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NMSP > Week 1 (Exam 1) > Flashcards

Week 1 (Exam 1) Flashcards

1
Q

Strong risk factors for taking triptans

A

Ischemic heart dz, Raynaud’s, HTN, hemiplegic or basal migraine, renal or hepatic impairment, MAOIs or other 5-HT1 agonists

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2
Q

Bulbar ALS

A

Degeneration of lower brainstem cranial motor nuclei
Occurs early, progresses rapidly
Deglutination and phonation difficulties

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3
Q

How do you treat an acetaminophen overdose?

A

Acetylcysteine: substitutes for depleted glutathione

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4
Q

What do glucose levels look like in bacterial meningitis?

A

Decreased: below 50

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5
Q

Acetaminophen MOA

A

Inhibits PGs in the CNS, but not in the periphery

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6
Q

Bat-Wing lateral ventricles

A

Agenesis of the Corpus Callosum

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7
Q

Toxicities of Carbamazepine

A 
Induces CYP450 (induces auto-induction)
Leukopenia / neutropenia / thrombocytopenia
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8
Q

What does Tau do?

A

Hyperphosphorylated, Axonal Microtubule-Associated protein that enhaces its assembly
MAP2 and Ubiquitin?

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9
Q

What brain regions are primarily affected by CO poisoning?

A

II and V of cerebral Cortex
Sommer’s Sector
Purkinje cells
Bilateral Necrosis of Globus Pallidus

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10
Q

What anti-epilleptic drugs cause accumulation of the parent drug (especially when used together)?

A

Valproic Acid and Lamotrigine

They inhibit conjugation of drugs by UGT

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11
Q

Most common sources of metz to the brain (highest to lowest)

A

Lung, breast, melanoma

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12
Q

Neurofibrillary Tangle Histology

A

Pyramidal Neurons: “Flame”
Round Nucleus: “Globose”, Basket Weave around it
Basophilics: Bielschowsky Stain (silver stain)
Resistance to clearance in vivo: “Ghost” or “tombstone”

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13
Q

3 etiologies of Hydrocephalus

A 
Increased production (in choroid plexus)
Obstruction (Intraventricular foramina, congenital, infections)
Decreased absorption
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14
Q

Where do people usually get brain tumors?

A

Adults are supratentorial

Kids are infratentorial, cerebellum and brainstem

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15
Q

GAD-stimulating drugs (pre-synaptic)

A

Valproic Acid
Gabapentin
Pregabalin

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16
Q

Schwannoma

A

Cerebellar Pontine Angle
Acoustic Neuroma: CN VIII, Tinnitus and Hearing loss
NF2: Loss of Merlin

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17
Q

Pyogenic Meningitis

A

Supprative exudate covering brainstem and cerebellum

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18
Q

Toxicities of Donepezil

A

Altered cardiac conduction
N/V diarrhea
Abrupt discontinuation problems
can worsen peptic ulcer, asthma/COPD, bladder outflow obstruction

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19
Q

What neoplastic disease is associated with HIV?

A

Primary CNS Lymphoma

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20
Q

What does Leptomeningeal fibrosis cause?

A

Hydrocephalus

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21
Q

Source of Embolus involving Patent Foramen Ovale

A

From Venous System, Bypasses Lungs via PFO straight to Brain: Paradoxical

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22
Q

Gaba-T inhibiting Drugs (pre-synaptic)

A

Vigabatrin

Valproic Acid

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23
Q

Protozoa causing Chronic Granulomatous Meningoencephalitis

A

Acanthamoeba

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24
Q

Sites of primary thrombosis

A

Carotid Bifurcation
Origin of MCA
Either end of Basilar A

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25
Q

Presentation of NMDA encephalitis

A

Most commonly in young or middle aged women

Commonly associated with teratoma

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26
Q

Safinamide

A

Reversible MAO-B inhibitor for Parkinsons

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27
Q

What 4 drugs are associated with Osteopenia / Osteoporosis and why?

A 
Carbamazepine
Phenytoin
Phenobarbital
Valproic Acid
Induce CYP450-dependent Vitamin D catabolism
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28
Q

HSV-1 Encephalitis

A

Children and young adults
Necrotizing and Hemorrhagic
Inferior and Medial Temporal Lobes (cingulate gyrus)
Cowdry Type A intranuclear viral inclusions

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29
Q

Donepezil MOA

A

Reversible, noncompetitive inhibition of centrally active acetylcholinesterase to treat Alzheimer dementia (off label for other types

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30
Q

How to treat sialorrhea associated with parkinsons

A

Botulinum toxin A injection into salivary glands

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31
Q

Black box warnings for Dihydroergotamine

A

All ergot alkaloids are contraindicated with potent inhibitors of CYP3A4
Concominant use associated with increased risk of vasospasm leading to cerebral/extremity ischemia

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32
Q

Tolcapone MOA

A

Selective and reversible inhibitor of COMT (degrades levodopa when decarboxylase is blocked)

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33
Q

Memantine MOA

A

NMDA receptor antagonist: decreases glutamate via Mg site binding
Tx Alzheimers, can combo with Donepezil

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34
Q

Turcot Syndrome:

A

Medulloblastoma or glioblastoma

Mutations in APC or mismatch repair genes

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35
Q

Etiology of Vasogenic Edema

A

Often follows Ischemic Injury

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36
Q

B12 deficiency presentation

A

Anemia, Numbness, Tingling and slight Ataxia in LE
Rapid progressio to spastic weakness of LE
Becomes Complete paraplegia (point of no return)

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37
Q

Tension headache presentation

A

Mild to moderate (does not prohibit daily activity)
Bifrontal, Bioccipital (neck, shoulders, band-like)
Dull, aching, squeezing, pressure
No prodrome or aura

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38
Q

How does Central Chromatolysis come about?

A

Nissl removed from center of cell to periphery

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39
Q

Classic migraine presentation

A

Aura: 15-30 minutes (visual sx or other neuro)

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40
Q

Kernohan’s Notch Phenomenon

A

Transtentorial Herniation presses the cerebellar peduncle against the tentorium cerebelli.
Ipsilateral Hemiparesis or Hemiplegia (Right herniation = left peduncle notch = right motor impairment)

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41
Q

Duloxetine MOA

A

Tricyclic Antidepressant: NE and 5HT reuptake inhibitor

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42
Q

Lasmiditan MOA

A

High affinity and selective for 5HT1F receptor agonist
Decreases stimulation of trigeminal system
Treats migraines without causing vasoconstriction

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43
Q

Warm, fresh water brain-eating ameba

A

Naegleria Fowleri

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44
Q

Pathophysiology of CTE

A

Accumulation of p-Tau as neurofibrillary tangles, b-Amyloid

Depigmentation of Substantia Nigra

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45
Q

Etiology of Primary CNS Lymphoma

A

Immunosuppressed (think AIDS)

CD20+ B cell origin (often EBV infected)

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46
Q

What does M. Tb do in chronic meningitis?

