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
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
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
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
5
Q
Which nerve of tongue does post 1/3 or ROOT gustatory & sensory?
A
VAGUS
6
Q
which tongue nerve transmits TASTE, Pain, temp, touch from post. 1/3
A
Glossopharyngeal
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
8
Q
Which drug is most commonly associated with Nueruoleptic Malignant syndrome?
which drugs treat this?
A
Haloperidol- due to antidopaminergic activity
bromocriptine
dantrolene
9
Q
Neuroleptic Malignant syndrome 4 features
difference from serotonin syndrome?
A
hyperthermia
extreme generalized rigidity
autonomic instability
altered mental status
NO MYOCLONUS
10
Q
Which drugs cause for serotonin syndrome
A
SSRI’s + MAOIs combined
11
Q
multiple ring enhancing lesions in an HIV pt?
diagnosis
A
Toxoplasmosis
12
Q
What type of reaction defect is seen in methlmalonic acidemia?
A
isomerization of methlmalonyl coA to succinyl CoA
13
Q
Catabolism of which 6 things leads to the formation of propionic acid?
A
isoleucine valine threonin methionine cholesterol oddchain fatty acids
14
Q
What disease presents with symptoms close to Marfan syndrome including ectopic lentis and developmental delay?
A
Homocystinuria caused by cystathione esynthetase deficiency
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
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
17
Q
What triadic companies normal pressure hydrocephalus?
A
Urinary incontinence
Ataxic gait
Dementia
Symmetric dilation of the ventricles
Wacky, wobbly, wet
18
Q
MC brain lesions in HIV patients?
A
Toxoplasmosis
Primary CNS lymphoma
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
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
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
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
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)
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
25
The infusion of glucose was outside mean in a alcoholic patient can cause what?
Encephalopathy
Confusion, ataxia, ophthalmoplegia, = triad of Warneke encephalopathy
bilateral mammillary body hemorrhages are also characteristic
26
Myoclonic seizure description?
First line therapy?
Breeze a rhythmic jerking
27
Tonic clonic seizures description?
First-line drug of choice?
Generalized tonic extension of extremities followed by clonic rhythmic movements
Loss of consciousness
Prolonged Post ictal confusion
Phenytoin, carbamazepine, valproate
28
Absence seizures description?
First and second line therapies question
Brief episodes of staring no postictal confusion
First line: ethosuximide
Second line: valproate
29
Partial seizures:
Difference between simple and complex?
First-line therapies for each?
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
30
M OA of sodium valproate (valproic acid)? Used for?
Suppresses abnormal electric activity in cortex by affecting GABA and NMDA receptors as well as Na and K channels
Myoclonic seizures
31
Ethosuximide is used for? MOA?
Absence seizures
Blocks T – type calcium channels that cause hyperpolarization (trigger and sustain rhythmical burst discharges) in THALAMIC neurons
32
Which three drugs act by inhibiting neuron neuronal high-frequency firing by reducing the ability of sodium channels to recover from inactivation?
Phenytoin
Carbamazepine
Valproic acid
33
MOA of barbiturates?
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
34
What are 3 endogenous opioid peptide derived from proopiomelanocortin (POMC).
Which two neurological systems are closely related due to these relationships?
Beta-endorphin
ACTH
MSH
Opioid system and stress axis
35
Which drug can reverse the peripheral and CNS symptoms of atropine toxicity?
Which similar drugs only limit CNS penetration?
Tertiary amine = >physostigmine (anticholinesterase agents)
Anticholinesterase agents (Quaternary amines):
Neostigmine
Edrophonium
36
What are 3 endogenous opioid peptide derived from proopiomelanocortin (POMC).
Which two neurological systems are closely related due to these relationships?
Beta-endorphin
ACTH
MSH
Opioid system and stress axis
37
Which drug can reverse the peripheral and CNS symptoms of atropine toxicity?
Which similar drugs only limit CNS penetration?
Tertiary amine = >physostigmine (anticholinesterase agents)
Anticholinesterase agents (Quaternary amines):
Neostigmine
Edrophonium
38
Name the four dopamine agonist and their types as well as describe their function
1. Ergot compounds – bromocriptine, pergolide
2. Non-ergot compounds – pramipexole, Ropinerole
Chemical structure similar to neurotransmitter dopamine and directly stimulate dopamine receptors.
39
Which drug is associated with retinal deposits that resemble retinitis pigmentosa
Which drug is associated with corneal deposits?
Retinal – thioridazine
Corneal – chlorpromazine
40
Name 5 examples of malformation?
```
Holoprosencephaly
Congenital heart disease
Anencephaly
Polydactyly
Syndactyly
```
41
Neonatal narcotic withdrawal symptoms?
