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1

Range of the glasgow coma scale?

3-15 ( 15 most consciousness)

2

way to asses level of consciousness?

AVPU
alert
verbal
pain
unresponsive

3

Structural causes of impaired consciousness?

internal
external

4

Global failure causes of impaired consciousness?

metabolism
infection
drugs/alcohol
seizures

5

external causes?

head injury most common
trauma

6

internal causes?

vascular - stroke - ischaemic/haemorrhagic
tumour - benign/primary/secondary
abscess

7

Metabolism causes?

hypoglycaemia
liver/renal failure
hypoxia
hyperaepnia
hypornatraemia
hypercalcaemia
hyperthyroidism
hypotension

8

Infection causes?

of brain - encephalitis, meningitis, malaria/other tropical diseases
of body - any other severe infection e/g pneumonia

9

drug causes?

opiates
alcohol
recreational drugs
overuse of sedative meds

10

what causes seizures/epilepsy?

excess electrical activity

11

pt has impaired consciousness, how to act?

ABCDE
identify and treat cause

12

what is epilepsy?

excessive electrical discharges in the brain

13

types of seizures?

focal/partial seizures - depends on what part of brain affected

generalised seizures - whole brain affected

14

simple focal seizures are?

shaking on one side

15

complex partial seizures are?

temporal lobe related
auras - olfactory hallucinations followed by odd behavious - automatisms

16

generalised seizures are usually?

grand mal/tonic clonic
tonic phase - limbs stiffen
clonic phase - limbs shake
may be incontinence, tongue biting, cyanosis
headache drowsy after

17

what are petit mal seizures?

type of generalised
-absence seizures - children- stare into space for 10 secs
-myoclonic - limbs jerk and collapse
-atonic - limbs collapse

18

primary causes of epilepsy?

often hereditaty involvement

19

secondary causes of epilepsy?

structural damage
-acute/chronic - b/c stroke,tumour, injury, meningitis
-metabolic - electrolyte disturbance, alcohol withdrawl, hypoglycaemia. always check blood sugar

20

investigations for epilepsy?

blood tests
brain imaging - MRI
electroencephalogram EEG

21

drug tx of epilepsy?

phenytoin
carbamazepine
sodium valproate

22

surgical tx of epilepsy?

tumour removal, arteriovenous malformations, poorly controlled primary epilepsy

23

avoid treating epileptic pt when?

epilepsy poorly controlled

24

divisions of headaches?

primary headache disorders
secondary headache disorders - associated with mortality/permanent disability

25

red flags with headaches?

-severity - sudden onset
-raised intracranial pressure - worsening on positional change/strain, present on waking, nausea/vomitting
-focal neurology
-visual changes
-impaired consciousness/confusion
-meningism, fever, rash
associated with cancer or HIV

26

types of primary headaches?

tension
migraines
cluster
medication overuse
trigeminal neuralgia

27

what is a tension headaches?

stress related - tight band symmetrical around head
chronic, gradual onset
worse at end of day

28

treatment of a tension headache?

concentional analgesics
tricyclic antidepressants for prophylaxis

29

what is a migraine?

temporary reduction in blood flow then compensatory excess blood flow
8% more common in females

30

migraine triggers?

often none or
wine, cheese, chocoalte, OCP, premenstrual, anxiety, exercise, fasting, sleep deprivation