A

Obliterative Endarteritis in Subarachnoid Space (gelatinous or fibrinous exudate)
Obliterates Cisterns and encases CNs (CN sx)
Tuberculoma (inactive lesions can Calcify)
Stains Acid Fast

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47
Q

GAT-1 inhibiting Drug (pre-synaptic)

A

Tiagabine

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48
Q

Felbamate MOA

A

NMDA receptor antagonist (for epilepsy)

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49
Q

Histology of AT/RT

A

+EMA and Vimentin
Divergent differentiation
Rhabdoid cells (eosinophilic cytoplasm with sharp borders and eccentric nucleus)

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50
Q

What cells are responsible for demyelination seen in MS and how?

A

TH1: secrete IFN-y which activates Macrophages (PAS+)
TH17: recruited Leukocytes
CD4

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51
Q

Ependymoma presentation

A

First two decades of life
4th ventricle is decrete, exophytic, enhancing
Supratentorial (cystic and paraventricular)
Ependymal rosettes (true) more dx than perivascular

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52
Q

Paretic Neurosyphilis

A

Insidious, associated with mood alterations, delusions of grandeur, ends with dementia
Associated with Granular Ependymitis (proliferation of subependymal glia under damaged ependymal lining, hydrocephalus)

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53
Q

What causes PML?

A

JC Polyomavirus

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54
Q

Subfalcine (cingulate) Hernia

A

Cingulate Gyrus displaced under the falx

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55
Q

How does aspirin become toxic?

A

Salicylates uncouple ox phos
Respiratory center thinks there’s no ATP
Hyperventilation, Resp Alkalosis
Depleted Bicarb, Metabolic Acidosis

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56
Q

Ziconotide black box warnings

A

Severe psychiatric sx and neurological impairment

Hightened risk of harming patient when used in error

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57
Q

Choroid plexus papilloma

A

Most common in children, lateral ventricles

Hydrocephalus: obstruction or CP carcinoma (more CSF)

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58
Q

Hirano Bodies

A

Elongated Glassy Eosinophilic Bodies, Lots of Actin

Abundant in Alzheimers

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59
Q

What drug is both a Na channel blocker and an AMPA receptor blocker?

A

Topiramate
(the other is perampanel, but just does AMPA blocking)
This treats epilepsy

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60
Q

What complication of Meningococcemia is deadly?

A

Adrenal Hemorrhage

This is Waterhouse-Friderichsen Syndrome

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61
Q

What parts of the spine are involved in Tabes Dorsalis?

A

Gracile Fasciculus: Ipsilateral Leg

Cuneate Fasciculus: Ipsilateral Arm

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62
Q

How does capsaicin treat pain?

A

Stimulates TRPV1 to deplete substance P
Same as Camphor
Menthol does TRPM8

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63
Q

Treatment for trigeminal neuralgia

A

Carbamazepine or Oxcarbamazepine

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64
Q

Indications for Tramadol

A

Management of severe pain

Off label for RLS and premature ejaculation

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65
Q

Meningioma WHO 1 presentation

A

Compresess brain, penetrates bone
Radiation induced
Usually happens after your 30s

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66
Q

Acetaminophen benefits

A

does not combat inflammation: No GI ulcers, No platelet suppression, No renal impairment

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67
Q

Testing for MS

A

MRI of the head, CT, Spine: Ovoid lesions

Lumbar puncture: Oligoclonal bands and/or high IgG

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68
Q

Red Stroke

A

Hemorrhagic, Intra-cerebral or sub-arachnoid
Emboli associated, Venous
Secondary to Reperfusion

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69
Q

Primidone

A

Treats non-PD tremor

Barbiturate and anticonvulsant

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70
Q

Histology of Leigh Syndrome

A

Spongiform periventricular brain tissue with vascular proliferation

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71
Q

Anterior Cerebral Arterydeficits

A 
Alien Hand
Contralateral Leg (more than arm or face)
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72
Q

Where does CMV localize?

A

Paraventricular Subependymal Regions

Causes Radiculoneuritis in lower spinal cord and roots

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73
Q

Apomorphine

A

DA agonist, sublingual film or sub Q injection for episodes (Parkinson’s)

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74
Q

Drug classes that enhance Post-Synaptic GABA-ergic neuronal transmission

A
  1. Barbiturates (phenobarbital / Primidone)
  2. Benzos
  3. Topiramate
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75
Q

Carbidopa MOA

A

Immediate precursor to DA, but can cross BBB
Peripheral DOPA decarboxylase inhibitor
Can combo as Carbidopa + Levodopa + Entacapone

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76
Q

SSPE

A

Widespread Gliosis and Myelin Degeneration

Viral inclusions, NF tangles

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77
Q

Findings in Pick Disease

A

Asymmetric atrophy of Frontal and Temporal Lobes with Sparing of Posterior 2/3 of superior temporal gyrus
KNIFE-EDGE thin GYRI

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78
Q

What shape is Neisseria meningitidis?

A

G- Diplococci

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79
Q

White Stroke

A

Bloodless, Thrombus associated w/ atherosclerotic lesions

Arterial

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80
Q

What does PML preferentially affect?

A

Oligodendroglial cells: demyelination of subcortical area

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81
Q

Treat Parkinsons patientorthostatic HPTN

A

a-Agonists and mineralocorticoids

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82
Q

Toxicities of CArbidopa

A

GI effects, Postural HPTN, Arrhythmias, etc

Wearing-off and On-Off Phenomena

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83
Q

Fronto-Temporal Dementias WITHOUT Tau pathology

A

Vascular Dementia

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84
Q

Genetics of Friedreich Ataxia

A

AR GAA trinucleotide repeat on Chr 9q13

FRATAXIN protein

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85
Q

Presentation of TSC

A

Hamartomas Renal Angiomyolipomas, cardiac rhabdomyomas, cutaneous lesions, Candle guttering (drop-=like masses bulge into ventricles)

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86
Q

Presentation of Parkinson Dz

A

Diminished Facial Expression
Festinating Gait (short, fast steps)
Pill-Rolling Tremor
Lewy bodies

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87
Q

Phenytoin adverse effects

A

Induces CYP450
Gingival Hyperplasia
Hypocalcemia / Vit D/ Osteoporosis
Zero-Order: Saturable pharmacokinetics

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88
Q

Celecoxib MOA

A

Inhibits COX2 only

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89
Q

When treating restless leg, how do you choose which therapy to give which patients?

