Fa - Neuro

Front 1

Where is the C2 dermatome?

Back 1

posterior half of a shull cap

Front 2

Where is the C3 dermatome?

Back 2

high turtleneck shirt

Front 3

Where is the C4 dermatome?

Back 3

low-collar shirt

Front 4

Where is the T4 dermatome?

Back 4

nipple; T4 at the teat pore

Front 5

Where is the T10 dermatome?

Back 5

at the umbilicus (important for early appendicitus pain referal); T10 at the belly butTEN

Front 6

Where is the L1 dermatome?

Back 6

inguinal ligament; L1 is IL (Inguinal Ligament)

Front 7

Where is the L4 dermatome?

Back 7

includes kneecaps; Down on L4s (all fours)

Front 8

What do the S2, S3, S4 dermatomes do?

Back 8

erection and sensation of penile and anal zones; S2, 3, 4, keeps the penis off the floor

Front 9

What is the function of the msucle spindle?

Back 9

Muscle spindles monitor muslce length (help you pick up a heavy suitcase when you didn't know how heavy it was ); In parallel with muscle fibers. Muscle stretch -> intrafusal stretch -> stimulates Ia affert->stumulates alpha motor neuron -> reflex muslce (extrafusal) contraction

Front 10

What is the function of the Golgi Tendon?

Back 10

monitor muscle tension (make you drop a heavy suitcase you've been holding too long)

Front 11

What is the purpose of the gammal loop in muscle control?

Back 11

CNS stimulates gamma neuron -> contracts intrafusal fiber -> increase sensitivity of reflex arc

Front 12

Biceps reflex

Back 12

C5 nerve root

Front 13

Triceps reflex

Back 13

C7 nerve root

Front 14

Patella reflex

Back 14

L4 nerve root

Front 15

Achiles reflex

Back 15

S1 nere root

Front 16

What is the Babinski reflex?

Back 16

dorsiflexion of the big toe and fanning of other toes with plantar stimulation; sign of UMN lesion but normal reflex in 1st year of life

Front 17

What is the moro reflex?

Back 17

extension of limbs when startled (primitive reflex) normall disappear within 1st year. May reemerge following frontal lobe lesion

Front 18

What is the rooting reflex?

Back 18

nipple seeking (primitive reflex) normall disappear within 1st year. May reemerge following frontal lobe lesion

Front 19

what is the palmar reflex?

Back 19

grasps objects in palm (primitive reflex) normall disappear within 1st year. May reemerge following frontal lobe lesion

Front 20

Brain stem-ventral view

Back 20

A/P order: olfactory bulb (CN I), Olfactory bulb, CN ii, Anterior perforated substance below optic chiasm, optic tract, infundibullum, tuber cinereum, mammillary body, CN III, cerebral peduncle (crus cerebri), pons (large), CN IV(arises dorsally), CN V, CN VI, CN VII, CN VIII, Middle cerebellar peduncle ,CN IX, CN X, CN XI, CN XII, pyramid, pyramidal decussation, C1

Front 21

Which CNs lie medially at the brain stem?

Back 21

CN III, VI, XII; 3(X2) = 6(x2)=12

Front 22

Brain stem- dorsal view (cerebellum removed)

Back 22

Superior to inferior: pineal body, superior colliculi, inferior colliculi, superior cerebellar peduncles, 4th ventricle, middle cerebellar peduncle, CN VIII, medulla (your eyes are above your ears, and the superior colliculus (visual) is above the inferior colliculus (auditory)

Front 23

What is the function of the pineal gland?

Back 23

melatonin secretion, circadian rhythms

Front 24

What is the function of the superior colliculi?

Back 24

conjugate vertical gaze center

Front 25

What is the function of the inferior colliculi?

Back 25

Auditory

Front 26

What is the Parnaud syndrome?

Back 26

Paralysis of conjugate vertical gaze due to leion in superior colliculi (e.g. pinealoma)

Front 27

Olfactory nerve

Back 27

CN I, Smell (only CN without thalamic relay to cortex), Sensory

Front 28

Optic nerve

Back 28

CN II, sight, sensory

Front 29

Oculomotr nerve

Back 29

CN III, Eye movement, pupil constriction, accommodation, eyelid opening (levator palpebrae) motor

Front 30

Trochlear nerve

Back 30

CN IV, eye movement, motor

Front 31

Trigeminal nerve

Back 31

CN V, mastication, facial sensation, both sensory and motor

Front 32

Abducens nerve

Back 32

CN VI, eye movement, motor

Front 33

Facial nerve

Back 33

CN VII, Facial movement, taste from anterior 2/3 of tongue, lacrimation, salivation (submandibular and sublingual glands), eyelid closing (orbicularis oculi), stapedius muscle in ear, both sensory and motor

Front 34

Vetibulocochlear nerve

Back 34

CN VIII, hearing and balance, sensory

Front 35

Glossopharyngeal nerve

Back 35

CN IX, taste from posterior 1/3 of tongue, swallowing, salivation (parotid gland), monitoring carotid body and sinus chemo- and baroreceptors, and stylopharungeus, both sensory and motor

Front 36

Vagus nerve

Back 36

CN X, taste from epiglottic region, swallowing, palate elevation, talking, coughing, thoracoabdominal viscera, monitoring aortic arch chemo- and baroreceptors, both sensory and motor

Front 37

Accesory nerve

Back 37

CN XI, head turning, shoulder shrugging, motor

Front 38

Hypoglossal nerve

Back 38

CN XII, tongue movement, motor

Front 39

Menmonic for cranial nerves

Back 39

Some Say Marry Money But My Brother Says Big Brains Matter Most

Front 40

What does the nucleus solitarius do?

