CNRN Exam 349 Questions with Verified Answers,100% CORRECT

CNRN Exam 349 Questions with Verified Answers Describe a hangmans fracture - CORRECT ANSWERbilateral fracture through the arch of C2 Tx for hangmans fx? - CORRECT ANSWERHalo or cervical traction Describe a jef ...

CNRN Exam 349 Questions with Verified Answers Describe a hangmans fracture - CORRECT ANSWERbilateral fracture through the arch of C2 Tx for hangmans fx? - CORRECT ANSWERHalo or cervical traction Describe a jefferson's fracture - CORRECT ANSWERburst fracture through the arch of c1 Describe anterior cord syndrome - CORRECT ANSWERLoss of motor, pain and temp, but keep deep touch, vibration and position sense Describe brown sequard - CORRECT ANSWERipsilateral motor touch and position loss. Contralateral pain and temp loss What vertebral level of injury requires a vent? - CORRECT ANSWERC4 Respiratory insufficiency is at what level? - CORRECT ANSWERT10 and above (no DBC d.t innervation of abd musc) What is poikliothermia? - CORRECT ANSWERLoss of temp regulation- loss of vasoconstriction, ability to shiver or sweat d/t symp damage What is spinal shock? - CORRECT ANSWERLoss of all reflexes, motor and sensation below the injury How long can spinal shock last? - CORRECT ANSWER2-16 wks When would spinal shock begin? - CORRECT ANSWERimmediately What is neurogenic shock? - CORRECT ANSWERMild hypotension and bradycardia d/t sympathetic interruption, and parasymp runs unopposed. Treatment for spinal shock? - CORRECT ANSWERResolves on it's own Treatment for neurogenic shock? - CORRECT ANSWERIVF & pressors ("rarely necessary" -Joanne) What's the difference between neurogenic shock and hypovolemic shock? - CORRECT ANSWERHypovolemic will have significant hypotension and bradycardia, cool skin and intact reflexes What causes autonomic dysreflexia? - CORRECT ANSWERSympathetic charge above injury and parasympathetic charge below Describe Lennox-Gastaut syndrome - CORRECT ANSWERchildhood form of epilepsy. 3 S/S: frequent sz of multiple types, EEG slowing and mod-severe cog delay What kind of meds work with GABA? - CORRECT ANSWERbenzos, topamax, propofol, phenobarb How fast can you give Dilantin? - CORRECT ANSWERNo Faster than 50mg/min List two rules about giving Dilantin IV - CORRECT ANSWERNot with dextrose and not with TF (decreases absorption) How does a DBS work to tx/prevent sz? - CORRECT ANSWERStimulates the anterior nucleus of the thalamus, modulates brain activity to prevent sz What symptoms would you see with an epidural hematoma? - CORRECT ANSWERIPSILATERAL blown pupil, contralateral weakness What is the best med to prevent embolic CVA? - CORRECT ANSWERanticoagulants are better than antiplatelet What does the Rankin Scale measure? - CORRECT ANSWERDisability caused by stroke Whats the best score on the Rankin Scale? - CORRECT ANSWER0. 6=dead What does the Barthel scale measure? - CORRECT ANSWERIndependence with ADL's in stroke pts Whats the best score on the Barthel scale? - CORRECT ANSWER15 ICA syndrome - CORRECT ANSWERcontralateral weakness, aphasia, visual changes Cerebellar artery syndrome - CORRECT ANSWERn/v, dysarthia/dysphagia, nystagmus, ataxia, vertigo, ipsilateral horners syndrome Vetrebrobasilar artery syndrome - CORRECT ANSWERimpaired LOC, CN palsies, dysarthia/dysphagia, ipsilateral horners syndrome, vertigo, n/v Basilar artery syndrome - CORRECT ANSWERlocked in How long until you can see a CVA on CT? - CORRECT ANSWER12-24hrs Glucose range for TPA admin - CORRECT ANSWER50-400 INR for tpa admin - CORRECT ANSWER>1.7 Giving TPA- can't have surgery within.. - CORRECT ANSWER2 wks Giving TPA- can't have had another CVA within - CORRECT ANSWER3 mos Giving TPA- can't have had an MI within - CORRECT ANSWER3 months Platelet levels for TPA admin - CORRECT ANSWER>100,000 Two major complications of TPA therapy - CORRECT ANSWERICH and angioedema Tx for angio edema? - CORRECT ANSWERSteroids, zantac, and benadryl Don't give mannitol if osmolality is ...? - CORRECT ANSWER>320 What side effect of ICH occurs up to 12hrs post bleed? - CORRECT ANSWERhematoma. can increase substantially up to 12 hrs post bleed, can displace tissues and cause vasogenic edema Three main risk factors for ICH - CORRECT ANSWERHTN, cigarette smoking and alcohol ingestion List three main s/s of ICH - CORRECT ANSWERn/v impaired LOC and headache List some diseases assoc with SAH? - CORRECT ANSWERmoyamoya, AVM, Marfan disease, polycystic kidney, pituitary tumors, neurofibromatosis, Ehlers Danlos syndrome List five classifications of aneurysm - CORRECT ANSWERsaccular/berry, fusiform, giant, mycotic, traumatic List s/s of SAH - CORRECT ANSWERThunderclap headache, decreased LOC, visual changes, vomiting, hemiparesis/plegia What meningial symptoms can you have with SAH? - CORRECT ANSWERnuchal rigidity, blurred vision, photophobia How many stages of the Hunt-Hess grading scale? - CORRECT ANSWER0-5 List four complications of SAH - CORRECT ANSWERlow NA, rebleeds, ischemia d/t vasospasm, increased ICP In a pt w SAH, what would you see on LP? - CORRECT ANSWERRBC that do not clump in the tbe When is the peak incidence of rebleeds? - CORRECT ANSWER12-48hrs When is the peak incidence of VS? - CORRECT ANSWER7-10 days What is triple H therapy? - CORRECT ANSWERHemodilution, hypertension and hypervolemic Describe agnosia - CORRECT ANSWERInability to process sensory information- 26 different types What is apraxia? - CORRECT ANSWERDifficulty preforming motor tasks/movement when asked. They can explain how to preform, but can't do it. List three treatments for AVM - CORRECT ANSWERBP management, surgical resection, SRS or embolization Whats the difference between an AVM and a CVT? - CORRECT ANSWERCVT is in a vein or