Help
Options
Didn't know it?
click below
click below
Knew it?
click below
click below
Don't Know
Remaining cards (0)
Know
retry
shuffle
restart
0:00
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
LTM Guide
guide to LTM quiz
| Question | Answer |
|---|---|
| according to joint commission, how many patient identifiers must be used? | 2 |
| true or false, a patients room number or location may be used as a personal identifier? | False |
| According to CDC and joint commission, When hands are not visibly dirty, _____ are the preferred method for cleaning your hands in the healthcare setting | alcohol-based hand sanitizers |
| according to joint commission patients most at risk for mix up in identification during an invasive procedure are those that involve ? | general anesthesia or deep sedation |
| what are the 3 components of universal protocol during invasive procedures according to joint commission? | 1. pre-procedure verification 2. site marking 3. time-out procedures |
| this is one of the 3 components of universal protocol for invasive procedures and is an ongoing process of information gathering and confirmation. | pre-procedure verification |
| this is done to prevent errors when there is more than one possible location for a procedure | site marking |
| according to the joint commission, who should be the one to mark the site during invasive procedures, per universal protocol? | the one who knows most about the patient. |
| during the site marking process of universal protocol for invasive procedures, what patients or situations may an alternative method be used? | 1. when anatomically impossible to mark the site 2. on teeth 3. on premature infants (marking may cause a permanent tattoo) |
| this is the final assessment to correctly identify the patient, site and procedure, where all activities are suspended, allowing those involved to communicate. | time out |
| according to OSHA, material safety data sheets are now known as | safety data sheets (SDS) |
| OSHA requires chemical manufacturers, distributors, or importers to provide___ for each hazardous chemical they produce or import to communicate the hazards of hazardous chemical products | safety data sheets |
| With the Occupational Safety and Health Act of 1970, Congress created the this to assure safe and healthful working conditions for working men and women by setting and enforcing standards and by providing training, outreach, education and assistance. | OSHA - occupational safety and health administration |
| defined as a sudden, involuntary time limited alteration in behavior, including a change in motor activity, autonomic function, consciousness or sensation, accompanied by abnormal electrical activity in the brain. | seizure |
| to be Dx as epilepsy a patient must have these 2 characteristics? | 1. two or more seizures 2. no underlying cause |
| 2 major types of seizure classification? | partial / focal and generalized |
| 2 classifications of partial / focal seizures | 1. partial without impairment 2. partial with impairment |
| 6 classification of generalized seizures | 1. absense 2. tonic 3. clonic 4. tonic-clonic 5 myoclonic 6. atonic |
| defined as a brief, subjective sensation that is considered a simple partial seizure (or partial / focal seizure without impairment). AKA a warning. | aura |
| an aura can be helpful in determining ? | site of cortical onset |
| 8 varieties of aura? | 1. visual 2. auditory 3 .gustatory 4. somatosensory 5. olfactory 6. psychic (experiential) 7. autonomic 8. abdominal |
| this type of seizure is conceptualized as originating at some point within, and rapidly engaging, bilaterally distributed networks. | generalized |
| these types of seizures are conceptualized as originating within networks limited to one hemisphere | focal / partial |
| 4 types of absence seizure? | 1. typical 2. atypical 3. wtih eyelid myoclonia 4. myoclonic |
| this type of seizure is a generalized seizure with abrupt onset and offset of altered awareness which can vary in severity. Clonic movements of eyelids, head, eyebrows, chin, perioral or other facial parts may occur, most typically at 3Hz | typical absence seizure |
| Rhythmic myoclonic jerks of the shoulders & arms with tonic abduction that results in progressive lifting of the arms. jerks are typically bilateral. lasts 10-60 seconds and typically occur daily describes what type of sz? | myoclonic absence |
| seizures accompanied by brief, repetitive, often rhythmic, fast (4-6 Hz) myoclonic jerks of the eyelids with simultaneous upward deviation of the eyeballs and extension of the head describes what type of sz? | absence with eyelid myoclonia |