A

Comorbid depression / obesity: DA agonist (ropinirole)
No comorbidies, pain, anxiety, insomnia, addiction problems: a-2-delta Ca channel ligand (gabapentin)
Intermittnent disabling: DA agonist, C/Levodopa, benzos
Pregnant: Fe supp/non-pharm, Clonazapam, C/Levodopa

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90
Q

Toxicities of Memantine

A

Confusion, Dizziness, Headache
Skin Hypersensitivity rxn
Avoid abrupt discontinuation

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91
Q

Neuromyelitis Optica

A

Synchronous Bilateral Optic Neuritis and Spinal Cord Demyelination
Ab to Aquaporins (maintain astrocyte food processes, blood brain barrier)
Try to Tx by decreasing Abs w/ Plasmapharesis

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92
Q

Marantic Emboli

A

Proteinaceous

From Non-Bacterial Thrombotic Endocarditis, Hypercoaguable state (like advanced malignancy)

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93
Q

Signaling groups of Medulloblastoma (IV/IV)

A

WNT (older kids, Chr 6, b-Catenin, 90% survival)
SHH (MYCN amp, intermediate between WNT and 3/4)
Grp 3: MYC amp and 17(i17Q), infants and children, worst
Grp4: I17Q, no MYC, +/- MYCN, intermediate

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94
Q

Histology of Wericke Encephalopathy

A

Foci of hemorrhage and necrosis in mammillary bodies and walls of 3rd and 4th ventricles

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95
Q

Tumor grading

A

I: low proliferative potential, try resecting it
II: infiltrative, cytological atypic
III: Anaplasia and Mitoses (Radiation / chemo)
IV: Microsvascular proliferation / necrosis (fatal)

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96
Q

How do you treat Status epileptics?

A
  1. IV Lorazepam or Diazepam, 3-5 minutes add more
  2. IV Fosphenytoin + Valproic Acid + Levetiracetam + Phenytoin
    (no IV access? Midazolam)
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97
Q

Pilocytic Astroma appearance

A 
Well-circumscribed, Cystic with mural nodule
Hair-like with long bipolar processes
Rosenthal Fibers (long standing gliosis)
Eosinophilic Granular Bodies
GFAP positive
Bi-phasic: Loose Glial, Dense cellular
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98
Q

Indicators of diffuse axonal injury

A

Silver stain or amyloid precursor protein and a-Synuclein immunostains
Axonal Spheroids

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99
Q

What are neutrophil levels like in Bacterial Meningitis?

A

Over 100

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100
Q

Presentation of Friedreich Ataxia

A

Begins in first decade of life with Gait ataxia
Cardiac Arrhythmias, DM in 10%, Wheelchair 5 years in
Intercurrent Pulmonary Infections & Cardiac Dz

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101
Q

Why are barbiturates more lethal than benzos?

A

High doses of Barbiturates are GABA independent (benzodiazepines are GABA Dependent)

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102
Q

Receptors expressed on mengiomas

A

70% express Progesterone, 31% express estrogen receptors

this means that many have relief after delivering a baby

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103
Q

Selegiline MOA

A

Irreversible MAO inhibitor (B>A)

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104
Q

Genetics of pilocystic astrocytoma

A

First 2 decades of life, cerebral hemispheres or cerebellum

NF1 predisposes, loss of Neurofibromin in tumor

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105
Q

MOA of Topiramate

A
  1. GABAa Agonist (increases frequency)
  2. Fast inactivation of Na channels
  3. AMPA receptor Antagonist
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106
Q

Drug that has a side effect of Permanent, progressive, bilateral, concentric vision loss?

A

Vigabatrin: prescribable only via REMS program

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107
Q

HSV-2 Encephalitis

A

50% of neonates born by vaginal delivery to women with active primary HSV develop this

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108
Q

Fronto-Temporal Dementias WITH Tau pathology

A

Pick Disease

Progressive Supranuclear Palsy

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109
Q

How to treat psychosis associated with parkinsons

A

Quetiapine and clozapine, pimavanserin (5-HT2a inverse agonist)

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110
Q

7 responses to the increased CSF in hydrocephalus

A

PAPILLEDEMA
Absorption in transventricular and nerve root sleeves
Dilation of frontal and temporal horns
Elevation of Corpus Callosum
Thinning of cerebral mantle
Stretching, perforating Septum Pellucidum
Enlargement of Third Ventricle Downward

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111
Q

Tramadol MOA

A

Codeine analog: Partial u opioid agonist

NE and 5HT reuptake inhibitor (primary MOA)

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112
Q

Brain tumor with Rosenthal Fibers and teeth. It looks like machine oil when you drain it. What is this a reaction to?

A

Reaction to craniopharyngioma (this is astrogliosis)

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113
Q

What does Pneumococcal Meningitis cause?

A

Chronic Adhesive Arachnoiditis

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114
Q

Genetics of ALS

A

SOD1 dysfunction on Chr 21

Also TDP-43 is implicated on the chart

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115
Q

Signaling components of Limbic Encephalitis

A

ANNA-1 Ab: Anti Hu, Small cell lung CA
NMDA receptor: Ovarian Teratomas
VGKC-complex Ab: Peripheral neuropathy

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116
Q

Which Leukodystrophy is X-Linked?

A

Most are AR, but Adrenoleukodystrophy is X-Linked

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117
Q

Hygroma

A

Separation of arachnoid from dura from contraction of underlying brain parenchyma s/p infarct

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118
Q

Clinical applications of benztropine

A

Parkinsons: tremor and dystonia in younger people, without cognitive impairment
Reduces excessive saliva, drooling

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119
Q

6 agents that prolong Fast-Inactivation state of Na channels (for epilepsy)

A 
Carbamazapine (and other azepines)
Lamotrigine
Phenytoin
Topiramate*
Valproic Acid
Lacosamide (and other amides)*
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120
Q

Source of Embolus causing Dissection of Carotid or Vertebral

A

Atherosclerosis of Aortic Arch

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121
Q

Ketamine MOA

A

Non-competitive NMDA receptor antagonist (blocks glutamate)

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122
Q

Toxicities of Celecoxib

A

Same as Ibuprofen

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123
Q

Genetics of Secondary Glioblastoma

A

Preceded by lower grade lesion (TP53)

IDH1 (R132H mut has way better px) and IDH2

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124
Q

MERRF presentation

A

Myoclonus, Seizure Disorder, Myopathy
Ataxia (neuron loss from cerebellar system)
Ragged Red Fibers

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125
Q

“The scream” on histology

A

Ependymoma

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126
Q

Neurofibromatosis 1 genetics and function

A

AD 17q11 NF1 mut for neurofibromin gene

Usually regulates RAS signaling

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127
Q

Black box warnings for Ibuprofen

A

Fetal Renal Dysfxn, oligohydramnios ~20 wks
Closure of Ductus Arteriosus at 30+ weeks
Risk of MI, Stroke, contraindicated in CABG
Increased GI Bleeding

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128
Q

AT genetics

A

AR Chr 11q22-q23 making ATM gene

Fails to remove cells with DS DNA breaks

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129
Q

Pramipexole

A

D2 agonist like ropinirole

Decreased HPTN and somnolence but more hallucinations

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130
Q

Syndromes that comes with Thiamine (B1) deficiency

A

Wernicke: Psychotic, ophthalmoplegia, reversible
Korsakoff: Confabulation, irreversible
Beriberi: cardiac failure

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131
Q

Tapentadol

A

Stronger opioid, works at mu and blocks NE reuptake

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132
Q

What is the main thing affected in hypertensive cerebrovascular disease?

