Neuro

Question 1

3 most common classifications AMS?

Answer 1

1. Delerium
2. Dementia
3. Psychosis

Question 2

In which class are vital signs irregular?

Answer 2

Delirium

Question 3

In which class are visual and audial hallucinations seen?

Answer 3

Visual: delirium
Audial: Psychosis

Question 4

What part of brain manages arousal? Cognition?

Answer 4

Arousal: Brainstem nuclei (RAS)
Cognition: Cortical functioning

Question 5

Most common causes delirium?

Answer 5

Almost always caused by underlying medical problem that has toxic or metabolic effects on the brain

Question 6

How to test pronator drift?

Answer 6

1. Hold arms outstretched with palms facing upward
2. Eyes closed: w/o vision, patient relies on proprioception alone to maintain position
3. UMN lesion, supinator muscles in upper limb are weaker than pronator muscles, and arm drifts downward and palm turns toward floor

Question 7

Definition stroke?

Answer 7

Acute onset of neurologic deficit caused by disruption of cerebral blood flow to a localized region of the brain

Question 8

Majority of strokes ischemic or hemorrhagic?

Answer 8

87% ischemic

Question 9

Risk factors stroke?

Answer 9

1. Hypertension / diabetes / hyperlipidemia
2. Smoking
3. Advanced age
4. A fib / prosthetic heart valve
5. Prior stroke

Question 10

Timeframe for giving TPA?

Answer 10

Door to decision to give: 45 minutes

Door to drug administration: 60 minutes (and less than 3 hours from onset)

Question 11

Imaging in suspected stroke?

Answer 11

Head CT w/o contrast on all patients to exclude hemorrhage

Question 12

Contradiction to tPA in head imaging?

Answer 12

Frank hypodensity on CT is indicative of completed stroke and may be a contraindication to thrombolytic therapy

Question 13

Inclusion criteria for tPA?

Answer 13

1. Diagnosis of ischemic stroke causing measurable neurological deficit
2. Onset of symptoms less than 3 hours
3. Aged ≥18 years

Question 14

Blood pressure goal after tPA?

Answer 14

Below 180/105 in first 24 hours

Question 15

Use of aspirin in stroke?

Answer 15

Aspirin within 24 – 48 hours of stroke onset is recommended

- Aspirin should not be administered for at least 24 hours after administration of rtPA

Question 16

Classic meningitis presentation?

Answer 16

1. Fever
2. Neck Stiffness
3. AMS

Question 17

What is papilledema?

Answer 17

Condition in which increased pressure in or around the brain causes optic nerve inside eye to swell. Symptoms may be fleeting disturbances in vision, headache, vomiting, or a combination

Question 18

Glucose in bacterial meningitis?

Answer 18

Less than 40 or ratio of CSF/blood glucose less than 0.40

Question 19

Rx HSV encephalitis?

Answer 19

Acyclovir

Question 20

Class presentation SAH?

Answer 20

1. Acute onset “thunderclap” HA
2. LOC
3. Vomiting
4. Neck stiffness
5. Seizure

Question 21

RFs intracerebral bleeds?

Answer 21

• ***FH 3 - 5x risk
  1. Recent exertion
  2. Hypertension
  3. Excessive alcohol consumption
  4. Sympathomimetic use
  5. Smoking

Question 22

What is an epidural hematoma?

Answer 22

Accumulations of blood between the skull and dura

- Typically occur after significant blunt head trauma

Question 23

Presentation EDH?

Answer 23

Brief LOC after blow to head, followed by a lucid period. - Soon after, level of consciousness deteriorates again

Question 24

What is a subdural hemorrhage?

Answer 24

Extra axial blood collections between the dura and the arachnoid mater

Question 25

What is cushings Triad?

Answer 25

Physiologic response to rapidly increasing ICP and imminent brain herniation. Its features are: 1. Hypertension 2. Bradycardia 3. Abnormal respiratory patterns

Question 26

How does bleeding appear on head CT?

Answer 26

Hyperdense (whiter) relative to the surrounding tissues

Question 27

How to control rising ICP?

Answer 27

1. Monitoring/lowering BP 2. Elevating head of bed to 30 degrees 3. Providing adequate sedation and analgesia 4. Mannitol 5. Mild hyperventilation

Question 28

Two categories seizure?

Answer 28

1. Generalized: involving both hemispheres of brain with loss of consciousness 2. Focal (partial): only one hemisphere is involved

Question 29

Two types focal seizures?

Answer 29

1. Simple partial: cognition is not impaired | 2. Complex partial: when cognition is impaired

Question 30

Evidence of seizure if not witnessed?

Answer 30

1. Tongue trauma from biting | 2. Urinary or bowel incontinence

Question 31

What is Todd's Paralysis?

Answer 31

Focal neurologic deficit mimicking a stroke which can be seen with seizure

Question 32

Secondary causes of seizure?

Answer 32

1. Alcohol withdrawal 2. Drug use 3. HYPOglycemia 4. HYPOnatremia

Question 33

Definition status epilepticus?

Answer 33

Seizure of greater than 5 minutes duration, or 2 or more seizures in a row without a return to baseline

Question 34

When are patients with primary seizures prone to seize?

Answer 34

1. Medical noncompliance: #1 2. Sleep deprivation 3. Emotional or physical stress

Question 35

Labs for first seizure?

Answer 35

1. CMP | 2. Pregnancy test

Question 36

Additional test in status?

Answer 36

LP, CT must be done first

Question 37

When to CT seizure?

Answer 37

1. First time 2. New type of seizure 3. Trauma 4. Fever 5. Prolonged post ictal 6. Status

Question 38

When to MRI seizure?

Answer 38

First time but as outpatient

Question 39

When is EEG need?

Answer 39

1. First seizure as o/p | 2. Status to make sure seizure has stopped

Question 40

Vitals in etoh withdrawal?

Answer 40

tachycardia, hypertension, hyperthermia and tachypnea

Question 41

Meds known to cause seizure?

Answer 41

1. Tricyclics | 2. Isoniazid

Question 42

Signs of PNES?

Answer 42

Rhythmic, controlled shaking activity, ability to talk or follow commands during the seizure, recall of a seizure that involves both sides of the body, or lack of a postictal period

Question 43

Can you place something in mouth in seizure?

Answer 43

Bite block or oropharyngeal airway to protect the tongue.

Question 44

Lines of therapy in status?

Answer 44

First line: benzodiazepines (usually lorazepam) Second line: fosphenytoin/phenobarbital/valproic acid Third line: versed/pentobarbital/propofol infusions

Question 45

Seizure meds that can be given IM?

Answer 45

Lorazepam, midazolam, and diazepam can all be given intramuscularly

Question 46

Rx secondary seizures?

Answer 46

Eclampsia – Magnesium sulfate Hyponatremia – Hypertonic saline Isoniazid – Pyroxidine Hypoglycemia – Dextrose

Question 47

When not to use NIPPV?

Answer 47

``` Respiratory arrest/absent respiratory drive Hemodynamic instability Aspiration Risk Airway obstruction Unable to tolerate mask Mask does not fit Altered mental status ```

Question 48

When to use NIPPV?

Answer 48

``` Moderate to severe dyspnea Accessory muscle use Paradoxical abdominal movement Fatigue RR > 25 bpm pH < 7.35, pCO2 >45 ```

Question 49

DDx for slow and rapid onset respiratory distress?

Answer 49

``` Rapid: 1. PE 2. Spontaneous pneumothorax Gradual: 1. COPD 2. Pneumonia 3. CHF ```