ALTERED LOC

Question 1

Components of Sensorium

Answer 1

Consciousness

Attention span

Orientation of time, place,person

Fund of information

Insight, judgement, planning

Calculation

Question 2

aware that you are aware

recognize awareness of self and environment

Answer 2

sensorium

Question 3

registers current internal and external contingencies

Answer 3

function of sensorium

Question 4

relates current internal and external stimuli to our memories and to our future hopes and desires

Answer 4

function of sensorium

Question 5

invests the stream do afferent stimuli with emotion, determines their significance and assigns priority that results in neglect or attention

Answer 5

function of sensorium

Question 6

state of full awareness of self and environment and normal responsiveness to external stimulation and inner needs

Answer 6

consciousness

Question 7

consciousness is dependent on two elements

Answer 7

arousal

awareness

Question 8

wakefulness

integrity of the ascending reticular activating system

Answer 8

arousal

Question 9

content

integrity of cerebral cortex

quality and coherence of thought and behavior

Answer 9

awareness

Question 10

condition of normal person when awake

fully responsive to a thought or perception and indicates by behavior and speech the same awareness of self and environment as that of the examiner

may fluctuate throughout the day

Answer 10

normal alertness

Question 11

inability to think with customary speed, clarity and coherence

impaired judgement and decision making

most events that involve the confused patient leave no trace in memory

Answer 11

confusion

Question 12

tests for confusion

Answer 12

recall events

Question 13

tests for defect in use of working memory

Answer 13

serial subtraction

spelling backwards

digit span and backwards

Question 14

may incorporate clouded interpretation of internal and external experience, and an inability t integrate and attach symbolic meaning to experience

Answer 14

apperception

Question 15

confusion is least pronounced

Answer 15

morning

Question 16

peak of consciousness

Answer 16

early evening hours

Question 17

to go out of the furrow

severe inattentiveness, altered mental content and sometimes hyperactivity

misperception of sensory stimuli often with hallucination

Answer 17

delirium

Question 18

disorientation order of delirium

Answer 18

time then place then person

Question 19

inability to sustain a wakeful state without application of verbal stimuli

decreased mental, speech and physical activity

Answer 19

drowsiness

Question 20

characteristics of drowsiness

Answer 20

lids droop

may snore

limbs relaxed

Question 21

to beat against or blunt

mental blunting

mild to mod reduction in alertness, accompanied by a lesser interest in the environment

slower response to stimulation

Answer 21

obtundation

Question 22

process of sensorium

Answer 22

sensory receptors → ascending pathways (SC to Cerebrum → then we become aware of the sensation → experienced is retained to our memory → react to that sensation → motor pathway is activated

Question 23

Lt. “to be stunned”

Deeper state than drowsiness

Responses to spoken commands are either absent, curtailed or slow and inadequate

Reduction or elimination of natural shifting position

Answer 23

Stupor

Question 24

Characteristics of stupor

Answer 24

Eyes are displaced slightly out and up which is same as in sleep

Question 25

stimulation of drowsiness

Answer 25

verbal stimulation or command

Question 26

stimulation obtundation

Answer 26

light, physical, nonpainful stimulation

Question 27

stimulation of stupor

Answer 27

noxious stimulation trapezius squeeze, sternal rub, deep nail bed pressure, supraorbital pressure

Question 28

Gk. “deep sleep or trance” Incapable of arousal by external stimuli or inner need

Answer 28

Coma

Question 29

corneal, pupillary, and pharyngeal reflexes can be elicited

Answer 29

lighter stage of coma

Question 30

no meaningful or purposeful reaction of any kind is obtainable, and corneal, pupillary, and pharyngeal responses are diminished

Answer 30

deepest stage of coma

Question 31

what are the kinds of altered state of conscious

Answer 31

persistent vegetative state brain death

Question 32

Patients who, after recovery from coma, return to state of wakefulness without cognition Eyes-open permanent unconsciousness with loss of cognitive function and awareness of the environment but preservation of sleep-wake cycles and vegetative function

Answer 32

Persistent vegetative state

Question 33

Persistent if vegetative syndrome of unconscious awakening persists for:

