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IDC Stuff > Clinical Care of the Nervous System > Flashcards

Clinical Care of the Nervous System Flashcards

1
Q

If a patient complains about a vice like headache and hypertonicity of neck muscles what are you thinking

A

Tension headache

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2
Q

What is the treatment for tension headaches

A

NSAIDS
ibuprofen 400-800mg PO q 4-6 hrs
max 2400mg/34hrs

 Napoxen 250-500mg PO q12hrs 

 Acetaminophen 325/1000mg PO 4-6 
 hrs Max 4G/24hrs
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3
Q

Middle ages man comes in agitated complaining of a headache with intense unilateral pain that starts around the temple or eye what are you thinking

A

Cluster headache

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4
Q

how long do cluster headaches usually last for 15 - 30 min

A

cluster headaches

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5
Q

if you suspect a cluster headache what should you ask about reassurance about headache

why

A

when do you have these types of headaches ?

cluster headaches occur seasonally and are grouped together

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6
Q

what other type of symptoms are you looking at if you suspect a cluster headache

A

ipsilateral congestion or rhinorrhea

Laceration and redness of the eye

Horner syndrome
Ptosis- drooping of the eye
Miosis- excessive pupil constriction
Anhidrosis- No sweating

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7
Q

how should be your first treatment of choice for a cluster headache

A

100% O2 for 15 min

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8
Q

what is a secondary treatment of choice for a cluster headache

A

Sumatriptan SubQ -6mg repeat if needed after 1hr max does 12mg/24hrs

or

Oral Zolmitriptan - 2.5mg repeat if needed after 2 hrs max dose 10mg/24hrs

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9
Q

a patient comes in complaining about a gradual build up of throbbing headache what are you thinking

A

migraine

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10
Q

if you suspect a migraine headache what questions are you asking

A

do you have a aura, visual disturbances, or hallucinations

Family Hx

Nausea vomiting

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11
Q

how should migraines be treaded

A

avoidance of precipitating factors, with treatment of Sx and prophylactics treatment

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12
Q

what shroud you do for the PT during an acute attack

A

have them rest in a quite dark room until Sx subside

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13
Q

what are abortive treatment for migraines

A

Simple analgesics and NSAIDS

Ketoralac 30mg IV/IM every 6 hrs or single dose of 60mg IM max 120mg/24hrs

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14
Q

what is the dosage of Sumatriptan for migraines

A

One oral dose of either 25/50/100mg

or

6mg IM

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15
Q

what is prophylaxis for migraines

A

antihypertensive - such as beta blockers

anticonvulsants

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16
Q

what should be given sx of migraines

A

antiemetics promethazine

antihistamines for nausea and vomiting

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17
Q

what is common tohave after a head injury

A

post traumatic headache

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18
Q

within how many days may a patient have a post traumatic headache

A

within 1-2 days and last for 7 10 days

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19
Q

what is usually accompanied with a post traumatic headache

A

impaired Memory

emotional Instability

poor Concentration

Emotional instability

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20
Q

what is the treatment for post traumatic headaches

A

No treatment

Sx management with

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21
Q

patient comes in complaining of headaches unresponsive to medications that use to work for their headaches what are you thinking

A

medication overuse headache

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22
Q

how do you treat medication overuse headaches

A

withdraw abused medication

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23
Q

how long should patients expect to recover from medication use headaches

A

months

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24
Q

what patient population are seizures common with

A

childhood and late adulthood

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25
Q

what is a seizure

A

an abnormal, excessive hypersynchronous discharge from an aggregate of CNS neuros

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26
Q

what are the the two types of focal seizures

A

focal seizure with retained awareness

focal seizure with impaired awareness

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27
Q

focal seizure with retained awareness were formally known as

A

simple partial seizure

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28
Q

focal seizure with impaired awareness were formally known as

A

complex partial seizure

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29
Q

how does a focal seizure with retained awareness present

A

depends on the foal area involved

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30
Q

what type of focal seizure does the patient appear to be awake but not coherent

A

focal seizure with impaired awareness

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31
Q

what do patients with focal seizure with impaired awareness usually remember

A

no memory of the event

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32
Q

patients with focal seizure with retained awareness or impaired awareness exhibit what automations

A 
facial grimacing
gesturing 
lip smacking 
chewing 
replacing words or phrases
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33
Q

focal seizure with retained awareness or impaired awareness exhibit what automations affect what part of the brain

