First Aid Flashcards
(177 cards)
1
Q
CNS/PNS origins
A
Neuroectoderm: CNS neurons, ependymal cells, oligodendroglia, astrocytes
Neural crest: PNS neurons, Schwann cells
Mesoderm: microglia
2
Q
3 findings in Neural tube defects
A
Ass w/ low folic acid intake before + during pregnancy
High AFP in amniotic fluid + maternal serum (except spina bifida occulta)
High AChE in amniotic fluid
3
Q
4 findings of Anencephaly
A
High AFP
Polyhydramnios
Ass w/ maternal type I db
Folate supplementation lowers risk
4
Q
5 findings in Holoprosencephaly
A
Failure in separation of L + R hemispheres \+/- mutations in sonic hedghog Moderate: cleft lip/palate Severe: cyclopia In Patau sd + fetal alcohol sd
5
Q
3 findings in Chiari II malformation
A
Herniation of cerebellar vermis (foramen magnum)
Aqueductal stenosis / hydrocephalus
Ass w/ lumbosacral meningomyelocele
6
Q
3 findings in Dandy-Walker syndrome
A
Agenesis of cerebellar vermis
Cystic enlargement of 4th ventricle
Ass w/ noncommunicating hydrocephalus / spina bifida
7
Q
4 characteristics of Chiari I malformation
A
Cerebellar tonsillar ectopia
Congenital
Asymptomatic in childhood
Headaches + cerebellar symptoms
8
Q
3 findings in Syringomyelia
A
Cystic cavity in central canal of spinal cord
Spinothalamic tract damaged (pain+temperature bilat. loss)
Ass w/ Chiari malfo, trauma, tumors
9
Q
CN for sensation + taste of tongue
A
Anterior 2/3: sensation V3 + taste VII
Posterior 1/3: sensation IX + taste IX
Extreme posterior: sensation X + taste X
10
Q
Motor innervation of tongue
A
CN XII: hyoglossus, genioglossus, styloglossus
CN X: palatoglossus
11
Q
Wallerian degeneration
A
Injury to axon
Degeneration distal to injury
Axonal retraction proximal to injury
Potential regeneration (if PNS)
12
Q
3 characteristics of astrocytes
A
From neuroectoderm
Marker: GFAP
Reactive gliosis (glial scar) secondary to neural injury
13
Q
4 characteristics of microglia
A
From mesoderm
Phagocytic scavenger cells of CNS
Activated when tissue damage
HIV-infected: giant cells in CNS
14
Q
4 characteristics of myelin
A
CNS: oligodendrocytes - PNS: Schwann cells
Reduces time constant
Raises space constant
Raises conduction velocity
15
Q
2 diseases that affect Schwann cells
A
Guillain-Barré syndrome Vestibular schwannoma (CN VIII)
16
Q
4 findings of oligodendroglia
A
From neuroectoderm
Predominant glial cell in white matter
Each myelinates ~30 axons in CNS
Injured in MS, PML, Leukodystrophies
17
Q
3 layers of peripheral nerve
A
Endoneurium (inflammatory infiltrate in Guillain-Barré)
Perineurium (rejoined in microsurgery)
Epineurium (surrounds fascicles + blood Vx)
18
Q
Neurotransmitter changes in Anxiety
A
Low GABA
Low Serotonin
High NE
19
Q
Neurotransmitter changes in Depression
A
Low Dopamine
Low NE
Low Serotonin
20
Q
Neurotransmitter changes in Schizophrenia
A
High Dopamine
21
Q
Neurotransmitter changes in Alzheimer disease
A
Low Acetylcholine
22
Q
Neurotransmitter changes in Huntington disease
A
Low ACh
Low GABA
High Dopamine
23
Q
Neurotransmitter changes in Parkinson disease
A
Low Dopamine
High Ach
High Serotonin
24
Q
3 structures of blood-brain barrier
A
Tight junctions (nonfenestrated capillary endothelial cells)
Basement membrane
Astrocyte foot processes
25
3 brain regions with fenestrated capillaries
Area postrema (vomiting post-CT)
OVLT (osmotic sensing)
Neurohypophysis (ADH release)
26
7 functions of Serotoninergic neurons
```
Sleep-wake cycle
Anxiety
Mood
Psychosis
Sexuality
Eating behavior
Impulsivity
```
27
7 functions of Hypothalamus
```
Thirst + water balance
Adenohypophysis control
Makes ADH + oxytocin released to Neurohypophysis
Hunger
Autonomic regulation
Temperature regulation
Sexual urges
```
28
Lateral + Ventromedial areas of hypothalamus
Lateral: Hunger - stimulated by ghrelin - inhibited by leptin
Ventromedial: Satiety - stimulated by leptin
29
Anterior + Posterior areas of hypothalamus
Anterior: cooling, parasympathetic
Posterior: heating, sympathetic
30
Suprachiasmatic + supraoptic + paraventricular nuclei of hypothalamus
Suprachiasmatic: circadian rhythm
Supraoptic: ADH
Paraventricular: Oxytocin
31
2 characteristics of circadian rhythm
Regulated by environment
| Controls nocturnal release of ACTH, prolactin, melatonin, NE
32
4 characteristics of REM sleep
Extraocular mvts due to PPRF
High ACh
Every 90min and longer through the night
Shorter when alcohol, NE, benzodiazephines, barbiturates
33
Inputs of ventral postero-lateral + ventral postero-medial nuclei of Thalamus
Ventral postero-lateral: spinothalamic + dorsal columns/medial lemniscus
Ventral postero-medial: trigeminal + gustatory pathway
34
Inputs of lateral geniculate + medial geniculate nuclei of thalamus
Lateral geniculate: CN II
| Medial geniculate: superior olive + inferior colliculus of tectum
35
Inputs of ventral lateral nucleus of thalamus
Ventral lateral: basal ganglia, cerebellum
36
5 structures + 5 functions of Limbic system
```
Hippocampus
Amygdala
Fornix
Mammillary bodies
Cingulate gyrus
```
```
Emotion
Long-term memory
Olfaction
Behavior modulation
ANS function
```
37
4 dopaminergic pathways + functions + 2 factors altering them
Mesocortical: regulates cognition + behavior
Mesolimbic: regulates cognition + behavior
Nigrostriatal: regulates coordination of voluntary mvts
Tuberoinfundibular: inhibits prolactin secretion
```
Drugs (antipsychotics)
Movement disorders (Parkinson)
```
38
Effects of the 4 dopaminergic pathways
Mesocortical: low activity will give negative symptoms
Mesolimbic: high activity will give positive symptoms
Nigrostriatal: low activity will give extrapyramidal symptoms
Tuberoinfundibular: low activity will raise prolactin
39
2 functions + 2 inputs + 1 output of Cerebellum
Modulates movement
Aids in coordination + balance
From contralateral cortex (middle cerebellar peduncle)
From ipsilateral proprioception (inferior cerebellar peduncle)
To contralateral cortex (superior cerebellar peduncle)
40
Lateral + Medial lesions of cerebellum
Lateral: voluntary mvt of extremities; fall toward injured side
Medial: midline structures + flocculonodular lobe; truncal ataxia (wide-based) + nystagmus + head tilting; bilateral motor deficits of axial + proximal limbs
41
2 functions + input + output of Basal ganglia
For voluntary mvts + postural adjustments
From cortex
Negative feedback to cortex
42
Excitatory + inhibitory pathways of basal ganglia
Excitatory: cortex +) striatum +) GABA -) GPi +) thalamus +) motion
Inhibitory: cortex +) striatum +) GABA -) GPe +) STN +) GPi -) thalamus -) motion
43
Athetosis, dystonia, myoclonus
Athetosis: basal gg, slow writhing mvt, fingers
Dystonia: sustained, involuntary muscle contraction
Myoclonus: sudden, brief, uncontrolled muscle contraction
44
Chorea, hemiballismus
Chorea: basal gg, sudden jerky purposeless mvt
Hemiballismus: contralateral subthalamic nucleus, sudden wild flailing arm + ipsilateral leg
45
Essential tremor, intention tremor, resting tremor
Essential: high-fqcy w/ sustained posture, worse w/ mvt-anxiety, ttt non selective beta-blocker/primidone.
Intention: cerebellar dysfunction, slow zigzag when pointing
Resting: Parkinson, uncontrolled mvt at rest, distal limbs, better w/ intentional mvt
46
4 causes + 2 ttt of Restless leg syndrome
Idiopathic
Iron deficiency
Uremia
Diabetes
Avoid aggravating factors (alcohol, sleep depriv.)
Dopa-agonists (Pramipexole)
47
3 findings + 5 symptoms of Parkinson disease
Degeneration of CNS
Lewy bodies
Loss of dopaminergic neurons of substantia nigra pars compacta
```
Tremor
Rigidity
Akinesia/bradykinesia
Postural instability
Shuffling gait
```
48
Advanced treatment of Essential tremor + Parkinson disease
Essential tremor: high fqcy stimulation of ventral intermediate nucleus of thalamus
Parkinson: high fqcy stimulation of globus pallidus internus or subthalamic nucleus
49
Excitatory + inhibitory pathways of basal ganglia
Excitatory: cortex +) striatum +) GABA -) GPi +) thalamus +) motion
Inhibitory: cortex +) striatum +) GABA -) GPe +) STN +) GPi -) thalamus -) motion
50
4 symptoms + 5 findings in Huntington disease
Choreiform movements
Aggression
Depression
Dementia
```
Low Ach, Low GABA, High dopamine
Neuronal death (NMDA-R binding + glutamate excitotoxicity)
Atrophy of caudate + putamen w/ hydrocephalus ex vacuo
```
51
2 findings in bilateral Amygdala lesion
Klüver-Bucy syndrome (disinhibited behavior)
| Ass w/ HSV-1 encephalitis
52
3 findings in Frontal lobe lesion
Right side: disinhibition
Left side: impaired performance (concentration, orientation, judgment), depressed affect, apathy
+/- primitive reflexes
53
2 findings in Nondominant parietal cortex lesion
Hemispatial neglect syndrome
| Constructional apraxia
54
1 finding in Dominant parietal cortex lesion
Gerstmann syndrome (Agraphia, Acalculia, Finger agnosia, Left-right disorientation)
55
1 finding in Reticular activating system (midbrain) lesion
Reduced levels of arousal + wakefulness
56
1 finding in bilateral Mamillary bodies lesion
Wernicke-Korsakoff syndrome (confusion, ophthalmoplegia, ataxia, memory loss, confabulations, personality changes)
57
3 findings + 2 diseases of Basal ganglia lesion
Resting tremor
Chorea
Athetosis
Parkinson disease
Huntington disease
58
4 findings in Cerebellar hemisphere
Intention tremor
Limb ataxia
Loss of balance
Ipsilateral deficits (falls toward side of lesion)
59
2 findings in Cerebellar vermis lesion
Truncal ataxia
| Dysarthria
60
1 finding in Subthalamic nucleus lesion
Contralateral hemiballismus
61
1 finding in bilateral Hippocampus lesion
Anterograde amnesia
62
1 finding in Paramedian pontine reticular formation lesion
Eyes look away from side of lesion
63
1 finding in Frontal eye fields lesion
Eyes look toward lesion
64
1 finding in Corpus callosum lesion
Split-brain syndrome
65
2 findings in Nondominant temporal lobe lesion
Impaired nonverbal memory
| Impaired musical ability
66
1 finding in Dominant temporal lobe lesion
Impaired verbal memory / word recognition
67
3 findings in Caudate nucleus lesion
```
Behavioral abnormalities (agitation, abulia, psychosis)
Speech/language disturbances
Movement disorders (choreoathetosis)
```
68
4 manifestations of increased ICP
Headache
Impaired consciousness
Focal neurologic deficits / seizures
Cushing triad (hypertension, bradypnea, bradycardia)
69
2 watershed zones + 2 symptoms when lesion
Anterior/middle cerebral arteries
Posterior/middle cerebral arteries
Upper leg/upper arm weakness
Defects in higher-order visual processing
70
Anatomy + symptoms in Anterior cerebral artery stroke
Motor + sensory cortices - lower limb
Contralateral paralysis + sensory loss - lower limb
71
Anatomy + symptoms in Middle cerebral artery stroke
```
Motor + sensory cortices - upper limb + face
Temporal lobe (Wernicke)
Frontal lobe (Broca)
```
Contralateral paralysis + sensory loss - upper limb + face
Aphasia (dominant hemisph)
Hemineglect (nondominant hemisph)
72
Anatomy + symptoms in Lenticulo-striate artery stroke
Striatum
Internal capsule
Contralateral paralysis +/- sensory loss - face + body
No cortical signs
73
Anatomy + symptoms in Posterior cerebral artery stroke
Occipital cortex
Visual cortex
Contralateral hemianopia w/ macular sparing
74
Anatomy + symptoms in Basilar artery stroke
Pons, medulla, lower midbrain, corticospinal T., corticobulbar T., ocular cranial nerve nuclei, PPRF
Locked-in syndrome: preserved consciousness, vertical eye movement, blinking, quadriplegia, loss of voluntary facial-mouth-tongue movements
75
Anatomy + symptoms in Anterior spinal artery stroke
Lateral corticospinal T.
Medial lemniscus
Caudal medulla (CN XII)
Contralateral paralysis - upper + lower limbs
Diminished contralateral proprioception
Ipsilateral hypoglossal dysfunction (tongue deviates ipsilat)
76
Anatomy + symptoms in Posterior inferior cerebellar artery stroke
Lateral medulla (Wallenberg syndrome)
Vestibular nuclei (vomiting, vertigo, nystagmus)
Lateral spinothalamic T., Spinal trigeminal nucleus (diminished pain+temperature - ipsilateral face + contralateral body)
Nucleus ambiguus (dysphagia, hoarseness, low gag reflex)
Sympathetic fibers (ipsilateral Horner syndrome)
Inferior cerebellar peduncle (ataxia, dysmetria)
77
Anatomy + symptoms in Anterior inferior cerebellar artery stroke
Lateral pons (lateral pontine syndrome)
Cranial nerve nuclei: vestibular nuclei (vomiting, vertigo, nystagmus), facial nucleus (paralysis of face, low lacrimation, salivation, low taste from ant 2/3), spinal trigeminal nucleus (diminished pain+temperature - ipsilateral face), cochlear nuclei
Spinothalamic T.: diminished pain+temperature - contralateral body
Corticospinal T.
