Consciousness

Question 1

What is consciousness?

Answer 1

• wakefullness = able to determine they are awake of asleep (wake-sleep cycle)
• aware = know that you exist (I and me)

Question 2

What is a coma, which is greek for deep sleep?

Answer 2

• state of unrousable unresponsiveness

- >6 hours

Question 3

What is a key feature of consciousness that we can physically see in a patient?

1 - muscle movements
2 - eyes open
3 - reflexes
4 - urination

Answer 3

2 - eyes open

- requires cognitive thought that they are awake and motor arousal required to open eyes

Question 4

A key feature of consciousness is the ability to sense sensory inputs. What are the 3 forms of this?

Answer 4

1 - external (5 senses, smell, sight etc…)
2 - interoception (internal feelings of the body, I feel full or thirsty for example)
3 - emotions

Question 5

A key feature of consciousness is the ability to have an effect (acute mood, happy sad etc..) and have controlled outputs. What are the 4 controlled outputs?

Answer 5

1 - motor (moving hand, smiling etc..)
2 - attention (paying attention to someone)
3 - cognition (interacting with someone)
4 - emotional

Question 6

There is a scale of consciousness, ranging from sleep to brain stem death. What is locked in syndrome?

1 - patients muscles and joints are locked in same position
2 - patient jaw is locked and they are unable to speak
3 - complete paralysis of voluntary muscles, but eyes are unaffected
4 - systematic pain causing coma

Answer 6

3 - complete paralysis of voluntary muscles, but eyes are unaffected
- a rare neurological disorder

Question 7

Is a coma always pathological?

Answer 7

• yes

Question 8

Are all comas permanent?

Answer 8

• no

- can be reversible or irreversible

Question 9

What are the 2 major group classifications of comas?

1 - neurological and metabolic
2 - neurological and traumatic
3 - traumatic and metabolic
4 - metabolic and toxic

Answer 9

1 - neurological and metabolic

Question 10

The 2 major group classifications of comas are neurological and metabolic. What are the 3 most common causes of neurological comas?

1 - trauma, infection, cerebrovascular impairment
2 - DVT, trauma, infection
3 - trauma, cerebrovascular impairment, DVT
4 - trauma, herpes virus, cerebrovascular impairment

Answer 10

1 - trauma, infection, cerebrovascular impairment

Question 11

The 2 major groups of classifications of comas are neurological and metabolic. What are the 3 most common causes of metabolic comas?

Answer 11

1 - hypoglycaemia
2 - hypoxia
3 - drugs and toxins

Question 12

Tools to measure consciousness are on a scale between normal consciousness and coma. What is the most commonly used tool for this?

Answer 12

• Glasgow coma scale (1974)

Question 13

The Glasgow Coma Scale (GCS) is the main tool we need to be aware of that measures a patients consciousness. What does the GCS measure?

Answer 13

• sensori-motor stimulus and responses

- combining senses with actions

Question 14

The Glasgow Coma Scale (GCS) is the main tool we need to be aware of that measures a patients consciousness. The GCS measures sensori-motor stimulus and responses, which is essentially the ability to combine senses with actions. The investigator will provide a stimulus and then assesses the response. What are the 5 things we are looking for when we provide a stimulus?

Answer 14

1 - eyes (open or closed)
2 - response to verbal and physical stimulus (pain etc)
3 - protective movements and postures
4 - spontaneous and voluntary movements
5 - voice

Question 15

The Glasgow Coma Scale (GCS) provides a score on the level of consciousness of the patient. When assessing a patient using the GCS, do we just do one stimulus for each of the 5 senses or would we do multiple, and would we take the average or the best response?

Answer 15

• multiple attempts at stimulating the patient
• record the best response
• GCS provides a score

Question 16

The Glasgow Coma Scale (GCS) provides a score on the level of consciousness of the patient. What is the lowest score you can get on the GCS?

