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;
613 Cards in this Set
- Front
- Back
|
Cranial nerve(s) arising from the spinal cord? |
CN XI
|
|
|
Cranial nerve(s) arising from the medulla oblongata? |
CN IX, X, XII
|
|
|
Cranial nerve(s) arising from the pontomedullary junction?
|
CN VII, VIII
|
|
|
Cranial nerve(s) arising from the pons?
|
CN V, VII
|
|
|
Cranial nerve(s) arising from the midbrain?
|
CN III, IV
|
|
|
Cranial nerve(s) arising from the diencephalon?
|
CN II
|
|
|
Cranial nerve(s) arising from the telencephalon?
|
CN I
|
|
|
Signs of Foster Kennedy syndrome?
|
(olfactory groove meningioma), IL anosmia, IL optic atrophy, CL papilledema
|
|
|
Cranial nerve sensory ganglia?
|
trigeminal, geniculate, superior and inferior ganglia (CN IX, X)
|
|
|
Cranial nerve motor ganglia?
|
ciliary, pterygopalatine, submandibular, otic, intramural (CN X)
|
|
|
Nerves traversing the jugular foramen?
|
CN IX, X, XI
|
|
|
Nerves traversing the supraorbital fissure?
|
CN III, IV, VI, V2
|
|
|
Nerves traversing the cavernous sinus?
|
CN III, IV, VI, V1 and V2
|
|
|
Nerves traversing the foramen rotundum?
|
CN V2
|
|
|
Nerves traversing the foramen ovale?
|
CN V3
|
|
|
Nerves traversing the foramen magnum?
|
CN XI
|
|
|
Nerves traversing the internal auditory meatus?
|
CN VII, VIII
|
|
|
Nerves traversing the stylomastoid foramen?
|
CN VII
|
|
|
Nuclei for CN III?
|
oculomotor, Edinger-Westphal
|
|
|
Nuclei for CN IV?
|
trochlear
|
|
|
What CN decussates before exiting the brainstem?
|
CN IV
|
|
|
Nuclei for CN V? chief sensory nucleus, mesencephalic, spinal trigeminal, trigeminal motor nucleus Nuclei for CN VI?
|
abducens
|
|
|
Nuclei for CN VII?
|
facial, superior salivatory, spinal trigeminal, solitary
|
|
|
Nuclei for CN IX?
|
nucleus ambiguous, inferior salivatory, spinal trigeminal, solitary
|
|
|
Nuclei for CN X?
|
nucleus ambiguous, dorsal vagal, spinal trigeminal, solitary
|
|
|
Nuclei for CN XI?
|
accessory nucleus (cervical spinal cord)
|
|
|
Nuclei for CN XII?
|
hypoglossal
|
|
|
Muscles innervated by CN III?
|
superior rectus, medial rectus, inferior oblique, inferior rectus, ciliary muscle, constrictor pupillae
|
|
|
Three components of the near triad?
|
convergance of eyes, pupillary constriction, contraction of ciliary muscle
|
|
|
Muscles innervated by CN IV?
|
superior oblique
|
|
|
Muscles innervated by CN VI?
|
lateral rectus
|
|
|
Nerve most likely injured with aneurysm of ICA in cavernous sinus?
|
CN VI
|
|
|
Signs of diabetic infarct in CN III?
|
oculomotor palsy with normal pupil
|
|
|
Signs of compressive injury to CN III?
|
dilated pupil with normal eye movements
|
|
|
Sign of injury to CN IV?
|
head tilt to opposite side
|
|
|
Site of horizontal gaze center?
|
pons
|
|
|
Site of vertical gaze center?
|
midbrain
|
|
|
Signs of Argyll-Robertson pupil?
|
pupil accommodates but doesn't react [to light]; tertiary syphilis
|
|
|
Signs of injury to right MLF?
|
[occurs in MS!] on leftward gaze, right eye does not adduct (convergance intact)
|
|
|
Signs of injury to the right abducens nerve?
|
IL CN VI palsy, cannot abduct eye
|
|
|
Sign of injury to right abducens nucleus?
|
on rightward gaze, R eye does not abduct, L eye does not adduct
|
|
|
Eye movement deficits in right medial pontine syndrome?
|
on rightward gaze, R eye does not abduct, L eye does not adduct + on leftward gaze, R eye does not adduct
|
|
|
Three causes of ptosis?
|
CN III palsy, Horner's syndrome, myasthenia gravis
|
|
|
Muscles innervated by CN V?
|
temporalis, masseter, medial and lateral pterygoid, ant digastric, tensor tympani, tensor veli palatini, mylohyoid
|
|
|
Muscles innervated by CN VII?
|
muscles of facial expression, post digastric, stapedius
|
|
|
Muscles innervated by CN IX?
|
stylohyoid
|
|
|
Muscles innervated by CN X?
|
laryngeal, pharyngeal, esophageal
|
|
|
Muscles innervated by CN XI?
|
trapezius, SCM
|
|
|
Muscles innervated by CN XII?
|
genioglossus, hyoglossus, styloglossus, intrinsic tongue muscles
|
|
|
Skin innervated by CN V?
|
face [V1: forehead, upper eyelid + nose; V2: cheek, lower eyelid, upper lip; V3: jaw, lower lip]
|
|
|
Skin innervated by CN VII, IX and X?
|
small area around ear
|
|
|
What is Ramsay Hunt syndrome?
|
herpes infection in the geniculate ganglion
|
|
|
Signs of Ramsay Hunt syndrome?
|
IL facial paralysis, hyperacusis, loss of taste, herpes vesicles on external ear, canal
|
|
|
Viscera innervated by CN III?
|
sphincter pupillae, ciliary muscle
|
|
|
Viscera innervated by CN VII?
|
nasal cavity, oral cavity, submandibular, sublingual glands
|
|
|
Viscera innervated by CN IX?
|
parotid gland, mucosa of middle ear
|
|
|
Viscera innervated by CN X?
|
larynx, pharynx, foregut, midgut
|
|
|
CN, ganglia and nucleus for taste at the anterior 2/3s of tongue?
|
CN VII, geniculate, solitary
|
|
|
General sensory innervation to anterior 2/3 of tongue?
|
CN V
|
|
|
Signs of CN VII injury at the internal auditory meatus?
|
IL complete facial paralysis, dry eye, dry mouth, hyperacusis, decreased taste on ant 2/3 of tongue + tinnitus/hearing loss (CN VIII)
|
|
|
Signs of CN VIII injury in facial canal?
|
IL complete facial paralysis; decreased taste on ant 2/3 of tongue
|
|
|
Signs of CN VII injury at the stylomastoid foramen?
|
IL complete facial paralysis
|
|
|
Nerves for corneal reflex?
|
CN V + VII
|
|
|
Nerves for pupillary light reflex?
|
CN II + III
|
|
|
Nerves for jaw jerk?
|
CN V
|
|
|
Nerves for cough reflex?
|
CN X (C3-5, intercostal ns)
|
|
|
Nerves for gag reflex?
|
CN IX + X
|
|
|
CN affected with aneurysm of anterior communicating/ICA?
|
CN II
|
|
|
CN affected with aneurysm of posterior communicating artery?
|
CN III
|
|
|
CN affected with aneurysm at basilar bifurcation?
|
CN III
|
|
|
CNs affected with aneurysm of PICA?
|
CN IX, X, XI, XII
|
|
|
Neurons in discriminative touch/proprioception/vibration pathway?
|
posterior root ganglia, nucleus gracilis/cuneatus, VPL thalamus, postcentral gyrus
|
|
|
Where does the posterior column/medial lemniscus pathway decussate?
|
rostral medulla
|
|
|
Injury to posterior columns in spinal cord?
|
IL loss of discriminative touch, proprioception and vibration
|
|
|
Injury to medial lemniscus?
|
CL loss of discriminative touch, proprioception and vibration
|
|
|
Neurons in pain/temperature pathway?
|
posterior root ganglia, posterior horn, VPL thalamus, postcentral gyrus
|
|
|
Where does the spinothalamic tract decussate?
|
anterior white commissure, spinal cord, all levels
|
|
|
Deficits in syringomyelia?
|
BL dermatomal loss of pain and temperature [usually upper limbs]
|
|
|
Location of lower motor neurons?
|
cerebral cortex, red nucleus, reticular formation
|
|
|
Location of upper motor neurons?
|
spinal cord, motor cranial nerve nuclei (III, IV, V, VI, VII, IX, X, XI, XII)
|
|
|
Upper motor neuron (UMN) signs?
|
hemiparesis, increase muscle stretch reflexes, + Babinski sign, spasticity
|
|
|
Lower motor neuron (UMN) signs?
|
paralysis, decreased muscles stretch reflexes, flaccid tone
|
|
|
Motor tracts in the posterior limb of the internal capsule?
|
corticospinal [upper limb, trunk, lower limb]
|
|
|
Corticospinal tracts decussates at what level?
|
pyramidal decussation, caudal medulla
|
|
|
Motor tracts in the genu of the internal capsule?
|
corticobulbar [cranial nerves]
|
|
|
Signs of injury to the corticospinal tract in the right internal capsule?
|
left, UMN signs
|
|
|
Signs of injury to the corticospinal tract in cervical spinal cord on the right?
|
right, UMN signs
|
|
|
Signs of injury to the corticobulbar tract in the right internal capsule?
|
left, lower facial paralysis; tongue points away from lesion
|
|
|
Location of lesion in decerebrate posturing?
|
midbrain: damage red nucleus or rubrospinal tract
|
|
|
Location of lesion in decorticate posturing?
|
rostral midbrain or thalamus: red nucleus intact
|
|
|
Neurons in auditory pathway?
|
spiral ganglion, cochlear nucleus, superior olive, inferior colliculus, medial geniculate, primary auditory cortex
|
|
|
Result of Rinne test in normal ear?
|
air conduction > bone conduction
|
|
|
Result of Rinne test in conductive hearing loss?
|
air conduction < bone conduction
|
|
|
Result of Rinne test in sensorineural hearing loss?
|
air conduction > bone conduction
|
|
|
Result of Weber test in normal hearing?
|
localize to midline
|
|
|
Result of Weber test with sensorineural hearing loss in R ear?
|
localize to left
|
|
|
Result of Weber test with conductive hearing loss R ear?
|
localize to right
|
|
|
Deficits with injury to CN VIII?
|
IL deafness
|
|
|
What is presbycusis?
|
age-related hearing loss, high frequencies lost first
|
|
|
Neurons in visual pathway?
|
retinal ganglion cells, lateral geniculate, primary visual cortex |
|
|
Signs of injury to optic nerve/retina?
|
IL visual loss, can affect both temporal & nasal hemifield
|
|
|
Signs of injury to optic chiasm?
|
bitemporal hemianopsia
|
|
|
Signs of injury to optic tract?
|
contralateral homonymous hemianopsia
|
|
|
Signs of injury to Meyer's loop?
|
upper quadrant homonymous hemianopsia
|
|
|
Visual deficits in PCA stroke affecting calcarine sulcus?
|
contralateral homonymous hemianopsia, with macular sparring
|
|
|
What is Marcus Gunn pupil?
|
optic nerve lesion, when light is shown into bad eye, pupil appears to dilate |
|
|
What structures comprise the basal ganglia [nuclei]?
|
caudate, putamen, globus pallidus, subthalamic nucleus, basal nucleus of Meynert
|
|
|
Brain region affected in Parkinson disease?
|
substantia nigra, pars compacta [dopamine]
|
|
|
Signs of Parkinson disease?
|
bradykinesia, pill-rolling tremor, masked facies, postural instability
|
|
|
Pathological sign of Parkinson disease?
|
Lewy bodies in SN
|
|
|
Brain regions affected in Huntington disease?
|
caudate nucleus
|
|
|
Signs of Huntington disease?
|
choreiform movements, dementia
|
|
|
Brain region injured in right hemiballismus?
|
left subthalamic nucleus
|
|
|
Signs of essential tremor?
|
chronic, progressive tremor in arms, neck, larynx, chin; reduced with alcohol consumption
|
|
|
What is Wilson disease?
|
inborn error of copper metabolism; Kayser-Fleischer rings; wing-beating tremor, rigidity
|
|
|
What are signs of cerebellar injury?
|
ataxia, dysmetria, dysdiadokinesia, nystagmus, dysarthria
|
|
|
Signs of injury to vestibulocerebellum (flocculonodular lobe)?
|
truncal ataxia, nystagmus
|
|
|
Signs of injury to lateral hemisphere of cerebellum?
|
limb ataxia, intention tremor, dysarthria
|
|
|
Signs of injury to middle cerebellar peduncle?
|
ipsilateral limb ataxia
|
|
|
Results of caloric testing in normal individual?
|
COWS: cold = nystagmus to opposite side; warm = nystagmus to same side
|
|
|
Signs of Arnold-Chiari I malformation?
|
extension of cerebellar tonsil below foramen magnum
|
|
|
Signs of Arnold-Chiari II malformation?
|
displaced vermis + myelomeningiocele
|
|
|
Signs of Dandy-Walker?
|
enlarged posterior fossa, small cerebellum, cystic dilation of 4th ventricle, hydrocephalus
|
|
|
Signs of injury to corticospinal tract in spinal cord?
|
UMN signs below lesion
|
|
|
Signs of injury to anterior horn of spinal cord?
|
LMN signs at level
|
|
|
Signs of injury to posterior columns?
|
IL loss of discriminative touch, proprioception and vibration
|
|
|
Signs of injury to spinothalamic tract?
|
CL loss of pain and temperature
|
|
|
Signs of intramedullary tumor/central cord syndrome?
|
sensory loss, sacral sparing of motor function; maybe bowel/bladder disturbances
|
|
|
Deficits in anterior spinal syndrome?
|
UMN signs below lesion, LMN signs at level, loss of pain & temp below lesion, disc touch, proprioception & vibration intact
|
|
|
Deficits in tabes dorsalis?
|
loss of disc touch, proprioception & vibration below lesion, Romberg sign
|
|
|
Deficits in Brown-Sequard injury?
|
IL loss of discriminative touch, CL loss of pain/temp, UMN signs below lesion, LMN signs at level
|
|
|
Deficits in Friedreich's ataxia?
|
loss of disc touch, proprioception & vibration below lesion, Romberg sign, ataxia & UMN signs below lesion
|
|
|
Deficits in subacute combined degeneration?
|
B12 deficiency; loss of disc touch, proprioception and vibration below lesion, UMN signs below lesion
|
|
|
Signs of spinal cord transection at C6?
|
LMN signs at C6 (brachioradialis), UMN signs below; complete sensory loss below C6
|
|
|
Signs of spinal cord transection at L4?
|
LMN signs at L4 (quads), UMN signs below; complete sensory loss below L4
|
|
|
Deficits in medial medullary syndrome?
|
CL loss of discriminative touch, UMN signs, tongue points to lesion
|
|
|
Artery involved in medial medullary syndrome?
|
alternating branches of anterior spinal artery
|
|
|
Deficits in lateral medullary syndrome?
|
IL loss of pain and temp on face, CL loss of pain and temp on body, dysphagia, hoarseness
|
|
|
Artery involved in lateral medullary syndrome?
|
PICA
|
|
|
Deficits in medial pontine syndrome?
|
CL loss of discriminative touch, UMN signs, IL CN VI palsy
|
|
|
Artery involved in medial pontine syndrome?
|
basilar, paramedian branches
|
|
|
Deficits in lateral pontine syndrome?
|
IL loss of pain and temp on face, CL loss of pain & temp on body, CN VII or V palsy
|
|
|
Artery involved in lateral pontine syndrome?
|
basilar, circumferential branches
|
|
|
Deficits in Weber syndrome?
|
IL CN III palsy, CL UMN sign, CL lower facial paralysis
|
|
|
Deficits in Benedikt syndrome?
|
IL CN III palsy, CL ataxia [superior cerebellar peduncle]
|
|
|
Deficits in Claude syndrome?
|
IL CN III palsy, CL UMN sign, CL lower facial paralysis, CL ataxia
|
|
|
Arteries involved in midbrain syndromes?
|
paramedian branches from PCA
|
|
|
Signs of cortical injury?
|
aphasia, agnosia, anosognosia, primitive reflexes: grasp, snout, suck, root, magnetic gate, astereognosia, apraxia, contralateral neglect
|
|
|
Deficits in left inferior division MCA stroke?
|
expressive aphasia, CL UMN signs [face + UL], CL sensory loss [face + UL]
|
|
|
Deficits in left superior division MCA stroke?
|
receptive aphasia, CL homonymous hemianopsia
|
|
|
Deficits in right MCA stroke?
|
CL UMN signs [face + UL], CL sensory loss [face + UL]
|
|
|
Deficits in left PCA stroke?
|
CL homonymous hemianopsia with macular sparing
|
|
|
Deficits in left ACA stroke?
|
CL UMN signs [LL], frontal lobe signs
|
|
|
Deficits in Parinaud syndrome?
|
vertical gaze palsy, obstructive hydrocephalus
|
|
|
Deficits in anterior choroidal artery stroke?
|
CL UMN signs, CL homonymous hemianopsia
|
|
|
Deficits in lenticulostriate artery hemorrhage?
|
CL UMN signs, CL lower facial paralysis, tongue deviates away from lesion
|
|
|
Strokes that can lead to Horner's syndrome?
|
lateral medullary, cervical spinal cord
|
|
|
Blood supply to thalamus?
|
posterior cerebral [thalamogeniculate + thalamoperforating]
|
|
|
Signs of thalamic hemorrhage?
|
CL sensory loss, CL homonymous hemianopsia
|
|
|
Signs of tonsillar herniation?
|
respiratory and cardiovascular arrest
|
|
|
Signs of uncal herniation?
|
CN III palsy, UMN signs, papilledema
|
|
|
Structure injured in contralateral neglect?
|
right parietal lobe
|
|
|
Signs of Gerstman's syndrome?
|
acalculia, left-right confusion, finger agnosia; left parietal lobe
|
|
|
Structure damaged in alexia without agraphia?
|
left splenium of corpus callosum
|
|
|
Where is Broca's area? Function?
|
left inferior frontal gyrus; expressive speech
|
|
|
Where is Wernicke's area? Function?
|
left supramarginal, angular, superior temporal gyri; receptive speech
|
|
|
Cause of Cushing's disease?
|
ACTH-secreting pituitary adenoma
|
|
|
Signs of LH or FSH secreting adenoma?
|
hypogonadism and infertility
|
|
|
Signs of prolactin-secreting adenoma?
|
amenorrhea in females; hypogonadism in men; galactorrhea, infertility, hair loss, decreased libido, weight gain
|
|
|
Signs of diabetes insipidus?
|
polyuria, polydipsia
|
|
|
Signs of SIADH?
|
concentrated urine with osmolality > 300 mOsm/L
|
|
|
SIADH treated with rapid infusion of hypertonic saline will cause?
|
central pontine myelinolysis
|
|
|
Signs of craniopharyngioma?
|
visual deficits, diabetes insipidus, adiposity, developmental delay, headaches, papilledema
|
|
|
Craniopharyngioma derived from?
|
remnant of rathke's pouch
|
|
|
Bladder problems in cortical lesions (paracentral lobule)?
|
uninhibited, spastic bladder
|
|
|
Bladder problems in brainstem/high spinal cord injury?
|
flaccid --> spastic [urge incontinence, hyperactive, empties too frequently]
|
|
|
Bladder problems in sacral spinal cord injury?
|
overflow incontinence
|
|
|
Disturbances of erection/ejaculation with spinal cord injury (above T12)?
|
loss of psychogenic erections, reflex erections intact; only reflex ejaculation
|
|
|
Disturbances of erection/ejaculation with sacral spinal cord injury?
|
loss of reflex erection, psychogenic may be preserved; ejaculation abolished
|
|
|
Signs of Horner's syndrome?
|
constricted pupil, ptosis, red face, anhydrosis
|
|
|
Components of the limbic system?
|
parahippocampal gyrus, uncus, hippocampus, amygdala...
|
|
|
Structures in the Papez circuit?
|
hippocampus, mammillary body (via fornix), ant nucleus of thalamus, cingulate cortex
|
|
|
Function of hippocampus?
|
consolidation of short term memory
|
|
|
Part of hippocampus most vulnerable to seizure activity?
|
CA4
|
|
|
Part of hippocampus most susceptible to anoxia?
|
CA1
|
|
|
Structure affected in Korsakoff syndrome?
|
mammillary bodies, dorsomedial thalamus
|
|
|
Signs of Korsakoff syndrome?
|
amnesia, confabulation with short term memory intact
|
|
|
Metabolic deficiency in Korsakoff syndrome?
|
thiamine
|
|
|
Signs of Wernicke-Korsakoff syndrome?
|
ophthalmoplegia, ataxia and disturbances of mentation and consciousness
|
|
|
Signs + injury in akinetic mutism?
|
immobile, mute and unresponsive but awake; bilateral lesion of cingulate gyrus
|
|
|
Signs of Kluvy-Bucy syndrome?
|
placid, visual agnosia, hyperorality
|
|
|
Brain region injured in Kluver-Bucy syndrome?
|
bilateral temporal lobe
|
|
|
Signs of normal pressure hydrocephalus?
|
wet [incontinent], wacky [mental decline] & wobbly [gait difficulties]
|
|
|
Structure damaged in epidural hematoma?
|
middle meningeal artery
|
|
|
Structure damaged in subdural hematoma?
|
bridging veins
|
|
|
How do you age subdural hematomas?
|
acute blood is white [hyperdense] on CT; isodense in 1-2 weeks and hypodense after that
|
|
|
Structure damaged in subarachnoid hemorrhage?
|
vessels in or around the circle of willis
|
|
|
Contents of cisterna magna?
|
vertebral artery, choroid plexus, CN IX, X, XI & XII
|
|
|
Contents of prepontine cistern?
|
basilar artery, CN VI
|
|
|
Contents of cerebellopontine cistern?
|
CN V, VII, VIII
|
|
|
Contents of interpeduncular cistern?
|
CN III
|
|
|
Contents of the ambient cistern?
|
CN IV
|
|
|
Structure comprising the lateral wall of the lateral ventricle?
|
caudate nucleus
|
|
|
Structure(s) comprising the lateral wall of the 3rd ventricle?
|
thalamus, hypothalamus
|
|
|
Structure at floor of 4th ventricle?
|
pons [facial colliculus], medulla [hypoglossal trigone]
|
|
|
Signs of injury to facial colliculus?
|
IL facial paralysis + IL CN VI palsy
|
|
|
Signs of injury to the reticular formation?
|
Coma
|
|
|
Components of the diencephalon?
|
thalamus, hypothalamus, epithalamus (pineal), subthalamus
|
|
|
Deficits in ALS?
|
UMN & LMN signs, sensation intact
|
|
|
Deficits in MS?
|
multiple (motor, sensory, special sensory, cognitive) deficits in time and lesions in space
|
|
|
Deficits in Guillan-Barre?
|
typically follows viral illness or vaccination, ascending paralysis (LE then UE), some sensory, autonomic effects
|
|
|
Structures innervated by posterior rami?
|
deep back muscles and overlying skin
|
|
|
Dermatome for C2?
|
back of the scalp; greater occipital nerve [posterior ramus of C2]
|
|
|
Signs of injury to musculocutaneous nerve in axilla?
|
decreased biceps reflex, weakness in elbow flexion, supination, sensory loss along lateral forearm
|
|
|
Signs of injury to median nerve at elbow?
|
severe weakness in forearm flexion, paralysis of thenar muscles, sensory loss over palmar aspect & tips of digits 1 - 3, lateral half of digit 4
|
|
|
Signs of injury to median nerve at carpal tunnel?
|
paralysis of thenar muscles, sensory loss over palmar aspect and tips of digits 1 - 3, lateral half of digit 4
|
|
|
Signs of injury to ulnar nerve at cubital tunnel?
|
weakness in flexion of digits 4 and 5, sensory loss in 5th digit (palmar and dorsal), weakness in ab/adduction of fingers, hypothenar muscles, adductor pollicis , Froment's sign, slight ulnar claw
|
|
|
Signs of ulnar nerve injury at Guyon's tunnel?
|
sensory loss in 5th digit (palmar only), weakness in ab/adduction of fingers, hypothenar muscles, adductor pollicis, Froment's sign, ulnar claw
|
|
|
Signs of injury to radial nerve with midshaft humeral fracture?
|
wrist drop, weak supination, sensory loss on dorsum of hand, normal triceps
|
|
|
Signs of injury to radial nerve in axilla?
|
paralyzed triceps, decreased triceps reflex, decreased brachioradialis reflex, wrist drop, weak supination, sensory loss on dorsum of hand
|
|
|
Signs of lesion to upper roots of brachial plexus?
|
Erb-Duchenne palsy, decreased biceps + brachioradialis reflexes; arm is medial rotated & extended [cant abduct, laterally rotate or flex at elbow], sensory loss over lateral arm
|
|
|
Signs of lesion to lower roots of brachial plexus?
|
Klumpke palsy, complete claw, sensory loss over 5th digit and medial arm, forearm
|
|
|
Signs of thoracic outlet syndrome?
|
weakness in intrinsic hand muscles, sensory loss over 5th digit and medial arm, forearm
|
|
|
Signs of injury to C5 nerve root?
|
weakness in abduction, lateral rotation & flexion at elbow, decreased biceps reflex, sensory loss over lateral arm
|
|
|
Signs of injury to C6 nerve root?
|
weakness in wrist extension, flexion at elbow, decreased brachioradialis reflex, sensory loss over lateral forearm
|
|
|
Signs of injury to C7 nerve root?
|
weakness in finger extension, elbow extension, wrist flexion, decreased triceps reflex, sensory loss over middle finger
|
|
|
Signs of injury to C8 nerve root?
|
weakness in finger flexion, sensory loss over 4th + 5th digit, medial forearm
|
|
|
Signs of injury to T1 nerve root?
|
weakness in finger ab/adduction, sensory loss over medial forearm/arm
|
|
|
Signs of injury to lateral femoral cutaneous nerve?
|
sensory loss over anterior and lateral thigh; aka meralgia paresthetica
|
|
|
Signs of entrapment/injury to saphenous nerve?
|
sensory loss along anterior and medial leg, medial malleolus and foot
|
|
|
Signs of injury to femoral nerve?
|
paralysis of quadriceps, decreased patellar reflex, sensory loss along anterior & medial thigh, leg, medial malleolus & foot
|
|
|
Signs of piriformis syndrome?
|
decreased achilles reflex, weakness in knee flexors, dorsiflexors, plantar flexors, sensory loss over lateral leg, lateral malleolus, dorsum of foot
|
|
|
Signs of injury to common fibular nerve?
|
foot drop, weakness in dorsiflexion, eversion, sensory loss over lateral leg & dorsum of the foot
|
|
|
Signs of injury to superficial fibular nerve?
|
weakness in eversion, sensory loss over dorsum of foot
|
|
|
Signs of injury to deep fibular nerve?
|
foot drop, weakness in dorsiflexion, eversion, sensory loss in the web between 1st & 2nd toes
|
|
|
Signs of injury to tibial nerve in popliteal fossa?
|
weakness in plantar flexion, toe flexion, weakness in intrinsic foot muscle, sensory loss on plantar surface of foot
|
|
|
Signs of injury to the tibial nerve in tarsal tunnel?
|
weakness in intrinsic foot muscles, - sensory loss on plantar surface of foot
|
|
|
Signs of injury to superior gluteal nerve?
|
Trendelenburg sign: pelvis drops to good side during gait, paralysis of gluteus medius, minimus and tensor fascia lata
|
|
|
Signs of injury to inferior gluteal nerve?
|
Paralysis of gluteus maximus, weakness in extension and lateral rotation of thigh
|
|
|
Signs of injury to L2 nerve root?
|
weakness in leg flexion, knee extension, adduction, sensory loss over anterior thigh
|
|
|
Signs of injury to L4 nerve root?
|
weakness in knee extension, decreased patellar reflex, sensory loss over anterior medial leg, medial malleolus
|
|
|
Signs of injury to L5 nerve root?
|
weakness in dorsiflexion, toe extension, abduction of thigh, sensory loss over anterior leg, dorsum of foot, digits 1 & 2
|
|
|
Signs of injury to S1 nerve root?
|
weakness in plantar flexion, eversion, hip extension, decreased achilles reflex, sensory loss over posterior leg, digits 3-5
|
|
|
Signs of injury to S2 nerve root?
|
weakness in toe flexion, decreased anal wink, sensory loss over posterior thigh, perineum
|
|
|
Structure infected in herpes zoster?
|
posterior root ganglion
|
|
|
Reflex for C5?
|
biceps [via musculocutaneous n]
|
|
|
Reflex for C6?
|
brachioradialis [via radial n]
|
|
|
Reflex for C7?
|
triceps [via radial n]
|
|
|
Reflex for L1?
|
cremaster
|
|
|
Reflex for L4?
|
patellar tendon [quadriceps, via femoral n]
|
|
|
Reflex for S1?
|
Achilles/calcaneal tendon [gastroc, via tibial n]
|
|
|
Levels of sympathetic innervation of the eye?
|
T1 - T4
|
|
|
Levels of sympathetic innervation of the heart?
|
T1 - T4
|
|
|
Levels of sympathetic innervation of the lungs?
|
T2 - T7
|
|
|
Levels of sympathetic innervation of the foregut?
|
T5 - T9
|
|
|
Levels of sympathetic innervation of the small intestine?
|
T9 - T10
|
|
|
Levels of sympathetic innervation of the large intestine to splenic flexure?
|
T11 - L1
|
|
|
Levels of sympathetic innervation of the descending colon to rectum?
|
L1 - 2
|
|
|
Levels of sympathetic innervation of the kidney?
|
T10 - L1 |
|
|
Levels of sympathetic innervation of the testes/ovary?
|
T10 - 11
|
|
|
Levels of sympathetic innervation of the pelvic organs?
|
T11 - L2
|
|
|
Levels of sympathetic innervation of the upper limb?
|
T5 - 7
|
|
|
Levels of sympathetic innervation of the lower limb?
|
T10 - L2
|
|
|
Parasympathetic innervation of the eye?
|
CN III, Edinger-Westphal
|
|
|
Signs of Adie's pupil?
|
tonically dilated pupil that constricts with low dose pilocarpine
|
|
|
Structure injured in Adie's pupil?
|
ciliary ganglion
|
|
|
Parasympathetic innervation of the lacrimal, submandibular and sublingual glands?
|
CN VII, superior salivatory
|
|
|
Parasympathetic innervation of the parotid gland?
|
CN IX, inferior salivatory
|
|
|
Parasympathetic innervation of the thoracic organs?
|
CN X, dorsal vagal
|
|
|
Parasympathetic innervation of midgut?
|
CN X, dorsal vagal
|
|
|
Parasympathetic innervation of the kidney?
|
CN X, dorsal vagal
|
|
|
Parasympathetic innervation of the testes/ovaries?
|
S2 - 4 + dorsal vagal |
|
|
Parasympathetic innervation of the hindgut?
|
S2 - 4
|
|
|
Parasympathetic innervation of pelvic organs?
|
S2 - 4 |
|
|
MOA of penicillin |
Block cell wall synthesis by inhibiting peptidoglycan cross-linkage |
|
|
Drug used for MRSA
|
Vancomycin
|
|
|
Vancomycin MOA
|
Blocks cell wall synthesis by sequestration
|
|
|
Genetic basis of low level resistance found with vancomycin
|
Point mutation
|
|
|
Meningitis prophylaxis for persons in contact with patients
|
Ciprofloxacin or Rifampin (for children less than 4 yrs old)
|
|
|
Technique used to diagnose perianal itching, and the drug used to treat it
|
Scotch tape technique and mebendazole
|
|
|
Antibiotic causing red-man syndrome, and prevention
|
Vancomycin, infusion at a slow rate and antihistamines
|
|
|
Common side effect of Rifampin
|
Red urine discoloration
|
|
|
Common side effect of hypnotic agents
|
Sedation
|
|
|
Occurs when sedative hypnotics are used chronically or at high doses
|
Tolerance
|
|
|
The most common type of drug interaction of sedative hypnotics with other depressant medications
|
Additive CNS depression
|
|
|
Benzodiazepines used to promote sleep
|
Temazpam, trizolam, flurazepam
|
|
|
Benzodiazepine used for anxiety
|
Alprazolam
|
|
|
Non-benzodiazepine used as an anxiolytic
|
Buspirone
|
|
|
Non-benzodiazepine used for sleep
|
Zolpidem
|
|
|
Major effect of benzodiazepines on sleep at high doses
|
REM is decreased
|
|
|
Neurologic SE of benzodiazepines
|
Anterograde amnesia
|
|
|
Reason benzos are used cautiously in pregnancy
|
Ability to cross the placenta
|
|
|
Main route of metabolism for benzodiazepines
|
Hepatic
|
|
|
Benzodiazepine that undergo extrahepatic conjugation (which are useful in older or hepatically impaired)
|
Lorazepam, oxazepam, and temazepam
|
|
|
MOA for benzodiazepines
|
increase the FREQUENCY of GABA- mediated chloride ion channel opening
|
|
|
Antidote to benzodiazepine overdose (antagonist that reverses the CNS effects)
|
Flumazenil
|
|
|
Benzodiazepine with useful relaxant effects in skeletal muscle spasticity of central origin
|
Diazepam
|
|
|
Benzodiazepine that has efficacy against absence seizures and in anxiety states, such as agoraphobia
|
Clonazepam
|
|
|
Benzodiazepines that are the most effective in the treatment of panic disorder
|
Alprazolam and Clonazepam
|
|
|
Benzodiazepine that is used for anesthesia
|
Midazolam
|
|
|
DOC for status epilepticus
|
Diazepam
|
|
|
Longer acting benzodiazepines used in the management of withdrawal states of alcohol and other drugs
|
Chlordiazepoxide and Diazepam
|
|
|
Agents having active metabolites, long half lives, and a high incidence of adverse effects
|
Diazepam, Flurazepam, chlordiazepoxide, and clorazepate |
|
|
Barbiturates may precipitate this hematologic condition
|
Acute intermittent porphyria |
|
|
Barbiturates decrease the effectiveness of many other drugs via this pharmacokinetics property
|
Liver enzyme INDUCTION
|
|
|
Barbiturates MOA
|
Increase the DURATION of GABA- mediated chloride ion channels
|
|
|
Barbiturate used for the induction of anesthesia
|
Thiopental
|
|
|
Most frequent route of metabolism
|
Hepatic enzymes
|
|
|
Mechanisms of action for Phenytoin, Carbamazepine, Lamotrigine
|
Sodium channel blockade
|
|
|
MOA for benzodiazepines and barbiturates
|
GABA-related targets
|
|
|
MOA for Ethosuximide
|
Calcium channels
|
|
|
MOA for Valproic acid at high doses
|
Affect calcium, potassium, and sodium channels
|
|
|
Drugs of choice for generalized tonic-clonic and partial seizures
|
Valproic acid and Phenytoin
|
|
|
DOC for febrile seizures
|
Phenobarbital
|
|
|
Drugs of choice for absence seizures
|
Ethosuximide and valproic acid
|
|
|
Drug of choice for myoclonic seizures
|
Valproic acid |
|
|
Drugs of choice for status epilepticus
|
IV diazepam for short term (acute) treatment; phenytoin for prolonged therapy
|
|
|
Drugs that can be used for infantile spasms
|
Corticosteroids
|
|
|
Anti-seizure drugs used also for bipolar affective disorder (BAD)
|
Valproic acid, carbamazepine, phenytoin and gabapentin
|
|
|
Anti-seizure drugs used also for Trigeminal neuralgia
|
Carbamazepine
|
|
|
Anti-seizure drugs used also for pain of neuropathic origin
|
Gabapentin
|
|
|
Anti-seizure agent that exhibits non-linear metabolism, highly protein bound, causes fetal hydantoin syndrome, and stimulates hepatic metabolism
|
Phenytoin
|
|
|
SE of phenytoin
|
Gingival hyperplasia, nystagmus, diplopia and ataxia
|
|
|
Anti-seizure agent that induces formation of liver drug-metabolism enzymes, is teratogen and can cause craniofacial anomalies and spina bifida
|
Carbamazepine
|
|
|
Agent that inhibits hepatic metabolism, is hepatotoxic and teratogen that can cause neural tube defects and gastrointestinal distress
|
Valproic acid
|
|
|
Laboratory value required to be monitored for patients on valproic acid
|
Serum ammonia and LFT's
|
|
|
SE for Lamotrigine
|
Stevens-Johnson syndrome
|
|
|
SE for Felbamate
|
Aplastic anemia and acute hepatic failure |
|
|
Anti-seizure medication also used in the prevention of migraines
|
Valproic acid |
|
|
Carbamazepine may cause
|
Agranulocytosis
|
|
|
Anti-seizure drugs used as alternative drugs for mood stabilization
|
Carbamazepine, gabapentin, lamotrigine, and valproic acid
|
|
|
Benzodiazepine receptor antagonist, it accelerates recovery from benzodiazepine overdose
|
Flumazenil
|
|
|
Local anesthetic with vasoconstrictive property, favored for head, neck, and pharyngeal surgery
|
Cocaine
|
|
|
These LA's have surface activity
|
Cocaine and benzocaine
|
|
|
During Phase I these agents worsen muscle paralysis by succinylcholine, but during phase II they reverse the blockade produced by succinylcholine
|
Cholinesterase inhibitors
|
|
|
Irreversible condition resulting from the use of antipsychotics, reserpine at high doses, and MPTP (by-product of illicit meperidine analog)
|
Drug induced Parkinsonism
|
|
|
Agent used in drug therapy of Parkinson's instead of Dopamine which has low bioavailability and does not cross the BBB
|
L-dopa
|
|
|
This is combined with L-dopa, inhibits DOPA decarboxylase (active only peripherally) which allows lower effective doses of L-dopa and allows for fewer SE's (GI distress, postural hypotension, and dyskinesias)
|
Carbidopa
|
|
|
Clinical response that may fluctuate in tx of Parkinson's dx
|
"On-off-phenomenon"
|
|
|
Anti-Parkinson's drug which increases intraocular pressure and is contraindicated in closed angle glaucoma
|
Levodopa
|
|
|
Ergot alkaloid that is a partial agonist at D2 receptors in the brain, used for patients who are refractory or cannot tolerate levodopa, causes erythromelalgia
|
Bromocriptine |
|
|
Non ergot agents used as first-line therapy in the initial management of Parkinson's
|
Pramipexole and ropinirole
|
|
|
Enhances dopaminergic neurotransmission SE's include CNS excitation, acute toxic psychosis and livedo reticularis
|
Amantadine
|
|
|
Inhibitor of MAO type B which slows down metabolism of dopamine, used adjunct to levodopa or as sole agent in newly diagnosed patients
|
Selegiline
|
|
|
Inhibitors of catechol-O-methyltransferase (COMT), used as adjuncts in Parkinson's dx and cause acute hepatic failure (monitor LFT's)
|
Tolcapone |
|
|
Agent decreases the excitatory actions of cholinergic neurons. May improve tremor and rigidity but have LITTLE effect on bradykinesia. Atropine-like side effects
|
Benztropine
|
|
|
Agent effective in physiologic and essential tremor
|
Propranolol
|
|
|
Agents used in Huntington's Disease
|
Tetrabenazine (amine depleting drug), reserpine
|
|
|
Agents used in Tourette's dx
|
Haloperidol, pimozide , clonidine |
|
|
Chelating agent used in Wilson's disease
|
Penicillamine
|
|
|
Example of three antidepressants that are indicated
|
Clomipramine, fluoxetine and
|
|
|
for obsessive compulsive disorder
|
fluvoxamine
|
|
|
Neurotransmitters affected by the action of antidepressants
|
Norepinephrine and serotonin |
|
|
Usual time needed for full effect of antidepressant therapy
|
2 to 6 weeks
|
|
|
Population group especially sensitive to side effects of antidepressants
|
Elderly patients
|
|
|
All antidepressants have roughly the same efficacy in treating depression, agents are chosen based on these criterion
|
Side-effect profile, drug interaction potential and prior pt response
|
|
|
Well-tolerated and are first-line antidepressants Monoamine oxidase inhibitors (MAOI)
|
SSRI's, bupropion, and venlafaxine
|
|
|
Most useful in patients with significant anxiety, phobic features, hypochondriasis, and resistant depression
|
Monamine oxidase inhibitors
|
|
|
Condition will result from in combination of MAOI with tyramine containing foods (ex. wine, cheese, and pickled meats)
|
Hypertensive crisis
|
|
|
MAOI should not be administered with SSRI's or potent TCA's due to development of this condition Tricyclic antidepressants (TCA)
|
Serotonin syndrome
|
|
|
Sedation is a common side effect of these drugs, they lower seizure threshold, uses include BAD, acute panic attacks, phobias, enuresis, and chronic pain and their overdose can be deadly
|
Tricyclic antidepressants (TCA)
|
|
|
Three C's associated with TCA toxicity
|
Coma, Convulsions, Cardiac problems (arrhythmias and wide QRS) |
|
|
Agents having higher sedation and antimuscarinic effects than other TCA's
|
Tertiary amines
|
|
|
TCA used in chronic pain, a hypnotic, and has marked antimuscarinic effects
|
Amitriptyline
|
|
|
TCA used in chronic pain, enuresis, and ADD
|
Imipramine
|
|
|
TCA with greatest sedation of this group, and marked antimuscarinic effects, used for sleep
|
Doxepin
|
|
|
TCA used in obsessive compulsive disorder (OCD), most significant of TCA's for risk of seizure, weight gain, and neuropsychiatric signs and symptoms
|
Clomipramine
|
|
|
Secondary amines that have less sedation and more excitation effect
|
Nortriptyline, Desipramine
|
|
|
Side effects seen with tricyclic antidepressants
|
Muscarinic blockade (dry mouth, constipation); weak alpha-1 block (orthostatic hypotension); weak hisamine block (sedation) |
|
|
Antidepressant associated with neuroleptic malignant syndrome
|
Amoxapine
|
|
|
Antidepressant associated with seizures and cardiotoxicity
|
Maprotiline
|
|
|
Antidepressant having stimulant effects similar to SSRI's and can increase blood pressure
|
Venlafaxine
|
|
|
Antidepressant inhibiting norepinephrine, serotonin, and dopamine reuptake
|
Venlafaxine, duloxetine
|
|
|
Antidepressant also used for sleep that causes priapism
|
Trazodone
|
|
|
Antidepressant which is inhibitor of CYP450 enzymes and may be associated with hepatic failure
|
Nefazodone
|
|
|
Heterocyclic antidepressants least likely to affect sexual performance, used for management of nicotine withdrawal, SE's include dizziness, dry mouth, aggravation of psychosis, and seizures
|
Bupropion
|
|
|
Antidepressant with MOA as alpha 2 antagonist, has effects on both 5-HT and NE, blocks histamine receptors, and is sedating
|
Mirtazapine
|
|
|
SE of mirtazapine
|
Liver toxicity, increased serum cholesterol
|
|
|
Except for these agents all SSRI have significant inhibition of CytP450 enzymes
|
Citalopram and its metabolite escitalopram
|
|
|
Side effects frequently seen with SSRIs
|
CNS stimulation; GI upset
|
|
|
Antidepressants with no effect on BP, no sedation
|
SSRIs
|
|
|
SSRI with long T1/2 and can be administered once weekly for maintenance, not acute tx
|
Fluoxetine
|
|
|
SSRI indicated for premenstrual dysphoric disorder
|
Fluoxetine (Sarafem)
|
|
|
Some of SSRIs' therapeutic effects beside depression
|
Panic attacks, social phobias, bulimia nervosa, and PMDD (premenstrual dysphoric disorder), OCD |
|
|
SSRI less likely to cause a withdrawal syndrome
|
Fluoxetine
|
|
|
Tolerance is marked and abstinence syndrome occurs
|
Amphetamines
|
|
|
Amphetamine agents
|
Dextroamphetamines and methamphetamine
|
|
|
Overdoses of this agent with powerful vasoconstrictive action may result in fatalities from arrhythmias, seizures, respiratory depression, or severe HTN (MI and stroke)
|
Cocaine "super-speed"
|
|
|
This agent has greater affinity for muscarinic receptors and used for postoperative and neurogenic * ileus and urinary retention
|
Bethanechol
|
|
|
Only direct acting agent that is very lipid soluble and used in glaucoma
|
Pilocarpine
|
|
|
This agent used to treat dry mouth in Sjögren's syndrome
|
Cevimeline
|
|
|
Indirect-Acting ACh Agonist, alcohol, short DOA and used in diagnosis of myasthenia gravis
|
Edrophonium
|
|
|
Carbamate with intermediate action, used for+A1170 postoperative and neurogenic ileus and urinary retention
|
Neostigmine
|
|
|
Treatment of atropine overdose and glaucoma (because lipid soluable). Enters the CNS rapidly and has a stimulant effect, which may lead to convulsions
|
Physostigmine
|
|
|
Treatment of myasthenia gravis Organophosphates
|
Pyridostigmine
|
|
|
Antiglaucoma organophosphate
|
Echothiophate
|
|
|
Associated with an increased incidence of cataracts in patients treated for glaucoma
|
Long acting cholinesterase inhibitors
|
|
|
Scabicide organophosphate
|
Malathion |
|
|
Organophosphate anthelmintic agent with long DOA
|
Metrifonate
|
|
|
Toxicity of organophosphate:
|
DUMBELSS (diarrhea, urination, miosis, bronchoconstriction, excitation of skeletal muscle and CNS, lacrimation, salivation, and sweating) |
|
|
The most frequent cause of acute deaths in cholinesterase inhibitor toxicity |
Respiratory failure |
|
|
The most toxic organophosphate
|
Parathion
|
|
|
Treatment of choice for organophosphate overdose
|
Atropine
|
|
|
This agent regenerates active cholinesterase and is a chemical antagonist used to treat organophosphate exposure
|
Pralidoxime
|
|
|
Prototypical drug is atropine
|
Nonselective Muscarinic Antagonists
|
|
|
Treat manifestations of Parkinson's disease and EPS
|
Benztropine, trihexyphenidyl
|
|
|
Treatment of motion sickness
|
Scopolamine, meclizine
|
|
|
Produce mydriasis and cycloplegia
|
Atropine, homatropine,C1208 tropicamide
|
|
|
Bronchodilation in asthma and COPD
|
Ipratropium
|
|
|
Reduce transient hyper GI motility
|
Dicyclomine, methscopolamine
|
|
|
Cystitis, postoperative bladder spasms, or incontinence
|
Oxybutynin, dicyclomine |
|
|
Toxicity of anticholinergics
|
block SLUD (salivation, lacrimation, urination, defecation)
|
|
|
Another mnemonic for anticholinergic toxicity
|
"dry as a bone, red as a beet, mad as a hatter, hot as a hare, blind as a bat" |
|
|
Atropine fever is the most dangerous effect and can be lethal in this population group
|
Infants
|
|
|
Contraindications to use of atropine
|
Infants, closed angle glaucoma, prostatic hypertrophy
|
|
|
Mnemonic for beta receptors
|
You have 1 heart (Beta 1) and 2 lungs (Beta 2)
|
|
|
This is the drug of choice for anaphylactic shock
|
Epinephrine
|
|
|
Phenylisopropylamines that are used legitimately and abused for narcolepsy, attention deficit disorder, and weight reduction
|
Amphetamines
|
|
|
Alpha agonist used to produce mydriasis and reduce conjunctival itching and congestion caused by irritation or allergy, it does not cause cycloplegia
|
Phenylephrine
|
|
|
Newer alpha 2 agonist (apraclonidine and brimonidine) treat glaucoma by acting to
|
Reduce aqueous secretion
|
|
|
Short acting Beta 2 agonists that is drug of choice in treatment of acute asthma but not recommended for prophylaxis
|
Albuterol
|
|
|
Longer acting Beta 2 agonist is recommended for prophylaxis of asthma
|
Salmeterol, formoterol (both in combination with corticosteroid; contraindicated as monotherapy) |
|
|
These agents increase cardiac output and may be beneficial in treatment of acute heart failure and some types of shock
|
Beta1 agonists
|
|
|
These agents decrease blood flow or increase blood pressure, are local decongestants, and used in therapy of spinal shock (temporary maintenance of blood pressure which may help maintain perfusion
|
Alpha1 agonists |
|
|
Shock due to septicemia or myocardial infarction is made worse by
|
Increasing afterload and tissue perfusion declines
|
|
|
Epinephrine is often mixed with a local anesthetic to
|
Reduce the loss from area of injection
|
|
|
Chronic orthostatic hypotension can be treated with
|
Midodrine
|
|
|
Beta 2 agonist used to suppress premature labor, but cardiac stimulatory effects may be hazardous to mother and fetus
|
Terbutaline
|
|
|
Sympathetic agent which stimulates heart rate and can dilate vessels in skeletal muscle at low doses
|
Epinephrine
|
|
|
Mast cells to reduce release of hisamine and inflammatory mediators
|
Epinephrine
|
|
|
Agent used in shock because it dilates coronary arteries and increases renal blood flow
|
Dopamine
|
|
|
Agent which stimulates cardiac contractile force more than rate with little effect on total peripheral resistance
|
Dobutamine
|
|
|
Long acting sympathomimetic, sometimes used to improve urinary continence in children and elderly with enuresis
|
Ephedrine
|
|
|
Alpha 1 agonist toxicity
|
Hypertension |
|
|
Beta 1 agonist toxicity
|
Sinus tachycardia and serious arrhythmias
|
|
|
Beta 2 agonist toxicity
|
Skeletal muscle tremor, tachycardia
|
|
|
The selective agents loose their selectivity at
|
high doses
|
|
|
Inhibit peptidyl dipeptidase (plasma kininase)
|
ACE inhibitors
|
|
|
SE of ACE inhibitors
|
Cough, hyperkalemia, angioedema
|
|
|
ACE inhibitors are contraindicated in
|
pregnancy and with K+
|
|
|
Agents that block L-type calcium channel
|
Calcium channel blockers
|
|
|
Partial Alpha agonist used in HTN, acts centrally
|
Clonidine |
|
|
Used primarily for hypertension during pregnancy, can give positive Coomb's test
|
Methyldopa |
|
|
SE of clonidine
|
sedation, dry mouth, mental depression
|
|
|
Antidote to reverse actions of warfarin
|
Vitamin K or fresh frozen plasma
|
|
|
324. Leading causes of congenital infections are |
ToRCH3eS-List To = Toxoplasma gondii R = Rubella C = CMV H = HSV-2 H = HIV H = HBV S = Syphilis List = Listeria monocytogenes |
|
|
433. Fever, headache, neck stiffness, and altered mental status; Kernig's/Brudzinski's sign, rash; CSF: WBC > 2000 or PMNs > 1200; glucose < 34, protein > 220 CSF gram stain of the most likely pathogen of ABM in a 6 mos-6yr old (or adults > 50 years) should reveal CSF gram stain of the most likely pathogen of ABM in an older child or young adult should reveal |
"Acute bacterial meningitis (ABM) Gram-positive diplococci Gram-negative diplococci |
|
|
433. Fever, headache, neck stiffness, and altered mental status; Kernig's/Brudzinski's sign, rash; CSF: WBC > 2000 or PMNs > 1200; glucose < 34, protein > 220 CSF gram stain of the most likely pathogen of ABM in a 6 mos-6yr old (or adults > 50 years) should reveal CSF gram stain of the most likely pathogen of ABM in an older child or young adult should reveal
|
"Acute bacterial meningitis (ABM) Gram-positive diplococci Gram-negative diplococci |
|
|
433. Fever, headache, neck stiffness, and altered mental status; Kernig's/Brudzinski's sign, rash; CSF: WBC > 2000 or PMNs > 1200; glucose < 34, protein > 220 CSF gram stain of the most likely pathogen of ABM in a 6 mos-6yr old (or adults > 50 years) should reveal CSF gram stain of the most likely pathogen of ABM in an older child or young adult should reveal
|
"Acute bacterial meningitis (ABM) Gram-positive diplococci Gram-negative diplococci"
|
|
|
434. Most common cause of sepsis/meningitis in newborns/neonates?
|
Streptococcus agalactiae
|
|
|
435. Cause of fever, headache, photophobia, nausea/vomiting, rash, diarrhea, meningeal signs, in older children in the summer months; CSF with 10-1,000 WBC typical, mostly monos, moderately elevated protein?
|
Aseptic meningitis (enteroviruses)
|
|
|
436. Cause of aseptic meningitis in men with exposure to rodents?
|
Leptospira interrogans
|
|
|
437. Cause of aseptic meningitis with hx of tick bite and erythema migrans?
|
Borrelia burgdorferi
|
|
|
438. Cause of aseptic meningitis with hx of sex with multiple partners; CSF PCR(+):
|
HSV-2 > 1
|
|
|
439. Cause of fever, headache, photophobia, meningismus, in pts w/ solid organ transplant, malignancy, corticosteroid use. CSF glucose < 2/3 serum glucose, elevated protein, WBC > 5 with PMNs
|
Listeria monocyotgenes
|
|
|
440. How does Listeria monocytogenes differ from other - hemolytic bacteria
|
Gram-positive rods; tumbling motility
|
|
|
441. Cause of chronic meningoencephalitis in a pt, who uses infliximab or native from endemic region; PE: papilledema. CXR (+). Lab: elevated monocytes on differential, low CSF glucose?
|
Mycobacterium tuberculosis
|
|
|
442. Test to confirm subacute mengoencephalitis in a, immunocompromised pt (CD4 <100); vesicular skin lesions [CSF profile: protein 30-150mg/dl, monos 10-100]?
|
CSF India ink |
|
|
443. Cause of meningoencephalitis after a hx of respiratory illness after travel to SW USA?
|
Coccidioides immitis
|
|
|
444. Test to confirm CNS pathology with fever, cognitive deficits, focal neurologic signs, seizures; temporal lobe involvement on MRI. Lab: no papilledema, CT (no brain lesion)?
|
CSF PCR (+)
|
|
|
445. Cause of fever, cognitive deficits, focal neurologic signs, seizures, abnormal mental status with ataxia, hemi-paresis, in a pt w/ AIDS?
|
JC virus > HHV-6
|
|
|
446. Cause of fever, cognitive deficits, focal neurologic signs, seizures or abnormal mental status with ataxia in an adult during outdoor activity?
|
West-Nile virus > SLE
|
|
|
447. Hx of fever, cognitive deficits, focal neurologic signs, seizures, in a pt w/ AIDS (CD4 < 50). MRI: multifocal (ringenhancing) lesions in basal ganglia. Rule out?
|
Toxoplasma encephalitis (TE)
|
|
|
448. HIV-infected Pt with TE should receive (for life)
|
pyrimethamine + leucovorin + sulfadiazine
|
|
|
449. Folinic acid (leucovorin) prevents bone marrow suppressive effect of
|
Pyrimethamine
|
|
|
450. Cause of confusion, stiff neck, irritability over wks to months, in immunocompromised pts; CT/MRI = multifocal lesions in midbrain, brain stem, & cerebellum; wet mount CSF = motile macrophage-like organisms
|
Acanthamoeba spp. (GAE)
|
|
|
"451. Cause of severe headache and other meningeal signs, fever, vomiting, and focal neurologic deficits, frequently progressing to coma, in a healthy boy (summer diving activity)?"
|
Naegleria fowleri (PAM) |
|
|
452. Cause of seizures, chronic headache, symptomatic hydrocephalus, in immigrants; pt. successfully responds to praziquantel + anti-convulsant drug?
|
Taenia solium (neurocysticercosis)
|
|
|
453. Pt from Africa had fever, lymphadenopathy, chancre, and pruritus weeks ago; now has headaches, somnolence, neuro Sns; slowly responds to pentamidine isothionate or suramin. TOW?
|
Sleeping sickness caused by Trypanosoma brucei
|
|
|
454. Hx of rigidity, muscle spasm, and autonomic dysfunction. Trismus due to masseter spasm in an infant w/ umbilical stump infection. Neurotoxin interferes w/
|
GABA and glycine
|
|
|
455. Hx of afebrile illness w/ diplopia, dysarthria, dysphoria, dysphagia, in a pt w/ IDU skin poppers with black tar heroin. Neurotoxin blocks the release of
|
Acetylcholine
|
|
|
456. Immediate treatment of a male infant w/ constipation, a weak cry, and drooling, hypotonea and cranial neuropathy, after ingestion of home-processed honey.
|
Equine immune globulin (infant botulism)
|
|
|
512. Non-stainable bacteria that are considered atypical and intracellular may be detected by microscopy using
|
Giemsa stain
|
|
|
14. Most commonly herniated intervertebral disc
|
L4-5
|
|
|
15. Most common nerve compressed with herniated intervertebral disc
|
L5
|
|
|
16. Spinal nerve affected by protrusion of the disc between C5/6
|
C6
|
|
|
17. Spinal nerve affected with herniated disc at L3/L4
|
L4
|
|
|
18. Thoracic intercostal space located deep to triangle of auscultation
|
sixth
|
|
|
19. Vertebral level of lumbar puncture
|
L4
|
|
|
22. Innervation of suboccipital muscles Suboccipital nerve
|
(Dorsal ramus C1)
|
|
|
23. Roof of suboccipital triangle
|
Semispinalis capitis
|
|
|
24. Floor of suboccipital triangle
|
Posterior arch of atlas; posterior atlanto-occipital membrane
|
|
|
25. Major vessel within suboccipital triangle
|
Vertebral artery
|
|
|
26. Synonym for dorsal ramus of C2
|
Greater occipital nerve |
|
|
27. Inferior extent of dura-arachnoid sac
|
SV2 |
|
|
28. Inferior extent of spinal cord
|
LV2
|
|
|
29. Location of internal vertebral plexus
|
Epidural space |
|
|
49. Spinal levels of axillary nerve
|
C5 and C6
|
|
|
50. Spinal levels of innervation to muscles of the hand
|
C8 and T1
|
|
|
51. Dermatome of thumb
|
C6
|
|
|
52. Nerve to thenar compartment
|
Recurrent branch of Median
|
|
|
53. Innervation of adductor pollicis
|
Ulnar (deep br.)
|
|
|
54. Innervation to all interosseous muscles
|
Ulnar (deep br.)
|
|
|
55. Innervation to nail bed of middle finger
|
Median nerve
|
|
|
56. Innervation to nail bed of ring finger
|
Ulnar and median
|
|
|
57. Region affected by upper trunk injury of brachial plexus
|
(C5-C6) Shoulder
|
|
|
58. Region affected by lower trunk injury of brachial plexus
|
(C8-T1) Intrinsic hand muscles |
|
|
59. Nerve compressed with carpal tunnel syndrome
|
Median
|
|
|
60. Nerve affected by cubital tunnel syndrome
|
Ulnar
|
|
|
61. Paralysis of which muscles results in total “claw” hand
|
Lumbricals
|
|
|
93. Cutaneous innervation to medial side of foot
|
Saphenous (L4) |
|
|
94. Cutaneous innervation to lateral side of foot |
Sural (S1)
|
|
|
95. Cutaneous innervation of heel
|
Tibial
|
|
|
98. Major dermatome to big toe
|
L4
|
|
|
99. Dermatome to small toe
|
S1
|
|
|
100. Spinal level of patellar reflex
|
L4
|
|
|
101. Spinal level of Achilles reflex
|
S1
|
|
|
108. Rib related to oblique fissure of lung posteriorly
|
2nd
|
|
|
109. Rib paralleled by horizontal fissure of right lung
|
4th
|
|
|
152. Dermatome to umbilical area
|
T10
|
|
|
153. Dermatome to suprapubic area
|
L1
|
|
|
225. Innervation of detrusor
|
Pelvic splanchnics (S2-4)
|
|
|
226. Innervation of trigone
|
Sympathetics (Pregang. T11-L2; lesser, least, lumbar splanchnic nn.)
|
|
|
227. Innervation of sphincter urethrae
|
Pudendal n. (S 2,3,4)
|
|
|
230. Chief artery to rectal mucosa
|
Superior rectal
|
|
|
231. Chief artery to rectal muscular wall
|
Middle rectal
|
|
|
257. Vertebral level of hyoid bone
|
CV3
|
|
|
258. Vertebral level of thyroid cartilage
|
CV4,5
|
|
|
259. Vertebral level of cricoid cartilage
|
CV6
|
|
|
260. Muscles that are innervated by CN XI
|
Trapezius, SCM
|
|
|
261. Structures that course between anterior and middle scalene
|
Brachial plexus, subclavian artery |
|
|
262. Innervation of omohyoid, sternohyoid and sternothyroid
|
Ansa cervicalis (C1-3 ventral rami)
|
|
|
263. Innervation of digastric
|
Anterior belly = CN V Posterior belly = CN VII
|
|
|
264. Innervation of carotid sinus and carotid body
|
CN IX, CN X
|
|
|
265. Major structures to pass through pharyngeal wall superior to Auditory tube
|
levator veli palatini, superior constrictor
|
|
|
266. Nerves of pharyngeal plexus
|
CN IX (mucosa), CN X (musculature), Sympathetics (vasomotor)
|
|
|
267. Only muscle innervated by CN IX
|
Stylopharyngeus
|
|
|
268. Structures that pierce thyrohyoid membrane
|
Internal laryngeal nerve, superior laryngeal artery
|
|
|
269. Only muscle to abduct vocal cords
|
Posterior cricoarytenoid
|
|
|
270. Innervation of cricothyroid
|
External laryngeal nerve
|
|
|
271. Innervation of laryngeal muscles exclusive of cricothyroid
|
Recurrent laryngeal
|
|
|
272. Muscle that increases tension on vocal cords
|
Cricothyroid
|
|
|
273. Sensory nerve to larynx superior to vocal cords
|
Internal laryngeal |
|
|
274. Sensory nerve to larynx inferior to vocal cords
|
Recurrent laryngeal
|
|
|
275. Site of aspirated lodged fishbone
|
Piriform recess
|
|
|
276. Afferent and efferent limbs of gag reflex
|
CN IX – CN X
|
|
|
277. Afferent and efferent limbs of cough reflex
|
CN X – CN X
|
|
|
278. Nerve at risk when performing thyroidectomy
|
Lt & Rt recurrent laryngeal nerves
|
|
|
279. Nerve injury that causes hoarseness following thyroid surgery
|
Recurrent laryngeal
|
|
|
280. Chief structures that traverse internal acoustic meatus
|
CN VII and VIII
|
|
|
281. Foramen where CN VII exits skull
|
Stylomastoid foramen
|
|
|
282. Major arterial supply to calvaria and supratentorial dura
|
Middle meningeal
|
|
|
283. Major cutaneous nerve of face
|
CN V
|
|
|
284. Major artery to internal structures of head
|
Maxillary
|
|
|
285. Spinal levels of sympathetic fibers to head
|
T1 – 2
|
|
|
286. Autonomic ganglia for CN III
|
Ciliary
|
|
|
287. Sensory ganglia for CN VII
|
Geniculate
|
|
|
288. Autonomic ganglia for CN VII
|
PPG and submandibular
|
|
|
289. Autonomic ganglia for CN IX
|
Otic
|
|
|
290. Muscle attached to disc of TMJ
|
Lateral pterygoid
|
|
|
291. Muscle that retracts mandible
|
Temporalis
|
|
|
292. Major nerve to TMJ (pain)
|
Auriculotemporal (V3)
|
|
|
293. Specific nerves that elicit secretion from the parotid gland
|
Tympanic branch of CN IX and lesser petrosal
|
|
|
295. Structure that opens into superior meatus of nasal cavity
|
Posterior ethmoid sinus
|
|
|
296. Structures that open into middle meatus of nasal cavity
|
Frontal, maxillary, anterior and middle ethmoid sinuses
|
|
|
297. Structure that opens into inferior meatus of nasal cavity
|
Nasolacrimal duct
|
|
|
299. Most common site of nose bleed
|
Kiesselbach’s plexus
|
|
|
300. Innervation of levator veli palatini
|
CN X
|
|
|
301. Muscle that opens auditory tube
|
Tensor veli palatini
|
|
|
302. Innervation of tensor veli palatini
|
CN V3
|
|
|
303. Nerve that provides taste to anterior 2/3 of tongue
|
Chorda tympani
|
|
|
304. Site of cell bodies for nerve that carries taste to anterior 2/3 of tongue
|
Geniculate ganglion
|
|
|
305. Specific nerve that elicits secretion from submandibular gland
|
Chorda tympani
|
|
|
306. Branch of CN V that carries parasympathetic to submandibular
|
Lingual
|
|
|
307. Nerve injured when tonsilar pillars sag and uvula deviates
|
CN X
|
|
|
308. Nerve potentially injured with tonsillectomy
|
CN IX |
|
|
309. Muscle that protrudes tongue
|
Genioglossus
|
|
|
310. Nerve injured when deviation of protruded tongue Ipsilateral
|
CN XII
|
|
|
311. Specific nerve that stimulates tear production
|
Greater petrosal CN VII
|
|
|
312. Sensory nerve to cornea
|
CN V1 (nasociliary)
|
|
|
313. Muscle that elevates and abducts eye
|
Inferior oblique
|
|
|
314. Muscle that depresses and abducts eye
|
Superior oblique
|
|
|
315. Site of preganglionic nerve cells that elicits dilation of pupil
|
Lateral horn, T1 - 2
|
|
|
316. Site of postganglionic nerve cells that elicits dilation of pupil
|
Superior cervical ganglion
|
|
|
317. Site of preganglionic nerve cells that elicits constriction of pupil
|
Edinger-Westphal
|
|
|
318. Site of postganglionic nerve cells that elicits constriction of pupil
|
Ciliary ganglion
|
|
|
319. Innervation of external surface of tympanic membrane
|
Auriculotemporal(V3),CN X
|
|
|
320. Innervation of internal surface of tympanic membrane
|
CN IX
|
|
|
Class of antibiotics that have 10% cross sensitivity with penicillins
|
Cephalosporins
|
|
|
Oral 3rd generation cephalosporins NOT able to cross the BBB
|
Cefixime
|
|
|
Cephalosporin causes kernicterus in neonates
|
Ceftriaxone or cefuroxime
|
|
|
Antidote for arsenic, mercury, lead, and gold poisoning
|
Dimercaprol
|
|
|
Antidote used in poisonings: copper (Wilson's disease), lead, mercury, and arsenic
|
Penicillamine
|
|
|
Antidote used for benzodiazepine toxicity
|
Flumazenil
|
|
|
Inducers of Cytochrome P450 (CYP450)
|
Barbiturates, phenytoin, carbamazepine, rifampin, St. John's Wort
|
|
|
Inhibitors of CYP450
|
Amiodarone, Diltiazem, Verapamil, Cimetidine, ketoconazole, erythromycin, isoniazid and grapefruit |
|
|
Drug elimination with a constant amount metabolized regardless of drug concentration
|
Zero order kinetics
|
|
|
SE of Aspirin
|
GI bleeding
|
|
|
Enhances dopaminergic neurotransmission SE's include CNS excitation, acute toxic psychosis and livedo reticularis
|
Amantadine
|
|
|
CCB with predominant effect on vasodilation
|
Nifedipine
|
|
|
Acetaminophen only has
|
Antipyretic and analgesic activity |
|
|
SE of acetaminophen
|
Hepatotoxicity
|
|
|
Antidote for acetaminophen toxicity Drugs-Modifying Anti-Rheumatic Agents (DMARDS)
|
N-acetylcysteine
|
|
|
Peptide causing increased capillary permeability and edema
|
Bradykinin and histamine |
|
|
Mediator of tissue pain, edema, inactivated by ACE, and may be a contributing factor to the development of angioedema
|
Bradykinin
|
|
|
Short-medium acting glucocorticoids
|
Cortisone, Hydrocortisone, Prednisone, Prednisolone, Methylprednisolone |
|
|
Intermediate acting glucocorticoids
|
Triamcinolone, Fluprednisolone
|
|
|
Long acting glucocorticoids
|
Betamethasone and dexamethasone |
|
|
Some side effects of corticosteroids
|
Osteopenia, impaired wound healing, inc. risk of infection, inc. appetite, HTN, edema, PUD, euphoria, psychosis, stria, thinning of skin |
|
|
MOA of corticosteroids
|
inhibit phospholipase A2
|
|
|
SE of long term corticosteroid therapy and remedy
|
Adrenal suppression and weaning slowly, respectively
|
|
|
5HT-3 antagonist used in chemotherapeutic induced emesis
|
Ondansetron, granisetron, dolasetron and alosetron
|
|
|
Prototype antagonist of H1 and H2 receptors
|
Diphenhydramine and cimetidine, respectively
|
|
|
Treatment of motion sickness
|
Scopolamine, meclizine
|
|
|
H1 antagonist used in motion sickness
|
Dimenhydrinate, meclizine, and other 1st generation
|
|
|
Aspirin reduces mortality in unstable angina by
|
Platelet aggregation inhibition
|
|
|
Cutaneous flush can be reduced by pretreatment with
|
Aspirin
|
|
|
NSAID contraindicated in gout
|
Aspirin
|
|
|
Drug used for MRSA
|
Vancomycin
|
|
|
Genetic basis of low level resistance found with vancomycin
|
Point mutation
|
|
|
Treatment of severe/relapsing pseudomembranous colitis
|
ORAL vancomycin
|
|
|
Agents that inhibit acetaldehyde dehydrogenase
|
Disulfiram, metronidazole, certain sulfonylureas and cephalosporins |
|
|
Penicillins active against penicillinase secreting bacteria
|
Methicillin, nafcillin, and dicloxacillin |
