Module Exam 6: Higher Corticals

Question 0

The state of arousal or the degree of variation from normal alertness as judged by the appearance of facial muscles, fixity of gaze, and body posture.

Answer 0

Level of consciousness

Question 1

The state of patient’s awareness of self and environment and his responsiveness to external stimulation and inner need

Answer 1

Consciousness

Question 2

Is by far the more important and dramatic aspect of disordered consciousness

Answer 2

Loss of normal arousal

Question 3

The condition of person when awake; fully responsive to a thought or perception and indicates by his behavior and speech the same awareness of self and environment as that by the examiner

Answer 3

Normal

Question 4

An inability to think with customary speed, clarity and coherence; marked by some degree of inattentiveness and disorientation; implies a degree of imperceptiveness and distractibility.

Answer 4

Confusion

Question 5

An inability to sustain a wakeful state without tye applicationof external stimuli; inattentiveness and mild confusion are the rule both improving with arousal. Indistinguishable from light sleep.m

Answer 5

Drowsiness

Question 6

Results most often from a process that influences the brain globally; can also be from focal __________ in various locations.

Answer 6

Confusion. Cerebral disease.

Question 7

An inability to sustain a wakeful state without the application of external stimuli. Inattentiveness and mild confusion are the rule both improving with arousal. Indistinguishable from __________.

Answer 7

Drowsiness. Light sleep.

Question 8

A state in which the patient can be roused only by vigorous and repeated stimuli but the state of arousal cannot be sustained without repeated external stimulation.

Answer 8

Stupor

Question 9

In stupor, responses to spoken commands are either ___________ and ________.

Answer 9

Absent/low. Inadequate.

Question 10

In stupor, this is common and there is a reduction or elimination of the natural shifting of body positions.

Answer 10

Restless/Stereotyped motor activity

Question 11

In stupor, when left ________, these patients quickly drift back into a sleep-like state. The eyes move ______ & ______.

Answer 11

Unstimulated. Outward. Upward.

Question 12

The patient appears to be asleep and is at the same time incapable of being aroused by external stimuli or inner need.

Answer 12

Coma

Question 13

no reaction of any kind is obtainable: corneal, pupillary, pharyngeal, tendon and plantar reflexes are in abeyance and tone in the limb muscles is diminished.

Answer 13

Deepest stage of coma

Question 14

Pupillary reactions, reflex ocular movements and corneal and other brainstem reflexes are preserved in varying degree, and muscle tone in the limbs may be increased; respiration may be slow or rapid, periodic, or deranged.

Answer 14

Lesser degrees coma

Question 15

In lighter stages, sometimes referred to by the ambiguous and unhelpful terms ________ or _______, most of the reflexes can be elicited, and the plantar reflexes may be either flexor or extensor ( ______ sign)

Answer 15

Semicoma/Obtundation. Babinski sign.

Question 16

Shares a number of other features with the pathologic states of drowsiness, stupor or coma. Include yawning, closure of the eyelids, cessation of blinking and swallowing, upward deviation or divergence or roving movements of the eyes, loss of muscular tone, decrease/loss of tendon reflexes, and even the presence of Babinskinsigns and irregular respirations, sometimes ________ in type.

Answer 16

Sleep. Cheyne-Stokes.

Question 17

Upon being awakened from deep sleep, a normal person may be _______ for a few moments.

Answer 17

Confused

Question 18

Sleeping persons may still respond to unaccustomed stimuli and are capable of some mental activity in the form of _______ that leave traces of _______, thus differing from persons in stupor or coma.

Answer 18

Dreams. Memory.

Question 19

The most important difference in relationship of sleep to coma: persons in sleep, when stimulated, can be roused to normal and ________.

Answer 19

Persistent consciousness

Question 20

Does not decrease during sleep, as it usually does in coma.

Answer 20

Cerebral oxygen uptake

Question 21

Recordable electrical activity- _____ and cerebral evoked responses- and spontaneous motor activity differ in two states.

Answer 21

EEG

Question 22

The patient remains totally inattentive, does not speak, and shows no signs of awareness of the environment or inner need; responsiveness is limited to primitive postural and reflex movements of the limbs. There is loss of sphincter control. There may be arousal or wakefulness in alternating cycles as reflected in partial eye opening, but the patient regains neither awareness nor purposeful behavior of any kind.

