Coma

Question 1

What is the level of consciousness:

normal awake and responsive state

Answer 1

Alert

Question 2

What is the level of consciousness:

easily aroused with mild stimulation. Arousal is more easily maintained.

Answer 2

Lethargy

Question 3

What is the level of consciousness:

Awakens and follows commands and will awaken to simple stimulation such as voice or touch but requires sustained stimulation to maintain arousal

Answer 3

Somnolent

Question 4

What is the level of consciousness:

arousable only with painful stimuli, does not respond to verbal stimuli or simple stimuli as much.

Answer 4

Obtunded/Stupor

Question 5

What is the level of consciousness:

no arousal, no or few purposeful movements despite vigorous stimulation

Answer 5

Comatose

Question 6

What is the evaluation of a Coma?

Answer 6

Start with level of consciousness

then check pupillary reflex

Question 7

What are some interpretations of the following exams during a coma:

1. eye movements
2. Fundoscopic exam
3. Babinski
4. pupillary

Answer 7

1. roving eye movements can suggest seizure
2. swollen optic disc = intracranial pressure
3. upper motor neuron deficit
4. brainstem is doing ok

Question 8

What do the following suggest?

1. bilateral small pupils
2. bilateral pin point pupils

Answer 8

1. sign of metabolic disorder

2. pontine lesion

Question 9

Interpret the following motor exams:

1. arms and legs turn into the body
2. feed and hands turned outwards

Answer 9

1. Decorticate - dysfxn above mid brain (red nucleus), BRAINSTEM problem
2. Decerebrate - dysfxn below mid brain, corticospinal tracts, Pontine injury

Question 10

What are signs that there may be a cerebellar herniation?

Answer 10

Abnormal respiration
Fixed/minimally reactive pupils, asymmetric dilated pupil
Gaze deviation
Decrebrate/decorticate postruing
Brady cardia

Question 11

what is the drug of choise of absence seizures?

Answer 11

Ethosuxamide