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Neuro Week 3 > Coma > Flashcards

Coma Flashcards

1
Q

what do you require to have consciousness?

A

1 cerebral hemisphere and the reticulare activating system

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2
Q

what are the three steps to coma?

A

decline in attention
delirium
stupor…then to coma

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3
Q

what is the key system that regulates consciousness.arousal?

A

reticular activating system

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4
Q

what excites the RAS?

A

sensory stimuli

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5
Q

what sensory stimuli activate the RAS?

A

somatosensory, auditory, visual, visceral

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6
Q

what do you rely on a lot in coma investigation?

A

lab data…because no history is there

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7
Q

what is the scale used for coma scores?

A

glasgow coma scores

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8
Q

is high or low score good in glasgow?

A

high is better

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9
Q

what are three aspects measures in glasgow coma score?

A

motor reactivity
verbal response
eye opening

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10
Q

what is difference in pupil size called?

A

aniscoria

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11
Q

how to measure pupil size?

A

have patient look at distant target that is big enough to avoid accomodation

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12
Q

name three locations where RAS neurons are located

A

tegmentus of brain stem
lateral hypothalamic area
medial/reticular nuclei of thalamus

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13
Q

what is nuchal rigidity?

A

when ask patient to take chin to neck and they are not able to due to stiff neck

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14
Q

who gets nuchal rigidity?

A

patients with meningitis

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15
Q

if patient has altered mental status with fever, what do they most likely have>

A

infectious cause

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16
Q

are pupils supposed to be larger or smaller in dark?

A

large in dark, small in light

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17
Q

a parasympathetic pupil issue leads to what problem?

A

greater anisocoria in bright light..due to larger pupil not constricting

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18
Q

a sympathetic pupil issue leads to what problem with pupillary change?

A

greater anisocoria in dark because smaller pupil not dilating

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19
Q

does sympathetic pupil issue have more problem anisocoria in light or dark?

A

dark

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20
Q

does parasympathetic pupil issue have more problem anisocoria in light or dark?

A

light

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21
Q

if pupils are reactive to light but way too small, what is issue?

A

opioid intoxication

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22
Q

if a pupil is large and unreactive to light, what is issue?

A

parasympathetic problem…due to CN III palsy

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23
Q

if a pupil is small and unreactive to dark, what is issue?

A

horners syndrome

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24
Q

what are the supranuclear eye movements?

A

eye movements toward object, voluntary eye movement

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25
Q

what are nuclear eye movements?

A

brainstem controlled eye movements

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26
Q

what are infranuclear eye movements?

A

peripheral nerve/NMJ/muscle issue related movements

27
Q

where is final common pathway for horizontal eye movement?

A

Pons

28
Q

where are vertical eye movements pathway from?

A

midbrain

29
Q

what three things should be given to comatose patients immdiately?

A

naloxone
thiamine
glucose

30
Q

what is a common metabolic cause of coma?

A

hyperglycemis

31
Q

what is a common OD cause of coma?

A

opioid

32
Q

is arousal present in coma?

A

no

33
Q

is arousal present in vegetative state?

A

yes

34
Q

is arousal present in minimally conscious state?

A

yes

35
Q

is arousal present in locked in syndrome?

A

yes

36
Q

is sleep wake cycle present in coma?

A

no

37
Q

is sleep wake cycle present in vegetativ state, minimally conscious state and locked in syndrome?

A

yes

38
Q

is awareness present in coma?

A

no

39
Q

is awareness present in vegetative state?

A

no

40
Q

is awareness present in minimally conscious state?

A

barely

41
Q

is awareness present in locked in state?

A

yes

42
Q

is motor fxn present in coma?

A

reflexes only

43
Q

is motor fxn present in vegetative state?

A

only postures or withdrawal to noxious stimuli

44
Q

is motor fxn present in minimally conscious state?

A

response to noxious stimuli and reaching, inconsistent command following

45
Q

is motor fxn present in locked in syndrome?

A

nothing

46
Q

is visual fxn preserved in coma?

A

no

47
Q

is visual fxn preserved in vegetative state?

A

brief visual fixation

48
Q

is visual fxn preserved in minimally conscious state?

A

sustained visual fixation or pursuit

49
Q

is visual fxn preserved in locked in syndrome?

A

totally

50
Q

is communication preserved in coma?

A

no

51
Q

is communication preserved in vegetative state?

A

no

52
Q

is communication preserved in minimally conscious state?

A

in/consistent vocalization with intelligible convo

53
Q

is communication preserved in locked in syndrome?

A

NO

54
Q

is emotion preserved in coma?

A

no

55
Q

is emotion preserved in vegetative state?

A

no..or just crying

56
Q

is emotion preserved in minimally conscious state?

A

crying and smiling

57
Q

is emotion preserved in locked in syndrome?

A

totally

58
Q

what is locked in syndrome caused by

A

bilateral ventral lesion of pons…lose corticobulbar and corticospinal tracts, but not the RAS

59
Q

what must temperature be in brain death?

A

normal body temp

60
Q

can you have electrolyte/acid base imbalance in brain death?

A

NO

61
Q

can you have drugs to be clarified brain dead?

A

no

62
Q

can you have motor response in brain death?

A

no

63
Q

can you have brainstem reflexes in brain death?

A

no

Neuro Week 3 (13 decks)

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