| this type of absence sz has less abrupt onset / offset of loss of awareness, and may be minimal with continuing activity, associated with loss of muscle tone and subtle myoclonic jerks. | atypical absence |
| EEG pattern seen with typical absence sz? | generalized 3 Hz spike and wave |
| EEG seen with myoclonic absence sz? | generalized 3 Hz spike and wave time locked with EMG |
| EEG in this type of sz shows high amplitude generalized 3-6 Hz spike / polyspike and wave triggered by eye closure and intermittent photic stim | absence with eyelid myoclonia |
| atypical absence EEG shows? | < 2.5 Hz generalized spike and wave. |
| types of seizures included with classified under convulsive sz's? | 1. tonic 2. clonic 3. tonic - clonic |
| EEG shows ___ during the tonic sz? | accelerating low amplitude fast activity, dominating anterio-central region |
| EEG shows ___ during the clonic sz? | spike and wave burst synchronous with clonic jerks. |
| Aura's can either be ___ or ___ | sensory or experiential |
| types of sensory aura? | 1. somatosensory 2. visual 3. auditory 4. olfactory 5. gustotory 6. epigastric (abdominal) 7. Cephalic |
| types of experiential (psychic) aura | 1. affective 2. mnemonic 3. hallucinatory 4. illusory |
| this is a sensory aura and is defined as phenomena including tingling, numbness, electric-shock like sensation, pain, sense of movement, or desire to move. Somatosensory aura occur in seizures involving the____ | somatosensory, sensorimotor cortex. |
| sensory aura described as elementary hallucinations such as flashing or flickering lights, spots or other shapes, simple patterns, scotomata, or amaurosis. these aura's arise in ___ | visual, occipital lobe |
| sensory aura's described as elementary phenomena including buzzing, ringing, drumming or single tones. arise in the ____ | auditory, auditory cortex (lateral superior temporal lobe) |
| sensory aura described as phenomena - usually an odor, which is often unpleasant. arises in ____ | olfactory, mesial temporal or orbitofrontal regions |
| sensory aura described as upper abdominal phenomena including discomfort, emptiness, tightness, churning and a sensation that may rise up to the chest or throat. arises in ___ | mesial temporal lobe |
| sensory aura described as a sensation in the head such as light-headedness or headache. | cephalic |
| experiential (psychic) aura described as phenomena such as fear, depression, joy and anger. | affective |
| experiential (psychic) aura described as memory phenomena such as feelings of familiarity (déjà vu) and unfamiliarity (jamais vu). | mnemonic |
| experiential (psychic) aura described as complex sensory phenomena that may involve visual (e.g. formed images), auditory (e.g. hearing voices) or other sensory modalities, without change in awareness. | hallucinatory |
| experiential (psychic) aura described as an alteration of actual perception involving visual, auditory, somatosensory, olfactory, and/or gustatory phenomena, without change in awareness | illusory |
| what separates the sensory aura's of visual and auditory from visual and auditory experiential aura's? | experiential aura's are more complex. |
| bilaterally increased tone of the limbs typically lasting seconds to a minute. They often occur out of sleep and in runs of varying intensity, clinically describes what type of sz? | tonic |
| these sz's are sudden loss or diminution of muscle tone without apparent preceding myoclonic or tonic features. they are very brief (<2 seconds) and may involve the head, trunk or limbs. typically seen in patients with intellectual impairment | atonic |
| Generalized spike-and-wave is typical, with atonia at the time of the slow wave describes the EEG what what type of sz? | atonic |
| 3 types of myoclonic sz | 1. myoclonic 2. negative myoclonus 3. myoclonic-atonic |
| seizure is a single or series of jerks (brief muscle contractions). Each jerk is typically milliseconds in duration. | myoclonic |
| EEG seen with myoclonic sz's | myoclonic jerk correlates with a generalized spike-and-wave or polyspike-and-wave. |
| is a seizure with brief cessation of background muscle tone, lasting less than 500 milliseconds. can have two components, an initial loss of posture caused by the negative myoclonus, and a subsequent voluntary, compensatory movement to restore posture. | negative myoclonic sz |
| negative myoclonus show what on EEG? | seen in association with the spike of a spike or spike-and-wave discharge on EEG. |
| described as myoclonic seizure followed by an atonic seizure. | myoclonic-atonic sz |
| what does the EEG show for a myoclonic-atonic sz | Myoclonic component is associated with a generalized spike or polyspike. The atonic component is associated with the after going high voltage slow wave. |
