunderclap headache (sudden onset, high pain)
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41
Q

Name some causes for seizure

A
  1. Structural disease (e.g. tumor, postinchemic, post traumatic)
  2. Infection
  3. Hypoglycaemia (low blood sugar)
  4. Cerebral edeema from trauma or heat stroke
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42
Q

Name the to types of seizures

A
  1. Localised
  2. Globalised
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43
Q

Name the to types of globalised seizures

A
  1. Tonic (stiff muscles)
  2. Clonic (movement of muscle) - shaking
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44
Q

What are the risks of seizuring?

A
  1. Head trauma
  2. Biting tongue - bleeding
  3. Hypoxia - damage to nerve cells
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45
Q

On the GCS score what would these responses score?
-Eyes open upon speech (eye)
-Gives confused answers (verbal)
-Localizes pain (motor)

A

3 + 4 + 5 = 12

46
Q

If the patient has closed eyes but opens them when you talk to him. How do you rate him on AVPU?

A

V (verbal)

47
Q

A patient has open eyes but makes no sense when he speaks. How do you rate him on AVPU?

A

A (alert)

48
Q

Name the 5 senses

A
  1. Touch/pain
  2. Smell
  3. Hearing
  4. Taste
  5. Seight
49
Q

What is typically indicated with traumatic injuries and GCS <8 ?

A

Patient usually cannot keep airway patent at this point. Intubation may be necessary

50
Q

What does AEIOUTIPS stand for?

A

A: Altitude
E: Environment (hypo/hyperthermia)
I: Infections
O: Overdose (drugs, alcohol)
U: Underdose (lack of sleep)
T: Toxins/trauma
I: Insulin (hypoglycemia
P: Poison
S: Stroke, seizure, shock

51
Q

What does somnolent mean?

A

Patient is sleepy, but can easily be woken

52
Q

What does stupor mean?

A

Patient is in a sleeplike-state, can be woken but it takes some time

53
Q

What does coma mean?

A

Patient is deep unconscious and does not respond to pain

54
Q

What are the qualitative changes to consciousness that we can assess?

A
  1. Disorientation (time, space, situation, personal credentials)
  2. Confusion (hallucination, dillusion)
55
Q

What are the 3 causes for syncope?

A
  1. Neural (reflex of e.g. the vagus nerve) 45%
  2. Orthostatic (fall in BP when moving) 10%
  3. Cardiogenic (heart issues) 20%
56
Q

What does prodromal symptoms mean?

A

Prodromal means “early sign or symptom leaning up to a disease or incident”

57
Q

Name some prodromes (symptoms leading up to) of syncobe

A
  1. Light-headed
  2. Dizziness
  3. Blurred vision
  4. Impaired hearing
  5. Palpitations (feeling of heart pumping hard)
  6. Chest pain
58
Q

Name some informations of the patient which could be used to diagnose cardiogenic syncope

A
  1. Known cardiovascular diseases or family history
  2. Feeling of cardiac arrhythmia or chest pain before syncobe accured
  3. Syncobes happens when supine or durin physical activity
59
Q

What is primary injury (TBI)

A

Traumatic injury (structural damage) to the scalp, scull, meninges, brain and vessels

60
Q

What is secondary injury regarding TBI

A

Injuries to structures in the brain caused by pathology of the primary TBI

61
Q

Name some secondary TBI injuries

A
  1. Mass effect
  2. Herniation
62
Q

What are the causes of meningitis?

A

Infection on meninges and/or brain
1. Viral (e.g. tick born abovirus)
2. Bacterial (e.g. meningococci)

63
Q

Normal ICP (inter cranial pressure)

A

15mmhg

64
Q

What is CPP?

A

Cerebral perfusion pressure
The pressure in which the blood perfuses the brain
CPP=MAP-ICP

65
Q

Why do we hyperventilate a TBI with signs of herniation?

A

To lower ICP and keep the brain from herniating. This causes vasoconstriction in the brain which sadly also leads to hypoxia

66
Q

What happens with ICP if a mass emerges in the cranium due to traumatic injury?

A

ICP increases. To maintain cerebral perfusion MAP pressure must increase as well (causing hypertension)

67
Q

What happens to ICP in decompensated state?

A

ICP rises beyond normal values. To maintain 70-80 mmhg CPP in the brain, only MAP pressure can now increase (causing systemic hypertension)

CPP=MAP-ICP

68
Q

Types of mass effects?

A
  1. Epidural hematoma
  2. Subdural hematoma
  3. Subarachnoid hematoma
  4. Intracerebral hematoma
69
Q

What are the characteristics of epidural hepatoma?

A
  1. Arterial bleed between the cranium and the dura mater.
  2. Often caused by blunt head trauma (e.g. by falling)
70
Q

What are the characteristics of a subdural hematoma?

A
  1. Venous bleed between dura mater and arachnoidea
  2. Slowly evolving symptoms
71
Q

What are the characteristics of subarachnoid hematoma?

A
  1. Aneurism rupture causing arterial hemorrhage
  2. Often at circle of Wilis
  3. Bleeding into sulk and gyri of the brain
72
Q

Signs of herniation

A
  1. Pupils not equal
  2. Flexion/extension of arms/wrists
  3. Extension of legs
  4. Abnormal breathing (cheyne-stoke, Biot)
  5. Cushings phenomenom
73
Q

What is the signs of cushings phenomenom?

A
  1. Systemic hypertension >200mmhg
  2. Bradicardia
  3. Abnormal breathing patterns
74
Q

Signs of TBI (HEADS)?

A

H: Headache
E: Ears ringing
A: Amnesia
D: Double vision
S: Something feels wrong

75
Q

Visual signs of TBI?

