CAPLAN CH10: Hypo

Question 1

Compared to the usual C-A-B, the sequence changes to ____in patients who drowned.

Answer 1

A-B-C (those with respiratory arrest only usually respond after a few artifical breaths are given).

Question 2

Features of Balint’s syndrome

Answer 2

1. Asimultagnosia
2. Optical ataxia
3. Apraxia of gaze

Question 3

Give examples of the following:
A. ischemic-hypoxic brain injury
B. hypoxic brain injury
C. anemic-hypoxic brain injury
D. histotoxic-hypoxic brain injury

Answer 3

A. sudden cardiac arrest
B. drowning or hanging
C. anemia from extreme blood loss
D. cyanide poisoning

Question 4

The most common initial rhythm in out-of-hospital cardiac arrest is __.

Answer 4

ventricular tachycardia or ventricular fibrillation

Question 5

With each passing minute of untreated ventricular fibrillation, the likelihood of survival is reduced by __.

Answer 5

7-10%

Question 6

The most common cause of ventricular tachycardia or ventricular fibrillation cardiac arrest is __.

Answer 6

myocardial ischemia

Question 7

Level of MAP that secures coronary perfusion?

Answer 7

MAP 65mmHg

Question 8

The most vulnerable neurons are those in the cerebral cortex especially layers ___.

Answer 8

III, V, VI

Question 9

Part of thalamus that is mainly activated in consciousness (receiving signals from the midbrain and pons)

Answer 9

intralaminar nuclei

Question 10

What is the difference between persistent vegetative state and permanent vegetative state?

Answer 10

Persistent- more than 30 days
Permanent- more than 3 months

Question 11

A condition of severely altered consciousness in which minimal but definite behavioral evidence of self or environmental awareness is demonstrated.

Answer 11

Minimally conscious state

Question 12

What is the reversal sign?

Answer 12

It is where the CT scan may display the reversal of the gray and white matter densities with relatively increased attenuation of the thalami, brainstem and cerebellum.

Question 13

The optimal time to image patients after cardiac arrest with MRI is between ___.

Answer 13

Days 3 and 5

Question 14

T/F. The brainstem is more resistant to hypoxic-ischemic injury than the cerebral cortex.

Answer 14

TRUE. That’s why the absence of brainstem reflexes suggests that the cortex must also be severely damaged.

Question 15

This is characterized by arrhythmic fine or coarse muscle jerking, markedly exaggerated when the limbs are used and often triggered by startle.

Answer 15

Lance Adams myoclonus

Question 16

What is the most validated biochemical marker for prognosis after cardiac arrest?

Answer 16

Neuron specifric enolase (NSE)

Question 17

This level of neuron specific enolase predicts a poor outcome

Answer 17

> 33microgram/L

Question 18

Even without hypothermia, prognostication after cardiac arrest should be delayed until ___ hours.

Answer 18

72 hours

Question 19

Where is the internal borderzone?

Answer 19

It is the white matter of the centrum semiovale and corona radiata (this lies in between the deep and superficial perforators of the MCA).

Question 20

Main mechanism of injury of hanging

Answer 20

Neck compression resulting in jugular venous and carotid arterial obstruction combined with hypoxemia from airway obstruction

Question 21

The affinity of hemoglobin for carbon monoxide is ___x greater than its affinity for oxygen. Carbon monoxide easily displaces oxygen from hemoglobin.

Answer 21

200x

Question 22

Reduction of this enzyme to less than 50% can be a cause of defective myelination

Answer 22

Arylsulfatase-A

Question 23

CT or MRI findings in CO poisoning typically show lesions of the ___.

Answer 23

globus pallidus
putamen
caudate nucleus
thalamus
substantia nigra

Question 24

Mainstay treatment of CO posioning. Why

Answer 24

100% oxygen

increase the partial pressure of oxygen levels
decrease halflife of CO2
facilitate dissociation from hemoglobin

Question 25

Sedation of choice for patients with CO poisoning?

Answer 25

non-benzodiazepine sedatives
(such as propofol or dexmedetomidine)

Question 26

Mechanisms of neurologic manifestations of cardiac failure?

Answer 26

1. Decrease cerebral perfusion due to low BP
2. HIgh ICP from increased venous hydrostatic pressure
3. Associated with pulmonary edema and hydroxemia
4. Medication induced
5. Autonomic nervous system dysfunction

Question 27

Proposed causes of abulia in patients with CHF?

Answer 27

Retention of CSFwithin the intracranial cavity outside the brain or in the ventricular system