Back 40

Visceral sensory information (e.g. taste, baroreceptors, gut distention). CN VII, IX, X

Front 41

What is the function of the nucleus ambiguus?

Back 41

Motor innervation of pharynx, larynx, and upper esophagus (e.g. swallowing, palate elevation). CN IX, X, XI

Front 42

What does the dorsal motor nucleus do?

Back 42

Sends autonomic (parasympathetic) fibers to heart, lungs, and upper GI

Front 43

What is the pathway in the skull for CN I?

Back 43

Cribriform plate

Front 44

What travels through the optic canal?

Back 44

CN II, ophthalmic artery, central retinal vein (middle cranial fossa, sphenoid bone)

Front 45

What travels through the superior orbital fissure?

Back 45

CN III, IV, V1, VI, and the ophthalmic vein (middle cranial fossa, sphenoid bone)

Front 46

What travels through the foramen rotundum?

Back 46

CN V2 (middle cranial fossa, sphenoid bone)

Front 47

What travels through the foramen ovale?

Back 47

CN V3 (middle cranial fossa, sphenoid bone)

Front 48

What travels through the foramen spinosum?

Back 48

middle meningeal artery (middle cranial fossa, sphenoid bone)

Front 49

What travels through the internal auditory meatus?

Back 49

CN VII, VIII (posterior cranial fossa through the temporal or occipital bone)

Front 50

What travels through the jugular foramen?

Back 50

CN IX, X, XI, jugular vein (posterior cranial fossa through the temporal or occipital bone)

Front 51

What travels through the hypoglossal canal?

Back 51

CN XII (posterior cranial fossa through the temporal or occipital bone)

Front 52

What travels through the fromaen magnum?

Back 52

Spinal roots of CN XI, brain stem, verterbral arteries (posterior cranial fossa through the temporal or occipital bone)

Front 53

What is the cavernous sinus?

Back 53

A collection of venous sinuses on either side of the pituitary. Blood from the eye and superficial cortex -> cavernous sinus -> internal jugular vein.

Front 54

What passes through the cavernous sinus?

Back 54

CN III, IV, V1, V2, and VI and postganglionic sympathetic fibers en route to the orbit all pass through the cavernous sinus. Only CN VI is free-floating. Cavernous portion of internal carotid artery is also here. (the nerves that control extraocular muscles (plus V1 and V2) pass through the cavernous sinus.

Front 55

What is cavernous sinus syndrome?

Back 55

ophthalmoplegia, ophthalmic and maxillary sensory loss (due to mass effect)

Front 56

Primary ion in perilymph of inner ear?

Back 56

Na+ (similar to ECF)

Front 57

Primary ion in endolymph of inner ear?

Back 57

K+

Front 58

Structure that produces endolymph in inner ear?

Back 58

stria vascularis

Front 59

Regarding the inner ear, where are maculae located and what is their function?

Back 59

Utricle and saccule, detect linear acceleration

Front 60

Regarding the inner ear, where are ampullae located and what is their function?

Back 60

Semicircular canals, detect angular acceleration

Front 61

Hair cells of inner ear project from what structure?

Back 61

organ of Corti

Front 62

What are the Rinne/Weber results in conductive hearing loss?

Back 62

negative Rinne (bone conduction > air conduction); Weber localizes to affected ear

Front 63

What are the Rinne/Weber results in sensorineural hearing loss?

Back 63

positive Rinne (air conduction > bone conduction); Weber localizes to normal ear

Front 64

Damage to apex of cochlear membrane would affect which sounds?

Back 64

low frequency - apex is wide & flexible

Front 65

Elderly have trouble hearing which type of sounds earliest, and which end of cochlear membrane does this represent?

Back 65

high frequency lost first, base of cochlear membrane (narrow & stiff)

Front 66

In posterior portion of eye, what layer is just within the sclera?

Back 66

choroid

Front 67

What extraocular muscles are innervated by each cranial nerve?

Back 67

LR6SO4R3: VI innervates lateral rectus, IV innervates superior oblique, III innervates rest (SR, IR, MR, IO, levator palpebrae superioris)

Front 68

Eye presenting with damaged CN III?

Back 68

Down and out (innervates SR, IR, MR, IO, levator palpebrae superioris, only LR and SO left)

Front 69

Eye presenting with damaged CN IV?

Back 69

Diplopia with defective downward gaze (innervates SO)

Front 70

Eye presenting with damaged CN VI?

Back 70

Medially directed (innervates LR)

Front 71

Which extraocular muscle abducts, intorts, and depresses, and what is it innervated by?

Back 71

Superior oblique, CN IV

Front 72

Describe the pupillary light reflex (what are the 3 major synapses, what is the result?)

Back 72

Light in either retina signals via CN II to pretectal nuclei => activate bilateral Edinger-Westphal nuclei => ciliary ganglia => pupils contract bilaterally (consensual reflex)

Front 73

What is the Marcus Gunn phenomenon, how is it tested, what might cause it?

Back 73

Afferent pupillar defect, causes diminshed pupillary light reflex (in swinging flashlight test, both pupils appear to dilate when light shining into affected side), may be caused by optic nerve damage or retinal detachment

Front 74

What action and cranial nerve are tested by saying aloud: Kuh-kuh-kuh?