A

only one part of the brain

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34
Q

Generalized seizure effect what part of the brain

A

the entire brain

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35
Q

what is the most common type of generalized seizure

A

tonic clonic seizure AKA grand mal

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36
Q

the tonic phase of tonic-clonic seizure is characterized by what

A

sudden muscle stiffening

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37
Q

the clonic phase of tonic-clonic seizure is characterized by what

A

rhythmic jerking

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38
Q

how long do tonic clonic seizure AKA grand mal last for

A

1-2 min

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39
Q

what are the other types of generalized seizures

A

absence seizure

clonic seizure

atonic seizure

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40
Q

what is the the phase called after a seizure

A

postictal phase

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41
Q

what happens in the postictal phase

A

somnolence

confusion

headache that last several hrs

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42
Q

in the postictal phase Todd paralysis happens is this

A

weakness of limbs occur

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43
Q

how are seizures diagnosed

A

video EEG

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44
Q

how are seizures treated

A 
start IV
electrolytes
LFT
CBC
finger stick glucose
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45
Q

During a seizure what can you give

A

Diazepam 5mg IM/IV Q5-10min max 30mg

46
Q

what is status epilepticus

A

single seizure that last 5min or more

or

2 or more seizure before the patient recovers from the last episode

47
Q

how do you treat status epilepticus

A

diazepam
valproic acid 30mg/kg
intubate

48
Q

what type of seizure is not associated with abnormal excessive neuronal activity

A

psychogenic nonepileptic seizure

49
Q

psychogenic nonepileptic seizure last how long

A

more than 2 min

50
Q

are a patients eyes open or closed during a psychogenic nonepileptic seizure

A

closed

51
Q

is there a postictal phase after psychogenic nonepileptic seizure

A

no

52
Q

psychogenic nonepileptic seizure are treated how

A

cognitive behavioral and interpersonal therapy

53
Q

an acute neurological injury that is a result of the interrupted blood flow to the brain is called

A

Stroke

54
Q

what are the two types of strokes

A

Hemorrhagic stroke

Ischemic stroke

55
Q

what type of stroke is one that is caused by a rupture of a blood vessel causing bleeding into the brain and lack of cerebral blood flow leading to ischemia

A

Hemorrhagic stroke

56
Q

what type of stroke is cause by blockage of a blood vessel causing lack of cerebra blood flow leading to ischemia

A

Ischemic stroke

57
Q

what are two subtypes of ischemic strokes

A

transient ischemic attack (TIA)

cerebral vascular accident (CVA)

58
Q

what are the mist common kind of strokes

A

Ischemic 80%

hemorrhagic 20%

59
Q

thrombotic ischemic stoke

A

obstruction of an artery die to a blockage from debris that has broken off from a distal area

60
Q

describe a embolic ischemic stroke

A

obstruction of an artery due to a blockage from debris that has broken off from a distal area

61
Q

describe a systemic hypoperfusion ischemic stroke

A

lack of blood flow to the brain due to lack of blood supply

62
Q

what kind of stroke is defined a a episode of neurological dysfunction caused by a focal brain, spinal cord, or retinal ischemia WITHOUT acute infarction

A

Transient ischemic attack

63
Q

what kind of stroke is defined a a episode of neurological dysfunction caused by a focal brain, spinal cord, or retinal ischemia WITH acute infarction

A

Cerebral vascular accident

64
Q

what is the onset of stoke sx

A

sudden

65
Q

what are sx for strokes

A

Face - drooping or numbness on once side

Arms one limb weaker than the other

Stability- steadiness on feet

talking - slurring garbled, nonsensical words, inability to respond normally

eye-visual changes

react - MEDEVAC

66
Q

intracerebral hemorrhages strokes bleed where

A

directly into the the brain tissue

67
Q

subarachnoid hemorrhage strokes bleed where

A

into the subarachnoid space

68
Q

what type of hemorrhage stroke is associated with “worse headache of my life”

A

subarachnoid hemorrhage

69
Q

what type of hemorrhage stroke has a gradual onset

A

intercranial hemorrhage

70
Q

for treatment of ischemic stroke where should o2 be maintained

A

> 94%

71
Q

for treatment of ischemic stroke what position should patients be placed in

A

reverse Trendelenburg

raise head 30 degrees

72
Q

how should BP of a ischemic patient not be lowered

A

acutely

may be only thing maintaining profusion

73
Q

if ischemic stroke patient BP is above 220 systolic and 120 diastolic what should you lower the be by

