MDT Neuro

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MDT Neuro
2011-05-27 05:04:02
MDT Neuro

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  1. Posttraumatic and Retrograde Amnesia, Loss of
    consciousness and Feeling ”in a fog
    or “zoned out” are symptoms of?

  2. What
    condition has symptoms of clumsiness, incoordination, genital anesthesia, and
    Blurred, Double or loss of vision in a single eye, which is aggravated by heat
    or exertion?
    Multiple Sclerosis

  3. What is a unilateral periorbital/temporal pain
    that primarily affects men 20-40 and can have up to 8 attacks per day?
    Cluster Headache

  4. What
    are differential diagnoses of Ischemic Stroke?
    • Migrain
    • Focal seizure

    • Tumor

    • Subdural hematoma

    • Hypoglycemia;

    • Hyperglycemia; Hypercalcemia.

  5. What are the two causative agents of Bacterial Meningitis? Which one is more common in adults, which is common in close quarter living situations?
  6. Neisseria meningitides (meningococci)

  7. Streptococcus pneumoniae (pneumococci
  8. Most common cause of meningitis in adults

  • What
    would be the treatment plan for a pt with a Subdural Hematoma

    • ABC’s
    • · Elevate head of bed to reduce intracranial pressure

    • · Avoid flexion of lower body until thoracic, lumbar, or sacral spine injuries are ruled out

    • · Maintain patient in rigid cervical collar until cervical spine is cleared radiographically

  • What would be the treatment plan for a pt with a Subdural Hematom


    Maintenance of adequate airway and ventilation and support of cardiovascular system to promote normal cerebral perfusion

    • · Treatment of multisystem trauma and precautions for cervical and other spine injury

    • · Keep head of bed flat

  • What
    is an abrupt onset of Headache and in 40% of the population characterized
    by having “worst headache of Life”?
    Subarachnoid Hemorrhage

  • How long must you observe a Pt who has
    experienced a concussion

    • Observation for the first 24 hours by responsible individual

    • Awake patient their first night every 2 hours to ensure normal state of alertness

  • What
    is the Pt Education for any person suffering from a seizure disorder?

    • No driving, operating heavy equipment, or firearms

    • Ask patient to maintain a seizure diary

    • Note potential triggers such as stress, sleep deprivation, drug use, discontinuation of alcohol or benzodiazepines, menses

  • Northern
    European Descent are more prevalent to present with what condition?
    Multiple Sclerosis

  • Which
    condition presents with focal neurological deficits depending on the location
    and size of the lesion and exam findings have Personality changes, seizures and
    Intracranial Tumors

  • What
    is another word for Tumors

  • What
    is a recurrent abnormal, unregulated discharge that occurs within the brain’s
    cortical gray matter and transiently interrupts normal brain function and are
    often due to structural abnormalities?
    Partial Seizure Disorder

  • What
    are the 5 phases of a migraine?

    Premonitory symptoms

    • Aura


    Headache termination

    • Postdrome

  • A
    TIA produces sudden Neuro deficits, are usually caused emboli from carotid
    arteries and in certain aspects centrifugal force. They present with neuro
    deficits similar to strokes and a temporary blindness lasting < 5 min called

    • Transient monocular
    • blindness

    Or Transient Ischemic stroke

  • This
    condition is characterized by a severe paroxysmal, lancinating facial pain
    lasting seconds to minutes?
    Trigeminal Neuralgia

  • What
    condition has exam finding consistent with Ataxia, Babinski Sign, Hyper active
    DTR’s and Hyperesthesia?
    Multiple Sclerosis

  • What
    is the Treatment for a pt with Myasthenia Gravis?

    Airway management


  • This
    condition is transmitted by a Mosquito and can present with signs of Mental
    Status Changes, Photophobia, lethargy progressing to coma, seizures and focal
    neurologic deficits and can have nonspecific symptoms (i.e. malaise, skin rash,
    fever and myalgia) that could precede neuro symptoms?
    Viral Encephalitis

  • Which
    condition would you use Rocephin as the treatment of choice
    Bacterial Meningitis

  • What
    condition has symptoms that follow a flu-like syndrome and usually produces a
    fever and headache?
    Aseptic Meningitis

  • A
    fracture of this bone can cross the area of the middle meningeal artery and
    potentially cause an epidural hematoma?
    • Skull
    • Fracture

  • Which
    Neurological condition can result in complications of loss or altered sense of
    smell, taste, hearing or vision?
    Traumatic Brain Injury

  • This
    test is used to assist in the diagnosis of Post Concussive Syndrome?
    Dix-Hall pike test

  • What
    is the treatment plan for concussion patients

    • ABC’s

    • Most patients need only physical and cognitive rest, serial clinical evaluations, to include neurologic checks, and a plan for follow-up evaluation

  • In
    order to fracture the Occipital Bone and basilar bones what type of impact must
    there be?

