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CMS > Week 12 - Neurology > Flashcards

Week 12 - Neurology Flashcards

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Introductory Sommelier Exam (CMS) flashcards
1
Q

impaired consciousness: what are the indexes used to measure this?

A
  • GCS: Glasgow Coma Scale

- AVPU: Alert, verbal, pain, unresponsive

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2
Q

impaired consciousness: general causes?

A
  • structural damage: external or internal

- global failure: metabolism, infection, drugs & toxins, seizure

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3
Q

impaired consciousness: structural damage: external & internal - examples?

A

external: head injury
internal:
- vascular, “stroke”. can be ischaemic stroke or haemorrhage stroke
- tumour: benign/primary/secondary
- abscess: organisms enter blood brain barrier and cause infection

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4
Q

impared consciousness: global brain failure - metabolic causes?

A
  • hypoglycaemia
  • liver failure (hepatic encephalopathy)
  • renal failure (uremic encephalopathy)
  • hypoxia
  • hypercapnia
  • hyponatraemia
  • hypercalcaemia
  • hypothyroidism
  • hypotension
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5
Q

impaired consciousness: global brain failure - examples of infections?

A
  • encephalitis
  • meningitis
  • malaria & other tropical illness
  • other severe infections like pneumonia, GI, urine infections
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6
Q

impaired consciousness: global brain failure - causative drugs and toxins?

A
  • alcohol
  • opiates
  • other recreational drugs
  • any prescribed sedating medication: benzodiazepines, tranquilisers, antidepressants, opiates, anti-epileptics
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7
Q

impaired consciousness: global brain failure - how do seizures/epilepsy contribute?

A
  • excess electrical activity
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8
Q

impaired consciousness: what is the clinical approach?

A
  • ABCDE

- identify and treat cause

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9
Q

describe the ABCDE approach to impaired consciousness

A
  • take note of airway obstruction
  • usually put in recovery position
  • administer oxygen
  • AVPU / GCS
  • check blood sugar
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10
Q

impaired consciousness: methods to identify causes?

A

upon examination:

  • trauma
  • rash
  • seizure activity
  • focal weakness
  • signs of co-existent illness: SEWS (temperature, BP, pulse, respiratory rate, oxygenation)
  • blood sugar
  • other clues i.e. jaundice, needle tracks, breath
  • collateral history
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11
Q

impaired consciousness: how to treat?

A
  • treat cause: usually hospitalization

- but first consider treating: hypoglycaemia, hypoxia, severe infection, benzodiazapine overdose

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12
Q

epilepsy: what is it characterized as?

A

excessive electrical discharges in the brain

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13
Q

epilepsy: what are the clinical features of the 2 different types?

A
  1. focal (partial) seizures: depends on part of brain affected
  2. generalized seizures: whole brain affected
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14
Q

epilepsy - focal/partial seizures: describe:

  • simple partial seizures
  • complex partial seizures
A
  1. shaking on one side (maintained consciousness)
  2. temporal lobe affected: aura, resulting in olfactory (rarely visual) hallucinations
    - odd behaviour: automatisms such as lip smacking, odd posture, staring
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15
Q

epilepsy - generalized seizures: list the forms of generalized seizures

A
  1. grand mal/tonic-clonic (usual)
  2. petit mal
  3. myoclonic
  4. atonic
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16
Q

epilepsy - generalized seizures: describe the characteristics of a grand mal/tonic-clonic seizure?

A
  • loss of consciousness
  • limbs stiffen: tonic phase
  • limbs shake: clonic phase
  • incontinence
  • tongue biting
  • cyanosis
  • headache, drowsiness afterwards
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17
Q

epilepsy - generalized seizures: describe the characteristics of a petit mal seizure?

A
  • absent-mindedness in children
  • staring into space, lasts about 10 seconds
  • instantly responsive after seizure
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18
Q

epilepsy - generalized seizures: describe the characteristics of a myoclonic seizure?

A
  • limbs jerking

- collapse

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19
Q

pilepsy - generalized seizures: describe the characteristics of an atonic seizure?

A
  • limbs collapse
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20
Q

epilepsy: primary causes?

A

often hereditary element

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21
Q

epilepsy: secondary causes?

A
  1. structural damage
    - acute or chronic: stroke, tumour, post head injury/surgery, arteiovenous malformation, meningitis
  2. metabolic damage
    - electrolyte disturbance, alcohol withdrawal, hypoglycaemia
    - always check blood sugar
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22
Q

epilepsy: methods of investigation?

A
  • blood tests
  • brain imaging: ideally MRI
  • electroencephalogram - EEG
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23
Q

epilepsy - treatment?

A
  1. drugs (usually)
    - phenytoin, carbamazepine, sodium valproate, lamotrigine, etc
  2. surgery
    - tumours, arteriovenous malformations
    - poor controlled primary epilepsy
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24
Q

epilepsy - dental aspects?

A
  • recognize how well controlled, avoid tx if poorly controlled
  • management of seizure
  • take note of drug side effects
25
Q

headache: different types?

A
  • primary headache disorders: unpleasant

- secondary headache disorders: associated with mortality or permanent disability

26
Q

headache: red flags?

A
  • severity
  • sudden onset
  • features of raised intracranial pressure
  • focal neurology
  • visual changes
  • impaired consciousness/confusion
  • meningism, fever, rash
  • associated history i.e. cancer/HIV
27
Q

features of raised intracranial pressure?

A
  • worsening headache on positional change/strain
  • headache present on waking
  • nausea and vomiting
28
Q

list the primary headache disorders

A
  • tension headache
  • migraine
  • cluster headache
  • medication overuse headache
  • trigeminal neuralgia
29
Q

headache - tension headache: describe its characteristics?

A
  • stress related
  • “tight band” feeling
  • pain is bilateral/symmetrical
  • chronic, gradual onset
  • gets worse towards end of the day
30
Q

headache - tension headache: treatment?

A
  • conventional analgesia

- tricyclic antidepressants for prophylaxis

31
Q

headache - migraine:

  • what is it?
  • what are its triggers?
A
  • temporary reduction in blood flow then compensatory excess blood flow
  • often has no triggers, but could be wine, cheese, chocolate, OCP, premenstrual, anxiety, exercise, sleep deprivation, fasting
32
Q

headache - migraine: what are its classic features?

A
  1. pre-headache aura ~ 15minutes.
    - visual: flashing lights, wavy lines, dots, spots, distorted vision
  2. headache within 1 hour
    - one sided, throbbing
    - nausea, vomiting
    - photophobia
33
Q

headache - migraine: treatment?

A

acute:

  • conventional analgesia (paracetamol, aspirin, ibuprofen)
  • metoclopramide
  • serotonin agonists: sumatriptan
34
Q

headache - migraine: prevention?

A
  1. anti-epileptics, amitryptyline, beta blockers

2. avoidance of triggers

35
Q

headache - cluster headache: caused by?
characterized by?
more common in?

A
  • dilatation of superficial temporal artery
  • severe pain around eye: watery, blood shot, lid swelling, runny nose
  • more common in males, smokers
36
Q

headache - medication overuse headache:

  • users of what are most at risk? can also occur with use of what drug?
  • management?
A
  • users of opiates and triptans
  • paracetamol
  • medication withdrawal to manage
37
Q

headache - trigeminal neuralgia:

  • how is the pain described?
  • precipitated by?
  • management?
A
  • intense stabbing pain, of 10/10 severity. felt along trigeminal nerve distribution
  • touch (shaving, washing, talking). can also be paroxysmal (spontaneous)
  • carbamazepine, after ruling out other causes
38
Q

headache - secondary headache disorders: what are the causes?

A
  • head injury
  • infections
  • non-traumatic bleeds
  • giant cell arteritis
  • glaucoma
39
Q

headache - raised intracranial pressure:

- causes?

A
  1. tumour
  2. bleeds: head injury/non-traumatic
  3. hydrocephalus: drainage problem (trauma/bleed, tumour, infection, idiopathic)
  4. abscess
40
Q

headache - raised intracranial pressure: how is it diagnosed?

A

diagnosis made from CT scan

41
Q

headache - bacterial meningitis:

- list the causative agents and who they affect?

A
  • meningococcus: infants, adolescents, young adults (contact spread)
  • pneumococcus: babies & the elderly)
  • haemophilus: babies & infants
42
Q

headache - bacterial meningitis: associated features?

A
  • impaired consciousness
  • meningism
  • meningococcal rash
  • drowsiness
  • photophobia
43
Q

headache - bacterial meningitis: how is diagnosis carried out?

A
  • lumbar puncture

- blood cultures

44
Q

headache - bacterial meningitis: treatment?

A
  • empirical antibiotics (if suspected in community)
  • urgent hospitalization
  • prophylaxis
45
Q

headache - encephalitis:

  • inflammation of?
  • what type of infection?
A
  • inflammation of brain parenchyma

- viral infection: herpes simplex, varicella zoster, rabies

46
Q

headache - encephalitis:

A
  • impaired consciousness
  • change in personality
  • meningism
  • seizures
47
Q

headache - encephalitis:

- diagnostic methods? management?

A
  • lumbar puncture
  • electroencephalogram
  • antivirals and hospitalization
48
Q

headache - cerebral abscess: usually caused by which bacteria?
symptoms?

A
  • staphylococci or streptococci

- raised ICP

49
Q

headache - cerebral abscess: diagnostic methods? management?

A
  • CT/MRI (better)
  • biopsy/ surgery sample
  • drainage and antibiotics
50
Q

headache - cerebral bleed: lost two types of non-traumatic cerebral bleeds

A
  1. sub-arachnoid haemorrhage (SAH)

2. intracerebral haemorrhage (ICH)

51
Q

headache - cerebral bleed (subarachnoid haemorrhage): what are the main causes?

A
  • congenital berry aneurysm
  • arteriovenous malformation
  • no cause (15%)
52
Q

headache - cerebral bleed (subarachnoid haemorrhage): clinical features?

A
  • sudden, severe headache “thunderclap”
  • often occipital
  • may be vomiting, collapse, drowsiness
53
Q

headache - cerebral bleed (subarachnoid haemorrhage): diagnostic methods & management?

A
  • CT scan, angiography. may require lumbar puncture if negative
    mx:
  • prevent re-bleeding
  • best outcome in those with little neurological damage: surgical clipping or coiling
54
Q

headache - cerebral bleed (intracerebral haemorrhage): bleeding into?
usually associated with?
other symptoms?

A
  • directly into brain tissue
  • usually associated with hypertension: charcot-bouchard aneurysm
  • raised ICP, focal neurology
55
Q

headache - cerebral bleed (intracerebral haemorrhage): how to diagnose?
management?

A
  • imaging

- may be fatal, mx with surgery or rehabilitation

56
Q

headache - giant cell arteritis: clinical features? importance?

A
  • scalp tenderness
  • jaw claudication
  • loss of vision
  • there is risk of blindness, stroke and death
57
Q

headache - giant cell arteritis: possible investigations?

treatment?

A
  • blood tests + temporal artery biopsy

- high dose prednisolone

58
Q

headache - glaucoma: clinical features?

A
  • constant ache around one eye
  • reduced vision
  • nausea & vomiting
  • red, congested eye, with dilated, non-reactive pupil

CMS (16 decks)

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