Neurology Flashcards
1
Q
Neuro cells of neuroectoderm origin
A
CNS neurons, ependymal cells, oligodendroglia, astrocytes
2
Q
Neuro cells of neural crest origin
A
Schwann cells and PNS neurons
3
Q
Neuro cells of mesoderm origin
A
Microglia
4
Q
What happens histologically in neuronal degeneration?
A
Cellular swelling, dispersal of nissl substance, peripheral nucleus
5
Q
What do neurendocrine and neuroectodermal cells express?
A
Synaptophysin
6
Q
What is the purpose of reactive gliosis and what cells carry it out?
A
Wall off old infarcts. Astrocytes
7
Q
What effect does myelin have on the electrophysiologic parameters of a nerve?
A
Increases the space constant and conduction velocity
8
Q
What types of cells have a fried egg appearance?
A
Oligodendrocytes, HPV infected cells, and testicular seminoma cells
9
Q
What do all glial cells express?
A
GFAP
10
Q
Inputs to the hypothalamus
A
Organum Vasculosum of the Lamina Terminalis (OVLT) and Area Postrema (emesis)
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)
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
13
Q
Treatment for essential tremor
A
Beta blockers
14
Q
What effect does alcohol have on essential tremor?
A
Decreases the intensity of it (patients may self medicate with alcohol)
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
16
Q
What artery ruptures in epidural hematomas and what artery is it a branch of
A
Middle meningeal (branch of maxillary)
17
Q
Complications of epidural hematoma
A
Transtorial herniation (also seen in subdural) and CN 3 palsy
18
Q
In whom are subdural hematomas seen?
A
Elderly, alcoholics, blunt trauma, shaken baby
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
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
21
Q
Symptoms of SAH
A
Worst headache of life. Nucchal rigidity is also often present
22
Q
Spinal tap in SAH
A
Bloody or yellow (xanthochromic)
23
Q
When is the risk of rebleed following SAH maximal?
A
2-3 days later
24
Q
Treatment to prevent rebleed following SAH
A
Nimodipine
25
Most common cause of intraparenchymal hemorrhage
Hypertension. Also amyloid angiopathy, vasculitis, or neoplasm
26
Brain areas most vulnerable to ischemia
Hippocampus, neocortex, cerebellum, watershed areas
27
Progression of histologic findings in ischemic brain diseas
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)
28
What about hypertension causes lacunar stroke?
Small vessel lipohyalinosis
29
The cerebral aqueduct connects what two structures?
3rd ventricle and 4th ventricle
30
What is the clinical triad in NPH and what causes it?
Dementia, ataxia, urinary incontinence. Caused by distortion of fibers of the corona radiata
31
Most common cause of communicating hydrocephalus
Decreased absorption in the arachnoid villi (eg arachnoid scarring post meningitis)
32
Hydrocephalus ex vacuo
Appearance of increased CSF in atrophy (eg alzheimers or picks). ICP is normal, symptoms of NPH are NOT present
33
Irritability, poor feeding, increased head circumference in an infant
Hydrocephalus. Long term risk of visual disturbances, learning disabilities, and LE spasticity
34
What causes lower extremity spasticity in long term hydrocephalus in infants?
Streching of periventricular pyramidal tracts
35
Where do spinal nerves exit relative to the vertebra?
nerves C1-C7 exit above the matching vertebra, all others exit below the corresponding vertebra
36
Lumbar puncture location
Between L3 and L4 or L4 and L5
37
What parts of the spinal cord do B12 deficiency, E deficiency, and Friedreichs ataxia affect?
Dorsal columns, lateral corticospinal tracts, and spinocerebellar tracts. Ataxic gait, hyporeflexia, and impaired position and vibration sense
38
Werdnig-Hoffman disease
Floppy babby. Infantile spinal muscular atrophy. AR. Degeneration of anterior horns (LMN)
39
Staggering gait, frequent falling, nystagmus, dysarthria, pes cavus, hammer toes, HOCM, foot abnormalities and diabetes
Friedreichs ataxia
40
Brown Sequard
Hemisection of spinal cord. Ipsilateral UMN, ipsilateral dorsal column loss, contralateral pain and temperature loss
41
If Brown Sequard occurs above what level, it can present with Horners syndrome?