Sympathetic fibers
Middle + inferior cerebellar peduncles: ataxia, dysmetria
78
4 characteristics of Saccular (berry) aneurysm
At bifurcations in circle of Willis (esp. ant communicating, ant cerebral)
Rupture: subarachnoid hge or hgic stroke
Ass w/ ADPKD, Ehlers-Danlos sd, coA of Aorta
Risk F.: age, HTN, smoking, black race
79
3 findings in Charcot-Bouchard microaneurysm
In small vessels
Not seen on angiogram
Ass w/ chronic HTN
80
2 characteristics of Central post-stroke pain syndrome
Neuropathic pain due to thalamic lesions
| First paresthesias then allodynia + dysesthesia
81
5 findings in Epidural hematoma
Middle meningeal artery (branch of maxillary)
After skull fracture
Rapid expansion (transtentorial herniation, CN III palsy)
Biconvex, hyperdense blood (CT)
Not crossing suture lines
82
6 findings in Subdural hematoma
```
Bridging veins
From brain atrophy, trauma, shaken baby
Acute (hyperdense) or chronic (hypodense) or acute on chronic
Crescent-shaped
Crosses suture lines
Causes midline shift
```
83
7 findings of Subarachnoid hemorrhage
Rupture of aneurysm
Arteriovenous malformation
Abuse of sympathomimetic drugs (cocaine)
Bloody/yellow spinal tap
Vasospasm after 4-10 days w/ ischemic infarct
Nimodipine to prevent vasospasm
High risk of communicating/obstructive hydrocephalus
84
6 findings in Intraparenchymal hemorrhage
In basal ganglia + internal capsule (or lobar)
By systemic hypertension
W/ amyloid angiopathy
W/ vasculitis
W/ neoplasm
After reperfusion injury (in ischemic stroke)
85
4 findings in Ischemic brain ds/stroke
Irreversible damage after 5 min of hypoxia
Most vulnerable: hippocampus, neocortex, cerebellum, watershed areas
Noncontrast CT detects ischemia in 6-24h
Diffusion-weighted MRI detects ischemia in 3-30min
86
5 histologic features according to time since brain ischemia
12-48h: red neurons, loss of Nissl substance
24-72h: necrosis, neutrophils
3-5d: macrophages (microglia)
1-2w: reactive gliosis, vascular proliferation
>2w: glial scar
87
3 types of ischemic stroke
Thrombotic: clot forms over atherosclerotic plaque
Embolic (AFib, DVT w/ PFO)
Hypoxic: hypoperfusion/hypoxemia (when cardiovasc surgery, watershed areas)
88
4 points in ischemic stroke treatment
tPA (within 3-4.5h of onset + if no hge/risk of hge)
Medical ttt (aspirin, clopidogrel)
Optimum control of BP + blood sugars + lipids
Ttt conditions that elevated risk (AFib)
89
4 findings in Transient ischemic attack
Focal ischemia
Brief + reversible
Negative imaging
Resolves in 15 minutes
90
3 characteristics of Venous sinus thrombosis
Signs/symptoms of elevated ICP
Ass w/ hypercoagulation (pregnancy, OCP, factor V Leiden)
May lead to venous hemorrhage
91
4 findings in Lacunes
Occlusion of small penetrating arteries (<15 mm)
In basal gg, post limb of internal capsule, pons, cerebellum
Ass w/ uncontrolled HTN + diabetes
Lipohyalinosis + microatheromas + hypertensive arteriolar sclerosis then liquefactive necrosis
92
7 findings in Idiopathic intracranial hypertension (pseudotumor cerebri)
Elevated ICP
No apparent cause on imaging
Risk F: young woman, vit A excess, danazol, tetracycline
Headache, diplopia, normal mental status (worse symptoms w/ Valsalva)
Bilateral symmetric papilledema
Lumbar puncture w/ high opening pressure + headache relief
Ttt: weight loss, acetazolamide, topiramate, invasive if refractory
93
4 findings in Communicating hydrocephalus
Decreased CSF absorption
High ICP
Papilledema
Herniation
94
4 findings in Normal pressure hydrocephalus
Idiopathic
Elderly
Episodically high CSF pressure
Triad: urinary incontinence, ataxia, cognitive dysfunction
95
1 finding in Noncommunicating hydrocephalus
Structural blockage of CSF circulation
96
4 findings in Ex vacuo ventriculomegaly
Imaging: appearance of increased CSF
Actually: decreased brain tissue (neuronal atrophy)
Ass w/ Alzheimer ds, advanced HIV, Pick ds
Normal ICP
97
Dorsal column: function, 1st-2nd-3rd neurons, synapses 1-2
Pressure, vibration, touch, proprioception
N1: ascends ipsilat.
