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
Q

mechanism of action of ethosuximide

A

blocks T-type Ca channelsin thalamic neurons

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26
Q

mechanism of action of phenytoin and carbamazepine (antiseizure)

A

blocks Na channels

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27
Q

mechanism of action of valproic acid (antiseizure)

A

blocks Na channels and increase GABA levels

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28
Q

mechanism of action of benzodiazepine and phenobarbital

A

increase GABA-a action

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29
Q

mechanism of action of Levetiracetam (antiseizure)

A

modulates GABA and glutamate release

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30
Q

what nerve can uncal herniation compress?

A

ipsilateral third canial nerve–>develop ipsilateral oculomotor nerve palsy with a fixed dilated pupil

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31
Q

first area of the brain damaged during global cerebral ischemia

A

hippocampus

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32
Q

iliohypogastric nerve provides sensation to what regions and motor function to what muslces?

A

suprapubic and gluteal regions

anterolateral abdominal wall muscles

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33
Q

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

A

Nimodipine (a calcium channel blocker)

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34
Q

what is “slasp-knife” spasticity? and is it a upper or lower motor neuron lesions?

A

initial resistance to passive extension followed by a sudden release of resistance

upper

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35
Q

vitamin b12 is a cofactor for what two enzyme

A

methylmalonyl-CoA mutase (converts methylmalonyl-CoA to succinyl-CoA)

methionine synthase (converts homocysteine and folic acid to methionine)

36
Q

protein involved in the assembly of small nuclear ribonucleoproteins (snRNPs) in motor neurons

A

spliceosomes (help remove introns from pre-mRNA during processing within the nucleus)

37
Q

three presentation of West Nile virus

A

encephalitis, meningitis, or flaccid paralysis

WNV= positive-sense, single strand RNA flavivirus

38
Q

what nerve can get injured when using crutches?

A

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
Q

medial geniculate bodies are part of the ________ pathway

A

auditory

40
Q

_______ necrosis is associated with large amounts of lipids and lysosomal enzymes in the nervous cells

A

liquefactive

41
Q

different results from rapid correction of hypernatremia vs. hyponatremia

A

hyper—> cerebral edema

hypo–> central pontine myelinolysis

42
Q

define the type of seizures that happens with status epilepticus

A

single seizure lasting >5 minutes or the occurence of multiple discrete seizures with incomplete recovery of consciousness between episodes

43
Q

list some narrow spectrum vs. broad spectrum anticonvulsants

A

narrow: carbamazepine, Gabapentin, Phenobarbital, Phenytoin
broad: Lamotrigine, Levetiracetam, Topiramate, Valproic acid

44
Q

function of the subthalamic nucleus

A
  • modulate basal ganglia output

- excite the globus pallidus internus to inhibit the thalamus to prevent movement. damage–> contralateral hemiballism

45
Q

dopamine agonists used to treat Parkinson’s

A

bromocriptine (ergot compounds-derived from ergot fungi),

pramipexole and ropinirole (nonergot compounds)

help delay the need to start levodopa

directly stimulate dopamine receptors

46
Q

mechanism of action of Entacapone

what is it used to treat?

A

decrease peripheral levodopa degradation

Parkinson’s

47
Q

5 factors that can lead to carpal tunnel syndrome

A

pregnancy (fluid accumulation), hypothyroidism (glycosaminoglycan buildup), diabetes (connective tissue thickening), rheumatoid athritis (tendon inflammation), hemodialysis (deposition of beta2-microglobulin)

48
Q

major functions of the hypothalamic nuclei

A
  • 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
Q

lissencephaly-what is it and associated symptoms

A

congenital absence of gyri–> severe mental retardation and seizures

brain surface is smooth

50
Q

mneumonics to remember the diseases that have psammoma bodies

A

PSaMMoma:

  • Papillary carcinoma of thyroid
  • serous papillary cystadenocarcinoma of ovary
  • meningioma
  • malignant mesothelioma
51
Q

symptoms after damage to infraorbital nerve that runs along the orbital floor

A

numbness and paresthesia of the upper cheek, upper lip, and upper gingiva

52
Q

nerve most often injured by pelvic trauma or iatrogenic damage occuring during hip surgery or buttocks injections

A

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
Q

histopathologic finding of HIV-associated dementia

A

microglial nodules= groups of activated macrophages/microglial cells formed around small areas of necrosis that may fuse to form multinucleated giant cells

