Neurology Flashcards
Afib stroke prophylaxis?
coumadin
Stroke on aspirin, tx?
Aspirin + dipyridamole
Focal neurologic deficit, no bleed, within 3 hours of presentation, tx?
tPA
Stroke secondary prophylaxis (what do you put them on after first stroke)?
Aspirin
Hemorrhagic stroke BP goal?
MAP < 110
Stroke, no tPA given - BP goal is?
220/120
New onset focal neurologic deficit, next step?
non-con CT
Ultrasound greater than 70% stenosis?
endarterectomy
On the test, when do you use clopidogrel?
aspirin intolerance
What drug is used to minimize vasoconstriction and delayed brain ischemia that can occur after subarachnoid hemorrhage?
nimodipine (CCB)
___ is an abnormal hypersynchronous electrical discharge of neurons.
Seizure
Among partial seizures, those in which __ is impaired are termed __, whereas those in which __ is preserved are termed __
awareness; complex; awareness; simple
Child with ADHD but it’s a seizure question, diagnosis?
Absence seizures
Face pain, lancinating pain, worse with chewing, diagnosis?
Trigeminal neuralgia
Abort a seizure, tx?
Benzodiazepines
How do you treat Absence?
ethosuximide
Abort status epilepticus, treatment?
IV benzos!!! fosphenytoin, phenobarbital, midazolam and propofol
How do you treat trigeminal neuralgia?
carbamazepine
In which type of seizure do you lose consciousness (2)?
Grand mal seizure, absence
In which type of seizure do you not lose consciousness (2)?
myoclonic (spastic contractions), atonic (loses tone)
Name VITAMINS (causes of seizures)
Vascular (stroke bleed); Infection (encephalitis, meningitis); Trauma (MVA, TBI); Autoimmune (lupus, vasculitis); Metabolic (Na, Ca, Mg, O2, Glucose); Idiopathic /Ingestion/wIthdrawal; Neoplasm (mets v primary); pSychiatric (faking it, iatrogenic)
What’s the treatment for atonic and myoclonic seizures?
valproate (and helmets for atonic)
No tremor at rest that arises with movement, diagnosis?
Essential tremor
How do you treat essential tremor?
Propranolol
Tremor that gets worse the closer to the target you get, diagnosis?
Cerebellar lesion (CVA, EtOH)
How do you treat Parkinson’s in a pt that is functional or less than 70?
Ropirinole or pramipexole (not bromocriptine)
How do you treat Parkinsons in a pt that is greater than 70 or non functional?
levidopa-carbidopa
HTN, tachycardia, hallucinations, diaphoresis, tremor, diganosis?
Delirium tremens
How do you treat delirium tremens?
Benzos (lorazepam prn tx; oxazepam or chlordiazepoxide (ppx))
How does carbidopa work?
prevents break down of L-dopa in to dopamine in the periphery
Lacrimation, ptosis, conjunctival injection, what type of HA?
Cluster (comes in clusters!)
Who cannot get triptans for migraines?
people with CAD
Photophobia, phonophobia, unilateral pounding headache, diagnosis?
Migraine
Young female on oral contraceptive with symptoms of a brain tumor, dx?
Benign intracranial hypertension (aka pseudotumor cerebri)
Abort cluster headaches, tx?
Oxygen
Prophylaxis against cluster headaches, tx?
verapamil
Abort migraines, tx?
Ergots or triptans
Prophylaxis against migraines?
Propranolol
How do you diagnose benign intracranial HTN?
CT scan first (rule out tumor), LP relieves symptoms
Vice like pain that radiates to the neck, diagnosis?
Tension headache
Which primary headaches are unilateral? bilateral?
cluster and migraine are unilateral
tension is bilateral
Tx of benign intracranial HTN (3)
first line: acetazolamide (also stop OCPs)
then serial LPs or VP shunt if necessary
Name 5 causes of 2ndary headaches?
hemorrhage, tumor, abscess, meningitis, IIH (idiopathic intracranial htn)
History of cancer and back pain, diagnosis?
Mets
Lightning pain down the leg of a young pt doing heavy lifting, diagnosis?
Disc herniation
History of trauma and upper motor neuro lesions in the spine, diagnosis?
Fracture, cord transection
Really old lady has back pain with tenderness on her spine, diagnosis and next step?
Compression fracture, start with xray
Back pain and sexual dysfunction, bowel and bladder dysfunction, diagnosis?
