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Step 1 Smart Book > Neuro > Flashcards

Neuro Flashcards

1
Q

The vein that drains the upper eyelid drains directly into what dural venous sinus?

A

Superior ophthalmic vein drains directly into cavernous sinus

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2
Q

What structure does poliovirus infect?

A

Alpha motor neurons of the ventral horn of the spinal cord

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3
Q

What visual field defect is associated with Wernicke’s aphasia?

A

Upper quadrantic anopia because the dorsal radiations are also located in the temporal lobe

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4
Q

What cerebrovascular syndrome involves the hypoglossal nucleus and what artery is affected in this syndrome?

A

Medial medullary - anterior spinal artery

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5
Q

What are the two free-living amoeba that can infect the brain and what characterizes the populations they infect?

A

Naegleria fowleri - swimmers/divers

Acanthamoeba - immunosuppressed (HIV, diabetics, alcoholics)

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6
Q

What is torticollis and what drugs is it associated with?

A

Torticollis - involuntary twisting or deviation of the neck, neck pain, the presence of a sensory tick, and abnormal head posture

Associated with dopamine receptor blocking drugs like antipsychotics (e.g. fluphenazine, haloperidol) and other dopamine antagonists (e.g. metoclopromaide, prochlorperazine)

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7
Q

What are effective pharmacologic treatments for OCD?

A
  1. Tricyclic antidepressants (e.g. clomipramine)

2. Selective serotonin reuptake inhibitors (e.g. fluoxetine)

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8
Q

What are the characteristic findings of Friedreich ataxia?

A

Progressive ataxia and severe dysarthria with onset in childhood; other classic findings include loss of reflexes, spasticity, extensor plantar responses, and impaired vibration and position sense

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9
Q

What are the genetics of Friedreich ataxia?

A

Autosomal recessive with trinucleotide repeat of GAA expansion

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10
Q

What are symptoms associated with using PCP (phencyclidine)?

A

Disorientations, detachment, reckless behavior, impaired judgment, distortions of body image

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11
Q

What is the Moro reflex and when does it disappear?

A

Startling an infant can produce extension and abduction of the arms followed by flexion and adduction of the arms. This is a normal reflex that disappears sometime between 3 and 6 months.

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12
Q

What is the characteristic histologic finding in HIV encephalitis?

A

Multinucleated giant cells

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13
Q

Where are the opacifications in cataracts located?

A

Lens

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14
Q

Where are the two places of greatest neuronal degradation in ALS?

A
  1. Cerebral cortex (UMN)

2. Spinal cord anterior horn (LMN)

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15
Q

What muscle does the median nerve pass through as it crosses the elbow to the forearm?

A

Pronator teres

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16
Q

What is progressive supranuclear palsy?

A

Pathologic changes: widespread neuronal loss and gliosis in subcortical sites with sparing of cerebral and cerebellar cortices

Clinical presentation: Ophthalmoplegia, pseudobulbar palsy (dysarthric speech), axial dystonia, bradykinesia

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17
Q

Give the anatomic location of dopaminergic neurons that are lost in Parkinson’s.

A

Substantia nigra pars compact in the midbrain - between the cerebral peduncles and the midbrain tegmentum (part of the midbrain that is between the cerebral peduncles and the cerebral aqueduct)

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18
Q

What sort of signal seems to initiate multiple sclerosis?

A

CD4+ T lymphocytes that react against self myelin antigens secrete cytokines like interferon-gamma to activate macrophages which are then responsible for the demyelination

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19
Q

What is the most common LMN disease in infants and what part of the spinal cord is preferentially affected?

A

Werdnig Hoffman or infantile muscular spinal atrophy involves atrophy of the anterior or ventral horns

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20
Q

What is the first line treatment for someone with status epilepticus?

A

Benzodiazepines (e.g. lorazepam or diazepam)

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21
Q

The orbital floor is also the roof of what sinus?

A

Maxillary

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22
Q

What nerve goes through the foramen ovale?

A

Mandibular (V3) nerve

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23
Q

What nerve carries general somatic sensation from the anterior 2/3 of the tongue?

A

Mandibular (V3) nerve

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24
Q

How is herpesvirus transported into neuronal bodies? By what mediator?

A

Retrograde axonal transmission - mediated by dynein

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25
Q

What is confabulation and what disease process is associated with this symptom?

A

Patient unconsciously makes up explanations for events that would otherwise be inexplicable - different from lying because it happens in the context of memory loss

Confabulation is a key symptom in Wernicke-Korsakoff syndrome

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26
Q

What is a strong social history association with Wernicke-Korsakoff syndrome?

A

Chronic alcoholism

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27
Q

What distinguishes type I from type II Arnold Chiari malformations?

A

Type I - usually asymptomatic, herniation of cerebellar tonsils into foramen magnum

Type II - often presents with hydrocephalus and brainstem dysfunction, herniation of parts of the hindbrain/cerebellar vermis/4th ventricle

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28
Q

What does a cerebellar abscess look like on MRI and what is its most common cause?

A

Multilocular mass with ring-enhancing borders

Associated with otitis media

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29
Q

What is the classic presentation of Creutzfeld-Jacob disease?

A

Rapidly progressive dementia with some motor symptoms (startle myoclonus) and abnormal EEG activity

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30
Q

What are the most common bacterial causes of abscess in the brain?

A

Staph, strep, bacteroides

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31
Q

What is a myelomeningocele? The failure of what process embryologically can lead to it?

A

Herniation of the meninges and spinal cord through a defect in the posterior vertebra and skin

Caused by failure closure of the caudal neuropore

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32
Q

Describe the mechanism of benzodiazepines.

A

Potentiate GABA effects (agonist) by binding to chloride ion channels and increasing their conductance/frequency of opening

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33
Q

What artery is most commonly involved in an epidural hematoma and where is it located in the brain?

