DISORDERS IN THE CNS CAUSED BY DRUGS

Question 1

The common drug and toxin transformations
involve ___________, which enhance their solubility and elimination
mainly by the kidney

Answer 1

hydroxylation, deamination, oxidation, and

dealkylation

Question 2

The process of movement from plasma to brain is by

_______ or by_______

Answer 2

diffusion through capillaries

facilitated transport

Question 3

The terms opioid and narcoticanalgesic
designate drugs with actions similar to those of
_______

Answer 3

morphine.

Question 4

Opioids activate G-coupled transmembrane
receptors, meaning they influence neuronal activity
through the intermediate of cAMP; the receptor types are
denomina.te􀃎 as______, _______, ______

Answer 4

mu, delta, and kappa

Question 5

Clinical effects of opioids

knowledge that these receptors are concentrated in the
thalamus and dorsal root ganglia (mu receptors,_______),
amygdala (________) and brainstem raphe (_________), and Edinger-Westphal nuclei _______

Answer 5

pain

affect

alertness

(pupillary miosis

Question 6

Receptors
in the brainstem, also of the ________type, are involved
in modulating respiratory responses to hypoxia and
hypercarbia (respiratory suppression).

Answer 6

mu

Question 7

Pts susceptible to Morphine side effects

Answer 7

myxedema,

Addison disease, chronic liver disease, and pneumonia

Question 8

___________, _________, ___________, ________, ___________ are the
we.ll-re􀃓ognized clinical manifestations of acute opioid
pmsonmg.

Answer 8

Unresponsiveness, shallow respirations, slow
respiratory rate (e.g., 2 to 8 per min) or periodic breathing,
pinpoint pupils, bradycardia, and hypothermia

Question 9

In pts with Opiate toxicity,

The immediate cause of death is usually ________

Answer 9

respiratory

depression with consequent asphyxia

Question 10

This consists of the support of ventilation and administration of ______ or the longer-acting
______ both specific antidotes to the opiates and also
to the synthetic analgesics

Answer 10

naloxone (Narcan),

nalmefene,

Question 11

The dose of naloxone in adults
is usually ______ and repeated in larger increments (the
second dose is typically 2 mg) every 2 min to a dose of
_______ intravenously.

The
improvements in ____ and _________ and reversal
of miosis are usually dramatic.

Answer 11

0.05 mg

15 mg

circulation and respiration

Question 12

Naloxone has less direct effect on _________
however, and the patient may remain drowsy for man;
hours

Answer 12

consciousness

Question 13

Although nalmefene has a plasma half-life
of _______ compared to ______for naloxone, it has no
clear advantage in emergency practice

Answer 13

11 h,

60 to 90 min

Question 14

an antidote must be used with great caution in an addict
who has taken an overdose of opioid, because in this
circumstance, it may precipitate ______

Answer 14

withdrawal phenomena

Question 15

Nausea and severe abdominal pain, presumably because
of _________ are
other troublesome symptoms of opiate use or withdrawal

Answer 15

pancreatitis (from spasm of the sphincter of Oddi),

Question 16

The onset of opioid use is usually in adolescence,
with a peak at 17 to 18 years; fully two-thirds of
addicts start using the drugs before the age of_______

Answer 16

21

Question 17

Opioid addiction consists of three recognizable
phases: 
1
2
3

Answer 17

(1) intoxication, or “euphoria,”
(2) pharmacogenic dependence or drug-seeking behavior (addiction), and
(3) the propensity to relapse after a period of abstinence

Question 18

the administration of opioids
produces a sense of unusual well-being, a state that has
traditionally been referred to as ________

Answer 18

morphine euphoria.

Question 19

The
latter refers to the symptoms and signs that become
manifest when the drug is withdrawn following a period
of continued use

Answer 19

physical dependence

Question 20

opioids
activate an opioid antinociceptive system ________, ________, _________ which are opioid receptors and
are located at many different levels of the nervous system

Answer 20

(enkephalins,

dynorphins, endorphins),

Question 21

The desensitization of opioid receptors, probably mainly the ________, accounts for tolerance through a mechanism of uncoupling of the receptor from the G-protein complex.

