Neuro 5 Flashcards
HIV patient
sensory ataxia
irregularly shaped pupils that do not react to light but do constrict with accomidation
Tabes dorsalis
Neurosyphilis
Cause of Argyl Robertson pupils
damage to the midbrain tectum
India Ink staining of CSF is used to diagnose:
Cyptococcal meningitis
Caused by cryptococcus neoformans
Treatment for cyptococcal meningitis
Amphotericin B and flucytosine
-> Use fluconazole for long term maitenance
Where is the caudate found
inferolateral wall of the anterior horn of the lateral ventricle. Separated from the globus pallidus and putamen by the internal capsule
In what genetic disease is the caudate atrophied?
Huntingtons
Two causes of glaucoma (broad)
Diminished outflow
increased secretion
MOA of timolol
Beta blocker
works by diminishing the secretion of aqueous humor by the ciliary epithelium
Which two sympathetic sites are not controlled by norepinephrine?
Adrenal glands and sweat glands (both use acetylcholine)
Pathway of thiopental through the body
IV-bloodstream-brain-muscle and adipose tissue
Parasthesias of the thumb, index, and middle finger
Carpel tunnel syndrome (entrapment of median nerve)
Causes of carpal tunnel syndrome
repetative movements Fluid retention- hypothyroidism diabetes RA dialysis associated amyloidosis (beta-2 microglobulin)
Most important biochemical abnormality in Alzheimers disease
decrease in acetylcholine level
Occurs due to deficiency of choline acetyltranferase
Most notable in the basal nucleus of Meynert and hippocampus
What meningococcal virulence factor allows for attachment to the nasopharynx
pili
spinal nerve root whose compression would cause pain purely in the posterior thigh and leg as well as diminution of the ankle jerk reflex
S1
MOA of nicotinic receptor
ligand gated ion channel that opens after binding acetlycholine. Results in immediate influx of Na, Ca into the cell and outflux of K+
Damage to what nerve causes foot drop and high stepping gait
common peroneal
Selegiline
inhibitor of MAO, type B.
Use: prevent MPTP damage to dopaminergic neurons. Delays progression of Parkinson’s disease
Clozapine
Atypical antipsychotic
Useful because it treats both positive and negative psychotic symptoms
Acts on D4 receptors, less likely to cause dopaminergic side effects
AE: risk of life threatening agranulocytosis, watch CBC. Seizures
MOA of ethosexamide
Decreases calcium current in thalamic neurons
MOA of Phenytoin, carbamazepine and valproic acid
reduces the ability of Na channels to recover from inactivation
Holoprosencephaly
failure of forebrain cleavage into cerebral hemispheres
Malformation
primary abnormality in a development process
Disruption
secondary destruction of a previously well-formed tissue or organ
Uses of bethanocol
stimulate peristalsis in postoperative ileus and treat non-obstructive urinary retention.
Uses of carbachol and pilocarpine
lower intraocular pressure in glaucoma
Why do cholinergics work well for glaucoma
miosis causes iris to move further from the cornea, widens he anterior chamber angle.
Clinical presentation of excessive cholinergic stimulation
DUMBELS diarrhea urination miosis bronchospasm Emesis lacrimation salivation
Effect of increased acetylcholine in nicotinic synapses of NMJ
fasiculations followed by paralysis
Why does atropine only fix some of the complications of organophosphate poisioning?
stimulates muscarinic and nicotinic cholinergic receptors. Atropine only reverses muscarinic effects.
Pralidoxime can, but is only effective early after exposure.
How do meningiomas cause damage?
Benign tumors, only cause damage when they compress other brain structures
Function of microglial cells
move into an area of damage after ischemic injury and phagocytize the fragments neurons, myelin and necrotic debris
Syringomyelia
cystic dilitation in cervical spinal cord. Causes damage to ventral white commisure and anterior horns Symptoms: - chronic loss of UE pain and temp - UE weakness and hyporeflexia (LMN) - LE weakness and hyperreflexia (UMN) -kyphoscoliosis Usually at levels C8 -T1
What CN is effected by infarcts of the anterior portion of the medial pons?
trigeminal
Rapid correction of what metabolite deficiency causes central pontine myelinolysis
chronic hyponatremia
What are the two types of typical antipsychotics? How do their side effects differ?
Low potency (Chlorpromazine, Thioridazine): non-neurologic High potency (Haloperidol, Fluphenazine): extrapyramidal
What disease causes lesions to both upper and lower motor neurons
AML
What drug is used for AML? What is it’s MOA?
Riluzole.
decreases glutamate release
How does hydrocephalus present in early infancy? What are the long-term sequelae?
Irritability, poor feeding, increased head circumfrence, and enlarged ventricles on CT
sequlae: lower extremity spasticity (due to stretching of the periventricular pyramidal tracts
visual diturbances
learning disabilites
Two mechanisms of diabetic neuropathy
- Non-enzymatic glycosylation of proteins leads to hyalinization of arteries -> ischemic nerve damage
- Intracellular hyperclycemia (turned into sorbitol) in nerves causes osmotic damage
What drugs are used to prevent cerebral vascular spasm after a subarachnoid hemorrhage
Calcium channel blockers, especially nimodipine
Most common first manifestation of alcohol withdrawl
tremulousness
Also: GI distress, agitation, anxiety, autonomic disturbance
What is the most common pathogen associated with foreign body infections. Why?
Staph epidermidis, because it can form biofilms.
Essential tremor
slowly progressive symmetric postural or kinetic tremor in upper extremitites. AD inherited (familial tremor)
What the first line treatment for essential tremor
Propranolol (nonspecific beta adernergic antagonist)
Halothane-associated hepatitis
two to four days after surgery under general anathesia
Liver tenderness, hepatomegaly, increase LFTs
Biopsy shows widespread centrilobular hepatic necrosis.
Due to direct injury by halothane metabolites
MOA of triptans
abortive therapy for migraines
serotonin agonists
What two types of drugs are used for migraine prophylaxis
beta blockers, TCAs, and anticonvulsants
Meniere’s disease
tinnitus, vertigo, sensurineural hearing loss
due to increased volume of endolymph
What drugs can cause drug-induced parkinsonism
D2 receptor blockers-> Antipsychotics, antiemetics, gastric motility agents
Treatment for drug-induced parkinsonism
Stop offending agent
benztropine (centrally acting antimuscarinic) and amantidine (anti-flu drug)
Three sites of action of first generation antihistamines that cause side effects
- anti-muscarininc
- anti-alpha adernergic
- anti-serotonergic
What drug is used for patients with combined tonic-clonic and absence seizures?
Valproate