A

Middle meningeal artery in the middle cranial fossa

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34
Q

In visual processing, what is the difference between the temporo-occipital association cortex vs. parieto-occipital association cortex?

A 
Temporo-occipital = the "what"
Parieto-occipital = the "where"
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35
Q

What should you be suspicious of in a patient with neurologic symptoms presenting several days to weeks after a traumatic head injury?

A

Subdural hematoma

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36
Q

What are common clinical findings in a patient with sciatica?

A

MOTOR:

  1. Weakened extension of the thigh
  2. Loss of flexion of the knee
  3. Loss of function below the knee

SENSORY: pain/sensory loss on the posterior thigh, lateral leg, entire foot

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37
Q

What kind of drugs can precipitate an acute closure glaucoma?

A

Drugs with anticholinergic effects because muscarinic receptors on the pupillary constrictor muscle are blocked –> pupil dilates –> narrows or closes the angle in the anterior chamber of the eye

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38
Q

What are significant side effects of amitriptyline?

A

TCA with significant anticholinergic side effects

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39
Q

What is seen on biopsy of a toxoplasmosis lesion?

A
  1. Large, round encysted bradyzoites

2. Free, crescent-shaped tachyzoites

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40
Q

Why does severe retinopathy of prematurity occur and what is its signature finding on retinal exam?

A

Hypoxia stimulates vascular proliferation - major risk factors include prematurity and intensive oxygen treatment

Finding: white pupillary reflex

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41
Q

Through what structure does CSF flow out of the lateral ventricles?

A

Bilateral foramina of Monro

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42
Q

What is the mechanism of imipramine?

A

Tricyclic antidepressant that inhibits the reuptake of serotonin and norepinephrine

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43
Q

Describe the characteristic histologic appearance of an oligodendroglioma.

A

“Fried egg” cells - round nuclei with clear cytoplasm

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44
Q

What neurotransmitter is most important for induction of REM sleep?

A

Acetylcholine

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45
Q

How can altering the activity of pyruvate dehydrogenase mimic thiamine deficiency?

A

Pyruvate dehydrogenase uses a number of co-factors including TPP (from the vitamin thiamine) to convert pyruvate to acetyl-CoA

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46
Q

What characterizes benign essential tremor?

A

6-12 Hz tremor primarily affecting the arms

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47
Q

What are effective first-line treatments for essential tremor?

A

Propanolol (beta blocker) and primidone (barbiturate)

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48
Q

What virus infects oligodendrocytes?

A

JC virus –> PML

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49
Q

What is the most common viral encephalitis in the U.S. and where is it localized to in the brain?

A

HSV-1 localizes to the temporal lobe

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50
Q

What is the triad for normal pressure hydrocephalus?

A

Wacky (dementia), wet (urinary incontinence), wobbly (apraxic)

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51
Q

Contrast the typical location of a subarachnoid hemorrhage caused by a berry aneurysm vs. AVM.

A

Berry aneurysms are usually centered near the base of the brain whereas AVM’s typically involve the superficial or deep cerebral hemispheres.

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52
Q

What is the most common vector for viral encephalitis during the summer months?

A

Arthropods (mosquitoes)

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53
Q

What is the classic cause of chronic meningitis?

A

Tuberculosis (mycobacteria)

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54
Q

What drugs are the preferred treatment for withdrawal symptoms in a patient with liver disease?

A

Benzodiazepines that are metabolized through phase II processes - lorazepam, oxazepam, temazepam

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55
Q

Where do axons from the olfactory bulb go?

A

Piriform cortex

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56
Q

What encephalitis is measles associated with?

A

Subacute sclerosing panencephalitis - rare complication occurring years after measles infection consisting of personality change, seizures, myoclonus, ataxia, photosensitivity, ocular abnormalities, spasticity, coma

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57
Q

Where do the majority of intraparenchymal hemorrhages occur from?

A

Basal ganglia and internal capsule

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58
Q

What kind of drug is phenelzine?

A

MAO inhibitor

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59
Q

If on CT, you see a bleed that is crescent shaped, does not cross the midline, but extends across different suture lines, you should be suspicious of what?

A

Subdural hematoma

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60
Q

Which pharyngeal arches give rise to the vessels in the circle of Willis?

A

4 and 6

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61
Q

What supplies sensation for the anterior half of the external ear canal?

A

Auriculotemporal nerve

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62
Q

What happens in the gag reflex if you just lose the motor component (vagus nerve)?

A

When you stimulate the gag afferent limb (CN IX), you will not elicit a gag on the ipsilateral side but you should still see contralateral raising of the palate and uvula deviation to the contralateral side

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63
Q

What side effects do you expect to see with benztropine?

A

Benztropine is an antimuscarinic so it has anti-SLUDGE properties: cause decreased Salivation, Lacrimation, Urination, Defecation, GI motility, Emesis. Therefore for side effects, they cause xerostomia (dry mouth), tachycardia, bronchodilation, mydriasis, blurred vision, and fever.

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64
Q

What is the mechanism of action of sumatriptan?

A

5HT (1D/1B) agonist

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65
Q

What antidepressant is good for treating both Parkinson disease and depression?

A

Tricyclics (e.g. amitryptyline) because they have strong anticholinergic properties and Parkinson’s neurotransmitter imbalance comes from depleted dopamine/too much ACh.

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66
Q

What is the mechanism of action of typical antipsychotics?

A

D2 receptor antagonists

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67
Q

Aneurysm of which three arteries may compress the oculomotor nerve as it exits the brain stem?

A

Superior cerebellar artery, posterior cerebral artery, basilar artery

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68
Q

What neurotransmitter is important for the induction of REM sleep?

A

Acetylcholine

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69
Q

In sensorineural hearing loss, what is damaged?

