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296 Cards in this Set
- Front
- Back
Where is the C2 dermatome?
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posterior half of a shull cap
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Where is the C3 dermatome?
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high turtleneck shirt
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Where is the C4 dermatome?
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low-collar shirt
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Where is the T4 dermatome?
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nipple; T4 at the teat pore
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Where is the T10 dermatome?
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at the umbilicus (important for early appendicitus pain referal); T10 at the belly butTEN
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Where is the L1 dermatome?
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inguinal ligament; L1 is IL (Inguinal Ligament)
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Where is the L4 dermatome?
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includes kneecaps; Down on L4s (all fours)
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What do the S2, S3, S4 dermatomes do?
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erection and sensation of penile and anal zones; S2, 3, 4, keeps the penis off the floor
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What is the function of the msucle spindle?
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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
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What is the function of the Golgi Tendon?
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monitor muscle tension (make you drop a heavy suitcase you've been holding too long)
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What is the purpose of the gammal loop in muscle control?
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CNS stimulates gamma neuron -> contracts intrafusal fiber -> increase sensitivity of reflex arc
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Biceps reflex
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C5 nerve root
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Triceps reflex
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C7 nerve root
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Patella reflex
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L4 nerve root
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Achiles reflex
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S1 nere root
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What is the Babinski reflex?
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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
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What is the moro reflex?
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extension of limbs when startled (primitive reflex) normall disappear within 1st year. May reemerge following frontal lobe lesion
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What is the rooting reflex?
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nipple seeking (primitive reflex) normall disappear within 1st year. May reemerge following frontal lobe lesion
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what is the palmar reflex?
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grasps objects in palm (primitive reflex) normall disappear within 1st year. May reemerge following frontal lobe lesion
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Brain stem-ventral view
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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
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Which CNs lie medially at the brain stem?
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CN III, VI, XII; 3(X2) = 6(x2)=12
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Brain stem- dorsal view (cerebellum removed)
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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)
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What is the function of the pineal gland?
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melatonin secretion, circadian rhythms
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What is the function of the superior colliculi?
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conjugate vertical gaze center
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What is the function of the inferior colliculi?
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Auditory
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What is the Parnaud syndrome?
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Paralysis of conjugate vertical gaze due to leion in superior colliculi (e.g. pinealoma)
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Olfactory nerve
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CN I, Smell (only CN without thalamic relay to cortex), Sensory
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Optic nerve
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CN II, sight, sensory
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Oculomotr nerve
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CN III, Eye movement, pupil constriction, accommodation, eyelid opening (levator palpebrae) motor
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Trochlear nerve
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CN IV, eye movement, motor
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Trigeminal nerve
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CN V, mastication, facial sensation, both sensory and motor
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Abducens nerve
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CN VI, eye movement, motor
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Facial nerve
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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
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Vetibulocochlear nerve
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CN VIII, hearing and balance, sensory
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Glossopharyngeal nerve
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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
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Vagus nerve
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CN X, taste from epiglottic region, swallowing, palate elevation, talking, coughing, thoracoabdominal viscera, monitoring aortic arch chemo- and baroreceptors, both sensory and motor
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Accesory nerve
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CN XI, head turning, shoulder shrugging, motor
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Hypoglossal nerve
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CN XII, tongue movement, motor
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Menmonic for cranial nerves
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Some Say Marry Money But My Brother Says Big Brains Matter Most
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What does the nucleus solitarius do?
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Visceral sensory information (e.g. taste, baroreceptors, gut distention). CN VII, IX, X
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What is the function of the nucleus ambiguus?
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Motor innervation of pharynx, larynx, and upper esophagus (e.g. swallowing, palate elevation). CN IX, X, XI
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What does the dorsal motor nucleus do?
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Sends autonomic (parasympathetic) fibers to heart, lungs, and upper GI
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What is the pathway in the skull for CN I?
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Cribriform plate
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What travels through the optic canal?
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CN II, ophthalmic artery, central retinal vein (middle cranial fossa, sphenoid bone)
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What travels through the superior orbital fissure?
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CN III, IV, V1, VI, and the ophthalmic vein (middle cranial fossa, sphenoid bone)
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What travels through the foramen rotundum?
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CN V2 (middle cranial fossa, sphenoid bone)
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What travels through the foramen ovale?