1 - 0
2 - 3
3 - 5
4 - 6

Answer 16

2 - 3

• the lowest score in all 3 sections of the GCS (eyes opening, verbal and motor response is 1)
• a response of 1 in all 3 sections of the GCS is no response

Question 17

The Glasgow Coma Scale (GCS) provides a score on the level of consciousness of the patient. What is the highest score you can get on the GCS?

1 - 0
2 - 3
3 - 10
4 - 15

Answer 17

4 - 15

• section 1 = eyes opening (scale 1-4)
• section 2 = verbal response (scale 1-5)
• section 3 = motor response (scale 1-6)
• 4 for eyes + 5 for verbal + 6 motor response = 15

Question 18

The Glasgow Coma Scale (GCS) provides a score on the level of consciousness of the patient. What is the range of the GCS score?

1 - 0-15
2 - 3-12
3 - 0-12
4 - 3-15

Answer 18

4 - 3 - 15

• 3 = lowest score
• 15 = highest score

Question 19

When providing a Glasgow coma score (GCS). The range of the score is 3-15, but what must you also provide with each score for the 3 sections?

1 - time and date when assessment was made
2 - person performing the assessment
3 - letters for each section (E, V, M)

Answer 19

3 - letters for each section (E, V, M)

• provides a total score and individual scores to help with diagnosis
• E 1-4 = Eyes
• V 1-5 = Vocal
• M 1-6 = Movement

Question 20

When we are trying to assess a patients own ability to maintain their own respiratory function, below what Glasgow Coma Score (GCS) would suggest that the patient is unable to maintain their own respiratory function?

1 - 0
2 - <3
3 - <8
4 - <12

Answer 20

3 - <8

• patients are unable to protect their airways
• GCS is correlated with outcomes in brain injury

Question 21

The Mini Mental State Examination (MMSE), Confusion Assessment Method (CAM) and 4 A’s Test (4AT) can be used by the bedside of the patient. It can be useful to assess what 3 conditions?

1 - stroke, confusion, dementia
2 - stroke, dementia, delirium
3 - dementia, delirium, confusion
4 - dementia, stroke, confusion

Answer 21

3 - dementia, delirium, confusion

Question 22

What is a transient loss of consciousness commonly called?

1 - epilepsy
2 - syncope
3 - seizure
4 - stroke

Answer 22

2 - syncope

• commonly referred to as fainting or passing out
• generally due to poor perfusion to the brain by blood
• caused by a temporary drop in the amount of blood that flows to the brain, may be due to hypotension and low heart rate

Question 23

Transient loss of consciousness commonly called syncope (fainting or passing out) is generally due to cardiac impairment that causes poor perfusion to the brain by blood. The temporary lack of blood to the brain causes a temporary drop in the amount of blood that flows to the brain and patients pass out. What are the 2 most common causes of syncope?

Answer 23

1 - orthostatic syncope (standing up too quickly, autonomic system is slow to respond)
2 - neurocardiogenic syncope (intense emotional stimulus), too much blood in peripheries and not in the brain and centrally

Question 24

When trying to understand what has caused a patients syncope, what can often provide the answer before running any tests?

Answer 24

• detailed history
• before event (change in posture, environment)
• during event (eyewitness accounts, seizures, blood glucose/pressure)
• after event (speed of recovery)
• look at risk factors

Question 25

What does the neuronal correlates of consciousnesses mean? 1 - minimum neuronal activity required to experience a conscious event 2 - neuronal activity required to cognitively engage with someone else 3 - minimum neuronal activity required to move 4 - minimum neuronal activity required to open your eyes

Answer 25

1 - minimum neuronal activity required to experience a conscious event

Question 26

What is the global neuronal workspace? 1 - how specific regions of the brain organise thoughts separately 2 - how regions of brain work together 3 - how cognitive system receive the same information but process this in different ways

Answer 26

3 - how cognitive system receive the same information but process this in different ways - the processing of this information is what allows us to be conscious

Question 27

What is the integrated information theory?

Answer 27

- implies that a sufficiently complex information processing structure is able to be conscious - this implies that a computer could be conscious

Question 28

Which lobes have been linked with consciousness? 1 - frontal, temporal and parietal 2 - frontal, temporal and occipital 3 - frontal, parietal and occipital 4 - temporal, parietal and occipital

Answer 28

4 - temporal, parietal and occipital - all but frontal lobe - especially posterior parietal = hot zone

Question 29

What is the hot zone in relation to consciousness? 1 - area of brain that can overheat 2 - area of the brain involved in regulating body temperature 3 - part of neocortex associated with minimal neural substrate essential for conscious perception 4 - part of brainstem associated with minimal neural substrate essential for conscious perception

Answer 29

3 - part of neocortex associated with minimal neural substrate essential for conscious perception

Question 30

What is the main lobe where the hot zone in relation to consciousness is based? 1 - temporal 2 - parietal 3 - occipital 4 - frontal

Answer 30

2 - parietal lobe | - known as the posterior hot zone as well

Question 31

There is a specific class of mammalian cortical neurons that can be located in the anterior insular cortex (portion of cerebral cortex folded deep within the lateral sulcus). What are these called and what are they involved in? 1 - Von economo neurons 2 - claustrum 3 - reticular activating system 4 - pons

Answer 31

1 - Von economo neurons | - involved in consciousness and ones self

Question 32

There is a thin, bilateral collection of neurons, that has been described as the most densely connected structure in the brain, with support of glial cells. What is the name of this area? 1 - Von economo neurons 2 - claustrum 3 - reticular activating system 4 - pons

Answer 32

2 - claustram | - located externally to the putamen

Question 33

The claustrum is a thin, bilateral collection of neurons, that has been described as the most densely connected structure in the brain, with support of glial cells. It is located laterally to the putamen as per the image below. What key areas of the brain does the collection of neurons connect?

Answer 33

- cortical (e.g., the pre-frontal cortex) | - subcortical regions (e.g., the thalamus)

Question 34

The claustrum is a thin, bilateral collection of neurons, that has been described as the most densely connected structure in the brain, with support of glial cells. It is located laterally to the putamen as per the image below. In the brain it connects the cortical (e.g., the pre-frontal cortex) and subcortical regions (e.g., the thalamus). What is the main process the claustrum has been associated with? 1 - pain 2 - consciousness 3 - memory 4 - learning

Answer 34

2 - consciousness

Question 35

There is a collections of neurons in the thalamus that are involved in consciousness. What are these called? 1 - Von economo neurons 2 - claustrum 3 - reticular activating system 4 - intralaminar thalamic nuclei

Answer 35

4 - intralaminar thalamic nuclei

Question 36

What are some key parts of the brain that are involved in consciousness?

Answer 36

- pons - midbrain - hypothalamus - forebrain

Question 37

What is the minimally conscious state?

Answer 37

- patients are awake (sleep/wake cycle) | - patients are not aware or minimal awareness

Question 38

What is the vegetative state?

Answer 38

- patient is awake with absent awareness - no spontaneous/stimulus arousal - capacity for spontaneous or stimulus-induced arousal evidenced by a range of reflexive and spontaneous behaviours

Question 39

What is brain stem death, also referred to as brain death?

Answer 39

- permanent and irrevocable loss of brainstem function - patient is on an artificial life support machine - patient will not regain consciousness or be able to breathe without support - patients who are brain dead are legally dead

Question 40

Brain stem death, also referred to as brain death is when a patient is placed on an artificial life support machine and the patient no longer has any brain functions. The patient will not regain consciousness or be able to breathe without support. Before the patient can be legally classified as dead, what must be done?

Answer 40

- cause must be ascertained and deemed irreversible - absence of brain stem reflexes (pupils, cornea, motor reflexes, gag, cough reflex, etc..) - if any reflexes are present then patient is not brain dead