Clin Med Exam 3 Flashcards by Megan Shuldes

Bipolar I

Manic episode + hypomanic or major depressive episode

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Bipolar II

Hypomanic episode + major depressive episode

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Membrane potential - net __ charge inside cell

Negative

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Sodium concentration is greater where?

Outside cell

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Potassium concentration is greater where?

Inside cell

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Cell membrane is more permeable to which ion?

Potassium

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How is resting membrane potential maintained?

Na-K pump –> K in and Na out of cell

2. K passively leaving cell

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In the presence of a chemical or electrical stimulus that reaches threshold…

Membrane permeability to Na increases
Na rushes into cell due to electrical and chemical gradient
Depolarization of cell

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ALS

Increased glutamate
Extremities affected first
Eye movement, sensation, B&B preserved

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Huntington’s Disease

Autosomal dominant
Random involuntary movements, dysdiadochokinesia
Atrophy of basal ganglia

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Multiple Sclerosis

Progressive demyelination (CNS)
Relapsing/ remitting
2 neurological lesions
Exercise helps function, avoid excess fatigue

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Parkinson’s Disease

Disease of basal ganglia, increased dopamine produced
Characterized by tremor, rigidity, bradykinesia
Festinating gait, cogwheel
PT: big movements

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Alzheimer’s disease

Slow decrease in memory, cognition, and behavior

Neurofibrillary tangles, amyloid plaques

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Charcot Marie Tooth Disease

Hereditary PNS disease

Demyelination, often of peroneal nerve –> foot deformities

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Guillan-Barre Syndrome

Progressive weakness due to infection that progresses from extremities up, may eventually lead to respiratory issues
Lesions in motor and sensory fibers –> demyelination

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Post-polio strength

Declining muscle strength in previously affected muscles

Never exercise to point of fatigue

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Myasthenia Gravis

Disease of neuromuscular transmission, decreased numbers of ACh receptors.
Generalized proximal weakness, especially eyes
Close monitoring for fatigue is important

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Acute pain

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Chronic pain

Pain that continues after noxious stimulus is gone

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Allodynia

Interpretation of pain in response to a typically non-painful stimulus

C fibers

Most common nociceptors
Unmyelinated and small
Transmit dull, throbbing, aching pain
Slow onset, long lasting
Respond well to opioids

A-Delta fibers

Myelinated and small
Transmit sharp, stabbing, pricking pain
Quick onset, shorter duration
Do not respond well to opioids

Sensitization of nociceptors

Activation threshold is decreased –> hypersensitive

Achieved via chemical mediators e.g. histamines, bradykinins, prostaglandins

Peripheral sensitization

Takes place at tissue site, nociceptors are hypopolarized

Central sensitization

Brain interpretation center is hypopolarized | Includes both specific and wide-dynamic range wide dynamic range respond to both noxious and non-nonxious stimuli

A-beta fibesr

Larger fibers that activate SG (inhibit T cells and pain transmission)

Where do a-delta fibers synapse?

More dorsal laminae (lower numbered laminae)

Where do a-beta fibers synapse?

Deeper, higher numbered laminae

What do T-Cells do?

Communicate with anterior horn cells --> muscle spasm --> compression of nerve endings --> physical stimulus --> pain --> spasm --> repeat

SG is inhibited by...

A-delta and C fibers

Ascending method of pain modification:

Gate theory

Descending method of pain modification:

Endogenous opioids block pain modulators (e.g. substance P) --> blocks peripheral sensitization

3 Mechanisms of seizure disorder drugs

1. Increase activity of GABA (CNS inhibitory neurons) 2. Decrease activity of CNS excitatory neurons (glutamate, aspartate) 3. Stabilize opening and closing of neuronal Na and Ca channels, prolonging absolute refractory period

Barbiturates

Increase effect of GABA

Benzodiazepenes

Potentiate inhbitory effect of GABA

Valproates

Limit sodium entry into excited neurons

2nd generation drugs compared to 1st generation

2nd generation drugs have more favorable pharmacokinetics, but use same mechanisms and are not necessarily more effective

Adrenocorticotropic Hormone

Used for infants who do not respond well to usual seizure medications

Side effects of seizure meds

Sedation | Lack or change of coordination/ cognition

Cerebral arteriography

Radiopaque contrast injected to map abnormalities in brain. Used for identification of ischemic and hemorrhagic stroke

Carotid duplex scan

Ultrasound of carotid to assess obstructions. Adds blood flow velocity to imaging. Used for TIA

Computed Tomography

Used for CNS diseases

MRI

Better than CT for contrast between normal and abnormal tissue, better for congenital malformations Used for CNS diseases

PET

Used for CNS diseases (decreased activity with AD)..highly radioactive

Myelography

X-ray image of subarachnoid space of spinal canal, used for SCI

Electroencephalogram

Used for dx of seizures

Electromyography

Used in muscle diseases and to differentiate between neurological conditions

Nerve conduction tests

Used to identify and document severity of peripheral nerve damage

Lumbar puncture

Used to diagnose infections