Exam 1 (week2) Flashcards
(297 cards)
1
Q
which transmitters are dysregulated in schizoprhenia (2)
A
serotonin
dopamine
2
Q
which dopamine receptor is blocked in drugs that work for antipsychotics
A
D2
3
Q
how could amphetamies cause psychotic symptoms
A
amphetamines come in to presynaptic neuron via trasmporter, kicks out dopamine, dopamine in synaptic cleft is increased - stimulates D2 channel causing symptoms
4
Q
why do you need to wait 4-6 weeks for antispychotics (D2 blockers) to work
A
“depolarization inactivation” - initially the presynaptic nerve fires harder because of autoreceptors - some are inhibited so the neuron thinks there’s less dopamine and wants to release more
eventually it wears out and will stop firing (chronic treatment)
5
Q
what happens to dopamine pathways during schizoprenia
A
for some reason, the connections between ventral tegmental to cortex die off, but the connections between ventral tegmental to limbic (nucleus accumbens) remain. there is a positive feedback loop from cortex to limbic because the cortex doesn’t sense enough stimulation. ramps up dopa firing to limbic system (nucleus accumbens)
6
Q
when do you see tardive dyskinesia (iatrogenic)
A
too much dopanie block - prolonged treatment with D2 receptor blockers – causes D2 receptor supersensitivity
7
Q
endocrine side effects of dopaine block
A
if you block D2, you increase PRL release, causing gynecomastia
8
Q
dopamine blockade and eating/weight
A
motor neurons around ventricles involved in eating behavior, D2 blockade around ventriles cause weight gain
9
Q
dopamine blockade and nausea
A
antiemetic because it blocks chemotrigger zone
10
Q
first gen antipsychotic drug types and prototype for each (2)
A
- phenothiazines (chlorpromazine)
2. butyrophenones (haloperidol)
11
Q
phenothiazine mech of action
A
like tricyclic - binds to a bunch of receptors, not just D2
12
Q
butyrophenones mech of action
A
way more potent D2 block than alpha 1
13
Q
second gen antipsychitic drugs - how did they change from first gen with respect to receptor blockade
A
increased the ratio of serotonin (5-HT2):D2 receptor blockade (less chance for tardive dyskinesia)
14
Q
clozapine mech of action
A
caused selective depolarization inactivation in limbic system
blocks 5-HT2 receptors
15
Q
adverse for clozzapine
A
- have to check blood because of risk for agranulocytosis - can’t give in patients with dyscrasia
- diabetes risk
16
Q
what are the atypicals/second gen antipsychotics (6)
A
- clozapine
- risperidone
- olanzepine
- quetiapine
- ziprasidone
- aripiprazole
17
Q
side effect ofs risperidone
A
dose-dependent - will cause extrapyramidal symptoms like first gen if dose is too high
NO risk of agranulocytosis or diabetes
18
Q
side effect of olanzepine (2)
A
- risk for diabetes and weight gain
2. increased serum prolactin
19
Q
side effect of quetiapine
A
diabetes risk
20
Q
side effect of ziprasidone
A
widens QT interval
21
Q
mech of action of aripiprazole
A
partial agonist at D2
damp down nucleus accumbens, incrase frontal cortex
22
Q
whats the super bad early side effect of antipsychotic drugs that could be fatal
A
neuroleptic malignant syndrome - causes catatonia, stupor, fever, HTN, myoglobinemia
23
Q
what’s the deal with antipsychotics and epilepsy
A
can lower seizure threshold
24
Q
what’s rabbit syndrome
A
perioral “chewing” syndrome - late neurological side effect of antipsychotic drug
25
what do you absolutely not give someone with tardive dyskinesia due to antipsychotics
anticholinergic, will suppress GABA activity even more by removing Ach tone
26
which antipsychotics have increased risk for diabetes, weight gain and hyperlipidemia 92)
olanzepine
| clozapine
27
alpha block is bad for which patient population
elderly (anatihypertensive - falls)
28
when can you give an anticholinergic to HELP side effects
with EPS symptoms from haliperidol, let's say
29
glutamate and dopamine relationship
glutamate directly increases dopa
| and indirectly regulates dopa via regulation of GABA which inhibits dopa
30
NMDA and schizophrenia
hypofunction in glutamate receptor is responsible for neurocognitive symptoms of schizophrenia - same process for PCP
31
what is timecourse for diagnosis of schizophrenia
1 month of active symptoms - 2 or more symptoms (one has to be positive)
and 6months of social dysfunction
32
what percentage of patients with schizophrenia commit suicide
10%
33
what chromosome might have relevance in schizophrenia
C4 component of 6
C4A causes synaptic pruning in prefrontal areas
34
what are the extrapyramidal side effects of D2 blockade (4)
1. acute dystonia (forceful muscle contractions)
2. akathisia (motor restlessness)
3. drug-induced parkinsonism (bradykensia, rigidity, tremors)
4. tardive dyskinesia (hyperkineic movement of head, limbs, tongue)
35
when do the EPS symptoms occur
hours to days - acute dystonia
days to weeks - akasthisa
weeks to months - parkinsonism
months to years - tardive dyskinesia
36
timecourse for brief psychotic disorder
1 day to 1 month
37
timecourse for schizophreniform disorder
1 month to 6 months
38
what symptoms are NOT present in delusional disorder
disorganized thought and behavior
functionality is not generally affected too much
39
diagnostic criteria for schizoaffective disorder (2)
1. features of schizophrenia AND mood disorder
| 2. psychotic symptoms for at least 2 weeks WITHOUT mood symptoms (to differentiate between MDD with psychosis etc.)
