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627 Cards in this Set
- Front
- Back
decreased pain and temp sensation over lat. aspects of both arms. where is the lesion
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syringomyelia
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penlight in pts right eye produces bilateral pupillary constriction. when moved to the left eye, there is paradoxical dilation.
what is the defect? |
atrophy of L optic nn
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decresassed prick sensation on lateral aspect of leg and foot.
deficit in what mm action can also be expected |
dorsiflexion & eversion of foot (common peronial nn)
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pt presents w/ tingling over lateral digits of her R hand.
What is the dx |
carpal tunnel syndrome.
median nn compression |
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decreased plantar flexion and decreased sensation over back fo thigh, calf, and latereal half of foot.
what spinal nn |
tibial (L4-S3)
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pt in MVA can't turn head to L & has rightt shoulder droop.
What sx is damaged. |
R CN XI (inn SCL & trap mm)
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pt presents w/ one wild flailing arm. where is the lesion?
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contralateral subthalamic nuccleus (hemiballismus)
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pt w/ cortical lesion does not know he has a dz. where is the lesion?
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right paraietal lobe
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pt cannot protrude tongue toward L side and has a R-sided spastic paralysis. Where is the lesion?
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L medulla, CN XII
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teen falls while rollarblading and hurts his elbow. He can't feel the medial part of his palm.
What is the nn & what is the injury. |
ulnar nn due to broken medial condyle
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pt presents to ER after falling on arm. X-ray shows midshaft break of the humerus? Which nn & aa are most lkely damaged?
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radial nn & deep brachial aa (run together
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pt cannot blink his R eye or seal his lips and has mild ptosis on R side. What is the dx and which nn is affected.
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bell's palsy; CN VII
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pt c/o numbness, & tingling sensation. She has wasting of thenar eminence. What is the dx/ What nn is affected?
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carpel tunnel syndrome (medial nn)
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stage of sleep where there is variable BP, penile tumescence & variable EEG.
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REM
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person demands only the best & most famous doctor in town.
what personality d/o |
narcissistic personality d/o
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nurse has episodes of hypoglycemia; blood analysis shows no elevation in C protien. What is the dx.
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factitious d/o. self scripted insulin
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woman presents w/ headache, visual disturbance, galactorrhea and amenorrhea
what is the dx |
prolactinoma
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pt experiences dizziness & tinnitis. ct shows enlarged internal acoustic meatus. What is the dx
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schannoma
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25 y/o female presents w/ sudden uniocular vision loss & slightly slurred speech. She has hx of weekness & parasthesias that have resoved. what is the dx
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MS
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10 y/o child "spaces out" in class (e.g., stops talking midsentance & then continues as if nothing happened. During spells there is slight quivering of lips. Dx?
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absence seizures
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man on several meds including antidepressants and antihypertensives, has mydriasis and becomes constipated. What is the cause of his symptoms
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TCA
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woman on MAO inhibitor has hypertensive crisis after a meal. What did she ingest?
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tyramine (wine or cheese)
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This CNS support cell helps maintain the blood-brain barrier. It's cell marker is GFAP
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astrocyte
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this CNS support cell makes up the inner lining of the ventricles
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ependymal cells
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this CNS support cell is the macrophage of the brain phagocytosing in areas of inflammation or neural damage. Like the macrophage, this cell is mesodermal in origen.
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microglia.
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This CNS support cell is responsible for myelin production
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oligodendroglia
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This pns support cell is responsible for peripheral myelin production
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schwann cell
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All CNS/ PNS support cells (except the microglia which originates from mesoderm)originate from this primary germ cell layer.
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ectoderm
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autopsy done on pt w/ HIV shows these support cells transformed into virus filled multinucleated giant cells in CNS
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microglia
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these CNS support cells are destroyed in MS
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oligodendroglia
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Acoustic neuroma is a neoplasm of this PNS support cell commonly associated with the internal acoustic meatus (CN VII, VIII)
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schwann cell
|
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Give following peripheral nn layers from inner most to outermost :
nn fibers endoneurium epineurium perineurium |
endoneurium-perineurium-epineurium-nn fibers
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this peripheral nn layer must be rejoined in microsurgery for limb reattachment
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perineurium
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this sensory corpuscle is a small, encapsulated nn ending found in the dermis of palms, soles, and digits of skin. It is involved in light discriminatory touch of glabrous (hairless) skin.
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meissner's corpuscle
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this sensory corpuscle is a large, encapsulated nn ending found in deeper layers of skin at ligaments, joint capsules, serous membranes, and mesenteries. It is involved in pressure, coarse touch, vibration, and tension.
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pacinian corpuscle
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this sensory corpuscle is a cup-shaped nn ending in dermis of fingertips, hair follicles, hard palate. It is involved in light, crude touch
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merkel's corpuscle
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when you hear high frequency sound, this part of the cochlea is responding (narrow & stiff)
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base
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when you hear low frequency sound, this part of the cochlea is responding (wide and flexible)
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apex
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perilymph in the inner ear is similar to (ECF or ICF)
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ECF (high Na+)
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when you hear high frequency sound, this part of the cochlea is responding (narrow & stiff)
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base
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endolymph in the inner ear is similar to (ECF or ICF)
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ICF (K+)
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Utricle and saccule of the inner ear contain maculae which detect which type of acceleration?
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linear
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Semicircular canals of the inner ear contain ampullae which detect which type of acceleration?
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angular
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hearing loss in the elderly usually begins with which type of frequency
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high frequencies
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blood brain barrier is formed by which 3 structures:
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1)astrocyte processes
2) basement membrane 3)tight jx b/n nonfenestrated capillary endothelial cells |
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glucose and amino acids cross the blood-brain barrier by which method.
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carrier mediated transport mechanism
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what crosses blood brain barrier more redily. water soluble substances or lipid soluble substances?
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lipid soluble
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the hypothalamus wears TAN HATS is a mneumonic for the fxns of the hypothalamus?
What does the T stand for (2 chances to get it right. |
either:
1)Thirst or 2)Temperature |
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the hypothalamus wears TAN HATS is a mneumonic for the fxns of the hypothalamus?
What does the A stand for (2 chances to get it right. |
Either
1) Adenohypophysis control or 2)Autonomic regulation |
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the hypothalamus wears TAN HATS is a mneumonic for the fxns of the hypothalamus?
What does the A stand for (2 chances to get it right. |
Either
1) Adenohypophysis control or 2)Autonomic regulation |
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the hypothalamus wears TAN HATS is a mneumonic for the fxns of the hypothalamus?
What does the N stand for |
Neurohypophysis hormones (synthesized in hypothalamic nucleii)
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the hypothalamus wears TAN HATS is a mneumonic for the fxns of the hypothalamus?
What does the H stand for |
Hunger
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the hypothalamus wears TAN HATS is a mneumonic for the fxns of the hypothalamus?
What does the S stand for? |
Sexual urges
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destruction of the lateral nucleus of the hypothalamus results in what type of food intake?
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anerexia & starvation
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destruction of the ventromedial nucleus of the hypothalamus results in what type of food intake?
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hyperphagia and obesity
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Anterior hypothalamus regulates what division of the ANS.
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parasympathetic
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Posterior hypothalamus regulates what division of the ANS.
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Sypathetic
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This nucleus controls circadian rhythms.
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suprachiasmatic nucleus
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This nucleus controls thirst and water balance
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supraoptic nucleus
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This part of the hypothalamus (anterior or posterior) kicks in and regulates heat concervation when cold.
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posterior hypothalamus
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This part of the hypothalamus (anterior or posterior) coordinates cooling when hot.
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anterior hypothalamus
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When this nucleus of the hypothalmus is destroyed--rage results?
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septal nucleus
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The posterior pituitary (neurohypophysis) recieves hypothalamic axonal projections from the supraoptic nucleii and releases what hormone?
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ADH
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The posterior pituitary (neurohypophysis) recieves hypothalamic axonal projections from the paraventricular nucleii and releases what hormone?
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oxytocin
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this part of the brain is the major relay for ascending sensory informationthat ultimately reaches the cortex?
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thalamus
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This geniculate nucleus of the thalamus (lateral or medial) is involved in relaying visual sensory information to the cortex.
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lateral
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This geniculate nucleus of the thalamus (lateral or medial) is involved in relaying auditory sensory information to the cortex.
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medial geniculate nucleus (MGN)
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This nucleus of the thalamus is involved in relaying BODY sensation information (proprioception, pressure, pain, touch, vibriation) to the cortex via the dorsal columns & the spinothalamic tract.
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Ventral Posterior Nucleus, Lateral part (VPL)
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This nucleus of the thalamus is involved in relaying FACIAL sensation information to the cortex via CN V
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Ventral Posterior nucleus, medial part (VPM)
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This nucleus of the thalamus is involved in relaying motor information to the cortex.
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Ventral Anterior/Lateral nucleus (VL)
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This "system" of the brain is responsible for the 5 Fs. Feeding, Fighting, Feeling, Flight, and Fucking.
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limbic system
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This part of the brain is important in voluntary movements and making postural adjustments.
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basal ganglia
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Parkinson's dz symptoms are do to decreased imput from this part of the basal gangia.
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substantia nigra.
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In Parkinson's dz the symptoms are due to decreased input from the substantia nigra of the basal ganglia. This leads to _______ (increased or decreased) stimulation of the direct pathway and _______ (increased or decreased) inhibition of the indirect pathway
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decreased
decreased |
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In the basal ganglia, _________ (D1)facilitates movement
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direct pathway
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In the basal ganglia, _________ (D2)inhibits movement
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indirect pathway
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In the cerebral cortex associative auditoritory fx is associated with which area?
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Wernicke's area (22)
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In the cerebral cortex speech motor fx is associated with which area?
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broca's area
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Your pt has become recently more and more disorganized. He reports problems concentrating and poor social judgement. What lobe of the brain could be involved.
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frontal lobe
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anterior cerebral artery hemarrage could result in sensory motor problems in which location of the body?
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lower extremity
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anterior cerebral aa supplies what part of the brain
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medial surface
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hemhorrage of the middle cerebral aa would involve what part of the brain.
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lateral
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hemhorrage of the middle cerebral aa could involve what pathologies?
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motor & sensory deficits of teh trunk-arm-face, Broca's and Wernicke's speech areas
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Anterior communicating artery lesion is the most common circle of Willis aneurism. It may cause this deficit.
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visual field defect
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Posterior communicating artery is also a common area of aneurism. It can result in this cranial nn palsy.
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CN III
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A stroke in this general part of the circule of wilis can cause general sensory and motor dysfunction and aphasia
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anterior circle
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A stroke in this general part of the circle of wilis can cause cranial n deficits (vertigo, visual deficits), coma, cerebellar deficits (ataxia)
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posterior circle
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this division of the middle cerebral aa is a common site of stroke. It feeds the internal capsule, caudate, putamen, & globus pallidus
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lateral striate
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Cerebral veins drain into the venous sinuses which drain into what?
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internal jugular vv
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lateral ventricle drains into the 3rd ventricle via the foramen of _______.
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monro
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3rd ventricle drains into the 4th ventricle via the aquaduct of ________
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sylvius
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4th ventricle drains into the subarachnoid space via the foramina of ________ (laterally) and the foramina of ________ (medially
|
Luschka
Magendie |
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How many spinal nn are there total?
|
31
8-C 12-T 5-L 5-S 1-coccygeal |
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Vertibral disk herniation usually occurs between what levels_______
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L5-S1
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At what levels do you want do a LP
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L3-L5
(spinal cord extends to lower border of L2; Subarachnoid space extends to lwer border of S2) |
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You perform an LP at the level of L4/L5 (iliac crest levels). List the following sx in the order that you will pierce them?
Ligaments Arachnoid Epidural space Subdural space skin/superficial fascia Dural matter Subarachnoid space CSF |
skin/superficial fascia
Ligaments Epidural space Dural matter Subdural space Arachnoid Subarachnoid space CSF |
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Should you pierce the Pia matter in a lubar puncture?
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No
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These columns relay sensation of pressure, vibration, touch, and proprioception to the cerebral cortex.
