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231 Cards in this Set
- Front
- Back
Origin of CNS neurons, ependymal cells, oligodendroglia, and astrocytes?
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Neuroectoderm
|
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Cells destroyed in Guillain-Barre?
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Schwann cells
|
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Which CNS cells are not readily discernable on Nissl stain?
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Microglia
|
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Which CNS cells have prominent nucleoli?
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Neurons (--> lots of Nissl substance)
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What does the epineurium contain?
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The entire nerve and blood vessels
- dense connective tissue |
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Nucleus where dopamine is found?
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Ventral tegmentum and SNc
- midbrain |
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Nucleus where 5-HT is found?
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Raphe nuclei
- throughout brainstem |
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Nucleus where ACh is found?
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Basal nucleus of Meynert
- in basal forebrain |
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Nucleus where GABA is found?
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Nucleus accumbens
- ventral striatum |
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Deep cerebellar nuclei?
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Lateral to medial: Dentate, Emboliform, Globose, Fastigial
- lateral: voluntary extremity movements - medial: balance, truncal coordination, ataxia |
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Which thalamic nucleus projects to the calcarine sulcus and what info does it carry?
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LGN
- carries vision from CN II |
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Why are patients with head trauma purposely hyperventilated?
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It creates a respiratory alkalosis which helps to constrict cerebral vessels and prevent vasogenic cerebral edema.
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Lateral vs ventromedial area of hypothalamus?
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Lateral: involved in hunger. Inhibited by leptin. Destruction leads to anorexia.
Ventromedial: involved in satiety. Stimulated by leptin. Destruction leads to hyperphagia. |
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Anterior vs posterior area of hypothalamus?
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Anterior: involved in cooling (A/C) and parasympathetic control.
Posterior: involved in heating and sympathetic control. |
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Limbic system pathway?
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Anterior thalamic nuclei --> cingulate gyrus --> cingulum --> hippocampus --> fornix --> mammillary body --> mammilo-thalamic tract --> anterior thalamic nuclei
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Lacunar stroke in subthalamic nucleus will cause what?
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Contralateral hemiballismus
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Histo findings in Parkinson's disease?
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Lewy bodies (alpha-synuclein: intracellular inclusion) and depigmentation of SNc (loss of dopaminergic neurons)
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Direct basal ganglia pathway?
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Dopamine from SNc --> D1 receptors on striatum (excitatory) --> GABA/Substance P (inhibitory)--> GPi/SNr --> inhibit thalamus --> cortex --> movement!
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Indirect basal ganglia pathway?
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Dopamine from SNc --> D2 receptors (inhibitory) on striatum --> GABA/Substance P --> inhibit GPe --> inhibit subthalamic nucleus --> stimulate GPi --> inhibit thalamus --> cortex --> movement
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What are the striatum and lentiform nucleus?
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Striatum = caudate + putamen
Lentiform nucleus = putamen + globus pallidus |
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Symptoms of central pontine myelinolysis?
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Acute paralysis, dysarthria, dysphagia, diplopia, loss of consciousness
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Brodmann areas of Principal and premotor areas, Principal Sensory area, Principal visual cortex, and Primary auditory cortex?
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Principal motor area: 4
Premotor area: 6 Principal Sensory area: 1, 2, 3 Principal visual cortex: 17 Primary auditory cortex: 41, 42 |
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Intention tremor is seen with?
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Cerebellar dysfunction
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Kluver-Bucy syndrome comes from?
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Bilateral lesion of the amygdala.
- hyperorality, hypersexuality, and disinhibited behavior |
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PPRF vs frontal eye field lesion?
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PPRF: eyes look AWAY from side of lesion
Frontal eye field lesion: eyes look TOWARD lesion |
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What areas do Charcot-Bouchard microaneurysms affect?
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Small vessels in the basal ganglia, thalamus, etc. Rupture leads to intracerebral hemorrhage.
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Conduction aphasia?
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Lesion of arcuate fasciculus. Poor repetition but fluent speech and intact comprehension.
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What general symptoms does a stroke of the anterior circle of Willis cause?
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General sensory and motor dysfunction, aphasia
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What general symptoms does a stroke of the posterior circle of Willis cause?
