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76 Cards in this Set
- Front
- Back
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What are the signs of Horner's Syndrome?
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ptosis and constriction (loss of symph)
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Normal intraocular pressure
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10-20 mmHg
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What is a good choice for dilating eyes/
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Tropicamide (mydriasil) 1%
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What test must be done before dilated a pt's eyes?
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Penlight test - shine bean across eye, parallel to plane of iris, if light goes all the way across - safe
if not - more likel to be angle closure glaucoma |
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How can conjunctivitis be diciphered from uveitis?
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Involvement of the both epibulbar and palpebral conjuctiva
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What does a stringy, white mucus conjuctival discharge usually indicate?
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allergies
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What does a clear conjuctival discharge usually indicate?
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viruses, chemical or allergic
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What is the most common infection for contact users?
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pseudomonas
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What virus classically causes pink eye?
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adenovirus
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How does adeno conjuctivitis present?
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follicles - lymphoid aggregates, palpable preauricular lymphadenopathy
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What is the complication of viral conjunctivitis and how should it be tx?
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corneal ulceration - topic steroids
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What dx tool is helpful for looking at corneal pathology?
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fluorescein dye
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What eye injury present as a dendritic ulcer of cornea?
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Herpes simple keratitis
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What is the #1 cause of inflammatory blindness and corneal ulceration in US?
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Herpes simple keratitis
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What hyperpurulent eye infections can cause significant damage if not tx early?
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N. meningitidis
N. gonorrhoeae |
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What is the most common cause of blindness worldwide?
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cataracts
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What is the #1 cause of cataracts?
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DM
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How are cataracts tx?
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surgery
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What is the normal flow of acqueous humor in the eye?
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In: zonules --> pupil --> ant chamber
Out: trabecular meshwork --> cavernous sinus |
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What is the presentation of open angle glaucoma?
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triad:
visual field los intraocular pressure Optic nerve damage |
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What is the typical intraocular pressure reading for a pt w/ open angle glaucoma?
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30
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What is seen on fundoscopy in open angle glaucoma?
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vertical elongation of cup, enlarge cup/disc diameter
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How does angle closure glaucoma present?
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pain, cloudy vision, rainbow halows around lights, nausea
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What is the typical introcular pressure reading for a pt w/ angle closure glaucoma?
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60-80
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What is the #1 cause of new adult cases of blindness in the US?
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Diabetic retinopathy
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What is the pathophysiology of diabetic retinopathy?
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hyperglycemia --> pericyte death and thickening of cap enothelial basement membrane --> change formation of blood-retinal barriers and makes vessels more permeable and less strong --> microaneurysms and rupture
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What are the stages of diabetic retinopathy and what is seen on exam?
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Nonproliferative - microaneurysms
Macular edema - edema, hard exudates Proliferative - presence of new vessels on optic disk/elsewhere in retina |
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What is used to tx proliferative diabetic retinopathy?
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triamcinolon or anti-VEGF, panretinal photocoagulation
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What is the pathophysiology in dry macular degeneration?
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Drusen (cholesterol?) --> accumulation b/w retina and choroid --> retinal detachment
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What is the pathophysiology in wet macular degeneration?
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vessels grow up from choroid behind retina --> detachmnt
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Where are the visual field deficit reported in macular degeneration?
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middle
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What is the vascular supply to the optic nerve?
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majority comes off ophthalmic artery, which pierces nerve itself --> central retinal artery...branches feed back to nerve head
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What CN is most affected by aneurisms?
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III
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What CN is the tentorium near to?
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IV
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What neuro dz are asc w/ loss of smell?
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Alzheimers, PD, prion dz
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What is the function of the pinna and ear canal?
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directs sound waves into auditory canal, aid in sound localization
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What is the function of the middle ear?
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transform and amplify vibration of air into fluid energy
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What is the #1 cause of conductive hearing loss in the elderly?
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otosclerosis
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In noise induced hearing loss, what frequencies are first to go?
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High
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What is the most common cause of unilateral sensorineural hearing loss?
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acoustic neuroma
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What is the etiology of myasthenia gravis?
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AI attack of ACh recepros
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Does myasthenia gravis tend to affect distal or proximal muscles more?
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proximal
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What dx test are used for myasthenia gravis?
