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Clin med exam 2 anatomy exam 1 > Ross - common Neuro complaints > Flashcards

Ross - common Neuro complaints Flashcards

1
Q

What is a “FAST” exam?

A 
FAST or Cincinnati scale is a prehospital stroke scale 
F - Facial droop
A - Arm Drift
S- Speech
T - Time of onset (must get exact time)
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2
Q

If a patient has focal weakness what should be your first consideration

A

It is from a neurological origin

i.e. CVA, MS, CN palsy, Guillain Barre, ETC

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3
Q

What is Guillain Barre…

A

A post-infectious polyneuritis causing autoimmune demyelination

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4
Q

Condition that causes ascending Paralysis, loss of deep tendon reflexes but sensation is preserved

A

Guillain Barre syndrome
acute flaccid paralysis that ascends quickly
24hrs

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5
Q

Condition that occurs 3-4 weeks after a viral infection. What is the most common cause of that infection?

A

Guillain Barre Syndrom

Camphylobacter jejuni
But can also occur after previous GI illness, mycoplasma infection, post vaccination

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6
Q

Treatments for Guillain Barre syndrome?

A

Consider CT - rule out intracranial event (can be done with history)
Lumbar Puncture - elevated protein, no WBC in CSF
Admit - monitor respiratory status (NIP test)
Plasmapheresis - filters out antibodies
IVIg

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7
Q

True or False: Bell’s palsy only causes weakness in the lower half of the face.

A

False: causes weakness of entire face (including forehead)

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8
Q

True or False: Bell’s palsy never have taste difficulties or ear pain.

A

False: BP may have taste difficulties and/or ear pain

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9
Q

What other neurological deficits will present in a patient with Bell’s palsy?

A

none. No other neurological deficits are present with isolated BP

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10
Q

True or False: Bells palsy has an acute onset, usually develop over 24-48 hours.

A

True

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11
Q

Name one way to differentiate Bell’s palsy from a CVA.

A

Forehead sparing. A CVA will spare the forehead because each 7th nerve nuclei innervate both sides of the forehead

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12
Q

Should a 68 yo person with suspected Bell’s palsy get a CT scan?

A

Yes. People over the age of 50 should get a CT to assess for CVA. MRI is also an option

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13
Q

Treatments for Bell’s palsy

A

Protect the eye (they are unable to close it)

Consider steroids and acyclovir if 1-4 days within start of symptoms

If persistent 6-8 weeks consider MRI

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14
Q

Which organism produces Botulism Toxin?

A

C. botulinum

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15
Q

What TOXIN inhibits acetylcholine release from pre-synapse at neuromuscular junction?

A

Botulism toxin

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16
Q

What are the 4 D’s of botulism?

A

1) diplopia
2) dilated eyes
3) dysphagia
4) descending flaccid paralysis

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17
Q

What are the 3 types of Botulism?

A

Food born - mainly from home canned goods
Wound form - IV drug users, incubation of 10 days
Infant form - constipation, feeding difficulties, weak cry

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18
Q

Treatment for Botulism

A

Antitoxin - binds to neurotoxins and prevents binding to NMJ

Admit to hospital for monitoring - especially respiratory status

Peds may use Botulinum immune globulin BIG-IV

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19
Q

Causes Descending paralysis

A

Botulism

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20
Q

Bacteria that causes Tetanus

A

Clostridium tetani

Found in soil infected wounds

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21
Q

This pathology starts by causing lockjaw and them moves down

A

Tetanus

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22
Q

How does clostridium tetani cause lockjaw?

A

Bacteria produces toxin tetanospasm by inhibiting the inhibitory neurotransmitter Glycine at the motor nerve endings

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23
Q

You have a person with a very dirty wound at high risk for tetanus. Within how many years should they have had a tetanus shot?

A

5 years

Immunization lasts 10 years but for high risk it is within 5.

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24
Q

Farmer cuts his hand and then falls into the cow pile next to the fence. He has never been immunized for tetanus what should the treatment be?

A

Needs tetanus immunoglobulin AND tetanus immunization.

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25
Q

True or False: Die Hard is a Christmas movie?

A

Yes no other answer is acceptable

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26
Q

Large Vessel CVA’s have a mortality of…

A

40%

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27
Q

Ischemic stokes account for what % of CVA’s

A

80%

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28
Q

Hemorrhagic strokes account for what % of CVA’s

A

20%

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29
Q

CVA’s are caused by

A 
Atherosclerosis
Either Thrombosis (plaques in the arteries) or emboli
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30
Q

The minimum cerebral blood flow the brain needs is ..

