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HD 4 - dental relevance > Neurological + special senses > Flashcards

Neurological + special senses Flashcards

(94 cards)

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1
Q

in how many hours does a TIA take to resolve?

A

24 hours

usually less than 1 hour

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2
Q

2 types of strokes + their percentage chance

A

infarction = 90%

haemorrhage = 10%

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3
Q

what scale is used for diagnosis of strokes?

A

ROSIER

+1 for asymmetrical face, arm, leg weakness, speech, visual

-1 loss of consciousness, seizure activity

score 1-5 likely stoke

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4
Q

what scale is used to determine stroke risk after TIA?

A

ABCD2

score 0-3 - aspirin + investigate in 2 weeks
score 4-7 - aspirin + assessment within 24hrs

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5
Q

main dental relevance of strokes?

A

pts on antithrombotic drugs

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6
Q

3 stages of swallowing

A

mastication
pharyngal stage
oesophageal stage

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7
Q

4 main causes of swallowing problems

A
  1. strokes
  2. neurological disease
  3. mechanical obstruction
  4. oesophageal motility disorders
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8
Q

how to assess swallowing if suspected mechanical obstruction?

A

barium swallow/upper endoscopy

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9
Q

what is achalasia

A

problem with plexus of nerves that controls peristalsis + LOS doesn’t open properly

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10
Q

what cranial nerve is tested with tuning fork test?

A

8th - vestibulocochlear

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11
Q

what are the 2 types of deafness?

A

conductive - air not transported - normally wax

sensory neural - 8th cranial nerve

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12
Q

2 tests to distinguish conductive + sensory deafness

A

rinne test - if bone connectivity > air conductivity = conductive deafness

weber test - if sound on same side as problem = conductive, if contralateral = sensory

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13
Q

what is glue ear?

A

otitis media - infection of middle ear causing inflammation + fluid build up

‘blue’ ear in children

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14
Q

what are grommets?

A

tubes that help drainage from middle to outer ear

cleft pts usually fitted with grommets due to association with Eustachian tube

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15
Q

2 places ear infections can spread?

A

up to Brian

backwards to mastoid

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16
Q

if an elderly pt presents with an enlarged temporal artery, headache and visual problems what is presumed until proven otherwise?

A

temporal arteritis/giant cell arthritis

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17
Q

triad of symptoms for behcets disease ?

A

oral ulceration
genital ulceration
uveitits

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18
Q

how do you test for behcets?

A

stick needle under skin, check for over response/red mark in a couple of days

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19
Q

2 examples of mucous membrane disorders that can effect the eye?

A

Steven johnson syndrome

mucous membrane pemphigoid

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20
Q

histological characteristic of mucous pemphigoid?

A

basement membrane antibody accumulation

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21
Q

histological characteristic of mucous pemphigus?

A

intracellular antibody accumulation

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22
Q

difference between pemphigoid + pemphigus?

A

pemphigoid = basement membrane - don’t pop

pemphigus = epidermis - pop

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23
Q

triad of symptoms for sjogrens syndrome?

A

dry eyes, dry mouth, dry tissue

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24
Q

what are eye blow fractures associated with?

