Neurology Flashcards
1
Q
What would you see in an ACA infarct?
A
Contralateral motor and sensory loss of lower limbs
2
Q
Where is glioblastoma tumor located?
A
Cerebral cortex (frontal, temporal etc)
3
Q
Where is meningioma tumor located?
A
It is from arachnoid cells, external, and benign
4
Q
What can cause parinaud syndrome?
A
Germinomas of the pineal gland (also in gonads and mediastinum)
5
Q
What presents with parinaud syndrome, precocious puberty, and obstructive hydrocephalus?
A
Germinomas of pineal gland (histologicall similar to seminomas)
6
Q
What is parinaud?
A
No conjugate vertical gaze due to lesion in superior colliculi
7
Q
What presents with unilateral headache and associated with rhinorrhea and periorbital pain?
A
Cluster headache; MC in men
8
Q
What levels do you see lateral horn in?
A
T1 - L2
9
Q
What do lower spinal cord segments look like?
A
Bigger ventral horn (more gray less white)
10
Q
What do upper spinal cord segments look like?
A
More white less gray
11
Q
What happens in age related macular degeneration wet?
A
Bleeding due to choroidal neovascularization
12
Q
What is the diagnosis? Grayish green subretinal membrane and hemorrhaging.
A
Wet age related macular degeneration
13
Q
Where is meyer’s loop?
A
Temporal lobe
14
Q
Where is upper optic radiation?
A
Parietal lobe
15
Q
What does the huntington mutation cause?
A
GOF mutation that causes histone deacetylation
16
Q
What chromosome is mutated with VHL?
A
Chromosome 3 (remember 3 letters in VHL)
17
Q
What gets damaged in noise induced hearing loss?
A
Stereocilia of organ of corti
18
Q
What does succinylcholine cause?
A
Life threatening hyperkalemia
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
20
Q
What is located in the internal capsule?
A
Corticospinal tract
21
Q
What is a 5mm cavity in the brain?
A
Small lacunar infarct from lipohyalnois and microemboli
22
Q
What do use for bradycardia in inferior wall MI?
A
Atropine
23
Q
What do you see ring enhancing lesions?
A
Toxoplasma, brain abscesses (complication of bacterial endocarditis from S. aureus usually), CNS lymphoma
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
25
What does friedreich ataxia affect?
Dorsal root ganglia, spinocerebellar tract, corticospinal tract, dorsal column --> spinal cord atrophy
26
What is a key presentation of Friedreich ataxia?
Wide-based gait with difficulty maintaining balance in 5-15 yo
27
How do you tell myasthenia gravis and lambert eaton apart?
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
28
What causes halos around light, vision worse after dark room (eye dilation)?
Closed angle glaucoma
29
What are two key findings for Wallenburg?
Dysphagia and dysarthria; nucleus ambiguus lesions are specific for it
30
How do you tell CN III palsy from INO?
Convergence is normal in INO
31
What is a calcified cystic mass with thick brownish fluid high in choelsterol?
Craniopharyngioma
32
How old is a child who can use utensils and copy a circle?
About 3 years old
33
What is a bilateral wedge shaped necrosis parallel to longitudinal fissures in hypoxic ischemic encephalopathy?
Watershed infarct
34
What is the MCC of aseptic meningitis?
Enteroviruses
35
What is the MCC of lobar hemorrhage in adults >60yo?
Cerebral amyloid angiopathy particularly in parietal and occipital lobes
36
Where is area postrema located?
Dorsal surface of medulla near caudal end of 4th ventricle
37
When do microglia move to area of infarct/ischemia?
3-5 days after injury and then astrocytes form scars
38
Which tracts does Vitamin b12 affect?
Lateral corticospinal and dorsal columns
39
What do you do if someone is above 40degree celsius?
This is hyperpyrexia. Lower temperature with cold blankets and then give anti-pyretics
40
What is a major side effect of halothane?
Hepatic necrosis (inc AST, ALT, prolonged PT, shrunken liver)
41
What part of Wernicke Korsakoff is irreversible?