A

Lenticulostriate arteries: Lacunar Infarcts (Pure motor hemiparesis)
Thalamic Lacunae: Contralateral Sensory Deficits
Basal Ganglia Lacune: Hemiballismus

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133
Q

Indications for Sumatriptan

A

Moderate to severe migraine

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134
Q

Histology of PML

A

Irregular white matter destruction:
Subcortical area of demyelination with lipid-laden macrophages in the center with fewer axons
Enlarged oligodendrocyte nuclei (filled with virus parts)
Reactive Astrocytes

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135
Q

Presentation of Leukodystrophies

A

Diffuse involvement of White matter

Deterioration of motor skills, spasticity, hypotonia or ataxia

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136
Q

Tonsillar Hernia

A

Cerebellar tonsils displaced through Foramen Magnum

Life Threatening

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137
Q

VHL gene, lesion, features

A

VHL on chronic 3p25.3, decreases HIF-1, more VEGF

RCC, Hemangioblastoma, Pancreatic Endocrine Neoplasm, Polycythemia

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138
Q

Clonidine

A

a2-adrenoreceptor agonist used for HTN and as epidural pain relief

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139
Q

Antoni B Schwannoma

A

Hypocellular, Myxoid extracellular matrix

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140
Q

Vasogenic vs Cytotoxic Edema Fluid Dynamics

A

Vasogenic Increases Extracellular Fluid

Cytotoxic increases Intracellular Fluid

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141
Q

How does rabies get to the brain?

A

Binds at Ach receptors and ascends via motor nerves

142
Q

What drug is only used for absence (petit mal) seizures?

A

Ethosuximide

Only inhibits T-Type Ca Channels

143
Q

Where do most AVM’s occur?

A

Subarachnoid s[ace involving MCA and Posterior Branches

144
Q

CSF has High WBC, High protein, and normal glucose

A

Brain Abscess

145
Q

Antoni A Schwannoma

A

Spindle Cells, Verocay bodies (palisading nuclei around nuclear free zones)

146
Q

How to identify medulloblastoma (IV / IV)

A

Cerebellum, midline, occludes CSF flow

Sheets of anapestic cells, abundant mitoses, homer wright rosettes

147
Q

Soap Bubbles in brain

A

Cryptococcus

148
Q

What slows and reverses Cerebral Edema?

A

Corticosteroids

149
Q

Subdural Emphema

A

Infection of skull bones or sinuses, spreads to subdural space. Thrombophlebitis of bridging vessels can lead to infarct

150
Q

Periventricular Leukomalacia

A

Infarcts in Supratentorial White Matter

Pre-mature infants, chalky yellow plaques = necrosis and calcification

151
Q

Glioblastoma WHO grade

A

IV / IV

152
Q

All Anti-Epileptic drug warnings

A

Abrupt withdrawal can cause status epileptics

Suicidal behavior and ideation

153
Q

What does Borrelia Burgdorferi (lyme dz) do in chronic meningitis?

A

Rash, progresses to neuro sx in ~4 weeks
CN palsies and peripheral neuropathies
CSF: Abs, can cross rxn w/ mono, RA, SLE, etc

154
Q

What is the significance of an X chromosome Filamin A and Double Cortin Protein mutation?

A

Males: Lissencephaly
Females: Subcortical band heterotopias

155
Q

How does Astrogliosis present on histology?

A

Gemistocytes and Dead Red Neurons, Rosenthal Fibers

156
Q

What regions are affected by methanol poisoning

A

Selective bilateral putamen necrosis

157
Q

PCA-1 Ab

A

Subacute Cerebellar Degeneration

Anti-Yo, women with ovarian, uterine, breast CA

158
Q

Primidone MOA

A

Barbiturate

159
Q

How to slow cognitive decline associated with Parkinsons

A

Rivastigmine or donepezil (cholinesterase inhibitors)

Memantiine (NMDA antagonist)

160
Q

Atypical II/IV vs Anaplastic (malignant) II/IV Meningioma WHO1

A

Atypical: worse, clear and chordoid
Anaplastic: Papillary/Rhaboid subtypes, more mitoses

161
Q

Amitriptyline MOA

A

Tricyclic Anti-depressant

Inhibits NE and 5HT reuptake (off label for neuropathic pain)

162
Q

Macrophages are often in the CNS upon demyelination. What are these markers?

A

CD68 and CR3

163
Q

Huntington’s Brain

A

Decreased body of corpus callosum
Decreased head of caudate nucleus (putamen later)
Decreased Globus Pallidus

164
Q

Ubrogepant MOA

A

Calcitonin gene related peptide receptor antagonist
Inhibits pathologic dilation of intracranial arteries without unwanted vasoconstriction
Treats migraines without aura in adults

165
Q

Presentation of ALS

A 
50's
Early asymmetric weakness of hands - Dropping stuff
Fasciculations
Progressive Muscular Atrophy
Progressive Bulbar Palsy
166
Q

If non-aspirin NSAIDs are reversible, why should you use as little as possible?

A

They suppress platelet aggregation, but increase risk of MI and stroke

167
Q

Toxicities of Amitriptyline

A

Black box warning for suicidal thinking and behavior in young people (all tricyclics)

168
Q

Dihydroergotamine MOA

A

Binds serotonin, adrenergic, and DA receptors

Constricts blood vessels for migraines

169
Q

Tabes Dorsalis

A

Sensory nerve dmg in dorsal roots
Locomotor Ataxia, Loss of Pain Sensation, Charcot (damaged) Joints, Lightning Pains, Absence of DTRs
Form of Neurosyphilis

170
Q

Arnold Chiari Malformations

A

I: Silent, may impair CSF flow
II: Vermis Pushed through Foramen Magnum
Usually associated with Myelomeningocele

171
Q

MAO-A vs B

A

A preferentially metabolizes Norepi and 5HT

B preferentially does Phenylethlyamine and Benzylamine

172
Q

What cells are dominant in meningitis?

A

Earl on, PMNs. Late, Lymphs

173
Q

Pinecytoma vs Pineblastoma

A

Pinecytoma: well differentiated, LG usually adults
Pineblastoma: High grade, necrosis, mitoses, HG, usually kids, RB gene, spreads throughout CNS

174
Q

What is the major difference in targets between leukodystrophies and mitochondrial encephalomyopathies?

