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NNSOCM 2023 > NEUROLOGY W4 > Flashcards

NEUROLOGY W4 Flashcards

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1
Q

What are the 3 main functions of CNS?

A
  1. Monitor internal/external environment
  2. Integrate sensory input (understanding-creating sensations)
  3. Coordinate voluntary/involuntary responses
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2
Q

What is a neuron?

A

A nerve cell

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3
Q

What are the components of a neuron?

A
  1. Nuclei (core)
  2. Dendrite (receiver/tentacle)
  3. Axon (transmitter/tail)
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4
Q

What is the function of an afferent nerve cell?

A

Transports sensory input towards the brain

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5
Q

The autonomic nerve system consists of what to types of response?

A

Parasymphatic (inhibitor/relaxation)
Symphatetic (Exiter/fight or flight)

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6
Q

Is it true that neurons can divide and renew them selves?

A

No. Dead neutrons cannot be restored, but their function can be somewhat resumes by other neurons close by

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7
Q

Which molecules are mainly involved in creating action potential?

A

Sodium (Na) and a smaller amount of potassium (K)

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8
Q

What does the myelin (coating) of the axons achieve?

A

Nerve impulse travels faster in highly myilated axons

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9
Q

Name 3 types of nerve terminals

A
  1. Nerve to nerve
  2. Nerve to muscle (neuromuscular-terminal)
  3. Nerve to gland (neuroglandular-terminal)
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10
Q

What happens in the synaptic cleft

A

Neurotransmitters interact with potsynaptic receptors and excites or inhibits a process

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11
Q

Name 3 different methods in which the body disposes of a neurotransmitter after it has been used

A
  1. Diffusion out of the synapsis cleft
  2. Inactivation/decomposition by enzymes
  3. Reuptake into the presynaptic knob (reused)
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12
Q

Name the 3 meninges (protective layers) of the brain

A
  1. Dura mater
  2. Arachnoidea
  3. Pia mater
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13
Q

What are the characteristics of arachnoidea?

A

Spiderlike connections between the two other meninges. Containing CSF (cerebrospinal fluid)

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14
Q

What are the characteristics of pia mater?

A

Thin, delicate, highly vascularised layer closest to the brain

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15
Q

What is the normal daily production amount of CSF

A

500ml

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16
Q

What is the normal constant volume of CSF?

A

150ml

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17
Q

What is the characteristics of CSF?

A
  1. Surrounds the brain and spinal cord
  2. Transports nutrients and waste
  3. Acts as shock absorbent
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18
Q

What is a ganglion?

A

A collection of nerve cell bodies (nuclei)

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19
Q

Name, function and type of CN I

A

Name: Olfactory
Function: Smelling
Type: Sensory

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20
Q

Name, function and type of CN II

A

Name: Optic
Function: Vision (sensory)
Type: Sensory

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21
Q

Name, function and type of CN III

A

Name: Oculomotor
Function: Eye movements (motor)
Type: Motory

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22
Q

Name and function of CN IV

A

Name: Trochlear
Function: Voluntary eye movements
Type: Motory

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23
Q

Name, function and type of CN V

A

Name: Trigeminal
Function: Sensation of head and face, movement of mandible
Type: Sensory + Motory