Back 74

Palate elevation, CN X - vagus

Front 75

What muscle and cranial nerve are tested by saying aloud: la-la-la?

Back 75

Tongue, CN XII-hypoglossal

Front 76

What cranial nerve is tested by saying aloud: mi-mi-mi?

Back 76

CN VII-facial, tests lips

Front 77

Which muscles of mastication close the jaw?

Back 77

Masseter, teMporalis, Medial pterygoid
M's Munch

Front 78

Which muscles of mastication open the jaw?

Back 78

Lateral Pterygoid
Lateral Lowers

Front 79

which cranial nerve innervates the muscles of mastication?

Back 79

CN V-Trigeminal (V3)

Front 80

Which muscle with the root glossus is NOT innervated by the hypoglossal nerve? What CN is it innervated by?

Back 80

the Palatoglossus - innervated by the vagus nerve (remember that the vagus nerve elevates the palate)
All other muscles with root glossus are innervated by the hypoglossal nerve.

Front 81

Which muscle with the root palat in its name is NOT innervated by the vagus nerve? Which CN is it innervated by?

Back 81

The tensor veli palatini-innervated by the mandibular branch of CN V-trigeminal nerve.
ALL other muscles with the root palat are innervated by the vagus nerve.

Front 82

What is the location of, and sensation associated with, Free nerve endings?

Back 82

Location: All skin and some viscera
Senses: Pain and Temperature

Front 83

What type of fibers make up free nerve endings?

Back 83

C, and Aδ fibers

Front 84

What is the location of, and sensation associated with, Meissner's Corpuscles?

Back 84

Location: Glabrous (hairless) skin, and 40% of fingertip receptors
Senses: Dynamic fine touch (e.g. manipulation)

Front 85

What is the location of, and sensation associated with, Pacinian corpuscles?

Back 85

Location: Deep skin layers, ligaments, joints, and 15% of fingertip receptors
Senses: Vibration

Front 86

What is the location of, and sensation associated with, Merkel's disks?

Back 86

Location: Hair follicles, and 25% of fingertip receptors
Senses: Static touch (e.g. shapes, edges, textures)

Front 87

Which sensory corpuscle is cup-shaped?

Back 87

Merkel's disks

Front 88

Internuclear ophthalmoplegia is characterized by a lesion in what location?

Back 88

Lesion in the medial longitudinal fasciculus (MLF) Also called MLF syndrome.

Front 89

What findings are characteristic in Internuclear Ophthalmoplegia?

Back 89

Ipsilateral (to the MLF lesion) medial rectus palsy, and nystagmus in the abducting eye (contralateral). Convergence is normal.

Explanation: 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. If the right MLF were lesioned, the right eye would not be able to look left. The left eye would look left but would also show nystagmus.

Front 90

What disorder is associated with internuclear ophthalmoplegia?

Back 90

Multiple Sclerosis. MLF = MS

Front 91

What would be the clinical findings in a person with a lesion in the Left MLF (medial longitudinal fasciculus)?

Back 91

When the patient is asked to look to their right, the right eye will move to the right (showing nystagmus) and the left eye will not look to the right. This is due to loss of innervation of the left medial rectus muscle because of the MLF lesion.

Front 92

Function of astrocytes

Back 92

Support, repair, metabolism, maintaining BBB with foot processes

Front 93

Astrocyte cell marker

Back 93

GFAP

Front 94

Ependymal cells produce what?

Back 94

CSF

Front 95

Also known as the macrophages of the brain

Back 95

Microglia (derived from mesoderm)

Front 96

This cell myelinates the CNS and is destroyed in MS

Back 96

Oligodendroglia (can myelinate up to 30 axons)

Front 97

This cell myelinates the PNS

Back 97

Schwann Cell (myelinates a single axon)

Front 98

Schwannomas typically arise from which CN?

Back 98

CN VIII

Front 99

Dopamine is synthesized in these two locations with in the CNS

Back 99

Ventral tegmentum and SNc

Front 100

What are the three structures of the BBB?

Back 100

Tight junctions, Basement Membrane, and Astrocyte Foot Processes

Front 101

The CTZ and neurohypophysis are two areas where what is absent

Back 101

BBB

Front 102

The functions of the hypothalamus are (HEAL)

Back 102

Homeostasis, Endocrine, Autonomic Control, Limbic/Learning

Front 103

Thirst is stimulated by what nucleus within the hypothalamus

Back 103

Supraoptic - it releases ADH

Front 104

Anterior and Posterior nuclei of the hypothalamus regulate what?

Back 104

Temperature (Ant - cooling when hot, Post - heating when cold)

Front 105

Posterior pituitary releases what two hormones?

Back 105

ADH and Oxytocin

Front 106

The Lateral Geniculate Nucleus of the Thalamus relays what information

Back 106

visual

Front 107

The Medial Geniculate Nucleus of the Thalamus relays what information

Back 107

auditory

Front 108

A lesion in the Ventral Anterior nucleus of the thalamus will cause what?

Back 108

A motor defect

Front 109

Difference between the VPM and VPL nucleus of the thalamus

Back 109

VPL - body sensations, VPM - facial sensation

Front 110

The Famous F's of the limbic system

Back 110

Feeding, Fleeing, Fighting, F***ing

Front 111

Input to the cerebellum is from what fibers?

Back 111

Climbing and Mossy

Front 112

Output of the cerebellum is through which fibers?

Back 112

Purkinje

Front 113

What are the signs of a Lower Motor Neuron (LMN) lesion?

