Neurology

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Questions and Answers

Which of the following is commonly associated with syncope?

  • Rapid increase in intracranial pressure
  • Hyperglycemia following a carbohydrate-rich meal
  • Under-activity of the parasympathetic nervous system
  • Over-activity of the sympathetic nervous system (correct)

What is the typical origin of syncope?

  • Bacterial
  • Viral
  • Fungal
  • Vaso-vagal (correct)

Altered breathing, cyanosis, and tongue biting are highly indicative of which type of seizure?

  • Absence seizure
  • Focal seizure
  • Generalised Tonic-Clonic seizure (correct)
  • Atonic seizure

Which of the following is a typical characteristic of Generalised Tonic-Clonic Epilepsy?

<p>Classically preceded by an aura (A)</p> Signup and view all the answers

A patient experiencing repetitive jerky movements, increased salivation, and marked bruxism is likely in which phase of a seizure?

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

Status Epilepticus, a medical emergency, is defined as a seizure that continues for how long?

<p>More than 5 minutes (B)</p> Signup and view all the answers

What are absence seizures (petit mal) typically characterized by?

<p>Brief periods of impaired attention (B)</p> Signup and view all the answers

Where do focal seizures originate?

<p>In one hemisphere of the brain (A)</p> Signup and view all the answers

Which of the following is a common symptom of Temporal Lobe Epilepsy?

<p>Staring and being unaware of surroundings (C)</p> Signup and view all the answers

Which intervention is most appropriate for managing febrile convulsions?

<p>Tepid sponging and paracetamol (B)</p> Signup and view all the answers

Stokes-Adams attacks result from which of the following?

<p>Cardiac arrhythmias (D)</p> Signup and view all the answers

What is the underlying cause of a Transient Ischemic Attack (TIA)?

<p>Temporary occlusion of cerebral circulation (C)</p> Signup and view all the answers

Which of the following is most characteristic of a Transient Ischemic Attack (TIA)?

<p>Symptoms resolving in less than 24 hours (C)</p> Signup and view all the answers

What potential risk in dentistry is associated with a patient's positioning during procedures?

<p>Risk of aspiration (C)</p> Signup and view all the answers

Autonomic dysfunction is particularly associated with which neurological disorder?

<p>Parkinson's Disease (C)</p> Signup and view all the answers

Why is it important to gather information from witnesses when a patient experiences a blackout?

<p>Witness accounts can help determine the cause of the blackout (A)</p> Signup and view all the answers

A patient reports experiencing dizziness, which is later determined to be related to a blackout episode. What is the significance of dizziness in the context of blackouts?

<p>Dizziness represents a possible range from loss of consciousness (D)</p> Signup and view all the answers

In the context of neurological disorders and dentistry, what does 'compliance' refer to?

<p>Following prescribed treatment (B)</p> Signup and view all the answers

A patient experiences syncope specifically when turning their head. Which type of syncope is most likely occurring?

<p>Carotid Sinus Syncope (B)</p> Signup and view all the answers

What is the relevance of considering surgery conditions, timing, and mobility in the context of neurological disorders in dentistry?

<p>To accommodate the patient's physical limitations (D)</p> Signup and view all the answers

Why is it important for dentists to inquire about a patient's medication history when dealing with neurological disorders?

<p>Medications can influence the dental procedures and vice-versa (C)</p> Signup and view all the answers

Why would a dentist need to be especially cautious about medication if the patient has epilepsy?

<p>Some medications may lower the seizure threshold. (C)</p> Signup and view all the answers

Febrile convulsions are common in infancy, how are they treated?

<p>Tepid Sponging (D)</p> Signup and view all the answers

What is the most important question a dentist or doctor should ask when a patient mentions that they have epilepsy?

<p>Does the medication work? (D)</p> Signup and view all the answers

A patient in the dental chair suddenly loses consciousness. Upon examination, you notice they have altered breathing, cyanosis, and evidence of tongue biting. Their medical history is unknown. What is the MOST likely cause, and what is the MOST critical next step?

<p>Generalised Tonic-Clonic Seizure; Protect the patient from injury and ensure an open airway. (D)</p> Signup and view all the answers

Which of the following conditions is NOT explicitly listed as a main neurological condition of concern in dentistry?

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

What specific aspect of patient management is directly impacted by neurological disorders, making it a key consideration in dentistry?

<p>Positioning of patient (C)</p> Signup and view all the answers

Aside from patient positioning, what poses a significant risk in dental settings for individuals with certain neurological conditions, such as Parkinson's disease?

<p>Risk of aspiration (A)</p> Signup and view all the answers

Why are 'surgery conditions, timing, and mobility' important considerations in dentistry when treating patients with neurological disorders?

<p>They can exacerbate symptoms and affect the safety and comfort of the patient. (A)</p> Signup and view all the answers

Autonomic dysfunction, frequently observed in Parkinson's disease, can directly influence which aspect of dental treatment?

<p>The patient's ability to regulate blood pressure and heart rate during procedures (B)</p> Signup and view all the answers

In the context of neurological disorders, what does 'compliance' primarily refer to, regarding dental care?

<p>The patient's adherence to their medication and treatment plans (B)</p> Signup and view all the answers

When managing patients with neurological disorders, why is it critical for dentists to gather a thorough medical history, specifically regarding medications?

<p>To identify potential drug interactions and manage possible side effects (C)</p> Signup and view all the answers

When a patient reports experiencing a 'blackout,' which of the following actions is MOST important for a dentist to take?

<p>Inquire about the events surrounding the blackout, including triggers and associated symptoms (B)</p> Signup and view all the answers

Why is obtaining information from witnesses particularly valuable when a patient has experienced a blackout?

<p>Witnesses can provide details the patient may not recall, aiding in diagnosis (B)</p> Signup and view all the answers

A patient reports experiencing dizziness during a blackout episode. What is the key significance of this symptom in the context of neurological assessment?

<p>Dizziness helps differentiate between various potential causes, such as cardiac, neurological, or inner ear issues (A)</p> Signup and view all the answers

What is the MOST critical element to ascertain when gathering the history about a patient's blackout episodes?

<p>The detailed sequence events before, during, and after the episode (B)</p> Signup and view all the answers

Syncope is MOSTLY due to what origin?

<p>Vaso-vagal (B)</p> Signup and view all the answers

Over-activity of which system is most strongly associated with the physiological mechanism of syncope?

<p>Sympathetic nervous system (D)</p> Signup and view all the answers

In addition to turning the head, in which other position can Carotid Sinus Syncope occur?

<p>Supine position (D)</p> Signup and view all the answers

Which finding in a patient’s history is MOST suggestive of Generalised Tonic-Clonic Epilepsy?

<p>Altered breathing, cyanosis and tongue biting (D)</p> Signup and view all the answers

What might classically precede a Generalised Tonic-Clonic Epilepsy seizure?

<p>An aura, such as visual, auditory or olfactory (D)</p> Signup and view all the answers

Besides an aura, what other changes might a patient experience before convulsions in Generalised Tonic-Clonic Epilepsy?

<p>Change in sensation/emotion/mood (D)</p> Signup and view all the answers

Besides repetitive jerky movements, what are the other signs exhibited in the clonic phase of Generalised Tonic-Clonic Epilepsy

<p>Increased salivation and marked bruxism (A)</p> Signup and view all the answers

What duration of continuous seizure activity, or recurrent seizure activity without recovery between seizures, defines Status Epilepticus, a medical emergency?

