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Dr. Mel - Neurology > UWorld 2017 > Flashcards

UWorld 2017 Flashcards

1
Q

Innervation of the 2 skeletal muscles of the middle ear

A

Stapedius muscle: CN VII

Tensor tympani muscle: CN V3

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2
Q

Highly lipophylic drugs (Propofol, …)

A

Quickly accumulating in tissues of high blood flow (rapid onset of action)
Redistribution to organs of low blood flow (short duration of action)

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3
Q

2 drugs used as monotherapy to ttt spasticity secondary to brain or spinal cord disease

A

Baclofen (GABA-B receptor agonist)

Tizanidine (alpha2-adrenergic agonist)

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4
Q

1 drug indicated + 3 to avoid in ttt of insomnia in elderly

A

Ramelteon (melatonin agonist)

Antihistamines
Sedating antidepressants
Benzodiazepines

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5
Q

Gene mutations ass w/ familial Alzheimer ds

A

Early-onset familial AD: APP (ch 21), presenilin 1, presenilin 2

Late-onset familial AD: apolipoprotein E4 genotype

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6
Q

1 ttt for acute migraine + 3 ttts for prophylaxis

A

Serotonin agonist 5HT1B/5HT1D (postsynaptic S receptor ag)

Anticonvulsivants
Antidepressants
Beta blockers

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7
Q

1 drug for absence + 1 for absence and tonic-clonic seizures

A

Sodium valproate

Ethosuximide

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8
Q

4 clinical findings in Tabes dorsalis (late form of neurosyphilis)

A

Sensory ataxia
Lancinating pains
Neurogenic urinary incontinence
Ass w/ Argyll Robertson pupils

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9
Q

Onset of action of gas anesthetic

A

Depends on its solubility in blood (blood/gas partition coefficient)
High coeff, more soluble in blood, slower equilibration with brain, longer onset time

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10
Q

MOA of opiate analgesics

A

Activation of presynaptic mu recept: closure of voltage-gated Ca2+ ch + reduced excitatory neurotransm

Binding to postsynaptic mu recept: opening of K+ ch + membrane hyperpolarization

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11
Q

Treatment of severe atropine toxicity (anticholinergic)

A

Tertiary amine: physostigmine (reverse CNS + periph symptoms) is the ttt

Quartenary ammonium: neostigmine and edrophonium (anticholinesterase) limit CNS penetration

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12
Q

Adverse effects of Levodopa/carbidopa

A 
Carbidopa reduces most of periph side eff of levodopa
Behavioral changes (anxiety, agitation) can worsen
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13
Q

MOA of ethosuximide

A

Phenytoin, carbamazepine, valproic acid: reduce Na ch recovery from inactivation
Ethosuximide: block T-type Ca ch in thalamic neurons

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14
Q

Serotonin syndrome

A

Confusion, agitation, tremor, tachycardia, HTN, clonus, hyperreflexia, hyperthermia, diaphoresis
By overdose of SSRIs esp combined w/ MAOinh
Tryptophan: precursor for serotonin
Ttt: cyproheptadine (antihistamine+antiserotoninergic)

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15
Q

Topical capsaicin

A

For neuropathic pain
Causes defunctionalization of afferent pain fibers + depletion of substance P
Initially: burning + stinging sensation
Chronic use: reduces pain transmission

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16
Q

Treatment of status epilepticus

A

Initial: IV Lorazepam then Phenytoin
Lorazepam: enhance effect on GABA-A recept, increase Cl influx
Phenytoin (long-acting, reduces Na ch recovery from inactivation, inhibits neuronal high-frequency firing)

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17
Q

Solubility of anesthetics

A

Arteriovenous concentration gradient reflects overall tissue solubility
High solubility, large AV concentration gradient + slow onset of action

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18
Q

Broad-spectrum + narrow-spectrum anticonvulsants

A

Broad: (lamotrigine, levetiracetam, topiramate, valproic acid) for most seizure types (focal or generalized)
Narrow: (carbamazepine, gabapentin, phenobarbital, phenytoin) for focal seizures or focal secondarly generalized

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19
Q

Potency of inhaled anesthetic

A

Inversely proportional to MAC

MAC (minimal alveolar concentration) = conc. of anesth in alveoli that renders 50% of ptts unresp to pain

