Neuro/Psych Flashcards
Eye’s are down and out–nerve damaged?
Aneurisym of?
CN3
Posterior Cerebral Artery or Superior Cerebellar Artery
ANS Drug used Alzheimer’s? Mechanism?
Donepezil, Rivastigmine, Galantamine
Anticholinesterases
What ANS modulation in?
Alzheimers
PD
What not in HD?
AD: Donezepil (increase ACh levels via AChEI)
PD: Benztropine (knock down PSNS with anticholinergic)
HD: too little ACh (like AD therefore DONT GIVE ANTICHOLINERGICS)
Drugs with anticholinergic effects that aren’t anticholinergics per se?
H1 blockers, TCAs, Typical Neuroleptics.
Amantidine
Gq GCPR subunit mechanism and ANS receptors using it?
“cue-tsie” Q–>Ca–>PLC–>PKC
HAVe 1 M&M
H1, A1, V1 (vasopressin), M1, and M3***
just gotta remember M3 (bladder, eyes, exocrine secretion)
Gi subunit mechanism?
Receptors?
Gi inhibits AC which decreases cAMP
“MAD 2’s”
M2, alpha2, D2 (dopamine)
1) Tyrosine Kinase Receptor? What binds it?
2) JAK STAT pathway?
1) “Growth Factors”
Insulin, IGF, FGF, PDGF, EGF
Think about tyrosine kinase receptor inhibitors used to stop cancer cuz you want to stop the growth factor signal
2) Prolactin, Immunomodulators (Interleukins), Growth Hormone (NOT PDGF***), EPO
Tinnitus Vertigo Hearing loss?
If constant: Acoustic Schwanomas associated with NF2
If periodic: Meniere’s disese (defective endolymph resorption)
Recurrent Hemorrhagic Strokes usually result of?
Cerebral amyloid angiopathy (usually in elderly)…these strokes are less severe than ones caused by HTN.
- Epi?
- NE?
- Isoproterenol?
- DA?
- Dutamine?
- Phenyleprine?
- Alubterol?
- B>A (alpha wins at high doses, thus use for septic shock) EBA
- a1>a2>b1 Increases BP but decreases Renal Perfusion NAAB (dont use in septic shock cuz A1 agonism causes too much vasoconstriction which decreases CO)
- ONLY BETA IBB
- D1=D2>B>A DADBA
- Low doses: increased GFR and renal excretion (D1/D2) (good for renal’s!)
- High doses increase inotropy (B1) and vasoconstriction (A1)
- B1>B2, alpha thus Ionotrophic > Chronotropic DBBA (give in acute Heart failure)
- Stronger inotrope than chronotrope
- a1>a2 Vasconstriction PAA
- B2>B1
Patient has sharp electric-like painful shocks in her jaw:
Dx? Tx? SE?
Trigenmenal Neuralgia
Carbamazepine. Aplastic Anemia.
(lengthens Na channels time from inactivation to deinactivation).
Anecphaly assocaited with? Marker?
Maternal Diabetes, AFP and ACh increased
Arnold Chiari Malformation (II)
Cb tonsil and vermal herniation thru foramen magnum.
Pinches cerebral aqueduct causing hydrocephalus.
Dandy Walker
Cb vermis agenesis w/ cystic enlargmnt of 4th ventricle (“filling the posterior fossa”): hydrocephalus and spina bifida association
“Can’t walk dandy cuz your Cb isn’t there”
Process of Guillain Barre?
Inflammatory infiltrate into the ENDONEURIUM (thus peripheral nerves)
NTs inc/dec in which conditions?
Anxiety
Depression
HD
PD
AD
- Anxiety
- inc NE, decreased 5-ht/Gaba
- Dep
- Dec NE, DA, 5-ht
- HD
- Inc DA, Dec ACh, GABA
- PD
- Dec DA, inc 5-ht, ACh
- AD
- dec ACh
Major source of ACh in brain?
GABA?
