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627 Cards in this Set

  • Front
  • Back
decreased pain and temp sensation over lat. aspects of both arms. where is the lesion
syringomyelia
penlight in pts right eye produces bilateral pupillary constriction. when moved to the left eye, there is paradoxical dilation.
what is the defect?
atrophy of L optic nn
decresassed prick sensation on lateral aspect of leg and foot.

deficit in what mm action can also be expected
dorsiflexion & eversion of foot (common peronial nn)
pt presents w/ tingling over lateral digits of her R hand.
What is the dx
carpal tunnel syndrome.
median nn compression
decreased plantar flexion and decreased sensation over back fo thigh, calf, and latereal half of foot.
what spinal nn
tibial (L4-S3)
pt in MVA can't turn head to L & has rightt shoulder droop.
What sx is damaged.
R CN XI (inn SCL & trap mm)
pt presents w/ one wild flailing arm. where is the lesion?
contralateral subthalamic nuccleus (hemiballismus)
pt w/ cortical lesion does not know he has a dz. where is the lesion?
right paraietal lobe
pt cannot protrude tongue toward L side and has a R-sided spastic paralysis. Where is the lesion?
L medulla, CN XII
teen falls while rollarblading and hurts his elbow. He can't feel the medial part of his palm.
What is the nn & what is the injury.
ulnar nn due to broken medial condyle
pt presents to ER after falling on arm. X-ray shows midshaft break of the humerus? Which nn & aa are most lkely damaged?
radial nn & deep brachial aa (run together
pt cannot blink his R eye or seal his lips and has mild ptosis on R side. What is the dx and which nn is affected.
bell's palsy; CN VII
pt c/o numbness, & tingling sensation. She has wasting of thenar eminence. What is the dx/ What nn is affected?
carpel tunnel syndrome (medial nn)
stage of sleep where there is variable BP, penile tumescence & variable EEG.
REM
person demands only the best & most famous doctor in town.
what personality d/o
narcissistic personality d/o
nurse has episodes of hypoglycemia; blood analysis shows no elevation in C protien. What is the dx.
factitious d/o. self scripted insulin
woman presents w/ headache, visual disturbance, galactorrhea and amenorrhea
what is the dx
prolactinoma
pt experiences dizziness & tinnitis. ct shows enlarged internal acoustic meatus. What is the dx
schannoma
25 y/o female presents w/ sudden uniocular vision loss & slightly slurred speech. She has hx of weekness & parasthesias that have resoved. what is the dx
MS
10 y/o child "spaces out" in class (e.g., stops talking midsentance & then continues as if nothing happened. During spells there is slight quivering of lips. Dx?
absence seizures
man on several meds including antidepressants and antihypertensives, has mydriasis and becomes constipated. What is the cause of his symptoms
TCA
woman on MAO inhibitor has hypertensive crisis after a meal. What did she ingest?
tyramine (wine or cheese)
This CNS support cell helps maintain the blood-brain barrier. It's cell marker is GFAP
astrocyte
this CNS support cell makes up the inner lining of the ventricles
ependymal cells
this CNS support cell is the macrophage of the brain phagocytosing in areas of inflammation or neural damage. Like the macrophage, this cell is mesodermal in origen.
microglia.
This CNS support cell is responsible for myelin production
oligodendroglia
This pns support cell is responsible for peripheral myelin production
schwann cell
All CNS/ PNS support cells (except the microglia which originates from mesoderm)originate from this primary germ cell layer.
ectoderm
autopsy done on pt w/ HIV shows these support cells transformed into virus filled multinucleated giant cells in CNS
microglia
these CNS support cells are destroyed in MS
oligodendroglia
Acoustic neuroma is a neoplasm of this PNS support cell commonly associated with the internal acoustic meatus (CN VII, VIII)
schwann cell
Give following peripheral nn layers from inner most to outermost :
nn fibers
endoneurium
epineurium
perineurium
endoneurium-perineurium-epineurium-nn fibers
this peripheral nn layer must be rejoined in microsurgery for limb reattachment
perineurium
this sensory corpuscle is a small, encapsulated nn ending found in the dermis of palms, soles, and digits of skin. It is involved in light discriminatory touch of glabrous (hairless) skin.
meissner's corpuscle
this sensory corpuscle is a large, encapsulated nn ending found in deeper layers of skin at ligaments, joint capsules, serous membranes, and mesenteries. It is involved in pressure, coarse touch, vibration, and tension.
pacinian corpuscle
this sensory corpuscle is a cup-shaped nn ending in dermis of fingertips, hair follicles, hard palate. It is involved in light, crude touch
merkel's corpuscle
when you hear high frequency sound, this part of the cochlea is responding (narrow & stiff)
base
when you hear low frequency sound, this part of the cochlea is responding (wide and flexible)
apex
perilymph in the inner ear is similar to (ECF or ICF)
ECF (high Na+)
when you hear high frequency sound, this part of the cochlea is responding (narrow & stiff)
base
endolymph in the inner ear is similar to (ECF or ICF)
ICF (K+)
Utricle and saccule of the inner ear contain maculae which detect which type of acceleration?
linear
Semicircular canals of the inner ear contain ampullae which detect which type of acceleration?
angular
hearing loss in the elderly usually begins with which type of frequency
high frequencies
blood brain barrier is formed by which 3 structures:
1)astrocyte processes
2) basement membrane
3)tight jx b/n nonfenestrated capillary endothelial cells
glucose and amino acids cross the blood-brain barrier by which method.
carrier mediated transport mechanism
what crosses blood brain barrier more redily. water soluble substances or lipid soluble substances?
lipid soluble
the hypothalamus wears TAN HATS is a mneumonic for the fxns of the hypothalamus?
What does the T stand for (2 chances to get it right.
either:
1)Thirst
or
2)Temperature
the hypothalamus wears TAN HATS is a mneumonic for the fxns of the hypothalamus?
What does the A stand for (2 chances to get it right.
Either
1) Adenohypophysis control
or
2)Autonomic regulation
the hypothalamus wears TAN HATS is a mneumonic for the fxns of the hypothalamus?
What does the A stand for (2 chances to get it right.
Either
1) Adenohypophysis control
or
2)Autonomic regulation
the hypothalamus wears TAN HATS is a mneumonic for the fxns of the hypothalamus?
What does the N stand for
Neurohypophysis hormones (synthesized in hypothalamic nucleii)
the hypothalamus wears TAN HATS is a mneumonic for the fxns of the hypothalamus?
What does the H stand for
Hunger
the hypothalamus wears TAN HATS is a mneumonic for the fxns of the hypothalamus?
What does the S stand for?
Sexual urges
destruction of the lateral nucleus of the hypothalamus results in what type of food intake?
anerexia & starvation
destruction of the ventromedial nucleus of the hypothalamus results in what type of food intake?
hyperphagia and obesity
Anterior hypothalamus regulates what division of the ANS.
parasympathetic
Posterior hypothalamus regulates what division of the ANS.
Sypathetic
This nucleus controls circadian rhythms.
suprachiasmatic nucleus
This nucleus controls thirst and water balance
supraoptic nucleus
This part of the hypothalamus (anterior or posterior) kicks in and regulates heat concervation when cold.
posterior hypothalamus
This part of the hypothalamus (anterior or posterior) coordinates cooling when hot.
anterior hypothalamus
When this nucleus of the hypothalmus is destroyed--rage results?
septal nucleus
The posterior pituitary (neurohypophysis) recieves hypothalamic axonal projections from the supraoptic nucleii and releases what hormone?
ADH
The posterior pituitary (neurohypophysis) recieves hypothalamic axonal projections from the paraventricular nucleii and releases what hormone?
oxytocin
this part of the brain is the major relay for ascending sensory informationthat ultimately reaches the cortex?
thalamus
This geniculate nucleus of the thalamus (lateral or medial) is involved in relaying visual sensory information to the cortex.
lateral
This geniculate nucleus of the thalamus (lateral or medial) is involved in relaying auditory sensory information to the cortex.
medial geniculate nucleus (MGN)
This nucleus of the thalamus is involved in relaying BODY sensation information (proprioception, pressure, pain, touch, vibriation) to the cortex via the dorsal columns & the spinothalamic tract.
Ventral Posterior Nucleus, Lateral part (VPL)
This nucleus of the thalamus is involved in relaying FACIAL sensation information to the cortex via CN V
Ventral Posterior nucleus, medial part (VPM)
This nucleus of the thalamus is involved in relaying motor information to the cortex.
Ventral Anterior/Lateral nucleus (VL)
This "system" of the brain is responsible for the 5 Fs. Feeding, Fighting, Feeling, Flight, and Fucking.
limbic system
This part of the brain is important in voluntary movements and making postural adjustments.
basal ganglia
Parkinson's dz symptoms are do to decreased imput from this part of the basal gangia.
substantia nigra.
In Parkinson's dz the symptoms are due to decreased input from the substantia nigra of the basal ganglia. This leads to _______ (increased or decreased) stimulation of the direct pathway and _______ (increased or decreased) inhibition of the indirect pathway
decreased
decreased
In the basal ganglia, _________ (D1)facilitates movement
direct pathway
In the basal ganglia, _________ (D2)inhibits movement
indirect pathway
In the cerebral cortex associative auditoritory fx is associated with which area?
Wernicke's area (22)
In the cerebral cortex speech motor fx is associated with which area?
broca's area
Your pt has become recently more and more disorganized. He reports problems concentrating and poor social judgement. What lobe of the brain could be involved.
frontal lobe
anterior cerebral artery hemarrage could result in sensory motor problems in which location of the body?
lower extremity
anterior cerebral aa supplies what part of the brain
medial surface
hemhorrage of the middle cerebral aa would involve what part of the brain.
lateral
hemhorrage of the middle cerebral aa could involve what pathologies?
motor & sensory deficits of teh trunk-arm-face, Broca's and Wernicke's speech areas
Anterior communicating artery lesion is the most common circle of Willis aneurism. It may cause this deficit.
visual field defect
Posterior communicating artery is also a common area of aneurism. It can result in this cranial nn palsy.
CN III
A stroke in this general part of the circule of wilis can cause general sensory and motor dysfunction and aphasia
anterior circle
A stroke in this general part of the circle of wilis can cause cranial n deficits (vertigo, visual deficits), coma, cerebellar deficits (ataxia)
posterior circle
this division of the middle cerebral aa is a common site of stroke. It feeds the internal capsule, caudate, putamen, & globus pallidus
lateral striate
Cerebral veins drain into the venous sinuses which drain into what?
internal jugular vv
lateral ventricle drains into the 3rd ventricle via the foramen of _______.
monro
3rd ventricle drains into the 4th ventricle via the aquaduct of ________
sylvius
4th ventricle drains into the subarachnoid space via the foramina of ________ (laterally) and the foramina of ________ (medially
Luschka
Magendie
How many spinal nn are there total?
31
8-C
12-T
5-L
5-S
1-coccygeal
Vertibral disk herniation usually occurs between what levels_______
L5-S1
At what levels do you want do a LP
L3-L5
(spinal cord extends to lower border of L2; Subarachnoid space extends to lwer border of S2)
You perform an LP at the level of L4/L5 (iliac crest levels). List the following sx in the order that you will pierce them?

