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CMS! > Neurology > Flashcards

Neurology Flashcards

1
Q

Define impaired consciousness.

A

the loss of normal level of awareness

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2
Q

what is the spectrum of impaired consciousness? from ? to ?

A

mild confusion to unrousable coma

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3
Q

what does GCS stand for?

A

glasgow coma scale

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4
Q

what is the minimum and maximum scores on the GCS?

A

3 - 15

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5
Q

what are the 3 subsections in the GCS?

A
  • movement
  • speech
  • eye opening
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6
Q

how many points can you get in movement in GCS?

A

6

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7
Q

how many points can you get in speech in GCS?

A

5

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8
Q

how many points can you get in eye opening in GCS?

A

4

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9
Q

The lower the GCS score, the…

A

less conscious (the greater the impaired consciousness)

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10
Q

what does AVPU stand for?

A

Alert
Verbal
Pain
Unresponsive

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11
Q

give the 2 broad causes of impaired consciousness.

A
  • structural damage

- global failure

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12
Q

what are the 2 types of structural damage? causing impaired c

A
  1. external (head injury)

2. internal (stroke, tumour, abscess etc)

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13
Q

what are the 4 types of global damage? causing impaired c

A
  • metabolism
  • infection
  • seizure
  • drugs & toxins
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14
Q

name 3 types of infections affecting the brain.

A
  • meningitis
  • malaria
  • encephalitis
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15
Q

name 3 other severe infections that could affect the brain.

A
  • urine
  • GI
  • pneumonia
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16
Q

Examples of drugs that can cause impaired conscious are..

A
  • alcohol
  • opiates
  • ‘recreational drugs’
  • anti-depressants
  • anti-epileptics
  • tranquilliser
  • benzodiazepines
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17
Q

the 3 stages of treatment for impaired consciousness are..

A

1 - ABCDE
2 - Identify causes
3 - treat cause

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18
Q

define epilepsy

A

excessive electrical discharge in the brain

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19
Q

what are the 2 clinical features of epilepsy?

A
  • focal (partial) seizures

- generalised seizures

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20
Q

what are the 2 types of focal seizure?

A
  • simple and complex
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21
Q

indications of a simple focal seizure?

A

shaking down one side

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22
Q

indications of a complex focal seizure?

A

1st an aura

2nd odd behaviour (lip smacking, staring, odd posture, “out of it”)

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23
Q

name 4 generalised seizures?

A
  1. tonic/clonic
  2. petit mal
  3. myoclonic
  4. atonic
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24
Q

what is a petit mal seizure and who do they effect?

A

absence seizure in children (staring into space for 10 sec)

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25
Q

what happens during a myoclonic seizure?

A

limbs jerking and collapse

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26
Q

what happens in a atonic seizure?

A

limbs collapse

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27
Q

what are some causes of epilepsy?

A

primary - hereditary
secondary
- structural damage
- metabolic damage

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28
Q

3 ways to investigate epilepsy?

A
  • blood tests
  • brain imaging
  • EEG
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29
Q

2 ways to treat epilepsy

A
  1. drugs

2. surgery

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30
Q

name 4 drugs that can be given to treat epilepsy?

A
  • phenytoin
  • carbamazepine
  • sodium valproate
  • lamatorigine
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31
Q

what are 2 surgery options that can help some kinds of epilepsy?

A
  • tumour removal

- arteriovenous malformation

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32
Q

when to avoid dental treatment with an epileptic patient?

A

if not well controlled

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33
Q

what are the red flags that indicate secondary headache disorders? (8)

A
  1. sudden onset
  2. severe pain
  3. features of raised intracranial pressure signs are
    - worse on change in position
    - present on walking
    - nausea and vomiting
  4. focal neurology (CNS deficit = weakness in limbs)
  5. impaired consciousness/confusion
  6. fever - meningitis?
  7. associated history ie cancer/HIV
  8. visual changes
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34
Q

name 5 types of primary headache disorders.

A
  • tension headache
  • migraine
  • cluster headache
  • medication overuse headache
  • trigeminal neuralgia
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35
Q

symptoms of a tension headache are…

A
  • gradual onset (chronic)
  • symetrical
  • ‘tight band’ feeling
  • worse towards end of the day
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36
Q

what is the cause of tension headache?

A

stress related

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37
Q

what are the 2 treatment options for tension headache?

A
  • conventional analgesic

- tricyclic anti depressants for prophylaxis

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38
Q

define a migraine.

A

the temporary reduction in blood flow, followed by compensatory increase in blood flow

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39
Q

what is the incidence of migraines?

A

common

8% more in females

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40
Q

what are common triggers of migraines?

A
  • often none
  • wine, cheese, chocolate, fasting
  • OCP, premenstrual
  • anxiety, sleep deprivation
41
Q

how long does the pre headache ‘aura’ typically last for?

A

15 mins

42
Q

what are 3 symptoms of a migraine?

A
  • one sided throbbing pain
  • nausea and vomiting
  • photophobia
43
Q

what are the 3 treatment options for acute migraines?

A
  • conventional analgesics
  • metoclopramide - to prevent nausea
  • serotonin agonists (sumatriptan)
44
Q

what are the 3 types of drugs that can be given in chronic migraines? what else can be done - other than drugs

A
  • anti-epilptics
  • amitriptyline
  • beta blockers
  • avoidance of triggers
45
Q

define cluster headaches.

A

the dilation of superficial temporal artery

46
Q

cluster headaches are more common in men or women?

A

men

47
Q

what are the symptoms of cluster headache?

A

severe pain around the eye

  • watery
  • blood shot
  • lid swelling
  • running nose
48
Q

what is the onset and duration of cluster headaches?

A
  • rapid onset

- lasting

49
Q

name two drug groups that give the greatest risk of medication overuse heachache?

