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Temporal Key Integrity Protocol and WPA2
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The temporal lobeFunciones del Lóbulo TemporalCoxal. Esfenoides. Temporal :)Jogo de Perguntas e Respostas 1.Por que a Funai considera a demarcação de terras indÃgenas uma estratégia central na COP30? Resposta: Porque a Funai entende que a demarcação fortalece a proteção ambiental, e isso é essencial para enfrentar a crise climática debatida na COP30. 2.Como a demarcação de terras contribui para a preservação ambiental segundo a Funai? Resposta: Porque territórios demarcados garantem a continuidade das práticas sustentáveis dos povos indÃgenas e reduzem o avanço do desmatamento. 3.Por que um evento climático internacional tem interesse na demarcação de terras indÃgenas? Resposta: Porque a proteção territorial indÃgena está diretamente ligada à conservação das florestas, elemento-chave nas negociações climáticas. 4.O que é o marco temporal? Resposta: É a tese que afirma que os povos indÃgenas só teriam direito à s terras que ocupavam em 5 de outubro de 1988. 5.Por que o marco temporal pode restringir direitos indÃgenas? Resposta: Porque ignora expulsões, violências e remoções que ocorreram antes de 1988, impedindo o reconhecimento de territórios historicamente ocupados. 6.O debate sobre o marco temporal revela o quê sobre a relação entre leis e justiça social? Resposta: Mostra que a aplicação da lei pode tanto garantir quanto limitar direitos, e que disputas jurÃdicas influenciam diretamente a vida dos povos indÃgenas. 7.Como o marco temporal pode dificultar os objetivos defendidos pela Funai na COP30? Resposta: Se o marco temporal limitar demarcações, menos territórios serão protegidos, enfraquecendo a preservação ambiental valorizada na COP30. 8.Por que a discussão sobre demarcação envolve ao mesmo tempo questões ambientais e jurÃdicas? Resposta: Porque a proteção territorial depende tanto de decisões legais (como o marco temporal) quanto do reconhecimento de que esses territórios são essenciais para a preservação ambiental destacada na COP30.¿Qué es la validez de un instrumento de investigación? A) La cantidad de Ãtems que contiene. B) La facilidad con la que se puede aplicar. C) La capacidad de medir lo que se supone que debe medir. D) La rapidez con la que se obtienen los resultados. Respuesta: C 2. ¿Cuál de los siguientes tipos de validez se refiere a la capacidad del instrumento para predecir resultados futuros? A) Validez de contenido B) Validez de criterio C) Validez concurrente D) Validez predictiva Respuesta: D 3. ¿Cuál de los siguientes análisis permite evaluar si los Ãtems están estructurados coherentemente dentro de un instrumento? A) Prueba-retest B) Análisis de validez de criterio C) Análisis factorial D) Análisis de intervalo de confianza Respuesta: C 4. ¿Qué tipo de validez compara los resultados de un instrumento con otros instrumentos que miden el mismo constructo? A) Validez de contenido B) Validez concurrente C) Validez predictiva D) Validez interna Respuesta: B 5. ¿Qué aspecto evalúa la confiabilidad de un instrumento? A) Su estructura teórica B) Su consistencia y estabilidad en los resultados C) Su diseño gráfico D) Su tipo de preguntas Respuesta: B 6. ¿Qué técnica se utiliza para evaluar la confiabilidad temporal de un instrumento? A) Análisis de varianza B) Entrevista estructurada C) Prueba-retest D) Análisis factorial Respuesta: C 7. ¿Qué caracteriza a los instrumentos cuantitativos? A) Se enfocan en la interpretación de significados. B) Utilizan entrevistas abiertas. C) Permiten análisis estadÃstico de datos numéricos. D) No permiten generalización de los resultados. Respuesta: C 8. ¿Cuál de las siguientes opciones corresponde a un instrumento cualitativo? A) Escala de medición de temperatura B) Encuesta con opciones múltiples C) Grupo focal con preguntas abiertas D) Prueba de rendimiento académico Respuesta: C 9. ¿Qué distingue a los instrumentos mixtos? A) Solo miden variables cualitativas. B) Utilizan únicamente escalas numéricas. C) Combinan medición cuantitativa y cualitativa. D) Se basan en observaciones no estructuradas únicamente. Respuesta: C 10. ¿Cuál de los siguientes es un ejemplo de instrumento mixto? A) Escala Likert B) Ficha de observación no estructurada C) Entrevista estructurada con preguntas abiertas y cerradas D) Prueba proyectiva sin escala Respuesta: C [t comes from the GREEK name "Epilepsia" which means "taking hold of or seizing". - It is a disorder characterized by: recurrent seizures. SEIZURES R ectment transient attacks of: R epresent: R esult from: ASSOCIATED WITH: somatic, psychic, or, autonomic clinical featmes. clinical features of abnormally hyperexcitable cortical neurons. paroxvsmal and excessive electrical neuronal discharges. EEG changes & may be disturbance of consciousness. same causes of convulsions 1. Idiopathic epile~ • It is the commonest cause. no cause can be detected ( 65 % ) • It may be associated with positive family history in some cases. • It starts in the l st & 2nd decades in the form of: -- Grand ma! epilepsy. Petit mal epilepsy. Myoclonic epilepsy. Atonic seizures. 