54
Q

intranuclear acidophilic inclusions are characteristics of

A

herpes simplex virus infection

55
Q

intranuclear basophilic inclusions are typically seen with

A

cytomegalovirus

56
Q

optimal site for femoral nerve block

A

inguinal crease at the lateral border of the femoral artery

57
Q

almost all volatile anesthetics ______ (increase or decrease) cerebral blood flow

A

increase–> undesirable because it results in increased ICP

58
Q

keys features of Friedreich ataxia

A

hypertrophic cardiomyopathy, kyphoscoliosis, high arches, staggering gait, dysarthria, nystagmus

damages to spinocerebellar tracts, lateral corticospinal tract, and dorsal columns

GAA trinucleotide repeat

59
Q

what vitamin deficiency closely mimic Friedreich ataxia

A

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
Q

extraocular muscle mneumonics

A

LR6-SO4-R3

61
Q

superior oblique _____ the eye while the inferior oblique ____ the eye

A

intort (internally rotate); extort (externally rotate)

62
Q

neonatal intraventricular hemorrhage usually occurs in the ________

A

germinal matrix- highly cellular and vascularized layer int he subventricular zone from which neurons and glial cells migrate out during brain development

63
Q

what is myotonic muscular dystrophy

A

abnormally slow relaxation of muscles –> type 1 fibers are affected the most

features: cataracts, frontal balding, gonadal atrophy

CTG trinucleotide repeat

64
Q

result of rupture comparing Charcot-Bouchard aneurysms vs. Saccular (berry) aneurysms

A

Charcot- intracerebral hemorrhage caused by hypertension

Saccular- subarachnoid hemorrhage due to ADPKD, Ehlers-Danlos syndrome, and hypertension

65
Q

adverse effects of inhaled anesthetics

A

hepatotoxicity, nephrotoxicity, proconvulsant, expansion of trapped gas in body , and malignant hyperthermia (also associated with succinylcholine)

66
Q

neurologic complications of measles virus (rubeola)

A
  • encephalitis (within days)
  • acute disseminated encephalomyelitis (within weeks)
  • subacute sclerosing panencephalitis (within years)
67
Q

ulnar nerve injury leads to what presentation with the hands

A

“ulnar claw”

weakness on wrist flexion/adduction, finger abduction/adduction, and flexion of 4th/5th digits

68
Q

intraparenchymal hemmorhage caused by damage to which cerebral blood vessels

A

lenticulostriate arteries (small branches off of the middle cerebral artery)

69
Q

Decerebrate vs decorticate posturing

A

Decerebrate: lesion at or below red nucleus so extensors predominate

Decorticate: lesion above red nucleus so flexors precominate

red nucleus: midbrain tegmentum, pons

70
Q

presentations of neuroleptic malignant syndrome

A

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
Q

treatment for neuroleptic malignant syndrome

A

dantrolene (direct-acting skeletal muscle relaxant by antagonizing the ryanodine receptors so inhibit Ca++ releaion from sarcoplasmic reticulum)

72
Q

symptom of Wernicke encephalopathy most likely to persist despite

A

memory and learning abnormalities (known as Korsakoff syndrome)

Korsakoff syndrome- anterior and dorsomedial thalamic nuclei

73
Q

myasthenia gravis— improves or worsens with repeated muscle use/ stimulation

A

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
Q

what to use alongside a cholinesterase inhibitors to limit the adverse effects related to muscarinic overstimulation?

A

scopolamine- selective muscarinic acetylcholine receptor antagonist that reduce effects of cholinesterase inhibitors in sites with muscarinic receptors like the gut

75
Q

what causes paraneoplastic cerebellar degeneration?

A

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
Q

Brown-Sequard syndrome

A

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
Q

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?

A

upper midbrain

78
Q

what is axonal reaction in Wallerian degeneration?

A

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
Q

what will show up on histology of pilocytic astrocytoma

A

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
Q

presentation of shaken baby syndrome or abusive head trauma

A

-tearing of the bridging veins and subdural hemorrhages
-retinal hemorrhages
posterior rib fractures
-developmentally delayed

81
Q

what do you see during eye exam of child with retinoblastoma

A

absence of the red reflex

-most common ocular tumor of infancy

82
Q

side effects of phenytoin

A

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
Q

symptoms of CN III palsy

A

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
Q

what is vasovagal syncope

A

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
Q

buspirone as treatment for generalized anxiety disorder

A

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
Q

pathophysiology of papilledema of idiopathic intracranial hypertension

A

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
Q

latissimus dorsi is innervated by what nerve

A

thoracodorsal nerve