neuro Flashcards
Spinal shock may result in bladder distension and acute urinary retention (AUR) if the injury occurs above the lumbosacral plexus. Management of spinal cord injuries in an emergency setting involves obtaining vital signs, airway stabilization, immobilization of the neck and body, a thorough neurological examination, and insertion of a urinary catheter. This patient has no bulbocavernosus reflex, which indicates that he will develop AUR unless catheterized. Therefore, the most appropriate next step would be to place a Foley catheter. Resolution of spinal shock, and return of the reflex usually occurs within 2–3 days of the injury. Persistence of the loss of the bulbocavernosus reflex would suggest a conus medullaris injury.
This patient has signs and symptoms of spinal shock, including flaccid, areflexic paralysis, hypotension, bradycardia, and no bulbocavernosus reflex.
one year child devp
By the end of one year, most children can stand without support, walk with support, know 1–3 words, and follow one-step commands with gestures. This child only has the gross motor development and speech development of a 6-month-old (sitting without support, monosyllabic speech). The fine motor development (pincer grip) and social development (e.g., willingness to engage in play by giving objects, separation anxiety) are appropriate for a 1-year-old child. The ability to feed onself with a spoon is only expected by the age of 15 months.
drugs that trigger porphyria
Barbiturates (like primidone) trigger acute intermittent porphyria by inducing synthesis of cytochrome P-450 enzymes that contain heme components, thereby reducing heme levels and leading to stimulation of δ-aminolevulinate synthase, which is part of the heme synthesis pathway. δ-aminolevulinate synthase stimulation leads to increased levels and accumulation of δ-aminolevulinate and porphobilinogen, causing the characteristic symptoms (e.g., abdominal pain, peripheral neuropathy, confusion, and elevated levels of aminolevulinic acid and porphobilinogen) seen in this patient.
paget disease activates
Paget disease of the bone is caused by RANKL-RANK receptor activation, which triggers downstream NF-κB signaling and increases osteoclast activity.
brain tumor neuronal origin stains for
synaptophysin
synaptophysin include neurocytomas, medulloblastomas, small cell carcinomas of the lung, and carcinoid tumors. Neurons also stain positive for neurofilaments, which are part of the neuronal cytoskeleton.
txt for organophosphate poisoning
Following atropine administration, an oxime (e.g., pralidoxime) and a benzodiazepine should be administered. In addition, decontamination of the patient (e.g., remove clothes, wash skin) is important to prevent absorption of the offending agent through the skin.
pralidoxine — acholinesterase reactivator
how can alcoholism cause hypocalcemia
Magnesium is necessary for proper calcium absorption and balance; hypomagnesemia is associated with PTH resistance and reduced secretion of PTH. Chronic excessive alcohol intake causes hypocalcemia by two main mechanisms: vitamin D deficiency from malnutrition and alcohol-induced increase in urinary excretion of magnesium. Although this patient should also receive calcium replacement, hypocalcemia with hypomagnesemia will not improve until the magnesium level is corrected.
Decreased pinch strength and sensory deficits over the little finger and palmar surfaces of the medial aspect of the right hand are suggestive of ulnar nerve entrapment at the level of the wrist.
fracture of hook hamate
This man has a pelvic ring fracture with decreased sensation over the right medial thigh. This is consistent with an obturator nerve injury.
adduction of hi[
absent cremasteric reflex
genitofemoral nerve
A spinal disc herniation is caused by prolapse of the nucleus pulposus which develops from a different embryologic layer. derived from
notochord
caudal regressions yndrome
missing lumbo sacral area
diabetic mother
phenytpin teratogeninc
neural tube defects
neurons with eosinophilic cytoplasm and pyknotic nuclei.
