Neurologic Emergencies

Question 1

What is the Monro-Kellie Doctrine?

Answer 1

80% Brain
10% Blood
10% CSF

Question 2

Intracranial Pressure

Answer 2

Normal ICP: 5-15 mmHg

Question 3

Herniation

Answer 3

Risk if ICP >20 longer than 5 mins

Question 4

MAP Equation

Answer 4

Diastolic + 1/3 (Systolic - Diastolic )

Question 5

Cerebral Perfusion Pressure

Answer 5

CPP = MAP - ICP

Question 6

Optic Ultrasound

Answer 6

Monitors ICP by measuring optic nerve diameter

Question 7

SjVO2

Answer 7

Fiber optic catheters placed into IJ to measure cerebral oxygen supply, perfusion, and consumption.

Question 8

PbtiO2

Answer 8

brain tissue oxygenation monitoring, electrode placed on at-risk tissue

Question 9

Intracerebral Microdialysis

Answer 9

Pulls minute amount of blood out to measure brain neurochemistry

Question 10

Penumbra

Answer 10

Area surrounding the dead tissue is hypoxic, irritated, and is salvageable

Question 11

Ischemic Stroke: BP Management

Answer 11

Systolic: 140-160
Diastolic: 70-90
<180/105 before, during and 24hrs after tPA

Question 12

tPA

Answer 12

Tissue Plasminogen Activator
-0.9 mg/kg max 90mg
-10% over 1 minute, 90% over 60 minute transfusion

Question 13

TNK

Answer 13

Tenecteplase
- Cheaper than tPA
- More favorable
- Given in a single bolus

Question 14

Subarachnoid Hemorrhage

Answer 14

SAH
“Worst headache of life”
“Thunderclap”
Starfish sign on CT

Question 15

AEIOU TIPS

Answer 15

Acidosis
Epilepsy
Insulin
Overdose
Uremia
Trauma
Infection
Psychosis
Seizures

Question 16

Glasgow Coma Scale

Answer 16

Eye opening (1-4)
Verbal responsiveness (1-5)
Motor function (1-6)

Question 17

Delirium

Answer 17

“Acute brain failure”

Question 18

GCS Eye Opening

Answer 18

4-Spontaneous
3-To sound
2- To pressure
1-None

Question 19

GCS Speech

Answer 19

5-Oriented
4-Confused
3-Words
2-Sounds
1-None

Question 20

GCS Motor Function

Answer 20

6-Obeys commands
5-Localized
4-Normal flexion
3-Abnormal Flexion
2-Extension
1-None

Question 21

Contraindications for thrombolytics

Answer 21

History of hemorrhagic stroke
CVA last 13 months
SBP >180
Pregnant or 1 month postpartum

Question 22

Lung development unable to sustain life at

Answer 22

<23 weeks gestation or < 1lb fetal weight

Question 23

Full term neonatal tidal volume

Answer 23

5-7 mL/kg

Question 24

PEEP in neonate

Answer 24

4-6 cmH20

Question 25

CPAP

Answer 25

First line vent support in neonates 4-6 PEEP 30 - 100% FiO2

Question 26

Surfactant Administration

Answer 26

3 mL/kg

Question 27

Meconium Aspiration Syndrome

Answer 27

Presents with: - Atelectasis - Persistent Pulmonary Hypertension (PPH) - Pneumothorax - Pneumothorax

Question 28

Meconium Aspiration Syndrome treatment

Answer 28

Monitor for resp distress, treat with PPV, high PEEP, or surfactant

Question 29

Respiratory Distress Syndrome (RDS)

Answer 29

Surfactant deficiency related to preterm delivery  Decrees compliance Atelectasis V/Q mismatch Tachypnea Increased work of breathing Ground glass chest radiography

Question 30

Respiratory distress syndrome

Answer 30

Treatment Oxygen administration CPAP 6–8 cmH20 Intubation, mechanical ventilation IV. Fluids. IV antibiotics 

Question 31

Gastroschisis

Answer 31

Herniation of abdominal contents through abdominal wall - Usually on right side of umbilicus

Question 32

Gastroschisis treatment

Answer 32

Treat like abdominal evisceration

Question 33

Omphalocele

Answer 33

Protrusion of viscera attached to the umbilical cord  Treatment: treat like abdominal evisceration 

Question 34

Congenital diaphragmatic hernia

Answer 34

Diaphragm fails to close during prenatal development, abdominal contents present in and thorax  - scaphoid abdomen - Bowel sounds over chest 

Question 35

Intestinal Malrotation and Volvulus

Answer 35

Malrotation: twisting of small bowel over on his self, resulting in obstruction Volvulus: strangulation about from malrotation what’s on

Question 36

Normal CPP

Answer 36

50-90

Question 37

Cranial Nerve I

Answer 37

Olfactory Smell

Question 38

Cranial Nerve II

Answer 38

Optic nerve Vision

Question 39

Cranial nerve 3

Answer 39

Oculomotor nerve Eye movement, pupil constriction

Question 40

Cranial Nerve IV

Answer 40

Trochlear nerve Eye movement

Question 41

Cranial nerve V

Answer 41

Trigeminal nerve Somatosensory information (touch, pain) from the face and head; muscles for chewing.

Question 42

Cranial nerve VI

Answer 42

Abducens Nerve Eye movement

Question 43

Cranial nerve VII

Answer 43

Facial Nerve Taste (anterior 2/3 of tongue); somatosensory information from ear; controls muscles used in facial expression.

Question 44

Cranial Nerve VIII

Answer 44

Vestibulocochlear Nerve Hearing, balance

Question 45

Cranial Nerve IX

Answer 45

Glossopharyngeal Nerve Taste (posterior 1/3 of tongue); Somatosensory information from tongue, tonsil, pharynx; controls some muscles used in swallowing.

Question 46

Cranial Nerve X

Answer 46

Vagus Nerve Sensory, motor and autonomic functions of viscera (glands, digestion, heart rate)

Question 47

Cranial Nerve XI

Answer 47

Spinal Accessory Nerve Controls muscles used in head movement

Question 48

Cranial Nerve XII

Answer 48

Hypoglossal Nerve Controls muscles of tongue