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NEUROLOGY Flashcards

0
Q

What’s the embryology neural development (3,5,6)

A

FOREBRAIN
▪️telencephalon ( cerebral hemisphere)
▪️diencephalon ( thalamus. 3 ventricle)

MIDBRAIN
▪️mesencephalon (midbrain)

HINDBRAIN
▪metencephalon (Pons , cerebellum upper 4 ventricle)
▪️ myelencephalon (medulla Lower 4 ventricle )

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1
Q

What’s the CNS origins

A

Neuroectoderm : ependimal cells
Neural crest PNS Schwann cells
Mesoderm: microblog macrophages

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2
Q

Labs to confirm neural tube defect

A

⬆️α-fetoprotein (AFP) in amniotic fluid and maternal serum.  ⬆️acetylcholinesterase (AChE) amniotic fluid

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3
Q

Which diseases are related with holoprosncephaly (2)?

A

Patau syndrome

Fetal alcohol syndrome

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4
Q

What’s chiari II syndrome?

A

Herniation of cerebellar tonsils and vermis
Hydrocephalus
Meningomyelocele

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5
Q

What’s dandy walker syndrome?

A

Agenesis vermis cerebellar
Hydrocephalus
Spina bifida

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6
Q

What’s syringomelia?

A

Cyst cavity into spinal cord

Associated whit chiari 1

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7
Q

Innervation of the tongue (3 actions)

A

TASTE VII,IX,X
PAIN V3,IX,X
MOTOR X palatoglossus XII

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8
Q

What’s the astrocyte marker?

A

GFAP

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9
Q

What disease is related whit acoustic neuroma bilateral?

A

Neurofibromatosis type 2

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10
Q

Types of sensory receptors (5)

A

Free nerve endings pain temp
Meissner corpuscles. Fine touch
Pacinian corpuscles. Vibration pressure
Merkel discs. Shapes edges position
Ruffini corpuscles slippage of objects

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11
Q

What layer nerve fiber have to be rejoined in surgery

A

Perineurium

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12
Q

Neurotransmitters and its localization

A

NE Locus ceruleus (pons)a PANIC ATTAKS

DOPAMINE Ventral tegmentum and substantia nigra pars compacta (midbrain) PARKINSON

5HT Raphe nuclei (pons, medulla, midbrain) ANOREXIA DEPRESION

ACh Basal nucleus of Meynert ALZHEIMER

GABA nucleus accumbens

NMDA receptors in the striatum N. Caudadus HUNTINGTON

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13
Q

Relation between neurotransmitters in Huntington and parkinson diseases

A

AL REVES!!

Parkinson ⬇️ dopamine⬆️ ACh

Huntington ⬆️ dopamine⬇️ACh ⬇️GABA

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14
Q

What regions of the CNS permits the crossover transport of molecules between CNS and BLOOD?

A

Area postrema :vomit
Osmotic sensing
Neurohypophysis

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15
Q

Areas of hypothalamus an it’s function

A

Lateral area. HUNGER
Ventromedial area SATIETY
Anterior hypothalamus COOLING
Posterior hypothalamus HEATING
Suprachiasmatic nucleus CIRCADIAN RYTHM

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16
Q

What substances decreases REM sleep phase? (4)

A

NE
Alcohol
BZD
Barbiturates

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17
Q

Management of sleep enuresis, night terrors and sleep walking

A

sleep enuresis DESMOPRESSIN

night terrors and sleep walking BZD

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18
Q

Sleep stages (6)

A 
BATS D B
Beta
Alpha
Teta
Splindles K complex
Delta
Beta REM!!!
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19
Q

Distribution of thalamus (5)

A

VPL Spinothalamic and dorsal columns/medial lemniscus
VPM Trigeminal and gustatory pathway
LGN CN II
MGN Superior olive and inferior colliculus of tectum
VL Basal ganglia, cerebellum

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20
Q

Symptoms of central pontine myelinolisis (5)

HYPONATREMIA CORRECTION

A 
Acute paralysis
dysarthria
dysphagia
diplopia
loss of consciousness
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21
Q

What are the cerebellum nucleus lateral to medial

A

Dentate, Emboliform, Globose, Fastigial

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22
Q

Which pathway uses the direct and indirect basal ganglia circuit ?

A

D1 DIRECT striatum-palidus internum-thalamus

D2 INDIRECT striatum- plaidus Externum- subtalamun -internum-thalamus

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23
Q

Lest bodies are seen in which disease ?

A

Parkinson disease

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24
Q

MRI findings in Huntington disease?

A

Atrophy of caudate nuclei with ex vacuo dilatation of frontal horns onMRI

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25
Q

Explain aphasias (6)

A

Broca : understand not talk not repeat
Wernike: not understand not repeat talk non sense
Conduction: NOT REPEAT
Transcortical motor broca but REAPET
Transcortical sensorial wernike but REAPET
Mix transcortical JUST REAPET

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26
Q

6 first common brain lesions

A

Amygdala (bilateral) Klüver-Bucy syndrome
Frontal lobe disinhibition primitive reflexes
Nondominant parietal- temporal cortex hemispatial neglect syndrome
Dominant parietal- temporal cortex Gerstmann Sx
Reticular activating system (midbrain) coma
Mammillary bodies (bilateral) wernicke -korsakoff

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27
Q

Second 6 brain lesions

A

Basal ganglia parkinson Huntington
Cerebellar hemisphere intention tremor ,ataxia, fall ipsilateral
Cerebellar vermis Subthalamic nucleus Truncated ataxia
Hippocampus (bilateral) anterograde amnesia AlZHEIMER
Paramedian pontine reticular formation eyes away from lesion
Frontal eye fields eyes toward lesion

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28
Q

What artery is implicate to lacunar infarcts due hypertension?

