Brainscape's Knowledge GenomeTM

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


See full index

Neurology II > Coma & Delirium > Flashcards

Coma & Delirium Flashcards

1
Q

what are the 2 major components of consciousness?

A

awareness/content

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

what is the diff betw Awareness and Arousal?

A

Awareness = higher cortical functions are intact, language as one of its facets, movements are appropriate & localized

Arousal = reflexes, groaning, flexion-extension, eye-opening

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

what are the different acutely altered states of consciousness?

A

confusion
delirium
obtundation
stupor
coma

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

what is the general incapacity of a patient to think with customary speed, clarityu and coherence?

A

confusion

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

what is the misperception of stimuli and vivid hallucinations, agitation, tremulousness?

A

delirium

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

what is the slow response to stimulation with mild to moderate reduction in alertness?

A

obtundation

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

what is the behavioral unresponsiveness and is arousable only by vigorous stimualtion?

A

stupor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

whta is the state of unresponsiveness even to vigorous stimulation

A

coma

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

what are the diff subacute/chronic atlerations of consciousness?

A

dementia
akinetic mutism
minimally conscious state
vegetative state

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

what type of alteration of consciousness involves limited responsiveness to primitive postural or reflexive movement of the limbs?

A

vegetative state

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what type of alteration of consciousness involves “transitional state” during recovery from coma or worsening of a progressive neurologic disease?

A

minimally conscious state

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

what type of alteration of consciousness involves condition of silent, alert-appearing immobility wherein sleep-wake cycles have returned?

A

akinetic mutism

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

what type of alteration of consciousness involves enduring and often progressive decline in mental processes?

A

dementia

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

what condition occurs if there is a pontine lesion, every motor function is obliterated, patient is unconscious, and eye movement in the only motor function intact?

A

Locked-in syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

what are the diff aspects of behavior are affected in delirium?

A

attention
perception
memory
thinking
emotion, mood & affect
impulse & activity
social behavior
loss of insight

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what are the different classificatio of confusional stateS?

A

Acute global confusion with psychomotor underactivity
Delirium with motor, mental, or autonomic hyperactivity
psychosis, particularly with manic features
Dementia or other brain disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q
A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are the causes of acute global confusion w/ psychomotor underactivity?

A

Metabolic disorders
Infectious illnesses
CHF or pulmonary failure
Postoperative & post-traumatic states

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

What are the common causes of delirium?

A
  1. Alcohol withdrawal
  2. Medications
  3. Beclouded dementia = baseline dementia + other medical/surgical problem
  4. Infection/post-operative states
  5. Non-convulsive status epilepticus
  6. Schizophrenia, bipolar psychosis during a medical or surgical illness
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are the signs of meningeal irritation?

A

Treat the underyling cause of infection
Systemic infection
Meningitis and encephalitis = lumbar puncture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are the dx tests done in px with focal neurologic signs or seizure?

A

Overt seizure
Neuroimaging and EEG

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

In px with delirium, do u still need to do an urgent neuroimaging scan if there is no focal sign on exmination?

A

No need but if you think your px is high-risk fr a vascular CNS event, then proceed with neuroimaging

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

How do you classify and diagnose coma?

A
  1. Is the coma neurologic or non-neurologic?
  2. Are there focal, lateralizing signs?
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

If there are focal lateralizing signs, what should u do next?

A

Brain imaging

(CN deficits, hemiparesis, Babinski sign)

25
Q

If the cause of coma is non-focal in exam what should u do?

A

Basic work-up (blood chem, ABG, infectious work up_

(No focal, lateralizing signs)

26
Q

What happens if lab tests come out as negatieve, what should u do?

A

Neuroimaging = CT/MRI/LP/EEG

27
Q

What should u do if there is high suspicion for seiure & CNS infection?

A

Seizure = do EEG
CNS infection = do a lumbar puncture

28
Q

What are structures in the brain that can cause coma when affected bILATERALLY?

A

Medial hemispheric wall including the basal forebrain
Caudate and putamen (striatum)
Diencephalon
Midbrain tegmentum and rostral pontine tegmentum

29
Q

What are brain lesions that can cause coma?

A
  • diffuse hemispheric damage
  • injury of diencephalon
  • damage to the paramedian portion of the upper midbrain and caudal diencephalon
  • high pontine or paramedian lower midbrain injury
30
Q

What condition ha a space occupying lesion or mass causing herniation across diffferent dural compartments?

A

Herniation syndrome

31
Q

What are the diff causes of herniation syndrome?

A
  • transfacial herniation
  • transtentorial uncal-parahippocampal
  • cerebellar tonsillar herniation
  • Kernohan-Woltman notch phenomenon/horizontal herniation
32
Q

What are the common causes of coma with focal or lateralizing signs?