A

Leukodystrophies involve White Matter

Mitochondrial Encephalomyopathies involve Gray Matter and Skeletal Muscle

175
Q

Ziconotide MOA

A

selectively binds N-type voltage sensitive Ca channels on nociceptive afferent nerves of dorsal horn

176
Q

What is associated with chronic / malignant HTN?

A

Charcot-Bouchard Microaneurisms in basal ganglia

177
Q

Pilocytic Astrocytoma WHO grade

A

I / IV

178
Q

Most common Pineal Tumor

A

Germinoma

179
Q

Tay Sachs Presentation

A

Child born fine until 1 year old, degenerates mentally and physically until death at 2-3 years old
Cherry Red Spots in Maculae

180
Q

Acute Necrotizing Hemorrhagic Encephalomyelitis (ANHE)

A

Demyelination in young adults and children with recent upper respiratory infection
Fatal in most, deficits in survivors

181
Q

Neurofibromatosis 1 gene, lesion, features

A

NF1, Pheochomocytoma lesion

Neurofibromatosis, Cafe-au-lait spots, optic nerve glioma, iris nodules (lische)

182
Q

Genetics of AT/RT

A

Over 90% have Chr 22, HSNF5/INI1

Under 5 years old is highly aggressive, fatal within a year

183
Q

What do protein levels look like in bacterial meningitis?

A

50 - 1000 (increased)

184
Q

Internal Carotid Occlusion / Stenosis

A

ACA-MCA Watershed Infarct - Cortical border zone
Proximal arm and leg weakness
Transcortical aphasia (lots of starts and stops)

185
Q

Source of Emolus causing A Fib

A

Left Atrial Appendage

186
Q

Posterior cerebral artery deficits

A

Contralateral homonymous hemianopia

187
Q

Indications for Amantadine

A

Tx Parkinson’s drug-induced extrapyramidal sx
Adjunctive for dyskinesias w/ levodopa
Monotherapy for mild motor sx

188
Q

Genetics of Oligodendroglioma

A

IDH1 and 2 isocitrate dehydrogenase (most common and favorable px)
1P19Q loss, favorable px

189
Q

Clinically isolated syndrome

A

Monofocal or Multifocal (acute disseminated encephalomyelitis / ADEM)

190
Q

Riluzole

A

Only drug to impact ALS survival (months)
Unknown mechanism, inhibits glutamate release, blocks postsynaptic NMDA and Kainite-type glutamate receptors, inhibits voltage- dependent Na channels

191
Q

Heubner Arteritis

A

Obliterative Endarteritis associated with Meningovascular Neurosyphilis (causes communicating hydrocephalus)

192
Q

What kind of cells do you see in chronic Aseptic Meningitis caused by HIV?

A

Microglial Nodules with Multinucleated Giant Cells

193
Q

Bunina Bodies

A

PAS+ Cytoplasmic inclusions
Remnants of Autophagic Vacuoles
Found in ALS

194
Q

Diastatic Fracture

A

Crosses a Stuture

Later fracture lines don’t extend across previous fracture lines

195
Q

MOA of Ropinirole

A

Non-ergot
High affinity for D2 nd D3 DA receptors (
D3 relevance unknown, D2 increases DA

196
Q

Histology of Oligodendroglioma

A

Perineuronal Satellitosis, Perivascular Aggregation, Subpial accumulation of tumor cells
Perinuclear Halos (fried eggs, artifact)
Delicate Anastamosing Capillaries (chicken wire)

197
Q

Bilateral Schwannomas (CN VIII)

A

NF2

198
Q

Where do the venous and arterial systems bleed into in the brain?

A

Arterial into the epidural space (usually skull fracture)

Venous into Subdural space (usually slower)

199
Q

Aspirin MOA

A

Irreversible COX 1 and 2 inhibitor

Decreases PG’s and TxA2

200
Q

Source of Emolus causing Myocardial Infarction

A

Hypokinetic or Akinetic Areas

201
Q

Cerebral Malaria

A

Caused by Plasmodium Falciparum

Causes long-term cognitive defects in survivors

202
Q

Histology of Kearn-Sayre Syndrome

A

Spongiform change in Gray and White Matter

Neuronal Loss most evident in Cerebellum

203
Q

What type of Brian tumors do people usually get

A

Adults get glioblastoma (new onset seizure)

Children usually get medulloblastoma

204
Q

Clinical manifestations of N Meningitidis

A

Petechia, Purpura, septicemia

Hemorrhagic infarction of adrenal glands (Waterhouse Friderichsen Syndrome)

205
Q

Histology of TSC lesions

A 
Shagreen patches (localized thickenings)
Ash-Leaf patches (hypopigmented areas)
206
Q

Pregabalin Indications

A

Neuropathic pain (diabetic, SC injury)
Post-herpetic neuralgia
Adjunct for seizures
Fibromyalgia

207
Q

Where would you expect different bacteria to colonize different areas of the brain?

A

Pneumococcal Meningitis over convexities near saggital sinus, H Influenza usually basal

208
Q

Amantadine MOA

A

unknown mechanism, but we do know its a weak, noncompetitive NMDA antagonist
(this is for parkinsons)

209
Q

Bergman Gliosis

A

Proliferation of Astrocytes found in advanced ethanol abuse.

Happens between depleted granular cell layer and molecular layer

210
Q

Intraparenchymal Hemorrhage

A

In germinal matrix of premature infants
Junction between thalamus and caudate nucleus
goes into ventricles, then becomes sub-arachnoid

211
Q

Where would you target for Device aided therapies for parkinsons

A

Subthalamic nucleus or globus pallidus interna

212
Q

Colloid Cyst of 3rd ventricle

A

Young adults
Attached to roof of 3rd ventricle
Obstructs foramen of monro = non-comm. hydrocephalus
can be rapidly fatal, can be positional

213
Q

What are Ependymal Cells?

A

Ciliated Columnar cells, line the ventricles

Disruption causes granulations, damaged in CMV

214
Q

Acute Poliomyelitis

A

Anterior Horn Motor Neuron Nuronophagia

Causes Flaccid Paralysis

215
Q

Pregabalin MOA

A

Binds a-2-d on voltage gated Ca channels (modulates Ca influx at nerve terminals)
Does not bind to GABA

216
Q

Presentation of AT

A

Telangiectasias, Death in early 20s, Immunodeficiency

Many develop Lymphoid neoplasms, gliomas, carcinomas

217
Q

In practice, we often see elements of both vasogenic and cytotoxic edema. How does this present?

