Neurology Facts Flashcards
1
Q
Which area of the brain controls vomiting?
A
Medulla - contains the chemoreceptor trigger zone (located outside of the BBB so can sense toxins in circulation)
2
Q
Prochlorperazine - class, use
A
Antipsychotic drug
- dopamine blocker at CTZ (chemoreceptor trigger zone)
- used as ANTI-EMETIC
3
Q
Treatment of PCP intoxication
A
- Benzodiazepines
- Haloperidol for severe symptoms
4
Q
ONLY output cells in cerebellum
A
Purkinje cells - GABAergic (all outputs of cerebellum are inhibitory)
5
Q
Treatment of ABSENCE seizures
A
Ethosuximide - blocks T-type calcium channels
6
Q
Neurotransmitter decreased in Narcolepsy
A
OREXIN A and B
- made in lateral hypothalamus
- promote wakefulness
7
Q
Drug used to treat neuroleptic malignant syndrome (side effect of antipsychotics)
A
Dantrolene - blocks excitation-contraction coupling - relaxes muscles
8
Q
Huntington - trinucleotide repeat
A
CAG on chrm 4
9
Q
Friedrich ataxia - trinucleotide repeat
A
GAA on chrm 9
10
Q
Cerebellum receives input from ipsilateral or contralateral side of body?
A
Ipsilateral
11
Q
What is the direct effect of activation of the subthalamic nucleus in a healthy brain?
A
Excitation of the internal segment of globus pallidus (part of the indirect motor pathway of basal ganglia)
12
Q
Treatment of narcolepsy
A
- daytime stimulants: amphetamines, modafinil (amphetamine derivative)
- night time: sodium oxybate
13
Q
Which nerve is blocked during labor for pain control?P
A
Pudendal nerve
14
Q
Lesion in neocerebellum (lateral part of cerebellum - responsible for fine movements of face and hands)
A
- dysdiadochokinesia (impairment of rapidly alternating hand movements)
- intension tremor (tremor when point to something)
15
Q
Symptoms of Horner’s syndrome
A
- ptosis (drooping eyelid)
- anhydrosis (lack of sweating)
- miosis (pupil constriction)
16
Q
Neuroleptic malignant syndrome
A
Side effect of atypical antipsychotic drugs
- muscle rigidity
- autonomic instability
- high fever (hyperpyrexia)
- myoglobinuria (myoglobin in urine)
17
Q
Which tracts are primarily affected by central pontine myelinolysis?
A
- corticospinal tract - MOTOR of torso and extremities
- corticobulbar tract - MOTOR of face, head and neck
- “LOCKED IN” syndrome
18
Q
Which enzyme is deficient in metachromic leukodystrophy?
A
Arylsulfatase A - get accumulation of cerebroside sulfate (stains brown with toluidine blue)
19
Q
Gabapentin - MOA
A
inhibits presynaptic voltage gated calcium channels
20
Q
Levetiracetam - MOA
A
inhibits vesicle fusion
21
Q
Fragile X syndrome - trinucleotide repeat
A
CGG on X chrm
- expansion is in fragile X mental retardation 1 gene (FMR1)
- see small gap at tip of long arm in X chrm
- > 200 CGG repeats —> HYPERMETHYLATION —> inactivates FMR1 gene
22
Q
Anterior Pituitary is derived from?
A
Surface ectoderm
23
Q
Posterior Pituitary is derived from?
A
Neural Tube
24
Q
Femoral nerve block
A
- location: inguinal crease
- anesthetizes skin and muscles of ANTERIOR THIGH (quadricep muscles), FEMUR AND KNEE
- also anesthetizes SAPHENOUS NERVE (terminal extension of femoral nerve) —> decreases sensation of medial leg below the knee
25
Why avoid amitriptyline in elderly?
ANTI-CHOLINERGIC EFFECTS
26
Tetanus inhibits release of which NTs?
GABA and glycine - SPASTIC PARALYSIS
27
Botulinum toxin inhibits release of which NT?