A

zygomatic fractures

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25
orbital cellulitis could be caused by what dental problem
tooth ache
26
CN 1
olfactory smell
27
CN2
optic sight
28
CN3
oculomotor movement of eye
29
CN4
trochlear movement of eye
30
CN 5
trigeminal sensory motor - MOM
31
CN 6
abducens eye movement
32
CN 7
facial motor - facial expression, lacrimation sensory - taste ant 2/3
33
CN 8
vestibulocochlear hearing + balance
34
CN 9
glossopharyngeal sensory - taste post 1/3 motor - stylopharyngeas contort - gag reflex
35
CN 10
vagus sensory - throat, abdomen, aortic body motor - muscles of pharynx, smooth muscles of glands of thorax + abdomen
36
CN 11
accessory shoulder shrug
37
CN 12
hypoglossal tongue
38
what is bells palsy?
exclusion diagnosis for facial palsy
39
does bells palsy effect upper or lower motor neurones of facial nerve?
lower
40
a lower motor neurone lesion of VII causes what sort of facial palsy?
total facial palsy on ipsilateral side
41
characteristic of upper motor neurone lesion of VII?
forehead spared, lower facial palsy on contralateral side eg. from stroke/tumour
42
how to test trigeminal nerve?
stoke both sides of face on forehead, maxilla + mandible look for altered sensation between sides
43
how to test motor facial nerve?
raise eyebrows/close eyes/smile/blow cheeks out check same power on both sides
44
how to test glossopharyngeal + vagus nerve?
say ahh - look for symmetry on soft palate - would be pulled to good side + weak side floppy
45
how to test accessory nerve?
shoulder shrug
46
how to test hypoglossal nerve?
stick tongue out - will go towards weak side as strong side pushes it
47
what does syncope mean?
temporary loss of consciousness
48
why do vasovagal syncopes happen?
over-activity of sympathetic NS in response to external stimuli e.g. fear tachycardia before, bradycardia after
49
why do carotid sinus syncopes happen?
turning head - pressure on carotid sinus most common in supine position - legs higher than heart doesn't recover as quickly as vasovagal treatment - jaw thrust/straighten neck
50
oral issues in gran Mal epilepsy? and which phase is this in?
increased salivation + bruxism clonic phase
51
when does epilepsy become a medical emergency? and how is it treated?
after 5 mins O2 15litres/min + 10mg midazolam buccal cavity
52
what causes stoke Adams attacks?
cardiac arrhythmias
53
what is PRIND?
progressive reversible ischemic neurological deficit half way between TIA + stroke
54
basic cause of multiple sclerosis?
demyelination
55
dental relevance of multiple sclerosis?
lose control of airway - can't cough up
56
what should always be suspected in a young female patient presenting with trigeminal neuralgia?
multiple sclerosis
57
basic MOA of Parkinson's?
degeneration of pigmented cells of substantial migration leading to dopamine deficiency
58
how does Parkinson's affect blood pressure?
hypotension impaired autonomic function leading to postural drop in BP medications may cause hypotension
59
dental relevance of motor neurone disease?
hard to cough + swallow
60
headache characteristic of brain tumour?
headache worse in morning
61
which cranial nerves are affects in bulbar palsy?
IX, X, XI, XII
62
what is bulbar palsy?
palsy of tongue, MOM/swallowing + facial muscles due to loss of function of motor nuclei in brain stem
63
2 causes of bulbar palsy?
acute - infection e.g. polio | chronic - tumour
64
what antipsychotic drug can cause drug induced tics?
phenothiazine therapy
65
what is Ramsay hunt syndrome?
facial paralysis with vesicles in pharynx + external auditory meatus of same side geniculate ganglion of VII infected with herpes zoster
66
what can be a cause of bacterial meningitis?
maxillofacial injuries involving mid third of face bacteria in through nasal/ethmoidal/frontal sinus
67
what is kernigs sign?
inability to straighten left when hip flexed at 90 degrees sign for meningitis
68
is viral or bacteria meningitis self limiting?
viral
69
how to test for meningitis rash?
press with glass, doesn't fade
70
upper incisor infection may cause brain abscess, which patients are most at risk?
patients with congenital heart disease
71
what causes cerebral palsy?
motor function disorder secondary to cerebral damage - birth injury/hypoxia
72
what deficiency causes spina bifida?
folic acid
73
what is Huntington's chorea?
genetic dementia - progressive death of brain cells autosomal dominant marked involuntary movements
74
anticonvulsant drug dentists can prescribe to treat neuralgia?
carbamazepine
75
how does carbamazepine work?
blocks Na channels via a-beta fibres
76
what are the 2 types of neuropathic pain?
1. neuralgia - rare + short lived | 2. constant neuropathic pain
77
2 MOA of anticonvulsants?
1. inhibition of ionic channels 2. enhancement of GABA mediated inhibition both inhibit rapid repetitive firing that causes seizures
78
how do benzodiazepines work as anticonvulsants?
increase GABA through Cl
79
as well as seizures what else can anticonvulsants be used for?
neuropathic pain
80
drug of choice for status epileptics?
BDZ - midazolam not drug of choice for prophylactically because of dependance
81
NNT of carbamezapine to treat trigeminal neuralgia and reduce pain by 50%?
<2
82
3 common side effects of carbamezapine?
1. Steven johnson syndrome 2. blood dycrasias 3. liver disorders
83
who must you be careful in prescribing carbamezapine too?
chinese/thai/malaysian race
84
common dental effects of the anticonvulsant phenytoin?
``` gingival overgrowth root shortening hypercementosis salivary gland hypertrophy cervical lymphadenopathy cleft lip + palate ```
85
common dental effects of the anticonvulsant carbamazepine ?
``` xerstomia glossitis ulceration cervical lymphadenopathy cleft lip + palate ```
86
how many pathways make dopamine + transport it in the brain? and which is most important to Parkinsons disease?
4 nigrostriatal system
87
when dopamine activity decreases what increases?
Acetylcholine actiivty - excitatory
88
2 classes of antiparkinsonian medication?
1. dopaminergic drugs | 2. anticholinergic drugs
89
can dopamine cross the BBB?
no - need precursor
90
what is levodopa?
precursor of dopamine tyrosine --> levodopa --> dopamine
91
4 ways dopaminergic medications work?
1. precursor of dopamine 2. decrease dopamine metabolism 3. direct dopamine synthetic agonists 4. stimulate dopamine release
92
why must you avoid IV sedation in degenerative disorders?
levodopa antagonised by BDZs
93
oral effect of antiparkinson drugs?
xerostomia
94
when should dentists see PD patients?
on 'on' times - usually 60-90mins after meds normally better in morning

HD 4 - dental relevance (12 decks)

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