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BCN EXAM 4 > Higher cerebral functions > Flashcards

Higher cerebral functions Flashcards

1
Q

consciousness

A 
reception 
processing 
cognition 
reactoin 
language 
memory 
foresight
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2
Q

Mental status exam

A 
memory 
orientation 
concentration 
language 
performance of learned skilled movements - apraxia
recognition of stimuli - agnosia
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3
Q

delirium

A

acute confusional state

ex: alcohol intoxication

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4
Q

dementia

A

failing memory and impairment of intellectual or cognitive function

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5
Q

Alzheimer’s disease

A

degeneration and loss of nerve cells in the cortical association areas and medial temporal lobes

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6
Q

Aphonia/dysphonia

A

less to do with brain and more to do with voice disturbance due to larynx or innervation issues

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7
Q

person will whisper with ______ paralysis

A

vocal chord paralysis

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8
Q

anarthria/dysartharia

A

more issue with using tongue, jaw, breathing to say words

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9
Q

words slurred

A

dyspraxia of speech involving cerebellum

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10
Q

Aphasia/dysphasia

A

problem with speaking

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11
Q

dysphagia

A

swallowing problem

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12
Q

Mini mental status exam

A 
orientation 
registration 
attention and calculation 
recall 
language

testing - memory, orientation, concentration, language

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13
Q

MMSE scale

A 
30 total possible 
28-30 normal 
21-27 Mild cognitive 
10-20 Moderate cognitive 
0-9 severe impairment
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14
Q

standardized min mental state examination (SMMSE)

A

if memory, orientation, concentration and language are intact, the performance of learned skilled movements and recognition of stimuli will also be intact

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15
Q

clouding of consciousness

A

patient has inattention and reduced wakefulness

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16
Q

confusional state

A

includes disorientation, bewilderment, and difficulty following commands

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17
Q

lethargy

A

severe drowsiness

patient can be aroused by moderate stimuli and then drifts back to sleep

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18
Q

obtundation

A

similar to lethargy
patient has little interest in the environment, slowed responses to stimulation and tends to sleep more than normal with drowsiness in between sleep states

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19
Q

stupor

A

pt aroused only by vigorous and repeated stimuli

when left undisturbed, the pt will immediately lapse back o the unresponsive state

20
Q

coma

A

state of unarousable unresponsiveness
deep - no reflex activity
light - reflex activity
no voluntary movement

21
Q

dysfunctions of ascending reticular activating system ARAS

A 
clouding of consciousness
confusional state 
delirium 
lethargy 
obtundation 
stupor 
dementia 
hypersomnia 
vegetative state 
akinetic mutism - frontal cortex problem, semi conscious , cant talk, move -> no motor planning 
locked in syndrome 
coma
22
Q

vegetative state

A

loss of cognition
intact wake/sleep cycle
intact autonomic functions

23
Q

Cause of altered state? evidence to look for

A

infection, HTN, shock, increased intracranial pressure with bradycardia, trauma (check for periorbital or retroauricular ecchymosis or blood behind tympanic membrane to suggest basilar skull fracture
is there papilledema or intraocular hemorrhage?
Icteric conjunctiva
stiff neck
intoxication

24
Q

Hepatic Encephalopathy

A 
Portal systemic encephalopathy 
due to chronic hepatic insuff/cirrhosis, intolerance of dietary protein, raised ammonia levels 
confusion, drowsiness, coma 
icteric conjuntiva 
develops over days to weeks
25
Q

Small reactive pupils

A

suggest diencephalic localization, freq metabolic basis

26
Q

large pupils that dilate and contract automatically but do not react to direct light stimulus

A

suggest tectal lesion

27
Q

Midposition fixed pupils

A

lesion of midbrain

28
Q

bilateral pinpoint pupils

A

indicative of opioid toxicity, pontine lesion, organophosphate toxicity (excess Ach)

29
Q

Most common cause of decreased state of consciousness

A

metabolic/toxic disturbance - acid-base disequilibrium, oxygen or glucose metabolism disorder, uremic and hepatic encephalopathy, drug overdose, poisoning
epilepsy
cerebrovascular issue - ischemia, hemorrhage

30
Q

Hypertensive encephalopathy

A

malignant HTN, hypertensive emergency
severe headache, nausea with vomiting, visual disturbance,confusion, coma
findings: Retinal hemorrhage, papilledema

31
Q

Midbrain RF lesion

A

EEG appearance of large amplitude

slow waves

32
Q

Pontine RF lesion

A

EEG alpha rhythm (vertical gaze palsy)
normal autonomic and somatomotor reflexes are present
almost like a normal drowsy

33
Q

Frontal lobe lesion

A

somnolent or apathetic

akinetic mutism

34
Q

lower brainstem lesion

A

produces coma but are usually fatal b/c stops breathing

35
Q

confusion, faitgue, lethargy, sleepiness, SOB, tachypnea, may be caused by

A

respiratory acidosis, hypercapnia: Low O2
respiratory alkalosis: cerebrovascular constriction
metabolic acidosis: ketoacidosis, dehydration, loss of bicarb (diarrhea, vomitting) renal disease
aspirin, methanol, ehtylene glycol poisoning
lactic acid

36
Q

occiptal ischemia

A

due to compression of ipsilateral posterior cerebral artery at the tentorial edge

37
Q

Boxer takes punch to face, twists head on neck

A

twists the brainstem and contorted in tentorial hiatus, small areas of hemorrhage or ischemia may develop within it, resulting in alterations in level of consciousness

38
Q

cerebellar lesions compress

A

brainstem and can cause coma

39
Q

subconscious mind

A

composite of everything one sees, hears and any info the mind collects that it cannot otherwise consciously process to make meaningful sense
stores info for the conscious mind to retrieve

40
Q

superconscious

A

collective unconscious
Jungian psychology
spirituality/religion

41
Q

Pt doesnt eat, drinks excessive liquids, drops potassium dangerously low,

A

CT shows black area that is liquid, indicating hydrocephalus ex vacuo.
Thalamus was ok but cortex was damaged leaving pt in vegetative state which is a loss of cognition with intact sleep/wake cycle and intact autonomic functions

42
Q

Pt unconscious after consuming diazepam, detropropoxyphene, and alcohol. After collapsed and stopped breathing twice for 15 mins was brought to hospital

A

pt lapsed into persistent vegetative state
Pt is in COMA - unconsciousness, unresponsive to stimuli
Cerebral cortex has moderate scarring
Thalamus was extensively damaged bilaterallly
brain stem undamaged - leaving cardiac and respiratory function intact
suggests thalamus plays role in consciousness

43
Q

Pt has has locked in syndrome for long time, what is he at risk for?

A

developing pneumonia because he cannot breath deeply

had a basal pontine stroke

44
Q

COMA

A

state of unconsciousness in which person cannot be awakened
fails to respond normally to painful stimuli, light or sound
lacks a normal wake-sleep cycle and doesnt intiate voluntary movement
no eye opening, speech/communication

45
Q

VEGETATIVE STATE

A

return of sleep/wake cycle with periods of eye opening and eye closing
may moan or make sounds esp when tight muscles are stretched
may cry or smile or make other facial expressions
-may briefly move eyes towards persons or objects
-may react to a loud sound w/ a startle
-unable to follow intstructions
-no speech or communication
-no purposeful movement

BCN EXAM 4 (8 decks)

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