Nervous system Flashcards
1
Q
Most common diabetic mononeuropathy
A
CNIII
Acute down and out with dipoplia - but can still react to light and accomodate because ps efferent are lateral and the nueuropathic infarction is central
ptosis - since CNIII also innervates levator palpebrae
2
Q
cranial nerve III compression
A
Pupillary dysfunction often first because peripheral PS
3
Q
Function of facial nerve VII
4
A
- Motor output to facial muscles
- PS innervation to lacrimal, submandibular, sublingual salivary glands
- Special affarent fibers for taste from ant 2/3 tongue
- Somatic affarent from the pinna and external auditory canal
4
Q
Patient with Bell’s palsy presentation
A
unilateral facial paralysis
decreased tearing
hyperacusis
loss of taste sensation over ant 2/3 tongue
5
Q
Which CN provides sensation to face?
A
CNV
6
Q
Pass through
Optic canal
A
CNII
Ophthalmic artery
Central retinal vein
7
Q
Pass through
superior orbital fissure
A
CN III, IV, V1, VI
opthalmic vein
sympathetic fibers
8
Q
Pass through
foramen rotundum
A
CN V2
9
Q
Pass through
foramen ovale
A
CN V3
10
Q
Pass through foramen spinosum
A
middle meningeal
11
Q
pass through internal auditory meatus
A
CN VII VIII
12
Q
Pass through jugular foramen
A
CN IX
CN X
CN XI
jugular vein
13
Q
pass through hypoglossal canal
A
CN XII
14
Q
Pass through foramen magnum
A
spinal roots of XI
Brain stem
vertebral arteries
15
Q
gall bladder and diaphragm referred pain
A
right shoulder via phrenic nerve receives referred pain
16
Q
where synthesis epinephrine
A
pons - locus ceruleus
17
Q
synthesis dopamin
relevant conditions
A
substantia nigra and ventral tegmentum
up in Huntingtons
down in Parkinsons and depresssion
18
Q
synethsis serotonin
A
raphe nuclei in pons/midbrain/medulla
19
Q
Acetylcholine synthesis and conditions
A
basal nucleus of Maynart
up in Parkinsons
down in Alzheimer’s and Huntingtons
20
Q
GABA synthesis and conditions
A
Nucleus accumbens
down in Huntingtons and anxiety
21
Q
how does glucose and aa get in brain?
A
carrier mediated transport to cross bbb
22
Q
sleep wave order
A
BATSDB Beta - awake eye open Alpha - awake eye closed Theta - 1 Sigma - 2 Delta -3 Beta - Rem
23
Q
VPL of thalamus
A
in - spinothalamic
to - 1ssc
24
Q
VML of thalamus
A
in - trigeminal and gust
to- 1ssc
25
LGN of thalamus
vision to calacrine
26
MGN of thalamus
hearing to auditory cortex of temporal
27
VL thalamus
basal ganglia / cerebellus to motor cortex
28
Hemiballismus
caused most frequently by a contralateral lacunar stroke in the subthalamic nucleus
29
intracellular inclusions in parkinson
lewy bodies -
| alpha-synuclein (eosinophilic)
30
atrophy seen in Huntingtons
caudate atrophy
31
nueronal death in huntingtons via
NMDA-R binding and glutamate toxicity
32
lesion to non-dominant parietal-temporal cortex
hemispatial neglect
33
lesion to dominant parietal-temporal cortex
agraphia / acalculia / finger agnosia / left-right disorientation (Gerstmann syndrome)
34
agnosia
to interpret sensations / recognize things
35
Mammilary body lesion
```
Wernicke Korsakoff
confusion
ophthalmoplegia
ataxia
memory loss
confabulation
```
36
cerebellar hemisphere lesion
limb ataxia
fall towarad side of lesion
balance problems
37
cerebellar central vermis lesion
truncal ataxia
38
subthalamic nucleus lesion
hemiballismus contralaterally
39
paramedian pontine recticular formation lesion
eyes look away from side of lesion
40
frontal eye field lesion
eyes look toward lesion
41
How does gaba-a receptor work?
chloride channel - open --> inhibition
42
How do benzos work
modulate GABA-A - increase the frequency of chloride channel opening
43
Diphenhydramine
sedating antihistimine - rerversibly blocks H1 receptors
44
in addition to their anxyloytic effects, what other effects to benzos have?
also have muscle relaxant and anti-convulsant effects - in addition to anxiolytic
45
inhibit norepinephrine and serotonin reuptake
TCADs
46
what makes the moa of barbiturates different from benzos
barbiturates stablizes the chloride channel (GABA-Ar) in the open position and have a longer half life
benzo increase the frequency that it is open
47
amino acid serotonin is synthesized from?
tryptophan
48
how does ondansetron work?
5HT3 receptor antagonist
useful to treat visceral nausea due to infection, chemo, distention
irritated mucosa releases 5HT3 which stimulates vagal affarents to activate the medullary vomiting center
49
when would we give antihistamine or anticholinergics for nausea
vestibular nausea
50
Metoclopramide
dopamine receptor antagonist
effective in treating central nausea (migraine)
adverse - extrapyramidal / sedation
51
Prochlorperazine
Dopamine receptor antagonist for central nausea
52
Loperamide
mu-opiod receptor agonist for diarrhea - antimotility agent
53
diphenhydramine
1st gen antihistamine -
| can be used to treat vestibular nausea - can cause sedation
54
meclizine
first gen antihistimaine
55
scopolamine
muscarinic antagonist - can be used to treat vestibular nausea
causes sedation
56
promethazine
dopamine and h1 receptor antagonist - rx for vestibular nausea
can cause sedation
57
ranitidine
H2 blocker - reduces gastric acid secretion - GERD
58
Octreotide
somatostatin receptor agonist - inhibits bioactive amine release - used to treat diarrhea in carcinoid syndrome and VIPomas
ALSO FOR ACUTE ESOPHAGEAL VARICES
59
5-HT3 receptor antagonist for visceral nausea
ondansetron
60
common causes of travelers' diarrhea
E Coli (bacteria)
Rotavirus
Cryptosporidium (aids)
61
classic finding in uncal herniation
blown pupil (dilated) due to ipsilateral oculomotor nerve palsy
62
Synthetic steroid that used to be used to treat endometeriosis that can cause idiopathic intracranial hypertension?
danazol
63
Rx for idiopathic intracranial htn?
acetozolamide (carbonic anhydrase inhibitor)
| topiramate (carbonic anhydrase inhibitor and apparent antiepileptic)
64
3 signs of normal pressure hydrocephalus
wet
wobbly
wacky
incontinence
ataxia
cognitive dysfunction
65
Cushing's triad for increased intracranial pressure
hypertention
bradycardia
bradyypnia
66
as uncal herniation progresses, you may see a fixed dilated pupil at first due to ipsilateral oculomotor nerve palsy, but what will happen as the hernia progresses?
progression results in damage to the mid-brain, which will result in fixed pupils bilaterally. Additional findings in advanced herniation include loss of vestibular ocular reflex and decorticate - above red nucleus (flexural) followed by deceburiate - below red nucleus (extensoral) posturing
67
trigeminal nueralgia first line therapy?
Carbamazepine - a neuroleptic medications (partial) - that reduces firing by reducing the ability of sodium channels to recover from inactivation
68
side effects of carbamazepine
bone marrow suppression - pancytopenia :(
| SIADH
69
Benztropine or Trihexyphenidyl
anti-muscarininc (central) that can help with extrapyramidal signs of anti-psychotics D2 blockers
70
dantrolene
direct acting skeletal muscle relaxant for neuroleptic malignant syndrome
71
Serotonin syndrome
| characterized by
```
restlessness
altered mental status
hyperreflexia
clonus
diaphoresis
tremors
```
72
TMP/SMX fetal consequences?
Neural tube defects
73
which antibiotics can cause neural tube defects?
TMP/SMX which is you think about it makes sense because they are dihydrofolate reductase inhibitors? or something along those lines... and we see neural tube defects in folate deficient madres
74
which drugs can lead to impaired fetal renal function and cause fetal anuria and oligohydramnios?
NSAIDs
75
Woudl you give a pregnant women acetomenophin
no! it is an NSAID and NSAIDs are toxic to tots
76
Some baby you are taking care of is yawning, sweating, and irritable with tremors - what do you think??
Maybe he had in utero exposure to opioids and is now going through opioid withdrawl
77
classic opioid withdrawl symptom
yawning - withdrawing from?
78
Akathisia - and treatment?
extrapyramidal side effect of antipsychotic characterized by inner restlessness and an inability to stand in one position - - thus, increasing antipsychotic dose - as might be done if misinterpreted as worsening of symptoms - would make matters worse - give them a beta blocker or benzo
79
Dopamine can make you nauseous, because it stimulates the emetic center in the brainstem - so if you add carbidopa - why would this help if the brainstem is where we are?
because the emetic center is outside the blood brain barrier
80
If a patient comes in with all sorts of ocular dysfunctions - ptosis / mydriasis / inability to move their eye in any direction - ipslaterally - how would you differentiate between a lesion in the brainstem and a problem in the cavernous sinus?
brainstem lesions should have accompanying crossed signals - i.e. ipsilateral cranial nerve palsy with contralateral hemiparesis and signs of ataxia
81
what important structures pass through the IOF?
Maxillary division of V
infraorbital vessels
branches of sphenopalatine ganglion
82
Vernet syndrome - lesions of the jugular foramen lead to ?
```
CN IX X XI functions impaired
dysphagia
hoarseness
loss of gag ipsilater
uvula deviation to normal
```
83
which nerves traverse the cavernous sinus and thus would present problems in cavernous sinus syndrome?
III
IV
V (1 and 2)
VI
84
Can phenytoin cause gingival hyperplasia?
yes
85
how does phenytoin cause gingival hyperplasia?
increased expression of PDGF - Exposure of macrophages to PDGF increases their synthesis of gingival cells (thats what it said)
86
aspirin can cause reye which can effect the liver - light microscopy will show?
steatosis - small fat vacuoles in cytoplasm of hepatocytes
em will show swelling, decreased # mitochondria, glycogen depletion
87
reye syndrome first fucks with the liver but can then cause
encephalopathy - toxic effect of hyperammonemia