<p>More than 5 minutes (D)</p> Signup and view all the answers

Which age group are absence seizures (petit mal) most commonly seen in?

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

Where are focal seizures located? (Petit Mal)

<p>Affect initially only one hemisphere of the brain (C)</p> Signup and view all the answers

Which of the following can be a symptom of Temporal Lobe Epilepsy?

<p>Staring and being unaware (B)</p> Signup and view all the answers

What type of treatment is suitable for febrile convulsions?

<p>Tepid sponging, fans, paracetamol (D)</p> Signup and view all the answers

Stokes-Adams attacks arise as a result of what?

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

What is the underlining cause of a Transient Ischemic Attack?

<p>TIA = a sudden onset of focal CNS signs or symptoms due to a temporary occlusion of part of a cerebral circulation (B)</p> Signup and view all the answers

Which of the following is a characteristic of Multiple Sclerosis (MS)?

<p>Diverse neurological signs and symptoms both in site and time (B)</p> Signup and view all the answers

What pathological changes are typically seen in cases of Multiple Sclerosis?

<p>Demyelination of nerve fibers (B)</p> Signup and view all the answers

Which of the following is the most common initial symptom of Multiple Sclerosis?

<p>Optic neuritis leading to visual disturbance (D)</p> Signup and view all the answers

What is meant by the term 'ataxia' in the context of Multiple Sclerosis?

<p>Impaired coordination and balance leading to unsteady movements (A)</p> Signup and view all the answers

A young patient presents with trigeminal neuralgia. Which of the following conditions should be highly suspected?

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

What is the primary cause of Parkinson's disease?

<p>Degeneration of pigmented cells in the substantia nigra leading to dopamine deficiency (D)</p> Signup and view all the answers

Which of the following is a common motor symptom associated with Parkinson's disease?

<p>Resting 'pill-rolling' tremor (B)</p> Signup and view all the answers

Bradykinesia is a key feature of Parkinson's Disease, what does it refer to?

<p>Slowness of Movement (B)</p> Signup and view all the answers

What is 'Akathisia' as it relates to Parkinson's Disease

<p>The inability to stay still (D)</p> Signup and view all the answers

Which of the following clinical features is characteristic of Parkinson's disease?

<p>A stooped posture and shuffling gait (C)</p> Signup and view all the answers

What autonomic nervous system impairment can occur in Parkinson's disease that is MOST relevant to dental practitioners?

<p>Postural drop in blood pressure (A)</p> Signup and view all the answers

How do 'on' times relate to Parkinson's disease?

<p>Periods when treatment is effectively controlling symptoms (D)</p> Signup and view all the answers

What are the basic diagnostic criteria for Parkinson's Disease?

<p>Tremor, rigidity, slow movement, and impaired balance (D)</p> Signup and view all the answers

How does parkinsonism differ from Parkinson's disease?

<p>Parkinsonism shows the same symptoms of Parkinson's disease, but it is not caused by dopamine deficiency (D)</p> Signup and view all the answers

Which of the following conditions is NOT associated with causing Parkinsonism/

<p>Alzheimer's Disease (D)</p> Signup and view all the answers

Why is it not feasible to directly administer dopamine as a treatment to patients with Parkinson's disease?

<p>Dopamine cannot cross the blood-brain barrier (B)</p> Signup and view all the answers

Which class of medications may be used as a dopamine agonist?

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

What dental management strategy is most appropriate for patients with Parkinson's disease?

<p>Aim to treat during 'on' times when symptoms are better controlled (C)</p> Signup and view all the answers

What is the typical recommendation for the length and timing of dental appointments for patients with Parkinson's disease?

<p>Short appointments, ideally in the morning (B)</p> Signup and view all the answers

What must be critically considered when providing dental local anesthetic ('LA') to patients with Parkinson's disease?

<p>Confirm there is no interaction between adrenaline in dental LA and the patient's medications (A)</p> Signup and view all the answers

Which of the following is not a factor to consider when treating people with Parkinson's?

<p>Optimising temperature control (too hot or too cold) (B)</p> Signup and view all the answers

What is a key characteristic of motor neurone disease?

<p>Involves both upper motor neuron (UMN) and lower motor neuron (LMN) damage (D)</p> Signup and view all the answers

What does dysphagia refer to in the context of motor neurone disease?

<p>Difficulty swallowing (D)</p> Signup and view all the answers

Why are headaches characteristically worse in the morning in patients with tumours?

<p>Due to increased intracranial pressure after lying down (C)</p> Signup and view all the answers

What pathological process is central to the development of Multiple Sclerosis?

<p>Demyelination of nerve fibers (B)</p> Signup and view all the answers

Which of the following is a common early symptom of Multiple Sclerosis that affects vision?

<p>Optic neuritis (D)</p> Signup and view all the answers

What is 'ataxia' as it relates to Multiple Sclerosis?

<p>Lack of muscle coordination. (B)</p> Signup and view all the answers

In a young patient presenting with trigeminal neuralgia, which of the following conditions should raise suspicion?

<p>Multiple Sclerosis (D)</p> Signup and view all the answers

Which of the following is accurate regarding the typical demographic affected by Multiple Sclerosis?

<p>Females are more commonly affected than males. (C)</p> Signup and view all the answers

What is the primary underlying cause of Parkinson's disease?

<p>Degeneration of the substantia nigra leading to dopamine deficiency (A)</p> Signup and view all the answers

Which of the following is a classic motor symptom observed in patients with Parkinson's disease?

<p>Pill-rolling tremor (B)</p> Signup and view all the answers

What characterizes 'cog-wheel rigidity' in Parkinson's disease?

<p>Ratchety, intermittent resistance to passive movement (D)</p> Signup and view all the answers

In the context of Parkinson's disease, what does 'Akathisia' refer to?

<p>An inner sense of restlessness (D)</p> Signup and view all the answers

Which of the following facial features is often associated with Parkinson's disease?

<p>Expressionless ('mask-like') face (B)</p> Signup and view all the answers

Aside from motor symptoms, Parkinson's disease can affect other areas of the body. What presentation is seen in people with Parkinson's with regards to saliva?

<p>Constant drooling caused by hypersalivation (B)</p> Signup and view all the answers

In Parkinson's disease, what do 'on' times indicate?

<p>Periods when the patient is most responsive to medication (B)</p> Signup and view all the answers

Which combination of symptoms is essential for the clinical diagnosis of Parkinson's disease?

<p>Tremor, rigidity, slow movement, and impaired balance (B)</p> Signup and view all the answers

What distinguishes parkinsonism from Parkinson's disease?

<p>Parkinsonism refers to symptoms of Parkinson's disease arising from causes other than dopamine deficiency. (B)</p> Signup and view all the answers

Which diagnostic method is LEAST likely to be used in the diagnosis of Parkinson's Disease?

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

Which of the following explains why dopamine is NOT directly administered in the treatment of Parkinson's disease?

<p>It cannot cross the blood-brain barrier (B)</p> Signup and view all the answers

What is the MOST important advice you could provide to a medical practitioner considering dopamine agonists as a treatment, for a patient with Parkinson's disease?

