09a: Psych/Neuro Flashcards
1
Q
Dementia symptoms: it’s important to screen for which reversible causes?
A
Depression, neurosyphilis
B12 deficiency, hypothyroidism
2
Q
Hypnogogic hallucinations versus hypnopompic hallucinations
A
HypnoGOgic: while GOing to sleep
Hypnopompic: while waking up from sleep
3
Q
Manic episode requires either (X) or at least 3 of which symptoms? For what period of time?
A
X = hospitalization
Sx for at least 1 week
“Manics DIG FAST”
- Distractability
- Irresponsibility (ex: hypersexual)
- Grandiosity
- Flight of ideas
- Agitation/activity (goal-oriented)
- Sleep (decreased need)
- Talkative/pressured speech
4
Q
Short-acting benzodiazepines
A
Triazolam, Oxazepam, Midazolam
“Short TOM triaz (tries) to be tall”
5
Q
Intermediate-acting benzodiazepines
A
Alprazolam (Xanax), Lorazepam, Temazepam
“Al, Lora, Temmy - a middle class family”
6
Q
Long-acting benzodiazepines
A
Diazepam, Flurazepam, Chlordiazepoxide
7
Q
Example of stimulus control therapy for insomnia
A
Bedroom only for sleeping and leave room after 20 min if can’t fall asleep
8
Q
PCP drug is (X) (agonist/antagonist)
A
X = NMDA
Antagonist
9
Q
Patient uses substance and becomes aggressive, has visual hallucinations, and alternates between agitation and sedation. Hours later, has forgotten most of preceding events. Substance?
A
PCP
10
Q
Patient has used substance and now has high BP, high HR, and vertical nystagmus
A
PCP
11
Q
Buspirone is in (X) class of drugs. Which property about it makes it useful in treating (GAD/acute anxiety) but not (GAD/acute anxiety)?
A
X = non-benzo anxiolytic (stimulates 5-HT1A receptors)
GAD; acute anxiety
Slow onset of action (can’t treat panic disorder)
12
Q
Medication that has shown superior efficacy in treatment-resistant schizophrenia
A
Clozapine
13
Q
Personality disorder: Hypersensitive to rejection, socially inhibited, timid, feelings of inadequacy, desires relationships with others
A
Avoidant
14
Q
26 yo mom presents with sudden onset blindness. She reports that her 2 yo son takes swimming lessons and almost drowned in the pool last week. She reporst no pain and seems in no acute distress. Diagnosis?
A
Conversion disorder
15
Q
Re-feeding syndrome: main electrolyte imbalance
A
Hypophosphatemia (due to increased insulin); leads to cardiac complications
16
Q
Sleep terror disorder occurs during which stage of sleep?
A
Deep (slow-wave) stage (hence no memory of arousal, unlike nightmares/dreams during REM)
17
Q
Narcolepsy is the result of (increased/decreased) production of (X) in (Y) part of brain
A
Decreased
X = hypocretin (orexin)
Y = lateral hypothalamus
18
Q
First-line Rx for narcolepsy
A
Modafinil
other daytime stimulants can be used: amphetamines
19
Q
Serum (X) levels serve as a sensitive indicator of alcohol use
A
X = gamma glutamyltransferase
20
Q
Chronic alcohol use upregulates (X) receptor and downregulates (Y) receptor
A
X = GABA(A) Y = NMDA
21
Q
Patient with liver disease should be given benzodiazepine with which property?
A
Not metabolized in liver
Lorazepam, oxazepam, temazepam (LOT)
22
Q
Amphetamine intoxication Rx
A
Benzos (for agitation and seizures)
23
Q
What’s dronabinol?
A
Pharmaceutical form of marijuana
canNABINOid, droNABINOl
24
Q
Delirium tremens characterized by (X). What’s the acid-base status of the patient?
A
Life-threatening alcohol withdrawal
X = autonomic hyperactivity (seizures, tremors, tachycardia)
Respiratory alkalosis
25
Aripiprazole is in which drug class?
Atypical antipsychotics
26
MAO-A breaks down:
NE, SA, DA
27
MAO-B breaks down:
DA
28
Greater sciatic foramen primarily occupied by (X). Which structures travel through superior border of foramen?
X = piriformis
Superior gluteal n, a, v
29
Post-ductal coarctation of aorta: collateral anterograde flow via (X) arteries and retrograde flow via (Y) arteries
```
X = internal thoracic (mammary) and anterior intercostal
Y = posterior intercostal
```
30
Methamphetamines MOA
Induce NE and DA release (via gaining entrance to nerve terminals and reversing transporters that normally mediate reuptake)
31
(X) brain tumor is pathognomonic for tuberous sclerosis. What would you see on biopsy?
X = Subependymal giant cell astrocytoma (grows from walls of lateral ventricles)
Large ganglioid cells with prominent nuclei
32
List the main genetic diseases associated with trinucleotide repeats
"Hunter, set My Dying, Fragile deer Free"
1. Huntington's (AD; CAG)
2. Myotonic Dystrophy (AD; CTG)
3. Fragile X (X-linked R; CGG)
4. Friedreich's ataxia (AR; GAA)
33
Gaucher disease enzyme deficiency:
Beta-glucocerebrosidase
34
Krabbe disease enzyme deficiency:
Beta-galactocerebrosidase
35
Metachromatic leukodystrophy enzyme deficiency:
Arylsulfatase A
36
(X) cells make CSF and are found where in CNS?
X = ependymal
Inner lining of ventricles
37
(X) cells are the macrophages of the CNS and originate from which embryological tissue?
X = microglia
Mesoderm
38
Aside from alpha-fetoprotein levels, (high/low) levels of (X) can be helpful confirmatory test for neural tube defects
High
| X = AChE (in amniotic fluid)
39
Agenesis of cerebellar vermis, with cystic enlargement of (X). Which syndrome?
Dandy-Walker
| X = 4th ventricle (fills enlarged posterior fossa)
40
Damage to CN X: which tongue movements compromised?
Palatoglossus muscle (elevation of posterior tongue)
41
Taste innervation by (X) cranial nerve(s) and fibers travel to (Y) brain area.
```
X = VII, IX, X
Y = solitary nucleus
```
42
T/F: Pain to tongue is carried by CN V fibers only
False - CN V (V3) as well as IX, X
43
Astrocyte cell marker is (X) and the cells are derived from which embryological origin?
X = GFAP
Neuroectoderm
44
Histology of brain region 3-5 days post-infarct will show (X) cells most abundantly
X = microglia (gobble up fragments; abundant lipids in cytoplasm from myelin breakdown products)
45
HIV-infected (X) cells fuse to form multi-nucleated giant cells in CNS
X = microglia
46
Myelin increases (time/space) constant
Space/length constant (how far impulse propagates before potential decrease to 37% of original value)
Decreases time constant
47
Each Schwann cell myelinates (one/many) axons. Each oligodendrocyte myelinates (one/many axons)
One; many (30ish)
48
Infammatory infiltrate in Guillain-Barré involves which layer of (central/peripheral) nerves?
Peripheral
Endoneurium
49
High/low levels of which NTs implicated in anxiety?
High NE; low SA and GABA
50
High/low levels of which NTs implicated in Huntington's disease?
High DA; low ACh and GABA
51
High/low levels of which NTs implicated in Parkinson's?
High ACh; low DA, SA
52
ACh synthesis/release from (X) brain region
X = Basal nucleus of Meynert
53
GABA synthesis/release from (X) brain region
X = nucleus accumbens
54
Layers of meninges derived from which embryological tissue?
Dura from mesoderm;
| Arachnoid and pia from neural crest
55
Inputs to the hypothalamus include which two areas?
1. OVLT (lamina terminalis) senses osmolarity change
2. Area postrema (in medulla) responds to emetics
*Note: these areas lack blood-brain barrier
56
Lateral hypothalamus responsible for (X) so damage causes (Y)
```
X = hunger
Y = anorexia, failure to thrive ("shrinking laterally")
```
57
Anterior hypothalamus responsible for (X).
X = cooling ("Anterior Cooling = A/C")
58
Melatonin release from (X) is stimulated by (Y) release from (Z)
```
X = pineal gland
Y = NE
Z = hypothalamus (suprachiasmatic nucleus)
```
59
Which drug is useful in treatment of bedwetting?
Oral desmopressin (preferred over imipramine)
60
T/F: Benzos decrease REM and delta wave sleep
True (same with barbiturates, EtOH); hence use in night terror disorder/sleepwalking
61
(X) sleep stage lasts the longest, 45% of the time
X = Stage N2 (deeper sleep with spindles/K complexes)
62
Extraocular movements during (X) sleep stage due to activity of (Y) center
```
X = REM
Y = PPRF (paramedian pontine reticular formation/conjugate gaze center)
```
63
Input to VPM thalamus
Trigeminal and gustatory pathways (face sensation and taste)
64
Lateral geniculate nucleus of thalamus input from (X). And medial from (Y).
```
X = CN II (ipsilateral temporal hemiretina and contralateral nasal hemiretina)
Y = superior olive and inferior colliculus (tectum)
```
65
Ventral lateral nucleus of thalamus receives input from (X) and sends it off to (Y)
```
X = cerebellum, basal ganglia
Y = motor cortex
```
66
List the only output pathway of the cerebellum
ALWAYS INHIBITORY
| Purkinje cells to deep nuclei to contralateral cortex (via superior cerebellar peduncle)
67
Wide-based cerebellar gait (truncal ataxia) and head tilting seen in (medial/lateral) cerebellar lesions
Medial (midline structures/flocculonodular lobe)
68
Straitum made up of which structures?
Caudate and putamen
69
Lentiform nucleus made up of which structures?
GP and putamen
70
Basal ganglia: input to direct pathway is via DA release from (X) and works via (Y) receptor.
```
X = Substantia nigra pars compacta
Y = D1
```
"D1R for D1Rect pathway"
71
Basal ganglia: input to indirect pathway is via DA release from (X) and works via (Y) receptor
```
X = Substantia nigra pars compacta
Y = D2
```
(INHIBITS INDIRECT PATHWAY)
72
Basal ganglia: direct pathway route. Overall effect is to (stimulate/inhibit) (X).
Stimulate
X = motor cortex (facilitate movement)
SNc stimulates putamen via G1-R
Putamen inhibits GPi, which releases its inhibition on thalamus
Thalamus activates motor cortex
73
Basal ganglia: indirect pathway route when stimulated. Overall effect is to (stimulate/inhibit) (X).
Inhibit
X = motor cortex (inhibit movement)
Motor cortex stimulates putamen
Putamen inhibits GPe, releasing its hold on subthalamic nucleus
Subthalamic nucleus stimulates GPi, which inhibits thalamus (thus inhibiting motor input to cortex)
74
T/F: Substantia nigra pars compacta dopamine release stimulates direct pathway and inhibits indirect pathway.
True (via D1 and D2 receptors)
75
Parkinson's: Deep Brain Stimulation can be targeted to (X) to (stimulate/inhibit) firing.
X = GPi or subthalamic nucleus
Inhibit
76
High ICP following acute stroke: how might the patient be instructed to alter his breathing?
Hyperventilate (to decrease PCO2 and cause vasoconstriction/decrease cerebral blood flow)
77
Which CN nuclei are medial?
CN III, IV, VI, XII
78
Patient got punched in the face. R eye shows enophthalmos. Loss of sensation of ipsilateral upper cheek, gingiva, and lip. Which structures have been injured?
Orbital floor fracture:
Inferior rectus (enophthalmos) and infraorbital nerve
79
Where is the conjugate vertical gaze center?
Superior colliculus
80
Structure immediately rostral to tectum is (X). And caudal is (Y).
```
X = Pineal body
Y = superior cerebellar peduncles (lateral to fourth ventricle)
```
81
Nucleus of CN (X) is in spinal cord
X = XI
82
Propionyl CoA comes from (X) amino acids and gets converted into (Y). Which enzyme/cofactor required?
```
X = Isoleucine, Val, Thr, Met (and odd chain FA)
Y = methylmalonyl CoA
```
Propionyl CoA carboxylase (needs biotin)
83
Methylmalonyl CoA synthesized from (X) and gets converted into (Y). Which enzyme/cofactor required?
```
X = Propionyl CoA
Y = Succinyl CoA (enters TCA)
```
Methylmalonyl CoA mutase (needs B12)
84
Space occupying lesions within temporal lobe can cause transtentorial herniation of (X)
X = uncus (compression of ipsilateral CN III)
85
(AR/AD) condition with retinal/cerebellar capillary hemangioblastomas and congenital cysts in kidney, liver, pancreas.
AD; Von Hippel-Lindau (also increased risk for RCC)
86
Biopsy findings in patient with HIV-induced dementia
Microglial nodules around areas of necrosis (may form multi-nucleated giant cells)
87
Thiamine is cofactor for which enzymes?
3 Dehydrogenases and Transketolase:
1. Branched chain alpha-ketoacid dehydrogenase
2. Pyruvate dehydrogenase
3. Alpha-ketoglutarate dehydrogenase
88
Excruciating, sharp, steady headaches presenting unilaterally, behind one eye, and lasting 15-90 minutes. Which other associated symptoms may be present?
Cluster headache
Lacrimation, sweating, flushing, nasal congestion
89
Edinger-Westphal nucleus responsible for (X) fibers
X = pre-ganglionic parasympathetics of CN III (synapsing at ciliary ganglion and eventually causing pupil constriction)
90
Why would patient with temporomandibular disorder have jaw pain and also have ear pain?
CN V also innervates tensor tympani muscle (V3)
91
CN (X) controls lacrimation and CN (Y) controls salivation
```
X = VII
Y = VII (submandibular and sublingual), IX (parotid)
```
92
70 yo patient presents with reduced tolerance and increased sensitivity to everyday sounds. What CN has been compromised?
CN VII (innervating stapedius muscle)
Stapedius paralyzed means stapes can oscillate freely/widely so decreased auditory volume modulation
93
List the three vagal nuclei and the general function of each
1. Nucleus Solitarius (visceral Sensory like taste, baroreceptors, gut distension)
2. Nucleus aMbiguous (Motor to pharynx, larynx, upper esophagus)
3. Dorsal motor nucleus (autonomic/parasympathetic fibers to heart, lungs, GI)
94
Jaw jerk reflex: what are the afferent and efferent fibers?
Both V3 (sensory/muscle spindle from masseter and then masseter contraction)
Note: injury will cause mandible to deviate toward ipsilateral side
95
(X) vertebral body lies on line drawn between highest points of iliac crests
X = L4
96
For most SC tracts, cervical/upper body innervation is located (medially/laterally). What is/are the exception(s)?
Medially (corticospinal and spinothalamic tracts)
Dorsal column tracts (fasciculus gracilis medial; cuneatus lateral)
97
Biceps and triceps reflexes, which nerve roots?
Biceps: C5, C6 ("pick up sticks")
Triceps: C7, C8 ("lay them straight")
98
Achilles and patellar reflexes, which nerve roots?
Patellar: L3, L4 ("kick the door")
Achilles: S1, S2 ("buckle my shoe")
99
Cremasteric and anal wink reflexes, which nerve roots?
Cremasteric: L1, L2 ("testicles move")
| Anal wink: S3, S4 ("winks galore")
100
Frontal eye field lesion classic presentation:
Deviation of eye toward side of lesion
101
Paramedian pontine reticular formation lesion classic presentation:
Deviation of eye toward side opposite of lesion
102
L medial longitudinal fasciculus lesion Sx:
Inability to adduct L (ipsilateral) eye; contralateral eye nystagmus
103
Gerstmann syndrome: lesion in (X)
X = dominant parietal cortex (angular gyrus)
104
Agraphia, acalculia, finger agnosia, L/R disorientation. Where is the lesion?
Dominant parietal cortex (angular gyrus; Gerstmann syndrome)
105
Hemispatial neglect: agnosia of (ipsilateral/contralateral) side of world with lesion in (X)
Contralateral
| X = non-dominant parietal cortex
106
Anterograde amnesia seen with lesion in (X)
X = hippocampus (bilateral)
107
Wild, involuntary, large amplitude flinging movements involving proximal limbs. Where is the brain lesion?
Hemiballismus;
| Subthalamic nucleus
108
HSV-1 encephalitis associated with which common brain lesion?
Bilateral amygdala/temporal lobes (Klüver-Bucy syndrome)
109
Parinaud syndrome is a lesion in (X). What's the classic finding?
X = superior colliculus
Can't gaze upward (paralysis of conjugate vertical gaze)
110
A lesion in (X) part of brainstem will impair MLF
X = dorsal pons (travels from abducens nucleus to oculomotor nucleus in midbrain)
111
Initial resistance to passive limb extension followed by sudden release of resistance referred to as (X) phenomenon and seen with which lesion?
X = clasp-knife spasticity
UMN lesion
112
Restless leg syndrome Rx:
DA agonist (pramipexole)
113
Complete contralateral sensory (touch, pain, vibration, propioception, etc) loss due to lesion in:
Ventral posterior thalamus
114
Which drugs are effective as monotherapy for spasticity (ex: in MS patients)?
1. Baclofen (GABA-B agonist)
| 2. Tizanidine (Alpha-2 R agonist)