sinus, AVM is tangle of arteries & Veins List the number one sign of a CVT - CORRECT ANSWERheadache (increasing over a few days, d/t increased ICP)Won't see dilated vents What is moyamoya? - CORRECT ANSWERanastomic vessels around the circle of willis and bilat ICA, progressive stenosis of bilat ICA extending to COW s/s of moyamoya - CORRECT ANSWERtia, headache, seizures, CVA, ICH List three main sinues - CORRECT ANSWERSuperior sag( up occ lobe to frontal), transverse (runs east/west across skull base), and cavernous (lateral to sella turcica) Acute complications from CVT - CORRECT ANSWERhydrocephalus, blindness d/t pressure on optic nerve How many types of Chiari malformations? - CORRECT ANSWER4 What's the worst kind of Chiari malformation & describe? - CORRECT ANSWER4- hypo/aplasia of cerebellum, do not survive infancy What's the best kind of Chiari malformation & describe? - CORRECT ANSWERdownward displacement of cerebella tonsils What type of CM do we see on 8000 & why? - CORRECT ANSWERType 2- bc it usually presents in young adults What is syringomyelia? - CORRECT ANSWERCSF accumulation in the spinal cord List some s/s of Chiari malformation in infants (type 1 & 2): - CORRECT ANSWERapnea (compressed brain stem), decreased gag (compressed CN 9 & 10 in medulla), nystagmus (cerebellar symptom), spasticity s/s of Chiari malform in children? - CORRECT ANSWERnystagmus, spasticity and bulbar dysfunction (medullary symptoms). s/s of Chiari malformation in adults? - CORRECT ANSWERheadache, cerebellar dysfunction ( poor balance, coordination, low muscle tone), n/t in BUE (central cord involvement), spasticity List two chronic complications of Chiari malformation- - CORRECT ANSWERhydrocephalus (if 4th vent has herniated) and chronic headaches List three possible causes of "Aquired CP": - CORRECT ANSWERbrain damage in the first months of life, bacterial meningitis/viral encephalitis, TBI List four fetal development alterations that can cause CP: - CORRECT ANSWER1) periventricular leukomalacia- damage to teh white matter of the brain. May be caused by fetal or maternal infection. 2) cerebral dysgenesis (abnormal development of the brain caused by infection, trauma, or fevers. 3) intracerebral strokes- blood clots from placenta, blood clotting abnormalities, malformed blood vessels, maternal HTN or infection. 4) asphyxia during delivery How to treat CP? - CORRECT ANSWERNo cure, symptomatic tx w muscle relaxants, baclofen pump, Robinul (decrease saliva) List the three types of spina bifida: - CORRECT ANSWER1) occulta- no symptoms or intervention. 2) Meningocele- not many symptoms bc spinal cord develops normally, just the meninges bilge out throw opening in the vertebrae. risk of tethered cord syndrome w repair 3) Myelomeningiocele- spinal column comes out with the meninges. Often child is paralyzed w/ bladder and bowel incontinence, seizures. What medication comes with SE of neural tube defects? - CORRECT ANSWERValproic Acid List three ways to test for SB - CORRECT ANSWERAFP, ultrasound and amnocentesis List three complications of SB: - CORRECT ANSWERTethered cord syndrome, hydrocephalus (bc the CSF doesn't circulate normally), or meningitis What kind of injuries are common in kids w/ SB? - CORRECT ANSWERfracturing of the paraplegic legs (epiphyseal plate abnormalities) What is central neuropathy (central pain)? - CORRECT ANSWERnerve pain d.t a central issue (lesion or disease affecting the central somatosensory system). Central neuropathy can be caused by strokes- where would these be? - CORRECT ANSWERthalamus and parietal lobe (thalamus being the primary pain center of the brain) Damage causes these neurons to misfire. What is CRPS? - CORRECT ANSWERComplex regional pain syndrome- chronic pain condition result of CNS or PNS dysfuncion. What is CRPS type 1 caused by? - CORRECT ANSWERtriggered by injury to soft tissue or bone, no nerve injury. Deep, burning pain that is out of proportion to the injury, patho unclear. What is CRPS type 2 caused by? - CORRECT ANSWERnerve injury. Ex) Nerves get damaged, turns into chronic pain, pt loses motor use, can look deformed/contracted. Color change, or can lose hair. One example- an extravasation can cause severe nerve injury. List three meds used to treat neuropathic pain- - CORRECT ANSWERgabapentin, lyrica, elavil, topamax, liodcaine patches. What chronic disease is assoc. with Trigeminal neuralgia? - CORRECT ANSWERTN can be one of the first signs of MS in a young person. What causes trigeminal neuralgia? - CORRECT ANSWERThe PRESUMED cause of TN is structures pushing on the trigeminal nerve as it exits the brainstem. Could be a blood vessel, tumor, chronic meningitis (scarring of meningies that causes nerve compression) or an aneurysm. How do you treat trigeminal neuralgia? - CORRECT ANSWER1) management of pain w/ neurogenic pain meds: AEDs, and tricyclics (carbamezepine (tegretol), oxcarbazepine ( trileptal), gabapentin, clonazepam. And additionally- baclofen!? 