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Flashcards in neuro Deck (235):
1

CN I

olfactory - smell

2

CN II

optic - vision

3

CN III

oculomotor (most EOMs, eyelid opening, pupil constriction)

4

CN IV

trochlear - down/inward eye movement

5

CN V

trigeminal (mastication, sensation: face, scalp, cornea, mucus membranes, nose)

6

CN VI

abducens - lateral eye movement

7

CN VII

facial (move face, close mouth/eyes, taste (anterior 2/3), saliva/tear secretion)

8

CN VIII

acoustic - hearing/equilibrium

9

CN IX

glossopharyngeal (phonation, gag reflex, carotid reflex, swallowing, posterior taste)

10

CN X

vagus (talking, swallowing, carotid body sensation, carotid reflex)

11

CN XI

spinal accessory (trapezius & sternomastoid movement ie shrugging)

12

CN XII

hypoglossal - tongue movement

13

which CN: gag reflex

IX - glossopharyngeal

14

which CN: pupil constriction

III - oculomotor

15

which CN: shoulder shrug

XI - spinal accessory

16

CN type mnemonic

Some Say Marry Money But My Brother Says Big Boobs Matter More

17

CN name mnemonic

On Old Olympus' Towering Tops A Fin And German Viewed Some Hops

18

which CN: make eyes do tricks

III, IV, VI

19

which CN: pure sensory

I, II, VII

20

which CN: puff cheeks

VII

21

which CN: hearing

VIII

22

which CN: seeing

II

23

which CN: smelling

I

24

which CN: raspberry

XII

25

Mental Status Assessment (or MMSE): scoring x4

30 max
24-30 (no cognitive impairment, 27 avg)
18-23 (delirium/dementia)
0-7 (severe impairment)

26

TIA definition *

transient ischemic attack
- acute cerebral insufficiency
- resolves in 3 hours

27

purpose of Mental Status Assessment

discern cognitive impairments

28

TIA causes x2

- ischemia d/t atherosclerosis, thrombus, arterial occlusion, embolus, intracerebral hemorrhage
- cardio-embolic events: a fib, acute MI, endocarditis, valve disease

29

TIA indicative of

impending stroke

30

? TIA pts will experience cerebral infarction w/in 5 years

1/3

31

TIA: 2 classic sx *

altered vision: amaurosis fugax (ipsilateral monocular blindness)

motor impairment: paresthesia in CONTRALATERAL arm, leg, face

32

TIA: s/s x8

- altered vision (amaurosis fugax)
- motor impairment (contralateral paresthesia)
- aphasia
- dysphagia
- vertigo
- nystagmus
- sensory deficits
- cognitive/behavioral abnormalities
(and more)

33

amaurosis fugax is

painless, transient, monocular loss of vision d/t retinal ischemia

- think: TIA

34

aphasia *

loss of language comprehension/production d/t data processing deficit

35

agnosia

failure to recognize form/nature of objects (pattern recognition defect)

agnOsia - Objects

36

apraxia

impaired performance of skilled/purposeful movement

37

agraphia

inability to write

38

dysarthria *

difficulty articulating words r/t motor impairment

39

hemianopia

defective vision in half of visual field

40

hemiparesis *

partial paralysis with incomplete loss of muscle power on ONE (entire) side - WEAKNESS

41

vertebrobasilar TIA cause *

inadequate blood flow from vertebral arteries

42

carotid TIA cause *

carotid stenosis

43

vertebrobasilar TIA: presentation x6 *

vertigo, dizziness
ataxia
confusion
visual field deficits
weakness

44

ataxia *

uncoordinated voluntary movements

45

carotid TIA: presentation x5 *

aphasia
dysarthria
altered LOC
weakness, numbness

46

priority diagnostic test to order in suspected TIA

CT - distinguishes between ischemia, hemorrhage, tumor

47

TIA: labs + diagnostics x5

CT
MRI
echo
carotid doppler/US
CTA

48

CT or MRI: superior for detecting ischemic infarcts

MRI

49

TIA mgmt x5

- aspirin
- clopidogrel/Plavix 75 mg qd PO
- ticlopidine (Ticlid)
- hypertension assessment
- carotid endarterectomy

50

why aspirin in TIA?

reduces CVA incidence, death

51

ticlopidine (Ticlid) AE considerations

associated with agranulocytosis, thrombotic thrombocytopenia purpura, GI intolerance

52

why hypertension assessment in TIA?

