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UWorld Facts > Neurology Facts > Flashcards

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)

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2
Q

Prochlorperazine - class, use

A

Antipsychotic drug

  • dopamine blocker at CTZ (chemoreceptor trigger zone)
  • used as ANTI-EMETIC
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3
Q

Treatment of PCP intoxication

A
  • Benzodiazepines

- Haloperidol for severe symptoms

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4
Q

ONLY output cells in cerebellum

A

Purkinje cells - GABAergic (all outputs of cerebellum are inhibitory)

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5
Q

Treatment of ABSENCE seizures

A

Ethosuximide - blocks T-type calcium channels

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6
Q

Neurotransmitter decreased in Narcolepsy

A

OREXIN A and B

  • made in lateral hypothalamus
  • promote wakefulness
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7
Q

Drug used to treat neuroleptic malignant syndrome (side effect of antipsychotics)

A

Dantrolene - blocks excitation-contraction coupling - relaxes muscles

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8
Q

Huntington - trinucleotide repeat

A

CAG on chrm 4

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9
Q

Friedrich ataxia - trinucleotide repeat

A

GAA on chrm 9

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10
Q

Cerebellum receives input from ipsilateral or contralateral side of body?

A

Ipsilateral

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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)

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12
Q

Treatment of narcolepsy

A
  • daytime stimulants: amphetamines, modafinil (amphetamine derivative)
  • night time: sodium oxybate
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13
Q

Which nerve is blocked during labor for pain control?P

A

Pudendal nerve

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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)
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15
Q

Symptoms of Horner’s syndrome

A
  • ptosis (drooping eyelid)
  • anhydrosis (lack of sweating)
  • miosis (pupil constriction)
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16
Q

Neuroleptic malignant syndrome

A

Side effect of atypical antipsychotic drugs

  • muscle rigidity
  • autonomic instability
  • high fever (hyperpyrexia)
  • myoglobinuria (myoglobin in urine)
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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
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18
Q

Which enzyme is deficient in metachromic leukodystrophy?

A

Arylsulfatase A - get accumulation of cerebroside sulfate (stains brown with toluidine blue)

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19
Q

Gabapentin - MOA

A

inhibits presynaptic voltage gated calcium channels

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20
Q

Levetiracetam - MOA

A

inhibits vesicle fusion

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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
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22
Q

Anterior Pituitary is derived from?

A

Surface ectoderm

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23
Q

Posterior Pituitary is derived from?

A

Neural Tube

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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
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25
Q

Why avoid amitriptyline in elderly?

A

ANTI-CHOLINERGIC EFFECTS

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26
Q

Tetanus inhibits release of which NTs?

A

GABA and glycine - SPASTIC PARALYSIS

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27
Q

Botulinum toxin inhibits release of which NT?

A

ACh (prevents fusion of SNARES and release of vesicle) - FLACID PARALYSIS

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28
Q

Postcentral gyrus

A

SENSORY

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29
Q

Precentral gyrus

A

MOTOR

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30
Q

Benzodiazepines - MOA

A
  • 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
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31
Q

Side effect of phenytoin

A

GINGIVAL HYPERPLASIA

- phenytoin increases PDGF which stimulates proliferation of gingival cells and alveolar bone

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32
Q

Anterior cerebral artery supplies:

A

The medial portions of 2 hemispheres - FRONTAL AND PARIETAL LOBES

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33
Q

Occlusion of the anterior cerebral artery results in:

A
  • contralateral motor and sensory deficits in the LOWER EXTREMITIES
  • behavior changes
  • urinary incontinence
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34
Q

Interscalene nerve block

A
  • 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
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35
Q

Posterior Cerebral Artery supplies:

A

OCCIPITAL LOBE

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36
Q

Occlusion of the posterior cerebral artery results in:

A

contralateral homonymous hemianopia with MACULAR SPARING

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37
Q

Occlusion of middle cerebral artery results in:

A

Contralateral motor and sensory deficits in UPPER EXTREMITIES

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38
Q

Neurofibromatosis 1 - genetics

A
  • AD

- mutation in NF1 gene located on chrm 17

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39
Q

Flow of CSF

A

lateral ventricles —> interventricular foramen of Monro —> the third ventricle —> cerebral aqueduct —> fourth ventricle —> subarachnoid space (absorbed through arachnoid granulations) —> venous sinuses

