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USMLE REVIEW > Neurology > Flashcards

Neurology Flashcards

1
Q

Phenytoin Side Effects

A

“Phenytoin Has Given MDS Frustration”

Peripheral neuropathy
Hirsutism
Gingival Hyperplasia
Megaloblastic Anemia
Drug Induced Lupus
Steven Johnson Syndrome
Fetal Hydantoin Syndrome
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2
Q

Drug of choice for absence seizures

A

Ethosuximide

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3
Q

Used to treat status epilepticus acutely… and prophalactically

A

Acutely = Benzodiazepines, increase frequency of GABA channels, increased Cl eflux

Chronic = Phenytoin

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4
Q

Used to treat eclampsia

A

Magnesium Sulfate (& delivery!)

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5
Q

Which anti-epileptics are teratogens?

A

Phenytoin
Carbamazepine
Valproic Acid- Spina Bifida

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6
Q

First line treatment for trigeminal neuralgia?

A

Carbamazepine

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7
Q

Three seizure drugs that inactivate Na+ channels

A

Valproic Acid
Carbamazepine
Phenytoin

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8
Q

What is seen in biopsy of shingles?

A

Cowdry A Inclusion bodies

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9
Q 
10 year-old boy
Neurological Symptoms
Multifocal white matter lesions
Corticol atrophy
Ventricular Enlargement

Hx of measles infection:
Koplik Spots
Multinucleated giant cells w/ inclusions

A

Subacute Sclerosing Panencephalitis

Acellular CSF w/ elevated gamma globulin

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10
Q

What infection can cause progressive multifocal leukoencephalopathy in HIV positive adults?

A

Polyomavirus JC virus

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11
Q

Microglia are derived from what embryologic origin?

A
  • resident phagocytes in CNS
  • Differentiate form circulating blood monocytes
  • MESODERMAL in origin
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12
Q

Seizure drug that causes agranulocytosis?

A

Carbamazepine

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13
Q

Seizure drug that causes gingival hyperplasia?

A

Phenytoin

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14
Q

What layer surrounds fascicles of peripheral nerve fibers and acts as the permeability barrier?

A

Perineurium

Endoneruium = invests single nerve fiber layers
Perineurium = surrounds fasicles of nerve fibers
Epinerurium = dense connective tissue surruond entire nerve (fascicles and blood vessels)
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15
Q 
Bradykinesia
Postural Instability
Festinating gait
Mask-Like Facies
Pill-rolling tremor
Cogwheel Rigidity
A

Parkinson Disease = loss of DA neurons in substantia nigra pars compacta (normally promotes movement so lesion causes slowing of movements)

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16
Q

What is seen on biopsy of Parkinson Disease?

A

Lewy bodies composed of alpha-synuclein = intracellular esoinophilic inclusions

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17
Q

Treatment for Parkinson

A

L-DOPA & Carbadopa
Segeline = MAO-B inhibitor
Tolcapone = COMT inhibitor
Bromocriptine = DA agonist
Benztropine = antimuscarinic to improve tremor and rigidity
Amantadine = increases DA release, and decreases reuptake

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18
Q

Chorea
Dementia
Atrophy of caudate and putamen

A

Huntington Disease

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19
Q

Increased DA
Decreased GABA
Decreased ACh

A

Huntington Disease

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20
Q

A male patient presents with involuntary flailing of one are. Where is the lesion?

A

Hemiballismus

Lesion in the subthalamic nucleus (on contralateral side)

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21
Q 
Cafe au lait spots
Cutaneous neurofibromas
Lisch Nodules = Iris hamartomas
Optic Gliomas
Pheochromocytomas
Scoliosis
Vertebral Defects
Long bond dysplasia
A

Neurofibromatosis Type 1

NF1 tumor suppressor gene on chromosome 17

Autosomal Dominant
100% penetrance
VARIABLE EXPRESIVITY

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22
Q

Bilateral acoustic schwannomas
Juvenile Cataracts
Meningiomas
Ependymomas

A

Neurofibromatosis Type 2

NF2 tumors suppressor gene on chromosome 22

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23
Q

Defect in what brachial arch would cause hoarseness?