#1 cause of heart failure

53

why carotid endarterectomy in TIA?

decreases risk of stroke, death in pt with recent TIA

54

when is carotid endarterectomy indicated? *

> 70 - 80% vascular stenosis in symptomatic patients

55

What is the strongest indicator of functional impairment at discharge? *

Cognitive impairment

56

Most important aspect in assessing mental status

orientation

57

Gold standard diagnostic for TIA

non-contrast head CT

58

Patient is asymptomatic but a carotid bruit is present on physical examination. What is the next step in the plan of care?

Order carotid doppler/ultrasound

59

Patient presents with L hand tingling and carotid Doppler revealed 90% occlusion of both carotids. What is the next step in the plan of care?

Carotid endarectomy of the right carotid first

60

What is the number one cause of heart failure

HTN

61

When do most TIAs resolve

around 3 hours

62

CVA

Rapid onset of neurological deficits lasting longer than 24 hrs

63

CVA causes

aneurysm
atherosclerosis
AVM
HTN (chronic)
trauma
tumor

64

describe the progression of CVA infarct presentation

subtle progressive or sudden neurological deficits
ischemic - gt 80% of CVAs

65

ischemic CVA s/s

LOC changes
motor weakness
paralysis
visual changes
vital sign changes

66

describe the progression of hemorrhagic CVA presentation

acute onset of focal neurological deficits
15-20% of CVAs

67

hemorrhagic CVA s/s x11

headache, sudden ↑ ICP, AMS, vomiting (when hemorrhage extensive)

L (dominant) hemisphere: R hemiparesis, aphasia, dysarthria, difficulty reading/writing

R (nondominant) hemisphere: L hemiparesis, R visual changes, spatial disorientation

68

What s/s do you see with an MCA infarct?

hemiplegia
deviation of eyes towards the lesion

69

s/s specific to hemorrhagic CVA in L hemisphere

R hemiparesis
aphasia
dysarthria
difficulty reading/writing

70

s/s specific to hemorrhagic CVA in R hemisphere

L hemiparesis
spatial disorientation
right visual field changes

71

In which hemisphere would a CVA be occurring if patient presented with right visual changes; left hemiparesis and spatial disorientation?

R (nondominant) hemisphere

72

In a L hemisphere CVA is aphasia an expected finding? What else?

yes
R hemiparesis
dysarthria
difficulty reading/writing

73

A 54 yo F suddenly falls out at church. What CVA do you expect?

hemorrhagic

74

gold standard CVA diagnostic

non-contrast head CT

75

CVA diagnostics

non-contrast head CT
CTA
LP (only if grade I or II aneurysm)

76

What must be obtained before LP?

non-contrast head CT

77

LP: contraindication + why?

large brain bleed
- brain stem herniation can be induced d/t rapid decompression of subarachnoid space

78

CVA: mgmt x8

- thrombotic: fibrinolytics lt *3* - 4.5 hrs of sx onset
- surgical evacuation
- ↓ BP (monitor for cerebral ischemia) + avoid hypotension (exacerbates ischemic deficits)
- ↓ ICP
- MAP 110-130 (tx cerebral vasospasm)
- intravascular vol replacement + hypertensive tx (↑ CPP, blood flow, O2 delivery)
- nimodipine (Nimotop)

OVERALL GOALS: maintain CPP + limit ↑ ICP

79

CVA mgmt: goal MAP & why

110 - 130 mmHg
- treat cerebral vasospasm

80

CVA mgmt: cerebral vasospasms x2

MAP 110 - 130 mmHg
nimodipine (Nimotop) calcium channel blocker

81

CVA mgmt: how to ↑ CPP x2

intravascular volume replacement
hypertensive therapy

(also increases blood flow & O2 delivery)

82

window for tPA in CVA management

less than 3-4.5 hrs since onset of symptoms

83

What increases ICP in CVA?

hypotension
hypoxemia
hypercapnia

84

45 yo. M s/p CVA is intubated on the ventilator. Most recent ABGs read: pH 7.48/pCO2 35/pO2 60 with FiO2 40%. What is your next step?

leave pCO2 at 35

85

What is the function of the lateral rectus muscle?

