everything Flashcards
(173 cards)
1
Q
What three drugs are FDA-approved for tx of fibromyalgia?
A
Pregabalin
Duloxetine
Milnacipran
2
Q
What is Pregabalin used for and what is the dose?
A
Fatigue
300-450 mg/day
3
Q
What is Duloxetine used for and what is the dose?
A
Mood
60-120 mg/day
4
Q
What is Milnacipran used for and what is the dose?
A
Pain, insomnia
100-200 mg/day
5
Q
What is the mechanism of action for Duloxetine and Milnacipran?
A
Selective serotonin and norepinephrine reuptake inhibitor
6
Q
What is the first line of treatment for spasticity associated with FM?
A
Baclofen
7
Q
What is the mechanism of action for Baclofen?
A
GABA-B agonist
8
Q
What is the first line of treatment for spasticity associated with MS or spinal cord injury/disease?
A
Tizanidine
9
Q
Recommended dose of Tinazidine
A
2 mg daily, then increased every 3-4 days, 2 mg each time
10
Q
T/F: Tinazidine can be used for children
A
False
11
Q
Treatment for nocturnal muscle spasms
A
Flexeril
12
Q
What drug is used to diagnose myasthenia gravis?
A
Erdrophonium
13
Q
What drug is used to treat MG and Lambert-Eaton?
A
Pyridostigmine Bromide
14
Q
Mechanism of action for cholinesterase inhibitors
A
Acetylcholinesterase cleaves ACh into Acetate and Choline, but Cholinesterase inhibitors, such as Carbamate, can bind Acetylcholinesterase in the place of Acetate and enhance the time that ACh is in the synapse
15
Q
Anticholinesterase that does NOT enter the CNS
A
Neostigmine
16
Q
Antidote for neuromuscular blockers, Myasthenia Gravis, GI and Urinary Tract Retention
Not used due to extreme side effects
A
Neostigmine
17
Q
Why is Pyridostigmine used instead of Neostigmine?
A
Fewer side effects and longer duration of action
18
Q
Antidote for carbamate poisoning
A
Atropine
19
Q
Carbamate poisoning causes…
A
SLUDGE leading to bronchospasm and respiratory failure
20
Q
Mechanism of action in carbamate poisoning
A
Peripheral effects on skeletal NICOTINE receptors —> depolarizing blockade
21
Q
Why are individuals with NMJ diseases more sensitive to skeletal muscle relaxants?
A
Skeletal muscle relaxants decrease the amount of depolarization that occurs at the NMJ, therefore patients with NMJ diseases who already have low levels of depolarization will be more affected by these drugs
22
Q
FAST ONSET (60-70 sec), but duration of action is 28 minutes MINIMAL CV SIDE EFFECTS, ALLERGIC REACTIONS
A
Rocuronium
23
Q
SLOW ONSET and eliminated by HOFMANN DEGRADATION
NO HISTAMINE RELEASE and has CV STABILITY
A
Cis-Atracurium
24
Q
What is the prototype NM blocking drug?
A
Curare (Tubocurarine)
25
What are the drawbacks of tubocurarine?
1. Blocks ganglia (loss of control of BP),
2. Affects muscarinic receptors (loss of parasympathetic control of heart rate → tachycardia)
3. Releases histamine → hypotension, bronchoconstriction and anaphylaxis
4. Duration of action is over 30 min (too long for short procedures such as intubation)
26
Succinylcholine mechanism of action
Depolarizing. Acts like ACh and activates postsynaptic receptor → receptor channel opens
27
How does succ stay in the post-synaptic cleft?
Succ not hydrolyzed by Synaptic AChE (only by plasma AChE)
28
What is the only remaining NM blocking drug that works by depolarizing APs?
Succinylcholine
29
Why is succ-induced depolarization in the peri-junctional muscle short-lived?
Na+ channels inactivated → propagation of depolarization is blocked
30
T/F: Succinylcholine is a depolarization agonist
True
31
What are two main short acting aminosteroids?
Vecuronium, Rocuronium
32
Which drug is active against Vecuronium and Rocuronium, but not against Succinylcholine?
