2 - common conditions in emergency medicine

Question 1

which three body systems are assessed in the initial triage exam/primary survey?

Answer 1

respiratory, cardiovascular, neurological

Question 2

list the 4 major cranial neuroanatomic localisation groups

Answer 2

forebrain, cerebellum, brainstem, vestibular

Question 3

list the 4 major spinal cord neuroanatomic localisation groups

Answer 3

cranial cervical (C1 - C5), cervical intumescence (C6 - T2), thoracolumbar (T3-L3), lumbar intumescence (L4 - S3)

Question 4

list the 3 major peripheral neuroanatomic localisation groups

Answer 4

peripheral nerve, neuromuscular junction, muscle

Question 5

define comatose

Answer 5

unconscious and not responsive to any stimuli (including pain)

Question 6

define stuporous

Answer 6

unconscious but rousable in response to painful stimuli only

Question 7

define obtunded

Answer 7

reduced level of consciousness but responsive to non-painful stimuli

Question 8

describe Schiff-Sherrington posture and localise the lesion

Answer 8

recumbent with rigid extension of neck and thoracic limbs, variable pelvic limb changes, - localises to T3-L3 (suggests severe impingement/transection, also occasionally seen with lesions caudal to this)

Question 9

describe decerebellate rigidity and localise the lesion

Answer 9

rigid extension of thoracic limbs, relaxed pelvic limbs, mentation typically normal - localises to cerebellum

Question 10

describe decerebrate rigidity and localise the lesion

Answer 10

rigid extension of thoracic and pelvic limbs, mentation typically abnormal - localises to brainstem (typically severe injury)

Question 11

define paresis

Answer 11

decreased voluntary motor function (weakness)

Question 12

define plegia

Answer 12

absence of voluntary motor function (paralysis)

Question 13

list 3 types of ataxia

Answer 13

cerebellar, vestibular, spinal

Question 14

list 5 neurological findings consistent with a forebrain lesion

Answer 14

abnormal LOC, decerebrate rigidity, head turn, wide circling, proprioceptive deficits, seizures

Question 15

list 5 neurological findings consistent with a cerebellar lesion

Answer 15

normal LOC, decerebellate rigidity, tight circling, proprioceptive deficits, hypermedia, intention tremors, absent menace, anisocoria

Question 16

describe cerebellar ataxia

Answer 16

incoordination and dysmetria (most often hypermetria) with preserved strength, head (and sometimes body) tremor, lack of menace response and vestibular signs (if lesions of lobus flocculonodularis are present).

Question 17

describe vestibular ataxia

Answer 17

most commonly unilateral - head tilt accompanied with difficulties with keeping balance, sometimes circling (in small circles), leaning, falling or rolling (usually towards the affected side) with vestibular signs (e.g., pathological nystagmus)

Question 18

describe proprioceptive ataxia

Answer 18

knuckling, proprioceptive deficits, if walking/running there will typically be an abnormal gait pattern such as an extended floating stride

Question 19

word roots of ATAXIA

Answer 19

greek - A = without, TAXIA = order. means lack of coordination

Question 20

list 3 neurological findings consistent with a brainstem lesion

Answer 20

abnormal LOC, decerebrate rigidity, proprioceptive deficits, cranial nerve deficits may be seen depending on location of lesion

Question 21

list 5 neurological findings consistent with a central vestibular lesion

Answer 21

abnormal LOC, head tilt, ataxia, hypermedia, CN V-XII deficits, nystagmus, strabismus

Question 22

list 4 neurological findings consistent with a peripheral vestibular lesion

Answer 22

normal LOC, head tilt, ataxia, CN VII deficits, nystagmus, strabismus

Question 23

describe neurological findings consistent with a C1-C5 lesion

Answer 23

proprioceptive deficits may be present in all limbs, normal to increased reflexes in thoracic limbs, normal to increased reflexes in pelvic limbs

Question 24

describe neurological findings consistent with a C6-T2 lesion

Answer 24

proprioceptive deficits may be present in all limbs, decreased reflexes in thoracic limbs, normal to increased reflexes in pelvic limbs

Question 25

describe neurological findings consistent with a T3-L3 lesion

Answer 25

proprioceptive deficits in pelvic limbs, increased reflexes in pelvic limbs, Schiff-Sherrington posture may be present with severe injuries

Question 26

describe neurological findings consistent with a L4-S3 lesion

Answer 26

proprioceptive deficits in pelvic limbs, decreased reflexes in pelvic limbs

Question 27

four anatomic locations for respiratory disease

Answer 27

upper airway, lower airway, pulmonary parenchymal, pleural space