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40
Q

Non-communicating hydrocephalus

A

CSF flow to subarachnoid space is disrupted

- ventricles above the obstruction are enlarged, ventricles below obstruction are normal

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41
Q

Communicating hydrocephalus

A

No obstruction, occurs secondary to destruction or obliteration of subarachnoid space

  • SYMMETRICALLY enlarged ventricles
  • caused by meningitis or subarachnoid/intraventricular hemorrhage
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42
Q

NF1 clinical presentation

A
  • Cafe-au-lait spots
  • cutaneous neurofibromas (Schwann cells - derived from neural crest cells)
  • OPTIC gliomas, other central nervous system neoplasms
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43
Q

Obturator nerve

A
  • L2-L4
  • exits pelvis through OBTURATOR FORAMEN (only one)
  • Adducts thigh
  • sensation over distal medial thigh
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44
Q

Organophosphate - class, MOA

A

IRREVERSIBLE cholinesterase inhibitor found in pesticides (treat toxicity with pesticides)

45
Q

Polymyalgia rheumatica

A
  • neck, torso, shoulder, pelvic girdle pain and morning stiffness
  • commonly seen in TEMPORAL ARTERITIS
46
Q

Cavernous hemangiomas

A
  • vascular malformations that occur mostly in the brain parenchyma
  • carry increased risk for SEIZURES and INTRACEREBRAL HEMORRHAGES
47
Q

Glosspharyngeal nerve (IX) lesion

A
  • 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
Q

Thiopental - class

A
  • 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
Q

Conversion disorder

A

NEUROLOGIC symptoms incompatible with any neurologic disease, often acute onset associated with STRESS

50
Q

Early onset Alzheimer’s - genes

A
  • APP
  • presenilin 1
  • presenilin 2
    all three promote formation of beta-amyloid
51
Q

Late onset Alzheimer’s - gene

A

ApoE4

52
Q

Target organs of beta-2

A
  • lungs
  • uterus
  • peripheral vasculature (vasodilation)
53
Q

Target organs of alpha-1

A
  • eyes
  • peripheral vasculature
  • bladder
54
Q

Carbamaxepine - MOA, use

A
  • 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
Q

Carbamaxepine - side effects

A
  • BONE MARROW SUPPRESSION
  • hepatotoxic, induces CYP450
  • SIADH —> increases ADH secretion
56
Q

Methylmalonic Acidemia

A
  • 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
Q

Watershed infarcts - description

A
  • 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
Q

Spinal muscular dystrophy

A
  • 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
Q

Schwannoma

A
  • 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
Q

Triptans - MOA, use

A
  • Serotonin receptor agonists

- ABORTIVE therapy for migraines

61
Q

Tay-Sachs - enzyme deficiency

A

Hexoamidase A deficiency —> accumulates GM2 ganglioside

62
Q

Subthalamic nucleus lesion

A
  • HEMIBALLISMUS on contralateral side
  • causes more inhibition (less excitation) of GPi —> release inhibition on thalamus —> MORE MOVEMENT
  • common in setting of LACUNAR STOKE
63
Q

Ulnar nerve injury

A
  • 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
Q

Orbital floor fractures

A
  • 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
Q

Myotonic Dystrophy

A
  • 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
Q

Musculocutaneous nerve - innervation

A
  • 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
Q

CNS tumors of neuronal origin stain for:

A

Synaptophysin: transmembrane glycoprotein located in presynaptic vesicles of neurons

68
Q

CNS tumors of glial origin stain for:

A

GFAP

69
Q

Blacofen

A

GABA-B receptor agonist

- effective as mono therapy for treatment of SPASTICITY in both brain and spinal cord lesions including MS

70
Q

Diabetic Neuropathy

A
  • 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
Q

High frequency deep brain stimulation for Parkinson’s targets which structures?

A

GPi

Subthalamic nucleus

72
Q

Intraventricular hemorrhage

A
  • common complication of prematurity: babies
73
Q

Ornithine transcarbamylase deficiency (OTC)

A
  • most common disorder of the UREA CYCLE
  • deficiency in ornithine transcarbamylase
  • get HYPERAMMONEMIA and increased OROTIC ACID in urine
74
Q

What precipitates Wernicke encephalopathy?

