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Step 1 > Neurology > Flashcards

Neurology Flashcards

1
Q

Neuro cells of neuroectoderm origin

A

CNS neurons, ependymal cells, oligodendroglia, astrocytes

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2
Q

Neuro cells of neural crest origin

A

Schwann cells and PNS neurons

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3
Q

Neuro cells of mesoderm origin

A

Microglia

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4
Q

What happens histologically in neuronal degeneration?

A

Cellular swelling, dispersal of nissl substance, peripheral nucleus

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5
Q

What do neurendocrine and neuroectodermal cells express?

A

Synaptophysin

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6
Q

What is the purpose of reactive gliosis and what cells carry it out?

A

Wall off old infarcts. Astrocytes

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7
Q

What effect does myelin have on the electrophysiologic parameters of a nerve?

A

Increases the space constant and conduction velocity

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8
Q

What types of cells have a fried egg appearance?

A

Oligodendrocytes, HPV infected cells, and testicular seminoma cells

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9
Q

What do all glial cells express?

A

GFAP

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10
Q

Inputs to the hypothalamus

A

Organum Vasculosum of the Lamina Terminalis (OVLT) and Area Postrema (emesis)

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11
Q

What areas does leptin act on and what does each do

A

Inhibits lateral hypothalamus (which generates hunger), and stimulates ventromedial area (which generates satiety)

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12
Q

Info in the 4 major thalamic nuclei (VPL, VPM, LGN, MGN)

A

VPL - sensory from body, VPM - sensory from face and taste, LGN - vision, MGN - hearing

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13
Q

Treatment for essential tremor

A

Beta blockers

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14
Q

What effect does alcohol have on essential tremor?

A

Decreases the intensity of it (patients may self medicate with alcohol)

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15
Q

Associations of Berry aneurysms and Charcot-Bouchard aneurysms respectively

A

Berry - ADPKD, Ehrlers-Danlos, Marfan, advanced age, HTN, smoking, race (AA). Charcot-Bouchard - chronic HTN

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16
Q

What artery ruptures in epidural hematomas and what artery is it a branch of

A

Middle meningeal (branch of maxillary)

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17
Q

Complications of epidural hematoma

A

Transtorial herniation (also seen in subdural) and CN 3 palsy

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18
Q

In whom are subdural hematomas seen?

A

Elderly, alcoholics, blunt trauma, shaken baby

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19
Q

How do you distinguish an epidural and subdural hematoma on CT?

A

Epidural does not cross suture lines but can cross falx and tentorium. Subdural can cross suture lines but does not cross falx or tentorium

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20
Q

What will you see on CT in SAH that you wont see in other intracranial hemorrhages?

A

Hyperdensities (very bright white areas) within the cisterns and sulci

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21
Q

Symptoms of SAH

A

Worst headache of life. Nucchal rigidity is also often present

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22
Q

Spinal tap in SAH

A

Bloody or yellow (xanthochromic)

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23
Q

When is the risk of rebleed following SAH maximal?

A

2-3 days later

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24
Q

Treatment to prevent rebleed following SAH

A

Nimodipine

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25
Q

Most common cause of intraparenchymal hemorrhage

A

Hypertension. Also amyloid angiopathy, vasculitis, or neoplasm

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26
Q

Brain areas most vulnerable to ischemia

A

Hippocampus, neocortex, cerebellum, watershed areas

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27
Q

Progression of histologic findings in ischemic brain diseas

A

Red neurons (12-48 hours), necrosis and neutrophils (24-72 hrs), macrophages (3-5 days), reactive gliosis and vascular porliferation (1-2 wks), glial scar (beyond 2 weeks)

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28
Q

What about hypertension causes lacunar stroke?

A

Small vessel lipohyalinosis

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29
Q

The cerebral aqueduct connects what two structures?

A

3rd ventricle and 4th ventricle

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30
Q

What is the clinical triad in NPH and what causes it?

