Reflexes
Nucleus, CN, and type (ex. branchial, somatic, visceral, special, sensory/motor) associated with pupillary light reflex
Edinger-Westphal Nucleus
CN III
Visceral motor
This is the pathway of the CSF from choroid plexus --> right atrium
Lateral ventricles -> foramen of monro -> 3rd ventricle -> cerebral aqueduct -> 4th ventricle -> foramen of magendie/luschka -> subarachnoid space -> arachnoid granulations -> dural venous sinus -> internal jugular vein -> brachiocephalic vein -> SVC
This symptom of alcohol withdrawal can occur after 48 hours
Delirium tremens (hyperthermia, arrhythmias, fluid imbalance, AMS, autonomic hyperactivity, hallucinations without orientation)
Bilateral internuclear opthalmoplegia with Marcus Gunn Pupil & weakness
Multiple Sclerosis (demyelination of oligodendrocytes = CN I, II, MLF)
This mnemonic can be used to remember the symptoms of depression (rapid fire list them)
SIGECAPS: sleep changes, interest loss, guilt, energy decrease, concentration changes, appetite change, psychomotor disturbances, suicidal ideation
Deep tendon reflex causes synapses at these 2 places
Alpha motor neuron (agonist contracts)
Interneuron that blocks alpha motor neuron at antagonist muscle (relaxes)
Pathway involving the upper vermis and intermediate zone in the cerebellum
Spinocerebellum: posterior tract takes from lower trunk/limb and cuneocerebellar tract takes from upper.
Synapse on Clarke's nucleus or accessory cuneate nucleus -> granule cell -> purkinje cell -> interposed nucleus -> most to contralateral red nucleus (-> ION and ventral horn), some to VA/VL (-> motor cortex)
Avoid prescribing this medication to a patient who presents with cocaine intoxication
Beta blockers (unopposed alpha effects can worsen hypertension and chest pain)
Weber and Rinne's findings for Meniere's disease
Weber: louder in good ear
Rinne: air conduction > bone
Sensorineural hearing loss, tinnitus, vertigo
These are the 5 stages of grief (in any order)
Denial, anger, bargaining, depression, acceptance
The jaw jerk reflex synapses on these 2 nuclei of CN V
Mesencephalic nucleus
Motor nucleus of V
Body, lesser wing, greater wing, and pterygoid process make up this important bone, which houses these 4 foramen for cranial nerves (name of bone and name of foramen)
Sphenoid bone
Optic canal
Superior orbital fissure
Foramen rotundum
Foramen ovale
This drug may be used to treat withdrawal OR may precipitate withdrawal in someone acutely intoxicated (at least give drug class if not name)
Buprenorphine: partial opioid agonist
Brown Sequard Syndrome diagnosis
Total loss of all sensations at level of injury
Ipsilateral loss of motor & vibration/position
Contralateral loss of pain/temp
These are 3 places the amygdala communicates with in response to anxiety (and the type of response generated)
3 of the below 5 options
Anterior cingulate cortex / orbitofrontal cortex (emotional)Periaqueductal gray (motor)
Hypothalamus (endocrine)
Locus coeruleus (autonomic/CV)
Hippocampus (reexperiencing)
These are 3 nuclei involved in the gag reflex
Solitary nucleus, Spinal V, nucleus ambiguus
Direct pathway of the basal ganglia
The cortex synapses striatum and releases glutamate. The ASN also synapses there and releases ACh. The substantia nigra pars compacta also synapses on the striatum and releases dopamine. Striatum gets activated and synapses on GPi and SNpr, releasing GABA and substance P. GPI and SNpr are therefore inhibited from releasing GABA. This disinhibits the thalamus (VA/VL) which can then release glutamate and stimulate the cerebral cortex
MH: succinylcholine - dantrolene (decreases Ca)
NMS: antipsychotics - dantrolene or bromocriptine (Da agonist)
SS: serotonin agents - cyproheptadine (5-HT antagonist)
Unilateral headache, eye pain, CN III palsy (eyes down and out, ptosis, pupil dilation)
PComm aneurysm
Instability, suicidal threats, and all good or bad thinking are characteristic of THIS disorder, which is in THIS cluster, along with 3 other disorders (3 responses for full credit)
Borderline personality disorder
Cluster B
Antisocial, histrionic, narcissistic personality disorders
These are the head and eye movements seen in response to cold caloric testing when placing cold water in right ear in
- awake person
- coma patient (brainstem intact)
- brainstem death (just a bonus since case this week)
Sensation that head is turning left -> eyes turn right -> eyes will then snap back to the left, causing nystagmus to the left (away from cold ear)
If coma, eyes will stay to the right, intact brainstem but no fast corrective saccade
(if brainstem death, slow and fast components will both be absent)
These 4 parasympathetic branches hitchhike with the trigeminal nerve (list CN and where it synapses)
CN 9: otic ganglion
CN 7: pterygopalatine ganglion
CN 7: submandibular ganglion
3977 COPS
Drugs which increase the FREQUENCY of GABA-a mediated Cl- channel opening can be used to treat many types of withdrawal, including these 3.
Benzos treat withdrawal from: cocaine, amphetamines, alcohol, benzodiazepine (long t1/2 then wean off), PCP
Ipsilateral Horner's
Ipsilateral hemiataxia
Ipsilateral loss of pain/temp on the face
Contralateral loss of pain/temp on the body
Vertigo
Decreased taste
Hoarseness/dysphagia
Lateral medullary syndrome
PICA or vertebral stroke
These are the 12 components of the MSE (rapid fire)
General appearance
Behavior/attitude
Motor activity
Speech
Mood/Affect
Thought process
Thought content
Perceptions
Cognition
Insight
Judgment
Impulse control