Ligaments
Arachnoid
Epidural space
Subdural space
skin/superficial fascia
Dural matter
Subarachnoid space CSF
skin/superficial fascia
Ligaments
Epidural space
Dural matter
Subdural space
Arachnoid
Subarachnoid space CSF
Should you pierce the Pia matter in a lubar puncture?
No
These columns relay sensation of pressure, vibration, touch, and proprioception to the cerebral cortex.
dorsal columns
This fasciculus within the dorsal column relays the sensation of pressure, vibration, touch, and proprioception from the upperbody and extremities to the cerebral cortex.
fascciculus cuneatus
This fasciculus within the dorsal column relays the sensation of pressure, vibration, touch, and proprioception from the lower body and extremities to the cerebral cortex.
fasciculus gracilis
These tracts relay sensation of pain and temperature up the spinal cord to the cerebral cortex
spinothalamic tract
These tracts relay motor signals from the brain down teh spinal cord.
lateral corticospinal tract
what is more lateral in the dorsal columns the fasciculus cuneatus or fasciculs gracilis
fasciculus cuneatus
Describe the path of a vibratory (or pressure, touch, proproceptive) sensation as after it signals a sensory nn up until its first synapse (must get 3 key points)
Sensation enters the DORSAL ROOT GANGLION to ascent the spinal cord IPSILATERALLY in the DORSAL COLUMN.
Describe the location of the first synapse of that vibratory (or pressure, touch, proproceptive) sensation (must give nucleus and brain location)
NUCLEUS CUNEATUS or GRACILIS in the MEDULLA
Describe the 2nd order neuron of that vibratory (or pressure, touch, proproceptive) sensation. (decussation & ascention)
decussates in the MEDULLA and ascends CONTRALATERALLY in the MEDIAL LEMNISCUS
Describe the 2nd synapse of that vibratory (or pressure, touch, proproceptive) sensation. (Nucleus and brain location)
VPL of the THALAMUS
Describe the final destination of the 3rd order neuron of that vibratory (or pressure, touch, proproceptive)sensation
SENSORY CORTEX
Describe the path of an ascending pain (or temperature) sensation after it signals a sensory nn up until its first synapse
travels from sensory nn endigns (A-delta and C-fibers)and enters spinal cord ipsilaterally.
Describe the first synapse of ascending pain and temperature sensation
IPSILATERAL synapse with gray matter in spinal cord.
Describe the 2nd order neuron transmission of the ascending pain and temperature sensation. (decussation & ascention)
Decussates at the ANTERIOR WHITE COMMISSURE and ascends CONTRALATERAL in the SPINOTHALAMIC TRACT
Describe the 2nd synapse of the ascending pain and temp sensation?
VPL of thalamus
Describe the 3rd order neuron final destination of the ascending pain and temperature sensation.
sensory cortex
You want to move you're right arm? Describe the 1st order neuron pathway.
begin in the LEFT HEMISPHERE PRIMARY MOTOR CORTEX. The UPPER MOTOR NEURONS descends IPSILATERALLY until decussating at CAUDAL MEDULLA (PYRAMIDAL DECUSSATION) and then descend CONTRILATERALLY.
You want to move you're right arm? Describe where the 1st synapse occurs.
CELL BODY OF THE ANTERIOR HORN (SPINAL CORD)
You want to move you're right arm? Describe the 2nd order neuron.
LOWER MOTOR NEURON leaves the spinal cord.
You want to move you're right arm? Describe where the 2nd synapse occurs.
neuromuscular jx
Give the brachial plexus dx from the BP damage:
Upper trunk (C5, C6)
waiters tip
Give the diagnosis from the location of Brachial Plexus damage:
Lower trunk (T1,C8)
claw hand
Give the diagnosis from the location of Brachial Plexus damage:
Posterior chord (C5-T1)
Wrist drop
Give the diagnosis from the location of Brachial Plexus damage:
Long Thoracic Nerve
Winged scapula
Give the diagnosis from the location of Brachial Plexus damage:
Axillary nn
Deltoid paralysis
Give the diagnosis from the location of Brachial Plexus damage:
Radial nn
Sadurday night palsy
Give the diagnosis from the location of Brachial Plexus damage:
musculocutaneous nn
difficulty flexing elbow, variable sensory loss
Give the diagnosis from the location of Brachial Plexus damage:
Median nn
decreased thumb fx-Pope's blessing
Give the diagnosis from the location of Brachial Plexus damage:
Ulnar branch
Intrinsic mm of hand, claw hand
What mm protects brachial plexus from injury in the case of the relatively common clavicle fracture
subclavius
This nn is known as the "great extensor nn" it provides innervation of the Brachioradialis, Extensors or the wrist and fingers, Supinator, and Triceps.
Radial nn.

mneu:RAD=BEST
Brachioradialis, Extensors or the wrist and fingers, Supinator, and Triceps.
Thenar mm (3)

Hypothenar mm (3)
Opponens pollicis, Abuctor pollicis brevis, Flexor pollicis brevis

Opponens digiti minimi, Abductor digiti minimi, Flexor digiti minimi

Both groups perform the same fx: Oppose, Abduct, and Flex (OAF)
Clinically important Landmarks:
-Ischial spine?
-2/3 of the way from the umbilicus to the anterior superior Iliiac Spine
-Iliac Crest
Pudendal nn block
McBurney's Pt-Appendix
Lumbar puncture
Landmark Dermatomes:
Posterior half of the scull "cap"
C2
Landmark Dermatomes: high turtle neck shirt
C3
Landmark Dermatomes: low collar shirt
C4
Landmark Dermatomes: T4
nipple

T4 at the "teat pore"
Landmark Dermatomes: xyphoid process
T7
Landmark Dermatomes: Umbilicus
T10

T10 at the belly butTEN
Landmark Dermatomes: Inguinal ligament
L1

L1 is IL
Landmark Dermatomes: includes the kneecaps
L4

down on L4s (all 4s)
Landmark Dermatomes:
erection, and sensation of penile and anal zones
S2,3,4

S2,3,4 keeps the penis off the floor
Gallbladder pain is referred to the right shoulder via this nn
phrenic nn
This work in prallel w/ mm fibers. When a mm is stretched it causes the intrafusal to stretch which stimulates the Ia afferent which in turn stimulates the alpha motor neuron which causes a reflex muscle (extrafusal ) contraction
muscle spindle
these monitor mm lenth. For example help you pick up a heavy suitcase when you didn't know how heavy it was.
muscle spindles
This senses tension and provides inhibitory feedbach to alpha motor neurons
golgi tendon organs
These monitor mm tension. For example make you drop a heavy suitcase you've been holding for too long
golgi tendon organs
CNS stimulates the gamma motor neuron which contracts intrafusal fiber and causees an increased sensitivity of the reflex arc
gamma loop
Clinical reflexes:
-Achillies:
-Patella:
-Biceps:
-Triceps:
S1,2
L3,4
C5,6
C7,8
Dorsiflexion of the big toe and fanning of other toes; sign of UMN lesion, but normal reflex in 1st year of life
Babinski
Primitive Reflexes:
extension of limbs when startled

(normally disappear w/in 1st year. May reemerge following a frontal lobe lesion)
moro reflex
Primitive Reflexes:
nipple seeking

(normally disappear w/in 1st year. May reemerge following a frontal lobe lesion)
rooting reflex
Primitive Reflexes:
grasps objects in palm

(normally disappear w/in 1st year. May reemerge following a frontal lobe lesion)
palmar reflex
Primitive Reflexes:
large toe dorsiflexes w/ plantar stimulation

(normally disappear w/in 1st year. May reemerge following a frontal lobe lesion)
babinski reflex
CNs that lie medially at brainstem
III, VI, XII

mneu: 3(x2)=6(x2)=12
Give Cranial nn by Fx: Is it Motor or sensory or Both?
Fx:
smell
CNI-olfactory(S)
Give Cranial nn by Fx: Is it Motor or sensory or Both?
Fx:
Sight
CN II: Optic (S)
Give Cranial nn by Fx: Is it Motor or sensory or Both?
Fx:
Eye movement (up(lateral & medial) down (lateral), pupil constriction, accommodation, eyelid opening
CN III: Oculomotor (M)
Give Cranial nn by Fx: Is it Motor or sensory or Both?
Fx:
Eye movement (down & medial)
CN IV: Trochlear (M)
Give Cranial nn by Fx: Is it Motor or sensory or Both?
Fx:
Mastication, Facial sensiation
CN V: Trigeminal (B)
Give Cranial nn by Fx: Is it Motor or sensory or Both?
Fx:
Eye movement (lateral)
CN VI: Abducens (M)
Give Cranial nn by Fx: Is it Motor or sensory or Both?
Fx:
Facial mvmt, taste from anterior 2/3 of tongue, lacrimation, salivation (submaxillary and sublingual glands, eyelid closing.
CN VII: Facial (B)
Give Cranial nn by Fx: Is it Motor or sensory or Both?
Fx:
Hearing, balance
CN VIII: Vestibulocochlear (S)
Give Cranial nn by Fx: Is it Motor or sensory or Both?
Fx:
Taste from post 1/3 of tongue, swallowing, salivation (parotid gland), monitoring carotid body and sinus chemo-and baroreceptors
CN IX: Glossopharyngeal (B)
Give Cranial nn by Fx: Is it Motor or sensory or Both?
Fx:
Tastte from epiglottic region, swallowing, palate elevaton, talking, throacoabdominal viscera, monitoring aortic arch chemo-and baroreceptors
CN X: Vagus (B)
Give Cranial nn by Fx: Is it Motor or sensory or Both?
Fx:
Head turning, shoulder shrugging
CN XI: Accessory (M)
Give Cranial nn by Fx: Is it Motor or sensory or Both?
Fx:
tongue mvmt
CN XII: Hypoglossal (M)
Cranial nn nucleii located in the Midbrain
CN III, IV
Cranial nn nucleii located in the Pons
CN V-VIII
Cranial nn nucleii located in the Medulla
IX-XII
Cranial nn nucleii located in the Midbrain
CN III, IV
Cranial nn more lateral in the brainstem tend to be ______; those more medially tend to be _______
sensory
motor
This vagal nucleii recieves visceral sensory information (e.g., taste baroreceptors, and gut distension) from cranial nn VII, IX, & X
Nucleus Solitarius
This vagal nucleii is responsible for Motor inervation of the pharynx, larynx and upper esophagus (e.g, swallowing, palate elevation)via CN IX,X,XI.
Nucleus aMbiguous
This vagal nucleii sends autonomic (parasympathetic) fibers to heart, lungs, and upper GI
Dorsal motor nucleus
Crandial nn and vessel pathways:
Cribiform plate
CN I
Crandial nn and vessel pathways:
optic canal
CN II, opthalmic artery, central retinal vein
Crandial nn and vessel pathways:
Superior orbital fissure
(CN III, IV, V1,VI, opthalmic vv)
Crandial nn and vessel pathways:
Foramen Rotundum
CN V2
Crandial nn and vessel pathways:
Foramen Ovale
CN V3
Crandial nn and vessel pathways:
Foramen spinosum
middle meningeal aa
Crandial nn and vessel pathways:
Internal auditory meatus
CN VII, VIII
Crandial nn and vessel pathways:
Jugular foramen
CN IX,X,XI, jugular vv
Crandial nn and vessel pathways:
Hypoglossal canal
CN XII
Crandial nn and vessel pathways:
Foramen magnum
Spinal roots of CN XI, brainstem, vertebral arteries
a collectionof venous sinuses on either side of the pituitary
cavernous sinus
nn that pass through cavernous sinuses
nn that control extaocular mm (CN III, IV, VI) plus V1 & V2
pt presents w/ opthalmoplegia, & opthalmic and mandibular sensory loss
what is a possible dx?
Cavernous sinus syndrome (e.g., due to mass effect
Muscles of mastication:
3 mm that close the jaw

innervated by?
Masseter, teMporalis, Medial pterygoid.

