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219 Cards in this Set
- Front
- Back
What neural cells come from:
Neuroectoderm? Neural crest? Mesoderm |
Neuroectoderm: CNS neurons, ependymal cells, oligodendroglia, astrocytes
Neural creset: Schwann cells, PNS neurons Mesoderm (M's): microglia (like macrophages) |
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what cells are destroyed in MS?
What cells are destroyed in Guillain-Barre? |
oligodendroglia
Schwann cells |
|
How are the levels of the following NTs changed in disease?
1. NE 2. Dopamine 3. 5-HT 4. Ach 5. GABA |
1. NE: high in anxiety, low in depression
2. Dopamine: high in schizophrenia, low in Parkinson's and depression 3. 5-HT: low in depression, anxiety 4. Ach: low in Alzheimer's, Huntington's, and REM sleep 5. GABA: low in anxiety, Huntington's |
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Which receptor type is carried by C fibers?
fxn of the receptors? |
free nerve endings (pain and temperature)
|
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where are these NT synthesized?
NE Dopamine 5-HT ACh GABA |
NE: locus ceruleus
Dopamine: Ventral tegmentum and SNc 5-HT: Raphe nucleus ACh: basal nucleus of meynert GABA: Nucleus accumbens |
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what part of brain is involved in stress and panic?
what part of brain is involved in reward center, pleasure, addiction? |
Locus ceruleus: stress and panic
Nucleus accumbens and septal nucleus: reward center, pleasure, addiction |
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What 3 structures make up the Blood-brain barrier?
|
tight junctions (b/w non-fenestrated capillary endothelial cells)
basement membrane astrocyte processes |
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List 2 sensory receptor types involved in position sense and touch.
How are they similar? different? |
Meissner's corpuscles: dynamic fine touch, adapts fast
Merkel's disks: static touch, adapts slow both sense position sense and carried by large, myelinated fibers (fast conduction) |
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What are the few specialized brain regions w/NO blood-brain barrier
|
area postrema (vomiting after chemo)
neurohypophysis (ADH release; also other neurosecretory products to enter circulation) |
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What are the few specialized brain regions w/NO blood-brain barrier
|
area postrema (vomiting after chemo)
OVLT (osmotic sensing) neurohypophysis (ADH release; also other neurosecretory products to enter circulation) |
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What are the functions of the hypothalamus?
|
TAN HATS
T: Thirst and water balance A: Adenohypophysis control N: neurohypophysis (release hormones from hypothalamus) H: Hunger A: Autonomic regulation T: Temp regulation S: sexual urges |
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Where is ADH made
|
Supraoptic nucleus of hypothalamus
|
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Where is oxytocin made
|
paraventricular nucleus of hypothalamus
|
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what controls cooling
|
anterior hypothalamus (parasympathetic)
(A/C: Anterior Cools) |
|
what controls heating
|
posterior hypothalamus
(sympathetic) if zap Posterior hypothal, become a Poikilotherm (cold-blooded like a snake) |
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what controls hunger
|
lateral area of hypothalamus
destruction leads to anorexia and failure to thrive in infants inhibited by leptin |
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what controls satiety
|
ventromedial area of hypothalamus
destruction (cranipharyngioma) -> hyperphagia stimulated by leptin |
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where is visual information in the thalamus
|
lateral geniculate nucleus
(Lateral for Light) |
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what control sexual urges
|
septal nucleus hypothalamus
|
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Where is auditory information in thalamus
|
Medium geniculate nucleus
(Medial for Music) |
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what controls circadian rhythm
|
suprachiasmatic nucleus of hypothalamus
|
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What information is sent to the Ventral Posterior nucleus, lateral (VPL)?
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body sensation (proprioception, pressure, pain, touch, vibration via dorsal column, spinothalamic tract)
|
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What information is sent to the Ventral posterior nucleus, medial (VPM)?
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facial sensation via CN 5 (Makeup on face, so vpM)
|
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What information if sent to Ventral anterior/lateral nuclei (VA/VL)
|
motor
|
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What is the blood supply to the thalamus?
|
Pcomm (posterior communicating),
PCA (posterior cerebral), ICA (anterior choroidal arteries) |
|
Input to cerebellum?
|
contralateral cortical input via MCP
ipsilateral proprioceptive info via ICP input nerves are climbing and mossy fibers |
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Output from cerebellum?
|
stimulatory feedback to contralateral cortex to modulate movement
output nerves are Purkinje fibers to deep nuclei of cerebellum, which output to cortex via SCP |
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What are the deep nuclei of the cerebellum, lateral to medial?
|
Don't Eat Greasy Foods
Dentate, Emboliform, Globose, Fastigial |
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What does the lateral cerebellum control
|
voluntary movement of extremities
|
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What does the medial cerebellum control?
|
truncal coordination, balance, ataxia,
propensity to fall toward injured (ipsi) side |
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What is the excitatory pathway in the basal ganglia?
|
SNc dopamine bind to D1 receptors in excitatory pathway -> stimulate excitatory pathway -> increase motion
cortex -> striatum -> GPi/SNr -> thalamus -> cortex |
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What is the inhibitory pathway in the basal ganglia?