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dorsal columns
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This fasciculus within the dorsal column relays the sensation of pressure, vibration, touch, and proprioception from the upperbody and extremities to the cerebral cortex.
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fascciculus cuneatus
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This fasciculus within the dorsal column relays the sensation of pressure, vibration, touch, and proprioception from the lower body and extremities to the cerebral cortex.
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fasciculus gracilis
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These tracts relay sensation of pain and temperature up the spinal cord to the cerebral cortex
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spinothalamic tract
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These tracts relay motor signals from the brain down teh spinal cord.
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lateral corticospinal tract
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what is more lateral in the dorsal columns the fasciculus cuneatus or fasciculs gracilis
|
fasciculus cuneatus
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Describe the path of a vibratory (or pressure, touch, proproceptive) sensation as after it signals a sensory nn up until its first synapse (must get 3 key points)
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Sensation enters the DORSAL ROOT GANGLION to ascent the spinal cord IPSILATERALLY in the DORSAL COLUMN.
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Describe the location of the first synapse of that vibratory (or pressure, touch, proproceptive) sensation (must give nucleus and brain location)
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NUCLEUS CUNEATUS or GRACILIS in the MEDULLA
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Describe the 2nd order neuron of that vibratory (or pressure, touch, proproceptive) sensation. (decussation & ascention)
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decussates in the MEDULLA and ascends CONTRALATERALLY in the MEDIAL LEMNISCUS
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Describe the 2nd synapse of that vibratory (or pressure, touch, proproceptive) sensation. (Nucleus and brain location)
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VPL of the THALAMUS
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Describe the final destination of the 3rd order neuron of that vibratory (or pressure, touch, proproceptive)sensation
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SENSORY CORTEX
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Describe the path of an ascending pain (or temperature) sensation after it signals a sensory nn up until its first synapse
|
travels from sensory nn endigns (A-delta and C-fibers)and enters spinal cord ipsilaterally.
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Describe the first synapse of ascending pain and temperature sensation
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IPSILATERAL synapse with gray matter in spinal cord.
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Describe the 2nd order neuron transmission of the ascending pain and temperature sensation. (decussation & ascention)
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Decussates at the ANTERIOR WHITE COMMISSURE and ascends CONTRALATERAL in the SPINOTHALAMIC TRACT
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Describe the 2nd synapse of the ascending pain and temp sensation?
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VPL of thalamus
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Describe the 3rd order neuron final destination of the ascending pain and temperature sensation.
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sensory cortex
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You want to move you're right arm? Describe the 1st order neuron pathway.
|
begin in the LEFT HEMISPHERE PRIMARY MOTOR CORTEX. The UPPER MOTOR NEURONS descends IPSILATERALLY until decussating at CAUDAL MEDULLA (PYRAMIDAL DECUSSATION) and then descend CONTRILATERALLY.
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You want to move you're right arm? Describe where the 1st synapse occurs.
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CELL BODY OF THE ANTERIOR HORN (SPINAL CORD)
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You want to move you're right arm? Describe the 2nd order neuron.
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LOWER MOTOR NEURON leaves the spinal cord.
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You want to move you're right arm? Describe where the 2nd synapse occurs.
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neuromuscular jx
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Give the brachial plexus dx from the BP damage:
Upper trunk (C5, C6) |
waiters tip
|
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Give the diagnosis from the location of Brachial Plexus damage:
Lower trunk (T1,C8) |
claw hand
|
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Give the diagnosis from the location of Brachial Plexus damage:
Posterior chord (C5-T1) |
Wrist drop
|
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Give the diagnosis from the location of Brachial Plexus damage:
Long Thoracic Nerve |
Winged scapula
|
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Give the diagnosis from the location of Brachial Plexus damage:
Axillary nn |
Deltoid paralysis
|
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Give the diagnosis from the location of Brachial Plexus damage:
Radial nn |
Sadurday night palsy
|
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Give the diagnosis from the location of Brachial Plexus damage:
musculocutaneous nn |
difficulty flexing elbow, variable sensory loss
|
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Give the diagnosis from the location of Brachial Plexus damage:
Median nn |
decreased thumb fx-Pope's blessing
|
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Give the diagnosis from the location of Brachial Plexus damage:
Ulnar branch |
Intrinsic mm of hand, claw hand
|
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What mm protects brachial plexus from injury in the case of the relatively common clavicle fracture
|
subclavius
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This nn is known as the "great extensor nn" it provides innervation of the Brachioradialis, Extensors or the wrist and fingers, Supinator, and Triceps.
|
Radial nn.
mneu:RAD=BEST Brachioradialis, Extensors or the wrist and fingers, Supinator, and Triceps. |
|
Thenar mm (3)
Hypothenar mm (3) |
Opponens pollicis, Abuctor pollicis brevis, Flexor pollicis brevis
Opponens digiti minimi, Abductor digiti minimi, Flexor digiti minimi Both groups perform the same fx: Oppose, Abduct, and Flex (OAF) |
|
Clinically important Landmarks:
-Ischial spine? -2/3 of the way from the umbilicus to the anterior superior Iliiac Spine -Iliac Crest |
Pudendal nn block
McBurney's Pt-Appendix Lumbar puncture |
|
Landmark Dermatomes:
Posterior half of the scull "cap" |
C2
|
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Landmark Dermatomes: high turtle neck shirt
|
C3
|
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Landmark Dermatomes: low collar shirt
|
C4
|
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Landmark Dermatomes: T4
|
nipple
T4 at the "teat pore" |
|
Landmark Dermatomes: xyphoid process
|
T7
|
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Landmark Dermatomes: Umbilicus
|
T10
T10 at the belly butTEN |
|
Landmark Dermatomes: Inguinal ligament
|
L1
L1 is IL |
|
Landmark Dermatomes: includes the kneecaps
|
L4
down on L4s (all 4s) |
|
Landmark Dermatomes:
erection, and sensation of penile and anal zones |
S2,3,4
S2,3,4 keeps the penis off the floor |
|
Gallbladder pain is referred to the right shoulder via this nn
|
phrenic nn
|
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This work in prallel w/ mm fibers. When a mm is stretched it causes the intrafusal to stretch which stimulates the Ia afferent which in turn stimulates the alpha motor neuron which causes a reflex muscle (extrafusal ) contraction
|
muscle spindle
|
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these monitor mm lenth. For example help you pick up a heavy suitcase when you didn't know how heavy it was.
|
muscle spindles
|
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This senses tension and provides inhibitory feedbach to alpha motor neurons
|
golgi tendon organs
|
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These monitor mm tension. For example make you drop a heavy suitcase you've been holding for too long
|
golgi tendon organs
|
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CNS stimulates the gamma motor neuron which contracts intrafusal fiber and causees an increased sensitivity of the reflex arc
|
gamma loop
|
|
Clinical reflexes:
-Achillies: -Patella: -Biceps: -Triceps: |
S1,2
L3,4 C5,6 C7,8 |
|
Dorsiflexion of the big toe and fanning of other toes; sign of UMN lesion, but normal reflex in 1st year of life
|
Babinski
|
|
Primitive Reflexes:
extension of limbs when startled (normally disappear w/in 1st year. May reemerge following a frontal lobe lesion) |
moro reflex
|
|
Primitive Reflexes:
nipple seeking (normally disappear w/in 1st year. May reemerge following a frontal lobe lesion) |
rooting reflex
|
|
Primitive Reflexes:
grasps objects in palm (normally disappear w/in 1st year. May reemerge following a frontal lobe lesion) |
palmar reflex
|
|
Primitive Reflexes:
large toe dorsiflexes w/ plantar stimulation (normally disappear w/in 1st year. May reemerge following a frontal lobe lesion) |
babinski reflex
|
|
CNs that lie medially at brainstem
|
III, VI, XII
mneu: 3(x2)=6(x2)=12 |
|
Give Cranial nn by Fx: Is it Motor or sensory or Both?
Fx: smell |
CNI-olfactory(S)
|
|
Give Cranial nn by Fx: Is it Motor or sensory or Both?
Fx: Sight |
CN II: Optic (S)
|
|
Give Cranial nn by Fx: Is it Motor or sensory or Both?
Fx: Eye movement (up(lateral & medial) down (lateral), pupil constriction, accommodation, eyelid opening |
CN III: Oculomotor (M)
|
|
Give Cranial nn by Fx: Is it Motor or sensory or Both?
Fx: Eye movement (down & medial) |
CN IV: Trochlear (M)
|
|
Give Cranial nn by Fx: Is it Motor or sensory or Both?
Fx: Mastication, Facial sensiation |
CN V: Trigeminal (B)
|
|
Give Cranial nn by Fx: Is it Motor or sensory or Both?
Fx: Eye movement (lateral) |
CN VI: Abducens (M)
|
|
Give Cranial nn by Fx: Is it Motor or sensory or Both?
Fx: Facial mvmt, taste from anterior 2/3 of tongue, lacrimation, salivation (submaxillary and sublingual glands, eyelid closing. |
CN VII: Facial (B)
|
|
Give Cranial nn by Fx: Is it Motor or sensory or Both?
Fx: Hearing, balance |
CN VIII: Vestibulocochlear (S)
|
|
Give Cranial nn by Fx: Is it Motor or sensory or Both?
Fx: Taste from post 1/3 of tongue, swallowing, salivation (parotid gland), monitoring carotid body and sinus chemo-and baroreceptors |
CN IX: Glossopharyngeal (B)
|
|
Give Cranial nn by Fx: Is it Motor or sensory or Both?
Fx: Tastte from epiglottic region, swallowing, palate elevaton, talking, throacoabdominal viscera, monitoring aortic arch chemo-and baroreceptors |
CN X: Vagus (B)
|
|
Give Cranial nn by Fx: Is it Motor or sensory or Both?
Fx: Head turning, shoulder shrugging |
CN XI: Accessory (M)
|
|
Give Cranial nn by Fx: Is it Motor or sensory or Both?
Fx: tongue mvmt |
CN XII: Hypoglossal (M)
|
|
Cranial nn nucleii located in the Midbrain
|
CN III, IV
|
|
Cranial nn nucleii located in the Pons
|
CN V-VIII
|
|
Cranial nn nucleii located in the Medulla
|
IX-XII
|
|
Cranial nn nucleii located in the Midbrain
|
CN III, IV
|
|
Cranial nn more lateral in the brainstem tend to be ______; those more medially tend to be _______
|
sensory
motor |
|
This vagal nucleii recieves visceral sensory information (e.g., taste baroreceptors, and gut distension) from cranial nn VII, IX, & X
|
Nucleus Solitarius
|
|
This vagal nucleii is responsible for Motor inervation of the pharynx, larynx and upper esophagus (e.g, swallowing, palate elevation)via CN IX,X,XI.
|
Nucleus aMbiguous
|
|
This vagal nucleii sends autonomic (parasympathetic) fibers to heart, lungs, and upper GI
|
Dorsal motor nucleus
|
|
Crandial nn and vessel pathways:
Cribiform plate |
CN I
|
|
Crandial nn and vessel pathways:
optic canal |
CN II, opthalmic artery, central retinal vein
|
|
Crandial nn and vessel pathways:
Superior orbital fissure |
(CN III, IV, V1,VI, opthalmic vv)
|
|
Crandial nn and vessel pathways:
Foramen Rotundum |
CN V2
|
|
Crandial nn and vessel pathways:
Foramen Ovale |
CN V3
|
|
Crandial nn and vessel pathways:
Foramen spinosum |
middle meningeal aa
|
|
Crandial nn and vessel pathways:
Internal auditory meatus |
CN VII, VIII
|
|
Crandial nn and vessel pathways:
Jugular foramen |
CN IX,X,XI, jugular vv
|
|
Crandial nn and vessel pathways:
Hypoglossal canal |
CN XII
|
|
Crandial nn and vessel pathways:
Foramen magnum |
Spinal roots of CN XI, brainstem, vertebral arteries
|
|
a collectionof venous sinuses on either side of the pituitary
|
cavernous sinus
|
|
nn that pass through cavernous sinuses
|
nn that control extaocular mm (CN III, IV, VI) plus V1 & V2
|
|
pt presents w/ opthalmoplegia, & opthalmic and mandibular sensory loss
what is a possible dx? |
Cavernous sinus syndrome (e.g., due to mass effect
|
|
Muscles of mastication:
3 mm that close the jaw innervated by? |
Masseter, teMporalis, Medial pterygoid.
inn: V3 mneu: Ms Munch |
|
Muscles of mastication:
1 mm opens the jaw innervated by: |
Lateral pterygoid.
inn: V3 mneu: Lateral Lowers |
|
All mm with the root glossus in their names are innervated by?
