Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
77 Cards in this Set
- Front
- Back
|
What are the grades of Concussions, traumatic brain injuries? |
I II III (a & b) |
|
|
What is a grade I concussion? |
confusion symptoms last less than 15 minutes no LOC |
|
|
What is a grade II concussion? |
symptoms last longer than 15 minutes no LOC |
|
|
What is a grade III concussion?
|
LOC a: unresponsive period lasts SECONDS b: unresponsive period lasts MINUTES |
|
|
What is the pathogenesis of primary brain injury?
|
direct insult blunt force, penetrating injury, shearing force, coup-countercoup |
|
|
What is the pathogenesis of secondary brain injury?
|
complication of primary injury delayed onset, seconds-days occurs from: ischemia, cerebral hypoxia, cerebral edema, possible hemorrhage, ICP-decrease blood flow |
|
|
What is the number one cause of head injury in all age groups?
|
falls
|
|
|
Why do elders have the highest mortality for falls?
|
more falls in this age group fragility of elder brain tissue |
|
|
When a person has a traumatic brain injury, what are common complaints?
|
HA, brief amnestic period, faintness, nausea/vomiting, change in vision blurring, drowsiness, LOC
|
|
|
What should be obtained in a traumatic brain injury assessment?
|
mechanism of injury, level of consciousness, progression of symptoms, patient's medical history (hypoglycemia, arrhythmias, ETOH/drug use, Coumadin use), associated symptoms (confusion in elders)
|
|
|
What is a normal Glasgow coma scale score?
|
15
|
|
|
Glasgow coma scale Minor head trauma |
Score =13-15 Loss of consciousness <20 minutes |
|
|
Glasgow coma scale Moderate head trauma |
Score = 9-12 With or without loss of consciousness |
|
|
Glasgow coma scale Severe head trauma |
Score <8 Comatose state for 6 or more hours |
|
|
What are signs of basilar skull fracture? |
Periorbital Ecchymosis = Raccoon eyes Post auricular /mastoid ecchymosis = battle sign CSF leak: otorrhea, rhinorrhea Blood in ear canal |
|
|
What must be done on a neuro examination to test for focal deficits? |
Pupil response EOM Extremity testing: *movement *sensation *strength |
|
|
What is a primary headache? |
Not a symptom of a medical condition Example: migraine, tension, cluster |
|
|
What is a secondary headache? |
Symptom of another medical problem Example: Sinusitis Tumor Hemorrhage Temporal arteritis Meningitis |
|
|
List the headache classifications: |
Tension-type Cluster Migraine without aura Migraine with aura |
|
|
What is the vascular theory of headache pathophysiology? |
Vasodilation and vasoconstriction |
|
|
What is the neurochemical pathophysiology of headaches? |
Vasodilation and vasoconstriction release serotonin, dopamine, substance P In response to stimulus or trigger |
|
|
For tension type headaches, what are the classifications for length of time set by the International Headache Society? |
< 180/year or <15/month 10 prior headaches that last 30 minutes to 7 days |
|
|
What are the characteristics of tension type headaches? |
Pressing or tightening quality Mild-moderate intensity Bilateral location Not aggravated by routine physical activity |
|
|
What characteristics must be absent to be classified as a tension type headache? |
Absence of nausea & vomiting Absence of photophobia or phonophobia |
|
|
Describe a tension headache's characteristics: |
Tight band around head (contracted muscles of scalp), nagging, pressing sensation, starts after awakening, rarely wakes person up |
|
|
What does the international headache classify as a cluster headache? |
5 attacks Frequency: every other day to 8/day Lasting 15 to 180 minutes |
|
|
What are the key symptoms of a cluster headache according to the international headache society? |
Severe unilateral orbital, supra orbital, and/or temporal pain Conjunctivitis injection Lacrimation Nadal congestion Rhinorrhea Forehead and facial swelling Miosis (constriction of pupil) Ptosis (drooping of lid) Eyelid edema |
|
|
Does a cluster headache awaken the person during the night? |
Yes. With retro-orbital pain. |
|
|
