Neuro Review Flashcards
1
Q
How many cranial nerves are there?
A
12
2
Q
How many spinal nerves are there?
A
31
3
Q
What are specialized cells that monitor changes in the internal and external enviroment?
A
Sensory Receptors
4
Q
What is a small mass of nervous tissue consisting of neuronal cells bodies in the PNS?
A
Ganglia
5
Q
What are the 3 basic functions of the nervous system?
A
Sensory (afferent)
Integrative (information process)
Motor (efferent)
6
Q
What are the two types of cells that make up the nervous tissues? What do they provide?
A
Neurons- Unique functions
Neuroglia - support, nourishment and protection of neurons
7
Q
What are the parts of the cell body?
A
Cell body
Dendrites
Axon
Axon Terminals
8
Q
What are Structural Classes of Neurons?
A
Multipolar
Bipolar
Unipolar
9
Q
What neuron class has several dendrites and one axon? Most common type in the brain and spinal cord.
A
Multipolar
10
Q
What neuron class has one dendrite and one axon?
A
Bipolar
11
Q
What neuron class has a fused dendrite and axon? Sensory neuron of spinal nerves
A
Unipolar
12
Q
What neuron class is this?
A
Bipolar
13
Q
What neuron class is this?
A
Unipolar
14
Q
What neuron class is this?
A
Multipolar
15
Q
What are sensory neuron functions?
A
Convey impulses into the CNS
16
Q
What are motor neuron functions?
A
Convey impulses from CNS through PNS to muscles or glands
17
Q
What are interneurons (integrative) neuron functions? Where are they located?
A
Transmit impulses between neurons (sensory and motor)
Located within CNS
18
Q
What neuron cell is responsible for support, nourishment and protection. Critical for homeostasis of interstitial fluid around neurons?
A
Neuroglia
19
Q
What are the types of neuroglia?
A
Astrocytes Oligodendrocytes Microglia Ependymal Schwann Satellite
20
Q
What neuroglia types are found in the CNS?
A
Astrocytes
Oligodendrocytes
Microglia
Ependymal
21
Q
What neuroglia are found in the PNS?
A
Schwann and Satellite
22
Q
Which neuroglia form the blood brain barrier?
A
Astrocytes
23
Q
Which neuroglia produce myelin in the CNS?
A
Oligodendrocytes
24
Q
Which neuroglia protect CNS cells from disease?
A
Microglia
25
Which neuroglia form CSF in the ventricles?
Ependymal
26
Which neuroglia produces myelin in the PNS?
Schwann
27
Which neuroglia support cells in PNS ganglia?
Satellite
28
What are gaps in the myelin along the axon?
Nodes of Ranvier
29
What are the two types of collection of nervous tissues?
Ganglion
| Nucleus
30
What collection of neuronal cell bodies are found in the PNS?
Ganglia
31
What collection of neuronal cell bodies are found in the CNS?
Nucleus
32
What are the type of axon bundles?
Nerve
| Tract
33
What are a bundles of axons found in the PNS?
Nerve
34
What are a bundle of axons found in the CNS?
Tract
35
What are the two matters that make up the spinal cord and brain?
White and grey matter
36
Which matter contains primarily myelinated axons?
White matter
37
Which matter contains cell bodies, dendrites, unmyelinated axons, axon terminals and neuroglia?
Grey matter
38
Where is the white and grey matter located in the spinal cord?
White matter surrounds a centrally located grey matter (H or butterfly)
39
Where is the white and grey matter in the brain?
Grey matter in thin cortex that surrounds the white matter.
40
What is action potential?
Communication between neurons
41
What are required to enact action potential?
A resting membrane potential
| Ion Channels
42
What is a charge difference across cell membrane (polarization)?
Resting membrane potential
43
What allows ions to move by diffusion from high to low concentration?
Ion Channels
44
What are the two types of ion channels?
Leakage
| Gate
45
What is the process of the initial event or stimulus?
1. Resting membrane triggered to become more permeable to Na+
2. Na+ entering reaches threshold
3. An action potential arises(all or nothing response)
46
What is the threshold required for action potential?
-55 mv
47
What are the 2 main phases of action potential?
Depolarizing and repolarizing
48
What action potential phase is when enough Na+ enters a cell and membrane potential rises and becomes positive?
Depolarizing
49
What action potential phase is when enough K+ leave a cell and the membrane potential is returned to a resting value?
