Neurological

Question 1

Gray matter bs white matter

Answer 1

Gray matter: neurons, unmyelinated axons

White matter: myelinated axons: most sensory + motor neurons

Question 2

Forebrain

Answer 2

Back part of the brain (for understanding)

Includes: cerebrum, thalamus, hypothalamus

Question 3

Brainstem

Answer 3

Bottom part of brain to neck

Include: midbrain, pons, medulla (pon and medulla connect brain to spinal cord)

Question 4

Temporal lobe

Answer 4

Auditory, memory consolidation, smell

Question 5

Wernicke vs Broca

Answer 5

Broca: can’t talk but can understand

Wernicke: can talk, but doesn’t make sense

Question 6

Parietal lobe

Answer 6

Somatic sensory input

Question 7

Brain lobes

Answer 7

Frontal
Parietal
Temporal
Occipital
Sensorimotor

Question 8

12 cranial nerves

Answer 8

OOO, teacher touch a frank’s very gloss vaginal a high

O: olfactory
O: optic
O: occumolotor

T: trochlear
T: trigeminal
A: abductee
F: facial: lacrimal & salivary gland: Bell’s palsy affect this nerve
V: vesticulocochlear
G: glossopharyngheal: gag reflex, pharynx movement & sensation
V: vagus
A: accessory:
H: hypoglossal: tongue movement

Question 9

Meninge

Answer 9

Brain outer layer

From out to inside to brain:

Dura, arachnoid, pia

Question 10

Dermatone

Answer 10

Dermatone is a specific skin area that is inner aged ar the spinal cord

Cervical: C2-C5
thoracic: T1-T12
Lumbar: L1-L5
Sacral: S1-S3

Question 11

Nervous system

Answer 11

CNS: brain & spinal cord
PNS:
——somatic nervous system: sensory motor pathway
——autonomic nervous system: involuntary control
————–1. Sympathetic: fight or light (pre: Ach– post: NE– adrenergic receptor)
—————2. Parasympathetic: relax (pre: Ach–post: Ach; Muscarinic receptor )

Question 12

Stage of altered arousal

Answer 12

Lethargy: limited spontaneous movement or speech, but easy aroused with normal speech or touch

Obstrundation: fall asleep unless verbally or tactilely. Answer with minimal response

Stupor: deep sleep. With repeat stimulation, person only open eyes

Coma: no verbal response to any stimuli

Question 13

Agnosia vs anomic aphasia

Answer 13

Agnosia: Can’t recognize object

Anomic aphasia: can’t find words to name person or object

Question 14

Stroke types

Answer 14

1. Thrombotic stroke:
   —–TIA (clot intermittently block circulation or cause spasm)
   —–Stroke in evolution: intermittent progression of neurological defect over hours or days
   —–completed stroke: reach max destruction
2. Embolic: thrombus outside brain
3. Hemorrhagic: ruptured aneurysm (DM, HN, CAD)
4. Lacunar: microinfarcts: motor and sensory symptoms (DLP, HTN, DM, smoking)

Focal: only affect specific zones

Question 15

Dementia treatment

Answer 15

Try 1st line, if not work combine 1& 2
1st line: Cholinesterase inhibitor: prevent acetylcholine to be degraded, increase Ach, improve cognition, slow progression, help with non cognitive behaviour: Donepezil (1st choice with few side effect); Galatamine (if no effect 3-6 month, try other); Rivastigmine (help Alzheimer’s and Parkinson): ADR for all: low HR, peptic ulcer; give Donepezil in daytime

2nd line: NMDA: affect glutamate: memantine: slow progression, good for moderate ro severe Alzheimer’s.

3rd: antipsychotic: increase death, atypical psychotic is preferrred (SSRI: sertraline, citalopram)

Question 16

Pathophysiological of dementia

Answer 16

1. Neurofibrillary tangles
2. cortical atrophy
3. neuronal destruction and loss
4. Ach level declines
5. Excessive stimulation glumate: cause neuronal toxicity
   Plaque formation

Question 17

What cause peripheral nerve pain

Answer 17

Block of neuron

Question 18

Parkinson’s disease’s treatment

Answer 18

1st line: levodopa: a precursor of dopamine: most effective with carbidopa (cabidopa is prevent levodopa to be eaten up by enzyme)

2nd: dopamine agonist: improve symptoms: ergot, nonergot derivatives (pramipexole, ropinirole, rotgotine)

Antiviral: amantadine: inhibit DMDA receptor to potentiate dopamine: amantadine

MAO- B inhibtor: (reduce enzyme, increase dopamine, serotonin, NE) delay need for levodopa but don;’t slow down progression: help motor symptoms: selegiline, rasagiline

Question 19

Sleep phase

Answer 19

REM: 20% (dream occurs)

NEM: 80%: deep rest

Question 20

Sleep apnea

Answer 20

Airway resistance

Question 21

Restless leg syndrome treatment

Answer 21

1. Iron
2. Pregabalin
3. Dopaminergic (mimic dopamine): ramipexole, ropinirole
4. Dopamine agonist: bromocriptine, pramipexole, ropinirole

Question 22

Narcolepsy

Answer 22

Chronic neurological disorder that body can’t regulate sleep wake cycle

Question 23

Reflex epilepsy

Answer 23

Sensory trigger seizure: video game

Question 24

Status epilepticus

Answer 24

Before brain recover from the previous seizure, another seizure occurs

Question 25

Dilatin
Valproic acid
Carbamazepine

Answer 25

1at line to treat seizure: but note that seizure treatment is based on type of seizure

MOA: prevent Na reflux during nerve impulse

Dilatin toxicity: lateral nystagmus, ataxia,lethargy
Valproic acid: enhance GABA action
Carbamazepine: redeuce influx across neural membrane

Question 26

Triptan MOA

Answer 26

Serotonin agonist

Cause cerebral vasoconstriction: no use more than 9 days per month

Question 27

Ergot derivative

Answer 27

Partial agonist, antagonist of serotonin, dopamine, alpha adrenergic: constrict peripheral and cranial vessels

Question 28

Migraine treatment

Answer 28

1st line: NASAID–> if can’t: tylenol

2nd line: Triptan

Prevention treatment:
1. Antihypertensive: BBB, ARB
2. Antidepressant: amitriptyline

Question 29

Drugs that can cause delirium

Answer 29

AntiBP: diuretic, BBB, ACE, hydralazine
Antihistamine

Question 30

Diagnostic test for delirium

Answer 30

CAM: confusion assessment method: >=3 can diagnose

• acute onset of fluctuation
• disorganized thinking
• alerted LOC
• inattention