A

Dementia, ataxia, urinary incontinence. Caused by distortion of fibers of the corona radiata

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31
Q

Most common cause of communicating hydrocephalus

A

Decreased absorption in the arachnoid villi (eg arachnoid scarring post meningitis)

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32
Q

Hydrocephalus ex vacuo

A

Appearance of increased CSF in atrophy (eg alzheimers or picks). ICP is normal, symptoms of NPH are NOT present

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33
Q

Irritability, poor feeding, increased head circumference in an infant

A

Hydrocephalus. Long term risk of visual disturbances, learning disabilities, and LE spasticity

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34
Q

What causes lower extremity spasticity in long term hydrocephalus in infants?

A

Streching of periventricular pyramidal tracts

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35
Q

Where do spinal nerves exit relative to the vertebra?

A

nerves C1-C7 exit above the matching vertebra, all others exit below the corresponding vertebra

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36
Q

Lumbar puncture location

A

Between L3 and L4 or L4 and L5

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37
Q

What parts of the spinal cord do B12 deficiency, E deficiency, and Friedreichs ataxia affect?

A

Dorsal columns, lateral corticospinal tracts, and spinocerebellar tracts. Ataxic gait, hyporeflexia, and impaired position and vibration sense

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38
Q

Werdnig-Hoffman disease

A

Floppy babby. Infantile spinal muscular atrophy. AR. Degeneration of anterior horns (LMN)

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39
Q

Staggering gait, frequent falling, nystagmus, dysarthria, pes cavus, hammer toes, HOCM, foot abnormalities and diabetes

A

Friedreichs ataxia

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40
Q

Brown Sequard

A

Hemisection of spinal cord. Ipsilateral UMN, ipsilateral dorsal column loss, contralateral pain and temperature loss

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41
Q

If Brown Sequard occurs above what level, it can present with Horners syndrome?

A

T1

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42
Q

What can cause partial Horners syndrome?

A

Cluster headaches

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43
Q

Which cranial nerves exit at the cerebellopontine angle

A

5, 7, and 8. 6 may as well but no-one cares about 6

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44
Q

Precocious puberty, paralysis of conjugate vertical gaze, hydrocephalus

A

Germinoma aka pinealoma. Can cause paralysis of conjugate vertical gaze (Parinaud) by pushing on superior colliculi. Hydrocephalus may or may not be present

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45
Q

Parinaud (paralysis of conjugate vertical gaze) is due to a lesion where?

A

Superior colliculi

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46
Q

Where is the CTZ located and what is it responsible for?

A

Dorsal medulla near the 4th ventrical (in area postrema). Responsible for vomiting

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47
Q

What nerve is responsible for sensation in middle ear?

A
  1. Also does gag reflex, sensation in upper pharynx, posterior tongue, and tonsils
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48
Q

What nerve is responsible for cutaneous sensation to posterior external ear canal?

A

Vagus. Can pass out with significant stimulation here

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49
Q

What nerve is responsible for cutaneous sensory of ear canal?

A

V3 (with help from X which covers posterior external ear canal)

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50
Q

What CN reflex is normally absent but presents in UMN lesion?

A

Jaw jerk (V3 to V3)

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51
Q

Result of damage to nucleus ambiguus

A

Hoarseness, dysphagia, loss of gag reflex

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52
Q

Which vagal nucleus sends parasympathetic fibers to the heart, lungs, and upper GI?

A

Dorsal motor nucleus

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53
Q

Through what bones do cranial nerves exit?

A

Cribriform plate (CN 1), Sphenoid bone (2 through 6), Temporal and Occipital bones (7 through 12)

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54
Q

Give the cranial exit of cranial nerves two through six

A

2 - optic canal with ophthalmic artery and central retinal vein. 3, 4, V1 and 6 - superior orbital fissure with ophthalmic vein and sympathetics. Rotundum - V2, Ovale - V3. Also spinosum - middle meningeal artery

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55
Q

Give the cranial exits of cranial nerves 7 through 12

A

Internal auditory meatus - 7 and 8. Jugular foramen - 9 through 11 with jugular vein. Hypoglossal canal - 12. Also spinal roots of 11, brain stem, and vertebral arteries through foramen magnum

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56
Q

At what vertebral levels does the sympathetic chain run?

