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Question 1

Give some of the first signs of an impairment of conciousness

Answer 1

Altered behaviourSlurred speechDifficulty finding words Change in moodUnsteady on feet

Question 2

Describe AVPU scale

Answer 2

AlertResponds to voiceResponds to painUnresponsive

Question 3

Outline the Glasgow Coma Scale

Answer 3

Best eye movement 1-4Best verbal response 1-5Best motor response 1-6

Question 4

Give the values that correspond to eye opening

Answer 4

1- none2 - responds to pain3 - responds to voice4 - sponataneous

Question 5

Give the values that correspond to verbal response

Answer 5

1 - none2 - incomprehensible3 - inappropriate words4 - confused5 - orientated

Question 6

Give the values that correspond to motor response

Answer 6

1 - none2 - extension/towards pain3 - abnormal flexion from pain4 - withdraws from pain5 - localises pain6 - obeys verbal command

Question 7

Give the interpretations of GCS

Answer 7

15 = maximum>13 = mild9-12 = moderate

Question 8

How can you cause a pain response in a patient?

Answer 8

• Squeeze above and below the clavicle- thumb under top of orbit and push upwards- sternal rub

Question 9

Give some reasons why a patient might have a loss of conciousness

Answer 9

Brain not getting substrate- hypoglycaemia- hypoxiaDepressed neuronal activity- drugs- alcoholTrauma- LOC- brainstem injuryRaised ICP- haematoma- tumour- swellingAbnormal activity- fitting

Question 10

Describe coma

Answer 10

A state of impaired consciousness in which the patient is not roused by external stimulation

Question 11

Describe locked-in syndrome

Answer 11

• resembles coma- due to an extensive lesion of the ventral pons (damages corticobulbar and corticospinal pathways)- Pt is alert but unable to speak or move their face or limbs - can communicate with their eyes- spares reticular pathways, therefore consciousness is not affected

Question 12

Define delerium

Answer 12

A clinical syndrome that involves abnormalities of though, perception and levels of awareness. Typically is acute and intermittent.

Question 13

What is the difference between the decorticate and the decerebrate response?

Answer 13

Decorticate = isolates cortex from the lower brain and spinal cordDecerebrate = lack of inhibition to descending motor tracts by the reticular formation.

Question 14

Describe the causes of the decorticate response

Answer 14

Due to a severe traum or a large infarct- isolates cortex from lower brain and spinal cord due to destruction of the connections between the thalamus and the cortex.

Question 15

What is the presentation of the decorticate response?

Answer 15

Lower limbs extendUpper limbs flex because the brainstem reticular inhibition centres are intact- Pt is unconscious but able to respond to painful stimuli

Question 16

Describe the cause of the decerebrate response

Answer 16

Lower parts of the brainstem are damaged. Causes lack of inhibition to the reticular formation over the descending motor tracts.

Question 17

Describe the presentation of the decerebrate response

Answer 17

Have a significant increase in muscle tone, causing extension of the arms and the legs. Pts will reflexively extend to pain.