Sleepiness/neck/arm Pain/subarachnoid Hemorrhage

Front 1

What triad is suggestive of obstructive sleep apnea?

Back 1

daytime sleepiness, obesity, hypertension

Front 2

Why does sleep apnea cause worsening hypertension?

Back 2

nocturnal hypoxemia -> hypothalamic activation --> sympathetic stimulation

Front 3

Where does hypertension due to OSA localize to ?

Back 3

hypothalamus

Front 4

Why would pts. with OSA get right heart failure --> ankle edema?

Back 4

repetitive anoxic insult to myocardium during sleep

Front 5

Where is "sleepiness" localized to?

Back 5

reticular activating system (brainstem), bicerebral hemispheres

Front 6

How does OSA affect the reticular activating system?

Back 6

disrupted sleep architecture --> nonstructural dysfunction of RAS

Front 7

What blood cell abnormality would you expect in OSA?

Back 7

mild polycythemia (due to nocturnal hypoxia)

Front 8

What is an apnea?

Back 8

cessation of airflow for > or = 10 seconds

Front 9

What is a hypopnea?

Back 9

50% reduction in airflow for > or = 10 seconds associated with > or = 3% oxygen desaturation

Front 10

What is the AHI?

Back 10

Sum of apneas + hypopneas/hour

Front 11

What is a normal RDI (AHI)?

Back 11

less than five; 10 is moderate, 15 is severe

Front 12

What causes increased tachyarrhythmias in OSA?

Back 12

Increased sympathetic activation

Front 13

What causes bradyarrhythmias in OSA?

Back 13

cyclical changes in parasympathetic activity

Front 14

What does polysomnography show in narcolepsy?

Back 14

NORMAL

Front 15

What test is abnormal in narcolepsy?

Back 15

multiple sleep latency testing

Front 16

What findings on MSLT indicate narcolepsy?

Back 16

More than two sleep-onset REM periods and mean sleep latency < 5 minutes

Front 17

Treatment for narcolepsy?

Back 17

strategically placed naps, stimulants

Front 18

Cataplexy treatment?

Back 18

TCAs, SSRIs

Front 19

What could you do other than CPAP for OSA?

Back 19

a tongue or jaw-retaining device or surgery (last choice)

Front 20

Caffeine, sedatives, and alcohol are bad for sleep apnea. Why?

Back 20

caffeine- delay onset of sleep, more frequent arousals
alcohol- decreased neuromuscular tone of the upper airway. also frequent awakenings at night
sedatives- decreased tone of upper airway, also depress RAS and prevent arousals

Front 21

transient sensory symptoms and weakness in one extremity, exacerbated by arm/neck position, and assoc. with neck pain on awakening are suggestive of?

Back 21

nerve/nerve root compression

Front 22

Positional symptoms suggest peripheral or CNS?

Back 22

peripheral

Front 23

sensation to the thumb is provided by which nerve root?

Back 23

C6

Front 24

C6 feeds into which two nerves serving the arm?

Back 24

radial, median

Front 25

history of repetitive wrist flexion --> ?

Back 25

carpal tunnel

Front 26

carpal tunnel symptoms are often worse when?

Back 26

at night

Front 27

How is smoking assoc. with neuropathy?

Back 27

risk factor for lung cancer which can metastasize to vertebrae

Front 28

How is alcohol associated with neuropathy?

Back 28

compression neuropathy from not moving during alcohol induced sleep

Front 29

What is Tinel sign?

Back 29

tapping on site of a nerve

Front 30

What is phalen sign?

Back 30

pushing dorsal surfaces of both flexed wrists together for 30-60 seconds- re-creates carpal tunnel symptoms

Front 31

which muscles are innervated by c6 nerve root?

Back 31

biceps, brachioradialis, wrist extensors

Front 32

which muscles does the musculocutaneous nerve supply?

Back 32

biceps, sensation to lateral forearm

Front 33

Musculocutaneous nerve- fibers/muscles

Back 33

Musculocutaneous nerve is composed of fibers from C5 & C6 nerve
roots. It only supplies the biceps muscle and sensation to the lateral
forearm

Front 34

Radial nerve- fibers/muscles

Back 34

Radial nerve is composed of fibers from C5, C6, C7, and C8. It supplies
the triceps, brachioradialis, wrist extensor muscles, and sensation
to the posterior arm.

Front 35

Median nerve-fibers/muscles

Back 35

Median nerve is composed of fibers from C6, C7, C8, and T1 nerve
roots. It supplies muscles of the hand including wrist and finger
flexors, thenar (thumb) muscles, and provides sensation to the 1st,
2nd, 3rd, and half of the 4th digits.
5/11/12
10

Front 36

where is weakness seen in carpal tunnel syndrome?

Back 36

grip

Front 37

What would you expect to see in CTS regarding reflexes?

Back 37

normal reflexes

Front 38

Treatment for c6 radiculopathy

Back 38

proper neck positioning, NSAIDs, cervical traction/surgery

Front 39

treatment for radial nerve palsy

Back 39

cock-up wrist splint

Front 40

how are the findings in radial nerve palsy different from c6 radiculopathy?

Back 40

radial nerve palsy has normal biceps, c6 has weak biceps

Front 41

Paraspinal tenderness might make you think of?

Back 41

epidural abscess, epidural hematoma

Front 42

What imaging tests would you use for diagnosing radiculopathy/neuropathy?

Back 42

EMG/nerve conduction study, MRI cervical spine

Front 43

What is EMG?

Back 43

Needle inserted into muscle - normal muscle is silent, but if there is damage, muscle will show signs of "denervation" such as fibrillations or positive sharp waves

Front 44

What is NCS?

Back 44

Stimulating electrode is placed on skin over nerve being testing,and current is run through causing nerve to fire; conduction velocity is recorded.

Front 45

If myeline is damaged, what will happen to NCS?

Back 45

Conduction velocity will be slowed

Front 46

In carpal tunnel, what are NCS results?

Back 46

conduction velocity is slower across the wrist

Front 47

C6 radiculopathy would have what EMG/NCS results?dis

Back 47

Evidence of denervation on NCS in left C6 distribution

Front 48

Treatment for cervical radiculopathy due to herniated disk?

Back 48

NSAIDs, steroids, cervical traction (PT), surgery

Front 49

What are indications for surgery in herniated disk radiculopathy?

Back 49

weakness, intractable pain

Front 50

What changes can pt. make around the house to help with cervical radiculopathy due to herniated disk?

Back 50

firm mattress, cervical pillow, supine/on side in bed, use of cervical collar- should have slight neck flexion.