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UWorld > Neuro 2 > Flashcards

Neuro 2 Flashcards

1
Q

Kinesin transports organelles toward __ end of microtubules, which are __ from the nucleus

toxic insult would impair __ transport, thus leading to a deficiency of __ at the nerve terminal

A

plus, distant

anterograde, vesicles

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2
Q

__ is a disproportionate loss of pain/temp in arms and hands
formation of __ in cervical region of SC

most commonly has damage to ventral __ and __

this is decussation for fibers of __ tract for pain/temp from periperhy to somatosensory cortex

1st order neurons are in __
2nd order neurons in __

axons decussate in VWC, adn asced in contralateral __

3rd order neurons located in __ of thalamus

4th order neurons found in primary __ of parietal lobe

A

syringomyelia
cavity

white commisure, horn

lateral spinothlamic

dorsal root ganglia
dorsal horn

lateral funiculus

VPN

somatosensory cortex

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3
Q

dextrxn of VWC leads to loss of __/__ bilaterally 1/2 levels below lesions and in dermatome

other senses are ___

ventral horns contain __ that receive impulses from lateral CS tract, responsible for voluntary __

damage can occur, but does not affect __/__
example of __ lesion

A

pain/temp

normal

motor neurons, motor activity

pain/temp
LMN

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4
Q

__ transmits light touch/pressure

damage to __ cuases contralateral loss of pain/temp

__ recieves neurons of sensory input
ie __ and __ synapses

dorsal columns contain __/__ fasciculi
primary mediator for __/__/__ sensation

A

ventral ST

contralateral lateral funiculus

dorsal horn
lateral ST, ventral ST

cuneate/gracilis

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5
Q

extrapyramidal symptom assc w recent antipsychotic meds is __ reaction
sudden __ of any muscle group
may have Oculogyric crisis, O__ or L

result from high potency __ blocking D2 in NS pathway (ie h/F)
excess __ results in extrapyramidal SE

tx w M1 receptor antags like B or antihistamine D

A

acute dystonic
contraction
opisthotnos, laryngospasm

1st gen antipsychotic
haloperidol, fluphenazine
cholingergic activity

benztropine, diphenhydramine

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6
Q

Blockade of __ receptors leads to ortho hypoTN

Gaba receptor antags like __ tx benzo overdose

antagonism of __ causes sedation/weight gain

low potency antipsych like C/C/T can cause ___ SE

A

A1A

Flumenazil

H1

chlorpromazine, clozapine, thioradizine

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7
Q

long standing RA involves __ and causes joint dxn w vertebral __ subluxation

__ joint involved as atlas C1 has high degree of __

sx include neck __/__ and neuro findings
__ can worsen it, leading to __/__ compression

see __ paralysis w absent __
paralysis becomes __

A

cervical spine, malalignment

atlantoaxial, mobility

pain/stiffness
intubation, SC/arterial

flaccid, reflexes
spastic

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8
Q

__ due to IE of left sided heart valve
see acute __ findings and __/__ finding

diffuse muscle rigidity w hyperthermia and myocyte breakdown dx ___

A

Cerebral septic emboli
neuro
murmur, cardio

Malignant hyperthermia

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9
Q

__ tremor aka __
inherited __, look for family history
improves w __
tx w __ a nonslective B antag

__ anticholingergic to tx Parkinson, counterract EPSE

A

essential, familial
AD
alcohol
propanolol

benztropine

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10
Q

__ contains optic nerve from temporal part of ipsi retina and nasal part of contra retina

Optic tract lesions result in __ homonyous hemaniopsia

frontal eye fields located in __ cortex
generates __ gaze movements
damage has eyes deviate __ side of lesion

contralateral homonyous hemaniopia w intact pupillary light reflexes may damage the __

lesion in __ producess contralateral upper quadrantopia

macula recieves collateral BF from __
not affected in __ infarct

A

optic tract

contralateral

prefrontal
conjugate
toward

LGN

Meyer loop

MCA
posterior cerebral artery

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11
Q

at rest, membrane is permeable to ion w __ potential

opening of ligand gated ion channels causes __ in membrane potential

opening of voltage gated ion channels causes __ in membrane potential, meaning that membrane is permeable to __ potential ion