5-ht
Da
NE
Basal nucleus of meynert
Nuc Accumbens
Raphe Nuc
VTA and SNc
LC
DA pathways and sxs?
Mesocortical
Mesolimbic
Nigrostriatal
Tubuloinfundibular
- Mesocortical
- VTA–>CTX; def cause negative sxs of psycosis
- Mesolimbic
- VTA–>limbic; def/inhibition causes RELIEF of psychosis
- Nigrostriatal
- sub nigra pars compacta –.straitum (caud/put)
- def=PD sxs
- stim=extrapyramidal sxs (eg neuroleptic malignant syndrome)
- Tubuloinfuldibular
- Arcuate nuc of hypothal–>pituitary
- blocking causes release of Prolactin from pituitary
- Stimulating can be used to tx prolactinomas
Where is oxytocin made?
Vasopressin?
Paraventricular nucleus of hypothalamus.
“pvN make oxytoCIN”
Supraoptic Nuc for ADH
Parts of hypothalamus:
PSNS/Cooling center?
SNS/Heating center?
Circadian rhythm?
“controls anterior pituitary?
ADH release?
GnRH release?
Anterior hypothal (A/C: anterior cooling via PSNS); also called preoptic area
Posterior heating (SNS controlled)
Suprachiasmatic nucleus (SCN)
A-rcuate controls A-nterior pit
Supraoptic
PREOPTIC (ANTERIOR NUC)
REM sleep _____ during the night?
Mediated by?
ETOH, Benzos, barbs effect on REM?
EEG wave form from awake to sleep?
Increases
PPRF (paramedian pontine reticular formatoin/conjugate eye gaze center)
Decreases REM and delta sleep
Beta, Alpha, Theta, Delta (BATD) (bedwetting/night terrors occur during DELTA)
Parts of Thalamus?
VPM
VPL
LGN
MGN
VL
vpM for trigeM
vpL for L-eminiscus (DCMLS)
LGN for vision
MGN auditory
VL motor
STN role?
STN stims GPi to inhibit VA/VL (indirect pathway): therefore damage to STN = hemibalisms
Lewy Bodies associated with?
Made of?
Disease characteristics?
PD
Alpha synuclein (intracellular esoinophillic inclusions)
PD TRAPS your body: Tremors (pill rolling), cogwheel R-igidity, Akinesia, Posturual instaiblity, Shuffling gate
Lesion in:
Amygdala (bilateral)
Frontal Lobe
Right Parietal temporal ctx
Left parietal temporal ctx
Mammillary bodies (bilateral)
Basal Ganglia
Amygdala (bilateral): Kluver bucy: hypersexuality, orality, and disinhibition
Frontal Lobe: orienation, judgement, concentration, possibly primitive reflexes
Right Parietal temporal ctx: Spatial neglect (contralateral agnosia)
Left parietal temporal ctx: Agraphia, acalculia, finger agnosia, and left-right disorientation (gerstmann syndrome)
Mammillary bodies (bilateral): Wernicke korsakoff syndrome
Basal Ganglia: Termor, hcorea, athetosis
Cb Hemispheres
Cb vermis
STN
Hippocampus (bilateral)
Paramedian Pontine Reticular Formation
Frontal Eye fields
Cb Hemispheres: Ipsi Ataxia, fall toward side of tremor
Cb vermis: Truncal ataxia and DYARTHRIA
STN: Contralateral Hemiballismus
Hippocampus (bilateral): Antergrade amnesia
Paramedian Pontine Reticular Formation: Eyes look away from side of lesion
Frontal Eye fields: eyes look towards lesion
Eyes looking up and to the right? (brain lesion not CNs)
Right sided frontal eye field defect or LEFT sided paramedian pontine reticular formation lesion
First line treatment for + SEs of drug:
Absence seizures
Simple/Complex Partial Seizures
Myoclonic
Absence + Tonic Clonic
Trigemnal Neuralgia First line?
