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Dr. Mel - Neurology > First Aid > Flashcards

First Aid Flashcards

1
Q

CNS/PNS origins

A

Neuroectoderm: CNS neurons, ependymal cells, oligodendroglia, astrocytes
Neural crest: PNS neurons, Schwann cells
Mesoderm: microglia

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2
Q

3 findings in Neural tube defects

A

Ass w/ low folic acid intake before + during pregnancy
High AFP in amniotic fluid + maternal serum (except spina bifida occulta)
High AChE in amniotic fluid

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3
Q

4 findings of Anencephaly

A

High AFP
Polyhydramnios
Ass w/ maternal type I db
Folate supplementation lowers risk

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4
Q

5 findings in Holoprosencephaly

A 
Failure in separation of L + R hemispheres
\+/- mutations in sonic hedghog
Moderate: cleft lip/palate
Severe: cyclopia
In Patau sd + fetal alcohol sd
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5
Q

3 findings in Chiari II malformation

A

Herniation of cerebellar vermis (foramen magnum)
Aqueductal stenosis / hydrocephalus
Ass w/ lumbosacral meningomyelocele

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6
Q

3 findings in Dandy-Walker syndrome

A

Agenesis of cerebellar vermis
Cystic enlargement of 4th ventricle
Ass w/ noncommunicating hydrocephalus / spina bifida

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7
Q

4 characteristics of Chiari I malformation

A

Cerebellar tonsillar ectopia
Congenital
Asymptomatic in childhood
Headaches + cerebellar symptoms

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8
Q

3 findings in Syringomyelia

A

Cystic cavity in central canal of spinal cord
Spinothalamic tract damaged (pain+temperature bilat. loss)
Ass w/ Chiari malfo, trauma, tumors

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9
Q

CN for sensation + taste of tongue

A

Anterior 2/3: sensation V3 + taste VII
Posterior 1/3: sensation IX + taste IX
Extreme posterior: sensation X + taste X

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10
Q

Motor innervation of tongue

A

CN XII: hyoglossus, genioglossus, styloglossus

CN X: palatoglossus

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11
Q

Wallerian degeneration

A

Injury to axon
Degeneration distal to injury
Axonal retraction proximal to injury
Potential regeneration (if PNS)

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12
Q

3 characteristics of astrocytes

A

From neuroectoderm
Marker: GFAP
Reactive gliosis (glial scar) secondary to neural injury

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13
Q

4 characteristics of microglia

A

From mesoderm
Phagocytic scavenger cells of CNS
Activated when tissue damage
HIV-infected: giant cells in CNS

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14
Q

4 characteristics of myelin

A

CNS: oligodendrocytes - PNS: Schwann cells
Reduces time constant
Raises space constant
Raises conduction velocity

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15
Q

2 diseases that affect Schwann cells

A 
Guillain-Barré syndrome
Vestibular schwannoma (CN VIII)
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16
Q

4 findings of oligodendroglia

A

From neuroectoderm
Predominant glial cell in white matter
Each myelinates ~30 axons in CNS
Injured in MS, PML, Leukodystrophies

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17
Q

3 layers of peripheral nerve

A

Endoneurium (inflammatory infiltrate in Guillain-Barré)
Perineurium (rejoined in microsurgery)
Epineurium (surrounds fascicles + blood Vx)

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18
Q

Neurotransmitter changes in Anxiety

A

Low GABA
Low Serotonin
High NE

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19
Q

Neurotransmitter changes in Depression

A

Low Dopamine
Low NE
Low Serotonin

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20
Q

Neurotransmitter changes in Schizophrenia

A

High Dopamine

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21
Q

Neurotransmitter changes in Alzheimer disease

A

Low Acetylcholine

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22
Q

Neurotransmitter changes in Huntington disease

A

Low ACh
Low GABA
High Dopamine

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23
Q

Neurotransmitter changes in Parkinson disease

A

Low Dopamine
High Ach
High Serotonin

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24
Q

3 structures of blood-brain barrier

A

Tight junctions (nonfenestrated capillary endothelial cells)
Basement membrane
Astrocyte foot processes

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25
Q

3 brain regions with fenestrated capillaries

A

Area postrema (vomiting post-CT)
OVLT (osmotic sensing)
Neurohypophysis (ADH release)

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26
Q

7 functions of Serotoninergic neurons

A 
Sleep-wake cycle
Anxiety
Mood
Psychosis
Sexuality
Eating behavior
Impulsivity
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27
Q

7 functions of Hypothalamus

A 
Thirst + water balance
Adenohypophysis control
Makes ADH + oxytocin released to Neurohypophysis
Hunger
Autonomic regulation
Temperature regulation
Sexual urges
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28
Q

Lateral + Ventromedial areas of hypothalamus

A

Lateral: Hunger - stimulated by ghrelin - inhibited by leptin
Ventromedial: Satiety - stimulated by leptin

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29
Q

Anterior + Posterior areas of hypothalamus

A

Anterior: cooling, parasympathetic
Posterior: heating, sympathetic

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30
Q

Suprachiasmatic + supraoptic + paraventricular nuclei of hypothalamus

A

Suprachiasmatic: circadian rhythm
Supraoptic: ADH
Paraventricular: Oxytocin

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31
Q

2 characteristics of circadian rhythm

A

Regulated by environment

Controls nocturnal release of ACTH, prolactin, melatonin, NE

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32
Q

4 characteristics of REM sleep

A

Extraocular mvts due to PPRF
High ACh
Every 90min and longer through the night
Shorter when alcohol, NE, benzodiazephines, barbiturates

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33
Q

Inputs of ventral postero-lateral + ventral postero-medial nuclei of Thalamus

A

Ventral postero-lateral: spinothalamic + dorsal columns/medial lemniscus
Ventral postero-medial: trigeminal + gustatory pathway

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34
Q

Inputs of lateral geniculate + medial geniculate nuclei of thalamus

A

Lateral geniculate: CN II

Medial geniculate: superior olive + inferior colliculus of tectum

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35
Q

Inputs of ventral lateral nucleus of thalamus

A

Ventral lateral: basal ganglia, cerebellum

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36
Q

5 structures + 5 functions of Limbic system

A 
Hippocampus
Amygdala
Fornix
Mammillary bodies
Cingulate gyrus
Emotion
Long-term memory
Olfaction
Behavior modulation
ANS function
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37
Q

4 dopaminergic pathways + functions + 2 factors altering them

A

Mesocortical: regulates cognition + behavior
Mesolimbic: regulates cognition + behavior
Nigrostriatal: regulates coordination of voluntary mvts
Tuberoinfundibular: inhibits prolactin secretion

Drugs (antipsychotics)
Movement disorders (Parkinson)
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38
Q

Effects of the 4 dopaminergic pathways

A

Mesocortical: low activity will give negative symptoms
Mesolimbic: high activity will give positive symptoms
Nigrostriatal: low activity will give extrapyramidal symptoms
Tuberoinfundibular: low activity will raise prolactin

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39
Q

2 functions + 2 inputs + 1 output of Cerebellum

A

Modulates movement
Aids in coordination + balance

From contralateral cortex (middle cerebellar peduncle)
From ipsilateral proprioception (inferior cerebellar peduncle)

To contralateral cortex (superior cerebellar peduncle)

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40
Q

Lateral + Medial lesions of cerebellum

A

Lateral: voluntary mvt of extremities; fall toward injured side

Medial: midline structures + flocculonodular lobe; truncal ataxia (wide-based) + nystagmus + head tilting; bilateral motor deficits of axial + proximal limbs

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41
Q

2 functions + input + output of Basal ganglia

A

For voluntary mvts + postural adjustments

From cortex

Negative feedback to cortex

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42
Q

Excitatory + inhibitory pathways of basal ganglia

A

Excitatory: cortex +) striatum +) GABA -) GPi +) thalamus +) motion

Inhibitory: cortex +) striatum +) GABA -) GPe +) STN +) GPi -) thalamus -) motion

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43
Q

Athetosis, dystonia, myoclonus

A

Athetosis: basal gg, slow writhing mvt, fingers
Dystonia: sustained, involuntary muscle contraction
Myoclonus: sudden, brief, uncontrolled muscle contraction

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44
Q

Chorea, hemiballismus

A

Chorea: basal gg, sudden jerky purposeless mvt
Hemiballismus: contralateral subthalamic nucleus, sudden wild flailing arm + ipsilateral leg

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45
Q

Essential tremor, intention tremor, resting tremor

A

Essential: high-fqcy w/ sustained posture, worse w/ mvt-anxiety, ttt non selective beta-blocker/primidone.
Intention: cerebellar dysfunction, slow zigzag when pointing
Resting: Parkinson, uncontrolled mvt at rest, distal limbs, better w/ intentional mvt

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46
Q

4 causes + 2 ttt of Restless leg syndrome

A

Idiopathic
Iron deficiency
Uremia
Diabetes

Avoid aggravating factors (alcohol, sleep depriv.)
Dopa-agonists (Pramipexole)

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47
Q

3 findings + 5 symptoms of Parkinson disease

A

Degeneration of CNS
Lewy bodies
Loss of dopaminergic neurons of substantia nigra pars compacta

Tremor
Rigidity
Akinesia/bradykinesia
Postural instability
Shuffling gait
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48
Q

Advanced treatment of Essential tremor + Parkinson disease

A

Essential tremor: high fqcy stimulation of ventral intermediate nucleus of thalamus
Parkinson: high fqcy stimulation of globus pallidus internus or subthalamic nucleus

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49
Q

Excitatory + inhibitory pathways of basal ganglia

A

Excitatory: cortex +) striatum +) GABA -) GPi +) thalamus +) motion

Inhibitory: cortex +) striatum +) GABA -) GPe +) STN +) GPi -) thalamus -) motion

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50
Q

4 symptoms + 5 findings in Huntington disease

A

Choreiform movements
Aggression
Depression
Dementia

Low Ach, Low GABA, High dopamine
Neuronal death (NMDA-R binding + glutamate excitotoxicity)
Atrophy of caudate + putamen w/ hydrocephalus ex vacuo
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51
Q