Repolarization
50
What action potential phase is (-70 ~ 0 ~ +30 mv)
Depolarizing
51
What action potential phase is (+30 ~ 0 ~ -70 mv)
Repolarization
52
What are the two types of nerve impulse conductions?
Continuous
| Saltatory
53
Which type of conduction is the slower form associated with unmyelinated axons.
Continuous
54
Which type of conduction is fast associated with myelinated axons, Nodes of Ranvier that allow impulses to leap?
Saltatory
55
What is synaptic transmission?
Communication from neurons to other neurons or effectors
56
What are the main components of synapse?
Presynaptic neuron
Synaptic cleft
Postsynaptic neuron
57
What component of synapse is the sending neuron and releases neurotransmitters?
Presynaptic neuron
58
what is the space between neurons in the synaptic transmission?
Synaptic cleft
59
What is the receiving neuron that has receptors that bind to the neurotransmitter?
Postsynaptic neuron
60
In the presynaptic neuron, increased Ca2+ concentration causes what to happen?
Exocytosis
61
What is released into the synaptic cleft after exocytosis?
Neurotransmitters
62
Neurotransmitters act as a chemical trigger open ion channels in what?
Postsynaptic neuron
63
Neurotransmitters are removed from the cleft how?
Diffusion
Destruction by enzymes
Reuptake into presynaptic cell
64
What are the types of neurotransmitters?
```
Acetylcholine
Amino Acids
Modified amino acids
Neuropeptides
Nitric oxide
```
65
Neurotransmitters bind to what in the postsynaptic neuron
Ligand-gated channels
66
What are forms of acetylcholine neurotransmitters?
Stimulatory (skeletal)
| Inhibitory (cardiac)
67
What are examples of amino acids?
Glutamate
Aspartate
gamma aminobutyric acid (GABA)
Glycine
68
What are examples of modified amino acids?
Norepinephrine
Dopamine
Serotonin
69
What are the two systems of the nervous tissue?
Central Nervous System
| Peripheral Nervous System
70
What nervous system is responsible for thoughts, emotions and memories?
Central Nervous System
71
What are the subcategories of the Peripheral Nervous System?
Somatic
Autonomic
Enteric
72
Sensory neurons of the SNS do what?
Convey info to CNS from head, body wall, limbs and special senses
73
Motor neurons in the SNS do what?
Conduct impulses to the skeletal muscles (voluntary control)
74
Sensory neurons of the ANS do what?
Convey information from visceral organs to the CNS
75
Motor Neurons of the ANS do what?
Conduction impulses to smooth/cardiac muscles and glands (involuntary control)
76
Autonomic Nervous System motor neurons are divided into what two subcategories?
Sympathetic and Parasympathetic
77
What subcategory of the ANS motor neurons is for fight or flight?
Sympathetic
78
What subcategory of the ANS motor neurons is rest and digest?
Parasympathetic
79
The Enteric Nervous System is known as what?
Brain of the gut
80
Sensory neurons of the ENS do what?
Monitor chemical change in the GI tract and stretching of walls
81
Motor neurons of the ENS do what?
regulate contractions, acid secretion and endocrine cell secretions
82
Enteric Nervous System is an involuntary or voluntary control?
Involuntary
83
What are the structures that protect the spinal cord?
Vertebral Column
Vertebral Ligaments
Meninges
Cerebrospinal Fluid
84
What are the three layers of connective tissue that make up the meninges
Dura
Arachnoid
Pia
85
Which layer of the meninges is the outer layer and is a tough dense connective tissue?
Dura mater
86
What layer is the middle layer of the meninges, resembles a spider web and extends into the subarachnoid space?
Arachnoid mater
87
What layer of the meninges is thin and delicate that adheres to the spinal cord and the brain and contains blood vessels?
Pia mater
88
What is the space between the arachnoid and pia matter that is filled with CSF?
Subarachnoid space
89
What space is between the vertebra and (above) dura mater that is made up of fat and helps with cushioning and protection?
Epidural space
90
The spinal cord is on average what length?
16-18 inches
91
The spinal cord extends from the ___________ to the ____________.
Medulla oblongata
Second Lumbar vertebra (L2)
92
What are the two grooves in the spinal cord that divide it into hemispheres?
Anterior median fissure
| Posterior median sulcus
93
The spinal cord has how many spinal nerves?
31 pairs
94
What are roots in the spinal cord? What are the different roots?
Two bundles of axons that connect each spinal nerve to to a segment of the cord.
Posterior and Anterior
95
Posterior spinal roots contain what?
Sensory axons which conduct nerve impulse from sensory receptors to into the CNS
96
Anterior spinal roots contain what?
Motor neurons (autonomic and somatic) which conduct nerve impulses from the CNS to effectors.
97
What are the plexuses that make up the spinal cord?
Cervical (C1-C5)
Brachial (C5-T1)
Lumbar (L1-L4)
Sacral (L4-S4)
98
What are the main functions of white matter in the spinal cord?
A tract that serves as highways for nerve impulses
99
What are the main functions of grey matter in the spinal cord?
Receives and integrates incoming and outgoing information and is a site for integration of reflexes.
100
Grey matter is subdivided into what?
Left and Right regions called horns that are relative to their location (anterior, lateral and posterior)
101
The posterior grey horn does what
contains cell bodies and axons of interneurons as well as axons of incoming sensory neurons.
102
The anterior grey horn contains
cell bodies of somatic motor neurons that provide impulses for contraction of muscles.
103
The lateral grey horn is only present where? And contains what?
Thoracic and upper lumbar segments
Contains cell bodies of the autonomic motor neuron that regulates cardiac/smooth muscle and glands.
104
White matter consists of two tracks, what are they?
Sensory and Motor
105
Sensory tracts direction is
ascending, spinothalamic tract
106
Motor tracts direction is
descending, corticospinal tract
107
Spinal nerves are a part of what nervous system?
Peripheral Nervous System
108
What is the breakdown of the spinal nerves?
```
8 cervical
12 thoracic
5 lumbar
5 sacral
1 coccyx
```
109
What root does sensory information go through the spinal cord?
Dorsal root
110
What root does motor information go through in the spinal cord?
anterior root
111
What are the spinal nerve layers
Endoneurium (wraps axons)
Fascicles (bundle of axons)
Perineurium (wraps Fascicles)
Epineurium (wraps Perineuriums of multiple fascicles or the entire spinal nerve)
112
Cervical plexus supplies what areas
posterior head, neck, upper shoulder and diaphragm.
113
Brachial plexus supplies what?
Upper limbs, some neck and shoulder muscles
114
Lumbar plexus supplies what
abdominal wall, external genitals and parts of the lower limb
115
Sacral plexus supplies what
Buttocks, perineum and most of the lower limbs
116
Brain protections is done by what parts?
```
Cranium
Meninges
- Dura
- Arachnoid
- Pia
```
117
The brain is supplied with blood from what structure?
Circle of willis
118
The circle of willis consists of what structures
Internal carotids
Vertebral artery
Anterior/posterior communicating arteries
119
The brain consist of what percent of the body's weight and requires how much of the body's oxygen supply?
2% of weight
| 20% of oxygen
120
Infarction happens when
the brain is deprived of oxygen for 4 or more minutes.
121
What lipid soluble materials are able to pass into the blood brain barrier?
O2
CO2
Alcohol
Anesthesia
122
What type of fluids cushions the brain
Cerebrospinal Fluid
123
Where does CSF circulate
subarachnoid space, central canal and ventricles of the brain
124
Where is CSF produced?
Choroid plexuses
125
Where is CSF reabsorbed?
arachnoid villi
126
What are the major parts of the brain?
Brain stem
Diencephalon
Cerebellum
Cerebrum
127
What does the brain stem contain?
medulla oblongata
pons
midbrain
128
Where does the medulla oblongata lie on the brain stem?
inferior aspect
129
What does the diencephalon contain
thalamus
hypothalamus
pineal gland
130
Where does the cerebellum lie and what are it's functions?
posterior and inferior to the cerebrum
| balance, equilibrium and coordination
131
What is the largest, most superior part of the brain?
Cerebrum
132
Medullary rhythmicity areas that regulate breathing are located in
medulla oblongata grey matter
133
posterior medulla oblongata nuclei are associated with
touch
pressure
vibration
proprioception
134
Medulla oblongata contains nuclei associated with which cranial nerves?
VIII-XII
135
What is part of the brain stem is known as the bridge and connects the right and left sides of the brain?
Pons
136
The pons contain nuclei associated with which cranial nerves?
