Neurology I Highlights

Question 1

Coma is when a pt is unarousable and unresponsive for ___________

Answer 1

> 1 hr

Question 2

True or false: Reflexes may still be intact with coma

Answer 2

True

Question 3

What do you need to repeat when a pt is in a coma?

Answer 3

Neurological checks

Question 4

What is a diagnosis of brain death based on?

Answer 4

Clinical exam

Question 5

What LOC can still have sleep-wake cycles and make sounds?

Answer 5

Pts in a vegetative state

Question 6

What LOC may appear awake but have no meaningful activity and no purposeful movement or meaningful speech?

Answer 6

Vegetative state

Question 7

What LOC is characterized by inconsistent levels of consciousness and some self-awareness?

Answer 7

Minimally conscious

Question 8

For each cause of coma, describe what the pupils would look like:
1) Toxic and metabolic disorders
2) Midbrain lesion or herniation
3) Pontine lesion
4) Opiate overdose

(not highlighted but she said it’s impt)

Answer 8

1) Normal (usually)
2) Unilateral or bilateral “blown” pupils
3) Small, responsive to light bilaterally
4) Pinpoint pupils bilaterally

Question 9

Motor function is absent and cognition is intact in what LOC?

Answer 9

Locked-in syndrome

Question 10

What LOC pts are mute and quadriplegic, but still conscious?

Answer 10

Locked-in syndrome

Question 11

In what LOC is the corticospinal tract usually affected?

Answer 11

Locked-in syndrome

Question 12

What is aphasia and what causes it?

Answer 12

Inability to express or receive written/verbal communication; damage to Wernicke’s or Broca’s areas

Question 13

1) Define agnosia
2) What causes it?
3) Give examples

Answer 13

1) Inability to recognize things/people/places
2) Damage to parietal, temporal or occipital lobes
3) Astereognosis, topographic agnosia

Question 14

1) Define apraxia
2) What can cause it?

Answer 14

1) Disordered skilled movements; can perform, but does so incorrectly
2) Can be widespread or focal cerebral damage

Question 15

1) Define amnesia
2) List some potential causes

Answer 15

1) Memory loss (recent or new memories)
2) Damage to hippocampus: stressful events, ischemia, h/o migraines, advanced age, injuries, drugs, alcohol, trauma, neurologic conditions

Question 16

Subdural hematomas affect what?

Answer 16

Bridging veins

Question 17

How do you know if something is a subdural hematoma?

Answer 17

CT scan; will not cross midline

Question 18

Subdural hematoma:
1) Most patients present with ipsilateral ______________ and contralateral _____________.
2) You should check to see if patient is on what meds?

Answer 18

1) pupillary dilation; hemiparesis
2) Anticoagulants

Question 19

When do you need to intubate a pt on the Glasgow coma scale?

Answer 19

If = or > 8

Question 20

How do you test for subdural hematoma?

(not highlighted but emphasized in class)

Answer 20

“Halo” of CSF around bloody discharge on white cloth/coffee filter

Question 21

Characterizing Headaches: What are some main ways to do this?

Answer 21

Primary and secondary & acute and chronic

Question 22

How do you Tx subdural hematomas?

Answer 22

Admit to hospital and neurosurgery consult

Question 23

What is your job as a PA when a pt presents with a headache?

Answer 23

Decide if “benign” headache vs. headache with dangerous neurologic or systemic pathology (Red Flag)

Question 24

Most headache diagnoses are based primarily on which of the following?
A. history
B. exam findings
C. laboratory testing
D. imaging

Answer 24

A. history

Question 25

Most headache diagnoses made based on what?

Answer 25

A detailed history

Question 26

1) What headaches are episodic, severe, unilateral with periorbital pain? 2) How long do these headaches last?

Answer 26

1) Cluster headaches 2) 15 min - 3 hr

Question 27

A pt being agitated and their headache being worse with activity are characteristics of what?

Answer 27

Cluster headaches

Question 28

Name one example of a trigeminal autonomic cephalgia

Answer 28

Cluster Headaches

Question 29

How to rule out DDxs for cluster headaches?