A

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
Q

Cocaine - action

A

Inhibits the presynaptic reuptake of NE, DOPAMINE and SEROTONIN

76
Q

Pramipexole - class, MOA

A

DOPAMINE AGONIST - stimulates dopamine receptors

Used for Parkinson’s, can delay the start of levadopa

77
Q

Risperidone - class, MOA, side effects

A

Atypical antipsychotic

  • inhibits D1 and D2 receptors
  • can cause increased prolactin —> amenorrhea and breast tenderness
78
Q

Valproic acid (valproate) - toxicity

A
  • Neural tube defects: prevents maternal absorption of folate —> contraindicated in pregnancy
  • rare but fatal hepatotoxicity
  • weight gain
  • tremor
  • GI
79
Q

Naltrexone - MOA, use

A
  • mu-opioid receptor blocker

- treats moderate to severe alcohol disorder: prevents CRAVINGS for alcohol

80
Q

Antabuse (Disulfiram) - MOA, use

A
  • inhibits aldehyde dehydrogenase

- causes adverse effects when ingest alcohol

81
Q

Acamprosate

A
  • modulates GABA transmission

- recommended for alcohol disorder once abstinence has been achieved

82
Q

Bupropion

A
  • 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
Q

Treatment of ALS

A

Riluzole: decreases glutamate release

84
Q

Essential tremor

A
  • tremor with sustained posture (i.e. holding an object)
  • AD
  • gets better with ALCOHOL
  • treat with beta-blockers, primidone
85
Q

PKU - enzyme deficiency

A
  • phenylalanine dehydrogenase

- can also occur with BH4 deficiency which is a cofactor needed for the enzyme

86
Q

Phenelzine - class, use

A
  • 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
Q

Causes of lithium toxicity

A
  • 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
Q

Which antibiotic has MAOI activity and can precipitate serotonin syndrome?

A

Linezolid: inhibits 50S

89
Q

Effects of cocaine on neurotransmission

A

Inhibits presynaptic reuptake of NE, serotonin and dopamine

90
Q

First line treatment of essential tremor

A

nonselective beta antagonist: PROPRANOLOL

91
Q

Entacapone and tolcapone - MOA, use

A
  • 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
Q

Serotonin syndrome - symptoms

A

confusion, agitation, tremor, tachycardia, hypertension, CLONUS, HYPERREFLEXIA, HYPERTHERMIA, diaphoresis

93
Q

Treatment of serotonin syndrome

A

cyproheptadine - anti-histamine with anti-serotonergic effects

94
Q

Treatment of choice for trigeminal neuralgia

A

Carbamazepine

95
Q

Role of N-acetylglutamate

A

Allosteric activator of carbamoyl phosphate synthetase I

  • part of urea cycle
  • NAG made ny NAG synthase
96
Q

Decerebrate posturing

A
  • lesion below red nucleus: midbrain tegmentum or pons

- EXTENSOR posturing

97
Q

Decorticate posturing

A
  • lesion above the red nucleus: cerebral hemispheres

- FLEXOR posturing

98
Q

Side effects of Lithium

A
  • Nephrogenic diabetes insipidus

- HYPOthyroidism

99
Q

Which neurological deficiency is most likely to persist despite thiamine treatment?

A

Memory loss —> Korsakoff syndrome is usually permanent

Wernike syndrome improves

100
Q

Cause of lacunar infarcts

A

Hypertensive arteriosclerosis of small penetrating arterioles

101
Q

Neurotransmitter changes seen in Huntington

A
  • decreased GABA and ACh

- increased dopamine

102
Q

Congenital Torticollis

A
  • 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
Q

Structures in the infundibulopelvic ligament (suspensory ligament of the ovary)

A

Ovarian vessels: artery, vein, lymphatics and nerve

104
Q

Structures in cardinal ligament

A

Uterine vessels

105
Q

The Left ovarian vein drains into . . . and the Right ovarian vein drains into . . .

A

Left: Left RENAL vein
Right: Inferior vena cava

106
Q

Infertility due to absent vas deferens (zoospermia) is indicative of which disease?

A

Cystic Fibrosis

107
Q

Gonadal arteries arise from which artery?

A

Abdominal aorta

108
Q

Treatment of PCOS

A
  • 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

UWorld Facts (12 decks)

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