ACh (prevents fusion of SNARES and release of vesicle) - FLACID PARALYSIS
28
Postcentral gyrus
SENSORY
29
Precentral gyrus
MOTOR
30
Benzodiazepines - MOA
- bind and modulate GABA receptor chloride channel in CNS neurons increasing its FREQUENCY OF OPENING —> increase Cl permeability hyper polarizes and stabilizes the membrane making it less excitable
- anxiolytic, anticonvulsant and muscle relaxant actions, AND sedative-hypnotic effects
31
Side effect of phenytoin
GINGIVAL HYPERPLASIA
| - phenytoin increases PDGF which stimulates proliferation of gingival cells and alveolar bone
32
Anterior cerebral artery supplies:
The medial portions of 2 hemispheres - FRONTAL AND PARIETAL LOBES
33
Occlusion of the anterior cerebral artery results in:
- contralateral motor and sensory deficits in the LOWER EXTREMITIES
- behavior changes
- urinary incontinence
34
Interscalene nerve block
- Anesthetizes the BRACHIAL PLEXUS (C5-T1) - provides anesthesia to the shoulder and upper arm
- also anesthetizes the roots of the phrenic nerve (C3-5) as they cross through the interscalene sheath —> get IPSILATERAL DIAPHRAGMATIC PARALYSIS
35
Posterior Cerebral Artery supplies:
OCCIPITAL LOBE
36
Occlusion of the posterior cerebral artery results in:
contralateral homonymous hemianopia with MACULAR SPARING
37
Occlusion of middle cerebral artery results in:
Contralateral motor and sensory deficits in UPPER EXTREMITIES
38
Neurofibromatosis 1 - genetics
- AD
| - mutation in NF1 gene located on chrm 17
39
Flow of CSF
lateral ventricles —> interventricular foramen of Monro —> the third ventricle —> cerebral aqueduct —> fourth ventricle —> subarachnoid space (absorbed through arachnoid granulations) —> venous sinuses
40
Non-communicating hydrocephalus
CSF flow to subarachnoid space is disrupted
| - ventricles above the obstruction are enlarged, ventricles below obstruction are normal
41
Communicating hydrocephalus
No obstruction, occurs secondary to destruction or obliteration of subarachnoid space
- SYMMETRICALLY enlarged ventricles
- caused by meningitis or subarachnoid/intraventricular hemorrhage
42
NF1 clinical presentation
- Cafe-au-lait spots
- cutaneous neurofibromas (Schwann cells - derived from neural crest cells)
- OPTIC gliomas, other central nervous system neoplasms
43
Obturator nerve
- L2-L4
- exits pelvis through OBTURATOR FORAMEN (only one)
- Adducts thigh
- sensation over distal medial thigh
44
Organophosphate - class, MOA
IRREVERSIBLE cholinesterase inhibitor found in pesticides (treat toxicity with pesticides)
45
Polymyalgia rheumatica
- neck, torso, shoulder, pelvic girdle pain and morning stiffness
- commonly seen in TEMPORAL ARTERITIS
46
Cavernous hemangiomas
- vascular malformations that occur mostly in the brain parenchyma
- carry increased risk for SEIZURES and INTRACEREBRAL HEMORRHAGES
47
Glosspharyngeal nerve (IX) lesion
- loss of gag reflex
- loss of sensation to upper pharynx, posterior tongue, tonsils and middle ear cavity
- loss of taste to posterior 1/3 of tongue
48
Thiopental - class
- short acting barbiturate - increases GABA inhibition
- used for induction of anesthesia
- goes from blood, equilibrates in brain tissue causing loss of consciousness, then REDISTRIBUTES IN SKELETAL MUSCLE —> rapid brain clearance allows for recovery from anesthesia
49
Conversion disorder
NEUROLOGIC symptoms incompatible with any neurologic disease, often acute onset associated with STRESS
50
Early onset Alzheimer's - genes
- APP
- presenilin 1
- presenilin 2
all three promote formation of beta-amyloid
51
Late onset Alzheimer's - gene
ApoE4
52
Target organs of beta-2
- lungs
- uterus
- peripheral vasculature (vasodilation)
53
Target organs of alpha-1
- eyes
- peripheral vasculature
- bladder
54
Carbamaxepine - MOA, use
- MOA: Blocks voltage-gated Na channels in CORTICAL NEURONS
