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65 Cards in this Set
- Front
- Back
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Uses and tox for bromocriptine
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dopamine agonist, used for hyperprolactinemia, and parkinsons
d/t dopamine action, hallucinations, confusion, nausea, orthostatic hypotension also inhibits prolactins stimulation of T cells in transplant patients |
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If dopamine is elevated in the brain then ACh is...
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low and vice versa
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Carbonic anhydrase inhibtors
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acetozolamide
inhibits carbonic anhydrase- treatment for open angle glaucoma, mountain sickness (diurese excess bicarb) Na/H transporter inhibited since less conversion to bicarb and H occurs, less Na + reuptake into cells, water follows Na and goes out through lumen |
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How do loop diuretics cause metabolic alkolosis?
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excretion of K into lumen causes cells to exchange for H ions
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Side effects of amiloride and trimatrene
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K sparing but not aldosterone blocking
get leg cramps, hyperK, hyperuricemia (seen with loops, thiazides too) and high BUN |
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MOA of CCBs and BBs in angina
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decease workload of heart leading to decreased O2 demand
CCBs also work for prinzmetals |
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Nitrates in chest pain
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decrease preload d/t venodilation leading to decreased venous return, increased dose leads to arterial vasodilation decreasing the resistance against the what the heart must pump, decreased afterload and dilation of coronary vessels
isosorbide is orally available not metabolizd by liver |
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safest place for an IM injection in but?
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upper lateral quadrant, risk of sciatic injury
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inward and outward rotation of leg?
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inward- semimembranosis
outward- biceps femoris both innervated by scaitic nerve |
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ACL tear/PCL tear, lateral ligament terar/mieniscus injuries
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ACL- tibia can be dwan anterior
PCL- can be drawn posteriorly lateral ligaments- tiba can be ebnt laterally meniscus- pain upon extension of flexed knee |
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injury to common fibular nerve
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winds around neck of fibula, commonly injured, leads to foot drop
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tibialis anterior vs. tibialis posterior
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posterior plantarflexes and inverts, innervated by tibial
anterior dorsiflexes and invers, deep peroneal nerve fibularis= superfical fibular nerve, plantarflex and evert |
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Infant has large mass from includes superior mediastinum and anterior mediastinum, wider than heart, what is it?
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thymus, large in infnacy,
posterior mediastinum contains esophagus and descending aorta middle and anterior cantains heart superior cntains thymus, vessels, trachea, esophagus |
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Important branches off RCA supply
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sinus and AV node
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Branches off of celiac trunk
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left gastric- stomach
splenic um spleen heatic, gastroduodenal and superior pancreatoduodenal arteries to proximal duodenum superior mesenteric has inferior pancreaticoduodenal |
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Stuff found in retroperitoneum
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aorta, vena cava, kidneys, pancreas, duodenum, ascending and descending colon
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layers of spermatic chord
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superifical- dartos msucles, external spermatic fascia from external oblique, cremaster muscle internal oblique, internal spermatic from fascia transversalis
deepest is arteries and pampinoform plexus |
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Compnenets of Hesselbach's triangle
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rectus abdominus, inferior epicastric artery, inguinal ligament
indirect hernias go lateral to inferior epigastric and into canl, direct goes medial to inferior epigastric |
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Important compoents of cortex, motor cortex and sensor cortex
Broca's and Wernicke's |
motor cortex- precentral gyrus
sensory cortex is postcentral Broca;s- frontal lobe near lateral fissure, good comprehension of speech, non fluent Wernicke's- fluent but nonsensical speech, poor comprehension, tempral lobe, superior gyrus |
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Occlusion of these vessles results in:
1. anterior cerebral 2. middle cerebral 3. posterior cerebral 4. cerbellar |
1. motor and snsory loss lower extremites
2. motor and snsory loss contralateral upper 3. homonymous hemianopsia 4. ataxia, brainstem |
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TIAs
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partial occlusion of cerebral arteries by plaques or embili
internal carotid- emiparesis or sensory loss contalateral, ipsalateral monocular blidnness vertbrobasillar- vertifgo, diplopia, ataxia, facial numbness, nausea |
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Hemorrhage into...
