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USLME Kiss my ass and pray > Neuro Phys > Flashcards

Neuro Phys Flashcards

1
Q

Gag reflex

A

Ipsilateral glossopharyngeal (afferent) -> bilateral vagus (efferent)

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2
Q

Spinothalamic tract

Carries?
1st order neuron?

A

pain and temperature sensation

peripheral nerves to posterior horn , cell body in DRG

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3
Q

Dorsal column medial lemniscus

Carries?
1st order neuron?

A

pressure, touch vibration, proprioception

peripheral nerves to medulla via dorsal column, cell body in DRG

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4
Q

lateral corticospinal

Carries?
1st order neuron?

A

voluntary movement

Pyramidal neurons in the cortex descent, cross in medullary pyramids,
Synapse on the anterior motor horn of the cord (UMN)

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5
Q

hypothalamospinal

carries?
1st order neuron?

A

sympathetic input to the face

Arrises from hypothalamus and synapses on lateral horn at T1

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6
Q

2nd order spinothalmic tract

A

arises from posterior horn, IMMEDIATELY CROSS, in anterior white commissure and ascend in spinothalmic tract to thalamus

3rd order - thalamus to cortex

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7
Q

2nd order dorsal column medial lemniscus

A

arises from the medulla, crosses LATE and ascends via the medial lemniscus to thalamus

3rd order - thalamus to cortes

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8
Q

2nd order corticospinal

A

Arises from the anterior motor horn and synapses on muscle (LMN)

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9
Q

2nd order hypothalamospinal

A

arises from the lateral horn at T1 and synapses on the superior cervical ganglion (sympathetic)

3rd order - superior cervical ganglion to eyelids, pupil and skin of face

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10
Q

Microglial origin

A

mesoderm - like macrophages

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11
Q

Neural crest cells -> what neural structures?

A

PNS (CN, DRG, celiac ganglia, ANS) and Schwann Cells

there are other ones….

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12
Q

Neuroectoderm leads -.

A

CNS neurons, epndymal cells, oligodendrocytes, astrocytes

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13
Q

Blood brain barrier made of

A

foot process of astrocytes
BM
non fenestrated endothelia

No BBB where hypothalamus releases ADH or measures osmolarity

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14
Q

Histiologic feature defining neurons

A

Nissl cebstances in the dendrocytes

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15
Q

HIV infected multinucleate giant cells formed by

A

microglia

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16
Q

Reactive gliosis preformed by

A

astrocytes
~fibroblasts in the brain
-ID’ed by GFAP

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17
Q

Cell destroyed in MS

A

Oligodendrocyte

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18
Q

Cell destroyed in Gulliene Barrie

A

Schwann Cell

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19
Q

Fried Egg apperance on Hand E (3)

A

Oligodendrocyte
koliocyte w/ HPV
seminoma

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20
Q

Acustic nurima is

A

type of schannoma -. internal acoustic meatus of CNVIII

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21
Q

Pathways associated w/ Schizophrenia +/-

A

mesocortical pathway

mesolimbic pathway

Dopamine

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22
Q

Pathway implicated Parkinsons

A

Nigrostriatal path (substantial nigra-> neostriatum)

Dopamine

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23
Q

Tuberoinfundibular Pathway

A

Dopamine path from arcuate nucleus in hypothalamus -> Pituitary leading regulation of prolactin levels

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24
Q

What passes the BBB (4)

A

Lipophilic substance
- small non polar

Glucose and AA w/ carrier transport

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25
Q

Nucleus accumbens

uses what Vitamin and AA

A

Creates GABA
-LOW in huntintons

Using glutamate and Vit B6

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26
Q

Locus ceruleus creates?

A

NE

  • high in anxiety
  • low in depression

Also reticular formation and solitary tract

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27
Q

Ventral tegmentum of midbrain creates?

A

Dopamine
Also SNc

Decreased dopamine in parkinsons and depression

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28
Q

Raphe nucleus in the pons makes?

A

5HT

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29
Q

Basal nucleus of meynert makes?

A

ACh

increased in REM sleep and parkinsons

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30
Q

Glycine?

A

inhibitory NT of the Spinal Cord

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31
Q

Glutamate?