Answer 21

mu type

Question 22

With morphine,
the majority of individuals receiving______ daily for
30 days or more will show moderately severe abstinence
symptoms following withdrawal

Answer 22

240 mg

Question 23

___________ the equivalent of emotional or
psychologic dependence, refers to the substitution of drugseeking
activities for all other aims and objectives in life.

Answer 23

Habituation,

Question 24

Abstinence symptoms from _______
are less intense than those from morphine and do not
become evident until 3 or 4 days after withdrawal; for
these reasons THIS can be used in the treatment
of morphine and heroin dependency

Answer 24

methadone

Question 25

_________ addicts are likely to

have dilated pupils and twitching of muscles

Answer 25

Meperidine

Question 26

In Europe, addicts who could not be detoxified
and kept free of drugs by any other means have been
given ________ the active ingredient in heroin,

Answer 26

diacetylmorphine,

Question 27

A randomized trial conducted by Fudala
and colleagues has demonstrated the superiority over
methadone of a combination of ________ AND _______ combined with brief counseling in keeping opioid addicts in treatment and abstinent of abused drugs

Answer 27

buprenorphine and

naloxone

Question 28

Neuro cx of Opiate use

________, probably
as a result of the toxic effects of quinine in the heroin
mixtures

Answer 28

Amblyopia

Question 29

Neuro cx of Opiate use

Most instances of this _______ are the result of inhalation of heated heroin vapor in a practice known as “chasing
the dragon.

Answer 29

leukoencephalopathy

Question 30

An acute generalized _____with myoglobinuria
and renal failure has been ascribed to the intravenous
injection of adulterated heroin

Answer 30

myonecrosis

Question 31

_________ and ________ are the sequelae of
venous thrombosis resulting from the administration of
heroin and its adulterants by the intramuscular and
subcutaneous routes.

Answer 31

Brawny edema and fibrosing

myopathy (Volkmann contracture)

Question 32

for barbiturates

T or F

The higher its lipid solubility, the
greater the drug’s central nervous system potency and
the quicker and briefer its action

Answer 32

T

Question 33

The action of barbiturates is to suppress neuronal
transmission, presumably by__________
at pre- and postsynaptic receptor sites, and to ___________

Answer 33

enhancing GABA inhibition

reduce
excitatory postsynaptic potentials

Question 34

T or F

Pentobarbital and secobarbital
produce their effects quickly and recovery is relatively
rapid

Answer 34

T

Question 35

In the case of long-acting barbiturates, such as ____________, the hypnotic-sedative effect lasts 6 h or more after an average oral dose;

with the intermediate-acting drugs such
as ___________, 3 to 6 h;

and with the short-acting drugs,
_________ and______, less than 3 h

Answer 35

phenobarbital and barbital

amobarbital

secobarbital and pentobarbital

Question 36

The potentially fatal dose of phenobarbital is____g.
The lowest plasma concentration
associated with lethal overdosage of phenobarbital
or barbital has been approximately ______ and
that of amobarbital and pentobarbital, 10 mg/mL.

Answer 36

6 to 10

60 mg/mL`

Question 37

flaccid coma with small reactive
pupils, hypothermia, and hypotension.

What type of toxicity

Answer 37

barbiturate

Question 38

Hemodialysis or hemofiltration with charcoal may be
used in comatose patients who have ingested long-acting
barbiturates and these treatments are particularly advisable if _____ or _____has developed

Answer 38

anuria or uremia

Question 39

B a rbitu rate Abst i n e n ce , o r Withd rawa l ,
Sy n d ro me

Immediately following withdrawal, the patient seemingly
improves over a period of ________, as the symptoms
of intoxication diminish

Answer 39

8 to 12 h

Question 40

With
chronic phenobarbital or barbital intoxication, withdrawal
symptoms may not become apparent until ___________h after the final dose

Answer 40

48 to

72

Question 41

In Barbiturate withdrawal

there is a greatly heightened
sensitivity to photic stimulation, to which the patient
responds with _________ or a seizure accompanied by
paroxysmal changes in the EEG

Answer 41

myoclonus

Question 42

This is the oldest and one of the safest, most effective, and
most inexpensive of the sedative-hypnotic drugs.