A

Cerebral hemorrhage
Basilar artery occlusion
Territorial infarction in internal carotid artery
Subdural hematoma
Trauma
Brain abscess
Hypertensive encephalopathy; Eclampsia
THrombotic thrombocytopenic purpura

33
Q

What are the diff disorders assoc with coma without focal or lateralizing signs bUT WITH signs of meningeal irritation?

A

Meningitis and encephalitis
Subarachnoid hemorrhage

34
Q

In px with coma without focal neurologic signs or meningeal irritation, when do you order a lumbar puncture?

A

If everything else is ruled out (no infection, normal blood chem, MRI, EEG) but px is still in a coma

35
Q

What is the most common cause of coma without focal neurologic signs or meningeal irritation, CSF & CT scan normal?

A

Alcohol intoxication

36
Q

What are the 3 facets checked in the Glasgow coma scale?

A

Eye response
Motor response
Verbal response

37
Q

What are the interpretation of GC scores?

A

> or equal to 13 = mild brain injury
9-12 = moderate brain injury
< or equal to 8 = severe brain injury

38
Q

What should u do if GCS less than or equal to 8?

A

Intubate the px & protect the airway

39
Q

What is the normal size of the pupil?

A

2-3mm

40
Q

What is the single most important test to distinguish a metabolic cause for coma vs neurologic ause?

A

Pupillary light reflex

41
Q

What are the indications of unilateral deficient pupil and bilaterally reactive pupil?

A
  1. Unilateral deficient pupil
    - focal lateralizing sign
    - if structural => neurologic problem
  2. Bilaterally reactive pupil
    - metabolic cause
    - medical, not structural then not neurologic
42
Q

What is the localization of lesion of Uncal Herniation (CN III) and midbrain?

A

Uncal herniation (CN III)
- unilateral dilated pupil
- fixed

Midbrain
- midposition
- fixed

43
Q

What is the localization of lesion for lesions on the Pons & Diencephalon?

A

Pons
- pinpoint, but not reactive
- narcotic intoxication
Diencephalon
- small, reactive

44
Q

What are pupil reaction if lesion is at teh pretectal or diffuse effects of drugs, metabolic encephalopathy?

A

Pretectal
- large, “fixed”, Hippus

Diffuse effects of drugs
- small, reactive

45
Q

What are the most common spontaneous eye movements in unconscious px?

A

Ocular bobbing & ocular dipping or inverse ocular bobbing

46
Q

What is the description & significance if there is ocular bobbing seen?

A
  • rapid, conjugate, downward movement
  • slow return to primary position

Significance
- pontine strokes
- other structural, metabolic, or toxic disorders

47
Q

What is the description & significance if there is ocular dipping or inverse ocular bobbing seen?

A
  • slow, donward movement
  • RAPID return to primaryposiiton
  • unreliable for localization & follows hYPOXIC-ISCHEMIC INSULT or metabolic disorder
48
Q

What is the description & significance if there is reverse ocular bobbing seen?

A
  • rapid, upward movement
  • slow return to primary position
    Unreliable for localization
  • may occur with metabolic disordes
49
Q

What are the diff brainstem reflexes checked in coma px?

A

EOMs = Doll’s eye reflex
Caloric reflexes
Corneal reflexes
Gag reflex

50
Q

What is done in caloric reflex?

A

Instillation of 120mL of ice water

Awake = deviation toward, nystagmus away
Comatose = deviation towards the side of cold water irrigation, away from side of warm water irrigatoin

51
Q

What is the indication if there is absence of corneal reflexes?

A

Brainstem reflexes are diminished

52
Q

What brainstem reflex is done usually if intubated?

A

Gag reflex

53
Q

What are checked in the motor response of coma px?

A

Response to pain
Primitive reflexes
Posturing

54
Q

What are the sites of repsonse to pain checking in motor response?

A

Supraorbital pressure
Fingernail bed pressure
Sternal rub
Pressure on both temples

55
Q

What are the responses in posturing if ther eis metabolic encephalopahty or diffuse cortical dysfunction with no focal alteralizing signs?

A

Patient raises a hand in attempt to remove the hand othe examiner
(+) = localization of pain

56
Q

What is the response in px with upper midbrain damage if posturing is ellicited?

A

DECORTICATE POSTURING = flexion of the upper extremities and EXTENSION of the LEs

57
Q

What is the respone of upper pontine damage in posturing of coma px?

A

DECEREBRATE POSRUTING = Extension of both UE & LE

58
Q

What aer the diff types of abnormal patterns of respiration seen in brain lesions?

A

Cheyne-stokes respiration
Central neurogenic hyperventilation
Apneustic breathing/apneusis
Cluster breathing & ataxic breathing
Apnea

Neurology II (7 decks)

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