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4th Yr - CMS 1 > Neurology 1 > Flashcards

Neurology 1 Flashcards

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Introductory Sommelier Exam (CMS) flashcards
1
Q

what is a seizure ?

A

caused by a synchronous neuronal activity in the brain - all the neurones firing synchronously at the same time

*normally neurones in ur brain are firing asynchronously

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2
Q

what does the type of seizure depend on?

A

location of the brain

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3
Q

which part of the brain is linked to high cognitive function?

A

frontal lobe

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4
Q

which part of brain is linked to motor and sensory control?

A

back of the brain

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5
Q

which part of the brain is linked to auditory processing

A

lateral part of brain

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6
Q

what are brokers and venicas responsible for?

A

producing and understanding speech

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7
Q

which part of the brain is responsible for the vision

A

occipital lobe at back of brain

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8
Q

what are seizures divided into?

A

focal (part) or generalised (all over)

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9
Q

what happens during a focal seizure ?

A

pt maybe aware of what’s happening or might not be aware depending on which part of brain is affected

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10
Q

what happened during generalised seizure ?

A

lose awareness of what’s going on

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11
Q

what re the symptoms of focal seizures ?

A

depends on the part of brain affected for eg. visual changes, shaking in one part of body, deja vu or sensing an odd smell

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12
Q

how do describe different types of seizures ?

A

tonic, atonic, myclonic, tonic clonic and absence

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13
Q

what is tonic?

A

increased tone in muscle= stiff

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14
Q

what is atonic ?

A

decrease in tone of muscle = floppy
- if happens to whole body = u drop to the floor

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15
Q

what is myclonic?

A

sudden spasm
myconic jerk

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16
Q

what is tonic clonic ?

A

increase in tone
pt becomes stiff and muscles repeatedly contracting and spasming

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17
Q

what are absence seizures ?

A
  • type of generalised seizure
  • pt becomes vacant and doesn’t remember the seizure
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18
Q

if someone has a focal seizure with a loss of awareness what symptoms may they have

A

lip smacking - automatisms

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19
Q

what are the 4 phases of a seizure?

A

prodrome
aura
ictal
post ictal

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20
Q

what is prodrome?

A

lasts hours to days
symptoms are vague - irritable or light headed

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21
Q

what is Aura?

A

some pts may not have them
migraine or odd sensations change in vision taste smell or visions happens before seizure

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22
Q

what is ictal?

A
  • seizure
  • can be muscular changes or loss of awareness
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23
Q

what is post ictal ?

A

after seizure
cognitive depression
neurones In brain having fired a lot then becomes tired
pt becomes sleepy after

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24
Q

is it true that not all seizures are epilepsy ?

A

yes

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25
Q

how many ppl experience a seizure in their life?

A

1 in 20

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26
Q

how many ppl will experience epilepsy in their life?

A

1 in 100

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27
Q

how do the WHO define epilepsy ?

A

2 or more unprovoked seizures
*ppl with epilepsy may have unprovoked seizure

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28
Q

what is a provoked seizure ?

A
  • an acute change
  • a recent change that triggers the seizure which change the brain structure or chemistry
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29
Q

list the 5 types of prove seizures

A

metabolic
drugs
infection
structural
vascular

30
Q

give eg of a metabolic cause

A
  • hypoxia
  • hypoglycaemia
31
Q

give eg of a drug cause

A
  • drugs or withdrawal of drugs
  • drugs may change how excitable neurone are (increases or decrease their activity )
32
Q

give eg of structural changes

A

trauma or tumour

33
Q

eg of vascular

A

stroke

34
Q

what are some of the causes of epilepsy

A

structural
genetic
metabolic
autoimmune
idiopathic

35
Q

how do we diagnose a epilepsy

A
  • if pt has had a seizure testing needs to be down to find out wether this was provoked or not this can be done by:
  • blood tests can find out any metabolic causes
  • brain imaging can find any structural causes
  • EEG detects brain waves
  • ECGS = rule things that may provoke a seizure or may not be a seizure eg. if someone has a cardiac arrhythmia leading to a cardiac syncope or if someone has a deep faint they may have muscle twitching due to reduced perfusion to brain
36
Q

how do we manage a pt that has had an unprovoked seizure?

A

anti epileptic meds or have a device implanted that stimulate the nervous system to preen them from having the seizure or if its structural abnormality u may have neural surgery to remove

37
Q

how do we manage a pt that has had a provoke seizure?

A

manage the cause

38
Q

list some anti epileptic meds

A
39
Q

what do pts need to think about if they have seizure/epilepsy?

A

DVLA - limitations on driving
safety - require safety assessments for some jobs, cant bathe alone
Drug interactions and side effects
SUDEP - 1 in 1000 Sudden and unexplained death

40
Q

what questions do we ask our pt who have seizures/epilspsy ?

A
  • ask them to describe exactly what happens
  • are they in remission = controlled
  • what drugs they’re taking
41
Q

what is prolonged seizure ?

A

lasts more than 5 mins

42
Q

what is a serial seizure?

A

3 or more in an hour - concerning

43
Q

which seizure is a med emergency ?

