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Neurology Flashcards

1
Q

What type of neuronal cell has a different embryonic origin than the rest?

A

Microglia - from mesoderm; CNS macrophage

Others are from neuroectoderm

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2
Q

Stains for different cells?

A

Nissl substance = dendrites, cell bodies (RER) - NOT axons

GFAP = astrocytes

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3
Q

Blood Brain Barrier

A
  1. tight junctions nonfenestrated endothelial cells
  2. BM
  3. astrocyte foot process

Lipids get through
Glucose/AA need carriers

NOT present in area postrema and neurohypophysis

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4
Q

Lateral Area Hypo

A

Hunger
Inhibited by Leptin
Destruction: anorexia, FTT

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5
Q

Ventromedial Area Hypo

A

Satiety
Stimulated by Leptin
Destruction: obesity, hyperphagia

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6
Q

Anterior Hypothalamus

A

Cooling, PNS

“Anterior nucleus = A/C”

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7
Q

Posterior Hypothalamus

A

Heating, Symp

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8
Q

Suprachiasmatic Nucleus

A

Circadian Rhythm

Stimulates pineal gland -> melatonin

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9
Q

Preoptic Area Hypothalamus

A

GnRH

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10
Q

Dorsomedial Nucleus

A

Stimulates GI - savage behavior, obesity

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11
Q

Arcuate Nucleus

A

Dopamine

GHRH

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12
Q

Supraoptic Nucleus

A

ADH

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13
Q

Paraventricular Nucleus

A

Oxytocin

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14
Q

Stages of Sleep and EEG waveform

A

“BATS Drink Blood”

Awake (open eyes) = beta (highest freq, lowest amp)
Awake (closed eyes) = alpha

N1 light sleep = theta
N2 deeper sleep; bruxism = sleep spindle, K complexes
N3 deepest/slow wave sleep = delta (lowest freq, highest amp)

REM = beta

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15
Q

What stage of sleep associated with night terrors, sleep walking, bedwetting? What drugs treat?

A

N3

EtOH, Benzo, Barb = decreased REM and delta sleep
Bedwetting = DDAVP

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16
Q

What happens during REM sleep?

A 
loss of motor tone 
variable pulse, BP 
dreaming 
penil/clitoral tumescence
memory processing
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17
Q

What characterizes narcolepsy? What stage? Tx?

A

Awake -> REM sleep:

  • excessive daytime sleepiness
  • cataplexy
  • HypnoGOgic (going to sleep); HypnoPOmpic (post sleep) hallucinations

Tx:

  • stimulants: amphetamine, modafinil
  • PM sodium oxybate GHB
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18
Q

Changes in sleep stages in depression?

A
  • dec. slow wave N3 deep sleep
  • inc. total REM
  • rpted PM awakenings
  • early AM awakening
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19
Q

Kallman Syndrome?

A

Dec. GnRH (Hypogonadism) + Anosmia

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20
Q

Corneal & Lacrimation Reflex

A

CN V1

CN VII

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21
Q

Jaw Jerk Reflex CN

A

V3

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22
Q

Pupillary Reflex CN

A

CN II

CN III

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23
Q

Gag Reflex CN

A

CN IX

CN X

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24
Q

Mnemonic for S vs. M in CN?

A

Some Say Marry Money But My Brother Says Big Brains Mean More

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25
Q

CN Pathway

A 
1 Cribiform Plate
2 Optic Canal 
3, 4, 6, V1 Superior Orbital Fissure
V2 Foramen Rotundum
V3 Foramen Ovale 
7, 8 Internal Auditory Meatus
9, 10, 11 Jugular Foramen
12 Hypoglossal Canal

Foramen Magnum = spinal roots of Cn XI, Brain stem, VA

V = Standing Room Only

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26
Q

Damage to CN III vs. IV vs. VI?

