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Neuro concepts Flashcards

1
Q

Pathophysiology of migraine

A

activation of trigem nerve

–>substance P and calcitonin GRP causes inflammation of meninges

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2
Q

How do triptans work?

A

5HT1B/1D AGONist

  • -Block vasoactive peptide release from neuron
  • -vasoconstriction
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3
Q

Bupropion mechanism

A

Dopa and NE reuptake inhibitor

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4
Q

Use of buproprion

A

depression and smoking cessation

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5
Q

TCA mechanism

A

Serotonin/NE reuptake inhibitor

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6
Q

Migraine prophylaxis

A

b-blocker

TCA and venlafaxine

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7
Q

Phenytoin mechanism

A

Inhibits Na channels from recovering from inactivation

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8
Q

phenytoin tox

A

lymphadenopathy

–hirsuitism/rash/gingival hypertrophy

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9
Q

carbamazepine tox

A

agranulocytosis

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10
Q

valproic acid tox

A

hepatotoxicity

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11
Q

lamotrigine tox

A

steven johnson hypersensitivity rash

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12
Q

phenobarbital tox

A

Acute intermittent prophyria

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13
Q

Benefits of zolpidem

A

less tolerance/addiction

Unlike benzos, it is missing the following

  • –No anticonvulsant properties
  • –No muscle relaxation
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14
Q

Syphilis destroys what part of CNS

A

tabes dorsalis

–posterior columns. Also happens in B12 deficiency

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15
Q

alar plate

A

dorsal sensory roots

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16
Q

basal plate

A

motor ventral roots

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17
Q

Forebrain

A

telencephalon and diencephalon

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18
Q

lateral ventricle

A

telencephalon

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19
Q

third ventricle

A

diencephalon

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20
Q

mesencephalon

A

midbrain

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21
Q

aqueduct

A

mesencephalon

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22
Q

Hindbrain (rhombencephalon)

A

metencephalon

myelencephalon

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23
Q

pons/cerebellum

A

metencephalon

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24
Q

medulla

A

myeencephalon

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25
Q

fourth ventricle derived from

A
  1. Metencephalon=upper

2. Myelencephalon=lower

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26
Q

you suspect NTD in a fetus with elevated AFP–how to confirm?

A

AChE

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27
Q

anencephaly assoc’d with

A

maternal diabetes

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28
Q

holoprosencephaly

A

left and right hemispheres don’t separate

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29
Q

holoprosencephaly caused by

A

hedgehog signaling pathway

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30
Q

cystic enlargement of 4th ventricle with hydrocephalus/spina bifida

A

dandy walker

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31
Q

cause of dandy walker

A

agenesis of cerebellar vermis (central area)

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32
Q

chiari II

A

aqueductal stenosus and hydrocephalus from cerebellar herniation

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33
Q

how does chiari II present?

A

paralysis and thoraco/lumbar myelomeningocele

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34
Q

syningomyelia is associated with

A

Chiari I

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35
Q

Muscles of tongue are derived from

A

occipital myotomes

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36
Q

anterior 2/3 of tongue from:

A

1st branchial arch

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37
Q

posterior 1/3 of tongue from:

A

3rd/4th branchial arch

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38
Q

taste goes to which nucleus?

A

solitary nucleus

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39
Q

PNS and schwann cells come from

A

neural crest cells. everything else comes from neuroectoderm except microglia (from mesoderm)

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40
Q

GFAP is a marker for

A

astrocytes

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41
Q

role of astrocytes

A
  1. BBB
  2. K metabolism
  3. Removing extra neurotransmitter
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42
Q

Multinucleated giant cells in the CNS are made of

A

microglia that are fused. Caused by HIV

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43
Q

Myelin effects on space and time constant

A

Increases space constant (distance signal will spread before dying)
Decreases time constant

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44
Q

which cells are destroyed in MS?

A

oligodendrocytes (white matter of CNS)

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45
Q

fried egg on H&E of brian matter

A

oligodendrocytes

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46
Q

large myelinated sensory fibers that adapt quickly

A

meissner’s

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47
Q

large myelinated fibers that adapt slowly

A

merkel’s discs

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48
Q

merkel’s discs sense:

A

pressure, position sense in hair follicles

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49
Q

C fibers

A

slow, unmyelinated pain fibers

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50
Q

Ad fibers

A

fast myelinated temperature fibers

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51
Q

endoneural inflammation

A

guillain barre

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52
Q

perifascicular/endomysial inflammation

A

polymyositis

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53
Q

Nucleus accumbens

A

reward center, fear

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54
Q

locus ceruleus

A

stress and panic

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55
Q

anxiety neurotransmitter

A

Increased NE, decreased 5HT, decreased GABA

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56
Q

schizophrenia neurotransmitter

A

increased dopamine

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57
Q

depression neurotransmitter

A

decreased NE
Decreased dopamine
Decreased serotonin

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58
Q

alzheimer’s neurotransmitter

A

decreased Ach

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59
Q

Huntington’s neurotransmitter

A

decreased Ach

decreased Gaba

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60
Q

REM sleep neurotransmitter

A

increased Ach

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61
Q

Synthesis of dopamine

A

ventral tegmentum and Snc (midbrian)

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62
Q

Synthesis of serotonin

A

raphe nucleus

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63
Q

Synthesis of Gaba

A

nucleus accumbens

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64
Q

Synthesis of Ach

A

basal nucleus of Meynert

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65
Q

Lateral hypothalamus

A

hunger

leptin inhibits

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66
Q

ventromedial hypothalamus

A

satiety

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67
Q

anterior hypothalamus

A

cooling

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68
Q

posterior hypothalamus

A

heating

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69
Q

VPL

A

ALS and DC-ML fibers going to somatosensory cortex

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70
Q

VPM

A

trigeminal and gustatory pathway

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71
Q

LGN

A

CNII fibers to calcarine sulcus (lateral light)

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72
Q

MGN

A

superior olive and inferior colliculus fibers to auditory cortex (medial music)

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73
Q

VL

A

Motor fibers from basal ganglia to motor cortex

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74
Q

LImbic system responsible for

A 
feeding
fleeing
fighting
feeling (emotion)
sex
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75
Q

structures of the limbic system

A 
hippocampus
amygdala
fornix
mamillary bodies
cingulate gyrus
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76
Q

Inputs to cerebellum through which peduncle?

A

middle and inferior

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77
Q

Input to cerebellum carries:

A

Middle: contralateral cortex info
Inferior: ipsilateral proprioceptive info from climbing/mossy fibers

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78
Q

Outputs from cerebellum:

A

Superior peduncle carrying info to contralateral cortex

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79
Q

Damage to lateral cerebellum:

A

impaired coordinated movement of extremities, with falling towards ipsilateral side

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80
Q

Effect of dopamine in basal ganglia

A

Stimulates D1
Inhibits D2 receptors
–>overall will facilitate movement through the direct pathway

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81
Q

Describe the direct pathway arc

A

Increased putamen stimulus
Decreased GPi
Increased thalamus
Increase cortex

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82
Q

Describe indirect pathway ard

A 
Increased putamen
Decreased GPe
Increased STN
Increased GPi
Decreased thalamus
Decreased cortex
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83
Q

parkinson’s changes in brain

A

lewy bodies with alpha synuclein and loss of Substantia nigra pars compacta dopaminergics

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84
Q

Huntington Sx

A

chorea, aggression, depression, dementia

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85
Q

Huntington causes neuronal death through:

A

NMDA-R binding and glutamate toxicity

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86
Q

Huntington=degeneration of:

A

striatal nucleus (putamen plus caudate

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87
Q

intention tremor seen in

A

cerebellar dysfunction

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88
Q

dystonia is:

A

sustained involuntary muscle contractions

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89
Q

Lesion in hemibalismus

A

contralateral subthalamic nucleus

–>STN normally stimulates the GPi to inhibit the thalamus. Loss of inhibition in basal ganglia!

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90
Q

kluver bucy

A

hyperorality
hypersexuality
disinhibited behavior

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91
Q

Kluver bucy lesion

A

amygdala

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92
Q

kluver bucy is associated with

A

HSV-1

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93
Q

Lx: Re-emergence of primitive reflexes

A

frontal lobe

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94
Q

left sided spatial neglect

A

right parietal lobe

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95
Q

lx: wernicke-korsakoff

A

mamillary bodies

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96
Q

intention tremor lesion:

A

cerebellar hemisphere lesion. (fall to ipsilateral side)

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97
Q

PPRF lesion

A

Eyes look away from side of lesion

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98
Q

Frontal eye fields

A

Eyes look toward lesion

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99
Q

Which area of the brain are damaged first in severe HTN? examples of deficits?

A

watershed regions:

  • -upper leg/arm weakness
  • -visual processing
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100
Q

Cerebral perfusion is primarily driven by

A

CO2

Only driven by hypoxemia when po2 < 50

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101
Q

Charcot bouchard

A

chronic HTN, affects small vessels in basal ganglia and thalamus

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102
Q

Causes of berry aneurysm

A

ADPKD
marfant’s
ehler danlos

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103
Q

site of berry aneurysm

A

communicating arteries

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104
Q

Acomm stroke

A

visual field defect

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105
Q

Pcomm stroke

A

CN III palsy (eye is down and out)

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106
Q

PCA stroke

A

contralateral hemianopia with macular sparing

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107
Q

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

A

AICA
–FACIAL NUCLEUS lesion
–vestibular nuclei, cranial nerve nuclei, spinal trigeminal nuclei also affected
“Facial droop means AICA’s pooped”

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108
Q

Stroke lesion:
vertigo; decrealsed pain and temperature to limbs/face
DYSPHAGIA and HOARSENESS, ipsilateral horner’s

A

PICA
–NUCLEUS AMBIGUOUS
“Don’t pica hoarse that can’t eat (dysphagia)”

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109
Q

stroke lesion:
contralateral hemiparesis of lower limbs
Tongue deviates ipsilaterally
Decreased contralateral proprioception

A

ASA

  • -lateral corticospinal
  • -DCML
  • -caudal medulla
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110
Q

lateral striate artery supplies the

A

striatum and internal capsule. Damage causes contralateral hemiparesis and hemiplegia
–Caused by HTN

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111
Q

Stroke lesion:

contralateral paralysis and loss of sensation in the lowerlimb

A

ACA

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112
Q

Lesion: aphasia and loss of motor and sensory from upper limb and face

A

MCA

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113
Q

Which intracranial hemorrhage gives a bloody tap?

A

subarachnoid hematoma.

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114
Q

worst headache of my life

A

subarachnoid

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115
Q

Other causes of intraparenchymal hemorrhage besides HTN

A

amyloid angiopathy, vasculitis, neoplasm

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116
Q

Which parts of the brain are most susceptible to hypoxic damage?

A

hippocampus
neocortex
cerebellum
watershed

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117
Q

red neurons

A

12-28 hours after injury

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118
Q

necrosis and neutrophils in brain

A

24-72 hrs after injury

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119
Q

macrophages in brain

A

3-5 days

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120
Q

reactive gliosis and vascular proliferation

A

1-2 weeks later

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121
Q

What connects the 4th ventricle to the subarachnoid space?

A

foramina of luschka (lateral) and foramina of magendie (medial)

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122
Q

Symptoms of normal pressure hydrocephalus

A

“wet wobbly and wacky” in elderly. Ventricles expand and cortex contracts

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123
Q

communicatin hydrocephalus

A

caused by decreased arachnoid granulation absorption

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124
Q

hydrocephalus ex vacuo

A

degeneration of cortex results in expanded hydrocephalus

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125
Q

fasciculations seen in UMN or LMN lesion?

A

LMN

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126
Q

atrophy seen in UMN or LMN lesion?

A

LMN

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127
Q

Werdnig hoffman disease

A

Like polio, affects anterior horns

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128
Q

Mutation in ALS

A

superoxide dismutase

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129
Q

subacute combined degeneration caused by:

A

Vit B12/E deficiency

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130
Q

Which areas damaged in SubacuteCD?

A 
Dorsal columns
Lateral corticospinal
spinocerebellar
--Ataxia, paresthesia
--Lost position/vibration
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131
Q

Infarction of anterior spinal artery damages which parts of spinal cord?

A

everything but dorsal columns of upper thoracic region

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132
Q

How does riluzole work?

A

Decrease glutamate (excitatory) release

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133
Q

floppy baby with hypotonia and tongue fasciculations. Death at 7 months

A

Werdnig hoffman, autosomal recessive inheritance

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134
Q

Friedreich’s ataxia caused by

A

GAA repeat (autosomal recessive)

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135
Q

How does Friederich’s ataxia present?

A

Kyphoscoliosis in childhood

  • -pes cavus
  • -staggering and falling
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136
Q

Loss of pain and temperature on one side, and propioception/vibration on the other side

A

Brown sequard syndrome. Lesion will be contralateral to the pain and temperature side

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137
Q

Contralateral loss of pain and Temp with ipsilateral paralysis of CN V, IX, X, XI

A

lateral medullary syndrome

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138
Q

contralateral paralysis

ipsilateral paralysis of tongue

A

medial medullary syndrome

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139
Q

Some common causes of horner’s

A

Pancoast tumor, brown sequard above T1

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140
Q

Describe the pathway for horner’s

A

Hypothalamus__.Spinal cord–>Exit at T1 to sympathetic ganglion–>Pupil

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141
Q

Gallbladder pain refers to which area?

A

the right shoulder (phrenic nerve)

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142
Q

C2/C3/C4 dermatomes

A

C2: skull cap
C3: tutleneck
C4: low cut shirt

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143
Q

S2/S3/S4 dermatomes

A

Penis

Anal zones

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144
Q

Biceps reflex

A

C5/6

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145
Q

Triceps reflex

A

C7/8

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146
Q

Patella reflex

A

L3/L4

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147
Q

Galant reflex

A

Stroking along one side of spine causes newborn to flex lower body toward that side

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148
Q

Cranial nerves that come out medially at the brain stem

A

3, 4, 12

medial to lateral:
3, 4
5 (pons)
6, 7, 8
9, 10
11
12
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149
Q

Superior colliculus

A

conjugate vertical gaze

150
Q

Inferior colliculus

A

auditory

151
Q

parinaud syndrome

A

paralysis of conjugate vertical gaze

152
Q

Cause of parinaud

A

lesion in superior colliculi

153
Q

Innervation of submandibular/sublingual

A

facial nerve

154
Q

innervation of stapedius muscle

A

facial

155
Q

innervation of stylopharyngeus

A

CN IX

156
Q

Innervation of carotid body/sinus

A

CN IX

157
Q

innervation of parotid gland

A

CN IX

158
Q

Midbrain CN nuclei

A

CN 3, 4

159
Q

Pontine CN nuclei

A

CN 5, 6, 7, 8

160
Q

Medullary CN nuclei

A

CN 9, 10, 12

161
Q

Spinal cord nuclei

A

CN 11

162
Q

Corneal reflex afferent/efferent

A

V1 opthalmic

VII efferent

163
Q

Lacrimation afferent/efferent

A

V1 afferent

VII efferent

164
Q

Three vagal nuclei

A

Solitarius
Ambiguous
Dorsal motor nucleus

165
Q

Innervation to nucleus solitarius

A

7, 9, 10 (taste, baroreceptors, gut)

166
Q

nucleus ambiguus sends what fibers

A

9, 10 (motor innervation of pharynx, larynx, and upper esophagus)

167
Q

dorsal motor nucleus sends what fibers

A

10 (parasympathetic fibers to heart, lungs, GI)

168
Q

Optic canal contents

A

CN II, opthalmic, central retinal vein

169
Q

Superior orbital fissure contents

A

III, IV< V1, VI, ophthalmic vein

170
Q

Foramen spinosum contents

A

Middle meningeal

171
Q

Internal auditory meatus

A

CN VII, VIII

172
Q

Jugular foramen

A

CN 9, 10, 11

173
Q

Foramen magnum

A

CN 11

174
Q

Hypoglossal canal

A

CN 12

175
Q

Cavernous sinus drains blood from:

A

eye and superficial cortex

176
Q

Which nerves travel through the cavernous sinus?

A

3, 4, V1, V2, 6

177
Q

Opthalmoplegia with normal vision

-decreased corneal and maxillary sensation

A

cavernous sinus syndrome

178
Q

CN V motor lesion sign

A

Jaw deviates toward lesion

179
Q

CN X lesion

A

uvual deviates away

180
Q

CN XI lesion

A

weakness turning head away from lesion

181
Q

CN XII lesion

A

tongue deviates toward lesion (lick the lesion)

182
Q

Conductive hearing loss finding

A

Abnormal rinne, localization to affected hear in weber

183
Q

Sensorineural hearing loss finding

A

Normal rinne, localizes to unaffected ear

184
Q

Which muscle opens the jaw?

A

lateral pterygoid

185
Q

which muscles close the jaw?

A

masster, temporalis, medial pterygoid

186
Q

if near sighted, light focuses…

A

in front of retina

187
Q

hyperopia/myopia

A

far/nearsighted

188
Q

Uveitis is inflammation of:

A

uveal coat (iris, ciliary body, choroid)

189
Q

Causes of retinitis

A

viral (CMV, HSV, HZV)

190
Q

Sx of open angle glaucoma

A

Painless Peripheral then central vision loss

191
Q

Cause of open angle glaucoma

A

Block of trabecular meshwork. Angle between the iris and cornea is “open”

192
Q

Sx of chronic closed angle glaucoma

A

asymptomatic usually. May lose peripheral vision

193
Q

Sx of acute closed angle glaucoma

A

painful sudden vision loss with a rock hard eye

194
Q

What should you NOT give in acute closed angle glaucoma?

A

epinephrine–causes mydriasis and constriction of pupillary dilator muscle

195
Q

pupillary dilator innervated by

A

Alpha 1

196
Q

Pupillary sphincter innervated by

A

M3

197
Q

Ciliary epithelium innervated by

A

Beta receptors–will produce more aqueous humor

198
Q

Signs of CN IV damage

A

Eyes move up when looking contralateral or when tilting head down (cannot see when walking down stairs)

199
Q

Miosis pathway

A

EW nucleus to ciliary ganglion by CN III

–Short ciliary nerve to pupillary sphincter

200
Q

Mydriasis pathway

A

Hypothalamus to center of budge

  • -Exit T1 to superior cervical ganglion
  • -Travel along internal carotid, long ciliary nerve to pupillary dilator
201
Q

Light compression of CN III results in

A

Blown pupil. Parasympathetics travel on the outside

202
Q

“curtain drawn down” on eyes preceded by flashes and floaters

A

retinal detachment

203
Q

Loss of central vision not caused by stroke

A

Macular degeneration

204
Q

dry vs wet MD

A

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
Q

treatment for dry AMD

A

multivitamin and antioxidants

206
Q

Meyer’s loop travels through

A

Temporal lobe carrying visual fibers

207
Q

Dorsal optic radiation travels through

A

parietal lobe

208
Q

Rapidly progressive dementia with startle myoclonus

A

Creutzfeldt-Jakob dz

209
Q

Dementia, aphasia, parkinsonism and change in personality

A

Pick’s disease

210
Q

Which areas of the brain are affected in Pick’s disease?

A

frontotemporal lobes

211
Q

histology of creutzfeldt-jakob

A

spongiform cortex with prions

212
Q

Spherical tau protein aggregates

A

pick bodies

213
Q

which genes cause early onset alzheimer’s?

A

APP (chromosome 21), presenilin-1/2 (chromosome 14), and ApoE4 (chromosome 19)

214
Q

Which gene is protective against alzheimer’s?

A

ApoE2

215
Q

Lab findings in multiple sclerosis

A

Increased protein IgG
Oligoclonal bands
MRI

216
Q

Treatment for multiple sclerosis:

A

Beta interferon
immunosuppression
natalizumab

217
Q

Symmetric ascending muscle paralysis

A

Acute inflammatory demyelinating polyradiculopathy (Guillain barre)

218
Q

Treatment for GBD

A

respiratory support

–consider IV globulins and plasmapheresis

219
Q

Dx of GBD

A

Increased protein in CSF

220
Q

Progressive multifocal leukoencephalopathy

A

demyelination of CNS from destruction of oligodendrocytes

221
Q

PML is associated with

A

JC virus

222
Q

Multifocal pervenular inflammation and demyelination after infection

A

Acute disseminated encephalomyelitis

223
Q

Metachromatic leukodystrophy

A

Auto-recessive lysosomal storage disease caused by arylsulfatase A deficiency. Sulfatides build up and impair myelin sheath

224
Q

Krabbe’s disease

A

Lysosomal storage disease with deficiency of galactocerebrosidase. Build up of galactocerebroside destroys the myelin sheath

225
Q

Charcot marie-tooth disease

A

Weakness of dorsiflexion from demyelination of common fibular nerve
–Defect in myelin protein gene

226
Q

Prophylactic for migraines

A

propranolol and topiramate

227
Q

Inheritance of sturge weber

A

sporadic

228
Q

Sx of sturge weber

A 
port wine stain
AVM (leptomeningeal angiomas)
Pheos
glaucoma
seizures
229
Q

Sx of tuberous sclerosis

A 
Hamartomas
Cutaneous angiofibromas
Ash leaf spots
Cardiac rhabdomyomas
Tubers
retardation
seizures
renal angiomyolipoma
AUTO DOM
230
Q

Sx of NF 1

A 
Cafe au lait
Lisch nodules
neurofibromas
Optic gliomas
Pheo
AutoDOM
--Mutation on NF-1 of CHROM 17
231
Q

Sx of VHL

A 
Cavernous hemangioma
bilateral renal cell carcinoma
Retinal Hemangioblastomas
pheo
AUTO DOM
VHL on chromosome 3
232
Q

Butterfly looking tumor

A

gliblastoma multiforme

233
Q

GFAP + tumor

A

glioblastoma multiforme in adults

pilocytic astrocytoma in kids

234
Q

Pseudopalisading tumor

A

gbm

235
Q

What is the most common and 2nd most common primary brain tumor?

A

GBM then meningioma

236
Q

spindle cells in a whorled pattern with psamomma bodies

A

meningioma

237
Q

bilateral acoustic schwannoma

A

NF-2

238
Q

S-100 positive

A

Schwannomas

239
Q

Slow growing, Fried egg tumor

A

Oligodendroglioma.

240
Q

1p:19q deletion tumor

A

Oligodendroglioma

241
Q

Pituitary adenoma presents as

A

Prolactinoma usually.

242
Q

Rosenthal fibers

A

pilocytic astrocytoma

243
Q

pilocytic astrocytomas found in

A

posterior fossa

244
Q

pilocytic astrocytoma good or bad prognosis?

A

good

245
Q

homer wright rosettes

A

medulloblastoma

246
Q

tumor that compresses 4th ventricle, causing hydrocephalus

A

medulloblastoma and ependyoma

247
Q

tumor sends drop metastases to spinal cord

A

medulloblastomsa

248
Q

PNET tumor

A

medulloblastoma

249
Q

Most childhood tumors are found in cerebellum except

A

ependyoma and craniopharyngioma

250
Q

perivascular pseudorosettes and rod-shaped blepharoplasts

A

ependyoma

251
Q

Childhood tumor associated with VHL and EPO producing

A

hemangioblastoma

252
Q

Foamy cells and high vascularity tumor

A

hemangioblastoma

253
Q

verocay bodies

A

NF-2

254
Q

brimonidine

A

alpha 2 agonist, decreases aqueous humor synthesis

255
Q

epinephrine treats glaucoma by….

A

decreasing aqueous humor through vasoconstriction

256
Q

Timolol, betaxolol, carteolol

A

Decrease aqueous humor synthesis without vision change

257
Q

Side effect of alpha agonists for glaucoma

A

Alpha receptors dilate the pupil, causing mydriasis

258
Q

Acetazolamide mechanism for glaucoma

A

decreased aqueous humor synthesis by inhibition of carbonic anhydrase
–no pupillary/vision change

259
Q

pilocarpine/carbachol for glaucoma

A

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
Q

Physostigmine, echothiophate

A

Indirect cholinergics, also used for glaucoma by contracting ciliary muscles and opening trabecular network

261
Q

Latanoprost for glaucoma

A

Increase outflow of aqueous humor

262
Q

Side effect of latanoprost

A

Darkens color of iris

263
Q

Class: meperidine, dextromethorphan, diphenoxylate

A

Opioids

264
Q

Mechanism of opioids

A

Bind to receptors

  • -open K channels, close Ca channels
  • -Decrease transmission
  • -inhibits release of Ach, Ne, Serotonin, glutamate, sub P
265
Q

Use of loperamide and diphenoxylate

A

diarrhea

266
Q

Butorphanol

A

Partial mu agonist and kappa opioid agonist

267
Q

use: butorphanol

A

severe pain, good b/c less respiratory depression

268
Q

Problem with using butorphanol

A

cannot reverse overdose as well with naloxone

269
Q

Tramadol side effect

A

decrease seizure threshold + normal opioid side effects

270
Q

Use of tramadol

A

chronic pain

271
Q

Mechanism tramadol

A

weak opioid agonist that inhibits serotonin and NE reuptake

272
Q

First line for partial seizure

A

carbamazepine

273
Q

First line for tonic clonic

A

phenytoin
valproic acid
carbamazepine

274
Q

First line for prophylaxis against status epilepticus

A

phenytoin

275
Q

Which drugs are only for partial seizures (most are for both)

A

tiagabine and vigabatrin

276
Q

First line for trigeminal neuralgia

A

carbamazepine

277
Q

mechanism phenytoin

A

sodium channel inactivation

278
Q

mechanism carbamazepine

A

sodium channel inactivation

279
Q

mechanism lamotrigine

A

Blocks voltage gated Na channels

280
Q

Gapapentin mechanism

A

Inhibits voltage Ca channels

281
Q

Other uses of gapapentin besides seizures

A

postherpetic neuralgia
peripheral neuropathy
bipolar disorder
migraines

282
Q

First line drug for seizures in children

A

Phenobarbital

283
Q

Mechanism of topiramate

A

Blocks Na channels and increases GABA action

284
Q

Mechanism of phenobarbital

A

Increases GABAa action by increasing duration of Cl- channel opening

285
Q

Mechanism of ethosuximide

A

Blocks thalamic T type calcium channels

286
Q

Benzo mechanism

A

Increase GABA by increasing frequency of Cl- channel opening

287
Q

Tx for seizures of eclampsia

A

Mg SO4

288
Q

Tigabine mechanism

A

Inhibits GABA

289
Q

Vigabatrin mechanism

A

Inhibits GABA transaminase to increase GABA

290
Q

Stevens Johnson syndrome occurs with which drugs

A

Carbamazepine
Ethosuximide
phenytoin
lamotrigine

291
Q

Sx of stevens johnson

A

purpuric macules–>epidermal necrosis and sloughing

292
Q

Carbamazepine side effects

A

agranulocytosis
teratogen
SIADH

293
Q

Which seizure drugs induce p-450

A

carbamazepine
phenobarbital
phenytoin

294
Q

Which seizure drugs are contraindicated in pregnancy

A

carbamazepine
phenytoin
valproid acid

295
Q

Lateral horn of spinal cord

A

Carries sympathetic fibers. Starts at T1. Knocked out in an expanded syringomyelia

296
Q

Frataxin gene normally regulates:

A

iron

297
Q

Friedreich ataxia is associated with what heart defect?

A

Hypertrophic cardiomyopathy

298
Q

the last stage of a healed stroke is

A

A gliotic cyst

299
Q

Xanthochromia

A

yellow spinal tap from hemoglobin

300
Q

Which chromosome is amyloid precursor protein found on?

A

Chromosome 21!

301
Q

Which layers of the cortex consist of the pyramidal neurons?

A

3,5,6. these are most susceptible to damage with a stroke

302
Q

tau protein normally does what?

A

makes microtubules in cells

303
Q

MTPT causes

A

Parkinson’s

304
Q

how do you tell apart lewy body dementia from parkinsons?

A

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
Q

how do you treat Normal pressure hydrocephalus?

A

Shunt the CSF. Sx will improve with lumbar puncture (decrease CSF pushing on brain tissue)

306
Q

Spongiform encephalopath histology

A

White open bubbles (spongy!)

307
Q

Side effects of phenytoin

A 
Ataxia
Gingival hyperplasia
hirsuitism
megaoblastic anemia
SLE syndrome
osteopenia
fetal hydantoin syndrome
308
Q

Side effect of valproic acid

A

Hepatotoxicity (check LFTs)
GI distress
weight gain
neural tube defects

309
Q

Side effect of topiramate

A

sedation
mental dulling
kidney stones
weight loss

310
Q

Which benzos have a higher addictive potential?

A

short acting

  1. triazolam
  2. oxazepam
  3. midazolam
311
Q

uses of benzos

A 
anxiety (blue jasmine)
status epilepticus
delirium tremens
night terrors/sleep walking
insomnia
312
Q

How do you treat a benzo overdose

A

flumenazil, a competitive GABA antagonist. Generally less addictive than barbiturates

313
Q

How do the non-benzo hypnotics work?

A

BZ1 subtype of GABA receptor. effects are also reversed by flumenazil

314
Q

Rapid induction anesthetics have what property?

A

Decreased solubility in blood

315
Q

Potent drugs have what property?

A

Increased solubility in lipids, determined by 1/MAC. Therefore a SMALL MAC means a highly potent drug

316
Q

tox: halothane

A

hepatotoxicity

317
Q

tox: methoxyflurane

A

nephrotox

318
Q

tox: enflurane

A

convulsant

319
Q

tox: inhaled anesthetics

A

malignant hyperthermia (except nitrous oxide). Nitrous oxide can expand trapped gas in a body cavity

320
Q

Thiopental

A

IV barbiturate used to induct anesthesia

321
Q

IV benzo

A

midazolam. used for endoscopy

322
Q

side effect of midazolam

A

severe respiratory depression

323
Q

Ketamine mech

A

blocks NMDA receptors. analog of PCP

324
Q

Side effect of ketamine

A

hallucination/bad dreams

325
Q

Propofol use

A

sedation in ICU, rapid anesthesia induction. less nausea than thiopental.

326
Q

How does propofol work?

A

Potentiates GABAa

327
Q

Local anesthetics: two types?

A

esters: procaine, cocaine, tetracaine
Amides: lidocaine, mepivacaine, bubivacaine

328
Q

How do local anesthetics work?

A

Block Na channels on INNER portion of channel. Often combined with epinephrine to enhance action

329
Q

Side effect of bupivacaine

A

cardiovascular toxicity

330
Q

Other side effects of local anesthetics

A

Hypertension, hypotension, arrythmias

331
Q

two phases of succinylcholine?

A

Phase I: depolarization: No antidote

Phase II: repolarized but blocked. Antidote=cholinesterase inhibitor like neostigmine

332
Q

Side defect of succinylcholine

A

hypercalcemia
hyperkalemia
malignant hyperthermia

333
Q

Nondepolarizing NMJ blockers

A

“-curiums”

–These are NMJ ACh receptor competitive antagonists

334
Q

Dantrolene mechanism

A

prevents release of Ca from SR of muscle.

335
Q

Clinical use of dantrolene

A

Treatment of malignant hyperthermia. A side effect of inhaled anesthetics and succinylcholine

Also for neuroleptic malignant syndrome

336
Q

What predisposes you to malignant hyperthermia?

A

Genetics

337
Q

Dopamine agonists for parkinson’s

A

Bromocriptine (ergot)
pramipexole (non-ergot)
Non-ergots are better

338
Q

Parkinson drug that increases dopamine

A

Amantadine

L-dopa/carbidopa (converted to dopamine in CNS)

339
Q

Toxicity of amantadine

A

ataxia

340
Q

Selegiline mechanism

A

Prevents dopamine breakdown by blocking MAO

341
Q

entacapone, tolcapone mechanism

A

COMT inhibitors preventing L dopa degradation in parkinsons

342
Q

Benztropine

A

For parkinsons, an antimuscarinic that improves tremor and rigidity
“Park your benz”

343
Q

What’s the role of carbidops in the levodopa/carbidopa combo?

A

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
Q

Side effects of levodopa

A

dyskinesia and arrhythmias

345
Q

Memantine

A

NMDA antagonist for alzheimers

346
Q

Donepezil, rivastigmine, galantamine

A

Acetylcholinesterase inhibitors for alzheimer’s

347
Q

Side effects of memantine

A

dizziness/confusion/hallucination

348
Q

Side effect of donepezil

A

nausea/dizziness/insomnia

349
Q

treatment for huntington

A

tetrabenzine and reserpine inhibit the VMAT limiting dopamine release

Also haloperidol, a dopamine antagonist

350
Q

Sumatriptan mechanism

A

5HT/1b1d agonist that inhibits trigeminal nerve activation.

351
Q

Sumatriptan is contraindicated in

A

coronary vasospasm (CAD or prinzmetal’s angina)

352
Q

cherry red spot on macula

A

retinal artery occlusion

353
Q

Negative rinne test

A

Louder outside the ear than in the mastoid bone.

354
Q

Abnormal Rinne

A

Conductive hearing loss

355
Q

Normal Rinne

A

Sensorineural hearing loss

356
Q

Medulloblastoma sx

A

Gait and limb ataxia

357
Q

bursts of conjugate eyemovements in many directions with hypotonia and myoclonus. Also an abdominal mass. and HTN

A

Neuroblastoma in kids. Generated in the adrenal medulla causing secretion of catecholamines

358
Q

gene responsible for neuroblastoma

A

c-myc

359
Q

Signs of guillain barre on microscopy

A

segmental demyelination and endoneural inflammation

360
Q

Loss of vibration/position
Paresis (spastic)
Ataxia

A

Subacute combined degeneration
Dorsal column loss
Lateral cerebrospinal tract loss

361
Q

Demyelination of peripheral nerves withOUT perineural inflammation

A

Beriberi (thiamine deficiency).

–pain and paresthesia with muscle weakness and areflexia

362
Q

Which sensory pathway is the only one that does not go through the thalamus?

A

smell

363
Q

Where would you find the area postrema?

A

Dorsal medulla, at the caudal end of the fourth ventricle

364
Q

Marcus Gunn pupils

A

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
Q

neurofibromas are made of

A

schwann cells, derived from neural crest

366
Q

inhaled anesthetics have what system wide effect?

A 
Increased cerebral blood flow
Myocardial depression
hypotension
respiratory depression
decreased renal function
367
Q

CN III: compression vs ischemia?

A

Compression damages parasympathetics first. Ischemia only affects somatic fibers (ptosis, down and out eye) with intact parasympathetics (PERRLA)

368
Q

Ergot compounds

A

bromocriptine and pergolide

369
Q

nonergot componds

A

pramipexole and ropinirole

370
Q

How do ergot/nonergot compounds work?

A

They directly stimulate the dopamine receptors

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