A

tonic clonic

44
Q

describe the tonic clonic seizure

A
  • stiff
  • breathe out with a large groan
  • symmetrical rhythmical muscle contractions thru out body - lasts few minutes
  • bites sides of tonnage
  • urinary fecal incontinence
  • risk of injuring themselves
45
Q

describe how we would manage tonic clonic

A

STOP
safety
time
oxygen
plan

midazolam

46
Q

describe the S part of managing tonic clonic

A
  • safety
  • lowering dental chair to prevent them from falling out - don’t hold pt down as u can harm yourself or them
  • don’t put hands near mouth as they can be bitten
  • cushion their head
47
Q

describe the t part of managing tonic clonic

A

time
- start stopwatch
- if lasts over 5 mins - call ambulance

48
Q

describe the o part of managing tonic clonic

A

oxygen
- thye have stopped breathing
- hypoxic
- may turn blue
- 15L non rebreather mask

49
Q

describe the p part of clonic tonic

A

plan
- do they have a care plan
- if they don’t have a history of seizures call ambulance
- if the seizure is longer than normal
- monitor pt for another hour to check if its prolonged
- if their seizure isn’t normal according to care plan then give midazolam and call ambulance

50
Q

what is important to note about midazolam?

A
  • can cause respiratory depression so make sure ambulance is called
51
Q

describe how u would manage pt in post ictal phase

A
  • recovery position - maintains airway
  • ABCDE
  • wean 02 - wait until u have pulse 02 readings - if u can’t remove 02 mask without pt turning hypoxic call ambulance
  • discharge
52
Q

when should u call an ambulance

A
  • first seizure
  • prolonged seizure
  • if midazolam given
  • if injuries sustained during seizure
  • ABCDE tell u to
53
Q

what conditions may look like a seizure ?

A

psychogenic non epileptic seizure
syncope

54
Q

what is a stroke ?

A
  • an acute vascular event in which the blood supply to the brain is interrupted which causes death of the brain tissue
55
Q

what are the 3 types of stroke?

A

ischaemic, hemorrhagic and TIA

56
Q

what is ischaemic stroke?

A

blockage to blood flow eg. clot or thrombus
- focal - one part of brain one part of body
85%

57
Q

what is a hemorrhagic stroke?

A

a bleed in an artery that supplies the brain - not enough blood to brain tissue starts to die

58
Q

what can stokes also be cause by?

A

dissection - defect in artery - blood moves into wall of artery instead of lumen - so reducing blood flow in which can lead to ischamia due to clot formation

59
Q

what can haemorrhagic stroke be categorised into?

A

small and big blood vessel

60
Q

what is small haemorrhagaic stroke?

A

small vessel within brain tissue could bleed due to high BP or if vessels are damaged from atheroma or amyloid plaques or anatomical abnormality

61
Q

what is a subarachnoid stroke?

A
  • bleeding takes place between arachnoid membrane and the brain
62
Q

why does a SS take place ?

A

due to anyuresym - ballooning of a blood vessel which bursts

63
Q

what symptoms do ppl with SS have ?

A
  • thunderclap headache = feels like a smack to the face
  • stiff neck = blood irritates the meninges (this also are in spinal cord) so when pt bends head forwards = stercthces membranes causing stiff neck
  • nausea
  • photophobia
  • can be Fatal
  • Call 999
64
Q

what are the risk factors for stroke?

A
  • baso anything that risks a thrombus formation in vessel wall
  • hypertension = damages vessel walls so easier for clot to form
  • diabetes - high sugar levels damaging artery walls
  • smoking and drinking = affects blood clotting
  • atrial fib = LA fibrillate - causes distribution to blood flow in heart = turbulent blood flow = clot formation
  • PFO= hole in heart between RA and LA should close up when ur born = clot goes from RA to LA then straight to systemic circulation and cause stroke
65
Q

what is a TIA?

A

-transient ischaemic attack
-aka mini stroke
-symptoms last 24hrs and damage isn’t lasting
-a sign that a pt has a high risk of having a full ischaemic stroke
come ppl may have several TIAs with then leads to a big stroke

66
Q

what does fast mean? and management of stroke

A

face - anything droopy
arm - ask to raise arm
speech - is speech affected ?slurring
time - call 999 and make a note of when symptoms started

*leg weakness, visual changes, coordination problems, neglect
*don’t give food water or meds when having a stroke, keep talking to them
* if lose consciousness - recover position
* stop breathing - CPR

67
Q

how do we diagnose a stroke?

A
  • neurological exam - CT head to identify bleeding
68
Q

how is an ischeamic stroke managed?

A

thrombolysis - clot dissolving drugs or thrmobectomy = removal of clot
- these are done 4 hours after symptoms

69
Q

how else is a stroke diagnosed ?

A
  1. Neurology exam
  2. CT head
  3. Thombolysis / thrombectomy
  4. Lumbar puncture / angiogram
  5. Neurosurgery
70
Q

how do we deal with the aftermath of a stroke?

A
  1. Antiplatelets or anticoagulation
  2. Statin or anti hypertensives
  3. Blood pressure control
  4. Physiotherapy
  5. Occupational Therapy
  6. Speech and Language Therapy
  7. Psychology
  8. Nutrition
  9. incontinence care
71
Q

what are some dental considerations ?

A
  1. Defer treatment for 6 months
  2. Accessibility
  3. Difficulty swallowing / chewing
  4. Risk of aspiration
  5. Drug interactions & side effects
  6. Potential sensitivity to sedatives / opioids
  7. Limit LA & avoid adrenaline in gingival retraction

4th Yr - CMS 1 (27 decks)

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