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Week 2 (Exam 1) Flashcards

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1
Q

Presentation of essential tremor

A

Postural or kinetic tremor of both hands, maybe head or voice
Can begin in early adulthood, often not until later in life
Usually progress slowly over years to decades
Subsides with EtOH

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2
Q

Fxn of ciliary muscle

A

Accommodation to near vision
Outflow of aqueous humor
M3 receptors contract the muscle

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3
Q

Drugs that reduce aqueous humor production

A

B Blockers
a2-adrenergic agonists: (Apraclonidine, Brimonidine!)
Carbonic Anhydrase Inhibitors:
Topical: (Brinzolamide and Dorzolamide)
Systemic: (Acetazolamide and Methazolamide)

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4
Q

Parkinson’s vs Lewy body disease

A

Parkinsons: mibrain Lewy bodies, Tremor

Lewy body Dz: Cortical Lewy bodies, hallucinations

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5
Q

What drugs might you give to reduce intra-ocular pressure in preparation for surgery?

A

Systemic osmotic diuretics: Oral Glycerin, IV mannitol

Pilocarpine (induces mitosis)

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6
Q

Locked in State sx

A

Arousal and awareness
N1 sensation and cognition
Complete Paralysis except vertical eye movements

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7
Q

Brainstem stroke sx

A

Cranial nerve findings, contralateral hemisensory or hemimotor sx, vertigo

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8
Q

Dementia + Giat Disturbance + Urinary incontinence

A

Normal Pressure Hydrocephalus

Potentially reversible with ventriculoperitoneal shunting (gait is most likely to be reversed)

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9
Q

Friedrich’s ataxia genetics

A

AR disorder from Chr 9 mutation

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10
Q

Sx of Persistent vegetative state

A

Arousal and awareness
No reproducible response to stimuli
Eyes may be open, roving eye movements
Unaware, BP/Pulse stable

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11
Q

b12 conversion products

A

Homocysteine to methionine

Methymelonic acid to SucCoA

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12
Q

What is the purpose of the Head Impulse Nystagmus Test of Skew

A

Distinguishes between brainstem lesion from peripheral lesion in patients with acute vestibular syndrome

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13
Q

b12 deficiency neuro effects

A

degeneration of posterior columns and lateral corticospinal tract
Can also cause peripheral neuropathy, dementia
“combined systems degeneration)

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14
Q

How can you get a Cu deficiency?

A

Too little absorption, too much Zinc

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15
Q

Notable side effects of carbonic anhydrase inhibitors

A

Decreased Libido
kidney stones
parasthesias

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16
Q

How is it that cerebellar neoplasms are most commonly associated with breast, ovary, and lung cancer?

A

Abs to tumor cell Abs cross react with cerebellar Purkinje cells

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17
Q

Central Neurogenic Hyperventilation

A

Midbrain lesion

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18
Q

What part of the brain does ethanol affect?

A

Cerebellar vermis: truncal and lower extremity ataxia

Irreversible

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19
Q

Absence (aka petit mal) Seizure presentation

A

Nonresponsive staring
Rapid blinking, clonic hand motion
LOC, 10-30 seconds

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20
Q

Oculocephalic maneuver (Dolls Eyes)

A

Mid Pons lesion: assesses CN III, IV, VI
Passive horizontal head rotation: eyes go horizontally opposite
Passive vertical head rotation: eyes go vertically opposite

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21
Q

Transient Global Anemia

A

Sudden, temporary, isolated episode of memory loss
No other sx, usually recognizes close people, not others
Usually lasts hours then resolves, no recurrence

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22
Q

Treatment for essential tremor

A 
b-Blockers
Primidone
Benzodiazepines
Topiramate
Deep Brain Stimulation
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23
Q

Presentation of Meniere’s disease

A

Recurrent episodes of spontaneous vertigo
Low frequency hearing loss
Tinnitus
Aural Fullness

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24
Q

Etiology of Superior Canal Dehiscence

A

Thinning of bone that separates Superior Canal and Middle Foosa: creates third inner ear window

