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Questions and Answers

Folic acid deficiency can manifest in which of the following ways?

  • Inability to walk
  • Epilepsy
  • Learning difficulties
  • All of the above (correct)

Huntington's disease is characterized by a reduction in which neurotransmitters within the corpus striatum?

  • GABA and Cholinergic Neurones (correct)
  • Adrenaline and Noradrenaline
  • Dopamine and Serotonin
  • Histamine and Melatonin

Which of the following is NOT a risk factor explicitly mentioned for epilepsy?

  • Brain tumors
  • Cerebral palsy
  • High cholesterol (correct)
  • Brain haemorrhage

If an individual has the gene for Huntington's disease, what is the likely disease progression?

<p>They may develop the disease, with symptoms typically appearing in middle age. (A)</p> Signup and view all the answers

At a cellular level, a seizure can result from an imbalance between excitatory and inhibitory neurotransmitters. Which of the following scenarios would be most likely to induce a seizure?

<p>Increased glutamate activity coupled with decreased GABA activity. (A)</p> Signup and view all the answers

What is the primary treatment for a brain abscess?

<p>Localized CT/MRI followed by Urgent surgical drainage and removal of underlying cause. (C)</p> Signup and view all the answers

A patient presents with severe facial paralysis accompanied by vesicles in the pharynx and external auditory meatus on the same side. Which condition is most likely?

<p>Ramsay Hunt Syndrome (B)</p> Signup and view all the answers

What is a key characteristic of a meningitis rash that differentiates it from other types of rashes?

<p>It remains red even when pressure is applied with a glass. (B)</p> Signup and view all the answers

What is the MOST common cause of Cerebral Palsy?

<p>Birth Injury/Hypoxia (C)</p> Signup and view all the answers

Why might bacterial meningitis occur following maxillofacial injuries, and which specific area of the face is most implicated in increasing this risk?

<p>Introduction of bacteria into the central nervous system; mid third of face (B)</p> Signup and view all the answers

From which anatomical structure do most cranial nerves originate?

<p>Brain stem (B)</p> Signup and view all the answers

During cranial nerve examination, what does the acronym 'W.I.P.E' primarily represent?

<p>Wash, introduce, patient details, explanation (C)</p> Signup and view all the answers

When assessing the olfactory nerve (CNI), what specific instruction should be given to the patient before presenting an odor?

<p>Close their eyes and block one nostril (A)</p> Signup and view all the answers

In a cranial nerve examination, which of the following is NOT typically assessed when evaluating the optic nerve (CNII)?

<p>Sense of smell (B)</p> Signup and view all the answers

A patient reports anosmia following a traumatic brain injury. Assuming no other cranial nerve damage, which of the following cranial nerves is MOST likely affected?

<p>Olfactory nerve (CNI) (B)</p> Signup and view all the answers

What is the primary distinction between a neurologist and a neurosurgeon?

<p>A neurologist primarily manages the medical aspects of neurological disorders, whereas a neurosurgeon specializes in the surgical treatment of these conditions. (B)</p> Signup and view all the answers

Which of the following neurological conditions is characterized by recurrent seizures?

<p>Epilepsy (A)</p> Signup and view all the answers

Why is understanding neurological disorders particularly important in the field of dentistry?

<p>The positioning of patients with neurological conditions, risk of aspiration, and medication effects can significantly affect dental treatment planning and delivery. (C)</p> Signup and view all the answers

In diagnosing syncope and blackouts, what is considered the MOST crucial element for a clinician to obtain?

<p>Detailed patient history (A)</p> Signup and view all the answers

Vaso-vagal syncope is primarily caused by:

<p>Over-activity of the sympathetic nervous system resulting in sudden vasodilation and reduced blood pressure. (D)</p> Signup and view all the answers

Carotid sinus syncope is characterized by fainting episodes potentially triggered by:

<p>Specific head movements or pressure on the neck. (A)</p> Signup and view all the answers

Which historical detail is MOST indicative of an epileptic seizure rather than other causes of loss of consciousness?

<p>Loss of consciousness associated with altered breathing, cyanosis, and tongue biting. (C)</p> Signup and view all the answers

Why is it critical for dental professionals to inquire about the effectiveness and patient compliance with epilepsy medication?