- use: simple partial, simple complex and tonic-clonic seizures - EPILEPSY DRUG, bipolar disorder and trigeminal neuralgia
55
Carbamaxepine - side effects
- BONE MARROW SUPPRESSION
- hepatotoxic, induces CYP450
- SIADH —> increases ADH secretion
56
Methylmalonic Acidemia
- deficiency in methylmalonyl -CoA mutase (converts propionyl CoA to methylmalonyl CoA)
- labs: hyperammonemia (part of urea cycle), hypoglycemia, ketosis (increased ketones because decreased glucose) and metabolic acidosis
- diagnosis: increased urine methylmalonic acid and proprionic acid
- clinical presentation: lethargy, vomitting, tachypnea in newborn
57
Watershed infarcts - description
- Watershed areas: distal parts of the cerebral vessels (very edge of where the arteries supply where they meet with another artery)
- BILATERAL, WEDGE-shaped, strips of necrosis over cerebral convexity, parallel and adjacent to longitudinal cerebral fissure
58
Spinal muscular dystrophy
- mutation in SURVIVAL MOTOR NEURON gene (SMN1): encodes protein involved in assembly of small nuclear ribonuclear proteins (snRNPs) that are part of the spliceosome
- get degeneration of ANTERIOR HORN cells - LMN lesion: flaccid paralysis, hypotonia, fascinations —> FLOPPY BABY
59
Schwannoma
- Schwann cell origin
- most often occur at cerebellopontine angle at CNVIII —> ACOUSTIC neuromas
- biphasic pattern of cellularity: Atoni A (high cellularity) and Atoni B (low cellularity)
- S100 Positive
60
Triptans - MOA, use
- Serotonin receptor agonists
| - ABORTIVE therapy for migraines
61
Tay-Sachs - enzyme deficiency
Hexoamidase A deficiency —> accumulates GM2 ganglioside
62
Subthalamic nucleus lesion
- HEMIBALLISMUS on contralateral side
- causes more inhibition (less excitation) of GPi —> release inhibition on thalamus —> MORE MOVEMENT
- common in setting of LACUNAR STOKE
63
Ulnar nerve injury
- loss of sensation to medial 1.5 digits and HYPOthenar eminence
- impaired wrist flexion/adduction, finger abduction/adduction and flexion of digits 4 and 5
- most common in "funny bone" injury - medial epicondyl
64
Orbital floor fractures
- results from direct trauma to orbit ( sports injuries, car accidents, assault)
- can damage INFRAORBITAL NERVE (runs along orbital surface of maxilla) - lose sensation of UPPER CHEEK, UPPER LIP, UPPER GINGIVA
- entrapped INFERIOR RECTUS - limits superior gaze
65
Myotonic Dystrophy
- mutation: increased number of trinucleotide repeats CTG on myotonia protein kinase gene
- inheritance: AD
- clinical presentation:
MYOTONIA - difficulty relaxing muscle (after handshake or releasing doorknob)
Muscle weakness
Cataracts
Frontal balding and gonadal atrophy
- biopsy: atrophy of TYPE 1 muscle fibers more affected
66
Musculocutaneous nerve - innervation
- C5-C7
- forearm flexors: biceps brachii, brachialis
- corachobrachialis (flexes and adducts the arm)
- becomes lateral cutaneous nerve of forearm: provides sensation to LATERAL FOREARM
- injured in trauma or strenuous upper extremity exercise
67
CNS tumors of neuronal origin stain for:
Synaptophysin: transmembrane glycoprotein located in presynaptic vesicles of neurons
68
CNS tumors of glial origin stain for:
GFAP
69
Blacofen
GABA-B receptor agonist
| - effective as mono therapy for treatment of SPASTICITY in both brain and spinal cord lesions including MS
70
Diabetic Neuropathy
- most commonly involves CNIII: central damage so get "down and out eye," pitosis, but reaction to light intact
- is caused by ISCHEMIA to nerve
71
High frequency deep brain stimulation for Parkinson's targets which structures?
GPi
| Subthalamic nucleus
72
Intraventricular hemorrhage
- common complication of prematurity: babies
73
Ornithine transcarbamylase deficiency (OTC)
- most common disorder of the UREA CYCLE
- deficiency in ornithine transcarbamylase
- get HYPERAMMONEMIA and increased OROTIC ACID in urine
74
What precipitates Wernicke encephalopathy?
