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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
What nerve is responsible for the afferent gag reflex?
Glossopharyngeal nerve (IX)
26
What nerve is responsible for the efferent gag reflex?
Vagus nerve (X)
27
What is the MOA of phenytoin?
Inhibits neuronal high frequency firing by reducing the ability of Na+ channels to recover Less Na+ current = less seizure
28
What is the first line Rx for status epilepticus?
Benzos
29
What Rx is used to prevent recurrence post status epilepticus?
Phenytoin
30
Keeping Schizo- Straight: Distant
Schizoid
31
Keeping Schizo- Straight: Odd thinking
Schizotypal
32
Keeping Schizo- Straight: Symptoms for
Brief Psychotic Disorder
33
Keeping Schizo- Straight: Symptoms for 1-6 mo
Schizophreniform Disorder
34
Keeping Schizo- Straight: Symptoms > 6mo
Schizophrenia
35
Keeping Schizo- Straight: Schizophrenic sx + psychotic sx + bipolar or depressed mood
Schizoaffective Disorder
36
Newborn is overreactive to stimuli and has a marked startle Excessive crying and sucking Cause?
Heroin withdrawal - These are the opposite of opioid effects - Rx: tincture of opium
37
What is internuclear ophthalmoplegia?
Affected eye cannot cross midline on conjugate gaze
38
Where is the lesion in internuclear opthalmoplegia?
The lesion is in the MLF, which connects CN III, IV, V, most likely to the Abducens (VI) nerve nucleus
39
CN responsible for afferent pupillary light reflex.
Optic nerve (II)
40
CN responsible for efferent pupillary light reflex
Oculomotor nerve (III), PS fibers
41
Trace the path of the pupillary light reflex.
``` Optic nerve > Pretectal nucleus (ipsi) > Edinger-Westphal nucleus (bilateral) > Oculomotor nerve > Ciliary ganglion> Synapse ```
42
What happens to the pupillary light reflex if the Optic nerve is demyelinated (Ex. MS)?
No direct on ipsi No consensual on contra Constriction of both pupils w light on unaffected side
43
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?
``` Optic nerve (CN II) on L side - Knocks out afferent arm of pupillary light reflex ```
44
What cells do tissue repair in the PNS?
Fibroblasts
45
What cells do tissue repair in the CNS?
Astrocytes (glial cells)
46
What are the 4 functions of astrocytes (glial cells)?
1. Repair 2. Structural support 3. Blood brain barrier 4. Metabolic support
47
How does Hydrochlorothiazide affect Lithium?
Increases Lithium reabsorption in the PT, along with Na+, thereby increasing potential for Lithium toxicity.
48
How do ACE-Is and NSAIDs affect Lithium?
Decrease renal clearance
49
What are signs of Lithium toxicity?
``` Neuromuscular excitability Tremor Fascicular twitch Agitation Ataxia Delirium ```
50
What is the Rx for Lithium toxicity?
Dialysis
51
What are the 3 most common primary brain tumors in adults?
1. Glioblastoma 2. Meningioma 3. Acoustic Neuroma (Schwannoma)
52
Name that brain tumor: - Astrocytes, large cells - Necrosis and hemorrhage - Found in cerebrum, crosses midline - Poor prognosis
Glioblastoma | - Most common
53
Name that brain tumor: - Arachnoid cells - Well circumscribed - Dural attachment - Benign
Meningioma
54
Name that brain tumor: - S-100 + - Cerebellopontine angle
Acoustic Neuroma (Schwannoma)
55
Where is the lesion in pt. with left-sided hemibalism?
Contralateral subthalamic nuclei (of basal ganglia)
56
What stroke causes hemibalism?
Lacunar stroke, typically in pt. with HTN
57
Pt. has had multiple spontaneous hemorrhages over several months, some of which affect vision. What is the underlying cause?
Cerebral Amyloid Angiopathy | - Beta amyloid deposits in cerebral arteries
58
What lobes does Cerebra Amyloid Angiopathy most affect?
Occipital and Parietal
59
What is the MOA of Busiprone?
Selective 5HT1a agonist
60
What is the indication of Busiprone?
GAD: anti-anxiety med with less abuse potential than Benzos - No sedative hypnotic or seizure side affects
61
What are the criteria for Major Depressive Disorder?