Treatment?
Popular and dilatation, rhinorrhea, sneezing, diarrhea, nausea, vomiting, chills, tremors, jittery movements, seizures
24 to 48 hours after birth
Diluted tincture of opium
42
Which drug classes increase levodopa availability to the brain?
DOPA decarboxylase COMT (catechol– O – methyl – transferase) blockers
COMT inhibitors-
Entacapone & tolcapone
43
How does bladder incontinence in patients with normal pressure-hydrocephalus occur?
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
44
```
Name an example of:
Disruption
Deformation
Sequence
Agenesis
```
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
45
Where is synaptophysin found?
Protein found in presynaptic vesicles of neurons, Neuroendocrine, neuroectodermal
46
Which which neoplasms stain for GFAP?
Glial origin neoplasms (astrocytomas, ependymoma, oligodendroglioma)
47
The plaques of multiple sclerosis contain which three characteristics?
Loss of myelin sheath
Depletion of oligodendrocytes
Lipid laden macrophages containing products of Myelin breakdown
48
Difference between arcuate and central scotoma?
Central scotoma is lesion in macula
Arcuate scotoma seen with damage to optic nerve head
49
The plaques of multiple sclerosis contain which three characteristics?
Loss of myelin sheath
Depletion of oligodendrocytes
Lipid laden macrophages containing products of Myelin breakdown
50
Which cardiac drug is often used to assist in the prevention of cerebral vascular spasm following subarachnoid hemorrhage?
Calcium channel blockers, specifically nimodipine
51
Which type of drug is used and increased intracranial pressure?
Osmotic diuretics such as mannitol
52
Which type of neoplasm is a cystic tumor in the cerebellum of a child?
What is seen on biopsy?
Well-differentiated neoplasm
spindle cells with hairlike glial processes (associated with microcysts)
mixed with Rosenthal fibers & granular eosinophilic bodies.
53
Describe Thalamic Syndrome?
total sensory loss on contralateral side of body
54
most common cause of lacunar infarcts?
small vessel lipohyalinosis
55
skeletal muscle carnitine deficiency? (4)
Myoglobinuria
Muscle weakness during exercise
elevated muscle triglycerides
hypoketonemia
56
MCAD deficiency SEs?
hypoglycemia
| hypoketonemia
57
what uses PKA second messenger? (4)
TSH
Glucagon
Beta-Adrenergic receptors
PTH
58
Endodermal embryologic derivatives
```
G.I. tract
Liver
Pancreas
Lungs
Thymus
Parathyroid
Thyroid follicular cells
Middle ear
Bladder and urethra
```
59
Neural crest embryological derivatives (8)
```
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
Neural tube embryological derivatives parentheses 5)
Brain and spinal cord, posterior pituitary, penial gland, retina
61
Embryological deliver derivatives of service ectoderm (6)
```
Rathke's pouch (anterior pituitary)
Lens and cornea
Inner ear sensory organs
Nasal and oral epithelial linings
Epidermis
Salivary, Sweat and mammary glands
```
62
LESION CN:
III-
IV-
VI-
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
CN III muscles:
CN IV m
CN VI m
III: superior rectus, medial rectus, inferior rectus, interior oblique, Leavator palpebra superioris
IV: superior oblique
VI: lateral rectus
64
What can lead to cranial nerve III palsy?
5 symptoms
Enlarging intercranial aneurysm
Ptosis
Downward and laterally deviated eye
Impaired people pupillary constriction and accommodation
Diagonal diplopia
65
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?
Optic tract
66
Wine & Cheese => hypertensive crisis while on which drug?
Name one?
MAO inhibitor-tyramine crisis.
Phenelzine
67
Where do TIMOLOL and other beta blockers work and glaucoma?
Decrease aqueous humor production by the ciliary epithelium
68
Which drugs promote ciliary muscle contraction?
Cholinomimetics
69
Which drugs cause miosis via contraction of the sphincter of iris
Cholinergic agonist
Pilocarpine, carbachol
70
First line for trigeminal neuralgia?
Carbamazepine
71
What component of blood transfusions may cause paresthesias? And how?
Citrate chelates calcium and magnesium & reduce their plasma levels
72
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?
Parvovirus B 19 infection
Highly tropic for erythroid precursor cells and replicates predominately in bone marrow
73
What activates NMDA receptors and is believed to enhance morphine tolerance? how is this done?
What blocks these receptors?
Glutamate increasing phosphorylation of opioid receptors increasing metric oxide levels
Ketamine, NMDA receptor blockers
74
What happens to the length constant and the time constant as myelination increases?
Increases length
| decreases time
75
Neonatal intravascular hemorrhage is usually located where?
Germinal matrix of lateral ventricles
76
Rupture of cortical bridging veins leads to?
Subdural hematoma
77
Temporal bone head trauma and rupture of middle meningeal artery leads to what?
Epidermal hematoma
78
What to diseases are associated with berry aneurysms?
What hemorrhages associated with this aneurysm?
Ehlers-Danlos syndrome,ADPKD
Sub arachnoid hemorrhage
79
What is associated with pica syndrome?
Iron deficiency anemia
80
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?
Nitrous oxide
Suppression of mucociliary clearance = >post operative atelectasis
Halothane, sevoflurane
81
What adverse effect is associated with inhaled anesthetics within the brain?
Cardiac?
Hepatic? Renal?
Increased cerebral blood flow = > increased intracranial pressure
Decreased cardiac output, increased atrial intraventricular pressures
Decreased hepatic bloodflow/Decreased renal function
82
Occlusion of anterior cerebral arteries causes what type of dysfunction?
Weakness and sensory deficits of contralateral legs, trunk, genitals
83
preCursor of serotonin?
Which antihistamine is used to reverse the effects of serotonin syndrome?
Tryptophan
Cryptoheptidine
84
What should be used to treat atypical depression or treatment resistant depression? Three symptoms of atypical depression?
name 2
MAO inhibitors
Mood reactivity, increased sleep and appetite, rejection sensitivity, laden fatigue=heavy arms/legs
Phenelzine
tranylcypromine
85
Name three high potency antipsychotics
Side effects associated?
Haloperidol, fluphenazine, pimozide
Extrapyramidal symptoms
Treats positive symptoms of schizophrenia= psychotic symptoms hallucinations disorganized speech delusions
86
Name two low potency antipsychotics
| two side effects associated with these?
Chlorpromazine
THioridazine
Anticholinergic
Antihistamine
87
Name four atypical antipsychotics?
Which symptoms do you these drugs treat of which disease?
Clozapine
Risperidone
olanzapine
Quetiapine
Treats both positive and negative symptoms of schizophrenia
88
4 symptoms of Friedrichs ataxia
```
Gait ataxia
Dorsal column degeneration = >loss of positional/vibration sense
Hypertrophic cardiomyopathy
Kyphoscoliosis, foot abnormalities
Diabetes mellitus
```
Frataxin gene
89
What is seen in communicating hydrocephalus, where does the dysfunction occur?
Symmetric enlargement of the ventricles
Dysfunction of arachnoid granulations/villi
a Sequelae of meningitis
90
Common causes of non-communicating hydrocephalus?
Aqueduct Olsten gnosis
Dandy walker malformation
Arnold-Chiari malformation
91
Common causes of aseptic meningitis? Laboratory findings in CSF?
Echovirus, Coxsackie a.k.a. Enteroviruses
LYMPHOCYTIC predominance
92
Common causes of bacterial meningitis? Laboratory findings in CSF?
Streptococcus pneumonia
Neisseria meningitis
White blood cell count >1000
Proteins elevated| glucose normal/decreased
NEUTROPHILIC predominance
93
What is responsible for the toxic effect of meningitis?
Lipooligosaccharide=LPS
94
Most effective treatment of TCA associated cardiac abnormalities question
Sodium bicarbonate
95
How does naloxone act?
Opioid receptor antagonist (competitive)
96
When is flumazenil used?
Benzodiazepine overdose
97
Where does he biosynthesis occur in erythrocytes and why is it not completed?
Mitochondria, mitochondria are lost
98
Bilateral acoustic neuromas are associated with which disease?
Neurofibromatosis type 2
99
What brain tumor has a whorled appearance and Psammoma bodies?
Where would they be located in the brain?
Meningiomas
Lateral hemispheric fissure
parasagittal aspect of brain convexity
100
Which tumors are located in the penial/suprasellar regions of the brain?
Which two diseases are associated with these tumors?
Germ cell tumors
```
Aqueduct stenosis
Paranoud syndrome (for Alysis of vertical kiddies)
```
101
Effects of Mu opioid receptors
Effects of Kappa Receptors
Respiratory depression
Decreased gastrointestinal motility
Miosis
102
Ventriculoperitoneal shunts are associated with which type of bacteria?
Staph epidermidis
103
Neurofibromatosis 1:
Symptoms
gene location and disease type
Café au lai spots, neurofibromas, Lisch nodules
Chromosome 11
104
3 symptoms associated with Pineal Germinomas?
Where is Pineal gland located on sagittal view?
Precocious puberty
Obstructive hydrocephalus
Paranaud syndrome
Between the Medulla and corpus callosum
105
Which type of lymphoma is associated with remission and recurrence?
translocation/mutation
Follicular B cell lymphoma
T(14:18)
bcl-2 oncogene overexpression
106
Ventromedial hypothalamic nuclei purpose
Lesion =?
Satiety center /Regulate food intake
| Lesion = aggressive behavior, obesity
107
What might occur when tricyclic antidepressants are used during the depressive phase of bipolar disorder?
Manic's episodes
108
Diagnosis of a patient with cerebellar hemangioblastomas, & congenital-kidney/liver/pancreas- cysts?
Von Hippel-Lindau disease
109
UNDesirable effects of phenytoin?
Cosmetic
Hirstuism, coarsening of facial features, acneiform rash, gingival hypertrophy
110
Mutation associated with LI-Fraumeni syndrome?
What malignancies are associated with this?
inactivation a p53
Brain breast adrenal cortex sarcomas leukemias
111
Major side effects associated with lithium use? What do you think should be monitored with this drug use?
Nephrogenic diabetes insipidus, hypothyroidism
TSH levels, renal function (blood urea nitrogen, creatinine)
112
Alzheimer's dementia biochemical abnormality:
Decreased acetylcholine levels in hippocampus/nucleus basalis
= >Deficient choline acetyltransferase
113
Prophylaxis of meningococcal meningitis?
Rifampin
114
Integrins bind what three things on the basement membrane?
Fibronectin
Laminin's
College
115
What are small infarcts that involve the basal ganglia, pons, internal capsule, deep white matter of brain
Lacunar infarct
116
Dysarthria/clumsy hand syndrome involves what area of the brain?
Basal pons, Genu of internal capsule
117
Peerman or hemiparesis is associated with what area of the brain?
Posterior limb of the internal capsule
118
What does etoposide inhibit?
TP II
| aka topo isomerase II
119
And diabetes neuropathy is associated with what kind of damage?
ISCHEMIC
120
Three common features of myotonic dystrophy, what mutation is associated with this?
Cataracts, frontal baldness, gonadal atrophy
Triple nucleotide repeat on myotonia protein kinase Gene.
121
Vincristine side effect? Prevents which phase of the cell cycle?
Neurotoxicity
| M-phase (microtubules)
122
The triad of tinnitus, vertigo, Sensorineural hearing loss is for which disease?
Meniere's Disease
increased volume & pressure of endolymph in a vestibular apparatus
123
Sacral agenesis causing lower extremity paralysis and urinary incontenice is characteristic of which neuro disease?
Caudal Regression Syndrome
Maternal Diabetes
124
Drug induced Parkinsonism should be treated with what in favor of?
Benztropine
Bromocriptine/DA agonists
125
Steptolysin O & S is responsible for what ? by which bacteria?
Beta--hemolysis ertyhrocyte damage
S Pyogenes
126
what component of S. Pyogenes causses fever& schock associated with scarlet fever and streptococcal toxic shhock syndrome?
Pyrogenic EXOTOXIN.
127
Shiga toxin affects ribosomes how? symptoms?
disables 60s subunit
ipithialal cell deah and diarrhea
128
how does edema factor work?
which bug has this? which bug is this MOA similar to?
adenylate cyclase that causes massive incr. in intracellular cAMP => nuetrophil and M0 dysfunction and tissue edema
Bacillus anthracis
Bordetella pertussis
129
what type of vaccine is the rabies vaccine?
killed
130
what receptors do Organophosphates stimulate?
muscarinic (DUMBELS) & nicotinic (Muscle Paralysis)
131
Which drug would you use to reverse BOTH muscarinic & nicotinic effects of organophosphates?
Pralidoxime
132
DOC for complex partial seizures and is also efective in generalized tonic clonic seizures
Carbemazepine
133
ANterior shoulder dislocation leads to what to happen?
flattening of the deltoid muscle
134
what Antibody is associated with CREST syndrome?
Anti-centromere
135
what antibody is associated with systemic sclerosis?
Anti-DNA topoisomerase
136
```
Epidural hematoma ^
BV?
Location?
presentaton?
CT?
```
Middle menigeal
Btw skull and dura
Lucid interval then LOC
biconvex hematoma
137
```
Subdural hematoma
BV?
Loction?
presentation?
CT?
```
Bridging cortical veins
Btw dura and arachnoid
Gradual onset of headache and confusion
Crecent shaped hematoma
138
```
Subarachnoid hemorrhage
BV?
location?
presentation?
CT?
```
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
MS
epidemiology?
initial symptoms?
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
