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0001 STEP ONE RAPID REVIEW DX > Nervous system > Flashcards

Nervous system Flashcards

1
Q

Most common diabetic mononeuropathy

A

CNIII
Acute down and out with dipoplia - but can still react to light and accomodate because ps efferent are lateral and the nueuropathic infarction is central
ptosis - since CNIII also innervates levator palpebrae

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2
Q

cranial nerve III compression

A

Pupillary dysfunction often first because peripheral PS

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3
Q

Function of facial nerve VII

4

A
  1. Motor output to facial muscles
  2. PS innervation to lacrimal, submandibular, sublingual salivary glands
  3. Special affarent fibers for taste from ant 2/3 tongue
  4. Somatic affarent from the pinna and external auditory canal
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4
Q

Patient with Bell’s palsy presentation

A

unilateral facial paralysis
decreased tearing
hyperacusis
loss of taste sensation over ant 2/3 tongue

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5
Q

Which CN provides sensation to face?

A

CNV

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6
Q

Pass through

Optic canal

A

CNII
Ophthalmic artery
Central retinal vein

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7
Q

Pass through

superior orbital fissure

A

CN III, IV, V1, VI
opthalmic vein
sympathetic fibers

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8
Q

Pass through

foramen rotundum

A

CN V2

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9
Q

Pass through

foramen ovale

A

CN V3

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10
Q

Pass through foramen spinosum

A

middle meningeal

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11
Q

pass through internal auditory meatus

A

CN VII VIII

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12
Q

Pass through jugular foramen

A

CN IX
CN X
CN XI
jugular vein

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13
Q

pass through hypoglossal canal

A

CN XII

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14
Q

Pass through foramen magnum

A

spinal roots of XI
Brain stem
vertebral arteries

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15
Q

gall bladder and diaphragm referred pain

A

right shoulder via phrenic nerve receives referred pain

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16
Q

where synthesis epinephrine

A

pons - locus ceruleus

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17
Q

synthesis dopamin

relevant conditions

A

substantia nigra and ventral tegmentum
up in Huntingtons
down in Parkinsons and depresssion

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18
Q

synethsis serotonin

A

raphe nuclei in pons/midbrain/medulla

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19
Q

Acetylcholine synthesis and conditions

A

basal nucleus of Maynart
up in Parkinsons
down in Alzheimer’s and Huntingtons

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20
Q

GABA synthesis and conditions

A

Nucleus accumbens

down in Huntingtons and anxiety

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21
Q

how does glucose and aa get in brain?

A

carrier mediated transport to cross bbb

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22
Q

sleep wave order

A 
BATSDB
Beta - awake eye open
Alpha - awake eye closed
Theta - 1
Sigma - 2
Delta -3 
Beta - Rem
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23
Q

VPL of thalamus

A

in - spinothalamic

to - 1ssc

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24
Q

VML of thalamus

A

in - trigeminal and gust

to- 1ssc

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25
Q

LGN of thalamus

A

vision to calacrine

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26
Q

MGN of thalamus

A

hearing to auditory cortex of temporal

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27
Q

VL thalamus

A

basal ganglia / cerebellus to motor cortex

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28
Q

Hemiballismus

A

caused most frequently by a contralateral lacunar stroke in the subthalamic nucleus

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29
Q

intracellular inclusions in parkinson

A

lewy bodies -

alpha-synuclein (eosinophilic)

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30
Q

atrophy seen in Huntingtons

A

caudate atrophy

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31
Q

nueronal death in huntingtons via

A

NMDA-R binding and glutamate toxicity

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32
Q

lesion to non-dominant parietal-temporal cortex

A

hemispatial neglect

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33
Q

lesion to dominant parietal-temporal cortex

A

agraphia / acalculia / finger agnosia / left-right disorientation (Gerstmann syndrome)

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34
Q

agnosia

A

to interpret sensations / recognize things

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35
Q

Mammilary body lesion

A 
Wernicke Korsakoff 
confusion 
ophthalmoplegia 
ataxia
memory loss 
confabulation
36
Q

cerebellar hemisphere lesion

A

limb ataxia
fall towarad side of lesion
balance problems

37
Q

cerebellar central vermis lesion

A

truncal ataxia

38
Q

subthalamic nucleus lesion

A

hemiballismus contralaterally

39
Q

paramedian pontine recticular formation lesion

A

eyes look away from side of lesion

40
Q

frontal eye field lesion

A

eyes look toward lesion

41
Q

How does gaba-a receptor work?

A

chloride channel - open –> inhibition

42
Q

How do benzos work

A

modulate GABA-A - increase the frequency of chloride channel opening

43
Q

Diphenhydramine

A

sedating antihistimine - rerversibly blocks H1 receptors

44
Q

in addition to their anxyloytic effects, what other effects to benzos have?

A

also have muscle relaxant and anti-convulsant effects - in addition to anxiolytic

45
Q

inhibit norepinephrine and serotonin reuptake

A

TCADs

46
Q

what makes the moa of barbiturates different from benzos

A

barbiturates stablizes the chloride channel (GABA-Ar) in the open position and have a longer half life
benzo increase the frequency that it is open

47
Q

amino acid serotonin is synthesized from?

A

tryptophan

48
Q

how does ondansetron work?

A

5HT3 receptor antagonist
useful to treat visceral nausea due to infection, chemo, distention
irritated mucosa releases 5HT3 which stimulates vagal affarents to activate the medullary vomiting center

49
Q

when would we give antihistamine or anticholinergics for nausea

A

vestibular nausea

50
Q

Metoclopramide

A

dopamine receptor antagonist
effective in treating central nausea (migraine)
adverse - extrapyramidal / sedation

51
Q

Prochlorperazine

A

Dopamine receptor antagonist for central nausea

52
Q

Loperamide

A

mu-opiod receptor agonist for diarrhea - antimotility agent

53
Q

diphenhydramine

A

1st gen antihistamine -

can be used to treat vestibular nausea - can cause sedation

54
Q

meclizine

A

first gen antihistimaine

55
Q

scopolamine

A

muscarinic antagonist - can be used to treat vestibular nausea
causes sedation

56
Q

promethazine

A

dopamine and h1 receptor antagonist - rx for vestibular nausea
can cause sedation

57
Q

ranitidine

A

H2 blocker - reduces gastric acid secretion - GERD

58
Q

Octreotide

A

somatostatin receptor agonist - inhibits bioactive amine release - used to treat diarrhea in carcinoid syndrome and VIPomas
ALSO FOR ACUTE ESOPHAGEAL VARICES

59
Q

5-HT3 receptor antagonist for visceral nausea

A

ondansetron

60
Q

common causes of travelers’ diarrhea

A

E Coli (bacteria)
Rotavirus
Cryptosporidium (aids)

61
Q

classic finding in uncal herniation

A

blown pupil (dilated) due to ipsilateral oculomotor nerve palsy

62
Q

Synthetic steroid that used to be used to treat endometeriosis that can cause idiopathic intracranial hypertension?

A

danazol

63
Q

Rx for idiopathic intracranial htn?

A

acetozolamide (carbonic anhydrase inhibitor)

topiramate (carbonic anhydrase inhibitor and apparent antiepileptic)

64
Q

3 signs of normal pressure hydrocephalus

A

wet
wobbly
wacky

incontinence
ataxia
cognitive dysfunction

65
Q

Cushing’s triad for increased intracranial pressure

A

hypertention
bradycardia
bradyypnia

66
Q

as uncal herniation progresses, you may see a fixed dilated pupil at first due to ipsilateral oculomotor nerve palsy, but what will happen as the hernia progresses?

A

progression results in damage to the mid-brain, which will result in fixed pupils bilaterally. Additional findings in advanced herniation include loss of vestibular ocular reflex and decorticate - above red nucleus (flexural) followed by deceburiate - below red nucleus (extensoral) posturing

67
Q

trigeminal nueralgia first line therapy?

A

Carbamazepine - a neuroleptic medications (partial) - that reduces firing by reducing the ability of sodium channels to recover from inactivation

68
Q

side effects of carbamazepine

A

bone marrow suppression - pancytopenia :(

SIADH

69
Q

Benztropine or Trihexyphenidyl

A

anti-muscarininc (central) that can help with extrapyramidal signs of anti-psychotics D2 blockers

70
Q

dantrolene

A

direct acting skeletal muscle relaxant for neuroleptic malignant syndrome

71
Q

Serotonin syndrome

characterized by

A 
restlessness
altered mental status
hyperreflexia
clonus
diaphoresis
tremors
72
Q

TMP/SMX fetal consequences?

A

Neural tube defects

73
Q

which antibiotics can cause neural tube defects?

A

TMP/SMX which is you think about it makes sense because they are dihydrofolate reductase inhibitors? or something along those lines… and we see neural tube defects in folate deficient madres

74
Q

which drugs can lead to impaired fetal renal function and cause fetal anuria and oligohydramnios?

A

NSAIDs

75
Q

Woudl you give a pregnant women acetomenophin

A

no! it is an NSAID and NSAIDs are toxic to tots

76
Q

Some baby you are taking care of is yawning, sweating, and irritable with tremors - what do you think??

A

Maybe he had in utero exposure to opioids and is now going through opioid withdrawl

77
Q

classic opioid withdrawl symptom

A

yawning - withdrawing from?

78
Q

Akathisia - and treatment?

A

extrapyramidal side effect of antipsychotic characterized by inner restlessness and an inability to stand in one position - - thus, increasing antipsychotic dose - as might be done if misinterpreted as worsening of symptoms - would make matters worse - give them a beta blocker or benzo

79
Q

Dopamine can make you nauseous, because it stimulates the emetic center in the brainstem - so if you add carbidopa - why would this help if the brainstem is where we are?

A

because the emetic center is outside the blood brain barrier

80
Q

If a patient comes in with all sorts of ocular dysfunctions - ptosis / mydriasis / inability to move their eye in any direction - ipslaterally - how would you differentiate between a lesion in the brainstem and a problem in the cavernous sinus?

A

brainstem lesions should have accompanying crossed signals - i.e. ipsilateral cranial nerve palsy with contralateral hemiparesis and signs of ataxia

81
Q

what important structures pass through the IOF?

A

Maxillary division of V
infraorbital vessels
branches of sphenopalatine ganglion

82
Q

Vernet syndrome - lesions of the jugular foramen lead to ?

A 
CN IX X XI functions impaired
dysphagia
hoarseness
loss of gag ipsilater
uvula deviation to normal
83
Q

which nerves traverse the cavernous sinus and thus would present problems in cavernous sinus syndrome?

A

III
IV
V (1 and 2)
VI

84
Q

Can phenytoin cause gingival hyperplasia?

A

yes

85
Q

how does phenytoin cause gingival hyperplasia?

A

increased expression of PDGF - Exposure of macrophages to PDGF increases their synthesis of gingival cells (thats what it said)

86
Q

aspirin can cause reye which can effect the liver - light microscopy will show?

A

steatosis - small fat vacuoles in cytoplasm of hepatocytes

em will show swelling, decreased # mitochondria, glycogen depletion

87
Q

reye syndrome first fucks with the liver but can then cause

A

encephalopathy - toxic effect of hyperammonemia

0001 STEP ONE RAPID REVIEW DX (25 decks)

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