Answer 42

chloral hydrate

Question 43

T or F

Tolerance and addiction to chloral hydrate develops usually

Answer 43

F

_rare

Question 44

The________ have been prescribed frequently
for the treatment of anxiety and insomnia, and they are
especially effective when the anxiety symptoms are
severe.

Answer 44

benzodiazepines

Question 45

____________ is particularly
useful in the treatment of delirious patients who require
parenteral medication.

Answer 45

Diazepam

Question 46

____________has a central place in the treatment o f panic
attacks and other anxiety states, and as an adjunct in
some depressive illnesses

Answer 46

Alprazolam

Question 47

______a specific pharmacologic antagonist
of the CNS effects of benzodiazepines, rapidly but
briefly reverses most of the symptoms and signs of
benzodiazepine overdose

Answer 47

Flumazenil,

Question 48

In chronic benzodiazepine users, the gradual tapering
of dosage over a period of _______minimizes the
withdrawal effects.

Answer 48

1 to 2 weeks

Question 49

MOA of anti-psychotic drugs

Answer 49

blocking the postsynaptic
mesolimbic dopamine receptors of which there
are four subtypes, termed D1 through D4 on neuronal
membranes

Question 50

The _______receptors are located mainly
in the frontal cortex, hippocampus, and limbic cortex,
and the______ receptors are in the striatum

Answer 50

D2

D1

Question 51

The newer “atypical” antipsychotic drugs, exemplified
by________ apparently achieve the same degree of D2
and D3 blockade in the temporal and limbic lobes while
exhibiting substantially less antagonistic activity in the
striatum-accounting also for their lesser parkinsonian
side effects.

Answer 51

clozapine,

Question 52

8 CLASSES OF ANTI-PSYCH

1.
2.
3.
( 4) the rauwolfias alkaloids;
(5) an indole derivative, loxapine, and a unique dihydroindolone, molindone;
(6) a diphenylbutylpiperidine, pimozide;
(7) dibenzodiazepines, typified by ______
(8) a benzisoxazole derivative, _______

Answer 52

1) the phenothiazines;
(2) the thioxanthenes;
(3) the butyrophenones;

clozapine and olanzapine; and
risperidone

Question 53

they are particularly favored in controlling the

confusion and psychosis of parkinsonian patients

Answer 53

clozapine

Question 54

_____ may be useful in the treatment
of haloperidol-refractory cases of Gilles de la Tourette
syndrome

Answer 54

Pimozide

Question 55

This group comprises 
chlorpromazine (Thorazine), 
promazine (Sparine), 
triflupromazine (Vesprin), 
prochlorperazine (Compazine), 
perphenazine (Trilafon),
 fluphenazine (Permitil, Prolixin), 
thioridazine (Mellaril), 
mesoridazine (Serentil), and 
trifluoperazine (Stelazine

Answer 55

Phenoth iazines

Question 56

The phenothiazines have had their widest application
in the treatment of the major psychoses, namely
_____ and, to a lesser extent, ________

Answer 56

schizophrenia

bipolar psychosis

Question 57

Side effects of Phenothiazines

Answer 57

cholestatic type of jaundice,
agranulocytosis, seizures, orthostatic
hypotension, skin sensitivity reactions, mental
depression, and, most importantly, immediate or delayed
extrapyramidal motor disorders