T1
42
What can cause partial Horners syndrome?
Cluster headaches
43
Which cranial nerves exit at the cerebellopontine angle
5, 7, and 8. 6 may as well but no-one cares about 6
44
Precocious puberty, paralysis of conjugate vertical gaze, hydrocephalus
Germinoma aka pinealoma. Can cause paralysis of conjugate vertical gaze (Parinaud) by pushing on superior colliculi. Hydrocephalus may or may not be present
45
Parinaud (paralysis of conjugate vertical gaze) is due to a lesion where?
Superior colliculi
46
Where is the CTZ located and what is it responsible for?
Dorsal medulla near the 4th ventrical (in area postrema). Responsible for vomiting
47
What nerve is responsible for sensation in middle ear?
9. Also does gag reflex, sensation in upper pharynx, posterior tongue, and tonsils
48
What nerve is responsible for cutaneous sensation to posterior external ear canal?
Vagus. Can pass out with significant stimulation here
49
What nerve is responsible for cutaneous sensory of ear canal?
V3 (with help from X which covers posterior external ear canal)
50
What CN reflex is normally absent but presents in UMN lesion?
Jaw jerk (V3 to V3)
51
Result of damage to nucleus ambiguus
Hoarseness, dysphagia, loss of gag reflex
52
Which vagal nucleus sends parasympathetic fibers to the heart, lungs, and upper GI?
Dorsal motor nucleus
53
Through what bones do cranial nerves exit?
Cribriform plate (CN 1), Sphenoid bone (2 through 6), Temporal and Occipital bones (7 through 12)
54
Give the cranial exit of cranial nerves two through six
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
55
Give the cranial exits of cranial nerves 7 through 12
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
56
At what vertebral levels does the sympathetic chain run?
T1-L3
57
Aneurysms of what arteries often cause CN 3 palsy?
Posterior cerebral and superior cerebellar (because CN3 travels right between these two)
58
Vertigo, nystagmus, nausea and vomiting
CN 8 lesion
59
Prolonged loud noises most damage what structure?
The organ of corti
60
Give the cranial nerve most responsible for each of the following sounds: Mi mi mi, La la la, and Khu khu khu
Mi mi mi - 7 (lips). Khu khu khu - 10 (palate). La la la - 12 (tongue)
61
Causes of Bells palsy
AIDS, Lyme, HSV, Sarcoid, Tumors, Diabetes
62
Muscles that close and open the jaw rspectively
Close - Masseter, Temporalis, Medial pterygoid. Open - Lateral pterygoid. All are innervated by V3
63
Branches of CN 7
Temporal, Zygomatic, Buccal, Mandibular, Cervical
64
What innervates the parotid gland?
CN 9
65
What innervates the salivary glands?
7 (except parotid, which is 9)
66
Retinitis in HIV patient
Most commonly CMV. Treat with ganciclycovir
67
Uncal herniation causes damage to what nerve?
CN 3
68
What is conveyed by the inner and outer parts of CN 3 respectively and what types of injury damage each?
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
How does INO present and what disease is it associated with most commonly?
Medial rectus palsy on attempted lateral gaze. Associated with MS
70
Sudden, painless, permanent monocular blindness, pale retina, cherry-red macula.
CRAO
71
Causes of dementia (10)
Alzheimer, Picks, Lewy body, CJD, Multi-infarct, Syphilis, HIV, Vit B12, Wilsons, NPH
72
Scanning speech, intention tremor, incontinence, nystagmus
Classic presentation of MS. Also includes INO
73
Tinnitus, vertigo, sensorineural hearing loss. Increased volume and pressure of endolymph in the vestibular apparatus
Menieres disease
74
Labyrinthitis
Inflammation of the labyrinth. Not usually recurrent
75
Histologic appearance of GBM
Psuedopalisading. Pleomorphic with central necrosis and hemorrhage
76
Histology of Schwannoma
Elongated cells with regular, oval nuclei. Areas of dense and loos growth
77
Which primary brain tumor is S-100 positive?
