Neurology Flashcards
Which cervical nerve: shoulder/scapula elevation
C4
Which cervical nerve: shoulder abduction
C5
Which cervical nerve: elbow flexion, wrist extension
C5,C6
Which cervical nerve: elbow extension, finger extension
C7
Which cervical nerve controls biceps reflex?
C5, C6 (radial nerve)
Which cervical nerve controls triceps reflex?
C7,C8
Which nerve innervates anterior scrotum (labia majora in women); base of penis (mons pubis); medial thigh?
illioinguinal nerve
Which CN originates in medulla, exits via jugular foramen and has both Somatic/motor functions?
CN IX glossopharyngeal
A pure hemisensory stroke most likely occured in which brain region?
thalamus
Which CN nerve controls taste in posterior 1/3 of tongue?
CN IX glossopharyngeal
What is it called when LFCN lateral femoral cuntaneous nerve from L2 to L3 goes under inguinal ligament and pt. has lateral thigh paresthesia
meralgia paresthetica
What is the use of therapeutic hypothermia (33-35 deg. C/92-95 deg F)?
decrease formation of ROS; lower ICP, reduce excitatory neurotransmitters; down inflammation and apoptosis; blocks TNF and caspase pathways
sciatic nerve controls which flexor
knee flexion
Which nerve controls dorsiflexion and eversion of foot?
common fibular nerve
Which nerve controls lateral calf and dorsal foot sensory?
common fibular nerve
Which nerve controls plantar flexion and inversion of foot?
tibial nerve
Which nerve controls plantar surface sensation and Achilles reflex?
Tibial nerve
What peptide is involved in migraine headaches?
CGRP calcitonin gene related peptide
Which medicine can block CGRP calcitonin gene related peptide release in migraine headaches?
triptans
What is the MOA of erenumab migraine med?
antibody to CGRP (calcitonin gene related peptide)
What is the syndrome called of a dominant parietal lobe lesion that causes finger agnosia, agraphia, acalculia, and left-right dissociation?
Gerstmann Syndrome
Which neurological problem can long term B12 deficiency lead to?
Subacute combined degeneration
What areas of the brain are affected in subacute combined degeneration?
dorsal column, spinocerebellar tract, lateral corticospinal tract (spastic paresis)
Signs of Subacute combined degeneration
loss of position and vibration/ +Romberg/ spastic paresis
ToRCHS
Toxoplasmosis
Rubella
Cytomegalovirus
HSV
Syphilis
Which neonatal ToRCHS presents with cataracts, heart defects, sensorineural hearing defects
Rubella
Which ToRCHS presents with chorioretinitis, hydroencephalus, and diffuse intracranial calcifications
Toxoplasmosis
Which ToRCHS presents with microencephaly, paraventricular calcification
CMV
Which ToRCHS presents with rhinorrhea, skeletal anomalies, rash
Syphilis
MOA of Phenytoin and Carbamazepine
Na channel blockers
MOA Valproic Acid
Na channel blocker, increase GABA
MOA Benzodiazepine and phenobarbital
increase GABA (benzo by activating Cl channel frequency and phenobarbital by activating Cl channel duration
Good med for SAH
nimodipine (CCB) up cerebral vasodilation; down Ca excitotoxicity
Most primary tumors in adults are supratentorial or below tentorium?
Supratentorial
Most primary CNS tumors in children are supratentorial or below tentorium?
below tentorium
Which CNS tumors are GFAP+ (glial fibrillary acidic protein)?
astrocytomas including glioblastoma multifome, oligodendroglioma, ependymomas and peripheral neural sheath tumors
Which neuro marker is found in presynaptic vesicles of neurons, neuroendocrine and neuroectodermal cells?
synaptophysin
What nerve controls motor function of tongue?
CN XII (except for palantoglussus nerve which is innervated by CN V)
What nerve controls sensory function of tongue’s anterior 2/3?
mandibular branch of CN V
What nerve controls sensory function of tongue’s posterior 1/3?
CN IX
What nerve controls posterior area of tongue root?
CN X
What nerve controls anterior 2/3 taste?
chorda tympani of facial nerve CN VII
What nerve controls posterior 1/3 taste?
CN IX
What will you find on biopsy 12-24 hours after ischemic stroke?
red neurons, eosinophilic cytoplasm, pyknotic nuclei, loss of Nissl substance of RER
What will you find on biopsy 24-72 hours after ischemic stroke?
neutrophic infiltration
What will you find on biopsy 3-7 days after ischemic stroke?
macrophage (microglia) phagocytosis
What will you find on biopsy 1-2 weeks after ischemic stroke?
gliosis and vascular proliferation (liquefactive necrosis 1 week to 1 month)
What will you find on biopsy more than 2 weeks after ischemic stroke?
glial scar
Which lobe of the brain controls personality, language, motor function and executive function?
frontal
proteins from neuronal microtubules become hyperphosphorylated and dissociate from microtubules to form paired helical filaments called….
tau proteins (neurofibrillary tangles) of Alzheimer’s
Name 5 folate antagonists used as meds (one for humans, one for bacteria, one for protozoa; one for IBD, one for diuresis)
Methotrexate (RA/Cancer); Trimethoprim (PCP); Pyramethamine (protozoa); Sulfasalazine (RA/IBD); Triamterene (with HTCZ, diuretic for edema/HTN)
In which disease is there a depletion of hypocretin 1 (orexin A) which are secretory neurons of lateral hypothalamus that maintain wakefulness? What is the treatment?
narcolepsy; TX: modafinil /amphetamines
During uncal herniation if the ipsilateral CNIII is affected, what are the signs?
ipsilateral fixed and dilated pupil; if continues there will be paralysis of CNIII= ptosis and down and out gaze
During uncal herniation if posterior communicating artery is compressed, what are the signs?
contralateral homonymous hemianopia with macular sparing
During uncal herniation if cerebral peduncle is compressed what are the signs?
contralateral hemiparesis; if continued pressure, it will rupture basilar artery (fatal)
Which virus could cause meningitis with lower limb flaccidness, fever, mibilliform rash on back and chest; parkinsonism?
West Nile Virus (south, southwest US)
Which kind of meningitis can we see thick, gelatinous exudate at basal portion of brain causing CN palsy, ventriculomegaly, multiple infarcts?
TB meningitis (esp. in HIV and immunocompromised)
most commonly tested progressive cystic neuro disease of putamen
Wilson’s
Which problem consists of sensory ataxia (+Romberg), lancinating pains, neuro urinary incontinence, and Argyl-Robertson pupils?
Tabes Dorsalis (Tertiary syphilis)
Which problem comes from abrupt acceleration/deceleration causing immediate shearing of white matter tracts which could cause accumulation of alpha synuclein and amyloid precursor proteins?
Diffuse Axonal Injury (traumatic brain injury)
Which proteins are associated with early onset familial Alzheimer’s?
- Amyloid precursor protein (APP) on Ch. 21
- Presenilin 1 gene on Ch. 14
- Presenilin 2 gene on Ch. 1
Which protein is associated with late onset (after 60) familial Alzheimer’s?
epsilon 4 allele of Apolipoprotein E (causing formation of senile plaques)
Very long chained fatty acids (VLCFA) and Branched chain fatty acids cannot go to mitochondria for beta oxidation, to which organelle must they go?
Peroxisome VLCFA beta ox.; branched chain, alpha ox
Which disease has defective peroxisomes, craniofacial abnormalities, hepatomegaly, hypotonia, and seizures?
Zellweger
Which disease is there defective transport of VLCFA to peroxisome causing neuro degeneration and adrenal insufficiency?
X-linked adrenoleukodystrophy
Which organelle: protein sorting and transport
Golgi apparatus
Which organelle: digestion of debris and pathogens
lysosomes
Which organelle: TCA cycle; fatty acid oxidation, ETC, apoptosis
mitochondria
Which organelle: oxidation of VLCFA and H2O2 degradation
peroxisomes
Which organelle: degradation of ubiquitinated proteins?
proteasomes
Which organelle: synthesis of membranous and secretory proteins?
