Neurology U WORLD Questions Flashcards
Incidence =
Prevalence =
New case/total-people w/ disease
Diseased/total
Drug for Partial and Grand Mal seizures, SJS or TEN risk, GI symptoms common
Lamotrigine, Na+ channels
Visual pathways
First Aid Page 486
Recurrent lapses into sleep strong emotion brief tone loss decress CSF hypocretin 1 Short Rem
Narcolepsy
White pupillary reflex in young =
Inc risk of?
Gene?
Retinoblastoma
Osteosarcoma
RB
retarded, asocial, macroorchidism, long face =?
Gene?
Fragile X
FMR1, CGG repeat, X linked, hypermethlyated
Early Alz
AV septal Defect
HIrshsprung
duodenal atresia
T1DM
Hypothyroid
Leukemia
Down Syndrome
Chrom 21 x3, APP gene multipled (NOT ApoE gene = late Alz)
Neisseria Meningitis recurrent attacks, why? (2)
MAC dysfxn
OR
too much IgA (disseminated infxn
GABA-A MOA
hyperpolarize: Cl- in
Left face, right body loss of pain, temp, ipsilateral ataxia
Wallenberg (Lateral Medullary Syndrome)
CN5 nucleus, Spinothalamic Tract, inferior peduncle
PICA fed by Vertebral (lateral formina of Cervical spine)
Farmer, inc ACh symptoms (SLUDGE)
organophosphate poisoning (covalent bonded)
treat w/ atropine, pralidoxime
Alcoholic presents with confusion, vision loss, unsteady gait
Wernicke-Korsakoff: mamillary body affected
Dec thiamine = dec erythroctye transketolase
give thiamine WITH glucose
Wernicke = reversible
Wernicke Korsakoff = irreversible
Diplopia, no adduction of eye, no corneal reflex =? (nerves)
exit they travel through?
CN3, CN6, CN5, superior ophthalmic vein
Superior orbital fissure
Most important aspect in diagnosing Tetanus
H&P
no ABs, cultures, or toxin tests
G+ intracellular motile rod
narrow hemolysis, tumbling
high and low temp multiply
virulence factor
Agar
immunity
most at risk?
Listeria monocytogenes
listeriolysin O
Blood
Cell mediated
neonates and Hodgkins lymphoma
Stiff neck, fever, altered mentation =
treat?
Bacterial meningitis
empiric Abx, LP, CSF analysis
Neisseria CNS pathway
Staph Aureus
Strep Pneumo
H Infl
MC adults: pharynx, blood, choroid, meninges
Wound
Ear
Lymph
Adrenergics
Alpha 1
Beta 1
Beta 2
dilate eye, contract PBS, contract bladder (Ep, NE, phenylephrine, methoxamine)
Inc heart rate (Ep, DA, dobutamine, isopretenol)
dilate PBS, dilate bronchi, relax uterus (Dobutamine, isopretenol, terbutaline, ritodrine)
unpredicatable on/off parkinson’s symptoms
on/off phenom: long term Parkinson’s treatment
inc nigrostriatal degen, dec therapeutic window
SNS to eccrine sweat glands and adrenals
PNS pre gang and post gang
Somatic
SNS to Renal vessels
SNS to Heart and Vessels
SNS to other sweat glands and vessels
NACh
NACh - MACh
NACh
NACh - D1
NACh - NE
NACh - MACh
Wernickes: alpha ketoglutarate
amino group of alanine tansferred to alpha ketoglutarate
then converted to glucose
thiamine is co factor
Short term non-addictive sleep help
Zolpidem: Zs for Zs
same mechanism as benzos (inc freq Cl- channel firing at GABA-A)
GABApentin MOA
voltage gated Ca channels in presynaptic neuron
block fusion and NT vesicle release
also enhances GABA activity
increased AFP and AChE on amniocentesis
failure of fusion of neural plate edges
neonate, MacConkey agar, pink colonies, G- rod=
Antigen?