inn: V3

mneu: Ms Munch
Muscles of mastication:
1 mm opens the jaw

innervated by:
Lateral pterygoid.
inn: V3

mneu: Lateral Lowers
All mm with the root glossus in their names are innervated by?
Except one exception. What is it and what is the innervation.
hypoglossal.
palatoglossus (inn by vagus)
All mm with the root palat in their names are innervated by this.
One exception what is it innervated by?
vagus


exception: tensor veli palatine (inn by Mandibular branch of CN V)
CN IV innervates what mm? What direction would you look?
SO--towards your nose
CN VI innervates what mm. What direction would you look
LR-laterally
What reflex? Light in either retina sends a signal via CN III to PRETECTAL nucleii in midbrain that activate bilateral EDINGER-WESTPHAL nucleii;pupls contract bilaterally (consensual reflex)
Pupillary light reflex
Saying KLM outloud tests what three CNs?
K (vagus) palate elevation
L (hypoglossal) tongue
M (facial) lips
What waveform?
awake (eyes open), alert, active mental concentration
Beta (highest frequency, lowest amplitude)
What waveform?
awake (eyes closed)
alpha
What waveform?
light sleep
What stage of sleep is this? What percentage of total sleep time is this in young adults?
Theta
1
5%
What waveform?
deeper sleep
What stage of sleep is this? What percentage of total sleep time is this in young adults?
Sleep spindles and K complexes
2
45%
What waveform?

Deepest sleep; sleepwalking; night terrors, bed wetting

What stage of sleep is this? What percentage of total sleep time is this in young adults?
Delta (lowest frequency, hightest amplitude)
3-4
25%
What waveform?

dreaming, loss of motor tone, possibly memory procesing fx, erections, increase brain oxygen use

What stage of sleep is this? What percentage of total sleep time is this in young adults?
Beta
REM
25%

mneu: At night, BATS Drink Blood
What type of sleep is this?
increase variable pulse, rapid eye movements, inceased and variable blood pressure, penile/clitoral tumenescence. Occurs every 90 min; duration increases throughout the night.
REM
principle neurotransmitter involved in REM sleep
Ach
REM sleep _______ (increases or decreases) with age
decreases
neural tube defects are associated with lack of this vitamen intake during pregnancy
folic acid
neural tube defects are associated with elevated levels of this in amniotic fluid and maternal serum
alpha fetoprotein levels
This describes failure of bony spinal canal to close, but no structural herniation. Usually seen at lower vertebral levels
spinal bifida occulta
This describes when the meninges herniate throgh a spinal canal defect
meningocele
This describes when meninges and spinal cord herniate through spinal canal defects
meningiomyelocele
Give the area of the brain lesion?

motor (nonfluent/expressive) aphasia with good comprehension
broca's area
Give the area of the brain lesion?
sensory (fluent/receptive) aphagia with poor comprehension
Wernicke's area
Give the area of the brain lesion?

conduction aphagia; poor repitition with good comprehension, fluent speech
Arcuate fasciculus
(connects Wernicke's to Broca's area
Give the area of the brain lesion?

Kluver-Bucy Syndrome (hyperorality, hypersexuality, disinhibited behavior)
Amygdala (bilateral)
Give the area of the brain lesion?

Personality changes and deficits in concentration, orientation, and judgement; may have reemergence of primitive reflexes
frontal lobe
Give the area of the brain lesion?

Spacial neglect syndrome (agnosia of the contralateral side of the world)
Right parietal lobe
Give the area of the brain lesion?

coma
reticular activating system
Give the area of the brain lesion?

wernicke-korsakoff syndrome
mamillary bodies (bilateral)
Give the area of the brain lesion?

tremor at rest, chorea, or athetosis
basal ganglia
Give the area of the brain lesion?

Intention tremor, limb ataxia
cerebellar hemisphere

mneu: cerebellar hemispheres are LATERALLY located--affect LATERAL limbs. Vermis is CENTRALLY located-affects CENTRAL body
Give the area of the brain lesion?

truncal taxia, dysarthria
cerebellar Vermis

mneu: cerebellar hemispheres are LATERALLY located--affect LATERAL limbs. Vermis is CENTRALLY located-affects CENTRAL body
Give the area of the brain lesion?

contralateral hemiballismus
subthalamic nucleus
Chorea--sudden, jerky, purposeless movements are characteristic of a lesion in this part of the brain. Give the classic dz example.
Basal ganglia
Huntington's dz
Athetosis are slow, writhing movements, especially of the fingers. This is characteristic of a lesion in this part of the brain
basal ganglia
hemiballismus involves the sudden wild flailing of 1 arm. What kind of lesion does this indicate (& on what side)
contralateral subthalamic nucleus

(results in loss of inhibition of thalamus through globus pallidus)
Broca's lesion is nonfluent aphagia with intact comprehension it involves this gyrus
inferior frontal gyrus
Wernicke's aphagia is fluent aphagia with impared comprehension it involves this gyrus
superior temporal gyrus
most common cause of dementia in the elderly. Associated w/ senile plaques (extracellular, Beta amyloid core) and neuro fibrillary tangles (intracellular, abnormally phosphorylated tau protiein)
Alzheimers dz
Familial form of alziemers is associeted w/ genes on chromosomes 1, 14, 19 (APOE4 allele), and 21 (p-App gene) is thought to be responsible for this percent of alzheimers cases
10%
What is the 2nd most common cause of dementia in the elderly
multi-infarct dementia

(may cause amyloid angiopathy)
pt presents with dementia, aphasia, parkinsonian aspects; associated with intracellular aggregated tau protien and is specific for frontal and temporal lobes.
Pick's dz
pt presents with chorea and dementia. Autopsy shows atrophy of caudate nucleus (loss of GABAergic neurons).
Huntinton's dz
Dz associated with chromasome 4--expansion of CAG repeats.
Huntinton's dz

mneu: CAG-Caudate loses ACh & GABA.
dz associated w/ Lewy bodies and depigmentation of the substantia nigra pars compacta (loss of dopaminergic neurons) Rare cases have been linked to exposure to MPTP, a contaminant in illicit sreet drugs.
Parkinson's dz

mneu: TRAP=Tremor (at rest), Rigidity, Akinesia, and Postural instability (you are TRAPped in your body.
Dz associated with BOTH LMN & UMN signs, no sensory defect. Also known as Lou Gehrig's dz
Amyotrophic lateral Sclerosis (ALS)
presents as birth as a "floppy baby", tongue fasciculations; median age of death is 7 months. Associated w/ degeneration of anterior horns. Autosomal-recessive inheritance.
Werdnig-Hoffmann dz
dz follws infection with poliovirus; LMN signs. Associated with degeneration of anterior horns.
Polio
Pt presents w malaise, headache, fever, nausea abdominal pain, sore throught. Progreses to signs of LMN lesions--mm weakness & atrophy, fasciculations, fibrillation, & hyporeflexia.
LP of CSF shows lymphocytic pleocytosis w/ slight elevation of protein.
What do you suspect?
Poliomyelits
this dz is causesd by the poliovirus, which is transmitted by the fecal-oral route. It replicates in the oropharynx and small intestine before spreading through the bloodstream to the CNS where it leads to the destruction of cells in the anterior horn of the spinal cord, leading in turn to LMN destruction.
poliomyelitis
This dz shows increased prevalence with increased distance from the equator.
MS
This dz shows periventricular plaques (areas of oligodendrocyte loss and reactive gliosis)with preservation of actions. There is an increase in protein (IgG) in CSF.
MS
dz associated with a relapsing-remitting course.
MS
With this dz pts often present w/ optic neuritis (sudden loss of vision) MLF syndrome (internuclear ophtalmoplegia), hemiperesis, hemisensory symptoms, or bladder/bowel incontinence.
MS
This dz classically presents with scanning speech, intension tremor, and nystagmus. It most often affects women in their 20s and 30s. And is more common in whites. Tx is Beta interferon or immunosuppressant therapy.
MS
This demyelinating dz is associated with the JC virus and is seen in 2-4% of AIDS pts.
Progressive multifocal leukoencephalopathy (PML)
This dz is associated with inflammationand demyelination of peripheral nn and motor fibers of the ventral roots (sensory effects are less severe than motor). This results in symmetric ASCENDING mm weakness begining in distal and lower extremities.

LP of CSF shows elevated protein with normal cell count (albuminocytologic dissociation). Elevated protien levels may lead to papilledema.

Pts usually recover completely.
Guillian-Barre Syndrome (acute idiopathic polyneuritis)
Guillian-Barr has been associated with certain infections including (2)
herpesvirus or Campylobacter jejuni
seizures involving only one area of the brain
partial seizures
simple partial seizures
1 area of the brain
conciousness intact
complex partial seizures
1 area of the brain
impaired consciousness
generalized seizures
diffuse areas of brain
generalized siezures involving a blank stare
absence (petit mal)
generalized siezures involving quick repetitive jerks
myoclonic
Generalized siezure involving alternating stiffening and movement
tonic-clonic
Pt hit in the side of the head with a baseball and fracturs his temperal bone. Rupture of the middle meningeal aa results. CT shows a "bioconvex disk" that does not cross suture lines. What is your dz of the Intracranial hemorrhage?
epidural hematoma
Alcoholic presents to the ER. He fell and hit his head the previous night but thought he was fine until neurological symptoms appeared the next morning. MRI shows a crescent-shaped hemorrhage that crosses suture lines. You suspect a venous bleed. What is your dx of this intracranial hemorrhage?
Subdural hematoma
Pt complains of "worst headache of their life." You worry it may be a rubture of a berry aneurism. Spinal tap is bloody. What is the d of this intracranial hemorrhage?
Subarachnoid hemorrhage
This type of aneurism often occurs at the bifurcation in the circule of Willis. The most common site is the bifurcation of the anterior communicating artery. Risk factors include adult polycystic kidney dz, Ehlers-Danlos syndrome, & Marphan's syndrome.
Berry aneurysms
most _______ (childhood v. adult) tumors are supratentorial, while most ________childhood v. adult) tumors are infratentorial.
adult
childhood

