Neuro K 2 Flashcards
Memory loss, visual hallucinations and parkinsonism; intracytoplasmic eosinophilic inclusion containing ubiquity; involves the limbic cortex, basal nucleus of Meynert and substantial nigra
Dementia with Lewy bodies
Order of events in Multiple Sclerosis
1) Acute plaques show dense lymphohistiolytic infiltration and active digestion of myelin byproducts
2) As inflammation and myelin breakdown diminish in older plaques, hyperplasia and hypertrophy of astrocytes transform the plaque into a gliotic area
3) Axons are relatively preserved but oligodendroglial cells are greatly diminished
The superior laryngeal artery accompanies the _____ n What happens if this nerve has a lesion?
accompanies internal branch of the superior laryngeal nerve
Lesion of the internal branch of the superior laryngeal n leads to loss of sensation in the laryngeal mucosa above the vocal folds and loss of the cough reflex
sensory innervation to the larynx above and below the vocal folds
above: internal branch of the superior laryngeal n
below: recurrent laryngeal n
Difference between the left and the right in terms of where the recurrent laryngeal nerve arises from
Left: recurrent laryngeal nerve arises from the vagus at the aortic arch
Right: arises from the vagus nerve at the right subclavian artery
sensory innervation to pharyngeal mucosa
glossopharyngeal nerve (afferent limb of gag reflex)
Motor innervation to cricothyroid muscle?
Motor innervation to lateral cricoaretynoid muscle?
external branch of the superior laryngeal nerve
recurrent laryngeal nerve
List the enzymes involved in each step of the catecholamine synthesis:
1) Tyrosine–>Dopa
2) Dopa–>Dopamine
3) Dopamine–>NE
4) NE–>Epi
1) Tyrosine hydroxyls
2) Dopa decarboxylase
3) Dopamine Beta hydroxyls
4) phenylethonolamine-N-methyl transferase (PMNT) (gene induced by stress)
*source of the methyl group is S-adenosylmethionine (SAM)
Sensorineural hearing loss can occur by damage to hair cells of the ____ _ _____. These cells can be damaged by trauma from very loud sounds or toxic drugs. In contrast what is Presbycusis?
Organ of corti
In contrast, presbycusis is an age related hearing loss in which a loss of hair cells at the base of the cochlea leads to high frequency hearing loss
Is the ampulla part of the auditory system or the vestibular system? What is its function?
vestibular
contains hair cells that detect changes in angular acceleration resulting from circular movements of the head
Is Middle cerebral a a part of the circle of willis? what is the consequence of this?
No; blockage to MCA can lead to significant ischemic damage because it is not part of the circle of willis and therefore does not have anastomoses that can compensate if its blocked
Histopathologic features of Alzheimer’s disease
Neurofibrillary tangles consisting of hyperphosphorylated tau protein
Extracellular senile plaques consisting of A-beta amyloid
Granulovacuolar degeneration and Hirano bodies
Amount of DNA (2N or 4N?) in a normal neuron. Why?
Neurons are primarily post mitotic and do not undergo DNA synthesis or mitosis so all cells should be 2N
- Slow-growing benign tumors (15% of intracranial tumors), most common in the elderly, females and in the parasagittal region
- Can present as mass lesion with seizures, headaches, and adjacent cortical compression
- Microscopically these tumor cells form whorls and psammoma bodies
Meningiomas
How to treat acute stroke? But must first rule what out?
thrombolytic therapy
Must rule out hemorrhage by obtaining head CT scan first
Intravenous altepase does what?
tPA
-causes fibrin-enhanced conversion of plasminogen to plasmin with limited conversion of plasminogen in the absence of fibrin
What to use aspirin?
propholaxys for preventing the formation of clots; cannot be used to lyse clots that are already formed
What do corticosteroids do in the setting of a mass lesion
Reduce swelling or increase intracranial pressure
*limited use for acute ischemic stroke
Metoprolol drug class and uses
beta blocker–used for controlling hypertension; cannot use acutely for stroke–only to control hypertension
Warfarin actions and uses
long acting anticoagulant useful in patients with atrial fibrillation or prophylaxis against clot formation; NOT useful for targeting clots that have already formed!
