3/25 neuro Flashcards Preview

Final FA review > 3/25 neuro > Flashcards

Flashcards in 3/25 neuro Deck (117):
1

Retinitis
-seen in who?
-common causes?

-immunosuppressed.
-CMV, HSV, HZV

2

Central retinal artery occlusion
-painful?
-how about macula?

-not painful
-cherry red macula (has collateral circ).

3

Diabetic retinopathy
-what are the 2 types?

-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.

4

Where is aqueous humor thats first made pumped into?

posterior chamber

5

Glaucoma
-what is it?

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

6

Open angle glaucoma
-painful?

no, its painless.

7

Narrow angle glaucoma:
-secondary: whats the cause?

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

8

Narrow angle glaucoma: acute closure:
-Sxs:
-can you give epinephrine?

-very painful.
-halos around lights.
-rock-hard eye
-frontal headache
*do NOT give epi bc of its mydriatic effects (alpha-1).

9

Dilator pupillae
-under what receptor control?

alpha-1

10

Fructose intolerance
-cataracts?

NO cataracts!

11

Cataract
-risk factors

-excessive sunlight
-alcohol, smoking
-prolonged corticosteroid use
-classic galactosemia, galactokinase deficiency, diabetes.

12

CN 3 damage
-do you get mydriasis or miosis?

mydriasis

13

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

CN 4 palsy

14

Sup & inf. rectus
-to have them aligned w/their axis, does eye need to be adducted or abducted?

-abducted about 23 degree.

15

sup & inf. oblique
-to have them aligned w/their axis, does eye need to be adducted or abducted?

-adducted

16

Miosis
-whats the muscle?
-run me thru the route of para fibers: nuclei & nerves.

-EW nucleus = para/pre
-CN3
-Ciliary ganglion = para/post
-short ciliary nerves
-pupillary sphincter muscles

17

ciliospinal center of Budge (C8–T2)
-what is it?

-part of lateral horn
-part of sym. inn. to cause miosis pathway.
-receives input from hypoT.

18

Nerves involved in miosis of eye?

CN3, short ciliary nerves.

19

Nerves involved in mydriasis of eye?

long ciliary nerve

20

Marcus Gunn pupil
-wheres the lesions?
-how do you test?

-afferent pupillary defect—due to optic nerve damage or severe retinal injury.
*both eyes are typically not affected, just one.
-“swinging flashlight test.”

21

Marcus Gunn pupil
-Sxs:

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

22

pupillary light reflex
-order of events?

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

23

CN3
-components?

motor & para

24

Problem w/right MLF =

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

25

right INO:
-which eye is paralyzed?
-what will happen w/non-paralyzed, abducting eye?

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

26

Medial longitudinal fasciculus
-more or less myelin than usual?

highly myelinated
-its gotta work fast.

27

INO
-convergence affected?

no, convergence is normal.

28

Familial Alzheimers: early onset
-which proteins?
-which chroms these proteins located on?

-APP (Chr 21)
-presenilin-1 (Chr 14)
-presenilin-2 (Chr 1)

29

Familial Alzheimers: late onset
-which proteins?
-which chroms these proteins located on?

-ApoE4 (Chr 19)
-ApoE2 (Chr 19) is protective.

30

Intracranial hemorrhage in Alzheimers
-why?

amyloid angiopathy

31

Neurofibrillary tangles
-what are they?
-what do they correlate with?
-what disease are they found in?

-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.

32

Alzheimers
-which memory losst? recent or distant?

Begins w/recent memory, progress to distant memory.

33

ApoE4 allele
-why does it lead to Alzheimers?

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

34

Pick disease
-which areas of brain affected?
-what are pick bodies?

-frontotemporal dementia
-pick bodies = spherical tau protein aggregates

35

Pick disease
-major Sxs?

-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.

36

Lewy body dementia
-compared to what disease?
-what are lewy bodies made of?
-presentation:

-Parkinsons disease w/early onset (1-2 yrs) dementia.
-lewy bodies made of α-synuclein.

*Initially dementia and visual hallucinations followed by parkinsonian features.

37

Creutzfeldt-Jakob disease
-which protein is elevated & in what compartment?
-Sxs:

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

38

Spongiform cortex
-seen in what disease?

Creutzfeldt-Jakob disease

39

vascular dementia

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

40

MS
-which HLA?

HLA-DR2

41

MS
-CSF findings?
-MRI findings?

-inc. protein (IgG) in CSF. Oligoclonal bands are diagnostic.
-Periventricular plaques (areas of oligodendrocyte loss and reactive gliosis) with destruction of axons.

42

MS
-Tx:

-b-interferon, immunosuppression, natalizumab.

43

natalizumab
-what is it?
-what disease is it used in?
-risk of what?

-Ab against α4-integrin
-MS, Crohns
-Risk of PML in patients with JC virus

44

MS: Neurogenic bladder
-what is it? peeing too much or too little?
-tx:

-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

45

MS: spasticity
-Tx:

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

46

Baclofen

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

47

Charcot classic triad of MS:
-mnemonic?
-whats the triad?

SIIIN
-scanning speech
-INO
-intention tremor
-incontinence
-nystagmus

48

Guillain-Barré
-which cells are destroyed?
-mechanism?
-symmetric or asymmetric?

Schwann cells
-autoimmune attack of peripheral myelin due to molecular mimicry, inoculations, and stress.
-symmetric ascending paralysis

49

Guillain-Barré
-lab findings?

-inc. CSF protein with normal cell count (albuminocytologic dissociation). 
-inc. CSF protein =>Ž papilledema.

50

Guillain-Barré
-Tx:

-plasmapheresis, IV immune globulins.

51

plasmapharesis
-what is it?

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

52

surfical neck of humerus fx
-which nerve?

axillary n.

53

midshaft fx of humerus
-which nerve?

radial n.

54

head of radius
-where is this?
-what nerve is here?

-where radius connects to humerus
-radial n.

55

radial head subluxation
-what deficits?

wrist drop but no sensory deficits
-only damages the deep radial nerve, not the superficial.

56

meningioma or medulloblastoma
-which one is in kids?

medulloblastoma

57

which brain tumor has a fried egg histological appearance?

oligodendroglioma

58

Most common manifestation of alcohol withdrawal?

the "shakes".
-tremulousness

59

Why does CNS undergo liquefactive necrosis?

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

60

CN3: motor output:
-affected primarily by what?

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

CN3: para output
-affected primarily by what?

compression

62

Brain infarcts
-usually resolve into cystic spaces filled w/what?

CSF

63

carotid atherosclerosis
-can cause what brain lesion?

embolic stroke!

64

hypoxic encephalopathy
-what is this?
-aka?

global cerebral ischemia

65

Why are neurons so sensitive to ischemia?

they dont store glycogen.

66

Global cerebral ischemia
-aka?

ischemic-hypoxic encephalopathy

67

Cardiac embolism to brain
-what would occur?

multiple infarcts in different vascular territories.

68

endoneural inflammatory infiltrate
-what disease?

Guillain barre

69

Senile plaques & amyloid angiopathy
-can these be seen in healthy elderly adults?

yes

70

Most common causes of dementia
#1=
#2=

#1 = Alzheimers
#2 = Vascular dementia = multi-infarct dementia

71

Vascular dementia
-what is it?

multi-infarct dementia

72

diabetic distal peripheral neuropathy
-bilateral?
-symmetric?

yes, both bilateral and symmetric.

73

Vitamin E
-function?
-def can lead to what?

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

74

temporal lobe encephalitis
-cause?

HSV-1

75

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

HSV-1 temporal lobe encephalitis

76

tender scalp & pain when combing hair
-think of what?

temporal arteritis
*check the sed rate.

77

PML: inc. risk of reactivation JC virus w/what med?
-and whats that med for?

-natalizumab
-MS

78

Acute disseminated (postinfectious) encephalomyelitis
-what happens?
-associated w/what?

-Multifocal perivenular inflammation and demyelination after infection.
-associated w/measles or VZV or certain vaccinations (e.g., rabies, smallpox)

79

Metachromatic leukodystrophy
-cause:
-Sxs:
-inheritance pattern?