Note: 50% of brain tumors are metastases
This tumor has an adult peak incidence. It is the most common primary brain tumor and it has a grave prognosis (<1 yr life expectancy). It is found in the cerebral hemisphere and can cross the corpus callosum.
"Pseudopalisading" tumor cells border central areas of necrosis and hemorrhage. Stain astrocytes with GFAP.
Glioblastoma multiforme (grade IV astrocytoma)
This tumor has an adult peak incidence. It is the second most common primary brain tumor. It most often occurs in the convexities of hemispheres and parasagital region. It arises from arachnoid cells external to the brain. It is usually resectable.
Meningioma
On pathology this primary brain tumor shows spindle cells concentrically arranged in a whorled pattern and psammoma bodies (laminated calcification) What is it?
Meningioma
This brain tumor has an adult peak incidence. It is the 3rd most common primary brain tumor. It is of Schwann cell origin and is often localized to the 8th nerve. It is resectable. What is it?
Schwannoma
Bilateral schwannoma is often found in what condition?
neurofibromatosis type 2
This primary brain tumor with an adult peak incidence is relatively rare. It is slow growing and most often occurs in the frontal lobes.
Oligodendroma
On pathology this tumor has "fried egg" cells-round nucleii with clear cytoplasm. They are often calcified.
Oligodendroma
This priary brain tumor that has an adult peak incidence most commonly comes in a prolactin secreting form. Often it occurs with bilateral hemianopia (due to pressure on optic chiasm)
pituitary adenoma
This primary brain tumor has a peak incidence in childhood. It is a diffusely infiltrating glioma. It is most often found in the posterior fossa. It is benign and carries a good prognosis.
Pilocytic (low grade) astrocytoma)
On pathology this primary brain tumor shows Rosenthal fibers (eosinophilic, corkscrew fibers)
Pilocytic (low grade )astrocytoma
This primary brain tumor that occurs with a peak incidence in children is a highly malignant cerabellar tumor. It is a form of primitive neuroectodermal tumor (PneT). It can compress the 4th ventricle causing hydrocephalus. It is highly radiosensitive.
Medulloblastoma
On pathology this tumor shows Rosettes or perivascular pseudorosette pattern of cells
medulloblastoma
This primary brain tumor that occurs with a peak incidence in children is an ependymal cell tumor most commonly found in the 4th ventricle. It can cause hydrocephalus and carries a poor prognosis.
ependymoma
On pathology this tumor has characteristic perivascular pseudorosettes. Rod shaped blepharoplasts (basal ciliary bodies) found near the nucleus
ependymoma
This primary brain tumor that occurs with a peak incidence in children is most often cerebeller. It is associated with Von Hippel-Lindau syndrome when found with retinal angiomas. Can produce EPO and lead to secondary polycythemia.

On pathology: Foamy cells and high vascularity are characteristic.
Hemangioblastoma
This primary brain tumor that occurs with a peak incidence in children is a benign tumor which can be confused with pituitary adenoma (can also cause bitemporal hemianopia). This is the most common childhood supratentorial tumor. It is derived from remnants of Rathke's pouch and calcification is common.
Craniopharyngioma
Sign of UMN or LMN lesion or both?

Weakness
Both

mneu: LOWER MN= everything is LOWERED (less mm mass, less mm tone, less reflexes, downgoing toes. UPPER MN= everything UP (tone, DTRs, toes)
Sign of UMN or LMN lesion or both?

Atrophy
LMN

mneu: LOWER MN= everything is LOWERED (less mm mass, less mm tone, less reflexes, downgoing toes. UPPER MN= everything UP (tone, DTRs, toes)
Sign of UMN or LMN lesion or both?

Fasciculation
LMN

mneu: LOWER MN= everything is LOWERED (less mm mass, less mm tone, less reflexes, downgoing toes. UPPER MN= everything UP (tone, DTRs, toes)
Sign of UMN or LMN lesion or both?

Increased Reflexes?
Decreased Reflexes?
UMN
LMN

mneu: LOWER MN= everything is LOWERED (less mm mass, less mm tone, less reflexes, downgoing toes. UPPER MN= everything UP (tone, DTRs, toes)
Sign of UMN or LMN lesion or both?

Increased tone?
Decreased tone?
UMN
LMN

mneu: LOWER MN= everything is LOWERED (less mm mass, less mm tone, less reflexes, downgoing toes. UPPER MN= everything UP (tone, DTRs, toes)
Sign of UMN or LMN lesion or both?

Babinski?
UMN

mneu: LOWER MN= everything is LOWERED (less mm mass, less mm tone, less reflexes, downgoing toes. UPPER MN= everything UP (tone, DTRs, toes)
These diseases result in lower motor neuron lesions only. They are due to destruction of the anterior horns and result in flacid paralysis. [pic]
Poliomyelitis & Werdinig Hoffman dz
This dz effects mostly the white matter of the cervical region. Random and asymmetrical demyelinating lesions are seen. Often pt presents with scanning speech, intention tremor, and nystagmus [pic]
MS
These diseases result in lower motor neuron lesions only. They are due to destruction of the anterior horns and result in flacid paralysis. [pic]
Poliomyelitis & Werdinig Hoffman dz
This dz involves combined UMN and LMN deficits with no sensory deficit. Pt often presents with both UMN & LMN neuron signs [pic]
ALS
When this happpens the only thing spared are the dorsal columns and tract of Lissauer[pic]
complete occlusion of ventral artery
This results in degeneration of the dorsal roots and dorsal columns. Pt presents with impared proprioception and locomotor ataxia.
Tabes dorsalis (tertiary syphilis)
This resultswhen the crossing fibers of the corticospinal tract are damaged. Pt presents with bilateral loss of pain and temperature sensation
syringomyelia
This results in demyelination of dorsal columns, lateral corticospinal tracts, and spinocerebellar tracts. Pt often presents with ataxic gait, hyperreflexia, impared position and vibration sense
vit B neuropathy and Friedreich's ataxia
This results when the central canal of the spinal cord is enlarged for some reason. The crossing fibers of spinothalamic tract are thus damaged. Pt shows bilateral loss of pain and temperature sensation in upper extremities with preservation of touch sensation.
Syringomyelia
Syringomyelia often presents with this congenital malformation.
Arnold-Chiari malformation
Syringomyelia is most common at this spinal level
C8-T1
This disorder is due to degeneration of the dorsal columns and dorsal roots due to tertiary syphilis. It results in impared proprioception and locomotor ataxia. Pt often presents with Charccot's joints (neuropathy of the joint), Argyll Robertson pupils (reactive to accommidation but not to light), and absensce of DTRs
Tabes dorsalis
Brown Sequard syndrome is a complete hemisection of the spinal cord. Give the findings.
1. Ipsilateral UMN signs(corticospinal tract) below lesion
2) Ipsilateral loss of tactile, vibration, proprioception sense (dorsal column) below lesion
3) Contralateral pain and temperature loss (spinothalamic tract) below the lesion
4) Ipsilateral loss of all sensation at the level of lesion
5) LMN signs at the level of the lesion

*note: if the lesion occurs above T1 the pt will present with Horner's syndrome
What are the symptoms of Horner's syndrome?
What spinal levels is it associated with?
What is a common cancer that may result in it?
1)Ptosis (droopy eyelid)
2)Anhydrosis (no sweating or flushing of effected side of face
3)Miosis (pupil constriction)

HS is associated with lesion of spinal cord above T1

Pancoast tumor
The 3 neuron OCULOSYMPATHETIC PATHWAY projects from 1)hypothalamus to the 2)intermediolateral column of the spinal cord, then to the 3) superior cervical (sympathetic) ganglion, and finally to the 4) pupil, the smooth mm of the eyelids, and the sweat glands of the forehead and face. Interruption of these pathways results in _________
Horner's syndrome
What nerve was injured?

Pt fractures the shaft of humerus. He presents with "wrist drop" ( extensor carpi radialis longus damage), loss of triceps and brachioradialis reflexes.

Loss of sensation on posterior surface of arm and forearm (posterior brachial cutaneous and posterior antebrachial cutaneous)
Radial nn
The 3 neuron OCULOSYMPATHETIC PATHWAY projects from 1)hypothalamus to the 2)intermediolateral column of the spinal cord, then to the 3) superior cervical (sympathetic) ganglion, and finally to the 4) pupil, the smooth mm of the eyelids, and the sweat glands of the forehead and face. Interruption of these pathways results in _________
Horner's syndrome
What nerve was injured?

Pt reports hitting his "funny bone" (medial epicondyle) hard! He now has impared wrist flexion and adduction. He can't adduct his thumb or the 4th and 5th digits resulting in a "claw hand".

He has a loss of sensation over the medial palm and his pinky finger.
ulnar
What nerve was injured?

pt experiences a break through the surgical neck of the humerus or has an anterior shoulder dislocation. He now has trouble abducting his arm above 30 degrees.
Axillary
What nerve was injured?

Pt presents with a loss of function of biceps, coracobrachialis, and brachialis muscle. He has no biceps reflex?
musculocutaneous
This nerve passes through the supinator
radial
this nerve passes through the pronator teres
median
this nerve passes through the flexor carpi ulnaris
ulnar
Child presents with "waiter's tip" appearance: arm hanging to one side (paralysis of abductors), medially rotated (paralysis of lateral rotators), and forarm is pronator (loss of biceps.

What is the dx? What are the nerve roots and what are you concerned about?
Erb-Duchenne palsy

traction tear of the upper trunk of the brachial plexis (C5 & C6 roots) often follows blow to shoulder,could be due to trauma during delivery or child abuse.
What nerve was injured?

Pt presents with loss of dorsiflexion resulting in "foot drop"
Common peroneal nerve (L4-S2)

PED= Peroneal Everts & Dorsiflexes; if injured, foot is dropPED
Deep peroneal nn innervates _______ compartment

Superficial peroneal nn innervates _______ compartment
anterior

lateral
What nn is injured?
pt presents with loss of plantar flexion.
Tibial (L4-S3)

TIP=Tibial Inverts & Plantarflexes; if injured, cant stand on TIPtoes.
What nn is damaged?
Pt presents with loss of knee extension and deminished pateller reflex.
Femoral (L2-L4)
What nn is injured?