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SNc dopamine bind to D2 receptors in inhibitory pathway -> inhibit inhibitory pathway -> increase motion
cortex -> striatum -> GPe -> subthalamic nucleus -> GPi -> thalamus -> cortex |
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How does Parkinson's dz affect the excitatory/inhibitory pathway in the basal ganglia?
|
loss of dopamine inhibits the excitatory pathway
and excites inhibitory pathway (disinhibits) both -> decrease in motion |
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Typical characteristics of Parkinson's dz
|
TRAP
T: Tremor (at rest, pill-rolling) R: cogwheel Rigidity A: Akinesia P: Postural instability TRAPped in body |
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What is Hemiballismus?
|
sudden, wild flailing of 1 arm +/- leg
contralateral subthalamic nucleus lesion (lacunar stroke in pt w/Hx of HTN) get loss of inhibition of thalamus through globus pallidus |
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Huntington's dz:
What is the mechanism of neuronal death? What are the gross pathology? associated sxs? |
Mechanism: NMDA-receptor binding and glutamate toxicity
Gross: atrophy of caudate nucleus (loss of GABA and Ach), enlarged lateral ventricles, atrophy of putamen and defined sulci chorea, athetosis, oculmotor abnormalities, depression, aggression |
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what are the main components of the basal ganglia?
|
striatum, pallidum (globus pallidus), substantia nigra, and subthalamic nucleus
striatum: caudate nucleus (cognitive) and putamen (motor) |
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What is an essential/postural tremor?
How do you treat it? |
Autosomal dominant,
action tremor (worsens when holding posture), pts often self-medicate w/EtOH, which decreases tremor Trx: B-blockers |
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What is Kluver-Bucy syndrome?
|
Amygdala (bilateral) lesion
hyperorality, hypersexuality, disinhibited behavior |
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What is an essential/postural tremor?
How do you treat it? |
Autosomal dominant,
action tremor (worsens when holding posture), pts often self-medicate w/EtOH, which decreases tremor Trx: B-blockers (propranolol) |
|
what happens with a lesion in the reticular activating system (RAS)?
where is the RAS located? |
reduced levels of arousal and wakefulness (e.g., coma)
located in the midbrain |
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Name the characteristics of Wernicke-Korsakoff syndrome.
What lesion is it associated with? |
Wernicke: confusion, ophthalmoplegia, ataxia
Korsakoff: confabulation, memory loss, personality changes assoc w/mammillary bodies lesion (bilateral) |
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What happens with a cerebellar hemisphere lesion?
w/a cerebellar vermis lesion? |
hemispheres are lateral -> affect lateral limbs
vermis is central -> affect central body hemisphere: intention tremor, limb ataxis, IPSIlateral deficits, fall toward side of lesion (cerebellum -> SCP -> contralateral cortex -> corticospinal decussation = ipsilateral) vermis: truncal ataxia, dysarthria |
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What happens w/a lesion in the PPRF (paramedian pontine reticular formation)?
w/a frontal eye fields (FEF) lesion? |
PPRF: eyes look AWAY from side of lesion
FEF: eyes look TOWARD side of lesion |
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Where is Broca's area located?
Wernicke's area? |
Broca's: inferior frontal gyrus
Wernicke's: superior temporal gyrus (associative auditory cortex) both in the dominant hemisphere |
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What is a conduction aphasia?
|
Poor repetition but fluent speech and intact comprehension
affects arcuate fasciculus, that connect broca's and wernicke's areas |
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What happens w/a Right parietal lobe lesion?
|
spatial neglect syndrome (agnosia of contralateral side of world)
|
|
Central pontine myelinolysis
sxs? cause? |
caused by very rapid correction of hyponatremia
acute paralysis, dysarthria, dysphagia, diplopia, and loss of consciousness |
|
Lateral medullary syndrome?
|
Wallenberg's syndrome, PICA (post. inf. cerebellar a.)
1. Spinothalamic tract: contralateral loss of pain and temp 2. CN V nucleus/tract: Ipsi loss of pain/temp on face 3. Nucleus ambiguus (CN IX, X): ipisilateral dysphagia, hoarseness, decrease gag reflex 4. Descending sympathetic: Horner's syndrome, diplopia 5. vestibular nucleus/tract: vertigo, nystagmus 6. Cerebellum: ipsi ataxia |
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what happens w/a posterior cerebral artery lesion?
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contralateral homonymous hemianopia w/macular sparing,
supplies the occipital cortex |
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what happens w/an MCA lesion?
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contralateral face and arm paralysis and sensory loss, aphasia (dominant sphere), left-sided neglect
|
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lateral inferior pontine syndrome?
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AICA
1. CN VII nucleus/tract: ipsi facial paralysis 2. CN VIII nucleus/trct: ipsi cochlear nucleus, vestibular (nystagmus), 3. Middle/inf cerebellar penducle: ipsi dystaxia 4. CN V nucleus/tract: temp, pain loss of ipsi face |
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What is the most common site of circle of Willis anuerysms
|
Anterior communicating artery
lesion may cause visual field deficit |
|
What artery is a common area of aneursyms?
what palsy can it cause? |
Posterior communicating artery,
can cause CN 3 palsy |
|
What areas do lateral striate arteries supply?
what is the consequence of an assoc. lesion? |
supply internal capsule, caudate, putamen, globus pallidus,
are "arteries of stroke." infarct of the posterior limb of internal capsule causes pure motor hemiparesis |
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An infarct in which artery causes "locked-in"syndrome?