A

Hair cells of the organ of Corti

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70
Q

What is the time frame for an epidural hematoma?

A

1 - 48 hours

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71
Q

What nerve root mediates the Achilles tendon reflex?

A

S1

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72
Q

What are the two types of local anesthetics?

A

Esters - have only one I in their spelling

Amides - have 2 I’s in their spelling

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73
Q

How can altering the activity of pyruvate dehydrogenase mimic thiamine deficiency?

A

Pyruvate dehydrogenase uses a number of co-factors including TPP (from the vitamin thiamine) to convert pyruvate to acetyl-CoA

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74
Q

What is the first line treatment for a seizure in which someone remains unconscious for more than 30 minutes (status epilepticus)?

A

Benzodiazepines

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75
Q

What syndrome might a family history of retinal angiomas suggest?

A

Von Hippel-Lindau disease

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76
Q

What aside from toxoplasmosis can cause multicentric ring-enhancing mass lesions in the brain and meninges?

A

CNS lymphoma

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77
Q

What do pseudounipolar cells of the spinal and cranial nerve ganglia derive from?

A

Neural crest cells

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78
Q

What nerve mediates hip abduction?

A

Superior gluteal nerve

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79
Q

What kind of bleed does a ruptured berry aneurysm cause?

A

Subarachnoid hemorrhage

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80
Q

What disease is marked by wasting of muscles of the anterior compartment of the leg, foot drop, and pes cavus (high-arched feet)?

A

Charcot-Marie Tooth

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81
Q

What nerve is most commonly affected in Charcot-Marie Tooth?

A

Deep peroneal nerve

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82
Q

What is a life-threatening complication of reactivated herpes zoster (shingles) in AIDS patients?

A

Multifocal encephalitis

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83
Q

What syndrome causes:

  • vertigo, nystagmus, nausea, vomiting (vestibular nuclei)
  • ipsilateral cerebellar signs (inferior cerebellar peduncle)
  • dysphagia and dysphonia (nucleus ambiguus)
  • loss of pain and temperature in ipsilateral face and contralateral body (spinal tract and nucleus of trigeminal nerve)
  • Horner syndrome (descending hypothalamics)
A

Lateral medullary or Wallenberg’s (PICA occlusion)

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84
Q

What disease does deficiency of arylsulfatase A (cerebroside sulfatase) result in?

A

Metachromatic leukodystrophy

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85
Q

What tends to cause a subarachnoid hemorrhage that centers over one of the hemispheres?

A

AVM

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86
Q

Which streptococcus can cause meningitis?

A

Pneumococcus

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87
Q

How can we prevent a newborn from getting group B strep from a mother with the infection?

A

Give the mother IV ampicillin during labor

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88
Q

What does a 6-7 year old child presenting with changes in personality, behavior, memory, myoclonic jerks, blindness, and spasticity likely have if there is a history of measles?

A

Subacute sclerosing panencephalitis

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89
Q

What type of tumor can cause a vertical gaze palsy by compressing the vertical gaze center in the tectum of the midbrain?

A

Pinealoma

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90
Q

What cranial nerve passes by the superior cerebellar artery?

A

Oculomotor

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91
Q

Why is tooth enamel organ likely to appear on histological examination of a craniopharyngioma?

A

Craniopharyngiomas are derived from Rathke’s pouch (oral ectoderm)

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92
Q

Microscopically, which brain tumor forms a whorling pattern?

A

Meningioma

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93
Q

How do you treat an essential tremor?

A

Beta blocker

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94
Q

What is the diagnosis for progressive bilateral tremors of the upper extremity without other neurological symptoms?

A

Essential tremor

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95
Q

When does the Moro reflex normally disappear?

A

3 - 6 months

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96
Q

What disease is suggested by large abnormal oligodendrocytes with eosinophilic inclusions?

A

PML because JC virus infects oligodendrocytes

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97
Q

What tumor is associated with bitemporal hemianopsia?

A

Pituitary adenoma (prolactinoma)

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98
Q

How does Group B Strep test on the CAMP test?

A

Positive

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99
Q

What nerve passes through the greater sciatic foramen?

A

Superior gluteal

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100
Q

What is the Cushing response or reflex (hypertension, bradycardia, irregular breathing) in a trauma in response to?

A

Increased intracranial pressure

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101
Q

What are the two main effects of amphetamines?

A
  1. Induce dopamine release (important for reward/reinforcing effects of these drugs)
  2. Induce norepinephrine release (responsible for systemic side effects like HTN)
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102
Q

Presentation: Hemiparesis and loss of tactile/proprioception/vibration sense on the same side of the body, tongue deviates to the opposite side

Diagnosis?

A

Medial medullary syndrome - infarction of the anterior spinal artery

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103
Q

What should you be suspicious of in a child with infection symptoms with white spots on the buccal mucosa?

A

Measles (white spots on the buccal mucosa = Koplik spots)

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104
Q

What do you see histologically with measles?

A

Syncytia (common in all members of paramyxoviridae) - formed from the fusion of the infected cells

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105
Q

What type of seizure is characterized by sudden loss of postural tone that lasts only a few seconds?

A

Atonic

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106
Q

What is cyclobenzaprine?

A

Tricyclic amine salt used as a spasmolytic with antimuscarinic side effects similar to TCA’s

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107
Q

What is the underlying pathophysiologic process in Guillain Barre?

A

Autoimmune attack on the myelin of peripheral nerves

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108
Q

What brain cancer occurs in the cerebral hemispheres and has a histologic finding of clear cells with round nuclei?

A

Oligodendroglioma (they have “fried egg” cells on histology)

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109
Q

What branch of the trigeminal nerve supplies the upper lip?

A

V2

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110
Q

What organisms cause temporal lobe abscess?

