Mind Flashcards
A sad woman overdoses on an anxiolytic drug. How can we reverse toxicity?
The benzodiazepines are sedative-hypnotic agents that exert anxiolytic, muscle-relaxant, anticonvulsant and amnestic effects by facilitating the action of gamma-aminobutyric acid (GABA) in the CNS.
Flumazenil is an antagonist of the benzodiazepine receptor. It is the drug of choice for benzodiazepine overdose.
Obsessive-compulsive disorder:
Obsession:
Compulsion:
Treatment:
Obsession: focusing on one thought, usually to avoid another
Compulsion: repetitive action that shields the person from thoughts; action fixes bad thought
Treatment: Fluoxetine (SSRI) or clomipramine (TCA)
A sad man overdoses on opioids. How can we reverse the toxicity?
Naloxone is a pure opioid antagonist that reverses the toxic effects of opioid analgesics, such as respiratory depression, sedation and hypotension.
Seizure, fever, headache, altered sense of smell, nasal discharge, and LP findings suggestive of meningitis (100 neutrophils, 50 lymphocytes, 30 mg/dL glucose, and 60 mg/dL protein) after swimming in a lake?
Naegleria fowleri is a free-living amoeba found in warm, freshwater lakes.
Diving into such lakes causes changes in pressure that can force the organism through the cribriform plate and result in the production of necrotic lesions spreading from the olfactory lobes.
The tissue form of the organism is a flagellated trophozoite.
Acquired primary amebic meningoencephalitis is caused by Naegleria fowleri. This organism is a free-living ameba that is found in warm, freshwater lakes. During the act of diving into such lakes, changes in pressure can force the organism through the cribriform plate and result in the production of necrotic lesions spreading from the olfactory lobes. The form of the organism that is found in human tissue is a flagellated trophozoite.
How can Ishan abort a migraine?
The “triptans” (5-HT1D/1B agonists), such as sumatriptan, are used in treatment of migraine with or without aura.
Sumatriptan, almotriptan, rizatriptan and zolmitriptan are serotonin 5HT1D/1B agonists that produce cerebral vascular vasoconstriction. These “triptans” are used to abort migraine headaches and are approved for the treatment of migraine with or without aura. They are not indicated for long-term migraine prophylaxis. Triptans are also effective in the treatment of cluster headaches.
Oligodendroglioma phrase?
The tip-off for oligodendroglioma is “fried egg” cells, which are tumor cells with round nuclei (the “yolk”) and cleared cytoplasm (the “white”). These tumors may contain areas of calcification, hemorrhage, or cysts. They tend to occur in the cerebral hemispheres of middle-aged patients of both sexes, and have a better prognosis (average survival 5 years) than astrocytomas.
What are the symptoms of lateral medullary syndrome?
Lateral medullary syndrome (Wallenberg syndrome) is caused by posterior inferior cerebellar (PICA) occlusion. Symptoms include:
Vertigo, nystagmus, nausea, vomiting (vestibular nuclei)
Ipsilateral cerebellar signs (inferior cerebellar peduncle)
Dysphagia and dysphonia (nucleus ambiguus)
Loss of pain and temperature in ipsilateral face and contralateral body (spinal tract and nucleus of trigeminal nerve)
Horner syndrome (descending hypothalamics)
A man cannot recognize his family after surgery.
Prosopagnosia literally means “the inability to recognize faces.” The condition is usually caused by a bilateral lesion of the visual association cortex. Depending on the location of the lesion, other types of agnosia are possible. Agnosia occurs when a patient has normal perception but the perception is devoid of meaning. For example, patients with prosopagnosia can describe another person’s face well and can identify that a face is a face, but they cannot recognize the face even if it belongs to someone that they know well.
An adult patient is unable to look upwards past horizontal. What’s on our differential?
Parinaud syndrome, which is a condition resulting from compression of the tectum, is the most important clinical presentation of pineal germinomas. This syndrome consists of a palsy of upward gaze, a dissociation of light and accommodation (light-near dissociation due to damage to the pretectal area), and a failure of convergence. It is also possible to have hydrocephalus because of compression of the cerebral aqueduct.
A 46-year-old woman comes to the physician because of “double vision” and the inability to adduct the right eye on attempted left lateral gaze.
This patient is suffering from internuclear ophthalmoplegia (INO), which is caused by a lesion of the medial longitudinal fasciculus (MLF). The MLF connects the oculomotor (III), trochlear (IV), and abducens (VI) nuclei and is essential for conjugate gaze. A lesion in the MLF will result in the inability to adduct the ipsilateral eye on attempted lateral gaze. However, a lesion of the motor fibers of the right oculomotor nerve would also lead to the same symptoms. The way to truly distinguish between an INO from either a lesion of the medial rectus muscle or a lesion of the motor fibers of CN III is to determine whether the patient can converge her eyes. If the innervation of the medial rectus muscle is interrupted, the patient will not be able to move the ipsilateral eye medially for either conjugate or dysconjugate (convergence) movements. However, if the lesion is in the MLF, this would only affect conjugate movement, and not convergence, as in this patient.
A corporate executive is acting strangely after heart surgery.
Delirium is a common complication of general anesthesia and surgery. It manifests by acute changes in mental status with waxing and waning level of consciousness, agitation, irritability, and psychosis. Patients usually respond to low-dose neuroleptics (risperidone) to achieve sedation. The course is usually self-limited.
Lower versus upper quadrantanopia
A right lower quadrantanopia can be caused by a lesion in the left parietal lobe.
A right upper quadrantanopia can be caused by a lesion in the left temporal lobe.
Lysosomal enzymes in the extra cellular space, with a profound developmental defect?
The presence of lysosomal enzymes in the extracellular space is highly indicative of I-cell disease. I-cell disease is caused by deficiency in the enzyme N-acetylglucosamine phosphotransferase. This leads to a defect in protein-associated mannose phosphorylation. When newly translated lysosomal enzymes are sorted through the Golgi apparatus, specific mannose residues must be phosphorylated before they are correctly targeted to lysosomes. However, the deficiency of this enzyme leads to mistargeting of lysosomal enzymes into the exocytotic pathway, thereby leading to the release of lysosomal enzymes into the extracellular space. I-cell disease is a rare autosomal recessive disorder in children that often presents with developmental delay and growth failure. Linear growth often decelerates and ceases by age 2. Developmentally, patients often acquire a social smile and grasp objects, but they do not roll over and cannot support their weight to stand. They often have hypotonia and poor head control. They have coarse facial features with gingival hypertrophy.
MSG is excitotoxic. Where does it bind to elicit this effect?
Although there are ionotropic and metabotropic glutamate receptors, the type that is most likely responsible for the excitotoxic effect is the N-methyl-D-aspartate (NMDA) receptor. NMDA receptors are permeable to Ca2+ and Na+. The NMDA receptor requires a ligand to activate it (ligand-gated), and it requires depolarization (voltage-gated) to expel the Mg2+ ion that plugs the channel under resting membrane conditions. In contrast to NMDA receptor agonists, NMDA receptor antagonists, such as ketamine, are used to produce anesthesia in animals and sometimes humans. Other glutamate receptors include the ligand-gated cation channels, the AMPA and kainate receptors.
X linked burning, tingling hands and feet.
The correct answer is A. Fabry disease is a lysosomal storage disease resulting from the absence of alpha-galactosidase A. Notably, Fabry disease follows an X-linked recessive pattern of inheritance. The clinical presentation includes:
Burning sensations in the hands which get worse with exercise and hot weather
Small, raised reddish-purple blemishes on the skin (angiokeratomas)
Eye manifestations, especially cloudiness of the cornea
Impaired arterial circulation and increased risk of heart attack or stroke
Enlargement of the heart and kidneys
Renal failure is often the cause of death.
For this question, even if you cannot remember the features of the individual lipid storage diseases, it is worth remembering that Fabry disease is the only X-linked lipid-storage disease; the rest are autosomal recessive. As a general rule, associate all of the lipid storage diseases with severe neurologic deterioration. The exception is Gaucher disease, which tends to affect the liver and spares the brain.