2 findings in bilateral Amygdala lesion

A

Klüver-Bucy syndrome (disinhibited behavior)

Ass w/ HSV-1 encephalitis

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52
Q

3 findings in Frontal lobe lesion

A

Right side: disinhibition
Left side: impaired performance (concentration, orientation, judgment), depressed affect, apathy
+/- primitive reflexes

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53
Q

2 findings in Nondominant parietal cortex lesion

A

Hemispatial neglect syndrome

Constructional apraxia

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54
Q

1 finding in Dominant parietal cortex lesion

A

Gerstmann syndrome (Agraphia, Acalculia, Finger agnosia, Left-right disorientation)

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55
Q

1 finding in Reticular activating system (midbrain) lesion

A

Reduced levels of arousal + wakefulness

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56
Q

1 finding in bilateral Mamillary bodies lesion

A

Wernicke-Korsakoff syndrome (confusion, ophthalmoplegia, ataxia, memory loss, confabulations, personality changes)

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57
Q

3 findings + 2 diseases of Basal ganglia lesion

A

Resting tremor
Chorea
Athetosis

Parkinson disease
Huntington disease

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58
Q

4 findings in Cerebellar hemisphere

A

Intention tremor
Limb ataxia
Loss of balance
Ipsilateral deficits (falls toward side of lesion)

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59
Q

2 findings in Cerebellar vermis lesion

A

Truncal ataxia

Dysarthria

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60
Q

1 finding in Subthalamic nucleus lesion

A

Contralateral hemiballismus

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61
Q

1 finding in bilateral Hippocampus lesion

A

Anterograde amnesia

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62
Q

1 finding in Paramedian pontine reticular formation lesion

A

Eyes look away from side of lesion

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63
Q

1 finding in Frontal eye fields lesion

A

Eyes look toward lesion

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64
Q

1 finding in Corpus callosum lesion

A

Split-brain syndrome

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65
Q

2 findings in Nondominant temporal lobe lesion

A

Impaired nonverbal memory

Impaired musical ability

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66
Q

1 finding in Dominant temporal lobe lesion

A

Impaired verbal memory / word recognition

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67
Q

3 findings in Caudate nucleus lesion

A 
Behavioral abnormalities (agitation, abulia, psychosis)
Speech/language disturbances
Movement disorders (choreoathetosis)
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68
Q

4 manifestations of increased ICP

A

Headache
Impaired consciousness
Focal neurologic deficits / seizures
Cushing triad (hypertension, bradypnea, bradycardia)

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69
Q

2 watershed zones + 2 symptoms when lesion

A

Anterior/middle cerebral arteries
Posterior/middle cerebral arteries

Upper leg/upper arm weakness
Defects in higher-order visual processing

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70
Q

Anatomy + symptoms in Anterior cerebral artery stroke

A

Motor + sensory cortices - lower limb

Contralateral paralysis + sensory loss - lower limb

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71
Q

Anatomy + symptoms in Middle cerebral artery stroke

A 
Motor + sensory cortices - upper limb + face
Temporal lobe (Wernicke)
Frontal lobe (Broca)

Contralateral paralysis + sensory loss - upper limb + face
Aphasia (dominant hemisph)
Hemineglect (nondominant hemisph)

72
Q

Anatomy + symptoms in Lenticulo-striate artery stroke

A

Striatum
Internal capsule

Contralateral paralysis +/- sensory loss - face + body
No cortical signs

73
Q

Anatomy + symptoms in Posterior cerebral artery stroke

A

Occipital cortex
Visual cortex

Contralateral hemianopia w/ macular sparing

74
Q

Anatomy + symptoms in Basilar artery stroke

A

Pons, medulla, lower midbrain, corticospinal T., corticobulbar T., ocular cranial nerve nuclei, PPRF

Locked-in syndrome: preserved consciousness, vertical eye movement, blinking, quadriplegia, loss of voluntary facial-mouth-tongue movements

75
Q

Anatomy + symptoms in Anterior spinal artery stroke

A

Lateral corticospinal T.
Medial lemniscus
Caudal medulla (CN XII)

Contralateral paralysis - upper + lower limbs
Diminished contralateral proprioception
Ipsilateral hypoglossal dysfunction (tongue deviates ipsilat)

76
Q

Anatomy + symptoms in Posterior inferior cerebellar artery stroke

A

Lateral medulla (Wallenberg syndrome)

Vestibular nuclei (vomiting, vertigo, nystagmus)
Lateral spinothalamic T., Spinal trigeminal nucleus (diminished pain+temperature - ipsilateral face + contralateral body)
Nucleus ambiguus (dysphagia, hoarseness, low gag reflex)
Sympathetic fibers (ipsilateral Horner syndrome)
Inferior cerebellar peduncle (ataxia, dysmetria)

77
Q

Anatomy + symptoms in Anterior inferior cerebellar artery stroke

A

Lateral pons (lateral pontine syndrome)