A

CN III: “Down and out,” ptosis, mydriasis, loss of accommodation

CN IV:

  • eye moves upward
  • esp with contralateral gaze
  • compensatory head tilt TOWARD side of the lesion

CN VI:
- medial eye, can’t abduct

  • Obliques move the eye in the Opposite direction”
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27
Q

Afferent vs. Efferent Pupillary Eye Defect?

A

Afferent = Marcus Gunn Pupil = Optic N. damage

  • affected eye: nothing constricts with light
  • unaffected eye: both will constrict with light

Efferent = Oculomotor N.
- affected eye UNABLE to constrict with light in EITHER eye

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28
Q

Meyer vs. Dorsal Optic Radiation?

A

Meyer = temporal loop

Dorsal Optic = parietal loop

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29
Q

Forebrain (Prosencephalon)

A 
Telencephalon = Cerebral Hemispheres; Lateral ventricles
Diencephalon = Thalamus; 3rd ventricle
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30
Q

Midbrain (Mesencephalon)

A

Mesencephalon = Midbrain; aqueduct

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31
Q

Hindbrain (Rhomboencephalon)

A 
Metencephalon = Pons, Cerebellum, upper 4th ventricle
Myelencephalon = Medulla, lower 4th ventricle
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32
Q

Screening for NT defects

When do neuropores normally fuse?

A

Elevated AFP in maternal serum or amniotic fluid

4th week

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33
Q

Spina Bifida Occulta vs. Meningocele vs. Myelomeningocele

A

Spina Bifida Occulta - opening in bone spinal canal, tuft hair/dimple, nl AFP

Meningocele - meninges out

Myelomeningocele - meninges + spinal cord out

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34
Q

Anencephaly associated with what condition?

A

Failure of anterior NT to close - inc. AFP

Polyhydramnios (no swallowing center)

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35
Q

Holoprosencephaly due to what?

A

Failure of L and R hemispheres to fuse.
Sonic Hedgehog Pathway
Midline deformities - cleft lip/palate, cyclopia

36
Q

Chiari I vs. II

A 
I = tonsils -> syringomyelia 
II = vermis & tonsils -> hydrocephalus, assoc. myelomeningocele
37
Q

Dandy-Walker

A

Agenesis of cerebellar vermis
Enlargement of 4th ventricle (to fill posterior fossa)
-> Hydrocephalus
-> Assoc. spina bifida

38
Q

Jaw, Uvula, Tongue, Neck Deviate towards or away lesion?

A 
Tongue = Towards "licking the lesion" CN XII
Uvula = Away - good side works CN X
Jaw = Towards CN V3 
Neck = Weakness turning head towards CONTRALAT side of lesion. (SCM). Droop of ipsilateral shoulder (Trapezius) CN XI
39
Q

Kluver-Bucy

A

hyperorality
hypersexuality
disinhibition

Bilateral Amygdala

40
Q

Right Parietal-Temporal (non-dom)

A

Hemineglect

41
Q

Left Parietal-Temporal (dom)

A

Gerstmann Syndrome

  • agraphia
  • acalculia
  • finger agnosia
  • L and R disorientation
42
Q

Mammillary Bodies - lesion leads to?

A

Wernicke-Korsakoff

  • ataxia, confusion
  • opthalmoplegia, CN VI palsy
  • memory loss, confabulation

CAN of beer = confusion, ataxia, nystagmus
Give thiamine!

43
Q

Cerebellar vermis vs. cerebellar hemisphere lesions?

A

IPSILATERAL defects

Hemisphere = “Hemispheres are lateral, affect lateral limbs”

  • lateral limb ataxia
  • intention tremor
  • fall TOWARD side of lesion

Vermis = “Vermis is centrally located; affect central body”

  • truncal ataxia
  • dysarthria
44
Q

Subthalamic Nucleus lesion?

A

Hemiballismus

45
Q

PPRF vs. Frontal eye field lesions?

A

PPRF: AWAY from side of lesion

Frontal Eye Field: TOWARD lesion

46
Q

Superior Colliculi lesion?

