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I am built like a neuroglia > Neuro MDT > Flashcards

Neuro MDT Flashcards

1
Q

Headache DANGER SIGNS

A
  • Thunderclap
  • Absence of prior headache
  • Focal neurosigns
  • Fever
  • Rapid onset with exercise
  • Nasal congestion
  • Papilledema
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2
Q

Thunderclap headache could be:

A

SAH

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3
Q

Absence of prior headache danger sign could be:

A

CNS infection

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4
Q

Focal Neurosigns other than auras could be

A

stroke or tumor

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5
Q

Fever with headache could be:

A

Meningitis

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6
Q

Rapid onset headache with exercise could be:

A

IC Hemmo./ Brain Aneurysm

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7
Q

Headache with nasal congestion could be:

A

Sinusitis

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8
Q

Headache with papilledema could be:

A

Increased ICP

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9
Q

Headache reasons to refer for imaging: (8)

A 
change in pattern
worsening despite tx
neuro. deficit
scalp tenderness
onset with exertion
visual changes
40 years or older
hx of trauma/ HTN
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10
Q

Tension Headache characteristics

A 
most prevalent
bilat
daily
"vice-like"
stress/fatigue/glare
No dx tests*
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11
Q

Tension Headache Tx

A

NSAIDS: Motrin 400-800mg Q4-6H/2400mg in 24H max

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12
Q

Tension Headache Tx

A

NSAIDS: Motrin 400-800mg Q4-6H/2400mg in 24H max
Naproxen 250-500mg PO Q12
Non-Sal: Tylenol 325-1000mg PO Q4-6H/ 4G in 24H max

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13
Q

Cluster Headache Sx

A
  • middle aged males
  • unilateral px
  • restless agitated
  • 15 min-3 hours
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14
Q

Cluster Headache Additional sx

A
  • ipsilateral congestion
  • lacrimation
  • Horner Syndrome
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15
Q

Homer Syndrome (3)

A

stop sweating
drooped eyelid
small pupil

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16
Q

Cluster Headache tx + MOA and Contraindications

A
  • O2 100% 15 min*
  • Sumatriptan SC 6mg/24h max 12mg
  • Zolmitriptan 2.5mg PO/ 10mg 24h max

MOA: Vasoconstriction/Trigeminal assistance
Contra: Cardiac/Bleeding issues

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17
Q

Migraine characteristics (6)

A 
throbbing 
unilateral or bilateral
aura (maybe)
visual disturbances
Fam Hx
NV
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18
Q

Migraine Dx:

A

Clinically using HPI

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19
Q

Migraine Tx

A 
avoidance
rest
analgesics 
Sumatriptan 25/50/100mg or 6mg SC
50mg works best*
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20
Q

Migraine prophylaxis + contraindications

A

beta blocker
Propranolol 20mg BID: 40-160mg range

CHF Cardio Hypotension

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21
Q

Migraine secondary treatments

A

Anti-depressant: Amitriptyline 10mg

Anti-emetic: Promethazine 12.5mg-25mg Q4-6H

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22
Q

Post Trauma Headache characteristics

A

1-2 days after injury
poor memory and concentration
emotional instability

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23
Q

Post Trauma Headache tx

A

analgesic

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24
Q

Med Overuse headache characteristics

A

50% of daily headaches
chronic px
heavy analgesic use

treat with med withdraw

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25
Q

Partial Seizures characteristics

A

dependent on cortical involvement

preictal phase can have auras

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26
Q

Focal Seizure with Retained Awareness

A

FKA: Simple Partial Seizure*

only 1 part of brain/sx dependent on this

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27
Q

Focal Seizure with Impaired Awareness

A

FKA: Complex Partial Seizure*
one part of brain
awake/not responding
no memory

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28
Q

Complex Partial Seizure 4 signs

A

Grimace
Gesturing
Lip Smack
Repeating

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29
Q

General Seizure

A

entire brain
altered consciousness
Tonic-Clonic aka Grand Mal

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30
Q

Tonic phase

A

stiffening

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31
Q

Clonic Phase

A

rhythmic jerking

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32
Q

Todd Paralysis

A

weakness of limbs

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33
Q

3 Postictal Phase Sx

A

somnolence
no recollection
Todd Paralysis

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34
Q

Seizure Dx

A

EEG

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35
Q

Seizure Tx

A

secure airway
treat sx
MEDEVAC

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36
Q

Seizure labs

A

electrolyte
LFT
CBC
Glucose

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37
Q

Active Seizure Med

A

Diazepam 5mg IV/IM Q5-10min; 30mg Max

binds with GABA

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38
Q

Status Epilepticus

A

seizure that lasts longer than 5 min, or having more than 1 seizure within a 5 minutes period, without returning to a normal level of consciousness between episodes

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39
Q

Status Epilepticus tx

A

Diazepam
Valproic Acid 30mg
Intubate

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40
Q

Frontal Lobe Sx

A

Head and Leg
Jacksonian March
Posturing

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41
Q

Parietal Lobe Sx

A

Paresthesia

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42
Q

Occipital Lobe Sx

A

Visual Phenomena

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43
Q

Temporal Lobe

“oh so no head?”