A

negative equilibrium

inc

dec, negative equilibrium

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12
Q

Intraplerual pressure is __ at rest due to recoil of lungs/chest

w inspiration, diaphragm contracts to make IPP __, drawing air in

w no dec in phrenic nerve activity, pt shows progressively __ diaphragm contractions
thus, pt has excessive skeletal muscle __ (COPD/IPF) or impaired __

women in post partum period are at high risk of developing ___

A

negative

more negatve

weakening
weakness, NT release

MG

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13
Q

Fracture to the __ can be damaged w direct trauma
contains the __/__

__ nerve runs along orbital surfave, before leaving infraorbital foramen

damage can result in numbness to upper __/__/__

can also see E and impaired __ gaze (trapped IR muscle)

A

orbital floor
zygoma, maxilla

infraorbital

cheek/lip/gingiva

exopthalmos, vertical

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14
Q

superior orbital fissure contains CN __/__/__/__
can lead to loss of __

hematoma over __ w periorbital eccymoses idicate fracture to __

fracture of __ can impair motor fxn of face

A

3/4/5/6

mastoid process, basilar skull

temporal bone

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15
Q

infant w delyaed motor development and flaccid paralysis has __
caused by mutation in __ gene
affects __ in LMN, impairing __ fxn
thus, __ cells degenerate

collection of snRPs and pre mRNA form a __ to remove introns from pre MRNA

A

spinal muscular atrrophy
SMN1
snRPs, spliceosome
anterior horn

spliceosome

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16
Q

first line tx of T gondii in HIV pt w ring enhancing lesions is P/S

Amphotercin and flucytosine can tx __ meningitis

Amphotercin can tx invasive ___
CNS aspergillosis presents w __ andd __ sx
this form, tx w __

__ tx listeria

CMV CNS involvement presents w P/transverse __, and E

A

pyrmethamine/sulfadiazine

cryptococcal

aspergillosis
abscess, pulm sx
voriconazole

listeria

polyneuro, myelitis, enceph

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17
Q

HIV Pt w neg t gondii serology, think __
see large, solitary lesions

origin is ___ NHL of b cells
__ infection is identified in most cases
dx w __ PCR of CSF
definitive dx w __

usually do not have __ infiltration

T cells are malignant in __ T cell lymphoma

__ is primary cell in histiocytomas

__ is precursor to glioblastoma multiforme

A

primary CNS lymphoma

DLBCL
EBV
EBV
brain biopsy

T cells

AIDS assc

macros

astrocytomas

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18
Q

varicella IgG ab and dermatome oriented, painful vesicular rash indicates __
this is a ___ w/in dorsal root ganglia

primary VZV occurs in __
typically resistant to __ later, but not __

varicella vacine induces __ for primary VZV but decreases over time

IgG is ineffective against __

A

herpes zoster
reactivation

childhood, chickenpox, zoster

immunity

dorsal root ganglion

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19
Q

polysaccharide antigens on latex agglutination test w meningitis due to __ in AIDs indiv
should see round/oval __ w india ink stain
yeast obstructs CSF outflow, leading to inc __

nonseptate hyphae branch at __ angles
seen in M/R

__ forms spherules which rupture to release endospores

A

cryptococcus

budding yeast
opening pressure

wide
mucor/rhizpus

coccidioides

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20
Q

__/__ transport Nitrogen throughout body

alanine fxn in the __/__ cycle to remove N2
alanine transported to __

there, converted to __ via ALT, as amino group trasnferred to __ to form glutamate

ammonia enters __ to form urea to get rid of N2

free ammonia then excreted in __

A

alanine, glutamine

glucose/alanine
liver

pyruvate, Aketoglutarate

urea cycle

urine

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21
Q

residual neuropathic pain in later zoster is known as __
sensitization of affarent nerves in __
tx w __ (amytriptaline) or anticonvulsants G/P

