Neurological

Question 1

What is the dura mater?

Answer 1

The tough outer membrane. It lies next to the skull, although the arteries that supply it lie between it and the skull

Question 2

What is the arachnoid mater?

Answer 2

The second layer of the meninges. Has spider like projections which project into the sub arachnoid space, where there is also CSF and the arteries suppling the brain

Question 3

What are the meninges?

Answer 3

The three membranes surrounding the brain.
Dura mater
Arachnoid matar
Pia Matar

Question 4

What is the GCS eye score?

Answer 4

4 eye opening spontaneously
3 eye opening to voice
2 eye opening to pain
1 no eye opening

Question 5

What is the verbal GCS score?

Answer 5

5-Orientated
4-mildly confused
3-very confused
2-moans and groans
1-no verbal response

Question 6

What’s the motor GCS score?

Answer 6

6-obeys commands
5-localises pain
4-withdraws from pain
3-flexion
2-extension
1-none

Question 7

What is a simple partial seizure?

Answer 7

Involves only one region of the brain
Patient remains conscious
May experience strange sensations
May experience involuntary movement such as jar eking of a single limb

Question 8

What is a complex partial seizure?

Answer 8

Involves only one region of the brain
Patient remains conscious but acts spaced out and may not responded to commands
Patient may manifest unusual repetitive behaviours such as picking their clothes or wandering in circles

Question 9

What is an absence seizure?

Answer 9

Most common in children
Brief blank stare often mistaken for daydreaming/poor attention
Lasts only a few seconds. It can occur as many as 200times a day

Question 10

What is a generalised seizure?

Answer 10

Patient may experience an aura-essentially a partial seizure which spreads to the entire brain
Patient becomes unconscious, may moan or cry
Initially body is rigid
Muscle jerks, frothing at mouth, shallow/absent Respirations, possible bladder/bowel control
Usually lasts 2-3min then normal resps resume level of consciousness gradually normalises

Question 11

What are common anticonvulsants used in NZ?

Answer 11

Tegretol
Dilantin
Epilim
Rivet rail

Question 12

How do we manage simple partial seizures?

Answer 12

No management needed

Question 13

How do we manage complex partial seizures.

Answer 13

Guide them away from danger, do not attempt to restrain. Reassure and reorientate when they have recovered.

Question 14

How do we manage absence seizures?

Answer 14

Reassure and reorientate

Question 15

How do ewe manage generalised seizures?

Answer 15

Ensure will not hurt themselves by moving objects etc.
Place soft object under their head
Administer oxygen
Clear airway of secretions and consider placing an opa
Left lateral position when seizure has stopped

Question 16

What is status epilepticus?

Answer 16

If a tonic clonic seizure continues for more than 5 minutes, if they do not regain consciousness between seizures.
Serious risk of hypoxia.
Requires ICP back up

Question 17

What are some acute causes of tonic clonic seizures?

Answer 17

Fever
Infections such as meningitis
Hypoxia
Head injury
Hypoglycaemia
Alcohol withdrawal
Heat exhaustion
Drug poisoning
Stroke
Hypertension

Question 18

What is hemiplegia?

Answer 18

Paralysis of the muscles of the face, arms and legs on one side of the body

Question 19

What is the difference between a TIA and a stroke?

Answer 19

Stroke lasts longer an 24 hours

Question 20

What vessels supply blood to the brain?

Answer 20

Carotids
Vertebral arteries - these branch from arteries supplying the arm. They pass through the cervical spine and unite at the top of the spinal cord to form the basilar artery.

Question 21

What is the circle of Willis?

Answer 21

At the base of the skull all the arteries supplying the brain form a network called the circle of Willis.

Question 22

What is an ischaemic stroke?

Answer 22

An obstructive stroke

Question 23

What is an intracerebral haemorrhage?

Answer 23

A haemorrhage into the brain substance

Question 24

What is a subarachnoid stroke?

Answer 24

A haemorrhage into the subarachnoid space around the brain

Question 25

What are the common clinical features of stroke?

Answer 25

Paralysis or weakness in the face, arms legs on one side of the body
Loss if sensation on one side of the body
Language disruption
Visual problems
Nausea and vomiting
Seizures
Dizziness
Altered level of consciousness
Headache

Question 26

What are the clinical features of a subarachnoid stroke?

Answer 26

Severe headache
Photophobia
Nausea
Vomiting
Altered LOC 
Collapse
They typically deteriorate very rapidly

Question 27

What are alpha 1 adrenergic receptors involved in?

Answer 27

Constriction of peripheral blood vessels
Constriction of arterioles
Pupil dilation
Decreased motility and tone of GI tract
Retention of urinary (through urinary bladder sphincter)

Question 28

What are the actions of alpha 2 adrenergic receptors?.

Answer 28

Contraction of smooth muscles
Aggregation of platelets
Noradrenaline uptake in the synaptic cleft (negative feedback)

Question 29

What are the actions of beta 1 adrenergic receptors?

Answer 29

Increased cardiac output
Increased heart rate
Increased contractility
Increased conductivity

Question 30

What are the actions of beta 2 adrenergic receptors?

Answer 30

Relaxation of bronchiole smooth muscle
Uterus relaxation
Glycogen breakdown in the liver
Stabilisation of mast cells

Question 31

What are the actions of beta 3 adrenergic receptors?

Answer 31

Enhancement of the breakdown of lipids in fatty tissue

Stabilisation of mast cells