Neurology Flashcards
alar plate is [ventral/dorsal]
dorsal (sensory)
what does the myelencephalon become
medulla
what does the metencephalon become
pons and cerebellum
what marker can confirm neural tube defect after you already detect a high AFP
acetylcholine esterase
what embryologically is the anterior 2/3 of the tongue derived from
1st and 2nd branchial (pharyngeal) arches
what embryologically is the posterior 1/3 of the tongue derived from
3rd and 4th branchial/pharyngeal arches
function hyoglossus
retracts and depresses tongue
function genioglossus
protrudes tongue
function styloglossus
draws sides of tongue upward
nerve and function of palatoglossus
X, elevates posterior tongue during swallowing
where can you find free nerve endings
all skin, epidermis, some viscera
what type of neurons have free nerve endings
A delta (myelinated) and C (unmyelinated) fibers
where can you find Meissner corpuscles
glabrous (hairless) skin
where can you find Pacinian corpuscles
deep skin layers, ligaments, joints
where can you find Merkel discs
finger tips, superficial skin
where can you find Ruffini corpuscles
finger tips, joints
free nerve endings sense
pain, temperature
Meissner corpuscles sense
dynamic, fine/light touch, position sense
Pacinian corpuscles sense
vibration, pressure
Merkel discs sense
pressure, deep static touch, position sense
Ruffini corpuscles sense
pressure, slippage of objects along surface of skin, joint angle change
where in CNS is acetylcholine made
basal cells of Meynert
where in CNS is dopamine made
ventral tegmentum, SN pars compacta
where in CNS is GABA made
nucleus accumbens
where in CNS is norepinephrine made
locus ceruleus
where in CNS is serotonin made
raphe nucleus
neurotransmitter changes in Parkinson
increased acetylcholine, decreased dopamine, decreased serotonin
neurotransmitter changes in Huntington disease
increased dopamine, decreased ACh, decreased GABA
neurotransmitter changes in Alzheimer
decreased ACh, increased glutamate
neurotransmitter changes in schizophrenia
increased dopamine
neurotransmitter changes in depression
decreased dopamine, decreased norepinephrine, decreased serotonin
neurotransmitter changes in anxiety
increased nore, decreased GABA, decreased serotonin
acetylcholine is increased in which disease(s)
Parkinson
ACh is decreased in which disease(s)
AD, huntington
dopamine is increased in which disease(s)
schizophrenia, huntington
dopamine is decreased in which disease(s)
depression, parkinson
GABA is decreased in which disease(s)
anxiety, huntington
norepinephrine is decreased in which disease(s)
depression
norepinephrine is increased in which disease(s)
anxiety
serotonin is decreased in which disease(s)
anxiety, dperession, parkinson
name 3 ares with fenestrated capillaries instead of BBB
area postrema (vomiting after chemo), OVLT (osmotic sensing), neurohypophysis
which hypothalamic nucleus makes ADH
supraoptic
which hypothalamic nucleus makes oxytocin
paraventricular
function of lateral area of hypothesis
hunger. “makes you grow laterally”
function of ventromedial area of hypothalamus
satiety. “makes your ventre shrink medially”
function anterior hypothalamus
parasympathetic, cooling
function posterior hypothalamus
sympathetic, heating
circadian rhythm is controlled by which hypothalamic nucleus
suprachiasmatic nucleus
EEG awake, eyes open
beta (highest frequency, lowest amplitude)
EEG awake, eyes closed
alpha
EEG N1 (light sleep)
theta
EEG N2 (deeper sleep)
sleep spindles and K complexes
EEG N3 (deepest non-REM)
delta waves (lowest frequency, high amplitude)
EEG REM sleep
beta waves (like when awake. highest frequency, lowest amplitude)
in which part of sleep is there loss of motor tone
REM
in which part of sleep is there sleep walking, night terrors and bedwetting
N3
in which part of sleep does bruxism occur
N2
in which part of sleep do dreaming, nightmares, and penile/clitoral tumescence occur
REM
where does LGN project to
calcarine sulcus
what are the inputs into MGN
superior olive and inferior colliculus
what are the inputs to the ventral lateral nucleus of thalamus
input from basal ganglia and cerebellum
where does the ventral lateral nucleus of the thalamus project to
motor cortex
decreased activity in which dopaminergic pathway leads to negative symptoms
mesocortical
increased activity in which dopaminergic pathway leads to positive symptoms
mesolimbic
which dopamine pathway inhibits prolactin release
tuberoinfundibular
which dopamine pathway is involved in movement in basal ganglia
nigrostriatal
name deep cerebellar nuclei from lateral to medial
dentate, emboliform, globose, fastigial
“don’t eat greasy foods”
which parts of brain compose striatum
caudate + putamen
which parts of brain compose lentiform
putamin + globus pallidus
what is blephorospasm
a type of dystonia, sustained eyelid twitching
treatment of essential tremor
nonselective beta blockers (e.g. propranolol), primidone, patients self-medicate with alcohol
characteristic lesion causing hemiballismus
contralateral STN lesion
Kluver-Bucy Syndrome
disinhibited behavior due to bilateral damage of amygdala. associated with HSV-1 encephalitis
in which direction do eyes look in a paramedian pontine reticular formation damage
away from lesion
in which direction do eyes look in frontal eye field damage
toward the lesion
AICA comes off which artery
basilar
PICA comes off which artery
vertebral
unique symptoms of lateral pontine syndrome
caused by AICA. hearing loss, paralysis of face, decreased lacrimation, decreased salivation, and decreased taste from anterior 2/3 of tongue
unique symptoms of lateral medullary syndrome
dysphagia, hoarseness, decreased gag reflex. caused by PICA
basilar artery infarct causes
locked in syndrome
AICA infarct causes
lateral pontine syndrome
PICA infarct causes
lateral medullary (Wallenberg) syndrome
anterior spinal artery infarct causes
medial medullary syndrome
what CCB can be used to prevent vasospasm following subarachnoid hemorrhage
nimodipine
first nerve synapse for DCML from upper body
nucleus cuneatus
first nerve synapse for DCML from legs
nucleus gracilis
genetic defect associated with some cases of ALS
superoxide dismutase 1
region UMN signs in brown sequard
below lesion ipsilaterally
region of LMN signs in brown sequard
at level of lesion ipsilaterally
dermatome that includes kneecaps
L4
dermatomes for penile and anal zones
S2, S3, S4
dermatomes that are like a high turtle neck
C3
dermatome for posterior half of skull cap
C2
dermatome for inguinal ligament
L1
dermatome for low collar shirt
C4
dermatome that includes thumbs
C6
dermatome at umbilicus
T10
dermatome at xiphoid
T7
dermatome at nipple
T4
cremaster reflex
L1, L2
triceps reflex
C7, C8
achilles reflex
S1, S2
patellar reflex
L3, L4
biceps reflex
C5, C6
anal wink reflex
S3, S4
what is the Galant reflex
lateral flexion of lower body toward stimulated side when in ventral suspension
what is the Monro reflex
abduct/extend arms, then draw them in
which cranial nerves have medial nuclei
III, IV, VI, XII
Parinaud syndrome
paralysis of conjugate vertical gaze due to lesion in superior colliculi
function and composition of solitarius nucleus
visceral sensory, including taste
VII, IX, X
function and composition of nucleus ambiguus
motor of pharynx, larynx, and upper esophagus
IX, X, XI (cranial portion)
Ramsay Hunt Syndrome
herpes zoster causing facial nerve palsy
which nerves go through/in wall of cavernous sinus
III, IV, V1, VI (all from superior orbital fissure. only VI goes through blood)
low frequency heard at (apex/base)
apex, wide and flexible
high frequency heard at (apex/base)
base, thin and rigid
what is Rinne test
air vs. bone conduction
what is Weber test
tuning fork on skull, see where it localizes
result of Rinne test in conductive hearing loss
abnormal result. in affected ear, bone > air
result of Rinne test in sensorineural hearing loss
normal result. in affected ear, air > bone
result of Weber test in conductive hearing loss
localizes to affected ear
result of Weber test in sensorineural hearing loss
localizes to normal ear
what is cholesteatoma
keratin debris in middle ear space
can erode ossicles and cause conductive hearing loss
retinitis pigmentos
inherited retinal degeneration. begins with night-blidness. has bone spicule-shaped deposits
which nuclei receive the light in the pupillary light reflex
pretectal nuclei
1st neuron in sympathetic path to eye from hypothalamus synapses on
ciliospinal center of Budge (c8-t2)
which neuron of the sympathetic path from hypothalamus to eye would be impinged by pancost tumor
2nd neuron
Marcus Gunn pupil
optic nerve damage causes abnormal swinging flashlight test. dilates when you come back to it
in which direction does head tilt when CN IV is damaged
toward side of lesion
finding in CN III palsy
down and out and/or blown pupil
finding in CN IV palsy
affected eye moves upward, especially when adducted
finding in CN VI palsy
eye is stuck medially because it cannot abduct
right INO refers to which eye
the eye that is paralyzed
which allele is associated with decreased risk of alzheimer
apo E2
which allele is associated with increased risk of alzheimer
apo e4
familial forms of alzheimer disease
presenilin 1, 2, APP
protein aggregates in frontotemporal dementia
hyperphos tau or ubiquinated TDP-43
Charcot triad of MS
scanning speech, intention tremor, nystagmus
defect in Krabbe disease
AR disorder in galactocerebrosidase
sx Krabbe disease
peripheral neuropathy, developmental delay, optic atrophy, globoid cells
defect metachromatic leukodystrophy
AR defect in arylsulfatase A
sx metachromatic leukodystrophy
CNS and PNS demyelination, ataxia, dementia
PML is at an increased risk with which therapies
natalizumab and rituximab
adrenoleukodystrophy defect
x-linked defect in very-long-chain fatty acid metabolism
frequency of absence seizures
3 Hz
acute treatment of cluster headache
100% O2, sumatriptan
cluster headache prophylaxis
verapamil
migraine acute treatment
NSAIDs, triptans, dihydroergotamine
migraine prophylaxis
lifestyle changes, beta blockers, CCBs, amitriptyline, topirimate, valproic acid
position testing in peripheral vertigo
delayed horizontal nystagmus
position testing in central vertigo
immediate nystagmus in any direction
defect in Surge-Weber (encephalotrigeminal angiomatosis)
activating GNAQ mutation affecting capillaries
cardiac associations with tuberous sclerosis
mitral regurgitation and cardiac rhabdomyoma
Lisch nodules
pigmented iris hamartomas. seen in NF1
characteristics of VHL
hemangioblastomas, angiomatosis, bilateral RCC, pheochromocytoma
which brain tumor causes parinaud syndrome
pinealoma. childhood tumor
which brain tumor causes perivascular pseudorosettes
ependymoma. childhood tumor
which brain tumor has pseudopalisading histology
glioblastoma. adult tumor
which brain tumor has psammoma bodies
meningioma. adult tumor
which brain tumor can cause EPO production
hemangioblastoma. adult tumor, MC in cerebellum
which brain tumor has chicken wire capillary pattern around the neoplastic cells
oligodendroglioma. adult tumor
which brain tumor has rosenthal fibers
pilocytic astrocytoma. childhood tumor
which brain tumor has primitive neuroectodermal histology
medulloblatoma. childhood tumor
which tumor has rod-shaped belpharoplasts (basal ciliary bodies) found near nucleus
ependymoma. childhood tumor
which brain tumor sends drop metastases to spinal cord
medulloblastoma. childhood tumor
which brain tumor has Homer-Wright rosettes
medulloblastoma. childhood tumor
which brain tumor has “motor oil-like” fluid in it
craniopharyngioma. childhood tumor
what is the best cholinomimetic to use in glaucoma emergencies
pilocarpine
class of drugs: dextromethorphan, diphenoxylate, pentazocine
opioids
which opioid receptor is for beta-endorphin
mu
which opioid receptor is for dynorphin
kappa
which opiod receptor is for encephalin
delta
which opioid is used in cough suppression
dextromethorphan, codeine
which opioid is used for diarrhea
loperamide, diphenoxylate
which opioid dilates the eye, unlike all the others
meperidine
which opioid is a kappa agonist, mu antagonist
pentazocine. used for moderate to severe pain
which opioid is a kappa agonist, mu partial agonist
butorphanol. used for severe pain
which drug is a weak opioid agonist that also inhibits 5HT
tramadol. used for chronic pain, but decreases seizure threshold
first line drug for partial seizures
carbamazepine
first line drug for tonic-clonic seizures
valproic acid or phenytoin
first line drug for absence seizures
ethosuximide. its the only seizure ethosuximide treats
first line drug for acute status epilepticus
benzodiazepines
first line drug for status epilepticus prophylaxis
phenytoin
seizure use ethosuximide
absence only
seizure use benzos
acute status epilepticus only
seizure use phenobarbital
general (partial + tonic-clonic)
seizure use phenytoin
general (1st line for tonic-clonic) + status epilepticus prophylaxis
seizure use carbamazepine
general (first line for partial)
seizure use valproic acid
broad spectrum (partial, tonic-clonic, absence). first line for tonic-clonic
seizure use vigabatrin
partial only
seizure use gabapentin
partial only
seizure use topiramate
general (partial + tonic-clonic)
seizure use lamotrigine
broad spectrum (partial, tonic-clonic, absence)
seizure use levetiracetam
general (partial + tonic-clonic)
seizure use tiagabine
partial only
which epliepsy drugs cause stevens johnsons?
ethosuximide, phenytoin, carbamazepine, lamotrigine
MOA ethosuximide
blocks thalamic T type calcium channels
MOA benzos
increase GABA-A action
MOA phenobarbital
increase GABA-A action
MOA phenytoin
blocks Na channels
MOA carbamazepine
blocks Na channels
MOA valproic acid
increases Na channel inactivation, increases GABA concentration
MOA vigabitran
increases GABA concentration
MOA gabapentin
inhibits high-voltage-activated Ca channels, GABA analog
MOA topiramate
blocks Na channels, increases GABA action
MOA lamotrigine
blocks voltage-gated Na channels
MOA levetiracetam
unknown
MOA tiagabine
inhibits GABA reuptake
which barbiturate is used for induction of amnesia
thiopental
short-acting benzos
alprazolam, triazolam, oxazepam, midazolam. (“ATOM”, more addicting)
which inhaled anesthetic is hepatotoxic
halothane
which inhaled anesthetic is nephrotoxic
methoxyflurane
which inhaled anesthetic is proconvulsant
enflurane
MOA ketamine
blocks NMDA receptors
order of sensations lost with local anesthetic
pain, temperature, touch, then pressure
which local anesthetic can cause CV toxicity
bupivicaine
which local anesthetic can cause methemoglobin
benzocaine
class of drugs: tubucurarine, pancuronium, atracurium
nondepolarizing NMJ blockers
GABA-B activator in spinal cord used to relax smooth muscle
baclofen
centrally acting muscle relaxant
cyclobenzaprine
MOA amantadine for parkinson
increases dopamine release and decreases uptake
livedo reticularis is an AE from which parkinson drug
amantadine
carbidopa MOA
inhibits peripheral DOPA carboxylase to prevent L-DOPA –> dopamine
entacapone, tolcapone MOA peripherally
inhibits COMT to prevent peripheral conversion of L-DOPA to 3-OMD
selegiline, rasagiline MOA
inhibit MAO-B centrally to block conversion of dopamine to DOPAC
central MOA for tolcapone
inhibits COMT centrally to prevent conversion of dopamine to 3-MT
memantine MOA
NMDA receptor antagonist used in Alzheimer
AChE inhibitors used in Alzheimer
donepezil, galantamine, rivastigmine, tacrine
tetrabenazine and reserpine MOA
inhibit VMAT to decrease dopamine packaging, used in Huntington
MOA riluzole
decreases glutamate excitotoxicity to modestly improve ALS survival
MOA triptans
5HT-1B/1D agonists that inhibit trigeminal nerve activation, prevent vasoactive peptide release, and induce vasoconstriction