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Step 1 Clues > PP Clues Neurology > Flashcards

PP Clues Neurology Flashcards

1
Q

What is the central nervous system?

A

Brain and spinal cord; oligodendrocytes

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2
Q

What is the peripheral nervous system?

A

Everything else; Schwann cells

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3
Q

What does the autonomic nervous system do?

A

Automatic stuff

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4
Q

What is the somatic nervous system

A

Moving your muscle

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5
Q

What is the parasympathetic

A

Rest-and-Digest => slows stuff down

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6
Q

How does the parasympathetic system behave?

A

DUMBBELS”:
Diarrhea
Urination
Miosis “constricts”
Bradycardia
Bronchoconstriction
Erection “point”
Lacrimation Salivation

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7
Q

What is the sympathetic system?

A

Fight-or-Flight => speeds stuff up

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8
Q

How does the sympathetic system behave

A

Opposite of Parasympathetics:
Constipation Urinary
retention
Mydriasis “eyes wide with fright”
Tachycardia Bronchodilate
Ejaculation “shoot”
Xerophthalmia (dry eyes)
Xerostomia (dry mouth)

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9
Q

Where is NE synthesized in cns?

A

Locus coerelues of the pons

globally modulate arousal states and adaptive behavior

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10
Q

what happens to NE in anxiety and depression?

A

up in anxiety
down in depression

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11
Q

Dopamine in Huntington, parkinson and depression

A

up in Huntington
down in Parkinson
down in depression

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12
Q

what is serotonin synthesized

pons

A

Raphe nucleus

part of reticular activating system regulating serotonin

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13
Q

serotonin in Parkinson, anxiety, and depression?

A

up in parkinson
down in anxiety
down in depression

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14
Q

What nucleus synthesized ach?

A

Basal nucleus of Meynert

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15
Q

ACh in parkinson
Alzheimer
Huntington

A

up in parkinson
down in Alzheimer
down in Huntington

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16
Q

what does the forebrain or prosencephalon give rise to?

A

Telencephalon = Cerebral Hemispheres
Diencephalon=Thalamus

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17
Q

Midbrain or mesencephalon give rise to

A

midbrain=mesencephalon

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18
Q

hindbrain or rhombencephalon give rise to

A

mesencephalon =pons and Cerebellum
Myelencephalon=medulla

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19
Q

HTN, Bradycardia and high ICP Triad?

A

Cushing’s triad

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20
Q

Budd-chiari?

A

hepatic vein obstruction

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21
Q

Arnold-chiari

A

foramen magnum obstruction

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22
Q

Anencephaly

A

Notochord did not make contact w/ brain= only have medulla

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23
Q

Encephalocele

A

Brain tissue herniation

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24
Q

Dandy walker malformation

A

no cerebellum, distended 4th/lateral ventricles

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25
Q

Arnold-chiari Malformation

A

Herniation of cerebellum through foramen magnum

Type I: cerebellar tonsils (asymptomatic)

Type II: cerbellar vermis/ medulla => hydrocephalus, syringomyelia (loss of pain/temp)

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26
Q

s Spina bifida occulta?

A

Covered by skin w/ tuft of hair

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27
Q

Spina bifida aperta?

A

Has opening (high AFP)

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28
Q

Meningocele

A

Sacral pocket w/ meninges in it

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29
Q

Meningomyelocele

A

Sacral pocket w/ meninges and nerves in it

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29
Q

Open-angle glaucoma?

A

Overproduction of fluid => painless
ipsilateral dilated pupil, gradual tunnel vision, optic disc cupping

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30
Q

Closed-angle glaucoma?

A

obstruction of canal of schlemm=>sudden onset, pain, emergency

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31
Q

Watershed areas?

A

Hippocampus, splenic flexture

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32
Q

CN III, CN IV, CN V(1), CN V (2), and CN VI, and postganglionic sympathetic fibers
What they have in common?

A

contents of the cavernous sinus?