40
whats the beginning of the retina (near the lens) called
ora serrata
41
developmental stages of eye (5)
from forebrain:
1. optic sulcus
2. optic vesicle
3. lens placode
4. optic cup
5. neural epitheilum of retina (in contact with layer behind - pigment epithelium of retina)
42
function of retinal pigment epihtelium cells (4)
1. support rots and cones
2. phagocytose 7,500 rod and cone outer segment discs
3. reconvert trans retinal to 11-cis retinal
4. make melanin
43
what disease occurs when there are mutations in genes that control reconversion of trans retinal to 11-cis retinal
retinitis pigmentosum - results in blindness
44
what do you see in fundus for RP
pigment deposition in patches
45
what do patients see with retinitis pigmentosum
lose peripheral vision
46
what do you see with retinal detachment
see sudden increase in floaters
47
what do you see in fundus for retinal detachment
"horseshoe tear"
48
what are the 3 layers of retina from inner to outer
ganglion cells, bipoarl cells, phtoreceptors
49
what nuclear layer are the rods and cones
outer nuclear layer
50
what are the synapse layers between nuclear layers in retina called (2)
plexiform layers
(outer is between inner and outer nuclear layers)
(inner is beween gancglion and inner nuclear layer)
51
what layers do mueller cells make
inner limiting and outer limiting membranes
52
what is nerve fiber layer made of
axons of ganglion cells
53
where are the nuclei of the mueller cells
in inner nuclear layer
54
which cells (rods or cones) contain color vision
cone
55
where are most of your cones
macula
56
difference between macula, fovea and foveola
foveola ONLY has cones - tiny central area (200 microns)
fovea more cones than macula (1.5mm)
macula (5.5mm - can appreciate on photo)
57
what do people see if they have macular degeneration
loss of central vision
58
what do you see on fundus for macular degeneration
destruction at macula - difference between wet (blood) and dry
59
what layer does uveitis affect
middle/choroid layer
60
what are 4 parts of middle layer
1. choroid (under retina)
2. ciliary body
3. ciliary processes
4. iris
61
what are layers of chroid beneath retina (2)
1. Bruch's membrane - small capillaries
| 2. choriocapillaris - larger vessels
62
what part of ciliary body actually pulls on lens
the zonule fibers produced by ciliary body and processes
63
functions of ciliary body and processes (3)
1. produce aqueous humor
2 produce zonules to attach to lens
3. ciliary muscles contract during accommodation
64
layers of outer eye (4)
1. mostly sclera (posterior to ora serrata)
2. lamina cribosa (where white meets clear)
3. corneoslceral junction/limbus
4. cornea
65
function of lamina cribosa
supports the optic nerve
if pressure is too high, axons of optic nerve get pinched, those retinal gangion cells will die, and you lose vision from hundreds of photoreceptors
66
what ratio do you measure in glaucoma
disc:cup ratio
67
what is special about corneoscleral jucntion
1. contain canals of schlemm
2. contain trabecular meshwork that can close vessels when sclerosed
3. contain corneal epithelial stem cells
68
layers of cornea from out to in (5)
1. stratefied squamous non-keratinizing epithelium
2. bowman's layer (specialized BM)
3. stroma
4. descemet's membrane (specialized BM)
5. endothelium
69
functions of cornea(3)
1. smooth surface over which tears can spread for vision
2. barrier to microbes
3. glial support for intraepithelial corneal sensory nerves (when you feel like something is in your eye)
70
what do fibroblasts in corneal stroma do (2)
1. synthesize collagen and proteoglycans that provide strength to cornea
2. pump out excess water to maintain clarity in cornea
71
what cells HAVE to be present in corneal transplant
endothelial cells
72
where in lens does proliferation occur
in anterior lens epithelial cells (they move posteriroly and differentiate into lens fibers)
73
when lens is flat, do you see close or far
far
74
when ciliary muscles contract, what happen to lens
rounds up
75
what are the layers of tears (3)
lipid outer, then acqueous, then mucin
76
after optic chiasm, where do optic tracts synapse
lateral geniculate nucleus (LGN) of thalamus
77
do you get convergence/binocular vision from thalamus?
