Consciousness

Question 1

What is consciousness?

Answer 1

State of wakefulness & awareness of self + environment

Question 2

What is it called when you have a aroused from sleep cycle, have eyes open and motor activity?

Answer 2

Wakefulness

Question 3

What is the feeling of “I am” and subjective experience called?

Answer 3

Awareness

Question 4

What is a state of unrousable responsiveness?

Answer 4

Coma

Question 5

What is a coma-like state that has some but very little responsiveness?

Answer 5

Stupor

Question 6

What is acute, cyclical pattern of confusion called?

Answer 6

Delirium

Question 7

What is abnormally slowed thinking called?

Answer 7

Obtundation

Question 8

What four things constitutes consciousness?

Answer 8

Brain arousal / activation
Connected thought patterns
Ability to sense sensory inputs
Ability to effect controlled outputs

Question 9

What is the sense of the internal state of the body called?

Answer 9

Interoception

Question 10

Where is the interoception sense located in the brain?

Answer 10

Anterior Insular Cortex

Question 11

Which neurons facilitate interoception?

Answer 11

von Economo neurons

Question 12

What is the definition of a coma?

Answer 12

A depressed level of consciousness resulting in an unresponsive P who cannot be awakened with pain - that lasts for MORE THAN 6 HOURS

Question 13

Do Ps have a normal sleep-wake cycle in a coma?

Answer 13

No

Question 14

Do Ps respond to painful stimuli, light or sound in a coma?

Answer 14

No

Question 15

How are the P’s eyes in a coma

Answer 15

May get blink response to visual threat & pupillary reactions

When moving P’s head, eyes may stay fixed on a stationary object (Doll’s head manoeuvre positive).

Question 16

Which two groups commonly cause impaired consciousness?

Answer 16

Neurological causes
Metabolic causes

Question 17

What are the commonest neurological causes of impaired consciousness?

Answer 17

Trauma
Cerebrovascular
Infection (esp meningitis)

Question 18

What are the commonest metabolic causes of impaired consciousness?

Answer 18

Hypoglycaemia
Hypoxia
Drugs & toxins

Question 19

Which test of consciousness is often used with dementia Ps?

Answer 19

4A’s Test (4AT)

Question 20

What is the GCS?

Answer 20

Glasgow Coma Scale

Question 21

What is the AVPU and how does it work?

Answer 21

Alert
Visual
Pain
Unresponsive

Which response on this scale that Ps respond to

Question 22

What is the RASS?

Answer 22

Richmond Agitation Sedation Scale

Question 23

What do we look at when assessing a P’s consciousness?

Answer 23

Sensori-motor stimulus and responses inc
- Eyes
- Verbal
- Protective movements and postures
- Spontaneous and voluntary movements
- Voice

Question 24

Which three things are assessed by the GCS?

Answer 24

Eye Opening (1 none, 4 spontaneous)
Best verbal response (1 none, 5 - orientated)
Best motor response (1 no movement, 6 - obeys commands)

Question 25

What is the lowest score a P can have on the GCS?

Answer 25

3

Question 26

What is localising pain in a P?

Answer 26

Patient can recognise where the pain is, localise and try to push you away from the pain

Question 27

When Ps move their limb in an abnormal way - by rotating or extending in response to pain - what does this indicate?

Answer 27

That the higher parts of the brain are not functioning

Question 28

Why do we use these tools?

Answer 28

To determine which Ps may need protection of airway & determine which are at risk of complications

Question 29

What is the score on the GCS at which Ps cannot protect their airway?

Answer 29

< 8

Question 30

How is GCS correlated to outcome in brain injury?

Answer 30

Score on GCS can be linked to the successfulness of an outcome for Ps with a brain injury,

Question 31

Name 3 questionnaires used to measure cognitive impairment

Answer 31

Mini Mental State Examination (MMSE) Confusion Assessment Method (CAM) 4 A's Test (4AT)

Question 32

Name three types of confusion

Answer 32

Hyperactive Hypoactive Mixed

Question 33

How can you determine delirium from dementia?

Answer 33

Delirium - acute & fluctuates Demential - chronic, steady progression

Question 34

What is a transient loss of consciousness called?

Answer 34

Blackout (or syncope)

Question 35

What is syncope usually caused by?

Answer 35

Cardiovascular causes

Question 36

What are the three causes of blackout?

Answer 36

Syncope Epilepsy Hypoglycaemia

Question 37

What is it important to treat blackouts caused by hypoglycaemia?

Answer 37

The brain has no store of glycogen = therefore important to treat this.

Question 38

What is it important to ask in the history about what happened prior to the blackout episode?

Answer 38

- Did it follow a change in posture / position - Did it follow an activity - Did they have an aura - Did they have chest symptoms - Do they remember falling? (Yes - blackout can be due to head injury, no - unconscious before they hit the floor)

Question 39

What symptoms are important during a blackout?

Answer 39

Duration Seizures? Urinary incontinence? Tongue biting? Pale? Flushing? Pulse? BP? BG?

Question 40

What are risk factors for blackout?

Answer 40

Past medical history Drugs