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Neurology > Patho 3 > Flashcards

Patho 3 Flashcards

Sorry it's not in order on the list !!

1
Q

Meningitis

- define

A
  • infection of connective tissue covering brain

- includes CSF

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2
Q

Meningitis - extent of infection

A
  • usually include entire subarachnoid space around brain and spinal cord (dt CSF circulation)
  • brain itself (encephalitis)
  • blood vessels (vasculitis)
  • ventricular system (ventriculitis)
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3
Q

Etiology of meningitis

A
  • bacterial
  • viral
  • fungal
  • protozoa
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4
Q

How treat bacterial meningitis

A
  • hospital admission with strong IV abx
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5
Q

How treat viral meningitis

A
  • Usually self limiting, no real treatment

- aseptic meningitis

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6
Q

True or false - the different types of meningitis present differently

A

FALSE

- all types are similar in presentation, only way to really differentiate is via lumbar puncture

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7
Q

When considering meningitis, what should the presence of focal neurological signs make you think?

A
  • NOT infectious etiology

- more likely a stroke

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8
Q

Delirium

- describe

A
  • temporary condition of confusion usually associated with reversible cause
  • Tx by treating underlying issue
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9
Q

causes of delirium

A
  • hypoglycemia
  • hypoxia
  • thiamine deficiency
  • hypovolemia
  • hyponatremia
  • chem/drug toxicty
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10
Q

How to treat delirium other than tx underlying issue

A
  • Rally pack or banana bag and O2

- except for hyponatremia and chem/drug tox

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11
Q

Rally pack contents

A

1 L over 4-8 hrs:

  • thiamine
  • folic acid
  • Multivitamin
  • magnesium sulfate
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12
Q

Dementia

A
  • progressive, irreversible process with periods of lucidity
  • may be indolent
  • interspersed with loss of cognitive ability
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13
Q

Two types of Dementia

A
  • Alzheimers (most common type)

- Multi-infarct

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14
Q

Alzheimers

  • onset
  • sx
A
  • slow onset (but can be fast and early onset too)
  • behavior changes
  • anxiety, depression, visual hallucinations, paranoia
  • don’t sleep at night, nap during the day
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15
Q

what is an early sx of Alzheimers

A

Discalculia: lose concept of money

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16
Q

Two histologic characteristics found on pathologic exam of brain

A
  • plaques
  • tangles

Also

  • shrunken gyre and exaggerated sulci
  • What looks like enlarged ventricles but is actually just loss of cortical mass called hydrocephalus ex-vacuo
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17
Q

Multi-infarct dementia

A
  • recurrent minor strokes
  • seen in pts with cerebral vascular disease
  • many small hemorrhages that accumulate and result in reduced function
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18
Q

Huntington’s Chorea

  • etiology
  • main sx
A
  • autosomal dominant
  • involuntary muscle movements
  • facial grimaces
  • personality changes
  • emotional disturbances
  • dementia
  • occurs mid-life
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19
Q

Huntington’s Chorea

- genetic problem

A
  • increased triplet nucleotide repeats in DNA
  • causes protein to misfold = loss of gaba neurons
  • caudate nucleus degenerates
  • more and more repeats in subsequent generations so disease is expressed earlier
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20
Q

What is the main neurotransmitter to be lost in:

  • Huntingtons
  • Parkinsons
A
  • Huntingtons: gaba

- Parkinsons: dopamine

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21
Q

Parkinsons

- cause

A
  • degenerative destruction of substantia nigra = loss of dopaminergic neurons going to forebrain structures (like caudate)
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22
Q

Parkinsons sx

A
  • pill rolling
  • postural changes
  • poor balance
  • shuffling gate
  • flat affect
  • 20-50% develop dementia
  • bradykinesia which progresses to rigidity
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23
Q

Cause of Parkinson’s

A
  • elusive

- neurotoxins (MPTP) can cause immediate onset bc they selectively target the substantia nigra

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24
Q

What are the two demyleninating disease

A
  • ALS

- MS (more common)

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25
Q

what are the two diseases that cause loss of neuron cell bodies

A
  • Huntingon’s

- Parkinson’s

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26
Q

Amyotrophic lateral sclerosis (ALS)

  • aka
  • describe
A
  • Lou Gehrig’s
  • degenerative disease with gradual progressive motor weakness leading to respiratory failure in 3-5 years
  • maintain complete awareness/consciousness but lose motor function
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27
Q

What degenerate in ALS

A
  • upper motoneurons (cerebral cortical cells)

- lower motor neurons in SC and brain stem

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28
Q

ALS etiology

A
  • familial

- sporadic

29
Q

Multiple Sclerosis

  • etiology
  • when does it usually occur
A
  • autoimmune reaction against oligodendrocytes, triggered by viral infection
  • around age 30 (females more often_
30
Q

Common first presenting complaint of MS

A

optic neuritis

31
Q

What is diagnoses of MS on a CT?

A

plaques involving white matter (where myelin is!)