Cord compression
Belt like pain around the lumbosacral region, diagnosis?
Musculoskeletal
Lightning pain down the leg of an old guy without heavy lifting, diagnosis?
Osteophytes
Best tx for musculoskeletal back pain?
NSAIDs and Stretches (not rest)
Claudication of the buttocks that is better going up stairs, diagnosis?
Spinal stenosis
Saddle anesthesia, diagnosis and what’s the next step?
Cord compression, steroids first, then MRI (then disease specific - drain hematoma, I&D/antibx for abscess, surgery/radiation for tumor, surgery for fracture)
Elderly person who has a slowly progressive dementia after a fall, diagnosis?
Subdural
Parkinson’s and dementia, diagnosis?
Lewy Body dementia
Young person with rapid onset dementia and myoclonus, diagnosis?
prion disease (CJD)
Elderly person who has a slowly progressive dementia after the death of their spouse, dx?
Pseudodementia (depression)
Dementia and a couple of strokes, diagnosis?
Vascular dementia
Loss of short term memory, but long term memory and social graces spared - dx?
Alzheimers (long term comes later)
Elderly man who is hyper sexual and foul mouthed when he wasn’t before - diagnosis?
Pick’s disease (frontotemporal dementia)
Name 5 causes of reversible dementia (there are likely more)
1) B12 deficiency; 2) syphilis; 3) hypothyroid; 4) CKD; 5) depression
What tests should you get to rule out reversible causes of dementia (5)?
1) B12 level, 2) RPR, 3) TSH and T4, 4) BUN/Cr
5) CT scan and MRI
Treatment for Meniere’s?
Diuretic and low salt diet
Vertigo with ataxia, dx and next step?
Central vertigo, get an MRI
vertigo with a focal neurologic deficit
Rotary Nystagmus, dx?
BPPV
Treatment for BPPV
Otolith removal = Epley maneuver
How do you diagnose BPPV?
Dix Hallpike shows rotary nystagmus (and history!)
Vertigo + tinnitus or hearing loss = ? (not Meniere)
Peripheral vertigo
What is the triad of Meniere’s? How long do episodes last?
tinnitus, hearing loss, episodic vertigo; greater than 30 mins less than one hour
Which one is associated with hearing loss, labyrinthitis or vestibular neuritis? How do they present
labyrinthitis; vertigo, nausea/vom, tinnitus, hearing loss (specifically labyrinthitis)
What causes labyrinthitis/vestibular neuritis?
post-viral syndrome (usually URI) (usually presents weeks after URI with vertigo, nausea/vom, tinnitus, hearing loss (specifically labyrinthitis)
How do you diagnose brain death?
2 physicians individually assess brainstem reflexes as absent, spontaneous breathing trial
Locked in syndrome is a stroke of what?
Basilar artery (pontine stroke)
No cerebral function, but has eye opening, sleep/wake cycles, and breathes, diagnosis?
Persistent vegetative state (they won’t come back from this - they have no cerebral function)
In coma pt has decreased __ function (can come back), and __ are intact.
cerebral (depressed level of consciousness); brain stem reflexes
How do you diagnose myasthenia?
Anti-Ach-R antibodies, then EMG
There are upper and motor neuron lesions at the same time; diagnosis?
ALS
How do you treat myasthenia crisis?
IVIg or plasmapheresis (they are the same)
What is the best test for MS?
brain MRI
Ascending paralysis after diarrhea, diagnosis?
Guillain-barre
How do you treat myasthenia gravis?
neostigmine (can also use steroids, thymectomy, or can use IVIg/plasmapheresis in acute crisis)
Blurry vision and dysphagia at the end of the day, diagnosis?
Myasthenia gravis
Leg weakness today, blurry vision a month ago, diagnosis?
multiple sclerosis
First thing to do with Guillain barre?
Assess lung function (not IVIg)
How do you diagnose guillain barre?
first check if they need intubation (PFTs), then LP which shows lots of protein and few cells, then best: nerve conduction study
Trouble rising from a chair or combing hair, diagnosis?
Eaton-lambert
How do you treat MS?
