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FNPII Test 3 > Nuro > Flashcards

Nuro Flashcards

1
Q

CM: facial pressure, pain behind forehead and/or cheekbones

A

sinus HA

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2
Q

Uncommon, males primarily
Occurs in cycles, seasonal component
CM: in and around one eye; autonomic symptoms (nasal congestions, sweating of forehead, watery eyes, runny nose) → looks like allergy HA, but on ONE SIDE

A

Cluster HA

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3
Q

Unilateral, punding, pulsating pain; fam hx common
Patho: most unknown; Vascular component instability around trigeminal nerve (neck, forehead, cheek, eye pain)
Typically decrease in elderly → if older individual presenting with HA consider secondary cause, medication overuse
CM: pain, nausea, visual changes, photophobia
Have to ask if worst HA they’ve ever had, if yes → ED to r/o hemorrhage
If systemic components like fever → refer

A

Migraine

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4
Q

Vague sx day before, just not feeling well, moody, irritable → many don’t recognize this

A

Prodrome

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5
Q

ALWAYS sensory, not motor!! Altered vision (most common), taste, smell, speech
Impacts treatment → always ask!

A

Aura

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6
Q

Can last a long time; most difficult to tx is one someone wakes up with

A

HA Attack

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7
Q

Up to 24 hours of feeling “off” after HA; majority experience this

A

Postdrome

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8
Q

Migraine Red flags

A

> 50 y/o, thunderclap HA (worst HA of life), neurological sx, immunocompromised

+ asymmetrical eye reflex, decreased DTR, personality changes

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9
Q

Criteria for migraine without aura (5, 2, 1)

A

5 or more episodic HA lasting 4-72 hours WITH:
2 of the following
Unilateral location, throbbing/pulsating, worsened by mvmt, moderate to severe intensity
1 of the following
n/v, phonophobia/photophobia

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10
Q

PE for Migraines

A

Vitals
neuro exam (CN 2-12, fundoscopic exam (rule out papilloedema), visual fields, strength, DTRs)
skin (meningeal rash → purpura, petechiae)
HEENT
CV

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11
Q

Most common headache, not often seen as people treat at home with OTC
CM: band-like squeezing of the head
Can be indicted my medications or stress

A

tension HA

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12
Q

OTC meds for HA

A

No ASA under 16 (no excedrin migraine!); NO opioids for migraine recommended!
Pt should not take more than 15 doses of NSAIDs/month

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13
Q

Tx of choice for migraine

Serotonin drugs, risk of serotonin syndrome (within 24 hours of initiation)

A

Triptans

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14
Q

NOT 1st line

Can cause peripheral ischemia (contraindicated for hx of CV dx) can cause N/V

A

Ergot derivatives

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15
Q

Can help break cycle of HA after many days

A

Steroids

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16
Q

1st line preventative meds for HA

A 
beta blockers (propranolol)
TCAs (amitriptyline) → none in elderly! ,

Depakote, Topiramate (least side effects; can decrease brain function/cognitive ability);
(alternative: verapamil)

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17
Q

2nd line preventative meds for HA

A

botox, ergot derivative (possible: cyproheptadine, gabapentin)

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18
Q

3rd line preventative meds for HA

A

calcitonin gene-related peptide (CGRP)

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19
Q

5-9 y/o; sx for 1-72 hours; midline abd pain; no HA, n/v; challenging to diagnose

A

Abdominal Migraine

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20
Q

vague presentation → irritable, whiny, appetite off, ℅ head hurting all over (10% school aged have migraines)

A

Young school age HA presentation

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21
Q

can present with headbanging

A

young kids with HA

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22
Q

shift to unilateral, adult-like presentation; recognizing triggers is important
Hormonal, weather-driven, food, lack of structured eating and bedtime routine

A

Adolescent HA presentation

23
Q

Tx pedi HA

A

OTC meds (1st line → ibuprofen, acetaminophen; NO

ASA >16 y/o)Antiemetics (phenergan, promethazine, compazine; NO zofran)

24
Q

PE for pedi HA

A

Vitals, head circumference, neuro, HEENT, mental status, skin, CN1-12
If brain tumor is cause: will have neuro signs (98%), typically gait is off

25
Q

RX meds for PEdi HA

A

Triptans (sumatriptan, rizatriptan >6 y/o; almotriptan, zolmitriptan >12 y/o)
Cyproheptadine (used in neurology, used to be used to help stimulate appetite in older population; can prevent AND treat HA)
Propranolol (titrate r/t possible effects)
*If patient is using more than 2x/week can cause HA

26
Q

What meds not to take with HA while pregnant

What can you take?

A

No ergotamine → category x, known teratogenic effects
Best to stop pre-conceiving

Taper preventative meds
None safe in pregnancy

Acetaminophen
ONLY recommended drug for tx

27
Q

resistance and head or neck pain are elicited when the patient bends over and touches toes

can indicate meningitis

A

Kernig Sign

28
Q

patient spontaneously flexes hip and knees after the examiner passively flexes the neck

Meningeal sign

A

Brudzinski

29
Q

CN 1-12

A

I= smells
II= Visual acuity, visual fields, fundoscopic exam
III, IV, & VI= Pupillary response to light, EOM, ptosis
V= Sensation to light facial touch, temporalis and masseter strength
VII= Symmetry of smile and rise of eyebrows, puff cheeks
VIII= Weber and Rinne; whisper test
IX & X= Say “ahh” see rise of uvula; gag reflex
XI= Shoulder shrug, turn head against resistance
XII= Stick out tongue

30
Q

Acute inflammation of CN VII; common disorder

A

Bell’s Palsy (CN VII)

31
Q

Abrupt onset of unilateral facial sx often preceded by 1-2 days of pain behind ear on affected side
Rapid progressive muscle weakness on one side of the face over 2-3 days
inability to close the eye, sagging of lower lid with subsequent eye irritation and tearing

A

Bell’s Palsy (CN VII)

32
Q

Causes of Bells Palsy

A

herpes simplex, CN lesions (multiple sclerosis, stroke, tumors, lyme dx); increased incidence with DM + lyme dx

33
Q

PE findings w/ bells palsy

A

Decreased nasolabial fold
Asymmetric smile
Pooling of food and saliva on affected side
Alteration of taste on one side of tongue
Hyperacusis of affected side

34
Q

What to rule out with bells palsy

A

STROKE!

35
Q

TX bells palsy?

A

Lubricating eye drops while awake and patch for sleeping → prevent corneal drying
massage/physical therapy of weakened muscles
Prednisone 60-80mg daily x7 days (except in diabetics)
Severe cases: acyclovir 1000mg TID x7 days
send to opthomology

36
Q

Compression of arterial blood supply to CN V
Irritation or demyelination of CN V
Typically develops in females >40

A

Trigeminal Neuralgia

37
Q

Intermittent pain: severe, sharp, shock-like, stabbing → lasting seconds to minutes
Pain from CN V irritated by tactile stimulation or even wind on face
Triggers: tactile stimulation, chewing, swallowing, wind, touching face, other mvmt
Location of trigger area usually 2nd or 3rd division of cranial nerve V
Associated grimacing (tics): tic douloureux with trigeminal nerve stimulation
Frequent relapsing/remitting

A

Trigeminal Neuralgia

38
Q

causes of Trigeminal Neuralgia

A

MS, basilar artery aneurysm, neoplasm, arterial venous compression, brainstem infarction

39
Q

Dx and tx of trigeminal neuralgia

A

Diagnostic= Clinical features, Brain CT/MRI to distinguish other diseases

Tx: 
Neurology referral** 
1st line: carbamazepine (anticonvulsant)
2nd: Baclofen, Lamotrigine 
Surgery if needed
40
Q

Generalized, last <15 min, do not recur in 24 hours

Most simple, last only few minutes, do not cause long term health problems; children 6 mos -5 y/o

A

simple febrile seizure

41
Q

What to do if child has febrile seizure?

A

Note start time; position child on side to prevent aspiration
If >5 min or less than 5 min and not recovering quickly → 911
Take child to ED to evaluate cause of fever

42
Q

Last >15 min OR occurs another time within 24 hours, includes postictal weakness; children 6 mos -5 y/o

A

complex febrile seizure

43
Q

prevention of febrile seizures?

A

Anti-seizure meds → NOT recommended
acetaminophen/ibuprofen → does not reduce risk, but helps with comfort and lowering fever
If prone to febrile seizure: diazepam when child HAS a fever

44
Q

concussion diagnostics

A

HEADSUP (Ace Concussions Exam {ACE}) exam tools

Blood work, scans PRN

45
Q

meds to help recover from concussion

A

Antiemetics, analgesics for acute sx
Antidepressants (SSRI > TCAs)
Amantadine → for poor concentration; concurrent with mental health provider

46
Q

acute tx of concussion

A

Rest from learning, screens, reading (anything taxing to brain)
Expected recovery: 5-10 days college-aged with no comorbidities
Kids may take longer to recover (30 or more days, be conservative in young athletes)
Adults typically recover within 30 days
Individualized mgmt is key!
work/school/sport note for accommodations

47
Q

how to tx cluster HA?

A

try and tx asap- fast onset…parental or nasal (triptan)
Oxygen 10-15 L (get script for pt to have at home)
practice= verapamil, lithium

48
Q

When can someone with concussion return to sports?

A

after gradual stepwise approach …
after the athlete has been asymptomatic for 24 48 h.
An athlete advances through the steps continually as
long as remaining asymptomatic. Each step should be a minimum of 24 h. If any symptoms occur, the athlete should then be asymptomatic for another 24 h before attempting the previous step. The steps include:
(1) no activity
(2) light aerobic exercise
(3) sport-specific exercise
(4) noncontact training drills
(5) full-contact practice
(6) return to play.4

49
Q

HA that comes in waves

A

pheochromocytoma

50
Q

HA not usually aggravated by physical activity

A

Tension

Can tx with CCB, BB

51
Q

Papilloedema
persisitent unilateral HA
abnormal eye movements

A

Red Flags

52
Q

Primary vs secondary trigeminal neuralgia?

A 
Primary= compression of the nerve 
secondary= pressure on the nerve by tumor, MS, cyst etc... "wave-like recurrent pain"
53
Q

What is important to remember when tx trigeminal neuralgia with carbamazepine?

A

titrating up to control the pain the decrease to lowest effective dose

FNPII Test 3 (7 decks)

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