Pt presents with a loss of hip adduction?
Obturator
Pt presents with:
1) atrophy of the thenar and hypothenar eminences
2) atrophy of the interosseous mm
3) sensory deficits on the medial side of the forearmand hand
4) disappearance of the radial pulse upon moving the head towards the opposite side

What do you suspect? Discribe this disorder?
Thoraci outlet syndrome (Klumpke's palsy)

Compression of subclavian aa and inferior trunk of brachial plexus (C8,T1)
In a LMN lesion of CN XII the tongue will deviate _____ (away or towards) the side of the lesion?
towards

mneu: lick your wounds
In a CN V motor lesion the jaw deviates ______ (towards or away) the side of the lesion
towards
in a CN X lesion the uvula will deviate _______ (towards or away) of the side of the lesion.
away
In a unilateral lesion of the cerebellum the pt tends to fall _______ (towards or away) the side of the lesion.
towards
In a CN XI lesion there is weakness turning head to the side _________ (ipsi or contralateral) to the lesion. There is also a shoulder droop (ipsi or contralateral) to the lesion
contralateral
ipsilateral
pt presents with paralysis of the lower half his face only. What do you suspect.
contralateral UMN lesion
(either of motor cortex or connection between cortex and facial nucleus)
pt presents with paralysis of one side of his entire face (upper and lower). What do you suspect?
ipsilater LMN lesion of CN VII
This disorder is due to a destruction of the facial nucleus itself or it's brancchial efferent fibers (facial nn). It results in ipsilateral facial paralysis with an inability to close the eye of the involved side. It is often idiopathic and there is gradual recovery in most cases
Bell's palsy
Give some diseases in which Bell's palsy is often seen as a complicaion.
Aids, Lyme dz, Sarcoidosis, Tumors, Diabetes

mneu: ALexander BELL with STD: AIDS, Lyme, Sarcoid, Tumors, Diabetes
This herniation syndrome can compress the anterior cerebral aa
Cingulate herniation under falx cerebri
These 3 herniation syndrome can result in coma and death if brain stem is compressed.
1)downward transtentoral (central herniation
2) Uncal herniation (Uncus=medial temporal lobe)
3)Cerebellar tonsillar herniation into the foramen magnum
In the case of an uncal herniation you may see ipsilateral dilated pupil/ptosis. This is due to what?
Stretching of CN III
In the case of an uncal herniation you may see contralateral homonymous hemianopia. This is due to what?
compression of ipsilateral posterior cerebral aa
In the case of an uncal herniation you may see ipsilateral paresis. This is due to what?
compression of contralateral crus cerebri (Kernohan's notch)
In the case of an uncal herniation you may see Duret hemorrhages (paramedian artery rupture). This is due to
caudal displacement of the brain stem
Pt can't see at all out of his right eye (right anopia) Where is the lesion?
Right optic nn
Pts has bilateral temporal visual field defects (bitemporal hemianopia) Where is the lesion?
Optic chiasm
Pt can't see the left visual field in either eye (Left homonymous hemianopia) Where is the lesion?
Right Optic Tract
Pt has Left upper quadratic anopsia (cant see up and to the right on both sides) Where is the lesion?
Right Temporal Lesion (Meyer's loop)
Pt has left lower quandrantic anopia (can't see down and to the left in either eye) Where is the lesion?
Right Parietal lesion
(Dorsal optic radiation)
Pt has left hemianopia with macular sparing??
???visual cortex??
this syndrome is seen in many patients with multiple sclerosis. It results in medial rectus palsy on attempted lateral gaze & nystagmus in the abducting eye. Convergence is normal.
Internuclear opthalmoplegia (MLF syndrome)

mneu: MLF=MS
explain the pathology of Internuclear opthalmoplegia (Medial longitudinal fasciculus [MLF] syndrome)[pic]
When looking left, the left nucleus of CN VI fires, which contracts the left lateral rectus and stimulates the contralateral (right) nucleus of CN III via the right MLF to contract the right medial rectus. Lesion in the MLF interrupts this process.
give the dz indicated by the following neurotransmitter changes:
↑NE,↓GABA,↓5HT
Anxiety
give the dz indicated by the following neurotransmitter changes:
↓NE & ↓5HT
depression
give the dz indicated by the following neurotransmitter changes:
↓ACh
Alzheimer's dementia
give the dz indicated by the following neurotransmitter changes:
↓GABA,↓ACh
Huntington's dz
give the dz indicated by the following neurotransmitter changes:
↑Dopamine
Schizophrenia
give the dz indicated by the following neurotransmitter changes:
↓ Dopamine
Parkinson's dz
When a person becomes disoriented they generally lose concept of person(their name, who they are), place (where they are), and time. In what order does this loss usually occur?
1st-time
2nd-place
last-person
what is anosognosia?
unawareness that one is ill
what is autotopagnosia
inability to locate one's own body parts
what is depersonalization
body seems unreal or dissociated
what is ANTEROgrade amnesia?
inability to remember things that occurred afte a CNS insult

mneu: antero=after
what is RETROgrade amnesia?
inability to remember things that occurred before a CNS insult

mneu: retro=before
what is substance dependance?
maladaptive pattern of substance use defined as 3 or more of the follwing signs in 1 yr:
1)tolerance
2)withrawal
3)substance taken in larger amounts or over longer period of time than desired
4) persistant desire or attempts to cut down
5) significant energy spent obtaining, using, or recovering from substance
6 Important social, occupational, or recreational activities reduced because of substance use
7) continued use in spite of knowing the problems it causes
What is substance abuse
maladaptive pattern leading to clinically significant imparment or distress. Symptoms have not met criteria for substance dependance. 1 or more of the follwing in 1 yr:
1) recurrent use resulting in failure to fulfill major obligations at work, school, or home
2) recurrent use in physically hazardous situations
3) recurrent substance-related legal problems
4)Continued use in spite of problems caused by use
intoxication of this drug results in disinhibition, emotional lability, slurred speech, ataxia, coma, blackouts.
alcohol
gamma glutamyltransferase (GGT) is a sensitive indicator of this drugs use
alcohol
withdrawal from this drug results in tremor tachycardia, hypertension, malaise, nausea, seizures, delerium tremens (DTs), tremulousness, agitation, hallucinations
alcohol
intoxication of this substance results in CNS depression, nausea and vomiting, constipation, pupillary constriction (pinpoint pupils), seizures
*overdose is life threatening
opiods
withdrawal from this substance results in anxiety, insomnia, anorexia, sweating, dilated pupils, piloerection (goose pimples), fever, rhinorrhea, nausea, stomach cramps, diarrhea ("flulike" symptoms), yawning
opiods
intoxication of this substance results in psychomotor agitation, impared judgement, pupillary dilation, hypertension, tachycardia, euphoria, prolonged wakefulness and attention, cardiac arrhythmias, delusions, hallucinations, fever
amphetamines
withdrawal from this substance results in post use "crash", including depression, lethargy, headache, stomach cramps, hunger, hypersomnolence
amphetamines
intoxication of with this substance results in euphoria, psychomotor agitation, impared judgement, tachycardia, pupillary dilation, hypertension, hallucinations (including tactile), paranoid ideations, angina, sudden cardiac death
cocaine
withdrawal from this substance results in a post-use "crash", including severe depression and suicidality, hypersomnolence, fatigue, malaise, and severe psychological craving
cocaine
intoxication with this substance results in belligerence, impulsiveness, fever, psychomotor agitation, vertical and horizontal nystagmus, tachycardia, ataxia, homicidality, psychosis, delirium
PCP
with this drug recurrence of intoxication symptoms can occur due to reabsorption in the GI tract, resulting in a sudden onset of severe, random, homicidal violence
PCP
intoxication with this substance can result in marked anxiety or depression, delusions, visual hallucinations, flashbacks, and pupil dilation
LSD
Intoxication with this substance can result in euphoria, anxiety, paranoid delusions, perception of slowed time, impared judgement, social withdrawal, increased appetite, dry moth, hallucinations
Marijuana
Intoxication with this drug is dangerous because of its low safety margin. higher doses result in respiratory depression
barbituates
withdrawal from this substance results in anxiety, seizures, delerium, and life-threatening cardiovascular collapse
barbiturates
These medications have a greater safety margin than barbituates. Intoxication can result in amnesia, ataxia, somnolence, minor respiratory depression.
benzodiazepines
these drugs have an additive effect with alcohol
benzodiazepines
withdrawal from these drugs results in rebound anxiety, seizures, tremor, and insomnia
benzodiazepines
excessive use of this drug results in restlessness, insomnia, increased diuresis, muscle twitching, and cardiac arrhythmias
caffeine
withdrawal from this drug results in headache, lethargy, depression, and weight gain
caffiene
use of this drug results in restlessness, insomnia, anxiety, and arrhythmias-no increased diuresis
nicotine
withdrawal from this drug results in irritability, headache, anxiety, weight gain, and extreme cravings
nicotine
use of this drug results in restlessness, insomnia, anxiety, and arrhythmias-no increased diuresis
nicotine
This dz is charachterized by physiologic tolerance and alcohol dependence with symptoms of withdrawal (tremor, tachycardia, hypertension, malaise, nausea, DTs when intake is interrupted. Pts will show continued drinking despite medical and social contradictions and life disruptions.
Alcoholism
What is a drug used in treatment of alcoholism
disulfiram
describe the metabolism and effects of ethenaol
image p. 360
When do DTs usually appear in alcoholics?
2-5D after last drink.
In alcoholics in withdrawal what occurs 1st--autonomic system hyperactivity (tachycardia, tremors, anxiety) or psychotic symptoms (hallucinations, delusions)
1st-autonomic hyperactivity
2nd-psychotic symptoms
How do you treat DTs in alcholics going through withdrawal?
benzodiazpenes
Long-term alcohol use leads to this involving micronodular cirrhosis with accompaning symptoms of jaundice, hypoalbuminemia, coagulation factor deficiencies, and portal hypertension.
alcoholic cirrhosis
This syndrome caused by vitamin B1 (thiamine) deficiency, is common in malnourished alcoholics. They classically present with a triad of confusion, opthallmoplegia, and ataxia. This may progress to memory loss, confabulation, and personality change. It is associated with periventricular hemorrhage/necrosis, especially in mamillary bodies.
Wernicke-Korsakoff syndrome
What is the tx of Wernicke-Korsakoff syndrome
IV vitamine B1 (thiamine)
this complication of alcoholism consists of longitudinal lacerations at the gastroesophageal junction caused by excessive vomiting. In contrast to esophageal varices it is associated with pain.
Mallory-Weiss syndrome
Heroine is a schedule __ drug
schedule I (not perscribable)
addicts of this drug are at increase risk of hepatitis, abscesses, overdose, hemorrhoids, AIDS, and right sided endocarditis.
heroine
These drugs can competatively inhibit opiods
Naloxone (narcan) and naltrexone
This long acting oral opiate is used for heroine detoxification or long term maitenance
methadone
this psychiatric illnesss involves rapid decrease in attention span and level of arousal. Pts show disorganized thinking, have hallucinations, illusions, misperceptions, disturbance in sleep wake cycle, and cognitive disfunction.

The key to diagnosis is its rapid onset and the waxing and waning of level of conciousness.
delerium

mneu: deliRIUM=changes in sensoRIUM
this is the most common psychiatric illness on medical and surgical floors.
delerium
delerium is often iatrogenic and reversable. Look at pts meds for ones with this effect.
anticholenergic
This psychiatric illness ivolves a gradual decrease in cognition--memory deficits, aphasia, apraxia, agnosia, loss of abstract thought, behavior/ personality changes, and impared judgement.