A

Lenticulostriate artery

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29
Q

What’s medial medullary syndrome?

A

Occlusion of ASA

Contralateral hemiparesis
⬇️ contralateral propiocepcion
Tongue deviates ipsilateral

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30
Q

What’s lateral medullary syndrome WALLENBERG

A 
Occlusion of PICA 
Vomiting, vertigo, nystagmus;
⬇️ pain and temperature sensation from ipsilateral face and contralateral body; 
dysphagia, hoarseness,  gag reflex; 
ipsilateral Horner syndrome; 
ataxia, dysmetria.
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31
Q

What’s lateral pontine syndrome

A

Vomiting, vertigo, nystagmus.
Paralysis of face,  lacrimation, salivation,  taste from anterior 2⁄3 of tongue.
Ipsilateral  pain and temperature of the face, contralateral  pain and temperature of the body.
Ataxia, dysmetria.

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32
Q

What’s “locked-in syndrome”

A

Just a have consciousness and blinking

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33
Q

How is the presentation of posterior communicate aneurism ?

A

CN III palsy—eye is “down and out” with ptosis and mydriasis

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34
Q

What are Charcot-Bouchard microaneurysm?

A

Small vases in basal ganglia and thalamus

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35
Q

What part of the cerebrum is most vulnerable to hypoxia damage ?

A

HYPOTHALAMUS

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36
Q

What are the communication between ventricles?

A

Foramen of monro
Cerebral aqueduct of Sylvius
Foramen of luschka
Foramen of magendie

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37
Q

What’s the idiopathic intracranial hypertension (4)

A

headaches
diplopia (usually from CN VI palsy)
no mental status alterations
Papilledema

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38
Q

Normal pressure hydrocephalus triad

A

urinary incontinence
ataxia
cognitive dysfunction

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39
Q

At what vertebral level spinal cord spends?
At what vertebral level subarachnoid space goes?
What’s the lumbar puncture level?

A

L1-L2

S2

L3-L4
L4-L5

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40
Q

Principal clinical presentations in medullar diseases

A

Poliomyelitis and spinal atrophy muscular flaccid paralysis
Multiple sclerosis scanning speech, intention tremor, nystagmus.
Amyotrophic lateral sclerosis UMN and LMN deficits no oculomotor
RILUZOLE
Complete occlusion of anterior spinal artery
Tabes dorsalis sensation and proprioception, progressive sensory ataxia argyll Rubens pupil
Syringomyelia loss of pain and temperature upper limbs
Vitamin B12 deficiency as tabes dorsalis plus ataxia gait

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41
Q

Genetic etiology , protein and clinical presentation of Friedreich ataxia

A

Repeat GAA
frataxin

Staggering gait, 
frequent falling, 
nystagmus, 
dysarthria, pes cavus, 
hammer toes, diabetes mellitus, 
hypertrophic cardiomyopathy
kyphoscoliosis
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42
Q

Principal clinical reflexes (4)

A 
Biceps = C5 nerve root. 
Triceps = C7 nerve root. 
Patella = L4 nerve root. 
Achilles = S1 nerve root.
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43
Q

What’s parinaud syndrome?

A

paralysis of conjugate vertical gaze

due to lesion in superior colliculi

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44
Q

Cranial nerve nuclei localization

A

ƒ Midbrain—nuclei of CN III, IV
ƒ Pons—nuclei of CN V, VI, VII, VIII
ƒ Medulla—nuclei of CN IX, X, XII ƒ
Spinal cord—nucleus of CN XI

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45
Q

Which pathways cranial nerve se use to exit of the cranium?(12)

A

Cribriform plate (CN I).
ƒOptic canal (CN II, ophthalmic artery,
central retinal vein)
ƒ Superior orbital fissure (CN III, IV, V1, VI,
ophthalmic vein, sympathetic fibers)
ƒ Foramen Rotundum (CN V2)
ƒ Foramen Ovale (CN V3)
ƒ Foramen spinosum (middle meningeal
artery)
ƒ Internal auditory meatus (CN VII, VIII)
ƒ Jugular foramen (CN IX, X, XI, jugular vein)
ƒ Hypoglossal canal (CN XII)
ƒ Foramen magnum (spinal roots of CN XI,
brain stem, vertebral arteries)

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46
Q

What are the vagus nucleus (3)

A

Nucleus Solitarius Visceral Sensory information (e.g., taste, baroreceptors, gut distention).

Nucleus aMbiguus Motor innervation of pharynx, larynx, upper esophagus (e.g., swallowing, palate elevation).

Dorsal motor nucleus Sends autonomic (parasympathetic) fibers to heart, lungs, upper GI

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47
Q

Clinical findings in V-X-XI-XII cranial nerves lesions

A

V Jaw deviates toward side of lesion
X Uvula deviates away from side of lesion.
XI Weakness turning head to contralateral side of lesion (SCM)
XII Tongue deviates toward side of lesion

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48
Q

What’s the first cranial nerve affected in cavernous sinus sindrome?

