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 )
1
Q
What’s the CNS origins
A
Neuroectoderm : ependimal cells
Neural crest PNS Schwann cells
Mesoderm: microblog macrophages
2
Q
Labs to confirm neural tube defect
A
⬆️α-fetoprotein (AFP) in amniotic fluid and maternal serum. ⬆️acetylcholinesterase (AChE) amniotic fluid
3
Q
Which diseases are related with holoprosncephaly (2)?
A
Patau syndrome
Fetal alcohol syndrome
4
Q
What’s chiari II syndrome?
A
Herniation of cerebellar tonsils and vermis
Hydrocephalus
Meningomyelocele
5
Q
What’s dandy walker syndrome?
A
Agenesis vermis cerebellar
Hydrocephalus
Spina bifida
6
Q
What’s syringomelia?
A
Cyst cavity into spinal cord
Associated whit chiari 1
7
Q
Innervation of the tongue (3 actions)
A
TASTE VII,IX,X
PAIN V3,IX,X
MOTOR X palatoglossus XII
8
Q
What’s the astrocyte marker?
A
GFAP
9
Q
What disease is related whit acoustic neuroma bilateral?
A
Neurofibromatosis type 2
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
11
Q
What layer nerve fiber have to be rejoined in surgery
A
Perineurium
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
13
Q
Relation between neurotransmitters in Huntington and parkinson diseases
A
AL REVES!!
Parkinson ⬇️ dopamine⬆️ ACh
Huntington ⬆️ dopamine⬇️ACh ⬇️GABA
14
Q
What regions of the CNS permits the crossover transport of molecules between CNS and BLOOD?
A
Area postrema :vomit
Osmotic sensing
Neurohypophysis
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
16
Q
What substances decreases REM sleep phase? (4)
A
NE
Alcohol
BZD
Barbiturates
17
Q
Management of sleep enuresis, night terrors and sleep walking
A
sleep enuresis DESMOPRESSIN
night terrors and sleep walking BZD
18
Q
Sleep stages (6)
A
BATS D B Beta Alpha Teta Splindles K complex Delta Beta REM!!!
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
20
Q
Symptoms of central pontine myelinolisis (5)
HYPONATREMIA CORRECTION
A
Acute paralysis dysarthria dysphagia diplopia loss of consciousness
21
Q
What are the cerebellum nucleus lateral to medial
A
Dentate, Emboliform, Globose, Fastigial
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
23
Q
Lest bodies are seen in which disease ?
A
Parkinson disease
24
MRI findings in Huntington disease?
Atrophy of caudate nuclei with ex vacuo dilatation of frontal horns onMRI
25
Explain aphasias (6)
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
26
6 first common brain lesions
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
27
Second 6 brain lesions
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
28
What artery is implicate to lacunar infarcts due hypertension?
Lenticulostriate artery
29
What's medial medullary syndrome?
Occlusion of ASA
Contralateral hemiparesis
⬇️ contralateral propiocepcion
Tongue deviates ipsilateral
30
What's lateral medullary syndrome WALLENBERG
```
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.
```
31
What's lateral pontine syndrome
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.
32
What's "locked-in syndrome"
Just a have consciousness and blinking
33
How is the presentation of posterior communicate aneurism ?
CN III palsy—eye is “down and out” with ptosis and mydriasis
34
What are Charcot-Bouchard microaneurysm?
Small vases in basal ganglia and thalamus
35
What part of the cerebrum is most vulnerable to hypoxia damage ?
HYPOTHALAMUS
36
What are the communication between ventricles?
Foramen of monro
Cerebral aqueduct of Sylvius
Foramen of luschka
Foramen of magendie
37
What's the idiopathic intracranial hypertension (4)
headaches
diplopia (usually from CN VI palsy)
no mental status alterations
Papilledema
38
Normal pressure hydrocephalus triad
urinary incontinence
ataxia
cognitive dysfunction
39
At what vertebral level spinal cord spends?
At what vertebral level subarachnoid space goes?
What's the lumbar puncture level?
L1-L2
S2
L3-L4
L4-L5
40
Principal clinical presentations in medullar diseases
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
41
Genetic etiology , protein and clinical presentation of Friedreich ataxia
Repeat GAA
frataxin
```
Staggering gait,
frequent falling,
nystagmus,
dysarthria, pes cavus,
hammer toes, diabetes mellitus,
hypertrophic cardiomyopathy
kyphoscoliosis
```
42
Principal clinical reflexes (4)
```
Biceps = C5 nerve root.
