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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.

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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

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3
Q

Methotrexate is a ______ antagonist?

A

Folic acid

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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)

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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.

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6
Q

What is a side effect of increased catecholamine?

A

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

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7
Q

What is the cause of neoplastic spinal cord compression?

A

Local extension of vertebral metastases into the epidural space.

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8
Q

How does neoplastic spinal cord compression present?

A

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

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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)

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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

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11
Q

What is N. meningitidis virulence factors?

A

Lipooligosaccharide.
Act as endotoxin.

**responsible for the severity of meningococcal dz.

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12
Q

What are some risk factors for development of cataracts?

A

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

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13
Q

What is the pathology of cataracts?

A

Chronic photooxidative injury.

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14
Q

Long term use of hydroxychloroquine can cause?

A

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

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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.

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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.

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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.

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18
Q

Initial treatment for status epilepticus?

A

IV lorazepam and phenytoin

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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.

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20
Q

What are some current Alzeimers Disease specific therapies?

A

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

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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

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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)

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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.

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24
Q

First line treatment for essential tremor is?

Inheritance?

A

Non specific B-antagonist (propranolol)

AD.

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25
Most common cause of temporal lobe epilepsy?
Hippocampal sclerosis (atrophy). Will also see reactive gliosis. Others: infection, head trauma, tumors, congenital malformations.
26
Where is medulloblastoma located?
Cerebellum (often vermis). Contains sheets of small, blue cells.
27
The most frequently affected location of hypertensive vasculopathy is?
Basal ganglia, cerebellar nuclei, thalamus and pons.
28
What is the putamen supplied by?
Lenticulostriate arteries. (branch of MCA).
29
Histopathology of craniopharyngiomas? Where do these arise from?
Suprasellar tumors found in children. Composed of calcified cysts containing cholesterol crystals. Rathkes patch (precursor to ant. pituitary)
30
Cavernous hemangiomas are vascular malformations that carry an increased risk of?
Hemorrhage and seizure
31
Kayser Fletcher ring is strongly associated with? What part of the brain is often affected?
Wilson Disease Basal ganglia atrophy
32
In neural tube defects what substances are seen in high quantities in amniotic fluid?
Elevated Alpha feto protein and acetylcholinesterase
33
How do neural tube defects occur?
Failuer of the neural folds to fuse.
34
Addition of epinephrine to lidocaine aids in?
Prolonging lidocaine duration of action. (Epi causes vasoconstriction/less bleeding/decreased absorption) so lidocaine remains at site of injection.
35
What is ornithine transport necessary for the proper functioning of?
Urea cycle
36
A transtentorial (i.e uncal) herniation often cause these symptoms?
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
37
Fractures of the orbital floor often involve which bones?
Zygomatic bones and maxilla.
38
What medications can act as emetic and pain relievers for severe migraines and HA associated with nausea and vomiting?
Dopamine receptor blockers (D2 - metoclopramide and prochlorperazine).
39
What medication is often given alongside dopa receptor blockers when given as antiemetics?
Diphenhydramine (to counteract cholinergic activity)
40
How does excess cholinergic activity present?
extrapyramidal symptoms (acute dystonia - torticollis, oculogyric crisis)
41
What are some virulence factors of N. menigitidis?
