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Uworld > Neuro > Flashcards

Neuro Flashcards

1
Q

Narcolepsy sx and signs

A

Recurrent lapses into sleep or naps >3x a week for 3 months

  • cataplexy: brief loss of muscle tone precipitated by strong laughter
  • low CSF hypocretin 1
  • shortened REM sleep

Associated features

  • sleep paralysis
  • hypnagogic hallucinations
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2
Q

__________ is a peripheral mononeuropathy caused by compression of the median nerve in the ___________

A

Carpal tunnel syndrome, carpal tunnel

  • long history of dialysis can get beta2 microglobulin (amyloid associated) deposits in carpal tunnel
  • 1st three digits and radial half of 4th
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3
Q

Obstruction of the _________ can cause enlarged lateral and third ventricles but a normal 4th ventricle

A

Cerebral aqueduct

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4
Q

Obstruction of the _________ would cause enlargement of all 4 ventricles

A

Foramen of magendie and lushka

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5
Q

Symptoms of organophosphate poisoning

A

“Tool shed”

Lacrimation, bradycardia, diaphoresis, bronchospasm, salivation,miosis

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6
Q

What chromosome is the amyloid precursor protein located on?

A

Long arm of 21- why Alz is associated with Down syndrome and it encodes transmembrane protein

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7
Q

Halogenated Anesthetics are associated with what side effect from CYP450 system

A

Acute hepatitis that presents a few days later with fever, Jaundice

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8
Q

Orbital floor fracture sx

A

Can see loss of sensation CN V because infraoribital nerve is branch of maxillary

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9
Q

Dopamine agonists directly ________ dopamine receptors

A

Stimulate

  • ergot: bromocriotine
  • non-ergot: pramipexole, roprinarole
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10
Q

Beta endorphin and ________ are both derived from POMC

A

ACTH, MSH

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11
Q

Rupture of bridging veins

A

Subdural hematoma: young- motor vehicle accident, elderly-minor trauma

Blood between dura and arachnoid

Crescent shaped mass

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12
Q

Rupture of berry anurysm or atriovenous malformation

A

Subarachnoid hemorrhage: WORST HEADACHE OF MY LIFE, anterior communicating artery most common

-blood between arachnoid and pia matter

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13
Q

Rupture of middle meningeal artery

A

Epidural hemorrhage, typ have a lucid interval followed by loss of consciousness

Biconvex hematoma

  • associate with fracture of TEMPORAL bone
  • damage between bone and dura matter
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14
Q

Syringomelia

A

Loss of upper extremity and pain temperature sensations, upper extremity weakness and hyporeflexia, lower extremity weakness and hyoerreflexia, Kyphoscoliosis

Central cystic dilation in Cervical spinal cord and damages ventral white commisure and anterior horns

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15
Q

ALS sx and tx

A

BOTH UPPER AND LOWER MOTOR NEURONS AFFECTED

  • lose neurons in anterior horn and demyelination of lateral corticospinal tract
  • loss neurons in motor nuclei: CN 5,9,10,12

Rx: riluzole- dec glutamate release

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16
Q

Facial nerve functions (4 bullets)

A
  • Motor out put to facial muscles
  • Parasympathetic to lacrimal, submandibular, and sublingual salivary glands
  • special after end for taste of ANTERIOR 2/3 tongue
  • somatic afferents from pinna and external auditory canal
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17
Q

Atropine can ________ HR and can lead to _________ in the eye which leads to

A

Increase, intraocular pressure, Acute closed angle glaucoma “eye pain”

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18
Q

Multiple sclerosis leads to demyelination with leads to ______

A

Decreased saltatory conduction

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19
Q

The ________ is a paired Brainstem nucleus located in posterior rostral pons near the lateral floor of the fourth ventricle and functions as _________ synthesis

A

Locus ceruleus, norepinephrine

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20
Q

Diabetics is associated with CN 3 mononeuropathy that is caused by _______ and presents as ______

A

Ischemic nerve damage, acute onset diplopia and “down and out”

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21
Q

Patients with Down syndrome are likely to get early on set _______. Levels of what are elevated in them?