A

Staph, strep, bacteroides

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111
Q

Meningitis caused by gram-positive in pairs and short chains. What is the organism?

A

Streptococcus pneumoniae

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112
Q

What enzyme is thiamine a cofactor for?

A

Pyruvate dehydrogenase

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113
Q

What is the difference between superficial vs. deep peroneal nerves?

A

Deep peroneal nerve - foot drop, more anterior compartment (associated with lead poisoning)

Superficial peroneal nerve - eversion, more lateral compartment

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114
Q

What is neurosyphiilis?

A

Late sequela of syphilitic infection (5 - 20 years later) with mental deterioration that eventually leads to general paralysis with mutism and incontinence

Mnemonic: PARESIS
Personality
Affect
Reflexes (hyperactive)
Eyes (Argyll Robertson)
Sensorium defects
Intellectual decline
Speech deficiency
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115
Q

Why are Alzheimer patients at increased risk of hemorrhage?

A

Cerebral amyloid angiopathy makes vessel weak and prone to rupture

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116
Q

What virus infects oligodendrocytes?

A

JC virus

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117
Q

When a patient cannot adduct the eye, how do you differentiate between an MLF lesion vs. a CN III lesion?

A

Check convergence. Someone with a CN III lesion will not be able to converge whereas someone with an MLF lesion can converge and only has a problem with conjugate movements.

Can also check to see if the pupillary reflexes are intact (should be intact in MLF but impaired with CN III lesion)

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118
Q

What is the role of the enzyme PNMT (phenylethanolamine-N-methyltransferase)?

A

Converts norepinephrine into epinephrine

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119
Q

What are the functions of CN IX?

A
  1. Salivation (parotid gland)
  2. Taste and tactile sensation for posterior 1/3 of the tongue
  3. Tactile sensation from external ear, pharynx, middle ear, auditory
  4. Input from carotid sinus/body
  5. Motor efferents to stylpharyngeus muscle
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120
Q

What atrophies in Friedreich ataxia?

A

Spinal cord, dorsal root ganglia, and to a lesser extent the cerebellum

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121
Q

What are tertiary syphilitic granulomas (gummas) made of?

A

Modified (epithelioid) macrophages

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122
Q

What should you be wary of in treating patients with Klebsiella infection (think associated social history and potential complications)?

A

Watch out for withdrawal symptoms from alcoholism - treat with benzodiazepines (specifically LOT: lorazepam oxazepam, temazepam)

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123
Q

Patient with neurological symptoms that cannot be explained by one focal lesion - suspect what?

A

Multiple sclerosis

124
Q

What does MS show on MRI?

A

Scattered, peri-ventricular lesions (caused by oligodendrocyte depletion)

125
Q

What is it called when someone has double vision walking down stairs and what does it indicate?

A

Vertical diplopia - trochlear nerve palsy

126
Q

Overuse of what vitamin can lead to intracranial hypertension, skin changes, hepatosplenomegaly?

A

Vitamin A

127
Q

Contrast Guillain Barre vs. polymyositis in terms of endoneural vs endomysial inflammatory infiltration.

A

Guillain Barre - endoneural

Polymyositis - endomysial

128
Q

What is the best way to prevent neonatal tetanus?

A

Vaccinate mom with tetanus toxoid during pregnancy

129
Q

Calcified cystic mass with thick brownish cholesterol-rich fluid inside. Accompanied by headaches and visual changes. Diagnosis?

A

Craniopharyngioma

130
Q

What are enteroviruses?

A

Picornaviruses except for rhinovirus (rhinovirus is the only one that isn’t transmitted fecal-oral)

131
Q

What is often the cause of aseptic meningitis?

A

Enteroviruses (Polio, Echo, Coxsackie)

132
Q

Why should you be careful to use TCA’s in patients with BPH?

A

Anticholinergic properties may cause urinary retention

133
Q

“Foamy histiocytes” filled with sphingomyelin accumulate in the liver, skin, and spleen in what disease?

A

Niemann-Pick

134
Q

In the U.S., the majority of overdose deaths are caused by what drugs?

A

Prescription drugs - in particular opioids

135
Q

If a child has very high levels of arginine (associated with spastic paresis of his lower extremities and choreoathetoid movements), what enzyme deficiency are you suspicious of?

A

Arginase - the enzyme that normally produces urea and ornithine from arginine

136
Q

Describe the defect in maple syrup urine disease.

A

Defect in alpha-keto acid dehydrogenase leading to an inability to degrade branched chain amino acids (e.g. leucine, isoleucine, valine)

137
Q

What is the difference between schizoaffective disorder and bipolar disorder with psychotic features?

A

Schizoaffective must have a period of at least 2 weeks of psychotic symptoms without mood symptoms

138
Q

Describe latent period effect.

A

The initial steps in pathogenesis and/or exposure to a risk factor sometimes occur years before clinical manifestations of a disease are evident

139
Q

Describe the relationship between narcolepsy and cataplexy.

A

Cataplexy is one of the symptoms/manifestations of narcolepsy

140
Q

On PE you see small, irregularly shaped pupils that do not react with light but do constrict with accommodation. What is this finding and what is it indicative of?

A

Argyll-Robertson pupil; indicative of tabes dorsalis

141
Q

What should patients taking levadopa be cautious of taking in addition?

A

B6 (found in most multivitamins) because it increases the peripheral metabolism of levadopa which decreases its effectiveness

142
Q

In Wernicke-Korsakoff syndrome, what defect is permanent even once thiamine is repleted?

A

Memory loss

143
Q

What is the significant of blotchy red muscle fibers on Gomori trichome stain?

A

Mitochondrial myopathies

144
Q

What is believed to be the underlying mechanism in the alteration of gene expression in Huntington disease?