Question 58

The ____________ is the most extreme complication of Phenothiazones

Answer 58

neuroleptic

malignant syndrome

Question 59

5 EPS syndromes associated with Phenothiazines

Answer 59

1. parkinsonian syndrome
2. Acute dyskinetic and dystonic reactions
3. Akathisia
4. Tardive dyskinesias
5. neuroleptic malignant syndrome

Question 60

Suppression of dopamine
in the ____________
is presumably the basis of the parkinsonian signs

Answer 60

striatum (similar to the effect of loss of

doparninergic nigral cells that project to the striatum)

Question 61

_______which is an inner restlessness reflected
by a persistent shifting of the body and feet and an
inability to sit still, such that the patient paces the
floor or jiggles the legs constantly

Answer 61

Akathisia,

Question 62

Of
all the phenothiazines, ________has a tendency to
cause akathisia. This disorder often responds to oral
propranolol.

Answer 62

molindone

Question 63

It has much the same therapeutic effects as the
phenothiazines in the management of acute psychoses
and shares the same side effects as the phenothiazines,
but exhibits little or no adrenergic blocking action

Answer 63

Butyrophen ones

Question 64

Butyrophenones is also one of the main drugs for the
treatment of _______

______is the only member of this group

Answer 64

Gilles de la Tourette syndrome

Haloperidol (Haldol)

Question 65

acute dystonic spasms usually
respond to cessation of the offending drug and to the
administration of_______

Answer 65

diphenhydramine

Question 66

Administration of antiparkinsonian drugs of the _________________ may hasten
recovery from some of the acute symptoms

Answer 66

anticholinergic type (trihexyphenidyl,
procyclidine, and benztropine)

Question 67

T or F

Oral, lingual, and laryngeal dyskinesias of the tardive
type are affected relatively little by any antiparkinsonian
drugs.

Answer 67

T

Question 68

_______ in doses of 50 to 100 mg tid has
been useful in a few of the cases of postphenothiazine
dyskinesia

Answer 68

Amantadine

Question 69

For severe and recalcitrant cases, particularly those
involving axial dystonias and similar disabling features,
Fahn recommends administration of the dopaminedepleting drug _____

Answer 69

tetrabenazine (similar but faster in action

and less toxic than reserpine) .

Question 70

This is the most dreaded complication o f phenothiazine
and haloperidol use; rare instances have been reported
after the institution or the withdrawal of L-dopa and
similar dopaminergic agents, as well as a few instances
reported with the newer antipsychosis drugs

Answer 70

N e u roleptic M a l i g n a nt Synd ro m e

Question 71

NMS syndrome

_______ and other signs of sympathetic overactivity, high serum________ values (up to 60,000 units), and, in some cases, renal failure because of myoglobinuria

Answer 71

hyperthermia, rigidity, stupor, unstable blood pressure, diaphoresis,

creatine kinase (CK)

Question 72

Drug used to control nausea that causes NMS

Answer 72

Promethazine

Question 73

If treatment of the neuroleptic malignant syndrome
is started early, when consciousness is first altered and
the temperature is rising, ___________will terminate the condition in a few hours.

Answer 73

bromocriptine in oral doses of

5 mg tid (up to 20 mg tid)

Question 74

In NMS Tx,

If oral medication can no longer be taken
because of the patient’s condition, __________ may be lifesaving

Answer 74

dantrolene, 0.25 to

3.0 mg intravenously,

Question 75

One pitfall is to m istake neuroleptic malignant syndrome

for ________

Answer 75

worsening of the psychosis and inadvisably administer

more antipsychosis medication

Question 76

Four classes of drugs-_______________-are

particularly useful in the treatment of depressive illnesses.

Answer 76

the MAO inhibitors, the tricyclic

compounds, the serotonergic drugs, and lithium

Question 77

_________ is located on the outer surface
of the mitochondria in neurons and is used in the
catabolism of catecholamines

Answer 77

Monoamine oxidase

Question 78

In the gut and liver, the isoenzyme __________normally serves to deaminate phenethylamine, tyramine, and tryptamine-all of which are products of protein catabolism

Answer 78

MAO-A

Question 79

Inhibition of
MAO-A allows these dietary amines, which have an
amphetamine-like action, to enter the systemic circulation
in increased quantities, thus r____________

Answer 79

eleasing norepinephrine

from sympathetic nerve endings

Question 80

Patients taking MAO-A inhibitors must be warned

against the use of________________ (see later), as well as sympathomimetic amines and hJramine-containing foods.