A

Alzheimer’s, serum amyloid precursor protein (early onset Alz)

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22
Q

Late onset Alzheimer’s is associated with inc _______

A

Apolipoprotein E

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23
Q

Hydrocephalus shows enlarged _________ on imaging. Sx are:

A

Ventricles, macroceohaly and poor feeding, hyperreflexia, development delay, bulging fontanelle

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24
Q

Hemorrhage with CN 3 nerve palsy is common in berry aneurysms. Which side of brain is affected

A

The ipsilateral posterior communicating artery

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25
Q

HIV associated dementia involves ________ of microglial cells

A

Inflammatory activation

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26
Q

Temporomandibular disorder

A

Problems with TMJ joint and muscles of mastication (pterygoid, masseuse, temporalis)

MANDIBULAR nerve affected

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27
Q

Tongue innervation

1) anterior 2/3 taste
2) anterior 2/3 sensory
3) posterior 1/3 taste, posterior 1/3 sensory, posterior motor

A

1) chorda tympani (of facial nerve)
2) mandibular division of trigeminal nerve
3) glossopharyngeal

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28
Q

Buprenorphine is a partial opioid _______ and in people on long term opioid therapy can precipitate _________

A

Agonist, withdrawal

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29
Q

Valproate is a great broad spectrum antiepileptic that covers ______

A

Absence and tonic clonic seizures

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30
Q

Phrenic nerve is levels C ____ and irritation can cause ______,_______, and ________

A

C3-5, hiccups, referred shoulder pain, dyspnea

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31
Q

What is cushings triad?

A

Hypertension, bradycardia, respiratory depression

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32
Q

Damage to Brainstem at or below the red nucleus leads to ________ posturing due to predominance form unopposed vestibulospinal tract

A

Extensor

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33
Q

Damage to levels above red nucleus (cerebral hemispheres, internal capsule) leads to _________ posturing

A

Flexor

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34
Q

_______ ________ is the most common cause of spontaneous lobar hemorrhage esp >60 yrs old

A

Amyloid angiopathy

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35
Q

Cavernous hemangiomas are associated with

A

Seizures and intracerebral hemorrhage

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36
Q

Cystic tumor of the cerebellum in a child with hair-like glial processed associated with microcysts, rosenthal fibers, granular eosinophilia bodies

A

Pilocytic astrocytoma

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37
Q

Primitive neuroectodermal tumor in posterior fossa, scant cytoplasm and little stroma, homer Wright rosettes

A

Medulloblastoma

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38
Q

Demyelination would decrease the _______ constant and increase the ________ constant

A

Length (dec the distance an impulse can travel), time ( slower impulse conduction)

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39
Q

Myelin _______ charge dissipation by _________ membrane resistance

A

Reduces, increasing

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40
Q

Propionyl coA is derived from which four amino acids? Deficiency of propionyl coA carboxylase leads to _______ and sx are?

A

Valine
Threonine
Isoleucine
Methionine

Propionic acidemia

Sx:Lethargy, poor feeding, vomiting, hypotonia

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41
Q

Optimal location for lumbar puncture is _____ or ___. Use the ______ as a landmark

A

L3/4 or L4/5, iliac crest

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42
Q

How does opioid abuse affect HR, pupils, and BP?

A

Miosis, bradycardia, hypotension

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43
Q

__________ are the most common pineal gland tumor

A

Germinomas,

Sx: obstructive hydrocephalus ( papilledema, headache, vomiting) and dorsal midbrain syndrome: limited upward gaze, bilateral eyelid retraction

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44
Q

Craniopharyngiomas are derived from ______ and show ______ areas. These areas are filled with _______ with the presence of cholesterol

A

Rathkes pouch, cystic, brownish yellow fluid

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45
Q

Obturator nerve _____ the thigh

A

Adducts

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46
Q

Dandy walker malformation is characterized by ________ of the cerebellum vermis and ______ of the 4th ventricle. Sx include:

A

Hyperplasia/ absence, cystic dilation

Developmental delay, progressive skull enlargement

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47
Q

Arnold Chiari malformation is characterized by ______ of the cerebellum vermis and tonsils ____ the foramen magnum

A

Downward displacement, below

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48
Q

Acute hemorrhage in the cerebellum can lead to

A

Truncal ataxia, vertigo/nystagmus if flocculonodular lobe is involved

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49
Q

What do you treat restless leg syndrome with?

A

Dopamine agonist

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50
Q

______ are the most common brain tumors in children and typically present with a cystic mass in the cerebellum

A

pilocytic astrocytoma

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51
Q

Succinylcholine can cause significant ______and life threatening arrthymias in pts. with burns, myopathies, crush injuries, and denervating injuries or disease

A

hyperkalemia

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52
Q

in addition to blocking histamine receptors, 1st , gen histamines have anti_______,________, and anti _______ as well

A

muscarinic, alpha adregergic, serotonergic

so can block ACh receptors—>blurry vision

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53
Q

_________ is the most common brain tumor in old adults and presents with necrosis and hemorrhage in the cerebral hemispheres leading to midline shift

A

glioblastoma

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54
Q

_______ are small ischemic infarcts involving the deep brain structures and subcortical white matter. Since they are so small they won’t show up on ____.

A

lacunar, CT

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55
Q

Lacunar strokes involve the ________ and are typically caused by chronic _____ which can lead to ___________

A

small penetrating arterioles, HTN, hypertensive arteriolar sclerosis

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56
Q

The infusion of ______ without thiamine in wernicke’s encephalopathy worsens the condition and precipitates encephalopathy

A

glucose

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57
Q

Proliferation of astrocytes in an area of neuron degeneration is called _____. It leads to the formation of a _______ which compensates for the volume loss that occurs after neuronal death

A

gliosis, glial scar

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58
Q

_______ is the most common complication after a subarachnoid hemorrhage. A _______ is typically given to prevent this

A

vasospasm, calcium channel blocker

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59
Q

______ is a potent dilator of cerebral vasculature, tachypnea causes hypocapnia and cerebral ______, thereby _____ cerebral blood volume and intracranial pressure

A

CO2, vasoconstriction, decreasing

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60
Q

__________ occurs in the elderly and presents as ataxia, urinary incontinence, dementia. Bladder control is influenced by descending _______ that run in the distended paraventricular area

A

normal pressure hydrocephalus, cortical fibers

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61
Q

Pontine micturition center coordinates the ______ of the external urethral sphincter and the _________ of the bladder

A

relaxation, contraction

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62
Q

Current 3 Alzhemier’s specific drugs

A

Donepezil (cholinesterase inhibitor), antioxidants (vit E), Memantine (NMDA antagonist)

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63
Q

_____ causes rapidly progressive dementia with myoclonic jerks. Multiple vacuoles are seen in the gray matter of brain

A

Creutzfeldt Jakob disease

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64
Q

Opsoclonus-myoclonus is a paraneoplastic syndrome associated with _______ that presents as an abdominal mass with ______ catecholamine breakdown products. This tumor typically arises from neural crest cells of the ________

A

neuroblastoma, increased, adrenal medulla

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65
Q

_______ has perivenular inflammatory cells directed against myelin components

A

multiple sclerosis

66
Q

flushed skin and dilated pupils signal

A

muscarinic antagonism (H1 blocks can lead to antimuscarinic effects)

67
Q

What are 5 drug classes known for anti-muscarinic effects

A

H1 receptor antagonists, atropine, tricyclic antidepressants, anti parkinsonian drugs, neuroleptics

68
Q

What neurotransmitter is commonly lost in Huntingtons

A

GABA

69
Q

Radial nerve injury is typically from a _______ fracture and affects the ______ artery

A

mid-humerus, deep brachial

70
Q

neuromyelitis optics presents similarly to MS but has normal brain MRI and at 3 contiguous segments on spinal cord lesions and what do you see in CSF?

A

anti-aquaporin 4 antibodies

71
Q

______ can be used to prevent vasospasm after subarachnoid hemorrhage. What are these sx?

A

calcium channel blockers, headaches/confusion

72
Q

Difference between parkinson’s and essential tremor

A
  • parkinsons has a resting tremor

- essential tremor is worse when holding an object and is familial (Autosomal dominant)

73
Q

What do you treat essential tremor with?

A

propanolol

74
Q

Extra cellular gradient drives which two icons into the cell that leads to a more positive membrane potential

A

Ca, Na

75
Q

Extracellular gradient drives ____ into the cell, making the membrane potential more negative

A

Cl-

76
Q

Intracellular gradient drives ____ out of the cell making membrane potential more negative

A

K+

77
Q

Normal pressure hydrocephalus is the result of ___________ resorption by the arachnoid granaulations. What is the classic triad? What do you see on imaging?

