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UWorld Journal > Neuro > Flashcards

Neuro Flashcards

1
Q

how do infants with hydrocephalus precent

A

irritability, poor feeding, muscle hypertonia, and hyperreflexia (due to upper motor neuron injury)

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2
Q

narcolepsy with cataplexy is most often caused by the lack of 2 related neuropeptides:

A

hypocretin-1 (orexin-A) and hypocretin-2 (orexin-B)

detected in CSF

these promote wakefulness and inhibit REM sleep-related phenomena

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3
Q

clinical presentation of Wernicke encephalopathy

A

ataxia, nystagmus, ophthalmoplegia, and anterograde amnesia

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4
Q

vaccines for Neisseria meingitidis contains

A

capsular polysaccharides to induce production of protective anticapsular antibodies

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5
Q

what is physostigmine

A

cholinesterase inhibitor

can be used to treat atropine poisoning since atropine has antimuscarinic effects

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6
Q

ataxia telangiectasia- clinical findings

A

superficial blanching nests of distended capillaries

failure to repair DNA double strand breaks

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7
Q

in the E. coli strains that cause neonatal meningitis, what is their major virulence factor

A

K1 capsular antigen

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8
Q

_________ is a potent vasodilator of cerebral vasculature

A

carbon dioxide

tachypnea causes hypocapnia and cerebral vasoconstriction to decrease cerebral blood volume and intracranial pressure

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9
Q

3 treatment options for alzheimer’s disease

A

cholinesterase inhibitors (Donepezil), antioxidants (vitamin E), and NMDA receptor antagonists (eg memantine)

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10
Q

treatment for malignant hyperthermia

A

dantrolene-blocks ryanodine receptors to stop Ca release into the cytoplasm of skeletal muscle

malignant hyperthermia due to anesthetics and/or succinylcholine to genetically susceptible people

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11
Q

symptoms of serotonin syndrome

A

autonomic instability (hyperthermia, hypertension, tachycardia), alterned mental status, neuromuscular hyperactivity, GI symptoms and diaphoresis

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12
Q

what drug combo causes serotonin syndrome

A

monoamine oxidase inhibitor combined with serotonergic antidepressant

(Linezolid has MAOI activity)

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13
Q

symptoms of pinealoma

A

Parinaud syndrome (compress tectum–> limit upward gaze, bilateral eyelid retraction, and light-near dissociation), obstructive hydrocephalus, precocious puberty in males

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14
Q

“locked-in” syndrome due to _______ hemorrhage or tumor

A

pontine

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15
Q

______ and ________ are effective as monotherapy for treatment of spasticity secondary to both brain and spinal cord disease, including multiple sclerosis

A

Baclofen (GABA-B receptor agonist); Tizanidine (alpha-2 adrenergic agonist)

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16
Q

what is the area postrema and where is it?

A

located on dorsal surface of medulla at the caudal end of the fourth ventricle

receives blood from fenestrated vessels (no blood-brain barrier) so can sample chemicals in the blood

associated with vomiting with chemotherapy

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17
Q

paralysis of the ________ muscle results in hyperacusis (increased sensitivity to sound)

and what nerve innervates this muscle?

A

stapedius musle; stapedius nerve, a branch of the facial nerve

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18
Q

ornithine transcarbamylase deficiency–> leads to defect in __________

A

hepatic urea cycle–> ammonia to accumulate in blood–> lethargy, vomiting, seizures, cerebral edema

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19
Q

main treatment for urea cycle disorders

A

protein restriction

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20
Q

bell’s palsy presentation (unique ones)

A

decreased tearing, hyperacusis (sensitivity to sound), and /or loss of tase sensation over the anterior 2/3 of tongue

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21
Q

what drug can be prescribed for sedative hypnotic drugs with anxiolytic, muscle relaxant and anticonvulsant actions

