Neurology Flashcards
1
Q
Valproic Acid
A
Use for generalized epilepsy (eg. Myoclonic seizures)
- Broad-spectrum
2
Q
Carbamazepine
A
Use for partial seizures
- Narrow-spectrum
3
Q
Phenytoin
A
All seizures and status epilepticus (NOT absence)
4
Q
Membrane Permeability:
A
- Resting membrane potential:
- Ligand gated channel permeability: Na+
- Voltage gated channel permeability: Cl-
5
Q
ALS compared to Polio
A
Loss of neurons in anterior horn (LMN) & atrophy of lateral corticospinal (UMN)
- Polio is only anterior horn damage
6
Q
NE Breakdown
A
NE converted to E by methylation then E is methylated to Vanillymandelic acid (a metanephrine)
7
Q
Autonomic postganglionic nerve:
A
Unmyelinated
8
Q
Trigeminal Nerve Exits at _______
A
Mid-Pons
9
Q
Facial Nucleus Located at ______
A
Caudal Pons
10
Q
S-100+
A
Schwannoma
Melanoma
Langerhan’s Histiocytosis
11
Q
Friedrich’s Ataxia
A
Spinocerebellar degeneration, kyphoscoliosis, pes cavus, hypertrophic cardiomyopathy
12
Q
Timolol
A
Beta blocker to treat glaucoma by decreasing aqueous humor production by ciliary epithelium
13
Q
Length Constant
A
Measure of how far along an axon an impulse can propagate
- Decreased by demyelination
14
Q
Ring Enhancing Lesions in brain
A
Staph Abscess, Toxoplasma, or Primary CNS Lymphoma
15
Q
Toxoplasma
A
- from undercooked meat (or cat feces)
- Treat toxoplasma with sulfadiazine and pyrimethamine
- Congenital (torch): macrocephaly and intracranial calcifications
16
Q
Primary CNS Lymphoma
A
multicentric ring lesions
- MC CNS tumor in immunocompromised
17
Q
Agnosia
A
- unable to recognize
- temporo-occipital cortex
18
Q
Marcus-Gunn Pupil
A
swinging flashlight test, both dilate when light moved from normal to affected eye (not actually dilating, just less constricted because the affected eye can’t transmit signal as well)
19
Q
Subacute Sclerosing Panencephalitis
A
May be caused by measles
20
Q
Hypertensive Hemorrhage
A
(lenticulostriate aneurysms): MC in basal ganglia and internal capsule
21
Q
Conduction Aphasia
A
arcuate fasciculus (cannot repeat, but is fluent and has full comprehension)
22
Q
Optic Neuritis aw/:
A
MS (autoimmune disorder in which CD4 T cells react against myelin via cytokines like IFN gamma)
23
Q
Tx for Status Epilepticus
A
- Benzodiazepines (lorazepam or diazepam) for active seizure
- Also give Phenytoin to prevent recurrence of seizures or if Benzo doesn’t work
24
Q
Tx for Drug-induced parkinsonism
A
Benztropine and trihexyphenadyl
25
Carbon Monoxide
Necrosis of globus pallidus and substantia nigra
26
Lumbar puncture Contraindications
- High intracranial pressure
| - Overlying infection
27
Oculomotor (3) Nerve Lesion
- no up, down, or medial, can't constrict pupils
- Nerve runs between PCA and superior cerebellar arteries
- Isolated 3rd nerve palsy → think actively enlarging intracranial aneurysm
28
Abducens (6) Nerve Lesion
No lateral (lateral rectus)
29
Trochlear (4) Nerve Lesion
No slight down and in (superior oblique)
30
HIV Encephalitis
- multinucleated giant cells in microglial nodules
| - w/ CD4 count
31
No Convergence w/:
Oculomotor (CN 3 ) palsy
| but can converge w/ INO (MLF lesion)
32
Vertical Diplopia
- double vision going down stairs from a trochlear nerve palsy
- Superior oblique not working so must tilt head to see properly
33
Tongue Innervation: Motor, Sensory, Tasts
Motor: hypoglossal nerve (XII)