A

decreased cerebrospinal fluid

  • gait difficulties
  • cognitive disturbances
  • urinary incontinence

ventriclar enlargement that is out of proportion to sulk enlargement

78
Q

Obstructive hydrocephalus is between the _______ and the _______. Congenital abnormalities or a tumor can lead to this. What sx?

A

ventricles, subarachnoid space

-n/v, headache

79
Q

Homebox genes encode __________ that play an important role in segmental organization of the embryo along the _________

A

DNA binding transcription factors, cranio-caudal

80
Q

The pupillary light reflex is assed by shining light in an eye and observing the response in that eye (direct) and the opposite eye (consensual). Which nerve controls what

A

the optic nerve controls the consensual response (afferent), the oculomotor nerve controls the direct(efferent)

81
Q

What is myopia

A

near sightedness (image focuses in front of retina)

82
Q

What is presbyopia

A 
far sightedness (denaturation of lens proteins--> loss accommodation) from REDUCTION in length of ciliary muscles
-image focuses behind retina
83
Q

Presbyopia and wrinkles are _______ changes

A

age related

84
Q

latanoprost is _____ that _____ the outflow of aqueous humor and treats open angle glaucoma

A

prostaglandin, inc

85
Q

Wet age related macular degeneration is characterized by retinal neovascualrization and inc levels of what? What color do you see on the sub retinal membrane. Tx with what?

A

Vascular endothelial growth factor (VEGF), gray-greenish, VEGF inhibitor

86
Q

aqueous humor is produced by the _______ cells of the ciliary body

A

epithelial

87
Q

timolol and other non-selective beta blockers work by diminishing the aqueous humor secretion by the

A

ciliary epithelium

88
Q

prostaglandins (latanoprost), cholimomimetics (pilocarpine, carbachol) dec intraocular pressure by ____________

A

inc outflow of aqueous humor

89
Q

topical preparations of alpha agonists cause vasoconstriction of of nasal mucosa and makes them work as ________. However, overuse of this drug causes _________ feedback, resulting in _____ norepinephrine synthesis which diminishes their effects. This phenomenon is known as what and what other med shows the same effect?

A

decongestants, negative, dec, tachyphylaxis, nitroglycerine

90
Q

In conductive hearing loss, ____ conduction will be greater than ____ conduction (abnormal Rienne test) and the Weber test will lateralize to the affected ear(put on middle of forehead)

A

bone, air

91
Q

______ lobe lesions lead to personality lesions. ______ sided tend to lead to apathy and depression and ________ sided tend to lead to disinhibited behavior

A

frontal, left, right

92
Q

The metencephalon gives rise to what?

A

cerebellum and pons

93
Q

The myelencephalon gives rise to what?

A

medulla

94
Q

The telencephalon gives rise to what?

A

cerebral hemispheres (frontal, temporal, parietal, occipital)

95
Q

The mesencephalon gives rise to what?

A

midbrain and cerebral peduncles

96
Q

The diencephalon gives rise to what?

A

thalamus and hypothalamus

97
Q

Hyperactivity of the _______ pathway is associated with positive symptoms of schizophrenia

A

mesolimbic

98
Q

Low activity of the ________ pathway is associated with negative symptoms of schizophrenia

A

mesocortical

99
Q

__________ presents as bilateral wedge shaped strips of necrosis and can occur from shock

A

hypoxia ischemic encephalopathy

100
Q

________ typically involves rupture that causes hemorrhage in deep brain structures

A

charcot bouchard aneurysm

101
Q

Abusive head trauma in babies can lead to what?

A

retinal hemorrhages, rib fractures, subdural hematoma

102
Q

The _________ is the first area damaged during global cerebral ischemia

A

hippocampus,

also purkinje fibers vulnerable as well

103
Q

In Alzheimer’s diseases there is dec levels of ________ in the nucleus basilis of Maynert and hippocampus . Diminished activity of _________ in these cerebral is the cause

A

acetylcholine, dec choline acteyltransferase

104
Q

A deficiency in __________ leads to hypopigmentation of catecholaminergic brain nuclei

A

phenylalanine hydroxylase

105
Q

vitamin ____ deficiency mimics Fredrich’s ataxia with lose of which spinal tracts?