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CN V3 (middle cranial fossa, sphenoid bone)
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What travels through the foramen spinosum?
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middle meningeal artery (middle cranial fossa, sphenoid bone)
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What travels through the internal auditory meatus?
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CN VII, VIII (posterior cranial fossa through the temporal or occipital bone)
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What travels through the jugular foramen?
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CN IX, X, XI, jugular vein (posterior cranial fossa through the temporal or occipital bone)
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What travels through the hypoglossal canal?
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CN XII (posterior cranial fossa through the temporal or occipital bone)
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What travels through the fromaen magnum?
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Spinal roots of CN XI, brain stem, verterbral arteries (posterior cranial fossa through the temporal or occipital bone)
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What is the cavernous sinus?
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A collection of venous sinuses on either side of the pituitary. Blood from the eye and superficial cortex -> cavernous sinus -> internal jugular vein.
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What passes through the cavernous sinus?
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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.
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What is cavernous sinus syndrome?
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ophthalmoplegia, ophthalmic and maxillary sensory loss (due to mass effect)
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Primary ion in perilymph of inner ear?
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Na+ (similar to ECF)
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Primary ion in endolymph of inner ear?
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K+
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Structure that produces endolymph in inner ear?
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stria vascularis
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Regarding the inner ear, where are maculae located and what is their function?
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Utricle and saccule, detect linear acceleration
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Regarding the inner ear, where are ampullae located and what is their function?
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Semicircular canals, detect angular acceleration
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Hair cells of inner ear project from what structure?
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organ of Corti
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What are the Rinne/Weber results in conductive hearing loss?
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negative Rinne (bone conduction > air conduction); Weber localizes to affected ear
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What are the Rinne/Weber results in sensorineural hearing loss?
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positive Rinne (air conduction > bone conduction); Weber localizes to normal ear
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Damage to apex of cochlear membrane would affect which sounds?
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low frequency - apex is wide & flexible
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Elderly have trouble hearing which type of sounds earliest, and which end of cochlear membrane does this represent?
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high frequency lost first, base of cochlear membrane (narrow & stiff)
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In posterior portion of eye, what layer is just within the sclera?
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choroid
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What extraocular muscles are innervated by each cranial nerve?
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LR6SO4R3: VI innervates lateral rectus, IV innervates superior oblique, III innervates rest (SR, IR, MR, IO, levator palpebrae superioris)
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Eye presenting with damaged CN III?
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Down and out (innervates SR, IR, MR, IO, levator palpebrae superioris, only LR and SO left)
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Eye presenting with damaged CN IV?
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Diplopia with defective downward gaze (innervates SO)
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Eye presenting with damaged CN VI?
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Medially directed (innervates LR)
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Which extraocular muscle abducts, intorts, and depresses, and what is it innervated by?
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Superior oblique, CN IV
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Describe the pupillary light reflex (what are the 3 major synapses, what is the result?)
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Light in either retina signals via CN II to pretectal nuclei => activate bilateral Edinger-Westphal nuclei => ciliary ganglia => pupils contract bilaterally (consensual reflex)
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What is the Marcus Gunn phenomenon, how is it tested, what might cause it?
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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
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What action and cranial nerve are tested by saying aloud: Kuh-kuh-kuh?
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Palate elevation, CN X - vagus
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What muscle and cranial nerve are tested by saying aloud: la-la-la?
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Tongue, CN XII-hypoglossal
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What cranial nerve is tested by saying aloud: mi-mi-mi?
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CN VII-facial, tests lips
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Which muscles of mastication close the jaw?
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Masseter, teMporalis, Medial pterygoid
M's Munch |
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Which muscles of mastication open the jaw?
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Lateral Pterygoid
Lateral Lowers |
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which cranial nerve innervates the muscles of mastication?
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CN V-Trigeminal (V3)
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Which muscle with the root glossus is NOT innervated by the hypoglossal nerve? What CN is it innervated by?
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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. |
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Which muscle with the root palat in its name is NOT innervated by the vagus nerve? Which CN is it innervated by?
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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. |
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What is the location of, and sensation associated with, Free nerve endings?
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Location: All skin and some viscera
Senses: Pain and Temperature |
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What type of fibers make up free nerve endings?
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C, and Aδ fibers
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What is the location of, and sensation associated with, Meissner's Corpuscles?