Moves eyes sideways and back

86

MOA of nimodipine (Nimotop) *

prevent calcium from entering smooth muscles cells and causing contraction

(use for CVA

87

seizure

paroxysmal event resulting from abnormal electrical activity in cerebral neurons

88

simple partial seizure: presentation x 6

rarely gt 1 minute
** no LOC **
parasthesia, flashing lights, hallucinations
motor symptoms start in one muscle group and spread to entire side of body

note: common with cerebral lesions

89

complex partial seizure: what & presentation x3

simple partial seizure followed by ** impaired LOC **
automatisms
aura
staring into space

90

generalized seizure: absence
- aka
- presentation x 3

aka petite mal
sudden arrest of motor activity + blank stare + begin/end suddenly

91

generalized seizure: tonic clonic
- aka
- presentation x 5

aka grand mal

tonic contractions + LOC, then...
clonic contractions
incontinence possible

lasts 2 - 5 min,
followed by postictal

92

status epilepticus is...

series of tonic clonic (grand mal) seizures 10+ min duration
- can occur when awake or asleep BUT consciousness not regained between attacks

MEDICAL EMERGENCY
- most uncommon & most life-threatening

93

seizure assessment: most important questions x3

loss of consciousness
duration
neuro changes after?

94

seizures: diagnostics

assessment (seven dimensions + description)
EEG (most important test)
CT head (indicated for all new onset seizures)

95

seizure classification: most important diagnostic

EEG

96

new onset seizure s/s indicating STAT non-con CT head? x3

headache
vertigo
personality change

97

Order what if pt complains of any of the following? What are you ruling out?
- new onset seizure, headache, vertigo, personality changes

non-con CT head
r/o brain tumor

98

seizure mgmt: initial

supportive (seizures self-limiting)
- maintain open airway
- protect from injury
- admin O2

DO NOT FORCE ARTIFICIAL AIRWAYS OR OBJECTS BETWEEN TEETH

99

seizure mgmt: drug indicated if unresponsive to phenytoin (Dilantin)

phenobarbital (Luminal)

100

status epilepticus: drug of choice + secondary

diazepam (Valium) 5-10 mg IV
phenytoin (Dilantin) = secondary

101

immediate seizure control: drug of choice

lorazepam (Ativan) 1-2 mg/minute IV @ 1 - 2 mg/min

102

Patient education in long-term seizure control

must taper down drugs due to risk for withdrawal seizures

103

most commonly prescribed maintenance (longterm) anticonvulsant?

carbamazepine (Tegretol)

104

new onset seizure: #1 ddx

brain tumor

105

35 yo. M s/p aneurysmal clipping. What is the initial action in the plan of care?

Place patient in a quiet room

106

Which serum abnormality increases the risk for pheyntoin (Dilantin) toxicity?

hypoalbuminemia

107

60 yo. M on Norvasc for HTN management. You find out he likely had an ischemic CVA four hours ago. What about this patient excludes the use of tPA?

time of onset of symptoms (lt3 hrs)

108

29 yo. F admitted to MSICU for ETOH abuse. You notice tremors during the physical exam. What is the next intervention?

administer vitamin B1 for tremors in ETOH

109

myasthenia gravis is...

autoimmune disorder: reduced ACH receptor sites at neuromuscular junction
= weakness that worsens with exercise

110

autoimmune destruction of ACh receptor sites at neuromuscular junction

myasthenia gravis

111

myasthenia gravis: s/s x9

ptosis (#1)
diplopia, dysarthria, dysphagia
extremity weakness (bilateral), fatigue
- worse after exercise, better w rest
respiratory difficulty
senses & DTRs --normal--

