Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
158 Cards in this Set
- Front
- Back
- 3rd side (hint)
|
which NT mediates opiod tolerance
|
glutamate
|
|
|
|
ketamine
|
NMDA antagonist, like PCP (can be used to prevent dev of opiod tolerance)
|
|
|
|
dextromethorphan
|
codeine derivative used as a cough suppressent (robutussin)
|
|
|
|
physical exam findings in tetanus
|
masseter muscle spasms (lockjaw), facial grimacing (risus sardonicus), other muscle spasms
|
|
|
|
internuclear ophthalmoplegia (INO)
|
common initial manifestation of MS -- degradation of MLF (medial longitudinal fasciculus), responsible for coordination of lateral gaze
|
|
|
|
dx of MS
|
scattered sclerotic plaques detectable on MRI
|
|
|
|
personality disorder of "low self esteem"
|
avoidant
|
|
|
|
microscopic changes in prion disease
|
spongiform transformation of gray mater (Creutzfield-Jakob, Bovine Spongiform Encephalopathy)
|
|
|
|
cytoplasmic inclusions in oligodendrocytes
|
PML (progressive multifocal leukoencephalopathy)
|
|
|
|
microglial nodules + multinucleated giant cells
|
HIV encephalopathy
|
|
|
|
rosenthal fibers
|
pilocytic astrocytoma
|
|
|
|
cystic tumor in cerbellum of kid
|
pilocytic astrocytoma
|
|
|
|
morphology of pilocytic astrocytoma
|
well-differentiated neoplasm comprised of spindle cells w/ hair-like glial processes a/w microcysts
|
|
|
|
2 most common brain tumors in kids
|
1) pilocytic astrocytoma; 2) medulloblastoma
|
None
|
|
|
most common location of ependymomas
|
infratentorial, roof of 4th ventricle in kids; spinal in adults
|
|
|
|
histo appearnce of ependymomas
|
ependymal pseudorosettes w/ GFAP=positive processes tapeirng toward BV
|
|
|
|
2 most common brain tumors in adults
|
1) glioblastoma multiforme (GBM); 2) meningioma (often adjacent to falk cerebri)
|
None
|
|
|
first brain area damaged by global systemic ischemia (aka hypoxic-ischemic encephalopathy)
|
hippocampus, followed by neocortex and cerebellum
|
|
|
|
csf findings in MS
|
increased IgG (oligoclonal band on protein electrophoresis)
|
|
|
|
opsoclonus-myoclonus
|
rapid involuntary eye movements and bring, involuntarily twitching muscles; a/w NEUROBLASTOMA
|
|
|
|
neurofibromas of neurofibromatosis
|
tumors of schwann cells -- skin/pink-colored nodules w/ pathognomonic "buttonholing" ("buttonhole" down thru skin with gentle pressure)
|
|
|
|
small yellow retinal lesions clustered in the macula
|
macular degeneration (progressive loss of central vision due to deposition of fatty tissue behind retina -- dry MD, and neovascularization of the retina -- wet MD)
|
|
|
|
CNS origin of 5-HT
|
raphe nuclei of brain stem -- involved in sleep-wake cycle, arousal level; lesions --> insomnia, depression
|
|
|
|
CNS origin of NE
|
nucleus ceruleus
|
|
|
|
CNS origin of ACh
|
nucleus basalis of Meynert (deficient in Alzheimer disease)
|
|
|
|
myotonia
|
abnormally slow relaxation of muscles (characteristic of myotonic muscular dystrophy)
|
|
|
|
myotonic dystrophy genetics
|
AD, CTG repeats (anticipation), presents childhoood->late adulthood
|
|
|
|
myotonic dystrophy findings
|
Type I fibers more affected; skeletal myotonia (inability to release handshake, doorknob); CATARACTS in almost all pts. Frontal balding, gonadal atrophy
|
|
|
|
role of gamma loop in reflex control
|
CNS stims gamma motor neuron, contracts intraufusal fiber -- increases sensitivity of reflex arc if muscle length changes
|
|
|
|
achilles reflex -- what nerve root
|
S1
|
|
|
|
patellar refelx -- what nerve root
|
L4
|
|
|
|
what causes primative reflexes to return?
|
frontal lobe lesion
|
|
|
|
moro reflex
|
startle reflex
|
|
|
|
which cranial nerves lie medially at BS?
|
3, 6, 12 (3x2=6x2=12)
|
|
|
|
which CNs control salivation?