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CN deficits (vertigo, visual), coma, cerebellar deficits, aphasia or contralateral neglect
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Where do the lateral striate arteries come from and what do they supply?
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Divisions of MCA. Supply internal capsule, caudate, putamen, globus pallidus.
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Watershed zones in brain and significance?
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Between ACA/MCA (--> upper leg/upper arm weakness), PCA/MCA (--> defective higher order visual processing)
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Medial medullary syndrome arises from what artery and causes what?
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Anterior spinal artery damage. Contralateral hemiparesis (lower extremities), defect in contralateral proprioception, and ipsilateral paralysis of CN XII.
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Lateral medullary syndrome (Wallenberg's) arises from what artery and causes what?
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PICA damage. Contralateral loss of pain/temp, ipsilateral dysphagia, hoarse, gag reflex, vertigo, diplopia, nystagmus, vomiting, ipsilateral Horner's, ipsilateral facial pain and temperature, trigeminal nucleus, ipsilateral ataxia.
9,10,11 |
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Lateral inferior pontine syndrome arises from what artery and causes what?
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AICA. Ipsilateral facial paralysis, ipsilateral cochlear nucleus, vestibular (nystagmus), ipsilateral facial pain and temp, ipsilateral dystaxia (MCP, ICP)
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Pure motor vs pure sensory stroke?
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Pure motor stroke from posterior limb of internal capsule.
Pure sensory from thalamus. |
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Which stroke type can cause vasospasm due to blood breakdown products that irritate vessels?
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Subarachnoid hemorrhage
- can treat with CCBs |
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What type of plaque causes Amaurosis fugax?
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Hollenhorst plaque (at the bifurcation of the retinal arteries)
|
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Lacunar stroke pathophys?
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Hyaline arteriosclerosis (often secondary to hypertension)
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Which type of stroke forms a cystic cavity with reactive gliosis afterwards?
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Atherosclerosis.
- get necrotic area (wedge-shaped) that becomes cystic |
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CSF flow?
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Choroid plexus --> lateral ventricle --> foramen of Monro --> 3rd ventricle --> cerebral aqueduct of Sylvius --> 4th ventricle --> foramen of Magendie and Luschka --> subarachnoid space --> superior sagittal sinus --> reabsorbed by arachnoid granulations/villi
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2 causes of communicating hydrocephalus?
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Decreased CSF absorption (arachnoid scarring post-meningitis) or increased CSF production (choroid plexus papilloma)
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Floppy baby at birth with tongue fasciculations?
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Werdnig-Hoffman disease (aka infantile spinal muscular atrophy)
- degeneration of anterior horns (LMN disease) - autosomal recessive |
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CSF findings with poliomyelitis?
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Lymphocytic pleocytosis with slight elevation of protein, no change in glucose
|
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Neuro disease caused by SOD1 (chromosome 21) mutation?
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Amyotrophic Lateral Sclerosis (Lou Gehrig's disease)
- LMN and UMN signs |
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Treatment to prolong survival in ALS patients?
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Riluzole
- decreases presynaptic glutamate release |
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Watershed area involving anterior spinal artery?
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Upper thoracic ASA territory
- artery of Adamkiewicz supplies ASA below T8 |
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What 3 conditions can cause demyelination of dorsal columns, lateral corticospinal tracts, and spinocerebellar tracts?
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Friedrich's ataxia, Vitamin B12 neuropathy, and Vitamin E deficiency
|
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Causes of Horner's syndrome?
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Lesion of spinal cord above T1: Pancoast tumor, Brown-Sequard syndrome, late stage syringomyelia
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Dermatome of nipple, xiphoid process, umbilicus?
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Nipple: T4, Xiphoid process: T7, Umbilicus: T10
|
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Findings in Friedrich's ataxia?
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Staggering gait, frequent falling, nystagmus, dysarthria, pes cavus, hammer toes, HCM
|
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Superior colliculus function and lesion?
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Conjugate vertical gaze center. Lesion such as pinealoma causes paralysis (dorsal midbrain syndrome).
|
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Pineal gland functions?
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Melatonin secretion, circadian rhythms
|
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Biceps and triceps reflexes?
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C5 (biceps), C7 (triceps)
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Patella and achilles reflexes?
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L4 (patella), S1 (achilles)
|
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Nucleus ambiguus?