A

E, spinocerebellar and dorsal columns

106
Q

Path of CSF flow

A

lateral ventricles–>inter ventricular foramen of Monro–>third ventricle–> cerebral aqueduct–>4th ventricle–>foramina of Lushka and Magendie–>subarachnoid space

107
Q

In the subarachnoid space, what is CSF absorbed by?

A

arachnoid granulations and then it enters the venous sinuses

108
Q

In _________ the ventricles are symmetrically dilated and it typically is from dysfunction or obliteration of ________ secondary to meningeal infections

A

communicating hydrocephalus, subarachnoid villi

-there’s no obstruction to CSF flow

109
Q

In __________ the flow of CSF from the ventriculi to the subarachnoid space is disrupted. What is this typically from?

A

non-communicating hydrocephalus

-congenital anomalies (aquedeuctal stenosis),

110
Q

The optimal site for femoral nerve block is the ___________

A

inguinal crease

111
Q

neural tube defects can lead to inc levels of what two in amniocentesis

A

alpha feto protein, acetylcholinesterase

112
Q

otic ganglion innervates the _____ gland

A

parotid

113
Q

what is cerebellar degeneration from alcohol use?

A

long term alcohol use >10 years, lose Purkinje cells(most prominent in cerebellar vermis

114
Q

Wernicke encephalopathy triad

A

encephalopathy, oculomotor dysfunction, ataxia

115
Q

Be cautious of adding ____ blockers in patients with parkinson’s disease

A

D2 (like metoclopromide)

116
Q

tissue ischemia leads to an inc in extracellular ____ concentration and reduces extracellular __,__,___. Cytoplasmic accumulation of ____ is a hallmark of ischemic injury

A

K+,
Na, Ca, HCO3-
Ca (from dec Na gradient to send Ca out of cell)

117
Q

What are three typical findings with pineal gland tumors

A

upward gaze palsy, absent pupillary light reflex, impaired convergence

118
Q

_______ equilibrium potential contributes the most to neuronal action potential during ________. So a decrease in _______ concentration outside the cell will lead to its equilibrium potential to be closer to 0

A

Sodium, depolarization, sodium

119
Q

what brain structure plays a role in subjective emotional experience, pain, body representation, and conscious cravings

A

insula

120
Q

Tardive dyskinesia is a _______ induced disorder characterized by abnormal involuntary movements of the mouth, tongue, chorea, trunk. It is due to prolonged exposure to ________ blocking agents causing the _________ of dopamine

A

medication, dopamine, upregulation and supersensitivity

121
Q

Dopamine beta hydroxylase is responsible for the synthesis of what to what? what happens in you lack this enzyme

A

dopamine—>norepinephrine

-impaired SNS activity so get orthostatic hypotension

122
Q

Neurofibromas are from ________ cells and are numerous fleshy skin nodules and other pigmented lesions

A

Schwann

123
Q

Langerhans cell histiocytosis are proliferation of immature ___________ cells with seborrheic rash and pruitic papule involving groin and genital region. Common in what age group?

A

dendritic mononuclear, children

-S100, CD1a pos

124
Q

An ____ herniation is when the temporal lobe goes through the tentorium cerebella and leads to _______ pupil

A

uncal, down and out

125
Q

Cerebellar tonsilla herniation occurs when the contents of the ________ are forced out the foramen magnum

A

posterior fossa

126
Q

neoplastic lesions can lead to midline shift and ___________ by disrupting the blood brain barrier

A

vasogenic edema

-present with n/v, papilledema

127
Q

neuronal apoptosis can lead to hydrocephalus ________

A

ex vacuo

128
Q

timolol/ other nonselective beta blockers and acetazolamide treat glaucoma by ____

A

dec aqueous humor from the ciliary epithelium

129
Q

cholinomemetics treat glaucoma by _________

A

miosis—>contraction of sphincter of iris–>wider anterior chamber angle and makes trabecular meshwork more accessible to outflow of aqueous humor

130
Q

Sumatriptan is abortive therapy for what headache?

A

migraine

131
Q

What are 3 prophylactics for migraine headaches?

A

verapamil, propanolol, amitryptiline

132
Q

What is abortive tx for cluster headache

A

oxygen

133
Q

hallucinations signal what dementia?

