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Sam: Neurology > Clin Med part 2 > Flashcards

Clin Med part 2 Flashcards

1
Q

Are Schwann cells found in the CNS or PNS?

A

PNS

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2
Q

What type of cells line the areas of the nervous system that have cerebrospinal fluid and help circulate the fluid?

A

Ependymal cells

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3
Q

What type of cells facilitate nutrient extraction from blood supply?

A

Astrocytes

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4
Q

What cells circulate through the nervous system and destroy bacteria or dead cells.

A

Microglial cells

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5
Q

Typically, what symptom do most MS patients present with first?

A

Optic neuritis – blurred or diminished vision

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6
Q

What criteria must be met to diagnose MS?

A

McDonald criteria

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7
Q

What must we see on MRI to diagnose MS?

A

Must show two or more different areas in central areas of white matter affected at different times

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8
Q

What other test besides MRI should we obtain when suspecting MS?

A

Lumbar puncture

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9
Q

What will the results of a lumbar puncture look like with a MS patient?

A
  1. mild lymphocytosis
  2. presence of oligoclonal bands
  3. if you do find albumin, this indicates disruption of the BBB
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10
Q

Most common type of MS?

A

relapsing remitting

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11
Q

What is Uhthoff’s phenomenon?

A

Heat intolerance seen in MS patients

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12
Q

How are acute attacks of MS treated?

A

Treated with glucocorticoids, most commonly IV methylprednisolone

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13
Q

What drug or MS is a mixture of amino acids antigenically similar to myelin protein and works by competing for T-cells?

A

Glatiramer [Copaxone]

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14
Q

What was the first oral med approved for MS?

A

Gilenya

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15
Q

What patient population cannot we not prescribe Gilenya to?

A

Diabetics

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16
Q

What drug results in down-regulation of receptors and T-cell sequestration in lymphoid tissue?

A

Gilenya

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17
Q

According to Alden-St.Pierre, what has historically been our first line drug for MS?

A

Glatiramer with out without interferon-B

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18
Q

“Cure” for MS?

A

Stem-cell transplant

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19
Q

what is an uncommon disease, but is the most common disease of neuromuscular transmission?

A

Myasthenia Gravis

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20
Q

Up to 75% of patients have __________ abnormalities.

A

thymic

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21
Q

Is there a genetic predisposition to myasthenia gravis?

A

yes

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22
Q

What is the main function of the thymus?

A

To provide an area for T lymphocyte maturation

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23
Q

Ptosis, diplopia, bulbar muscle weakness, expressionless face, neck muscles (head drop) are all symptoms of what disease?

A

Myasthenia gravis

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24
Q

On physical exam of MG, you will find fatigability of muscles. What muscle in particular?

A

Muscles of the eye and mouth

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25
Q

Is neuromuscular transmission improved at cooler or warmer temperatures?

A

Cooler – thats why we do the ice pack test with myasthenia gravis.

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26
Q

80-90% of MG patients will have circulating antibodies against?

A

NAchR

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27
Q

If your patient is seronegative for MG, but you still believe they have the disease, what other test can you do?

A

Electrophysiologic testing – single fiber EMG – more complex specialized procedure.

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28
Q

What is the cornerstone of treatment with MG?

A

Acetylcholinesterase inhibitors

Pyridostigmine, Neostigmine

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29
Q

What treatment is useful for acute decline from MG or myasthenic crisis?

A

Plasma exchange

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30
Q

What is MG crisis?

A

Respiratory weakness that can lead to respiratory failure

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31
Q

What are inherited disorders causing progressive muscle weakness and atrophy due to a genetic defect?

A

Muscular dystrophies

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32
Q

This muscular dystrophy is caused by a defective gene on the X chromosome responsible for producing dystrophin.

A

Duchenne Muscular Dystrophy

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33
Q

How is Becker muscular dystrophy different from duchenne muscular dystrophy?

A

Those affected with BMD make some dystrophin where as in DMD none is produced.

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34
Q

What is the classic triad of Emery-Dreifuss Muscular Dystrophy?

A

Contractures of elbows, ankle plantar flexors, and spine

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35
Q

What is the most common form of muscular dystrophy in whites?

A

Myotonic dystrophy

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36
Q

What type of muscular dystrophy affects shoulder girdle and/or hip girdle?

A

Limb-Girdle Muscular Dystrophy

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37
Q

which our muscular dystrophies is autosomal dominant?

A

Facioscapulohumeral muscular dystrophy

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38
Q

Which muscular dystrophy will have tongue atrophy and facial muscle weakness?

A

Oculopharyngeal muscular dystrophy

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39
Q

What is referred to as “floppy baby syndrome:?

A

Congenital muscular dystrophy

40
Q

Which our muscular dystrophies will have scapular winging as a symptom?

A

Facioscapulohumeral muscular dystrophy

41
Q

When it comes to concussions, what does secondary injury refer to?

A

Occurs in minutes, hours, days AFTER the initial insult

can be intracellular swelling, electrolyte imbalances, inflammatory response

42
Q

What are classic signs of a basilar skull fracture?

A
  1. Battle’s sign
  2. Raccoon eyes
  3. CSF rhinorrhea or otorrhea
  4. Hemotympanum
43
Q

What is second impact syndrome?

A

Diffuse cerebral swelling –> increased cranial pressure

Rare, but fatal

44
Q

What guidelines do we follow when evaluating whether an athlete is allowed to participate post concussion?

A

Stepwise return to play:

  1. No activity and rest until asx
  2. Light aerobic exercise
  3. Sport-specific training
  4. Non-contact drills
  5. Full-contact drills
  6. Game play

Can only progress if Asx

45
Q

Do we give narcotics for pain with concussion?

A

NO

46
Q

Put these in the right order:

  1. Perception
  2. Transmission
  3. Transduction
  4. Modulation
A
  1. Transduction: noxious stimuli are converted to electrical signals in sensory nerve endings
  2. Transmission: neural events which relay the information from the periphery to the cortex
  3. Modulation: the nervous system can selectively inhibit the transmission of pain signals
  4. Perception: subjective interpretation by the cortex of the noxious stimulus
47
Q

Pain occurring in the absence of detectable ongoing tissue-damaging process is a clinical feature of what type of pain?

A

Neuropathic

48
Q

What were opioids originally used for?

A

Diarrhea – dysentery

49
Q

what are the three cloned opioid receptors?

A

mu, delta, and kappa

50
Q

opioid analgesics can work at several levels, what are they?

A
  1. peripheral receptors
  2. spinal cord
  3. supraspinal sites
51
Q

What is a desirable effect of opioids?

A

Analgesia

52
Q

What are some undesirable effects of opioids?

A

Nausea, vomiting, constipation, and respiratory depression

53
Q

What are some mixed desirability effects of opioids?

A

Sedation, decreased bowel motility, and euphoria

54
Q

What is the process in which previous exposure to a drug results in diminution of an effect or the need for a higher dose to maintain an effect?

A

Tolerance

55
Q

What is the most life-threatening of the side-effects associated with opioid analgesics?

A

Respiratory depression

56
Q

What drug reverses the depressant effects of most opioids?

A

Narcan

57
Q

What drug is used in the treatment of heroin addiction and managing opioid withdrawal?

A

Methadone

58
Q

What drug is marketed as a compound with efficacy similar to codeine with less side-effects?

A

Tramadol

59
Q

What drug is indicated for opioid-induced constipation in patients with advanced illness and who are not responding to conventional laxative therapy?

A

Methylnaltrexone

60
Q

Describe a resting tremor

A

Body part affected is supported against gravity, no muscle contraaction

61
Q

An action tremor is produced by _________ muscle contraction

A

Voluntary

62
Q

What type of tremor is present during visually-guided, target-directed motion?

A

Intentional tremor

63
Q

What is the most common movement disorder worldwide?

A

Benign Essential Tremor

64
Q

95% of benign essential tremors start with postural ________ ____ ______

A

distal arm tremor

65
Q

The amplitude of a benign essential tremor increases with?

A

stress, fatigue, CNS stimulants

66
Q

The amplitude of a benign essential tremor decreases with?

A

EtOH, beta-blockade, rest

67
Q

Treatment options for benign essential tremor?

A

Primidone, beta-blockade – propranolol

68
Q

3 take home points of benign essential tremor

A
  1. active tremor
  2. neurological exam NORMAL
  3. slow onset
69
Q

4 cardinal signs of Parkinson’s. Go.

A
  1. Tremor
  2. Rigidity
  3. Bradykinesia
  4. Postural impairment/gait
70
Q

true or false

patients with parkinson’s will have weakness and decreased DTRs.

A

False!

No weakness, and no change in DTRs

71
Q

What part of the brain is affected with Parkinson’s?

A

Substantia nigra

72
Q

When do you start treatment for Parkinson’s?

A

When functional disability starts

73
Q

What symptoms do anticholinergics help with for Parkinson’s patients?

A

tremor

74
Q

Take home points of Parkinson’s?

A
  1. pill rolling, gait disturbance, start hesitation
  2. slow onset
  3. treat when FUNCTIONAL disability begins
  4. Dopamine
75
Q

What is Huntington’s triad?

A

Motor, cognitive, and psychiatric symptoms

76
Q

Tell me about the levels of the following neurotransmitters in Huntington’s

  1. GABA
  2. Acetylcholine
  3. Dopamine
A

GABA decreases
Acetylcholine decreases
Dopamine decreases

77
Q

What chromosome is Huntington’s associated with?

A

4

78
Q

How many repeats of the glutamine “CAG” sequence results in Huntington’s?

A

40+

79
Q

Take home points of Huntington’s?

A
  1. Disease of the YOUNG
  2. Symptomatic treatment
  3. Multi-care specialty care needed
  4. Genetic counseling
  5. Watch for SI
80
Q

What is an inherited neurobehavioral disorder characterized by sudden involuntary repetitive muscle movements and vocalizations?

A

Tourette’s

81
Q

Symptoms need to begin before this age to be diagnosed with Tourette’s?

A

18

82
Q

How long does a person need to have Tourette symptoms before being diagnosed?

A

1 year

83
Q

What is echopraxia?

A

meaningless repetition or imitation of the movements of others

84
Q

What word is used to describe repeating one’s own words?

A

Palilalia

85
Q

What are other conditions associated with Tourette’s?

A

OCD, ADD, rage, anxiety

86
Q

Tourette’s is caused by excessive _______ in the basal ganglia.

A

glutamate

87
Q

For Tourette’s patients, what should we try before starting medications?

A

Habit reversal training

88
Q

Take home points of Tourette’s?

A
  1. Treatment goal = functional preservation
  2. Many will have other psychiatric issues
  3. Meds can be useful but don’t forget about behavior modification therapy
89
Q

What is a movement disorder in which involuntary sustained or intermittent muscle contractions cause twisting and repetitive movements, abnormal postures or both?

A

Cerebral palsy

90
Q

What element may prevent cerebral palsy?

A

Magnesium

91
Q

What is compression at the superior thoracic outlet resulting from excess pressure placed on a neurovascular bundle passing between the anterior scalene and middle scalene muscles?

A

Thoracic Outlet Syndrome

92
Q

What branches of the trigeminal nerve is usually affected with trigeminal neuralgia?

A

2nd and 3rd

93
Q

What are triggers for trigeminal neuralgia?

A

Light touch – breeze, kiss, shaving, chewing, washing, talking

94
Q

Does firm pressure elicit pain with trigeminal neuralgia?

A

no

95
Q

What drugs do we use to treat trigeminal neuralgia?

A

anti-convulsants –> carbamazepine, phenytoin

96
Q

Take home points of trigeminal neuralgia?

A
  1. extremely painful
  2. consider alternative diagnosis above age 50
  3. exam normal except for severe pain with light touch
97
Q

What site on the body is most at risk for developing post herpetic neuralgia?

A

Trigeminal and brachial plexus

Sam: Neurology (4 decks)

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