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Year 2 - Control > Control - Clinical > Flashcards

Control - Clinical Flashcards

1
Q

what is consciousness vs wakefulness

A

c - awareness, alertness, appropriate responses (thinking feeling etc)

w - activity of reticular activating substance from the brainstem associated with connections between cells and areas of the cerebral cortex

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2
Q

what is coma and how it is measured

A

eyes not open, no command response, no voluntary movement
not secondary use to paralytic agents

measured using Glasgow coma scale (GCS) - come = lower than 8

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3
Q

what is locked in syndrome

A

aware awake and breathe
cannot move or speak
damage to ventral pons
can blink, feel pain, autonomic system still works

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4
Q

what is vegetative state vs persistent VS

A

no evidence of awareness of self or environment
no language
no voluntary moves or expression

PVS - after 30 days not response
50% chance improve
reflex autonomic and sponanteous behaviours yes but not awareness of self or environment

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5
Q

what causes a vegetative state

A

destruction of cortex and hemispheres but intact ascending reticular activating substance

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6
Q

what is minimal conscious state

A

severely altered consciousness

reproducible but inconsistent

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7
Q

how do you measure level of disorders of consciousness

A

SMART - sensory modality assessment and rehabilitation technique

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8
Q

what is brain stem death and how do you test for it

A

no breathe or conscious, destroy brainstem, no electrical activity

absent brain stem reflexes - persistent apnoea - requires 2 assessments on two occasions

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9
Q

what are the three types of anaesthesia

A

general - total loss
regional - region or part of body
local - topical, infiltration

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10
Q

what are the three A’s of anaesthesia

A

amnesia - unconsciousness
analgesia - pain relief
akinesia - paralysis

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11
Q

what is balanced anaesthesia and what is the triad of balanced anaethsisa

A

smaller doses of a combination of drugs - max benefit and final toxic

unconsciousness , analgesia, muscle relaxation

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12
Q

what does the process of anaesthesia involve

A

induction, maintenance and reversal of process

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13
Q

describe how you would induce loss of consciousness

and common agents

A

IV - modulate transmitters gated ion channels acting on PNS/cerebral cortex/ RAS, basal ganglia, cerebellum, motor pathways

thiopentone, ketamine, etomiidate, propofol

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14
Q

how do we maintain loss of consciousness in aneasthtsia

A

vapour - NO, soflurane, desflurane
uses minimum alveolar consciousness - minimum amount of vapour to prevent reaction to standard surgical stimuli in 50% subjects

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15
Q

what are the problems with being under general anaesthesia for too long

A

hangover effects, stored in fat cells and releases slowly

amnesia, hypnosis, vasodilation, organ perfusion and hepatotoxicity

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16
Q

what type of agents are used for analgesia in anaesthetic

A

opioids - short or long acting

fentanyl, morphine, paracetamol

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17
Q

how do you reverse muscle relaxation in anaesthesia

A

reversal with neostigmine and glycopyrrolate

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18
Q

what is the clinical diagnosis of stroke

A

sudden onset
focal neurological deficit
of presumed vascular origin
symps last more than 24 hours or leading to death
if symps last less than 24 hours classed as TIA

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19
Q

what are the two types of strokes and how common are they

A

ischemic (85%) and haemorrhage (15%)

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20
Q

what are the causes and risks of ischamic stroke

A

thrombosis of large extra cranial arteries
small arteries intracranially
embolism (in the heart or vital arteries)
(most common is large vessel atherosclerosis)

risks - hypertension, obesity, diet, cardiac, diabetes

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21
Q

what are the best treatments for secondary stroke prevention

A

aspirin, warfarin - anticoagulants and decrease risk of clotting
carotid endarterectomy
drugs to lower BP such as aspirin and clopidogrel

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22
Q

what does FAST mean in stroke

A

face
arms
speech
time

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23
Q

what is the pathophysiology of stroke

A

initial reduction in cerebral blood flow - alteration sin cellar chemistry caused by ischemia and cellular necrosis

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24
Q

what are the thresholds of cerebral ischamia

A

normal is 50 ml/100g/min which can be above 20 ml

10-20 is electrical malfunctions

7.5-10 - release K and water out intracellularly

0-7.5 - cell death

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25
describe the ischeamic penumbra
zone of reversible ischaemia around core or irreversible infarction overtime from 1 to 30 min the ischamia increase in the penumbra after a couple jours the ischamia reaches the oligemia where blood flow is reduced but no damage
26
what is sentrievers used for
halt stroke in time | stent across occlusion to reperfuse the brain
27
what is the definition of TIA
neurological defect lasting less than 24 ours attributable to cerebral or retinal ischamiea - may or may not have brain damage
28
what are the causes of TIA
vascular risk factors - arterial disease - cardiac embolism
29
what types of diseases does TIA mimic
``` siezures syncope hypoglycaemia migraine acute confusion states ```
30
what are the signs of TIA
dysphasia transit blindness in one eye ataxia, diplopia, vertigo
31
what is the scoring system for TIA
ABCD2 age blood pressure clinical features duration of symptoms diabetes
32
what is the treatment of TIA
polypill - statin, aspirin, folic acid carotid endarectomy targeting unstable plaque occluded carotid artery
33
what are the three layers of the skin
epidermis (top) - stratified squamous, produces keratin - no blood vessels dermis - fibrous and adipose - blood vessels nerve supply and sensory receptors subcutis - boots - large blood vessels and supporting fat
34
ho would you describe the epithelium of the epidermis
keratinised stratified squamous epithelium
35
what are the 5 layers of thick skin
``` basal layer - stratum basale prickle cell layer - stratum spinosum granular layer - stratum granulosum stratum lucidum (only in skin of sole) keratin layer (stratum corneum) ```
36
what is the stratum lucidum
several layers of flattened dead cells
37
how do keratinocytes change as they move to the top of the skin
get more mature as they move up and lose nucleus and become flatter
38
what are three types of cells found in the epidermis
keratinocytes melanocytes langerhans cells
39
what is the function of langerhans cell is n the epidermis
APC's of the skin migrate to dermis then lymphatics irregularly lobulated nuclei
40
what are the "extras" of the skin and what is their role
sebaceous gland - secrete sebum into hair follicle and surface of skin hair follicle eccrine glands - thermoregulation - sweat production apocrine glands erector pilli muscle - smooth muscle - contract when cold for thermoregulation
41
what are the skin differences between the scalp and the foot
foot = no hair, glabourous, dermis thicker, epidermis thicker, scalp - lots of hair, thin epidermis, no basket weaved keratin
42
what are the 4 skin receptors
meissners corpuscles - fast adapting discriminatory touch and vibration merkel - slow adapting discrimantory touch and pressure pacinian - encapsulated boddie sin deep skin - fast adapting rapid vibration (deepest) ruffini ending
43
which layers of skin do you find the sensory receptors merkel cells and meissners corpuscle
merkel cells - intra epidermal receptors of the basal layer meissners corpuscle - superficial dermis
44
what are the three degrees of burn
1st - no damage to dermis, superficial burn affecting epidermis no sensory receptors in epidermis so feel pain 2nd - damage to dermis and epidermis - pain 3rd - full thickness burn - damage to epidermis dermis and subcutaneous tissue - does not hurt as all receptors burnt away
45
what are the kinds of sensations we feel from the outside vs internal
outside - touch inside - temperature and pain
46
what are the 4 main classes of somatosensory receptors
tactile (innocuous) sensations - low threshold mechanoreceptors - merkel, ruffini, meissner, pacinian proprioception - muscle spindle and joint golgi tendon thermal sensations - thermorecerptors localised to decree zones nociceptive - mechanical, thermal and polymodal nociceptors
47
what are the specific locations of the sensory receptors of the skin
meissners and merkel beneath dermis Meissners between dermal papillae merkel aligned with pupillage pacinian located in subcutaneous tissue ruffians located deep in there dermis
48
what is the morphology of the 4 skin receptors
meissners - looping axonal terminals that intertwine supporting cells merkels - dome structure atop axon terminals pacinain corpuscle - sensory axon surrounded ny fluid (onion) ruffini - nerve terminals intertwined with collagen fibrils noicceptors - free nerve endings penetrate epithelial cells
49
what is the adaption vs receptive field size of the 4 skins receptors
fast adapting - mesissners and pacinian slow adapting - ruffini / merkels small receptive field - messiness and merkels large receptive field ruffians and pacianin
50
which sensory receptors are used in braille
merkel afferents
51
describe the 2 point discrimination in different areas of sensitivity
sensitivity is correlated with density of the sensory innervation areas of high sensitivity - fingertips and face can distinguish between two points very small apart areas of low - toros and limbs - can't discriminate two stimuli close
52
which family of receptors are responsible for thermal
TRP family
53
what is capsaicin and what receptors does it affect
chemical in the vanilloids cause burning sensation in mouth | act on thermal VR1 receptors also activated by heat
54
what are the two receptors involved in proprioception
the scull spindle - sensory feedback from muscle fibres on body poison and movement golgi tendon - regulate muscle tension or force of contraction and prevent muscle eoverlaod
55
describe the 4 groups of sensory axons from the skin
Aa - largest diameter - proprioceptors of the skin - low threshold mechanoreceptors - rapid conducting Ab - mechanoreceptors Ad - pain / temperature - slow conducting C - temperature, pain, itch
56
what is the relationship between axon diameter and speed of conduction
larger the diameter than quicker the conduction
57
which virus affects dermatomes
herpes zoster - chicken pox - primary sensory neurons - inflammation and blistering of skin of affected dorsal root
58
what is the main role of the two ascending spinal pathways
dorsal column - innocuous sensitivity (not harmful) spinothalamaic - noxious and thermal sensitivity
59
where is crossing of the ascending spinal tracts
doral column crosses midline in medulla spinothalamic crosses midline in the spinal cord
60
what is the difference in axon fibres in the ascending pathways
dorsal column = Aa/b/d spinothalamic = Ad/c
61
what is agnosia
inability to recognise objects despite normal sensory functioning
62
where is the sensory integration area
posterior parietal cortex
63
what is astereoagnosia
inability to identify objects on basis of touch alone | damage to posterior parietal cortex
64
what is neglect syndrome
parietal cortical lesion - part of visual world in ignored | most common to the right hemisphere
65
describe the schematic representation of somatosensory processing
mechanorerptors - spinal cord - dorsal column in medulla - ventrobasal complex in thalamus - posterior parietal and post central gyrus - limbic system/motor system/ association pathways
66
what is brown sequared syndrome
hemicord lesion - inflammation of the spinal cord = myelitis
67
what is wallenburgs syndrome
stroke by occlusion of posterior inferior cerebellar artery
68
what are the red flags of a headache
cognitive effects, seizes, fever, visual disturbance, vomiting and weight loss
69
what is raised intracranial pressure due to
``` mass effect brain swelling increased venous pressure hydrocephalus increased CSF ```
70
what are the symptoms of raised intracranial pressure
headache - worse when lying, vomiting, seizures, papilloedema
71
what is the acute treatment for increased intracranial pressure
broad spectrum IV antibiotics such as cefotaxmie | steroids (dexamethasone)
72
what is temporal arteritis and treatment
inflammation of temporal arteries transient loss of vision and tenet temporal artery high dose steroids - prednisolone
73
how does a migraine occur
unilateral headache cortical spreading depression caused by sleeping deprivation, hunger stress and oestrogen - releases chemically active irritants
74
what medications are used for migraine
naproxen triptans paracetamol
75
what are trigeminal autonomic cephalgia
activation of trigeminal - parasympathetic systems | causes short lasting headaches with unilateral pain
76
what are the types of headaches associated with trigeminal autonomic cephalgia
cluster headache paroxysmal hemicranial SUNCT
77
what is the management of trigeminal autonomic cephalgia
pain relief - sumatriptan and high flow oxygen prevention - prednisolone, verapamil
78
what is a tension headache and its management
constricting high band relaxation and massage acupunture
79
what arse the causes of new daily persistent headache
raised ICP Low ICP chronic meningitic post head injury
80
what is the definition of chronic daily headache and the causes
headache lasting more than 4 hours more than 15 days a most de novo via new daily persistent headache previous episodic headache
81
what are the categories of epilepsy
generalised or focal
82
what is the difference between generalised or focal epilepsy
g - whole brain affected with tonic clonic seizure f - begin in certain part of the brain
83
what are some causes of symptomatic epilepsy
birth injury, infection, trauma, cavernoma
84
what disease shows grey matter around the ventricles and is a congenital malformation
perivenricualr nodular dysplasia
85
what is a cavernoma
blood vessel abnormality - raspberry look, risk of bleeding and seizure
86
what are the differential diagnosis of seizure
syncope psychiatric illness hypoglycaemia cataplexy or sudden raised ICP
87
when taking history of epilepsy who do you need to question
witness of the event mainly
88
what is the difference between vasovagal and cardiac syncope
v - cause = illness or injury, rapid recovery prodrome of warmth light headedness and visual impairment - treat by recognise prodrome and lie down or raise legs c - older people, vascular risk factors - pacemaker treatment
89
what is the cause of dissociative seizures
psychiatric cause - brain reacts by shutting down
90
who is affected most by dissociative seizures and what is the treatment
young females | psychological support
91
what is used to treat patient after first generalised tonic-clonic convulsion
anti-epileptic drugs (AED)
92
what is the treatment after first seizure
none
93
what are some counselling topics when you have epilepsy
``` management prevention occupational issues bathing driving leisure ```
94
what is the most common generalised type of epilepsy and what is it caused by
juvenile myoclonic epilepsy caused by sleep deprivation and stress
95
give an example of effective AED's in juvenile myoclonic epilepsy
levetiracetam
96
what are the difference in side effects of lamotrigine vs topiramate/zonisamide
l - mood stabiliser | T/Z - makes moods worse
97
15 year old boy has vacant attacks over 3 months with memory loss and auditory hauulicinations - what is the likely cause
medial temporal lobe epilepsy
98
what is the most common focal epilepsy
medial temporal lobe epilepsy
99
which AED;s are used for medial temporal lobe epilepsy
lamotrigine and carbamazepine
100
what is the MRI difference in medial temporal lobe epilepsy vs frontal lobe epilepsy
temporal - high signal and atrophy in left hippocampus frontal - small area high signal in frontal lobe
101
what symptoms are frontal lobe epilepsy associated with
tonic-clonic movements and psychiatric presentation
102
what is lennox gas taut syndrome and its treatment
1-7 y/o nocturnal, atonic, myoclonic slow wave ecg t - sodium valproate, ketogenic diet (hunger = seizure control), vagus nerve stimulator
103
what are the top 3 neurological conditions
headache stroke epilepsy
104
what is the definition of epilepsy
abnormally excessive and hypersynchronous activity of neurones located predominantly in the cerebral cortex
105
what is secondary generalised seizures
partial seizure that later spreads to involve majority of 2 cerebral cortexes
106
what is status epilepticus
brain is in constant state of seizure - long lasting seizures
107
what are the two types of partial seizure
simple - when consciousness not impaired complex - impairment of awareness and responsiveness
108
describe the montreal procedure
local anaesthetic during surgery - removal brain tissue after cortical stimulation
109
what is the neuronal mechanism of generalised seizures
thalamocortical circuitry attack and synchronised firing of neurones brain wide - bilateral symmetry
110
what is the main diagnostic tool in epilepsy
EEG | electroencephalogram
111
what are causes of seizures
hypoxia, infection, trauma, tumour, congenital abnormalities
112
what is the type of inheritance pattern of epilepsy
polygenic (not mendelian inheritance)
113
what are the usual tumours of the CNS in males vs females
male s- glioma | f - meningioma
114
what is the histological criteria for malignancy in brain tumours
mitotic activity necrosis - secrete TNF to kill cells vascular proliferation
115
what are microscopical features of astrocytic tumours
fine fibrillary and microcystic background inc cellular density pleomorphism
116
what is the difference between diffuse astrocytoma 2 and anapaestic astrocytoma 3
2 - fibrillary, low cellular density, mild atypia, no mitotic activity 3 - mitosis, moderate cellular density + pleomorphism
117
what are the 3 features of glioblastoma 4
high cellular density and mots is | necrosis and vascular proliferation
118
what are the features of pilocytic astrocytoma 1
children in cerebellum pliocyetes rosenthal fibres
119
what disease would you see round uniform nucelar cytoplasm and fried egg apparence with calcification of astrocytes
oligodendroglioma
120
what are three types of glioma
astrocytoma oligodendroglioma ependyoma
121
what are the features of ependyoma
well define tumour of ventricles | pseudo-rosettes
122
what would be present in a meningioma and who is affected more
women | whorls and psammoma bodies
123
what is PNET 4 (medulloblastoma) and who does it affect
children - high cellular density | rosette formation
124
what are three types of nerve sheath tumours
spindle cell tumour shwannoma 1 neurofibroma 1
125
what are the presentation, signs and symptoms of intracranial tumours
raised ICP epilepsy headaches (morning) blurred vision
126
give three examples of intracranial tumour markers
aFP, Bhcg, PSA
127
what are some investigations into intracranial tumours
fMRI MRS cerebral angiography
128
what are 4 surgical options for intracrhail tumours
stereotactic neuro-navigation endoscopic free hand
129
which CNS tumour is the hardest to treat
high grade glioma - glioblastoma
130
which hemisphere is most dominant in language
left hemisphere
131
where would the lesion likely be in someone who is withdrawn, apethtic and bad tempered vs numbness down one side of body
frontal lobe - personality changes parietal - sensory loss, dyspraxia

Year 2 - Control (16 decks)

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