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25
Three P's of Pinpoint Pupils
Pontine Lesion, oPiates, PilocarPine
26
How to treat Benign Positional Vertigo
usually resolves spontaneously PT, exxcercises Meds: Anxiolytics, Antiemetics, Vestibular Suppressants
27
Sydenham's Chorea
Usually in children, maybe follow Grp A Strep infection | Unilateral. Tx with Abx and bedrest
28
A stroke of which hemisphere is associated with aphasia?
Left
29
Ataxic respiratory pattern
Completely irregular | Medullary respiratory centers
30
Decerebrate posture
All extremities extended (brainstem lesion)
31
Requirements for vestibular migraine
At least 5 episodes lasting 5 min - 72 hours Current or previous hx of migraine One+ migraine features in at least half of episodes Unaccounted for by other dx
32
Apneustic Breathing
Long inspiration followed by no breathing Mid low pons Anoxia, hypoglycemia, meningitis
33
Wilsons disease movement sx
Restin or postural tremor Choreiform movements Rigitity Bradykinesia
34
Muscarinic receptors and the aqueous humor
More outflow: Contraction of ciliary muscle and iris circular muscle
35
All stroke patients need IV access. What considerations should you make when giving fluid?
DO NOT give glucose: hyperglycemia is associated with worse neurologic outcomes
36
Etiology of Meniere's disease
Increase in volume of labyrinthine endolymph because of poor absorption (end-lymphatic hydrops)
37
Iris circular muscle
Contracts pupil to cause miosis and humor outflow | Effect is from M3 receptor activation
38
Cheynes-stokes
Respiration pattern of hyper vs apnea | Bilateral hemispheres or diencephalon lesions
39
What would count as an abnormal Head Impulse Nystagmus Test of Skew?
Normal HIT Bidirectional or direction-changing nystagmus Presence of skew deviation
40
Possible sx of torsion dystonia presentation
``` Torticollis (neck twisting to one side) Blephrospasm (forced eyelid closure) Oromandibular Dystonia (mout spasms) Hyperpronated arm w/ flexed wrist and extended fingers Extended leg, pronated and inverted foot ```
41
What drugs can induce closed angle glaucoma?
Anything that causes mydriasis: a1 adrenomimetics Antimuscarinics
42
Akinetic Mutism sx
Appears to have arousal, no awareness | No spontaneous motor activity
43
Cerebellar stroke sx
Ipsilateral ataxia, vertigo, nystagmus
44
Drugs used to treat sickness of disembarkment
Meclizine, Scopolamine, Benzos
45
How do you test for Benign Positional Vertigo (BPV)?
Posterior and anterior: Dix Hallpike maneuver | Horizontal: Supine roll test (panini-McClure
46
Cingulate gyrus herniation
Goes under the falx
47
Spontaneous, roving stupor
Conjugate: brainstem intact Dysconjugate: brainstem lesion (destructive: away from lesion)
48
notable side effects of cholinergic agonists
eyelid twitching cataracts iris-lens adhesions
49
Iris radial muscle
Dilates pupil to cause mydriasis and no humor flow | Effect is from a1 adrenergic receptor activation
50
Caloric (oculovestibular) reflex
Lower pons lesion Cold water irrigation: Eyes deviate to irrigated side if unilateral irrigation Eyes deviate downward if bilateral irrigation
51
Presentation of Friedrich's ataxia
1: onset before 20, gait ataxia, muscle weakness, no DTR 2: Pes Cavus, Scoliosis, Cardiomyopathy, Extensor plantar responses, maybe optic atrophy and nystagmus
52
Types of vertigo associated with BPV
Posterior: Torsional Horizontal: Horizontal direction changing Anterior: Downbeat torsional
53
Progressive Supranuclear Palsy (PSP)
Bradykinesia and rigidity | Loss of voluntary eye control (esp. vertical)
54
Decorticate posture
Arms flexed, legs extended | Hemispheric lesion
55
Presentation of AT
Choreoathetosis, loss of vibration and position sense in legs, voluntary eye movement disorders, mental def. Progressive ataxia, oculocutaneous telangiectasia Immunologic deficiency
56
Notable side effects of prostaglandin analogs
iris hyperpigmentation corneal erosion conjunctival hyperemia hyperpigmentation around eyelashes when discontinued
57
Secondary generalized partial seizure presentation
Bilateral tonic-clonic activity LOC, 1-3 minutes post-ictal state