<p>Behavioural and psychological side effects can occur (B)</p> Signup and view all the answers

Regarding dental treatment, what is the best time of day to book an appointment for a Parkinson's disease patient?

<p>Mornings, as treatments are optimised within 60-90 minutes of medications (B)</p> Signup and view all the answers

What is a critical consideration when providing local anesthesia to patients with Parkinson's disease?

<p>The vasoconstrictor in local anesthesia can alter the metabolism of dopamine-related medications (D)</p> Signup and view all the answers

Which of the following is a key characteristic of motor neurone disease?

<p>Degeneration of motor neurons in the brain and spinal cord (A)</p> Signup and view all the answers

In the context of motor neurone disease, what does dysphagia refer to?

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

When carrying out extractions for a patient suffering from motor neurone disease, what is the most important consideration?

<p>That the patient can expectorate or swallow effectively (B)</p> Signup and view all the answers

Headaches associated with brain tumours are characteristically worse at what time of day?

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

In cases of intracranial tumours, are these more commonly benign, malignant, primary or metastatic?

<p>Malignant &amp; Metastatic (B)</p> Signup and view all the answers

Which of the following is characteristically associated with headaches caused by brain tumors?

<p>Headaches are characteristically worse in the morning. (B)</p> Signup and view all the answers

In the context of intracranial tumors, which type is statistically more common?

<p>Metastatic tumors (D)</p> Signup and view all the answers

Cerebral metastases most commonly originate from which of the following organs?

<p>Lung, breast, gastrointestinal tract and kidney (C)</p> Signup and view all the answers

What is the underlying mechanism of Myasthenia Gravis (MG)?

<p>An antibody-mediated autoimmune reaction causing a deficiency of functioning acetylcholine receptors (A)</p> Signup and view all the answers

Which demographic group is most commonly affected by Myasthenia Gravis?

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

In Eaton-Lambert Syndrome, muscle strength characteristically changes in what way with activity?

<p>Muscles get stronger rather than weaker with activity. (B)</p> Signup and view all the answers

Eaton-Lambert Syndrome is commonly associated with which underlying condition?

<p>Lung or other cancers (D)</p> Signup and view all the answers

What is the definition of bulbar palsy?

<p>Palsy of the tongue, muscles of mastication/swallowing and facial muscles due to loss of function of motor nuclei in the brain stem (C)</p> Signup and view all the answers

Which of the following cranial nerves is NOT directly involved in the motor functions affected by bulbar palsy?

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

Which cranial nerve is responsible for both sensory and motor functions?

<p>Trigeminal nerve (V) (C)</p> Signup and view all the answers

A patient presents with an inability to look laterally with their left eye. Which cranial nerve is MOST likely affected?

<p>Abducens nerve (VI) (C)</p> Signup and view all the answers

What is a common cause of Trochlear nerve (IV) palsy?

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

Diplopia is commonly observed with problems relating to which cranial nerve?

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

Which of the following is a typical sign of oculomotor nerve (III) dysfunction?

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

Which of the following conditions can potentially cause problems with the oculomotor nerve (III)?

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

When assessing the sensory function of the trigeminal nerve, what is the recommended procedure?

<p>Test sensation in all three nerve divisions (C)</p> Signup and view all the answers

What is the MOST appropriate method to assess the motor function of the trigeminal nerve?

<p>Test/estimate the power of the muscles of mastication (A)</p> Signup and view all the answers

What are common causes of sensory problems affecting the trigeminal nerve?

<p>Idiopathic, trauma, IDN/lingual nerve damage (B)</p> Signup and view all the answers

In assessing facial nerve function, what distinguishes an upper motor neuron (UMN) lesion from a lower motor neuron (LMN) lesion?

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

Bell's palsy, skull fractures, and parotid tumors are associated with which type of facial nerve lesion?

<p>Lower motor neuron (LMN) lesion (D)</p> Signup and view all the answers

After a stroke or due to an intracranial tumour, what facial weakness would you expect to see as a result of an Upper Motor Neurone lesion?

<p>Forehead sparing weakness (B)</p> Signup and view all the answers

Ramsay Hunt syndrome is characterised by which features?

<p>Profound facial paralysis with vesicles in the pharynx and external auditory meatus of the same side (A)</p> Signup and view all the answers

Which of the following is the infectious agent in Ramsay Hunt Syndrome?

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

After a maxillofacial trauma involving the mid third of the face, what is a possible complication of it?

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

What is the recommended treatment in the case of a nervous system infection?

<p>Prompt antimicrobial treatment (B)</p> Signup and view all the answers

What is the underlying cause of muscle weakness in Myasthenia Gravis (MG)?

<p>Antibody-mediated destruction of acetylcholine (ACh) receptors. (A)</p> Signup and view all the answers

Which demographic is most commonly affected by Myasthenia Gravis (MG)?

<p>Young women. (D)</p> Signup and view all the answers

In Eaton-Lambert Syndrome, how does muscle strength typically respond to sustained activity?

<p>Muscle strength initially increases with activity, and then weakens. (A)</p> Signup and view all the answers

Eaton-Lambert Syndrome is most frequently linked to which underlying condition?

<p>Small cell lung cancer. (D)</p> Signup and view all the answers

Damage to which area typically results in bulbar palsy?

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

Which cranial nerve provides both sensory and motor innervation?

<p>Trigeminal nerve (V) (C)</p> Signup and view all the answers

A patient cannot move their eye laterally. Which cranial nerve is most likely affected?

<p>Abducens nerve (VI) (C)</p> Signup and view all the answers

Diplopia suggests a problem relating to nerve function of which cranial nerve?

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

Which sign is typical of oculomotor nerve (III) dysfunction?

<p>Dilated Pupil (D)</p> Signup and view all the answers

Which medical condition can potentially cause problems with the oculomotor nerve (III)?

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

What assessment can be done to test the motor functions governed by the trigeminal nerve?

<p>Test/estimate the power of the muscles of mastication. (A)</p> Signup and view all the answers

Sensory problems along the trigeminal nerve are commonly caused by?

<p>Idiopathic factors, trauma, or IDN/lingual nerve damage. (B)</p> Signup and view all the answers

How does an upper motor neuron (UMN) lesion differ from a lower motor neuron (LMN) lesion related to the facial nerve?

<p>UMN lesions result in forehead-sparing weakness, while LMN lesions cause total facial weakness. (A)</p> Signup and view all the answers

What is associated with Lower Motor Neuron lesion of the facial nerve?

<p>Bell's Palsy (B)</p> Signup and view all the answers

What facial weakness would you expect to see as a result of an Upper Motor Neurone lesion arising from a stroke or an intracranial tumour?

<p>Forehead sparing weakness (B)</p> Signup and view all the answers

Which features characterize Ramsay Hunt syndrome?

<p>Profound facial paralysis with vesicles in the pharynx and external auditory meatus. (B)</p> Signup and view all the answers

What is the infectious agent in Ramsay Hunt Syndrome?

<p>Varicella Zoster Virus (B)</p> Signup and view all the answers

Following a maxillofacial trauma involving the mid-face, which complication may arise due to nervous system involvement?

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

The most important course of action in the presence of a nervous system infection is what?

