Neurology 1 Flashcards

(64 cards)

1
Q

Range of the glasgow coma scale?

A

3-15 ( 15 most consciousness)

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2
Q

way to asses level of consciousness?

A
AVPU
alert
verbal
pain
unresponsive
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3
Q

Structural causes of impaired consciousness?

A

internal

external

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4
Q

Global failure causes of impaired consciousness?

A

metabolism
infection
drugs/alcohol
seizures

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5
Q

external causes?

A

head injury most common

trauma

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6
Q

internal causes?

A

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

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7
Q

Metabolism causes?

A
hypoglycaemia
liver/renal failure
hypoxia
hyperaepnia
hypornatraemia
hypercalcaemia
hyperthyroidism
hypotension
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8
Q

Infection causes?

A

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

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9
Q

drug causes?

A

opiates
alcohol
recreational drugs
overuse of sedative meds

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10
Q

what causes seizures/epilepsy?

A

excess electrical activity

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11
Q

pt has impaired consciousness, how to act?

A

ABCDE

identify and treat cause

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12
Q

what is epilepsy?

A

excessive electrical discharges in the brain

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13
Q

types of seizures?

A

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

generalised seizures - whole brain affected

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14
Q

simple focal seizures are?

A

shaking on one side

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15
Q

complex partial seizures are?

A

temporal lobe related

auras - olfactory hallucinations followed by odd behavious - automatisms

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16
Q

generalised seizures are usually?

A
grand mal/tonic clonic
tonic phase - limbs stiffen
clonic phase - limbs shake
may be incontinence, tongue biting, cyanosis
headache drowsy after
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17
Q

what are petit mal seizures?

A

type of generalised

  • absence seizures - children- stare into space for 10 secs
  • myoclonic - limbs jerk and collapse
  • atonic - limbs collapse
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18
Q

primary causes of epilepsy?

A

often hereditaty involvement

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19
Q

secondary causes of epilepsy?

A

structural damage

  • acute/chronic - b/c stroke,tumour, injury, meningitis
  • metabolic - electrolyte disturbance, alcohol withdrawl, hypoglycaemia. always check blood sugar
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20
Q

investigations for epilepsy?

A

blood tests
brain imaging - MRI
electroencephalogram EEG

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21
Q

drug tx of epilepsy?

A

phenytoin
carbamazepine
sodium valproate

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22
Q

surgical tx of epilepsy?

A

tumour removal, arteriovenous malformations, poorly controlled primary epilepsy

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23
Q

avoid treating epileptic pt when?

A

epilepsy poorly controlled

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24
Q

divisions of headaches?

A

primary headache disorders

secondary headache disorders - associated with mortality/permanent disability

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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
31
features of a migraine?
pre headache aura for 15 mins - usually visual headache within one hour one side throbbing, nausea, vomitting, photophobia
32
treatment of a migraine?
acute - analgesia, metoclopramide. serotonin antagonists
33
prevention of migraines?
anti epileptics beta blockers amitryptiline avoidance of triggers
34
what is a cluster headache?
dilation of superficial temporal artery most common in male smokers rapid onset episodic -
35
medication overuse headache?
chronic headaches | opiates/triptans = most risky
36
what are trigeminal neuralgia headaches?
intense stabbing pain 10/10 severity precipitated by touch - shaving, washing,talking paroxysmal = spontaneous tx with carbamazepine
37
increased intracranial pressure caused by?
tumours non traumatic bleeds hydrocephalus = drainage problem - trauma, bleed, tumour, infection, abscess
38
diagnose raised intracranial pressure with?
CT scan
39
what is bacterial meningitis?
contact spread, common in infancts, adolescents, young adults pneumococcal - babies and elderly haemophilius - babies and infants
40
feautures of bacterial meningitis?
``` impaired consciousness meningism +/- rash drowsy photophobia ```
41
diagnose meningitis with?
lumbar punctures | blood cultures
42
treatment of bacterial meningitis?
empirical antibiotics if suspected in the community hospital prophylaxis for contacts
43
what is enchepalitis?
inflammation of brain parenchyma | by viral infection - herpes simplex, varicella zoster, rabies
44
symptoms of enchepalitis?
impaired consciousness, personality change, meningism, seizures
45
diagnose enchepalitis?
lumbar puncture, ECG
46
treat encheplalitis?
antivirals, hospital
47
abscess caused by?
staphylococci/streptococci | ostitis media/mastoidosis, sinusitis, infections, trauma
48
abscess can cause?
raised intracranial pressure
49
how to diagnose an abscess?
CT/MRI | biopsy
50
Non traumatic bleed divisions?
SAH - sub arachnoid hemorrhage | ICH - intracerebral hemorrhage
51
what is a SAH?
blood in the sub arachnoid space 70% rupture - congenital berry aneurysm 15% rupture - anteriovenous malformation 15% = no cause
52
SAH incidence?
between 35-65 years | 15 per 100 000
53
SAH symptoms?
sudden severe headache often occipital vomit/collapse/drowsy
54
SAH diagnosed how?
CT scan +/- angiography to see aneurysm | lumbar puncture in necessary
55
how to prevent re bleed?
surgery - clip coils poss. residual disability
56
what is an intercerebal heamorrhage?
directly into brain tissue | associated with hypertension - charcot bouchard aneurysms
57
symptoms of intercerebral haemorrhage?
increased intracranial pressure focal neurology not always headaches
58
how to diagnose ICH?
imaging
59
how to tx ICH?
surgery | rehabillitation
60
what is giant cell arteritis?
``` rare under 55 years old scalp tenderness jaw claudication loss of vision risk of blindness, stroke, death ```
61
tests for giant cell arteritis?
ESR, PV, temporal artery biopsy
62
tx giant cell arteritis?
high dose prednisolone, immediately
63
what is glaucoma?
``` common in elderly constant ache around eye reduced vision nausea and vomitting red congested eye, dilated, non reactive pupil ```
64
tx gluacoma?
urgent opthamology ref