- Does all muscles except palatoglossus (done by vagus)
Anterior 2/3:
- Taste: chorda tympani of facial nerve (VII)
- Sensation: V3 branch of trigeminal
Posterior 1/3:
- Taste & Sensation: Glossopharyngeal
Most posterior aspect/epiglottis
- Taste and Sensation: Vagus
34
Alzheimer's
decreased Ach levels (basal nucleus of meynert) due to deficiency of choline acetyltransferase
35
Innervation of Ear/Ear Canal
- Vagus (auricular branch): posterior external auditory canal
(May experience syncope if stimulated)
- V2 (auriculotemporal branch): remainder of external auditory canal, external tympanic membrane
- Glossopharyngeal IX (tympanic branch): inner surface of tympanic membrane
- Stapedius is innervated by Facial Nerve (CN VII) which if paralyzed causes hyperacusis
36
Cochlea: High and Low Frequency Sounds
- Low Freq at apex (wide and floppy) near Helicotrema
| - High Freq at base (narrow and rigid) near oval and round windows
37
Glaucoma Tx: reduce aqueous humor secretion by ciliary epithelium
Timolol, other non-selective Beta blockers, and Acetazolamide
38
Glaucoma Tx: Increased aqueous humor outflow
Prostaglandins and Cholinomimetics (contracting iris sphincter opens up path to trabecular meshwork)
39
Werdnig-Hoffman
(aka SMA, spinal muscular atrophy): floppy child, anterior horn damage
40
Tx for General Tonic-Clonic Seizure
Valproic Acid
41
Internal Capsule Lesion
Motor Deficit
42
Thalamus Lesion
Sensory deficit w/ some difficulty w/ proprioception
43
Pons Lesion
Pinpoint pupils, decerebrate rigidity, bilateral paralysis
44
Caudate Nucleus Lesion
Transient hemiparesis, chorea, dyskinesia, agitation, psychosis
45
Glucose infusion can exacerbate:
Thiamine deficiency
46
Hearing Loss: Rinne Test
Air should be louder than bone
| - Abnormal suggests conductive hearing loss (in tested ear)
47
Hearing Loss: Weber Test
Sound should be equal on both sides
- Conductive: lateralizes to affected ear (due to diminished ambient noise)
- Sensorineural: lateralizes to unaffected ear (because impair ear can’t sense vibration)
48
POMC cleaved into:
ACTH, MSH, and B-endorphin (endogenous opioid)
49
Notochord forms at:
3 weeks (day 16)
50
Sympathetics to Sweat glands and Adrenal Medulla
Sympathetic send Ach to sweat glands (via post ganglionic nerve) and to adrenal medulla (preganglionic)
- Everything else is Ach preganglionic, and adrenergic postganglionic
51
Parasympathetic transmits via:
Ach
- Preganglionic is Nicotinic (ligand gated ion channel, fast)
- Postganglionic is Muscarinic (G ptn, slow)
52
______ contraindicated in Glaucoma
Anti-cholinergics
53
Raphe Nucleus
Serotonin
54
Locus Ceruleus
NE (Norepinephrine)
55
Nucleus Basalis of Maynert
Acetylcholine
56
Caudate Nucleus
GABA
57
Substantia Nigra
Dopamine
58
PCP: MC cause of death
Trauma, NOT seizures
59
Only sensory pathway that doesn't pass through thalamus
Olfactory (smell)
60
______ should always be added to cover for Listeria in infants and immunocompromised
Ampicillin
61
Meniere's Disease
Due to decreased absorption of endolymph in vestibular apparatus:
tinnitis, vertigo, and sensorineural hearing loss
62
Neural Tube -->
CNS (brain and spinal cord)
63
Neural Crest -->
PNS and leptomeninges
64
Notochord -->
Nucleus pulposis
65
Prosencephalon (forebrain):
Telencephalon: Cerebral hemispheres + ventricles
Diencephalon: Thalamus + 3rd Ventricle
66
Mesencephalon (midbrain):
Mesencephalon: Midbrain + Aqueduct