A

6th Brachial Arch - all intrinsic muscles of the larynx (except cricothyroid)

Innervated by CN X

Lesion = hoarseness or trouble with speech

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24
Q

Only muscle derived from the 3rd brachial arch?

A

Stylopharyngeous (CN 9)

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25
Q

What neurotransmitter induces REM sleep?

A

ACh

Decreased in normal aging, thats why old people sleep less!

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26
Q

What is deficient in Pellegra? What are three symptoms?

A

Pellegra = Niacin (B3) deficiency

Three D’s = Dermatitis, Diarrhea, Dementia

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27
Q

What amino acid is Niacin derived from?

A

Tryptophan

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28
Q

What nerve innervates the adductor muscles in the medial compartment of the thigh?

A

Obturator nerve

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29
Q

Ascending muscle weakness
Recent diarrheal illness
Increased CSF protein

A

Guilain-Barre Syndrome

Autoimmune attack of Schwann Cells

Inflammation AND demylination of peripheral nerves and motor fibers - Endoneurium

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30
Q

Treatment for malignant hyperthermia?

A

Dantrolene

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31
Q

What neurotransmitter is lost in Narcolepsy?

A

Orexin-A and Orexin B that promote wakefulness

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32
Q

Which type of dementia is associated with visual hallucinations?

A

Lewy Body Dementia

alpha-synuclein defect

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33
Q

What fuses to form multi-nucleated giant cells in the CNS of HIV-infected patients?

A

Microglia

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34
Q

Contralateral hemianopia with macular sparing would indicate a thrombus in which artery?

A

Posterior cerebral artery

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35
Q

Scanning Speech
Intention tremor
Nystagmus

A

Multiple Sclerosis

*also incontinence and intranuclear opthalmoplegia

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36
Q

Floppy Baby at birth
Hypotonia
Tongue Fasciculations

A

Werdnig Hoffmann Disease/spinal muscular atrophy = congenital degeneration of anterior horns of spinal cord

LMN lesion

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37
Q

Anti seizure med used to treat combination of Absence and tonic-clonic

A

Valproic Acid

Increased Na+ channel inactivation

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38
Q

What are lewy bodies made of?

A

alpha-synuclein

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39
Q

Degenerative disorder of CNS associated with Lewy bodies and loss of domapinergic neurons

A

Parkinson’s

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40
Q

only thing in neuro that is derived from mesoderm?

A

Microglia (like Macrophages, orginates from Mesoderm)

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41
Q

What week do the neuropores fuse?

A

Week 4

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42
Q

What is derived from neuroectoderm?

A

CNS neurons
Ependymal cells
Oligodendroglia
Astrocytes

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43
Q

What is derived from Neural crest?

A

PNS

Schwann Cells

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44
Q

Herniation of cerebellar tonsils and vermis through foramen magnum leading to aqueductal stenosis and hydrocephalus

A

Chiari II

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45
Q

Agenesis of cerebellar vermis with cystic enlargement of 4th ventricle

A

Dandy-Walker

46
Q

Most common location of Syringomyelia

A

C8-T1

47
Q

Bilateral loss of pain and temp in upper extremities with fine touch sensation preserved

A

Syringomyelia

*Associated with Chiari I malformation = cerebellar tonsillar ectopia

48
Q

Innervation of tongue

A

Anterior 2/3 = sensation is V3, taste is 7

Posterior 1/3 = sensation and taste are 9

49
Q

Stain for neurons?

A

Nissle stains (stains RER)

50
Q

Marker for Astrocytes?

A

GFAP

51
Q

What type of neuron is able to regenerate?

A

Injury, wallerian degeneration, then if in PNS can regenerate

52
Q

Bilateral acoustic neuroma

A

NFT2

Type of scwannoma

53
Q

Sensory receptor for vibration and pressure.

A

Pacinian corpuscles

54
Q

Sensory receptor to fine/light touch and position sense

A

Meissner corpuscles

55
Q

Where are ADH and oxytocin made in the hypothalamus?