Gram positive, catalase negative, beta hemolytic, bacitracin resistant, and CAMP test-positive
Group B Strep (S. agalactiae)–#1 cause of neonatal meningitis
Wernicke’s aphasia clinical features
- can be caused by lesion of superior part of temporal lobe
- cannot comprehend spoken language and have fluent verbalization that lacks meaning (word salad)
- Reading and writing similarly affected
- This part of temporal lobe also has fibers of the visual radiations going to Primary visual cortex, so can also see right upper quadrantopia (pie in the sky)— right visual field deficit because Wernickes area is on the left
Pineal gland tumor clinical features
- compress vertical gaze center in tectum of midbrain
- can lead to Parinaud syndrome–vertical gaze palsy and light-near dissociation
Tabes Dorsalis clinical features
- Argyll Robertson pupil
- impaired vibration and position sense
- astereognosis
- paroxysmal pains
- ataxia
- diminished stretch reflexes
- incontinence
Drugs used to treat OPEN ANGLE glaucoma
Epinephrine combined with motifs, beta blockers, hyperosmotics, prostaglandins or carbonic anhydrase inhibitors (contraindicated for narrow-angle glaucoma because causes mydriasis which exacerbates symptoms)
Latanaprost, brimatoprost, travoprost
prostaglandin F2alpha analog–topical agent that reduces IOP by increasing the outflow of aqueous humor
-used for OPEN-ANGLE glaucoma
Scopolamine
Tropic amide
–association with glaucoma? Uses?
Absolutely contraindicated in angle closure glaucoma because both are antimuscarinic agents that would cause mydriasis and could trigger or worsen angle-closure glaucoma
- Scopolamine=used for motion sickness
- Tropicamide=opthalmic agent used to dilate the eye prior to eye exams
Treatment for bipolar disorder; how are the drugs eliminated from the body?
- Lithium, carbamazepine, valproic acid
- Lithium eliminated entirely by kidneys
- valproate is eliminated by liver so need to monitor liver transaminases; valproate also associated with thrombocytopenia and platelet dysfunction so need to monitor
Lithium and its association to thyroid function
can inhibit thyroid function which should be monitored by measuring thyroid stimulating hormone (TSH) every 6-12 months of therapy
Bleomycin, busulifan, and amiodarone—need to monitor patients on this drug by checking X rays because they are susceptible to what?
pulmonary fibrosis
Mechanism of action of Lithium in stabilizing mood
-prevents recycling of inositol (decreases PIP2) in the phoshpoinositol cascade
Adverse effects of Lithium
- TREMOR–tx using propranolol; nausea, polyuria, thirst, weight gain, cognitive impairment
- HYPOTHYROIDISM and goiter –Tx with T4
- NEPHROGENIC DIABETES INSIPIDOUS–Decreased ADH causing polyuria and dilute urine; amiloride is used to tx
- TERATOGENECITY–ebsteins anomaly–malformed tricuspid valve
Adverse effects of Lithium
- TREMOR–tx using propranolol; nausea, polyuria, thirst, weight gain, cognitive impairment
- HYPOTHYROIDISM and goiter –Tx with T4
- NEPHROGENIC DIABETES INSIPIDOUS–Decreased ADH causing polyuria and dilute urine; amiloride is used to tx
- TERATOGENECITY–ebsteins anomaly–malformed tricuspid valve
Occlusion of left middle cerebral a results in?
- Broca’s aphasia
- Spastic paresis of the contralateral lower face and upper limb
- Anesthesia of contralateral face and upper limb
- May also present with Wernicke’s aphasia depending on location of occlusion
- Blood supply to the internal capsule
- what causes ischemia in this region
- Lenticulostriate arteries arising from the middle cerebral arteries
- ischemia here can be a result of uncontrolled hypertension, manifesting as contralateral hemiplegia
