Exam 1 - Week 2 Flashcards
1
Q
what is the most common demyelinating disease
A
MS
2
Q
MS Pt demographic
A
white women 20s-30s
3
Q
MS is associated with what genes
A
HLA
4
Q
MS etiology
A
autoimmune demyelination of CNS as a result of a type IV hypersensitivity reaction (involving T cells)
5
Q
MS ssx
A
diverse neuro ssx including extreme fatigue, optic neuritis, diplopia, bladder dysfunction, temperature sensitivity
6
Q
most common form of MS
A
relapsing/remitting
7
Q
MS imaging findings
A
irregularly scattered plaques on MRI, may be found periventricular, brain stem, optic nerves
8
Q
MS CSF findings
A
elevated IgG with oligoclonal bands
9
Q
MS treatment
A
monoclonal antibodies, interferon
10
Q
GBS classic patient
A
2-4 weeks after infection with campylobacter, CMS, EBV, Zika or post-vaccine
11
Q
GBS etiology
A
acute inflammatory destruction of schwann cells causing demyelination of peripheral nerves - may be due to molecular mimicry
12
Q
GBS ssx
A
ascending symmetrical motor weakness and hyporreflexia starting with legs, mild sensory deficits, ANS dysfunction +/-respiratory failure
13
Q
GBS CSF findings
A
elevated protein, normal cell count
14
Q
GBS tx
A
respiratory support PRN, IV IgG, plasmaphoresis
15
Q
GBS prognosis
A
may take 3-4 months for remyelination to occur
16
Q
B12 deficiency classic Pt
A
vegan, absorption problem due to celiac/crohn’s/gastric bypass, pernicious anemia
17
Q
B12 deficiency pathophys
A
demyelination in posterior column and lateral column of spinal cord
18
Q
B12 deficiency ssx
A
slow progression: tingling in hands and feet followed by loss of proprioception/vibration. Weaklness, ataxia, spastic paralysis with positive Romberg and UMN signs
19
Q
B12 deficiency diagnosis
A
B12 level, elevated MMA, intrinsic factor antibody test, +/-macrocytic anemia
20
Q
B12 deficiency tx
A
supplementation
21
Q
B12 deficiency aka
A
subacute combined degeneration
22
Q
PML classic patient
A
immunocompromised patients, HIV with CD4<200, cancer or organ transplant Pts
23
Q
PML etiology
A
reactivation of JC virus causes severe demyelination of CNS due to destruction of oligodendrocytes
24
Q
PML ssx
A
encephalopathy and focal deficits (visual loss, paralysis, dementia) occurring over weeks
25
PML diagnosis
DNA test for virus in CSF, brain biopsy, MRI
26
PML MRI findings
multiple white matter lesions
27
PML prognosis
often fatal, no treatment
28
post infectious encephalomyelitis classic patient
3-4 weeks post varicella/measles infection or rabies vaccine
29
post infectious encephalomyelitis etiology
autoimmune demyelination of CNS
30
post infectious encephalomyelitis ssx
acute onset of multifocal neurological ssx, including headache, AMS, fever, coma
31
post infectious encephalomyelitis MRI findings
white matter surrounding small veins is infiltrated by mononuclear cells
32
post infectious encephalomyelitis tx
high dose steroids, plasmapheresis, IV Ig
33
Charcot Marie Tooth classic patient
hereditary disease with onset in late childhood or early adolescence
34
Charcot Marie Tooth etiology
defect in production of myelin or nerve proteins affecting sensory and motor nerves
35
Charcot Marie Tooth ssx
bilat leg muscle wasting and weakness, foot drop, foot/hand deformities, falls, clumsiness
36
Charcot Marie Tooth diagnosis
genetic testing, EMG, nerve biopsy
37
Charcot Marie Tooth tx
PT/OT, braces/orthotics, orthopedic surgery
38
polio route
fecal-oral
39
polio etiology
virus destroys anterior horn of spinal cord in an asymmetric fashion with distal predominance
40
polio ssx
flaccid paralysis, muscle weakness, hyporeflexia appearing 1-10 days post infection
41
CSF findings polio
increased WBC and protein, normal glucose
42
polio diagnosis
stool PCR
43
ALS classic patient
40-60 y/o, mostly sporadic
44
ALS pathophys
reduced glutamate transport
45
ALS ssx
slow progression starting with UMN ssx followed by LMN ssx without sensory deficit sparing oculomotor, bowel/bladder function
46
