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130 Cards in this Set
- Front
- Back
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Glaucoma is caused by...?
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Optic nerve damage
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___ is the second leading cause of blindness in adults in the United States.
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Glaucoma
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Which of the following is not a risk factor for glaucoma? A) Family history B) Thin cornea C) Farsightedness D) Eye trauma D) Prolonged use of systemic corticosteroids
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C) Farsightedness
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There are two theories as to how increased IOP leads to glaucoma (damage to the optic nerve). What are they?
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Direct mechanical theory (suggests that high IOP damages the retinal layer as it passes through the optic nerve head). The indirect ischemic theory suggests that high IOP compresses the microcirculation in the optic nerve head, resulting in cell injury and death.
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An abnormal inner ear fluid balance caused by a malabsorption in the endolymphatic sac or a blockage in the endolymphatic duct.
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Meniere's disease
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The ___ hypothesis states that, because of limited space for expansion within the skull, an increase in any one of the components causes a change in the volume of the others.
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Monro-Kellie hypothesis
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A(n) (increase/decrease) in PaCO2 causes cerebral vasodilation.
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Increase
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The brain's ability to change the diameter of its blood vessels to maintain a constant cerebral blood flow during alterations in systemic blood pressure.
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Autoregulation
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The cerebral perfusion pressure is calculated by...
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Subtracting the ICP from the mean arterial pressure.
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What is Cushing's response?
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Seen when cerebral blood flow decreases significantly. When ischemic, the vasomotor center triggers an increase in arterial pressure in an effort to overcome the increased ICP. A sympathetically mediated response causes an increase in the systolic blood pressure with a widening of the pulse pressure and cardiac slowing.
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What is the Cushing's triad?
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Bradycardia, hypertension, and bradypnea associated with the brain's inability to autoregulate.
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What is the earliest sign of increasing ICP?
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Change in level of consciousness. Slowing of speech and delay in response to verbal suggestions are other early indicators.
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Abnormal flexion of the upper extremities and extension of the lower extremities.
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Decortication
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Extreme extension of the upper and lower extremities.
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Decerbration
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True/False. Lumbar puncture is avoided in patients with increased ICP.
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True. The sudden release of pressure in the lumbar area can cause the brain to herniate.
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___ waves indicate cerebral ischemia.
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A/Plateau
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___ waves indicate intracranial hypertension and variations int he respiratory cycle.
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B waves
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___ waves relate to variations in systemic arterial pressure and respirations.
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C waves
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___ involves the measuring of glutamate, lactate, pyruvate, and glucose via cortical probes placed near the injured area.
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Microdialysis
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What is a normal CPP?
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Greater than 70 mm Hg. A lower CPP indicates that the cardiac output is insufficient to maintain adequate cerebral perfusion.
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Why is monitoring temperature critical in neuro patients?
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Fever increases cerebral metabolism and the rate at which cerebral edema forms.
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Metabolic demands may be reduced through the administration of ___.
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Barbiturates or propofol.
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Cheyne-Stokes respirations indicate a problem where?
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Frontal loves or deep midline structures
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Hyperventilation indicates a problem where?
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Midbrain
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Ataxic breathing or irregular breathing indicates a problem where?
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Medulla and pons (brain stem)
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True/False. Enemas are an effective means to treat constipation in head injury patients.
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False. Enemas and cathartics are avoided, because they cause abdominal distention, which increases intra-abdominal and intrathoracic pressure and ICP.
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For patients undergoing the acute phase of a dehydrating procedure, an output greater than ___ for 2 consecutive hours may indicate the onset of diabetes insipidus.
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200 mL/hr
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Projectile vomiting indicates increased pressure where?
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The reflex center of the medulla
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What analgesics are used for patients with increased ICP?
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Acetaminophen, morphine, or codeine.
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What is the difference between a simple partial seizure and a complex partial seizure?
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In a simple partial seizure, consciousness remains intact.
