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Year 2 NSB > Consciousness > Flashcards

Consciousness Flashcards

1
Q

What is consciousness?

A
  • wakefullness = able to determine they are awake of asleep (wake-sleep cycle)
  • aware = know that you exist (I and me)
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2
Q

What is a coma, which is greek for deep sleep?

A
  • state of unrousable unresponsiveness

- >6 hours

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3
Q

What is a key feature of consciousness that we can physically see in a patient?

1 - muscle movements
2 - eyes open
3 - reflexes
4 - urination

A

2 - eyes open

- requires cognitive thought that they are awake and motor arousal required to open eyes

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4
Q

A key feature of consciousness is the ability to sense sensory inputs. What are the 3 forms of this?

A

1 - external (5 senses, smell, sight etc…)
2 - interoception (internal feelings of the body, I feel full or thirsty for example)
3 - emotions

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5
Q

A key feature of consciousness is the ability to have an effect (acute mood, happy sad etc..) and have controlled outputs. What are the 4 controlled outputs?

A

1 - motor (moving hand, smiling etc..)
2 - attention (paying attention to someone)
3 - cognition (interacting with someone)
4 - emotional

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6
Q

There is a scale of consciousness, ranging from sleep to brain stem death. What is locked in syndrome?

1 - patients muscles and joints are locked in same position
2 - patient jaw is locked and they are unable to speak
3 - complete paralysis of voluntary muscles, but eyes are unaffected
4 - systematic pain causing coma

A

3 - complete paralysis of voluntary muscles, but eyes are unaffected
- a rare neurological disorder

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7
Q

Is a coma always pathological?

A
  • yes
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8
Q

Are all comas permanent?

A
  • no

- can be reversible or irreversible

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9
Q

What are the 2 major group classifications of comas?

1 - neurological and metabolic
2 - neurological and traumatic
3 - traumatic and metabolic
4 - metabolic and toxic

A

1 - neurological and metabolic

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10
Q

The 2 major group classifications of comas are neurological and metabolic. What are the 3 most common causes of neurological comas?

1 - trauma, infection, cerebrovascular impairment
2 - DVT, trauma, infection
3 - trauma, cerebrovascular impairment, DVT
4 - trauma, herpes virus, cerebrovascular impairment

A

1 - trauma, infection, cerebrovascular impairment

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11
Q

The 2 major groups of classifications of comas are neurological and metabolic. What are the 3 most common causes of metabolic comas?

A

1 - hypoglycaemia
2 - hypoxia
3 - drugs and toxins

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12
Q

Tools to measure consciousness are on a scale between normal consciousness and coma. What is the most commonly used tool for this?

A
  • Glasgow coma scale (1974)
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13
Q

The Glasgow Coma Scale (GCS) is the main tool we need to be aware of that measures a patients consciousness. What does the GCS measure?

A
  • sensori-motor stimulus and responses

- combining senses with actions

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14
Q

The Glasgow Coma Scale (GCS) is the main tool we need to be aware of that measures a patients consciousness. The GCS measures sensori-motor stimulus and responses, which is essentially the ability to combine senses with actions. The investigator will provide a stimulus and then assesses the response. What are the 5 things we are looking for when we provide a stimulus?

A 
1 - eyes (open or closed)
2 - response to verbal and physical stimulus (pain etc)
3 - protective movements and postures
4 - spontaneous and voluntary movements
5 - voice
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15
Q

The Glasgow Coma Scale (GCS) provides a score on the level of consciousness of the patient. When assessing a patient using the GCS, do we just do one stimulus for each of the 5 senses or would we do multiple, and would we take the average or the best response?

A
  • multiple attempts at stimulating the patient
  • record the best response
  • GCS provides a score
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16
Q

The Glasgow Coma Scale (GCS) provides a score on the level of consciousness of the patient. What is the lowest score you can get on the GCS?