Triceps = C7 nerve root.
Patella = L4 nerve root.
Achilles = S1 nerve root.
```
43
What's parinaud syndrome?
paralysis of conjugate vertical gaze
| due to lesion in superior colliculi
44
Cranial nerve nuclei localization
Midbrain—nuclei of CN III, IV
Pons—nuclei of CN V, VI, VII, VIII
Medulla—nuclei of CN IX, X, XII
Spinal cord—nucleus of CN XI
45
Which pathways cranial nerve se use to exit of the cranium?(12)
Cribriform plate (CN I).
Optic canal (CN II, ophthalmic artery,
central retinal vein)
Superior orbital fissure (CN III, IV, V1, VI,
ophthalmic vein, sympathetic fibers)
Foramen Rotundum (CN V2)
Foramen Ovale (CN V3)
Foramen spinosum (middle meningeal
artery)
Internal auditory meatus (CN VII, VIII)
Jugular foramen (CN IX, X, XI, jugular vein)
Hypoglossal canal (CN XII)
Foramen magnum (spinal roots of CN XI,
brain stem, vertebral arteries)
46
What are the vagus nucleus (3)
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
47
Clinical findings in V-X-XI-XII cranial nerves lesions
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
48
What's the first cranial nerve affected in cavernous sinus sindrome?
VI
49
Where the high and low frequency sounds are processed in the inner ear?
High base of cochlea
| Low Apex near to helicotrema
50
Difference between conductive and sensorineural hearing loss
```
Conductive Abnormal (bone > air) Localizes to affected ear Normal
Sensorineural (air > bone) Localizes to unaffected ear
```
51
Which muscles close and open the jaw (3,1)
Masseter
Temporalis
Medial pterygoid
Lateral pterygoid
52
What's hypopyon?
Pus in anterior chamber
53
Types an treatment for diabetic retinopathy (2)
Non proliferative - capilar damage macular laser
Proliferative - chronic hypoxia anti-VEGF bevacizumab
54
What's retinitis pitgmentosa?
Inherited retinal degeneration. Painless, progressive vision loss beginning with night blindness (rods affected first).
55
How is the pupillary light reflex circuit?
Light.⏩ II nerve ⏩pretectal nuclei ⏩Edinger wesphal⏩ III nerve ⏩ciliary ganglion ⏩short ciliary nerves ⏩pupillary sphincter
56
Mydriasis circuit
Hypothalamus to ciliospinal cent of budge⏩ ext at T1 to superior chervil a ganglion ⏩plexus along internal carotid⏩ciliary nerve ⏩Pupillary dilator muscles
57
What's Horner Syndrome?
Ptosis
Anhidrosis
Miosis
58
What cranial nerve is affected in posterior communicant aneurism and uncal herniation?
Parasympathethic III nerve
Midriasis
Down out gaze
59
How is seen IV nerve damage?
When see to contralateral side
The eye move upward
Problems going down stairs
60
Three Easiest visual fields affecting the right side of cerebrum?
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 bilateral projection to occiput
61
What's inter nuclear ophthalmoplegia?
Lesion of medial longitudinal fasciculus
So in horizontal gaze, when the MLF
The ipsilateral eye cannot go in direction of its brother
62
What risk factor are related most whit Alzheimer disease?(3)
ApoE4: r
APP
| presenilin-1, presenilin-2
63
What are pick bodies presented in pick disease ( frontotemporal dementia)
silver-staining spherical tau protein aggregates
64
What's the most important clinical feature of Lewy body dementia?
VISUAL HALLUCINATIONS !!!!!!!
65
What's the Charcot triad for Multiple Sclerosis?(5)
Scanning speech
Intention tremor
Incontinence
Internuclear ophthalmoplegia
Nystagmus
66
CSF diagnosis in MS
Protein
| OLIGOCLONAL BANDS
67
MRI in MS
Peri ventricular plaques
68
Treatment of MS
Beta -interferon
| Natalizumab
69
Types of partial and generalization seizures (2,4)
Simple partial
Complex partial
```
Abscense
Myoclonic
Tonic-colonic
Tonic
Atonic
```
70
Principal features of the 6 adult brain tumors
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
71
Most important features of childhood brain tumors(5)
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+
72
Signs of uncal herniation
```
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).
