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QBank Qs > Neuro 5 > Flashcards

Neuro 5 Flashcards

1
Q

What fetal abnormality can be seen in infants of mothers who take lithium during early pregnancy?

A

Ebstein’s anomaly: atrialized RV d/t downward displacement of tricuspid valve

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2
Q

What congenital anomaly is most likely to occur in pregnant pts who take valproate and why?

A

NTDs b/c valproate inhibits intestinal folic acid absorption

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3
Q

What 3 products are derived from POMC and what does this indicate?

A

B-endorphins, ACTH, and MSH - suggests there may be a close physiological relationship between stress axis and opioid system

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4
Q

What are 3 classic symptoms of pineal germinomas?

A
  1. precocious puberty: increased B-hDG
  2. obstructive hydrocephalus d/t compression of cerebral aqueduct
  3. Parinaud syndrome d/t compression of tectal area of the midbrain
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5
Q

Which hallucinogen presents with Sx of agitation, dissociation, hallucinations, violent behavior, and memory loss and PE findings of nystagmus and ataxia?

A

Phencyclidine

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6
Q

Which stimulant presents with Sx of euphoria, increased arousal, agitation, chest pain, headaches, and seizures and PE findings of tachycardia, hypertension, and mydriasis?

A

Cocaine

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7
Q

Which stimulant presents with Sx of agitation, psychosis, diaphoresis, and violent behavior with PE findings of tooth decay, HTN, tachycardia, and choreiform movements?

A

Methamphetamine

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8
Q

Which hallucinogen presents with Sx of visual hallucinations, depersonalization, euphoria, occasional dysphoria and panic and PE findings of mild tachycardia, milk HTN, and pt alert and oriented?

A

LSD

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9
Q

Which psychoactive drug presents with Sx of increased appetite, euphoria, slowed reflexes, and impaired time perception and PE findings of dry mouth, conjunctival injection, and mild tachycardia?

A

Marijuana

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10
Q

Which opioid analgesic presents wiht Sx of mild euphoria or lethargy to coma and PE findings of miosis, decreased respiratory rate, and decreased bowel sounds?

A

Heroin

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11
Q

What is the MOA of PCP?

A

hallucinogen that works as an NMDA antagonist leading ot excess release of excitatory NTs

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12
Q

Which vitamin deficiency leads to degeneration of spinocerebellar tracts, dorsal column of spinal cord, and peripheral nerves?

A

Vitamin E

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13
Q

Which vitamin deficiency presents with the triad of ataxia, confusion, and ophthalmoplegia?

A

Thiamine

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14
Q

What blood disorder causes acute abdominal pain, peripheral neuropathy, and hyponatremia?

A

acute intermittent porphyria

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15
Q

What disorder does severe vitamin E deficiency resemble?

A

Friedreich ataxia

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16
Q

What is the most common medical cause of excessive daytime sleepiness in the US?

A

obstructive sleep apnea

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17
Q

What are risk factors for obstructive sleep apnea?

A

obestiy, tonsillar hypertrophy, and hypothyroidism

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18
Q

What are Sx and PE findings of obstructive sleep apnea?

A

Sx: poor orophyrngeal tone leading to daytime sleepiness, morning headaches, and depression
PE: obesity and increased soft tissue in oropharynx

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19
Q

Which barbituate-like IV anesthetic agent is often used in surgery?

A

Thiopental

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20
Q

What is the cause of the short half life and rapid plasma decay of thipoental?

A

REDISTRIBUTION to other tissues throughout the body, such as skeletal muscle and adipose tissue

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21
Q

What is the course of CN III?

A

It exits the midbrain and courses between the PCA and superior cerebellar arteries

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22
Q

Aneurysm of which arteries can lead to a non-pupil sparing CN III palsy?

A

PCA or superior cerebellar a.

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23
Q

What type of injuries are GVE and GSE fibers of CN III susceptible to, respectively?

A

GVE: injury from compression (i.e. aneurysm and tumor) bc on outside of CN III

GSE: injury from ischemia (i.e. diabetes) bc on inside of CN III

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24
Q

A 34 yo swimmer presents with ear infection. While inspecting the pt, you insert a speculum into the external auditory meatus in close contact with its posterior wall. The pt faints during the procedure. Irritation of which of the following nerves was most likely induced?

A

CN IX - it does cutaneous innervation to the posterior part of the external auditory canal via small auricular branch and pt fainted d/t vasovagal syncope

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25
Q

What innervates most of the external auditory canal, including the external portion of the tympanic membrane?

A

auriculotemporal branch of CN V3

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26
Q

What innervates the inner surface of the tympanic membrane?

A

tympanic branch of CN IX

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27
Q

Ascending paralysis that starts a few weeks after an upper respiratory infection or GI infection is most likely d/t what infectious agent?

A

C. jejuni - Guillain-Barre syndrome

-acute demyelinating peripheral neuropathy

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28
Q

What is the pathogenesis of the ascending flaccid paralysis seen in Guillain-Barre syndrome?

A

Antibodies against the infectious agent cross-react with myelin of spinal roots and peripheral nerves which is accommpaned by an “endoneural inflammatory infiltrate” consisting of lymphocytes and macrophages

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29
Q

What is the pathogenesis of diabetic microangiopathy?

A

hyalinization of nerve arterioles leading to the narrowing of the arterial lumen and ischemic nerve injury

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30
Q

What disease is characterized by “endomysial” inflammatory infiltration that manifests with bilateral, symmetric weakness of proximal muscles?

A

Polymyositis

31
Q

What is seen on light microscopy in Guillain-Barre syndrome?

A

segmental demyelination of peripheral nerves and endoneural inflammatory infiltrate

32
Q

What is the difference between sublimation and altruism?

A

Sublimation converts negative emotions in to productivity, whereas altruism confers benefit others

33
Q

What are 4 TCA drugs?

A

imipramine, doxepin, amitriptyline, and clomipramine

34
Q

Why must TCAs be used with caution in pts who use them for short-term pain relief for painful diabetic neuropathy?

A

they may cause urinary retention d/t antagonism of central and peripheral muscarinic ACh receptors

35
Q

What are classic Sx of mytonic muscular dystrophy?

A
  • difficulty loosening a grip after a handshake or inability to release the doorknob
  • cataracts, frontal balding, and gonadal atrophy
36
Q

What is the genetic basis behind myotonic dystrophy?

A

abnormal CTG repeat that codes for a myotonia-protein kinase leading ot anticipation

37
Q

What is seen on light microscopy of myotonic dystrophy?

A

atrophy of Type 1 muscle fibers

38
Q

How is the Dx of tetanus made?

A

Clinically
-baed on Hx of penetrating wound in a pt who has not been vaccinated and clinical signs such as trismus, risus sardonicus, msucel spasrm, etc.

39
Q

What biochemical process undergoes ATP-dependent attachment to other proteins and labeling them for degradation - such as antigen processing, muscle wasting, cell cycle regulation, DNA repair, and disposal of misfolded proteins and regulatory enzymes?

A

Ubiquitin

40
Q

Impairment of what biochemical process can contribute to development of neurodegenerative disorders such as Parkinson and Alzheimer?

A

ubiquitin-proteasome system

41
Q

What is the effect of fluorinated anesthetics on the brain?

A

It leads to an increase in cerebral blood flow which can result in increased ICP

42
Q

What are the effects if inhalation anesthetics on the heart, lungs, liver, and kidney?

A

heart: myocardial depression and hypotension
lungs: respiratory depression
kidney: decreased GFR, increased renal vascular resistance, and decreased renal plasma flow
liver: decreased hepatic flow

43
Q

What are the two classes of DA agonists and what do they stimulate?

A
  1. ergot compounds: bromocriptine and pergolide

2. nonergot compounds: pramipexole and ropinirole

44
Q

How does amantadine work to alleviate Parkinson Sx?

A

It is an indirect and direct dopaminergic agent and enhances effects of endogenous dopamine bc thought to have some anticholinergic properties

45
Q

What is the action of selegiline for PD?

A

it is a MAO-B and decreases central DA degradation

  • MAO-B is present in the brain; therefore selegiline prevents degradation of DA in the brain
  • it delays clinical progression of PD
46
Q

What is the MOA of COMT inhibitors and dopa decarboxylase inhibitors?