SIG E CAPS: 5sx x 2 wks - Sleep disorder - Interest decreased - Guilt - Energy decreased - Concentration decreased - Appetite change - Psychomotor decreased - Suicidality
62
What are the criteria for Dysthymic Disorder?
Chronic, low intensity Depressed mood most days + 2 sx x 2 yrs
63
What are 3 drugs used in the Rx of Alzheimer's?
Donepizil: AchE-I Vitamin E: anti-oxidant Memantine: NMDA receptor antagonist
64
What is the indication and MOA of Donepizil?
Alzheimer's, acetylcholinesterase inhibitor
65
What is the indication and MOA of Memantine?
Alzheimer's, NMDA receptor antagonist
66
What is the first sign of uncal herniation?
Fixed, dilated pupil (ipsi) because of CN III compression
67
What are causes of uncal herniation?
Hemorrhage Tumor (Compression)
68
What is the cause of: - Ipsi occulomotor paralysis - Hemiparesis - Contra homonymous hemianopia
Uncal herniation | progressive sx, first one being fixed, dilated pupil
69
What is the MOA of Carbidopa?
Prevents peripheral conversion of Levodopa | - CNS adverse effects persist, like anxiety and agitation
70
What are 2 meds used in Rx of Benign Essential Tremor?
Primidone + Propanolol
71
What is the MOA of Primidone?
Narrow spectrum anticonvulsant | Phenobarbitol + Phenylethylmalomide
72
What is a beta blocker used in Rx of Benign Essential Tremor?
Propanolol
73
Nerve responsible for afferent corneal reflex.
Trigeminal, V1
74
Nerve responsible for efferent corneal reflex.
Facial, VII
75
What are the 3 most common brain tumors in children?
1. Pilocytic Astrocytoma 2. Medulloblastoma 3. Ependymoma
76
Name that (kids) tumor: - Cerebellum > cerebrum - Cystic + protruding nodule - Astrocytes + Rosenthal fibers - Good prognosis
Pilocytic Astrocytoma
77
Name that (kids) tumor: - Cerebellum only - Solid sheets of blue cells - Malignant
Medulloblastoma
78
Name that (kids) tumor: - Increased CSF - Hydrocephalus - Rosettes
Epedymoma
79
What is the age-related eye condition caused by fatty tissue deposits in the retina +/- neovascularization?
Macular Degeneration ``` Dry = fatty tissue only Wet = + new bvs ```
80
Where is the macula?
Central retina
81
What are two ergot-derived DA agonists?
Bromocriptine Pergolide - Directly stimulate DA receptor
82
What are two non-ergot DA agonists?
Pramipexole Ropinerole - Directly stimulate DA receptor
83
Hypertensive arteriolosclerosis with underlying HTN likely causes what kind of infarct?
Lacunar infarct
84
What vessels are usually involved in a lacunar infarct?
Stroke involves small penetrating vessels supplying: - Basal ganglia - Pons - Internal capsule - Corona radiata
85
What is myotonia?
Abnormally slow relaxation of muscles
86
What is myotonic dystrophy?
AD condition causing myotonia, along with: - Cataracts - Frontal balding - Gonadal atrophy Increased trinucleotide repeats
87
What are the broad spectrum anti-epileptics?
Lamotrigine, Valproate, Topiramate
88
What are the narrow spectrum anti-epileptics?
Carbamazepine, Gabapentin, Phenobarbital, Phenytoin
89
What type of seizure responds to narrow spectrum anti-epileptics?
Focal
90
What type of seizure responds to broad spectrum anti-epileptics?
Most types
91
What is the difference between schizoaffective disorder and bipolar disorder with psychotic features?
In bipolar with psychotic features, the psychoses only occur during manic/depressive episodes. In schizoaffective, will have psychosis in the absence of mood episodes.
92
What is vasovagal syncope?
Decreased BP and HR due to vagal stimulation
93
Touching what part of the ear can result in vasovagal syncope?
External auditory canal | - Vagus innervates
94
What is a first gen. antipsychotic with low potency?
Chlorpromazine
95
What are the adverse effects of first gen. antipsychotics with low potency?
Sedation Anticholinergic affects Orthostatic hypotension
96
What are two first gent. antipsychotics with high potency?