<p>Poorly controlled epilepsy or medication non-compliance raises the risk of seizures during dental procedures and indicates potential issues with treatment adherence in general. (A)</p> Signup and view all the answers

Which of the following is NOT typically considered a direct trigger for seizures?

<p>Dehydration (C)</p> Signup and view all the answers

In describing a seizure, which aspect is LEAST relevant according to established classification methods?

<p>The color of the patient's face during the seizure (B)</p> Signup and view all the answers

A patient experiencing muscle stiffness followed by a fall backwards is MOST likely experiencing which type of seizure?

<p>Tonic seizure (B)</p> Signup and view all the answers

What key feature distinguishes a complex partial seizure from a simple partial seizure?

<p>Loss of consciousness or awareness (B)</p> Signup and view all the answers

A child is observed to have brief periods of 'spacing out' or daydreaming, often without any convulsions. Which type of seizure is MOST likely occurring?

<p>Absence seizure (A)</p> Signup and view all the answers

Which of the following seizure types is characterized by a sudden decrease in muscle tone, potentially leading to a forward fall?

<p>Atonic (B)</p> Signup and view all the answers

A patient presents with symptoms resembling a seizure, but exhibits behaviors inconsistent with typical epileptic activity. Which differential diagnosis should be given MOST consideration?

<p>Psychogenic non-epileptic seizures (PNES) (B)</p> Signup and view all the answers

According to the diagnostic criteria outlined, under what condition is a patient formally considered to have epilepsy?

<p>After experiencing two or more seizures. (D)</p> Signup and view all the answers

When taking a patient history related to seizures, which aspect is MOST crucial for a neurologist to ascertain?

<p>Events immediately preceding the seizure. (C)</p> Signup and view all the answers

Why are renal function tests included in a full blood count for a patient presenting with seizures?

<p>To evaluate kidney function, as impaired renal function can sometimes contribute to seizures. (B)</p> Signup and view all the answers

An electroencephalogram (EEG) is a valuable diagnostic tool for epilepsy, but what is its primary limitation?

<p>A normal EEG result does not definitively rule out epilepsy. (D)</p> Signup and view all the answers

Cerebral pathology, such as brain tumors or stroke damage, is investigated using MRI or CT scans in patients with seizures. What is the MAIN purpose of these imaging studies in this context?

<p>To identify structural abnormalities in the brain that may be causing seizures. (C)</p> Signup and view all the answers

Phenytoin and carbamazepine, commonly used anti-epileptic drugs (AEDs), share which primary mechanism of action?

<p>Blocking voltage-gated sodium channels. (B)</p> Signup and view all the answers

Which characteristic is shared by phenytoin, carbamazepine, and sodium valproate, making it a significant consideration during pregnancy?

<p>They are all known to be teratogenic. (C)</p> Signup and view all the answers

Gingival hyperplasia is a well-documented side effect associated with which specific anti-epileptic drug?

<p>Phenytoin. (C)</p> Signup and view all the answers

A patient taking phenytoin requires dental treatment. Which of the following medications, commonly used in dentistry, could potentially INTERFERE with phenytoin metabolism, potentially increasing phenytoin levels?

<p>Metronidazole. (A)</p> Signup and view all the answers

Status epilepticus is defined as a seizure lasting longer than:

<p>5 minutes. (A)</p> Signup and view all the answers

During the immediate management of a patient experiencing a tonic-clonic seizure, what action is CONTRAINDICATED?

<p>Restraining the patient's movements to prevent injury. (C)</p> Signup and view all the answers

Which of the following scenarios highlights the importance of understanding neurological disorders in the context of dental practice?

<p>A patient with Parkinson's disease experiencing postural hypotension during dental treatment. (C)</p> Signup and view all the answers

In distinguishing between syncope and other causes of loss of consciousness, what historical sign is MOST indicative of a seizure?

<p>Witnessed tongue biting. (A)</p> Signup and view all the answers

Why is it particularly important to determine if a patient's epilepsy medication is effective and if they adhere to their prescribed regimen?

<p>To ensure the patient does not experience a breakthrough seizure during dental treatment. (C)</p> Signup and view all the answers

A patient experiences syncope while turning their head. Which underlying mechanism is MOST likely responsible for this specific type of syncope?

