B & B Exam 3 pt 2

eem8u's version from 2016-10-09 22:28

Stroke Syndromes

for each vessel, indicated affected area and clinics presentation
Question Answer
anterior circulation, general(often involves MCA territory) hemiparesis, hemisensory loss of face, hand, amor, leg (leg is more in ACA/ arm more in MCA), MCA can also affect internalcapusle/basal ganglia
ACA(frontal pole/mesial frontal lobe) broca’s or anterior conduction aphasia, frontal signs (e.g.abulia) , contralateral leg/foot sensorimotor deficit
MCA(posterior frontal, temporal and parietal) arm/face> leg sensorimotor loss, visual field cut, neglect (if non dominant hemisphere), **IPSIlateral gaze preference, aphasia/alexia/agraphia (if dominant hemisphere) ** MCA can also affect internalcapusle/basal ganglia
internal carotidACA and MCA syndromes, preceded by **AMAUROSIS FUGAX (transient monocular visual loss = curtain coming down)
PCA(occipital lobe) control lateral visual field loss (w/ ocular sparing), alexia w/o agraphia, bilayer = anton’s syndrome (cortical blindness), if thalamus - sensory loss of ALL kinds
basilar artery(pons) locked in
vertebral artery - medial medullacontralateral (hemibody weakness/loss of vibration and proprioception) / ipsilateral (tongue weakness
vertebral artery - lateral medulla and PICAwallenberg syndrome (headache, ataxia, nausea/vomiting, ipsilateral paralysis of tongue and swallowing difficulties, ipsilateral face and contralateral body pain and temperature loss, Horner's Syndrome)
PICA, AICA, or SCA acute cerebellar symptoms
general signs of dominant (left) cerebral hemisphereaphasia/LEFT gaze preference, right sensorimotor loss, RIGHT visual field deficit
general signs of nondominant (right) cerebral hemisphereneglect, RIGHT gaze preference, left sensorimotor loss, left hemiparesis


Question Answer
overnweight vs obese BMI>25, >30
role of lateral hypothalamus in feedingOrexigenic
role of medial hypothal in feedingANorexigenic
role of hypothalamus vs mesolimbic dopamine system in feedingpsychologic need for food vs. DESIRE for food (as reward substance)
leptin’s target and 3 general functions(HYPOTHALAMUS, arcuate nucleus) decrease feeding, increase energy consumption (metabolism), decrease fat storage
leptin is proportional tofat Cells!
Leptin inhibit 2 orexigenic peptidesNPY and ARP
Leptin stimulates 2 Anorexigenic peptidesa-MSH and CART (cocaine- and amphetamine-regulated transcript)

Sedatives, hypnotics, anxiolytics

Question Answer
clinical findings w/ barbiturate toxicitysmall to midpoint pupils, diminished reflexes
barbiturate used to tx epilepsyphenobarbital
barbiturate used for headachesbutalbital
Midazolam - use/duration of actionprocedural anesthesia/SHORT
Lorazepaminsomnia (valium) / intermediate (status epilepticus!!)
Clonazepam - use/duration of actionparasomnias, intermediate- longer acting
diazepam - use/duration of actionalcohol withdraw, sleep disorder (LONG)
which benzo’s do not undergo 1st pass metabolism LOT Lorazepam, oxazepam, temazepam (good for hepatic disease)
Zolpidem - mechanism of action / use/ side effectsGABA- A-1 specific / sleep (decreases *REM and latency of onset), SE-abnormal nocturnal behavior
chlordiazepam - use/duration of actionalcohol withdrawal (DOC), LONG acting
Ramelteon - mechanism of action / use/ side effectsMT/1/mT2 agonist / reduce latency of sleep (no sleep architecture effects) / dizzinesss, somnolence
acute vs chronic effects of alcohol on CNSacute (depress myocardial contractility, vasodilation, GI) / chronic (tissue damage due to ethanol and acetaldehyde, liver and CV disease, pancreatitis, gastritis, malnutrition) and in CNS chronic (Upregulation of NMDA glut receptors, cerebellar toxicity)
sx of wernike korsakoffEOM paralysis, ataxia, confusion (due to thiamine definiciency, think alcoholism!)
which alcohol metab substrates are most toxicacetaldehyde (and causes major side effects
signs and symptoms of methanol vs ethylene glycol toxicitymethanol (gastritis, anion gap metabolic acidosis, visual disturbance) vs ethylene (transient excitation also followed by anion gap metabolic acidosis, **OXALATE CRYSTALS**)
disulfiram - mechanism of action / usealcohol withdrawal (longterm)/ blocks Aldehyde DH (very unpleasant)
acomprosate - mechanism of action / use /SE and AElongterm alcohol withdrawal, NMDA and GABA-a agonist, some GI and rash issues (not good for renal impairment)
**Drug for status epilepticsLorazepam! or Diazepam!!

General Anesthetics and anti epileptics

Question Answer
define MAC (low or high?)minimum alveolar concentration (like EC50) - measure of potency (lower = more potent) ***additive between MAC’s***
oil:gas partition coefficientmeasure of anesthetic potency —> The greater the oil solubility, the lower the MAC (e.g. Isofluorane, sevoflurane very soluble… N2O and desflurane are LOW solubility)
blood solubilityindicates rate of induction - more soluble is slower induction (N2O and desflurane are LOW blood solubility)
Effect of ventilation rate on induction rateincreases induction only in highly blood SOLUBLE drugs
MAC for anesthesia vs induction1.4 vs 3-4
passive increase in ventilation w/ ___N20 b/c nitrous moves faster into blood than nitrogen moves out of blood
second gas effecther inhalation anesthetic is co-administered with nitrous, initial delivery rate of this “second gas” will increase as a consequence of the nitrous-related increase in ventilation
2 risks w/ n20 1) Increased pressure in trapped air spaces (pneumothorax, middle ear, e.g.) 2) diffusion hypoxia b/c nitrous leaves quick and floods alveoli
balanced anesthesiacombine analgesia, paralysis, and amnesia (lower dose of NMJ needed b/c of membrane stabilization)
sevoflurane effect on CV functionDECREASE MAP and CO
N2o effect on CV functionrelatively no change to MAP, CO, or HR
malignant hypothermia risk and txwhen anesthesia used w/ succynlcholine, tx with dantrolene
major side effect of propofoldecrease BP!!!, respiratory depression
explain propofol half lifecontext sensitive b/c of distribution to poorly perfused tissues (including fat)
ketamine - describe use/effect and SEthink “special K” - dissociative anesthetic and analgesic, block NMDA receptors, Increases HR/BP• Bronchodilation • No significant respiratory depression!
AED’s that are more likely to INDUCE Cyp450phenytoin, phenobarbital, carbamazapime (also valproate)
focal anesthetic w/ renal eliminationgabapentin (good for liver disease)
generalized AED good for POLY therapyLevatiracem