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Spring ER > Neurologic > Flashcards

Neurologic Flashcards

(61 cards)

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1
Q

What is coma

A

– state of reduced alertness and responsiveness; patient cannot be aroused

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2
Q

MCC AMS in ED

A

hypoglycemia

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3
Q

Causes of miosis

A 
COPS
clonidine & cholinergics
opiates & organophosphates
pilocarpine & phenothiazines & pontine bleed/lesion
sedative hypnotics (benzos)

+ Horner Syndrome

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4
Q

Causes of mydriasis

A

anticholinergics

sympathomimetics

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5
Q

fixed dilated pupil

A

temporal lobe herniation on same side or if alert, could be from drops or compression of CN III

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6
Q

apneustic breathing

A

prolonged pause after inspiration –

pontine infarct

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7
Q

ataxic breathing

A

irregular, no pattern,

preterminal

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8
Q

MC location of HA in SAH

A

occipitonuchal

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9
Q

Life threatening causes of HA

A 
Subarachnoid Hemorrhage
Meningitis
Intraparenchymal Hemorrhage and Cerebral Ischemia
Subdural Hematoma
Brain Tumor
Cerebral Venous Thrombosis
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10
Q

Risk Factors for SAH

A 
HTN
smoking
excessive EtOH
fhx
polycystic kidney dis
coartaction of aorta
Marfan Syndrome
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11
Q

T or F:

uncomplicated syncompe w/out trauma or other sxs should persue SAH

A

False

every syncope does not need CT

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12
Q

Remote trauma with HA
+anticoag/alcohol/elderly

suspected dx & how to dx

A

Subdural hematoma
Noncontrast Ct
- may need contrast if subacute or chronic

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13
Q

HA worse in AM think

A

Brain tumor

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14
Q

Hypercoaguable state:
oral contraceptives, postpartum/post op, etc
+
HA, vomiting, seizures

A

Cerebral Venous Thrombosis

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15
Q

60 yo F HA and jaw claudication

A

Temporal Arteritis

Start on prednisone

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16
Q

Tx for benign intracranial htn (pseudotumor cerebri)

A

Acetazolamide

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17
Q

– young patient with chronic HAs. N/V, visual problems, papilledema, normal CT, elevated CSF pressure

A

Benign Intracranial Hypertension

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18
Q

DHE in contraindicated for migraine treatment in

A

pregnancy,
uncontrolled HTN,
CAD

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19
Q

Tx tension HA

A

analgesics or NSAIDs

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20
Q

Tx cluster HA

A

high flow oxygen

DHE, triptans, analgesics

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21
Q

Tx trigeminal neuralgia

A

Carbamazepine

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22
Q

Contralateral hemiparesis, facial plegia, and sensory loss. Homonymous hemianopsia and gaze preference toward side of infarct (away from the deficit). Face and upper extremity affected more than lower. If dominant hemisphere involved, aphasia (receptive, expressive, or both) present. If nondominant hemisphere involved, inattention, neglect, often present.

A

Middle Cerebral Artery Stroke

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23
Q

Contralateral sensory and motor symptoms in lower extremity, sparing of hands and face. May have aphasia neglect, incontinence

A

Anterior Cerebral Artery stroke

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24
Q

unilateral headache, contralateral homonymous hemianopsia and unilateral cortical blindness.

A

Posterior Cerebral Artery stroke

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25
vertigo (with cerebellar or brainstem signs), HA, nausea, visual disturbances, oculomotor palsies, ataxia, sensory disturbance, bilateral limb weakness
Vertebrobasilar stroke
26
MC artery affected in ischemic stroke
middle cerebral artery
27
Stroke pt who is a candidate for thrombolytics. Lower BP to___ via which drugs___
SBP <110 labetalol, nicardipine, esmolol
28
tPA must be given within
3hrs of onset sxs (some places 4.5-6) must know last baseline!
29
ED tx of TIA
antiplatelet therapy – aspirin alone clopidogrel or aspirin plus dipyridamole
30
Dx cervical artery dissection
MRI/MRA and CT/CTA
31
ED tx cervical artery dissection
heparin followed by Coumadin | admit for monitoring
32
Nystagmus with ataxia suggests
pathology is central, not in the cord or periphery
33
Apraxic gait is
lost ability to initiate walking – seen with nondominant hemispheric lesions
34
Festinating gait is
narrow based shuffling steps - Parkinson's
35
Worsening (+) Romberg suggests
sensory ataxia with problem in posterior column, vestibular dysfunction, or peripheral neuropathy
36
perception of movement when none exists
Vertigo
37
transient loss of consciousness due to loss of postural tone with spontaneous recovery
Syncope
38
light-headedness with concern for syncope
Near Syncope
39
– feeling of unsteadiness, imbalance, or sensation of floating while walking
Disequilibrium
40
MCC vertigo in elderly
Benign paroxysmal positional vertigo
41
Hallpike maneuver diagnoses | A (+) result=
Benign paroxysmal positional vertigo (+) nystagmus toward AFFECTED ear
42
Treatment for BPPV
antihistamines
43
Acoustic schwannoma affects cranial nerve
VIII (8)
44
Vertigo with head movement and accompanied nausea. | NO hearing loss or tinnitus
BPPV
45
status epilepticus lasts more than ____ minutes
5
46
initial treatment of status epilepticus
IV Lorazepam or Diazepam not working: Phenytoin or Fosphenytoin
47
If a neuromuscular blocker (Vecuronium) is used in status epilepticus, what must you do?
EEG monitoring drug does not affect neuronal activity. Body will not demonstrate seizure even though they are still experiencing it
48
Pt complains of lateralized weakness and on exam is hyper-reflexive with a + Babinski. What kind of lesion is most likely?
Central lesion
49
"floppy infant" with poor feeding and lethargy
Botulism
50
Gi sxs- n,v,d, cramps + descending symmetric paralysis diplopia, dilated pupils
Botulism
51
Sub acute ascending symmetric weakness or paralysis and loss of DTR’s
Guillain-Barre Syndrome
52
Most common plexopathy and nerve roots involved
Brachial plexopathy | C5-T1 nerve roots
53
best way to dx MS
MRI T2 weighted showing multiple lesions in white matter, ventricles, or spinal cord
54
acute treatment for MS flare-up
IV steroids
55
Urine dipstick says + for blood but no RBCs found on microscopic exam
Rhabdomyolisis
56
MC presenting symptoms of myasthenia gravis what kind of weakness does this symptom have?
ptosis and diplopia also see proximal weakness relieved by rest
57
What cholinergic inhibitor drug used in myasthenia gravis?
pyridostigmine | neostigmine
58
Dx myasthenic crisis/ myasthenia gravis?
Edrophonium IV push | if muscle weakness improves then myasthenic crisis
59
Pt presents with hyperthermia, rigidity, and AMS | exam shows "lead pipe" rigidity
neuroleptic malignant syndrome
60
what causes neuroleptic malignant syndrome
dopamine antagonism/depletion
61
Treatment for neuroleptic malignant syndrome
``` ABCs Cooling measures Fluids & alkaline diuresis Bromocriptine- dopamine agonist Dantrolene- prevents muscle contraction Nipride of CCB for HTN Paralyze and intubate pt with nondepolarizing neuromuscular blockers ```

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