Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

CM 4 GERI & NEURO > Sz, Stroke and Infections > Flashcards

Sz, Stroke and Infections Flashcards

1
Q

define these types of seizure

Absence:

Myoclonic:

Tonic:

Clonic :

Atonic :

Tonic-clonic :

A

Absence: petite mal sz –cessation of activities, blank stare

Myoclonic: brief shock like contraction of m.

Tonic: ↑ in muscle contraction (extension)

Clonic : prolonged repetitive contractions

Atonic : loss of muscle tone

Tonic-clonic : sequence of tonic followed by clonic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

dx of SZ

A

FS Glu – hypoglycemic common cause of seizure

Head CT/MRI - Evaluation for underlying cause of SE

EEG

  • Evaluation for continuing Sz activity
  • Distinguish between types of epilepsy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

define types of SZ & causes

provoked

unprovoked

focal

generalized

A

Provoked – have an underlying cause

  • Hemorrhagic ischemia / stroke
  • Encephalopathy
  • Drugs/alcohol

Unprovoked – no underlying cause

  • Prior stroke, vascular malformation
  • Dementia
  • Brain tumors

Focal - one cerebral hemisphere

Generalized –BOTH hemispheres

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

define status epilpeticus

A

Continuous Sz OR Repeated Sz w/o resumption of consciousness

Sz duration: 15-30 min

Practically: ≥2 discrete Sz lasting ≥5 min

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

status epilpticus sz can be divided into what 2 categories

A

convulsive

nonconvulsive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

tx of convulvive SZ

first IV
second IV

NO IV access
when stable

A

FIRST IV – benzos IV Lorazepam/ diazepam

  • Wait 3 mins and give more benzo

SECOND IV – anticonvulsants

  • Fosphenytoin / phenytoin
  • Valproic acid/ Levetiracetam

NO IV Access: IM / IN/ Buccal Midazolam

  • Rectal Diazepam

+/- airway management + Continuous EEG

Once Stable: Midazolam/ Propofol/ Pentobarbital infusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

GCSE: –> irreversible neuronal injury

A
  • Cardiorespiratory dysfunction
  • Hyperthermia
  • Metabolic derangements
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

GCSE sequelae:

A

Cardiac arrythmias

Hypoventilation/hypoxia

Systemic manifestations

Aspiration pneumonitis

Neurogenic pulmonary edema

Respiratory failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

age afected by febrile sz

A

6m – < 5y ,

Peak age: 18m

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

define 2 types of febrile SZ

A

Simple (more common) generalized sz

  • <15 min, no recurrence in 24 hrs

Complex (focal) >15 min w/ Multiple Sz in 24h

  • Younger kids OR Dev. Issues
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

si/sx of febrile SZ

A

happen QUICK

  • Generalized tonic – clonic
  • Staring w/ change in muscle tone
  • Jerking movements w/o prior stiffening
  • Focal stiffness or jerking
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

RF for febrile SZ

A
  • Temp >38°C
  • Viral infection
  • Recent immunization(MMR, DTap)
  • FHx/ Neurodevelopmental delays
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

tx of febrile sz

>5 min

not controlled w/ first line

rectal diazapam if at risk for??

A

Sx >5 min

  • IV Diazepam or Lorazepam
  • Buccal Midazolam / IN Lorazepam
  • Cardiorespiratory support

febrile status epilepticus not controlled w/ benzo –> Fosphenytoin

Rectal diazepam if at risk for:

  • Recurrent OR prolonged febrile Sz
  • Very low threshold for febrile Sz
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

febrile sz- EEG & LP should be done??

A

LP: Concern for CNS infec.