Be sure to differentiate this from delerium. The key to diognosis is the more gradual onset and the fact that pt is alert with no change in his/her level of conciousness.
Dementia

mneu: DeMEMtia is characterized by MEMory loss. Commonly irreversable.
In elderly pts this disease can often present like dementia.
depression
DSM Criteria of Major depressive episode
characterized by at least 5 of the following for 2 weeks, including either depressed mood or anhedionia:
1) Sleep disturbance
2)↓ Interest
3)Guilt or feelings of worthlessness
4)↓ Energy
5)↓Concentration
6)↕Appetite
7)Psychomotor retardation/agitation
8)Suicidal ideations

mneu: SIG E CAPS
Lifetime prevalence of a major depressive episode is _____ for males and _____ for females
5-12% - males
10-25% - females
This variation on Major depressive disorders invoves 2 or more major depressive episodes with a symptom free interval of 2 months
RRECURRENT Major Depressive Disorder
This disorder is a milder form of depression that lasts at least 2 years
dysthymia
Pts with depression typically have the follwing 3 changes in their sleep stages.
1)↓ slow wave sleep
2)↓REM latency
3) Early-morning awakening (important screening question
Risk factors for suicide completion
Sex (male)
Age (teenager or elderly)
Depression
Previous attempt
Etoh (or drug use)
Rational thinking (loss of)
Sickness (≥3 perscriptions)
Organized plan
No spouce (esp if childless)
Social support lacking

mneu: SAD PERSONS
ECT is a treatment option when?
MDD refractory to other treatment
Major adverse effects of ECT
anterograde and retrograde amnesia, and confusion
T or F: ECT is painful.
F
This psychiatric disorder is characterized by a period of abnormally and persistantly elevated, expansive, or irritable mood lasting at least one week.
Manic episode
Describe the DSM criteria for a manic episode.
During a manic episode, 3 or more of the follwing are present:
1) Distractibility
2) Irresponsibility
3) Grandiosity
4) Flight of ideas
5)↑Activity
6)↓Sleep
7)Talkativeness

mneu: DIG FAST
this psychiatric disturbance is like a manic episode except mood disturbance is not severe enough to cause marked imparement in social and/or occupational functioning or to necessitate hospitalization. There are no psychotic features
Hypomanic episode
In this disorder pt consciosly fakes or claims to have a disorder in order to attain a specific gain (e.g., avoiding work, obtaining drugs)
malingering
Drug of choice for bipolar disorder
lithium
what is cyclothymic disorder?
a milder form of bipolar disorder lasting at least 2 years
In this disorder the pt conciously creates symptoms in order to assume the "sick role" and to get medical attention.
factitious disorder
This form of factitious disorder is manifested by a chronic history of multiple hospital admissions and willingness to receive invasive procedures.
Munchausen's syndrome
This factitious disorder is seen when an illness in the child is caused by the parent. The motivation is unconscious. It is a form of child abuse and must be reported.
Muchausen's syndrome by proxy
In this psychiatric disorder both illness production and motivation are unconcious drives. These are more common in women and manifest themselves in a variety of ways.
Somatoform disorders
Type of somatoform disorder in which pt presents with motor or sensory symptoms (e.g., paralysis, pseudoseizure) that suggest neurologic of physical disorder, but tests and physical exam are negative. Onset of symptoms often follow an acute stressor. Pt may seem strangely unconcerned about symptoms
Conversion disorder
Type of somatoform disorder in which pt presents with prolonged pain that is not explained completely by an illness.
Somatoform pain disorder
Type of somatoform disorder in which pt presents with preoccupation with and fear of having a serious illness in spite of medical reassurance
hypochondriasis
Type of somatoform disorder in which pt presents with a variety of complaints in multiple organ sytems with no identifiable underlying physical findings
Somatization disorder
Type of somatoform disorder in which pt presents with preoccupation with minor or imagined physical flaws. Pts often seek cosmetic surgery
Body dysmorhic disorder
Type of somatoform disorder in which pt presents with false belief of being pregnant associated with objective physical signs of pregnancy
pseudocyesis
What type of gain: primary, secondary, tertiary?

What the symmptom does for the patients internal psychic economy
primary gain
What type of gain: primary, secondary, tertiary?

What the symptom gets the patient (sympathy, attention)
secondary gain
What type of gain: primary, secondary, tertiary?

What the caretaker gets (like an doctor on an interesting case)
tertiary
Describe DSM characterization of panic disorder
recurrent periods of intense fear and discomfort peaking in 10 minutes with 4 of the following:
Palpitations
Paresthesias
Abdominal distress
Nausa,
Intense fear of dying or losing control
lIght headedness
Chest pain
Chills
Choking
disConnectedness
Sweating
Shaking
Shortness of breath

mneu: PPANIICCCCSSS

note: panic disorder is descrribed in context of occurrence (e.g., panic d/o w/ agoraphobia)
This psychiatric disorder involves a specific fear that is excessive or unreasonable. It is cued by presence or anticipation of a specific object or situation. Exposue to this object or situation provokes an anxiety response. Person recognizes the fear is excessive (insight). This fear interfears with normal routine.
specific phobia
what form of psychotherapy works well for specific phobias
systematic desensitation
gamophobia
fear of marrage
algophobia
fear of pain
acrophobia
fear of heights
agoraphobia
fear of open spaces
In this disorder person experiences or witnesses an event that involved actual or threatened death or serious injury. response involves intense fear, helplessness, or horror. The traumatic event is persistently reexperienced as nightmares or flashbacks. The person persistantly avoids stimuli associated with the trauma and experiences persistant symptoms of increased arousal. Disturbance lasts > 1mo and cuases distress or socia/occupation imparent. This disorder often follwos acute stress disorder which lasts up to 2-4 weeks.
Post-traumatic stress disorder
In this disorder emotional symptoms (anxiety, depression) causing impairment follw an identifiable psychosocial stressor (e.g., divorse, moving). This lasts less than 6 months
Adjustment disorder
This psychiatric disorder is characterized by uncontrollable anxiety for at least 6 months that is unrelated to a specific person, situation, or event. Sleep disturbance, fatigue, and difficulty concentrating are common.
generalized anxiety disorder
children with this disorder have severe communication problems and difficulty forming relationships. This disorder is characterized by repetitive behavior, unusual abilities (savants), and usually below-normal intelligence.
Autistic disorder
This disorder is a milder form of autism involving problems with social relationships and repetitive behavior. These children are of normal intellegence and lack social or cognitive deficits.
Asperger disorder
This is an X-linked disorder seen only in girls (affected males die in utero). It is characterized by a loss of development and mental reatardation appearing at approximately age 4. There is steriotyped hand-wringing.
Rett disorder
this disorder is characterized by limited attention span and hyperactivity. Children are emotionally labile, impulsive, and prone to accidents. These children typically have normal intellegence.
Attention Deficit Hyperactivity Disorder (ADHD)
What is the treatment of ADHD
methylphenidate
This psychiatric disorder of childhood is characterized by behavior that continually violates social norms. At >18 y/o this disorder is recategorized as antisocial personality disorder.
Conduct disorder
This psychiatric disorder of childhood is characterized by noncompliance in the absence of criminality.
Oppositional defiant disorder.
This psychiatric disorder of childhood is characterized by motor/vocal tics and involuntary profanity. Onset is <18 y/o.
Tourette's syndrome
What is the treatment for Tourette's syndrome
haloperidol
This psychiatric disorder of childhood is characterized by fear of loss of attachment figure leading to factitious physical complaints to avoid going to school. The common onset is age 7-8.
Seperation anxiety disorder.
This eating disorder is commonly seen in adolescent girls and coexists with depression. It is characterized by excessive dieting, body image distortion, and increased exercise. Pts often experience severe weight loss, amenorrhea, anemia and eventually electrolyte disturbance.
Anerexia nervosa
This eating disorder is characterized by binge eating followed by self-induced vomiting or use of laxitives. Body weight is typically normal. Parotitis, enamel erosion, electrolyte disturbances, alkalosis, and dorsal hand calluses are common physical exam/lab findings.
Bulimia nervosa
Hallucinations v. Illusion v. Delusions

______ are perceptions in the absense of external stimuli
Hallucinations
Hallucinations v. Illusion v. Delusions

__________ are misinterpretations of actual external stimuli
illusions
Hallucinations v. Illusion v. Delusions

______ are false beliefs not shared with other members of culture/subculture that are firmly maintained in spite of obvious proof to the contrary
Delusions
Delusions v. Loose associations

a _____ is a disorder in the CONTENT of the thought (the actual idea)
delusion
Delusions v. Loose associations

a _____ is a disorder in the FORM of the thought (the way the ideas are tied together)
loose association
hallucination types:

______ and _____ hallucinations are common in schizophrenia
auditory and visual
hallucination types:

_____ hallucination often occurs as an aura of a psychomotor siezure
olfactory
hallucination types:

_____ hallucinations are rare
gustatory
hallucination types:

_____ hallucinations are common in DTs. Also seen in cocaine abusers ("cocaine bugs")
tactile hallucination
formication
sensation of ants crawling on one's skin
by definition hypnagogic hallucinations occur when?
going to sleep

mneu: hypnaGOgic hallucination occurs while GOing to sleep
by definition hypnopompic hallucinations occur when?
while waking from sleep
In this disorder a person stops brathing for at least 10 seconds repeatedly during sleep.

It is associated with obesit, loud snoring, systemic/pulmonary hypertension, arrhythmias, and possibly sudden death.