112

myasthenia gravis: diagnostics

antibodies to ACh receptors (AChR-ab) - 85%
edrophonium (Tensilon) test

113

myasthenia gravis: mgmt

neurology referral (!)
pyridostigmine bromide (Prostigmin)
immunosuppressants
plasmapheresis
vent during crisis

114

myasthenia gravis: drug of choice + MOA

pyridostigmine bromide (Prostigmin)
anticholinesterase: blocks hydrolysis of ACh

115

multiple sclerosis is...

autoimmune disease: attack of myelin
= weakness + loss of muscular coordination

116

multiple sclerosis: s/s

numbness, weakness, loss of muscle coordination
problems: vision, speech, bladder control

117

myelin: function

nerve insulator, helps with nerve signal transmission

118

multiple sclerosis: s/s x10s

* weakness, numbness, tingling, limb unsteadiness (may progress to all)
disequilibrium
diplopia, optic atrophy, nystagmus
urinary urgency/hesitancy

119

multiple sclerosis: diagnostics

* definitive diagnosis never based solely on labs! *

brain MRI
LP
CSF elevated protein (slight)
Elevated CSF IgG
lymphocytosis (slight)

THINK CSF

120

What is abnormal in multiple sclerosis CSF?

elevated CSF protein & IgG

121

multiple sclerosis: management

* NO CURE - no tx for dz progression *
neurology referral
steroids: recovery from acute relapse ONLY
plasmapheresis
immunosuppressants

classic:
* antispasmodics
* interferon therapy

122

The most common site of intracranial thrombosis is:

middle cerebral artery

123

Differentials for syncope

anxiety
aortic stenosis
hypoglycemia

124

What is the most common sign of vertebrobasilar insufficiency?

Vertigo

125

75 yo. F is diagnosed with a SAH after falling down a flight of steps. She has developed obstructive hydrocephalus. What would be the first sign of increased ICP?

altered LOC

126

50 yo. F is in the neuro ICU POD #1 s/p craniotomy. She develops Cushing's Response. What is the criteria for Cushing's Response and what is it a sign of?

bradycardia
hypertension
irregular RR
late sign of increased ICP

127

guillain-barré syndrome
( what + involves + results )

acute, rapidly progressing inflammatory polyneuropathy
- characterized by: peripheral nerve demyelination
- results: progressive symmetrical ascending paralysis
M/F incidence equal

128

guillain-barré syndrome: progression

- *viral infection* + fever 1 - 3 wks before onset weakness in LE
- acute bilateral symmetrical ascending paralysis
- flaccid paralysis w/in 48 - 72 hrs

129

guillain-barré syndrome: s/s

rapidly progressing ascending paralysis
- cranial nerve impairment: difficulty in speech, swallow, mastication
- reflexes: hypo or absent
- respiratory muscle paralysis

130

guillain-barré syndrome: diagnostics

↑ CSF protein (esp IgG)
CBC: early leukocytosis w left shift
LP, MRI, CT: can aid dx

131

guillain-barré syndrome: management + recovery

- neuro consult
- supportive tx: allow myelin to regenerate
- sx improvement ~2 wks
- recovery ~2 years

132

meningitis is...

infection: pia mater & arachnoid mater membranes of brain or spinal cord

acute bacterial meningitis = medical emergency

133

* fever + neuro symptoms in ANY pt should = concern for what? *

meningitis
- esp w hx infection or head trauma

134

cause of 80-90% meningitis cases

* Streptococcus pneumoniae *
Hemophilius influenzae
Neisseria meningitidis

135

meningitis: s/s

fever (101 - 103F)
nuchal rigidity
+ Kernig & Brudzinski
photophobia, seizures, severe HA
n/v

136

Kernig sign is?

hamstring pain, spasms

137

Brudzinski sign is?

flexion: head to chest = flexion: hips & knees

138

Spasms and pain of the hamstring muscle is...

+ Kernigs

139

Flexion of head and neck to chest causes flexion of hips and knees is...