|
7: submaxillary and sublingual glands; 9: parotid gland
|
|
|
|
which CNs are in the midbrain
|
3 and 4
|
|
|
|
which CNs are in the pons
|
5, 6, 7, 8
|
|
|
|
which CNs are in the medulla
|
9, 10, 12
|
|
|
|
what makes endolymph
|
stria vascularis
|
|
|
|
motor and sensory nuclei of CN 9 and 10
|
Sensory = Solitary nucleus (taste, baroreceptor, visceral sens from 7,9,10); Motor = nucleus aMbiguus (motor innervation to pharynx, larynx, and upper esophagus for 9,10,11)
|
|
|
|
autonomic motor nucleus of vagus
|
DORSAL MOTOR NUCLEUS: autonomic fibers to heart, lungs, upper GI
|
|
|
|
holes in middle cranial fossa (sphenoid bone) (5), and which CNs
|
Optic canal, Superior orbital fissure, Foramen Rotundum, Foramen Ovale, Foramen spinosum; CNs 2-6
|
|
|
|
holes in posterior cranial fossa (temporal or occipital bone) (4), and which CNs
|
Internal auditory meatus, Jugular foramen, Hypoglossal canal, Foramen magnum; CNs 7-12
|
|
|
|
hypothalamic nuclei that modulate hunger and satiety
|
hunger: LATERAL; satiety: VENTROMEDIAL (when you lesion your ventromedial nucleus, your ventromedial area [gut] grows)
|
|
|
|
what goes through optic canal
|
CN 2, ophthalmic artery, central retinal vein
|
|
|
|
what goes through superior orbital fissure
|
CN 3, 4, 5.1, 6; ophthalmic vein
|
|
|
|
what goes through foramen rotundum
|
CN 5.2
|
|
|
|
what goes through ovale
|
CN 5.3
|
|
|
|
what goes through spinosum
|
Middle meningeal artery
|
|
|
|
what goes through internal auditory meatus
|
CNs 7, 8
|
|
|
|
what goes through jugular foramen
|
CNs 9, 10, 11; jugular vein
|
|
|
|
what goes through hypoglossal canal
|
CN 12
|
|
|
|
what goes through foramen magnum
|
spinal roots of CN 11; vertebral arteries; brain stem
|
|
|
|
tx for trigeminal neuralgia
|
carbamazepine
|
|
|
|
what nerves/vessels do you find in cavernous sinus?
|
internal carotid; CNs 3, 4, 5.1, 5.2, 6; OTHERS: pit gland
|
|
|
|
which nerve is "free-floating" in the cavernous sinus?
|
CN VI (others are attached to lateral walls)
|
|
|
|
mastication muscles
|
Masseter, Medial pterygoid, teMporalis all close jaw (Munch); Lateral pterygoid Lowers jaw (opens)
|
|
|
|
which "glossus" has a different innervation?
|
palatoglossus (10 vagus), others are all 12
|
|
|
|
which "palat" has a different innervation?
|
tensor veli palatini (5, along w/ tensor tympani), rest are 10
|
|
|
|
actions of superior oblique muscle and its innervation
|
down and out (CN 4)
|
|
|
|
how does trochlear nerve lesion present
|
CN IV -- superior oblique muscle -- vertical diplopia when looking at nose (eg trying to walk down stairs)
|
|
|
|
how to test oral muscles with sounds?
|
Lick My Cock (Li = 12, hypoglossal; My = 7, face; Co = 10, vag)
|
|
|
|
what NT initiates sleep, and from where?
|
5-HT from raphe nucleus
|
|
|
|
cataplexy
|
transient attack of extreme gernalized weakness, often precipitated by emotion state; often seen in narcolepsy
|
|
|
|
hypnagogic vs hypnopompic hallucinations
|
hypnagogic: when FALLING ASLEEP; hypnopompic: when WAKING ("gogic = gone, pompic = poppin")
|
|
|
|
with which sleep stage is teeth grinding (bruxism) associated?
