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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
What neurotransmitter induces REM sleep?
ACh Decreased in normal aging, thats why old people sleep less!
26
What is deficient in Pellegra? What are three symptoms?
Pellegra = Niacin (B3) deficiency Three D's = Dermatitis, Diarrhea, Dementia
27
What amino acid is Niacin derived from?
Tryptophan
28
What nerve innervates the adductor muscles in the medial compartment of the thigh?
Obturator nerve
29
Ascending muscle weakness Recent diarrheal illness Increased CSF protein
Guilain-Barre Syndrome Autoimmune attack of Schwann Cells Inflammation AND demylination of peripheral nerves and motor fibers - Endoneurium
30
Treatment for malignant hyperthermia?
Dantrolene
31
What neurotransmitter is lost in Narcolepsy?
Orexin-A and Orexin B that promote wakefulness
32
Which type of dementia is associated with visual hallucinations?
Lewy Body Dementia | alpha-synuclein defect
33
What fuses to form multi-nucleated giant cells in the CNS of HIV-infected patients?
Microglia
34
Contralateral hemianopia with macular sparing would indicate a thrombus in which artery?
Posterior cerebral artery
35
Scanning Speech Intention tremor Nystagmus
Multiple Sclerosis *also incontinence and intranuclear opthalmoplegia
36
Floppy Baby at birth Hypotonia Tongue Fasciculations
Werdnig Hoffmann Disease/spinal muscular atrophy = congenital degeneration of anterior horns of spinal cord LMN lesion
37
Anti seizure med used to treat combination of Absence and tonic-clonic
Valproic Acid | Increased Na+ channel inactivation
38
What are lewy bodies made of?
alpha-synuclein
39
Degenerative disorder of CNS associated with Lewy bodies and loss of domapinergic neurons
Parkinson's
40
only thing in neuro that is derived from mesoderm?
Microglia (like Macrophages, orginates from Mesoderm)
41
What week do the neuropores fuse?
Week 4
42
What is derived from neuroectoderm?
CNS neurons Ependymal cells Oligodendroglia Astrocytes
43
What is derived from Neural crest?
PNS | Schwann Cells
44
Herniation of cerebellar tonsils and vermis through foramen magnum leading to aqueductal stenosis and hydrocephalus
Chiari II
45
Agenesis of cerebellar vermis with cystic enlargement of 4th ventricle
Dandy-Walker
46
Most common location of Syringomyelia
C8-T1
47
Bilateral loss of pain and temp in upper extremities with fine touch sensation preserved
Syringomyelia *Associated with Chiari I malformation = cerebellar tonsillar ectopia
48
Innervation of tongue
Anterior 2/3 = sensation is V3, taste is 7 Posterior 1/3 = sensation and taste are 9
49
Stain for neurons?
Nissle stains (stains RER)
50
Marker for Astrocytes?
GFAP
51
What type of neuron is able to regenerate?
Injury, wallerian degeneration, then if in PNS can regenerate
52
Bilateral acoustic neuroma
NFT2 | Type of scwannoma
53
Sensory receptor for vibration and pressure.
Pacinian corpuscles
54
Sensory receptor to fine/light touch and position sense
Meissner corpuscles
55
Where are ADH and oxytocin made in the hypothalamus?
ADH in supraoptic nucleus | Oxytocin in paraventricular nucleus
56
What nuclei of the hypothalamus regulate hunger satiety?
Lateral = hunger, inhibited by leptic Ventromedial = satiety, stimulated by lepti
57
What nuclei in hypothalamus regulate temperature?
Anterior = cooling, parasympathetic Posterior = heating, sympathetic
58
Part of hypothalamus responsible for circadian rhythm?
Suprachiasmatic nucleus = regulated by environment (like light)
59
Stages of sleep
"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
When does bruxism (teeth grinding occur)?
N2
61
When does sleepwalking, night terror and bewetting occur?
N3
62
Treatment for night terrors and sleepwalking?
Benzos - decreased N3 time
63
Athetosis
Writhing, snake like movementt | Lesion in basal ganglia - Huntington
64
Hemiballismus
Lesions to CONTRALATERAL subthalamic nucleus
65
Myclonus
Sudden, brief, uncontrolled muscle contraction
66
``` Pill-rolling tremor (RESTING tremor) Rigidity Akinesia Postrual instability Shuffling gate ```
Parkinson | Degeneration of dopaminergic neurons in Substanstia Nigra
67
What are the eosinophilic intracellular inclusions found in Parkinsons?
Lewy Bodies made up of alpha-synuclein
68
Atrophy of caudae nuclei with ex vacuo dilation of frontal horns on MRI?
Huntington Disease
69
Where is wernicke's area located? lesion?
