Neurology Flashcards
1
Q
In which part of the brain is atrophy most pronounced in Alzheimer’s
A
Hippocampus and frontal lobe
2
Q
CNS/PNS cells that originate from Neuroectoderm
A
- CNS neurons
- ependymal cells (make CSF)
- Oligodendroglia
- Astrocytes
3
Q
CNS/PNS cells that originate from Neural Crest:
A
- Schwann cells
- PNS neurons
4
Q
CNS/PNS cells that originate from Mesoderm:
A
- Microglia
* **note: microglia=macrophages of the brain!
5
Q
Nissl substance
A
RER in cell body, dendrites of neurons; NOT in axons
6
Q
GFAP
A
astrocyte marker
–>so, also a marker for astrocyte tumors: glioblastoma and pilocytic astrocytoma
7
Q
Astrocytes:
- roles?
- marker for astrocytes?
A
physical support and repair; maintain BBB; create scar tissue in response to injury
*GFAP = astrocyte marker (elevated in astrocyte tumors: glioblastoma and pilocytic astrocytoma)
8
Q
macrophages/phagocytes of the CNS?
A
- ->Microglia
- mesodermal origin
- when tissue damage, microglia respond by differentiating into large phagocytic cells
- HIV-infected microglia fuse to form giant cells in CNS
9
Q
oligodendrocytes:
A
produce myelin in the CNS
- one oligodendrocyte can myelinat many CNS axons (up to 30!)
- destroyed in MS!
- Look like fried eggs on histology
10
Q
Schwann cells
A
produce myelin in the PNS
-one Schwann cell only myelinates one PNS axon
11
Q
Cell types that look like fried eggs on histology (various, not just neuro):
A
- Oligodendrocytes
- Koilocytes (HPV)
- Seminomas
12
Q
Type of cells that are destroyed in MS?
A
Oligodendrocytes
13
Q
Type of cells destroyed in Guillain-Barre syndrome?
A
Schwann cells
14
Q
Acoustic neuroma:
A
type of Schwannoma; usually located in internal acoustic meatus (CN VIII)
–>see bilateral acoustic schwannomas in NF 2)
15
Q
Endoneurium, Perineurium, Epineurium
A
Endoneurium: surrounds single nerve fibers
Perineurium: surrounds a fascicle of nerve fibers
Epineurium: dense connective tissue that surrounds an entire nerve
16
Q
Diseases with increased NE?
A
- ->Anxiety
- ->Mania
17
Q
Disease with decreased NE?
A
Depression
18
Q
Disease associated with increased dopamine?
A
Schizophrenia
19
Q
Diseases with decreased dopamine?
A
- Parkinson’s
- Depression
20
Q
Diseases with decreased serotonin (5-HT)?
A
- Anxiety
- Depression
21
Q
Diseases with decreased Ach?
A
- Alzheimer’s
- Huntington’s
22
Q
Disease with increased ACh?
A
- Parkinson’s
- Also: increased ACh in REM sleep (b/c ACh is the principal neurotransmitter in REM sleep)
23
Q
Diseases with decreased GABA?
A
- Anxiety
- Huntington’s
24
Q
What is synthesized in Locus ceruleus?
A
- ->location of NE synthesis
- stress and panic! (elevated NE)
25
What is synthesized in Raphe nucleus?
location of serotonin synthesis
26
What is synthesized in Nucleus Accumbens?
- GABA
| - ->nucelus accumbens and septal nucleus = reward center, pleasure, addiction, fear
27
What is synthesized in the ventral tegmentum?
Dopamine
28
What is synthesized in the basal nucleus of Meynert?
ACh
29
What vitamin is used in GABA synthesis? What is the precursor to GABA?
Glutamate is the precursor to GABA
| -->Vitamin B6 = cofactor in GABA synthesis from Glutamate
30
3 structures that form the blood-brain-barrier:
- tight junctions (b/w endothelial cells)
- basement membrane
- astrocyte processes
31
What types of substances can cross the BBB rapidly via diffusion?
Nonpolar/Lipid-soluble substance (lots of anesthetic agents are lipid-soluble!)
32
What substances can cross the BBB slowly by carrier-mediated transport?
glucose and amino acids
33
How does glucose get across the BBB?
glucose crosses the BBB slowly by carrier-mediated transport mechanism
34
Area postrema of the brain
-->area of the brain that has fenestrated capillaries and no BBB; crossing of substances into this area is what results in vomiting post chemo
*Area postrema inputs info into the hypothalamus
35
OVLT = organum vasculosum of lamina terminalis
area of the brain that has fenestrated endothelium and lacks BBB (like the area postrema)
-->can sense osmolarity of the blood and respond (ie by regulating ADH-releasing neurons)....
36
supraoptic nucleus of the hypothalamus:
makes ADH
37
paraventricular nucleus of the hypothalamus:
makes oxytocin
38
Functions of the Hypothalamus:
"Hypothalamus wears TAN HATS"
- Thirst and water balance
- Adenohypophysis regulation
- Neurohypophysis releases hormones from the hypothalamus (ADH, oxytocin)
- Hunger
- Autonomic regulation
- Temperature regulation
- Sexual urges
39
Lateral area/nucleus of the hypothalamus:
- role?
- if destroyed?
- inhibited by?
- ->responsible for hunger
- if destroyed, get anorexia, FTT in infants
- inhibited by leptin (leptin-->decreased hunger)
"if zap the lateral nucleus, you shrink laterally!"
40
Ventromedial area/nucleus of the hypothalamus:
- role?
- if destroyed?
- stimulated by?
- involved in satiety
- if destroyed (ie craniopharyngoma) --> don't get full, eat more = hyperphagia
- stimulated by leptin
"if zap ventromedial nucleus, you grow ventrally and medially"
41
Anterior hypothalamic nucleus:
| -Role?
Involved in cooling the body
| "Anterior Cools like an A/C"
42
Posterior hypothalamic nucleus:
involved in heating the body
43
Suprachiasmatic nucleus:
| -role?
involved in the circadian rhythm
44
Which hypothalamic nuclei send axonal projections to the post pituitary?
- supraoptic nucleus --> ADH
| - paraventricular nucleus --> oxytocin
45
VPL (Ventral Posterolateral) Nucleus of the Thalamus:
| -role?
* Roles in:
- pain and temperature
- pressure
- touch
- vibration
- proprioception
*where the dorsal column and spinothalamic tracts have their 2nd synapses!
46
VPM (Ventral Posteromedial) nucleus of the thalamus:
| -role?