V-VIII
137
What part of the brain stem connects the pons to the diencephalon?
Midbrain
138
The midbrain consists of what parts
Cerebral peduncles
Substantia nigra
red nuclei
139
The midbrain contains nuclei associated with which cranial nerves?
III-IV
140
What part of the diencephalon has major sensory relay center, contributes to motor functions and plays a role in consciousness?
Thalamus
141
What part of the diencephalon is responsible for homeostasis?
Hypothalamus
142
What part of the diencephalon is a part of the endocrine system and is responsible for the secretion of melatonin and sets the body's biological clock?
Pineal gland
143
The cerebellar cortex is what type of matter?
Grey matter
144
What is the structure in the brain that has a tree like appearance of white and grey nuclei?
Cerebellum
145
What part of the brain receives a wide range of sensory inputs and compares actual movements to intended ones?
Cerebellum
146
What divides the cerebrum into right and left cerebral hemispheres?
longitudinal fissure
147
What part of the cerebrum connects the right and left hemispheres?
Corpus Callosum
148
What 3 areas comprise the basal ganglia?
Globus pallidus
putamen
Caudate nucleus
149
What does the basal ganglia assist with
motor control, emotions, behavior, executive function
150
The folds of the cerebrum are called
Gyri or gyrus
151
The shallow grooves of the cerebrum are called
sulci or sulcus
152
Each cerebrum hemisphere has how many lobes?
4
153
The 4 lobes of each cerebrum hemisphere are
frontal
parietal
temporal
occipital
154
The central sulcus separates the frontal and parietal lobes is the divide between what
precentral gyrus
| postcentral gyrus
155
The precentral gyrus is the primary area for what?
motor
156
The postcentral gyrus is the primary area for
somatosensory area
157
Posterior to the primary somatosensory area areas do what
store memories of past sensory experiences
158
Premotor areas do what
generate nerve impulses causing a specific group of muscles to contract in specific sequence.
159
What is a ring structure on the inner border of the cerebrum and floor of the diencephalon?
Limbic system
160
The limbic system is referred to as the __________ as it plays a role in the pain, pleasure, anger, affection and behavior?
emotional brain
161
IRT to the brain and body, lateralization means
one side of the brain controls the other side of the body
162
All sensory and motor pathways cross where
CNS
163
The left hemisphere of the brain is responsible for what type of skills?
language
numerical
scientific
reasoning
164
the right hemisphere of the brain is responsible for what type of skills?
spatial and pattern recognition
emotional content of language
generating images of sight, sound, taste and smell
165
Somatic Nervous System Pathways
Sensory and Motor
166
What nervous system is voluntary, it's motor pathway has one neuron from CNS to effector and releases ACH neurotransmitter?
Somatic Nervous System
167
What are the three neurons in the somatic sensory pathway?
Cell body #1 in dorsal root ganglion
Cell body #2 in the spinal cord or brainstem
Cell body #3 in the thalamus to post central gyrus
168
What are two examples of a somatic sensory pathway
Posterior column- medial lemniscus pathway
Spinothalamic Pathway
-Lateral spinothalamic tract
-Anterior
169
The medial lemniscus pathway senses what
touch
pressure
vibration
conscious proprioception
170
The anterior spinothalamic pathway senses
Light touch, deep pressure
171
The lateral spinothalamic pathways senses
pain sensation and temperature sensation
172
The Somatic Motor pathways signals come from
Upper motor neurons
basal ganglia
cerebellum
sensory neurons or interneurons via reflexes
173
What corticospinal tract pathway neuron originates in the primary motor cortex and synapes with a lower motor neuron of appropriate spinal level?
Upper motor neuron
174
What corticospinal tract pathway neuron exits the spinal ventral root to the muscle for movement
Lower Motor Neuron
175
What nervous system is an unconscious/involuntary system with two divisions that controls viscera and releases norepinephrine and acetylcholine?
Autonomic Nervous System
176
What are the two divisions of the autonomic nervous system?
Sympathetic and Parasympathetic
177
What is the motor pathway of the ANS
Series of two neurons from CNS to the effector
178
what is dual innervation?
Most viscera supplied with nerves of both symp and parasymp divisions
179
Sympathetic and Parasympathetic have what effects in contrast to each other?
Antagonistic
180
How does the sympathetic and parasympathetic effect Heart rate?
S- stimulates
| P- inhibits
181
How does the sympathetic and parasympathetic effect Digestive organs?
S- inhibits
| P- Stimulates
182
What two motor neurons does the ANS pathway have?
Preganglionic and postganglionic
183
Preganglionic path is
neuron from CNS to neuron in autonomic ganglion
184
Post ganglionic path is
from cell body in ganglion to effector
185
Where do sympathetic preganglionic nerves reside?
cell bodies in the lateral grey horn of spinal cord segments T1-L2.
186
What is often referred to as the thoracolumbar division?
Sympathetic preganglionic neurons in the T1-L2
187
What is the path of the sympathetic preganglionic neurons
axons emerge from spinal cord via anterior root and pass through ventral roots of spinal nerves
188
Where does most synapse occur with postganglionic neurons?
sympathetic trunk ganglion
189
How many post ganglionic neuron cell bodies can synapse with a single preganglionic axon?
20 or more
190
What are the abdominal arteries the prevertebral ganglia follow along?
celiac
superior mesenteric
inferior mesenteric
191
Parasympathetic preganglionic neurons cell bodies are located where?
Brainstem - CN III, VII, IX, X
| Spinal cord - S2-S4
192
What nerves carry 80% of all parasympathetic nerve impulses?
Vagus
193
Where do parasympathetic post ganglionic neurons reside?
terminal ganglia
194
Parasympathetic nerves cause what kind of effects?
precise, localized
195
What are the sympathetic effects on the autonomic nervous system?
```
FIGHT OR FLIGHT
increase HR, contraction and BP
dilate pupils and airways
Dilate vessels to muscles, heart, liver and adipose tissue
Constrict vessels to nonessential organs
Mobilize nutrients for energy
```
196
What is the parasympathetic effect on the autonomic nervous system?
SLUDD
```
Salivation
Lacrimation
Urination
Defecation
Digestion
```
197
What are the types of Headaches
```
Tension
Cluster
Migraine
Post Traumatic HA
Medication Overuse
```
198
What headache is bilateral, often daily, described as vice like and may present with hypertonicity of neck muscles
Tension
199
What is the treatment of tension HAs?
NSAIDS
| Tylenol
200
What HAs usually affect middle aged men, present with unilateral pain around the temple/eye, occur in 15-3 hours episodes and horner's syndrome?
Cluster
201
What is horner's syndrome?
ptosis
miosis
anhidrosis
202
What is the treatment for cluster HAs?
Oxygen 100% 15 mins
SubQ sumatriptan 6mg, 12 mg in 24 hr period
Oral zolmitirptan 2.5mg, 10mg in 24 hr period
203
What HAs have a gradual buildup of throbbing HA, last several hours, may have Aura, associated with nausea and vomiting and family history?
Migraine
204
Treatment for migraine
```
rest in dark area
Analgesic/NSAID
Sumatriptan
-oral, 25/50/100 mg
-subQ, 6mg up to 12 in 24hrs
Zolmitriptan
-2.5mg up to 10 in 24 hrs
```
205
What are some migraine prophylaxis? What indicates use?
```
Needed when migraines occur 2-3 times per month
Antihypertensives
-Propanolol- 40mg - 160mg
Antidepressants
-Amitryptyline 10mg - 20-50mg
Anticonvulsants
-Topiramate 100-200mg/day
Symptomatic treatment
-Antiemetic-promethazine 12.5-25mg q4-6h
```
206
What is the pathophysiology of a seizure?
An abnormal, excessive, hypersynchronous discharge from an aggregate of CNS neurons
207
What type of seizure is identified by how much cortical involvement occurs?
Partial or focal seizure
208
What type of focal seizures are there?
Focal w/ and w/o impaired awareness
209
What is the difference between focal w/ and w/o impaired awareness?
Patient appears to be awake but not in contact with others, does not respond normally and has no recollection of what occurred during seizure with impaired awareness.
210
What automatisms may a patient exhibit during a focal seizure?
```
Facial grimacing
Gesturing
Lip smacking
Chewing
Repeating words or phrases
```
211
Generalized Seizures involve how much of the brain?
Entire brain
212
What is the most common type of generalized seizure?
tonic-clonic seizure (grand mal)
213
What does tonic mean?
Muscle stiffening
214
What does clonic mean?