- Absence Seizures:
- ethosuxsimide
- blocks T type calcium channels in thalamus
- GI, headahce, rash, steven johnson
- Simple/Complex Partial Seizures
- Carbemezipine
- Increases Na channel inactivation
- Risk for Agranulocytosis
- Myoclonic
- Valproic Acid
- Inc Na channel inactivation and [GABA]
- Hepatox, and Neural tube defects (teratogenic)
- Absence + Tonic Clonic
- Valporic >>>Ethosux
- Trigemnal Nerulagia
- Carbamazepine
Patient presents with right sides paralysis, and tongue deviates left. Stroke of?
- Left ASA Infarct
- Medial Medullary Syndrome (Medial nuclei are MOTOR)
- Contralateral Hemiparesis and proprioception issues, Ipsilateral hypoglaossal dysfunction
Patient presenets with Vomiting and vertigo, decreased pain and temperature on left side of body and right side of face. The patient has dysphagia and hoarseness with decreased gag reflex. Stroke of?
- Right PICA
- Lateral Medullary (wallenberg) Syndrome (lateral cranial nerve nuclei are sensory)
- Ipsi Face and contra STT of body, DYSPHAGIA AND HORSENESS (tell you medulla not pons***)
Paralysis and loss of pain/temp of Left Face, vertigo nystagmus, decreased corneal reflex. Stroke of?
- Left AICA
- Lateral Pontine Syndrome
- Ipsi paralysis of face, cerebellar, and cranial nerve 4-7 issues
Patient presents with visual field defects. Aneurisym of?
Anterior communicating artery compressing CNII
Patient’s eye is down and out with ptosis and pupil dilation. Aneurisym of?
Posterior Communicating Artery compressing CNIII (CN 4 and 6 still working to pull eye down and out)
Patient comes in with unstable gait, incoherent and has peed themselves
Normal Pressure Hydrocephalus
“Wet Wobbly and Wacky”
Person has troubling looking up or down?
Conjugate (both eyes) vertical gaze palsy due to a pinealoma compressing the superior colliculi.
Parinaud Syndrome
Brain stem nuclei for (associated CN?):
Visceral Sensory
Motor
ANS motor
- nucleus S-olitarius (sensory)
- CN 7, 9, 10 (taste, baroceptors, gut distention)
- lateral=sensory
- nucleus aMbiguus (M-motor)
- CN 9, 10, 11
- medial motor aMbiguus
- Dorsal Motor Nucleus
- CN 10 (PSNS to heart lungs, upper GI)
Where does CN pass thru:
2, 3, 4, 5-1/2/3, 6, Middle Meningeal A
2: Optic Canal
3, 4, 5-1, 6: Superior Orbital Fissure
5-2: Foramen Rotundum
5-3: Foramen Ovale
“SRO: Standing room only”
Middle Meningeal A: Foramen Spinosum
Where does CN pass thru:
CN 7, 8, 9, 10, 11, 12?
What passes thru foramen magnum?
7, 8: Internal Auditory Meatus
9, 10, 11, Jugular vein: Jugular Foramen
"JUGs at i-XXX-i (IX, X, XI)"
12: Hypoglossal Canal
Foramen magnum: spinal roots of CN 11, brain stem, vertebral Arteries
Damage to Superior orbital fissure results in loss of what reflexes?
CN 3, 5
Therefore loss of ADDuction (CN3), and loss of corneal reflex (CN5)
Opthalmoplegia, decreased corneal and maxillary sensation with NORMAL vision?
Cavernous sinus syndrome (mass effect or fisutal/thrombosis)
CN 3, 4, 5-1/2, 6 and post gang thru cavernous sinus
(here showing defects of 3, 5-1, and 5-2)
PSNS and SNS innervation of the eye
SNS: Lateral horn of SC (Ciliospinal center of buldge C8-T2)–>Superior Cervical ganglion (travels along cervical sympathetic chain)–>carodi plexus to Ciliary nerve to pupillary dilator muscles
PSNS–>Edinger westphal nucleus to ciliary ganglia via CN3 (only PSNS)–>Short ciliary nerves to upillary sphincter muscles
Disease associated with:
Spherical tau protein aggregates
Alpha synuclein
Spongiform cortex
Pick Disease (Frontotemporal Dimentia)–Pick bodies; spares pareital and posterior 2/3s of parietal. PD aspects + dimentia.
Lewy body dementia–dimentia with visual hallucinations followed by PD aspects.
Creutzfeldt-Jakob disease: Rapidly progressive. DIMENTIA WITH MYOCLONUS (startle myoclonus)—PrPsc into beta pleated shees
Nonautoimmune Destruction of Oligodendrocytes
Progressive Multifocal Leukoencephalopathy
JC virus in aids (BK virus in kidneys; JC=Junky Cerebrum, BK=bad kidney)
Rapidly progressive, usually fatal.
increased risk associated with Natalizumab (anti-alpha 4 integrin)
Patient with dark stains on face with seizures?
Sturge Weber Syndrome
STURGE: “Sporadic/Seizures, Tram track Ca2+, Unilateral, Retardation, Glaucoma, GNAQ gene, Epilepsy
Weber~port Wine
Glioblastoma Multiforme:
Adults, common, Malignant, cerebral hemispheres, Butterfly glioma (“buttergli”; crosses corpus callosum), GFAP+.
Pseudopalisading: border central areas of necrosis and hemorrhage (cuz its growing so fast) with VASCULAR PROLIFERATION
Meningioma
adult, Benign, common, arachnoid cell derived, dural attachment “tail”, seizures or focal deficits
Psammoma bodies, spindle cells concentrically arranged in whorled pattern
Possibly Estrogen sensitive (Hormone replacement therapy increases risk)
Schwannoma
adults, Central type vertigo, cerebellopontine angle
S-100+
Bilateral associated with NF-2 (chromo 22)
Hemangioblastoma
adults, Cerebellar, can produce EPO
von Hippel Lindau (chromo 3) when found with retinal angiomas
Closely arranged thin walled capiliaries
Oligodendroglioma
adult, Rare, slow growing
Frontal lobe, FRIED EGG cells (round nuc w/ clear cyto—PERINUCLEAR HALO: no pink stain just around the nuc)
Chicken wire caiplary pattern
Pituitary Adenoma
adults, Bitemporal hemianopsia
hyper/hypo pituitary sequelae
Pilocytic Astrocytoma
Histological feature??
Kids, well circumscribed posterior fossa (most CNS tumors are in post. fossa in kidos)
GFAP+, benign; CYSTIC AND SOLID (two components on MRI imaging vs 1 of medullo on imaging)*****
ROSENTHAL FIBERS (eosinophilic corkscrew fibers)
Medulloblastoma
Malignant Cb tumor of kids
Compresses 4th ventricle causing hydrocephalus
medBLUEloblastoma=blue cells that can “drop” met to SC
HOMER-WRIGHT ROSETTES
Features of:
Pilocytic Astrocytoma
Medulloblastoma
Craniopharyngioma
GBM
Menignoma
Oligodendroma
Pilocytic Astrocytoma: Rosenthal fibers (eosinophilic corkscrew fibers)
Medulloblastoma: Homer-wrigth rosettes (solid small blue cells)
Craniopharyngioma: Calcification
GBM: butterfly glioma (buttergli)
Menignoma: Psammoma bodies
Oligodendroma: Fried egg
DD Pilocytic astro with Medulloblastoma
DD neuroblastoma with medulloblastoma
1) Pilocytic astrocytoma will show cystic and solid component on imaging; medullo only solid
2) Neuroblastoma: adrenal tumor, crosses midline of abdomen (WIlms doesn’t), Bombesin +, produces catecholamines (HVA in urine) N-myc.
OPSOCLONUS-MYOCLONUS SYNDROME: nonrhythmic conjugate eye movments (not seen in medulloblastoma***)
Blown pupils, vision issues, ipsilateral paralysis
UNCAL HERNIATION compressing CN3 (blown pupil can be down and out), ipsilateral PCA compression (contralateral homonmous hemianopsia), contralateral crus cerebri (ipsi paralysis: false localixation sign)
Subluxation of the Lens?
Marfans or Homocysteinuria
Three strategies to increase DOPA availible for the brain?
Carbidopa: peripheral dopa decarboxylase inhibitor allows more dopa to get to brain
Entcapone/Tocopone: Peripheral** COMT inhibitors allowing more DOPA to get to brain (only effective if given with Levodopa). Tocapone=heptotox. Entacpone doesn’t have tox cuz ENts are awesome.
Selegiline/Resagiline: MAO-B (b for brain specific) inhibitors preventing central DA degredation. Selegiline has HTN crisis SEs
Chemo drug used for Brain cancers?
Nitrosureas cuz they can cross the BBB
Tx for ALS?
Riluzole.
Inhibits glutamate release resynaptically by blocking Na channel.
Riluzole: R-elief for Lou Gehrig disease
Anesthetics:
Decrease sol=?
Increase sol=?
Decrease solubility=rapid induction and recovery times
Increased solubility=increased potency=1/MAC; slower onset of action because more must be absorbed before adquate concentrates can be delivered to tissues
Associations?
Halothane
Methoxyflurane
Convulsions
Brain surgery
Halothane=Hepatotox (severe 80% mortality rate)
Methoxyflurane=Nephrotox (Meth for Neph)
Convulsions=Enflurane
Brain surgery=Isoflurane
Depolarizing NMJ blocker?
Antidote?
Describe phases and what antidote might do?
Succinylcholine
Neostigmine (AChEI)
Phase 1–shorter spikes; AChEI will POTENTIATE EFFECTS
Phase 2–tapering down of spikes (what all non-depol blockers look like)–AChEI will act as antidote
PD strategy?
BALSA:
Bromocriptine
Amantadine
Levodopa/carbidopa (B6 increased DA metabolism***)
Selegiline (and comt inhibitors): Entacpone (no tox, only peripheral inhibition), Tolcapone (hepatox, some CNS in addition to peripheral inibition); Selegiline=MOAB; good for MPT exposure from homemade demerol
Benztropine: antimuscarinic (improves tremor, no effect on bradykinesia)
AD drugs?
Memantine: NMDA receptor antagonists (dec Ca2+ excititotox)
Donepezil/Galantamine/Rivastigmine: AChEI
HD drug?
Haloperidol=DAR antagonist (want to knock down extra DA)
Personality Disorders?
“Weird, Wild, Worried” A, B, C
A: Weird (Accusatory, Aloof, Akward)– Paranoid, Schizoid (social withdrawal), Schizotypal (magical thinking)
B: Wild (B-ad to the B-one)–Antisocial, Borderline, Histrionic, Narcissistic
C: Worried (Cowardly, Compulsive, Clingy)–Avoidant, Obsessive compulsive, Dependent
Schizoid Personality?
Withdrawn no interest in social interactions
Schizotypal Personality
Withdrawn with MAGICAL THINKING
Borderline Personality?
Histrionic Personality
Obsessive Complusive Personlity?
Unstable mood and relationships. Self mutilation and impulsiveness.
Excessive Emotionality, Attention seeking, Sexually Provacative
Perfectionism; Behavior is consistent with own beliefs (compared with OCD that isn’t consistent)
Time frame for schizophrenia?
Brief psychotic d/o < 1 month < schizophreniform < 6 months < schiophrenia
Schizoaffective (schizo+bp)=2 weeks of stable mood with psychotic symptoms (shows that the disease is more schizo and less Bp/MDD
Typical Neuroleptics:
High Potency (2) and SEs:
Low Potency (2) and SEs:
How are atypical different?