Haloperidol, Fluphenazine
97
What are the adverse effects of first gen. antipsychotics with high potency?
Neuro effects | Extrapyramidal sx
98
What characterizes communicating hydrocephalus?
Free flow through ventricles - Decreased CSF absorption - Have abnormal arachnoid granules in TB and SAH - All ventricles are dilated
99
What characterizes non-communicating hydrocephalus?
Obstruction of CSF flow - Only ventricles proximal to obstruction are dilated
100
What characterizes hydrocephalus ex-vacuo?
Not true hydrocephalus; rather, ventricular enlargement secondary to brain atrophy
101
What conditions evidence hydrocephalus ex-vacuo?
Alzheimer's, Pick's, advanced HIV/AIDS
102
What is the MOA of cocaine?
Inhibits reuptake of monoamines (NE, DA, 5HT) - Increased sympathetic stimulation (increased arousal, agitation, seizures) - Coronary vasospasm, mucosal atrophy, septal perf
103
What is a type I Chiari malformation?
Cerebellar tonsils into vertebral canal | - Presents in adulthood with headache and cerebellar sx
104
What is a type II Chiari malformation?
Cerebellum + medulla through foramen mangum - Presents in neonates, more severe - Lumbar meningiocele + hydrocephalus
105
What are the symptoms of Atropine OD?
Antimuscarinic effects (opp. of DUMBELS)
106
What is the Rx for Atropine OD?
Physostigmine "phyxes Atropine OD" | - AChE-I that increases levels of acetylcholine
107
What is Rx in opioid withdrawal?
Pentazocine - Partial agonist and antagonist at mu receptors - May precipitate withdrawal sx if given with agonist
108
Derived from what tissue: Rathke's pouch
Surface ectoderm
109
Derived from what tissue: Lens and cornea
Surface ectoderm
110
Derived from what tissue: Inner ear
Surface ectoderm
111
Derived from what tissue: Olfactory, nasal, and oral epithelium
Surface ectoderm
112
Derived from what tissue: Salivary, sweat, and mammary glands
Surface ectoderm
113
Derived from what tissue: Brain and spinal cord
Neural tube
114
Derived from what tissue: Posterior pituitary
Neural tube
115
Derived from what tissue: Pineal gland
Neural tube
116
Derived from what tissue: Retina
Neural tube
117
Derived from what tissue: Autonomic, sensory, and celiac ganglia
Neural crest
118
Derived from what tissue: Schwann cells
Neural crest
119
Derived from what tissue: Pia and arachnoid mater
Neural crest
120
Derived from what tissue: Aorticopulmonary septum, endocardial cushions, branchial arches
Neural crest
121
Derived from what tissue: Skull bones
Neural crest
122
Derived from what tissue: Melanocytes
Neural crest
123
Derived from what tissue: Adrenal medulla
Neural crest
124
Derived from what tissue: Muscles, CT, bone, and cartilage
Mesoderm
125
Derived from what tissue: Blood, lymph, spleen, kidney, adrenal cortex
Mesoderm
126
Derived from what tissue: Gi tract, liver
Endoderm
127
Derived from what tissue: Lungs
Endoderm
128
Derived from what tissue: Thymus, thyroid follicles, parathyroid
Endoderm
129
Derived from what tissue: Bladder, urethra
Endoderm
130
Derived from what tissue: Middle ear
Endoderm
131
What is the Rx for Alcohol withdrawal?
Benzos - Long acting preferred: Diazepam, Chlordiazepoxide - Short acting if liver dysfx: Lozepam, Oxazepam
132
What is an ocular adverse effect of Atropine?
Closed angle glaucoma | - Due to increased intraocular pressure
133
Neurocutaneous syndromes: - Hemangioblastomas in retina/cerebellum - Pancreatic cysts (also kidney, liver) - kidneY at risk for RCC
VHL: Von Hippel Lindau | - AD
134
Neurocutaneous syndromes: ``` PNS tumors Neurofibromas Optic nerve gliomas Lisch nodules in the iris Cafe au lait spots ```
NF 1
135
Neurocutaneous syndromes: Bilateral acoustic neuromas Meningiomas
NF 2 | - AD
136
Neurocutaneous syndromes: Encphalotrigeminal angtiomatosis - Skin - Retardation - Skull radioopacitiies - "Tram track" on CT
Sturge-Weber "VVV for Weber + CN V"
137
Neurocutaneous syndromes: Hamartomas Cysts Cardiac rhabdomyomas Seizures
Tuberous Sclerosis
138
Neurocutaneous syndromes: Hemorrhagic telangiectasias Rupture causes bleeding No cysts
Osler-Weber-Rendu "Red-u blood"
139
In what part of the neuron does Wallerian Degeneration occur after injury?
