Nevous System Exam #3 Flashcards
1
Q
What is a CVA?
A
cerebral vascular accident
abrupt onset of neurological deficit from lack of blood supply to a specific part of the brain
2
Q
What are 5 non-modifiable risk factors for CVA?
A
gender (females) age (increased age = increased risk) race (AA, Hispanic, American Indian) Family Hx Personal Hx
3
Q
What is the #1 modifiable risk factor for CVA?
A
HTN (control)
4
Q
What are 5 lifestyle habits that increase ur risk of CVA?
A
smoking ETOH poor diet stress sedentary lifestyle
5
Q
Which arteries supple anterior brain circulation? posterior?
A
anterior = internal carotids posterior= vertebral arteries join to form basilar artery
6
Q
What is cerebral autoregulation?
A
ability of cerebral blood vessels to change diameter independently from systemic BP to regulate cerebral blood flow
7
Q
is CO2 a vasodilator or vasoconstrictor?
A
vasodilator = increased blood flow
8
Q
What stimulates ischemic cascade?
A
decreased blood flow (= inadequate ATP)
9
Q
What is a penumbra?
A
surrounds core ischemic area
10
Q
What are 2 classifications of CVA?
A
Ischemic & hemorrhagic
11
Q
What usually precedes an ischemic stroke?
A
TIA
12
Q
What is an ischemic stroke?
A
decreased blood flow to brain secondary to partial or complete occlusion of a vessel
13
Q
Which type of CVA is most common?
A
ischemic
14
Q
what are 2 subdivisions of ischemic strokes?
A
Thrombotic & embolic stroke
15
Q
What is a warning sign that a TIA may happen?
A
athersclerosis
16
Q
What is true of Sx of TIA?
A
they are temporary!
17
Q
What causes a thrombotic stroke?
A
a thrombus located in a cerebral vessel that causes narrowing and occlusion
18
Q
What are risk factors for thrombotic stroke?
A
athersclerosis!
HTN, DM & TIA
19
Q
What is the onset like of a thrombotic stoke?
A
gradual progression of Sx over period of time b/c collateral circulation can compensate initially. No LOC change in 1st 24 hours. Around 72 hours infarction & cerebral edema peak
20
Q
When do thrombotic stokes most often occur? why?
A
during or after sleep b/c liver makes clotting factors during sleep.
21
Q
What is a lacunar stroke?
A
occlusion of a small artery that results in cavity formation, not infarction. Asymptomatic unless multiple occur over period of time
22
Q
What is an embolic stoke?
A
a stroke that occurs when a plaque breaks off & enters cerebral circulation (usually originates from heart) causing necrosis & edema at affected area
23
Q
What is associated with development of emboli?
A
heart diseases
24
Q
What causes a hemorrhagic stroke?
A
cerebral hemorrhage causes a lack of blood flow to brain
25
What are 2 subdivisions of hemorrhagic stroke?
intracerebral & subarachnoid
26
What are S/Sx of intracerebral hemorrhagic stroke?
Sudden onset N&V with SEVERE HA, decreased LOC, HTN as body tries to compensate
27
Where is bleeding in intracerebral hemorrhagic stroke?
directly into brain tissue from deep cerebral blood vessel
28
What is the primary cause of an intracerebral hemorrhagic stoke?
HTN (weakens blood vessels)
29
Which kind of stroke has the slowest recovery time?
intracerebral hemorrhagic stroke, extensive residual loss!
30
Where is bleeding in subarachnoid hemorrhagic stroke?
into the subarachnoid space
31
What is the most common cause of a subarachnoid hemorrhagic stroke?
ruptured aneurysm
32
What are S/Sx of a subarachnoid hemorrhagic stroke?
N/V, SEVERE HA, seizures & stiff neck (b/c CSF fills with blood causing increased pressure)
33
What is primary complication we are concerned about with a subarachnoid hemorrhagic stroke?
Vasospasms (narrowed vessels)
| ICU monitoring for 2 weeks until risk decreases.
34
What is an arteriovenous malformation (AVM)? and what causes them?
tangled web of arteries connected directly to veins with out a capillary bed
caused by traumatic injury
35
What can a CT tell you about a CVA?
differentiate between ischemic & hemorrhagic
| size & location of lesion
36
What Dx test is used after a TIA? why?