    • high-intensity impact Fractures

  • What
    are the types of Arboviruses that cause Viral Encephalitis?

    • St. Louis encephalitis,

    • Japanese encephalitis,

    • Eastern/Western equine encephalitis,

    • Venezuelan equine encephalitis,

    • West Nile fever

  • What
    condition can be a hematogenous spread or direct extension from Otitis,
    Mastoiditis, Sinusitis or Dental infection?
    Brain Abscess

  • Which
    type of stroke is a focal brain infarction that produces sudden Neuro deficits
    persisting > 24hrs.
    Ischemic stroke

  • You
    should always maintain oxygenation with Acute Stroke Patients. T/F

  • Fluctuating
    Estrogen Levels (as well as other hormonal factors) are potent triggers for
    what type of headache?

  • This condition has pain always in a unilateral orbitotemporal distribution, is
    excruciating, peaks within minutes and subsides spontaneously within 30
  • Cluster Headache

  • What are the two clinical forms of Myasthenia Gravis? Which one commonly affects ocular as well as a variable combination of bulbar, proximal limb and respiratory muscles?

    Generalized MG (85%): Commonly affects ocular as well as a variable combination of bulbar, proximal limb, and respiratory muscles.

    • Ocular MG
  • Imitrex should not be given within 24hrs of what derivative treatment of migraines?
    Ergot derivatives or other triptan
  • What are the complications of Transient Ischemic Strokes?
    Stroke, Death
  • What condition has signs and exam findings of Hemiplegia, Hemianesthesia, aphasia, ataxia, n/v, coma and death (if basilar artery occlusion is complete)?
    Ischemic Stroke
  • What type of hemorrhage from blunt force trauma is generally acute with 30% have a “Lucid interval”?
    Epidural Hematoma
  • In what condition may you see CSF Otorrhea?
    Skull Fracture
  • What is a transient and reversible post-traumatic alteration in mental status lasting from seconds to minutes and, by arbitrary definition >6 h?
  • Name 2 locations of Battle signs?
    Battle Sign: Behind the Ears