<p>Hypersensitivity of the baroreceptors in the carotid sinus. (B)</p> Signup and view all the answers

A patient consistently experiences syncope triggered by exposure to heat, fear, or prolonged fasting. Which physiological response is MOST directly implicated in this patient's syncope?

<p>Over-activity of the sympathetic nervous system. (B)</p> Signup and view all the answers

Besides epilepsy and learning difficulties, what other significant motor impairment is associated with folic acid deficiency?

<p>Inability to walk (C)</p> Signup and view all the answers

How is Huntington's disease primarily inherited?

<p>Autosomal dominant (A)</p> Signup and view all the answers

What is the most likely effect on dental treatment if a patient has a neurological disorder?

<p>It may directly impact dental treatment (C)</p> Signup and view all the answers

Which of the following molecular scenarios in the central nervous system is MOST likely to precipitate a seizure?

<p>Increased glutamate release coupled with decreased GABA activity (C)</p> Signup and view all the answers

A researcher is investigating new therapeutic targets for Huntington's disease. Based on the known pathophysiology, which of the following approaches would be MOST promising?

<p>Increasing GABA and acetylcholine levels within the corpus striatum (A)</p> Signup and view all the answers

Ramsay Hunt Syndrome is characterized by facial paralysis and vesicles. Which specific anatomical structure is primarily affected by the herpes zoster virus in this condition?

<p>Geniculate ganglion of the VII cranial nerve (B)</p> Signup and view all the answers

In the context of maxillofacial injuries, particularly those involving the midface, which type of nervous system infection is of heightened concern due to potential breaches in the protective barriers?

<p>Bacterial meningitis (D)</p> Signup and view all the answers

The 'cup test' is a clinical method used to assess a specific type of rash associated with meningitis. If a rash remains visibly red when pressure is applied with a clear cup, what does this indicate about the nature of the rash?

<p>The rash is non-blanching, suggesting it is purpuric or petechial and potentially indicative of meningococcal septicaemia. (C)</p> Signup and view all the answers

While oral sepsis, middle ear infections, and paranasal sinus infections are recognized as potential precursors to brain abscesses, which pre-existing condition significantly elevates the risk of brain abscess formation due to circulatory disturbances?

<p>Congenital Heart Disease (A)</p> Signup and view all the answers

Cerebral Palsy is described as a disorder of motor function resulting from cerebral damage, most frequently associated with birth injury or hypoxia. Considering the pathophysiology, what is the most critical distinction in the nature of cerebral damage in Cerebral Palsy compared to progressive neurodegenerative diseases?

<p>Cerebral Palsy results from non-progressive brain damage occurring during brain development, whereas neurodegenerative diseases involve ongoing and progressive neuronal loss. (A)</p> Signup and view all the answers

For a patient with well-controlled epilepsy, how should dental treatment be scheduled relative to their seizure patterns?

<p>Schedule treatment during 'good' phases of epilepsy, when seizures are least frequent. (A)</p> Signup and view all the answers

Which of the following could potentially INTERFERE with phenytoin metabolism, potentially increasing phenytoin levels in a patient?

<p>Aspirin (A)</p> Signup and view all the answers

Why is it critical to avoid restraining a patient during a seizure?

<p>Restraining could result in bone fractures or other physical injuries to the patient. (B)</p> Signup and view all the answers

A patient experiencing frequent seizures despite medication requires a full blood count. A finding of elevated C-reactive protein (CRP) MOST strongly suggests the need to rule out what?

<p>Underlying infection exacerbating seizure threshold (B)</p> Signup and view all the answers

A known epileptic patient presents to your dental practice. During conversation, they mention they have started a new 'high fat, very low carbohydrate' diet to help control their seizures, but are unsure of the mechanism. Which of the following is the MOST accurate explanation you can provide?

<p>This diet promotes ketone body production, providing an alternative energy source for the brain and potentially decreasing seizure frequency. (B)</p> Signup and view all the answers

In managing a patient on XLA (likely referring to an anticoagulant medication), on what day of the week should INR (International Normalized Ratio) be checked to ensure it's within the desired range?

<p>The day of XLA administration. (C)</p> Signup and view all the answers

Which of the following sensory experiences is classically associated with the aura that precedes a generalized tonic-clonic seizure?

