NBME (First Aid Content) Flashcards
(500 cards)
1
Q
A kind of learning where a natural response is elicited by a conditioned stimulus that was previously presented in conjunction with an unconditioned stimulus
A
Classical conditioning
2
Q
Neurotransmitter changes in Alzheimer’s
A
Decreased ACh, increased glutamate
3
Q
List an example of classical conditioning in PTSD
A
Something along the lines of flinching or ducking (natural response) in response to loud noises (learned stimulus) that were experienced in combat in the context of gunshots or explosions (unconditioned stimulus)
4
Q
Learning in which an action is elicited because it produces a punishment or reward
A
Operant conditioning
4
Q
Neurotransmitter changes in Parkinson disease
A
Decreased dopamine, increased ACh
5
Q
List an example of negative reinforcement that might be used to convince a prisoner to speak in an interrogation situation
A
Remove the prisoner’s chains or other painful conditions every time that the prisoner speaks
6
Q
A doctor notices that his patient reminds him of his younger brother - what is this called?
A
Countertransference
7
Q
A teenager is angry at her sister, so she goes to kickboxing class to let out her anger. What is this called, and is it mature or immature?
A
Sublimation - mature ego defense
8
Q
What are the four mature ego defenses?
A
Sublimation, Altruism, Suppression, Humor
9
Q
A man feels guilty about his diet and his inability to lose weight, so he decides to donate to a charity to help people suffering from food insufficiency. What is this called, and is it mature or immature?
A
Altruism - mature ego defense
10
Q
An 8-year-old has difficulty focusing and sitting still in school, and is fidgety and impulsive at home. His father says that he helps himself to sugary snacks even when he is told not to, and appears to not have good control over his impulses. He has been struggling in school, and has been sent to the office twice this month for acting out or acting impulsively. What diagnosis do you suspect, and how might you treat it?
A
Attention deficit hyperactivity disorder - onset before age 12, with hyperactivity, impulsivity, and/or inattention in multiple settings. Treat with stimulants (methylphenidate) and CBT, could also use atomoxetine, guanfacine, clonidine
12
Q
Neurotransmitter changes in depression
A
Decreased norepinephrine, decreased 5-HT, decreased dopamine
13
Q
Neurotransmitter changes in anxiety
A
Increased norepinephrine, decreased GABA, decreased 5-HT
14
Q
Mid-line hand wringing is a key stereotyped behavior of which condition?
A
Rett Syndrome - X-linked dominant, seen almost exclusively in girls
15
Q
Neurotransmitter changes in Huntington disease
A
Decreased GABA, decreased ACh, increased dopamine
16
Q
Neurotransmitter changes in schizophrenia
A
Increased dopamine
17
Q
A patient projects her feelings about her mother onto her psychiatrist - what is this called?
A
Transference
18
Q
Decreased cognitive functioning without changes in level of consciousness, characterized by memory deficits, apraxia, aphasia, agnosia, behavior or personality changes, impaired judgment
A
Dementia
19
Q
Treatment of delirium
A
Identify and treat underlying condition, use haloperidol as needed, use benzodiazepines for delirium tremens in alcohol withdrawal
20
Q
List an example of how positive punishment and negative punishment might be used to teach a child not to throw food on the floor
A
Positive punishment: Say “No!” loudly every time the kid throws food
Negative punishment: Take away dessert every time the kid throws food on the floor
21
Q
Herniation of the cerebellar vermis through the foramen magnum with aqueductal stenosis, leading to hydrocephalus
A
Chiari II malformation - often associated with lumbosacral meningomyelocele
22
Q
Reversible causes of dementia-like symptoms
A
Hypothyroidism, depression, vitamin B12 deficiency, neurosyphilis
23
Q
Distorted perception of reality characterized by delusions, hallucinations, and/or disorganized thinking
A
Psychosis
24
Q
Hallucinations that can occur when waking up from sleep
A
Hypnopompic
25
How long do symptoms of schizophreniform disorder have to last in order to make a diagnosis?
1-6 months
26
Pain and popping sensation on internal rotation of tibia
Lateral meniscal tear
27
List an example of positive reinforcement that you might use to teach a child to be toilet trained
Child might receive a sticker or other small prize, or even just verbal praise, every time they successfully use the toilet
28
How long do symptoms of schizoaffective disorder have to last in order to make a diagnosis?
>2 weeks
29
Fracture of this carpal bone in a fall on an outstretched hand can damage the ulnar nerve
Hook of the hamate
30
Patient with flattened deltoid, loss of shoulder abduction, loss of sensation in lateral arm
Axillary nerve injury - will also damage teres minor
31
Mental health complication of frequent cannabis use in teens
Schizophrenia and psychosis
32
Waxing and waning level of consciousness with acute onset, decreased attention span, decreased level of arousal, disorganized thinking, may have hallucinations, cognitive dysfunction
Delirium
33
First-line schizophrenia treatment
Atypical antipsychotics such as risperidone
34
Dislocation of this bone can cause carpal tunnel
Lunate
35
Nerve injury with fractured surgical neck of humerus
Axillary (C5-6)
36
Baker's cyst location
Gastrocnemius-semimembranosus bursa, in the popliteal fossa
38
Positive symptoms of schizophrenia
Delusions, hallucinations, disorganized speech, disorganized or catatonic behavior (need at least one of the first 3 plus another or negative symptoms to make the diagnosis)
38
Pain after repetitive extension of elbow
Lateral epicondylitis - tennis elbow
40
Duration of symptoms necessary for classification as a manic episode
At least one week
40
Infant born with a tuft of hair at the L3 level of the mid-back. What is the disorder? If the mother had gotten an AFP test during pregnancy, what would the result have been?
Spina bifida occulta. Bony spinal canal didn't close, but there is no herniation of the meninges or the spinal cord. SB occulta would have a normal maternal AFP, unlike the other two forms of spina bifida.
41
Widening of medial joint space of knee
MCL tear
42
A mother is folate-deficient and her infant is born with a neural tube closure defect on the lower mid-back. If the baby is diagnosed with a meningocele, what does that mean? What about a myelomeningocele?
Meningocele - meninges, but no neural tissue, herniated through the bony defect.
Myelomeningocele - meninges and neural tissue herniated through. This kid might not even have skin over the defect.
