Neuro Flashcards
conjugate lateral gaze palsy, with nystagmus and diplopia during lateral gaze
Internuclear ophthalmoplegia
degeneration of the dorsal columns
tabes dorsalis
demyelinating disease in a young woman
multiple sclerosis
mixed upper and lower motor neuron disease
ALS
classic presenting sign of MS
Charcot’s triad:
scanning speech, intention tremor, nystagmus
also can see bowel/bladder incontinence, optic neuritis, internuclear ophthalmoplegia
newborn with arm paralysis following a difficult labor
Erb-duchenne palsy
unable to extend 4th and 5th fingers
ulnar n
unable to abduct thumb
median n
unable to flex index and middle finger
median n
wrist drop
radial n
scapular winging
long thoracic
loss of sensation over fingers 1-4
median
cannot abduct or adduct fingers
ulnar n
loss of shoulder abduction
axillary
loss of elbow flexion and forearm supination
musculocutaneous
loss of wrist extension
radial
pricking pain (fast, myelinated)
A delta fiber
burning or dull pain and itch (slow, unmyelinated)
c-polymodal
receptor for cold
A delta cold thermoreceptor
receptor for warm
warm thermorecptor (c-polymodal)
vibration and pressure
Pacinian corpuscle
dynamic/changing light, discriminatory touch
Meissner’s corpuscle
static/unchanging light touch
Merkel
proprioception: muscle length
muscle spindle (intrafusal muscle fiber 1a afferent)
proprioception: muscle length
golgi tendon organ (1b afferent)
Cardinal features of Parkinson’s
tremor: resting or pill-rolling
rigidity: cogwheel
akinesia or hypokinesia
postural instability
mask-like facies
festinating gait
initial vision loss in open and closed angle glaucoma
open: peripheral then central
closed: sudden vision loss
treatment of glaucoma
prostaglandins, B-blockers, alpha agonists, carbonic anhydrase inhibitors (acetazolamide), cholinergic agonists
pt has vertigo, tinnitus and hearing loss
Meniere disease
acute otitis media bugs
Streptococcus pneumoniae
nontypable H. influenzae
Moraxella catarrhalis
otitis externa bugs
Pseudomonas aeruginosa
S. aureus sometimes
chronic otitis media sometimes results in cystic lesion lined by karatinizing squamous epithelium that is filled with amorphous disease
cholesteatoma
symptoms of a lesion to C5 and C6 nerve roots
Erb-Duchenne palsy “waiter’s tip”
medial rotation, straight arm, flexed wirst
symptoms of a lesion to inferior trunk of brachial plexus
Klumpke’s palsy
loss of sensory on forearm and medial hand
atrophy of thenar, hypothenar, and interosseous muscles
intranuclear inclusions in herpes simplex encephalitis
Cowdry type A
cytoplasmic inclusions pathognomonic of rabies
negri bodies
neuronal inclusions characteristic of Parkinson’s
Lewy bodies
cytoplasmic inclusion bodies associated with aging
lipofuscin granules
dark cytoplasmic pigment in neurons of the substantia nigra and locus ceruleos, not seen in pts with Parkinson
melanin
eosinophilic, rod-like inclusions in hippocampus of Alzheimer’s pt
Hirano bodies
diagnostic of Alzheimer’s
neurofibrillary plaques and tangles
filamentous inclusions that stain with silver, do not survive neuronal death
Pick bodies
fliamentous inclusions that stain with PAS and ubiquitin
Lewy body
resembles an onion in cross section
Pacinian corpuscle
robust spindle-shaped structures found on soles of the feet
Ruffini
found only in areas of skin without hair
Meissner’s
simplest sensory receptor thought to be pain receptor or thermoreceptor
free nerve endings
touch receptor that is tough to distinguish from melanocytes
Merkel cell
diseases associated with Lewy bodies
Lewy body dementia
Parkinson
rare type of Alzheimer’s
Delirium
acute onset fluctuating daily course "waxing and waning" decreased level of consciousness disorganized thought production delusions or hallucinations reversible (drugs or UTI cause most)
Dementia
gradual onset consistent daily course normal level of consciousness impoverished though production minimal psychotic features irreversible
components of a dementia work-up
Mini mental state exam rule out other causes: RPR (syphilis) HIV TSH B12 levels MRI (for normal pressure hydrocephalus and multi-infarct dementia)
Mechanism of Alzheimer’s drugs
cholinesterase inhibitor NMDA antagonist (block glutamate)
most common cause of dementia
Alzheimer’s
second most common cause of dementia
multi-infarct dementia (vascular)
extracellular amyloid deposits in grey matter
Alzheimer’s
intracellular deposits of hyperphosphorylated tau protein
Alzheimer’s
intracellular spherical aggregates of tau protein seen on silver stain
Pick disease (frontotemporal)
Lewy body dementia
alpha-synuclein aggregates
visual hallucinations, repeated syncopal episodes, very fast progression
unable to wipe bottom is injury to which n
thoracodorsal
weak external rotation of arm is injury to which n
suprascapular
4 major dopaminergic pathways
mesocorticol: ventral tegmental of midbrain -> cortex
lesion: increae negative symptoms of psychosis
mesolimbic: midbrain -> limbic
lesion: decreased positive signs of schizophrenia
nigrostriatal: substanita nigra pars compacta -> neostriatum
lesion: Parkinson
tuberoinfundibular: arcuate n of hypothalamus -> pituitary
lesion: increased prolactin
Tx of narcolepsy
daytime stimulants: amphetamines, modafinil
nightL sodium oxybate (GHB)
drug of choice for absence seizures
ethosuximide 1st
valproic acid 2nd
treat status epilepticus
benzos: diazepam or lorazepam
phenytoin 1st line for prophylaxis
treatment of eclampsia
MgSO4 1st
benzos 2nd
teratogenic anti-epileptic drugs
phenytoin
carbamazepine
valproic acid
cause stevens-johnson syndrome
ethosuximide, lamotrigine, carbamazepine, phenytoin, phenobarbital, sulfonamides, penicillins, allopurinol
drugs that cause agranulocytosis
remember the C's carbamazepine clozapine colchicine PTU methimazole
drugs that induce p450 system
Coronas, Guiness and PBRs induce chronic alcoholism carbamazepine griseofulvin phenytoin barbiturates rifampin st john's wort chronic alcoholism
treatment for tonic-clonic seizures
phenytoin
carbamazepine
valproic acid
