Neuro 1 pt9

Question 1

With CJD, there are 2 types. which affects who, is more common, which is mad cow disease?

Answer 1

Sporatic is more common – older ppl
Varient is less common – younger ppl
Mad cow disease = varient. Ppl ingest prions.

Question 2

__ type of CJD, soil can be reservoir for prions from shedding/decomposition of carcasses

Answer 2

Sporatic

Question 3

In CJD, the mutated gene assembles the cytoplasm’s amino acids wrongly, producing _____

Answer 3

infectious proteins, or prions

Question 4

CJD- typical clinical course (5)

Answer 4

Psychiatic (depression) followed by sensory manifestations
advanced once ataxia occurs
50% develop paresis of upward gaze (lose ability to look up)
cog. impairment, invol. movements, immobility
unresponsiveness, mutism are common

Question 5

3 tests for CJD. Which is the gold standard that is rarely done?/why is it rarely done?

Answer 5

LP
EEG
Brain Biopsy - rarely done b/c the evidence is already overwhelming. You notice how quickly this develops, much quicker than Alzheimers

Question 6

Pulvinar sign on an MRI helps identify:

Answer 6

CJD

Question 7

don’t tell PETA this way to definitely diagnose CJD

Answer 7

transmission of characteristic neurdegenerative dz to experimental animals

Question 8

*Triad to diagnose Normal Pressure Hydrocephalus (NPH)

Answer 8

Wet (incontinence), Wacky (dementia), wobbly (genetic, wide based gait –can’t pick up feet, stomp like a robot)

Question 9

Only Tx available for NPH:

Answer 9

Ventriculoperitoneal Shunt

Question 10

attentive pt. c impaired retentive memory way out of proportion to all other cognitive functions(global confusional state)
but patient has no insight into his illness, is apathetic & indifferent about it

Answer 10

Wernicke-Korsakoff Syndrome

Question 11

low B1(thiamine); also dz that affects medial thalami or hippocampal portion temp. lobe. AN EMERGENCY

Answer 11

Beriberi aka Wernicke-Korsakoff Syndrome

Question 12

Wernicke is __

Korsakoff is __

Answer 12

Acute

Chronic

Question 13

the chronic phase of it Beriberi Can still do calculations, but can’t remember the 3 components of the MiniMental test.

Answer 13

Korsakoff

Question 14

Tx of wernicke-korsakoff syndrome

Answer 14

give thiamine & folate

Question 15

\_\_\_ is the brain’s conductor
regulates muscle contraction
force of contraction
sequence of movement
works by enabling or suppressing movements via two simultaneous pathways

Answer 15

Basal Ganglia

Question 16

in the basal ganglia motor circuit, what are the 2 NT? What is each’s function

Answer 16

Glutamate - excite

GABA - inhibit

Question 17

Substantia Nigra uses what NT? Is it excitatory or inhibitory?

Answer 17

Dopamine. It’s both!

Question 18

What goes wrong with the Basal Ganglia motor circuit with Parkinsons?

Answer 18

normally the direct and indirect pathways work normally, with parkinson’s the direct pathway is not working.
there is no substantia nigra

Question 19

Normal dopamine producing neurons number 550,000 in Substancia Nigra; PD=___

Answer 19

100,000

Question 20

4 cardinal signs of Parkinson’s Ds

Answer 20

Resting tremor (only one side)
Rigidity
Bradykinesia
gait disturbance w/postural instability

Question 21

__ pathway dysfunction (D1) create __ signs when can’t disinhibit desired movements well:
akinesia(“absence of movement”/less spontaneous movement/blinking)/bradykinesia(slowness)/postural instability
__ pathway dysfunction(D2) create __ signs when can’t functionally inhibit undesired movements well:
rigidity, tremors

Answer 21

Direct - positive

Indirect - negative

Question 22

What common drugs can cause a Parkinsonism-like movement Problems?
*What is the most common drug to cause movement disorders?

Answer 22

D2 antagonism causes extrapyramidal side effects

*Reglan

Question 23

Parkinson Ds tx: (4)

Answer 23

Exercise, therapy
Levodopa
Dopamine agonists
COMT - Catecholomine -O-MethylTransferase - increase plasma levodopa, tolcapone

Question 24

in advanced Parkinson Ds, when meds are no longer effective, you can evaulate for:

Answer 24

DBS - deep brain stimulation

Question 25

in terms of parkinson ds, what does “on” phase and “off” phase mean?

Answer 25

On phase: a good time when they don’t have many symptoms

Question 26

Difference between Essential Tremors and Parkinson’s

Answer 26

can be differentiated by postural kinetics(flex-extension) vs. supination-pronation(PD)

Essential tremors are much more common than Parkinson’s

Question 27

*3 sx that rule out Parkinson’s

(if any of these 3 are apparent, figure out an alternative dx

Answer 27

symmetrical motor signs
poor response to levo-dopa
lack of at rest tremor