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B12 MSK > Altered Memory and Consciousness > Flashcards

Altered Memory and Consciousness Flashcards

1
Q
  1. Define Dementia

2. Name the 5 most common subtypes of dementia

A
  1. chronic/progressive disease of the brain, leading to cognitive impairments, and deterioration in emotional control, social control or motivation
2. alzheimer's disease
    vascular dementia
    dementia with Lewy bodies
    frontotemporal dementia
    mixed dementia
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2
Q

How does dementia differ from mild cognitive impairment?

A

mild cognitive impairment is not severe enough to impair ADL

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3
Q

Name 4 general symptoms of dementia

A
  1. memory problems
    - retention of new info, forgetting names, getting lost in familiar places
  2. impairments in cognitive abilities
  3. impairments in communication
    - repetitive
    - difficulties in following and engaging in conversation
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4
Q
  1. What changes can be seen in CT in a person with Alzheimer’s disease
  2. What two abnormal proteins are hallmarks of Alzheimer’s disease
  3. What is the normal function of these proteins?
  4. What neurotransmitter is implicated in Alzheimer’s disease?
A
  1. cortical atrophy, particularly in temporal, frontal and parietal areas
  2. Amyloid plaques
    Neurofibrillary tangles of tau
  3. Amyloid - protects against glutamate excitation
    Tau - microtubules; structural integrity and neuronal cell commiuncation
  4. lower levels of AcH
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5
Q

Name 2 pharmacological agents used in the treatment of Alzheimer’s disease

A

AcH esterase inhibitors - Donepezil, rivastigmine, galatamine

NMDA antagonist - memantine

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6
Q
  1. What is vascular dementia caused by?
  2. Describe the progression of vascular dementia
  3. Name 5 risk factors for vascular dementia?
  4. How is vascular dementia managed?
A
  1. problems with blood circulation to the brain - TIAs and stroke
  2. erratic/stepwise - depends on frequency, severity and site of TIAs
  3. age, male, fam Hx, smoking, poor physical health
  4. manage/reduce risk factors
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7
Q
  1. What is dementia with Lewy bodies?

2. What kind of symptoms are seen?

A
  1. dementia associated with the accumulation of lewy bodies which disrupt neuronal communication
  2. Alzheimer’s and Parkinson’s disease like
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8
Q
  1. In what age group is frontotemporal dementia more common?
  2. What mutations are associated with frontotemporal dementia
  3. Name the two main types of frontotemporal dementia
A
  1. <65yrs
  2. Tau gene
  3. Behavioural varient frontotemporal dementia (Pick’s disease)
    primary progressive aphasia
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9
Q
  1. Name symptoms of behavioural variant frontotemporal dementia
  2. Name the two subcategories of primary progressive aphasia and their symptoms
A
  1. changes in personality, apathy and withdrawal, obsessive behaviour, loss of empathy, changes in appetite, emotional blunting, difficulties with decision making and problem solving
  2. semantic dementia - loss of knowledge of the meaning of words

progressive non-fluent aphasia - progressive difficulty in language; slow hesitant speech, problems with grammar and complex sentences

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10
Q

What is the triad of anaesthesia

A
  1. Hypnosis (sleep)
  2. Areflexia (muscle relaxation)
  3. Analgesia
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11
Q
  1. What is curare used for in anaesthesia?

2. Name some other agents which have been used historically in anaesthetics

A
  1. muscle relaxant

2. ether, nitrous oxide, chloroform

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12
Q
  1. What are inhalational anaesthetic agents used for?
  2. What are intravenous anaesthetic agents used for?
  3. name three unwanted effects of anaesthetic agents
A
  1. maintenance of anaesthesia
  2. induction of anaesthesia
  3. decreased cardiac contractility
    sympathetic inhibition
    respiratory depression
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13
Q
  1. How is anaesthetic potency expressed?
  2. What is the relationship between anaesthetic potency and lipid solubility?
  3. Name three molecular targets that anaesthetics are thought to act on
A
  1. Minimal alveolar concentration required to abolish a response to surgical incision in 50% of patients
  2. potency is directly proportional to lipid solubility
  3. NMDA receptors
    GABA receptors
    two pore domain potassium channels
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14
Q
  1. Name four intravenous anaesthetics used
  2. Name the most commonly used volatile anaesthetic
  3. what anaesthetic is useful for day case surgery and why?
A
  1. proprofol, thiopental, etomidate, ketamine
  2. isoflurane
  3. desflurane. faster onset and recovery than isoflurane
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15
Q
  1. Name 2 local anaesthetic agents
  2. name the local anaesthetic toxicity response
  3. How is local anaesthetic toxicity managed?
A
  1. esters and amides
  2. CNS excitation (tingling, agitation) then depression (loss of consciousness and respiratory arrest)
    myocardial depression
  3. stop injecting, oxygen, intralipid injection (provides large lipid load to the circulation)
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16
Q
  1. Where do neuromuscular blocking drugs act?
  2. Name a depolarising neuromuscular drug
  3. name three non-depolarising neuromuscular drugs
A
  1. NMJ
  2. suxamethonium
  3. tubocuarine, atracurium, vecuronium
17
Q