Except one exception. What is it and what is the innervation. |
hypoglossal.
palatoglossus (inn by vagus) |
|
All mm with the root palat in their names are innervated by this.
One exception what is it innervated by? |
vagus
exception: tensor veli palatine (inn by Mandibular branch of CN V) |
|
CN IV innervates what mm? What direction would you look?
|
SO--towards your nose
|
|
CN VI innervates what mm. What direction would you look
|
LR-laterally
|
|
What reflex? Light in either retina sends a signal via CN III to PRETECTAL nucleii in midbrain that activate bilateral EDINGER-WESTPHAL nucleii;pupls contract bilaterally (consensual reflex)
|
Pupillary light reflex
|
|
Saying KLM outloud tests what three CNs?
|
K (vagus) palate elevation
L (hypoglossal) tongue M (facial) lips |
|
What waveform?
awake (eyes open), alert, active mental concentration |
Beta (highest frequency, lowest amplitude)
|
|
What waveform?
awake (eyes closed) |
alpha
|
|
What waveform?
light sleep What stage of sleep is this? What percentage of total sleep time is this in young adults? |
Theta
1 5% |
|
What waveform?
deeper sleep What stage of sleep is this? What percentage of total sleep time is this in young adults? |
Sleep spindles and K complexes
2 45% |
|
What waveform?
Deepest sleep; sleepwalking; night terrors, bed wetting What stage of sleep is this? What percentage of total sleep time is this in young adults? |
Delta (lowest frequency, hightest amplitude)
3-4 25% |
|
What waveform?
dreaming, loss of motor tone, possibly memory procesing fx, erections, increase brain oxygen use What stage of sleep is this? What percentage of total sleep time is this in young adults? |
Beta
REM 25% mneu: At night, BATS Drink Blood |
|
What type of sleep is this?
increase variable pulse, rapid eye movements, inceased and variable blood pressure, penile/clitoral tumenescence. Occurs every 90 min; duration increases throughout the night. |
REM
|
|
principle neurotransmitter involved in REM sleep
|
Ach
|
|
REM sleep _______ (increases or decreases) with age
|
decreases
|
|
neural tube defects are associated with lack of this vitamen intake during pregnancy
|
folic acid
|
|
neural tube defects are associated with elevated levels of this in amniotic fluid and maternal serum
|
alpha fetoprotein levels
|
|
This describes failure of bony spinal canal to close, but no structural herniation. Usually seen at lower vertebral levels
|
spinal bifida occulta
|
|
This describes when the meninges herniate throgh a spinal canal defect
|
meningocele
|
|
This describes when meninges and spinal cord herniate through spinal canal defects
|
meningiomyelocele
|
|
Give the area of the brain lesion?
motor (nonfluent/expressive) aphasia with good comprehension |
broca's area
|
|
Give the area of the brain lesion?
sensory (fluent/receptive) aphagia with poor comprehension |
Wernicke's area
|
|
Give the area of the brain lesion?
conduction aphagia; poor repitition with good comprehension, fluent speech |
Arcuate fasciculus
(connects Wernicke's to Broca's area |
|
Give the area of the brain lesion?
Kluver-Bucy Syndrome (hyperorality, hypersexuality, disinhibited behavior) |
Amygdala (bilateral)
|
|
Give the area of the brain lesion?
Personality changes and deficits in concentration, orientation, and judgement; may have reemergence of primitive reflexes |
frontal lobe
|
|
Give the area of the brain lesion?
Spacial neglect syndrome (agnosia of the contralateral side of the world) |
Right parietal lobe
|
|
Give the area of the brain lesion?
coma |
reticular activating system
|
|
Give the area of the brain lesion?
wernicke-korsakoff syndrome |
mamillary bodies (bilateral)
|
|
Give the area of the brain lesion?
tremor at rest, chorea, or athetosis |
basal ganglia
|
|
Give the area of the brain lesion?
Intention tremor, limb ataxia |
cerebellar hemisphere
mneu: cerebellar hemispheres are LATERALLY located--affect LATERAL limbs. Vermis is CENTRALLY located-affects CENTRAL body |
|
Give the area of the brain lesion?
truncal taxia, dysarthria |
cerebellar Vermis
mneu: cerebellar hemispheres are LATERALLY located--affect LATERAL limbs. Vermis is CENTRALLY located-affects CENTRAL body |
|
Give the area of the brain lesion?
contralateral hemiballismus |
subthalamic nucleus
|
|
Chorea--sudden, jerky, purposeless movements are characteristic of a lesion in this part of the brain. Give the classic dz example.
|
Basal ganglia
Huntington's dz |
|
Athetosis are slow, writhing movements, especially of the fingers. This is characteristic of a lesion in this part of the brain
|
basal ganglia
|
|
hemiballismus involves the sudden wild flailing of 1 arm. What kind of lesion does this indicate (& on what side)
|
contralateral subthalamic nucleus
(results in loss of inhibition of thalamus through globus pallidus) |
|
Broca's lesion is nonfluent aphagia with intact comprehension it involves this gyrus
|
inferior frontal gyrus
|
|
Wernicke's aphagia is fluent aphagia with impared comprehension it involves this gyrus
|
superior temporal gyrus
|
|
most common cause of dementia in the elderly. Associated w/ senile plaques (extracellular, Beta amyloid core) and neuro fibrillary tangles (intracellular, abnormally phosphorylated tau protiein)
|
Alzheimers dz
|
|
Familial form of alziemers is associeted w/ genes on chromosomes 1, 14, 19 (APOE4 allele), and 21 (p-App gene) is thought to be responsible for this percent of alzheimers cases
|
10%
|
|
What is the 2nd most common cause of dementia in the elderly
|
multi-infarct dementia
(may cause amyloid angiopathy) |
|
pt presents with dementia, aphasia, parkinsonian aspects; associated with intracellular aggregated tau protien and is specific for frontal and temporal lobes.
|
Pick's dz
|
|
pt presents with chorea and dementia. Autopsy shows atrophy of caudate nucleus (loss of GABAergic neurons).
|
Huntinton's dz
|
|
Dz associated with chromasome 4--expansion of CAG repeats.
|
Huntinton's dz
mneu: CAG-Caudate loses ACh & GABA. |
|
dz associated w/ Lewy bodies and depigmentation of the substantia nigra pars compacta (loss of dopaminergic neurons) Rare cases have been linked to exposure to MPTP, a contaminant in illicit sreet drugs.
|
Parkinson's dz
mneu: TRAP=Tremor (at rest), Rigidity, Akinesia, and Postural instability (you are TRAPped in your body. |
|
Dz associated with BOTH LMN & UMN signs, no sensory defect. Also known as Lou Gehrig's dz
|
Amyotrophic lateral Sclerosis (ALS)
|
|
presents as birth as a "floppy baby", tongue fasciculations; median age of death is 7 months. Associated w/ degeneration of anterior horns. Autosomal-recessive inheritance.
|
Werdnig-Hoffmann dz
|
|
dz follws infection with poliovirus; LMN signs. Associated with degeneration of anterior horns.
|
Polio
|
|
Pt presents w malaise, headache, fever, nausea abdominal pain, sore throught. Progreses to signs of LMN lesions--mm weakness & atrophy, fasciculations, fibrillation, & hyporeflexia.
LP of CSF shows lymphocytic pleocytosis w/ slight elevation of protein. What do you suspect? |
Poliomyelits
|
|
this dz is causesd by the poliovirus, which is transmitted by the fecal-oral route. It replicates in the oropharynx and small intestine before spreading through the bloodstream to the CNS where it leads to the destruction of cells in the anterior horn of the spinal cord, leading in turn to LMN destruction.
|
poliomyelitis
|
|
This dz shows increased prevalence with increased distance from the equator.
|
MS
|
|
This dz shows periventricular plaques (areas of oligodendrocyte loss and reactive gliosis)with preservation of actions. There is an increase in protein (IgG) in CSF.
|
MS
|
|
dz associated with a relapsing-remitting course.
|
MS
|
|
With this dz pts often present w/ optic neuritis (sudden loss of vision) MLF syndrome (internuclear ophtalmoplegia), hemiperesis, hemisensory symptoms, or bladder/bowel incontinence.
|
MS
|
|
This dz classically presents with scanning speech, intension tremor, and nystagmus. It most often affects women in their 20s and 30s. And is more common in whites. Tx is Beta interferon or immunosuppressant therapy.
|
MS
|
|
This demyelinating dz is associated with the JC virus and is seen in 2-4% of AIDS pts.
|
Progressive multifocal leukoencephalopathy (PML)
|
|
This dz is associated with inflammationand demyelination of peripheral nn and motor fibers of the ventral roots (sensory effects are less severe than motor). This results in symmetric ASCENDING mm weakness begining in distal and lower extremities.
LP of CSF shows elevated protein with normal cell count (albuminocytologic dissociation). Elevated protien levels may lead to papilledema. Pts usually recover completely. |
Guillian-Barre Syndrome (acute idiopathic polyneuritis)
|
|
Guillian-Barr has been associated with certain infections including (2)
|
herpesvirus or Campylobacter jejuni
|
|
seizures involving only one area of the brain
|
partial seizures
|
|
simple partial seizures
|
1 area of the brain
conciousness intact |
|
complex partial seizures
|
1 area of the brain
impaired consciousness |
|
generalized seizures
|
diffuse areas of brain
|
|
generalized siezures involving a blank stare
|
absence (petit mal)
|
|
generalized siezures involving quick repetitive jerks
|
myoclonic
|
|
Generalized siezure involving alternating stiffening and movement
|
tonic-clonic
|
|
Pt hit in the side of the head with a baseball and fracturs his temperal bone. Rupture of the middle meningeal aa results. CT shows a "bioconvex disk" that does not cross suture lines. What is your dz of the Intracranial hemorrhage?
|
epidural hematoma
|
|
Alcoholic presents to the ER. He fell and hit his head the previous night but thought he was fine until neurological symptoms appeared the next morning. MRI shows a crescent-shaped hemorrhage that crosses suture lines. You suspect a venous bleed. What is your dx of this intracranial hemorrhage?
|
Subdural hematoma
|
|
Pt complains of "worst headache of their life." You worry it may be a rubture of a berry aneurism. Spinal tap is bloody. What is the d of this intracranial hemorrhage?
|
Subarachnoid hemorrhage
|
|
This type of aneurism often occurs at the bifurcation in the circule of Willis. The most common site is the bifurcation of the anterior communicating artery. Risk factors include adult polycystic kidney dz, Ehlers-Danlos syndrome, & Marphan's syndrome.
|
Berry aneurysms
|
|
most _______ (childhood v. adult) tumors are supratentorial, while most ________childhood v. adult) tumors are infratentorial.
|
adult
childhood Note: 50% of brain tumors are metastases |
|
This tumor has an adult peak incidence. It is the most common primary brain tumor and it has a grave prognosis (<1 yr life expectancy). It is found in the cerebral hemisphere and can cross the corpus callosum.