A

15%

74
Q

what type of BP medications should be used for ischemic strokes

A

non selective beta blocker

75
Q

if a transient ischemic attack patient shows no neuro exam abnormalities what can be given

A

aspirin with MO guidance

76
Q

what do you think if a patient comes ion complaining of “creeping crawling” or pins and needles feeling” in the limbs

A

Restless leg syndrome

77
Q

what is a aggravating factor of restless leg syndrome

A

periods of inactivity

especially at night

78
Q

what types of medications make Restless leg syndrome worse

A

antihistamines

dopamine receptor antagonist

antidepressant

79
Q

what are Restless leg syndrome diagnosis differentials

A

Volitional movements - foot taping, bouncing leg rocking

Akathisia - intense desire to move

Nocturnal le\g cramps

80
Q

what labs should be drawn for restless leg syndrome

A

iron levels

81
Q

if iron is low in pt diagnosed with restless leg syndrome what should be prescribed

A

ferrous sulfate

82
Q

what is type of injury is a mild subset of TBI

A

closed head injury

83
Q

what happens in a closed head injury

A

force is applied to the brain that creates a shear force at the white/grey matter junction

84
Q

what word is used to describe a injury at the opposite side of the head

A

Coup-Countercoup

85
Q

what are hallmarks for closed head injuries

A

confusion and amnesia

86
Q

in additon to confusion and amnesia what are common signs of closed head injuries

A

vacant stare

delayed verbal expression

inability to focus

disorientation

slurred incoherent speech

incoordination

emotional

memory deficits

87
Q

within how many hours must a MACE exam be administered

A

48 hours

88
Q

during a closed head injury facial fractures are concerning for what

A

occult injury

89
Q

how are concussions managed

A

direct observation for 24 hrs

low level of activity for 24 hrs

no alcohol, sedatives or pain relivers other than NSIAD for 48 hrs

90
Q

what phrase is used to describe an occurrence when a patient is still having sx from the first concussion and suffers a second concussion

A

second impact syndrome

91
Q

what are the two types of cranial fractures

A

linear fractures

Comminuted/stellate

92
Q

what type of fracture has a less risk for underlying damage

A

linear fracture

93
Q

what type of head fracture requires significant force and underlying damage is likely

A

Comminuted/stellate

94
Q

what part of the skull are easiest to break

A

temporal regions

nasal sinuses

95
Q

what is Cushing triad

A

bradycardia

hypertension

raspatory irregularity

96
Q

if do you do if there are are rapid signs of ICP herniation

A

secure/ maintain airway

reveres Trendelenburg 25-30 degrees

97
Q

what type of iv solutions do you not use with ICP/ herniation patients

A

solutions containing glucose or hypotonic

98
Q

hyperventilation should be used how

A

last resort

99
Q

where does epidural hematoma occur

A

between the dura matter and the skull

100
Q

where doe subdural hematoma occur

A

between the dura mater and the arachnoid matter

101
Q

where does a subarachnoid hematoma occur

A

between arachnoid matter

102
Q

what does a epidural hemorrhage usually affect

A

middle meningeal artery

103
Q

hw does epidural hemorrhage present

A

lucid interval with recovery of consciousness

104
Q

when do you intubate epidural hemorrhage patient

A

GCS <8

105
Q

who does a subdermal hemorrhage affect most

A

elderly

alcohol abusers

anticoagulated at risk

106
Q

subdural hemorrhage presents in how many days

A

1-2 days

107
Q

who as more at risk for subarachnoid hemorrhage

A

drug users (coke and amphetamines)

smokers

hypertension

alcohol use

108
Q

what are hallmarks for subarachnoid hemorrhage

A

thunderclap headache

worse headache of my life

109
Q

how do you treat subarachnoid hemorrhage

A

bed rest
analgesia
avoid anticoagulation

110
Q

all service members diagnosed with their 1st TBI concussion must have a minimum of how many hrs of recovery time

A

24 hrs

111
Q

all service members diagnosed with their 2st TBI/concussion within 12 months must have a minimum of how much recovery time

A

7 days

112
Q

all service members diagnosed with their 3rd TBI/concussion within 12 months must have a minimum of how much recovery time

A

until a recurrent concussion evaluation has been completed

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