A

ADH in supraoptic nucleus

Oxytocin in paraventricular nucleus

56
Q

What nuclei of the hypothalamus regulate hunger satiety?

A

Lateral = hunger, inhibited by leptic

Ventromedial = satiety, stimulated by lepti

57
Q

What nuclei in hypothalamus regulate temperature?

A

Anterior = cooling, parasympathetic

Posterior = heating, sympathetic

58
Q

Part of hypothalamus responsible for circadian rhythm?

A

Suprachiasmatic nucleus = regulated by environment (like light)

59
Q

Stages of sleep

A

“At Night, BATS Drinks Blood”

Beta - awake, eyes open
Alpha- awake, eyes closed
Theta - N1
Sleep sindles, K complexes = N2
Delta =N3
Beta = REM
60
Q

When does bruxism (teeth grinding occur)?

A

N2

61
Q

When does sleepwalking, night terror and bewetting occur?

A

N3

62
Q

Treatment for night terrors and sleepwalking?

A

Benzos - decreased N3 time

63
Q

Athetosis

A

Writhing, snake like movementt

Lesion in basal ganglia - Huntington

64
Q

Hemiballismus

A

Lesions to CONTRALATERAL subthalamic nucleus

65
Q

Myclonus

A

Sudden, brief, uncontrolled muscle contraction

66
Q 
Pill-rolling tremor (RESTING tremor)
Rigidity 
Akinesia
Postrual instability
Shuffling gate
A

Parkinson

Degeneration of dopaminergic neurons in Substanstia Nigra

67
Q

What are the eosinophilic intracellular inclusions found in Parkinsons?

A

Lewy Bodies made up of alpha-synuclein

68
Q

Atrophy of caudae nuclei with ex vacuo dilation of frontal horns on MRI?

A

Huntington Disease

69
Q

Where is wernicke’s area located? lesion?

A

Superior Temporal Gyrus of temporal lobe

FLuent aphasia with impaired comprhension and repetition

**Wernickes wordy but makes not sense

70
Q

Where is Broca? Lesion?

A

Inferior frontal gyrus of frontal lobe

Nonfluent aphasia with intact comprehension and imparied repetition

Broca = Broken Boca

71
Q

Can’t repeat phrases (poor repetition_ but fluent speech and intact comprehension

A

Conduction Aphasia - damage to arcuate fasciulus

72
Q

Hyperphagia
Hypersexuality
Hyperorality

A

Kluver-Bucy syndrome - lesion to the amygdala

73
Q

Hemi neglect syndrome

A

Non-dominant parietal-temporal cortex

74
Q

Agraphia
Acalculia
Finger agnosia
Left-right disorientation

A

Dominant Parietal-temporal cortex

Gerstmann Syndrome

75
Q

Anterograde amnesia- inability to make new memories

A

Lesions to hippocampus

**Most vulnerable to ischemia hypoxia

76
Q

What molecule drives brain perfusion?

A

PCO2

77
Q

Unmanaged HTN and stroke

A

Usually lacunar infarcts in the lenticulostriate arteries (affecting striatum and internal capsule) causing contralateral hemiparesis/hemiplegia

78
Q

Uvula deviating to the right indicates…..

A

Vagus lesion on the left

79
Q

Ptosis
Miosis
Anhydrosis

A

Horner Syndrome

No sympathetics

80
Q

Two things that can cause internuclar opthalmoplegia?

A

Multiple Sclerosis

Medial Pontine Strokes (Basilar Artery)

81
Q

Stroke of the Lateral Medulla?

A

Wallenberg Syndrome = PICA

82
Q

A stroke in what area would causes a blown pupil?

A

Anterior Midbrain Infarction from occlusion of the paramedian branches of the posterior cerebral artery

83
Q

Saccular (berry) aneurysm of the posterior communicating artery would cause what CN defects?

A

CN III palsy

Eye is down and out with ptosis and mydriasis

84
Q

Saccular aneurysm is associated with what two diseases?