12-24 hrs after ischemoa
Neutrophilic infiltration with central necrosis is seen on histopathologic examination of brain
1-3 days
Infiltration of macrophages (microglia) with local tissue destruction is seen on histopathologic examination of brain
3-5 days
n chromosome 9, which encodes an iron-binding mitochondrial protein
fraxatin
friedrich ataxia
upper eyelid droop
occulomotor injury
diabetic patient
microischemia
A child presenting a triad of preceding viral illness, hepatomegaly, and acute encephalopathy (vomiting due to elevated ICP, lethargy, and confusion) can be diagnosed with Reye’s syndrome caused by
aspirin
low does decreases uric acid excretion
ndicated for the prevention of seizure recurrence in status epilepticus and for short-term (< 5 days) treatment of epilepsy.
phenytoin
increases sodium efflux
status epilipticus
lorazepam to abort seizure
then phytoin for ecurrence
including diplopia, hepatotoxicity, and hyponatremia (probably due to associated SIADH), all of which are seen in this patient. Other possible side effects include Stevens-Johnson syndrome, ataxia, CYP-450 induction, and blood count abnormalities (agranulocytosis, aplastic anemia).
carbamezapine
An abnormal breathing pattern characterized by crescendo-decrescendo pattern of tidal volumes followed by a period of apnea.
cheyene stokes
galop rhhytm
heart failure
partial vs complete central DI
In partial central DI, urine osmolality increases by approximately 10%, while in complete central DI, urine osmolality increases by over 50%. This patient’s urine osmolality increased from 310 to 355 mOsm/kg H2O, an approximate 15% increase, which is sufficient to diagnose partial central DI.
PSAMMOMA
papillary carcinoma of thyroid, mesothelioma, and serous papillary cystadenocarcinoma of ovary and endometrium.
origin of meningioma
arachnoid cells
origin of hemangiobblastoma
blood vessels
he inhibition of arabinosyltransferase, which subsequently inhibits the synthesis of arabinogalactan,
for CELLWALLLLLLL
A similar pattern of spinal cord degeneration is seen in subacute combined degeneration due to vitamin B12 deficiency. and ??
in CTG
chr 9
fraxitin gene
freidrich ataxia
Charcot-Bouchard aneurysms (microaneurysms of the lenticulostriate arteries) suggest chronic hypertension. The finding of bilateral zona glomerulosa hyperplasia indicates that primary hyperaldosteronism (i.e., Conn syndrome) is the underlying cause of this patient’s chronic hypertension.
what other sympptoms can this pt have
primary hyperald
muscle weakness — hypokalemia
rmmber no edema dua to aldosterone escape by ANP BNP —–natriuresis
csf changes in guillane bare
increase in protein but not similar increase in WBC
due to disruption of blood brain barrier
cross-reactive antibodies against gangliosides (e.g., anti‑GM1 antibodies) or other unknown antigens of peripheral Schwann cells, which leads to segmental demyelination and axonal degeneration.
eyelid closure nerve
CN 7
eyelid openin
CNIII
combination of Potter sequence and hepatic involvement suggests a different renal pathology.
cystic dialltation of collecting duc t
seenin APKD on chr 6
cataplexy in narcolepsy treatmen
sodium oxybate
Lipohyalinotic thickening of penetrating cerebral vessels
pure motor lacunar infarct
post limb of internal capsuel
narcolepsy diagnosis
rapid onset betawaves
normally only seen in REM and wakeful stte
post herpatic neuralgia
pt has urinary retention and constipation
TCA
desipramine
amytriptaline
gabapentine
Enthesitis causes tenderness at the insertion of the Achilles tendon, another common manifestation of
reactive arthritsi
reactive arthritsi
This patient’s urethritis (dysuria), asymmetric oligoarticular arthritis, and conjunctivitis comprise the classic triad of reactive arthritis, a condition commonly triggered by diarrheal illness.
reactive arthritsi
This patient’s urethritis (dysuria), asymmetric oligoarticular arthritis, and conjunctivitis comprise the classic triad of reactive arthritis, a condition commonly triggered by diarrheal illness.
