Glasgow Coma Scale

Question 1

Scores for eye opening response

Answer 1

4 - Spontaneously
3 - to speech
2 - to pain
1 - no response

Question 2

Scores for best verbal response

Answer 2

5 - oriented to time, place and person 
4 - confused 
3 - inappropriate words
2 - incomprehensible sounds 
1 - no response

Question 3

Scores for best motor response

Answer 3

6 - obeys commands 
5 - moves to localised pain 
4 - flexion withdrawal from pain 
3 - abnormal flexion 
2 - abnormal extension 
1 - no response

Question 4

Abnormal flexion decorticate/decerebrate?

Answer 4

Decorticate

Question 5

Abnormal extension decorticate/decerebrate?

Answer 5

Decerebrate

Question 6

Comatose client score

Answer 6

8 or less

Question 7

Totally unresponsive score

Answer 7

3

Question 8

2 options for pain application in cranial nerve regions

Answer 8

Trapezius squeeze or supraorbital ridge

Question 9

How is ICH diagnosed?

Answer 9

Non-contrast CT scan

Question 10

Where is it normal to see calcifications in CT scan of adult brain? (2)

Answer 10

Pineal gland (midline) and bilaterally in lateral ventricles

Question 11

Bilateral symmetrical hyperdensities of basal ganglia and thalamus on CT scan indicates what?

Answer 11

Basal ganglia calcification which indicates rare severe Fahr’s disease

Question 12

What are units called for measuring densities on CT scans? What is pure water? Which is + and - of air/fat (black) and blood/bone/calcifcation (white)

Answer 12

Hounsfield units
Pure water is 0,
Black -
White +

Question 13

Tumour will show up as what in IV contrast CT and why?

Answer 13

White because tumour broken blood-brain barrier broken down

Question 14

CT angiography good for diagnosing what cause of ICH?

Answer 14

AVM

Question 15

CTA is better for what then CT with contrast?

Answer 15

Characterising blood vessels

Question 16

If concerned about cerebral artery aneurysm causing ICH what is gold standard investigation?

Answer 16

DSA - digital subtraction angiography

Question 17

Pathology of hypertension causing ICH?

Answer 17

Hypertension causes microaneurysms to form in parenchymal brain arteries

Question 18

Microaneurysms due to hypertension most commonly form in which arteries?

Answer 18

Lenticulostriate vessels to basal ganglia

Question 19

Linear fracture of occiptal bone commonly causes what?

Answer 19

Opposite side brain contusion e.g. if right occipital injury, contusion will be in front left brain

Question 20

MRIs are specifically good for parenchymal lesions as opposed to vascular abnormalities. However they are specifically good for delineating what kind of lesion that relates to vascular?

Answer 20

Cavernoma - popcorn lesion

Question 21

Medical management of ICH? (3)

Answer 21

Reduce ICP,
Correct clotting,
Control BP

Question 22

What cause of ICH typically presents with ICH?

Answer 22

Cavernoma

Question 23

Surgery indicated for what 2 causes of ICH to prevent re-bleed?

Answer 23

Aneurysm or AVM

Question 24

Treatment of ICH is variable and individual to patient. Surgery probably most beneficial to the well who have significant risk of deterioration with lobar/cerebellar haemorrhages. True/false?

Answer 24

True