```
73
Indirect and direct cholinomimetics drugs for glaucoma(2,2)
Direct (pilocarpine, carbachol)
Indirect (physostigmine, echothiophate)
⬆️outflow of aqueous humor via contraction of ciliary muscle and opening of trabecular meshwork
IN EMERGENCES USE PILOCARPINE!!!!!!
74
Mechanism of latanoprost in glaucoma
Is a PGF 2alpha analog ⬆️outflow aqueous humor
75
How opioids ⬇️ synaptic transmition?
open K+ channels, close Ca2+ channels⏩ ⬇️synaptic transmission.
76
What's the problem whit butorphanol
Partial agonist of μ-opioid receptor and κ-opioid agonist
| cause opioid withdrawal symptoms
77
Indications for epilepsy drugs (9)
```
Ethosuximide. ABSCENSE
BZD ECLAPSIA (MgSO4)
Phenytoin ALL
Carbamazepine TRIGEMINAL NEURALGIA TERATOGENESIS
Valproic Acid NO IN PREGNANCY!!!!
Gabapentin POSTHERPETIC NEURALGY
Phenobarbital NEONATES
Topiramate MIGRAINE PREVENTION
```
78
Mechanism of action of Barbiturates
Facilitate GABAA action by duration of Cl− channel opening, thus neuron firing
Contraindicated in porphyria.
79
Mechanism of action of benzodiazepines and what have short t1/2 ATOM
```
Facilitate GABAA action by ⬆️ frequency of Cl− channel ⬇️REM sleep.
Alprazolam
Triazolam
Oxazepam
Midazolam
```
80
Mechanism of action of anti insomnia drugs ZZZ
Act via the BZ1 subtype of the GABA receptor
81
Relationship between blood solubility and induction and lipid solubility and potency
blood solubility and induction INVERSE
| lipid solubility and potency DIRECT
82
What drug cause most nausea thiopental or propofol?
THIOPENTAL!!!!!!!
83
Order of Los sensations in local anesthetics
(1) pain, (2) temperature, (3) touch, (4) pressure.
84
Phases of Reversal blockade of depolarizing Drugs (2)
```
Phase I (prolonged depolarization)—no antidote. Block potentiated by cholinesterase inhibitors.
Phase II (repolarized but blocked; ACh receptors are available, but desensitized)—antidote is cholinesterase inhibitors.
```
86
What are the mechanism of action of anti Alzheimer disease?(2)
NMDA receptor antagonist MEMANTINE
AChE inhibitors donepezil tacrine
86
How reversal of blockade of non depolarizing drugs
NEOSTIGMINE!!!! +ATROPINE
87
What are the BALSA drugs for parkinson disease
Bromocriptine ergot ( not ergot pramipexole ropirinole)AmantadineLevodopa (with carbidopa) Entacapone Tolcapone
Selegiline MAO-B inhibitor (and COMT inhibitors Tolcapone )
Antimuscarinics
88
Mechanism of action of Triptans
5-HT1B/1D agonists. Inhibit trigeminal nerve activation
No in CAD prizmetal angina
89
What are the principal embryologic derivatives (3)
▪️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
90
What type of cells are developed in cuteness Neurofibromatosis type 1, and what is its embryological Origen?
Schwann cells
| Neural crest
91
What nerve is affects in trendelenburg sign?
Superior gluteal nerve
Paralysis of gluteus mediums and minimums
92
What neurotransmitter is linked whit tetanus?
Tetanospasmin impaired the release of inhibitory neurotransmitters
GLICINE GABA
93
What fish toxins acts open or closing the NA Channels (2,2)?
CLOSE. tetrodotoxin,saxitoxin
OPEN ciagiatoxin, Batrachotoxin (frog)
94
What are the products of PROPIOMELANOCORTINA (3)?
ACTH
MSH
Beta-endorphins
95
What part of the cerebrum is impaired in Alzheimer disease?(2)
Temporal lobes
| Hypocampus
96
Principal features of essential tremor -familial tremor (4)
Autosomal dominant
Worse static posture
Improve whit alcohol
Tto PROPANOLOL
97
What drug counteract the parkinson-like effects of haloperidol?
Benzotropine
98
How is seen Intracranial hemorrhage in the CT scan?
HYPERATTENUATED
| BRIGTH!!!!!!!
99
Big differences between secular aneurism and Charcot-Bouchard aneurysms (2)
Sacular aneurism
Subarachnoid hemorrhage
Not neurological deficits
Charcot-Bouchard aneurysms
Intraparenchimatous basal ganglia
Acute neurological deficits
100
Where the hemorrhage is seen in cerebral amyloid angiopathy?
Lobar/cortical parenchymal hemorrhage
101
Cause if binasal hemianopsia
Calcification of carotid arteries
102
What's the effect of inhaled anesthetics in renal and hepatic function?
⬇️ GFR
⬆️renal vascular resistance
⬇️hepatic blood flow
103
What's the pathogen edits of HIV associated dementia
Inflammatory activation of microglia cells
| Microglia nodules
104
Histologic all changes in Alzheimer disease (3)
Neurofibrilar tangles intracellular agregates of hyperphosphorilated tau portein
Senile plaques
Amyloid angiopathy
105
Different cell inclusions in HSV and CMV
HSV intranuclear acidophilic inclusions
| CMV intranuclear Basophilic inclusions
106
Principal action of AChE inhibitors , and what can cross de BBB to treat atropine toxicity?
PRO-MUSCARINICS DRUGS!!!!!!!
| PHYSOSTIGMINE tertiary amine can cross BBB
107
What drugs are more implied in malignant hyperthermia syndrome?
HALOTANE
| SUCCINYLCHOLINE
108
Difference between non-depolarizing an depolarizing bockers?
depolarizing constant stimulation of ACh receptor
| non-depolarizing prevent ACh binding receptor
109
Mechanism of action of Cholinergic agonists (3)
Bind to ACh receptor and prevent interaction whit ACh
| ATROPINE, SCOPOLAMINE, IPRATROPIUM
110
How Gabapentin works?
Blocking presynaptic voltage-gated calcium channels
111
What anti insomnia drug is safer in elderly patients?
RAMELTEON
| melatonin agonist
112
What group of drugs have to be avoid in elderly patients ?
BZDs
Antihistamines
Antidepressants
113
Which situation promotes periphery neuropathy by Vit B6 deficiency?
USE OF ISONIAZID IN TB
114
Other differences between frontotemporal dementia (Pick's disease) and Alzheimer disease
frontotemporal dementia
50-60s
Forntotemporal
Socially inappropriate behavior
Alzheimer
60-70s
Parieto-temporal
Recent memory
115
What is the consequence of sub-thalamic nucleus damage?
HEMIBALLISMUS
116
What's pseudotumor cerebri?
Elevated ICP
| Young women overweight
117
What Damaged regions cause superior and inferior quadrantanopia?
Lingual gyrus Superior Quadrantanopia
Cuneus gyrus Inferior quadrantanopia
118
Which pathway is involve in the antipsychotics drugs action?
Mesolimbic-mesocortical pathway
119
What important nerve can be blocked in interscalene nerve block ?
PHRENIC NERVE!!!!!!
120
All posganglionic neurons in the sympathetic system release norepinephrine ,all except...(2)
Eccrine sweat glands
| Adrenal medullae
121
What's the Cushing Triad?
Hypertension
Bradicardia
Bradypnea
122
At what level the compression of sciatic nerve ocurrs?
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
How L5 nerve is evaluated?
Foot dorsi flexion
Eversion
Inversion
Toe extension
124
What nerve is injured in L5-S1 if there is an foramininal stenosis and herniation of the intervertebral disc?
foramininal stenosis L5
| herniation of the intervertebral disc S1
125
Rules about membrane potential
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
Differences between decerebrate and decorticated postures
Decerebrated
EXTENSORS PREDOMINATE
below red nucleus (pons, midbrain tegmentum)
Decorticated
FLEXORS PREDOMINATE
over red nucleus
127
Changes in hypertensive retinopathy (4)
Flame-shape retinal hemorrhage
Cotton-wool spots
Cooper or silver wiring
Arteriovenous nicking
128
What is the weed similar to atropine like symptoms ?
Jimson weed : Datura stramonium
Gardner's midriasis
Treatment : physostigmine
129
How is seen Alzheimer disease in Congo red stain in hypothalamus?
Apple green birefringence
| Due to beta-sheet structure
130
Histologic findings of parkinson disease ?
Intracellular eosinophilic inclusions composed of alpha-synuclein LEWY BODIES
131
What drugs are related whit drug reaction whit eosinophilia and systemic symptoms syndrome ? DRESS
Anticonvulsivants
Allopurinol
Sulfonamides
Antibiotics
132
What drugs induce anti eutrophic cytoplasmic antiboides? (2)
Anti hyperthyroidism
| Hydralazine
133
What neuromuscular disease is related with temporal arteritis?
Polymilagia rheumatica
134
Treatment for Wilson disease (cooper acumulation)
D-penicilamine
135
What are the cells which acts like macrophages after 1 week brain ischemia?
MICROGLIA!!!!!
136
Which cells acts like fibroblasts after 2 week of brain schemia?
ASTROCYTES!!!!!
137
Which nerve is compressed in transtentorial herniation?
OCULOMOTOR!!!
| III CN
138
Which characteristic of the electrical potential is increased by the presence of myelin I the nerve?
LENGTH CONSTANT OR SPACE CONSTANT!!!!
| How far ca go!!!!
139
What are the TWO main categories of cell membrane receptors?(1-4)
IONOTROPIC
🔹Nicotin Cholinergic receptor
```
SECOND MESSENGERS
🔹Alfa -1
🔹Alfa-2
🔹Beta-2
🔹Muscharinic Cholinergic receptor
```
140
What are the clinical findings in serotonin syndrome?
```
Neuromuscular excitation ( clonus, rigidity, hyperreflexia)
Autonomic stimulation (hyperthermia ,tachycardia,vomit, diarrhea)
Altered mental status (agitation, confusion )
```
141
What amino acid is precursor of serotonin?
TRYPTOPHAN!!!!
142
Antidote for serotonin syndrome
CYPROHEPATDINE!!!!
| Histamine and serotonine antagonist
143
In a patient whit multiple sclerosis what is the treatment for muscular spasms?
BACLOFEN!!! GABA agonist
| TISANIDINE!!!!
144
Which anticonvulsants are indicated in focal and generalized seizures?
```
FOCAL
🔹carbamzepine
🔹Gabapentin
🔹phenobarbital
🔹phenytoin
```
```
GENERALIZED
🔹valproic acid
🔹levetiracetam
🔹topiramate
🔹Lamotigene
```
145
Drug indicated in ABSCENSE SEIZURE?
ETHOSUXIMIDE!!!!!
146
How is the potency of the inhalator anesthetic in relation If temp and age?
⬆️ age:⬇️potency
| ⬆️ temp:⬆️potency
147
What arterio-venous gradient of anesthetic means?
If is short means rapid onset of action
148
Thiopental suffers redistribution phenomenon, which tissues are implicated? (2)
SKELETAL MUSCLE
| ADIPOSE TISSUE
149
Third cranial nerve passes through what two important arteries?
Posterior cerebral
Superior cerebelar arteries
150
What nerve is impaired when the patient CANNOT GO DOWN STAIRS?????
TROCLEAR!!!!!!
IV CN!!!!!
SUPERIOR OBLIQUE !!!!!
151
What anatomic structure is affected in Huntington disease?
Caudate nucleus !!!
152
Which central structures are implicated in Wilson disease?
Lentigo fm nucleus ( glubus palidus ,putamen)
153
What is the dorsal midbrain (parinaud)syndrome in the pnineal gland mass? Which has obstructive hydrocephalus as well ?
Paralysis upward gaze
Ptosis
Pupillary abnormalities
154
What is the cardinal symptom of damage to the Nucleus ambiguous ?
Myoclonus
155
Where the acoustic schwannomas are located?
Cerebellopontine angle
BETWEEN THE CEREBELLUM AND LATEAL PONS!!!!
156
Which muscle close the jaw?
Lateral pterygoid
157
Different Microscopic findings in medulloblastoma and pilocityc astrocytoma
Medulloblastoma sheets of primitive cells whit many mitotic figures
Pilocityc astrocytoma pilocityc astrocytes and rosenthal fibers
158
Period of hemorrhagic transformation risk
First 7 days after ischemia
159
When occurs axon degeneration ( wallerian degeneration)
In the peripheral nerve system
NO IN THE CNS (myelin debris,neural inhibitory factors,glial scarring)
160
What triphasic spikes at the electroencephalogram means?
Creutzfeldt-Jakob disease
An a chaperon disease disorder
161
Which diseases from glycoproteins storage and immunodeficiency can be treated whit enzyme replacement Therapy? (2)
Gaucher 🔹 glucocerebrosidase replacement
Several immunodeficiency combined 🔹 Adenosin deaminase ADA
162
How are seen in behavior early stages of Alzheimer disease?
Confusion
Disoriented
Difficulty to control
Violent
163
How opiods acts?
Decrease release of substance P in dorsal horn
| Peri aqueducts gray region leading to stimulation of Mu receptors
164
How acts Entacapone and Tolcapone ?
Entacapone 🚫COMT PERIFERIC!!!!
Tolcapone 🚫COMT CENTRAL!!!!
165
How rheumatoid arthritis can cause ventilatory failure?
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
In rune test bone conduction greater than air conduction means....
Conductive hearing loss
167
Which another symptoms besides floppy baby are seen in botulinum toxin exposition? 3Ds
Diplopia
Dysphagia
Dry mouth
168
What's kinesin?
Motor protein whit anterograde transport of vesicles in micro tubules
169
What are the hypothalamic centers of hunger and satiety?
HUNGER Lateral
| SATIETY Ventromedial
170
Horner sign ➕ unilateral arm pain and weakness =
AUTONOMIC GANGLIA IMPAIRMENT
171
Differences among meniere, benign paroxysmal position vertigo, labyrinthitis?
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
what are the management strategy for alzheimer disease?(3)
```
donepezil (cholinesterase inhibitor)
Vit E ( antioxidant)
memantine (NMDA receptor antagonist) |
```
173
What deficits are in FRIEDERICH ATAXIA equal to VIT E DEFICIENCY?
❎ spinocerebellar tracts
❎ dorsal columns
❎ peripheral nerve degeneration
174
Which tract and cells are impaired in syringomelia?
```
Ventral white commisure ( Spinothalamic)
Anterior horns (lower motor neurons)
```
```
Upper extremities ( LMN syndrome + anesthesia)
Lower extremities (UMN syndrome)
```
175
Mechanism of action of Triptans against migraine...
Inhibit pre and postsynaptic serotonin receptors
176
Lateral horns are seen just in ....
THORACIC LEVELS OF SPINAL CORD!!!!!
177
Form of cervical levels in axial image?..
OVAL!!!!
178
What is the marker for neurons,neuroectoderm, neuroendocrine cells tumors? <1%
SYNAPTOPHYSIN!!!!!
The majority other tumors have GFAP ✅
179
Explain which fibers are in the posterior, genu "knee" and anterior portion of the internal capsule.
POSTERIOR corticospinal and sensorial
GENU corticobulbar
ANTERIOR thalamocortical
180
Treatment for Serotonin syndrome?
CYPROHEPATDINE!!!!
| Serotonin receptor antagonist
181
What vessels are implied in intraventricular hemorraghe in a premature patient?
Terminal matrix
182
How distinguish the most common Brian tumor in children?
PILOCITYC ASTROCYTOMA!!!!
Two zones in the CEREBELLUM!!!
1. Solid mass
2. Cyst
Good prognosis
183
Which nerves participate in corneal reflex?(2)
Afferent V3
Efferent VII
184
Triad of cerebral toxoplasmosis ?
Hydrocephalus
Intracranial calcifications
Chorioretinitis
185
Management of age-related macular degeneration?
VEGF INHIBITORS!!!!
Ranibizumab
Bevacizumab
186
What is pituitary apoplexy?
Acute hemorrhage into the pituitary gland after pituitary adenoma (mostly)
187
Mutations of apolipoprotein E can increase the risk of what neurological disease?
ALZHEIMER DISEASE
Impaired clearance of Amyloid beta plaques
188
Big difference between glioblastoma and oligodendrogliomas?
```
Glioblastoma :
rapid grow
Mass effect
White matter
Butterfly Glioma
Poor defined
```
Oligodendroglioma
Slow grow
Gray mass calcification
Week defined
189
Besides contralateral hemianopia whit macular sparing , what other signs has the occlusion of PCA?
Dislexia
Visual agnosia
Prosopagnosia (can't recognize faces)
190
Principal actions of benzodiazepines?(3)
Anxiolytic
Muscle relaxant
Anticonvulsant
191
Where the Spinothalamic tract and dorsal columns go in the thalamus?
Ventral posterior thalamus
192
What are the primary cause of lacunar infarcts?
Lipohyalinosis and microatheromas
193
Wilson disease (acomulation of copper by deficit of ceruloplasmin) have oxidative lesions in.. And treatment?
Cornea
Basal ganglia
D-penicilamine
Trientene
194
Which part of the retina contribution more to the afferents light reflex ?