"Pseudopalisading" tumor cells border central areas of necrosis and hemorrhage. Stain astrocytes with GFAP. |
Glioblastoma multiforme (grade IV astrocytoma)
|
|
This tumor has an adult peak incidence. It is the second most common primary brain tumor. It most often occurs in the convexities of hemispheres and parasagital region. It arises from arachnoid cells external to the brain. It is usually resectable.
|
Meningioma
|
|
On pathology this primary brain tumor shows spindle cells concentrically arranged in a whorled pattern and psammoma bodies (laminated calcification) What is it?
|
Meningioma
|
|
This brain tumor has an adult peak incidence. It is the 3rd most common primary brain tumor. It is of Schwann cell origin and is often localized to the 8th nerve. It is resectable. What is it?
|
Schwannoma
|
|
Bilateral schwannoma is often found in what condition?
|
neurofibromatosis type 2
|
|
This primary brain tumor with an adult peak incidence is relatively rare. It is slow growing and most often occurs in the frontal lobes.
|
Oligodendroma
|
|
On pathology this tumor has "fried egg" cells-round nucleii with clear cytoplasm. They are often calcified.
|
Oligodendroma
|
|
This priary brain tumor that has an adult peak incidence most commonly comes in a prolactin secreting form. Often it occurs with bilateral hemianopia (due to pressure on optic chiasm)
|
pituitary adenoma
|
|
This primary brain tumor has a peak incidence in childhood. It is a diffusely infiltrating glioma. It is most often found in the posterior fossa. It is benign and carries a good prognosis.
|
Pilocytic (low grade) astrocytoma)
|
|
On pathology this primary brain tumor shows Rosenthal fibers (eosinophilic, corkscrew fibers)
|
Pilocytic (low grade )astrocytoma
|
|
This primary brain tumor that occurs with a peak incidence in children is a highly malignant cerabellar tumor. It is a form of primitive neuroectodermal tumor (PneT). It can compress the 4th ventricle causing hydrocephalus. It is highly radiosensitive.
|
Medulloblastoma
|
|
On pathology this tumor shows Rosettes or perivascular pseudorosette pattern of cells
|
medulloblastoma
|
|
This primary brain tumor that occurs with a peak incidence in children is an ependymal cell tumor most commonly found in the 4th ventricle. It can cause hydrocephalus and carries a poor prognosis.
|
ependymoma
|
|
On pathology this tumor has characteristic perivascular pseudorosettes. Rod shaped blepharoplasts (basal ciliary bodies) found near the nucleus
|
ependymoma
|
|
This primary brain tumor that occurs with a peak incidence in children is most often cerebeller. It is associated with Von Hippel-Lindau syndrome when found with retinal angiomas. Can produce EPO and lead to secondary polycythemia.
On pathology: Foamy cells and high vascularity are characteristic. |
Hemangioblastoma
|
|
This primary brain tumor that occurs with a peak incidence in children is a benign tumor which can be confused with pituitary adenoma (can also cause bitemporal hemianopia). This is the most common childhood supratentorial tumor. It is derived from remnants of Rathke's pouch and calcification is common.
|
Craniopharyngioma
|
|
Sign of UMN or LMN lesion or both?
Weakness |
Both
mneu: LOWER MN= everything is LOWERED (less mm mass, less mm tone, less reflexes, downgoing toes. UPPER MN= everything UP (tone, DTRs, toes) |
|
Sign of UMN or LMN lesion or both?
Atrophy |
LMN
mneu: LOWER MN= everything is LOWERED (less mm mass, less mm tone, less reflexes, downgoing toes. UPPER MN= everything UP (tone, DTRs, toes) |
|
Sign of UMN or LMN lesion or both?
Fasciculation |
LMN
mneu: LOWER MN= everything is LOWERED (less mm mass, less mm tone, less reflexes, downgoing toes. UPPER MN= everything UP (tone, DTRs, toes) |
|
Sign of UMN or LMN lesion or both?
Increased Reflexes? Decreased Reflexes? |
UMN
LMN mneu: LOWER MN= everything is LOWERED (less mm mass, less mm tone, less reflexes, downgoing toes. UPPER MN= everything UP (tone, DTRs, toes) |
|
Sign of UMN or LMN lesion or both?
Increased tone? Decreased tone? |
UMN
LMN mneu: LOWER MN= everything is LOWERED (less mm mass, less mm tone, less reflexes, downgoing toes. UPPER MN= everything UP (tone, DTRs, toes) |
|
Sign of UMN or LMN lesion or both?
Babinski? |
UMN
mneu: LOWER MN= everything is LOWERED (less mm mass, less mm tone, less reflexes, downgoing toes. UPPER MN= everything UP (tone, DTRs, toes) |
|
These diseases result in lower motor neuron lesions only. They are due to destruction of the anterior horns and result in flacid paralysis. [pic]
|
Poliomyelitis & Werdinig Hoffman dz
|
|
This dz effects mostly the white matter of the cervical region. Random and asymmetrical demyelinating lesions are seen. Often pt presents with scanning speech, intention tremor, and nystagmus [pic]
|
MS
|
|
These diseases result in lower motor neuron lesions only. They are due to destruction of the anterior horns and result in flacid paralysis. [pic]
|
Poliomyelitis & Werdinig Hoffman dz
|
|
This dz involves combined UMN and LMN deficits with no sensory deficit. Pt often presents with both UMN & LMN neuron signs [pic]
|
ALS
|
|
When this happpens the only thing spared are the dorsal columns and tract of Lissauer[pic]
|
complete occlusion of ventral artery
|
|
This results in degeneration of the dorsal roots and dorsal columns. Pt presents with impared proprioception and locomotor ataxia.
|
Tabes dorsalis (tertiary syphilis)
|
|
This resultswhen the crossing fibers of the corticospinal tract are damaged. Pt presents with bilateral loss of pain and temperature sensation
|
syringomyelia
|
|
This results in demyelination of dorsal columns, lateral corticospinal tracts, and spinocerebellar tracts. Pt often presents with ataxic gait, hyperreflexia, impared position and vibration sense
|
vit B neuropathy and Friedreich's ataxia
|
|
This results when the central canal of the spinal cord is enlarged for some reason. The crossing fibers of spinothalamic tract are thus damaged. Pt shows bilateral loss of pain and temperature sensation in upper extremities with preservation of touch sensation.
|
Syringomyelia
|
|
Syringomyelia often presents with this congenital malformation.
|
Arnold-Chiari malformation
|
|
Syringomyelia is most common at this spinal level
|
C8-T1
|
|
This disorder is due to degeneration of the dorsal columns and dorsal roots due to tertiary syphilis. It results in impared proprioception and locomotor ataxia. Pt often presents with Charccot's joints (neuropathy of the joint), Argyll Robertson pupils (reactive to accommidation but not to light), and absensce of DTRs
|
Tabes dorsalis
|
|
Brown Sequard syndrome is a complete hemisection of the spinal cord. Give the findings.
|
1. Ipsilateral UMN signs(corticospinal tract) below lesion
2) Ipsilateral loss of tactile, vibration, proprioception sense (dorsal column) below lesion 3) Contralateral pain and temperature loss (spinothalamic tract) below the lesion 4) Ipsilateral loss of all sensation at the level of lesion 5) LMN signs at the level of the lesion *note: if the lesion occurs above T1 the pt will present with Horner's syndrome |
|
What are the symptoms of Horner's syndrome?
What spinal levels is it associated with? What is a common cancer that may result in it? |
1)Ptosis (droopy eyelid)
2)Anhydrosis (no sweating or flushing of effected side of face 3)Miosis (pupil constriction) HS is associated with lesion of spinal cord above T1 Pancoast tumor |
|
The 3 neuron OCULOSYMPATHETIC PATHWAY projects from 1)hypothalamus to the 2)intermediolateral column of the spinal cord, then to the 3) superior cervical (sympathetic) ganglion, and finally to the 4) pupil, the smooth mm of the eyelids, and the sweat glands of the forehead and face. Interruption of these pathways results in _________
|
Horner's syndrome
|
|
What nerve was injured?
Pt fractures the shaft of humerus. He presents with "wrist drop" ( extensor carpi radialis longus damage), loss of triceps and brachioradialis reflexes. Loss of sensation on posterior surface of arm and forearm (posterior brachial cutaneous and posterior antebrachial cutaneous) |
Radial nn
|
|
The 3 neuron OCULOSYMPATHETIC PATHWAY projects from 1)hypothalamus to the 2)intermediolateral column of the spinal cord, then to the 3) superior cervical (sympathetic) ganglion, and finally to the 4) pupil, the smooth mm of the eyelids, and the sweat glands of the forehead and face. Interruption of these pathways results in _________
|
Horner's syndrome
|
|
What nerve was injured?
Pt reports hitting his "funny bone" (medial epicondyle) hard! He now has impared wrist flexion and adduction. He can't adduct his thumb or the 4th and 5th digits resulting in a "claw hand". He has a loss of sensation over the medial palm and his pinky finger. |
ulnar
|
|
What nerve was injured?
pt experiences a break through the surgical neck of the humerus or has an anterior shoulder dislocation. He now has trouble abducting his arm above 30 degrees. |
Axillary
|
|
What nerve was injured?
Pt presents with a loss of function of biceps, coracobrachialis, and brachialis muscle. He has no biceps reflex? |
musculocutaneous
|
|
This nerve passes through the supinator
|
radial
|
|
this nerve passes through the pronator teres
|
median
|
|
this nerve passes through the flexor carpi ulnaris
|
ulnar
|
|
Child presents with "waiter's tip" appearance: arm hanging to one side (paralysis of abductors), medially rotated (paralysis of lateral rotators), and forarm is pronator (loss of biceps.
What is the dx? What are the nerve roots and what are you concerned about? |
Erb-Duchenne palsy
traction tear of the upper trunk of the brachial plexis (C5 & C6 roots) often follows blow to shoulder,could be due to trauma during delivery or child abuse. |
|
What nerve was injured?
Pt presents with loss of dorsiflexion resulting in "foot drop" |
Common peroneal nerve (L4-S2)
PED= Peroneal Everts & Dorsiflexes; if injured, foot is dropPED |
|
Deep peroneal nn innervates _______ compartment
Superficial peroneal nn innervates _______ compartment |
anterior
lateral |
|
What nn is injured?
pt presents with loss of plantar flexion. |
Tibial (L4-S3)
TIP=Tibial Inverts & Plantarflexes; if injured, cant stand on TIPtoes. |
|
What nn is damaged?
Pt presents with loss of knee extension and deminished pateller reflex. |
Femoral (L2-L4)
|
|
What nn is injured?
Pt presents with a loss of hip adduction? |
Obturator
|
|
Pt presents with:
1) atrophy of the thenar and hypothenar eminences 2) atrophy of the interosseous mm 3) sensory deficits on the medial side of the forearmand hand 4) disappearance of the radial pulse upon moving the head towards the opposite side What do you suspect? Discribe this disorder? |
Thoraci outlet syndrome (Klumpke's palsy)
Compression of subclavian aa and inferior trunk of brachial plexus (C8,T1) |
|
In a LMN lesion of CN XII the tongue will deviate _____ (away or towards) the side of the lesion?
|
towards
mneu: lick your wounds |
|
In a CN V motor lesion the jaw deviates ______ (towards or away) the side of the lesion
|
towards
|
|
in a CN X lesion the uvula will deviate _______ (towards or away) of the side of the lesion.
|
away
|
|
In a unilateral lesion of the cerebellum the pt tends to fall _______ (towards or away) the side of the lesion.
|
towards
|
|
In a CN XI lesion there is weakness turning head to the side _________ (ipsi or contralateral) to the lesion. There is also a shoulder droop (ipsi or contralateral) to the lesion
|
contralateral
ipsilateral |
|
pt presents with paralysis of the lower half his face only. What do you suspect.
|
contralateral UMN lesion
(either of motor cortex or connection between cortex and facial nucleus) |
|
pt presents with paralysis of one side of his entire face (upper and lower). What do you suspect?
|
ipsilater LMN lesion of CN VII
|
|
This disorder is due to a destruction of the facial nucleus itself or it's brancchial efferent fibers (facial nn). It results in ipsilateral facial paralysis with an inability to close the eye of the involved side. It is often idiopathic and there is gradual recovery in most cases
|
Bell's palsy
|
|
Give some diseases in which Bell's palsy is often seen as a complicaion.