Acute flare: high dose IV steroids (methylprednisolone x 5 days)
Chronic: interferon + glatiramer, fingolimod
Name the neurologic findings for this site of hemorrhage: basal ganglia (4)
contralateral hemiparesis and hemisensory loss, homonymous hemianopsia, gaze palsy
Name the neurologic findings for this site of hemorrhage: cerebellum (4)
usually NO hemiparesis, facial weakness, ataxia and nystagmus, occipital headache and neck stiffness
Name the neurologic findings for this site of hemorrhage: thalamus (5)
contralateral hemiparesis and hemisensory loss, nonreactive miotic pupils, upgaze palsy, eyes deviate toward hemiparesis (away from lesion)
Name the neurologic findings for this site of hemorrhage: cerebral lobe (5)
contralateral hemiparesis (frontal lobe), contralateral hemisensory loss (parietal lobe), homonymous hemianopsia (occipital lobe), eyes deviate toward the lesion, high incidence of seizures
Name the neurologic findings for this site of hemorrhage: pons (3)
deep coma and total paralysis within minutes, pinpoint reactive pupils
Name the mechanism and side effects (2): levodopa/carbidopa
dopamine precursor; somnolence, confusion, hallucinations AND later dyskinesia
Name the mechanism and side effects: trihexphenidyl
(also benztropine) - anticholinergic; side effects are dry mouth, blurred vision, constipation, nausea, urinary retention
Name the mechanism and side effects (2): amantadine
unclear mechanism; ankle edema and livedo reticularis
Name the mechanism and side effects: apomorphine (and name three other with same mech/SEs)
dopamine agonists (bromocriptine, pramipexole, ropirinole); somnolence, hypotension, confusion AND hallucinations (older pts)
Name the mechanism and side effects (5): entacapone and tolcapone
COMT inhibitors; dyskinesia, hallucinations, confusion, nausea, orthostatic hypotension
Name the mechanism and side effects (2): selegiline
MAO B inhibitor; insomnia and confusion
CSF examination in patients with Guillain Barre typically shows ___
albuminocytologic dissociation (high protein with few cells)
How do you treat GBS?
IV immunoglobulin or plasmapheresis
Autonomic dysfunction is seen in 70% of pts with GBS - give examples (3)
tachycardia, urinary retention, arrhythmias
Name two contraindications to sumatriptan
ischemic cardiac disease and pregnancy
Syringomyelia, a ___ in the spinal cord, is a condition most commonly associated with __.
fluid-filled cavity; Arnold Chiari malformation type I
Syringomyelia causes loss of what and where?
loss of pain and temperature sensation bilaterally (in the dermatomes corresponding to the site of spinal involvement); as it enlarges can also interrupt the anterior horn gray matter resulting in LMN signs
What is the major cause of death within the first 24 hours of presentation of subarachnoid hemorrhage? 3-10 days after presentation?
rebleeding; vasospasm (can be prevented with nimodipine!)
Mononeuropathy multiplex are most commonly seen in patients who have ___. Mononeuropathy multiplex is a painless/ful a/symmetric sensory/motor ___ involving isolated damage to greater than or equal to 2 separate nerves.
systemic vasculitides; painful asymmetric asynchronous sensory and motor peripheral neurpathy
Thalamic pain syndrome (aka __ syndrome) is characterized by severe paroxysmal __ over the affected area and is classically exacerbated by ___ (__)
Dejerine-Roussy; burning pain; light touch (allodynia)
occurs several weeks to months following the stroke
Multiple system atrophy (aka ___ syndrome) is a degenerative disease characterized by these 3 things
Shy-Drager; Parkinsonism; Autonomic dysfunction (postural hypotension, abnormal sweating, disturbance of bowel or bladder control, abnormal salivation, lacrimation, impotence, gastroparesis); Widespread neurologic signs (cerebellar, pyramidal, or LMN)
In a pt with Parkinsonism and orthostatic hypotension, always consider __ syndrome. Treatment is aimed at __.