Answer 80

phenothiazines, CNS stimulants, and

tricyclic and serotoninergic antidepressants

Question 81

They block the reuptake of amine
neurotransmitters, both norepinephrine and serotonin.

Blocking this amine pump mechanism (called the presynaptic plasma transporter), which ordinarily terminates synaptic transmission, permits the persistence of neurotransmitter substances in the synaptic cleft

Answer 81

TCA

Question 82

They have activity as reuptake
inhibitors of norepinephrine and serotonin

which have a preferential
effect on reuptake of norepinephrine.

Answer 82

tertiary amines

secondary amines

Question 83

Tertiary or secondary?

imipramine, amitriptyline and doxepin, trirnipramine

Answer 83

3

Question 84

desipramine, amoxapine, maprotiline,

nortriptyline, protriptyline

Answer 84

2

Question 85

T or F

The side
effects of the tricyclic drugs are more frequent and far less
serious than those of the MAO inhibitors.

Answer 85

F

less frequent

Question 86

T or F

The tricyclic drugs should not
be given with an MAO inhibitor; serious reactions have
occurred when small doses of imipramine were given to
patients who had discontinued the MAO in the previous
days or week

Answer 86

T

Question 87

Mortality from TCA overdose is mostly a result of cardiac
rhythm disturbances, particularly _______, and
impaired _________

Answer 87

tachyarrhythmias

conduction (atrioventricular block).

Question 88

What class of drug?

paroxetine (Paxil),
fluoxetine (Prozac), and sertraline (Zoloft)

Answer 88

SSRI

Question 89

_______
has also been used with benefit in a group of autistic
children

Answer 89

Fluoxetine

Question 90

The symptoms o f a_____________ that results
from excessive intake of the above listed drugs or from
the concurrent use of MAO inhibitors include confusion
and restlessness, tremor, tachycardia, hypertension,
clonus and hyperreflexia, shivering, and diaphoresis

Answer 90

“serotonin syndrome”

Question 91

In serotonin syndrome,

The treatment is by discontinuation of the
medication, reduction of temperature and hypertension,
__________ to control agitation, and in severe
cases, the addition of ________, a 5-HT 2A receptor
blocker.

Answer 91

benzodiazepines

cyproheptadine

Question 92

Lithium:

Its value is much more certain in treatment of the _________ of bipolar disorder and prevention of recurrences of ________ than it is in treatment of anxiety and depression

Answer 92

manic phase

cyclic mood shifts

Question 93

With blood levels of lithium in the upper therapeutic
range (therapeutic 0.6 to 1 .2 mEq/L), it is not uncommon
to observe a :
1.
2.
3.
4.
5.

Answer 93

fast-frequency action tremor or asterixis,
together with nausea, loose stools, fatigue, polydipsia,
and polyuria

Question 94

T or F

Discontinuing lithium in the intoxicated patient,
which is the initial step in therapy, results in
immediate disappearance of toxic symptoms

Answer 94

F

does not result in immediate

Question 95

___________analeptics
(CNS stimulants) and in addition have significant hypertensive,
respiratory-stimulant, and appetite-depressant
effects.