life expectancy for ALS
2-4 years
47
ALS tx
glutamate antagonist: Riluzole
48
Botulism route
foodborne
49
botulism ssx
paralysis of facial muscles followed by descending motor weakness including respiratory function
50
botulism etiology
impaired Ach release
51
botulism tx
respiratory support, IV botulinum IgG, anti-toxin
52
what is syringomyelia associated with
chiari malformations in cerebellom and kyphoscoliosis
53
what is syringomyelia
fluid-filled cysts in spinal cord
54
syringomyelia pathophys
damages spinothalamic tract nerve fibers as they cross spinal canal
55
syringomyelia ssx
bilateral loss of pain and temp sensation at level of cyst
56
most common syringomyelia location
C8/T1
57
syringomyelia diagnosis
MRI of spine
58
syringomyelia tx
drainage of syrinx, placement of shunt
59
what is cauda equina syndrome
compression of SC or nerve roots at or below L2
60
cauda equina syndrome causes
tumor, trauma, severe central herniated discs
61
cauda equina syndrome ssx
severe low back pain, saddle anesthesia, bowel/ bladder dysfunction, absent patellar/achilles reflexes, normal babinski
62
cauda equina diagnosis
MRI/CT of lower spine
63
herniated disc radiculopathy etiology
posterolateral herniation of nucleus pulposus in spinal canal causing nerve compression
64
2 most common locations for herniated disc
L4/L5 (L5 deficits), L5/S1 (S1 deficits)
65
herniated disc ssx
pain, numbness/tingling in dermo/myotome innervated by compressed nerve
66
L4/L5 herniated disc ssx
sciatica with normal reflexes
67
L5/S1 herniated disc ssx
pain down back of leg, weakness of plantar flexion, absent ankle reflex
68
most common motor disability in childhood
cerebral palsy
69
cerebral palsy etiology
brain injury occuring during pregnancy or birth (or early life from meningitis/head trauma)
70
cerebral palsy ssx
oculomotor, hypo/hyperreflexia, involuntary movements, hypotonia, ataxia, spasticity, dysphagia, delay in developmental milestones. Ssx do not worsen with age
71
cerebral palsy treatment
OT/PT, orthotics, braces
72
carpal tunnel risk factors
female, repetitive hand motions, wrist problems, trauma
73
carpal tunnel etiology
irritation/compression of median nerve
74
carpal tunnel ssx
tingling, numbness on palmar side of hands and fingers, thenar wasting, weakness in grip strength
75
carpal tunnel diagnosis
tinel/phalen tests, EMG/nerve conduction
76
carpal tunnel tx
rest, ergonomic workstation changes, wrist bracing, steroid injections, carpal tunnel release
77
peripheral neuropathy etiology
damage or irritation to peripheral nerves with sensory predominance
78
peripheral neuropathy ssx
burning, stabbing, pins and needles, numbness, weakness, allodynia in a stocking and glove pattern
79
peripheral neuropathy tx
underlying causes, gabapentin, amitriptyline, capsaicin cream, TENS, acupuncture
80
thoracic outlet syndrome classic patient
female 20-40 y/o
81
thoracic outlet syndrome risk factors
repetitive arm or shoulder movements, trauma, anatomical defects, poor posture, pregnancy
82
thoracic outlet syndrome etiology
compression of blood vessels/brachial plexus nerves
83
thoracic outlet syndrome ssx
pain in anterior shoulder, numbness/weakness/coldness in arm, hand, fingers, pallor/swelling in arm
84
thoracic outlet syndrome tx
PT/OT, pain relief, surgical decompression
85
risk factors complex regional pain syndrome
middle aged female with hx of autoimmune disease
86
what is complex regional pain syndrome
chronic pain that occurs after injury
87
cmplex regional pain syndrome etiology
abnormal inflammation or nerve dysfunction affecting small unmyelinated sensory nerve fibers
88
complex regional pain syndrome ssx
pain out of proportion with injury, neuropathic pain, change in skin color or texture, temperature. Swelling of limb
89
complex regional pain syndrome treatment
NSAIDs, gabapentin, topical anesthetics, steroids, PT, biofeedback
90
spinal cord white matter consists of
glial cells, myelinated axons
91
