Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

OMS - 2 Neuro Final > Brain Death & Coma > Flashcards

Brain Death & Coma Flashcards

1
Q

Define coma

A

UNarousable & UNresponsive

(don’t use stupor or obtunded; it is too subjective)

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

What keeps humans awake and alert

(system?)

A

Ascending Reticular Activating System (ARAS)

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

ARAS receives input from the _______ & ______.

A
  • vestibular
  • auditory apparatus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

ARAS sends information received from the auditory and vestibular apparatus to the ________ → _______ → cortex

A

raphe & reticular nuclei → intra-laminar thalamic nuclei

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

_____ provides a relay of inputs to the cerebral cortex.

A

intralaminar thalamic nuclei

(this gives us conscious perception)

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

4 Primary mechanisms of coma (causes)

A
  1. toxic
  2. metabolic
  3. infection
  4. hypothermia

(always check glucose)

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

coma patient: upon arrival, what do you do (3)?

A
  1. interview EMT
  2. friends/fam
  3. check medical alert bracelet or old charts
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

If a patient abruptly becomes comatose, it is likely due to ______.

A

subarachnoid hemorrhage or seizure

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

If a patient gradually becomes comatose, it is likely due to ______.

A

brain tumor

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

If a patient fluctuations into coma, it is likely due to _____ (3).

A
  1. metabolic
  2. subdural hematoma
  3. recurring seizure
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

If the coma patient has focal signs prior to LOC, it is likely due to ______.

A

structural lesion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

If a coma patient has transient visual sx prior to LOC, it is likely due to _______.

A

structural lesion

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

If a coma patient has headache and N/V prior to LOC, it is likely due to _______.

A

Subarachnoid hemorrhage

(they would also lose consciousness abruptly)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Coma patient presents & blood gas shows acidosis. If they are hyperventilating, the cause is ______. If they are hypoventilating, the cause is _______.

A
  • metabolic acidosis (uremia, DKA, alcohol)
  • respiratory acidosis (respiratory failure or peripheral NS disease)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Coma patient presents & blood gas shows alkalosis. If they are hyperventilating, the cause is ______. If they are hypoventilating, the cause is _______.

A
  • respiratory alkalosis (hepatic failure, sepsis)
  • metabolic alkalosis (vomiting, alkali ingestion)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

ipsilateral mydriasis in a coma patient indicates______.

A

intracranial herniation

(MC is uncal)

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

Coma patients with mid/fixed pupils indicate _____ or _____ (location of lesion).

A
  • midbrain/upper pons
  • medulla
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

If a coma patient has pinpoint/fixed pupils, this indicates lesion location in the _______.

A

lower pons/medulla

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

A coma patient with a vestibulo-ocular reflex indicates a _______ lesion location

A

diencephalic

(all others will have absent VOR)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

deCORTicate indicates ______ lesion location; deCEREbrate indicates _______ lesion location.

A
  • diencephalic
  • midbrain/upper pons
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Triple flexion in a coma patient indicates _______ lesion location.

A

lower pons/medulla

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

define Triple flexion (motor response)

A

foot stimulation → thigh & leg flexion, dorsiflexion

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

Cheyne-stokes breathing indicates a ______ lesion location.

(pronounced “shane-stokes”, ramps up and ramps down)

A

diencephalon

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

Hyperventilation indicates a ______ lesion location.

A

midbrain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Apneustic breathing indicates a ______ lesion location.

(pronounced “app-new-istic”; slow & stops at times)

A

rostral pons

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Ataxic breathing indicates a ______ lesion location.

A

lower pons

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Respiratory arrest indicates a ______ lesion location.

A

upper medulla

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Decorticate posturing has the arms in ______ and the lesion is ______ to the red nucleus.

A
  • flexion
  • caudal

(Decerebrate is the opposite)

29
Q

Asterixis

A

flapping and extended arms and wrists

30
Q

asterixis indicates

A

hepatic encephalopathy

(commonly seen in alcoholics)

31
Q

If a patient is conscious with altered consciousness, what are 3 exams you can utilize to asses the cause?

A
  1. kernig (lift their knee)
  2. brudzinski (lift their brain)
  3. MMSE
32
Q

Conditions that are mistaken for coma

A
  1. Locked-in syndrome
  2. Akinetic mutism

(also psychogenic unresponsiveness/dissociative attack)

33
Q

2 requisites for locked-in syndrome

(often mistaken for coma)

A
  1. alert & retain cognitive ability
  2. paralysis of limbs and oral structures w/some blinking & vertical eye movement
34
Q

_______ causes locked-in syndrome
(commonly mistaken for coma).

A

focal injury to base of pons (embolic occlusion of the basilar a.)

35
Q

DDx: locked-in syndrome (4)

A
  1. myopathy/neuropathy
  2. severe upper spinal cord lesion
  3. NMJ disease
  4. extreme muscle rigidity
36
Q

Akinetic mutism is due to _____ injury

A

prefrontal or premotor

37
Q

Akinetic mutism patients can _______, but does NOT _____.

