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1

Pathophysiology of migraine

activation of trigem nerve
-->substance P and calcitonin GRP causes inflammation of meninges

2

How do triptans work?

5HT1B/1D AGONist
--Block vasoactive peptide release from neuron
--vasoconstriction

3

Bupropion mechanism

Dopa and NE reuptake inhibitor

4

Use of buproprion

depression and smoking cessation

5

TCA mechanism

Serotonin/NE reuptake inhibitor

6

Migraine prophylaxis

b-blocker
TCA and venlafaxine

7

Phenytoin mechanism

Inhibits Na channels from recovering from inactivation

8

phenytoin tox

lymphadenopathy
--hirsuitism/rash/gingival hypertrophy

9

carbamazepine tox

agranulocytosis

10

valproic acid tox

hepatotoxicity

11

lamotrigine tox

steven johnson hypersensitivity rash

12

phenobarbital tox

Acute intermittent prophyria

13

Benefits of zolpidem

less tolerance/addiction

Unlike benzos, it is missing the following
---No anticonvulsant properties
---No muscle relaxation

14

Syphilis destroys what part of CNS

tabes dorsalis
--posterior columns. Also happens in B12 deficiency

15

alar plate

dorsal sensory roots

16

basal plate

motor ventral roots

17

Forebrain

telencephalon and diencephalon

18

lateral ventricle

telencephalon

19

third ventricle

diencephalon

20

mesencephalon

midbrain

21

aqueduct

mesencephalon

22

Hindbrain (rhombencephalon)

metencephalon
myelencephalon

23

pons/cerebellum

metencephalon

24

medulla

myeencephalon

25

fourth ventricle derived from

1. Metencephalon=upper
2. Myelencephalon=lower

26

you suspect NTD in a fetus with elevated AFP--how to confirm?

AChE

27

anencephaly assoc'd with

maternal diabetes

28

holoprosencephaly

left and right hemispheres don't separate

29

holoprosencephaly caused by

hedgehog signaling pathway

30

cystic enlargement of 4th ventricle with hydrocephalus/spina bifida

dandy walker

31

cause of dandy walker

agenesis of cerebellar vermis (central area)

32

chiari II

aqueductal stenosus and hydrocephalus from cerebellar herniation

33

how does chiari II present?

paralysis and thoraco/lumbar myelomeningocele

34

syningomyelia is associated with

Chiari I

35

Muscles of tongue are derived from

occipital myotomes

36

anterior 2/3 of tongue from:

1st branchial arch

37

posterior 1/3 of tongue from:

3rd/4th branchial arch

38

taste goes to which nucleus?

solitary nucleus

39

PNS and schwann cells come from

neural crest cells. everything else comes from neuroectoderm except microglia (from mesoderm)

40

GFAP is a marker for

astrocytes

41

role of astrocytes

1. BBB
2. K metabolism
3. Removing extra neurotransmitter

42

Multinucleated giant cells in the CNS are made of

microglia that are fused. Caused by HIV

43

Myelin effects on space and time constant

Increases space constant (distance signal will spread before dying)
Decreases time constant

44

which cells are destroyed in MS?

oligodendrocytes (white matter of CNS)

45

fried egg on H&E of brian matter

oligodendrocytes

46

large myelinated sensory fibers that adapt quickly

meissner's

47

large myelinated fibers that adapt slowly

merkel's discs

48

merkel's discs sense:

pressure, position sense in hair follicles

49

C fibers

slow, unmyelinated pain fibers

50

Ad fibers

fast myelinated temperature fibers

51

endoneural inflammation

guillain barre

52

perifascicular/endomysial inflammation

polymyositis

53

Nucleus accumbens

reward center, fear

54

locus ceruleus

stress and panic

55

anxiety neurotransmitter

Increased NE, decreased 5HT, decreased GABA

56

schizophrenia neurotransmitter

increased dopamine

57

depression neurotransmitter

decreased NE
Decreased dopamine
Decreased serotonin

58

alzheimer's neurotransmitter

decreased Ach

59

Huntington's neurotransmitter

decreased Ach
decreased Gaba

60

REM sleep neurotransmitter

increased Ach

61

Synthesis of dopamine

ventral tegmentum and Snc (midbrian)