<p>Prompt antimicrobial treatment (A)</p> Signup and view all the answers

Which type of intracranial tumor is statistically more common?

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

If a patient says their headaches are worse in the mornings, this is characteristic of what?

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

What does a positive Kernig's sign, as depicted in the image, typically indicate?

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

Which of the following is characteristic of viral meningitis?

<p>Typically mild and self-limiting (B)</p> Signup and view all the answers

A patient presents with severe headache, stiff neck, photophobia and a purpuric rash. Which condition is MOST likely?

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

Oral sepsis, paranasal sinus infections, and middle ear infections can be aetiological factors for which of the following conditions?

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

What is the PRIMARY treatment approach for a brain abscess?

<p>Localization with CT/MRI, urgent surgical drainage, and addressing the underlying cause (C)</p> Signup and view all the answers

Which of the following is most frequently associated with cerebral palsy?

<p>Birth injury or hypoxia (B)</p> Signup and view all the answers

A patient with cerebral palsy exhibits disturbance of balance. Which type of cerebral palsy is MOST likely?

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

What is the primary cause of spina bifida?

<p>Failure of the vertebral arches to fuse, often linked to folic acid deficiency (D)</p> Signup and view all the answers

Which condition may be present in conjunction with Spina Bifida?

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

Huntington's disease is characterised by what?

<p>Progressive dementia, epilepsy, autonomic dysfunction and marked involuntary movements (B)</p> Signup and view all the answers

A marked reduction in what neurotransmitter is associated with Huntington's Disease?

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

Why is epilepsy so commonly observed in Huntington's Disease?

<p>The marked reduction in GABA and cholinergic neurones in the corpus striatum disrupting the balance of neuronal inhibition and excitation (B)</p> Signup and view all the answers

From a dental practitioner's perspective, what is the MOST crucial reason to be knowledgeable about neurological conditions?

<p>To ensure safe and effective dental practice, as neurological disorders may directly impact dental treatment (B)</p> Signup and view all the answers

Consider a patient presenting with a suspected neurological issue. They are unable to comprehend your questions, or answer logically, and display odd involuntary movements. What is the MOST appropriate next step?

<p>Refer them urgently to a neurologist, and postpone dental treatment unless for emergency. (D)</p> Signup and view all the answers

What would be the MOST appropriate recall frequency (time between appointments) you could suggest for a patient whose neurological condition is poorly controlled?

<p>Three months or less, depending on disease and oral hygiene considerations (A)</p> Signup and view all the answers

What is a key element in gathering information about blackouts and syncope?

<p>Obtaining a thorough history, including witness accounts. (A)</p> Signup and view all the answers

Syncope is often associated with which of the following physiological responses?

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

A patient reports experiencing syncope episodes exclusively when squatting. This is most likely to be what?

<p>Carotid Sinus Syncope. (A)</p> Signup and view all the answers

In Generalised Tonic-Clonic Epilepsy, what often precedes the tonic phase?

<p>An aura – visual, auditory, or olfactory. (D)</p> Signup and view all the answers

Besides sensory changes, what other alterations might a patient experience before convulsions in Generalised Tonic-Clonic Epilepsy?

<p>Changes in emotion or mood. (A)</p> Signup and view all the answers

Which of the following is MOST characteristic of the clonic phase in Generalised Tonic-Clonic Epilepsy?

<p>Repetitive jerky movements, increased salivation, and marked bruxism. (C)</p> Signup and view all the answers

What part of the brain do focal seizures originate?

<p>Initially, only one hemisphere of the brain. (B)</p> Signup and view all the answers

Which of the following is a common sign of temporal lobe epilepsy?

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

Febrile convulsions are NOT epilepsy but can be managed by?

<p>Tepid sponging, fans, and paracetamol. (D)</p> Signup and view all the answers

Stokes-Adams attacks arise as a result of which of the following?

<p>Cardiac arrhythmias. (D)</p> Signup and view all the answers

Transient Ischemic Attacks (TIAs) typically resolves in what time frame?

<p>24 hours. (A)</p> Signup and view all the answers

Multiple Sclerosis is characterised by what?

<p>Diverse neurological signs and symptoms both in site and time. (C)</p> Signup and view all the answers

Which of the following is a common initial symptom of Multiple Sclerosis?

<p>Optic neuritis leading to visual disturbance or blindness. (D)</p> Signup and view all the answers

In the context of Multiple Sclerosis, what does 'ataxia' mean?

<p>Disturbance of balance. (A)</p> Signup and view all the answers

Which of the following conditions should be highly suspected in a young patient presenting with trigeminal neuralgia?

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

Parkinson's disease is a degenerative condition, caused by ?

<p>Degeneration of the pigmented cells of the substantia nigra. (C)</p> Signup and view all the answers

What does bradykinesia refer to, in the context of Parkinson's disease?

<p>Slow movement. (D)</p> Signup and view all the answers

A patient with Parkinson's disease may have impaired autonomic function leading to postural hypotension. What is MOST important for a dentist to do?

<p>Avoid quick postural changes. (C)</p> Signup and view all the answers

What do 'on' times indicate in the context of Parkinson's disease?

<p>The period when treatment is working effectively. (C)</p> Signup and view all the answers

Why is the administration of dopamine itself not a feasible treatment for Parkinson's disease?

<p>It does not cross the blood-brain barrier. (B)</p> Signup and view all the answers

Which class of medications may be used as a dopamine agonist in the treatment for Parkinson's disease?

<p>Monoamine oxidase B inhibitors. (B)</p> Signup and view all the answers

Regarding Parkinson's Disease dental appointments, when is optimum length?

<p>60-90 minutes. (A)</p> Signup and view all the answers

In Eaton-Lambert Syndrome, how does muscle strength characteristically change with activity?

<p>Muscles get stronger with activity. (C)</p> Signup and view all the answers

Which cranial nerve might be affected if you have diplopia?

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

Pupil dilation, ptosis (drooping eyelid) and problems with moving the eye are all signs of functional problems with which nerve?

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

What distinguishes an upper motor neuron (UMN) lesion from a lower motor neuron (LMN) lesion regarding facial nerve function?

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

Ramsay Hunt syndrome is caused by the infection of which cranial nerve, by what?

<p>The geniculate ganglion of the VII cranial nerve, infected with herpes zoster. (D)</p> Signup and view all the answers

In the context of neurological disorders, what is the primary concern regarding patient positioning during dental treatment?

<p>Minimising the risk of aspiration, especially in patients with swallowing difficulties. (B)</p> Signup and view all the answers

Why is 'surgery conditions, timing, and mobility' a key factor when planning dental treatment for patients with neurological disorders?

<p>To accommodate potential physical limitations and ensure patient safety and comfort during procedures. (D)</p> Signup and view all the answers

Why is it important for a dentist to be aware of a patient's autonomic dysfunction, especially in the context of Parkinson's disease?

<p>To manage potential blood pressure changes and hypersalivation during dental procedures. (C)</p> Signup and view all the answers

Syncope, often referred to as fainting, is MOSTLY due to what origin?

<p>Vaso-vagal response. (A)</p> Signup and view all the answers

Which of the following factors can precipitate syncope?

<p>Fear, heat, or lack of food. (A)</p> Signup and view all the answers

What is a key diagnostic indicator derived from the patient history for Generalised Tonic-Clonic Epilepsy?