A

Hypermethylation of histones

145
Q

Symmetric degeneration of both dorsal columns and corticospinal tracts (ascending AND descending) is suggestive of what pathology?

A

B12 deficiency - subacute combined degeneration

146
Q

Contrast the eye findings in use of thioridazine vs. chlorpromazine.

A

Thioridazine - retinal deposits

Chlorpromazine - corneal deposits

147
Q

Most of the toxic effects from infection with Neisseria meningitidis comes from what?

A

Outer membrane lipooligosaccharide - analogous to LPS

148
Q

What is the major cause of lacunar infarcts?

A

Hypertensive arteriosclerosis of small penetrating arterioles

149
Q

How would you treat TCA-associated cardiac abnormalities?

A

Sodium bicarbonate

150
Q

What is tetrodotoxin?

A

Pufferfish poison that binds to voltage-gated sodium channels and inhibits the influx of sodium

151
Q

What is used for prenatal diagnoses of neural tube defects?

A

Elevated alpha fetal protein and acetylcholinesterase levels (they leak out from fetal cerebrospinal fluid in the case of NTD)

152
Q

How is cryptococcus neoformans diagnosed?

A

India ink stain - the background is stained while the organism remains transparent

153
Q

What is the main treatment for cryptococcus neoformans?

A

Amphotericin B and flucytosine

154
Q

How is listeria eliminated from the body?

A

Cell-mediated immunity (macrophage activation and killing)

155
Q

Where does rabies virus bind?

A

Acetylcholine receptors

156
Q

Presentation: fever, severe agitation, disorientation, hallucinations, light sensitivity, dysphagia, excessive salivation - diagnosis?

A

Rabies

157
Q

Where is Broca’s area located?

A

Inferior frontal gyrus of the dominant lobe

158
Q

Baby with diaper that smells like burnt sugar - diagnosis?

A

Maple syrup urine disease - defective breakdown of branched chain amino acids (leucine, isoleucine, valine)

159
Q

Branched chain alpha ketoacid dehydrogenase, pyruvate dehydrogenase and alpha ketoglutarate dehydrogenase all require which 5 cofactors?

A

Mnemonic: tender loving care for nancy

Thiamine pyrophosphate
Lipoate
Coenzyme A
FAD
NAD
160
Q

How do we treat orotic aciduria?

A

Supplementation with uridine (which can be converted to UMP and go on to make pyrimidines)

161
Q

The FDA requires periodic monitoring of what with administration of clozapine?

A

WBC count because of the risk of agranulocytosis (the other important side effect is seizure)

162
Q

Where is urea’s nitrogen derived from?

A

NH3 and asparatate

163
Q

How can Horner’s syndrome affect the arm/forearm?

A

Can compress the ipsilateral brachial plexus leading to weakness and/or sensation deficits in the ipsilateral arm and forearm

164
Q

Presentation: Mental retardation, facial deformities and macroorchidism - diagnosis?

A

Fragile X syndrome

165
Q

What lab test is uniformly elevated in patients with temporal arteritis?

A

ESR

166
Q

Most sympathetic output to the viscera involves a 2 neuron system that ultimately synapses on what kind of receptor?

A

Noradrenergic

167
Q

What are the two exceptions to the typical set up of sympathetic output?

A
  1. Adrenal glands - directly innervated by the preganglionic neuron which secretes ACh
  2. Sweat glands - 2 neuron system that both use ACh
168
Q

What drug is indicated for patients that suffer from both tonic-clonic and absence seizures?

A

Valproate

169
Q

Autopsy of the brain: bilateral wedge-shaped bands of necrosis seen over cerebral convexity - diagnosis?

A

Hypoxic encephalopathy (from ischemia)

170
Q

Presentation: Child with difficulty walking, frequent respiratory infections, and cultured cells showing a high rate of radiation induced genetic mutation. Diagnosis?

A

Ataxia-telangiectasia

171
Q

What would you see with ataxia-telangiectasia in the brain?

A

Cerebellar atrophy

172
Q

What immune deficiency predisposes someone to getting Neisseria infections?

A

Inability to form membrane attack complex - deficiency of complement

173
Q

Presentation: Abdominal pain, neuropsychiatric manifestations, color change in urine upon standing - diagnosis?

A

Acute intermittent porphyria

174
Q

What are 2 treatments for the acute intermittent porphyria?

A

Glucose and IV heme

175
Q

How does glucose help acute intermittent porphyria?

A

Represses ALA synthase activity

176
Q

What accumulates in Tay Sach’s disease?

A

GM2 ganglioside (cell membrane glycolipid)

177
Q

What is the primary site of entry for cryptococcus neoformans?

A

Lungs

178
Q

Kyphoscoliosis, foot abnormalities, heart failure, and neurologic symptoms should make you suspicious of what inherited disorder?

A

Friedrich ataxia

179
Q

What infectious organism is associated with Guillain Barre?

A

Campylobacter jejuni

180
Q

What drug has a similar mechanism of action as benzodiazepines but a much lower risk of tolerance dependence?

A

Zolpidem

181
Q

What vitamin deficiency closely resembles Friedrich ataxia in how it causes degeneration of spinocerebellar tracts, dorsal columns, and peripheral nerves?

A

Vitamin E

182
Q

Foci of hemorrhage and necrosis in the mamillary bodies and periaqueductal gray matter in an alcoholic on autopsy are suggestive of what?

A

Thiamine deficiency

183
Q

What test can be used to look for thiamine deficiency?

A

Erythrocyte transketolase activity - thiamine is a cofactor for transketolase, pyruvate dehydrogenase, and alpha ketoglutarate dehydrogenase

184
Q

What is the difference between schizophreniform and schizophrenia?

A

Schizophreniform - symptoms for 1 to 6 months vs. schizophrenia - more than 6 months

185
Q

What is the equation to calculate a 95% confidence interval?

