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USMLE World Q Bank > Neurology > Flashcards

Neurology Flashcards

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USMLE® Step 1 flashcards
1
Q

Methylmalonic Acid excess is cause by a deficiency in what enzyme?

A

Methylmalonyl CoA Isomerase which produces Succinyl CoA

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2
Q

Ragged red fibers on muscle biopsy are consistent with what type of disease?

A

Mitochondrial myopathy

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3
Q

What are the three bones of the ear?

A

Stapes, Malleus & Incus

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4
Q

What are the nuclei that project Acetylcholine, Norepinephrine and Seratonin to the brain?

A

Nucleus Basalis, Nucleus Ceruleus and Raphe Nucleus respectively. Matched when organized alphabetically.

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5
Q

If someone’s urine turns black that is pathopmnemonic for…

A

Homogentisate Oxidase. Which is part of the tyrosine to fumarate degradation pathway. This is known as alkaptonuria.

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6
Q

Which nerve do carotid and aortic baroreceptors travel up?

A

Glossopharyngeal for carotids and Vagus for aortic.

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7
Q

Which side effects of opioids are resistant to tolerance?

A

Constipation and miosis.

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8
Q

What is the difference between Wet and Dry Age-related macular degeneration (AMD)?

A

Dry AMD has subretinal drusen or pigments. Wet AMD has blood vessel proliferation that is driven by VEGF. Dry progresses to Wet.

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9
Q

Describe the appearance of a craniopharyngioma?

A

Suprasellar calcified cysts with stratified squamous epithelium filled with a yellow cholesterol fluid.

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10
Q

Which hypothalamic nucleus regulates the circadian rhythm?

A

Suprachiasmatic

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11
Q

Which hypothalamic nucleus regulates hunger?

A

Lateral, destruction leads to anorexia (Lateral makes you grow sideways)

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12
Q

Which hypothalamic nucleus regulates satiety?

A

Ventromedial, destruction leads to hyperphagia (medial makes you thin)

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13
Q

What can be a complication of correcting hyponatremia too quickly?

A

Central Pontine Myelinolysis (demyelenation)

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14
Q

What is the Chemoreceptor Trigger Zone (CTZ) and where is it located?

A

Sense chemicals in the blood and causes vomiting. It is on the dorsal surface of the medulla just inferior to the 4th ventricle. The fenestrated vessels allow it to sense all chemicals.

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15
Q

What is the signaling pathway of Mu Opioid receptors?

A

G-protein coupled receptors that increase K permeability in post synaptic neurons

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16
Q

What does organophosphate poisoning do?

A

They are acetylcholine esterase inhibitors. So they cause DUMBELS plus Muscle spasm/paralysis and they can even cause CNS depression or seizures.

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17
Q

What is the only mono-drug treatment for organophosphate poisoning?

A

Pralidoxine breaks the bond between AChE and the poison. All other drugs are either M or N antagonists.

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18
Q

Which drug gets metabolized to phenobarbital?

A

Primidone

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19
Q

What is the presentation of congenital toxoplasmosis?

A

Hydrocephalus, cognitive deficits, white-yellow chorioretinal lesions, intracranial calcifications.

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20
Q

What can be used to diagnose B1 deficiency?

A

Erythrocyte Transketolase Activity

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21
Q

The middle meningeal artery is a branch of what artery?

A

Maxillary Artery

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22
Q

What is the name of the junction between the frontal, parietal, sphenoid and temporal bones?

A

The Pterion. It is a week spot of the cranium and the middle meningeal artery can be injured.

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23
Q

What is the first line treatment for partial seizures?

A

Carbamazepine

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24
Q

What is the first line treatment for tonic-clonic seizures?

A

Phenytoin, Carbamazepine, and Valproate

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25
Q

What is the first line treatment for myoclonic seizures?

A

Valproic acid

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26
Q

What is the first line treatment for absence seizures?

A

Ethosuximide

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27
Q

Rosenthal fibers are pathopnemonic for…

A

Pilocytic astrocytoma: A child/teen CNS tumor with good prognosis. The histology also shows hair-like glial fibers and microcysts.

28
Q

What is the major histologic finding in Alzheimer’s disease?

A

Neurofibrillary tangles of tau protein.

29
Q

Describe a cluster headache?

A

Unilateral periorbital and temporal pain accompanied by lacrimation, ptosis and congestion. 15 to 90 minutes. Same time of day. Males > Females

30
Q

What causes recurrent lobar hemorrhages in an elderly patient?

A

Cerebral Amyloid Angiopathy. The beta amyloid plaques in the arteries cause weakness and lead to recurrent hemorrhagic strokes.

31
Q

What is the mechanism of action of Ethosuximide?

A

Blocks calcium T-type channels.

32
Q

What is the mechanism of action of phenytoin, carpamazepine and valproic acid?

A

Increase Na+ channel inactivation.

33
Q

What is the most COMMON complication after a sub-arachnoid hemorrhage? The most SERIOUS?

A

Common: Vasospasms of vasculature near the site of a ruptured aneurysm leading to ischemic focal injuries.
Serious: Rebleed.

34
Q

What are the three most important dopaminergic systems? Name their function.

A

Mesolimbic-mesocortical: Regulates behavior and is associated with Schizophrenia. Nigrostriatal for coordination of voluntary movement. Tuberoinfundibular to inhibit prolactin secretion.

35
Q

Which of the first line treatments for Tonic-Clonic seizures is also useful for bipolar disorder?

A

Valproic Acid. Gabapentin also treats both but it is not first line for either.

36
Q

In the case of inhaled analgesics what does the arterial-venous gradient indicate?

A

High gradients imply high solubility in the periphery which is undesirable as it will take longer to reach equilibrium and reach the desired targets.

37
Q

Explain the phases of neuromuscular block by Succinylcholine.

A

Phase I is the depolarization of N receptors. Muscle twitch is seen and it is potentiated by AChE inhibitors. Phase II the muscle depolarizes but the receptors are desensitized. Overcomes by AChE inhibitors.

38
Q

Which neurologic tumor has psammoma bodies?

A

Meningioma

39
Q

What are the three main adverse effects of succinylcholine? Describe a bit of the etiology.

A

Malignant hyperthermia from channels that remain open and cause Ca release and muscle contractions.
Severe hyperkalemia from the opening of the ACh N Receptor leakage of K. Seen in patients with myopathy, burns, crush injury and denervation.
Bradycardia from M activity or Tachycardia from sympathetic ganglion activity.

40
Q

What are the signs and symptoms of Tuberous Sclerosis?

A 
Hamartomas in the CNS
Angiofibroma
Mitral Regurgitation
Ash Leaf Spots
Rhabdomyoma
Tuberous Sclerosis
dOminant autosomal
Mental retardation
Angiomyolipoma
Seizures
41
Q

Compare and contrast Pilocytic astrocytoma and Medulloblastoma?

A

Both are brain tumors seen in the cerebellum of children. On MRI Pilocytic astrocytomas have a solid portion and a cystic portion. They are also more common. Medulloblastomas are solid tumors composed of sheets and they are more malignant.

42
Q

Compare and contrast microatheromas and Charcot-Bouchard aneurysms.

A

Both are caused by hypertension but cause different diseases with different findings. Microatheromas (lipohyalinosis) cause lacunar infarcts on the internal capsule, base of the pons or thalamus secondary to ischemia. Charcot-Bouchard are small aneurysms in the basal ganglia that rapture and cause hemorrhagic strokes. On MRI hemorrhage can be easily seen and lacunar infracts can be seen later as a cyst.

43
Q

What is the most neurologically relevant biochemical change in Alzheimer’s? (This is about biochemistry, not histopathology)

A

Decreased choline acetyltransferase activity in the nucleus basalis which has Cholinergic projections to the entire cortex.

44
Q

Which vitamin should be avoided by those on levadopa/carbidopa?

A

B6

45
Q

Describe Wernicke’s Encephalopathy. Which part of the brain is most often affected?

A

Cuased by thiamine deficiency and it often affects the mammillary bodies. Presents with amnesia, ataxia, nystagmus, opthalmoplegia. It can progress to Korsakoff psychosis.

46
Q

Describe the function of topoisomerase I and topoisomerase II? Which drugs target them?

A

Topoisomerase I only causes single stranded breaks to relieve negative coiling. Topoisomerase II causes double stranded breaks to relieve positive and negative coils. Etoposide targets I. Irinotecan and topotecan target II.

47
Q

What is the pathophysiology of Friedreich Ataxia?

A

Trinucleotide repeat in the Frataxin gene on Chromosome 9 leads to a mitochondrial dysfunction that causes excess free radicals.

48
Q

What are the signs and symptoms of Friedreich Ataxia?

A

Degeneration of spinal tracts. Ataxia. Kyphoscoliosis. Hypertrophic Cardiomyopathy that can lead to death.

49
Q

When giving IM injections to the gluteal region which two nerves can be injured? Where are they located?

A

Shots should be given on the superior-lateral quadrant because the sciatic nerve is in the inferior-medial quadrant and the superior gluteal is in the superior-medial.

50
Q

What is the first line treatment for trigeminal neuralgia?

A

Carbamazepine

51
Q

What is the presentation of halothane (inhaled anesthetic) toxicity?

A

Type 1 is a mild elevation of AST/ALT. Type 2 is a fulminant hepatitis seen days after the procedure. Prolonged PTT and esoniphilia. Believed to be an autoimmune cross-reactivity.

52
Q

Which polypeptide neurotransmitters are created by cleaving Proopiomelanocortin (PMC)?

A

Beta-endorphins (endogenous opioid), ACTH, MSH

53
Q

Which cell types are involved in the CNS response to ischemic injury?

A

First neutrophils and 3-5 days after infarct it should be microglial cells. These cell phagocytose myelin remnants and thus stain deeply with lipid stains. Astrocytes than form a boundary around the area. This is known as gliosis.

54
Q

What is the mechanism of action of triptans such as Sumatriptan? What are they used for?

A

Migraines and Cluster headaches can be relieved by this Serotonin receptor agonist that prevents the release of vasoactive peptides (ie. CGRP) by afferent neurons of the trigeminal nerve.

55
Q

What anatomical process does the internal branch of the superior laryngeal nerve run through? What reflex loop is it involved in?

A

The piriform recess. Cough reflex.

56
Q

What are the side effects of Carbamezapine?

A

Bone marrow suppression, hepatotoxicity, SIADH

57
Q

What type of movement disorder is characterized by a sustained contraction?

A

Dystonia.

58
Q

How do you distinguish lesions in the optic tract from lesions in the LGN?

A

Optic tract lesion damage the pupillary light reflex. LGN lesions have an intact light reflex.

59
Q

A pale retina with a cherry red spot on the macula is suggestive of…

A

Retinal Artery Occlusion

60
Q

What three drugs are used to increase dopamine and/or reduce Levidopa breakdown in Parkinsons?

A

Selegiline (MAO-B Inhibitor) Entacapone & Tolcapone (COMT inhibitors). Carbidopa somewhat increases CNS bioavailability by decreasing the L-DOPA decarboxylase activity in the periphery.

61
Q

Precocious puberty in combination with Parinaud syndrome (paralysis of upward gaze or convergence) are suggestive of what?

A

Pineal Gland Germinoma. The Parinaud sign is due to mass effects. Can also cause hydrocephalus.

62
Q

What is the first area damaged during global cerebral ischemia?

A

Hippocampus

63
Q

What drug can prevent CNS damage after a Sub-Arachnoid Hemorrhage?

A

Nimodipine (A Ca++ channel blocker) because it prevent the reaction vasospasm that cause ischemic brain injury.

64
Q

What is the treatment for essential tremor?

A

Patients self-medicate with EtOH. But beta blockers or primidone work best.

65
Q

How do ergot compounds (bromocriptine and pergolide) as well as pramipexole and ropinerol potentiate Parkinson therapy?

A

These are the direct Dopamine agonist.

USMLE World Q Bank (14 decks)

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