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UWORLD QuestionQuestions > Neuro > Flashcards

Neuro Flashcards

1
Q

What occurs in the brain 3-5 days post ischemia/infarct?

Eventually what is seen in this area?

A

Micoglia (macrophage derivitiive) move to area and phagocytize fragments of neurons,myelin & decrotic debris.

cystic space replaces necrosis and astrocytes form glial scar around periphery

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2
Q

Deficient DNA-repair enzyme diseases: (5)

A

Ataxia-telangiectasia- DNA hypersensitivity to Ionizing radiation

Xeroderma pigmentosum- DNA hypersensitivity to UV radiation

Fanconi Anemia-DNA hypersensitivity to cross-linking agents

Bloom Syndrome - chromosomal instability

Hereditary nonplyposis colorectal cancer- defective DNA mismatch repair enzymes

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3
Q

Manifestations of ataxia telangectasia (4) ? and what is the disorder?

A

DNA hypersensitivity to IONIZING RADIATION

cerebellar ataxia
oculocutaneous telangiectasias
repeated sinopulmonary infections
increased incidence of malignancy

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4
Q

Anterior 2/3rds of the Tongue innervation:
General Sensation?
Gustatory sensation?

A

General-Mandibular division of Trigeminal

Gustatory- chorda tympani of the facial nerve

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5
Q

Which nerve of tongue does post 1/3 or ROOT gustatory & sensory?

A

VAGUS

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6
Q

which tongue nerve transmits TASTE, Pain, temp, touch from post. 1/3

A

Glossopharyngeal

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7
Q

How does Infant hydrocephalus present?

long term effects?

A

irratability
poor feeding
incr. head circumference
enlarged ventricles

lower extremity spasticity- stretch periventricular pyramidal tracts
visual disturbances
learning disabilities

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8
Q

Which drug is most commonly associated with Nueruoleptic Malignant syndrome?

which drugs treat this?

A

Haloperidol- due to antidopaminergic activity

bromocriptine
dantrolene

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9
Q

Neuroleptic Malignant syndrome 4 features

difference from serotonin syndrome?

A

hyperthermia
extreme generalized rigidity
autonomic instability
altered mental status

NO MYOCLONUS

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10
Q

Which drugs cause for serotonin syndrome

A

SSRI’s + MAOIs combined

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11
Q

multiple ring enhancing lesions in an HIV pt?

diagnosis

A

Toxoplasmosis

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12
Q

What type of reaction defect is seen in methlmalonic acidemia?

A

isomerization of methlmalonyl coA to succinyl CoA

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13
Q

Catabolism of which 6 things leads to the formation of propionic acid?

A 
isoleucine
valine
threonin
methionine
cholesterol
oddchain fatty acids
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14
Q

What disease presents with symptoms close to Marfan syndrome including ectopic lentis and developmental delay?

A

Homocystinuria caused by cystathione esynthetase deficiency

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15
Q

What the three things are true of drugs with a high blood/gas partition coefficient?

MOA

Name a drug like this.

A

Higher solubility in blood
Demonstrates lower equilibration with the brain
Longer onset times

Blood saturates slowly leading to delayed rise in partial pressure = > slows brain saturation and increases onset time

Halothane

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16
Q

Which drug has a low blood/gas partition coefficient? What does this mean?

A

N2O-nitrous oxide

Blood saturates quickly leading to fast rise and partial pressure = >increased pressures speeds brain saturation decreasing onset time

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17
Q

What triadic companies normal pressure hydrocephalus?

A

Urinary incontinence
Ataxic gait
Dementia

Symmetric dilation of the ventricles

Wacky, wobbly, wet

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18
Q

MC brain lesions in HIV patients?

A

Toxoplasmosis

Primary CNS lymphoma

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19
Q

Primary CNS lymphoma in HIV patients is of what origin? What infection is strongly associated with this disease?

A

B – lymphocyte origin

Latent EBV infection

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20
Q

Ornithine transferred to the mitochondria is essential and the urea cycle, what causes neurological damage?

How would you prevent this?

What patient with this present in?

A

Ammonia buildup

Protein restriction

Infants

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21
Q

What three mutations and which genotype is associated with Alzheimer’s disease?

A

A PP (chromosome 21)
presenilin1
presenillin2

Apolipoprotein E 4 genotype

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22
Q

What type of drug is buspirone?
What is a use for?
Which Side effects does it avoid ?

