exam 3 Flashcards
A 25-year-old man has a 3 year history of excessive daytime sleepiness. He goes to bed at 10 PM and gets up at 6 AM. He wakes up briefly 4-5 times during the night. He feels refreshed upon waking but after about an hour starts getting very drowsy. He naps 2-3 times during the day, for 30-45 minutes each time and feels much better right after naps. Some mornings he can’t move for 2-3 minutes after waking up. He describes vague right hand weakness when he tells a funny joke which occasionally causes him to drop things. He denies snoring or gasping.
Which neurotransmitter is deficient in the likely diagnosis in this case? What is likely diagnosis?
-
Orexin/Hypocretin
- Narcolepsy: cataplexy (Type 1), sleepiness (feel refreshed after awake initially)
- Tx: sleep hygiene
23-year-old woman with a painful right eye and visual blurring over the last two days. In the past 2 years she has had three episodes, each lasting between 2-4 weeks, of numbness in the right hand, weakness in the left foot, and bladder retention. They were all so mild she did not seek medical attention. What does she have and what treatment?
MS corticosteroids, will not change course of MS but can speed up recovery from relapse
Someone with MS wants to get pregnant what treatment should she get for her MS?
Glatirame Acetate
A 78-year-old man presents with memory trouble. It started two years ago and has been gradually progressive. The main problem is short-term memory. Wife denies change in gait, posture, smile, speech or personality. His exam is remarkable for: Mental status: Montreal Cognitive Assessment (MoCA) score is 21/30. He could only repeat 1/5 words at five minutes, could not put the hands of a clock in correctly, missed number repetition backwards, was only correct with serial 7s from 100-93, and listed only seven words starting with the letter “F”.
Alzheimer’s Dementia
frontotemporal - perksonality changes
diffuse levy body disease- sleep disturbance, parkinsons
mulit-infarct dementia-
Parkinson’s disease clinical features
- Bradykinesia
- Resting tremor
- Rigidity
- Stooped posture
65-year-old male comes to your office complaining of 6 months of gait changes. He also developed a tremor of the left hand 1 year ago but never sought medical attention. He is concerned about his ability to continue to work as a watch-maker and would like to know what is going on with his body.
On ROS, he endorses loss of smell for the past 10 years. He also endorses “weird” behaviors at night. His wife jumps in and tells you he has a tendency to kick and punch her at night. He has been doing this for the past 10 years.
Treatment?
Rasagiline - MAO-B inhibitor
Carbidopa/levodopa- Levodopa is dopamine precursor that is converted to dopamine.
Carbidopa blocks the peripheral conversion of levodopa to dopamine causing side-effects
What does DaT scan show?
- DaTscan works by measuring dopamine through the dopamine transporter on the pre-synaptic neuron
- can show Parkinson’s disease
Suprachiasmatic nuclei (SCN) does what?
In hypothalamus, responsible for Master circadian clock
Preoptic anterior nucleus (POA) and posterior nuclei function?
antagonistic interactions to control thermalregulation
Paraventricular nucleus (PVN) function?
- regulator of the ANS and posterior pituitary
- direct influence over both sympathetic and parasympathetic outflow.
Dorsomedial nucleus (DMH) function?
- integrates information from body to regulate ANS functions including cardiac and blood pressure responses
- interacts with the PVN to reduce glucocorticoid release for energy regulation.
Mammillary bodies function in hypothalamus?
aid in conversion of memories short to long term
Hypothalamic efferent DLF is associated with?
Parasympathetic
Hypothalamic efferent: hypothalamospinal fibers are?
Sympathetic
Circadian rhythm effected by sleep?
- Temperature- decrease with sleep
- growth hormone- increase with sleep
- cortisol- peaks right before wake up
Name 3 limbic structures
- Nucleus accumbens (reward pathway)
- amygdala
- hippocampus
Limbic structures highly interconnected with what?
Hypothalamus, cortex, brainstem
Amygdala function
Emotional and drive related behavior, work with hypothalamus, brainstem and cord
Kluver-Bucy syndrome
Lesion amygdala,
fearless, inappropriate social and sexual behavior, flat affect, overly curious
Example of hippocampus pathology
CA1 Sommer sector
Wernicke-Korsakoff Syndrome
- Alcoholics
- Thiamine deficiency
- triad: mental status change, abnormal eye movements, and ataxia
- treatment: IV thiamine, then glucose
Korsakoff syndrome
- 80% patients that survive wernicke encephalopathy get
- permanent neurological deficit
- pathology in limbic system, mammillary bodies, amygdala, and dorsomedial and anterior thalamus
patient with severe conductive hearing loss in the right ear Weber test will be loudest in what ear? Rhine test result will be…
Right because Weber test is bone conduction
Rhine loudest when on mastoid bone on right ear
Things that would cause conductive hearing loss
blockage in the external auditory meatus, rupture of the tympanic membrane, damage to the ossicles (eg otosclerosis, a pathological bone growth of an ossicle, usually the stapes, which reduces the mobility of the ossicles), or damage to the middle ear (eg due to repeated ear infections or cholesteatoma).
Which brainstem structure provides the neural control over conscious state and sleep?
reticular formation
Lesions within the ascending reticular activating system generally present with which notable characteristic?
comatose state
On electroencephalographic recordings, non-REM sleep (particularly N3 stage) is typically characterized by large amplitude, low frequency __________ waves while REM sleep is more characteristic of low amplitude, high frequency __________ waves.
delta, beta
Hemineglect
insult to the (nondominant) right superior parietal association cortex resulting in a completely unaware of objects and events in the left half of his or her surrounding space