no - the inputs from R and L eye are separated
78
after lateral geniculate nucleus, where do they go
optic radiations/ geniculocalcarine tract project to visual/calcarine cortex via EITHER retrolenticular internal capsule through parietal lobe
OR sublenticular internal capsule through temporal lobe
79
what's the difference between sublenticular and retrolenticular
(meyer's loop) sublenticular detect upper part of visual field (detects bottom of retina)
retrolenticular detect lower part of visual field (detects upper part of retina)
80
what are the lenticular nuclei
putamen and globus pallidus
81
what are the Brodmann's area numbers for vision
area 17 = primary visual cortex
| areas 18 and 19 are visual association cortex (above and below calcarine sulcus
82
homonymous visual field defect
means corresponding halves of visual field for both eyes (L for both, R for both)
83
what is hemionospia
half of vision lost
84
blood supply to visual cortex, and what kind of vision losses do you have with issues with this vessel
posterior cerebral artery, get macular sparing because of collateral blood supply from middle cerebral artery
85
what are the components of the "ventral stream" of image processing and what kinds of vision processing does it do
V1 is light, detects a lot of things, projects to V2, which detects fewer, but more specific things, V3 which detects even fewer and more specific things
pathway used for object recognition
86
what are components of the "dorsal stream" of image processing and what kinds of vision processing doe sit do
V1 to V2 to MT (which detects movement)
pathway used for spatial vision
87
when are photoreceptors hyper or depolarized
in the dark, cGMP is constituately produced, which causes Na+ influx and K+ efflux, DEPOLARIZING the cell
in the light, decreased cGMP is hydrolyzed (due to opsin coupled to cis retinal) causes closing sodium channel, reducing Na+ influx and K+ efflux, causing HYPERPOLARIZATION
88
how long do manic symptoms have to last for a diagnosis
at least 1 week (OR requiring hospitalization)
89
how many symptoms do people need to express for diagnosis of mania
3 (or 4 if irritable)
90
time course for hypomania
4 days (could be less)
91
diagnostic criteria for bipolar 1 (in terms of episodes)
one manic episode
92
diagnostic criteria for bipolar 2 (in terms of episodes)
one hypomanic plus one major depressive episode
93
in bipolar 1 and 2, which episodes are more common, manic or depressive
depressive by a lot
94
definition of rapid cycling in bipolar disorder
4 or more episodes in a y ear
95
which cranial nerves have parasympathetic function
3
7
9
10
96
what does gag reflex test
CN9 (sensation/afferent)
| CN10 (motor/efferent)
97
what does "open and say ah" test
CN10
98
what does sticking out your tongue test
CN12
99
what 3 things does dysfunction of CNX cause
1. loss of gag/swallow reflex
2. loss of carotid sinus (heart rate control)
3. loss of oculocardiac reflex causing dysphagia
100
what are the nuclei of CNX (4)
1. dorsal motor nucleus (parasymp output)
2. nucleus ambiguus (skeletal motor output)
3. nucleus solitaris (visceral sensory input and taste input)
4. spinal trigeminal nucleus (general sensory input)
101
what does visceral sensory function of CN10 control (2)
1. cough reflex
| 2. nausea and vomitting reflex
102
what is skeletal motor nucleus of CN10 called
nucleus ambiguus
103
what specific nerve branch is responsible for cough reflex
internal laryngeal nerve (branch of vagus nerve)
104
what's the medical term for hoarseness
dysphonia
105
what's the medical term for "losing your voice"
dysarthria
106
which branch of which nerve can cause dysfunction of vocal cords
recurrent laryngeal branch of vagus
107
where is the general sensory location (on skin) of vagus
small area of skin of external ear canal
108
where is taste location of vagus
epiglottis and pharynx
109
patient with bilateral loss of smell and taste for 7mo and headache for 5mo
meningioma
110
patient with unilateral painful loss of vision and otpic neuritis
MS
111
patient with papilledema and horizontal diplopia
brain tumor causing increased ICP
112
patient with syncope, shaking, confusion, numbness over left jaw for past 2 years
lesion impacting CN5 as it exits cerebellar/pontine angle in medial temporal lobe (epileptic location)
113
facial weakness in upper vs lower motor neuron lesion
lower motor - can't more upper or lower facial muscles (whole face)
upper motor - deficits in lower facial ONLY
114
if someone complains of things being really loud, what CN are you thinking about
CN7 (stapedius in innervated by CN7 - doesn't dampen stapes)
115
Rinne and Weber testing - how to do it, and what does it test
tuning fork (512 Hz)
Weber: place fork in middle of center head on top (should hear on both sides equally, conducive (blockage) louder on affected ear)
Rinne: compare air and bone (normally air is louder than bone, conducive bone is louder than bone, sensorineural air is louder than bone)
116
someone with unilateral sensorineural hearing loss, vertigo, and tinnitis
Meniere's (increased endolymph production)
117
when neurons need to regenerate, what structural components are upregulated and downregulated
upregulate microfilaments and microtubules (which are more dynamic), downregulate intermediate filaments, neurofilaments (which are more stable)
118
what is the most common way to damage neurons
upregulation of glutamate that triggers caspase elevation and apoptosis
119
functional recovery vs regeneration
functional recovery = getting function back via recruitment of OTHER neurons, versus repairing the damaged neurons themselves
120
what are neurotrophins
growth factors that bind to neurons to promote growth
121
3 things that happen in CNS in response to neuronal injury
1. astrocyte proliferation and expression of GFAP, resulting in "glial scar"
2. proliferation of oligodendroglial precursors and oligodendrocytes
3. microglial recruitment and activation
122
what do olfactory unsheathing cells do
cells like Schwann cells that can be transplanted into CNS to promote recovery
123
animal examples of neuronal stem cells (2)
1) fish retinas that get bigger as fish grows
| 2) song birds learning new songs each year
124
2 areas of human brain where stem cell populations reside
1. subventricular zone (SVZ) that give rise to olfactory bulb
2. dentate gyrus in hippocampus (memory and learning?)
125
symptoms of lateral medullary syndrome and what areas are affected (4)
1. dizziness (vestibular)
2. hoarseness, difficulty swallowing (nucleus ambiguus of CN9,10,11)
3. loss of pain and temp ipsilaterally in face (CNV)
4. loss of pain and temp contralaterllly in body (spinothalamic)
126
lateral medullary syndrome caused by issue in what blood vessel
PICA
127
symptoms and areas affected by medial medullary syndrome
1. deviation of tongue, tongue atrophy, speech problems (hypoglossal nerve)
2. contralateral hemiplegia in body (corticospinal tract)
3. loss of discriminative touch contralaterally in body (medial lemniscus)
128
what blood vessel causes medial medullary syndrome
anterior spinal artery from vertebral artery
129
oculocardiac reflex
pressure on orbit due to sx or tumor, travels along opthalmic V1 through trigeminal ganglion to sensory nucleus in pons, where INTERNUCLIAL FIBERS in RETICUALAR FORMATION connect to DORSAL MOTOR nucleus of 10 which SLOWS HEART
130
what CN does special sensory to posterior 1/3 of tongue
CN9 - glossopharyngeal
131
what is parasymp nucleus of glossopharyngeal nerve and what does it control?
inferior salivatory nucleus - controls parotid gland function
132
middle ear sensory i smediated by what nerve
glossopharyngeal 9
133
visceral sensory of CN9 - what nucleus and what function
into nucleus solitaris, sensory from carotid body and sinus
134
which part of carotid body/sinus senses what (chemo/baro)
```
body = chemo
sinus = baro
```
135
skeletal motor component and nucleus for CN9
nucleus ambiguus - stylopharyngeal muscle for swallowing
136
what is general sensation for CN9 - what nucleus and what sensation (4)
through spinal trigeminal nucleus
sensation for:
1. soft palate
2. pharynx
3. posterior 1/3 of tongue
4. middle ear cavity
137
what does CN11 do
motor only- innervates trapezius and sternocleidomastoid
138
where is CN12 nucleus
most ventral and medial
139
what does CN12 do
innervates muscle of tongue - protrusion
140
what side does tongue deviate to with CN12 injury
lower motor neuron - flaccid paralysis, deviates to the side of injury
141
what muscle attaches to coronoid process of mandible
temporalis
142
what bones articulate to form TMJ
condyloid process of mandible with zygomatic arch - articular tubercle prevents anterior dislocation
143
what ligament stabilizes TMJ
lateral ligament to prevent posterior dislocation
144
what movement does superior compartment of TMJ allow for
gliding/translation - jutting chin out when you open very wide
145
what movements does inferior compartment of TMJ allow for
elevation
| depression
146
what is the blood supply to the infratemporal fossa and what is it a branch from
superficial temporal artery - branch of external carotid
147
what is the sensory innervation of the infratemporal fossa and what is it a branch of
auriculotemporal nerve - branch of V3
148
movements of temporalis muscle (2)
1. elevation of mandible
| 2. retraction of mandible
149
movements of masseter
1. elevation of mandible
| 2. protrusion
150
movements of lateral pterygoid muscle
bilateral:
1. protrusion
2. depression
unilateral
1. contralateral excursion
151
medial pterygoid muscle movements
bilateral
1. protrusion
2. elevation
unilateral
1. contralateral excursion
152
which pterygoid muscle is superior
lateral
153
what are the 2 terminal branches of external carotid
maxillary artery
| superficial temporal artery
154
what are the sections of the maxillary artery
1. deep to neck of mandible
2. laterl pterygoid (anterior)
3. pterygopalatine fossa
155
branches of maxillary artery first portion (what is supplied)
1. middle meningeal (goes up to dura)
| 2. inferior alveolar (dives down, supplies teeth exits mental foramen)
156
branches of maxillary artery second portion (what is supplied)
1. deep temporal (goes up to muscles of mastication)
| 2. buccal artery (down to buccinator)
157
branches of maxillary artery third part (what is supplied)
infra orbital artery (floor of orbit)
158
venous drainage of infratemporal fossa (3)
1. retromandibular vein (side of face/neck)
2. facial (front of face)
3. inferior ophthalmic vein (to cavernous sinus)
159
what foramen does V3 exit from skull
foramen ovale
160
what is special about auriculotemporal nerve
acts as a highway for postganglionic parasympathetic (from otic ganglion) to parotid gland
161
sensory info to anterior 2/3 of tongue supplied by what
lingual nerve of V3
162
what is special about lingual nerve
highway for chorda tympani (branch of facial) that carries BOTH taste and preganglionic parasympthatetic fibers of submandibular and sublingual glands
163
what does parasymp of CN7 do
innervates submandibular and sublingual glands
164
what does parasymp of CN9 do
innervates parotid gland
165
what is the ganglion that parasymp of CN7 go to
submandibular ganglion
166
what are the SENSORY nuclei of trigeminal from superior to inferior
mesencephalic
main
spinal trigeminal
167
where are first order neurons of sensory trigeminal nerve
in trigeminal ganglion (analagous to dorsal root ganglion)
168
where are the second order neurons of sensory trigeminal nerve
EITHER main sensory or spinal trigeminal nuclei
169
where are the 3rd order neurons of sensory trigeminal nerve
ventral posteroMEDIAL nucleus (VPM) of thalamus
170
when do sensory trigeminal nerves deccusate
between 2nd and 3rd order neurons
171
what info is carried in main sensory nucleus
discriminative touch and pressure - like dorsal column, meets up with medial lemniscus
172
where is main sensory nucleus
PONS
173
where does info go after main sensory nucleus
ascends in medial lemniscus - most contralaterally, but some from ORAL CAVITY are ipsilateral as trigeminothalamic tract
174
where is face on homunculous
laterally, right above lateral fissure
175
what info is carried in spinal trigeminal nucleus (2)
1. pain and temp from face
| 2. sensory info from CN 7, 9, 10
176
where is spinal trigeminal nucleus located
pons, medulla and spinal cord C1-C3
177
what is the pathway of trigeminal trigeminal tract neurons
enter from trigeminal ganglion and DESCEND in spinal trigeminal tract (lateral) to reach spinal trigeminal nculeus
178
what info does mesencephalic nucleus contain?
prprioception from head (how to regulate force of bite)
179
what is different about mesencephalic nucleus compared to the other trigeminal sensory nuclei
it contains first order neurons (the other first order neurons are in the trigeminal ganglion)
180
what is path of neurons in mesencephalic nucleus
from mesencephalic to trigeminal motor nucleus (below and medial) and then back out through V3
181
what is input to motor trigeminal nucleus
1. mesencephalic for force of bite
| 2. bilateral corticobulbar
182
how to test motor of CN5
jaw jerk test - USUALLY DOES NOT CAUSE RESPONSE. if there's an upper motor neuron lesion, there will be a reflex
183
what can cause someone to have violent bursts of pain sensation coming from all 3 branches of CN5
trigeminal neuralgia caused by arterial compression from superior cerebellar artery (SCA)
184
nuclei of CN7 and location in mid-pons
1. motor nucleus (middle and medial, tract loops up and around abducens nucleus)
2. spinal trigeminal (middle and lateral)
3. nucleus solitarus (up/dorsal, between abducens and spinal trigeminal)
4. superior salivatory nucleus (medial and up to motor nucleus)
185
where are 1st order neurons for CN7
geniculate ganglion
186
what info does nucleus solitaris carry for CN7
taste from anterior 2/3rd of tongue
187
what info does spinal trigeminal nucleus carry for CN7
somatic sensory from external ear
188
what info does superior salivatory nucleus carry
parasymp neurons to lacrimal, nasal, palatal, submandibular and sublingual glands
189
where does CN7 exit skull
with vestibular cochlear through INTERNAL ACOUSTIC MEATUS
190
what does geniculate ganglion contain
CN7 taste and sensory neurons
191
what is the "hay fever" ganglion
pterygopalatine galgnion (pregang parasymp from CN7)
192
where does CN7 exit face
stylomastoid foramen
193
what nerve branch of 7 is parasymp
petrosal nerve
194
which part of face recieves bilateral innervation
upper face
195
what kind of innervation does lower face recieve
ONLY contralateral innervation
196
what kind of facial paralysis will you see with upper motor neuron lesions
partial paralysis of upper, full paralysis of lower
197
what kind of facial paralysis will you see with lower motor neuron lesions
paralysis to both upper and lower face (bell's palsy)
198
what carries taste from hard palate
greater petrosal
199
what nerve does pterygopalatine postganglionic neruons hitchhike on to get to lacrimal
V2
200
componentes of blink reflex
afferent via V1 of CN5
motor via CN7 to blink
tearing via parasymp of CN7
201
is high or low cortisol protective against PTSD
high (fast cortisol response shuts down the stress response)
202
what areas of brain are hypoactive in PTSD (3)
prefrontal cortex
dorsal cingulate cortex
hippocampus (can become damaged/ atrophied)
203
what area of brain is hyperactive in PTSD
amygdala
204
medicine in PTSD (3 to use, 1 not to)
firstline = SSRIs
Prazosin for nightmares
Topiramate for nightmares
avoid prolonged use of benzos - could cause more risk
205
gender risk for PTSD
female:male is 2:1
206
what percentage of PTSD risk is genetic
30%
207
how to test CN8 in comatose patient
caloric reflex
warm water into ear - eyes deviate toward contralateral ear, fast nystagmus towards ipsilateral
cold water into ear - eyes deviate toward ipsilateral ear and fast phase is in opposite direction
208
dizziness in diabetic patient when standing, what could the cause be
orthostatic hypertension due to dysautonomia - disruption of autonomic nervous system
or position sense
or medication
209
definition of orthostatic hypotension
drop in systolic BP of 20 or diastolic BP of 10 within 3 min of standing
210
what does pulse do in neurogenic orthostatic hypertension
doesn't change
211
what phase of nystagmus do you define it by
fast phase
212
in peripheral vertigo, what direction is fast phase of nystagmus
away from the affected ear
213
if you see vertical nystagmus, what could it be
Brainstem disease
214
which type of nystagmus is fatiguable
peripheral (inner ear)
215
which pole of eye determines direction of nystagmus in rotatory nystagmus
upper
216
what is head impulse thrust test
move head to left and to right, look at eyes. if eyes are able to stay fixed forward, that's normal. if you turn the head to the right and it takes some time before the eyes turn back forward, there's a vestibular lesion on the right
217
3 maini causes of peripheral vertigo
1. benign postural vertigo
2. meniere's
3. vestibular neuronitis
218
what is hallpike maneuver
patient sits down, turn head 45 degrees, keep eyes open, tell them to lie down with head over edge - you will see delayed nystagmus that will eventually disappear (if inner ear vertigo)
219
what to do for benign paroxismal postural vertigo
ekley maneuver to try to move crystals away
220
tx for meneiers
salt and volume reduction
221
kinocilium structure and function
nonmotile cilium (no central core)- only one per array of stereocilia in vestibules that bend towards kinocilium to cause calcium flux via pulling on tip-links between stereocilia
222
what is source of endolymp
stria vascularis in cochlear duct, drains through endolymphatic sac
223
NCC and ear development
NCC stimulate differentiation of hair cells
224
emmetropic means what
normal eye
225
normal length from lens to retina
17mm
226
diopters of cornea and lens
40 and 20
227
myopia - where do rays converge and what kind of lens do you need
before the retina - too much converging power - need concave (-) lens
228
hyperopia - where do rays converge and what kind of lens do you need
behind the retina - not enough converging power, need convex (+) lens
229
what does lens have to do when you're trying to read
has to get more round - ciliary muscles have to contract so that the zonule fibers relax
230
types of blepharatis
anterior (ulcerative or sebhorreic)
| posterior
231
what is a stye
AKA external Hordeolum
| staph abcess of lash follicle
232
what is chalazion
chronic blockage of meibomian gland - PAINLESS
233
sx for acute lacrymal sac infection/inflammation
dacryocystorhinostomy - connect sac with nasal mucosa
234
what is the discharge like in viral conjunctivitis
watery
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what is pingueculum
whitish deposit on bulbar conjuctiva (does not involve cornea) usually due to UV exposure - deveneration of conjunctiva. lubricate for tx
236
what is pterygium
can extend over cornea - can happen in hot climates
237
how to test between episcleritis or scleritis
episcleritis will blanch with phenlephrine and is mobile
238
causes of scleritis
usually connected to connective tissue disorders, can also be (rarely) infectious like syphilis. rule out infection betfore treating with immunosuppression or steroids
239
risk factors for infectious keratitis (2)
```
contact wearing
herpes simplex (see dendritic keratitis)
```
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when to check eye with herpes zoster
when tip of nose is involved
241
3 components of uvea
iris
ciliary body
choroid
242
symptoms of uveitis (4)
1. diffuse injection
2. keratic percipitates
3. hypopyon
4. inflammation of blood vessels if posterior is involved
243
what does traumatic cataract look like
rosette shaped
244
sx of choice for catarats
phacoemulsification
245
what is dreaded complication of cataract sugery
endophthalmitis (1:1,000) - inflamation of cavities caused by infection - 50% of eyes will become blind
246
when you do peripheral iridotomy, where are you maing a hole
between anterior and posterior chambers
247
which is worse for the eye, acids or bases
bases - can result in liquefaction necrosis - can penetrate tissues faster
248
older one day of vision loss, shadow at bottom of vision, now middle too, flashing lights and floaters, hx of cataract surgery
```
retinal detachment (shadow)
(retina tear caused floaters/flashers)
```
249
what kind of retinal detachment do you see in DM
tractional
250
older woman, decreased vision for 2 weeks, black spot in center of vision, hx of smoking and HTN
macular degeneration (see hemorhage in one eye, drusen in the other)
251
which are better, soft or hard drusen
hard. soft will more likely become wet macular degeneration
252
hx of blurriness for a year, getting worse. last week noticed new floaters. decreased red reflex. hx of DM, HTN and smoking
diabetic retinopathy - proliferative
253
decreased vision, progressively worse, feels "darker", hx: HTN, PE, smoking, lots of infarcts and bleeding on fundoscope "blood and thunder"
central retinal vein occlusion
254
older man, 1 day of dark vision in R eye, last week, vision became blurry, then black, then normal. hx of HTN, high cholesterol and smoking. see "cherry red spot" on fundoscope
central retinal artery occlusion
255
older man, dark vision, blurry then black then normal, headache, jaw claudication, scalp tenderness, joint aches
giant cell arteritis
256
tx for GCA
steroids
257
older woman, pain redness photophobia and decreased vision. had cataract sx 1 week ago
post op endophthalmitis due to staph
258
tx for post op endophthalmitis
aspirate vitreous (or sx if really bad vision), inject broad spectrum antibiotics
259
what are the "order" neurons for the vestibular reflexes
```
1 = vestibular ganglion cells
2 = vestibular nuclei
3 = motor nucleus
```
260
which vestibular nuclei are involved in vestibuloocular reflex
all 4
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which vestibular nuclei are involved in vesteibulocolic reflex
medial vestibular nucleus
262
which vestibular nuclei are involved in vestibulospinal reflex
lasteral vestibular nucleus only
263
what is the range of hearing for intensity/loudness of sound (in decibels)
0 dB = threshold of hearing
20 dB = whisper
60 dB = convo
120 dB = thunder
264
which middle ear bones have muscles attached to them and what are they innervated by
malleus = tensor tympani muscle innervated by CN5
stapes = stapedius muscle innervated by CN7
265
what ions and neurotransmitters cause transduction at inner hair cells
potassium at tip links, calcium at base, glutamate to auditory nerve cell
266
pathway from orgain of corti to auditory cortex
auditory ganglion cell to dorsal and ventral cochlear nuclei, then most cross over, synapse in superior olive or just straight ascend to inferior colliculus, then to MGN, then to auditory cortex
267
describe the vetsibuloocular reflex as you turn your head left
left vestibular nerve excites neurons in left vestibular nuclei. neurons then cross over and excite the RIGHT ABDUCENS nucleus to excite RIGHT LATERAL RECTUS. the abducens nucleus also contains INTERNUCLEAR NEUROS which cross back over, ascend in MEDIAL LONGITUDINAL FASCULIS and excite LEFT OCULOMOTOR and thus LEFT MEDIAL RECTUS
268
if you have on left sided internuclear opthalmoplegia, what would happen when you move your head to the left
right eye lateral rectus would work, but medial rectus on left eye wouldn't
269
woman with colors looking pink in one eye, with bluriness and dark spot in superior visual field, got worse with hot bath
MS - clinically isolated syndrome
| papilledema
270
patient with white matter lesions that is NOT MS, what is it?
migraine
271
what will you find more of in CSF in MS
IgG
272
what are dawson's fingers and what are they characteristic of
lesions at 90 degree angles to ventricles - characteristic of MS
273
if you find aquaporin 4 in blood, why dont you think it's MS
because it's Devic's disease/neuromyelitis optica - also the lesion will travel for multiple spinal cord segments
274
what is a big risk for biologics used for MS (underlying issue)
PML (Progressive multifocal leukoencephalopathy) due to JC virus
275
first medication with defined benefit in primary progressive MS
ocrelizumab (very similar to rituximab)
276
most common reason for relapse in MS
non compliance with meds
277
DSM criteria (2+) for personality disroder
deviation from cultural norms in 2+ ways:
1. cognition
2. affectivity
3. interpersonal functioning
4. impulse control
these traits are inflexibile and maladaptive
278
how old do you have to be to be dx with personality disorders
can be less than 18 if you have symptoms for more than a year, however, antisocial personality disorder needs you to be 18y/o for dx
279
what are cluster A personality disorders (3)
"odd, eccentric, weird"
1. paranoid personality disorder (no psychosis)
2. schizoid personality
3. schizotypal personality
280
what are cluster B personality disorders (4)
"dramatic, emotional, wild"
1. antisocial personality disroder (need conduct disorder in adolescence)
2. borderline personality
3. histrionic personality disorder
4. narcissistic personality
281
what are the cluster C personality disorders
"anxious"
1. avoidant personality disorder
2. dependent personality disorder
3. obsessive compulsive personality disorder
282
schizoid personality traits (and tx)
does not enjoy relationships, detachment, emotional coldness, hard to tx with therapy
283
schizotypal personality traits (and tx)
odd beliefs, magical thinking, social anxiety, peculiar speech, tx with social skills training
284
antisocial personality traits (and tx)
breaks the law, lies, cons people, impulsivity, recklessness, irresponsibility, lack of remorse, violence, use of weapons and drugs, low risk preventional benefit with group parenting training
285
borderline personality disorder traits (and tx)
associated with hx of abuse, very sensitive to stress and interpersonal slights, suicidal behavior, or non-suicidal self-harm, impulsivity that are self-damaging, feeling of emtpiness. tx dialectical behavioral therapy, transferance focus, mentalization-based.
286
histrionic personality diroder traits
excessive emotionality and attention seeking, provocative, need to be center of attention, rapidly shifting and shallow emotional expression, speech is impressionistic and lacking in detail, is suggestible
287
narcissistic personality disorder traits
grandiose sense of self, needs to be liked, lack of empathy, thinks they are special and can only be understood by high-status people, fantasies of power, success, brilliance, is arrogance, interpersonal exploitative.
288
avoidant personality disorder traits
avoids interpersonal contact, shows restraint within intimate relationships for fear of being ridiculed, very low self esteem, preoccupied with criticism and rejection, reluctant to take personal risks
289
dependent personality disorder traits
needs a lot of reaassurance from others, needs other to assume responsibility, difficulty expressing disagreement with others for fear of loss of support, difficulty initiating project or doing things on their own, will volunteer to do things that are unpleasant to obtain support from others, feels uncomfortable when alone, seeks relationships as source of care
290
obsessive compulsive personality disorder traits
preoccupation with orderliness, perfectionism, control, at the expense of efficiency, can't meet deadlines, excludes leisure activities, can't delegate, shows rigidity, ego-syntonic (doesn't see it as an issue),
291
somatic symptom disorder traits
excesive thoughts, feelings or behaviors related to symptoms (disproportionate thoughts about severity, energy devoted to symptoms, high anxiety) for 6months
292
illness anxiety diroder traits
hypochondria - preoccupation with having or acquiring a serious illness for more than 6 months, with mild or absent somatic symptoms. equally common in men and women (somatic symptom and conversion more common in women)
293
conversion disorder traits
symptoms of altered voluntary motor or sensory function incompatible with known conditions - diplopia, blindness, deafness, numbness, dysphasia, seizures, tremor (sometimes with indifference to these symptoms). usually just an acute response to an acute stressor
294
pseudocyesis
false belief of pregnancy - amenhhoreah, fat distribution, breast enlargement
295
primary gain
something rewarding about being in sick role - i.e. when people were sick in abusive childhood, they were taken care of
296
secondary gain
external rewards - bed, drugs, benefits
297
factitious disorder AKA
munchausens
