BMB 2 - Altered Mental Status; Coma

Question 1

What mnemonic is useful in remembering the differential for altered mental status?

Answer 1

‘HE STOPS for TIPS on VOWELS’

Question 2

Using the mnemonic ‘HE STOPS for TIPS on VOWELS,’ state some of the general causes of altered mental status using the ‘HE STOPS’ portion.

Answer 2

Hepatic

Electrolytes

Stroke

Temperature abnormality

Oxygen desaturation

Psychiatric disturbance

Sepsis

Question 3

Using the mnemonic ‘HE STOPS for TIPS on VOWELS,’ state some of the general causes of altered mental status using the ‘TIPS’ portion.

Answer 3

Trauma

Infection

Porphyria

Seizure

Question 4

Using the mnemonic ‘HE STOPS for TIPS on VOWELS,’ state some of the general causes of altered mental status using the ‘AEIOU’ portion.

Answer 4

Alcohol

Endocrine

Intoxication

Opiates

Uremia

Question 5

What is consciousness?

Answer 5

An awareness of oneself and one’s surrounding

Question 6

What is arousal (in terms of being awake)?

Answer 6

The level of consciousness

Question 7

What are the four levels of arousal in terms of consciousness?

Answer 7

Alert

Lethargic

Stupor

Coma

Question 8

True/False.

Arousal is one’s level of consciousness; awareness is the content of that consciousness.

Answer 8

True.

Question 9

A patient is awake and shows normal consciousness. This patient is _______ (level of arousal).

Answer 9

A patient is awake and shows normal consciousness. This patient is alert.

Question 10

A patient is arousable by voice and can respond verbally. This patient is _______ (level of arousal).

Answer 10

A patient is arousable by voice and can respond verbally. This patient is lethargic.

Question 11

A patient is unresponsive and requires repeated vigorous stimuli to arouse. This patient is _______ (level of arousal).

Answer 11

A patient is unresponsive and requires repeated vigorous stimuli to arouse. This patient is in a stupor.

Question 12

A patient is completely unresponsive to stimuli. This patient is _______ (level of arousal).

Answer 12

A patient is completely unresponsive to stimuli. This patient is in a coma.

Question 13

A patient presents with altered mental status. What are some of the first steps of work-up?

Answer 13

1. Assess vitals
2. Take thorough medical history
3. Check medications

Question 14

Define delerium.

Answer 14

Acute change with impaired, fluctuating consciousness

(usually has an underlying cause)

Question 15

Define dementia.

Answer 15

Slow, progressing, consistent cognitive impairment

(think memory loss, agnosia, apraxia, aphasia, etc.)

Question 16

True/False.

Most causes of altered mental status are due to some loss of homeostasis.

Answer 16

True.

Question 17

What sorts of labs are useful in working up a case of altered mental status?

Answer 17

CBC,

glucose,

BUN,

LFTs,

toxicology,

urinalysis,

TSH,

B12

Question 18

What sorts of imaging are useful in working up a case of altered mental status?

Answer 18

CXR,

CT (head and/or C-spine)

Question 19

True/False.

Comas often arise due to causes that affect the cortex globally and bilaterally.

Answer 19

True.

Question 20

Comas often arise due to damage to which specific portions of the brain?

Answer 20

The reticular activating system;

bilateral thalamic lesions

Question 21

Occlusion of which artery is especially associated with bilateral thalamic infarction and resultant coma?

Answer 21

The artery of Percheron

Question 22

A patient presents with constricted pupils and a low respiratory rate. What category of substances do you expect is the proximal cause?

Answer 22

Narcotics

Question 23

A patient is unresponsive after ingesting tricyclic medications.

What will their pupil state be?

Answer 23

Dilated

Question 24

The Glascow coma scale follows a range of ____ - ____.

Answer 24

The Glascow coma scale follows a range of 3** - **15.

Question 25

A coma is typically described as a GCS score of ≤ ______.

Answer 25

A coma is typically described as a GCS score of ≤ 8.

Question 26

What are the three assessments of the Glascow coma scale?

Answer 26

Eye response (1 - 4)

Verbal response (1 - 5)

Motor response (1 - 6)

Question 27

An unconscious patient presents with flexed, adducted arms with supinated wrists.

This is a sign of de_______tion and damage to the ______________.

Answer 27

An unconscious patient presents with flexed, adducted arms with supinated wrists.

This is a sign of decortication and damage to the upper midbrain.

Question 28

An unconscious patient presents with extended arms with pronated, flexed wrists.

This is a sign of de_______tion and damage to the ______________.

Answer 28

An unconscious patient presents with extended arms with pronated, flexed wrists.

This is a sign of decerebration and damage to the upper pons.

Question 29

Locked-in syndrome (i.e. you are conscious and yourself but unresponsive and immobile) occurs due to occlusion of which artery?

Answer 29

The basilar artery

Question 30

Management of comatose patients involves what sort of targeted temperature adjustments?

Answer 30

Maintenance at 33°C (91.4°F) or 36°C (96.8°F) followed by strict avoidance of fever.

Question 31

What is the medical term for a vegetative state (i.e. one is awake, exhibits reflexes, and may even keep their eyes open, but they are still unresponsive and exhibit no signs of awareness or interaction with their environment)?

Answer 31

Unresponsive wakefulness syndrome

Question 32

A patient has suffered a severe brain injury and resultant loss of consciousness. She awakes briefly every now and then and seems to exhibit purposeful behavior for very short periods of time. She has no language ability.

What is this termed?

Answer 32

Minimally conscious state (-)

Question 33

A patient has suffered a severe brain injury and resultant loss of consciousness. She awakes briefly every now and then and seems to exhibit purposeful behavior for very short periods of time. She has some language ability.

What is this termed?

Answer 33

Minimally conscious state (+)

Question 34

What is the presentation of an individual with brain death?

Answer 34

Preservation of systemic circulation with irreversible loss of function of the brain and/or brainstem

Question 35

What are the three steps of assessing and determining brain death in a patient?

Answer 35

1. Coma or unresponsiveness- no cerebral motor responses to pain in all extremities
2. Absence of brainstem reflexes - pupillary, oculocephalic, corneal, jaw, pharyngeal reflexes are absent
3. Apnea test - the patient is not breathing above the ventilator settings