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Coma & Drugs
Final-Lecture 20
58
Medical
Graduate
07/28/2013

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Term
Level of consciousness based on Glasgow Coma Scale
Does not open eyes
Definition
Score=1
Term
Level of consciousness based on Glasgow Coma Scale
Opens eyes in response to painful stimuli
Definition
Score=2
Term
Level of consciousness based on Glasgow Coma Scale
Opens eyes in response to voice
Definition
Score=3
Term
Level of consciousness based on Glasgow Coma Scale
Opens eyes spontaneously
Definition
Score=4
Term
Pupil reaction upon passive eyelid opening in normal vs. comatose patient
Definition
Normal-pupil constriction
Sleeping/comatose=dilation
Term
2 possible interpretations of bilateral pinpoint pupils that still react to light
Definition
heroin overdose
damage to pons
Term
3 possible interpretations of bilateral, dilated and unreactive pupils
Definition
med overdose
hypothermia
severe anoxia
Term
Describe a positive response to testing doll's eye movements
Definition
Positive=eyes rotate to the opposite side of the direction head rotation, thus midbrain and brainstem are intact
Term
In coma, if the eye turns upwards but the eyelid does not close there is CN ____ lesion
Definition
CN7 lesion (Bell's phenomenon)
Term
In coma, if they eye does not turn upward and the eyelid does not close there is a CN _____ lesion
Definition
CN 5 lesion
Term
Best way to test corneal sensitivty in coma pt, that avoids corneal trauma
Definition
Drop sterile saline onto cornea from a height of 10 cm
Term
Sometimes patients can't lift their lids even with the help of frontalis, this is called __________ __________
Definition
Cerebral Ptosis
Term
If there is horizontal deviation of the eyes along with cerebral ptosis and hemiplegia due to hemispheric lesion, in which direction is the deviation
Definition
Horizontal deviation is usually AWAY from hemiparetic side
Term
If there is horizontal deviation of the eyes along with cerebral ptosis and hemiplegia due to pons or thalamus lesion, in which direction is the deviation
Definition
Expect a 'wrong way' deviation towards hemiparesis
Term
How does Caloric testing (cold water) affect endolymph
Definition
becomes more viscous
Term
Describe the nystagmus caused by ice cold water in the left ear
Definition
fast phase jerk to the right side and slow phase towards ear
COWS-reference to fast phase of nystagmus
Term
With COWS testing, which direction will the eyes deviate (after the nystagmus)
Definition
Eyes will deviate towards the cold water, even when trying to look straight up
Term
____________ lesions can result in classic ocular bobbing
Definition
Pontine lesions
Term
Eye movements in classic ocular bobbing
Definition
Spontaneous Rapid eye Movements downwards, with slow drifts upwards
Term
What type of ocular bobbing can be caused by benzodiazepines
Definition
Reverse bobbing
Term
What type of ocular bobbing can be caused by CO poisoning
Definition
Inverse bobbing
Term
What type of ocular bobbing can be caused by AIDS or bipolar meds
Definition
Converse bobbing
Term
Reverse ocular bobbing is ____________ jerks
Definition
Upward jerks
Term
Inverse ocular bobbing is very slow ____________movements
Definition
very slow downward movements
Term
Converse ocular bobbing is very slow ____________ eye movements
Definition
very slow upward eye movements
Term
Ocular bobbing =_________________________ lesion
Definition
cerebellar lesion
Term
Effect of Depressants on Convergence
Definition
Convergence insufficiency
Term
Effect of Depressants on Eyelids
Definition
Eyelid ptosis
Term
Effect of Depressants on Fixation
Definition
Horizontal gaze nystagmus
Vertical gaze nystagmus with high dose
Term
Effect of Depressants on Pupils
Definition
Pupil dilation
Term
Effect of Stimulants on Fixation
Definition
None
Term
Effect of Cannabis on Convergence
Definition
Convergence Insufficiency
Term
Effect of Stimulants on Pupils
Definition
Dilated and sluggish
Term
Effect of Hallucinogens on Fixations
Definition
None
Term
Effect of Hallucinogens on Convergence
Definition
None
Term
Effect of Hallucinogens on Pupils
Definition
Dilated but still reactive
Term
Effect of PCP on Fixations
Definition
Vertical and Horizontal Gaze Nystagmus
Term
Effect of PCP on Convergence
Definition
Convergence Insufficiency
Term
Effect of PCP on Pupils
Definition
None, pupils are normal
Term
Effect of Narcotic Analgesics on Fixations
Definition
None
Term
Effect of Narcotic Analgesics Convergence
Definition
None
Term
Effect of Narcotic Analgesics on Pupils
Definition
Constricted, miotic reaction or none
Term
Effect of Narcotic Analgesics on Eyelids
Definition
Bilateral Ptosis
Term
An ocular side effect of both tramadol and oxycodone
Definition
Both cause swelling of the eyes
Term
Effect of Inhalants on Fixations
Definition
HGN and VGN in high dose
Term
Effect of Inhalants on Convergence
Definition
Convergence Insufficiency
Term
Effect of Inhalants on Pupils
Definition
Normal or dilated, sluggish
Term
Effect of Cannabis on Fixation
Definition
None
Term
Effect of Stimulants on Convergence
Definition
None
Term
Effect of Cannabis on Pupils
Definition
Dilated, normal reaction
Term
Effect of Cannabis on eyelids
Definition
Eyelid tremors
Term
2 effects of cannabis on the eyes
Definition
Reddening
Decreased IOP
Term
3 Illicit drugs that cause horizontal gaze nystagmus
Definition
Depressants
PCP
Inhalants
Term
Illicit drugs that affect convergence
Definition
Depressants
Cannabis
PCP
Inhalants
Term
3 Illicit drugs that DO NOT affect convergence
Definition
Stimulants
Hallucinogens
Narcotic Analgesics
Term
Which illicit drugs dilate pupils
Definition
Depressants
Stimulants
Hallucinogens
Maybe inhalants
Term
Which illicit drugs constrict pupils
Definition
Narcotic analgesics
Term
Which illicit drugs affect the pupil light response
Definition
Depressants
Stimulants
Narcotic Analgesics
Inhalants
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