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NMSP > Week 2 (Exam 1) > Flashcards

Week 2 (Exam 1) Flashcards

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
Q

Three P’s of Pinpoint Pupils

A

Pontine Lesion, oPiates, PilocarPine

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26
Q

How to treat Benign Positional Vertigo

A

usually resolves spontaneously
PT, exxcercises
Meds: Anxiolytics, Antiemetics, Vestibular Suppressants

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27
Q

Sydenham’s Chorea

A

Usually in children, maybe follow Grp A Strep infection

Unilateral. Tx with Abx and bedrest

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28
Q

A stroke of which hemisphere is associated with aphasia?

A

Left

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29
Q

Ataxic respiratory pattern

A

Completely irregular

Medullary respiratory centers

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30
Q

Decerebrate posture

A

All extremities extended (brainstem lesion)

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31
Q

Requirements for vestibular migraine

A

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

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32
Q

Apneustic Breathing

A

Long inspiration followed by no breathing
Mid low pons
Anoxia, hypoglycemia, meningitis

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33
Q

Wilsons disease movement sx

A

Restin or postural tremor
Choreiform movements
Rigitity
Bradykinesia

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34
Q

Muscarinic receptors and the aqueous humor

A

More outflow: Contraction of ciliary muscle and iris circular muscle

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35
Q

All stroke patients need IV access. What considerations should you make when giving fluid?

A

DO NOT give glucose: hyperglycemia is associated with worse neurologic outcomes

36
Q

Etiology of Meniere’s disease

A

Increase in volume of labyrinthine endolymph because of poor absorption (end-lymphatic hydrops)

37
Q

Iris circular muscle

A

Contracts pupil to cause miosis and humor outflow

Effect is from M3 receptor activation

38
Q

Cheynes-stokes

A

Respiration pattern of hyper vs apnea

Bilateral hemispheres or diencephalon lesions

39
Q

What would count as an abnormal Head Impulse Nystagmus Test of Skew?

A

Normal HIT
Bidirectional or direction-changing nystagmus
Presence of skew deviation

40
Q

Possible sx of torsion dystonia presentation

A 
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
Q

What drugs can induce closed angle glaucoma?

A

Anything that causes mydriasis:
a1 adrenomimetics
Antimuscarinics

42
Q

Akinetic Mutism sx

A

Appears to have arousal, no awareness

No spontaneous motor activity

43
Q

Cerebellar stroke sx

A

Ipsilateral ataxia, vertigo, nystagmus

44
Q

Drugs used to treat sickness of disembarkment

A

Meclizine, Scopolamine, Benzos

45
Q

How do you test for Benign Positional Vertigo (BPV)?

A

Posterior and anterior: Dix Hallpike maneuver

Horizontal: Supine roll test (panini-McClure

46
Q

Cingulate gyrus herniation

A

Goes under the falx

47
Q

Spontaneous, roving stupor

A

Conjugate: brainstem intact
Dysconjugate: brainstem lesion (destructive: away from lesion)

48
Q

notable side effects of cholinergic agonists

A

eyelid twitching
cataracts
iris-lens adhesions

49
Q

Iris radial muscle

A

Dilates pupil to cause mydriasis and no humor flow

Effect is from a1 adrenergic receptor activation

50
Q

Caloric (oculovestibular) reflex

A

Lower pons lesion
Cold water irrigation:
Eyes deviate to irrigated side if unilateral irrigation
Eyes deviate downward if bilateral irrigation

51
Q

Presentation of Friedrich’s ataxia

A

1: onset before 20, gait ataxia, muscle weakness, no DTR
2: Pes Cavus, Scoliosis, Cardiomyopathy, Extensor plantar responses, maybe optic atrophy and nystagmus

52
Q

Types of vertigo associated with BPV

A

Posterior: Torsional
Horizontal: Horizontal direction changing
Anterior: Downbeat torsional

53
Q

Progressive Supranuclear Palsy (PSP)

A

Bradykinesia and rigidity

Loss of voluntary eye control (esp. vertical)

54
Q

Decorticate posture

A

Arms flexed, legs extended

Hemispheric lesion

55
Q

Presentation of AT

A

Choreoathetosis, loss of vibration and position sense in legs, voluntary eye movement disorders, mental def.
Progressive ataxia, oculocutaneous telangiectasia
Immunologic deficiency

56
Q

Notable side effects of prostaglandin analogs

A

iris hyperpigmentation
corneal erosion
conjunctival hyperemia
hyperpigmentation around eyelashes when discontinued