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33
Q

bug that loves frontal lobe

A

Rubella

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34
Q

bug that loves temporal lobe

A

HSV

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35
Q

bug that loves parietal lobe

A

toxoplasma

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36
Q

bug that loves hippocampus

A

rabies

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37
Q

bug that loves posterior fossa

A

TB

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38
Q

bug that loves DCML

A

Treponema

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39
Q

migraines presentation

A

Aura, photophobia, numbness and tingling, throbbing HA, nausea

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40
Q

Tension HA presentation

A

Band-like pain starts in posterior neck, worse as day progresses, sleep disturbance

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41
Q

cluster headaches present

A

Rhinorrhea, unilateral orbital pain, suicidal, facial flushing, worse w/lying down

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42
Q

temporal arteritis

A

pain with chewing, blind in one eye

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43
Q

trigeminal neuralgia

A

sharp, shooting face pain

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44
Q

2 kinds of partial seizures

A

simple(aware), complex (not aware)

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45
Q

what are the 3 kinds of generalized seizures

A

Tonic-Clonic “Grand mal”
Absence “Petit mal”
Status Epilepticus

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46
Q

How does an epidural hematoma present?
🍋

A

Intermittent consciousness, “lucid interval

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47
Q

How does a subdural hematoma present

A

Biconvex Lens, crossing suture lines
🍌

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48
Q

Headache 4wks after trauma, elderly (loose brain)

A

subdural hematoma

fragile vessel

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49
Q

How does a subdural hematoma look on CT?

🌙🌛

A

crescent shape, crosses suture lines, midline shift

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50
Q

subarachnoid hemorrhage presentation

A

worst headache of my life, h/o berry aneurysm

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51
Q

Astrocytoma

A

Rosenthal fibers, #1 in kids w/ occipital

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52
Q

Ependymoma

A

Rosettes, in 4th Ventricle, hydrocephalus

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53
Q

Craniopharyngioma

A

motor oil biopsy, tooth enamel, rathe’s pouch, ADH problem, bitemporal hemianopsia

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54
Q

glioblastoma multiforme

A

pseudopalisading, necrosis, worst prognosis, intrapersonal hemorrhage

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55
Q

Meningioma

A

parasagittal, psammoma bodies, whorling pattern, best prognosis

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56
Q

MC place to metastasize to the brain

A

lung,
breast,
skin
seen at white grey junction

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57
Q

oligodendroglioma

A

nodular calcification and fried-egg appearance

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58
Q

pinealoma

A

loss of upward gaze, loss of circadian rhythms=>precocious puberty

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59
Q

Schwannoma

A

CN8 tumor, unilateral deafness

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60
Q

Neurofibromatosis

A

Café au lait spots (hyperpigmentation) => peripheral nerve tumors, axillary freckle

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61
Q

Sturge-Weber?

A

Port wine stain (big purple spot) on forehead, angioma of retina

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62
Q

Brain: inhibitory NT

A

GABA: Chloride influx

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63
Q

NT inhibitory for Spinal cord

A

Glycine: chloride influx

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64
Q

Drug causing chloride influx

A

Benzo
Barbiturates
Alcohol
Opiates

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65
Q

Affecting glycine

A

Tetanus
Strychnine

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66
Q

Over stimulation of nerve

A

Excitotoxicity

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67
Q

Mediates reinforcement of addictive behavior

A

NMDA Pathway

aspartate

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68
Q

Uses ach for pre and post ganglionic fiber
Depolarize head/neck and belt

A

Parasympathetic

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69
Q

Has longer preganglion and shorter post ganglionic
Hyper-polarizes thoracolumbar

A

ACH

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70
Q

Excitatory NT

A

Glutamate
Aspertate:NMDA

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71
Q

Memantine n Riluzole moa

A

Block glutamate

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72
Q

Catacholamines excitatory neurotransmitter

A

Dopamine

Norepinephrine

Epinephrine (Hormone)