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Repetitive nerve stimulation (progressive decrement in consecutive AP)
Single-fiber EMG (latency is abnormally variable) |
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What is the tx of myasthenia gravis?
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pyridostigmine (anitcholinesterase)
prednisone - if sxs worsen despite tx |
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What is Lambert-Eaton syndrome asc w/?
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underlying neoplasm (small-cell) or AI like pernicious anemia
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What is the target in Lamber-Eaton syndrome?
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voltage-gated Ca channel involved in ACh release
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How is Lambert-Eaton different in presentation from Myasthenia Gravis?
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Extraocular and respiratory muscles are spared
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What is the dx tool for Lambert-Eaton syndrome?
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repetitive nerve stimulation (inc in size of muscle repsonse to stimulation)
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What does botulism toxin do?
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prevents activation of both nicotinic and muscarinic ACh receptors
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In what neuromuscular disorder are oculobulbar sxs most prominent and precede limb weakness?
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botulism
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What is Guillain-Barre syndrome?
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acute/subacute AI polyneuropathy that can follow minor infections, inoculations or surgical procedures
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How does Guillain-Barre present?
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symmetric weakness - usually beginning in legs (proximal>distal)
Sensory complaints less than motor Abset DTR |
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What is the tx of Guillain-Barre?
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plasmapheresis/IVIg
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What is the inheritance pattern and defect in CMT?
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AD --> disrupt myelin production
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What is the difference b/w CMT 1 and 2?
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1 - demyelinating
2- neuronal (spares sensory neurons) |
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How does CMT present?
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Weakness/wasting of distal limb (usually legs)
Pes cavus (highly arched foot) reduced/absent tendon reflexes |
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How does ALS present?
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muscle weakness and atrophy throughout body
fasciculation spared cognitive function hyperreflexia |
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What is responsible for the "awake" drive?
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suprachiasmatic nucleus
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what is entrainment?
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alignment of own circadian rhythm w/ external rhythm
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What is the pathophysiology of light entrainment?
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melanopsin --> retinohypothalamic tract --> SCN --> local connection to other parts of hypothalamus --> inhibits pineal gland --> inhibits melatonin secretion --> inhibits drowsiness
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What is the neuroanatomy of sleep?
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SNC sends awake output to rest of hypothalamus and extra-hypothalamic nuclei --> inhibition of VLPO --> hypocretin release
When VLPO is activated --> GABA to hypothalamus --> inhibition of hypocretin --> inhibition of many structure (mostly TMN) --> dec/acsent activity in thalamus/cortex --> sleep |
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How is adolescent sleep characterized?
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stage 3-4 occur predominantly during early hours - REM increases as night goes on
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What consequences as asc w/ too much/little sleep?
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htn, glucose intolerance
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Who does narcolepsy affect?
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teens mostly
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What is the pathophysiology of narcolepsy?
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absence of hypocretin-producing cell
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What is the multiple sleep latency test and what dx is it most helpful for?
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tests how long it take pts to go to sleep in nap:
Narcolepsy <8 min (normal >10) sleep onset REM period (w/i 2 naps for narcolepsy dx) |
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What is the HLA types asc w/ narcolepsy?
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DQB1-0602 (-15)
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How is sleep apnea severity measured?
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apnea-hypopnea index = # event/hr
Mild = 5-15 Moderate = 15-30 Severe = 30+ |
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What are the 2 broad categories of central sleep apnea defects?
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hypercapnic at baseline (pts don't breathe enough when awake - prob w/ brain/nerves, lungs or muscles)
normocapnic at baseline (pts are overly sensitive to normal hypoventilation that occurs during sleep) |
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What is restless leg syndrome commonly asc w/?
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B12 deficiency or anemia
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What is thought to be the role of Fe in restless leg?
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how dopamine works
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What are the criteria for restless leg dx?
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1. Compelling urge to move
2. Improvement w/ movement 3. Worse at rest/inactivity |
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What are the 2 medical tx of RLS?
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dopaminergics
Requip/Mirapex |
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What are the 3 types of Non-REM arousal disorders?
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Confusional, somnambulism, sleep terrors
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What are REM-arousal disorders asc w/?
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Parkinson's and other alpha synuclein dz
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What is the main tx for REM-arousal disorders?
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Benzo
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