<p>Altered breathing, cyanosis, and tongue biting. (D)</p> Signup and view all the answers

What is the typical nature of the aura that precedes a Generalised Tonic-Clonic Epilepsy seizure?

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

What changes in sensation, emotion, or mood might a patient experience before the convulsive phase of Generalised Tonic-Clonic Epilepsy?

<p>Alterations that lead to convulsions before recovery. (C)</p> Signup and view all the answers

What key event may arise in the tonic phase that then progresses to the clonic phase in Generalised Tonic-Clonic Epilepsy?

<p>Progresses to repetitive jerky movements, increased salivation and marked bruxism. (D)</p> Signup and view all the answers

How long must continuous seizure activity or recurrent seizure activity without recovery between seizures, last to be defined as Status Epilepticus?

<p>More than 5 minutes. (D)</p> Signup and view all the answers

What are the speech and attention differences that highlight absence seizures (petit mal)?

<p>Speech and attention affected. (C)</p> Signup and view all the answers

What are some of the signs of the Temporal Lobe Epilepsy condition?

<p>Staring and being unaware. (A)</p> Signup and view all the answers

Stokes-Adams attacks arise due to?

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

What underlying cause can induce a Transit Ischemic Attack (TIA)?

<p>Temporary occulsion of part of cerebral circulation. (C)</p> Signup and view all the answers

How long do TIAs typically last?

<p>Resolves in less than 24 hours. (B)</p> Signup and view all the answers

Which pathological process underlies the diverse neurological symptoms observed in Multiple Sclerosis (MS)?

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

Which of the following is a recognized early symptom of Multiple Sclerosis?

<p>Optic neuritis leading to visual disturbance/blindness. (C)</p> Signup and view all the answers

In the context of Multiple Sclerosis, what does the term 'ataxia' refer to??

<p>Lack of balance of coordination. (B)</p> Signup and view all the answers

A younger patient presents with facial pain in line with trigeminal neuralgia. What possible condition could this mean?

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

Parkinson's disease results from a deficiency of which neurotransmitter?

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

What motor symptom is a key feature of Parkinson's disease?

<p>Pill-rolling tremor. (B)</p> Signup and view all the answers

What key element defines cog-wheel rigidity in Parkinson's Disease??

<p>Rhythmic, ratchet-like resistance to passive movement of a limb. (D)</p> Signup and view all the answers

What does 'Akathisia' refer to in the context of Parkinson's Disease?

<p>A state of motor restlessness, causing an inability to stay still. (D)</p> Signup and view all the answers

What is commonly the facial appearance/presentation for people suffering from Parkinson's Disease?

<p>Expressionless ('mask-like) face. (C)</p> Signup and view all the answers

What non-motor symptom related to saliva production is often observed in patients with Parkinson's disease?

<p>Hypersalivation. (D)</p> Signup and view all the answers

In Parkinson's disease, what do 'off' episodes indicate?

<p>Periods when the treatment effects are wearing off. (C)</p> Signup and view all the answers

What is the crucial combination of clinical presentations that suggests clinical diagnosis of Parkinson's?

<p>Tremor, rigidity, slow movement and impaired balance (or postural instability). (D)</p> Signup and view all the answers

Why is dopamine NOT directly administered in the treatment of Parkinson's disease??

<p>It does not cross the blood-brain barrier. (D)</p> Signup and view all the answers

What is the optimum length of the dental appointments for patients with Parkinson's Disease?

<p>Short appointments best. Optimum treatment usually within 60-90 minutes of medications. (B)</p> Signup and view all the answers

When providing local anesthesia to patients with Parkinson's disease, what is a critical consideration for an oral health practitioner?

<p>Adrenaline can interact with medicines. (C)</p> Signup and view all the answers

What key characteristic defines motor neurone disease?

<p>A rapidly progressive, invariably fatal, neurological condition. (D)</p> Signup and view all the answers

What is a key aetiological element of Motor Neurone Disease?

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

How long is the life of a person with motor neurone disease?

<p>3-5 years. (A)</p> Signup and view all the answers

In most cases, are intracranial tumors benign, malignant, primary or metastatic?

<p>Secondary metastases. (B)</p> Signup and view all the answers

If cerebral metastases occur, where do these most commonly originate??

<p>Lung, breast, GIT and kidney . (A)</p> Signup and view all the answers

In Eaton-Lambert Syndrome, muscles get stronger due to?

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

Eaton-Lambert Syndrome is associated with what?

<p>Seen in patients with lung/other cancers. (D)</p> Signup and view all the answers

What is the consequence of motor nuclei issues that are located around the brain stem (Bulbar Palsy)?

<p>Palsy of the tongue, muscles of mastication/swallowing and facial muscles. (C)</p> Signup and view all the answers

What trauma may come about a person experiencing trochlear issues?

<p>Trauma. (D)</p> Signup and view all the answers

What factors commonly relate to sensory problems affecting the trigeminal nerve?

<p>All of these. (B)</p> Signup and view all the answers

How does an upper motor neuron lesion of the facial nerve differ from a lower motor neuron lesion based on clinical findings??

<p>UMN - Upper motor neurone spares forehead, while LMN - Lower motor neurone is total facial weakness on that side. (D)</p> Signup and view all the answers

Which facial weakness would you expect to see as a result of an Upper Motor Neurone lesion that occurred due to a stroke or intracranial tumour?

<p>Forehead Sparing weakness. (A)</p> Signup and view all the answers

Which cranial nerve is affected in Ramsay Hunt.

<p>VII. (D)</p> Signup and view all the answers

Following a nervous infection, what is the most important course of action?

<p>Prompt antimicrobial treatment. (B)</p> Signup and view all the answers

In the context of neurological disorders, why is it important to consider the positioning of a patient during dental treatment?

<p>To prevent aspiration, especially in patients with swallowing difficulties. (D)</p> Signup and view all the answers

What is the primary significance of obtaining a detailed history from a patient presenting with blackouts?

<p>To identify potential causes, triggers, and associated symptoms. (B)</p> Signup and view all the answers

In which position can Carotid Sinus Syncope occur, besides turning the head?

<p>Lying supine. (B)</p> Signup and view all the answers

Which of the following is a common precipitating factor for vaso-vagal syncope?

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

Which of the following is almost diagnostic of a Generalised Tonic-Clonic seizure?

<p>Altered breathing, cyanosis, and tongue biting. (D)</p> Signup and view all the answers

What type of aura classically precedes a Generalised Tonic-Clonic Epilepsy seizure?

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

Besides an aura, what other changes might a patient experience before convulsions in a Generalised Tonic-Clonic Epilepsy seizure?

<p>Change in sensation, emotion or mood. (A)</p> Signup and view all the answers

During which phase of Generalised Tonic-Clonic Epilepsy might increased salivation and marked bruxism be observed?

<p>Clonic phase. (D)</p> Signup and view all the answers

In addition to repetitive jerky movements during the clonic phase of Generalised Tonic-Clonic Epilepsy, what other signs may occur?

<p>Increased salivation and marked bruxism. (A)</p> Signup and view all the answers

Your patient has a seizure which continues for more than 5 minutes. What is this called?