43
Hallucinations that can occur while going to sleep
Hypnagogic
44
4 bones that, when fractured, are probably at the highest risk of developing avascular necrosis
Femoral neck fracture; scaphoid fracture; navicular bone fracture, talus fracture
45
Agenesis of the cerebellar vermis with massive cystic enlargement of the 4th vesicle, such that it fills the posterior fossa, displacing the cerebellum and occipital nerve upwards
Dandy-Walker malformation. Often associated with non communicating hydrocephalus and spina bifida
46
Initial abduction of arm
Supraspinatus - suprascapular nerve
47
Widening of lateral joint space of knee
LCL tear
48
How long do symptoms of schizophrenia have to last in order to make a diagnosis?
>6 months
49
Empty can test assesses this muscle
Supraspinatus
51
Pain after repetitive flexion of elbow
Medial epicondylitis - golfer's elbow
52
Negative symptoms of schizophrenia
Flat affect, lack of volition, anhedonia, asociality, alogia
52
Most commonly fractured carpal bone, prone to avascular necrosis
Scaphoid bone
53
Loss of sensation of lateral forearm, loss of forearm flexion and supination
Musculocutaneous nerve injury, probably due to upper trunk compression
54
Duration of symptoms necessary for classification of a hypomanic episode
At least 4 consecutive days
55
Pain and popping sensation on external rotation of tibia
Medial meniscal tear
56
Pathophysiology and imaging of schizophrenia
Associated with increased dopamine, decreased dendritic branching, ventriculomegaly on brain imaging
57
Knee ligament extending from lateral femoral condyle to anterior tibia
ACL
58
Knee ligament extending from medial femoral condyle to posterior tibia
PCL
59
Pathologic finding elicited by valgus maneuver
MCL injury
60
Pathologic finding elicited by varus maneuver
LCL injury
61
Rotator cuff muscle that laterally rotates arm
Infraspinatus
62
Carpal bone immediately proximal to first metacarpal
Trapezium
63
Carpal bone immediately proximal to second metacarpal
Trapezoid
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Carpal bone proximal to third metacarpal
Capitate
65
Carpal bone proximal to fourth and fifth metacarpals
Hamate
66
Radial nerve injury presentation
Wrist drop, decreased grip strength, loss of sensation on posterior arm/forearm and distal hand
67
Nerve injury causing wrist drop
Radial nerve
68
Nerve injury causing decreased grip strength
Radial nerve
69
Nerve injury causing thenar atrophy and inability to make a fist with first three fingers
Proximal Median nerve injury
70
Nerve injury causing inability to extend digits 4 and 5 in the hand
Distal Ulnar nerve injury
71
Nerve injury causing inability to extend digits 1-3 in the hand
Distal Median nerve injury
72
Nerve injury causing inability to make a fist with fingers 4 and 5
Proximal Ulnar nerve injury
73
Fracture of medial epicondyle of humerus
Proximal ulnar nerve injury -> inability to make a fist with fingers 4 and 5 (OK gesture)
74
Fractured hook of hamate
Distal ulnar nerve injury -> inability to extend digits 4/5 (ulnar claw)
75
Supracondylar fracture of humerus
Proximal median nerve injury -> can't make a fist with first three fingers (Benediction hand)
76
Wrist laceration
Distal median nerve injury -> can't extend digits 1-3 in the hand (median claw)
77
Superficial laceration of palm
Thenar atrophy -> inability to do opposition, flexion, or abduction of thumb, but no loss of sensation
78
Sensation to lateral half of dorsal hand (not counting digits 2 and 3)
Radial nerve
79
Wrist drop
Radial nerve injury
80
Midshaft fracture of humerus
Radial nerve injury
81
Using crutches that are inappropriately large
Radial nerve injury
82
Loss of abduction and adduction of fingers
Ulnar nerve injury - it innervates the interossei
83
Loss of sensation over hypothenar eminence
Ulnar nerve injury
84
Loss of forearm flexion and supination
Musculocutaneous nerve injury
85
Compression of the upper trunk of the brachial plexus
Musculocutaneous nerve injury -> loss of forearm flexion and supination, loss of sensation to lateral forearm
86
Arm hanging at side, medially rotated, extended, and pronated
Erb's palsy - tear of upper trunk (C5-6), can occur in infants during delivery. Leads to deficits of deltoid and supraspinatus (loss of abduction), infraspinatus (loss of lateral rotation), biceps brachii (loss of flexion and supination)
87
Total claw hand
Klumpke palsy - tear of C8-T1/lower trunk, can occur with an upward force on a baby's arm during delivery or due to upward forces in trauma. Leads to deficits of intrinsic hand muscles: lumbricals, interossei, thenar muscles, hypothenar muscles.
88
Atrophy of intrinsic hand muscles, and ischemia, pain, and edema in the affected arm
Thoracic outlet syndrome: compression of lower trunk and subclavian vessels. Will look the same as Klumpke's palsy.
89
Patient with a claw hand and vascular insufficiency to that arm
Thoracic outlet syndrome
90
Winged scapula
Damage to long thoracic nerve, leading to serratus anterior deficit. Patient cannot abduct arm above horizontal position.
91
Function of lumbricals at MCP joints
flexion
92
Function of lumbricals at PIP and DIP joints
extension
93
Decreased sensation to medial thigh, decreased adduction at hip
Obturator nerve injury (L2-4 anterior division fibers)
94
Decreased thigh flexion at hip and leg extension
Femoral nerve injury (L2-4 posterior division fibers)
95
Inability to curl toes, loss of sensation on plantar foot, loss of inversion, loss of plantarflexion
Proximal injury to tibial nerve. Foot will appear everted and dorsiflexed at rest.
96
Inability to curl toes and loss of sensation to plantar foot, but inversion and plantarflexion are intact
Distal tibial nerve injury, probably due to tarsal tunnel syndrome
97
Fibular neck fracture resultant nerve injury
Common peroneal nerve injury
98
Foot drop with loss of eversion and dorsiflexion, loss of sensation on dorsum of foot
Common peroneal nerve injury
99
Nerve deficit from Baker cyst
Tibial nerve injury
100
Nerve deficit from compression of lateral leg
Common peroneal nerve injury
101
Trendelenburg sign
Pelvis tilts downward on one side. Lesion is CONTRALATERAL to the side of the hip that drops down, which is not the side the patient is standing on. Due to weakness of aBduction in the weight-bearing leg.
102
Superior gluteal nerve injury
Trendelenburg sign
103
Difficulty climbing stairs and rising from seated position, with loss of hip extension
Inferior gluteal nerve injury or problem with gluteus maximus
104
Site for IM injection in gluteal muscle in order to avoid nerve injury
Superior lateral gluteal quadrant
105
Direction that intervertebral discs generally herniate
Posterolaterally
106
Injury at disc level L3/4 affects what nerve?
L4
107
Injury at disc level L4/5 affects what nerve?
L5
108
Injury at disc level L5/S1 affects what nerve?
S1
109
Radiculopathy with weakness of knee extension and decreased patellar reflex
L4 radiculopathy
110
Radiculopathy with weakness of dorsiflexion, can't walk on heels
L5 radiculopathy
111
Radiculopathy with weakness of plantarflexion, can't walk on toes, decreased Achilles reflex
S1
112
Artery that runs with long thoracic nerve
Lateral thoracic artery
113
Artery that runs with axillary nerve
Posterior circumflex artery
114
Artery that runs with radial nerve
Deep brachial artery
115
Artery that runs with median nerve
Brachial artery
116
Artery that runs with tibial nerve
Popliteal artery in popliteal fossa -> posterior tibial artery posterior to the medial malleolus
117
Muscle fibers that do mostly oxidative phosphorylation
Type I - slow twitch red fibers with increased myoglobin and mitochondria
118
Muscle fibers that do mostly anaerobic glycolysis
Type II - fast twitch white fibers with less mitochondria and myoglobin
119
Bone formation of long and short bones
Endochondral ossification
120
Cartilagenous bone model then replaced with woven bone, which is then replaced with lamellar bone
Endochondral ossification
121
Woven bone
bone type that occurs in endochondral bone formation, after fractures
122
Bone formation of skull, flat bones
Woven bone formed directly without cartilage -> intermembranous ossification
123
Bone cell that differentiates from mesenchymal stem cells in periosteum
Osteoblast
124
Osteoblast function
Build bone by secreting collagen, manage bone signaling
125
Osteoclast function
Resorb bone by secreting H+
126
PTH function at low, intermittent levels
Builds bone
127
PTH function at overly high levels
Leads to bone catabolism/resorption
128
Hormone that inhibits apoptosis in osteoblasts and induces apoptosis in osteoclasts
Estrogen
129
FGFR3 mutation
Achondroplasia: failure of endochondral ossification due to inhibition of chondrocyte proliferation
130
Bone mineral density with a T score of less than or equal to -2.5
Osteoporosis
131
Osteoporosis prophylaxis
Weight-bearing exercise, calcium, vitamin D
132
Acute back pain, loss of height, kyphosis
Vertebral compression fracture
133
Treatment of osteoporosis
Bisphosphonates, teriparatide, SERMS, denosumab
134
Thickened and dense bones that are prone to fracture, with pancytopenia
Osteopetrosis (due to defective osteoclasts with mutations in carbonic anhydrase, etc)
135
Osteopenia in adults, with defective mineralization of osteoid
Osteomalacia
136
Defective mineralization of cartilagenous growth plates leading to epiphyseal widening and bow-legs
Rickets
137
Vitamin D, calcium, PTH, phosphate, and ALP levels in osteomalacia or rickets
Low vitamin D, low calcium, high PTH, low phosphate, high ALP
138
Most common site of osteonecrosis
Femoral head
139
Causes of osteonecrosis
Corticosteroids, alcoholism, sickle cell, trauma, the bends, idiopathic, Gaucher disease, slipped femoral epiphysis
140
Radiographs of osteonecrosis
Bone looks like there's been a bite taken out of it
141
Serum calcium, phosphate, ALP, and PTH in primary hyperparathyroidism
Calcium high, phosphate low, ALP high, PTH high
142
Serum calcium, phosphate, ALP, and PTH in secondary hyperparathyroidism
Calcium low, phosphate high, ALP high, PTH high
143
Serum calcium, phosphate, and PTH in an excess of vitamin D (oversupplementation or granulomatous disease)
Calcium high, phosphate high, PTH low
144
Osteoarthritis or rheumatoid arthritis: mechanical wear and tear causes it
Osteoarthritis
145
Osteoarthritis or rheumatoid arthritis: autoimmune mechanism
Rheumatoid arthritis
146
Osteoarthritis or rheumatoid arthritis: risk factors include age, being female, obesity, trauma
Osteoarthritis
147
Osteoarthritis or rheumatoid arthritis: risk factors include being female, HLA-DR4, smoking, RF, CCP
Rheumatoid arthritis
148
Osteoarthritis or rheumatoid arthritis: pain in weight-bearing joints after use
Osteoarthritis
149
Osteoarthritis or rheumatoid arthritis: pain and morning stiffness/swelling get better with use
Rheumatoid arthritis
150
Osteoarthritis or rheumatoid arthritis: osteophytes, joint space narrowing, begins medially in knee, subchondral sclerosis, low WBCs in synovial fluid
Osteoarthritis
151
Osteoarthritis or rheumatoid arthritis: Erosions, cysts, high WBCs in synovial fluid
Rheumatoid arthritis
152
Treatment for osteoarthritis
Acetaminophen, NSAIDs, glucocorticoid injections
153
Joints most commonly involved in osteoarthritis
Knee, hip, DIPs, PIPs, first carpometacarpal joint
154
Joints most commonly involved in rheumatoid arthritis of the hand
MCP, PIP, wrist
155
Negatively birefringent, needle-shaped, yellow under parallel light crystals
Uric acid -> gout
156
Positively birefringent, rhomboid, blue under parallel light crystals
Calcium pyrophosphate
157
Common pathogens for septic arthritis
S. aureus, Streptococcus, N. gonorrhoeae
158
Purulent synovial fluid, WBC > 50,000
Septic arthritis
159
Gonococcal arthritis presentations
Septic arthritis (knee) or reactive arthritis (polyarthralgias, tenosynovitis, rash)
160
Pain and stiffness in shoulders and hips in an older woman, without weakness, with high ESR and CRP, that responds quickly to low-dose corticosteroids
Polymyalgia rheumatica (associated with giant cell arteritis)
161
Treatment for fibromyalgia
Exercise, therapy, TCAs, SNRIs
162
Endomysial inflammation with CD8+ T cells, progressive symmetric proximal weakness
Polymyositis
163
Perimysial inflammation and atrophy, CD4+ T cells, heliotrope rash, Gottron papules, symmetric proximal weakness
Dermatomyositis
164
A diagnosis of dermatomyositis suggests you should do what?