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Location: Glabrous (hairless) skin, and 40% of fingertip receptors
Senses: Dynamic fine touch (e.g. manipulation) |
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What is the location of, and sensation associated with, Pacinian corpuscles?
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Location: Deep skin layers, ligaments, joints, and 15% of fingertip receptors
Senses: Vibration |
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What is the location of, and sensation associated with, Merkel's disks?
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Location: Hair follicles, and 25% of fingertip receptors
Senses: Static touch (e.g. shapes, edges, textures) |
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Which sensory corpuscle is cup-shaped?
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Merkel's disks
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Internuclear ophthalmoplegia is characterized by a lesion in what location?
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Lesion in the medial longitudinal fasciculus (MLF) Also called MLF syndrome.
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What findings are characteristic in Internuclear Ophthalmoplegia?
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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. |
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What disorder is associated with internuclear ophthalmoplegia?
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Multiple Sclerosis. MLF = MS
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What would be the clinical findings in a person with a lesion in the Left MLF (medial longitudinal fasciculus)?
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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.
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Function of astrocytes
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Support, repair, metabolism, maintaining BBB with foot processes
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Astrocyte cell marker
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GFAP
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Ependymal cells produce what?
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CSF
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Also known as the macrophages of the brain
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Microglia (derived from mesoderm)
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This cell myelinates the CNS and is destroyed in MS
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Oligodendroglia (can myelinate up to 30 axons)
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This cell myelinates the PNS
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Schwann Cell (myelinates a single axon)
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Schwannomas typically arise from which CN?
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CN VIII
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Dopamine is synthesized in these two locations with in the CNS
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Ventral tegmentum and SNc
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What are the three structures of the BBB?
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Tight junctions, Basement Membrane, and Astrocyte Foot Processes
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The CTZ and neurohypophysis are two areas where what is absent
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BBB
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The functions of the hypothalamus are (HEAL)
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Homeostasis, Endocrine, Autonomic Control, Limbic/Learning
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Thirst is stimulated by what nucleus within the hypothalamus
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Supraoptic - it releases ADH
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Anterior and Posterior nuclei of the hypothalamus regulate what?
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Temperature (Ant - cooling when hot, Post - heating when cold)
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Posterior pituitary releases what two hormones?
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ADH and Oxytocin
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The Lateral Geniculate Nucleus of the Thalamus relays what information
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visual
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The Medial Geniculate Nucleus of the Thalamus relays what information
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auditory
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A lesion in the Ventral Anterior nucleus of the thalamus will cause what?
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A motor defect
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Difference between the VPM and VPL nucleus of the thalamus
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VPL - body sensations, VPM - facial sensation
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The Famous F's of the limbic system
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Feeding, Fleeing, Fighting, F***ing
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Input to the cerebellum is from what fibers?
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Climbing and Mossy
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Output of the cerebellum is through which fibers?
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Purkinje
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What are the signs of a Lower Motor Neuron (LMN) lesion?
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Weakness, Atrophy, Fasciculations, Decreased Reflexes, Decreased Tone
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What are the signs of an Upper Motor Neuron (UMN) lesion?
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Weakness, Increased Reflexes, Increased Tone, Positive Babinski
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What is the pathogenesis of Syringomyelia, a bilateral loss of pain and temperature in the upper extemities?
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Enlargement of the central canal of the spinal cord damages the crossing fibers of the spinothalamic tract
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Name the disorder: Degeneration of dorsal columns and dorsal roots due to tertiary syphilis, resulting in impaired proprioception and locomotor ataxia
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Tabes Dorsalis
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Poliomyelitis destroys which part of the spinal cord?
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Anterior horns, leading to flaccid paralysis
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Describe the spinal cord lesions of Multiple Sclerosis
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Random, asymmetric demyelination of white matter
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Degeneration of the corticospinal tract and anterior horn cells is seen in which disease of the spinal cord?
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ALS (Amyotrophic Lateral Sclerosis)
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Fridreich's Ataxia involves demyelination of which spinal cord tracts?
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Dorsal columns, Lateral Corticospinal tracts and Spinocerebellar tracts
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What are the components of Brown-Sequard Syndrome?
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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 |
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What are the 3 components of Horner's Syndrome?
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Ptosis, Anhidrosis, Miosis
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Describe Broca's Aphasia
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Nonfluent aphasia with intact comprehension.