<p>Visual, auditory, or olfactory hallucination. (A)</p> Signup and view all the answers

During the clonic phase of a generalized tonic-clonic seizure, which of the following oral manifestations is MOST likely to occur, requiring immediate intervention?

<p>Increased saliva production and bruxism. (C)</p> Signup and view all the answers

Differentiate between upper motor neuron (UMN) and lower motor neuron (LMN) facial nerve lesions based on forehead involvement:

<p>UMN lesions spare the forehead, while LMN lesions cause total facial weakness. (D)</p> Signup and view all the answers

A patient presents with acute bulbar palsy following a recent infection. While awaiting specialist neurological assessment, which of the following possible acute causes of Bulbar Palsy would generally be considered untreatable?

<p>Viral infection of cranial nerves IX, X, XI, and XII. (B)</p> Signup and view all the answers

Which of the following factors is LEAST likely to trigger a seizure in individuals with epilepsy?

<p>Periods of intense physical exercise (A)</p> Signup and view all the answers

A patient experiences a seizure characterized by an initial twitching of the right hand that subsequently spreads to involve the entire right arm, followed by a loss of consciousness. Which type of seizure is MOST likely occurring?

<p>Secondary generalized seizure (B)</p> Signup and view all the answers

During a neurological evaluation, a patient reports experiencing brief episodes of an unusual metallic taste just before the onset of a seizure, remaining fully aware throughout. Which type of seizure is MOST consistent with these symptoms?

<p>Simple partial seizure (B)</p> Signup and view all the answers

A patient is observed during a seizure to suddenly lose muscle tone, causing them to slump forward. Which specific type of generalized seizure is MOST likely occurring, and what is the underlying physiological mechanism?

<p>Atonic seizure; characterized by a sudden decrease in muscle tone. (D)</p> Signup and view all the answers

A patient presents with episodes of impaired awareness characterized by repetitive, purposeless movements such as lip-smacking and fumbling with their clothing. EEG results are normal, but the episodes are only aborted following administration of a dopamine antagonist. What is the MOST probable diagnosis?

<p>Psychogenic non-epileptic seizure (PNES) (C)</p> Signup and view all the answers

Why is it important to avoid placing anything in a patient's mouth during a seizure?

<p>To avoid potential injury to the patient or rescuer, and because it is ineffective and can cause harm. (C)</p> Signup and view all the answers

Which of the following is the MOST likely reason for including liver function tests in a full blood count for a patient presenting with seizures?

<p>To evaluate the potential impact of liver disease on seizure threshold and medication metabolism. (B)</p> Signup and view all the answers

A patient with well-controlled epilepsy is scheduled for a dental extraction. Which of the following pre-operative measures is MOST crucial, considering potential drug interactions?

<p>Consult with the patient's neurologist and verify their current medication regimen to identify potential interactions with dental medications. (C)</p> Signup and view all the answers

A dentist is treating a patient with carbamazepine-induced dry mouth. Beyond saliva substitutes, which additional intervention directly addresses the underlying mechanism of this side effect?

<p>Considering a medication review with the patient's physician to explore alternative anti-epileptic drugs with fewer anticholinergic effects. (D)</p> Signup and view all the answers

According to the provided text, from which anatomical structure do cranial nerves III to XII originate?

<p>Brain stem (A)</p> Signup and view all the answers

During a seizure, a dental practitioner notices the patient's skin turning blue (cyanosis). Assuming standard emergency protocols are being followed, which of the following BEST explains the pathophysiology behind the cyanosis in this context?

<p>Impaired respiratory function due to sustained muscle contractions leading to decreased oxygen saturation. (B)</p> Signup and view all the answers

In the context of cranial nerve examination, what does the acronym 'W.I.P.E.' primarily represent at the beginning of the examination process?

<p>Wash hands, Introduce, Patient details, Explanation of procedure (D)</p> Signup and view all the answers

When assessing the olfactory nerve (CNI), which of the following is the correct procedure according to the provided text?

<p>Waft an odor towards one nostril while the other is blocked and ask the patient to describe the scent. (B)</p> Signup and view all the answers

Based on the provided information about optic nerve (CNII) examination, which of the following assessments directly evaluates the function of CNII?