-Lysosomal storage disease = arylsulfatase A deficiency.
*Buildup of sulfatides => impaired production of myelin sheath.
-central and peripheral demyelination with ataxia, dementia.

80

Metachromatic leukodystrophy
-inheritance pattern

-Autosomal recessive

81

Charcot-Marie-Tooth disease
-aka?
-what is it?
-inheritance pattern?

-Hereditary motor and sensory neuropathy (HMSN).-
-inherited peripheral neuropathy.
-auto dom.

82

Charcot-Marie-Tooth disease
-problem?
-associated w/?
-commonly involved nerve?

-mutation in myelin protein gene.
-scoliosis & foot deformities
-common peroneal nerve
*PED: peroneal = evert & dorsiflex.

83

Krabbe disease
-what is it?
-deficiency of what enzyme?
-whats built up & what does it damage?

-lysosomal storage disease
-deficiency of galactocerebrosidase
-Buildup of galactocerebroside and psychosine destroys myelin sheath.

84

Krabbe disease
-inheritance?
-Sxs/findings:

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

85

Krabbe disease
-aka

-globoid cell leukodystrophy

86

Adrenoleukodystrophy
-whats the problem?

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

Partial (focal) seizures
-most commonly originate where?
-often preceded by what?

-medial temporal lobe.
-often preceded by seizure aura.

88

Partial (focal) seizures
-what are the 2 types?

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

89

Partial (focal) seizures
-Tx: 1st line:

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

90

Generalized seizures
-name the 5 types

-Absence (petit mal)
-Myoclonic
-Tonic-clonic (grand mal)
-Tonic
-Atonic

91

Which type of seizure = grand mal?

-tonic-clonic

tonic = stiff
clonic = movement

92

Most common cause of seizure
-child:
-adult:
-elderly:

-child: genetic
-adult: tumor
-elderly: stroke

93

Which headache is preceded by an aura?

migraine
*not cluster

94

Horner syndrome
-may be induced by what headache?

cluster

95

chronic pain from tension headaches
-Tx:

amitriptyline (TCA)

96

Migraine headache
-release of which chemicals?

Substance P, CGRP, vasoactive peptides.
*Calcitonin gene-related peptide

97

Migraine
-prophylactic therapies:

propranolol, topiramate, calcium channel blockers, amitriptyline.

98

Irritation of which CN can lead to migranie?

CN V

99

Peripheral vertigo
-wheres the lesion?
-Positional testing Žshows:

-inner ear pathology
-delayed horizontal nystagmus.

100

Ménière disease
-peripheral or central vertigo?

-peripheral
-too much endolymph.

101

Central vertigo
-wheres the lesion?
-Positional testing Žshows:

-cerebellar or brainstem lesion.
-immediate nystagmus in any direction; may change directions.

102

Ménière disease
-what freq of hearing loss? high or low?

low freq hearing loss

103

Which muscle attaches to the malleus & whats its innervation?

-tensor tympani
-V3

104

Kyphoscoliosis & high plantar arch.
-his brother had neuro problem & died at 25 of heart problem.

Friedreich Ataxia

105

spinocerebellar lesion
-Sx:

gait ataxia
-messes up proprioception.

106

myotonia
-define

abnormally slow relaxation of muscle.
-seen in myotonic dystrophy

107

myotonic dystrophy
-whats the repeat?
-whats the gene?
-gene product?

-CTG
-DMPK gene
-myotonin protein kinase

108

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

myotonic dystrophy

109

myotonic dystrophy
-inheritance pattern?

auto dom

110

fatal familial insomnia
-example of what kind of disease?

prions

111

PML
-which cells are preferentially destroyed?

oligodendrocytes

112

Normal Pressure Hydroceph vs Alzheimers
-similar image, how to differentiate?

-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

communicating hydroceph vs NPH
-difference?

-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

superior tarsal muscle
-aka?

Muller muscle

115

pyknosis

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

116

what the active form of vitamin D called?

calcitriol

117

anticonvulsant to use in pregnancy?

phenobarbital
-high plasma protein binding