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USMLE Step 1 Quick Notes > Neurology > Flashcards

Neurology Flashcards

1
Q

What would you see in an ACA infarct?

A

Contralateral motor and sensory loss of lower limbs

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2
Q

Where is glioblastoma tumor located?

A

Cerebral cortex (frontal, temporal etc)

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3
Q

Where is meningioma tumor located?

A

It is from arachnoid cells, external, and benign

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4
Q

What can cause parinaud syndrome?

A

Germinomas of the pineal gland (also in gonads and mediastinum)

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5
Q

What presents with parinaud syndrome, precocious puberty, and obstructive hydrocephalus?

A

Germinomas of pineal gland (histologicall similar to seminomas)

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6
Q

What is parinaud?

A

No conjugate vertical gaze due to lesion in superior colliculi

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7
Q

What presents with unilateral headache and associated with rhinorrhea and periorbital pain?

A

Cluster headache; MC in men

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8
Q

What levels do you see lateral horn in?

A

T1 - L2

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9
Q

What do lower spinal cord segments look like?

A

Bigger ventral horn (more gray less white)

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10
Q

What do upper spinal cord segments look like?

A

More white less gray

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11
Q

What happens in age related macular degeneration wet?

A

Bleeding due to choroidal neovascularization

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12
Q

What is the diagnosis? Grayish green subretinal membrane and hemorrhaging.

A

Wet age related macular degeneration

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13
Q

Where is meyer’s loop?

A

Temporal lobe

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14
Q

Where is upper optic radiation?

A

Parietal lobe

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15
Q

What does the huntington mutation cause?

A

GOF mutation that causes histone deacetylation

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16
Q

What chromosome is mutated with VHL?

A

Chromosome 3 (remember 3 letters in VHL)

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17
Q

What gets damaged in noise induced hearing loss?

A

Stereocilia of organ of corti

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18
Q

What does succinylcholine cause?

A

Life threatening hyperkalemia

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19
Q

What happens to CN III function in diabetic neuropathy?

A

Ocular motion lost but accommodation intact because only central part is affected and the parasympathetic fibers are on the outside

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20
Q

What is located in the internal capsule?

A

Corticospinal tract

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21
Q

What is a 5mm cavity in the brain?

A

Small lacunar infarct from lipohyalnois and microemboli

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22
Q

What do use for bradycardia in inferior wall MI?

A

Atropine

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23
Q

What do you see ring enhancing lesions?

A

Toxoplasma, brain abscesses (complication of bacterial endocarditis from S. aureus usually), CNS lymphoma

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24
Q

Why do Friedreich ataxia people get ataxic symptoms?

A

Mutation in frataxin (binds iron) that impairs mitochondrial functioning and causes degeneration of myelinated axons

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25
Q

What does friedreich ataxia affect?

A

Dorsal root ganglia, spinocerebellar tract, corticospinal tract, dorsal column –> spinal cord atrophy

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26
Q

What is a key presentation of Friedreich ataxia?

A

Wide-based gait with difficulty maintaining balance in 5-15 yo

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27
Q

How do you tell myasthenia gravis and lambert eaton apart?

A

Myasthenia has diplopia, dysarthria etc whereas lambert eaton is more likely to present with proximal muscle weakness and autonomic symptoms (dry mouth, impotence etc) and minimal change with AchE inhibitors

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28
Q

What causes halos around light, vision worse after dark room (eye dilation)?

A

Closed angle glaucoma

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29
Q

What are two key findings for Wallenburg?

A

Dysphagia and dysarthria; nucleus ambiguus lesions are specific for it

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30
Q

How do you tell CN III palsy from INO?

A

Convergence is normal in INO

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31
Q

What is a calcified cystic mass with thick brownish fluid high in choelsterol?

A

Craniopharyngioma

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32
Q

How old is a child who can use utensils and copy a circle?

A

About 3 years old

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33
Q

What is a bilateral wedge shaped necrosis parallel to longitudinal fissures in hypoxic ischemic encephalopathy?

