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Neuro DRx > 05a: Muscle relaxants > Flashcards

05a: Muscle relaxants Flashcards

1
Q

Cisatracurium is in (X) class of drugs and works by which MOA?

A

X = non-depolarizing (competitive) neuromuscular blocker

Competitive inhibition of ACh binding to nicotinic receptor

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2
Q

Cisatracurium has (slow/quick) onset of action and (can/cannot) cross BBB.

A

Quick (2-8 min)

Cannot (quat amine)

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3
Q

Cisatracurium effect can be antagonized by

A

ACEi (due to increased ACh overcoming competitive inhibition)

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4
Q

Succinycholine is in (X) class of drugs and works by which MOA?

A

X = depolarizing (non-competitive) neuromuscular blocker

Binds to nicotinic ACh receptor and evokes receptor desensitization and channel inactivation

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5
Q

Succinycholine stages of block

A
  1. Fasciculation
  2. Phase I block (depolarizing)
  3. Phase II block (desensitizing)
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6
Q

T/F: Muscle is depolarized in all stages of block by succinylcholine.

A

False - repolarizes in Phase II (but ACh receptors still not responsive)

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7
Q

(Succinylcholine/Cisatracurium) degraded by plasma esterases.

A

Both

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8
Q

Succinylcholine has (slow/quick) onset of action.

A

Quick (1 min!)

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9
Q

Malignant hyperthermia is a dangerous side effect of (X) neuromuscular blocking agent. What’s the antidote?

A

X = succinylcholine

Dantrolene (Ryanodine-R antagonist)

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10
Q

Malignant hyperthermia in patients with hereditary deficiency in (X). What’s the mechanism of this Sx?

A

X = plasma cholinesterase

High succinylcholine causes excess Ca2+ release in muscle, causing ATP use to increase as muscle attempts to reabsorb Ca2+ (this generates heat)

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11
Q

Brain abscess (bacterial): what are the layers (from inside to out)?

A
  1. Purulent/pus-filled center (degenerating PMNs and bac)
  2. Neovascularization around central necrotic zone
  3. Dense fibrous capsule
  4. Reactive astrocytosis around capsule
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12
Q

T/F: Zika can be spread via sex.

A

True - also mosquitos, vertically, and blood transfusion

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13
Q

Which autoimmune disease is strongly associated with Zika?

A

Guillain-Barré (but only small portion of people with Zika get it)

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14
Q

Which category of CNS infections associated with formation of microglial nodules and neuronophagia?

A

Viral Meningoencephalitis

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15
Q

Which category of CNS infections likely associated with perivascular lymphocytes?

A

Viral Meningoencephalitis

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16
Q

A characteristic feature of HSV meningoencephalitis is involvement of (X) parts of brain

A

X = inferior and medial temporal lobes; lower frontal lobes

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17
Q

Which CNS infection associated with Cowdry type A eosinophilic intra-(cytoplasmic/nuclear) inclusions?

A

Intranuclear;

HSV-1 meningoencephalitis

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18
Q

Which CNS infection associated with Negri bodies, intra-(cytoplasmic/nuclear) inclusions?

A

Intracytoplasmic;

Rabies

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19
Q

Which CNS infection (in immunocompromised) associated with patchy demyelination/gliosis, microglial nodules, and multinucleated Giant cells.

A

HIV-1 meningoencephalitis

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20
Q

T/F: Fungal Meningoencephalitis almost always originates from CNS tissue.

A

False - almost always spread from primary focus elsewhere in body

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21
Q

(X) meningoencephalitis: Multiple intraparenchymal microabscesses stained purple in whole mount section.

A

X = candida

22
Q

(X) meningoencephalitis: hemorrhagic infarct, secondary to (Y).

A 
X = aspergillus or mucor
Y = angioinvasion (invades artery)
23
Q

Aside from causing brain infarcts, (X) fungal species may cause multiple (Y)

A 
X = aspergillus or mucor
Y = hemorrhagic abscesses
24
Q

(X) meningoencephalitis: cribiform appearance (“bubbles”) from infectious agent’s proliferation in perivascular space

A

X = cryptococcal

25
Q

T/F: Crytpo is most common opportunistic fungal CNS

infections in AIDS

A

True

26
Q

Your pt with AIDs has fungal meningoencephalitis. The capsule of (X) fungus may be easily seen with (Y) stain

A 
X = Cryptococcus
Y = mucicarmine
27
Q

T/F: Prions have no nucleic acid component

A

True - composed solely of protein

28
Q

T/F: PrP(SC) and PrP(C) are encoded by the same gene and are therefore identical in sequence.

A

True - differ due to post-translational modifications

29
Q

PrP(C) is protease (sensitive/resistant) and found where in/on cells?

A

Sensitive (normal protein);

On cell surface

30
Q

PrP(SC) is protease (sensitive/resistant) and found where in/on cells?

A

Resistant;

In intracellular vesicles and is secreted

31
Q

Incubation period for Prion diseases can be as long as (X).

A

X = 30 y

32
Q

T/F: There is no immune response in prion diseases.

A

True

33
Q

List procedures that can inactivate prions

A
  1. Autoclave (for hours)
  2. NaOH
  3. Hypochlorite
34
Q

Killed (inactivated) Rabies virus vaccine prepared by chemical
inactivation of rabies-infected (X) cells.

A

X = human diploid

HDCV (human diploid cell vaccine)

35
Q

T/F: Previously vaccinated patient was bitten by animal with rabies. There’s no need to give the rabies Ig (only the vaccine).

A

True

36
Q

Prion diseases: post-morten brain shows (X) in (cortex/cerebellum) (with/without) inflammation.

A

X = large vacuoles
Both
Without

37
Q

Prion disease clinical Sx:

A

loss of muscle control & coordination,

tremors, progressive dementia

38
Q

Prion appearance on EM:

A

filamentous rods

39
Q

PrP(SC) has more (alpha helices/beta sheets) than PrP(C).

A

Beta sheets

40
Q

T/F: Prion disease can be inherited.

A

True

41
Q

(X) Prion disease generally found in patients over 50 with clinical Sx initially similar to psych disorders. Progress to dementia and which other Sx?

A

X = Creuztfeldt-Jakob (CJD)

Change in gait, involuntary movement, seizure

42
Q

Unlike CJD, nvCJD seen in (X) patients and transmitted by (Y).

A 
X = younger
Y = eating infected beef (similar to BSE, bovine spongiform encephalopathy)
43
Q

How do you assess CN II in comatose patient?

A

Pupillary reflex (CN II, III)

44
Q

Disrupted pupillary reflex can be either due to brainstem lesion, (X) herniation, and/or lateral shift of (Y).

A 
X = uncal
Y = supratentorial compartment (with stretching of CN III against clivus)
45
Q

Disrupted pupillary reflex can be either due to brainstem lesion, (X) herniation, and/or lateral shift of (Y).

A 
X = uncal
Y = supratentorial compartment (with stretching of CN III against clivus)
46
Q

Pupils in mid-position and fixed. Where do you suspect lesion to be?

A

Midbrain

47
Q

Pupils are small and reactive. Where do you suspect lesion to be?

A

Diencephalon

48
Q

How do you assess CN V in comatose patient?

A

Corneal reflex (V, VII)

49
Q

How do you assess CN V in comatose patient?

A

Corneal reflex (V, VII)

50
Q

(X) causes of comas represent 65% of etiologies, so they need to be ruled out, even while pursuing others.

A

X = Toxic/metabolic

Neuro DRx (10 decks)

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