Exam 2 (week 1) Flashcards
(266 cards)
1
Q
what nerves are in posterior triangle of neck
A
- spinal accessory
- nerves of cervical plexus
- brachial plexus
2
Q
what are the little trianges within anterior triangle
A
- submental (right under chin)
- submandibular
- muscular triangle
- carotid triangle
3
Q
what structures are in submandibular triangle (nerve, vasculature, glands)
A
- submandibular gland
- hypoglossal nerve
- facial artery and vein
4
Q
what structures are in the muscular triangle
A
- thyroid and parathyroid
2. laryngeal prominence
5
Q
what are the suprahyoid muscles (4)
A
- digastric (anterior relates to mylohyoid, posterior relates to stylohyoid)
- sylohyoid
- mylohyoid
- geniohyoid
6
Q
what are the infrahyoid muscles (4)
A
- omohyoid (shoulder-hyoid)
- sternohyoid
- sternothyroid
- thyrohyoid
7
Q
deep muscles of neck
A
- scalenes - fix the ribs (1st and 2nd-posterior)
2.
8
Q
what musches do brachial plexus pass between in neck
A
anterior and middle scalenes
9
Q
what muscles does phrenic pass through in neck
A
anterior and middle scalenes
10
Q
what muscles do subclavian artery pass through in neck
A
anterior and middle scalenes
11
Q
watch the opening of eustacian tube in pharynx called
A
torus tubarius
12
Q
where is tonsilar fossa located
A
between palatopharyngeal and palatoglossal arch - where the palatine tonsils are
13
Q
where does food get stuck in throat (not when choking)
A
piriform recess
14
Q
what is Waldeyer’s tonsilar ring made of? (4)
A
- pharyngeal tonsil
- tubal tonsils
- palatine tonsils
- lingual tonsil
15
Q
what does tensor veli palatini do and what is it innervated by
A
innervated by V3
widens soft palate and opens auditory tube
16
Q
what does levator veli palatini do and what is it innervated by
A
elevates soft palate, innervated by 10
17
Q
what does musculus uvulae do and what is it innervated by
A
innervated by 10
shortens and elevates uvula
18
Q
what does palatoglossus do and what is it innervated by
A
innervated by 10
elevates posterior tongue to soft palate
19
Q
what does palatopharyngeus do and what is it innervated by
A
innervated by 10
tightens and elevates pharynx
20
Q
what are the inner pharyngeal muscles and what are they innervated by (3)
A
- stylopharyngeus (glossopharyngeal)
- salpingopharyngeus (vagus)
- palatopharyngeus (vagus)
21
Q
definition of clouding of consciousness
A
minimally reduced wakefulness/awareness, incomplete orientation, inattentive, agitated OR drowsy
22
Q
lesions in midbrain cause (in terms of sleep disorder)
A
sleepiness
23
Q
patients with lesions in hypothalamus cause (in terms of sleep disorder)
A
insomnia
24
Q
patients with lesions between hypothalamus and midbrain cause (in terms of sleep disorder)
A
narcolepsy
25
older woman who doesn't know what year it is, poorly attentive, hyperaroused, purposeless activity, just started a new med. what kind of med might it be
anticholinergic - interferes with ascending arousal system - decrease ability to maintain arousal
26
how does hypoglycemia cause delerium
regional impairment of ACh metabolism
27
older woman, profound memory loss, confabulation (making things up), indifference to noxious stimuli, nystagmus and gait ataxia, vitals are unstable. what could it be
thiamine deficiency (also see with severe alcoholism)
28
path findings for alcohol related thiamine deficiency
hemorrhage in shrunken mamillary bodies, whitening on CT in midbrain (most sensitive to thiamine deficiency)
29
woman with pneumonia, lethargy, confusion, clinical deydration, what could it be
hyperglycemia - causes cerebral edema
30
ammonia in blood causes confusion - how?