| focal seizues | |
| 3 types of complex motor movements? | 1. hypermotor 2. negative - motor 3. automatism |
| proximal limb or axial muscles, producing irregular large amplitude ballistic movements, such as pedaling, pelvic thrusting, jumping, thrashing and/or rocking movements describes what kind of motor movements | hypermotor |
| a stereotyped contraction of a muscle or group of muscles. Such motor features may be predominantly convulsive, dystonic, and versive , discribes what major type of motor movements? | elementary |
| what are the 2 major categories of motor movements? | elementary and complex |
| 2 ways the international league against epilepsy defines seizures types (classifies seizures) | 1. clinical manifestation 2. EEG findings |
| defined as a set of brief, unconscious behaviors of purposeless and repetitive movement associated with impaired awareness | automatism |
| automatisms such as bicycling, pelvic thrusting, disruptive behavior, fear, and sexual behaviors most likely arise from what area of the brain? | frontal lobe |
| automatisms involving hands and mouth, lip smacking, chewing, picking motions mostly likely arise from what area of the brain? | temporal lobe |
| defined as a seizure or series of seizures that continue for at lest 5 minutes without return of consciousness between seizures, and considered a medical emergency | status epilepticus |
| defined as events that are not generated by the brain, and do not involve abnormal , rhythmic discharges of cortical neurons | non-epileptic events |
| defined as epilepsy syndromes with specific age related onset, clinical and electrographic characteristics, and presumed genetic mechanism | idiopathic epilepsy |
| a seizure caused secondarily by a previously known or suspected CNS disorder | symptomatic epilepsy |
| an ictal EEG is ... | during the event |
| an interictal EEG is ... | time in between the event |
| a postictal EEG is | the period of time immediately following an event |
| what is the frequency and duration of a slow wave? | F = 0-4 Hz D = >200ms |
| what is the frequency and duration of a sharp wave? | F = 5-14 Hz D = 70-200ms |
| what is the frequency and duration of a spike wave? | F = 14-50 Hz D = 20-70ms |
| what area of the brain controls expressive speech? | broca's area |
| what area of the brain controls receptive speech? | wernicke's area |
| this is AKA heschl's gyrus and is the primary auditory cortex? | transverse temporal gyrus |
| functions of the angular gyrus? | 1. processes related to language 2. number processing 3. spatial recognition 4. memory retrieval 5. attention |
| this is located deep within lateral fissure between temporal and frontal lobes. its function is perception, motor control, self awareness, interpersonal experience, regulation of homeostasis, consciousness, and emotion. | insula |
| 3 parts of the limbic system | 1. hippocampus 2. amygdala 3. anterior thalamic nuclei |
| functions of the limbic system | 1. emotion 2. behavior 3. long term memory 4. olfaction |
| a patient displays bilateral tonic posturing. what area of the brain might this be coming from? | frontal lobe |
| a patient displays simple motor movements such as limb twitching or jacsonia march. what area of the brain might this be coming from? | contralateral frontal lobe |
| a patient displays head and eye deviation with posturing. what area of the brain might this be coming from? | supplementary motor cortex |
| a patient display abnormal taste sensation. what area of the brain might this be coming from? | insula |
| a patient displays visceral or autonomic abnormalities what area of the brain might this be coming from? | insular - orbital frontal cortex |
| a patient displays olfactory hallucinations. what area of the brain might this be coming from? | anteromedial temporal lobe |
| a patient displays chewing movements, salivation, speech arrest. what area of the brain might this be coming from? | amygdala, opercular region |
| a patient displays complex automatic behaviorisms. what area of the brain might this be coming from? | temporal lobe |
| a patient displays visual hallucinations (formed images) what area of the brain might this be coming from? | posterior temporal lobe or amygdalo - hippocampus |
| a patient displays localized sensory disturbances, such as tingling or numbness of limb. what area of the brain might this be coming from? | parietal lobe |
| a patient displays visual hallucinations (unformed images). what area of the brain might this be coming from? | occipital lobe |
| this is a small space in the back of the skull and houses the brainstem, cerebellum and fourth ventricle | posterior fossa |
| what is the most common location for pediatric tumors? | posterior fossa |
| most common pediatric tumor? | 1. medulloblastoma |
| gold standard for assessing hippocampal sclerosis (AKA mesial temporal sclerosis) | MRI |
| this is used in MRI and is a 3D modeling technique used to visually represent neural tracts using data collected by diffusion tensor imaging. | tractography |
| purpose of tractography | to show structural abnormalities |
| this neuroimaging test measures brain activity by detecting associated changes in blood flow, to help map sensory, motor and language | fMRI - functional magnetic resonance imaging |
| this is an imaging test that uses a radioactive substance, called a tracer, to look for a disease in the body | PET - positron emission tomography |
| most common tracer used on a PET scan | FDG - fluorodeoxyglucose |
| what 2 areas are revealed about tissues and organs during a PET scan? | 1. glucose metabolism 2. HYPOmetabolism |
| this neuroimaging test measures blood flow and shows function of organs as well as hypoperfusion | SPECT - single photon emission computed tomography |
| functional neuroimaging technique for mapping brain activity by recording magnetic fields produced by electrical currents occurring naturally in the brain | MEG - magneto-encephalography |
| MEG has the ability to map? | seizure focus, sensory , motor and language |
| primary notable difference between fMRI and MEG? | MEG can map a seizure focus. |
| this phase of the EMU uses surface electrodes, using the expanded international 10-20 system | phase 1 |
| this phase of the EMU uses intracranial electrodes for surgical candidates | phase 2 |
| this phase of the EMU does resections for epilepsy surgery | phase 3 |
| 3 types of intracranial electrodes | 1. grid 2. strip 3. depth |
| how are depth and strip electrodes placed | via a burr hole |
| how are grid and strip electrodes placed | via craniotomy |
| t1, t2 are placed... | 1/3 the distance anterior to the auditory canal and outer canthus of the eye and 1 cm above the auditory canal. |
| sphenoidal electrode record what area of the brain? | the mesial or anterior aspects of the temporal lobe in the region of the foramen ovale |
| surface electrodes are made of ___ and are typically placed using the ___ system | silver/ silver chloride or gold, 10-20 |
| sphenoidal electrodes are made of | fine flexible braided stainless steel wire, insulated at the tip |
| what are grid electrodes made of? | small platinum or stainless steel disks that are embedded into soft silastic |
| grid electrodes are placed... | epi- or subdurally over the cerebral cortex |
| these electrodes consist of a row of disks embedded in silastic, or a bundle of fine wires, each tip of which is a recording point. | strip |
| 2 major types of depth electrodes | ridged and flexible probes |
| these electrodes record from within the brain | depth (AKA intracerebral) |
| depth electrodes are normally made of ___ or MRI compatible metals such as___ | stainless steel, nichrome |
| in this montage each electrode is referenced to an average of the electrodes directly surrounding it. | laplacian reference |
| what are the benefits of laplacian reference montage? | 1. allows comparison of amplitude between channels for mapping 2. effective for minimizing the effects of moderate artifact. |
| 4 treatment option for epilepsy? | 1. AEDs 2. ketogentic diet 3. VNS stimulator 4. surgical Tx |
| a special high-fat, low-carbohydrate diet that helps to control seizures in some people with epilepsy. | ketogenic diet |
| the WADA test was names after? | Juhn Wada |
| this is performed during an angiography in interventional radiology to establish dominant hemisphere for language and memory. | WADA test |
| WADA is also known as | intracarotid sodium amobarbital test (ISAT) |
| the WADA test uses a ___ via catheter from the ____ | barbiturate, femoral artery |
| this procedure disconnects right and left hemispheres of the brain. | corpus callostomy |
| the corpus collosotomy is most useful for what type of seizures? | atonic / drop attacks. |
| corpus callosotomy is often seen used in what disorder? | lennox-gastaut syndrome |
| this is designed to prevent seizures by sending regular, mild pulses of electrical energy to the brain via the vagus nerve | VNS stimulator |
| where is the VNS placed | under the skin on the chest wall and a wire runs from it to the vagus nerve in the neck. |
| this is part of the autonomic nervous system, which controls functions of the body that are not under voluntary control, such as the heart rate. | vagus nerve |
| spike and seizure detection is best managed using what montage? | laplacian ref |
| most common barbiturate used on the WADA test? | brevital |
| what percentage of the population is left hemisphere dominant? | 90 % |
| a type of electrophysiological monitoring that uses electrodes placed directly on the exposed surface of the brain to record electrical activity from the cerebral cortex | electrocorticography (ECOG) |
| ECOG is useful for ? | functional mapping |
| recommended bandpass for ECOG | 1-70 Hz |
| default sensitivity for ECOG | 70-100 uV |
| considered the gold standard to define eloquent cortex? | direct cortical stimulation |
| 2 methods used to stop after discharges during direct cortical stim? | 1. stimulate again 2. apply cool saline / water flush |
| intensity range of direct cortical stim? | 0-20mA |
| stimulation duration of direct cortical stim? | 0.1-0.3 ms |
| stimulation rate of direct cortical stim? | 50 Hz |
| stimultaion period of direct cortical stimulation | 1-0 seconds |
| threshold motor cortex during direct cortical stim | 2-5 mA |
| threshold language during direct cortical stim | 5-15 mA |
| first line AED Tx for an absense sz? | ethosuximide |
| infantile spasms | ACTH |
| partial sz's | carbamazepine |
| JME | valproic acid |
| slow rolling eye movements, V waves, waxing and waning of PDR and increased theta describes what stage of sleep? | 1 |
| sleep spindles, k complex, dominant theta describes what stage sleep? | 2 |
| mentally restorative, 20% or greater delta in BG, possible beta superimposed on delta describes what stage of sleep? | stage 3, slow wave sleep (3-4 combined now to just 3) |
| physically restorative, atonia sawtooth waves, irregular respiration, irrgular HR, rapid eye movement, mix frequencies describes what stage of sleep | REM |
| defined as sudden and transient episode of muscle weakness accompanied by full conscious awareness, typically triggered by strong emotions such as crying, fear , laughing | cataplexy |
| a chronic sleep disorder causing excessive daytime drowsiness and sleep | narcolepsy |
| EEG in narcolepsy | onset REM (within 5 minutes of sleep) |
| what percentage of people with narcolepsy also have cataplexy? | 70-75% |
| frequency of sleep spindles | 12-14 Hz |
| described as very low or suppressed muscle tone | atonia |
| this is abnormal pattern of breathing characterized by progressively deeper, faster breathing, followed by a gradual decrease that results in a temporary apnea | cheyne-stokes respiration |
| in cheyne-stokes respiration, the pattern repeats, with each cycle taking ___ to ___ | 30 seconds to 2 minutes |
| cheyne-stokes respiration is associated with ___ ___ apnea | central sleep |
| a disorder in which your breathing repeatedly stops and starts during sleep because your brain doesn't send proper signals to the muscles that control your breathing | central sleep apnea |
| BAER = | brainstem auditory evoked response |
| true of false. a BAER may be used for an ECI recording? | true |
| if there is no response during a BAER, recording for ECI , this indicates | no outcome value |
| if there is only a wave 3 response during a BAER, recording for ECI , this indicates | poor prognosis |
| this states that researchers should have the welfare of the research participant as a goal of any clinical trial or other research study. | Beneficence |
| medical professionals are obligated to 2 things in regards to patient welfare? | 1. weigh possible benefits vs possible risks of an action 2. prevent and remove harm in a situation |
| this is a commonly used model for the development of seizures and epilepsy in which the duration and behavioral involvement of induced seizures increases after seizures are induced repeatedly. | kindling |
| defined as the inability to process sensory information, typically with loss of ability to recognized objects, persons, shapes, smells or sounds. | agnosia |
| when a patient is suffering from agnosia, specific sense is ___ ___ | not defective |
| agnosia is associated with brain injury or neurological illness, such as stroke or dementia, specifically to what areas of the brain? | parietal and occipital lobes |
| defined as the loss of sense of smell; inability to perceive odor or a lack of functioning olfaction | anosmia |
| this can be caused by allergies, cold, nasal polyps, meningitis, neurosyphilis, brain injury affecting the olfactory nerve or neurodegenerative diseases. | anosmia |
| this is caused by an injury to the brain, and is defined as the inability to execute a voluntary or purposeful motor movement despite being able to demonstrate normal muscle function. | apraxia |
| what part of the brain is injured if a patient is suffering from apraxia? | posterior parietal cortex |
| this is related to a dysfuntion of the nervous system and is defined as a lack of voluntary coordination of muscle movements that includes gait abnormality | ataxia |
| what area of the brain is affected in a patient suffering from ataxia? | cerebellum |
| defined as a condition in which the person maintains consciousness / awareness, but the body and most of the facial muscles are paralyzed and the ability to perform certain eye movements is preserved. | locked- in syndrome |
| what area of the brain is injured in a patient experiencing locked- in syndrome? | brainstem |
| periodic lateralized epileptiform discharges is now known as | LPDs (lateralized periodic discharges) |
| 3 things that may show PLED's (LPDs)? | 1. stroke 2. herpes simplex 3. encephalitis |
| BiPLEDs is now known as | BiPDs - bilateral periodic discharges |
| main clinical significance seen in BiPDs? | hypoxic encephalopathy |
| GPEDs is now known as | GPDs - generalized periodic discharges |
| main clinical significance seen with GPDs | hypoxic encephalopathy |
| FIRDA is now known as | GRDA - generalized rhythmic delta activity, frontally predominant |
| main clinical significance seen in GRDA | metabolic encephalopathy |
| SIRPIDs ( stimulus induced rhythmic, periodic or ictal discharges) is now known as | SI - stimulus induced |
| main clinical significance of SI | 1. acute brain injury 2. anoxic insult |
| triphasic waves are now known as | triphasic morphology |
| clinical significance of triphasic morphology? | 1. metabolic encephalopathy 2. hepatic encephalopathy 3. CJD |
| RAWOD - | regional attenuation without delta |
| what is the clinical significance of RAWOD? | distinctive EEG pattern that can aid in the diagnosis and management of acute ischemic stroke (AIS) |
| RDA - | rhythmic delta activity |
| SUDEP - | sudden unexpected death in epilepsy |
| MELAS - | mitochondiral encephalomyopathy, lactic acidosis, and stroke-like episodes |
| MELAS is caused by | DNA mutation |
| MELAS is considered a rare form of | dementia |
| MELAS can cause | seizures |
| ESES - | electrical status epilepticus of sleep |
| what is ESES commonly associated with? | LKS - landau - kleffner syndrome |
| a rare inflammatory neurological disease that affects on hemisphere of the brain | Rasmussens syndrome / encephalitis |
| side affects of Rasmussens syndrome | 1. sz 2. loss of motor / speech skill 3. hemiparesis (contralateral) |
| this is considered a secondary epileptogenic foci, in which the spike focus is in the collateral hemisphere, transferred via corpus callosum, with a slight delay between hemispheres | mirror focus |
| a head injury in which the brain is injured on the side of direct impact is considered | coup |
| a head injury in which the brain is injured due to rebound on the skull is considered | counter-coup |
| defined as a brief period of temporary paralysis following a sz | todd's paralysis |
| todd's paralyssis can last ___ and may affect ___ and ___ | 30 minutes to 36 hour, speech and vision |
| most common syndrome seen with Hypsarrhythmia | wests syndome |
| why is it important to do cEEG in the ICU? | because 25-35% of unresponsive and coma patients are experiencing NCSE |
| according to the ACNS guidelines, how long should patients in the ICU be recorded on cEEG to rule out NCSE? | 24 hours |
| what unit is intracranial pressure measured in? | millimeters of mercury (mmHg) |
| normal intracranial pressure for a resting adult in supine position | 7-15 mmHg |
| at what intracranial pressure is it needed to treat? | 20-25 mmHg |
| sustained intracranial pressure > 28 mmHg correlates with what EEG pattern? | burst suppression |
| how is pressure relieved in intracranial pressure. | via a catheter inserted through the lateral ventricle , allowing CSF to drain |
| glasgow coma scale | |
| coma grades | |
| neonatal EEG sleep- wake cycle duration? | 60 minutes |
| quiet and active sleep both present as early as ? | 28 weeks |
| favorable outcome; normal sleep features with frontal monorhythmic delta, describes what coma grade | 1 |
| prognostically uncertain; nonreactive diffuse delta, describes what coma grade | 2 |
| poor outcome; low amplitude, diffuse, irregular delta, describes what coma grade | 3 |
| poor outcome; burst suppression pattern, in particular when epileptiform discharges are seen with low output EEG, describes what coma grade | 4 |
| fatal outcome; isoelectric EEG or non reactive alpha coma, describes what coma grade | 5 |
Created by:
LTM
Popular EEG sets