|
Aids, Lyme dz, Sarcoidosis, Tumors, Diabetes
mneu: ALexander BELL with STD: AIDS, Lyme, Sarcoid, Tumors, Diabetes |
|
This herniation syndrome can compress the anterior cerebral aa
|
Cingulate herniation under falx cerebri
|
|
These 3 herniation syndrome can result in coma and death if brain stem is compressed.
|
1)downward transtentoral (central herniation
2) Uncal herniation (Uncus=medial temporal lobe) 3)Cerebellar tonsillar herniation into the foramen magnum |
|
In the case of an uncal herniation you may see ipsilateral dilated pupil/ptosis. This is due to what?
|
Stretching of CN III
|
|
In the case of an uncal herniation you may see contralateral homonymous hemianopia. This is due to what?
|
compression of ipsilateral posterior cerebral aa
|
|
In the case of an uncal herniation you may see ipsilateral paresis. This is due to what?
|
compression of contralateral crus cerebri (Kernohan's notch)
|
|
In the case of an uncal herniation you may see Duret hemorrhages (paramedian artery rupture). This is due to
|
caudal displacement of the brain stem
|
|
Pt can't see at all out of his right eye (right anopia) Where is the lesion?
|
Right optic nn
|
|
Pts has bilateral temporal visual field defects (bitemporal hemianopia) Where is the lesion?
|
Optic chiasm
|
|
Pt can't see the left visual field in either eye (Left homonymous hemianopia) Where is the lesion?
|
Right Optic Tract
|
|
Pt has Left upper quadratic anopsia (cant see up and to the right on both sides) Where is the lesion?
|
Right Temporal Lesion (Meyer's loop)
|
|
Pt has left lower quandrantic anopia (can't see down and to the left in either eye) Where is the lesion?
|
Right Parietal lesion
(Dorsal optic radiation) |
|
Pt has left hemianopia with macular sparing??
|
???visual cortex??
|
|
this syndrome is seen in many patients with multiple sclerosis. It results in medial rectus palsy on attempted lateral gaze & nystagmus in the abducting eye. Convergence is normal.
|
Internuclear opthalmoplegia (MLF syndrome)
mneu: MLF=MS |
|
explain the pathology of Internuclear opthalmoplegia (Medial longitudinal fasciculus [MLF] syndrome)[pic]
|
When looking left, the left nucleus of CN VI fires, which contracts the left lateral rectus and stimulates the contralateral (right) nucleus of CN III via the right MLF to contract the right medial rectus. Lesion in the MLF interrupts this process.
|
|
give the dz indicated by the following neurotransmitter changes:
↑NE,↓GABA,↓5HT |
Anxiety
|
|
give the dz indicated by the following neurotransmitter changes:
↓NE & ↓5HT |
depression
|
|
give the dz indicated by the following neurotransmitter changes:
↓ACh |
Alzheimer's dementia
|
|
give the dz indicated by the following neurotransmitter changes:
↓GABA,↓ACh |
Huntington's dz
|
|
give the dz indicated by the following neurotransmitter changes:
↑Dopamine |
Schizophrenia
|
|
give the dz indicated by the following neurotransmitter changes:
↓ Dopamine |
Parkinson's dz
|
|
When a person becomes disoriented they generally lose concept of person(their name, who they are), place (where they are), and time. In what order does this loss usually occur?
|
1st-time
2nd-place last-person |
|
what is anosognosia?
|
unawareness that one is ill
|
|
what is autotopagnosia
|
inability to locate one's own body parts
|
|
what is depersonalization
|
body seems unreal or dissociated
|
|
what is ANTEROgrade amnesia?
|
inability to remember things that occurred afte a CNS insult
mneu: antero=after |
|
what is RETROgrade amnesia?
|
inability to remember things that occurred before a CNS insult
mneu: retro=before |
|
what is substance dependance?
|
maladaptive pattern of substance use defined as 3 or more of the follwing signs in 1 yr:
1)tolerance 2)withrawal 3)substance taken in larger amounts or over longer period of time than desired 4) persistant desire or attempts to cut down 5) significant energy spent obtaining, using, or recovering from substance 6 Important social, occupational, or recreational activities reduced because of substance use 7) continued use in spite of knowing the problems it causes |
|
What is substance abuse
|
maladaptive pattern leading to clinically significant imparment or distress. Symptoms have not met criteria for substance dependance. 1 or more of the follwing in 1 yr:
1) recurrent use resulting in failure to fulfill major obligations at work, school, or home 2) recurrent use in physically hazardous situations 3) recurrent substance-related legal problems 4)Continued use in spite of problems caused by use |
|
intoxication of this drug results in disinhibition, emotional lability, slurred speech, ataxia, coma, blackouts.
|
alcohol
|
|
gamma glutamyltransferase (GGT) is a sensitive indicator of this drugs use
|
alcohol
|
|
withdrawal from this drug results in tremor tachycardia, hypertension, malaise, nausea, seizures, delerium tremens (DTs), tremulousness, agitation, hallucinations
|
alcohol
|
|
intoxication of this substance results in CNS depression, nausea and vomiting, constipation, pupillary constriction (pinpoint pupils), seizures
*overdose is life threatening |
opiods
|
|
withdrawal from this substance results in anxiety, insomnia, anorexia, sweating, dilated pupils, piloerection (goose pimples), fever, rhinorrhea, nausea, stomach cramps, diarrhea ("flulike" symptoms), yawning
|
opiods
|
|
intoxication of this substance results in psychomotor agitation, impared judgement, pupillary dilation, hypertension, tachycardia, euphoria, prolonged wakefulness and attention, cardiac arrhythmias, delusions, hallucinations, fever
|
amphetamines
|
|
withdrawal from this substance results in post use "crash", including depression, lethargy, headache, stomach cramps, hunger, hypersomnolence
|
amphetamines
|
|
intoxication of with this substance results in euphoria, psychomotor agitation, impared judgement, tachycardia, pupillary dilation, hypertension, hallucinations (including tactile), paranoid ideations, angina, sudden cardiac death
|
cocaine
|
|
withdrawal from this substance results in a post-use "crash", including severe depression and suicidality, hypersomnolence, fatigue, malaise, and severe psychological craving
|
cocaine
|
|
intoxication with this substance results in belligerence, impulsiveness, fever, psychomotor agitation, vertical and horizontal nystagmus, tachycardia, ataxia, homicidality, psychosis, delirium
|
PCP
|
|
with this drug recurrence of intoxication symptoms can occur due to reabsorption in the GI tract, resulting in a sudden onset of severe, random, homicidal violence
|
PCP
|
|
intoxication with this substance can result in marked anxiety or depression, delusions, visual hallucinations, flashbacks, and pupil dilation
|
LSD
|
|
Intoxication with this substance can result in euphoria, anxiety, paranoid delusions, perception of slowed time, impared judgement, social withdrawal, increased appetite, dry moth, hallucinations
|
Marijuana
|
|
Intoxication with this drug is dangerous because of its low safety margin. higher doses result in respiratory depression
|
barbituates
|
|
withdrawal from this substance results in anxiety, seizures, delerium, and life-threatening cardiovascular collapse
|
barbiturates
|
|
These medications have a greater safety margin than barbituates. Intoxication can result in amnesia, ataxia, somnolence, minor respiratory depression.
|
benzodiazepines
|
|
these drugs have an additive effect with alcohol
|
benzodiazepines
|
|
withdrawal from these drugs results in rebound anxiety, seizures, tremor, and insomnia
|
benzodiazepines
|
|
excessive use of this drug results in restlessness, insomnia, increased diuresis, muscle twitching, and cardiac arrhythmias
|
caffeine
|
|
withdrawal from this drug results in headache, lethargy, depression, and weight gain
|
caffiene
|
|
use of this drug results in restlessness, insomnia, anxiety, and arrhythmias-no increased diuresis
|
nicotine
|
|
withdrawal from this drug results in irritability, headache, anxiety, weight gain, and extreme cravings
|
nicotine
|
|
use of this drug results in restlessness, insomnia, anxiety, and arrhythmias-no increased diuresis
|
nicotine
|
|
This dz is charachterized by physiologic tolerance and alcohol dependence with symptoms of withdrawal (tremor, tachycardia, hypertension, malaise, nausea, DTs when intake is interrupted. Pts will show continued drinking despite medical and social contradictions and life disruptions.
|
Alcoholism
|
|
What is a drug used in treatment of alcoholism
|
disulfiram
|
|
describe the metabolism and effects of ethenaol
|
image p. 360
|
|
When do DTs usually appear in alcoholics?
|
2-5D after last drink.
|
|
In alcoholics in withdrawal what occurs 1st--autonomic system hyperactivity (tachycardia, tremors, anxiety) or psychotic symptoms (hallucinations, delusions)
|
1st-autonomic hyperactivity
2nd-psychotic symptoms |
|
How do you treat DTs in alcholics going through withdrawal?
|
benzodiazpenes
|
|
Long-term alcohol use leads to this involving micronodular cirrhosis with accompaning symptoms of jaundice, hypoalbuminemia, coagulation factor deficiencies, and portal hypertension.
|
alcoholic cirrhosis
|
|
This syndrome caused by vitamin B1 (thiamine) deficiency, is common in malnourished alcoholics. They classically present with a triad of confusion, opthallmoplegia, and ataxia. This may progress to memory loss, confabulation, and personality change. It is associated with periventricular hemorrhage/necrosis, especially in mamillary bodies.
|
Wernicke-Korsakoff syndrome
|
|
What is the tx of Wernicke-Korsakoff syndrome
|
IV vitamine B1 (thiamine)
|
|
this complication of alcoholism consists of longitudinal lacerations at the gastroesophageal junction caused by excessive vomiting. In contrast to esophageal varices it is associated with pain.
|
Mallory-Weiss syndrome
|
|
Heroine is a schedule __ drug
|
schedule I (not perscribable)
|
|
addicts of this drug are at increase risk of hepatitis, abscesses, overdose, hemorrhoids, AIDS, and right sided endocarditis.
|
heroine
|
|
These drugs can competatively inhibit opiods
|
Naloxone (narcan) and naltrexone
|
|
This long acting oral opiate is used for heroine detoxification or long term maitenance
|
methadone
|
|
this psychiatric illnesss involves rapid decrease in attention span and level of arousal. Pts show disorganized thinking, have hallucinations, illusions, misperceptions, disturbance in sleep wake cycle, and cognitive disfunction.
The key to diagnosis is its rapid onset and the waxing and waning of level of conciousness. |
delerium
mneu: deliRIUM=changes in sensoRIUM |
|
this is the most common psychiatric illness on medical and surgical floors.
|
delerium
|
|
delerium is often iatrogenic and reversable. Look at pts meds for ones with this effect.
|
anticholenergic
|
|
This psychiatric illness ivolves a gradual decrease in cognition--memory deficits, aphasia, apraxia, agnosia, loss of abstract thought, behavior/ personality changes, and impared judgement.