A

750ml/min

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31
Q

What cerebral blood flow amount indicates brain death?

A

Below 60 ml/min

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32
Q

These types of strokes usually present with pure motor or sensory deficits; usually associated with chronic HTN.

A

Lacunar strokes

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33
Q

What are the 4 large vessels of the brain?

A

Anterior cerebral artery
Middle cerebral artery
Basalar artery
posterior cerebral artery

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34
Q

True or false: tPA is very helpful in treating lacunar strokes?

A

False. tPA not really helpful

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35
Q

Areas most commonly impacted by lacunar strokes.

A

small penetrating vessels of
basal ganglia
internal capsule
upper brain stem (lenticulostriate arteries)

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36
Q

Examples of Stoke mimics

A 
diabetic - low blood sugar
seizure - postictal, Todds paralysis 
Complex Migraines 
Bell's palsy
Brain tumor
infection
MS
Conversion disorder
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37
Q

4 main risk factors for CVA

A

HTN
Smoking
DM
known atherosclerosis

38
Q

Exam used to assess CVA’s (not the FAST)

A

NIHSS

National institutes of health stroke scale

39
Q

True or false: tPA can be given up to 5 hours after onset of symptoms.

A

False. tPA can be given within 3 hours and 4 if at stroke center

40
Q

What at the 6 must haves before admin of tPA?

A 
non-contrast head CT - read by radiologist 
NIHSS score
Make sure no stroke mimics
Blood pressure under control
Go though exclusion criteria 
Get consent from patient / family
41
Q

What is the mechanism of action of tPA

A

Breaks up fibrin clots by plasmin activation

42
Q

Controversy of tPA

A

2% mortality rates in those receiving the drug due to ICB

43
Q

Which large vessel would you suspect if a patient could not move their leg?

A

Anterior cerebral

44
Q

Which large vessel would you suspect if a patient presented with face / arm paralysis, gaze towards defect, and homonymous hemianopsia?

A

Middle cerebral

45
Q

In CVA’s localized to the areas of posterior circulation what signs / symptoms would you expect?

A

Impaired vision, visual agnosia and 3rd nerve palsy
can have LOC
impairment of thought process

46
Q

Contralateral motor/sensory loss in limbs and facial sensory findings (pain/temp) are indicative of what area of infarct?

A

Cortical infarcts

47
Q

In brain stem infarcts what location would you get deficits?

A

Crossed findings - Left limbs and Right arm (visa versa)

48
Q

A lesion in this area would cause coma, miosis, and gaze paralysis

A

Pontine lesion

49
Q

This type of brain lesion would result in dizziness, nausea, and difficulty standing.

A

Cerebellar lesion

50
Q

While waiting to get your patient to CT for a suspected CVA what general treatments would you provide?

A

Oxygen / airwary management - prevent hypoxia
address any hypoglycemia - give glucose if needed
HTN management - Labetalol
Head of bed - 30 degrees
No PO fluids

51
Q

Transient episodes of neurologic dysfunction caused by ischemia of spinal cord, retina or CNS with infarction are called.

A

Transient ischemic attacks

52
Q

10% of TIA patients develop _____ _______ ______ within 3 months, half of them within the first 48 hours

A

Acute ischemic stroke

53
Q

ABCD2 scale for hospitalization

A 
Age > 60
Blood pressure >140/90
Clinical feature unilateral motor
Duration: greater than 60 min
Diabetic
54
Q

Which medciation should a patient be on “for life” after suffering a TIA?

A

Asprin. Reduces mortality and morbidity

55
Q

The #1 risk factor for hemorrhagic bleeds?

A

Anticoagulation (Warfarin)

56
Q

Are from which more subarachnoid bleeds originate?

A

5 ARM STAR OF DEATH!!!! or circle of willis

57
Q

What is the gold stardard diagnostic test for Subarachnoid hemorrhages?

A

Lumbar puncture

58
Q

Pt reports sudden onset of “worst headache of my life” and possibly began during exertion or valsalva is experiencing what time of event?

A

Subarachnoid hemorrhage

59
Q

Meningitis / brain abscess have which classic symptoms?

A

Photophobia, neck stiffness, fever

60
Q

Limitation or pain with eye movments can be caused by?

A

Cavernous sinus thrombosis

61
Q

Red flags of new onset HA after age 50 could indicate?

A

glaucoma
temporal arteritis
Intracranial lesion

62
Q

Work up for first time headache or red flag headache?