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You are assessing a patient with a known history of epilepsy, and the patient's mouth begins to jerk uncontrollably. He complains of feelings of dizziness, and states that he has a bad taste in his mouth. What kind of seizure do you suspect he is experiencing?
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Simple partial
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___ is the leading cause of seizures in the elderly.
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Cerebrovascular disease
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What is a toxic side effect of Tegretol?
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Severe skin rash, blood dyscrasias, hepatitis
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Klonopin toxic effect?
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Hepatotoxicity, thrombocytopenia
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What is a toxic side effect of Lamictal?
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Stevens-Johnson syndrome
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What is a common side effect of Phenytoin (Dilantin)?
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Gingival hyperplasia
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What is a toxic side effect of Topiramate (Topamax)?
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Nephrolithiasis
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Depakote toxicity can lead to what?
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Hepatotoxicity, skin rash, nephritis
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What sort of diet may be helpful in patients with epilepsy?
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Ketogenic diet
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A series of generalized seizures that occur without full recovery of consciousness between attacks.
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Status epilepticus
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What are the three factors that precipitate status epilepticus?
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Withdrawal of seizure medications, fever, and concurrent infection.
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What are the three kinds of primary headache?
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Migraine, tension, and cluster
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___ is a type of headache in the older population, reaching its greatest incidence in those older than 70.
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Cranial arteritis. It is caused by inflammation of the cranial arteries.
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A construction worker wanders into the ER complaining of excruciating pain over his right eye that extends into his forehead that has come and gone all day. What do you suspect he has?
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A cluster headache
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Name some medications used in the treatment of migraines.
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Beta-blockers (propranolol, meoprolol), Elavil, serotonin agonists, calcium antagonists (verapamil).
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Alcohol, nitrites, vasodilators, and histamines may precipitate ___ headaches.
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Cluster
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The ___ are the most specific antimigraine agents available.
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Triptains (serotonin receptor antagonists)
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The most widely used triptan is __ and is effective for the threatment of acute migraine and cluster headaches in adults.
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Imitrex (sumatriptan succinate)
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Currently approve thrombolytic therapy has a treatment window of ___ after the onset of a stroke.
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3 HOURS
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These are the most common type of ischemic stroke.
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Small penetrating artery thrombotic strokes (lacunar strokes)
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Another name for small artery thrombotic strokes?
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Lacunar strokes
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___ is ischemic brain tissue that may be salvaged with timely intervention. It is the area of low cerebral blood flow.
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Peumbra region
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Difficulty speaking.
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Dysarthria
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Impaired speech; Loss of speech
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Dysphagia; aphasia
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Inability to perform a previously learned action
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Apraxia
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Deficits in the ability to recognize previously familiar objects perceived by one or more of the senses.
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Agnosia
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If a stroke occurs in the ___ hemisphere of the brain, the patient will demonstrate increased distractibility, impulsive behavior and poor judgment, and lack of awareness of deficits.
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Right hemispheric stroke
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If a stroke occurs in the ___ hemisphere of the brain, the patient will demonstrate aphasia (expressive, receptive, or global), altered intellectual ability, and slow, cautious behavior.
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Left hemispheric stroke
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A neurological deficit typically lasting less than 1 hour.
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TIA
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The INR target is ___ in patients at risk for stroke.
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2-3
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Which of the following drugs is not indicated in the treatment or prevention of strokes? A) Aspirin B) ACE inhibitors C) Statins D) Thiazide diuretics E) None of the above
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E) None of the above. All those drugs are used in the prevention of strokes.
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Which of the following patients is not a candidate for TPA?
A) A patient with a platelet count of 150,000 B) A patient with an INR of 2 C) A patient with a symptom onset 2 hours prior to admission D) A patient with no seizure at the onset of stroke |
B) A patient with an INR of 2. INR must be less than 1.7, and PT less than 15 seconds.
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Severe, unilateral headache improved by sitting upright or standing is indicative of what complication?