Be sure to differentiate this from delerium. The key to diognosis is the more gradual onset and the fact that pt is alert with no change in his/her level of conciousness. |
Dementia
mneu: DeMEMtia is characterized by MEMory loss. Commonly irreversable. |
|
In elderly pts this disease can often present like dementia.
|
depression
|
|
DSM Criteria of Major depressive episode
|
characterized by at least 5 of the following for 2 weeks, including either depressed mood or anhedionia:
1) Sleep disturbance 2)↓ Interest 3)Guilt or feelings of worthlessness 4)↓ Energy 5)↓Concentration 6)↕Appetite 7)Psychomotor retardation/agitation 8)Suicidal ideations mneu: SIG E CAPS |
|
Lifetime prevalence of a major depressive episode is _____ for males and _____ for females
|
5-12% - males
10-25% - females |
|
This variation on Major depressive disorders invoves 2 or more major depressive episodes with a symptom free interval of 2 months
|
RRECURRENT Major Depressive Disorder
|
|
This disorder is a milder form of depression that lasts at least 2 years
|
dysthymia
|
|
Pts with depression typically have the follwing 3 changes in their sleep stages.
|
1)↓ slow wave sleep
2)↓REM latency 3) Early-morning awakening (important screening question |
|
Risk factors for suicide completion
|
Sex (male)
Age (teenager or elderly) Depression Previous attempt Etoh (or drug use) Rational thinking (loss of) Sickness (≥3 perscriptions) Organized plan No spouce (esp if childless) Social support lacking mneu: SAD PERSONS |
|
ECT is a treatment option when?
|
MDD refractory to other treatment
|
|
Major adverse effects of ECT
|
anterograde and retrograde amnesia, and confusion
|
|
T or F: ECT is painful.
|
F
|
|
This psychiatric disorder is characterized by a period of abnormally and persistantly elevated, expansive, or irritable mood lasting at least one week.
|
Manic episode
|
|
Describe the DSM criteria for a manic episode.
|
During a manic episode, 3 or more of the follwing are present:
1) Distractibility 2) Irresponsibility 3) Grandiosity 4) Flight of ideas 5)↑Activity 6)↓Sleep 7)Talkativeness mneu: DIG FAST |
|
this psychiatric disturbance is like a manic episode except mood disturbance is not severe enough to cause marked imparement in social and/or occupational functioning or to necessitate hospitalization. There are no psychotic features
|
Hypomanic episode
|
|
In this disorder pt consciosly fakes or claims to have a disorder in order to attain a specific gain (e.g., avoiding work, obtaining drugs)
|
malingering
|
|
Drug of choice for bipolar disorder
|
lithium
|
|
what is cyclothymic disorder?
|
a milder form of bipolar disorder lasting at least 2 years
|
|
In this disorder the pt conciously creates symptoms in order to assume the "sick role" and to get medical attention.
|
factitious disorder
|
|
This form of factitious disorder is manifested by a chronic history of multiple hospital admissions and willingness to receive invasive procedures.
|
Munchausen's syndrome
|
|
This factitious disorder is seen when an illness in the child is caused by the parent. The motivation is unconscious. It is a form of child abuse and must be reported.
|
Muchausen's syndrome by proxy
|
|
In this psychiatric disorder both illness production and motivation are unconcious drives. These are more common in women and manifest themselves in a variety of ways.
|
Somatoform disorders
|
|
Type of somatoform disorder in which pt presents with motor or sensory symptoms (e.g., paralysis, pseudoseizure) that suggest neurologic of physical disorder, but tests and physical exam are negative. Onset of symptoms often follow an acute stressor. Pt may seem strangely unconcerned about symptoms
|
Conversion disorder
|
|
Type of somatoform disorder in which pt presents with prolonged pain that is not explained completely by an illness.
|
Somatoform pain disorder
|
|
Type of somatoform disorder in which pt presents with preoccupation with and fear of having a serious illness in spite of medical reassurance
|
hypochondriasis
|
|
Type of somatoform disorder in which pt presents with a variety of complaints in multiple organ sytems with no identifiable underlying physical findings
|
Somatization disorder
|
|
Type of somatoform disorder in which pt presents with preoccupation with minor or imagined physical flaws. Pts often seek cosmetic surgery
|
Body dysmorhic disorder
|
|
Type of somatoform disorder in which pt presents with false belief of being pregnant associated with objective physical signs of pregnancy
|
pseudocyesis
|
|
What type of gain: primary, secondary, tertiary?
What the symmptom does for the patients internal psychic economy |
primary gain
|
|
What type of gain: primary, secondary, tertiary?
What the symptom gets the patient (sympathy, attention) |
secondary gain
|
|
What type of gain: primary, secondary, tertiary?
What the caretaker gets (like an doctor on an interesting case) |
tertiary
|
|
Describe DSM characterization of panic disorder
|
recurrent periods of intense fear and discomfort peaking in 10 minutes with 4 of the following:
Palpitations Paresthesias Abdominal distress Nausa, Intense fear of dying or losing control lIght headedness Chest pain Chills Choking disConnectedness Sweating Shaking Shortness of breath mneu: PPANIICCCCSSS note: panic disorder is descrribed in context of occurrence (e.g., panic d/o w/ agoraphobia) |
|
This psychiatric disorder involves a specific fear that is excessive or unreasonable. It is cued by presence or anticipation of a specific object or situation. Exposue to this object or situation provokes an anxiety response. Person recognizes the fear is excessive (insight). This fear interfears with normal routine.
|
specific phobia
|
|
what form of psychotherapy works well for specific phobias
|
systematic desensitation
|
|
gamophobia
|
fear of marrage
|
|
algophobia
|
fear of pain
|
|
acrophobia
|
fear of heights
|
|
agoraphobia
|
fear of open spaces
|
|
In this disorder person experiences or witnesses an event that involved actual or threatened death or serious injury. response involves intense fear, helplessness, or horror. The traumatic event is persistently reexperienced as nightmares or flashbacks. The person persistantly avoids stimuli associated with the trauma and experiences persistant symptoms of increased arousal. Disturbance lasts > 1mo and cuases distress or socia/occupation imparent. This disorder often follwos acute stress disorder which lasts up to 2-4 weeks.
|
Post-traumatic stress disorder
|
|
In this disorder emotional symptoms (anxiety, depression) causing impairment follw an identifiable psychosocial stressor (e.g., divorse, moving). This lasts less than 6 months
|
Adjustment disorder
|
|
This psychiatric disorder is characterized by uncontrollable anxiety for at least 6 months that is unrelated to a specific person, situation, or event. Sleep disturbance, fatigue, and difficulty concentrating are common.
|
generalized anxiety disorder
|
|
children with this disorder have severe communication problems and difficulty forming relationships. This disorder is characterized by repetitive behavior, unusual abilities (savants), and usually below-normal intelligence.
|
Autistic disorder
|
|
This disorder is a milder form of autism involving problems with social relationships and repetitive behavior. These children are of normal intellegence and lack social or cognitive deficits.
|
Asperger disorder
|
|
This is an X-linked disorder seen only in girls (affected males die in utero). It is characterized by a loss of development and mental reatardation appearing at approximately age 4. There is steriotyped hand-wringing.
|
Rett disorder
|
|
this disorder is characterized by limited attention span and hyperactivity. Children are emotionally labile, impulsive, and prone to accidents. These children typically have normal intellegence.
|
Attention Deficit Hyperactivity Disorder (ADHD)
|
|
What is the treatment of ADHD
|
methylphenidate
|
|
This psychiatric disorder of childhood is characterized by behavior that continually violates social norms. At >18 y/o this disorder is recategorized as antisocial personality disorder.
|
Conduct disorder
|
|
This psychiatric disorder of childhood is characterized by noncompliance in the absence of criminality.
|
Oppositional defiant disorder.
|
|
This psychiatric disorder of childhood is characterized by motor/vocal tics and involuntary profanity. Onset is <18 y/o.
|
Tourette's syndrome
|
|
What is the treatment for Tourette's syndrome
|
haloperidol
|
|
This psychiatric disorder of childhood is characterized by fear of loss of attachment figure leading to factitious physical complaints to avoid going to school. The common onset is age 7-8.
|
Seperation anxiety disorder.
|
|
This eating disorder is commonly seen in adolescent girls and coexists with depression. It is characterized by excessive dieting, body image distortion, and increased exercise. Pts often experience severe weight loss, amenorrhea, anemia and eventually electrolyte disturbance.
|
Anerexia nervosa
|
|
This eating disorder is characterized by binge eating followed by self-induced vomiting or use of laxitives. Body weight is typically normal. Parotitis, enamel erosion, electrolyte disturbances, alkalosis, and dorsal hand calluses are common physical exam/lab findings.
|
Bulimia nervosa
|
|
Hallucinations v. Illusion v. Delusions
______ are perceptions in the absense of external stimuli |
Hallucinations
|
|
Hallucinations v. Illusion v. Delusions
__________ are misinterpretations of actual external stimuli |
illusions
|
|
Hallucinations v. Illusion v. Delusions
______ are false beliefs not shared with other members of culture/subculture that are firmly maintained in spite of obvious proof to the contrary |
Delusions
|
|
Delusions v. Loose associations
a _____ is a disorder in the CONTENT of the thought (the actual idea) |
delusion
|
|
Delusions v. Loose associations
a _____ is a disorder in the FORM of the thought (the way the ideas are tied together) |
loose association
|
|
hallucination types:
______ and _____ hallucinations are common in schizophrenia |
auditory and visual
|
|
hallucination types:
_____ hallucination often occurs as an aura of a psychomotor siezure |
olfactory
|
|
hallucination types:
_____ hallucinations are rare |
gustatory
|
|
hallucination types:
_____ hallucinations are common in DTs. Also seen in cocaine abusers ("cocaine bugs") |
tactile hallucination
|
|
formication
|
sensation of ants crawling on one's skin
|
|
by definition hypnagogic hallucinations occur when?
|
going to sleep
mneu: hypnaGOgic hallucination occurs while GOing to sleep |
|
by definition hypnopompic hallucinations occur when?
|
while waking from sleep
|
|
In this disorder a person stops brathing for at least 10 seconds repeatedly during sleep.
It is associated with obesit, loud snoring, systemic/pulmonary hypertension, arrhythmias, and possibly sudden death. The individual may become chronically tired. |
sleep apnea
|
|
In this subcagegory of sleep apnea, the pt shows no respiratory effort
|
central sleep apnea
|
|
In this subcagegory of sleep apnea, the pt shows respiratory effort against airway obstruction
|
obstructive sleep apnea
|
|
This diagnosis is categorizecd by disordered sleep-wake cycles. It may include hypnagogic (just before sleep) or hypnopompic (just before waking) hallucinations. The person's sleep episodes start off with REM sleep.
|
narcolepsy
|
|
This form of narcolepsy involves a loss of all muscle tone follwing a strong emotional stimulus.
|
cataplexy
|
|
Tx for narcolepsy
|
ampetamines
|
|
This psychiatric illness is characterized by periods of psychosis and disturbed behavior with adecline in functioning lasting >6months.
|
schizophrenia
|
|
Give the DSM criterial for schizophrenia.
|
2 or more of the following symptoms (1-4 are positive symptoms)
1)Delusions 2)Hallucinations 3)Disorganized thought 4) Disorganized or catatonic behavior. 5. "negative symptoms"-flat affect, social withdrawal, lack of motivation, lack of speech or thought. |
|
What is the most common type of hallucination in schizophrenia
|
auditory
|
|
in schizophrenia, disorganized thought often takes the form of ______
|
loose associations
|
|
in the etiology of schizophrenia, what is more important, genetic or enviornmental factors
|
genetic
|
|
Symptoms of schizophrenia that last 1-6 mo
|
schizophreniform disorder
|
|
Symptoms of schizophrenia that last <1 mo
|
brief psychotic disorder (usually stress related)
|
|
Lifetime prevelence of schizophrenia
|
1.5%
|
|
schizophrenia typically presents earlier in _______ (males or females)
|
males
|
|
this psychiatric condition involves a combination of schizophrenia and a mood disorder
|
schizoaffective disorder
|
|
What are the 5 subtypes of schizophrenia
|
1)disorganized
2) catatonic 3)paranoid 4)undifferentiated 5) residual |
|
This is an enduring pattern of perceiving, relating to, and thinking about the enviornment and oneself that is exhibited in a wide reange of important social and personal contexts.
|
personality trait
|
|
This results when personality patterns become inflexible and maladaptive, causing impairment in social or occupational functioning or subjective disress. The person is usually not aware of the problem. These disordered patterns are stable only by early adulthood and not usually diagnosed in children.
|
personality disorders
|
|
This cluster of personality disorders usually present as "odd" or "eccentric. They cannot develop meaningful social relationships. Give cluster and types.
|
Cluster A "Wierd"
1)Paranoid 2)Schizoid 3) Schizotypal |
|
This cluster of personality disorders shows no psychosis but there is a genetic association with schizophrenia.
|
Cluster A "Wierd"
1)Paranoid 2)Schizoid 3) Schizotypal |
|
personality disorder characterized by distrust and suspiciousness
|
paranoid personality disorder
|
|
main defence mechonism exiped by those with paranoid personality disorder
|
projection
|
|
personality disorder characterized by voluntary social withdrawal and limited emotional expression
|
schizoid
|
|
personality disorder characterized by interpersonal awkwardness, odd beliefs or magical thinking. Often eccentric in appearance.
|
Schizotypal
|
|
This cluster of personality disorders is dramatic, emotiona, and eratic.