1. putamen 2. thalamus 3. pons |
1. contralateral weakness, including face, contralateral hemianopsia
2. thalamus- contralateral hemiparesis, sensory changes 3. coma, small reactive puils, quadiplegia |
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Tongue muscles all innervated by hypoglossal except...
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palatoglossus
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CN innervation of pupils, ciliary muscles, glands except parotid, parotids
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pupils and cilarry- CN III
glands- VII parotid- IX |
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Visual field defects by lesion:
1. at optic nerve 2. at chiasm 3. at tract 4. temprotal optic radiation 5. parietal optic radiaiton |
1. lose the eye
2. at chiasm lose peripheral portion of each eye 3. lose contralateral half vision in each eye 4. temporal- superior contralatereal quadrant for both 5. parietal- inferior contralateral quadrant, for both |
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Dorsal motor nucleus and Edinger Westphal nucleus are locations for parasympathetcis for...
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dorsal motor nucleus = X
Edinger-westphal - ciliary ganglion, CN III in eye superior (VII sublingual and submaxilary) and inferior (IX otic parotid) salivary nucleus |
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Basal ganglia
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recieve input from cortex and project via thalamus to precentral motor cortex, proramming of movement
caudate, putamen and globus pallidus Parkinson's, Huntingtons (caudate nucleus atrophy), copper accumulation in lentiform nucleus |
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Thalamus
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receives all sensory input except olfaction, basal ganglia -> thalamus -> cortex
posterior thalamus- medial geniculate is auditory, lateral geniculate, optic tract VPL (medial lemniscus, spinothalamic) and VPM (tirgeminal) |
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walenberg syndrome
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lateral medulla infaction d/t occlusion of PICA
involves vital centers for resp and CV, reticular activating system determines consciousness |
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Infarction of spinothalmic trat vs. spinal tract nucleus V
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spinal tract of V- ipsalateral face pain/temp loss
spinothalamic- contralateral body pain/temp loss |
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Infaction of reticular formation (pons or lateral edulla), corticospinal tract, medial long fasciculos
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reticular formation- ipsalteral Horner's syndrome
corticospinal tract- contralateral UMN spastic paralysis MLF- ipsalateral eye can not addcuct |
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Decussation point for medial lemniscus and coticospinal tract?
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lower medulla
corticospnal- efferent motor medial lemniscus- touch and proproception Sensory of spinal cord feet are medial, face is lateral |
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Key dermatomes, skull, nipple, belly button, big toe
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skull C2
nipps T5 belly B T10 big toe L4 |
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Hemisection of left spinal cord results in...
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spastic paralysis of left leg, loss of proprioception on left, pain and temp loss on right
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wallne berg syndrome
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infact of lateral medulla
loss of pain and temp sensation side of body, right lower face, paralysis of body on left |
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flaccid paralysis, loss of sensation in both legs, ascending =
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Guillan Barre
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Homonculus, if there is an infarction of the middle cerebral artery which extremity will be affected? Anterior cerebral?
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Middle cerebral- contralateral arm, more lateral on brain
anterior cerebral- contalateral leg, more medial in brain |
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Patient 10-20 y/o present with mass at end of long bone, see spirs on bone at metaphyses. Tumor of bone and cartilage. At risk for...