A

5 HT1A agonist

Generalized anxiety disorder

No hypnotic, sedative, euphoric effects

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23
Q 
Cellular receptor of each virion:
Cytomegalovirus
Epstein bar virus
HIV
Rabies
Rhinovirus
A 
Cytomegalovirus – cellular integrations
EBV – CR 2 (CD 21)
HIV – CD4 & CXCR/CCR 5
Rabies –Nicotinic acetylcholine receptor
Rhino –I CAM1 CD54)
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24
Q

Rhabdovirus how what cellular shape and type?

Symptoms?

A

Single-stranded RNA virus enveloped by a bullet shaped capsule which is studded by glycoprotein spikes that bind to nicotinic acetylcholine receptor

Agitation, disorientation, pharyngeal spasm, photophobia leading to coma is suggested of rabies encephalitis

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25
Q

The infusion of glucose was outside mean in a alcoholic patient can cause what?

A

Encephalopathy

Confusion, ataxia, ophthalmoplegia, = triad of Warneke encephalopathy
bilateral mammillary body hemorrhages are also characteristic

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26
Q

Myoclonic seizure description?

First line therapy?

A

Breeze a rhythmic jerking

<one sec, occur and clusters, no loss of consciousness

Valproic acid

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27
Q

Tonic clonic seizures description?

First-line drug of choice?

A

Generalized tonic extension of extremities followed by clonic rhythmic movements
Loss of consciousness
Prolonged Post ictal confusion

Phenytoin, carbamazepine, valproate

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28
Q

Absence seizures description?

First and second line therapies question

A

Brief episodes of staring no postictal confusion

First line: ethosuximide
Second line: valproate

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29
Q

Partial seizures:
Difference between simple and complex?

First-line therapies for each?

A

Simple: one body part involved, no LOC, no postictal confusion

Complex: temporal lobe involvement (mood changes, hallucinations)
Impaired consciousness
Postictal state president

Carbamazepine is first line for both

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30
Q

M OA of sodium valproate (valproic acid)? Used for?

A

Suppresses abnormal electric activity in cortex by affecting GABA and NMDA receptors as well as Na and K channels

Myoclonic seizures

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31
Q

Ethosuximide is used for? MOA?

A

Absence seizures

Blocks T – type calcium channels that cause hyperpolarization (trigger and sustain rhythmical burst discharges) in THALAMIC neurons

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32
Q

Which three drugs act by inhibiting neuron neuronal high-frequency firing by reducing the ability of sodium channels to recover from inactivation?

A

Phenytoin
Carbamazepine
Valproic acid

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33
Q

MOA of barbiturates?

A

Binds to GABA-A receptor enhances/mimics the action of GABA by increasing CHLORIDE conductance through the ion channel

= > hyperpolarization of the cell membrane
= > increasing threshold of excitability of postsynaptic neuron

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34
Q

What are 3 endogenous opioid peptide derived from proopiomelanocortin (POMC).

Which two neurological systems are closely related due to these relationships?

A

Beta-endorphin
ACTH
MSH

Opioid system and stress axis

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35
Q

Which drug can reverse the peripheral and CNS symptoms of atropine toxicity?

Which similar drugs only limit CNS penetration?

A

Tertiary amine = >physostigmine (anticholinesterase agents)

Anticholinesterase agents (Quaternary amines):
Neostigmine
Edrophonium

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36
Q

What are 3 endogenous opioid peptide derived from proopiomelanocortin (POMC).

Which two neurological systems are closely related due to these relationships?

A

Beta-endorphin
ACTH
MSH

Opioid system and stress axis

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37
Q

Which drug can reverse the peripheral and CNS symptoms of atropine toxicity?

Which similar drugs only limit CNS penetration?

A

Tertiary amine = >physostigmine (anticholinesterase agents)

Anticholinesterase agents (Quaternary amines):
Neostigmine
Edrophonium

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38
Q

Name the four dopamine agonist and their types as well as describe their function

A
  1. Ergot compounds – bromocriptine, pergolide
  2. Non-ergot compounds – pramipexole, Ropinerole

Chemical structure similar to neurotransmitter dopamine and directly stimulate dopamine receptors.

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39
Q

Which drug is associated with retinal deposits that resemble retinitis pigmentosa

Which drug is associated with corneal deposits?

A

Retinal – thioridazine

Corneal – chlorpromazine

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40
Q

Name 5 examples of malformation?

A 
Holoprosencephaly
Congenital heart disease
Anencephaly
Polydactyly
Syndactyly
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41
Q

Neonatal narcotic withdrawal symptoms?

Treatment?

A

Popular and dilatation, rhinorrhea, sneezing, diarrhea, nausea, vomiting, chills, tremors, jittery movements, seizures
24 to 48 hours after birth

Diluted tincture of opium

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42
Q

Which drug classes increase levodopa availability to the brain?

A

DOPA decarboxylase COMT (catechol– O – methyl – transferase) blockers

COMT inhibitors-
Entacapone & tolcapone

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43
Q

How does bladder incontinence in patients with normal pressure-hydrocephalus occur?

A

Ventricular distention stretches descending cortical fibers in the paraventricular area

Progressively loss of cortical in addition on sacral micturition center causes development of urge incontinence

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44
Q 
Name an example of:
Disruption
Deformation
Sequence
Agenesis
A

disruption-amniotic band syndrome (secondary destruction of a previously well formed tissue/organ)

deformation-congenital hip dislocation, clubfeet, flat facies(secondary to extrinsic compression)

sequence-Potter syndrome (also Deformation-flat facies)

Renal agenesis, complete absence of Oregon

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45
Q

Where is synaptophysin found?

A

Protein found in presynaptic vesicles of neurons, Neuroendocrine, neuroectodermal

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46
Q

Which which neoplasms stain for GFAP?

A

Glial origin neoplasms (astrocytomas, ependymoma, oligodendroglioma)

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47
Q

The plaques of multiple sclerosis contain which three characteristics?

A

Loss of myelin sheath

Depletion of oligodendrocytes

Lipid laden macrophages containing products of Myelin breakdown

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48
Q

Difference between arcuate and central scotoma?

A

Central scotoma is lesion in macula

Arcuate scotoma seen with damage to optic nerve head

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49
Q

The plaques of multiple sclerosis contain which three characteristics?

A

Loss of myelin sheath

Depletion of oligodendrocytes

Lipid laden macrophages containing products of Myelin breakdown

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50
Q

Which cardiac drug is often used to assist in the prevention of cerebral vascular spasm following subarachnoid hemorrhage?

A

Calcium channel blockers, specifically nimodipine

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51
Q

Which type of drug is used and increased intracranial pressure?

A

Osmotic diuretics such as mannitol

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52
Q

Which type of neoplasm is a cystic tumor in the cerebellum of a child?

What is seen on biopsy?

A

Well-differentiated neoplasm
spindle cells with hairlike glial processes (associated with microcysts)

mixed with Rosenthal fibers & granular eosinophilic bodies.

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53
Q

Describe Thalamic Syndrome?

A

total sensory loss on contralateral side of body

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54
Q

most common cause of lacunar infarcts?

A

small vessel lipohyalinosis

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55
Q

skeletal muscle carnitine deficiency? (4)

A

Myoglobinuria
Muscle weakness during exercise
elevated muscle triglycerides
hypoketonemia

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56
Q

MCAD deficiency SEs?

A

hypoglycemia

hypoketonemia

57
Q

what uses PKA second messenger? (4)

A

TSH
Glucagon
Beta-Adrenergic receptors
PTH

58
Q

Endodermal embryologic derivatives

A 
G.I. tract
Liver
Pancreas
Lungs
Thymus
Parathyroid
Thyroid follicular cells
Middle ear
Bladder and urethra
59
Q

Neural crest embryological derivatives (8)

A 
Autonomic, sensory, celiac ganglia
Schwan cells
Pia and arachnoid matter
Aorticopulmonary septum, Endocardial cushions
Branchial arches(Bones and cartilage)
Skull bones
Melanocytes
Adrenal Medela
60
Q

Neural tube embryological derivatives parentheses 5)

A

Brain and spinal cord, posterior pituitary, penial gland, retina

61
Q

Embryological deliver derivatives of service ectoderm (6)

A 
Rathke's pouch (anterior pituitary)
Lens and cornea
Inner ear sensory organs
Nasal and oral epithelial linings
Epidermis
Salivary, Sweat and mammary glands
62
Q

LESION CN:
III-
IV-
VI-

A

III-I deviated down and lat, diag. diplopia, dilated pupil/loss of acommodation, ptosis

IV- eye deviated upward vertical/torsional diplopia

VI- I deviated immediately horizontal diplopia

63
Q

CN III muscles:
CN IV m
CN VI m

A

III: superior rectus, medial rectus, inferior rectus, interior oblique, Leavator palpebra superioris

IV: superior oblique

VI: lateral rectus

64
Q

What can lead to cranial nerve III palsy?

5 symptoms

A

Enlarging intercranial aneurysm

Ptosis
Downward and laterally deviated eye
Impaired people pupillary constriction and accommodation
Diagonal diplopia

65
Q

Contralateral homonymous hemianopia along with afferent pupillary defect a.k.a. Marcus gunn pupil would result from a lesion where in the optic signaling track?

A

Optic tract

66
Q

Wine & Cheese => hypertensive crisis while on which drug?

Name one?

A

MAO inhibitor-tyramine crisis.

Phenelzine

67
Q

Where do TIMOLOL and other beta blockers work and glaucoma?

A

Decrease aqueous humor production by the ciliary epithelium

68
Q

Which drugs promote ciliary muscle contraction?

A

Cholinomimetics

69
Q

Which drugs cause miosis via contraction of the sphincter of iris

A

Cholinergic agonist

Pilocarpine, carbachol

70
Q

First line for trigeminal neuralgia?

A

Carbamazepine

71
Q

What component of blood transfusions may cause paresthesias? And how?

A

Citrate chelates calcium and magnesium & reduce their plasma levels

72
Q

What is a febrile respiratory illness and a child followed by sudden appearance of red flushed cheeks?

Where is this virus usually predominantly produced at?

A

Parvovirus B 19 infection

Highly tropic for erythroid precursor cells and replicates predominately in bone marrow

73
Q

What activates NMDA receptors and is believed to enhance morphine tolerance? how is this done?

What blocks these receptors?

A

Glutamate increasing phosphorylation of opioid receptors increasing metric oxide levels

Ketamine, NMDA receptor blockers

74
Q

What happens to the length constant and the time constant as myelination increases?

A

Increases length

decreases time

75
Q

Neonatal intravascular hemorrhage is usually located where?

A

Germinal matrix of lateral ventricles

76
Q

Rupture of cortical bridging veins leads to?

A

Subdural hematoma

77
Q

Temporal bone head trauma and rupture of middle meningeal artery leads to what?

A

Epidermal hematoma

78
Q

What to diseases are associated with berry aneurysms?

What hemorrhages associated with this aneurysm?

A

Ehlers-Danlos syndrome,ADPKD

Sub arachnoid hemorrhage

79
Q

What is associated with pica syndrome?

A

Iron deficiency anemia

80
Q

Which inhaled anesthetic is not associated with respiratory depression (all others are)

What is another adverse respitory effect of inhaled anesthetics? Which two and aesthetics do not have this affect?

A

Nitrous oxide

Suppression of mucociliary clearance = >post operative atelectasis

Halothane, sevoflurane

81
Q

What adverse effect is associated with inhaled anesthetics within the brain?

Cardiac?
Hepatic? Renal?

A

Increased cerebral blood flow = > increased intracranial pressure

Decreased cardiac output, increased atrial intraventricular pressures

Decreased hepatic bloodflow/Decreased renal function

82
Q

Occlusion of anterior cerebral arteries causes what type of dysfunction?

A

Weakness and sensory deficits of contralateral legs, trunk, genitals

83
Q

preCursor of serotonin?

Which antihistamine is used to reverse the effects of serotonin syndrome?

A

Tryptophan

Cryptoheptidine

84
Q

What should be used to treat atypical depression or treatment resistant depression? Three symptoms of atypical depression?

name 2

A

MAO inhibitors
Mood reactivity, increased sleep and appetite, rejection sensitivity, laden fatigue=heavy arms/legs

Phenelzine
tranylcypromine

85
Q

Name three high potency antipsychotics

Side effects associated?

A

Haloperidol, fluphenazine, pimozide

Extrapyramidal symptoms

Treats positive symptoms of schizophrenia= psychotic symptoms hallucinations disorganized speech delusions

86
Q

Name two low potency antipsychotics

two side effects associated with these?

A

Chlorpromazine
THioridazine

Anticholinergic
Antihistamine

87
Q

Name four atypical antipsychotics?

Which symptoms do you these drugs treat of which disease?

A

Clozapine
Risperidone
olanzapine
Quetiapine

Treats both positive and negative symptoms of schizophrenia

88
Q

4 symptoms of Friedrichs ataxia

A 
Gait ataxia
Dorsal column degeneration = >loss of positional/vibration sense
Hypertrophic cardiomyopathy
Kyphoscoliosis, foot abnormalities
Diabetes mellitus

Frataxin gene

89
Q

What is seen in communicating hydrocephalus, where does the dysfunction occur?

A

Symmetric enlargement of the ventricles

Dysfunction of arachnoid granulations/villi

a Sequelae of meningitis

90
Q

Common causes of non-communicating hydrocephalus?

A

Aqueduct Olsten gnosis
Dandy walker malformation
Arnold-Chiari malformation

91
Q

Common causes of aseptic meningitis? Laboratory findings in CSF?

A

Echovirus, Coxsackie a.k.a. Enteroviruses

LYMPHOCYTIC predominance

92
Q

Common causes of bacterial meningitis? Laboratory findings in CSF?

A

Streptococcus pneumonia
Neisseria meningitis

White blood cell count >1000
Proteins elevated| glucose normal/decreased
NEUTROPHILIC predominance

93
Q

What is responsible for the toxic effect of meningitis?

A

Lipooligosaccharide=LPS

94
Q

Most effective treatment of TCA associated cardiac abnormalities question

A

Sodium bicarbonate

95
Q

How does naloxone act?

A

Opioid receptor antagonist (competitive)

96
Q

When is flumazenil used?

A

Benzodiazepine overdose

97
Q

Where does he biosynthesis occur in erythrocytes and why is it not completed?

A

Mitochondria, mitochondria are lost

98
Q

Bilateral acoustic neuromas are associated with which disease?

A

Neurofibromatosis type 2

99
Q

What brain tumor has a whorled appearance and Psammoma bodies?

Where would they be located in the brain?

A

Meningiomas

Lateral hemispheric fissure
parasagittal aspect of brain convexity

100
Q

Which tumors are located in the penial/suprasellar regions of the brain?

Which two diseases are associated with these tumors?

A

Germ cell tumors

Aqueduct stenosis
Paranoud syndrome (for Alysis of vertical kiddies)
101
Q

Effects of Mu opioid receptors

Effects of Kappa Receptors

A

Respiratory depression
Decreased gastrointestinal motility

Miosis

102
Q

Ventriculoperitoneal shunts are associated with which type of bacteria?

A

Staph epidermidis

103
Q

Neurofibromatosis 1:
Symptoms
gene location and disease type

A

Café au lai spots, neurofibromas, Lisch nodules

Chromosome 11

104
Q

3 symptoms associated with Pineal Germinomas?

Where is Pineal gland located on sagittal view?

A

Precocious puberty
Obstructive hydrocephalus
Paranaud syndrome

Between the Medulla and corpus callosum

105
Q

Which type of lymphoma is associated with remission and recurrence?

translocation/mutation

A

Follicular B cell lymphoma

T(14:18)
bcl-2 oncogene overexpression

106
Q

Ventromedial hypothalamic nuclei purpose

Lesion =?

A

Satiety center /Regulate food intake

Lesion = aggressive behavior, obesity

107
Q

What might occur when tricyclic antidepressants are used during the depressive phase of bipolar disorder?

A

Manic’s episodes

108
Q

Diagnosis of a patient with cerebellar hemangioblastomas, & congenital-kidney/liver/pancreas- cysts?

A

Von Hippel-Lindau disease

109
Q

UNDesirable effects of phenytoin?

A

Cosmetic

Hirstuism, coarsening of facial features, acneiform rash, gingival hypertrophy

110
Q

Mutation associated with LI-Fraumeni syndrome?

What malignancies are associated with this?

A

inactivation a p53

Brain breast adrenal cortex sarcomas leukemias

111
Q

Major side effects associated with lithium use? What do you think should be monitored with this drug use?

A

Nephrogenic diabetes insipidus, hypothyroidism

TSH levels, renal function (blood urea nitrogen, creatinine)

112
Q

Alzheimer’s dementia biochemical abnormality:

A

Decreased acetylcholine levels in hippocampus/nucleus basalis

= >Deficient choline acetyltransferase

113
Q

Prophylaxis of meningococcal meningitis?

A

Rifampin

114
Q

Integrins bind what three things on the basement membrane?

A

Fibronectin
Laminin’s
College

115
Q

What are small infarcts that involve the basal ganglia, pons, internal capsule, deep white matter of brain

A

Lacunar infarct

116
Q

Dysarthria/clumsy hand syndrome involves what area of the brain?

A

Basal pons, Genu of internal capsule

117
Q

Peerman or hemiparesis is associated with what area of the brain?

A

Posterior limb of the internal capsule

118
Q

What does etoposide inhibit?

A

TP II

aka topo isomerase II

119
Q

And diabetes neuropathy is associated with what kind of damage?

A

ISCHEMIC

120
Q

Three common features of myotonic dystrophy, what mutation is associated with this?

A

Cataracts, frontal baldness, gonadal atrophy

Triple nucleotide repeat on myotonia protein kinase Gene.

121
Q

Vincristine side effect? Prevents which phase of the cell cycle?

A

Neurotoxicity

M-phase (microtubules)

122
Q

The triad of tinnitus, vertigo, Sensorineural hearing loss is for which disease?

A

Meniere’s Disease

increased volume & pressure of endolymph in a vestibular apparatus

123
Q

Sacral agenesis causing lower extremity paralysis and urinary incontenice is characteristic of which neuro disease?

A

Caudal Regression Syndrome

Maternal Diabetes

124
Q

Drug induced Parkinsonism should be treated with what in favor of?

A

Benztropine

Bromocriptine/DA agonists

125
Q

Steptolysin O & S is responsible for what ? by which bacteria?

A

Beta–hemolysis ertyhrocyte damage

S Pyogenes

126
Q

what component of S. Pyogenes causses fever& schock associated with scarlet fever and streptococcal toxic shhock syndrome?

A

Pyrogenic EXOTOXIN.

127
Q

Shiga toxin affects ribosomes how? symptoms?

A

disables 60s subunit

ipithialal cell deah and diarrhea

128
Q

how does edema factor work?

which bug has this? which bug is this MOA similar to?

A

adenylate cyclase that causes massive incr. in intracellular cAMP => nuetrophil and M0 dysfunction and tissue edema

Bacillus anthracis
Bordetella pertussis

129
Q

what type of vaccine is the rabies vaccine?

A

killed

130
Q

what receptors do Organophosphates stimulate?

A

muscarinic (DUMBELS) & nicotinic (Muscle Paralysis)

131
Q

Which drug would you use to reverse BOTH muscarinic & nicotinic effects of organophosphates?

A

Pralidoxime

132
Q

DOC for complex partial seizures and is also efective in generalized tonic clonic seizures

A

Carbemazepine

133
Q

ANterior shoulder dislocation leads to what to happen?

A

flattening of the deltoid muscle

134
Q

what Antibody is associated with CREST syndrome?

A

Anti-centromere

135
Q

what antibody is associated with systemic sclerosis?

A

Anti-DNA topoisomerase

136
Q 
Epidural hematoma ^
BV?
Location?
presentaton?
CT?
A

Middle menigeal
Btw skull and dura
Lucid interval then LOC
biconvex hematoma

137
Q 
Subdural hematoma
BV?
Loction?
presentation?
CT?
A

Bridging cortical veins
Btw dura and arachnoid
Gradual onset of headache and confusion
Crecent shaped hematoma

138
Q 
Subarachnoid hemorrhage
BV?
location?
presentation?
CT?
A

Aneurysm / AV malformation of ant/post communicating arteries

Btw aracnoid & pia mater

severe hedache/worst of life fever nuchal rigidit

Blood in the basal cisterns

139
Q

MS
epidemiology?
initial symptoms?

A

females 20-30

1-optic neuritis-central scotoma, painful eye movement
2-intranuclear opthalmoplegia-MLF degen= pain adducting during lat. gaze
3-sensory deficits bowel/bladder dysfxn
4-cerebellar dysfxn

worsens with heat exposure

UWORLD QuestionQuestions (12 decks)

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