Back 113

Weakness, Atrophy, Fasciculations, Decreased Reflexes, Decreased Tone

Front 114

What are the signs of an Upper Motor Neuron (UMN) lesion?

Back 114

Weakness, Increased Reflexes, Increased Tone, Positive Babinski

Front 115

What is the pathogenesis of Syringomyelia, a bilateral loss of pain and temperature in the upper extemities?

Back 115

Enlargement of the central canal of the spinal cord damages the crossing fibers of the spinothalamic tract

Front 116

Name the disorder: Degeneration of dorsal columns and dorsal roots due to tertiary syphilis, resulting in impaired proprioception and locomotor ataxia

Back 116

Tabes Dorsalis

Front 117

Poliomyelitis destroys which part of the spinal cord?

Back 117

Anterior horns, leading to flaccid paralysis

Front 118

Describe the spinal cord lesions of Multiple Sclerosis

Back 118

Random, asymmetric demyelination of white matter

Front 119

Degeneration of the corticospinal tract and anterior horn cells is seen in which disease of the spinal cord?

Back 119

ALS (Amyotrophic Lateral Sclerosis)

Front 120

Fridreich's Ataxia involves demyelination of which spinal cord tracts?

Back 120

Dorsal columns, Lateral Corticospinal tracts and Spinocerebellar tracts

Front 121

What are the components of Brown-Sequard Syndrome?

Back 121

Hemisection of spinal cord:
1. Ipsilateral UMN signs below lesion
2. Ipsilateral loss of touch, vibration, and proprioception below lesion
3. Contralateral loss of pain and temperature below lesion
4. Ipsilateral loss of all sensation at level of lesion
5. LMN sign at level of lesion

Front 122

What are the 3 components of Horner's Syndrome?

Back 122

Ptosis, Anhidrosis, Miosis

Front 123

Describe Broca's Aphasia

Back 123

Nonfluent aphasia with intact comprehension.
Lesion of Inferior Frontal gyrus

Front 124

Describe Wernicke's aphasia

Back 124

Fluent aphasia with impaired comprehension.
Lesion of Superior Temporal gyrus

Front 125

Damage to the Mammillary bodies is seen in which disorder?

Back 125

Wernicke-Korsakoff Syndrome

Front 126

Signs of Basal Ganglia lesion?

Back 126

Tremor at rest, Chorea or Athetosis

Front 127

Signs of Cerebellar Hemisphere lesion?

Back 127

Intention tremor, limb ataxia

Front 128

Signs of Cerebellar Vermis lesion?

Back 128

Truncal ataxia, dysarthria

Front 129

Signs of Subthalamic Nucleus lesion?

Back 129

Contralateral hemiballismus

Front 130

Describe Conduction Aphasia

Back 130

Poor repitition, good comprehension, fluent speech.
Lesion of Arcuate Fasciculus

Front 131

What is Kluver-Bucy Syndrome?

Back 131

Hyperorality, hypersexuality, disinhibited behavior.
Lesion of Bilateral Amygdala

Front 132

Sign of Reticular activating system lesion?

Back 132

Coma

Front 133

What is Spatial Neglect Syndrome?

Back 133

Right Parietal lobe lesion
Agnosia of the contralateral side of the world

Front 134

Signs of Frontal Lobe lesion?

Back 134

Personality changes, poor judgement, primitive reflexes

Front 135

Name for sudden, jerky, purposeless movements characteristic of basal ganglia lesion

Back 135

Chorea

Front 136

Name for slow, writhing movements of the fingers characteristic of basal ganglia lesions

Back 136

Athetosis

Front 137

Name for sudden, wild flailing of one arm, characteristic of contralateral subthalamic nucleus lesion

Back 137

Hemiballismus

Front 138

Most common D/O causing dimentia in elderly

Back 138

Alzheimer's - most common cause in elderly, multi-infarct - 2nd most common cause

Front 139

Degenerative ds of cerebral cortex

Back 139

Alzheimer's, Pick's, Lewy body dementia, CJD

Front 140

What are the characteristics of Alzheimer's disease

Back 140

diffuse cortical atrophy, senile plaques (extracellular β-amyloid core) and neurofibrillary tangles (intracellular, abnl phosphorylated tau protein

Front 141

Which chromosomal abnl is associated with Alzheimer's ds

Back 141

Down syndrome

Front 142

Characteristics of Pick's ds

Back 142

dementia, aphasia, parkinsonian aspects, PICK BODIES (intracellular, aggregated tau protein)

Front 143

Describe Lewy body dementia

Back 143

parkinsonism with dementia and hallucinations, caused by α-synuclein defect

Front 144

Features of Creutzfelt-Jakob ds (CJD)

Back 144

rapidly progressive dementia with myoclonus, spongiform cortex

Front 145

Findings in CJD

Back 145

prions

Front 146

Degenerative ds of basal ganglia and brain stem

Back 146

Huntington's, Parkinson's

Front 147

Inheritance patern in Huntington's ds

Back 147

AD - triplet repead of CAG

Front 148

Findings in Huntington's ds

Back 148

chorea, dementia, atrophy of caudate nucleus (loss of GABAergic neurons). Enlarged lateral ventricles due to loss of caudate

Front 149

Findings in Parkinson's ds

Back 149

Lewy bodies (α-synuclein) and depigmentation of substantia nigra (loss of dopaminergic neurons)

Front 150

Sx of Parkinson's ds

Back 150

TRAP = Tremor, cogwheel Rigidity, Akinesia, Postural instability

Front 151

Degenerative ds of Spinocerebellar Motor neuron

Back 151

olivopontocerebellar atrophy, Friedreich's ataxia, ALS, Werdnig-Hoffmann ds, Poloi

