neuro Flashcards
1
Q
CN I
A
olfactory - smell
2
Q
CN II
A
optic - vision
3
Q
CN III
A
oculomotor (most EOMs, eyelid opening, pupil constriction)
4
Q
CN IV
A
trochlear - down/inward eye movement
5
Q
CN V
A
trigeminal (mastication, sensation: face, scalp, cornea, mucus membranes, nose)
6
Q
CN VI
A
abducens - lateral eye movement
7
Q
CN VII
A
facial (move face, close mouth/eyes, taste (anterior 2/3), saliva/tear secretion)
8
Q
CN VIII
A
acoustic - hearing/equilibrium
9
Q
CN IX
A
glossopharyngeal (phonation, gag reflex, carotid reflex, swallowing, posterior taste)
10
Q
CN X
A
vagus (talking, swallowing, carotid body sensation, carotid reflex)
11
Q
CN XI
A
spinal accessory (trapezius & sternomastoid movement ie shrugging)
12
Q
CN XII
A
hypoglossal - tongue movement
13
Q
which CN: gag reflex
A
IX - glossopharyngeal
14
Q
which CN: pupil constriction
A
III - oculomotor
15
Q
which CN: shoulder shrug
A
XI - spinal accessory
16
Q
CN type mnemonic
A
Some Say Marry Money But My Brother Says Big Boobs Matter More
17
Q
CN name mnemonic
A
On Old Olympus’ Towering Tops A Fin And German Viewed Some Hops
18
Q
which CN: make eyes do tricks
A
III, IV, VI
19
Q
which CN: pure sensory
A
I, II, VII
20
Q
which CN: puff cheeks
A
VII
21
Q
which CN: hearing
A
VIII
22
Q
which CN: seeing
A
II
23
Q
which CN: smelling
A
I
24
Q
which CN: raspberry
A
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