Does a cluster headache awaken the person during the night? |
Yes. With retro-orbital pain. |
|
|
How would a person describe the experience of having a cluster headache? |
Intensity in 15 minutes, lasts 90 min up to 3 hours, may happen several times/day Painful, can't sit still, restless, moaning, crying, pacing Thoughts of suicide possible |
|
|
What is a chronic cluster headache? |
No remission lasting longer than 14 days (2 weeks) |
|
|
Migraines are more prevalent in which population? |
Women, age 40 yrs |
|
|
What is the pathogenesis of a migraine? |
Serotonin (5-HT), a powerful vasoconstriction sensitizes vessels to dilation Substance P propagates pain impulses from periphery to CNS causing dilation, plasma, extravastion, inflammation & pain |
|
|
According to the international headache society, what classifies a migraine without aura? |
At least 5 attacks Headache lasting 4 to 72 hours |
|
|
What symptoms define a migraine without aura according to the international headache society? |
Unilateral location Pulsating quality: pounding, throbbing Moderate-severe intensity Aggravated by physical activity |
|
|
In order for the classification of migraine without aura, according to the international headache society, during headache what must occur? |
Nausea or vomiting Photophobia or photophobia |
|
|
What are the 3 types of migraine with aura? |
Visual Somatosensory Migraine prodromal |
|
|
What defines an aura in migraine? |
Occurs before onset of head pain Can be seconds to 20 minutes |
|
|
What defines a visual migraine headache? |
Spots, jagged lines, shimmering bright lights, area of visual loss |
|
|
What defines a somatosensory migraine? |
Numbness tingling of fingers Motor loss: hemiparesis, monoparesis Congitive disorder |
|
|
What defines a migraine prodromal migraine? |
Several days before start of head pain Low energy, food cravings, increased irritability, sense of doom |
|
|
What is vertigo?
|
Illusion of self or environment moving, typically rotating
|
|
|
What is disequilibrium?
|
Sense of insecurity or imbalance unsteadiness in walking often absence of head sensation |
|
|
What is presyncope?
|
Sense of wooziness or impending faint lightheadness |
|
|
What is syncope?
|
Fainting LOC |
|
|
How is vertigo classified as a peripheral disorder?
|
Problem of the inner ear, vestibular nerve (i.e. acute labryrinthitis, Meniere's disease) s/s: nausea, position related normal physical exam |
|
|
How is vertigo classified as a central disorder?
|
Problem of the brainstem or cerebellum (i.e. ischemia, multiple sclerosis) s/s: neurological findings, not position related |
|
|
How is vertigo classified as disequilibrium?
|
history of balance problem classic "furniture walking" multisystem impairment -vision -peripheral sensory function |
|
|
How is vertigo classified as lightheadedness?
|
related to cardiovascular issues cardiac arrhythmias, vasovagal response, orthostatic hypotension, anemia |
|
|
What is a vasovagal (presyncopal/syncope) event?
|
trigger event noxious stimuli (i.e blood draw) prodromal symptoms: nausea, lightheaded, warmth, diaphoresis increased heart rate then bradycardia |
|
|
What is the most common cause of syncope in the older adult?
|
Bradycardia
|
|
|
What is orthostatic hypotension?
|
common in elderly inadequate perfusion SBP drop of 20 mm/Hg or more standing |
|
|
What is the 3rd leading cause of death in the US?
|
Stroke -ischemic 7.5% chance of death -hemorrhagic 38% chance of death (intracerebral or subarachnoid) |
|
|
What is replacing the term for T.I.A?
|
Acute cerebrovascular syndrome (ACVS) events resolve with minutes to 24 hr increased risk of stroke refer to neurologist |
|
|
Ischemic stroke (more prevalent) results from what?
|
atherosclerotic process slowly, progressive occlusive: embolism (clot) or rupture of unstable plaque travels to brain to block blood flow |
|
|
Hemorrhagic stroke (lower incidence) results from what?
|
aneurysm rupture arteriovenous malformation (AVM) trauma |
|
|
Where is a subarachnoid bleed?
|
Within the covering on the brain
|
|
|
Where is a intracerebral bleed?
