[Richo]

Hello There

I am a student about to do my final exam and was wondering if anyone could help me with a practice exam question I have here. It is asking: Assessment findings of pinpoint pupils, varied responses to painful stimuli and absent reflexes most likely indicates which of the following:

a. Permanent vegetative state
b. Locked in Syndrome
c. Coma
d. Brain Death

This question has my friend and I stumped because with Brain Death, there is absolutely no response at all, locked in syndrome the patient is aware of their surroundings though is paralysed therefore would be unable to display a varied response to painful stimuli, Coma - the pupils are dilated/fixed? Can anyone help us out and maybe explain a little bit about the difference between these conditions? Any help would be appreciated.

Regards
T & J

[Janet Barclay]

Don't forget that coma is a generic sort of state which can be caused by a number of different things. The pinpoint pupils may be caused by narcotics, which could also be the cause of the coma. Dilated/fixed pupils are a late sign of high intracranial pressure. I think the best answer is coma.
good luck

[Richo]

Thanks Janet, yes I knew that narcotics could do this but did not think of it causing a state of coma - how silly ! I can't wait to get out there and do some prac, hopefully all of this theory I have done I can relate to real situations, as I think it will sink in alot easier that way. Thankyou for answering, it is much appreciated!

Tracy

Originally Posted by Janet Barclay

Don't forget that coma is a generic sort of state which can be caused by a number of different things. The pinpoint pupils may be caused by narcotics, which could also be the cause of the coma. Dilated/fixed pupils are a late sign of high intracranial pressure. I think the best answer is coma.
good luck

[gwenith]

A case can be made for the answer to be Locked-in Syndrome.

According to one of the Neuro "Bibles" - Hickey's Neurological and Neurosurgical Nursing

Pinpoint pupils "May result from the loss of sympathetic innervation. The cause is usually pontine haemorrhave, but this condition can also occur with administration of opiate drugs" P 115 4th Ed.

Locked in Syndrome - "The usual cause is the interruption of the descending corticobulbar and corticospinal tract at or below the pons." In a true Locked in Syndrome from pontine infarct the spinal reflex loop remains intact. P 141

This is a brilliant example of an extremely poorly constructed question. The person who devised this has little understanding of the underlying conditions but wants to show they are "clever"

Why do I say that??

Because the relevant information that should have been included is left out.

i.e. "Varied repsonses to painful stimuli" means ZIP!!! Are you getting localisation/extension/flexion or a combination or maybe one limb is responding while the others are not. Are they including lower limb response as response to painful stimuli??

Absent reflexes - fine but WHICH reflexes. Are we talking deep tendon reflexes gag, cough, light response, accomodation - which and where.

In fact there is only one answer there that definitely does NOT fit the clinical picture given and that is brain death.

IF you ever find out the answer to this please let us know and let us out of our misery.

[Richo]

Hi Gwenith

I feel so much better now. As a student I think alot of the questions this lecturer has given appear to have more than one possible answer. It has made it extremely difficult as a student to try and decide or find the correct answer to some of these questions. I dont feel I am learning anything extra by this, rather I feel more uncertain and indecisive about some of the questions/topics than what I did before taking on this unit. I do know I am not alone as the students i talk to that are doing this subject (that have no prior experience nursing) are having similar feelings. I also know she changed it from an open book exam (100 multiple answer questions) to 125 closed book questions, and a student who began the subject when the exam was open book but had to repeat it, has commented how the questions have not changed, which I feel is unfair. I have done the exam now and have absolutely no idea how I will go, I only pray I pass as it is all I have left to do besides the final prac. Thankyou for your replies once again.

Regards
Tracy

[gwenith]

If the questions are like the one above I would take it over her head to your head of school and bring it to his/her attention especially if you take my response add in some more on description of coma and persistant vegatative state because as I said this is an extremely poor question. I might though, even for "political" reasons go to her first with my response and show her - and ask her what answer she intended. Sometimes a good educator will set a question like this to get you to research the conditions cited but usually if you are going to do that you let the students know otherwise there are some complex psychological responses that will impede the learning process.

[EricTAMUCC-BSN]

I would go with coma too.

[nursedani08]

Wierd, I was just googling for the answer to that exact question

[GooeyRN]

Originally Posted by nursedani08

Wierd, I was just googling for the answer to that exact question

Hmm.. I wonder if you guys go to the same school.


Questions like these are one of the main reasons I do not miss nursing school.