Nefazodone – hepatic failure

All antidepressants – increased risk of suicide in children under 24

Clozipine – agranulocytosis, myocarditis, cv and respiratory reactions, seizures

Divalproex sodium (Depakote) – hepatotoxcity, hemorrhagic pancreatis, teratogenicity

Lamotrigine – Stevens Johnson

Flumazenil – seizures

grab a friend… yea I think you need some social interaction mr caffeine fiend study in a corner.

Read these questions to each other and answer them!

PartUnoBNS3

1. DSM-IV TR Axes

a) Axis I: Clinical Disorders

b) Axis II: Personality Disorders

c) Axis III: General Medical Conditions

d) Axis IV: Psychosocial/Environmental Problems

e) Axis V: GAF: Global Assessment of Fxning

2. The names of the cranial nerves and how to test them.

a) General Observation:

i. Ptosis (III)

ii. Facial Droop or Asymmetry (VII)

iii. Hoarse Voice (X)

iv. Articulation of Words (V, VII, X, XII)

v. Abnormal Eye Position (III, IV, VI)

vi. Abnormal or Asymmetrical Pupils (II, III)

b) I (Olfactory): use aromatic substance

c) II (Optic): Visual acuity, Visual fields, PERRLA?

d) III (Oculomotor), IV (Trochlear), VI (Abducens): EOMs

e) V (Trigeminal): Temporal/Masseter mm. strength, Pain at V1, V2, V3, Corneal reflex

f) VII (Facial): Raise eyebrows, Close both eyes to resistance, Smile, Frown, Show teeth, Puff out cheeks

g) VIII (Auditory): Whisper away “99”, Weber, Rinne, Rubbing fingers

h) IX (Glossopharyngeal), X (Vagus): Ask patient to swallow, Say “ahh”, Test gag reflex

i) XI (Spinal Acc.): Assess shoulder shrug and SCM fxn

j) XII (Hypoglossal): Listen to pt.’s articulation and ask to protrude tongue

3. The Mental Status Examination, especially

a) Ability to Pay Attention, (there are a # of ways, pick one).

b) Ability to Concentrate, (same as A)

c) How to test Intermediate Memory.

d) How to test Long-term Memory.

e) What is necessary to corroborate your test of Long-Term Mem.

f) How to test the ability to Abstract.

4. Typical MSE:

a) Appearance/Attitude: Objective description of appearance and attitude (cooperative, guarded, angry, suspicious)

b) Motor Activity: Sitting normally, or are there any abnormal mvmts.?

c) Thought/Speech: Logical, Slowed, Pressured, Derailment, Incoherent, Delusions

d) Mood/Affect:

i. Mood: neutral, euphoric, depressed, anxious, irritable

ii. Affect: Flat/Blunted, Inappropriate

e) Perception: Presence of hallucinations(abnormal sensory perception in absence of stimulus), Illusions(misinterpreted stimulus)?

f) Orientation: Person, Place, Time

g) Memory:

i. Short Term: Repeat back three items (green car, black moustache, red pen)

ii. Intermediate: Recall the three items in 3-5 min.

iii. Long Term:

h) General Info: Ask for the last 3 presidents; What happened on 9/11/01?

i) Calculations: Serial 7s from 100; Ask to calculate change

j) Capacity to Read/Write: Ask pt. to read simple text

k) Visuospatial Ability: Ask to draw a square in a circle; face of clock w/ certain time

l) Attention: Spell “world” backwards; Ask to name 5 things that start w/ letter “S”

m) Abstraction: What do “A rolling stone gathers no moss”, “Don’t cry over spilt milk” mean?

n) Judgement/Insight: Insight to illness:“Do you believe that you are mentally ill?”, or “Do you believe that you need treatment?”. Judgement: “If you find an addressed stamped envelope, what do you do?”, or “If you are in a theater and smell smoke, what do you do?”

5. How to perform the following tests and their clinical significance.

a) Rhomberg: Assesses Dorsal Columns and Cerebellar fxn (Proprioception); Have pt. stand w/ eyes closed, and monitor for swaying/falls

b) Pronator Drift: Assesses for spasticity r/t UMN lesions. Have pt. stick out supinated arms and then close eyes, watch for drift

c) RAM: Assesses cerebellar fxn (dysdiadochokinesia); Flip hand rapidly in opposite palm

d) Finger-nose: Assesses cerebellar fxn (dysmetria); Finger-nose w/ eyes closed

e) Brudzinski’s: Assesses meningeal irritation; Pt. lying flat and then raise head

f) Kernig’s: Assesses meningeal irritation; Flex hips, then extend knees

g) Asterixis: Assesses for Hepatic Encephalopathy; Patient extends hands to assess for tremor at wrist

h) Ankle Clonus: Assesses Pyramidal tract lesions; Rapid alternating flexion and extension of the ankle when pressure is applied to bottom of foot.

Basic Motor and Sensory pathway would help for mondays test.

Admin Edit- 

Read more or download below.

FosterAnswered

1. What is the sulcus limitans?
   1. A groove of the neural canal that seperates the alar and basal plates
2. What are the alar and basal plates? Know some examples of nuclei derived from them
   1. The mantle in the dorsal part of the developing brain is called the alar plate and develops into sensory areas.
      1. Nuclei: Special Somatic Afferent (eg hearing and balance), General Somatic Afferent (touch), Special Visceral Afferent (taste), General Visceral Afferent.
   1. The mantle in the ventral part of the developing brain is called the basal plate and develops into motor areas. 
      1. Nuclei: General Visceral Efferent (parasympathetics), Special Visceral Efferent (branchial arch muscles), General Somatic Efferent (other muscles)
3. What are the general somatic efferent columns?  Know examples of these in parts of the brainstem.
   1. Medial most tract within the basal plate contained within the medualla and mesencephalon.  See part 2 of the development lecture for illustration.
4. What can result if the rostral or caudal neuropores fail to close?
   1. If the rostral neuropore fails to close then the result is exencephaly
   2. If the caudal neuropore fails to close then the result is spina bifida.
5. What structures are derived from the neuroectoderm, ectoderm or cranial neural crest cells?
   1. Neuroectoderm: brain, spinal chord, retina, pigmented epithelium of the eye, optic nerve and pars nervosa of the pituitary gland (posterior part)
   2. Ectoderm: skin (epidermis), epidermal glands (sweat, sebaceous, mammary), hair, nails, lens, corneal epithelium, inner ear labyrinth, anterior pituitary
   3. Neural Crest Cells: autonomic ganglia, suprarenal medulla, melanocytes, sensory ganglia, cranial nerves, Schwann cells, meninges of the brain and spinal cord, some skeletal and muscular components of the head, DRG.
6. What are the structures that are derived from the different parts of the brain or the brain vesicles?
   1. Prosencephalon
      1. telencephalon
         1. paleocortex
         2. corpus stiratum
         3. neocortex
      1. Diencephalon
         1. Epithalamus
         2. Thalamus
         3. Hypothalamus
         4. Infandibulum
   1. Mesencephalon
      1. mesencephalon
         1. Tectum
         2. Tegmentum
         3. Cerebral peduncles
   1. Rhombencephalon
      1. Metencephalon
         1. Cerebellum
         2. Pons
      1. Myencephalon
         1. Medulla
   1. Cavity of Rhombencephalon
      1. 4th Ventricle
   1. Cavity of mesencephalon
      1. Aquaduct
   1. Cavity of diencephalon
      1. Third ventricle
   1. Cavity of telencephalon
      1. lateral ventricle (one in each hemisphere)
7. What structures are located in gray and white matter?
   1. gray matter: cell bodies, alar and basal plates, dendrites, and unmyelinated cell bodies
   2. white matter: axons, cell bodies of oligodendrocytes and astrocytes
8. What are the different types of glia cells?  What do they do?
   1. Astroglia
      1. There are 2 types.  Protoplasmic astrocytes are mostly found in the gray matter and fibrous astrocytes are mostly found in the white.
      2. Both types have a star like radiating pattern.
      3. These cells are involved in selectively isolating specialized areas of synaptic exchange between nerve cells.
      4. Also have supportive, nutritive, and reparative roles
      5. Astrocyte processes terminate as “end-feet” near blood vessels and the external surfaces of the CNS.
      6. Astrocytic processes reach the brain and spinal cord and form a protective covering (external limiting membrane or glial membrane)
      7. Astrocytic processes also reach the outside of capillaries and form part of the blood brain barrier.
      8. Also function in: electrolytic balance of the CNS, remove neurotransmitters from the synaptic cleft, produce trophic factors necessary for neuronal survival, and form scars after CNS injury.
   1. Microglia
      1. Most likely of mesodermal origin
      2. Has phagocytic function within the CNS
   1. Oligodendrocytes
      1. involved in formation and maintenance of myelin in the CNS.
      2. Myelin is formed by oligodendrocyte processes that wrap around the nerve axons.
      3. ONE oligodendrocyte can form myelin around a variable number of axons (up to 40 or 50).
   1. Ependymal
      1. These cells are derived from the neural tube and they form an epithelial sheet which covers the interal cavities (ventricular system) of the brain and spinal cord.
   1. Schwann Cells
      1. Myelinate axons in the periphery
   1. Capsular (satellite) cells
9. That forms the BBB?
   1. The blood brain barrier is composed of endothelial cells that line the blood vessels in the brain.  Due to the tight junctions nutrients must be actively transported across the membrane/barrier.  The astrocytes also add to the bbb as well.  But, it is hypothesized that the tight junctions between endothelial cells play the major role.
10. What are some of the general histological characteristics of neurons and their components?
    1. Cytoplasm contains rER and ribosomes causing it to stain with basic dye.  These structures are called Nissl bodies after their discoverer.
    2. The nucleus is usually filled with euchromatin and contains a prominent nucleolus.
    3. Dendrites can be small or large in diameter and may contain some Nissl substance, microtubules, neurofilaments, and mitochondria.  Neurons can have one or more dendrites and the general rule is that the dendrite transports information from other neurons, cells, etc. to the soma.
    4. Axons convey information away from the soma.  Usually each neuron will only have one that originates in a specialized region of the perikaryon called the axon hillock. 
    5. Typically contain microtubules, neurofilaments, microtubules, and mitochondria but lack Nissl and Golgi bodies.  Due to this axons tend to not pick up stain and stay relatively clear.
11. Where are the different neurons in the olfactory and taste pathways to the primary sensory cortices located?
    1. Taste: CN XII, IX, and X afferents come into T. solitarius then move into N. Solitarius. From N. Solitarius to the thalamus then to the primary gustatory cortex.
    2. Olfactory:  Comes from lateral striae to the lateral olfactory region of the amygdala.  From the amygdala to the diagonal band of broca which ends in the septum.  Then to the Median Forbrain Bundle which then go to the sympathetics or parasympathetics in the thalamus. From the thalamus to the primary olfactory cortex.
12. What are the characteristics of the receptors for smell and taste?
    1. Taste
       1. receptors clustered together and contained within taste buds
       2. Each taste bud contains supporting cells, receptor cell with microvilli, and basal cells
       3. Afferent nerves run into the receptor cells they are not directly exposed like olfactory nerve cells.
       4. Seromucus glands wash the taste stimulation out of the taste receptor.
       5. Also highly regenerated
    1. Olfactory
       1. contains receptor cells, supportive cells, and basal cells.
       2. Regenerate rapidly
       3. Each neuron only expresess one odorant receptor.  But each receptor may be activated through different chemicals by chemical similarity.
       4. G-couple receptor
       5. bipolar neurons
       6. Receptors hang down through cribiform plate
13. What are the primary gustatory and olfactory sensory cortex?
    1. Tongue and pharnyx are located at the lateral fissure of the cortex (refer to homonculus)
    2. The nose is located slightly higher.
14. What are the general characteristics of chemical synaptic transmission?
    1. Stimulation caused depolarization which causes and influx of calcium which then leads to exocytosis of vesicles and release of neurotransmitters into the synaptic cleft.  The neurotransmitter then binds to receptors on the postsynaptic cell causing it to depolarize.  Any extra neurotransmitters are taken back in by endocytosis.
15. What structures are derived from different components of the embryonic ear?
    1. Most structures of the ear are associated with the ectoderm and branchial arches with no direct origin with the neuroectoderm.
    2. The inner ear develops form the otic vesicle which is an ectoderm vesicle.
    3. Inner ear develops as the cartilage of the petrous portion of the temporal bone (called otic capsule) is forming mainly out of mesenchymal neural crest cells.
    4. The nerve to the inner ear develops from the ectoderm as well in a similar manner as neural crest cells.
    5. The otic placode invaginates to form the otic pit which then closes off to form the otic vesicle which is surrounded by mesoderm.
    6. Neural placode cells form CN VIII
    7. Spiral ligament and bony canal are of mesoderm origin
    8. Everything that lines the cochlear duct (scala media) is of otic vesicle origin.
    9. Sprial ganglion is of neural placode origin
    10. External ear and middle ear develop from the pharyngeal region
    11. External ear come from branchial arch 1 (tragus and anterior helix) and brachial arch 2 (antitragus and posterior helix).
    12. External auditory meatus come from the 1st branchial groove.
    13. Middle ear comes from 1st pharnygeal pouch
    14. Malleus and Incus come from the first branchial arc (also known as Meckel’s Cartilage)
    15. Staped comes from the second branchial arch
16. Which cells are the primary receptor cells for hearing and balance?
    1. Balance
       1. maculae of the utricle and saccule receive and transmit information to the CNS about the position of the head in space
       2. The three cristae ampullaris  receive and transmit information to the CNS about the direction of movement of the head.
    1. Hearing
       1. The organ of corti is the primary receptor for hearing.
17. What cells produce endolymph?
    1. The dark cells of the stria vascularis within the membranous labyrinth.
18. Where is high frequency and low frequency sound percived?
    1. High frequency sounds cause waves of maximal amplitude close to the base of cochlea.
    2. Low frequency sounds cause waves of maximal amplitude close to the apex of cochlea.
    3. Tonotopic representation is held constant through the auditory pathways.
19. How is sound transduced in the cochlea?
    1. Sound comes in and causes vibration of the inner ear ossicles.  The stapes transfers that vibration via the oval window to the cochlea.  This movement of the stapes causes displacement of the perilymph which causes deflection of the basilar membrane.  If the deflection causes the stereocilia to move outward toward the stria vascularis you get a depolarization due to the opening of K+ gates.  This depolarization causes an influx Ca2+ which causes release of glutamate containing vesicles to the synaptic membrane.  The glutamate is then released into the synaptic cleft causing depolarization of the afferent fiber.  This action potential is then transmitted down the length of the cochlear nerve fibers.   If the stereocilia move inward away from the stria vascularis you get hyperpolarization.  These signals are transferred to the cochlear nerve.  The mixing of hyperpolarizations and depolarizations result in different tones heard.
20. What are the characteristics of hair cells?
    1. Hair cells are columnar cells with a tuft if non-motile stereocili and one non-motile cilium (kinocilium) located at the apical surface.
    2. Hair cells come in 2 flavors:
       1. Type I: flask shaped cells that are surrounded by a cup shaped afferent nerve ending called a calyx or chalice.
       2. Type II: rod-shaped cells, smaller afferent and efferent nerve endings.

 

http://www.youtube.com/watch?v=f2IiMEbMnPM&NR=1

Here is one for Wernicke’s:

http://www.youtube.com/watch?v=aVhYN7NTIKU&feature=related

first 53 seconds

http://www.youtube.com/watch?v=fGisFJffJK4

Its what nielson is always talking about.  Might help for basics.