Memory loss
42
What causes IVH in neonates?
Fragile germinal matrix bleeding
43
Where is broca's area located?
Lower frontal lobe
44
What happens if you get pure internal capsule stroke?
Pure motor weakness in arms, leg, face
45
What innervates the posterior part of external auditory meatus?
Vagus
46
What innervates the inner part of tympanic membrane?
Glossopharyneal
47
What type of tremor happens with certain actions and improves with alcohol?
Essential tremor
48
How do you treat an essential tremor?
Primidone, Propranolol
49
What is the treatment for status epilepticus?
1st line is benzodiazepines then give phenytoin. Phenobarbital if they are seizing still.
50
What do you see cortical atrophy as well as caudate and putamen atrophy?
Huntington
51
What does PCA stroke cause?
Homonymous hemianopia with macular sparing (MCA doesn't spare macula)
52
What is the time constant?
Time it takes for a change in membrane potential
53
What is the length constant?
How far conduction travels before it dissipates
54
What does myelination do time and length constant?
Decreases time constant and increases elngth constant
55
What do you see anti-yo, hu, P/Q antibodies in?
Paraneopalstic cerebellar degeneration
56
What is paraneoplastic cerebellar degeneration?
Immune response against tumor cells that cross react with purkinje neuron antigens. Associated with lung cancers. Causes dysarthria, visual problems, ataxia
57
What is the diagnosis? Muscle rigidity, fever after surgery under inhaled anesthetics?
Malignant hyperthermia
58
Who gets malignant hyperthermia?
Those who inherit a defect in ryanodine receptor that causes large amounts of Ca to be released from SR
59
What does malignant hyperthermia present with?
Muscle rigidity, tachycardia, HTN, hyperkalemia, myoglobinuria, fever
60
What type of meningits? Elevated protein, normal glucose, lymphocytes
Viral meningitis
61
What is associated with polyhadamnios?
Anencephaly and GI obstruction
62
How does entacapone work?
Prevents L-dopa degradation and increases quantity entering the brain
63
What is the diagnosis? Ipsilateral pain/weakness of shoulder, miosis, ptsosis.
Pancoast tumor
64
What does hepatic encephalopathy deplete?
Glutamate and alpha-ketoglutrate (because it is used in neurons to detoxify accumulated glutamine; use alpha KG to convert it to glutamate)
65
How do mu receptors work?
Increase potassium efflux and close Ca channels
66
What ciliary epithelium do?
Produce aqueous humor
67
What targets ciliary epithelium?
Timolol (targets beta receptor)
68
What are the short acting benzos?
Triazolam, Alprazolam, Oxazepam
69
What side effects do you see with short acting benzos?
Less sedation but more withdrawal
70
How do you opioid analgesics affect the gallbladder?
Cause sphincter of oddi smooth muscle contraction causing biliary colic
71
What happens to albumin in hepatic necrosis?
Remains the same since it has a long half life; only changed with end stage liver disease
72
What ion contributes to resting membrane potential?
Mostly K and some Na
73
Which way does chloride flow?
Into the cell despite negative potential
74
What is Naloxone?
Mu antagonist
75
What presents with transient numbness and tingling that onsets suddenly and disappears in 20 minutes?
TIA
76
Where do the cerebral hemishperes and lateral ventricles come from?
Telencephalon (which comes from the prosencephalon)
77
Where do the third ventricle and thalamus come from?
Diencephalon (which comes from the prosencephalon)
78
Where do the aqueduct and mdibrain come from?
Mesencephalon (which also comes from the mesencephalon aka midbrain)
79
Where do the upper part of the fourth ventricle, pons, cerebellum come from?
Metencephalon (which comes from rhombencephalon)
80
Where do the lower part of fourth ventricle and medulla come from?
Myelencephalon (which comes from rhombencephalon)
81
Where do PNS neurons and Schwann cells come from?
Neural crest
82
What is the confirmatory test for neural tube defects?
AchE
83
What is anencephaly associated with?
Polyhydramnios and maternal diabetes type I
84
What is Dandy Walker malformation associated?
Hydrocephalus and Spina bifida
85
What is wallerian degeneration?
Degeneration distal to injury and proximal axon retraction
86
What is the gene associated with holoprosencephaly?
SHH
87
What fuses to form mutlinucleated giant cells in the CNS in HIV patients?
Microglia
88
Which nerve fibers are unmyelinated?
Autonomic postganglionic and C fibers
89
What are the sensory corpuscles?
Merkel: deep static touch, position, slow
Meissner's: fine/light touch, position, fast
Ruffini: stretch of skin, slow
Pacinian: vibration, pressure, fast
90
What nucleus is involved with stress and panic?
Locus cereleus because NE increases in anxiety
91
What neurotransmitters are implicated in huntington's?
Decreased GABA and Ach
92
In what disease did Ach increase?
Parkinson's
93
How does NE promote sleep?
SCN makes NE which stimulates pineal gland to make melatonin
94
What causes rapid eye movement in REM?
PPRF
95
What is Papez's circuit?
Cingulate --> hippocampus --> fornix --> mamillary body --> thalamus
96
What are the inputs to the cerebellum?
Middle cerebellar peduncle: contralateral cortex
| Inferior cerebellar peduncle: ipsilateral proprioception
97
What are the outputs of the cerebellum?
Superior cerebellar peduncle: contralateral cortex (via deep nuclei)
Deep nuclei: : dentate, emboliform, globose, fastigial (lateral to medial)
98
What are the trinucleotide repeats in each disease?
Fragile X: CGG
Friedreich: GAA
Huntington: CAG
Myotonic dystrophy: CTG
99
What are amygdala lesions associated with?
HSV-1
100
What presents with hyperorality, hypersexuality, disinhibited behavior? Where is the problem?
Kluver-bucy
| In the amygdala
101
What presents with agraphia, alcalculia, finger agnosia, left right disorientation?
Gertsmann syndrome
Problem in left parietal - temporal cortex
102
How to tell PPRF lesion from frontal eye field lesion?
PPRF looks away from lesion
| FEF look toward lesion
103
If you correct hypernatremia too fast what happens?
Cerebral edema and herniation
104
Where is the infarct: contralateral hemiparesis, decreased contralateral proprioception and tongue deviating ipsilaterally?
ASA (anterior spinal artery)
105
Where is the infarct most likely if you see dysphagia and hoarseness?
PICA - Lateral medullary syndrome (Wallenburg): because nucleus ambiguus effects are specific to it
106
Where is the infarct most likely if you see facial paralysis?
AICA - Lateral pontine syndrome
107
Where is the second MC location of berry aneurysms?
Post. communicating
108
What symptoms do you see if there is an aneurysm of posterior communicating?
CN III palsy
109
What do you see transtentorial herniation and CN III palsy with?
Epidural hematoma
110
What is a lobar intraparenchymal hemorrhage caused by?
Cerebral amyloid angiopathy
111
What do yo see at 3-5 days after stroke?
Macrophages
112
What do you see 12-48 hours after stroke?
Necrosis + neutrophils
113
What is the inheritance pattern of SMA?
AR
114
What has hammer toes and pes cavus, kyphoscoliosis?
Friedreich Ataxia
115
What degenerated in friedreich?
Large myelianted sensory neurons in DRG, dorsal columns
116
What is it called when you have hemisection of spinal cord?
Brown Sequard
117
What can cause Horner's besides Brown sequard and pancoast?
Late stage syringomyelia
118
What did S2, 3, 4 do?
Erection, penile and anal sensation
119
What are the reflexes?
Biceps: C5
Triceps: C7
Patella: L4
Achilles: S1
120
What may cause primitive reflexes to reappear in adults?
Frontal lobe lesions
121
What is the galant reflex?
Stroking along one side of spine while newborn is face down causes lateral flexion of body towards that size
122
When do the primitive reflexes disappear?
Moro: 3 mos
Rooting: 4 mos
Palmar: 6 mos
Plantar: 12 mos
123
What two nerves are at cerebellopontine angle?