1 - 0
2 - 3
3 - 5
4 - 6

A

2 - 3

  • the lowest score in all 3 sections of the GCS (eyes opening, verbal and motor response is 1)
  • a response of 1 in all 3 sections of the GCS is no response
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17
Q

The Glasgow Coma Scale (GCS) provides a score on the level of consciousness of the patient. What is the highest score you can get on the GCS?

1 - 0
2 - 3
3 - 10
4 - 15

A

4 - 15

  • section 1 = eyes opening (scale 1-4)
  • section 2 = verbal response (scale 1-5)
  • section 3 = motor response (scale 1-6)
  • 4 for eyes + 5 for verbal + 6 motor response = 15
18
Q

The Glasgow Coma Scale (GCS) provides a score on the level of consciousness of the patient. What is the range of the GCS score?

1 - 0-15
2 - 3-12
3 - 0-12
4 - 3-15

A

4 - 3 - 15

  • 3 = lowest score
  • 15 = highest score
19
Q

When providing a Glasgow coma score (GCS). The range of the score is 3-15, but what must you also provide with each score for the 3 sections?

1 - time and date when assessment was made
2 - person performing the assessment
3 - letters for each section (E, V, M)

A

3 - letters for each section (E, V, M)

  • provides a total score and individual scores to help with diagnosis
  • E 1-4 = Eyes
  • V 1-5 = Vocal
  • M 1-6 = Movement
20
Q

When we are trying to assess a patients own ability to maintain their own respiratory function, below what Glasgow Coma Score (GCS) would suggest that the patient is unable to maintain their own respiratory function?

1 - 0
2 - <3
3 - <8
4 - <12

A

3 - <8

  • patients are unable to protect their airways
  • GCS is correlated with outcomes in brain injury
21
Q

The Mini Mental State Examination (MMSE), Confusion Assessment Method (CAM) and 4 A’s Test (4AT) can be used by the bedside of the patient. It can be useful to assess what 3 conditions?

1 - stroke, confusion, dementia
2 - stroke, dementia, delirium
3 - dementia, delirium, confusion
4 - dementia, stroke, confusion

A

3 - dementia, delirium, confusion

22
Q

What is a transient loss of consciousness commonly called?

1 - epilepsy
2 - syncope
3 - seizure
4 - stroke

A

2 - syncope

  • commonly referred to as fainting or passing out
  • generally due to poor perfusion to the brain by blood
  • caused by a temporary drop in the amount of blood that flows to the brain, may be due to hypotension and low heart rate
23
Q

Transient loss of consciousness commonly called syncope (fainting or passing out) is generally due to cardiac impairment that causes poor perfusion to the brain by blood. The temporary lack of blood to the brain causes a temporary drop in the amount of blood that flows to the brain and patients pass out. What are the 2 most common causes of syncope?

A

1 - orthostatic syncope (standing up too quickly, autonomic system is slow to respond)
2 - neurocardiogenic syncope (intense emotional stimulus), too much blood in peripheries and not in the brain and centrally

24
Q

When trying to understand what has caused a patients syncope, what can often provide the answer before running any tests?

A
  • detailed history
  • before event (change in posture, environment)
  • during event (eyewitness accounts, seizures, blood glucose/pressure)
  • after event (speed of recovery)
  • look at risk factors
25
Q

What does the neuronal correlates of consciousnesses mean?

1 - minimum neuronal activity required to experience a conscious event
2 - neuronal activity required to cognitively engage with someone else
3 - minimum neuronal activity required to move
4 - minimum neuronal activity required to open your eyes

A

1 - minimum neuronal activity required to experience a conscious event

26
Q

What is the global neuronal workspace?

1 - how specific regions of the brain organise thoughts separately
2 - how regions of brain work together
3 - how cognitive system receive the same information but process this in different ways

A

3 - how cognitive system receive the same information but process this in different ways
- the processing of this information is what allows us to be conscious

27
Q

What is the integrated information theory?