Pili (for attachment to nasopharyngeal epithelium). IgA protease. Capsular. Endotoxin (lpo-oligo saccride) and opa proteins (endothelial attachment).
42
Focal seizures with impaired awareness are typical manifestations of ___ epilepsy?
Temporal lobe | often localizes to mesial temporal lobe - hippocampus, amydyla, parahippocampal gyrus
43
What disease can be associated with hydrocephalus - ex vacuo? Why?
Neurodegenerative diseases (AIDS, dementia) Due to significant cortical atrophy
44
How does Wilson's disease present clinically?
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)
45
How is Wilson's disease inherited?
Autosomal recessive (Gene - ATP7B)
46
What type of Amyloid is found in pts with Down's syndrome presenting with early onset Alzheimer's?
Amyloid Beta (an amyloid precursor protein) ** Located on Chromosome 21
47
In patients with asthma what is the preferred inhaled anesthetic?
Halothane and sevoflurane (have bronchodilation properties)
48
What form of bacterial meningitis is particularly responsive to glucocorticoid treatment?
Pneumococcal meningitis
49
Describe px for cluster HA?
Unilateral, around orbital, with autonomic symptoms (nasal congestion, lacrimation), occur in clusters (same time each day).
50
Mechanical derangement of the TMJ can also affect this nearby structure?
Ear (ear pain and muffled hearing) **pathological contraction of the pterygoid muscles.
51
Hydrocephalus ex-vacuole symptoms are due to ? Loss of ____ in this condition leads to urge incontinence?
Stretching of the descending cortical fibers (corona radiata) Cortical inhibition of sacral micturition.
52
What part of the brain is most atrophied in Alzheimer's Disease?
Hippocampus
53
Irreversible ischemic injury to brain tissue causes?
Tissue digestion by the hydrolytic enzymes -> liquefactive necrosis.
54
What is the pathophysiology of HIV associated dementia? Underlying pathology is due to?
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
What is a rare adverse effect of lamotrigine?
Stevens-Johnson syndrome and toxic epidermal necrolysis (px with flu like sx, widespread mucocutaneous epidermal necrolysis.
56
What is the MOA of lamotrigine?
Treats partial and generalized seizures by blocking voltage gated sodium channels.
57
Chronic thiamine (vitamin B1) deficiency impairs _____ in CNS? Why?
Glucose utilization Impairs activity of enzymes that use thiamine as a cofactor.
58
How can you diagnose thiamine deficiency?
Baseline erythrocyte transketolase activity is low but increases after addition of thiamine pyrophosphate.
59
What enzymes in glucose metabolism utilize thiamine as a cofactor?
Pyruvate dehydrogenase Pyruvate -> acetyl coA) Alpha ketoglutarate dehydrogenase (citric acid cycle) Branched chain alpha dehydrogenase Transketolase (Pentose pathway)
60
What gene is responsible for the fragile X syndrome?
FXS (fragile X syndrome) - is also X linked.
61
Most patients with myastenia gravis also have ___ disorder?
Thymic abnormalities (e.g thymoma, thymic hyperplasia).
62
Differentiate between Lambert Eaton and Myasthenia Gravis?
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
The most common primary cerebral neoplasm in adults is?
Glioblastoma.
64
How does a glioblastoma present?
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
Pathophysiology of oligo dendromas?
Affects white matter or cerebral hemispheres, well circumscribed, grey masses with calcification
66
The neurofibromas in schwann cells are embryologically derived from?
Schwann cell (neural crest).
67
What are the derivatives of Neural tube (neuroectoderm)?
Brain and Spinal cord Post pituitary Pineal gland Retina
68
What is internuclear opthalmoplegia?
Disorder of impaired horizontal gaze caused by lesion in MLF.
69
What are some of the treatment options of MG?
Cholinesterase inhibitors, thymectomy and immunosuppressant. **Antimuscarinic eg glycopyrrolate can attenuate muscarinic effects.
70
How does St. John Wort affect CYP450?
It is an inducer of CYP450
71
Why is physostigmine different from other cholinesterase inhibitors?
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
What is the MOA of pramipexole/ropinirole?
Directly stimulate dopa receptors (non-ergot). **two classes of dopa agonist (ergot - bromocriptine and non-ergot compounds)
73
What is the drug of choice for treatment of trigeminal neuralgia?
Carbamazepine
74
Anosmia is often interpreted as?
Loss of taste
75
The most common CNS tumor in immunosuppressed patients is ?
CNS lymphoma. Arise from B cells and is associated with EBV
76
The stapedius muscle in the ear is innervated by? Paralysis of this nerve causes?
Stapedius muscle (branch of facial nerve) Hyperacusis (increased sensitivity to sound)
77
With what medication do you treat crypto meningitis?
Amphotericin B & flucytosine | Long term fluconazole maintenance therapy
78
Diffuse axonal injury is a type of traumatic brain injury that results from?
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
HSV can affect these two nerves?
CN 5 & 7
80
How will trapezius weakness present?
Drooping of the shoulder, problems with abduction of arm above 100 degrees and lateral displacement of scapula.
81
Deltoid vs trapezius in arm abduction?
Deltoid - 30 -100 degrees | Trapezius >100
82
Injury in the posterior triangle of the neck can affect this nerve?
CN XI - spinal accessory
83
What is the pathology behind paraneoplastic cerebellar degeneration?
Immune response against tumor cells cross react with Purkinje neurons antigens -> acute onset cerebellar degenration
84
What antibodies would you find in paraneoplastic cerebellar degeneration?
Anti Yo (obstetric and breast cancer), anti-Tri (P/Q) CNS lymphoma, and anti-Hu (small cell lung cancer).
85
Schwannomas can arise from peripheral nerve roots except?
CN II
86
Why does axonal regeneration not occur the CNS?
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
Even though etomidate is hemodynamically neutral, it can lead to ___ suppression?
Transient adrenocortical suppression
88
Horner syndrome is associated with this lung tumor?
Pancoast.
89
Superior vena cava syndrome is associated with?
Small cell lung cancer (centrally located or mediastinal spread)
90
What muscles do the musculocutaneous nerve innervate?
Forearm flexors (brachialis, biceps brachii and coracobrachialis). Derived from C5-C7. Becomes lateral cutaneous and provides sensation to lateral forearm.
91
How does arginase deficiency present?
Unable to convert arginine to urea or ornithine. WIll px as progressive spastic diplegia, growth delay, abnormal movements.
92
Gingival hyperplasia caused by phenytoin medication is due to increased expression of this?
PDEF
93
Pupillary asymmetry is caased by lesion in _____ or ____ pathway?
Ocular parasympathetic or sympathetic pathways.
94
Dysfunction in the cerebellum causes these features?
Intention tremors Ipsi dysdiadochokinesia (impaired rapid alternating movements) Dysmetria (overshoot/undershoot during targeted movement).
95
What are the 2 causes of ring enhancing lesions with mass effect in HIV pts?
Toxoplasma 2nd - Primary CNS lymphoma (PNCNSL)
96
Primary cCNS lymphoma (PNCNSL) is typically composed of?
B lymphocytes
97
What is the function of peroxisomes in the cell?
Oxidation of v. long & branched fatty acids & hydrogen peroxide degradation.
98
What is the most common cause of ocular disease in patients with untreated AIDS with CD4 <50?
Cytomegalovirus retinitis.
99
Treatment for cytomegalovirus retinitis?
Ganciclovir
100
How does a pt with cytalomegalovirus retinitis present?
Slowly progressive blurred vision, scotoma (blind spots), floaters or photopsia (flashing light)
101
What does funduscopy of CMV retinitis look like?
Yellow-white fluffy retinal lesions near the retinal vessels associated with hemorrhage.
102
How does open angle glaucoma present?
Progressive loss of peripheral visual fields
103
What are the preferred treatment for open angle glaucoma? MOA?
Topical prostaglandins Decrease aqueous humor by increase in outflow.
104
Wet age-related macular degeneration is characterized by?
Retinal neovascularization due to increased VEGF levels. RAPID loss of vision due to bleeding.
105
Dry age related macular degeneration is charcterized by?
Subretinal inflammation -> abnormal ECM formation -> Deposition of drusen bodies with GRADUAL decrease in vision.
106
Succinylcholine is rapidly hydrolyzed by?
Plasma pseudocholinesterase
107
'Red ragged' muscle fibers are seen in ____ disease?
Mitochondrial. Abnormal mitochondria accumulate under the sarcolemma. **show maternal inheritance
108
How does N. Meningitidis spread to the meninges ?
Transcellular penetration of the cerebral capillary endothelium or entry at the choroid plexus.
109
Clinically this MAO-B inhibitor can be used to delay progression of _______?
Parkinson's disease ** prevents MPTP induced damage of dopaminergic neurons
110
Arnold Chiari Type II is often associated with these 2 conditions?
``` Lumbar myelomeningocele (lower limb paralysis) & Non communicating hydrocephalus due to aqueductal stenosis. ```
111
PDE5 inhibitors (sildenafil, tadalafil) are often used inthe treatment of?
Erectile Dysfunction.
112
Adverse effects of PDE5 inhibitors?
Also inhibit PDE6 in the retina (color vision). Effects: bluish discoloration to vision.
113
In syringomyelia, which tract is often damaged?
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
Syringmyelia casues damage to ?
Ventral white commissure (spinothalamic tract) and anterior horns (LMN symptoms).
115
Opsoclonus - myoclonus (non rhythmic eye movements and involuntary jerking) in a young patient should prompt evaluation for ?
Neuroblastoma
116
Where does a neuroblastoma typically occur? These patients have elevated levels of ____?
Adrenal glands Catecholamines
117
From what cells do these tumors arise? What gene presence is predictive of a poor prognosis?
Neural crest N-myc amplification
118
How does a patient with myotonic dystrophy present?
Sustained M. contraction (myotonia) + weakness and atrophy. Often seen with cataracts Other sx: frontal balding and gonadal atrophy
119
Underlying pathology of myotonic dystrophy?
Increased number of trinucleotide repeats on myotonia-protein kinase gene (MPK)
120
Patients with retinoblastoma often have increased risk for secondary tumors especially?
Osteosarcomas
121
Diabetic neuropathy leads to _______?
Length dependent axonopathy Small fibers - +ve sx: pain, paresthesias Large fibers: -ve sx: numbness, loss of proprioception and vibration sense.
122
How would a patient with glioblastoma px?
Slowly worsening HA, seizure and/or focal neurological issues
123
Most gliomas present with mutations that increase ______?
Epidermal growth factor expression promoting cellular survival
124
Oligoclonal bands are highly sensitive but not specific for?
Multiple Sclerosis

UWORLD Q REVIEWS (13 decks)

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