MDT Altered Mental Status

Question 1

patients that respond only to repeated vigorous stimuli

Answer 1

Stuporous

Question 2

patients that are unarousable and unresponsive

Answer 2

Comatose

Question 3

Level of consciousness is depressed

Answer 3

Altered mental status

Question 4

These can cause

(a) Seizures,
(b) Hypothermia,
(c) Metabolic disturbances,
(d) Structural lesions causing bilateral cerebral hemispheric dysfunction
(e) A disturbance of the brainstem reticular activating system.
(f) A mass lesion involving one cerebral hemisphere may cause coma by compression of the brainstem.

Answer 4

Coma

Question 5

Assessment & Emergency Measures

The diagnostic workup of the comatose patient must proceed concomitantly with_____

Answer 5

Management

Question 6

Assessment & Emergency Measures
In hypothermia, all vital signs may be _______, and all such patients should be
_______ before the prognosis is assessed

Answer 6

absent

rewarmed

Question 7

Assessment & Emergency Measures
The patient can be positioned on _____ with the neck partly extended, dentures removed, and secretions cleared by suction; if necessary, the patency of the airways is maintained with an ________.

Answer 7

one side

oropharyngeal airway

Question 8

What are labs you would draw for a comatose PT

Answer 8

serum glucose, 
electrolyte, 
calcium levels; 
arterial blood gases;
liver biochemical and kidney function tests; and toxicologic studies as indicated

Question 9

Abrupt onset of coma could suggest?

Answer 9

(a) Subarachnoid hemorrhage,
(b) Brainstem stroke,
(c) Intracerebral hemorrhage,
(d) Whereas a slower onset and progression occur with other structural or mass lesions.

Question 10

What type of imaging of the head is appropriate if it can be obtained directly from the emergency department, in order to identify intracranial hemorrhage, brain herniation, or other structural lesion that may require immediate neurosurgical
intervention.

Answer 10

Urgent non-contrast CT

Question 11

A metabolic cause is likely with a preceding _________ or _________.

Answer 11

intoxicated state

agitated delirium

Question 12

_________posturing may occur with lesions of the internal capsule and rostral cerebral peduncle and decerebrate (extensor) posturing with dysfunction or destruction of the midbrain and rostral pons.

Answer 12

Decorticate (flexor)

Question 13

__________ posturing occurs in the arms accompanied by flaccidity or slight flexor responses in the legs in patients with extensive brainstem damage extending down to the pons at the trigeminal level.

Answer 13

Decerebrate

Question 14

_________ of responsiveness suggests brainstem involvement, bilateral
pyramidal tract lesions, or psychogenic unresponsiveness.

Answer 14

Bilateral absence

Question 15

________ of responses despite application of stimuli to both sides of the body in turn implies a corticospinal lesion.

Answer 15

Unilateral absence

Question 16

_________ from painful stimuli implies that sensory pathways from and motor pathways to the stimulated limb are _______.

Answer 16

Purposeful limb withdrawal

functionally intact

Question 17

mydriasis

Answer 17

Dilated pupils

Question 18

miosis

Answer 18

Constricted pupils

Question 19

Ocular Findings

______ could suggest brainstem compression, drug overdose on MDMA, cocaine, amphetamines

Answer 19

Dilated pupils (mydriasis)

Question 20

Ocular Findings

________ could suggest drug overdose with opiates/opioids

Answer 20

Constricted pupils (miosis)

Question 21

Corneal reflex tests what CN?

Answer 21

5th trigeminal

Question 22

_______of the eyes to the side suggests the presence of an ipsilateral hemispheric lesion, a contralateral pontine lesion, or ongoing seizures from the contralateral hemisphere.

Answer 22

Conjugate deviation

Question 23

______ breathing (a completely irregular pattern of breathing with deep and shallow breaths occurring randomly) is associated with lesions of the lower pontine tegmentum and medulla

Answer 23

Ataxic