Coma

Question 1

what do you require to have consciousness?

Answer 1

1 cerebral hemisphere and the reticulare activating system

Question 2

what are the three steps to coma?

Answer 2

decline in attention
delirium
stupor…then to coma

Question 3

what is the key system that regulates consciousness.arousal?

Answer 3

reticular activating system

Question 4

what excites the RAS?

Answer 4

sensory stimuli

Question 5

what sensory stimuli activate the RAS?

Answer 5

somatosensory, auditory, visual, visceral

Question 6

what do you rely on a lot in coma investigation?

Answer 6

lab data…because no history is there

Question 7

what is the scale used for coma scores?

Answer 7

glasgow coma scores

Question 8

is high or low score good in glasgow?

Answer 8

high is better

Question 9

what are three aspects measures in glasgow coma score?

Answer 9

motor reactivity
verbal response
eye opening

Question 10

what is difference in pupil size called?

Answer 10

aniscoria

Question 11

how to measure pupil size?

Answer 11

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

Question 12

name three locations where RAS neurons are located

Answer 12

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

Question 13

what is nuchal rigidity?

Answer 13

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

Question 14

who gets nuchal rigidity?

Answer 14

patients with meningitis

Question 15

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

Answer 15

infectious cause

Question 16

are pupils supposed to be larger or smaller in dark?

Answer 16

large in dark, small in light

Question 17

a parasympathetic pupil issue leads to what problem?

Answer 17

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

Question 18

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

Answer 18

greater anisocoria in dark because smaller pupil not dilating

Question 19

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

Answer 19

dark

Question 20

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

Answer 20

light

Question 21

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

Answer 21

opioid intoxication

Question 22

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

Answer 22

parasympathetic problem…due to CN III palsy

Question 23

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

Answer 23

horners syndrome

Question 24

what are the supranuclear eye movements?

Answer 24

eye movements toward object, voluntary eye movement

Question 25

what are nuclear eye movements?

Answer 25

brainstem controlled eye movements

Question 26

what are infranuclear eye movements?

Answer 26

peripheral nerve/NMJ/muscle issue related movements

Question 27

where is final common pathway for horizontal eye movement?

Answer 27

Pons

Question 28

where are vertical eye movements pathway from?

Answer 28

midbrain

Question 29

what three things should be given to comatose patients immdiately?

Answer 29

naloxone thiamine glucose

Question 30

what is a common metabolic cause of coma?

Answer 30

hyperglycemis

Question 31

what is a common OD cause of coma?

Answer 31

opioid

Question 32

is arousal present in coma?

Answer 32

no

Question 33

is arousal present in vegetative state?

Answer 33

yes

Question 34

is arousal present in minimally conscious state?

Answer 34

yes

Question 35

is arousal present in locked in syndrome?

Answer 35

yes

Question 36

is sleep wake cycle present in coma?

Answer 36

no

Question 37

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

Answer 37

yes

Question 38

is awareness present in coma?

Answer 38

no

Question 39

is awareness present in vegetative state?

Answer 39

no

Question 40

is awareness present in minimally conscious state?

Answer 40

barely

Question 41

is awareness present in locked in state?

Answer 41

yes

Question 42

is motor fxn present in coma?

Answer 42

reflexes only

Question 43

is motor fxn present in vegetative state?

Answer 43

only postures or withdrawal to noxious stimuli

Question 44

is motor fxn present in minimally conscious state?

Answer 44

response to noxious stimuli and reaching, inconsistent command following

Question 45

is motor fxn present in locked in syndrome?

Answer 45

nothing

Question 46

is visual fxn preserved in coma?

Answer 46

no

Question 47

is visual fxn preserved in vegetative state?

Answer 47

brief visual fixation

Question 48

is visual fxn preserved in minimally conscious state?

Answer 48

sustained visual fixation or pursuit

Question 49

is visual fxn preserved in locked in syndrome?

Answer 49

totally

Question 50

is communication preserved in coma?

Answer 50

no

Question 51

is communication preserved in vegetative state?

Answer 51

no

Question 52

is communication preserved in minimally conscious state?

Answer 52

in/consistent vocalization with intelligible convo

Question 53

is communication preserved in locked in syndrome?

Answer 53

NO

Question 54

is emotion preserved in coma?

Answer 54

no

Question 55

is emotion preserved in vegetative state?

Answer 55

no..or just crying

Question 56

is emotion preserved in minimally conscious state?

Answer 56

crying and smiling

Question 57

is emotion preserved in locked in syndrome?

Answer 57

totally

Question 58

what is locked in syndrome caused by

Answer 58

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

Question 59

what must temperature be in brain death?

Answer 59

normal body temp

Question 60

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

Answer 60

NO

Question 61

can you have drugs to be clarified brain dead?

Answer 61

no

Question 62

can you have motor response in brain death?

Answer 62

no

Question 63

can you have brainstem reflexes in brain death?

Answer 63

no