Potency refers more to the side effects that does their effectiveness/dosing
High Potency: Extrapyramidal>Anticholinergic; Fluphenazine and Haloperidol
Low Potency: Anticholinergic > Extrapyramidal
Chlorpromazine (chloro=corneal deposits), Thioridazine (_thio hurts your eye-o’s=retinal deposit_s)
ATYPICALS TREAT BOTH POSTIIVE AND NEGATIVE SXS of schizo (vs typicals only treat positve)
Olanzapine: drug type? SEs?
Atypical neuroleptic
Weight gain, and risk for DM
Clozapine: drug type? SEs?
Atypical Neuroleptic
Agranulocytosis (why its used a third line for refractory schizo despite being so effective)
Overdose of Tricyclics?
pramines/triptylines
“Tri-Cs”: Convulsions, Coma, Cardiotox
PTSD vs Acute stress disorder?
3 days < Acute Stress disorder < 1 month PTSD
Buspirone use?
ONLY IN GENERALIZED ANXIETY DISORDER! (not for MDD etc)
Young woman who complains of weakness and numbness in extremeties with recent psychological stressor?
Conversion disorder
Not factitious (munchausen) or malingering (faking it for $$ gains)
Intraventricular hemorrhage result from damage to which artery?
Germinal Matrix Arteries
Result of proximal portion of neuron when distal is going thru wallerian degen? What does it look like?
Axonal Reaction
neuron because rounded, nucleus pushed to side, and RER becomes dispersed.
Pathways that use cAMP?
FLAT ChAMP
FSH, LH, ACH, TSH, CRH, hCG, ADH (V2), MSH, PTH
and calcitonin, GHRH, glucagon
Endocrine pathways that use IP3
GOAT HAG
GnRH, Oxytocin, ADH (V1), TRH, Histaimine, Angiotensin II, Gastrin
Steroid Receptors?
VETTT CAP
Vitamin D, Estrogen, Testo, T3, T4
Cotrisol Aldo, P4
S-100 positive tells you? Two examples?
Vimentin?
Cytokeratin?
S-100 tells you neural crest derived. Melanoma and Schwannomas are universially positive
Vimentin: Intermediate filament of mesenchymal tissues
Cytokeratin: Epitheleal cells
Suspected cause of narcolepsy?
Tx for Narcolepsy?
1) Decreased hypocretin (orexin)–used to stim wakefullness and inhibit REM sleep when you don’t want it
2) Modafinil (non-amphetamine stimulant) “provigil”
Charcot - Bouchard Pseudoneruisym vs Berry Aneurism?
Associated with? Presentation?
Large Lacunar Infarcts associated with?
Charcot: Associated with HTN, patient will present with focal neruo loss, usually in basal gang. NO SUBARACHNOID SXS usually.
Berries: heridiatry syndromes (Ehrlos-Danlos, Marfans, ADPKD), resulting in Subarachnoid hemorrhage (worst headache of life). Altered level of consciouness >> focal neuro deficits. Usually in circle of willis.
3) Hypertensive Arteriolar Sclerosis
Tx for serotonin syndrome?
Cyproheptadine (first gen antihistamine with antichol and antiserotin properties)
Effect of timolol on glaucoma?
Inhibits aqeuous humor of the epithelial cells of cilliary body
Medial Anterior horn vs Lateral Anterior horn?
Lateral anterior horn is for distal muscles (eg limbs)
Medial anterior horn is for proximal limb muscles (trunk)
MAOI’s–when to use them and what characterizes the condition?
Atypical Depression:
Mood reactivity, leaden fatigue (heavy arms/legs), rejection sensitivity, increased sleep/apetitie
Phentolamine?
Alpha 1 blocker
Insulin secretion regulation?
PSNS=stimulates thru sight and smell
SNS=Alpha 2 inhibits, Beta2 stimulates
Redirecting anger to something else? (2)
Sublimation: mature form–redirecting to something acceptable eg working out/sports
Displacement: redirecting to something unacceptable eg kids/pets