Front 152

Sx of Amyotrophic lateral sclerosis (ALS)

Back 152

LMN and UMP signs. No sensory deficit

Front 153

Enzyme defect in ALS

Back 153

superoxide dismutase 1 (SOD1)

Front 154

inheritance in Werdnig-Hoffmann ds

Back 154

AR

Front 155

Presentation in Werdnig-Hoffmann ds

Back 155

presents at birth as floppy baby, tongue fasciculations, median age of death 7 months. Degeneration of anterior horns. LMN involvement only

Front 156

Presentation in Polio

Back 156

degeneration of anterior horns. LMN signs

Front 157

infective agent in Poliomyelitis

Back 157

poliovirus --> transmitted by fecal-oral route, replicates in oropharynx and small intestine before speading throught the bloodstream to the CNS --> destroys anterior horn and LMN

Front 158

Sx of Poliomyelitis

Back 158

malaise, headache, fever, nausea, abdominal pain, sore throat. LMN lesions - muscle weakness and atrophy, fasciculations, fibrillation and hyporeflexia

Front 159

Findings in Poliomyelitis

Back 159

CSF with lymphocytic pleocytosis with slight elevation of protein. NO change in CSF glucoase. Virus in stool or throat

Front 160

Demyelinating and dysmyelinating ds

Back 160

MS, Progressive multifocal leukoencephalopathy (PML), acute disseminated encephalomyelitis, metachromatic leukodystrophy, Guillain-Barre syndrome

Front 161

MS findings

Back 161

periventricular plaques (areas of oligodendrocyte loss and reactive gliosis) with preservation of axons. High protein (IgG) in CSF. Relapsing-remitting course. Optic neuritis, MLF, hemiparesis, hemisensory Sx, bladder/bowel incontinence

Front 162

MS triad

Back 162

SIN = Scanning speech, Intention tremor, Incontinence, Internuclear ophtalmoplegia, Nystagmus

Front 163

PML is seen in….

Back 163

associated with JC virus and in 2-4% of AIDS pts

Front 164

inheritance and deficiencyin Metachromatic leukodystrophy

Back 164

AR - lysosomal storage ds; arylsulfatase A deficiency

Front 165

Sx in Guillaine-Barre syndrome

Back 165

inflammation and demyelination of peripheral nerves and motor fibers of ventral roots - sensory effect less severe than motor. Symmetric ascending muscle weakness, facial paralysis, autonomic function severely affected

Front 166

Findings in Guillaine-Barre

Back 166

elevated CSF protein with nl cell ct. Elevated protein --> papilledema

Front 167

Bacteria in Guillaine-Barre

Back 167

autoimmune attack of peripheral myelin due to molecular mimicry with Camphylobacter jejuni or herpesvirus

Front 168

Types of Seizures

Back 168

Partial seizures (simple and complex) and generalized seizures (absence, myoclonic, tonic-clonic, tonic, atonic)

Front 169

describe partial seizures

Back 169

one area of brain.

Front 170

Describe simple partial seizures

Back 170

motor, sensory, autonomic, psychic. CONSCIOUS

Front 171

Describe complex partial seizures

Back 171

Impaired consciousness

Front 172

Describe generalized sizures

Back 172

Diffuse

Front 173

Describe the types of generalized seizures

Back 173

Absence - blank stare, Myoclonic - quick, repetitive jerks, Tonic-clonic - alternating stiffening and movement, Tonic - stiffening, Atonic - drop seizures

Front 174

epidural hematoma - artery responsible, common causes

Back 174

rupture of middle meningeal artery, often secondary to fx of temporal bone.

Front 175

CT findings in epidural vs subdural hematoma

Back 175

epidural - biconvex disk, not crossing suture lines. Subdural - crescent shaped hemorrhage, crosses suture lines

Front 176

Subdural hematoma - vescle responsible, common causes

Back 176

rupture of bridging veins. Venous bleed so less pressure --> delayed oneset. Elderly, alcoholics, blunt trauma, shaken baby

Front 177

subarachnoid hemorrhage - causes, presentation

Back 177

rupture of aneurysm (usually berry or AVM). wort headache of my life bloody or yellow spinal tap

Front 178

parenchymal hematoma - causes

Back 178

HTN, amyloid angiopathy, DM and tumor

Front 179

berry aneurysm - common sites

Back 179

occur at bifurcatons in circle of Willis. Most common site is bifurcation of anterior communicating artery.

Front 180

berry aneurysm - associations

Back 180

adult polycystic kidney ds, Ehlers-Danlos syndrome, Marfan's, advanced age, HTN, smoking, race (blacks)

Front 181

charcot-Bouchard microaneurysms - association

Back 181

chronic HTN; affects small vessels

Front 182

berry aneurysm - rupture

Back 182

most common complication. Leads to hemorrhagic stroke/subarachnoid hemorrhage

Front 183

findings in communicating hydrocephalus

Back 183

enlarged ventricles with nl opening pressure on lumbar puncture

Front 184

triad of communicating hydrocephalus

Back 184

dementia, gait problems, urinary incontinence

Front 185

cause of communicating hydrocephalus

Back 185

impaired absorption of CSF by arachnoid granulations

Front 186

cause of noncommunicating hydrocephalus

Back 186

structural bloackage of CSF circulation within ventricular systems - stenosis of aqueduct of Sylvius