E coli meningitis
K1 capsule
Rifampin, Carbamezapine, phenobarbitol, phenytoin do what to P450 and serum of drugs metabolized by P450
Fluconazole, cimetidine, omprazole, do what to P450 and serum of drugs metabolized by 450
inc P450, so dec serum level of drugs
block P450, inc serum level of drugs
brachial plexus block affects diaphragm by?
phrenic nerve roots pass through?
ipsilateral diaphragm paralysis
phrenic nerve roots C3-5 pass thru scalenes
No abduction past horizontal, shoulder droop
location of nerve
CN 11 effected
Post Triangle of neck
Ptosis, down and out, fixed and dilated, loss of accomodation =
CN3 lesion
Do secondary messengers play a role in presynaptic release?
no, Ca+ channels
left dysdiadochokinesia?
left cerebellar mass
Parkinson’s drugs that worsen anxiety and agitation
Carbidopa and levodopa
weak wrist flex, add, 4th and 5th digits, claw
place nerve gets compressed
Spinal Levels of nerve?
Ulnar nerve (ulnar claw)
Guyon’s canal
C8-T1
Right nasal hemianopia
Right internal carotid artery, perichiasmal lesion
Migraines
Symptom treatment
abortive therapy
Prophylaxis
Sumatriptan 5HT
B blockers, anticonvulsants
SNRIs
young boy/man, ataxia, muscle weakness, kyphoscoliosis, pes cavus, frequent falls
associated disorder?
Inheritance
Friedreich’s Ataxia
HCM
AR: frataxin gene, GAA tri nuke repeat, chrom 9 (mitochondrial fxn)
Lipid stained macrophages, how long since stroke?
microglia, 3-5 days post stroke
Loss of CNS myelination =
common sign of MS
MS or multifocal encephalopathy: oligodendrocyte depletion
Oligoclonal IgG bands
asc. bilateral muscle weakness
MC bacteria associated
GBS, immune mediated
Campylobacter Jejuni
Foramen spinosum
Foramen Rotundum
Foramen Ovale
V1 ophthalmic branch, MMA and V
V2 maxillary branch
V3 mandibular branch
Ataxia, recurrent pulmonary infections, telangeictasia =
Gene?
ataxia telangectasia
ATM: AR: DNA break repair
BPDII mother, child born with neural tube defect
folic acid and valproate: 4 weeks gestation
Ventrolateral nuclei
Ventromedial nuclei
anterior nuclei
posterior Nuclei
arcuate nuclei hormones
Paraventricular nuclei hormones
supra optic nuclei hormones
suprachiasmatic nuclei hormones
hunger: destruction = anorexia
satiety: destruction = hyperphagia
Destory = hypertherm
Destroy = hypotherm
DA, GHRH, GnRH
AD, CRH, oxy, TRH
ADH, Oxy secrete
Circadian and pineal fxn
extensor muscle palsy =
crutch palsy, saturday night palsay, radial nerve palsy
worry about everything
GAD
B blockers help with?
exacerbate
angina (B1 dec HR and BP)
Asthma/COPD B2 bronchoconstriction
Resting membrane permeable =
Ligand gated
voltage gated
K
Na
Cl
Dementia + HIV
whats affected
pathology
HIV associated dementia
subcortical (deep) gray
inflammatory microglial nodules
CN3 palsy ispilateral temporal lobe mass
uncal herniation, downward displacement
Oral thrush + musltiple ring enhancing lesions
HIV, toxoplasmosis
Amitryptilin: type of drug?
side effects?