Histology shows densely packed, thin-walled capillary vessels surrounded by large stromal cells with intracytoplasmic lipid inclusions
hemangio
VHL
DRESS syndromw
Increased absolute eosinophil count is seen in DRESS (drug rash with eosinophilia and systemic symptoms) syndrome, which is a potentially fatal drug-induced hypersensitivity reaction that can occur 1–8 weeks after exposure to a substance such as an antiepileptic drug (e.g., lamotrigine, phenytoin, carbamazepine), allopurinol, or antibiotics (e.g., sulfonamide). As seen in this patient, DRESS is characterized by systemic inflammation with typical involvement of the skin (e,g., itching rash and facial edema), liver (e.g., elevated liver function tests, hepatomegaly), lymphoid tissue (e.g., diffuse lymphadenopathy), and blood (e.g., thrombocytopenia, atypical lymphocytosis, eosinophilia).
Fever, facial edema, a diffuse morbilliform rash, lymphadenopathy, and hepatomegaly within some weeks after initiating treatment with an anticonvulsant agent are suggestive of
DRESS
n open cranial vault and absence of the forebrain
anencephaly
increase alpha fetoprtein and acetylcholinastraes
superior division MCA
inf division MCA
sup — frontal
inf—- temporal
natalizumab
Natalizumab is a recombinant monoclonal antibody that targets integrin alpha-4 surface subunitsa
adrenal leukodystrphy
Rapidly deteriorating vision, hearing, motor abilities, and cognition in the presence of spasticity, sensory loss, and adrenal insufficiency (suggested by hyperpigmented skin) in a young boy are characteristic of adrenoleukodystrophy. A family history of what was likely the same condition in a maternal relative supports the diagnosis of this X-linked recessive condition.
This patient has had a massive ischemic stroke. The GFAP-positive cells described here are most likely astrocytes, which are derived from the neuroectoderm.
reactive gliosis
10 days
Multiple episodes of unresponsiveness lasting less than a minute with eyelid fluttering and concomitant early morning tonic-clonic seizures is suggestive of juvenile absence epilepsy. The first-line medication for long-term management is an antiepileptic drug that can also be used as a mood stabilizer in bipolar disorder.
valproate
the eggs of Taenia solium
neurocystecercosis
The patient’s acute, painless, unilateral loss of central vision (central scotoma), together with his history of gradual loss of central vision and fundoscopic findings of a subretinal hemorrhage and grayish-green retinal discoloration, are characteristic of wet age-related macular degeneration.
ranibizumab
anti vegf
anticodies in GRAVES
Graves disease is caused by thyrotropin-receptor autoantibodies (TRAbs) that activate the TSH receptor. TRAbs induce hyperthyroidism by stimulating follicular epithelial cells to produce abnormally high amounts of triiodothyronine (T3) and thyroxine (T4). As seen
triad of vertigo, tinnitus, and sensorineural hearing loss (normal Rinne test, lateralization to the unaffected side) is characteristic of Ménière disease.
Endolymphatic hydrops, which results in accumulation of endolymph within the membranous labyrinth, is the underlying mechanism of Ménière disease.
njured during radical prostatectomy.
cavernous nerve
EDysf
an antidepressant that also stimulates appetite
mitarzipine
a2 antag
antiparkinson drug wth SE livedo reticularis
ortho hypoT
edema
ataxia
amantadine
increases dopamine release
Blood in the sphenoid sinus and a transverse fracture on imaging are indicative of an anterior fracture of the middle cranial fossa. Anterior middle cranial fossa fractures may involve the orbital apex, superior orbital fissure, and clinoid processes.
inward dev of eye
sphenoid blood collection anterior cranial fossa fracture
carbidopa avoids the side effects like
ortho hypotension
vit E anemia
hemolytic
dec haptoglobin
age 2 what can a baby do
By the age of 2 years, most children can run and can walk up and down stairs (gross motor). They can copy a line but would not be expected to draw a circle or a plus sign (fine motor). They know at least 6 words and can speak in 2-word sentences (language). In their interactions with others, they exhibit selfish behavior and they would not be expected to dress themselves yet (social). This child’s gross motor skills and language are therefore delayed. Her fine motor skills and social development are normal, though
meningomyelocele or other neural tube defects are linkd to wch type of chiari
CHIARI 2
The patient’s findings of enophthalmos (posteriorly displaced eye) and infraorbital rim tenderness are suggestive of an orbital floor fracture (orbital blowout fracture). The mechanism of this injury can lead to downward displacement of orbital fat and inferior rectus muscle entrapment, which in turn can cause impaired upward gaze
clouding of max sinus
The patient’s findings of enophthalmos (posteriorly displaced eye) and infraorbital rim tenderness are suggestive of an orbital floor fracture (orbital blowout fracture). The mechanism of this injury can lead to downward displacement of orbital fat and inferior rectus muscle entrapment, which in turn can cause impaired upward gaze
clouding of max sinus
virulence factor of n.meningitidis that is the first step in fectin
fimbrae
capsule – protects fromy protecting it from antibody-/complement-mediated killing and inhibiting phagocytosis
Chocolate agar is sheep blood that is slowly heated until red blood cells lyse and release factors V (NAD) and X (hematin).
hem influenza
episode of cough when otuching inner ear
cranial nerve X vagus
vagus damage can present as
ipsilateral vocal cord palsy
contralateral uvula deviation
schwan cells
S100
neural crest cells
Hypercellular areas of spindle cells and hypocellular areas of myxoid stroma are characteristic findings of
schwanoma
Whorls of densely packed cells with areas of lamellated calcification
meningioma
Small blue cells arranged in rosettes around a central neuropil, known as Homer-Wright rosettes,
medulloblastoma
oy has a history consistent with fat-malabsorption (persistent diarrhea that improved on a low-fat diet), vitamin E deficiency (muscular weakness and myopathy, spinocerebellar dysfunction), vitamin A deficiency (night blindness), and failure to thrive. Acanthocytes in the blood smear and extremely low cholesterol levels strongly suggest
abetalipoproteinemia
headache, abdominal pain, altered mental status, tachycardia, shortness of breath, bright red skin tone, and breath smelling of bitter almonds with a normal pulse oximetry is most likely caused by
cyanide poisoning
atropine only reverse muscarinic effects what else must be added for nicotinic
pralidoxine
Drooping of the ipsilateral eyelid
CN III palsy
nic agonist commonly given for postoperative or postpartum urinary retention.
bethanechol
entacapone
peripheral
COMT inhibitors
treatment for CMV retinits
gancyclovir
responds to high frequency sounds in ear
base cochlea
cranial nerve 3 damage para vs symp
symp — middle of nerve– in diabetes — doqn and out gaze… motor output problem
para— pcom aneurysm/ uncal herniation…. doqn and out gaze
external branch of sup laryngeal nerve
supplies cricothyroid
hoarsness
close to sup thyroid artery
recurrent laryngeal nerve
close to inf thyroid
pelvic fracture most common cause of which nerve injury
obturator
genitofemoral nerve
L1 L2
cremestric reflex
acts by postsynaptic blockade of dopamine D2 receptors and also inhibition of serotonin 2, α-adrenergic, and histamine H1 receptors.
clozapine
A lumbar disc herniation between the vertebral bodies L5 and S1 is a common cause of S1 radiculopathy
weak achilles tendon reflex
myoclonus (jerky, repetitive, twitching movements) and rapidly-progressive dementia associated with aphasia and agnosis.
creutzfelt jacob
il12 il23
IL-12 induces Th1-cell differentiation and IFN-γ production, whereas IL-23 plays a role in controlling TH17 development
ustekinumab
tumor assoc with tuberous sclerosis
astrocytoma
presentation of atrophy restricted to the thenar eminence is a common early sign of
ALS
nucleus acuumbens
nucleus accumbens is a basal forebrain structure that has a role in the reward pathway