S1: nucleus cuneatus or gracilis (medulla)
N2: decussates in medulla, ascends contralat. in medial lemniscus
S2: VPL (thalamus)
N3: sensory cortex
98
Spinothalamic tracts: function, 1st-2nd-3rd neurons, synapses 1-2
Lateral spinothalamic: pain, temperature
Anterior spinothalamic: crude touch, pressure
N1: enters spinal cord
S1: ipsilat. gray matter
N2: decussates at ant. white commissue, ascends contralat.
S2: VPL (thalamus)
N3: sensory cortex
99
Lateral corticospinal tract: function, 1st-2nd neurons, synapses 1-2
Lateral (and anterior) corticospinal: voluntary motor
UMN: (1* motor cortex) descends ipsilat. in internal capsule, most fibers decussate at caudal medulla, descends contralat.
S1: ant. horn of spinal cord
LMN: leaves spinal cord
S2: NMJ
100
6 findings in UMN lesion + 6 in LMN lesion
UMN lesion: weakness, high reflexes, high tone, +Babinski, spastic paralysis, clasp knife spasticity
LMN lesion: weakness, atrophy, fasciculations, low reflexes, low tone, flaccid paralysis
101
6 findings in Poliomyelitis + Werdnig-Hoffmann disease
Autosomal recessive
Congenital degeneration of anterior horns
LMN lesions only
Hypotonia + tongue fasciculations
Death at ~ 7 months
Asymmetric weakness (poliom.) / Symmetric weakness (Werdnig)
102
6 findings in Amyotrophic Lateral Sclerosis (Lou Gehrig ds)
Loss of cortical + spinal cord motor neurons
Combined UMN + LMN lesions
Defect in superoxide dismutase 1
Asymmetric limb weakness, fasciculations, atrophy
Fatal
Ttt: Riluzole
103
2 findings in Complete occlusion of anterior spinal artery
Spares dorsal columns + Lissauer tract
| Upper thoracic ASA territory is watershed
104
4 findings in Tabes dorsalis
By 3* syphilis
Degeneration of dorsal columns (impaired proprioception)
Absence of DTRs
Positive Romberg
105
3 findings in Syringomyelia
By syrinx, seen in Chiari I
Damaged anterior white commissure of spinothalamic tract
Bilateral loss of pain + temperature
106
3 findings in Vitamin B12 deficiency
Subacute combined degeneration
Demyelination of spinocerebellar T., lateral corticospinal T., dorsal columns
Ataxic gait, paresthesia, impaired position/vibration
107
6 findings in Friedreich ataxia
Autosomal recessive trinucleotide repeat (GAA)
Impaired mitochondrial functioning
Degeneration of multiple spinal cord tracts
Muscle weakness, loss of DTRs + proprioception + vibration
Nystagmus, dysarthria, hammer toes, diabetes, hypertrophic cardiomyopathy
Kyphoscoliosis, pes cavus
108
Brown-Séquard syndrome
Hemisection of spinal cord
At level of lesion: ipsilat loss of all sensation; ipsilat LMN signs (ant horn)
Below level of lesion: ipsilat loss of tactile, vibration, proprioception (dorsal column); ipsilateral UMN signs (corticospinal T); contralat loss of pain, temperature (spinothalamic T)
If lesion above T1, ipsilat Horner syndrome (oculosympathetic)
109
Conus medullaris syndrome
Lesion at L2
Flaccid paralysis of bladder-rectum, impotence, saddle anesthesia (S3-S5)
Mild weakness of leg if sparing of lumbar cord + adj spinal+lumbar nerve roots
110
Cauda equina syndrome
Massive rupture of intervertebral disk, trauma, mass
Compression of >=2/18 roots of cauda equina
Low back pain radiating to 1-2 legs
Saddle anesthesia
Loss of anocutaneous reflex, bowel+bladder dysfunction
Loss of ankle jerk reflex
111
3 structures of dorsal view of the brain stem
Pineal gland: melatonin, circadian rhythms
Superior colliculi: conjugate vertical gaze center (paralysis in Parinaud sd)
Inferior colliculi: auditory
112
3 vagal nuclei + functions + CN
N. Solitarius: visceral sensory info - VII, IX, X
N. Ambiguus: motor innervation of pharynx, larynx, upper esophagus - IX, X, XI
Dorsal motor N.: autonomic (parasymp) to heart, lungs, upper GI - X
113
Corneal, pupillary, lacrimation, vestibuloocular reflexes
Corneal: V1 ophthalmic - VII
Pupillary: II - III
Lacrimation: V1 - VII
Vestibuloocular: VIII - III, IV, VI
114
Jaw jerk, gag, cough, carotid sinus reflexes
Jaw jerk: V3 - V3
Gag: IX - X
Cough: X (internal laryng. N) - X
Carotid sinus: IX - X
115
4 mastication muscles
Close jaw: masseter, temporalis, medial pterygoid
| Opens jaw: lateral pterygoid
116
UMN and LMN lesions of CN VII
UMN: contralateral paralysis of lower muscles
LMN: ipsilateral paralysis of upper+lower muscles, hyperacusis, loss of taste of ant. tongue
117
6 findings in Facial nerve palsy
Peripheral CN VII lesion
Partial or complete loss of fct (dep. on location/severity)
Idiopathic (Bell palsy)
Lyme ds, herpes simplex, herpes zoster (Ramsay Hunt sd), sarcoidosis, tumors, diabetes
TTT: corticosteroids, acyclovir
Gradual recovery usually
118
4 signs/symptoms in Cavernous sinus syndrome
Ophthalmoplegia
Decreased corneal sensation
Horner syndrome
Decreased maxillary sensation
119
Function of DH4 + symptoms in case of DH4 deficiency
Cofactor used by hydroxylase enzymes in synthesis of tyrosine, dopamine and serotonin
Hyperphenylalanemia, phenylketonuria, intellectual disability, neurotransmitter deficiency
120
4 symptoms + 6 causes of Dementia
Diminished cognitive ability, memory or function w/ intact consciousness
```
Alzheimer ds
Frontotemporal dementia
Lewy body dementia
Vascular dementia
Creutzfeldt-Jakob ds
Other causes
```
121
5 findings in Alzheimer disease
Widespread cortical atrophy
Senile plaques (in gray matter, extracellular, beta- amyloid)
Neurofibrillary tangles (intracellular, tau protein)
Ass w/ altered proteins (ApoE2, ApoE4, APP, presenilin-1 and -2)
High risk in Down sd
122
4 findings in Frontotemporal dementia (Pick ds)
Frontotemporal lobe degeneration
Early changes in personality + behavior or aphasia
Ass w/ movement disorders
Tau or TDP-43
123
3 findings in Lewy body dementia
Dementia + visual hallucinations
Then parkinsonian features
Intracellular Lewy bodies (in cortex, alpha-synuclein)
124
3 findings in Vascular dementia
Multiple arterial infarcts +/- chronic ischemia
Decline in cognitive ability
Late-onset memory impairment
125
2 symptoms in Creutzfeldt-Jacob disease
Rapidly progressive dementia
| Myoclonus
126
6 other causes of dementia
```
Syphilis
HIV
Vitamin B1, B3 or B12 deficiency
Normal pressure hydrocephalus
Hypothyroidism
Wilson ds
```
127
5 characteristics of Osmotic demyelination syndrome
Central pontine myelinolysis
Massive demyelination
2* to osmotic changes (rapid correction of hypoNa+)
Acute paralysis, dysarthria, dysphagia, diplopia, loss of cs
+/- locked-in sd
128
5 findings in Multiple sclerosis
Autoimmune inflammation + demyelination of CNS
Relapsing/remitting +++ (3 other patterns)
CSF: High IgG + myelin basic protein
Dg: oligoclonal bands
MRI: periventricular plaques, white matter lesions separated in space+time
129
8 symptoms + treatment of Multiple sclerosis
Charcot triad: Scanning speech, Intention tremor, Nystagmus
Optic neuritis, INO, hemiparesis, hemisensory symptoms, bladder/bowel dysfunction
Acute ttt w/ IV steroids
Symptomatic ttt: neurogenic bladder, spasticity, pain
Slow progression w/ beta-IFN, glatiramer, natalizumab
130
9 findings in Acute inflammatory demyelinating polyradiculopathy
#1 subtype of Guillain-Barre sd
Inflammation + demyelination of peripheral nerves
Symmetric ascending muscle weakness/paralysis (lower extr. first)
Facial paralysis (50%)
+/- autonomic dysregulation or sensory abnl
Majority recover (weeks-months)
CSF: high protein
Ass w/ infections (Campylobacter)
Ttt: Respiratory support critical, plasmapheresis, IVIg
131
5 demyelinating/dysmyelinating diseases (other than ODS, MS, GB)
Acute disseminated (postinfectious) encephalomyelitis
Charcot-Marie-Tooth ds
Krabbe ds
Metachromatic leukodystrophy
Progressive multifocal leukoencephalopathy
132
Causes of seizures by age
Children: genetic, infection (febrile), trauma, congenital, metabolic
Adults: tumor, trauma, stroke, infection
Elderly: stroke, tumor, trauma, metabolic, infection
133
Treatment of acute + prophylaxis of Cluster headache
Acute: sumatriptan, 100% O2
Prophylaxis: verapamil
134
Treatment of acute + chronic Tension headache
Acute: analgesics, NSAIDs, acetaminophen
Chronic: amitriptyline
135
3 structures irritated in headaches + 3 in migraine
Headaches: dura, cranial nerves, extracranial structures
Migraine: CN V, meninges, blood vessels (substance P, calcitonin gene-related peptide, vasoactive peptides)
136
Treatment of acute migraine + prophylaxis
Acute: NSAIDs, triptans, dihydroergotamine
Prophylaxis: lifestyle changes, beta-blockers, CCBs, amitriptyline, topiramate, valproate
137
Treatment of Trigeminal neuralgia
Carbamazepine
138
4 neurocutaneous disorders
Sturge-Weber syndrome (encephalotrigeminal angiomatosis)
Tuberous sclerosis
Neurofibromatosis type I (von Recklinghausen ds)
von Hippel-Lindau ds
139
6 findings in Sturge-Weber syndrome
Sporadic anomaly of neural crest derivatives
Activating mutation of GNAQ gene
Port-wine stain on face
Ipsilat leptomeningeal angioma (seizures)
Intellectual disability
Episcleral hemangioma (glaucoma)
140
8 findings in Tuberous sclerosis
```
Hamartomas in CNS + skin
Cutaneous angiofibromas
Mitral regurgitation
Ash-leaf spots
Cardiac rhabdomyoma
Intellectual disability
Renal angiomyolipoma
Seizures
```
141
7 findings in Neurofibromatosis type I
```
Café-au-lait spots
Lisch nodules (iris hamartomas)
Cutaneous neurofibromas
Optic gliomas
Pheochromocytomas
Meningiomas-gliomas-astrocytomas
Congenital pseudoarthrosis-scoliosis
```
142
4 findings in von Hippel-Lindau ds
Hemangioblastomas (retina, brain stem, cerebellum, spine)
Angiomatosis (skin, mucosa, organs)
Bilateral renal cell carcinomas
Pheochromocytomas
143
5 findings in Glioblastoma multiforme (grade IV astrocytoma)
Highly malignant (1 yeal survival)
Cerebral hemispheres +/- cross corpus callosum
GFAP
Pseudopalisading pleomorphic cells
Neovascularisation + central necrosis/hge
144
6 characteristics of Meningioma
Benign
From arachnoid cells
Extra-axial +/- dural attachment
Asymptomatic ++ / seizures, focal neuro signs
Spindle cells in whorled pattern (psammoma bodies)
Resection +/or radiosurgery
145
4 findings in Hemangioblastoma
Cerebellar
Ass w/ von Hippel-Lindau sd (when w/ retinal angiomas)
Can produce EPO (2* polycythemia)
Close thin-walled capillaries
146
6 findings in Schwannoma
From any CN (except CN II) or any peripheral nerve
Esp vestibular, at cerebellopontine angle
Bilateral vestib schw in NF-2
Schwann cell (elongated w/ oval nuclei); biphasic
S-100+
Resection or stereotactic radiosurgery
147
3 findings in Oligodendroglioma
Frontal lobes
Oligodendrocytes (fried egg cells; round nuclei w/ clear cytoplasm)
Calcified ++
148
4 characteristics of Pituitary adenoma
Prolactinoma ++; non functioning adenoma
Bitemporal hemianopia
Sequelae: hyper or hypopituitarism
Hyperplasia of a single type of endocrine cell
149
3 findings in Metastatic brain tumors
Lung, breast, skin, renal cancers
Along white-gray junction
Area of reactive gliosis + edema + central necrosis
150
6 findings in Pilocytic astrocytoma (low grade)
```
Children
Posterior fossa +/- supratentorial
Benign
Well circumscribed (cystic)
GFAP+
Rosenthal fibers (eosino)
```
151
5 findings in Medulloblastoma
```
Children
Highly malignant
Cerebellum
Noncommunicating hydrocephalus; drop metastases to spinal cord
Homer-Wright rosettes, small blue cells
```
152
6 findings in Ependymoma
```
Children
Esp in 4th ventricle
Hydrocephalus
Poor prognosis
Perivascular rosettes
GFAP+
```
153
5 findings in Craniopharyngioma
```
Children
Supratentorial
From remnant of Rathke pouch
Bitemporal hemianopia, hypopituitarism, hyperprolactenemia, DI, headache, hydrocephalus
3 components: solid, cystic, calcified
```
154
3 findings in Pinealoma
Children
Parinaud sd, obstructive hydrocephalus, precocious puberty in males
Similar to germ cell tumors (histo)
155
4 herniation syndromes + consequences
Cingulate: ant cerebral artery compression
Downward transtentorial: rupture of paramedian basilar artery branches (Duret hge)
Uncal: ipsilat CN III, ipsilat PCA, contralat crus cerebri (ipsilat paresis) compression
Cerebellar tonsilar: brain stem compression (coma + death)
156
MOA + clinical use of Opioid analgesics
Agonists at opioid receptors
Reduce synaptic transmission (open K+, close Ca2+ ch)
Inhibit release of ACh, NE, 5-HT, glutamate, substance P
Not for all molecules: pain, cough suppression, diarrhea, acute pulm edema, maintenance for heroin addict
157
Adverse effects of Opioid analgesics + toxicity ttt
```
Addiction
Respiratory depression
Constipation
Miosis (mydriasis w/ Meperidine)
CNS depression (if w/ other drugs)
```
Ttt toxicity w/ Naloxone or Naltrexone
158
MOA + indication + adverse effects of Tramadol
Very weak opioid agonist
Inhibits 5-HT + NE reuptake
Chronic pain
Adv eff as opioids + decrese seizure threshold, serotonin sd
159
First line ttt for absence seizures
Ethosuximide (!! Stevens-Johnson sd)
160
MOA + Indications + adverse effects of Benzodiazepines
Rise GABAa action
First line ttt for acute status epilepticus
Second line ttt for eclampsia seizures (after MgSO4)
Sedation, tolerance, dependence, respiratory depression
161
First line ttt for neonatal epilepsy
Phenobarbital
162
MOA + indications + adverse effects of Phenytoin
Blocks Na+ ch, zero-order kinetics
First line ttt for tonic-clonic epilepsy (as valproic acid)
First line prophylaxis for status epilepticus
Neuro, dermato (SJ sd, DRESS sd, gingival hyperplasia), musculoskeletal, hemato, teratogenesis, CYP450 induction
163
MOA + indications + adverse effects of Carbamazepine
Blocks Na+ ch
First line ttt for simple or complex partial epilepsy
First line ttt for trigeminal neuralgia
Agranulocytosis, aplastic anemia, teratogenesis (neural tube def), SIADH, SJ sd, CYP450 induction
164
MOA + indications + CI of Valproic acid
Na+ ch inactivation
Raises GABA concentration
First line ttt for tonic-clonic epilepsy
For myoclonic seizures, bipolar disorder
For migraine prophylaxis
CI in pregnancy (neural tube def)
165
MOA + indications of Gabapentin
Inhibits high-voltage activated Ca ch
Simple or complex partial epilepsy
Peripheral neuropathy
Postherpetic neuralgia
166
Adverse effect of Lamotrigine (epilepsy drug)
Benign rash (10%)
Stevens-Johnson sd
Toxic epidermal necrolysis (1%)
167
MOA + indications + adv effects of Barbiturates
Prolongs duration of Cl- ch opening, facilitate GABAa action
Sedative (anxiety, seizures, insomnia, induction of anesth)
Respiratory+cardiovasc+CNS(esp if alcohol) depression, dependence, induction of CYP450
Ovedose ttt: supportive
168
9 indications for Benzodiazepines
Anxiety, spasticity, status epilepticus, eclampsia, detoxification (alcohol), night terrors, sleepwalking, general anesthetic (amnesia, M. relaxation), insomnia
169
MOA + adverse effects of benzodiazepines
Raises frequency of Cl- ch opening, facilitates GABAa action
Dependence
CNS depression ESP W/ alcohol, barbiturates, neuroleptics, 1st gen antihistamines
Overdose ttt: flumazenil
170
Effects + adverse effects of Inhaled anesthetics
Myocardial+respiratory depression, N/V, high cerebral blood flow
```
Hepatotoxicity, nephrotoxicity, proconvulsant, expansion of trapped gas
Malignant hyperthermia (ttt: dantrolene)
```
171
2 indications + 6 advers effects of local anesthetics
Minor surgical procedures, spinal anesthesia
CNS excitation, severe cardiovasc toxicity (bupiv), hyper/hypotension, arrhythmias (coca), methemoglobinemia (benzoc)
172
Neuromuscular blocking drugs
Depolarizing: succinylcholine (strong ACh recept agonist)
Nondepolarizing: -ium (competitive antagonist for ACh recept), neostigmine (w/ atropine), edrophonium, other cholinesterase inh
173
2 indications of Dantrolene
Malignant hyperthermia
| Neuroleptic malignant sd
174
5 main drugs for Parkinson disease
Dopamine agonists (ergot
175
3 drug families of Alzheimer ds + MOA + adverse effects
Memantine: NMDA recept antagonist - dizziness, confusion, hallucinations
Donepezil, galantamine, rivastigmine, tacrine: AChE inhibitors - nausea, dizziness, insomnia
Vitamine E: antioxidant
176
2 family drugs of Huntington ds
Tetrabenazine, reserpine: lowers dopa vesicle packaging+release
Haloperidol: D2 receptor antagonist
177
MOA + indication + adv effects of Sumatriptan
5-HT1B/1D agonist
Acute migraine, cluster headache attacks
Coronary vasospasm, mild paresthesia