CT angiogram. to visualize occlusions & narrowing in blood vessels
37
What does an MRI show you in reference to a CVA?
extent of the damage, more accurate than a CT
38
What is the best Dx tool for locating source of subarachnoid hemorrhagic stroke?
Cerebral angiogram
39
When is a LP performed after CVA?
If suspected subarachnoid stroke, but CT negative. LP will show blood in CSF. Contraindicated with IICP!!
40
Which factors affect the S/Sx of CVA??
site & size of lesion
rate of onset
presence of collateral circulation
41
What does FAST stand for?
Facial weakness
Arm & leg weakness
Speech problems
Time is tissue
42
What are S/Sx of CVA?
Unilateral numbness or weakness of face, arm, leg
confusion or other change in mental status
trouble speaking
visual disturbances
ataxia
43
If a patient has a MCA stroke where will they experience Sx?
UE compared to LE
44
Motor Sx of stroke are contralateral. Why? and what does contralateral mean?
lesions on R side of brain affect L side of body and vice versa. b/c motor pathways cross at the medulla
45
What is dysarthria?
difficulty with motor aspect of speech = slurred speech. Impaired pronounciation, articulation, phonation
46
What do L sided lesions cause?
L= Language & Lengthy (pt becomes more cautious)
47
What do R sided lesions cause?
R= Rapid (quick & impulsiveness) & Risk for falls
| problems with space & awareness, time & judgement
48
What is neglect syndrome?
when a patient denies their own body parts (more common with R side lesions)
49
What is homonymous hemianopsia?
blindness that occurs in same half of visual field in both eyes (more common with R side lesions)
50
What is agnosia?
Inability to recognize an object (more common with R side lesions)
51
What is apraxia?
Inability to perform sequential movements on command (more common with R side lesions)
52
What lifestyle changes can be made to prevent stroke?
diet, exercise, control HTN!!!, smoking cessation
53
What is medication therapy for TIA?
Antiplatelet medications (ASA, plavix)
Oral anticoagulation for those w Afib (coumadin & predexa)
Statins to control cholesterol & reduce athersclerosis
54
What are surgical Tx for TIA?
```
carotid endarterectomy (removal of plaques from carotid artery)
EC-IC (anastamose an extracranial artery to an intracranial artery to perfuse beyond an obstruction)
Transluminal angioplasty (balloon inflated in carotid artery to open vessel)
```
55
Why do we not Tx HTN in acute stage of stroke until it is greater than 220?
b/c the HTN is a compensatory mechanism to improve perfusion of brain
56
why is airway compromised in ischemic stroke?
decreased LOC
57
What is drug therapy for ischemic stroke?
tPA- tissue plasmainogen activator. "clot buster"
58
When must tPA be taken?
3-4.5 hours after onset of 1st S/Sx
59
Where is tPA administered with an MCA stroke?
locally at the blockage site guided via catheter, within 6 hrs of Sx onset
60
What is surgical Tx for ischemic stroke?
MERCI (mechanical embolus retrieval in cerebral ischemia) clot pulled out of body using corkscrew like instrument
61
Acute hemorrhagic stroke care:
Maintain BP & increase cerebral perfusion AFTER aneurysm is treated. (must stop bleeding first)
seizure prophylaxis
62
What is hemorrhagic stroke drug therapy?
Antiplatelet & anticoagulation therapy CONTRAINDICATED!!!
| Nimotop!!
63
What does nimotop do?
prevents vasospasm
64
Surgical therapy for hemorrhagic stroke?
craniotomy to evacuate hematomas > 3 cm
Tx of aneurysm: coils or clamp
Tx of AVM: Radiation causes to clot off or "super glue" to reduce
65
When should you initiate ROM exercises?
Day 1!
66
When turning pt to prevent pressure ulcers, how long should they lay on their affected side?
30 minutes
67
Why do we avoid enemas for stroke patients?
b/c excess stimulation of vagal nerve can increase ICP
68
What kind of IVF should be used with ICP?
hypertonic IVF
69
What should you teach pt with homonymous hemianopsia?
to scan environment
70
After how much time are deficits considered to be permanent?