<p>Status Epilepticus. (B)</p> Signup and view all the answers

Which is MOST correct regarding the aetiology of focal seizures?

<p>They affect one hemisphere of the brain (B)</p> Signup and view all the answers

Which sign or symptom is least commonly associated with temporal lobe epilepsy?

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

Is medication usually required for a patient experiencing febrile convulsions?

<p>No, tepid sponging and paracetamol administration are usually sufficient. (A)</p> Signup and view all the answers

Stokes-Adams attacks are primarily a result of what?

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

TIAs are MOST accurately described as what?

<p>Signs and symptoms of a focal neurological deficit that fully resolve within 24 hours. (D)</p> Signup and view all the answers

TIAs are very important because...

<p>...they may be harbingers of stroke. (D)</p> Signup and view all the answers

How would you describe the signs and symptoms that arise from a patient with Multiple Sclerosis?

<p>Diverse in both site and time. (A)</p> Signup and view all the answers

Which of the following pathological features is characteristic of Multiple Sclerosis?

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

What is the MOST common initial symptom of Multiple Sclerosis?

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

In the context of Multiple Sclerosis, what does 'ataxia' refer to?

<p>Disturbance of balance and coordination. (C)</p> Signup and view all the answers

Which of the following should raise the highest degree of suspicion in a young patient presenting with trigeminal neuralgia?

<p>Multiple Sclerosis. (D)</p> Signup and view all the answers

Which of the following is the underlying cause of Parkinson's disease?

<p>Degeneration of the pigmented cells of the substantia nigra leading to dopamine deficiency. (B)</p> Signup and view all the answers

Which of the following is characteristic of 'cog-wheel rigidity' in Parkinson's disease?

<p>Ratchety, intermittent resistance to passive movement. (C)</p> Signup and view all the answers

What does the term 'Akathisia' refer to in the context of Parkinson's disease?

<p>A feeling of inner restlessness and an inability to stay still. (B)</p> Signup and view all the answers

Which facial feature is most associated with Parkinson's Disease?

<p>Expressionless ('mask-like') face. (A)</p> Signup and view all the answers

Other than motor symptoms, in what way does Parkinson's disease commonly affect saliva production?

<p>Excessive saliva production (hypersalivation). (B)</p> Signup and view all the answers

In Parkinson's disease, what do 'on' times indicate regarding a patient's condition?

<p>A period when the patient's medication is effectively controlling their symptoms. (D)</p> Signup and view all the answers

Which combination of the following is essential to confirm for a clinical diagnosis of Parkinson's disease?

<p>Rigidity, slow movement, and impaired balance. (A)</p> Signup and view all the answers

Which of the following explains why dopamine itself is NOT directly administered in the treatment of Parkinson's disease?

<p>Dopamine does not cross the blood-brain barrier. (C)</p> Signup and view all the answers

Which of the following medications can be used as a dopamine agonist in the treatment of Parkinson's disease?

<p>Bromocriptine (or other similar examples). (B)</p> Signup and view all the answers

Why is it important to check that adrenaline in local anesthetic will not interact with any of the Parkinson's Disease medications?

<p>Drug interactions can cause changes in blood pressure or cardiac arrhythmias. (C)</p> Signup and view all the answers

Regarding intracranial tumours, are they more commonly primary or metastatic?

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

What is the underlying mechanism of muscle weakness in Myasthenia Gravis (MG)?

<p>Antibody-mediated autoimmune attack on acetylcholine receptors. (D)</p> Signup and view all the answers

How does muscle strength typically change with activity in Eaton-Lambert Syndrome?

<p>Improves with activity. (C)</p> Signup and view all the answers

Which clinical symptoms best characterize bulbar palsy?

<p>Palsy of the tongue, muscles of swallowing and mastication, and facial muscles. (D)</p> Signup and view all the answers

Which of the following cranial nerves is responsible for both sensory and motor functions?

<p>Trigeminal nerve (V). (C)</p> Signup and view all the answers

What can cause isolated Trochlear nerve palsy?

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

Which cranial nerve relates to diplopia as a functional problem?

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

When assessing a patient's trigeminal nerve function, what motor test should be completed?

<p>Estimate the power of the muscles of mastication. (D)</p> Signup and view all the answers

What are some fairly common causes of sensory problems affecting the trigeminal nerve?

<p>Idiopathic, trauma, and iatrogenic inferior alveolar nerve/lingual nerve damage. (C)</p> Signup and view all the answers

After a cerebrovascular accident (stroke), what would be the MOST likely type of facial paralysis that would be present?

<p>Paralysis of the lower face, whilst the upper face is spared. (C)</p> Signup and view all the answers

Which consideration is particularly important in dentistry due to the potential risk of aspiration?

<p>Risk of aspiration. (C)</p> Signup and view all the answers

In taking a patient's history of blackouts and syncope, which aspect is MOST critical?

<p>Detailed character of the episodes. (D)</p> Signup and view all the answers

Which of the following is LEAST associated with Generalized Tonic-Clonic Epilepsy?

<p>Cardiac arrythmias. (B)</p> Signup and view all the answers

In Generalised Tonic-Clonic Epilepsy, what does the tonic phase typically transition into?

<p>Clonic phase with repetitive jerky movements. (A)</p> Signup and view all the answers

Beyond the presence of an aura, what other premotor symptoms or signs may arise prior to the convulsive phase of Generalised Tonic-Clonic Epilepsy?

<p>Change in sensation/emotion/mood. (D)</p> Signup and view all the answers

How does Status Epilepticus define a medical emergency?

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

Which of the following is NOT a recognized characteristic of Temporal Lobe Epilepsy?

<p>Sudden collapse without warning. (C)</p> Signup and view all the answers

What are Transient Ischemic Attacks (TIAs) often indicative of?

<p>Are harbingers of stroke. (A)</p> Signup and view all the answers

Which pathological process is centrally involved in Multiple Sclerosis?

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

Aside from optic neuritis, what other initial symptoms affecting limbs, maybe seen?

<p>Weakness or paralysis. (A)</p> Signup and view all the answers

What might Nystagmus and ataxia indicate?

<p>Presence or progression of Multiple Sclerosis. (E)</p> Signup and view all the answers

What underlying change leads to Parkinson's disease?

<p>Degeneration of cells in the substantia nigra. (D)</p> Signup and view all the answers

Which of the following is NOT typically associated with Parkinson's disease?

<p>Muscle weakness. (B)</p> Signup and view all the answers

Apart from classical motor symptoms, what is a common autonomic presentation in Parkinson's Disease?

<p>Postural drop in BP/hypersalivation. (A)</p> Signup and view all the answers

In the context of Parkinson's disease, what do 'on' times specifically indicate?

<p>Times when the medication is working effectively. (A)</p> Signup and view all the answers

What is Parkinsonism?

<p>Side effect of antipsychotics or methamphetamine, causing Parkinson's symptoms but not due to dopamine deficiency. (C)</p> Signup and view all the answers

What is the basis for the diagnosis of Parkinson's Disease?

<p>Tremor, rigidity, slow movement and impaired balance. (C)</p> Signup and view all the answers

Which of the following explains why providing external dopamine is ineffective as treatment for Parkinson's disease?

<p>Dopamine does not cross the blood-brain barrier. (D)</p> Signup and view all the answers

Which type of motor and sensory neurone degeneration occurs in Motor Neurone Disease?