Shy Drager; intravascular volume expansion (fludrocortisone, salt supplementation, alpha adrenergic agonists, compression socks)
Riley Day syndrome (aka ___) is a ___(PoI) disease seen predominately in children of Ashkenazi Jewish ancestry. It is characterized by gross dysfunction of the __ with severe ___.
familial dysautonomia; autosomal recessive; autonomic nervous system; orthostatic hypotension
Down and out gaze is associated with __.
oculomotor nerve (CN III) palsy
CN III contains inner __ fibers that control __and superficial __ fibers that control __. Ischemia affects __ first and compression affects __ first.
somatic; levator muscle and 4 EOMs; parasympathetic; the sphincter of the iris and the ciliary muscles (controlling pupillary dilation); inner (somatic); superficial (parasympathetic)
Anterior spinal cord syndrome results in these 2 things. It is a common complication of ___.
loss of pain and temperature sensation below the level of the injury and bilateral hemiparesis (often present abruptly with flaccid paralysis due to spinal shock, and UMN signs develop over days to weeks); thoracic aortic aneurysm surgery
Fluorescein examination shows corneal staining defect, dx?
corneal abrasion
What innervates taste in the anterior 2/3 of the tongue?
facial nerve
What innervates eyelid opening? Eyelid closure?
CN III (oculomotor); CN VII (facial)
What nerve is responsible for monitoring of the aortic arch baro and chemoreceptors?
CN X (vagus)
What nerve innervates taste in the epiglottis?
CN X (vagus)
What nerve innervates lacrimation (via the greater petrosal.vidian nerves)?
CN VII (facial)
What nerve innervates salivation (via __)?
facial nerve; chora tympani
Which branch of trigeminal nerve contains both motor and sensory?
V3 (mandibular branch)
Name 4 differential diagnoses of neuromuscular weakness of UMN origin
leukodystrophies, vasculitis, brain mass, vitamin B12 deficiency
Name 4 differential diagnoses of neuromuscular weakness of anterior horn cell origin
spinal muscular atrophy, ALS, paraneoplastic syndromes; poliomyelitis
Name 5 differential diagnoses of neuromuscular weakness of peripheral nerve origin
hereditary primary motor sensory neuropathy; GBS; diabetic neuropathy; amyloid neuropathy (myeloma); lead poisoning
Name 4 differential diagnoses of neuromuscular weakness of neuromuscular junction origin
myasthenia gravis, lambert-eaton syndrome, organophosphate poisoning, botulism
Name 5 differential diagnoses of neuromuscular weakness of muscle fiber origin
muscular dystrophies, polymyositis/dermatomyositis, hypothyroidism, corticosteroids, HIV myopathy
A brain that has seized for greater than 5 mins is at increased risk of developing permanent injury due to ___. ___ is the hallmark of prolonged seizures and can lead to persistent neuro deficits and recurrent seizures.
excitatory cytotoxicity; cortical laminar necrosis
Spinal epidural abscess (SEA) classically result in this triad. Diagnosis? Treatment?
1) fever; 2) back pain; 3) neurologic deficits; MRI of the spine; broad spectrum antibiotics and aspiration/surgical decompression
What is the pattern of inheritance of neurofibromatosis type I? Name 4 common findings.
autosomal dominant; café au lait macules, clustered freckles (particularly axillary and inguinal), lisch nodules (raised, tan colored hamartomas of the iris), and neurofibromas (peripheral nerve sheath tumors)
Pt has renal angiomyolipoma, benign hamartomas of several organs, ash leaf spots, and shagreen patches, dx?
tuberous sclerosis
Retinal hemangioblastomas are associated with __ syndrome.
von hippel landau (also causes RCC)
This anti-epileptic drug is a know teratogen that causes fetal hydantoin syndrome (orofacial clefts, microcephaly, nail/digit hypoplasia, cardiac defects, dysmorphic facial features)
phenytoin
What is the protein found in Lewy bodies?
alpha synuclein (lewy bodies are intracytoplasmic inclusions)
Nipples are innervated by what spinal vertebral level?
T4
Optic neuritis presents as ___ over a few days. There is commonly __ with eye movement.
unilateral visual loss; pain
(often also see loss of color vision and an afferent pupillary defect - sometimes the optic disc is swollen with flame shaped hemorrhages)
Generalized 3-Hz spike and slow wave discharges on EEG, dx?
absence seizure
What is the lhermitte phenomenon and what is it associated with?
a transient electric shock that radiates down the spine with flexion of the neck; MS
___ is the most common presenting complaint of a TIA causing vertebrobasilar ischemia
dizziness (other sxs include feeling of heaviness, eyelid drooping, diplopia, drowsiness, bilateral leg and arm weakness, numbness and dysarthria)
What is the CSF-specific marker protein?
beta-2-transferrin
If there is a reflex abnormality present in true cauda equina syndrome, it would be ___.
hyporeflexia (hyperactive reflexes actually exclude cauda equina)
Which brain tumor has drop metastasis? Which one grows as a mass filling the fourth ventricle? Where does oligodendroglioma usually arise?
medulloblastoma; ependymoma; cerebral hemispheric white matter
Neurofibromatosis type 2 manifests with multiple ___, including these 3
brain tumors; schwannomas of CN8, meningiomas, and gliomas
Name 4 areas that can get compressed during transtentorial (uncal) herniation
contralateral crus cerebri against the tentorial edge; ipsilateral oculomotor nerve (CN III) by the herniated uncus); ipsilateral posterior cerebral artery (i.e. ischemia of visual cortex); reticular formation
Name the 4 possible neurologic signs of transtentorial (uncal) herniation
ipsilateral hemiparesis (crus cerebri); loss of parasympathetic innervation of CN III early, followed by motor innervation if it gets worse (ptosis, down and out of ipsilateral); contralateral homonymous hemianopsia (posterior cerebral artery); altered level of consciousness/coma (reticular formation)
Myotonic muscular dystrophy presents with weakness of ___. Myotonia is ___. Name 3 manifestations
skeletal, smooth, and cardiac muscles; delayed muscle relaxation; 1) skeletal muscle weakness (face, forearms, hands, ankle dorsiflexors = bilateral foot drop); 2) dysphagia (most dangerous smooth muscle manifestation - increases aspiration pneumonia risk); 3) cardiac conduction problems
Name 4 comorbidities of myotonic muscular dystrophy. What is the pattern of inheritance?
arrythmias, cataracts, balding, testicular atrophy/infertility; Autosomal dominant expansion of CTG trinucleotide repeat
Positive gower’s sign, dx?
duchenne muscular dystrophy (the getting up thing)
Name 2 comorbidities of duchenne muscular dystrophy and 1 of becker.
scoliosis and cardiomyopathy
cardiomyopathy
___ imaging is better at depicting bone and ___ is superior for soft tissue details.
CT; MRI
Immediate intervention for central retinal artery occlusion includes ___. Medical management and ___ to lower intraocular pressure may be used, but the first thing has the most rapid action. ___ therapy or ___ therapy have been shown to be beneficial if given early.
ocular massage (dislodges embolus to a point further down the arterial circulation and improves retinal perfusion); anterior chamber paracentesis; Carbogen; hyperbaric oxygen
Sudden painful loss of vision with red eye, dx? Treatment?
acute angle glaucoma; topical pilocarpine and beta blockers
In acute exacerbation of MS, treat pts with ___. If refractory, ___ can be used.
glucocorticoids; plasmapheresis
In cerebellar ataxia, pt tends to fall towards/away from side of lesion
towards! (may also see nystagmus, hypotonia, dysarthria, loss of coordination, inability to perform rapid, alternating mvmts)
Spastic gait is seen with lesions of ___.
upper motor neuron (eg spinal cord injury or cerebral palsy) (the mvmts of the affected extremities are slow, stiff, effortful)
Gait disequilibrium results from disorders of the __ and __.
frontal lobe; multiple sensory systems
Sensory ataxia is seen with lesions involving these 3 things. What does it look like?
peripheral nerves, dorsal roots, or posterior columns (loss of proprioception results in wide based high stepping gait)
Vestibular ataxia results in a __ gait with ___ movements of the head during walking. It is typically accompanied by __ and __.
en-bloc (staggering?); minimal; vertigo; nystagmus
The ___ gait in pts with Parkinsonism is typically broad/narrow based.
hypokinetic; narrow-based
Dystonic gait is characterized by __, __, __ mvmts of the limbs and trunk
involuntary, sustained, twisting
Tx for neonatal conjunctivitis due to gonorrhea? chlamydia? What’s the age of onset for both?
single IM dose of 3rd generation cephalosporin; PO macrolide; gonorrhea: 2-5 days; Chlamydial (5-14 days)
CJD causes rapidly progressive dementia and for diagnosis you need 2/4 of these clinical features
1) myoclonus; 2) akinetic mutism; 3) cerebellar or visual disturbance; 4) pyramidal/extrapyramidal dysfunction
In CJD what do you see on EEG? What protein are you looking for in CSF?
sharp wave complexes; 14-3-3
Demonstrated __ gene mutations can be seen in CJD
PRNP
In internuclear opthalmoplegia, the affected eye (ipsilateral to the lesion) is unable to __ and the contralateral eye __ with __. __ and __ are preserved.