Sugammadex
33
Gamma-cyclodextrin ring with lipophilic cavity
Sugammadex
34
Tracts/nerves affected in Weber's syndrome
CN III
Corticospinal
Corticobulbar
35
Possible etiologies for Weber's
Medial midbrain lesion
| PCA occlusion
36
```
Ipsilateral down and out/dilated eye
Contralateral hemiparesis
UMN motor weakness
Exaggerated gag reflex
Spastic tongue
Spastic dysarthria
```
Weber's syndrome
37
Patient cannot look up. She most likely suffers from....
Parinaud's syndrome
38
Vertical gaze palsy
| Pupils accommodate, but do not constrict to light
Parinaud's
39
Parinaud's + non-communicating hydrocephalus indicates which additional structure has been affected?
Cerebral aqueduct
40
Structures affected in Parinaud's syndrome
Superior colliculi
| Pretectal area
41
Lateral gaze palsy. Which nerve is affected?
CN VI
42
Which three structures conduct lateral gaze and what level of the brainstem are they located in?
CN VI
PPRF
MLF
Pons.
43
Classic cause of lateral pontine syndromes
AICA stroke
44
Classic cause of medial medullary syndrome
Anterior spinal artery stroke
45
Classic cause of Wallenberg's syndrome
PICA stroke
46
Patient has complete motor weakness. We know they don't have.....
ACA or MCA stroke
47
Hemiplegia + down and out eye = ______
Weber's syndrome
48
Location of Weber's syndrome in brainstem
Medial midbrain lesion
49
Location of Wallenberg's syndrome in brainstem
Lateral medullary lesion
50
What mediates the corneal reflex?
V: detects
VII: blinks
51
MLF lesion presentation
Nystagmus in contralateral eye
52
What is the only cranial nerve that exits dorsally?
CN IV
53
Cavernous sinus occlusion would cause...
Abducens lesion (Lateral gaze palsy)
54
Which cranial nerves synapse in the nucleus ambiguus?
IX, X, XI
55
Jugular foramen occlusion would cause...
Inability to turn head to affected side
56
Gag reflex is afferent or efferent?
Afferent
57
What tract provides sensory innervation for the pharynx and larynx?
Spinal trigeminal
58
FDA approved drug for fibromyalgia
Minalsaprin
59
Which level of the brainstem is the red nucleus located in?
Midbrain
60
What extraocular structures does CNIII innervate?
Super, medial, inferior rectus
| Inferior oblique
61
What structure does CN IV innervate?
Superior oblique
62
Which structures yield contralateral deficits?
Spinothalamic
Medial lemniscus
Trigeminal lemniscus
Corticospinal
63
Which structures yield only ipsilateral deficits?
Cranial nerves
Descending tract of V
Posterior columns in the lower medulla
64
A lesion involving which structures would yield ipsilateral cranial nerve deficits and contralateral loss of pain and temperature sensations from the body?
CNs V, VII, IX, X, and XI exit the brainstem in close proximity with the spinothalamic tract. As a result, a lesion in one of these regions may involve one of these nerves as well as the spinal lemniscus.
65
A lesion involving which structures would yield cranial nerve deficits with alternating hemiplegia?
CNs III, V, VI, XII + Corticospinal tract
66
Which cranial nerves exit the brainstem adjacent to the corticospinal tract?
III, V, VI, XII
67
Unilateral lesion of the CST would cause which symptoms?
Contralateral spastic hemiplegia
68
Unilateral lesions of the CBT above the level of the decussation results in what symptoms?
Contralateral paralysis of the mimetic muscles of the lower face --> supranuclear facial palsy
Cranial palsies due to denervation of abducens nuscleus, hypoglossal nucleus, and nucleus ambiguus
69
Unilateral lesions of the CBT below the level of decussation would cause what symptoms?
Ipsilateral cranial nerve palsies
70
Where does the CBT decussate?
In the lower pons between the levels of trigeminal and abducens nerve
71
What does the CBT innervate?
