Neuro

Question 1

cranial nerve 1

Answer 1

olfactory

Question 2

cranial nerve 2

Answer 2

optic - sight NOT pupillary reaction

Question 3

cranial nerve 3

Answer 3

oculomotor - pupillary function

Question 4

cranial nerve 4

Answer 4

trochlear- -movement of the eye muscle

Question 5

cranial nerve 5

Answer 5

trigeminal -corneal, chewing

Question 6

cranial nerve 6

Answer 6

abducens - outward movement of the eye

Question 7

cranial nerve 7

Answer 7

facial

Question 8

cranial nerve 8

Answer 8

vestibulocochlear -doll’s eye and caloric exams

Question 9

cranial nerve 9

Answer 9

glossopharyngeal -swallow, gag

Question 10

cranial nerve 10

Answer 10

vagus - pharyngeal/laryngeal movement

Question 11

what supplies the blood supply to the lower area of the brain

Answer 11

basilar artery

Question 12

so for a neuro assessment eyes will deviate toward or away from pathlogy

Answer 12

toward

Question 13

pupil changes happen on

Answer 13

same side

Question 14

visual changes such as homonymous heminopsia happen on

Answer 14

contralateral

Question 15

motor changes are

Answer 15

contralateral

Question 16

babinski is

Answer 16

contralateral

Question 17

what is cushing triad and what is it indicative of

Answer 17

widenened pulse pp, decrease HR and decrease in RR
brain herniation

Question 18

uncal herniation you’ll see what changes first

Answer 18

pupillary (on same side) BEFORE LOC!!!

Question 19

with central herniation you would see

Answer 19

change in LOC, then pupillary changes and babinski + bilaterally

Question 20

stroke assessment: if you have a right sided brain bleed/infarct what direction your:
eyes
muscle weakness
homonymous hemianopsia
babinski

Answer 20

eyes deviate RIGHT
muscle weaknes LEFT
homonymous heminopsie LEFT visual field
babinski LEFT

Question 21

Tx of acute ischemic stroke

Answer 21

r/o hypoglycemia
assess airway/breathing/circulation
BP management but do not treat unless sbp >220 mmhg because a sudden drop in blood pressure will decrease perfusion esp in areas that have already lost it
labs
CT scan within 25 mintes!

Question 22

what kind of patients can get rTPA and what is it

Answer 22

for acute isehemic strokes

Recombinant tissue plasminogen activator
CT has to be negative, onset was < 4.5 hours ago, and no contraindications (such as major surgery or active bleeds or < 100,000 platelet count)

Question 23

moa for rTPA

Answer 23

r-tPA binds to fibrin in a blood clot.

It converts plasminogen (inactive) into plasmin (active enzyme).

Plasmin digests fibrin, which is the structural meshwork of blood clots.

The clot dissolves = fibrinolysis (aka thrombolysis)

Question 24

what usually causes a SAH

Answer 24

aneurysm of the. middle cerebral artery

Question 25

signs of a rutpured aneurysym

Answer 25

sudden explosive headache decreased loc nuchal rigidity U waves on ecg

Question 26

complications of SAH

Answer 26

hydrocepharlus because chorion villi in the subarachnoid space are blocked and the CSF can't be absorbed - rebleeds -vasospasms (ESP IN HYPONATREMIA)

Question 27

first sign of increased icp

Answer 27

change in loc

Question 28

normal icp

Answer 28

1-10 mmhg

Question 29

high icp

Answer 29

>20 mmhg

Question 30

what is CPP?

Answer 30

CPP = MAP -ICP

Question 31

noraml CPP is

Answer 31

80-100 mmhg and minimum for perfusion is 50

Question 32

signs and symptoms of ICP high

Answer 32

altered LOC, agitation, headache, seizures, cushing's triad

Question 33

in ICP monitoring, which are the worst waves

Answer 33

A WAVES ARE AWFUL, b are bad, and c is common

Question 34

treatment for increased icp

Answer 34

mannitol, 3% saline, furosemide and keep pH nromal!!! if low vasodilation can happen

Question 35

what to avoid in patients with elevated icp

Answer 35

acidosis (vasodilation which increases ICP) alkalosis (vasoconstriction and decreased blood flow to brain) peep -- increase intrathoracic pressure and prevents outflow from jugular venous restraits and agitation fever

Question 36

epidural hematomas can lead to

Answer 36

uncal herniation change in pupils BEFORE Loc remember!

Question 37

linear skull fractures

Answer 37

do not require surgery

Question 38

basilar skull fractures are a type of linear fracture but can cause

Answer 38

meningeal tear

Question 39

signs of a basilar skull fracture

Answer 39

rhinorrhea raccoon eyes periorbital edema battle's sign (discolaration at the back of the ear) otorrhea as a nurse make sure its CSF, put it on a 4x4 and if you see a clot surrounded by a yellow halo its CSF

Question 40

what is status

Answer 40

seziure activity of more than 5 minutes or more

Question 41

what can cause a seizure

Answer 41

tumors, withdrawal, cns infection, hypoglycemia etc veeg used many times for nonconvuslive seizures

Question 42

in bacterial vs viral csf you'll see

Answer 42

decrease glucose , and much higher protein and wbc's in bacterial and the csf is purulent

Question 43

signs of meningeal irritation

Answer 43

nuchal rigidity brudinski's sign (chin to chest if legs come up its +) kernig's (legs up and down pain in neck? posoitive)

Question 44

myasthenia gravis

Answer 44

issue with ach binding to NICOTONIC (EXCITATORY) receptors so the treatment is mestinon which prevents the break down of ach so myasthernic criss will get better with this mestinon!! but if your patient is having a cholingeric crisis, then more ach will make it worse and so giving mestinon will worsen symptoms ## Footnote Component Role in MG Autoantibodies (IgG) Attack nicotinic ACh receptors

Question 45

treatment if tensilon test with mestinon leads to worsening symptoms and why

Answer 45

ATROPINE so even though ach in this case revolves around nicotonic receptors, because you gave mestinon there is SO much ach that it also binds to muscarnic and you'll have symptoms that are parasympatehic. so atropine will bind to these muscarinic receptors and prevent that from happening

Question 46

nif

Answer 46

how strong inspiratory force is so more negative the better, can indicate impending respiraotry failure