A

Watershed infarct

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34
Q

What is the MCC of aseptic meningitis?

A

Enteroviruses

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35
Q

What is the MCC of lobar hemorrhage in adults >60yo?

A

Cerebral amyloid angiopathy particularly in parietal and occipital lobes

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36
Q

Where is area postrema located?

A

Dorsal surface of medulla near caudal end of 4th ventricle

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37
Q

When do microglia move to area of infarct/ischemia?

A

3-5 days after injury and then astrocytes form scars

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38
Q

Which tracts does Vitamin b12 affect?

A

Lateral corticospinal and dorsal columns

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39
Q

What do you do if someone is above 40degree celsius?

A

This is hyperpyrexia. Lower temperature with cold blankets and then give anti-pyretics

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40
Q

What is a major side effect of halothane?

A

Hepatic necrosis (inc AST, ALT, prolonged PT, shrunken liver)

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41
Q

What part of Wernicke Korsakoff is irreversible?

A

Memory loss

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42
Q

What causes IVH in neonates?

A

Fragile germinal matrix bleeding

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43
Q

Where is broca’s area located?

A

Lower frontal lobe

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44
Q

What happens if you get pure internal capsule stroke?

A

Pure motor weakness in arms, leg, face

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45
Q

What innervates the posterior part of external auditory meatus?

A

Vagus

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46
Q

What innervates the inner part of tympanic membrane?

A

Glossopharyneal

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47
Q

What type of tremor happens with certain actions and improves with alcohol?

A

Essential tremor

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48
Q

How do you treat an essential tremor?

A

Primidone, Propranolol

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49
Q

What is the treatment for status epilepticus?

A

1st line is benzodiazepines then give phenytoin. Phenobarbital if they are seizing still.

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50
Q

What do you see cortical atrophy as well as caudate and putamen atrophy?

A

Huntington

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51
Q

What does PCA stroke cause?

A

Homonymous hemianopia with macular sparing (MCA doesn’t spare macula)

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52
Q

What is the time constant?

A

Time it takes for a change in membrane potential

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53
Q

What is the length constant?

A

How far conduction travels before it dissipates

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54
Q

What does myelination do time and length constant?

A

Decreases time constant and increases elngth constant

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55
Q

What do you see anti-yo, hu, P/Q antibodies in?

A

Paraneopalstic cerebellar degeneration

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56
Q

What is paraneoplastic cerebellar degeneration?

A

Immune response against tumor cells that cross react with purkinje neuron antigens. Associated with lung cancers. Causes dysarthria, visual problems, ataxia

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57
Q

What is the diagnosis? Muscle rigidity, fever after surgery under inhaled anesthetics?

A

Malignant hyperthermia

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58
Q

Who gets malignant hyperthermia?

A

Those who inherit a defect in ryanodine receptor that causes large amounts of Ca to be released from SR

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59
Q

What does malignant hyperthermia present with?

A

Muscle rigidity, tachycardia, HTN, hyperkalemia, myoglobinuria, fever

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60
Q

What type of meningits? Elevated protein, normal glucose, lymphocytes

A

Viral meningitis

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61
Q

What is associated with polyhadamnios?

A

Anencephaly and GI obstruction

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62
Q

How does entacapone work?

A

Prevents L-dopa degradation and increases quantity entering the brain

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63
Q

What is the diagnosis? Ipsilateral pain/weakness of shoulder, miosis, ptsosis.

A

Pancoast tumor

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64
Q

What does hepatic encephalopathy deplete?

A

Glutamate and alpha-ketoglutrate (because it is used in neurons to detoxify accumulated glutamine; use alpha KG to convert it to glutamate)

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65
Q

How do mu receptors work?

A

Increase potassium efflux and close Ca channels

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66
Q

What ciliary epithelium do?

A

Produce aqueous humor

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67
Q

What targets ciliary epithelium?

A

Timolol (targets beta receptor)

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68
Q

What are the short acting benzos?

A

Triazolam, Alprazolam, Oxazepam

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69
Q

What side effects do you see with short acting benzos?