Segment of the axon that lost connection to the cell body
140
In what part of the neuron does Axonal Regeneration occur after injury?
Cell body - Edema - Nucleus in periphery - Dispersed Nissl - 24-48 hrs post injury
141
Aneurysm caused by HTN - Occurs in the ponds, thalamus, cerebellum, basal ganglia -
Charcot-Bouchard Aneurysm
142
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
Berry Aneurysm
143
What part of the ear is damaged in noise-induced hearing loss?
Sterocilia of the hair cells within the Organ of Corti
144
What is the function of the Organ of Corti?
To transduce mechanical audition from the tympanic membrane to the nerve
145
What is the function of the Mammillary Body?
Cortical control of emotion and memory | - Part of the Circuit of Papez in the Limbic System
146
What part of the brain undergoes necrosis in Wernicke-Korsakoff Syndrome?
Mammillary Bodies
147
What nerve is affected in Bell's Palsy?
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
What is Central Pontine Myelinolysis?
Osmotic demyelination of neurons in pons - Quadriplegia due to demyelination of corticobulbar tracts - Pseudobulbar palsy: head and neck muscle weakness, dysphagia, dysarthria
149
What is the cause of Central Pontine Myelinolysis?
Rapid correction of hyponatremia
150
What are 2 mechanisms of diabetic peripheral neuropathy?
1) Endoneural arteriole hyalinization | 2) Intracellular hyperglycemia > osmotic damage to neurons
151
What is the role of Lithium in bipolar disorder?
Manic and depressive episodes, maintenance
152
What is the role of Valproate in bipolar disorder?
Manic episodes, maintenance
153
What is the role of Carbamazepine in bipolar disorder?
Manic episodes, maintenence
154
What is the role of Lamotrigine in bipolar disorder?
Depressive episodes, maintenence
155
What drugs can be used in manic episodes of bipolar?
Lithium Valproate Carbamazepine
156
What drug can be used in depressive episodes of bipolar?
Lamotrigine
157
What drugs can be used in maintenance therapy of bipolar?
Lithium Valproate Carbamazepine Lamotrigine
158
What are the adverse effects of Lithium?
DI Hypothyroid Tremor Ebstein's anomaly
159
What are the adverse effects of Valproate?
Hepatotoxicity | Neural tube defects
160
What are the adverse effects of Carbamazepine?
Agranulocytosis SIADH Neural tube defects
161
What are the adverse effects of Lamotrigine?
Steven Johnson Syndrome
162
What is the Rx for Trigeminal Neuralgia?
Carbamazepine
163
Clasp-knife spasticity (initial resistance, sudden release) indicates what kind of brain lesion?
Pyramidal motor system: corticospinal tract, medulla, pons, midbrain, internal capsule, precentral gyrus
164
What area of the brain makes up the extrapyramidal motor tract?
Basal ganglia
165
Dizziness + truncal atazia + dysarthria + visual changes + cancer diagnosis indicates:
Paraneoplastic Cerebellar Degeneration
166
What is the mechanism behind paraneoplastic cerebellar degeneration?
Antibodies against tumor cross reacts with Purkinje neurons | - Anti-Yo, Anti-P/Q, Anti-Hu
167
What cancers are prone to paraneoplastic cerebellar degeneration?
Small cell lung cancer | Breast, ovarian, uterine cancers
168
What is the major cause of death in TCA overdose?
Cardiac arrhythmia | - Inhibition of Na channels in cardiac myocytes (though not related to anti-depressive mechanism)
169
What type of brain bleed involves a lucid interval?
Epidural hematoma
170
What tumor is characterized by: - Precocious puberty - Obstructive hydrocephalus (compression) - Paralysis of upward gaze and convergence (Parinaud's)
Germinoma, pineal gland tumor
171
What is the lesion: - Loss of pain and temp over cape like distribution - Uppers show LMN signs - Lowers show UMN signs - Setting of scoliosis
Syringomyelia
172
Where is the lesion in Syringomyelia?
Ventral White Commissure
173
What is a neuro complication of measles?
Subacute Sclerosing Panencephalitis (SSPE)
174
What are the symptoms of SSPE?
Ataxia, myoclonus, visual changes
175
What makes the diagnosis of SSPE?
Measles antibodies (oligoclonal bands) in CSF
176
Where does the virus accumulate and replicate in SSPE?
Neurons and oligodendrocytes | - Causes demyelination and gliosis
177
What antidepressants can cause mania in susceptible patients?
TCAs, Venlafaxine
178
What pathological findings are evidenced in the brain of a Huntington's patient?
Bilateral atrophy of caudate and putamen (striatum) Dilation of frontal horns of lateral ventricles Atrophic areas show gliosis + neuronal loss
179
What type barrier makes up the BBB?
Tight junctions/zonula occludens - Claudins and occludins - Limits transport to trancellular diffusion or carrier-mediated
180
Which cranial nerves are affected by acoustic neuromas?
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
Valproate inhibits folate absorption from the gut, putting pregnant women at risk for...
Neural tube defects in the fetus
182
What seizures is Valproate indicated for?
Absence | Tonic clonic
183
What is the Rx for Serotonin Syndrome?
Cyproheptadine | - Antihistamine with 5HT2 antagonist properties
184
What type of receptors are mu opioid receptors?
GPCRs | - Activate various 2nd messenger pathways
185
What ist he morphine pathway?
Activate mu receptor (GPCR) - Increase K+ efflux - Hyperpolarization - No pain transmission
186
What is the MOA of Thiopental?
Short acting barbiturate | Used for induction of anesthesia
187
What is the lethal side effect of Cocaine?
MI
188
What is the lethal side effect of Opioids?
Respiratory Depression
189
What is the lethal side effect of PCP?
Trauma secondary to violent behavior
190
What is the role of the cerebral cortex in urination?
Inhibits sacral nerves | inhibition lost in NPHydrocephalus
191
What is the role of pontine fibers in urination?
Relax external urethral sphincter
192
What is the role of sacral nerves 2-4 in urination?
Bladder contraction (PS fibers)
193
B1 (thiamine) is needed as a cofactor for:
1. Pyruvate dehydrogenase (pyruvate > acetyl CoA) 2. Alphaketoglutarate dehydrogenase (TCA cycle) 3. Transketolase (HMP hunt, pentose > G3P)
194
What are the causes of glaucoma?
Increased intraocular pressure due to: - Increased production of aqueous humor OR - Decreased outflow
195
What is the Rx for glaucoma?
TImolol, beta blocker that decreases aqueous production by ciliary epithelium
196
What is the MOA of Levodopa in Parkinson's?
Dopamine analog
197
What is the MOA of Carbidopa in Parkinson's
Does not cross BBB Inhibitor of dopa-decarboxylase Blocks peripheral effects of L-dopa
198
What is the MOA of Selegiline in Parkinson's?
MAO-I | Prevents damage to DA neurons
199
What is the MOA of Amantadine in Parkinson's
Mainly an antiviral, with dopaminergic anticholinergic action
200
What is the MOA of Pergolide in Parkinson's?
DA agonist (D2 Rs)
201
What is the initial treatment for Parkinson's?
Selegeline/Amantadine/Anticholinergics Later, Levodopa/Carbidopa
202
What is are underlying causes to Cheyne-Stokes respiration?
Hyperventilation and apnea in alternation can be caused by CHF or can be neurogenic (NOT due to obstructive sleep apnea)
203
What is a common adverse effect of SSRIs, including Sertraline, Paroxetine, and Velafaxine?
Sexual dysfunction
204
What sense does not go through thalamic relay?
Smell
205
What tracts go through the VPL thalamic relay?
Spinothalamic tract and medial lemniscus
206
What tracts go through the VPM thalamic relay?
Trigeminal and gustatory
207
What goes through the LGN thalamic relay?
Vision (lateral = light)
208
What goes through the MGN thalamic relay?
Sound (medial = music)
209
What is an SSRI without the adverse effect of sexual dysfunction?
Buproprion
210
What are the adverse effects of Buproprion?
Agitation Insomnia Seizure (esp. with electrolyte imbalance) - Contraindicated in bulimia and anorexia
211
Loss of ankle reflex in Sciatica indicates what nerve root is damaged?
S1
212
What is the MOA of inhaled anesthetics?
Increased GABA inhibition by locking K+ channels in hyperpolarization
213
What are the adverse effects of inhalation anesthetics?
Mycoardial depression (decreased CO) Hypotension Respiratory depression Decreased renal fx
214
What nerve and muscle are damaged in the Trendelenberg Gait?
Superior gluteal nerve | Gluteus medius muscle
215
What is the function of the suprachiasmatic nucleus?
Regulates Circadian Rhythm
216
What is indicated by: ``` "Hot as a hare" "Dry as a bone" "Red as a beet" "Blind as a bat" "Mad as a hatter" ```
Anticholinergic Syndrome ``` Fever Dry skin and mucous membranes Flushing Mydriasis and cycloplegia Altered mental status ```
217
What are some drugs that cause anticholinergic syndrome?
Atropine Antihistamines (diphenhydramine, hydroxizine) Antipsychotics (cholorpromazine, olanzapine) Antispasmodics (dicyclomine) Tricyclic antidepressants (amitryptiline, desipramine)
218
What is sublimation?
Mature defense mechanism Convert/channel unacceptable feelings or drives into a more socially acceptable venus
219
Diagnosis of: - 20-30 yr old presets with headaches and papilledema - Pituitary failure and cranial nerve dysfunction - Bitemporal hemianopsia - Calcified lesion on head CT
Craniopharyngeoma
220
What is a craniopharyngeoma?
Suprasellar tumor arising from remnants of Rathke's pouch
221
What is the histology of a craniopharyngeoma?
3 parts: solid, cystic, calcified | - Brownish fluid filled with cholesterol
222
What brain tumor has 3 parts: solid, cystic, and calcified?
Craniopharyngeoma, arising from remnants of Rathke's pouch
223
What is the MOA of Ethosuximide?
Blocks T-type Ca channels in thalamic neurons, keeping them hyperpolarized
224
What is the indication for Ethosuximide?
Absence seizure
225
What is the MOA of Phenytoin, Carbamazepine, Valproate?
Block Na current in cortical neurons, reducing ability to recover from inactivation
226
What additional Rs does Valproate block?
Na channels in cortical neurons AND - NMDA Rs - GABA Rs - K+ channels
227
What is transference?
Shifting of emotions associated with one person to another
228
What is displacement?
Expressing emotions to/on a safer surrogate
229
What is projection?
Attributing one's own unacceptable thoughts to another
230
What does the MAC of an inhaled anesthetic indicate?
Potency Low MAC = high potency
231
What does A/V concentration of an inhaled anesthetic indicate?
Solubility in tissues High A/V = increased time to saturate blood
232
What does the blood/gas partition of an inhaled anesthetic indicate?
Solubility in blood Increased blood/gas = increase time to saturate
233
What is the pathogenesis of organophosphate (insecticide) poisoning?
Acetylcholinesterase inhibition - All of the secretions - Muscle paralysis - Bradycardia - Miosis
234
What is the Rx for organophosphate poisoning?
Atropine: muscarinic antagonist - Cannot change muscle paralysis Pralidoxime: cholinesterase enzyme reactivator
235
What is the path of CSF circulation?
``` Lateral ventricles > Interventricular Foramen of Monro > Third Ventricle > Cerebral Aqueduct > Fourth Ventricle > Luschka and Magendie > Central Canal ```
236
What is the MOA of succinylcholine?
NMJ depolarizing blockade | - Ca cause flaccid paralysis
237
Poorly demarcated brain tumor with necrosis and hemorrhage and variegated appearance
Glioblastoma Multiforme
238
From what cell type does Glioblastoma Multiforme derive?
Astrocyte
239
Brain tumor with psuedopalisading necrosis, new vessel formation, small round cells, bizarre giant cells, and many mitoses
Glioblastoma multiforme
240
What is the presentation of Glioblastoma Multiforme
Headache Seizure Mental status change Focus neuro sx 40-70 yo
241
What parts of the brain does Glioblastoma Multiforme affect?
Frontal and temporal lobes Basal ganglia Crosses midline "butterfly"
242
What is the prognosis of Glioblastoma Multiforme?
High malignant | Death within 1-2 years
243
What is the presentation of hydrocephalus in infancy?
Poor feeding and irritability Hyperreflexia and muscle hypertonicity (UMN) due to stretching of periventricular tracts Ventricular sized enlarged on CT
244
What cell type makes up a tumor that stains with Synaptophysin?
Neurons
245
What cell type makes up a tumor that stains with GFAP?
Glial cells
246
What tumors stain for GFAP (3)?
Astrocytomas Ependymomas Oligodendrogliomas
247
What is the location of a pure motor or pure sensory stroke?
Internal capsule | - Will take out motor/sensation to the contralateral limbs and face
248
What is the length constant?
How far along an axon a signal can propagate
249
What is the time constant?
How long it takes to change membrane potential
250
How does MS affect the length and time constants?
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
What are the indications of Carbamazepine?
Simple and complex, tonic-clonic seizures Bipolar mood stabilizer Trigeminal Neuralgia
252
What is the MOA of Carbamazepine?
Blocks voltage gated Na channels in cortical neurons
253
What are the adverse effects of Carbamazepine?
Bone marrow suppression Hepatotoxicity SIADH
254
Give me some tongue: Taste anterior 2/3
Chorda Tympani of Facial Nerve (VII)
255
Give me some tongue: Pain/temp anterior 2/3
Lingual Nerve of Trigeminal Nerve (V3)
256
Give me some tongue: Taste posterior 1/3
Glossopharyngeal (IX)
257
Give me some tongue: Pain/temp posterior 1/3
Glossopharyngeal (IX)
258
Give me some tongue: Taste to epiglottis and pharynx
Vagus (X)
259
What genes (on what chromosomes) are associated with Early Onset Alzheimer's?
``` APP (chromo 21) Presenillin 1 (chromo 14) Presenillin 2 (chormo 1) ``` These make beta amyloid
260
What gene is associated with Late Onset Alzheimer's?
ApoE4 makes senile plaques
261
What is the inheritance pattern of NF1?
AD, 100% penetrance with pleiotropy (variable expression) May arise spontaneously through germline mutation (germine mosaicism) in individual with no family history
262
Name the class of unmyelinated fibers.
Group C
263
What are afferent Group C (unmyelinated) fibers?
Sensory fibers for flow pain, temperature, and olfaction
264
What are efferent Group C (unmyelinated) fibers?
Post-ganglionic autonoimc
265
What is the MOA of Pilocarpine
Direct muscarinic cholinergic agnoist | - Can cause pupillary constriction in deenervated eyes because it is direct!
266
Name the disorder: Emotional stressor becomes physical symptoms Not reproducible on volition Not corroborated on physical exam
Conversion Disorder
267
Name the disorder: Many body disorders/complaints in various systems Over-utilization of medical system Not corroborated on physical exam
Somatization
268
What other neuro meds are contraindicated with first gen antihistamines?
Benzos, because both cause drowsiness/sedation
269
What are first generation H1 antagonists (antihistamines)?
Diphenhydramine, chlorpheniramine, promethazine, hydroxyzine Sleep from DC to PHilly
270
Paralysis of what muscle and nerve causes hyperacusis?