A

T1-L3

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57
Q

Aneurysms of what arteries often cause CN 3 palsy?

A

Posterior cerebral and superior cerebellar (because CN3 travels right between these two)

58
Q

Vertigo, nystagmus, nausea and vomiting

A

CN 8 lesion

59
Q

Prolonged loud noises most damage what structure?

A

The organ of corti

60
Q

Give the cranial nerve most responsible for each of the following sounds: Mi mi mi, La la la, and Khu khu khu

A

Mi mi mi - 7 (lips). Khu khu khu - 10 (palate). La la la - 12 (tongue)

61
Q

Causes of Bells palsy

A

AIDS, Lyme, HSV, Sarcoid, Tumors, Diabetes

62
Q

Muscles that close and open the jaw rspectively

A

Close - Masseter, Temporalis, Medial pterygoid. Open - Lateral pterygoid. All are innervated by V3

63
Q

Branches of CN 7

A

Temporal, Zygomatic, Buccal, Mandibular, Cervical

64
Q

What innervates the parotid gland?

A

CN 9

65
Q

What innervates the salivary glands?

A

7 (except parotid, which is 9)

66
Q

Retinitis in HIV patient

A

Most commonly CMV. Treat with ganciclycovir

67
Q

Uncal herniation causes damage to what nerve?

A

CN 3

68
Q

What is conveyed by the inner and outer parts of CN 3 respectively and what types of injury damage each?

A

Outer ring is parasympathetic output. Damaged by compression (eg uncal herniation gives blown pupil). Inner area is output to ocular muscles, damaged by vascular disease. Eg. diabetes gives ptosis and down and out gaze

69
Q

How does INO present and what disease is it associated with most commonly?

A

Medial rectus palsy on attempted lateral gaze. Associated with MS

70
Q

Sudden, painless, permanent monocular blindness, pale retina, cherry-red macula.

A

CRAO

71
Q

Causes of dementia (10)

A

Alzheimer, Picks, Lewy body, CJD, Multi-infarct, Syphilis, HIV, Vit B12, Wilsons, NPH

72
Q

Scanning speech, intention tremor, incontinence, nystagmus

A

Classic presentation of MS. Also includes INO

73
Q

Tinnitus, vertigo, sensorineural hearing loss. Increased volume and pressure of endolymph in the vestibular apparatus

A

Menieres disease

74
Q

Labyrinthitis

A

Inflammation of the labyrinth. Not usually recurrent

75
Q

Histologic appearance of GBM

A

Psuedopalisading. Pleomorphic with central necrosis and hemorrhage

76
Q

Histology of Schwannoma

A

Elongated cells with regular, oval nuclei. Areas of dense and loos growth

77
Q

Which primary brain tumor is S-100 positive?

A

Schwanomma

78
Q

Which primary brain tumor includes tooth like calficiation?

A

Craniopharyngioma

79
Q

Which glaucoma drugs increase outflow (as opposed to the rest which decrease inflow)?

A

Cholinomimetics (eg pilocarpine, carbachol, physostigmine, and echothiophate) and prostaglandins (latanoprost)

80
Q

Classes of drugs used to treat glaucoma

A

Alpha-agonists (epi, brimonidine), Beta-blockers (timolol, betaxolol, carteolol), Acetazolamide, Cholinomimetics, and Prostaglandins (latanoprost)

81
Q

Opioid analgesics (8)

A

Morphine, fentanyl, codein, heroin, methadone, meperidine, dextromethorphan, diphenoxylate

82
Q

What side effect of opioids is meperidine least likely to cause?

