case 10

Question 1

What does the Glasgow Coma Scale look at?

Answer 1

eye
speech
motor

Question 2

What is the reticular activating system formed by?

Answer 2

• midbrain reticular formation
• mesencephalic nucleus
• thalamic intralaminar nucleus
• dorsal hypothalamus
• tegmentum

Question 3

How can be define consciousness (in relation to neuronal activity)?

Answer 3

-neural activity of reticular activating system:

auditory, visual and ascending sensory tracts

Question 4

What are the three phases of anaesthesia?

Answer 4

• induction
• maintenance
• recovery

Question 5

What is the triad of general anaesthesia?

Answer 5

hypnosis
analgesia
muscle relaxation

Question 6

What hypnotics are there?

Answer 6

• propofol
• barbituates
• benzodiazepines
• isoflurane (trichloethylone, halothane, enflurane)

Question 7

What analgesics are there?

Answer 7

opiates ie fentanyl

Question 8

What muscle relaxants are there?

Answer 8

-depolarising
suxamethonium

-non-depolarising
atracium

Question 9

Which type of muscle relaxant do you need to give for intubation?

Answer 9

non depolarising

ie atracium

Question 10

What is solubility and potency of drug? (inhalant gas)

Answer 10

• solubility = how it dilutes in the blood (you want it to have low solubility to be faster acting)
• potency = lipid solubility: enter membrane faster

Question 11

What do you use to measure blood gas solubility (coefficient)?

Answer 11

Oswald coefficient

Question 12

How do hypnotics work?

Answer 12

-disrupt synaptic transmission
(pure-synaptic membrane, altering reuptake, altering binding, altering activation/ionic conduction of postsynaptic membrane)

-direct action on neuronal plasma membrane

Question 13

What do you use to measure lipid solubility and anaesthetic potency?

Answer 13

Meyer-Overton theory

Question 14

What are the different mu receptors and what do they do?

Answer 14

Mu1: analgesia
Mu2: respiratory depression
Mu3: vasodilation
+ dependence, constipation, nausea, vomitting, confusion, dysphoria, meiosis

Question 15

What do you use in opiate over dose?

Answer 15

naloxone (bids to receptor without being potent: dislodges opiate)

Question 16

How does suxamethonium work?

What are the adverse effects?

Answer 16

• depolarising blocker: binds to ACh receptors and blocks them (very profound relaxation)
• but short acting (broken down by AChE)

AE: muscle pain, hyperkalaemia, malignant hyperthermia, anaphylaxis

Question 17

How does curare/atracium work?

What are the adverse effects?

Answer 17

• non depolarising blocker; structurally similar to ACh –> dipoles ACh but doesn’t cause depolarisation
• long acting: competitive inhibitor, effect is concentration dependent (if increase ACh concentration, will no longer have inhibition because it will be displaced)

AE: hypotension, histamine release, wheeze, tachycardia or bradycardia, anaphylaxis, complete reversal)

Question 18

How does neostigmine work? when is it given? With what is it given?

Answer 18

• reverse muscle relaxation: anti cholinesterase: stops breakdown of ACh: ACh builds up and start to displace the other drugs
• given with glycopyrrolate: prevents neostigmine muscarinic effects

Question 19

How does propofol work?

Answer 19

binds oto beta subunit on GABA-A receptor

Question 20

When do you use a neuropsychological assessment?

Answer 20

test people with known/possible neurologic or neuropsychiatric conditions

Question 21

What do you test in a neuropsychological assessment?

Answer 21

• range of cognitive abilities/deficits that ate known to be linked to brain structures/pathways
• personal/interpersonal and contextual factors: psychological function

Question 22

Why do you do a neuropsychological assessment?

Answer 22

• measuring cognitive defects/strength
• differential diagnosis
• guide rehab strategy
• monitor changes over time
• scientific investigation
• medico-legal evaluation

Question 23

How is neuropsychological assessment carried out?

Answer 23

(imaging, spinal fluid, evoked potentials, vestibular functioning etc)

1. basic neurological exam
2. interviews, observation behavioural rating
3. full measurement using standardised measures (cognitive functions including perception, memory, language and intellectual abilities)

–> rehab plan

Question 24

Which cognitive functions are measured?

Answer 24

• perception
• memory
• language
• intellectual ability