Smart book CNS & psych Flashcards
Where craniopharyngioma come from?
what embryonal layer
Rathke’s pouch - anterior pituitary
surface ectoderm
What drug class is used to treat Alzhiemers
which drug specifically?
AchE inhibitors
Donepezil, galantamine, rivastigmine
Which toxin is contained in mushrooms (when you eat them) that can cause bad effects like throwing up?
Muscarine which is a muscarinic agonist
incr. parasympathetic
Activation of _______ promotes synthesis of nitric oxide
M3 receptors
A collection of snRNPs and other pre mRNA proteins are called ______
whats its function?
Spliceosomes
remove introns by cleaving
What is incidence?
The number of NEW cases of a illness each year
whats the triad for meningitis?
Fever, neck stiffness, altered mental status
what type of speech is involved in Broca? what other finding would you see?
nonfluent speech and right hemiparesis
Whats the function of the cerebellar hemispheres
what are the three signs of a lesion here?
Motor Planning and coordination of ipsilateral extremeties
-dysdiadochokinesia (impaired rapidly alternating movements)
-limb dysmetria, intention tremor
cognitive tests
whats the triad for Wernickes encephalopathy
what part of the brain is involved?
Confusion Ataxia Neurologic symptoms
Opthtalmoplegia
Mamillary bodies
What is anterograde (from axon to skin) axonal transport mediated by?
Kinesin
whats Akathisia
extrapyramidal side effect of antipsychotics
restlessness inability to sit still
what are the side effects of antipsychotics
when a patient is on isoniazid what should you give along with it?
b6-pyridoxine to prevent isoniazid neuropathy
patients with major depressive episodes should be screened for what before starting antidepressents?
SHould be screened for manic episodes
this is to rule out/differentiate between MDD and bipolar disorder
starting antidepressants in bipolar do can induce mania
what are the symptoms of PKU
due to decr. phenylalanine hydroxylase or tetrahydrobipterin
-mental retardation, seizures, growth retardation, fair skin, musty odor
whats the function of the obturator nerve
Adduction of thigh
cutaneous innervation of medial thigh
What are the symptoms of west nile virus
Encephalitis, meningitis, flaccid paralysis
(+) ssRNA flavi virus
what are the prenatal tests to check for Neural tube defects?
Incr. AFP & AchE
Whats the deficient in each nerve injury
Obturator
Femoral
Common peroneal
Tibial
Superior gluteal
obturator- leg Adduction/medial cutaneous
Femoral - leg extension/thigh flexion
C. peroneal - foot drop
Tibial - cant curl toes/ foot everted
S. gluteal- pelvis tilts
what is fragile X caused by?
Trinucleotide CGG repeat on FXMR1 (fragile X mental retardation) gene
Hypermethylation and inactivation of gene
what does rabies bind to in that leads to infection?
Ach receptors
what are the serum findings in wilson dz
how do you treat it?
Low Ceruloplasmin
high Copper
-D-penicillamine
what all bio reactions is thiamine involved in?
ATP
A-ketoglutarate, Transketolase, Pyruvate dehydrogenase
How would B12 deficiency present?
Megaloblastic anemia (impaired DNA synthesis) and
nuerologic deficits
Subacute combined degeneration of dorsal column/lateral corticospinal
What symptom is permanent even after treatment in Wernicke encephalopathy?
Memory impairment
whats the first line drug for status epilipticus
Benzos!!!!
How does Fragile X syndrome present?
FMR1 gene mutation (Methylation –> inactivation)
CGG repeat
Fragile X has eXtra large jaws, ears, testes
whats the physical presentation of downsyndrome?
Low ears, short neck, epicanthic folds
whats the physical presentation of Marfans syndrome
Arachnodactyl (long skinny fingers), scoliosis, lens dislocation
Whats the physical presentation of Fetal alcohol syndrome
Thin vermillion border( thin upper lip), smooth philtrum (dip on upper lip) microencephaly,
What happens with an Internal capsule lesion in the brain?
“clasp-knife” spasticity: initial resistance then flaccid extension.
what is deficient in Narcolepsy
Hypocretin1 aka Orexin
guy falls from a tree and grabs a branch. and now he cant really use his hand. what is it? and what nerves are messed up?
Klumpke palsy
-tear of Lower trunk of brachial plexus
where are the serotonin releasing nuerons located in the brainT
The Raphe nucleus
Bilateral infarcts of the brain should lead you to think _______
water shed areas - hypoxic ischemic stroke
as opposed to emoblism which would have infarcts everywhere in different locations
What all do you know about wilsons dz
young guy with ataxia and liver problems (incr. transaminase)
excessive copper deposition in
liver, basal ganglia, cornea
what are the muscles and bones associated with the pharyngeal pouches
1,2,3,4&6
1- muscles: mastication / bones: maxilla, mandible, incus mallus
2 - muscles: Facial expression muscles / bones: stapes, stylohyoid, lesser bone of hyoid
3 - muscles: stylopharyngeaus / bone: greater horn of hyoid
4&6- muscles: laryngeal/pharyngeal / bone: Cricord and thyroid cartilage
Ubiquination
plays an important role in: antigen processing, muscle wasting, Dna repair, disposal of misfolded proteins
2 year old with abdominal mass
dancing eyes dancing feet
Neuroblastoma
Neural crest cells - Nmyc overexpression
Stroke of the ACA presents as
why?