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Hyperperfusion syndrome. It occurs when cerebral vessel autoregulation fails, and arteries accustomed to diminished blood flow may be permanently dilated.
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True/False. The use of a hand roll is effective in preventing spasticity of an upper extremity.
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False. If an upper extremity is spastic, a hand roll is not used because it stimulates the grasp reflex.
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Hemorrhagic strokes are primarily caused by ___ or ___ hemorrhage.
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Intracranial or subarachnoid
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A common cause of intracerebral hemorrhage in the elderly is:
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Cerebral amyloid angiopathy
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___ is a serious complication of subarachnoid hemorrhage and is the leading cause of morbidity and mortality in those who survive the initial subarachnoid hemorrhage.
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Vasospasm
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A patient recently hospitalized for subarachnoid hemorrhage is presenting with a worsening headache and decreased LOC 4 days after his initial injury. What do you suspect?
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Vasospasm
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The most frequently used medication to prevent vasospasm in patients with hemorrhagic stroke is:
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Nimodipine (Nimotop)
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What is "Triple-H" therapy?
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A therapy aimed at minimizing the deleterious effects of the associated cerebral ischemia of hemorrhagic stroke. The three H's are: Hypervolemia (fluid volume expanders), Hypertension, and Hemodilution.
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The lowest level at which sensory and motor functions are normal in SCI.
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Neurologic level
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The intercostals are associated with which vertebrae?
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T1-T11
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Ipsilateral paralysis or paresis is noted, together with ipsilateral loss of touch, pressure, and vibration and contralateral loss of pain and temperature.
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Brown-Sequard Syndrome (Lateral Cord Syndrome)
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Complete loss of all reflex, motor, sensory, and autonomic activity below the level of the lesion that causes bladder paralysis and distention.
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Spinal shock
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True/False. Autonomic dysreflexia occurs only after spinal shock has resolved.
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True
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Autonomic dysreflexia occurs among patients with cor lesions above ___.
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T6
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Increased systolic BP with a dec. or no change in diastolic BP = widening pulse pressure.
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Cushing's response
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Most significant risk factor for stroke.
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Hypertension
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___ strokes occur most often at night or first thing in the morning.
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Ischemic strokes
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__ stroke is the most common type of stroke in patients with DM.
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Thrombotic
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Which is expressive and which is receptive aphasia?
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Wernicke's: Receptive; Broca's: Expressive
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Broca's aphasia is associated with an infarct where?
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In the frontal lobe
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Wernicke's aphasia is associated with an infarct where?
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In the temporal lobe
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Agnosia occurs with an infarct where?
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Temporal or occipital lobes
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"Locked in" syndrome occurs with a stroke located where?
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Brain stem, cerebellum, or posterior hemisphere
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Why is a stroke patient's BP maintained in the hypertensive range?
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To maintain perfusion
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What IV fluid should you AVOID in patients with acute stroke?
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AVOID D5W because it becomes hypotonic!
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Candidates with a SBP greater than ___ are NOT candidates for TPA.
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220. Also, diastolic greater than 140.
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This cranial nerve controls the muscles for chewing.
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Trigeminal
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This cranial nerve controls movement of bolus in the mouth.
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Facial
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This cranial nerve controls pharynx and swallowing/gag reflex.
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Glossopharyngeal
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This cranial nerve controls tongue movement.
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Hypoglossal
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Aphasia is associated with a ___ hemisphere problem.
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Left
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Flaccidity of muscles is associated with (early/late) brain dysfunction. Spasticity is associated with (early/late) dysfunction.
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Flaccidity: early; spasticity: late
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Cerebral arterial constriction and a rise in serotonin levels occurs during the ___ phase of migraines.
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Prodromal
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Neck and scalp muscles may contract during the ___ phase of a migraine.
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Recovery (final)
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Triptans are contraindicated in which patients?
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Patients with ischemic heart disease or angina because of the potential for coronary vasospasms.