|
stage 2 (sleep spindles, k complexes); pt usually unaware
|
|
|
|
physiologic changes in REM
|
inc pulse and BP, penile/clitoral erection -- state of AROUSAL, decreases with age
|
|
|
|
csf findings in meningitis from bacteria vs fungus
|
BOTH have inc cells, dec glucose, inc proteins, inc pressure; BACTERIA have PMNs, FUNGUS have LYMPHOCYTES
|
|
|
|
causes of viral encephalitis
|
Arthropod (St. Louis, California, Toga [WEE, EEE, VEE]); HSV; RABIES; HIV
|
|
|
|
sx of acruate fasciculus lesion
|
"conduction aphasia:" poor repetition with good comprehension and fluent speech
|
|
|
|
cerebellar lesions: hemisphere vs. vermis
|
hemispheres located LATERALLY, cause ataxia of LATERAL limbs; vermis located CENTRALly, causes ataxia of CENTRAL body (trunk)
|
|
|
|
basal ganglia lesions presentation (2)
|
1) CHOREA: sudden jerky purposeless movements, dance-like; 2) ATHETOSIS: slow, writhing movements, esp of fingers
|
|
|
|
NT changes in Alzheimer's and Tx
|
dec ACh (from nucleus basalis of Meynert); Tx with AChEi
|
|
|
|
pick's disease
|
like alzheimer's dz -- dementia; intracellular aggregated tau protein (Pick bodies); FRONTAL and temporal lobe atrophy, aphasia, parkinsonian aspects
|
|
|
|
NT changes in Huntington's
|
loss of ACh and GABA (from caudate nucleus atrophy)
|
|
|
|
MPTP
|
opiod contaminant in street drugs -- causes destruction of dopaminegic cells in s.nigra --> parkinsons
|
|
|
|
sx of parkinson's dz
|
"TRAPped in your own body:" Tremor (resting), Rigidity (cogwheel), Akinesia, Postural instability
|
|
|
|
alpha-synuclein in damaged cells
|
Lewy bodies, found in Parkinson's disease
|
|
|
|
friedreich's ataxia
|
AR dz w/ trinucleotide expansion on 9q; causes ataxia, dysarthria, scoliosis, muscle paralysis (lower extremities); a/w hypertrophic cardiomyopathy
|
|
|
|
ALS (amyotrohpic lateral sclerosis)
|
aka Lou Gherig's Dz; loss of both UMN (lateral corticospinals) and LMN, no sensory deficit
|
|
|
|
werdnig-hoffman disease
|
degeneration of ANTERIOR HORNS; AR, "floppy baby" -- tongue fasciulations, death < 1y;
|
|
|
|
which neurons affected by polio?
|
LMN (anterior horn)
|
|
|
|
polio: transmission and replication
|
transmitted fecal-oral ==> replicates in oropharnyx / small intestines --> blood --> CNS spread
|
|
|
|
csf changes in MS
|
oligoclonal spikes (IgG)
|
|
|
|
albumino-cytologic dissociation
|
seen in GUILLAIN-BARRE: greatly increased protein conc with only moderatly increased cell count
|
|
|
|
viral infection of oligodendrocytes --> demyelination
|
progressive multifocal leukoencephalopathy (PML), caused by JC virus (a polyoma virus of the Papova family)
|
|
|
|
neuro: lucid interval
|
epidural hematoma: skull fracture --> temporary imporvement --> brain damage after minutes/hrs
|
|
|
|
causes of subdural hematoma
|
rupture of bridging veins; predisposing factors: brain atrophy (pulls brain from dura --> stretched veins), shaking, whiplash
|
|
|
|
cause / presentation of subarachnoid hemorrhage
|
rupture of aneurysm (usu berry) or AVM; "worst headache of life," blood in spinal tap
|
|
|
|
charcot-bouchard aneurysms
|
dilations at small artery bifurcations, formed by chronic HTN; prone to rupture --> PARENCHYMAL/INTRACRANIAL HEMORRHAGE (often in basal ganglia/thalamus)
|
None
|
|
|
MCC severe viral encephalitis
|
HSV
|
|
|
|
most common site of berry aneurysm
|
anterior communicating artery of circle of willis
|
|
|
|
dzs a/w berry aneurysm
|
adult polycystic kidney disease, ehlers-danlos, marfan's
|
|
|
|
hemorrhagic lesions of temporal lobes -- what infectious cause?