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73
Q

Monoamines excitatory NT

A

Serotonin • Dopamine • Norepinephrine

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74
Q

Sympathetic in the CNS • Parasympathetic in the PNS • Made from tryptophan

A

Serotonin

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75
Q

Control Reticulate activating system (raphe nucleus0
Ands hallucinations
Helps focus on one thing at a time

A

Serotonin

76
Q

Serotonin syndrome treat with

(5HT)-1a and 5HT-2 receptors

A

Cyproheptadine

altered mental status, autonomic instability, and tremor, hi reflex

77
Q

Carcinoid syndrome

treatment

A

Octriotide

78
Q

Used in making Nor-epi, and made from tyrosine

A

Dopamine

79
Q

Used by basal ganglia and vomitting center

A

Dopamine
Control urges(mesolimbic system)

80
Q

Vomiting control
CNS chemotactic trigger zone area postrema

A

Promethazine
Perchloromethazine
GI- ondensitron

81
Q

MCC of autonomic dysfunction

A

Diabetes
Riley-day syndrome
Shy-dragger
Sick sinus syndrome
Drugs

82
Q

Catacholemine/monoamin that control sympathetic, no methyl group, made from tyrosine

A

Nor epi

83
Q

Short acting adrenal stress hormone
Receptors

A

Epi-beta
Beta 2…1..then alpha 1&2

84
Q

Beta 2 effects on bp

A

Lower BP

85
Q

Polypeptides

A

Cck
Substance P
Neuropeptide

86
Q

Neuropeptide Y

most abundant

A

Response to stress; circadian rhythms; controls cardiovascular system; inhibits release of glutamate; increases appetite

87
Q

what are the endo-opioids

A

Beta endorphins
Enkaphalins
Dynorphins

pain relief and behavior reinforcemnt pathways

88
Q

only retrograde neurotransmitter

A

endocannabinoids

89
Q

What does NO and CO have in common

A

cGMP
NO> vasodilator
CO> help with smell (CN1)

L-Arginine makes NO

90
Q

preganglionic fibers for SNS releases

A

ACH

91
Q

Primary postganglionic fibers

A

Nor Epi

some pathways use DA or Serotonin

92
Q

SNS

sympathetic system depolarize and hyperpolarizes?

A

brain and thoracolumbar
Sacral

long postganglionic fibers

93
Q

second Messengers

parasympathetic:
Sympathetic:

A

parasympathetic: c-GMP
Sympathetic: c-AMP

94
Q

2nd msg

smooth muscle contraction by neurotransmitter or hormone

A

IP3/DAG

95
Q

2nd msg

smooth muscle contraction by distention

A

Calcium-calmodulin

96
Q

use to diagnose pheochromocytomas and neuroblastomas

A

VMA
HVA
Metanephrines

97
Q

neuroblastomas signs

A

opsoclonus
myoclonus
Raccoon sign with no trauma

98
Q

used to diagnose Carcinoid syndrom

A

5-HIAA

txt: ceproheptadine

99
Q

Parasympathetic receptor

A

mostly Muscarinic
Nicotinic at Ske. mm and ganglia

100
Q

competitive inhibitor of choline with fight/flight response

A

Hemicholinium

101
Q

block vesiculation

vesamicol

ACH

A

causes sympathetic SE

102
Q

Block vesiculation

Reserpine

DA, NE

A

hypertention with autonomic dysfunction and parkinson-like

103
Q

promotes parasympathetic: relax

Cholinergic Agonists

A

ACH
pilocarpine
Bethanechol
Carbachol
methacholine

104
Q

Reversible

AchE Inhibitor

A

Edrophonium
Neostigmine
Pyridostigmine
Physostigmine(cns)
Rixastigmine

promotes more parasympathetic

105
Q

Irreversible

AchE Inhibitors

Everything relaxes

A

Echothiophate
DUMBELLS/SLUDGE

remove clothing, Atropine and pralidoxime

106
Q

promotes sympathetic (antiparasympathetic)

Anticholinergic

A

Atropine
Homatropine
Tropicamide
Benztropine
Scopolamine
Ipratropium
Methylscopolamine

107
Q

amplify Dopamine

COMT inhibitor

A

Tolcapone
Betalcapone(entacapone)

108
Q

serotonin agonists

metoclopramide

A

high incident of drug induce parkinson

109
Q

serotonin agonists

methysergide

A

used for magrine but too strong
causes Retroperitoneal fibrosis

110
Q

serotonin agonists

Traptans

A

Magrine
causes stroke and MI

111
Q

serotonin agonists

affect P450 dependents

A

warfarin
estrogen
phenytoin
Theophyline
Digoxin

112
Q

Migraine management

A

Prophylaxis: propranolon, topiramate
Abortive: Oxygen, Triptans
Chronic: Botox injections

113
Q

sympathetic receptors are

A

nicotinic except of sweat glands which are muscarinic

114
Q

sympathetic

anticholinergic

A

can’t sweat:
Hot dry skin

115
Q

Status Epilepticus

Continuous seizures for more than 20 min

treatment

A

Lorazepam
Diazepam

116
Q

Lennox Gastaut Syndrome

TXT

A

Lobectomy

117
Q

Myotonic seizures treatment

A

valproic acid

Na/ca blocker

118
Q

Infantile spasm treatment

A

ACTH injections

119
Q

absence seizures treatment

A

ethosuximide

Ca++

120
Q

Febrile seizure treatment

A

acetaminophen

121
Q

Temporal seizure treatment

A

carbamazepine

122
Q

Generalized seizures treatment

A

children: phenobarbital
in adults: phenytoin

123
Q

children with hundrends of seizures each day

A

Lennox Gastaut syndrome

124
Q

myotonic seizure present

A

sudden contraction of abdominal muscles

125
Q

Infantile spasms

A

sudden contration of abdominal muscle

126
Q

Benign Rolandic seizures

A

child wakes up, eyes fluttering, falls back to sleep, no memory

127
Q

Atonic seizure origin

A

frontal cortex

128
Q

Febrile seizures last for

A

<20min

complex recurrent last >20min

129
Q

EEG and neurological exam in febrile seizure

normal or abnormal

A

normal

130
Q

mc seizure in children

staring spells

A

absence seizures

131
Q

Three per second spike and wave pattern on EEG

A

absence seizures

132
Q

change in muscle follow by shaking and jerking

A

Tonic clonic seizure

133
Q

pre-seizure hallucination

smell, hearing or visceral

A

temporal lobe seizure

134
Q

epilepsy management

A

treatment: least 2 years
must be seizure free : 6 months

135
Q

mcc of seizure

A

uncontrolled depolirazation
Ischemia

mass, CNS infection, metabolic disorders

136
Q

unknown seizure etiology is called

A

seizure disorder

137
Q

spinal cord lesion present with

A

pain and temp on opposite side of all other deficits

location 2 dermatones above pain/temp

138
Q

only 2 CN that crosses midline

A

CN 7 and 12

CN 7: lower .5 of opposite face, LMN @ ganglion, entire .5 face droop

139
Q

medulla CN

breathing and HRT rate control

A

9,10,11,12

12 midline

140
Q

Pons CN

lock in syndrome

A

5,6,7,8

6 midline:

141
Q

midbrain CN

A

3,4

3 midline

142
Q

dorsal root ganglion dz

A

Polio-2 wks post GI enteritis
varicella-zoster
Rabies

143
Q

sensitive to osmotic shifts

A

pons

slowly correct glucose and Na

144
Q

contains pneumotactic and apneustic center

A

pons

145
Q

dz affecting spinocerebellar pathway

A

alcohol(vermis)
friedrieck’s ataxia
ataxia telangiectasia
adrenoleukodystrophy

146
Q

GI malabsorption, IgA, skin cancer, cerebellum symptom

A

ataxic telengiectasia

147
Q

CAT 1 enzyme defficiency

A

adrenoleukodystrophy

148
Q

scoliosis, telangiectasia

A

Friedrieck’s Ataxia

149
Q

intention tremor
dysmetria
dysdiodokinesis
romberg sign

A

spinocerebella lesion

crosses twice: ipsilateral always

150
Q

fibers enter S. cord assend 2 levels cross at antirior white commisure

A

spinothalamic tract

Pain and temp

151
Q

Dorsal column pathology

A

syphilis
B-12 def(type A gastritis)
Brown-sequard(hemisection)

