CNS Flashcards
patient recently started on schizo meds, has torticolis, what is mechanism?
D2 antagonism leads to acute dystonic reaction
demyelinating disease causes decrease in what in the neuron?
length (space) constant. velocity equals length/time. length constant is how far impulse can travel- because myelin creates high resistance in membrane, impulse can travel farther
cystic degeneration of putamen is commonly caused by
wilson’s
21 yo with impaired balance, tremor and difficulty speaking, sibling who has progressive neurological disease, dx and pathognomonic sign?
wilson’s- keyser-fleischer rings, slit lamp examination
HIV dementia, histology?
microglial nodules and multinucleated giant cells
patient with RA given anesthetic then develops quadriparesis, dx and mechanism?
vertebral sublaxation. RA involves atlantoaxial joint and then anesthetic worsens this sublaxation causing compression of vertebral arteries/spinal cord
rural farmer in penn, has splinter injury, and develops lockjaw and difficulty swallowing, cannot turn neck, dx?
tetanus- clinical diagnosis.
hyperkalemia after anestehtic? which one?
succinylcholine- dont give in burn, myopathy, quadreplegic patients
post herpetic neuralgia given topical capsaicin, whcih substance does it regulate?
substance P, not NPY
boy with papilledema, unable to look up, eyelid retraction, blurry vision. dx?
parinaud syndrome due to midbrain compression, by pineal gland
HIV patient, has meningitis symptoms, organism and what would you see?
cryptococcus, on india ink you would see budding yeasts. can also do a latex agglutination test for the polysaccharide capsule
isoflurane anestehtic side effect
increased cerebral blood flow
upon looking right, the left eye does not adduct, dx and lesion?
internuclear opthalmoplegia, due to damage to MLF commonly due to lacunar stroke
agraphia, acalculia, left-right disorientation
gerstmann syndrome in angular gyrus in dominant parietal lobe
RTA, fracture at pterion (where three bones meet), what artery is damaged and what can it lead to?
maxillary artery branch- middle meningeal artery- epidural hematoma
equilibrium potential given and permeability to the ion… at resting membrane potential, at ligand gated channel and voltage gated channel
potassium sodium chloride
face and arm weakness, leg spared. which artery?
middle cerebral
needs anesthesia for anterior thigh muscles, where should you inject?
inguinal crease
brain tumor, positive for synaptophysin, negative for GFAP. what is the origin of this tumor?
neurons
course of median nerve?
brachial plexus, between ulnar and humeral heads of pronator teres, then between FDP and FDS
man dies with alcohol related vomitus aspiration on the sidewalk. hemorrhage of mamillary bodies. what enzyme is low?
transketolase - thiamine deficiency in wernicke’s. thiamine is essential for PPP, which uses transketolase
meningitic symptoms, fever, biopsy shows clear cells, dx?
cryptococcus
nerve conduction study shows delayed action potential after stimulus, what is wrong with neuron?
schwann cells due to compression and apoptosis. axon damage would cause decrease in amplitude
old woman with headache with left lower limb paralysis, and tremor of hand, csf shows lymphocytic pleocytosis and RNA from virus. dx?
west nile virus infection
person with diffuse muscle rigidity, hyperthermia and altered sensorium and dysautonomia on haloperidol and sertraline, dx, rx, and mecahnism?
neuroleptic malignant, dantrolene, blocks ryanodine receptor to inhibit Ca release from sarcoplasmic reticulum
cherry red macula, startle reflex, macrocephaly, developmental delay in 8 month old, abdo exam normal. dx and enzyme missing and what accumulates?
tay sachs, hexosaminidase A, GM2 ganglioside. contrast with niemann-pick has hepatosplenomegaly (sphingomyelinase deficiency)
fragile X syndrome baby, what is genetic abnormality?
hypermethylation of FMR1 gene
male patient has myclonic epilepsy, muscle biopsy shows blotchy red appearance, what is probability that offspring will get disease?
0% because mitochondrial inheritance. MERRF, LHON, MELAS
posterior triangle dissection, shoulder abduction weakness later. what muscle is affected?
trapezius. posterior triangle dissection led to spinal accessory nerve injury
MS patient with painful spasticity of muscles, rx?
baclofen- GABA-B agonist and tizanidine alpha 2 agonist can also be used
SAH, 5 days later, new FND. what is dx? and Rx?
vasospasm causing infarct. can give CCB
high levels of acetylcholinesterase in amniocentesis of week 18 baby, dx?
neural tube defect
4 yo patient w difficulty walking, frequent respi infections, high rate of radiation induced genetic mutation, dx?
ataxia-telangiectasia. cerebellar atrophy
japanese restaurant eating fish, neurotoxicity, where in action potential?
binds to voltage gated sodium channels, prevents depolarization
battle sign, racoon eyes/orbital floor fracture?
basilar skull fracture, infraorbital nerve damaged
orninthine cannot get into mitochondria, what should be restricted in the diet?
protein; because urea cycle is defective
retinoic acid inhibits what in fetus?
hox pathway- face, thymus, cartilage
endorphins are structurally similar to what normal hormone?
ACTH. both made from POMC
treatment for cryptococcal meningitis?
Ampho B and flucytosine, then long-term fluconazole
hydrocephalus, intracranial calcification and chorioretinitis?
toxoplasmosis, from cat droppings, in-utero infection TORCHES
long term parkinsons patient on levodopa carbidopa treatment. why on-off?
because of nigrostriatial destruction
why, in mitochondrial diseases, is there such varaibility in phenotype?
heteroplasmy because mitochondria are unequally distributed
anestehtic has increased arteriovenous concentration gradient which means that it has a _______; how about high blood gas coefficient
slower onset of action; because peripheral tissue is taking up the anesthetic a lot, must be replaced; this means that more is being solubilized so more needs to be given
what does adding carvidopa to levodopa do?
dopa decarboxylase inhibitor so it can go into brain more. peripheral side effects of dopamine such as postural hypotension and hot flashes and vomitng/nausea are reduced, but brain activity increases so anxiety and agitation might get worse
SVT ablation at RA, crysta terminalis. what nerve can be injured?
R phrenic nerve, elevation of diaphragm will show it
camping trip to new mexico, torticolis, mydriasis, drooling, painful esophageal spasms, cannot eat or drink, dx and where is the entry point?
rabies encephalitis, muscle ACh receptor
perivenular inflammatory infiltrates in brain and astrocyte hyperplasia -glial scarring, dx?
MS
what anesthetics lead to liver failures?
halogenated- esoflurane etc
trendelenburg sign nerve
superior gluteal nerve
sponteaneous local recurrent lobar hemorrhage in elderly , dx?
cerebral amyloid angiopathy
TMJ dysfunction and hearing issues, what nerve?
mandibular (V3)