A
  • implies that a sufficiently complex information processing structure is able to be conscious
  • this implies that a computer could be conscious
28
Q

Which lobes have been linked with consciousness?

1 - frontal, temporal and parietal
2 - frontal, temporal and occipital
3 - frontal, parietal and occipital
4 - temporal, parietal and occipital

A

4 - temporal, parietal and occipital

  • all but frontal lobe
  • especially posterior parietal = hot zone
29
Q

What is the hot zone in relation to consciousness?

1 - area of brain that can overheat
2 - area of the brain involved in regulating body temperature
3 - part of neocortex associated with minimal neural substrate essential for conscious perception
4 - part of brainstem associated with minimal neural substrate essential for conscious perception

A

3 - part of neocortex associated with minimal neural substrate essential for conscious perception

30
Q

What is the main lobe where the hot zone in relation to consciousness is based?

1 - temporal
2 - parietal
3 - occipital
4 - frontal

A

2 - parietal lobe

- known as the posterior hot zone as well

31
Q

There is a specific class of mammalian cortical neurons that can be located in the anterior insular cortex (portion of cerebral cortex folded deep within the lateral sulcus). What are these called and what are they involved in?

1 - Von economo neurons
2 - claustrum
3 - reticular activating system
4 - pons

A

1 - Von economo neurons

- involved in consciousness and ones self

32
Q

There is a thin, bilateral collection of neurons, that has been described as the most densely connected structure in the brain, with support of glial cells. What is the name of this area?

1 - Von economo neurons
2 - claustrum
3 - reticular activating system
4 - pons

A

2 - claustram

- located externally to the putamen

33
Q

The claustrum is a thin, bilateral collection of neurons, that has been described as the most densely connected structure in the brain, with support of glial cells. It is located laterally to the putamen as per the image below. What key areas of the brain does the collection of neurons connect?

A
  • cortical (e.g., the pre-frontal cortex)

- subcortical regions (e.g., the thalamus)

34
Q

The claustrum is a thin, bilateral collection of neurons, that has been described as the most densely connected structure in the brain, with support of glial cells. It is located laterally to the putamen as per the image below. In the brain it connects the cortical (e.g., the pre-frontal cortex) and subcortical regions (e.g., the thalamus). What is the main process the claustrum has been associated with?

1 - pain
2 - consciousness
3 - memory
4 - learning

A

2 - consciousness

35
Q

There is a collections of neurons in the thalamus that are involved in consciousness. What are these called?

1 - Von economo neurons
2 - claustrum
3 - reticular activating system
4 - intralaminar thalamic nuclei

A

4 - intralaminar thalamic nuclei

36
Q

What are some key parts of the brain that are involved in consciousness?

A
  • pons
  • midbrain
  • hypothalamus
  • forebrain
37
Q

What is the minimally conscious state?

A
  • patients are awake (sleep/wake cycle)

- patients are not aware or minimal awareness

38
Q

What is the vegetative state?

A
  • patient is awake with absent awareness
  • no spontaneous/stimulus arousal
  • capacity for spontaneous or stimulus-induced arousal evidenced by a range of reflexive and spontaneous behaviours
39
Q

What is brain stem death, also referred to as brain death?

A
  • permanent and irrevocable loss of brainstem function
  • patient is on an artificial life support machine
  • patient will not regain consciousness or be able to breathe without support
  • patients who are brain dead are legally dead
40
Q

Brain stem death, also referred to as brain death is when a patient is placed on an artificial life support machine and the patient no longer has any brain functions. The patient will not regain consciousness or be able to breathe without support. Before the patient can be legally classified as dead, what must be done?

A
  • cause must be ascertained and deemed irreversible
  • absence of brain stem reflexes (pupils, cornea, motor reflexes, gag, cough reflex, etc..)
  • if any reflexes are present then patient is not brain dead

Year 2 NSB (53 decks)

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