Capsaicin causes activation of __ to cause buildup of Ca to defunctionaize nerves

also depletes __ important in pain

use as __ to dec pain

__/__ activate U and K opioid receptors respectively

A

post herpetic neuralgia
dorsal horn
TCA
gabapentin/pregabalin

TRPV1

Substance P

topical

endorphin/dynorphin

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22
Q

FXS

PE finings include marco-__ and long/narrow __ w prominent __/__
N/P disorders like __ delay, A, and A develop

mutation in __ gene on long arm of X chromosome
expands during __ in oocytes
seen w >200 __ repeats, resulting in hyper__

this __ FMR1, inhibiting neural development

use __ to determine degree of methylation

A

orchidism, face
chin/forehead
develop, ADHD, ASD

FMR1
meiosis
CGG
methylation

inactivates
southern blot

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23
Q

MG is caused by antibody/complement mediated destrxn of _ receptors on NMJ

long acting ACHe inhibs like P used for tx
__ Ach in NMJ

pt may be undertreated aka __
Tensilon test w short acting __
if positive, inc __ of pyridostigamine

too high AChE inhibitor causes __
leads to muscle weakness bc NMJ is __ to acetylcholine
does not respond to __
__ pyridostigmine

A

nicotinic
pyridostigamine
inc

myasthenic
edrophonium
dose

cholinergic crisis
insensitive
edrophonium
discontinue

24
Q

Fragile X cells will not stain in __ deficient medium
see small __ in long arm of chromosome X

Klinefelter syndrome has dec ___ secretion bc of fibrotic testes
causing __/__

A

folate
gap

testosterone
oligospermia/infertility

25
Q

Gingival hyperplasia in phenytoin is due to inc __
macrophages stimulate __/__
regresses w ___

Phenytoin is anticonvulsant for __ seizure, __ seizure and status __

inhibits abnormal __ in brain by blocking voltage gated __ in neurons

SE A/N/H/__ anemia
induces __
avoid in __

A

PDGF
gingival cells, alveolar bone
dscontinue

grand mal, partial, epilepticus

electrical activity
Na channels

ataxia/nystagmus/hirsutism/macrocytic
p450
pregnancy

26
Q

__ toxicity assc w coarse tremor, twitching, motor agitation, ataxia
can cause NDI, hypo___ and __ defects

__ withdrawal assc w sever depression
Cocaine blocks reuptake of __/__/__

SE of clozapine A/S

A

lithium
thyroid, cardiac

cocaine, depression
NE/dop/serotonin

agranulocytosis/seizure

27
Q

ADPKD assc w __

AMS, focal neuro defects can indivate ___

CCB like __ can prevent SAH

A

SAH/berry aneurysm

cerebral vasospasm

nimodipine

28
Q

Pt w cardiogenic shock w evidence of watershed necrosis suffered from __/__ encephalopathy
profound __ diminished blood flow to brain causing ischemia

neurons do not store __ and are susceptible to ischemia

Pyramidal cells of __ and perkinje cells of __ are most vulnerable

cortical watershed infarcts present as bilateral __ strips of necrosis over convexity

pt w severe carotid artery stenosis may have __ infarct

A

hyoxic/ischemic
hypoTN

glygogen

hippocampus, cerebellum

wedge shaped

unilateral

29
Q

__ aneurysm involves hemorrhage of __ structures

cardaic embolism has __ infarcts in different territories

HA/v/confusion indicates __ encephalopathy
braid __/__ seen on autopsy

A

charcot bouchard
deep

multiple

hyperTN enceph
edema/hemorrhage

30
Q

NF1 is mutation in __ tumor suppressor

cutaneous neurofibromas are neoplasms of __ derived from __

pt at inc risk of __ neoplasm

A

NF1

schwann cells, NCC

CNS

31
Q

cystic degeneration of the putamen occurs in __ dz

located lateral to __/__

__ mediates fear/SNS stimulation

A

wilsons dz

globus pallidus/internal capsule

32
Q

young woman w INO, episodes of ON should indicate __
demyelination of __
autoimmune response at __

myelin sheath aids in __ as impulse jumps between nodes of Ranvier where __ is concentrated

aids in __ up impulses

demyelination in MS results in ___
surviving oligodendrocytes partially __ neurons

loss of axons/neurons over time indicates __ MS

A

MS
CNS
oligodendrocytes

saltatory condxn
sodium channels

speeding up
slowed condxn
remyelinate

chronic

33
Q

right sided pure hemisensory loss has suffered a __ stroke
VPLN receives input from __ tract and __ column

