Death and Dying Midterm IDST 112I

Dr. Loeb and Dr. Chua midterm study guide @ UNC-CH

What is empiricism?

Knowledge based on observable phenomena and data.

What is rationalism?

Using reason, logic, and deduction to reach conclusions.

What is naturalistic observation?

Observing a phenomenon as it naturally occurs.

What is a case study?

In-depth information gathering about one or a few cases.

What is a survey?

Asking people questions to collect empirical information.

What is an experiment?

Manipulating one variable to determine whether it causes an effect.

What are the steps of scientific research?

Know topic → hypothesis → design → collect data → statistics → conclusions.

Why do researchers use samples?

Researchers cannot measure everyone, so samples are used to generalize findings.

What do inferential statistics measure?

The probability that results were due to chance.

What p-value is statistically significant?

p ≤ .05 is statistically significant; p < .01 is also significant.

What is an operational definition?

Insufficient notes.

Why are larger samples better?

Insufficient notes; notes only explain why samples are necessary.

What brain functions can cranial nerve reflexes assess?

Basic brain functions; specific nerves are not given in the notes.

What does the Doll’s eyes test measure?

Arousal of the eyes through their movement opposite head tilting.

What is arousal?

Wakefulness/alertness; supported by the brainstem, thalamus, and reticular activating system.

What is awareness/consciousness?

Conscious perception, cognition, memories, and intentions.

What supports awareness/consciousness?

The cerebral cortex/frontoparietal network and thalamus.

What are the two types of awareness?

Environmental awareness and self-awareness.

Does being awake guarantee awareness?

No; you must be awake to be aware, but wakefulness does not guarantee awareness.

Is consciousness all-or-nothing?

No; consciousness exists on a continuum.

What does the medulla control?

Unconscious vital functions including breathing and circulation.

What does the pons control?

Sleep and arousal; it connects the brainstem and cerebellum.

What does the midbrain do?

Integrates vision/hearing and supports dopamine, arousal, breathing, pain, and reflexes.

What does the thalamus do?

Relays almost all sensory information except smell to the cortex and integrates it.

What does the hypothalamus control?

Basic biological needs, autonomic functions, and survival.

What does the limbic system support?

Emotion and memory.

What does the hippocampus support?

Learning, memory, and memory consolidation.

What does the amygdala support?

Fear, emotional processing, and aggression.

What does the cerebrum/cortex support?

Thinking, learning, memory, consciousness, and voluntary movement.

What does the occipital lobe control?

Vision.

What does the parietal lobe process?

Touch, body position, and somatosensory information.

What does the temporal lobe process?

Hearing and language comprehension.

What does the frontal lobe support?

Movement and higher thinking.

What does the prefrontal cortex support?

Planning, decision-making, and self-control.

What do mirror neurons support?

Social cognition and imitation.

What does the left hemisphere primarily support?

Language and verbal functions.

What does the right hemisphere primarily support?

Visual-spatial abilities, faces, and music.

What does Broca’s area support?

Speech production.

What does Wernicke’s area support?

Language comprehension.

What is coma?

A state with no arousal and no awareness.

How long must coma last before diagnosis?

At least one hour, after ruling out temporary unconsciousness.

What are signs of coma?

Closed eyes, no sleep-wake cycles, no commands/speech, and no purposeful actions.

What happens to metabolism during coma?

It is reduced by about 50–70%.

What brain damage can cause coma?

Diffuse cortical/white-matter damage or a brainstem lesion.

What is UWS?

Arousal without awareness; the person is awake but unaware.

What purposeful behaviors occur in UWS?

None; observed movements are reflexive rather than purposeful.

What functions can remain in UWS?

Sleep-wake cycles, blinking, swallowing, yawning, crying, smiling, and groaning.

Why can someone survive in UWS?

Hypothalamic and brainstem autonomic functions can remain preserved.

What is persistent UWS?

UWS lasting more than one month.

What is permanent UWS?

More than 3 months non-traumatic or more than 1 year traumatic.

What is MCS?

Arousal with inconsistent but definite signs of awareness.

What indicates MCS?

Purposeful behavior, commands, understandable speech, visual tracking, or appropriate emotion.

How must MCS behaviors appear?

They must be reproducible and sustained to distinguish them from reflexes.

What is emergence from MCS?

