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Neuro 12 Loss Of Con
Loss of Consciousness
| Question | Answer |
|---|---|
| What two medications could be used for prophylaxis against meningococcal meningitis? | Rifampin and cipro |
| WHat two classes of medication could be used both to treat chronic HTN and also to prevent recurrent migraines? | CCB and beta blockers |
| How do edrophonium, neostigmine, and pyridostigmine work in the tx of myasthenia gravis? | Block AChE from breaking down ACh at the NMJ |
| ID the type of syncope: assoc'd with emotional stress, trauma, pain, sight of blood, and prolonged standing | vasovagal reflex syncope |
| ID the type of syncope: associated with micturition, defecation, coughing, GI stimulation | situational reflex syncope |
| ID the type of syncope: assoc'd with head-turning, shaving, tight collar | carotid sinus hypersensitivity |
| ID the type of syncope: assoc'd with exertion, palpitations, chest pain, SOB | cardiogenic |
| ID the type of syncope: dx with tilt test | orthostatic |
| ID the type of syncope: associated with prolonged loss of consciousness, seizures, and neuro deficits | cerebrovascular |
| Which cause of syncope is consistent with these historial items or PE findings?: while shaving | carotid sinus hypersensitivity |
| Which cause of syncope is consistent with these historial items or PE findings?: while singing in a choir concert | vasovagal |
| Which cause of syncope is consistent with these historial items or PE findings?: with a positive tilt test after taking BP meds | orthostatic |
| Which cause of syncope is consistent with these historial items or PE findings?: with prolonged loss of consciousness | cerebrovascular |
| Which cause of syncope is consistent with these historial items or PE findings?: preceded by palpitations | cardiogenic |
| Which cause of syncope is consistent with these historial items or PE findings?: in a type 1 diabetic interrupted while eating | hypoglycemia |
| What test is used to confirm the MCC of syncope? | Tilt test (MCC=vasovagal) |
| What measurements make for a positive tilt test? | Increased HR >/= 20bpm while standing Decreased SBP >/= 20 points while standing Decreased DBP >/= 10 points while standing |
| What is the differential diagnosis for a pt presenting to the ER for loss of consciousness (remember the mnemonic)? | AEIOU TIPS: Alcohol, Epilepsy/Environmental, Insulin, OD/Opioids, Uremia, Trauma, Infection, Psychogenic, Stroke |
| What should you think about for initial empiric therapy in a pt coming into the ER with loss of consciousness? | 1. Thiamine first! 2. Then glucose 3. Naloxone |
| Why is thiamine given in a glucose infusion to alcoholics with hypoglycemia? | B/c glucose administration in the absence of thiamine can theoretically exacerbate damage to the mammillary bodies and worsen Wernicke's encephalopathy |
| In an intact brainstem, the pt's eye should move in which direction with ice water infusion into an ear canal? | Toward the ear receiving the ice water |
| What are the elbows doing in decorticate posturing? | Flexing |
| A pt is brougth into the ER with loss of consciousness. What do you igve before starting empiric glucose infusion? | Thiamine |
| Pt with normal sleep cycles, an inability to perceive or interact with the environment, and preserved autonomic function for >1mo. Dx? | Persistent vegetative state. Unlikely to recover after 3 mos of sx. |
| What do large, non-reactive pupils in a comatomse pt suggest? | damage below midbrain, blown pupil (CN3), possible uncal herniation or supratentorial mass effect |
| What do small, reactive pupils in a comatomse pt suggest? | Thalamic involvement, transtentorial herniation |
| What do pinpoint pupils in a comatomse pt suggest? | Opioid overdose, toxic effect, exces cholinergic activity (insecticides, organophosphates) |
| What does a lack of ocular motility but reactive pupils suggest in a comatose pt? | Metabolic cause, benzo OD |
| What do the following cold water in ear test results suggest?: conjugate deviation toward ice water | intact brain stem |
| What do the following cold water in ear test results suggest?: no abduction, no adduction | CN 3 and 6 involvement |
| What do the following cold water in ear test results suggest?: conjugate nystagmus | Psychogenic cause |
| What do "doll's eyes" (when moving head side to side, eyes move in opposite direction of head movements) in a comatose pt suggest? | Intact brain stem (this is the oculocephalic reflex which may be masked in an awake pt) |
| What injury/involvement is suggested by the following changes to motor function in a comatose pt?: spastic paralysis | High spinal cord injury |
| What injury/involvement is suggested by the following changes to motor function in a comatose pt?: decorticate posturing (elbows flexed, legs extended) | Cortical or thalamic compression |
| What injury/involvement is suggested by the following changes to motor function in a comatose pt?: decerebrate posturing (elbows extended, legs extended) | Midbrain involvement |
| What injury/involvement is suggested by the following changes to motor function in a comatose pt?: no response to painful stimuli | Pontine, medullary, or reticular activating system involvement |
| What injury/involvement is suggested by the following changes to motor function in a comatose pt?: appropriate pain response | Superfical cause (not deep brain) |
Created by:
sarah3148
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