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Final FA review > 3/25 neuro > Flashcards

3/25 neuro Flashcards

1
Q

Retinitis

  • seen in who?
  • common causes?
A
  • immunosuppressed.

- CMV, HSV, HZV

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2
Q

Central retinal artery occlusion

  • painful?
  • how about macula?
A
  • not painful

- cherry red macula (has collateral circ).

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3
Q

Diabetic retinopathy

-what are the 2 types?

A
  • Non-proliferative: dmged caps => lipids/fluids leak into retina => hemorrhage & edema => Tx: sugar control + laser.
  • Proliferative: chronic hypoxia => neovasc. => messes up retina => Tx: anti-VEGF, periph. retinal photocoag.
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4
Q

Where is aqueous humor thats first made pumped into?

A

posterior chamber

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5
Q

Glaucoma

-what is it?

A
  • progressive atrophy of optic disc w/characteristic cupping.
  • usually w/inc. intraocular pressure (pressure atrophy to optic disc).
  • progressive peripheral visual field loss.
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6
Q

Open angle glaucoma

-painful?

A

no, its painless.

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7
Q

Narrow angle glaucoma:

-secondary: whats the cause?

A

-hypoxia from retinal disease (e.g., diabetes, vein occlusion) induces vasoproliferation in iris that contracts angle.

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8
Q

Narrow angle glaucoma: acute closure:

  • Sxs:
  • can you give epinephrine?
A
  • very painful.
  • halos around lights.
  • rock-hard eye
  • frontal headache
  • do NOT give epi bc of its mydriatic effects (alpha-1).
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9
Q

Dilator pupillae

-under what receptor control?

A

alpha-1

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10
Q

Fructose intolerance

-cataracts?

A

NO cataracts!

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11
Q

Cataract

-risk factors

A
  • excessive sunlight
  • alcohol, smoking
  • prolonged corticosteroid use
  • classic galactosemia, galactokinase deficiency, diabetes.
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12
Q

CN 3 damage

-do you get mydriasis or miosis?

A

mydriasis

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13
Q

Problems going down stairs, may present with compensatory head tilt in the opposite direction.
-whats the problem?

A

CN 4 palsy

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14
Q

Sup & inf. rectus

-to have them aligned w/their axis, does eye need to be adducted or abducted?

A

-abducted about 23 degree.

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15
Q

sup & inf. oblique

-to have them aligned w/their axis, does eye need to be adducted or abducted?

A

-adducted

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16
Q

Miosis

  • whats the muscle?
  • run me thru the route of para fibers: nuclei & nerves.
A
  • EW nucleus = para/pre
  • CN3
  • Ciliary ganglion = para/post
  • short ciliary nerves
  • pupillary sphincter muscles
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17
Q

ciliospinal center of Budge (C8–T2)

-what is it?

A
  • part of lateral horn
  • part of sym. inn. to cause miosis pathway.
  • receives input from hypoT.
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18
Q

Nerves involved in miosis of eye?

A

CN3, short ciliary nerves.

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19
Q

Nerves involved in mydriasis of eye?

A

long ciliary nerve

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20
Q

Marcus Gunn pupil

  • wheres the lesions?
  • how do you test?
A
  • afferent pupillary defect—due to optic nerve damage or severe retinal injury.
  • both eyes are typically not affected, just one.
  • “swinging flashlight test.”
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21
Q

Marcus Gunn pupil

-Sxs:

A

-dec. bilateral pupillary constriction when light is shone in affected eye relative to unaffected eye.

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22
Q

pupillary light reflex

-order of events?

A

CN 2 => pretectal nucleus => EW nucleus => CN3 => ciliary ganglion => short ciliary nerves => pupillary sphincter => miosis.

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23
Q

CN3

-components?

A

motor & para

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24
Q

Problem w/right MLF =

A

-palsy of right medial rectus w/attempted left lateral gaze.

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25
Q

right INO:

  • which eye is paralyzed?
  • what will happen w/non-paralyzed, abducting eye?
A

right.

-Abducting eye gets nystagmus (CN VI overfires to stimulate CN III).

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26
Q

Medial longitudinal fasciculus

-more or less myelin than usual?

A

highly myelinated

-its gotta work fast.

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27
Q

INO

-convergence affected?

A

no, convergence is normal.

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28
Q

Familial Alzheimers: early onset

  • which proteins?
  • which chroms these proteins located on?
A
  • APP (Chr 21)
  • presenilin-1 (Chr 14)
  • presenilin-2 (Chr 1)
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29
Q

Familial Alzheimers: late onset

  • which proteins?
  • which chroms these proteins located on?
A
  • ApoE4 (Chr 19)

- ApoE2 (Chr 19) is protective.