A
  • opiates

- triptans (serotonin receptor agonists)

50
Q

how to manage medication overuse headaches?

A
  • medication withdrawal
51
Q

what brings about pain from trigeminal neuralgia?

A
  • touch ( shaving, washing, talking )
    or
  • spontaneous
52
Q

management of trigeminal neuralgia is

A
  • rule out other causes

- carbamazepine

53
Q

give 5 causes of secondary headache disorders

A
  • head injury
  • infection (eg meningitis)
  • non-traumatic bleeds
  • giant cell arteritis (temporal arteritis)
  • glaucoma (increased pressure in eyeball)
54
Q

what is hydrocephalus?

A 
a drainage problem that can follow 
- head injury
- tumour 
- infection 
or can be idiopathic
55
Q

4 causes of raised intracranial pressure are…

A
  • tumour
  • bleeds (either head injury or non-traumatic)
  • hydrocephalus
  • abscess
56
Q

how can raised intracranial pressure be diagnosed?

A

CT scan

57
Q

name the 3 types of bacterial meningitis.

A
  1. meningococcus
  2. pneumococcus
  3. haemophilus
58
Q

who is affected by meningococcus meningitis? how is it spread?

A
  • infants
  • adolescents
  • young adults

spread through contact

59
Q

who is affected by pneumococcus meningitis?

A
  • babies

- elderly

60
Q

who is affected by haemophilus meningitis?

A
  • babies

- infants

61
Q

what are the 5 common symptoms of meningitis?

A
  1. impaired consciousness
  2. meningism = neck stiffness
  3. drowsy
  4. photophobia
  5. +/- rash with meningococcus
62
Q

2 ways that meningitis can be diagnosed are…

A
  1. lumbar puncture = spinal fluid collected

2. blood clutures

63
Q

management of meningitis?

A
  • urgent hospitalisation
  • empirical antibiotics
  • prophylaxis for contacts
64
Q

define encephalitis

A

Inflammation of the brain parenchyma

65
Q

what is the cause of encephalitis?

A

viral infections

  • herpes simplex
  • varicella zoster
  • rabies
66
Q

associated features of encephalitis are… 4 things

A
  • impaired consciousness
  • personality changes
  • menigism (neck stiffness)
  • seizures
67
Q

2 ways to diagnose encephalitis…

A
  1. lumbar puncture

2. EEG

68
Q

2 ways to mange encephalitis?

A
  • hospitalisation

- anti-virals

69
Q

the most common cerebral abscess is caused by what?

A

streptococci or staphlococci infections from

  • otits mitus
  • mastoiditis
  • sinusitis
  • dental infections
70
Q

what is otitus mitus?

A

inflammation of the middle ear

71
Q

what is mastoiditis?

A

inflammation of the mastoid process

72
Q

what is sinusitis?

A

inflammation of the nasal sinus

73
Q

name the 3 types of infections causing secondary headache disorders are?

A
  • meningitis
  • encephalitis
  • cerebral abscess
74
Q

symptoms of cerebral abscess are?

A
  • increased intracranial pressure

- focal neurology

75
Q

2 ways that cerebral abscess can be diagnosed are?

A
  • CT scan (MRI better)

- biopsy/surgery sample

76
Q

what is the 2 ways to manage a cerebral abscess

A
  1. antibiotics

2. drainage

77
Q

name the 2 types of non-traumatic cerebral bleed?

A
  1. sub-arachnoid haemorrhage (SAH)

2. intracerebral haemorrhage (ICH)

78
Q

where in the brain is affected by a SAH?

A

the subarachnoid space

79
Q

where in the brain is affected by ICH?

A

bleed is directly into the brain tissue

80
Q

in 70% of SAH what happens and why?

A

rupture due to congenital berry aneurysm

81
Q

in one 15% of SAH what happens? and the other 15%?

A 
15% = no cause 
15% = rupture due to arterovenous malformation
82
Q

what is ICH associated with?

A

hypertension

83
Q

what can ICH also be called?

A

charcot-bochard aneurysms

84
Q

what is the incidence of SAH?

A

35-65 year olds

15 in 100,000

85
Q

4 symptoms of SAH?

A
  • sudden severe headache (often occipital area)
  • drowsy
  • vomiting
  • collapse
86
Q

true or false

ICH is always accompanied by a headache.

A

False

87
Q

what 2 additional symptoms (from SAH) are present with ICH?

A
  • focal neurology

- raised intracrainal pressure

88
Q

how would you diagnose ICH?

A

imaging

89
Q

how would you diagnose SAH? 2 things

A
  • CT scan +/- angiogram

- lumbar puncture

90
Q

how common is re-bleeding in SAH? what %

A

30% re-bleeding

91
Q

what are the two treatment options?

A
  • surgery (clipping)

- coils - probs preferred option

92
Q

what is giant cell arteritis?

A

where the medium and large arteries in the neck become inflamed

93
Q

who is most likely to be affected by giant cell arteritis?

A

over 55

94
Q

what are the 3 main concerns with someone who had giant cell arteritis?

A

risk of

  • blindness
  • stroke
  • death
95
Q

what are the 3 main clinical features of giant cell arteritis/

A
  1. scalp tenderness (esp at the temporal area)
  2. jaw claudication - pain when chewing
  3. loss of vision
96
Q

what are the 2 investigations into giant cell arteritis?

A
  1. blood samples - ESR/PV

2. Temporal artery biopsy

97
Q

what is the treatment for giant cell arteritis?

A

HIGH dose IMMEDIATE prednisolone

98
Q

symptoms of glaucoma are?

A
  • constant ache around 1 eye
  • reduced vision
  • watery eye, blood shot red
  • dilated and non reactive pupils
  • nausea and vomiting

CMS! (23 decks)

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