Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Med Year 3 > Transient Loss of Consciousness > Flashcards

Transient Loss of Consciousness Flashcards

1
Q

what is epilepsy?

A

tendency to have seizures = a transient episode of ABNORMAl electrical activity in the brain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what is the post-ictal period

A

prolong period of confusion, drowsiness, irritability and disorientation following a seizure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what is the pathophysiology of seizures?

A

look in notes for synapses and receptor notes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what are generalised tonic clonic seizures, and how are they managed?

A
  • USUALLY starts on both sides of brain
LOC
Tonic (muscle tensing)
Clonic (muscle jerking) movements 
Tonic phase comes before clonic phase
Tongue biting, incontinence, groaning and irregular breathing
After seizure: post-ictal period

Management of tonic-clonic seizures:
First line: sodium valproate
Second line: lamotrigine or carbamezapine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what are focal seizures?

A

affects just ONE part of brain

starts in temporal lobes

Affect hearing, speech, memory and emotions
Various ways that focal seizures can present
 Hallucinations
 Memory flashbacks
 Déjà vu
 Doing strange things on autopilot

Management:
First line: carbamezapine (or lamotrigine)
Second line: sodium valproate or levetiracetam

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what are absence seizures?

A

Typically in children
Patient becomes black, stares into space and returns to normal quickly
During episode: unaware of surroundings and won’t respond
Only lasts 10-20s
Most patients stop having absence seizures as they get older

Management:
 Sodium valproate or ethosuximide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what are atonic seizures?

A

Drop attacks
Characterised by brief lapses in muscle tone
Usually lasts less than 3 minutes
Typically begins in childhood

Management:
 1st line sodium valproate
 Second line lamotrigine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what are myoclonic seizures (part of generalised)

A

Sudden brief muscle contractions like a sudden jump
Patient usually remains awake during the episode
Occur in various forms of epilepsy but typically happen children as part of juvenile myoclonic epilepsy

Management:
 1st line: sodium valproate
 Others: lamotrigine, levetiracetam, topiramate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what are infantile spasms?

A 
West syndrome
Rare disorder starting around 6 months of age 
Full body spasms = clusters 
Poor prognosis: 1/3 die by age 35
o	First line: prednisolone
o	Second: vigabatrin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what are febrile convulsions?

A

seizures in children age 6m to 5y who have a fever simultaneously

not caused by neuro pathology

no lasting damage

but slight increase risk for future epilepsy diagnosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what are alcohol withdrawal seizures and how do you manage or prevent them

A

patients w history of alcohol excess who suddenly stop drinking

seizures occur around 36h following cessation

give benzos following cessation of drinking to reduce the risk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what is the pathophysiology of alcohol withdrawal seizures

A

chronic alcohol consumption = enhances GABA and inhibits NMDA glutamate

withdrawal = opposite so inhibition of GABA is decreased and increased NMDA glutamate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what are non-epileptic seizures / seizure disorder

A

present with epileptic like seizures but no characteristic electrical discharges

patients may have a history of mental health problems or a personality disorder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what are other, rare causes of seizures?

A

migranous events
vestibular disorders
cerebrovascular disorders
sleep disorders

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

what investigations would you do for a seizure?

A 
history 
EEG
MRI brain
ECG to exclude heart problems
electrolytes, blood glc, blood cultures where sepsis or encephalitis is suspected
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

when do you offer an EEG and what is it?

A

electroencephalogram of brain

perform after 2nd simple tonic clonic seizure in adults, or 1 for kids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

what is the DVLA advice for people with epilepsy?

A

6 months seizure free if isolated

or 12 months seizure free if epileptic patient

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

what is the aim of AEDs

A

to raise seizure thershold and reduce patients risk of having a seizure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

what are the side effects of sodium valproate

A

Teratogenic – hence MUST be avoided in girls unless there are no suitable alternatives – make sure they are on contraception and will NOT get pregnant
Liver damage and hepatitis
Hair loss
Tremor

20
Q

what are the side effects of carbamezapine?

A

Agranulocytosis
Aplastic anaemia
Induces the P450 system so there are many drug interactions

21
Q

what are the side effects of phenytoin?

A 
Folate and vitamin D deficiency
Megaloblastic anaemia (folate deficiency)
Osteomalacia (vitamin D deficiency)
22
Q

what are the side effects of ethosuximide?

A

night terrors and rashes

23
Q

what are the side effects of lamotrigine?