  • <12
  • Prolonged complex febrile
  • Febrile status epilepticus
  • pretreated w/ abx
  • Sz after 2nd day of illness

EEG: Febrile status epilep

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

most common cause of embolic stroke

A

AFIB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

most common cause of ICH/ ischemic stoke

A

Hypertension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

define causes of hemhorragic stoke and list examples

A

•Bleeding into the cranial cavity

  • Intracerebral hemorrhage (ICH)
  • Subarachnoid hemorrhage (SAH)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

define causes of ischemic stoke and list example

A

Too little blood supply (oxygen and nutrients) to a part of the brain

  • Thrombosis (atherosclerosis)
    • Large Vessels (classic) – suddenly develop paralysis
    • _Small Vessel_s (indolent symptoms/dementia)
  • Embolism (cardioembolisms)
  • Systemic hypoperfusion – not enough perfusion to entire brain due to systemic issue such as hypoperfusion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

____and_____ strokes can develop hemorrhagic conversion

A

Thrombotic and embolic strokes can develop hemorrhagic conversion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

define SAH

A

Rupture of arterial aneurysms that lie at base of brain

Bleeding from vascular malformations that lie near the pial surface –>AV malformations

  • Where CSF fluid would travel
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

pathophys of SAH

A

Blood is released directly into CSF under arterial pressure–> Blood spreads quickly though CSF –> rapidly ↑ICP

  • Death or coma if bleeding continues
  • Bleeding lasts only a few seconds but rebleeding is common
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Abrupt onset, sudden, severe, widespread HA (“thunderclap” HA) “worst HA of my life”

A

SAH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

pathophys of ICH

A

Derived from arterials or small arteries bleeding directly into the brain –> forms localized hematoma that spreads along white matter pathways

  • Accumulation of blood over minutes to hours
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

RF for SAH

A

HTN

ETOH

Smoking

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

RF for ICH

A
  • HTN
  • ETOH
  • Cocaine/amphetamines
  • Advancing age
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

si/sx of ICH

A

Symptoms increase gradually over minutes to hours

  • do not begin abruptly and are not maximal at onset
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

ICH si/sx basd on location

putamen & internal capsule

cerebellum

left temporal lobe

A

putamen & internal capsule –> contralateral limb motor and/or sensory signs

cerebellum –> difficulty walking

left temporal lobe –> aphasia

  • Headache
  • Vomiting
  • ↓ consciousness if hematoma large enough to ↑ICP
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Coma is a complication of what type of stroke

A

SAH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

thrombotic stroke can be divided into what 2 categories

give examples of each

A

Large Vessel Disease

Extracranial aa:

  • Internal carotid arteries
  • Vertebral arteries

Intracranial aa: Circle of Willis & proximal branches

Small Vessel Disease: AKA Lacunar infarcts

Intracerebral arteries arise from:

  • distal vertebral artery
  • basilar artery
  • middle cerebral artery stem
  • Circle of Willis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

define Lacunar Infarcts

cause

mechanisms

A

Small (0.2 to 15mm in diameter) – mostly asymptomatic due to size

Non-cortical infarcts, discovered incidentally

Caused by occlusion of single penetrating branch of an artery

Mechanisms for occlusions are most likely from:

  • lipohyalinosis (rather than typical thrombosis/embolism
  • but can also be from typical athersclerosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Lacunar Infarcts are what type of stroke

A

thrombolic small vessel ischemic stroke

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

define Cerebellar tasks

A

Cerebellar tasks

  • Romberg
  • heel to shin
  • finger to nose
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

when speaking w/ a stroke pt is it MOST important to ???
this is due to what about medication admin??

