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47 Cards in this Set

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1. What are the proper levels of consciousness?
Conscious or unconscious, Stimulus needed to awaken (Voice, Touch, Pain), Orientation (awareness of env - person, time, place); proper terminology - alert and oriented (x1,x2,x3)
2. Define Coma
Unconsciousness, unresponsive to any stimuli. No voluntary movement. Deep: no reflex activity
3. Signs of dysphonia
Dysphonia: voice disturbance due to larynx or its innervation (laryngitis, vocal chord paralysis = whisper
4. Signs of dysartria
Dysartria: motor deficiency (words slurred, indistinct)
5. Describe Broca’s Aphasia
Expressive (Broca's) Aphasia: Nonfluent, slow speech, Words meaningful, small words dropped, Spontaneous speech impaired
6. Describe Wernicke’s Aphasia
Receptive (Wernicke’s) Aphasia: Speech: fluent, effortless, but sentences lack meaning
7. What are the pros of CT scan for CNS imaging?
Pros CT scan: detects fresh hemorrhages; availability, quicker; lower cost; less restrictions v. MRI
8. What are limitations of MRI for CNS imaging?
MRI contradindicated: pacemakers, ferrous foreign body. Relative contraindications: claustrophobia, non-magnetic metal artifact
9. What are the main indications and limitations for EEG?
EEG Indications: Epilepsy/seizure (diagnosis, monitor response to therapy). EEG is NOT indicated to diagnoses brain death.
10. What is the criteria for brain death?
No reflexes above foramen magnum level (including corneal, gag, and occulocephalic reflexes (dolls eyes)); No oculovestibular response; Pupils fixed (at 24hrs; Atropine, Epinephrine effect has worn off); Apnea off ventilator (oxygenation) 10min (pCO2 50+); No cerebral circulation; body temp > 34C (93F); No drug intoxication, paralyzing agents or anesthetics
What are clinical indicators of increased intercranial pressure (ICP)?
Clinical manifestations: bradycardia, hypertension, hyperventilation.
What are medical treatments for increased ICP?
Intubation, mechanical ventilation with hyperventilation (short term effect). Preserved renal function vital: Mannitol which acts as osmotic agent to draw fluid “off brain”, and consider Furosemide (Lasix) to enhance diuresis. For patients with increased ICP due to malignancy, use Dexamethasone (corticosteroid)
What long term risks are associated with coma?
Decubitis ulcers (bed sores); aspiration pneumonitis/ pneumonia risk; Deep vein thrombosis/ Pulmonary emboli
What symptom would you see in a coma patient induced by narcotic/opiod overdose? How would you treat them?
Pinpoint pupils. Tx Naloxone (Narcan)
What would the differential diagnosis be of coma with fever?
Infection (urinary tract infections, pneumonia, or bacterial meningitis); heat stroke (loss of ability to sweat; indicator is dry skin); rarely, lesion affecting temperature regulatory center (bad prognosis)
Explain the course of hepatic encephalopathy.
Severity of symptoms corresponds to Ammonia level, but fall in ammonia level precedes clinical improvement.
What would be precipitators of hepatic encephalopathy?
Precipitating factors: increased dietary protein, upper GI bleeding, constipation, sedative – hypnotic medications.
How would you diagnose hepatic encephalopathy?
Develops over days to weeks. Symptoms: confusion, drowsiness, and coma. May not be reversible. Reason to test for ammonia levels (blood flow is shifted around liver +/- liver is diseased, ammonia is not converted to urea.
How would you diagnose and treat hypertensive encephalopathy?
Symptoms include severe headache, nausea with vomiting, visual disturbance, confusion, coma. Exam findings: retinal hemorrhages, papilledema. Treatment: Nitroprusside
Describe the use and components of the Glasgow Coma Scale (GCS).
Assessment tool for coma patient (scale 3-15) = eyes open (1-4) + verbal response (1-5) + motor response (1-6)
What is the most common symptom of Acoustic Neurinoma?
Unilateral sensorineural hearing loss
What is the cranial nerve involved in Acoustic Neurinoma?
A benign tumor, Schwann cell of the superior vestibular division of 8th cranial nerve.
Describe ataxic gait?
Frankenstein-like movements: legs widely apart and extended, arms extended in compensatory balance, short steps, look at ground for additional sensory input.
What are common properties, symptoms and physical findings of Friedreich’s ataxia?