GLUCOSE INFUSION:
- thiamine (B1) is a cofactor needed for glucose metabolism so giving glucose will deplete thiamine even more
- need to give glucose with thiamine
75
Cocaine - action
Inhibits the presynaptic reuptake of NE, DOPAMINE and SEROTONIN
76
Pramipexole - class, MOA
DOPAMINE AGONIST - stimulates dopamine receptors
| Used for Parkinson's, can delay the start of levadopa
77
Risperidone - class, MOA, side effects
Atypical antipsychotic
- inhibits D1 and D2 receptors
- can cause increased prolactin —> amenorrhea and breast tenderness
78
Valproic acid (valproate) - toxicity
- Neural tube defects: prevents maternal absorption of folate —> contraindicated in pregnancy
- rare but fatal hepatotoxicity
- weight gain
- tremor
- GI
79
Naltrexone - MOA, use
- mu-opioid receptor blocker
| - treats moderate to severe alcohol disorder: prevents CRAVINGS for alcohol
80
Antabuse (Disulfiram) - MOA, use
- inhibits aldehyde dehydrogenase
| - causes adverse effects when ingest alcohol
81
Acamprosate
- modulates GABA transmission
| - recommended for alcohol disorder once abstinence has been achieved
82
Bupropion
- class: atypical antidepressant
- MOA: NE and Dopamine reuptake inhibitor
- use: major depressive disorder
- side effects: seizures in ANOREXIA/BULIMIA patients but less weight gain and NO SEXUAL DYSFUNCTION
83
Treatment of ALS
Riluzole: decreases glutamate release
84
Essential tremor
- tremor with sustained posture (i.e. holding an object)
- AD
- gets better with ALCOHOL
- treat with beta-blockers, primidone
85
PKU - enzyme deficiency
- phenylalanine dehydrogenase
| - can also occur with BH4 deficiency which is a cofactor needed for the enzyme
86
Phenelzine - class, use
- MAO inhibitor
- atypical depression, anxiety
- note: have to wait two weeks after continuing this drug before can use SSRI to prevent serotonin syndrome (too much serotonin)
87
Causes of lithium toxicity
- overdose
- volume depletion: decrease GFR —> absorb more in the proximal tubule along with sodium to maintain volume
- drug interactions: hydrochlorothiazide, NSAIDS (not aspirin) and ACE inhibitors
88
Which antibiotic has MAOI activity and can precipitate serotonin syndrome?
Linezolid: inhibits 50S
89
Effects of cocaine on neurotransmission
Inhibits presynaptic reuptake of NE, serotonin and dopamine
90
First line treatment of essential tremor
nonselective beta antagonist: PROPRANOLOL
91
Entacapone and tolcapone - MOA, use
- COMT inhibitors: prevent peripheral breakdown of dopamine by inhibiting peripheral methylation
- increases availability of dopamine to brain
- entacapone: associated with hepatotoxicity but not tolcapone
- talcapone: inhibits peripheral and central methylation
92
Serotonin syndrome - symptoms
confusion, agitation, tremor, tachycardia, hypertension, CLONUS, HYPERREFLEXIA, HYPERTHERMIA, diaphoresis
93
Treatment of serotonin syndrome
cyproheptadine - anti-histamine with anti-serotonergic effects
94
Treatment of choice for trigeminal neuralgia
Carbamazepine
95
Role of N-acetylglutamate
Allosteric activator of carbamoyl phosphate synthetase I
- part of urea cycle
- NAG made ny NAG synthase
96
Decerebrate posturing
- lesion below red nucleus: midbrain tegmentum or pons
| - EXTENSOR posturing
97
Decorticate posturing
- lesion above the red nucleus: cerebral hemispheres
| - FLEXOR posturing
98
Side effects of Lithium
- Nephrogenic diabetes insipidus
| - HYPOthyroidism
99
Which neurological deficiency is most likely to persist despite thiamine treatment?
Memory loss —> Korsakoff syndrome is usually permanent
| Wernike syndrome improves
100
Cause of lacunar infarcts
Hypertensive arteriosclerosis of small penetrating arterioles
101
Neurotransmitter changes seen in Huntington
- decreased GABA and ACh
| - increased dopamine
102
Congenital Torticollis
- sternocleidomastoid fibrosis and injury —> child prefers to hold head towards affected muscle
- develops by 2 to 4 weeks after birth
- due to MALPOSITIONING of head in utero or birth trauma
103
Structures in the infundibulopelvic ligament (suspensory ligament of the ovary)
Ovarian vessels: artery, vein, lymphatics and nerve
104
Structures in cardinal ligament
Uterine vessels
105
The Left ovarian vein drains into . . . and the Right ovarian vein drains into . . .
Left: Left RENAL vein
Right: Inferior vena cava
106
Infertility due to absent vas deferens (zoospermia) is indicative of which disease?
Cystic Fibrosis
107
Gonadal arteries arise from which artery?
Abdominal aorta
108
Treatment of PCOS
- if want to be pregnant: weight loss, clomiphene (FERTILITY DRUG: estrogen receptor modulator that decreases negative feedback inhibition on the hypothalamus —> increase gonadotropin production)
- if do not want to be pregnant: OCP minimize endometrial proliferation, decrease androgenic effects and prevent unwanted pregnancy
