B & B exam 3

eem8u's version from 2016-10-09 22:03

CSF findings

polymorphs? / lymphocytes? / glucose / CSF:plasma glucose ratio / protein / culture
Question Answer Column 3 Column 4 Column 5 Column 6 Column 7
bacterial meningitispredominatelowDECREASED++<40%increased +++POSITIVE
viral meningitisearlypredominatenormalnormalpossible increasenegative
TBpossiblyincreaseddecreased+<30%increased+positive (MTB)

CNS infection presentation

Question Answer
common cause of meningitis in NEONATESGroup B Strep, E. Coli, Listeria Monocytongenes
presentation of meningitis in NEONATESbulging fontanelles
common cause of meningitis in ADULTSS. Pneumonia** / N. meningitidis* (contact!( / H. flu / L. monocytogenes / group B
common cause of meningitis in OLDER adultsS. Pneumonia** / L. Monocytogenes* (N. meningitidus / Group B / H Flu)
presentation of meningitis in adults/childrenSudden high fever.
Stiff neck.
Severe headache that seems different than normal.
Headache with nausea or vomiting.
MRI findings w/ meningitismeningeal enhancement and sulcal effacement and hydrocephalus

Misc related to CNS infection

Question Answer
Water house-friedrichsen syndromeacute 1° adrenal insufficiency due to adrenal hemorrhage associated with septicemia (usually Neisseria meningitidis), DIC, endotoxic shock)
meningeal signs also occur in (confounders)alcoholics, elderly, immunosuppressed patients, those with neurosurgical procedures
2 possible form of neural TBTB meningitis, tuberculoma of meninges or parenchyma
diagnosis of syphillispositive CSF VDRL (but negative does not rule out w/o CSF FTA-fluorotreponemal antibody)
primary fungal cause***Cryptococcus neoformans, Histoplasma capsulatum, Coccidioides immitis, Paracoccidioides braziliensis, Blastomyces dermatitidis
opportunisitic fungal causesAspergillus, candida, mucormycosis (cavernous sinus thrombosis!)
common causes of encephalitisVIRUS (entero, arbo, herpes simplex), poliomyelitis, Rabies
sx of HSV (herpes)temporal lobe lesion (hemorrhagic) --> aphasia/poor memory, high morbidity/mortality

Stimulants, Anorexigenics, Hallucinogens:

Question Answer
2 general classes of stimulantscocaine/amphetamine
mechanisms of action of stimulant (general)increase synaptic DA**, NE, 5HT by blocking REUPTAKE inhibitors
cocaine vs amphetamine mechanism of actioncocaine blocks DAT transporter, amphetamine COMPETES with DA for DAT and VMAT (preventing vesicle loading in pre-synaptic)
side effects/toxic effects of COCAINE1) classical conditioning of reward by upregulation of DA 2) **CV EFFECTS -- VASOconstrictin (alpha mediated), increased HR/contractility (risk of stroke!)
side effects/toxic effects of AMPHETAMINE1) HR effects vary (unlike cocaine), see reflex bradycardia 2) increase BP
therapeutic use of amphetaminesADHD / obesity / narcolepsy / decongestant (L-methamph) / (some off-label for depression/fatigue)
therapeutic use of MODANIFILimproves wakefulness (sympathomimetic)
side effects/toxic effects of prescribed NICOTINE (low doses)increased BP, HR, CO, and vasoconstriction
**LSD and MDMA drug type & mechanism of actionHALLUCINOGEN, 5HT2 partial agonist (receptors esp on prefrontal cortex, activation leads to excitation mediated by glutamate)
sx of LSD/MDMA usevisual hallucinations, synesthesias, elation
PCP (angel dust) drug type & mechanism of actionHALLUCINOGEN, Non-competitive antagonist at NMDA (glutamate receptor)
sx of PCP usevisual/auditory hallucinations, hostile/combative behavior, insensitivity to pain, NYSTAgMUS (ADDICTIVE!))
difference in abuse potential b/t hallucinogens and stimulantshallucinogens (acid/molly) do NOT produce withdrawl (not addictive) or compulsive seeking behavior
cannabinoid mechanism of actionCB1**/CB2 agonists --> stimulates psychoactive properties (esp THC)
name & therapeutic uses of synthetic cannabinoidsMJ (appetite stimulation, nausea), Dronabinol (anorexia in AIDS, nausea in cancer)
effects of abused inhalantsCerebellar degeneration, cognitive decline o Renal tubular acidosis o Arrhythmias and myocarditis o Cough, wheezing, pneumonitis o Bone marrow suppression

Hypothalamic Nuclei

describe the fx of the following nuclei
Question Answer
preoptic/anteriorcooling/parasympathetic (sex, sleep), electrolyte/fluid balance ""think A/C for anterior cooling""
suprachiasmaticcircadian rhythms ""sketchy fan w/ lights""
arcuate aka infundibulumsite of feeding peptides (for feeding/weight), reg. pituitary growth hormone secretion, reg. prolactin secretion ""arc of 3 p's""
ventromedial and dorsomedialregulates feeding/weight (reduces) ""zap VM area = grow VMedially (gain weight)""
lateralregulates feeding/weight (increases) ""zap lateral area = SHRINK laterally (lose weight)"" also produces OREXIN
paraventricular N - magnocellularproduce oxytocin, ADH project directly to POSTERIOR pit
paraventricular N - parvocellcularproduce releasing factor (CRF, TRF, GnRF) that release into pituitary portal system --> anterior pituitary
**supraoptic N (magnocellular)prodcue ADH (Vasopressin), project directly to POSTERIOR pit
mamillary Npart of limbic system, invovled in memory (communication with hippocampus
tuberomamillary N**histamine (sole source in brain)

Cerebellar Dysfunction

Vermal (midline) vs. Hemispheric dysfunction
Question Answer Column 3
associated nucleusfastigialdentate
functionslocomotion, posture, EOM's, position of head relative to trunkplanning of movement, fine/skilled mvmt
clinical symptomsgait problems/ataxia, truncal postural distrubance, imbalance, nystagmus, head bobbingabnormal skilled and voluntary movements of IPSILATERAL limb / incoordination (HYPOtonia, dysarthrai, dysmetria, dysdiadocokinesia, past pointing)
examobserve gait/eye movement / rombergfinter-to-nose (dysmetria) / heel-to-shin (dysmetria) / rapid alternating
causes**alcohol, tumorinfarct, **neoplasm, abscess
type of fallindiscriminatetowards IPSIlateral side

Clinical cerebellar Dysfunction cont...

Question Answer
causes that affect ENTIRE cerebellumtoxic/metabolic, infection, paraneoplastic, hypoglycemia
eye opening and balance with cerebellar ataxiaDOES NOT improve w/ eyes open...
postural tremor(non cerebellar) limb in a fixed position against gravity/ indicative of metabolic/toxic
intention tremor(CEREBELLAR) maximal towards a target
essential tremor(hereditary, non cerebellar) absent at rest, usually bilateral (hands/head/voice) aka senile tremor
asterixis(non cerebellar) not a tremor - sign of chronic renal/liver failure (flicking of wrists when hands are extended)


Question Answer
location and function of Wernicke's areaposterior superior tempora, primary auditory comprehension
location and function of transcortical sensorytemporal-parietal assc area (wide C_shaped swath), auditory information to determine meaning
location and function of broca's areainferior frontal gyrus (frontal lobe), primary output of lanugage
location and function of transcortical motordiffus frontal region, assembling syntactical architecture
location and function of arcuate fasiculusconnects wernicke's/ broca's - mediates repetition
non-dominant wernicke homologuereceptive prosody - difficulty discerning affective values (e.g. emotional valence)
non-dominant broca homologueexperessive prosody - difficulty w/ expression
disconnection syndromealexia w/o agraphia - due to lesion in visual pathway (eg. PCA STROKE)
region responsible for Working memoryDLPFC
region responsible for Encoding, short-term memoryhippocampus
region responsible for retrieval/storagePFC and distributed
region responsible for working memoryPFC
lesion that causes neglectNONdominant parietal lobe
cause of Agnosiadeficit of sensory association areas --> impaired recognition
cause of DyspraxiaDOMINANT parietal lesion (on contra-lateral side) --> inability to perform previously-learned motor task;
**PFC region responsible for motivation and clinical presentation of lesionAnterior Cingulate (medial) - abulic- akinentic syndrome
PFC region responsible for inhibition and clinical presentation of lesionorbital frontal lobe / inhibition --> disinhibiton syndrome (pheneas gage)
**PFC region responsible for executive fx (attentional/inhibitory control) and clinical presentation of lesionVL and DLPFC / dysexecutive syndrome

Pharamacology (misc.)

Consider mechanism, tx for ____, SE/AE..
Question Answer
apomorphine(Parkison's) direct DA agonist, (SE similar to DOPA) CV effect, ortho hypotension, psych
rasagiline(Parkinson) MAO_B inhibitor, no AMPHET metabolites
trihexyphenidyl(Parkinson adjunct, in sketchy) muscarinic agonist - used for tremor, AE **CNS - confusion, sedation, contraindication in closed angle glaucoma
DOC for medicine - induced parkinson'samantadine (MANATEE)
botulinum toxin(antispasticity, DOC) blocks Ach at NMJ
tetrabenazine(Huntington, motor sx) monamine (DA) reuptake blocker = deletes presynaptic stores, AE - psych
dantrolene(antispasticity, malignant hypothermia) blocks release of Ca2+ from SR
baclofen(antispasiticty) GABA-B agonists
tizanidine(musle relaxant) a2 agonist, inhibits motor neuron through PRESYNAPTIC corticalspianl inputs

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