+ Brudzinski

140

meningitis: diagnostics

LP -- ASAP dx is suspected
CT head

CSF: cloudy/xanthrochromic
+/- ↑ pressure, protein
+/- WBCs present
+/- ↓ glucose

141

bacterial meningitis: CSF findings

cloudy or xanthrochromic
↑ opening pressure
↑ protein
↑ glucose
WBCs

142

meningitis: mgmt

- control sx + maintain lyte balance
- high dose parenteral abx ASAP if bacterial suspected; one of the following:
-- Pcn G
-- vanc + 3rd gen cephalosporin (until C&S available)
-- fluroquinolones

143

most common demyelinating central nervous system disease

multiple sclerosis

144

40 yo. F presents to ED with complaints of bilateral weakness in lower extremities ptosis and diplopia. You suspect myasthenia gravis. What is the diagnostic test that should be done?

antibody ACh
Tensilon

145

CCP: what + normal range

cerebral perfusion pressure
CPP = MAP - ICP
normal: 50 - 130 mmHg

146

viral meningitis: CSF findings

clear
normal glucose & protein

147

chief cause of death in males under 35

accidents (chiefly MVCs)
- 70% involve head trauma

148

which brain bleed is characterized by a lucid interval?

epidural hematoma

149

major complication of head trauma

CUSHING'S TRIAD: increased ICP
- widening pulse pressure (SBP ↑ to maintain CPP - often seen first)
- ↓ RR
- ↓ HR

150

24 yo. F s/p procedure for hematoma. She is currently agitated and combative and the priority intervention is for her to be still. What is next in your plan of care?

sedation with holidays to assess neuro status

151

4 P's of Spinal Cord Injury

paralysis, paraesthesia, pain, position

152

cervical spine injuries result in x3

quadriplegia
problems in arms through hands

153

respiratory center of spinal cord located where?

C3

154

thoracic spine injuries result in x2

paraplegia
no trunk control

155

muscle strength: 5/5

normal movement against gravity & resistance

156

muscle strength: 3/5

full ROM against gravity but NOT resistance

157

muscle strength: 0/5

no visible/palpable muscle contraction or extremity movement

158

spinal cord injury: drug given + why

methylprednisolone 30 mg/kg IV bolus
- followed by 5.4 mg/kg/hr gtts for 23 hrs

admin w/in 8 hrs of injury = improves neurological recovery

159

When to administer methylprednisolone in spinal injury

within 8 hours

160

injury @ C4 or above: major resulting complication

respiratory compromise

161

T4 - T6 injury: resulting complication

autonomic dysreflexia

162

autonomic dysreflexia

T4 - T6 injury - EMERGENCY
exaggerated autonomic response caused by stimulus (bladder/bowel distension, hot/cold, restrictive clothing)

163

autonomic dysreflexia: s/s x8

* flushing + diaphoresis (above level of injury) *
* chills + severe vasoconstriction (below level of injury) *
hypertension, bradycardia
headache, nausea

164

autonomic dysreflexia: treatment x2

first, stimulus removal
then, antihypertensives

165

injury @ T6 or above: complication

neurogenic shock

166

neurogenic shock is...

d/t T6 or above SCI
- disruption of transmission of sympathetic impulses that cause unopposed parasympathetic stimulation
- leads to loss of vasomotor tone → massive vasodilation
-- results in: hypovol, ↓ venous return & CO

167

neurogenic shock: treatment & why

sympathomimetic vasopressors to maintain BP

168

Parkinson's Disease

degenerative disorder d/t insufficient amount of DOPAMINE

169

degenerative disorder d/t insufficient amount of dopamine

Parkinson's

170

Parkinson's Disease: s/s

(3 most common)
* tremor / at rest
* rigidity
* bradykinesia

impaired swallowing
mask-like facies
drooling, less blinking, Myerson's sign

171

* Parkinson's Disease: mgmt *

increase dopamine
- carbidopa-levodopa (Sinemet), amantadine (Symmetryl), pramipexole (Mirapex), ropinirole (Requip)

anticholinergics (alleviate tremor, rigidity)
- benztropine (Cogentin), trihexyphenydyl (Artane)

172

Parkinson's Disease: why anticholinergics & which x2

reduce tremors, rigidity
- benztropine (Cogentin)
- rihexyphenydyl (Artane)

173

65 yo. M diagnosed with Parkinson's complains of increasing tremor. What medication is indicated?

anticholinergic (alleviate tremor and rigidity)
- benztropine (Cogentin), trihexyphenydyl (Artane)

174

delirium is...

sudden, transient onset: clouded sensorium assoc with physical stressor

175

delirium: causes x7

toxins, alcohol/drugs
trauma
anesthesia
impactions in elderly, poor nutrition, electrolyte imbalances

176

dementia is...