A

Less sedation but more withdrawal

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70
Q

How do you opioid analgesics affect the gallbladder?

A

Cause sphincter of oddi smooth muscle contraction causing biliary colic

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71
Q

What happens to albumin in hepatic necrosis?

A

Remains the same since it has a long half life; only changed with end stage liver disease

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72
Q

What ion contributes to resting membrane potential?

A

Mostly K and some Na

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73
Q

Which way does chloride flow?

A

Into the cell despite negative potential

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74
Q

What is Naloxone?

A

Mu antagonist

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75
Q

What presents with transient numbness and tingling that onsets suddenly and disappears in 20 minutes?

A

TIA

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76
Q

Where do the cerebral hemishperes and lateral ventricles come from?

A

Telencephalon (which comes from the prosencephalon)

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77
Q

Where do the third ventricle and thalamus come from?

A

Diencephalon (which comes from the prosencephalon)

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78
Q

Where do the aqueduct and mdibrain come from?

A

Mesencephalon (which also comes from the mesencephalon aka midbrain)

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79
Q

Where do the upper part of the fourth ventricle, pons, cerebellum come from?

A

Metencephalon (which comes from rhombencephalon)

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80
Q

Where do the lower part of fourth ventricle and medulla come from?

A

Myelencephalon (which comes from rhombencephalon)

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81
Q

Where do PNS neurons and Schwann cells come from?

A

Neural crest

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82
Q

What is the confirmatory test for neural tube defects?

A

AchE

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83
Q

What is anencephaly associated with?

A

Polyhydramnios and maternal diabetes type I

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84
Q

What is Dandy Walker malformation associated?

A

Hydrocephalus and Spina bifida

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85
Q

What is wallerian degeneration?

A

Degeneration distal to injury and proximal axon retraction

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86
Q

What is the gene associated with holoprosencephaly?

A

SHH

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87
Q

What fuses to form mutlinucleated giant cells in the CNS in HIV patients?

A

Microglia

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88
Q

Which nerve fibers are unmyelinated?

A

Autonomic postganglionic and C fibers

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89
Q

What are the sensory corpuscles?

A

Merkel: deep static touch, position, slow
Meissner’s: fine/light touch, position, fast
Ruffini: stretch of skin, slow
Pacinian: vibration, pressure, fast

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90
Q

What nucleus is involved with stress and panic?

A

Locus cereleus because NE increases in anxiety

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91
Q

What neurotransmitters are implicated in huntington’s?

A

Decreased GABA and Ach

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92
Q

In what disease did Ach increase?

A

Parkinson’s

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93
Q

How does NE promote sleep?

A

SCN makes NE which stimulates pineal gland to make melatonin

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94
Q

What causes rapid eye movement in REM?

A

PPRF

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95
Q

What is Papez’s circuit?

A

Cingulate –> hippocampus –> fornix –> mamillary body –> thalamus

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96
Q

What are the inputs to the cerebellum?

A

Middle cerebellar peduncle: contralateral cortex

Inferior cerebellar peduncle: ipsilateral proprioception

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97
Q

What are the outputs of the cerebellum?

A

Superior cerebellar peduncle: contralateral cortex (via deep nuclei)
Deep nuclei: : dentate, emboliform, globose, fastigial (lateral to medial)

98
Q

What are the trinucleotide repeats in each disease?

A

Fragile X: CGG
Friedreich: GAA
Huntington: CAG
Myotonic dystrophy: CTG

99
Q

What are amygdala lesions associated with?

100
Q

What presents with hyperorality, hypersexuality, disinhibited behavior? Where is the problem?

A

Kluver-bucy

In the amygdala

101
Q

What presents with agraphia, alcalculia, finger agnosia, left right disorientation?

A

Gertsmann syndrome

Problem in left parietal - temporal cortex

102
Q

How to tell PPRF lesion from frontal eye field lesion?

A

PPRF looks away from lesion

FEF look toward lesion

103
Q

If you correct hypernatremia too fast what happens?

A

Cerebral edema and herniation

104
Q

Where is the infarct: contralateral hemiparesis, decreased contralateral proprioception and tongue deviating ipsilaterally?

A

ASA (anterior spinal artery)

105
Q

Where is the infarct most likely if you see dysphagia and hoarseness?

A

PICA - Lateral medullary syndrome (Wallenburg): because nucleus ambiguus effects are specific to it

106
Q

Where is the infarct most likely if you see facial paralysis?

A

AICA - Lateral pontine syndrome

107
Q

Where is the second MC location of berry aneurysms?

A

Post. communicating

108
Q

What symptoms do you see if there is an aneurysm of posterior communicating?

A

CN III palsy

109
Q

What do you see transtentorial herniation and CN III palsy with?

A

Epidural hematoma

110
Q

What is a lobar intraparenchymal hemorrhage caused by?

A

Cerebral amyloid angiopathy

111
Q

What do yo see at 3-5 days after stroke?

A

Macrophages

112
Q

What do you see 12-48 hours after stroke?

A

Necrosis + neutrophils

113
Q

What is the inheritance pattern of SMA?

114
Q

What has hammer toes and pes cavus, kyphoscoliosis?

A

Friedreich Ataxia

115
Q

What degenerated in friedreich?

A

Large myelianted sensory neurons in DRG, dorsal columns

116
Q

What is it called when you have hemisection of spinal cord?

A

Brown Sequard

117
Q

What can cause Horner’s besides Brown sequard and pancoast?

A

Late stage syringomyelia

118
Q

What did S2, 3, 4 do?

A

Erection, penile and anal sensation

119
Q

What are the reflexes?

A

Biceps: C5
Triceps: C7
Patella: L4
Achilles: S1

120
Q

What may cause primitive reflexes to reappear in adults?

A

Frontal lobe lesions

121
Q

What is the galant reflex?

A

Stroking along one side of spine while newborn is face down causes lateral flexion of body towards that size

122
Q

When do the primitive reflexes disappear?

A

Moro: 3 mos
Rooting: 4 mos
Palmar: 6 mos
Plantar: 12 mos

123
Q

What two nerves are at cerebellopontine angle?

A

CN VII, VIII

124
Q

What does superior colliculi do?

A

Conjugate vertical gaze

125
Q

What is a common cause of Parinaud?

A

Pinealoma or Germinoma in pineal gland

126
Q

Where are the cranial nerve nuclei?

A

Midbrain: 3, 4
Pons: 5, 6, 7, 8
Medulla: 9, 10, 12
Spinal cord: 11

127
Q

What is nucleus ambiguus?

A

CN 9, 10, 11. Does motor innervation of pharynx, larynx, and upper esophagus

128
Q

What is nucleus solatrius?

A

CN 7, 9, 10. Does sensory information (taste, baroreceptors, gut distension)

129
Q

What nerve go through jugular foramen?

A

CN 9, 10, 11

130
Q

Which way does jaw deviate in CN V motor lesion?

131
Q

What causes hyperacusis?

A

Stapedial nerve injury

132
Q

What hearing do you lose first?

A

High frequency

133
Q

What is prebyopia?

A

Decrease in focusing ability during accommodation due to sclerosis and decreased elasticity

134
Q

What fixes your myopia?

A

Presbyopia because it doesn’t focus as well so it allows the image (which normally lands before retina) to land on the retina

135
Q

What causes open angle glaucoma?

A

Primary is unclear. Secondary is blocked trabecular meshwork from WBC (uveitis), RBC (vitreous hemorrhage), retinal elements (retinal detachment)

136
Q

What causes closed angle glaucoma?

A

Primary: lens pushes against iris causing fluid to build up which pushes iris towards cornea blocking trabecular meshwork
Secondary: hypoxia induces vasoproliferation in iris

137
Q

What do you not give for acute closure in closed angle glaucoma?

A

Epinephrine

138
Q

What is the path of nerves to cause miosis (parasympathetic)?