Front 187

Sturge-Weber syndrome - features

Back 187

congenital d/o with port-wine stains and ipsilateral leptomeningeal angioma. Galucoma, seizures, hemiparesis and mental retardation

Front 188

tuberous sclerosis - features

Back 188

hemartomas in CNS, skin, organs, cardiac rhabdomyoma, renal angiomyolipoma, subependymal giant cell astrocytoma, MR, seizures, ash leaf spots, sebaceous adenoma, shagreen patch

Front 189

neurofibromatosis - features

Back 189

café-au-lait spots, lisch nodules, neurofibromas in skin

Front 190

von Hippel-lindau ds - inheritance and features

Back 190

AD - cavernous hemangiomas in skin, mucosa, organs, renal cell carcinoma, hemangioblastoma in retina, brain stem, cerebellum

Front 191

general location of adult and childhood brain tumors

Back 191

adult - supratentorial, childhood - infratentorial

Front 192

adult tumors - peak incidence

Back 192

glioblastoma - most common, meningioma 2nd, schwannoma 3rd

Front 193

glioblastoma - Px, location, Dx

Back 193

Px - grave (< 1yr life expectancy). Location - cerebral hemispheres, can cross corpus callosum = buttefly gleoma. Dx - stain astrocytes for GFAP

Front 194

glioblastoma - features

Back 194

pseudopalisading pleomorphic tumor cells - border central areas of necrosis and hemorrhage

Front 195

meningioma - location, Px

Back 195

convexities of hemispheres and parasagittal region. Arises from arachnoid cells external to brain. Resectable

Front 196

meningioma - features

Back 196

spindle cells concentrically arranged in a whorled pattern. PSAMMOMA bodies

Front 197

schwannoma - location, Px

Back 197

localized to CN VIII --> acoustic schwannoma. Resectable

Front 198

schwannoma - associated with….

Back 198

Neurofibromatosis type 2

Front 199

oligodendroglioma - location

Back 199

frontal lobes

Front 200

oligodendroglioma - features

Back 200

chicken wire capillary pattern. Oligodendrocytes = FRIED EGG cells - round nuclei with clear cytoplasm. Often calcified in oligodendroglioma

Front 201

pituitary adenoma - Sx and most common hormone secreted

Back 201

Prolactin secreting most common form. Bitemporal hemianopia due to pressure on optic chiasm and hyper- or hypopituitarism

Front 202

pituitary adenoma - location

Back 202

Rathke's pouch

Front 203

pilocytic astrocytoma (low grade) - location and Px

Back 203

well circumscribed. Posterior fossa. Px - good, benign

Front 204

pilocytic astrocytoma - features

Back 204

rosenthal fibers - eosinophilic, corkscrew fibers

Front 205

medulloblastoma - Px, location, Sx

Back 205

Px - highly malignant. Radiosensitive. Location - cerebellar tumor Sx - can compress 4th ventricle, causing hydrocephalus

Front 206

medulloblastoma - features

Back 206

rosettes or perivascular pseudorosette pattern of cells.

Front 207

ependymoma - location, Sx, Px

Back 207

location - ependymal cell tumors mostly in 4th ventricle. Sx - hydrocephalis. Px - poor

Front 208

ependymoma - features

Back 208

perivascular pseudorosettes. Rod-shaped blepharoplasts (basal ciliary bodies) found near nucleus

Front 209

hemangioblastoma - location, Sx

Back 209

location - cerebellar. Sx - produce EPO --> secondary polycythemia

Front 210

hemangioblastoma - features

Back 210

foamy cells and high vascularity

Front 211

hemangioblastoma - associated with….

Back 211

von Hippel Lindau syndrome

Front 212

craniopharyngioma - Px, location

Back 212

benign. Most common childhood supratentorial tumor

Front 213

craniopharyngioma - confused with…..

Back 213

pituitary adenoma

Front 214

craniopharyngioma - Sx

Back 214

can cause bitemporal hemianopia

Front 215

craniopharyngioma - derived from and features

Back 215

derived from remnants of Rathke's pouch. Features - calcification is common

Front 216

Arnold-Chiari - findings

Back 216

small posterior fossa, downward displacement of cerebellum, medulla deformity, associated with tonsillar herniation

Front 217

Chiari I - findings

Back 217

low-lying cerebellum obstructs CSF flow and compresses medulla. Cerebellar tonsils descend through foramen magnum. Frequently Asx and correctable with surgery

Front 218

Chiari II - findings

Back 218

cerebellar vermis and medulla descend through foramen magnum. Fatal

Front 219

Dandy-Walker - findings

Back 219

large posterior fossa, absent cerebellum with cyst in its place

Front 220

CN XII lesion

Back 220

tongue deviates toward side of lesion (lick your wounds)

Front 221

CN V motor lesion

Back 221

jaw deviates toward side of lesion

Front 222

unilateral lesion of cerebellum

Back 222

fall toward side of lesion

Front 223

CN X lesion

Back 223

uvula deviates away from side of lesion

Front 224

CN XI lesion

Back 224

weakness turning head to contralateral side of lesion. Shoulder droop on side of lesion

Front 225

UMN facial lesion

Back 225

lesion of motor cortex or connection between cortex and facial nucleus - contralateral paralysis of lower face only. Only lower face affected because upper face has contralateral and ipsilateral innervation by CN VII

Front 226

LMN facial lesion

Back 226

ipsilateral paralysis of upper and lowar face

Front 227

bell's palsy

Back 227

complete destruction of facial nucelus or facial n proper. Peripheral ipsilateral facial paralysis with inability to close eye on involved side.

