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BMB Test 3 > B7-049 Coma > Flashcards

B7-049 Coma Flashcards

1
Q

midline structural lesions of the […] can affect the RAS on both sides, leading to coma

A

diencephalon (thalamic area)

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2
Q

an occlusion of […] artery could cause diencephalic coma

A

top of basilar

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3
Q

midline structural process affecting the brain stem

A

subtentorial

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4
Q

space occupying lesion pushing the brain down and compressing the RAS causing coma

A

supratentorial

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5
Q

diffuse toxic process affecting the entire cortex leading to coma

A

metabolic

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6
Q

two stages of supratentorial lesion

A
  1. diencephalic stage (early)
  2. midbrain stage (late)
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7
Q

cortex and RAS working completely fine, but in coma

A

psychogenic

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8
Q

psychological stressors precedes coma

A

pyschogenic

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9
Q

delirium w/o focal signs precedes coma

A

metabolic

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10
Q

sudden onset coma [2]

A

diencephalic
subtentorial

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11
Q

focal signs precede coma

A

supratentorial

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12
Q

hemorrhage in the pons is an example of process causing […] coma

A

subtentorial

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13
Q

neurologic examination in coma involves [4]

A

level of consciousness
pupils
extraocular movements
motor function

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14
Q

the pupillary parasympathetic system is […] to toxic-metabolic processes

A

resistant

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15
Q

the pupillary sympathetic system is […] to toxic-metabolic processes

A

sensitive

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16
Q

almost all patients with coma will experience […] dysregulation

A

sympathetic

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17
Q

pupils will be mid-range and reactive in patients experiencing […] coma

A

psychogenic

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18
Q

pupils will be small and reactive in patients experiencing […] coma [3]

A

metabolic
diencephalic
early stage supratentorial

(due to unopposed parasympathetic stimulation)

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19
Q

pupils will be mid-range and unreactive in patients experiencing […] coma [2]

A

late stage supratentorial
subtentorial

(due to loss of both sympathetic and parasympathetic systems)

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20
Q

unreactive pupils tell you the […] system is not working

A

parasympathetic

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21
Q

if the pupils are small, this tells you the […] system is intact

A

parasympathetic

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22
Q

small pupils are typically […]

A

reactive

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23
Q

fast eye movements (saccades) require that the […] is intact

A

frontal eye fields

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24
Q

if you have fast eye movements, your […] is intact

A

cerebral cortex

(not in coma)

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25
Q

fast eye movements is […] to toxic metabolic processes

A

sensitive

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26
Q

slow eye movements indicates […] is working

A

brainstem

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27
Q

slow eye movements is […] to toxic metabolic processes

A

moderately sensitive

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28
Q

the presence of slow eye movement means that

A

there is no brainstem lesion

(the absence does not necessarily mean there is though)

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29
Q

intact slow movements means the […] is intact

A

brainstem

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30
Q

normal oculocephalic reflex

A

eyes continue to point in the same direction while head is turned side to side

(brainstem is working)

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31
Q

what do you expect to see when cold calorics is used on a patient in a coma if their brainstem is intact?

A

slow tonic movements of the eye toward the side being irrigated

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32
Q

which method would be best to test the eye movements of a patient in a coma with neck trauma?

A

cold calorics

(don’t want to move their head side to side as with oculocephalic)

33
Q

if you are doing cold calorics on a patient in a coma and you see saccades, the patient is […]

A

not in a coma

(frontal eye field is working)

34
Q

if you’re suspicious a patient is in psychogenic coma, what eye movement test is helpful in determining that?

A

cold calorics

(will have fast saccades –> not in true coma)

35
Q

intact fast eye movements
intact slow eye movements

A

psychogenic

36
Q

absent fast eye movements
intact or abnormal slow eye movements

A

metabolic

37
Q

absent fast eye movements
intact slow eye movements [2]

A

diencephalic
early stage supratentorial

brainstem intact

38
Q

absent fast eye movements
abnormal slow eye movements [2]

A

late supratentorial
subtentorial

39
Q

[…] motor findings characterize most patients in coma, regardless of cause

A

bilateral symmetric

(bilateral corticospinal tract findings)

40
Q

localized response is a […] prognostic indicator for a patient in a coma

A

good

41
Q

flexion of upper extremities
extension of lower extremities

A

decorticate posturing

42
Q

extension of upper extremities
extension of lower extremities

A

decerebate posturing

43
Q

motor responses in coma [3]

A

localized response
decorticate posturing
decerebate posturing

44
Q

does decorticate or decerebate posturing have a worse prognosis?

