ANP Certification Neuro Mental Health Flash Cards.txt

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ANP Certification Neuro Mental Health Flash Cards.txt
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2010-10-26 09:38:24
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NP Certification Neuro Mental Health Flash Cards
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NP Certification Neuro Mental Health Flash Cards
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  1. Alzheimers Disease definition & how many stages
    Progressive disorder of brain which affects memory, thought and language, 4 stages
  2. Stage 1 Alzheimers
    Onset, slower, easily angered
  3. Stage 2 Alzheimers
    Supervision needed with detailed activities, train of thought is lost easily
  4. Stage 3 Alzheimers
    Marked Personality Change, Depression
  5. Stage 4 Alzheimers
    Cant recognize anyone, urinary incontinence, absent memory
  6. Tension type headache lasts how long, where is it located and what is quality?
    30 minutes to 7 days. Bilateral location. Pressing not pulsatile
  7. Migraine without Aura lasts for how long, where is it located, what is quality?
    4 hours to 72 hours. Unilateral. Pulsating, plus one or more of: nausea, vomiting, photophobia and phonophobia.
  8. Migraine with Aura has what characteristics?
    Aura develops over 4 minutes. Dread, anxiety, fatigue, nervousness. GI upset, visual or olfactory alteration. + FHx will be noted in many cases.
  9. Cluster headache had what characteristics?
    Headaches occur in a cluster of headaches. Last several weeks to months. Often wakes you up out of sleep. Hot poker behind one eye. Runny eyes, ptosis, and nasal stuffiness can occur on ipsilateral side
  10. What headache is a sinus headache?
    A cluster headache.
  11. What headaches are more common in men?
    Cluster headaches are more common in men
  12. What headache can cause nasal stuffiness and conjunctival injection?
    Cluster headache. Due to histamine component implicated in these headaches.
  13. What headaches can be unilateral?
    Cluster. Migraine can be unilateral, and sometimes bilateral
  14. What are some headache triggers?
    MSG, cheeses, ETOH, chocolate, stress, perfume, hunger,
  15. What are some examples of rescue therapy in headaches?
    Opioids, antiemetics, short course of corticosteroids
  16. What are the migraine specific medications?
    Triptans (selective serotonin receptor agonists), and Ergot derivatives
  17. Prophylactic controller drugs in headache prevention?
    Beta Blockers, Calcium Channel Blockers, TCAs, anti-epileptic drugs such as Gabapentin and Valproate. Lithium can be given for cluster headaches.
  18. Treatment of cluster headaches can include this non-pharmaceutical type of medical treatment?
    High flow oxygen
  19. When considering head imaging in neuro problem or headache, what are you looking for that is appropriate for MRI?
    Tumor
  20. When considering head imaging in neuro problem or headache, what are you looking for that is appropriate for CT scan?
    Hemorrhage, either acute or chronic.
  21. What is the best choice for an abortive migraine medication in someone with angina?
    Ibuprofen. Cannot use Ergotamine or Triptans in angina patient because they have vasoactive effects.
  22. Complication of giant cell arteritis?
    Blindness
  23. What is Giant cell arteritis?
    Autoimmune disorder causing systemic vasculitis of medium to large vessels. Typically age 70.
  24. How is Giant Cell arteritis treated and for how long will therapy be?
    Long term corticosteroid therapy, often 6 to 18 months long. High dose prednisone 80 mg per day.
  25. Corticosteroids cause ulcers in the stomach, duodenum or both?
    Stomach. Add Cytotec or a PPI. Not a localized irritation, more a systemic irritation by thinning out protective layer in stomach.
  26. What medications should you add when you start people on corticosteroid therapy?
    Stomach protection. Bone demineralization protection by adding bisphosphonate and calcium and vitamin D.