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Basilar artery (CN 3 is typically intact)
|
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What artery is a common area of aneurysm that can cause CN III palsy?
|
Posterior communicating artery,
|
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What happens with a watershed zone infarct?
When do these infarcts clinically happen? |
upper leg/upper arm weakness, defects in higher-order visual processing
happen from damage in severe HYPOtension located b/w ACA/MCA, MCA/PCA |
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What is the risk of subarachnoid hemorrhage 2-3 days after?
|
vasospasm due to blood breakdown products which irritate vessels. Trx w/Ca-channel blockers
|
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Berry aneurysm: most common site? risk factors
Charcot-bouchard aneurysm: affected sites? the risk factor? |
Berry aneurysm:
Anterior communicating cerebral artery Marfan's, Ehlers-Danlos, ADPKD Charcot-Bouchard microaneurysm: small vessels (e.g. in basal ganglia and thalamus) associated with chronic HTN |
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what are the etiologies of ischemic stroke?
|
AFib, carotid dissection, PFO, endocarditis
trx: is tPA w/in 3 hours |
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describe flow of ventricular system?
|
Lateral ventricle -> 3rd ventricle (via foramen of monro) -> 4th ventricle (via cerebral aqueduct) -> subarachnoid space (via foramina of Luschka and Magendie)
Luschka is Lateral; Magendie is Medial |
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what are the most vulnerable parts of the brain to ischemia?
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hippocampus (pyramidal cells)
neocortex (pyrmidal cells) cerebellum (purkinje cells) watershed areas |
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What are the characteristics of Normal pressure hydrocephalus?
|
Wet, Wobbly, Wacky
Ventricle expansion distorts fibers of corona radiata -> urinary incontinence, ataxia, and dementia (reversible cause of dementia in elderly) NO increase in subarachnoid space volume |
|
List order of structures pierced in a lumbar puncture
At what level? landmark for finding the level? contraindication? why? |
1. Skin/superficial fascia
2. Ligaments (supraspinous, interspinous, ligamentum flavum) 3. Epidural space 4. Dura mater 5. Subdural space 6. Arachnoid 7. subarachnoid space - CSF Pia is NOT pierced LP in L3/L4 or L4/L5 at the level of cauda equina (at the level of iliac crest) contraindicated in papilledema bc LP can cause tonsilar herniation |
|
Poliomyelitis
affected site? lost fxns? mode of transmission? |
anterior horn cell destruction -> LMN destruction (atrophy/weakness, fasciculation, fibrillation, hyporeflexia)
fecal-oral transmission and virus replicates in oropharynx and small instestine before spreading through blood to CNS CSF has lymphocytic pleocytosis w/slight elevation of protein (NO glucose change) virus recovered from stool and throat |
|
Werdnig-Hoffman dz
|
infantile spinal muscular atrophy (SMA)
auto-recessive; presents at birth as "floppy baby," tongue fasciculations, median age of death 7 months anterior horn degeneration. only LMN involvement |
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Tabes dorsalis: characteristics
|
Charcot's joints, shooting (lightning) pain, Argyll-Robertson pupils, ABSENCE OF DTRs, positive Rhomberg, sensory ataxia at night
|
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Friedreich's ataxia: characteristics
|
staggering gait, frequent falling, nystagmus, dysarthria, pes cavus, hammer toes, HYPERTROPHIC CARDIOMYOPATHY (cause of death). presents in childhood w/kyphoscoliosis
is the FRatastic (frataxin gene GAA repeat, chrom 9) frat brother, always falling, staggering |
|
Loss of both LMN and UMN
dx? causes? common presentation? |
Amyotrophic lateral sclerosis (AML or Lou Gehrig's disease)
caused by defect in superoxide dismutase 1 (SOD1) , betel nut ingestion commonly presents as fasciculations |
|
What are the findings in Brown-Sequard syndrome?
|
Ipsilateral: UMN signs below lesion (corticospinal), loss of tactile/vibration/proprioception sense below lesion (dorsal columns), loss of all sensation AT level of column
Contralateral: pain and temp loss below lesion (spinothalamic) LMN signs AT level of lesion |
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What if a Brown-Sequard syndrome lesion occurs above T1?
|
pt will present with Horners's syndrome
|
|
Causes of Horner's syndrome?
|
Pancoast tumor, Brown-Sequard, late-stage syringomyelia
assoc w/lesions of cord above T1 |
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What are the dermatome landmarks?