A

excitatory NT of CNS

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32
Q

Arcuate nucleus

Hypothalamus

A

releases dopamine and GnRh

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33
Q

Lateral nucleus

hypothalamus

A

Hunger
-inhibited by leptin
Destruction -> anorexia

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34
Q

Ventromedial nucleus

hypothalamus

A

Satiety
-stimulated by leptin
Destruction -> hyperphagia - >excessive eating

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35
Q 
Anterior hypothalamus(2)
hypothalamus
A

Cooling (A/C)

parasympathetic stim

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36
Q 
Posterior hypothalamus(2)
hypothalamus
A

Heating

sympathetic stim

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37
Q

Dorsal medial nucleus

hypothalamus

A

Stimulates the GI

works w/ VMN

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38
Q

Suprachiasmatic nucleus

hypothalamus

A

master clock

circadium rhythm

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39
Q

Preoptic nucleus

hypothalamus

A

Secreted GnRH -> FSH and LH

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40
Q

Supraotic nucleus

hypothalamus

A

ADH release

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41
Q

Paraventricular nucleus

hypothalamus

A

Oxytocin

- give synthetic ptocin for Uterine contraction and clamping down the uterus after birth to control bleeding

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42
Q

Mammary body

A

in hypothalamus

contains hemorhagicc lesion of Wernicke encephalopathy

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43
Q

Melatonin

A

secreted by pineal gland during period of darkness

also follows circadian rhythm

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44
Q

Limbic system and at the 5 Fs

A 
Feeding
Fleeing
fighting
Fucking 
Feeling
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45
Q

Anxiety is due to these changes in NTs (3)

A

increased NE
decreased 5Ht
decreased GABA

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46
Q

Stages of Sleep and EEG (6)

A 
awake-beta
relaxing- alpha
NI- Theta
NII - Sleep spindle and K complexes
NIII- Delta
REM - Beta
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47
Q

Night terrors and bed wetting found in

A

NIII

Rx w/ benzos or imiprimine

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48
Q

Bruxism is what and where is it found

A

Teeth grinding in stage II sleep

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49
Q

Sleep enuresis can be treated w/

A

imiprimine (TCA)

Desmopressin - ADH

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50
Q

paramedian pontine reticular formation is important in sleep when?

A

rapid eye movement in REM

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51
Q

Depressed sleep changes (4)

A

decreased REM latency and increased REM early in sleep cycle
repeated nighttime awakenings and early morning awakening
low slow sleep

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52
Q

Narcolepsy characterized by what sleep cycle

Rx:

A

Awake -> REM
- Cateplexy and Hallucinations

Tx w/ modafinil
-nightime sodium oxybate

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53
Q

Insomina Rx

1st line

Benzo alternative Rx? (3)

A

antihistamines

Zolpidem
Zaleplon
eszopiclone - long term

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54
Q 
Tounge nerves
Anterior 2/3 taste?
Anterior 2/3 sensation
Posterior taste?
posterior sensation
A

Facial nerve
trigeminal - mandibular branch
glossopharyngeal
glossopharyngeal

Vagus is taste in epiglotic

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55
Q

Olfactory nerve exits

A

cribiform plate

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56
Q

Lesions of the olfactory nerve (2)

A

cribiform plate frature

Kallman syndrom e9infertile as well)

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57
Q

Exits the superior orbital fissure (4)

A

Occulomotor
Trochlear
trigeminal opthalmic branch
abducens

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58
Q

Trigeminal maxillary branch exits

A

foramen rotundum

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59
Q

Trigeminal mandibular branch exits

A

foramen ovale

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60
Q

2 nerves exiting internal acoustic meatus

A

facial

vestibularcochlear nerve

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61
Q

3 nerves exiting the jugular foramen

A

glossopharyngeal
vagus
spinal accessory nerve

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62
Q

Hypoglosseal nerve exits the

A

hypoglosseal canal

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63
Q

Cranial nuclei of midbrain

A

3 occulomotor

4 trochlear

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64
Q

Cranial nuclei of the pons

A

5 trigeminal
6 abducens
7 facial
8 vestibularchochlear

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65
Q

Cranial nuclei of the medulla

A

9 Glossopharyngeal
10 Vagus
12 hypoglosseal

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66
Q

Cranial nuclei of spinal cord

A

11 accessory

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67
Q

Muscles of mastication

  • open
  • close
  • nerve
A

open - lateral petrygoid
close - temporal is, masseter, medial pterygoid

V3 - mandibular branch of trigeninal

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68
Q

5 branches of facial nerve

A

To Zanzibar By Motor Car

Temporal
Zygomatic
Buccal
Marginal mandibular
Cervical
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69
Q

Parotid gland innervation

A

glossopharyngeal

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70
Q

Submandibular and sublingual innervation

A

facial nerve

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71
Q

Lesions of the hypoglosseal see?

A

tounge pointing toward the lesion

72
Q

lessons of vagus nerve see?

A

Uvula points away from lesion

73
Q

Pupillary reflex

A

II shine in light

III constricts

74
Q

Corneal reflex

A

V1 senses touch

VII temporal branch shuts

75
Q

CNIII damage

A

Down and out pupil

76
Q

CN IV damage

A

eyes gazes upward, hard with stairs

77
Q

CN VI damage

A

medially directed eye

78
Q

Nucleus Solitaris(3)

A

Vagus nuclei- Visceral sensory
taste
baroreceptors
gut distension

79
Q

Nucleus ambiguous (3)

A

Vagus nuclei -Motor
pharynx
larynx
upper esophagus (swallowing, plate elevation)

80
Q

Dorsal motor nucleus

A

Parasympathetic control of vagus

heart
lungs
Upper Gi

81
Q

Infection of cavernous sinus leads to what neuro defects

A

Ophthalmoplegia (CN 3, 4 ,6)

Upper and middle face sensation change (V1 and 2)

82
Q

Marcus gunn pupil

A

afferent pupillary defect - damage or retina detachment ->

Bilateral constriction when light is shown in unaffected eye

Neither constrict in affected

83
Q

Bitemporal hemanopia

A

optic tract lesion

84
Q

Left homonymous hemianopia

A

R optic tract lesion

85
Q

Right anopia

A

Right optic nerve lesion

86
Q

central scotomata - loss of central vision

A

macular degeneration

87
Q

Left hemanopia w/ macular sparing

A

Posterior cerebral artery infarct- collateral from middle cerebral spares the macula

88
Q

Increased AFP seen in maternal serum and amniotic (3)

Down in ?

A

anterior abdominal wall defect
Spina bifida
Anencephaly

Down in Down syndrome

89
Q

Anencephaly

Clues(2)?

A

malformation of anterior neural tube-> no forebrain, low folate of DM type 1 risk

polyhydramnios - no swallowing reflex
Increase AFP

90
Q

Holoprosencephaly is ?

Due to

A

failure of L and R hemispheres to separate

sonic hedgehog signaling mutation

91
Q

Proencephalon/Forebrain -> (2)

embryology

A

telencephalon -> cerebral hemispheres

Diencephalon -> thalamus

92
Q

Mesenecephalon/Midbrain ->

embryology

A

mesencephalon -> midbrain

93
Q

rhombencephalon/hindbrain -> (2)

A

metencephalon (Pons and cerebellum)

Myelencephalon (medulla)

94
Q

Chiari One is at risk for?

Characterized by

A

syringomelia
- can be connected to trauma as well

mild cerebellar tonsils herniate

95
Q

Chiari type II is what ?

Leads to (3)

A

Significant cerebellar tonsillar/vermian herniation through foramen magnum

aquaductal stenosis,
hydrocephalus,
thoraco-lumbar myelomeningocele

96
Q

cystic enlargement of the 4th ventricle w/ enlarged posterior fossa
- Agenesis of cerebellar vermis is called

A

Dandy walker

97
Q

C8-T1 lesion w/ loss of pain and temp sensation is at further risk for what neuro defects?

What tract is affected 1st

A

Syringomyelia

can have additional weakness of arms w/ progressive anterior horn involvement

spinothalamic tract

98
Q

Brachial cleft derived from

99
Q

Brachial pouches derived from

100
Q

Brachial arches derived from

101
Q

Branchial cleft cyst characterized by

Other major cleft derivative?