  27. Classic Giant cell arteritis happens in what patient population?
    Older women, aged 70
  28. What does Romberg test?
    Cerebellar function
  29. What reflex number documents normal reflex?
    2+
  30. What is symptoms of acute bacterial meningitis?
    Acute onset of very high fever, severe headache, stiff neck, meningeal irritation signs, purple petechia rash, nausea, vomiting, photophobia
  31. What does Kernigs sign check for and how it is elicited?
    Tests for meningeal irritation. Supine position, bend up knee and then try to straighten lower leg. If resistance to leg straightening due to inflamed lumbar root will have pain at hamstring.
  32. What does Brudzinskis sign test for and how is it elicited?
    Meningeal irritation if when supine patient head is lifted up into flexion, the legs also come up in attempt to relieve irritation
  33. What does temporal arteritis affect?
    Medium to large arteries, systemic inflammatory process
  34. What if temporal arteritis is left untreated? Untoward effect?
    Blindness
  35. What are the symptoms of temporal arteritis?
    Tender or nodular, pulseless vessel especially in temporal artery area with sever unilateral headaches and scalp tenderness. Can have acute vision changes of loss, or diplopia, or eye pain. Amaurosis fugax.
  36. What is amaurosis fugax?
    Temporary, transient blindness of one eye
  37. What is often see along with Temporal arteritis?
    Giant cell arteritis and polymyalgia rheumatica often found together
  38. How is temporal arteritis diagnosed?
    Gold Standard: Temporal artery biopsy, or may do color doppler
  39. Trigeminal Neuralgia, what does it affect? Symptoms?
    CN 5, irritation, compression and inflammation. Headache
  40. What is the concern for herpes zoster infection of CN 5?
    Ophthalmic branch of CN 5 affected with herpes can cause blindness
  41. What is another name for Aseptic meningitis?
    Viral
  42. Point of entry for acute bacterial meningitis?
    Direct or droplet via the nose or throat. Or AOM or ABRS can lead to meningitis
  43. Treatment of choice for bacterial meningitis?
    Third generation cephalosporin such as cefdinir, Rocephin PLUS chloramphenicol for BBB penetration
  44. What is prophylaxis for those in close contact with bacterial meningitis?
    Rifampin or Rocephin
  45. What WBC is predominantly seen in Bacterial Meningitis CSF sample?
    Neutrophils. WBC >1,200
  46. What WBC is predominantly seen in Viral Meningitis CSF sample?
    Lymphocytes
  47. What Glucose level is predominantly seen in Bacterial Meningitis CSF sample?
    Lower glucose. Bacterial love to eat up the sugar
  48. What Glucose level is predominantly seen in Viral Meningitis CSF sample?
    Normal
  49. What Protein level is predominantly seen in Viral Meningitis CSF sample?
    • Elevated protein
    • What Protein level is predominantly seen in Bacterial Meningitis CSF sample?
    • Normal
  50. What is incubation period for meningitis?
    3-4 days
  51. What is a scotoma?
    Blind spots in vision, associated with migraine aura
  52. What portion of the brain do the Aura symptoms originate?
    Cerebral cortex or from brain stem
  53. What are 5HT1 agonists?
    Triptan drugs for abortive migraine therapy.
  54. What are 5HT1 drugs not to be mixed with?
    Do not give Triptans with Ergotamine, or within 2 weeks of MAOI drugs
  55. How do 5HT1 agonists work?
    Allow for increased uptake of serotonin, they are selective serotonin receptor agonists
  56. Why are 5HT1 agonists contraindicated with MAOI drugs?
    Can cause serotonin syndrome due to excessive availability of serotonin.
  57. What is Cafergot?
    Caffeine and Ergotamine combo medication that is potent vasoconstrictor.
  58. What kind of headache resembles a TIA?
    Focal Migraines cause stroke like symptoms. Often these people are at a higher risk for stroke. Avoid estrogens or clot promoting agents in these people
  59. What treatment is good for a PMS migraine prophylaxis?
    A phasic oral contraceptive with a 7 day per month off week from pills.
