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Neuro 12 Loss Of Con

Loss of Consciousness

QuestionAnswer
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