2) Surgery- nerve blocks or ablation, rhizotomy (cut the nerve), SRS (one session only), microdecompression to remove vascular compression from CNV, good success rate. What are two complications of surgical management for TN? - CORRECT ANSWERhearing loss and abnormal sensation around the face. What's another name for the precentral gyrus? - CORRECT ANSWERMotor strip What kind of headaches are assoc with miosis, ptosis? - CORRECT ANSWERCluster (Kendra was asked about this on her test- autonomic symptoms assoc. w cluster headaches) What kind of headaches are assoc with visual disturbances? - CORRECT ANSWERMigraines What kind of headaches are nocturnal? - CORRECT ANSWERCluster What kind of headaches are at the base of the skull? - CORRECT ANSWERTension Ergotamine is a serotonin receptor agonist. What is one serious complication of using it to treat headaches? - CORRECT ANSWERCoronary & peripheral vasoconstricton- serious or life threatening peripheral ischemia when used with macrolide abx. Triptans are the first line drug for what kind of benign headache? - CORRECT ANSWERMigraine List three categories used to PREVENT migraines/benign headaches: - CORRECT ANSWERBeta blockers, tricyclic antidepressants (best with tension or chronic daily), AEDs (gabapentic, topamax, valproic acid), SSRIs. cyproheptadine (periactin- antihistamine with tricyclic structure), CCB (pg 71) T or F- Menieres disease is usually bilateral. - CORRECT ANSWERF- unilateral What are some dietary considerations that might help improve symptoms of menieres? - CORRECT ANSWERLots of fluid intake, avoiding caffeine (makes tinnitus worse), avoiding alcohol, avoiding tyramine, avoiding too much sodium? Why would you have hearing loss with Menieres disease? - CORRECT ANSWERCN8 has two parts (vestibulo (hearing) + coclear (balance), may have dual involvement What causes Menieres disease? - CORRECT ANSWERFluid volume changes in the labyrinth. An increase in the endolymph (fluid) effects the way the nerve receptors (crystals) tell the brain where the body is in relation to space. List three medications used to treat Menieres: - CORRECT ANSWERAntihistamines, anticholinergics (S/E: blurred vision, dry mouth, low HR), antiemetics, sympathomimetics (ephedrine) How to treat Meniers Disease? - CORRECT ANSWER1) Medical: inject gentamicin, into ear to destroy CN8 = destruction of vestibular cells with minimal hearing loss. 2) Surgical: posterior fossa crani to resect CN8 Four of the five meds for AD are what kind of medication? - CORRECT ANSWERAcetylcholinesterase inhibitors. What labs should you watch while a pt is on Aricept (Ache Inhibitor) - CORRECT ANSWER- liver enzymes What other category of meds treat AD? - CORRECT ANSWERNMDA receptor agonist- Memantine (Namenda) How does an NMDA receptor agonist work? - CORRECT ANSWERprevents volume loss by binding to glutamate, which can cause volume loss and thus memory loss. Pts can also be on antipsychotic drugs to curb behaviors- What kind of side effects should you be looking for? - CORRECT ANSWERExtrapyramidal effects List extrapyramidal symptoms: - CORRECT ANSWER(apathy, drooling, dysphagia, tremors, involuntary eye movement, tardive dyskinesia, invol. trunk movements) What two other symptoms are indicative of PD? - CORRECT ANSWERcogwheel rigidity and bradykinesis (trouble initiating or changing movement) What's the difference between primary and secondary PD? - CORRECT ANSWERPrimary has no known cause, secondary is caused by trauma, toxins (carbon monoxide, cyandie, insecticides, agent orange) or medications (thorazine, aldomet)- secondary is usually reversible What parts of the brain are effected by PD? - CORRECT ANSWERbasal ganglia, subthalmic nucleus and substantia negra (produces dopamine)- those are AKA extrapyramidal system Talk about the pathophysiology of PD: - CORRECT ANSWERDestruction of the dopamine producing cells in the substantia negra, creating and increase in muscle tone (pill rolling, tremor, cogwheel & lead-pipe rigidity) bc of too much AchE (opposing force is dopamine) Pg 80 What is the definitive (not clinical) way to diagnose PD? - CORRECT ANSWERLewy bodies in midbrain on autopsy Why are anticholinergic agents used in PD? - CORRECT ANSWERUsed to manage tremors and rigidity, but there is low recommendation for this How do dopaminergic agents work? - CORRECT ANSWERIncrease dopamine in the CNS ex) Sinemet (carbidopa/levopoda)- Levodopa is converted into dopamine List two SE of sinemet: - CORRECT ANSWERorthostatic hypotension, hallucinations/psychosis What syndrome is caused by suddenly stopping sinemet? - CORRECT ANSWERneuroleptic malignant syndrome (AMS, lead pipe muscle rigidity and autonomic dysfunction (diaphoresis, labile BP, high fever) dosage and serum concentrations are usually wnl. How do you treat neuroleptic malignant syndrome? - CORRECT ANSWERStop antipsych meds (usually haldol), and supportive therapy. How does a dopamine Agonist work? - CORRECT ANSWERActivates dopamine receptors to make more dopamine- these are used first to delay need for sinemet. Ex Parlodel, Mirapex, requip MAO-B inhibitors (med called Eldepryl) are the first line drug used in PD, how does it work? - CORRECT ANSWERSlows the progression of early PD, and delays need for sinemet, also Prolongs the half-life of levodopa when added. MAO inhibitors can cause sudden and severe HTN when combined with what? - CORRECT ANSWERTyramine- containing foods, like red wine, cheeses, aged food SRS can be used to treat PD, how? - CORRECT ANSWERaimed at destroying parts of the BG to relieve tremors and rigidity Where would YOU put a DBS to treat PD? - CORRECT ANSWERUnilateral or bilateral subthalmic nucleus (part of the basal ganglia) How does a DBS work? - CORRECT ANSWERadds electrical current to the subthalmic nucleus to pt can improve dopamine usage. List two syndromes in children that can cause congenital hydrocephalus? - CORRECT ANSWERChiari malformations and spinal bifida List two (of the many) ways a person could get acquired hydrocephalus? - CORRECT ANSWERMeningitis, IVH, tumors, encephalitis Decompensated congenital hydrocephalus will present similar to what other syndrome? - CORRECT ANSWERNormal pressure hydrocephalus (decompensated congenital hydroceph is not acute, and there is no rise in ICP) List three s/s of acute hydrocephalus. - CORRECT ANSWERnausea/vomiting, headache, AMS, papilledema What is an endoscopic third ventriculostomy? - CORRECT ANSWEREndoscopic