A

both decrease breakdown of levodopa in peripheral tissues and increase the amount available to cross the BBB

47
Q

How do anticholinergics play a role in alleviated Parkinson Sx?

A

Trihexyphenidyl and benztropin inhibit central muscarinic receptors which treats drug-induced Parkinsonism and pts with tremors

48
Q

What is the MOA of reserpine?

A

it inhibits DA entry into presynaptic vesicles, causing a chemical sympathectomy which reduces BP and HR

49
Q

What is the MOA of guanethedine?

A

It is an adrenergic neuron blocker that inhibits NE release

50
Q

How do BBs aid in acute Tx of myocardial ischemia and what is an important AE?

A

BBs reduce BP and cardiac work; but when nonselective agents are used, bronchoconstriction may be seen

51
Q

What is a major cause of morbidity and mortality 4-12 days after a subarachnoid hemorrhage and how will the pt present?

A

vasopasm - will present with weakness in one arm and leg

52
Q

What med is prescribed to prevent vasospasm after subarachnoid hemorrhage?

A

Nimodipine - selective CCB

53
Q

What is the most dangerous complication of SAH and how will it present?

A

rebleeding: sudden development of a severe headache, severe N&V, change in consciousness, appearance of new neurologic deficits

54
Q

What is the drug of choice for alcohol withdrawal?

A

long0acting BZs, like diazepam or chlordiazepoxide

55
Q

What is the MOA of baclofen?

A

GABAb agnost used for spastic conditions

56
Q

What do signs of pain with ocular movement and decreased vision indicate?

A

optic neuritis

57
Q

What is intention tremor a sign of?

A

cerebellar dysfucntion

58
Q

What condition is optic neuritis and cerebellar dysfucntion commonly seen together?

A

MS

59
Q

What are the 3 most important mitochondrial myopathies?

A
  1. myoclonic epilepsy with ragged red fibers (MERRF)
  2. Leber optic neuropathy (blindness)
  3. mitochondrial encephalopathy with stroke-like episodes and lactic acidosis (MELAS)
60
Q

Why are ragged red muscle fibers seen in mitochondrial diseases?

A

abnormal mitochondira accumulate under the sarcolemma

61
Q

What are signs of common peroneal nerve injury and where does it occur?

A

signs: foot drop and high-stepping gait
location: trauma to leg near head of the fibula

62
Q

Branched-chain ketoacid dehydrogenase catalyzes decarboxylation of a-ketoacid derivatives of which aas?

A

leucine, isoleucine, and valine

63
Q

What is an AR disorder of tyrosine degradation caused by a deficiency of homogentisic acid oxidase leading to connective tissue hyperpigmentation and degenerative joint disease?

A

Alkaptonuria

64
Q

What are two causes of PKU?

A

deficiency of phenylalanine hydroxylase or its cofacter tetrahydrobiopterin

65
Q

What structures may be hypopigmented in PKU?

A

skin, hair, eyes, and catecholaminergic brain nuclei (substantia nigra, locus ceruleus, and vagal nucleus dorsalis)

66
Q

What CNS tumor has Homer-Wright rosettes?

A

medulloblastoma

67
Q

What is the triad of Wernicke syndrome?

A

ophthamoplegia, ataxia, and confusion

68
Q

What are 3 enzymes that thiamine serves as a cofactor for?

A
  1. pyruvate dehydrogenase
  2. a-ketoglutarate dehydrogenase
  3. transketolase
69
Q

How can thiamine deficiency be diagnosed?

A

measuring erythrocyte transketolase activity

70
Q

What are 5 CYP450 inducers?

A
  1. carbamazepine
  2. phenobarbital
  3. phenytoin
  4. rifampin
  5. Griseofulvin
71
Q

What are 7 CYP450 inhibitors?

A
  1. cimetidine
  2. ciprofloxacin
  3. erythromycin
  4. azole antifungals
  5. grapefruit juice
  6. isoniazid
  7. ritonavir (protease inhibitors)
72
Q

Korsakoff syndrome is associated with damage to which nuclei?

A

anterior and dorsomedial thalamic nuclei –> results in confabulation

73
Q

What are 4 disorder associated with trinucleotide repeats and anticipation?

A

Huntington, Fragile X, myotonic dystrophy, and Friedreich ataxia

QBank Qs (15 decks)

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