<p>All of the above. (D)</p> Signup and view all the answers

During the introductory phase of a cranial nerve examination, as described by 'W.I.P.E.' and the subsequent dialogue example, what is the MOST important aspect to establish with the patient before proceeding with physical tests?

<p>Ensuring the patient is not currently experiencing pain and is comfortable proceeding with the examination. (B)</p> Signup and view all the answers

Flashcards

Ramsay-Hunt Syndrome

Facial paralysis with vesicles in the pharynx and external auditory meatus. Geniculate Ganglion of VII infected with HERPES ZOSTER. Facial Weakness.

Meningitis

Infection of the meninges, often presenting with severe headache, nausea/vomiting, drowsiness, stiff neck, photophobia and sometimes a purpuric rash.

Meningitis Rash

Using a cup pushing against a meningitis rash, will still be red

Brain Abscess

Localized infection in the brain, potentially from oral sepsis, middle ear infection, or paranasal sinus infection. Higher risk in patients with congenital heart disease. Localisation by CT/MRI and Urgent Surgical Drainage.

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Cerebral Palsy

A disorder of motor function secondary to cerebral damage, most frequently associated with birth injury/hypoxia.

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Neurologist

A doctor specializing in diseases of the nervous system.

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Syncope

Brief loss of consciousness, ranging from a dizzy spell to complete unresponsiveness.

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Vaso-Vagal Syncope

Fainting caused by overstimulation of the vagus nerve, often triggered by fear, heat, or hunger.

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Carotid Sinus Syncope

Fainting triggered by turning the head due to a hypersensitive carotid sinus.

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Cough Syncope

Loss of consciousness due to excessive coughing.

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Epilepsy

A neurological disorder characterized by recurrent seizures.

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Epilepsy Diagnosis

Changes in breathing, cyanosis, and tongue biting are indicators.

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Epilepsy Medication Check

Assess medication effectiveness and adherence.

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Huntington's Disease

An autosomal dominant neurodegenerative disorder causing progressive dementia and involuntary movements, typically appearing in middle age.

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Neurotransmitter Changes in Huntington's

A marked reduction of GABA and cholinergic neurons in the corpus striatum. Associated with Huntington's Disease.

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Epileptic Seizure

Recurrent convulsion or transient disturbance in consciousness caused by abnormal cerebral electrical activity.

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Cellular Causes of Seizures

Too much glutamate (excitation) or not enough GABA (inhibition) at a cellular level.

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Epilepsy Risk Factors

Brain tumors, brain injury, drug use, ASD, infections, family history, cerebral palsy, brain hemorrhage.

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Cranial Nerve Origins

Cranial nerves originate either from the cerebellar cortex (CN I & II) or the brain stem (CN III-XII).

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W.I.P.E. for Cranial Nerve Exam

  1. Wash hands. 2. Introduce yourself. 3. Patient Details. 4. Explanation of examination. 5. Pain Assessment. 6. Questions. 7. Apply hand gel and wipe.
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Olfactory Nerve (CNI) Test

Assess for changes in the sense of smell. Each nostril is tested separately with different odors.

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Optic Nerve (CNII) Exam

Involves assessing visual acuity, visual fields, pupillary reflexes, and color vision.

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Pupil Size

Size of the pupils depends on lighting conditions.

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Seizure Triggers

External factors/stimuli that may provoke a seizure in susceptible individuals.

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Focal/Partial Onset Seizure

Seizures originating within one cerebral hemisphere.

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Generalised Onset Seizure

Seizures involving both cerebral hemispheres from the outset. Typically involves loss of consciousness.

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Unknown Onset Seizure

Seizures where the beginning/initial area of the seizure in the brain in unknown.

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Simple Partial Onset Seizure

A type of focal seizure where the patient remains conscious and aware.

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Complex Partial Onset Seizure

A type of focal seizure where the patient experiences a loss of consciousness or altered awareness.

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Atonic Seizure

Generalized seizure characterized by a sudden loss of muscle tone leading to a fall.

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Tonic-Clonic Seizure

A type of generalized seizure which leads to loss of consciousness, then stiffening (tonic) followed by jerking (clonic).

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EEG

Records brain electrical activity to detect abnormalities aiding in diagnosis of seizures, but a normal result doesn't rule out epilepsy.

