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Neuro Flashcards

1
Q

what does the notochord become?

A

nucleus pulposus of intervertebral disc

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2
Q

markers for neural tube defect during pregnancy

A

elevated AFP in amniotic fluid and maternal serum

inc acetylcholinesterase in amniotic fluid to confirm

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3
Q

risk factor for anencephaly

A

maternal type 1 DM

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4
Q

Arnold Chiari malformation

A

herniation of cerebellar tonsils and vermis through foramen magnum > hydrocephalus and impaired coordination. Can be assoc w/ throaco-lumbar myelomeningocele

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5
Q

Dandy Walker malformation

A

agenesis of cerebellar vermis, cystic enlargement of 4th ventricle
assoc w/ hydrocephalus and spina bifida

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6
Q

syringomelia

A

cystic enlargement of central canal of spinal cord

crossing fibers of STT damaged first

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7
Q

nerves providing taste and pain sensation in parts of the tongue

A

anterior - taste is 7, pain is V3
post - both are 9
extreme posterior - both are 10

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8
Q

Wallerian degeneration

A

degeneration of neurons - allows for axonal regeneration in PNS
degen distal to injury and axonal retraction proximally

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9
Q

C fibers vs Adelta fibers

A

C - slow, unmyelinated

Adelta - fast, myelinated

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10
Q

Meissner’s corpuscles vs Pacinian corpuscles vs Merkel’s discs - where are they and what do they sense

A

Meissner - hairless skin, fine/light touch (adapt quickly)
Pacinian - deep skin, vibration/pressure
Merkel’s - hair follicles, pressure / static touch

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11
Q

function of perineurium

A

permeability barrier around nerve

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12
Q

where is ACh synth in CNS?

A

basal nucleus of Meynert

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13
Q

3 structures that form BBB

A

tight jxns of endothelial cells
basement membrane
astrocyte foot processes

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14
Q

2 hypothalamic input areas not contained by BBB

A

OVLT - senses osmolarity

area postrema - senses emetics

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15
Q

where are ADH and oxytocin made in brain?

A

ADH - supraoptic nucleus

oxytocin - paraventricular nucleus

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16
Q

lateral and ventromedial hypothal - fns

A

lateral - hunger

ventromedial - satiety

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17
Q

anterior and posterior hypotha - fns

A

ant - cooling (AC), PSNS

post - heating, SYNS

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18
Q

what do these thalamic nuclei connect (input/output)?

VPL, VPM, LGN, MGN, VL

A

VPL - STT/DC > primary somatosensory
VPM - trigeminal and gustatory pathway > primary somatosensory
LGN - CN2 > calcarine sulcus
MGN - superior olive and inf colliuclus > auditory
VL - basal ganglia > motor cortex

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19
Q

3 cerebellar peduncles and what they carry

A

superior - output to contra motor cortex
middle - input from contra cortex
inferior - input from ipsi proprioceptive pathways

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20
Q

cerebellar deep nuclei from lateral > medial, and what does lateral do vs medial?

A

Dentate, Emboliform, Globose, Fastigial (don’t eat greasy foods)
lateral - voluntary mvmt
medial - balance/coordination

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21
Q

what composes striatum and lentiform nucleus?

A

striatum - putamen + caudate

lentiform nucleus - putamen + globus pallidus

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22
Q

direct and indirect pathway in basal ganglia

A

direct - putamen (D1) > inhib GPi > disinhibition of thalamus > inc motion

indirect - putamen (D2) > inhib GPe > disinhibition of STN > stimulation of GPi > inhibition of thalamus > dec motion

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23
Q

result of dopamine in basal ganglia pathways

A

dopamine always inc motion
direct - D1 stimulates excitatory pathway
indirect - D2 inhibits inhibitory pathway

