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Flashcards in Neurology Deck (313):
1

In which part of the brain is atrophy most pronounced in Alzheimer's

Hippocampus and frontal lobe

2

CNS/PNS cells that originate from Neuroectoderm

-CNS neurons
-ependymal cells (make CSF)
-Oligodendroglia
-Astrocytes

3

CNS/PNS cells that originate from Neural Crest:

-Schwann cells
-PNS neurons

4

CNS/PNS cells that originate from Mesoderm:

-Microglia
***note: microglia=macrophages of the brain!

5

Nissl substance

RER in cell body, dendrites of neurons; NOT in axons

6

GFAP

astrocyte marker
-->so, also a marker for astrocyte tumors: glioblastoma and pilocytic astrocytoma

7

Astrocytes:
-roles?
-marker for astrocytes?

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

macrophages/phagocytes of the CNS?

-->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

oligodendrocytes:

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

Schwann cells

produce myelin in the PNS
-one Schwann cell only myelinates one PNS axon

11

Cell types that look like fried eggs on histology (various, not just neuro):

-Oligodendrocytes
-Koilocytes (HPV)
-Seminomas

12

Type of cells that are destroyed in MS?

Oligodendrocytes

13

Type of cells destroyed in Guillain-Barre syndrome?

Schwann cells

14

Acoustic neuroma:

type of Schwannoma; usually located in internal acoustic meatus (CN VIII)
-->see bilateral acoustic schwannomas in NF 2)

15

Endoneurium, Perineurium, Epineurium

Endoneurium: surrounds single nerve fibers
Perineurium: surrounds a fascicle of nerve fibers
Epineurium: dense connective tissue that surrounds an entire nerve

16

Diseases with increased NE?

-->Anxiety
-->Mania

17

Disease with decreased NE?

Depression

18

Disease associated with increased dopamine?

Schizophrenia

19

Diseases with decreased dopamine?

-Parkinson's
-Depression

20

Diseases with decreased serotonin (5-HT)?

-Anxiety
-Depression

21

Diseases with decreased Ach?

-Alzheimer's
-Huntington's

22

Disease with increased ACh?

-Parkinson's
-Also: increased ACh in REM sleep (b/c ACh is the principal neurotransmitter in REM sleep)

23

Diseases with decreased GABA?

-Anxiety
-Huntington's

24

What is synthesized in Locus ceruleus?

-->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