Neuro Flashcards Preview

Primary Care 3 > Neuro > Flashcards

Flashcards in Neuro Deck (75)
1

Shock

cellular and tissue hypoxia due to reduced oxygen delivery or increased oxygen consumption or inadequate oxygen utilization

2

4 types of shock

Distributive, Cardiogenic, Hypovolemic, Obstructive

3

Distributive shock

has many causes including septic, SIRS, neurogenic shock, anaphylactic, toxic and endocrine like through addisons disease. A reduced systemic vascular resistence leads to a compensatory increase in cardiac output. All other forms of shock have an increased SVR and decrease cardiac output.

4

Cardiogenic shock

cardiomyopathic through MI, arrythmia like sustained VTach, or mechanical abnormality like valvular rupture

5

Hypovolemic shock

hemorrhagic from trauma or nonhemorrhagic fluid loss from vomiting

6

Obstructive shock

Pulmonary embolism or pulmonary vascular related, due to mechanical causes like tension pneumo, pericardial tamponade (obstructing oxygen flow --> shock)

7

Anaphylaxis

serious allergic or hypersensitivity reaction that is rapid in onset and may cause death

8

Criteria for anaphylaxis

acute onset of illness involving the skin or mucosal tissue and at least one of the following: resp compromise (wheeze, stridor) or reduced BP or s/s end organ malperfusion (hypotonia, syncope) can be after a likely allergen with two of the following: skin issue, resp compromise, reduced BP, GI symptoms. Known allergen: reduced bp systolic

9

Children and those with food induced anaphylaxis do not usually have this symptom

hypotension

10

Anaphylaxis results from this

igE mediated allergic reaction from foods, insects, medications or anything really including allergen immunotherapy, chemotherapy, vaccines, food additives, spices, cat dander, human seminal fluid, latex

11

Anaphylaxis blood work

within 15 minutes to 3 hours obtain total tryptase in serum or plasma or plasma histamine in excluding other disorders which do not involve mast cells. Histamine between 2 and 15 minutes no vacuum tube manually pul blood both on ice

12

Symptoms of anaphylaxis

Warm, flushing, itching, urticaria, angioedema, hair standing on end, tingling lips, edema of lips, tongue, metallic taste, congestion, sneezing, sob, tightness, cough, nausea, abd pain, diarrhea, syncope, ams, incontinence, anxious, headaches, sudden behavior change, tearing, eye itching, uterine cramps

13

Increased risk for stroke with those who have this type of migraine

migraine with aura

14

Stroke risk most increased in women with these risk factors

child bearing age, migraine with aura, smoking, taking the pill

15

migraine with aura causing strokes describes as

silent infarct-like lesions in posterior circulation of the white matter or cerebellum

16

patho of migraine leading to stroke

vasospams and changes in blood flow

17

patients with vascular disease are not allowed to take these medications

vasoconstrictive meds that treat migraines including triptans and ergots and seratonin agonists

18

women with migraine with aura who are smoking need to do these two things to control their risk factor of stroke

control blood pressure, use another form of birth control other than the pill

19

Biggest priorities in managing a patient with a traumatic brain injury

prevent hypoxia (Pa02

20

First thing to order with a TBI

CT Head

21

Treatment for impending herniation following a TBI from increased ICP

Head of bed elevation and IV Mannitol osmotic therapy

22

Treatment with a severe TBI causing mass hamatoma, contusions and swelling

ventriculostomy placement with ICP monitoring

23

target ICP pressure number

20 mmHg

24

prevention og early seizures post TBI

only one week of antiepileptic drugs (valproic acid,m phenytoin)

25

exacerbates secondary neurological injury

fever and hyperglycemia both need to be avoided

26

glasgow coma scale meaures

eye opening, verbal response, motor response. 3-15. 3 is the worst.

27

do not use this to manage TBI as it will lead to increased mortality

glucocorticoids

28

symptoms of elevated ICP

Headache from the pain fibers of CN 5, depressed global consciousness, vomiting

29

papilledema

intracranial hypertension leading to a blurred optic disc margin, loss of physiological cupping and fullness in the veins

30

TIA

transient episode of neurological dysfunction by focal brain, spinal cord, or retinal ischemia without an acute infarction. Absent end organ injury. The defined end point is tissue injury and not timed 24 hours

31

TIA timing

Was less than 24 hours caused by decreased blood supply but this is inadequate as even relatively brief ischemia can cause a permanent brain injury so the new TIA definition is absent end organ injury

32

Antithrombotic treatment of TIA

4.5 hours after symptom onset for yPa and 6 hours for a mechanical thrombectomy

33

Acute ischemic stroke antithrombotic treatment

no urgent anticoagulation, instead do early aspirin therapy 160 or 325 daily, ideally start within 48 hours of stroke onset. beyond the acute phase it should continue with asa plus plavix

34

Antithrombolytic for symptomatic large artery disease

aspirin plus plavix for 90 days

35

Options to prevent stroke with large artery disease

revascularization with carotid endarterectomy/stenting and multifactoral risk reduction with antiplatelets, antihypertensive drugs, and statins

36

treatment for symptomatic carotid atherosclerosis

carotid endarterectomy

37

When is surgical revascularization a viable option

when residual flow can be demonstrated in the internal carotid artery. If completely occluded, medical mgmt is the only practical option

