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(DIT) Rapid Fire + 4/5 Stars > Neuro > Flashcards

Neuro Flashcards

1
Q

Most common adult brain tumors and key histologic characteristics of each

A

“MGM Studios”

  1. Metastasis
  2. Glioblastoma - GFAP+, pseudopallisading
  3. Meningioma - Psammoma bodies, assoc NF2
  4. Schwannomas - around CNVIII, S100, assoc NF2

Oligodendroglioma - fried egg, frontal lobe “O-leggo-my-eggo”

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2
Q

Most common childhood brain tumors and key histology characteristics of each

A

“Prepubescent Minds Eaten by Cancer”

  1. Pilocytic astrocytoma - GFAP+, Rosenthal fibers (red coils), in posterior fossa
  2. Medulloblastoma: Homer-Wright Rosettes (Homer is married to Marge, they have KIDS… so it’s the M one), cerebellar, compresses 4th ventricle –> noncommunicating hydrocephalus
  3. Ependymoma: perivascular pseudo rosettes, compress 4th ventricle –> noncommunicating hydrocephalus
  4. Craniopharyngioma: rathe’s, supratentorial, compresses optic chiasm –> bitemporal hemianopsia
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3
Q

Signs of subfalcine herniation

A

compresses ACA –> lower body

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4
Q

Signs of uncal herniation

A

Compress CN III

  1. parasympathetics lost to pupil –> mydriasis
  2. lose motor –> down and out

Contralateral homonymous hemianopsia - PCA compression
Ipsilateral paresis as contralateral side compressed

Direct hemorrhages in paramedian arteries

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5
Q

UMN lesion sx

A

problem above anterior horn of spinal cord

spastic paralysis
hyperreflexia
babinski reflex present

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6
Q

LMN lesion sx

A

problem w/ nerves from anterior horn

flaccid paralysis
atrophy of muscles
muscle fasciculations
hyporeflexia - loss reflex arc

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7
Q

Polio

A

fecal-oral virus - replicate in oropharynx before going to GI
-can recover virus in throat and stool for confirmation

Damage anterior horn –> LMN sx
other nonspecific sx: fever, HA, malaise, N, abd pain, sore throat

Asymmetric limbs d/t atrophy

CSF:
lymphocytic pleocytosis
slight increased protein
no change in glucose

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8
Q

Brown-Sequard Sn

A

Complete hemisection of spinal cord

ipsilateral UMN, tactile, vibration, proprioception, LMN - flaccid paralysis below lesion

contralateral pain/temp 2-3 segments below lesion

at lesion - ipsilateral pain and temp loss for 2-3 segments

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9
Q

Syringomyelia

A

cavitary lesion of spinal cord that fills with fluid - syrinx
MC in cervical spinal cord - expands longitudinally

assoc w/ Chiari I malformation, spinal cord trauma

Syrinx compresses crossing fibers of spinothalamic tract, damages anterior white commissure
–> b/l loss of pain/temp in upper extremities
If extends laterally –> damage of motor neurons of anterior horn –> weakness and atrophy of hands

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10
Q

Spinal muscular atrophy (Werdnig-Hoffman)

A

AR
death of neurons in anterior horn of spinal cord

causes infantile flaccid paralysis –> death before 1 yo

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11
Q

Amyotrophic lateral sclerosis

A

Anterior horn and LCST damage
LMN Sx - anterior horn
UMN Sx - LSCT

rapidly progressive weakness
muscle atrophy
fasciculations
spasticity
dysarthria
dysphagia
dyspnea

cause: defective superoxidase dismutase I

Tx: Riluzole - decreases presynaptic glutamate release that can be neurotoxic

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12
Q

Tabes Dorsalis

A

Tertiary syphilis obliterates dorsal column

+ Romberg sign - fall down as need 2/3 to maintain balance: vestibular, proprioceptive (destroyed), vision (eyes closed)

Argyll Robinson pupil - accommodate but not reactive

Absent DTR

Sensory ataxia at night - wide based gait to avoid falling

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13
Q

Anterior spinal occlusion

A

Lesion everything but dorsal columns and lissaur tracts

lose pain and temp
lose b/l motor command UMN and LMN

Below lesion:
complete motor paralysis
loss pain/temp
areflexia

Causes: aortic aneurysms, aortic dissections, direct trauma to aorta, atherosclerosis (severe)

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14
Q

Multiple sclerosis

A

random and asymmetric lesions in white matter along entire CNS

Dz of oligodendroglia –> demyelination

Autoimmune - women 20-30s

Charcot’s triad: scanning speech, intention tremor, nystagmus

INO if MLF involved - stare at side of lesion (no adduction), nystagmus in abducting eye