Answer 29

Ipsilateral autonomic symptoms

Question 30

What is the main Tx for cluster headaches?

Answer 30

High flow O2 via non-rebreather mask

Question 31

True or false: Migraine patients will have normal neuro exam.

Answer 31

True

Question 32

Migraine headaches last how long?

Answer 32

4-72 hrs w/o tx

Question 33

What should you not mistake a migraine for?

Answer 33

A stroke

Question 34

List 4 primary characteristics of migraines

Answer 34

1) Unilateral 2) Pulsating 3) Nausea or vomiting 4) Photo or phonophobia

Question 35

What type of HA is much more common in females?

Answer 35

Migraines

Question 36

How do you differentiate migraines and strokes?

Answer 36

Normal neuro exam w. migraine

Question 37

Migraine HA Tx: **Triptans:** preferred nasal sprays or injections can be used in patients with n/v, but are CONTRAINDICATED in _____________ and _______________

Answer 37

CAD and cerebrovascular disease

Question 38

Combo therapy is the highest yield migraine Tx, aka __________ + ____________.

Answer 38

NSAIDs + Triptans. (can also add metoclopramide or Compazine in pts with n/v as well)

Question 39

What should you avoid in treating migraine pts?

Answer 39

NEVER Rx opioids

Question 40

Are tension headaches pulsating? Describe them

Answer 40

Non-pulsating; not aggravated by routine physical activity

Question 41

True or false: Corticosteroids can be used to reduce occurrence of migraines, but do not work acutely

Answer 41

True

Question 42

True or false: migraines are throbbing, not pulsating

Answer 42

True

Question 43

What is the most common headache type?

Answer 43

Tension headaches

Question 44

True or false: Tension headaches involve heightened sensitivity of pain pathways in the CNS, and focal neuro deficits

Answer 44

FALSE; NO focal neuro deficits

Question 45

Tension headaches: 1) What is most likely if it's chronic? 2) What are some DDxs? 3) What are the potential Txs?

Answer 45

1) Chronic = typically secondary to medication overuse or depression 2) Migraines, cluster HA, medication overuse, sinus HA 3) NSAIDs, nonpharmacologic interventions (acupuncture, massage, trigger point injections, PT) * Note, Botox does not work here*

Question 46

What is the most common type of headache seen in primary care? A. cluster B. migraine C. tension D. post traumatic

Answer 46

C. tension

Question 47

List 2 important low-risk HA criteria

Answer 47

1) Not “worst headache ever” 2) Normal neuro exam

Question 48

What is the SNNOOPPPP mnemonic for red flag Sx in pts with headaches?

Answer 48

**Systemic symptoms** (fever, rash, myalgia, WL, HTN) **Neoplasm** (Hx CA) **Brain primary or mets** **Neurologic deficit or dysfunction** (focal exam, Sz AMS/cognitive changes) **Onset abrupt** (thunderclap HA)* **Older patient** (> 50 y/o) **Pattern change or new type of HA **Papilledema Painful eye Pregnancy

Question 49

What 4 severe headache Sxs warrant emergent evaluation?

Answer 49

1) Thunderclap HA 2) Fever with neck stiffness 3) Papilledema with focal neuro signs or impaired MS 4) Acute glaucoma

Question 50

True or false: Stable primary headaches rarely need neuroimaging

Answer 50

True

Question 51

What likely suggests an underlying cause with headaches?

Answer 51

Abnormal neuro exam

Question 52

Bells Palsy is sudden onset palsy of CN _____ (______ nerve) due to nerve inflammation that affects the ____________ and face.

Answer 52

CN VII (facial nerve); forehead

Question 53

Will other neuro deficits besides CNVII be found in Bell's Palsy?

Answer 53

**NO OTHER neuro deficits**

Question 54

Symptoms that can occur due to damage to the lower cranial nerves (CN 9-12) are called what?

Answer 54

Bulbar palsy

Question 55

What Dx should you be thinking of if a pt has Bulbar palsy?

Answer 55

ALS