Stapedius muscle, innervated by Stapedius nerve (of VII)
271
Syndrome/symptoms produced by a stroke to the: MCA
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
Syndrome/symptoms produced by a stroke to the: ACA
Motor and sensory loss to contra lower limb - M1/S1
273
Syndrome/symptoms produced by a stroke to the: Lenticulostriate artery
Lacunar Infarct 2 to HTN (hyaline arteriolosclerosis) - Internal capsule, striatum Contralateral hemiparesis/hemiplegia
274
Syndrome/symptoms produced by a stroke to the: ASA
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
Syndrome/symptoms produced by a stroke to the: PICA
``` 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
Syndrome/symptoms produced by a stroke to the: AICA
Lateral Pontine Syndrome - Lateral pons Paralysis of face, loss of pain and temp, ipsi Horner's "Facial droop means AICA's pooped"
277
Syndrome/symptoms produced by a stroke to the: PCA
Contra hemianopia with macular sparing | - Occipital/visual cortex
278
Syndrome/symptoms produced by a stroke to the: Basilar Artery
Locked-in Syndrome
279
Demyelinating disorder: Caused by JC virus
Progressive multifocal leukoencephalopathy - Reactivation of virus by immunocomp state - Rapidly progressive, usually fatal
280
Demyelinating disorder: Caused by measles
Subacute sclerosing panencephalitis (SSPE) - Years after initial infection - Ataxia, dementia
281
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
Charcot-Marie-Tooth
282
Demyelinating disorder: AR lysosomal storage disease due to deficiency of galactocerebrosidase Destroys myelin sheath Developmental delay, optic atrophy, globoid cells
Krabbe
283
Demyelinating disorder: AR lysososmal storage disease due to deficiency of arylsulfatase A Build up sulfatides Impaired production of myelin sheath Ataxia, dementia
Metachromatic Leukodystrophy
284
Demyelinating disorder: X-linked disorder of disrupted metabolism of VLCFA Excessive buildup in CNS and adrenal glands Progressive losses, adrenal crisis
Adrenoleukodystrophy
285
Demyelinating disorder: Occurs when correcting hyponatremia too quickly Results in locked-in syndrome
Central Pontine Myelinolysis
286
Name that tumor and its derivation: Adult brain tumor GFAP + Pseudopalisading pleomorphic cells Central necrosis and hemorrhage
GBM, derived from astrocytes
287
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 ```
Meningioma, derived from arachnoid cells
288
Name that tumor and its derivation: Adult tumor typically Cerebellopontine angle S-100+ Bilateral in NF2
Schwannoma, derived from Schwann Cells
289
Name that tumor and its derivation: Cerebellar Associated with VHL Can produce EPO and 2 polycythemia Thin walled capillaries with interleaving parenchyma
Hemangioblastoma, derived from endothelial cells
290
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 ```
Oligodendroglioma, derived from oligodendrocytes
291
Name that tumor and its derivation: Adult tumor Most commonly prolactinoma Bitemporal hemianopsia
Pituitary adenoma, derived from pituitary
292
Name that tumor and its derivation: ``` Childhood tumor Well circumscribed Posterior fossa (cerebellum) Solid + cystic Eosinophilic corkscrew fibers GFAP + ```
Pilocytic astrocytoma, derived from glial cells Think: pilo-cystic
293
Name that tumor and its derivation: ``` Childhood tumor Cerebellum Hydrocephalus, compressing 4th ventricle Drop metastases to spinal cord Rosettes Small blue cells ```
Medulloblastoma, derived from neuroectoderm
294
Name that tumor and its derivation: Childhood tumor 4th ventricle Perivascular rosettes
Ependymoma, from ependymal cells
295
Name that tumor and its derivation: Childhood tumor Bitemporal hemiaopsia Supratentorial Calcificiations
Craniopharyngioma, from remnants of Rathke's pouch (ectoderm)
296
What area of the brain causes acute nausea post-chemo?
Chemoreceptor Trigger Zone
297
Where is the CTZ located?
Area postrema of DORSAL MEDULLA near 4th ventricle
298
What is the mechanism of opioid tolerance?
Activation of NMDA Rs by glutamate
299
What medication decreases morphine tolerance, and what is the mechanism?
Ketamine, blocks NMDA R + actions of glutamate
300
Vertical diplopia indicates...
Trochlear Nerve Palsy
301
An increased blood gas coefficient of an inhaled anesthetic indicates (slow/rapid) onset of action?
Slow onset bc soluble in blood = slow equilibrium in brain
302
What syndrome is characterized by: 1. Pineal gland tumor 2. Upward gaze palsy, absent pupillary light reflex, failure of convergence 3. Wide based gait
Parinaud's Syndrome
303
What syndrome is characterized by: Bilateral destruction of temporal lobe, esp. amygdala Hypersexual, oral fixation, hyperphagia Loss of normal anger and fear responses, placidity
Kluver Bucy Syndrome
304
What are some etiologies of Kluver Bucy?
HSV-1 encephalitis | TBI
305
What are the side effects of TCAs (ex. Amytryptiline)?
Antimuscarinic + alpha antagonistic effects | - Ex. urinary retention and sinus tachy

UWorld (15 decks)

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