A

establish the time of onset of stroke symptoms

*Therapeutic window for IV thrombolysis- 4.5 hrs from symptom onset

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

tx of acute stroke

A

Thrombolysis w/n 4.5 hrs (best if <60min)

  • thrombolysis (Alteplase = tPA)

BP management: thrombolysis tx only <185/<110

Fluid management (IVNS)

  • ↓intravascular volume
  • avoid excess free water - exacerbate cerebral edema

Tx hypoglycemia (can cause focal neurologic deficits that mimic stroke and can cause neuronal injury)

Tx hyperglycemia (may augment brain injury)

Admit to telemetry

35
Q

ischemic stroke ongoing tx

A

Mechanical thrombectomy –> large artery occlusion in the anterior circulation w/in 24hours of symptom onset

Aspirin w/in 48 hours of onset

High intensity statin therapy

HTN management

36
Q

work - up of cause of stroke

cardioembolic

astherscolerosis

A

Cardioembolic

  • Heart Rhythm Monitoring - EKG, continuous telemetry, holter monitor – assess for Afib
  • Transesophageal echo

Assess for atherosclerosis / risk:

  • Bilateral carotid US –> i_nt carotid a. stenosis_
37
Q

secondary prevention of stroke tx

atheroscleosis

Afib

A

Atherosclerosis:

  • Clopidogrel (Plavix) or Aspirin + ER dipyridamole (Aggrenox)
  • OR just Aspirin

For afib: Anticoagulation

  • Warfarin (Coumadin)
  • Dabigatran (Pradaxa)
  • Rivaroxaban (Xarelto)
  • Apixaban (Eliquis)
38
Q

List TOAST Classification for stroke

A

Large Artery atherosclerosis –

  • Carotid a.
  • Vertebral a.
  • Circle of Willis

Cardioembolic – Afib/ flutter

Small Vessel occlusion:

  • Atherosclerosis
  • Lacunar infarct

Undetermined other etiology

Undetermined etiology

  • Two or more causes identified
  • Negative evaluation
  • Incomplete evaluation
39
Q

causes of systemic hypoperfusion

A

Cardiac pump failure (ex. arrest, arrythmia)

DEC CO (ex. MI, PE, hemorrhage)

Iatrogenic (ex. aggressively lowering BP)

Encephalopathy

40
Q

identify and describe complication of systemic hypoperfusion

A

Watershed infarct - most severe global ischemia

Occurs in border zone regions b/w major cerebral supply arteries

  • Cortical blindness
  • Stupor
  • Weakness of the shoulders and thighs, sparing face, hands and feet “man-in-a-barrel
41
Q

imaging options for stroke & thir pros and cons

A

Non-Contrast Head CT >48hrs– r/o bleed, other causes (Rapid)

  • Will NOT demonstrate acute stroke; takes 24-48h to show up on CT

MRI brain : <48 hrs Sensitive & Detects early, evolving cerebral infarction

  • Limited by availability, cost, claustrophobia
42
Q

identify classifications of stroke on NIH stroke scale

A

0 – no stroke sx

1-4 minor stroke

5-15 mod stroke

16-20 mod-severe stroke

21-42 severe stroke

43
Q

High-risk cardiac sources of embolic stroke

A
  • **Afib and paroxysmal Afib
  • Rheumatic mitral or aortic valve disease (dilated chambers)
  • Bioprosthetic and mechanical heart valves (immediate post-procedure
  • Atrial or ventricular thrombus
  • Sinus node dysfunction (atrial thrombus)
  • Sustained atrial flutter (atrial thrombus)
  • Recent MI (↓ inotrope and/or ventricular wall stunning post reperfusion)
  • Dilated cardiomyopathy
  • Infective endocarditis
44
Q

Other Potential Cardiac Source of Embolic Stroke

A
  • *Patent foramen ovale
  • Mitral annular calcification
  • Atrial septal aneurysm
45
Q

MC cause of Thrombotic stroke

artery invilved?

A

•Atherosclerosis (internal carotid aa.)

46
Q

MC cause of embolic stroke

A

Afib

47
Q

MC cause of thromboembolic stroke

A

carotid a. stenosis –> second leading cause of ischemic stroke after Afib

48
Q

second leading cause of ischemic stroke after Afib

A

carotid a stenosis

49
Q

differentiate b/w CVA and TIA

A

Transient ischemic attack (TIA) – “mini stroke” like ischemia – no death of brain tissue

  • neurologic sx are temporary < 24hours.

Cerebrovascular accident (CVA = infarction) – causing long lasting death of brain tissue (>24 hours

50
Q

Goals of stroke rehab

A
  • Functional restoration
  • Community reintegration
  • Maximize quality of life
51
Q

initial stroke rehab interventions

A
  • Assess ability to swallow (aspiration is a large risk)
  • Patient and caregiver education
  • Motor assessment, activation, exercises
52
Q

deficits addressed during stroke rehab

A

Language:

  • aphasia – speech pathologist, computer (or ipad) based modalities
  • Dysarthria – articulatory treatment

Cognition

  • Attention/ Concentration
  • Perception / Memory / Executive functioning

Swallowing

53
Q

common pathogens responsible for bactera meningitis

A

N. meningitidis: no predisposing conditions & Occurs in outbreaks

  • High-risk groups: individuals who live in close quarters

S. pneumoniae

  • Infection: PNA, OM, Sinusitis
  • Asplenia
  • Hypogammaglobulinemia
  • Complement deficiency
  • Alcoholism
  • DM
  • Listeria

S. aureus

54
Q

classic triad of bacterial meningitis

A

Classic triad:

  • •Fever
  • •HA (worse w/ movements)
  • •Nuchal rigidity
55
Q

lost si/sx of meningeal irritation

A
  • Neck stiffness: Resistance in flexion (touch chin to chest)
  • Kernig’s sign & Brudzinski’s sign
  • Jolt accentuation of HA
  • Meningococcal rash
56
Q

define positive kernig & brudzinski signs

A

Kernig’s sign – pt supine w/ hip flexed to 90 –>

  • knee cannot be fully extended (+)

Brudzinski’s sign – passive flexion of neck causes flexion of legs & thighs

57
Q

meningitis : Head CT/MRI: Prior to LP if:

A
  • Head trauma
  • Concern for mass lesion
  • Immunocompromised state
  • Known malignancy
  • Focal neurologic findings
58
Q

compare / contrast LP in bacterial vs viral meningitis

A

Bacterial

  • ↑OP >20m
  • ↑cell count (PMNs, L shift) >1000
  • ↑protein >100
  • ↓glucose <10

Viral

  • ↓OP <20
  • cell count (Lymphocytes) 5-500
  • protein 5—150
  • glucose normal
59
Q

common pathogens responsible for viral meningitis

A
  • Enteroviruses
  • VZV

•HSV

  • EBV
  • Arthropod viruses
  • HIV
60
Q

tx of bacterial meningitis

A

Broad spectrum abx

  • vanco + ceftriaxone or cefotaxime
  • OR vanco + ampicillin + 3rd gen ceph

LP is delayed –> Obtain Blood Cx & Start empiric antibiotics

ICU admission

Dexamethasone

61
Q

tx of viral menigitis

A

none

Hospitalized, severe cases w/ HSV, EBV, VZV

IV Acyclovir

62
Q

bacterial meningitis prevention

A

Vaccination

Chemoprophylaxis of close contacts

In meningococcal disease: Rifampin

  • Alt: Ciprofloxacin, Azith, CTX

H. influenzae: unimmunized <6 yr Rifampin

63
Q

name 2 types of viral encephalitits and their causes

A

Sporadic –> herpesvirus

Endemic –> arbovirus (ex. WNV)- summer

64
Q

si/sx of viral encephalitiis

A

Like viral meningitis + sx of brain tissue involvement:

  • Altered consciousness
  • Seizures
  • Focal neuro- findings

Meningeal signs: variable

65
Q

si/sx of viral encephalitis

HSV

WNV

St Louis or WNV

mumps

rabies

VZV

A

HSV encephalitis: Frontotemporal region:

  • Olfactory hallucinations, Anosmia
  • Bizarre behavior, Memory disturbance

Hemiparesis, Aphasia, Seizures

WNV encephalitis:

  • Motor manifestations -> acute poliomyelitis-like paralysis
  • Maculopapular rash