58
Dix Hallpike results
Posterior canal BPV: nystagmus w/ affected ear down | Anterior: Nystagmus with affected ear up
59
Presentation of Superior Canal Dehiscence
Episodic vertigo, nystagmus, oscillopsia, chronic disequilibrium Triggered by loud noises, pressure in ext. auditory canal
60
Treatment of open angle glaucoma
b-blocker or prostaglandin agent | alt: brimonidine or carbonic anhydrase inhibitor
61
Criteria for Persistence of brain death
6 hours with flat ECG 12 hours without confirmatory isoelectric EEG 24 hours for anoxic brain injury without confirmatory isoelectric EEG
62
Treatment for Wilson's Disease
Penicillamine (copper chelating agent) | Restriction of dietary copper
63
Presentation of Lewy body disease
Dementia Parkinsonian sx Prominent psychotic sx (esp hallucinations) Extreme Sensitivity to Anti-Psychotic Agents
64
What is the b-blocker of choice for treating glaucoma?
Timolol: lacks local anesthetic effects (like propranolol)
65
Sx of Uncal Transtentorial Herniation
CNIII compression: Ipsilateral dilated pupil, poor EOM, ptosis Then, contralateral brainstem (ipsilateral hemiparesis) Respiratory bad, posturing, fixed pupils, death
66
Idiopathic Torsion Dystonia presentation
Dystonic Movements and postures, no other sx Inherited AD, AR, or X Onset maybe in childhood or later, but persists
67
Central Transtentorial Herniation
Goes into Foramen Magnum Leads to early coma, small pupils, normal EOMs, Posturing and later bilateral fixed pupils Respiratory arrest and death
68
Myoclonic seizure presentation
Brief, rapid symmetrical jerking of extremities/torso LOC, lasts seconds Minimal post-ictal state
69
Genetics of AT
AR chr 11 mut, begins in infancy
70
Closed angle glaucoma with vs without pupillary block
With: iris and lens contact blocks humor flow, iris moves forward and block outflow Without: ciliary processes push iris forward to block humor outflow
71
Atonic Seizure Presentation
Sudden loss of muscle tone Head drops or collapses LOC, variable duration Post-Ictal state
72
Complex partial seizure
``` Non-responsive staring Possible preceding aura Automatisms LOC, 1-3 minutes Post-ictal state ```
73
Tonic-Clonic Seizure Presentation
Bilateral extension followed by symmetrical jerking of extremities LOC, 1-3 minutes Post-ictal state
74
Psychogenic coma sx
Altered arousal and awareness | Changing / inconsistent physical examination
75
Sympathetic nervous system and the aqueous humor
Decreased outflow: contraction of iris radial muscle | More uveoscleral outflow: Relaxed ciliary muscle
76
Role of ciliary epithelium
Secretes aqueous humor b-adrenergics increase humor (Gs) a3 adrenergic decrease humor (Gi)
77
Vestibular Neuronitis
Spontaneous Vertigo w/out hearing loss, non-positional peaks in 24 hours, lasting days to weeks Maybe CN VIII lesion, resolves spontaneously
78
Cortical basal degeneration
Cortical and basal ganglionic dysfunction Bradykinesia and rigidity Maybe sensory loss, apraxia, myoclonus or aphasia
79
Sings and sx of cerebellopontine angle tumor
Generally involves CN V, VII, VIII Starts with Hearing loss and absent corneal reflex Generally associated with NF1 and NF2
80
How to treat meniere's disease
Lorazepam / Diazepam Na restriction to 1.5-2 mg /day Thiazides / Furosemide Endolymphatic sac decompression
81
What drugs can induce open angle glaucoma
Glucocorticoids | Topical antimuscarinic drugs
82
Sensory Disequilibrium
Visual impairment, vestibular disorders. | Worse in the dark, associated w/ Romberg Sign
83
Drugs that cause outflow of aqueous humor
PG analogs: (Latanoprost / Bimatoprost! / Travoprost) a2-Adrenergic analogs: (Apraclonidine / Brimonidine) Direct Cholinergic: (Carbachol / Pilocarpine) Cholinesterase inhibitors (Echothiophate)
84
Stroke scale and hemorrhage risk
Below 10? 2-3% risk | Above 20? 17% risk
85
Simple partial seizure presentation
Focal motor or sensory activity | Lasts seconds
86
Tourette's treatments (3)
Clonidine Haloperidol Phenothiazines
87
What might you use to treat focal torsion dystonia?
Botox

NMSP (7 decks)

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