Answer 22

Persistent Vegetative State

Question 23

In PVS, there is a lack of _______ visual following of objects.

Answer 23

Consistent

Question 24

Syndrome of unconscious awakening lasting _______ after nontraumatic and ______ after traumatic injury.

Answer 24

Persistent Vegetative State. 3months. 12months.

Question 25

In Persistent Vegetative State, most common pathologic bases are _______________ as a result of _________, widespread necrosis of the cortex after cardiac arrest, and thalamic necrosis from a number of causes.

Answer 25

Diffuse Cerebral injury. Closed head trauma.

Question 26

In Persistent Vegetative State, the most common prominent pathologic changes are usually in the

Answer 26

Thalamic & Subthalamic nuclei

Question 27

In traumatic cases of PVS, the pathologic findings are of diffuse ___________ ( described as diffuse __________), prominent thalamic degeneration, and ischemic damage in the cortex.

Answer 27

Subcortical white matter degeneration. Axonal injury.

Question 28

In Persistent Vegetative State, anatomic findings suggest that the ________ is either diffusely injured or effectively disconnected and isolated from the _______ or the ________ are destroyed.

Answer 28

Cortex. Thalamus. Thalamic nuclei.

Question 29

In either the traumatic or anoxic types of PVS, atrophy of the cerebral white matter may lead to _________ enlargement and thinning of the _______.

Answer 29

Ventricular. Corpus Callosum.

Question 30

The patient is capable of some rudimentary behavior such as following a simple command, gesturing, or producing single words or brief phrases, always in an inconsistent way from one examiner to another.

Answer 30

Minimally Conscious State

Question 31

In MCS, there is preservation of the ability to carry out basic _________ that demonstrate a degree of ______, at least at some times.

Answer 31

Motor behaviors. Alertness.

Question 32

In Minimally Conscious State, the causes and pathologic changes are identical to those of vegetative state, including frequent finding of __________ and __________.

Answer 32

Thalamic. Multiple cerebral lesions.

Question 33

There is little or no disturbance of awareness but only an inability of the patient to respond adequately. Is most often caused by a lesion of the _________ as a result of basilar artery occlusion.

Answer 33

Locked-in syndrome. Ventral pons (basis pontis).

Question 34

In Locked-in Syndrome, such an infarction spares both _________ pathways and the ___________ responsible for arousal and wakefulness, as well as certain midbrain elements that allow the eyelids to be raised and give the appearance of wakefulness.

Answer 34

Somatosensory. Ascending neuronal systems.

Question 35

The lesion in Locked-in syndrome essentially interrupts the _________ & _________ pathways, depriving the patient of speech and the capacity to respond in any way except by _______ & _______.

Answer 35

Corticobulbar. Corticospinal. Vertical gaze. Blinking.

Question 36

Patients who are silent and inert as a result of bilateral lesions usually of the anterior parts of the _________, leaving intact the motor and sensory pathways. The patient is profoundly apathetic, lacking to an extreme degree the psychic drive or impulse to action (_______)

Answer 36

Akinetic mutism. Frontal lobe. Abulia.

Question 37

The patient appears unresponsive, in a state that stimulates stupor, light coma, or akinetic mutism. There are no signs of structural brain disease such as pupillary or reflex abnormalities.

Answer 37

Catatonia

Question 38

In catatonia, these are preserved, as in the awake state; there is usually resistance to eye opening, and some patients display a waxy flexibility of passive limb movement that gives the examiner a feeling of bending a wax rod; there is also the retention for a long period of seemingly uncomfortable limb postures.

Answer 38

Oculocephalic responses

Question 39

Retention for a long period of seemingly uncomfortable limb postures.

Answer 39

Catalepsy

Question 40

Display a waxy flexibility of passive limb movement that gives the examiner a feeling of bending a wax rod.

Answer 40

Flexibilitas cerea

Question 41

Absence of all cerebral & brainstem functions, including spontaneous respiratiin. Irreversibility of the state.

Answer 41

Brain Death

Question 42

Absence of cerebral function: presence of __________ and total lack of __________ and of motor and vocal responses to all visual, auditory, and cutaneous stimulation.