|
herpes simplex virus
|
|
|
|
toxo vs cryptococcus
|
both cause CNS infection in AIDS pts; cryptococcus causes meningioencephalitis, toxoplasma causes parenchymal abscesses
|
|
|
|
cerebellar tumors in kids
|
MEDULLOBLASTOMA (v. malignant, rosettes/pseudorosettes, can cause hydrocephalus, primitive neuroectoderm tumors [PNET]); HEMANGIOBLASTOMA (foamy cells w/ high vascularity, a/w VHL, produces EPO); PILOCYTIC ASTROCYTOMA (rosenthal fibers, low-grade tumors, better prog than medulloblastoma)
|
|
|
|
tumors that cause hydrocephalus
|
MEDULLOBLASTOMA and EPENDYMOMA (both also have perivascular pseudorosettes and carry a poor prognosis);
|
|
|
|
spinal cord lesion in complete occlusion of ventral artery
|
spares dorsal columns and tract of lissauer
|
|
|
|
spinal cord deficit in Vit B12 deficiency
|
demyelination of dorsal columns, lateral corticospinal tracts, and spinocerebellar tracts
|
|
|
|
spinal cord deficit in Friedreich's ataxia
|
same as vit b12: dorsal columns, lateral corticospinals, spinocerebellars
|
|
|
|
most common site and functional deficit in syringomyelia
|
most common at C8-T1, causes b/l loss of pain/temp in upper extremities (preservation of touch)
|
|
|
|
with what dz is syringomyelia associated?
|
Arnold-Chiari malformation
|
|
|
|
brown-sequard syndrome
|
hemisection of spinal cord --> IPSILATERAL {UMN, dorsal column, sensation loss} below lesion; CONTRALATERAL pain/temp loss below lesion; LMN signs AT LEVEL of lesion
|
|
|
|
causes of horner syndrome
|
lesion of spinal cord above T1 (Pancoast's tumor, hemisection [brown-sequard], late-stage syringomyelia)
|
|
|
|
what nerve needed for forearm pronation
|
median
|
|
|
|
action and roots of obturator nerve
|
adduction of hip; L2-L4 (same as femoral n)
|
|
|
|
presentation of CN XII lesion (LMN)
|
tongue deviates TOWARD side of lesion
|
|
|
|
presentation of CN V motor lesion
|
jaw deviates TOWARD side of lesion
|
|
|
|
presentation of unilateral cerebellar lesion
|
fall TOWARD side of lesion
|
|
|
|
presentation of CN X lesion
|
uvula deviates AWAY from side of lesion
|
|
|
|
presentation of CN XI lesion
|
weakness turning head AWAY from lesion, should droop ON SIDE of lesion
|
|
|
|
causes of bell's palsy
|
ALexander bell with an STD (AIDS, Lyme disease, Sarcoid, Tumor, Diabetes)
|
|
|
|
arnold-chiari malformation associations
|
syringomyelia + thoracolumbar meningomyecele
|
|
|
|
complications of cingulate herniation
|
herniation under falx cerebri, can compress anterior cerebral artery
|
|
|
|
where is the uncus?
|
medial temporal lobe
|
|
|
|
complications of uncal herniation
|
1) CN III (ipsilateral mydriasis from parasympathetic interruption, eventual "down and out"); 2) PCA (contralateral visual field loss); 3) vessel stretch --> DURET hemorrhages (advanced stages); 4) contralateral CRUS CEREBRI (descending corticospinal fibers --> ipsilateral paresis)
|
|
|
|
how does INO present
|
NYSTAGMUS during lateral gaze of abducting eye; lesion to MLF (often first sign of MS); medial rectus palsy on attempted lateral gaze (lateral looking eye initiates movement, syncs medially looking eye via MLF; with INO, medially looking eye never gets the signal)
|
|
|
|
NT changes in anxiety
|
inc NE, dec GABA, dec 5-HT
|
|
|
|
NT changes in depression
|
dec NE, dec 5-HT
|
|
|
|
NT changes in Huntington's
|
dec GABA and ACh
|
|
|
|
NT changes in schizophrenia
|
inc DA (antipsychotics are DA antagonists)
|
|
|
|
order of loss of orientation
|
1) time 2) place 3) person
|
|
|
|
anosognosia
|
unaware that one is ill (nosos = disease)
|
|
|
|
autotopagnosia
|
unable to locate one's own body parts (topos = place)
|
|
|
|
depersonalization
|
body seems unreal or dissociated
|
|
|
|
substance abuse
|
maladaptive behavior as a result of use -- obligations, personal safety, legal problems
|
|
|
|
substance dependence
|
withdrawl/tolerance (physical dependence), increasing amounts, failed attempts to cut down, signifcant time/energy spent (at expense of activities) using/acquiring substance, continued use despite knowledge
|
|
|
|
sensitive indicator of alcohol use
|
GGT
|
|
|
|
flu-like sx with what withdrawal?