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This type of headache is associated with REM sleep, napping, or relaxation.
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Cluster
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A patient with a known history of epilepsy begins smacking his lips and patting at his clothes during a routine assessment. What type of seizure do you expect he is having?
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Complex partial
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Psychomotor seizures typically occur in which lobe of the brain?
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Temporal
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Which anticonvulsant can cause SIADH?
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Tegretol
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A phenytoin level greater than what is associated with decreased LOC?
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40; 20-30 = nystagmus; 30-40 = ataxia; >40 = dec. LOC
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Abdominal and chest pain is associated with what kind of meningitis?
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Viral
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Flex the patient's leg at both the hip and knee, and then straighten the knee. This maneuver should not produce pain.
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Kernig's sign
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Hip and knee flex when the patient's neck is flexed.
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Brudzinski's sign
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Deficit of CN ___ may indicate development of hydrocephalus.
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VI (Abducens)
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Stool and urine precautions only are required for which meningitis?
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Viral; Isolation is required for bacterial meningitis
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Do not ELEVATE the HOB during the acute phase of care following (infratentorial/supratentorial) surgery. Do not LOWER HOB after (infratentorial/supratentorial).
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Infratentorial; supratentorial
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___ cord syndrome results in impaired pain, temperature (lateral spinothalamic tract) and crude touch and pressure (anterior spinothalamic tract), while leaving fine touch and proprioception intact.
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Anterior
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Damage to the back side of the spinal cord results in impaired fine touch and proprioception. Intact pain, temperature, crude touch, and pressure.
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Posterior cord syndrome
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Damage to the spinal cord results in loss of function of arms, but typically the legs are preserved.
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Central cord syndrome
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Injury above ___ results in loss of innervation to the diaphragm and intercostal muscles.
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C4
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SCIs above the ___ develop a reflex bladder; SCIs at the ___ develop a nonreflex bladder.
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Conus medullaris; cauda equina
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___ is the most common cause of acute encephalitis in the US.
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Herpes simplex
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An immune-mediated, progressive demyelinating disease of the CNS.
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Multiple sclerosis
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An autoimmune disorder affecting the myoneural junction, characterized by varying degrees of weakness of the voluntary muscles. Deficient Ach.
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Myasthenia Gravis
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An autoimmune attack on the peripheral nerve myelin.
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Guillain-Barre Syndrome
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Parkinson's is associated with decreased levels of ___.
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Dopamine
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A patient with Guillain-Barre's lumbar puncture will indicate what?
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Increase in protein without an increase in cell count
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What drug inhibits the breakdown of ACh at the postsynaptic membrane (used for MG)?
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Tensilon
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What is the antidote to tensilon?
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Atropine
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Cause of disease may be related to an excess of glutamate which is a chemical responsible for relaying messages between the motor neurons.
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ALS
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What glutamate antagonist drug do you use to treat ALS?
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Rilutek
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Amantadine is a drug used for what condition?
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Parkinson's
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What is a major teaching point about Amantadine?
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It must A) be withdrawn gradually, and B) has side effects like dry mouth, blurred vision, INSOMNIA, HALLUCINATIONS, AND DELIRIUM.
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An inflammation or infection of the cornea that can be caused by a variety of microorganisms or other factors.
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Keratitis
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This type of glaucoma is characterized by "tunnel vision," and develops slowly.
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Primary open-angle glaucoma
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This type of glaucoma is characterized by sudden, excruciating pain in or around the eyes and colored halos, blurred vision and ocular redness.
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Angle-closure glaucoma
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Which of the following medications is NOT a treatment for acute and chronic open-angle glaucoma? A) Beta blockers B) Alpha blockers C) Cholinergics (miotics) D) Carbonic anhydrase inhibitors
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B) Alpha blockers. The correct answer is alpha-adrenergic agonists
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A patient arrives in the ER complaining of having a veil-like curtain or shadow obscuring parts of his visual field. What do you suspect he has?
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Retinal detachment
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