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CMS > Neurology 1 > Flashcards

Neurology 1 Flashcards

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1
Q

Range of the glasgow coma scale?

A

3-15 ( 15 most consciousness)

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2
Q

way to asses level of consciousness?

A 
AVPU
alert
verbal
pain
unresponsive
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3
Q

Structural causes of impaired consciousness?

A

internal

external

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4
Q

Global failure causes of impaired consciousness?

A

metabolism
infection
drugs/alcohol
seizures

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5
Q

external causes?

A

head injury most common

trauma

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6
Q

internal causes?

A

vascular - stroke - ischaemic/haemorrhagic
tumour - benign/primary/secondary
abscess

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7
Q

Metabolism causes?

A 
hypoglycaemia
liver/renal failure
hypoxia
hyperaepnia
hypornatraemia
hypercalcaemia
hyperthyroidism
hypotension
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8
Q

Infection causes?

A

of brain - encephalitis, meningitis, malaria/other tropical diseases
of body - any other severe infection e/g pneumonia

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9
Q

drug causes?

A

opiates
alcohol
recreational drugs
overuse of sedative meds

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10
Q

what causes seizures/epilepsy?

A

excess electrical activity

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11
Q

pt has impaired consciousness, how to act?

A

ABCDE

identify and treat cause

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12
Q

what is epilepsy?

A

excessive electrical discharges in the brain

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13
Q

types of seizures?

A

focal/partial seizures - depends on what part of brain affected

generalised seizures - whole brain affected

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14
Q

simple focal seizures are?

A

shaking on one side

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15
Q

complex partial seizures are?

A

temporal lobe related

auras - olfactory hallucinations followed by odd behavious - automatisms

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16
Q

generalised seizures are usually?

A 
grand mal/tonic clonic
tonic phase - limbs stiffen
clonic phase - limbs shake
may be incontinence, tongue biting, cyanosis
headache drowsy after
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17
Q

what are petit mal seizures?

A

type of generalised

  • absence seizures - children- stare into space for 10 secs
  • myoclonic - limbs jerk and collapse
  • atonic - limbs collapse
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18
Q

primary causes of epilepsy?

A

often hereditaty involvement

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19
Q

secondary causes of epilepsy?

A

structural damage

  • acute/chronic - b/c stroke,tumour, injury, meningitis
  • metabolic - electrolyte disturbance, alcohol withdrawl, hypoglycaemia. always check blood sugar
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20
Q

investigations for epilepsy?

A

blood tests
brain imaging - MRI
electroencephalogram EEG

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21
Q

drug tx of epilepsy?

A

phenytoin
carbamazepine
sodium valproate

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22
Q

surgical tx of epilepsy?

A

tumour removal, arteriovenous malformations, poorly controlled primary epilepsy

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23
Q

avoid treating epileptic pt when?

A

epilepsy poorly controlled

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24
Q

divisions of headaches?

A

primary headache disorders

secondary headache disorders - associated with mortality/permanent disability

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25
Q

red flags with headaches?

A

-severity - sudden onset
-raised intracranial pressure - worsening on positional change/strain, present on waking, nausea/vomitting
-focal neurology
-visual changes
-impaired consciousness/confusion
-meningism, fever, rash
associated with cancer or HIV

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26
Q

types of primary headaches?

A 
tension
migraines
cluster
medication overuse
trigeminal neuralgia
27
Q

what is a tension headaches?

A

stress related - tight band symmetrical around head
chronic, gradual onset
worse at end of day

28
Q

treatment of a tension headache?

A

concentional analgesics

tricyclic antidepressants for prophylaxis

29
Q

what is a migraine?

A

temporary reduction in blood flow then compensatory excess blood flow
8% more common in females

30
Q

migraine triggers?

A

often none or

wine, cheese, chocoalte, OCP, premenstrual, anxiety, exercise, fasting, sleep deprivation

31
Q

features of a migraine?

A

pre headache aura for 15 mins - usually visual
headache within one hour
one side throbbing, nausea, vomitting, photophobia

32
Q

treatment of a migraine?

A

acute - analgesia, metoclopramide. serotonin antagonists

33
Q

prevention of migraines?

A

anti epileptics
beta blockers
amitryptiline
avoidance of triggers

34
Q

what is a cluster headache?

A

dilation of superficial temporal artery
most common in male smokers
rapid onset
episodic -

35
Q

medication overuse headache?

A

chronic headaches

opiates/triptans = most risky

36
Q

what are trigeminal neuralgia headaches?

A

intense stabbing pain 10/10 severity
precipitated by touch - shaving, washing,talking
paroxysmal = spontaneous
tx with carbamazepine

37
Q

increased intracranial pressure caused by?

A

tumours
non traumatic bleeds
hydrocephalus = drainage problem - trauma, bleed, tumour, infection, abscess

38
Q

diagnose raised intracranial pressure with?

A

CT scan

39
Q

what is bacterial meningitis?

A

contact spread, common in infancts, adolescents, young adults
pneumococcal - babies and elderly
haemophilius - babies and infants

40
Q

feautures of bacterial meningitis?

A 
impaired consciousness 
meningism
\+/- rash
drowsy
photophobia
41
Q

diagnose meningitis with?

A

lumbar punctures

blood cultures

42
Q

treatment of bacterial meningitis?

A

empirical antibiotics if suspected in the community
hospital
prophylaxis for contacts

43
Q

what is enchepalitis?

A

inflammation of brain parenchyma

by viral infection - herpes simplex, varicella zoster, rabies

44
Q

symptoms of enchepalitis?

A

impaired consciousness, personality change, meningism, seizures

45
Q

diagnose enchepalitis?

A

lumbar puncture, ECG

46
Q

treat encheplalitis?

A

antivirals, hospital

47
Q

abscess caused by?

A

staphylococci/streptococci

ostitis media/mastoidosis, sinusitis, infections, trauma

48
Q

abscess can cause?

A

raised intracranial pressure

49
Q

how to diagnose an abscess?

A

CT/MRI

biopsy

50
Q

Non traumatic bleed divisions?

A

SAH - sub arachnoid hemorrhage

ICH - intracerebral hemorrhage

51
Q

what is a SAH?

A

blood in the sub arachnoid space
70% rupture - congenital berry aneurysm
15% rupture - anteriovenous malformation
15% = no cause

52
Q

SAH incidence?

A

between 35-65 years

15 per 100 000

53
Q

SAH symptoms?

A

sudden severe headache
often occipital
vomit/collapse/drowsy

54
Q

SAH diagnosed how?

A

CT scan +/- angiography to see aneurysm

lumbar puncture in necessary

55
Q

how to prevent re bleed?

A

surgery - clip
coils
poss. residual disability

56
Q

what is an intercerebal heamorrhage?

A

directly into brain tissue

associated with hypertension - charcot bouchard aneurysms

57
Q

symptoms of intercerebral haemorrhage?

A

increased intracranial pressure
focal neurology
not always headaches

58
Q

how to diagnose ICH?

A

imaging

59
Q

how to tx ICH?

A

surgery

rehabillitation

60
Q

what is giant cell arteritis?

A 
rare under 55 years old
scalp tenderness
jaw claudication
loss of vision
risk of blindness, stroke, death
61
Q

tests for giant cell arteritis?

A

ESR, PV, temporal artery biopsy

62
Q

tx giant cell arteritis?

A

high dose prednisolone, immediately

63
Q

what is glaucoma?

A 
common in elderly
constant ache around eye
reduced vision
nausea and vomitting
red congested eye, dilated, non reactive pupil
64
Q

tx gluacoma?

A

urgent opthamology ref

CMS (42 decks)

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