2. Secondary epilepsy A. Local causes in the brain: l. Congenital: 2. Traumatic: cerebral palsy. a cause can be detected cerebral contusion or laceration. 3. Inflammatory: 4. Neoplastic: 5. Degenerative: 6. Vascular: encephalitis, brain tumours. mening1t1s, presenile dementia. brain abscess. stroke (especially hemon-hagic), hypertensive encephalopathy. B. General causes with secondary effects on the brain: I. Toxic: 2. Iatrogenic: 3. Metabolic: 4. Endocrinal: 5. Organ failure: 6. Heart disease: 7. Nutritional: - Alcohol, cocaine, lead. - Lidocaine, INH. - j glucose & ! glucose. - Hypoparathyroidism. - Hepatic failme. - Adam's Stoke's attacks. - Pellagra. - Botulism, tetanus. - Ambilhar, Amphetamine, Aminophylline. - j Ca & ! Ca. - Hype1thyroid crisis. - Renal failure. - Fallot's tetralogy. - j Na & ! Na. - Vitamin B6 deficiency. 8. Physical: 9. HYSTERICAL. - High fevers. - Heat stroke. 136 137 CLINICAL PICTURE 1. GENERALISED SEIZURES " Excessive electrical discharges from cortical neurons in BOTH hemispheres simultaneously " I. II. 1. Grand Mal Epile~: 1. Pre-ictal stage "attacks of tonic-clonic convulsions " (aura) It is a warning sign of a coming attack. It may be: • Somatic: • Psychic: • Autonomic: 2. Ictal stage Myoclonus, Hallucinations. Tachycardia, (seizure) Sudden loss of consciousness: Parasthesias. Sweating. for seconds to minutes. -- Tonic phase (few seconds) o The UL & LL: o o o o The HEAD: The JAWS: CYANOSIS: are extended. is retracted to one side & the eye balls rolled up. are firmly clenched, with biting of the TONGUE. due to impaired respiration. There may be incontinence of urine. Clonic phase (few minutes) o The UL & LL: o The HEAD: 3. Post-ictal stage - It may be: • Somatic: • Psychic: • Autonomic: Drug of choice: contract & relax repeatedly & rapidly. jerks forcibly. (sequelae) Todd's paralysis(< 24 hours, due to neuronal exhaustion). Confusion. Vomiting. Carbamazepine (Tegretol) or Phenytoin (Epanutin) Petit Mal Epilepsy: "attacks of loss of consciousness " " Absence " It starts in childhood & improves at puberty & usually disappears at the age of 20. 2. It is NOT PRECEEDED by aura & NOT FOLLOWED by sequelae. 3. It is usually PRECIPITATED by: hyperventilation 4. It is characterized by: or photic stimulation. sudden loss of consciousness of short duration (few seconds). 5. It may be associated with: • High frequency ( 50 attacks / day). • Falling to the ground without warning. • Jerky movements of the head & UL Drug of choice: (myoclonic petit mal). Valproate (Depakine) or Succinimide (Zarontin) 137 138 Ill. M oclonic Seizures: "attacks of involuntary clonic movements " - It is characterized by: sudden, jerky, shock-like INVOLUNTARY muscle contraction. • The jerks are bilateral contractions, mainly of the shoulders and arms. • However, some patients repmtjerking in the lower limbs, trunk, or head. - It may be of 2 types: - Occurs singly • Simple: • As a pait of: I Drug of choice: IV. Atonic seizures: (no loss of consciousness). - Grand mal epilepsy (aura). - Petit mal epilepsy. Valproate (Depakine) or Clonazepam (Rivotril) I - Transient attacks of brief loss of postural tone, often resulting in falls and injuries. 2. PARTIAL SEIZURES "Excessive electrical discharges from cmtical neurons in a ce1tain area in ONE hemisphere" A. Simple seizures: " No disturbance in consciousness " - The CP depends on the site of the hyperexcitable neurones in the cerebral cortex, whether in: "Motor area or Senso,y areas". 1. Motor fits: • Focal fits: • Motor jacksonian fits: 2. General Sensory fits: • Focal fits: • Sensory jacksonian fits: 3. Special Senso1y fits: • Visual hallucinations: • Auditory hallucinations: • Olfactory hallucinations: B. Complex seizures: - SITE: movement of part of a limb or the whole limb. movement of one side of the body (see before). parasthesia of part of a limb or the whole limb. parasthesia of one side of the body (see before). irritation of the visual sensory area. irritation of the auditory sensory area. initation of the uncus. " disturbance in consciousness " The hyperexcitable neurons are in the Temporal lobe "Temporal lobe epilepsy". - DURATION: The seizure lasts few seconds to few minutes. - The seizure starts with A ura, followed by A bsence, Automatism, Amnesia: 1. 