MCA
Contralateral paraylsis/sensory loss of LOWER
the ACA does the frontal lobe and sagital sulcus (hommunculus) which at the sulcus starts with feet
-mca would be more upper limb and face problems
what happens after neuronal damage to a section of brain (how does it get repaired)
Glial cells like AStrocytes go through hyperplasia to repair
Gliosis
whats parinaud? what causes it?
diminished vertical gaze due to lesion of superior caliculi
-stroke, hydroceph, pinealoma
where would you give a femoral nerve block?
Iliac crease
a person comes in with Subarachnoid hemorhage. wwhat do you give to prevent Cerebral vasospasm
CCB
got an old person suddenly going crazy
waxing and waning. how do you treat?
Delirium
haloperidol
how long does adjustment disorder last?
6 months
whats the route to the meninges for Nisseara meningitis
infected by respiratory droplets
pharynx-> blood -> Choroid plexus -> meninges
whats freidrich ataxia? where is the lesion in the spinal cord. most common cause od death?
Ataxia, with diabetes, hypertrophic heart, kyphoscoliosis
-lateral spinocerebellar/dorsal column degeneration
what nerve innervates the forearm flexors
and what about sensory innervation
Musculocutaneous
lateral forearm
why do you get GB (ascending paralysis) after camp or influenza. what kind of response?
Antibodies against the infectious agent also attack myelin of peripheral nerves
-endoneural inflam infiltrate
recurrant unilateral headaches
Lacrimation and rhinorhea. perioribtal pain
tx?
Cluster headaches
acute: Sumatriptan
prophylaxis: verapamil
where are the muscarinic and nicotinic receptors?
M1: Nerves and CNS : Gq receptor(ip3dag)
M2: Heart, atria SA AV node : Gi (camp)
M3: Glands and smooth muscle : Gq ip3-dag
_______________
Nicotinic: Skeletal muscle (motor end plate) and Adrenals
Shoulder drop and cant lift pass the horizontal position. what muscle is fucked?
Trapezius
Most common Viral causes of meningitis
Enterovirus, Arbovirus, HSV 2
difference between normal pressure and obstructive (non communicating) hydrocephalus
Obstructive is due to aqueduct stenosis or tumor that leads to incr. ICP that causes headache N/V
Guy comes in with muscle weakness and paresthesias after eating fish at a japanese resturaunt. what is the cause and MOA
Puffer fish - Tetrodotoxin - Blocks Na channels
What nerve is messed up in bells palsy and what does it innvervate
Facial nerve CN 7
-face muscles, anterior 2/3 taste, hearing, salivary and lacrimal glands
what can occur after Subarachnoid hemmorage?
how do you treat it?
Vasospams causing
CCB
What are the target organs for Alpha, Beta1, & Beta2 receptors
Stimulation
Alpha-vasoconstriction, urinary retntion, and mydriasis
Beta 1- Heart (incr. rate, contractility, conductance)
Beta2- Bronchodilation, uterus relaxation
Decerebrate vs Decortate posturing
Decerebrate: extension of extremities due to a lesion below the Red nucleus (pons, midbrain,)
Decortate: flexion of arms due to a lesion above the red nucleus which disinhibits it.
*red nucleus causes flexing. so above or below will tell you
Whats the bond types between primary and secondary protein structures?
Primary - Peptide bonds
Secondary - Hydrogen bonds
What should you know about glioblastoma?
Its an astrocytoma, common primary malignant
Buttergly Glioma, resides in Cerebral hemisphere
GFAP
necrosis and hemorrhage
What innervates dorsum of foot and if fucked can cause foot drop
Common Peroneal
Whats the function of Radial nerve
Extensors, skin sensory to posterior arm and forearm
whats the inheritance of Neurofibromatosis
Autosomal dominant
Spontaneous deep intercerebral stroke due to hypertension
Basal ganglia / lenticulostriate muscles
Route of Rabies
Wound- motor neurons -salivary glands
Difference between Oppositional Defiant disorder and Conduct disorder
OPP is argumentative, defiant behavior, with deliberate teasing and blaming others
Conduct is cruelty to others with no regards
what is acute stress disorder and its timeframe
hyperarousal and avoidance symptoms as a result of life threatening or traumatic event
3 days to 1 months
Social anxiety do vs panic
Panic: recurrant episodes of stress and worrying about when the next one will come
Social anxiety: worried more about the criticism of others and not the stress itself
when you see ornithine you should think
UREA CYLCE
Whats a romberg test
Asking a patient who has ataxia to stand up and balance with eyes closed.’
Positve test: once they close their eyes they stumble (meaning that they were relying on other senes to balance which means the dorsal column is fucked)
Negative test: means that the ataxia is a cerebellar problem and not the spinal cord
whats diabetic retinopathy caused by?
poorly controlled diabetes leading to ischemia of the nerve
Which brain tumor has S100 +
Schwannoma
CN VIII Cerebellar pontain angle
What part of the brain is first effected by ischemia
pyramidal cells of the Hippocampus
purkinje cells of cerrebellum
how would dandy walker syndrome present
Absence of vermis
enlargment of 4th ventricle, noncommunicating hydrocephalus, large head, spina bifida
difference between Tourrettes and Chronic tic syndrome
Tourettes: both motor and vocal(phonic tic)
________
Chronic tic syndrome : one or the other for greater than a year
What do you tell a pt going through on off phenomenom of parkinsons treatment?
Its unpredictable
thought to be due to closing therapuetic window
Upper vs Lower motor neuron problem
Upper: Babinski sign, hyper reflexia
Lower: fasiculations atrophy