Lesion of Inferior Frontal gyrus |
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Describe Wernicke's aphasia
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Fluent aphasia with impaired comprehension.
Lesion of Superior Temporal gyrus |
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Damage to the Mammillary bodies is seen in which disorder?
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Wernicke-Korsakoff Syndrome
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Signs of Basal Ganglia lesion?
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Tremor at rest, Chorea or Athetosis
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Signs of Cerebellar Hemisphere lesion?
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Intention tremor, limb ataxia
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Signs of Cerebellar Vermis lesion?
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Truncal ataxia, dysarthria
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Signs of Subthalamic Nucleus lesion?
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Contralateral hemiballismus
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Describe Conduction Aphasia
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Poor repitition, good comprehension, fluent speech.
Lesion of Arcuate Fasciculus |
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What is Kluver-Bucy Syndrome?
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Hyperorality, hypersexuality, disinhibited behavior.
Lesion of Bilateral Amygdala |
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Sign of Reticular activating system lesion?
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Coma
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What is Spatial Neglect Syndrome?
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Right Parietal lobe lesion
Agnosia of the contralateral side of the world |
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Signs of Frontal Lobe lesion?
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Personality changes, poor judgement, primitive reflexes
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Name for sudden, jerky, purposeless movements characteristic of basal ganglia lesion
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Chorea
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Name for slow, writhing movements of the fingers characteristic of basal ganglia lesions
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Athetosis
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Name for sudden, wild flailing of one arm, characteristic of contralateral subthalamic nucleus lesion
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Hemiballismus
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Most common D/O causing dimentia in elderly
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Alzheimer's - most common cause in elderly, multi-infarct - 2nd most common cause
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Degenerative ds of cerebral cortex
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Alzheimer's, Pick's, Lewy body dementia, CJD
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What are the characteristics of Alzheimer's disease
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diffuse cortical atrophy, senile plaques (extracellular β-amyloid core) and neurofibrillary tangles (intracellular, abnl phosphorylated tau protein
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Which chromosomal abnl is associated with Alzheimer's ds
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Down syndrome
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Characteristics of Pick's ds
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dementia, aphasia, parkinsonian aspects, PICK BODIES (intracellular, aggregated tau protein)
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Describe Lewy body dementia
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parkinsonism with dementia and hallucinations, caused by α-synuclein defect
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Features of Creutzfelt-Jakob ds (CJD)
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rapidly progressive dementia with myoclonus, spongiform cortex
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Findings in CJD
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prions
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Degenerative ds of basal ganglia and brain stem
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Huntington's, Parkinson's
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Inheritance patern in Huntington's ds
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AD - triplet repead of CAG
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Findings in Huntington's ds
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chorea, dementia, atrophy of caudate nucleus (loss of GABAergic neurons). Enlarged lateral ventricles due to loss of caudate
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Findings in Parkinson's ds
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Lewy bodies (α-synuclein) and depigmentation of substantia nigra (loss of dopaminergic neurons)
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Sx of Parkinson's ds
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TRAP = Tremor, cogwheel Rigidity, Akinesia, Postural instability
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Degenerative ds of Spinocerebellar Motor neuron
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olivopontocerebellar atrophy, Friedreich's ataxia, ALS, Werdnig-Hoffmann ds, Poloi
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Sx of Amyotrophic lateral sclerosis (ALS)
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LMN and UMP signs. No sensory deficit
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Enzyme defect in ALS
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superoxide dismutase 1 (SOD1)
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inheritance in Werdnig-Hoffmann ds
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AR
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Presentation in Werdnig-Hoffmann ds
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presents at birth as floppy baby, tongue fasciculations, median age of death 7 months. Degeneration of anterior horns. LMN involvement only
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Presentation in Polio
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degeneration of anterior horns. LMN signs
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infective agent in Poliomyelitis
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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
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Sx of Poliomyelitis
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malaise, headache, fever, nausea, abdominal pain, sore throat. LMN lesions - muscle weakness and atrophy, fasciculations, fibrillation and hyporeflexia
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Findings in Poliomyelitis
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CSF with lymphocytic pleocytosis with slight elevation of protein. NO change in CSF glucoase. Virus in stool or throat
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Demyelinating and dysmyelinating ds
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MS, Progressive multifocal leukoencephalopathy (PML), acute disseminated encephalomyelitis, metachromatic leukodystrophy, Guillain-Barre syndrome
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MS findings
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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
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MS triad
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SIN = Scanning speech, Intention tremor, Incontinence, Internuclear ophtalmoplegia, Nystagmus
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PML is seen in….