A

benzodiazepines

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22
Q

cholinergic toxicity-muscarinic effects and nicotinic effects

A

muscarinic: DUMBELS
diarrhea/diaphoresis, urination, miosis, bronchospasm, bronchorrhea & bradycardia, emesis, lacrimation, and salivation

nicotinic: muscle weakness, paralysis & fasciculations

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23
Q

mechanism of action of organophosphates

A

inhibit cholinesterase in both muscarinic and nicotinic cholinergic synapses–> decreased acetylcholine degradation

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24
Q

treatment for cholinergic toxicity that would degrade excess acetylcholine and treats both muscarinic and nicotinic effects of the toxicity

A

pralidoxime- cholineseterase-reactivating agent

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25
mechanism of action of ethosuximide
blocks T-type Ca channelsin thalamic neurons
26
mechanism of action of phenytoin and carbamazepine (antiseizure)
blocks Na channels
27
mechanism of action of valproic acid (antiseizure)
blocks Na channels and increase GABA levels
28
mechanism of action of benzodiazepine and phenobarbital
increase GABA-a action
29
mechanism of action of Levetiracetam (antiseizure)
modulates GABA and glutamate release
30
what nerve can uncal herniation compress?
ipsilateral third canial nerve-->develop ipsilateral oculomotor nerve palsy with a fixed dilated pupil
31
first area of the brain damaged during global cerebral ischemia
hippocampus
32
iliohypogastric nerve provides sensation to what regions and motor function to what muslces?
suprapubic and gluteal regions anterolateral abdominal wall muscles
33
what to use after a subarachnoid hemorrhage to prevent cerebral vascular spasm that would lead to altered mental status as well as focal neurological deficits
Nimodipine (a calcium channel blocker)
34
what is "slasp-knife" spasticity? and is it a upper or lower motor neuron lesions?
initial resistance to passive extension followed by a sudden release of resistance upper
35
vitamin b12 is a cofactor for what two enzyme
methylmalonyl-CoA mutase (converts methylmalonyl-CoA to succinyl-CoA) methionine synthase (converts homocysteine and folic acid to methionine)
36
protein involved in the assembly of small nuclear ribonucleoproteins (snRNPs) in motor neurons
spliceosomes (help remove introns from pre-mRNA during processing within the nucleus)
37
three presentation of West Nile virus
encephalitis, meningitis, or flaccid paralysis WNV= positive-sense, single strand RNA flavivirus
38
what nerve can get injured when using crutches?
Radial nerve proximal radial nerve injury---- repetitive pressure/trauma caused by an ill-fitting crutch--> weakness and paralysis of forearm, hand, and finger extensor muscles
39
medial geniculate bodies are part of the ________ pathway
auditory
40
_______ necrosis is associated with large amounts of lipids and lysosomal enzymes in the nervous cells
liquefactive
41
different results from rapid correction of hypernatremia vs. hyponatremia
hyper---> cerebral edema hypo--> central pontine myelinolysis
42
define the type of seizures that happens with status epilepticus
single seizure lasting >5 minutes or the occurence of multiple discrete seizures with incomplete recovery of consciousness between episodes
43
list some narrow spectrum vs. broad spectrum anticonvulsants
narrow: carbamazepine, Gabapentin, Phenobarbital, Phenytoin broad: Lamotrigine, Levetiracetam, Topiramate, Valproic acid
44
function of the subthalamic nucleus
- modulate basal ganglia output | - excite the globus pallidus internus to inhibit the thalamus to prevent movement. damage--> contralateral hemiballism
45
dopamine agonists used to treat Parkinson's
bromocriptine (ergot compounds-derived from ergot fungi), pramipexole and ropinirole (nonergot compounds) help delay the need to start levodopa directly stimulate dopamine receptors
46
mechanism of action of Entacapone what is it used to treat?
decrease peripheral levodopa degradation Parkinson's
47
5 factors that can lead to carpal tunnel syndrome
pregnancy (fluid accumulation), hypothyroidism (glycosaminoglycan buildup), diabetes (connective tissue thickening), rheumatoid athritis (tendon inflammation), hemodialysis (deposition of beta2-microglobulin)
48
major functions of the hypothalamic nuclei
- ventromedial=satiety - lateral= hunger - anterior= heat dissipatioin - posterior= heat conservation - arcuate= secretion of dopamine, GHRH, GRH - paraventricular= antidiuretic hormone, CRH, oxytocin, and thyrotropin-releasing hormone secretion - supraoptic= secretion of antidiuretic hormone and oxytocin - suprachiasmastic= circadian rhythm regulation and pineal gland function
49
lissencephaly-what is it and associated symptoms
congenital absence of gyri--> severe mental retardation and seizures brain surface is smooth
50
mneumonics to remember the diseases that have psammoma bodies
PSaMMoma: - Papillary carcinoma of thyroid - serous papillary cystadenocarcinoma of ovary - meningioma - malignant mesothelioma
51
symptoms after damage to infraorbital nerve that runs along the orbital floor
numbness and paresthesia of the upper cheek, upper lip, and upper gingiva
52
nerve most often injured by pelvic trauma or iatrogenic damage occuring during hip surgery or buttocks injections
superior gluteal nerve the muscles innervated by this nerve stabilize the pelvis so when injuried--> pelvis will sag toward the unaffected (contralateral) side (positive Trendelenburg sign) gluteus medius lurch- walk by leaning on the affected (ipsilateral) side
53
histopathologic finding of HIV-associated dementia
microglial nodules= groups of activated macrophages/microglial cells formed around small areas of necrosis that may fuse to form multinucleated giant cells
54
intranuclear acidophilic inclusions are characteristics of
herpes simplex virus infection
55
intranuclear basophilic inclusions are typically seen with
cytomegalovirus
56
optimal site for femoral nerve block
inguinal crease at the lateral border of the femoral artery
57
almost all volatile anesthetics ______ (increase or decrease) cerebral blood flow
increase--> undesirable because it results in increased ICP
58
keys features of Friedreich ataxia
hypertrophic cardiomyopathy, kyphoscoliosis, high arches, staggering gait, dysarthria, nystagmus damages to spinocerebellar tracts, lateral corticospinal tract, and dorsal columns GAA trinucleotide repeat
59
what vitamin deficiency closely mimic Friedreich ataxia
E-- ataxia (degeneration of spinocerebellar tracts), loss of position and vibration sense (degeneration of the dorsal columns), and loss of deep tendon reflexes (peripheral nerve degeneration)
60
extraocular muscle mneumonics
LR6-SO4-R3
61
superior oblique _____ the eye while the inferior oblique ____ the eye
intort (internally rotate); extort (externally rotate)
62
neonatal intraventricular hemorrhage usually occurs in the ________
germinal matrix- highly cellular and vascularized layer int he subventricular zone from which neurons and glial cells migrate out during brain development
63
what is myotonic muscular dystrophy
abnormally slow relaxation of muscles --> type 1 fibers are affected the most features: cataracts, frontal balding, gonadal atrophy CTG trinucleotide repeat
64
result of rupture comparing Charcot-Bouchard aneurysms vs. Saccular (berry) aneurysms
Charcot- intracerebral hemorrhage caused by hypertension Saccular- subarachnoid hemorrhage due to ADPKD, Ehlers-Danlos syndrome, and hypertension
65
adverse effects of inhaled anesthetics
hepatotoxicity, nephrotoxicity, proconvulsant, expansion of trapped gas in body , and malignant hyperthermia (also associated with succinylcholine)
66
neurologic complications of measles virus (rubeola)
- encephalitis (within days) - acute disseminated encephalomyelitis (within weeks) - subacute sclerosing panencephalitis (within years)
67
ulnar nerve injury leads to what presentation with the hands
"ulnar claw" | weakness on wrist flexion/adduction, finger abduction/adduction, and flexion of 4th/5th digits
68
intraparenchymal hemmorhage caused by damage to which cerebral blood vessels
lenticulostriate arteries (small branches off of the middle cerebral artery)
69
Decerebrate vs decorticate posturing
Decerebrate: lesion at or below red nucleus so extensors predominate Decorticate: lesion above red nucleus so flexors precominate red nucleus: midbrain tegmentum, pons
