PCCN Neurology Exam 43 Questions with Verified Answers,100% CORRECT

PCCN Neurology Exam 43 Questions with Verified Answers Frontal lobe functions - CORRECT ANSWER Personality, motor function, motor speech, morals, emotions, judgment Parietal lobe function - CORRECT ANSWER Sensation, pain, interpretation, temperature, pressure Occipital lobe function - CORRECT ANSWER visual Cerebellum functions - CORRECT ANSWER coordination of muscle movement & tone, equilibrium What does the glasgow coma scale assess? - CORRECT ANSWER 1. eye opening 2. motor response 3. verbal response Early S/S of increased ICP - CORRECT ANSWER 1. Change in LOC (earliest sign) 2. headache 3. N/V (can project to projectile) 4. Lethargy 5. Irritability 6. slow decision making Late S/S of increased ICP - CORRECT ANSWER 1. pupillary changes 2. Seizures 3. Posturing 4. Can progress to coma Who should ICP monitoring be done for? - CORRECT ANSWER 1. head injuries (GCS 8) 2. Cerebral edema 3. Large Ischemic stroke 4. Hydrocephalus Normal ICP - CORRECT ANSWER 0-15 mmHg tx is indicated when ICP is greater than? - CORRECT ANSWER sustained 20-25 mmHg Positioning of patients w/increased ICP? - CORRECT ANSWER 1. prevent compression of jugular veins 2. HOB 30-45 degrees 3. Straight legs 4. Decrease stimuli Medical tx for increased ICP - CORRECT ANSWER 1. mannitol 2. Hypertonic saline (3% saline) 3. loop diuretics Monro-kellie doctine - CORRECT ANSWER Balance of tissue, CSF & blood to create an equilibrium Diffuse axonal injury - CORRECT ANSWER severe head injury -damage to axons -disconnects cerebral hemisphere from reticular activating system What is a Basilar skull fracture - CORRECT ANSWER -fracture in floor of skull -eyes, ears, nose or spine affected -risk of injury to cranial nerves Key assessment with a skull fracture? - CORRECT ANSWER to determine if dura torn- if so will need surgery to remove bone fragments What should be avoided in patients w/basilar skull fractures? - CORRECT ANSWER Nasogastric or oral tubes! -can end up in brain -also avoid oral suctioning Battle sign is... - CORRECT ANSWER bruising over mastoid bone- sign of basilar skull fracture Acute Epidural hematoma is usually what type of bleed? - CORRECT ANSWER Arterial (laceration meningeal artery) S/S of acute epidural hematoma - CORRECT ANSWER -N/V, agitation, confusion -loss of consciousness -- lucid -- coma -NEURO EMERGENCY! Subdural hematoma is usually what type of bleed? - CORRECT ANSWER Venous! Complications associated w/TBI? - CORRECT ANSWER 1. Hypo/hypernatremia 2. SIADH 2. DI 3. Pulmonary complications (asp. pneumonia) 4. seizures 5. immobility 6. DVT Cushing's triad? - CORRECT ANSWER 1. Wide Pulse pressure 2. Bradycardia 3. Increased systolic pressure Decorticate posturing - CORRECT ANSWER Flexion (to core) or arms, wrists & fingers -internal rotation of lower extremities Decerebrate posturing - CORRECT ANSWER -Extension/arch of back -arms extended and pronated *worse of the 2 Brain death exam - CORRECT ANSWER 1. normothermic 2. Narcotics/sedatives cleared from system 3. flat EEG 4. Absence of cerebral blood flow 5. No pupillary response Oculocephalic reflex - CORRECT ANSWER "Doll's eyes" -tests CN III, VI, VIII -normal= eyes move w/head turn -absent= brain dead (like barbie) Oculovestibular reflex - CORRECT ANSWER -tests CN III, VI, VIII -instill ice cold saline into ear -normal response= look towards stimulus with suspected stroke what test is done immediately - CORRECT ANSWER CT scan w/o contrast to R/O hemorrhage *will not see embolic stroke Prior to starting tPA what needs to be done? - CORRECT ANSWER Control BP! less than 185/110 Other medical interventions w/ischemic stroke - CORRECT ANSWER -give 325 mg aspirin within 24-48 hrs -don't give other anticoagulants within 24 hrs -restart statins if previously taking them Other things to monitor post stroke? - CORRECT ANSWER 1. Avoid fever!! 2. BG (goal 140-180), 3. swallow screen 4. Avoid urinary catheters 5. avoid hyponatremia S/S of carotid stenosis - CORRECT ANSWER -TIAs, visual changes, memory loss, vertigo, syncope -bruit or thrill Post op carotid endarterectomy monitor for what? - CORRECT ANSWER Bleeding/hematoma- can push on airway -neuro assessment of CN VII, IX, X, XI, XII BP management for hemorrhagic stroke? - CORRECT ANSWER Consider reducing if SBP 200 or MAP 150 What medication is given for a ruptured cerebral aneurysm to prevent vasospams? - CORRECT ANSWER CCB- Nimodipine Risk factors for aneurysms - CORRECT ANSWER -congenital -HTN -smoking -Polycystic kidney disease S/S of ruptured aneurysm - CORRECT ANSWER -Worst headache of life -N/V -photophobia -diplopia -nuchal rigidity (stiff neck) -kernig's sign, brudzinski sign -seizures -decreased LOC Tx for aneurysm - CORRECT ANSWER -SBP 160 -surgical or endovascular clip -transcranial doppler to detect vasospasms Tx for hydrocephalus - CORRECT ANSWER -Ventriculostomy -VP shunt (long term) Causes for seizures? - CORRECT ANSWER -genetic -congenital -exposure to drugs -withdrawal from drugs -low Na or glucose -infection -trauma -tumors Status epilepticus - CORRECT ANSWER seizure that lasts 30 min 20-30% mortality Administration of dilantin - CORRECT ANSWER -give slowly -peaks in 15-20 min -monitor for bradycardia & hypotension -use a filter -monitor IV site for infiltration -assess levels (10-20)