3/26 Neuro Flashcards
1
Q
fovea: nasal or temporal?
optic disc: nasal or tempora?
A
fovea: temporal
optic disc: nasal
2
Q
anopia/anopsia
-define:
A
defect in field of vision
-so when its describing it, like bilateral temporal hemianopsia, it means the temporal visual field is fucked up on both sides.
3
Q
optic radiations
-the path from what to what?
A
LGN => V1 via optic radiations.
4
Q
optic radiations
-what are the two paths?
A
1) Meyers loop
2) Dorsal optic radiation
5
Q
Brain lesion where can damage meyers loop?
-stroke in which art dmgs meyers loop?
A
- temporal lobe
- MCA
6
Q
Meyers loop
- inf or sup retina?
- inf or sup visual field?
- mnemonic?
A
- inferior retina (on that side) which obviously = superior VF.
- (Max) Myers: lower in brain (inf. 1/2 of neurons) but superior in appearance (sup. 1/2 of VF).
7
Q
What visual process loops around inferior horn of lateral ventricle?
A
Meyers loop
8
Q
What visual path runs thru the internal capsule?
A
Dorsal optic radiation
9
Q
Lesion where damages the Dorsal optic radiation?
-stroke in which art dmgs dorsal optic radiation?
A
- Parietal lobe
- MCA.
10
Q
Dorsal optic radiation
- inf or sup retina?
- where in brain is it located?
- mnemonic
A
- sup. retina
- parietal lobe
- “parietal lobe is higher up than temporal lobe, DOR is superior 1/2 of retina.”
11
Q
4 destinations of optic tract fibers?
A
1) LGN
2) pretectal nucleus
3) superior colliculus
4) suprachiasmatic nucleus (of hypoT)
12
Q
Sturge-Weber syndrome
- somatic or inherited?
- developmental anomaly of what tissue derivatives?
- ectoderm? mesoderm? endoderm?
A
- somatic
- neural crest cells.
- ectoderm & mesoderm.
13
Q
Sturge-Weber syndrome
- what type of mutation?
- which gene?
A
- activating mutation
- GNAQ gene
14
Q
Sturge-Weber syndrome
-in basic terms, whats the problem here?
A
- problem w/blood vessels.
- you get port-wine stain on face & neurological problems from excessive blood vessel growth on brain (angiomas).
15
Q
Sturge-Weber syndrome
- Sxs:
- mnemonic:
A
STURGE:
- Sporadic, port-wine Stain
- Tram track Ca2+ (opposing gyri)
- Unilateral
- Retardation
- Glaucoma, GNAQ gene
- Epilepsy.
16
Q
Tuberous sclerosis
- Sxs:
- mnemonic?
A
HAMARTOMAS
- Hamartomas in CNS and skin
- Angiofibromas
- Mitral regurgitation
- Ash-leaf spots
- cardiac Rhabdomyoma
- Tuberous sclerosis
- autosomal dOminant
- Mental retardation
- renal Angiomyolipoma
- Seizures, Shagreen patches
17
Q
Tuberous sclerosis
-inheritance pattern
A
auto dom.
-must have variable expressivity.
18
Q
Neurofibromatosis type I (von Recklinghausen disease)
- mutation in what gene?
- whats the gene product?
- which chrom?
- inheritance pattern?
A
-NF1 tumor suppressor gene
-neurofibromin, a negative regulator of Ras
-chrom 17
-
19
Q
Neurofibromatosis type I
-Sxs:
A
Its a PNS tumor syndrome
- Café-au-lait spots
- Lisch nodules (pigmented iris hamartomas)
- neurofibromas in skin
- optic gliomas
- pheochromocytomas.
20
Q
von Hippel-Lindau disease
- inhertiance pattern?
- which gene?
- which chrom?
A
- auto dom
- VHL tumor suppressor gene
- chrom 3
21
Q
von Hippel-Lindau disease
-gene products that are over-expressed?
