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everything Flashcards

1
Q

What three drugs are FDA-approved for tx of fibromyalgia?

A

Pregabalin
Duloxetine
Milnacipran

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2
Q

What is Pregabalin used for and what is the dose?

A

Fatigue

300-450 mg/day

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3
Q

What is Duloxetine used for and what is the dose?

A

Mood

60-120 mg/day

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4
Q

What is Milnacipran used for and what is the dose?

A

Pain, insomnia

100-200 mg/day

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5
Q

What is the mechanism of action for Duloxetine and Milnacipran?

A

Selective serotonin and norepinephrine reuptake inhibitor

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6
Q

What is the first line of treatment for spasticity associated with FM?

A

Baclofen

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7
Q

What is the mechanism of action for Baclofen?

A

GABA-B agonist

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8
Q

What is the first line of treatment for spasticity associated with MS or spinal cord injury/disease?

A

Tizanidine

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9
Q

Recommended dose of Tinazidine

A

2 mg daily, then increased every 3-4 days, 2 mg each time

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10
Q

T/F: Tinazidine can be used for children

A

False

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11
Q

Treatment for nocturnal muscle spasms

A

Flexeril

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12
Q

What drug is used to diagnose myasthenia gravis?

A

Erdrophonium

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13
Q

What drug is used to treat MG and Lambert-Eaton?

A

Pyridostigmine Bromide

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14
Q

Mechanism of action for cholinesterase inhibitors

A

Acetylcholinesterase cleaves ACh into Acetate and Choline, but Cholinesterase inhibitors, such as Carbamate, can bind Acetylcholinesterase in the place of Acetate and enhance the time that ACh is in the synapse

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15
Q

Anticholinesterase that does NOT enter the CNS

A

Neostigmine

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16
Q

Antidote for neuromuscular blockers, Myasthenia Gravis, GI and Urinary Tract Retention
Not used due to extreme side effects

A

Neostigmine

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17
Q

Why is Pyridostigmine used instead of Neostigmine?

A

Fewer side effects and longer duration of action

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18
Q

Antidote for carbamate poisoning

A

Atropine

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19
Q

Carbamate poisoning causes…

A

SLUDGE leading to bronchospasm and respiratory failure

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20
Q

Mechanism of action in carbamate poisoning

A

Peripheral effects on skeletal NICOTINE receptors —> depolarizing blockade

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21
Q

Why are individuals with NMJ diseases more sensitive to skeletal muscle relaxants?

A

Skeletal muscle relaxants decrease the amount of depolarization that occurs at the NMJ, therefore patients with NMJ diseases who already have low levels of depolarization will be more affected by these drugs

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22
Q 
FAST ONSET (60-70 sec), but duration of action is 28 minutes
MINIMAL CV SIDE EFFECTS, ALLERGIC REACTIONS
A

Rocuronium

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23
Q

SLOW ONSET and eliminated by HOFMANN DEGRADATION

NO HISTAMINE RELEASE and has CV STABILITY

A

Cis-Atracurium

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24
Q

What is the prototype NM blocking drug?

A

Curare (Tubocurarine)

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25
Q

What are the drawbacks of tubocurarine?

A
  1. Blocks ganglia (loss of control of BP),
  2. Affects muscarinic receptors (loss of parasympathetic control of heart rate → tachycardia)
  3. Releases histamine → hypotension, bronchoconstriction and anaphylaxis
  4. Duration of action is over 30 min (too long for short procedures such as intubation)
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26
Q

Succinylcholine mechanism of action

A

Depolarizing. Acts like ACh and activates postsynaptic receptor → receptor channel opens

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27
Q

How does succ stay in the post-synaptic cleft?

A

Succ not hydrolyzed by Synaptic AChE (only by plasma AChE)

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28
Q

What is the only remaining NM blocking drug that works by depolarizing APs?

A

Succinylcholine

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29
Q

Why is succ-induced depolarization in the peri-junctional muscle short-lived?

A

Na+ channels inactivated → propagation of depolarization is blocked

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30
Q

T/F: Succinylcholine is a depolarization agonist

A

True

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31
Q

What are two main short acting aminosteroids?

A

Vecuronium, Rocuronium

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32
Q

Which drug is active against Vecuronium and Rocuronium, but not against Succinylcholine?