Superior Temporal Gyrus of temporal lobe FLuent aphasia with impaired comprhension and repetition **Wernickes wordy but makes not sense
70
Where is Broca? Lesion?
Inferior frontal gyrus of frontal lobe Nonfluent aphasia with intact comprehension and imparied repetition Broca = Broken Boca
71
Can't repeat phrases (poor repetition_ but fluent speech and intact comprehension
Conduction Aphasia - damage to arcuate fasciulus
72
Hyperphagia Hypersexuality Hyperorality
Kluver-Bucy syndrome - lesion to the amygdala
73
Hemi neglect syndrome
Non-dominant parietal-temporal cortex
74
Agraphia Acalculia Finger agnosia Left-right disorientation
Dominant Parietal-temporal cortex Gerstmann Syndrome
75
Anterograde amnesia- inability to make new memories
Lesions to hippocampus **Most vulnerable to ischemia hypoxia
76
What molecule drives brain perfusion?
PCO2
77
Unmanaged HTN and stroke
Usually lacunar infarcts in the lenticulostriate arteries (affecting striatum and internal capsule) causing contralateral hemiparesis/hemiplegia
78
Uvula deviating to the right indicates.....
Vagus lesion on the left
79
Ptosis Miosis Anhydrosis
Horner Syndrome | No sympathetics
80
Two things that can cause internuclar opthalmoplegia?
Multiple Sclerosis | Medial Pontine Strokes (Basilar Artery)
81
Stroke of the Lateral Medulla?
Wallenberg Syndrome = PICA
82
A stroke in what area would causes a blown pupil?
Anterior Midbrain Infarction from occlusion of the paramedian branches of the posterior cerebral artery
83
Saccular (berry) aneurysm of the posterior communicating artery would cause what CN defects?
CN III palsy Eye is down and out with ptosis and mydriasis
84
Saccular aneurysm is associated with what two diseases?
Ehlers-Danlos | ADPKD
85
Most common cause of Charcot-Bouchard aneurysm?
Hypertension Affects small vessels Basal ganglia,thalamus
86
Part of brain most vulnerable to ischemia?
Hippocampus
87
Histologic Features of ischemia event?
``` 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
Focal neuro symptoms for less than 24 hours
TIA`
89
Pseudotumor Cerebri
Idiopathic intracranial hypertension
90
Fasciculations means what kind of lesion?
LMN
91
LMN lesions only
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
Both UMN and LMN lesions
ALS (Lou Gehrig) Defect in superoxide dismutase 1 Treat = Riluzole (decreases presynaptic glutamate release)
93
Complete occlusion of spinal artery would cause what deficits?
Spares only dorsal columns and lissauer tract Loss of pain and temp Motor paralysis Areflexia
94
Tabes dorsalis
Degeneration of dorsal columns are roots Caused by 3 syphilis Absence of DTR + Romberg Argyll Robertson Pupil
95
Syringomyelia is associated with what congenital malformation?
Chiari I malformation
96
"Floppy Baby" with marked hyptonia and tongue fasiculations
Spinal msucular atrophy (Werdnig-Hoffmann) disease Congential degeneration of anterior horns of spinal cords
97
Cranial nerve exits for CN5
``` V1= Superior Orbital Fissure V2= Rotundum V3= Ovale ``` **Foramen Spinosum = middle meningeal artery
98
What nerve is most susceptible to injury from cavernous sinus syndrome?
Abducens CN 6
99
Overgrowth of desquamated keratin debri with in middle ear space
Cholesteatoma Causes conductive hearing loss
100
Things that can cause a cherry red spot on macula?
Tay Sachs Neimann Pick Retinal Artery Occlusion
101
Therapy to slow progression of MS?
B-interferon | Natalizumab
102
Where would you find the inflammatory infiltrate in Guillan Barre?
Endoneurium
103
Dsypnea Hiccups Referred pain to shoulder
Phrenic Nerve irritation - C3-C5 Descends through neck and thorax to innervate the ipsilateral hemidiaphragm **Likely irritated to lung cancer
104
What week do the neuropores fail to fuse causing a neural tube defect?
4th WEEK!!!! AHHHHHH
105
Ataxia + multiple spinal cord lesions Hypertrophic Cardiomyopathy Kyphoscoliosis
``` Friedreich Ataxia Trinucleotide Repeat (GAA) ``` Encodes frataxin (iron binding protein) - impaired mito functioning
106
Brown-Sequard Syndrome
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
Erection and sensation of penile and anal zones
S2, S3, S4 keep the penis off the floor
108
Innervation of uvula
Vagus
109
CN most susceptible to injury in cavernous sinus?
CN 6
110
What causes rapid induction and recovery time in anesthetics?
Rapid induction = DECREASED blood solubility
111
What determines potency of an anesthetic?
Increased solubility in lipids = increased potency

USMLE REVIEW (25 decks)

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