A

lateral neck location that does not move w/ swallowing

-vs thyoglossal cyst(midline and moves)

Cleft 1 -> external auditory meatus

102
Q

1st brachial arch derivatives think

Muscles(3)

Nerves(2)

A

Ms and Ts

Muscles of mastication(Temporalis, Maseter, lateral and medial pterygoid)
Mylohyloid
Tensor Tympani
Tensor veli palatini

Mandibular and Maxilliary branch of trigeminal

103
Q

2nd brachial arch derivatives think

Muscles(4)

Nerve(1)

A

S’s

Facial expression (CN Seven)
Stapedius
Stylohyoid
posterior belly of digastric

CN VII

104
Q

3rd brachial arch derivatives think

Muscle (1)

Nerve (1)

A

pharyngeal

Stylopharyngeous

glossopharyngeal

105
Q

4-6th brachial arch derivative think

Muscle(2)

Nerve (1 w/ 2 branches)

A

thyroid and cricoid

4th
swallowing muscles - cricothyroid, levator palatine and pharyngeal constrictors

–enervated by superior laryngeal branch

6th
Larynx/voice box (EXCEPT cricothyroid)
–enervated by recurrent laryngeal branch

106
Q

Inferior parathyroids and thymus come from

A

3rd brachial pouch

107
Q

superior parathyroids come from

A

4th brachial pouch

108
Q

middle ear cavity comes from

A

1st brachial pouch

109
Q

palatine tonsils develop from

A

2nd brachial pouch

110
Q

monitors carotid body and sinus chemoreceptors

A

CN 9 - glossopharyngeal

111
Q

Unilateral lower extremity sensory and or motor loss

A

contra-lateral lesion of the anterior cerebral artery

112
Q

Unilateral facial and arm sensory and/or motor loss

A

contra-lateral lesion of middle cerebral artery

113
Q

vision defects

A

poterior cerebral artery

114
Q

hypersexulaty, hyperorality and disinhibited behavior found in

A

Kluver Bucy syndrome

Bilateral amygdala lesion

115
Q

Disinhibited behavior and problems with judgement and concentration

A

Lesion in the frontal lobe

116
Q

Views/pays attention to only half the world -

A

contrallateral lesion of the parietal lobe (non dominant)
- usually the R ignoring the L

hemineglect syndrome

117
Q

Agraphia, acalcula, finger agnosia and can’t from R from L -> lesion in

A

Dominant parietal lobe. usually the Left in a Right handed person

Gestman syndrome

118
Q

Lesion in the reticular activating system leads to

A

decreased levels of arousal

in the midbrain

119
Q

Common lesion of the mammalary bodies due to

A

Thiamin - B1 deficiency - seen in alcoholics

120
Q

Wenicke Korsakoff syndrome characterized by(5)

A 
confusion
opthalmoplegia
ataxia
memory loss
confabulation 
personality changes
121
Q

Basal ganglia lesions you may see

A

tremor at rest
chorea
athetosis

Anything coordinating voluntary movement from the cortex

122
Q

Intention tremor and limb ataxia seen in

may fall towards the lesion

A

cerebellar hemisphere lesion

123
Q

truncal ataxia and dysarthia (muscles of the mouth)

A

Cerebellar vermis lesion

124
Q

involuntary flailing of the limbs (contralateral hemiballismus ) seen in

A

lesion subthalamic nucleus

125
Q

Inability to make new memories (anterograde amnesia causing lesion )

A

hippocampus

126
Q

Lesion of paramaedian pontine reticular formation see

A

eyes looking away from the lesion

127
Q

paralysis of upward gaze

A

Parinauds syndrome

superior colliculi lesion

128
Q

Lesion of ? leads to inability to repeat phrases

A

arcuate fasciulus

129
Q

Wernickes

A

Fluent aphasia
- speaks but does not comprehend or make sense
word salad

superior temporal gyrus of temporal lobe

130
Q

Brocas

location?

A

nonfluent aphasia
-can’t speak but comprehends, very frustrating

inferior frontal gyrus of frontal lobe

131
Q

Nondominate Brocas lesion?

A

inability to express emotion (robot talk)

-probably a lesion on the R

132
Q

Nondominate Wernickies lesion ?

A

inability to comprehend emotion (spock)

- probably a lesion on the R

133
Q

Issue associated w/ inhaled anesthetics

A

hepatotoxicity

especially halothane

134
Q

Blood solubility and lipid solubility effects on anesthetics

A

Lipid solubility will determine how quickly it gets into the BBB and also the potency

Blood solubility is the time to effect. Low blood solubility means quicker reaction to effect

ex nitrous oxide is rapid in its effect (low blod solubility) but not very potent- not very lipid soluble

Halothane takes longer to have effect ( more blood soluble) but not more lipid soluble and thus more potent

135
Q

Inhaled anesthetics

4

A

Halothan
enflurane
sevoflurane
nitrous oxide

Used for induction and maintenance of general anesthesia (won’t remember)

136
Q

IV anesthetics types and MOA

4

A

Also some sedation seen as well

barbituates - acts on GABA receptor increasing the duration of Cl channels being open (thiopental or phenobarbital)

benzodiazepines- acts on GABA receptor increasing the frequency of Cl channels being open ( Diazapam and lorazepam)

ketamine - dissociative anesthetic- blocking NMDA receptors

Propofol - uses for sedation potentiating GABAa, rapid induction (Michael Jackson)

137
Q

Analgesics used in surgery (2)

Why might you choose one over the other?

A

Opioids

Morphine -local histamine release side effect

Fentanyl - more potent

Others
Butorphanol 
dextromethorphan
tramadol
loeramide and diphoxylate
138
Q

Blood flow concerns during brain surgery which IV anesthetic do you use

A

Barbituates have decreased blood flow in the brain

NOTE: ketamine causes increased cerebral blood flow

139
Q

Rx for barbituate overdose?

Rx for benzodiazapine overdose

A

none - supportive

flumazenil

140
Q

High risk of tryglcerides levels w/ continued use of this IV anesthetic

A

propofol

Used for rapid sedation in the ICU and short procedures

141
Q

Barbituate examples (4)

A

Thiopental
phenobarbital -> induces liver enzymes (Crigler Najarr Syndrome type II Rx?)
phentobarbiol
secobarbitol

142
Q

Most common drug used in conscious sedation

143
Q

Benzodiazabine examples (6)

A

diazapam
lorazapam
alprazolam
midazolam

tamazapm
chlordiazepoxide

144
Q

Uses of Benzodiazapones (7)

A

conscious sedation
anesthesia

alcohol withdrawal
anxiety
seizures
night terrors
insomnia
145
Q

2 types of local anesthetics
- both act how?

examples of each (3 each)

A

esters - procaine, cocaine, tetracaine

amides - lidocaine, mepivacaine, bupivacaine (2 Is)

all act by blocking Na channels on the inner portion of the channel, prefers active channels

does not work as well in acidic environments, like an infection, may need to use more

146
Q

Given w/ local anesthetics to potentiate result

A

vasoconstrictors like epinephrine

147
Q

3 things needs for general anesthesia

A

anesthetic
analgesic
immobilization - muscle paralysis

148
Q

MAC - in anesthesia

A

minimal alveolar concentration which 50% of pop anesthetized -

increased potency = 1/MAC
highly lipid drugs

149
Q

2 types to create neuromuscular blockade and examples of each

A

Depolarizing - Succinycholine

Nondepolarizing - -curarine; -curium; -curonium

tubocurarine,
atracurium, mivacurium,
pancuronium, vecuronium, rocuronium

150
Q

Succinylcholine MOA

risk?

A

strong ACH receptor agonist -> fasiculations and eventual paralysis with depolarization
-depolarizing

vc. non depolarizing which is a competitive antagonist

Worry of malignant hypertension

151
Q

Malignant hypertension seen in (2)

Gene?

Rx

A

succinylcholine use and neuroleptic malignant syndrome

Ryr1 mutation - rytanidine receptor

Rx Dantrolene - blocks Ca release from sarcoplasmic reticulum

152
Q

Non-depolarizing neuromuscular blocking drugs MOA and examples

Rx?

