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Neurology
| Question | Answer |
|---|---|
| What is a blockage of blood flow to the brain without acute infarction? | TIA |
| What is a permanent neurologic damage; due to hemorrhage or clot (most common)? | Stroke |
| What is the most important thing to do when a stroke is suspected in a patient? | Refer to ED QUICK!! |
| When should tPA be administered for the best outcome if a clot is suspected in a stroke patient? | Within 4 hours! |
| Which neuro assessments will evaluate a patient's cerebellar function? | Balance, Coordination, Movement, Reflexes, Sensation |
| What tests do you use to evaluate balance in a patient? | 1) Romberg test 2) Heel-to-toe test |
| What tests do you use to evaluate coordination in a patient? | 1) Rapid alternating movements 2) Heel-to-shin test 3) Finger-to-nose test |
| What tests do you use to evaluate movement in a patient? | 1) Muscle strength, size, tone 2) Assess for tics, tremors |
| What tests do you use to evaluate reflexes in a patient? | Achilles (S1), Patellar (L4), Biceps (C5 & C6), Triceps (C7) 0-5: +2 is normal |
| What tests do you use to evaluate sensation in a patient? | Touch, vibration, proprioception |
| Which conditions can mimic a stroke? | Migraine HA (asymmetric), Seizure (absent seizure), Hypoglycemia |
| Which 3 characteristics may be found in a patient who presents with Bell's Palsy? | 1) Disappearance of the nasolabial fold 2) Decreased tearing on the affected side 3) Loss of taste sensation may be present |
| What is the most important thing to consider in a patient with Bell's Palsy when it comes to the eye? | Pay attention to the eye on the AFFECTED SIDE because the patient is unable to blink properly and the lid is unable to cover the eye so it dries out. |
| What is important thing to consider as management of a patient's eye who has Bell's Palsy? | Use ocular lubrication every hour while awake and a viscus ocular lubricant at bedtime. |
| What medication class is used to treat Bell's Palsy? | Steroids PO |
| What are the 3 primary headaches? | 1) Migraine 2) Tension 3) Cluster |
| What are secondary headaches? | Underlying pathology, "red flag" headaches (tumors, brain bleed, increased ICP) |
| When a middle or older adult (35 y/o or older) complain of a new onset headache, what type of headache is it? What do they need? | SECONDARY; An imaging study! |
| How do you approach a patient who has a complaint of a headache? | 1) Get a good hisory! |
| What is a thunderclap headache? | A headache that starts suddenly and is very severe |
| What should you think about when a patient c/o a thunderclap headache? | A bleed somewhere! |
| What is the most common thunderclap headache secondary to a bleed? | Subarachnoid hemorrhage |
| What are the first two things you suspect when a patient states "this is the first headache I have ever had" or "this is the worst headache I have ever had?" | Think hemorrhage or infection |
| What are the two things you suspect when a patient has focal neuro symptoms? | Mass or AVM |
| What are focal neuro symptoms? | 0 |
| What are 3 other red flags in a history taking regarding a headache other than thunderclap, first, or worst HA? | 1) Change in personality 2) Change in mental status 3) Chance in LOC |
| What is the diagnosis of a patient who comes in with a recent onset HA secondary to a sudden stabbing pain on face? | Trigeminal Neuralgia |
| What is the diagnosis of a patient who comes in with a recent onset HA secondary to a sudden unilateral vision loss? | Stroke OR optic lesion |
| What is the diagnosis of a patient who comes in with a recent onset HA secondary to ear pain when opening mouth? | TMJ |
| What is the diagnosis of a patient who comes in with a recent onset HA secondary to HA in the AM that improves with sitting up? | Increased ICP |
| What is the diagnosis of a patient who comes in with a recent onset HA secondary to drooping eyelid and corner of mouth? | Bell's Palsy |
| What is the diagnosis of a patient who comes in with a recent onset HA secondary to pain in the right temple area? | Giant cell arteritis |
| What is the diagnosis of a patient who comes in with a recent onset HA secondary to papilledema? | Increased ICP |
| What is papilledema? | Swelling of the optic disc due to increased ICP. |
| Is papilledema usually unilateral or bilateral? Why? | Bilateral due to the increased ICP |
| What imaging study do you order when you want to look at a cavity (chest, abdomen, sinuses) within the body? | CT |
| What imaging study do you order when you want to look at "soft" tissue of the body including the meniscus, brain, spinal cord, ligaments, tendon injuries, and others? | MRI |
| What is the cost range for a CT? | $800-$3200 |
| What is the cost range for an MRI? | $1200-$4000 |
| Which image study uses radiation? Which does not? | CT does MRI does not |
| What does contrast dye do? | Contrasts something from something in close proximity to it. (A patient who has had lumbar surgery - contrast is used to distinguish between the soft tissue and the scar tissue) |
| When do you absolutely not order contrast dye in a patient? | If there is a suspected leak |
| Why would an MRI be preferred over a CT? | MRI is more sensitive for edema, vascular lesions, intracranial pathology |
| Why would a CT be used more than a MRI? | CTs are more widely available with quicker results |
| Does a patient who c/o HA lateral and superior of her eye with a tentative diagnosis of Giant Cell Arteritis (GCA) or temporal arteritis need an imaging study? What diagnostic test do they need? | NO; ESR and CRP |
| What is a definitive test for GCA? | Biopsy |
| Are migraine HAs more common in women or men? | Women |
| How do you diagnose a migraine headache? | HISTORY: How long does your headache last? What are the characteristics of your HA? Do you have any symptoms during your HA? |
Created by:
alexandrat2008
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