Nervous System

Question 1

What is the somatic nervous system responsible for controlling in the body?

Answer 1

Voluntary movement

Question 2

What is the autonomic nervous system responsible for controlling in the body?

Answer 2

Involuntary processes and organ function

Question 3

Which cranial nerve innervates the diaphragm?

Answer 3

The phrenic nerve

Question 4

Which cranial nerve is implicated during the type of syncope brought on when someone’s trying too hard to get a poop out?

Answer 4

The vagus nerve (vasovagal syncope)

Question 5

Which acronym can be used to describe reasons for altered LOC?

Answer 5

AEIOUTRIPS
A: Acidosis, Abuse of Substances, Arrhythmias
E: Environmental, Epilepsy, Encephalopathy, Electrolytes, Endocrine
I: Infection
O: Overdose
U: Underdose, Uremia
T: Trauma, Tumour
R: Respiratory (not always part of this list)
I: Insulin
P: Poisoning, Psychogenic
S: Shock, Stroke, Seizure, Syncopy

Question 6

What are the 5 phases of a grand mal (tonic-clonic) seizure?

Answer 6

1. Aura
2. Tonic
3. Hypertonic
4. Clonic
5. Postictal

Question 7

What is a petit mal (absence) seizure? Describe.

Answer 7

A brief loss of consciousness without any associated motor activity. Usually lasts less than 15 seconds.

Question 8

What do afferent neurons do?

Answer 8

They are sensory neurons which carry information from the PNS to the CNS.

Question 9

What do efferent neurons do?

Answer 9

They are motor neurons which carry impulses from the CNS to the effector organs.

Question 10

What do interneurons do?

Answer 10

They are association neurons which exist in the CNS and link the afferent and efferent neurons.

Question 11

What is a grand mal (tonic-clonic) seizure? Describe.

Answer 11

A stereotypical seizure which is characterized by 5 phases. Involves loss of consciousness, muscle rigidity, convulsions, and a confused post-seizure period.

Question 12

What is a simple focal seizure? Describe.

Answer 12

Characterized by clonic activity to a specific body area. Usually resulting from overstimulation/damage to a particular part of the brain.

Question 13

What is a complex focal seizure? Describe.

Answer 13

Like a simple focal seizure in that activity is limited to one part of the body/brain. Additionally, can present with ALOC, memory loss, changes in behaviour, or repetitive behaviour.

Question 14

What is a pseudoseizure? Describe.

Answer 14

A condition which mimics a true seizure but usually originates from a psychological disorder. Does not have a postictal phase and can sometimes be deliberately interrupted.

Question 15

You are called to a patient who has been experiencing a seizure. At what point might you consider them to be in status epilepticus rather than a normal seizure?

Answer 15

If their seizure lasts more than 5 minutes or if they do not return to consciousness between 2 or more generalized seizures. (request ACP!)

Question 16

If a patient is experiencing status epilepticus, why is it important to call ACPs without delay?

Answer 16

They can give benzodiazepines to treat this condition. This may be the only effective pre-hospital treatment available to us.

Question 17

What patient population is most at risk for a febrile seizure? What causes these?

Answer 17

Usually seen in children between 6 months and 3 years old (can occur up to 6 years though). Brought on by a sudden spike in core temp >40C.

Question 18

Give at least 3 examples of mechanisms which could cause syncopy.

Answer 18

Any of:
- Vasovagal reaction
- Torsades de pointes
- Transient asystole
- Ventricular tachycardia
- Bradycardia (any type)
- Cardiomyopathy
- Drugs or medications
- Dehydration
- Hypoglycemia
- Pulmonary embolism
+ Many more (even idiopathic)

Question 19

What is nystagmus? (kind of a tough one, sorry)

Answer 19

A rhythmic up and down, side to side, or circular motion of the eyes occurring with syncopy.

Question 20

What is delirium? What usually causes this? (note: “Delirium” and “Excited Delirium” present differently and have different pathologies).

Answer 20

Delirium presents as abrupt disorientation and may be accompanied by hallucinations. It is mostly brought on by severe illness causing brain dysfunction.

Question 21

What differentiates delirium and dementia? How can we figure out which one a patient is experiencing? (note: “Delirium” and “Excited Delirium” present differently and have different pathologies).

Answer 21

Delirium is a new-onset condition while dementia is usually a progressive and chronic illness that this patient has been experiencing for some time. A good history from a witness is the best way to differentiate in the pre-hospital setting.

Question 22

True or False: Alzheimer’s Disease and Dementia are synonymous terms and can be used interchangeably.

Answer 22

False. Alzheimer’s Disease is a TYPE of Dementia (general term for cognitive decline) caused by neurodegeneration. Other causes of dementia exist.

Question 23

What is Bell’s Palsy? What other neurological condition can it sometimes be mistaken for?

Answer 23

Bell’s Palsy is an inflammation of the 7th cranial nerve. It causes facial muscle paralysis and can present with the same one-sided drooping facial expression that can be seen during a stroke.

Question 24

What acronym is used to identify whether someone is having a stroke? What acronym is used to assess stroke severity?

Answer 24

FAST (Face, Arms, Speech, Time) and VAN (Vision, Aphasia, Neglect)

Question 25

A patient is presenting with left-sided weakness that started about 3 hours ago. They have no other injuries but their heart rate seems elevated. What life-threatening condition might they be experiencing?

Answer 25

Even though they don’t have any facial droop or speech abnormalities, they could still be experiencing a stroke. The increased HR could be compensatory for the blockage in their brain.

Question 26

A patient called 9-1-1 due to a “sudden awful headache” and when you arrive they have vomited and are seizing. What condition are they likely experiencing?

Answer 26

A hemorrhagic stroke can present this way. Rapid transport is imperative.

Question 27

Describe the symptoms which characterize Cushing’s reflex. What causes this?

Answer 27

Hypertension, Bradycardia, and diminished respiratory effort. Caused by increased ICP.