CN VII, VIII
124
What does superior colliculi do?
Conjugate vertical gaze
125
What is a common cause of Parinaud?
Pinealoma or Germinoma in pineal gland
126
Where are the cranial nerve nuclei?
Midbrain: 3, 4
Pons: 5, 6, 7, 8
Medulla: 9, 10, 12
Spinal cord: 11
127
What is nucleus ambiguus?
CN 9, 10, 11. Does motor innervation of pharynx, larynx, and upper esophagus
128
What is nucleus solatrius?
CN 7, 9, 10. Does sensory information (taste, baroreceptors, gut distension)
129
What nerve go through jugular foramen?
CN 9, 10, 11
130
Which way does jaw deviate in CN V motor lesion?
Toward
131
What causes hyperacusis?
Stapedial nerve injury
132
What hearing do you lose first?
High frequency
133
What is prebyopia?
Decrease in focusing ability during accommodation due to sclerosis and decreased elasticity
134
What fixes your myopia?
Presbyopia because it doesn't focus as well so it allows the image (which normally lands before retina) to land on the retina
135
What causes open angle glaucoma?
Primary is unclear. Secondary is blocked trabecular meshwork from WBC (uveitis), RBC (vitreous hemorrhage), retinal elements (retinal detachment)
136
What causes closed angle glaucoma?
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
What do you not give for acute closure in closed angle glaucoma?
Epinephrine
138
What is the path of nerves to cause miosis (parasympathetic)?
Edinger westphal --> CN III --> ciliary ganglion --> short ciliary --> pupillary sphincter
139
What is the path of nerves to cause mydriasis (sympathetic)?
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
What is Marcus Gunn pupil?
Lack of afferent so no response when light shone in affected eye
141
What are retinal breaks more common with?
High myopia and preceeded by posterior vitreous detachment (flashes and floaters) w/ eventual monocular loss --> SURGICAL EMERGENCY)
142
Why do you get nystagmus in abducting eye with MLF lesion?
The LR on the abducting eye overfires to cause the not functioning eye to move
143
What does right INO mean?
Right eye is paralyzed
144
What are the findings of MS?
IgG in CSF, oligoclnal bands, periventricular plauqes
145
When do symptoms of MS worsen?
After hot shower or post workout (ie with heat exposure)
146
What is the albuminocytologic disassociation and what is it with?
It is increased CSF protein with normal cell count. Seen with AIDP/ Guillan Barre
147
What is ADEM?
Multifocal perivenular inflammation and demylination after measles of VZV or vaccine (rabies, smallpox)
148
What is wrong in charcot marie tooth?
Can't make proteins that are involved in peripheral nerve or myelin sheath function/structure
149
What does charcot marie tooth present with and what is its inheritance?
AD; Scoliosis and pes cavus
150
What is adrenoleukodystrophy?
X-linked; can lead to coma/death and adrenal gland crisis. Can't metabolize very long chain FA
151
Where do partial seizures MC occur?
Medial temporal lobe
152
What are two heart drugs you can use for migraine headaches?
Propranolol, CCB
153
How do you tell peripheral from central vertigo?
Via positional testing:
Peripheral: delayed nystagmus
Central: immediate nystagmus
154
What is the mutation in Sturge-Weber?
Noninherited mutation in GNAQ. anomal of neural crest derivatives
155
What do you see a leptomeningeal angioma with?
Sturge Weber
156
What does VHL inhibit?
HIF
157
Which tumor do you see psammoma bodies with?
Meningioma
158
Where does Schwannoma most commonly occur?
Cerebellopontine angle
159
What do you see secondary polycythemia with?
Hemangioblatoma because it can produce EPO
160
What has biphasic growth pattern?
Schwannoma
161
Where is oligodendroglioma most commonly occur?
Frontal lobes
162
What has a chicken wire capillary pattern?
Oligodendroglioma
163
Where does hemangioblastoma most commonly occur?
Cerebellum
164
Where does colloid cyst occur?