A

Contraction of smooth muscle at the spincter of oddi (biliary colic)

83
Q

Biochemical action of opioid analgesics

A

Opens K channels and closes Ca channels, decreasing synaptic transmission and inhibiting release of ACh, NE, 5-HT, gluamate, and substance P

84
Q

Pentazocine

A

Partial agonist with some antagonist activity at mu receptors. Pain control without dependence. Can cause withdrawal in pts dependent on opioids

85
Q

Butorphanol

A

Partial agonist at opioid mu receptors, agonist at kappa receptors. Pain relief with less respiratory depression. Causes withdrawal if dependent on full agonist

86
Q

Tramadol

A

Very weak opioid agonist. Inhibits 5-HT and NE reuptake. Use in chronic pain, may precipitate seizures

87
Q

Drugs useful in seizure treatment (12)

A

Phenytoin, Carbamazepine, Lamotrigine, Gabapentin, Topiramate, Phenobarbital, Valproic acid, Ethosuximide, Benzos, Tiagabine, Vigabatrin, Levetiracetam

88
Q

Drug of choice for absence seizures

A

Ethosuximide. If absence and GTCs, use valproic acid (ethosuximide not effective against GTCs)

89
Q

First line drugs for GTCs (3)

A

Phenytoin, Carbamazepine, Valproic acid

90
Q

First line for myoclonic seizures

A

Valproic acid

91
Q

First line for trigeminal neuralgia

A

Carbamazepine

92
Q

Epilepsy drugs that act on sodium channels (5)

A

Phenytoin, Carbamazepine, Lamotrigine, Topiramate (and GABA), Valproic acid (and GABA)

93
Q

Epilepsy drugs that act on GABA channels (7)

A

Topiramate (and Na), Phenobarbital, Valproic acid (and Na), Benzos, Tiagabine, Vigabatrin, Levetiracetam (and glutamate)

94
Q

Epilepsy drugs that act on Ca channels (2)

A

Gabapentin, Ethosuximide

95
Q

First line epilepsy drug in pregnant women and children

A

Phenobarbital

96
Q

Treatment for status epilepticus

A

Lorazepam to terminate and phenytoin to prophylax (can give them simultaneously)

97
Q

What limits phenytoin use?

A

Mostly cosmetic side effects - hirsutism, acne, corsening of facial features, gingival hyperplasia. Also lymphadenopathy, nystagmus, anemia, and CYP effects

98
Q

Mechanism of barbiturates

A

Increased duration of Cl channel opening at GABA-A

99
Q

In what condition are barbiturates contraindicated?

A

Porphyria

100
Q

Primidone metabolism and the consequences of this.

A

Metabolized to phenobarital and phenylethylmalonde (PEMA). All 3 are anticonvulsants and you can get an overdose

101
Q

Short acting benzos

A

Triazolam, Oxazepam, Midazolam

102
Q

Mechanism of benzos

A

Increase frequency of Cl channel opening at GABA-A

103
Q

Flumazenil

A

Competitive antagonist at GABA benzo receptor. Treat benzo overdose with this

104
Q

Non-benzodiazepine hypnotics

A

Zolpidem (Ambien), Zaleplon (Sonata), Eszopiclone (Lunesta)

105
Q

Measure of an anesthetics solubility in blood and relation to use

A

Blood-gas partition coefficient. Lower solubility in blood means rapid induction and recovery

106
Q

Measure of an anesthetics solubility in lipids and what it means in use

A

1 / MAC. Higher solubility in lipid means higher potency

107
Q

Inhaled anesthetics (6)

A

Halothane, enflurance, isoflurance, sevoflurane, methoxyflurane, nitrous oxide

108
Q

What effect do inhaled anesthetics have on cerebral blood flow

A

Increase it (by decreasing vascular resistance in the brain)

109
Q

Significant side effect of halothane

A

Delayed hepatotoxicity

110
Q

Use of thiopental and what terminates its action

A

Used for induction and short procedures. Effect terminated by rapid redistribution into tissue and fat

111
Q

For inhaled anesthetics, what does a high value for each of the following mean: Blood-gas partition coefficient, AV concentration gradient, and MAC?

A

Blood-gas PC - high solubility in blood, slower onset. AV CG - high solubility in tissue, slower onset. MAC - low solubility in lipid, lower potency

112
Q

Classes of local anesthetics

A

Esthers (procain, cocaine, tetracaine) and Amides (two Is in name)

113
Q

What type of drug is succinylcholine?

A

A depolarizing neuromuscular blocking drug

114
Q

Reversal of succinylcholine.

A

During phase 1 - no antidote. Made worse by ACHe inhibitors. During phase 2 - ACHe inhibitors (eg neostigmine)

115
Q

Nondepolarizing neuromuscular blockers (6)

A

Tubocurarine, atracurium, mivacurium, pancuronium, vecuronium, rocuronium. Competitively compete with ACh

116
Q

Reversal of blockage from nondepolarizing neuromuscular blockers

A

ACHe inhibitors (neostigmine, edrophonium, etc)

117
Q

Dopamine receptor agonists (3)

A

Bromocriptine, pramipexole, ropinirole

118
Q

Amantadine

A

Increases dopamine release. Also, antiviral against influenza A and rubella. May cause ataxia

119
Q

Selegiline

A

MAO-B inhibitor. Prevents dopamine breakdown

120
Q

Entacapone and Tolcapone

A

COMT inhibitors. Prevent L-dopa degradation

121
Q

Benztropine

A

Antimuscarinic. Improves tremor and rigidity in Parkinsons but does not affect bradykinesia

122
Q

Treatment for drug induced parksinsons

A

Antimuscarinics (eg benztropine). Do not use levodopa

123
Q

Memantine

A

NMDA receptor antagonist. Prevents excitotoxicity in Alzheimers

124
Q

Donepezil, Galantamine, Rivastigmine

A

Acetylcholinesterase inhibitors used in Alzheimers

125
Q

Reserpine

A

Pharmacologic sympathectomy. Blocks release of monoamine vesicles. Can cause MDD. Used in Huntingtons

126
Q

NT abnormalities in Huntingtons

A

Increased dopamine, decreased GABA and ACh

127
Q

Drugs used in Huntingtons

A

Reserpine, Tetrabenzine, Haloperidol

128
Q

Sumatriptan

A

5-HT-1B and 1D agonist. Causes vasoconstriction and inhibition of trigeminal activation. Use in migraine and cluster headache. May cause coronary vasospasm

129
Q

Saddle anesthesia, loss of anocutaneous reflex

A

Cauda Equina syndrome. Damage to S2-S4

130
Q

What electrolyte is in much higher concentrations in CSF than in plasma?

A

CL

131
Q

Queckenstedts maneuver

A

Have the patient valsava and the pressure should be transmitted all the way through the neck veins, dural sinuses, arachnoid granulations, spinal fluid, and to your manometer in LP position. If spinal stenosis, pressure increase is dulled (mostly replaced by CT and MRI now)

132
Q

General location of most brain tumors in adults and kids respectively

A

Adults - 70 percent are supratentorial. Kids - 70 percent are infratentorial

133
Q

General appearance of tumors of the choroid plexus

A

Papillary looking

134
Q

Dandy-Walker

A

Cerebellar vermis is not developed

135
Q

Complications of Arnold-Chiari

A

Hydrocephalus and platybasia

136
Q

Loss of pain and temperature in cape like distribution

A

Syringomyelia

137
Q

What can prevent the arachnoid granulations from scarring off in meningitis and thus can prevent hydrocephalus in these cases?

A

Steroids

138
Q

Most common cause of rabies in US

A

Skunks

139
Q

Periventricular calcifications

A

CMV

140
Q

Test of choice for CMV

A

Urine culture

141
Q

Why should pregnant women avoid soft cheeses?

A

Because these have listeria (third most common cause of neonatal menigitis)

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