A

VI

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49
Q

Where the high and low frequency sounds are processed in the inner ear?

A

High base of cochlea

Low Apex near to helicotrema

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50
Q

Difference between conductive and sensorineural hearing loss

A 
Conductive Abnormal (bone > air) Localizes to affected ear Normal 
Sensorineural  (air > bone) Localizes to unaffected ear
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51
Q

Which muscles close and open the jaw (3,1)

A

Masseter
Temporalis
Medial pterygoid

Lateral pterygoid

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52
Q

What’s hypopyon?

A

Pus in anterior chamber

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53
Q

Types an treatment for diabetic retinopathy (2)

A

Non proliferative - capilar damage macular laser

Proliferative - chronic hypoxia anti-VEGF bevacizumab

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54
Q

What’s retinitis pitgmentosa?

A

Inherited retinal degeneration. Painless, progressive vision loss beginning with night blindness (rods affected first).

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55
Q

How is the pupillary light reflex circuit?

A

Light.⏩ II nerve ⏩pretectal nuclei ⏩Edinger wesphal⏩ III nerve ⏩ciliary ganglion ⏩short ciliary nerves ⏩pupillary sphincter

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56
Q

Mydriasis circuit

A

Hypothalamus to ciliospinal cent of budge⏩ ext at T1 to superior chervil a ganglion ⏩plexus along internal carotid⏩ciliary nerve ⏩Pupillary dilator muscles

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57
Q

What’s Horner Syndrome?

A

Ptosis
Anhidrosis
Miosis

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58
Q

What cranial nerve is affected in posterior communicant aneurism and uncal herniation?

A

Parasympathethic III nerve
Midriasis
Down out gaze

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59
Q

How is seen IV nerve damage?

A

When see to contralateral side
The eye move upward
Problems going down stairs

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60
Q

Three Easiest visual fields affecting the right side of cerebrum?

A

Left upper quadrantic anopia
(right temporal lesion, MCA) Meyer loop

Left lower quadrantic anopia
(right parietal lesion, MCA) dorsal optic radiation

Left hemianopia with macular sparing
(PCA infarct),
macula Ž bilateral projection to occiput

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61
Q

What’s inter nuclear ophthalmoplegia?

A

Lesion of medial longitudinal fasciculus
So in horizontal gaze, when the MLF
The ipsilateral eye cannot go in direction of its brother

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62
Q

What risk factor are related most whit Alzheimer disease?(3)

A

ApoE4:  r
ƒAPP

presenilin-1, presenilin-2

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63
Q

What are pick bodies presented in pick disease ( frontotemporal dementia)

A

silver-staining spherical tau protein aggregates

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64
Q

What’s the most important clinical feature of Lewy body dementia?

A

VISUAL HALLUCINATIONS !!!!!!!

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65
Q

What’s the Charcot triad for Multiple Sclerosis?(5)

A

ƒScanning speech
ƒIntention tremor
Incontinence
Internuclear ophthalmoplegia
Nystagmus

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66
Q

CSF diagnosis in MS

A

Protein

OLIGOCLONAL BANDS

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67
Q

MRI in MS

A

Peri ventricular plaques

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68
Q

Treatment of MS

A

Beta -interferon

Natalizumab

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69
Q

Types of partial and generalization seizures (2,4)

A

Simple partial
Complex partial

Abscense
Myoclonic
Tonic-colonic
Tonic
Atonic
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70
Q

Principal features of the 6 adult brain tumors

A

Glioblastoma multiform 1 yr survival, butterfly , pseudopalizading central necrosis hemorrhage
Meningioma benign spider cells , psammoma bodies
Hmqngioblastoma CEREBELAR hippel-Lyndau produce EPO
Schwannoma NF-2 , S-100, CN VIII
Oligodendroglioma fried egg cells frontal lobes
Pituitary adenoma bitemporal hemianipia

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71
Q

Most important features of childhood brain tumors(5)

A

Pilocytic astrocytoma benign posterior fossa GFAP✅ rosenthal, corkscrew fibers
Medulloblastoma malignant cerebellar hydrocephalus compress 4 ventricle Homer-wright rosettes
Ependymoma malign hydrocephalus compress 4 ventricle pericentricular pseudorosettes
Craniopharyngioma derived of remanent rathke pouch like tooth benign
Neuroblastoma MMC extracranial solid tumor NEUROPIL S-100+⬆️HVA ⬆️VMA. N-MYC+

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72
Q

Signs of uncal herniation

A 
ipsilateral CN III (blown pupil, “down-and- out” gaze), 
ipsilateral PCA (contralateral homonymous hemianopia), 
contralateral crus cerebri at the Kernohan notch (ipsilateral paresis; a “false localization” sign).
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73
Q

Indirect and direct cholinomimetics drugs for glaucoma(2,2)

A

Direct (pilocarpine, carbachol)
Indirect (physostigmine, echothiophate)

⬆️outflow of aqueous humor via contraction of ciliary muscle and opening of trabecular meshwork

IN EMERGENCES USE PILOCARPINE!!!!!!

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74
Q

Mechanism of latanoprost in glaucoma

A

Is a PGF 2alpha analog ⬆️outflow aqueous humor

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75
Q

How opioids ⬇️ synaptic transmition?