32
Q

How to diagnose MS

A

Diagnosis of exclusion unless plaques on the CT

33
Q

MS

- progression

A
  • subtle sx like urinary incontinence
  • sx progress to blindness, incontinence, ataxia, paraplegia
  • episodic exacerbations and remissions
34
Q

Acute idiopathic polyneuritis

  • aka
  • describe
A
  • Guillain-Barre Syndrome
  • ascending motor paralysis affecting both spinal and cranial nerves (get to C4 affects diaphragm = ventilator)
  • post-infectious autoimmune disorder
35
Q

Two common triggers for Acute idiopathic polyneuritis

A
  • campylobacter jejuni

- vaccinations

36
Q

Acute idiopathic polyneuritis

- recovery

A
  • gradual
  • w/o residual defect
  • recover from top down
37
Q

Acute idiopathic polyneuritis tx

A
  • admit to hospital

- often tx with steroids to reduce inflammation

38
Q

Inborn errors of metabolism

A
  • gene prevents normal enzymatic pathway
  • often related to low IQ, developmental issues
  • usually die young
39
Q

Two metabolic diseases

A
  • Tay-Sachs

- Riemann-Pick disease

40
Q

Tay-Sachs

  • describe
  • inheritance pattern
  • common in what population
A
  • deficit of ganglioside lipids important in cellular membranes, esp. in nervous tissue in brain
  • autosomal recessive
  • Ashkenazi jews
41
Q

neoplastic disease of the CNS

- clinical manifestations

A

Depend on both

  • local effects: irritative, compressive, destructive
  • generalized effects: increased pressure, edema, hemorrhage, etc.
42
Q

neoplastic disease of the CNS

- metastasis

A
  • all are potentially malignant but extra neural metastasis is rare (usually don’t live long enough for mets to occur)
43
Q

neoplastic disease of the CNS

- how does age affect risk?

A
  • risk increases with age
    BUT also
  • second most common group of childhood tumors
44
Q

Astrocytoma

  • where in brain
  • when in life
  • sx
  • prognosis
A
  • white matter
  • 3rd and 4th decades peak risk
  • seizures, ICP, motor deficits, mental changes
  • slow growing, lots of time to get it out
45
Q

Glioblastoma

  • where in brain
  • when in life
  • how common
  • sx
A
  • usually frontal or temporal lobes
  • 5th or 6th decade
  • most common type of brain tumor in adults
  • same sx as other astrocytomas but more rapid progression/deterioration
46
Q

Glioblastoma

- life expectancy

A
  • untreated 14 weeks

- treated 10-11 months

47
Q

Metastatic tumors of the brain

  • how common
  • sx
  • where in brain
A
  • 15-30% intracranial tumors
  • HA, seizure, motor deficits, mental change - all due to local expansion/edema
  • usually in cortex at gray-white junction
48
Q

5 most common primary sites that cause brain mets in order of most frequent

A 
Lung
Breast
Melanoma
Kidney
GI
49
Q

Muscle diseases

- how related to neuro

A
  • caused by lesions of anterior horn, peripheral axons, neuromuscular junction
50
Q

Most common type of muscle disease related to neuro

A
  • muscular dystrophies

- Duchenne is most common

51
Q

Muscular dystrophy

- describe

A
  • genetic

- regressive alterations in muscle fibers = weakness

52
Q

Duchenne type muscular dystrophy

A
  • degeneration of muscles, have extreme weakness
  • usually of trunk/pelvis
  • classic description of kid who gets off teh floor with arms, not “normal” way
53
Q

Duchenne type muscular dystrophy

life expectancy

A
  • not great
  • usually die in 20-30s
  • commonly dt pulmonary complications
54
Q

Duchenne type muscular dystrophy

- gastrocnemius

A
  • may appear enlarged dt pseudohypertorphy (fatty infiltrate between muscle fibers)
55
Q

Myasthenia gravis

  • etiology
  • when does it show up
  • presentation
A
  • autoimmune, antibody to Ach receptor on muscles that impairs the neuromuscular junction
  • early adulthood
  • abnormal muscular fatigue and weakness
56
Q

Myasthenia gravis tx

A
  • Cholinergic meds or meds that block Ach-esterase

- if don’t treat diaphragm won’t work - die

57
Q

How to test for myasthenia gravis

A
  • blink a bunch of times, lids will tire
  • give tensilon, Ach burst will let them blink again
  • test for antibodies
58
Q

Prion

- define

A
  • proteinaceous and infectious
  • “ion” ending as analogy to virion
  • small proteinaceous infectious particles that resist inactivation by procedures that modify nucleic acids
  • everyone has prion proteins, they are not dangerous until they misfold
59
Q

What is crazy about prions

A
  • defy convention
  • “replicate” without DNA
  • not a true replication, induces a conformational change in other prions
60
Q

Common way to transfer prions

A

eat misfolded prion from someone/something else

61
Q

Name for prion diseases, why?

A
  • spongiform encephalopathy

- prions kill neurons, produces vacuoles/holes in cortex

62
Q

Prion diseases

  • how dangerous
  • cure
  • cause
  • what is protein resistant to?
A
  • all are fatal
  • no cure for any
  • misfolded prion proteins accumulate in cytosol
  • resistant to heat, proteases, anti-invectives, UV irradiation, etc.
63
Q

Prion disease MC 3 sx

A
  • dementia
  • ataxia
  • myoclonus
64
Q

Prion disease other sx other than three MC

A
  • progressive loss of motor function
  • loss of speech
  • hallucinations
  • seizures
  • visual agnosia
65
Q

List 6 common prion diseases

A
  1. Scrapie in sheep
  2. Bovine spongiform encephalopathy (aka BSE or mad cow disease)
  3. Chronic wasting syndrome (white tailed deer, elk, moose)
  4. Feline spongiform encephalopathy
  5. Kuru - New Guinea women
  6. Creutzfeldt-Jakob disease
66
Q

Iatrogenic transmission of prion disease

A
  • human growth hormone injections in France 2009
  • dura grafts
  • corneal transplants
  • neurosurgical instruments up to 2 years after autoclaved (now all disposable)
67
Q

Creutzfeldt-Jakob disease

- etiology

A
  • mostly sporadic, can be iatrogenic, variant, familial
68
Q

Familial defect in prion gene

A

Fatal familial insomnia

  • 35 families
  • symptomatic in 40s, can’t sleep
  • die from insomnia

Neurology (11 decks)

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