NEUROCOGNITIVE DISORDER
gradual memory loss w decreased intellectual functioning
usually in 60+

177

dementia: causes top 4 + 3 more

*neurotransmitter deficits
* atherosclerosis
* alzheimers disease
* cortical atrophy

ventricular dilation, loss of brain cells, virus

178

most common cause of dementia

Alzheimer's disease

179

DEMENTIA mnemonic
(r/o other diseases)

D rugs
E motional disorder
M etabolic disorder
E ar/eye disorder
N utritional imbalance
T umor
I nfection
A rteriosclerosis

180

* Alzheimer's Disease x5

multiple cognitive defects including
- memory impairment (impaired ability to learn new info and recall previously learned)

PLUS, 1+ of...
aphasia, apraxia, agnosia, inability to plan/organize/sequence/abstract differences

181

* Alzheimer's Disease: hallmark signs

memory impairment
cannot learn new info
cannot recall old info
aphasia
apraxia
agnosia
inability to plan organize make abstract decisions

182

Alzheimer's patient cannot recognize a spoon. This is an example of what?

agnosia

183

What is the most common initial complaint from family members with a patient diagnosed with Alzheimer's?

loss of short term memory

184

2 most significant neuro changes in elderly

↑ pain tolerance
↓ sense of touch

185

meningitis: priority diagnostics if suspected

LP
CT head

186

Initial differential if blood found in CSF after LP?

SAH

187

45 yo. M presents to ED with garbled speech and wife reports new onset paralysis of left arm and left leg. The neurologist suspects right middle cerebral artery infarction. If this is so, which of the following physical findings may develop?
a. bradyarrythmias
b. left homonymous hemianopia
c. right hemiplegia
d. spasticity

B

188

Rapidly lowering BP given CVA puts the patient at risk for...?

cerebral hypoperfusion and worsening of CVA

189

65 yo. M is found lying on the street and is brought to the ED. Pt is lethargic and poor historian. His clothes are dirty and he appears to have poor hygiene. Vital signs: T 99 HR 100 RR 22 BP 100/60. What diagnostic tests should be obtained in this patient?
a. EEG
b. LP
c. BMP and glucose level
d. CT head

c. BMP and glucose

190

65 yo. M is found lying on the street and is brought to the ED. Pt is lethargic and poor historian. His clothes are dirty and he appears to have poor hygiene. Vital signs: T 99 HR 100 RR 22 BP 100/60. A bottle of Percocet is found on the patient and you suspect narcotic ingestion. What is the treatment for narcotic overdose?

naloxone (Narcan)

191

EtOH patient expected to have withdrawal tremors when?

6 - 48 hrs

192

4th leading cause of death in the US

CVA

193

s/s specific to extensive hemorrhagic CVA x4

headache, sudden ↑ ICP, AMS, vomiting

194

L (dominant) hemisphere

R hemiparesis, aphasia, dysarthria, difficulty reading/writing

195

s/s specific to hemorrhagic CVA in R (nondominant) hemisphere

L hemiparesis, R visual changes, spatial disorientation

196

LP in CVA patients indicated when/why?

grade I or II aneurysm / detect blood in CSF

197

overall goals for CVA mgmt x2

- maintain CPP
- limit ↑ ICP to lt 20 mmHg

198

what is an automatism?

seen in complex partial seizures - lip smacking, picking at clothing, etc

199

seizures: priority diagnostic

CT head

200

seizure mgmt: all options

- initial: supportive
- parenteral anticonvulsants (diazepam for status, lorazepam for average)
- barbiturate coma or general anesthesia w NMB

201

seizure maintenance med: considerations x2

(anticonvulsants)
dosages should be titrated
taper to d/c NEVER ABRUPT

202

edrophonium (Tensilon) test is...