A

open K+ channels, close Ca2+ channels⏩ ⬇️synaptic transmission.

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76
Q

What’s the problem whit butorphanol

A

Partial agonist of μ-opioid receptor and κ-opioid agonist

cause opioid withdrawal symptoms

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77
Q

Indications for epilepsy drugs (9)

A 
Ethosuximide. ABSCENSE
BZD ECLAPSIA  (MgSO4)
Phenytoin ALL 
Carbamazepine TRIGEMINAL NEURALGIA TERATOGENESIS
Valproic Acid NO IN PREGNANCY!!!!
Gabapentin POSTHERPETIC NEURALGY 
Phenobarbital NEONATES
Topiramate  MIGRAINE PREVENTION
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78
Q

Mechanism of action of Barbiturates

A

Facilitate GABAA action by  duration of Cl− channel opening, thus  neuron firing
Contraindicated in porphyria.

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79
Q

Mechanism of action of benzodiazepines and what have short t1/2 ATOM

A 
Facilitate GABAA action by ⬆️ frequency of Cl− channel ⬇️REM sleep. 
Alprazolam
Triazolam
Oxazepam 
Midazolam
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80
Q

Mechanism of action of anti insomnia drugs ZZZ

A

Act via the BZ1 subtype of the GABA receptor

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81
Q

Relationship between blood solubility and induction and lipid solubility and potency

A

blood solubility and induction INVERSE

lipid solubility and potency DIRECT

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82
Q

What drug cause most nausea thiopental or propofol?

A

THIOPENTAL!!!!!!!

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83
Q

Order of Los sensations in local anesthetics

A

(1) pain, (2) temperature, (3) touch, (4) pressure.

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84
Q

Phases of Reversal blockade of depolarizing Drugs (2)

A 
Phase I (prolonged depolarization)—no antidote. Block potentiated by cholinesterase inhibitors. ƒ 
Phase II (repolarized but blocked; ACh receptors are available, but desensitized)—antidote is cholinesterase inhibitors.
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86
Q

What are the mechanism of action of anti Alzheimer disease?(2)

A

NMDA receptor antagonist MEMANTINE

AChE inhibitors donepezil tacrine

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86
Q

How reversal of blockade of non depolarizing drugs

A

NEOSTIGMINE!!!! +ATROPINE

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87
Q

What are the BALSA drugs for parkinson disease

A

Bromocriptine ergot ( not ergot pramipexole ropirinole)AmantadineLevodopa (with carbidopa) Entacapone Tolcapone
Selegiline MAO-B inhibitor (and COMT inhibitors Tolcapone )
Antimuscarinics

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88
Q

Mechanism of action of Triptans

A

5-HT1B/1D agonists. Inhibit trigeminal nerve activation

No in CAD prizmetal angina

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89
Q

What are the principal embryologic derivatives (3)

A

▪️ECTODERM
🔺Surface Ectoderm: rathke’s pouch anterior pituitary Lens cornea,inner ear, olfactory,epidermis , nasal oral, mammary sweat glands.
🔺Neural Tube:Brain spinal cord , posterior pituitary, pineal gland,retina
🔺Neural Crest: PNS Schawnn, pia,arachnoids aortopulmonar septum, endocardial cuishions, skull bones, melanocytes, adrenal medulla.
▪️MESODERM: muscle, bones ,cartilagen, CV,inter genitalia kidneys ureteres,adrenal cortex
▪️ENDODERM: GI,lungs, thymus parathyroid ,thyroid,middle ear bladder urethra

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90
Q

What type of cells are developed in cuteness Neurofibromatosis type 1, and what is its embryological Origen?

A

Schwann cells

Neural crest

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91
Q

What nerve is affects in trendelenburg sign?

A

Superior gluteal nerve

Paralysis of gluteus mediums and minimums

92
Q

What neurotransmitter is linked whit tetanus?

A

Tetanospasmin impaired the release of inhibitory neurotransmitters
GLICINE GABA

93
Q

What fish toxins acts open or closing the NA Channels (2,2)?

A

CLOSE. tetrodotoxin,saxitoxin

OPEN ciagiatoxin, Batrachotoxin (frog)

94
Q

What are the products of PROPIOMELANOCORTINA (3)?

A

ACTH
MSH
Beta-endorphins

95
Q

What part of the cerebrum is impaired in Alzheimer disease?(2)

A

Temporal lobes

Hypocampus

96
Q

Principal features of essential tremor -familial tremor (4)

A

Autosomal dominant
Worse static posture
Improve whit alcohol
Tto PROPANOLOL

97
Q

What drug counteract the parkinson-like effects of haloperidol?

A

Benzotropine

98
Q

How is seen Intracranial hemorrhage in the CT scan?

A

HYPERATTENUATED

BRIGTH!!!!!!!

99
Q

Big differences between secular aneurism and Charcot-Bouchard aneurysms (2)

A

Sacular aneurism
Subarachnoid hemorrhage
Not neurological deficits

Charcot-Bouchard aneurysms
Intraparenchimatous basal ganglia
Acute neurological deficits

100
Q

Where the hemorrhage is seen in cerebral amyloid angiopathy?

A

Lobar/cortical parenchymal hemorrhage

101
Q

Cause if binasal hemianopsia

A

Calcification of carotid arteries

102
Q

What’s the effect of inhaled anesthetics in renal and hepatic function?

