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Flashcards in Neurology Deck (98)
1

Define impaired consciousness.

the loss of normal level of awareness

2

what is the spectrum of impaired consciousness? from ? to ?

mild confusion to unrousable coma

3

what does GCS stand for?

glasgow coma scale

4

what is the minimum and maximum scores on the GCS?

3 - 15

5

what are the 3 subsections in the GCS?

- movement
- speech
- eye opening

6

how many points can you get in movement in GCS?

6

7

how many points can you get in speech in GCS?

5

8

how many points can you get in eye opening in GCS?

4

9

The lower the GCS score, the...

less conscious (the greater the impaired consciousness)

10

what does AVPU stand for?

Alert
Verbal
Pain
Unresponsive

11

give the 2 broad causes of impaired consciousness.

- structural damage
- global failure

12

what are the 2 types of structural damage? causing impaired c

1. external (head injury)
2. internal (stroke, tumour, abscess etc)

13

what are the 4 types of global damage? causing impaired c

- metabolism
- infection
- seizure
- drugs & toxins

14

name 3 types of infections affecting the brain.

- meningitis
- malaria
- encephalitis

15

name 3 other severe infections that could affect the brain.

- urine
- GI
- pneumonia

16

Examples of drugs that can cause impaired conscious are..

- alcohol
- opiates
- 'recreational drugs'
- anti-depressants
- anti-epileptics
- tranquilliser
- benzodiazepines

17

the 3 stages of treatment for impaired consciousness are..

1 - ABCDE
2 - Identify causes
3 - treat cause

18

define epilepsy

excessive electrical discharge in the brain

19

what are the 2 clinical features of epilepsy?

- focal (partial) seizures
- generalised seizures

20

what are the 2 types of focal seizure?

- simple and complex

21

indications of a simple focal seizure?

shaking down one side

22

indications of a complex focal seizure?

1st an aura
2nd odd behaviour (lip smacking, staring, odd posture, "out of it")

23

name 4 generalised seizures?

1. tonic/clonic
2. petit mal
3. myoclonic
4. atonic

24

what is a petit mal seizure and who do they effect?

absence seizure in children (staring into space for 10 sec)

25

what happens during a myoclonic seizure?

limbs jerking and collapse

26

what happens in a atonic seizure?

limbs collapse

27

what are some causes of epilepsy?

primary - hereditary
secondary
- structural damage
- metabolic damage

28

3 ways to investigate epilepsy?

- blood tests
- brain imaging
- EEG

29

2 ways to treat epilepsy

1. drugs
2. surgery

30

name 4 drugs that can be given to treat epilepsy?

- phenytoin
- carbamazepine
- sodium valproate
- lamatorigine

31

what are 2 surgery options that can help some kinds of epilepsy?

- tumour removal
- arteriovenous malformation

32

when to avoid dental treatment with an epileptic patient?

if not well controlled

33

what are the red flags that indicate secondary headache disorders? (8)

1. sudden onset
2. severe pain
3.features of raised intracranial pressure signs are
- worse on change in position
- present on walking
- nausea and vomiting
4. focal neurology (CNS deficit = weakness in limbs)
5. impaired consciousness/confusion
6. fever - meningitis?
7. associated history ie cancer/HIV
8. visual changes

34

name 5 types of primary headache disorders.

- tension headache
- migraine
- cluster headache
- medication overuse headache
- trigeminal neuralgia

35

symptoms of a tension headache are...

- gradual onset (chronic)
- symetrical
- 'tight band' feeling
- worse towards end of the day

36

what is the cause of tension headache?

stress related

37

what are the 2 treatment options for tension headache?

- conventional analgesic
- tricyclic anti depressants for prophylaxis

38

define a migraine.

the temporary reduction in blood flow, followed by compensatory increase in blood flow

39

what is the incidence of migraines?

common
8% more in females

40

what are common triggers of migraines?

- often none
- wine, cheese, chocolate, fasting
- OCP, premenstrual
- anxiety, sleep deprivation

41

how long does the pre headache 'aura' typically last for?

15 mins

42

what are 3 symptoms of a migraine?

- one sided throbbing pain
- nausea and vomiting
- photophobia

43

what are the 3 treatment options for acute migraines?

- conventional analgesics
- metoclopramide - to prevent nausea
- serotonin agonists (sumatriptan)

44

what are the 3 types of drugs that can be given in chronic migraines? what else can be done - other than drugs

- anti-epilptics
- amitriptyline
- beta blockers

- avoidance of triggers

45

define cluster headaches.

the dilation of superficial temporal artery

46

cluster headaches are more common in men or women?

men

47

what are the symptoms of cluster headache?

severe pain around the eye
- watery
- blood shot
- lid swelling
- running nose

48

what is the onset and duration of cluster headaches?

-rapid onset
-lasting

49

name two drug groups that give the greatest risk of medication overuse heachache?