TCA
insomnia, anti ACh (no sludge) urinary retention, confusion, constipation
treatment for toxoplasmosis ring enhancing lesions
pyrimethamine and sulfadiazine (clindamycin if allergy), follinic acid
Mass lesions with HIV and EBV
primary CNS lymphoma, B cells
CN5 neuralgia treatment
MOA
adverse
Carbamezapine
Na channels
bone marrow suppress and SIADH
Restless leg syndrome treatment
MOA
DA agonist, pramipexole
Fe+ deficient or idiopathic
Cavitary lesion, HTN, deep, hemiparesis
if atherosclerosis
HTN, small lacunar infarct, internal capsule
history of, big stroke
Serotonin syndrome (hyperthermia, tremor, clonus, hyperreflexia)
SSRI OD in depression
tryptophan
Cyproheptadine MOA
block Histamine and serotonin: antipsychotic
DIC w/ adrenal destruction post infection
N. meningitidis, Waterhouse Freidrichson
Hip drop contralateral on Trendelenburg test =
weak Glute Med, lean ipsilateral, superior gluteal nerve injury on standing leg
Gardener w/ mydriasis (dry and dilated eyes)
plant that blocks AChM: atropine poisoning
need physostigmine (AChEI that crosses BBB)
HSV (shingles) CN5 tract: anterior or retrograde?
kinesin or dynein
latent or active phase
anteriorgrage, kinesin, active
retrograde, dynein, latent
dec CO2 =? on ICP
use to treat>
vasoconstrict, = inc vascular resistance = dec in CBF = dec. in
cerebral edema
CN9, 10, 11 ipsilateral syndrome
Venet syndrome, jugular foramen mass
Low 5HT w/ neurodeterioration (retard) =?
due to deficient in ?
treat with ?
Phenyketouria
BH4 (tetrahydropiopterin) or pheynl-hydroxylase, inc phenylalanine
low phenyl diet and BH4
TMD
Mandibular division of CN5 (V3) does?
Maxillary (V2) does?
all mastication muscles and tensor tympani middle ear
sensory
Viral LP shows?
normal glucose, inc protein, 90% leukocytes
Treatment for tonic/clonic + absence seizure
Absence alone?
Valproate
Ethosuximide
papilledema is due to?
impaired axoplasmic flow in optic nerve
unilateral facial paralysis, dec tearing, hyperacusis, loss of ant. 2/3 taste
Bells palsy
L-R disorientation, agraphia, acalcula, agnosia
Gerstmann syndrome
angular gyrus of dominant parietal lobe
loss of fxn of mammilary body (alcoholic)
short term memory loss
Familial Parkinson’s pathological feature
due to
alpha synuclein lewy bodies
Ubiquitiation problem
Down and out eye, artery involved
muscles active
Posterior communicating artery
lateral rectus, superior oblique
Lateral forearm sensory?
elbow flexion and 6 shooter?
lateral cutaneous nerve
MSK cutaneous nerve
Epidural hematoma (looks like, due to)?
subdural hematoma (looks like, due to)?
lens, MMA rupture
crescent, cortical bridging veins
Hemangioblastoma, kidney liver, pancrease
Hamartomas and cutaneous angiofibromas
PNS tumor, neurofibromas, optic gliomas, caf a luit, iris nodules
Bilateral CN8 Schwannomas and meningiomas
cutaneous facial angiomas, leptomeningial angiomas, retard, seizure, hemipegia, tram track skull
Telangectasias
VHL syndrome AD
TS
Von Recklinghuasens (NF1)
NF2 AD
Sturg Weber
Osler Weber
Symmetrical ventricle enlargement, tuberculosis infxn can cause?
due to?
communicating hydrocephalus
arachnoid granulation problem
Neuronal shrinkage, cytoplasmic eosinophila?
glial hyperplasia
kid, parkinsons, inc transaminases, dec ceruplasmin
gene
treat
Wilson’s
AR ATP73
D Penicillamine
BBB: made of
can cross freely?
areas w/ no BBB
Tight jxns, end feet of astrocytes, BM
Nonpolar/lipid soluble
area postrema (vomit), post pituitary (ADH release), organ of lamina terminalis (blood osmolality)
Narcolepsy area of the brain
lab values
lateral hypothalamus: promotes wakefulness and REM
Dec hypocretin 1, 2, orexins A and B
contralateral homonymous hemianopia
occipital cortex
neonate hydrocephalus, IC calcifications, chorioretinitis (yellow) = ?
due to ?
congenital toxo
in utero cat feces
absence seizures treatment
MOA
ethosuximide
dec Ca++ channel current in thalamic nuclei
Adult polycystic kidney disease associated w/?
treat w/, MOA
SAH
Nimodipine (dec. Ca++ current) prevent vasospasm and neurodeficits
decrease accomodation, cant read, drugs used?