Work patient up for an occult malignancy
165
Autoantibodies to post-synaptic ACh receptor
Myasthenia gravis
166
Ptosis, diplopia, and weakness that worsens with muscle use
Myasthenia gravis
167
Treatment for myasthenia gravis
Pyridostigmine
168
Pyridostigmine MOA
Acetylcholinesterase inhibitor
169
Proximal muscle weakness with autonomic symptoms; improves with muscle use
Lambert-Eaton syndrome
170
Autoantibodies to pre-synaptic Ca++ channel lead to decreased ACh release
Lambert-Eaton syndrome
171
Muscles affected most in Lambert-Eaton
proximal large muscles
172
Muscles affected most in myasthenia gravis
Extraocular muscles
173
Malignancy associated with Lambert-Eaton syndrome
small cell lung cancer
174
Reversible cyclooxygenase inhibitor that is analgesic but not anti-inflammatory and is metabolized in the liver
Acetaminophen
175
Irreversible COX1 and COX2 inhibitor
Aspirin
176
COX2-selective NSAID used in osteoarthritis and rheumatoid arthritis
Celecoxib
177
Adverse effects of non-aspirin NSAIDs
Interstitial nephritis, gastric ulcer, renal ischemia
178
MOA of bisphosphonates
Pyrophosphate analogs that bind hydroxyapatite and inhibit osteoclasts
179
Side effects of bisphosphonates
Osteonecrosis of jaw, atypical stress fractures
180
MOA of teriparatide
Recombinant PTH analog that increases osteoblast activity
181
Preventative gout drugs
Allopurinol and Febuxostat (xanthine oxidase inhibitors)
182
Acute gout drugs
NSAIDs (naproxen, indomethacin), glucocorticoids, colchicine
183
Sensory and motor deficits in a child with meningomyelocele
At/below the level of the meningomyelocele
184
Neural cells derived from neuroectoderm
CNS neurons, ependymal cells/choroid plexus, oligodendrocytes, astrocytes
185
Neural cells derived from neural crest
PNS neurons, Schwann cells
186
Neural cells derived from mesoderm
Microglia
187
Two markers that are elevated in amniotic fluid in spina bifida
AFP, fetal acetylcholinesterase
188
Mutations in sonic hedgehog signaling pathway causing a failure of left and right hemispheres to separate
Holoprosencephaly
189
Syndromes with holoprosencephaly
Patau syndrome, fetal alcohol syndrome
190
Cranial nerves that sense taste
CN VII, IX, X
191
Cranial nerves sensing pain to the tongue
CN V3, IX, X
192
Cranial nerves providing motor innervation to the tongue
CN, X, XII
193
Wallerian degeneration
An injury to an axon causes it to degenerate distal to the injury, leading to axonal retraction proximally
194
Neural cell responsible for physical support and blood-brain barrier
Astrocytes
195
Neural cell that serves the function of a macrophage
Microglia
196
How does myelin affect conduction velocity?
Increases it
197
Cell that myelinates CNS
Oligodendrocytes
198
Cell that myelinates PNS
Schwann cells
199
How many axons can a Schwann cell myelinate?
Only 1
200
Cell type that may be injured in Guillain-Barre syndrome
Schwann cells
201
C-type free nerve endings
Slow, unmyelinated fibers that sense pain and temperature
202
Adelta type free nerve endings
Fast, myelinated fibers that sense pain and temperature
203
Large myelinated fibers that adapt quickly and sense light touch and position sense
Meissner corpuscles
204
Large myelinated fibers that adapt quickly and sense vibration and pressure
Pacinian corpuscles
205
Large myelinated fibers that adapt slowly and sense pressure, static touch (shapes, edges, etc), position sense
Merkel discs
206
Dendritic endins with a capsule that adapt slowly and sense pressure, objects moving along the surface of skin, and joint angle changes
Ruffini corpuscles
207
Inflammatory infiltrate is within this layer in Guillain-Barre syndrome
Endoneurium (at the level of single fibers)
208
This layer surrounding nerves must be rejoined in microsurgery for nerve or limb repair
Perineurium
209
This layer of tissue surrounds entire nerves - fascicles and microvasculature
Epineurium
210
Location of ACh synthesis
Basal nucleus of Meynert
211
Location of dopamine synthesis
Ventral tegmentum, SNpc (substantia nigra pars compacta)
212
Location of GABA synthesis
Nucleus accumbens
213
Location of norepinephrine synthesis
Locus coeruleus
214
Location of serotonin synthesis
Raphe nucleus
215
Disease states with decreased ACh
Alzheimer's, Huntington's disease
216
Disease states with increased ACh
Parkinson's disease
217
Disease states with decreased dopamine
Depression, Parkinson's disease
218
Disease states with increased dopamine
Schizophrenia, Huntington's disease
219
Disease states with decreased GABA
Anxiety, Huntington's disease
220
Disease states with increased norepinephrine
Anxiety
221
Disease states with decreased norepinephrine
Depression
222
Disease states with increased serotonin
Parkinson's disease
223
Disease states with decreased serotonin
Anxiety, Depression
224
3 structures that form the blood-brain barrier
Tight junctions between capillary endothelial cells; basement membrane; astrocyte foot processes
225
Chemicals made by the hypothalamus
ADH, oxytocin
226
Paraventricular nucleus of hypothalamus
Makes oxytocin
227
Supraoptic nucleus of hypothalamus
Makes ADH
228
Where are ADH and oxytocin stored and released?
Posterior pituitary
229
Function of lateral area of hypothalamus
Sense of hunger. Stimulated by ghrelin, inhibited by leptin. If you destroy it, you starve yourself
230
Function of ventromedial hypothalamus
Sense of satiety. Stimulated by leptin. If you destroy it, you eat too much
231
Function of anterior hypothalamus
Cooling, parasympathetics
232
Function of posterior hypothalamus
Heating, sympathetic
233
Function of suprachiasmatic nucleus of hypothalamus
Circadian rhythm
234
What area of the brain controls extraocular movements in REM sleep?
PPRF (paramedian pontine reticular formation/conjugate gaze center) in the pons
235
Describe the trends in REM and NREM sleep throughout the night
You start by entering NREM sleep. REM sleep occurs every 90 minutes and its duration increases throughout the night.
236
How is melatonin release regulated?
Suprachiasmatic nucleus -> NE release -> acts on pineal gland -> melatonin release, all regulated by the circadian rhythm
237
Affects of alcohol, benzos, and barbiturates on sleep
Decreases REM sleep and delta wave sleep
238
EEG waveform when awake with eyes open
Beta waves - highest frequency, lowest amplitude
239
EEG waveform when awake with eyes closed
Alpha waves
240
EEG waveform when in NREM stage N1
Theta waves
241
EEG waveform in NREM stage N2
K complexes and sleep spindles
242
EEG waveform in NREM stage N3
Delta waves - lowest frequency, highest amplitude
243
EEG waveform in REM sleep
Beta waves - looks like when awake
244
Disorders of NREM sleep
Sleepwalking, night terrors, bedwetting
245
Characteristics of REM sleep
Loss of motor tone, increased use of O2 by brain, increased and variable pulse and blood pressure, this is when dreaming occurs
246
Describe the path of neurons passing through the ventral posterolateral nucleus of the thalamus
These are neurons from the spinothalamic (decussates 1-2 levels above SC input) and dorsal column tracts (dorsal columns decussate at the medial lemniscus). Carrying pain and temperature (spinothal) and pressure, touch, vibration, proprioception (dorsal columns). The neurons whose cell bodies are in the thalamus synapse in the primary somatosensory cortex.
247
Describe the path of neurons passing through the ventral posteromedial nucleus of the thalamus
These are trigeminal/taste sensation nuclei - face and taste - headed to the primary somatosensory cortex.
248
Describe the path of neurons passing through the lateral geniculate nucleus of the thalamus
These are inputs from CN II carrying vision, destined for the calcarine sulcus.
249
Describe the path of neurons passing through the medial geniculate nucleus of the thalamus
Inputs from the superior olive and inferior colliculus, containing information about hearing, destined for the auditory cortex.
250
Describe the path of neurons passing through the ventral lateral nucleus of the thalamus
These are neurons from the basal ganglia and the cerebellum carrying information about motor regulation and feedback, destined for the motor cortex.
251
5 Fs of the limbic system
Feeding, Fleeing, Fighting, Feeling, ...Sex
252
Decreased activity of the nigrostriatial pathway
Extrapyramidal symptoms like dystonia, akasthisia, parkinsonism, tardive dyskinesia
253
Major dopaminergic pathway of brain
Nigrostriatial pathway
254
Primary therapeutic target of antipsychotic drugs
Mesolimbic dopaminergic pathway
255
Pathway whose dysfunction is responsible for "negative" symptoms
Decreased activity of mesocortical pathway
256
Pathway whose dysfunction is responsible for "positive" symptoms
Increased activity of mesolimbic pathway
257
Patient presentation of a left-sided lateral cerebellar lesion
Will fall toward the left (ipsilateral) due to impact on voluntary movement of extremities
258
Patient presentation of a medial or midline cerebellar lesion
Lesion involves vermis, other midline structures, and/or flocculonodular lobe, so patient will have a wide-based gait (truncal ataxia), nystagmus, head tilting, bilateral motor defects (axial and proximal limbs)
259
Input from the contralateral motor cortex to the cerebellum enters the cerebellum via:
middle cerebellar peduncle
260
Input from the spinocerebellar tracts enters the cerebellum via:
inferior cerebellar peduncle
261
Output via Purkinje cells -> deep nuclei of cerebellum -> contralateral cortex leaves cerebellum via:
superior cerebellar peduncle
262
Describe the excitatory pathway of the basal ganglia
Cortical inputs stimulate GABA release from striatum, inhibiting GABA release from GPI, which disinhibits the thalamus, leading to increased motion
263
Describe the inhibitory pathway of the basal ganglia
Cortical inputs stimulate the striatum to release GABA that disinhibits the subthalamic nucleus by inhibiting GPe, and since the subthalamic nucleus is disinhibited, that stimulates the GPi to inhibit movement
264
Dopamine binding to D1
stimulation of excitatory pathway
265
Dopamine binding to D2
inhibition of inhibitory pathway
266
Lesion of basal ganglia preventing the inhibitory pathway of the basal ganglia
Sudden jerky purposeless movements -> chorea, like in Huntington's disease
267
Contralateral subthalamic nucleus lesion
Hemiballismus - half of body (arm and/or leg) undergoes sudden wild flailing because there is damage to the inhibitory pathway
268
Cerebellar dysfunction might produce this type of tremor
Intention tremor
269
Intention tremor
Slow, zigzag motion when trying to point at a target (like in nose-finger test)
270
Sudden, brief, uncontrolled muscle contraction
Myoclonus
271
Tremor seen in Parkinson's disease
Resting tremor - uncontrolled movement of distal appendages
272
Dysfunction to this basal ganglia function occurs in Parkinson's disease
Dysfunction of excitatory pathway, due to lack of dopamine production in the SNlc
273
Intracellular eosinophilic inclusions composed of alpha-synuclein in neurons
Lewy bodies, seen in Parkinson's disease and Lewy Body Dementia
274
Disorder with depigmentation of substantia nigra pars compacta and Lewy bodies
Parkinson disease
275
Presentation of Parkinson disease
Tremor at rest, rigidity (cogwheel sign), akinesia/bradykinesia, postural instability, shuffling gait
276
Trinucleotide repeat (CAG) disorder on chromosome 4 that is autosomal dominant
