3/23 Neuro Flashcards Preview

Final FA review > 3/23 Neuro > Flashcards

Flashcards in 3/23 Neuro Deck (113):
1

subthalamic nucleus
-whats it do?
-lesion here causes what?

-inhibits movement on the contralateral side of the body.
-Hemiballismus of the contralateral side, or wild, uncontrollable movement of the right arm and leg.

2

Parkinsons
-chemical imbalance?

dec. dopamine
inc. ACh

3

Lewy bodies
-seen in what disease?
-composed of what?

-Parkinsons, Lewy body dementia
-α-synuclein

4

Huntingtons
-chemical imbalance?
-mnemonic?

Expansion of CAG
-Caudate loses ACh & GABA.
-dec. ACh
-dec. GABA

5

Huntingtons
-what causes the neuronal death?

-NMDA-R binding and glutamate toxicity.

6

Hemiballismus
-usually caused by what?

-lacunar infarct

7

Athetosis
-define:
-seen in what?

-Slow, writhing movements; especially seen in fingers.
-damage to basal ganglia (ie. huntingtons).

8

Dystonia
-define:
-examples:

-Sustained, involuntary muscle contractions.
-Writer’s cramp; blepharospasm (sustained eyelid twitch).

9

Resting tremor
-what relieves it?

-tremor alleviated by intentional movement.

10

Klüver-Bucy syndrome
-wheres the lesion?
-Sxs?
-associated w/which viral infection?

-Amygdala (bilateral).
-hyperorality, hypersexuality, disinhibited behavior.
-HSV-1

11

Spatial neglect syndrome (agnosia of the contralateral side of the world).
-wheres the lesion?

Right parietal-temporal cortex.
*agnosia = inability to process sensory information.

12

agnosia
-define

Inability to process sensory information.

13

Agraphia, acalculia, finger agnosia, and left-right disorientation.
-wheres the lesion?
-whats this disease called?

-Left parietal-temporal cortex
-Gerstmann syndrome

14

Reduced levels of arousal and wakefulness (e.g.,coma)
-wheres the lesion?

Reticular activating system (midbrain)

15

Wernicke-Korsakoff syndrome
-wheres the lesion?
-mnemonic for Sxs?
-associated w/which vitamin def?

Mammillary bodies (bilateral)
-CAN of beer:
-Confusion, Ataxia, Nystagmus.
-thiamine (B1)

16

Damage to cerebellar hemispheres
-contra or ipsilateral deficits?

ipsilateral
-fall toward side of lesion.

17

Cerebellar vermis lesion
-Sxs?

-Truncal ataxia, dysarthria.
-Vermis is centrally located—affects central body.
*as opposed to cerebellar hemispheres which = laterally located and affect lateral limbs.

18

Paramedian pontine reticular formation lesion
-eyes look toward or away from side of lesion?

Eyes look away from side of lesion.

19

Frontal eye fields
-eyes look toward or away from side of lesion?

Eyes look toward lesion

20

Central pontine myelinolysis
-aka?
-cause?
-mnemonic?

-Ostmotic demyelination syndrome.
-Caused by overly rapid correction of hyponatremia.
-“From low to high, your pons will die” (CPM)

21

Fast dec. in serum sodium
-can cause what?
-mnemonic?

“From high to low, your brain will blow”.
-cerebral edema/herniation

22

Central pontine myelinolysis
-Sxs:
-which two tracts are most commonly affects?

-Can cause “locked-in syndrome.”
-Acute paralysis, dysarthria, dysphagia, diplopia, and loss of consciousness.
-corticobulbar & corticospinal tracts.

23

dysarthria
-define:

Motor speech disorder
-movement deficit. As opposed to aphasia which is a language deficit.

24

Where is the brain is the speech center?
-what artery supplies this area?

-Left cerebral hemisphere, in a vascular area supplied by the left middle cerebral artery.