A

DRESS syndrome (life threatening skin rashes)

leukopenia

24
Q

what is the mechanism of sodium valproate and benzos?

A

increases GABA activity in brain by reducing metabolism of GABA transaminase

also enhances GABA receptors

blocks sodium and calcium channels

25
Q

what is the mechanism of action of lamotrigine?

A

blocks sodium channel in presynaptic membrane and also acts on calcium channels (so does pregabalin)

26
Q

what is the mechanism of action of levetiracetam?

A

acts on synaptic vesicle 2 and inhibits discharge of NT onto synaptic cleft

27
Q

what are some behaviours indicative of non-epileptic attack disorder? helps to differentiate from epilepsy

A

v gradual onset or termiantion
pseudosleep
discontinous
irregular activity like side to side movement, stuttering, weeping

unresponsiveness and eye closure

  • non cyanosed, no incontinence
28
Q

how do you treat acute seizures?

A

put patient on floor in recovery position if possible
something soft under head
note time and end of seizure
call ambulance if 1st seizure or lasting more than 4 mins

patients may have been prescribed benzos so family can administer

29
Q

what is status epilepticus

A

medical emergency = seizures lasting more than 5 minutes or > 2 seizures within a 5 minute period without person returning to normal between them

30
Q

what is the priority in management of a seizure and why

A

terminating it, bc prolonged = irreversible brain damage

31
Q

how do you manage status epilepticus in a hospital?

A

Secure the airway

Give high-concentration oxygen
Assess cardiac and respiratory function
Check blood glucose levels
Gain intravenous access (insert a cannula)
IV lorazepam, repeated after 10 minutes if the seizure continues
If seizures persist then infuse IV phenytoin, consider intubation and ventilation, and ICU care

32
Q

what do you do if a seizure cannot be stopped and it has been 45 minutes?

A

induction of general anaesthesia

33
Q

what is syncope

A

defined as a transient loss of consciousness due to global cerebral hypoperfusion

rapid onset, short duration and spontaneous complete recovery

34
Q

what are the main questions you ask in a syncope history?

A

pre syncopal symptoms (cold, dizzy, abnormal taste, deja vu)

what were you doing before

how did you feel after, and where did you wake up?

eye witness history: twitching, colour change

concurrent illness - fever, infection

secondary injuries

palpitations or chest pain

neuro symptoms

happened before?

FH cardiac problems or sudden death

35
Q

3 ways of classifying syncope

A

reflex
orthostatic
cardiac

36
Q

what is reflex syncope

A

vasovagal: triggered by emotion, pain or stress.

‘fainting’

ANS has a problem regulating BF to the brain

vagus nerve receives signal of pain or stress - stimulates the PNS which counteracts ANS and hence blood vessels relax

o situational: cough, micturition, gastrointestinal
o carotid sinus syncope

37
Q

what is orthostatic syncope

A

primary autonomic failure: Parkinson’s disease, Lewy body dementia
secondary autonomic failure: e.g. Diabetic neuropathy, amyloidosis, uraemia
drug-induced: diuretics, alcohol, vasodilators
volume depletion: haemorrhage, diarrhoea

38
Q

what is cardiac syncope

A

arrythmias, tachycardias

structural: valvular, MI, hypertrophy

PE

low BP

39
Q

what changes would you see on an ECG in cardiac syncope

A

QRS complexes may suddenly stop or change during that specific period

Eye-roll and slump back is textbook characteristic

40
Q

what are the primary causes of syncope?

A

dehydration, missed meals, extended standing in warm environment

41
Q

what are the secondary causes of syncope

A 
hypoglylcaemia 
anaemia 
infection
anaphylaxis
cardiac
42
Q

what are the signs and symptoms of syncope

A 
•	Prodrome = remember in event or how you felt before
•	Hot or clammy 
•	Sweaty 
•	Dizzy and lightheaded 
•	Vision going blurry or dark 
- falling to ground
43
Q

what investigations would you do for syncope?

A

CV exam
• postural blood pressure readings: a symptomatic fall in systolic BP > 20 mmHg or diastolic BP > 10 mmHg or decrease in systolic BP < 90 mmHg is considered diagnostic
• ECG
• tilt table test
• 24 hour ECG
• Bloods: FBC for anaemia, electrolytes, blood glucose

44
Q

what are the differences between seizures and syncope?

A

look at table in notes

45
Q

how do you manage syncope

A

lifestyle: water, avoid missing meals etc

during episode: sit or lie down, water and food

Med Year 3 (25 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions