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Neuro Flashcards

1
Q

Sturge-Weber syndrome

A

Congenital, non-inherited, inactivation of GNAQ gene, development issue with NC derivatives; affects capillary (port-wine stain), ipsi leptomeningeal angioma (seizures/epilepsy/intellectual disability), episcleral hemangioma (glaucoma)

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2
Q

Tuberous sclerosis

A

Hamartomas in CNS/skin, ash-leaf spots, rhabdomyoma/MR, mental retardation/seizures, renal angiomyolipoma

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3
Q

Neurofibromatosis type 1

A

Mutated NF1 tumor suppressor gene (neurofibromin, a negative regulator of RAS) on c17; skin tumors (from NC cells), cafe-au-lait spots, lische nodules, optic gliomas

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4
Q

von Hippel-Lindau disase

A

Hemangioblastomas (high vascularity with hyperchromatic nuclei) in retina, brain stem, cerebellum, spine; angiomatosis (e.g. cavernous hemangiomas), b/l RCC, pheo

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5
Q

GBM

A

Cerebral hemisphere, crosses corpus callosum, astrocytes stain for GFAP; histo: “pseudopalisading” pleomorphic tumor cells

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6
Q

Meningioma

A

Arachnoid cells, extra-axial, and may have dural “tail;” histo: spindle cells concentrically arranged in a whorled pattern with psammoma bodies (laminated calcification)

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7
Q

Hemangioblastoma

A

Cerebellar; a.w. von Hippel-Lindau syndrome if found with retinal angioma; produces EPO - polycythemia; histo: closely arranged, thin-walled capillaries with minimal intervening parenchyma

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8
Q

Schwannoma

A

Cerebellopontine angle, often CNVIII, S-100. If b/l vestibular, suspect NF-2

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9
Q

Oligodendroglioma

A

Frontal lobes; chicken-wire capillary pattern with oligodendrocytes with fried-egg cells

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10
Q

Pilocytic astrocytoma

A

Posterior fossa, well-circumscribed, GFAP-positive, benign; histo: rosenthal fibers (eosinophilic, corkscrew fibers), cystic

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11
Q

Medulloblastoma

A

Cerebellar, highly malignant; can compress 4th ventricle and cause hydrocephalus, can “drop metastasis” into spinal cord; histo: homer-wright rosettes, small blue cells,

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12
Q

Ependymoma

A

4th ventricle, ependymal cell, cause hydrocephalus, poor prognosis; histo: characteristic perivascular rosettes, rod-shaped blepharoplasts (basal cilary bodies) near nucleus

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13
Q

Craniopharyngioma

A

Supratentorial, derived from Rathke pouch remnants, may be confused with pituitary adenoma; histo: calcifications

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14
Q

Cingulate herniation

A

Under falx cerebri; compress ACA

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15
Q

Transtentorial herniation

A

Caudal displacement of brain step, rupture of paramedian basilar artery branches, duret hemorrhages, usually fatal

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16
Q

Uncal herniation

A

Medial temporarl lobe, compresses ipsi CN III, ipsi PCA, contra crus cerebri (ipsi paresis)

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17
Q

Cerebellar tonsillar herniation

A

Compression of brain stem, coma and death

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18
Q

Ventral posterolateral nucleus (VPL)

A

spinothalamic tract (P/T), medial lemniscus (position/propprioception); primary somatosensory cortex

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19
Q

Ventral posteromedial nucleus (VPM)

A

Trigeminal, taste pathways; primary sensory cortext

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20
Q

Lateral geniculate body

A

Opitc nerve; visual cortex (calcarine sulcus)

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21
Q

Medial geniculate body

A

Superior olivary nucleus/inferior colliculus of the pons; auditory cortex of the temporal lobe

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22
Q

Which sense does not have a relay nucleus in the thalamus

A

Smell

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23
Q

Three DA systems, function, and related disease

A

Mesolimbic-mesocortical/regulates behavior/schizophrenia; nigrostriatal/coordination of voluntary movements/ Parkinsonism; tuberinfundibular/prolactin secretion/hyperproactinemia

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24
Q

GABA receptors types/location

A

GABAa: brain, ion channel; GABAb: brain, g-protein; GABAc: retina, ion channel

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25
Q

BZD, barbs, ETOH moa

A

Bind to different GABAa receptor and facilitate inhibitory action in the CNS

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26
Q

Craniopharyngioma

A

Calcified cystic mass in suprasellar region with yellow, viscous, cholesterol-filled fluid; histo: cysts lined by stratified squamous epithelium with keratin pearls; derived from Rathke’s pouch (ectoderm that develops into anterior part of the pituitary gland); pw HA, growth failure, bitemporal hemianopia

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27
Q

Beta-endorphin precursor

A

POMC, a polypeptide precusor that also produces ACTH and MSH

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28
Q

S-ANS usual setup and deviants

A

2-neuron unit that synapse on noradrenergic receptors on target organs (viscera); the innervation of adrenal glands (no 2nd neuron) and sweat glands (both neurons use ACh)

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29
Q

Alzheimer disease

A

Neurofibrillary tangles and A-beta-amyloid plaques

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30
Q

Neurofibromatosis Type 1

A

Single-gene AD mutation of NF1 gene on c17; pw cafe-au-lai spots, multiple neurofibromas, lisch nodules (pigmented asymptomatic hamartomas of iris)

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31
Q

Bulimia nervosa vs anorexia

A

Binge-eating and either restrictive or purging compensatory behaviors; different from anorexia in that pt maintains regular body weight (>17.5 BMI) and does not have amenorrhea

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32
Q

Neural structures and neurons: NE, ACh, DA

A

nucleus ceruleus (dorsal pons), nucleus basalis of Meynert, substantia nigra

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33
Q

PICA

A

Common in pregnancy, often with ice, a.w. Fe deficiency

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34
Q

Thalamic stroke

A

Total sensory loss on contralateral side; proprioception deficit may lead to ataxia

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35
Q

Lacunar infarcts moa, RF

A

Small vessel lipohyalinosis and athersclerosis involving the pentrating vessels of the deep brain structures (BG, posterior limb of internal capsule, pons, cerebellum); uncontrolled HTN and DM

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36
Q

Central pontine myelinolysis presentation

A

Spastic quadriplegia and pseudobulbar palsy

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37
Q

Huntington moa, presentation, histo

A

AD increased CAG repeats in HD gene on c4; NMDA receptors bind glutamate and die; loss of GABA neurons in caudate nucleus and putamen; progressive dementia, aggressive behavior, choreiform

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38
Q

Acoustic neuromas

A

Sensineural hearing loss, tinnitus, facial muscle paralysis, loss of corneal reflex indicate CN 5, 7, 8 involvement; located at cerebellopontine angle

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39
Q

Germ cell tumors

A

Pineal and suprasellar regions, can cause obstructive hydrocephalus (2/2 aqueductal stenosis) and parinaud syndrome (paralysis of vertical gaze)

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40
Q

MCA stroke

A

Hemiparesis (arm>leg), and if on dominant hemisphere, Broca’s aphasia

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41
Q

ACA stroke

A

Hemiparesis (leg>arm), urinary incontinence, primitive reflexes

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42
Q

AICA stroke

A

lateral inferior pontine syndrome, which is contra loss of P/T, ipsi CN 5, 7, horner’s syndrome and cerebellar syndrome

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43
Q

PICA stroke

A

Lateral medullary syndrome (Wallenberg), which is contra P/T loss, ipsi CN 5, 8, 10, 11, and horner’s syndrome

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44
Q

Malignant hyperthermia

A

Occurs in certain genetically-susceptible individuals after inhalation anesthetics or succinylcholine. Treated with dantrolene, which blocks ryanodine receptors and prevent release of Ca into SK fibers

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45
Q

Diabetic neuropathy 2 moa

A

1) hyalinization of nerve arterioles, narrowing of lumen, ischemic injury; 2) accumulation of sorbitol and fructose in nerve axons

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46
Q

GBS

A

Segmental demyelination of peripheral nerves and endoneural inflammatory infiltrate; pw ascending flaccid paralysis (esp lungs, CN 7), areflexia, albumino-cytologic disassociation

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47
Q

CN4 palsy

A

Vertical diplopia

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48
Q

Werdnig-Hoffman syndrome

A

Anterior horn cell damage, LMN lesions; flaccid weakness, areflexia, muscle atrophy, fasciculation (“floppy child” syndrome)

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49
Q

Thiamine deficiency

A

Key coenzyme in pyruvate dehydrogenase; giving glucose without thiamine will exacerate deficiency and Wernicke encephalopathy; affect the mammillary body

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50
Q

Inhaled anesthetics SE

A

Increased cerebral blood flow and ICP; other SE include myocardial depression, hypotension, respiratory depression, and decreased renal function

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51
Q

Cerebral amyloid angiography

A

Beta-amyloid deposited into arterial wall, predisposing to rupture; related to age, unrelated to systemic amyloidosis; presents with recurrent hemorrhages in cerebral areas. Smaller, less severe than HTN hemorrhages (which tend to be in BG)

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52
Q

Kinesin and dynein

A

Microtubular transport proteins; anterograde, retrograde, respectively; Dynein also functions in ciliary and flagellar movement

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53
Q

B12 deficiency

A

Anemia with subacute, combined degeneration of the posterior and lateral spinal columns; diagnosis with increased methylmalonic acid

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54
Q

Old infact

A

Cystic cavity surrounded by wall of astrocyte processes (gliosis)

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55
Q

Opiod SE that do not develop tolerance

A

Constipation and miosis

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56
Q

Morphine tolerance MOA

A

Phosphorylation of opioid receptors, increased AC activity or increased NO activity; glutamate activation of NMDA receptors enhance morphine tolerance; NMDA receptors like ketamine block the actions of glutamate and can decreased tolerance

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57
Q

5-HT syndrome

A

Neuromuscular excitation (hyperreflexia, clonus, myoclonus, rigidity, tremor), ANS stimulation (hyperthermia, taachycardia, diaphoresis, vomiting/diarrhea), AMS (agitation, confusion); can occur with single OD or with combined MAO-I; precursor is tryptophan; can treat with cyproheptadine (antihistamine with anti-serotonergic properties)

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58
Q

Clozapine

A

Acts on D4 receptors (unlike tradiational DA agaonists, which act on D2 receptors); SE: life-threatening agranulocytosis

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59
Q

MS

A

Acute: histologically, demyelination with relative preservation of axons, accumulation of lipid-laden macrophages, astrocytosis, infiltration by lymphocytes and mononuclear cells; chronic: loss of axons, neurons, and oligodendrocytes

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60
Q

Primary CNS lymphoma

A

Diffuse large B-cell lymphoma is m/c, cells positive for B-cell markers CD-20 and CD-79a; histo: dense, cellular aggregates of uniform, atypical lymphoid cells

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61
Q

Phenytoin moa

A

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

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62
Q

Cholernergic agonist effect

A

GI smooth muscle (N/V, ab cramps, diarrhea), cardiac (bradycardia, negative chronotropy, ionotropy, hypotension), periphery (vasodilation/hypotension, excess sweating/salivation, lacrimation), lungs (bronchoconstriction and increased bronchial secretion)

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63
Q

Bethanechol

A

Cholinergic agaonist to stimulate peristalsis in post-operative ileus and treat non-obstructive urinary retention 2/2 atonic bladder

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64
Q

Carbachol, pilocarpine

A

Lower IOP in glaucoma (2/2 cholinergic associated miosis moving iris further from cornea and increase anterior chamber angle)

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65
Q

Puffer fish poisoning moa

A

Tetrodotoxin binds to VG Na channels in nerve and cardiac tissue to prevent Na influx and depolarization; same MOA as saxitoxin produced by dinoflagelletes in red tide

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66
Q

Neuron injury: 12-48 hours

A

“Red neurons” with eosinophilic cytoplasm, pykonic nuclei, loss of Nissl substance

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67
Q

Neuron injury: 24-72 hours

A

Necrosis and PMN

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68
Q

3-5 days

A

MO infiltration and phagocytosis

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69
Q

1-2 weeks

A

Reactive gliosis and vascular proliferation (macroscopically, liquefactive necrosis with well-demarcated soft area, 1 week - 1 month)

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70
Q

> 2 weeks

A

Glial scare (macroscopically, cystic area surrounding by gliosis, >1 month)

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71
Q

Ventromedial

A

Stimulated by leptin, mediates satiety; destruction leads to hyperphagia

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72
Q

Lateral

A

Inhibited by leptin, mediates hunger; destruction leads to anorexia

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73
Q

Anterior

A

Mediates cooling/heat dissipation via P-ANS; destruction leads to hyperthermia

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74
Q

Posterior

A

Mediates heating/heat conservation via S-ANS; destruction leads to hypothermia

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75
Q

Arcuate

A

Secretion of DA, GnRH, gonadotropin

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76
Q

Paraventricular

A

ADH, CRH, oxytocin, TRH hormone

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77
Q

Supraoptic

A

ADH, oxytocin

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78
Q

Suprahiasmatic

A

Circadian rhythm regulation and pineal gland function

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79
Q

AMS

A

Mutation in copper-zinc superoxide dismutase (SOD-1); macro: thin anterior roots, mild atrophy of the precentral gyrus; micro: degeneration of lateral corticospinal tracts, loss of neurons in the anterior horn, loss of CN, denervation atrophy of muscles;

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80
Q

AChase inhibitors like organophosphate compounds

A

Prevent breakdown of ACh in NMJ, leads to muscarinic overstimulation; depolarizing blockade (muscle weakness, fasciculations, paralysis), miosis, bradycardia, increased lacrimation/salivation

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81
Q

Atropine/scopalamine

A

Competive antagonists of muscarinic ACh receptors, leads to ACh poisoning (cutaneous vasodilation, anhidrosis, hyperthermia, mydriasis, delirium)

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82
Q

Botulism

A

Nicotinic (descending paralysis, starting with diplopia, dysphagia, difficulty speaking) and muscarinic blockade (e.g. dry mouth); enters nerve through endocytosis and binds to ACh vesicles, preventing their release

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83
Q

Thiopental and cause of rapid plasma decay

A

Redistribution

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84
Q

Hypocretin-1 and hypocretin-2 function, deficiency results in?

A

Neuropeptides produced in lateral hypothalamus that promote wakefulness and inhibito REM sleep-related phenomena; deficiency results in nacrolepsy with cataplexy (CSF= undetectable levels of hypocretin-1)

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85
Q

Cataplexy

A

Conscious, brief episodes of b/l muscle tone loss precipitated by laughter/joking; or spontaneous, abnormal facial movements without emotional triggers

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86
Q

Drugs that increase levodopa in the CNS

A

DOPA decarboxylase inhibitor (L-Dopa), COMT inhibitors like entacapone (periphery)/tolcapone (periphery and central);

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87
Q

Stapedius muscle

A

Innervated by CN7; paralysis results in hyperacusis

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88
Q

Alzheimer MRI finding

A

Hippocampus atrophy, diffuse brain atrophy

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89
Q

Dividing point between anterior 2/3 and posterior 1/3 of tongue

A

Terminal sulcus and foramen cecum

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90
Q

Fragile X

A

X-linked, pw MR, dysmoprhic facial features (large jaw, protruding ears), macroorchidism

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91
Q

Klinefelter syndrome

A

47 XXY, pw tall stature, gynecomastia, small, firm testes, infertlity

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92
Q

Acute mania treatment

A

Mood stabilizer (lithium, valproate, carbamazepine) plus atypical AP (olanzapine)

93
Q

Global cerebral ischemia

A

Watershed infarcts; present as bilateral wedge-shaped bands of necrosis over the cerebral convexity, just lateral to interhemispheric sphere; neurons lack glycogen and thus very susceptible to ischemia

94
Q

DRESS

A

2-8 weeks after exposure to high-risk drug like anticonvulsant (phenytoin, carbamazepine, allopurinol, sulfonamides). Patients develop fever, generalized LN, facial edema, diffuse morbilliform skin rash, eosinophilila, and internal organ dysfunction

95
Q

Severe vitamin E deficiency

A

Degeneration of spinocerebellar tracts, dorsal column of spinal cord, peripheral nerves; mimics symptoms of Friedreich ataxia (ataxia, dysarthria, dorsal column loss)

96
Q

Mutations a.w. early-onset Alzheimer; mutations a.w. late-onset Alzheimer

A

Amyloid precursor protein (APP) on c21, presenilin 1 gene on c 14, presenilin 2 gene on c1; ApoE4

97
Q

CN7 functon

A

Motor output to facial muscles, parasympathetic innervation to lacrimal, submandibular, sublingual salivary glands, taste fibers for anterior 2/3 of tongue, somatic affects from the pinna and external auditory cancal

98
Q

Myotonic dystrophy

A

AD, increased trinucleotides on myotonia-protein kinase; sustained muscle contraction, weakness, muscle atrophy (Type 1 fibers), cataracts, frontal balding and gonadal atrophy

99
Q

Phrenic nerve

A

Motor innervation to diaphragm, sensory innervation to thoracic viscera

100
Q

Schizoaffective d/o

A

Psychosis must occur in the absence of major mood episodes, but mood symptoms have to be present for most of illness. In MDD or bipolar disorder with psychotic feature, pscychotic symptoms occur only in modd episodes

101
Q

Neonatal intraventricular hemorrhage

A

Arises from fragile germinal matrix (highly cellular and vascluarized layer from which neurons and glial cells migrate out; the vessels lack glial fibers for support), increases in frequency with decreasing age and BW. Common complication of prematurity and can lead to neurodevelopmental impairment

102
Q

Hydrocephalus vs hydrocephalus ex vacuo

A

Increase in CSF volume and pressure in forner; no increase in CSF pressure in the latter

103
Q

SAH etiology, complications, related rx

A

saccular aneurysms, AV malformations; severe vasospasm 4-12 days after initial insult; Nimodipine

104
Q

Temporal arteritis

A

Segmental, granulomatous infllamation of media of arteries; pw HA, jaw claudication, monocular blindness, polymyalgia rheumatica (neck, torso, shoulder, pelvic pain with stiffness with some systemic sx)

105
Q

Transverse spinal cord section

A

More proximal levels have more white matter and more ovoid sections; lower cervical and lumbosacral regions have large ventral horns; thoracic and early lumbar sections ontain lateral horns (pre-symp ganglions)

106
Q

First arch syndrome

A

Malformation of the mandible, maxilla, malleus, incus, palate, and temporal bone; associated with CN5

107
Q

Schwannomas

A

histo: biphasic pattern of cellularity (antoni A, B areas) and S-100 positivity (NC origins); can arise from peripheral nerves, nerve roots, cranial nerves (except II)

108
Q

Nasal hemianopia

A

Aneurysm or athersclerotic calcification of ICA can laterally impinge on optic chiasm and dmg uncrossed optic nerve fibers

109
Q

Global cerebral ischemia

A

Most susceptible cells are pyramidal cells of the hippocampus and the neocortex and the purkinje cells of cerebellum. Hippocampus is the first area damaged during global cerebral ischemia.

110
Q

HSV-1 encephalitis

A

Bilateral temporal lobes; pw aphasia, olfactory hallucinations (olfactory cortex), personality changes (amygdala)

111
Q

Serotonin syndrome-inducing drugs when used with 5-HT drugs

A

Tramadol, ondansetron, and linezolid

112
Q

MAO-I (phenelzine) SE

A

MAO is a mitochondrial enzyme, degrades excess neurotransmitter amines; MAO-I work by blocking degradation of amine NT (NE)to accumulate in pre-synaptic stores; food (wine, cheese, etc) containing tyramine (sympathomimetic) are typically metabolized in the GI tract, but MAO-I block this degradation and allow its release into circulation, HTN crisis

113
Q

NT defects leaks what?

A

Alpha-fetoprotein and acetylcholinesterase

114
Q

Atropine; undone by what?

A

reversible cholinergic antagonist; cholinesterase inhibitor (physostigmine)

115
Q

Organophosphate poisoning moa, sx, and rx

A

Irreversible cholinesterase inhibition leads to cholinergic toxicity; pw excessive salivation, lacrimation, diaphoresis, urinary incontinence, diarrhea, emesis, miosis, bradycardia; rx with atropine (muscarinic antagonist) and pralidoxime (cholinesterase enzyme reactivator)

116
Q

Akathisia

A

EPS SE of AP medication, pw inner restlessness and inability to sit/stand in one position. Misdiagnosed as agitation and AP dose incorrectly raised.

117
Q

Pentazocine

A

Opioid narcotic designed to produce analgesia with reduced abuse potential; acts as a partial agaonist with weak antagonist acitivty at mu receptors; can come withdrawal symptoms in patients who are dependent/tolerent to opioids

118
Q

Cystic tumor in the cerebellum of a child

A

pilocytic astrocytoma: well-differentiated neoplasm with spindle cells with hair-like glial processes, mixed with Rosenthal fibers and granular eosinophilic bodies

119
Q

Cholinergic activity at blood vessels

A

Binds to muscarinic receptors on endothelial cells to promote NO/EDRF release; NO activiates guanylate cyclase, diminishes endothelium Ca concentration, which produces vasodilation

120
Q

Cholinergic effect at GI

A

Cholinomimetics increase smooth muscle tone at visceral walls; increase motility and secretion in GI tract, leading to N/V, ab cramps, and diarrhea; contrarily, anti-Ch drugs relax GI wall and increase spinctor contraction, leading to constipation

121
Q

Neuroblastoma

A

Increased number of N-myc genes, derived from neuroblasts in adrenal medulla, m/c extracranial childhood cancer; pw opsoclonus-myoclonus (non-rhythmic conjugate eye movement with myoclonus), HTN 2/2 increased catecholamines

122
Q

Fragile X molecular mechanism

A

Fragile X mental retardation 1 (FMR-1) gene is on the X chromosome; increased CGG trinucleotide repeats leads to hypermethylation of cytosine and gene inactivation.

123
Q

Schizophrenia

A

2/5 of following symptoms: delusions, hallucinations, disorganized speech, grossly symptoms, and negative symptoms (6 months)

124
Q

NPH

A

Wet, wacky and wobbly; communicating hydrocephalus 2/2 diminshed reabsorptive capcacity of arachnoid villi; CT shows symmetrical dilatation

125
Q

Marijuana immediate symptoms

A

Rapid heart rate and conjunctival injection

126
Q

Mu receptor MOA

A

GPLR, increased K conductance and efflux, which leads to hyperpolarization of postsynaptic neurons to block pain transmission

127
Q

Mid-pons infarct

A

CN 5, pw dysarthria, contra ataxic hemiparesis (contra because pontocerebellar fibers enter through contralateral cerebellar peduncle)

128
Q

Three types of signal pathways in ANS

A

cAMP: Beta 1, 2, M2; IP3: alpha 1, M1, M3 ; ion channel: nicotinic receptors (ligand-gated ion channels that open after binding with ACh and results in immediate influx of Na, Ca and outflow of K)

129
Q

Central SE of dopamine that are worsened with the addition of carbidopa

A

Anxiety and agitation

130
Q

CN3 pathway, components, and pathology

A

Exits midbrain and courses between the PCA and superior cerebellar arteries (susceptible to related aneurysms); parasym fibers (responsible for pupillary light and near-reflex pathways) susceptible to compression (aneurysm/tumor); somatic fibers (oculomotor muscles) susceptible to injury from ischemia (DM)

131
Q

Examples of malformation (primary abnormality in development), disruption (secondary destruction of previously well-formed tissue or organ), deformation (secondary to extrinsic problem), sequence (single primary defect leads to multiple manifestations)

A

Holoprosencephaly (failure of forebrain cleavage into cerebral hemisphere); amniotic band syndrome (rupture of amnion leads to band formation that can compress limbs); congeintal hip displication/clubbed feet/flat facies 2/2 oligohydramnios; Potter syndrome

132
Q

Trazadone moa, main SE

A

Highly sedating anti-depressant for insomnia, adjunct to SSRI in treating depression-related insomnia; priapism

133
Q

Liquefactive necrosis

A

Complete digestion and removal of necrotic tissue: first, ischemic neurons release lysosomal enzymes to degrade the tissue, then phagocytes migrant and remove necrotic tissue before astrocytes proliferate and form scar (gliosis)

134
Q

Drug-induced parkinsonism

A

Blockage of D2 receptors lead to rigidity, bradykinesia, tremor, masked facies; rx by decreasing drugs or giving benztropine or amantadine; levodopa or other DA agonists (e.g. bromocriptine) are contraindicated as they may precipitate psychosis

135
Q

Vita E deficiency MOA

A

Protects FA from oxidation; thus, cell membranes with high FA content (neurons/RBC) prone to damange in deficiency; pw neuromuscular disease (spinocerebellar ataxia, dorsal column sensory loss) and hemolytic anemia

136
Q

Acute neuronal injury

A

Shrinkage of cell body, shrunken/basophilic nucleus, loss of Nissl substance, eosinophilic cytoplasm

137
Q

Axonal reaction 2/2 loss of axon

A

Enlargement of cell body, eccentric nucleus, enlargement of the nucleolus, dispersion of Nissl substance

138
Q

Neuronal atrophy 2/2 progressive degenerative dz

A

Loss of neurons, reactive gliosis

139
Q

“On-off” phenomena in advanced PD

A

Unpredictable, dose-independent loss of L-dopa effects ; but do not increase dose, which will not improve motor symptoms and carry higher risk of dyskinesia

140
Q

Buspirone MOA

A

Selective agonist of 5-HT1a receptor, safe and effective for GAD. No hypnotic, sedative, or euphoric effects. Not effective for panic d/o, phobias. No dependence over time. Clinical response delayed up to 2 weeks.

141
Q

Hydrocephalus in infant pw, long-term complications?

A

irrability, poor feeding, increased head circumference, enlarged ventricles; LE spasticity 2/2 stretching of periventricular pyramidal tracts, visual disturbances, learning disabilities

142
Q

Which anti-depressants induce mania?

A

All can, but venlafaxine and TCA are most likely

143
Q

Penicillin and cephalosporins moa

A

Bind to penicillin-binding proteins like transpeptidase (NOT cell wall glycoproteins)

144
Q

PD treatment

A

Selegiline (MAO-I that prevents MPTP induced dmg of DA neurons), amantadine (DA agonist with anti-ACh activity) , ACh

145
Q

Astrocytes

A

Neuroectoderm origin, contain glial fibrillary acidic protein (GFAP), functions are to repair, structural support, maintain BBB, metabolic

146
Q

Oligodendrocytes

A

Neuroectoderm, small round dark nuclei surrounded by pale halo, production of myelin

147
Q

Microglia

A

BM-originated MO, small, elongated nuclei, phagocytosis

148
Q

Direct Xa inhibitors

A

Increase PT, aPTT

149
Q

Unfractionated heparin and direct thrombin inhibitors

A

Increase thrombin time

150
Q

Motion sickness stimulated by what receptors, medications?

A

M1 muscarinic and H1 histaminic receptor; meclizine (anti-histaminic with anti-muscarinic properties) or scopalamine (anti-muscarinic properties only)

151
Q

Valproate acid teratogenic effect

A

NT defect

152
Q

Blotchy red muscle fibers on gomori trichome stain is evidence of what? What is an example?

A

Mitochondrial myopathy; myoclonic epilepsy with ragged red fibers

153
Q

MS plaques

A

Loss of myelin sheathes and depletion of oligodendrocytes; oligocloncal bands of IgG on CSF analysis

154
Q

Progressive multifocal leukoencephalopathy

A

Oligodendrocyte depletion

155
Q

Scotoma

A

Visual field defect that involves retina or optic nerve that results in a discrete area of altered vision surrounded by zones of normal vision (2/2 MS, diabetic retinopathy, macular degeneration); lesions of the macula cause central scomatas

156
Q

In the US, majority of OD deaths related to

A

Opioid analgesics

157
Q

Treatment for GAD, panic disorder

A

SSRI with short-term BZD (4 weeks)

158
Q

BZD best for treating insomnia in patients employed in critical positions

A

Trazolam

159
Q

CN9 lesions

A

Loss of gag reflex (2/2 afferent limb loss), loss of sensation in upper pharynx, posterior tongue, tonsils, middle ear cavity and loss of taste sensation in posterior 1/3 of tongue

160
Q

Neuroleptic malignant syndrome

A

Haloperidol; pw hyperthermia, extreme rigidity, ANS instability, AMS; different from serotinin syndrome in the presence of rigidity and absence of myoclonus; rx with DA agonists like bromocriptine and/or muscle relaxants like dantrolene

161
Q

ETOH withdrawal

A

tremulousness (first), anxiety, angitation, ANS disturbance, GI distress; DT can occur between 2-3 days of last drink

162
Q

Conus medullaris syndrome

A

Flaccid paralysis of bladder/rectum, impotence, saddle anesthesia

163
Q

Cauda equina

A

Low back pain radiating downwards, saddle anesthesia, loss of “anal wink,” bowel/bladder dysfunction (S3-S5), and loss of ankle-jerk reflex

164
Q

Light reflex pathway

A

CN2, pretectal nucleus (near superior colliculus), ipsi/contra edinger-westphal (decussating via posterior commissure), motor neuron preganglionic neurons in edinger-westphal nucleus, CN3, ciliary ganglion, post-ganglionic neurons, iris spincter

165
Q

NF2

A

NF2 tumor suppressor gene that codes for merlin on c22; pw b/l acoustic neuromas

166
Q

NF1

A

NF1 -1 gene mutation on c17, AD

167
Q

Lamotrigene SE

A

Refractory partial seizures; SE that is life-threatening in children

168
Q

Micturition reflex

A
  1. Sacral micturition center: located in S2-S4 and responsible for bladder contraction. Parasympathetic fibers travel down and stimulate cholinergic receptors on bladder wall. 2. Cerebral cortex: inhibits sacral micturition center. 3. Pontine micturition center: located in the pontine reticular formation, and coordination relaxation of external urethral spincter with bladder contraction during voiding.
169
Q

Lacunar stroke to subthalamic nucleus

A

Contra hemiballism

170
Q

Lacunar infarcts

A

<15 mm in diameter in BG, pons, internal capsule, deep white matter; most often occur with hypertensive arteriosclerosis of small, penetrating arteries

171
Q

Lacunar infarts: location and effect? pure motor hemiparesis, pure sensory, ataxia-hemiplegia syndrome, dysarthria-clumsy hand syndrome

A

Posterior limb of internal capsule, VPL/VPM thalamus, base of pons, base of pons/genu of internal capsule

172
Q

Diseases with anticipation

A

Huntington, Fragile X, mytonic dystrophy, Friedreich ataxia

173
Q

Primidone metabolites

A

Phenobarbitol and phenylethylmalonamide (all three compounds are active anticonvulsants)

174
Q

First generation anti-histaminics (diphenhydramine, chlorpheniramine) MOA and SE

A

Decrease the activity of H1 histamine receptor by increasing the proportion of inactive H1 receptors (reverse blockade); antimuscarinic (pupillary dilation, dry mouth, urinary retention, and constipation), anti-adrenergic (hypotension, postural dizziness), and anti-seroternergic (appetite stimulation and weight gain)

175
Q

Phenytoin SE

A

Gingival hyperplasia (2/2 increased PDGF, stimulation of gingival macrophages, stimulation proliferation of gingival cells and alvelar bone), ataxia/nystagmus (cerebellum and vesticular system); megaloblastic anemia 2/2 interference with FA metabolism, P450 cytochrome inducer; teratogen (fetal hydantoin syndrome)

176
Q

Lithium toxicity

A

Neuromuscular excitability (course tremors, fascicular twitching, agitation, ataxia), nephrogenic DI, hypothyroidism, cardiac conduction defects

177
Q

Alpha 1: receptor locations and agonists

A

Peripheral vasculature (increase SBP); bladder (contraction of internal urethral spincter; eye (contraction of pupillary dilator muscle); epi, NE, phenyleprhine

178
Q

Beta 1: receptor location and agaonists

A

Heart (chronotropy, ionotropy); epi, dopamine, dobutamin, isoproterenol

179
Q

Beta 2

A

Peripheral vasculature in SK muscle (vasodilation, decreased DBP), bronchi (bronchodilation), uterus (relaxation/tocolysis); isoproterenol, terbutaline

180
Q

BZD choice in ETOH withdrawal

A

Long-acting (diazepam, chlordiazepoxide); short-acting (lorazepam, oxazepam) for liver failure patients

181
Q

Atropine SE on eyes

A

Myadrisis, preciptating closed-angle glaucoma, pw unilateral severe eye pain and visual disturbances

182
Q

Syringomyelia

A

Fixed segmental loss of UE P/T, UE LMN signs, LE UMN in setting of scoliosis

183
Q

Rx for bipolar disease and seizure prophylaxis, and related SE

A

Valproate (hepatotoxicity, NT defect); Carbamazapine (agranulocytosis, hyponatremia, NT defect, CYP450 inducer); Lamotrigine (SJS in children)

184
Q

Cocaine MoA

A

indirect sympathomimetic by inhibiting the presynaptic reuptake of NE, DA, 5-HT; also causes vasoconstriction of heart and atrophy of nasal mucosa/septum

185
Q

Naloxone MoA

A

Pure opioid receptor antagonist, used in OD, with greatest affinity for mu receptors, given parenterally

186
Q

Polyhydramnios moa, etiologies

A

Decreased fetal swallowing (2/2 duodenal, esophogeal, intestinal atreia or anencephaly) or increased urination (high cardiac output 2/2 anemia or TTFS)

187
Q

Lithium SE

A

hypothyroidism, nephrogenic diabetes inspidus, accumulation in patients with renal insufficiency

188
Q

Alzheimer disesae MOA

A

Diminished activity of choline acetyltransferase in the nucleus basalis of Maynert and hippocampus

189
Q

SSRI SE

A

sexual dysfunction

190
Q

TCA SE

A

Urinary retention, cardiac arrhythmias (QT prolongation), seizures, orthostatic hypotension

191
Q

Sciatica: compression of S1

A

Pain in posterior thigh and leg, diminution of the ankle jerk reflex

192
Q

Sciatica: compression of L5

A

Posterior and lateral thigh and leg pain shooting to the inner foot

193
Q

Determinants of inhaled anesthetic onset of action

A

Tension in inhaled air, pulmonary ventilation rate, solubility in blood, solubility in peripheral tissue

194
Q

Friederich ataxia

A

AR, trinucleotide repeat in frataxin gene, pw cerebellar ataxia, loss of position and vibration sensation, kypohscoliosis, hypertrophic cardiomyopathy. Foot abnormalities and DM also common.

195
Q

Buproprion indications, SE, contraindications

A

Major depression, tobacco dependence, hypoactive sexual disorder; seizures; patient with seizure disorder or bulimia/anorexia diagnosis

196
Q

Medications with seizure as a SE

A

buproprion, clozapine, isoniazid, ciprofloxacin, imipenim

197
Q

ADPKD patient presents with HA

A

Intracranial berry aneurysm presents with SAH

198
Q

Atropine MOA, limitation as rx for organophosphate poisoning, and supplemental rx

A

Competitively binds muscarinic ACh receptors; pt still at risk for muscle paralysis (2/2 nicotinic receptors); rx with pralidoxime (“restores” AChase from its bonds to the organophosphate)

199
Q

Meniere dz MOA, pw

A

defective resorption of endolymph leads to increased volume of endolymph; pw tinnitus, vertigo, and sensorineural hearing loss

200
Q

Macular sparing in PCA stroke 2/2

A

Collateral blood from MCA to the occipital pole

201
Q

OHS moa, pw

A

Obesity impedes expansion of chest and abdominal wall, creating increased respiratory work and decreased respiratory drive; pw hypercapnia, hypoxia

202
Q

Cimetidine moa, se

A

H2-receptor blocker; gynecomastia, inhibit P450 (increasing warfarin, phenytoin, propanolol, metoprolol, quinidine, theophyline)

203
Q

What vitamin increases peripharal metabolism of levodopa?

A

B6

204
Q

Phrenic nerve irritation pw

A

Hiccups, diphragmatic paralysis with dyspnea

205
Q

Paraneoplastic cerebellar degeneration

A

Small cell lung cancer, breast/ovarian/uterine cancer; worsening dizziness, limb/truncal ataxia, dysarthria, visual disturbance (diplopia); immune response against tumor cells that cross-reacts with Purkinje neuron antigens; anti-yo, anti-P/Q, anti-hu

206
Q

Huntington mutation

A

Gain of function mutation that leads to increased histone deacetylation and transcriptional silencing of genes needed for neuronal survival;

207
Q

Atypical depression pw, rx

A

Mood reactivity (positive response to positive events), leaden fatigue, rejection sensitivity, and increased sleep/appetite; MAO-I like phenelzine is particularly helpful

208
Q

TCA SE

A

Inhibition of muscarinic receptors (tachycardia, delirium, dilated pupils, flushing, decreased diaphoresis, hyperthermia, intestinal ileus, urinary retention); peripheral alpha-1 adrenergic (peripheral vasodilation and orthostatic hypotension); cardiac fast Na channels (arrhythmias), presynaptic NT reuptake (seizures, tremors), H1 receptors (sedation)

209
Q

Narcolepsy treatment

A

Scheduled daytime naps and modafinil (non-amphetamine) stimulant

210
Q

Migraine moa, rx

A

Activation of trigeminal afferents that innervate meninges, which release vasoactive neuropeptides (substance P and calcitonin gene-related peptide); sumatripan (5-HT1b/5-HT1D) agonists directly counter the pathophysiologic mechanism by inhibiting the release of vasoactive peptides and promoting vasoconstriction.

211
Q

Carpel tunnel etiologies

A

Hypothyroidism, diabetes mellitus, RA, dialysis-related amyloidosis

212
Q

MG: myasthenic and cholinergic chrisis

A

Myasthenic crisis: not enough neostigmine, not enough ACh; cholinergic crisis: too much neostigmine, too much ACh; Clinical improvement after edrophonium administration means myasthenic crisis

213
Q

Patient feints after inserting a speculum into the posterior wall of the external auditory meatus

A

Vagus nerve provides some cutaneous sensation to the posterior external auditory cancel by small auricular branch

214
Q

P450 Inducer

A

Rifampin, carbamazepine, phenobarbital, chronic ETOH consumption, griseofulvin

215
Q

P450 inhibitor

A

Isoniazid, cimetidine, macrolides, azole antifungals, and grapefruit juice

216
Q

BZD

A

Increase the frequency of opening of CNS GABAa receptor chloride channels and have anxiolytic, anticonvulsant, muscle relaxant, sedative-hypnotive effects

217
Q

Barbituates

A

increase the duration of opening of the GABAa receptor-chloride in CHS neurons

218
Q

TCA-related cardiac abnormalities: treat with?

A

sodium bicarbonate

219
Q

Minimal alveolar concentration

A

Concentration of anesthetic in alveoli needed to render 50% of patients unresponsive to painful stimuli; measures potency of inhaled anesthetic

220
Q

Physostigmine vs neostigmine/edrophonium

A

Former penetrates CNS/periphery; latter cannot cross BBB

221
Q

MELAS

A

Mitochondrial encephalopathy with Lactic Acidosis and Stroke like episodes

222
Q

2nd generation anti-histamine

A

Fexofenadine, with minimal sedative and antimuscarinic effects

223
Q

Deep branch of the radial nerve

A

Arises from the lateral epicondyle of the humerus; radial head subluxation can dmg this nerve and cause weakness of the forearm/hand extensors but no sensory deficits

224
Q

Wilson’s disease causes cystic degeneration in what structure?

A

putamen

225
Q

Methadone special characteristic

A

Long half-life allows for prolonged ability to suppress withdrawal symptoms

226
Q

Korsakoff syndrome

A

Permanent memory loss and confabulation

227
Q

Charcot-Bouchard pseudoaneurysms

A

A.w. HTN-induced hyaline arteriosclerosis in BG and internal capsule; <1 mm; intracerebral hemorrhage; sudden onset of focal deficits

228
Q

Subacute sclerosing panencephalitis (SSPE)

A

Complication of measles; virus with absent matrix protein proliferate intracellularly and accumulate viral nucleocapsids within neurons, intranuclear inclusions eventually lead to inflammation, demyelination, gliosis; present with high titers of measles antibodies in serum and csf

229
Q

Friedreich ataxia

A

AR, mutation on c9 has increased trinucleotide repeats; a.w. hypertrophic cardiomyopathy, DM, kyphoscoliosis, foot deformities

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