Answer 95

The amphetamines (d-amphetamine, d-l-amphetamine, pemoline,
methamphetamine, methylphenidate)

Question 96

Other indications of amphethamines

Answer 96

They are effective in the management of narcolepsy, for the control of obesity, the abolition
of fatigue, and the treatment of hyperactivity in children

Question 97

Pathophysio of ICH and SAH in Amphetamine use

Answer 97

vasospasm and arteritis

Question 98

A sense of well-being, euphoria, loquacity, and

restlessness are the familiar effects of what drug

Answer 98

Cocaine

Question 99

MOA of cocaine

Answer 99

it blocks the presynaptic reuptake of biogenic amines,

thus producing

Question 100

withdrawal syndrome FROM cocaine

Answer 100

insomnia,
restlessness, anorexia, depression, hyperprolactinemia,
and signs of dopaminergic hypersensitivity

Question 101

Cocaine and amphetamines also, on occasion, produce
a state of generalized__________ leading to multiple
cortical infarctions and posterior white matter changes
that are evident on imaging studies, essentially a form of
_______

Answer 101

vasospasm

hypertensive encephalopathy

Question 102

______, ________and other manifestations
of ________ may develop within several hours of
cocaine use.

Answer 102

Anxiety, paranoia, psychosis

Question 103

Examples of psychoactive or

psychotomimetic drugs or as hallucinogens and psychedelics.

Answer 103

lysergic acid diethylamide (LSD), phenylethylamine derivatives (mescaline or peyote), psiloct;bin, certain indolic derivatives, can nabis (marijuana),
phencyclidine (PCP),

Question 104

this agent the CB1 receptor, mainly on gabanergic neurons in the hippocampus, amygdala, and cortex.

Activation of the receptor inhibits the release of oligopeptide neurotransmitters and monoamines

Answer 104

Marijuana

Question 105

These agents bind even more
avidly to cannabinoid receptors than does the original
drug and produce a heightened stimulant effect

Answer 105

S y n t h et i c C a n n a b i n o i d s

Question 106

In Tetanus,

a single dose of ________ should be given along with a 10-day course of
1.
2.
3.

Answer 106

antitoxin (3,000 to 6,000 U of tetanus immune
human globulin)

penicillin ( 1 .2 million U of procaine penicillin daily), metronidazole (500 mg q6h intravenously or 400 mg rectally), or tetracycline (2 g daily) .

Question 107

In Tetanus,

The _______
are the most useful drugs for both sedation and muscle
relaxation;

Answer 107

benzodiazepines

Question 108

In Tetanus,

_________or more can be given
in frequent divided doses if ventilatory support is
available; alternatively _______ can be
used in a continuous intravenous infusion

Answer 108

diazepam 120 mg / d

midazolam or propofol

Question 109

Failure of these measures to control the tetanic
paroxysms requires that intravenous administration of
neuromuscular blocking agents such as _______ or _______ be used to abolish all muscle activity;

Answer 109

pancuronium

or vecuronium

Question 110

All persons should be immunized against tetanus
and receive a booster dose of toxoid every _________-a
practice that is frequently neglected in the elderly

Answer 110

10 years

Question 111

Injuries
that carry a threat of tetanus should receive toxoid if
the patient has not received a booster injection in the
preceding year, and a second dose of toxoid is needed
_________ later.

Answer 111

6 weeks

Question 112

T or F

An attack of tetanus does not
confer permanent immunity and persons who recover
should be actively immunized.

Answer 112

T

Question 113

The faucial-pharyngeal
form of the disease, which is the most common clinical
type, is characterized by the formation of an inflammatory
exudate of the throat and trachea

Answer 113

D i p htheria

Question 114

In Diphtheria,

It begins locally, with _______ between the fifth and
twelfth days of illness

Answer 114

palatal paralysis (nasal voice,
regurgitation, and dysphagia)

Question 115

In Diphtheria,

Ciliary body paralysis with loss of accommodation and blurring of vision but with preserved light reaction usually appears in the ________ (the opposite of the Argyll Robertson reaction)

Answer 115

second or third week

Question 116

What distinguished Diphtheria from other forms of polyneuropathy?

Answer 116

The early oropharyngeal symptoms, the ciliary
paralysis with relatively retained pupillary response to
light, and subacute evolution of a delayed symmetrical
sensorimotor peripheral neuropathy distinguish
diphtheria from other forms of polyneuropathy

Question 117

Diphtheria the toxin reaches the Schwann cells in
the most vascular parts of the peripheral nervous system
within _________h of infection but its metabolic effect on
cell membranes extends over a period of weeks.

Answer 117

24 to 48

Question 118

Tx of Diphtheria

There is no specific treatment for the neurologic
complications of diphtheria. It is generally agreed
that the administration of antitoxin within ________ of the
earliest symptoms of the primary diphtheritic infection
lessens the incidence and severity of the peripheral
nerve complications

Answer 118

48 h

Question 119

Site of infection of botulism

Answer 119

presynaptic membrane

Question 120

MOA of botulism

Answer 120

The toxin interferes with the release of acetylcholine from peripheral motor nerves at the neuromuscular synapse.

Question 121

Sx of botulism

Symptoms usually appear within _____ of
ingestion of the tainted food. Anorexia, nausea, and
vomiting occur in most patients

Answer 121

12 to 36 h

Question 122

In Botulism,

EMG findings:

Answer 122

here is reduced amplitude of evoked muscle potentials and an increase in amplitude with rapid repetitive nerve stimulation (the opposite of what is found in myasthenia gravis)

Question 123

Initial Tx for Botulism

An initial dose of ________is given intravenously after intradermal testing for sensitivity to horse serum, followed by daily doses of______ intramuscularly until improvement begins.

Answer 123

10,000 U

50,000 U

Question 124

Initial Tx for Botulism

_____ or ________are given to eradicate the
organism in a wound (but are not as useful if the
exogenous preformed toxin has been ingested).

Answer 124

Penicillin or metronidazole

Question 125

_____________ has been
somewhat useful in reversing the weakness of limb and
extraocular muscles

Answer 125

Guanidine hydrochloride (50 mg/kg)

Question 126

the _________ envenomation,
are neurotoxic, producing pupillary dilatation,
ptosis, ocular palsies, ataxia, and respiratory paralysis

Answer 126

coral snake

Question 127

These develop over a
period of 3 to 6 weeks. The child becomes anorectic,
less playful and less alert, and more irritable. These
symptoms may be misinterpreted as a behavior disorder
or a manifestation of mental retardation. Intermittent
vomiting, vague abdominal pain, clumsiness, and ataxia
may be added.

What metal poisoning?

Answer 127

Lead

Question 128

CSF picture of lead poisioning

Answer 128

the CSF is under increased pressure
with manifest papilledema, and there may be a slight
lymphocytic pleocytosis and elevated protein but normal
glucose values.

Question 129

In Lead poisoning:

Lead lines at the _________and ______ of red cells are seen but are too inconstant to be relied on, but basophilic stippling of bone marrow erythroblasts is uniformly
increased.

Answer 129

metaphyses of long bones

basophilic stippling

Question 130

Impairment of heme synthesis, which is
exquisitely sensitive to the toxic effects of lead, results
in the increased excretion of _____ and _______

Answer 130

urinary coproporphyrin
(UCP) and of delta-aminolevulinic acid (ALA).

Question 131

In the dx of Plumbism

The diagnosis can be confirmed by promoting lead
excretion with _____________. Excretion of over 500
mg in 24 h is indicative of plumbism

Answer 131

calcium disodium edetate (CaNa 2
ethylenediarninetetraacetic acid [EDTA]), given in three
doses (25 mg/kg) at 8-h intervals

Question 132

The measurement of
_______ in the blood is another reliable
means of determining the presence and degree of lead
exposure

Answer 132

zinc protoporphyrin (ZPP)

Question 133

The seriousness of lead
encephalopathy is indicated by the fact that most of the
children who become stuporous or comatose remain
_______despite treatment.

Answer 133

mentally retarded

Question 134

PATHOLOGY of Plumbism

There are also _____ changes in arteries and arterioles and in some places, perivascular infiltrates of lymphocytes and mononuclear cells.