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MRI/CT scan (for seizures)

Used to check the structure and health of the brain in order to exclude other causes of the seizure.

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Anti-Epileptic Drugs (AEDs)

Medications that either boost GABA (inhibitory) activity or inhibit neuron activity to control seizures.

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Ketogenic diet (for epilepsy)

High-fat, low-carb diet that shifts the brain's energy source from glucose to ketones to reduce seizure frequency/severity.

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Status Epilepticus

Seizure lasting longer than 5 minutes.

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Seizure Management

Protect the patient, prevent injury, do not put anything in their mouth, administer oxygen, and monitor seizure duration.

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Prolonged Seizure Treatment

Administer buccal midazolam.

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Dental and Epilepsy

Dental treatment should be carried out in the good phase of epilepsy, where the seizures are infrequent.

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Dental Considerations of Epilepsy

Gingival overgrowth, acid reflux, increased salivation

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Drugs to avoid when treating epilepsy.

Drugs such as azoles, aspirin, and erythromycin interfere with phenytoin or carbamazepine.

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Blackouts/Syncope

Conditions where a person loses consciousness, ranging from dizziness to complete unresponsiveness.

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Neurological Disorders in Dentistry

Patient positioning, risk of aspiration, surgical timing, autonomic dysfunction, medication compliance need to be considered.

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Meningitis & Facial Trauma

Bacterial infection of the meninges, occurring post maxillofacial injuries. Involves the mid third of the face, requiring prompt antimicrobial treatment.

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Viral Meningitis

Usually mild and self-limiting form of meningitis.

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Positive Kernig's Sign

Inability to fully extend the knee when the hip is flexed due to meningeal irritation.

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Cerebral Palsy Cause

Neurological condition, often from birth injury/hypoxia, leads to motor function deficits.

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Spina Bifida

Failure of vertebral arches to completely close during fetal development.

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Seizure

A transient disturbance in consciousness or convulsion resulting from abnormal electrical activity in the brain.

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EEG purpose in seizures

Used to check the electrical activity of the brain to see if there is any abnormal activity during seizures.

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Sodium Valproate Action

A type of medication that increases GABA activity in the brain (inhibitory neurotransmitter).

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Seizure First Aid

Protect the patient, prevent injury, do not put anything in their mouth, give oxygen, observe seizure duration.

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Gingival Hyperplasia

Due to Phenytoin. Can be managed with gingival surgery or changing the AED.

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What is a Seizure?

Sudden, uncontrolled electrical disturbance in the brain, causing changes in behavior, movement, feelings or consciousness.

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INR Checking Frequency

Regular monitoring of INR levels, ideally on the same day each week as XLA administration, to ensure therapeutic effectiveness of anticoagulation therapy.

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Generalized Tonic-Clonic Seizure

A type of generalized seizure classically preceded by an aura (visual, auditory, or olfactory), followed by loss of consciousness, tonic phase (stiffening), clonic phase (jerking), and potential incontinence.

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Absence Seizures (Petit Mal)

Brief periods of loss of awareness seen in children, affecting speech and attention, often manifesting as staring or inattentiveness at school.

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Focal Seizures

Seizures that initially affect only one hemisphere of the brain.

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Facial Nerve LMN

Facial weakness involving the entire side of the face, including the forehead, resulting from damage to the facial nerve.

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Cranial Nerve Examination

Comprehensive evaluation of the twelve cranial nerves to assess neurological function.

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W.I.P.E. Acronym

Wash hands, Introduce self, Patient details, Explanation, Check for pain.

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Olfactory Nerve

Sensory nerve (CNI) responsible for the sense of smell.

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Optic Nerve

Sensory nerve (CNII) responsible for vision and pupillary reflexes.

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Seizure History

Important questions to determine seizure factors

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Common AED Actions

Phenytoin and Carbamazepine block sodium channels, while Sodium Valproate boosts GABA.

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Seizure Trigger Avoidance

Avoiding situations that lead to seizures.

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Epilepsy Complications

Increases risk of accidents, psychological issues, and aspiration pneumonia; some AEDs are teratogenic.

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Managing a Seizure

Protect, prevent injury, do not put anything in the mouth, administer oxygen, recovery position

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