Most common type of hereditary ataxia. Ataxia begins in childhood and progresses (Ataxia > Areflexia > Babinski sign before 25). Mean age of death at 37yo. Most common cause of death: Heart failure. Interstitial fibrosis leads to ventricular hypertrophy.
How would you differentiate weight-bearing from non-weight bearing components of the spinal column?
Weight-bearing: Intervertebral Disc, vertebral body anteriorly; Non-weight-bearing: vertebral arch, spinous process, transverse process
Explain the physiology of extension of the spine
Extension of the spine reduces the size of the intervertebral foramen
Define Radicular Pain
Radicular Pain: Cutaneous distribution of compressed nerve root (ie. Sciatica)
Where does osteoporosis vertebral fractures occur?
Osteoporotic fractures and Tumors typically occur in the thorax
What is the classic pain description of spinal canal stenosis?
Spinal Canal Stenosis: Worse with walking, especially up an incline (slight flexion of spine)
How would you assign grade to muscle strength?
Muscle Strength: 5/5: Normal Strength, 4/5: Active Power (deconditioned), 3/5: Power to overcome gravity, but not resistance, 2/5: Movement, not against gravity, 1/5: Muscle Contraction, 0/5 No movement, contraction
What is the dermatome of nipple and umbilicus?
Nipple – T4 dermatome; Umbilicus – T10 dermatome (L2/3 Vertebral Level)
How would you recognize a good quality lateral C-spine x-ray?
Good Lateral Cervical Spine X-Ray: must include all 7 vertebrae and C7/T1 junction
What is the definitive imaging study of the spinal cord?
MRI is definitive study for the Spinal Cord
How would you assess thoracic motor function?
Recognize lack of ability to assess thoracic motor function, especially compared to cervical and lumbar. Only T1 – Hand intrinsics – finger ABducion.
What is typical position of acute spinal cord injury?
Most Devastating injuries occur with neck flexed – “Keep your head up”
How would you "clear" a spine clinically?
Clinically Clearing the spine in a Pt with no neurological deficits. Alert, oriented patient; No alcohol; No narcotics, hallucinagens, sedatives; No distracting injuries (ie. major fracture)
What spinal level innervates the diaphragm?
Diaphragm is innervated by C4
What pharmacological treatment would be used for acute injury?
Pharmacological Therapy for Acute injury: Methylprednisolone (Solu-Medrol) – Anti-inflammatory Steroid
What classes of medicines are used to prevent stress ulcers?
Medicine to reduce risk for stress ulcers (caused by low blood flow & steroids): raise pH in stomach. Antacids, Sucralfate (Carafate), Histamine (H2) blockers, Proton Pump Inhibitors (PPI)
What are the risks for urinary tract infections in chronic spinal cord injury pts?
Neurogenic Bladder (20% risk, each year); Lack of reflex bladder contraction when filled; Urinary retention; Self catheterization; Chronic indwelling foley catheter or suprapubic catheter
What are typical agents used to treat spasticity?
Typical Agents used to treat spasticity (caused by UMN): Antispasmotic: Baclofen, Benzodiazepine: Diazepam (Valium), Dantrolene, Clonidine (Catapress),
What are methods for prevention and treatment of decubitis ulcers?
Prevention and Treatment of Decubitis Ulcers: Frequent turning / repositioning, q 24 hours; Cushioning; Barrier products, ie. Creams, artificial skin; Moisture protection; Good nutrition; Good circulation
What are the four cardinal signs of parkinsonism?
tremor at rest, bradykinesia (slow low movement), rigidity, postural instability (falls)
What are the pathologic findings in Parkinson's disease?
Parkinson's disease - pathologically, depigmentation of Substantia Nigra and Lewy bodies; Substantia Nigra - loss of dopaminergic neurons, Lewy bodies - eosinophilic cytoplasmic
How would you diagnose Parkinsonism?
Average age: 55. 60+ years of age: 1% prevalence, Men: Women 3:2, clinical diagnosis: resting tremor (tremor goes away with movement or intention)
How would you diagnose Huntington's Chorea?
chorea - continuous irregular jerklike movement, Dementia, Psychiatric disturbances, Peak onset: 4th and 5th decade (30s, 40s)
How do you recognize and treat medication induced dystonia?
Involuntary, spasmodic muscle twitching causing abnormal postures (i.e. torticollis) (self-limiting), Common cause: dopamine receptor blocking drugs, i.e. Chlorpromazine (Compazine); Treat with Diphenhydramine (Benadryl)