Misc First Aid Flashcards
CL paralysis and sensory loss - lower limb
artery?
area of lesion?
anterior cerebral artery
motor and sensory cortices - lower limb
CL paralysis and sensory loss - face and upper limb; aphasia if in dominant hemisphere; hemineglect if lesion affects nondominant side
artery?
area of lesion?
middle cerebral artery
motor and sensory cortices - upper limb and face
temporal lobe - wernicke area; frontal lobe - broca area
Wernicke aphasia is a/w what visual field defect?
why?
right superior quadrant visual field defect due to temporal lobe involvement
CL paralysis and or sensory loss - face and body; absence of cortical signs (eg neglect, aphasia, visual field loss)
artery?
area of lesion?
lenticulostriate artery
striatum, internal capsule
common location of lacunar infarcts due to hyaline arteriosclerosis secondary to unmanaged HTN
striatum, internal capsule
CL paralysis - upper and lower limbs
artery?
area of lesion?
anterior spinal artery
lateral corticospinal tract
decreased CL proprioception
artery?
area of lesion?
anterior spinal artery
medial lemniscus
ipsilateral hypoglossal dysfunction (tongue deviates ipsilaterally)
artery?
area of lesion?
anterior spinal artery
caudal medulla - hypoglossal nerve
what is caused by infarct of paramedian branches of ASA and/or vertebral arteries
medial medullary syndrome
dysphagia, hoarseness, decreased gag reflex; vomiting, vertigo, nystagmus, decreased pain and temp sensation from CL body, ipsilateral face
artery?
area of lesion?
posterior inferior cerebellar artery
lateral medulla: Nucleus ambiguus (CN IX, X, XI), vestibular nuclei, lateral spinothalamic tract, spinal trigeminal nucleus
ipsilateral horner syndrome,
ataxia, dysmetria
artery?
area of lesion?
PICA or AICA
Lateral medulla: sympathetic fibers and inferior cerebellar peduncle
Lateral pons: sympathetic fibers and middle and inferior cerebellar peduncles
paralysis of face, decreased lacrimation, decreased salivation, decreased taste from anterior 2/3 tongue
artery?
area?
anterior inferior cerebellar artery
Lateral pons: facial nucleus
1)vomiting, vertigo, nystagmus 2) decreased pain and temp sensation from CL body, ipsi face
artery?
area?
AICA
1) lateral pons: vestibular nuc
2) lateral pons: spinothalamic tract, spinal trigeminal nuc
What is the area of the lesion in locked in syndrome? What tracts are affected?
pons, medulla, lower midbrain
corticospinal and corticobulbar tracts
ocular cranial nerve nuclei, paramedian pontine reticular formation
CL hemianopia with macular sparing
artery?
area?
posterior cerebral artery
occipital lobe
early changes in personality and behavior or aphasia; may have associated movement disorders;
frontotemporal lobe degeneration
dx?
what do you see on micro?
Pick disease
inclusions of hyperphosphorylated tau (round Pick bodies) or ubiquitinated TDP-43
In regard to Alzheimer disease, having ApoE2 will…
decrease risk of sporadic form
In regard to Alzheimer disease, having ApoE4 will…
increase risk of sporadic form
What genetic things would indicate potentially having a familiar form of AD with earlier onset?
APP, presenilin-1, presenilin-2
autosomal dominant trinucleotide (CAG)n repeat disorder on chromosome 4
Huntington disease
step-wise decline in cognitive ability with late-onset memory impairment; second MCC of dementia in elderly
vascular dementia
Charcot triad of MS
scanning speech
intention tremor (also incontinence and internuclear ophthalmoplegia)
nystagmus
triad of urinary incontinence, ataxia, and cognitive dysfunction
normal pressure hydrocephalus
What happens when you correct Na+ too rapidly?
- from low to high, your pons will die
- osmotic demyelination syndrome
- from high to low, your brain will blow
- cerebral edema/herniation
What is Lhermitte phenomenon?
in MS, neck flexion causing a sensation of electric shock running down the spine
peripheral neuropathy, developmental delay, optic atrophy, globoid cells
dx?
deficiency of what, causing what?
Krabbe disease
deficiency of galactocerebrosidase causing a build up of galactocerebroside and psychosine which destroys myelin sheath
autosomal recessive lysosomal storage disease, MC due to arylsulfatase A deficiency
dx?
what does this cause?
findings
Metachromatic leukodystrophy
build up of sulfatides, impaired production and destruction of myelin sheath
central and peripheral demyelination with ataxia, dementia
disruption of metabolism of very long chain fatty acids causing accumulation in nervous system, adrenal glands, and testes
dx?
adrenoleukodystrophy
somatic mosaicisim for an activating mutation in one copy of GNAQ gene
dx?
acronym of ssx?
Sturge-Weber syndrome
- S - sporadic, port wine stain
- T - tram track calcifications (opposing gyri)
- U - unilateral
- R - retardation (intellectual disability)
- G - glaucoma, GNAQ
- E - epilepsy
TSC1/TSC2 mutation on chromosome 16; increase incidence of subependymal giant cell astrocytomas and ungual fibromas
dx?
acronym that goes with?
Tuberous sclerosis
- H- hamartomas in CNS and skin
- A - angiofibromas
- M - mitral regurg
- A - ash-leaf spots
- R - cardiac Rhabdomyoma
- T - tuberous sclerosis
- O - autosomal dOminant
- M - mental retardation
- A - renal Angiolipoma
- S - seizures, Shagreen patches
What disease do you find Lisch nodules in?
What are they?
Neurofibromatosis type I (von Recklinghausen disease)
pigmented iris hamartomas
Hemiangioblastomas in retina, brainstem, cerebellum, and spine; angiomatosis; bilateral renal cell carcinomas; pheochromocytomas
dx?
genetics?
von Hippel-Lindau disease
deletion of VHL gene on chromosome 3p; autosomal dominant
butterfly glioma
dx?
histology?
glioblastoma multiforme (grade IV astrocytoma)
- astrocyte origin
- GFAP +
- pseudopalisading pleomorphic tumor cells border central areas of necrosis and hemorrhage
relatively rare brain tumor, slow growing. most often in frontal lobes, “chicken-wire” capillary pattern
dx?
histology?
oligodendroglioma
- oligodendrocyte origin
- “fried-egg” cells - round nuclei with clear cytoplasm
- often calcified
common, typically benign primary brain tumor, most often occurs near surfaces of brain and in parasagittal region
extra-axial and may have a dural attachment (tail)
dx?
histology?
meningioma
- arachnoid cell origin
- spindle cells concentrically arranged in a whorled pattern
- psammoma bodies (laminated calcifications)
most of in the cerebellum, this tumor is associated with von Hippel-Lindau syndrome when found with retinal angiomas
dx?
what can this produce/cause?
histology?
hemangioblastoma
can produce EPO, causing secondary polycythemia
- blood vessel origin
- closely arranged, thin-walled capillaries with minimal intervening parenchyma
What visual defects might be with a pituitary tumor?
bitemporal hemianopia due to pressure on optic chiasm
What tumor is classically at the cerebellopontine angle but can be along any peripheral nerve?
schwannoma
schwann cell origin, S100+
- glial cell origin
- GFAP +
- Rosenthal fibers - eosinophilic, corkscrew fibers
- cystic and solid (grossly)
dx?
description?
pilocytic (low-grade) astrocytoma
- usually well circumscribed
- in kids, most often in posterior fossa
- may be supratentorial
- benign, good prognosis
form of primitive neuroectodermal tumor (PNET); Homer-Wright Rosettes, small blue cells
medulloblastoma
what childhood primary brain tumor is most commonly found in the fourth ventricle, potentially causing hydrocephalus?
ependymoma
characteristic perivascular rosettes; rod-shaped blepharoplasts (basal ciliary bodies) found near the nucleus
ependymoma
MC childhood supratentorial tumor; may be confused with pituitary adenoma bc it also causes bitemporal hemianopia
dx?
derived from?
description?
craniopharyngioma
remnants of Rathke pouch
calcification is common; cholesterol crystals found in “motor oil” like fluid within the tumor
parinaud syndrome, obstructive hydrocephalus, precocious puberty in males
pinealoma
aging related sensorineural hearing loss (often higher frequencies) due to destruction of hair cells at the cochlear base (preserved low frequency hearing at the apex)
presbycusis
What drugs will decrease aqueous humor production from the non-pigmented epithelium on ciliary bodies?
beta blockers, alpha 2 agonists, carbonic anhydrase inhibitors
What neurons are used in the pathway of miosis in pupillary control?
- parasympathetic
- 1st neuron: Edinger-Westphal nucleus to ciliary ganglion via CN III
- 2nd neuron: short ciliary nerves to sphincter pupillae muscles
What nerves and brain areas are involved in the pupillary light reflex?
light in either retina sends a signal via CN II to pretectal nuclei in midbrain that activates bilateral Edinger-Westphal nuclei;
pupils contract bilaterally
What neurons are inolved in the mydriasis pathway?
- sympathetic
- 1st neuron: HT to ciliospinal center of Budge (C8-T2)
- 2nd neuron: exit at T1 to superior cervical ganglion
- 3rd neuron: plexus along internal carotid, through cavernous sinus; enters orbit as long ciliary nerve to pupillary dilator muscles
What are cluster A personality disorders?
(Weird)
Paranoid
Schizoid
Schizotypal
What are Cluster B personality disorders?
Wild
Antisocial
Borderline
Histrionic
Narcisstic
What are Cluster C personality disorders?
worried
Avoidant
Obesseive-Compulsive
Dependent
glucagonoma is a tumor of…
it presents with what ssx?
pancreatic alpha cells
dermatitis, diabetes, DVT, declining weight, depression
tumor of pancreatic delta cells
dx?
what does this cause physiologically?
- somatostatinoma
- decreased secretion of secretin, cholecystokinin, glucagon, insluin, gastrin, gastric inhibitory peptide (GIP)
What is the MC malignancy in the small intestine?
carcinoid syndrome
Carcinoid syndrome has neuroendocrine tumors secreting high levels of serotonin which cause this presentation of ssx…
recurrent diarrhea, cutaneous flushing, asthmatic wheezing, right sided valvular heart disease (tricuspid regurg, pulmonic stenosis)
increased hydroxyindoleacetic acid (5-HIAA) in urine, niacin deficiency (pellagra)
How is Zollinger-Ellison syndrome diagnosed?
Positive secretin stimulation test: gastrin levels remain elevated after admin of secretin, which normally inhibits gastrin release
MEN1 is associated with what three things and what mutation?
- Pituitary tumors
- Pancreatic endocrine tumors
- Parathyroid adenomas
mut MEN1 (menin, a tumor suppressor, chromosome 11)
MEN2A is associated with what disorders and what mutation?
- Parathyroid hyperplasia
- Medullary thyroid carcinoma
- Pheochromocytoma
mut in RET (codes for tyrosine receptor kinase) in cells of neural crest origin
MEN2B is associated with what disorders and what mutation?
- Medullary thyroid carcinoma
- Pheochromocytoma
- mucosal neuromas
marfanoid habitus, mut in RET gene
guaifenesin (drug)
expectorant - thins respiratory secretions, does not suppress cough reflex
N-acetylcysteine
mucolytic- liquifies mucus in chronic bronchopulmonary disease by disrupting disulfide bonds
antidote for acetaminophen overdose
dextromethorphan
antitussive (antagonizes NMDA glutamate receptors); synthetic codeine analog
mild opioid effect when used in excess
may cause serotonin syndrome when used with other serotonergic agents
alpha-adrenergic agonists, used as nasal decongestants
pseudoephedrine, phenylephrine
PGI2 (prostacyclin) with direct vasodilatory effects on pulmonary and systemic arterial vascular beds; inhibits platelet aggregation
epoprostenol
iloprost
5-lipoxygenase pathway inhibitor; blocks conversion of arachidonic acid to leukotrienes
zileuton
What leukotriene receptors do montelukast and zafirlukast block?
What are these drugs especially good for?
CysLT1
especially good for aspirin-induced and exercise-induced asthma
What drug is used in allergic asthma? What does this drug bind?
omalizumab
binds mostly unbound serum IgE; used in allergic asthma with increased IgE levels resistant to inhaled steroids and LABAs
nonselective muscarinic receptor (M3) agonist
methacholine
What does the drug theophylline do? Why is its use limited?
- likely causes bronchodilation by inhibiting phosphodiesterase
- increasing cAMP levels due to decreased cAMP hydrolysis
- usage limited bc of narrow therapeutic index
- cardiotoxicity and neurotoxicity
- metab by P450
- blocks action of adenosine
generalized reabsorptive defect in PCT; associated with increased excretion;
dx?
what acid base disturbance might occur?
Fanconi syndrome
metabolix acidosis (proximal renal tubular acidosis)
resorptive defect in thick ascending loop of henle
dx?
what transporter is affected?
what does this result in?
Bartter syndrome
affects Na/K/2Cl cotransporter
results in hypokalemia and metabolic acidosis with hypercalciuria
reabsorptive defect of NaCl in DCT
dx?
what does this lead to?
what is it similar to (drug taking wise)?
Gitelman syndrome
leads to hypokalemia, hypomagnesemia, metabolic alkalosis, hypocalcicuria
similar to using life-long thiazide diuretics
Gain of function mutation that increases Na reabsorption in collecting tubules (increase activity of Na channel)
dx?
results in?
What does this present like?
tx?
Liddle syndrome
results in hypertension, hypokalemia, metabolic alkalosis, decreased aldosterone
presents like hyperaldosteronism, but aldosterone is nearly undetectable
amiloride
hereditary deficiency of 11B-hydroxysteroid dehydrogenase, normally converts cortisol to cortisone in cells containing mineralcorticoid receptors
dx?
how would one acquire this disorder?
syndrome of apparent mineralcorticoid excess
can acquire disorder from glycyrrhetinic acid (in licorice) which blocks activity of 11B-hydroxysteroid dehydrogenase
