Miscellaneous terms/ disease

Question 1

GCS

• Significance
• Criteria

Answer 1

Method of assessing level of consciousness.

• Helps to asses need to protect the airway.
• Monitors deterioration of neurological function.

8 and below= unconscious

Criteria
Eyes (4)
- 4= spontaneous
- 3= Opens to voice
- 2= Opens to pain
- 1= no response

Speech (5)

• 5= spontaneous, orientated speech
• 4= Disorientated speech
• 3= Confused speech
• 2= Mumbling

Motor (6)

• 6= Commanded movement
• 5= Localises to pain
• 4= Withdrawal from pain
• 3= Abnormal flexion (decorticate)
• 2= Abnormal extension (decerebrate)

Question 2

Cauda Equina syndrome

• Definition
• Signs and symptoms

Answer 2

Damage of the cauda equina, leading to characteristic set of symptoms:

• Lower back pain
• Sciatica
• Saddle anaesthesia (S3-5)
• Urinary retention/ incontinence
• Fecal incontinence
• Absent ankle reflux

Question 3

Cauda Equina syndrome

- Causes

Answer 3

Disc herniation
- Commonly at L4/5, L5/S1

Spinal vertebral fractures/ subluxation

Neoplasm

Infection- abscess, TB

Lumbar spinal stenosis

Inflammatory

• Paget
• Ankylosing spondylitis
• Neurosarcoidosis

Question 4

Cauda equina syndrome

- Investigations

Answer 4

Post void bladder scan
- Looks for urinary retention

Pin prick around saddle region
- Anesthesia/ paraesthesia of s3-5 regions.

DRE
- Testing anal reflex (which will be absent)

MRI of spine
- Looking for etiology

Question 5

Cauda equina syndrome

- Management

Answer 5

Surgical spinal decompression
- Must be done 6-48 hours of developing symptoms from compressive lesion

Steroids if inflammatory cause

Antibiotics to treat infection

Question 6

Antibiotics associated with C. difficile

Answer 6

Risk factors= PPI

Clindamycin

Second and third generation cephalosporins

Fluoroquinolones (ciprofloxacin)