nervous system Flashcards Preview

joy's deck for FNP > nervous system > Flashcards

Flashcards in nervous system Deck (36):
1

dangerous headaches

thundercalp
sudden

2

bacterial meningitis

stiff neck, classic purple colored petechial rash. emergency

3

temporal arteritis (giant cell arteritis)

headache one side of temple
temple has indurated, red, cordlike artery, tender
jaw pain (artery obstruction)
at risk: poymyalgia rheumatica

4

narrow angle glaucoma

ED
headache/pain behind an eye, n/v
cornea an looks hazy, pupil is dilated midway

5

stoke

hemorrhagic- uncontrolled HTN, abrust heacha, nuchal rigidity

embolization (afib, immobilzation )

6

subarchnoid hemmorhage

"worse headache of my life", stiff neck,

7

mini mental exam

orientation
reigstration (recite 3 unrelated words)
attention
calculation
spell "world" backward or serial 7's
look for aphasia (difficulty speaking)

8

cerebellar system

romberg

romberg- arms/hands staring on each side, close eyes.

positive- swaying
next, tell pt to hold arms straight



9

tandem gait

walk straight
then walk, toe to toe

10

sensory tests

vibration - use 128 hz and place distal joint of each thumb
shar/dull
temperature

11

stereognosis

ability to recognize familiar object through touch

12

graphesthesia

ability to identify number or letter written on skin

13

motor exam

gait, pronator drift , pincer grasp, etc

14

reflexes grading

0= no response
1= low response
2= NORMAL
3= brisk
4=clonus

15

quadricep reflex ( knee jerk)

tap patellar

reflex center at L2 to L4

16

achillis reflex

L5 to S2

17

plantar reflex

L4-S2

18

test for meningeal irritation

kerning's sign: resistance to leg straight dt hamstring tightness ( or c/o back pain)

brudzinski's flexes hips/knee when head is passively flexed

nuchal rigitiy: touch chest with the chin= pain
.

19

Cranial nerve test for zoster

CN 5 (trigeminal) ophthalmic branch can lead to corneal blindess

20

cranial nerves

Olfactory
Optic
Oculomotor
Trochlear
Trigeminal
Abducents
Facial
Acoustic
Glossopharyngeal
Vagus- damage causes increase heart rate, difficulty swallowing
Spinal accessroy
Hypoglossal

21

bacterial meningitis

acute bacterial infection of the brain/spinal cord (S. pneumonia, N. meningitides, H. influenza


3 main s/s:
fever
nuchal regidity

22

labs for meningitis and rx

lumbar puncture: CSF (cloudy csf), MRI

Rx: IV cephlasporins plus chloramphenicol
infants: ampicillin
>50: amoxcilllin plus 3rd genertion cephalosprin

Prophylaxis oaf close contact with rifampin or ceftriaxon. REPORTABLE

23

3 most common bacteria strain for meningitis

Neisseria meningitidis (meningococcus),
Streptococcus pneumoniae (pneumococcus), and
Haemophilus influenzae type b (Hib).

24

migraine tx

5 HT 1 agonists: sumatriptain (imitrex)

first, r/o cardiovascular disease (MI, angina, CVA, TIA)

do not start within first 2 wks of maoi use

25

propylactic migraine tx

propranolol (Inderol)
TCA: amitriptyline (elevil) at HS
neurontin

26

tests and tx for temporal arteritis (giant cell arteritis)

tests: ESR and SED rte
normal rnge ESR 0-22 (men), 0-29 (women)

tx: high dose prednisone

high risk of blindness (refer to ophthalmologist asap for biopsy and tx)

27

polmyalgia rheumatica

high risk for developing temporal arteritis!

s/s: morning stiffness and aching (shoulders, hips, torso (diffictuly putting on clothes/bra).

28

trigeminal neuralgia (tic doulourux)

3 divisions; opthalmic, maxi ally, and mandibular

unilateral headache dt compression of nerve root, located near nasal and cheeks ( near nose/chewing area)

tx: high dose anticonvulsants (i.e. carbamezipin/tegretol or phenytoi/dilantin. MRI

29

bells palsy

unilateral facial paralysis dt dysfunction of CN 7 (facial). tear production on affected side may stop.
viral, autoimmune, pressure from a tumor

rule out: stroke, TIA, mastoid infection, fracture, lyme disease, tumor
corticosteroids at high dose x 10 days
acyclovir if herpes suspected
copmlications- corneal ulceration

30

cluster headache

SEVERE one sided headache
"ice pick" behind one eye, tearing
several times a day, resolves spontaneously

tx: high dose 02 ( don't use if COPD)
Sumatriptan (imitrex)

31

rebound headache

over use of nsaids, aspirin, narcotics. taper the dose

32

TIA

resembles a stroke but resolves in 24 hours.

33

test for carpal tunnel syndrome

tinel's sign (pins and needles when tapping wrist)
phalen's sign (full flexion of wrist for 1 min causes tingling sensation of media nerve.

34

bilateral headache

muscle tension ( all others are unilateral )

35

trigeminal neuralgia (tic douloureux)

pain on ONE side of the face/cheek precipitated by talking, chewing, cold food, cold air

36

cluster headache

ONLY headache accompanied by TEARING and NASAL CONGESTION. sever pain ONE side of eye.

middle aged males
risk of suicide.