Neurological Assessment

Question 1

What are the three section of GCS and how much score does each one have?

Answer 1

Eye Opening - 4
Verbal Response - 5
Motor Response - 6

Question 2

GCS what does each score on the eyes section mean.

Answer 2

4 - unprompted eye opening
3 - “Hello open your eyes”
2 - Trap squeeze ( Pain )
1 - No eye opening

Question 3

GCS what does each score on the verbal section mean?

Answer 3

5 - “what month is is”, “where are you”“name”
4 - Full coherent sentences
3 - Random words out of context
2 - Noise and Sounds
1 - No verbal response

Question 4

GCS what does each score on the motor section mean?

Answer 4

6- “Grip my finger” - Obeys command
5 - Trap squeeze - Localises pain
4 - Flexion/withdrawal from pain
3 - Abnormal flexion to pain
2 - Extension to pain
1 - No response

Question 5

Mild to severe head injury score on GCS

Answer 5

Mild head injury = GCS 13-15
Moderate head injury = GCS 9-12
Severe head injury = GCS 3-8 (suggests coma with need for intubation)

Question 6

What does PEARL stand for in neurological assessment?

Answer 6

Pupils
Equal
And
Reacting to
Light

Question 7

When should we assess pupils?

Answer 7

Head injury
Haemorrhagic stroke
Opioid overdose
Brain stem function

Question 8

What are some signs of a skull fracture

Answer 8

Battle signs (bruising around back of ears)
Racoon eyes (bruising around eyes)

Question 9

What is a Transient Ischemic Attack (TIA)

Answer 9

Temporary disruption in the blood supply to the brain will cause stroke like symptoms.

TIA is a medical emergency, risk of stroke is up to 10% in the week following a TIA.

Question 10

How long does it take a TIA to resolve

Answer 10

Self Resolves within 24 hours

Question 11

What are the two type of stroke and what percentage are they likely to occur

Answer 11

Ischemic = 85%
Haemorrhagic = 15%

Question 12

What increases the risk of strokes in children

Answer 12

Congenital heart disease increases risk by 19x
Thrombolytic stroke risk is 6x higher after a recent illness such as chickenpox.

Question 13

What does FAST stand for

Answer 13

Face
Arms
Speech
Time

Question 14

What is expressive aphasia (neurological assessment)

Answer 14

Unable to produce meaningful words or sentences, although their comprehension remains in tact, their ability to express is not.

Question 15

What is receptive aphasia (neurological assessment) (speech)

Answer 15

unable to produce vast sentences/speech at a normal rate, but there will be no meaning or value to what they are saying.

Question 16

What is anomic aphasia (neurological assessment) (speech)

Answer 16

Word finding difficulties
Eg A watch is a pen

Question 17

What is dysphagia (neurological assessment) (speech)

Answer 17

Difficulty with swallowing

Question 18

What is meningococcal disease

Answer 18

A life threatening infection of the meninges. Its a term to describe to major illnesses - meningitis and septicaemia.

Question 19

What is a petechial meningitis rash

Answer 19

Small, red pin prick rash. Non blanching

Question 20

What is purpuric meningitis rash

Answer 20

0.5 cm point rashes. purple/pink. Non blanching.

Question 21

What are the causes of meningitis

Answer 21

Infection (bacterial, fungal, viral)
Parasite
Inflammatory disease

Question 22

What are the signs and symptoms of meningitis?

Answer 22

Pyrexia
Rapid progression of fever
Irritability
Seizures (5-20%)
Neck Stiffness
Headache
Confusion (50%)
Altered levels of consciousness
Pallor
Photophobia
Floppy baby (Hypotonia)

Question 23

What is hypotonia

Answer 23

Loss of muscle control, goes floppy (floppy baby)

Question 24

Paramedic treatment of meningitis

Answer 24

Think Sepsis
O2 at 15lpm
If suspected septicaemia, put pt on IM/IV ABX - Benzypenicillin

Question 25

What are the four different types of seizure

Answer 25

Generalised
Febrile
Absence
Focal

Question 26

What are generalised seizures

Answer 26

Tonic Clonic - loss of consciousness with stiffness and jerking of limbs

Question 27

What are febrile seizures

Answer 27

3 months to 5 yrs old. Seizure due to high fever.

Question 28

What are absent seizures

Answer 28

End of activity of responsiveness, the pt has ‘turned of’

Question 29

What are focal seizures

Answer 29

One portion of the brain with overactive discharge.
Consciousness its sometimes saved.

Question 30

What are some common causes of seizures

Answer 30

Infection - meningitis
Metabolic derangements (sodium levels)
Drugs (cocaine, amphetamines)
Ethanol withdrawal
Intracranial mass
Head injury

Question 31

Paramedic seizure management

Answer 31

Recovery position
Consider airway adjuncts
Suctioning
02 - High flow
Diazepam - Rectal if no IV access

Question 32

What three key questions should we ask regarding headaches

Answer 32

Is this this the worst headache you’ve had
Is it different from your usual headache
Is this a new headache

Question 33

What are tension headaches

Answer 33

Most common type
Provoked by stress or fatigue
No focal neurology
Generalised or posterior/occiput (back of head)

Question 34

What are cluster headaches

Answer 34

Sharp, unilateral pressure
Headaches are in a cluster, repeat attacks
Rare
Men affected 3x more than woman

Question 35

What are migraines

Answer 35

More common in woman
Recurrent
Typically last 4-72 hours
Unilateral
N&V
Can be severe and dehabilitating

Question 36

What is sinusitis

Answer 36

Caused by inflamed sinuses
Can require Abx (antibiotics) if bacterial
Pain worse if patient leans forward
Chronic sinusitis can require surgery