A
  1. Battlesigns
  2. Raccon eyes
  3. CSF leaking out of ear or nose
  4. Dilated pupils
76
Q

Classifications of TBI (GCS)

A

Mild: GCS 13-15
Moderate: GCS 9-12
Severe: GCS 3-8

77
Q

What is the most predictive component of GCS for determining neurological outcome?

A

Motory function

78
Q

2 important interventions when dealing with TBI patients? (per TCCC)

A
  1. Disarm
  2. Remove or disconnect communication/radio
79
Q

What are the preferred BP for TBI?

A

100-110 mmhg

80
Q

What can you do as last resort when dealing with TBI were signs of herniation occurs?

A
  1. Elevate upper body 30 degrees
  2. Administer Hypertonic saline (250ml 3-5%)
  3. Hyperventilate (RR 20 ETCO2 30-35 mmhg)
81
Q

TSI severity depends on what?

A
  1. Region of injured spine
  2. How much of the spinal cord that is affected
82
Q

What is primary spinal injury?

A

Initial trauma/structure damage

83
Q

What is secondary spinal injury?

A

Injury that worsens neurological deficit. Can be caused by manipulation/movement of a fractured spine.

84
Q

Types of spinal injury?

A
  1. Complete (both sides of the body affected)
  2. Incomplete (one-sided sensory/motory deficits)
85
Q

What is spinal shock?

A

Acute loss of motory/sensory functions distal typically due to trauma. Reversible over time.

86
Q

What is neorogenic shock and what happens?

A
  1. A type of distributive shock
  2. Vasodilation distal to fracture due to loss of parasymphathetic function. This causes hypotension.
  3. Bradycardia can be present if fracture is in the cervical segment
87
Q

What is worst per GCS motory function: Abnormal flexion or abnormal extension?

A

Abnormal extension (1 point)

88
Q

What does encephalon mean?

A

Brain

89
Q

Cerebellum means

A

Small brain

90
Q

Signs & symptoms of mild TBI?

A

Headache, fatigue, difficulty concentrating, loss of balance, nausia, Insomnia, vision changes, sensivity to light and noise

91
Q

What are the names of the 4 arteries supplying the brain?

A
  1. Carotid arteries (internal left and right)
  2. Vertebral arteries (left and right)
92
Q

What is the function of a efferent nerve?

A

Transports motory signals from the brain towards the muscles

93
Q

What are the characteristics of dura mater?

A

Thick, fibrous (connective tissue), contains vessels and nerves. Protects the brain. Lies closest to the cranium of all meninges

94
Q

Name 3 types of noxious stimuli?

A
  1. Mechanical (pressure, stretching)
  2. Chemical (acid, inflammation)
  3. Thermal (cold, heat)
95
Q

What is a nociceptor?

A

A nerve ending that can react to noxious stimuli

96
Q

What is the physiology of pain perception?

A
  1. Nocicepter reacts (potential dangerous stimuli)
  2. Transduction of stimuli to electrical impulse
  3. Impulse goes via nerves to different parts of the brain for interpretation
  4. A subjective sensation of pain is generated
97
Q

What is referred pain?

A

Typical visceral pain (pain from organs) can be felt as pain in other parts of the body.
Example: Heart muscle ischemia can be felt as pain in the left arm.

98
Q

Name the 3 types of systemic analgesia

A
  1. Opiod (i.e. fentanyl, morphine)
  2. Non-opiod (i.e. paracetamol)
  3. Modulation (i.e. ketamine)
99
Q

What is true regarding mixing of analgesia-types?

A
  1. You can treat with a mix of opioids, non-opioids and modulation-drugs
  2. You shouldn’t treat with a mix of different types of opioids together
100
Q

How does local anaesthesia work?

A

By blocking transmission of the nerves locally (and distal from injection)

101
Q

Which nerves are thickest and requires higher concentration of local anesthetia to work?

A

Nerves in charge of movement (motory)

102
Q

What is a digital nerve block?

A

A local anaesthesia of a finger or a toe

103
Q

What are the most common substances for local anesthesia?

A

Xylocain or Lidocain

104
Q

Talk through the procedure of digital nerve block

A
  1. Assess perfusion of finger/toe
  2. Prep equipment (alcoswap, draw up xylocain into syringe, apply injection needle)
  3. Identify and disinfect injection point
  4. Advance the needle into the area around the dorsal nerve.
  5. Aspirate to check for blood
  6. Inject xylocain (0,5-1ml)
  7. Advance to palmar digital nerve
  8. Aspirate to check for blood
  9. Inject xylocain (0,5-1ml)
  10. Place needle in sharp box when done.
105
Q

How does opioids work?

A

Blocks the feeling/perception of pain in the brain

106
Q

How does non-opioids work?

A

Usually they prevent nociceptors of feeling stimuli. In example NSAIDS decreases the inflammation processes and causes pain relief.

107
Q

What are the physiological responses of pain?

A
  1. Reflex (happens in the spinal cord)
  2. Agitation (sympathetic activity increases)
  3. Syncobe (the brain shuts your consciousness off to prevent you from percieving huge pain)
108
Q

Phrenic nerve paralysis can be caused by injury to what level of vertebrae?

A

C3-C5

109
Q

What are the 3 “high-risk factors” which mandates immobilization

A
  1. Age >65
  2. Dangerous mechanism
  3. Numbness or tingeling in extremeties
110
Q

Abnormal flexion is also called (GCS)

A

Decorticate

111
Q

Abnormal extension is also called (GCS)

A

Decerebrate

NNSOCM 2023 (16 decks)

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