Schwanomma
78
Which primary brain tumor includes tooth like calficiation?
Craniopharyngioma
79
Which glaucoma drugs increase outflow (as opposed to the rest which decrease inflow)?
Cholinomimetics (eg pilocarpine, carbachol, physostigmine, and echothiophate) and prostaglandins (latanoprost)
80
Classes of drugs used to treat glaucoma
Alpha-agonists (epi, brimonidine), Beta-blockers (timolol, betaxolol, carteolol), Acetazolamide, Cholinomimetics, and Prostaglandins (latanoprost)
81
Opioid analgesics (8)
Morphine, fentanyl, codein, heroin, methadone, meperidine, dextromethorphan, diphenoxylate
82
What side effect of opioids is meperidine least likely to cause?
Contraction of smooth muscle at the spincter of oddi (biliary colic)
83
Biochemical action of opioid analgesics
Opens K channels and closes Ca channels, decreasing synaptic transmission and inhibiting release of ACh, NE, 5-HT, gluamate, and substance P
84
Pentazocine
Partial agonist with some antagonist activity at mu receptors. Pain control without dependence. Can cause withdrawal in pts dependent on opioids
85
Butorphanol
Partial agonist at opioid mu receptors, agonist at kappa receptors. Pain relief with less respiratory depression. Causes withdrawal if dependent on full agonist
86
Tramadol
Very weak opioid agonist. Inhibits 5-HT and NE reuptake. Use in chronic pain, may precipitate seizures
87
Drugs useful in seizure treatment (12)
Phenytoin, Carbamazepine, Lamotrigine, Gabapentin, Topiramate, Phenobarbital, Valproic acid, Ethosuximide, Benzos, Tiagabine, Vigabatrin, Levetiracetam
88
Drug of choice for absence seizures
Ethosuximide. If absence and GTCs, use valproic acid (ethosuximide not effective against GTCs)
89
First line drugs for GTCs (3)
Phenytoin, Carbamazepine, Valproic acid
90
First line for myoclonic seizures
Valproic acid
91
First line for trigeminal neuralgia
Carbamazepine
92
Epilepsy drugs that act on sodium channels (5)
Phenytoin, Carbamazepine, Lamotrigine, Topiramate (and GABA), Valproic acid (and GABA)
93
Epilepsy drugs that act on GABA channels (7)
Topiramate (and Na), Phenobarbital, Valproic acid (and Na), Benzos, Tiagabine, Vigabatrin, Levetiracetam (and glutamate)
94
Epilepsy drugs that act on Ca channels (2)
Gabapentin, Ethosuximide
95
First line epilepsy drug in pregnant women and children
Phenobarbital
96
Treatment for status epilepticus
Lorazepam to terminate and phenytoin to prophylax (can give them simultaneously)
97
What limits phenytoin use?
Mostly cosmetic side effects - hirsutism, acne, corsening of facial features, gingival hyperplasia. Also lymphadenopathy, nystagmus, anemia, and CYP effects
98
Mechanism of barbiturates
Increased duration of Cl channel opening at GABA-A
99
In what condition are barbiturates contraindicated?
Porphyria
100
Primidone metabolism and the consequences of this.