"Make-up goes on the face; vpM"
| -->face sensation and taste
47
LGN (lateral geniculate) nucleus of the thalamus:
"L for Light"
| -->involved in relaying vision
48
MGN (medial geniculate nucleus) of the thalamus:
"M for Music"
| -->involved in relaying Hearing
49
What is the function of the thalamus?
Thalamus is the major relay center for all ascending sensory information, except olfaction
-->relays sensory and motor information to the cerebral cortex
50
Thalamic syndrome: Vascular lesion to the thalamus (from ischemic or hemorrhagic stroke) - what are the results/symptoms?
-->damage to VPL and VPM nuclei; so get complete CONTRALATERAL SENSORY loss. may also have proprioceptive defects. NO motor deficits.
51
What structures make up the Limbic System?
- Hippocampus
- Cingulate gyrus
- Fornix
- Mammillary bodies
- Septal nucleus (reward center, pleasure, addiction, fear)
52
What are the Functions of the Limbic System?
5 F's - all are primitive functions:
- Feeding
- Fleeing
- Fighting
- Feeling
- sex
53
What information does the cerebellum receive contralaterally? ipsilaterally?
Cerebellum receives:
- contralateral cortical input
- ipsilateral proprioceptive information
54
Deep nuclei of the cerebellum (from Lateral to Medial):
"Dentists Embody Global Fasts"
- Dentate
- Emboliform
- Globose
- Fastigial
*note: Emboliform and Globose nuclei = "interposed nuclei"
55
Main function of Basal Ganglia?
-->Voluntary movements and making postural adjustments
56
Depigmentation of substantia nigra pars compacta? What role does the substantia nigra normally play?
Parkinson's syndrome:
-->the substantia nigra is part of the basal ganglia, and normally facilitates movement. But, in Parkinson's get loss of dopaminergic neurons, so get inhibition of movement from basal ganglia.
57
Main symptoms of Parkinson's:
"TRAP"
- Tremor at rest ("pill-rolling tremor")
- cogwheel Rigidity
- Akinesia
- Postural instability
*have decreased dopamine, increased ACh
58
Hemiballismus
- sudden, wild flailing of 1 arm +/- leg
- ->get this with contralateral subthalamic nucleus lesion (like a lacunar stroke in a pt with HTN hx)
- ->loss of inhibition of thalamus through the globus pallidus (of the basal ganglia)
59
Neuronal death via NMDA-R binding and glutamate toxicity; and, atrophy of striatal nuclei in what disease?
Huntington's disease
60
C's of Huntington's disease:
- Chorea (b/c atrophy of striatal nuclei, which normally inhibits movement; so, get increased movement)
- Caudate nucleus degeneration
- Crazy (dementia)
- CAG repeats
- decreased ACh and decreased GABA
"CAG --> Caudate loses ACh and GABA"
(decreased GABA-->increased movement)
61
Chorea is seen in what types of brain injuries?
-->injuries to basal ganglia (like in Huntington's)
62
Athetosis:
- what is it?
- seen in what types of brain injuries?
- ->slow, writhing movements, especially of fingers (snake-like)
- ->see in basal ganglia lesions (like Huntington's)
63
Myoclonus
=sudden, quick muscle contractions; like hiccups, jerks.
64
Intention Tremor
slow, zigzag movement when pointing toward an object; associated with cerebellar dysfxn, MS
(vs essential/postural tremor --> familial, alcohol, beta-blockers; and resting tremor --> Parkinson's)
65
Kluver-Bucy syndrome:
- presentation?
- d/t lesion in what part of brain?
- associated with what virus?
- Hyperorality, hypersexuality, disinhibited behavior
- bilateral lesion of the amygdala
- associated with HSV-1
66
Spatial neglect syndrome:
| -->d/t lesion to what area of brain?
lesion of Right parietal lobe (assuming that Right = NON-dominant lobe)
*don't recognize/see contralateral side of the world!
67
Reduced levels of arousal and wakefulness (ie coma) d/t lesion of what area of brain?
Reticular Activating System (in midbrain)
68
What area of the brain is lesioned in Wernicke-Korsakof syndrome?
Bilateral lesion to mammillary bodies
69
Presentation of Wernicke-Korsakoff syndrome?
* Wernicke: confusion, ophthalmoplegia, ataxia
| * Korsakoff: memory loss, confabulation, personality changes
70
Tremor at rest, chorea, athetosis (snake-like mvmnts): what area of brain is lesioned?
-->Basal ganglia lesion
71
Truncal ataxia and dysarthria: what area of brain is lesioned?
Cerebellar vermis
| *note: lesion to cerebellar hemispheres affects lateral limbs; whereas lesion to cerebellar vermis affects central body.
72
Contalateral hemiballismus: what area of brain is lesioned?
-->lesion to subthalamic nucleus
73
Anterograde amnesia=can't make new memories: area of brain lesioned?
-->Hippocampus lesion
74
Eyes look AWAY from side of lesion: area of brain lesioned?
-->PPRF lesion (Paramedian Pontine Reticular Formation)
75
Eyes look TOWARD lesion: area of brain lesioned?
Frontal eye fields
76
Consequence of correcting hyponatremia too rapidly?
- ->Central Pontine Myelinolysis:
- Acute paralysis
- Dysarthria (motor inability to speak)
- Dysphagia
- Diplopia
- Loss of consciousness
- on MRI, see abnormally increased signal in pons
- IRREVERSIBLE!
77
Aphasia vs Dysarthria:
- Aphasia = higher-order inability to speak
| - Dysarthria = motor inability to speak
78
Where is Broca's area?
Inferior frontal gyrus
79
Where is Wernicke's area?
Superior temporal gyrus
80
Conduction aphasia:
- presentation?
- cause?
-->No connection between what pt says and what pt understands (comprehension is intact, and have fluent speech, but no connection between comprehension and speech)
*caused by lesion to: Arcuate fasciculus = connects Broca's and Wernicke's areas
81
Arcuate fasciculus
connects Broca's and Wernicke's areas
82
Area supplied by the Anterior Cerebral Artery?
-->anteromedial surface
83
Area of brain supplied by Middle Cerebral Artery?
-->lateral surface of brain
84
Area of brain supplied by Posterior Cerebral Artery?
-->posterior and inferior surfaces
85
Which artery supplies Broca's and Wernicke's areas?
MCA (b/c MCA supplies lateral surface of brain...)
86
What drives Cerebral Perfusion Pressure, PCO2 or PO2?