  60. What is another name for Trigeminal Neuralgia?
    tic douloureux
  61. Difference between Naproxen (Naprosyn) and naproxen sodium (Aleve)?
    Naproxen sodium has quicker onset of action
  62. Side effect of chronic Fioricet use?
    Caffeine, butalbital, and Tylenol. Causes rebound headaches if chronic use.
  63. What is signs of trigeminal neuralgia?
    Unilateral headache caused by impingement or inflammation of trigeminal nerve. CN 5
  64. What characteristic pain can clue you into diagnosis of trigeminal neuralgia?
    Sharp shooting pain on one side of face, triggered by food, cold foods, cold air. Causes lancinating pain that lasts for seconds then stops when irritant ceases.
  65. Treatment for trigeminal neuralgia can include?
    Tegretol, TCAs, botox injections
  66. All headaches are unilateral except one?
    Tension are bilateral
  67. What is Bells Palsy?
    CN 7 unilateral facial paralysis affecting motor branch of CN 7
  68. Common noted symptoms of Bells Palsy?
    Unilateral loss of facial expression, difficulty chewing, and decreased taste
  69. What is medication treatment for Bells Palsy?
    High dose corticosteroids x10 days then wean. Acyclovir if herpes is suspected. Eye lubricant and patch. Early treatment is essential to speed progression to normal
  70. What is anisicoria?
    Unequal pupils
  71. Cranial nerves responsible to move the eye ball around?
    CN 3, CN 4, CN 6
  72. Cranial nerves for taste?
    CN 7, and CN 9
  73. CN 10,the vagus nerve provides why type of regulation to what organs?
    Parasympathetic regulation by slowing heart rate, digestive rate, blood pressure
  74. Kinesthetic sensation and how is it tested?
    Position sense. Tested by moving toe and asking if up or down with pt eyes closed
  75. Graphesthesia sensation and how is it tested?
    Draw letters on palm
  76. Stereognosis sensation and how is it tested?
    Place small OBJECT in hand and ask to identify it
  77. What is Ageusia?
    Loss of taste or inability to discriminate taste
  78. What does walking heel to toe asses?
    Proprioception. Which controls balance, posture, coordination
  79. What is a Fugue State?
    Carry on activities and then later cannot recall them
  80. Lesion of what cranial nerve causes diplopia,
    Diplopia, double vision, is caused by problem with cranial nerve 3
  81. What headache symptom timing is indicative of increased ICP?
    Worse headache upon awakening
  82. What medications can cause headaches?
    Estrogen, Progesterone, Vasodilators
  83. What is the goal for relief of headache in prophylactic headache treatment?
    Minimize headache incidence by half
  84. What neuroleptics are indicated in the treatment of migraines?
    Neuroleptics (first generation antipsychotics) such as Prochlorperazine (compazine) or Promethazine (phenergan) are given for anti emetic properties
  85. What is the definition of Multiple Sclerosis?
    Chronic, demyelinating disorder of CNS
  86. What type of vision loss is noted in MS?
    Monocular vision loss, diplopia, nystagmus, optic neuritis
  87. What are the two forms of MS and which is more common?
    RRMS, Relapsing Remitting MS is the most common. Episodes nearly totally resolve in between exacerbations. Primary Progressive MS has cumulative neurological deficits.
  88. What does MRI reveal on MS?
    Demyelinating plaques
  89. What things can worsen MS exacerbation?
    Hot showers, fevers
  90. How is MS exacerbation treated?
    High dose corticosteroids to shorten acute episodes
  91. What long term therapy options are there for MS patients?
    Immunomodulator therapy with Interferon can significantly decrease exacerbation frequency and long term disability in RRMS. Immunosuppressive therapy. And Monoclonal antibody.
  92. What are the 6 cardinal signs of Parkinsons disease?
    Resting Tremor, Rigidity, Bradykinesia, flexed posture, loss of postural reflexes, mask-like facies
  93. What is chemical change that happens in brain with Parkinsons disease?
    Alteration in Dopaminergic pathway.