Answer 33

3 months after nontraumatic brain injury 12 months after traumatic injury

Question 34

Causes of persistent vegetative state

Answer 34

Anoxia – Ischemia Metabolic or encephalitic coma Head trauma

Question 35

worst prognosis of persistent vegetative state

Answer 35

anoxia-ischemia

Question 36

laboratory tests for persistent vegetative state

Answer 36

EEG Neuroimaging

Question 37

State of coma in which brain was irreversibly damaged and has ceased to function, but pulmonary and cardiac function could still be maintained by artificial means State of complete unresponsiveness to all modes of stimulation, arrest of respiration, and absence of all EEG activity for 24 hours

Answer 37

Brain death

Question 38

characteristics of brain death

Answer 38

absence of all cerebral functions absence of all brainstem functions including spontaneous respiration

Question 39

Deep coma Total lack of spontaneous movement and of motor and vocal responses to all visual, auditory and cutaneous stimulation

Answer 39

Absence of cerebral function

Question 40

Loss of pupillary response Loss of corneal, oculocephalic, oculovestibular (caloric testing), gag and cough reflex Absence of facial movement to noxious stimuli Absence of cerebrally mediated movement to noxious stimulation of extremities

Answer 40

Absence of Brainstem function

Question 41

Destruction of the medulla Unresponsiveness of medullary centers to high carbon dioxide tension the ventilator is removed and checked if the patient will breathe on their own

Answer 41

Apnea Test

Question 42

Reflects loss of cardiac innervation by damaged medullary vagal neurons

Answer 42

Absence of tachycardia in response to atropine

Question 43

Confirms cerebral death Electrocerebral silence, flat or isoelectric EEG

Answer 43

EEG for brain death

Question 44

Used to rule out reversible cause

Answer 44

Toxicologic screening

Question 45

Lack of contrast pacification during 4VA

Answer 45

Digital Subtraction Angiography (DSA)

Question 46

Hypothermia or intoxication with sedative-hypnotic drugs and immediately post cardiac arrest

Answer 46

Isoelectric EEG with preserved brainstem reflexes

Question 47

Scale used to objectively describe the extent of impaired consciousness in all types of acute medical and trauma patients

Answer 47

Glasgow Coma Scale

Question 48

3 aspects of Glasgow Coma Scale

Answer 48

Eye opening Verbal response Motor response

Question 49

grade 4 eye opening (glasgow)

Answer 49

opens eyes spontaneously

Question 50

grade 3 eye opening (glasgow)

Answer 50

opens eyes to voice

Question 51

grade 2 eye opening (glasgow)

Answer 51

opens eyes to pain

Question 52

grade 1 eye opening (glasgow)

Answer 52

no eye opening

Question 53

grade 5 verbal response (glasgow)

Answer 53

appropriate and oriented

Question 54

grade 4 verbal response (glasgow)

Answer 54

confused

Question 55

grade 3 verbal response (glasgow)

Answer 55

inappropriate words

Question 56

grade 2 verbal response (glasgow)

Answer 56

incomprehensible (moans/groans/ sounds)

Question 57

grade 1 verbal response (glasgow)

Answer 57

no sound

Question 58

grade 6 motor response (glasgow)

Answer 58

obeys commands

Question 59

grade 5 motor response (glasgow)

Answer 59

localizes pain

Question 60

grade 4 motor response (glasgow)

Answer 60

withdraws to pain (normal flexion)

Question 61

grade 3 motor response (glasgow)

Answer 61

abnormal flexor response

Question 62

grade 2 motor response (glasgow)

Answer 62

abnormal extensor response

Question 63

grade 1 motor response (glasgow)

Answer 63

no movement

Question 64

highest score and lowest score for glasgow coma response

Answer 64

highest: 15 lowest: 3

Question 65

2018 – Paul Brennan, Gordon Murray, and Graham Teasdale 4th number (pupil reactivity score, PRS) that is subtracted from the standard GCS score

Answer 65

GCS-P

Question 66

score 2 pupil reaction

Answer 66

Neither pupil reacts to light

Question 67

score 1 pupil reaction

Answer 67

One pupil doesn’t react to light

Question 68

score 0 pupil reaction

Answer 68

Both pupils reactive to light

Question 69

mild tbi score

Answer 69

13-15

Question 70

moderate tbi

Answer 70

9-12

Question 71

severe tbi

Answer 71

3-8

Question 72

severe

Answer 72

with gcs 1-8

Question 73

how to compute gcs-p

Answer 73

GCS-P = GCS - PRS