T4 T7 T10 L1 L4 S2 - S4 |
T4: nipple
T7: xiphoid process T10: umbilicus (important for appendicitis pain referral) L1: inguinal ligament L4: kneecaps S2- S4: erection and sensation of penile anal zone |
|
Moro reflex
what is it? When is it observed? (2) |
"hang on for life": abduct/extend limbs when startled, and then draw together
in the first year of life. may reemerge following frontal lobe lesion |
|
What cranial nerves lie medially in the brain stem?
where is the pineal gland? fxn? |
CN 3, 6, 12 (motor = medial)
pineal gland is located dorsally superior to the colliculi. fxn: melatonin secretion, cracadian rhythm |
|
What is parinaud syndrome?
|
paralysis of conjugate vertical gaze due to lesion in superior colliculi (e.g., pinealoma)
|
|
Where are the cranial nerve nuclei located in the brainstem
What nuclei are in the midbrain? in the pons? in the medulla? |
Tegmentum portion (b/w dorsal and ventral portions)
midbrain: CN 3, 4 pons: CN 5-8 medulla: CN 9-12 |
|
What cranial nerve nuclei and information is sent by the Nucleus Solitarius?
|
Visceral Sensory info (taste, baroreceptor, gut distention)
CN 7, 9, 10 |
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What cranial nerve nuclei and information is sent by the Nucleus Ambiguus?
|
Motor Innervation of pharynx, larynx, and upper esophagus (swallowing, palate elevation)
CN, 9-11 |
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What info does the dorsal motor nucleus send?
|
sends autonomic (PARAsympathetic) fibers to heart, lungs and upper GI
|
|
What is cavernous sinus syndrome?
|
(from mass effect): ophthalmoplegia, ophthalmic and maxillary sensory loss
nerves that control extraocular mm (plus V1 and V2) also pass through cavernous sinus |
|
What happens w/a LMN lesion of CN 7
What happens w/an UMN lesion of CN 7? |
LMN: ipsilateral paralysis of upper and lower face
UMN: contralateral paralysis of lower face ONLY b/c upper face is innervated bilaterally |
|
What are some causes of Bell's palsy?
Findings? |
AIDS, Lyme dz, Herpes zoster, Sarcoidosis, Tumors, Diabetes
(ALexander graHam Bell w/STD) complete destruction of facial nucleus or peripheral branches --> ipsilateral facial paralysis with inability to close eye on involved side |
|
What innervates palatoglossus?
What innervates tensor veli palatini? |
palato: CN X
(every other "glossus" m innervated by CN XII) tensor veli palatini: CN V (V3, mandibular br.) (every other "palat" muscle innvervated by CN X) |
|
Epidural hematoma vs Subdural hematoma
rupture vessel? CT shows? |
epidural hematoma: rupture of middle menigeal artery, biconvex disk on CT; can cross falx, tentorium but no suture lines
Subdural hematoma: rupture of bridging veins, Crescent-shaped hemorrhage on CT; crosses suture lines but does not cross falx, tentorium |
|
Subarachnoid hemorrhage
presentation? cause? |
"worst headache of my life"
rupture of a berry aneurysm in Marfan's, Ehlers-Danlos, APCKD, or AVM |
|
parenchymal hematoma
causes? typical locations? |
causes:
chronic HTN (Charcot-Bouchard aneurysm) cerebral amyloid angiopathy tumor, DM typicaly basal ganglia and internal capsule |
|
Describe the timeline of irreversible neuronal injury from first 12 hrs to after 2 weeks.
|
12-48 hrs: red neurons
24-72 hrs: necrosis + neutrophils 3-5 days: foamy macrophages 1-2 weeks: reactive gliosis + vascular proliferation > 2weeks: glial scar |
|
Transient ischemic attack (TIA)
|
brief, reversible episodes of neurologic dysfxn to focal ischemia.
typically, sxs last for < 24 hrs |
|
Stroke imaging
how does it look on CT? MRI? |
MRI: bright for 10 days
CT: dark in 24 hrs |
|
Hydrocephalus ex vacuo
pathogenesis? associated diseases? how is it compared to normal pressure hydrocephalus? |
appearance of increased CSF due to atrophy
seen in Alzheimer's advanced HIV, Pick's disease, Huntington's normal intracranial pressure but no triad seen (dementia, ataxia, urinary incontinence) |
|
Scanning speech, intention tremor, nystagmus, MLF lesion
dx? |
Multiple sclerosis
|
|
What 2 nutrition defiencies can have similar presentations as Freidreich's ataxia?
|
Vitamin B12 neuropathy
vitamin E deficiency ataxic gait, hyperreflexia, impaired position, vibraiton sense |
|
Muscle spindle vs Golgi Tendon organ
fxn of each? how is muscle spindle maintain its sensitivity? |
Muscle spindle monitors muscle length by stimulating alpha neurons to contract the extrafusal fibers
Golgi tendon organ monitors muscle tendon by inhibit contraction Muscle spindle's sensitivity is controlled by intrafusal fibers, which are contracted with gamma neuron stimulation (influenced by the brain) |
|
Alpha motor neuron vs gamma motor neuron
|
alpha: innervates extrafusal fibers for muscle contraction
gamma: innervates intrafusal fibers for maintaining the sensitivity of the muscle spindle |
|
What nerves innervate salivation?