38

Aortic arch disease mgmt

antiplatelet and statin therapy

39

AF is associated with these types of strokes

worsened ischemic strokes and longer TIAs due to embolization of larger particles

40

Confirm absence of intracranial hemorrhage before starting anti-thrombotic therapy by

cranial CT and MRI

41

When to initiate TPA (alteplase)

4.5 hours, preferably 3, from the onset on symptoms with acute ischemic stroke to reduce long term disability

42

Most effective long term therapy for prevention of recurrent stroke

Warfarin. Target INR 2-3

43

Mild versus moderate versus severe TBI

13 > mild. 9-12 moderate. less than 8 is severe.q

44

Primary TBI

intra- and extra=parenchymal hemorrhages and diffuse axonal injury from shearing mechanisms showed as white matter tracks

45

Secondary TBI

Cascade of molecular injury mechanisms that are initiated at the time of initial trauma and continue for hours or days. This can be exaccerbated by hypotension, hypoxia, fever and seizures

46

Leading cause of TBI

Falls. Second leading cause is MVA

47

Subdural hematoma

between the dura and the arachnoid membrane caused by bleeding. Most commonly caused by tearing of the brdiging veins that drain from the surface of the brain to the dural sinus.

48

Epidural hematoma

space between the dura and the skull

49

Subdural hematoma s/s

can be from a loss of consciousness to a coma.

50

Acute subdural hematoma

coma is usually present at the time of injury,some may have a lucid interval followed by a progressive neurological decline. Headache, vomiting, anisocoria, dysphagia, cranial nerve palsies, nucal rigidity On CT it is a high dense crescent collection

51

Chronic subdural hematoma

insidious onset of headache, light headedness, cognitive impairment, somnolence and occasional seizures, on CT it is a hypodense crescent shaped lesion

52

Refer to a neurologist if a child has these symptoms of concussion

symptoms > 10 days, those with multiple concussions occuring with progressively less force and or are associated with more intense symptoms, uncertain dx of concussion

53

concussion s/s

headache, dizzy, nausea, difficulting concentrating, vision changes, drowsiness, amnesia, sensitivity to noise, tinnitus, irritability, loss of consciousness, hyperexcitability

54

Most SAH caused by

ruptured saccular aneurysms

55

s/s SAH

sudden, severe headache, worst headache of my life may be a/w LOC, seizures, n/v.

56

dx SAH

CT. If negative and still suspicious then do a lumbar puncture which will show elevated RBCs. After CT do an angiography.

57

Migraine s/s

unilateral, throbbing, pulsating, nausea, vomiting, photophobia, phonophobia, crescendo pattern, aggravated by activity duration 4-72 hours

58

Migraine triggers

stress, menstruation, visual stimuli, weather changes, nitrates, fasting, wine, sleep disturbances, aspartame

59

Tension headache

mild to moderate, bilateral, nonthrobbing, no other features, 30min to 7 days, pressure and tightness will wax and wane no other symptoms

60

Cluster headache

idiopathic, unilateral, severe with autonomic symptoms. orbital, supraorbital or temporal pain, lacrimation, conjunctival injection, rhinorrhea, nasal congestion

61

Physical exam done with headache complaint

blood pressure, pulse, bruit at neck, palpate head, neck and shoulders, check temporal and neck arteries, examine spine and neck muscles. Mental status, cranial nerves, gait

62

Danger signs

SNOOP. Systemic symptoms (fever, weight loss, cancer) Neuro symptoms (confusion, papilledema, seizures) Onset is new or sudden (after 40 or thunderclap) Other symptoms (head trauma, drug use, worse with valsalva) Previous headache history with a progression or change in attack.

63

giant cell arteritis

chronic vasculitis of large and medium sized vessels. Older than 50. Temporal or frontal. Fever, fatigue, weight loss, visual changes, polymyalgia rheumatica

64

trigeminal neuralgia

sudden, unilateral severe brief stabbing pain across trigeminal nerve older than 50 years of age

65

chronic subdural hematoma

insidious onset of headaches, light headed, dizzy, apathy, cognitive impairment, tired, possible seizures

66

new onset seizure older than 50 worry about

brain tumor

67

anaphylaxis

acute, potentially lethal, multi system syndrome resulting from a sudden release of mast cell, basophil and macrophage derived mediators into circulation

68

immunologic anaphylaxis

igE and igG mediated reaction with immune complex mediated mechanisms

69

nonimmunologic anaphylaxis

caused by agent or event that induces a sudden, massive mast cell or basal cell degranulation without antibodies

70

anaphylaxis is a/w these cardiac issues

MI and arrhythmias, due to cardiac hx, exogenous epinephrine and hemodynamic stress

71

anaphylaxis resp s/s

bronchospasm, mucus plugging, larygeal edema and asphixiation esp w those w hx asthma

72

meds that make anaphylaxis worse

opiods, nsaids, ethanol, beta blockers, ACE inhibitors

73

level that supports diagnosis of anaphy.

serum tryptase 15 min to 3 hours after diagnosis

74

diagnosing anaphylaxis

acute onset of illness with skin, mucosal tissue (swollen lips/tongue...hives) with at least 1) resp compromise OR 2) decreased BP

75

Exposure to known allergen dx

bp less than 90 or a 30 percent decrease from baseline, infants and children are age specific