Metabolized to phenobarital and phenylethylmalonde (PEMA). All 3 are anticonvulsants and you can get an overdose
101
Short acting benzos
Triazolam, Oxazepam, Midazolam
102
Mechanism of benzos
Increase frequency of Cl channel opening at GABA-A
103
Flumazenil
Competitive antagonist at GABA benzo receptor. Treat benzo overdose with this
104
Non-benzodiazepine hypnotics
Zolpidem (Ambien), Zaleplon (Sonata), Eszopiclone (Lunesta)
105
Measure of an anesthetics solubility in blood and relation to use
Blood-gas partition coefficient. Lower solubility in blood means rapid induction and recovery
106
Measure of an anesthetics solubility in lipids and what it means in use
1 / MAC. Higher solubility in lipid means higher potency
107
Inhaled anesthetics (6)
Halothane, enflurance, isoflurance, sevoflurane, methoxyflurane, nitrous oxide
108
What effect do inhaled anesthetics have on cerebral blood flow
Increase it (by decreasing vascular resistance in the brain)
109
Significant side effect of halothane
Delayed hepatotoxicity
110
Use of thiopental and what terminates its action
Used for induction and short procedures. Effect terminated by rapid redistribution into tissue and fat
111
For inhaled anesthetics, what does a high value for each of the following mean: Blood-gas partition coefficient, AV concentration gradient, and MAC?
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
Classes of local anesthetics
Esthers (procain, cocaine, tetracaine) and Amides (two Is in name)
113
What type of drug is succinylcholine?
A depolarizing neuromuscular blocking drug
114
Reversal of succinylcholine.
During phase 1 - no antidote. Made worse by ACHe inhibitors. During phase 2 - ACHe inhibitors (eg neostigmine)
115
Nondepolarizing neuromuscular blockers (6)
Tubocurarine, atracurium, mivacurium, pancuronium, vecuronium, rocuronium. Competitively compete with ACh
116
Reversal of blockage from nondepolarizing neuromuscular blockers
ACHe inhibitors (neostigmine, edrophonium, etc)
117
Dopamine receptor agonists (3)
Bromocriptine, pramipexole, ropinirole
118
Amantadine
Increases dopamine release. Also, antiviral against influenza A and rubella. May cause ataxia
119
Selegiline
MAO-B inhibitor. Prevents dopamine breakdown
120
Entacapone and Tolcapone
COMT inhibitors. Prevent L-dopa degradation
121
Benztropine
Antimuscarinic. Improves tremor and rigidity in Parkinsons but does not affect bradykinesia
122
Treatment for drug induced parksinsons
Antimuscarinics (eg benztropine). Do not use levodopa
123
Memantine
NMDA receptor antagonist. Prevents excitotoxicity in Alzheimers
124
Donepezil, Galantamine, Rivastigmine
Acetylcholinesterase inhibitors used in Alzheimers
125
Reserpine
Pharmacologic sympathectomy. Blocks release of monoamine vesicles. Can cause MDD. Used in Huntingtons
126
NT abnormalities in Huntingtons
Increased dopamine, decreased GABA and ACh
127
Drugs used in Huntingtons
Reserpine, Tetrabenzine, Haloperidol
128
Sumatriptan
5-HT-1B and 1D agonist. Causes vasoconstriction and inhibition of trigeminal activation. Use in migraine and cluster headache. May cause coronary vasospasm
129
Saddle anesthesia, loss of anocutaneous reflex
Cauda Equina syndrome. Damage to S2-S4
130
What electrolyte is in much higher concentrations in CSF than in plasma?
CL
131
Queckenstedts maneuver
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
General location of most brain tumors in adults and kids respectively
Adults - 70 percent are supratentorial. Kids - 70 percent are infratentorial
133
General appearance of tumors of the choroid plexus
Papillary looking
134
Dandy-Walker
Cerebellar vermis is not developed
135
Complications of Arnold-Chiari
Hydrocephalus and platybasia
136
Loss of pain and temperature in cape like distribution
Syringomyelia
137
What can prevent the arachnoid granulations from scarring off in meningitis and thus can prevent hydrocephalus in these cases?
Steroids
138
Most common cause of rabies in US
Skunks
139
Periventricular calcifications
CMV
140
Test of choice for CMV
Urine culture
141
Why should pregnant women avoid soft cheeses?
Because these have listeria (third most common cause of neonatal menigitis)