Huntington disease
277
Part of the brain impacted in Huntington disease
Caudate nucleus - loses ACh and GABA production, and has increased dopamine, leading to lack of the inhibitory pathway of the basal ganglia
278
Pathology on autopsy or imaging in Huntington disease
Atrophy of caudate and putamen, hydrocephalus ex vacuo
279
Patient with choreiform movements, aggression, depression, and dementia
Huntington disease
280
Cause of neuronal death in Huntington disease
NMDAR binding and glutamate excitotoxicity
281
Nonfluent aphasia with intact comprehension, impaired repetition
Broca's aphasia
282
Fluent aphasia with impaired comprehension, impaired repetition
Wernicke's aphasia
283
"It... hard... ... talk"
Broca's aphasia
284
"I want to elevator because talk blue"
Wernicke's aphasia
285
Lesion location in Broca's aphasia
inferior frontal gyrus of frontal lobe
286
Lesion location in Wernicke's aphasia
superior temporal gyrus of temporal lobe
287
Fluent aphasia with intact comprehension but impaired repetition
Conduction aphasia
288
Lesion location in conduction aphasia
Arcuate fasciculus
289
Nonfluent aphasia with impaired comprehension and impaired repetition
Global aphasia - affects arcuate fasciculus, Broca's area, and Wernicke's area
290
Nonfluent aphasia with intact comprehension and intact repetition
Transcortical motor aphasia
291
Lesion location in transcortical motor aphasia
Frontal lobe around Broca's area, but not Broca's area itself
292
Fluent aphasia with impaired comprehension but intact repetition
Transcortical sensory aphasia
293
Lesion location in transcortical sensory aphasia
Temporal lobe around Wernicke's area, but not Wernicke's area itself
294
Nonfluent aphasia with impaired comprehension but intact repetition
Transcortical mixed aphasia
295
HSV encephalitis may cause disinhibited behavior as a result of damage to this structure
Amygdala
296
Lesion to frontal lobe
Disinhibition, defects in concentration/orientation/judgment
297
Lesion to nondominant (usually R) parietal cortex
Hemispatial neglect syndrome
298
Lesion to dominant parietal cortex
Agraphia, acalculia, finger agnosia
299
Lesion to reticular activating system in the midbrain
Coma - reduced levels of arousal and wakefulness
300
Confusion, ophthalmoplegia, truncal ataxia, memory loss, personality changes
Wernicke-Korsakoff syndrome - associated with thiamine deficiency and excessive alcohol use
301
How can you accidentally induce Wernicke encephalopathy?
Giving glucose without thiamine to a patient who is thiamine deficient (like a long-term alcoholic)
302
Lesion to mamillary bodies
Wernicke-Korsakoff syndrome
303
Lesion to cerebellar hemisphere
Intention tremor, limb ataxia, loss of balance, defects are ipsilateral to the lesion
304
Lesion to cerebellar vermis
Truncal ataxia and dysarthria, other central body defects
305
Lesion to subthalamic nucleus
Contralateral hemiballismus
306
Lesion to hippocampus
Anterograde amnesia
307
Lesion to paramedian pontine reticular formation
Eyes look away from the side of the lesion
308
Lesion to frontal eye fields
Eyes look toward the lesion
309
Normally, pressure of which gas drives cerebral perfusion?
PCO2
310
Consequence of decreased BP or increased ICP
Decreased cerebral perfusion pressure
311
Equation for Cerebral Perfusion Pressure
CPP = MAP - ICP
312
CPP = 0
Brain death - no cerebral perfusion
313
How to treat acute cerebral edema that's unresponsive to other interventions
Therapeutic hyperventilation to decrease PCO2 -> vasoconstriction -> cerebral blood flow decreases -> ICP decreases
314
Severe hypotension can damage which areas of the brain first?
Watershed areas between the territories supplied by the cerebral arteries
315
Anteromedial surface of brain supplied by:
Anterior cerebral artery
316
Lateral surface of brain supplied by:
Middle cerebral artery
317
Posterior and inferior surface of brain supplied by:
Posterior cerebral artery
318
A stroke producing aphasia is likely where?
MCA, in dominant hemisphere. Temporal lobe if fluent aphasia (Wernicke), frontal lobe if nonfluent aphasia (Broca)
319
An MCA stroke in the non-dominant hemisphere could produce what finding, in addition to contralateral paralysis and sensory loss?
Hemineglect
320
A stroke producing contralateral paralysis/sensory loss of the face and upper limb is likely where?
MCA
321
A stroke producing contralateral paralysis/sensory loss of the lower limb is likely where?
ACA
322
A stroke producing contralateral paralysis/sensory loss of the face and body without cortical signs (neglect, aphasia, visual field loss) is likely where?
Lenticulostriate artery
323
A pure motor stroke would impact what area?
Internal capsule - lacunar infarct
324
A stroke with contralateral hemianopia would be due to which vessel?
PCA
325
A stroke with "locked-in syndrome" - conscious, but with vertical eye movement and blinking, and with quadriplegia and paralysis of most of the face, would be due to which vessel?
Basilar artery
326
A stroke with facial droop, decreased lacrimation and salivation, decreased taste would likely be due to which vessel?
Anterior inferior cerebellar artery - facial nucleus effects are specific to AICA
327
A stroke with dysphagia and hoarseness, as well as ipsilateral Horner syndrome, and decreased pain and temperature of ipsilateral face and contralateral body, would be from which vessel?
Posterior inferior cerebellar artery - nucleus ambiguus effects are specific to PICA
328
Contralateral paralysis and decreased contralateral proprioception, with a tongue deviating ipsilaterally, would be due to a stroke in which vessel?
Anterior spinal artery
329
Location of a berry aneurysm
Bifurcations in the circle of Willis, most commonly where anterior communicating artery and ACA join
330
"Worst headache of my life" in a patient with ADPKD or Ehler-Danlos
Berry aneurysm rupture causing subarachnoid hemorrhage
331
An aneurysm of the ACA might compress which structures?
Optic chiasm, causing visual acuity defects and bitemporal hemianopia
332
An aneurysm of the PCA might compress which structures?
CN III - blown pupil (mydriasis), with ptosis, and eye pointing down and out. This is an ipsilateral CN III palsy.
333
Lentiform area of hyperdensity on CT that does not cross suture lines
Epidural hematoma
334
Rupture of this artery most commonly causes epidural hematoma
Middle meningeal
335
Rupture of these vessels causes subdural hematoma
Bridging veins
336
Intracranial hemorrhage in shaken babies
Subdural hematoma
337
Crescent hemorrhage crossing suture lines
Subdural hematoma
338
Brain distortion that occurs in subdural hematoma
Midline shift
339
Rupture of what can cause a subarachnoid hemorrhage?
AV malformation, or aneurysm
340
"Worst headache of my life"
Subarachnoid hemorrhage
341
Star-shaped hyperdensity on CT near midline
Subarachnoid hemorrhage due to bursting of a saccular aneurysm
342
Hemorrhagic stroke that can result from systemic hypertension
Intraparenchymal hemorrhage
343
Areas that are typically affected by intraparenchymal hemorrhage
Basal ganglia, internal capsule; can be lobar
344
Area of brain most vulnerable to hypoxia
Hippocampus
345
Imaging procedure with a stroke
Noncontrast CT to exclude hemorrhage must be done before tPA can be given
346
Conditions under which you can give tPA
Within 3 hours of onset of the stroke, no hemorrhage, no substantial risk of hemorrhage
347
Ways to reduce risk of ischemic stroke
Antithrombotic medications (aspirin, clopidogrel), control blood pressure and blood sugars and lipids, treat conditions like afib that increase risk
348
Headache, seizures, focal neurologic deficits in a patient with factor V Leiden disease
May have venous sinus thrombosis
349
Main location of CSF return to venous circulation
Arachnoid granulations in the superior sagittal sinus
350
Cells that make CSF
Ependymal cells of choroid plexus
351
Interventricular foramen, aka foramen of Monro
Connections between lateral ventricles and third ventricle
352
Cerebral aqueduct, aka Sylvian aqueduct
Connection between 3rd and 4th ventricles
353
Foramina of Lushcka and Foramen of Magendie
Connections between the 4th ventricle and subarachnoid space (Luschka is lateral, Magendie is medial)
354
Increased ICP with no apparent cause on imaging in a woman of childbearing age
Pseudotumor cerebri (aka idiopathic intracranial hypertension)
355
Papilledema and increased opening pressure on LP
Pseudotumor cerebri
356
What does a lumbar puncture accomplish in pseudotumor cerebri?
Reveals the increased opening pressure, provides headache relief, may be able to treat it
357
RFs for pseudotumor cerebri
Female of childbearing age, vitamin A excess, danazol, tetracycline
358
Headache, diplopia with CN VI palsy, papilledema, no change in mental status
Increased ICP... Could be pseudotumor cerebri
359
Treatment for pseudotumor cerebri
Weight loss, acetazolamide, topiramate, shunt placement, repeat lumbar puncture
360
Mechanism of communicating hydrocephalus
Less CSF absorption by arachnoid granulations leads to increased ICP, papilledema, herniation. Can occur with arachnoid scarring after meningitis.
361
Urinary incontinence, ataxia (magnetic gait - feet stuck to floor), and cognitive dysfunction in an elderly patient with CSF pressure normal/occasionally elevated
Normal pressure hydrocephalus. Ventricles are expanded, distorting the corona radiata
362
Structural blockage of CSF within the ventricular system
Noncommunicating hydrocephalus
363
Vertebral level at which the spinal cord ends
L1-L2
364
Vertebral level to which the subarachnoid space extends
S2
365
Vertebral levels for lumbar puncture
L3/4 or L4/5
366
Voluntary motor tract in the lateral part of the spinal cord
Lateral corticospinal tract (sacral most outside radially, cervical most medial)
367
Voluntary motor tract in the anterior part of the spinal cord
Anterior corticospinal tract
368
Ascending fibers for pressure, vibration, touch, and proprioception
Dorsal columns - fasciculus gracilis and cuneatus
369
Ascending tracts for pain and temperature
Lateral spinothalamic tract
370
Ascending tract for crude touch and pressure
Anterior spinothalamic tract
371
Sympathetic neurons in the spinal cord
Lateral horn, T1-L2
372
Where do the dorsal column fibers decussate?
Medial lemniscus
373
Where do the dorsal column and spinothalamic neurons synapse in the thalamus?
VPL
374
Where do the spinothalamic tract fibers decussate?
At anterior commissary
375
Nerve endings whose sensations are transmitted in spinothalamic tract
Free nerve endings -Adelta and C fibers
376
Where do descending fibers of the lateral corticospinal tract decussate?
Decussate on of the pyramids
377
Weakness, atrophy, fasciculations, hyporeflexia, negative Babinski sign, flaccid paralysis
LMN signs
378
Weakness, hyperreflexia, increased muscle tone, positive Babinski, spastic paralysis
UMN signs
379
What kind of clinical signs would occur with a lesion that only affects the anterior horn bilaterally?
Affects LMNs only, so LMN signs -> floppy, fasciculations, hypotonia, hyporeflexia, atrophy, etc.
380
Where does spinal cord damage occur in polio?
Anterior horn, bilaterally
381
Where does spinal cord damage occur in ALS?
Lateral corticospinal tracts and anterior horn
382
What kind of deficits are present in ALS?
UMN defects due to lesions in lateral corticospinal tract
| LMN defects due to lesions in anterior horn
383
Treatment for ALS
Riluzole - not curative
384
Asymmetric limb weakness, especially hands and feet, fasciculations, and progressive atrophy over time due to a defect in superoxide dismutase 1
ALS
385
Complete occlusion of the anterior spinal artery would damage which tracts?
Everything except for the dorsal columns: pressure, vibration, touch, and conscious proprioception would be preserved at levels above and below the lesion, but everything else would be impaired.
386
Tertiary syphilis can cause what spinal cord lesion?
Tabes dorsalis - demyelination of dorsal columns and dorsal nerve roots, leading to sensory ataxia due to impaired proprioception, and sensory defects for all kinds of sensory fibers at the level of the lesion.
387
Charcot joints, shooting pain, abnormal pupils, no deep tendon reflexes, positive Romberg test
Tabes dorsalis
388
What kind of a lesion is caused in syringomyelia?
Central lesion of the spinal cord damaging the anterior commissure, leading to bilateral loss of pain and temperature at the level of the lesion
389
What kind of a lesion is present in vitamin B12 deficiency?
