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General neuro 0425Q Flashcards

1
Q

anticholinergic toxicity

A

signs: fever, flushing, dry mucosa, dilated poorly reactive pupils, confusion
ex: TCA (amitriptyline), atropine

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2
Q

narcolepsy tx

A

scheduled daytime sleepiness

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3
Q

narcolepsy features

A

daytime sleepiness PLUS
cataplexy, hypnogogic/hypnopompic hallucinations, sleep paralysys.

due to low levels of orexin (hypocretin) involved in wakefulness and REM suppression.

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4
Q

eye change in myotonic dystrophy

A

CATARACTS in almost all pts.

also: sustained muscle contraction, weakness, atrophy. frontal balding. gonadal atrophy.

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5
Q

which fibers are more affected in myotonic dystrophy?

A

type 1 skeletal muscle fibers (atrophy)

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6
Q

micro changes in prion disease

A

vacuoles in gray matter (spongiform encephalopathy) with NO INFLAMMATION.

vacuoles grow larger over time. can form cysts.

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7
Q

what prion protein (PrP) conformation is resistant to proteases?

A

beta pleated sheet - accumulates in gray matter

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8
Q

CSF pattern with viral meningitis

A

normal glucose.
elevated proteins.
lymphocytic pleocytosis (increase).

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9
Q

CSF pattern with bacterial meningitis

A

LOW glucose.
high protein.
NEUTROPHIL predominance.

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10
Q

thiopental

A

short-acting barbiturate - induction of anesthesia.

levels equilibrate in brain then rapidly redistribute to skel mm and adipose tissue with rapid recovery from anesthesia.

(maintain general anesthesia with inhaled anesthetic)

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11
Q

damage in Wernicke encephalopathy

A

hemorrhage and necrosis of MAMILLARY BODIES.

must give THIAMINE with glucose to prevent encephalopathy in chronic thiamine deficiency.

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12
Q

SSRI and MAO-I

A

co-admin can cause serotonin syndrome due to decreased reuptake and decreased metabolism.

wait 14 days after MAO-I discontinuation before starting SSRI. enough time for regeneration of MAO.

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13
Q

lithium toxicity

A

presents with neuro sx (coarse tremors, fascicular twitching, agitation, ataxia, delirium.

renal excretion. filtered and reabsorbed in prox tubule. like sodium.

drugs may cause tox: thiazide diuretics, ACE-I, NSAIDs.

reduce bld lithium levels by hemodialysis.

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14
Q

transtentorial (uncal) herniation

A

complication of ipsi mass lesion (hemorrhage, tumor).

first sign: ipsi fixed and dilated pupil.

affected structures: CN III. PCA. contra cerebral peduncle.

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15
Q

clozapine side effect

A

granulocytopenia -

schizo tx. acts on D4R. monitor WBC. also can cause seizure.

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16
Q

myoclonic seizures

A

repetitive seizures with brief muscular contractions, loss of body tone. tend to fall with injury to face or mouth.

occur in morning. worse with stress and sleep deprivation.

tx: sodium valproate - suppress abn electric activity in cortex via GABA and NMDA receptors, Na and K channels.

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17
Q

global cerebral ischemia (hypoxic-ischemic encephalopathy)

A

due to systemic hypoperfusion.

most susceptible: pyramidal cells of hippocampus/neocortex. purkinje cells of cerebellum. hippocampus damaged first.

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18
Q

CJD

A

rapidly progressive dementia and myoclonic jerks

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19
Q

medulloblastoma

A 
second most common childhood tumor.
located in cerebellum.
primitive neuroectodermal tumor. 
small round blue cells with mitoses.
increased ICP (morning HA, lethargy) and cerebellar dysfunction. 
poorly differentiated, bad prognosis.
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20
Q

pupillary light reflex

A 
optic n (CN II): afferent limb
oculomotor n (CN III): efferent limb
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21
Q

CN III palsy

A

somatic

  1. ptosis: paralysis of levator palpebrae
  2. down and out gaze: unopposed action of lateral rectus and superior oblique

parasymp

  1. fixed dilated pupil: iris sphincter
  2. loss of accommodation (cycloplegia): ciliary muscle
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22
Q

length constant (space constant)

A

measure of how far along an axon an electrical impulse can propagate.

low constant reduces distance traveled.
myelin increases length constant, decreases time constant (overall increase in conduction velocity)

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23
Q

schizoaffective disorder

A

sx of schizophrenia with prominent mood sx.

at least 2 wks of psychotic sx without mood sx required for dx.

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24
Q

primary HSV1 infx

A

fever.
vesiculoulcerative gingivostomatitis.
cervical lymphadenopathy.

*REACTIVATION limited to perioral blisters (cold sores)

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25
neurosyphilis
TABES DORSALIS: demyelination of dorsal columns and dorsal roots of SC. accompanied by loss or proprioception/vibration, ataxia, argyll robertson pupil, positive Romberg.
26
acute neonatal narcotic withdrawal
``` pupillary dilation. rhinorrhea, sneezing. nasal stuffiness. NVD. chills, tremors, jittery. ``` tx: opium soln (tincture of opium or paregoric), slowly withdrawn.
27
severe vit E deficiency mimics what?
Friedreich ataxia. degeneration of spinocerebellar tracts, dorsal column, peripheral nerves. sx: ataxia, dysarthria, loss of position/vibration sense
28
similar mechanism of diphtheriae and Pseudomonas toxins
ribosylate and inactivate elongation factor 2 (EF2), thus inhibiting host cell protein synthesis and causing cell death
29
diphtheriae toxin effect on heart
severe myocarditis and heart failure
30
high sensitivity
important in screening tests - identify the most pts with disease
31
hyperacusis
increased sensitivity to sound. due to paralysis of stapedius m. innervated by stapedius n. of CN VII. ipsi presentation with Bell's palsy.
32
craniopharyngioma
calcified cystic mass. usu. filled with yellow viscous fluid with cholesterol crystals. suprasellar region. from remnant of Rathke's pouch (precursor of ant pituitary). sx: growth failure, HA, bitemporal hemianopia.
33
arginase
produces urea and ornithine from arginine.
34
change in range of host cell types that enveloped RNA virus can infect
most dependent on mutations in viral encoded surface glycoprotein that mediates virion attachment to host cell plasmalemma receptors
35
beta endorphin
endogenous opioid peptide derived from propiomelanocortin (POMC) (also the precursor polypeptide to ACTH and MSH.
36
polyhydramnios
excess amniotic fluid. related to decreased fetal swallowing: GI obstruction due to duodenal/esoph/intestinal atresia. anencephaly. OR to increased fetal urination: anemia with high CO. twin-twin transfusion syndrome.
37
effect of polyhydramnios on mother
uterine enlargement out of proportion to gest. age. at risk for preterm labor due to uterine overdistention.
38
glaucoma tx
timolol and other BB decrease aq humor production by ciliary epith.
39
tetrahydrobiopterin (BH4)
cofactor in synthesis of tyrosine, dopa, serotonin, nitric oxide
40
dihydrobiopterin reductase
reduces dihydrobiopterin the tetrahydrobiopterin (BH4). deficiency is uncommon cause of PKU.
41
transamination
between amino acid and alpha-keto acid (alpha keto acid becomes an amino acid). pyridoxal phosphate (vit B6) is a cofactor.
42
delirium
``` acute onset. impaired consciousness. fluctuating sx. reversible sx. global memory impairment. ```
43
dementia
``` gradual onset. intact consciousness. progressive decline. irreversible sx. remote memory spared. ```
44
disorganized schizophrenia
one of FIVE subtypes. disorganized speech and behavior. flat or inappropriate affect.
45
mucormycosis
facial pain and HA in DKA pt. caused by mucor, rhizopus, or absidia. fungus proliferates in bld vessel walls. classic black necrotic eschar in nasal cavity. dx: mucosal bx. fungi have broad nonseptate hyphae with RIGHT angle branching.
46
COD with diphtheria
cardiomyopathy
47
tx of diphtheria
PASSIVE IMMUNIZATION WITH ANTITOXIN. | also antibiotics to kill bact and active immunization for future protection.
48
diphtheria exotoxin specificity
for neural and cardiac tissue
49
acute diphtheria infx
pseudomembranous pharyngitis
50
temporal arteritis
polymyalgia rheumatica - neck, torso, shoulder, pelvic girdle pain. morning stiffness. also monocular vision loss
51
congenital torticollis
child prefers to hold head tilted to one side. due to intrauterine malposition or birth trauma leading to SCM injury and fibrosis
52
precipitating event for Guillain barre syndrome
onset after infection, immunization or allergic rxn *CAMPYLOBACTER
53
thiamine deficiency - beri beri
demyelination of peripheral nerves. no perineural (endoneural) inflamm. muscle weakness, areflexia with pain and paresthesia. DISTAL LOWER LIMB involvement.
54
congenital rubella syndrome
HEAD: microcephaly, MR EYES: cataracts (white pupils) EARS: sensorineural deafness HEART: PDA, peripheral pulmonic stenosis
55
rubella vaccination
live attenuated rubella virus vaccine recommended for children and NON-pregnant females of child bearing age
56
H.influenzae type b diseases
meningitis pneumonia sepsis epiglottitis
57
Hib vaccine
H.influenzae type b. | cell wall polysaccharide conjugated with protein toxoid from either diphtheria or tetanus.
58
peroxisomal disease
absent or nonfunctional peroxisomes. problem with VLCFA beta oxidation and BCFA (phytanic acid) alpha oxidation. lead to neuro defects from improper CNS myelination.
59
Zellweger syndrome
peroxisome dz. improper myelin formation in CNS. sx: hypotonia, seizures, hepatomegaly, MR, early death.
60
Refsum dz
peroxisome dz. defect in alpha oxidation. phytanic acid accumulation. tx: avoid chlorophyll in diet.
61
PCA territory
``` CN III, IV midbrain structures thalamus mesial temporal lobe splenium of corpus callosum parahippocampal gyrus fusiform gyrus occipital lobe WHAT! ```
62
hypoxic encephalopathy
decreased oxygenation of blood. | present similar to global ischemia.
63
hypertensive encephalopathy
global sx caused by CEREBRAL EDEMA in pts with severe ACUTE HTN
64
minimal alveolar concentration
best measure of potency of inhaled anesthetic. intrinsic property of drug but depends on ambient temp and age of pt (decreased with age > 40). less MAC = more potent.
65
CNS depression with anesthetics
gas partial pressure in brain equilibrates with other compartments (lungs, arterial blood) when brain is saturated with anesthetic.
66
dystrophin
protein that allows interaction btn extracellular CT and intracellular contraction apparatus in skel mm. deleted in Duchenne musc dystrophy.
67
DMD sx
prox muscle weakness, age 3-6. enlargement of distal mm (calf pseudohypertrophy with fat build-up).
68
opsoclonus-myoclonus
paraneoplastic syndrome assoc. with neuroblastoma. | non-rhythmic conjugate eye mvmts with myoclonus.
69
neuroblastoma
most common extracranial childhood cancer. develops from neuroblasts in ADRENAL MEDULLA. onset age 2. small round blue cells.
70
neuroblastoma clinical
retroperitoneal mass (displace kidney). hypertension. anorexia, weight loss. increased catecholamine in urine.
71
neuroblastoma mets
invasion of epidural space (dumbbell tumor) w/SC compression. BM: pancytopenia liver: hepatomegaly skin: palpable nodules periorbital paraneoplastic: opsoclonus-myoclonus, truncal ataxia
72
CSF in bact meningitis
elevated opening pressure. increased neutrophils decreased glucose elevated proteins
73
most common bact meningitis in all adults
strep pneumoniae lancet-shaped, gm + cocci in pairs. often follows pulmo or mild URI.
74
S.pneumoniae diseases
leading cause of CAP, OM, and meningitis in adults
75
marijuana
contains THC (tetrahydrocannabinol) - stimulates CB1, CB2 (cannabinoid) receptors to affect mood, perception, memory. immediate sx: rapid HR, conjunctival injection. also: mild euphoria with laughing behavior, slow reflexes, dizziness, impaired coordination, short term memory loss.
76
marijuana metabolism
effects last 1-4 hrs after inhaled. | metab in liver, stored in lipophilic tissues for slow release. detected in urine for up to 30 days later.
77
GABA receptors
GABA-A: ion channel in brain causing Cl influx (hyperpol) GABA-B: G-protein linked in brain causing decreased K efflux, decrease Ca influx, adenylyl cyclase inhibition GABA-C: ion channel in retina causing Cl influx
78
GABA
effect is INHIBITORY in CNS. made from glutamate (via glutamate decarboxylase). catabolism (transamination) by GABA transaminase. *both enzymes require PYRIDOXINE (B6) cofactor
79
common adverse effect of MS in eye
demyelinization of optic n (CN II). | impaired light reflex pathway.
80
neurofibroma
tumor of schwann cells (neural crest). cutaneous neurofibromas are skin-colored or pink nodules with RUBBERY texture and typical BUTTON HOLING. both cutaneous and subcutaneous NFs part of NF1 (von Recklinghausen). along with cafe au lait spots.
81
Lesch Nyhan syndrome
HGPRT defect - failure of purine salvage pathway. increased hypoxanthine and guanine degraded to uric acid. increased de novo purine synthesis to replace lost bases - INCREASED PHOSPHORIBOSYL-PYROPHOSPHATE LEVELS lead to increased PRPP amidotransferase activity
82
akathisia
movement disorder - inner restlessness, inability to sit or stand in one position. complication of anti-psychotic tx. often misinterpreted as worsening psychotic behavior and agitation. dose needs to be DECREASED. may add antiparkinson drug.
83
tardive dyskinesia
involuntary perioral mvmt - biting, chewing, grimacing, tongue protrusion. may have involuntary head, limb, trunk mvmt.
84
fragile X syndrome
2nd most common cause of genetic MR. most common inherited MR. ``` features: mild to severe MR long thin face, prominent forehead and jaw post-pubertal macroorchidism large protruding ears tooth crowding arched palate ``` ``` defect of FMR gene. trinucleotide repeats (full mutation > 200. premutation has normal phenotype). increased repeats cause hypermethylation of FMR gene (cytosine bases) leading to gene inactivation. ``` NOT assoc. with increased chromo instability/breakage. region on X chromo just appears thin/constricted.

Neuro (15 decks)

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