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30
Q

Intracranial hemorrhage in Alzheimers

-why?

A

amyloid angiopathy

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31
Q

Neurofibrillary tangles

  • what are they?
  • what do they correlate with?
  • what disease are they found in?
A

-intracellular hyperphosphorylated tau protein = insoluble
cytoskeletal elements.
-tangles correlate with degree of dementia.
-Alzheimers disease

*Pick disease also has Tau protein, but not in neurofibrillary tangles.

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32
Q

Alzheimers

-which memory losst? recent or distant?

A

Begins w/recent memory, progress to distant memory.

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33
Q

ApoE4 allele

-why does it lead to Alzheimers?

A

-ApoE4 allele inc. conversion of APP to A-beta amyloid.

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34
Q

Pick disease

  • which areas of brain affected?
  • what are pick bodies?
A
  • frontotemporal dementia

- pick bodies = spherical tau protein aggregates

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35
Q

Pick disease

-major Sxs?

A
  • frontal cortex damage => behavior problems
  • temporal cortex damage => language problems.

Pick disease has clinical features similar to the features
of Alzheimer disease, but initially it causes less memory loss and more behavioral changes.

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36
Q

Lewy body dementia

  • compared to what disease?
  • what are lewy bodies made of?
  • presentation:
A
  • Parkinsons disease w/early onset (1-2 yrs) dementia.
  • lewy bodies made of α-synuclein.

*Initially dementia and visual hallucinations followed by parkinsonian features.

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37
Q

Creutzfeldt-Jakob disease

  • which protein is elevated & in what compartment?
  • Sxs:
A

-elevated levels of 14-3-3 protein in CSF.
-Rapidly progressive (weeks to months) dementia
with myoclonus (“startle myoclonus”).

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38
Q

Spongiform cortex

-seen in what disease?

A

Creutzfeldt-Jakob disease

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39
Q

vascular dementia

A
  • layers 3, 5, 6 of cortex = vulnerable to ischemia
  • hippocampus also = vulnerable to ischemia
  • knocking either of these out => dementia.
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40
Q

MS

-which HLA?

A

HLA-DR2

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41
Q

MS

  • CSF findings?
  • MRI findings?
A
  • inc. protein (IgG) in CSF. Oligoclonal bands are diagnostic.
  • Periventricular plaques (areas of oligodendrocyte loss and reactive gliosis) with destruction of axons.
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42
Q

MS

-Tx:

A

-b-interferon, immunosuppression, natalizumab.

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43
Q

natalizumab

  • what is it?
  • what disease is it used in?
  • risk of what?
A
  • Ab against α4-integrin
  • MS, Crohns
  • Risk of PML in patients with JC virus
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44
Q

MS: Neurogenic bladder

  • what is it? peeing too much or too little?
  • tx:
A
  • peeing too much, cant control bladder. “genic” means produce. So its a problem w/nervous system where you can’t control your bladder.
  • catheterization, muscarinic antagonists
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45
Q

MS: spasticity

-Tx:

A

Baclofen

  • only drug that uses GABAb (not GABAa) receptor complex. GABAb causes potassium efflux which also hyperpolarizes the cell.
  • its an anti-spasmodic.
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46
Q

Baclofen

A
  • only drug that uses GABAb (not GABAa) receptor complex. GABAb causes potassium efflux which also hyperpolarizes the cell.
  • its an anti-spasmodic.
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47
Q

Charcot classic triad of MS:

  • mnemonic?
  • whats the triad?
A

SIIIN

  • scanning speech
  • INO
  • intention tremor
  • incontinence
  • nystagmus
48
Q

Guillain-Barré

  • which cells are destroyed?
  • mechanism?
  • symmetric or asymmetric?
A

Schwann cells

  • autoimmune attack of peripheral myelin due to molecular mimicry, inoculations, and stress.
  • symmetric ascending paralysis
49
Q

Guillain-Barré

-lab findings?

A
  • inc. CSF protein with normal cell count (albuminocytologic dissociation). 
  • inc. CSF protein =>Ž papilledema.
50
Q

Guillain-Barré

-Tx:

A

-plasmapheresis, IV immune globulins.

51
Q

plasmapharesis

-what is it?

A

-plasma is what contains the Abs. So plasmapharesis removed the pts plasma and replaces it w/donor plasma.

52
Q

surfical neck of humerus fx

-which nerve?

A

axillary n.

53
Q

midshaft fx of humerus

-which nerve?

A

radial n.

54
Q

head of radius

  • where is this?
  • what nerve is here?
A
  • where radius connects to humerus

- radial n.

55
Q

radial head subluxation

-what deficits?

A

wrist drop but no sensory deficits

-only damages the deep radial nerve, not the superficial.

56
Q

meningioma or medulloblastoma

-which one is in kids?

A

medulloblastoma

57
Q

which brain tumor has a fried egg histological appearance?

A

oligodendroglioma

58
Q

Most common manifestation of alcohol withdrawal?

A

the “shakes”.

-tremulousness

59
Q

Why does CNS undergo liquefactive necrosis?

A

large amount of lipids & lysosomal enzymes in nervous cells.
-also a lack of substantive supportive stroma in the CNS.

60
Q

CN3: motor output:

-affected primarily by what?

A

vascular disease/ischemia.
-compromised vascular that resides on the outside of the nerve.

*as opposed to parasym output of CN3 which is usually affected by compression.

61
Q

CN3: para output

-affected primarily by what?

A

compression

62
Q

Brain infarcts

-usually resolve into cystic spaces filled w/what?

A

CSF

63
Q

carotid atherosclerosis

-can cause what brain lesion?

A

embolic stroke!

64
Q

hypoxic encephalopathy

  • what is this?
  • aka?
A

global cerebral ischemia

65
Q

Why are neurons so sensitive to ischemia?

A

they dont store glycogen.

66
Q

Global cerebral ischemia

-aka?

A

ischemic-hypoxic encephalopathy

67
Q

Cardiac embolism to brain

-what would occur?

A

multiple infarcts in different vascular territories.

68
Q

endoneural inflammatory infiltrate

-what disease?

A

Guillain barre

69
Q

Senile plaques & amyloid angiopathy

-can these be seen in healthy elderly adults?

A

yes

70
Q 
Most common causes of dementia
#1=
#2=
A 
#1 = Alzheimers
#2 = Vascular dementia = multi-infarct dementia
71
Q

Vascular dementia

-what is it?

A

multi-infarct dementia

72
Q

diabetic distal peripheral neuropathy

  • bilateral?
  • symmetric?
A

yes, both bilateral and symmetric.

73
Q

Vitamin E

  • function?
  • def can lead to what?
A

-primary fcn = protect membrane fatty acids from oxidation.
-hemolytic anemia, acanthocytosis, muscle weakness,
DC/ML & spinocerebellar demyelination.

74
Q

temporal lobe encephalitis

-cause?

A

HSV-1

75
Q

23 year old male w/bilateral hemorrhagic necrosis of temporal lobes.

A

HSV-1 temporal lobe encephalitis

76
Q

tender scalp & pain when combing hair

-think of what?

A

temporal arteritis

*check the sed rate.

77
Q

PML: inc. risk of reactivation JC virus w/what med?

-and whats that med for?

A
  • natalizumab

- MS

78
Q

Acute disseminated (postinfectious) encephalomyelitis

  • what happens?
  • associated w/what?
A
  • Multifocal perivenular inflammation and demyelination after infection.
  • associated w/measles or VZV or certain vaccinations (e.g., rabies, smallpox)
79
Q

Metachromatic leukodystrophy

  • cause:
  • Sxs:
  • inheritance pattern?
A
  • Lysosomal storage disease = arylsulfatase A deficiency.
  • Buildup of sulfatides => impaired production of myelin sheath.
  • central and peripheral demyelination with ataxia, dementia.
80
Q

Metachromatic leukodystrophy

-inheritance pattern

A

-Autosomal recessive

81
Q

Charcot-Marie-Tooth disease

  • aka?
  • what is it?
  • inheritance pattern?
A
  • Hereditary motor and sensory neuropathy (HMSN).-
  • inherited peripheral neuropathy.
  • auto dom.
82
Q

Charcot-Marie-Tooth disease

  • problem?
  • associated w/?
  • commonly involved nerve?
A
  • mutation in myelin protein gene.
  • scoliosis & foot deformities
  • common peroneal nerve
  • PED: peroneal = evert & dorsiflex.
83
Q

Krabbe disease

  • what is it?
  • deficiency of what enzyme?
  • whats built up & what does it damage?
A
  • lysosomal storage disease
  • deficiency of galactocerebrosidase
  • Buildup of galactocerebroside and psychosine destroys myelin sheath.
84
Q

Krabbe disease

  • inheritance?
  • Sxs/findings:
A
  • auto recessive

- peripheral neuropathy, developmental delay, optic atrophy, globoid cells.

85
Q

Krabbe disease

-aka

A

-globoid cell leukodystrophy

86
Q

Adrenoleukodystrophy

-whats the problem?

A

Disrupts metabolism of very-long-chain fatty acids =>Ž excessive buildup in nervous system, adrenal gland, and testes.
-Progressive disease that can lead to long-term coma/death and adrenal gland crisis.

87
Q

Partial (focal) seizures

  • most commonly originate where?
  • often preceded by what?
A
  • medial temporal lobe.

- often preceded by seizure aura.

88
Q

Partial (focal) seizures

-what are the 2 types?

A

1) Simple partial (consciousness intact)- motor, sensory, autonomic, psychic
2) Complex partial (impaired consciousness) - lose memory of the event.

89
Q

Partial (focal) seizures

-Tx: 1st line:

A

-carbamazepine = 1st line Tx for partial-simple & partial-complex.

90
Q

Generalized seizures

-name the 5 types

A
  • Absence (petit mal)
  • Myoclonic
  • Tonic-clonic (grand mal)
  • Tonic
  • Atonic
91
Q

Which type of seizure = grand mal?

A

-tonic-clonic

tonic = stiff
clonic = movement
92
Q

Most common cause of seizure

  • child:
  • adult:
  • elderly:
A
  • child: genetic
  • adult: tumor
  • elderly: stroke
93
Q

Which headache is preceded by an aura?

A

migraine

*not cluster

94
Q

Horner syndrome

-may be induced by what headache?

A

cluster

95
Q

chronic pain from tension headaches

-Tx:

A

amitriptyline (TCA)

96
Q

Migraine headache

-release of which chemicals?

A

Substance P, CGRP, vasoactive peptides.

*Calcitonin gene-related peptide

97
Q

Migraine

-prophylactic therapies:

A

propranolol, topiramate, calcium channel blockers, amitriptyline.

98
Q

Irritation of which CN can lead to migranie?

A

CN V

99
Q

Peripheral vertigo

  • wheres the lesion?
  • Positional testing Žshows:
A
  • inner ear pathology

- delayed horizontal nystagmus.

100
Q

Ménière disease

-peripheral or central vertigo?

A
  • peripheral

- too much endolymph.

101
Q

Central vertigo

  • wheres the lesion?
  • Positional testing Žshows:
A
  • cerebellar or brainstem lesion.

- immediate nystagmus in any direction; may change directions.

102
Q

Ménière disease

-what freq of hearing loss? high or low?

A

low freq hearing loss

103
Q

Which muscle attaches to the malleus & whats its innervation?

A
  • tensor tympani

- V3

104
Q

Kyphoscoliosis & high plantar arch.

-his brother had neuro problem & died at 25 of heart problem.

A

Friedreich Ataxia

105
Q

spinocerebellar lesion

-Sx:

A

gait ataxia

-messes up proprioception.

106
Q

myotonia

-define

A

abnormally slow relaxation of muscle.

-seen in myotonic dystrophy

107
Q

myotonic dystrophy

  • whats the repeat?
  • whats the gene?
  • gene product?
A
  • CTG
  • DMPK gene
  • myotonin protein kinase
108
Q

myotonia, muscle wasting, frontal balding, cataracts, testicular atrophy, arrythmia
-whats the disease?

A

myotonic dystrophy

109
Q

myotonic dystrophy

-inheritance pattern?

A

auto dom

110
Q

fatal familial insomnia

-example of what kind of disease?

A

prions

111
Q

PML

-which cells are preferentially destroyed?

A

oligodendrocytes

112
Q

Normal Pressure Hydroceph vs Alzheimers

-similar image, how to differentiate?

A
  • NPH begins w/gait abnormality & urinary incontinence before the dementia kicks in. This is crucial to differentiating it vs. Alzheimers.
  • Alzheimers can cause hydroceph. ex vacuo which can look similar to NPH on imaging.
113
Q

communicating hydroceph vs NPH

-difference?

A
  • NPH = chronic, happens in elderly. Gradual dec. in CSF resorption. So no inc. in ICP.
  • CH = acute, so there is an inc. in ICP.
114
Q

superior tarsal muscle

-aka?

A

Muller muscle

115
Q

pyknosis

A

-irreversible condensation of chromatin in a cell undergoing necrosis or apoptosis.

116
Q

what the active form of vitamin D called?

A

calcitriol

117
Q

anticonvulsant to use in pregnancy?

A

phenobarbital

-high plasma protein binding

Final FA review (52 decks)

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