Answer 134

Hyperplastic

Question 135

In the Tx of Plumbism

In cases of acute encephalopathy, combined chelation therapy with ________ and _________

This is followed by a course of________ (40 mg/kg, not exceeding 1 g/ d

Answer 135

2,3-dimercaptopropanol (British anti-Lewisite [BAL]; 12 to 24 mg/kg) and CaNa2
EDTA (0.5 to 1 .5 g/m 2 body surface area) for 5 to 7 days

oral penicillamine

Question 136

_______, frequently precipitated by an intercurrent
infection or by alcohol intoxication, is characterized by
severe, poorly localized abdominal pain, often with
rigidity of abdominal muscles but without fever or
leukocytosis.

Answer 136

Lead colic

Question 137

The diagnostic tests for plumbism in children are
generally applicable to adults, with the exception of
__________ which are of no value in the latter.

Answer 137

bone films,

Question 138

What type of poisoning?

Insomnia, irritability,
delusions, and hallucinations are the usual clinical
manifestations, and a maniacal state may develop. The
hematologic abnormalities of inorganic lead poisoning
are not found, and chelating agents are of no value in
treatment

Answer 138

Organic lead poisoning

Question 139

______ exerts its toxic effects by reacting with the
sulfhydryl radicals of certain enzymes necessary for
cellular metabolism. The effects on the nervous system
are those of an encephalopathy or peripheral neuropathy.

Answer 139

Arsenic

Question 140

Polyneuropathy in Arsenic poisoning, temporal pattern?

Answer 140

distal sensorimotor areflexic syndrome developed subacutely

Question 141

Pathology of Arsenic poisoning:

Answer 141

dying back pattern of myelin and
axons with macrophage and Schwann cell reactions and
chromatolysis of motor neurons and sensory ganglion
cells.

Question 142

transverse white
lines, 1 to 2 mm in width, above the lunula of each
fingernail in Arsenic poisoning

Answer 142

Mee’s lines

Question 143

PAthology of ARsenic poisoning

Answer 143

capillary
necrosis and of pericapillary zones of degeneration,
which, in turn, are ringed by red cells (brain purpura)

Question 144

The diagnosis of arsenical poisoning depends on the

demonstration of increased levels of arsenic in the ______ and _____

Answer 144

hair

and urine

Question 145

Tx for Mn toxicity

Answer 145

The neurologic abnormalities have not responded to

treatment with chelating agents

Question 146

In the chronic dystonic
form of manganese intoxication, dramatic and sustained
improvement has been reported with _________

Answer 146

L Dopa

Question 147

Sx of tremor of the extremities, tongue, and lips; mental confusion; and a progressive cerebellar syndrome, with
ataxia of gait and arms, intention tremor, and dysarthria

Answer 147

Mercury poisoning

Question 148

Mercury poisoning

The pathologic changes are characterized by a striking
degeneration of the _______ of the cerebellar
cortex, with relative sparing of the ________ and
neuronal loss and gliosis of the calcarine cortex and to a
lesser extent of other parts of the cerebral cortex

Answer 148

granular layer

Purkinje cells

Question 149

The term__________
was coined to describe the timidity, memory loss, and
insomnia that were said to be characteristic of chronic
intoxication with Mercury

Answer 149

erethism

Question 150

Acute exposure to inorganic mercury in larger
amounts is even more corrosive to the gastrointestinal
system and produces _______

Answer 150

nausea, vomiting, hematemesis,
abdominal pain, and bloody diarrhea, as well as renal
tubular necrosis.

Question 151

A painful neuropathy of children \_\_\_\_\_\_\_\_ has
been traced to mercury exposure from interior latex paint,
to calomel (mercurous chloride),

Answer 151

(acrodynia)

Question 152

In the treatment of chronic mercury
poisoning, __________has been the drug of choice,
because it can be administered orally and appears to
chelate mercury selectively, with less effect on copper,
which is an essential element in many metabolic processes.

Answer 152

penicillamine