procedure that creates an opening between the third ventricle and basal cisterns (surgery to bypass obstruction b.c most common site for obstruction is between 3rd and 4th vent) ou can get NPH as an older adult, but you can also acquire it from... ? - CORRECT ANSWERSAH, trauma or meningitis. These can block reabsorbtion of CSF in the arachnoid villi How much CSF would you take off in a lumbar tap for NPH? - CORRECT ANSWER40-50cc. List two environmental hazards which could give someone a brain tumor. - CORRECT ANSWER1) Chemical agents (pesticides, formaldehyde), 2) low-frequency electromagnetic fields (low evidence of this), 3) ionizing radiation (radiation therapy, x-ray) What's the difference between extraaxial and intraaxial brain tumors? - CORRECT ANSWERExtraaxial tumors originate within the skull, meninges, cranial nerves, and pituitary gland ex) pit tumors or meningiomas. Intraaxial are inside the cranium, originate in glial cells, ex) GBM Tumors arise from two types of nervous cells, name these. - CORRECT ANSWERGlial cells (5 times more numerous than neurons) and neurons. List three glial cell types that can form tumors. - CORRECT ANSWERAstrocytes, Oligodendrocytes, and Ependymal cells. What is the job of astrocytes? - CORRECT ANSWERMake up the blood brain barrier. They extend into the pia-glial membrane next to sub arachnoid space. What's the most common type of glial tumor? - CORRECT ANSWERAstrocytoma What's the second most common type of glial tumor? - CORRECT ANSWERmeningioma List five types of tumors that are more common in kids. - CORRECT ANSWER1) Pilocytic (cerebellar) astrocytoma, 2) subependymal giant cell astrocytoma 3) brain stem glioma and ependyomas. 4) medulloblastoma 5) craniopharyngioma Where would you find a craniopharyngioma? - CORRECT ANSWERsella turcica, pituitary. Excellent prognosis with microsurgery, Presents with increased ICP, vision changes or pit/hypothal dysfunction Children usually have neurofibromatosis- how do you get it? - CORRECT ANSWERAutosomal dominant disorder- three types. NF1- brown spots on body, usually benign. NF2- BILATERAL schwanomma AKA acoustic neuroma, NF3 AKA schwanommatosis, painful schwanommas develop on spinal and peripheral nerves. Ependymomas arise along the ventricles and spinal cord central canal. This makes the pt susceptible to what? - CORRECT ANSWERCSF dissemination and systemic metastasis What's the most common type of neuroma? - CORRECT ANSWERAcoustic neuroma (Schwannoma) Acoustic neruomas are usually located at the cerebellopontine angle. This location makes it likely that it would compress which structure? - CORRECT ANSWERpons. If the tumor grows large enough it will eventually compress the brain stem and cerebellum (also CN IV-X) Pt may also have hydroceph d/t obstruction of CSF flow What other cranial nerve damage would you expect with an acoustic neuroma? - CORRECT ANSWERdamage to CN V and VII (all in the midbrain) What type of symptoms would a patient with acoustic neuroma present with? - CORRECT ANSWERtinnitus, dizziness, loss of balance, vertigo, loss of facial sensation, nystagmus, unilateral hearing loss. If the tumor grows larger, may also have facial weakness/numbness, hydrocephalus and bulbar symptoms Acoustic neuromas are the most common type of neuroma. List two other examples of a neuroma. - CORRECT ANSWERPineal tumors (rare) and pituitary adenomas A person with a brain tumor has endocrine dysfunction, which type of tumor would you expect they had? - CORRECT ANSWERpituitary adenoma List two common complications of transphenoidal resection of a pit adenoma. - CORRECT ANSWERCSF leak and Diabetes insipidus List three different hormones that a pituitary tumor can secrete- - CORRECT ANSWERGrowth hormone, prolactin, and adrenocorticotropic hormone (idk, kendra listed these- hard to know if we need to know this or not. pg 100 on her outline) A pituitary tumor that is secreting growth hormone can cause which two syndromes? (Either one or the other) - CORRECT ANSWERGigantism if before puberty, Acromegaly if after puberty (bc the growth plates have sealed) What symptoms would you see in a pt with a pit tumor that was secreting TSH? - CORRECT ANSWERweight loss, high HR, irritability, excessive sweating Cortisol secreting pituitary hormone can cause which syndrome? - CORRECT ANSWERCushings disease Where would you find a hemangioblastoma? - CORRECT ANSWERCerebellum, usually curable with surgery. assoc wiht von Hippel Lindau disease Describe the pathophysiology of Von Hippel Lindau disease- - CORRECT ANSWERautosomal dominant gene mutation, causing tumors (hemangioblastomas, pheochromocytoma, renal cell carcinoma), strokes, heart attacks, cardiovascular disease and visual problems. Your patient has a metastasis to the brain. List three places the primary source could be. - CORRECT ANSWERLung, breast, kidney, malignant melanoma Signs of brain tumors depend on where the tumor is. List three symptoms you might see in a frontal lobe tumor: - CORRECT ANSWERAMS, inappropriate behavior, emotional lability, speech changes, motor dysfunction, incontinence Temporal lobe mass symptoms? - CORRECT ANSWERreceptive aphasia, generalized psychomotor seizures, visual field changes, personality changes, ataxia Parietal lobe mass symptoms - CORRECT ANSWERsensory deficits, motor and sensory focal seizures, speech deficits, paresthesias, apraxi Occipital lobe mass symptoms? - CORRECT ANSWERheadache, visual changes, field cuts, visual hallucinations, focal or generalized seizures Pituitary/hypothalamus brain tumor symptoms? - CORRECT ANSWERvision changes (d/t optic atrophy & paralysis of one or more extraocular muscles), headache, hormonal dysfunction, water imbalance, sleep pattern