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associated with JC virus and in 2-4% of AIDS pts
|
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inheritance and deficiencyin Metachromatic leukodystrophy
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AR - lysosomal storage ds; arylsulfatase A deficiency
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Sx in Guillaine-Barre syndrome
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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
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Findings in Guillaine-Barre
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elevated CSF protein with nl cell ct. Elevated protein --> papilledema
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Bacteria in Guillaine-Barre
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autoimmune attack of peripheral myelin due to molecular mimicry with Camphylobacter jejuni or herpesvirus
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Types of Seizures
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Partial seizures (simple and complex) and generalized seizures (absence, myoclonic, tonic-clonic, tonic, atonic)
|
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describe partial seizures
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one area of brain.
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Describe simple partial seizures
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motor, sensory, autonomic, psychic. CONSCIOUS
|
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Describe complex partial seizures
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Impaired consciousness
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Describe generalized sizures
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Diffuse
|
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Describe the types of generalized seizures
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Absence - blank stare, Myoclonic - quick, repetitive jerks, Tonic-clonic - alternating stiffening and movement, Tonic - stiffening, Atonic - drop seizures
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epidural hematoma - artery responsible, common causes
|
rupture of middle meningeal artery, often secondary to fx of temporal bone.
|
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CT findings in epidural vs subdural hematoma
|
epidural - biconvex disk, not crossing suture lines. Subdural - crescent shaped hemorrhage, crosses suture lines
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Subdural hematoma - vescle responsible, common causes
|
rupture of bridging veins. Venous bleed so less pressure --> delayed oneset. Elderly, alcoholics, blunt trauma, shaken baby
|
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subarachnoid hemorrhage - causes, presentation
|
rupture of aneurysm (usually berry or AVM). wort headache of my life bloody or yellow spinal tap
|
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parenchymal hematoma - causes
|
HTN, amyloid angiopathy, DM and tumor
|
|
berry aneurysm - common sites
|
occur at bifurcatons in circle of Willis. Most common site is bifurcation of anterior communicating artery.
|
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berry aneurysm - associations
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adult polycystic kidney ds, Ehlers-Danlos syndrome, Marfan's, advanced age, HTN, smoking, race (blacks)
|
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charcot-Bouchard microaneurysms - association
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chronic HTN; affects small vessels
|
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berry aneurysm - rupture
|
most common complication. Leads to hemorrhagic stroke/subarachnoid hemorrhage
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findings in communicating hydrocephalus
|
enlarged ventricles with nl opening pressure on lumbar puncture
|
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triad of communicating hydrocephalus
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dementia, gait problems, urinary incontinence
|
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cause of communicating hydrocephalus
|
impaired absorption of CSF by arachnoid granulations
|
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cause of noncommunicating hydrocephalus
|
structural bloackage of CSF circulation within ventricular systems - stenosis of aqueduct of Sylvius
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Sturge-Weber syndrome - features
|
congenital d/o with port-wine stains and ipsilateral leptomeningeal angioma. Galucoma, seizures, hemiparesis and mental retardation
|
|
tuberous sclerosis - features
|
hemartomas in CNS, skin, organs, cardiac rhabdomyoma, renal angiomyolipoma, subependymal giant cell astrocytoma, MR, seizures, ash leaf spots, sebaceous adenoma, shagreen patch
|
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neurofibromatosis - features
|
café-au-lait spots, lisch nodules, neurofibromas in skin
|
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von Hippel-lindau ds - inheritance and features
|
AD - cavernous hemangiomas in skin, mucosa, organs, renal cell carcinoma, hemangioblastoma in retina, brain stem, cerebellum
|
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general location of adult and childhood brain tumors
|
adult - supratentorial, childhood - infratentorial
|
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adult tumors - peak incidence
|
glioblastoma - most common, meningioma 2nd, schwannoma 3rd
|
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glioblastoma - Px, location, Dx
|
Px - grave (< 1yr life expectancy). Location - cerebral hemispheres, can cross corpus callosum = buttefly gleoma. Dx - stain astrocytes for GFAP
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glioblastoma - features
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pseudopalisading pleomorphic tumor cells - border central areas of necrosis and hemorrhage
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meningioma - location, Px
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convexities of hemispheres and parasagittal region. Arises from arachnoid cells external to brain. Resectable
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meningioma - features
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spindle cells concentrically arranged in a whorled pattern. PSAMMOMA bodies
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schwannoma - location, Px
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localized to CN VIII --> acoustic schwannoma. Resectable
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schwannoma - associated with….
