Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

UWORLD Q REVIEWS > Neuro Block Wk 3 > Flashcards

Neuro Block Wk 3 Flashcards

1
Q

What does a patient with progressive loss of peripheral vision have?

A

Open angle glaucoma (from elevated intraocular pressure)

**more common with advancing age and in AA population.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

How do non-selective beta blockers work to treat glaucoma?

Which other drug acts in the same way?

A

Diminishing secretion of aqueous humor by ciliary epithelium.

Acetazolamide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Methotrexate is a ______ antagonist?

A

Folic acid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What happens in retinitis pigmentosa?

A

A genetic condition (inherited) that results in progressive (painless) degeneration of retinal pigmented epithelium and photoreceptors. Starts with night blindness (rods go first)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

How do pts with retinitis pigmentosa present?

A

Night blindness first.

Will find bone spicule deposits (intraretinal pigments) around macula (where photoreceptors are missing.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is a side effect of increased catecholamine?

A

Increased catecholamine release (bronchodilation) and can be used in patients with bronchospasms.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the cause of neoplastic spinal cord compression?

A

Local extension of vertebral metastases into the epidural space.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How does neoplastic spinal cord compression present?

A

Severe back pain (worse at night), motor weakness, and or sensory deficits.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What parts of the spinal cord does tabes dorsalis affect?

A

Dorsal column and dorsal roots (absent deep tendon reflexes)

**will also present with lancinating pain (sharp, stabbing pains that many last minutes/hours)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

This disorder happens to children who have a high fever due to a viral illness?

A

Febrile seizures. Occurs in children 6 months -5 years. Hyperthermia induced short generalized seizure.

*Tx is supportive with antipyretics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is N. meningitidis virulence factors?

A

Lipooligosaccharide.
Act as endotoxin.

**responsible for the severity of meningococcal dz.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are some risk factors for development of cataracts?

A

Age >60, DB, Chronic sunlight exposure, tobacco use, immunosuppression (HIV, corticosteroids).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the pathology of cataracts?

A

Chronic photooxidative injury.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Long term use of hydroxychloroquine can cause?

A

Retinopathy (decreased central visual acuity, photopsia (flashing light) and central macular degeneration.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What will light microscopy show in a patient with Guillian Barre?

A

Segmental demyelination and endoneurial inflammatory infiltrate composed of lymphocytes and macrophages.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the MOA of phenytoin?

A

Anticonvulsant that inhibits neuronal high frequency firing by reducing the ability of sodium channels to recover from inactivation.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is status epilepticus?

A

Single seizure lasting >5 minutes or the occurrence of multiple discrete seizures with incomplete recovery of consciousness between episodes.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Initial treatment for status epilepticus?

A

IV lorazepam and phenytoin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

In Lesch Neyhan Syndrome, which enzyme must have increased activity to compensate for the malfunction found in this dz?

A

PRPP amidotransferase must increase (de novo synthesis of purine ). Since HGPRT is non functional and unable to salvage and recycle purine.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are some current Alzeimers Disease specific therapies?

A

Donepezil (cholinesterase inhibitors, antioxidants (vitamin E) and NMDA receptor antagonist (memantine).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Where does the third branch of trigeminal nerve exit the skull?

What is this branch resposbible for?

A

Foramen ovale

Sensory to mandible and muscles of mastication

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is an effective monotherapy for the treatment of spasticity secondary to both brain and spinal cord dz?

MOA?

Other med?

A

Baclofen.

GABA-B receptor. Helps to decrease the spasticity by decreasing excitability of spinal reflexes.

Tizanidine (alpha agonist)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Pudendal nerve injury leads to?

A

Weakness of the perineural muscles. causing fecal urinary incontinence, perineal pain and sexual dysfunction.

**often injured in delivery due to stress on pelvic floor.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

First line treatment for essential tremor is?

Inheritance?

A

Non specific B-antagonist (propranolol)

AD.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Most common cause of temporal lobe epilepsy?

A

Hippocampal sclerosis (atrophy). Will also see reactive gliosis.

Others: infection, head trauma, tumors, congenital malformations.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Where is medulloblastoma located?

A

Cerebellum (often vermis). Contains sheets of small, blue cells.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

The most frequently affected location of hypertensive vasculopathy is?

A

Basal ganglia, cerebellar nuclei, thalamus and pons.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What is the putamen supplied by?

A

Lenticulostriate arteries. (branch of MCA).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Histopathology of craniopharyngiomas?

Where do these arise from?

A

Suprasellar tumors found in children. Composed of calcified cysts containing cholesterol crystals.

Rathkes patch (precursor to ant. pituitary)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Cavernous hemangiomas are vascular malformations that carry an increased risk of?

A

Hemorrhage and seizure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Kayser Fletcher ring is strongly associated with?

What part of the brain is often affected?

A

Wilson Disease

Basal ganglia atrophy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

In neural tube defects what substances are seen in high quantities in amniotic fluid?

A

Elevated Alpha feto protein and acetylcholinesterase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

How do neural tube defects occur?

A

Failuer of the neural folds to fuse.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Addition of epinephrine to lidocaine aids in?

A

Prolonging lidocaine duration of action. (Epi causes vasoconstriction/less bleeding/decreased absorption) so lidocaine remains at site of injection.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What is ornithine transport necessary for the proper functioning of?

A

Urea cycle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

A transtentorial (i.e uncal) herniation often cause these symptoms?

A
  1. CN III compression (dilated pupil)
  2. Ipsilateral PCA
  3. Compression of contralateral cerebral peduncle (ipsi hemiparesis)
  4. Brainstem hemorrhages (i.e Duret) in pons and midbrain due to rupture of basilar artery -> fatal
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Fractures of the orbital floor often involve which bones?

A

Zygomatic bones and maxilla.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

What medications can act as emetic and pain relievers for severe migraines and HA associated with nausea and vomiting?

A

Dopamine receptor blockers (D2 - metoclopramide and prochlorperazine).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

What medication is often given alongside dopa receptor blockers when given as antiemetics?

A

Diphenhydramine (to counteract cholinergic activity)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

How does excess cholinergic activity present?

A

extrapyramidal symptoms (acute dystonia - torticollis, oculogyric crisis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

What are some virulence factors of N. menigitidis?

A

Pili (for attachment to nasopharyngeal epithelium). IgA protease. Capsular. Endotoxin (lpo-oligo saccride) and opa proteins (endothelial attachment).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Focal seizures with impaired awareness are typical manifestations of ___ epilepsy?

A

Temporal lobe

often localizes to mesial temporal lobe - hippocampus, amydyla, parahippocampal gyrus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

What disease can be associated with hydrocephalus - ex vacuo?

Why?

A

Neurodegenerative diseases (AIDS, dementia)

Due to significant cortical atrophy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

How does Wilson’s disease present clinically?

A

Hepatic (acute liver failure, hepatitis, cirrhosis)
Neuro - (parkinsonism, gait disturbances, dysarthria)
Psch sx (depression, personality changes, psychosis)
Will also see Kayser Fleischer rings (dx with slit lamp exam)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

How is Wilson’s disease inherited?

A

Autosomal recessive (Gene - ATP7B)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

What type of Amyloid is found in pts with Down’s syndrome presenting with early onset Alzheimer’s?

A

Amyloid Beta (an amyloid precursor protein)

** Located on Chromosome 21

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

In patients with asthma what is the preferred inhaled anesthetic?

A

Halothane and sevoflurane (have bronchodilation properties)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

What form of bacterial meningitis is particularly responsive to glucocorticoid treatment?

A

Pneumococcal meningitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Describe px for cluster HA?

A

Unilateral, around orbital, with autonomic symptoms (nasal congestion, lacrimation), occur in clusters (same time each day).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Mechanical derangement of the TMJ can also affect this nearby structure?

