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Neuro Flashcards

1
Q

Neural development

  • differentiation initiated by
  • after plate
  • remnant of notochord
  • dorsal vs ventral
A
  • notochord, telling ectoderm to form neural plate
  • plate forms into neural tube and crest cells
  • nuc pulposus of inter vertebral disk
  • dorsal is sensory and ventral is motor
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2
Q

Regions of brain

  • fore brain: other name, becomes, which differentiates into
  • mid brain: other name, differentiates into
  • hind brain: other name,
A
  • prosencephalon, telencephalon -> cerebrum && diencephalon -> hypothal and thal
  • mescencepahlon -> midbrain
  • rhombocephalon, metencephalon -> pons and cerebellum && myelencephalon -> medulla
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3
Q

Central and Peripheral nervous system origin

  • CNS: components; origin
  • PNS: components; origin
  • Microglia: what is it, origin
A
  • CNS neurons, oligodendrocytes, and astrocytes; neural tube
  • PNS neurons, schwann cells; neural crest
  • marophage like cells, mesoderm
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4
Q

Neural tube defects

  • spina bifida occulta: what is it, assocaited with
  • meningocele: what is it
  • myelomeningocele: what is it
  • myeloschisis: what is it
  • anencephaly: what is it
A
  • failure of caudal neuropore to close, w/o herniation; tuft or hair or skin dimple at bony defect
  • failure of caudal neuropore to close, w/ herniation of meninges
  • failure of caudal neuropore to close, w/ herniation of meninges and neural tissue
  • exposed unfused neural tissue w/o skin/meningeal covering
  • failure of rostral neuropore to close; no forebrain and open calvarium
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5
Q

Holoproencephaly

  • what is it
  • mutation
  • sxs
  • associated w/
A
  • failure of forebrain to separate into 2 cerebral hemispheres
  • sonic hedge hog
  • cleft lip/palate to cyclopia
  • trisomy 13 and fetal EtOH syndrome
  • monoventricle and fusion of basal ganglia
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6
Q

Lissencephaly

  • cause
  • result
A
  • failure of neural migration

- smooth brain w/o sulci and gyri

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7
Q

Posterior Fossa Malformation

  • Chiari I: what is it; cause; sxs
  • Chiari II: what is it; associated w/
  • Dandy Walker: what is it; associated w/
A
  • displacement of cerebellar tonsils inferior to foramen magnum; congenital; headaches and cerebellar sxs
  • herniation of cerebellar vermis and tonsils through foramen magnum w/ aqueductal stenosis; lumbosacral myelomeningocele
  • agenesis of cerbellar vermis causing cystic enlargement of 4th ventricle; noncommunicating hydrocephalus and spina bifida
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8
Q

Syringomyelia

  • what is it
  • what is affected and what sxs does that cause
  • location
A
  • cystic cavity in central canal of spinal cord
  • fibers in anterior white commisure -> cape like symmetrical loss of pain and temp in upper extremities
  • cervical > thor> lumbar
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9
Q

Tongue Development

  • anterior 2/3 formed from, sensation, taste
  • posterior 1/3 formed from, sensation, taste
  • motor innervation
  • hyoglossus
  • genioglossus
  • styloglossus
  • palatoglossus, innervation
A
  • 1st and 2nd pharyngeal arches; CN V3; CN VII
  • 3rd and 4th pharyngeal arches; CN IX
  • XII
  • retracts and depresses tongue
  • protrudes tongue
  • draws sides of tongue up to make trough when swallowing
  • elevates posterior tongue during swallowing, CN X
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10
Q

Cells of Nervous system

  • Neurons: function; adult; staining
  • Astrocytes: function, derived from, marker
  • Microglia: function; activation
  • Ependymal cells: cell type; location; function
  • Myelin: function; location; produced by
  • Schwann cells: function
  • Oligodendrocyte: function, derived from; histo; involved in
A
  • signal transmitting cells of nervous system; do not divide; Nissl staining for dendrites and cell body
  • repair, remove extra NT, part of BBB, glycogen fuel reserve; neuroectoderm; GFAP
  • scavenger cells of CNS; line ventricles and central canal of spinal cord; response to tissue damage
  • ciliated simple columnar glial cells; ventricles and central canal of spinal cord; produce/ absorb/ and circulate CSF
  • wraps and insulates axons; nodes of ranvier; oligodendrocytes
  • promote axon regeneration in PNS
  • myelinate axons in CNS; neuroectoderm; fried egg appearance; injured in MS
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11
Q

Sensory Receptors

  • Free nerve endings: A delta, C; detect
  • Meissner corpuscles: time frame; detect
  • Pacinian corpuscles: time frame; detect
  • Merkel discs: time frame; detect
  • Ruffini corpuscles: time frame; detect
A
  • A: fast, myelinated; c: unmyelinated, slow; pain, temp
  • quick, fine light touch
  • quick, vibration/pressure
  • slow, pressure
  • slow, finger tips and joints; pressure, slippage of objects, joint angle change
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12
Q

Peripheral nerve Layers

  • endoneurium: function
  • perineurium: function
  • epineurium: function
A
  • thin, supportive CT that ensheaths and support individual myelinated nerve fiber
  • surrounds fasicle of nerve fibers
  • dense CT that surround entire nerve
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13
Q

Chromatolysis

  • what is it
  • changes
  • wallerian degeneration: what is it, compensation
A
  • reaction of cell body to axon injury
  • round cellular swelling, displacement of nuc to periphery, dispersion of nissl substance throughout cytoplasm
  • disintegration of axon and myelin sheath distal to site of axon injury; axon proximal to injury will retract and cell body sprouts new protrusions that grow toward other neurons for potential re-innervation
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14
Q

Meninges

  • what is it
  • dura: composition, derived from
  • arachnoid: composition, derived from
  • pia: composition, derived from
  • CSF location
  • epidural space
A
  • layers that surround and protect brain and spinal cord
  • thick outer layer closest to skull; mesoderm
  • middle, web-like; neural crest
  • thin, fibrous inner layer, adheres to brain/SC; neural crest
  • between arachnoid and pia
  • above dura, filled with fat and vessels
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15
Q

Blood Brain Barrier

  • function
  • formed by
  • damaged by
  • areas w/o
A
  • prevents circulating blood substances from reaching CSF
  • tight junctions between endothelial cells in capillaries, basement membrane, astrocyte foot processes
  • infarction/ neoplasm bc it destroys tight junctions of endo cells
  • vommitting center and neurohypophysis
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16
Q

Vomiting center

  • coordinated by
  • info from
  • CTZ receptors
  • tx of vommitting
A
  • nucleus tract solitarius in medulla
  • chemoreceptor trigger zone in area postrema in 4th ventricle
  • muscarinic, dopaminergic, histamin, serotonin, neurokinin
  • musc and histamine for motion sickness and histamine, dopamine and neurokinin for chemo
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17
Q

Sleep

  • regulated by
  • pathway
  • awake eyes open: description, waves
  • awake eyes closed: waves
  • Non Rem: N1: description, waves; N2: description, waves; N3: description, waves
  • Rem: what happens, when does it occur, effects of depression, waves
A
  • suprachiasmatic nuc of hypothal
  • SCN- > nor epi released -> pineal gland -> increase melatonin
  • alert, Beta
  • alpha
  • N1: light sleep, theta; N2: Deeper sleep, bruxism occurs, sleep splindels and K complexes; N3: deepest non REM sleep, sleepwalking/ night terrors/ and bed wetting occurs; delta
  • loss of motor tone; dreaming, nightmares, woody, extra-ocular movements; every 90 min and duration increases throughout night; depression increases REM and decreases N3; beta
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18
Q

Hypothalamus

  • lateral nuc
  • ventromedial nuc
  • ant nuc
  • post nuc
  • suprachiasmatic nuc
  • supraoptic and paraventricular nuc
  • preoptic nuc
A
  • hunger, stimulated by grehlin; anorexia; lat makes lean
  • satiety, stimulated by leptin; hyperphagia; ventromed makes very massive
  • cooling, parasympathetic; Ant -> cooling A/C
  • heating, sympathetic; hot pot
  • circadian rhythm; sun sensing nuc
  • synthesizes ADH and oxytocin
    thermoreg, sex beahvior, releases GnRH
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19
Q

Thalamus

  • ventral-postero-lateral: senses, input, destination
  • ventral- postero- medial: senses, input, destination
  • lateral geniculate nuc: senses, input, destination
  • medial geniculate nuc: senses, input, destination
  • ventral lateral: senses, input, destination
A
  • sensory from body; spinothalamic and dorsal columns; cortex
  • sensory from trigeminal; trigeminal and gustatory pathway; cortex
  • vision; CN II, optic tract; calcarene sulcus
  • hearing; sup oliver and inferior colliculus; auditory cortex of temporal lobe
  • motor: cerebellum and basal ganglia; motor cortex
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20
Q

Limbic System

  • what is it
  • structures involved
  • function
A
  • collection of neural structures involved in emotion, long term memory, olfaction, behavior mod
  • hippocampus, amygdala, mammillary bodies, thalamic nuc, cingulate gyrus
  • feeding, feeling, fighting, fleeing, Sex
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21
Q

Dopamine pathways

  • mesocortical: decrease causes
  • mesolimbic: increase causes
  • nigrostriatal: decrease causes
  • tuberoinfundibular: decrease causes
A
  • negative sxs in schizo
  • positive sxs in schizo
  • extrapyramidal sxs
  • increase in prolactin -> decreased libido, sex dysfunction, galactorrhea, gynecomastia
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22
Q

Cerebellum

  • function
  • lateral lesion
  • medial lesion
A
  • modulated movement, aids in coordination and balance
  • affects voluntary movement of extremities
  • truncal ataxia, nystagmus, head tiliting
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23
Q

Basal Ganglia

  • function
  • overall pathway
  • direct pathway
  • indirect pathway
A
  • important in voluntary movement and adjusting posture
  • cortex sends info, decides whether to supress or activate and send signal back to cortex
  • cortex activates striatum -> signal intensified with dopamine from sub nig binding to D1 receptors-> globus pallidus is inhibited -> stop inhibiting activation of thal to cortex
  • cortex activates striatum -> signal intesifies with dopamine from sub nig binding to D2 receptors -> striatum inhibit subthalalmic nuc -> allows activation Globus pallidus externus which will activate globus pallidus internus to inhibit thalamus which inhibits cortex
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24
Q

Cerebral Cortex Locations

  • primary motor
  • premotor
  • frontal eye field
  • pre frontal
  • broca
  • limbic area
  • primary auditory cortex
  • Wernicke area
  • primary visual cortex
  • primary somatosensory
A
  • primary motor: frontal lobe, anterior to central sulcus
  • pre-motor: in front of primary motor
  • frontal: in front of pre motor
  • pre-frontal: in front of frontal eye field
  • broca: lateral side of frontal lobe
  • limbic: anterior temporal lobe
  • primary auditory: central temporal lobe
  • wernicke: posterior temporal lobe
  • primary visual: posterior occipital lobe
  • primary somatosensory: parietal lobe, right after central sulcus
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25
Q

Cerebral Perfusion

  • regulation
  • driven by
  • therapeutic hyperventilation
  • tx
A
  • on auto,
  • pCO2
  • decreases pCO2 -> vasoconstriction -> decreased cerebral blood flow -> decrease intracranial pressure
  • acute cerebral edema
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26
Q

Homunculus

  • sensory
  • motor
A
  • genitals, lower extremities, upper extremities, face, abdomen, pharynx
  • lower extremities, upper extremities, face, swallowing
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27
Q

Cerebral Arteries

  • anterior
  • middle
  • posterior
A
  • lower extremities, medial cortex
  • trunk, upper extemities, face, head (lat cortex); temporal area
  • occipital region
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28
Q

Watershed zones

  • location
  • infarct due
  • sxs
A
  • between ant and middle cerebral a and between post and middle cerebral a
  • severe htn
  • proximal upper and lower extremity weakness
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29
Q

circle of willis

- which vessels

A
  • internal carotid -> middle cerebral -> ant cerebral -> ant communicating -> middle cerebral -> posterior cerebal
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30
Q

dural venous sinuses

  • what are they
  • function
  • drain into
  • venous sinus thrombosis: sxs, leads to, caused by
A
  • venous channels that run through periosteal and meningeal layers of dura
  • drain blood from cerebral v and receive CSF from arachnoid granulations
  • internal jugular v
  • signs and sxs of increased ICP, leading to venous hemorrhage; hypercoagulable state
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31
Q

ventricular system

- pathways

A
  • lat ventricles -> foramina of monro -> 3rd ventricle -> cerebral aqueduct -> 4th ventricle -> foramina of luscha and foramen of magendie -> subarachnoid space -> reabsorbed by arachnoid granulations -> drains into venous sinuses
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32
Q

Cranial Nerves and outlets

  • cribiform plate
  • optic canal
  • sup orbital fissure
  • foramen rotundum
  • foramen ovale
  • foramen spinosum
  • internal auditory meatus
  • jugular foramen
  • hypoglossal canal
  • foramen magnum
A
  • I
  • II
  • III, IV, V1, VI
  • V2
  • V3
  • VII, VIII
  • IX, X, XI
  • XII
  • brain stem
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33
Q

Cranial Nerves

  • Olfactory
  • Optic
  • Oculomotor
  • Trochlear
  • Trigeminal
  • Abducens
  • Facial
  • Vestibulocochlear
  • Glossopharyngeal
  • Vagus
  • Accessory
  • Hypoglossal
A
  • smell
  • sight
  • inferior oblique, super and inferior rectus and medial rectus
  • superior oblique
  • 3 divisions: Face sensation - opthalmic, maxillary, mandibular; matication, sensory from anterior 2/3 of tongue
  • lateral rectus
  • taste from ant 2/3 of tongue, facial movement, salivation
  • hearing, balance
  • taste and sensation from post 1/3 tongue, monitor carotid body and sinus
  • taste, uvula, talking, parasympathetic thoracoabdominal viscera
  • SCM
  • tongue movement
  • some say marry money but my brother says big brains matter more
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34
Q

Vagal nuclei

  • nuc tractus solitarius
  • nuc ambiguus
  • dorsal motor nucleus
A
  • visceral sensory info
  • motor innervation of pharynx, larynx, and upper esophagus
  • parasympathetics to heart, lungs, upper GI
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35
Q

Cranial Nerve reflexes

  • corneal: afferent innervation, efferent innervation
  • lacrimation: afferent innervation, efferent innervation
  • jaw jerk: afferent innervation, efferent innervation
  • pupillary: afferent innervation, efferent innervation
  • gag: afferent innervation, efferent innervation
A
  • V1 opthalmic, VII temporal branch - orbicularis oculi
  • V1 opthalmic, VII
  • V3, V3
  • II, III
  • IX, X
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36
Q

Mastication muscles

  • muscles close
  • muscle opens
  • innervation
A

masseter, temporalis, medial pterygoid

  • lateral pterygoid
  • V3
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37
Q

Spinal nerves

  • how many: total, cervical, thoracic, lumbar, sacral, coccygeal
  • location of nerves
  • end
A
  • 31, 8, 12, 5, 5, 1
  • C 1-7 above vert, C8 through T1 below vert
  • L2
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38
Q

Lumbar puncture

  • location
  • function
  • needle passes through
A
  • L3-L4 OR L4-L5
  • obtain sample of CSF w/o damaging spinal cord
  • skin, sub cu, supraspinous lig, interspinous lig, lig flavum, epidural space, dura mater, arachnoid mater, subarachnoid space
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39
Q

Tracts in spinal cord

  • sensory
  • motor
  • dorsal: function, pathway
  • spinothalamic: function, pathway
  • lateral corticospinal: function, pathway
A
  • dorsal medial lemniscus, lateral spinothalamic
  • corticospinal tracts, ant and lateral
  • pressure, vibration, touch; sensory nerve into spinal cord, ascends up, synapses at nucleus gracilus or cuneatus, crosses over in medulla and ascends in medial lemniscus -> VPL
  • lateral- pain and temp, ant - pressure; sensory nerve into spinal cord, synapses in dorsal horn, crosses over through ant white commisure ascends up contralateral side -> VPL
  • voluntary movement of limbs; cortex -> descends ipsi through posterior limb of internal capsule -> crosses over in medulla at pyramids -> descends contralaterally -> synapses at cell body in anterior horn
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40
Q

Neuro Exam Reflexes

  • achilles
  • patellar
  • bicep
  • tricep
  • cremasteric
A
  • S 1, 2
  • L 3, 4
  • C 5,6
  • C 6, 7
  • L 1-2
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41
Q

Primitive Reflexes

  • present vs asent
  • Moro
  • Rooting
  • Sucking
  • Palmar
  • Plantar
  • Galant
A
  • present in newborn absent in adult
  • startle reflex, abduct/extend arms when startled
  • movement of head toward side of cheek that is stroked
  • sucking response when roof of mouth is touched
  • curling of fingers if palm is stroked
  • curling of fingers if palm is stroked
  • babinski, toe dorsiflexes and fan out
  • lateral flexion of lower body towards side of stroked spine while pt face down
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42
Q

Dermatomes

  • C2
  • C3
  • C4
  • C5
  • C6
  • C7
  • C8
  • T4
  • T7
  • T10
  • L1
  • L4
  • S2,3,4
A
  • 2: post half of skull
  • 3: turtle neck
  • 4: low collar
  • 5: collar bones and lateral arm
  • 6: thumb and lateral arm
  • 7: index and middle
  • 8: ring and pinky; medial arm
  • 4: nipple
  • 7: at xiphoid
  • 10: at umbilicus
  • 1: at inguinal lig
  • includes knee cap and medial leg
  • penis
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43
Q

Brain lesions

  • frontal lobe
  • fontal eye field
  • paramedian pontine reticular formation
  • medial longitudinal fasiculus
  • dominant parietal coretx
  • nondominant parietal cortex
  • hippocampus
  • basal ganglia
  • subthalamic nucleus
  • mamillary bodies
  • amygdala
  • dorsal midbrain
  • reticular activating system
  • cerebellar hemisphere
  • red nucleus
  • cerebellar vermis
A
  • frontal lobe: deficits in concentration, orientation, judgement
  • frontal eye field: eyes look toward side of lesion
  • medial long: eyes look toward side of hemiplegia
  • dominant: impaired adduction of ipsi eye and abduction of contralateral eye
  • non dom parietal: agnosia of contralateral side
  • hippocampus: inability to make new memories
  • basal ganglia: tremor at rest
  • subthalamic: contralateral hemiballismus
  • mamillary: wernicke-kosakoff syndrome -> confusion, ataxia, nystagmus, opthalmoplegia
  • amygdala: kluver-bucy syndrome: disinhibited behavior (hyperphagia, hypersex)
  • dorsal mid: perinaud sndrome:
  • reticular: reduced level of arousal
  • cerebellar: intention tremor, limb ataxia, loss of balance
  • red nuc: decorticate if above, decerebrate if below
  • Vermis: truncal ataxia
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44
Q

Ischemic stroke

  • pathogenesis
  • types
  • irreversible damage
  • histo: 12-24 hrs, 24-72 hrs, 3-5 days, 1-2 wks, > 2 wks
  • procedure/ tx
A
  • 8acute blockage of vessels -> disruption of blood flow -> ischemia -> liquefactive necrosis
  • thrombotic: clot forms directly at site of infection, embolic: clot formed in other part of body and traveled to brain where it got stuck, hypoxic: caused by hypoperfusion
  • after 5 min
  • 12-24 hrs: eosinophilic cytoplasm and pyknotic nuclei, 24-72: necorsis and neutrophils, 3-5 days macrophages, 1-2 wks: reactive gliosis and vascular proliferation, > 2 wks: vascular scar
  • get CT, make sure not hemmorrhagic stroke and give TPA if sxs started within 3-4.5 hrs
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45
Q

Neonatal intraventricular hemorrhage

  • what is it
  • risk
  • starts
  • sxs
A
  • bleeding into ventricles
  • premature or low birth weight
  • germinal matrix
  • altered level of conciousness, bulging fontanelle, hypotension, seizure, coma
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46
Q

Epidural Hematoma

  • vessel affected
  • cause
  • sxs
  • CT
A
  • middle meningeal a
  • skull fracture
  • transient LOC and rapid deterioriation
  • CT does not cross suture lines
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47
Q