adduct; abducts with nystagmus; convergence and pupillary light reflex
Edinger-Westphal nucleus provides pre/post ganglionic __ outflow to the eye. Damage to this structure results in what?
pre-ganglionic parasympathetic; ipsilateral fixed and dilated pupil that is nonreactive to light or accommodation
Damage to the lateral geniculate nucleus would cause what?
contralateral homonymous hemianopsia
Lesion of the optic chiasm would result in ___. This may occur with __ or __.
bitemporal hemianopsia; anterior communicating artery aneurysms; tumors within the sella turcica (craniopharyngioma, pituitary adenoma)
Unilateral medial longitudinal fasciculus lesions can occur with ___. Bilateral are seen in __.
lacunar stroke in pontine artery distribution; multiple sclerosis
In any acute spinal injury of any process, the first intervention should be __ after an initial neurologic examination
high dose of IV steroids (anti-inflammatory and should decrease pressure on the spinal column)
What makes it proliferative instead of non-proliferative diabetic retinopathy?
neovascularization
In open angle glaucoma, there is gradual loss of __ vision. Intraocular pressure is __. On exam, there may be ___.
peripheral (leading to tunnel vision); high; cupping of the optic disc
___ affects central vision. ___ affects peripheral vision.
macular degeneration; open angle glaucoma
In people with ___, they usually complain of blurred vision, problems with nighttime driving, and glare.
cataracts (oxidative damage of lens)
Sudden loss of consciousness without any prodrome with immediate return to baseline after event, dx?
cardiogenic syncope
Presyncope (lightheadedness, pallor, diaphoresis), LOC with immediate return to baseline after event, dx?
Vasovagal syncope
Sudden loss of consciousness, loss of postural tone, delayed return to baseline mental status, dx?
should raise suspicion for generalized seizure (some pts experience aura before and/or tongue biting during event)
___ refers to intermittent or constant ocular misalignment. Important examination findings include asymmetric __ or __ or a __ during the cover test.
Strabismus; red reflexes; corneal light reflexes; deviation (the cover test works by fixing gaze on a target while examiner covers one eye while observing the mvmt of the other - misaligned eye shifts to re-fixate on the object when normal eye is covered)
Presbyopia is a common age related disorder that results from ___, which prohibits __ of the lens, which is required to focus on near objects
loss of elasticity in the lens; accommodation
In pts with acute angle closure glaucoma, IV __ may lower the ___. Permanent cure is offered with ___.
acetazolamide (followed by oral); intraocular pressure; laser peripheral iridotomy
In myasthenic crisis, treatment includes __ followed by these 3.
intubation (due to deteriorating respiratory status); plasmapheresis, IVIG, corticosteroids
__ presents as blurred vision with moderate pain, conjunctival injection, and constricted pupils.
Uveitis
___ presents with excessive tearing, burning sensation, mild pain, conjunctival, and eyelid edema. Vision is NOT affected
conjunctivitis
Lateral medullary infarct (___syndrome) occurs due to occlusion of ___. Pts develop these 4 groups of symptoms
Wallenberg; PICA; vestibulocerebellar symptoms (vertigo, nystagmus, ipsilateral ataxia); Sensory sxs (loss of pain and temp on ipsilateral face and contralteral trunk and limbs); ipsilateral bulbar weakness (dysphagia, dysarthria, hoarseness (vocal cord paralysis); autonomic dysfunction (horner’s, intractable hiccups)
In this type of stroke subtype, symptoms progress over minutes to hours. Focal neurologic symptoms appear early, followed by features of increased ICP (vomiting, headache, bradycardia, reduced alertness)
intracerebral hemorrhage
___ is the mainstay of medical treatment for infantile spasms
ACTH
___ presents with dry eyes, foreign body sensation, photophobia, and conjunctival irritation.
keratoconjunctivitis
Treatment of acute angle closure glaucoma is aimed at increasing aqueous outflow (name 3 types of drugs) or decreasing aqueous production (name 3 types). Definitive therapy is __ or __.
increasing outflow: cholinergics, epinephrine compounds, alpha adrenergic agonists
decreasing production: alpha agonists, beta blockers, carbonic anhydrase inhibitors
surgical or laser treatment
(tonometric testing will detect elevated intraocular pressures, gt 21 mmHg)
Idiopathic endolymphatic hydrops is also known as ___.
Meniere disease
