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Neuro Flashcards

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USMLE® Step 1 flashcards
1
Q

What CNS abnormality is associated with Shh mutation?

A

Holoprosencephaly (failure of L-R separation)

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2
Q

What is Chiari 1 Malformation?

Chiari 2?

A

Chiari 1 = cerebellar tonsil herniation + syringomyelia

Chiari 2 = lumbosacral myelomeningocele + cerebellar vermis herniation + hydrocephalus

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3
Q

What is a Dandy Walker malformation?

A

Agenesis of cerebellar vermis

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4
Q

Fried egg cells (3)

A

Oligodendrocytes, HPV koilocytosis, testicular seminomas

“Oligo my eggo”

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5
Q

Which CNS cell type is directly infected by HIV?

A

Microglial - form multinucleate giant cells

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6
Q

What 3 pathologies decrease 5HT levels?

A

Parkinson disease, anxiety, and depression

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7
Q

Where is ACh made in the brain?

A

Basal nucleus of Meynert

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8
Q

What effect does ACh have one movement?

A

Inhibits movement (indirect extrapyramidal pathway)

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9
Q

What NT is made in the Locus ceruleus?
Raphe nucleus?
Nucleus accumbens?

A

NE
5HT
GABA

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10
Q

What is damaged in transcortical motor aphasia?

How does this affect speech?

A

Pre-Broca’s input

Non-fluent spontaneous speech with intact repetition (Broca’s aphasia has non-fluent speech with impaired repetition)

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11
Q

What is damaged in transcortical sensory aphasia?

How does this affect speech?

A

Pre-Wernicke’s input

Poor comprehension with intact repetition (Wenicke’s aphasia has poor comprehension with impaired repetition)

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12
Q

How does mixed transcortical aphasia present?

A

Confluent speech + impaired comprehension + normal repetition

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13
Q

What is dysprosody?

A lesion in what area of the brain affects it?

A

Musical quality/inflections of speech
Lesion of Broca’s/Wernicke’s on the non-dominant hemisphere (Brocas = monotone speech, Wernickes = don’t understand sarcasm)

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14
Q

Agraphia + acalculia + R-L disorientation + finger agnosia (cannot distinguish fingers)

A

Gerstmann syndrome - lesion the dominant (left) angular gyrus (parietal lobe = synthesizes information)

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15
Q

Hemispatial neglect results from a lesion in what location of the brain?

A

Non-dominant (right) parietal lobe

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16
Q

Return of primitive reflexes could indicate a lesion in what lobe?

A

Frontal lobe

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17
Q

Lesion to left frontal eye field would cause gaze in which direction?

A

Left - FEF are constitutively active (lesion L FEF = unopposed R FEF = L-ward gaze)

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18
Q

Lesion to left PPRF would cause gaze in which direction?

A

Right - PPRF are downstream from contralateral FEFs and transmit message for ipsilateral gaze (lesion L PPRF = impaired transmission from R FEF = unopposed L FEF = R-ward gaze)

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19
Q

Impaired upward gaze

A

Parinaud syndrome - lesion of superior colliculus

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20
Q

Wernicke-Korsakoff syndrome

A

Nystagmus/opthalmoplegia + ataxia + amnesia/confabulation

Lesion to the mammillary bodies (thiamin B1 deficiency)

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21
Q

Kluver-Bucy syndrome

A

Hyper-orality + hypersexuality + disinhibited behavior

Lesion to the amygdala

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22
Q

What is hemiballismus?

What lesion causes it?

A

Flailing of one arm

Subthalamic nucleus

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23
Q

How will compression of CN3 present?

Ischemia?

A

Compression - lesion outer fiber = parasympathetics (blown pupil
Ischemia - lesion inner fiber = motor neurons (ptosis + down and out)

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24
Q

What is the most common cause of Bell’s Palsy?

A

HSV/VZV

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25
Q

R vagus nerve lesion will cause uvula to deviate in which direction?

A

Left (L palate elevates = uvula points L)

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26
Q

What CN originates from the nucleus ambiguous?

What 2 functions are mediated there?

A

CNX

Speech and swallow

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27
Q

Are motor CN nuclei found medially or laterally in the brainstem?

A

Motor medial, sensory lateral

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28
Q

Horseness/dysphagia + vertigo/nystagmus + uvula deviates R + L ptosis/miosis/anhydrosis + R pain/temp loss in legs + L pain/temp loss in face

A

Wallenberg syndrome - L lateral medulla infarct = L PICA

CN 5 is huge and extends down into the medullar

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29
Q

L spastic paralysis + L proprioceptive loss + tongue deviates R

A

R Medial medullary syndrome - ASA

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30
Q

L facial droop + L pain/temp loss in face + R pain/temp loss in legs

A

Lateral inferior pontine syndrome - L AICA

CN7 is in the inferior pons, superior pons would be CN5 presenting with jaw weakness

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31
Q

Left gaze causes L eye nystagmus + no R eye abduction + L spastic paralysis + L proprioceptive loss +/- preferential gaze to L

A

R Medial pontine syndrome - Basilar a

R PPRF damage would cause preferential gaze to contralateral side

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32
Q

If L gaze causes L eye nystagmus, which side is the MLF lesioned?

A

R MLF - impaired R eye adduction

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33
Q

Dysphagia + L spastic hemiparesis + R ptosis/mydriasis/down and out

A 
Weber syndrome (midbrain peduncle infarct) - paramedian branches of the R PCA
(corticobulbar tract - dysphagia, corticospinal tract - paralysis, strabismus - CN3 travels thru peduncles)
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34
Q

Paraventricular hypothalamic nucleus

A

Secretes oxytocin

“Causes milk let down, need it for your para tits”

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35
Q

Lateral hypothalamic nucleus

Ventromedial hypothalamic nucleus

A

Lateral - hunger “Grow laterally”

Ventromedial - satiety “V points down, decreases hunger)

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36
Q

Anterior hypothalamic nucleus

Posterior hypothalamic nucleus

A

Anterior - cooling (Anterior = AC), pArasympathetic

Posterior - warming, sympathetic

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37
Q

Supraoptic hypothalamic nucleus
Preoptic hypothalamic nucleus
Suprachiasmatic hypothalamic nucleus

A

Supraoptic - ADH “Osmolarity above all”
Preoptic - GnRH “Must ovulate before conception”
Suprachiasmatic - Circadian rhythm “Charisma requires sleep”

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38
Q

Urinary incontinence + ataxia + cognitive dysfunction (dementia)

A

Normal pressure hydrocephalus - normal ICP with ventricle expansion that distorts the corona radiata
“Wet, wacky, and wobbly”

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39
Q

Young obese woman + daily pulsatile headaches + papeilledema

A

Pseudotumor cerebri (idiopathic intracranial HTN) - increased ICP without hydrocephalus (i.e. normal CSF volume)

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40
Q

What is one cause of Pseudotumor cerebri?

What drug can be sued to treat it?

A

Vitamin A toxicity (isotretinoin)

Acetazolamide (decreases CSF production)

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41
Q

Patient with worst headache of life is stabilized, days later present with hemiparesis. CT scan shows no changes.
What happened?
How would you treat?

A

Vasospasm following subarachnoid hemorrhage

Treat with nimodipine (CCB)

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42
Q

What conditions are associated with berry aneurysms?

A

ADPKD and Ehlers Danlos

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43
Q

What microscopic changes are seen following an ischemic stroke over time?

A

Red neurons | PMN, M0 | granulation | scar

1 day 1 wk 1 mo

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44
Q

What 3 tissues are most vulnerable to ischemia during hypo perfusion?

A

Cerebellum, cortical layers (esp in watershed areas), and the hippocampus

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45
Q

What is associated with a partial seizure?

Where do they typically occur?

A

Aura (burning rubber smell)

Temporal lobe

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46
Q

What’s the difference between a simple and complex partial seizure?

A

Simple - no loss of consciousness

Complex - loss of consciousness

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47
Q

Seizures + angiofibromas + intellectual disability

A

Tuberous sclerosis

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48
Q

Seizures + CNV1 port-wine stain + intellectual disability

A

Sturge-Weber syndrome
(Seizures/intellectual disability due to leptomeningeal angioma - damages underlying gyri causing seizures and tram-track calcifications)

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49
Q

Treatment for Trigeminal neuralgia

A

Carbamazepine

50
Q

What is the mechanism of Ethosuxamide?

A

T-type Ca channel blocker, used for absence seizures
“When a girl has an absence seizure she is vulnerable to getting sux’d, milk will come out which contains Ca” (this is the worst)

51
Q

What is the mechanism of Valproic acid?

A

Na channel blocker and GABA agonist (same as topiramate)

“Val is salty, she just GABs and GABs”

52
Q

What seizure drugs block Na channels?

A

Phenytoin, carbamazepine, valproic acid/topiramate, lamotrigine

53
Q

What seizure drugs are GABA agonists?

A

BDZ/barbiturates, valproic acid/topiramate, GABApentin

54
Q

What is first line treatment for absence seizures?

Second line?

A

Ethosuximide

Valproic acid

55
Q

Treatment for Status epilepticus

A

Benzodiazepine (terminate) + phenytoin (prophylaxis)

56
Q

Treatment for seizures due to eclampsia

A

Magnesium sulfate

57
Q

Phenytoin side effects

“Phenytoin Status-epilepticus Seizure Prohylaxis May Get Horrible Feedback”

A

Peripheral neuropathy, SLE-like syndrome, SJS, P450 inducer, Megaloblastic anemia, Gingival hyperplasia, Hirsutism, and Fetal hydantoin syndrome (cleft lip/palate + congenital heart disease)

58
Q

Which 3 seizure drugs are teratogenic?

A

Carbamazepine, valproic acid - spina bifida

Phenytoin - fetal hydantoin syndrome

59
Q

What 4 drugs cause SJS?

A 
Seizure drugs (Phenytoin, phenobarbital, carbamazepine, ethosuximide, lamotrigine)
Sulfonamides, penicillins, allopurinol
60
Q

What 4 drugs cause agranulocytosis?

A

Carbamazepine - anti-seizure
Clozipine - antipsychotic
Colchicine - gout
PTU/methimazole - antithyroid

61
Q

What anti seizure drugs cause hepatotoxicity?

A

Carbamazepine and valproic acid

62
Q

What drugs induce P450s?

“Coronas, Guiness, and PBRS induce Chronic alcoholism”

A

Carbamazepine, griseofulvin, phenytoin, barbiturates, rifampin, St Johns wort, and chronic alcoholism

63
Q

Treatment for tonic-clonic seizures (3)

A

Phenytoin, valproic acid, or carbamazepine

64
Q

Treatment for cluster headaches (2)

A

Sumpatriptan or 100% O2

65
Q

What is the mechanism of sumatriptan?

What are side effects?

A

5HT 1B/1D agonist (vasoconstriction and reduces activity in CN5)
Vasospasm - contraindicated in CAD/prinzmental angina and pregnancy

66
Q

Treatment for migraines (3)

A

Sumatriptan (abortive)

Prophylaxis - propranolol, CCBs

67
Q

What dietary intake exacerbates migraines?

A

Tyramine

68
Q

GFAP + brain tumor

A

Adult - glioblastoma

Kids - astrocytoma

69
Q

Brain tumor with psammoma bodies

A

Meningioma

70
Q

S100+ primary brain tumor

A

Schwannoma (originate from neural crest cells)

71
Q

Rosenthal fibers in brain tumor (dark pink, thick, corkscrew fibers)

A

Astrocytoma

72
Q

Differential for brain tumor in 4th ventricle

A

Medulloblastoma or ependymoma

73
Q

Homer-wright rosettes (rosette around central fibril tangles)

A

Medulloblastoma

74
Q

Perivascular rosettes

A

Ependymoma

75
Q

Bitemporal hemianopsia + cyst filled with brown fluid + calcifications

A

Craniopharyngioma (originates from Rathke’s pouch)

76
Q

L eye strabismus + R eye homonymous hemianopsia + L spastic paralysis

A

L uncal herniation (ipsi CN3, ipsi PCA = conta visual field, contra corticospinal tract = ipsi weakness)

77
Q

Brain tumor + polycythemia

A

Medulloblastoma

78
Q

Medilloblastoma + retina angiomas

A

Von Hippel Lindau

79
Q

What EEG waveforms correspond to the sleep stages?

A

NREM1 - theta
NREM2 - sleep spindle/K complexes
NREM3 - delta
REM - beta

80
Q

Inhaled anesthetics - what correlates with:
Lipid solubility
Blood solubility

A 
Lipid solubility (MAC) = potency (gets into brain easier)
Blood solubility = onset of action (low solubility = fast)
81
Q

What side effect is common to the inhaled anesthetics?

A

Hepatotoxicity

82
Q

Patient in ICU on ventilator for a week and develops acute pancreatitis - why?

A

Propofol (a sedation agent) has high TG content that can predisposed to acute pancreatitis if given for more than a few days

83
Q

Dissociative anesthetic (conscious/aware but disconnected)

A

Ketamine (PCP analog)

84
Q

What IV anesthetic is preferred for brain surgeries?

A

Barbiturates (thiopental) - decreases cerebral blood flow

85
Q

Kid starts having hallucinations post-op - why?

A

Ketamine used as anesthetic (since PCP analog can cause this, especially in kids)

86
Q

Conscious sedation (relaxation and amnesia, but still awake)

A

Benzodiazepines (given with opioid for analgesia)

87
Q

Antidote for BDZ OD?

A

Flumazenil

88
Q

What is fentanyl?

How is it superior to morphine?

A

An opioid

Does not cause histamine release like morphine does

89
Q

What is the mechanism of -curine/curonium drugs?

A

Non-depolarizing neuromuscular blocking agents

90
Q

When can a AChEI (Neostigmine) be used to antagonize succinylcholine?

A

At high doses - phase 2 blockade (AChRs have repolarized but succinylcholine is still bound competitively)

91
Q

PostOp hyperthermia + rigidity = what pathology?
What drugs caused this?
What mutation is associated with this?

A

Malignant hyperthermia
Succinylcholine + inhaled anesthetic
RYR1 gene mutation

92
Q

Why don’t local anesthetics work in infected tissue?

A

Low pH = ionized drug = cannot passively diffuse through PM to bind their ion channels from the inside

93
Q

What is blocked at lower doses of local anesthetics:
Small or large?
Myelin or unmyellin?

A

Small

Myelinated

94
Q

What synapses at the thalamic nuclei:
VPL, VPM
LGN, MGN

A

VPL - spinothalamic, DCML (“Very Painful Legs”)
VPM - trigeminal and taste (“Very Painful Mouth”)
LGN - vision (CN2 to calcarine sulcus)
MGN - hearing (inf colliculus to temporal lobe)

95
Q

What does the Romberg test evaluate?

A

Posterior column function (proprioceptive part of balance)

96
Q

Rapid/fine tremor of hands, head, voice with family history. Improves with alcohol

A

Essential tremor (present at rest and with movement)

97
Q

Treatment for essential tremor

A

B blockers, primidone (anti-seizure drug)

98
Q

What is the mechanism of Bromocriptine?

Why is it not first line?

A

Ergot DA agonist used in Parkinson Disease

Has peripheral action which increases BP

99
Q

What is the mechanism for pramipexole and ropinirole?

What are 2 indications?

A

Non-ergot DA agonists

Parkinson disease and restless leg syndrome

100
Q

What is the mechanism for Amantadine in the treatment of Parkinson disease?

A

Increases DA release and decreases repute = increases DA in the synapse

101
Q

What is the mechanism of Selegiline?

A

MAO type B inhibitor

102
Q

What is the mechanism of entocapone/tolcapone?

A

Peripheral COMT inhibitors - used with L-dopa/carbidopa to increase CNS delivery and decrease PNS side effects
“Alcapone evaded taxes, tolcapone evades peripheral L-dopa loss”

103
Q

Treatment for MPTP exposure

A

Selegiline

104
Q

What symptoms can benztropine improve? What does it not improve?

A

Tremor and rigidity can be reduced, bradykinesia has little improvement

105
Q

What is the genetic defect in Huntington disease?
What grossly changes are seen in the brain?
What 3 NTs are affected?

A

CAG trinucleotide repeat on chr 4
Caudate atrophy
Increase DA, decrease GABA and ACh

106
Q

What 3 drugs are used to treat Huntingtons?

A

Tetrabenazine, reserpine - VMAT inhibitor (decreases DA in vesicles)
Haloperidol (D2R antagonist)

107
Q

What is Werdnig-Hoffmann disease?

A

Spinal muscular atrophy - congenital LMN death due to destruction of the anterior horns in the spinal cord
Floppy baby + tongue fasciculations

108
Q

What two infectious agents attack the anterior horns in the spinal cord?

A

Poliovirus and west nile virus

109
Q

What is Charcot’s triad associated with neurology?

What is Charcot’s triad associated with GI?

A

Scanning speech + intention tremor + nystagmus = MS

Jaundice + fever + RUQ pain (+ HoTN + altered mental status) = cholangitis (biliary tree infection)

110
Q

What mutation is associated with ALS?

A

Superoxide dismutase 1 mutation

111
Q

What is Subacute combined myelopathy?

A

Dorsal column/corticospinal tract demyelination due to vitamin B12 deficiency

112
Q

What are 2 causes of bilateral Bell’s Palsy?

A

Guillan Barre and lyme disease

113
Q

JC virus destroys what cell type?

A

Oligodendrocyte (demyelinating disease seen in AIDS pts)

114
Q

Arylsulfatase A deficiency, sulfatide accumulation

A

Metachromatic leukodystrophy (lysosomal storage disease) = ataxia and dementia

115
Q

What is Charcot-Marie Tooth disease?

What is the inheritance pattern?

A

Defect in myelin proteins = PNS dysmyelination (progressive loss of muscle tissue and touch sensation)
Autosomal dominant

116
Q

What does CSF look like in Guillan Barre?

A

Increased protein with normal cell count

117
Q

Galactocerebrosidase deficiency, galactocerebroside/psychosine accumulation

A

Krabbe disease = peripheral neuropathy, developmental delay, optic atrophy, globoid cells

118
Q

Defect in very long chain FA metabolism

What is the inheritance pattern?

A

Adrenoleukodystrophy = neuropathies and adrenal gland crisis

X-linked

119
Q

What 2 drugs can be used in glaucoma to decrease aqueous humor production?

A

B blockers and acetazolamide

120
Q

What 3 drugs can be used in glaucoma to increase outflow?

A

PGs, apraclonidine (a agonist), and pilocarpine (cholinergic agonist)

USMLE (12 decks)

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