152
Q

medulla pushed through foramen magnum

A

all extremity extend
decerebrate posturing

153
Q

herniation goes beyond the red nucleus

extensors activated

A

CST, corticobulbar and rubrospinal tract lost

Decerebrate posturing

154
Q

first sign of herniation(trauma)

compression of CST & Corticobulbar

A

CN III paralysis
loss of pupillary reflex
anisocoria

herniate just above the red nucleurs

155
Q

Decorticate presentation

second sign of herniation

A

CN III compressed, still above red nucleus

156
Q

Hi ICP u first see

A

papilledema
headache

157
Q

Hi ICP 2nd sign

A

esotropia
diplopia/blurred vision

158
Q

CST pathology

A

ALS
B-12 deficiency
Atonic seizure:frontal cortex

159
Q

CST fibers originate from

A

frontal lobes and precentral gyri

160
Q

which fibers descend the internal capsule and cross at medullary pyramids

A

CST

161
Q

responsible for fine motor activity
inhibit extension
smooth flexion

A

Corticospinal tract

162
Q

drug that decrease REM sleep

A

benzo and barbiturates

REM rebound when drug are stopped

163
Q

NT in REM

A

ACH

164
Q

ADD/ADHD

treatment

A

methylphenidate
promoline
dexadrine
adderall

165
Q

night terrors
restless legs syndrome
bruxism
somnambalism

A

Delta wave

166
Q

sleep spindles and k-complex

A

Theta:light sleep

167
Q

maintains focus on 1 activity
require NE & serotonin

A

Reticular activating system

168
Q

2nd msg of Reticular activating system

A

c-AMP

169
Q

lacunar hemorrhage: HTN
lenticulostriate arteries

A

Internal capsule

170
Q

Parkinson DZ treatment

A

L-dopa/carbidopa
Bromocriptine/carbergeline
Amantadine
selegiline

increases Dopamine

171
Q

initiates movement

A

substantia Nigra

172
Q

what NT in Substantia Nigra

A

Dopamine

173
Q

how is Substantia Nigra inhibited

A

Basal ganglia via ACH or GABA

174
Q

subthalamic nucleus function

A

final relay for coordinating fine motor movements

lesion: Ballismus and Hemiballismus

175
Q

curling’s ulcers

A

Burn

176
Q

cushing’s ulcers

A

brain

177
Q

IBS: sym/parasym/both?

A

Parasym: Diarrhea
Sympathetic: constipations

178
Q

drug causing hallucination

A

LSD: coloful
PCP:Strong
Ecstasy: strong/thrsty

amphetamines

179
Q

vertical nystagmus

A

Amphetamines

180
Q

hallucination B4 seizure
schizo
dementias

A

Temporal lobe lesions

Drugs: SSRI, amphetamines

181
Q

Dementia: alzheimer& pick’s dz
Schizo: loss of asymmetry

A

frontal lobe

182
Q

lesion in calcarin fissure

A

quadrantanopia
pie in the sky deficit

inferior or superior

183
Q

monocular blindness in newborns

A

cataracts or retinoblastoma

184
Q

monocular blindness children

A

optic nerve gliomas
NF
MEN 2b

185
Q

monocular blindness adults

A

TIA
Acute retinal artery occlusion
acute retinal vein occlusion

186
Q

monocular blindness Elderly

A

Macular degeneration

187
Q

Newborn white reflex

A

Retinoblastoma
RB gene
Cancer
Ewing’s sarc

188
Q

90% idiopathic
diabetes or galactosemia
Rubella

effect on eye

A

Opacification of the lens

Step 1 Clues (27 decks)

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