A

Sugammadex

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33
Q

Gamma-cyclodextrin ring with lipophilic cavity

A

Sugammadex

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34
Q

Tracts/nerves affected in Weber’s syndrome

A

CN III
Corticospinal
Corticobulbar

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35
Q

Possible etiologies for Weber’s

A

Medial midbrain lesion

PCA occlusion

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36
Q 
Ipsilateral down and out/dilated eye
Contralateral hemiparesis
UMN motor weakness
Exaggerated gag reflex
Spastic tongue
Spastic dysarthria
A

Weber’s syndrome

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37
Q

Patient cannot look up. She most likely suffers from….

A

Parinaud’s syndrome

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38
Q

Vertical gaze palsy

Pupils accommodate, but do not constrict to light

A

Parinaud’s

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39
Q

Parinaud’s + non-communicating hydrocephalus indicates which additional structure has been affected?

A

Cerebral aqueduct

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40
Q

Structures affected in Parinaud’s syndrome

A

Superior colliculi

Pretectal area

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41
Q

Lateral gaze palsy. Which nerve is affected?

A

CN VI

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42
Q

Which three structures conduct lateral gaze and what level of the brainstem are they located in?

A

CN VI
PPRF
MLF

Pons.

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43
Q

Classic cause of lateral pontine syndromes

A

AICA stroke

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44
Q

Classic cause of medial medullary syndrome

A

Anterior spinal artery stroke

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45
Q

Classic cause of Wallenberg’s syndrome

A

PICA stroke

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46
Q

Patient has complete motor weakness. We know they don’t have…..

A

ACA or MCA stroke

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47
Q

Hemiplegia + down and out eye = ______

A

Weber’s syndrome

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48
Q

Location of Weber’s syndrome in brainstem

A

Medial midbrain lesion

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49
Q

Location of Wallenberg’s syndrome in brainstem

A

Lateral medullary lesion

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50
Q

What mediates the corneal reflex?

A

V: detects
VII: blinks

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51
Q

MLF lesion presentation

A

Nystagmus in contralateral eye

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52
Q

What is the only cranial nerve that exits dorsally?

A

CN IV

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53
Q

Cavernous sinus occlusion would cause…

A

Abducens lesion (Lateral gaze palsy)

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54
Q

Which cranial nerves synapse in the nucleus ambiguus?

A

IX, X, XI

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55
Q

Jugular foramen occlusion would cause…

A

Inability to turn head to affected side

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56
Q

Gag reflex is afferent or efferent?

A

Afferent

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57
Q

What tract provides sensory innervation for the pharynx and larynx?

A

Spinal trigeminal

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58
Q

FDA approved drug for fibromyalgia

A

Minalsaprin

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59
Q

Which level of the brainstem is the red nucleus located in?

A

Midbrain

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60
Q

What extraocular structures does CNIII innervate?

A

Super, medial, inferior rectus

Inferior oblique

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61
Q

What structure does CN IV innervate?

A

Superior oblique

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62
Q

Which structures yield contralateral deficits?

A

Spinothalamic
Medial lemniscus
Trigeminal lemniscus
Corticospinal

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63
Q

Which structures yield only ipsilateral deficits?

A

Cranial nerves
Descending tract of V
Posterior columns in the lower medulla

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64
Q

A lesion involving which structures would yield ipsilateral cranial nerve deficits and contralateral loss of pain and temperature sensations from the body?

A

CNs V, VII, IX, X, and XI exit the brainstem in close proximity with the spinothalamic tract. As a result, a lesion in one of these regions may involve one of these nerves as well as the spinal lemniscus.

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65
Q

A lesion involving which structures would yield cranial nerve deficits with alternating hemiplegia?

A

CNs III, V, VI, XII + Corticospinal tract

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66
Q

Which cranial nerves exit the brainstem adjacent to the corticospinal tract?

A

III, V, VI, XII

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67
Q

Unilateral lesion of the CST would cause which symptoms?

A

Contralateral spastic hemiplegia

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68
Q

Unilateral lesions of the CBT above the level of the decussation results in what symptoms?

A

Contralateral paralysis of the mimetic muscles of the lower face –> supranuclear facial palsy
Cranial palsies due to denervation of abducens nuscleus, hypoglossal nucleus, and nucleus ambiguus

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69
Q

Unilateral lesions of the CBT below the level of decussation would cause what symptoms?

A

Ipsilateral cranial nerve palsies

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70
Q

Where does the CBT decussate?

A

In the lower pons between the levels of trigeminal and abducens nerve

71
Q

What does the CBT innervate?

A

CN motor nuclei of the brainstem

72
Q

Ipsilateral paralysis and atrophy of the muscles of mastication
Diminished jaw-jerk reflex

A

Motor nucleus of V lesion

73
Q

Ipsilateral facial palsy

Loss of corneal reflex

A

Motor nucleus of VII lesion

74
Q

Dysarthria
Dysphagia
Hoarseness
Deviation of the uvula away from the affected nucleus

A

Nucleus ambiguus lesion

75
Q

Pupillary dilation

Difficulties in accommodation

A

Edinger-Westphal nucleus lesion

76
Q

Ipsilateral loss of lacrimation

A

Superior salivatory nucleus

77
Q

Ipsilateral loss of salivation from the parotid gland

A

Inferior salivatory nucleus lesion

78
Q

Transient parasympathetic deficits

A

Dorsal motor nucleus of X lesion

79
Q

External strabismus

Complete ptosis

A

Oculomotor nucleus lesion

80
Q

Gaze of the contralateral eye is directed down and out

Head tilts toward side of the affected nucleus

A

Trochlear nucleus lesion

81
Q

Ipsilateral paralysis of lateral gaze

Internal strabismus

A

Abducens nucleus lesion

82
Q

Ipsilateral paralysis and atrophy of the intrinsic muscles of the tongue
Protruded tongue deviates toward side of lesion

A

Hypoglossal nucleus lesion

83
Q

Ipsilateral loss of proprioception from 1/2 of the head

Diminished jaw-jerk reflex

A

Mesencephalic nucleus of V lesion

84
Q

Ipsilateral loss of fine proprioception and two-point discrimination from 1/2 of the face

A

Main sensory nucleus of V lesion

85
Q

Ipsilateral loss of pain and temperature from 1/2 of the face

A

Descending nucleus of V lesion

86
Q

Ipsilateral loss of taste from the tongue and oropharnyx

Diminished/absent visceral pain sensations from the ipsilateral palate and pharynx

A

Solitary nucleus lesion

87
Q

Problems with equilibrium and posture

Nystagmus

A

Vestibular nuclei lesion

88
Q

Conveys proprioceptive, vibratory, and two-point tactile discrimination from the opposite 1/2 of the body
In upper pons and midbrain, carries fibers thsat convey taste from the ipsilateral 1/2 of the tongue and pharynx

A

Medial lemniscus

89
Q

Conveys bilateral auditory information

Predominantly information from the opposite ear

A

Lateral lemniscus

90
Q

Loss of pain/temperature sensation from ipsilateral face

A

Descending tract of V lesion

91
Q

Bilateral diminution of hearing which is most predominant in the contralateral ear

A

Lesion:
Lateral lemniscus
Brachium of inferior colliculus

92
Q

A 67-year-old man presents with loss of pain/temp on the left side of his face and right side of his body. In addition, he has difficulty swallowing, hoarseness of speech, and an unsteady gait. Where is the lesion located and what vascular occlusion could cause this?

A

Lateral medulla –> Wallenberg’s

PICA occlusion

93
Q

How can you tell the difference between a trochlear nerve lesion and a trochlear nucleus lesion?

A 
Nucleus = head tilted toward lesion
Nerve = head tilted away from lesion
94
Q

What modality of fibers does the solitary tract contain?

A

[General and special] Visceral afferent fibers from CNs VII, X, XI

95
Q

What is the defect in Dandy-Walker Syndrome?

A

Congenital absence of lateral apertures (Luschka) & median (Magendie)

96
Q

What is the result of the defects in Dandy-Walker?

A

Partial/complete agenesis of C vermis (striated part of cerebellum)
Cystic dilation in poster fossa and 4th ventric
Absence/abnormality of corpus callosum

97
Q

Symptoms of Dandy-Walker

A 
Macrocephaly
Vomiting
Headeaches
Truncal ataxia
Delayed motor skills
CN problems
98
Q

Treatment for Dandy-Walker

A

Cyst decompression and shunt (e.g. redirect CSF to peritoneum)

99
Q

Pathology of Type II Arnold Chiari Malformation

A

Herniation of medulla into vertebral canal

IV ventricle compression: obstructive hydrocephaly – blocks CSF flow (non-communicating)

100
Q

Symptoms of Arnold Chiari Type II

A

Increased pressure on cerebellum, medulla + CN lX,X,Xl,Xll

Frequent with L meningomyelocele & syringomyelia

101
Q

Treatment for Arnold Chiari

A

Shunt: an inert, flexible tube containing a unidirectional flow valve is inserted into the lateral ventricles to allow CSF fluid to drain into a body cavity (typically the abdominal cavity) where it can be resorbed.

102
Q

Alpha-fetoprotein is increased/decreased in Down syndrome?

A

Hepatic alpha-fetoprotein is decreased

103
Q

Cause and timeline of anencephaly

A

Failure of anterior neural tube to close in days 21-28

104
Q

What structures is the cephalic flexure located betwixt?

A

Prosencephalon and mesencephalon

105
Q

What structures is the cervical flexure located betwixt?

A

Rhombencephalon and future spinal cord

106
Q

What nucleus receives baroreceptor and chemoreceptor input?

A

Solitary nucleus

107
Q

Describe parasympathetic innervation of the heart

A

Nucleus ambiguus sends parasympathetic preganglionic neurons to join the vagus nerve and directly inhibit the heart.

108
Q

What is the function of CVLM?

A

CVLM inhibits RVLM with GABA

109
Q

What is the function of RVLM?

A

Excitatory. Sympathetic fibers from the IML synapse at the stellate gangliong to relax vessels and slow down the heart.

110
Q

What are the sensory fibers?

111
Q

What is frequently added to LAs to increase duration?

A

Epi, norepi

112
Q

What is scala media filled with?

A

Endolymph (high K+)

113
Q

What separates the scala media from the scala tympani?

A

Basilar membrane

114
Q

Where do sounds localize in the scala media?

A

High frequency —> base

Low frequency –> apex

115
Q

How does the basilar membrane transfer mechanical energy through the organ of Corti?

A

BM displaced upward/laterally –> hair cell activation (stereocilia move toward kinocilia)
BM displaced downward/medially –> hair cell inhibition

116
Q

The basilar membrane causes hair cells to come into contact with what structure?

A

Tectorial membrane

117
Q

What happens when the BM is displaced upward/laterally?

A

Hair cells come into contact with tectorial membrane (stereocilia move toward kinocilia) and activate. Ion channels on the hair cells open, allowing an INWARD flow of K+ and Ca2+. Depolarization leads to NT release, which transmits impulses to the inferior colliculus and auditory cortex.

118
Q

What happens when the BM is displaced downward/medially?

A

Hyperpolarization; K+ flows out.

119
Q

In the auditory system, what happens if there is no influx of Ca2+?

A

No NT release

120
Q

How do you measure hearing problems in newborns?

A

Otoacoustic emission

121
Q

Where does CN VIII enter the brainstem?

A

Both vestibular and cochlear branches enter in the rostral medulla

122
Q

Where is the primary auditory cortex located?

A

Transverse gyri of Heschl

123
Q

What is sensorineural deafness?

A

Processes that damage hair cells, cochlear nerve fibers, or cochlear nuclei. Leads to deafness in ipsilateral ear.

124
Q

Explain the results of a Weber’s test

A

Vibration in affected ear –> conductive (obstructive) hearing loss
Vibration in unaffected ear –> sensorineural loss

125
Q

Explain the results of Rinne’s test

A

Sound louder on mastoid process –> conductive hearing loss

Sound louder in air –> sensorineural loss

126
Q

What are the decibel levels of a jet takeoff, normal speech, and a whisper?

A

120, 60, 30

127
Q

Smaller and delayed evoked potentials indicate what condition?

A

Acoustic neuroma

128
Q

What ganglion/nuclei are involved in the auditory pathway?

A
  1. Spiral ganglion
  2. V/D cochlear nucleus (rostral medulla)
  3. Superior olivary nucleus (mid-pons)
  4. Nucleus of lateral lemniscus (pons-midbrain junction)
  5. Inferior colliculus (caudal midbrain)
  6. Medial geniculate nucleus (thalamus)
  7. Auditory cortex
129
Q

What is right MLF syndrome?

A

Lesion of MLF traveling to midbrain AFTER abducens nucleus.

On attempted gaze to left, there is a right ocular adduction paresis and left nystagmus (from trying to coordinate with right eye).

130
Q

What does the caloric test evaluate?

A

Semicircular canals

131
Q

What are the normal results of a caloric test?

A

COWS = cool water causes nystagmus on opposite side, warm water causes nystagmus on the same side

132
Q

What is the vesitublo-ocular reflex?

A

A reflex to stabilize images on the retina during head movement.

133
Q

What are the steps of the VOR?

A
  1. Vestibular nerve sends impulses to the vestibular nuclei
  2. These fibers then cross contralaterally to the abducens nucleus
  3. From the abducens nucleus, one pathway projects directly to the right lateral rectus, causing it to contract
  4. The other pathway projects from the abducens nucleus by the medial longitudinal fasciculus to the contralateral oculomotor nucleus, contracting the left medial rectus muscle
134
Q

Which nerves contribute to the sensation of taste?

A

VII - anterior 2/3 tongue (geniculate gang, solitary nuc)
IX - posterior 1/3 tongue (petrosal gang, solitary nuc)
X - pharynx/epiglottis (nodose gang, solitary nuc)

135
Q

What are mitral/tufted cells?

A

Output neurons; transmit signals via Glutamate/Aspartate

136
Q

What are granule/periglomerular cells?

A

Interneurons; transmit signals via GABA

137
Q

In the VOR, activation of the vestibular nuclei leads to what two actions?

A

Contralateral abducens activation and ipsilateral oculomotor activation

138
Q

T/F: Filiform papillae have no taste buds.

139
Q

Salt activates ___ channel

140
Q

Sour activates ____ channel

141
Q

How are sweet tastes transmitted?

A

Activation of GPCR –> activation of adenylyl cyclase –> PKA activation –> inhibition of K+ channels –> depolarization –> Ca2+ influx –> vesicle release

142
Q

How are bitter tastes transmitted?

A

GPCR –> phospholipase C –> IP3 –> Ca2+ release from internal stores –> vesicle release

143
Q

What receives taste input from the solitary nucleus?

A

VPM of the thalamus

144
Q

Where do olfactory receptor cells synapse?

A

On second order neurons at the GLOMERULUS in the olfactory bulb

145
Q

T/F: Olfactory projection reaches prefrontal cortex without making a synapse in the thalamus first

146
Q

Where do axons from mitral and tufted cells project?

A

Primary olfactory cortex (PIRIFORM CORTEX)

147
Q

Occlusion of which artery would cause urinary incontinence?

148
Q

What NT does CVLM send to RVLM?

A

GABA (inhibitory)

149
Q

Loss of rods creates what vision problem?

A

Night blindness

150
Q

T/F: Rods contain more photosensitive pigments than cones.

151
Q

What kinds of cells create the optic nerve?

A

Ganglionic axons of the retina

152
Q

Magno = ______

A

Fast-moving objects

153
Q

In phototransduction, the nerve is always _____

A

Depolarized

154
Q

What creates an action potential down the optic nerve?

A

Glutamate from rods/cones inhibits bipolar cells. When light hits the rods and cones, glutamate release is reduced, which leads to activation of bipolar cells and an AP down the optic nerve.

155
Q

What are the contralateral fibers in the visual system? Ipsilater?

A

1, 4, 6

2, 3, 5

156
Q

In the visual system, what layers do fibers 1 and 2 transmit to? 3, 4, 5, 6?

A

Magnocellular (fast-moving objects)

Parvocellular (color vision and visual acuity)

157
Q

What happens if you fuck up the Meyer’s loop?

A

You can’t see in your contralateral superior visual field

158
Q

T/F: PCA occlusion will have macular sparing.

159
Q

What controls rapid eye movements?

A

Superior colliculus

160
Q

Usually bilateral and associated with tertiary syphilis

A

Argyll Robertson pupil

161
Q

What is likely damaged in Argyll Robertson pupil?

A

Pretectal area in pons

162
Q

Right PPRF and right VI nucleus lesions will lead to….

A

Right lateral gaze palsy

163
Q

MLF lesions will lead to…

A

Contralateral nystagmus

Paralysis of ipsilateral eye in midline

164
Q

MLF + nucleus VI lesion will lead to….

A

Contralateral nystagmus

Paralysis of ipsilateral eye in midline

165
Q

What is the screening test for meningocele in a fetus?

166
Q

A mass was noted in the third ventricle with enlargement of the lateral ventricles which would raise the possibility of:

A

Non-communicating hydrocephalus

167
Q

Most cases of hydrocephalus are due to…

A

Impaired flow and impaired absorption

168
Q

What is one of the most common causes of hydrocephalus?

A

Aqueductal stenosis

169
Q

What condition is Arnold Chiari often associated with?

A

Meningomyelocele

170
Q

What are the three hallmarks of Dandy Walker?

A

The three essential features are: agenesis of the vermis, cystic dilatation of the fourth ventricle and enlargement of the posterior fossa

171
Q

Patient fell and now has edema and unilateral dilated pupil. What do they most likely have?

A

Transtentorial herniation

172
Q

Stocking and glove neuropathy has to do with…

A

Segmental demyelination

173
Q

Herpes is _____ nuclei; polio is _____ nuclei

A

Sensory / motor

BCN (6 decks)

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