MOA
1st gen antihistamines (chlorpheniramine, diphenhydramine)
block histamine and ACh at ciliary muscle
central scotomas
lesions of macula
sudden arm up jerking lesion where?
spinal levels
associated
lower trunk brachial plexus, Klumpkes claw hand, intrinsic hand muscles
C8-T1
Horners
finger and thumb Extension weakness, repetitive pronation, supination, trauma = ?
radius subluxation, radial nerve, supinator canal
Right sided pure hemisensory loss
posterior lateral
posterior medial
thalamic stroke contralateral
body
face
dementia, ataxia, urinary incontenence in older individual
spinal levels
Normal pressure hydrocephalus
S2-S4
Traumatic event then neuromptoms
Conversion disorder
CN5, mandible, maxilla, zygoma, incus, malleus, masstication muscles come from?
CN7, stapez, styloid, lesser horn hyoid, facial muscles come from?
neonate missing any of these
1st arch
2nd arch
treacher collins syndrome
Kids w/ stroke like neuro deficits
mitochondrial diseases, heteroplasmy, inc, lactate variability of presentation: MELAS
self mutilation (biting), hyperuricemia, decrease HGPRT, increase PRPP =
MOA
Lesch Nylon
inc blood uric acid, kids w/ developmental delays
acute painless monocular vision loss
central retinal artery occulsion: cherry red macula
progressive weakness
MG, AChR Abs, thymoma
esosinophilic staining red neurons
ischemic stroke 12-24hrs ago
parkinsons treatment
MOA
pramipexole
direct DA receptor stimulus
pregnant w/ monolike illness
infant at greatest risk for
CMV
chorioretinitis
brady cardia after inferior MI due to?
treatment?
can cause?
dec Sa and AV node conductance
atropine
closed angle glaucoma
kinesin antero or retrograde
affect if missing
antero
dec synaptic vesicles
anxiety treatment
assoicated NT
brain location where NT is produced
SSRI fluoxeteine
5HT
Raphe nuclei
ANterior pituitary is produced from?
surface ectoderm
Multiple sclerosis low or hgih neuronal length constant
low
Late Alzhemiers associated w/? (3)
ApoE4, E4
APP chrom 21
Presenlin 1 (chrom 14), and 2 (chrom 1)
Rapid recovery from propafol anesthesia due to
tissue redistribution of drug
neonate, acidosis, inc anion gap, ketosis, hypoglycemia, inc propionic acid due to
methylmalonyl coa deficit, cant metabolize Val, isoleu, metho, threonine
puffere fish toxin?
MOA
tetrodotoxin
Na+ channels, carrdiac and nerve tissue
how to prevent MPTP damage to DA neurons?
MAO-B blocker: selegiline
premie, large anterior fontanels, <1500g, hypotonia, prominent scalp veins
intraventricular hemorrhage
thymoma on CT, large mass
MG, autoantibodies to AChR
Parkinsons treatment
Levodopa (crosses BBB)
Carbidopa (blocks decaroxylase)
Entacapones (blocks COMT
pupil constrict, hypotension, vasodilate, which receptor stimulated
M3 ACh
alpha heli to beta pleated sheet
H bond rearrangement
Focal Seizures:
Simple
Complex
Treatment
Partial hemisphere
motor symptoms only (arm jerk)
Motor + absence seizure
carbamazepine, gababpentin, pehnobarbitol, phenytoin
Generalized Seizures
Tonic/clonic
Myoclonic
ABsence
Treatment
both hemispheres
LOC and jerking
brief jerk
LOC
Lamotrigine, levetiracetam, topiramate, valproate, ethosuximide
lymphoma, dec immunity, india ink stain and suocraud agar = ?
Treatment
Cryptococcal meningitis
Amphotericin B and Flucytosine
recurrent seizures more than 5min
treatment
status epilepticus
IV lorazepam (GABA)
IV phenytoin (Na+)