A
  • follow with eyes
  • initiate other movements or obey commands
38
Q

_____ (3) remains in tact with akinetic mutism patients

A
  1. tone
  2. reflexes (including cold calorics)
  3. postural reflexes
39
Q

psychogenic unresponsiveness: key to diagnosis

A

resist passive eye opening

40
Q

psychogenic unresponsiveness patients will roll away from _____ and turn their eyes ______.

A
  • painful stimuli
  • toward the floor no matter which side they are lying on
41
Q

psychogenic unresponsiveness diagnosis is supported by _______.

A

cold caloric stimulation

(positive test also indicates akinetic mutism)

42
Q

vegetative state

A

no awareness of self or environment, but cycling of arousal states and periodic eye opening

43
Q

persistent vegetative state

A

vegetative state > 30 days

44
Q

Persistent vegetative state patients can be maintained for ______ (time); brain dead patients can be maintained for _____ (time)

A
  • 37 years
  • 3 months
45
Q

Persistent vegetative state patients are legally alive and have lost ______ function; brain dead patients are legally dead and have lost ______ function

A
  • cerebral ONLY
  • cerebral & brainstem
46
Q

Prognosis for persistent vegetative state? Brain death?

A
  • can maintain for 37 years; rare recovery
  • 3 months; NO recovery cases
47
Q

Locked-in syndrome lesion location

A

pontine

48
Q

coma lesion location

A

bilateral cerebral or upper brain stem

49
Q

Akinetic mutism lesion location

A
  • bifrontal deep gray matter
  • upper brain stem
50
Q

Catatonia lesion location? Persistent vegetative state?

A
  • NONE
  • diffuse cerebral hemisphere
51
Q

Glasgow Coma Scale Eye opening scale

A

4-1

52
Q

Glasgow Coma Scale for verbal

A

5-1

53
Q

Glasgow coma scale for motor function has _____ possible points. What are the items on the list?

A
  • 6
  1. follows commands
  2. localizes to pain
  3. withdraws from pain
  4. abnormal flexion
  5. abnormal extension
  6. none
54
Q

Best possible score on Glasgow Coma Scale

A

15

(10T if intubated; -5 because they can’t talk)

55
Q

Worst possible Glasgow Coma Scale Score

A

3

(2T when intubated)

56
Q

Define brain death (4)

A
  1. absence of consciousness
  2. lack of motor response to noxious stimuli
  3. NO brainstem reflexes
  4. NO respiratory drive

(irreversible)

57
Q

Before determining the brain death, you must check for _______ (5 clinical features).

A
  1. medications/toxins
  2. clear C-spine
  3. no severe electrolyte or endocrine disturbance
  4. normal SBP
  5. euthermic
58
Q

Brainstem reflexes (5)

A
  1. pupillary response
  2. ocular movements
  3. corneal reflex
  4. no fascial muscle movement to noxious stimulus
  5. gag reflex absent
59
Q

Oculocephalic or oculovestibular: abnormal reflex

A

eyes stuck in head/fixed when head is moved

(normally they will move with the head, but lag)

60
Q

Caloric testing : normal response

(make sure he head of bed is 30 raised & have intact TMs)

A
  1. 50 mL ice water into RIGHT ear w/head straight up: eyes will deviate to right (left mid-brain intact)
  2. nystagmus toward midline (left frontal lobe in tact)
61
Q

What does it indicate when caloric testing is done by inserting ice water into the RIGHT ear and eyes deviate to RIGHT w/no nystagmus

A

no cortical response

(must wait 1 minute)

62
Q

What does it indicate when caloric testing is done by inserting ice water into the RIGHT ear and eyes do NOT deviate and there is no nystagmus

A

no midbrain or cortical response

(wait 3-4 minutes and examine the other side)

63
Q

Caloric testing: what is the normal response if you insert cold water into both ears at once?

A
  1. both eyes initially go down
  2. vertical nystagmus
64
Q

corneal reflex

A

touch cornea with wisp of cotton → blinking

(V1 sensory → VII motor response of obicularis oculi)

65
Q

How do you test for facial muscle movement in response to noxious stimuli (2)?

A
  1. press on mandibular condyles at TMJ
  2. press on subraorbital ridge
66
Q

How do you test the cough/tracheal reflex?

A

catheter into the trachea to carina → 2 sweeps suction motions → cough

67
Q

How do you perform the apnea test?

A

oxygenate to >95% → unplug the respirator → put oxygen near face → blood gas

(positive if second blood gas is < 62 mmHg)

68
Q

Test to confirm brain death (5)

A
  1. EEG
  2. Cerebral or CT angio
  3. Nuclear scan
  4. Transcranial doppler
  5. MRI/MRA

OMS - 2 Neuro Final (36 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions