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Hailey - Neuro > Block 3 More plz > Flashcards

Block 3 More plz Flashcards

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1
Q

sympathetic NS

A 
mydriasis
a1 contracts pupillary dilator muscle
a1 contracts superior tarsal muscle
b2 relax ciliary muscle = increase long distance vision
b increase aq humor formation
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2
Q

parasympathetic NS

A 
miosis
ptosis
muscarinic receptors:
M3 contract pupillary sphincter
M3 contract ciliary muscle = increase near vision
M3 increase drainage of aq humor
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3
Q

mydriatic agents

A

ATROPINE: muscarinic receptor antagonist > cycloplegia (paralysis of ciliary muscle)

PHENYLEPHRINE a1 agonist, reverts ptosis in Horner’s syndrome
EPINEPHRINE a1 agonist, increases aq humor outflow, inhibits aq humor formation*

COCAINE blocks axoplasmic pump, inc NE
AMPHETAMINE release of NE

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4
Q

miotic agents

A

PILOCARPINE muscarinic agonist
ACETYLCHOLINE muscarinic agonist
NICOTINE activates para sympathetic nerves
PHYSOSTIGMINE anticholinesterase AChE

TERAZOSIN a1 antagonist

RESERPINE depletes NE

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5
Q

Tx for glaucoma

A

ECOTHIPHATE and PHYSOSTIGMINE anticholinesterases
PILOCARPINE muscarinic agonist
= increase outflow of aqueous humor

APROCLONIDINE a2 agonist
ACETAZOLAMIDE CA inhibitor
TIMOLOL b antagonist/blocker
= suppress aq humor formation

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6
Q

alpha agonists

A

phenylephrine a1
epinephrine a1
aproclonidine a2

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7
Q

muscarinic agonists

A

pilocarpine

acetylcholine

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8
Q

anticholinesterases

A

physostigmine

ecothiophate

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9
Q

botulism toxin

A

suppresses ACh release from neurons

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10
Q

optic nerve pathway

A

retinal ganglia > optic nerve > optic chiasm > optic tract > lateral geniculate nucleus > optic radiation > visual cortex (occipital lobe)

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11
Q

Meyer’s Loop/sublenticular

A

upper visual field fibers –> temporal lobe –> visual cortex

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12
Q

retrolenticular

A

lower visual field fibers –> parietal lobe –> visual cortex

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13
Q

Area 17

and 18 and 19

A

visual cortex in occipital lobe

then 18 and 19 association cortex

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14
Q

CN I special neurons

A

BIPOLAR

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15
Q

bipolar neurons through

A

cribriform plate to olfactory bulb

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16
Q

receptors and 1* neuron process

A
  1. activate receptor protein
  2. activates G protein (G-olf)
  3. inc cAMP
  4. cAMP opens ligand gated Na+ channel > DEPOLARIZATION
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17
Q

2* olfactory neuron called

A

mitral neuron, in olfactory bulb, which goes to synapse a bunch of places

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18
Q

primary olfaction cortex

A

piriform “pear shaped” cortex

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19
Q

orbital frontal cortex

A

where taste and smell meet to produce “flavor”

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20
Q

gustation involves which CN

A

CN V (touch and temp), VII (taste), IX (taste touch temp), X

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21
Q

gustation receptor cells are not

A

primary neurons
they are RECEPTOR CELLS
(100 receptor cells per taste bud, each cell does one of five tastes, receptor cells turn over q10days)

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22
Q

gustation process/pathway

A
  1. receptor is activate
  2. G protein (sweet, omami, bitter) / Na channel or proton closes K channel (sour, salty)
  3. 2nd mess (sweet, umami, bitter)
  4. open channel for DEPOLARIZATION
  5. open VG Ca++ or release intracellular Ca++
  6. AP
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23
Q

gustation receptor cell types

A

sweet, sour, bitter, omami, salty

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24
Q

taste buds (tip to back of tongue)

A

fungiform, foliate, circumivallate

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25
CN XI origin
C 1-5 of spinal cord
26
CN XI stroke on right | Sx
weak SCM same side (can't turn to opposite side)
27
CN IX glossopharyngeal supplies
tonsillar area and TM
28
retropharyngeal space
worry about infeciton
29
adenoidectomy
pharyngeal tonsils
30
cough afferent reflex
CN VII
31
cricothyroid muscle innervation
external branch of superior laryngeal nerve of vagus
32
piriform recess innervation
internal branch of superior laryngeal nerve of vagus
33
CN X vagus
cough swallow speech | PALATOGLOSSUS
34
4 gaze systems
1. saccadic movements (rapid, jerky movements, scan to find salience) 2. smooth pursuit (moving image centered on fovea) 3. VOR (steady fovea during head movement) 4. vergence (image on fovea when object is nearer or farther away)
35
MLF medial longitudinal fasciculus
nerves that supply pairs of eye muscles yoke together through this column of axons
36
UMN vs LMN anatomy
UMN: cortex to nucleus LMN: nucleus to wherever (innervating or synapse)
37
anisocoria
pupils of different size
38
uveitis
iris ciliary body choroid
39
chorioretinitis
choroid | retinal layers
40
endophthalmitis
aqueous and vitreous humor RECENT INTRAOCULAR SURGERY esp cataracts normal flora: pseudomonas, staph, candida Tx: fluoroquinolone or vance injected into eye
41
eye infections: route of infection
``` trauma paranasal sinuses IC anatomical abnormalities (dysfxn tear states) blood born sexually transmitted ```
42
tear include
sIgA and lysozome lubrication sIgA (secretory IgA = dimer) protects IgA from being degraded
43
why not use corticosteroids during eye infections?
corticosteroids facilitate corneal penetration
44
Chlamydia trachomatis serotypes
INCLUSION conjunctivits serotypes D-K TRACHOMA serotypes A-C *leading cause of blindness worldwide (due to multiple inf and non lasting immunity, scar cornea each time)
45
Chlamydia trachomatis Dx
direct fluorescent ab
46
Chlamydia trachomatic inf
*co-infection with N. gonorrhea BASOPHILIC INCLUSION BODIES elementary bodies (rigid membrane) enter epithelia cell > change into reticulate bodies > replicates binary fission > leaves as EB
47
Tx chlamydia
AZITHROMYCIN
48
adenovirus
``` ds DNA non enveloped lytic in epithelial cells latent in lymphoid highly contagious ``` *infects epithelia cells of RESPIRATORY TRACT, CONJUNCTIVA, ENTERIC ORGANS because antigen and ability to act on certain receptors > Sx path: migration into (HOST CELL) microtubules > induce cell cycle > block apoptosis > block host mRNA transport and translation > disrupt cytokeratin network (HOST ORG) antagonize interferon, TNF
49
how Dx adenovirus
ADENOPLUS test | detects hexon proteins (part of viral capsid)
50
chronic conjunctivitis associated with
blepharitis | staphylococcus
51
hordeolum
``` STYE Tx: erythromycin ointment warm compress massage open keep clean ```
52
allergic rhinoconjunctivitis
IgE response | Tx: antihistamines, avoid steroids
53
viral conjuctivitis neonatal adult
``` HSV adenovirus Tx: cold compress topical vasoconstrictors ```
54
acute bacterial conjunctivitis kids adults
staph aureus+ strep pneumo+ h flu- staph aureus+ Tx: EMPIRIC (gram - and gram +) TRIMETHOPRIM POLYMYXIN OPHTHALMIC DROPS = POLYTRIM*
55
hyperacute bacterial conjunctivits
Neisseria gonorrheae preauricular adenopathy copious yellow/green PURULENT DISCHARGE Tx: CEFTRIAXONE
56
newborns receive prophylactic
erythromycin ointment | to prevent ophthalmia neonatorum
57
keratoconjunctivitis HSV
topical trifulridine and system acylovir
58
trifluridine
pyrimidine analog *effective aginst acyclovir resistant virus bc can be phosphorylated BY HOST KINASES TOXIC, TOPICAL ONLY
59
pseudomonas aeroginosa
gram -, rod, flagella PYOCYANIN inhibits mto enz, disrupts ciliary beating biofilms adherence factors secreted cytotoxins (destroy corneal epithelium) host imm resp damages cornea > scarring, loss visual acuity Tx: POLYMYXCIN B
60
acanthamoeba
single cell, EUK cysts and trophozoites in tissue Tx: AZOLES
61
CMV retinitis
BRUSHFIRE
62
Toxoplasma
Dx: IgM serology Tx: pyrimethamine and sulfadiazine
63
keratitis Sx
vision defects photophobia pain (cornea has lots nerve endings) foreign body sensation
64
keratitis Tx
acyclovir and trifluridine VIRAL | moxifloxacin eyedrops
65
iritis (anterior uveitis)
notn infectious
66
chorioretinitis
IC or HIV: toxoplasma or CMV
67
conjunctivitis bilateral
allergic (usually)
68
conjunctivitis discharge type
viral, serous Chlamydia, mucoid/mucopurulent bacterial, mucopurulent
69
preauricular adenopathy
viral chlamydia neisseria gon
70
labyrinthitis
inner ear infection
71
associate recurrent OM (otitis media) with
conductive HL meningitis mastoiditis
72
commonly occur together, similar agents
bacterial conjunctivitis otitis media sinusitis
73
Moraxella catarrhalis
``` gram - diplococcus OXIDASE + FASTIDIOUS CHOCOLATE AGAR 95% produce BETA-LACTAMASES* HOCKEY PUCK TEST ```
74
Haemophilus influence NTHi
``` gram - LPS > rash CHOCOLATE AGAR NONENCAPSULATED BETA-LACTAMASES* ```
75
Strep pneumo
gram + lancet shape diplococcus many virulence suscept: alcoholism, DM, chronic RD
76
strep pneumo virulence
resistance capsule choline-biding prot (bind carb on surface epithel) neuramoinidases (cleave host mucins) pneumolysis (pore forming toxin, disrupts host cilia > HL, causes apoptosis iron acquisition A (compete with host for iron)
77
OM Tx
1. amox 2. augmentin (amok with clavulanate) 3. azithromycin 4. eartube insertion to drain fluid (8PM TM)
78
Otitis externa Tx
``` cleanse with acetic acid topical abx: NEOMYCIN + POLYMXYIN - HYDROCORTISONE itch ``` *avoid flushing unless TM intact
79
otitis media with effeusion
NOT AN INFECTION | fluid in eustachian tube > resolves on own
80
complications of OM
CHOLESTEATOMA cyst of epithelial cells > erode IE or bone or brain, eardrum sucked inward CONDUCTIVE HL MASTOIDITIS red, hot, swollen behind ear
81
otitis externa micro
staph + pseudomonas - aspergillus candida
82
otitis externa Sx and issues
Sx: unilateral, inflam ear canal, pain, itch, purulent ear draiage 1. pustule with hair follicle 2. itches, red canal, pain (can progress to) 3. invasion adj bone and cartilage --> CN PALSY/DEATH (more common in elderly, poorly controlled DM, IC)
83
Olfactory projections
Olfactory bulb > olfactory tract > 1. olfactory tuburcle/amygdala > hypothalamus VISCERAL RXNS, HOMEOSTASIS, EMOTIONAL 2. piriform cortex pear > MD thalamus > orbitofrontal cortex CONSCIOUS PERCEPTION, FLAVOR 3. entorhinal cortex > hippocampus MEMORIES
84
Gustatory projections
CN VII, IX, X (1*) > solitary tract > SOLITARY NUCLEUS > 1. hypothalamus 2. amydala (emotions) 3. nucleus ambiguus (gag reflexes to stop intake of spoiled foods) 4. salivatory nucleus 5. hypoglossal nucleus 6. BILATERAL (2*) to VPM > (3*) gustatory cortex (insula) > orbitofrontal cortex (combination of taste and smell = flavor)
85
``` sense of taste tells: salt sweet umami sour bitter ```
``` salt content high-energy carbs proteins pH toxic substances ```
86
Spinal accessory nerves is special because
it is the only cranial nerve to both enter and exit the skull
87
CN XII damage | when protrude the tongue...
deviates TOWARDS side of damaged NERVE | deviates AWAY side of lesioned CORTICOBULBAR TRACT
88
rate of blinking can be diagnostic because
descengin control from basal ganglia and cortex is regulated by DOPAMINERGIC CIRCUITS
89
epiphora produced by induced by
over-tearing increased tear production decreased outflow CORNEAL STIMULATION reflex strong emotional responses LIMBIC SYSTEM
90
Refraction definition
bending light inverted and reversed light when hits cornea gets bent > lens is adjustable for refraction
91
emmetropic
perfect vision: refracting normally, infinity in focus
92
refractive power measured in
diopters | cornea + lens
93
diplopia
oculomotor damage (or abducens or trochlear)
94
what is happening when lens is flat?
see long-distance (sympathetic) ciliary muscle relaxed zonules tight
95
what is happening when lens is FAT?
see close (parasympathetic) ciliary muscle contracted (M3 Rec) zonules relaxed
96
hyperopia myopia
farsightedness eyeball too short nearsightedness eyeball too long
97
presbyopia
decreased accommodative power with age
98
cataract
glycoslylation of LENS proteins
99
associate SYMPATHETIC EYE
superior cervical ganglion NE and a1 superior tarsal (injury: ptosis) pupillary DILATOR (injury: miosis)
100
associate PARASYMPATHETIC EYE
ciliary ganglion ACh and M3 pupillary SPHINCTER/CONSTRICTOR (injury: mydriasis)
101
pupillary light reflex pathway
CN II > optic chiasm > optic tract > optic radiations > edinger westphal nucleus in midbrain > PREganglionic PARAsympathetic to ciliary ganglion > synapse at ciliary ganglion > POSTganglionic PARAsympathetic to pupillary sphincter > miosis
102
aqueous humor production in absorbed in
posterior chamber anterior chamber (canal of Schlemm)
103
increase outflow of aqueous humor by
MIOSIS: give AChE
104
b2 increases concentration of
cAMP > increase aq humor volume > increased intraocular pressure Beta blockers decrease aqueous humor formation
105
inflow of aqueous humor
1. b2 sympathetics increase [cAMP] | 2. CA incrases osmotic bleh so Cl- secretion
106
outflow of aqueous humor
1. paraysmpathetics > miosis (AChEs) | 2. PGF2 > relaxation of ciliary muscle
107
glaucoma open angle closed angle
increased INTRAOCULAR PRESSURE OPEN: common, slow progression, late symptoms increased production, decreased outflow normal angle CLOSED: MEDICAL EMERGENCY acute, suden onset SEVERE PAIN, BLURRY, RED EYE iris moves and blocks Schlemms canal
108
closed angle glaucoma progression >
edema and decreased transparency = "halo effect" damages PRs neural conduction of CNII affected
109
Muller cells (of eye)
specialized glial cells
110
Retina 3 nuclear layers
most inner: ganglion cell bodies (axons form optic nerve) middle: INNER NUCLEAR LAYER bipolar cell bodies outer: OUTER NUCLEAR LAYER PRs cell bodies
111
3 neurons that begin the process of visual perception
1* PRs 2* bipolar neurons 3* ganglion cells ganglion axons go to form the optic nerve (CN II) > optic chiasm > optic tract > optic radiation > visual cortex
112
___% cones are in fovea
90%
113
blind spot
optic disk, where all ganglion cell axons leave to go to brain no PRs
114
PRs adequate stimulus
LIGHT | 350-750nM
115
PRs encode
``` frequency = color intensity = brightness ```
116
scotopic vision photopic vision
can see in dark, RODS vision in bright lights, CONES
117
RODS
``` scopotic vision more pigment more sensitive to single photon saturate sooner RHODOPSIN integrated: low spatial and temporal resolution slower ```
118
CONES
``` photopic vision less pigment less sensitive to detecting photons bright light color vision per certain wavelengths precise, high temporal and spatial resolution faster ```
119
color vision wavelengths
blue: short wave green: medium wave red: long wave * red doesn't overlap -> red vision from cones
120
types visual acuity
1. spatial ( two points in space, eye chart) 2. temporal (two events as separate, critical fusion freq: 50Hz) 3. spectral (two colors as different)
121
rhodopsin
light activated > change conformation > G protein > PDE > cGMP to GMP > CLOSE cAMP depending Na channels > HYPERPOLARIZATION
122
rhodopsin/rod vision special because
stimulus CLOSES channel, not open it HYPERPOLARIZATION 2nd messenger: get AMPLIFICATION > increased sensitivity > CAN SEE IN DARK
123
Retinitis Pigmentosa and Retinopathy
neither involved in inflammation both STOP PRs from working NIGHT BLINDNESS FIRST
124
Vitamin A deficiency
NIGHT BLIND because rods don't work well
125
Macular degeneration (Fitz)
degeneration in RPE
126
rhodopsin cycle with RPE
light > rod > rhodopsin to opsin > all transretinal > all transretinol > TO RPE CELL > all transretinol > 11-cis-retinal > TO ROD > makes more rhodopsin
127
adaptation definition dark adaptation
decreased response to sustained stimulus RPE pumps retinal components into rods > more rhodopsin > more sensitive
128
upper visual fields project to lower visual fields project to
lingual gyrus (of occipital) cuneate gyrus (of occipital)
129
macular representation in area 17 peripheral field representation in area 17
macular = most caudal = towards back of head peripheral = rostral 2/3 of area 17 = back of head towards eyes
130
dorsal stream (parietal and upper temporal visual association cortex) ventral stream (inferior temporal visual association cortex)
"where" (lying on back/dorsally in ocean, where am I?) "what" (lying on stomach/ventrally in ocean, what am I looking at?)
131
projections to superior colliculus
via optic radiation and brachium of superior colliculus i. SCANNING movement ii. ACCOMMODATION/ CONVERGENCE reflex
132
homonymous defects
right POST-CHIASMATIC defects left homonymous hemianopsia left upper homonymous quadrantanopsia left homonymous hemianopsia with macular sparing
133
heteronymous defects
``` OPTIC CHIASM (can't see periphery) bitemporal heteronmymous hemianopsia ```
134
hemianopsia
defective vision or blindness in one half of visual field ``` bitemporal heteronymous hemianopsia, left homonymous (with and without macular sparing) ```
135
accommodation reflex
(initiated when gaze is shifted from distant object to near one and image becomes blurred) OCULAR CONVERGENCE both MR contract MIOSIS constrictor pupillae sharpen image LENS THICKENING ciliary muscle contracts, increasing refractive power of lens
136
Horner's Sx
ptosis miosis vasodilation (flushing of face) anhidrosis (absence of sweating)
137
Argyll Robertson pupil
pupil ACCOMMODATES to near objects but DOES NOT REACT TO LIGHT (issues with pretectal area) tabes dorsalis/tertiary syphilis, SLE, DM
138
strabismus
squint: failure of coordination of extra ocular eye muscle, resulting in deviation of affected eye and diplopia
139
amblyopia
lazy eye decreased visual acuity in absence of anatomical defects in visual pathway to avoid diplopia, vision in one eye is suppressed at level of the visual cortex
140
scotoma
island of visual loss within visual field
141
sphenoid sinus does not open into
middle nasal meatus
142
nasolacrimal duct communicates with
inferior nasal meatus
143
sensory neurons to roof of hard and soft palate
nasopalatine nerve of V
144
tympanosclerosis
calcium plaque in ME | perforation of TM
145
cholesteatoma
long standing retraction of TM into ME, negative pressure > skin cyst > cyst slowly erodes bone Sx: facial paralysis, HL, dizziness, can erode brain cavity
146
hemotympanium
blood in middle ear | BAD
147
red eye, minor cold, clear eye drainage
adenovirus
148
visual field deficit, most common in HIV infected individuals
CMV
149
releases pnemolysin pore forming toxin
streptococcus pneumonea
150
green/yellow discharge from eyes
neisseria gonorrhea
151
ototoxic drugs
gentamicin, lasix, cisplatin, ASA/NSAIDS, antimalarials
152
presbycusis
most common cause of loss of hair cells, progressive
153
Otosclerosis
autosomal dominant poor conduction stapes needs fixing
154
BPPV
most common "roll out of bed, turn and room starts spinning" Dix Hallpike
155
Ostemoa
benign growth in ear canal cold water exposure nothing to do about it looks like cholesteatoma
156
Meniere's
inner ear spontaneous VERTIGO lapses ENDOLYMPH LEAKING
157
Acute Otitis Media
``` 2nd most common disease in children Eustachian tube dysfunciton s. pneumo h. flu moraxella ```
158
Allergic rhinitis
IgE mediated hypersensitivity of nasal mucosa to foreign substances affects 20% US pop DOESN'T HAPPEN BEFORE AGE 2, BUT BY 20YO M>F Sx: sneezing, rhinorrhea, nasal congestion, lacrimation
159
macular degeneration dry wet
DRY DRUSEN, can get wet WET, BLOOD Subretinal hemorrhage, grayish = bad
160
wet macular degneration Tx
anti-VEGF
161
glaucoma
optic nerve cupping: ENLARGED OPTIC CUP | LOSS OF OPTIC NERVE FIBERS
162
diabetic retinopathy
can cause BLINDNESS NONPROLIFERATIVE microanurysms, blot hem, exudates, macular edema, cotton wool spotaj PREPROLIFERATIVE venous beading, intraretinal microvascular changes, ischemic areas (cotton wool spots) PROLIFERATIVE BOAT HEMORRHAGE
163
diabetic retinopathy Tx
anti-VEGF | proliferative; panretinal photocoagulation
164
hypertensive retinopathy
silver wiring | cotton wool spots
165
amaurosis fugax
sudden vision loss no pain vascular insufficiency CARDIAC WORKUP
166
ophthalmic migraine
hallmark: SCINTILLATINGN SCOTOMA: aura, colorful/shimmery aura 20-30 minutes Spasm of arteriol in occipital cortex
167
retinal arterial occlusion
``` CHERRY RED SPOTS sudden vision loss one eye painless BREATHE CO2 TIMOLOL ACETAZOLAMIDE IV ```
168
retinal vein occlusion
SQUASHED TOMATO
169
temporal arteritis
history is key EXTREME TENDER SCALP STEROIDS IMMEDIATELY
170
CN III palsy
"down and out" mydriatic ptosis diplopia
171
CN IV palsy
common one eye slightly higher than other vertical diplopia (not horizontal)
172
CN VI palsy
one eye in "down and in"
173
alkali eye injury
irrigate forever
174
hyphema
DON'T MISS THIS | blood in anterior chamber
175
subconjunctival hemorrhage
blood on surface of sclera, under conjunctiva | harmless
176
sudden painless loss of vision
retinal detachment retinal vein occlusion - squashed tomato retinal artery occlusion - cherry red vitreous hemorrhage
177
sudden painful loss of vision
corneal abrasion uveitis traumatic hyphema acute glaucoma
178
sudden BILATERAL vision loss
painless: meds painful: toxins, chemical exposure
179
gradual vision loss
macular degeneration | cataracts

Hailey - Neuro (10 decks)

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