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24
Q

Name, function and type of CN VI

A

Name: Abducent
Function: Eye movement (lat. rectus)
Type: Motory

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25
Name and function of CN VII
Name: Facial Function: Taste, Facial expression Type: Sensory + Motory
26
Name and function of CN VIII
Name: Vestibulocochlear Function: Hearing and balance Type: Sensory
27
Name, function and type of CN IX
Name: Glossopharyngeal Function: Control swallowing Type: Sensory + Motory
28
Name, function and type of CN X
Name: Vagus Function: Pharynx, larynx-control + speech Type: Sensory + Motory
29
Name, function and type of CN XI
Name: Accessory Function: Rotation of head, shoulder shrug. Type: Motory
30
Name, function and type of CN XII
Name: Hypoglossal Function: Movement of tongue Type: Motor
31
How many peripheral nerve pairs do a human body have?
31 pairs
32
What is a dermatome?
An area of the skin a given nerve serves. Therefor the nerve can be tested for function at this given area.
33
What is a myotome?
A muscle that is served by a given nerve. Therefor the nerve can be tested for function at this given muscle
34
What is the plexus?
A structure found many places in the body were several efferent and afferent fibres of nerves merge to form peripheral nerves that innervate a specific muscle or skin area
35
What is a reflex?
A rapid and automatic response to a specific stimulus that happens in the spinal cord
36
What are the most common and easy recognizable signs and symptoms of meningitis?
Fever Stiff neck Headache
37
What is brudzinzki's sign?
The "test" were you bend the patients neck upwards. If the patient flexes the hip upwards due to pain and swollen meninges it is a sign of meningitis.
38
When should you always perform neurological examination?
1. Suspected head or spinal injury 2. Complaints of neurological deficits
39
What are the to causes of stroke?
1. Ischemia (85%) 2. Haemorrhage (15%)
40
Name some of the signs & symptoms of stroke
1. Sensory deficit 2. Motory deficit 3. Aphasia (speech problems) 4. Blindness 5. Dizziness 6. Decreased LOC 7. Thunderclap headache (sudden onset, high pain)
41
Name some causes for seizure
1. Structural disease (e.g. tumor, postinchemic, post traumatic) 2. Infection 3. Hypoglycaemia (low blood sugar) 4. Cerebral edeema from trauma or heat stroke
42
Name the to types of seizures
1. Localised 2. Globalised
43
Name the to types of globalised seizures
1. Tonic (stiff muscles) 2. Clonic (movement of muscle) - shaking
44
What are the risks of seizuring?
1. Head trauma 2. Biting tongue - bleeding 3. Hypoxia - damage to nerve cells
45
On the GCS score what would these responses score? -Eyes open upon speech (eye) -Gives confused answers (verbal) -Localizes pain (motor)
3 + 4 + 5 = 12
46
If the patient has closed eyes but opens them when you talk to him. How do you rate him on AVPU?
V (verbal)
47
A patient has open eyes but makes no sense when he speaks. How do you rate him on AVPU?
A (alert)
48
Name the 5 senses
1. Touch/pain 2. Smell 3. Hearing 4. Taste 5. Seight
49
What is typically indicated with traumatic injuries and GCS <8 ?
Patient usually cannot keep airway patent at this point. Intubation may be necessary
50
What does AEIOUTIPS stand for?
A: Altitude E: Environment (hypo/hyperthermia) I: Infections O: Overdose (drugs, alcohol) U: Underdose (lack of sleep) T: Toxins/trauma I: Insulin (hypoglycemia P: Poison S: Stroke, seizure, shock
51
What does somnolent mean?
Patient is sleepy, but can easily be woken
52
What does stupor mean?
Patient is in a sleeplike-state, can be woken but it takes some time
53
What does coma mean?
Patient is deep unconscious and does not respond to pain
54
What are the qualitative changes to consciousness that we can assess?
1. Disorientation (time, space, situation, personal credentials) 2. Confusion (hallucination, dillusion)
55
What are the 3 causes for syncope?
1. Neural (reflex of e.g. the vagus nerve) 45% 2. Orthostatic (fall in BP when moving) 10% 3. Cardiogenic (heart issues) 20%
56
What does prodromal symptoms mean?
Prodromal means "early sign or symptom leaning up to a disease or incident"
57
Name some prodromes (symptoms leading up to) of syncobe
1. Light-headed 2. Dizziness 3. Blurred vision 4. Impaired hearing 5. Palpitations (feeling of heart pumping hard) 6. Chest pain
58
Name some informations of the patient which could be used to diagnose cardiogenic syncope
1. Known cardiovascular diseases or family history 2. Feeling of cardiac arrhythmia or chest pain before syncobe accured 3. Syncobes happens when supine or durin physical activity
59
What is primary injury (TBI)
Traumatic injury (structural damage) to the scalp, scull, meninges, brain and vessels
60
What is secondary injury regarding TBI
Injuries to structures in the brain caused by pathology of the primary TBI
61
Name some secondary TBI injuries
1. Mass effect 2. Herniation
62
What are the causes of meningitis?
Infection on meninges and/or brain 1. Viral (e.g. tick born abovirus) 2. Bacterial (e.g. meningococci)
63
Normal ICP (inter cranial pressure)
15mmhg
64
What is CPP?
Cerebral perfusion pressure The pressure in which the blood perfuses the brain CPP=MAP-ICP
65
Why do we hyperventilate a TBI with signs of herniation?
To lower ICP and keep the brain from herniating. This causes vasoconstriction in the brain which sadly also leads to hypoxia
66
What happens with ICP if a mass emerges in the cranium due to traumatic injury?
ICP increases. To maintain cerebral perfusion MAP pressure must increase as well (causing hypertension)
67
What happens to ICP in decompensated state?
ICP rises beyond normal values. To maintain 70-80 mmhg CPP in the brain, only MAP pressure can now increase (causing systemic hypertension) CPP=MAP-ICP
68
Types of mass effects?
1. Epidural hematoma 2. Subdural hematoma 3. Subarachnoid hematoma 4. Intracerebral hematoma