A
-constitutive expression of HIF (transcription factor) and
activation of angiogenic growth factors.
22
Q
von Hippel-Lindau disease
A
- Cavernous hemangiomas in skin, mucosa, organs
- bilateral renal cell carcinomas
- hemangioblastoma in retina, brain stem, cerebellum
- pheochromocytomas.
23
Q
do meningiomas stain for GFAP?
A
no
24
Q
butterfly glioma =?
A
glioblastoma multiforme
25
“Pseudopalisading” pleomorphic tumor cells—border central areas of necrosis and hemorrhage.
-which tumor?
glioblastoma multiforme
26
meningioma
- typically found where?
- tumor of what cell?
- near the surface of brain & parasagittal.
| - arachnoid cell.
27
Spindle cells concentrically arranged in a whorled pattern; psammoma bodies.
-which tumor?
meningioma
28
new-onset seizures in adult female
| -imaging shows mass attached to the dura
meningioma
29
Hemangioblastoma
- child or adult?
- cerebral or cerebellar?
- adult
| - cerebellar
30
Cerebellar hemangioblastoma w/retinal angiomas
| -what disease?
VHL
31
Hemangioblastoma
| -which paraneoplastic hormone?
EPO
32
Oligodendroglioma
| -most commonly found where?
frontal lobes
33
Pilocytic astrocytoma
- benign or malignant?
- marker?
- benign.
| - GFAP
34
Rosenthal fibers
- what do they look like?
- what disease are they found in?
- eosinophilic, corkscrew fibers.
| - pilocytic astrocytoma
35
Pilocytic astrocytoma
| -gross appearance?
- cystic + solid
| - Mural node = small mass of tissue that adheres to the wall of the cyst.
36
Ependymoma
| -most often found in which ventricle?
4th ventricle
37
Perivascular rosettes & rod-shaped blepharoplasts
| -which disease?
ependymoma
38
Subfalcine herniation
- what is it?
- what can be compressed?
- Cingulate gyrus herniation under falx cerebri.
| - ACA can be compressed
39
Uncal herniation
- what is it?
- what CN be compressed?
- Uncus = medial temporal lobe, herniates thru tentorium cerebelli.
- Compressed CN 3 => CN3 palsy + blown pupil.
40
Uncal herniation
| -what visual defect?
-Compressed ipsilateral PCA => contralateral homonymous hemianopia.
41
Uncal herniation
| -what type of paralysis?
-compressed contralateral crus cerebri => ipsilateral paralysis, “false localization” sign.
42
First sign of uncal hernation?
fixed & dilated pupil
43
Cerebellar tonsillar herniation
- herniates into where?
- Sxs:
- causes of death:
- foramen magnum
| - Coma and death result when these herniations compress the brain stem (and inhibit respiration).
44
Brimonidine
- what is it?
- whats it used for?
alpha2-agonist
| -glaucoma: dec. humor prod
45
Epinephrine
- how does it treat glaucoma?
- which glaucoma does it treat?
- dec. aqueous humor synthesis via vasoconstriction.
| - do NOT use on closed-angle bc it causes mydriasis!
46
Emergency closed-angle glaucoma
| -Tx:
pilocarpine
47
loperamide
- what is it?
- common use?
- opiate
| - Its an anti-diarrheal.
48
diphenoxylate
- what is it?
- common use?
- opiate
| - Its an anti-diarrheal.
49
Opiates
| -what does pt never develop tolerance to?
miosis & constipation.
50
naloxone
| -route of admin?
IV
51
Which opiate do you use in biliary & colic pain?
meperidine
52
meperidine
- how is it metabolized?
- what is its metabolite?
- P450 metabolism.
| - Its metabolite (normeperidine) = SSRI
53
Why should you be careful prescribing an opiate to a pt w/hypotension?
-all mu opioids cause histamine release => vasodilation & itching.
54
Mu receptors
| -what type of receptor?
- Gi coupled
- open K channels = hyperpolarization.
- close Ca channels & prevent release of NTs.
55
Opiates
| -inhibit release of what chemicals?
Inhibit release of ACh, norepinephrine, 5-HT, glutamate, substance P.
56
Pentazocine =
- partial agonist @ Mu receptor.
| - can cause withdrawals to opiate addict.
57
Meperidine overdose
| -can you give naloxone?
No
58
How do opiates treat acute pulmonary edema?
-Improves pulmonary hemodynamics, helps normalize ventilation, helps allay anxiety.
59
How do opiates depress your central respiratory center?
| -if your respiratory center is depressed, what keeps your ventilation going?
- Your pCO2 centers in your medulla (central respiratory center) have mu receptors, so morphine will shut them down.
- You also have peripheral O2 receptors (carotid body/aortic body) called your "hypoxic drive". This is what will remain when a pt is under the influence of an opiate b/c central respiratory center is shut down.
60
Can you give O2 to a pt under opiates?
- Do NOT give O2 to pt under opiates unless pt is mechanically ventilated.
- Lots of oxygen will turn off the pO2 centers (carotid/aortic bodies) so there wont be any signals to breathe.
61
Butorphanol
- what is it?
- how do you treat OD?
- Mu-opioid receptor partial agonist and kappa-opioid receptor agonist; produces analgesia.
- Overdose not easily reversed with naloxone.
62
Tramadol
- mech?
- mnemonic?
- Weak opioid agonist; also inhibits serotonin and NE reuptake
- works on multiple neurotransmitters—“tram it all” in with tramadol.
63
Tramadol
| -tox:
- Similar to opioids
- Decreases seizure threshold
- Serotonin syndrome
64
MI presenting w/brady & hypotension?
- wheres the infarct?
- which artery?
- which leads?
- SA node.
- RCA
- 2, 3, aVF
65
pseudogout
- deposition of what type of crystals?
- shape?
- are they +/- birefringent?
- calcium pyrophosphate
- rhomboid
- weakly positively birefringent.
66
gout
- what are crystals made of?
- are crystals +/- birefringent?
- monosodium urate
| - neg. birefringent.
67
Gout
| -what color are crystals in parallel light?
yellow
68
Pseudgout
| -what color are crystals in parallel light?
blue
69
Destructino of oligodendrocytes seen in which diseases?
MS & PML
| *which is funny bc natalizumab is used to treat MS but can cause PML.
70
pleomorphic
| -define:
differing in size & shape.
71
cutaneous facial angiomas & leptomeningeal angiomas
Sturge Weber syndrome
72
femoral neck fx
| -which artery is at risk?
medial circumflex art.
73
inc or dec levels of hepcidin in hemochromatosis?
| -how about ferroportin expression?
decreased levels of hepcidin which will upregulate (basolateral) ferroportin which allows enterocytes to release more iron into circulation.
74
Hemochromatosis
| -which pancreatic functions are destroyed and which are retained?
- endocrine destroyed
* bc iron overload in blood, and endocrine part is much more highly vascularized.
- exocrine retained (so no malabsorption).
75
How do OCPs reduce risk of ovarian cancer?
- when you ovulate/rupture a follicle, you have to then repair surface of ovary. This repairative process can lead to ovarian surface cancers.
- OCPs reduce number of times a woman ovulates, so it reduces these risks.
76
If cell wants to go from G1 to S, does Rb need to be phosphorylated or not-phosphorylated?
-phosphorylated means the cell cycle can continue.
77
primary cell in gout thats causing problems?
neutrophils phagocytose the crystals and release inflammatory cytokines.
78
Ethosuximide
- mech?
- use?
- Blocks thalamic T-type Ca2+ channels.
| - absence seizures.
79
first line for acute status epilepticus.
Lorazepam
80
phenytoin & megaloblastic anemia
| -how?
phenytoin blocks intestinal conjugase needed to absorb folate.
81
How does phenytoin dec. vit D levels?
by inc. P450.
| -P450 system metabolizes vitamin D.
82
Which drugs follow 0 order kinetics?
| -mnemonic?
PEA (looks like 0)
| -phenytoin, ethanol, aspirin.
83
Phenytoin
| -side effects?
- gingival hyperplasia
- hirsutism
- P450 induction
- megaloblastic anemia
- teratogen
84
Do 0-order drugs have wide or narrow therapeutic window?
narrow therapeutic window
85
Unique use of carbamazepine
neurogenic pain
| -ie. trigeminal neuralgia
86
Carbamazepine
| -side effects?
- agranulocytosis
- SIADH
- aplastic anemia
- P450 inducer
87
Valproic acid
| -mech:
- Na channel inactivation
- inhibit GABA transaminase
- T-type Ca channel blocker
88
Besides ethosuximide, which drugs can be used for absence seizures?
Valproic acid, Lamotrigine.
89
Valproic acid
| -side effects
- hepatotoxicity
- P450 inhibitor
- neural tube defects
- pancreatitis
- teratogen
90
Valproic acid
| -besides seizures, what can it be used for?
bipolar disorder
91
Gabapentin
| -what is it?
Ca channel inhbitor + GABA analog
| -anti-epileptic
92
Topiramate
| -what is it?
- blocks Na channels, inc GABA action
| - anti-epileptic
93
Lamotrigine
- what is it?
- tox:
- blocks Na channels
- anti-epileptic
- steven johnsons
94
Levetiracetam
| -what is it?
-anti-epileptic
95
Tiagabine
| -what is it?
- GABA reuptake inhibitor
| - anti-epileptic
96
Vigabatrin
| -what is it?
- irreversible GABA transaminase inhibitor
| - anti-epileptic
97
Which one can you OD harder on, benzos or barbs?
barbs.
| -benzos reach a plateau.
98
Barbs & benzos
- analgesia?
- sedation?
pure sedation, no analgesia.
99
Barbiturates
| -C/I: if pt has what disease?
porphyrias
100
which barb is used to induce anesthesia?
thiopental
101
P450 induction
| -what happens on lineweaver plot?
inc. Vmax.
102
Benzos
| -effect on sleep?
-dec. REM sleep.
103
Short acting benzos:
| -mnemonic?
triazolam, oxazepam, midazolam, alprazolam.
| -TOM & AL bundy has a short fuse.
104
Barbs/Benzos/ethanol
| -bind GABAa or GABAb?
GABAa
105
Night terrors, sleepwalking
| -Tx:
benzos
106
Benzo OD
| -Tx:
flumazenil
107
Which sedative has anterograde amnesia?
benzos
108
Zolpidem
| -what is it?
- BZ1 subtype of the GABA receptor.
| - Insomnia.
109
Zaleplon
| -what is it?
- BZ1 subtype of the GABA receptor.
| - Insomnia.
110
esZopiclone
| -what is it?
- BZ1 subtype of the GABA receptor.
| - Insomnia.
111
Blood/gas ratio
| -if you want fast on/off, do you want high or low blood/gas ratio?
low blood/gas ratio = fast on/off.
112
Anesthetic: solubility in blood
| -if you want fast on/off, do you want high or low solubility in blood?
low solubility in blood = fast on/off
| -will = low blood/gas ratio
113
Steepness of arterial tension curve for anesthetic
| -if you want a steep curve, do you have high or low solubility in blood?
- less soluble = steeper curve
| - Partial pressure in the blood rises more quickly w/less soluble anesthetics, producing a steeper curve.
114
Nitrous oxide
| -how is it cleared/eliminated?
-not metabolized, just exhaled.
115
Inhaled anesthetics
| -mechanism of action:
mechanism unknown.
116
Inhaled anesthetics
- effect on cerebral blood flow?
- effect on cerebral metabolic demand?