25

Conduction aphasia
-what is it?
-wheres the lesion?

-Poor repetition but fluent speech, intact comprehension.
-left superior temporal lobe and/or left supramarginal gyrus.

26

Nonfluent aphasia with good comprehension and repetition.
-whats the disease?

Transcortical motor aphasia

27

Poor comprehension with fluent speech and repetition.
-whats the disease?

Transcortical sensory aphasia

28

Nonfluent speech, poor comprehension, good repetition.
-whats the disease?

Mixed transcortical aphasia

29

lenticulostriate
-off what big artery?

MCA

30

PCA branches off basilar artery at the:

pontomesencephalic junction.

31

brain
-watershed zones
-what Sxs will you see in severe hypotension?

-upper leg/upper arm weakness.
-defects in higher-order visual processing.

32

Therapeutic hyperventilation (brain)
-what is it?

When you have acute inc. ICP/cerebral edema:
-your body hyperventilates, so you dec. pCO2 which leads to vasoconstriction & dec. cerebral perfusion => dec. ICP.

33

MCA stroke
-Sxs:

-language defects (if in dominant hemo = left hemi).
*contralat. hemineglect if in non-dom side.
-motor/sensory for contralateral upper limb and face.

34

ACA stroke
-Sxs:

-motor/sensory for contralateral lower limbs.

35

Lenticulo-striate stroke
-what region do they feed?
-Sxs:

-Striatum, internal capsule.
-Contralateral hemiparesis/hemiplegia.

36

(hemi)paresis =
(hemi)plegia =

paresis = weakness
plegia = paralysis

37

fasciculations
-sign of LMN or UMN lesion?

LMN

38

brisk DTR
-UMN or LMN lesion?

UMN lesion

39

why does macula get spared in a PCA infarct (which feeds occipital lobe).

Gets collateral blood from MCA.
*the part of the lobe that processes macular information is what we're talking about.

40

Cystic degeneration of putamen
-seen in what disease?

Wilson's disease

41

apixaban, rivaroxaban
-mech:
-use:

-directly inhibit factor 10a.
-Tx & prophylaxis of DVT/PE/stroke.

42

Why is PT so minimally inc. w/heparin admin?

The PT reagent has chemicals that neutralize heparin.

43

Intimate partner violence
-whats your first step?

-supportive open ended inquiry & identification of emergency safety plans.

*do not pressure the partner to disclose, report the abuse, or leave the partner.

44

Bupropion
-reuptake inhibitor for which chemicals?

-dopamine & NE.

45

Pain in shoulders & hips then sudden blindness in a 65 year old woman.

polymyalgia rheumatica & temporal arteritis.

46

qualitative study

Using discussion groups, interviews, & other anthropological methods to obtain narrative info that may explain quantitative findings.

47

phenelzine
-what is it?

nonselective MAO inhibitor

48

TCAs
-block reuptake of which chemicals?

NE & serotonin

49

Which drugs can cause drug-induced parkinsons?
-tx:

D2 receptor blockers
-antipsychotics (1st gen>2nd gen)
-anti-emetics (metoclopramide, prochlorperazine).

-Tx: benztropine, diphenhydramine

50

Why can't you use levodopa or dopamine agonists to treat drug-induced parkinsons caused by anti-psychotics?

bc they can induce psychosis.
-problem was too much dopamine in the first place.

51

fluoxetine
-what is it?

SSRI

52

imipramine
-what is it?

TCA

53

Take atropine & sudden eye pain.
-Dx?

mydriasis = exacerbated angle-closure glaucoma.

54

pramipexole, ropinirole

dopamine agonists

55

neuroblastoma vs wilms tumor
-which can cross the midline?

neuroblastoma can cross the midline.

56

factitious disorder
-what is its?
-subtypes?

-consciously creating Sxs so you can assume the "sick role" & to get medical attention.
-munchaushen & munchausen by proxy.