Nasal portion
Injury of optic tract can present contralateral afferents light reflex impairment of the pupil
195
In frontal eye field injury where the eyes look?
Look toward the lesion.
196
Different clinical findings between aneurysmal compression of III CN and Diabetic ophthalmoplegia affecting IIICN?
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
Cause of Noise-induced hearing loss?
Trauma to the stereo-ciliated hair cells of the
| ORGAN OF CORTI!!!!
198
mutations linked with early-onset familial Alzheimer disease? (4)
APP(21)
presenilin 1 (14)
presenilin 2 (1)
Apo E4
199
how is the sensitive and the gustatory innervation of the tongue
1/3 ant G VII, S V3
1/3 post G IX, S IX
base G X , S X
200
Lesion which cause right nasal hemianopia?
Right peri-chiasmal lesion
| Calcification or aneurysm of INTERNAL CAROTID ARTERY
201
Which artery is implied in optic tract lesion?
Anterior choroidal artery
202
"Clasp-knife" 🗡 spasticity is more related whit what type of neuronal lesion?
UPPER MOTOR NEURON LESIONS!!!!
203
Which specific part of the brain is affected by Wilson disease (copper)?
PUTAMEN
204
Difference between myasthenia gravis and lambert-eaton syndrome?
```
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
Side effects of carbamazepine ( first line drug for trigeminal neuralgia)?(2)
1. Bone marrow supression
| 2. SIADH
206
What lesions can cause Horner syndrome?(2)
Ipsilateral lateral hypothalamus
| Sympathetic tracts in the brainstem
207
Genetic problem in Alzheimer disease and cause?
Polymorphisms in apolipoprotein E
Acomulation of amyloid-B
208
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?
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
Typical presentation of Creuzfeldt-Jakob disease ?(2)
Rapidly progressive dementia
| MYOCLONIC JERKS
210
What is the most common agent which cause viral meningitis ?
ENTEROVIRUS!!!
211
Why after long time of parkinson treatment with carbidopa-levodopa there are fluctuations of symptoms?
"On-off" phenomenon
Levodopa cause nigrostriatal degeneration
⬇️
Narrowing the therapeutic window
And fluctuation of symptoms
212
Insomnia drug which does not cause dependency?
ZOLPIDEM!!!
similar mechanism of action of BZDs
⬇️ tolerance and addiction
No anticonvulsant
No muscle relaxation
No anesthesia
213
Explain the mechanism of action of antiglaucoma drugs? (3)
⬇️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
Explain the afferent and efferent of cough, gag,carotid sinus reflexes .
Afferent. Efferent
cough. X. X
gag. IX. X
carotid sinus. IX. X
215
Which nerve lies under piriform recess?
Internal laryngeal nerve from laryngeal superior from VAGUS CN X
216
Histologic features of multiple sclerosis.
1. Demyelination preserving the axons
2. Lipid-laden macrophages
3. Astrocytosis
4. Lymphocytosis
217
Antihemetic drug groups (5)
Antimuscarinics. Scopolamine
Antihistamines diphenhydramine
Dopamine receptors antagonist METOCLOPRAMIDA
Serotonine receptor antagonist ONDARSETRON
Neurokinin receptor antagonist APREPITAN
218
Which symptom of wernicke-korsakoff syndrome Persist despite treatment ?
Memory loss.
219
Clinical use of METOCLOPRAMIDA?
Nausea associated with migraine!!!!
220
whats the primary site of entry of cryptococcus?
the LUNGS!!!!
220
Which cerebral tumor has biphasic cellularity ( highly and low cellularity areas)
SCHWANNOMA!!!!!
221
what are trh dopamine agonists?
ergot compounds: Bromocriptine
| Nonergot compounds: Pramipexole - Ropinirole.
221
The most important cell marker in neural crest originated cells?
S-100!!!
222
difference between chorea, myoclonus, dystonia and hemibalism?
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
What's opsoclonus-myoclonus syndrome?
Non-rhythmic conjugate eye movements
Myoclonus
Neuroblastoma at adrenal medulla
226
What is cholesteatoma ?
Pearl mass behind tympanic membrane (congenital or acquired)
Tympanic retraction and perforation
Squamus cells debris
Easy infection
227
what is axonal reaction presented in Wallerian degeneration?
cell body edema
nucleus displaced to the periphery
Nissl substance becomes dispersed