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This is a osteochondroma, increased risk of chondrosarcoma (malignant cartilage tumor)
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Osteoma vs. osteoid osteoma vs. osteoblastoma
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osteoma- painless and multiple
osteiod osteoma- painful and small, extremities osteoblastoma- larer, milder pain ahy, dull |
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1st symptom of osteosarcoma
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often is pathologic fracture, findins o Codman's triangle from lifting of cortex through periosteum
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Eqing's sarcoma buzzwords
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painful lesion, fever, anemia, leukocytosis
Homer-Wright rosettes "onionskin on periosteum) |
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myotonic dystrophy
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AD trinucleootide repeat, long face, inability to relax voluntarily after contation
distal muscle weakness, temporal/masseter muscle wasting, cataracts MR, hyperglycemia, cardiac arrymthias |
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3 common resentations for brian tumor
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positional headaches, focal neurologic deficits, new onset seizures
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most common type of astrocytoma
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fibirillary- 80% usually in cerbral hemispheres, neoplastic astrocytes
3 subtpes, low grade, anaplastic (more aggressive) Glioblastoma multiforme- high grade, pseudopalsiding necorti regions, always fatal, both cerebral hemispheres forming a buterfly shape |
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Location of pilocytic astrocytoma
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Children and young adults, occurs in the cerebellum, cystic with cells that hair like processes
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Most common childhood brian tumr
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medulloblastoma, excussivle yin cerebellum, occurs midline in children, may cause hydrocephalus, sheets of anaplastic cells, death w/o tx but very radiosenstive
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oligodendrogliomas
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middle age, calcifications, causes seizures, fired egg appearance
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ependyoma
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from lining of ventricular system, cells form rossetes or perivascular pseudorosettes, spinal cord is most common location
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meningioma
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benign tu mor of adults, can be associated with NF2 gene, encapsulated, well-defined dural mass, whirrling pattern and psammona bodies
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Craniopharyngioma
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derived from Rathke's pouch, slow growing, may encroach on optic chiasm
MOST COMMON SUPRATENTORIAL TUMOR IN KIDS cystic w/ calcifications, mixture of squamous epithelial cells and CT |
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Patient w/ aennorhea, glactorrhea, infertility and visual distrubance?
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prolactinoma usually > 10 mm = macroadenoma
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Cushing's disease is caused by
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overproduction of ACTH from microadenoma
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HIV patient has brain tumor, likely etiology?
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lymphoma, aggressive poor response to tx
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Reason for giving cholinesterase inhbitors for Alzheimer's
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amyloid beta protein deposits primarily affect ACh transmitting neurons, neurons destroyed d/t oxidative damage
results in atrophy of brain |
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Picks Dz
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frontotemporal dementia, leads to change in personality and language problems
see Pick bodies - inclusion bodies of tau protein in large balloned cels rapid progression to advanced stage |
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Lewy bodies
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intracytoplasmic eosinophilic inclusions found in SN and nucleus in Parkinson's patients, form in olfactory bulb and dorsal motor nculeus then progress to SN
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ALS
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degeneration of UM and LMNs (cortiocspinal tracts and anterior horn cells)
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Neurons affected in Huntington's disease
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cholinergic and GABA-ergic neurons in spiny striatal neruons resposnible for motor output from basal ganglia
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Friedrick;s ataxia
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AR, Chr 9 trinculeotide repeat if GAA leads to degeenration of posterior columns, corticospinal tract, cerbellum CN nuclei of VIII, X, XII, wheel-chair bound within 5 years
ataxia, dysarthria, pes cavus, dereased DTRs, type I betees, cardiomyopathy |
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Werdnig hoffman syndrome
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AR, spinal muscular atrophy, destruction of anterior horn cells
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Patinet with fatigue, diploplia, vertigo and muscle weakness, + ologclonal bands in CSF =
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MS
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Adrenoleukodystrophy
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XL, deficiency in transporter enzyme can't catabolize long chain fatty acids, high levels of these in serum inabilty to use for lipid metabolism
poor meylin produciton, axonal defeneration |
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Metachromatic leukodystrophy
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sphinoglipidosis w/ deficit in arylsulfatase A leading to accumulation of sulfatides leading to demylenination of CNS and PNS
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Subactue combined degeneration
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B12 deficiecny leads to demyleination and destrucition starting with dorsal columns then later corticosponal tract, leads to distal paresthesisas and worse
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Wernicke's and Lorsakoffs
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Wernickes d/t deficit in B1 focal hemorrhage and necorsis of mamillary bodies leading to opthalmoplegia, confusion and tataxia can progress to Korsakoff which is not reversible, brain lined with heomosiderin laden macrophages, severe psychosis and dementia resuult
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