problems Lateral and 3rd ventricle brain tumor symptoms: - CORRECT ANSWERheadache, vomiting, symptoms of increased ICP. 4th ventricle tumor symptoms: - CORRECT ANSWERheadache, vomiting, nuchal rigidity, sudden death d/t compression of the medulla Cerebellar tumor symptoms: - CORRECT ANSWERunsteady gait, falling, ataxia, incoordination, tremors, nystagmus, decreased corneal reflex, CN8-12 dysfunction Brainstem tumor symptoms- - CORRECT ANSWERvertigo, dizziness, nystagmus, vomiting, CN4-12 dysfunction, List three ways (illnesses) you could get a CNS infection.cture - CORRECT ANSWERMiddle ear infections, sinusitis, mastoiditis, fracture to frontal or facial bones, post op craniotomy, basal skull fra What CNS infection is spread by droplet transmission? - CORRECT ANSWERmeningococcal meningitis, or hemophilus influenza meningitis What bacteria causes meningococcal meningitis? - CORRECT ANSWERneisseria meningitides If you've had pneumonia, what kind of meningitis are you at risk for? - CORRECT ANSWERPnuomococcal meningitis (this is the most common type) What cranial nerves are most likely to be damaged by meningitis? - CORRECT ANSWERCN8, 3,4 and 6 (dysconjugate gaze and hearing loss) True or False- you can get meningitis from TB. - CORRECT ANSWERTrue. May have tuberculomas on brain and spinal cord What type of meningitis can you get from soft cheeses? - CORRECT ANSWERListeria, may also have brain abscesses What kind of meningitis would you likely see in a patient with otitis media or pharyngitis? - CORRECT ANSWERHemophilus influenza List the key changes you'd see on a CSF analysis on a pt w bacterial meningitis? - CORRECT ANSWERLow glucose, high protein and elevated PMNs and NEUTROPHILS Viral meningitis on CSF looks like: - CORRECT ANSWERmild elevation of protein, and lymphocytes List three possible complications of meningitis. - CORRECT ANSWEREncephalitis, abscess formation and chronic hydrocephalus requiring VPS (pg 107) A brain abscess will commonly present as what other cerebral infection syndrome? - CORRECT ANSWERmeningitis How would you treat an abscess caused by mycobacterium tuberculosis? - CORRECT ANSWERburr hole or crani to drain abscess, then anitbiotics How is CJD different from vCJD? - CORRECT ANSWER"Variant CJD" is a newer type, initial symptoms are different and occurs in younger pts. Psychosis first, then ataxia. Regular CJD is the opposite. 237) List three cool ways a pt might get CJD? - CORRECT ANSWERHereditary, spontaneously, or transmission from an infected animal List three symptoms of CJD: - CORRECT ANSWERpersonality changes, myoclonus, ataxia, psych changes, confusion, memory problems, hallucinations, incontinence, slurred speech, dysphagia What is one safe way to diagnose CJD? - CORRECT ANSWEREEG, MRI or LP Define encephalopathy. - CORRECT ANSWERGeneralized cortical dysfunction" Describe the pathophysiology of uremic encephalopathy- - CORRECT ANSWERwith acute or chronic kidney disease (GFR of less than 15), high calcium levels cause brain dysfunction, usually responds well with hemodialysis. List three of the (MANY) possible causes of encephalopathy: - CORRECT ANSWERalcohol induced, wernickes, hepatic, hypertensive encephalopathy, toxic/metabolic encephalopathy, hasmimotos encephalopathy, infection, drug induced. Describe the pathophysiology of malignant hypertension- - CORRECT ANSWERIncrease in HTN causes cerebral edema, either acute (malignant) or chronic (chronic HTN). Malignant hypertension is also called what? - CORRECT ANSWERPRES Wernickes encephalopathy is caused by what vitamin deficiency? - CORRECT ANSWERB1 (thiamine) It's important to remember NOT to give this with thiamine replacement. - CORRECT ANSWERDextrose! Can make thiamine levels go down Describe the pathophysiology of hepatic encephalopathy: - CORRECT ANSWERLiver disease is so bad that body turns to portosystemic shunting- basically circulation skips the liver all together, and the toxins that WOULD HAVE been filtered out end up in the brain, causing impaired function. AKA take your lactulose. BUT- "High ammonia levels do not add to the grading, severity or prognosis of hepatic encephalopathy." -Kendra pg 115 Describe the pathophysiology of MS. - CORRECT ANSWERPlaques are formed in the CNS, immune system sees plaques as foreign and attack, unfortunately this process damages the myelin sheath. What would you see in CSF on an MS pt? - CORRECT ANSWERincreased IgG, mild protein elevation, mild increase in lymphocytes, and oligoclonal bands List two motor symptoms of MS: - CORRECT ANSWERweakness, paralysis, spasticity, positive babinski reflex (hyperreflexia), abnormal deep tendon reflexes List cranial nerve symptoms of MS: - CORRECT ANSWERblurred vision, diplopia, dysconjugate gaze, dulbar symptoms, facial weakness, eyeball pain List sensory involvement of MS: - CORRECT ANSWERparesthesias, numbness, pain and LHERMITTES sign (electric/shock sensations down spine and into arms or legs) What causes Lhermittes? - CORRECT ANSWER"Probably a buckling effect on the dorsal roots of the posterior columns from sclerotic plaques." Hickey 698 Cerebellar symptoms of MS: - CORRECT ANSWERdysarthria, tremors, ataxia, vertigo, fatigue True or False- MS pts may have cognitive decline. - CORRECT ANSWERTrue- short term memory deficits, WFD, short attention span, mood alteration What is the McDonald criteria? - CORRECT ANSWERTwo or more attacks, and two or more lesions in different locations. Remember- remyelination may occur, so these lesions on an MRI can come and go. What other immune disorders are assoc. with Myesthenia Gravis? - CORRECT ANSWERThymoma (tumor OR hyperplasia), lupus, RA, b12 deficiency Describe the pathophysiology of MG- - CORRECT