St Louis or WNV encephalitis:

  • Tremors of the eyelids, tongue, lips, extremities

Mumps: –> Parotitis

Rabies:

  • Hydrophobia, aerophobia
  • Pharyngeal spasms, hyperactivity

VZV: grouped vesicles in dermatomal pattern

66
Q

dx of viral enceph

A

CSF studies: CSF profile similar to viral meningitis

  • lymphocyte predominance
  • Viral PCR
  • Viral specific Ab
  • Viral Cx

MRI: ↑ signal in R temporal lobe confined predominantly to the gray matter

EEG

67
Q

tx of viral encephalitis

HSV OR Severe EBV, VZV encephalitis:

CMV encephalitis:

A

HSV OR Severe EBV, VZV encephalitis: Acyclovir

CMV encephalitis: Ganciclovir +/or Foscarnet

68
Q

tyopes of cerebral edema and their causes

A

Vasogenic (BBB breakdown) –> Peritumor edema

Cellular

  • Insult of glial, neuronal & endothelial cells
  • Traumatic brain injury, Stroke

Interstitial (Disruption of CSF outflow) – meningitis

Osmotic (osmolarity) - Hyponatremia, DKA

69
Q

in cerebral edema Prompt identification is crucial bc??

A

IF untreated –>

brainstem compression & herniation –> death

70
Q

tx of cerebral edema

A

ICP monitoring & management:

  • Positioning
  • Hyperosmolar therapy: Mannitol, Hypertonic NS
  • Antipyretics
  • Sedatives, Paralytics
  • Modulation of PcO2
  • Surgical intervention

Glucocorticoids –> vasogenic edema

NO hypotonic IVFs

71
Q

brain stem herniation is a complication of what dz??

A

cerbral edema

72
Q

RF for brain abcess

A

•Otogenic (Paranasal sinusitis)

•Dental

  • Cardiopulmonary (cyanotic heart dz, ToF, PFO, endocarditis)
  • Head injury
  • Neurosurgical procedures
73
Q

typical presentation & triad of si/sx in brain abcess

A

Typical presentation: expanding intracranial mass lesion

Triad

  • headache
  • •fever
  • •focal neuro- deficit:
74
Q

dx of brain abcess

A

Stereotactic needle aspiration –> gram stain & cx

Head CT/MRI: Focal areas of hypodensity surrounded by ring enhancement

75
Q

tx of brain abcess

A

Neurosurgery drainage + abx

  • Empiric abx (Metronidazole, Vanco, Ceftriaxone)

Glucocorticoids: Dexamethasone- prevent cerebral edema

Anticonvulsant ppx – to prevent SZ

76
Q

Infection within epidural space around spinal cord

•Hematogenous or direct spread

Dx? most common pathogen??

A

Spinal epidural abscess

S. aureus

77
Q

si/sx of spinal epidural abcess

A

Stage 1: Back pain & fever, HA

Stage 2: radicular pain

Stage 3:

  • Spine tenderness
  • Spinal irritation
  • Sensory deficits

Stage 4: hemiplegia/quad

78
Q

tx of spinal epidural abcess

A

IV abx & Surgical drainage

  • Vancomycin & 3rd generation Cephalosporin
  • or Cipro-
79
Q

causes of intrcranial epidural abcess

A

Staph. Aureus

Gram negatives

Streptococcus

Anaerobes

80
Q

define Subdural empyema & most liekly cause

A

Infection in the space between dura & arachnoid

  • Usually from infected paranasal sinuses

Sinusitis

81
Q

si/sx of subdural emypema

A
  • HA
  • Fever
  • Neuro deficits
  • Stiff neck
  • ­ ICP
82
Q

bacterial meningitis si/sx of nuchal rigidity shoes reistance to ____

A

FLEXION

83
Q

pt w/ AMS & focal neuro findings?

A

viral encephalitis

CM 4 GERI & NEURO (4 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions