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LTM Guide

guide to LTM quiz

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 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 abrutp 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 arura? 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 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 thta 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? frontlal 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 amygdaly - hyppocampus
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 teh 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 isa 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 - flurodexy glucose
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 hyopperfusion SPECT - single photon emission computed tomography
functional neuroiaging 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 foucs, 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 syste 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. vangus 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 oucome; 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