Exam 2 - week 4/5 Flashcards
1
Q
nicotinic receptors locations
A
ganglia, skeletal muscle
2
Q
muscarinic receptors locations
A
heart, smooth muscle, gland cells, sweat glands (sympathetic)
3
Q
receptors for renal vasculature/smooth muscle
A
dopamine (D1)
4
Q
describe sympathetic stimulation of adrenals
A
cholinergic preganglionic terminals synapse onto chromaffin cells in the adrenal medulla, and they release epinephrine into the bloodstream
5
Q
M2 receptors location
A
heart
6
Q
M3 receptors location
A
blood vessels, lungs, salivary glands
7
Q
describe bladder filling
A
mediated by sympathetic nervous system, detrusor muscle is relaxed (B2 receptors), internal and external sphincters are contracted (alpha 1 receptors and somatic, respectively)
8
Q
describe urination
A
mediated by parasympathetics, detrusor muscle is contracted, internal and external sphincters are relaxed
9
Q
muscarinic receptor agonist examples
A
bethanechol, methacholine, pilocarpine
10
Q
bethanechol uses
A
post-operative ileus, relieve urinary retention
11
Q
methacholine uses
A
challenge test for diagnosis of astham
12
Q
pilocarpine uses
A
glaucoma, dry mouth
13
Q
muscarinic receptor antagonists examples
A
atropine, scopolamine, ipratropium, oxybutinin
14
Q
atropine uses
A
dilation of pupil for eye exam
15
Q
scopolamine uses
A
motion sickness
16
Q
oxybutynin uses
A
bladder spasms/neurogenic bladder
17
Q
anticholinesterase agents examples
A
pyridostigmine, neostigmine, physostigmine, donepezil
18
Q
pyridostigmine uses
A
myasthenia gravis
19
Q
neostigmine uses
A
paralytic ileus, bladder atony
20
Q
physostigmine uses
A
glaucoma
21
Q
donepezil uses
A
Alzheimers
22
Q
alpha 1 receptor agonist examples
A
epinephrine, pseudoephedrine
23
Q
alpha 1 receptor antagonist example and use
A
prazosin, BPH
24
Q
beta receptor agonist examples
A
albuterol, amphetamine (indirectly by blocking norepi reuptake)
25
selective beta receptor antagonists examples
atenolol, metoprolol
26
nonselective beta receptor antagonist examples
propranolol
27
anticholinergic toxidrome causative agents
atropine, scopolamine, jimson weed, TCAs, antihistamines
28
anticholinergic toxidrome
dry skin, hyperthermia, flushing, dry mouth/eyes, dilated pupils, blurry vision, delirium
29
anticholinergic toxicity treatment
physostigmine
30
cholinergic toxidrome ssx
SLUDGEMM and the killer Bs (bradycardia, bronchorrhea, bronchospasm)
31
cholinergic toxidrome tx
atropine (muscarinic antagonist), pralidoxime (regenerates AchE)
32
giant cell arteritis ssx
headache, scalp tenderness, thickened temporal arteries, jaw claudication, weight loss, fever, night sweats, malaise, depression
33
giant cell arteritis diagnosis
age >50 with new onset HA, ESR >50, biopsy
34
what is giant cell arteritis
most common systemic vasculitis in adults
35
CCM mutations and inheritance
CCM1, CCM2, CCM3 on chromosome 7, autosomal dominant
36
what is CCM
collections of capillaries in the brain that are enlarged and irregular
37
early ssx of berry aneurysm
impingement of CN II/III
38
most common location for berry aneurysms and why
anterior and posterior communicating arteries, gaps in smooth muscle near arterial bifurcations are vulnerable to high BP
39
SAH associated with what conditions
ADPKD, EDS, NF1, Marfan, smoking, HTN
40
% of patients with AVM that eventually hemorrhage
50%
41
effects of cerebral ischemia
excitotoxicity, oxidative stress, and inflammation lead to neuronal cell death, apoptosis, necrosis, and vasogenic edema
42
most common artery affected by embolization
middle cerebral artery
43
causes and characteristics of thrombotic stroke
obstruction due to clot in region of decreased flow, typically due to atherosclerotic plaque. Slow, stuttering course
44
causes and characteristics of embolic stroke
embolus derived from other part of the body (ASVD, DVT, carotid stenosis), sudden ssx
45
80% of adult brain tumors are ____
supratentorial
46
80% of pediatric brain tumors are _____
infratentorial
47
brain tumor ssx
headache, seizure, motor/sensory deficits, ataxia
48
what are extra-axial tumors
lesions that are external to the brain parenchyma and can originate in the skull, meninges, cranial nerves, and brain appendages (ie pituitary gland)
49
what are intra-axial tumors
tumors within the brain parenchyma that often infiltrate normal structures
50
prognosis of extra axial vs intra-axial brain tumors
extra-axial have better prognosis, intra-axial are rarely cured
51
most common pediatric brain tumors
medulloblastoma, pilocytic astrocytoma
52
examples of extra-axial tumors
meningioma, schwannoma, neurofibroma
53
tumors that metastasize to the brain
lung, breast, melanoma
54
most common adult brain tumor
glioblastoma
55
glioblastoma characteristics
malignant, rapidly progressive, fatal in < 1 year, usually >65 y/o
56
2nd most common adult brain tumor
meningioma
57
meningioma locations
convexities of hemisphere near surface of brain
58
meningioma arises from ____
arachnoid cells
59
meningioma characteristics
usually benign, often asymptomatic but may present with seizures, more common in females and those who had childhood malignancies with radiation, associated with NF 2
60
meningioma tx
surgical resection
61
location of schwannoma
schwann cells of PNS, cerebellopontine angle CN VII, VIII
62
schwannoma characteristics
benign, slow-growing, usually in adults
63
schwannoma tx
monitoring or surgery/radiation
64
oligodendroma
tumor of myelinated axons in white matter of frontal lobes
65
oligodendroma ssx
often presents with seizures
66
oligodendroma characteristics
slow-growing, tend to recur, difficult to resect, can be benign or malignant, 74% 5-year survival
67
oligodendroma tx
surgery, radiation, chemo
68
hemangioblastoma location
often cerebellar, can be brainstem or spinal cord
69
hemangioblastoma characteristics
very rare, multiple highly vascular lesions, slow-growing, can produce EPO
70
hemangioblastoma is associated with ____
von hipple-landau
71
hemangioblastoma tx
surgery
72
pituitary adenoma characteristics
benign, associated with MEN1 gene
73
pituitary adenoma ssx
amenorrhea, galactorrhea, impotence, HA, bitemporal hemianopsia
74
pituitary adenoma tx
monitor or endoscopic transnasal trans-sphenoidal surgery, radiation, treat hormone imbalance
75
most common pediatric brain tumor
astrocytoma
76
astrocytoma location
posterior fossa (Cerebellum)
77
astrocytoma characteristics
benign, well-circumscribed, can cause ataxia
78
astrocytoma risk factors and tx
previous exposure to radiation, surgery
79
medulloblastoma location
cerebellat
80
medulloblastoma characteristics
rare, highly malignant, 75% survival to adulthood
81
medulloblastoma ssx
can't stand without falling, hydrocephalus, back pain, cauda equina
82
medulloblastoma tx and sequelae
surgery, radiation, chemo. Hearing loss, neurocognitive deficits
83
medulloblastoma is what type of tumor
neuroectodermal
84
medulloblastoma is associated with ____
drop metastases to spinal cord via CSF
85
ependymoma characteristics
mostly benign, worse prognosis in children
86
ependymoma location
4th ventricle, posterior fossa
87
ependymoma ssx
features of ICP, cauda equina
88
inheritance of neurocutaneous disorders
autosomal dominant
89
NF1 mutation and ssx
NF1 on chromosome 17, optic glioma, leisch nodules, developmental delay, neurofibromas, cafe au lait spots, pheochromocytomas, scoliosis, inguinal/axillary freckling
90
NF1 aka
von recklinghausen
91
NF2 mutation and ssx
NF2 on chromosome 22, bilateral schwannomas, cataracts, meningiomas, ependymomas
92
tuberous sclerosis mutations and onset
TSC1, TSC2, first decade of life. mostly de novo mutations
93
tuberous sclerosis ssx
cortical tubers in cortex, seizures, intellectual disability, subependymal nodules, hydrocephalus, facial fibromas, ash-leaf spots, shagreen patches, cardiac rhabdomyoma (mitral regurg), renal angiomyolipomas (pain, HTN)
94
von hippel lindau mutation and ssx
VHL on chromosome 3, hemangioblastomas causing vision problems, dizziness, limb weakness; angiomatosis (diffuse vascular skin tumors), bilateral renal cell carcinoma, pheochromocytoma, cysts in kidneys, pancreas, liver
95
what is sturge-weber syndrome
congenital vascular disorder causing capillary vascular malformations
96
sturge-weber syndrome ssx
leptomeningeal angioma (seizures, hemiparesis, HA, intellectual disability), choroidal hemangiomas (glaucoma, impaired vision), port-wine stain on face in trigeminal territories
97
indications for alteplase
less than 4.5 hours since last known well, disabling deficit, absence of contraindications
98
indications for mechanical thrombectomy
less than 24 hours since last known well, LVO on vessel imaging, ASPECTS or CT perfusion scan
99
when to give ASA for CVA
ASAP but wait 24 hours after tPA
100
BP target if no intervention
<220/110
101
BP target prior to thrombolytics
<180/105
102
BP management options in CVA
labetalol, nicardipine
103
secondary prevention after CVA
antiplatelet therapy (ASA), high intensity statin (atorvastatin), optimize BP, A1C<7%, lifestyle, treat underlying conditions (a fib, etc)
104
cardioembolic strokes characteristics
cortical signs, large lesions on MRI in multiple vascular territories, 37% of ischemic strokes
105
large-artery atherosclerosis strokes characteristics
16% of ischemic strokes, presence of cortical signs, large lesions on MRI, >50% stenosis of major artery supplying brain
106
small artery embolism strokes characteristics
lacunar syndrome (no cortical signs, pure motor or sensory), small lesions on MRI generally in basal ganglia, thalamus, pons, subcortical white matter such as internal capsule, DM/HTN
107
strokes of undetermined etiology characteristics
unclear cause, variable findings, require further testing such as loop recorder
108
dual antiplatelet duration for mild stroke/TIA
21 days
109
antiplatelet therapy for intracranial large artery atherosclerosis
90 days of dual antiplatelet, single antiplatelet after that
110
lateral midbrain syndrome name and what it affects
benedikt, medial lemniscus, CN III, red nucleus
111
benedikt syndrome ssx
contralateral loss of proprioception/vibration of body, CN III palsy (drooping eyelid, down and out, fixed pupil), tremor, ataxia, involuntary movements
112
medial midbrain syndrome name and what it affects
weber's syndrome. Corticospinal tracts, corticobulbar tract, CN III, substantia nigra
113
weber's syndrome ssx
contralateral hemiparesis of body and lower face, ipsilateral CN III palsy, contralateral parkinsonism
114
lateral pontine syndrome what does it affect
sympathetic tract, spinothalamic tract, CN IV spinal nucleus, CN VII nucleus, CN VIII
115
lateral pontine syndrome ssx
horner's syndrome, contralateral loss of pain and temp to body, ipsilateral pain and temp loss to face and ipsilateral facial droop, nystagmus, vertigo
116
what does medial pontine syndrome affect
corticospinal tract, CN VI, CN VII
117
medial pontine syndrome ssx
contralateral hemiparesis of body, ipsilateral lateral gaze palsy, ipsilateral facial weakness
118
lateral medulla syndrome name and what it affects
Wallenberg. Sympathetic tract, spinothalamic tract, CN V spinal nucleus, CN IX, X nucleus ambiguus, CN VIII
119
wallenberg syndrome ssx
horners syndrome, contralateral pain and temp loss of body, ipsilateral pain and temp loss in face, hoarseness, dysphagia, nystagmus, vertigo
120
medial medullary syndrome what does it affect
corticospinal tract, medial lemniscus, CN XII
121
medial medullary syndrome ssx
contralateral hemiparesis of body, contralateral loss of proprioception/vibration to body, deviation of tongue to side of injury
122
pediatric posterior fossa tumors
medulloblastoma, juvenile pilocytic astrocytoma, ependymoma
123
glaucoma risk factors
age, previous eye injury, long-term steroid use, DM, poor circulation, far/near sighted
124
normal cup to disc ratio
0.3
125
normal intraocular pressure
6-21 mmHg
126
aqueous humor is made by
ciliary body
127
medications to lower intraocular pressure
carbonic anhydrase inhibitors, beta blockers, prostaglandin analogs, alpha-2 agonists, etc
128
what is hyperopia
far-sightedness - the focal point is projected behind the retina
129
what is myopia
the focal point is focused in front of the eye - near-sightedness
130
astigmatism
cornea/lens is not spherical so there are multiple focal points
131
what is presbyopia
age-related loss of accommodation
132
origin of CN VIII
pons-medulla border
133
exiting foramen CN VIII
internal auditory meatus
134
test for vestibular control of balance and movement
Romberg
135
functions of vestibular system
detection of head orientation/acceleration, maintain balance
136
dysfunction of vestibular system ssx
false sense of motion, vertigo
137
what is the vestibulospinal reflex
senses falling/tipping and contracts limb muscles for postural support
138
what is the vestibulocollic reflex
acts on neck musculature to stabilize the head if body moves
139
what is the vestibulo-ocular reflex
stabilizes visual image during head movement by causing eyes to move simultaneously in opposite direction and in equal magnitude to head movement
140
vestibulospinal tract origin
vestibular nuclei in lateral pons
141
vestibulospinal tract function
facilitates extensor activity, especially for lower limbs
142
weber test nerve deafness
tone is heard in normal ear
143
weber test conduction deafness
tone is louder in affected ear
144
upper homonymous quadrantanopia aka
Meyer's loop quadrantanopia
145
meyer's loop quadrantanopia cause
contralateral temporal lobe damage
146
lower homonymous quadrantanopia cause
contralateral parietal lobe damage
147
carbamazepine side effects
diplopia, ataxia, blood dyscrasias, liver toxicity, teratogenesis, SIADH, SJS
148
ethosuximide side effects
fatigue, GI distress, HA, itching, SJS
149
lamotrigine side effects
SJS, hemophagocytic lymphohisitiocytosis
150
oxcarbazepine side effects
ataxia, dizziness, HA, nystagmus, somnolence, tremor, agitation, anxiety, apathy, depression, rashes
151
valproate side effects
congenital abnormalities, drowsiness, n/v, tremor, alopecia, weight gain
152
phenytoin side effects
hirsutism, gingival hyperplasia, nystagmus, diplopia, ataxia, sedation, n/v, SJS, megaloblastic anemia
153
preferred drugs for absence seizures
ethosuximide and valproate
