2. Neuro Flashcards
What abnormalities are often found with a Chiari malformation?
Type 1: cerebellar tonsil herniates down; syringomyelia
Type 2: lumbosacral myelomeningocele, hydrocephaly
What are the classic presenting sxs of a syringomyelia? (2)
- capelike dist. loss of p/t in upper extremities
- hand weakness + atrophy
What amniotic fluid lab abnormalities might point you to a diagnosis of anencephaly?
increased AFP (in mom’s serum and amniotic fluid)
From which branchial pouch are each of the following structures derived?
a. middle ear and eustachian tubes
b. superior parathyroid
c. inferior parathyroids
d. epithelial lining of the palatine tonsil
e. thymus
a. 1st pouch
b. 4th pouch
c. 3rd pouch
d. 2nd pouch
e. 3rd pouch
Which nervous system cell looks like fried eggs under histo staining?
oligodendrocytes
Which nervous system cell forms multinucleated giant cells in the CNS when infected with HIV?
microglia
Which nervous system cell is damaged in GBS?
schwann cell
Which nervous system cell is the macrophages of the CNS?
microglia
In which neurological diseases is Ach altered? (3)
Alzheimers (decreased)
Huntington (decreased)
Parkinson (increased)
In which diseases are levels of GABA altered? (2)
Anxiety (decreased)
Huntington (decreased)
What are the components of the BBB? (3)
- non-fenestrated capillary endothelial cells with tight junctions
- BM
- foot process of astrocytes
A lesion to which area of the brain is responsible for hemispatial neglect?
non-dominant parietal lobe
A lesion to which area of the brain is responsible for poor repetition?
Arcuate fasciculus (conductive aphasia)
A lesion to which area of the brain is responsible for poor comprehension?
Wernicke’s
A lesion to which area of the brain is responsible for poor verbal expression?
Broca’s
A lesion to which area of the brain is responsible for personality changes and disinhibition?
frontal lobe
A lesion to which area of the brain is responsible for dysarthria?
cerebellar vermis
A lesion to which area of the brain is responsible for agraphia and acalculia?
angular gyrus in dominant parietal lobe (Gerstmann syndrome)
What typically is the cause of a lesion to the mammillary bodies?
Thiamine deficiency
Where is the pathology located in each of the following scenarios?
a. right anopsia
b. bilateral hemianopsia
c. right homonymous hemianopsia
a. right optic nerve
b. optic chiasm
c. left optic tract
What 2 nerves are tested with the gag reflex?
9 (aff)
10 (eff)
A 19yo man presents with a furuncle on his philtrum, and the cavernous sinus becomes infected. What neurological deficits might you see in this patient?
CN 3, 4, 6 –> ophthalmoplegia, diplopia
CN5 –> pain, numbness of upper face
How can a stroke of the facial motor cortex be distinguished from Bell’s palsy?
Facial motor cortex = contralateral paralysis of lower face, with forehead/eyebrow sparing (central)
Bell’s palsy = paralysis to both upper and lower face
What artery supplies the medullary pyramids and the medial lemniscus in the medulla?
anterior spinal artery
What artery supplies the inferior cerebellar peduncle, nucleus ambiguus, and the lateral spinothalamic tract in the medulla?
PICA
What is the triad of Horner syndrome?
- Ptosis
- Anhidrosis (decreased sweating)
- Miosis (constriction)
A patient comes to the ER with double vision and left-sided weakness. On p/e, she cannot abduct her right eye. In addition to motor weakness of the left arm and leg, she also has loss of fine touch, proprioception, and vibration sense in the left arm and leg. Where is the lesion and what vessel is most likely involved?
Right medial pontine syndrome
paramedian branches of basilar artery
A patient presents with vertigo, nystagmus, and slurred speech. P/e reveals right-sided ptosis and miosis, decreased gag reflex on the right, deviation of the uvula to the left, diminished P/T on the right side of his face, and left side of his body. Where is the lesion and what vessel is most likely involved?
Right lateral medullary syndrome (Wallenberg)
Right PICA
A patient presents with double vision, slurred speech, hoarse voice and acute right-sided weakness. P/e shows weakness of the right arm and leg, and left eye is depressed and abducted. Where is the lesion and what vessel is most likely involved?
Left anterior midbrain (Weber syndrome)
L PCA
- cerebral peduncle lesion leads to
- corticobulbar tract damage (dysphagia, dysphonia, dysarthria)
- corticospinal tract damage
(contralateral spastic hemiparesis) - CN3 palsy –> down and out
savage behavior and obesity result from STIMULATION of which hypothalamic nuclei?
dorsomedial (regulates hunger)
savage behavior and obesity result from DESTRUCTION of which hypothalamic nuclei?
ventromedial (regulates satiety; stimulated by leptin)
which hypothalamic nuclei is the master clock for setting circadian rhythms
suprachiasmatic nucleus
which hypothalamic nuclei releases hormone affecting the anterior pituitary (3)
- arcuate (secretes GnRH, dopamine, pulsatile GnRH secretion)
- preoptic (secretes GnRH)
- paraventricular (secretes oxytocin, CRH, TRH)
which hypothalamic nuclei is responsible for sweating and cutaneous vasodilation in hot temperature? (cooling)
anterior (thermoregulation; cooling)
damage causes hyperthermia
which hypothalamic nuclei is responsible for shivering and decreased cutaneous blood flow in the cold? (warming)
posterior (thermoregulation; warming)
damage causes hypothermia
which hypothalamic nuclei produces ADH to regulate water balance?
supraoptic
which hypothalamic nuclei regulates the release of gonadotropic hormones (LH, FSH)?
preoptic, arcuate
destruction of which hypothalamic nuclei results in inability to stay warm?
posterior
which hypothalamic nuclei receives input from the retina?
suprachiasmatic
stimulation of which hypothalamic nuclei leads to eating and destruction leads to anorexia?
lateral (regulates hunger; inhibited by leptin)
destruction of which hypothalamic nuclei results in diabetes insipidus?
supraoptic (secretes ADH)
kluver bucy syndrome is a lesion to which structure?
bilateral amygdala lesion
Where is CSF generated? Where is it reabsorbed?
- choroid plexus
- arachnoid granulations (in the superior sagittal sinus)
What is the difference b/w communicating and noncommunicating hydrocephalus?
communicating = non-obstructive (decreased absorption of CSF)
noncommunicating = obstructive
Drug used to treat status epilepticus?
benzo
What is fetal hydantoin syndrome?
- cleft lip/palate
- congenital heart disease
- mental retardation with dev delay
which anti-epileptics are teratogens? (3)
- phenytoin
- carbamazepine
- valproic acid
What drugs are known for causing Stevens-Johnson syndrome?
- anti-epileptic drugs (esp. lamotrigine)
- allopurinol
- sulfa drugs
- penicillin
“Steven Johnson has epileptic allergy to sulfa drugs and penicillin”
What are the toxic effects of phenytoin? (6 main, 2 additional)
- gingival hyperplasia
- hirsutism
- fetal hydantoin syndrome
- drug-induced lupus
- Steven-Johnson
- induces p450
- megaloblastic anemia
- peripheral neuropathy
What is the mechanism of action of sumatriptan?
5-HT (serotonin) agonist (1B, 1D receptors)
Contraindications to sumatriptan use? (3)
- CAD
- prinzmetal angina
- pregnancy
b/c sumatriptan causes vasoconstriction
What are the 3 most common primary brain tumors in adults?
- GBM
- Meningioma
- Schwannoma
What are the 3 most common primary brain tumors in children?
- pilocytic astrocytoma
- medulloblastoma
- ependymoma
Which primary brain tumor fits the following description?
- pseudopalisading necrosis
GBM
Which primary brain tumor fits the following description?
- polycythemia
hemangioblastoma
Which primary brain tumor fits the following description?
- NF2
schwannoma
Which primary brain tumor fits the following description?
- associated with von Hippel-Lindau
hemangioblastoma
Which primary brain tumor fits the following description?
- foamy cells, high vascularity
hemangioblastoma
Which primary brain tumor fits the following description?
- psammoma bodies
meningioma
Which primary brain tumor fits the following description?
- fried egg appearance
oligodendroglioma
Which primary brain tumor fits the following description?
- perivascular pseudorosettes
ependymoma
Which primary brain tumor fits the following description?
- bitemporal hemianopsia (2)
- pit adenoma, craniopharyngeoma
Which primary brain tumor fits the following description?
- worst prognosis of any primary brain tumor
GBM
Which primary brain tumor fits the following description?
- child with hydrocephalus (2)
medulloblastoma, ependymoma
Which primary brain tumor fits the following description?
- horner-wright pseudorosettes
medulloblastoma
What EEG waveforms correspond to the diff. stages of sleep?
awake awake (relax) N1 N2 N3 REM
awake = beta awake (relax) = alpha N1 = theta N2 = sleep spindle + K complexes N3 = delta (deepest sleep) REM = beta
BATS Drink Blood
What drugs are used to shorten stage N3 sleep (2)
imipramine (TCA)
benzo
These can be given for night terrors, sleep walking, enuresis
What is the sleep pattern in a pt with narcolepsy?
rapidly transition from awake state –> REM
In what stage of sleep are night terrors found?
N3
Which anesthetic fits each of the following description?
- IV; associated with hallucinations and bad dreams
ketamine
Which anesthetic fits each of the following description?
- IV; most common drug used for conscious sedation
midazolam
Which anesthetic fits each of the following description?
- inhaled; side effect of hepatotoxicity
halothane
Which anesthetic fits each of the following description?
- IV; used for rapid anesthesia induction and short duration of action
propofol
Which anesthetic fits each of the following description?
- IV; decreases cerebral blood flow (important in brain surgery)
barbiturates
Which anesthetic fits each of the following description?
- opioid that does not induce histamine release
fentanyl
Which anesthetic fits each of the following description?
- high triglyceride content, increases the risk of pancreatitis with long-term use
propofol
What is the MoA of dantrolene?
prevents release of Ca2+ from the SR of skeletal muscle –> causes relaxation (prevents contraction)
What is the MoA of local anesthetics?
block Na+ channels
Which nerve fibers are blocked first with local anesthesia?
small myelinated > small unmyelinated > large mye > large unmyelinated
What drugs can be used to reverse neuromuscular blockade?
cholinesterase inhibitors (neostigmine)
*remember, only works for nondepolarizing drugs (which are competitive antagonists at ACh receptors)
Diff between depolarizing and nondepolarizing neuromuscular blocking drugs?
- depolarizing = strong ACh receptor agonist; produce sustained depolarization and prevents muscle contraction. no antidote for phase 1
(ex. Succinylcholine) - non-depolarizing = competitive antagonist at ACh receptor
What are the 3 goals of general anesthesia?
- amnesia - no memory
- analgesia - no pain
- immobilization - paralysis
What are the differences b/w the 1a afferent motor pathway and the 1b afferent motor pathway?
1a: comes from muscle spindle; stimulates alpha-MN –> muscle contraction
1b: comes from golgi tendo organ –> inhibits contraction
What is the different b/w essential tremor, resting tremor, and intention?
essential: occurs both @ rest + mvt (family hx)
resting: only at rest (Parkinson)
intention: w/ movement (lateral cerebellar hemisphere damage)
What is Romberg testing?
dorsal column!!! (not cerebellum)
a 28 yo chemist presents with MPTP exposure. What neurotransmitter is depleted?
Dopamine
[MPTP –> MPP –> destroys dopaminergic neurons in substantia nigra]
How do each of the following structures normally impact movement?
a. globus pallidus interna
b. subthalamic nucleus (STN)
c. substantia nigra pars compacta
a. inhib
b. inhib
c. stimulate
A male patient presents with involuntary flailing of one arm. Where is the lesion?
contralateral STN
What neurotransmitters are altered in Huntington?
glutamate toxicity
- decreased ACh
- decreased GABA
- increased dopamine
Which spinal tract convey voluntary motor command from motor cortex to head/neck?
corticobulbar tract
Which spinal tract is important for postural adjustments and head movements?
vestibulospinal tract
Which spinal tract convey proprioceptive information for the cerebellum?
dorsal and ventral spinocerebellar tracts
What are the findings of Brown-Sequard syndrome? (5)
- ipsilateral UMN signs below lesion
- ipsi loss of p/v below lesion
- contra p/t loss 2-3 segments below lesion
- ipsi p/t loss @ the level of lesion
- LMN sign @ the lesion (anterior horn)
What nerve is damaged when pt is unable to extend 4th and 5th fingers?
ulnar (ulnar claw)
What nerve is damaged when pt is unable to flex index and middle finger?
median (hand of benediction)
What nerve is damaged when pt has wrist drop?
radial nerve
What nerve is damaged when pt has scapular winging
long thoracic
SALT –> serratus anterior, long thoracic
What nerve is damaged when pt has loss of sensation over fingers 1-4
median
What nerve is damaged when pt cannot abduct or adduct fingers
ulnar
What nerve is damaged when pt has loss of shoulder abduction
axillary
What nerve is damaged when pt has loss of elbow flexion and forearm supination
musculocutaneous
What nerve is damaged when pt has loss of wrist extension
radial
What nerve is the most at risk of injury with fracture of the shaft of the humerus?
radial
What nerve is the most at risk of injury with fracture of the surgical neck of the humerus?
axillary
What nerve is the most at risk of injury with anterior shoulder dislocation
axillary
What artery and nerve are most at risk of being damaged with anterior dislocation of shoulder?
axillary nerve
posterior circumflex artery
Which nerve would most likely be damaged with pelvic fracture?
femoral nerve
Which nerve would most likely be damaged with anterior hip dislocation?
obturator nerve
Which nerve would most likely be damaged with posterior hip dislocation?
superior and inferior gluteal nerves
Which nerve would most likely be damaged with vertebral disc herniation
sciatic
Which nerve would most likely be damaged with knee injury
tibial nerve
Which nerve would most likely be damaged with habitual crossing of the leg
common peroneal nerve
Which 2 muscle receptors are responsible for opening the sarcoplasmic reticulum in response to depolarization?
dihydropyridine receptor coupled to ryanodine receptor
What drug prevents the release of calcium from the sarcoplasmic reticulum of skeletal muscle?
dantrolene
what is the difference b/w type 1 and type 2 muscle fibers?
Type 1: slow twitch, red (b/c of high levels of mitochondria and myoglobin)
- oxidative phosphorylation
- sustained contraction
Type 2: fast twitch
- anaerobic glycolysis
What sensory receptor communicates pricking pain (fast, myelinated)?
A-delta
What sensory receptor communicates burning or dull pain and itch (slow, unmyelinated)
C fibers
What sensory receptor communicates vibration and pressure?
Pacinian corpuscles
What sensory receptor communicates dynamic/changing light, discriminatory touch?
Meissner
What sensory receptor communicates static/unchanging light touch?
Merkel
What sensory receptor communicates proprioception information (muscle length monitoring)?
muscle spindle (around intrafusal muscle fibers)
What sensory receptor communicates proprioception information (muscle TENSION monitoring)?
golgi tendon organ
What initial type of vision loss is commonly seen in pts with open angle glaucoma?
peripheral vision loss
What drug classes are used in the treatment of glaucoma? (2 main, 3 others)
1st line
- Beta blockers
- prostaglandins
Others:
- alpha-agonist
- carbonic anhydrase inhibitors
- cholinergic agonists
What is the treatment for dry age-related macular degeneration? (2)
- smoking cessation
- anti-oxidant vitamins
A patient presents with vertigo, tinnitus, and hearing loss. What is the diagnosis?
Meniere disease (endolymphatic hydrops)
Which organisms are most commonly responsible for acute otitis media? (3)
S. pneumo
nontypable H. influenzae
M. catarrhalis
What organism is most commonly responsible for otitis externa?
Pseudomonas
Chronic otitis media can sometimes result in a cystic lesion that is lined by keratinizing squamous epithelium, which can be metaplastic, that is filled with amorphous debris. What is the name of this condition?
Cholesteatoma
Why is Alzheimer disease more common in pts with Down syndrome?
b/c of extra chromosome 21 (which has APP gene)
What is the MoA of the drugs used in the treatment of Alzheimer disease? (2)
- cholinesterase inhibitors
- NMDA receptor antagonist