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20
Q

DRESS (Drug reaction + eosinophilia + systemic symptoms) syndrome

A

2-8 weeks after exposure to high-risk drugs
Phenytoin, carbamazepine, allopurinol, sulfasalazine, minocycline, vancomycin
Fever, generalized lymphadenopathy, facial edema, diffuse skin rash, eosinophilia, internal organ dysfunction

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21
Q

Vitamin E deficiency

A 
Neuro symptoms (mimic Friedreich ataxia)
Ataxia (degen of spinocerebellar T)
Loss of position + vibration sense (degen of dorsal columns)
Loss of deep tendon reflexes (periph nerve degen)
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22
Q

CN III palsy (anatomy + presentation)

A

Between post cerebral + superior cerebellar arteries
Compression from ipsilateral post communicating artery aneurysm
Injury: mydriasis (superf parasymp fiber) + diplopia, ptosis, down+out (somatic efferent fiber)

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23
Q

Alzheimer disease

A

Neurofibrillary tangles + amyloid-beta plaques

Trisomy 21: 3 copies of APP (Amyloid Precursor Protein) gene; increase amyloid-beta accumulation; high risk for Alzh

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24
Q

Mechanism of neurodegenerative disorders (Parkinson, Alzheimer)

A

Ubiquitin undergoes ATP-dep attachment to proteins labelling them for degradation
Modified proteins enter proteasome: degraded
Impaired ubiquitin-proteasome system: neurodegen disorders

25
Q

Amyloid Precursor Protein processing (alpha+gamma secretases)

A

Inappropriate processing: beta+gamma secretase
Gives beta-amyloid
Insufficient clearance of beta-amyloid: extracellular accumulation, neurotoxic, Alzheimer dementia

26
Q

Cavernous sinus thrombosis

A

Infection of medial face, sinuses (ethmo, spheno), teeth
Spread through valveless venous system into cavernous sinus: thrombosis
Headache, fever, proptosis, ipsilateral deficits in CN III,IV,VI,V1,V2

27
Q

Von Recklinghausen (NF-1)

A

Peripheral nervous system tumor syndrome

Neurofibromas, optic nerve gliomas, Lisch nodules (iris), café-au-lait spots

28
Q

NF-2

A

Nervous system tumor syndrome
Bilateral cranial nerve VIII schwannomas
Multiple meningiomas

29
Q

Sturge-Weber syndrome (encephalotrigeminal angiomatosis)

A

Neurocutaneous disorder
Cutaneous facial angiomas (over CN V1, V2 distributions)
Leptomeningeal angiomas
Mental retardation, seizures, hemiplegia, skull radiopacities

30
Q

Tuberous sclerosis

A 
Kidney, liver, pancreatic cysts
Cortical + subependymal hamartomas (not angiomas) - seizures
Cutaneous angiofibromas
Renal angiomyolipomas
Cardiac rhabdomyomas
31
Q

von Hippel-Lindau disease

A

Cerebellar hemangioblastoma

Congenital cysts of kidneys, liver, pancreas

32
Q

Myotonic dystrophy

A

Increased number of trinucleotide repeat (CTG) on myotonia-protein kinase gene
Sustained muscle contraction (myotonia) + weakness + atrophy (type 1 fibers)
Cataracts, frontal balding, gonadal atrophy
# Duchenne (necrosis of muscle fibers + fibrofatty replacement)

33
Q

Denervation muscle atrophy, inflammatory myopathy, ion channel myopathy

A

Denervation: axonal destruction (trauma, ischemia, ALS); paralysis+atrophy
Inflammatory: dermatomyositis, polymyositis
Ion channel: myotonia, hypotonic paralysis (w/ exercise); no atrophy; PAS-positive

34
Q

Epidural hematoma

A

Rare complication of epidural anesthesia
After few hours to days
Sudden back pain or radicular pain
Progression to partial/complete paralysis of lower extremities

35
Q

Ischemic injury in brain tissue vs other organs

A

Brain: liquefactive necrosis
Organs: coagulative necrosis

36
Q

Activation of GABA-A receptors

A

Increase conductance of Cl- ions (enter)

Hyperpolarization of membrane potential

37
Q

Chronic opioid use

A

Dev of tolerance to analgesic effects + most side effects
Exception of constipation + miosis
Prophylaxis ttt w/ fluid intake + laxatives

