Acute Medicine Presentations 2 Flashcards
Which of the following is NOT a neurological cause of impaired consciousness?
1 - Trauma
2 - Cerebrovascular (haemorrhage or hypoperfusion)
3 - Epilepsy (postictal or (non)convulsive status epilepticus)
4 - Infection and sepsis
5 - Hypoglycaemia or hyperglycaemia
6 - Space-occupying lesion
5 - Hypoglycaemia or hyperglycaemia
Which of the following is NOT a metabolic cause of impaired consciousness?
1 - Space-occupying lesion
2 - Hypoglycaemia or hyperglycaemia
3 - Endocrine
4 - Hypothermia
5 - Hypoxia or Hypercarbia
Other electrolyte disturbance
6 - Uraemic encephalopathy
7 - Hepatic encephalopathy
8 - Drugs and toxins
1 - Space-occupying lesion
There are 3 sections of the Glasgow Coma Scale (GCS). Which of the following is NOT a section of the GCS?
1 - best motor response
2 - best reflex
3 - best verbal response
4 - eye opening
2 - best reflex
- minimum scores is 3
- maximum score is 15
What does myoclonus relate to?
1 - spontaneous muscle contraction and relaxation
2 - sudden/brief involuntary twitching or jerking of a muscle or group of muscle
3 - cocking of wrists backwards and forwards
4 - all of the above
2 - sudden/brief involuntary twitching or jerking of a muscle or group of muscle
What is asterix?
1 - spontaneous muscle contraction and relaxation
2 - sudden/brief involuntary twitching or jerking of a muscle or group of muscle
3 - cocking of wrists backwards and forwards
4 - all of the above
3 - cocking of wrists backwards and forwards
When we are trying to assess a patients own ability to maintain their own respiratory function, below what Glasgow Coma Score (GCS) would suggest that the patient is unable to maintain their own respiratory function?
1 - 0
2 - <3
3 - <8
4 - <12
3 - <8
- patients are unable to protect their airways
- GCS is correlated with outcomes in brain injury
When looking at the cranial nerves we can remember the football formation, 4, 4, 2, 2. Which cranial nerves are located in cerebrum?
1 - CNI Olfactory nerve.
2 - CNII Optic nerve.
3 - CNIII Oculomotor nerve.
4 - CN IV Trochlear nerve.
1 - Olfactory nerve.
2 - Optic nerve.
- the first 2 in the 4, 4, 2, 2 formation
When looking at the cranial nerves we can remember the football formation, 4, 4, 2, 2. Which cranial nerves are located in the midbrain?
1 - CNI Olfactory nerve.
2 - CNII Optic nerve.
3 - CNIII Oculomotor nerve.
4 - CN IV Trochlear nerve.
3 - Oculomotor nerve.
4 - Trochlear nerve.
- the second 2 in the 4, 4, 2, 2 formation
When looking at the cranial nerves we can remember the football formation, 4, 4, 2, 2. Which cranial nerves are located in the pons?
1 - CNV Trigeminal nerve.
2 - CNVI Abducens nerve.
3 - CNVII Facial nerve.
4 - CNVIII Vestibulocochlear nerve
1 - CNV Trigeminal nerve.
2 - CNVI Abducens nerve.
3 - CNVII Facial nerve.
4 - CNVIII Vestibulocochlear nerve
- the first 4 in the 4, 4, 2, 2 formation
When looking at the cranial nerves we can remember the football formation, 4, 4, 2, 2. Which cranial nerves are located in the medulla?
1 - CNIX glossopharyngeal nerve
2 - CNX vagus nerve
3 - CNXI accessory nerve
4 - CNXII hypoglossal nerve
1 - CNIX glossopharyngeal nerve
2 - CNX vagus nerve
3 - CNXI accessory nerve
4 - CNXII hypoglossal nerve
- the second 4 in the 4, 4, 2, 2 formation
There are 4 main parts of respiratory control located in the brain stem. Which 2 of these parts is located in the pons?
1 - pneumotaxic centre
2 - apneustic centre
3 - dorsal respiratory group
4 - ventral respiratory group
1 - pneumotaxic centre
- inhibits DRG and limits inspiration
- increases respiratory rate but limits tidal volume
2 - apneustic centre
- prolongs DRG inspiratory signal
There are 4 main parts of respiratory control located in the brain stem. Which 2 of these parts is located in the medulla?
1 - pneumotaxic centre
2 - apneustic centre
3 - dorsal respiratory group
4 - ventral respiratory group
3 - dorsal respiratory group
- inspiratory centre
4 - ventral respiratory group
- expiratory centre
The dorsal respiratory group (DRG) is an important component of the respiratory centre located in the medulla of the brain stem. Which cranial nerves provide sensory input to the DRG?
1 - CNIX glossopharyngeal nerve
2 - CNX vagus nerve
3 - CNXI accessory nerve
4 - CN IV Trochlear nerve.
1 - CNIX glossopharyngeal nerve
2 - CNX vagus nerve
- receive input from mechanoreceptors (in lungs) and chemoreceptors
If a patient had a lesion, but was able to breathe normally, would the lesion be above or below the brainstem?
- above
- respiratory centre is in the pons and medulla of the brain stem
If a patient has lost consciousness we may want to check for neck stiffness. One way of doing this is the Brduzinski sign. What is this sign?
1 - hip on one side drops
2 - inability to straighten leg while flexing the hip
3 - neck is flexed resulting in flexion of the knees and/or hips
4 - toes extend and abduct
3 - neck is flexed resulting in flexion of the knees and/or hips
If a patient has lost consciousness we may want to check for neck stiffness. One test for this is called the Kernigs sign. What is this?
1 - hip on one side drops
2 - inability to straighten leg while flexing the hip
3 - neck is flexed resulting in flexion of the knees and/or hips
4 - toes extend and abduct
2 - inability to straighten leg while flexing the hip
Which of the following are possible causes of loss of consciousness?
1 - Meningitis
2 - Brain Tumour
3 - Acute stroke
4 - Spinal cord compression
5 - Toxic-Metabolic derangement
6 - all of the above
6 - all of the above
What colour is normal cerebrospinal fluid?
1 - clear
2 - turbid
3 - fibrin web
4 - coloured based on organism
1 - clear
In patients with infections, is the pressure of the CSF going to be higher or lower?
- always higher
When comparing bacterial, viral and fungal/TB, which typically has the highest protein content?
- bacterial
- but others can also be high
Why can protein content increase in the CSF during an infection? (select 2)
1 - blood brain barrier becomes leaky
2 - proteins collect at the site of infection
3 - proteins are secreted by inflammatory/invading cells
4 - lumbar puncture causes proteins to be secreted
1 - blood brain barrier becomes leaky
3 - proteins are secreted by inflammatory/invading cells
When comparing bacterial, viral and fungal/TB, which typically has the lowest glucose content?
- bacterial
Which cell type is high in the CSF if there is a bacterial infection?
1 - neutrophils
2 - macrophages
3 - lymphocytes
4 - platelets
1 - neutrophils
Which cell type is high in the CSF if there is a viral, fungal or TB infection?
1 - neutrophils
2 - macrophages
3 - lymphocytes
4 - platelets
3 - lymphocytes
Why can glucose levels change in the CSF during an infection? (select 2)
1 - blood brain barrier becomes leaky
2 - proteins collect at the site of infection
3 - proteins are secreted by inflammatory/invading cells
4 - lumbar puncture causes proteins to be secreted