CSF: very high protein - Ig light chains - oligoclonal brands on electrophoresis

MRI: lesions in brain and spinal cord

Tx: high dose steroids x 7 days
Beta-interferon
natalizumab

sx treatments

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15
Q

Parkinson Disease

A

Lewy Body inside cells of substantial nigra pars compacta - interfere w/ functioning –> loss of dopaminergic neurons = can’t make dopamine

hypokinesia, bradykinesia, akinesia
postural instability - can’t make small fine tuning movements
festinating gate - trouble initiating/stopping walking - fall forward
Pill rolling tremor
cogwheel rigidity
mask like facies - expression less

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16
Q

MPTP exposure

A

manufacturing meperidine (synthetic demerol) produces MPTP in the process

Metabolized to MPP in body which destroys dopaminergic cells in substantial nigra causing parkinsonism features

Tx: selegiline - blocks formation of MPP

17
Q

Levodopa

A

L-dopa precursor of dopamine that crosses BBB
Converted to dopamine by dopa carboxylase

First line for PD

Side effects:
Peripheral conversion –> HTN, arrhythmias (give carbidopa to avoid)
Hallucinations, delusions, psychosis
tolerance - “wearing off” phenomenon

18
Q

Carbidopa

A

given w/ levodopa to inhibit peripheral conversion of l-dopa to dopamine

more L-DOPA into CNS
Reduces side effects and increases bioavailability

19
Q

“Other” PD drugs

A

“BALSA”

Bromocriptine (ergot –> HTN), non ergots (also used in restless leg sn): pramipexole, ropinirole

Amantadine: increase dopamine release, decrease dopamine reuptake

Levodopa-carbidopa

Selegiline, rasagiline - inhibit dopamine breakdown via MAO-B

Antimuscarinics: benztropine - increase ACh to tx rigidity and tremor

20
Q

Draw basal ganglia regulation of movement pathways

A

page 84

21
Q

Result of lesions of substantial nigra pars compacta

A

hypokinesis - parkinson dz

22
Q

Result of lesion of sub thalamic nucleus

A

ex lacunar stroke

hemiballismus - too much movement

23
Q

Non pharm treatment of PD

A

create lesion of sub thalamic nucleus
-removes inhibition –> movement

deep brain stimulation exhausts nucleus, not as permanent as surgical lesions

24
Q

Hemiballismus

A

wild flailing motion of u/l arm or leg

lesion of sub thalamic nucleus on contralateral side of movement

25
Q

chorea

A

brief purposeless, non repetitive jerks of individual muscles
“dancing”

26
Q

Myoclonus

A

brief, sudden muscle contractions

27
Q

Athetosis

A

slow, writhing, snake-like movements of hands and fingers

28
Q

Akathisia

A

compulsion to move, chose to move

29
Q

Huntington Disease

A

aka Huntington’s chorea
excessive movement disorder
AD trinucleotide repeat disorder

"C's"
CAG trinucleotide repeat
Chr cuatro (4)
Cuarenta (40 yo)
Chorea
Cognitive decline - dementia, depression, psychosis
Caudate atrophy on MRI (and putamen)

Excessive excitation by glutamate on NMDA receptors (neurotoxic)

Increased dopamine
Decreased GABA and ACh

Tx: block dopamine
-tetrabenzine
Neuroleptics - olanzapine, haloperidol

30
Q

Guillian Barre syndrome

A

Autoimmune inflammatory demyelination of peripheral nerves at schwann cells

Associated with preceding infection: Campylobacter jejuni, GI illness - 20% diarrheal in last month

  • Respiratory tract infection
  • Stress

Ascending muscle weakness - sensory intact
-legs to hands to trunk
-50% facial weakness/paralysis - b/l
-10-30% respiratory m. weakness needing vent support
Sx over days

Recovery phase - weeks to months

Dx: decreased nerve conduction studies
CSF: increased protein w/ normal cell count

Tx: supportive, plasmapheresis, IVIG

31
Q

Charcot-Marie-Tooth disease

A

hereditary motor and sensory neuropathy
Progressive loss of muscle tissue and touch sensation across various parts of body

mutations –> defects in neuronal proteins

32
Q

Progressive multifocal leukoencephalopathy

A

demyelination of CNS d/t destruction of oligodendrocytes

assoc w/ JC virus - classic AIDS dz

33
Q

Acute disseminated post-infectious encephalomyelitis

A

inflammation and demyelination after viral infection or vaccine
-chicken pox, measles

34
Q

Metachromatic leukodystrophy

A

AR lysosomal storage dz

def of arylsulfatase A –> buildup of sulfatide –> destruction of myelin

(DIT) Rapid Fire + 4/5 Stars (162 decks)

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