Give the cluster and the subtypes |
Cluster B: "Wild"
1)Antisocial 2) Borderline 3) Histrionic 4)Narcissistic |
|
This cluster of personality disorders has a genetic associateion with mood disorders and subsance abuse.
|
Cluster B: "Wild"
1)Antisocial 2) Borderline 3) Histrionic 4)Narcissistic |
|
personality disorder characterized by disregard and violation of the rights of others, usually manifesting itself in criminality. It affects males > females. Before 18 y/o it is called conduct disorder
|
antisocial personality diosrder
|
|
personality disorder characterized by unstable mood and interpersonal relationships, impulsiveness, sense of emptiness. Effects females more than males
|
Borderline
|
|
personality disorder characterized by excessive emotionality, attention seeking, sexually provocative
|
histrionic
|
|
personality disorder characterized by grandiosity & sense of entitlement. May react to criticism with rage.
|
Narcissistic
|
|
This cluster of personality disorders is charicterized by anxiety and fear. Give the cluster and the types.
|
Cluster C: "Worried"
1)avoidant 2)obsessive-compulsive 3)dependant |
|
This cluster of personality disorders has a genetic association with anxiety diosrders.
|
Cluster C: "Worried"
1)avoidant 2)obsessive-compulsive 3)dependant |
|
personality disorder characterized by sensitivity to rejection, socially inhibited, timid, feelings of inadequacy
|
avoidant
|
|
personality disorder characterized by preocupation with order, perfectionism, and control
|
obsessive-compulsive
|
|
personality disorder characterized by submissive and clinging behavior. They have an excessive need to be taken care of and low self confidence.
|
dependant
|
|
This dz is due to a loss of dopaminergic neurons and excess cholinergic activity
|
parkinsonism
|
|
The treatments for parkinson's dz can be summarized by the mneumonic BALSA. What does this stand for
|
Bromocriptine
Amantadine Levodopa (w/ carbidopa) Selegine (&COMT inhibitors) Antimuscarinics |
|
This drug is an erogot alkaloid an a partial dopamine agonist. The strategy behind this drug is to antagonize dopamine receptors.
|
bromocriptine
|
|
This drug may increase dopamine release.
|
Amantadine
|
|
This drug is converted to dopamine in the CNS
|
L-dopa/carbidopa
|
|
This drug is a selective MAO type B ihibitor. The strategy of this Parkensons drug is that it prevents dopamine breakdown.
|
Selegiline
|
|
This drug is a COMT ihibitor. The strategy of these Parkensons drugs is that it prevents dopamine breakdown.
|
entacapone & tolcapone
|
|
This drug is an antimuscarinic and thus curbs excess cholinergic activity seen in parkinsons. It improves tremor and rigitity but has little effect on bradykinesia
|
Benzotropine
|
|
The MOA of this parkinson's drug is that it ↑ levels of dopamine in the brain. Unlike dopamine, this drug can cross the blood-brain barrier and is converted by dopa decarboxylase in the CNS to dopamine
|
L-dopa (levvodopa)/carbidopa
|
|
What is the most common toxicity of L-dopa
|
arrhthmias from peripheral conversion to dopamine
|
|
Why is carbidopa given with levodopa.
|
carbidopa is a peripheral decarboxylase inhibitor. It is given with L-dopa inorder to limit the peripheral side effects.
|
|
Long term use of ______ can lead to the of dyskinesia follwing administraiton, and akinesia between doses.
|
L-dopa
|
|
This parkinsons drug acts by selectively inhibiting MAO-B, therby ↑ the availabilty of dopamine.
|
Selegine
|
|
This drug is a 5-HT (1D) agonist. It causes vasoconstriction and is used for acute migrane or cluster headache attacks.
|
Sumatriptan
|
|
This drug for acute migrane & cluster headache attacks has toxicities that include coronary vasosasm, thereore it is contraindicated in pts with CAD or Prinzmetal's angina
|
Sumatriptan
|
|
This drug is 1st line for tonic clonic siezures and status epilepticus prophylaxis. It acts by ↑ Na+ channel inactivation
|
phenytoin
|
|
This drug is first line for tonic clonic siexures and trigeminal neuralgia. It acts by ↑ Na+ channel inactivation.
|
Carbazepine
|
|
This siezure medication blocks voltage gaited Na+ channels, but has no effect on GABA release
|
Lamotrigine
|
|
This epilepsy medication acts to ↑ GABA release. It is also used for peripheral neuropathy
|
Gabapentin
|
|
This epilepsy medication acts to block Na+ channels and ↑ GABA release.
|
topiramate
|
|
This epilepsy medication acts to ↑ GABA action. It is 1st line in pregnant women & children
|
phenobarbital
|
|
This epilepsy medication acts to ↑ Na+ channel inactivation & ↑ GABA concentration. It is 1st line for tonic-clonic/ myoclonic seizures and can be used for absence seizures.
|
valproic acid
|
|
This epilepsy medication is 1st line for absence seizures. It acts by blocking the thalamic T-type Ca++ channesls.
|
ethsuximide
|
|
This epilepsyy drug acts by ↑ GABA action. It is first line for acute status epilepticus. It is also usd for seizures of eclampsia (however NOT 1st line--which is MgSO4)
|
Benzodiazepines
(diazepam or lorazepam) |
|
Give the epilepsy drug associated with the following toxicities:
sedation, tolerance, dependence |
benzodiazepines
|
|
Give the epilepsy drug associated with the following toxicities:
Diplopia, ataxia, blood dyscrasias (agranulocytosis, aplastic anemia), liver toicity, teratogenesis, induction of cytochrome P-450. |
Carbamazepine
|
|
Give the epilepsy drug associated with the following toxicities:
GI distress, lethargy, headache, uticaria, Stevens-Johnson syndrome |
Ethosuximide
|
|
Give the epilepsy drug associated with the following toxicities:
Sedation, tolerance, dependance, induction of cytocrome P-450. |
Phenobarbital
|
|
Give the epilepsy drug associated with the following toxicities:
Nystagmus, diplopia, ataxia, sedaton, gingival hyperplasia, hirsuitism, megaloblastic anemia, teratogenesis, SLE-like syndrome, induction of cytocrome P-450. |
Phenytoin
|
|
Give the epilepsy drug associated with the following toxicities:
GI distress, rare but fatal hypatotoxicity (measure LFTs), neural tube defects in fetus (spinal bifida), tremor, weight gain. |
Valproic acid
|
|
Give the epilepsy drug associated with the following toxicities:
Stevens-Johnson syndrome |
Lamotrigine
|
|
Give the epilepsy drug associated with the following toxicities:
Sedation, ataxia |
Gabapentin
|
|
Give the epilepsy drug associated with the following toxicities:
Sedation, mental dulling, kidney stones, weight loss |
Topiramate
|
|
The mechanism of this drug is blockade of Na+ channels; inhibition of glutamate release from exitatory presynaptic neurons
|
phenytoin
|
|
This drug is 1st line for tonic clonic siezures and for prophylaxis of status epilepticus. It is also a class IB antiarrhythmic.
|
phenytoin
|
|
The toxicities of this drug include: nystagmus, ataxia, diplopia, sedation, SLE-like syndrome, induciton of cytocrome P-450. Chronic use produces gingival hyperplasia in children, peripheral neuropathy, hirsutism, megaloblastic anemia (↓B12), and malignant hyperthermia (rare). It is also teratogenic.
|
phenytoin
|
|
This drug acts by facilitating GABA action by ↑ duration of Cl- channel opening, thus ↓ neuron firing
|
barbituates (phenobarbital, pentobarbital, thiopental, secobarbital)
mneu: BarbiDURATe (increased DURATion) |
|
This group of drugs is used as a sedative for anxiety, siezures, insomnia, induction of anesthesia
|
barbituates (phenobarbital, pentobarbital, thiopental, secobarbital)
|
|
Toxicities of this drug include dependence, additivee CNS depression effects with etoh, respiratory of CV depession (can lead to death. There are also many drug interactions owing to induction of liver microsomal enzymes (cytocrome P-450)
|
barbituates (phenobarbital, pentobarbital, thiopental, secobarbital)
|
|
this type of drugs is contraindicated in porphyria
|
barbituates (phenobarbital, pentobarbital, thiopental, secobarbital)
|
|
What do you do if someone ODs on barbituates?
|
symptom management (assist respiration, manage BP)
|
|
The mechanism of this drug is to facilitate GABA action by ↑ frequency of Cl- channel opening
|
Benzodiazepines (Diazepam, lorazepam, triazolam, temazepam, oxazepam, midazolam, chlordiazepoxide, alprazolam)
mneu: FREnzodiazepenes (increased FREquency) |
|
Most benzodiazepines have long half-lives and active metabolites. The short acting ones are what? (3)
|
Triazolam, Oxazepam, Midazolam
mneu: TOM Thumb |
|
These drugs are used to treat anxiety, spasticity, status epilepticus, detoxification (esp etoh w/drawl[DTs]), night terrors, & sleep walking.
|
Benzodiazepines (diazepam, lorazepam, triazolam, temazepam, oxazepam, midazolam, chlordiazepoxide, alprazolam)
|
|
Toxicity of this drug includes dependence, additive CNS depression effects with alcohol. Less risk of respiratory depressiona nd coma than with barbituates.
|
Benzodiazepines (diazepam, lorazepam, triazolam, temazepam, oxazepam, midazolam, chlordiazepoxide, alprazolam)
|
|
Treat Benzodiazepine overdose with ________
|
Flumazenil (competitive antagonist at GABA receptor)
|
|
These drugs are used to treat anxiety, spasticity, status epilepticus, detoxification (esp etoh w/drawl[DTs]), night terrors, & sleep walking.
|
Benzodiazepines (diazepam, lorazepam, triazolam, temazepam, oxazepam, midazolam, chlordiazepoxide, alprazolam)
|
|
phenobarbital, pentobarbital, thiopental, secobarbital are ________
|
barbituates
|
|
diazepam, lorazepam, triazolam, temazepam, oxazepam, midazolam, chlordiazepoxide, alprazolam are _______ (drug category)
|
Benzodiazepines
|
|
Thioridazine, haloperidol, fluphenazine, chlorpromazine are all _______ (drug category)
|
Antipsychotics (neuroleptics)
|
|
This drug acts to block dopamine (D2) receptors
|
antipsychotics (neuroleptics
|
|
This drug category is used to treat psychosis, acute mania, and tourettes syndrome
|
antipsychotics
|
|
Toxicies of this group of drugs include extrapyramidal system (EPS side effects)
|
antipsychotics
|
|
Toxicies of this group of drugs include endocrine side effects (e.g., dopamine receptor antagonism →hyperprolactinemia→gynomastia)
|
antipsychotics
|
|
Toxicies of this group of drugs include side effects arising from muscarinic block (dry mouth &constipation), alpha receptors (hypotension) and histamine receptors (sedation)
|
antipsychotics
|
|
This toxicity of antipsychotic involves symptoms that include rigidity, myoglobinuria, autonomic instability, hyperpyrexia.
|
Neuroleptic malignant syndrome
|
|
How do you treat Neuroleptic malignant syndrome (antipsychotic toxicity)
|
dandrolene and dopamine agonists)
|
|
This antipsychotic toxicity includes stereotypic oral-facal movements, probably due to dopamine receptor sensitization, which results from long term antipsychotic use.
|
Tarditive dyskinesia
|
|
Evelution of EPs side effects with antipsychotic use:
|
4 h acute dystonia
4 d akinesia 4 wk akathisia 4 mo tarditive dykinesia (often reversible) |
|
The drugs clozapine, olanzapine, risperidone are of the category _________
|
Atypical antipsychotis
mneu: i'ts not ATYPICAL for OLd CLOsets to RISPER |
|
This group of drugs acts by blocking 5-HT2 and dopamine receptors
|
Atypical Antipsychotics
|
|
These drugs are used in treatment of schizophrenia; they are useful for positive and negative symptoms and they have fewer extrapyramidal and anticholinergic side effects than other antipsychotics.
|
Atypical antipsychotics
|
|
This atypical antipsychotic is also used for OCD, anxiety disorder, depression, mania, and tourettes syndrome
|
Olanzapine
|
|
This atypical antipsychotic may cause agranulocytosis and requires weekly WBC monitoring
|
Clozapine
|
|
The mechanism of this drug is not established. It is possibly related to an inhibition of the phosphoinositol cascade.
|
Lithium
|
|
This drug is used as a mood stabilizer for bipolar affective disorder. It blocks relapse and acute manic events.
|
Lithium
|
|
Toxicity of this drug includes tremor, hypothyroidism, polyuria (ADH antagonist causing nephrogenic diabetes insipidus), teratogenesis.