Answer 42

Deep coma. Spontaneous movement.

Question 43

Absence of cerebral function: may persist, and the toes often flex slowly in response to plantar stimulation. But a well developed _______ is unusual.

Answer 43

Spinal reflexes. Babinski sign.

Question 44

Absence of cerebral function: is seen from time to time as a transitional phenomenon just after brain death becomes evident.

Answer 44

Extensor or flexor posturing

Question 45

Absence of Brainstem function: loss of spontaneous eye movements, midpoint of the eyes, and lack of response to _______ and ________ testing. The presence of dilated or midposition fixed pupils (not smaller than ___ mm).

Answer 45

Oculocephalic & Oculovestibular (Caloric). 3mm.

Question 46

Absence of Brainstem function: paralysis of _________, no facial movement or gag, cough, corneal or sucking reflexes.

Answer 46

Bulbar musculature

Question 47

Absence of Brainstem function: an absence of ______ & ______ responses to noxious stimuli. And absence of ___________.

Answer 47

Motor & Autonomic. Respiratory movements.

Question 48

Absence of Brainstem function: clinical findings should show ___________ of brain function, not an ________.

Answer 48

Complete absence. Approximation.

Question 49

To demonstrate unresponsiveness of the medullary centers to a high carbon dioxide tension.

Answer 49

Apnea test

Question 50

Serves both as a stimulus to breathing and a confirmation that spontaneous ventilation has failed. If no ________ is observed and examination of blood gases shows that an adequate level of _____ has been attained, the presence of this component of brain death is corroborated.

Answer 50

Breathing. PCO2.

Question 51

Loss of consciousness of certain conditions parallels the reduction in

Answer 51

Cerebral metabolism

Question 52

Acetone bodies are present in high concentration

Answer 52

Diabetes

Question 53

There is probably an accumulation of dialyzable small molecular toxins, notably phenolic derivatives of the aromatic amino acids.

Answer 53

Uremia

Question 54

Elevation of blood NH3 (ammonia) to 5 to 6 times normal levels corresponds roughly to the level of coma.

Answer 54

Hepatic coma

Question 55

Drugs such as general anesthetics, alcohol, opiates, barbiturates, phenytoin, antidepressants and diazepines induce _____ by their direct effects on _________ in the cerebrum and _____ or on neurotransmitters and their receptors.

Answer 55

Coma. Neuronal membranes. RAS.

Question 56

May affect the brain by lowering arterial blood pH to less than _____.

Answer 56

Lactic acidosis. 7.

Question 57

The impairment of consciousness that accompanies pulmonary insufficiency that is related mainly to

Answer 57

Hypercapnea

Question 58

In acute hyponatremia (Na

Answer 58

Neuronal dysfunction

Question 59

Act by producing metabolic acidosis

Answer 59

Methyl alcohol & Ethylene glycol

Question 60

The sudden and excessive neuronal discharge that characterizes an _________ is another common mechanism of coma; presumably because the spread of the seizure discharge to ___________ paralyzes their function; In other types of seizures, in which consciousness is interrupted from the very beginning, a _______ origin has been postulated.

Answer 60

Epileptic seizure. Deep central neuronal structures. Diencephalic.

Question 61

There is an enormous increase in intracranial pressure.

Answer 61

Closed head injury

Question 62

In concussion, it is likely that the sudden __________ of the brain induced by the acceleration and deceleration from blow to the head produces a rotation (_______) of the cerebral hemispheres around the axis of the upper brainstem. Disruption of the function of the neurons in some unknown way is the proximate cause of __________.

Answer 62

Swirling motion. Torque. Loss of consciousness.

Question 63

Is produced by one of two broad groups problems: clearly morphologic, consisting either of discrete lesions in the upper ________ and lower ________ or of more widespread changes throughout the hemispheres. Metabolic or submicroscopic, resulting in suppression of neuronal activity.

Answer 63

Coma. Brainstem. Diencephalon.

Question 64

3 types of lesion: A large mass in the ________ - chiefly a tumor, abscess, massive edematous infarct, or intracerebral, subarachnoid, subdural or epidural. Cause coma by compression of the _______ & ______ region of the RAS.

Answer 64

Cerebral hemisphere. Midbrain & Subthalamic region.

Question 65

Pathologic Anatomy of Coma, a destructive lesion is located in the _______ or _______, in which case the neurons of the RAS are damaged directly. Characterizes brainstem stroke from the _______, _______ and __________ hemorrhages, as well as some forms of traumatic damage.

Answer 65

Thalamus. Midbrain. Basilar artery occlusion. Thalamic. Upper brainstem.

Question 66

In pathologic coma, there is widespread bilateral damage to the _______ & ________, the result of traumatic damage (contusions, diffuse axonal injury), bilateral infarcts or hemorrhages, encephalitis, meningitis, hypoxia or global ischemia. Coma in these cases results from interruption of ___________ impulses of from generalized destruction of cortical neurons.

Answer 66

Cortex. Cerebral white matter. Thalamocortical.

Question 67

Process raw sensory signals into complex concepts that can be remembered and used to create new ideas that can be formulated into action. It is the part of the brain which is for example converts a sound (_______) into a word then into a sentence. Integrates (______) i to ideas/memory.

Answer 67

Higher Cortical Functions. Sensation. Conception.

Question 68

Involves many interaction among may cortical subcortical regions, and often between both hemispheres. __________ is most responsible for language and motor control such as writing. _______ is dominant in 95% of right handed and ____ of left handed individuals.

Answer 68

Higher cortical functions. Dominant hemisphere. Left hemisphere. 70%.

Question 69

Region in the cerebral cortex that deals with visual, auditory and somatosensory.

Answer 69

Primary sensory cortex

Question 70

Region in the cerebral cortex that refines single sensory information.

Answer 70

Unimodal association cortex

Question 71

Region in the cerebral cortex that receives input from all sensory modalities and handles complex intellectual functions.

Answer 71

Multimodal association cortex

Question 72

Responsible for problem solving, self-monitoring, planning, mental tracking and abstract thinking.

Answer 72

Prefrontal lobe

Question 73

Participates in memory and emotion.

Answer 73

Limbic association cortex

Question 74

The setting for language, space orientation, complex movement, and recognition of self and the world.

Answer 74

Parietal association cortex

Question 75

Clinical dysfunction occurs when damage is fairly large and involves both sides of this structure. (Trauma) Damage can produce such reflexes as grasp, snout, suck and rooting.

Answer 75

Prefrontal lobe

Question 76

In prefrontal lobe damage, patients often demonstrate _________ without _______ to the consequences, inability to perform several tasks simultaneously, lack of _______ to work or complete tasks, and tendency to appear _______ or half-dressed.

Answer 76

High impulsivity. Forethought. Drive. Disheveled.

Question 77

Consolidates long term memories from immediate memory and short term memory. No single brain location appears responsible for the repository of long-term memories. Thus no single brain lesion can eradicate well-formed long term memories.

Answer 77

Limbic system. Hippocampal formation.

Question 78

In limbic system, lesions that cause memory impairment are usually bilateral and may involve the

Answer 78

hippocampal formation, dorsomedial nuclei of the thalami, or mamillary bodies "HDM"

Question 79

Part of limbic system that produce verbal memory deficits

Answer 79

Left temporal lobe damage

Question 80

Part of limbic system that produce non-verbal memory deficits

Answer 80

Right temporal lobe damage

Question 81

Stimulation of various sites in the limbic system may produce fear or sorrow through

Answer 81

Aversion centers

Question 82

Stimulation of various sites in the limbic system may produce pleasure through

Answer 82

Gratification centers

Question 83

Bilateral damage to the __________ or __________ may dramatically diminish emotional responses and produce an awake- appearing patient who is immobile, mute and unresponsive to his/her environment (__________)

Answer 83

Anterior cingulate gyri. Supplemental motor area. Akinetic mutism.

Question 84

Is a higher order integration center.

Answer 84

Parietal lobe

Question 85

Patients with lesions involving the ________, especially in the ___________, usually have intact perception of pain, touch, pressure, temperature and vibration but often have cortical sensory deficits. Astereognosis, Agraphesthesia & Loss of double simultaneous sensory stimulation.

Answer 85

Postcentral gyrus. Hand primary sensory area.