The individual may become chronically tired.
sleep apnea
In this subcagegory of sleep apnea, the pt shows no respiratory effort
central sleep apnea
In this subcagegory of sleep apnea, the pt shows respiratory effort against airway obstruction
obstructive sleep apnea
This diagnosis is categorizecd by disordered sleep-wake cycles. It may include hypnagogic (just before sleep) or hypnopompic (just before waking) hallucinations. The person's sleep episodes start off with REM sleep.
narcolepsy
This form of narcolepsy involves a loss of all muscle tone follwing a strong emotional stimulus.
cataplexy
Tx for narcolepsy
ampetamines
This psychiatric illness is characterized by periods of psychosis and disturbed behavior with adecline in functioning lasting >6months.
schizophrenia
Give the DSM criterial for schizophrenia.
2 or more of the following symptoms (1-4 are positive symptoms)
1)Delusions
2)Hallucinations
3)Disorganized thought
4) Disorganized or catatonic behavior.
5. "negative symptoms"-flat affect, social withdrawal, lack of motivation, lack of speech or thought.
What is the most common type of hallucination in schizophrenia
auditory
in schizophrenia, disorganized thought often takes the form of ______
loose associations
in the etiology of schizophrenia, what is more important, genetic or enviornmental factors
genetic
Symptoms of schizophrenia that last 1-6 mo
schizophreniform disorder
Symptoms of schizophrenia that last <1 mo
brief psychotic disorder (usually stress related)
Lifetime prevelence of schizophrenia
1.5%
schizophrenia typically presents earlier in _______ (males or females)
males
this psychiatric condition involves a combination of schizophrenia and a mood disorder
schizoaffective disorder
What are the 5 subtypes of schizophrenia
1)disorganized
2) catatonic
3)paranoid
4)undifferentiated
5) residual
This is an enduring pattern of perceiving, relating to, and thinking about the enviornment and oneself that is exhibited in a wide reange of important social and personal contexts.
personality trait
This results when personality patterns become inflexible and maladaptive, causing impairment in social or occupational functioning or subjective disress. The person is usually not aware of the problem. These disordered patterns are stable only by early adulthood and not usually diagnosed in children.
personality disorders
This cluster of personality disorders usually present as "odd" or "eccentric. They cannot develop meaningful social relationships. Give cluster and types.
Cluster A "Wierd"
1)Paranoid
2)Schizoid
3) Schizotypal
This cluster of personality disorders shows no psychosis but there is a genetic association with schizophrenia.
Cluster A "Wierd"
1)Paranoid
2)Schizoid
3) Schizotypal
personality disorder characterized by distrust and suspiciousness
paranoid personality disorder
main defence mechonism exiped by those with paranoid personality disorder
projection
personality disorder characterized by voluntary social withdrawal and limited emotional expression
schizoid
personality disorder characterized by interpersonal awkwardness, odd beliefs or magical thinking. Often eccentric in appearance.
Schizotypal
This cluster of personality disorders is dramatic, emotiona, and eratic.
Give the cluster and the subtypes
Cluster B: "Wild"
1)Antisocial
2) Borderline
3) Histrionic
4)Narcissistic
This cluster of personality disorders has a genetic associateion with mood disorders and subsance abuse.
Cluster B: "Wild"
1)Antisocial
2) Borderline
3) Histrionic
4)Narcissistic
personality disorder characterized by disregard and violation of the rights of others, usually manifesting itself in criminality. It affects males > females. Before 18 y/o it is called conduct disorder
antisocial personality diosrder
personality disorder characterized by unstable mood and interpersonal relationships, impulsiveness, sense of emptiness. Effects females more than males
Borderline
personality disorder characterized by excessive emotionality, attention seeking, sexually provocative
histrionic
personality disorder characterized by grandiosity & sense of entitlement. May react to criticism with rage.
Narcissistic
This cluster of personality disorders is charicterized by anxiety and fear. Give the cluster and the types.
Cluster C: "Worried"
1)avoidant
2)obsessive-compulsive
3)dependant
This cluster of personality disorders has a genetic association with anxiety diosrders.
Cluster C: "Worried"
1)avoidant
2)obsessive-compulsive
3)dependant
personality disorder characterized by sensitivity to rejection, socially inhibited, timid, feelings of inadequacy
avoidant
personality disorder characterized by preocupation with order, perfectionism, and control
obsessive-compulsive
personality disorder characterized by submissive and clinging behavior. They have an excessive need to be taken care of and low self confidence.
dependant
This dz is due to a loss of dopaminergic neurons and excess cholinergic activity
parkinsonism
The treatments for parkinson's dz can be summarized by the mneumonic BALSA. What does this stand for
Bromocriptine
Amantadine
Levodopa (w/ carbidopa)
Selegine (&COMT inhibitors)
Antimuscarinics
This drug is an erogot alkaloid an a partial dopamine agonist. The strategy behind this drug is to antagonize dopamine receptors.
bromocriptine
This drug may increase dopamine release.
Amantadine
This drug is converted to dopamine in the CNS
L-dopa/carbidopa
This drug is a selective MAO type B ihibitor. The strategy of this Parkensons drug is that it prevents dopamine breakdown.
Selegiline
This drug is a COMT ihibitor. The strategy of these Parkensons drugs is that it prevents dopamine breakdown.
entacapone & tolcapone
This drug is an antimuscarinic and thus curbs excess cholinergic activity seen in parkinsons. It improves tremor and rigitity but has little effect on bradykinesia
Benzotropine
The MOA of this parkinson's drug is that it ↑ levels of dopamine in the brain. Unlike dopamine, this drug can cross the blood-brain barrier and is converted by dopa decarboxylase in the CNS to dopamine
L-dopa (levvodopa)/carbidopa
What is the most common toxicity of L-dopa
arrhthmias from peripheral conversion to dopamine
Why is carbidopa given with levodopa.
carbidopa is a peripheral decarboxylase inhibitor. It is given with L-dopa inorder to limit the peripheral side effects.
Long term use of ______ can lead to the of dyskinesia follwing administraiton, and akinesia between doses.
L-dopa
This parkinsons drug acts by selectively inhibiting MAO-B, therby ↑ the availabilty of dopamine.
Selegine
This drug is a 5-HT (1D) agonist. It causes vasoconstriction and is used for acute migrane or cluster headache attacks.
Sumatriptan
This drug for acute migrane & cluster headache attacks has toxicities that include coronary vasosasm, thereore it is contraindicated in pts with CAD or Prinzmetal's angina
Sumatriptan
This drug is 1st line for tonic clonic siezures and status epilepticus prophylaxis. It acts by ↑ Na+ channel inactivation
phenytoin
This drug is first line for tonic clonic siexures and trigeminal neuralgia. It acts by ↑ Na+ channel inactivation.
Carbazepine
This siezure medication blocks voltage gaited Na+ channels, but has no effect on GABA release
Lamotrigine
This epilepsy medication acts to ↑ GABA release. It is also used for peripheral neuropathy
Gabapentin
This epilepsy medication acts to block Na+ channels and ↑ GABA release.
topiramate
This epilepsy medication acts to ↑ GABA action. It is 1st line in pregnant women & children
phenobarbital
This epilepsy medication acts to ↑ Na+ channel inactivation & ↑ GABA concentration. It is 1st line for tonic-clonic/ myoclonic seizures and can be used for absence seizures.
valproic acid
This epilepsy medication is 1st line for absence seizures. It acts by blocking the thalamic T-type Ca++ channesls.
ethsuximide
This epilepsyy drug acts by ↑ GABA action. It is first line for acute status epilepticus. It is also usd for seizures of eclampsia (however NOT 1st line--which is MgSO4)
Benzodiazepines
(diazepam or lorazepam)
Give the epilepsy drug associated with the following toxicities:

sedation, tolerance, dependence
benzodiazepines
Give the epilepsy drug associated with the following toxicities:

Diplopia, ataxia, blood dyscrasias (agranulocytosis, aplastic anemia), liver toicity, teratogenesis, induction of cytochrome P-450.
Carbamazepine
Give the epilepsy drug associated with the following toxicities:

GI distress, lethargy, headache, uticaria, Stevens-Johnson syndrome
Ethosuximide
Give the epilepsy drug associated with the following toxicities:

Sedation, tolerance, dependance, induction of cytocrome P-450.
Phenobarbital
Give the epilepsy drug associated with the following toxicities:

Nystagmus, diplopia, ataxia, sedaton, gingival hyperplasia, hirsuitism, megaloblastic anemia, teratogenesis, SLE-like syndrome, induction of cytocrome P-450.
Phenytoin
Give the epilepsy drug associated with the following toxicities:

GI distress, rare but fatal hypatotoxicity (measure LFTs), neural tube defects in fetus (spinal bifida), tremor, weight gain.
Valproic acid
Give the epilepsy drug associated with the following toxicities:

Stevens-Johnson syndrome
Lamotrigine
Give the epilepsy drug associated with the following toxicities:

Sedation, ataxia
Gabapentin
Give the epilepsy drug associated with the following toxicities:

Sedation, mental dulling, kidney stones, weight loss
Topiramate
The mechanism of this drug is blockade of Na+ channels; inhibition of glutamate release from exitatory presynaptic neurons
phenytoin
This drug is 1st line for tonic clonic siezures and for prophylaxis of status epilepticus. It is also a class IB antiarrhythmic.
phenytoin
The toxicities of this drug include: nystagmus, ataxia, diplopia, sedation, SLE-like syndrome, induciton of cytocrome P-450. Chronic use produces gingival hyperplasia in children, peripheral neuropathy, hirsutism, megaloblastic anemia (↓B12), and malignant hyperthermia (rare). It is also teratogenic.
phenytoin
This drug acts by facilitating GABA action by ↑ duration of Cl- channel opening, thus ↓ neuron firing
barbituates (phenobarbital, pentobarbital, thiopental, secobarbital)

mneu: BarbiDURATe (increased DURATion)
This group of drugs is used as a sedative for anxiety, siezures, insomnia, induction of anesthesia
barbituates (phenobarbital, pentobarbital, thiopental, secobarbital)
Toxicities of this drug include dependence, additivee CNS depression effects with etoh, respiratory of CV depession (can lead to death. There are also many drug interactions owing to induction of liver microsomal enzymes (cytocrome P-450)
barbituates (phenobarbital, pentobarbital, thiopental, secobarbital)
this type of drugs is contraindicated in porphyria
barbituates (phenobarbital, pentobarbital, thiopental, secobarbital)
What do you do if someone ODs on barbituates?
symptom management (assist respiration, manage BP)
The mechanism of this drug is to facilitate GABA action by ↑ frequency of Cl- channel opening
Benzodiazepines (Diazepam, lorazepam, triazolam, temazepam, oxazepam, midazolam, chlordiazepoxide, alprazolam)

mneu: FREnzodiazepenes (increased FREquency)
Most benzodiazepines have long half-lives and active metabolites. The short acting ones are what? (3)
Triazolam, Oxazepam, Midazolam

mneu: TOM Thumb
These drugs are used to treat anxiety, spasticity, status epilepticus, detoxification (esp etoh w/drawl[DTs]), night terrors, & sleep walking.
Benzodiazepines (diazepam, lorazepam, triazolam, temazepam, oxazepam, midazolam, chlordiazepoxide, alprazolam)
Toxicity of this drug includes dependence, additive CNS depression effects with alcohol. Less risk of respiratory depressiona nd coma than with barbituates.
Benzodiazepines (diazepam, lorazepam, triazolam, temazepam, oxazepam, midazolam, chlordiazepoxide, alprazolam)
Treat Benzodiazepine overdose with ________
Flumazenil (competitive antagonist at GABA receptor)
These drugs are used to treat anxiety, spasticity, status epilepticus, detoxification (esp etoh w/drawl[DTs]), night terrors, & sleep walking.
Benzodiazepines (diazepam, lorazepam, triazolam, temazepam, oxazepam, midazolam, chlordiazepoxide, alprazolam)
phenobarbital, pentobarbital, thiopental, secobarbital are ________
barbituates
diazepam, lorazepam, triazolam, temazepam, oxazepam, midazolam, chlordiazepoxide, alprazolam are _______ (drug category)
Benzodiazepines
Thioridazine, haloperidol, fluphenazine, chlorpromazine are all _______ (drug category)
Antipsychotics (neuroleptics)
This drug acts to block dopamine (D2) receptors
antipsychotics (neuroleptics
This drug category is used to treat psychosis, acute mania, and tourettes syndrome
antipsychotics
Toxicies of this group of drugs include extrapyramidal system (EPS side effects)
antipsychotics
Toxicies of this group of drugs include endocrine side effects (e.g., dopamine receptor antagonism →hyperprolactinemia→gynomastia)
antipsychotics
Toxicies of this group of drugs include side effects arising from muscarinic block (dry mouth &constipation), alpha receptors (hypotension) and histamine receptors (sedation)
antipsychotics
This toxicity of antipsychotic involves symptoms that include rigidity, myoglobinuria, autonomic instability, hyperpyrexia.
Neuroleptic malignant syndrome
How do you treat Neuroleptic malignant syndrome (antipsychotic toxicity)
dandrolene and dopamine agonists)
This antipsychotic toxicity includes stereotypic oral-facal movements, probably due to dopamine receptor sensitization, which results from long term antipsychotic use.
Tarditive dyskinesia
Evelution of EPs side effects with antipsychotic use:
4 h acute dystonia
4 d akinesia
4 wk akathisia
4 mo tarditive dykinesia
(often reversible)
The drugs clozapine, olanzapine, risperidone are of the category _________
Atypical antipsychotis