ANSWERantibodies destroy Ache receptors in the post synaptic membrane, decreasing the effectiveness of Ache What factors might worsen MG? - CORRECT ANSWERStress, emotional upset, systemic illness, pregnancy, menstrual cycle, extremes in temperature What type of symptoms are usually reported first with MG? - CORRECT ANSWERVisual- ptosis and diplopia, inability to close eyelid, blurred vision, and brain stem symptoms: dysarthria, dysphagia, dysphonia How do diagnose MG? - CORRECT ANSWEREMG. Also cholinesterase inhibitor drug testing- give the drug (like Edrophonium, Tensilon or Neostigmine), and pt gets way better within 5-10 min. Also can do blood work (look for Ache-R antibody) How does Mestinon work? - CORRECT ANSWERSlow the breakdown of Ach by inhibiting Ache (breaks down Ach) = anticholinesterase medication Two other types of medications can help MG. What are they? - CORRECT ANSWERcorticosteroids and immunosuppressants How would plasmaphoresis help a pt with MG? - CORRECT ANSWERremoves AchR antibodies with the exchange of plasma, for short term sudden worsening of symptoms True or False- IVIG can also be used to treat MG. - CORRECT ANSWERTrue List medications that could interfere w MG/ make weakness worse - CORRECT ANSWERlocal anesthetics, antiarrhythmics, aminoglycoside antibiotics, clindamycin, lincomycin, morphine, beta blockers, CCB, antacids, laxatives, and many others. What's the difference between cholinergic crisis and myasthenia crisis? - CORRECT ANSWERCholinergic crisis is d/t overmedication, myasthenia crisis is usually d/t infection. How can you tell the difference between a cholinergic crisis and a myasthenia crisis? - CORRECT ANSWERCholinergic crisis = slow onset, excessive pulmonary secretions, and abdominal cramping/diarrhea present for some time before worsening. Myasthenia crisis is a sudden relapse of symptoms after (commonly) infection Treatment for cholinergic crisis? - CORRECT ANSWERpossible intubation and holding of Ache medications. Treatment for myasthenia crisis? - CORRECT ANSWERpossible intubation and holding of Ache medications Acute inflammatory polyradiculoneuropathy (AIDP) and chronic inflammatory polyradiculoneuropathy (CIDP) are also known as what? - CORRECT ANSWERGuillain Barre Describe the pathophysiology of GBS. - CORRECT ANSWERDemyelination of peripheral nerves, causing bilateral, ascending paralysis. Usually d/t virus effecting myelin on peripheral nerves, causing immune system to damage MS along with virus. Most GBS pts have motor and sensory symptoms. Also can have brain stem involvement- list brain stem symptoms a GBS pt might experience: - CORRECT ANSWERbilateral facial weakness, weakness with EOM, dyspnea, dysphagia, dysarthria GBS can also cause autonomic symptoms. These are: - CORRECT ANSWERorthostatic hypotension, heart block, tachycardia, cardiac arrythmias, bladder atony, GI dysmotility Why isn't there muscle atrophy with GBS? - CORRECT ANSWERusually too sudden of onset for atrophy to kick in CSF on GBS pt will show: - CORRECT ANSWERincreased protein, CSF pleocytosis How do we treat GBS? - CORRECT ANSWERSupportive therapies + plasmophoresis OR IVIG, not both. Describe the pathophysiology of ALS- - CORRECT ANSWERDamage to and reduction of motor neurons in the anterior horn cells of the spinal cord, motor nuclei of the brain stem, (esp CN 7 and 12), corticospinal tracts and frontal lobe. List four functions of the brain that are spared by ALS. - CORRECT ANSWERCognition, sensory function, EOM (CN 2, 4 and 6 intact), and hearing. List the two types of symptoms you will see in ALS - CORRECT ANSWERupper AND lower motor symptoms List two ways we can diagnose ALS. - CORRECT ANSWERMRI or EMG mostly. no specific blood workup for ALS. There's one medication that FDA has approved for ALS, it slows the progression of the disease. What is it called? - CORRECT ANSWERRiluzole (Rilutek) List three drugs used to treat benign essential tremor- - CORRECT ANSWERpropranolol, mysoline (AED), Diamox (carbonic anhydrase inhibitors), klonopin, Botox. Also gabapentin, CCB, Topamax, Remeron. Lymes disease has three stages. List symptoms from Stage 2- - CORRECT ANSWERcardiac conduction abnormalities, arthritis, fatigue, fever, peripheral neuropathy, possibly meningitis? List symptoms from stage 3 of Lyme's disease: - CORRECT ANSWERimpaired memory and concentration, fatigue, encephalopathy What's the treatment plan for Lymes disease? - CORRECT ANSWERCeftriaxone (2-4weeks) What causes Bell's palsy? - CORRECT ANSWERinflammation within the fallopian canal, trauma during surgery, trauma to face, viral (Cytomegalovirus, Epstein Barr, rubella, HIV, mumps) or bacterial infections (Most common) List a situation in which only part of CN7 would be effected in bells palsy - CORRECT ANSWERInflammation/infections usually effect CN7 before it exits the skull and branches out, meaning that the whole CN7 is effected (the whole face). Sometimes w trauma during surgeries, only part of the CN7 is nicked/damaged, so only part of the face would be effected. List some symptoms of Bell's Palsy- - CORRECT ANSWERMuscle weakness, impossible or difficult to blink, nasal drips/stuffiness, difficulty speaking/eating/drinking, facial swelling, ear pain, drooling What is the treatment for Bell's Palsy? - CORRECT ANSWER1) remove cause of damage to nerve, corticosteriods, antivirals (treat within 7days for best results) How long does it take to get better from BP? - CORRECT ANSWERdays to a few months, 60-80% recover within a short time. How can we diagnose neurocysticercosis? - CORRECT ANSWERCSF studies (increased pressire, pleocytes w/ eosinophils or lymphocytes, elevated protein and IgG, low glucose) or MRI or CT scan Where would you