CNS

Question 1

How do you treat Wernicke encephalopathy?

Answer 1

Thiamine + glucose; glucose alone will precipitate attack b/c thiamine is a cofactor of enzymes responsible for glucose metabolism

Question 2

What is macular degeneration? What kinds are there?

Answer 2

progressive loss of central vision due to deposition of fatty tissue (drusen) behind the retina (dry MD) and neovascularization of the retina (wet MD)

Question 3

What causes binasal hemianopia?

Answer 3

pressure to lateral areas of optic chiasm, for example due to calcified carotid arteries

Question 4

What is an arcuate scotoma?

Answer 4

Damage to a particular region of the optic nerve head → visual defect following the arcuate shape of the nerve fiber pattern

Question 5

What is Fabry disease?

Answer 5

A sphingolipodosic lysosomal storage disease caused by deficiency in α-galactosidase A. Ceramide trihexoside accumulates. Inheritance: XR
Findings: peripheral neuropathy of hands/feet, angiokeratomas, cardiovascular/renal disease.

Question 6

A patient presents with an enlarged abdomen, recurrent infections, fatigue, and hip pain. X-ray reveals degeneration of the femur. What lysosomal storage disease is on your differential?

Answer 6

Gaucher disease, caused by an AR deficiency in glucocerebrosidase (β-glucosidase) resulting in the accumulation of Glucocerebroside.
Findings: hepatosplenomegaly, pancytopenia, aseptic necrosis of the femur, bone crises, Gaucher cells.
Treat with glucocerebrosidase

Question 7

What is the typical microscopic finding in the blood smear of Gaucher disease?

Answer 7

Gaucher cells: lipid-laden macrophages resembling crumpled tissue paper

Question 8

What is the classic eye finding in Tay-Sachs disease? What other lysosomal storage disease also presents with this finding, and how do you differentiate the two diseases?

Answer 8

Cherry red spot on macula; also occurs in Niemann-Pick disease. However, Niemann pick patients also have hepatosplenomegaly.

Question 9

What is delirium tremens?

Answer 9

A fluctuant arousal level after acute intoxication. It begins 48-72 hours after last drink and is potentially fatal.

Question 10

What is generally the first symptom of alcohol withdrawal?

Answer 10

Termulousness

Question 11

What part of the cortex does the olfactory tract project to?

Answer 11

Piriform cortex (primary olfactory cortex)

Question 12

What two cranial nerves can be affected by CPA tumors?

Answer 12

VII and VIII

Question 13

What viral encephalitis in immunocompromised patients is characterized by multinucleated giant cells?

Answer 13

HIV encephalitis

Question 14

What is alteplase?

Answer 14

tPA!

Question 15

What functions are associated with the premortor cortex? What happens when there is a lesion here?

Answer 15

coordinates movement of the hands;
lesion → motor apraxia (uncoordinated and nonpurposeful hand movement); may also affect the complex activities related to speech, voluntary eye movement and head rotation

Question 16

What cells give rise to medulloblastomas?

Answer 16

primitive cells in the cerebellum

Question 17

Does consciousness waver in delirium?

Answer 17

No, awareness might fluctuate however

Question 18

What types of drugs cause dystonia?

Answer 18

dopamine receptor blocking drugs or other dopamine antagonists (especially high potency antipsychotics s.a. haloperidol and fluphenazine; this is an EPS)

Question 19

What are two characteristic symptoms of Lesch-Nyhan syndrome? What accumulates in the blood?

Answer 19

Self-mutilation (e.g. constantly banging head, biting fingers, lips), gouty arthritis; monosodium urate builds up because of loss of purine recycling

Question 20

In the sympathetic system, what is the post-ganglionic NT released onto cardiac and smooth muscle? Sweat glands? Renal vasculature?

Answer 20

Cardiac/smooth mm.: NE
Sweat glands: Ach
Renal vasculature: Dopamine

Question 21

What is bromocriptine?

Answer 21

a dopamine agonist

Question 22

What are the 3 dopamine systems in the brain, and what disease is associated with each?

Answer 22

1. Mesolimbic-mesocortical: schizophrenia
2. Nigrostriatal: parkinson’s
3. Tuberoinfundibular: hyperprolactinemia

Question 23

What is the main cause of death in TCA overdose?

Answer 23

inhibition of fast Na+ channels in cardiac myocytes → cardiac arrhythmias and refractory hypotension

Question 24

What is pentazocine?

Answer 24

an opioid with partial agonist and weak antagonist activity at mu receptors designed for analgesia w/out abuse potential: will cause withdrawal in ppl tolerant/dependent on opioids

Question 25

What is the difference b/w tolcapone and entacapone?

Answer 25

both are COMT inhibitors which prevent Levodopa degradation but entacopone only works peripherally while tolcapone works both centrally and peripherally