A

Hallucinations
Epigastric rising
Automatisms
Deja vu

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44
Q

Psychogenic Non Epileptic Seizure

A

not assoc. with neuronal activity
longer than 2 min
no incontinence
no postictal phase

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45
Q

PNES tx

A

psychotherapy

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46
Q

Supplies blood to the brain

A

internal carotid arteries

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47
Q

2 internal carotid branches

A

Anterior Cerebral Artery

Medial Cerebral Artery

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48
Q

Vertebral artery

A

Basilar artery

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49
Q

connects cerebral and vertebral arteries

A

Circle of Willis

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50
Q

Hemorrhagic Stroke

A

rupture of a blood vessel causing bleeding into the brain and lack of cerebral blood flow leading to ischemia

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51
Q

Ischemic Stroke

A

blockage of a blood vessel causing lack of blood flow leading to ischemia

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52
Q

Ischemic Stroke 2 subtypes

A

CVA and TIA
cerebrovascular accident
transient ischemic attack

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53
Q

Thrombotic Ischemic Stroke

A

obstruction of artery due to blockage in vessel

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54
Q

Embolic Ischemic Stroke

A

blockage of artery due to debris

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55
Q

Systemic hypoperfusion Ischemic Stroke

A

lack of blood brain flow due to decreased systemic blood flow

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56
Q

Transient ischemic attack

A

transient episode of neurologic dysfunction caused by brain, spinal cord, or retinal ischemia, without acute infarction

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57
Q

Only way to differentiate TIA vs CVA

A

MRI

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58
Q

FASTER mnemonic

A 
Face (drooping numbness)
Arms (one limb being weaker)
Stability (steadiness on feet)
Talking (slurred garbled)
Eyes (visual changes)
React (MEDEVAC)
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59
Q

ISchemic stroke risk factors

A 
vascular disease
A-fib
DVT
recent MI
clotting disorders
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60
Q

Without acute infarction is

A

TIA

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61
Q

with acute infarction is

A

CVA

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62
Q

2 hemorrhagic stroke subtypes

A

ICH

SAH

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63
Q

ICH risk factors

A 
HTN
Trauma
Bleeding disorders
Drug use
Aneurisms
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64
Q

Ischemic Stroke tx

A

> 94% 02
elevate 30 degrees
labs: EKG CBC Glucose O2 sat

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65
Q

Ischemic stroke BP monitoring

A

do not lower unless 220/120; reduce by 15%

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66
Q

Ischemic Stroke meds + MOA + vitals

A

Aspirin 325mg

selective beta blocker Labetalol
10-20mg IV

MOA: inhibits B1 to dec HR

BP every 15min

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67
Q

TIA tx

A

med advice
aspirin
MEDEVAC

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68
Q

states strokes are disqualifying

A

MANMED 15-106

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69
Q

Stuporous patients respond to

A

vigorous stimuli

70
Q

Coma can result from

A 
Seizures
Hypothermia 
Metabolic disturbances
Structural lesions 
Disturbance of circulation
Mass causing compression of brain stem
71
Q

Abrupt onset of coma could suggest

A

SAH
ICH
stroke

72
Q

Decorticate

A

flexion

73
Q

Decerebrate

A

extension

74
Q

Coma ancillary study

A

NON CONTRAST* CT

75
Q

Other name for dilated pupils

A

mydriasis; associated with brainstem compression or drug use

76
Q

Other name for constricted pupils

A

miosis; could suggest drug overdose with opiates

77
Q

GCS scores

A

Mx 15
Low 3
Intubate 8 or less

78
Q

Naloxone dose

A

0.4-2mg

79
Q

Coup-countercoup

A

injury at impact as well as opposite side from rebound

80
Q

Concussion hallmarks*

A

amnesia

lack of recall

81
Q

early concussion symptoms

A 
headache
dizziness 
vertigo
imbalance 
nausea 
vomiting
82
Q

delayed concussion symptoms

A

mood/cognitive disturbance
light/noise sensitivity
sleep disturbance

83
Q

MACE within how long?