Rhythmic jerking
215
What are other types of generalized seizures?
absent
clonic
atonic (w/o tone)
216
What is the phase after a seizure that the patient is somnolence, confused with HAs, no recollection and Todd's paralysis?
Postictal Phase
217
What is Todd's paraylsis?
Weakness of the limbs
218
What is the only definitive way to diagnosis a seizure?
Video EEG
219
Treatment of Seizure
First aid
- Clear area
- maintain airway
- Start IV
- Blood work
Diazepam 5mg IV/IM Q5-10M, do not exceed 30mg
Medevac
220
What is a condition that a single seizure last greater than 5 mins or 2 or more seizures during the postictal phase?
Status eplilepticus
221
What is a condition that a single seizure last greater than 5 mins or 2 or more seizures during the postictal phase?
Status eplilepticus
222
What is the treatment for status eplilepticus?
Diazepam 5mg IM/IV Q5-10m, do not exceed 30mg
Valproic acid 30mg/kg
Correct possible underlying issue
Intubate
223
What are the two major branches of internal carotid arteries?
Anterior and middle cerebral artery
224
Two verterbral arteries fuse to become _______ that create the __________.
Basilar Artery
| Vertebral-basilar arteries
225
What are the two types of strokes?
Hemorrhagic
| Ischemic
226
What are the two types of Ischemic Strokes?
Transient ischemic attack (TIA)
| Cerebral Vascular Accident (CVA)
227
What is an acute neurologic injury that occurs in the result of interrupted blood flow to the brain?
Stroke
228
What type of stroke is caused by a ruptured blood vessel causing bleeding into the brain and lack of cerebral blood flow?
Hemorrhagic
229
What type of stroke is from a blockage of a blood vessel causing lack of cerebral blood flow?
Ischemic
230
What are the percentages of types of strokes?
80% ischemic, 20% hemorrhagic
231
What are the subtypes of Ischemic Strokes?
Thrombotic
Embolic
Systemic hypoperfusion
232
What stroke is caused by and obstruction of an artery due to a blockage that forms in the vessel? (atherosclerosis)
Thrombotic
233
What type of stroke is caused by and obstruction of an artery due to a blockage from debris that has broken off from a distal area?
Embolic
234
What type of stroke is caused by a lack of brain flow due to decreased systemic blood flow? (hypovolemia)
Systemic hypoperfusion
235
What is defined as a transient episode of neurologic dysfunction caused by focal brain, spinal cord or retinal ischemia without acute infarction and may be reversible?
Transient Ischemic Attack (TIA)
236
What is defined as a neurologic dysfunction caused by focal brain, spinal cord or retinal ischemia with infarction of central nervous system tissue?
Cerebral Vascular Accident
237
What is the only way to determine TIA vs CVA?
MRI
238
What is the FASTER mneumonic?
Face-drooping or numbness on one side
Arms- one limb being weaker or more numb
Stability- steadiness on feet
Talking- slurring, garbled, nonsensical words,
Eyes- visual changes
React- MEDEVAC immediately, note time of symptoms
239
What are two subtypes of hemorrhagic or intracranial hemorrhagic stroke (ICH)
Intracerebral Hemorrhage
| Subarachnoid hemorrhage
240
What are the initial interventions for ischemic stroke?
Maintain oxygenation > 94%
| Elevate head to 30 degrees
241
When should you lower blood pressure for a stroke patient?
Only if Bp is 220/120, lower by 15%.
242
What drug is given to stroke patients to reduce BP?
Labetalol
| 10-20mg IV, same or double dose every 10-20 mins, max is 150mg
243
What medication may be given with MO guidance?
Aspirin 325mg
244
What is the hallmark symptom of restless leg syndrome?
unpleasant or uncomfortable urge to move legs that is transiently relieved with movement, usually deep sensation.
245
What is the treatment for restless leg syndrome?
Ferrous Sulfate, after labs
325mg x3 day for 3-6 months
Avoid aggravating drugs/substances
Increase exercise
Leg massages
246
At what Glasgow Coma Scale must you intubate?
Less than 8, intubate
247
What is a reversal for opioids?
Naloxone IV, IM, SubQ
| .4-2mg repeat doses 2-3 mins
248
What is the most common type of cranial trauma?
Linear fracture (75%)
249
What cranial trauma injury has a high likelihood of infection?
Open fracture
250
What are the thin areas of the skull susceptible to fractures?
Temporal
| Nasal Sinuses
251
What are signs of a basilar skull fracture?
Battle signs
raccoon eyes
hemotympanum
CSF rhino/otorrhea
252
What is cushings triad?
Bradycardia
Hypertension
Respiratory irregularity
253
What can be given for osmotic therapy in a patient with ICP
Mannitol 1g/1kg IV
| 7.5% hypertonic NaCl 250 bolus
254
What occurs in 85% of patients with a skull fracture?
Arterial injury, usually middle meningeal artery
255
What is a classic presentation of an epidural hemorrhage?
Immediate LOC, lucid interval
256
What is the clinical presentation for subdural hematoma?
Acute presents in 1-2 days
| Chronic -15 days or more
257
What is the clinical presentation of a Subarachnoid Hemorrhage?
Thunder Clap
| Nucal rigidity
258
What are the mortality rates for the types of hematomas?
subdural - 60%
| subarachnoid-51 %
259
What are the most common reasons for a spinal cord injury?
MVA 47%
Falls 23%
Violence 14%
Sports 9%
260
Treatment of spinal cord injury?
ABCs
C-Spine
Foley if bladder paralysis
Sedate if needed
261
What medication may be given for spinal cord injury with MO consult?
Methylprednisolone 125mg IM/IV Q4-6H prn
262
What is the NEXUS Criteria (NSAID)
```
Used to determine need for x-ray
N-focal neurological deficit
S-Midline spinal tenderness
A-Altered mental status
I-Intoxicated
D-Distracting injuries
```
263
What causes radiculopathy?
Lumbar disk herniation
264
What are the most common disks affected in radiculopathy?
L5-S1 (90%)
265
What is a medical emergency in herniated disk injury that could present with saddle sensation?
Cauda equina syndrome
266
During a straight leg test, what is the sign that occurs with worsening pain with the manuever?
Lasegue's Sign
267
What is the clinical presentation for cauda equina?
Pain/n/t in lower back, down 1 or both legs
foot drop
bowel/bladder control
problems with sex
268
What can cause cauda equina?
Herniated disk
Infection or inflammation
Cancer
Spinal Stenosis
269
What is the treatment for carpal tunnel syndrome?
Modify hand activity, affected wrist in splint for up to 3 months.
Steroids or NSAIDs
Refer is sxs persist more than 3 months
270
What are the test for carpal tunnel syndrome?
Tinel's
| Phalan's
271
What is the lower motor neuron CN affected in Bell's palsy?
VII
272
What is the clinical presentation of bell's palsy?
Abrupt onset of unilateral face paralysis
ipsilateral restriction of eye closure
tearing or eye dryness
bell's phenomenon
273
What is the difference between bell's palsy and stroke?
Stroke-no paralysis of the forehead
274
Treatment of bell's palsy
Protect/lubricate eye
Steroid-Prednisone 60mg x7 days then taper 5 days
Antiviral-Valacyclovir 1000mg 3x/day x7 days
275
What are the possible etiologies of Meningitis?
Bacterial
Fungal
Spirochete
276
What are common bacterial etiologies for meningitis?
Streptococcus pneumonia
Neisseria Meningitides
Listeria Monocytogenes
277
What are common viral etiologies for meningitis
enterovirus
herpes simplex virus
West nile virus
278
Differential between meningitis and encephalitis?
Meningitis-cerebral function usually intact
| Encephalitis-usually associated with AMS
279
Two test for meningitis
Brudzinski
| Kernig
280
What is the treatment of meningitis?
Ceftriaxone 2g IV Q12H
Vanc
Dexamethasone .15mg/kg IV Q6H
Acyclovir for HSV suspect
281
Meningitis contact prophylaxis treatement?
Ciprofloxacin 500mg X1
282
What are the types of chronic pain?
Nociceptive
Neuropathic
Centralized
283
What are the stages of Nonrapid eye movement (NREM) sleep?
1 light
2 less aware, deeper
3 deepest sleep stage
284
What are medication treatments for insomnia?
Melatonin 3-5mg PO
Trazodone 50mg po
Vistaril 25-50 mg po
Diphenhydramine 25-50 mg po
285
What are the two types of vertigo?
Peripheral
| Central
286
Which type of vertigo is associated with tinnitus and hearing loss?
Peripheral
287
What is the test that will help determine peripheral vs central vertigo?
Dix Halpike