6 months
71
What is a hordeolum?
a sty
72
What is an acute infection of the sebaceous gland on the lid margin called?
a hordeolum
73
What causes a hordeolum?
staph aureus
| poor hygiene & cosmetic use
74
What are S/Sx of a hordeolum?
local erythema, edema, pain
75
What are Tx for hodeolum?
warm, moist compresses
| ABX topical or eye drops
76
What is a chalazion?
Chronic (wks to months) inflammation of the meinomian (sebaceous) gland with granuloma
77
S/Sx of chalazion?
granuloma = hard, shiny lump within eyelid, with local erythema, edema & pain
78
What is Tx for chalazion?
compresses QID
| surgical removal if impacting vision
79
What is the most common infection worldwide?
conjunctivits
80
What is conjunctivitis?
inflammation & infection of the conjunctiva
81
What is "pink eye"?
conjunctivitis caused by bacteria
82
S/Sx of bacterial conjunctivitis?
crusting, tearing, redness, epiphora, irritation & mucopurulent drainage
83
What is Tx for bacterial conjunctivitis?
ABX eye drops to shorten duration from weeks to just days
84
What is Tx for viral conjunctivitis?
there is no Tx to cure or shorten duration
| topical steroids can help with discomfort if severe
85
What is trachoma?
bilateral conjunctivitis caused by a chlamydial infection
86
What are 2 types of trachoma?
```
Chlamydial trachomatis (Serotypes A-C)
AIC (adult inclusion conjunctivitis (serotypes D-K)
```
87
What is the most preventable cause of blindness worldwide?
Chlamydial trachomatis (serotypes A-C)
88
How is chlamydial trachomatis spread?
Not sexually! contaminated hands & flies, poor sanitation
89
How is AIC spread?
sexually transmitted. does not cause blindness!
90
What are S/Sx of Trachoma?
mucopurulent drainage, erythema, irritation & edema
91
What is Tx for Trachoma?
ABX oral or ocular
92
What causes neonatal conjunctivitis? What are S/Sx & how is Tx?
exposure to chlamydia or gonorrhea during birth.
S/Sx= ocular inflammation, yellow D/C, & edema.
Tx= erythromycin ointment (all babies prophylactically)
93
What is Keratitis?
corneal inflammation or infection caused by injury, bacteria, virus or fungus
94
How is bacterial keratitis Tx'ed?
subconjunctival ABX (injection into conjunctiva)
95
What is most common cause of viral keratitis?
herpes
96
What do mydriatics cause?
| What are cyclopegics?
Mydriatics cause pupil dilation by constricting iris muscle
| cyclopegics cause pupil dilation by blocking Ach @ the iris sphincter
97
What is a corneal ulcer?
complication of corneal infection where corneal tissue is lost. ER b/c cornea is avascular & cant defend itself
98
What is Tx for corneal ulcer?
topical anti-infective qhour 24 hr/day for up to 3 weeks
99
What is blepharitis?
"Eye dandruff" inflammation of lid margins caused by staph or seborrhea
100
What are Sx of blepharitis?
itching, erythema, scales, crusting, burning
101
What is Enucleation?
Surgical removal of the entire eye & part of the optic nerve
102
What is panopthalmitis?
inflammation of all 3 layers of the eye (sclera, cornea & retina)
103
What is keratoconjunctivitis sicca?
decrease in quality or quantity of tears "dry eyes"
104
What is a retinoblastoma?
Malignant retinal tumor
105
What causes retinoblastoma?
chromosome 13
106
What are S/Sx of retinoblastoma?
Cat's eye, strabismus, erythema, swelling
107
What is Tx for retinoblastoma?
enucleation
108
What is emmetropia?
normal vision in which cornea bends light and focuses it on the retina precisely
109
What is myopia? & how is it Tx'ed?
Near-sightedness (far vision is blurred) too long so image focuses in front of retina
Tx with concave lenses
110
What is hyperopia? & how is it Tx'ed?
Far-sightedness (near vision is blurred) too short so image focuses beyond the retina
Tx with convex lenses
111
What is presbyopia?
form of hyperopia that occurs with aging (MOM!!!) lens becomes rigid & can't accommodate near objects
112
Astigmatism?
irregular corneal shape causes image to focus on 2 points of the retina
113
What is strabismus?
"cross-eyed"
114
What is amblyopia?
"lazy-eye"
115
What are cataracts?
lens clouding or opacity of lens caused by changes in metabolism = H2O accumulation in lens
116
How are cataracts Dx'ed?
Opthalmoscope or slit lamp
117
How are cataracts Tx'ed?
surgical cataract removal = only cure
118
What is Aphakia?
absent lens, either congenital or surgical
119
What is Glaucoma?
increased intraocular pressure caused by an obstruction in outflow of aqueous humor (secreted by ciliary body)
120
What occurs as a result of inability to drain aqueous humor?
increase in pressure decreases blood flow to retina and puts pressure on optic nerve = vision loss
121
How is glaucoma Dx'ed?
```
tonometry readings (normal = 10-21 mmHGg)
slit lamp microscopy
gonioscopy (to measure angle & distinguish type)
```
122
What is primary open angle glaucoma?
inadequate outflow caused by clogging of the tribecular meshwork. 22-33 mmHg
123
S/Sx of Primary open angle glaucoma?
gradual peripheral vision loss, "tunnel vision"
124
What is Tx for primary open angle glaucoma?
Beta-Blocker drops decrease aqueous humor production by effect on ciliary body
Alpha adrenergic blockers decrease aqueous humor secretion
miotics/cholinergics increase outflow @ tribecular meshwork by contracting iris sphincter muscle
125
What is closed-angle glaucoma?
| AKA primary angle-closure glaucoma
medical emergency: sudden onset of increased IOP. vision loss will occur within 48-72 hours.
126
What are S/Sx of closed-angle glaucoma?
Frosted cornea, halos around lights, sudden pain, N&V, HA, blurry vision, tonometry 50+ mmHg
127
Tx of closed-angle glaucoma
hyperosmotics (glycerin or osmotriol)
128
What medications must patients with glaucoma never take?
mydriatics & cyclopegics
129
What is age-related macular degeneration?
Partial blindness (macula= sharp, central vision
130
What are 2 types of macular degeneration? Which is more common? Which is more serious?
Dry & wet
Dry = more common
Wet = more serious
131
How is macular degeneration Dx'ed?
Amsler grid: lines appear wavy
Opthalmoscope exam: look at retinal layer to see drusen or vessels
Fundal photography IV angiography determine wet or dry
132
Tx for dry mac-degen:
| Tx for wet mac-degen:
Dry: antioxidants & betacarotene
Wet: IV injection of photosensitive dye, activated by cold laser, causes destruction of abnormal blood vessels.
Also vitreous cavity injections of Macugen, Avastin, Lucentis (inhibits endothelial growth factor responsible for abnormal proliferation of blood vessels)
133
What are 2 types of retinopathy?
| Which is more severe?
Nonproliferative & proliferative
| Proliferative is more severe
134
S/Sx of retinopathy:
Blurred vision, floaters, spots, black/red lines
135
What are characteristics of nonproliferative retinopathy?
microaneurysms, retinal swelling, & hard exudates
136
What are characteristics of proliferative retinopathy?
collateral circulation forms, new vessels are fragile & weak, hemorrhage easily, bleed into vitreous cavity blocking light focusing.
137
Dx retinopathy:
fluorescein angiography (inject dye to look for leakage of broken vessels)
138
Tx retinopathy:
Photocoagulation
| Vitrectomy (drain vitreous cavity if blood present, replace with saline)
139
what separates in retinal detachment:
sensory retina (rods & cones) separates from pigment epithelium (nourishing layer)
140
What are S/Sx of detaching retina?
vision changes or loss with out pain, floaters, cobwebs, photopsia (light flashes)
141
S/Sx of detached retina?
depends where detached, peripheral or central vision loss, described as curtain falling over eye
142
What is Tx for retinal detachment?
for tears: stimulate inflammation to induce scarring to seal hole/tear. photocoagulation, cryopexy
for detachment: surgery required:
scleral buckling procedure
Pneumatic retinopexy: injection of gas bubble puts pressure on retina to help reattach
143
What is important after pneumatic retinopexy?
head position to keep bubble at site (like a carpenters level)
144
What is total blindness?
no light perception or visual field
145
What is functional blindness?
some light perception but not visual field (inadequate to guide in anyway)
146
What is criteria to be considered legally blind?
visual field less than or equal to 20 degrees
| visual acuity 20/200 or less with correction