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Motor innervation of pharynx, larynx, and upper esophagus (swallowing, palate elevation)
- CN IX, X, XI |
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Nucleus solitarius?
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Visceral sensory information (taste, baroreceptors, gut distention)
- CN VII, IX, X |
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Dorsal motor nucleus?
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Sends autonomic (parasympathetic) fibers to heart, lungs, and upper GI
|
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Structures that pass through foramen magnum?
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Spinal roots of CN XI, brain stem, vertebral arteries
|
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Structures that pass through optic canal?
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CN II, opthalmic artery, central retinal vein
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Structures that pass through superior orbital fissure?
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III, IV, V1, ophthalmic vein, sympathetic fibers
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Structure that passes through foramen spinosum?
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Middle meningeal artery
|
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Innervation of ear muscles?
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Stapedius (VII) and tensor tympani (V3)
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What does cavernous sinus syndrome cause?
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Ophthalmoplegia, ophthalmic and maxillary sensory loss
|
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Which nerves pass through the cavernous sinus?
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CN III, IV, V1, V2, VI
|
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Which nerve runs closest to internal carotid artery within the cavernous sinus?
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VI
|
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CN V motor lesion: what happens to the jaw?
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Deviates TOWARD the side of the lesion (lateral pterygoid gets bilateral cortical input)
|
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4 muscles of mastication and innervation?
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Masseter, temporalis, medial pterygoid all close jaw. Lateral pterygoid opens jaw.
- All are innervated by V3 |
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Causes of Bell's palsy?
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Sarcoid, HSV, AIDS, Lyme disease, Tumor, Diabetes, Pregnancy
|
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View of eye with papilledema?
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Elevated optic disk with blurred margins (especially the temporal margin)
- pts have bigger blind spot |
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Describe the decreased vision with cataracts.
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Blurring, glare, induced myopia
|
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What happens to the ciliary muscle for near vision?
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Ciliary muscle contracts --> zonula fibers relax --> lens relaxes --> more convex
|
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What happens to the lens with aging?
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Sclerosis and decreased elasticity causes the lens to change shape
|
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Ciliary muscle receptor?
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M3 stimulation causes accommodation.
|
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Location of obstruction in open angle glaucoma?
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Canal of Schlemm
- associated with myopia, age, and African American race |
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What is a Marcus Gunn pupil?
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Afferent pupillary defect (optic nerve damage, retinal detachment, etc). Decreased bilateral pupillary constriction when light is shone in affected eye.
|
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Long vs short ciliary nerve?
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Long: sympathetic from superior cervical ganglion
Short: parasympathetic from ciliary ganglion |
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Describe vision changes in age-related macular degeneration.
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Loss of central vision (scotoma) due to degeneration of macula (central area of retina)
|
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Histo finding in Lewy body dementia?
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Alpha-synuclein defect (intraneuronal)
- like Parkinsonism (w/ dementia and hallucinations) |
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Histo finding in frontotemporal dementia?
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Pick bodies: intracellular, aggregated tau protein (hence the alternative name Pick's disease)
- frontotemporal atrophy (more on L side --> aphasia) |
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Genes associated with early and late onset familial Alzheimer's?
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Early: APP (21), presenilin1 (14), presenilin2 (1)
Late onset: ApoE4 (19) |
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2 main histo findings in Alzheimer's?
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1. Senile plaques: amyloid A-beta, can cause amyloid angiopathy
2. Neurofibrillary tangles: intracellular, hyperphosphorylated tau (GSK-3-beta), correlate with degree of dementia |
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Diagnostic findings in MS?
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CSF: increased protein (IgG), oligoclonal bands (diagnostic), increased myelin basic protein
Periventricular plaques (oligodendrocyte loss and reactive gliosis), preservation of axons. |
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MS hypersensitivity type(s)?
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Type II and type IV
|
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Characteristics of tension headache?
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BIlateral. >30 mins of stead pain. Not aggravated by light or noise. No aura.
|
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Mechanism of migraine?
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Irritation of CN V and release of substance P, CGRP, vasoactive peptides
|
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Partial vs generalized seizure?
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Partial: one area of the brain (most often medial temporal lobe)
Generalized: diffuse |
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Simple vs complex seizure?
