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Designated study period: daily cards > March 15 - Neurology > Flashcards

March 15 - Neurology Flashcards

1
Q

Pathophysiology of diabetic neuropathy

A

Hyalinization of nerve arterioles leads to ischemic nerve injury.

Accumulation of sorbitol and fructose in nerve axons also contributes to damage.

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2
Q

CNS repair after ischemic injury

A
  • 48 hours after can see red neurons - sign of irreversible damage
  • then neutrophils come in
  • 3-5 days after can see microglia which phagocytose damaged material
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3
Q

De novo purine synthesis pathway

A 
Ribose-5-phosphate
PRPP
5-phosphoribosylamine
IMP (cnoversion requires tetrahydrofolate)
GMP and AMP
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4
Q

Regulation of cerebral blood flow

A

1) systemic BP: autoregulation works within 60-140mmHg
2) arterial blood gases: decreased pCO2 such as in hyperventilation results in vasoconstriction and decreased cerebral blood flow

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5
Q

Ventilator management of increased ICP

A

Increase RR to decrease pCO2, causing vasoconstriction in the brain and decreased cerebral blood flow.

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6
Q

BH4

A

Cofactor in synthesis of serotonin, tyrosine, and DOPA. Produced by dihydropteridine reductase which reduces BH2 to BH4

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7
Q

PKU: two causes

A

Most cases due to phenylalanine hydroxylase deficiency
Also can be dihydropteridine reductase deficiency resulting in BH4 deficiency, impairing synthesis of both catecholamines and serotonin

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8
Q

Nerve conduction: length and time constants and effect of myelin

A

Length constant: how far along axon electric impulse propagates; increased by myelin

Time constant: how long it takes membrane potential to change; decreased by myelin

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9
Q

Birth defect associated with valproate

A

neural tube defects

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10
Q

Sympathetic pathway to eye

A

First order neuron: hypothalamus; axons go through brainstem to spinal cord

Second order neuron: intermediolateral cell column (pre-ganglionic fibers)

Third order neuron: superior cervical ganglion (post ganglionic fibers)

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11
Q

Pancoast tumor: presentation

A

Non-small cell lung cancer near superior sulcus in lung apex. Can compress/invade brachial plexus resulting in parasthesias, weakness, areflexia. Can invade superior cervical sympathetic ganglia resulting in Horner syndrome

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12
Q

POMC

A

precursor to endorphins, ACTH, and MSH

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13
Q

Dandy-Walker malformation: three findings

A

Hypoplasia/absence of cerebellar vermis
Cystic dilation of 4th ventricle
Posterior fossa enlargement

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14
Q

Early symptom of uncal herniation

A

Oculomotor nerve palsy

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15
Q

N-acetylglutamate

A

activator of carbamoyl phosphate synthetase I

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16
Q

Friedreich ataxia: neuro and non-neuro manifestations

A

Neuro: progressive gait ataxia, impaired joint position and vibration sense due to spinal tract damage

Non-neuro: hypertrophic cardiomyopathy, skeletal abnormalities, diabetes

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17
Q

Craniopharyngioma: gross pathology and pathophys

A

Suprasellar tumor seen in kids. Cystic, filled with brown-yellow fluid with protein and cholesterol. Remnant of rathke’s pouch which is oral ectoderm that gives rse to the anterior pituitary

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18
Q

COMT inhibitors

A

Entacapone: inhibits peripheral methylation of L-dopa
Tolcapone: inhibits both peripheral and central methylation of L-dopa

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19
Q

Atropine MOA

A

anti muscarinic

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20
Q

Branched chain amino acids

A

isoleucine, valine, leucine

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21
Q

Thiamine: three enzymes its a cofactor for

A
  1. Pyruvate dehydrogenase (glycolysis)
  2. Alpha-ketoglutarate dehydrogenase (TCA cycle)
  3. Transketolase (HMP shunt)
22
Q

Inhaled anesthetics effect on blood flow

A
  • decrease CO resulting in systemic hypotension
  • decrease cerebral vascular resistance which can increase ICP
  • decrease flow to kidney and liver
23
Q

positioning in coma

A

Decerebrate: extensors predominate, lesion below red nucleus

Decorbitate: flexors predominate, lesion above red nucleus

24
Q

Pineal gland mass presentation

A

Obstructive hydrocephalus, impaired upward gaze

25
Q

Lamotrigine toxicity

A

Skin rash (10%). Can be very severe rarely with SJS or toxic epidermal necrolysis

26
Q

Trapezius: innervation and function

A

CNXI

Elevates scapula, rotates scapula up, stabilizes shouldr

27
Q

Accessory nerve damage: cause and presentation

A

Caused by trauma to posterior triangle of neck

Presentation: drooped shoulder, winged scapula, impaired abduction of shoulder above horizontal

28
Q

Sympathetic innervation of eccrine sweat glands

A

ACh is the NT at both pre and post synaptic nerve terminals

29
Q

Vitamin A toxicity: acute and chronic

A

Acute: N/V, vertigo, blurred vision

Chronic: alopecia, dry skin, hyperlipidemia, hepatoxociity and HSM, vision problems, pseudotumor cerebri with increased ICP

30
Q

Lateral horns

A

Carry pre ganglionic symp fibers. T1-L2 spinal level

31
Q

Oculomotor nerve palsy: two types

A

Ischemia: extraocular efferents on the inside effected more, down and out eye

Compression: parasympathetics on outside affected more, APD

32
Q

Phenytoin: MOA and side effects

A

MOA: blocks VG Na+ channels

Side effects: narrow therapeutic index drugs with many ADRs. One is gingival hyperplasia. Also is a CYP450 inducer

33
Q

Femoral nerve block: location

A

Inguinal crease, lateral to femoral artery. That way anesthatizes skin and muscles of anterior thigh, femur, and knee

34
Q

Pramipexole

A

Nonergot dopamine agonist used to treat PD

35
Q

Pathologic finding in CJD

A

Large intracytoplasmic vacuoles

36
Q

Pathologic finding in brain in rabies

A

Negri bodies

37
Q

Biochemical alteration in huntington disease

A

Loss of GABA-containing neurons results in decreased GABA levels in the brain

38
Q

Cavernous hemangioma: what it is, presentation, and complication

A

Vascular malformation in brain parenchyma with clusters of dilated capillaries

Presentation: seizures, as progresses can see focal defects

Complication: can bleed and cause ICH

39
Q

Barbiturates: kinetics

A

Plasma level rapidly decreases due to drug redistribution into tissue

40
Q

Carbamazepine: MOA, Use, and ADRs

A

MOA: blocks Na+ channels in cortical nuerons
Use: complex partial seizures, mood stabilizer, trigeminal neuralgia
ADRs: bone marrow suppression, hepatotoxicity, SIADH, CYP450 inducer

41
Q

Aneurysms: Charcot-Bouchard vs Berry

A

Charcot-Bouchard aneurysms: in basal ganglia, cerebellum, thalamus, pons. Rupture to cause ICH

Berry aneurysms: in circle of willis. Rupture to cause SAH.

Both associated with HTN. Berry also associated with ADPKD and ehlers danlos

42
Q

Tabes dorsalis vs subacute combined degeneration

A

Tabes dorsalis: form of neurosyphilis. involves dorsal columns and dorsal roots (sensory only)

Subacute combined degeneration: B12 def, involves dorsal columns and lateral tracts (Sensory + UMN symptoms)

43
Q

Treatment of restless leg syndrome

A

dopamine agonist

44
Q

Intraventricular hemorrhage

A

Seen as complication of prematurity. Bleeding originates from germinal matrix

45
Q

Isoniazid toxicity - neuropathy

A

Isoniazid is chemically similar to vitamin B6 and competes with B6 for neurotransmitter synthesis. Increase in urinary B6 excretion can cause person to become deficiency. Thus, supplemental B6 often given to prevent peripheral neuropathy from occurring.

46
Q

Thiopental kinetics and MOA

A

Short acting barbiturate. Rapidly equilibrates with brain, knocking patient out in a minute following IV administration. Then redistributes to skeletal muscle and adipose tissue.

47
Q

Basal ganglia: two pathways

A

1) Direct pathway
-sub niagra excites striatum via D1 receptors
-striatum inhibits GPi
-GPi inhibits thalamus
Net effect: disinhibition of thalamus

2) Indirect pathway
-sub niagra inhibits striatum via D2 receptors
-striatum inhibits GPe
-GPe inhibits subthalamic nucleus
-subthalamic nucleus excites GPi
-GPi inhibits thalamus
Net effect: also disinhibition of thalamus

48
Q

Subacute cerebellar degeneration

A

Paraneoplasic syndrome associated with small cell lung cancer

49
Q

Geniculate nuclei

A

Medial: auditory information
Lateral: vision information

50
Q

ALS vs poliomyelitis

A

ALS: affects anterior horn, descending spinal tracts (mixed upper and lower motor neuron)

Polio: affects anterior horn only (pure LMN)

51
Q

Vitamin E deficiency

A

Neurologic symptoms mimicking Friedreich’s ataxia: ataxia, loss of position/vibration sense, loss of DTRs.

Hemolysis

Designated study period: daily cards (32 decks)

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