mneu: i'ts not ATYPICAL for OLd CLOsets to RISPER
This group of drugs acts by blocking 5-HT2 and dopamine receptors
Atypical Antipsychotics
These drugs are used in treatment of schizophrenia; they are useful for positive and negative symptoms and they have fewer extrapyramidal and anticholinergic side effects than other antipsychotics.
Atypical antipsychotics
This atypical antipsychotic is also used for OCD, anxiety disorder, depression, mania, and tourettes syndrome
Olanzapine
This atypical antipsychotic may cause agranulocytosis and requires weekly WBC monitoring
Clozapine
The mechanism of this drug is not established. It is possibly related to an inhibition of the phosphoinositol cascade.
Lithium
This drug is used as a mood stabilizer for bipolar affective disorder. It blocks relapse and acute manic events.
Lithium
Toxicity of this drug includes tremor, hypothyroidism, polyuria (ADH antagonist causing nephrogenic diabetes insipidus), teratogenesis.
This drug also has a narrow therapeutic window requiring close monitoring of serum levels.
lithium

mneu: LMNOP
Lithium side effects:
Movement (tremor)
Nephrogenic dbts insipidus
hypOthyroidism
Pregnancy problems
ANTIDEPRESSANTS [image]p.371
--
The drugs Fluoxetine, sertraline , paroxetine, and citalopram belong to this category of drugs
Serotonin-specific reuptake Inhibitors (SSRI)
This drug is indicated for endogenous depression, and obsessive compulsive disorder
SSRIs
This drug boast fewer toxicities than TCAs but has been associated with GI distress, sexual dysfuncion (anorgasmia).
SSRIs
When used with MAO inhibitors, SSRIs can cause "serotonin syndrome." What three things does this involve.
hyperthermia, muscle rigidity, CV collapse
The drugs Imipramine, amitriptyline, desipramine, nortriptyline, clomipramine, and doxepin are of this medication category
Tricyclic antidepressants
These drugs act to block the reuptake of NE and serotonin
tricyclic antidepressants
These drugs are indicated for major depression that does not respond to SSRIs
tricyclic antidepressants
This tricyclic antidepressant is indicated for bedwetting
imipramine
This is the only tricyclic antidepressant indicated for OCD
clomipramine
The side effects of these drugs include sedation, alpha blocking effects (hypotension), atropine like (anticholinergic) side effects (tachycardia, urinary retention)
tricyclic antidepressants
Secondary TCAs like ______ have less anticholinergic side effects than do tertiary TCAs like amitriptyline
nortriptyline
This TCA is the least sedating.
desipramine
The side effects of these drugs include sedation, alpha blocking effects (hypotension), atropine like (anticholinergic) side effects (tachycardia, urinary retention)
tricyclic antidepressants
Give the 3 Cs of Tricyclic antidepressant toxicity
Convulsions, Coma, Cadiotoxicity (arrhythmias)

also can have respiratory depression & hyperpyrexia?
Your elderly pt on TCAs develops confusion and hallucinations. What could this be due to and what is an alternative TCA that could be given?
This could be due to the anticholinergic side effects of TCAs. Use nortriptyline.
Bupropion, Venlafaxine, Mirtazapine, Maprotiline, Trazodone belong to what drug category
heterocyclic antidepressents

mneu: You need BUtane in your VEiNs to MURder for a MAP of AlcaTRAZ
These are 2nd and 3rd generation antidepressante with varied and mixed mechanisms of action. They are used to treat major depession.
heterocyclic antidepressants
This heterocyclic antidepressant is also used for smoking cessation. Its mechanism s not well known. Toxicity includes stimulant effects (tachycardia, insomnia), headache, and siezure in bulimic pts. It does NOT cause sexual side effects.
Buproprion
This heterocyclic antidepressant is also used in generalized anxiety disorder. It inhibits serotonin, NE, & dopamine reuptake. Toxicity includes stimulant effects, sedation, nausea, constipation and increased BP.
Venlafaxine
This heterocyclic antidepressant is an alpha2 antagonist (↑ release of NE and serotonin) and a potent 5-HT(2) & 5-HT(3) receptor antagonist. Toxicity includes sedation ↑ appetite, weight gain, and dry mouth.
Mirtazapine
This heterocyclic antidepressant blocks NE reuptake. Toxicity includes sedation and orthostatic hypotension.
Maprotiline
This heterocyclic antidepressant acts primarily to inhibit seratonin reuptake. Toxicity includes sedation, nausea, priaprism, and postural hypotension
Trazodone
The drugs Phenelzine & tranylcypromine are of this catigory
Monoamine oxidase Inhibitors (MAOIs)
This drug acts by non-selectively inhibiting Monoamine oxidase (MAO)→↑ levels of amine neurotransmitters
Monoamine oxidase inhibiters (MAOIs)
These drugs are used for atypical depression (i.e., with psychotic or phobic features, anxiety, and hypochondriasis.
Monoamine oxidase inhibiters (MAOIs)
These drugs can cause a hypertensive crisis with tyramine ingestion (wine & cheese) and merperidine. They also can cause CNS stimulation.
Monoamine oxidase inhibiters (MAOIs)
These drugs are contraindicated with SSRIs or Beta agonists (to prevent seratonin syndrome)
Monoamine oxidase inhibiters (MAOIs)
CNS anesthetics must be ______ soluable in order to cross teh blood-brain barrier
lipid
anesthetics with ↓ solubility in blood have ____ induction and recovery times
rapid
anesthetics with ↑ solubility in lipids have ______ potency
increased
relative potency of inhalation anesthetics is indicated by what index
Minimal anesthetic concentration
Minimal anesthetic concentration is ________ (proportional or inversely proportional) to potency
inversely proportional

potency =1/MAC
Fill in the blanks regarding general principles of anesthesia.
↑ solubility in ______ =
↑ Potency =1/MAC
lipids
N2O has low blood and lipid solubility. What is the rate of induction and what is the potency?
fast
low
Halothane has ↑ lipid and blood solubility, and thus ____ potency and ____ induction
high
slow
anesthetics with ↓ solubility in blood have ____ induction and recovery times
rapid
anesthetics with ↑ solubility in lipids have ______ potency
increased
halothane, enflurane, isoflurane, sevoflurane, methoxyflurane, and nitrous oxide are all this type of anesthetic
inhaled anesthetics
These drugs result in myocardial & respiratory depression, nausea/emesis, and increased cerebral blood and decreased cerebral metabolic demand.
inhaled anesthetics
This inhaled anesthetic has a toxicity of hepatotoxicity
halothane
This inhaled anesthetic has a toxicity of nephrotoxicity
methoxyflurane
This inhaled anesthetic has a toxicity of seizures.
enflurane
This is a rare but very dangerous toxicity of inhaled anesthetics
malignant hyperthermia
This is a barbituate intravenous anesthetic. It is high potency (high lipid solubility). It is used for induction of anesthesia and short surgical procedures. It decreases cerebral blood flow.
Thiopental
This benzodiazepine given IV is the most common anesthetic used for endoscopy. It may cause severe postoperative respiratory depression, decreased BP, and amnesia.
Midazolam
You give your pt Midazolam for his endoscopy. Postoperatively he developse hypotension. What drug do you give him?
flumazenil
Thses PCP analogs given IV act as dissociative anesthetics. They are cardiovascular stimulants. They cause hallucinations and bad dreams. They increase cerebral blood flow.
Arylcyclohexamines (Ketamine)
These opiates are given IV with other CNS depressants during general anesthesia
morphine, fentanyl
This IV anesthetic is used for rapid anesthesia induction and short procedures. It has less postoperative nausea than thiopental.
Propofol
What are the IV anesthetics?
Barbituates
Benzodiazepines
Ketamine
Opiates
Propofol

mneu: B.B. King on OPIATES PROPOses FOOLishly
This drug is used in the treatment of malignant hyperthermia and neuroleptic malignant syndrome.
dantrolene
This condition can be caused by the concomitant use of inhalation anesthetics (except N2O) and succinylcholine.
Malignant hyperthermiia
The drugs procaine, cocaine, tetracaine, lidocaine, mepivacaine, pubivacaine are in this category
local anestetics
Procaine, cocaine, tetracaine, are considered this type of local anesthetics.
esters
lidocaine, mepivacaine, pubivacaine are considered this type of local anesthetics.
amides

mneu: amIdes all have 2 "I"s in their names
This group of drugs acts by blocking Na+ channels in nerves by binding to secific receptors on the inner portion of the channel
local anesthetics
Your pt has infected tissue that needs to be anesthetized. Do you need more or less local anesthetic?
More-infected tissue is acidic and therefore charged. The charged anesthetics will have trouble penetrating the membrane effectively.
Give the order of anesthetic nn block regarding diameter of nn and myelination

small melinated autonomic fibers
large myelinated autonomic fibers
small unmyelinated pain fibers
small diameter> large diameter
Myelinated>unmyelinated

Overall size factor predominates over myelination factor

small unmyelinated pain fibers> small melinated autonomic fibers>large myelinated autonomic fibers
What is the order of loss in sensation upon administration of a local anesthetic.

touch,pain,pressure, temp
pain>temp>touch>pressure
Local anesthetics are usually given with this to enhance local action--↓bleeding, ↑ anesthesia by ↓ systemic concentration.
epinephrine (or another vasoconstrictor)
These drugs are used for minor surgical procedures and as spinal anesthesia.
local anesthetics
You want to give you're pt a local anesthetic but she is allergic to esters. Name an amide you can give her.
lidocaine, mepivacaine, bupivancaine
a toxicity of this local anesthetic is CV toxicity
bupivacaine
a toxicity of this local anesthetic is arrhythmias
cocaine
general side effects of local anesthetics may include?
CNS exitation, hypertension, hypotension
These drugs are used for muscle paralysis in surgery or mechanical ventilation. They are selective for the motor (v. autonomic) nicotinic receptor
neuromuscular blocking drug
The depolarizing neuromuscular blocking drug is __________
succinylcholine
The drugs tubocurarine, atracurium, mivacurium, pancuronium, vecuronium, rapacuronium are of this category of neuromuscular blocking drugs
nondepolarizing
Nondepolarizing neuromuscular blocking drugs compete with ____ for receptors
ACh
In order to reverse the blockade of nondepolarizing blocking agents you can use __________
any cholinesterase inhibitor:
e.g., neostigmine, edrophonium
With depolarizing neuromuscular blocking drugs phase I is known as the ___________ phase
prolonged depolarization phase
With depolarizing neuromuscular blocking drugs phase I -prolonged depolarization - is potentiated by what?
cholinesterase inhibitors
With depolarizing neuromuscular blocking drugs phase II is known as the ___________ phase
repolarized but blocked phase
after initiating paralysis with a depolarizing neuromuscular blocking drugs, is it possible to reverse the effects.
During phase II (repolarized but blocked phase) only-- the antidote consists of cholinesterase inhibitors (e.g., neostigmine)