- ->PCO2 normally drives the cerebral perfusion pressure
* But, in severe hypoxia (when PO2 < 50 mmHg) PO2 also drives the cerebral perfusion pressure
**Cerebral Perfusion Pressure is proportional to PCO2 until PCO2 > 90 mmHg, then cerebral perfusion pressure levels off)
87
Which arteries are responsible for anterior circulation? posterior circulation?
* Anterior circulation--> arteries derived from Internal Carotid: ACA, Lateral striate, MCA
* Posterior circulation--> arteries derived from Subclavian: AICA, ASA (ant spinal artery), Basilar, PICA, PCA, Vertebral
88
Most common sites of saccular/berry aneurysms? 2nd most common site?
```
#1 = AComm (ant communicating artery)
#2 = PComm (post communicating artery)
```
89
What does rupture of a saccular/berry aneurysm lead to?
-->hemorrhagic stroke/subarachnoid hemorrhage
90
3 conditions associated with berry aneurysms?
- ADPKD
- Marfan's syndrome
- Ehlers-Danlos syndrome
91
CN III palsy:
- presentation?
- cause?
- eye is "down and out"
| - cause = PCOM aneurysm rupture (saccular/berry aneurysm)
92
Bitemporal hemianopia/visual field defects:
| -cause?
-->AComm sacular/berry aneurysm rupture
93
Contralateral hemianopsia with macular sparing:
| -->area of lesion? what artery is stroke in?
* macular sparing = hallmark of occipital lob lesions
| * this is an occipital cortex, visual cortex lesion; d/t stroke in PCA
94
Charcot-Bouchard microaneurysms:
- associated with chronic hypertension
| - affects small vessels (ie in basal ganglia, thalamus)
95
Cause of epidural hematoma?
-->rupture of middle meningeal artery (branch of maxillary artery), often secondary to fracture of temporal bone
96
Cause of subdural hematoma?
- ->rupture of bridging veins
* Seen in:
- elderly
- alcoholics
- blunt trauma
- shaken baby
97
Shaken baby syndrome causes what kind of intracranial hemorrhage?
-->subdural hematoma
98
Cause of subarachnoid hemorrhage?
-->rupture of aneurysm (ie berry aneurysm) or AVM (ArterioVenous Malformation --> problem in vein-artery connection)
99
Time course of a subarachnoid hemorrhage?
-->Rapid
100
Risks 2-3 days after a subarachnoid hemorrhage?
- ->Risk of vasospasm d/t blood breakdown (constriction of blood vessels) --> prevent vasospasm with CCB = Nimodipine
- ->Risk of rebleed
101
How to prevent vasospasm following a subarachnoid hemorrhage?
--> treat with Nimodipine (a CCB)
102
Most common sites of Intraparenchymal/Hypertensive Hemorrhage?
-->basal ganglia and internal capsule
*usually caused by hypertension, but may also be caused by amyloid angiopathy, vasculitis, and neoplasms.
103
Ipsilateral hypoglossal dysfunction (tongue deviates ipsilaterally); contralateral hemiparesis; pain and temp preserved: what artery is lesioned?
ASA = Anterior Spinal Artery
104
loss of pain and temperature sensation on ipsilateral face, but contralateral body: What artery is lesioned?
PICA (posterior inferior cerebellar artery)
- ->this is Lateral Medullary/Wallenberg's syndrome
* **Other findings:
- dysphagia, hoarseness, decreased gag reflex, ipsilateral Horner's syndrome, ataxia, etc...
105
Dysphagia, hoarseness, and decreased gag reflex; ipsilateral Horner's syndrome: What artery is lesioned?
-->PICA ("don't PICK A (pica) HORSE (hoarseness) that CAN'T EAT (dysphagia)!"
* ** find this in Lateral medullary / Wallenberg's syndrome
- ->Other findings:
- decreased pain/temp sensation on ipsilateral face, contralateral body
- ataxia, dysmetria
- vomiting, vertigo, nystagmus
106
Lateral Medullary/Wallenberg's syndrome:
- what artery is lesioned (where is stroke)?
- presentation?
* stroke in PICA
* presentation:
- decreased pain/temp sensation on ipsilateral face and contralateral body
- hoarseness, dysphagia, decreased gag reflex
- ataxia, dysmetria
- ipsilateral horner's
- vomiting, vertigo, nystagmus
107
Paralysis of face (Facial Drooping); ipsilateral Horner's; decreased lacrimation, salivation; decreased pain/temp sensation on face; decreased hearing ipsilaterally, vomiting, vertigo, nystagmus: What artery is lesioned/where is stroke?
-->AICA (ant inf cerebellar artery)
=Lateral Pontine Syndrome
***Facial nucleus affects = specific to AICA lesions
108
Contralateral hemiplegia/hemiparesis: What artery is lesioned/where is stroke?
-->Lateral striate arteries = "arteries of stroke"; usually secondary to unmanaged HTN (so area lesioned= striatum and internal capsule)
109
Contralateral paralysis and loss of sensation on UPPER limb and face: what artery is lesioned?
-->MCA (Middle Cerebral Artery)
110
Contralateral paralysis and loss of sensation on LOWER limb: what artery is lesioned/where is stroke?
-->ACA = Anterior Cerebral Artery
111
Areas of the brain that are most vulnerable to ischemia/irreversible injury from ischemia?
- hippocampus
- neocortex
- cerebellum
- watershed areas
112
Ischemic brain injury - what's seen at each time after damage:
* 12-48 hours?
* 24-72 hours?
* 3-5 days?
* 1-2 weeks?
* after 2 weeks?
* 12-48 hours: red neurons (=neurons that are dying d/t ischemia :()
* 24-72 hours: necrosis + neutrophils
* 3-5 days: macrophages
* 1-2 weeks: reactive gliosis + vascular proliferation
* after 2 weeks: glial scar (glial cells = fibroblasts of the brain)
113
Treatment of an ischemic stroke?
tPA as long as it's within 4.5 hours of stroke
114
Stroke imaging: CT and MRI; hemorrhagic vs ischemic strokes?
* Can see area on MRI within 3-30 minutes, and continue to see for 10 days (can see signs of ischemia on MRI)
* Can see on CT within 24 hours; but, can only see signs of hemorrhagic stroke, not ischemic...
115
CSF: produced by? reabsorbed by?