A

Ehlers-Danlos

ADPKD

85
Q

Most common cause of Charcot-Bouchard aneurysm?

A

Hypertension

Affects small vessels

Basal ganglia,thalamus

86
Q

Part of brain most vulnerable to ischemia?

A

Hippocampus

87
Q

Histologic Features of ischemia event?

A 
12-48 hours = red neurons
24-72 = necrosis + neutrophils
3-5 days = MACs
1-2 weeks = reactive gliosis + vascular proliferation
> 2 weeks = Glial scar
88
Q

Focal neuro symptoms for less than 24 hours

A

TIA`

89
Q

Pseudotumor Cerebri

A

Idiopathic intracranial hypertension

90
Q

Fasciculations means what kind of lesion?

A

LMN

91
Q

LMN lesions only

A

Poliomyelitis
Destruction of anterior horns
Flaccid paralysis

CSF = lymphocytes, normal glucose

Polio Virus = picorna virus = +ss linear RNA

Vaccines: oral = live attenuated, IM = killed

92
Q

Both UMN and LMN lesions

A

ALS (Lou Gehrig)

Defect in superoxide dismutase 1

Treat = Riluzole (decreases presynaptic glutamate release)

93
Q

Complete occlusion of spinal artery would cause what deficits?

A

Spares only dorsal columns and lissauer tract

Loss of pain and temp
Motor paralysis
Areflexia

94
Q

Tabes dorsalis

A

Degeneration of dorsal columns are roots

Caused by 3 syphilis

Absence of DTR
+ Romberg

Argyll Robertson Pupil

95
Q

Syringomyelia is associated with what congenital malformation?

A

Chiari I malformation

96
Q

“Floppy Baby” with marked hyptonia and tongue fasiculations

A

Spinal msucular atrophy (Werdnig-Hoffmann) disease

Congential degeneration of anterior horns of spinal cords

97
Q

Cranial nerve exits for CN5

A 
V1= Superior Orbital Fissure
V2= Rotundum
V3= Ovale

**Foramen Spinosum = middle meningeal artery

98
Q

What nerve is most susceptible to injury from cavernous sinus syndrome?

A

Abducens CN 6

99
Q

Overgrowth of desquamated keratin debri with in middle ear space

A

Cholesteatoma

Causes conductive hearing loss

100
Q

Things that can cause a cherry red spot on macula?

A

Tay Sachs
Neimann Pick
Retinal Artery Occlusion

101
Q

Therapy to slow progression of MS?

A

B-interferon

Natalizumab

102
Q

Where would you find the inflammatory infiltrate in Guillan Barre?

A

Endoneurium

103
Q

Dsypnea
Hiccups
Referred pain to shoulder

A

Phrenic Nerve irritation - C3-C5

Descends through neck and thorax to innervate the ipsilateral hemidiaphragm

**Likely irritated to lung cancer

104
Q

What week do the neuropores fail to fuse causing a neural tube defect?

A

4th WEEK!!!! AHHHHHH

105
Q

Ataxia + multiple spinal cord lesions
Hypertrophic Cardiomyopathy
Kyphoscoliosis

A 
Friedreich Ataxia
Trinucleotide Repeat (GAA)

Encodes frataxin (iron binding protein) - impaired mito functioning

106
Q

Brown-Sequard Syndrome

A

Hemisection of spinal cord

Ipsilateral UMN signs below level f lesion
Ipsilateral loss of DCML pathway
Contralateral pain/temp loss
Ipsilateral loss of all sensation at level of lesion
Ipsilateral LMN signs at level of lesion

107
Q

Erection and sensation of penile and anal zones

A

S2, S3, S4 keep the penis off the floor

108
Q

Innervation of uvula

A

Vagus

109
Q

CN most susceptible to injury in cavernous sinus?

A

CN 6

110
Q

What causes rapid induction and recovery time in anesthetics?

A

Rapid induction = DECREASED blood solubility

111
Q

What determines potency of an anesthetic?

A

Increased solubility in lipids = increased potency

USMLE REVIEW (25 decks)

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