Cranial nerve nuclei: vestibular nuclei (vomiting, vertigo, nystagmus), facial nucleus (paralysis of face, low lacrimation, salivation, low taste from ant 2/3), spinal trigeminal nucleus (diminished pain+temperature - ipsilateral face), cochlear nuclei
Spinothalamic T.: diminished pain+temperature - contralateral body
Corticospinal T.
Sympathetic fibers
Middle + inferior cerebellar peduncles: ataxia, dysmetria

78
Q

4 characteristics of Saccular (berry) aneurysm

A

At bifurcations in circle of Willis (esp. ant communicating, ant cerebral)
Rupture: subarachnoid hge or hgic stroke
Ass w/ ADPKD, Ehlers-Danlos sd, coA of Aorta
Risk F.: age, HTN, smoking, black race

79
Q

3 findings in Charcot-Bouchard microaneurysm

A

In small vessels
Not seen on angiogram
Ass w/ chronic HTN

80
Q

2 characteristics of Central post-stroke pain syndrome

A

Neuropathic pain due to thalamic lesions

First paresthesias then allodynia + dysesthesia

81
Q

5 findings in Epidural hematoma

A

Middle meningeal artery (branch of maxillary)
After skull fracture
Rapid expansion (transtentorial herniation, CN III palsy)
Biconvex, hyperdense blood (CT)
Not crossing suture lines

82
Q

6 findings in Subdural hematoma

A 
Bridging veins
From brain atrophy, trauma, shaken baby
Acute (hyperdense) or chronic (hypodense) or acute on chronic
Crescent-shaped
Crosses suture lines
Causes midline shift
83
Q

7 findings of Subarachnoid hemorrhage

A

Rupture of aneurysm
Arteriovenous malformation
Abuse of sympathomimetic drugs (cocaine)
Bloody/yellow spinal tap
Vasospasm after 4-10 days w/ ischemic infarct
Nimodipine to prevent vasospasm
High risk of communicating/obstructive hydrocephalus

84
Q

6 findings in Intraparenchymal hemorrhage

A

In basal ganglia + internal capsule (or lobar)
By systemic hypertension
W/ amyloid angiopathy
W/ vasculitis
W/ neoplasm
After reperfusion injury (in ischemic stroke)

85
Q

4 findings in Ischemic brain ds/stroke

A

Irreversible damage after 5 min of hypoxia
Most vulnerable: hippocampus, neocortex, cerebellum, watershed areas
Noncontrast CT detects ischemia in 6-24h
Diffusion-weighted MRI detects ischemia in 3-30min

86
Q

5 histologic features according to time since brain ischemia

A

12-48h: red neurons, loss of Nissl substance
24-72h: necrosis, neutrophils
3-5d: macrophages (microglia)
1-2w: reactive gliosis, vascular proliferation
>2w: glial scar

87
Q

3 types of ischemic stroke

A

Thrombotic: clot forms over atherosclerotic plaque
Embolic (AFib, DVT w/ PFO)
Hypoxic: hypoperfusion/hypoxemia (when cardiovasc surgery, watershed areas)

88
Q

4 points in ischemic stroke treatment

A

tPA (within 3-4.5h of onset + if no hge/risk of hge)
Medical ttt (aspirin, clopidogrel)
Optimum control of BP + blood sugars + lipids
Ttt conditions that elevated risk (AFib)

89
Q

4 findings in Transient ischemic attack

A

Focal ischemia
Brief + reversible
Negative imaging
Resolves in 15 minutes

90
Q

3 characteristics of Venous sinus thrombosis

A

Signs/symptoms of elevated ICP
Ass w/ hypercoagulation (pregnancy, OCP, factor V Leiden)
May lead to venous hemorrhage

91
Q

4 findings in Lacunes

A

Occlusion of small penetrating arteries (<15 mm)
In basal gg, post limb of internal capsule, pons, cerebellum
Ass w/ uncontrolled HTN + diabetes
Lipohyalinosis + microatheromas + hypertensive arteriolar sclerosis then liquefactive necrosis

92
Q

7 findings in Idiopathic intracranial hypertension (pseudotumor cerebri)

A

Elevated ICP
No apparent cause on imaging
Risk F: young woman, vit A excess, danazol, tetracycline
Headache, diplopia, normal mental status (worse symptoms w/ Valsalva)
Bilateral symmetric papilledema
Lumbar puncture w/ high opening pressure + headache relief
Ttt: weight loss, acetazolamide, topiramate, invasive if refractory

93
Q

4 findings in Communicating hydrocephalus

A

Decreased CSF absorption
High ICP
Papilledema
Herniation

94
Q

4 findings in Normal pressure hydrocephalus

A

Idiopathic
Elderly
Episodically high CSF pressure
Triad: urinary incontinence, ataxia, cognitive dysfunction

95
Q

1 finding in Noncommunicating hydrocephalus

A

Structural blockage of CSF circulation

96
Q

4 findings in Ex vacuo ventriculomegaly

A

Imaging: appearance of increased CSF
Actually: decreased brain tissue (neuronal atrophy)
Ass w/ Alzheimer ds, advanced HIV, Pick ds
Normal ICP

97
Q

Dorsal column: function, 1st-2nd-3rd neurons, synapses 1-2

A

Pressure, vibration, touch, proprioception
N1: ascends ipsilat.
S1: nucleus cuneatus or gracilis (medulla)
N2: decussates in medulla, ascends contralat. in medial lemniscus
S2: VPL (thalamus)
N3: sensory cortex

98
Q

Spinothalamic tracts: function, 1st-2nd-3rd neurons, synapses 1-2

A

Lateral spinothalamic: pain, temperature
Anterior spinothalamic: crude touch, pressure
N1: enters spinal cord
S1: ipsilat. gray matter
N2: decussates at ant. white commissue, ascends contralat.
S2: VPL (thalamus)
N3: sensory cortex

99
Q

Lateral corticospinal tract: function, 1st-2nd neurons, synapses 1-2

A

Lateral (and anterior) corticospinal: voluntary motor
UMN: (1* motor cortex) descends ipsilat. in internal capsule, most fibers decussate at caudal medulla, descends contralat.
S1: ant. horn of spinal cord
LMN: leaves spinal cord
S2: NMJ

100
Q

6 findings in UMN lesion + 6 in LMN lesion

A

UMN lesion: weakness, high reflexes, high tone, +Babinski, spastic paralysis, clasp knife spasticity

LMN lesion: weakness, atrophy, fasciculations, low reflexes, low tone, flaccid paralysis

101
Q

6 findings in Poliomyelitis + Werdnig-Hoffmann disease

A

Autosomal recessive
Congenital degeneration of anterior horns
LMN lesions only
Hypotonia + tongue fasciculations
Death at ~ 7 months
Asymmetric weakness (poliom.) / Symmetric weakness (Werdnig)

102
Q

6 findings in Amyotrophic Lateral Sclerosis (Lou Gehrig ds)

A

Loss of cortical + spinal cord motor neurons
Combined UMN + LMN lesions
Defect in superoxide dismutase 1
Asymmetric limb weakness, fasciculations, atrophy
Fatal
Ttt: Riluzole

103
Q

2 findings in Complete occlusion of anterior spinal artery

A

Spares dorsal columns + Lissauer tract

Upper thoracic ASA territory is watershed

104
Q

4 findings in Tabes dorsalis

A

By 3* syphilis
Degeneration of dorsal columns (impaired proprioception)
Absence of DTRs
Positive Romberg

105
Q

3 findings in Syringomyelia

A

By syrinx, seen in Chiari I
Damaged anterior white commissure of spinothalamic tract
Bilateral loss of pain + temperature

106
Q

3 findings in Vitamin B12 deficiency

A

Subacute combined degeneration
Demyelination of spinocerebellar T., lateral corticospinal T., dorsal columns
Ataxic gait, paresthesia, impaired position/vibration

107
Q

6 findings in Friedreich ataxia

A

Autosomal recessive trinucleotide repeat (GAA)
Impaired mitochondrial functioning
Degeneration of multiple spinal cord tracts
Muscle weakness, loss of DTRs + proprioception + vibration
Nystagmus, dysarthria, hammer toes, diabetes, hypertrophic cardiomyopathy
Kyphoscoliosis, pes cavus

108
Q

Brown-Séquard syndrome

A

Hemisection of spinal cord
At level of lesion: ipsilat loss of all sensation; ipsilat LMN signs (ant horn)
Below level of lesion: ipsilat loss of tactile, vibration, proprioception (dorsal column); ipsilateral UMN signs (corticospinal T); contralat loss of pain, temperature (spinothalamic T)
If lesion above T1, ipsilat Horner syndrome (oculosympathetic)

109
Q

Conus medullaris syndrome

A

Lesion at L2
Flaccid paralysis of bladder-rectum, impotence, saddle anesthesia (S3-S5)
Mild weakness of leg if sparing of lumbar cord + adj spinal+lumbar nerve roots

110
Q

Cauda equina syndrome

A

Massive rupture of intervertebral disk, trauma, mass
Compression of >=2/18 roots of cauda equina
Low back pain radiating to 1-2 legs
Saddle anesthesia
Loss of anocutaneous reflex, bowel+bladder dysfunction
Loss of ankle jerk reflex

111
Q

3 structures of dorsal view of the brain stem

A

Pineal gland: melatonin, circadian rhythms
Superior colliculi: conjugate vertical gaze center (paralysis in Parinaud sd)
Inferior colliculi: auditory

112
Q

3 vagal nuclei + functions + CN

A

N. Solitarius: visceral sensory info - VII, IX, X
N. Ambiguus: motor innervation of pharynx, larynx, upper esophagus - IX, X, XI
Dorsal motor N.: autonomic (parasymp) to heart, lungs, upper GI - X

113
Q

Corneal, pupillary, lacrimation, vestibuloocular reflexes

A

Corneal: V1 ophthalmic - VII
Pupillary: II - III
Lacrimation: V1 - VII
Vestibuloocular: VIII - III, IV, VI

