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UWorld > Neuro > Flashcards

Neuro Flashcards

1
Q

What is the Rx for ADHD?

A

Methylphenidate

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2
Q

What is the MOA of Methylphenidate?

A

Amphetamine–indirect sympathomimetic

Increases release of DA, NE

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3
Q

Name 2 S-100+ tumors.

A

Schwannoma

Skin, melanoma

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4
Q

What is the Rx for Restless Leg Syndrome?

A

Levodopa

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5
Q

What kind of stroke affects the (contralateral) upper extremity more than the lower extremity and 2/3 of the face?

A

MCA stroke

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6
Q

What are the findings of an MCA stroke?

A

Affects contralateral uppers > lowers

+ 2/3 face

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7
Q

What infarct syndrome affects ipsilateral CN III + contralateral body?

A

Weber’s Syndrome

- Basilar or PCA

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8
Q

What are the sequelae of a stroke to the Basilar Artery or the PCA?

A

Weber’s Syndrome:

  • Ipsilateral CN III
  • Contralateral body
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9
Q

What kind of brain bleed can present with symptoms minutes or months after trauma (fall) occurred?

A

Subdural hematoma

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10
Q

What vessels are ruptured in a subdural hematoma?

A

Bridging cortical veins

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11
Q

What does a subdural hematoma look like on CT?

A

Moon-like sliver against the skull

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12
Q

What vessels are ruptured in an epidural hematoma?

A

Middle Meningeal

bleed bends towards the MIDDLE of the brain

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13
Q

What does an epidural hematoma look like on CT?

A

Bleed is convex and bends towards the middle of the brain, like a lower case ‘e’ abutting the skull

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14
Q

What vessels are ruptured in a SAH?

A

Usually Berry aneurysm

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15
Q

What does a SAH look like on CT?

A

Spotty bleeding in anterior brain

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16
Q

What vessels are ruptured in an intracerebral (intraparenchymal) hemorrhage?

A

Lenticulostriate arteries of the internal capsule

internal capsule bleeds STRAIGHT (striate) into the brain

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17
Q

What does an intracerebral (intraparenchymal) hemorrhage look like on CT?

A

Big burgeoning bleed in the middle of the brain

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18
Q

What kind of bleed is caused by a Charcot Bouchard aneurysm?

A

Intracerebral (intraparenchymal) hemorrhage

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19
Q

What is a complication that occurs 4-12 days after SAH?

A

Vasospasm, causing ischemia and new deficits

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20
Q

What med can prevent vasospasm post SAH?

A

Nimodipine

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21
Q

What is the path of the Glossopharyngeal nerve (IX) within the brain (origin and exit)?

A

Medulla to Jugular Foramen

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22
Q

What muscle does the Glossopharyngeal nerve (IX) innervate?

A

Stylopharyngeus

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23
Q

To what gland does the Glossopharyngeal nerve (IX) carry PS fibers?

A

Parotid

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24
Q

What nerve provides sensory information from the inner surface of the tympanic membrane, Eustachian tube of the ear, posterior 1/3 tongue, tonsilar region, upper pharynx, and carotid body sinus?

A

Glossopharyngeal nerve (IX)

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25
Q

What nerve is responsible for the afferent gag reflex?

A

Glossopharyngeal nerve (IX)

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26
Q

What nerve is responsible for the efferent gag reflex?

A

Vagus nerve (X)

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27
Q

What is the MOA of phenytoin?

A

Inhibits neuronal high frequency firing by reducing the ability of Na+ channels to recover

Less Na+ current = less seizure

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28
Q

What is the first line Rx for status epilepticus?

A

Benzos

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29
Q

What Rx is used to prevent recurrence post status epilepticus?

A

Phenytoin

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30
Q

Keeping Schizo- Straight:

Distant

A

Schizoid

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31
Q

Keeping Schizo- Straight:

Odd thinking

A

Schizotypal

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32
Q

Keeping Schizo- Straight:

Symptoms for

A

Brief Psychotic Disorder

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33
Q

Keeping Schizo- Straight:

Symptoms for 1-6 mo

A

Schizophreniform Disorder

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34
Q

Keeping Schizo- Straight:

Symptoms > 6mo

A

Schizophrenia

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35
Q

Keeping Schizo- Straight:

Schizophrenic sx + psychotic sx + bipolar or depressed mood

A

Schizoaffective Disorder

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36
Q

Newborn is overreactive to stimuli and has a marked startle
Excessive crying and sucking

Cause?

A

Heroin withdrawal

  • These are the opposite of opioid effects
  • Rx: tincture of opium
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37
Q

What is internuclear ophthalmoplegia?

A

Affected eye cannot cross midline on conjugate gaze

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38
Q

Where is the lesion in internuclear opthalmoplegia?

A

The lesion is in the MLF, which connects CN III, IV, V, most likely to the Abducens (VI) nerve nucleus

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39
Q

CN responsible for afferent pupillary light reflex.

A

Optic nerve (II)

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40
Q

CN responsible for efferent pupillary light reflex

A

Oculomotor nerve (III), PS fibers

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41
Q

Trace the path of the pupillary light reflex.

A 
Optic nerve >
Pretectal nucleus (ipsi) >
Edinger-Westphal nucleus (bilateral) >
Oculomotor nerve >
Ciliary ganglion>
Synapse
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42
Q

What happens to the pupillary light reflex if the Optic nerve is demyelinated (Ex. MS)?

A

No direct on ipsi
No consensual on contra

Constriction of both pupils w light on unaffected side

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43
Q

Patient with MS presents with:

  • No constriction of L eye with light shined in L eye
  • No constriction of R eye with light shined in L eye
  • Constriction of both eyes with light shined in R eye

Where is the lesion?

A 
Optic nerve (CN II) on L side
- Knocks out afferent arm of pupillary light reflex
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44
Q

What cells do tissue repair in the PNS?

A

Fibroblasts

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45
Q

What cells do tissue repair in the CNS?

A

Astrocytes (glial cells)

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46
Q

What are the 4 functions of astrocytes (glial cells)?

A
  1. Repair
  2. Structural support
  3. Blood brain barrier
  4. Metabolic support
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47
Q

How does Hydrochlorothiazide affect Lithium?

A

Increases Lithium reabsorption in the PT, along with Na+, thereby increasing potential for Lithium toxicity.

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48
Q

How do ACE-Is and NSAIDs affect Lithium?

A

Decrease renal clearance

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49
Q

What are signs of Lithium toxicity?

A 
Neuromuscular excitability
Tremor
Fascicular twitch
Agitation
Ataxia
Delirium
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50
Q

What is the Rx for Lithium toxicity?

A

Dialysis

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51
Q

What are the 3 most common primary brain tumors in adults?

A
  1. Glioblastoma
  2. Meningioma
  3. Acoustic Neuroma (Schwannoma)
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52
Q

Name that brain tumor:

  • Astrocytes, large cells
  • Necrosis and hemorrhage
  • Found in cerebrum, crosses midline
  • Poor prognosis
A

Glioblastoma

- Most common

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53
Q

Name that brain tumor:

  • Arachnoid cells
  • Well circumscribed
  • Dural attachment
  • Benign
A

Meningioma

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54
Q

Name that brain tumor:

  • S-100 +
  • Cerebellopontine angle
A

Acoustic Neuroma (Schwannoma)

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55
Q

Where is the lesion in pt. with left-sided hemibalism?

A

Contralateral subthalamic nuclei (of basal ganglia)

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56
Q

What stroke causes hemibalism?

A

Lacunar stroke, typically in pt. with HTN

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57
Q

Pt. has had multiple spontaneous hemorrhages over several months, some of which affect vision. What is the underlying cause?

A

Cerebral Amyloid Angiopathy

- Beta amyloid deposits in cerebral arteries

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58
Q

What lobes does Cerebra Amyloid Angiopathy most affect?

A

Occipital and Parietal

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59
Q

What is the MOA of Busiprone?

A

Selective 5HT1a agonist

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60
Q

What is the indication of Busiprone?

A

GAD: anti-anxiety med with less abuse potential than Benzos

  • No sedative hypnotic or seizure side affects
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61
Q

What are the criteria for Major Depressive Disorder?

A

SIG E CAPS: 5sx x 2 wks

  • Sleep disorder
  • Interest decreased
  • Guilt
  • Energy decreased
  • Concentration decreased
  • Appetite change
  • Psychomotor decreased
  • Suicidality
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62
Q

What are the criteria for Dysthymic Disorder?

A

Chronic, low intensity

Depressed mood most days + 2 sx x 2 yrs

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63
Q

What are 3 drugs used in the Rx of Alzheimer’s?

A

Donepizil: AchE-I
Vitamin E: anti-oxidant
Memantine: NMDA receptor antagonist

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64
Q

What is the indication and MOA of Donepizil?

A

Alzheimer’s, acetylcholinesterase inhibitor

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65
Q

What is the indication and MOA of Memantine?

A

Alzheimer’s, NMDA receptor antagonist

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66
Q

What is the first sign of uncal herniation?

A

Fixed, dilated pupil (ipsi) because of CN III compression

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67
Q

What are causes of uncal herniation?

A

Hemorrhage
Tumor

(Compression)

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68
Q

What is the cause of:

  • Ipsi occulomotor paralysis
  • Hemiparesis
  • Contra homonymous hemianopia
A

Uncal herniation

progressive sx, first one being fixed, dilated pupil

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69
Q

What is the MOA of Carbidopa?

A

Prevents peripheral conversion of Levodopa

- CNS adverse effects persist, like anxiety and agitation

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70
Q

What are 2 meds used in Rx of Benign Essential Tremor?

A

Primidone + Propanolol

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71
Q

What is the MOA of Primidone?

A

Narrow spectrum anticonvulsant

Phenobarbitol + Phenylethylmalomide

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72
Q

What is a beta blocker used in Rx of Benign Essential Tremor?

A

Propanolol

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73
Q

Nerve responsible for afferent corneal reflex.

A

Trigeminal, V1

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74
Q

Nerve responsible for efferent corneal reflex.

A

Facial, VII

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75
Q

What are the 3 most common brain tumors in children?

A
  1. Pilocytic Astrocytoma
  2. Medulloblastoma
  3. Ependymoma
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76
Q

Name that (kids) tumor:

  • Cerebellum > cerebrum
  • Cystic + protruding nodule
  • Astrocytes + Rosenthal fibers
  • Good prognosis
A

Pilocytic Astrocytoma

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77
Q

Name that (kids) tumor:

  • Cerebellum only
  • Solid sheets of blue cells
  • Malignant
A

Medulloblastoma

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78
Q

Name that (kids) tumor:

  • Increased CSF
  • Hydrocephalus
  • Rosettes
A

Epedymoma

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79
Q

What is the age-related eye condition caused by fatty tissue deposits in the retina +/- neovascularization?

A

Macular Degeneration

Dry = fatty tissue only
Wet = + new bvs
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80
Q

Where is the macula?

A

Central retina

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81
Q

What are two ergot-derived DA agonists?

A

Bromocriptine
Pergolide

  • Directly stimulate DA receptor
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82
Q

What are two non-ergot DA agonists?

A

Pramipexole
Ropinerole

  • Directly stimulate DA receptor
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83
Q

Hypertensive arteriolosclerosis with underlying HTN likely causes what kind of infarct?

A

Lacunar infarct

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84
Q

What vessels are usually involved in a lacunar infarct?

A

Stroke involves small penetrating vessels supplying:

  • Basal ganglia
  • Pons
  • Internal capsule
  • Corona radiata
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85
Q

What is myotonia?

A

Abnormally slow relaxation of muscles

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86
Q

What is myotonic dystrophy?

A

AD condition causing myotonia, along with:

  • Cataracts
  • Frontal balding
  • Gonadal atrophy

Increased trinucleotide repeats

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87
Q

What are the broad spectrum anti-epileptics?

A

Lamotrigine, Valproate, Topiramate

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88
Q

What are the narrow spectrum anti-epileptics?

A

Carbamazepine, Gabapentin, Phenobarbital, Phenytoin

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89
Q

What type of seizure responds to narrow spectrum anti-epileptics?

A

Focal

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90
Q

What type of seizure responds to broad spectrum anti-epileptics?

A

Most types

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91
Q

What is the difference between schizoaffective disorder and bipolar disorder with psychotic features?

A

In bipolar with psychotic features, the psychoses only occur during manic/depressive episodes.

In schizoaffective, will have psychosis in the absence of mood episodes.

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92
Q

What is vasovagal syncope?

A

Decreased BP and HR due to vagal stimulation

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93
Q

Touching what part of the ear can result in vasovagal syncope?

A

External auditory canal

- Vagus innervates

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94
Q

What is a first gen. antipsychotic with low potency?

A

Chlorpromazine

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95
Q

What are the adverse effects of first gen. antipsychotics with low potency?

A

Sedation
Anticholinergic affects
Orthostatic hypotension

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96
Q

What are two first gent. antipsychotics with high potency?

A

Haloperidol, Fluphenazine

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97
Q

What are the adverse effects of first gen. antipsychotics with high potency?

A

Neuro effects

Extrapyramidal sx

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98
Q

What characterizes communicating hydrocephalus?

A

Free flow through ventricles

  • Decreased CSF absorption
  • Have abnormal arachnoid granules in TB and SAH
  • All ventricles are dilated
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99
Q

What characterizes non-communicating hydrocephalus?

A

Obstruction of CSF flow

  • Only ventricles proximal to obstruction are dilated
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100
Q

What characterizes hydrocephalus ex-vacuo?

A

Not true hydrocephalus; rather, ventricular enlargement secondary to brain atrophy

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101
Q

What conditions evidence hydrocephalus ex-vacuo?

A

Alzheimer’s, Pick’s, advanced HIV/AIDS

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102
Q

What is the MOA of cocaine?

A

Inhibits reuptake of monoamines (NE, DA, 5HT)

  • Increased sympathetic stimulation (increased arousal, agitation, seizures)
  • Coronary vasospasm, mucosal atrophy, septal perf
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103
Q

What is a type I Chiari malformation?

A

Cerebellar tonsils into vertebral canal

- Presents in adulthood with headache and cerebellar sx

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104
Q

What is a type II Chiari malformation?

A

Cerebellum + medulla through foramen mangum

  • Presents in neonates, more severe
  • Lumbar meningiocele + hydrocephalus
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105
Q

What are the symptoms of Atropine OD?

A

Antimuscarinic effects (opp. of DUMBELS)

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106
Q

What is the Rx for Atropine OD?

A

Physostigmine “phyxes Atropine OD”

- AChE-I that increases levels of acetylcholine

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107
Q

What is Rx in opioid withdrawal?

A

Pentazocine

  • Partial agonist and antagonist at mu receptors
  • May precipitate withdrawal sx if given with agonist
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108
Q

Derived from what tissue:

Rathke’s pouch

A

Surface ectoderm

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109
Q

Derived from what tissue:

Lens and cornea

A

Surface ectoderm

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110
Q

Derived from what tissue:

Inner ear

A

Surface ectoderm

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111
Q

Derived from what tissue:

Olfactory, nasal, and oral epithelium

A

Surface ectoderm

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112
Q

Derived from what tissue:

Salivary, sweat, and mammary glands

A

Surface ectoderm

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113
Q

Derived from what tissue:

Brain and spinal cord

A

Neural tube

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114
Q

Derived from what tissue:

Posterior pituitary

A

Neural tube

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115
Q

Derived from what tissue:

Pineal gland

A

Neural tube

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116
Q

Derived from what tissue:

Retina

A

Neural tube

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117
Q

Derived from what tissue:

Autonomic, sensory, and celiac ganglia

A

Neural crest

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118
Q

Derived from what tissue:

Schwann cells

A

Neural crest

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119
Q

Derived from what tissue:

Pia and arachnoid mater

A

Neural crest

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120
Q

Derived from what tissue:

Aorticopulmonary septum, endocardial cushions, branchial arches

A

Neural crest

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121
Q

Derived from what tissue:

Skull bones

A

Neural crest

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122
Q

Derived from what tissue:

Melanocytes

A

Neural crest

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123
Q

Derived from what tissue:

Adrenal medulla

A

Neural crest

124
Q

Derived from what tissue:

Muscles, CT, bone, and cartilage

A

Mesoderm

125
Q

Derived from what tissue:

Blood, lymph, spleen, kidney, adrenal cortex

A

Mesoderm

126
Q

Derived from what tissue:

Gi tract, liver

A

Endoderm

127
Q

Derived from what tissue:

Lungs

A

Endoderm

128
Q

Derived from what tissue:

Thymus, thyroid follicles, parathyroid

A

Endoderm

129
Q

Derived from what tissue:

Bladder, urethra

A

Endoderm

130
Q

Derived from what tissue:

Middle ear

A

Endoderm

131
Q

What is the Rx for Alcohol withdrawal?

A

Benzos

  • Long acting preferred: Diazepam, Chlordiazepoxide
  • Short acting if liver dysfx: Lozepam, Oxazepam
132
Q

What is an ocular adverse effect of Atropine?

A

Closed angle glaucoma

- Due to increased intraocular pressure

133
Q

Neurocutaneous syndromes:

  • Hemangioblastomas in retina/cerebellum
  • Pancreatic cysts (also kidney, liver)
  • kidneY at risk for RCC
A

VHL: Von Hippel Lindau

- AD

134
Q

Neurocutaneous syndromes:

PNS tumors
Neurofibromas
Optic nerve gliomas
Lisch nodules in the iris
Cafe au lait spots
A

NF 1

135
Q

Neurocutaneous syndromes:

Bilateral acoustic neuromas
Meningiomas

A

NF 2

- AD

136
Q

Neurocutaneous syndromes:

Encphalotrigeminal angtiomatosis

  • Skin
  • Retardation
  • Skull radioopacitiies
  • “Tram track” on CT
A

Sturge-Weber

“VVV for Weber + CN V”

137
Q

Neurocutaneous syndromes:

Hamartomas
Cysts
Cardiac rhabdomyomas
Seizures

A

Tuberous Sclerosis

138
Q

Neurocutaneous syndromes:

Hemorrhagic telangiectasias
Rupture causes bleeding
No cysts

A

Osler-Weber-Rendu

“Red-u blood”

139
Q

In what part of the neuron does Wallerian Degeneration occur after injury?

A

Segment of the axon that lost connection to the cell body

140
Q

In what part of the neuron does Axonal Regeneration occur after injury?

A

Cell body

  • Edema
  • Nucleus in periphery
  • Dispersed Nissl
  • 24-48 hrs post injury
141
Q

Aneurysm caused by HTN
- Occurs in the ponds, thalamus, cerebellum, basal ganglia
-

A

Charcot-Bouchard Aneurysm

142
Q

Aneurysm caused by ADPKD, Ehler’s Danlos, HTN

  • Occurs in the Circle of Willis
  • 2-25 nm
  • Subarachnoid hemorrhage
  • Focal neuro deficits uncommon
  • Sudden severe headache
A

Berry Aneurysm

143
Q

What part of the ear is damaged in noise-induced hearing loss?

A

Sterocilia of the hair cells within the Organ of Corti

144
Q

What is the function of the Organ of Corti?

A

To transduce mechanical audition from the tympanic membrane to the nerve

145
Q

What is the function of the Mammillary Body?

A

Cortical control of emotion and memory

- Part of the Circuit of Papez in the Limbic System

146
Q

What part of the brain undergoes necrosis in Wernicke-Korsakoff Syndrome?

A

Mammillary Bodies

147
Q

What nerve is affected in Bell’s Palsy?

A

CN VII

  • Motor output to facial muscles > 1/2 paralysis
  • PS fibers to lacrimal/submandibular/sublingual/salivary glands > lack of tearing
  • Taste > anterior 2/3 of tongue
  • Somatic afferents from pinna and EAM > hyperacusis
148
Q

What is Central Pontine Myelinolysis?

A

Osmotic demyelination of neurons in pons

  • Quadriplegia due to demyelination of corticobulbar tracts
  • Pseudobulbar palsy: head and neck muscle weakness, dysphagia, dysarthria
149
Q

What is the cause of Central Pontine Myelinolysis?

A

Rapid correction of hyponatremia

150
Q

What are 2 mechanisms of diabetic peripheral neuropathy?

A

1) Endoneural arteriole hyalinization

2) Intracellular hyperglycemia > osmotic damage to neurons

151
Q

What is the role of Lithium in bipolar disorder?

A

Manic and depressive episodes, maintenance

152
Q

What is the role of Valproate in bipolar disorder?

A

Manic episodes, maintenance

153
Q

What is the role of Carbamazepine in bipolar disorder?

A

Manic episodes, maintenence

154
Q

What is the role of Lamotrigine in bipolar disorder?

A

Depressive episodes, maintenence

155
Q

What drugs can be used in manic episodes of bipolar?

A

Lithium
Valproate
Carbamazepine

156
Q

What drug can be used in depressive episodes of bipolar?

A

Lamotrigine

157
Q

What drugs can be used in maintenance therapy of bipolar?

A

Lithium
Valproate
Carbamazepine
Lamotrigine

158
Q

What are the adverse effects of Lithium?

A

DI
Hypothyroid
Tremor
Ebstein’s anomaly

159
Q

What are the adverse effects of Valproate?

A

Hepatotoxicity

Neural tube defects

160
Q

What are the adverse effects of Carbamazepine?

A

Agranulocytosis
SIADH
Neural tube defects

161
Q

What are the adverse effects of Lamotrigine?

A

Steven Johnson Syndrome

162
Q

What is the Rx for Trigeminal Neuralgia?

A

Carbamazepine

163
Q

Clasp-knife spasticity (initial resistance, sudden release) indicates what kind of brain lesion?

A

Pyramidal motor system: corticospinal tract, medulla, pons, midbrain, internal capsule, precentral gyrus

164
Q

What area of the brain makes up the extrapyramidal motor tract?

A

Basal ganglia

165
Q

Dizziness + truncal atazia + dysarthria + visual changes + cancer diagnosis indicates:

A

Paraneoplastic Cerebellar Degeneration

166
Q

What is the mechanism behind paraneoplastic cerebellar degeneration?

A

Antibodies against tumor cross reacts with Purkinje neurons

- Anti-Yo, Anti-P/Q, Anti-Hu

167
Q

What cancers are prone to paraneoplastic cerebellar degeneration?

A

Small cell lung cancer

Breast, ovarian, uterine cancers

168
Q

What is the major cause of death in TCA overdose?

A

Cardiac arrhythmia

- Inhibition of Na channels in cardiac myocytes (though not related to anti-depressive mechanism)

169
Q

What type of brain bleed involves a lucid interval?

A

Epidural hematoma

170
Q

What tumor is characterized by:

  • Precocious puberty
  • Obstructive hydrocephalus (compression)
  • Paralysis of upward gaze and convergence (Parinaud’s)
A

Germinoma, pineal gland tumor

171
Q

What is the lesion:

  • Loss of pain and temp over cape like distribution
  • Uppers show LMN signs
  • Lowers show UMN signs
  • Setting of scoliosis
A

Syringomyelia

172
Q

Where is the lesion in Syringomyelia?

A

Ventral White Commissure

173
Q

What is a neuro complication of measles?

A

Subacute Sclerosing Panencephalitis (SSPE)

174
Q

What are the symptoms of SSPE?

A

Ataxia, myoclonus, visual changes

175
Q

What makes the diagnosis of SSPE?

A

Measles antibodies (oligoclonal bands) in CSF

176
Q

Where does the virus accumulate and replicate in SSPE?

A

Neurons and oligodendrocytes

- Causes demyelination and gliosis

177
Q

What antidepressants can cause mania in susceptible patients?

A

TCAs, Venlafaxine

178
Q

What pathological findings are evidenced in the brain of a Huntington’s patient?

A

Bilateral atrophy of caudate and putamen (striatum)
Dilation of frontal horns of lateral ventricles
Atrophic areas show gliosis + neuronal loss

179
Q

What type barrier makes up the BBB?

A

Tight junctions/zonula occludens

  • Claudins and occludins
  • Limits transport to trancellular diffusion or carrier-mediated
180
Q

Which cranial nerves are affected by acoustic neuromas?

A

Mainly CN VIII: sensorineural hearing loss, tinnitus, vertigo, disequilibrium, nystagmus

Also CN V (facial sensation, mastication)
and CN VII (facial muscles, taste, lacrimation, hyperacusis)

181
Q

Valproate inhibits folate absorption from the gut, putting pregnant women at risk for…

A

Neural tube defects in the fetus

182
Q

What seizures is Valproate indicated for?

A

Absence

Tonic clonic

183
Q

What is the Rx for Serotonin Syndrome?

A

Cyproheptadine

- Antihistamine with 5HT2 antagonist properties

184
Q

What type of receptors are mu opioid receptors?

A

GPCRs

- Activate various 2nd messenger pathways

185
Q

What ist he morphine pathway?

A

Activate mu receptor (GPCR)

  • Increase K+ efflux
  • Hyperpolarization
  • No pain transmission
186
Q

What is the MOA of Thiopental?

A

Short acting barbiturate

Used for induction of anesthesia

187
Q

What is the lethal side effect of Cocaine?

A

MI

188
Q

What is the lethal side effect of Opioids?

A

Respiratory Depression

189
Q

What is the lethal side effect of PCP?

A

Trauma secondary to violent behavior

190
Q

What is the role of the cerebral cortex in urination?

A

Inhibits sacral nerves

inhibition lost in NPHydrocephalus

191
Q

What is the role of pontine fibers in urination?

A

Relax external urethral sphincter

192
Q

What is the role of sacral nerves 2-4 in urination?

A

Bladder contraction (PS fibers)

193
Q

B1 (thiamine) is needed as a cofactor for:

A
  1. Pyruvate dehydrogenase (pyruvate > acetyl CoA)
  2. Alphaketoglutarate dehydrogenase (TCA cycle)
  3. Transketolase (HMP hunt, pentose > G3P)
194
Q

What are the causes of glaucoma?

A

Increased intraocular pressure due to:

  • Increased production of aqueous humor OR
  • Decreased outflow
195
Q

What is the Rx for glaucoma?

A

TImolol, beta blocker that decreases aqueous production by ciliary epithelium

196
Q

What is the MOA of Levodopa in Parkinson’s?

A

Dopamine analog

197
Q

What is the MOA of Carbidopa in Parkinson’s

A

Does not cross BBB
Inhibitor of dopa-decarboxylase
Blocks peripheral effects of L-dopa

198
Q

What is the MOA of Selegiline in Parkinson’s?

A

MAO-I

Prevents damage to DA neurons

199
Q

What is the MOA of Amantadine in Parkinson’s

A

Mainly an antiviral, with dopaminergic anticholinergic action

200
Q

What is the MOA of Pergolide in Parkinson’s?

A

DA agonist (D2 Rs)

201
Q

What is the initial treatment for Parkinson’s?

A

Selegeline/Amantadine/Anticholinergics

Later, Levodopa/Carbidopa

202
Q

What is are underlying causes to Cheyne-Stokes respiration?

A

Hyperventilation and apnea in alternation can be caused by CHF or can be neurogenic

(NOT due to obstructive sleep apnea)

203
Q

What is a common adverse effect of SSRIs, including Sertraline, Paroxetine, and Velafaxine?

A

Sexual dysfunction

204
Q

What sense does not go through thalamic relay?

A

Smell

205
Q

What tracts go through the VPL thalamic relay?

A

Spinothalamic tract and medial lemniscus

206
Q

What tracts go through the VPM thalamic relay?

A

Trigeminal and gustatory

207
Q

What goes through the LGN thalamic relay?

A

Vision (lateral = light)

208
Q

What goes through the MGN thalamic relay?

A

Sound (medial = music)

209
Q

What is an SSRI without the adverse effect of sexual dysfunction?

A

Buproprion

210
Q

What are the adverse effects of Buproprion?

A

Agitation
Insomnia
Seizure (esp. with electrolyte imbalance)
- Contraindicated in bulimia and anorexia

211
Q

Loss of ankle reflex in Sciatica indicates what nerve root is damaged?

A

S1

212
Q

What is the MOA of inhaled anesthetics?

A

Increased GABA inhibition by locking K+ channels in hyperpolarization

213
Q

What are the adverse effects of inhalation anesthetics?

A

Mycoardial depression (decreased CO)
Hypotension
Respiratory depression
Decreased renal fx

214
Q

What nerve and muscle are damaged in the Trendelenberg Gait?

A

Superior gluteal nerve

Gluteus medius muscle

215
Q

What is the function of the suprachiasmatic nucleus?

A

Regulates Circadian Rhythm

216
Q

What is indicated by:

"Hot as a hare"
"Dry as a bone"
"Red as a beet"
"Blind as a bat"
"Mad as a hatter"
A

Anticholinergic Syndrome

Fever
Dry skin and mucous membranes
Flushing
Mydriasis and cycloplegia
Altered mental status
217
Q

What are some drugs that cause anticholinergic syndrome?

A

Atropine
Antihistamines (diphenhydramine, hydroxizine)
Antipsychotics (cholorpromazine, olanzapine)
Antispasmodics (dicyclomine)
Tricyclic antidepressants (amitryptiline, desipramine)

218
Q

What is sublimation?

A

Mature defense mechanism

Convert/channel unacceptable feelings or drives into a more socially acceptable venus

219
Q

Diagnosis of:

  • 20-30 yr old presets with headaches and papilledema
  • Pituitary failure and cranial nerve dysfunction
  • Bitemporal hemianopsia
  • Calcified lesion on head CT
A

Craniopharyngeoma

220
Q

What is a craniopharyngeoma?

A

Suprasellar tumor arising from remnants of Rathke’s pouch

221
Q

What is the histology of a craniopharyngeoma?

A

3 parts: solid, cystic, calcified

- Brownish fluid filled with cholesterol

222
Q

What brain tumor has 3 parts: solid, cystic, and calcified?

A

Craniopharyngeoma, arising from remnants of Rathke’s pouch

223
Q

What is the MOA of Ethosuximide?

A

Blocks T-type Ca channels in thalamic neurons, keeping them hyperpolarized

224
Q

What is the indication for Ethosuximide?

A

Absence seizure

225
Q

What is the MOA of Phenytoin, Carbamazepine, Valproate?

A

Block Na current in cortical neurons, reducing ability to recover from inactivation

226
Q

What additional Rs does Valproate block?

A

Na channels in cortical neurons AND

  • NMDA Rs
  • GABA Rs
  • K+ channels
227
Q

What is transference?

A

Shifting of emotions associated with one person to another

228
Q

What is displacement?

A

Expressing emotions to/on a safer surrogate

229
Q

What is projection?

A

Attributing one’s own unacceptable thoughts to another

230
Q

What does the MAC of an inhaled anesthetic indicate?

A

Potency

Low MAC = high potency

231
Q

What does A/V concentration of an inhaled anesthetic indicate?

A

Solubility in tissues

High A/V = increased time to saturate blood

232
Q

What does the blood/gas partition of an inhaled anesthetic indicate?

A

Solubility in blood

Increased blood/gas = increase time to saturate

233
Q

What is the pathogenesis of organophosphate (insecticide) poisoning?

A

Acetylcholinesterase inhibition

  • All of the secretions
  • Muscle paralysis
  • Bradycardia
  • Miosis
234
Q

What is the Rx for organophosphate poisoning?

A

Atropine: muscarinic antagonist
- Cannot change muscle paralysis

Pralidoxime: cholinesterase enzyme reactivator

235
Q

What is the path of CSF circulation?

A 
Lateral ventricles >
Interventricular Foramen of Monro >
Third Ventricle >
Cerebral Aqueduct >
Fourth Ventricle >
Luschka and Magendie >
Central Canal
236
Q

What is the MOA of succinylcholine?

A

NMJ depolarizing blockade

- Ca cause flaccid paralysis

237
Q

Poorly demarcated brain tumor with necrosis and hemorrhage and variegated appearance

A

Glioblastoma Multiforme

238
Q

From what cell type does Glioblastoma Multiforme derive?

A

Astrocyte

239
Q

Brain tumor with psuedopalisading necrosis, new vessel formation, small round cells, bizarre giant cells, and many mitoses

A

Glioblastoma multiforme

240
Q

What is the presentation of Glioblastoma Multiforme

A

Headache
Seizure
Mental status change
Focus neuro sx

40-70 yo

241
Q

What parts of the brain does Glioblastoma Multiforme affect?

A

Frontal and temporal lobes
Basal ganglia
Crosses midline “butterfly”

242
Q

What is the prognosis of Glioblastoma Multiforme?

A

High malignant

Death within 1-2 years

243
Q

What is the presentation of hydrocephalus in infancy?

A

Poor feeding and irritability
Hyperreflexia and muscle hypertonicity (UMN) due to stretching of periventricular tracts
Ventricular sized enlarged on CT

244
Q

What cell type makes up a tumor that stains with Synaptophysin?

A

Neurons

245
Q

What cell type makes up a tumor that stains with GFAP?

A

Glial cells

246
Q

What tumors stain for GFAP (3)?

A

Astrocytomas
Ependymomas
Oligodendrogliomas

247
Q

What is the location of a pure motor or pure sensory stroke?

A

Internal capsule

- Will take out motor/sensation to the contralateral limbs and face

248
Q

What is the length constant?

A

How far along an axon a signal can propagate

249
Q

What is the time constant?

A

How long it takes to change membrane potential

250
Q

How does MS affect the length and time constants?

A

Demyelination decreases the length constant (how far along an axon a signal can propagate) and increases the time constant (how long it takes to change membrane potential)

251
Q

What are the indications of Carbamazepine?

A

Simple and complex, tonic-clonic seizures
Bipolar mood stabilizer
Trigeminal Neuralgia

252
Q

What is the MOA of Carbamazepine?

A

Blocks voltage gated Na channels in cortical neurons

253
Q

What are the adverse effects of Carbamazepine?

A

Bone marrow suppression
Hepatotoxicity
SIADH

254
Q

Give me some tongue:

Taste anterior 2/3

A

Chorda Tympani of Facial Nerve (VII)

255
Q

Give me some tongue:

Pain/temp anterior 2/3

A

Lingual Nerve of Trigeminal Nerve (V3)

256
Q

Give me some tongue:

Taste posterior 1/3

A

Glossopharyngeal (IX)

257
Q

Give me some tongue:

Pain/temp posterior 1/3

A

Glossopharyngeal (IX)

258
Q

Give me some tongue:

Taste to epiglottis and pharynx

A

Vagus (X)

259
Q

What genes (on what chromosomes) are associated with Early Onset Alzheimer’s?

A 
APP (chromo 21)
Presenillin 1 (chromo 14)
Presenillin 2 (chormo 1)

These make beta amyloid

260
Q

What gene is associated with Late Onset Alzheimer’s?

A

ApoE4 makes senile plaques

261
Q

What is the inheritance pattern of NF1?

A

AD, 100% penetrance with pleiotropy (variable expression)

May arise spontaneously through germline mutation (germine mosaicism) in individual with no family history

262
Q

Name the class of unmyelinated fibers.

A

Group C

263
Q

What are afferent Group C (unmyelinated) fibers?

A

Sensory fibers for flow pain, temperature, and olfaction

264
Q

What are efferent Group C (unmyelinated) fibers?

A

Post-ganglionic autonoimc

265
Q

What is the MOA of Pilocarpine

A

Direct muscarinic cholinergic agnoist

- Can cause pupillary constriction in deenervated eyes because it is direct!

266
Q

Name the disorder:

Emotional stressor becomes physical symptoms
Not reproducible on volition
Not corroborated on physical exam

A

Conversion Disorder

267
Q

Name the disorder:

Many body disorders/complaints in various systems
Over-utilization of medical system
Not corroborated on physical exam

A

Somatization

268
Q

What other neuro meds are contraindicated with first gen antihistamines?

A

Benzos, because both cause drowsiness/sedation

269
Q

What are first generation H1 antagonists (antihistamines)?

A

Diphenhydramine, chlorpheniramine, promethazine, hydroxyzine

Sleep from DC to PHilly

270
Q

Paralysis of what muscle and nerve causes hyperacusis?

A

Stapedius muscle, innervated by Stapedius nerve (of VII)

271
Q

Syndrome/symptoms produced by a stroke to the:

MCA

A

MCA is “major”
- M1/S1

Motor and sensory to contra upper limb and face
Aphasia if dominant hemisphere (usually left)
- Broca’s Area (Frontal Lobe)
- Wernicke’s Area (Temporal Lobe)
Hemineglect if nondominant hemisphere

272
Q

Syndrome/symptoms produced by a stroke to the:

ACA

A

Motor and sensory loss to contra lower limb

  • M1/S1
273
Q

Syndrome/symptoms produced by a stroke to the:

Lenticulostriate artery

A

Lacunar Infarct 2 to HTN (hyaline arteriolosclerosis)
- Internal capsule, striatum

Contralateral hemiparesis/hemiplegia

274
Q

Syndrome/symptoms produced by a stroke to the:

ASA

A

Medial Medullary Syndrome
- Lateral corticospinal tract, medial lemnisucus, caudal hypoglossal nerve

Contral hemiparesis of upper and lower limbs
Ipsi hypoglossal dysfunction (togue deviates ipsi)

275
Q

Syndrome/symptoms produced by a stroke to the:

PICA

A 
Lateral Medullary (Walleberg) Syndrome
- Lateral medulla

Pain and temp from ipsi face and contra body
Hoarseness, dysphagia
Vomiting vertigo nystagmus

“Don’t PICA horse that can’t eat”

276
Q

Syndrome/symptoms produced by a stroke to the:

AICA

A

Lateral Pontine Syndrome
- Lateral pons

Paralysis of face, loss of pain and temp, ipsi Horner’s

“Facial droop means AICA’s pooped”

277
Q

Syndrome/symptoms produced by a stroke to the:

PCA

A

Contra hemianopia with macular sparing

- Occipital/visual cortex

278
Q

Syndrome/symptoms produced by a stroke to the:

Basilar Artery

A

Locked-in Syndrome

279
Q

Demyelinating disorder:

Caused by JC virus

A

Progressive multifocal leukoencephalopathy

  • Reactivation of virus by immunocomp state
  • Rapidly progressive, usually fatal
280
Q

Demyelinating disorder:

Caused by measles

A

Subacute sclerosing panencephalitis (SSPE)

  • Years after initial infection
  • Ataxia, dementia
281
Q

Demyelinating disorder:

AD disorder related to defective production of proteins involved in structure and function of peripheral nerves or myelin sheath
Associated with scoliosis and foot deformities

A

Charcot-Marie-Tooth

282
Q

Demyelinating disorder:

AR lysosomal storage disease due to deficiency of galactocerebrosidase
Destroys myelin sheath
Developmental delay, optic atrophy, globoid cells

A

Krabbe

283
Q

Demyelinating disorder:

AR lysososmal storage disease due to deficiency of arylsulfatase A
Build up sulfatides
Impaired production of myelin sheath
Ataxia, dementia

A

Metachromatic Leukodystrophy

284
Q

Demyelinating disorder:

X-linked disorder of disrupted metabolism of VLCFA
Excessive buildup in CNS and adrenal glands
Progressive losses, adrenal crisis

A

Adrenoleukodystrophy

285
Q

Demyelinating disorder:

Occurs when correcting hyponatremia too quickly
Results in locked-in syndrome

A

Central Pontine Myelinolysis

286
Q

Name that tumor and its derivation:

Adult brain tumor
GFAP +
Pseudopalisading pleomorphic cells
Central necrosis and hemorrhage

A

GBM, derived from astrocytes

287
Q

Name that tumor:

Adult female typically
External to brain parenchyma
May have dural attachment
May present with seizures
Spindle cells in whorled pattern
Psammoma bodies
A

Meningioma, derived from arachnoid cells

288
Q

Name that tumor and its derivation:

Adult tumor typically
Cerebellopontine angle
S-100+
Bilateral in NF2

A

Schwannoma, derived from Schwann Cells

289
Q

Name that tumor and its derivation:

Cerebellar
Associated with VHL
Can produce EPO and 2 polycythemia
Thin walled capillaries with interleaving parenchyma

A

Hemangioblastoma, derived from endothelial cells

290
Q

Name that tumor and its derivation:

Adult tumor, slow growing
Frontal lobe
Fried egg cells and calcifications
Chicken wire capillary pattern
May present with seizure
A

Oligodendroglioma, derived from oligodendrocytes

291
Q

Name that tumor and its derivation:

Adult tumor
Most commonly prolactinoma
Bitemporal hemianopsia

A

Pituitary adenoma, derived from pituitary

292
Q

Name that tumor and its derivation:

Childhood tumor
Well circumscribed
Posterior fossa (cerebellum)
Solid + cystic
Eosinophilic corkscrew fibers
GFAP +
A

Pilocytic astrocytoma, derived from glial cells

Think: pilo-cystic

293
Q

Name that tumor and its derivation:

Childhood tumor
Cerebellum
Hydrocephalus, compressing 4th ventricle
Drop metastases to spinal cord
Rosettes
Small blue cells
A

Medulloblastoma, derived from neuroectoderm

294
Q

Name that tumor and its derivation:

Childhood tumor
4th ventricle
Perivascular rosettes

A

Ependymoma, from ependymal cells

295
Q

Name that tumor and its derivation:

Childhood tumor
Bitemporal hemiaopsia
Supratentorial
Calcificiations

A

Craniopharyngioma, from remnants of Rathke’s pouch (ectoderm)

296
Q

What area of the brain causes acute nausea post-chemo?

A

Chemoreceptor Trigger Zone

297
Q

Where is the CTZ located?

A

Area postrema of DORSAL MEDULLA near 4th ventricle

298
Q

What is the mechanism of opioid tolerance?

A

Activation of NMDA Rs by glutamate

299
Q

What medication decreases morphine tolerance, and what is the mechanism?

A

Ketamine, blocks NMDA R + actions of glutamate

300
Q

Vertical diplopia indicates…

A

Trochlear Nerve Palsy

301
Q

An increased blood gas coefficient of an inhaled anesthetic indicates (slow/rapid) onset of action?

A

Slow onset bc soluble in blood = slow equilibrium in brain

302
Q

What syndrome is characterized by:

  1. Pineal gland tumor
  2. Upward gaze palsy, absent pupillary light reflex, failure of convergence
  3. Wide based gait
A

Parinaud’s Syndrome

303
Q

What syndrome is characterized by:

Bilateral destruction of temporal lobe, esp. amygdala
Hypersexual, oral fixation, hyperphagia
Loss of normal anger and fear responses, placidity

A

Kluver Bucy Syndrome

304
Q

What are some etiologies of Kluver Bucy?

A

HSV-1 encephalitis

TBI

305
Q

What are the side effects of TCAs (ex. Amytryptiline)?

A

Antimuscarinic + alpha antagonistic effects

- Ex. urinary retention and sinus tachy

UWorld (15 decks)

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