and VPMN (info from __ pathway ) send __ projections to cortex
damage leads to complete contralateral __ loss
no pain/temp/vibration/proprioception

may lead to __ gait

A

thalamic
ST/dorsal

trigeminal
somatosensory
sensory

unsteady

34
Q

injury to __ assc w contra weakness/ataxia due to descending motor tracts

damage to __ seen w behavioral abnorms and chorea

most lesions to internal capsule result in combined __ defects

A

base of pons

caudate nucleus

somatomotor

35
Q

__ are small cavity infarcts of BG/internal capsule/pons/cerebellum

result from occlusion of small __ supplying structures
usually result of __/__

__ occurs w leakage of plasma proteins through damaged endothelium
see __ thickening of vasc wall, collagen sclerosis, and __ macros

__ result from accumulation of lipid laden macrophages

both result in small vessel __ and __ necrosis w fluid filled cavity

A

lacunes

penetrating arterioles, HTN/DM

lipohyalinosis
hyaline, foamy

microatheromas

occlusion, liq necrosis

36
Q

__ is tumor of PNS from schwann cells

appear __ w high/low cell areas

Antoni A areas coposed of __ cells in palisading pattern
nuclear free region known as __ body

usually __ positive due to NCC origin
__ is another S100 positive tumor

Schwann cells are __ insulation of axons
can occur in cranial __/spinal __

A

schwanomma

biphasic

spindle
Verocay

S100
melanoma

PNS
vault, canal

37
Q

Schwannoma may arise in any CN except __ which is covered w oligodendrocytes

most common site of involvement is __ angle CN8

known as __ w tinnitus/vertigo/hearing loss

A

2

cerebellopontine

acoustic neuroma

38
Q

__ is bizarre looking glial cells w mitotic figures, necrosis, hemorrhage
seen in frontotemporal __
grows across ___

__ is a slow growing tumor arising in __ cells of arachnoid
appear as cells in __ or __
may have __

L/S/B/R can metastasize to brain
usually at __ jxn
look for central __ w reactive __ and edema

__ assc NF1, made of immature __
Microcystic __ and __ fibers

A

glioblastoma, white matter
corpus callosum

meningioma
meningoethelial
loules/whorls
psmamomma bodies

lung, skin, bone, renal
G-W
necrosis
gliosis

optic glioma
astrocytes
degen w Rosenthal fibers

39
Q

__ is seizure lasting > 5 min or occurrence of multiple seizures w incomplete __

may be due to __ brain injury, I, __ abnorms, __ noncompliance

IV __ potentiates GABA and is drug of choice
IV __ is admin concurrently, anticonvulsant to prevent __

Phenytoin inhibits ___

__ is irreversible inhibitor of GABA transaminase
used for __ resistant epilepsy

A

status epilepticus
recovery

structural, infection, met, med

Lorazepam
phenytoin, recurrence

Na channels

vigabitrim

40
Q

__ blocks Na channels and inc Gaba

Benzo/phenobarbitol inc __ action

__ modulates gaba/glutamate release

__ blocks Thalamic T type Ca channels

A

valproic acid

GABA a

levetiracetam

ethosuxamide

41
Q

__ is opioid analgesic for chronic pain

all opioid receptors coupled to inhibitory __ proteins

Morphine has high affinity for the __ receptor

this reduces __ influx by closing presynaptic voltage gated channels and dec __ NT release from presynaptic terminal

also bind to mu receptor on __ to open K channels allowing for __

thus producing __

A

morphine

G proteins

mu

Ca
excitatory

postsynapse, efflux

42
Q

Fluent aphasia that cannot understand language is due to lesion in __ area

this is the posterior portion of superior temporal gyrus in __ lobe
known as the __ cortex

supplied by inferior terminal ___

superior terminal MCA supplies __ area

A

wernicke

temporal
auditory association

MCA

broca

43
Q

__ nerve descends in obturator canal to supply __ muscle
powers muscles for __

anterior division gives of terminal cutaneous branch for __ over distal medial thigh