A

Paralysis of upward gaze (Parinaud’s Syndrome)

47
Q

Central Pontine Myelinolysis causes?

A

Locked In Syndrome
Correct HypoNa too fast

“If you go from low to high, your pons will die”
“If you go from high to low, your brain will blow”

48
Q

Broca vs. Wernicke vs. Conduction

A 
Broca = expressive aphasia
Wernicke = comprehensive aphasia 
Conduction = can't repeat; arcuate fasiculus
49
Q

Cavernous Sinus Structures

A

CN 3, 4, 6, V1, V2
Internal Carotid
Internal Jugular Vein

50
Q

Weber Syndrome?

A

Midbrain Infarction - PCA

  • CN III palsy
  • contralateral spastic hemiparesis (cerebellar peduncle)
51
Q

What artery supplies the pons?

52
Q

Medial Inferior vs. Lateral Pons

A

Medial Inferior

  • Motor - contralateral
  • ML - DC contralateral
  • PPRF - gaze towards side of lesion
  • CN VI

Lateral: 4 “S” + 7,8

  • spinocerebellar - ipsi
  • spinothalamic - ALS contra
  • sympathetic - ipsi Horners
  • sensory nuclei of V
  • CN VII
  • CN VIII

“Facial droop = AICA’s pooped”

53
Q

4 Ms and 4 S of brainstem lesions?

A

M:

  • Motor
  • ML
  • MLF
  • Motor CN

S:

  • spinocerebellar - ipsi
  • spinothalamic - ALS contra
  • sympathetic - ipsi Horners
  • sensory nuclei of V
54
Q

Wallenberg Syndrome?

A

Lateral Medulla - PICA

4 S + 
Nucleus Ambiguus +
- hoarseness 
- dysphagia
CN VIII 
- n/v, vertigo, ataxia
55
Q

Medial Medulla Syndrome?

A

ASA

  • Motor, ML
  • CN XII
56
Q

Acom vs. Pcom presentation?

A

Both are usually saccular aneurysm

ACom = Bitemporal Hemianopsia
PCom = CN III palsy
57
Q

Right INO sx

A

MLF - coordinates abducens with CN III to move eyes in same direction

Right INO = Right MLF messed up
On leftward gaze,
- R eye can’t adduct
- L eye nystagmus

“MLF in MS”

58
Q

Areas of brain most vulnerable to ischemic stroke? What about hemorrhagic stroke?

A 
Ischemic: 
Hippocampus
Neocortex
Cerebellum 
Watershed!

“ischemic HYPOxia - “HIPPOcampus” most vulnerable

Hemorrhagic:
Basal Ganglia

59
Q

Imaging type to show changes in ischemic stroke earliest?

A

Diffusion Weighted MRI: bright

Note: NCHCT: dark

60
Q

Communicating vs. Noncommunicating Hydrocephalus? Sx?

A 
Communicating = dec. CSF absorption 
Noncommunicating = structural blockage

H/A, papeilledema, uncal herniation - CN III palsy, death

61
Q

NPH

A

“wet, wobbly, wacky”

62
Q

Triptan - MOA, Toxicity?

A

Serotonin agonist - inhibits CN V activation, vasoconstrict

Toxicity: coronary vasospasm (contraindicated in CAD, Prinzmetal angina)

63
Q

Acronym for Brain Tumors: Adult vs. Child

A

Adult: MGM Studios:
Metastatic, GBM, Meningioma, Schwannoma

Child: Animal Kingdom, Magic Kingdom, Epcot:
Pilocytic Astrocytoma, Medulloblastoma, Ependymoma

64
Q

Histologic Features of Adult Brain Tumors

A

GBM (Malig, Astrocytoma IV): pseudopalisading, GFAP

Meningioma (Benign): dural tail, whorled pattern, psamomma bodies

Schwannoma: S-100(+), cerebellarpontine angle

Hemangioblastoma: thin-walled capillaries, with minimal interweaving parenchyma

Oligodendroma = fried egg

65
Q

Hemangioblastoma associated what condition?

A

von Hippel Lindau:

  1. hemangioblastoma - CNS, retina
  2. erythropoietin -> polycythemia
  3. renal cell carcinoma
66
Q

Histologic Features of Child Brain Tumors

A

Pilocytic Astrocytoma: GFAP, Rosenthal fibers (corkscrew eosinophilic)

Medulloblastoma: Homer-Wright Rosettes (rosettes around just fibers)

Ependymoma: Perivascular Rosettes (rosettes around capillary

Craniopharyngioma: Calcifications

67
Q

Uncal Herniation Features

A

Uncus = medial temporal lobe

  1. CN III - down and out
  2. ipsi PCA - contralat homonymous hemianopsia
  3. contral cerebral peduncle = ipsilateral paralysis
68
Q

IV Benzo used for anesthesia?

A

Thiopental

69
Q

IV Benzo used for anesthesia?

70
Q

Toxic effect of inhaled anesthetics?

A

Malignant Hyperthermia (All except NO)

Halothane is Hepatotoxic

71
Q

What anesthetic can cause dissociation, disorientation, hallucination?

72
Q

Why shouldn’t we keep someone in the ICU on propafol drip?

A

Rapid induction, but HIGH TAG content

73
Q

Local Anesthetic: two organic molecule types?

A
  • caine
    Esters
    Amides: two I’s
74
Q

What do you give to enhance local anesthetics?

A

Epinephrine vasoconstrict

75
Q

What situation would you probably need more local anesthetic?

A

infected (acidic) tissue - can’t get thru membrane as effectively since alkaline anesthetics will be charged

76
Q

Toxicity of Local anesthetics?

A

CNS excitation, Arrhythmias

77
Q

What are the two types of Neuromuscular blocking drugs?

A
  1. Depolarizing = Succinylcholine
    - depolarizes, so Ach agonist but its sustained so no muscle contraction
  2. Nondepolarizing = -curarine, curium
    - competitive antagonist to Ach
78
Q

Order of loss with local anesthetics

A
  1. pain
  2. temperature
  3. touch
  4. pressure

Small > Large
Myelinated > Non

79
Q

How do you reverse nondepolarizing NM agents?

A

Neostigmine + Atropine (prevent Muscarinic effects like bradycardia)

80
Q

Toxic Effects of Succinylcholine

A

HyperCa
HyperK
Malignant Hyperthermia

81
Q

STURGE-weber

A 
Sporadic; Stain - port wine 
Tram Track Ca
Unilateral 
Retardation
Glaucoma/GNAQ gene
Epilepsy
82
Q

Tuberous Sclerosis

A

HAMARTOMAS:

Hamartomas in CNS and skin
Angiofibromas on the skin (reddish brown papules)
MR 
Ash-leaf spots
Rhabdomyoma cardiac
(Tuberous Sclerosis) 
autosomal dOminant
Mental Retardation 
Angiomyolipoma renal 
Seizures/Shagreen patches/SEGA
83
Q

NF I

A

ADom: Chr 17

cafe au lait
lisch nodules 
neurofibromas 
pseudoarthrosis
meningioma, astrocytoma, glioma, pheo
84
Q

vHL

A

autosomal dominant:

  1. cavernous hemangioma
  2. bilateral renal cell carcinoma
  3. hemangioblastoma
  4. pheo

vHL = tumor suppressor

85
Q 
NT - location of synthesis
NE
Dopa
5HT
Ach
GABA
A 
NE - locus ceruleus (pons)
Dopa - substantia nigra (midbrain)
5HT - raphe nucleus (pons, medulla, midbrain)
Ach - Basal nucleus of Meynert 
GABA - nucleus accumbens

First Aid/DIT (5 decks)

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