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Designated study period: daily cards > March 15 - Neurology > Flashcards

March 15 - Neurology Flashcards

(51 cards)

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1
Q

Pathophysiology of diabetic neuropathy

A

Hyalinization of nerve arterioles leads to ischemic nerve injury.

Accumulation of sorbitol and fructose in nerve axons also contributes to damage.

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2
Q

CNS repair after ischemic injury

A
  • 48 hours after can see red neurons - sign of irreversible damage
  • then neutrophils come in
  • 3-5 days after can see microglia which phagocytose damaged material
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3
Q

De novo purine synthesis pathway

A 
Ribose-5-phosphate
PRPP
5-phosphoribosylamine
IMP (cnoversion requires tetrahydrofolate)
GMP and AMP
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4
Q

Regulation of cerebral blood flow

A

1) systemic BP: autoregulation works within 60-140mmHg
2) arterial blood gases: decreased pCO2 such as in hyperventilation results in vasoconstriction and decreased cerebral blood flow

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5
Q

Ventilator management of increased ICP

A

Increase RR to decrease pCO2, causing vasoconstriction in the brain and decreased cerebral blood flow.

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6
Q

BH4

A

Cofactor in synthesis of serotonin, tyrosine, and DOPA. Produced by dihydropteridine reductase which reduces BH2 to BH4

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7
Q

PKU: two causes

A

Most cases due to phenylalanine hydroxylase deficiency
Also can be dihydropteridine reductase deficiency resulting in BH4 deficiency, impairing synthesis of both catecholamines and serotonin

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8
Q

Nerve conduction: length and time constants and effect of myelin

A

Length constant: how far along axon electric impulse propagates; increased by myelin

Time constant: how long it takes membrane potential to change; decreased by myelin

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9
Q

Birth defect associated with valproate

A

neural tube defects

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10
Q

Sympathetic pathway to eye

A

First order neuron: hypothalamus; axons go through brainstem to spinal cord

Second order neuron: intermediolateral cell column (pre-ganglionic fibers)

Third order neuron: superior cervical ganglion (post ganglionic fibers)

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11
Q

Pancoast tumor: presentation

A

Non-small cell lung cancer near superior sulcus in lung apex. Can compress/invade brachial plexus resulting in parasthesias, weakness, areflexia. Can invade superior cervical sympathetic ganglia resulting in Horner syndrome

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12
Q

POMC

A

precursor to endorphins, ACTH, and MSH

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13
Q

Dandy-Walker malformation: three findings

A

Hypoplasia/absence of cerebellar vermis
Cystic dilation of 4th ventricle
Posterior fossa enlargement

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14
Q

Early symptom of uncal herniation

A

Oculomotor nerve palsy

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15
Q

N-acetylglutamate

A

activator of carbamoyl phosphate synthetase I

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16
Q

Friedreich ataxia: neuro and non-neuro manifestations

A

Neuro: progressive gait ataxia, impaired joint position and vibration sense due to spinal tract damage

Non-neuro: hypertrophic cardiomyopathy, skeletal abnormalities, diabetes

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17
Q

Craniopharyngioma: gross pathology and pathophys

A

Suprasellar tumor seen in kids. Cystic, filled with brown-yellow fluid with protein and cholesterol. Remnant of rathke’s pouch which is oral ectoderm that gives rse to the anterior pituitary

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18
Q

COMT inhibitors

A

Entacapone: inhibits peripheral methylation of L-dopa
Tolcapone: inhibits both peripheral and central methylation of L-dopa

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19
Q

Atropine MOA

A

anti muscarinic

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20
Q

Branched chain amino acids

A

isoleucine, valine, leucine

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21
Q

Thiamine: three enzymes its a cofactor for

Study These Flashcards
A
  1. Pyruvate dehydrogenase (glycolysis)
  2. Alpha-ketoglutarate dehydrogenase (TCA cycle)
  3. Transketolase (HMP shunt)
22
Q

Inhaled anesthetics effect on blood flow

Study These Flashcards
A
  • decrease CO resulting in systemic hypotension
  • decrease cerebral vascular resistance which can increase ICP
  • decrease flow to kidney and liver
23
Q

positioning in coma

Study These Flashcards
A

Decerebrate: extensors predominate, lesion below red nucleus

Decorbitate: flexors predominate, lesion above red nucleus

24
Q

Pineal gland mass presentation

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A

Obstructive hydrocephalus, impaired upward gaze

25
Lamotrigine toxicity
Skin rash (10%). Can be very severe rarely with SJS or toxic epidermal necrolysis
26
Trapezius: innervation and function
CNXI Elevates scapula, rotates scapula up, stabilizes shouldr
27
Accessory nerve damage: cause and presentation
Caused by trauma to posterior triangle of neck Presentation: drooped shoulder, winged scapula, impaired abduction of shoulder above horizontal
28
Sympathetic innervation of eccrine sweat glands
ACh is the NT at both pre and post synaptic nerve terminals
29
Vitamin A toxicity: acute and chronic
Acute: N/V, vertigo, blurred vision Chronic: alopecia, dry skin, hyperlipidemia, hepatoxociity and HSM, vision problems, pseudotumor cerebri with increased ICP
30
Lateral horns
Carry pre ganglionic symp fibers. T1-L2 spinal level
31
Oculomotor nerve palsy: two types
Ischemia: extraocular efferents on the inside effected more, down and out eye Compression: parasympathetics on outside affected more, APD
32
Phenytoin: MOA and side effects
MOA: blocks VG Na+ channels Side effects: narrow therapeutic index drugs with many ADRs. One is gingival hyperplasia. Also is a CYP450 inducer
33
Femoral nerve block: location
Inguinal crease, lateral to femoral artery. That way anesthatizes skin and muscles of anterior thigh, femur, and knee
34
Pramipexole
Nonergot dopamine agonist used to treat PD
35
Pathologic finding in CJD
Large intracytoplasmic vacuoles
36
Pathologic finding in brain in rabies
Negri bodies
37
Biochemical alteration in huntington disease
Loss of GABA-containing neurons results in decreased GABA levels in the brain
38
Cavernous hemangioma: what it is, presentation, and complication
Vascular malformation in brain parenchyma with clusters of dilated capillaries Presentation: seizures, as progresses can see focal defects Complication: can bleed and cause ICH
39
Barbiturates: kinetics
Plasma level rapidly decreases due to drug redistribution into tissue
40
Carbamazepine: MOA, Use, and ADRs
MOA: blocks Na+ channels in cortical nuerons Use: complex partial seizures, mood stabilizer, trigeminal neuralgia ADRs: bone marrow suppression, hepatotoxicity, SIADH, CYP450 inducer
41
Aneurysms: Charcot-Bouchard vs Berry
Charcot-Bouchard aneurysms: in basal ganglia, cerebellum, thalamus, pons. Rupture to cause ICH Berry aneurysms: in circle of willis. Rupture to cause SAH. Both associated with HTN. Berry also associated with ADPKD and ehlers danlos
42
Tabes dorsalis vs subacute combined degeneration
Tabes dorsalis: form of neurosyphilis. involves dorsal columns and dorsal roots (sensory only) Subacute combined degeneration: B12 def, involves dorsal columns and lateral tracts (Sensory + UMN symptoms)
43
Treatment of restless leg syndrome
dopamine agonist
44
Intraventricular hemorrhage
Seen as complication of prematurity. Bleeding originates from germinal matrix
45
Isoniazid toxicity - neuropathy
Isoniazid is chemically similar to vitamin B6 and competes with B6 for neurotransmitter synthesis. Increase in urinary B6 excretion can cause person to become deficiency. Thus, supplemental B6 often given to prevent peripheral neuropathy from occurring.
46
Thiopental kinetics and MOA
Short acting barbiturate. Rapidly equilibrates with brain, knocking patient out in a minute following IV administration. Then redistributes to skeletal muscle and adipose tissue.
47
Basal ganglia: two pathways
1) Direct pathway -sub niagra excites striatum via D1 receptors -striatum inhibits GPi -GPi inhibits thalamus Net effect: disinhibition of thalamus 2) Indirect pathway -sub niagra inhibits striatum via D2 receptors -striatum inhibits GPe -GPe inhibits subthalamic nucleus -subthalamic nucleus excites GPi -GPi inhibits thalamus Net effect: also disinhibition of thalamus
48
Subacute cerebellar degeneration
Paraneoplasic syndrome associated with small cell lung cancer
49
Geniculate nuclei
Medial: auditory information Lateral: vision information
50
ALS vs poliomyelitis
ALS: affects anterior horn, descending spinal tracts (mixed upper and lower motor neuron) Polio: affects anterior horn only (pure LMN)
51
Vitamin E deficiency
Neurologic symptoms mimicking Friedreich's ataxia: ataxia, loss of position/vibration sense, loss of DTRs. Hemolysis

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