A

Mean +/- 1.96 * SD/sqrt(n)

186
Q

What is the equation to calculate a 99% confidence interval?

A

Mean +/- 2.58 * SD/sqrt(n)

187
Q

What is the best way to prevent vertical transmission of tetanus?

A

Vaccination of young adults - mom will then have IgG against tetanus which will be passed on to the infant through the placenta

188
Q

What is the point of edrophonium test?

A

For myasthenia gravis if you give edrophonium and it works, it means the patient is being undertreated. If it doesn’t work, it suggests the patient is having a cholinergic crisis.

189
Q

What is the incidence of a disease?

A

Number of NEW cases per year divided by total population at risk

190
Q

Why is there variable severity in mitochondrial diseases?

A

Heteroplasmy - random distribution of normal and mutated mitochondria between daughter cells during mitosis

191
Q

How is delusional disorder different from schizophrenia?

A

Delusional disorder usually involves a single overriding delusion that is non-bizarre (unlikely but theoretically possible delusion). These patients can function without significant impairment in day to day life.

192
Q

Presentation: infant without prenatal care born to a homeless mother has shrill crying, tremor, rhinorrhea, sneezing, and diarrhea - diagnosis?

A

Opiate withdrawal

193
Q

What is the treatment for opiate withdrawal in a neonate?

A

Opium solution

194
Q

What does cryptococcus neoformans look like on CSF?

A

Round or oval budding yeast

195
Q

How does neisseria meningitidis gain access to the blood stream?

A

Pharynx –> blood –> choroid plexus –> meninges

196
Q

Methylmalonic acidemia results from a defect in what reaction?

A

The isomerization of methylmalonic coA to succinyl coA

197
Q

What enzyme is upregulated in Lesch Nyan syndrome?

A

PRPP amidotransferase in order to increase de novo purine synthesis because of the increase in substrate (PRPP) since in Lesch Nyan syndrome, you have a deficit in the enzyme HGPRT which results in failure of purine salvage.

198
Q

How does a muscarinic agonist produce vasodilation?

A

Promotes endothelial cells to release NO (EDRF) –> activates guanylate cyclase –> increased cGMP –> activates Ca pump –> Ca efflux –> vascular smooth muscle wall relaxation

199
Q

Psamomma bodies are characteristic of which brain tumor?

A

Meningioma

200
Q

Presentation: Aggression, nystagmus, ataxia, agitation, disorientation, confusion - what drug did this person take?

A

PCP

201
Q

What is the main difference between low potency and high potency antipsychotics?

A

Low potency - more likely to cause non-neurologic side effects (sedation, anticholinergic, orthostatic hypertension) vs. high potency - more likely to cause extrapyramidal side effects (dystonia, akathisia, parkinsonism)

202
Q

What injury typically causes weak wrist extension but no sensory deficits?

A

Radial head subluxation - damages the deep part of the radial nerve

203
Q

What is the difference between mass lesion at the cerebellopontine angle vs. Meniere’s disease?

A

Cerebellopontine angle - symptoms would be constant vs. Meniere’s disease - symptoms come and go in episodes

204
Q

What nerve root is involved with pain in the posterior thigh and leg as well as diminuition of the ankle jerk reflex?

A

S1

205
Q

What part of the brain is first damaged in global cerebral ischemia?

A

Hippocampus

206
Q

What cranial nerve does transtentorial herniation affect?

A

Oculomotor

207
Q

Ornithine transport into the mitochondria is essential for what process?

A

Formation of urea

208
Q

What cranial nerve arises at the level of the middle cerebellar peduncle (you can see the connection between the cerebellum and the brain stem)?

A

Trigeminal

209
Q

Hypertensive crisis after eating certain foods on an antidepressant med should make you think of?

A

MAO inhibitor - anything containing tyramine (e.g. wine and cheese party)

210
Q

Why is coadministration of an SSRI and MAOI contraindicated?

A

Could result in really high levels of serotonin since SSRI inhibits its reuptake while MAOI inhibits its degradation - wait 2 weeks after discontinuing an MAOI before starting SSRI for enzyme levels to readjust since MAOI binds irreversibly and enzyme levels increase in response to the drug

211
Q

What 2 enzymes does lead inactivate?

A

ALAD and ferrochelatase

212
Q

Which receptor does naloxone have the greatest affinity for?

A

Mu

213
Q

What is the problem in Meniere’s disease?

A

Defective resorption of endolymph causes an increased volume of endolymph in the inner ear

214
Q

What brain tumor is associated with paralysis of upward gaze?

A

Parinaud syndrome is associated with brain germinomas which are typically tumors of the pineal gland

215
Q

Total sensory loss on the contralateral side of the body is indicative of what?

A

Thalamic syndrome - no motor deficits but proprioception is profoundly affected so patient is very subject to falls

216
Q

Does bulimia nervosa necessarily have a purging component?

A

No - the patient can exhibit other compensatory behaviors for binge eating (e.g. intense exercise, diet, or fasting)

217
Q

What is the mechanism of action of ethosuxamide?

A

Blocks T type calcium channels

218
Q

What is the mechanism of action of phenytoin, carbamazepine, valproic acid?

A

Inhibits neuronal high-frequency firing by reducing ability of Na channels to recover from inactivation

219
Q

Which antidepressant does NOT have sexual side effects?

A

Bupropion

220
Q

When treating cholinergic crisis with atropine, what effects do we still need to worry about?

A

Muscle paralysis because atropine only blocks muscarinic receptors and cholinergic crisis also has some nicotinic effects (this is why we give pralidoxime)

221
Q

At what point in the action potential is K conductance greatest?

A

During repolarization (NOT at the overshoot)

222
Q

What 2 opioid side effects are resistant to tolerance?