Question 86

Cause lack of attention to the contralateral side of the body or to the contralateral visual space. Anosognosia, Anton's syndrome, Dressing Apraxia, Constructional Apraxia, Ideational Apraxia & Ideomotor Apraxia.

Answer 86

Neglect syndromes

Question 87

For judgment, insight, foresight, ambition & sense of purpose.

Answer 87

Prefrontal lobe

Question 88

For Short-term memory. Consolidation of long-term memory. Emotional response.

Answer 88

Limbic system

Question 89

For perception of somatosensory input. Integration of all sensory data. Awareness of body and its relationship to external space. Language.

Answer 89

Parietal lobe

Question 90

Nonfluent but content, understandable with truncated phrases containing mainly informational words. Good for simple one step commands but impaired for complex commands.

Answer 90

Broca's Aphasia

Question 91

Mute or nonfluent. Poor to absent.

Answer 91

Global Aphasia

Question 92

Fluent but noncomprehensible with excess non information words and paraphasias. Ability to comprehend is poor to absent.

Answer 92

Wernicke's Aphasia

Question 93

A general mental capacity that includes reasoning, planning, solving problems, thinking abstractly, comprehending complex ideas, learning quickly and learning from experience.

Answer 93

Intelligence

Question 94

Comes from dysfunction or damage of many bilateral areas of higher cortical function.

Answer 94

Low intelligence

Question 95

Neurologic changes of normal Aging: there is age related decline in ______ of central processing, Performance on _______, ______ memory retrieval and learning.

Answer 95

Cognition. Speed. Timed tasks. Recent.

Question 96

Neurologic changes of normal Aging: cranial nerves most affected by aging are those for

Answer 96

Vision and hearing

Question 97

Neurologic changes of normal Aging: visual loss diminishes due to the _______ becoming progressively smaller and less reactive to light and accomodation. Increasing opacity of the _____ & ______. Subtle ______ changes.

Answer 97

Pupils. Lens & Vitreous. Retinal.

Question 98

Occurs and range of vertical eye movements diminishes with advanced age.

Answer 98

Presbyopia

Question 99

Is a progressive elevation of the auditory threshold, especially for higher frequencies.

Answer 99

Presbycusis

Question 100

Changes of aging more prominent in _____: loss of ______ hair cells. Degeneration of __________ neurons. Atrophy of the ___________.

Answer 100

Men. Cochlear. Spiral ganglion. Cochlear stria vascularis.

Question 101

Neurologic changes of Normal Aging in Strength, Gait & Coordination: there is progressive decline in ________,________ and ________ of movement.

Answer 101

Muscle bulk. Speed. Coordination.

Question 102

Neurologic changes of normal Aging in Sensation: the elderly have mild progressive loss of _______ & _______ sense, mainly in the feet, from a progressive loss of distal peripheral nerve sensory nerve axons resulting to _________. Diminishes ________.

Answer 102

Vibration & Position sense. Poor balance. Ankle jerk.

Question 103

An acquired loss of intellect (IQ) that is sufficient to impair the individuals reasoning, planning and problem-solving skills, as well as the ability to think abstractly, comprehend complex ideas, learn quickly and learn from experience.

Answer 103

Dementia

Question 104

In dementia, final common pathway is __________ in one or more of the multimodal association cortices.

Answer 104

Loss of neurons

Question 105

Used to describe the earliest signs and symptoms of dementia. The transitional zone between normal aging and dementia. These individuals complain of memory impairments but still lead relatively independent lives.

Answer 105

Mild cognitive impairment

Question 106

Defined as occurring in patients who have adequate general cognitive functioning and perform normally in ADLs but show subjective memory impairment that is corroborated by a spouse or a friend and have objective memory impairment on standardized memory tests that is atleast 1.5 SD below the normal for age and educational status.

Answer 106

Mild cognitive impairment

Question 107

A disability characterized by significant limitations both in intellectual functioning and in adaptive behavior as expressed in conceptual, social and practical adaptive skills

Answer 107

Mental Retardation

Question 108

MR usually begins in ________ and before age ___.

Answer 108

Early life. 18.

Question 109

Mild MR

Answer 109

50-70

Question 110

Moderate MR

Answer 110

35-49

Question 111

Severe MR

Answer 111

20-34

Question 112

Profound MR

Answer 112

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