A

Competitive antagonists for ACh at the neuromuscular junction

Tubocurarine, atracurium, mivacurium, pancuronium, rocuronium,

Rx w/ neostigmine (cholinestrase inhibitor) - less degradation -> more Ach to overcome

153
Q

2 Types of depolarizing neuromuscular blocking and Rx

A

Phase I - prolonged depolarization

  • normal dose of succinylcholine
  • NO antidote, wait 10 min

Phase II - depolarized but blocked

  • overdose of succinylcholine
  • antidote w/ cholinesterase inhibitors like in non depolarizing blockade (20-30 min)
154
Q

seizure affecting only 1 area of the brain

Usually what lobe?

A

partial or focal

the temporal

either
simple - consciousness intact
complex - LOC

155
Q

What is the difference between a simple and complex siezure

A

both are partial seizures usually affecting the temporal lobe

Simple - consciousness intact
complex - LOC

156
Q

Status epileptics is defined by

Rx?

A

continuous seizure greater then 5 min or recurrent seizure w/o regaining conscious ness for >30 min

Benzodiazapin 1st line - diazepam or lorazepam

157
Q

5 types of diffuse seizures and differences

A

Absence - blank star
myoclonic - quick repetitive jerk
tonic - stiffening
tonic clonic- gran maul - alters between stiff and moving
atonic- drop seizure (appears to be fainting)

158
Q

Top 3 causes of seizures in kids

A

congenital, developmental and infection (febrile)

trauma and metabolic

159
Q

Top 3 causes of seizures in adults

A

tumors, trauma and stroke

maybe infection

160
Q

Top 3 causes of seizures in elderly

A

stroke, tumor and trauma

Maybe metabolic and infection

161
Q

Rx for trigeminal neuralgia (1 + 3 others)

usually affects which branch

A

Carbamazepine

phenytoin, gabapentin, topiramate

  • maxillary - > touch leads to EXTREME pain
162
Q

See port-wine stains (nevus flames) over the eye (V1 distribution called?

Causes (3)

A

Sturge Weber syndrome - congenital disease
- worry of ipsilateral leptomeningeal anginoma under the eye

Causes Seizures, glaucoma, and mental retardation

163
Q

Presentation of
Seizures, adenoma sebaceous (cutaneous angiofibromas),mental retardation
due to an autosomal Dom disease?

Which gene?

Associated symptoms (2)

Tumors (3)

A

Tuberous Sclerosis
- complete penetrance w/ variable expression
(TSC1 or 2 gene; hamartin or tuberin protein)

Ash leaf spots(hypomelaocytic macuoles), , harmatomas in CNS(retina) and skin (cortical tubers),

Tumors:
renal angiomyolipoma,
astrocytomas,
cardiac rhabdomyoma

164
Q

5 Seizure drugs blocking Na Channels

A 
Phenytoin
Carbamazapine
Lomotrigone
topiramate
valproic acid
165
Q

7 seizure drugs that increase GABA activity

A 
gabapentin
phenobarbital
valproic acid
benzodiazapine
tigabine
vigabatrin
levetiracetum
166
Q

3 seizure drugs that block T type Ca channels

A

gabapentin
ethosuximde
phenytoin - at high doses

167
Q

Rx of choice for absence seizures?

A

Ethosuximide -> valproic acid

168
Q

Rx for status epilepticus

A

benzodiazapine - lorazepam and diazepam

169
Q

Rx for eclampsia

A

Magnesium sulfate

maybe a benzo

170
Q

7 odd Side effects of phenytoin

A 
gingerval hyperplasia
hirsutism
fetal hydrantoin syndrome (cleft lip/palat; mental retardation, congenital heart)
megaloblastic anemia - low folate
peripheral neuropathy
drug induced lupus
Steven johnson syndrome
171
Q

Anti epileptics that are teratogens

A

phenytoin
carbamazapine
valproic acid - spina bifida worries

172
Q

Hepatotoxic epileptics(2)

A

valproic acid

carbamazapine

173
Q

Treatment for tonic clonic seizures (3)

A

Valproic acid
phenytoin
carbamazapine

174
Q

3 receptors and endogenist agonists to opiod receptors

A

mu - beta endorphin
delta - enkephalin
kappa -dynorphin

175
Q

aneurysm causes the eye to look down and out

A

posterior communicating artery

176
Q

aneurysm leading to loss of peripheral vision bilaterally

A

anterior communicating artery

USLME Kiss my ass and pray (33 decks)

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