57

binge/purge anorexia vs bulimia nervosa
-difference?

-The anorexic pt has very low BMI & amenorrhea.
-The bulimic has normal BMI.

58

Conversion disorder

Sudden loss of sensory or motor function s/p acute stressor.
-chick w/severe weakness in left leg s/p fiance breaking up with her.

59

schizophreniform
-time frame?

1-6 months

60

Parinaud syndrome
-whats is it?
-cause?

-paralysis of upward gaze.
-due to lesion in superior colliculi (ie. pinealoma).

61

B12 deficiency
-whats it called?
-what part of spinal cord gets fucked up?

"Subacute combined degeneration"
-dorsal columns
-lateral corticospinal tracts
-axonal degen of periph. nerves.

62

Stroke - ASA (ant. spinal art).
-whats damaged?

-Lateral corticospinal tract.
-Medial lemniscus.
-Caudal medulla—hypoglossal nerve.

*Dorsal columns spared.

63

Stroke - ASA (ant. spinal art).
-Sxs:

-Contralateral hemiparesis—upper and lower limbs.
-Dec. contralateral proprioception.
-Ipsilateral hypoglossal dysfunction (tongue deviates ipsilaterally).

64

Stroke - PCA
-Sxs:

-Contralateral hemianopia with macular sparing.

65

Stroke - Basilar artery
-Sxs:

-“Locked-in syndrome.”
-just like Central pontine myelinosis bc basilar artery feeds the pons.

66

Acom
-most common lesion?
-Sxs?
-mnemonic:

Berry aneurysm
-Visual field defects
-"A Com (communications) major must be good w/visuals."

67

PCom
-most common lesions?
-Sxx?

Berry aneurysm
-CN3 palsy (eye is down and out) w/ptosis & mydriasis.

68

A lesion in which art will => CN 3 palsy?

PCom

69

Central post-stroke pain syndrome
-where are the lesions?

-Neuropathic pain due to thalamic lesions.
-Initial sensation of numbness and tingling followed in
weeks to months by allodynia and dysaesthesia.

70

allodynia

-ordinarily painless stimuli cause pain.

71

dysaesthesia

-Abnormal, unpleasant sense of touch. Typically w/pain.

72

middle meningeal art = branch of what? which is a branch of what?

External carotid => maxillary art. => middle meningeal a.

73

What type of brain hematoma causes CN3 palsy?

epidural hematoma

74

Epidural hematoma
-can blood cross suture lines?
-can blood cross falx?
-can blood cross tentorium?

-cross suture = no
-cross falx = yes
-cross tentorium = yes

75

Subdural hematoma
-can blood cross suture lines?
-can blood cross falx?
-can blood cross tentorium?

-cross suture = yes
-cross falx = no
-cross tentorium = no

76

Bloody or yellow (xanthochromic) spinal tap
-seen in what?
-what does this predispose to?

-Subarachnoid hemorrhage
-2–3 days afterward, risk of vasospasm due to blood
breakdown and rebleed.

77

Subarachnoid hemorrhage
-vasospasm, Tx?

nimodipine

78

berry aneurysms
-lack what layer?

media

79

Ischemic brain disease
-irreversible damage after how long?

Irreversible damage begins after 5 min of hypoxia.

80

Brain: where is most vulnerable to ischemia?

-hippocampus, neocortex, cerebellum, watershed areas.

81

What scan has highest sensitivity for early brain ischemia?

MRI

82

How long to see ischemia on CT scan?
-what do you see?

12-24 hrs.
-dark abnormality.

83

How long after ischemic event do you see red neurons?

12-48 hrs

84

How long after ischemic event do neutrophils show up & necrosis start happening?

24-72 hrs

85

How long after ischemic event do macros show up?

3-5 days

86

How long after ischemic event does reactive gliosis & vascular prolif start?

1-2 weeks

87

How long after ischemic event is there a glial scar?