114
Q

Jaw jerk, gag, cough, carotid sinus reflexes

A

Jaw jerk: V3 - V3
Gag: IX - X
Cough: X (internal laryng. N) - X
Carotid sinus: IX - X

115
Q

4 mastication muscles

A

Close jaw: masseter, temporalis, medial pterygoid

Opens jaw: lateral pterygoid

116
Q

UMN and LMN lesions of CN VII

A

UMN: contralateral paralysis of lower muscles
LMN: ipsilateral paralysis of upper+lower muscles, hyperacusis, loss of taste of ant. tongue

117
Q

6 findings in Facial nerve palsy

A

Peripheral CN VII lesion
Partial or complete loss of fct (dep. on location/severity)
Idiopathic (Bell palsy)
Lyme ds, herpes simplex, herpes zoster (Ramsay Hunt sd), sarcoidosis, tumors, diabetes
TTT: corticosteroids, acyclovir
Gradual recovery usually

118
Q

4 signs/symptoms in Cavernous sinus syndrome

A

Ophthalmoplegia
Decreased corneal sensation
Horner syndrome
Decreased maxillary sensation

119
Q

Function of DH4 + symptoms in case of DH4 deficiency

A

Cofactor used by hydroxylase enzymes in synthesis of tyrosine, dopamine and serotonin

Hyperphenylalanemia, phenylketonuria, intellectual disability, neurotransmitter deficiency

120
Q

4 symptoms + 6 causes of Dementia

A

Diminished cognitive ability, memory or function w/ intact consciousness

Alzheimer ds
Frontotemporal dementia
Lewy body dementia
Vascular dementia
Creutzfeldt-Jakob ds
Other causes
121
Q

5 findings in Alzheimer disease

A

Widespread cortical atrophy
Senile plaques (in gray matter, extracellular, beta- amyloid)
Neurofibrillary tangles (intracellular, tau protein)
Ass w/ altered proteins (ApoE2, ApoE4, APP, presenilin-1 and -2)
High risk in Down sd

122
Q

4 findings in Frontotemporal dementia (Pick ds)

A

Frontotemporal lobe degeneration
Early changes in personality + behavior or aphasia
Ass w/ movement disorders
Tau or TDP-43

123
Q

3 findings in Lewy body dementia

A

Dementia + visual hallucinations
Then parkinsonian features
Intracellular Lewy bodies (in cortex, alpha-synuclein)

124
Q

3 findings in Vascular dementia

A

Multiple arterial infarcts +/- chronic ischemia
Decline in cognitive ability
Late-onset memory impairment

125
Q

2 symptoms in Creutzfeldt-Jacob disease

A

Rapidly progressive dementia

Myoclonus

126
Q

6 other causes of dementia

A 
Syphilis
HIV
Vitamin B1, B3 or B12 deficiency
Normal pressure hydrocephalus
Hypothyroidism
Wilson ds
127
Q

5 characteristics of Osmotic demyelination syndrome

A

Central pontine myelinolysis
Massive demyelination
2* to osmotic changes (rapid correction of hypoNa+)
Acute paralysis, dysarthria, dysphagia, diplopia, loss of cs
+/- locked-in sd

128
Q

5 findings in Multiple sclerosis

A

Autoimmune inflammation + demyelination of CNS
Relapsing/remitting +++ (3 other patterns)
CSF: High IgG + myelin basic protein
Dg: oligoclonal bands
MRI: periventricular plaques, white matter lesions separated in space+time

129
Q

8 symptoms + treatment of Multiple sclerosis

A

Charcot triad: Scanning speech, Intention tremor, Nystagmus
Optic neuritis, INO, hemiparesis, hemisensory symptoms, bladder/bowel dysfunction

Acute ttt w/ IV steroids
Symptomatic ttt: neurogenic bladder, spasticity, pain
Slow progression w/ beta-IFN, glatiramer, natalizumab

130
Q

9 findings in Acute inflammatory demyelinating polyradiculopathy

A

1 subtype of Guillain-Barre sd

Inflammation + demyelination of peripheral nerves
Symmetric ascending muscle weakness/paralysis (lower extr. first)
Facial paralysis (50%)
+/- autonomic dysregulation or sensory abnl
Majority recover (weeks-months)
CSF: high protein
Ass w/ infections (Campylobacter)
Ttt: Respiratory support critical, plasmapheresis, IVIg

131
Q

5 demyelinating/dysmyelinating diseases (other than ODS, MS, GB)

A

Acute disseminated (postinfectious) encephalomyelitis
Charcot-Marie-Tooth ds
Krabbe ds
Metachromatic leukodystrophy
Progressive multifocal leukoencephalopathy

132
Q

Causes of seizures by age

A

Children: genetic, infection (febrile), trauma, congenital, metabolic
Adults: tumor, trauma, stroke, infection
Elderly: stroke, tumor, trauma, metabolic, infection

133
Q

Treatment of acute + prophylaxis of Cluster headache

A

Acute: sumatriptan, 100% O2
Prophylaxis: verapamil

134
Q

Treatment of acute + chronic Tension headache

A

Acute: analgesics, NSAIDs, acetaminophen
Chronic: amitriptyline

135
Q

3 structures irritated in headaches + 3 in migraine

A

Headaches: dura, cranial nerves, extracranial structures

Migraine: CN V, meninges, blood vessels (substance P, calcitonin gene-related peptide, vasoactive peptides)

136
Q

Treatment of acute migraine + prophylaxis

A

Acute: NSAIDs, triptans, dihydroergotamine
Prophylaxis: lifestyle changes, beta-blockers, CCBs, amitriptyline, topiramate, valproate

137
Q

Treatment of Trigeminal neuralgia

A

Carbamazepine

138
Q

4 neurocutaneous disorders

A

Sturge-Weber syndrome (encephalotrigeminal angiomatosis)
Tuberous sclerosis
Neurofibromatosis type I (von Recklinghausen ds)
von Hippel-Lindau ds

139
Q

6 findings in Sturge-Weber syndrome

A

Sporadic anomaly of neural crest derivatives
Activating mutation of GNAQ gene
Port-wine stain on face
Ipsilat leptomeningeal angioma (seizures)
Intellectual disability
Episcleral hemangioma (glaucoma)

140
Q

8 findings in Tuberous sclerosis

A 
Hamartomas in CNS + skin
Cutaneous angiofibromas
Mitral regurgitation
Ash-leaf spots
Cardiac rhabdomyoma
Intellectual disability
Renal angiomyolipoma
Seizures
141
Q

7 findings in Neurofibromatosis type I

A 
Café-au-lait spots
Lisch nodules (iris hamartomas)
Cutaneous neurofibromas
Optic gliomas
Pheochromocytomas
Meningiomas-gliomas-astrocytomas
Congenital pseudoarthrosis-scoliosis
142
Q

4 findings in von Hippel-Lindau ds

A

Hemangioblastomas (retina, brain stem, cerebellum, spine)
Angiomatosis (skin, mucosa, organs)
Bilateral renal cell carcinomas
Pheochromocytomas

143
Q

5 findings in Glioblastoma multiforme (grade IV astrocytoma)

A

Highly malignant (1 yeal survival)
Cerebral hemispheres +/- cross corpus callosum
GFAP
Pseudopalisading pleomorphic cells
Neovascularisation + central necrosis/hge

144
Q

6 characteristics of Meningioma

A

Benign
From arachnoid cells
Extra-axial +/- dural attachment
Asymptomatic ++ / seizures, focal neuro signs
Spindle cells in whorled pattern (psammoma bodies)
Resection +/or radiosurgery

145
Q

4 findings in Hemangioblastoma

A

Cerebellar
Ass w/ von Hippel-Lindau sd (when w/ retinal angiomas)
Can produce EPO (2* polycythemia)
Close thin-walled capillaries

146
Q

6 findings in Schwannoma

A

From any CN (except CN II) or any peripheral nerve
Esp vestibular, at cerebellopontine angle
Bilateral vestib schw in NF-2
Schwann cell (elongated w/ oval nuclei); biphasic
S-100+
Resection or stereotactic radiosurgery

147
Q

3 findings in Oligodendroglioma

A

Frontal lobes
Oligodendrocytes (fried egg cells; round nuclei w/ clear cytoplasm)
Calcified ++

148
Q

4 characteristics of Pituitary adenoma

A

Prolactinoma ++; non functioning adenoma
Bitemporal hemianopia
Sequelae: hyper or hypopituitarism
Hyperplasia of a single type of endocrine cell

149
Q

3 findings in Metastatic brain tumors

A

Lung, breast, skin, renal cancers
Along white-gray junction
Area of reactive gliosis + edema + central necrosis

150
Q

6 findings in Pilocytic astrocytoma (low grade)

A 
Children
Posterior fossa +/- supratentorial
Benign
Well circumscribed (cystic)
GFAP+
Rosenthal fibers (eosino)
151
Q

5 findings in Medulloblastoma

A 
Children
Highly malignant
Cerebellum
Noncommunicating hydrocephalus; drop metastases to spinal cord
Homer-Wright rosettes, small blue cells
152
Q

6 findings in Ependymoma

A 
Children
Esp in 4th ventricle
Hydrocephalus
Poor prognosis
Perivascular rosettes
GFAP+
153
Q

5 findings in Craniopharyngioma

A 
Children
Supratentorial
From remnant of Rathke pouch
Bitemporal hemianopia, hypopituitarism, hyperprolactenemia, DI, headache, hydrocephalus
3 components: solid, cystic, calcified
154
Q

3 findings in Pinealoma

A

Children
Parinaud sd, obstructive hydrocephalus, precocious puberty in males
Similar to germ cell tumors (histo)

155
Q

4 herniation syndromes + consequences

A

Cingulate: ant cerebral artery compression
Downward transtentorial: rupture of paramedian basilar artery branches (Duret hge)
Uncal: ipsilat CN III, ipsilat PCA, contralat crus cerebri (ipsilat paresis) compression
Cerebellar tonsilar: brain stem compression (coma + death)

156
Q

MOA + clinical use of Opioid analgesics

A

Agonists at opioid receptors
Reduce synaptic transmission (open K+, close Ca2+ ch)
Inhibit release of ACh, NE, 5-HT, glutamate, substance P

Not for all molecules: pain, cough suppression, diarrhea, acute pulm edema, maintenance for heroin addict

157
Q

Adverse effects of Opioid analgesics + toxicity ttt

A 
Addiction
Respiratory depression
Constipation
Miosis (mydriasis w/ Meperidine)
CNS depression (if w/ other drugs)

Ttt toxicity w/ Naloxone or Naltrexone

158
Q

MOA + indication + adverse effects of Tramadol

A

Very weak opioid agonist
Inhibits 5-HT + NE reuptake

Chronic pain

Adv eff as opioids + decrese seizure threshold, serotonin sd

159
Q

First line ttt for absence seizures

A

Ethosuximide (!! Stevens-Johnson sd)

160
Q

MOA + Indications + adverse effects of Benzodiazepines

A

Rise GABAa action

First line ttt for acute status epilepticus
Second line ttt for eclampsia seizures (after MgSO4)

Sedation, tolerance, dependence, respiratory depression

161
Q

First line ttt for neonatal epilepsy

A

Phenobarbital

162
Q

MOA + indications + adverse effects of Phenytoin

A

Blocks Na+ ch, zero-order kinetics

First line ttt for tonic-clonic epilepsy (as valproic acid)
First line prophylaxis for status epilepticus

Neuro, dermato (SJ sd, DRESS sd, gingival hyperplasia), musculoskeletal, hemato, teratogenesis, CYP450 induction

163
Q

MOA + indications + adverse effects of Carbamazepine

A

Blocks Na+ ch

First line ttt for simple or complex partial epilepsy
First line ttt for trigeminal neuralgia

Agranulocytosis, aplastic anemia, teratogenesis (neural tube def), SIADH, SJ sd, CYP450 induction

164
Q

MOA + indications + CI of Valproic acid

A

Na+ ch inactivation
Raises GABA concentration

First line ttt for tonic-clonic epilepsy
For myoclonic seizures, bipolar disorder
For migraine prophylaxis

CI in pregnancy (neural tube def)

165
Q

MOA + indications of Gabapentin

A

Inhibits high-voltage activated Ca ch

Simple or complex partial epilepsy
Peripheral neuropathy
Postherpetic neuralgia

166
Q

Adverse effect of Lamotrigine (epilepsy drug)

A

Benign rash (10%)
Stevens-Johnson sd
Toxic epidermal necrolysis (1%)

167
Q

MOA + indications + adv effects of Barbiturates

A

Prolongs duration of Cl- ch opening, facilitate GABAa action

Sedative (anxiety, seizures, insomnia, induction of anesth)

Respiratory+cardiovasc+CNS(esp if alcohol) depression, dependence, induction of CYP450
Ovedose ttt: supportive

168
Q

9 indications for Benzodiazepines

A

Anxiety, spasticity, status epilepticus, eclampsia, detoxification (alcohol), night terrors, sleepwalking, general anesthetic (amnesia, M. relaxation), insomnia

169
Q

MOA + adverse effects of benzodiazepines

A

Raises frequency of Cl- ch opening, facilitates GABAa action

Dependence
CNS depression ESP W/ alcohol, barbiturates, neuroleptics, 1st gen antihistamines
Overdose ttt: flumazenil

170
Q

Effects + adverse effects of Inhaled anesthetics

A

Myocardial+respiratory depression, N/V, high cerebral blood flow

Hepatotoxicity, nephrotoxicity, proconvulsant, expansion of trapped gas
Malignant hyperthermia (ttt: dantrolene)
171
Q

2 indications + 6 advers effects of local anesthetics

A

Minor surgical procedures, spinal anesthesia

CNS excitation, severe cardiovasc toxicity (bupiv), hyper/hypotension, arrhythmias (coca), methemoglobinemia (benzoc)

172
Q

Neuromuscular blocking drugs

A

Depolarizing: succinylcholine (strong ACh recept agonist)

Nondepolarizing: -ium (competitive antagonist for ACh recept), neostigmine (w/ atropine), edrophonium, other cholinesterase inh

173
Q

2 indications of Dantrolene

A

Malignant hyperthermia

Neuroleptic malignant sd

174
Q

5 main drugs for Parkinson disease

A

Dopamine agonists (ergot

175
Q

3 drug families of Alzheimer ds + MOA + adverse effects

A

Memantine: NMDA recept antagonist - dizziness, confusion, hallucinations
Donepezil, galantamine, rivastigmine, tacrine: AChE inhibitors - nausea, dizziness, insomnia
Vitamine E: antioxidant

176
Q

2 family drugs of Huntington ds

A

Tetrabenazine, reserpine: lowers dopa vesicle packaging+release

Haloperidol: D2 receptor antagonist

177
Q

MOA + indication + adv effects of Sumatriptan

A

5-HT1B/1D agonist

Acute migraine, cluster headache attacks

Coronary vasospasm, mild paresthesia

Dr. Mel - Neurology (3 decks)

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