Describe the following stages of Anaesthesia

  1. Stage 1
  2. Stage 2
  3. Stage 3
  4. Stage 4
A
  1. induction
    - progression from analgesia to anmesia
    - ends at loss of consciousness
  2. excitement
    - irregular heart and breathing rate
    - uncontrolled movements, vomiting, pupillary dilation
    - can lead to airway compromise - must be actively managed to reach stage 3 ASAP
  3. operative amnesia
    - respiratory depression
    - eye movements slow and stop
    - skeletal muscles relax
  4. severe brain stem and medullary depression
    can lead to respiratory and cardiovascular collapse
    lethal without advanced support
18
Q
  1. Which are more reliable signs to monitor the depth of anaesthesia - autonomic or CNS signs?
  2. Name 4 advanced methods of monitoring the depth of anaesthesia
  3. What does the bispectral index monitor interpret?
  4. What score represents surgically useful anaesthesia?
A
  1. CNS signs
  2. EEG analysis, isolated forearm technique, lower oesophageal contractility, evoked potentials
  3. integrated interpretation of EEG
  4. 45-60
19
Q
  1. What is a seizure?

2. What is epilepsy?

A
  1. abnormal paroxysmal discharge of cerebral neurons, sufficient to cause clinically detectable intermittent disturbance of conscuousness, behaviour, emotion, motor/sensory function
  2. condition in which seizures recur, usually spontaneously
20
Q
  1. Do the majority of patients with epilepsy have focal or generalised seizures?
  2. Where do the majority of focal seizures originate?
A
  1. focal

2. temporal lobe

21
Q
  1. What is a generalised seizure?

2. What is a focal seizure?

A
  1. involves both hemispheres; involves loss of consciousness

2. remains localised to one hemisphere

22
Q
  1. What is status epilepticus?

2. What constitutes status epilepticus? (3)

A
  1. common, life threatening condition characterised by an acute, prolonged epileptic crisis
  2. active part of seizure lasts >5 mins
    a person goes into second seizure without recovering consciousness first
    repeated seizures for >30 mins
23
Q

Name some causes of epilepsy

A
  • genetic conditions
  • hippocampal sclerosis
  • tumours
  • post-traumatic head injury
  • cerebrovascular disease/malformation
24
Q
  1. Describe features of frontal lobe epilepsy
  2. Describe features of parietal lobe epilepsy
  3. Describe features of temporal lobe epilepsy
  4. Describe features of occipital lobe epilepsy
A
  1. eye movements deviating away from focus. Difficulties speaking. Explosive screams. Abnormal Posturing
  2. ALTERED SENSATION
  3. aura, auditory hallucinations. Speech arrest/repetitive vocalisation. Changes in HR
  4. Visual disturbances (tend to be uniformed, circular and multicoloured)
25
Q

How does epilepsy differ from TIA and Migraine, in terms of positive and negative symptoms

A

TIA - negative symptoms only

Migraine - positive and/or negative symptoms; slow onset

Epilepsy - positive symptoms followed by negative symptoms

26
Q

Name 7 red flags for generalised epilepsy

A
  1. early morning myoclonic jerks
  2. absences
  3. auras/dejavu
  4. history of trauma; birth and childhood hx
  5. other medical problems
  6. drugs and alcohol
  7. fam hx
27
Q

Name 6 triggers for epileptic seizures

A
  1. lack of sleep
  2. psychological stress
  3. other medications
  4. metabolic derangements
  5. hormonal changes
  6. alcohol and recreational drugs
28
Q

Name three investigations for epilepsy

A
  1. bloods
  2. EEG (spike and wave)
  3. CT/MRI
29
Q

Name the MOA of the following anti-epileptic medications

  1. ethosuxamide
  2. Benzodiazepines
  3. Phenobarbitol
  4. Carbamezipine
  5. Phenytoin
  6. Valproate
  7. Gabapentin/Pregabalin
  8. Lamotrigine
  9. Levetiracetam
A
  1. inhibits T type calcium channels
  2. GABA receptor agonists
  3. GABA receptor agonists
  4. use dependent inhibition of sodium channels
  5. use dependent inhibition of sodium channels
  6. inhibits GABA transaminase
  7. inhibits NMDA receptors
  8. inhibits glutamate release
  9. inhibits neurotransmitter release
30
Q

Which are the main drugs used to treat:

  1. absence seizures
  2. tonic clonic seizures
  3. acute seizures
  4. Which drug can’t be used to treat absence seizures
A
  1. ethosuxamide
  2. carbamezipine
  3. benzodiazepines
  4. phenytoin

B12 MSK (12 decks)

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