38
Q

GFAP + Synaptophysin

A

Synaptophysin: presynaptic vesicles of neurons, neuroendocrine, neuroectodermal cells
GFAP: astrocytes, oligodendrocytes, ependymal cells (glial origin)

39
Q

Lesions resp for decerebrate vs decorticate posturing

A

Decerebrate: damage to brainstem at/below red nucleus (midbrain tegmentum or pons)
Decorticate: damage to structures above red nucleus (hemispheres, internal capsule)

40
Q

Vitamin B12 and folic acid deficiencies

A

Similar hemato symptoms
Neuro dysfunction only in vit B12 def
Neuro dysfunction worsen if vit B12 def is ttt w/ folate alone

41
Q

Neurosyphilis

A

Different manif
Tabes dorsalis: degen of dorsal columns + dorsal roots of spinal cord (loss of proprioception + vibration, ataxia)
Argyll Robertson pupils

42
Q

Dysfunction/obliteration of subarachnoid villi

A 
Communicating hydrocephalus (symmetrical enlargement of ventriculi)
Sequelae of meningeal inf (tuberculosis meningitis, ...)
Sequelae of subarachnoid/intraventricular hge
43
Q

Activation of muscarinic receptors

A

Endoth cells: NO + peripheral vasodilation; smooth muscle relaxation, hypotension
Other sites: smooth muscle contraction

44
Q

Structures entering superior orbital fissure

A 
CN III
CN V1
CN IV
CN VI
Superior ophthalmic vein
45
Q

Anatomy of area postrema

A

Dorsal medulla near 4th ventricle

46
Q

Beta-endorphin

A

Endogenous opioid

Derived from POMC (like ACTH + MSH)

47
Q

Wallerian degeneration

A

Axonal degen + breakdown of myelin sheath distal to injury
No axonal regen in CNS bcz persistence of myelin debris, secretion of neuronal inhib factors, dev of dense glial scarring

48
Q

Creutzfeldt-Jacob ds

A

Rapidly progressive dementia + myoclonic jerks

Multiple vacuoles in gray matter

49
Q

Neuroblastoma

A

Extracranial, from neural crest cells of adrenal medulla
Abdo mass
High catecholamine breakdown products
Paraneopl sd: opsoclonus-myoclonus

50
Q

Wernicke encephalopathy + Korsakoff psychosis

A

Acute VitB1 def: Wernicke (mamillary body lesion, part of Papez circuit) = triad (confusion, ataxia, oculomotor dysfct)
Chronic VitB1 def: Korsakoff (permanent memory loss + confabulation)

51
Q

Locus ceruleus

A

Brainstem nucleus in post rostral pons near lateral floor of 4th ventricle
Principle site of NE synthesis in brain
Projects to all CNS parts: control mood, arousal, sleep-wake states, cognition, autonomic fct

52
Q

Pilocytic astrocytomas vs medulloblastomas

A

Both: in cerebellum
Piloc astr: cystic + solid components
Medullobl: solid component

53
Q

MOA of normal pressure hydrocephalus

A

Distortion of periventricular white matter

Bladder control: influenced by descending cortical fibers (pass in distended paraventricular area) - urge incontinence

54
Q

Most common causes of meningitis

A

Viral: enteroviruses, arboviruses, HSV-2
Bacterial - adults: Strep pneumo, N meningitidis
Bacterial - neonates: group B strep, G- bacilli

55
Q

Epidural hematoma

A

Tear in middle meningeal artery
Ass w/ bone fracture
Between bone + dura mater
Lucid interval before clinical presentation, then loss of consciousness

56
Q

Idiopathic intracranial HTN (pseudotumor cerebri)

A

Daily headache
Bilat symmetric papilledema
Transient visual disturbances
High intracranial pressure: optic N compression, impaired axoplasmic flow + optic disc edema

57
Q

Fetal toxicity of Valproate

A

Decreases folic acid

Increases risk of neural tube def (meningoc, myelomeningoc)

58
Q

Bell’s palsy

A

Unilateral facial paralysis
Decreased tearing
Hyperacusis
Loss of taste sensation over anterior 2/3

Dr. Mel - Neurology (3 decks)

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