femoral nerve innervate __ for leg extension

extension of thigh via __ and IGN innervation

Psoas, iliacus, sartorius used to __ the thigh

A

obturator nerve
obturator externus
thigh adduction

sensation

quad femoris

gluteus maximus

flex

44
Q

blurry vision, diplopia, weak/numb, bowel bladder dysfxn in woman <50 is __

__ is monocular visual loss w pain on eye movement and afferent light defect

look for white matter lesions in __ region

pathology is __ reacting to antigens in myelin

B cells indicate __ Ig bands in CSF

__ proliferate and form the scar after attack to oligodendrocytes

A

MS

optic neuritis

paraventricular

Helper T cells

oligoclonal

astrocytes

45
Q

__ cells found in choroid plexus and produce CSF

__ are macrophages in CSF

___ targeted by peripheral demyelinating disorders

A

ependymal cells

microglia

schwann cells

46
Q

loss of grey-white matter differentiation w sulcal effaceemnt indicates __ brain injury w cardiac arrest

nonreactive pupils to light folllow cardiac rest means damage has occurred to __

optic nerve transmits light to midbrain and is received by __ nucleus

bilateal occipital lesions lead to __ blindness

__ lobes process signals from other brain areas
Nondominant leads to __ and apraxia
Dominant leads to L/R __

A

anoxic

midbrain

pretectal

cortical

parietal
hemineglect
confusion

47
Q

pons used for __ gaze and doll eye reflex

bilateral __ damage has pinpoint pupils due to lost descending symp fibers

__ lobe injury can lead to memory/speech/vision/hearing problems

A

horizontal

pontine

temporal

48
Q

nonrhythmic conj eye movements and involuntary jerking movements in young pt should be ___

arises from __ of AM/symp ganglion
should see firm __ mass and const symptoms
__ ecchymoses possible

majority of pt have elevated __ metabolites
biopsy shows small round blue __ and __ rosettes

teset for __ amplification, which carries a poor prognosis

A

neuroblastoma

NCC
abdominal
periorbital

catecholamine
cells, HW

nMYC

49
Q

Opsoclnus-myoclonus is paraneoplastic syndrome for

__ is common in kids
arises in __ causing ataxia

may have __ rosettes as well

A

neuroblastoma

medulloblastoma

HW

50
Q

Lacunar stroke seen w chronic H/D/S

get hypertensive arteiolar __ and narrowing of lumen

presents w pure motor hemiparesis w __ involvement
pure sensory stroke w __/__ of thalamus
ataxia hemiplegia syndrome w ___

usually not seen by __
can turn into __

A

HTN/DM/smoking

sclerosis

posterior internal capsule
VPLN/VPM
posterior internal capsule

CT
lacunes

51
Q

spontaneous lobar/cortical hemorrhage is most commonly due to cerebral __ angiopathy

__ aneurysm leads to intraparenchymal hemorrhage

saccular aneurysm seen w __
hyperattenuation of __/__

A

amyloid

CB

SAH
sulci/cisterns

52
Q

__ modulates ataxia and truncal posture
coordinates w __ descending motor systems

lesion to this region results in truncal __ w unsteady/broad based gait

pt can also get V/N w involvement of lower vermis/flocculonodular lobe

limb dysmetria occurs w damage to __ and lateral descending motor system

A

vermis
medial

ataxia

vertigo/nystagmus

cerebellar hemispheres

53
Q

optimal site for femoral nerve is the ___

anesthetize __/___ of anterior thigh/femur/knee

__ is not in the femoral canal

__ is a landmark for pudendal nerve block

A

inguinal crease

skin/muscles

femoral nerve

54
Q

TCA like __ have strong __ properties like C and urinary __

__ is SNRI used for depression/anx/chronic pain
SE is C

A

amitryptaline, anticholinergic
retention

duloxetine
confusion

55
Q

Putaminal hemorrhage involves ___ w contralateal hemiparesis/anesthesia

disrupted __/__ in posterior limb
leads to HA/N/V/AMS

appears as __ on CT and can result in __ w midline shift

most freq affected location is __, cerebellar nuclei, T/P
basal ganglia supplied by __ arteries from the MCA

A

interenal capsule

CS/somatosensory fibers

hyperdense
mass effect

basal ganglia, thalamus, pons
lenticulostriate

56
Q

spontaneous deep intracerebral hemorrhage caused by __ vasculopathy

A

HTN

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