Front 228

bell's palsy - seen in

Back 228

AIDS, Lyme, Sarcoidosis, Tumors, Diabetes (ALexander BELL with STD)

Front 229

name the 4 types of brian herniations

Back 229

Cingulate (subfalcine), Transtentorial, Uncal and Cerebellar tonsillar herniation into foramen magnum

Front 230

Which structure can get compressed due to a cingulate herniation?

Back 230

Anterior cerebral artery

Front 231

Clinical signs of Uncal herniation

Back 231

ipsilateral dilated pupil (CN III), contralateral homonymous hemianopia (ipsilateral PCA), Ipsilateral paresis (contralateral crus cerebri), Duret hemorrhages (paramedia artery rupture due to caudal displacement of brain stem)

Front 232

Name 5 classes of drugs to treat Glaucoma.

Back 232

alpha agonists, beta blockers, diuretics, cholinomimetics, prostglandins

Front 233

mechanism & side effects of epinephrine to Rx Glaucoma?

Back 233

alpha agonist-decreased aqueous humor synthesis d/t vasoconstriction, SE: mydriasis & stinging, not for closed angle glaucoma

Front 234

mechanism & side effects of brimonidine to Rx Glaucoma?

Back 234

alpha agonist-decreased aqueous humor synthesis, SE: no pupillary or vision changes

Front 235

mechanism & side effects of timolol, betaxolol, carteolol to Rx Glaucoma?

Back 235

beta blocker- decreased aqueous humor SECRETION, SE: no pupillary or vision changes

Front 236

mechanism & side effects of acetazolamide to Rx. Glaucoma?

Back 236

diuretic- decreases aqueous humor secretion d/t decrease HCO3- (via ihib. of carbonic anhydrase), SE: no pupillary or vision changes

Front 237

mechanism & side effects of pilocarpine, carbachol, physostigmine, echothiophate to Rx Glaucoma?

Back 237

cholinomimetics- increase outflow of aqueous humor, contract ciliary muscle muscle and open trabecular meshwork, pilocarpine in emergencies, very effective at opening Canal of Schlemm, SE: miosis, cycloplasm (cycloplegia)

Front 238

mechanism & side effects of latanoprost to Rx Glaucoma?

Back 238

prostaglandins- increase outflow of aqueous humor, SE- darkens color of iris (browning)

Front 239

morphine, fentanyl, codeine, heroin, methadone, meperidine, and dextromethorphan are all-------?

Back 239

opioid analgesiscs

Front 240

mechanism of opioid analgesics? (name specific receptors & drug, name channels affected)

Back 240

agonists at opioid receptors (mu=morphine, delta=enkephalin, kappa=dynorphin), decreased synaptic transmission (opens K+, closes Ca2+)

Front 241

toxicity of opioid analgesics?

Back 241

addiction, RESPIRATORY DEPRESSION, constipation, miosis, additive CNS depression w/ other drugs. No tolerance to miosis & constipation.

Front 242

treating toxicity from opioid analgesics?

Back 242

naloxone or naltrexone (opioid receptor antagonists)

Front 243

name a drug used to treat pain and has less respiratory depression than a full opiod agonist?

Back 243

butorphanol- partial agonist at opioid mu and agonist at kappa receptors

Front 244

what drug is used to treat chronic pain and works on multiple neurotransmitters, side effect?

Back 244

tramadol ( very weak opiod agonist, inhibits seratonin and NE reuptake)

Front 245

side effect of tramadol?

Back 245

decreased seizure threshold

Front 246

increased Na+ channel inactivation, 1st line prophylaxis for status seizures (also simple, complex, tonic clonic-1st line)

Back 246

phenytoin

Front 247

what is the mechanism of benzodiazipines and what are they first line treatment for?

Back 247

Facilitate GABA (a) action by increasing frequency of Cl- channel opening and 1st for acute status seizures

Front 248

a first line treatment of tonic clonic seizures that increases GABA concentration and increases Na+ channel inactivation

Back 248

Valproic acid

Front 249

first line treatment for absence seizures

Back 249

ethosuxamide

Front 250

first line treatment for tonic clonic seizures and only increases Na+ channel inactivaiton?

Back 250

carbamazepine

Front 251

first line treatment of seizures in pregnant women and in children?

Back 251

phenobarbital

Front 252

mechanism of action for lamotrigine?

Back 252

blocks voltage-gated Na+ channels

Front 253

mechanism of action for ethosuximide?

Back 253

blocks thalamic T-type Ca(2+) channels

Front 254

Epilepsy drug with a side effect of Stevens-Johnson syndrome?

Back 254

lamotrigine

Front 255

Epilepsy drug that is contraindicated in pregnancy? Why?

Back 255

Valproic acid- neural tube defects (spina bifida)

Front 256

3 epilepsy drugs that induce cytochrome P-450?

Back 256

carbamazepine, Phenobarbital, Phenytoin

Front 257

Ethosuximide side effects?

Back 257

Fatigue, GI distress, Headaches (EFGH)

Front 258

Mechanism and use of Phenytoin?

Back 258

use-dept. block of Na+ channels, inhib. Glutamate release from presynaptic neurons/ use-tonic-clonic seizures, class IB antiarrhythmic

Front 259

name a benefit of benzodiazepines over barbiturates.

Back 259

less risk of respiratory depression

Front 260

how would your treat an overdose of benzodiazepines?