This drug also has a narrow therapeutic window requiring close monitoring of serum levels. |
lithium
mneu: LMNOP Lithium side effects: Movement (tremor) Nephrogenic dbts insipidus hypOthyroidism Pregnancy problems |
|
ANTIDEPRESSANTS [image]p.371
|
--
|
|
The drugs Fluoxetine, sertraline , paroxetine, and citalopram belong to this category of drugs
|
Serotonin-specific reuptake Inhibitors (SSRI)
|
|
This drug is indicated for endogenous depression, and obsessive compulsive disorder
|
SSRIs
|
|
This drug boast fewer toxicities than TCAs but has been associated with GI distress, sexual dysfuncion (anorgasmia).
|
SSRIs
|
|
When used with MAO inhibitors, SSRIs can cause "serotonin syndrome." What three things does this involve.
|
hyperthermia, muscle rigidity, CV collapse
|
|
The drugs Imipramine, amitriptyline, desipramine, nortriptyline, clomipramine, and doxepin are of this medication category
|
Tricyclic antidepressants
|
|
These drugs act to block the reuptake of NE and serotonin
|
tricyclic antidepressants
|
|
These drugs are indicated for major depression that does not respond to SSRIs
|
tricyclic antidepressants
|
|
This tricyclic antidepressant is indicated for bedwetting
|
imipramine
|
|
This is the only tricyclic antidepressant indicated for OCD
|
clomipramine
|
|
The side effects of these drugs include sedation, alpha blocking effects (hypotension), atropine like (anticholinergic) side effects (tachycardia, urinary retention)
|
tricyclic antidepressants
|
|
Secondary TCAs like ______ have less anticholinergic side effects than do tertiary TCAs like amitriptyline
|
nortriptyline
|
|
This TCA is the least sedating.
|
desipramine
|
|
The side effects of these drugs include sedation, alpha blocking effects (hypotension), atropine like (anticholinergic) side effects (tachycardia, urinary retention)
|
tricyclic antidepressants
|
|
Give the 3 Cs of Tricyclic antidepressant toxicity
|
Convulsions, Coma, Cadiotoxicity (arrhythmias)
also can have respiratory depression & hyperpyrexia? |
|
Your elderly pt on TCAs develops confusion and hallucinations. What could this be due to and what is an alternative TCA that could be given?
|
This could be due to the anticholinergic side effects of TCAs. Use nortriptyline.
|
|
Bupropion, Venlafaxine, Mirtazapine, Maprotiline, Trazodone belong to what drug category
|
heterocyclic antidepressents
mneu: You need BUtane in your VEiNs to MURder for a MAP of AlcaTRAZ |
|
These are 2nd and 3rd generation antidepressante with varied and mixed mechanisms of action. They are used to treat major depession.
|
heterocyclic antidepressants
|
|
This heterocyclic antidepressant is also used for smoking cessation. Its mechanism s not well known. Toxicity includes stimulant effects (tachycardia, insomnia), headache, and siezure in bulimic pts. It does NOT cause sexual side effects.
|
Buproprion
|
|
This heterocyclic antidepressant is also used in generalized anxiety disorder. It inhibits serotonin, NE, & dopamine reuptake. Toxicity includes stimulant effects, sedation, nausea, constipation and increased BP.
|
Venlafaxine
|
|
This heterocyclic antidepressant is an alpha2 antagonist (↑ release of NE and serotonin) and a potent 5-HT(2) & 5-HT(3) receptor antagonist. Toxicity includes sedation ↑ appetite, weight gain, and dry mouth.
|
Mirtazapine
|
|
This heterocyclic antidepressant blocks NE reuptake. Toxicity includes sedation and orthostatic hypotension.
|
Maprotiline
|
|
This heterocyclic antidepressant acts primarily to inhibit seratonin reuptake. Toxicity includes sedation, nausea, priaprism, and postural hypotension
|
Trazodone
|
|
The drugs Phenelzine & tranylcypromine are of this catigory
|
Monoamine oxidase Inhibitors (MAOIs)
|
|
This drug acts by non-selectively inhibiting Monoamine oxidase (MAO)→↑ levels of amine neurotransmitters
|
Monoamine oxidase inhibiters (MAOIs)
|
|
These drugs are used for atypical depression (i.e., with psychotic or phobic features, anxiety, and hypochondriasis.
|
Monoamine oxidase inhibiters (MAOIs)
|
|
These drugs can cause a hypertensive crisis with tyramine ingestion (wine & cheese) and merperidine. They also can cause CNS stimulation.
|
Monoamine oxidase inhibiters (MAOIs)
|
|
These drugs are contraindicated with SSRIs or Beta agonists (to prevent seratonin syndrome)
|
Monoamine oxidase inhibiters (MAOIs)
|
|
CNS anesthetics must be ______ soluable in order to cross teh blood-brain barrier
|
lipid
|
|
anesthetics with ↓ solubility in blood have ____ induction and recovery times
|
rapid
|
|
anesthetics with ↑ solubility in lipids have ______ potency
|
increased
|
|
relative potency of inhalation anesthetics is indicated by what index
|
Minimal anesthetic concentration
|
|
Minimal anesthetic concentration is ________ (proportional or inversely proportional) to potency
|
inversely proportional
potency =1/MAC |
|
Fill in the blanks regarding general principles of anesthesia.
↑ solubility in ______ = ↑ Potency =1/MAC |
lipids
|
|
N2O has low blood and lipid solubility. What is the rate of induction and what is the potency?
|
fast
low |
|
Halothane has ↑ lipid and blood solubility, and thus ____ potency and ____ induction
|
high
slow |
|
anesthetics with ↓ solubility in blood have ____ induction and recovery times
|
rapid
|
|
anesthetics with ↑ solubility in lipids have ______ potency
|
increased
|
|
halothane, enflurane, isoflurane, sevoflurane, methoxyflurane, and nitrous oxide are all this type of anesthetic
|
inhaled anesthetics
|
|
These drugs result in myocardial & respiratory depression, nausea/emesis, and increased cerebral blood and decreased cerebral metabolic demand.
|
inhaled anesthetics
|
|
This inhaled anesthetic has a toxicity of hepatotoxicity
|
halothane
|
|
This inhaled anesthetic has a toxicity of nephrotoxicity
|
methoxyflurane
|
|
This inhaled anesthetic has a toxicity of seizures.
|
enflurane
|
|
This is a rare but very dangerous toxicity of inhaled anesthetics
|
malignant hyperthermia
|
|
This is a barbituate intravenous anesthetic. It is high potency (high lipid solubility). It is used for induction of anesthesia and short surgical procedures. It decreases cerebral blood flow.
|
Thiopental
|
|
This benzodiazepine given IV is the most common anesthetic used for endoscopy. It may cause severe postoperative respiratory depression, decreased BP, and amnesia.
|
Midazolam
|
|
You give your pt Midazolam for his endoscopy. Postoperatively he developse hypotension. What drug do you give him?
|
flumazenil
|
|
Thses PCP analogs given IV act as dissociative anesthetics. They are cardiovascular stimulants. They cause hallucinations and bad dreams. They increase cerebral blood flow.
|
Arylcyclohexamines (Ketamine)
|
|
These opiates are given IV with other CNS depressants during general anesthesia
|
morphine, fentanyl
|
|
This IV anesthetic is used for rapid anesthesia induction and short procedures. It has less postoperative nausea than thiopental.
|
Propofol
|
|
What are the IV anesthetics?
|
Barbituates
Benzodiazepines Ketamine Opiates Propofol mneu: B.B. King on OPIATES PROPOses FOOLishly |
|
This drug is used in the treatment of malignant hyperthermia and neuroleptic malignant syndrome.
|
dantrolene
|
|
This condition can be caused by the concomitant use of inhalation anesthetics (except N2O) and succinylcholine.
|
Malignant hyperthermiia
|
|
The drugs procaine, cocaine, tetracaine, lidocaine, mepivacaine, pubivacaine are in this category
|
local anestetics
|
|
Procaine, cocaine, tetracaine, are considered this type of local anesthetics.
|
esters
|
|
lidocaine, mepivacaine, pubivacaine are considered this type of local anesthetics.
|
amides
mneu: amIdes all have 2 "I"s in their names |
|
This group of drugs acts by blocking Na+ channels in nerves by binding to secific receptors on the inner portion of the channel
|
local anesthetics
|
|
Your pt has infected tissue that needs to be anesthetized. Do you need more or less local anesthetic?
|
More-infected tissue is acidic and therefore charged. The charged anesthetics will have trouble penetrating the membrane effectively.
|
|
Give the order of anesthetic nn block regarding diameter of nn and myelination
small melinated autonomic fibers large myelinated autonomic fibers small unmyelinated pain fibers |
small diameter> large diameter
Myelinated>unmyelinated Overall size factor predominates over myelination factor small unmyelinated pain fibers> small melinated autonomic fibers>large myelinated autonomic fibers |
|
What is the order of loss in sensation upon administration of a local anesthetic.
touch,pain,pressure, temp |
pain>temp>touch>pressure
|
|
Local anesthetics are usually given with this to enhance local action--↓bleeding, ↑ anesthesia by ↓ systemic concentration.
|
epinephrine (or another vasoconstrictor)
|
|
These drugs are used for minor surgical procedures and as spinal anesthesia.
|
local anesthetics
|
|
You want to give you're pt a local anesthetic but she is allergic to esters. Name an amide you can give her.
|
lidocaine, mepivacaine, bupivancaine
|
|
a toxicity of this local anesthetic is CV toxicity
|
bupivacaine
|
|
a toxicity of this local anesthetic is arrhythmias
|
cocaine
|
|
general side effects of local anesthetics may include?
|
CNS exitation, hypertension, hypotension
|
|
These drugs are used for muscle paralysis in surgery or mechanical ventilation. They are selective for the motor (v. autonomic) nicotinic receptor
|
neuromuscular blocking drug
|
|
The depolarizing neuromuscular blocking drug is __________
|
succinylcholine
|
|
The drugs tubocurarine, atracurium, mivacurium, pancuronium, vecuronium, rapacuronium are of this category of neuromuscular blocking drugs
|
nondepolarizing
|
|
Nondepolarizing neuromuscular blocking drugs compete with ____ for receptors
|
ACh
|
|
In order to reverse the blockade of nondepolarizing blocking agents you can use __________
|
any cholinesterase inhibitor:
e.g., neostigmine, edrophonium |
|
With depolarizing neuromuscular blocking drugs phase I is known as the ___________ phase
|
prolonged depolarization phase
|
|
With depolarizing neuromuscular blocking drugs phase I -prolonged depolarization - is potentiated by what?
|
cholinesterase inhibitors
|
|
With depolarizing neuromuscular blocking drugs phase II is known as the ___________ phase
|
repolarized but blocked phase
|
|
after initiating paralysis with a depolarizing neuromuscular blocking drugs, is it possible to reverse the effects.
|
During phase II (repolarized but blocked phase) only-- the antidote consists of cholinesterase inhibitors (e.g., neostigmine)
|