Functional communication or consistent appropriate use of multiple objects.

What is LIS?

Full consciousness with near-complete paralysis.

Why can LIS look like a coma?

The person appears unresponsive despite being fully aware.

What is communication in LIS often based on?

Eye movements or blinking, with communication aids when needed.

What causes LIS?

A brainstem lesion; about 90% is vascular according to the notes.

What is brain death?

Irreversible loss of brain function, brainstem reflexes, and spontaneous respiration.

What must be excluded before brain-death diagnosis?

Hypothermia, drug intoxication, electrolyte abnormalities, and endocrine disturbances.

What is assessed for brain death?

Cause of coma, confounders, coma/GCS, apnea, brain function, and brainstem reflexes.

How long after initial brain-death evaluation is assessment repeated?

After 6 hours.

What tests are listed as brain-death confirmatory tests?

EEG, PET scan, and angiography.

What does an EEG measure?

Overall net brain activity and functional brain information.

What does PET measure?

Brain activity through radioactive markers and glucose consumption.

What does a CT scan show?

Brain structure using computer-enhanced X-rays.

What does an MRI show?

Detailed brain structure using magnetic fields and radio waves.

What does fMRI measure?

Blood flow/oxygen use to map brain activity.

What did Adrian Owen pioneer?

Using brain scans to challenge physical diagnoses of vegetation and detect awareness.

What percentage of UWS patients may actually be MCS?

Insufficient notes; no percentage is provided.

What is the GCS?

A scale assessing eye, motor, and verbal responses.

What is a limitation of the GCS?

It requires verbalization, making it problematic with intubated patients.

What does a very low GCS indicate?

Poor prognosis; notes do not provide an exact cutoff.

What is the FOUR score?

A scale assessing eye, motor, brainstem reflexes, and respiration.

What is the FOUR score useful for?

Distinguishing UWS, locked-in syndrome, and brain death.

What is the JFK Coma Recovery Scale-Revised?

A comprehensive scale distinguishing UWS and MCS.

What does the JFK scale assess?

Auditory, visual, motor, verbal, communication, arousal, and brainstem reflexes.

What is the relationship between brain metabolism and consciousness?

Coma reduces metabolism 50–70%; MCS reduces it 20–40%.

What factors predict better recovery?

Younger age, traumatic injury, and shorter impaired-consciousness duration.

What was the TBI UWS independent-living rate after 1 month?

24% at one year.

What was the TBI UWS independent-living rate after 3 months?

16% at one year.

What was the TBI UWS independent-living rate after 6 months?

4% at one year.

Why is accurate prognosis important?

It informs diagnosis, treatment, rehabilitation, and end-of-life decisions.

Why is accurately determining death important?

It affects end-of-life decisions, organ donation, estate planning, and life-support decisions.

How was death traditionally determined?

By pulse and respiration, often using a stethoscope.

Why did CPR complicate death determination?

Cardiac arrest became potentially reversible, making irreversible death less clear.

What was the Schwab triad?

Fixed/dilated pupils, absent reflexes/movement, apnea, and an isoelectric EEG.

What did the Harvard Ad Hoc Committee define?

Unreceptive/unresponsive coma, absent reflexes, no movement/breathing, and isoelectric EEG.

What did the President’s Commission affirm in 1981?

The validity of whole-brain death.

What are the two UDDA definitions of death?

Irreversible circulatory/respiratory cessation OR irreversible cessation of all brain functions.

What does total brain death mean?

Irreversible loss of all functions of the entire brain, including the brainstem.

What is higher brain death?

Insufficient notes; the notes mention it but do not define it.

What does the Jahi McMath case highlight?

Potential problems with the total-brain standard and retained hypothalamic function.

How does a physician determine death based on the notes?

By irreversible circulatory/respiratory cessation or irreversible cessation of all brain functions.

What is anthropology?

The holistic, comparative study of humankind and human diversity.

What are anthropology’s four subdisciplines?

Cultural anthropology, archaeology, linguistics, and biological anthropology.

What is positivism?

Knowledge is valid when produced through scientific methods and generalizable patterns.

What is anti-positivism?

An approach emphasizing meaning, interpretation, context, and socially constructed reality.

What is ethnocentrism?

Assuming what is most familiar is common sense.

What are major qualitative anthropological methods?

Ethnography, interviews, and participant observation.