62

Synthesis of serotonin

raphe nucleus

63

Synthesis of Gaba

nucleus accumbens

64

Synthesis of Ach

basal nucleus of Meynert

65

Lateral hypothalamus

hunger
(leptin inhibits)

66

ventromedial hypothalamus

satiety

67

anterior hypothalamus

cooling

68

posterior hypothalamus

heating

69

VPL

ALS and DC-ML fibers going to somatosensory cortex

70

VPM

trigeminal and gustatory pathway

71

LGN

CNII fibers to calcarine sulcus (lateral light)

72

MGN

superior olive and inferior colliculus fibers to auditory cortex (medial music)

73

VL

Motor fibers from basal ganglia to motor cortex

74

LImbic system responsible for

feeding
fleeing
fighting
feeling (emotion)
sex

75

structures of the limbic system

hippocampus
amygdala
fornix
mamillary bodies
cingulate gyrus

76

Inputs to cerebellum through which peduncle?

middle and inferior

77

Input to cerebellum carries:

Middle: contralateral cortex info
Inferior: ipsilateral proprioceptive info from climbing/mossy fibers

78

Outputs from cerebellum:

Superior peduncle carrying info to contralateral cortex

79

Damage to lateral cerebellum:

impaired coordinated movement of extremities, with falling towards ipsilateral side

80

Effect of dopamine in basal ganglia

Stimulates D1
Inhibits D2 receptors
-->overall will facilitate movement through the direct pathway

81

Describe the direct pathway arc

Increased putamen stimulus
Decreased GPi
Increased thalamus
Increase cortex

82

Describe indirect pathway ard

Increased putamen
Decreased GPe
Increased STN
Increased GPi
Decreased thalamus
Decreased cortex

83

parkinson's changes in brain

lewy bodies with alpha synuclein and loss of Substantia nigra pars compacta dopaminergics

84

Huntington Sx

chorea, aggression, depression, dementia

85

Huntington causes neuronal death through:

NMDA-R binding and glutamate toxicity

86

Huntington=degeneration of:

striatal nucleus (putamen plus caudate

87

intention tremor seen in

cerebellar dysfunction

88

dystonia is:

sustained involuntary muscle contractions

89

Lesion in hemibalismus

contralateral subthalamic nucleus
-->STN normally stimulates the GPi to inhibit the thalamus. Loss of inhibition in basal ganglia!

90

kluver bucy

hyperorality
hypersexuality
disinhibited behavior

91

Kluver bucy lesion

amygdala

92

kluver bucy is associated with

HSV-1

93

Lx: Re-emergence of primitive reflexes

frontal lobe

94

left sided spatial neglect

right parietal lobe

95

lx: wernicke-korsakoff

mamillary bodies

96

intention tremor lesion:

cerebellar hemisphere lesion. (fall to ipsilateral side)

97

PPRF lesion

Eyes look away from side of lesion

98

Frontal eye fields

Eyes look toward lesion

99

Which area of the brain are damaged first in severe HTN? examples of deficits?

watershed regions:
--upper leg/arm weakness
--visual processing

100

Cerebral perfusion is primarily driven by

CO2
Only driven by hypoxemia when po2 < 50

101

Charcot bouchard

chronic HTN, affects small vessels in basal ganglia and thalamus

102

Causes of berry aneurysm

ADPKD
marfant's
ehler danlos

103

site of berry aneurysm

communicating arteries

104

Acomm stroke

visual field defect

105

Pcomm stroke

CN III palsy (eye is down and out)

106

PCA stroke

contralateral hemianopia with macular sparing

107

Stroke lesion:
vertigo, facial paralysis, loss of lacrimation and salivation and taste from anterior tongue, decreased corneal reflex

Face has loss of pain and temperature sensation, ipsilateral horner's

AICA
--FACIAL NUCLEUS lesion
--vestibular nuclei, cranial nerve nuclei, spinal trigeminal nuclei also affected
"Facial droop means AICA's pooped"

108

Stroke lesion:
vertigo; decrealsed pain and temperature to limbs/face
DYSPHAGIA and HOARSENESS, ipsilateral horner's

PICA
--NUCLEUS AMBIGUOUS
"Don't pica hoarse that can't eat (dysphagia)"

109

stroke lesion:
contralateral hemiparesis of lower limbs
Tongue deviates ipsilaterally
Decreased contralateral proprioception

ASA
--lateral corticospinal
--DCML
--caudal medulla

110

lateral striate artery supplies the

striatum and internal capsule. Damage causes contralateral hemiparesis and hemiplegia
--Caused by HTN

111

Stroke lesion:
contralateral paralysis and loss of sensation in the lowerlimb

ACA

112

Lesion: aphasia and loss of motor and sensory from upper limb and face

MCA

113

Which intracranial hemorrhage gives a bloody tap?

subarachnoid hematoma.

114

worst headache of my life

subarachnoid

115

Other causes of intraparenchymal hemorrhage besides HTN

amyloid angiopathy, vasculitis, neoplasm

116

Which parts of the brain are most susceptible to hypoxic damage?

hippocampus
neocortex
cerebellum
watershed

117

red neurons

12-28 hours after injury

118

necrosis and neutrophils in brain

24-72 hrs after injury

119

macrophages in brain

3-5 days

120

reactive gliosis and vascular proliferation

1-2 weeks later

121

What connects the 4th ventricle to the subarachnoid space?

foramina of luschka (lateral) and foramina of magendie (medial)

122

Symptoms of normal pressure hydrocephalus

"wet wobbly and wacky" in elderly. Ventricles expand and cortex contracts

123

communicatin hydrocephalus

caused by decreased arachnoid granulation absorption

124

hydrocephalus ex vacuo

degeneration of cortex results in expanded hydrocephalus

125

fasciculations seen in UMN or LMN lesion?

LMN

126

atrophy seen in UMN or LMN lesion?

LMN

127

Werdnig hoffman disease

Like polio, affects anterior horns

128

Mutation in ALS

superoxide dismutase

129

subacute combined degeneration caused by:

Vit B12/E deficiency

130

Which areas damaged in SubacuteCD?

Dorsal columns
Lateral corticospinal
spinocerebellar
--Ataxia, paresthesia
--Lost position/vibration

131

Infarction of anterior spinal artery damages which parts of spinal cord?

everything but dorsal columns of upper thoracic region

132

How does riluzole work?

Decrease glutamate (excitatory) release

133

floppy baby with hypotonia and tongue fasciculations. Death at 7 months

Werdnig hoffman, autosomal recessive inheritance

134

Friedreich's ataxia caused by

GAA repeat (autosomal recessive)

135

How does Friederich's ataxia present?

Kyphoscoliosis in childhood
--pes cavus
--staggering and falling

136

Loss of pain and temperature on one side, and propioception/vibration on the other side

Brown sequard syndrome. Lesion will be contralateral to the pain and temperature side

137

Contralateral loss of pain and Temp with ipsilateral paralysis of CN V, IX, X, XI

lateral medullary syndrome

138

contralateral paralysis
ipsilateral paralysis of tongue

medial medullary syndrome

139

Some common causes of horner's

Pancoast tumor, brown sequard above T1

140

Describe the pathway for horner's

Hypothalamus__.Spinal cord-->Exit at T1 to sympathetic ganglion-->Pupil

141

Gallbladder pain refers to which area?

the right shoulder (phrenic nerve)

142

C2/C3/C4 dermatomes

C2: skull cap
C3: tutleneck
C4: low cut shirt

143

S2/S3/S4 dermatomes

Penis
Anal zones

144

Biceps reflex

C5/6

145

Triceps reflex

C7/8

146

Patella reflex

L3/L4

147

Galant reflex

Stroking along one side of spine causes newborn to flex lower body toward that side

148

Cranial nerves that come out medially at the brain stem

3, 4, 12

medial to lateral:
3, 4
5 (pons)
6, 7, 8
9, 10
11
12

149

Superior colliculus

conjugate vertical gaze

150

Inferior colliculus

auditory

151

parinaud syndrome

paralysis of conjugate vertical gaze

152

Cause of parinaud

lesion in superior colliculi

153

Innervation of submandibular/sublingual

facial nerve

154

innervation of stapedius muscle

facial

155

innervation of stylopharyngeus

CN IX

156

Innervation of carotid body/sinus

CN IX

157

innervation of parotid gland

CN IX

158

Midbrain CN nuclei

CN 3, 4

159

Pontine CN nuclei

CN 5, 6, 7, 8

160

Medullary CN nuclei

CN 9, 10, 12

161

Spinal cord nuclei

CN 11

162

Corneal reflex afferent/efferent

V1 opthalmic
VII efferent

163

Lacrimation afferent/efferent

V1 afferent
VII efferent

164

Three vagal nuclei

Solitarius
Ambiguous
Dorsal motor nucleus

165

Innervation to nucleus solitarius

7, 9, 10 (taste, baroreceptors, gut)

166

nucleus ambiguus sends what fibers

9, 10 (motor innervation of pharynx, larynx, and upper esophagus)

167

dorsal motor nucleus sends what fibers

10 (parasympathetic fibers to heart, lungs, GI)

168

Optic canal contents

CN II, opthalmic, central retinal vein

169

Superior orbital fissure contents

III, IV< V1, VI, ophthalmic vein

170

Foramen spinosum contents

Middle meningeal

171

Internal auditory meatus

CN VII, VIII

172

Jugular foramen

CN 9, 10, 11

173

Foramen magnum

CN 11

174

Hypoglossal canal

CN 12

175

Cavernous sinus drains blood from:

eye and superficial cortex

176

Which nerves travel through the cavernous sinus?

3, 4, V1, V2, 6

177

Opthalmoplegia with normal vision
-decreased corneal and maxillary sensation

cavernous sinus syndrome

178

CN V motor lesion sign

Jaw deviates toward lesion

179

CN X lesion

uvual deviates away

180

CN XI lesion

weakness turning head away from lesion

181

CN XII lesion

tongue deviates toward lesion (lick the lesion)

182

Conductive hearing loss finding

Abnormal rinne, localization to affected hear in weber

183

Sensorineural hearing loss finding

Normal rinne, localizes to unaffected ear

184

Which muscle opens the jaw?

lateral pterygoid

185

which muscles close the jaw?

masster, temporalis, medial pterygoid

186

if near sighted, light focuses...

in front of retina

187

hyperopia/myopia

far/nearsighted

188

Uveitis is inflammation of:

uveal coat (iris, ciliary body, choroid)

189

Causes of retinitis

viral (CMV, HSV, HZV)

190

Sx of open angle glaucoma

Painless Peripheral then central vision loss

191

Cause of open angle glaucoma

Block of trabecular meshwork. Angle between the iris and cornea is "open"

192

Sx of chronic closed angle glaucoma

asymptomatic usually. May lose peripheral vision

193

Sx of acute closed angle glaucoma

painful sudden vision loss with a rock hard eye

194

What should you NOT give in acute closed angle glaucoma?

epinephrine--causes mydriasis and constriction of pupillary dilator muscle

195

pupillary dilator innervated by

Alpha 1

196

Pupillary sphincter innervated by

M3

197

Ciliary epithelium innervated by

Beta receptors--will produce more aqueous humor

198

Signs of CN IV damage

Eyes move up when looking contralateral or when tilting head down (cannot see when walking down stairs)

199

Miosis pathway

EW nucleus to ciliary ganglion by CN III
--Short ciliary nerve to pupillary sphincter

200

Mydriasis pathway

Hypothalamus to center of budge
--Exit T1 to superior cervical ganglion
--Travel along internal carotid, long ciliary nerve to pupillary dilator

201

Light compression of CN III results in

Blown pupil. Parasympathetics travel on the outside

202

"curtain drawn down" on eyes preceded by flashes and floaters

retinal detachment

203

Loss of central vision not caused by stroke

Macular degeneration

204

dry vs wet MD

dry most common: with yellow material beneath retinal pigment (drusen).

Wet: rapid loss of vision from bleeding off of choroidal neovascularization. Will see gray subretinal membrane

205

treatment for dry AMD

multivitamin and antioxidants

206

Meyer's loop travels through

Temporal lobe carrying visual fibers

207

Dorsal optic radiation travels through

parietal lobe

208

Rapidly progressive dementia with startle myoclonus

Creutzfeldt-Jakob dz

209

Dementia, aphasia, parkinsonism and change in personality

Pick's disease

210

Which areas of the brain are affected in Pick's disease?

frontotemporal lobes

211

histology of creutzfeldt-jakob

spongiform cortex with prions

212

Spherical tau protein aggregates

pick bodies

213

which genes cause early onset alzheimer's?

APP (chromosome 21), presenilin-1/2 (chromosome 14), and ApoE4 (chromosome 19)

214

Which gene is protective against alzheimer's?

ApoE2

215

Lab findings in multiple sclerosis

Increased protein IgG
Oligoclonal bands
MRI

216

Treatment for multiple sclerosis:

Beta interferon
immunosuppression
natalizumab

217

Symmetric ascending muscle paralysis

Acute inflammatory demyelinating polyradiculopathy (Guillain barre)

218

Treatment for GBD

respiratory support
--consider IV globulins and plasmapheresis

219

Dx of GBD

Increased protein in CSF

220

Progressive multifocal leukoencephalopathy

demyelination of CNS from destruction of oligodendrocytes

221

PML is associated with

JC virus

222

Multifocal pervenular inflammation and demyelination after infection

Acute disseminated encephalomyelitis

223

Metachromatic leukodystrophy

Auto-recessive lysosomal storage disease caused by arylsulfatase A deficiency. Sulfatides build up and impair myelin sheath

224

Krabbe's disease

Lysosomal storage disease with deficiency of galactocerebrosidase. Build up of galactocerebroside destroys the myelin sheath

225

Charcot marie-tooth disease

Weakness of dorsiflexion from demyelination of common fibular nerve
--Defect in myelin protein gene

226

Prophylactic for migraines

propranolol and topiramate

227

Inheritance of sturge weber

sporadic

228

Sx of sturge weber

port wine stain
AVM (leptomeningeal angiomas)
Pheos
glaucoma
seizures

229

Sx of tuberous sclerosis

Hamartomas
Cutaneous angiofibromas
Ash leaf spots
Cardiac rhabdomyomas
Tubers
retardation
seizures
renal angiomyolipoma
AUTO DOM

230

Sx of NF 1

Cafe au lait
Lisch nodules
neurofibromas
Optic gliomas
Pheo
AutoDOM
--Mutation on NF-1 of CHROM 17

231

Sx of VHL

Cavernous hemangioma
bilateral renal cell carcinoma
Retinal Hemangioblastomas
pheo
AUTO DOM
VHL on chromosome 3

232

Butterfly looking tumor

gliblastoma multiforme

233

GFAP + tumor

glioblastoma multiforme in adults
pilocytic astrocytoma in kids

234

Pseudopalisading tumor

gbm

235

What is the most common and 2nd most common primary brain tumor?

GBM then meningioma

236

spindle cells in a whorled pattern with psamomma bodies

meningioma

237

bilateral acoustic schwannoma

NF-2

238

S-100 positive

Schwannomas

239

Slow growing, Fried egg tumor

Oligodendroglioma.

240

1p:19q deletion tumor

Oligodendroglioma

241

Pituitary adenoma presents as

Prolactinoma usually.

242

Rosenthal fibers

pilocytic astrocytoma

243

pilocytic astrocytomas found in

posterior fossa

244

pilocytic astrocytoma good or bad prognosis?

good

245

homer wright rosettes

medulloblastoma

246

tumor that compresses 4th ventricle, causing hydrocephalus

medulloblastoma and ependyoma

247

tumor sends drop metastases to spinal cord

medulloblastomsa

248

PNET tumor

medulloblastoma

249

Most childhood tumors are found in cerebellum except

ependyoma and craniopharyngioma

250

perivascular pseudorosettes and rod-shaped blepharoplasts

ependyoma

251

Childhood tumor associated with VHL and EPO producing

hemangioblastoma

252

Foamy cells and high vascularity tumor

hemangioblastoma

253

verocay bodies

NF-2

254

brimonidine

alpha 2 agonist, decreases aqueous humor synthesis

255

epinephrine treats glaucoma by....

decreasing aqueous humor through vasoconstriction

256

Timolol, betaxolol, carteolol

Decrease aqueous humor synthesis without vision change

257

Side effect of alpha agonists for glaucoma

Alpha receptors dilate the pupil, causing mydriasis

258

Acetazolamide mechanism for glaucoma

decreased aqueous humor synthesis by inhibition of carbonic anhydrase
--no pupillary/vision change

259

pilocarpine/carbachol for glaucoma

Increase outflow of aqueous humor by contraction of ciliary muscle (M3) and opening trabecular meshwork. Causes miosis and cyclospasm
--Pilocarpine esp good for emergencies (acute closed angle)

260

Physostigmine, echothiophate

Indirect cholinergics, also used for glaucoma by contracting ciliary muscles and opening trabecular network

261

Latanoprost for glaucoma

Increase outflow of aqueous humor

262

Side effect of latanoprost

Darkens color of iris

263

Class: meperidine, dextromethorphan, diphenoxylate

Opioids

264

Mechanism of opioids

Bind to receptors
--open K channels, close Ca channels
--Decrease transmission
--inhibits release of Ach, Ne, Serotonin, glutamate, sub P

265

Use of loperamide and diphenoxylate

diarrhea

266

Butorphanol

Partial mu agonist and kappa opioid agonist

267

use: butorphanol

severe pain, good b/c less respiratory depression

268

Problem with using butorphanol

cannot reverse overdose as well with naloxone

269

Tramadol side effect

decrease seizure threshold + normal opioid side effects

270

Use of tramadol

chronic pain

271

Mechanism tramadol

weak opioid agonist that inhibits serotonin and NE reuptake

272

First line for partial seizure

carbamazepine

273

First line for tonic clonic

phenytoin
valproic acid
carbamazepine

274

First line for prophylaxis against status epilepticus

phenytoin

275

Which drugs are only for partial seizures (most are for both)

tiagabine and vigabatrin

276

First line for trigeminal neuralgia

carbamazepine

277

mechanism phenytoin

sodium channel inactivation

278

mechanism carbamazepine

sodium channel inactivation

279

mechanism lamotrigine

Blocks voltage gated Na channels

280

Gapapentin mechanism

Inhibits voltage Ca channels

281

Other uses of gapapentin besides seizures

postherpetic neuralgia
peripheral neuropathy
bipolar disorder
migraines

282

First line drug for seizures in children

Phenobarbital

283

Mechanism of topiramate

Blocks Na channels and increases GABA action

284

Mechanism of phenobarbital

Increases GABAa action by increasing duration of Cl- channel opening

285

Mechanism of ethosuximide

Blocks thalamic T type calcium channels

286

Benzo mechanism

Increase GABA by increasing frequency of Cl- channel opening

287

Tx for seizures of eclampsia

Mg SO4

288

Tigabine mechanism

Inhibits GABA

289

Vigabatrin mechanism

Inhibits GABA transaminase to increase GABA

290

Stevens Johnson syndrome occurs with which drugs

Carbamazepine
Ethosuximide
phenytoin
lamotrigine

291

Sx of stevens johnson

purpuric macules-->epidermal necrosis and sloughing

292

Carbamazepine side effects

agranulocytosis
teratogen
SIADH

293

Which seizure drugs induce p-450

carbamazepine
phenobarbital
phenytoin

294

Which seizure drugs are contraindicated in pregnancy

carbamazepine
phenytoin
valproid acid

295

Lateral horn of spinal cord

Carries sympathetic fibers. Starts at T1. Knocked out in an expanded syringomyelia

296

Frataxin gene normally regulates:

iron

297

Friedreich ataxia is associated with what heart defect?

Hypertrophic cardiomyopathy

298

the last stage of a healed stroke is

A gliotic cyst

299

Xanthochromia

yellow spinal tap from hemoglobin

300

Which chromosome is amyloid precursor protein found on?

Chromosome 21!

301

Which layers of the cortex consist of the pyramidal neurons?

3,5,6. these are most susceptible to damage with a stroke

302

tau protein normally does what?

makes microtubules in cells

303

MTPT causes

Parkinson's

304

how do you tell apart lewy body dementia from parkinsons?

In Parkinson's, dementia is a VERY late finding. early onset dementia suggests lewy body dementia.

Lewy bodies are found in cortex in lewy body dementia

305

how do you treat Normal pressure hydrocephalus?

Shunt the CSF. Sx will improve with lumbar puncture (decrease CSF pushing on brain tissue)

306

Spongiform encephalopath histology

White open bubbles (spongy!)

307

Side effects of phenytoin

Ataxia
Gingival hyperplasia
hirsuitism
megaoblastic anemia
SLE syndrome
osteopenia
fetal hydantoin syndrome

308

Side effect of valproic acid

Hepatotoxicity (check LFTs)
GI distress
weight gain
neural tube defects

309

Side effect of topiramate

sedation
mental dulling
kidney stones
weight loss

310

Which benzos have a higher addictive potential?

short acting
1. triazolam
2. oxazepam
3. midazolam

311

uses of benzos

anxiety (blue jasmine)
status epilepticus
delirium tremens
night terrors/sleep walking
insomnia

312

How do you treat a benzo overdose

flumenazil, a competitive GABA antagonist. Generally less addictive than barbiturates

313

How do the non-benzo hypnotics work?

BZ1 subtype of GABA receptor. effects are also reversed by flumenazil

314

Rapid induction anesthetics have what property?

Decreased solubility in blood

315

Potent drugs have what property?

Increased solubility in lipids, determined by 1/MAC. Therefore a SMALL MAC means a highly potent drug

316

tox: halothane

hepatotoxicity

317

tox: methoxyflurane

nephrotox

318

tox: enflurane

convulsant

319

tox: inhaled anesthetics

malignant hyperthermia (except nitrous oxide). Nitrous oxide can expand trapped gas in a body cavity

320

Thiopental

IV barbiturate used to induct anesthesia

321

IV benzo

midazolam. used for endoscopy

322

side effect of midazolam

severe respiratory depression

323

Ketamine mech

blocks NMDA receptors. analog of PCP

324

Side effect of ketamine

hallucination/bad dreams

325

Propofol use

sedation in ICU, rapid anesthesia induction. less nausea than thiopental.

326

How does propofol work?

Potentiates GABAa

327

Local anesthetics: two types?

esters: procaine, cocaine, tetracaine
Amides: lidocaine, mepivacaine, bubivacaine

328

How do local anesthetics work?

Block Na channels on INNER portion of channel. Often combined with epinephrine to enhance action

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Side effect of bupivacaine

cardiovascular toxicity

330

Other side effects of local anesthetics

Hypertension, hypotension, arrythmias

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two phases of succinylcholine?

Phase I: depolarization: No antidote
Phase II: repolarized but blocked. Antidote=cholinesterase inhibitor like neostigmine

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Side defect of succinylcholine

hypercalcemia
hyperkalemia
malignant hyperthermia

333

Nondepolarizing NMJ blockers

"-curiums"
--These are NMJ ACh receptor competitive antagonists

334

Dantrolene mechanism

prevents release of Ca from SR of muscle.

335

Clinical use of dantrolene

Treatment of malignant hyperthermia. A side effect of inhaled anesthetics and succinylcholine

Also for neuroleptic malignant syndrome

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What predisposes you to malignant hyperthermia?

Genetics

337

Dopamine agonists for parkinson's

Bromocriptine (ergot)
pramipexole (non-ergot)
Non-ergots are better

338

Parkinson drug that increases dopamine

Amantadine
L-dopa/carbidopa (converted to dopamine in CNS)

339

Toxicity of amantadine

ataxia

340

Selegiline mechanism

Prevents dopamine breakdown by blocking MAO

341

entacapone, tolcapone mechanism

COMT inhibitors preventing L dopa degradation in parkinsons

342

Benztropine

For parkinsons, an antimuscarinic that improves tremor and rigidity
"Park your benz"

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What's the role of carbidops in the levodopa/carbidopa combo?

L dopa is converted to dopamine in the CNS. Carbidopa is a decarboxylase inhibitor that STAYS in the peripheral circulation and prevents L dopa activation in the periphery.

344

Side effects of levodopa

dyskinesia and arrhythmias

345

Memantine

NMDA antagonist for alzheimers

346

Donepezil, rivastigmine, galantamine

Acetylcholinesterase inhibitors for alzheimer's

347

Side effects of memantine

dizziness/confusion/hallucination

348

Side effect of donepezil

nausea/dizziness/insomnia

349

treatment for huntington

tetrabenzine and reserpine inhibit the VMAT limiting dopamine release

Also haloperidol, a dopamine antagonist

350

Sumatriptan mechanism

5HT/1b1d agonist that inhibits trigeminal nerve activation.

351

Sumatriptan is contraindicated in

coronary vasospasm (CAD or prinzmetal's angina)

352

cherry red spot on macula

retinal artery occlusion

353

Negative rinne test

Louder outside the ear than in the mastoid bone.

354

Abnormal Rinne

Conductive hearing loss

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Normal Rinne

Sensorineural hearing loss

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Medulloblastoma sx

Gait and limb ataxia

357

bursts of conjugate eyemovements in many directions with hypotonia and myoclonus. Also an abdominal mass. and HTN

Neuroblastoma in kids. Generated in the adrenal medulla causing secretion of catecholamines

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gene responsible for neuroblastoma

c-myc

359

Signs of guillain barre on microscopy

segmental demyelination and endoneural inflammation

360

Loss of vibration/position
Paresis (spastic)
Ataxia

Subacute combined degeneration
Dorsal column loss
Lateral cerebrospinal tract loss

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Demyelination of peripheral nerves withOUT perineural inflammation

Beriberi (thiamine deficiency).
--pain and paresthesia with muscle weakness and areflexia

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Which sensory pathway is the only one that does not go through the thalamus?

smell

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Where would you find the area postrema?

Dorsal medulla, at the caudal end of the fourth ventricle

364

Marcus Gunn pupils

Light shown in one eye fails to show pupillary constrict on both sides.
--Note that NASAL portion of the retina contributes more input to the pretectal nucleus....so an optic tract defect could cause marcus gunn (even though light input to both eyes! so tricky!)

365

neurofibromas are made of

schwann cells, derived from neural crest

366

inhaled anesthetics have what system wide effect?

Increased cerebral blood flow
Myocardial depression
hypotension
respiratory depression
decreased renal function

367

CN III: compression vs ischemia?

Compression damages parasympathetics first. Ischemia only affects somatic fibers (ptosis, down and out eye) with intact parasympathetics (PERRLA)

368

Ergot compounds

bromocriptine and pergolide

369

nonergot componds

pramipexole and ropinirole

370

How do ergot/nonergot compounds work?

They directly stimulate the dopamine receptors