A

48 hours

84
Q

Direct observation of suspected concussion time

A

24 hours

85
Q

Second impact syndrome

A

diffuse cerebral swelling can develop with 2nd concussion
(2 concussions back to back)
rare but potentially fatal

86
Q

Post concussion syndrome

A

headache
dizziness
cognitive impairment
resolves in weeks to months

87
Q

CTE

A

chronic traumatic encephalopathy

88
Q

CTE sx

A

behavior changes
Parkinson’s
speech and gait abnormalities

89
Q

thin areas of skull

A

temporal

nasal sinus

90
Q

Basilar skull fracture

A 
Battle sign
“Raccoon” eyes
Hemotympanum
CSF rhinorrhea/otorrhea
Cranial nerve deficits
91
Q

ICP tx

A

elevate head 25-30 degrees
secure airway
ventilate
NS or LR

92
Q

Mannitol dose

A

1g/kg IV initial

.25-.5 g/kg IV Q6-8

93
Q

hypertonic saline dose

A

7.5% NS 250cc bolus

94
Q

Epidural hematoma layers

A

in-between dura mater and skull

95
Q

Subdural Hematoma layers

A

between dura mater and arachnoid

96
Q

Subarachnoid hematoma layers

*in the JEA

A

between subarachnoid mater and pia mater

*high association with aneurysms and AV malformations

97
Q

3 ICH type

A

Epidural hematoma
Subdural hematoma
Subarachnoid Hematoma

98
Q

Most commonly affected with Epidural Hemmorhage

A

MMA

middle meningeal artery

99
Q

Epidural hemorrhage presentation (2)

A

immediate LOC
Lucid Interval with consciousness
deteriorating neuro function
Seizure/Coma

100
Q

Epidural hemorrhage acute management

A

oxygen/intubate
neuro consult
monitor for ICP
MEDEVAC

101
Q

Subdural Hemorrhage

A

more common
elderly/EOTH abuse
may occur without impact
likely to die

102
Q

Subdural Hematoma physiology

A

venous flow into sinus spaces

may tamponade causing inc flow

103
Q

Subdural hematoma clinical manifestations

A

1-2 days after onset
chronic could be 15 days
headaches/light headed/cognitive impairment/somnolence

104
Q

Subdural Hematoma acute management

A

Same as epidural hematoma

non-contrast CT to determine

105
Q

Subarachnoid hemorrhage epidemiology

A

usually aneurysm

high pressure bleed with CSF

106
Q

SAH hallmarks

A

Thunder Clap aka worst headache of my life

sudden/may have meningeal irritation from blood

107
Q

SAH risk factors

A

drug use, smoking, HTN, alcohol use

108
Q

SAH tx

A

rest
Tylenol
MEDEVAC

109
Q

Complications of SAH

A 
death
rebleeding
ischemia
ICP
seizures
110
Q

MACE: HEADS

A 
Headache or vomiting?
Ear ringing?
Amnesia, altered consciousness?
Double vision?
Something feels wrong?
111
Q

Recurrent concussion

A

3 concussions within 1 year. needs neurologist

112
Q

Recurrent Concussion Evaluation

A

Comprehensive Neurological Eval
neuroimaging
functional assessment
duty status determination

113
Q

Spinal cord injury presentation

A

flaccid paralysis
loss of bowel or bladder control
anesthesia
loss of reflex activity

114
Q

C3,4 &5…

A

keep the lungs alive

115
Q

Spinal cord injury tx

A 
ABC
C-collar
O2/BP
Foley Cath
Sedate if necessary
MEDEVAC ASAP
116
Q

Spinal cord injury Med

A

Methylprednisone 125mg IV Q4-6

117
Q

Nexus criteria for C-spine

A 
N neuro deficit 
S spinal tenderness
A altered mental status
I intoxicated
D distracted injuries
118
Q

Common radiculopathy discs

A

L5-S1

119
Q

Radiculopathy

A

lumbar disk herniation usually due to heavy lifting

120
Q

Radiculopathy clinical presentation

A

px with sitting
radiating to leg
lower extremity numbness

121
Q

L1 radiculopathy

A

pain, paresthesia, inguinal sensory loss

122
Q

L2-L4 radiculopathy

A

acute back px radiates to anterior thigh/knee

weak hips

123
Q

L5 radiculopathy

A

most common back pain radiating down lateral aspect of leg into foot

124
Q

S1 radiculopathy

A

back pain radiates posterior to foot

125
Q

Straight leg testing

A

Lay patient supine and raise patient’s extended leg on the symptomatic side with foot dorsiflexed.

126
Q

Lasegue’s sign

A

presence or worsening of radicular pain with straight leg maneuver.

127
Q

Radiculopathy imaging

A

radiograph and MRI

128
Q

Radiculopathy tx

A

NSAIDs and analgesics

muscle relaxers

129
Q

Radiculopathy Med

A

Cyclobenzaprine 5mg PO Q8

130
Q

Radiculopathy reevaluation

A

4-6 weeks after

  1. PT should be considered
  2. Consult to px management
131
Q

Cauda Equina

A

bundle of nerves that spread out from te bottom of the spinal cord

132
Q

Cauda equina syndrome

A

cauda equina is squeezed or damaged

133
Q

Cauda Equine pathophysiology

A

herniated disc
infection/inflammation
cancer
spinal stenosis

134
Q

Spinal Stenosis

A

vertebrae bumps called bone spurs; can compress nerves.

135
Q

Cauda Equina Clinical Presentation

A

pain/numb/tingling in lowerback and/or legs
foot drop
bowel problems or incontinence
problems with sex

136
Q

Cauda Equina tx

A

MEDEVAC
MRI
treat cause of sx (surgery or meds)

137
Q

Carpal Tunnel Syndrome

A

entrapment neuropathy of the median nerve of carpal ligament
caused by repetitive wrist activities

138
Q

3 predispositions for carpal tunnel

A

preg
DM
arthritis

139
Q

Carpal Tunnel presentation

A

pain burning tingling
bothersome during sleep
late sx: atrophy

140
Q

Carpel tunnel test

A

Tinel or Phalen

141
Q

Carpal Tunnel Tx

A

splint up to 3 months
Thumb Spica*
NSAIDS/Steroids

142
Q

Restless Leg Syndrome

A

Creepy Crawling or Pins and needles in the Limbs

worse at evening or night

143
Q

hyperalgesia

A

low px tolerance

144
Q

akathisia

A

intense desire to move

145
Q

Restless Leg Syndrome differential

A

Volitional movements

Nocturnal Leg Cramp

146
Q

Class of meds that worsen Restless Leg Syndrome

A

Antihistamines
Anti-nausea
Antidepressants

147
Q

Lab for Restless leg syndrome

A

Iron (serum ferritin)

148
Q

Restless Leg Syndrome Med

A

Ferrous Sulfate 325mg with laxative

149
Q

Bell’s Palsy CN and part of brain

A

CN 7 (along the pons)

150
Q

Bell’s Palsy associated diseases

A

HSV
HIV
Lyme

151
Q

Bell’s Palsy clinical presentation

A 
unilateral facial paralysis 
px around ear 
facial stiffness 
inability to close eyelid*
skin does not wrinkle*
152
Q

Bell’s phenomenon

A

upward rolling of the eye on attempted lid closure

153
Q

Bell’s Palsy vs Stroke

A

no paralysis of forehead in stroke

intact forehead suggest stroke

154
Q

Bell’s Palsy tx

A

protect the affected eye
Prednisone 60mg x7 days
Valacyclovir 1000mg

155
Q

Bell’s Palsy differentials

A

HSV
Otitis Media
Lyme
Guillain-Barre Syndrome

156
Q

Meningitis signs and symptoms

A

fever
nuchal rigidity (neck stiffness)
altered mental status

157
Q

Bell’s Palsy hallmarks

A

forehead paralysis

cannot close eye

158
Q

Meningitis lab test

A

Lumbar Puncture

159
Q

Meningitis tests

A

Brudzinksi

Kerning

160
Q

Meningitis med

A

Ceftriaxone 2g IV

161
Q

Meningitis Prophylaxis

A

Ciprofloxacin 500mg

162
Q

Meningitis associated vaccinations

A

MGC
S. Pneumonia
FLU

163
Q

3 classes of chronic px

A

noncaptive
neuropathic
centralized

164
Q

Chronic px time

A

greater than 6-12 weeks

165
Q

nociceptive pain

A

caused by stimuli

166
Q

neuropathic pain

A

resulting from damage or pathology

167
Q

centralized pain

A

reduced ability of the CNS to diminish responses to peripheral stimuli

168
Q

Chronic pain syndrome tx

A

Acupuncture

spinal manipulation

169
Q

Insomnia risk factors

A

EOTH
stimulant
tobacco
psychiatric

170
Q

Benign paroxysmal positioning vertigo test

A

Dix-Hallpike

171
Q

Peripheral Vertigo presentation

A

sudden
horizontal nystagmus
tinnitus

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