A

decerebate

45
Q

a lesion between the cortex and the red nucleus causes […] posturing

A

decorticate

46
Q

a lesion between the red nucleus and the vestibular nuclei causes […] posturing

A

decerebate

47
Q

motor response that might be seen with patients in a psychogenic or metabolic coma

A

localized response

(don’t put too much stock in abnormal posturing though)

48
Q

motor response that might be seen with patients in a diencephalic or early supratentorial coma

A

decorticate posturing

(don’t put too much stock in abnormal posturing though,not specific)

49
Q

motor response that might be seen with patients in a late supratentorial or subtentorial coma

A

decerebate posturing

(don’t put too much stock in abnormal posturing though)

50
Q

a CT can help diagnose a […] mass lesion

A

supratentorial

51
Q

what types of coma will have an intact brainstem? [4]

A

psychogenic
metabolic
diencephalic
early supratentorial

52
Q

what types of coma will not have an intact brainstem? [2]

A

late supratentorial
subtentorial

53
Q

most common cause of coma

A

metabolic

54
Q

workup for toxic metabolic coma should include [4]

A

routine labs
stat lumbar puncture
EEG for seizure hx
MRI

55
Q

patients with […] will open their eyes to pain

A

stupor

56
Q

the neurologic exam on a normal person would be most like the neurologic exam of a patient in what type of coma?

A

psychogenic

57
Q

in most patients with coma, the […] system controlling pupillary […] is affected

A

sympathetic
dilation

58
Q

the presence of fact eye movements indicates the […] is intact

A

frontal eye fields

59
Q

most important element of neurologic examination to determine the cause of coma

A

pupillary activity

60
Q

the pathological absence of consciousness

A

coma

61
Q

the physiologic absence of consciousness

A

sleep

62
Q

patients with […] will open their eyes to speech

A

lethargy

63
Q

patients in […] will not open their eyes

A

coma

64
Q

differential for subtentorial coma

A

pontine or cerebellar hemorrhagic stroke (would see on CT)

basilar artery ischemic stroke (would not see on CT)

65
Q

how would you determine if it is psychogenic?

A

look for fast eye movements
look for eye tracking (mirror in front of face)

66
Q

what would you do to differentiate a metabolic vs diencephalic stroke?

A

look for obvious toxic metabolic cause (labs)

if none, stat CT angiogram to look for top of the basilar occlusion

67
Q

most common cause of metabolic coma in ER

A

drugs

68
Q

eyes look toward the brain lesion when the lesion is in the […]

A

frontal eye fields

(seen in MCA stroke)

69
Q

eyes look away from the brain lesion (toward the hemiplegia) when the lesion is in the […]

A

PPRF

70
Q

bilateral mammilary body lesions would be seen in […] syndrome

A

Wernicke-Korsakoff

71
Q

bilateral amygdalal lesions are seen in

A

HSV-1 encephalitis

(causes hyperphagia, hypersexuality, hyperorality)

72
Q

is decorticate posturing a specific finding?

A

apparently not

can be seen in toxic metabolic processes and structural processes involving the RAS

73
Q

the appropriate study to look for a supratentorial process in the ER is

A

non-contrast CT

74
Q

[…] eye movements can only be present when consciousness is preserved

A

fast

75
Q

fast eye movements require intact

A

frontal eye fields

76
Q

an overdose of […] could cause coma with fixed dilated pupils

A

anticholinergics

(amytriptyline, diphenhydramine, etc)

77
Q

most causes of metabolic coma would not affect the […]

A

pupils

78
Q

hallmark of psychogenic coma

A

presence of fast eye movements

BMB Test 3 (18 decks)

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