|
opiods
|
|
|
|
pcp intox
|
VIOLENCE, horizontal nystagmus, homicidality, delrium, HYPERACUSIS
|
|
|
|
pcp withdrawal
|
actually RECURRENCE of tox sx due to reabsorption in GI tract --> sudden onset homocidal violence
|
|
|
|
LSD intox
|
delusions, visual hallucinations, flashbacks
|
|
|
|
alcohol withdrawal
|
1) "the shakes"; 2) seizures; 3) hallucinations; 4) delirium; 5) DEATH
|
|
|
|
delrium tremens, onset and tx
|
2-5 days after last drink; tx w/ benzos; life-threatening
|
|
|
|
wernicke's encephalopathy
|
triad: confusion, ophthalmoplegia, and ataxia
|
|
|
|
mallory-weiss vs esophageal varices
|
both produce blood loss, but mallory-weiss is PAINful
|
|
|
|
naloxone vs nalterxone
|
both competitively inhibit opiods; naloxone works faster (fewer letters in name)
|
|
|
|
delirium vs dementia
|
DELERIUM: acute, attention deficit, agitation, ALTERETED CONSCIOUSNESS (waxing/waning), reversible; DEMENTIA: aphasia, agnosia, apraxia, amnesia, NO CHANGE in consciousness, gradual onset, irreversible
|
|
|
|
pseudodementia
|
depression in elderly patients that presents like dementia
|
|
|
|
sleep patterns in depressed patients
|
1) dec stage 4 sleep; 2) dec REM latency (enter REM earlier); 3) early morning awakenings (impt screening q)
|
|
|
|
somatoform vs factitious vs malingering
|
SOMATOFORM: neither sx nor motivation is conscious; FACTITIOUS: conscious production of sx without conscious knowledge of motivation; MALINGERING: both sx and motivation are conscious
|
|
|
|
somatization vs conversion disorders
|
SOMATIZATION: MULTIPLE organ systems; CONVERSION: MOTOR/SENSORY sx, "la belle indifference:" pt not concerened not concerned about sx;
|
|
|
|
pseudocyesis
|
false belief of being pregnant
|
|
|
|
rett disorder
|
x-linked disorder only seen in FEMALES; MR at age 4, sterotyped hand-wringing (sometimes confused with autism)
|
|
|
|
tx for ADHD
|
amphetamine-like substances!! METHYLPHENIDATE (ritalin) or MODAFINIL
|
|
|
|
tx for Tourette's
|
haloperidol
|
|
|
|
bulemia vs anorexia
|
ANOREXIA is egosyntonic, <85% IBW, 15-19yo, AMENORRHEA/low t'one; BULEMIA is ego-dystonic, >= 100% IBW, 19-24yo
|
|
|
|
hallucinations vs illusions
|
hallucinations are perceptions in ABSENCE of external stimuli; illusions are MISINTERPRETATIONS of actual external stimuli
|
|
|
|
visual/auditory vs olfactory hallucinations
|
visual/auditory in schizophrenia; olfactory in aura of psychomotor epilepsy
|
|
|
|
symptoms of narcolepsy, tx
|
hypnagogic/hypnopompic hallucinations; direct to REM sleep; CATAPLEXY: loss of all muscle tone following strong emotional stim; TX w/ AMPHETAMINES
|
|
|
|
5 types of schizophrenia
|
1) disorganized; 2) catatonic; 3) paranoid; 4) undifferentiated; 5) residual
|
|
|
|
time criteria for schizophrenia
|
psychosis and disturbed behavior > 6 mos (1-6mos = schizophreniform, < 1mo = brief psychotic disorder)
|
|
|
|
what do craniopharyngiomas look like macroscopically and microscopically?
|
MACRO: cystic; MICRO: cysts lined with stratified squamous epithelium, filled with yellow viscous fluid rich in cholesterol crystals
|
|
|
|
rare dz assumption
|
odds ratio approximates relative risk for rare diseases
|
|
|
|
best way to prevent neonatal tetanus
|
immunize mother --> protective IgGs will cross placenta
|
|
|
|
source of beta-endorphin
|
derived from POMC (same polypeptide precursor for ACTH and MSH)
|
|
|
|
first signs of normal pressure hydropcephalus (NPH)
|
gait abnormality and urinary incontinence ==> eventually leads to progressive dementia and emotional blunting; order of sx helps distinguish NPH from alzheimers
|
|
|
|
normal pressure hydrocephalus (NPH) vs parkinsonism
|
BOTH have gait disturbance and emotional bluting, but NPH doesn't have tremor
|
|