A

Lewy body

134
Q

What do you see on path for frontotemporal dementia?

A

silver staining intranuclear inclusions

135
Q

a destructive expanding mass of keratinizing squamous epithelium within the middle ear

A

cholesteatoma

136
Q

characterized by abnormal bone deposition at the footplate that leads to fixation of the stapes at the oval window, preventing normal vibration, presents as bilateral conductive hearing loss

A

otosclerosis

137
Q

unilateral vision loss and pt. says that it seems like a curtain is over their eye and see “floaters”

A

retinal detachment

138
Q

In Huntington’s _____ dopamine and _____ GABA leads to chorea

A

inc dopamine, dec GABA

139
Q

In Parkinson’s there is ____ dopamine in what two areas

A

dec, substantia nigra and pars compacta of the basal ganglia

140
Q

In the ear, high frequency sounds are sensed at the ______ of the basilar membrane and low frequency sounds are sensed at the ______ of the basilar membranr

A

base, apex

141
Q

Whatever ear the Weber test localizes to is the normal ear so if CN 8 is messed up, it will be for the _______ nerve

A

opposite

142
Q

Both the sympathetic and parasympathetic nervous systems have ______ receptors on the postganglionic neurons

A

nicotinic AcH

143
Q

auditory pathway:

A

lateral leminscus contains fibers from contralateral nuclei and both superior olivary nuclear complexes—> inferior colliculus in midbrain—>medial geniculate nucleus in the thalamus

144
Q

lesions of the right parietal lobe often cause left sided ________

A

hemineglect
-the left hemisphere is responsible for awareness of the right visual field, where the right hemisphere is responsible for awareness of both left and right visual fields
(only shaving right side of face, only drawing half clock on right side)

145
Q

Guillan Barre attacks _________

A

between myelin sheath of axons

146
Q

The __________cerebellum is responsible for rapid eye movements, posture and balance,

A

vestibulocerebellum

147
Q

The _________cerebellum is most damaged by chronic alcohol abuse and is responsible for trunk balance and helps regulate limb movements

A

spinocerebellum

148
Q

The __________cerebellum is responsible for the fine movements of the hands/face, motor planning, coordination of complex motor tasks

A

cerebrocerebellum

149
Q

The ________ nucleus of the thalamus receives input form the trigeminal and gustatory pathways and is responsible for sensation of face as well as taste

A

ventral poster-medial nucleus (VPM)

150
Q

The _______ nucleus of the thalamus receives input from spinothalamic and DCML tracts. It’s the primary output to the somatosensory cortex

A

ventral postero-lateral nucleus (VPL)

151
Q

The ________ receives input from CN 2 and is responsible for sense of vision and its output so to calcimine sulcus

A

lateral geniculate nucleus

152
Q

The ________ receives input from superior olive and inferior colliculus and is responsible for sense of hearing and gives auditory output to auditory cortex of temporal lobe

A

medial geniculate nucleus

153
Q

decorticate posturing is the same as

A

spastic flexion of upper extremities

154
Q

decerebrate posturing is the same as

A

spastic extension of the upper extremities

155
Q

The corticospinal tract normally inhibits the ____ nucleus (_______ tract) and when not inhibited leads to _________ posturing

A

red, rubrospinal tract, decorticate

156
Q

Tau protein is an element of the _______ and is the primary constituent of __________. This is more likely when Tau is _________phosphorylated

A

cytoskeleton, neurofibrillary tangles, hyper–>aggregates

157
Q

________ presents with sudden onset of vestibular symptoms (vertigo, peripheral nystagmus) and nausea, vomiting, imbalance

A

Vestibular neuritis

-the nystagmus worsens by gaze to healthy side and diminishes with gaze to affected side

158
Q

____________ is a sudden cause of vestibular dysfunction. However, it’s intermittent and attacks are precipitated by a change in the head

A

Benign positional vertigo

159
Q

ConVEX hyperdensity on Brain CT

A

Epidural hematoma

160
Q

CONCAVE hyperdensity on Brain CT

A

Subdural hematoma

161
Q

If Brown Sequard occurs above T1, can see ipsilateral

A

Horner’s syndrome

-damage to hypothalamus has potential to cause

162
Q

lysosomal rupture is a ________ part of cell death

A

irreversible

Uworld (26 decks)

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