70
presentations of neuroleptic malignant syndrome
diffuse muscle rigidity, high fever, autonomic instability (hypertension, tachycardia), and altered sensorium increased creatine kinase elevation due to rhabdomyolysis--> myoglobinuria and acute renal failure
71
treatment for neuroleptic malignant syndrome
dantrolene (direct-acting skeletal muscle relaxant by antagonizing the ryanodine receptors so inhibit Ca++ releaion from sarcoplasmic reticulum)
72
symptom of Wernicke encephalopathy most likely to persist despite
memory and learning abnormalities (known as Korsakoff syndrome) Korsakoff syndrome- anterior and dorsomedial thalamic nuclei
73
myasthenia gravis--- improves or worsens with repeated muscle use/ stimulation
worsens improves strength with rest autoantibodies against postsynaptic nicotinic acetylcholine receptors--> decreasednumbers of functional acetylcholine receptors at the neuromuscular junction--> reduce motor end plate potential
74
what to use alongside a cholinesterase inhibitors to limit the adverse effects related to muscarinic overstimulation?
scopolamine- selective muscarinic acetylcholine receptor antagonist that reduce effects of cholinesterase inhibitors in sites with muscarinic receptors like the gut
75
what causes paraneoplastic cerebellar degeneration?
associated with small cell lung cancer immune response against tumor cells that cross-reacts with Purkinje neuron antigens, leading to acute-onset rapid degeneration of the cerebellum
76
Brown-Sequard syndrome
loss of pain, temperature, and light touch on contralateral side loss of motor function and vibration, position, and deep touch sensation on ipsilateral side
77
where are the neural structures (eg. optic nerve, pretectal nuclei, Edinger-Westphal nuclei, oculomotor nerve) that mediate the direct and consensual pupillary light reflex located?
upper midbrain
78
what is axonal reaction in Wallerian degeneration?
changes seen in the neuronal body after the axon is severed: - round cellular swelling - displacement of the nucleus to the periphery - dispersion of the Nissl substance throughout the cytoplasm happens 24-48 hrs after injury
79
what will show up on histology of pilocytic astrocytoma
well-differentiated neoplasm in the cerebellum comprised of spindle cells with hair-like glial processes that are associated with microcysts cell mixed with Rosenthal fibers and granular eosinophilic bodies
80
presentation of shaken baby syndrome or abusive head trauma
-tearing of the bridging veins and subdural hemorrhages -retinal hemorrhages posterior rib fractures -developmentally delayed
81
what do you see during eye exam of child with retinoblastoma
absence of the red reflex -most common ocular tumor of infancy
82
side effects of phenytoin
gingival hyperplasia, SLE-like syndrome, coarsening of facial featues, hirsutism, megaloblastic anemia, drug interaction because it induces P450, fetal hydantoin syndrome (if taken during pregnancy) -used to treat grand mal (tonic-clonic) seizures, partial seizures, and status epilepticus
83
symptoms of CN III palsy
ptosis (paralysis of the levator palpebrae) - unopposed action of the lateral rectus and superior oblique muscles leads to "down-and-out" gaze - fixed, dilated pupil and loss of accommodation due to paralysis of iris sphincter and ciliary muscle
84
what is vasovagal syncope
syncope after stimulation of posterior external auditory canal. this would hit the vagus nerve and causes parasympathetic outflow to decrease heart rate and blood pressure
85
buspirone as treatment for generalized anxiety disorder
stimulates 5-HT1A receptors nonbenzodiazepine anxiolytic, slow onset, lacks muscle relaxant or anticonvulsant properties, no risk of dependence, does not cause sedation, does not interact with alcohol
86
pathophysiology of papilledema of idiopathic intracranial hypertension
increased intracranial pressure compresses optic nerves--> impaired axoplasmic flow and optic disc edema presents in young obese women with daily headache(which worsens during Valsalva (popping ears by blowing and holding nose)
87
latissimus dorsi is innervated by what nerve
thoracodorsal nerve

UWorld Journal (18 decks)

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