AChE inhibitor given to distinguish between myasthenia & cholinergic crises

- myasthenia: weakness improves temporarily
- cholinergic: weakness becomes more severe (OD!)

203

cholinergic crisis is...

can be d/t overdose of anticholinesterase drugs, such as pyridostigmine (Prostigmin)

OVERSTIMULATION

204

similar major symptom between myasthenia & cholinergic crises

severe muscle weakness

205

simple difference between MG & MS labs

MG: blood vs MS: CSF

206

monroe-kellie doctrine

skull contents = blood + brain + CSF
- when one increases another must decrease to compensate and maintain normal ICP

207

leading cause of death in all trauma cases

head trauma

208

two-thirds of all MVCs involve what?

head trauma

209

which brain bleed is characterized as "worst headache of my life"?

subarachnoid hemorrhage

210

What is Cushing's Triad?

INCREASED ICP
- widening pulse pressure (SBP ↑ to maintain CPP - often seen first)
- ↓ RR
- ↓ HR

211

head trauma: important to assess x

- time/place injury
- how event occurred
- sx onset
- LOC
- associated seizure activity
- lucid interval?
- amnesia? (indicative of severity)

212

lucid interval in head trauma can suggest what?

expanding/epidural hematoma

213

what aspect of Cushing's Triad is often seen first?

widening pulse pressure (SBP increase to maintain constant CPP)

214

head trauma: s/s

- Cushing's Triad (decompensation)
- Basilar skull fracture (Battle's Sign or Raccoon eyes)
- Otorrhea or rhinorhea

215

2 signs of basilar skull fracture

Battle's Sign (bruising behind ear @ mastoid process)
Raccoon eyes

216

Battle's Sign is...

a sign of basilar skull fracture - bruising behind ear @ mastoid process

217

head trauma: diagnostics

cervical spine films - ALL PTS
skull films
head CT

218

when can you remove C collar from head trauma patient?

if cervical spine films are clear

219

head trauma: mgmt

ABCs (any pt w altered LOC or significant trauma)
stabilize vitals
ongoing neuro evals
neurosurgery consult

220

tingling fingers = spinal injury likely at...?

C7

221

lumbar spinal segments control... x2

lower legs + perineum

222

sacral spinal segments control... x3

bowel, bladder, sexual function

223

muscle strength: 1/5

muscle contracts but extremity can't move

224

meningitis: abx when & choices (x3)

high dose parenteral abx ASAP if bacterial suspected; one of the following:
-- Pcn G
-- vanc + 3rd gen cephalosporin (until C&S available)
-- fluroquinolones

225

spinal cord trauma: diagnostics x3

spinal XRay series
CT
MRI
myelography

226

Parkinson's Disease: 3 most common s/s

* tremor / at rest
* rigidity
* bradykinesia

227

Parkinson's Disease: drugs to increase dopamine x4

- carbidopa-levodopa (Sinemet)
- amantadine (Symmetryl)
- pramipexole (Mirapex)
- ropinirole (Requip)

228

Parkinson's Disease: diagnostics

none - diagnosis of exclusion

229

Lewy Body

refers to either Lewy Body Dementia or Parkinson's Disease

230

Alzheimer's: deficiency in?

acetylcholine

231

Parkinson's vs Alzheimer's deficiencies

Parkinson's: dopamine deficiency
Alzheimer's: acetylcholine deficiency

232

Alzheimer's: diagnostics x9 (split into 2 categories)

use labs to r/o other diseases
CBC, lytes, glucose, BUN/creat, LFT, B12 VDRL, etc

CT or MRI: r/o tumors

233

Alzheimer's: additional disease findings x5

limb rigidity
flexion posture
disorientation
gait disturbance
impaired memory/judgment

234

Alzheimer's: mgmt

- neuro consult
- acetylcholinesterase inhibitors
-- donepezil (Aricept) = memory improvement
-- rivastigmine (Exelon)
-- galantamine (Razadyne)
- refer pt/family for counseling

235

drug class of choice for Alzheimer's

acetylcholinesterase inhibitors