A

Flattened Gyri, Sulci Narrowed, Ventricles Compressed, can lead to HERNIATION

218
Q

Imaging of Kuru Plaque

A

Congo red and PAS+

Found in the cerebellum of vCJD cause by bovine spongiform encephalopathy

219
Q

Neurofibromatosis 2 genetics and function

A

AD 22q12 NF2 mut for Merlin gene

Usually integrates cytoskeletal signaling and acoustic neuromas

220
Q

Rasagiline

A

MAO-B selective irreversible inhibitor with greater potency and similar adverse effects of Selegiline
(parkinsons)

221
Q

Black box warning for Acetaminophen

A

Medication errors and overdose: Hepatotoxic, Death

222
Q

DHE (Raskin) protocol for headaches

A

Metoclopromide / prochlorperazine IV 60 sec
wait 5 min
DHE IV 60 sec, wait 3-5 min. Repeat if needed 8 hrs

223
Q

problems with CNS Ach muscarinic agonists given to tx parkinsons

A

Dementia (that’s why you don’t give it to old people)

224
Q

Problems with CNS D2 receptors given to tx parkinsons

A

Psychosis

N/V

225
Q

Presentation of VHL

A

Dizziness, headache
Visual Loss
Unilateral Ataxia

226
Q

Histology of HSV

A

Ground Glass Multi-Nuclei
Microglial Nodules
Intranuclear Inclusions
Margination of Chromatin

227
Q

Cystic (medulloblastoma is solid), biphasic architecture, lower cellularity

A

Pilocytic astrocytoma

228
Q

Identify chronic meningitis

A

Elevated protein, lymphocytes, low glucose for at least 4 weeks
M. Tuberculosis, Neuroborreliosis, Neurosyphilis

229
Q

Botulinm Toxin A

A

Tx non-PD tremor

Binds cholinergic terminals, decreases ACh

230
Q

Clinical applications for dexmedetomidine

A

Sedation of mechanically ventilated patients in ICU

231
Q

Source of artery to artery embolus

A

Stenosed ICA or Vertebral A

232
Q

Propranolol motor indication

A

Non-PD tremor

233
Q

CSF Findings in MS

A

Mildly elevated protein
Moderate Pleocytosis in 1/3
Increased IgG
Oligoclonal IgG bands (gamma region)

234
Q

Black box warning for Tolcapone

A

Risk for fatal acute fulminant liver failure

Only use in parkinsons w/ L-Dopa/carbidopa who have fluctuations and are not responding well to other stuff

235
Q

Perinatal Ischemic lesions I the depths of the sulci, causing thinned-out glycolic gyri

A

Ulegyria

236
Q

Identify a basilar skull fracture

A

Skull deformity, Raccoon eyes, Fluid drainage, Battle’s Sign (bruised rear neck)

237
Q

Cluster Headache presentation

A 
severe, excruciating
F:M 1:6
Associated with obstructive sleep apnea
100% unilateral, usually orbitotemporal
Frenetic, pacing, rocking
Ipsilateral ptosis, mitosis, conjunctivitis, lacrimation, runny or stuffed nose
238
Q

What is the K+ channel opener used to treat epilepsy?

A

Ezogabine

239
Q

Presentation of MELAS

A

Recurrent episodes of acute neurons dysfunction, cognitive changes
Muscle involvement with weakness and lactic acidosis
Stroke-Like episodes: reversible, not corresponding to specific vascular territories

240
Q

What cells do you see in hepatic encephalopathy?

A

Alzheimer’s Type II

241
Q

Thickened leptomeninges

A

Causes Obstructive Hydrocephalus

242
Q

Diagnostic sx of Rabies

A

Paresthesias around wound

also has negri bodies in purkinje cells

243
Q

Histology of Prion Disease

A

Spongiform Change: intracellular vacuoles in neurons and glia

244
Q

The only drug available for Primary Progressive M.S.

A

Ocrevus

245
Q

Multiple System Atrophy system involvement

A 
Striatonigral Circuit (results in Parkinsonism)
Olivopontocerebellar circuit (results in ataxia)
Autonomic NS (dsfxn like orthostatic HPTN)
246
Q

Why does CADASIL cause recurrent strokes and dementia?

A

Thickening of the media and adventitia, loss of SM cells, Basophilic PAS+ Deposits

247
Q

Adverse effects of amatadine

A 
CNS depression
Impulse control disorders
Psychosis
Suicidal Ideation / depression
Lived reticular (discoloration, usually legs)
248
Q

How to treat Parkinsons associated orthostatic HPTN

A

Midodrine (a-adrenergic agonist), Doperidone (peripheral D2 antagonist), Fludrocortisone (Mineralocorticoid)

249
Q

Adverse effects of aspirin

A

Ulcer, Bleeding, Drug interactions
Reye Syndrome in children
Increased Serum Creatinine

250
Q

Dysphagia, Dysarthria, Diplopia, Loss of Consciousness

A

Central Pontine Myelinolysis
Overly rapid correction of hyponatremia, severe electrolyte imbalance
Demyelinates Basis Points and Pontine Tegmentum symmetrically

251
Q

Wet, Wacky, and Wobbly

A

Normal Pressure Hydrocephalus

252
Q

NMDA encephalitis has at least one of these

A 
Abnormal EEG (extreme delta brush, epileptic, focal or diffuse slow or disorganized activity)
CSF with pleocytosis or oligoclonal bands and/or NMDA abs
253
Q

What kind of brain necrosis is associated with hypoglycemia?

A

Pseudolaminar Necrosis. Also selective for the large pyramidal neurons of cerebral cortex

254
Q

Transtentorial (uncinate, uncle) Hernia

A

Medial Temporal Lobe pressed against Tentorium

CN3: Dilated Pupil and Impaired Eye Movement

255
Q

What causes Chronic Meningitis?

A

Tuberculosis, Spirochetes (neurosyphilis and neuroborreliosis) or Cryptococcus

256
Q

MELAS genetics

A

Mitochondrial inheritance usually tRNA mutation

257
Q

Necrotic zone of toxoplasmosis

A

Free Tachyzoites and Encysted Bradyzoites at periphery

258
Q

Other reversible AChE inhibitors for dementia (besides doneepzil)

A

Rivastigmine: transdermal option

Galantamine

259
Q

Genetics of MS

A

DR2 links susceptibility

IL-2 and IL-7 receptor genes

260
Q

Trigeminal Autonomic Cephalgias

A

Unilateral trigeminal distribution of headaches

Cluster Headaches, SUNCT syndrome (short, unilateral, neuralgiform, conjunctivitis, tearing), Paroxysmal hemicrania

261
Q

Where do primary germ cell tumors occur?