ammonia is typically converted to urea in liver for excretion. if liver stops working, brain and muscle get the ammonia, and up-regulate enzymes (glutamate from astrocytes). glutamine is a waste product, which causes astrocyte swelling - focal brain dysfunction in midbrain
31
older woman with known alcoholic liver disease, asterixis, acting strangly
hepatic encephalopathy
32
what do you see with hepatic encephalopathy on histo of brain
astrocyte swelling - alzheimer's type two
33
woman is confused, apathetic, dull, tremor, known renal failure
uremic encephalopathy
- won't see any classic path or imaging findings
- dialysis improves symptoms
34
what are the basal ganglia/nuclei of cerebral hemispheres
grey matter deep to cerebral hemispheres:
- caudate nucleus
- putamen
- globus pallidus
35
where do association fibers run
within the same hemisphere
36
where do commissural fibers run
cross over to other cerebral hemisphere
37
where do projection fibers run
descend to connect cerebral cortex with subcortical structures
38
where does arcuate fasciculus go
from frontal down through parietal, occipital and temporal
39
where does uncinate faciculus go
from parietal through temporal
40
what kind of fibers make up corpus callosum
commissural fibers from L to R and vis versa (for hand movement coordination etc)
41
what does anterior commissure connect
temporal gyri on both sides
42
internal capsule contains what (2)
descending projection fibers
| thalamocortical axons
43
what is contained within corona radiata
corticospinal fibers from cortex before it hits internal capsule (then as it descends, it's called crus cerebri, the pyramids, and then corticospinal tracts)
44
where do corticopontine fibers start and end
start from widespread cortex areas to pontine grey - for controlling motor activity with cerebellum (middle cerebellar peduncle)
45
which fibers in corona radiata are the most numerous
corticopontine fibers
46
what part of brain is subthalamic nucleus located
diencephalon
47
what part of brain is substantia nigra located
midbrain
48
what is phrenology
lumps on surface of head - determine features or personality traits of individual - hopeful, constructive etc.
49
primary brodman's area for somatosensory
3, 1, 2
50
primary brodman's area for visual
17
51
primary brodman's area for auditory
41
52
what is the secondary sensory area for somatosensory
area S2
53
what is secondary sensory area for auditory
area 42
54
what is association area for somatosensory
5, 7 in superior parietal lobule
55
what is association area for visual system
18, 19 above and below primary visual cortex
56
what is assocation area for auditory
22, in superior temporal gyrus
57
difference between unibodal and multimodal areas
unimodal (somato, visual, auditory) concerned with processing signals from one primary area
multimodal - involved in higher processing
58
major thalamic input to somatosensory cortex
VPM from face
| VPL from body
59
what sensory deficit will someone have if you have lesion in superior parietal lobule
lesion in somatosensory areas 5 and 7 - results in astereognosis
60
what sensory deficit will someone have if you have lesion in inferior parietal lobule
results in contralateral neglect - ignores opposite side of body
61
what brodmans areas are within wernickes
areas 22, 39, and 40
62
what does a lesion to superior temporal gyrus, supramarginal gyrus, or angular gyrus
difficulty understanding speech
63
speech and handed-ness
R handed person has speech areas on L side of brain
64
where is brocas area
inferior frontal gyrus
65
what does the temporal/parietal area on opposite side of wernicke's/broca control
prosody - emotional content of speech
66
what site of brain is involved in agraphia
dominant angular gyrus (angular 39)
67
what site of brain is involved in alexia
dominant parietal lobe
68
if patient has PCA stroke on eft side, what deficits would he hve
can see, can write but can't read
69
what area thalamus is involved iwth primary auditory cortex
MGN
70
what areas of thalamus are involved im notor activity
VA and VL thalamus
71
what area of thalamus is involved in prefrontal cortex
MDN
72
what are absence seizures
petit mal - 10-45s start in childhood
73
what ions are involved in seizures
increase in extracellular potassium depolarizes neirghboring neurons, this causes accumulation of calcium in presynaptic terminals which increases transmitter release and increased glutamate (NMDA) activation
74
what area of brain is involved in termporal lobe epilepsy, and how could this cause problems
hippocampus- severe memory issues
75
what cells have glutamate
pyramidal
76
what kind of molecule is glutamate
amino acid
77
what cells have GABA
interneurons
78
3 types of glutamate receptors
NMDA
AMPA
kainate
79
what kind of seizures do you use benzos for
status epilepticus
80
vigabatrin mech of action
inhibits GABA-transaminase (GABA-T)
| reduces GABA breakdown
81
vigabatrin side effect
concentric field deficit retina dies - lose peripheral vision
82
benzo mech of action
increases affinity of GABA for GABA a receptor
83
carbamazepine mech of action
increase inactivation of sodium channels by keeping sodium gate in closed position for longer.