67
Rhombencephalon (hindbrain):
Metencephalon: Pons, Cerebellum, + Upper 4th ventricle
Myelencephalon: Medulla + Lower 4th ventricle
68
Gene aw/ Holoprosencephaly
SHH (sonic hedgehog) gene
69
Syringomyelia
usually bilateral pain and temp loss of upper extremity
| - May also see Upper LMN signs and Lower UMN signs
70
Wallerian Degeneration
degeneration distal to injury and proximal axon retraction
71
Meissner Corpuscle and Merkel Discs
Superficial
Meissner: light touch, fast adapting
Merkel: pressure, slow adapting
72
Pacinian Corpuscle and Ruffini
Deep
Pacinian: vibration and pressure, fast adapting
Ruffini: stretch, slow adapting
73
Nucleus Accumbens
GABA
74
Neurotransmitters in Huntingons
Decreased GABA and Ach
| Increased Dopamine
75
Neurotransmitters in Alzheimers
Decreased Ach
76
Neurotransmitters in Parkinsons
Decreased Dopamine and Serotonin
| Increased Ach
77
Neurotransmitters in Depression
Decreased NE, Dopamine, Serotonin
78
Cytogenic vs Vasogenic Edema
Cytogenic: extra to intracellular (failed membrane pump after ischemic insult)
Vasogenic: intra to extracellular (increased permeability of barrier with neoplastic or inflammatory disorders)
79
Benzodiazepines, Barbiturates, Alcohol, and NE: effect on REM
ALL decrease REM
80
Treatment for Bedwetting
DDAVP or imipramine
81
REM induced by
Ach
82
NREM induced by
Serotonin
83
EEG Waves in Sleep
```
Awake: alpha and beta
N1: Theta
N2: sleep spindles and K complexes
N3: delta
REM: beta, sawtooth
```
84
Papez's Circuit
Cingulate gyrus --> hippocampus --> fornix --> mammillary bodies --> thalamus
85
Medial Cerebellar Lesions
Truncal ataxia, wide gait, bilateral (axial and proximal musculature)
86
Lateral Cerebellar Lesions
Problem with voluntary movement of extremities
| - fall towards injured side
87
Peduncles and Cerebellum:
Superior: contra output
Middle: contra input
Inferior: ipsi input
88
Cerebellar Nuclei: lateral to medial
Dentate, Emboliform, Globose, Fastigial (don't eat greasy foods)
89
Striatum
Putamen + Caudate
90
Lentiform
Putamen + Globus pallidus
91
Direct and Indirect Pathways: Dopamine
Direct: disinhibits thalamus --> movement
Indirect: inhibits thalamus --> no movement
Dopamine facilitates movement by:
(from Substantia Nigra pars compacta)
D1: activates direct
D2: inhibits indirect
92
D2 agonists to treat Parkinson's
Pramipexole and Ropinerole
93
Lewy Bodies composed of:
a-synuclein
94
Kluver-Bucy Syndrome
- Hyperorality, hypersexual, disinhibited behavior
- aw/ HSV 1 or trauma
- lesion in amygdala (bilateral temporalectomies)
95
Gerstmann Syndrome
Finger agnosia, acalculia, agraphia
| - Left parietal-temporal cortex
96
Confusion, Ataxia, Nystagmus
Wernicke's Encephalopathy
97
PRPP vs FEF Lesion
PRPP: look AWAY from side of lesion
FEF: look TOWARDS lesion
98
Intracranial Pressure and CO2
Therapeutic hyperventilation helps to decrease CO2 and cerebral pressure by vasoconstricting
99
Medial Medullary Syndrome
ASA infarct (anterior spinal)
- contra hemiparesis
- ipsi hypoglossal dysfunction
100
Lateral Medullary Syndrome (Wallenberg)
PICA infarct
- dyphagia, hoarseness
- Horner
- vomiting, vertigo, nystagmus
- impaired pain/temp from ipsi face and contra body
101
Lateral Pontine Syndrome
AICA infact
- Facial paralysis
- loss of pain and temp in face
- Ipsi hearing and horners of face
102
Locked In Syndrome
