LOBs

Question 1

what are indications for XRAY after head injury?

Answer 1

• history of significant injury/ impaired consciousness/ continuing manifestations
• signs of a skull fracture
• scalp lacerations
• GCS <15
• penetrating head injury

Question 2

what are indications for CT after head injury?

Answer 2

• signs of fracture + GCS <15
• GCS <12
• neuro signs
• continuing or new symptoms

Question 3

what is the ICD10 criteria for alcohol dependence?

Answer 3

1. cravings
2. difficulties in controlling substance use
3. physiological withdrawal state
4. physiological tolerance
5. increased salience
6. persistant use despite knowledge of consequences

Question 4

in what time period does DT occurs?

Answer 4

72-96 hours after stopping alcohol

Question 5

what does ‘CAGE’ ask about?

Answer 5

1. concern
2. Annoyed
3. Guilt
4. eye opener (morning drinking)

Question 6

what are adverse consequences of chronic alcohol?

Answer 6

wernickes encephalopathy
dementia
epileptic tits
peripheral neuropathy
cerebellum degeneration

Question 7

what is delirum tremens?

Answer 7

serious withdrawal condition

• clouding of consciousness
• agitation
• tremors
• fits
• visual hallucinations
• delusions
• coma

Question 8

what can be given as an antidote for benzo OD?

Answer 8

flumazenil

Question 9

how do benzodiazepines work?

Answer 9

act at the GABA receptor and change the structure –> GABA can attach more effectively –> encouragement of chloride into the cell –> hyperpolarisation

Question 10

when should you give a benzo for seizures?

Answer 10

if it’s lasted longer than 5 minutes

Question 11

what is a good benzo for seizures?

Answer 11

lorazepam

Question 12

how does alcohol change the CNS?

Answer 12

acute use: GABA agonist, NMDA antagonist causes more GABA and less glutamate

Chronic: decrease GABA and increased NMDA as the CNS tries fighting the acute effects

withdrawal: due to the increased NMDA and decreased GABA there is hyperexcitability

Question 13

what is the treatment for alcohol withdrawal?

Answer 13

1. pabrinex MUST BE GIVEN BEFORE GLUCOSE
2. glucose if needed
3. chlordizaepine

Question 14

what is the wernickes triad?

Answer 14

Ataxia
Nystagmus
opthalmoplegia

Question 15

what levels have changed in wernickes?

Answer 15

decreased thiamine

increased glutamate

Question 16

why is there decreased thiamine due to alcohol?

Answer 16

• decreased nutritional intake
• decreased absorption and utilisation
• decreased liver storage
• decreased phosphorylation to thiamine pyrophosphate

Question 17

why can brain injury occur due to thiamine deficiency?

Answer 17

1. transkeletase in the pentose phosphate pathway uses thiamine meaning less myelin sheath
2. pyruvate dehydrogenase is thiamine dependant so lactate will build up
3. alpha ketogluterate is dependant meaning increased glutamate and free radicals

Question 18

what is pallega?

Answer 18

vitamin B3 deficiency

Question 19

what are signs of vitamin b3 deficiency?

Answer 19

redness and swelling of the mouth and tongue
diarrhoea
skin rash
abdo pain

Question 20

what is the course of dementia vs delirium?

Answer 20

delirium: fluctuating
dementia: progressive

Question 21

what cognitive defects are seen in delirium vs dementia?

Answer 21

dementia: poor STM and attention
delirium: same

Question 22

what is the behaviour of hallucinations/ dellusions in dementia/ delirium?

Answer 22

dementia: no hallucinations and often no delusions but if present often paranoid and fixed
delirium: common visual hallucinations and fleeting delusions

Question 23

what neurotransmitters are involved in delirium?

Answer 23

increased dopamine leading to less ACh release
decreased GABA
increased serotonin
increased cortisol
decreased ach

Question 24

what are the most common causes of delirium?

Answer 24

Hypoxia
Infection- uti, pneumonia, sepsis
D- drugs; benzos, analgesics, anticholinergics
E; endocrine; diabetes and cushings
M; metabolic; hyper/hypocalcemia, hyponatraemia
A alcohol
P psychosis

Question 25

what is the diagnosis criteria for epilepsy?

Answer 25

• at least two unprovoked seizures occurring more than 24 hours apart
• once provoked seizure and a probability of a further seizure
• diagnosis of an epilepsy syndrome

Question 26

what electrical activity in the brain causes a seizure?

Answer 26

sustained post synaptic depolarisation can be due to decreased GABA, inhibition of cortical excitability or increased glutamate

Question 27

what does the middle cerebral artery supply?

Answer 27

Lateral surface of the hemispheres