RER
Which organelle: drug detox, lipid/phospholipid sythesis; steroid synthesis
SER
Which analgesics have mu, delta, kappa and are coupled with G inhibitor proteins?
opiate analgesics
MOA opiate analgesics
close voltage gated Ca channels, reduce Ca influx, decrease neurotransmitter release (Ach, NE, Serotonin, glutamate, substance P) from presynaptic cleft; and at the post synaptic cleft open K channels and make hyperpolarized
Which neuromuscular blocking agents are competitive antagonists of nicotinic Ach receptors?
vecuronium, rocuronium
In which patients are vecuronium and rocuronium contraindicated?
myasthenia gravis pts. because they have few receptors and vecuronium/rocuronium will lead to paralysis with loss of airway patency
Name some abortive migraine therapies
triptans, NSAIDS, antiemetics, ergotamine
Name some preventative migraine therapies
topiramate/valproate (anticonvulsives); B blockers, TCA or venlafaxine (antidepressants)
Wallenberg syndrome usually involves which artery?
Posterior inferior cerebral artery PICA from vestibular artery
In Wallenberg’s: what does lesion of inferior cerebellar penduncle cause?
ataxia
In Wallenberg’s: what does lesion of vestibular nucleus cause?
vertigo, diplopia, nystagmus, vomiting
In Wallenberg’s: what does lesion of spinal trigeminal nucleus cause?
ipsilateral facial pain and temp. sensation loss
In Wallenberg’s: what does the lesion of nuclear ambiguus cause?
diminished gag reflex
In Wallenberg’s: what does lesion of spinothalmic tract cause?
contralateral loss of trunk and extremity pain and temperature sensation
+ Romberg’s defect in which nerves (central or peripheral) and what could cause + Romberg’s
peripheral nerve defect: tabes dorsalis, posterior column defect, or B12 deficiency
- Romberg’s associated with which kind of ataxia
cerebellar ataxia
Which kind of diagnostic tests could you use for cerebellar ataxia?
rapid alternating movements; finger to nose; heel to shin
Which problem is seen with ptosis, inability to smile or frown, disappearance of nasolabial fold, decreased tearing, and possible hyperacusis and/or loss of taste in ant. 2/3 tongue? Which CN?
Bell’s palsy, CN VII
With inhaled anesthesia is there more or less perfusion to the brain? What effect does that have? What effect to other organs?
more perfusion to brain causing increase in intercranial pressure; decreased blood flow to other organs
How does N. Fowleri enter the body and what are some treatments?
enters through the nose (warm, fresh water); Tx: dexamethasone, amphotericin B, azithromycin, fluconazole, rifampin, miltefosine
Which selective muscarinic antagonists can be used to reduce SE of cholinesterase inhibitors (diarrhea, nausea, sweating, abdominal cramp)
Glycopyrrolate or Hyoscyamine
MC cause of Phenylketonuria
phenylalanine hydroxylase deficiency
another cause of phenylketonuria
BH4 (dihydropteridine ) reductase deficiency : phenylalanine increased; serotonin decreased TX: low PHE diet and BH4 supplements
decerebrate and decorticate postures are caused by lesions in which brain area
pons and red nucleus
cause of Fragile X
hypermethalation on long arm of X chromosome causes inactivaton of FMR1 (Fragile X mental retardation 1) gene
Diabetic neuropathy: what kind of symptoms do lesions on small fibers cause?
positive symptoms (pain, paresthesia, allodynia which is pain out of proportion)
Diabetic neuropathy: what kind of symptoms do lesions on large fibers cause?
numbness, loss of proprioception and vibrational sense, + Romberg
What is CIM (critical illness myopathy)
decrease muscle membrane excitability and loss of myosin (atrophy of myofiber) after critical illness
What is CIP (critical illness polyneuropathy)
decreased nerve excitablitiy, axonal degeneration (injured by inflammatory mediators)
What area of the brain does anterior cerebral artery cover?
inferior frontal, medial frontal, superior medial parietal, anterior 4/5 corpus callosum, olfactory bulb, anterior basal ganglia, and internal capsule
What area of brain does MCA cover?
temporal lobe, deep subcortical structure like internal capsule and basal ganglia,
What area of brain does basilar artery cover?
brainstem and bilateral cerebellar hemispheres
What area of brain does the artery of Percheron cover?
It is a branch of PCA that supplies bilateral thalamic and dorsal midbrain
What area of brain does anterior choroidal artery cover?
final branch of internal carotid that supplies posterior limb of internal capsule, optic tract, lateral geniculate; choroid plexus, hippocampus, amygdala
What are the clinical presentation of ALS (amyotrophic lateral sclerosis) and current treatment and treatment’s MOA?
LMN symptoms: muscle weakness, atrophy, fasciculations
UMN symptoms: spasticity, hyperreflexia, and pathological reflex
Tx; riluzole (think riLOUzole for Lou-Gherig) MOA decrease glutamate release
Innermost layer of connective tissue that surrounds nerve axon which is affected in Guillain Barre
endoneurium
Which part of hypothalamus controls satiety?
ventromedial
Which part of hypothalamus controls hunger?
lateral
Which part of hypothalamus mediate heat dissipation?
anterior
Which part of hypothalamus mediates heat conservation?
posterior
Which part of hypothalamus secretes dopamine and GHRH ?
arcuate
Which part of hypothalamus secretes GnRH and regulates sexual behavior?
medial preoptic
Which part of hypothalamus secretes oxytocin, CRH, TRH and small amounts of ADH
paraventricular
Which part of hypothalamus secretes ADH and small amount of oxytocin
supraoptic
Which part of hypothalamus regulates circadian rhythm and pineal gland function
suprachiasmatic
L2-L4 radiculopathy weakness
hip flexion (iliopsoas); hip adduction; knee extension (quadriceps) ; affected patellar reflex
L5 radiculopathy weakness
foot dorsiflexion and inversion (tibalis anterior)
foot eversion (peronius)
toe extension (extensor hallucis and digitorium)
S1 radiculopathy weakness
hip extension (gluteus maximus)
foot plantarflexion (gastrocnemius); affected Achilles reflex
S2-S4
affected anocutaneous (wink); urinary or fecal incontinence; sexual dysfunction
What kind of brain herniation occurs under the cingulate gyrus and what are the signs?
subfalcine: contralateral leg weakness (ipsilateral ACA compression)
What kind of brain herniation happens when medial temporal lobe herniates under tentorium cerebelli and its signs?
uncal herniation: ipsilateral dilated and fixed pupil; early contralateral hemiparesis due to ipsilateral cerebral peduncle compression; late ipsilateral hemiparesis due to contralateral cerebral peduncle compression
What kind of herniation involves caudal displacement of diencephalon and brainstem and what are the signs?
central herniation: bilateral midposition and fixed pupils (loss of sympathetic and parasympathetic innervation); decerebrate or decorticate posturing (involves red nucleus); later rupture of basilar artery branches and death
Which nerve controls hip flexion, knee extension and sensation in anterior thigh
femoral nerve
Which nerve controls sensory in medial leg and foot?
saphenous
two dopa agonists used in Parkinson’s
Bromocriptine and Pramipexole
What is TDP43?
transactive response DNA binding protein43: protein that normally transmitter inhibitor or helps in DNA repair but abnormal ubiquitination leads to immunoreactive inclusions; plays a role in frontal lobar dementia and ALS
What is it called when you have mutation of BCHE gene and are unable to metabolize succinylcholine (have paralysis for hours)?
pseudocholinesterase deficiency (AR)
Which microaneurysms occur at the basal ganglia, cerebellum, thalamus, pons, are caused by HTN and lead to progressive deficits:
Charcot-Bouchard aneurysms
Possible cause of absence seizures
hippocampal sclerosis from childhood febrile seizures
focal seizures that occur in a single hemisphere
focal aware seizures (previously known as simple partial seizures)
focal seizures consisting of blank stares and automatisms
focal impaired awareness seizures
DRESS and which drugs cause it?
drug reaction with eosinophila and systematic symptoms: commonly caused by anticonvulsants, allopurinol, sulfonamide, antibiotics (vancomycin)
defect in SMN1 gene which encodes a protein involved in assembly of small nuclear ribonucleoproteins (snRNPs) in lower motor neurons; defective snRNPs=impaired spliceasome: dysfunction and degeneration of anterior horns of spinal cord: which disease?
Spinal Muscular Atrophy
pharyngeal arch 1 which nerve
trigeminal nerve CN 5
Pharyngeal arch 2 which nerve
facial nerve CN7
pharyngeal arch 3 which nerve
glossopharyngeal CN9
pharyngeal arch 4+6 which nerve
Vagus CN10
Which tract controls voluntary muscle activity?
corticospinal tract (pyramidal)
damage to UMN results in
spastic paralysis, clasp knife rigidity, hyperreflexia, Babinski+
damage to LMN
flaccid paralysis; hypotonia; hyporeflexia; atrophy; fasciculations
abnormal, dilated blood vessels with thin adventitia and lacking elastic fibers and smooth muscles (may cause seizures)
cavernous hemagioma
What modulates basal ganglia output?
subthalmic nucleus
lacunar stroke to subthalmic nucleus can cause
hemiballismus
scapular wing found in which nerve damage
long thoracic n.
nerve easily injured during mastectomy from C5-C7 and responsible for full extension and medial rotation and adduction of arm
thoracodorsal N
damage to this nerve will show weakness in flexing or extending humerus
medial pectoral and lateral pectoral
Which nerves are purely sensory for upper arm and axilla?
intercostobrachial n.
muscles of inspiration
SCM( C1-C4), diaphragm(C3-C5phrenic n.), scalenes (C4-C8), external intercostales (T1-T11)
muscles of expiration
internal intercostal T1-T11
abdominal muscles T4-L1
trochlear nerve palsy (CN IV)
innervates superior oblique, causes eye to intort (up and in); seen in DM2 and microvascular nerve ischemia; usually tilt head to correct vision
innervates forearm flexors, biceps, brachialis, and coracobrachialis and lateral forearm cutaneous innervation
musculocutaneous n.
seizure med that causes gingival hyperplasia, coarse facial features and hirsutism in long term use
phenytoin
Failure of repair DNA (BRCA1/BRCA2) cause mutation in FAN gene) causes aplastic anemia; AML;
Fanconi Anemia
TX for Fanconi Anemia
bone marrow transplant (definitive)
list some disorders caused by deficiency to repair DNA
1) ataxia telangiectasia
2) xeroderma pigmentosa
3) Fanconi anemia
4) Bloom syndrome (generalized chromosome instability, susceptible to neoplasms)
5)HNPCC
MCC of spontaneous lobar hemorrhage
amyloid angiopathy
MCC of spontaneous lobar hemorrhage in children
AVM
Disease which manifests with lower extremity weakness, muscle atrophy, peripheral neuropathy, mutations encoding peripheral nerve axons or myelin
Charcot-Marie-Tooth (CMT1 gene)
receptor when stimulated causes constriction of internal urinary sphincter, raises BP and mydriasis
alpha 1
receptor when stimulated raises heart rate, and increases heart’s contractility and conductance
beta 1
receptor when stimulated dilates bronchioles, relaxes uterus (tocolysis); and vasodilates (lowers BP)
beta 2
Condition in which spinothalamic tract is impinged and causes loss of temperature or pain sensation
syringomelia
Ataxia due to degeneration of spinocerebellar tracts; loss of vibration and position (degeneration of dorsal columns)
Friedrich’s ataxia
Which vitamin deficiencies can mimic Friedrich’s ataxia?
Vita B12 or Vita E
Which brain tumor is paraventricular and has pseudorosettes surrounding capillary
ependymoma
Which brain tumor has eosinophilic granular bodies and hairlike processes (Rosenthal)
pilocytic astrocytoma
Which brain tumor has cells with “fried egg appearance”
Oligodendroglioma
Which brain tumor has small blue cells that surround neuropile ; Homer Wright rosettes
medulloblastoma
Which brain tumor: hypercellular areas of atypical astrocytes bordering regions of necrosis (pseudopallisading)
glioblastoma
VEGF inhibitors for age related macular degeneration
ranizumab, bevacizumab
progressive dystrophy of retinal pigment and photo receptors
retinitis pigmentosa
nerve that innervates SCM and trapezius
spinal accessory nerve CNXI
SCLC, breast, ovarian, uterine malignancies: progressive worsening and dizziness, limb and trunk ataxia, dysarthria, visual disturbance, immune response against tumor cells that cross react with Purkinje neuron antigens: antiYo, antiHu, anti P/Q
paraneoplastic cerebellar degeneration
melatonin agonist, good sedative for elderly
Ramelteon
main area of sertonergic neurons
raphe nucleus
cholinergic neurons that are decreased in Alzheimers causing Ach to decrease
nucleus basalis of Meynert
motor coordination of upper extremities
red nucleus
dopaminergic area
substatia nigra
reward and pleasure area
nucleus accumbens
