Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Senior - E Med > 2 - Altered Mental > Flashcards

2 - Altered Mental Flashcards

1
Q

Disorders of consciousness may be divided into?

A

Processes that affect either:

  • arousal
  • content of consciousness

or a combination of both

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Where do the neuronal structures responsible for the content of consciousness reside?

A

Cerebral cortex

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Content of consciousness includes___

A
  • Self-awareness
  • Reasoning
  • Spatial relationship integration
  • Emotions
  • Complex integral processes that make us human
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is dementia?

A

Failure of the content of portions of consciousness with relatively preserved alerting functions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is delirium

A

Arousal system dysfunction with the content of consciousness affected as well

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is a coma?

A

Failure of both arousal and content functions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Pts with delirium?

A

Notice symptoms over days with fluctuating effects
They have disordered attention and cognition with either reduced or hyperalert consciousness
Their orientation is impaired and they may have hallucinations, delusions
Their movements are asterixis and often have tremors

Chart on slide 7 if that works better

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Pts with dementia?

A

Have an insidious onset with stable symptoms
They are alert with normal attention
Cognition and orientation are impaired
There are generally no hallucinations, delusions or movement abnormalities

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Pts with psychiatric disorders?

A

Symptoms have a sudden onset and are stable
Pts are alert with disordered attention and impaired cognition/orientation
Hallucinations are usually auditory and delusions are sustained
Typically no movement disorders

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Delirium definition?

A

Transient disorder with impairment of attention and cognition

Aka: 
Acute confusional state
Acute cognitive impairment
Acute encephalopathy
Altered Mental status
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Pathophysiology of delirium? (4 general causes)

A
  1. Primary intercranial disease
  2. Systemic diseases secondarily affecting the CNS
  3. Exogenous toxins
  4. Drug withdrawl
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

With delirium it is not unusual for?

A

Symptoms to be intermittent, not unusual for different caregivers to witness completely different behaviors w/in a brief timespan

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Sleep wake cycle for delirium pts?

A

Often disrupted

  • increased somnolence during day
  • agitation at night/sundown
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Clinical signs of delirium

A 
Tremor
Asterixis
Tachycardic
Sweating 
HTN
Emotional outburst
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What type of hallucinations do delirious pts have?

A

Usually visual but auditory is also possible

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Symptoms thatre “virtually diagnostic” of delirium?

A

Actue onset of attention deficits and cognitive abnormalities fluctuating in severity throughout the day with worsening symptoms at night

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What must be done for a diagnosis of delirium?

Tests

A

R/O drugs, pneumonia, UTI etc

Test electrolytes, hepatic and renal, UA, CBC and chest radiograph

Head CT

Lumbar puncture (post CT)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are some diagnostic tools that can be used to diagnose delirium?

A

Mini-mental (doesnt do mild impairment)

Quick confusion scale (no reading, writing, or drawing required)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

___ often resembles hypoactive delirium but can be differentiated by?

A

Depression

But r/o by:

  • Rapid fluctuation of symptoms
  • Clouding of consciousness (absent)
  • Depressed pts can follow commands
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Status epilepticus or complex partial status epilepticus?

A

Unusual cause of confusional state but may be under-recognized

Get an EEG if suspected

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Tx for delirium?

A

Detect and treat the underlying cause

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Common delirium drugs?

A

Haloperidol (5-10mg PO, IM, IV)

Benzodiazepines: lorazepam (0.5-2.0 PO, IM, IV)

Often combined

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Common causes of delirium?

A

Infections

Metabolic/toxic

Neurologic

Cardio

Drugs

Slide 20 has examples of these

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Almost all delirium pts get?

