Neuro 3 Flashcards
Chronic toxicity d/t overdose of this vitamin include alopecia, dry skin, hyperlipidemia, hepatotoxicity, hepatosplenomegaly, and visual difficulties
Vitamin A
Teratogenic effects of excessive ingestion of this vitamin leads to microcephaly, cardiac anomalies, and fetal death
Vitamin A
Pt is an older, mentally slow woman of northern European descent who is “lemon colored” (anemic and icteric), has a smooth shiny tongue indicative of atrophic glossitis, and demonstrates a shfuffling broad-based gait. What vitamin deficiency is she most likely experiencing?
Vitamin B12 (cobalamin)
Deficiency of what vitamin is characterized by cheilosis, stomatitis, glossitis, dermatitis, corneal vascularization, and ariboflavinosis?
Vitamin B2 (riboflavin)
Differentiate between delirium and dementia with regard to:
- Onset
- Consciousness
- Course
- Prognosis
- Memory impairment
- Onset: acute in delirium vs. gradual in dementia
- Consciousness: impaired in delirium vs. intact in dementia
- Course: fluctuating Sx in delirium vs. progressieve decline in dementia
- Prognosis: reversible Sx in delirium vs. irreversible Sx in dementia
- Memory impairment: global in delirium vs. remote memory spared in dementia
What metabolite is derived from Val, Ile, Met, and Thr, odd-numbered FAs, and cholesterol side chans that is involved in the conversion to methylmalonic acid –> succiniyl CoA –> enter into the TCA cycle?
propionyl CoA
Congenital deficiency of what enzyme intermediate of BCAAs leads to poor feeding, vomiting, hypotonia, lethargy, dehydration, and anion gap acidosis?
propionyl CoA carboxylase: converts propionyl CoA -> MMA
What kind of herniation occurs when the anterior medial temporal lobe herniates through the gap between the crus cerebri and the tentorium (free margin of the tnetorium cerebelli)?
Transtentorial (uncal) herniation
What kind of herniation occurs when the cingulate gyrus hernates under the falx cerebri? What vessel may be compressed?
Subfalcine herniation - may compress ACA
What kind of herniation occurs when the cerebellar tonsils displace through the foramen magnum? What structure may be compressed?
Tonsillar herniation - may compress medulla
What are 4 main structures that are likely to be compressed with an uncal herniation?
- Ipsilateral CN III - down and out
- Ipsilateral PCA - contralateral homonymous hemianopsia with macular sparing
- Contralateral cerebral peduncle against tentorium - damge to contralateral CST leads to ipsilateral hemiparesis
- Brainstem hemorrhages in pons and midbrain d/t stretching and rupture of basilar artery - fatal
What defense mechanism is the unconscious belief that people are either wholly good or holly bad? What is a hallmark of?
Splitting - hallmark of borderline personality disorderq
A stroke in what area would be characterized by total sensory loss on the contralateral side of the body in addition to proprioception defects leading to falls?
thalamus (VPL or VPM)
intraventricular hemorrhage (IVH) originates from a highly cellular and vascularized layer in the subventricular zone from which neurons and glial cells migrate out during brain development known as
germinal matrix
A fragile germinal matrix in a low birth weight baby d/t complication of prematurity leading to long-term neurodevelopment impairment can cause
neonatal intraventricular hemorrhage
What is a long-term complication of hydrocephalus in infants?
lower extremity spasticity d/t stretching of the periventricular pyramidal tracts, visual disturbances, and learning disabilities
What molecular locally dissociates dsDNA into ssDNA?
DnaA
what molecule binds ssDNA at the origin of replication, moves into the repication fork, and then proceeds to separate and uniwind the dsDNA?
helicase
What are 3 extrapyramidal side effects of antipsychotics?
acute dystonic reaction: sudden-onset sustained muscle contractions
akathisia: subjective restlessness with inability to sit still
drug-induced parkinsonism: tremor, rigidity, bradykinesia, masked facies
What term describes involuntary movements after chronic use of antipsychotics?
tardive dyskinesia
What term describes fever, rigidity, mental status changes, and autonomic instability as an antipsychotic side effect?
neuroleptic malignant syndrome
Which opioid narcotic works through partial agonist activity and weak antagonist activity at mu receptors which can cause withdrawal Sx in pts who are dependent or tolerant to morphine or other opioids?
Pentazocine
How do colinergic agonists exert their effect on blood vessels?
They bind to muscarinic receptors on endothelial cells and promote release of NO (EDRF). NO activates guanylate cyclase and diminishes endothelium Ca2+ concentration which produces vasodilation
What is disorder is characterized by excessive daytime sleepiness and REM sleep-related phenomena such as cataplexy, sleep paralysis, and hpnagogic/hypnopompic hallucinations?
Narcolepsy
What causes the pain associated with migrains?
activation of trigeminal afferents that innervate the meningies and cause release of vasoactive neurpeptides like substance P and CGRP which lead to neurogenic inflammation dt vasodilation and plasma protein extravasation
What is the MOA of triptans (i.e. sumatriptan) in the Tx of migraine headaches?
Triptans are serotonin 5-HT1B/5-HT1D agonists that directly counter the pathophysiologic mechanism of migrain headaches by inhibiting the release of vasoactive peptides, promoting vasoconstriction, and blocking pain pathways in the brainstem
What are commonly used for migraine prophylaxis?
BBs: postsynaptic NE receptor blockade, and TCAs
What is a DA and NE reuptake inhibitor used for Tx depression and smoking cessation?
Bupropion
What is the MOA for SSRIs in depression?
presynaptic selective serotonin reuptake inhibition (fluoxetine, sertraline, and paroxetine)
What is the first line treatment for essential tremor?
Propanolol
What is the MOA of Clozapine?
It is an atypical antipsychotic that blocks 5HT2 receptors in the CNS
Where does HSV-1 encephalitis occur?
Temporal lobe - macroscopic brain exam reveals edema and hemorrhagic necrosis
What describes a primary defect in the cells or tissue that form an organ (intrinsic developmental abnormality)?
Malformation
What are examples of malformation?
holoprosencephaly, congenital heart disease, anencephaly, plydactyly, and syndactyly
What is the name for oligohydramnios that caues fetal compression by utuers resulting in flattened facies, abnormal libs and hypoplastic lungs?
Potter syndrome/sequence
How does an old cerebral infarct appear on autopsy
cystic cavity surrounded by gliosis d/t release of lysosomal enzymes from ischemic neruons leading to degradation of tissue in ischemic region - known as liquefactive necrosis
What is the main form of restriction for urea cycle disorder such as impaired orinithine transport into the mitochondria?
protein restriction
What are the biochemical abnormalities seen with Alzheimer disease?
decreased acetylcholine levels in the hippocampus and nucleus basalis of Meynert d/t deficiency of choline acetyltransferase
What nucleus is located in the caudal pontine central gray mater and contains large amounts of NE?
locus ceruleus
What nucleus forms the medial part of the brainstem’s reticular formation (medulla, pons, and midbrain) with serotonergic neurons?
raphe nuclei
What is the drug of choice to treat trigeminal neuralgia?
carbamazepine
What CNS tumors occur in immunosuppressed pts that arise from B cells and are universally associated with EBV?
Primary CNS lymphomas
What is the postsynaptic action of opioids on mu receptors?
mu receptors are G protein-linked receptors whose actions are mediated through various secondary messengers, one involving K+ efflux –> morphine binding to mu increases K+ conductance which blocks pain transmission
What are 3 diseases associated with early onset Alzheimer?
- APP on chromosome 21
- Presenilin 1 gene on chromosome 14
- Presenilin 2 gene on chromosome 1
What genotype is associated with late-onset familial Alzheimer disease?
apolipoprotein E4
What foramen contains the meningeal branch of the ascending pharyngeal artery and the artery and nerve o the pterygoid canal?
foramen lacerum
What is a destructive vessel lesion characterized by loss of normal arterial architecture, mural foam cells, and evidence of fibrinoid vessel wall necrosis?
Lipohyalinosis
What results from an accumulation of lipid-laden macrophages within the intimal layer of a vessel?
Microatheromas
What disorder of the inner ear is characterized by an increased volume of endolymph - defectiev resorption of endolymph?
Meniere disease
What is the triad associated with Meniere?
tinnitus, vertigo, and sensorineural hearing loss
What is Cloazapine used for and what is its main SE that must be monitored?
It is used as Tx for Tx-resistant schizophrenic pts with both positive and negative Sx adn acts on D4 recetptors. Its main SE is agranulocytosis - most monitor CBC.
What kind of antihistamines have minimal sedative and antimuscarinic effects?
second-generation antihistamines like fexofenadie
What is the most common cause of damage to subthalamic nucleus?
lacunar stroke
Where is the chemoreceptor trigger zone located?
on the dorsal surface of the medulla at he caudal end of the 4th ventricle, aka area posterma
What disease is caused by a utation of hte genes responsible for the synthesis of myelin leading to decreased nerve conduction velocity, commonly presenting with weakness of foot dorsiflexion d/t involvement of the common peroneal nerve?
Charcot-Marie-Tooth disease
What vascular pathology is seen in peripheral neuropathy associated with DM?
- non-enzymatic glycosylation of proteins leading to increased thickness, hyalinizaiton, and narrowing of arteriole walls
- intracellular hyperglycemia occuring in peripheral nerves - accumulating glucose is converted int osorbitol and fructose by aldose reductase - leads to osmotic damage to axons and Schwann cells