2. 3. 4. A ura: A bsence: Automatism: A mnesia: Olfactory hallucinations, Deja-vu phenomenon, Sensation of fear. Absent patient with staring eyes (with no response to conversation). Involuntary Purposeless acts: motor ( eg, lip smacking, chewing) or verbal. No recalling of the seizure. 138 139 3. PARTIAL SEIZURES ~ GENERALISED SEIZURES " Partial seizures may spread to involve the whole brain .- secondarily generalised seizures " . HY-sterical epilepsY • Usually: • The cause: • Incidence: young neurotic Sj2 . psychological & there is no organic lesion. usually occurs in the presence of people. • It is associated with: • EEG: • It is not associated with: normal. • Missed ttt. • Menses. • Alkalosis. anxiety, palpitaion & hyperventilation. tongue biting or incontinence of urine. • Alcohol use & Drug abuse ( e.g. cocaine ). • S timulation by photons & Hyperventilation. • S leep deprivation & Stress & sudden withdrawal of antiepileptic drngs. INVESTIGATIONS 1. EEG: • It is the most specific test for epilepsy because it records the electrical activity of the brain. • It shows specific pattern: 2. LOCAL INVESTIGATIONS: "Epilepsy waves". "CT & MRI of the brain" • To identify or exclude a LOCAL CAUSE of seizures in the brain. 3. GENERAL INVESTIGATIONS: "Laboratory investigations" • To search for a GENERAL CAUSE of seizures, e.g. blood glucose. 139 140 TREATMENT A. General Measures: 1. 2. Moderation of the patient's physical activity. A void the precipitating factors ( Alcohol, hyperventilation, photic stimulation ...... ). 3. A ketogenic diet is encouraged because it will induce acidosis: - Acidosis is beneficial as it raises the threshold of stimulation of the brain cells. B. Specific Treatment: 2. 1. Treatment of the cause in secondary epilepsy. Anti-epileptic drugs: a) Always sta1t with one drug, then add another drug if there is no response. b) Always stop the drugs ONLY if: • The patient stays free of symptoms for at least 2 years. • The patient has a normal EEG. 3. Side effects of Anti-epileptic drugs: I . Skin rash. 2. 3. Bone marrow depression. Ataxia. Drug 1. Barbiturates (Pbenonobarbitone) 2. Hydantoin (Epanutin) 3. Carbamazepine 4. Clonazepam 5. Valproate 6. Succinamide ANTI-EPILEPTIC DRUGS NEW ANTI-EPILEPTIC DRUGS - These drugs are new dtugs that may be used in resistant seizures. 1. Lamotrigine: 200 - 400 mg/ day. 2. Felbamate: 3. Gabapentin: 400- 800 mg/ day. 600 - 1200 mg/ day. \ " General rules for use ": Dose 100-600 mg I day 100-600 mg / day 200-600 mg I day 2-6 mg I day 500-1500 mg I day 500-1000 mg / day Best indicated - Broad spectrum. - Not for petit mal. - Grand mal. - Motor Jacksonian fits. - Grand mal. - Motor Jacksonian fits. - Complex seizures. - Not for petit ma!. - Myoclonic. - Grand mat. - Broad spectrum. - Petit mat. 140 141 STATUS EPILEPTICUS DEFINITION - A medical emergency: 1. Repeated attacks of generalized convulsions, with lack of recove,y of consciousness, 2. Persistent attack of seizure lasting for at least 30 minutes. OR, - If the convulsions are not stopped rapidly, coma deepens & death may occur due to: heart failure or respiratory failure or brain damage or hyperpyrexia. - The most common causes are: sudden withdrawal of anti-epileptic drugs & stroke. TREATMENT A. General Measures: l. Take care of: " ABC " • Place the patient on the ground, to guard against falling from bed. • Mouth gag & 02 inhalation ( endo-tracheal intubation may be needed). • Record the vital signs regularly. 2. Take a sample of: - Venous blood: for the level of: - A.tierial blood: for the level of: 3. a nti-epileptic drugs, a lcohol. pH, p0 2, pC02, HC0 3. Give cerebral dehydrating measures: e.g. Frusemide, cone. Mannitol, Dexamethazone. B. Specific Treatment: - Phenytoin with diazepam (or clonazepam) immediately: 1. Phenytoin: 2. Diazepam: Clonazepam: seizures recur: 15 mg I Kg slow infusion. 5 mg slowly IV, to be repeated after 5 minutes if seizures recur: maximum dose: 20 mg. OR: 2 mg slowly IV, to be repeated after 5 minutes if maximum dose: 6 mg. - If seizures persist after 20 min. of Phenytoin & diazepam: 3. PHENOBARBITONE: - In resistant cases: 200 mg infusion. 4. GENERAL ANAESTHESIA: may be used.Quiz 1 (PR1- 4th Grading)Ikatlong Summative Test sa Filipino