57
Q

Secondary generalized partial seizure presentation

A

Bilateral tonic-clonic activity
LOC, 1-3 minutes
post-ictal state

58
Q

Dix Hallpike results

A

Posterior canal BPV: nystagmus w/ affected ear down

Anterior: Nystagmus with affected ear up

59
Q

Presentation of Superior Canal Dehiscence

A

Episodic vertigo, nystagmus, oscillopsia, chronic disequilibrium
Triggered by loud noises, pressure in ext. auditory canal

60
Q

Treatment of open angle glaucoma

A

b-blocker or prostaglandin agent

alt: brimonidine or carbonic anhydrase inhibitor

61
Q

Criteria for Persistence of brain death

A

6 hours with flat ECG
12 hours without confirmatory isoelectric EEG
24 hours for anoxic brain injury without confirmatory isoelectric EEG

62
Q

Treatment for Wilson’s Disease

A

Penicillamine (copper chelating agent)

Restriction of dietary copper

63
Q

Presentation of Lewy body disease

A

Dementia
Parkinsonian sx
Prominent psychotic sx (esp hallucinations)
Extreme Sensitivity to Anti-Psychotic Agents

64
Q

What is the b-blocker of choice for treating glaucoma?

A

Timolol: lacks local anesthetic effects (like propranolol)

65
Q

Sx of Uncal Transtentorial Herniation

A

CNIII compression: Ipsilateral dilated pupil, poor EOM, ptosis
Then, contralateral brainstem (ipsilateral hemiparesis)
Respiratory bad, posturing, fixed pupils, death

66
Q

Idiopathic Torsion Dystonia presentation

A

Dystonic Movements and postures, no other sx
Inherited AD, AR, or X
Onset maybe in childhood or later, but persists

67
Q

Central Transtentorial Herniation

A

Goes into Foramen Magnum
Leads to early coma, small pupils, normal EOMs, Posturing and later bilateral fixed pupils
Respiratory arrest and death

68
Q

Myoclonic seizure presentation

A

Brief, rapid symmetrical jerking of extremities/torso
LOC, lasts seconds
Minimal post-ictal state

69
Q

Genetics of AT

A

AR chr 11 mut, begins in infancy

70
Q

Closed angle glaucoma with vs without pupillary block

A

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
Q

Atonic Seizure Presentation

A

Sudden loss of muscle tone
Head drops or collapses
LOC, variable duration
Post-Ictal state

72
Q

Complex partial seizure

A 
Non-responsive staring
Possible preceding aura
Automatisms
LOC, 1-3 minutes
Post-ictal state
73
Q

Tonic-Clonic Seizure Presentation

A

Bilateral extension followed by symmetrical jerking of extremities
LOC, 1-3 minutes
Post-ictal state

74
Q

Psychogenic coma sx

A

Altered arousal and awareness

Changing / inconsistent physical examination

75
Q

Sympathetic nervous system and the aqueous humor

A

Decreased outflow: contraction of iris radial muscle

More uveoscleral outflow: Relaxed ciliary muscle

76
Q

Role of ciliary epithelium

A

Secretes aqueous humor
b-adrenergics increase humor (Gs)
a3 adrenergic decrease humor (Gi)

77
Q

Vestibular Neuronitis

A

Spontaneous Vertigo w/out hearing loss, non-positional
peaks in 24 hours, lasting days to weeks
Maybe CN VIII lesion, resolves spontaneously

78
Q

Cortical basal degeneration

A

Cortical and basal ganglionic dysfunction
Bradykinesia and rigidity
Maybe sensory loss, apraxia, myoclonus or aphasia

79
Q

Sings and sx of cerebellopontine angle tumor

A

Generally involves CN V, VII, VIII
Starts with Hearing loss and absent corneal reflex
Generally associated with NF1 and NF2

80
Q

How to treat meniere’s disease

A

Lorazepam / Diazepam
Na restriction to 1.5-2 mg /day
Thiazides / Furosemide
Endolymphatic sac decompression

81
Q

What drugs can induce open angle glaucoma

A

Glucocorticoids

Topical antimuscarinic drugs

82
Q

Sensory Disequilibrium

A

Visual impairment, vestibular disorders.

Worse in the dark, associated w/ Romberg Sign

83
Q

Drugs that cause outflow of aqueous humor

A

PG analogs: (Latanoprost / Bimatoprost! / Travoprost)
a2-Adrenergic analogs: (Apraclonidine / Brimonidine)
Direct Cholinergic: (Carbachol / Pilocarpine)
Cholinesterase inhibitors (Echothiophate)

84
Q

Stroke scale and hemorrhage risk

A

Below 10? 2-3% risk

Above 20? 17% risk

85
Q

Simple partial seizure presentation

A

Focal motor or sensory activity

Lasts seconds

86
Q

Tourette’s treatments (3)

A

Clonidine
Haloperidol
Phenothiazines

87
Q

What might you use to treat focal torsion dystonia?

A

Botox

NMSP (7 decks)

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