spinal cord grey matter consists of
neurons, glial cells, synapses, unmyelinated axons
92
DCML pathway functions
light touch, conscious proprioception, 2 point discrimination, vibratory sense
93
where does DCML decussate
medulla at medial lemniscus
94
spinothalamic tract functions
pain, temperature
95
where does spinothalamic tract decussate
at same level of entry across white commissure
96
corticospinal tract aka
pyramidal
97
corticospinal tract function
voluntary movement of body
98
how does corticospinal tract descend through brain
through internal capsule
99
where does corticospinal tract decussate
lower medulla
100
UMN lesion ssx
spastic paralysis on contralateral side
101
LMN lesion ssx
flaccid paralysis on ipsilateral side
102
which type of motor lesion has fasciculations
LMN
103
UMN neurotransmitters
glutamate, GABA
104
LMN neurotransmitter
acetylcholine
105
what is spasticity
velocity dependent increase in muscle tone in response to passive stretch
106
what is rigidity
velocity independent resistence to passive stretch that is present throughout movement
107
spasticity is seen in what type of lesion
corticospinal tract lesions
108
rigidity is seen in what type of lesion
basal ganglia lesions
109
what is clasp knife spasticity
resistance to initial stretch is lost and limbs become flaccid
110
how to tell the difference between stroke and Bells palsy
stroke: lower face paralysis only. Bells palsy: Entire side of face is paralyzed
111
anterior spinal artery supplies
anterior 2/3 of spinal cord
112
posterior spinal arteries supply
posterior horns, DCMLS
113
what arteries supply spinal nerve roots
radicular arteries
114
cervical and lumbar enlargements characteristics
voluminous ventral horns due to increased numbers of motor neurons
115
what is true of thoracic segments of spine
have high ratio of white:gray matter, lateral horns containing SNS neurons
116
where is gracile fasciculus located
entire length of spinal cord
117
where is cuneate fasciculus located
above T6 only
118
where do LMN cell bodies reside
ventral horn
119
T4 dermatome
nipple line
120
T10 dermatome
umbilicus
121
L1 dermatome
inguinal ligament
122
L4 dermatome
kneecaps
123
jaw jerk reflex
CN V
124
biceps reflex
C5-C6
125
triceps reflex
C6-C7
126
patellar reflex
L3-L4
127
ankle jerk reflex
S1 S2
128
cremasteric reflex
L1/L2
129
anal wink reflex
S3/S4
130
reflex score 0
no reflex
131
reflex score 1+
diminished, LMN
132
reflex score 2+
normal
133
reflex score 3+
brisk, UMN lesion
134
reflex score 4+
very brisk
135
reflex score 5+
sustained contraction, clonus
136
rooting reflex
touch corner of baby's mouth and baby will turn head and open mouth in the direction of touch
137
when does rooting reflex disappear
4 months
138
sucking reflex
when roof of baby's mouth is touched, baby will suck
139
when does sucking reflex begin and end
32nd week of pregnancy, ends at 2-4 months
140
moro reflex
response to startle: baby throws back head, extends arms/legs, cries, pulls arms/legs back in
141
palmar reflex
babies will curl their fingers in order to grasp an object if their palm is touched
142
when does palmar reflex disappear
3-6 months
143
galant reflex
stroking along one side of spine with newborn face down causes lateral flexion of lower body toward stimulated side
144
galant reflex dissipates at
8-10 months
145
plantar reflex
plantar stimulation causes dorsiflexion of large toe and fanning of others
146
when should plantar reflex go away
10-15 months
147
where do corticobulbar tracts decussate
brainstem (pons/medulla)
148
where do first order neurons of corticobulbar tract reside
lateral 1/3 of motor cortex
149
what are the second order neurons of corticobulbar tract
cranial nerves
150
barbiturates MOA
increase duration of GABAa receptor channel openings
151
barbiturates uses
sedative for anxiety and insomnia, epilepsy (phenobarbital), induction of anesthesia (thiopental)
152
barbiturates side effects
sedation, nausea, teratogen, tolerance, withdrawal