A

⬇️ GFR
⬆️renal vascular resistance

⬇️hepatic blood flow

103
Q

What’s the pathogen edits of HIV associated dementia

A

Inflammatory activation of microglia cells

Microglia nodules

104
Q

Histologic all changes in Alzheimer disease (3)

A

Neurofibrilar tangles intracellular agregates of hyperphosphorilated tau portein
Senile plaques
Amyloid angiopathy

105
Q

Different cell inclusions in HSV and CMV

A

HSV intranuclear acidophilic inclusions

CMV intranuclear Basophilic inclusions

106
Q

Principal action of AChE inhibitors , and what can cross de BBB to treat atropine toxicity?

A

PRO-MUSCARINICS DRUGS!!!!!!!

PHYSOSTIGMINE tertiary amine can cross BBB

107
Q

What drugs are more implied in malignant hyperthermia syndrome?

A

HALOTANE

SUCCINYLCHOLINE

108
Q

Difference between non-depolarizing an depolarizing bockers?

A

depolarizing constant stimulation of ACh receptor

non-depolarizing prevent ACh binding receptor

109
Q

Mechanism of action of Cholinergic agonists (3)

A

Bind to ACh receptor and prevent interaction whit ACh

ATROPINE, SCOPOLAMINE, IPRATROPIUM

110
Q

How Gabapentin works?

A

Blocking presynaptic voltage-gated calcium channels

111
Q

What anti insomnia drug is safer in elderly patients?

A

RAMELTEON

melatonin agonist

112
Q

What group of drugs have to be avoid in elderly patients ?

A

BZDs
Antihistamines
Antidepressants

113
Q

Which situation promotes periphery neuropathy by Vit B6 deficiency?

A

USE OF ISONIAZID IN TB

114
Q

Other differences between frontotemporal dementia (Pick’s disease) and Alzheimer disease

A

frontotemporal dementia
50-60s
Forntotemporal
Socially inappropriate behavior

Alzheimer
60-70s
Parieto-temporal
Recent memory

115
Q

What is the consequence of sub-thalamic nucleus damage?

A

HEMIBALLISMUS

116
Q

What’s pseudotumor cerebri?

A

Elevated ICP

Young women overweight

117
Q

What Damaged regions cause superior and inferior quadrantanopia?

A

Lingual gyrus Superior Quadrantanopia

Cuneus gyrus Inferior quadrantanopia

118
Q

Which pathway is involve in the antipsychotics drugs action?

A

Mesolimbic-mesocortical pathway

119
Q

What important nerve can be blocked in interscalene nerve block ?

A

PHRENIC NERVE!!!!!!

120
Q

All posganglionic neurons in the sympathetic system release norepinephrine ,all except…(2)

A

Eccrine sweat glands

Adrenal medullae

121
Q

What’s the Cushing Triad?

A

Hypertension
Bradicardia
Bradypnea

122
Q

At what level the compression of sciatic nerve ocurrs?

A

L5-S1
Weaknes of thigh extension gluteus Maximus
Weakness of knee flexion hamstrings (isquiotibiales)
Weakness of foot plantar flexion ( gastrocnemius)
ABSCENSE ankle jerk reflex

123
Q

How L5 nerve is evaluated?

A

Foot dorsi flexion
Eversion
Inversion
Toe extension

124
Q

What nerve is injured in L5-S1 if there is an foramininal stenosis and herniation of the intervertebral disc?

A

foramininal stenosis L5

herniation of the intervertebral disc S1

125
Q

Rules about membrane potential

A

POTENTIAL MEMBRANE MEANS THE NUMBER AT THERE IS A MAJOR FLUX OF THE ION

In the negative base line there is a flux of ion negative

When goes to positive there is flux to positive ion
When goes to negative there is a flux of negative ion

126
Q

Differences between decerebrate and decorticated postures

A

Decerebrated
EXTENSORS PREDOMINATE
below red nucleus (pons, midbrain tegmentum)

Decorticated
FLEXORS PREDOMINATE
over red nucleus

127
Q

Changes in hypertensive retinopathy (4)

A

Flame-shape retinal hemorrhage
Cotton-wool spots
Cooper or silver wiring
Arteriovenous nicking

128
Q

What is the weed similar to atropine like symptoms ?

A

Jimson weed : Datura stramonium
Gardner’s midriasis

Treatment : physostigmine

129
Q

How is seen Alzheimer disease in Congo red stain in hypothalamus?

A

Apple green birefringence

Due to beta-sheet structure

130
Q

Histologic findings of parkinson disease ?

A

Intracellular eosinophilic inclusions composed of alpha-synuclein LEWY BODIES

131
Q

What drugs are related whit drug reaction whit eosinophilia and systemic symptoms syndrome ? DRESS

A

Anticonvulsivants
Allopurinol
Sulfonamides
Antibiotics

132
Q

What drugs induce anti eutrophic cytoplasmic antiboides? (2)

A

Anti hyperthyroidism

Hydralazine

133
Q

What neuromuscular disease is related with temporal arteritis?

A

Polymilagia rheumatica

134
Q

Treatment for Wilson disease (cooper acumulation)

A

D-penicilamine

135
Q

What are the cells which acts like macrophages after 1 week brain ischemia?

A

MICROGLIA!!!!!

136
Q

Which cells acts like fibroblasts after 2 week of brain schemia?

A

ASTROCYTES!!!!!

137
Q

Which nerve is compressed in transtentorial herniation?

A

OCULOMOTOR!!!

III CN

138
Q

Which characteristic of the electrical potential is increased by the presence of myelin I the nerve?

A

LENGTH CONSTANT OR SPACE CONSTANT!!!!

How far ca go!!!!

139
Q

What are the TWO main categories of cell membrane receptors?(1-4)

A

IONOTROPIC
🔹Nicotin Cholinergic receptor

SECOND MESSENGERS
🔹Alfa -1 
🔹Alfa-2
🔹Beta-2
🔹Muscharinic Cholinergic receptor
140
Q

What are the clinical findings in serotonin syndrome?

A 
Neuromuscular excitation ( clonus, rigidity, hyperreflexia)
Autonomic stimulation (hyperthermia ,tachycardia,vomit, diarrhea)
Altered mental status (agitation, confusion )
141
Q

What amino acid is precursor of serotonin?

A

TRYPTOPHAN!!!!

142
Q

Antidote for serotonin syndrome

A

CYPROHEPATDINE!!!!

Histamine and serotonine antagonist

143
Q

In a patient whit multiple sclerosis what is the treatment for muscular spasms?

A

BACLOFEN!!! GABA agonist

TISANIDINE!!!!

144
Q

Which anticonvulsants are indicated in focal and generalized seizures?

A 
FOCAL
🔹carbamzepine
🔹Gabapentin
🔹phenobarbital 
🔹phenytoin 
GENERALIZED
🔹valproic acid
🔹levetiracetam
🔹topiramate
🔹Lamotigene
145
Q

Drug indicated in ABSCENSE SEIZURE?

A

ETHOSUXIMIDE!!!!!

146
Q

How is the potency of the inhalator anesthetic in relation If temp and age?

A

⬆️ age:⬇️potency

⬆️ temp:⬆️potency

147
Q

What arterio-venous gradient of anesthetic means?

A

If is short means rapid onset of action

148
Q

Thiopental suffers redistribution phenomenon, which tissues are implicated? (2)

A

SKELETAL MUSCLE

ADIPOSE TISSUE

149
Q

Third cranial nerve passes through what two important arteries?

A

Posterior cerebral

Superior cerebelar arteries

150
Q

What nerve is impaired when the patient CANNOT GO DOWN STAIRS?????

A

TROCLEAR!!!!!!
IV CN!!!!!

SUPERIOR OBLIQUE !!!!!

151
Q

What anatomic structure is affected in Huntington disease?

A

Caudate nucleus !!!

152
Q

Which central structures are implicated in Wilson disease?

A

Lentigo fm nucleus ( glubus palidus ,putamen)

153
Q

What is the dorsal midbrain (parinaud)syndrome in the pnineal gland mass? Which has obstructive hydrocephalus as well ?

A

Paralysis upward gaze
Ptosis
Pupillary abnormalities

154
Q

What is the cardinal symptom of damage to the Nucleus ambiguous ?

A

Myoclonus

155
Q

Where the acoustic schwannomas are located?

A

Cerebellopontine angle

BETWEEN THE CEREBELLUM AND LATEAL PONS!!!!

156
Q

Which muscle close the jaw?

A

Lateral pterygoid

157
Q

Different Microscopic findings in medulloblastoma and pilocityc astrocytoma

A

Medulloblastoma sheets of primitive cells whit many mitotic figures

Pilocityc astrocytoma pilocityc astrocytes and rosenthal fibers

158
Q

Period of hemorrhagic transformation risk

A

First 7 days after ischemia

159
Q

When occurs axon degeneration ( wallerian degeneration)

A

In the peripheral nerve system

NO IN THE CNS (myelin debris,neural inhibitory factors,glial scarring)

160
Q

What triphasic spikes at the electroencephalogram means?

A

Creutzfeldt-Jakob disease

An a chaperon disease disorder

161
Q

Which diseases from glycoproteins storage and immunodeficiency can be treated whit enzyme replacement Therapy? (2)

A

Gaucher 🔹 glucocerebrosidase replacement

Several immunodeficiency combined 🔹 Adenosin deaminase ADA

162
Q

How are seen in behavior early stages of Alzheimer disease?

A

Confusion
Disoriented
Difficulty to control
Violent

163
Q

How opiods acts?

A

Decrease release of substance P in dorsal horn

Peri aqueducts gray region leading to stimulation of Mu receptors

164
Q

How acts Entacapone and Tolcapone ?

A

Entacapone 🚫COMT PERIFERIC!!!!

Tolcapone 🚫COMT CENTRAL!!!!

165
Q

How rheumatoid arthritis can cause ventilatory failure?

A

Subluxation of atlantoaxial joint
By destruction of traverse ligament and progressive erosion or fracture of Odontoid process whit spinal cord compression worsened by hyperextension in the intubation 😵😤

166
Q

In rune test bone conduction greater than air conduction means….

A

Conductive hearing loss

167
Q

Which another symptoms besides floppy baby are seen in botulinum toxin exposition? 3Ds

A

Diplopia
Dysphagia
Dry mouth

168
Q

What’s kinesin?

A

Motor protein whit anterograde transport of vesicles in micro tubules

169
Q

What are the hypothalamic centers of hunger and satiety?

A

HUNGER Lateral

SATIETY Ventromedial

170
Q

Horner sign ➕ unilateral arm pain and weakness =

A

AUTONOMIC GANGLIA IMPAIRMENT

171
Q

Differences among meniere, benign paroxysmal position vertigo, labyrinthitis?

A

meniere: ⬆️pressure endolymph.. Vertigo,ear fullnes , hearing loss

benign paroxysmal position vertigo: head movements, no hearing loss

labyrinthitis: severe vertigo, no hearing loss single episode

172
Q

what are the management strategy for alzheimer disease?(3)

A 
donepezil  (cholinesterase inhibitor)
Vit E ( antioxidant)
memantine (NMDA receptor antagonist) |
173
Q

What deficits are in FRIEDERICH ATAXIA equal to VIT E DEFICIENCY?

A

❎ spinocerebellar tracts
❎ dorsal columns
❎ peripheral nerve degeneration

174
Q

Which tract and cells are impaired in syringomelia?

A 
Ventral white commisure  ( Spinothalamic)
Anterior horns (lower motor neurons) 
Upper extremities ( LMN syndrome + anesthesia)
Lower extremities (UMN syndrome)
175
Q

Mechanism of action of Triptans against migraine…

A

Inhibit pre and postsynaptic serotonin receptors

176
Q

Lateral horns are seen just in ….

A

THORACIC LEVELS OF SPINAL CORD!!!!!

177
Q

Form of cervical levels in axial image?..

A

OVAL!!!!

178
Q

What is the marker for neurons,neuroectoderm, neuroendocrine cells tumors? <1%

A

SYNAPTOPHYSIN!!!!!

The majority other tumors have GFAP ✅

179
Q

Explain which fibers are in the posterior, genu “knee” and anterior portion of the internal capsule.

A

POSTERIOR corticospinal and sensorial
GENU corticobulbar
ANTERIOR thalamocortical

180
Q

Treatment for Serotonin syndrome?

A

CYPROHEPATDINE!!!!

Serotonin receptor antagonist

181
Q

What vessels are implied in intraventricular hemorraghe in a premature patient?

A

Terminal matrix

182
Q

How distinguish the most common Brian tumor in children?

A

PILOCITYC ASTROCYTOMA!!!!

Two zones in the CEREBELLUM!!!

  1. Solid mass
  2. Cyst

Good prognosis

183
Q

Which nerves participate in corneal reflex?(2)

A

Afferent V3

Efferent VII

184
Q

Triad of cerebral toxoplasmosis ?

A

Hydrocephalus
Intracranial calcifications
Chorioretinitis

185
Q

Management of age-related macular degeneration?

A

VEGF INHIBITORS!!!!

Ranibizumab
Bevacizumab

186
Q

What is pituitary apoplexy?

A

Acute hemorrhage into the pituitary gland after pituitary adenoma (mostly)

187
Q

Mutations of apolipoprotein E can increase the risk of what neurological disease?

A

ALZHEIMER DISEASE

Impaired clearance of Amyloid beta plaques

188
Q

Big difference between glioblastoma and oligodendrogliomas?

A 
Glioblastoma : 
rapid grow
Mass effect 
White matter
Butterfly Glioma
Poor defined

Oligodendroglioma
Slow grow
Gray mass calcification
Week defined

189
Q

Besides contralateral hemianopia whit macular sparing , what other signs has the occlusion of PCA?

A

Dislexia
Visual agnosia
Prosopagnosia (can’t recognize faces)

190
Q

Principal actions of benzodiazepines?(3)

A

Anxiolytic
Muscle relaxant
Anticonvulsant

191
Q

Where the Spinothalamic tract and dorsal columns go in the thalamus?

A

Ventral posterior thalamus

192
Q

What are the primary cause of lacunar infarcts?

A

Lipohyalinosis and microatheromas

193
Q

Wilson disease (acomulation of copper by deficit of ceruloplasmin) have oxidative lesions in.. And treatment?

A

Cornea
Basal ganglia

D-penicilamine
Trientene

194
Q

Which part of the retina contribution more to the afferents light reflex ?

A

Nasal portion

Injury of optic tract can present contralateral afferents light reflex impairment of the pupil

195
Q

In frontal eye field injury where the eyes look?

A

Look toward the lesion.

196
Q

Different clinical findings between aneurysmal compression of III CN and Diabetic ophthalmoplegia affecting IIICN?

A

aneurysmal compression of III CN compress externally
Midriasis & los of acomodation
Ptosis & ophthalmoplegia

Diabetic ophthalmoplegia affecting III CN affect internally
“Down and out” position
Normal pupil reflexes
Ptosis

197
Q

Cause of Noise-induced hearing loss?

A

Trauma to the stereo-ciliated hair cells of the

ORGAN OF CORTI!!!!

198
Q

mutations linked with early-onset familial Alzheimer disease? (4)

A

APP(21)
presenilin 1 (14)
presenilin 2 (1)
Apo E4

199
Q

how is the sensitive and the gustatory innervation of the tongue

A

1/3 ant G VII, S V3
1/3 post G IX, S IX
base G X , S X

200
Q

Lesion which cause right nasal hemianopia?

A

Right peri-chiasmal lesion

Calcification or aneurysm of INTERNAL CAROTID ARTERY

201
Q

Which artery is implied in optic tract lesion?

A

Anterior choroidal artery

202
Q

“Clasp-knife” 🗡 spasticity is more related whit what type of neuronal lesion?

A

UPPER MOTOR NEURON LESIONS!!!!

203
Q

Which specific part of the brain is affected by Wilson disease (copper)?

A

PUTAMEN

204
Q

Difference between myasthenia gravis and lambert-eaton syndrome?

A 
MG. 
🔹ABs against acetylcholine receptors
🔹weakness worse whit exercise, extra ocular muscles
🔹Thymoma 
🔹improve whit edrophonium 
LES
🔹ABs against presynaptic  Ca channels 
🔹weakness improves whit exercise 
🔹pre-existence of malignancy 
🔹no improve with edrophonium 
🔹Small Cell Lung Carcinoma
205
Q

Side effects of carbamazepine ( first line drug for trigeminal neuralgia)?(2)

A
  1. Bone marrow supression

2. SIADH

206
Q

What lesions can cause Horner syndrome?(2)

A

Ipsilateral lateral hypothalamus

Sympathetic tracts in the brainstem

207
Q

Genetic problem in Alzheimer disease and cause?

A

Polymorphisms in apolipoprotein E

Acomulation of amyloid-B

208
Q

How are the orders of basal ganglia motor pathways?

And in consequence surgery for parkinson patients will look for brain stimulation (blocking ) of what nucleus?

A

NO-SI -NO-SI

G. Pallidus externa say NO!!!! To
Subthalamic nucleus say SI!!!! To. [SURGERY]
G. Pallidus interna. Say NO!!! To. [SURGERY]
Thalamus say SI!!!!!! To
CORTEX 🏃🏻

209
Q

Typical presentation of Creuzfeldt-Jakob disease ?(2)

A

Rapidly progressive dementia

MYOCLONIC JERKS

210
Q

What is the most common agent which cause viral meningitis ?

A

ENTEROVIRUS!!!

211
Q

Why after long time of parkinson treatment with carbidopa-levodopa there are fluctuations of symptoms?

A

“On-off” phenomenon

Levodopa cause nigrostriatal degeneration
⬇️
Narrowing the therapeutic window
And fluctuation of symptoms

212
Q

Insomnia drug which does not cause dependency?

A

ZOLPIDEM!!!
similar mechanism of action of BZDs

⬇️ tolerance and addiction
No anticonvulsant
No muscle relaxation
No anesthesia

213
Q

Explain the mechanism of action of antiglaucoma drugs? (3)

A

⬇️aqueous humor inflow by🚫ciliary epithelium
🔹B-blockers (Timolol) 🔹alpha 2 agonist 🔹CAIs 🔹acetazolamide

⬆️trabecular outflow
🔹 Muscharinic agonist. Pilocarpine car school myosis by contraction of sphincter of iris

⬆️Uveoscleral outflow
🔹Prostaglandin F2alpha latanoprost travopost

214
Q

Explain the afferent and efferent of cough, gag,carotid sinus reflexes .

A

Afferent. Efferent
cough. X. X
gag. IX. X
carotid sinus. IX. X

215
Q

Which nerve lies under piriform recess?

A

Internal laryngeal nerve from laryngeal superior from VAGUS CN X

216
Q

Histologic features of multiple sclerosis.

A
  1. Demyelination preserving the axons
  2. Lipid-laden macrophages
  3. Astrocytosis
  4. Lymphocytosis
217
Q

Antihemetic drug groups (5)

A

Antimuscarinics. Scopolamine
Antihistamines diphenhydramine
Dopamine receptors antagonist METOCLOPRAMIDA
Serotonine receptor antagonist ONDARSETRON
Neurokinin receptor antagonist APREPITAN

218
Q

Which symptom of wernicke-korsakoff syndrome Persist despite treatment ?

A

Memory loss.

219
Q

Clinical use of METOCLOPRAMIDA?

A

Nausea associated with migraine!!!!

220
Q

whats the primary site of entry of cryptococcus?

A

the LUNGS!!!!

220
Q

Which cerebral tumor has biphasic cellularity ( highly and low cellularity areas)

A

SCHWANNOMA!!!!!

221
Q

what are trh dopamine agonists?

A

ergot compounds: Bromocriptine

Nonergot compounds: Pramipexole - Ropinirole.

221
Q

The most important cell marker in neural crest originated cells?

A

S-100!!!

222
Q

difference between chorea, myoclonus, dystonia and hemibalism?

A

CHOREA movements that flows form one group to another
MYOCLONUS sudden brief severe muscle contrraction
DYSTONIA sostein contractoions to abnormal painful movements TORTICOLIS Blepharospasm
HEMIBALISM one side of the body contrallateral to subthalamic nucleus lesion

225
Q

What’s opsoclonus-myoclonus syndrome?

A

Non-rhythmic conjugate eye movements
Myoclonus
Neuroblastoma at adrenal medulla

226
Q

What is cholesteatoma ?

A

Pearl mass behind tympanic membrane (congenital or acquired)
Tympanic retraction and perforation
Squamus cells debris
Easy infection

227
Q

what is axonal reaction presented in Wallerian degeneration?

A

cell body edema
nucleus displaced to the periphery
Nissl substance becomes dispersed

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