Basilar artery infarction or CPM (central pontine myelinosis from rapid correction of hyponatremia)
103
PComm Saccular Aneurysm
- may cause CN III palsy
104
AComm Saccular Aneurysm
- MC location
| - visual field defects (bitemporal hemianopia)
105
Intraparenchymal Hemorrhage
Usually due to hypertension
- in basal ganglia and internal capsule
(can be a Charcot Bouchard Aneurysm, whereas a subarachnoid hemorrhage is usually due to a berry/saccular aneurysm)
106
Irreversible damage to brain after ____ hypoxia
5 minutes
107
Neonatal Intraventricular Rupture
In the germinal matrix
| - increased risk with low birth weight or prematurity
108
Wet, Wobbly, Wacky
Normal Pressure Hydrocephalus
- ventricles englarged
- incontinence due to stretching of the descending cortical fibers that control the bladder
109
Riluzole
NMDA antagonist used for ALS
110
Tabes Dorsalis
Tertiary syphilis
dorsal column degeneration
- charcot joints, argyll robertson pupils (prostitute pupil)
111
Hammer Toes
Friedreich Ataxia
112
Long ciliary nerve
Sympathetic
| - innervates pupillary dilator
113
Moro Reflex
Gone by 3 months (startle reflex)
114
Rooting reflex
Gone by 4 months (nipple seeking)
115
Plantar/Babinski Reflex
Gone by 1 year (fanning of toes up)
116
Biceps and Triceps Reflexes
Biceps: C5
Triceps: C7
117
CN III comes out:
Above Pons (medial) (between the PCA and superior cerebellar artery)
118
CN IV comes out near:
Upper Pons
119
CN V comes out near:
Middle to Inferior Pons
120
CN VI comes out by:
Top of pyramids just below pons (medial)
121
CN VII and VIII exit at:
Cerebellopontine angle
122
CN IX, X, and XI exit:
Below Cerebellopontine angle
123
CN XII exits:
On top of pyramids (medial)
| hypoglossal --> tongue motor nerve problems
124
Parinaud Syndrome
Paralysis of conjugate vertical gaze
| - lesion in superior colliculi
eg. germinomas such as a pinealoma
125
Inferior Collicus
Auditory
126
Alar plate and Basal plate
Alar: sensory, lateral nuclei
Basal: motor, medial nuclei
127
Cranial Nerve Nuclei
Midbrain: 3, 4
Pons: 5-8
Medulla: 9, 10, 12
Spinal Cord: 11
128
Nucleus Ambiguus
CN 9, 10, 11
PICA lesion
Motor innervation of pharynx, larynx and upper esophagus
129
Nucleus Solitarius
CN 7, 9, 10
| Visceral sensory information
130
CN V Motor Lesion
Jaw deviates towards lesion (unopposed force from opposite pterygoid)
131
Face UMN Lesion
Only bottom half of contra face is paralyzed
132
Face LMN Lesion
Entire ipsi half of face paralyzed (Bell's Palsy)
133
Presbyopia
Decrease in focusing during accommodation due to decreased elasticity and sclerosis
- may appear to correct myopia due to decrease in focusing
134
Flexner Wintersteiner Rosettes
Retinoblastoma
135
Open Angle Glaucoma
Caused by blocked absorption by trebecular meshwork (by WBCs, RBCs, or retinal elements)
136
Acute Closed Angle Glaucoma
Emergency, very painful, rock-hard eyes, lens is abruptly pushed forwards, may see halos or have vision loss, and headache
- Do not use epinephrine (which would dilate)
137
Parasympathetic and Sympathetic to Pupil
Para: constricts via Short Ciliary (Edinger westphal to ciliar ganglion via CN 3, 2nd neuron is short ciliary)
Symp: dilates via Long Ciliary (hypothalamus --> exits at T1 to sup cerv ganglion and then along internal carotid and enters orbit as long ciliary)
138
Pupillary Light Reflex Path
Light in through CN 2 --> pretectal nucleus --> E-W nuclei --> Ciliary ganglion --> sphincter pupillae