A

Miosis and constipation

223
Q

What is propionic acid?

A

Intermediate in the catabolism of branched chain amino acids

224
Q

How does a beta blocker help in the treatment of chronic glaucoma?

A

Targets the ciliary epithelium to produce less aqueous humor

225
Q

What 2 drugs are both anticonvulsants AND mood stabilizers?

A

Valproic acid and carbamazepine - valproic is preferred for absence, generalized tonic-clonic, and myoclonic seizures

226
Q

What antiepileptic drug is metabolized to phenobarbital and phenylethylmalonamide?

A

Primidone

227
Q

What is the function of N-acetylglutamate in the urea cycle?

A

Required as an essential activator of carbamoyl phosphate synthase I (enzyme) in the first step of the urea cycle

228
Q

What are the two causes of polyhydramnios?

A
  1. Decreased fetal swallowing (GI obstruction, intestinal atresia, or anencephaly)
  2. Increased fetal urination
229
Q

Child with bilateral lens subluxation (dislocated lens) - suspicious of?

A

Homocystinuria

230
Q

What is phenelzine?

A

MAO inhibitor

231
Q

What do we use MAO inhibitors for?

A

Atypical depression - characterized by mood reactivity meaning a person with atypical depression will have improvement in mood to something positive

232
Q

What distinguished buspirone in terms of its side effect profile?

A

Minimal to no hypnotic, sedative, or euphoric effects

233
Q

question 10

A

come back

234
Q

What is the main virulence mechanism of staphylococcus epidermidis?

A

Common cause of foreign body infection because of its ability to produce adherent biofilm - extracellular polysaccharide matrix

235
Q

How is the diagnosis of tetanus made?

A

Clinical suspicion (history and physical) - there is no serum toxin assay or antibody test and blood cultures are often unsuccessful in isolating the organism

236
Q

Abnormal slow relaxation of muscles, frontal balding, gonadal atrophy?

A

Myotonic dystrophy - autosomal dominant disorder

237
Q

Patients with narcolepsy have decreased levels of which hormones?

A

Hypocretin-1 and 2

238
Q

What is chlorpheniramine and what is its major side effect?

A

Anti-histamine - causes sedation

239
Q

Stimulation of what receptor causes mydriasis?

A

Alpha 1

240
Q

What is entacapone?

A

COMT inhibitor that helps prevent peripheral metabolism of L-DOPA (given with levodopa for treatment of Parkinson’s)

241
Q

Presentation: Dilated pupils, yawning, piloerection, lacrimation, hyperactive bowel sounds - withdrawal from what?

A

Opioids (e.g. heroin)

242
Q

Why is methadone a good treatment for heroin abusers?

A

Long half life means that it is able to suppress withdrawal symptoms well

243
Q

What three drugs can cause lithium toxicity due to their effect on the kidney?

A

NSAIDs, thiazides, ACE inhibitors

244
Q

What is selegiline?

A

Inhibitor of MAO type B

245
Q

What is the most common cause of bacterial meningitis in adults?

A

Strep pneumo

246
Q

Before alanine can be converted to glucose, its amino group is transferred to what?

A

Alpha-ketoglutarate

247
Q

What is pentazocine?

A

Partial opioid agonist

248
Q

Why are benzodiazepines associated with increased risk of falls?

A

Daytime drowsiness

249
Q

Describe the mechanism of action of paraneoplastic syndrome.

A

Often tumor cells producing substances that induce an autoimmune reaction and cause damage and degeneration of healthy organs and tissues

250
Q

What is the main treatment for homocystinuria?

A

Vitamin B6 (pyridoxine)

251
Q

Are alprazolam, triazolam, oxazepam short/medium/long acting benzo’s (correlate with severity of side effects)?

A

Short - less side effects

252
Q

Are estazolam, lorazepam, temazepam short/medium/long acting benzo’s (correlate with severity of side effects)?

A

Medium - moderate side effects

253
Q

Are chlordiazepoxide, clorazepate, diazepam, flurazepam short/medium/long acting benzo’s (correlate with severity of side effects)?

A

Long - more severe side effects

254
Q

What cofactor is necessary for the conversion of oxaloacetate to acetate?

A

B6 (pyridoxine) - necessary cofactor for transamination and decarboxylation of amino acids

255
Q

Thiamine deficiency most affects what neural structure?

A

Mamillary body (on a sagittal section, looks like it’s under the hippocampus)

256
Q

Restlessness, agitation, dysphagia progressing to coma following an exposure to bats should make you suspicious of?

A

Rabies

257
Q

What is prophylaxis for rabies?

A

Killed vaccine

258
Q

What organism produces botulinum toxin?

A

Clostridium botulinum

259
Q

What distinguishes clostridia?

A

Produce spores

260
Q

Crescent shaped mass on CT is suggestive of?

A

Subdural hematoma

261
Q

What is ruptured in a subdural hematoma?

A

Bridging veins

262
Q

The onset of action of a gas anesthetic depends on what?

A

Its solubility in the blood (blood/gas partition coefficient)

263
Q

If a gas anesthetic has high blood/gas partition coefficient, does it have a quicker or slower onset of action?

A

Slower because it takes more to saturate the blood (more soluble in blood) and you have to saturate the blood before it will move into brain tissue

264
Q

At what age should a child be able to copy simple shapes?

A

Age 3

265
Q

What other cerebellar tumor affects children aside from pilocytic astrocytoma?

A

Medulloblastoma

266
Q

How do we distinguish pilocytic astrocytoma from medulloblastoma?

A

Histology
Pilocytic astrocytoma - Rosenthal fibers
Medulloblastoma - sheets of small cells with deeply basophilic nuclei and scant cytoplasm with abundant mitoses

267
Q

What is the unconscious manifestation of neurologic symptoms when pathophysiological explanations for the symptoms cannot be found (typically in women and accompanied by life stressor)?

A

Conversion disorder

268
Q

What is tetrahydrobiopterin used for?

A

Cofactor in the synthesis of tyrosine, dopa, serotonin, and nitric oxide

269
Q

What does a high arteriovenous concentration gradient tell you about the rate of onset of an anesthetic?

A

Slow because high arteriovenous concentration means high tissue solubility (which is why the venous concentration is lower) meaning you need more of the drug to saturate the blood so that it can then go to brain tissue

270
Q

What is the major determinant of virulence in E. coli strains that cause meningitis in infants?

A

K1 capsular antigen - protects the bacteria during hematogenous spread so it can reach the meninges

271
Q

What do we use cholinomimetics to treat?

A

Non-obstructive urinary retention, paralytic ileus, glaucoma

272
Q

What in the brain will stain for lipids?

A

Microglia that come and break down myelin

273
Q

How do penicillins and cephalosporins work?

A

Irreversible binding to penicillin-binding proteins such as transpeptidases

274
Q

What are neurofibromas derived from?

A

Schwann cells (neural crest)

275
Q

Characterize nicotinic vs. muscarinic vs. adrenergic receptors.

A

Nicotinic - ligand gated ion channels

Adrenergic and muscarinic - G coupled protein receptors

276
Q

What is the most common cause of intraparenchymal hemorrhage?

A

Hypertension - through the formation of small Charcot-Bouchard pseudoaneurysms in the small arterioles that penetrate the basal ganglia and thalami

277
Q

Empty bottle of pills with presentation of confusion, agitation, tremor, tachycardia, hypertension, clonus, hyperreflexia, hyperthermia, diaphoresis?

A

Serotonin syndrome

278
Q

What do we use to treat serotonin syndrome?

A

Cyproheptadine - antihistamine with antiserotonergic properties

279
Q

What is the precursor of serotonin?

A

Tryptophan

280
Q

What are pramipexole and ropinirole?

A

Non-ergot compounds that are dopamine agonists (used in the treatment of Parkinson’s)

281
Q

What is the function of pili for meningococcus?

A

Attachment to epithelia of oro and nasopharynx

282
Q

Hydrocephalus, intracranial calcifications, chorioretinitis in an infant?

A

Congenital toxoplasmosis

283
Q

What antibiotic can cause serotonin syndrome?

A

Linezolid

284
Q

What enzyme is deficient in atypical PKU?

A

Dihydrobiopterin reductase - cofactor for tyrosine hydroxylase (which converts tyrosine to DOPA)

285
Q

What drug is given to prevent the recurrence of seizures in status epilepticus?

A

Phenytoin

286
Q

What is the mechanism of action of phenytoin (what other drugs have a similar mechanism)?

A

Decrease sodium current in cortical neurons (similar to carbamazepine and lamotrigine)

287
Q

Where is the lesion if it produces contralateral homonymous hemianopia and Marcus Gunn pupil in the contralateral eye?

A

Optic tract

288
Q

What is malformation?

A

Intrinsic developmental abnormality

289
Q

What is disruption?

A

Secondary breakdown of previously normal tissue or structure

290
Q

What is holoprosencephaly an example of?

A

Malformation

291
Q

What do second generation (atypical) antipsychotics treat in schizophrenia that first generation do not?

A

Negative symptoms - 2nd generation treat both positive and negative vs. 1st generation only treat positive

292
Q

Clozapine, risperidone, olanzapine, quetiapine are examples of what?

A

Atypical antipsychotics

293
Q

Which vitamin deficiency in CF patient presents with neurologic symptoms (decreased proprioception and hyporeflexia in lower extremities) and hemolytic anemia?

A

Vitamin E

294
Q

Recurrent lobar hemorrhages in an elderly patient suggests what underlying pathology?

A

Cerebral amyloid angiopathy

295
Q

Which antiepileptic is associated with generalized lymphadenopathy as a side effect?

A

Phenytoin

296
Q

What generation is fexofenadine?

A

2nd generation antihistamine

297
Q

What generation is chlorpheniramine?

A

1st generation antihistamine

298
Q

Is rifampin a cyp450 inducer or inhibitor?

A

Inducer

299
Q

What are the cyp450 inducers?

A

Mnemonic: Chronic alcoholic Mona steals phen-phen and never refuses greasy carbs.

Chronic alcohol use
Modafinil
St. John's wort
Phenytoin
Phenobarbital
Nevirapine
Rifampin
Griseofulvin
Carbamazepine
300
Q

What are the cyp450 inhibitors?

A

Mnemonic: A cute gentlemen cipped iced grapefruit juice quickly and kept munching on soft cinnamon rolls

Acute alcohol
Ciprofloxacine
Isoniazid
Grapefruit juice
Quinidine
Amiodarone
Ketoconazole
Macrolides
Sulfonamides
Cimetidine
Ritonavir
301
Q

What sensory divisions does CN IX cover?

A

Posterior 1/3 of the tongue, tonsillar region, upper pharynx, carotid body, carotid sinus, inner surface of tympanic membrane, Eustachian tube

302
Q

Cerebellar hemangioblastoma with congenital cysts of liver, kidney, and/or pancreas is suggestive of what?

A

vHL

303
Q

What drug is used as chemoprophylaxis for meningococcal meningitis?

A

Rifampin

304
Q

Hypothyroidism is a major side effect of what psych drug?

A

Lithium

305
Q

Neuron with shrunken nuclei, no detectable Nissl substance, intensely eosinophilic cytoplasm?

A

Red neuron - irreversible injury

306
Q

Describe the mechanism of action of botulinum toxin.

A

Blocks the presynaptic exocytosis of ACh vesicles

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