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24
Q

Parkinson’s dz - protein accumulations

A

Lewy bodies - composed of alpha synuclein

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25
where is the lesion causing hemiballismus?
contra STN
26
tx of essential tremor
beta blockers, primidone
27
Kluver-Bucy syndrome
bilat amygdala lesions, assoc w/ HSV1 | hyperorality, hypersexuality, disinhibited behavior
28
Wernicke-Korsakoff syndrome - sx, cause
confusion, ophthalmoplegia, ataxia, memory loss, confabulation, personality change assoc w/ thiamine (B1) def and excessive ETOH, precipitated by giving glucose w/o B1 to B1 def pt
29
how to tell side of lesion based on eye direction for PPRF and FEF lesions
PPRF - eyes look away from lesion | FEF - eyes look toward lesion
30
conduction aphasia - what is it and what is the lesion
poor repetition but fluent and can comprehend | dmg to arcuate fasciculus
31
what is the primary driver behind cerebral perfusion and how can this be used to your advantage?
PCO2 | therapeutic hyperventilation - dec PCO2 to dec ICP in acute cerebral edema
32
sx of MCA stroke
contra paralysis/loss of sensation to upper limb and face | aphasia or hemineglect based on what side (dominant/nondominant)
33
sx of ACA stroke
contra paralysis/ loss of sensation of lower limb
34
sx of lateral striate artery stroke and what usually causes it
contra hemiparesis/hemiplegia | lacunar infarcts 2/2 HTN
35
sx of ASA stroke
contra hemiparesis of lower limbs dec contra proprioception tongue deviates ipsi
36
sx of PICA stroke
``` vestibular - vomiting vertigo nystagmus cerebellar - ataxia dysmetria STT - dec pain/temp sensation in face/limbs dysphagia** hoarseness ipsi Horner's ``` **lateral medullary (wallenberg's syndrome)
37
sx of AICA stroke
vestibular - vomiting, vertigo, nystagmus paralysis of face** dec pain/temp sensation in face ipsi Horner's and dec hearing ataxia dysmetria
38
sx of PCA stroke
contra hemianopsia w/ macular sparing
39
sx of AComm stroke
visual field defects (usually a berry aneurysm, not a stroke)
40
sx of PComm stroke
CN III palsy - eye down and out, ptosis, pupil dilation
41
MC site of berry aneuryism
AComm artery
42
Charcot bouchard microaneurysm - assoc w/? where?
chronic HTN | small vessel - basal ganglia, thalamus
43
where do hypertensive hemorrhages tend to occur?
basal ganglia and internal capsule
44
flow of CSF
lateral ventricles > intraventricular foramina of Monro > 3rd ventricle > cerebral aqueduct of sylvius > 4th ventricle > go to subarachnoid space via Lateral foramina of Luschka or Medial Foramen of Magendie
45
sx of normal pressure hydrocephalus
"wet wobbly and wacky" | urinary incontinence, ataxia, cog dysfn
46
2 causes of isolated LMN lesions
poliomyelitis and Wednig-Hoffman dz
47
genetic cause of ALS
defect in superoxide dismutase 1
48
Werdnig Hoffman dz
AR congenital degernation of anterior horn of SC floppy baby w/ marked hypotonia and tongue fasciculations, die at 7 mo
49
Friedreich's ataxia - inheritance, gene, sx
AR triplet repeat frataxin staggering gait, frequent falling, nystagmus, dysarthria, pes cavus (high arch), hammer toe, kyphoscoliosis, hypertrophic cardiomyopathy (cause of death)
50
sx of Horner's syndrome and what location of lesion causes it
ptosis, anhidrosis, miosis | lesion of SC above T1
51
dermatomes of - nipple, umbilicus, inguinal ligament, kneecaps
nipple T4 umbilicus T10 inguinal ligament L1 kneecap L4
52
myotomes of biceps, tricepss, patellar, and achilles reflexes
biceps - C5,6 triceps - C7,8 patellar - L3,4 achilles - S1,2
53
Parinaud syndrome
paralysis of conjugate vertical gaze due to lesion in superior colliculi like a pinealoma
54
nucleus where PSNS neurons synapse to cause pupillary constriction
Edinger Westphal nucleus
55
CN IV controls
superior oblique
56
where are the CN 3-12 nuclei located (which part of brainstem) and mnemonic for where they are lateral vs medial
midbrain - 3,4 pons - 5,6,7,8 medulla - 9,10,12 SC - 11 lateral - sensory medial - motor (both M's)
57
vagal nuclei fns
nucleus solitarius - visceral sensory info nucleus ambiguus - motor innervation of pharynx/larynx/upper esophagus dorsal motor nucleus - autonomic fibers to heart lungs upper GI
58
which CN pass through cavernous sinus?
3,4,V1,V2,6
59
with a CN V motor lesion, does jaw deviate toward or away from lesion?
toward side of lesion
60
which muscles open vs close the jaw?
open - lateral pterygoid | closed - masseter, temporalis, medial pterygoid
61
retina whitening w/ cherry red spot on fundoscopic exam
central retinal artery occlusion
62
Marcus gunn pupil
afferent pupillary defect - bilat dec in pupil constriction when light is shone in affected eye
63
in CN III, what type of nerve fibers are more vulnerable to vascular damage vs compression?
vascular - motor fibers | compression - PSNS fibers
64
drusen assoc w/
dry macular degeneration
65
Meyer's loop
carries inf retina information, loops around inferior horn of lateral ventricle (temporal loop)
66
internuclear ophthalmoplegia - lesion to what structure? what does it cause?
MLF | impaired horizontal conjugate gaze beyond midline, convergence is spared
67
protein accumulations in alzheimer's
extracellular amyloid plaques | intracellular tau tangles
68
protein accumulation in Pick's disease
pick bodies - spherical tau protein aggregates
69
Lewy body dementia - unique symptom and what protein is in Lewy bodies
hallucinations | alpha synuclein
70
2 MC causes of dementia in elderly
1 - alzheimer's | 2 - multi-infarcts
71
Charcot's classic triad of MS sx
scanning speech intention tremor nystagmus
72
other name for Guillain Barre
acute inflammatory demyelinating polyradiculopathy
73
CSF findings in Guillain Barre
inc protein w/ nl cell count
74
metachromatic leukodystrophy - what is it generally, inheritance, cause
lysosomal storage dz > impaired production of myelin AR arylsulfatase A def
75
Charcot Marie Tooth disease - what kind of disease does it cause, general pathophys
motor and sensory neuropathy | defective production of proteins needed to make myelin sheath
76
Krabbe's disease - inheritance, type of disorder, protein cause > what general problem
AR lysosomal storage disorder galactocerebrosidase def > destroys myelin sheath
77
MC site of partial seizure
medial temporal lobe
78
MC causes of seizures in kids, adults, and elderly
kids - genetic adults - tumors elderly - stroke
79
Sturge Weber syndrome
neurocutaneous disorder | port wine stains in V1 distribution, leptomeningeal angiomas, pheochromocytomas, glaucoma, seizures, hemiparesis, MR
80
3 MC primary brain tumors
1 - glioblastoma 2 - meningioma 3 - schwannoma
81
brain tumor w/ "pseudopalisading" pleomorphic tumor cells. central areas of necrosis w/ hemorrhage
glioblastoma
82
brain tumor w/ spindle cells in a whorled pattern, psammoma bodies
meningioma
83
MC type of pituitary adenoma
prolactinoma
84
Rosenthal fibers assoc w/
pilocytic astrocytoma (benign childhood brain tumor)
85
Homer-Wright rosettes assoc w/
medulloblastoma
86
craniopharyngioma is derived from what?
remnants of Rathke's pouch
87
MC childhood supratentorial tumor
craniopharyngioma
88
5 types of drugs used for glaucoma
alpha agonists - epi, brimonidine beta blockers - timolol, betaxolol, carteolol diuretics (CA inhibs) - acetazolamide cholinomimetics - pilocarpine, carbachol, physostigmine, echothiophate prostaglandins - PGF2alpha - latanoprost
89
mechanism of opioids
open K channels, close Ca channels > dec synaptic transmission > inhibit NT release
90
butorphanol
mu opioid receptor partial agonist and kappa opioid agonist > produces analgesia w/ less respiratory depression
91
tramadol
weak opioid agonist. also inhib serotonin and NE reuptake. used for chronic pain
92
1st line drug for partial seizures
carbamazepine
93
1st line for absense seizures
ethosuximide
94
1st line for status epilepticus (acute vs prophylaxis)
acute - benzos | prophylaxis - phenytoin
95
1st line seizure med in kids
phenobarbital
96
tox of carbamazepine
diplopia, ataxia, blood dyscrasias (agranulocytosis, aplastic anemia), liver tox, SIADH, Stevens Johnson syndrome, teratogen
97
tox of ethosuximide
GI distress, fatigue, HA, urticaria, Stevens Johnson
98
tox of phenytoin
nystagmus, diplopia, ataxia, sedation, gingival hyperplasia, hirsutism, megaloblastic anemia, teratogen, drug induced lupus, LAN, Stevens Johnson, osteopenia
99
tox of valproic acid
GI distress, fulminant hepatotox (rare), neural tube defects, tremor, wt gain
100
mech of phenytoin
blockade of Na channels > inhib glutamate release
101
mech of barbiturates
facilitate GABAa action by inc duration of Cl channel opening
102
barbiturates are contraindiated in what condition
porphyrias
103
benzos mech
facilitate GABAa action by inc frequency of Cl channel opening
104
what do you treat benzo OD w/?
flumazenil
105
zolpidem, zaleplon, eszopiclone - mech, use
nonbenzo hypnotics - act via BZI subtype of GABA receptor | tx insomnia
106
MAC as it relates to anesthetics
minimum alveolar conc at which 50% of population is anesthetized inversely related to potency
107
which drugs can cause malignant hyperthermia?
all inhaled anesthetics except nitrous oxide
108
thiopental - class, use
barbiturate | IV anesthesia - used for induction and short procedures
109
midazoloam - class, use
benzo | IV anesthesia - MC drug used for endoscopy
110
arylcyclohexamines - ex, mech
ketamine | PCP analog - block NMDA receptors
111
propofol - mech, use
potentiates GABAa | sedation in ICU and short procedures
112
how to tell esters from amides in local anesthetics
amides have 2 i's in the name, esters just have 1
113
tricks w/ local anesthetics - how to increase local action? using in infected areas?
local action increased by vasoconstrictors like epi | infected tissue is more acidic > anesthetics stay charged > can't penetrate membranes > need more anesthetic
114
order of sensation loss w/ local anesthetics
pain > temp > touch > pressure
115
which type of local anesthetic tends to have allergic reactions?
esters
116
succinylcholine - mech and tox
depolarizing NMJ blocker | hyperCA, hyperK, malignant hyperthermia
117
nondepolarizing NMJ blockers naming
-cur- (ex vecuronium)
118
reversing NMJ blockers
use cholinesterase inhibs like neostigmine
119
dantrolene - mech, use
prevent release of Ca from sarcoplasmic retic | tx malignant hyperthermia and neuroleptic malignant syndrome
120
tx of malignant hyperthermia
dantrolene
121
tx modalities for parkinson's dz
``` DA agonists (bromocriptine -ergot, non ergots: pramipexole, ropinirole) inc DA - carbidopa, amantadine (inc DA release) prevent DA breakdown - selegiline (MAOb inhib), entacapone/tolcapone (COMT inhib) curb excess cholinergic activity - benztropine (helps w/ tremor and rigidity but not bradykinesia) ```
122
selegiline - mech, use
``` MAOb inhib (preferentially reduce breakdown of DA over NE / 5-HT) parkinson's ```
123
memantine - mech, use
NMDA receptor antagonist - prevent excitotox | alzheimer's
124
donepezil / galantamine / rivastigmine - mech, use
AChE inhibs | alzheimer's
125
tetrabenazine / reserpine - mech, use
inhibit VMAT - limit DA vesicle packaging and release | huntington's
126
tx for Huntington's
tetrabenazine and reserpine | haloperidol
127
sumatriptan - mech, use, tox
5HT 1b/1d agonist, inhib trigeminal nerve activation, induce vasoconstriction acute migraine, cluster HA tox - coronary vasospasm

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