CSF is produced by choroid plexus
CSF is reabsorbed by venous sinuses via arachnoid granulations; arachnoid granulations drain into the superior sagittal sinus
116
Pathway of CSF: from lateral ventricle to subarachnoid space:
* Lateral ventricle --> 3rd ventricle via Foramen of Monro
* 3rd ventricle --> 4th ventricle via Cerebral aqueduct
* 4th ventricle to subarachnoid space via Foramina of Luschka (laterally) and Foramen of Magendie (medially)
117
Dementia + Ataxia + Urinary Incontinence:
Normal Pressure Hydrocephalus
-->Expansion of ventricles (see really dilated ventricles); No increase in subarachnoid space volume
*this is a cause of reversible dementia in elderly pts; why it's so important to do a CT in a dementia work-up!!
**"Wet (incontinenc), Wobbly (ataxia), Wacky (dementia)"
118
Communicating Hydrocephalus:
- cause?
- presentation?
*decreased absorption of CSF by arachnoid granulations--> increased CSF within ventricles (maybe d/t arachnoid scarring, like after meningitis)
* presentation/results:
- increased ICP
- papilledema
- herniation
"communicating" --> b/c CSF still flows between ventricles
119
Obstructive/Non-communicating hydrocephalus:
| -cause?
Blockage of CSF circulation (like d/t a brain tumor, or stenosis of the cerebral aqueduct (aqueduct of Sylvius)
120
Hydrocephalus ex vacuo:
Have atrophy of brain (like in Alzheimer's, advanced HIV, Pick's disease), so it appears like there is increased amount of CSF. But no symptoms, and ICP is normal.
121
Spinal Nerves:
- how many total?
- how many of each type?
- where do they exit the vertebrae?
* 31 total
- 8 cervical
- 12 thoracic
- 5 lumbar
- 5 sacral
- 1 coccygeal
*C1-C7 exit through the intervertebral foramina above the corresponding vertebrae (so, C1 exits above C1 vertebrae; etc). The rest exit below the corresponding vertebrae (So, C8 exits below C8, above T12)
122
Vertebral disk herniation: between which vertebrae does it usually occur?
- ->usually between L5 and S1
| - ->it's the herniation of the nucleus pulposus through the annulus fibrosus.
123
Between what vertebrae should an LP be done?
-->b/t L3 and L5 (find ASIS and go from there; it marks L4!)
124
To what vertebrae does the spinal cord extend in adults? subarachnoid space?
- ->spinal cord goes to L1-L2
| - ->subarachnoid space to S2 (why do LP b/w L3-L5; want to get CSF, but not damage spinal cord)
125
Spinothalamic Tract: information?
Ascending pain and temperature sensation
126
Lateral Corticospinal Tract: information?
Descending voluntary movement of contralateral limbs
127
Dorsal Column: information transmitted?
Ascending pressure, vibration, touch, proprioceptive sensations
128
Fasciculus cuneatus:
dorsal column tract nucleus: more lateral, sensations from upper body, extremities
129
Fasciculus gracilis:
dorsal column tract nucleus: more medial; sensations from lower body, extremities
130
Polio: where in spinal cord is lesion?
-->Destruction of Anterior Horns; get LMN lesion --> flaccid paralysis
131
Werdnig-Hoffmann disease: where in spinal cord is lesion?
- ->Destruction of anterior horns; LMN lesion --> flaccid paralysis
* **like Polio
132
Where in spinal cord are lesions in MS?
-->various locations - random, assymetric; but, mostly in the WHITE matter of cervical region, b/c it's d/t de-myelination (white matter=composed of myelinated axons and glial cells; gray matter=composed of neurons)
133
Where in spinal cord are lesions in ALS (Amyotrophic Lateral Sclerosis = Lou Gehrig's)?
Both UMN and LMN lesions; no sensory deficit (so, see lesions in lateral corticospinal tract and anterior horn)
134
Tabes dorsalis/tertiary syphilis: what area of spinal cord is lesioned?
-->degeneration of dorsal roots and dorsal columns --> impaired proprioception, locomotor ataxia
135
Syringomyelia: what area of spinal cord is lesioned?
-->damages anterior white commissure (so, spinothalamic tract cannot deccusate, where 2nd order neurons of spinothalamic tract are) --> get bilateral loss of pain and temperature sensation
-->can expand and thus affect other tracts too
--> see syringomyelia in Chiari I types 1 and 2
136
Vitamin B12 neuropathy: what areas of spinal cord are lesioned?
get combined degeneration-demyelination of dorsal columns, lateral corticospinal tracts, and spinocerebellar tracts
-->ataxic gait (cerebellum), hyperreflexia (corticospinal), impaired position and vibration sense (dorsal column)
137
Vitamin E deficiency: what areas of spinal cord are lesioned?
(same as Vit B12 neuropathy):
- combined degeneration-demyelination of dorsal column, lateral corticospinal tract, spinocerebellar tract
- ->ataxic gait, hyperreflexia, impaired position and vibration sense
138
Friedrich's ataxia: what areas of spinal cord are lesioned?
(same as Vitamin B12 neuropathy and Vitamin E deficiency):
- combined degeneration-demyelination of dorsal column, lateral corticospinal tract, spinocerebellar tract
- ->ataxic gait, hyperreflexia, impaired position and vibration sense
139
signs of both UMN and LMN lesions, but no sensory deficit?
-->ALS (lesions to lateral corticospinal tract and anterior horn)
140
Bilateral loss of pain and temperature sensation?
-->Syringomyelia --> damage to anterior white commissure, so interferes with spinothalamic tract
*seen with Chiari I types 1 and 2
141
Ataxic gait + hyperreflexia + impaired position and vibration sense?
- Vitamin B12 neuropathy
- Vitamin E deficience
- Friedrich's ataxia
142
LMN signs from anterior horn destruction:
- Polio
| - Werdnig-Hoffmann disease
143
"floppy baby" + tongue fasciculations
Werdnig-Hoffman disease = "infantile spinal muscular atrophy"
- ->autosomal recessive
- ->degeneration of anterior horn of spinal cord; LMN lesion signs.
144
Defect in superoxide dismutase 1 (SOD1) may cause this disease?
-->ALS
145
Riluzole
drug that can be used to treat ALS; decreases presynaptic glutamate release; can lengthen survival somewhat
146
Impaired proprioception and locomotor ataxia; Charcot's joints, pupils that don't constrict in response to light, absent deep tendon reflexes, and positive Romberg sign?
--> Tabes dorsalis (affects dorsal columns and dorsal roots)
*Charcot joints = loss of sensationin a joint; may damage joints without knowing it, because can't feel it
147
Cause of death in Friedrich's ataxia?
Hypertrophic cardiomyopathy
148
Frataxin
protein that is mutated in Friedrich's ataxia
| -->leads to impairment in mitochondrial functioning
149
Brown-Sequard syndrome:
- what is it?
- presentation?
- ->hemisection of spinal cord
* presentation:
- ipsilateral UMN signs below lesion (corticospinal tract)
- ipsilateral dorsal column lesion signs below lesion (loss of touch, vibration, proprioception sensations)
- loss of contralateral pain and temp sensation below lesion (spinothalamic tract)
- ipsilateral loss of all sensation at level of lesion
- LMN lesion signs (ie flaccid paralysis) at level of lesion
*If lesion occurs above T1 --> presents with Horner's syndrome
150
Horner's syndrome:
- Ptosis (droopy eyelid)
- Miosis (pupil constriction)
- Anhidrosis (no sweating; flushed face on side that's affected)
*d/t loss of sympathetic innervation of face
151
What 3 conditions may be associated with Horner's syndrome?
* Any lesion of the spinal cord above T1
- Pancoast tumor
- Brown-Sequard syndrome
- Syringomyelia (late stage, if it expands)
152
Gallbladder and diaphragm pain referred to right shoulder via which nerve?
Phrenic nerve
153
Where is the T4 dermatome?
Nipple level
154
Where is the L1 dermatome?
level of inguinal ligament
155
Where is the T10 dermatome?
level of umbilicus
156
Which dermatomes are involved in erection and sensation of penile and anal zones?
S2, S3, S4 "keep the penis off the floor"
157
Where is the L4 dermatome?
Includes the kneecaps
158
What is a positive Babinski sign?
- ->dorsiflexion of big toe and fanning of other toes (so big toe extends up, other toes just fan out)
- UMN lesion sign
- NORMAL in 1st year of life!
159
Moro reflex
infant reflex --> "hang on for life"; when startled, abduct/extend limbs, and then draw them together
160
Rooting reflex
=nipple-seeking reflex; if stroke one cheek, move head towards that cheek
161
Sucking reflex
sucking when roof of mouth is touched
162
Palmar and Plantar reflexes
curl fingers/toes if palms of hands/feet are stroked
163
Pineal body
- secretes melatonin
| - involved in circadian rhythm
164
Superior colliculi
vision --> conjugate vertical gaze center
165
Inferior colliculi
Auditory
166
Parinaud syndrome
-->lesion in superior colliculi (like from a pinealoma); get paralysis of conjugate vertical gaze
167
Which cranial nerves are sensory? motor? both?
"Some Say Money Matters But My Brother Says Big Brains Matter More"
```
CN I --> sensory
CN II --> sensory
CN III --> motor
CN IV --> motor
CN V --> both
CN VI --> motor
CN VII --> both
CN VIII --> sensory
CN IX --> both
CN X --> both
CN XI --> motor
CN XII --> motor
```
168
Only cranial nerve without thalamic relay to cortex?
--> CN I (olfactory)
169
Taste from anterior 2/3 of tongue?
Facial Nerve (CN VII)
170
Taste from posterior 1/3 of tongue?
Glossopharyngeal (CN IX)
171
Taste from epiglottic area (base of tongue)?
Vagus nerve (CN X)
172
Which CNs have nuclei in the midbrain?
CN III, IV
173
Which CNs have nuclei in the pons?
CN V, VI, VII, VIII
174
Which CNs have nuclei in the medulla?
CN IX, X, XI, XII
175
Sensation from anterior 2/3 of tongue?
CN V3 = Mandibular division of Trigeminal nerve
176
Sensation from posterior 1/3 of tongue?
Glossopharyngeal (CN IX)
177
Nucleus Solitarius
vagal nucleus --> involved in visceral sensory information (ie taste, baroreceptors, gut distention)
178
Nucleus Ambiguus
vagal nucleus --> involved in Motor innervation of pharynx, larynx, upper esophagus (swallowing, palate elevation...)
179
Dorsal Motor Nucleus
vagal nucleus --> sends Autonomic (Parasympathetic) fibers to heart, lungs, upper GI
180
What CN passes through the cribriform plate?
-->CN I = olfactory
181
What passes through the cavernous sinus?
CN III, IV, V1, V2, VI and postganglionic sympathetic fibers; also, internal carotid artery
182
Cavernous sinus syndrome:
Ophthalmoplegia + Ophthalmic (V1) and maxillary (V2) sensory loss
183
Tongue deviates TOWARD side of lesion: Cause?
lesion to CN XII (Hypoglossal)
| -->b/c have weakened tongue muscles on affected side
184
Jaw deviates TOWARD side of lesion: cause?
```
CN V (trigeminal) motor lesion
-->b/c unopposed force from opposite pterygoid muscle (weakened muscle on affected side)
```
185
Uvula deviates AWAY from side of lesion: cause?
```
CN X (Vagus) lesion
-->weak side collapses, so uvula points away
```
186
In an accessory nerve (CN XI) lesion: what is the presentation?
- shoulder drop on side of lesion (trapezius)
| - can't turn head to side opposite lesion (SCM)
187
Facial paralysis d/t UMN or LMN lesions:
* UMN lesion: contralateral paralysis of lower face only (b/c upper face gets bilateral innervation)
* LMN lesion: ipsilateral paralysis of both upper and lower parts of face (like what see with Bell's palsy)
188
Bell's palsy:
- Cause?
- Presentation?
- Complication of what conditions?
- destruction of the facial nucleus
- ->ipsilateral paralysis of upper and lower face (like LMN lesion)
* Complication of: "ALexander graHam bell with STD"
- AIDS
- Lyme disease
- HSV
- Sarcoidosis
- Tumors
- Diabetes
189
Which 3 muscles close the jaw? Which 1 opens it?
* muscles that close the jaw:
- Masseter
- Temporalis
- Medial pterygoid
* muscle that closes jaw:
- lateral pterygoid
190
Cherry red spot on macula of eye: DD?
- Occlusion of central retinal artery
- Tay-Sachs
- Niemann-Pick disease
191
Clouding of cornea: DD?
- Hurler's disease (a mucopolysaccharidosis; not Hunter's though)
- I-cell disease
192
Subluxation of lens: DD
- Marfan's
| - Homocysteinuria
193
Anterior Uveitis = inflammation of iris and ciliary body: DD?
Reactive Arthritis (and other PAIR and inflammatory diseases)
194
Obstruction of Canal of Schlemm?
Glaucoma (impaired outflow of aqueous humor); seen in open/wide-angle glaucoma
195
Open/Wide Angle vs Closed/Narrow Angle Glaucoma:
* Open/Wide Angle: d/t obstructed outflow of aqueous humore (like obstruction of Canal of Schlemm) -->increased introaocular pressure...
- ->more common, painless, insidious onset
* Closed/Narrow Angle: obstruction of aqueous humor flow between iris and lens --> pressure builds up behind iris
- ->really painful, decreased vision, frontal headache
- ->emergency!
- ->don't treat with epinephrine, b/c can lead to mydriasis (pupil dilation)
196
Cataracts:
- what is it/presentation?
- risk factors?
* Painless, bilateral opacification of lens; get decreased vision
* Risk factors:
- Diabetes (sorbitol)
- Galactokinase deficiency and Classic Galactosemia
- trauma, infection, age, smoking, alcohol, sunlight...
197
innervation of extraocular muscles:
SO4 LR6 R3
* CN IV = Trochlear nerve --> innervates Superior Oblique m.
* CN VI = Abducens nerve --> innervates Lateral Rectus m.
* CN III = Oculomotor nerve --> innervates all the other muscles!
198
Vertical diplopia - eye drifts upward (like when reading newspaper, going down stairs) --> cause?
CN IV (Trochlear N) damage
199
Medially-directed eye: cause?
CN VI (Abducens n) damage
200
eye looks down and out, ptosis, pupillary dilation, loss of accomodation: cause?
CN III (oculomotor nerve) damage
201
Cause of Right Anopia (visual defect in right eye)?
Injury to right optic nerve
202
Cause of bitemporal hemianopia (visual defect in both eyes when looking laterally/toward temples)?
injury to optic chiasm
203
Cause of left homonymous hemianopia (can't look to left with either eye)?
-->lesion to right optic tract
204
Cause of Left upper quadrant anopia (can't see upper left/lateral)?
Right temporal lesion, MCA
205
Cause of left lower quadrant anopia (can't see lower left/lateral)?
Right parietal lesion, MCA
206
Cause of Left hemianopia with macular sparing (can't see left side of either eye, but CAN see through center of eye)?
PCA lesion
207
Only can't see out center of eye?
Macular degeneration = Central scotoma
208
MLF syndrome = Internuclear Ophthalmoplegia:
- Presentation?
- Associated with what disease?
* Presentation:
- when look straight ahead, both eyes look straight ahead
- Right MLF lesion: when try to look to left: left eye moves, but right eye continuous to look straight, cannot adduct (or visa versa). Left eye (which moved), has nystagmus when looking to left
*Seen in MS
209
Genes associated with:
- early onset Alzheimers?
- late onset Alzheimers?
- Protective against Alzheimers?
* Early Onset:
- APP (chrom 21-->why down's pts have increased risk of AD)
- Presenilin-1
- Presenilin-2
* Late-onset: ApoE4
* Protective: ApoE2
210
Senile plaques
Beta-amyloid cortical deposits; seen in Alzheimer's
211
Neurofibrillary tangles:
cortical, intracellular, abnormally phosphorylated tau protein
-->seen in Alzheimer's
212
Aphasia + Dementia + Personality changes:
- ->Pick's disease = Frontotemporal dementia
| - have Pick bodies = intracellular, aggregated tau protein
213
alpha-synuclein defect
Lewy body dementia
214
Parkinsonian symptoms + dementia + visual hallucinations?
Lewy body dementia
215
Rapidly progressive dementia with myoclonus (brief, involuntary twitching of muscles):
Creutzfeldt-Jakob disease (CJD)
216
Diagnostic findings in MS:
- increased IgG protein in CSF
- oliclonal bands (from Igs) = diagnostic
- MRI = gold-standard
- Periventricular plaques (areas of oligodendrocyte loss and reactive gliosis)
217
Charcot's triad of symptoms in MS (not really a triad...):
"SIIIN"
- Scanning speech
- Incontinence
- Intention tremor (make zig-zag line when reach for things)
- Internuclear Ophthalmoplegia = MLF syndrome
- Nystagmus
218
CSF findings in Guillain-Barre syndrome:
- increased protein
- normal cell count
*get papilledema d/t increased protein
219
Cause of Guillan-Barre (after an infection)?
-->autoimmune attack of peripheral myeline d/t molecular mimicry
220
Treatment/Therapy for Guillan-Barre?
* Respiratory support = must until recovery (b/c have ascending demyelination, so want to prevent weakening of diaphragm, respi failure!)
- Plasmpharesis
- IV Ig's
221
PML = Progressive Multifocal Leukoencephalopathy:
- associated with JC virus; seen in AIDS pts
- demyelination of CNS d/t destruction of oligodendrocytes (similar to MS)
- ->rapidly progressive; usually fatal
222
Charcot-Marie-Tooth Disease
Group of progressive hereditary nerve disorders; has to do with defective production of proteins involved in structure and function of peripheral nerves and myelin sheath--> so lack of myelination
223
In which part of brain do partial seizures usually originate?
Temporal lobe
224
Acute and Prophylactic treatment for migraines:
* Acute --> Triptans (serotonin agonists)
| * Prophylactic --> Propranolol and NSAIDs
225
Bilateral headache; steady pain for >30 minutes; not effected by light, noise; no aura
Tension headache (like a band around head)
226
Unilateral headache; brief, repetitive headaches; periorbital pain, ipsilateral lacrimation, rhinorrhea, Horner's syndrome:
Cluster headache
227
Treatment for cluster headaches:
Oxygen = 1st line treatment
| -->can also treat with triptans (serotonin agonists)
228
Meniere's disease:
Peripheral Vertigo + Tinnitus + Hearing loss
229
port-wine stains, seizures, early-onset glaucoma, hemiparesis, mental retardation:
Sturge-Weber syndrome (a congenital vasculitis)
230
Possible presentations of Tuberous Sclerosis: "HEMARTOMAS"
- Hemartomas in CNS and skin (benign growths, resemble tissue of origin)
- Adenoma sebaceum (cutaneous angiofibromas--> looks like a whole bunch of bad acne on face; kind of malar area)
- Mitral regurgitation
- Ash-leaf spots
- cardiac Rhabdomyoma (primary cardiac tumor, usually seen in children)
- Tuberous sclerosis
- autOsomal dominant
- Mental retardation
- renal Angiomyolipoma (benign kidney tumor)
- Seizures
231
Cardiac Rhabdomyoma
most common primary cardiac tumor in children; associated with tuberous sclerosis
232
Renal Angiomyolipomas
Benign tumors in kidney; highly associated with Tuberous Sclerosis
233
cafe au lait vs ash leaf spots:
-cafe au lait --> NF1; darker skin pigmentation
| ash leaf spots--> tuberous sclerosis; lighter; depigmented
234
Presentations of Neurofibromatosis type 1:
- ->autosomal dominant
- Cafe-au-lait spots
- Lisch nodules (pigmented iris hamartomas)
- Pheochromocytoma
- optic gliomas (tumor of optic nerve; may cause vision loss)
- neurofibromas in skin
235
Presentations of von Hippel-Lindau disease:
- Bilateral renal cell carcinoma
- pheochromocytomas
- hemangioblastomas (tumors) in retina, brain stem, cerebellum
- autosomal dominant
236
Bitemporal Hemianopsia from brain tumor in adult? child?