A

Ear (ear pain and muffled hearing)

**pathological contraction of the pterygoid muscles.

51
Q

Hydrocephalus ex-vacuole symptoms are due to ?

Loss of ____ in this condition leads to urge incontinence?

A

Stretching of the descending cortical fibers (corona radiata)

Cortical inhibition of sacral micturition.

52
Q

What part of the brain is most atrophied in Alzheimer’s Disease?

A

Hippocampus

53
Q

Irreversible ischemic injury to brain tissue causes?

A

Tissue digestion by the hydrolytic enzymes -> liquefactive necrosis.

54
Q

What is the pathophysiology of HIV associated dementia?

Underlying pathology is due to?

A

Microglial nodules (groups of activated microglia/macrophages around small areas of necrosis) and multinucleated giant cells.

Release of neurotoxic compounds since HIV does not directly infect neurons.

55
Q

What is a rare adverse effect of lamotrigine?

A

Stevens-Johnson syndrome and toxic epidermal necrolysis (px with flu like sx, widespread mucocutaneous epidermal necrolysis.

56
Q

What is the MOA of lamotrigine?

A

Treats partial and generalized seizures by blocking voltage gated sodium channels.

57
Q

Chronic thiamine (vitamin B1) deficiency impairs _____ in CNS?

Why?

A

Glucose utilization

Impairs activity of enzymes that use thiamine as a cofactor.

58
Q

How can you diagnose thiamine deficiency?

A

Baseline erythrocyte transketolase activity is low but increases after addition of thiamine pyrophosphate.

59
Q

What enzymes in glucose metabolism utilize thiamine as a cofactor?

A

Pyruvate dehydrogenase Pyruvate -> acetyl coA)
Alpha ketoglutarate dehydrogenase (citric acid cycle)
Branched chain alpha dehydrogenase
Transketolase (Pentose pathway)

60
Q

What gene is responsible for the fragile X syndrome?

A

FXS (fragile X syndrome) - is also X linked.

61
Q

Most patients with myastenia gravis also have ___ disorder?

A

Thymic abnormalities (e.g thymoma, thymic hyperplasia).

62
Q

Differentiate between Lambert Eaton and Myasthenia Gravis?

A

Myasthenia Gravis - muscle fatigability over the course of the day.

Lambert - Proximal muscle weakness that improves with muscle use. Commonly occurs in pts with small cell lung cancer.

63
Q

The most common primary cerebral neoplasm in adults is?

A

Glioblastoma.

64
Q

How does a glioblastoma present?

A

Located within cerebral hemispheres, may cross midline (butterfly glioma). Soft, poorly defined,
and contain areas of necrosis and hemorrhage.

Malignant with very poor prognosis.

65
Q

Pathophysiology of oligo dendromas?

A

Affects white matter or cerebral hemispheres, well circumscribed, grey masses with calcification

66
Q

The neurofibromas in schwann cells are embryologically derived from?

A

Schwann cell (neural crest).

67
Q

What are the derivatives of Neural tube (neuroectoderm)?

A

Brain and Spinal cord
Post pituitary
Pineal gland
Retina

68
Q

What is internuclear opthalmoplegia?

A

Disorder of impaired horizontal gaze caused by lesion in MLF.

69
Q

What are some of the treatment options of MG?

A

Cholinesterase inhibitors, thymectomy and immunosuppressant.

**Antimuscarinic eg glycopyrrolate can attenuate muscarinic effects.

70
Q

How does St. John Wort affect CYP450?

A

It is an inducer of CYP450

71
Q

Why is physostigmine different from other cholinesterase inhibitors?

A

It has a tertiary ammonium structure that can penetrate the CNS and reverse central and peripheral symptoms of anticholinergic activity. Others have quaternary structure that limits CNS penetration

72
Q

What is the MOA of pramipexole/ropinirole?

A

Directly stimulate dopa receptors (non-ergot).

**two classes of dopa agonist (ergot - bromocriptine and non-ergot compounds)

73
Q

What is the drug of choice for treatment of trigeminal neuralgia?

A

Carbamazepine

74
Q

Anosmia is often interpreted as?

A

Loss of taste

75
Q

The most common CNS tumor in immunosuppressed patients is ?

A

CNS lymphoma.

Arise from B cells and is associated with EBV

76
Q

The stapedius muscle in the ear is innervated by?

Paralysis of this nerve causes?

A

Stapedius muscle (branch of facial nerve)

Hyperacusis (increased sensitivity to sound)

77
Q

With what medication do you treat crypto meningitis?

A

Amphotericin B & flucytosine

Long term fluconazole maintenance therapy

78
Q

Diffuse axonal injury is a type of traumatic brain injury that results from?

A

Disruption/shearing of white matter tracts.

Px as widespread axonal swelling at grey white junction and accumulation of transport proteins (amyloid precursor and alpha synuclein - since transport is impaired) at site of injury

79
Q

HSV can affect these two nerves?

A

CN 5 & 7

80
Q

How will trapezius weakness present?

A

Drooping of the shoulder, problems with abduction of arm above 100 degrees and lateral displacement of scapula.

81
Q

Deltoid vs trapezius in arm abduction?

A

Deltoid - 30 -100 degrees

Trapezius >100

82
Q

Injury in the posterior triangle of the neck can affect this nerve?

A

CN XI - spinal accessory

83
Q

What is the pathology behind paraneoplastic cerebellar degeneration?

A

Immune response against tumor cells cross react with Purkinje neurons antigens -> acute onset cerebellar degenration

84
Q

What antibodies would you find in paraneoplastic cerebellar degeneration?

A

Anti Yo (obstetric and breast cancer), anti-Tri (P/Q) CNS lymphoma, and anti-Hu (small cell lung cancer).

85
Q

Schwannomas can arise from peripheral nerve roots except?

A

CN II

86
Q

Why does axonal regeneration not occur the CNS?

A

Persistence of myelin debris because recruitment of microglial to site of injury is slow and limited by BBB.
Also, because of secretion of neuronal inhibitory factors and development of glial scarring.

87
Q

Even though etomidate is hemodynamically neutral, it can lead to ___ suppression?

A

Transient adrenocortical suppression

88
Q

Horner syndrome is associated with this lung tumor?

A

Pancoast.

89
Q

Superior vena cava syndrome is associated with?

A

Small cell lung cancer (centrally located or mediastinal spread)

90
Q

What muscles do the musculocutaneous nerve innervate?

A

Forearm flexors (brachialis, biceps brachii and coracobrachialis). Derived from C5-C7. Becomes lateral cutaneous and provides sensation to lateral forearm.

91
Q

How does arginase deficiency present?

A

Unable to convert arginine to urea or ornithine. WIll px as progressive spastic diplegia, growth delay, abnormal movements.

92
Q

Gingival hyperplasia caused by phenytoin medication is due to increased expression of this?

A

PDEF

93
Q

Pupillary asymmetry is caased by lesion in _____ or ____ pathway?

A

Ocular parasympathetic or sympathetic pathways.

94
Q

Dysfunction in the cerebellum causes these features?

A

Intention tremors
Ipsi dysdiadochokinesia (impaired rapid alternating movements)
Dysmetria (overshoot/undershoot during targeted movement).

95
Q

What are the 2 causes of ring enhancing lesions with mass effect in HIV pts?

A

Toxoplasma

2nd - Primary CNS lymphoma (PNCNSL)

96
Q

Primary cCNS lymphoma (PNCNSL) is typically composed of?

A

B lymphocytes

97
Q

What is the function of peroxisomes in the cell?

A

Oxidation of v. long & branched fatty acids & hydrogen peroxide degradation.

98
Q

What is the most common cause of ocular disease in patients with untreated AIDS with CD4 <50?

A

Cytomegalovirus retinitis.

99
Q

Treatment for cytomegalovirus retinitis?

A

Ganciclovir

100
Q

How does a pt with cytalomegalovirus retinitis present?

A

Slowly progressive blurred vision, scotoma (blind spots), floaters or photopsia (flashing light)

101
Q

What does funduscopy of CMV retinitis look like?

A

Yellow-white fluffy retinal lesions near the retinal vessels associated with hemorrhage.

102
Q

How does open angle glaucoma present?

A

Progressive loss of peripheral visual fields

103
Q

What are the preferred treatment for open angle glaucoma?

MOA?

A

Topical prostaglandins

Decrease aqueous humor by increase in outflow.

104
Q

Wet age-related macular degeneration is characterized by?

A

Retinal neovascularization due to increased VEGF levels. RAPID loss of vision due to bleeding.

105
Q

Dry age related macular degeneration is charcterized by?

A

Subretinal inflammation -> abnormal ECM formation -> Deposition of drusen bodies with GRADUAL decrease in vision.

106
Q

Succinylcholine is rapidly hydrolyzed by?

A

Plasma pseudocholinesterase

107
Q

‘Red ragged’ muscle fibers are seen in ____ disease?

A

Mitochondrial.

Abnormal mitochondria accumulate under the sarcolemma.

**show maternal inheritance

108
Q

How does N. Meningitidis spread to the meninges ?

A

Transcellular penetration of the cerebral capillary endothelium or entry at the choroid plexus.

109
Q

Clinically this MAO-B inhibitor can be used to delay progression of _______?

A

Parkinson’s disease

** prevents MPTP induced damage of dopaminergic neurons

110
Q

Arnold Chiari Type II is often associated with these 2 conditions?

A 
Lumbar myelomeningocele (lower limb paralysis) 
&amp; Non communicating  hydrocephalus due to aqueductal stenosis.
111
Q

PDE5 inhibitors (sildenafil, tadalafil) are often used inthe treatment of?

A

Erectile Dysfunction.

112
Q

Adverse effects of PDE5 inhibitors?

A

Also inhibit PDE6 in the retina (color vision). Effects: bluish discoloration to vision.

113
Q

In syringomyelia, which tract is often damaged?

A

Spinothalamic tract (esp of upper extremity - usually in cervical spine) remember this tract crosses at the level it enters at the at the anterior white commissure.

114
Q

Syringmyelia casues damage to ?

A

Ventral white commissure (spinothalamic tract) and anterior horns (LMN symptoms).

115
Q

Opsoclonus - myoclonus (non rhythmic eye movements and involuntary jerking) in a young patient should prompt evaluation for ?

A

Neuroblastoma

116
Q

Where does a neuroblastoma typically occur?

These patients have elevated levels of ____?

A

Adrenal glands

Catecholamines

117
Q

From what cells do these tumors arise?

What gene presence is predictive of a poor prognosis?

A

Neural crest

N-myc amplification

118
Q

How does a patient with myotonic dystrophy present?

A

Sustained M. contraction (myotonia) + weakness and atrophy.
Often seen with cataracts

Other sx: frontal balding and gonadal atrophy

119
Q

Underlying pathology of myotonic dystrophy?

A

Increased number of trinucleotide repeats on myotonia-protein kinase gene (MPK)

120
Q

Patients with retinoblastoma often have increased risk for secondary tumors especially?

A

Osteosarcomas

121
Q

Diabetic neuropathy leads to _______?

A

Length dependent axonopathy
Small fibers - +ve sx: pain, paresthesias
Large fibers: -ve sx: numbness, loss of proprioception and vibration sense.

122
Q

How would a patient with glioblastoma px?

A

Slowly worsening HA, seizure and/or focal neurological issues

123
Q

Most gliomas present with mutations that increase ______?

A

Epidermal growth factor expression promoting cellular survival

124
Q

Oligoclonal bands are highly sensitive but not specific for?

A

Multiple Sclerosis

UWORLD Q REVIEWS (13 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions