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Neuro > General neuro 0425Q > Flashcards

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
Q

neurosyphilis

A

TABES DORSALIS: demyelination of dorsal columns and dorsal roots of SC.

accompanied by loss or proprioception/vibration, ataxia, argyll robertson pupil, positive Romberg.

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26
Q

acute neonatal narcotic withdrawal

A 
pupillary dilation.
rhinorrhea, sneezing.
nasal stuffiness.
NVD.
chills, tremors, jittery.

tx: opium soln (tincture of opium or paregoric), slowly withdrawn.

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27
Q

severe vit E deficiency mimics what?

A

Friedreich ataxia.

degeneration of spinocerebellar tracts, dorsal column, peripheral nerves.

sx: ataxia, dysarthria, loss of position/vibration sense

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28
Q

similar mechanism of diphtheriae and Pseudomonas toxins

A

ribosylate and inactivate elongation factor 2 (EF2), thus inhibiting host cell protein synthesis and causing cell death

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29
Q

diphtheriae toxin effect on heart

A

severe myocarditis and heart failure

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30
Q

high sensitivity

A

important in screening tests - identify the most pts with disease

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31
Q

hyperacusis

A

increased sensitivity to sound.
due to paralysis of stapedius m.
innervated by stapedius n. of CN VII.
ipsi presentation with Bell’s palsy.

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32
Q

craniopharyngioma

A

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.

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33
Q

arginase

A

produces urea and ornithine from arginine.

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34
Q

change in range of host cell types that enveloped RNA virus can infect

A

most dependent on mutations in viral encoded surface glycoprotein that mediates virion attachment to host cell plasmalemma receptors

35
Q

beta endorphin

A

endogenous opioid peptide derived from propiomelanocortin (POMC) (also the precursor polypeptide to ACTH and MSH.

36
Q

polyhydramnios

A

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
Q

effect of polyhydramnios on mother

A

uterine enlargement out of proportion to gest. age.

at risk for preterm labor due to uterine overdistention.

38
Q

glaucoma tx

A

timolol and other BB decrease aq humor production by ciliary epith.

39
Q

tetrahydrobiopterin (BH4)

A

cofactor in synthesis of tyrosine, dopa, serotonin, nitric oxide

40
Q

dihydrobiopterin reductase

A

reduces dihydrobiopterin the tetrahydrobiopterin (BH4).

deficiency is uncommon cause of PKU.

41
Q

transamination

A

between amino acid and alpha-keto acid (alpha keto acid becomes an amino acid).

pyridoxal phosphate (vit B6) is a cofactor.

42
Q

delirium

A 
acute onset.
impaired consciousness.
fluctuating sx.
reversible sx.
global memory impairment.
43
Q

dementia

A 
gradual onset.
intact consciousness.
progressive decline.
irreversible sx.
remote memory spared.
44
Q

disorganized schizophrenia

A

one of FIVE subtypes.
disorganized speech and behavior.
flat or inappropriate affect.

45
Q

mucormycosis

A

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
Q

COD with diphtheria

A

cardiomyopathy

47
Q

tx of diphtheria

A

PASSIVE IMMUNIZATION WITH ANTITOXIN.

also antibiotics to kill bact and active immunization for future protection.

48
Q

diphtheria exotoxin specificity

A

for neural and cardiac tissue

49
Q

acute diphtheria infx

A

pseudomembranous pharyngitis

50
Q

temporal arteritis

A

polymyalgia rheumatica -
neck, torso, shoulder, pelvic girdle pain.
morning stiffness.

also monocular vision loss

51
Q

congenital torticollis

A

child prefers to hold head tilted to one side.

due to intrauterine malposition or birth trauma leading to SCM injury and fibrosis

52
Q

precipitating event for Guillain barre syndrome

A

onset after infection, immunization or allergic rxn

*CAMPYLOBACTER

53
Q

thiamine deficiency - beri beri

A

demyelination of peripheral nerves.
no perineural (endoneural) inflamm.
muscle weakness, areflexia with pain and paresthesia.

DISTAL LOWER LIMB involvement.

54
Q

congenital rubella syndrome

A

HEAD: microcephaly, MR

EYES: cataracts (white pupils)

EARS: sensorineural deafness

HEART: PDA, peripheral pulmonic stenosis

55
Q

rubella vaccination

A

live attenuated rubella virus vaccine recommended for children and NON-pregnant females of child bearing age

56
Q

H.influenzae type b diseases

A

meningitis
pneumonia
sepsis
epiglottitis

57
Q

Hib vaccine

A

H.influenzae type b.

cell wall polysaccharide conjugated with protein toxoid from either diphtheria or tetanus.

58
Q

peroxisomal disease

A

absent or nonfunctional peroxisomes.
problem with VLCFA beta oxidation and BCFA (phytanic acid) alpha oxidation.
lead to neuro defects from improper CNS myelination.

59
Q

Zellweger syndrome

A

peroxisome dz.
improper myelin formation in CNS.
sx: hypotonia, seizures, hepatomegaly, MR, early death.

60
Q

Refsum dz

A

peroxisome dz.
defect in alpha oxidation.
phytanic acid accumulation.
tx: avoid chlorophyll in diet.

61
Q

PCA territory

A 
CN III, IV
midbrain structures
thalamus
mesial temporal lobe
splenium of corpus callosum
parahippocampal gyrus
fusiform gyrus
occipital lobe
WHAT!
62
Q

hypoxic encephalopathy

A

decreased oxygenation of blood.

present similar to global ischemia.

63
Q

hypertensive encephalopathy

A

global sx caused by CEREBRAL EDEMA in pts with severe ACUTE HTN

64
Q

minimal alveolar concentration

A

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
Q

CNS depression with anesthetics

A

gas partial pressure in brain equilibrates with other compartments (lungs, arterial blood) when brain is saturated with anesthetic.

66
Q

dystrophin

A

protein that allows interaction btn extracellular CT and intracellular contraction apparatus in skel mm.

deleted in Duchenne musc dystrophy.

67
Q

DMD sx

A

prox muscle weakness,
age 3-6.
enlargement of distal mm (calf pseudohypertrophy with fat build-up).

68
Q

opsoclonus-myoclonus

A

paraneoplastic syndrome assoc. with neuroblastoma.

non-rhythmic conjugate eye mvmts with myoclonus.

69
Q

neuroblastoma

A

most common extracranial childhood cancer.
develops from neuroblasts in ADRENAL MEDULLA.
onset age 2.
small round blue cells.

70
Q

neuroblastoma clinical

A

retroperitoneal mass (displace kidney).
hypertension.
anorexia, weight loss.
increased catecholamine in urine.

71
Q

neuroblastoma mets

A

invasion of epidural space (dumbbell tumor) w/SC compression.
BM: pancytopenia
liver: hepatomegaly
skin: palpable nodules
periorbital
paraneoplastic: opsoclonus-myoclonus, truncal ataxia

72
Q

CSF in bact meningitis

A

elevated opening pressure.
increased neutrophils
decreased glucose
elevated proteins

73
Q

most common bact meningitis in all adults

A

strep pneumoniae
lancet-shaped, gm + cocci in pairs.
often follows pulmo or mild URI.

74
Q

S.pneumoniae diseases

A

leading cause of CAP, OM, and meningitis in adults

75
Q

marijuana

A

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
Q

marijuana metabolism

A

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
Q

GABA receptors

A

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
Q

GABA

A

effect is INHIBITORY in CNS.
made from glutamate (via glutamate decarboxylase).

catabolism (transamination) by GABA transaminase.

*both enzymes require PYRIDOXINE (B6) cofactor

79
Q

common adverse effect of MS in eye

A

demyelinization of optic n (CN II).

impaired light reflex pathway.

80
Q

neurofibroma

A

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
Q

Lesch Nyhan syndrome

A

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
Q

akathisia

A

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
Q

tardive dyskinesia

A

involuntary perioral mvmt - biting, chewing, grimacing, tongue protrusion.

may have involuntary head, limb, trunk mvmt.

84
Q

fragile X syndrome

A

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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