139
CN III Motor and Parasympathetic
Diabetes will not affect the parasympathetic (only motor) because its a central problem, and parasympathetics run along outside (Diabetic Mononeuropathy)
- Parasympathetic are the first to be affected by compression
- Motor inside/central so affected by ischemia
140
MLF
Crosstalk between CN 6 and CN3 to coordinated horizontal movement of eyes
CN 6 --> 6 nucleus --> contra CN 3 nucleus --> CN3 --> medial rectus
- Lesion in MLF (INO)- abducting eye will get nystagmus in its attempt to fire stronger to get the other eye to move
- aw/ MS
- right INO refers to paralyzed eye
- left MLF (comes from right cn VI nucleus)
141
Amyloid Angiopathy can cause:
Intracranial Hemorrhages
142
Prion Disease Histology
Spongiform
143
Guillian Barre (AIDP- Acute Inflammatory demylinating polyradiculopathy): Lab Findings
Increased CSF protein (albuminocytologic dissociation)
| - autoimmune attack due to molecular mimicry
144
Multiple Sclerosis
disseminated in time and space
- autoreactive CD4 cells against myelin proteins
- aw/ DON or INO
- Increased protein IgG in CSF, oligoclonal bands, and periventricular plaques
145
ADEM
postinfectious encephalomyelitis
multifocal perivenular inflammation and demyelination
- after measles, vzv or vaccine
146
Metachromatic Leukodystrophy
LSD, arylsulfatase deficiency; ataxia and dementia
147
Krabbe Disease
LSD, globoid cell leukodystrophy
deficiency of galactocerebrocidase
peripheral neuropathy
148
Charcot Marie Tooth
hereditary motor and sensory neuropathy
| AD, scoliosis, foot deformities, stork legs (champagne bottle), tripping/clumsy, onion bulb pathology
149
Adrenoleukodystrophy
Peroxisomal disorder due to decreased metabolism of very long chain FA
- adrenal gland crisis
- progressive disease of nervous system, adrenal gland, and testes
- X-linked
150
Lenox Gaustaut
severe (rare) debilitating "drop" seizures
151
Peripheral Vertigo
```
Delayed horizontal nystagmus
More common (inner ear problem)
```
152
Central Vertigo
Immediate nystagmus in any direction
| brainstem or cerebellar problem
153
Sturge Weber Gene
GNAQ mutation
154
Constitutive expression of HIF and angiogenic growth factor activation
VHL
155
Adult vs Children Brain Tumor Location
Adult: supratentorial
Child: posterior fossa
156
Pseudopalisading cells w/ necrosis and vascular proliferation in brain
GBM (adult)
157
Benign tumor w/ spindle cells, whorled, psammoma bodies
Meningioma (adult)
| also has dural attachment
158
Hemangioblastoma
aw/ VHL if w/ retinal angioma
| - can produce EPO and cause secondary polycythemia
159
S100+ tumor at cerebellopontine angle
Schwannoma (adult)
| aw/ NFT2
160
Fried egg appearance and often calcified
Oligodendroglioma (adult)
161
Benign tumor (GFAP+) in posterior fossa (rosenthal fibers, Cystic + Solid)
```
Pilocytic Astrocytoma (child)
- MC tumor
```
162
Tumor w/ Homer-Wright Rosettes, small blue cells, synaptophysin + that can compress 4th ventricle, also has drop metastases
Medulloblastoma (child)
| rod shaped blepharoplasts [basal ciliary bodies] as well
163
Tumor w/ Perivascular and true rosettes that is found in the 4th ventricle
Ependymoma (child)
164
Cingulate (subfalcine) herniation
compress ACA
165
Uncal Herniation
- Ipsi CN III palsy
- Ipsi PCA (contra homon. hemianopsia)
- Contra crus cerebri (ipsi paralysis
- Duret hemorrhage
166