A

Electrolytes, CBC
CT head with and without contrast - masses or blood
Subarachnoid bleeds need LP
CT angiogram
MRI - bad for acute blood but good for tumor, masses, small strokes

63
Q

Pt with fever, HA, and RAPID DECLINE you should consider _______ _______

A

Herpes enchephalitis

64
Q

Cluster Headaches

A 
Age 2-50
M>F
Periorbital pain and unilateral 
tearing, nasal discharge and conjunctival irritation
can have ptosis 
Treatment is with 100% O2
65
Q

ICH pseudo tumor

A 
Typically female
Overweight
HA for months
Papilledema 
CT / MRI normal
Need LP to measure opening pressure
66
Q

A clear definition of migraine is..

A

3 attacks in 6 months

67
Q

A sphenopalatine ganglion block is used to treat?

A

Migraines

68
Q

Dopamine agonist treatments for migraine

A

Prochloperazine (Compazine)

Metoclopramide (Reglan)

69
Q

5-HT agonist for migraine

A

Erogtamine, sumatrytphan DHE 45

70
Q

Steroids for migraine

A

Dexamethasone (Decadron)

71
Q

Anti-inflammatory for migraine

A

Ketoralac (Torodol)

72
Q

Treatment for Temporal arteritis

A

biopsy and steroids immediately

73
Q

Which type of seizure is the most concerning and causes changes in mental status?

A

Tonic-clonic

74
Q

Which type of seizure is this: Brief eposodes of unresponsiveness usually no motor activity. Pt does not remember the event

A

Absence seizure

75
Q

True or false: partial seizures have bilateral tremors and loss of consciousness.

A

False. Usually does not cross midline. There is no change in mental status

76
Q

What is the most common mimic of a seizure?

A

Syncope

77
Q

SICK DRIFTER for DDx of seizures

A 
Substrate
infection
cation's (Na, Ca, mag)
Kids (eclampsia)
drugs
rum (alcohol)
Illness (chronic seizure disorder)
Fever
Trauma
Extra toxins
Rat poison
78
Q

True or false: Todds paralysis causes bilateral deficits

A

false. Unilateral. Todds paralysis is a residual neuro deficit occurs after a seizure

79
Q

True or false: First time seizures need an urgent full work up.

A

True

80
Q

ED seizure workup for first time or atypical seizures

A

Head CT, CMP, LFT’s
Lactate, prolactin (both will be increased after a seizure)
Consider tox screen, ETOH

81
Q

Acute Seizure medications

A

Potentiate Gaba –Benzodiazapines

  • -Lorazapam 0.1 mg/kg
  • -diazepam 5-10mg q4min up to 30

Inhibition of Na dependent action potentials

  • -phenytoin: 20mg/kg
  • -phosphenytoin 20mg/kg

Inhibition of Ca channels

  • -valproic acid
  • -gabapentin
82
Q

When a patient does not return to baseline mental status before another seizure starts or if a seizure lasts more than 5 min

A

Status Epilepticcus

83
Q

Treatment for status epilepticcus

A

Oxygen, ECG monitor, keep safe
Glucose
Lorezapam (ativan) 0.1mg/kg IVP

84
Q

True or false: You should treat eclampsia seizures with Magnesium and Benzodiazapines

A

True. Eclampsia presents with seizures, proteinuria, and edema.
May occur up to 8 weeks post partum

85
Q

PRES syndrome

A

Posterior reversible encephalopathy syndrome

  • -seizures
  • -AMS
86
Q

True or false: Simple febrile seizures longer than 15min

A 
False.  
Simple febrile seizures <15min duration
age 6months - 5 years 
Otherwise healthy
Key - child had fever and the mental status is normal a few min after the seizure
87
Q

Complex febrile seizures features

A

Duration >15 min
Any focal neurological features after or during seizure
outside age range (6month -5year)

88
Q

Work up for peds 1st time seizure

A

Check glucose!

CBC, blood culture, metabolic panel, LP

89
Q

Exam preformed to assess for CVA (not the FAST)

A

NIHSS

national institutes of health stroke scale

90
Q

True or false: tPA can be given within 5 hours of symptom onset?

A

False. tPA must be given within 3 hours, 4hours at stoke centers

91
Q

The 6 must haves before giving tPA?

A 
Non-contrast head CT
NIHSS score
Make sure no stroke mimics
Blood pressure under control
Go though exclusion criteria 
get consent from patient / family

Clin med exam 2 anatomy exam 1 (8 decks)

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