Describe the routes from nuclei to the effect? |
CN VII: submandibular, and subligual gland
reaches the effector glands via superior salivatory nucleus -> chorda tympani n. -> lingual n. -> glands CN IX: parotid gland Inf salivatory gland -> otic ganglion -> auricotemporal n. (CN V) -> parotid gland |
|
What nerves receive taste informaiton? be specific
|
CN VII: anterior 2/3 of tongue
CN IX: posterior 1/3 of tongue CN X: taste from epiglottic region |
|
what nerve innervates the lacrimal glands?
|
CN VII
|
|
Which nerves are involved in the following reflexes?
1. corneal 2. lacrimation 3. gag |
1. corneal: V1 (nasociliary branch) -> VII (temporal branch)
2. lacrimation: V1 -> VII; loss of reflex does not preclude emotional tear 3. gag: IX -> IX, X |
|
Nucleus Solitarius
fxn? what nerves are associated? location? |
one of the vagal nuclei in the pons
located laterally (sensory) Visceral sensory info: taste, baroreceptors, gut distension VII, IX, X |
|
What CN nucleus is involved in motor innervation of the viscera?
|
dorsal motor nuclei (vagus)
sends parasympathetic fibers to heart, lungs, and upper GI |
|
Superior orbital fissure
location? what goes through it? (6) |
in the middle cranial fossa through sphenoid bone
CN III, IV, V1, VI, opthalmic vein, sympathetic fibers |
|
How do trigeminal fibers reach their destination from the brainstem?
|
through holes in the middle cranial fossa (through sphenoid bone)
Standing Room Only Superior orbital fissure: V1 Foramen Rotundum: V2 Foramen Ovale: V3 |
|
Internal auditory meatus
location? what goes through it? |
posterior cranial fossa
CN VII, VIII |
|
jugular foramen
location? what goes through it? |
posterior cranial fossa
CN IX, X, XI, jugular vein |
|
Cavernous sinus
contents? which is free floating? |
CN III, IV, VI, V1, V2
Internal carotid artery Sympathetics (postganglionic) CN VI is free floating |
|
CN X lesion
presentation of uvula? |
uvula deviates to the opposite of the lesion (affected side is weakened)
|
|
What CNs are tested with "kuh, la, mi" sounds?
|
kuh: CN IX
la: CN XII mi: CN VII |
|
What muscle opens the jaw?
what muscles close the jaw? |
open: gravity and lateral pterygoids
close: temporalis, masseter, medial pterygoids |
|
What ion is the major content of endolymph?
how about perilymph? |
Peri: like ECF; Na+
endo: like ICF: K+ |
|
List 3 inner ear structures that senses acceleration.
|
Utricle: horizontal
saccule: vertical semicircular canal: angular |
|
what type of sound is detected at the helicotrema end of the cochlea?
|
high frequency
|
|
What type of sound is lost first in the elderly?
|
high frequency
|
|
Weber test lateralizes to the left
Rinne: AC>BC dx? |
Right sided sensorineural hearing loss
|
|
Weber test lateralizes to the right
Rinner: BC>AC dx? |
right sided conductive hearing loss
|
|
Describe the sensory innervation of the tympanic membrane.
|
Outer: V3 (auriculotemporal)
Inner: CN IX via tympanic brach |
|
Describe the sensory innervation of external auditory duct.
|
Most: V3 (auriculotemporal)
posterior part: auricular branch of CN X |
|
Amaurosis fugax vs retinal artery occlusion
compare and contrast |
both cause painless monocular vision loss
amaurosis fugax: transient; only lasts a few seconds; due to a small embolus to the opthalmic artery Retinal artery occlusion: presents with cherry red macula and pale retina |
|
ciliary muscle of the eye
fxn? receptor? |
accomodation
M3 |
|
What do you see on the fundoscopic exam in glaucoma pts?
How is this different from pts with papilledema? |
glaucoma: due to impaired flow of aqueous humor --> increase intraocular pressure --> optic disk atrophy with cupping
papilledema: due to increased intracranial pressure --> elevated optic disk with blurred margins, bigger blind spot |
|
Open angle glaucoma vs closed angle glaucoma
|
open angle: due to obstructed outflow
closed/narrow: obstruction of flow b/t iris and lens |
|
What drugs are contraindicated in glaucoma pts?
|
anti-muscarinics: will inhibit contraction of sphincter constrictor muscle
epinephrine (only in closed): will contract dilator/radial muscle, which will narrow the pathway for the flow |
|
List risk factors for cataracts. (only list risk factors related to sugar metabolism)
|
classic galactosemia, galactokinase deficiency, diabetes (sorbitol)
|
|
ocular presentation of CN III damage
|
eye looks down and out; ptosis, pupillary dilation, loss of accomodation
|
|
ocular presentation of CN IV damage
|
diplopia with defective downward gaze
adjust by tilting head toward lesion (if lesion is before crossing) |
|
How do you test for inferior oblique muscle of the eye?
|
IOU
to test Inferior Oblique, have pt look Up |
|
Strabismus
Amblyopia |
strabismus: misalignment of eyes.
Amblyopia: reduction of vision from disuse in critical period |
|
What muscle produces mydriasis?
Describe how this muscle is innervated. |
radial muscle
T1 pregang sympathetic -> superior cervical ganglion -> postgang -> long ciliary nerve |
|
what muscle produces miosis?
Describe how this muscle is innervated? |
pupillary sphincter muscle
CN III form Edinger-Westphal nucleus --> ciliary ganglion |
|
Marcus Gunn Pupil
|
afferent pupil defect --> decreased bilateral pupillary constriction when light is shown in affected eye
|
|
How does diabetes affect CN III?
How does compression affect CN III? |
diabetes -> vascular disease -> affects inner layer of CN III -> affects extraocular muscles
compression -> affects the outer layer -> affects parasympathetics (accomodation and miosis) |
|
What 2 layers are separated in retinal detachment?
|
neurosensory layer of retina from pigment epithelium
|
|
Dry ARMD vs wet ARMD
|
age-related macular degeneration
dry: slow, due to fat deposits and cause gradual loss of vision wet: rapid, due to neovascularization |
|
Describe the visual defect
1.Right Lesion in dorsal optic radiation 2. Pit tumor |
1. dorsal optic radiation: Left lower quadrantic anopia (right parietal lesion, MCA)
2. pit tumor: bitemporal hemianopia |
|
Describe the visual defect
1. right Meyer's loop lesion 2. right PCA occlusion |
1. left upper quadrantic anopia
2. left hemianopia with macular sparing b/c macula receives bilateral input |
|
right MLF damage
presentation |
when asked to look left
right eye: medial rectus palsy left eye: right beating nystagmus |
|
explain the caloric test
|
Caloric test is used to exam vestibular apparatus
COWS: nystagmus with quick phase correction Cold water: nystagmus toward the lesion with quick phase to Opposite side Warm water: nysgatmus to opposite side with quick phase to Same side |
|
List genes associated with early onset Alzheimer's disease.
late onset gene? |
early onset: APP (chrom 21), presenilin-1 (chrom 14), presenilin-2 (chrom 1)
late onset: ApoE4 (19) |
|
What gene is protective from Alzheimer's disease?
|
ApoE2 (19)
|
|
What is the gross finding of Alzheimer's disease?
List 2 histological findings in Alzheimer's. |
widespread cortical atrophy (esp. temporal lobe)
Senile plaques (extracellular beta- amyloid) Neurofibrillary tangles (abnormally phosphorylated tau protein) |
|
What histological finding correlates with degree of dementia in Alzheimer's?
|
Neurofibrillary tangle
|
|
what is the complication of senile plaques?
|
amyloid angiopathy --> intracranial hemorrhage
|
|
List 2 diseases associated with abnormal tau protein.
|
Alzheimer's
Pick's disease (frontotemporal dementia) |
|
What lobes are atrophied in Pick's disease? spared?
|
atrophy of frontotemporal lobe, but spares posterior 2/3 of superior temporal gyrus
|
|
Parkinsonism with dementia and hallucinations
dx? hallmark finding? |
Lewy body dementia
lewy body: defective alpha-synuclein |
|
Charcot's triad of MS
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SIN
Scanning speech Intention tremor, Incontinence, Internuclear ophthalmoplegia Nystagmus |
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MS
affected population? diagnostic finding? histological finding? |
white women in 20s and 30s
diagnostic finding: IgG oligoclonal band histo: periventricular plaques with preservation of axons |
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Guillain-Barre syndrome
pathogenesis? lab findings? |
autoimmune attack of peripheral myelin due to molecular mimicry (e.g. Campylobacter jejuni or herpesvirus infection)
High CSF protein with normal cell count (albuminocytologic dissociation increased protein -> papilledema |
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Symmetric ascending muscle weakness beginnign in distal extremities. 50% are affected facial paralysis. Autonomic fx may be affected.
dx? |
Guillain-Barre syndrome (acute inflammatory demyelinating polyradiculopathy)
affects the peripheral nerves and motor fibers of ventral roots |
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Demyelinating disease associated with JC virus?
affected population? |
PML (progressive mutlfocal leukoencephalopathy)
seen in AIDS pts |
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arylsulfatase A deficiency. Buildup of sulfatides
dx? |
Metachromatic leukodystrophy
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originates from mesial temporal lobe, one area of brain, and pt is unaware of the seizure
what type of seizure? |
partial, complex
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alternating stiffening and movement
what type of seizure? |
tonic-clonic (grand mal)
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"drop" seizures
what type of seizure |
atonic
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tx for trigeminal neuralgia?
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Carbamazepine (inhibit high frequency firing by preventing Na channels to recover from inactivation)
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Migraine
presentations? pathogenesis? tx? |
unilateral; 4-72 hrs of pulsating pain with nausea, photophobia. +/- aura of neurologic sxs before headache, including visual, sensory, speech disturbances
due to irritation of CN V and release of substance P, CGRP, vasoactive peptides tx: propranolol, NSAIDs, and sumatriptan (acute migraines) |
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Cluster headache
presentation? |
unilateral
repetitive brief headaches characterized by periorbital pain associated with ipsilateral lacrimation, rinorrhea, Horner's syndrome |
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Meniere's disease
pathogenesis? sx? |
increased endolymph in inner ear and loss of cochlear hairs
peripheral vertigo (illusion of mvmt) |
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How do you differentiate b/t peripheral vertigo and central vertigo?
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use positional testing
Peripheral: delayed horizontal nystagmus Central: immediate nystagmus in any direction (usually due to PICA or AICA occlusion) |
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Port-wine stains in V1 opthalmic distribution, ipsilateral leptomeningeal angiomas, pheochromocytoma
dx? |
Sturge-Weber syndrome
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ash leaf spots, sebeaceous adenoma, hamartomas, cardiac rhabdomyoma, renal angiomyolipoma, subependymal giant cell astrocytoma
dx? |
Tuberous sclerosis
TSC1: chrom 9 TSC2: chrom 16 |
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von Recklinghausen's disease
aka? associated gene and chrom? presentation? |
neurofibromatosis 1
mutated NF-1 gene on chrom 17 Cafe-au-lait spots, Lisch nodules (pigmented iris hemartomas), neurofibromas in skin, optic gliomas, pheochromocytoma |
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von Hippel-Lindau disease
mutation? presentation? |
mutated tumor suppressor VHL on chrom 3
cavernous hemagiomas in skin, mucosa, organs bilateral renal cell carcinoma Hemagioblastoma in retina, brain stem, cerebellum pheochromocytoma |
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Glioblastoma multiforme
stain? histology? |
stains astrocytes for GFAP
pseudopalisating pleomorphic tumor cells: border central areas of necrosis and hemorrhage |
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whorled pattern
psammoma bodies what brain tumor? |
meningioma
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S100 positive, bilateral, Antoni A/B pattern cells
what brain tumor? |
bilateral Schwannoma found in NF2
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Chicken-wire capillary pattern, Fried egg cells
what brain tumor? |
Oligodendroglioma
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Most common tumor in children?
2nd most common in children? Most common location of brain tumor in children? |
most common: pilocytic astrocytoma
2nd: medulloblastoma infratentorial |
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Perivascular pseudorossettes in the brain
ddx? (2) |
medulloblastoma
ependymoma |
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histology of medulloblastoma?
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rosettes or perivascular pseudorossette pattern of cells
small blue cells |
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List 4 types of herniation in herniation syndrome
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1. cingulate (subfalcine) herniation under falx cerebri
2. downward transtentorial (central) herniation 3. uncal herniation 4. Cerebellar tonsillar herniation into foramen magum |
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Most severe complication of brain herniation?
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compress brainstem -> coma and death
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4 clinical signs of uncal herniation
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1. ipsilateral dilated pupil/ptosis: stretching of CN III
2. contralateral homonymous hemianopia with macula sparing: compression of ipsilateral PCA 3. Ipsilateral paresis: compression of contralateral crus cerebri (Kernohan's notch) 4. Duret (pontine) hemorrhage: paramedian artery rupture |
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ddx for ring-enhancing lesion on CT.
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metastases, abscesses, toxoplasmosis, AIDS lymphoma
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List 5 classes of drugs used in glaucoma
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1. alpha agonists (epi and brimonidine)
2. beta blockers 3. Acetazolamide 4. Cholinomimetics 5. Prostaglandin: Latanoprost |
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Brimonidine
MOA? Indication? |
alpha2 agonist
decrease aqueous humor synthesis |
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what drug is indicated in Emergency glaucoma?
MOA? |
Pilocarpine (direct cholinomimetic)
contract ciliary muscle and open trabecular meshwork |
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Methadone
MOA? Indication? why? |
agonist at opioid mu receptor and opens K+ channels and close Cl- channels -> decrease synaptic tranmission
indicated for maintenance programs for addicts b/c it has a long half-life, which suppresses the withdrawal sxs and reduces risks of addiction |
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Morphine
toxicity? what sxs do not develop tolerance? |
addiction, respiratory depression, additive CNS depression wither other drugs, miosis, constipation
Miosis and constipation do not develop tolerance |
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Tramadol
class/MOA? toxicity? |
very weak opioid agonist; SNRI
decreases seizure threshold |
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Phenytoin
MOA? indication? toxicity? |
increases Na channel inactivation
indicated for seizures; first line for tonic-clonic and status epilepticus prophylaxis Gingival hyperplasia, megaloblastic anemia, fetal hydantoin syndorme, SLE-like syndrome, induction of cytochrome P450 |
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1st line tx for status elipticus prophylaxis
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phenytoin
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1st line tx for acute sxs of status epilepticus
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Diazepam and lorazepam
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1st line tx for absence seizure
MOA? |
Ethosuximide
blocks thalamic T type Ca channels |
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1st line tx for tonic-clonic generalized seizure (3)
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Phenytoin
Valproic acid Carbamazepine |
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First line tx for trigeminal neuralgia.
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carbamazepine
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first line tx for seizures in pregnant women and children
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phenobarbital
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first line tx to prevent seizures of eclampsia
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MgSO4
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Carbamazepine
class/MOA? toxicity? |
anti-seizure medication; increases inactivation of Na channels
agranulocytosis, aplastic anemia, teratogenesis, induction of P450, SIADH, Stevens-Johnson syndrome |
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List anti-seizure medications associated with Stevens-Johnson syndrome.
What is Stevens-Johnson syndrome? |
Carbamazepine, Ethosuximide, lamotrigine
SJ syndrome: allergic rxn to the drugs; prodrome of malaise and fever followed by rapid onset of erythematous/purpuric macules (oral, ocular, genital). Skin lesions progress to epidermal necrosis and sloughing |
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Valproic acid
toxicity? |
rare but fetal hepatotoxicity, spina bifida in fetus
contraindicated in pregnancy |
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Barbiturates
MOA? toxicity? contraindication? |
facilitate GABAa axn by increasing the DURATION of Cl- channel opening, thus decreasing the neuron firing
additive CNS depression with EtOH, respiratory or CV depression, P450 induction contraindicated in porphyria |
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Benzodiazepines
MOA? Advantage over barbiturates? |
facilitate GABAa axn by increasing frequency of Cl channel opening. Decreased REM sleep
less risk of respiratory depression and coma than with barbiturates |
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what drug is used for detoxification, esp EtOH withdrawal?
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long acting benzo: diazepam and chlordiazepoxide
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list 3 short-acting benzodiazepines.
side effect? |
TOM Thumb
Tirazolam Oxazepam Midazolam highly addictive |
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how do you tx overdose of benzodiazepine?
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flumazenil: competitive antagonist at GABA receptor
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N2O as inhaled anesthetic
induction rate? potency? toxicity? |
low blood solubility -> fast induction
low lipid solublity -> low potency expansion of trapped gas |
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Halothane as inhaled anesthetic
induction rate? potency? toxicity? |
high blood solubility -> slow induction
high lipid solubility -> high potency hepatotoxicity |
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how is potency measures?
how does AV concentration gradient related to onset of action? |
potency = 1/ MAC
MAC: minimum alveolar conc at which 50% of population of anesthesized high AV conc gradient = high solubility = more gas required to saturate tissue = SLOWER onset of action |
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Thiopental
class? indication? why? |
barbiturate
used for induction of anesthesia b/c it has high potency, high lipid solubility, rapid entry into brain |
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what is the most common anesthetic used for endoscopy?
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Midazolam (benzodiazepine)
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What anesthetic acts as dissociative anesthetics and causes disorientation, hallucination and bad dreams?
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Ketamine (arycyclohexylamines)
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Propofol
MOA? indication? |
potentiate GABAa
for rapid anesthesia induction and short procedures |
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List 2 classes of local anesthetics.
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Esters: procaine, cocaine, tetracaine
Amides (2 I's in the name): Lidocaine, mepivacaine, bupivavaine |
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In what situation do you need to apply more local anesthetics to achieve the same result?
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in infected (acidic) wound b/c alkaline anesthetics are charged and cannot penetrate membrane effectively
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What drug is co-administered to increase the effect of local anesthetics?
exception? |
epinephrine to enhance local vasoconstriction
except for cocaine |
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Which sensation is blocked first with local anesthetics? last?
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Pain (first) > temperature > touch > pressure (last)
small-diameter, and myelinated fibers are affected first. Size predominates over myelination |
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succinycholine
class/MOA? indications? toxicity? |
depolarizng neuromuscular (nicotinic) blocker
indicated for muscle paralysis in surgery or mechanical ventilation complications: hypercalcemia and hyperkalemia irreversible during depolarizing phase |
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Tubocurarine, pancuronium
class/MOA? indication? reversal of action? |
nondepolarzing neuromuscular blocker (nicotinic receptor)
indicated for muscle paralysis in surgery or mechanical ventilation reversal by cholinesterase inhibitors (neostigmine, edrophonium) |
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Malignant hyperthermia
cause? tx? |
caused by inhalation of anesthetics (except N2O) and succinycholine
treat with dantrolene |
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List drugs used in Parkinson's. (5)
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BALSA
1. Bromocriptine: agonize DA receptors 2. Amatadine: increase DA 3. Levodopa (with carbidopa): act as DA 4. Selegiline: MAO B inhibitor; prevent breakdown of DA 5. Antimuscarinic (Benztropine): curb excess cholinergic activity |
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List 2 phenomenon observed with long-term Parkinson's therapy.
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On-off phenomenon
wearing off phenomenon |
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Benztropine
MOA indication |
muscarinic antagonist
Used in Parkinson's: improves tremor and rigidity but has little effect on bradykinesia |
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What is co-administered with L-dopa? why?
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carbidopa to prevent peripheral conversion of L-dopa to DA, which can cause arrhythmia and decreased the bioavailability in the brain
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Selegiline
MOA? indication? |
MAO-B inhibitor (MAO-B selective degrades DA over NE and 5HT)
adjunctive to L-dopa in tx of Parkinson's |
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Tx strategy for Huntington's
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Huntington's is characterized by increased DA and decreased GABA + Ach
Reserpine + tetrabenazine: amine depleting (decrease DA) Haloperidol: DA receptor antagonist |
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Sumatriptan
MOA? indication? toxicity? |
5-HT1b/1d agonist
causes vasoconstriction, inhibition of CN V activation and vasoactive peptide release used in acute migraine and cluster headache toxicity: coronary vasospasm and mild tingling |
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memantine
MOA? indication? |
NMDA receptor antagonist; helps prevent excitotoxicity
used in Alzheimer's drugs |