|
vessel with the brain
|
|
|
List non-modifiable risk factors for ISCHEMIC stroke:
|
Increased Age Male gender Family history Race Prior Stroke |
|
|
List modifiable risk factors for ISCHEMIC stroke:
|
Hypertension Diabetes, Obesity Smoking, drug abuse (cocaine use) Carotid stenosis > 80% a fib CHF, MI Posthetic heart valves Elevated serum cholesterol |
|
|
List modifiable risk factors for HEMORRHAGIC stroke: |
Hypertension Smoking Acute alcohol intoxication Recreational drug use (cocaine) |
|
|
List non-modifiable risk factors for HEMORRHAGIC stroke |
intracranial vascular abnormalities family history polycystic kidney disease SLE Pregnancy |
|
|
What are signs of carotid artery (anterior) circulation impairments in an ischemic stroke?
|
ischemia to ipsilateral eye - creates visual disturbance - amaurosis fugax amaurosis fugax = transient, painless visual loss (shade being pulled over visual field) ischemia to brain hemisphere - weakness, numbness of face/limbs of contralateral side, language, cognitive problems |
|
|
What are signs of vertebrobasilar (posterior) circulation impairments in an ischemic stroke?
|
vertigo, nystagmus, diplopia, dysconjugate gaze, deficits of CN III to XII
|
|
|
What are signs of both anterior and posterior circulation impairments in an ischemic stroke?
|
hemiparesis hemi-sensory loss visual field deficit ataxia dysarthria (speaking) reflex asymmetry Babinski sign Headache |
|
|
What is the clinical presentation of an ischemic stroke?
|
ACVS (TIA) precedes single attack common progress over a few hours step-wise fashion until fully developed may occur during sleep |
|
|
Key features of SUBARACHNOID HEMORRHAGIC stroke include a presentation of the following:
|
"the worst headache of my life" s/s: nausea, vomiting, meningeal irritation, neurologic dysfunction, loss of consciousness, possible seizure sentinel headaches: atypical headaches days to weeks before event |
|
|
Key features of INTRACEREBRAL HEMORRHAGIC stroke include a presentation of the following:
|
Hypertensive no consistent warnings usually occur when patient is active onset during sleep rare Headache--> unilateral facial lag, slurred speech, weakness in arm/leg, eye deviation from weakened side coma --> death |
|
|
What is the definition of Bell's Palsy?
|
acute onset unilateral peripheral facial palsy lower facial motor neuron paralysis Cranial Nerve VII |
|
|
What are the etiologies of Bell's Palsy?
|
Viral HSV: herpes zoster, CMV, Epstein-Barr Lyme Pregnancy |
|
|
What is the pathophysiology behind Bell's Palsy?
|
trigger event protective inflammatory response edema of facial nerve ischemia with resultant demyelination motor control loss |
|
|
List clinical findings in Bell's Palsy presentation:
|
within 40-72 hrs smooth forehead, wide palpebral fissure inability to close one eye flattened nasolabial fold Asymmetrical smile post-auricular pain, tinnitus altered taste (anterior 2/3 tongue) sensitivity to sound |
|
|
What should be asked during the subjective assessment for Bell's Palsy?
|
recent viral illness? pregnancy? skin rash or insect bite? facial trauma? |
|
|
What should be done during the physical examination assessment for Bell's Palsy? |
check cranial nerves corneal reflex check ear canal for lesions / vesicles photograph for facial muscles |
|
|
What defines trigeminal neuralgia aka "tic douloureux"?
|
CN V trigeminal facial pain syndrome in the distribution of >1 sensory divisions of trigeminal nerve women > men |
|
|
What are the three sensory divisions of the CN V trigeminal nerve?
|
ophthalmic maxillary mandibular motor : jaw & behind the nose |
|
|
List the features present in clinical presentation of trigeminal neuralgia:
|
recurrent paroxysms of unilateral facial pain in any branch of CN V s/s: lasting 15 min - burning, stabbing, sharp, electric shock reoccurrence: 1x/month or several times daily triggers: cold weather, chewing, talking, facial movement, touch |
