nervous system Flashcards by Joy Sheppard

dangerous headaches

thundercalp

sudden

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bacterial meningitis

stiff neck, classic purple colored petechial rash. emergency

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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

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narrow angle glaucoma

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

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stoke

hemorrhagic- uncontrolled HTN, abrust heacha, nuchal rigidity

embolization (afib, immobilzation )

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subarchnoid hemmorhage

“worse headache of my life”, stiff neck,

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mini mental exam

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

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cerebellar system

romberg

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

positive- swaying
next, tell pt to hold arms straight

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tandem gait

walk straight

then walk, toe to toe

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sensory tests

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

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stereognosis

ability to recognize familiar object through touch

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graphesthesia

ability to identify number or letter written on skin

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motor exam

gait, pronator drift , pincer grasp, etc

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reflexes grading

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

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quadricep reflex ( knee jerk)

tap patellar

reflex center at L2 to L4

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achillis reflex

L5 to S2

plantar reflex

L4-S2

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
.

Cranial nerve test for zoster

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

cranial nerves

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

bacterial meningitis

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

3 main s/s:
fever
nuchal regidity

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

3 most common bacteria strain for meningitis

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

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

propylactic migraine tx

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

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)

polmyalgia rheumatica

high risk for developing temporal arteritis! s/s: morning stiffness and aching (shoulders, hips, torso (diffictuly putting on clothes/bra).

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

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

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)

rebound headache

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

TIA

resembles a stroke but resolves in 24 hours.

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.

bilateral headache

muscle tension ( all others are unilateral )

trigeminal neuralgia (tic douloureux)

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

cluster headache

ONLY headache accompanied by TEARING and NASAL CONGESTION. sever pain ONE side of eye. middle aged males risk of suicide.