    Raccoon Eyes: Bruising around the Eyes
  • Name 4 symptoms of Bacterial Meningitis.
    Headache. Fever. Stiff neck. Altered mental status.
  • When dealing with a Brain Abscess, what are the most common infective organisms?
    • Streptococci,
    • staphylococci,
    • enteric Gram-negative bacilli and
    • anaerobes (usually same as source of infection), Nocardia.
  • What are the differential diagnoses for an Ischemic Stroke?
    Migraine / Focal seizure / Tumor Subdural hematoma / Hypoglycemia / Hyperglycemia Hypercalcemia
  • What condition has symptoms of bilateral Headache lasting 30 min for 7 days and is characterized by Pressing/tightening (non-pulsating) quality?
    Tension Headache
  • This seizure causes tonic/clonic movements that may involve 1 entire side of the body or may be more localized?
    Partial Seizure Disorder
  • A concussion Pt that has developed blurred vision requires
  • What is Characterized by brief complete loss of muscletone and consciousness usually occurs in Children (which they fall or pitch to the ground, risking trauma particularly in the head)?
    Generalized Seizure Disorder
  • Name all the differential diagnoses of Intracranial tumors.
    • Intracranial hemorrhage
    • • Hydrocephalus
  • This condition is an acute progressive weakness that appears 1-2 weeks after a resolved respiratory illness and affects the motor and autonomic peripheral nerve in an ascending pattern?
    Guillain-Barre Syndrome
  • What condition has symptoms of Clumsiness, In coordination and Blurred, double or loss of vision in a single eye that is aggravated by heat or exertion?
    - Multiple Sclerosis
  • This condition has signs of respiratoy illness or sore throat (which often precede the more characteristic symptoms, positive Kernig/Brudzinski’s (in about 50%) and Adults can become desperately ill within 24 hrs?
    Bacterial Meningitis
  • What should you consider for a treatment when dealing with Viral Encephalitis?
    Treat symptoms
  • Why are anti-platelet drugs contraindicated in pt’s with Ischemic Stroke?
    Antiplatelet drugs (Aspirin contraindicated due to not being able distinguish between ischemic or hemorrhagic cause in independent setting
  • This type of Simple Partial Seizure is characterized as a discharge that spreads through motor cortex, tonic-clonic activity spreads in a predictable fashion?
    Jacksonian march":
  • What type of seizures are formerly called Petit Mal and consist of 10 to 30 sec LOC with eyelid fluttering; axial muscle tone may or may not be lost?
    Absence seizures
  • What are usually the earliest symptoms of Guillain-Barre Syndrome?
    • • Pain common: especially back, legs
    • • Acute, symmetric, and usually ascending weakness of limbs within days of dysesthesias
  • This condition has symptoms of excruciating lip and/or gum and/or facial pain?
    Trigeminal Neuralgia
  • This condition is known as an autoimmune disorder of episodic muscle weakness and easy fatigability.
    Myasthenia Gravis
  • When performing tests on you notice that you have a Patient with an Altered Mental Status, A Macular and erythematous rash and a positive Kernig’s and Brudzinski’s sign, what do you think the pt Diagnosis is?
    Bacterial Meningitis
  • Tissue Plasminogen Activator (tPA) is a clot dissolving enzyme that must be given within 3 of onset of deficits and only if determined to be not hemorrhagic in etiology?
    Ischemic Stroke:(tPA) may be given if within 3 hours of onset of deficits and only if determined to be not hemorrhagic in etiology.
  • What condition has signs/exam findings of Ptosis, Diplopia and dysarthria?
    • Ischemic Stroke: Facial paresis, Diplopia, Dysarthria (132)
    • - Myasthenia Gravis: Ptosis, Diplopia (243)
  • What is the treatment plan for Pt’s suffering from a seizure disorder?
    • • Place pt in safe comfortable, reclined supine position with something soft under their head
    • • Place nothing in their mouth
    • • After seizure place in recovery position
    • • ABC’s
    • • Eventually underlying cause will need to be treated if present
  • Which condition is related to a known condition (i.e. alcohol withdrawal, acute or chronic CNS injury-trauma, infection, stroke, mass/vascular lesion, metabolic disorder, encephalopathy (hypoxic or degenerative))?
    Status Epilepticus Disorder
  • Where do Tension Headaches originate? How are they described?
    occipital or bi-frontal region and spread over the entire head, and sometimes described as viselike
  • What condition will you use O2, Sumatriptan (Imitrex) for treatment?
    Cluster Headache
  • What is Cushings Triad? It is evident of what sign?
    • • Elevated BP
    • • Decreased pulse rate
    • • Slow or irregular breathing

    Evidence of increased intracranial pressure (ICP)
  • What is the name of the test to denote possible CSF?
    • • Cerebrospinal fluid (CSF) analysis
    • • MRI
  • Amnesia of events that occurred prior to the trauma
    or disease that caused the amnesia
    Retrograde Amnesia
  • Inability to form new long term memories after the trauma or disease that caused the condition
    Anterograde Amnesia
  • What is your first priority in pt with any type of head injury?
    ABC’s take priority over head injury
  • How many concussion grades are there?
  • Describe the concussion grades?
    • 1- No loss of consciousness, symptoms =15 minutes
    • 2- No loss of consciousness, symptoms >15 minutes
    • 3- Any loss of consciousness
  • How many ways are there to examine a Pt for a Concussion?
    • Dix-Hall pike test
    • Neuropsychological testing
    • CT/ MRI
    • Neurology consult
  • What are the 3 areas examined by the GCS?
    • - Eye Opening: 4-1
    • - Verbal Response: 5-1
    • - Motor Response: 6-1
  • What do open head injuries pose a high risk of?
    Traumatic Brain Injury
  • Why is Aspirin contraindicated in pt with a stroke?
    • Antiplatelet drugs (Asprin contraindicated due to not
    • being able distinguish between ischemic or hemorrhagic cause in independent setting)
  • How often should you wake a concussion pt?
    every 2 hours
  • What medications are helpful in aborting very severe and persistent attacks?
    • IV Dihydroergotamine with a dopamine antagonist antiemetic
    • • Metoclopramide 10 mg IV (or)
    • • Prochlorperazine 5 to 10 mg IV
  • What condition has complications of Progressive destruction of the CNS leading to Multi Neuro deficits, coma, delirium, Emotional Liability, Nystagmus, Optic Nerve Atrophy, Paraplegia, Sexual Impotence (men), UTI’s?
    Multiple Sclerosis
  • What are some symptoms of Intracranial Tumors (Neoplasms)?
    • Focal neurological deficits depending on the location and size of lesion.
    • General symptoms of increased intracranial pressure