Subdural Hematoma

  • vessel affected
  • causes: acute vs chronic
  • CT
A
  • bridging veins
  • acute bc of trauma
  • chronic seen in older and infants, mild trauma
  • CT crosses suture lines
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48
Q

Subarachnoid Hemorrhage

  • location
  • cause
  • sxs
  • Dx
  • sequale
  • increased risk for
A
  • bleeding between pia and arachnoid
  • trauma or rupture of aneurysm
  • worst headache of life
  • bloody or yellow LP
  • vasospasm -> ischemic infarct; nimodeipine
  • communicating or obstuctive hydrocephalus
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49
Q

Intraparenchymal Hemorrhage

  • cause
  • location
A
  • systemic hypertension or amyloid angiopathy

- hypertensive hemm normally occur in basal ganglia, thalamus, pons

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50
Q

Effects of stroke

  • ACA: location affected and sxs
  • MCA: location affected and sxs
  • PCA
  • lenticulo-striate artery: location affected and sxs
  • ant. spinal a: location affected and sxs (2)
  • PICA: location affected and sxs (3)
  • AICA: location affected and sxs (4)
  • basilar: location affected and sxs
A
  • motor and sensory to lower limb, contralateral
  • motor and sensory to upper limb and face, contralateral and aphasia w/ wernicke and broca affected
  • occipital lobe; contralateral hemianopia
  • striatum and internal capsule affected, conralateral paralysis w/o cortical signs (neglect, aphasia)
  • lateral corticospinal tract -> contralateral paralysis and medial lemniscus -> contralateral proprioception
  • lateral medulla : nuc ambigus -> dysphagia, hoarseness, decreased gag reflex and vestibular nuc -> vertigo, nystagmus and lateral spinothalamic -> decreased pain and temp on contralateral side
  • lateral pons: facial nucleus -> paralysis of face and vestibular nuc -> vertigo, nystagmus and spinothalamic tract -> decrease pain and temp from contralateral side and labrynthine a -> ipsilateral sensorineural deafness
  • pons, medulla, lower mid brain -> locked in syndrome and corticospinal/bulbar tracts -> quadriplegia and loss of face, mouth, tongue movements and ocular CN nuclei -> loss of horizontal but not vertical eye movements
51
Q

Central poststroke pain syndrome

  • what is it
  • sxs
  • how common
A
  • neuropathic pain bc of thalamic lesion
  • starts w/ paresthesia and then causes allodynia (painless stimuli cause pain)
  • 10% stroke pts
52
Q

Diffuse axonal injury

  • caused by
  • results in
  • MRI
A
  • traumatic shearing forces during rapid acceleration or deceleration
  • devastating neuro injury -> causing coma or veg state
  • multiple lesions of white matter tracts
53
Q

Aphasia

  • broca
  • wernicke
  • conduction
  • gobal
  • transcortical motor
  • transcortical sensory
  • transcortical mixed
A
  • able to understand and wants to speak but cannot
  • able to speak but does not make sense, poor comprehension but able to speak
  • damage to arcuate fasiculus, good comprehension and good speech but poor repitition
  • everything is affected
  • good repetition and comprehension but no speech
  • good repetition and speech but no comprehension
  • good repetition but non fluent speech and poor comprehension
54
Q

Aneursym

  • what is it
  • saccular: other name, occurs, mort common location, sxs
  • charcot- bouchard: associated w, type vessel, causes, agiography
A
  • dilation of artery due to weakening in the wall
  • berry; bifurcation in circle of willis, Acomm and ACA; silent until rupture -> subarachnoid bleed -> worst headache of life
  • chronic HTN, small vessels, hemorrhagic intraparenchymal stroke, not visible
55
Q

Seizure

  • partial vs generalized
  • simple partial
  • complex partial
  • absence
  • myoclonic
  • tonic clonic
  • tonic
  • atonic
  • epilepsy
  • status epilepticus
A
  • partial is only one area of brain while generalized is entire brain
  • seizure w/ concoiusness still intact
  • impaired conciousness
  • blank stare, no postictal confusion
  • quick repetitive jerks
  • alternating between stiffness and jerking, positical confusion, incontinence, and tongue biting
  • stiffness
  • drop seizures
  • recurrent, unprovoked seizures
  • continuous seizure for >5 min
56
Q

Causes of seizure

  • children
  • adult
  • eldery
A
  • genetic, infection, trauma, congenital, metabolic
  • tumor, trauma, stroke, infection
  • stoke, tumor, trauma, metabolic, infection
57
Q

Fever vs Heat Stroke

  • patho phys
  • temp
  • complication
  • tx
A
  • F: cytokine activation during infection, H: inability of body to dissipate heat
  • F: below 104, H: above 104
  • F: benign, H: CNS dysfxn, ARDS, rhabdo
  • F: tylenol, ibuprofen, antibiotic; H: rapid coolingm rehydration
58
Q

Headache

  • cluster: localized, duration, description, tx
  • migraine: localized, duration, description, tx
  • tension: localized, duration, description, tx
A
  • unilateral, 15 min to 3 hr, repetitive, excrutiating pain w/ lacrimation and rhinorrhea, sumatriptan and verapimil
  • unilateral; 4-72 hr; pulsating pain w/ nausea, photophobia, or phonophobia, can have aura, caused by irritation of CN V, meninges or blood vessels; NAIDS, triptans, dihydroergotamine
  • bilateral; less than 30 min; steady band like pain; analgesics, tricyclics
59
Q

Neurodegenerative disorder

  • Parkinson: sxs, caused by/ histo
  • Huntington: cause, sxs, gross, neuro chemicals
  • Alzheimers: genes; gross, histo
  • Frontotemporal dementia: sxs, gross, histo
  • Lewy body dementia: sxs, histo
  • vascular dementia: cause; sxs; MRI
  • Creutzfeldt- Jakob: what is it/ sxs; gross; cause
  • idiopathic intracranial htn
A
  • pill rolling tremor, cogwheel rigidity, bradykinesia, shuffling gait; loss of dopaminergic neurons in sub nigra and lewy bodies (alpha synuclein)
  • auto-dom trinuc (CAG) in HTT gene on chrome 4; chorea, aggression, depression, dementia; atrophy of caudate and putamen; increase in dopamine decrease in epi and Ach
  • Apo E2 is protective, Apo E4 is risk for sporadic, APP causes familial which is earlier onset; widespread cortical atrophy (hippocampus), Beta amyloid plaques and neurofibrillary tangles
  • early changes in personality or behavior; frontotemporal degeneration and hyperphosphorylated tau or ubiquinated TDP43
  • visual hallucinations and dementia, get cognitive abnormalities before physical abnormalities and onsets must be greater than 1 yr apart; lewy bodies in cortex
  • multiple arterial infarct and chronic ischemia; step wise decline in cognitive ability w/ late onset memory impairment; MRI shows multiple cortical or subcortical infarcts
  • rapidly progressive dementia w/ myoclonus and ataxia; spongiform cortex, and prion
  • increased ICP w/o cause; female, tetracycline, obesity, excess vit A, danazol; headache, tinnitus, diplopia; impaired optic N axoplasmic flow -> papilledema; enlarged blind spot on visual field test, and increased opening pressure on LP and provides temporary headache relief
60
Q

Hydrocephalus

  • what is it
  • communicating: what is it, sxs
  • normal pressure: affects, when does it occur, sxs, tx
  • noncommunicating: what is it
  • ex vacuo vantriculomegaly: what is it
A
  • increased CSF
  • decreased CSF absorption by arachnoid granulations -> increased ICP, papilledema, herniation
  • affects elderly, CSF pressure elevated only episodically; does not result in increased volume in subarachnoid space; urinary incontinence, gait apraxia, cog dysfunction; reversible with shunt placement
  • structural blockage of CSF circulation in ventricular system
  • appearance of increased CSF on imaging but due to decreased brain tissue and neuronal atrophy, ICP is normal
61
Q

MS

  • what is it
  • sxs
  • exacerbated
  • clinical course
  • affects
  • dx
  • tx
A
  • AI inflammation that demyelinates CNS
  • acute optic neuritis (painful unilateral vision loss), brain stem syndrome (ataxia, scanning speech, intention tremor), pyramidal demylenation (weakness), spinal cord syndromes (electric shock like sensation)
  • increased boy temp
  • relapsing and remitting
  • women in 20s and 30s
  • high IgG levels and myelin basic protein in CSF, MRI is gold standard w/ multiple white matter lesions disseminated in space and time
  • stop relapses and halt/slow progression w/ beta interferon, glatiramer, natalizumab
62
Q

Other demyelinating and dysmyelinating disorders

  • osmotic demyelination syndrome: what is it/ cause; sxs
  • acute inflammatory demyelinating: subtype, what is it, facilitated by, sxs, CSF, tx
  • acute disseminated encephalomyelitis: what is it, sxs
  • charcot-marie-tooth: what is it, genetics, sxs,
  • progressive multifocal leukoencephalopathy: what is it, secondary to, risk to pt, areas involved,
A
  • massive axonal demyelination in pontine white matter secondary to osmotic changes; iatrogenic bc of hyponatremia and rapid shifts of osmolytes; acute paralysis, dysarthria, dysphagia, diplopia; locked in syndrome
  • subtype of guillian-bare syndrome; AI condition that destroys schwann cells via inflammation; facilitated by molecular mimicry and triggered by innoculation or stress (campylobacter jejuni); symmetric ascending muscle weakness and depressed DTRs in LE, facial paralysis, and respiratory failure; increase in CSF protein w/ normal cell count; plamapharesis or IV Ig
  • multi-focal inflammation and demyelination after infection or vaccination, presents w/ rapidly progressive multifocal neuro sxs
  • hereditary nerve disorder relate to defective production of proteins involved in structure and function of peripheral nerves or myelin sheath; typically auto dominant; associated w/ foot deformities, LE weakness and sensory deficits; CMT1A is caused by PMP22 gene duplication
  • demyelination of CNS because of destruction of oligodendrocytes secondary to reactivation of JC virus, seen in 2-4% of patients w/ AIDS, rapidly progressive, involves parietal and occiptal areas, visual sxs are common
63
Q

Neurocutaneous disorders

  • struge-weber
  • tuberous sclerosis
  • neurofibromatosis type I
  • neurofibromatosis type II
  • von hippel lindau dx
A
  • congenital nonhereditary anomaly of neural crest derivatives, somatic mosaicism of activating mutation; affects capillary sized blood vessels -> port wine stain in V1/2 distribution and ipsilateral leptomeningeal angioma -> seizures/epilepsy
  • Auto dom, TSC1 mutation on chrom 9 or TSC2 mutation on chrom 16; hamartoma in CNS, angiofibromas, mitral regurg, ash leaf spot, cardiac rhabdomyoma, mental retardation
  • AD, mutation in NF1 on chrom 17; cafe au lait spot, intellectual disability, cutaneous neurofibromas, lisch nodule, optic glioma
  • AD, mutation in NF2 on chrom 22; bilateral vestibular schwannomas, juvenile cataracts, meningiomas, ependymomas
  • AD, deletion of VHL on chrom 3; hemangioblastoma in retina, brain stem, cerebellum, spine, angiomatosis, bilateral renal cell carcinoma, pheochromocytoma
64
Q

Adult brain tumors

  • glioblastoma multiforme: what is it, prognosis, location
  • oligodendroglioma: common, location, prognosis, x-ray
  • meningioma: common, prognosis, epi, location, sxs
  • hemangioblastoma: location, associated w/ , produces
  • pit adenoma: types
  • schwannoma: location, involves, along
A
  • grade IV astrocytoma, highly malignant, 1 yr survival rate, cerebral hemisphere
  • rare, slow growing, in frontal lobe, calcified
  • common, benign, common in females, parasaggital extra-axial region, asymptomatic or present w/ seizures or focal neuro sign
  • cerebellar, von hippel lindau when round with retinal angioma, can produce EPO -> secondary polycythemia
  • nonfunction (do not produce hormone) or functioning (produce hormones)
  • at cerebellopontine angle involving both VII and VIII but can be along any peripheral nerves, resection or radiosurgery
65
Q

Child brain tumors

  • pilocytic astrocytoma
  • medulloblastoma
  • ependymoma
  • craniopharyngioma
  • pinealoma
A
  • low grade astrocytoma, most common tumor in childhood, well circumscribed, posterior fossa, supratentorial, benign, good prognosis
  • malignant brain tumor in childhood, involves cerebellum, can compress 4th ventricle cauing headaches and papilledema; form of primitive neuroectodermal tumor
  • found in 4th ventricle, can cause hydrocephalus, poor prognosis
  • most common childhood supratentorial tumor, can be confused with pit adenoma
  • tumor of pineal gland, can cause parinaud syndrome ( compression of tectum -> vertical gaze palsy)
66
Q

Herniation syndromes

- what is it

A
  • causes tonsillar herniation into foramen magnum
67
Q

Motor Neuron Signs

  • weakness
  • atrophy
  • fasiculations
  • reflexes
  • tone
  • babinski
  • spastic paresis
  • flaccid paralysis
  • clasp knife spasticity
A
  • weak - UMN: +, LMN:+
  • atrophy - UMN: -, LMN: +
  • fasiculation - UMN: -, LMN: +
  • reflexes - UMN: increased, LMN: decreased
  • tone - UMN: increase, LMN: decreased
  • babinski - UMN: +, LMN: -
  • spastic - UMN: +, LMN: -
  • flaccid - UMN: -, LMN: +
  • clasp - UMN: +, LMN: -
68
Q

Spinal Cord Lesion

  • spinal muscular atrophy
  • AML
  • tabes dorsalis
  • syringomyelia
  • vit B12 def
A
  • congenital degeration of ant horn of spinal cors, symmetric weakness, floppy baby w/ marked hypotonia and tongue fasiculations, auto recessive SMN1 mutation
  • combined UMN and LMN degeneration, no sensory deficits; defect in superoxide dismutase 1
  • caused y tertiary syphilis, results from degeneration/demyelination of dorsal columns and roots -> progressive sensory ataxia, + romberg sign and absent DTR, argyll robertson pupils
  • syrinx expands and damages ant white commisure of spinothalamic tract -> bilateral symmetrical loss of pain and temp sensation in cape distribution, chiari I malformation
  • subacute demyleination of spinocerebellar tracts lateral coticospinal and dorsal columns; ataxic gait, paresthesia, impaired vibration sense
69
Q

Poliomyelitis

A
  • polio virus -> replicates in oropharynx and small intestine before spreading through blood into CNS
  • destruction of cells in anterior horn of spinal cord
  • signs of LMN lesion
  • CSF shows increased WBC and slight increase of protein
70
Q

Brown-Sequard syndrome

A
  • hemi-section of spinal cord
  • ipsilateral loss of all sensation at level oflesion, ipsi LMN signs at level and ipsi UMN signs above lesion
  • ipsi loss of proprioception, vibration, light touch below level of lesion
  • contra loss of pain, temp, and crude touch below level of lesion
71
Q

Friedreich ataxia

A
  • auto recessive tri nuc repeat on chrom 9
  • impairs mito functioning
  • degeneration of lateral corticospinal tract, spinocerebellar tract, dorsal column; staggering gait, frequent falling, nystagmus, dysarthria, hammer toes, DM, HCM
72
Q

Bells palsy

A
  • most common cause of peripheral facial palsy
  • develops after HSV reactivation
  • corticosteroids +/- acyclovir
  • lyme dx, herpes zosterm sarcoidosis, tumor, DM
73
Q

Cholesteatoma

  • what is it
  • sequalae
  • type hearing loss
  • sxs
A
  • overgrowth of desquamated keratin debris within middle ear space,
  • may erode ossicles or mastoid air cells
  • conductive hearing loss
  • painless otorhea
74
Q

Auditory physiology

  • outer ear: consists of, function
  • middle ear: consists of, function
  • inner : consists of, function
A
  • pinna, auditory canal and TM; transfers sound waves via vibration of TM
  • air filled space w/ 3 bones that conduct and amplify sound from TM to inner ear
  • Snail shaped fluid filled cochlea; basilar membrane w/ hair cells vibrates secondary to sound waves causing the hair cells to move and send signal; low is heard at apex and high heard at base
75
Q

Diagnosing hearing loss; Weber vs Rinne

  • Normal
  • Conductive
  • Sensorineural
A
  • W: equal, R: air> bone
  • W: localize to affected ear; R: bone>air
  • W: localize to unaffected ear; R: air> bone
76
Q

Types of hearing loss

  • noise induced hearing loss: damages, frequency lost, sudden/extreme causes
  • prebycusis: related to; kind; frequency; caused by
A
  • damage to stereociliated cells in organ of Corti; Loss of high frequency hearing first; Sudden extreme loud noises can produce hearing loss due to tympanic membrane rupture
  • aging related progressive, bilateral sensorineural hearing loss, higher frequencies first, destruction of hair cells at cochlear base
77
Q

vertigo

  • what is it
  • peripheral
  • central
A
  • sensation of spinning while actually stationary
  • inner ear etiology (semi circ canal debris, vestibular nerve infection), menniere dx (vertigo, tinnitus, hearing loss) -> low salt diet and diuretics, BPPV (otolith out of place in semi-circ canals) -> epley maneuver
78
Q

vertigo

  • what is it
  • peripheral: etiology, meniere, BPPV
  • central: etiology, sxs
A
  • sensation of spinning while actually stationary
  • inner ear etiology (semi circ canal debris, vestibular nerve infection), menniere dx (vertigo, tinnitus, hearing loss) -> low salt diet and diuretics, BPPV (otolith out of place in semi-circ canals) -> epley maneuver
  • brain stem or cerebellar lesion; directional or purely vertical nystagmus, diplopia, dysmetria and focal neuro findings
79
Q

Conjunctivitis

  • what is it
  • allergy: sxs
  • bacterial: sxs, tx
  • viral: bug, sxs, tx
A
  • inflammation of conjunctiva
  • allergic: itchy eyes, bilateral
  • bacterial: pus, treat w/ anti biotics
  • viral: most common, often adenovirus, sparse mucus discharge w/ swollen pre-auricular node, self limited
80
Q

Refractive errors

  • what is it
  • hyperopia: what is it, pathogenesis, tx
  • myopia: what is it, pathogenesis, tx
  • astigmatism: what is it, pathogenesis, tx
A
  • cause of impaired vision, corrected with glasses
  • farsighted (can only see far), eye too short for refractive power of cornea and lens -> light focused behind retina, convex lenses
  • nearsightedness (can only see near), eye too long for refractive power of cornea and lens -> light focused in front of retina, concave lenses
  • abnormal curvature of cornea -> different refractive power at diff axes, cylindrical lenses
81
Q

presbyopia

  • what is it
  • caused by
  • tx
A
  • aging related impaired accomodation
  • decrease in lens elasticity, changes in lens curvature, decreased ciliary muscle strength
  • reading glasses
82
Q

cataract

- what is it

A
  • opacification of lens
  • painless, bilateral, glare and decreased vision
  • age, smoking, EtOH, sunlight, prolonged corticosteroid, DM, trauma, infection
  • galactokinase def, trisomy 21, TORCHES infections, marfans, alport syndrome
83
Q

aqueous humor pathway

  • pathway
  • prostaglandin agonists
  • M3 agonists
  • beta blockers
A

ciliary bodies produce AQH -> travels through posterior chamber between iris and lens -> into anterior chamber -> into trabecular meshwork -> into canal of shlemm to nose or drains into uvea and sclera

  • increased drainage into uvea and sclera increased
  • increased into canal of schlem
  • decrease formation of AQH from ciliary body
84
Q

Glaucoma

  • what is it
  • open: primary and secondary cause
  • closed: cause, chronic, acute
A
  • optic disk atrophy w/ cupping bc of increase intraocular pressure and progressive peripheral visual field loss
  • primary cause is unknown but can be caused secondarily to uveitis, vitreous hemorrhage or retinal detachment -> causes blockage of meshwork
  • enlargement or anterior movement of lens against iris blocking outflow of AQH -> iris pushed up against cornea -> flow impeded into trabecular meshwork; chronic- asynptomatic w/ damage to optic nerve and peripheral vision, acute- opthalmic emergency, painful red eye with sudden vision loss, frontal headache, fixed pupil, n/v
85
Q

Uveitis

  • what is it
  • anterior
  • posterior
  • sxs: hypopyon
  • associated with
A
  • inflammation of uvea
  • iritis
  • choriditis, retinitis
  • accumulation of pus in ant chamber or conjunctivits
  • sarcoidosis, RA, juvenile idiopathic arthritis
86
Q

Age related macular degeneration

  • what is it
  • lose
  • dry: cause, tx
  • wet: onset, cause, tx
A
  • degenration of macula
  • loss of central vision
  • depostion of drusen in between bruch membrane and retinal epi cells; multivitamin and antioxidant supplement
  • rapid; caused by bleeding secondary to chorioid neovascularization; anti-VEGF injection (bevacizumab)
87
Q

Diabetic retinopathy

  • what is it
  • non prolif: pathogenesis, tx
  • prolif: pathogenesism, tx
A
  • retinal damage caused by chroni hyperglycemia
  • non prolif: damaged capillaries leak blood -> fluid and lipid seep into retina -> hemorrhage and macular edema; control blood sugar
  • prolif: chronic hypoxia results in new blood vessels; anti-vegf injection
88
Q

Hypertensive retinopathy

  • what is it
  • histo/ sxs
A
  • retinal damage bc of chronic uncontrolled HTN

- flame shaped retinal hemm, cotton wool spots, papilledema

89
Q

Retinal vein occlusion

  • what is it
  • histo
A
  • blockage of central or branch retinal v bs of compression from nearby arterial atherosclerosis
  • retinal hemm and venous engrogement
90
Q

Retinal detachment

  • pathogenesis
  • opthalmic exam
  • common in
  • preceded by
  • sequlae
A
  • separation of neurosensory layer of retina from outermost pigmented epi -> degeneration of photoreceptors -> vision loss
  • crinkling of retinal tissue and change in vessel direction
  • common in patient w/ myopia or hx of head trauma
  • preceded by posterior vitreous detachment
  • monocular loss like curtain coming down
91
Q

Central retinal A occlusion

  • what is it
  • opthalmic eval
  • next step
A
  • acute, painless monocular vision loss
  • retina cloudy w/ attenuated vessels and cherry red spot at fovea
  • evaluate for embolic source
92
Q

Retinitis pigmentosa

  • what is it
  • sxs
  • opthalmic eval
A
  • inherited retinal degeration
  • painless, progressive vision loss beginning with night time blindness
  • bone spicule shaped depostis around macula
93
Q

Papilledema

  • what is it
  • sxs
  • opthalmic eval
A
  • optic disc swelling due to increased ICP
  • enlarged blind spot
  • elevated optic dic w/ blurred margins
94
Q

Leukocoria

  • what is it
  • causes
A
  • loss of red reflex

- RB, congenital cataract, toxcariasis

95
Q

Pupillary control

  • miosis: function, controlled by, pathway
  • mydriasis: function, controlled by, pathway
A
  • constricton; controlled by PS; edinger westphal nuc to ciliary gangion vic CNIII, synpase on short ciliary nerves to sphincter pupillae muscles
  • dilation, sympathetic; hypothal to ciliospinal center (syn)-> exit at T1 to sup cervical ganglion (synapse) travel along vessel -> onto long ciliary N to pupillary dilator muscle
96
Q

Pupillary light reflex

- pathway

A

light in either retina sends signal via CN II to pretectal nuc -> activated bilateral edinger-westphal nuc -> pupils constric bilaterally

97
Q

Marcus Gunn pupil

  • what happens
  • caused by
A
  • when light is shined into one eye, both eyes constrict, but when light is swung to other eye both eyes dilate
  • impaired conduction of light signal along injured optic nerve
98
Q

Horner syndrome

  • what is it
  • sxs
  • cause
A
  • sympathetic denervation of face
  • ptosis (eyelid drops, miosis (pupil constricts), anhydrosis (no sweat)
  • lesions along symp chain
99
Q

Movement of eye muscles

  • SR
  • IR
  • LR
  • MR
  • IO
  • SO
A
  • SR: up and lateral
  • IR: down and lateral
  • LR: lateral
  • MR: medial
  • IO: up and medial
  • SO: down and medial
100
Q

CN III damage

  • causes
  • motor
  • parasympathetics
A
  • ischemia, PCOmm aneursym, cavernous sinus thrombosis, midbrain stroke
  • motor primarily affected by vascular dx; ptosis, down and out gaze
  • paraymathetic mostly affected by compression; diminished or absent pupilary light reflex
101
Q

CN IV damage

  • affected eye
  • compensation
A
  • pupil is higher in affected eye

- head tilt to contralateral side to compensate for lack of intortion of affected eye

102
Q

CN VI damage

- affected eye

A
  • affected eye unable to AB-duct
103
Q

Visual field deficits

  • right anopia: what is it
  • bitemporal hemianopia: what is it; cause
  • left homonymous hemianopia: what is it
  • left upper quadrantanopia: what is it; cause
  • left lower quadrantanopia: what is it; cause
  • left hemianopia w/ macular sparing: what is it; cause
  • central scrotoma: what is it; cause
A
  • vision loss from entire right eye
  • vision loss from the lateral vision fields in both eyes; pit lesion
  • vision loss from the left vision fields in both eyes
  • vision loss from the left upper vision fields in both eyes; right temporal lesion, MCA
  • vision loss from the left lower vision fields in both eyes; right parietal lesion, MCA
  • vision loss from the left vision fields in both eyes but with central vision spared; right occipital lesion, PCA
  • central vision loss; macular degeneration
104
Q

Meyer loop and Dorsal Optic radiation

- what are they

A
  • Meyers: lower retina, loops around inferior horn of lateral ventricle
  • Dorsal: superior retina, takes shortest path to internal capsule
105
Q

Internuclear opthalmoplegia

- MLF: what is it

A
  • medial longitudinal fasiculus: pair of tracts that allows for cross talk between nuclei of CN III and VI; both eyes
106
Q

Internuclear opthalmoplegia

  • MLF: what is it
  • lesions
  • naming
A
  • medial longitudinal fasiculus: pair of tracts that allows for cross talk between nuclei of CN III and VI; both eyes are able to move in same horizontal direction
  • a conjugate horizontal gaze palsy; lack of comm so that when VI activates ipsi lateral rectus contralateral III does not stimulate medial rectus to contract
  • named by eye unable to adduct
107
Q

Epilepsy drugs

  • Benzo: type of seizure, MOA, side effects, also used for
  • Carbamazepine
  • Ethosuximide
  • Gabapentin
  • Lamotrigine
  • Levetiracetam
  • Phenobarbital
  • Phenytoin
  • Topiramate
  • Valproic acid
  • Vigabatrin
A
  • benz: status epi; increased GABA action; sedation,tolerance, dependence, resp depression; eclampsia
  • carb: partial, and tonic clonic; blocks Na channels; diplopia, ataxia, liver tox, teratogens
  • etho: absence; blocks thalamic T-type Ca channels; fatigue, GI distress, headache, itching
  • gaba: partial, inhibits high voltage activated Ca channels, GABA analog; sedation, ataxia
  • lamo: partial, tonic-clonic, absence; blocks voltage gated Na channels, inhibits release of glutamate; SJS
  • leve: partial, tonic clonic; modulate GABA and glut release; neuro sxs
  • pheno: partial, tonic-clonic, status epi; increased GABA action; sedation, tolerance, dependents
  • pheny: partial, tonic- clonic, status epi; block Na channels; P450 induction, hirsutism, nystagmus
  • topira: partial, tonic-clonic; blocks Na channels and increase GABA action; sedation kidney stones, weight loss; used for migraine prophylaxis
  • valproic: parital, tonic-clonic, absence; Increase NA inactivation and increase GABA concentration; GI disress, hepatotox; migraine prophylaxis
  • viga: partial; increase GABA, irreversible; permanent visual loss
108
Q

Barbituates

  • suffix
  • MOA
  • indication
  • side effect
A
  • barbital
  • facilitate GABA action by increased durationof Cl channel opening
  • sedative for anxiety, seizures, insomnia, induction of anesthesia
  • resp and cardio depression
109
Q

Benzos

  • suffix
  • MOA
  • indication
  • side effect
A
  • pam and lam
  • facilitate GABA action by increasing frequency of Cl channel opening, long half life
  • anxiety, panic disorder, status epi, detox
  • dependence, CNS depression
110
Q

Non-benzo hypnotics

  • ex
  • indication
  • mech
  • reversed by
  • side effect
A
  • zolpidem, zaleplon, esZopiclone
  • insomnia
  • act via the BZ GABA receptor
  • flumazenil
  • ataxia, headache, confusion
111
Q

Suvorexant

  • indication
  • MOA
  • side effects
A
  • insomnia
  • orexin receptor antagonist
  • CNS depression, headache
112
Q

Ramelteon

  • indication
  • MOA
  • side effect
A
  • insomnia
  • melatonin receptor agonist, binds MT1 and 2 in suprachiasmatic nuc
  • dizziness, nausea, fatigue, headache
113
Q

Triptans

  • indication
  • MOA
  • side effect
A
  • acute migraine, and cluster headache
  • 5-HT antagonist, inhibit trigeminal N activation, prevent vasoactive peptide release, induce vasoconstriction
  • coronary vasospasm, mild paresthesia
114
Q

Parkinsonian drugs

  • Dopamine agonists
  • increase dopamine availability
  • increase L-DOPA availability
  • prevent dopamine breakdown
  • curb excess cholinergic activity
A
  • bromocriptine -> ergot derivative, pramipexole, ropinirole -> non ergot derivative
  • amatadine
  • carbidopa -> inhibits DOPA decarboxylase; entacapone -> prevents peripheral L-DOPA degradation by inhibiting COMT
  • act centrally to inhibit breakdown of dopamine; selegiline: block coversion of dopamine into DOPAC, entacapone
  • benztropine: antimuscarinic, improves tremor and rigidity but has little effect on bradykinesia
115
Q

Neurodegenerative dx durgs

  • alzheimers: drugs, MOA
  • ALS: drug name, MOA
  • Huntington dx: drug name, transporter,
A
  • donepezil; AchE inhibitor OR memantine; NMDA receptor antagonist, helps prevent excitotoxicity; used for moderate to advanved dementia
  • riluzole; decrease neuron glutamate excitotoxicity; only to increase survival
  • tetrabenazine: inhibit vesicular monoamine transporter -> decrease dopamine vesicle packaging and release
116
Q

Inhaled anesthetics

  • effects
  • side effects
A
  • myocardial depression, respiratory depression, post op nausea and vomiting, increased cerebral blood flow
  • hepatotox, nephrotox, proconvulsant
117
Q

Intravenous anesthetics

  • thiopental: drug type, used for, side effects
  • midazolam: drug type, used for, side effects
  • propofol: MOA, used for, side effects
  • ketamine: MOA, used for, side effects
A
  • barbituate; short surgical procedures; decreased cerebral blood flow, high lipid solubility
  • benzo; procedural sedation; cause severe post op respiratory depression
  • potentiates GABA; rapid anesthesia induction, ICU sedation; may cause resp depression
  • NMDA receptor antagonist; dissociative anesthesia, increased cerebral blood flow
118
Q

Local anesthetics

  • MOA
  • given with
  • used for
A
  • block Na channels
  • given with vasoconstrictors to enhance local action
  • minor surgical procedures, spinal anesthesia
119
Q

Neuromuscular blocking drugs

  • depolarizing neuromuscular blocking drugs: what is used MOA, complications
  • nondepolarizing: MOA, in the middle
A
  • succinylcholine: strong Ach receptor agonist, procedures sustained depolarization and prevents muscle contraction; reversal of blockade; complication include hypercalcemia, hyperkalemia, malignant hyperthermia
  • Ach anatognist; cur
120
Q

Spasmolytics

  • baclofen: MOA, indication
  • cyclobenzaprine: MOA, indication
  • dantrolene: MOA, indication
  • tizanidine: MOA, indication
A
  • GABA receptor agonist in spinal cord, muscle spasticity dystonia; MS
  • acts within CNS at brainstem, muscle spasticity
  • prevents release of Ca from SR of skeletal muscle by inhibiting ryanodine receptor; malignant hyperthermia
  • alpha 2 agonist, acts centrally; muscle spasticity, MS, ALS, cerebral palsy
121
Q

Opioid analgesics

  • MOA
  • efficacy
  • indication
  • side effects
A
  • acts as agonist at opioid receptors to modulate synaptic transmission; close pre-synaptic Ca channels opens K channels -> decrease synaptic transmission
  • full agonist: morphine, codeine, heroine; partial: buprenorphine; mixed: nalbuphine, antagonist: naloxone
  • moderate to severe or refractory pain, acute pulm edema, maitenance for heroin addicts
  • nausea, vomitting, pruritis, addiction, resp depression
122
Q

Mixed opioid analgesics

  • pentazocine: MOA, indication
  • butorphanol: MOA, indication
A
  • k opioid receptor agonist and mu opioid receptor weak atagonist or partial agonist; analgesia for moderate to severe pain
  • k opioid receptor agnist and mu opioid partial agonist; severe pain
123
Q

Tramadol

  • MOA
  • indication
A
  • very weak opioid agonist, also inhibits reuptake of norepi and serotonin
  • chronic pain
124
Q

Glaucoma drugs

  • Beta blocker: MOA
  • alpha agonist: MOA, adverse effect
  • diuretics: name, MOA
  • prostaglandin: MOA
  • cholinomimetics: MOA
A
  • decrease AQH synthesis
  • decrease AQH synthesis and vasoconstriction; do not use in closed-angle glaucoma
  • acetazolamide; decrease outflow of AQH synthesis via inhibition of carbonic anhydrase
  • increase outflow of AQH via decrease resistance of flow through uveoscleral pathway
  • increase outflow of AQH via contraction of ciliary muscle and opening of trabecular meshwork

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