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MRCS A > Neuro - Neurological emergencies > Flashcards

Neuro - Neurological emergencies Flashcards

1
Q

Def status epilepticus

A

Life-threatening neuro condition - 5 or more mins of either continuous seizure activity or seizure activity w/o gaining consciousness

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2
Q

RF status epilepticus (4)

A

Non-adherence to anticonvulsant Dx
Chronic alcoholism
Refractory epilepsy
Toxic/metabolic causes

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3
Q

1st step Mx status epilepticus

A

A-E
High flow O2
BM
Temp
Establish Hx /collateral Hx
IV access

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4
Q

2nd step Mx status epilepticus

A

After 5 mins
Buccal midazolam or IV lorazepam

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5
Q

3rd step Mx status epilepticus

A

After another 10 mins - give 2nd dose of benzos
Make sure anaesthatist has been called

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6
Q

4th step Mx status epilepticus

A

IV phenytoin 18mg/kg
Max = 50mg /min

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7
Q

Acute causes of NM ventilatory compromise

A

GBS
Myasthenic crisis

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8
Q

Chronic causes of NM ventilatory compromise

A

MND
Myotonic dystrophy

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9
Q

Sx NM ventilatory compromise (7)

A

Resp failure
Weak cough
Paradoxical diaphragm movement
Breathless when flat
Use of accessory mm
Incr RR
Can’t clear secretions

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10
Q

Bedside Ix NM ventilatory compromise (2)

A

VITAL CAPACITY!!!
ABG

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11
Q

ABG results acute NM ventilatory compromise

A

pH <7.35
PO2 <8
PCO2 >6
Bicarb = low/norm

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12
Q

ABG results chronic NM ventilatory compromise

A

pH norm
PCO2 >6
Bicarb >26mmol/L

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13
Q

What is a primary traumatic brain injury

A

Immediate result of trauma

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14
Q

What is a secondary traumatic brain injury

A

From complications of the trauma
I.e. hypoxia, ischaemia, haematoma

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15
Q

Def concussion

A

Transient LOC but no persistent neuro signs

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16
Q

Features of concussion

A

Temporary confusion/amnesia

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17
Q

PS diffuse axonal injury

A

Decr [ ]/memory
Personality change

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18
Q

Mx diffuse axonal injury

A

Supportive

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19
Q

2 types of damage in focal brain injury

A

Coup + counter-coup

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20
Q

What is post-concussion syndrome

A

Dizziness
Headache
Decr [ ]/memory

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21
Q

Mx post-concussion syndrome

A

Physio + OT helps

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22
Q

Assessment of someone with suspected head injury

A

C-Spine
A-E
Record GCS
Hx if conscious
Check for signs incr ICP
Imaging - CT/C spineXR

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23
Q

Signs of declining neurological status after head injury (5)

A

Decr in GCS
Pupil changes
Development of focal signs
Change in resp rate
Cushings sign - decr pulse but incr BP

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24
Q

Why does Cushings signs occur?

A

Pressure on medulla oblongata

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25
Q

Bilateral pupil changes after head injury signify

A

Pre-terminal

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26
Q

Who must have a CT head within an hour? (7)

A

If GCS <13 on admission
or <15 at 2hrs
Focal neuro deficit
Incr ICP
Suspected skull #
Post-trauma seizure
Vom >1

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27
Q

Who must have CT head within 8hrs (4)

A

Anti-coag’d
LOC + :
+65 y/o
Dangerous mechanism
Retrograde amnesia >30 mins before injury

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28
Q

Which bone is involved in a posterior fossa fracture?

A

Temporal bone

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29
Q

What is Battle’s sign

A

Bruising over mastoid

30
Q

PS posterior fossa fracture

A

Battles sign
CSF otorrhoea
Bleeding in ear
Conductive deafness
CN palsy 5-7

31
Q

Mx posterior fossa fracture

A

Rx to neurosurgery

32
Q

What bones are involved in an anterior fossa fracture

A

Occipital
Sphenoid
Ethmoid

33
Q

PS anterior fossa fracture

A

Raccoon eyes
CSF rhinorrhoea
Bleeding from nose

34
Q

Mx anterior fossa #

A

Rx to neurosurgery

35
Q

Complications fossa # (3)

A

Intracranial infection
Facial nn palsy
Carotid injury

36
Q

Mx depression skull #

A

Surgical exploration within 12hrs

37
Q

GCS - E4

A

Open eyes spontaneously

38
Q

GCS - E3

A

Open eyes to speech

39
Q

GCS - E2

A

Open eyes to pain

40
Q

GCS - E1

A

No response

41
Q

GCS - V5

A

Oriented to time, person + place

42
Q

GCS - V4

43
Q

GCS - V3

A

Inapprop words

44
Q

GCS V2

A

Incomprehensible sounds

45
Q

GCS V1

A

No response

46
Q

GCS M6

A

Obeys command

47
Q

GCS M5

A

Moves to localised pain

48
Q

GCS M4

A

Flex to withdraw from pain

49
Q

GCS M3

A

Abnormal flexion

50
Q

GCS M2

A

Abnormal extension

51
Q

GCS M1

A

No response

52
Q

DDx - unconscious pt

A

Vascular (stroke,shock,haematoma, SAH)
Infective - sepsis, meningitis, encephalitis, abscess
Trauma
Autoimmune - BS demyelination
Metabolic - gllucose, Ca, Na
Neoplasm

53
Q

What does Cheyne stokes breathing indicated

54
Q

What does Kussmal resp indicate

A

Acidosis
or
Uraemia

55
Q

Cause of extradural haemorrhage

A

Blow to side of head

56
Q

Which artery is classically affected in extradural haemorrhage

57
Q

PS extradural haemorrhage (4)

A

brief LOC
Lucid phase
Progressive hemiparesis + stupor
Coning - dilated pupil

58
Q

If unTx, how can extra-dural haemorrhage progress

A

To hemiplegia + resp arrest

59
Q

Ix findings extradural haemorrhage

A

CT - lemon shape

60
Q

Mx extradural haemorrhage

A

Urgent Rx neurosurgery
Burr hole

61
Q

What is hydrocephalus

A

Excessive CSF within cranium

62
Q

What are the 2 types of hydrocephalus

A

Non-communicating
Communicating

63
Q

What is non-communicating hydrocephalus due to?

A

Blockage of CSF pathway from ventricles to SAS

64
Q

What is communicating hydrocephalus due to?

A

impairment of CSF reabsorption in arachnoid villi
Infection/SAH

65
Q

Who are the 3 pt groups at risk of suffering from hydrocephalus?

A

Congen malformations - stensis aqueduct of sylvius
tumour (post fossa/BS)
Post brain assault (SAH/head injury/meningitis)

66
Q

PS of acute hydrocephalus

A

Headache
Vom
Papilloedema
Ataxia
Bilatereal pyramidal signs

67
Q

Ix acute hydrocephalus

A

CT
MRI if suspect tumour

68
Q

Mx acute hydrocephalus

A

Acetazolamide +/- furosemide
Surgical shunt

69
Q

What are the 2 types of shunts used in hydrocephalus Mx ?

A

Ventriculo-arterial
Ventriculo-peritoneal

70
Q

What is normal pressure hydrocephalus?

A

syndrome of enlarged lat ventricles which usually presents in elderly t

71
Q

What is the clinical triad seen in normal pressure hydrocephalus

A

WACKY, WEEING, WOBBLY
Dementia
Urinary incontinence
Apraxic gait

72
Q

What is an apraxic gait

A

Slow
Broad based
Shuffling

MRCS A (36 decks)

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