A

Admitted

Unless they have a readily reversible cause

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
What are the largest categories of dementia?
Idiopathic dementia - alzheimers (#1 in US) Vascular dementia - diagnosis of exclusion
26
pathognomonic for alzheimre’s disease?
Amyloid deposition Neurofibrillary tangles and plaques
27
What is the pathology of vascular dementia?
CVD with multiple infarctions
28
List of possible causes of dementia?
``` Degenerative Vascular Infectious Inflammatory Neoplastic Traumatic Toxic (etoh) Metabolic Psychiatric Hydrocephalic ``` (Slide 25 has examples)
29
Characteristic of the onset of dementia associated with Alzheimer’s?
Impaired memory and orientation with preserved motor and speech
30
Early stage of degenerative dementia?
Memory loss Naming problems Forgetting of items
31
Middle stage of degenerative dementia?
``` Progression of early stage + Loss of reading Decreased social function Loss of direction ```
32
Late stage degenerative dementia?
``` Early and middle + Extreme disorientation Inability to self care Personality changes ```
33
Pts with vascular or multi-infarct dementia show similar symptoms to degenerative but they also often have?
Exaggerated/asymmetric DTR Gait abnormalities Weakness of an extremity
34
Presence of focal neurologic signs may suggest?
Vascular dementia | Mass lesion
35
Increased motor tone and extrapyramidal signs (rigidity or movement disorder) indicate?
Parkinson’s
36
Labs and images for Dementia?
``` CBC CMP UA Thyroid function Serum B12 Syphilis test ESR Folate level HIV ``` CXR CT/MRI Lumbar puncture (maybe)
37
You cannot have a diagnosis of probably vascular dementia w/o?
Signs of CVD
38
Differentiating between stroke and vascular dementia?
Stroke: symptoms w/in 3 mo (temporally related) VD: fluctuating, stepped course
39
Pseudo dementia?
Depression-imitating dementia
40
What may cause a rapid decline in a mild demented pt?
UTI CHF Hypothyroid And many more similar things
41
All types of dementia are treatable at least to some degree by?
environmental or psychosocial interventions
42
Who should antipsychotic drugs be reserved for?
Pts with persistent psychotic features or those with extreme disruptive or dangerous behaviors
43
How is vascular dementia treated?
Tx is limited to tx of risk factors including HTN
44
When should you consider normal-pressure hydrocephalus?
If Urinary incontinence and gait disturbance develop early in the disease process
45
Your pt has excessively large ventricles on head CT, what does this suggest? What can you do about it?
Normal-pressure hydrocephalus Consider a trial of lumbar puncture with CSF drainage or ventricular shunting
46
What does the ED do with dementia pts?
They r/o thing that are immediately treatable or will kill the pt then attempt to admit or arrange for an outpatient diagnosis. ED isn’t set up to do all the in depth testing and therapy required for this diagnosis
47
Definition of coma?
State of reduced alertness and responsiveness from which the patient cannot be aroused
48
What limitations does the Glasgow coma scale have?
Doesn’t acknowledge: - hemiparesis - focal motor signs Doesn’t test for - higher cognitive function
49
GCS
Slide 36
50
If a pt is intubated how is their GCS assessed?
The verbal testing is not done and a T is written next to the score i.e. 10T The new lowest score possible is 2T
51
GCS number ranges?
13-15: mild head injury 9-12: moderate head injury = 8: sever head injury (intubate)
52
Common pathophysiology of coma?
Deficiency of substrates (hypoxia) Systemic cause (global) Primary CNS cause (hemorrhage) Specific areas (look for CN signs)
53
Do strokes cause comas?
Not alone The function of the brainstem and/or both hemispheres must be impaired for unresponsiveness to occur
54
Cerebral autoregulation maintains cerebral blood flow at a MAP of?
50-100mmHg
55
What happens when cerebral MAP is off?
Cerebral blood flow is reduced leading to diffuse ischemia
56
What is cerebral perfusion pressure?
Cerebral perfusion pressure = MAP - ICP
57
If an unresponsive pt has a hx of seizures you must consider?
Ongoing non convulsive seizures - subtle status epileptics or ictal coma These may continue in the absence of clinical seizures
58
Coma clinical features?
Widely varied: - increased ICP -> complete loss of motor tone - variety of abnormal breath patterns - pupillary findings
59
Findings on a toxic-metabolic coma?
- lack of specific brain region findings - movements/reflexive posturing is symmetric - muscle stretch reflexes symmetric - pupils are small but reactive - extraocular moments are absent
60
Exception to the rules of toxic coma?
Sedative poisoning (barbiturates) - pupils = large - extraoccular movement absent - muscles flaccid - apneic (looks like brain death)
61
How do supratentorial lesions present?
``` Progressive hemipareiss Asymmetric muscle tone/ reflexes Lateralizing signs Reflex changes in BP and HR HTN Bradiacardia ```
62
Coma without lateralizing signs may result from?
Decreased cerebral perfusion secondary to increased ICP
63
In reality however supratentorial lesions frequently present how?
Large acute supratentorial lesios are seen w/o the features consistent with temporal lobe herniation
64
Signs that a coma may actually be a pseudocoma?
Normal and intact - Pupilary responses - EOM - Muscle tone - Reflexes Avoidance of gaze Nystagmus (strong evidence)
65
The posterior fossa cannot take much expansion so infratentorial lesions often cause?
Abrupt coma Abnormal extensor posturing Loss of pupillary reflexes Lose of EOM
66
Pinpoint-sized pupils indicate?
Pontine hemorrhage
67
History and PE can vary greatly with coma so:
Liberal use of CT scanning is encouraged
68
Abrupt coma suggests?
Abrupt CNS failure - catastrophic stroke - seizure
69
Slow progressive onset coma suggests?
progressive CNS lesions - tumor - subdural hematoma Also could be metabolic - hyperglycemia
70
Findings that suggest CNS lesions?
Asymmetric findings of CN exam - pupillary exam - corneal reflexes - oculovestibular reflex
71
The goal of the physician when diagnosing coma pts?
Rapidly determine if the CNS dysfunction is from - diffuse - focal Focal may be treatable with surgery
72
Midline shift and mass lesions?
Acute hemorrhage
73
If CT is unremarkable and subarachnoid hemorrhage or CNS infection is suspected?
Do a lumbar puncture
74
“Normal” CT with hyperdense basilar artery?
Suspect basilar artery thrombosis Get an MRI or cerebral angiography
75
Continuing state of electrical seizures w/o corresponding motor movements is aka?
Nonconvulsive status epileptics Subtle status epileptics Electromechanical dissociation of brain and body
76
If a seizing pt stops convulsing and doesnt wake up in 30 min?
Consider nonconvulsive status epileptics
77
Tx of coma?
Find and fix the problem Maintain: - Airway - ventilation - circulation
78
Antidotes for some coma’s?
Thiamine (before dextrose) Dextrose Naloxone
79
What drug is not recommended for routine use as a coma antidote?
Flumazenil
80
Elevated ICP tx?
- Paralytic/sedatives - Elevate bed 30* - mannitol (0.5 - 1.0 gram/kg IV) - dexamethasone (10mg IV) - hyperventilation (reduce PPCO2)
81
Recommendations for using hyperventilation in ICP pts?
Avoid excessive hyperventilation (PPCO2 /= 35 mmHg) in the 1st 24 hrs Brief hyperventilation for refractory intracranial HTN
82
Haloperidol dose?
5-10mg PO, IM or IV Reduced dosing of 1-2 for elderly
83
Lorazepam dose?
0.5 - 2.0mg PO, IM, IV When combined w haloperidol does = 1-2mg
84
Holy Jesus! What is that? What the fuck is that? WHAT IS THAT, PRIVATE PYLE?
Sir, a jelly doughnut, sir!
85
Central herniation syndrome S/S?
- Progressive LOC - loss of brainstem reflexes (vitals/pain reaction etc) - decorticate posturing - irregular respiration
86
S/S Uncal herniation syndrome
Medial temporal lobe shifts to compress the upper brainstem, resulting in - progressive drowsiness - followed by unresponsiveness - Ipsilateral pupil is sluggish - Dilated/nonreactive pupil (3rd CN compression) Brain stem is an anchor that gets pushed the opposite direction of the swelling

Senior - E Med (8 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions