• Author / Uploaded
• MedShare

Citation preview

Neuroscience – Part 4

14Mar2009

Neuro #1 – Pharmacology: CNS Drugs (Chapter 21) 1) When enough excitatory postsynaptic potentials (EPSPs) are generated, ____ of the membrane occurs and an action potential is generated. Inhibitory postsynaptic potentials (IPSPs) involve ____ of the membrane and a selective increase in membrane permeability to ____ ions. a) Depolarization; Hyperpolarization; Na+ & K+ b) Depolarization; Hyperpolarization; Clc) Hyperpolarization; Depolarization; Na+ & K+ d) Hyperpolarization; Depolarization; Cl2) Which of the following correctly describes the order in which metabotropic receptors cause the activation of ion channels? a) Receptor => Diffusible messenger => Activating enzyme => G-protein b) Receptor => G-protein => Diffusible messenger => Activating enzyme c) Receptor => G-protein => Activating enzyme => Diffusible messenger d) Receptor => Activating enzyme => Diffusible messenger => G-protein e) Receptor => Activating enzyme => G-protein => Diffusible messenger Match the channel blocker with the ion channel site of action: 3.1) Nicotinic ACh receptor ligand a) Tetrodotoxin (Puffer fish) 3.2) Ca++ voltage N-type channel b) Apamin (Honeybee) 3.3) Na+ voltage channel from outside c) Omega conotoxin (Pacific cone snail) 3.4) Glycine receptor ligand d) !-bungarotoxin (Marine snake) 3.5) Small Ca++ activated K+ channel e) Strychnine (Indian plant) 3.6) Which of the following describes how strychnine affects ion channels? a) Competitive antagonist b) Non-competitive antagonist c) Irreversible antagonist d) Competitive agonist e) Non-competitive agonist 3.7) Which of the following describes how !-bungarotoxin affects ion channels? a) Competitive antagonist b) Non-competitive antagonist c) Irreversible antagonist d) Competitive agonist e) Non-competitive agonist 4) If the resting potential of a given membrane is -70mV, which of the following best describes how an inhibitory postsynaptic potential (IPSP) of 20mV would affect the membrane? a) Depolarize the membrane, moving it to -50mV b) Depolarize the membrane, moving it to -90mV c) Hyperpolarize the membrane, moving it to -50mV d) Hyperpolarize the membrane, moving it to -90mV 5) After exposure to a sarin (GB) nerve agent at a mass-casualty incident scene, a paramedic self-administers a Mark-1 kit, containing auto-injectors of atropine and pralidoxime chloride (2-PAM). The affects seen by exposure to sarin are similar to pyridostigmine, neostigmine, and physostigmine. 2-PAM works as an antidote to the affects of sarin in the neuromuscular junction, effectively:

DO NOT DISTRIBUTE

-1-

Neuroscience – Part 4

14Mar2009

a) Prevents the movement of Ca++ b) Blocks acetylcholine c) Blocks cholinesterase d) Reactivates acetylcholine e) Reactivates cholinesterase 6) Which of the following is a likely and beneficial role of recurrent neurons? a) Cause excessive neurotransmitter release b) Prevent any neurotransmitter release c) Prevent excessive neurotransmitter release d) Prevent too little neurotransmitter release 7.1) Which of the following criteria for neurotransmitter identification would use selective pharmacologic antagonism to determine the manner in which a synaptically released transmitter is acting? a) Localization of neurotransmitter b) Release of neurotransmitter c) Synaptic mimicry of neurotransmitter 7.2) Which of the following criteria for neurotransmitter identification would involve electrically or chemically stimulating a slice of brain tissue and measuring substances near the stimulated area? a) Localization of neurotransmitter b) Release of neurotransmitter c) Synaptic mimicry of neurotransmitter Match the following agonist/receptor type with the transmitter: 8.1) NMDA a) Acetylcholine 8.2) Bromocriptine b) Dopamine 8.3) Nicotine c) GABA 8.4) Bethanechol d) Glutamate 8.5) Kainic acid e) Serotonin 8.6) Taurine, B-alanine f) Glycine 8.7) 2-methyl-5-HT 8.8) Muscimol, Baclofen Neuro #2 – Pharmacology: Sedatives- Hypnotics (Chapter 22) 1) Generalized CNS depression produced by sedative-hypnotics can depress respiratory and vasomotor centers in what part of the brain, leading to coma and death? a) Medulla b) Pons c) Midbrain d) Diencephalon e) Cerebellum 2) Which of the following has an active metabolite seen during degradation? a) Zolpidem b) Zaleplon c) Phenobarbital d) Diazepam e) Flumazenil

DO NOT DISTRIBUTE

-2-

Neuroscience – Part 4

14Mar2009

3.1) Which of the following GABA-A subunits is involved in the benzodiazepine binding site? a) ! subunit b) " subunit c) # subunit d) $ subunit e) % subunit 3.2) The chloride channels is triggered by binding of GABA to which of the following subunits? a) ! & " b) " & # c) # & $ d) $ & % e) % & ! 4.1) Which of the following describes the action of benzodiazepines? a) Increase frequency of GABA-mediated Cl- channel opening b) Increase duration of GABA-mediated Cl- channel opening c) Increase frequency of GABA-mediated Cl- channel opening and block glutamic acid d) Increase duration of GABA-mediated Cl- channel opening and block glutamic acid 4.2) Which of the following describes the action of barbiturates? a) Increase frequency of GABA-mediated Cl- channel opening b) Increase duration of GABA-mediated Cl- channel opening c) Increase frequency of GABA-mediated Cl- channel opening and block glutamic acid d) Increase duration of GABA-mediated Cl- channel opening and block glutamic acid 5) Low dose benzodiazepines and barbiturates exert a calming affect with anxiety relief (sedation). Higher doses will induce sleep (hypnosis). During hypnosis induced by sedative-hypnotics, which of the following is increased? a) Time to fall asleep b) Duration of stage 2 NREM sleep c) Duration of REM sleep d) Duration of stage 4 NREM slow-wave sleep e) Psychomotor and cognitive functions 6.1) Which of the following is NOT characteristic of physiological dependence to a drug when the user stops taking the drug? a) Anxiety b) Tremors c) Compulsion d) Seizures e) Hyper-reflexia 6.2) Sedative-hypnotics are NOT commonly associated with development of tolerance. a) True b) False

DO NOT DISTRIBUTE

-3-

Neuroscience – Part 4

14Mar2009

7.1) Which of the following drugs should be given if the goal is to decreases the latency of sleep onset (fall asleep quickly) without affecting REM sleep? a) Zolpidem b) Zaleplon c) Eszopiclone, low dose d) Eszopiclone, high dose 7.2) Which of the following drugs should be given if the goal is to increase total sleep time without decreasing REM sleep? a) Zolpidem b) Zaleplon c) Eszopiclone, low dose d) Eszopiclone, high dose 8) Flumazenil (Romazicon, Anexate) acts as a competitive antagonist to reverse the CNS depressant effects of which of the following? a) Cocaine b) Ethanol c) Opioids d) Barbiturates e) Benzodiazepines 9.1) Which of the following acts as a partial agonist at brain 5-HT1A receptors, exerting an anxiolytic effect? a) Zolpidem (Ambien) b) Zaleplon (Sonata) c) Eszopiclone (Lunesta) d) Buspirone (BuSpar) 9.2) Which of the following is a non-benzodiazepine used for short-term treatment of insomnia? a) Zolpidem (Ambien) b) Zaleplon (Sonata) c) Eszopiclone (Lunesta) d) Buspirone (BuSpar) 10) Which of the following is NOT true regarding the use of benzodiazepines for treatment of anxiety? a) Relatively high therapeutic index b) Availability of drug(s) to treat overdose c) Low risk of drug interactions based on liver enzyme induction d) Minimal effects on cardiovascular or autonomic functions e) Fast elimination rates 11) Which of the following drugs would have the highest risk of adverse effects (anxiety, orthostatic hypotension, hyper-reflexia, seizures) if it were discontinued abruptly? a) Eszopiclone, 6 hour half-life b) Zolpidem, 1.5-3.5 hour half-life c) Zaleplon, 1-2 hour half-life d) Triazolam, 2-3 hour half-life e) Flurazepam, 40-100 hour half-life

DO NOT DISTRIBUTE

-4-

Neuroscience – Part 4

14Mar2009

12) Which of the following dosages should be used when giving benzodiazepines to elderly patients? a) 3 times younger-adult dose b) 2 times younger-adult dose c) Normal dosage d) 1/2 younger-adult dose e) 1/3 younger-adult dose 13.1) Which of the following drugs has the highest risk of causing impaired cognitive function, impaired psychomotor skills, and excessive daytime sedation in an elderly patient, which could lead to falls and fractures? a) Eszopiclone, 6 hour half-life b) Zolpidem, 1.5-3.5 hour half-life c) Zaleplon, 1-2 hour half-life d) Triazolam, 2-3 hour half-life e) Flurazepam, 40-100 hour half-life 13.2) A college student presents to the Emergency Room with anterograde amnesia stating she believes she was recently given a date-rape drug. Which of the following would most likely show up in blood work if benzodiazepines were suspected? a) Triazolam, low dose b) Triazolam, high dose c) Flunitrazepam, low dose d) Flunitrazepam, high dose e) Eszopiclone 13.3) Extensive clinical use of this of the following can lead to serious CNS effects including behavioral disinhibition, delirium, aggression, and violence? a) Alprazolam b) Diazepam c) Flurazepam d) Midazolam e) Triazolam Neuro #3 – Pharmacology: Alcohols (Chapter 23) 1.1) Which of the following is NOT equivalent to the amount of alcohol that can be metabolized by a typical adult in an hour? a) 7-10g of alcohol b) 3.5oz of wine c) 16oz of beer d) 1oz of distilled 80 proof spirits 1.2) Which of the following is true regarding alcohol dehydrogenase (ADH) metabolism? a) Liver metabolism is lower in women than in men b) Liver metabolism is lower in men than in women c) Brain metabolism is lower in women than in men d) Brain metabolism is lower in men than in women e) Gastrointestinal metabolism is lower in women than in men 1.3) When is the microsomal enzyme-oxidation system (MEOS) activated? a) Initially with consumption of any ethanol, prior to ADH metabolism

DO NOT DISTRIBUTE

-5-

Neuroscience – Part 4

14Mar2009

b) Initially with conjunction with the ADH metabolism c) Initially until the ADH pathway becomes saturated d) After the ADH pathway becomes saturated e) As the concentration of ethanol decreases below 100mg/dL in blood 2.1) Which of the following levels of ethanol in the blood is normally associated with gross drunkenness without loss of consciousness, anesthesia, or coma? a) 20mg/dL b) 70mg/dL c) 150mg/dL d) 300mg/dL e) 500mg/dL 2.2) Which of the following is NOT true regarding the mechanism of action for ethanol or its metabolite acetaldehyde? a) Facilitates action of GABA at GABA-A receptors b) Inhibits the ability of glutamate to activate NMDA receptors c) Modifies the activities of adenylyl cyclase, phospholipase C, and ion channels d) Depression of cardiac contractility e) Vasoconstriction of smooth muscle 3) Which of the following is the most common complication of alcohol abuse? a) Hypoglycemia, gynecomastia, testicular atrophy b) Thiamine deficiency, Wernicke-Korsakoff syndrome c) Pancreatitis d) Hepatic disease e) Cardiovascular disease 4) Which of the following would NOT be used in treatment for acute alcohol intoxication? a) Thiamine administration b) Administering IV dextrose c) Monitoring the airway for aspiration d) Maintaining vital signs e) Placing the patient supine on a backboard to prevent spinal injury Match the drug used to treat alcoholism with the mechanism of action: 5.1) NMDA-R antagonist, GABA-A-R activator a) Disulfiram (Antabuse) 5.2) Inhibits aldehyde dehydrogenase b) Acamprosate (Campral) 5.3) Opioid receptor antagonist c) Naltrexone (Revia, Depade) 6.1) A young boy presents to a rural Emergency Room with bradycardia, shortness of breath, and intermittent seizures. The boy is having trouble seeing and says it looks like he’s “in a snow storm.” The attending physician suspects methanol poisoning. Which of the following should be given to the patient if the goal is to compete with alcohol dehydrogenase and thus suppress metabolism of the methanol? a) IV Fomepizole b) IV Disulfiram c) IV Naloxone d) IV Flumazanil e) IV Ethanol

DO NOT DISTRIBUTE

-6-

Neuroscience – Part 4

14Mar2009

6.2) An infant presents to the emergency room with metabolic acidosis and severely compromised vital signs. A frantic mother believes the child drank antifreeze (ethylene glycol) in the garage. Which of the following should be given to the patient if the goal is to inhibit alcohol dehydrogenase and thus prevent metabolism of ethylene glycol? a) IV Fomepizole b) IV Disulfiram c) IV Naloxone d) IV Flumazanil e) IV Ethanol Neuro #4 – Pharmacology: Anti Seizure Drugs (Chapter 24) 1.1) Which of the following is a tricyclic antidepressant that is considered a drug of choice for partial seizures? a) Phenytoin (Dilantin) b) Carbamazepine (Tegretol) c) Phenobarbital (Luminal) d) Primidone (Mysoline) 1.2) Which of the following is very effective against absence seizures and is associated with both thrombocytopenia and hepatotoxicity? a) Lamotrigine (Lamictal) b) Gabapentin (Neurontin) c) Ethosuximide (Zarotin) d) Valproic acid/Sodium valproate (Depekene) 1.3) Which of the following is a long-acting benzodiazepine with efficacy against absence seizures, may have pronounced sedative effects, and has tolerance issues? a) Clonazepam (Klonopin) b) Lorazepam (Ativan) c) Diazepam (Valium) d) Midazolam (Versed) 1.4) Which of the following is used to treat trigeminal neuralgia (“tic doulouereux”) and is associated with aplastic anemia in some cases? a) Phenytoin (Dilantin) b) Carbamazepine (Tegretol) c) Phenobarbital (Luminal) d) Primidone (Mysoline) 1.5) Which of the following is a drug of choice in treating absence seizures as it lacks the idiosyncratic hepatotoxicity of other such drugs and also has a well established role as the first choice in anti-absence seizures? a) Lamotrigine (Lamictal) b) Gabapentin (Neurontin) c) Ethosuximide (Zarotin) d) Valproic acid/Sodium valproate (Depekene) 1.6) Which of the following is NOT true of phenytoin (Dilantin)? a) Blocks Na+ channels and inhibits repetitive action potentials b) Is effective against partial seizures c) Should be given via the IM route

DO NOT DISTRIBUTE

-7-

Neuroscience – Part 4

14Mar2009

d) Is highly protein bound e) Can cause nystagmus, diplopia, and ataxia 1.7) Which of the following benzodiazepines is a powerful anxiolytic and is used as an adjunctive antiemetic in chemotherapy? a) Clonazepam (Klonopin) b) Lorazepam (Ativan) c) Diazepam (Valium) d) Midazolam (Versed) 1.8) Valproate will cause a two-fold increase in which of the following drug’s half-life? a) Lamotrigine (Lamictal) b) Gabapentin (Neurontin) c) Ethosuximide (Zarotin) 1.9) Which of the following benzodiazepines is NOT used for short surgical procedures such as dental extraction or pre-surgery anti-anxiety? a) Clonazepam (Klonopin) b) Midazolam (Versed) c) Diazepam (Valium) 1.10) Which of the following is an amino acid analog of GABA effective against partial seizures? a) Lamotrigine (Lamictal) b) Gabapentin (Neurontin) c) Ethosuximide (Zarotin) d) Valproic acid/Sodium valproate (Depekene) 1.11) Which of the following is the most commonly used barbiturate, acts on the GABA receptor, and is a common drug of abuse? a) Phenytoin (Dilantin) b) Carbamazepine (Tegretol) c) Phenobarbital (Luminal) d) Primidone (Mysoline) 1.12) What is a commonly seen adverse effect of ethosuximide (Zarotin)? a) Hepatotoxicity b) Aplastic anemia c) Thromboxytopenia d) Gastric distress e) Tachypnea 1.13) Which of the following is NOT true of vigabatrin? a) Is useful in partial seizures b) Is useful in West Syndrome c) Irreversibly inhibits GABA aminotransferase d) Decreases the amount of GABA released at synaptic sites 2.1) Patients who suffer from what type of seizures often wear helmets to prevent serious head injuries? a) Complex partial seizures b) Generalized tonic-clonic (grand mal) seizures c) Absence (petit mal) seizures d) Myoclonic jerking seizures

DO NOT DISTRIBUTE

-8-

Neuroscience – Part 4

14Mar2009

e) Atonic seizures f) None of the above 2.2) What type of seizure always involves the limbic system, involves memory loss of the event, and usually involves automatisms (e.g. lip smacking, fumbling, walking about)? a) Complex partial seizures b) Generalized tonic-clonic (grand mal) seizures c) Absence (petit mal) seizures d) Myoclonic jerking seizures e) Atonic seizures f) None of the above 2.3) In the Emergency Room, a mother rushes to the reception desk distressed that her child is “shaking all over the bed.” Entering the child’s room, the patient is convulsing and has urinary incontinence. Which of the following drugs would NOT be an option for this patient? a) Valproate b) Phenytoin c) Barbiturates d) Carbamazepine e) Ethosuximide 2.4) A mentally retarded infant presents with brief, recurrent myoclonic jerks of the body with sudden flexion and extension of the limbs. Which of the following drugs should be administered via the IM route? a) Clonazepam b) Phenytoin c) Barbiturates d) Carbamazepine e) Corticotrophin 2.5) Which of the following is a drug of choice for atonic seizures? a) Clonazepam b) Phenytoin c) Valproate d) Carbamazepine e) Lamotrigine 2.6) Which of the following would NOT be given for absence status seizures? a) Diazepam b) Lorazepam c) Phenytoin d) Clonazepam e) Midazolam 3) Which of the following teratogenic drugs has been implicated in spina bifida and is not associated with fetal hydantoin syndrome (embryopathy)? a) Phenytoin b) Valproate c) Carbamazepine d) Phenobarbital

DO NOT DISTRIBUTE

-9-

Neuroscience – Part 4

14Mar2009

Neuro #5 – Pharmacology: General Anesthetics (Chapter 25) 1.1) Which of the following inhaled anesthetics is NOT a volatile liquid at room temperature? a) Nitrous oxide b) Halothane c) Enflurane d) Isoflurane e) Desflurane f) Sevoflurane g) Methoxyflurane Match the common intravenous anesthetic with description: 1.2) Used for Rapid Sequence Intubation (RSI) and conscious sedation a) Thiopental 1.3) Opioid analgesic &81x more potent than morphine b) Midazolam 1.4) Very common anesthesia induction agent, opaque white in color c) Fentanyl 1.5) Ultra-short-acting barbiturate sometimes used in interrogation d) Propofol 1.6) Short-acting benzodiazepine derivative with reversal drug available e) Etomidate 2) A patient is being induced by an anesthesiologist prior to surgery and has lost the eyelash reflex, responsiveness to a small electric shock on the face, and has established a regular respiratory pattern. What state of anesthesia is this patient in? a) Stage 1 – Analgesia b) Stage 2 – Excitement c) Stage 3 – Surgical anesthesia d) Stage 4 – Medullary depression 3) Which of the following has the more rapid onset and recovery (elimination via lungs)? a) Nitrous oxide, blood:gas partition coefficient of 0.47 b) Sevoflurane, blood:gas partition coefficient of 0.69 c) Isoflurane, blood:gas partition coefficient of 1.40 d) Halothane, blood:gas partition coefficient of 2.30 e) Methoxyflurane, blood:gas partition coefficient of 12 4.1) Given the blood:gas partition coefficient, which of the following most likely has the highest minimum alveolar concentration (MAC), and thus is the least potent? a) Nitrous oxide, blood:gas partition coefficient of 0.47 b) Sevoflurane, blood:gas partition coefficient of 0.69 c) Isoflurane, blood:gas partition coefficient of 1.40 d) Halothane, blood:gas partition coefficient of 2.30 e) Methoxyflurane, blood:gas partition coefficient of 12 4.2) Which of the following anesthetics, unlike the mechanisms of most other anesthetics, does NOT affect GABA? a) Thiopental b) Midazolam c) Ketamine d) Propofol e) Etomidate 4.3) Which of the following corresponds to a stage III response to anesthetics? a) Interruption of spinothalamic (ALS) tract via neurons in the substantia gelatinosa of the dorsal horn of the spinal cord

DO NOT DISTRIBUTE

- 10 -

Neuroscience – Part 4

14Mar2009

b) Blockage of many small inhibitory neurons in the brain c) Depression of ascending pathways in the reticular activating system d) Depression of respiratory and vasomotor centers of the medulla 4.4) Which of the following is NOT true regarding minimum alveolar concentration (MAC) of general anesthetics? a) At 760mmHg of nitrous oxide, most (>50%) patients are still mobile b) Individual patients required between 0.5 and 1.5 MAC for surgery c) 100% of patients with 1.0 MAC will not respond to a surgical incision d) 0.4 MAC of an IV anesthetic and 0.7 MAC of an inhaled anesthetic will yield an overall 1.1 MAC 4.5) Which of the following anesthetics decreases mean arterial pressure and is arrhythmogenic? a) Halothane b) Enflurane c) Sevoflurane d) Isoflurane 5) Which of the following drugs, like nitrous oxide, dissolves the least in blood? a) Methoxyflurane b) Halothane c) Isoflurane d) Sevoflurane e) Desflurane 6.1) Which of the following drugs is associated with post-op hepatitis (hepatotoxicity)? a) Nitrous oxide b) Halothane c) Isoflurane d) Sevoflurane e) Desflurane 6.2) Which of the following toxic effects of inhaled anesthetics is treated with the Ca++ release blocker dantrolene? a) Hepatotoxicity b) Nephrotoxicity c) Malignant hyperthermia d) Chronic toxicity (mutagenicity) 6.3) Which of the following drugs is associated with nephrotoxicity? a) Methoxyflurane b) Halothane c) Isoflurane d) Sevoflurane e) Desflurane 7) Which of the following works by blocking the NMDA glutamic acid receptor, shows cardiovascular stimulating effects (raises HR, BP, CO), and can produce dissociative anesthesia with perceptual illusions? a) Thiopental b) Midazolam c) Ketamine

DO NOT DISTRIBUTE

- 11 -

Neuroscience – Part 4

14Mar2009

d) Propofol e) Etomidate 8) If rapid recovery is associated with fewer post-operative adverse effects, which of the following inhaled anesthetics would be a poor choice in balance anesthesia (inhaled + IV anesthetic)? a) Nitrous oxide b) Halothane c) Sevoflurane d) Desflurane e) Methoxyflurane 9.1) Which of the following drugs is preferred in patients with cerebral swelling as it does not increase intracranial pressure? a) Etomidate b) Propofol c) Midazolam d) Thiopental e) Fentanyl 9.2) Which of the following is associated with a high incidence of anterograde amnesia (clinically useful effect)? a) Etomidate b) Propofol c) Midazolam d) Thiopental e) Fentanyl 9.3) What drug in combination with N2O and droperidol gives neuroleptanesthesia, which is amnesia and analgesia? a) Etomidate b) Propofol c) Midazolam d) Thiopental e) Fentanyl 9.4) Which of the following is NOT true regarding propofol (Diprivan)? a) Has antiemetic actions b) Is popular as an induction agent c) Is used for anesthesia maintenance d) Causes a decrease in blood pressure e) Is relatively cheap 9.5) Naloxone is a receptor antagonist that can reverse the effects of which of the following? a) Etomidate b) Propofol c) Midazolam d) Thiopental e) Fentanyl 9.6) Which of the following drugs is used to induce patients with limited cardiovascular reserve and can cause adrenocortical suppression?

DO NOT DISTRIBUTE

- 12 -

Neuroscience – Part 4

14Mar2009

a) Etomidate b) Propofol c) Midazolam d) Thiopental e) Fentanyl 10) Which of the following is NOT true regarding conscious sedation? a) Alleviates anxiety b) Alleviates pain c) Causes motor paralysis d) Allows for maintenance of patent airway e) Allows for the ability to respond to verbal commands Neuro #6 – Pharmacology: Local Anesthetics (Chapter 26) 1) Which of the following is the most potent amide (relative to procaine) as well as longest acting? a) Cocaine b) Tetracaine c) Lidocaine d) Prilocaine e) Bupivicaine 2.1) Most local anesthetics are weak ____, with the neutral form allowing for penetration of nerve membranes. At physiologic pH, the ____ form of the anesthetic prevails. a) Acids; Anionic (-) b) Acids; Cationic (+) c) Bases; Anionic (-) d) Bases; Cationic (+) 2.2) If a local anesthetic is injected into infected tissue, which has a low extracellular pH, which of the following is true? a) The anesthetic is more effective b) The anesthetic is equally effective c) The anesthetic is less effective 3) Which of the following types of nerve fibers is the least susceptible to local anesthetics, which block voltage gated sodium channels? a) Delta pain/temperature fibers b) Dorsal root pain fibers c) Type B preganglionic autonomic fibers d) Alpha proprioceptive/motor fibers e) Sympathetic postganglionic fibers 4) Hypercalcemia would partially ____ the action of local anesthetics and hyperkalemia would partially ____ the action of local anesthetics. a) Agonize; Agonize b) Agonize; Antagonize c) Antagonize; Antagonize d) Antagonize; Agonize 5) Which of the following cases is the most susceptible to local anesthetics? a) Smaller fibers, heavily myelinated, located circumferentially

DO NOT DISTRIBUTE

- 13 -

Neuroscience – Part 4

14Mar2009

b) Larger fibers, heavily myelinated, located circumferentially c) Smaller fibers, unmyelinated, located circumferentially d) Larger fibers, heavily unmyelinated, located circumferentially e) Smaller fibers, heavily myelinated, located centrally f) Larger fibers, heavily myelinated, located centrally 6.1) Which of the following anesthetics would be the best choice for a short-term Bier Block procedure of the distal arm? a) Tetracaine b) Bupivacaine c) Lidocaine d) Etidocaine e) Ropivocaine 6.2) Which of the following local anesthetics is NOT a vasodilator and is associated with cerebral hemorrhage, cardiac arrhythmia, and myocardial infarction? a) Cocaine b) Tetracaine c) Lidocaine d) Prilocaine e) Bupivicaine 6.3) Which of the following is NOT true of local anesthetics? a) Can depress cortical inhibitory pathways leading to convulsions, visual and auditory disturbances b) Can pool in the cauda equina and interfere with axonal transport c) Can excite normal pacemaker activity and conduction via chloride channels d) Are required in smaller doses for anesthesia of pregnant patients 7.1) Which of the following anesthetics may cause abnormal conversion of hemoglobin to methemoglobin, leading to hematologic toxicity? a) Cocaine b) Tetracaine c) Lidocaine d) Prilocaine e) Bupivicaine 7.2) Which of the following local anesthetics would NOT be responsible for allergic reactions caused by metabolism to p-aminobenzoic acid derivatives? a) Cocaine b) Lidocaine c) Procaine d) Tetracaine Neuro #7 – Pharmacology: Parkinsonism & Movement Disorders (Chapter 28) 1) Which of the following describes slow, writhing movements? a) Temor b) Chorea c) Athetosis d) Dystonia e) Tics

DO NOT DISTRIBUTE

- 14 -

Neuroscience – Part 4

14Mar2009

2) Which of the following is used to treat Parkinson disorders as it can cross the bloodbrain barrier and is converted to a useful form? a) Dopamine b) Carbidopa c) L-DOPA d) Glutamate e) Glycine 3) What is the role of carbidopa in the drug Sinemet? a) Increase metabolism of levodopa in the periphery b) Increase metabolism of levodopa in the brain c) Decrease metabolism of levodopa in the periphery d) Decrease metabolism of levodopa in the brain 4) Which of the following is NOT a side effect seen in patients receiving L-DOPA treatment? a) Nausea and vomiting b) Bradycardia c) Atrial fibrillation d) Dyskinesias e) Choreoathetosis of the face 5) Fluctuations in clinical state unrelated to timing of L-DOPA doses is known as the “on-off phenomenon.” The recommended clinical method to alleviate this is to have the patient discontinue the drug for 3-21 days (“drug holiday”). a) True b) False, this will not alleviate symptoms c) False, the risks likely outweigh the benefit 6) Which of the following patients should NOT receive L-DOPA? a) Diabetic patients b) Hypertensive patients c) Patients with decreased cardiac output d) Patients with angle-closure glaucoma e) Patients with resting tremors 7) Which of the following is true regarding dopamine agonists in the treatment of Parkinson disease? a) They require enzymatic conversion to an active metabolite b) They have at least two toxic metabolites c) They compete with substances for active transport into the blood d) The have a lower incidence of “on-off phenomenon” fluctuations e) They should be used as a replacement to L-DOPA 8.1) Which of the following is NOT a contraindication of dopamine agonist drugs? a) Psychotic illness b) Dyskinesias c) Recent MI d) Active peptic ulcerations e) Peripheral vascular disease 8.2) Which of the following dopamine agonist drugs is a D3 receptor agonist, used to treat mild and advanced disease Parkinsonism?

DO NOT DISTRIBUTE

- 15 -

Neuroscience – Part 4

14Mar2009

a) Bromocriptine b) Pergolide c) Pramipexole d) Ropinirole 8.3) Which of the following is a monoamine oxidase inhibitor (MAOI) B, which retards the breakdown of dopamine and enhances the effect of L-DOPA? a) Benztropine b) Amantadine c) Selegiline d) Bromocriptine e) Entacopone 8.4) A patient with Parkinson disease is being put on a drug (tolcapone) to help decrease the peripheral metabolism of L-DOPA. They are told they will need to complete a consent form, have liver function tests every two-weeks for a year, and that their urine might turn orange. What type of drug is this? a) Dopamine receptor agonist b) Monoamine oxidase (MAO) inhibitor c) Catechol-O-methyl transferase (COMT) inhibitor d) Anti-viral agent e) Acetylcholine blocker 8.5) A patient with Parkinson disease is given the anti-viral agent amantadine after ensuring the patient does not have a history of seizures or heart failure. What is the mechanism of action for this drug? a) Dopamine receptor agonist b) Selective MAO inhibitor c) Acetylcholine blocker d) Acetylcholine esterase agonist e) Unknown 8.6) Benztropine should be avoided in patients with prostatic hyperplasia, obstructive GI disease, or angle-closure glaucoma. What is the mechanism of action for this drug? a) Dopamine receptor agonist b) Monoamine oxidase (MAO) inhibitor c) Catechol-O-methyl transferase (COMT) inhibitor d) Anti-viral agent e) Acetylcholine blocker 9) In patients with severe Parkinsonism and long-term complications of L-DOPA therapy, such as the on-off phenomenon, a trial of what type of drug may be worthwhile? a) Dopamine receptor agonist b) Monoamine oxidase (MAO) inhibitor c) Catechol-O-methyl transferase (COMT) inhibitor d) Anti-viral agent e) Acetylcholine blocker 10) A patient presents with progressive chorea and dementia. History reveals an autosomal dominant disorder of chromosome 4. Which of the following drugs should be given if the goal is the deplete cerebral dopamine in the nigostriatal pathway by preventing intraneuronal storage?

DO NOT DISTRIBUTE

- 16 -

Neuroscience – Part 4

14Mar2009

a) Reserpine b) Haloperidol c) Perphenazine d) Olanzapine e) Phenothiazine or butyrophenones 11) What is the drug of choice for patients with chronic, multiple tics (Tourette syndrome)? a) Clonidine b) Haloperidol c) Perphenazine d) Penicillamine e) Roprinole 12.1) A 16-year-old patient presents with recurrent hepatic disease. Testing reveals increased urinary copper and a low serum ceruloplasmin ( 3mm in diameter c) Visualizing the circle of Willis d) Detecting subdural hematomas e) Screening for aortic stenosis Neuro #21 – Amyotrophic Lateral Sclerosis (Case 3) 1) A 45-year-old male presents with marked progressive weakness in his hands and arms. Which of the following is the most likely? a) Poliomyelitis b) Multiple sclerosis c) Myasthenia gravis d) Amyotrophic lateral sclerosis e) Guillain-Barré syndrome 2) Which of the following diagnostic laboratory tests and studies is most abnormal in a patient with amyotrophic lateral sclerosis? a) Blood chemistry b) Cerebrospinal fluid c) CT scan of brain d) CT scan of cervical spine e) Electromyogram 3) Which of the following is an inflammatory demyelinating disease, usually involving the peripheral nerves, with high incidence in young adults? a) Poliomyelitis b) Multiple sclerosis c) Myasthenia gravis d) Amyotrophic lateral sclerosis e) Guillain-Barré syndrome 4) Which of the following describes the lesion seen in amyotrophic lateral sclerosis? a) Bilateral loss of touch, vibration, and tactil sense from lower limbs due to lesion of the fasciculus gracilis b) Bilateral loss of pain and temperature one level below due to lesion of the ventral white commissure (spinothalamic tract)