153
barbiturates interactions
induce cytochrome P450; reduced levels of digoxin, phenytoin, alcohol, other CNS depressants
154
benzos MOA
increase frequency of GABAa receptor channel openings
155
benzos uses
anxiety, seizures, alcohol withdrawal, muscle spasms, insomnia, anesthesia (midazolam)
156
benzos side effects
sedation, AMS, ataxia, dependence, withdrawal
157
benzo OD tx
flumazenil
158
benzos interactions
other CNS depressants, ETOH, liver disease
159
nonbenzo hypnotics examples
zolpidem, zaleplon, eszopiclone
160
nonbenzo hypnotics MOA
GABA receptor agonists that bind to same site as benzos
161
nonbenzo hypnotics uses
short term treatment of insomnia
162
nonbenzo hypnotics side effects
anterograde amnesia, hallucinations, confusion, ataxia
163
nonbenzo hypnotics OD tx
flumazenil
164
what is suvorexant
orexin receptor antagonist for insomnia
165
what is ramelteon
melatonin receptor agonist that acts in suprachiasmatic nucleus
166
what is buspirone
partial agonist at 5-HT1A receptors for generalized anxiety disorder
167
non-depolarizing neuromuscular blocking agents MOA
competes with Ach for binding at the Ach receptor
168
reversal agent for non-depolarizing neuromuscular agents
cholinesterase inhibitors+ atropine, sugammedex
169
duration of non-depolarizing neuromuscular blockers
20-50 mins
170
side effects of nondepolarizing neuromuscular blockers
hypotension, bronchoconstriction, tachycardia
171
nondepolarizing neuromuscular blockers interactions
potentiated by general anesthetics and antibiotics
172
depolarizing NMB prototype
succinylcholine
173
depolarizing NMB MOA
mimics Ach at the Ach receptors to induce sustained depolarization
174
reversal for depolarizing NMB
stop infusion
175
depolarizing NMB interactions
use with inhaled anesthetics: Malignant hyperthermia
176
treatment for malignant hyperthermia
dantrolene
177
succinylcholine side effects
hyperkalemia in susceptible patients, rhabdo, myalgia, hypercalcemia, bradycardia
178
duration of succinylcholine
less than 8 minutes
179
2 phases of action with depolarizing NMB
phase 1: depolarizing block of sodium channels preventing inactivation of receptor
phase 2: desensitization of Ach receptor
180
spasmolytics examples
baclofen, cyclobenzaprine
181
baclofen MOA
GABAb agonist that reduces reflex muscle activation
182
cyclobenzaprine MOA
works centrally to depress muscle neuron excitation
183
baclofen side effects
hypotonia, drowsiness, GI upset
184
cyclobenzaprine side effects
dry mouth, drowsiness, confusion
185
tizanidine MOA
centrally acting alpha 2 agonist
186
tizanidine uses
treat spasticity associated with MS, ALS, CP
187
tizanidine side effects
hypotension and bradycardia
188
dantrolene uses
malignant hyperthermia, neuroleptic malignant syndrome
189
dantrolene MOA
inhibits calcium release from sarcoplasmic reticulum of myocytes
190
dantrolene side effects
hepatotoxicity, CNS effects, GI upset
191
which side effects of opioids do not go away over time
miosis, constipation
192
pure opioid agonists
morphine, methadone, fentanyl, hydromorphone, meperidine
193
buprenorphine MOA
high affinity partial agonist of mu receptor and kappa opioid receptor antagonist
194
tramadol moa
weak agonist of mu opioid receptors that also inhibits norep and serotonin uptake
195
examples of inhaled anesthetics
sevoflurane, desflurane, isoflurane, nitrous oxide
196
examples of IV general anesthetics
benzos, opioids, barbiturates, propofol, etomidate, ketamine, dexmedetomidine
197
what is balanced anesthesia
combination of inhaled anesthetics and IV meds
198
what is monitored anesthesia
oral or parenteral sedatives plus local anesthetics
199
what causes an inhaled anesthetic to have a shorter induction time
low solubility in blood
200
what causes an inhaled anesthetic to have higher potency
higher lipid solubility
201
ester anesthetics have ____
one "i" in the name
202
amide anesthetics have _____
two "i's" in the name