69
What are the characteristics of epidural hepatoma?
1. Arterial bleed between the cranium and the dura mater. 2. Often caused by blunt head trauma (e.g. by falling)
70
What are the characteristics of a subdural hematoma?
1. Venous bleed between dura mater and arachnoidea 2. Slowly evolving symptoms
71
What are the characteristics of subarachnoid hematoma?
1. Aneurism rupture causing arterial hemorrhage 2. Often at circle of Wilis 3. Bleeding into sulk and gyri of the brain
72
Signs of herniation
1. Pupils not equal 2. Flexion/extension of arms/wrists 3. Extension of legs 4. Abnormal breathing (cheyne-stoke, Biot) 5. Cushings phenomenom
73
What is the signs of cushings phenomenom?
1. Systemic hypertension >200mmhg 2. Bradicardia 3. Abnormal breathing patterns
74
Signs of TBI (HEADS)?
H: Headache E: Ears ringing A: Amnesia D: Double vision S: Something feels wrong
75
Visual signs of TBI?
1. Battlesigns 2. Raccon eyes 3. CSF leaking out of ear or nose 4. Dilated pupils
76
Classifications of TBI (GCS)
Mild: GCS 13-15 Moderate: GCS 9-12 Severe: GCS 3-8
77
What is the most predictive component of GCS for determining neurological outcome?
Motory function
78
2 important interventions when dealing with TBI patients? (per TCCC)
1. Disarm 2. Remove or disconnect communication/radio
79
What are the preferred BP for TBI?
100-110 mmhg
80
What can you do as last resort when dealing with TBI were signs of herniation occurs?
1. Elevate upper body 30 degrees 2. Administer Hypertonic saline (250ml 3-5%) 3. Hyperventilate (RR 20 ETCO2 30-35 mmhg)
81
TSI severity depends on what?
1. Region of injured spine 2. How much of the spinal cord that is affected
82
What is primary spinal injury?
Initial trauma/structure damage
83
What is secondary spinal injury?
Injury that worsens neurological deficit. Can be caused by manipulation/movement of a fractured spine.
84
Types of spinal injury?
1. Complete (both sides of the body affected) 2. Incomplete (one-sided sensory/motory deficits)
85
What is spinal shock?
Acute loss of motory/sensory functions distal typically due to trauma. Reversible over time.
86
What is neorogenic shock and what happens?
1. A type of distributive shock 2. Vasodilation distal to fracture due to loss of parasymphathetic function. This causes hypotension. 3. Bradycardia can be present if fracture is in the cervical segment
87
What is worst per GCS motory function: Abnormal flexion or abnormal extension?
Abnormal extension (1 point)
88
What does encephalon mean?
Brain
89
Cerebellum means
Small brain
90
Signs & symptoms of mild TBI?
Headache, fatigue, difficulty concentrating, loss of balance, nausia, Insomnia, vision changes, sensivity to light and noise
91
What are the names of the 4 arteries supplying the brain?
1. Carotid arteries (internal left and right) 2. Vertebral arteries (left and right)
92
What is the function of a efferent nerve?
Transports motory signals from the brain towards the muscles
93
What are the characteristics of dura mater?
Thick, fibrous (connective tissue), contains vessels and nerves. Protects the brain. Lies closest to the cranium of all meninges
94
Name 3 types of noxious stimuli?
1. Mechanical (pressure, stretching) 2. Chemical (acid, inflammation) 3. Thermal (cold, heat)
95
What is a nociceptor?
A nerve ending that can react to noxious stimuli
96
What is the physiology of pain perception?
1. Nocicepter reacts (potential dangerous stimuli) 2. Transduction of stimuli to electrical impulse 3. Impulse goes via nerves to different parts of the brain for interpretation 4. A subjective sensation of pain is generated
97
What is referred pain?
Typical visceral pain (pain from organs) can be felt as pain in other parts of the body. Example: Heart muscle ischemia can be felt as pain in the left arm.
98
Name the 3 types of systemic analgesia
1. Opiod (i.e. fentanyl, morphine) 2. Non-opiod (i.e. paracetamol) 3. Modulation (i.e. ketamine)
99
What is true regarding mixing of analgesia-types?
1. You can treat with a mix of opioids, non-opioids and modulation-drugs 2. You shouldn't treat with a mix of different types of opioids together
100
How does local anaesthesia work?
By blocking transmission of the nerves locally (and distal from injection)
101
Which nerves are thickest and requires higher concentration of local anesthetia to work?
Nerves in charge of movement (motory)
102
What is a digital nerve block?
A local anaesthesia of a finger or a toe
103
What are the most common substances for local anesthesia?
Xylocain or Lidocain
104
Talk through the procedure of digital nerve block
1. Assess perfusion of finger/toe 2. Prep equipment (alcoswap, draw up xylocain into syringe, apply injection needle) 3. Identify and disinfect injection point 4. Advance the needle into the area around the dorsal nerve. 5. Aspirate to check for blood 6. Inject xylocain (0,5-1ml) 7. Advance to palmar digital nerve 8. Aspirate to check for blood 9. Inject xylocain (0,5-1ml) 10. Place needle in sharp box when done.
105
How does opioids work?
Blocks the feeling/perception of pain in the brain
106
How does non-opioids work?
Usually they prevent nociceptors of feeling stimuli. In example NSAIDS decreases the inflammation processes and causes pain relief.
107
What are the physiological responses of pain?
1. Reflex (happens in the spinal cord) 2. Agitation (sympathetic activity increases) 3. Syncobe (the brain shuts your consciousness off to prevent you from percieving huge pain)
108
Phrenic nerve paralysis can be caused by injury to what level of vertebrae?
C3-C5
109
What are the 3 "high-risk factors" which mandates immobilization
1. Age >65 2. Dangerous mechanism 3. Numbness or tingeling in extremeties
110
Abnormal flexion is also called (GCS)
Decorticate
111
Abnormal extension is also called (GCS)
Decerebrate

NNSOCM 2023 (16 decks)

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