Brainscape's Knowledge GenomeTM

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


See full index

Neuro Exam 2 > Disorders of Consciousness > Flashcards

Disorders of Consciousness Flashcards

1
Q

Altered Mental Status (AMS): _____

A

A change in mental function that stems
from illness, disorders, and injuries affecting the brain that can result in
changes in awareness, movement, and behaviors.

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

There are three main types of AMS

A

● Delirium: Sudden and reversible, usually due to a medical emergency
such as injury or metabolic derangement (
the main discussion today).
● Dementia: Progressive decline in mental functioning that affects daily
life, primarily seen in geriatric patients.
● Psychosis: Temporary condition in which a person loses touch with
reality, usually due to a mental health condition or medication.

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

_____: A chiefly mental condition marked by absence of spontaneous movement, greatly diminished responsiveness to stimulation, and
usually impaired consciousness

A

Stupor

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

Coma: _____

A

A state of profound unconsciousness caused by disease, injury, or
poison. A patient experiencing coma could be described as comatose

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

Syncope: _____

A

Loss of consciousness resulting from insufficient blood flow to the brain. Syncope is generally neurologic or cardiovascular in nature

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

When a patient with Altered Mental Status presents to the clinic or ED,
this should immediately trigger an ____

A

urgent evaluation and workup

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

The top 3 causes of delirium and coma
outside the hospital:

A

○ Intoxication (ETOH or drugs)
○ Diabetic Dysregulation
○ Traumatic Brain Injury (TBI)

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

In general, the initial management priority
in any cause of unresponsiveness is to
_____

A

protect the patient’s airway and breathing
○ Most patients who are in a comatose
state require intubation

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

In an emergent situation (usually in the ED), the approach to a patient
with altered mental status is the following:

A

○ Stabilize
○ Diagnose
○ Manage

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

Classification and Causes of Coma - Structural brain injury

A

○ Intracerebral Hemorrhage
○ Aneurysmal Subarachnoid Hemorrhage
○ MCA Occlusion
○ Hemorrhagic Contusion
○ Cerebral Abscess
○ Brain Tumor
○ Penetrating TBI
○ Closed TBI
○ Anoxic/Ischemic Encephalopathy
○ Multiple Cerebral Infarcts

And others

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

Classification and Causes of Coma - brainstem

A

○ Pontine Hemorrhage
○ Basilar Artery Occlusion
○ Central Pontine Myelinolysis
○ Brainstem Hemorrhagic Contusion

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

Classification and Causes of Coma - cerebellum

A

○ Cerebellar Infarct
○ Cerebellar Hematoma
○ Cerebellar Abscess
○ Cerebellar Tumor

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

Classification and Causes of Coma - Acute Metabolic/Endocrine Derangement

A

○ Hypoglycemia
○ Hyperglycemia
○ Hyponatremia
○ Hypernatremia
○ Addison’s Disease
○ Hypercalcemia
○ Acute Hypothyroidism
○ Acute Panhypopituitarism
○ Acute Uremia
○ Hyperbilirubinemia
○ Hypercapnia

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

Classification and Causes of Coma - Diffuse Physiological Brain Dysfunction

A

○ Generalized Seizures
○ Poisoning/Toxicity
○ Illicit Drug Use
○ Hypothermia
○ Gas Inhalation
○ Acute Malignant Neuroleptic Syndrome

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

Classification and Causes of Coma - Psychogenic Unresponsivenes

A

○ Hysterical
○ Malingering or Factitious
○ Conversion Disorder

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

Assessment of the vital signs may reveal Cushing’s Triad, which is:

A

○ This important triad refers to a set of signs that are indicative of
increased intracranial pressure (ICP), and consists of:
■ Bradycardia
■ Irregular breathing (Cheyne-Stokes Respirations)
■ Widened pulse pressure

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

If ICP increases, MAP should increase to maintain CCP. If CCP falls too much, the
brain can become _____

A

hypoxic

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

The presence of _____ is considered a poor prognostic indicator

A

Cushing’s Triad

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

____ is when the patient can clearly obey commands for movement

A

M6

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

____ is when the patient does not clearly follow commands, but when
presented with a noxious stimulus, they localize to the pain

A

M5

21
Q

____ is when the patient does not
localize, but does withdraw from
noxious/painful stimuli

A

M4

22
Q

_____ are when the patient
responds to painful stimuli by
abnormal posturing

A

M3 and M2

23
Q

____ is when there is no motor response

A

M1

24
Q

_____ are both common means of administering noxious or painful stimuli, but may also result in a reflex that is mostly spinal in nature

A

Pinching nail beds and the sternal rub

25
Q

One way of administering a
painful stimulus that does not
pass through the spinal cord is by
_____

A

pressing firmly on the Supraoptic
Nerve, which is a distal branch of
the Trigeminal Nerve (V1)

25
Q

What does abnormal posturing mean?