Third ventricle
165
What is a highly malignant tumor in kids?
Medulloblastoma
166
What tumor is found in the fourth ventricle?
Ependymoma
167
Where do kids tumors occur mostly?
Under the tentorium cerebelli (ie where cerebellum etc are)
168
What herniates in an uncal herniation?
Medial temporal lobe
169
How do cholinomimetics treat glaucoma?
Cholinomimetics contract ciliary muscle to open up trabecular meshwork
170
What is latanoprost?
PGE analog that increases aqueous humor outflow. Causes darkening of iris
171
What two side effects does tolerance not develop to with opioid analgesics?
Constipation and Miosis
172
What is butarphanol?
Mu partial agonist and kappa agonist. Less respiratory depression than full agonists.
173
Which opiod analgesic does nalaxone not reverse?
Butarphanol
174
What is a major side effect of Tramadol?
Sertonin Syndrome
175
How does Tramadol work?
Very weak opiod agonist and inhibits 5HT and NE reuptake
176
What is the 1st line treatment of eclampsia seizures?
MgSO4
177
What are major side effects of Valproate?
Fatal hepatotoxicity, spina bifida. Also tremor and weight gain
178
What is the drug of choice for partial seizures?
Carbamazepine
179
What is 1st line epilepsy drug in neonates?
Phenobarbital
180
How does Gabapentin work?
Inhibits Vca channels
181
What is contraindicated in porphyria?
Barbiturates
182
What are the short acting benzos?
Alprazolam, triazolam, midazolam, oxazepam
183
What do you have less risk of drowsiness with but more withdrawal?
Short DOA barbiturates (Alprazolam, Triazolam, Oxazepam, Midazolam)
184
What do you give for bedwetting
Desmopressin
185
What are the inhaled anesthetics?
Halothane and "fluranes" and NO
186
How does Dantrolene work?
Prevents release of Ca from SR in skeletal muscle
187
What is the toxicity for halthone?
MAJOR hepatotoxicity
188
What is the toxicity for methoxyflurane?
Nephrotoxicity
189
What is the toxicity for enflurane?
Proconvulsant
190
What is thiopental?
IV barbiturate anesthetic High potency and lipid solubility. Decreases cerebral BF. Used for induction of anesthesia and short surgical procedures
191
What redistributes to skeletal muscle and fat?
Thiopental
192
What are the side effects of Midazolam?
Severe postop respiratory depression. Decreased Bp and anterograde amnesia
193
What is Midazolam?
IV benzo anesthetic used for endoscopy. Used adjunctively with gaseous anesthetics and narcotics
194
What is ketamine?
PCP analog that acts as dissociative anesthetic. Blocks NMDA receptors. CV stimulant. Increases cerebral BF
195
What are the side effects of ketamine?
Disorientation, hallucination, bad dreams
196
What are the IV opioid anesthetic?
Morphine, Fentanyl
197
What is propofol?
Potentiates GABA. Used for ICU sedation, rapid anesthesia and short procedures. Less postop nausea than thiopental.
198
What are the local anesthetics?
Esters (procaine, cocaine, tetracaine)
| Amines (lidocaines, mepivcaine, bupivcaine) - have two "I"
199
How do local anesthetics work?
Block Na channels especially activated ones so effective for rapidly firing neurons
200
What can local anesthetics be given with?
Vasoconstrictors (Epinephrine usually) --> enhances local acion - dec bleeding, inc anestheisa by dec systemic concentration
201
What happens with local anesthetics in acidic tissue?
Alkaline ones are charged and can't penetate membrane so need to give more
202
What type of nerves do anesthetics block?
Small > large; myelinated > unmyelinated (size preference over myelination)
203
What is the order of sensory loss in local anesthetics?
Pain > temperature > touch > pressure
204
What are the toxicities for local anesthetics?
CNS excitation
205
What is a toxicity with bupivicaine?
Severe CV toxicity
206
What are neuromuscular blocking drugs specific for?
Motor nicotinic receptor
207
What are the side effects of depolarizing neuromuscular blockers?
Hypercalcemia, hyperkalemia, malingant hyperthermia
208
What are the neuromuscular blocking agents?
Depolarizing: Succinylcholine
| Non-depolarizing: "urium" and "uronium" and Tubocurarine
209
How do non-depolarizing neuromuscular blocking agents work?
Competitive antagonists of Ach
210
What do antimuscarinics improve with parkinsons?
Tremor and rigidity BUT NOT BRADYKINESIA
211
What is amantadine for?
Increases dopamine release and for influenza A and rubella
212
What is the toxicity for amantadine?
Ataxia
213
What is a toxicity with L-dopa and carbidopa?
"On-off" due to varying drug levels. Dyskinesia while on and akinesia while off.
214
How does Selegiline work?
MAO-B inhibitor (MAO-B preferentially metabolizes dopamine over 5HT and NE)
215
What are common side effects of L-dopa?
Anxiety and agitation
216
What are the side effects of Sumatriptan?
Coronary vasospasm (contraindicated in CAD and Prinzmetal), mild tingling
217
What blocks morphine tolerance?
Ketamine through its inhibitor action on NMDA receptors preventing glutamate from binding
218
What pathway connects hypothalamus and pituitary gland?
Tuberoinfundibular
219
What would infarct of anterior medial pons show?
Dysarthria and contralateral ataxic hemiparesis
220
Where does CN V exit?
Middle cerebellar peduncle at lateral aspect of mid pons
221
What does Vitamin E deficiency show?
Dorsal column, spinocerebellar tract, and peripheral nerve degeneration
222
How does pramipexole work?
Dopamine agonist so stimulates dopamine receptors
223
What are glial cells?
Ependymal, oligodendrocytes, astrocytes
224
What cells are synpathophysin positive?
Neurons
225
What is the terminal sulcus?
Divides anterior 2/3 of tongue from posterior 1/3
226
What is the foramen cecum i the tongue?
Midline at terminal sulcus (divides anterior 2/3 of tongue from posterior 1/3)
227
What presents with rock hard eye, halos, and sudden pain in the eye?
Acute closure glaucoma
228
What is cerebral amyloid angiopathy?
Elderly; causes intracerebral hemorrhage that would present with headache and focal neurologic deficits
229
What does it mean if there is a high arteriovenous concentration gradient after administering an anesthetic gas?
It means more peripheral uptake from arterial blood and less to the brain. Means it would have a slow onset of action.
230
What is Pentazocine?
Opioid narcotic with partial agonist and weak antagonist activity. If given with morphine it will have antagonist effects and can worsen withdrawal symptoms.
231
What are neurofibromas a proliferation of?
Schwann Cells (elongated, wavy cells with spindle nuclei)
Also fibroblasts and neurites
232
What is the mechanism of action of phenobarbital?
Facilitate GABA action by increasing duration of Cl channel opening (barbiDURate)!
233
What causes ataxia, wide based gait, nystagmus and head tilting?
Cerebellum medial lesion
234
Hemorrhage where would present with pinpoint pupils, loss of horizontal gaze, quadriparesis, decrebrate posturing and rapidly evolving coma leading to death within hours?
Pontine hemorrhage
235
Hemorrhage where would produce contralateral sensory loss, aphasia, temporary homonymous hemianopia?
Thalamic hemorrhage
236
What is vasogenic edema?
"Extracellular"
Fluid shifts from intra to extracellular
Neoplasm or infarction cause it (destroy endothelial tight junctions)
Increases ICP
237
What is cytotoxic edema?
"Intracellular"
Fluid shifts from extra to intracellular
From ischemia that impairs Na/K ATPase --> fluid shifts in
238
If hyperreflexia and tongue deviation on protrusion toward side of lesion, what part of medulla is the lesion in?
Pyramids because the hypoglossal nerve comes off the pyramids and the corticospinal tracts decussate there
239
Where does CN III come off?
Above pons
240
What are the complications of succinylcholine?
Hyperkalemia, hypercalcemia, malignant hyperthermia