CN motor nuclei of the brainstem
72
Ipsilateral paralysis and atrophy of the muscles of mastication
Diminished jaw-jerk reflex
Motor nucleus of V lesion
73
Ipsilateral facial palsy
| Loss of corneal reflex
Motor nucleus of VII lesion
74
Dysarthria
Dysphagia
Hoarseness
Deviation of the uvula away from the affected nucleus
Nucleus ambiguus lesion
75
Pupillary dilation
| Difficulties in accommodation
Edinger-Westphal nucleus lesion
76
Ipsilateral loss of lacrimation
Superior salivatory nucleus
77
Ipsilateral loss of salivation from the parotid gland
Inferior salivatory nucleus lesion
78
Transient parasympathetic deficits
Dorsal motor nucleus of X lesion
79
External strabismus
| Complete ptosis
Oculomotor nucleus lesion
80
Gaze of the contralateral eye is directed down and out
| Head tilts toward side of the affected nucleus
Trochlear nucleus lesion
81
Ipsilateral paralysis of lateral gaze
| Internal strabismus
Abducens nucleus lesion
82
Ipsilateral paralysis and atrophy of the intrinsic muscles of the tongue
Protruded tongue deviates toward side of lesion
Hypoglossal nucleus lesion
83
Ipsilateral loss of proprioception from 1/2 of the head
| Diminished jaw-jerk reflex
Mesencephalic nucleus of V lesion
84
Ipsilateral loss of fine proprioception and two-point discrimination from 1/2 of the face
Main sensory nucleus of V lesion
85
Ipsilateral loss of pain and temperature from 1/2 of the face
Descending nucleus of V lesion
86
Ipsilateral loss of taste from the tongue and oropharnyx
| Diminished/absent visceral pain sensations from the ipsilateral palate and pharynx
Solitary nucleus lesion
87
Problems with equilibrium and posture
| Nystagmus
Vestibular nuclei lesion
88
Conveys proprioceptive, vibratory, and two-point tactile discrimination from the opposite 1/2 of the body
In upper pons and midbrain, carries fibers thsat convey taste from the ipsilateral 1/2 of the tongue and pharynx
Medial lemniscus
89
Conveys bilateral auditory information
| Predominantly information from the opposite ear
Lateral lemniscus
90
Loss of pain/temperature sensation from ipsilateral face
Descending tract of V lesion
91
Bilateral diminution of hearing which is most predominant in the contralateral ear
Lesion:
Lateral lemniscus
Brachium of inferior colliculus
92
A 67-year-old man presents with loss of pain/temp on the left side of his face and right side of his body. In addition, he has difficulty swallowing, hoarseness of speech, and an unsteady gait. Where is the lesion located and what vascular occlusion could cause this?
Lateral medulla --> Wallenberg's
| PICA occlusion
93
How can you tell the difference between a trochlear nerve lesion and a trochlear nucleus lesion?
```
Nucleus = head tilted toward lesion
Nerve = head tilted away from lesion
```
94
What modality of fibers does the solitary tract contain?
[General and special] Visceral afferent fibers from CNs VII, X, XI
95
What is the defect in Dandy-Walker Syndrome?
Congenital absence of lateral apertures (Luschka) & median (Magendie)
96
What is the result of the defects in Dandy-Walker?
Partial/complete agenesis of C vermis (striated part of cerebellum)
Cystic dilation in poster fossa and 4th ventric
Absence/abnormality of corpus callosum
97
Symptoms of Dandy-Walker
```
Macrocephaly
Vomiting
Headeaches
Truncal ataxia
Delayed motor skills
CN problems
```
98
Treatment for Dandy-Walker
Cyst decompression and shunt (e.g. redirect CSF to peritoneum)
99
Pathology of Type II Arnold Chiari Malformation
Herniation of medulla into vertebral canal
| IV ventricle compression: obstructive hydrocephaly – blocks CSF flow (non-communicating)
100
Symptoms of Arnold Chiari Type II
Increased pressure on cerebellum, medulla + CN lX,X,Xl,Xll
| Frequent with L meningomyelocele & syringomyelia
101
Treatment for Arnold Chiari
Shunt: an inert, flexible tube containing a unidirectional flow valve is inserted into the lateral ventricles to allow CSF fluid to drain into a body cavity (typically the abdominal cavity) where it can be resorbed.
102
Alpha-fetoprotein is increased/decreased in Down syndrome?
Hepatic alpha-fetoprotein is decreased
103
Cause and timeline of anencephaly
Failure of anterior neural tube to close in days 21-28
104
What structures is the cephalic flexure located betwixt?
Prosencephalon and mesencephalon
105
What structures is the cervical flexure located betwixt?
Rhombencephalon and future spinal cord
106
What nucleus receives baroreceptor and chemoreceptor input?
Solitary nucleus
107
Describe parasympathetic innervation of the heart
Nucleus ambiguus sends parasympathetic preganglionic neurons to join the vagus nerve and directly inhibit the heart.
108
What is the function of CVLM?
CVLM inhibits RVLM with GABA
109
What is the function of RVLM?
Excitatory. Sympathetic fibers from the IML synapse at the stellate gangliong to relax vessels and slow down the heart.
110
What are the sensory fibers?
A-delta,C
111
What is frequently added to LAs to increase duration?
Epi, norepi
112
What is scala media filled with?
Endolymph (high K+)
113
What separates the scala media from the scala tympani?
Basilar membrane
114
Where do sounds localize in the scala media?
High frequency ---> base
| Low frequency --> apex
115
How does the basilar membrane transfer mechanical energy through the organ of Corti?
BM displaced upward/laterally --> hair cell activation (stereocilia move toward kinocilia)
BM displaced downward/medially --> hair cell inhibition
116
The basilar membrane causes hair cells to come into contact with what structure?
Tectorial membrane
117
What happens when the BM is displaced upward/laterally?
Hair cells come into contact with tectorial membrane (stereocilia move toward kinocilia) and activate. Ion channels on the hair cells open, allowing an INWARD flow of K+ and Ca2+. Depolarization leads to NT release, which transmits impulses to the inferior colliculus and auditory cortex.
118
What happens when the BM is displaced downward/medially?
Hyperpolarization; K+ flows out.
119
In the auditory system, what happens if there is no influx of Ca2+?
No NT release
120
How do you measure hearing problems in newborns?
Otoacoustic emission
121
Where does CN VIII enter the brainstem?
Both vestibular and cochlear branches enter in the rostral medulla
122
Where is the primary auditory cortex located?
Transverse gyri of Heschl
123
What is sensorineural deafness?
Processes that damage hair cells, cochlear nerve fibers, or cochlear nuclei. Leads to deafness in ipsilateral ear.
124
Explain the results of a Weber's test
Vibration in affected ear --> conductive (obstructive) hearing loss
Vibration in unaffected ear --> sensorineural loss
125
Explain the results of Rinne's test
Sound louder on mastoid process --> conductive hearing loss
| Sound louder in air --> sensorineural loss
126
What are the decibel levels of a jet takeoff, normal speech, and a whisper?
120, 60, 30
127
Smaller and delayed evoked potentials indicate what condition?
Acoustic neuroma
128
What ganglion/nuclei are involved in the auditory pathway?
1. Spiral ganglion
2. V/D cochlear nucleus (rostral medulla)
3. Superior olivary nucleus (mid-pons)
4. Nucleus of lateral lemniscus (pons-midbrain junction)
5. Inferior colliculus (caudal midbrain)
6. Medial geniculate nucleus (thalamus)
7. Auditory cortex
129
What is right MLF syndrome?
Lesion of MLF traveling to midbrain AFTER abducens nucleus.
On attempted gaze to left, there is a right ocular adduction paresis and left nystagmus (from trying to coordinate with right eye).
130
What does the caloric test evaluate?
Semicircular canals
131
What are the normal results of a caloric test?
COWS = cool water causes nystagmus on opposite side, warm water causes nystagmus on the same side
132
What is the vesitublo-ocular reflex?
A reflex to stabilize images on the retina during head movement.
133
What are the steps of the VOR?
1. Vestibular nerve sends impulses to the vestibular nuclei
2. These fibers then cross contralaterally to the abducens nucleus
3. From the abducens nucleus, one pathway projects directly to the right lateral rectus, causing it to contract
4. The other pathway projects from the abducens nucleus by the medial longitudinal fasciculus to the contralateral oculomotor nucleus, contracting the left medial rectus muscle
134
Which nerves contribute to the sensation of taste?
VII - anterior 2/3 tongue (geniculate gang, solitary nuc)
IX - posterior 1/3 tongue (petrosal gang, solitary nuc)
X - pharynx/epiglottis (nodose gang, solitary nuc)
135
What are mitral/tufted cells?
Output neurons; transmit signals via Glutamate/Aspartate
136
What are granule/periglomerular cells?
Interneurons; transmit signals via GABA
137
In the VOR, activation of the vestibular nuclei leads to what two actions?
Contralateral abducens activation and ipsilateral oculomotor activation
138
T/F: Filiform papillae have no taste buds.
True
139
Salt activates ___ channel
Na+
140
Sour activates ____ channel
H+
141
How are sweet tastes transmitted?
Activation of GPCR --> activation of adenylyl cyclase --> PKA activation --> inhibition of K+ channels --> depolarization --> Ca2+ influx --> vesicle release
142
How are bitter tastes transmitted?
GPCR --> phospholipase C --> IP3 --> Ca2+ release from internal stores --> vesicle release
143
What receives taste input from the solitary nucleus?
VPM of the thalamus
144
Where do olfactory receptor cells synapse?
On second order neurons at the GLOMERULUS in the olfactory bulb
145
T/F: Olfactory projection reaches prefrontal cortex without making a synapse in the thalamus first
True
146
Where do axons from mitral and tufted cells project?
Primary olfactory cortex (PIRIFORM CORTEX)
147
Occlusion of which artery would cause urinary incontinence?
ACA
148
What NT does CVLM send to RVLM?
GABA (inhibitory)
149
Loss of rods creates what vision problem?
Night blindness
150
T/F: Rods contain more photosensitive pigments than cones.
True
151
What kinds of cells create the optic nerve?
Ganglionic axons of the retina
152
Magno = ______
Fast-moving objects
153
In phototransduction, the nerve is always _____
Depolarized
154
What creates an action potential down the optic nerve?
Glutamate from rods/cones inhibits bipolar cells. When light hits the rods and cones, glutamate release is reduced, which leads to activation of bipolar cells and an AP down the optic nerve.
155
What are the contralateral fibers in the visual system? Ipsilater?
1, 4, 6
| 2, 3, 5
156
In the visual system, what layers do fibers 1 and 2 transmit to? 3, 4, 5, 6?
Magnocellular (fast-moving objects)
| Parvocellular (color vision and visual acuity)
157
What happens if you fuck up the Meyer's loop?
You can't see in your contralateral superior visual field
158
T/F: PCA occlusion will have macular sparing.
True
159
What controls rapid eye movements?
Superior colliculus
160
Usually bilateral and associated with tertiary syphilis
Argyll Robertson pupil
161
What is likely damaged in Argyll Robertson pupil?
Pretectal area in pons
162
Right PPRF and right VI nucleus lesions will lead to....
Right lateral gaze palsy
163
MLF lesions will lead to...
Contralateral nystagmus
| Paralysis of ipsilateral eye in midline
164
MLF + nucleus VI lesion will lead to....
Contralateral nystagmus
| Paralysis of ipsilateral eye in midline
165
What is the screening test for meningocele in a fetus?
AFP
166
A mass was noted in the third ventricle with enlargement of the lateral ventricles which would raise the possibility of:
Non-communicating hydrocephalus
167
Most cases of hydrocephalus are due to...
Impaired flow and impaired absorption
168
What is one of the most common causes of hydrocephalus?
Aqueductal stenosis
169
What condition is Arnold Chiari often associated with?
Meningomyelocele
170
What are the three hallmarks of Dandy Walker?
The three essential features are: agenesis of the vermis, cystic dilatation of the fourth ventricle and enlargement of the posterior fossa
171
Patient fell and now has edema and unilateral dilated pupil. What do they most likely have?
Transtentorial herniation
172
Stocking and glove neuropathy has to do with...
Segmental demyelination
173
Herpes is _____ nuclei; polio is _____ nuclei
Sensory / motor