A

Along Midline: Pineal (mostly men) and suprasellar

262
Q

Benzo vs barbiturate MOA

A

Benzos open Cl- channel with greater frequency, barbiturates open Cl- channel with greater duration

263
Q

CADASIL Genetics

A

AD NOTCH 3 Mutation (preferentially expressed in vascular smooth muscle)

264
Q

Intranuclear Neuronal Inclusions

A

Herpes Cowdry Bodies, CMV (both intranuclear and cytoplasmic)

265
Q

Histology Hallmarks of Glioblastoma

A
  1. Necrosis (serpentine)
  2. Pseudo-Palisading of cells around necrosis
  3. Vascular / Endothelial proliferation
266
Q

Intracytoplasmic neuronal inclusions

A

Lipofuscin

Rabies Negri Bodies, Alzheimers NF Tangles, Parkinson Lewey Bodies, CJD

267
Q

Gabapentin MOA

A

GABA analog that doesn’t bind GABA receptors

a2-d of voltage gated Ca

268
Q

(frequent) initial presentation of MS

A

Unilateral visual impairment (10-50% develop MS)

269
Q

Tay Sachs Genetics

A

HEXA gene ecoding Hexosaminidase A on Chr 15

Never goes away: GM2 Gangliosides

270
Q

How do you minimize the anti-platelet actions of Aspirin?

A

Take it 2 hours before other NSAIDs

The other NSAIDS counteract the platelet effects

271
Q

Expanded Roofless 4th Ventricle

A

Dandy Walker Malformation
Cerebellar Vermis absent or rudimentary, replaced with cyst that has ependymal lining contiguous with leptomeninges on outer surface

272
Q

What drug both prolongs the fast-inactivation and enhances the slow-inactivation state of Na channels

A

Lacosamide (for epilepsy)

273
Q

Duloxetine Indications

A

Off label for chemo-induced neuropathic pain, stress urinary incontinence

274
Q

Brain abscesses in Toxoplasmosis

A

near gray white junction and deep gray nuclei

275
Q

Rotigotine

A

D2 agonist like ropinirole

24 hour patch

276
Q

Medications for acute exacerbation in MS

A

High dose Corticosteroids

ACTH (actor gel) or IVIg who don’t tolerate traditional steroids

277
Q

Bromocriptine

A

Early DA agonist, ergot alkaloid derivative for parkinsons

278
Q

Ziconotide indications

A

only for chronic severe pain patients where intrathecal administration is warranted and when refractory to other treatments

279
Q

MERRF genetics

A

Mitochondrial inheritance

Most tRNA mutations (can overlap with MELAS)

280
Q

CSF in Chronic meningitis caused by cryptococcus Neoformans

A

Inda Ink Prep
Cryptococcal Polysaccharide Ag
Cellular immune dysfunction predisposes it

281
Q

Identify Primary CNS LYmphoma

A

Multifocal, Periventricular spread
Accumulate around vessels
Hooping: cells separated by reticulin

282
Q

Neurological deficits separated in time and separated in (white matter) space

A

MS. Gradual recovery, frequency decreases during course

283
Q

Pathophysiology of ALS

A

Loss of LMNs in spinal cord and brainstem
Loss of UMNs that project into corticospinal tract
Loss of anterior horn neurons, thin anterior roots

284
Q

What disorders do oligodendrocytes respond to?

A

PML: Intranuclear inclusions

Multiple System Atrophy (MSA): Cytoplasmic inclusions / a-Synuclein

285
Q

Genetics of Parkinsons

A

AD: a-Synuclein on Chr 4q21 causes CAG repeats

Juvenile AR: PARKIN

286
Q

What causes Subacute Sclerosing Panencephalitis (SSPE)

A

Paramyxovirus (measles [rubeola])

287
Q

Sommer’s sector

A

CA1 and CA2 regions of hippocampus

Most vulnerable to hypoxia

288
Q

Unfavorable form of oligodendroglioma (similar to glioblastoma)

A

Anapestic (III/IV): Vascular hypertrophy and necrosis

Increase grade with increased N:C, Mitoses, cellularity

289
Q

Gorlin Sydrome

A

Medulloblastoma

Mutations in PTCH gene: up regulates SHH

290
Q

NMDA encephalitis hits quick and has at least 4 out of these 6 sx:

A

Abnormal psych behavior or cognitive fxn
Speech dysfxn
Seizures
Movement disorder, dyskinesias, rigidity/ posture shit
Decreased level of consciousness
Autonomic dysfunction or central hypoventilation

291
Q

What is CMV opportunistic of?

A

AIDS (fetuses and immunocompromised)

292
Q

Genetics of Kearn-Sayre Syndrome

A

Sporadic Large Mitochondrial DNA deletion/rearrangement

293
Q

Alien Hand Syndrome

A

Semiautomatic movements of contralateral arm not under voluntary control
Associated with ACA deficits

294
Q

Common migraine presentation

A 
Moderate to severe
Women 3:1
Unilateral
Throbbing / sharp / pressure
Retreatment to dark, quiet room
No Aura
295
Q

Adverse effects of Ropinirole

A 
Dyskinesias
Impulse control disorders
Increased melanoma risk
Orthostatic HPTN
Psychotic effects
Somnolence
296
Q

Molar Tooth brain

A

Joubert Syndrome: Cerebellar Vermis Hypoplasia, Deepened Interpeduncular Fossa, Elongated Superior Cerebellar Peduncles

297
Q

Presentation of Kearn-Sayre Syndrome

A

Cerebellar Ataxia, Pigmentary Retinopathy, Cardiac Conduction Defects
Progressive inability to move eyes and eyebrows

298
Q

What Anti-epilleptic drugs induce conjugation by UGT and what does this mean?

A

Phenytoin, carbamazepine, phenobarbital

Cause reduction of parent drug

299
Q

Contrast Ring Enhancing Lesion with Hypodense Central Necrosis

A

Glioblastoma (IV/IV)

300
Q

Dexmedetomidine MOA

A

Selective a2-adrenoreceptor agonist
Inhibits norepinephrine release
vasoconstriction

301
Q

Most common cause of fungal meningitis

A

Cryptococcus

302
Q

Leigh Syndrome Presentation

A

Early Childhood Lactic Acidemia, Seizures, Extra-Ocular Palsies and Weakness with Hypotonia

303
Q

Sumatriptan MOA

A

Selective 5-HT1B and 5-HT1D agonist

Activates receptors on intracranial bv and sensory nerves of trigeminal system

304
Q

What drugs block the a2d subunit of P/Q type Ca channels?

A

Gabapentin and Pregabalin

305
Q

Treatment for Paroxysmal Hemicrania

A

Indomethacin

306
Q

Most important histopathologic indicator of CNS injury

A

Gliosis: Astrocyte Hypertrophy, Hyperplasia

307
Q

Black box warning for Selegiline

A

Antidepressants increased risk of suicidal thoughts and behaviors

308
Q

Aggregates recognized histologically as inclusions for three different degenerative CNS diseases

A

Huntingtoins: Polyglutamine Repeats
Alzheimers: B-Amyloid
Parkinsons: a-Synuclein

309
Q

Progressive Supranuclear Palsy

A

Truncal Rigidity with other CNS findings
2x in men, 50-70 y.o., Fatal within 5-7 years
Widespread Neuronal Loss, 4R Tau Straight filaments making Globose Neurofibrillary Tangles

310
Q

Post-Polio Syndrome

A

25 - 35 years after resolution of polio

Progressive weakness with decreased muscle mass and pain

311
Q

Li-Fraumeni Syndrome

A

Medulloblastomas, mutations in TP53

312
Q

Where does Meningioma WHO 1 happen?

A

Dura based: meningothelial origin of arachnoid (EMA+)

Intraventricular: from stroll arachnoid cells of choroid (Left Lateral ventricle favored

313
Q

Dilated ventricles, shrinking brain substance, normal pressure

A

Hydrocephalus Ex Vacuo

314
Q

Most common cause of bacterial meningitis

A

Strep Pneumoniae

315
Q

Valproic Acid MOA

A
  1. Na Channel Blocker
  2. Pre-synaptic GAD stimulator
  3. Pre-synaptic GABA-T inhbitor
316
Q

Copper-reducing agents (for Wilsons disease)

A

Penicillamine: copper chelator

K Disulfide: reduces intestinal absorption

317
Q

Histology of Viral Encephalitis

A

Perivascular Lymphocytic Cuffs

Microglial Nodules

318
Q

What is the blood supply of the Internal Border Zone

A

Between LCA and MCA (watershed)

319
Q

Middle Cerebral Artery deficits

A

Gaze Preference Toward Side of Lesion
Often have lacunas: small deep infarcts of penetrating branches
Aphasia, face-arm or other sensorimotor loss

320
Q

Indications for Carbidopa

A

Parkinsonian Syndrome

Off label for restless leg, other Parkinson-like conditions

321
Q

Morphology of ADEM

A

Myelin loss with relative axon preservation
Early is PMN, Later is Mononuclear
Accumulation of lipid-laden macrophages (from myelin breakdown)

322
Q

Devic’s Disease (Neuromyelitis Optica)

A

Inflammation and demyelination of optic nerves and SC
Test for Aquaphorin Abs in Blood and CSF
Steroids / plasma exchange, then immunosuppression

323
Q

Benztropine MOA

A

Cholinergic antagonist at muscarinic receptors like atropine (activates GABA)
Also blocks histamine receptors

324
Q

Chronic Migraine presentation

A

15+ days/mo
4 hours+
At least 3 mos

325
Q

4 cardinal features of Parkinsons

A

Bradykinesia
Muscular Rigidity
Resting Tremor
Impairment of postural balance: falls and bad gait

326
Q

Genetics of Meningoma WHO 1

A

NF2 (22q12): most common

TRAF7: second most common, lower grade, more stable

327
Q

Black box warnings for Tramadol

A 
Medication errors / OD
Addiction, abuse, misuse
Interactions with CYP450
Withdrawl
Respiratory depression (w/ benzos or other CNS stuff)
328
Q

What happens with CMV in Utero?

A

Periventricular Necrosis, leading to Microcephaly and Periventricular Calcification

329
Q

Areas associated with movement disorders in degenerative diseases

A 
Basal Ganglia (esp Nigrostriatal Pathway)
Brainstem
330
Q

What does CSF look like with a viral infection?

A

Clear and colorless

Cloudy or turbid in bacterial meningitis

331
Q

Large cells with paranuclear filamentous inclusions, problem with large cell Medulloblastoma

A

Atypical teratoid/Rhabdoid tumor

332
Q

Appearance of Oligodendroglioma

A

Primarily cerebral hemispheres

Calcification usually restricted to the cortex w/ curvilinear or pyriform distribution

333
Q

What deficiency is strongly associated with alcoholism?

A

B1 / Thiamine

334
Q

What are the two major responses of macrophages in the CNS?

A

Formation of Microglial Nodules

Neuronophagia

335
Q

Histology of B12 deficiency

A

Swelling of Myelin Layers, becoming vacuoles
Degeneration of Posterior Column Ascending Tracts and Descending Pyramidal Tracts = Subacute combined degeneration of SPC

336
Q

Syringomyelia (Syrinx)

A

Fluid filled cleft-like cavity in inner portion of cord

Loss of Pain and Temp sensation in upper body

337
Q

Histology of Meningioma WHO 1

A

Calcified Psammoma Bodies
En Plaque: sheet like spread of tumor along a surface
Whoreld Clusters of Monotonous Cells
Secretory subtype has PAS+ droplets in cytoplasm

338
Q

Perivascular Pseudorosettes, less cellular and more fibrillar than medulloblastoma

A

Ependymoma

339
Q

What are extradural abscesses usually associated with?

A

Osteomyelitis

Can cause cord compression (neuro emergency)

340
Q

Cowden genetics and presentation

A

AD 10q23 for PTEN gene / protein (IK3/AKT signaling)
Lipid phosphatase/benign follicular appendage tumors
Internal adenocarcinoma (often breast or endometrial)

341
Q

Ibuprofen MOA

A

Reversibly blocks COX 1 and 2

342
Q

Indications for Selegiline

A

Adjunct for Parkinsons with Levo-/Carbidopa

Off label for early parkinsons

343
Q

What drugs are used to block synaptic Vesicle 2A protein to treat epilepsy?

A

Levetiracetam

Brivarecetam

344
Q

Acute Disseminated Encephalomyelitis (ADEM)

A

Perivenous and Monophasic, follows Viral infection (or rarely viral immunization)
20% die, Lethargy, Coma. Survivors recover completely

345
Q

Glioma grading

A

Parameters: Nuclear Atypia, Mitoses, Necrosis, Microvascular proliferation
Grading: II (one parameter) III (anapestic, 2 parameters), IV (3-4 parameters)

346
Q

Presentation of Lgl1 encephalitis

A

More commonly in men
Sleep disturbance half the time
Temporal lobe (esp hippocampal) abnormality
Faciobrachial dystonic seizures (unilateral)

347
Q

What drug blocks T-Type Calcium channels in seizures and also blocks Na channels?

A

Zonisamidem

348
Q

Entacapone

A

Nitrocatechol COMT inhibitor with 0.8 hour half life

Cannot cross BBB: treats “off” sx

349
Q

Trihexyphenidyl

A

Anticholinergic for parkinsons, like benztropine

350
Q

Tuberous sclerosis genetics and function

A

AD 9q34 TSC1 gene for Hamartin mut
AD 16p13 TSC2 gene for Tuberin mut
Complex together to regulate mTOR/angiofibromas/mental retardation

351
Q

MCA-PCA Watershed Occlusion

A

Cortical Border Zone

Higher order visual processing deficits

352
Q

What co-morbitity skyrockets your chances of having early onset alzheimers

A

Down Syndrome

NMSP (7 decks)

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