  94. What is treatment medications for Parkinsons disease?
    Dopamine receptor agonists, Amantadine, COMT inhibitors, MAO B inhibitors, Anticholinergics.
  95. What is the role of anticholinergics in Parkinsons disease treatment?
    To reduce tremor and restore acetylcholine dopamine imbalance. But undesirable side effects in elderly.
  96. What is examples of Dopamine Receptor Agonists used in Parkinsons?
    Ropinirole (Requip) and Pramipexole (Mirapex). Provide neuroprotective effect with less side effects than Levodopa. Other DRA include Pergolide (permax) and Bromocriptine (Parlodel Cycloset)
  97. What happens with long term levodopa use greater than 5 to 10 years?
    Develop dyskinesia. Often given with Carbidopa
  98. What are the noted extrapyramidal side effects of antipsychotics?
    Akathisia, dystonia, parkinsonism movements.
  99. What is Akathisia?
    Inability to stay still, continuous restless movement
  100. What is Dystonia?
    Involuntary spasms, movements of face, arms, legs, neck
  101. What is parkinsonism movements?
    Tremors, shuffling gait, drooling, rigidity
  102. What drugs are used to counteract extrapyramidal movements?
    Anticholinergics, such as Cogentin or Artane. Dopaminergic agonists such as Amantadine
  103. What happens during a Parkinsons OFF period?
    Occurs at end of Levodopa blood level when patient has difficult initiating movement or has uncontrolled movements
  104. What is typically the first sign of Parkinsons?
    Resting tremor.
  105. What occurs in Myasthenia Gravis?
    Autoimmune disorder with acetylcholine receptor antibodies. Is a neuromuscular junction disorder.
  106. What is Guillian-Barre disorder?
    Rapidly progressive acute demyelinating disorder.
  107. What part of the nervous system does Guillain Barre affect?
    Peripheral nervous system is affected in a rapidly ascending pattern. Reflexes are 0 to 1. Possible link to Viral respiratory infection, GI infection, CMV, HZV, General anesthesia
  108. What is Korsakoffs Syndrome and what causes it?
    Chronic ETOH abuse causes dementia due to chronic Thiamine deficiency. May lead to permanent brain damage
  109. How long will urine be positive after smoking Marijuana?
    30 days
  110. What is the Hallpike Maneuver used for?
    Assessing peripheral vertigo. Series of head maneuvers to elicit vertigo
  111. What is noted in a Petit Mall seizure?
    AKA Absence seizure. Often just blank stare 5 to 30 minutes and decreased level of consciousness
  112. What is noted in a myoclonic seizure?
    One or more muscle groups cause brief jerking.
  113. What is noted in a tonic clonic seizure?
    AKA Grand Mall seizure. Rigid Extension, followed by jerking. Positive Loss of consciousness. Bowel and bladder incontinence noted
  114. What is noted in a simple partial or focal seizure?
    Awake state. Or Jacksonian seizure. Abnormal sensory, autonomic or psych behavior
  115. What is noted in a complete partial seizure?
    Aura of unusual taste or smell. Hallucination. Vague stare and facial movement with muscle contraction and relaxation and autonomic signs. Can cause LOC
  116. How long can a TIA last?
    Less than 24 hours
  117. What is the typical secondary prevention medication for person with TIA or CVA?
    ASA or Aggrenox (ASA plus dipyridamole). If multivessel disease, give Plavix. Plus need statin
  118. Which C spine injury still allows you to maneuver a wheel chair?
    C 6, can self transfer to chair. Definitely can use wheel chair in C7,C8 injury.
  119. What are the symptoms of Acute Serotonin Syndrome?
    Shivering, diaphoresis, hyperreflexia, mental status changes, myoclonus
  120. What has the shortest half life of all the benzodiazepines?
    Xanax. Best for elderly
  121. What tests for proper alignment of eyes?
    Corneal light reflex. Will be unequal in strabismus
  122. What checks for the cardinal fields of gaze?
    Check extraocular movements

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