- opiates
- triptans (serotonin receptor agonists)

50

how to manage medication overuse headaches?

- medication withdrawal

51

what brings about pain from trigeminal neuralgia?

- touch ( shaving, washing, talking )
or
- spontaneous

52

management of trigeminal neuralgia is

- rule out other causes
- carbamazepine

53

give 5 causes of secondary headache disorders

- head injury
- infection (eg meningitis)
- non-traumatic bleeds
- giant cell arteritis (temporal arteritis)
- glaucoma (increased pressure in eyeball)

54

what is hydrocephalus?

a drainage problem that can follow
- head injury
- tumour
- infection
or can be idiopathic

55

4 causes of raised intracranial pressure are...

- tumour
- bleeds (either head injury or non-traumatic)
- hydrocephalus
- abscess

56

how can raised intracranial pressure be diagnosed?

CT scan

57

name the 3 types of bacterial meningitis.

1. meningococcus
2. pneumococcus
3. haemophilus

58

who is affected by meningococcus meningitis? how is it spread?

- infants
- adolescents
- young adults

spread through contact

59

who is affected by pneumococcus meningitis?

- babies
- elderly

60

who is affected by haemophilus meningitis?

- babies
- infants

61

what are the 5 common symptoms of meningitis?

1. impaired consciousness
2. meningism = neck stiffness
3. drowsy
4. photophobia
5. +/- rash with meningococcus

62

2 ways that meningitis can be diagnosed are...

1. lumbar puncture = spinal fluid collected
2. blood clutures

63

management of meningitis?

- urgent hospitalisation
- empirical antibiotics
- prophylaxis for contacts

64

define encephalitis

Inflammation of the brain parenchyma

65

what is the cause of encephalitis?

viral infections
- herpes simplex
- varicella zoster
- rabies

66

associated features of encephalitis are... 4 things

- impaired consciousness
- personality changes
- menigism (neck stiffness)
- seizures

67

2 ways to diagnose encephalitis...

1. lumbar puncture
2. EEG

68

2 ways to mange encephalitis?

- hospitalisation
- anti-virals

69

the most common cerebral abscess is caused by what?

streptococci or staphlococci infections from
- otits mitus
- mastoiditis
- sinusitis
- dental infections

70

what is otitus mitus?

inflammation of the middle ear

71

what is mastoiditis?

inflammation of the mastoid process

72

what is sinusitis?

inflammation of the nasal sinus

73

name the 3 types of infections causing secondary headache disorders are?

- meningitis
- encephalitis
- cerebral abscess

74

symptoms of cerebral abscess are?

- increased intracranial pressure
- focal neurology

75

2 ways that cerebral abscess can be diagnosed are?

- CT scan (MRI better)
- biopsy/surgery sample

76

what is the 2 ways to manage a cerebral abscess

1. antibiotics
2. drainage

77

name the 2 types of non-traumatic cerebral bleed?

1. sub-arachnoid haemorrhage (SAH)
2. intracerebral haemorrhage (ICH)

78

where in the brain is affected by a SAH?

the subarachnoid space

79

where in the brain is affected by ICH?

bleed is directly into the brain tissue

80

in 70% of SAH what happens and why?

rupture due to congenital berry aneurysm

81

in one 15% of SAH what happens? and the other 15%?

15% = no cause
15% = rupture due to arterovenous malformation

82

what is ICH associated with?

hypertension

83

what can ICH also be called?

charcot-bochard aneurysms

84

what is the incidence of SAH?

35-65 year olds
15 in 100,000

85

4 symptoms of SAH?

- sudden severe headache (often occipital area)
- drowsy
- vomiting
- collapse

86

true or false
ICH is always accompanied by a headache.

False

87

what 2 additional symptoms (from SAH) are present with ICH?

- focal neurology
- raised intracrainal pressure

88

how would you diagnose ICH?

imaging

89

how would you diagnose SAH? 2 things

- CT scan +/- angiogram
- lumbar puncture

90

how common is re-bleeding in SAH? what %

30% re-bleeding

91

what are the two treatment options?

- surgery (clipping)
- coils - probs preferred option

92

what is giant cell arteritis?

where the medium and large arteries in the neck become inflamed

93

who is most likely to be affected by giant cell arteritis?

over 55

94

what are the 3 main concerns with someone who had giant cell arteritis?

risk of
-blindness
-stroke
-death

95

what are the 3 main clinical features of giant cell arteritis/

1. scalp tenderness (esp at the temporal area)
2. jaw claudication - pain when chewing
3. loss of vision

96

what are the 2 investigations into giant cell arteritis?

1. blood samples - ESR/PV
2. Temporal artery biopsy

97

what is the treatment for giant cell arteritis?

HIGH dose IMMEDIATE prednisolone

98

symptoms of glaucoma are?

- constant ache around 1 eye
- reduced vision
- watery eye, blood shot red
- dilated and non reactive pupils
- nausea and vomiting