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Neurofibromatosis type 2
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oligodendroglioma - location
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frontal lobes
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oligodendroglioma - features
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chicken wire capillary pattern. Oligodendrocytes = FRIED EGG cells - round nuclei with clear cytoplasm. Often calcified in oligodendroglioma
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pituitary adenoma - Sx and most common hormone secreted
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Prolactin secreting most common form. Bitemporal hemianopia due to pressure on optic chiasm and hyper- or hypopituitarism
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pituitary adenoma - location
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Rathke's pouch
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pilocytic astrocytoma (low grade) - location and Px
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well circumscribed. Posterior fossa. Px - good, benign
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pilocytic astrocytoma - features
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rosenthal fibers - eosinophilic, corkscrew fibers
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medulloblastoma - Px, location, Sx
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Px - highly malignant. Radiosensitive. Location - cerebellar tumor Sx - can compress 4th ventricle, causing hydrocephalus
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medulloblastoma - features
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rosettes or perivascular pseudorosette pattern of cells.
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ependymoma - location, Sx, Px
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location - ependymal cell tumors mostly in 4th ventricle. Sx - hydrocephalis. Px - poor
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ependymoma - features
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perivascular pseudorosettes. Rod-shaped blepharoplasts (basal ciliary bodies) found near nucleus
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hemangioblastoma - location, Sx
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location - cerebellar. Sx - produce EPO --> secondary polycythemia
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hemangioblastoma - features
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foamy cells and high vascularity
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hemangioblastoma - associated with….
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von Hippel Lindau syndrome
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craniopharyngioma - Px, location
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benign. Most common childhood supratentorial tumor
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craniopharyngioma - confused with…..
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pituitary adenoma
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craniopharyngioma - Sx
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can cause bitemporal hemianopia
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craniopharyngioma - derived from and features
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derived from remnants of Rathke's pouch. Features - calcification is common
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Arnold-Chiari - findings
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small posterior fossa, downward displacement of cerebellum, medulla deformity, associated with tonsillar herniation
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Chiari I - findings
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low-lying cerebellum obstructs CSF flow and compresses medulla. Cerebellar tonsils descend through foramen magnum. Frequently Asx and correctable with surgery
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Chiari II - findings
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cerebellar vermis and medulla descend through foramen magnum. Fatal
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Dandy-Walker - findings
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large posterior fossa, absent cerebellum with cyst in its place
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CN XII lesion
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tongue deviates toward side of lesion (lick your wounds)
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CN V motor lesion
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jaw deviates toward side of lesion
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unilateral lesion of cerebellum
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fall toward side of lesion
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CN X lesion
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uvula deviates away from side of lesion
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CN XI lesion
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weakness turning head to contralateral side of lesion. Shoulder droop on side of lesion
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UMN facial lesion
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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
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LMN facial lesion
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ipsilateral paralysis of upper and lowar face
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bell's palsy
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complete destruction of facial nucelus or facial n proper. Peripheral ipsilateral facial paralysis with inability to close eye on involved side.
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bell's palsy - seen in
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AIDS, Lyme, Sarcoidosis, Tumors, Diabetes (ALexander BELL with STD)
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name the 4 types of brian herniations
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Cingulate (subfalcine), Transtentorial, Uncal and Cerebellar tonsillar herniation into foramen magnum
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Which structure can get compressed due to a cingulate herniation?
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Anterior cerebral artery
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Clinical signs of Uncal herniation
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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)
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Name 5 classes of drugs to treat Glaucoma.
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alpha agonists, beta blockers, diuretics, cholinomimetics, prostglandins
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mechanism & side effects of epinephrine to Rx Glaucoma?
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alpha agonist-decreased aqueous humor synthesis d/t vasoconstriction, SE: mydriasis & stinging, not for closed angle glaucoma
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mechanism & side effects of brimonidine to Rx Glaucoma?