- inc. cerebral blood flow (inc. ICP).
| - dec. cerebral metabolic demand (working less so needs less energy, obviously).
117
N2O
- name?
- is there resp. depression?
- nitrous oxide
| - no respiratory depression.
118
Do inhaled anesthetics cause analgesia?
yes
| -they do everything you want in a general anesthetic.
119
A good inducer:
- solubility in blood:
- A-V conc. diff:
- blood/gas ratio:
- low solubility in blood
- low A-V conc. diff
- low blood/gas ratio.
120
Which inhaled anesthetic can cause:
| -hepatotoxicity
halothane
121
Which inhaled anesthetic can cause:
| -nephrotoxicity
methoxyflurane
122
Which inhaled anesthetic can cause:
| -seizures
enflurane
123
Which inhaled anesthetic can cause:
| -expansion of trapped gas in a body cavity
nitrous oxide
124
Which inhaled anesthetic can NOT cause malignant hyperthermia?
nitrous oxide
125
Malignant hyperthermia
- most common causes:
- Tx:
- halothane, succinylcholine.
| - Tx: dantrolene.
126
Which inhaled anesthetic should pregnant women not use?
N2O can cause spontaneous abortion.
127
Halothane hepatitis
- how long after does it happen?
- where is the necrosis?
- 2 days to 4 weeks after surgery
| - centilobular necrosis
128
Malignant hyperthermia
| -where is the problem?
ryanodine receptor
129
Dantrolene
| -mech:
Blocks Ca release from SR.
130
IV anesthetics
| -whats the pro?
Do not cause N/V.
131
Anesthetics
| -What does lipid solubility correlate with?
High lipid solubility = high potency = lower the MAC.
132
IV barbs
| -effect on cerebral blood flow?
dec. cerebral blood flow
| - opposite inhaled anesthetics which inc. cerebral blood flow.
133
What does potency tell you about the anesthetic?
Just tells you how much you have to use to get the job done, thats pretty much it.
134
What risk is associated w/IV barbiturates?
laryngospasm
135
ketamine
- mech:
- is it analgesic?
- what type of anesthesia do they cause?
- Block NMDA receptors
- good analgesic.
- dissociative anesthesia.
136
ketamine
- side effect?
- C/I in what pts?
- nightmares
| - C/I in PTSD pts.
137
ketamine
- effect on CV system?
- effect on cerebral blood flow?
- CV stimulant.
| - inc. cerebral blood flow.
138
Which anesthetics inc. cerebral blood flow?
inhaled anesthetics, ketamine.
139
Which anesthetics dec. cerebral blood flow?
barbiturates.
140
Binding of what is required for NMDA receptor activation?
glutamate & glycine.
141
Propofol
- mech:
- effect:
- s/e:
- potentiates GABAa
- sedative, no analgesia = INDUCTION AGENT.
- hypotension, its a vasodilator.
142
Most ORs use what as the induction agent?
| -why this one?
propofol
| -less post-op N/V than thiopental.
143
Propofol
| -same mech as what other drugs?
benzos
144
Local anesthetics
| -esters vs amides: how do you remember, whats the mnemonic?
-amIdes have 2 I’s in name!
145
tetracaine
| -what is it?
ester local anesthetic
146
procaine
| -what is it?
ester local anesthetic
147
local anesthetics
- mech?
- which channels do they preferentially bind?
- Block Na+ channels (from inside the nerve).
| - Preferentially bind to activated Na+ channels, so most effective in rapidly firing neurons.
148
local anesthetics
- what needs to happen before they can work?
- explain the different forms:
Need to get into the nerve.
- They're weak bases so need an alkaline environment so they remain neutrally charged so they can get in.
- Then, once inside, the acidic pH of the cell ionizes them so they can function.
149
local anesthetics
| -amides: where are they metabolized?
Liver
150
local anesthetics: which nerve fibers are blocked first
- small or large?
- myelinated or non-myelinated?
- small
| - myelinated
151
local anesthetics: which nerve fibers are blocked first
| -small unmyelinated or large myelinated?
small unmyelinated
| -size predominates over myelination.
152
```
local anesthetics: order of loss, put these in order:
touch
pain
pressure
temperature
```
(1) pain
(2) temperature
(3) touch
(4) pressure
*-PTTP: pressure is last.
153
Which local anesthetic can cause:
| -severe cardiovascular toxicity
bupivacaine
154
Which local anesthetic can cause:
| -arrhythmias
cocaine
155
Neuromuscular blocking drugs
| -what kind of paralysis do they cause?
flaccid paralysis
| -you wouldn't ever want to cause a spastic paralysis - thats what happens in malignant hyperthermia!
156
succinylcholine
| -phase 1: how do you reverse it?
-pseudocholinesterase metabolizes the succinylcholine.
157
succinylcholine
| -phase 2: how do you reverse it?
AChE inhibitors
158
succinylcholine
| -tox:
hypercalcemia, hyperkalemia, and malignant hyperthermia.
159
Non-depolarizing NMJ blockers
- suffix?
- mech?
- curium
- curonium
- competetive inhibitors of ACh at Nm.
*Tubocurarine as well.
160
Tubocurarine
| -what is it?
Non-depolarizing NMJ blockers
161
Malignant hyperthermia
| -what do 50% of these pts have?
-auto dom. mutation in ryanodine receptor, causing LOTS of Calcium release from SR.
162
carbidopa
| -mech:
noncompetetive inhibitor of dopa decarboxylase.
163
Amantadine
- use in parkinsons?
- tox?
- inc. dopamine release
| - tox = ataxia
164
Selegiline
- mech:
- use:
- selective MAO type B inhibitor
- parkinsons
*MAO-B metabolizes dopamine.
165
entacapone, tolcapone
- mech:
- use:
- COMT inhibitors => prevent l-dopa degradation => inc. dopamine availability.
- parkinsons
166
entacapone vs tolcapone
| -whats the diff?
- entacapone only works in the periphery.
| - tolcapone work in both periphery & central.
167
MAO-A
| -what does it metabolize?
NE & serotonin
168
Which anti-muscarinic used most commonly in parkinsons?
benztropine
| -"Park my Benz"
169
What do anti-muscarinics do in parkinsons? Which Sxs do they manage?
-Antimuscarinic; improves tremor and rigidity but has little effect on bradykinesia.
170
Which vitamin inc. peripheral degradation of levodopa?
B6
171
Levodopa/carbidopa
| -tox:
- Arrhythmias from inc. peripheral formation of catecholamines.
- Long-term use can lead to dyskinesia (on-off phenomenon).
172
Selegiline
- what are its metabolites?
- what can they cause?
- amphetamines
| - insomnia, agitation.
173
Memantine
- mech:
- use:
- tox:
- NMDA receptor antagonist; helps prevent excitotoxicity (mediated by Ca2+).
- Huntingtons
- Dizziness, confusion, hallucinations.
174
Donepezil, galantamine
- mech:
- use:
AChE inhibitors
-Alzheimers
*also rivastigmine.
175
Sumatriptan
| -tox:
coronary vasospasm
176
Sumatriptan
- mech:
- use:
- 5-HT1B/1D agonist. Inhibits trigeminal nerve activation; prevents vasoactive peptide release; induces vasoconstriction.
- acute migraine, cluster headache.
177
myoclonic seizures
| -1st line med:
valproic acid.
178
clonic
| -define
movement
179
postictal
| -define:
following a seizure
180
Which ABx can cause serotonin syndrome if taken w/SSRI?
linezolid
| -its a weak MAO inhibitor.
181
migraine
| -abortive therapy:
sumatriptan
182
which nerve is responsible for migraine headaches & releasing vasoactive peptides to meninges?
trigeminal n.
| -activated by meningeal irritation.
183
Which NT is released in all ganglia?
ACh
