[HYHO] HPS 1

Question 1

What scale is used to describe general level of consciousness in patients with TBI or other head injury?

Answer 1

Glascow Coma Scale

Question 2

What are the 3 parameters of the Glascow Coma Scale? What are the maximum scores for each?

Answer 2

Eye opening - 4

Best Verbal response - 5

Best Motor response - 6

Question 3

How are the parameters for Glascow Coma Scale scored?

Answer 3

Individually

E.g. E2V3M4 = GCS 9

Question 4

What are the GCS scores for mild, moderate, and severe brain injury?

Answer 4

>13 = Mild

9 to 12 = Moderate

<8 = Severe

Question 5

How is GCS scored for intubated patients?

Answer 5

Scored with a “T” bc no verbal response (intubated)

Min - 2T

Max - 10T

Question 6

Delirium or Dementia?

Richmond Agitation-Sedation Score

Answer 6

Delirium

Question 7

What is the purpose of using the Richmond Agitation-Sedation Score?

Answer 7

Screen level of alertness in a mechanically ventilated patient

Used before CAM-ICU or bCAM in Delirium Triage Screen

Question 8

Delirium or Dementia?

Confusion Assessment Method (CAM)

Answer 8

Delirium

Question 9

What screening test allows non-psychiatrists to detect delirium in high risk environments?

Answer 9

Confusion Assessment Method (CAM)

Question 10

What are the 4 features required for a positive CAM?

Answer 10

1 - Acute onset and fluctuating course

2 - Inattention

3 - Altered Level of Consciousness

4 - Disorganized thinking

Must have features 1 AND 2 + either 3 OR 4

Question 11

What are the 3 steps to performing the Richmond Agitation-Sedation Scale?

Answer 11

1. Observe pt. Are they alert and calm (score 0)? Agitated/combative (+)? Difficult to arouse (-)?
2. If pt not alert, loudly state pt’s name and direct them to open eyes and look at speaker.
3. If pt does not respond to voice, physically stimulate by shaking shoulder and rubbing sternum

Question 12

How are the positive scores on the Richmond Agitation-Sedation Scale described?

Answer 12

+4 - overtly Combative or violent, immediate danger

+3 - very agitated, aggressive to staff

+2 - Agitated, frequent nonpurposeful movement

+1 - Restless, anxious

Question 13

How are the negative scores of the Richmond Agitation-Sedation Scale described?

Answer 13

• 1: Drowsy, >10 sec awake with eye contact and response to voice
• 2: Light sedation, <10 sec awakens with eye contact to voice
• 3: Mod sedation, Any movement to voice (no eye contact)
• 4: Deep sedation, no response to voice but responds to physical stimulation
• 5: Unarousable, no response to any stimulation

Question 14

Delirium Triage Screen vs bCAM

Which is more sensitive? Specific?

Answer 14

Sensitive - Delirium Triage Screen

Specific - bCAM

Question 15

Dementia or Delirium?

Onset: Slow

Course: Progressive

Answer 15

Dementia

Question 16

Dementia or Delirium?

Abnormal physical exam

Visual hallucinations

Answer 16

Delirium

Question 17

Dementia or Delirium?

Disturbance in attention/cognition

Evidence of cause by medical condition, substance intoxication/withdrawal, medication side effect

Answer 17

Delirium

Question 18

Avoid ______ to treat delirium, except in alcohol withdrawal

Answer 18

Benzodiazepines!!!!

Question 19

What is the strongest risk factor for dementia?

Answer 19

Advanced age

Question 20

Review: Most common cause of dementia?

Answer 20

ALZHEIMER’S DZ

never forget

Question 21

In general for dementia, decline in ______ precedes decline in ______

Answer 21

In general for dementia, decline in cognition precedes decline in function

Question 22

When diagnosing dementia, you must first rule out _____

Answer 22

When diagnosing dementia, you must first rule out depression

Question 23

What are the two classes of drugs used to treat dementia?

Answer 23

NMDA receptor antagonist - memantine

Cholinesterase inhibitors - donepezil, rivastigmine, galantamine

Question 24

What kind of dementia is characterized by progressive course, prominent memory loss, symmetric neurological exam?

Answer 24

Alzheimer’s dementia

Question 25

What kind of dementia is characterized by **asymmetric neurological exam, risk factors/hx of stroke?**

Answer 25

Vascular dementia

Question 26

What kind of dementia is characterized by 2/3 of the following: **parkinsonism, fluctuating cognition, well-formed visual hallucinations?**

Answer 26

Lewy body dementia

Question 27

What is the criterion for **Parkinson's disease with dementia?**

Answer 27

Parkinson's dz diagnosis **precedes** dementia by **at least 1 year**

Question 28

What is the "I WATCH DEATH" mnemonic used for?

Answer 28

Differentia dx of **delirium**

Question 29

What does "I WATCH DEATH" stand for? **I\_\_\_\_** **W\_\_\_\_** **A\_\_\_\_** **T\_\_\_\_** **C\_\_\_** **H\_\_\_** **D\_\_\_** **E\_\_\_** **A\_\_\_** **T\_\_\_** **H\_\_\_**

Answer 29

**_I-nfection_** **_W-ithdrawal_** **_A-cute metabolic_** **_T-rauma_** **_C-NS pathology_** **_H-ypoxia_** **_D-eficiencies_** **_E-ndocrinopathies_** **_A-cute vascular_** **_T-oxins or drugs_** **_H-eavy metals_**

Question 30

_Dementia scoring: **Mini-cog**_ ## Footnote **Components (2)**

Answer 30

1 - 3 item recall test 2 - clock drawing test *Higher sensitivity for detecting MCI than MMSE, less affected by age and education levels, **short (3 min)***

Question 31

_Dementia scoring: **Montreal Cognitive Assessment (MoCA)**_ **Score range? Normal?**

Answer 31

Score range 0-30, **normal \>25** ## Footnote * Better at detecting **MCI** than MMSE* * Age **55-85** (idk why this one is specifically this number bc they all say for "older people" or "the elderly" so...)*

Question 32

_Dementia scoring: **MMSE**_ ## Footnote **Not uncommon for someone with AD to have scores decrease _____ points per year**

Answer 32

Decrease **2-4 points per year** ***Score range same as MoCA (0-30, normal \>25)*** ***Widely used***

Question 33

_Dementia scoring: **SLUMS**_ ## Footnote **What is the normal scoring for SLUMS?**

Answer 33

Score 0-30 ## Footnote **Normal:** **25+ if less than high school education** **27+ if high school education** *Equivalent to MoCA for detecting MCI*

Question 34

What is **Battle's sign?**

Answer 34

Bruising over the **mastoid process** caused by extravasation of blood along the **posterior auricular A.** Sign of **head trauma**

Question 35

What is **hemotympanum**?

Answer 35

Preesence of blood in the tympanic cavity of the ear, **often as a result of basilar skull fx**

Question 36

_5-Model Approach to AMS_ - Biomechanical OMT modalities

Answer 36

FPR, BLT, ST, MET, consider HVLA

Question 37

_5-Model Approach_ - Neurological OMT modalities

Answer 37

S/CS Paraspinal inhibition

Question 38

_5-Model Approach_ - OMT Modalities Respiratory/Circulatory

Answer 38

Rib raising, lymphatics, ST to C and T spine

Question 39

_5-Model Approach_ - OMT modalities Metabolic, Energetic, Immune

Answer 39

Lymphatics, mesenteric release, FPR, BLT, ST, MET

Question 40

_5-Model Approach_ - OMT modalities Behavioral

Answer 40

ST techniques for anxiety/depression