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alpha agonist-decreased aqueous humor synthesis, SE: no pupillary or vision changes
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mechanism & side effects of timolol, betaxolol, carteolol to Rx Glaucoma?
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beta blocker- decreased aqueous humor SECRETION, SE: no pupillary or vision changes
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mechanism & side effects of acetazolamide to Rx. Glaucoma?
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diuretic- decreases aqueous humor secretion d/t decrease HCO3- (via ihib. of carbonic anhydrase), SE: no pupillary or vision changes
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mechanism & side effects of pilocarpine, carbachol, physostigmine, echothiophate to Rx Glaucoma?
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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)
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mechanism & side effects of latanoprost to Rx Glaucoma?
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prostaglandins- increase outflow of aqueous humor, SE- darkens color of iris (browning)
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morphine, fentanyl, codeine, heroin, methadone, meperidine, and dextromethorphan are all-------?
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opioid analgesiscs
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mechanism of opioid analgesics? (name specific receptors & drug, name channels affected)
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agonists at opioid receptors (mu=morphine, delta=enkephalin, kappa=dynorphin), decreased synaptic transmission (opens K+, closes Ca2+)
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toxicity of opioid analgesics?
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addiction, RESPIRATORY DEPRESSION, constipation, miosis, additive CNS depression w/ other drugs. No tolerance to miosis & constipation.
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treating toxicity from opioid analgesics?
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naloxone or naltrexone (opioid receptor antagonists)
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name a drug used to treat pain and has less respiratory depression than a full opiod agonist?
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butorphanol- partial agonist at opioid mu and agonist at kappa receptors
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what drug is used to treat chronic pain and works on multiple neurotransmitters, side effect?
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tramadol ( very weak opiod agonist, inhibits seratonin and NE reuptake)
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side effect of tramadol?
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decreased seizure threshold
|
|
increased Na+ channel inactivation, 1st line prophylaxis for status seizures (also simple, complex, tonic clonic-1st line)
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phenytoin
|
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what is the mechanism of benzodiazipines and what are they first line treatment for?
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Facilitate GABA (a) action by increasing frequency of Cl- channel opening and 1st for acute status seizures
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a first line treatment of tonic clonic seizures that increases GABA concentration and increases Na+ channel inactivation
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Valproic acid
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first line treatment for absence seizures
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ethosuxamide
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first line treatment for tonic clonic seizures and only increases Na+ channel inactivaiton?
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carbamazepine
|
|
first line treatment of seizures in pregnant women and in children?
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phenobarbital
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|
mechanism of action for lamotrigine?
|
blocks voltage-gated Na+ channels
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|
mechanism of action for ethosuximide?
|
blocks thalamic T-type Ca(2+) channels
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|
Epilepsy drug with a side effect of Stevens-Johnson syndrome?
|
lamotrigine
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Epilepsy drug that is contraindicated in pregnancy? Why?
|
Valproic acid- neural tube defects (spina bifida)
|
|
3 epilepsy drugs that induce cytochrome P-450?
|
carbamazepine, Phenobarbital, Phenytoin
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|
Ethosuximide side effects?
|
Fatigue, GI distress, Headaches (EFGH)
|
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Mechanism and use of Phenytoin?
|
use-dept. block of Na+ channels, inhib. Glutamate release from presynaptic neurons/ use-tonic-clonic seizures, class IB antiarrhythmic
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name a benefit of benzodiazepines over barbiturates.
|
less risk of respiratory depression
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how would your treat an overdose of benzodiazepines?
|
flumazenil (competitive antagonist of GABA receptor)
|
|
mechanism of action of barbiturates?
|
facilitate GABA(a) action by increasing duration of Cl- channel opening, thus decreasing neuron firing
|
|
status epilepticus Rx?
|
lorazepam and diazepam
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|
in anesthetics, does a drug with high solubility have high or low potency? Give an example.
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high solubility= high potency and slow induction. Example=halothane
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|
what is MAC in anesthetics?
|
the minimum alvelolar concentration at which 50% of the populaiton is anesthetized. Decreases with age.
|
|
what are the effects of inhaled anesthetics?
|
myocardial depression, respiratory depression, nausea/ emesis, increased cerebral blood flow
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|
Name 5 intravenous anesthetics.