Back 260

flumazenil (competitive antagonist of GABA receptor)

Front 261

mechanism of action of barbiturates?

Back 261

facilitate GABA(a) action by increasing duration of Cl- channel opening, thus decreasing neuron firing

Front 262

status epilepticus Rx?

Back 262

lorazepam and diazepam

Front 263

in anesthetics, does a drug with high solubility have high or low potency? Give an example.

Back 263

high solubility= high potency and slow induction. Example=halothane

Front 264

what is MAC in anesthetics?

Back 264

the minimum alvelolar concentration at which 50% of the populaiton is anesthetized. Decreases with age.

Front 265

what are the effects of inhaled anesthetics?

Back 265

myocardial depression, respiratory depression, nausea/ emesis, increased cerebral blood flow

Front 266

Name 5 intravenous anesthetics.

Back 266

barbiturates, benzodiazepines, ketamine, opiates, propofol

Front 267

what is thiopental used for?

Back 267

used for induction of anesthesia and short surgical procedures; it reduces cerebral blood flow

Front 268

what is midazolam used for?

Back 268

most common drug used for endoscopy, used adjunctively with gaseous anesthetics and narcotics

Front 269

what is a side effect of midazolam?

Back 269

may cause post-op respiratory depression, decreases BP, and amnesia

Front 270

does ketamine increase cerebral blood flow?

Back 270

increases cerebral blood flow

Front 271

what are some side effects of ketamine?

Back 271

casues disorientation, hallucination, and bad dreams

Front 272

when are opiates used?

Back 272

morphine and fentanyl are used during general anethesia with CNS depressants

Front 273

how does propofol work and when does it use?

Back 273

potentiates GABA(a) and is used for rapid anesthesia induction and short procedures

Front 274

what is an added benefit of propofol over thiopental?

Back 274

less postoperative nausea

Front 275

what is the mechanism of local anesthetics?

Back 275

bocks to Na+ channels by binding to specific receptors on inner portion of channel, most effective in rapidly firing neurons

Front 276

what is the clinical use of local anesthetics?

Back 276

minor surgical procedures, spinal anesthesia

Front 277

what are the two classes of local anesthetics?

Back 277

esters (procaine, cocaine, tetracaine) and amides (lidocaine, mepivacaine, bupivacaine)

Front 278

what is the toxicity behind local anesthetics?

Back 278

CNS excitation, severe cardiovascular toxicity (bupivacaine), hypertension, hypotension, & arrhythmias (cocaine)

Front 279

what are the main uses of neuromuscular blocking drugs?

Back 279

they are used for muscle paralysis in surgery or in mechanical ventilation. They are selective for motor nicotinic receptors

Front 280

what is an example of a depolarizing neuromuscular blocking drug?

Back 280

succinylcholine w/ complications of hypercalcemia and hyperkalemia

Front 281

how would you reverse the blockade of neuromuscular blocking drugs?

Back 281

during phase I- no antidote. Block potentiated by cholinesterase inhibitors, phase II- antidote is cholinesterase inhibitors like neostigmine

Front 282

give an example of a nondepolarizing neuromuscular blocking drug and how you would reverse the block.

Back 282

atracurium is an example of a nondepolarizing NM blocking drug. It works by competing with Ach for receptors. The block is reversed by neostigmine, edrophonium, and other cholinesterase inhibitors.

Front 283

name a drug used in the treatment of malignant hyperthermia.

Back 283

Dantrolene

Front 284

name the mechanism of a drug used to treat neuroleptic malignant syndrome.

Back 284

a drug like dantrolene- prevents the release of Ca2+ from the sarcoplasmic reticulum of skeletal muscle

Front 285

Parkinson's is due to the loss of what kind of neurons?

Back 285

Due to the loss of dopamingergic neurons and excess cholingeric activity

Front 286

what is the mechanism of bromocriptine?

Back 286

it antagonizes dopamine receptors

Front 287

name a drug used in the treatment of Parkinson's and Influenza A and rubella.

Back 287

Amantadine

Front 288

how does Amatadine work to treat Parkinson's?

Back 288

it increases dopamine release

Front 289

name another drug that increases the amount of dopamine.

Back 289

L-dopa/ carbidopa

Front 290

Name a drug used to prevent dopamine breakdown. Name the mechanism.

Back 290

Selegiline- a selective MAO type B inhibitor

Front 291

how does benztropine help treat Parkinson's disease?

Back 291

Benztropine is an antimuscarinic that improves tremor and rigidity, but has little effect on bradykinesia

Front 292

Name the mechanism of use of Memantine and Donepezil?

Back 292

Memantine is an NMDA receptor antagonist, and Donepezil is an Acetylcholinesterase inhibitor--both used to Rx Alzheimer's

Front 293

Name a use of Sumatriptan. Name the mechanism.

Back 293

Sumatriptan is a 5HT(1B/1D) agonist. It causes vasoconstriction, inhibition of trigeminal activation and vasoactive peptide release. USE--Acute Migraine, cluster headache attacks.

Front 294

What is a potential toxicity associated with Selegiline?

Back 294

It may enhance the adverse effects of L-dopa.

Front 295

Name the toxicity associated with L-dopa. A long-term side effect?

Back 295

Arrhythmias from peripheral conversion to dopamine. Dyskinesia from long-term use after administration. Akinesia between doses.

Front 296

What can be given with L-dopa to increase bioavailability?

Back 296

Carbidopa, a peripheral decarboxylase inhibitor, increases bioavailabiilty of L-dopa in the brain and limits peripheral SE.