* Adult --> pituitary adenoma/prolactinoma
* Kid --> Craniopharyngioma (benign)
***both may arise from Rathke's pouch
237
GFAP positive brain tumors:
- Glioblastoma multiforme (adults)
- Pilocytic astrocytoma (kids)
-->both are astrocyte tumors
238
Brain tumor with psammoma bodies and spindle cells concentrically arranged in a whorled pattern:
Meningioma (adult brain tumor)
239
Adult brain tumor that is S-100 positive?
Schwannoma (ie an acoustic schwannoma)
240
List the 4 most common Adult brain tumors:
"MGM Studios"
- Metastasis
- Glioblastoma
- Meningioma
- Schwannoma
*also: Oligodendroglioma, Pituitary adenoma
241
slow-growing adult primary brain tumor with "fried egg" cells and chicken-wire capillary pattern.
Oligodendroglioma
242
Glioblastoma multioforme
- most common primary adult brain tumor
- astrocyte origin --> GFAP positive
- bad prognosis
- found in cerebral hemispheres; may cross the corpus callosum
243
Meningioma:
- 2nd most common primary adult brain tumor
- psammoma bodies and spindle cells arranged in a whorled pattern
- arises from arachnoid cells external to brain (like cells from arachnoid granulations)
- resectable!
244
Psammoma bodies - DD? (various, not just neuro)
* PSaMMoma:
- Papillary thyroid cancer
- Serous carcinoma of ovaries
- Meningiomas
- Malignant mesothelioma
***psammoma bodies look kind of like a rose! or rings on a tree!
245
Schwannoma:
- 3rd most common adult primary brain tumor
- S-100 positive
- Schwann cell origin
- Resectable
- often acoustic schwannoma (localized to CN VIII) in cerebellopontine angle
- ->bilateral schwannomas are associated with NF2
246
Oligodendroglioma:
- Rare, slow growing adult primary brain tumor
- "fried egg" cells and chicken-wire capillary pattern on microscopy
- originate from oligodendrocytes
247
Pituitary adenoma
- usually prolactinoma
- have bilateral hemianopsia (from compressing the optic chiasm)
- symptoms of hyper- an hypo-pituitarism
- ->amenorrhea, hypogonadism, galactorrhea....
248
Homer-Wright Pseduorosettes:
* found in 2 childhood tumors:
- Medulloblastoma (primary brain tumor)
- Neuroblastoma (adrenal tumor; like a pheochromocytoma, but in kids)
249
2 primary brain tumors that may cause hydrocephalus in kids:
- Medulloblastoma --> may compress 4th ventricle, causing hydrocephalus
- Ependymoma --> most commonly found in 4th ventricle, causing hydrocephalus
250
Primary brain tumor with Rosenthal fibers = eosinophilic, corkscrew fibers
Pilocytic astrocytoma (benign, good prognosis)
251
Highly malignant childhood cerebellar tumor:
- ->Medulloblastoma
- may compress 4th ventricle-->hydrocephalus
- Homer-wright pseudorosettes
- small blue cells
- gait instability and limb ataxia, b/c it's cerebellar
- a PNET = primitive neuroectodermal tumor
252
Perivascular pseudorosettes, hydrocephalus, tumor within 4th ventricle:
Ependymoma
253
Hemangioblastoma:
childhood primary brain tumor
- ->associated with von-Hippel Lindau syndrome (get retinal angiomas)
- may also have increased production of EPO (perhaps secondary to VHL syndrome)--> polycythemia
254
Craniopharyngioma
- benign childhood tumor; derived from remnants of Rathke pouch
- can cause bilateral hemianopsia, and thus look like a pituitary adenoma
255
Medulloblastoma:
- childhood primary brain tumor
- really malignant, cerebellar tumor (so may have cerebellar defects-->ataxia, gait instability...)
- may compress 4th ventricle, causing hydrocephalus
256
Ring-enhancing lesion - DD:
- Abscesses
- Toxoplasma
- Metastases (from lung > breast > melanoma > kidney > GI)
- primary CNS lymphoma (from AIDS, EBV)
257
5 classes of medications that can be used to treat glaucoma:
- alpha-agonists (epinephrine, brimonidine)
- beta-blockers (timolol, betaxolol, carteolol)
-diuretics (Acetazolamide for long-term;
Mannitol for acute/emergency cases)
- Cholinergic agonists (direct-->pilocarpine, carbachol; indirect-->physostigmine, echothiphate)
- Prostaglandins (Latanoprost -->PGF-2-alpha)
258
Of the glaucoma drugs, which should NOT be used in closed-angle glaucoma?
-->Epinephrine
259
Dextromethorphan
=DXM, DM (in robitussin, nyquil, etc)
- opiod analgesic
- used for cough suppression
260
Loperamide
opioid analgesic; used to treat diarrhea
261
Diphenoxylate
opioid analgesic; used to treat diarrhea
262
drug given to opioid addicts in maintenance programs?
-->methadone
263
Naloxone or Naltrexone
- ->opioid receptor antagonists
| - treat opioid toxicity
264
Fentanyl
opioid analgesic
265
Mechanism of Opioid analgesic drugs
*Opioid anelgesics: Morphine, Codeine, Fentanyl, Diphenoxylate, Dextromethorphan, heroin, methadone, meperidine
* Mechanim:
- ->act as agonists at opiod receptors (mu, delta, kappa), modulating synaptic transmission: open K+ channels, close Ca2+ channels --> decrease synaptic transmission
- ->inhibit release of ACh, NE, Serotonin, Glutamate, substance P (normally causes pain, so decreased substance P-->decreased pain)
266
Codeine
opioid analgesic
267
morphine
opioid analgesic
268
meperidine
opioid analgesic
269
heroin
opioid analgesic
270
Main toxicities of opiods?
- ->what are 2 opioid toxicities that one does NOT develop tolerance to?
- ->treatment for opioid toxicity?
* Main toxicities:
- Respiratory depression
- Addiction
- Constipation
- Miosis = pinpoint pupils
- CNS depression is additive with other drugs
* Don't develop tolerance to: Miosis and Constipation
* Treat toxicity with: Naloxone or Naltrexone (opioid receptor antagonists)
271
Tramadol
- ->weak opioid agonist; inhibits serotonin and NE reuptake, too (works on many NTs--> "tram-it-all in!"
- used to treat chronic pain
***decreases seizure threshold!
272
Butorphanol
partial agonist at opioid mu receptors; full agonist at opioid kappa receptors
-used to treat pain; causes less respiratory distress than full opioid agonists
273
3 1st line treatments for tonic-clonic seizures?
-->Valproic Acid, Phenytoin, Carbamezapine
274
1st line for prophylaxis against status epilepticus?
Phenytoin
275
1st line treatment for partial seizures (simple and complex)?
Carbamezapine
276
1st line treatment for absent seizures?
Ethosuximide
277
1st line treatment for acute status epilepticus?
-->Benzos! (Diazepam or Lorazepam)
278
1st line treatment for trigeminal neuralgia?
Carbamezapine
279
1st line treatment of seizures in pregnant women and children?
Phenobarbital
280
Epilepsy drug that can be used for seizures of Eclampsia? What is 1st line in treating seizures of eclampsia?
- ->can treat eclampsia seizures with Benzodiazepines (Diazepam or Lorazepam)
- 1st line treatment for eclampsia seizures is MgSO4, though
281
phenytoin and carbamezapine mechanism?
Inactivate Na-channels
282
Gabapentin mechanism?
-->GABA analog; but, main mechanism = inhibits Ca channels
283
Phenobarbital mechanism?
-->stimulates GABA
284
Valproic acid mechanism?
inactivates Na channels, and increases GABA concentration
285
Ethosuximide mechanism?
blocks Calcium channels
286
Tigabine
```
epilepsy drug (for partial seizures)
-->inhibits GABA reuptake
```
287
Vigabatrin
```
epilepsy drug (for partial seizures)
-->increases amount of GABA
```
288
Levetiracetam
```
epilepsy drug (for partial seizures and tonic clonic seizures)
-->unknown mechanism; may increase GABA...
```
289
anti-epileptic drugs that may lead to Steven-Johnson syndrome?
Presentation of SJS?
Drugs (all categories) that causes SJS?
* Ethosuxamide, Phenytoin, Lamotrigine, Carbamezapine, Phenobarbital
* first malaise and fever, then rapid onset of erythematous/purpuric macules (oral, ocular, genital)... eventually skin lesions become necrotic and slough
* **SJS from
- cillins
- sulfas
- seizures
290
3 anti-epileptic drugs that are contraindicated in pregnancy:
- Phenytoin-->can lead to fetal hydantoin syndrome
- Valproic acid
- Carbamezapine
***both valproic acid and carbamezapine decrease folate absorption, similarly to folate-antagonists. So, if use during pregnancy, must increase folate supplementation.
291
Which anti-epileptic drugs are Cytochrome P-450 Inducers?
- phenobarbital
- phenytoin
- carbamezapine
292
Infant with IUGR, microcephaly, dysmorphic craniofacial features, mental retardation, hypoplastic nails and distal phalanges, cardiac defects: Which anti-epileptic was mother taking during pregnancy?
Phenytoin
293
Infant with neural tube defects: which anti-epileptic taken during pregnancy can cause this?
Valproic Acid
| Carbamezapine
294
Agranulocytosis and Aplastic Anemia: Caused by which anti-epileptic?
Carbamezapine
295
Carbamezapine side effects:
- cytochrome P-450 inducer
- liver toxicity
- agranulocytosis
- aplastic anemia
- teratogenic (neural tube defects, b/c decreases folate absorption)
- SIADH
- diplopia
- ataxia
296
Which anti-epileptic drug may cause SIADH?
Carbamezapine
297
Which anti-epileptic drug may cause drug-induced lupus?
Phenytoin
298
Phenytoin side effects:
- Megaloblastic anemia
- Teratogenic (fetal hydantoin syndrome)
- cytochrome P-450 inducer
- hirsutism
- drug-induced lupus
- gingivial hyperplasia
299
Gingivial hyperplasia is a side effect of which anti-epileptic drug?
Phenytoin
300
Thiopental
babiturate
| -can be used to induce anesthesia
301
Why can phenobarbital be used to treat Crigler-Najjar syndrome?
Phenobarbital increases liver enzyme synthesis, so can get increased synthesis of UDP-glucorynl transferase, and thus convert more indirect bilirubin to direct in the liver
(barbiturates are cytochrome P-450 inducers...not sure if that has anything to do with it, but I imagine it does...)
302
Short-acting benzos:
"TOM"
- Triazolam
- Oxazepam
- Midazolam
-->short-acting benzos have highest addictive potential
303
Chlordiazepoxide
a benzo
304
Which 2 benzos can be used to treat status epilepticus?
- Lorazepam
| - Diazepam
305
Treat benzo overdose with? mechanism?
Flumazenil
| -->competitive antagonist at GABA benzo receptor
306
Zolpidem:
| mechanism?
=Ambien
- ->also acts on GABA and enhances inhibitor properties of GABA
- ->metabolized by cytochrome P-450, so short duration
- ->less tolerance, addiction, withdrawal symptoms than benzos
307
Zaleplon
non-benzo hypnotic (for insomnia); similar to zolpidem
308
Eszopiclone
non-benzo hypnotic (for insomnia); similar to zolpidem
309
MAC (Minimal Alveolar Concentration): how is it related to potency?
Lower MAC--> Higher potency
(potency = 1/MAC)
*Low MAC = high potency = high lipid solubility = Low Km
- ->has to do with anesthetics...
- ->varies with age!
- ->it's literally a measurement at which 50% of the population is anesthetized.
310
Solubility of a drug in blood vs lipids: How is it related to potency? induction time?
* Drugs that have low solubility in blood--> rapidly induced and rapid recovery times
* Drugs that have high solubility in lipids --> increased potency
***So, a drug that has low blood and low lipid solubility: fast induction, low potency (ie Nitrous oxide)
***Drug that has high blood and lipid solubility: slow induction, high potency (ie Halothane)
311
Potency and induction times of a drug with: low blood and lipid solubility?
-->example = Nitrous Oxide
Fast induction, low potency
312
Potency and induction of a drug with high blood and lipid solubility?
-->example = Halothane
Slow induction, high potency
313
Inhaled anesthetic that can cause hepatotoxicity?
-->Halothane