Cerebellar Tonsil Herniation
Cardiorespiratory arrest due to compression of brain stem
| - Due to symmetric expansion of supratentorial contents
167
Cholinomimetics for Glaucoma
Contract ciliary muscle to open up trebecular meshwork and increased outflow of aqueous humor
168
Latanaprost
PGE analog that increases outflow of aqueous humor for glaucoma
- darkens iris color
169
AFP and AchE in amniotic fluid
Suggests Neural Tube Defect (failed fusion)
170
Age Related Macular Degeneration
Dry: drusen, gradual
Wet: neovascularization (due to VEGF), worse, shows grayish green discoloration of retina with adjacent edema or hemorrhage
171
Bell's Palsy: Symptoms aside from Facal Paralysis
Decreased lacrimation, hyperacusis, and loss of taste over anterior 2/3 of tongue
- all done by Facial nerve (CN VII)
172
Cauda Equina Syndrome
Saddle Anesthesia
- Fecal Incontinence
- Late urinary retention
173
Subarachnoid Hemorrhage caused by:
Berry Aneurysm or AVM
174
Recurrent intracerebral hemorrhage (multiple small areas)
| - MC cause of spontaneous lobar/cortical hemorrhage in elderly
Cerebral Amyloid Angiopathy
175
Small intracerebral hemorrhage in basal ganglia, cerebellar nuclei, or thalamus in a patient with chronic HTN
- intraparenchymal hyperdensity on CT (visible on imaging)
Charcot-Bourchard Aneurysm
176
Tuberculous Meningitis may cause:
Communicating hydrocephalus due to decreased absorption of CSF by subarachnoid granulations (often seen with meningeal infections)
177
Pharm Tx for Restless Leg Syndrome
Dopamine Agonists ( eg. pramipexole)
178
Tardive Dyskinesia
Rhythmic involuntary movements of mouth and tongue
- Due to long term use of antipsychotics (typical)
- Due to upregulation of Dopamine Receptors and hypersensitivity
- concomitant decrease in cholinergic tone of striatum
179
Neurofibromas
Fleshy skin nodules that contain Schwann Cell proliferations
180
Pontine Intracerebral Hemorrhage
Pinpoint pupils, loss of horizontal gaze, quadriplegia, decerebrate posturing
- often die soon after
181
On-Off phenomenon
Long term use of parkinson's treatments w/ levodopa can be complicated with periodic and sometimes unpredictable fluctuations in motor function
- nigrostriatal neurodegeneration makes the response unpredictable
182
Hemi-Ballism
Damage to the subthalamic nucleus
| - usually due to lacunar infarct
183
Effect of PCO2 on Cerebral Blood Flow
Direct relationship
As PCO2 increases, so does cerebral blood flow
As PCO2 decrease, cerebral blood flow decreases
PO2 has a less strong effect, only when it is below 50 will it cause an increase in cerebral blood flow
184
Progressive headache and nausea/vomiting followed by nonlocalized neurologic symptoms
Hypertensive Encephalopathy
185
Abrupt onset headache and hyperattenuation of sulci on CT
Saccular aneurysm rupture
186
Lacunar infarcts
small ischemic infarcts involving deep brain structures (basal ganglia, pons), and subcortical white matter (internal capsule)
- MC due to hypertensive arteriolosclerosis of small, penetrating arterioles
- Will not see on imaging right away
- Lakelike cavity a few weeks later
187
Old Ischemic Infarcts
Cystic appearance
| - macrophages phagocytize the fragments and debris and the wall of the cyst is by astrocytes (gliosis)
188
Rapidly progressive dementia w/ myoclonic jerks
Creutzfeldt-Jakob disease (prion)
| - multiple vacuoles/spongiform encephalopathy