84
what kind of seizures do you use carbamazepine for
focal seizures or tonic clonic seizures
85
side effects of carbamazepine (2)
stevens johnosn symdrome
blood dyscrasias
86
pheytoin used for what seizures
status epilepticus and focal seizures and GTCS
87
phenytoin mech of action
increases sodium channel inactivation, reducing neurotansmitter release
88
dosing of phenytoin
non-linear relationship between dose and plasma level, have to monitor
89
adverse effects of phenytoin
1. cardiac arrythmias
2. SJS, TEN
3. gingival hyperplasia
HLA-B 1502 in Han Chinese can be at higher risk (also for carbamazepine)
90
primidone mech of action
increases sodium channel inactivation
91
topiramate mech of action (3)
1. increases sodium channel inactivation
2. inhibits kainate and/or AMPA receptors
3. enhances actions of GABA
92
uses for topiramate 92)
focal seizures, GTCS
| also anti migraine and migraine prophylaxis
93
lamotrigine mech of action (2)
1. increases sodium channel inactivation
| 2. inhibits release of excitatory amino acids by acting on presynaptic voltage gated Ca2+ channels
94
lamotrigine adverse
rash - SJS
95
zonisamide use
adjuct therapy
96
zonisamide mech of action (2)
primary sit of action on sodium channel, also on T-type voltage gated calcium channels
97
benefit of zonisamide
does not interact with other AEDs
98
gabapentin use
adjuct therapy for focal seizures and chronic pain management
99
gabapentin mech of action (2)
binds to voltage gated Ca2+ subunit to decrease glutamate release
also inhibits GABA-T
100
gabapentin benefit
no drug reactions
101
levetiracetam mech of action
synaptic vesicle protein 2A protein ligand, inhibits excitatory amino acid transmitter release by interfering with fusion of vesicles
102
adverse effect of levetiracetam
behavioral changes, espectially in patients with psychiatric conditions
103
ethosuximide mech of action
inhibits T-type Ca2+ channel activity in thalamic neurons
104
side effect of ethosuximide
gastric distress
105
valproic acid side effects (2)
1. GI distress
| 2. hepatotox
106
mech of action of valproic acid (3)
1. like phenytoin increases Na channel inactivation
2. reduces T-type Ca2+ activity
3. increases GABA levels by inhibiting breakdown
107
uses of valpoic acid
GTCS, absence, myoclonic
108
TIA time definition
less than 24 hours
109
if you have a young person with stroke, what do you think it could be a result of
drug use (cocaine, heroin, amphetamines)
110
what is the limiting factor in cerebral meatbolism - glucose or oxygen?
oxygen
111
at what time point does irreversible brain damage occur with hypoxia
~6 minutes
112
difference between hypoxia and ischemia
ischemia is not enough blood volume (oxygen content is normal)
hypoxia is not enough oxygen content (blood flow is normal)
113
what neuronal sites are the most vulnerable to hypoxia (3)
1. hippocampal pyramida nuerons in sommer sector (CA1)
2. pyramidal nuerons of cerebral cortex (layers 3+5)
3. purkinje cells of cerebellum
114
what neurotransmiter predominates in neurons that are highly susceptible to hypoxia
glutamate
decreased ATP leads to increased excitatory transmitter receptor activation, this causes calcium influx increases, damages mitochondria, stimulates NO and free radical production, leading to apoptosis and inflammatory mediators
115
what areas in the brain are the most damaged in global hypoxia
zones at outer limit of vascualr territories
| "watershed infarcts" - between ACA and MCA areas
116
what areas in brain are affected by ACA issue
middle cerebral
117
what areas in brain are affected by MCA issue
lateral cerebral, along lateral fissure
118
what areas of brain are affected by central artery issue
around 3rd ventrical
119
what areas are affected by PCA issue
occipital and inferior temporal
120
anemic infarct characteristics and cause
pale, bland, non-hemorrhagic
no reperfusion to necrotic area, characteristic of thrombotic (in situ) infarct
121
hemorrhagic infacrt characteristics and cause
red
reperfusion of necrotic area, characteristic of embolic (travelled) infarcts
122
stages of infarct gross (and timing) (3)
1. acute; 0-2 days (dusky blurring)
2. subacute; 2-4 days (edema, soft)
3. chronic; 4 days on (liquefactive necrosis first, cystic cavitation later)
123
stages of infarct microscopic (histo)
1. acute (red neurons, neutrophil migration to edge)
2. subacute (red neurons break up - liquefactive necrosis, and neutrophils replaced by foamy macrophages and lymphocutes)
3. chronic (necrotic cavity with edge of reactive astrocytes and new capillary formation and hemosiderin deposition on rim)
124
major causes of subarachnoid hemorrhage (4)
1. trauma
2. saccular aneurysm rupture
3. AVM rupture
4. spread of intracerebral or intraventricular hemorrhage)
125
major causes of intracerebral (parenchymal) hemorrhages (4)
1. trauma
2. chroninc HTN
3. hemorrhagic infacrt
4. cerebral amyloid angiopathy
126
what are charcot-bouchard aneurysms
microaneurysms caused by hyaline arteriolosclerosis in deep perforating central branches
127
what kind of hemorrhages do you see with chronici HTN
Intracerebral/ganglionic
128
what kind of hemorrhages do you see with amyloid
intracerebral/lobar - peripheral. not in region of basal ganglia
129
where are the sites of hemorrhage with chronic HTN
in area of basal ganglia
130
what does epithalamus contain
pineal gland and habenular nucleus (limbic)
131
what does subthalamus control
somatic motor control
132
what part of thalamus is pineal gland near
posterior pole
133
what are the divisions made by internal medullary lamina
anterior thalamic nuclei, medial thalamic nuclei, lateral and ventral thalamic nuclei
134
what are nuclei within intralamina called and where do they project
midline nuclei
| project to basal nuclei and diffuse areas of cerebral cortex
135
what does reticular thalamic nucleus do
projects to different thalamic nuclei
136
what are the lateral thalamic nuclei (what info do they recieve)
```
lateral posterior (association of cortex)
lateral dorsal (limbic)
```
137
pulvinar does what
connect with association areas of cortex (parietal, temporal and occipital)
138
what are the ventral thalamic nuclei (what info do they recieve)
ventral anterior (motor)
ventral lateral (motor)
ventral posterior lateral (sensory body)
ventral posterior medial (sensory face)
139
where are LGN and MGN located
under pulvinar in posterior thalamus
140
anterior nucleus of thalamus does what
limbic
141
medial dorsal thalamus does what
connects to association areas of cortex
142
relay nuclei of thalamus in general go where (specific or broad areas)
to specific areas,
143
anterior and lateral dorsal pathway to where
project to cingulate gyrus of limbic system
144
medial dorsal projects to where and controls what functions
reciprocal to prefrontal cortex for executive function (ambition, drive, planning and personality)
145
ventral anterior and ventral lateral input and output
input from globus pallidus and cerebellum
output to primary and premotor cortex
146
what lesions cause thalamic pain
lesion in VPL or VPM
147
PICA is brach off of what
vertebral artery
148
anterior spinal artery is branch off of what
vertebral artery
149
major branches of ICA (interal carotid) (4)
1. ophthalmic
2. anterior cerebral
3. middle cerebral
4. lenticulostriate and penetrating arteries
150
what do lenticulostriate and penetrating artieries supply and what is stroke of these arteries called
internal capsule
| stroke causes lacunar stroke
151
branches of vertebral artery (2)
1. spinal arteries
| 2. posterior inferior cerebellar artery (PICA)
152
PICA infarct causes what
lateral medullary syndrome (wallenberg)
153
what are the spinal arteries and where do they come out
1 anterior spinal artery
2 posterior spinal arteries
come out sporadically down the spinal cord - not regular
154
branches of basilar artery (4)
1. anterior inferior cerebellar artery (AICA)
2. pontine branches
3. superior cerebellar artery (SCA)
4. posterior cerebral artery (PCA)
155
"FAST" pneumonic is for what kind of stroke
MCA
| face, arm, speech, time
156
imipramine characteristics and use
very lipid soluble - TCA antidepressant
157
problem with giving large amount of L-Dopa
body will change transport mech to make it harder to take up dopa
158
how many of CSF is produced daily
500mL
159
how many times is CSF turned over daily
3x (drugs will be washed away within 8 hrs)
160
how much protein should you have in CSF
basically 0 -- 0.004
161
how much glucose should you have in csf
0.6
162
CSF:plasma protein level increases in CSF, what does that mean
neurodegenerative disorder
163
what causes aura in migraine
cortical spreading depression (CSD) - firing then not firing, changing blood flow
164
what causes pain in migraine
activation of trigeminal system - vasodilated and inflammed vessels, relayed up through trigeminal system
165
relation between aura and pain in migraine
CSD triggers neurons to release inflammatory mediatiors, which dilate meningial vellsel, causing activation of trigmeinal system and pain
166
what nuclei give inputs/modulation into trigeminal system in migrains and what neurotransmitters are invovled
raphe and locus coeruelues (NE and serotonin)
167
serotonin and migraine connection
serotonin constricts cerebral vessels, and effective migraine drugs have serotonin receptor effects
168
what are the 5HT receptor subtype targets for migraine
5-HT1B, 5-HT1Da,b
169
migraine prophylaxis and CSD relationship
migraine prophylactic meds elevate CSD threshold and suppress CSD (implicated in aura)
170
beta blocker used for migraine and mech
propranolol
| - mech unknown
171
anticonvulsants used for migraine and mech (2)
valproate:
- increases GABA
- side effects not great
topiramate:
- blocks Na and Ca channels, inhibits glutamate, enhances GABA, inhibits trigeminal system
- weight loss, fuzziness, taste abmormalities
172
how does botox work for migraine
cleaves SNARES in release of CGRP
173
erenumab use and mech
migraine prophyaxis
monoclonal ab to CGRP receptor
174
what antidepressants are used in migraine prophylaxis (2)
low doses of amitryptyline and nortriptyline
175
drugs for acute MILD/MODERATE migraine (3)
1. naproxen
2. caffeine
3. metoclopramide (good for nausea, not for pain)
176
drugs for acute SEVERE migraine (2)
1. ergots (bad side effects)
| 2. triptans
177
mech of action of ergotamine
non-selective 5HT agonist at trigeminal nerve
178
when to use ergotamine
very early in the migraine
179
ergotamine side effects
nausea, vomiting, cramps, vertigo, ischemia, gangrene, cold extremities
180
triptans (all) mech of action
5-HT1B, 5-HT1D and new ones F
D = peripheral to meningieal vessles, reduce release of inflammatory mediators
B = on blood vessels - direct vasoconscriptions
B, D and F also centrally to inhibit neurotransmission
181
side effect of triptans (2)
1. re-emergent/rebound migraine
| 2. coronary artery vasoconstriction (Avoid with ischemic heart disease)
182
what is CGRP
calcitonin gene-related peptide
183
what does amyloid look like on histo
vessel within a vessel, pright pink. or congo red apple green birefringence
184
what is the most common cause of non-traumatic subarachnoid hemorrhage (and what's a cause of that)
berry anueyrsm in branch points in circle of willis due to integrity defects in vessel (autosomal dominant polycystic kidney disease)
185
most common site of berry aneurysim
junction between anterior communicating artery and anterior cerebral artery
186
what are complications of berry aneurysm rupture (2)
1. vasospasm due to blood causing infarct
| 2. arachnoid fibrosis causing communicating hydrocephalus (not in ventricular system)
187
arteriovenous malformation location and description
commonly in MCA - artery goes to vein without capillary. "tangle of worms"
188
how might arteriovenous malformation and cavernous hemangiomas present
can leak over time and cause seizure disorders
189
histology of cavernous hemangioma
benign growth of capillaries, vessels with thin fibrous walls, no SM
190
what is Binswanger's disease
subcortical arteriosclerotic leukoencephalopathy causing vascular dementia (related to HTN, DM and atherosclerosis)
191
diastatic fracture
fracture crossing bony suture line
192
what artery is often involved in epidural hematoma
middle meningeal
193
why are epidural hematomas emergencies
quick buildup of pressure pushes brain down and can herniate into brainstem and be fatal very quickly
194
symptoms of epidermal hematoma
might be confused at first, and then can have lucid interval as blood accumulates
195
common cause of subdural hematoma
tear in bridging vein between cortical surface and dural sinus
196
why are subdural hematomas less emergent
they're venous blood - don't go as quickly. only sometimes fatal
197
subarachnoid hemorrhage causes (3)
extend from AVM aneurysms
can come from trauma
contusions from parenchymal
198
coup injury site, and contrecoup injury site
coup contusion AT impact site
| contrecoup contusion on opposite side of skull due to rebound of brain
199
where is damage seen with contusions
crowns of gyri
200
diffuse axonal injury (what is it, and when is it seen)
stretching and shearing in deep white matter. axonal flow is disrupted - see axonal swellings with silver stain
concussion and shaken baby syndrome
201
where do olfactory info neurons synapse in brain (4)
pyriform cortex
orbitofrontal cortex
amygdala
entorhinal cortex
202
which epithelium is thicker, respiratory or olfactory epithelium
olfactory is thicker
203
how many genes are in the family of odorant receptors
1,000, each receptor only expresses one allele of one gene
204
cells in piriform cortex
2 types - finely tuned versus not finely tuned
205
vomeronasal system purpose
sensing mates, predators and prey
| dimorphism in genders
206
what are olfactory glomeruli
single glomeruli are innervated by axons from ORNs that express the same single type of odorant receptor
207
medial boundary of hypothalamus
4rd ventricl e
208
3 regions of hypothalamus
anterior, tuberal, posterior
209
what divides lateral and medial area of hypothalamus
fornix
210
where is medial forebrain bundle found
in lateral hypothalamus
211
what are the nuclei in the anterior medial hypothalamus (5)
1. medial preoptic
2. supraoptic
3. paraventricular
4. anterior
5. suprachiasmatic
212
what are the nuclei in the tuberal medial region of the hypothalamus (3)
1. dorsomedial
2. ventromedial
3. arcuate
213
what are the nuclei in the posterior medial region of the hypothalamus
1. mamilary
| 2. posterior
214
dorsal longitudinal fasciculus (where does it go to and from, and what info does it convey)
From hypothalamus, through periacqueductal grey, to smidbrain where it terminates on reticular formation, dorsal motor nucleus of 10, and salivatory nuclei
conveys visceral, somatic pain and tem, as taste TO hypothalamus
conveys symp and parasymp info FROM hypothalamus to intermediolateral horn and craniosacral parasympathetic neurons
215
medial forebrain bundle (where does it go to and from, and what info does it convey)
extends from septal areal and forebrain through hypothalamus, down to spinal cord (parasymp and symp)
plays a role in reward pathway and "higher" function
216
parasymp is mostly controlled by what area of hypothalamus
anterior hypothalamus
217
symp is mostly controlled by what area of hypothalamus
posterior hypothalamus
218
what is the role of the paraventricular nucleus
connects anterior and posterior nuclei of hypothalamus for autonomic control
219
what sends pain and temp info to and motor response from paraventricular nucleus
DLF
220
what sends emotional/limbic info to paraventricular for autonomic control
MFB
221
how are temperature "set points" set
warm sensitive neurons (in preoptic) inhibit cool sensitive neurons (in posterior) when temps increase over 98.6 and increase parasympathetic mechanisms to reduce body temp (slow heart rate, panting)
when body is cooling, warm sensitive neurons reduce inhibition of cool-sensitive neurons, which stimulates sympathetic mechanisms to increase body temp (shivering, vasoconstriction)
222
what controls circadian rhythm, pathway
suprachiasmatic nucleus:
blue light to retina to suprachiasmiatic to pineal gland - decreased melatonin secretion
223
pituitary and hypothalamus connections
PVN and supraoptic produce ADH/oxytocin down to neurohypohysis (posterior pituitary)
arcuate nucleus produce releasing and inhibiotory factors into portal system (hypothalamophyphyseal portal system) into anterior pituitary
224
what hypothalamic nucleus controls feeding behavior
ventromedial nucleus = satiety center
225
eye deviation direction in L MCA stroke
toward lesion, away from hemiparesis
226
how might subcortical strokes prsent
no eye or speech issues, no behavior change. most likely lacunar
face=arm=leg equally weakened
227
when can you give tpa - what window?
up to 4.5 hrs
228
when can you do mechanical clot extraction for large vessel occlusion - what time window?
up to 6 hours for anyone, and up to 24 hours if there's a large enough penumbra
229
what factors contribute to stroke risk after tia
ABCDD
1. age
2. blood pressure
3. clinical symptoms (focal weakness or speech impairment)
4. diabetes
5. duration of symptoms
230
do you treat HTN after ischemic stroke?
not unless BP is over 220/120
231
what kind of saline do you use in stroke patient
only normal saline
232
stroke prevention drug for non-cardiogenic recurrent stroke
antiplatelet (aspirin)
| warfarin (no better than aspirin)
233
stroke prevention drug for cardiogenic recurent stroke
warfarin
234
examples of cardiogenic causes of stroke (4)
1. afib
2. mechanical valve replacement
3. cardiac thrombus
4. MI
235
most common arteries affected by arterial dissection
internal carotid
| vertebral artery
236
symptoms with arterial dissection (2 kinds)
anterior (ICA) = pain, horner's, hemiparesis, retinal ischemia
posterior (vertebral artery) = pain, cerebellar or lateral medullary syndrome
237
tx for arterial dissection
aspirin
238
mortality is higher in which kind of stroke - hemorrhagic or ischemic
hemorrhagic - 50%
239
biggest risk factor for hemorrhagic stroke
HTN
240
what are the areas most commonly involved in HTN intercerebral hemorhage
basal ganglia most common
| then brainstem or cerebellum
241
if someone has hemorrhagic stroke, what other systemic tests do you do (3)
1. send to ophtho to look for retinopathy
2. do EKG to look for cardiomyopathy
3. look at kidney labs to look for renal dysfunction
242
what population do you expect to see amyloid angiopathy in
older and with alzheimers
243
what kind of stroke (and where) does amyloid angiopahty cause
hemorraghic
recurrent lobar hemorrhage
244
what vessel does an AV malformation commonly affect
MCA
245
most common primary brain tumor to cause hemorrhagic stroke
glioblastoma multiforme
246
most common mets to brain that cause hehmorrhagic stroke (2)
melanoma
| carcinoma of lung
247
do you treat HTN after hemorrhagic stroke?
yes, if it's HTN cause. tx with labetalol and nicardipine
248
when do you perform sx after hemorrhagic stroke (2)
if there's a cerebellar hemorrhage greater than 3cm
or intracerebral associated with aneurysm or vascular malformation
249
which way does subarachnoid hemorrhage spread
in to out, most common - asosciated with ruptured aneurysm in circle of willis
250
tx for subarachnoid hemorrhage
nimodipine to prevent vasospasm to delay ischemic deficit
251
what are the tributaries of internal jugular from top to bottom (7)
1. occipital
2. retromandibular
3. lingual
4. facial
5. superior thyroid
6. middle thyroid
7. inferior thyroid (usually drains into brachiocephalic)
252
branches off of external carotid from bottom to top (8)
Some Anatomists Like Freaking Out Poor Medical Students
1. superior thyroid
2. ascending pharyngeal (comes off medially)
3. lingual
4. facial
5. occipital (comes of medially)
6. posterior auricular (comes off medially)
7. maxillary
8. superficial temporal
253
carotid sinus innervated by
glossopharyngeal
254
after superior cervical ganglion, what to symp fibers travel on into head
internal carotid nerve plexus
255
what inputs into superior cervical gnalgion (C_-C_)
C1-C4
256
posterior plexus of cervical plexus carry what info
sensory info from scalp, ear, anterior/lateral neck, shelf of shoulder
257
anterior plexus of cervical plexus carry what info
motor to muscles of anterior and lateral neck
258
what is punctum nervosum
where all 4 sensory nerves exit posterior cervical plexus (where you can put nerve block)
259
what are the posterior plexus nerves and what spinal segment are they from (4)
1. lesser occipital (C2)
2. great auricular (C2,3)
3. transverse cervical (C2,3)
4. supraclavicular (C3,4)
260
what nerve innervates skin on back of head
dorsal rami if C2
261
what nerve roots make up ansa cervicalis
C1-C3
262
what are the deep cervical fascial layers (4)
1. investing layer
2. pretracheal fascia
includes pretrach infrahyoid investing
includes pretrach visceral fascia
includes buccopharyngeal fascia
3. prevertebral fascia
4. carotid sheath
263
is ansa cervicalis inside or outside carotid sheath
outside
264
contents of carotid sheath (6)
1. common carotid
2. internal carotid
3. internal jugular
4. vagus
5. carotid sinus
6. some sympathetics
265
zones for penetrating neck trauma
zone 1 = clativcles to cricoid
zone 2 = cricoid to angles of mandible
zone 3 = angles of mandible
266
which zones of penetrating neck trauma are the greatest risk for morbidity and mortality
1 and 3 because they can obstruct airway and the structure are compact and hard to visualize for repair and control bleeding