find a neurofibroma? - CORRECT ANSWERAnywhere, but can be along the peripheral nerves, causing pain or numbness. What genetic disorder is assoc. with neurofibromas? - CORRECT ANSWERneurofibramitosis type 1 Describe patho for carpal tunnel syndrome - CORRECT ANSWERmedian nerve compression d.t edema from repetitive movements. The carpal tunnel is a narrow tunnel which the median nerve passes through, if there is narrowing of the tunnel the movement of the nerve and muscles is compromised. List sx of CPS - CORRECT ANSWERsensory loss in first three fingers, pain/paresthesias in wrist and hand (often at night), paresis or wasting of the hand muscles. What is tinel's sign? - CORRECT ANSWERpain and tingling elicited by tapping over median nerve @ wrist What is phalen's sign? - CORRECT ANSWERPain and tingling occurs in the wrists when they are flexed at right angles for 1 minute How to confirm carpal tunnel syndrome dx? - CORRECT ANSWERDx by EMG/nerve conduction studies Tx for Carpal tunnel syndrome? - CORRECT ANSWERNSAIDS, corticosteriod injections, immbolization of the wrist w. splints, rehab or surgery What surgery would tx CPS? - CORRECT ANSWERsurgical decompression to free the median nerve of compression Miller Fisher syndrome is a type of what? - CORRECT ANSWERGBS. Seen as triad of ophthalmoplegia, ataxia and areflexia. How to tell the difference between vestibular or cerebellar dizziness? - CORRECT ANSWERvestibular dizziness is like swirling, but cerebellar dysfunction feels like walking on a boat (side to side) Cochlear = - CORRECT ANSWERhearing vestibular = - CORRECT ANSWERequilibrium/coordination/orientation in space Rhinnes test is for what? - CORRECT ANSWERto eval. air and bone conduction Weber's test is for what? - CORRECT ANSWERto evaluate lateralization (hearing in one ear better than another) What is conduction deafness? - CORRECT ANSWERproblem conduction sound waves along the outer ear (ex hearing loss d.t middle ear infection) What is sensorineural deafness? - CORRECT ANSWERcaused by damage to the inner ear or nerve (ex aging) Define Papiledema - CORRECT ANSWERoptic disc swelling caused by increased ICP, pt has normal vision What is Marfan syndrome? - CORRECT ANSWERAutosomial dominant genetic disorder effecting connective tissue. pts usually tall with long limbs/fingers. Pts at risk for AVM, SAH, thin dura along spine (dural ectasia), aortic aneurysm, MVR Define Ehlers Danlos syndrome - CORRECT ANSWERGenetic connective tissue disorder causing hyperflexible/unstable joints, loose skin, aortic dissection & osteoarthritis Also at risk for CPS and Chiari? What is mirtazapine for? - CORRECT ANSWERantidepressant- noradrenergic and specific serotonergic antidepressant List two types of SSRI - CORRECT ANSWERFluoxetine (Prozac) Sertraline (Zoloft) Paroxetine (Paxil) Escitalopram (Lexapro) Citalopram (Celexa) List two tricyclic antidepressants - CORRECT ANSWERAmitriptyline (Elavil) Nortriptyline (Pamelor, Aventyl) List two atypical antidepressants - CORRECT ANSWERBupropion (Wellbutrin) Duloxetine (Cymbalta) Venlafaxine (Effexor) Mirtazapine (Remeron) Trazodone (Desyrel) Name two MAOI - CORRECT ANSWERPhenelzine (Nardil) Tranylcypromine (Parnate) meds for tic douloureux - CORRECT ANSWERcarbamezepine (monitor liver enzymes) baclofen, phenytoin, gabapentinlamotrigine, zolpidem and tizanidine What neuropathies would you see in a pt with HIV? - CORRECT ANSWERDistal sensory polyneuropathy (DSP). Burning in soles of feet, worsened by pressure. Tx: tricyclic antidepressants, carbamazepine, phenytoin, topical capsaicin or lidocaine Meds to treat diabetic neuropathy - CORRECT ANSWERamitriptyline, nortriptyline, carbamazepine, phenytoin, gabapentin. or NSAIDS, methadone if NSAIDS fail? Define Charcot-Marie-Tooth disorder - CORRECT ANSWERHereditary motor and sensory neuropathies of the PNS. Shows up early adulthood- pt w musc wasting, foot droop (usually 1st sx), and loss of sensation in the feet and hands. C2 sensory= - CORRECT ANSWERoccipital/back of head C3 sensory= - CORRECT ANSWERneck C4 sensory= - CORRECT ANSWERneck/upper shoulders C6 sensory= - CORRECT ANSWERThumb, radial aspect of arm, index finger C7 sensory= - CORRECT ANSWERmiddle finger/palm/back of hand C8 sensory= - CORRECT ANSWERRing and little finger, ulnar forearm T4 sensory= - CORRECT ANSWERnipple T1-2 sensory - CORRECT ANSWERInner aspect of arm and shoulder blade T7 sensory - CORRECT ANSWERLower costal margin T10 sensory= - CORRECT ANSWERumbilical T12-L1 sensory= - CORRECT ANSWERgroin L2 sensory= - CORRECT ANSWERanterior thigh L3-4 sensory - CORRECT ANSWERAnterior knee and lower leg L5 sensory= - CORRECT ANSWEROuter aspect of lower leg, dorsum of foot, big toe S1 sensory- - CORRECT ANSWERsole of foot/Four remaining toes S3 sensory= - CORRECT ANSWERmedial thigh S4-5 sensory - CORRECT ANSWERGenitals/saddle C1-4 motor - CORRECT ANSWERneck flexion/extension/rotation C3-5 motor - CORRECT ANSWERdiaphragm C5 motor - CORRECT ANSWERShoulder movement, flexion/supination of elbow C6 motor - CORRECT ANSWERPronation of elbow, wrist flexion C7 motor - CORRECT ANSWERExtension of forearm and wrist, hand intrinsics C8 motor - CORRECT ANSWERHand intrinsics, grasp and let go T1-12 motor - CORRECT ANSWERControl of thoracic, abdominal, and back muscles L1-3 motor - CORRECT ANSWERflexion of the hip L2-4 motor - CORRECT ANSWERExtension of leg, adduction of thigh L4-5 motor - CORRECT ANSWERAdduction of thigh, flexion of knee, dorsiflexion of foot L5-S1 motor - CORRECT ANSWERplantar flex S2-4 - CORRECT ANSWERperineal area and sphincters List some dietary triggers for Menieres disease - CORRECT ANSWERTriggers for Meniere disease may include high salt intake, caffeine, alcohol, nicotine, stress, monosodium