<p>No sensory loss. (C)</p> Signup and view all the answers

Define bulbar palsy.

<p>Paralysis of the tongue, muscles of mastication/swallowing and facial muscles. (B)</p> Signup and view all the answers

Which of these has the MOST potential to become bacterial meningitis?

<p>Oral sepsis or infection of middle ear or paranasal sinuses. (B)</p> Signup and view all the answers

Which treatment is MOST appropriate for a brain abscess?

<p>Localisation by CT/MRI and urgent surgical drainage and removal of underlying cause. (B)</p> Signup and view all the answers

What can injuries sustained involving the mid third of the face increase the risk of?

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

What is Cerebral Palsy MOST frequently caused by?

<p>Injury during birth/hypoxia. (B)</p> Signup and view all the answers

If a patient presents with ataxic cerebral palsy, how does this MOST commonly manifest itself?

<p>Disturbance of balance. (C)</p> Signup and view all the answers

What deficiency is most likely to lead to Spina Bifida?

<p>Folic acid. (B)</p> Signup and view all the answers

Which dominant type of trait is Huntington's Disease?

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

Reduction in what neurotransmitter can cause Huntington's Disease?

<p>GABA. (D)</p> Signup and view all the answers

What causes Myasthenia Gravis (MG)?

<p>Autoimmune reaction affecting acetylcholine receptors. (B)</p> Signup and view all the answers

Which of the following is characteristic of Eaton-Lambert Syndrome?

<p>Muscle strength increases with activity. (C)</p> Signup and view all the answers

Eaton-Lambert Syndrome is very often linked with what other co-morbidity?

<p>Lung/other cancers. (B)</p> Signup and view all the answers

Which of the following is NOT directly affected by Bulbar Palsy?

<p>Extraocular eye muscles. (A)</p> Signup and view all the answers

Which cranial nerve has both sensory and motor functions?

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

What is a possible cause of Trochlear nerve (IV) palsy?

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

A patient presents with the inability to abduct his eye, in other words, move it laterally, and it is deviated towards the nose. Which cranial nerve is MOST likely affected?

<p>Abducens Nerve. (D)</p> Signup and view all the answers

When assessing the motor function of the trigeminal nerve, a dental practitioner should test which?

<p>Power of the muscles of mastication. (D)</p> Signup and view all the answers

What is the MOST important course of action in the presence of a nervous system infection?

<p>Prompt antimicrobial treatment. (D)</p> Signup and view all the answers

Cerebral metastases are MOST likely to begin where?

<p>Lung, breast, kidney and GI tract. (A)</p> Signup and view all the answers

Kernig's sign, like Brudzinski's sign, is used to assess for what condition?

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

Viral Meningitis presents in which way?

<p>Mild and self-limiting. (B)</p> Signup and view all the answers

Flashcards

Syncope

Temporary loss of consciousness, ranging from lightheadedness to complete fainting.

Epilepsy

A seizure disorder characterized by recurrent, unprovoked seizures.

Transient Ischemic Attack (TIA)

Brief interruption of blood supply to the brain, causing stroke-like symptoms that resolve within 24 hours.

Generalized Tonic-Clonic Epilepsy

Neurological disorder classically preceded by visual, auditory or olfactory aura.

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Status Epilepticus

A continuous seizure lasting longer than 5 minutes or seizures that occur close together without recovery in between.

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Absence Seizures (Petit Mal)

Brief seizures common in children that cause staring and loss of awareness.

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Focal Seizures

Seizures that start in one area of the brain.

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Temporal Lobe Epilepsy

Seizures that may cause staring, unresponsiveness, repeated swallowing, lip smacking, or fidgeting.

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Stokes-Adams Attacks

Rapid changes in heart rhythm cause reduced blood flow to the brain.

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Syncope cause?

Temporary loss of consciousness, often due to vaso-vagal causes like fear or heat.

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Carotid Sinus Syncope

A type of syncope that can be triggered by turning the head or lying supine.

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Epilepsy diagnosis

A neurological condition characterized by recurrent seizures, often indicated by altered breathing, cyanosis, and tongue biting.

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Febrile Convulsions

Convulsions associated with fever, commonly seen in infants and young children.

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Multiple Sclerosis (MS)

An autoimmune disease with varied neurological symptoms due to demyelination in the brain and spinal cord, occurring in both site and time.

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Demyelination

A process where the myelin sheath around nerve fibers is damaged or destroyed.

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Optic Neuritis

Inflammation of the optic nerve that can lead to blurred vision or blindness.

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Nystagmus

Involuntary, rapid, and repetitive eye movements.

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Ataxia

A neurological condition marked by impaired coordination and balance.

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Loss of Sphincter Control

Inability to control the bladder or bowels.

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Parkinson's Disease

A chronic, progressive neurological disorder affecting movement, often linked to dopamine deficiency.

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Substantia Nigra Degeneration

Degeneration of pigmented cells in the substantia nigra, leading to dopamine deficiency.

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"Pill-Rolling" Tremor

A typical tremor in Parkinson's disease where the thumb and fingers move in a circular way, resembling rolling a pill.

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"Cog-Wheel" Rigidity

Rigidity in Parkinson's disease where resistance to movement feels jerky, like turning a cogwheel.

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Bradykinesia

slowness of movement and is a common symptom of Parkinson's disease.

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Akathisia

Motor restlessness with inability to sit still

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Expressionless Face

A face lacking expression due to reduced facial muscle movement

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Stooped Posture

A forward-leaning posture.

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Shuffling Gait

A gait characterized by short steps.

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'On' Times

The period when Parkinson's medication is effectively controlling symptoms.

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'Off' Times

The period when Parkinson's medication wears off, and symptoms return.

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Parkinsonism

A condition where Parkinson's-like symptoms are present but not due to dopamine deficiency.

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Parkinson's Management

Uses dopamine agonists e.g. Bromocriptine, selegeline (a Monoamine oxidase B inhibitor which inhibits dopamine breakdown).

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Deep Brain Stimulation (DBS)

A surgical treatment option involving implantation of a device to deliver electrical stimulation to specific brain areas.

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Motor Neurone Disease

A group of progressive neurological disorders that affect motor neurons.

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Dysphagia

Difficulty swallowing.

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Multiple Sclerosis

An autoimmune disease that affects the brain and spinal cord, leading to diverse neurological symptoms due to demyelination.

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MS Viral Aetiology

A theory suggesting that viral infections may be a causative factor.

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Demyelination in MS

A process in MS where the myelin sheath is damaged, impairing nerve function

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Optic Neuritis in MS

A condition where the optic nerve becomes inflamed, leading to vision issues.

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Nystagmus in MS

Involuntary, rapid eye movements that can occur in MS

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Ataxia in MS

A condition marked by impaired coordination, sometimes seen in MS patients.

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Substantia Nigra

The degeneration of dopamine-producing cells that leads to Parkinson's.

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Expressionless ('mask-like) face

A facial appearance marked by reduced facial expression.

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Parkinson's 'Off' Times

Periods when Parkinson's symptoms return.

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Dopamine Challenge

Medication cannot penetrate the blood-brain barrier.

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Surgical Management

Surgical procedure that can help some cases of Parkinson's.

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Tumor Types

Tumors can be benign or malignant; latter is more common

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Tumor Headaches

Headaches are characteristically worse in the morning.

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Common Sites of Cerebral Metastases

Lung, breast, gastrointestinal tract, and kidney.

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Myasthenia Gravis (MG)

An autoimmune disease where antibodies disrupt acetylcholine receptors function.

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Eaton-Lambert Syndrome

An acquired autoimmune disease where weakness improves with repeated muscle contraction.

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Bulbar Palsy

Palsy: tongue, muscles of mastication/swallowing, and facial muscles.

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Bulbar Palsy Etiology

Acute: infection (e.g., polio, Guillain-Barre). Chronic: tumors.

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Cranial Nerves List

I: Olfactory; II: Optic; III: Oculomotor; IV: Trochlear; V: Trigeminal; VI: Abducens; VII: Facial; VIII: Vestibulo-cochlear; IX: Glossopharyngeal; X: Vagus; XI: Accessory; XII: Hypoglossal.

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Oculomotor Nerve Problems

Oculomotor nerve can be affected by diabetes and intracranial pressure.

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Trochlear Nerve Problems

Trauma.

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Abducens Nerve Problems

Multiple sclerosis, stroke.

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Trigeminal Nerve Functions

Sensory and Motor.

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Trigeminal Testing

Test sensation in all three nerve divisions and power of mastication muscles.

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Facial Nerve LMN lesion

Lower Motor Neuron lesion; Bell's Palsy, skull fracture or a parotid tumor. Total facial weakness.

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Facial Nerve UMN lesion

Upper motor neuron lesions due to stroke or tumor. Forehead sparing weakness.

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Facial Tics Causes

Habitual or drug -induced (e.g., long-term phenothiazine therapy).

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Ramsay Hunt Syndrome

Profound facial paralysis with vesicles in the pharynx and external auditory meatus of the same side.

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Ramsay Hunt Cause

Geniculate ganglion of VII is infected with herpes zoster.

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Nervous System Infections Origins

Bacterial or viral origin.

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Bacterial Meningitis Cause

Maxillofacial injuries involving mid third of the face.

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Myasthenia Gravis (MG) Characteristics

An autoimmune disease caused by a deficiency of functioning ACh receptors, more commonly affecting young women.

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Bulbar Palsy definition

Bulbar palsy resulting from motor nuclei loss in the brainstem affecting the tongue, mastication, swallowing, and facial muscles.

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Olfactory Nerve (I)

Cranial nerve responsible for smell.

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Optic Nerve (II)

Cranial nerve responsible for vision.

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Oculomotor Nerve (III)

Cranial nerve responsible for eye movement, pupil dilation, and eyelid elevation; problems can result from diabetes or increased intracranial pressure.

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Trochlear Nerve (IV)

Cranial nerve responsible for superior oblique muscle control; problems can cause diplopia upon trauma.

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Abducens Nerve (VI)

Cranial nerve responsible for lateral eye movement; problems can result from multiple sclerosis or stroke causing deviation towards the nose.

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Nervous System Infections & Meningitis

Systemic infection of either bacterial or viral origin, bacterial meningitis can occur in maxillofacial injuries.

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Meningitis

Inflammation of the meninges, indicated by headache, stiff neck, and sensitivity to light.

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Kernig's Sign

A sign of meningitis where straightening the leg when the hip is flexed causes pain.

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Viral Meningitis

A mild and self-limiting form of meningitis caused by viral infections.

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Brain Abscess

A localized infection in the brain, often secondary to other infections.

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Cerebral Palsy

A disorder of motor function due to brain damage, often from birth injury.

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Spastic Cerebral Palsy

A type of cerebral palsy characterized by muscle contractions.

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Ataxic Cerebral Palsy

A type of cerebral palsy causing balance and coordination issues.

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Athetoid Cerebral Palsy

A type of cerebral palsy with involuntary, writhing movements.

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Spina Bifida

A birth defect where the vertebral arches fail to close completely.

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Meningocele

A form of spina bifida where the meninges protrude through the vertebral defect.

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Huntington's Disease

An inherited neurodegenerative disease causing progressive dementia and involuntary movements (chorea).

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Neurological Conditions knowledge Importance

Indicates that you need to comprehend the nervous system to conduct safe dental practice

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Blackouts

Brief loss of consciousness, history taking is critical for diagnosis.

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Parkinson's Dental Management

Optimizing moisture control and preventing quick postural changes.

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Motor Neurone Disease (MND)

Group of degenerative disorders affecting motor neurons, unknown cause, males more affected.

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Brain Abscess Treatment

Treatment targets localization by CT/MRI, surgical drainage and removal of root cause.

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Transient Ischemic Attack

A sudden onset of focal CNS signs or symptoms resulting from a temporary blockage of cerebral circulation, resolving in less than 24 hours and signaling higher stroke risk.

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Parkinson's dental appointments

Check 'On' periods and treat then. Maintain moisture, check for drug interactions, avoid quick postural changes.

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Huntington's

A progressive disease featuring autosomal dominant inheritance, dementia, and involuntary movements, caused by a reduction in GABA and cholinergic neurons.

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Cranial Nerve Examination

Examine cranial nerves I-XII.

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Trochlear Nerve (IV) problem

Trauma to the nerve, resulting in diplopia.

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Nervous System Infections

Nervous system infections can result from bacteria and viruses, and bacterial meningitis may occur in maxillofacial trauma.

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Study Notes

Nervous System Infections

  • Bacterial or viral infections may affect the nervous system.
  • Bacterial meningitis can occur in maxillofacial injuries involving the mid-third of the face.
  • Prompt antimicrobial treatment is needed.

Viral Meningitis

  • Usually mild and self-limiting

Meningitis

  • Signs and symptoms include a severe headache, nausea/vomiting, drowsiness, a painful, stiff neck, photophobia, and a purpuric rash.

Brain Abscess

  • A brain abscess secondary to oral sepsis or infection of the middle ear or paranasal sinuses is possible.
  • There is an increased risk in patients with congenital heart disease
  • A brain abscess can be a complication of infective endocarditis
  • Treatment involves localization by CT/MRI, urgent surgical drainage, and removal of the underlying cause.

Cerebral Palsy

  • Cerebral palsy is a disorder of motor function secondary to cerebral damage.
  • Most frequently associated with birth injury/hypoxia.
  • The most common cause of a congenital physical disability.
  • There are three main types of cerebral palsy: spastic (muscles contracted), ataxic (disturbance of balance), and athetoid (writhing movements).

Spina Bifida

  • Vertebral arches fail to fuse, potentially due to folic acid deficiency.
  • It can result in an inability to walk, epilepsy, or learning difficulties.
  • May be associated with hydrocephalus.

Huntington’s Disease (Chorea)

  • Huntington’s Disease is autosomal dominant
  • Signs do not begin to appear until middle age and has an insidious onset
  • Characterised by progressive dementia with marked involuntary movements.
  • Marked reduction in GABA and cholinergic neurones in the corpus striatum result from Huntington's Disease
  • Epilepsy is a common sign, as is personality change

Summary

  • A basic knowledge of neurological conditions is essential for safe dental practice.
  • Neurological disorders may directly impact dental treatment.

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