Neuro concepts Flashcards
1
Q
Pathophysiology of migraine
A
activation of trigem nerve
–>substance P and calcitonin GRP causes inflammation of meninges
2
Q
How do triptans work?
A
5HT1B/1D AGONist
- -Block vasoactive peptide release from neuron
- -vasoconstriction
3
Q
Bupropion mechanism
A
Dopa and NE reuptake inhibitor
4
Q
Use of buproprion
A
depression and smoking cessation
5
Q
TCA mechanism
A
Serotonin/NE reuptake inhibitor
6
Q
Migraine prophylaxis
A
b-blocker
TCA and venlafaxine
7
Q
Phenytoin mechanism
A
Inhibits Na channels from recovering from inactivation
8
Q
phenytoin tox
A
lymphadenopathy
–hirsuitism/rash/gingival hypertrophy
9
Q
carbamazepine tox
A
agranulocytosis
10
Q
valproic acid tox
A
hepatotoxicity
11
Q
lamotrigine tox
A
steven johnson hypersensitivity rash
12
Q
phenobarbital tox
A
Acute intermittent prophyria
13
Q
Benefits of zolpidem
A
less tolerance/addiction
Unlike benzos, it is missing the following
- –No anticonvulsant properties
- –No muscle relaxation
14
Q
Syphilis destroys what part of CNS
A
tabes dorsalis
–posterior columns. Also happens in B12 deficiency
15
Q
alar plate
A
dorsal sensory roots
16
Q
basal plate
A
motor ventral roots
17
Q
Forebrain
A
telencephalon and diencephalon
18
Q
lateral ventricle
A
telencephalon
19
Q
third ventricle
A
diencephalon
20
Q
mesencephalon
A
midbrain
21
Q
aqueduct
A
mesencephalon
22
Q
Hindbrain (rhombencephalon)
A
metencephalon
myelencephalon
23
Q
pons/cerebellum
A
metencephalon
24
Q
medulla
A
myeencephalon
25
fourth ventricle derived from
1. Metencephalon=upper
| 2. Myelencephalon=lower
26
you suspect NTD in a fetus with elevated AFP--how to confirm?
AChE
27
anencephaly assoc'd with
maternal diabetes
28
holoprosencephaly
left and right hemispheres don't separate
29
holoprosencephaly caused by
hedgehog signaling pathway
30
cystic enlargement of 4th ventricle with hydrocephalus/spina bifida
dandy walker
31
cause of dandy walker
agenesis of cerebellar vermis (central area)
32
chiari II
aqueductal stenosus and hydrocephalus from cerebellar herniation
33
how does chiari II present?
paralysis and thoraco/lumbar myelomeningocele
34
syningomyelia is associated with
Chiari I
35
Muscles of tongue are derived from
occipital myotomes
36
anterior 2/3 of tongue from:
1st branchial arch
37
posterior 1/3 of tongue from:
3rd/4th branchial arch
38
taste goes to which nucleus?
solitary nucleus
39
PNS and schwann cells come from
neural crest cells. everything else comes from neuroectoderm except microglia (from mesoderm)
40
GFAP is a marker for
astrocytes
41
role of astrocytes
1. BBB
2. K metabolism
3. Removing extra neurotransmitter
42
Multinucleated giant cells in the CNS are made of
microglia that are fused. Caused by HIV
43
Myelin effects on space and time constant
Increases space constant (distance signal will spread before dying)
Decreases time constant
44
which cells are destroyed in MS?
oligodendrocytes (white matter of CNS)
45
fried egg on H&E of brian matter
oligodendrocytes
46
large myelinated sensory fibers that adapt quickly
meissner's
47
large myelinated fibers that adapt slowly
merkel's discs
48
merkel's discs sense:
pressure, position sense in hair follicles
49
C fibers
slow, unmyelinated pain fibers
50
Ad fibers
fast myelinated temperature fibers
51
endoneural inflammation
guillain barre
52
perifascicular/endomysial inflammation
polymyositis
53
Nucleus accumbens
reward center, fear
54
locus ceruleus
stress and panic
55
anxiety neurotransmitter
Increased NE, decreased 5HT, decreased GABA
56
schizophrenia neurotransmitter
increased dopamine
57
depression neurotransmitter
decreased NE
Decreased dopamine
Decreased serotonin
58
alzheimer's neurotransmitter
decreased Ach
59
Huntington's neurotransmitter
decreased Ach
| decreased Gaba
60
REM sleep neurotransmitter
increased Ach
61
Synthesis of dopamine
ventral tegmentum and Snc (midbrian)
62
Synthesis of serotonin
raphe nucleus
63
Synthesis of Gaba
nucleus accumbens
64
Synthesis of Ach
basal nucleus of Meynert
65
Lateral hypothalamus
hunger
| leptin inhibits
66
ventromedial hypothalamus
satiety
67
anterior hypothalamus
cooling
68
posterior hypothalamus
heating
69
VPL
ALS and DC-ML fibers going to somatosensory cortex
70
VPM
trigeminal and gustatory pathway
71
LGN
CNII fibers to calcarine sulcus (lateral light)
72
MGN
superior olive and inferior colliculus fibers to auditory cortex (medial music)
73
VL
Motor fibers from basal ganglia to motor cortex
74
LImbic system responsible for
```
feeding
fleeing
fighting
feeling (emotion)
sex
```
75
structures of the limbic system
```
hippocampus
amygdala
fornix
mamillary bodies
cingulate gyrus
```
76
Inputs to cerebellum through which peduncle?
middle and inferior
77
Input to cerebellum carries:
Middle: contralateral cortex info
Inferior: ipsilateral proprioceptive info from climbing/mossy fibers
78
Outputs from cerebellum:
Superior peduncle carrying info to contralateral cortex
79
Damage to lateral cerebellum:
impaired coordinated movement of extremities, with falling towards ipsilateral side
80
Effect of dopamine in basal ganglia
Stimulates D1
Inhibits D2 receptors
-->overall will facilitate movement through the direct pathway
81
Describe the direct pathway arc
Increased putamen stimulus
Decreased GPi
Increased thalamus
Increase cortex
82
Describe indirect pathway ard
```
Increased putamen
Decreased GPe
Increased STN
Increased GPi
Decreased thalamus
Decreased cortex
```
83
parkinson's changes in brain
lewy bodies with alpha synuclein and loss of Substantia nigra pars compacta dopaminergics
84
Huntington Sx
chorea, aggression, depression, dementia
85
Huntington causes neuronal death through:
NMDA-R binding and glutamate toxicity
86
Huntington=degeneration of:
striatal nucleus (putamen plus caudate
87
intention tremor seen in
cerebellar dysfunction
88
dystonia is:
sustained involuntary muscle contractions
89
Lesion in hemibalismus
contralateral subthalamic nucleus
| -->STN normally stimulates the GPi to inhibit the thalamus. Loss of inhibition in basal ganglia!
90
kluver bucy
hyperorality
hypersexuality
disinhibited behavior
91
Kluver bucy lesion
amygdala
92
kluver bucy is associated with
HSV-1
93
Lx: Re-emergence of primitive reflexes
frontal lobe
94
left sided spatial neglect
right parietal lobe
95
lx: wernicke-korsakoff
mamillary bodies
96
intention tremor lesion:
cerebellar hemisphere lesion. (fall to ipsilateral side)
97
PPRF lesion
Eyes look away from side of lesion
98
Frontal eye fields
Eyes look toward lesion
99
Which area of the brain are damaged first in severe HTN? examples of deficits?
watershed regions:
- -upper leg/arm weakness
- -visual processing
100
Cerebral perfusion is primarily driven by
CO2
| Only driven by hypoxemia when po2 < 50
101
Charcot bouchard
chronic HTN, affects small vessels in basal ganglia and thalamus
102
Causes of berry aneurysm
ADPKD
marfant's
ehler danlos
103
site of berry aneurysm
communicating arteries
104
Acomm stroke
visual field defect
105
Pcomm stroke
CN III palsy (eye is down and out)
106
PCA stroke
contralateral hemianopia with macular sparing
107
Stroke lesion:
vertigo, facial paralysis, loss of lacrimation and salivation and taste from anterior tongue, decreased corneal reflex
Face has loss of pain and temperature sensation, ipsilateral horner's
AICA
--FACIAL NUCLEUS lesion
--vestibular nuclei, cranial nerve nuclei, spinal trigeminal nuclei also affected
"Facial droop means AICA's pooped"
108
Stroke lesion:
vertigo; decrealsed pain and temperature to limbs/face
DYSPHAGIA and HOARSENESS, ipsilateral horner's
PICA
--NUCLEUS AMBIGUOUS
"Don't pica hoarse that can't eat (dysphagia)"
109
stroke lesion:
contralateral hemiparesis of lower limbs
Tongue deviates ipsilaterally
Decreased contralateral proprioception
ASA
- -lateral corticospinal
- -DCML
- -caudal medulla
110
lateral striate artery supplies the
striatum and internal capsule. Damage causes contralateral hemiparesis and hemiplegia
--Caused by HTN
111
Stroke lesion:
| contralateral paralysis and loss of sensation in the lowerlimb
ACA
112
Lesion: aphasia and loss of motor and sensory from upper limb and face
MCA
113
Which intracranial hemorrhage gives a bloody tap?
subarachnoid hematoma.
114
worst headache of my life
subarachnoid
115
Other causes of intraparenchymal hemorrhage besides HTN
amyloid angiopathy, vasculitis, neoplasm
116
Which parts of the brain are most susceptible to hypoxic damage?
hippocampus
neocortex
cerebellum
watershed
117
red neurons
12-28 hours after injury
118
necrosis and neutrophils in brain
24-72 hrs after injury
119
macrophages in brain
3-5 days
120
reactive gliosis and vascular proliferation
1-2 weeks later
121
What connects the 4th ventricle to the subarachnoid space?
foramina of luschka (lateral) and foramina of magendie (medial)
122
Symptoms of normal pressure hydrocephalus
"wet wobbly and wacky" in elderly. Ventricles expand and cortex contracts
123
communicatin hydrocephalus
caused by decreased arachnoid granulation absorption
124
hydrocephalus ex vacuo
degeneration of cortex results in expanded hydrocephalus
125
fasciculations seen in UMN or LMN lesion?
LMN
126
atrophy seen in UMN or LMN lesion?
LMN
127
Werdnig hoffman disease
Like polio, affects anterior horns
128
Mutation in ALS
superoxide dismutase
129
subacute combined degeneration caused by:
Vit B12/E deficiency
130
Which areas damaged in SubacuteCD?
```
Dorsal columns
Lateral corticospinal
spinocerebellar
--Ataxia, paresthesia
--Lost position/vibration
```
131
Infarction of anterior spinal artery damages which parts of spinal cord?
everything but dorsal columns of upper thoracic region
132
How does riluzole work?
Decrease glutamate (excitatory) release
133
floppy baby with hypotonia and tongue fasciculations. Death at 7 months
Werdnig hoffman, autosomal recessive inheritance
134
Friedreich's ataxia caused by
GAA repeat (autosomal recessive)
135
How does Friederich's ataxia present?
Kyphoscoliosis in childhood
- -pes cavus
- -staggering and falling
136
Loss of pain and temperature on one side, and propioception/vibration on the other side
Brown sequard syndrome. Lesion will be contralateral to the pain and temperature side
137
Contralateral loss of pain and Temp with ipsilateral paralysis of CN V, IX, X, XI
lateral medullary syndrome
138
contralateral paralysis
| ipsilateral paralysis of tongue
medial medullary syndrome
139
Some common causes of horner's
Pancoast tumor, brown sequard above T1
140
Describe the pathway for horner's
Hypothalamus__.Spinal cord-->Exit at T1 to sympathetic ganglion-->Pupil
141
Gallbladder pain refers to which area?
the right shoulder (phrenic nerve)
142
C2/C3/C4 dermatomes
C2: skull cap
C3: tutleneck
C4: low cut shirt
143
S2/S3/S4 dermatomes
Penis
| Anal zones
144
Biceps reflex
C5/6
145
Triceps reflex
C7/8
146
Patella reflex
L3/L4
147
Galant reflex
Stroking along one side of spine causes newborn to flex lower body toward that side
148
Cranial nerves that come out medially at the brain stem
3, 4, 12
```
medial to lateral:
3, 4
5 (pons)
6, 7, 8
9, 10
11
12
```
149
Superior colliculus
conjugate vertical gaze
150
Inferior colliculus
auditory
151
parinaud syndrome
paralysis of conjugate vertical gaze
152
Cause of parinaud
lesion in superior colliculi
153
Innervation of submandibular/sublingual
facial nerve
154
innervation of stapedius muscle
facial
155
innervation of stylopharyngeus
CN IX
156
Innervation of carotid body/sinus
CN IX
157
innervation of parotid gland
CN IX
158
Midbrain CN nuclei
CN 3, 4
159
Pontine CN nuclei
CN 5, 6, 7, 8
160
Medullary CN nuclei
CN 9, 10, 12
161
Spinal cord nuclei
CN 11
162
Corneal reflex afferent/efferent
V1 opthalmic
| VII efferent
163
Lacrimation afferent/efferent
V1 afferent
| VII efferent
164
Three vagal nuclei
Solitarius
Ambiguous
Dorsal motor nucleus
165
Innervation to nucleus solitarius
7, 9, 10 (taste, baroreceptors, gut)
166
nucleus ambiguus sends what fibers
9, 10 (motor innervation of pharynx, larynx, and upper esophagus)
167
dorsal motor nucleus sends what fibers
10 (parasympathetic fibers to heart, lungs, GI)
168
Optic canal contents
CN II, opthalmic, central retinal vein
169
Superior orbital fissure contents
III, IV< V1, VI, ophthalmic vein
170
Foramen spinosum contents
Middle meningeal
171
Internal auditory meatus
CN VII, VIII
172
Jugular foramen
CN 9, 10, 11
173
Foramen magnum
CN 11
174
Hypoglossal canal
CN 12
175
Cavernous sinus drains blood from:
eye and superficial cortex
176
Which nerves travel through the cavernous sinus?
3, 4, V1, V2, 6
177
Opthalmoplegia with normal vision
| -decreased corneal and maxillary sensation
cavernous sinus syndrome
178
CN V motor lesion sign
Jaw deviates toward lesion
179
CN X lesion
uvual deviates away
180
CN XI lesion
weakness turning head away from lesion
181
CN XII lesion
tongue deviates toward lesion (lick the lesion)
182
Conductive hearing loss finding
Abnormal rinne, localization to affected hear in weber
183
Sensorineural hearing loss finding
Normal rinne, localizes to unaffected ear
184
Which muscle opens the jaw?
lateral pterygoid
185
which muscles close the jaw?
masster, temporalis, medial pterygoid
186
if near sighted, light focuses...
in front of retina
187
hyperopia/myopia
far/nearsighted
188
Uveitis is inflammation of:
uveal coat (iris, ciliary body, choroid)
189
Causes of retinitis
viral (CMV, HSV, HZV)
190
Sx of open angle glaucoma
Painless Peripheral then central vision loss
191
Cause of open angle glaucoma
Block of trabecular meshwork. Angle between the iris and cornea is "open"
192
Sx of chronic closed angle glaucoma
asymptomatic usually. May lose peripheral vision
193
Sx of acute closed angle glaucoma
painful sudden vision loss with a rock hard eye
194
What should you NOT give in acute closed angle glaucoma?
epinephrine--causes mydriasis and constriction of pupillary dilator muscle
195
pupillary dilator innervated by
Alpha 1
196
Pupillary sphincter innervated by
M3
197
Ciliary epithelium innervated by
Beta receptors--will produce more aqueous humor
198
Signs of CN IV damage
Eyes move up when looking contralateral or when tilting head down (cannot see when walking down stairs)
199
Miosis pathway
EW nucleus to ciliary ganglion by CN III
| --Short ciliary nerve to pupillary sphincter
200
Mydriasis pathway
Hypothalamus to center of budge
- -Exit T1 to superior cervical ganglion
- -Travel along internal carotid, long ciliary nerve to pupillary dilator
201
Light compression of CN III results in
Blown pupil. Parasympathetics travel on the outside
202
"curtain drawn down" on eyes preceded by flashes and floaters
retinal detachment
203
Loss of central vision not caused by stroke
Macular degeneration
204
dry vs wet MD
dry most common: with yellow material beneath retinal pigment (drusen).
Wet: rapid loss of vision from bleeding off of choroidal neovascularization. Will see gray subretinal membrane
205
treatment for dry AMD
multivitamin and antioxidants
206
Meyer's loop travels through
Temporal lobe carrying visual fibers
207
Dorsal optic radiation travels through
parietal lobe
208
Rapidly progressive dementia with startle myoclonus
Creutzfeldt-Jakob dz
209
Dementia, aphasia, parkinsonism and change in personality
Pick's disease
210
Which areas of the brain are affected in Pick's disease?
frontotemporal lobes
211
histology of creutzfeldt-jakob
spongiform cortex with prions
212
Spherical tau protein aggregates
pick bodies
213
which genes cause early onset alzheimer's?
APP (chromosome 21), presenilin-1/2 (chromosome 14), and ApoE4 (chromosome 19)
214
Which gene is protective against alzheimer's?
ApoE2
215
Lab findings in multiple sclerosis
Increased protein IgG
Oligoclonal bands
MRI
216
Treatment for multiple sclerosis:
Beta interferon
immunosuppression
natalizumab
217
Symmetric ascending muscle paralysis
Acute inflammatory demyelinating polyradiculopathy (Guillain barre)
218
Treatment for GBD
respiratory support
| --consider IV globulins and plasmapheresis
219
Dx of GBD
Increased protein in CSF
220
Progressive multifocal leukoencephalopathy
demyelination of CNS from destruction of oligodendrocytes
221
PML is associated with
JC virus
222
Multifocal pervenular inflammation and demyelination after infection
Acute disseminated encephalomyelitis
223
Metachromatic leukodystrophy
Auto-recessive lysosomal storage disease caused by arylsulfatase A deficiency. Sulfatides build up and impair myelin sheath
224
Krabbe's disease
Lysosomal storage disease with deficiency of galactocerebrosidase. Build up of galactocerebroside destroys the myelin sheath
225
Charcot marie-tooth disease
Weakness of dorsiflexion from demyelination of common fibular nerve
--Defect in myelin protein gene
226
Prophylactic for migraines
propranolol and topiramate
227
Inheritance of sturge weber
sporadic
228
Sx of sturge weber
```
port wine stain
AVM (leptomeningeal angiomas)
Pheos
glaucoma
seizures
```
229
Sx of tuberous sclerosis
```
Hamartomas
Cutaneous angiofibromas
Ash leaf spots
Cardiac rhabdomyomas
Tubers
retardation
seizures
renal angiomyolipoma
AUTO DOM
```
230
Sx of NF 1
```
Cafe au lait
Lisch nodules
neurofibromas
Optic gliomas
Pheo
AutoDOM
--Mutation on NF-1 of CHROM 17
```
231
Sx of VHL
```
Cavernous hemangioma
bilateral renal cell carcinoma
Retinal Hemangioblastomas
pheo
AUTO DOM
VHL on chromosome 3
```
232
Butterfly looking tumor
gliblastoma multiforme
233
GFAP + tumor
glioblastoma multiforme in adults
| pilocytic astrocytoma in kids
234
Pseudopalisading tumor
gbm
235
What is the most common and 2nd most common primary brain tumor?
GBM then meningioma
236
spindle cells in a whorled pattern with psamomma bodies
meningioma
237
bilateral acoustic schwannoma
NF-2
238
S-100 positive
Schwannomas
239
Slow growing, Fried egg tumor
Oligodendroglioma.
240
1p:19q deletion tumor
Oligodendroglioma
241
Pituitary adenoma presents as
Prolactinoma usually.
242
Rosenthal fibers
pilocytic astrocytoma
243
pilocytic astrocytomas found in
posterior fossa
244
pilocytic astrocytoma good or bad prognosis?
good
245
homer wright rosettes
medulloblastoma
246
tumor that compresses 4th ventricle, causing hydrocephalus
medulloblastoma and ependyoma
247
tumor sends drop metastases to spinal cord
medulloblastomsa
248
PNET tumor
medulloblastoma
249
Most childhood tumors are found in cerebellum except
ependyoma and craniopharyngioma
250
perivascular pseudorosettes and rod-shaped blepharoplasts
ependyoma
251
Childhood tumor associated with VHL and EPO producing
hemangioblastoma
252
Foamy cells and high vascularity tumor
hemangioblastoma
253
verocay bodies
NF-2
254
brimonidine
alpha 2 agonist, decreases aqueous humor synthesis
255
epinephrine treats glaucoma by....
decreasing aqueous humor through vasoconstriction
256
Timolol, betaxolol, carteolol
Decrease aqueous humor synthesis without vision change
257
Side effect of alpha agonists for glaucoma
Alpha receptors dilate the pupil, causing mydriasis
258
Acetazolamide mechanism for glaucoma
decreased aqueous humor synthesis by inhibition of carbonic anhydrase
--no pupillary/vision change
259
pilocarpine/carbachol for glaucoma
Increase outflow of aqueous humor by contraction of ciliary muscle (M3) and opening trabecular meshwork. Causes miosis and cyclospasm
--Pilocarpine esp good for emergencies (acute closed angle)
260
Physostigmine, echothiophate
Indirect cholinergics, also used for glaucoma by contracting ciliary muscles and opening trabecular network
261
Latanoprost for glaucoma
Increase outflow of aqueous humor
262
Side effect of latanoprost
Darkens color of iris
263
Class: meperidine, dextromethorphan, diphenoxylate
Opioids
264
Mechanism of opioids
Bind to receptors
- -open K channels, close Ca channels
- -Decrease transmission
- -inhibits release of Ach, Ne, Serotonin, glutamate, sub P
265
Use of loperamide and diphenoxylate
diarrhea
266
Butorphanol
Partial mu agonist and kappa opioid agonist
267
use: butorphanol
severe pain, good b/c less respiratory depression
268
Problem with using butorphanol
cannot reverse overdose as well with naloxone
269
Tramadol side effect
decrease seizure threshold + normal opioid side effects
270
Use of tramadol
chronic pain
271
Mechanism tramadol
weak opioid agonist that inhibits serotonin and NE reuptake
272
First line for partial seizure
carbamazepine
273
First line for tonic clonic
phenytoin
valproic acid
carbamazepine
274
First line for prophylaxis against status epilepticus
phenytoin
275
Which drugs are only for partial seizures (most are for both)
tiagabine and vigabatrin
276
First line for trigeminal neuralgia
carbamazepine
277
mechanism phenytoin
sodium channel inactivation
278
mechanism carbamazepine
sodium channel inactivation
279
mechanism lamotrigine
Blocks voltage gated Na channels
280
Gapapentin mechanism
Inhibits voltage Ca channels
281
Other uses of gapapentin besides seizures
postherpetic neuralgia
peripheral neuropathy
bipolar disorder
migraines
282
First line drug for seizures in children
Phenobarbital
283
Mechanism of topiramate
Blocks Na channels and increases GABA action
284
Mechanism of phenobarbital
Increases GABAa action by increasing duration of Cl- channel opening
285
Mechanism of ethosuximide
Blocks thalamic T type calcium channels
286
Benzo mechanism
Increase GABA by increasing frequency of Cl- channel opening
287
Tx for seizures of eclampsia
Mg SO4
288
Tigabine mechanism
Inhibits GABA
289
Vigabatrin mechanism
Inhibits GABA transaminase to increase GABA
290
Stevens Johnson syndrome occurs with which drugs
Carbamazepine
Ethosuximide
phenytoin
lamotrigine
291
Sx of stevens johnson
purpuric macules-->epidermal necrosis and sloughing
292
Carbamazepine side effects
agranulocytosis
teratogen
SIADH
293
Which seizure drugs induce p-450
carbamazepine
phenobarbital
phenytoin
294
Which seizure drugs are contraindicated in pregnancy
carbamazepine
phenytoin
valproid acid
295
Lateral horn of spinal cord
Carries sympathetic fibers. Starts at T1. Knocked out in an expanded syringomyelia
296
Frataxin gene normally regulates:
iron
297
Friedreich ataxia is associated with what heart defect?
Hypertrophic cardiomyopathy
298
the last stage of a healed stroke is
A gliotic cyst
299
Xanthochromia
yellow spinal tap from hemoglobin
300
Which chromosome is amyloid precursor protein found on?
Chromosome 21!
301
Which layers of the cortex consist of the pyramidal neurons?
3,5,6. these are most susceptible to damage with a stroke
302
tau protein normally does what?
makes microtubules in cells
303
MTPT causes
Parkinson's
304
how do you tell apart lewy body dementia from parkinsons?
In Parkinson's, dementia is a VERY late finding. early onset dementia suggests lewy body dementia.
Lewy bodies are found in cortex in lewy body dementia
305
how do you treat Normal pressure hydrocephalus?
Shunt the CSF. Sx will improve with lumbar puncture (decrease CSF pushing on brain tissue)
306
Spongiform encephalopath histology
White open bubbles (spongy!)
307
Side effects of phenytoin
```
Ataxia
Gingival hyperplasia
hirsuitism
megaoblastic anemia
SLE syndrome
osteopenia
fetal hydantoin syndrome
```
308
Side effect of valproic acid
Hepatotoxicity (check LFTs)
GI distress
weight gain
neural tube defects
309
Side effect of topiramate
sedation
mental dulling
kidney stones
weight loss
310
Which benzos have a higher addictive potential?
short acting
1. triazolam
2. oxazepam
3. midazolam
311
uses of benzos
```
anxiety (blue jasmine)
status epilepticus
delirium tremens
night terrors/sleep walking
insomnia
```
312
How do you treat a benzo overdose
flumenazil, a competitive GABA antagonist. Generally less addictive than barbiturates
313
How do the non-benzo hypnotics work?
BZ1 subtype of GABA receptor. effects are also reversed by flumenazil
314
Rapid induction anesthetics have what property?
Decreased solubility in blood
315
Potent drugs have what property?
Increased solubility in lipids, determined by 1/MAC. Therefore a SMALL MAC means a highly potent drug
316
tox: halothane
hepatotoxicity
317
tox: methoxyflurane
nephrotox
318
tox: enflurane
convulsant
319
tox: inhaled anesthetics
malignant hyperthermia (except nitrous oxide). Nitrous oxide can expand trapped gas in a body cavity
320
Thiopental
IV barbiturate used to induct anesthesia
321
IV benzo
midazolam. used for endoscopy
322
side effect of midazolam
severe respiratory depression
323
Ketamine mech
blocks NMDA receptors. analog of PCP
324
Side effect of ketamine
hallucination/bad dreams
325
Propofol use
sedation in ICU, rapid anesthesia induction. less nausea than thiopental.
326
How does propofol work?
Potentiates GABAa
327
Local anesthetics: two types?
esters: procaine, cocaine, tetracaine
Amides: lidocaine, mepivacaine, bubivacaine
328
How do local anesthetics work?
Block Na channels on INNER portion of channel. Often combined with epinephrine to enhance action
329
Side effect of bupivacaine
cardiovascular toxicity
330
Other side effects of local anesthetics
Hypertension, hypotension, arrythmias
331
two phases of succinylcholine?
Phase I: depolarization: No antidote
| Phase II: repolarized but blocked. Antidote=cholinesterase inhibitor like neostigmine
332
Side defect of succinylcholine
hypercalcemia
hyperkalemia
malignant hyperthermia
333
Nondepolarizing NMJ blockers
"-curiums"
| --These are NMJ ACh receptor competitive antagonists
334
Dantrolene mechanism
prevents release of Ca from SR of muscle.
335
Clinical use of dantrolene
Treatment of malignant hyperthermia. A side effect of inhaled anesthetics and succinylcholine
Also for neuroleptic malignant syndrome
336
What predisposes you to malignant hyperthermia?
Genetics
337
Dopamine agonists for parkinson's
Bromocriptine (ergot)
pramipexole (non-ergot)
Non-ergots are better
338
Parkinson drug that increases dopamine
Amantadine
| L-dopa/carbidopa (converted to dopamine in CNS)
339
Toxicity of amantadine
ataxia
340
Selegiline mechanism
Prevents dopamine breakdown by blocking MAO
341
entacapone, tolcapone mechanism
COMT inhibitors preventing L dopa degradation in parkinsons
342
Benztropine
For parkinsons, an antimuscarinic that improves tremor and rigidity
"Park your benz"
343
What's the role of carbidops in the levodopa/carbidopa combo?
L dopa is converted to dopamine in the CNS. Carbidopa is a decarboxylase inhibitor that STAYS in the peripheral circulation and prevents L dopa activation in the periphery.
344
Side effects of levodopa
dyskinesia and arrhythmias
345
Memantine
NMDA antagonist for alzheimers
346
Donepezil, rivastigmine, galantamine
Acetylcholinesterase inhibitors for alzheimer's
347
Side effects of memantine
dizziness/confusion/hallucination
348
Side effect of donepezil
nausea/dizziness/insomnia
349
treatment for huntington
tetrabenzine and reserpine inhibit the VMAT limiting dopamine release
Also haloperidol, a dopamine antagonist
350
Sumatriptan mechanism
5HT/1b1d agonist that inhibits trigeminal nerve activation.
351
Sumatriptan is contraindicated in
coronary vasospasm (CAD or prinzmetal's angina)
352
cherry red spot on macula
retinal artery occlusion
353
Negative rinne test
Louder outside the ear than in the mastoid bone.
354
Abnormal Rinne
Conductive hearing loss
355
Normal Rinne
Sensorineural hearing loss
356
Medulloblastoma sx
Gait and limb ataxia
357
bursts of conjugate eyemovements in many directions with hypotonia and myoclonus. Also an abdominal mass. and HTN
Neuroblastoma in kids. Generated in the adrenal medulla causing secretion of catecholamines
358
gene responsible for neuroblastoma
c-myc
359
Signs of guillain barre on microscopy
segmental demyelination and endoneural inflammation
360
Loss of vibration/position
Paresis (spastic)
Ataxia
Subacute combined degeneration
Dorsal column loss
Lateral cerebrospinal tract loss
361
Demyelination of peripheral nerves withOUT perineural inflammation
Beriberi (thiamine deficiency).
| --pain and paresthesia with muscle weakness and areflexia
362
Which sensory pathway is the only one that does not go through the thalamus?
smell
363
Where would you find the area postrema?
Dorsal medulla, at the caudal end of the fourth ventricle
364
Marcus Gunn pupils
Light shown in one eye fails to show pupillary constrict on both sides.
--Note that NASAL portion of the retina contributes more input to the pretectal nucleus....so an optic tract defect could cause marcus gunn (even though light input to both eyes! so tricky!)
365
neurofibromas are made of
schwann cells, derived from neural crest
366
inhaled anesthetics have what system wide effect?
```
Increased cerebral blood flow
Myocardial depression
hypotension
respiratory depression
decreased renal function
```
367
CN III: compression vs ischemia?
Compression damages parasympathetics first. Ischemia only affects somatic fibers (ptosis, down and out eye) with intact parasympathetics (PERRLA)
368
Ergot compounds
bromocriptine and pergolide
369
nonergot componds
pramipexole and ropinirole
370
How do ergot/nonergot compounds work?
They directly stimulate the dopamine receptors