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barbiturates, benzodiazepines, ketamine, opiates, propofol
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|
what is thiopental used for?
|
used for induction of anesthesia and short surgical procedures; it reduces cerebral blood flow
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|
what is midazolam used for?
|
most common drug used for endoscopy, used adjunctively with gaseous anesthetics and narcotics
|
|
what is a side effect of midazolam?
|
may cause post-op respiratory depression, decreases BP, and amnesia
|
|
does ketamine increase cerebral blood flow?
|
increases cerebral blood flow
|
|
what are some side effects of ketamine?
|
casues disorientation, hallucination, and bad dreams
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|
when are opiates used?
|
morphine and fentanyl are used during general anethesia with CNS depressants
|
|
how does propofol work and when does it use?
|
potentiates GABA(a) and is used for rapid anesthesia induction and short procedures
|
|
what is an added benefit of propofol over thiopental?
|
less postoperative nausea
|
|
what is the mechanism of local anesthetics?
|
bocks to Na+ channels by binding to specific receptors on inner portion of channel, most effective in rapidly firing neurons
|
|
what is the clinical use of local anesthetics?
|
minor surgical procedures, spinal anesthesia
|
|
what are the two classes of local anesthetics?
|
esters (procaine, cocaine, tetracaine) and amides (lidocaine, mepivacaine, bupivacaine)
|
|
what is the toxicity behind local anesthetics?
|
CNS excitation, severe cardiovascular toxicity (bupivacaine), hypertension, hypotension, & arrhythmias (cocaine)
|
|
what are the main uses of neuromuscular blocking drugs?
|
they are used for muscle paralysis in surgery or in mechanical ventilation. They are selective for motor nicotinic receptors
|
|
what is an example of a depolarizing neuromuscular blocking drug?
|
succinylcholine w/ complications of hypercalcemia and hyperkalemia
|
|
how would you reverse the blockade of neuromuscular blocking drugs?
|
during phase I- no antidote. Block potentiated by cholinesterase inhibitors, phase II- antidote is cholinesterase inhibitors like neostigmine
|
|
give an example of a nondepolarizing neuromuscular blocking drug and how you would reverse the block.
|
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.
|
|
name a drug used in the treatment of malignant hyperthermia.
|
Dantrolene
|
|
name the mechanism of a drug used to treat neuroleptic malignant syndrome.
|
a drug like dantrolene- prevents the release of Ca2+ from the sarcoplasmic reticulum of skeletal muscle
|
|
Parkinson's is due to the loss of what kind of neurons?
|
Due to the loss of dopamingergic neurons and excess cholingeric activity
|
|
what is the mechanism of bromocriptine?
|
it antagonizes dopamine receptors
|
|
name a drug used in the treatment of Parkinson's and Influenza A and rubella.
|
Amantadine
|
|
how does Amatadine work to treat Parkinson's?
|
it increases dopamine release
|
|
name another drug that increases the amount of dopamine.
|
L-dopa/ carbidopa
|
|
Name a drug used to prevent dopamine breakdown. Name the mechanism.
|
Selegiline- a selective MAO type B inhibitor
|
|
how does benztropine help treat Parkinson's disease?
|
Benztropine is an antimuscarinic that improves tremor and rigidity, but has little effect on bradykinesia
|
|
Name the mechanism of use of Memantine and Donepezil?
|
Memantine is an NMDA receptor antagonist, and Donepezil is an Acetylcholinesterase inhibitor--both used to Rx Alzheimer's
|
|
Name a use of Sumatriptan. Name the mechanism.
|
Sumatriptan is a 5HT(1B/1D) agonist. It causes vasoconstriction, inhibition of trigeminal activation and vasoactive peptide release. USE--Acute Migraine, cluster headache attacks.
|
|
What is a potential toxicity associated with Selegiline?
|
It may enhance the adverse effects of L-dopa.
|
|
Name the toxicity associated with L-dopa. A long-term side effect?
|
Arrhythmias from peripheral conversion to dopamine. Dyskinesia from long-term use after administration. Akinesia between doses.
|
|
What can be given with L-dopa to increase bioavailability?
|
Carbidopa, a peripheral decarboxylase inhibitor, increases bioavailabiilty of L-dopa in the brain and limits peripheral SE.
|