glutamate (MSG), and allergies. An aura is what type of seizure? - CORRECT ANSWERSimple partial List the three types of seizures - CORRECT ANSWERSimple partial, complex partial and generalized Define simple partial seizure - CORRECT ANSWERfocal sz with no LOC Define complex partial seizure - CORRECT ANSWERfocal seizure with LOC Define generalized seizure - CORRECT ANSWERneuronal discharges between two hemispheres What kind of seizure is absence seizure - CORRECT ANSWERGeneralized (really!) What kind of event will present as wandering confused - CORRECT ANSWERSE List four "disease modifying" meds for MS - CORRECT ANSWERGlatiramer acetate, natalizumab, interferobs, fingolimod How does glatiramer acetate work? - CORRECT ANSWERenhances remyelination, regulates T cells List two symptoms to manage with MS - CORRECT ANSWERspasticity and fatigue How does natalizumab work for MS? - CORRECT ANSWERreduces relapses and slows disease progression List three meds you would give during an MS flare - CORRECT ANSWERdecadron, corticotrophin (stimulates body to make own cortisol), and interferon beta (avonex, decreases severity of flare) Where is the ANS control center? - CORRECT ANSWERhypothalamus Name the three structures within the brainstem - CORRECT ANSWERmidbrain, medulla and pons What is the number one sign of heparin induced thrombocytopenia? - CORRECT ANSWERDrop in platelets How much alcohol is okay to drink w coumadin? - CORRECT ANSWERGo on a bender! jk don't- it's NONE. Okay to go off your MS meds when you're pregnant? - CORRECT ANSWERYes- most people have an improvement in symptoms while pregnant How long will you see xanthrochromia in CSF after SAH? - CORRECT ANSWER2 weeks. Good for diagnosing if a person HAD a SAH It's cool to smoke with cluster headaches, right? - CORRECT ANSWERNO> How often do you want you SCI pt to have a BM? - CORRECT ANSWER1-3 days, doesn't matter if it's at the same time every day What nerve injury/symdrome is common with pregnancy? - CORRECT ANSWERCPS You wouldn't treat lesions <4cm with this... why? - CORRECT ANSWERGamma knife radiation- it can't see undetected cells that have infiltrated normal tissue List two meds you can't take with Methotrexate & why - CORRECT ANSWERNSAIDS & ASA. What vitamin should you take with Methotrexate? - CORRECT ANSWERFolic Acid What's the most common source of a brain abscess? - CORRECT ANSWERhematogenous spread from other infected sites like lung abscess, or endocarditis Define lipohyalinosis - CORRECT ANSWERcondition of small vessels that leads to lacunar CVA No glucose containing IVF in a pt with TBI, bc glucose can contribute to... - CORRECT ANSWERneurotoxic acidosis Define DESD, and who gets it? - CORRECT ANSWERDetrusor-external sphincter dyssynergia (DESD) is characterized by involuntary contractions of the external urethral sphincter during an involuntary detrusor contraction. Pt's w MS, SCI, TM. Why would you insert an NG in a pt with SCI? - CORRECT ANSWERParalytic bowel!!!!!! Pt is at risk for ileus. List some s/s of autonomic storm - CORRECT ANSWERHTN, fever, tachycardia, pupil dilation & posturing, decreased LOC Meds for autonomic storm? - CORRECT ANSWERmorphine (#1), then inderal, catapres or throazine Why should TF be started on a TBI pt right away? - CORRECT ANSWERPt is in hypermetabolic state, needs nutrition by day 7 at least. Oxygen consumption rises approx 10% for every ___ degree elevation in temp - CORRECT ANSWER1 degree celcius What is a hygroma? - CORRECT ANSWERcollection of CSF in the subdural space, caused by a tear in the arachnoid mater Define Erbs Palsy - CORRECT ANSWERdamage to C5-6 nerve/brachial plexus d/t shoulder dystocia @ birch. Tx: Will resolve on own over mos, rehab, or surgery Lifetime risk for an AVM bleeding is.. - CORRECT ANSWERhigh. 105-pt age at dx = lifetime risk that AVM will bleed What's the risk a CVT will have hemorrhagic transformation? - CORRECT ANSWER30% What's one risk factor for getting a meningioma? - CORRECT ANSWERradiation Treatment for intramedullary tumor? - CORRECT ANSWEROR Where would you find an intramedullary tumor? - CORRECT ANSWERspine Treatment for bells palsy? - CORRECT ANSWERantivirals alone, not in addition to steriods Seizures can be found in what stage of AD? - CORRECT ANSWER3 pseudotumor cerebri is also known as what? - CORRECT ANSWERidiopathic intracranial hypertension or benign intracranial hypertension Describe patho for pseudotumor cerebri - CORRECT ANSWERgradual increase in ICP, s/s headache, n/v, tinnitus, double vision. Assoc w/ obesity, oral contraceptives and toxic levels of Vit A, lithium. permanent blindness d/t pressure on optic nerve How does levodopa work? - CORRECT ANSWERLevodopa is able to cross the BBB, then converts into dopamine How does carvidopa work? - CORRECT ANSWERinhibits enzymes that break down levodopa, allowing levodopa to cross BBB What chronic disease is assoc w. downs syndrome? - CORRECT ANSWERDementia #1 neuro symptom in pts with HIV? - CORRECT ANSWERperipheral neuropathy- either AIDP (earlier) or DSPN (later), or mononeuropathy multiplex What MS med is assoc with progressive multifocal leukoencephalopathy (PML)? - CORRECT ANSWERnatalizumab Describe patho for PML - CORRECT ANSWERinflammation of the white matter of the brain, caused by JC virus (usually kept in check by a healthy immune system) progresses over weeks/months, 30-50% mortality. treatment aims at boosting immunity, we're unable to treat the infection What chronic disease is assoc w bells palsy? - CORRECT ANSWERDM What elecrtolyte would you watch while rewarming a pt? - CORRECT ANSWERK You shouldn't take triptans if you have a hx of this - CORRECT ANSWERheart disease, CVA, or risk factors for these