A

Edinger westphal –> CN III –> ciliary ganglion –> short ciliary –> pupillary sphincter

139
Q

What is the path of nerves to cause mydriasis (sympathetic)?

A

Hypothalamus (posterior) –> through spinal cord –> exit at T1 –> superior cervical ganglion –> plexus around internal carotid –> through cavernous sinus –> enters orbit as long ciliary —> pupillary dilator

140
Q

What is Marcus Gunn pupil?

A

Lack of afferent so no response when light shone in affected eye

141
Q

What are retinal breaks more common with?

A

High myopia and preceeded by posterior vitreous detachment (flashes and floaters) w/ eventual monocular loss –> SURGICAL EMERGENCY)

142
Q

Why do you get nystagmus in abducting eye with MLF lesion?

A

The LR on the abducting eye overfires to cause the not functioning eye to move

143
Q

What does right INO mean?

A

Right eye is paralyzed

144
Q

What are the findings of MS?

A

IgG in CSF, oligoclnal bands, periventricular plauqes

145
Q

When do symptoms of MS worsen?

A

After hot shower or post workout (ie with heat exposure)

146
Q

What is the albuminocytologic disassociation and what is it with?

A

It is increased CSF protein with normal cell count. Seen with AIDP/ Guillan Barre

147
Q

What is ADEM?

A

Multifocal perivenular inflammation and demylination after measles of VZV or vaccine (rabies, smallpox)

148
Q

What is wrong in charcot marie tooth?

A

Can’t make proteins that are involved in peripheral nerve or myelin sheath function/structure

149
Q

What does charcot marie tooth present with and what is its inheritance?

A

AD; Scoliosis and pes cavus

150
Q

What is adrenoleukodystrophy?

A

X-linked; can lead to coma/death and adrenal gland crisis. Can’t metabolize very long chain FA

151
Q

Where do partial seizures MC occur?

A

Medial temporal lobe

152
Q

What are two heart drugs you can use for migraine headaches?

A

Propranolol, CCB

153
Q

How do you tell peripheral from central vertigo?

A

Via positional testing:
Peripheral: delayed nystagmus
Central: immediate nystagmus

154
Q

What is the mutation in Sturge-Weber?

A

Noninherited mutation in GNAQ. anomal of neural crest derivatives

155
Q

What do you see a leptomeningeal angioma with?

A

Sturge Weber

156
Q

What does VHL inhibit?

157
Q

Which tumor do you see psammoma bodies with?

A

Meningioma

158
Q

Where does Schwannoma most commonly occur?

A

Cerebellopontine angle

159
Q

What do you see secondary polycythemia with?

A

Hemangioblatoma because it can produce EPO

160
Q

What has biphasic growth pattern?

A

Schwannoma

161
Q

Where is oligodendroglioma most commonly occur?

A

Frontal lobes

162
Q

What has a chicken wire capillary pattern?

A

Oligodendroglioma

163
Q

Where does hemangioblastoma most commonly occur?

A

Cerebellum

164
Q

Where does colloid cyst occur?

A

Third ventricle

165
Q

What is a highly malignant tumor in kids?

A

Medulloblastoma

166
Q

What tumor is found in the fourth ventricle?

A

Ependymoma

167
Q

Where do kids tumors occur mostly?

A

Under the tentorium cerebelli (ie where cerebellum etc are)

168
Q

What herniates in an uncal herniation?

A

Medial temporal lobe

169
Q

How do cholinomimetics treat glaucoma?

A

Cholinomimetics contract ciliary muscle to open up trabecular meshwork

170
Q

What is latanoprost?

A

PGE analog that increases aqueous humor outflow. Causes darkening of iris

171
Q

What two side effects does tolerance not develop to with opioid analgesics?

A

Constipation and Miosis

172
Q

What is butarphanol?

A

Mu partial agonist and kappa agonist. Less respiratory depression than full agonists.

173
Q

Which opiod analgesic does nalaxone not reverse?

A

Butarphanol

174
Q

What is a major side effect of Tramadol?

A

Sertonin Syndrome

175
Q

How does Tramadol work?

A

Very weak opiod agonist and inhibits 5HT and NE reuptake

176
Q

What is the 1st line treatment of eclampsia seizures?

177
Q

What are major side effects of Valproate?

A

Fatal hepatotoxicity, spina bifida. Also tremor and weight gain

178
Q

What is the drug of choice for partial seizures?

A

Carbamazepine

179
Q

What is 1st line epilepsy drug in neonates?

A

Phenobarbital

180
Q

How does Gabapentin work?

A

Inhibits Vca channels

181
Q

What is contraindicated in porphyria?

A

Barbiturates

182
Q

What are the short acting benzos?

A

Alprazolam, triazolam, midazolam, oxazepam

183
Q

What do you have less risk of drowsiness with but more withdrawal?

A

Short DOA barbiturates (Alprazolam, Triazolam, Oxazepam, Midazolam)

184
Q

What do you give for bedwetting

A

Desmopressin

185
Q

What are the inhaled anesthetics?

A

Halothane and “fluranes” and NO

186
Q

How does Dantrolene work?

A

Prevents release of Ca from SR in skeletal muscle

187
Q

What is the toxicity for halthone?

A

MAJOR hepatotoxicity

188
Q

What is the toxicity for methoxyflurane?

A

Nephrotoxicity

189
Q

What is the toxicity for enflurane?

A

Proconvulsant

190
Q

What is thiopental?

A

IV barbiturate anesthetic High potency and lipid solubility. Decreases cerebral BF. Used for induction of anesthesia and short surgical procedures

191
Q

What redistributes to skeletal muscle and fat?

A

Thiopental

192
Q

What are the side effects of Midazolam?

A

Severe postop respiratory depression. Decreased Bp and anterograde amnesia

193
Q

What is Midazolam?

A

IV benzo anesthetic used for endoscopy. Used adjunctively with gaseous anesthetics and narcotics

194
Q

What is ketamine?

A

PCP analog that acts as dissociative anesthetic. Blocks NMDA receptors. CV stimulant. Increases cerebral BF

195
Q

What are the side effects of ketamine?

A

Disorientation, hallucination, bad dreams

196
Q

What are the IV opioid anesthetic?

A

Morphine, Fentanyl

197
Q

What is propofol?

A

Potentiates GABA. Used for ICU sedation, rapid anesthesia and short procedures. Less postop nausea than thiopental.

198
Q

What are the local anesthetics?

A

Esters (procaine, cocaine, tetracaine)

Amines (lidocaines, mepivcaine, bupivcaine) - have two “I”

199
Q

How do local anesthetics work?

A

Block Na channels especially activated ones so effective for rapidly firing neurons

200
Q

What can local anesthetics be given with?

A

Vasoconstrictors (Epinephrine usually) –> enhances local acion - dec bleeding, inc anestheisa by dec systemic concentration

201
Q

What happens with local anesthetics in acidic tissue?

A

Alkaline ones are charged and can’t penetate membrane so need to give more

202
Q

What type of nerves do anesthetics block?

A

Small > large; myelinated > unmyelinated (size preference over myelination)

203
Q

What is the order of sensory loss in local anesthetics?

A

Pain > temperature > touch > pressure

204
Q

What are the toxicities for local anesthetics?

A

CNS excitation

205
Q

What is a toxicity with bupivicaine?

A

Severe CV toxicity

206
Q

What are neuromuscular blocking drugs specific for?

A

Motor nicotinic receptor

207
Q

What are the side effects of depolarizing neuromuscular blockers?

A

Hypercalcemia, hyperkalemia, malingant hyperthermia

208
Q

What are the neuromuscular blocking agents?

A

Depolarizing: Succinylcholine

Non-depolarizing: “urium” and “uronium” and Tubocurarine

209
Q

How do non-depolarizing neuromuscular blocking agents work?

A

Competitive antagonists of Ach

210
Q

What do antimuscarinics improve with parkinsons?

A

Tremor and rigidity BUT NOT BRADYKINESIA

211
Q

What is amantadine for?

A

Increases dopamine release and for influenza A and rubella

212
Q

What is the toxicity for amantadine?

213
Q

What is a toxicity with L-dopa and carbidopa?

A

“On-off” due to varying drug levels. Dyskinesia while on and akinesia while off.

214
Q

How does Selegiline work?

A

MAO-B inhibitor (MAO-B preferentially metabolizes dopamine over 5HT and NE)

215
Q

What are common side effects of L-dopa?

A

Anxiety and agitation

216
Q

What are the side effects of Sumatriptan?

A

Coronary vasospasm (contraindicated in CAD and Prinzmetal), mild tingling

217
Q

What blocks morphine tolerance?

A

Ketamine through its inhibitor action on NMDA receptors preventing glutamate from binding

218
Q

What pathway connects hypothalamus and pituitary gland?

A

Tuberoinfundibular

219
Q

What would infarct of anterior medial pons show?

A

Dysarthria and contralateral ataxic hemiparesis

220
Q

Where does CN V exit?

A

Middle cerebellar peduncle at lateral aspect of mid pons

221
Q

What does Vitamin E deficiency show?

A

Dorsal column, spinocerebellar tract, and peripheral nerve degeneration

222
Q

How does pramipexole work?

A

Dopamine agonist so stimulates dopamine receptors

223
Q

What are glial cells?

A

Ependymal, oligodendrocytes, astrocytes

224
Q

What cells are synpathophysin positive?

225
Q

What is the terminal sulcus?

A

Divides anterior 2/3 of tongue from posterior 1/3

226
Q

What is the foramen cecum i the tongue?

A

Midline at terminal sulcus (divides anterior 2/3 of tongue from posterior 1/3)

227
Q

What presents with rock hard eye, halos, and sudden pain in the eye?

A

Acute closure glaucoma

228
Q

What is cerebral amyloid angiopathy?

A

Elderly; causes intracerebral hemorrhage that would present with headache and focal neurologic deficits

229
Q

What does it mean if there is a high arteriovenous concentration gradient after administering an anesthetic gas?

A

It means more peripheral uptake from arterial blood and less to the brain. Means it would have a slow onset of action.

230
Q

What is Pentazocine?

A

Opioid narcotic with partial agonist and weak antagonist activity. If given with morphine it will have antagonist effects and can worsen withdrawal symptoms.

231
Q

What are neurofibromas a proliferation of?

A

Schwann Cells (elongated, wavy cells with spindle nuclei)

Also fibroblasts and neurites

232
Q

What is the mechanism of action of phenobarbital?

A

Facilitate GABA action by increasing duration of Cl channel opening (barbiDURate)!

233
Q

What causes ataxia, wide based gait, nystagmus and head tilting?

A

Cerebellum medial lesion

234
Q

Hemorrhage where would present with pinpoint pupils, loss of horizontal gaze, quadriparesis, decrebrate posturing and rapidly evolving coma leading to death within hours?

A

Pontine hemorrhage

235
Q

Hemorrhage where would produce contralateral sensory loss, aphasia, temporary homonymous hemianopia?

A

Thalamic hemorrhage

236
Q

What is vasogenic edema?

A

“Extracellular”

Fluid shifts from intra to extracellular
Neoplasm or infarction cause it (destroy endothelial tight junctions)
Increases ICP

237
Q

What is cytotoxic edema?

A

“Intracellular”

Fluid shifts from extra to intracellular
From ischemia that impairs Na/K ATPase –> fluid shifts in

238
Q

If hyperreflexia and tongue deviation on protrusion toward side of lesion, what part of medulla is the lesion in?

A

Pyramids because the hypoglossal nerve comes off the pyramids and the corticospinal tracts decussate there

239
Q

Where does CN III come off?

A

Above pons

240
Q

What are the complications of succinylcholine?

A

Hyperkalemia, hypercalcemia, malignant hyperthermia

USMLE Step 1 Quick Notes (17 decks)

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