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Simple: consciousness is intact
Complex: impaired consciousness |
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Types of generalized seizures?
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Absence (petit mal), myoclonic (repetitive jerks), tonic-clonic (grand mal), tonic (stiff), atonic ("drop")
|
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Leading cause of seizure in kids, adults, elderly?
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Kids: genetic, infection
Adults: tumors, trauma Elderly: stroke, tumor |
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Which disease has albuminocytologic dissociation of CSF?
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Guillain-Barre
- increased CSF protein with normal cell count - increased protein can cause papilledema |
|
Pathophys of metachromatic leukodystrophy?
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Lysosomal storage disease. Arylsulfatase A deficiency. Buildup of sulfatides leads to impaired myelin sheath production.
|
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Cavernous hemangiomas, bilateral renal cell carcinoma, hamangioblastoma in retina, brain stem, & cerebellum, pheo. Disease?
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Von Hippel-Lindau disease
- mutated VHL tumor suppressor (chromosome 3) |
|
Hamartomas in CNS, skin, organs, cardiac rhabdomyoma, renal angiomyolipoma, subependymal giant cell astrocytoma, mental retardation, SZ, "ash leaf spots," sebaceous adenoma, shagreen patch. Disease?
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Tuberous sclerosis.
- aut dom |
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Port wine stains (nevus flammeus) in V1 distribution, ipsilateral leptomeningeal angiomas, pheo, glaucoma, SZ, hemiparesis, MR. Disease?
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Sturge-Weber syndrome.
|
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Cafe-au-lait spots, Lisch nodules (iris hamartomas), neurofibromas in skin, optic gliomas, pheo. Disease?
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Neurofibromatosis type 1
- mutated NF-1 on chromosome 17 - associated with pheo, Wilm's tumor, and juvenile CML |
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NMDA antagonist to help with Alzheimer's?
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Memantine.
- helps prevent excitotoxicity |
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Amine depleting drugs used in Huntington's disease?
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Reserpine & Tetrabenazine
|
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Contraindications of sumatriptan use?
|
CAD or Prinzmetal's angina
- 5-HT1A/B agonists, causes vasoconstriction and can cause coronary vasospasm |
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AChE inhibitors used in Alzheimer's?
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Donepezil, galantamine, rivastigmine
|
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Adverse effect of long time levodopa use?
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Dyskinesia following administration and akinesia in between doses
|
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Nondepolarizing NMJ blockers?
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Tubocurarine, atracurium, mivacurium, pancuronium, vecuronium, rocuronium
|
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2 phases of reversal of blockade of succinylcholine?
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Phase I (prolonged depolarization): no antidote
Phase II (repolarized but blocked): can give AChEI as antidote |
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Use of benztropine for symptoms of Parkinson's?
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Muscarinic antagonist: improves tremor and rigidity
|
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What does amantadine do in Parkinson's disease?
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Increases dopamine release (toxicity = ataxia)
|
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Ergot and non-ergot derivative dopamine agonists?
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Ergot: bromocriptine
Non-ergot (preferred): pramipexole, ropinirole |
|
Complications of uncal herniation?
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- CN III compression --> ipsilateral dilated pupil/ptosis
- PCA compression --> contralateral homonymous hemianopia - Compress contralateral crus cerebri (Kernohan's notch) --> ipsilateral paresis - Caudal displacement of brainstem --> Duret hemorrhages (paramedian artery rupture) |
|
4 types of cerebral herniation?
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Cingulate/subfalcine, Cerebellar tonsillar (into foramen magnum), Transtentorial, Uncal
|
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Ddx of uniformly enhancing brain lesion?
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Lymphoma, meningioma, metastases (but usually ring enhancing)
|
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Ddx of heterogeneously enhancing brain lesion?
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Glioblastoma multiforme
|
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Ddx of ring enhancing brain lesion?
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Metastases, abscesses, toxoplasmosis, AIDS lymphoma
|
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What is tramadol and what is it used for?
|
Weak opioid agonist, inhibits 5-HT and NE reuptake.
Used for chronic pain. Can also decrease seizure threshold. |
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What is butorphanol?
|
Partial agonist at opioid mu receptors and agonist at kappa receptors.
- Used for pain and causes less respiratory depression than full agonists |
|
Opioid analgesics?
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Fentanyl > morphine > codeine. Heroin, methadone, meperidine, dextromethorphan
|
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Opioid mechanism of action?
|
Opioid receptors: open K+ channels, close Ca channels --> decrease synaptic transmission. Inhibit release of ACh, NE, 5-HT, glutamate, and substance P.
|
|
Which glaucoma drugs will give pupillary or vision changes?
|
Alpha agonist (Epi) or cholinomimetics
|
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Side effect of latanoprost (PGF2-alpha) use for glaucoma?
|
Darkened color of iris (browning)
|
|
Beta blockers used for glaucoma?
|
Timolol, betaxolol, carteolol
- decrease aqueous humor secretion |
|
Function of brimonidine?
|
Alpha agonist
- decreases aqueous humor synthesis in glaucoma |
|
Cholinomimetics for glaucoma?
|
They open trabecular meshwork by contracting ciliary muscle.
- Direct: pilocarpine, carbachol Indirect: physostigmine, echothiophate |
|
Rathke's pouch tumor with calcification?
|
Craniopharyngioma
|
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Tumor with verocay bodies and Merlin mutation, associated with NF2?
|
Schwannoma (acoustic)
- S100 positive |
|
Tumor in 4th ventricle that can cause hydrocephalus?
|
Ependymoma
- perivascular pseudorosettes - rod shaped blepharoplasts (basal ciliary bodies) |
|
Frontal lobe tumor with chicken wire capillary pattern?
|
Oligodendroglioma
- calcifications |
|
GBM histo characteristics?
|
Pseudopalisading pleomorphic tumor cells that border central areas of necrosis and hemorrhage, atypical mitoses, giant cells
|
|
Solid small blue cell brain tumor?
|
Medulloblastoma.
form of PNET, highly malignant but radiosensitive |
|
Rosenthal fibers (eosinophilic, corkscrew) seen in cystic and solid tumor. Diagnosis?
|
Pilocytic astrocytoma
- low grade, well circumscribed - often in posterior fossa/cerebellum - GFAP positive |
|
Short acting benzos?
|
Triazolam, Oxazepam, Midazolam
|
|
Panic attacks - use?
|
Alprazolam (Xanax)
- intermediate acting benzo |
|
Status epilepticus - which benzos to use?
|
Diazepam, Lorazepam
|
|
Non-benzo hypnotics?
|
Zolpidem (Ambien), Zaleplon, Eszopiclone
|
|
Induction and recovery time of anesthetics depends on?
|
Solubility in blood
- decreased solubility = rapid induction and recovery time - increased solubility: more gas required to saturate blood --> slower onset of action |
|
Potency of anesthetics depends on?
|
Solubility in lipids
- increased lipid solubility --> increased potency (1/MAC) |
|
Affect of arteriovenous (AV) concentration gradient on speed of onset of anesthetic?
|
Increased gradient --> increased solubility --> increased gas required to saturate tissue --> slower onset of action
|
|
Inhaled anesthetic effects?
|
Myocardial depression, respiratory depression, nausea/emesis, increased cerebral blood flow
|
|
Toxicities of inhaled anesthetics?
|
Hepatotoxicity (halothane), nephrotoxicity (methoxyflurane), proconvulsant (enflurane), malignant hyperthermia, expansion of trapped gas (nitrous oxide)
|
|
Phenytoin mechanism?
|
Use-dependent blockade of Na+ channels. Increase refractory period and inhibit glutamate release.
|
|
Phenytoin toxicity?
|
Nystagmus, ataxia, diplopia, sedation, SLE-like syndrome, CYP450 induction, gingival hyperplasia, peripheral neuropathy, hirsutism, megaloblastic anemia, teratogenic (fetal hydantoin syndrome)
|
|
Epilepsy drug that causes weight gain? Weight loss?
|
Valproic acid: weight gain
Topiramate: weight loss |
|
Carbamazepine toxicity?
|
Diplopia, ataxia, blood dyscrasia (agranulocytosis, aplastic anemia), liver toxicity, teratogenesis, induction of CYP450, SIADH, SJS
|
|
How does propofol work?
|
Potentiates GABA-A
|
|
Ketamine mechanism?
|
Block NMDA receptors. CV stimulant
|
|
First line meds for status epilepticus?
|
Benzos for acute, Phenytoin for prophylaxis
|
|
First line meds for tonic-clonic seizures?
|
Phenytoin, Carbamazepine, and Valproic acid
|
|
Complication of cerebellar tonsillar herniation?
|
Compression of the medulla with cardiorespiratory arrest
|
|
IQ ranges for mental retardation?
|
IQ < 70 = mental retardation
IQ < 40 = severe MR IQ < 20 = profound MR |
|
What parts of the brain does classical conditioning use?
|
Amygdala and Cerebellum
|
|
4 mature ego defenses?
|
Altruism (compensation)
Humor Sublimation Suppression (voluntary) |
|
What is anaclitic depression?
|
Aka hospitalism
- depression in an infant attributable to continued separation from caregiver. Infant becomes withdrawn and unresponsive. Can result in failure to thrive and developmental disturbances. |
|
Neurotransmitter changes in Parkinson's disease?
|
Decreased Dopamine
Increased 5-HT, ACh |
|
Neurotransmitter changes in anxiety?
|
Increased NE
Decreased GABA, 5-HT |
|
3 criteria of Autistic disorder?
|
1. severe language impairment
2. poor social interactions 3. repetitive behaviors |
|
Key differences between Asperger's and Autistic disorder?
|
Asperger's: no language/verbal/cognitive impairment and usually normal intelligence
|
|
Stereotyped hand-wringing, regression, MR, and loss of verbal skills in 3yo female?
|
Rett's disorder
- X-linked, only in girls |
|
Who usually presents with childhood disintegrative disorder?
|
3-4 yo boys (M > F)
- regression in multiple areas of functioning (language, social, bowel/bladder control, motor skills, play, etc) |
|
Difference between conduct disorder and oppositional defiant disorder?
|
ODD: no serious violations of social norms (theft, physical aggression, destroying property)
|
|
Time period for Tourette's?
|
>1 year
- sudden, rapid, recurrent, nonrhythmic stereotyped motor movements and vocalizations (tics) |
|
3 treatment options for ADHD?
|
Methylphenidate (Ritalin)
Amphetamines (Dexedrine) Atomoxetine (nonstimulant SNRI) |
|
Causes of dementia?
|
Alzheimer's, vascular thrombosis/hemorrhage, HIV, Pick's disease, substance abuse, CJD
|
|
Common causes of loss of orientation?
|
Alcohol, drugs, fluid/electrolyte imbalance, head trauma, hypoglycemia, nutritional deficiencies
|
|
What is dissociative amnesia?
|
Inability to recall important personal information
- usually after trauma or stress |
|
Gender difference in schizophrenia presentation?
|
Presents ~10 years later in women (late 20s to early 30s)
- prevalence is the same in both genders |
|
5 criteria of schizophrenia?
|
1. Delusions
2. Hallucinations (often auditory) 3. Disorganized speech (loose associations) 4. Disorganized or catatonic behavior 5. Negative symptoms |
|
Depersonalization vs derealization?
|
Derealization involves distorted reality
- depersonalization: detached/estranged from body, social situation, or the environment |
|
Criteria for manic episode? (need 3 or more for >1 week)
|
Distractibility
Irresponsibility/pleasure seeking Grandiosity Flight of ideas Activity (goal directed) or agitation Sleep (decreased need) Talkativeness/pressured speech |
|
Treatment of bipolar episode?
|
Mood stabilizers (lithium, valproic acid, carbamazepine), atypical antipsychotics
|
|
Depression criteria?
|
5/9 + depressed mood or anhedonia
SIGECAPS: - sleep disturbance, loss of interest, guilt, loss of energy, loss of concentration, appetite/weight change, psychomotor agitation/retardation, suicidal ideation, depressed mood |
|
Difference in suicide between genders?
|
Women try more often.
Men succeed more often. |
|
Criteria for panic disorder?
|
4/10 of the following that peak in 10 minutes
Palpitations Abdominal distress Nausea Intense fear of dying, light-headedness Chills, chest pain, choking, disconnectedness Shortness of breath, sweating, shaking |
|
Treatment for panic disorder?
|
Cognitive behavioral therapy
SSRI TCA Benzos |
|
Postpartum blues vs postpartum depression?
|
Blues: <10 days, supportive treatment, 50-85% incidence
Depression: 2wks to 2mo, treat with antidepressants and psychotherapy, 10-15% incidence |
|
OCD treatment?
|
SSRIs or clomipramine
|
|
OCD vs OCPD?
|
Personality disorder is ego-syntonic: behavior is consistent with beliefs and attitudes
|
|
3 criteria of PTSD?
|
1. Re-experiencing (nightmares, flashbacks)
2. Avoidance of stimuli associated with trauma 3. Persistently increased arousal |
|
"La belle indifference" refers to what?
|
Conversion disorder (type of somatoform disorder)
|
|
Cluster A personality disorders and association?
|
Cluster A = "mad"
- Paranoid, Schizoid, Schizotypal - associated with schizophrenia |
|
Cluster B personality disorders and association?
|
Cluster B = "bad"
- Borderline, Antisocial, Histrionic, Narcissistic - associated with mood disorders and substance abuse |
|
Cluster C personality disorders and association?
|
Cluster C = "sad"
- Obsessive-compulsive, Dependent, Avoidant - associated with anxiety disorders |
|
Complications of anorexia nervosa?
|
Amenorrhea, decreased bone density, metatarsal stress fractures, anemia, electrolyte disturbances
|
|
Complications of bulimia nervosa?
|
Parotitis, enamel erosion, electrolyte disturbances, alkalosis, dorsal hand calluses (Russell's sign)
|
|
Key distinction between substance abuse vs dependence?
|
Dependence: involves both tolerance and withdrawal
|
|
Complications of alcoholism?
|
Hepatitis, pancreatitis, Cirrhosis, peripheral neuropathy, Mallory-Weiss tears, Wernicke-Korsakoff syndrome, testicular atrophy
|
|
Order of appearance of symptoms in DT?
|
Autonomic system hyperactivity (tachycardia, tremors, anxiety, seizures) then psychotic symptoms (hallucinations, delusions), confusion
|
|
What is suboxone and what is it used for?
|
Naloxone and buprenorphine (partial agonist)
- long acting, fewer withdrawal sx than methadone - Naloxone only active if injected |
|
LSD abuse signs?
|
Anxiety, depression, delusions, visual hallucinations, **flashbacks**, dilated pupils
|
|
PCP abuse signs?
|
Belligerence, impulsivity, fever, psychomotor agitation, vertical and horizontal nystagmus, tachycardia, homicidality, psychosis, delirium
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Opioid withdrawal signs?
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Sweating, dilated pupils, piloerection ("cold turkey"), fever, rhinorrhea, nausea, stomach cramps, diarrhea ("flulike-sx")
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Stomach cramps, hunger, and hypersomnolence: signs of withdrawal of what?
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Amphetamines
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Suicidality, hypersomnolence, malaise, severe craving: signs of withdrawal of what?
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Cocaine
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Typical vs atypical antipsychotics for schizophrenia symptoms?
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Typical: only work for positive symptoms
Atypical: good for positive and negative |
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Atypical antipsychotics?
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Olanzapine, Clozapine, Quetiapine, Risperidone, Aripiprazole, Ziprasidone
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Atypical antipsychotic mechanism?
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Block 5-HT2, dopamine, alpha, and H1 receptors
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Typical antipsychotics?
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Haloperidol, Trifluoperazine, Fluphenazine > Thioridazine, Chlorpromazine
(haloperidol + "-azine"s) |
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Typical antipsychotic mechanism?
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Block D2 receptors (increase cAMP)
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Extrapyramidal side effects of neuroleptics?
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Acute dystonia (muscle spasm, stiffness, oculogyric crisis) (within hrs)
Akinesia (days) Akathisia (restlessness) (weeks) Tardive dyskinesia (months) (irreversible) |
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Neuroleptic malignant syndrome signs/symptoms?
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"FEVER":
Fever Encephalopathy Vitals unstable Elevated enzymes Rigidity of muscles |
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Trazodone mechanism?
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Inhibit serotonin reuptake
- used for insomnia |
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Mirtazapine mechanism?
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Alpha-2 antagonist (--> increase release of NE and serotonin) and 5-HT2 and 5-HT3 antagonist
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Maprotiline mechanism and side effect?
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Block NE reuptake.
- can cause sedation |
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MAOi's are contraindicated with what other meds?
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SSRIs or meperidine
- want to prevent serotonin syndrome |
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MAOi's?
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Phenelzine, tranylcypromine, isocarboxazid, selegiline (MAO-B)
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SNRIs and use?
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Venlafaxine, duloxetine
- used for depression - Venlafaxine: also for GAD - Duloxetine: also for diabetic neuropathy |
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SSRIs?
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Fluoxetine, Fluvoxamine, Paroxetine, Sertraline, Citalopram
|
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Treatment for serotonin syndrome?
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Cyproheptadine
- 5-HT2 antagonist |
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Toxicity of TCAs and treatment?
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Convulsions, Coma, and Cardiotoxicity
- can use NaHCO3 for CV toxicity - also anti-cholinergic (atropine-like) side effects |
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TCAs?
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Imipramine, amitriptyline, desipramine, nortriptyline, clomipramine, doxepin, amoxapine
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Least sedating TCA and one with most anticholinergic side effects?
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Least sedating ("Doesn't Sedate") = DeSipramine (but lower seizure threshold also)
Amitriptyline = Anticholinergic |
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Common age of onset of ADHD, Tourette's, and separation anxiety disorder?
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ADHD: <7 yo
Tourette's: <18 yo Separation anxiety disorder: 7-9 yo |
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Stereotyped hand-wringing is seen in?
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Rett's disorder
- X linked, in girls |
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Common age of onset of Rett's disorder and childhood disintegrative disorder?
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Rett's disorder: 1-4 yo
Childhood disintegrative disorder: 3-4 yo |
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In what conditions do patients experience visual hallucinations?
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Delirium & Lewy body dementia
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What is varenicline?
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Drug to treat nicotine withdrawal
|
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What are heroin users at increased risk for?
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Hepatitis, Abscesses, Overdose, Hemorrhoids, AIDS, and right-sided Endocarditis
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What is Mirtazapine useful for treating?
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Depression with insomnia
|
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High vs low potency typical antipsychotics?
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High potency: Haloperidol, Trifluoperazine, Fluphenazine
- extrapyramidal sx Low potency: Thioridazine, Chlorpromazine - Anticholinergic, antihistamine, and alpha blocking effects |
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Deposits seen with Chlorpromazine and Thioridazine use?
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Chlorpromazine: Corneal deposits
Thioridazine: reTinal deposits |
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Mechanism of atypical antipsychotics?
|
Block 5-HT2, dopamine, alpha, and H1 receptors
|
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Treatment for serotonin syndrome?
|
Cyproheptadine: 5-HT2 antagonist
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Receptor that stimulates aqueous humor production?
|
Beta1
On ciliary process |
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Receptor for ciliary muscle accomodation?
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M3
|
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Receptor on dilator/radial muscle in eye?
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Alpha1
Causes mydriasis |
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AChE inhibitors used in Alzheimer's?
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Donepezil
Galantamine Rivastigmine |
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Brain tumor with foamy cells and high vascularity that can produce EPO?
|
Hemangioblastoma
- often cerebellar - associated with VHL |
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Brain tumor in kid with perivascular pseudorosette and rod-shaped blepharoblasts (basal ciliary bodies near nucleus)?
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Ependymoma
|
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Malignant small blue cell brain tumor with perivascular pseudorosettes?
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Medulloblastoma
|
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Two brain tumors with perivascular pseudorosettes?
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Ependymoma
Medulloblastoma |
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Benign brain tumor in kids with Rosenthal fibers (eosinophilic corkscrew fibers)?
|
Pilocytic (low grade) astrocytoma
|
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Frontal lobe calcification in adult: what tumor?
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Oligodendroglioma
|
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Tumor marker for Schwannoma?
|
S-100
|
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Brain tumors that stain positive for GFAP?
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Glioblastoma multiforme (grade IV astrocytoma)
Pilocytic (low grade) astrocytoma |
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Brain tumor with "pseudopalisading" pleomorphic tumor cells around a center of necrosis and hemorrhage?
|
GBM
|
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Causes of peripheral vs central vertigo?
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Peripheral: semicircular canal debris, vestibular nerve infection, Meniere's disease
Central: vestibular nuclei, posterior fossa tumor |