A

an involuntary motor response that is highly indicative of severe brain/brainstem injury (with very poor prognosis)

25
Q

The _____ in the midbrain helps to
coordinate motor function in the extremities,
along with the Basal Ganglia and Cerebellum

A

Red Nucleus

26
Q

_____ occurs when the connections
to the Red Nucleus are severed or damaged

A

Abnormal posturing

27
Q

Decorticate Posturing

A

Also known as Flexor Posturing, results from damage to the red nucleus associated motor
pathways above the red nucleus.

28
Q

Decerebrate Posturing

A

also known as Extensor Posturing, results from
damage to the red nucleus associated
motor pathways below the red nucleus
in the brainstem

29
Q

T/F a cranial nerve assessment can mostly still be completed even in AMS

A

T

30
Q

_____ can be related to opioid
overdose, but can also be a sign of a pontine
hemorrhage that interrupts sympathetic
outflow to the pupils

A

Pinpoint pupils

31
Q

A dilated pupil (which may be unresponsive or
“blown”) in a comatose patient can indicate
______

A

brainstem injury or increased intracranial pressure.

32
Q

Medication that can dilate pupils

A

Amphetamines

33
Q

Tonic deviation of the eyes in a horizontal
plane may indicate an _____ affecting the frontal eye fields (such as hemorrhagic stroke in the frontal lobe).

A

ipsilateral hemispheric lesion

34
Q

What is dolls eyes?

A

○ Normally rotating the head side to side causes the eyes to shift so the gaze is maintained, but in severe brainstem injury or brain death, the eyes do not shift with head rotation

35
Q

Imaging of choice for patients that have AMS

A

noncontrast Head CT

36
Q

Lab testing for AMS

A

○ POC Glucose
○ CMP
○ CBC
○ PT/INR
○ PTT
● ABGs should be drawn as soon as possible.
● Consider Troponins if there is a cardiac concern.
● Consider an LP if a neuro infection is suspected

37
Q

Syncope presentation

A

● Syncope should be thought of as a symptom more than a diagnosis, and is a
transient, brief, and self-limited loss of consciousness.
○ Syncopal episodes are followed by prompt recovery without
resuscitative measures

38
Q

Reflex Syncope

A

(neural mediated) is generally due to excessive vagal tone or impaired reflex of peripheral circulation.
■ The most common type is Vasovagal Syncope, often initiated by a stressful, painful, or claustrophobic experience.
■ Enhanced vagal tone with resulting hypotension, cerebral hypoperfusion.

39
Q

Orthostatic (postural) Hypotension

A

another common cause of syncope in which normal vasoconstrictive response to assuming an
upright posture is impaired.
■ Common in older adults, or patients with diabetic neuropathy, POTS, hypovolemia, or patients taking vasodilators, diuretics, or beta-blockers.

40
Q

Cardiogenic Syncope

A

generally either mechanical or arrhythmic, and
generally occurs rather suddenly without warning (injury risk is high).
■ Mechanical is generally valvular in nature, as can occur with aortic stenosis
(where the heart cannot increase stroke volume in circumstances of
increased peripheral demand), pulmonary stenosis, HOCM, etc.

41
Q

More commonly, cardiogenic syncope occurs due to a _____

A

sudden arrhythmia event

42
Q

Vasovagal syncope generally has a prodrome of symptoms (sometimes called vasodepressor premonitory symptoms), which can include _____

A

nausea,
diaphoresis, tachycardia, and pallor

43
Q

T/F Cardiogenic syncope has a prodrome of symptoms

A

F

44
Q

All patients presenting with syncope should get a ______

A

12-lead EKG

45
Q

Treatment and Referral Considerations for syncope

A

○ In cases of vasovagal syncope (most common), treatment generally
consists of patient education on the benign nature of the condition and
about avoiding predisposing situations
○ For patients experiencing recurrent vasovagal syncope, counterpressure
maneuvers (squatting, leg crossing, abdominal contraction) can
sometimes be helpful for terminating episodes
○ If symptomatic bradyarrhythmias or supraventricular tachycardias are
detected and felt to be the cause of cardiogenic syncope, permanent
pacing (implanted defib/pacemaker) is indicated

46
Q

_____ is an alpha-agonist that can increase
peripheral vasoconstriction and has been shown to reduce the frequency of syncopal episodes in small trials

A

Midodrine

Neuro Exam 2 (6 decks)

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