DO NOT DISTRIBUTE

- 53 -

Neuroscience – Part 4

14Mar2009

c) Combined UMN and LMN lesion of corticospinal tract d) Bilateral Horner syndrome, loss of bladder control due to lesion of corticospinal tract e) Ipsilateral flaccid paralysis, ipsilateral spastic paresis, contralateral loss of pain and touch due to loss of spinothalamic tract Neuro #22 – Alzheimer Disease (Case 35) 1) An elderly patient presents with progressive memory loss, confusion, agitation, and forgetfulness. Which of the following is the most likely? a) Brain tumor b) Chronic alcoholism c) Hypothyroidism d) Neurosyphilis e) Alzheimer disease 2) Which of the following diagnostic laboratory tests and studies would be the least useful for an elderly patient with progressive memory loss? a) Thyroid function test b) VDRL test c) Thiamine assay d) Electrocardiogram e) Vitamin B12 assay 3) Which of the following is associated with cold intolerance, weight gain, mental slowness, thinning hair, and edema of the face/hands? a) Brain tumor b) Chronic alcoholism c) Hypothyroidism d) Neurosyphilis e) Alzheimer disease Match the disease with the deficient vitamin: 4.1) Night blindness a) Vitamin B1 (thiamin) 4.2) Megaloblastic anemia b) Vitamin B3 (niacin) 4.3) Pellegra c) Vitamin B12, folic acid 4.4) BeriBeri d) Vitamin A 4.5) Which of the following cranial nerves is NOT normally affected in Alzheimer disease? a) CN I b) CN II c) CN II, IV, VI d) CN V e) CN VII f) CN VIII 4.6) Which of the following causes of dementia is autosomal recessive and involves the accumulation of galactocerebroside in the brain? a) Alzheimer disease b) Huntington disease c) Parkinson disease

DO NOT DISTRIBUTE

- 54 -

Neuroscience – Part 4

14Mar2009

d) Krabbe disease e) Metachromatic leukodystrophy 5) Which of the following is an autosomal recessive lysosomal storage disease that results in demylination and progressive dementia, caused by an accumulation of sulfatide in the brain, kidneys, liver, and peripheral nerves? a) Alzheimer disease b) Huntington disease c) Parkinson disease d) Krabbe disease e) Metachromatic leukodystrophy Neuro #23 – Down Syndrome (Case 43) 1) A 4-week-old male patient presents for a well baby examination. He is the product of an uncomplicated pregnancy of a 40-year-old mother. The mother reports having a low #-fetoprotein (AFP) level during pregnancy. On physical examination, the patient is noted to have a flat occiput; white spots in his iris (Brushfield spots); a large, protruding tongue; small, low-set ears; broad, short feet and hands; a flexion crease across his palm (simian crease); clindodactyly of the fifth digit; a systolic ejection mumur; split S2; and hypertonia. Which of the following is most likely? a) Cri du chat syndrome (5p-) b) Edwards syndrome (trisomy 18) c) Fragile X syndrome d) Down syndrome (trisomy 21) e) Patau syndrome (trisomy 13) f) Fetal alcohol syndrome 2) Which of the following would NOT be seen in diagnostic laboratory tests and studies of a patient with Down syndrome? a) Trisomy 21 b) Endocardial cushing defect c) Maternal serum AFP decreased d) Maternal unconjugated estriol decreased e) Maternal human chorionic gonadotropin (hCG) decreased 3.1) Which of the following is associated with low-set ears, rocker-bottom feet, and micrognathia? a) Cri du chat syndrome (5p-) b) Edwards syndrome (trisomy 18) c) Fragile X syndrome d) Down syndrome (trisomy 21) e) Patau syndrome (trisomy 13) 3.2) Which of the following is associated with large ears, macrocephaly, a long face, and macroorchidism? a) Cri du chat syndrome (5p-) b) Edwards syndrome (trisomy 18) c) Fragile X syndrome d) Down syndrome (trisomy 21) e) Patau syndrome (trisomy 13)

DO NOT DISTRIBUTE

- 55 -

Neuroscience – Part 4

14Mar2009

4) Which of the following is a genetic imprinting disease (methylation inactivation) involving paternal 15q deletion? a) Angelman syndrome b) Prader-Willi syndrome c) Down syndrome d) Cri du chat syndrome e) Patau syndrome James Lamberg

DO NOT DISTRIBUTE

- 56 -

Neuroscience – Part 4 AnswerKey Neuro #1 1) B 2) C 3.1) D 3.2) C 3.3) A 3.4) E 3.5) B 3.6) A 3.7) C 4) D 5) E 6) C 7.1) C 7.2) B 8.1) D 8.2) B 8.3) A 8.4) A 8.5) D 8.6) F 8.7) E 8.8) C Neuro #2 1) A 2) D 3.1) C 3.2) A 4.1) A 4.2) D 5) B 6.1) C 6.2) B 7.1) B 7.2) C 8) E 9.1) D 9.2) C 10) E 11) D 12) D 13.1) E 13.2) D 13.3) E

14Mar2009

Neuro #3 1.1) C 1.2) E 1.3) D 2.1) C 2.2) E 3) D 4) E 5.1) B 5.2) A 5.3) C 6.1) E 6.2) A Neuro #4 1.1) B 1.2) D 1.3) A 1.4) B 1.5) C 1.6) C 1.7) B 1.8) A 1.9) A 1.10) B 1.11) C 1.12) D 1.13) D 2.1) E 2.2) A 2.3) E 2.4) E 2.5) C 2.6) C 3) B Neuro #5 1.1) A 1.2) E 1.3) C 1.4) D 1.5) A 1.6) B 2) C 3) A

DO NOT DISTRIBUTE

4.1) A 4.2) C 4.3) C 4.4) C 4.5) A 5) E 6.1) B 6.2) C 6.3) A 7) C 8) A 9.1) D 9.2) C 9.3) E 9.4) E 9.5) E 9.6) A 10) C Neuro #6 1) E 2.1) D 2.2) C 3) D 4) D 5) A 6.1) C 6.2) A 6.3) C 7.1) D 7.2) B Neuro #7 1) C 2) C 3) C 4) B 5) C 6) C 7) D 8.1) B 8.2) C 8.3) C 8.4) C 8.5) E 8.6) E

9) C 10) A 11) B 12.1) D 12.2) E Neuro #8 1.1) B 1.2) C 1.3) A 1.4) B 1.5) B 1.6) C 1.7) A 1.8) D 1.9) A 2) C 3) C 4) C 5) A 6) D 7) B 8) E 9.1) A 9.2) E 9.3) B 9.4) E 9.5) G 9.6) B 9.7) C 10.1) B 10.2) A Neuro #9 1) D 2.1) D 2.2) D 2.3) E 3.1) A 3.2) G 3.3) F 3.4) B 3.5) C 3.6) D 3.7) E 3.8) D

- 57 -

Neuroscience – Part 4 3.9) C 4.1) A 4.2) E 4.3) D 4.4) E Neuro #10 1) D 2) B 3) D 4) E 5.1) B 5.2) B 5.3) A 5.4) C 6) C 7) E 8.1) F 8.2) B 9.1) E 9.2) C 10) A 11.1) B 11.2) A 12) B 13) C 14) D 15) C 16.1) C 16.2) E 16.3) F 17) E 18) C 19) C 20.1) D 20.2) B 20.3) C 20.4) A 20.5) E 21.1) C 21.2) D 21.3) B 21.4) D 22) B 23) E 24) E

14Mar2009 25.1) F 25.2) E 25.3) D 25.4) C 25.5) B 25.6) A Neuro #11 26) B 27.1) D 27.2) E 28) D 29.1) C 29.2) C 29.3) D 29.4) C 29.5) E 30) B 31.1) D 31.2) D 32.1) A 32.2) B Neuro #12 33) A 34.1) B 34.2) D 34.3) A 34.4) C Neuro #13 35.1) E 35.2) D 36) C 37.1) E 37.2) G 37.3) C 38) D 39) B 40.1) F 40.2) D 40.3) A 40.4) E 40.5) B 40.6) C 41.1) C

DO NOT DISTRIBUTE

41.2) E 41.3) B 42) C Neuro #14 43) A 44) D 45) D 46.1) B 46.2) E 46.3) B 46.4) B 47) E 48) B 49) A 50.1) A 50.2) A 51.1) C 51.2) D 52.1) A 52.2) D 52.3) E 52.4) B 52.5) C 52.6) D 52.7) B 53.1) B 53.2) C 53.3) B 53.4) A 53.5) B 53.6) A 53.7) C 53.8) E 54.1) C 54.2) D 55.1) D 55.2) F 55.3) E 55.4) C 55.5) B 55.6) G 55.7) A Neuro #15 56.1) G

56.2) B 57) D 58.1) E 58.2) A 59.1) D 59.2) C 59.3) C 59.4) A 59.5) C 60) D 61) B 62) D 63) B 64) D 65.1) B 65.2) C 65.3) B 65.4) D 66) D 67) C 68) C 69) E 70.1) E 70.2) A 70.3) E 70.4) D Neuro #16 71) C 72) A 73.1) C 73.2) F 73.3) B 73.4) E 73.5) A 73.6) D 74) B 75.1) B 75.2) B 75.3) E Neuro #17 76) D 77) E 78) E 79) D

- 58 -

Neuroscience – Part 4 80.1) B 80.2) E 80.3) A 80.4) D 80.5) A 81) E 82) C 83) B 84) E 85) E 86.1) D 86.2) B 86.3) C 86.4) A 87) A 88) E 89) C 90) B 91.1) A 91.2) C Neuro #18 92) D 93) A 94) C 95) D 96) C 97) E 98.1) D 98.2) C 98.3) B 98.4) A 99) E 100) E 101) D 102) A 103) C 104) C Neuro #19 105) A 106) D 107.1) D 107.2) B 107.3) C 107.4) A

14Mar2009 108) E 109.1) D 109.2) C 109.3) B 109.4) A 110) D 111) B 112) F 113) C 114.1) F 114.2) B 114.3) E 114.4) C 114.5) D 115) C 116) A 117.1) C 117.2) A 117.3) B

Neuro #23 1) D 2) E 3.1) B 3.2) C 4) B

Neuro #20 118.1) B 118.2) C 119) C 120) A 121) E 122) D Neuro #21 1) D 2) E 3) E 4) C Neuro #22 1) E 2) D 3) C 4.1) D 4.2) C 4.3) B 4.4) A 4.5) D 4.6) D 5) E

DO NOT DISTRIBUTE

- 59 -