> 2 weeks

88

Most common site of intracerebral hemorrhage?

basal ganglia

89

hemorrhagic vs ischemic stroke presentation:

-hemorrhagic stroke presents w/acute onset of
focal neuro deficits. Ischemic stroke evolves
over a few hours.

90

Ischemic stroke
-which is only one that wont be hemorrhagic due to reperfusion?

thrombotic (hypertensive)
-the thrombus is not going to break down.
-keep in mind its a thrombus on top of an atheroma.

91

ischemic stroke
-Tx:

tPa

92

Dural venous sinuses
-drain into what vein?

internal jugular vein

93

Lateral ventricle => 3rd ventricle
-goes thru what?

foramina of monroe

94

3rd ventricle => 4th ventricle
-goes thru what?

aqueduct of sylvius
-aka cerebral aqueduct

95

Normal pressure hydrocephalus
-mnemonic?
-clinical triad?
-cause?

"wet, wobbly, & wacky like Mark".
-urinary incontinence, ataxia, and cognitive dysfunction.
-corona radiata distorted by expansion of ventricles.

96

Hydrocephalus ex vacuo
-cause?

-brain atophy = dec. neural tissue.

97

How many Spinal nerves
-name the segments & how many there are:

-31 total
cervical = 8
thoracic = 12
lumbar = 5
sacral = 5
coccyx = 1

98

Do spinal nerves exit above or below the corresponding vertebrae?

-Nerves C1–C7 exit above the corresponding
vertebra. All other nerves exit below.
-so C7 has one nerve exiting above and one below = C7 and C8. Thats where the extra C comes in.

99

Vertebral disc herniation
-whats herniating out of what?
-which direction?
-which levels?

-nucleus pulposus (soft central disc) herniates thru annulus fibrosus.
-usually posterolaterally.
-L4-L5 or L5-S2 = most common

100

Lower border of s. cord?
Lower border of subarachnoid space?

-s.cord ends at L2
-subarachnoid space ends at S2

101

Stimulus control therapy
-what is it?

Leave the room if you cant fall asleep for 20 min.
-goal = dissociate bedroom from any stimulating activities.

102

normal action potential
-when is membrane most permeable to K?

-Its not at the peak of the membrane potential, but once the repolarization has already started that the membrane is most permeable to K.
-so not the top of the peak (in the overshoot), but once the cell has already repolarized a bit.

103

primidone
-use?
-what are its metabolites?

-first line med for benign essential tremor.
-metabolites = phenobarbital phenylethylmalonamide.

104

Upper extremity LMN signs & lower extremity UMN signs in the setting of scoliosis.
+loss of upper extremity pain/temp sensation.

syringomyelia

105

restless leg syndrome
-tx:

dopamine agonist
-ie. pamipexole, ropinirole.

106

Middle cerebellar peduncle
-connects what structures?
-landmark for what?

-cerebellum to pons
-trigeminal nerve (CN 5)

107

Which is the only CN to decussate before innervating its target?

Trochlear nerve.
-so it innervates the contralateral superior oblique.

108

narcolepsy
-lack of what chemicals in the CSF?
-where are these chemicals made?

-hypocretin 1 (orexin A)
-hypocretin 2 (orexin B)

-made in lateral hypothalamus.

109

Homovanillic acid (HVA)
-breakdown product of what?
-CSF conc. in parkinsons?

-dopamine
-dec. CSF conc. in parkinsons.

110

CN3
-courses btwn which arteries as it leaves midbrain?

PCA & SCA (superior cerebellar)

111

thiopental
-where does it rapidly redistribute to?

skeletal muscle & fat.

112

diphenoxylate
-what is it?

opiate

113

opsoclonus-myoclonus syndrome
-what is it?
-what disease is it associated with?

-non-rhythmic conjugate eye movement associated w/myoclonus.
-paraneoplastic syndrome associated w/neuroblastoma.