Subacute combined degeneration - demyelination of spina cerebellar, lateral corticospinal, and dorsal column tracts. Patients have impaired position and vibration sense, paresthesias, and ataxic gait.
390
What kind of a lesion is present in Brown-Sequard syndrome?
Hemisection of the spinal cord - ipsilateral UMN signs below the level of lesion due to loss of corticospinal tracts, ipsilateral loss of tactile/vibration/proprioception sense below the level of lesion due to loss of dorsal columns, contralateral loss of pain and temperature below the lesion due to spinothalamic tract loss, ipsilateral loss of all sensation as well as presence of LMN signs at the level of the lesion itself.
391
Brown-Sequard syndrome above T1 may produce what additional finding?
Ipsilateral Horner syndrome due to damage to oculosympathetic pathway
392
Biceps reflex
C5 nerve root
393
Triceps reflex
C7 nerve root
394
Patellar reflex
L4 nerve root
395
Achilles' tendon reflex
S1 nerve root
396
Function of superior colliculi
Conjugate vertical gaze center
397
Function of inferior colliculi
Auditory signal integration
398
Cranial nerves that are purely sensory
I, II, VIII
399
Cranial nerves that are purely motor
III, IV, VI, XI, XII
400
Cranial nerves that have both motor and sensory components
V, VII, IX, X
401
Function of solitary nucleus
Viscerosensory info (taste, baroreceptors, etc) to VII, IX, X
402
Function of nucleus ambiguus
Motor innervation of pharynx, larynx, upper esophagus (IX, X, XI)
403
Corneal reflex
Afferent V1, efferent VII
404
Lacrimation reflex
Afferent V1, efferent VII
405
Pupillary light reflex
Afferent II, efferent III
406
Gag reflex
Afferent IX, efferent X
407
Cranial nerve lesion causing jaw to deviate to the right
CN V motor on the right side, jaw will deviate TOWARD the lesion
408
Cranial nerve lesion causing uvula to deviate to the right
CN X lesion on the left; uvula will deviate away because the weakened side collapses
409
Cranial nerve lesion causing weakness when turning head to the left, and shoulder droop on the right
CN XI lesion on the right side
410
Cranial nerve lesion causing tongue to deviate toward the right
CN XII lesion on the right side
411
Contralateral paralysis of lower muscles of facial expression, sparing the forehead
Upper motor neuron lesion of CN VII, due to destruction of motor cortex or the connection between the motor cortex and the facial nucleus in the pons. Forehead is spared because it is bilaterally innervated by CN VII UMNs.
412
Ipsilateral paralysis of upper and lower muscles of facial expression with loss of taste sensation to anterior tongue.
Lower motor neuron lesion of CN VII, due to destruction of the facial nucleus or CN VII anywhere along its course.
413
Idiopathic CN VII LMN lesion
Bell's palsy (treat with corticosteroids and acyclovir)
414
Structures that pass through the cavernous sinus
CN III, IV, VI, V1, V2, internal carotid artery
415
Nerve most susceptible to injury in cavernous sinus syndrome
CN VI
416
How does the outer ear transfer sound waves?
Vibration of tympanic membrane
417
How does the middle ear transfer sound?
Ossicles conduct and amplify the sound
418
How does the inner ear conduct sound?
Basilar membrane in the cochlea vibrates due to the sound waves, and the vibrations are transduced via hair cells into signaling along CN VII.
419
Area of the cochlea that best hears low-frequency sounds
At the apex, near the helicotrema
420
Area of the cochlea that best hears high-frequency sounds
At the base of the cochlea
421
Abnormal Rinne test (increased conduction through the bone), and abnormal Weber test localizing sound to the affected ear
Conductive hearing loss
422
Normal Rinne test, and Weber test localizes to the unaffected ear
Sensorineural hearing loss
423
Where is aqueous humor produced?
Nonpigmented epithelium on ciliary body
424
Factors that decrease aqueous humor production
Beta blockers, alpha-2 agonists, carbonic anhydrase inhibitors
425
How does aqueous humor leave the anterior chamber?
Through the angle of the anterior chamber, either by passing through the trabecular mesh work or by draining into the urea and sclera
426
Light is focused behind the retina due to an eye that is too short along the AP axis
Hyperopia (farsighted)
427
Light is focused in front of the retina, due to an eye that is too long in the AP direction
Myopia (nearsightedness)
428
Abnormal curvature of cornea causing different refractive power at different axes
Astigmatism
429
Age-related impairment in accommodation due to decreased lens elasticity
Presbyopia
430
Ciliary flush, sudden painful vision loss, halos, nausea and vomiting, rock-hard eye
Acute angle closure glaucoma
431
Itchy red eyes bilaterally with clear discharge
Allergic conjunctivitis
432
Red eye with purulent discharge
Bacterial conjunctivitis, treat with ABX
433
Virus most responsible for viral conjunctivitis
Adenovirus
434
Swollen preauricular LNs, sparse mucous discharge, and red eye
Viral conjunctivitis - self-resolving
435
Accumulation of pus in anterior chamber
Hypopyon
436
Hypopyon and/or conjunctival redness in patients with a history of systemic inflammatory disorders (think HLA-B27)
Uveitis/iritis
437
Slowly progressive metamorphopsia and eventual loss of central vision
Age-related macular degeneration
438
Rapid loss of vision due to bleeding beneath choroidal neovascularization
Wet macular degeneration - treat with anti-VEGF injections
439
Retinal hemorrhages and macular edema in a diabetic patient
Nonproliferative diabetic retinopathy - treat with blood sugar control
440
Neovascularization and chronic retinal hypoxia in a diabetic patient
Proliferative diabetic retinopathy
441
Compression from hypertension or retinal artery atherosclerosis leads to retinal hemorrhage and venous engorgement with edema
Central retinal venous occlusion
442
Separation of the photoreceptor layer of the retina from the outermost pigmented epithelium leading to vision loss, appearing as crinkling of retinal tissue on fundoscopic exam
Retinal detachment - often preceded by posterior vitreous detachment (flashes and floaters)
443
Treatment of flashes/floaters/curtain
Emergent retinal detachment - Urgent ophtho surgery referral
444
Acute painless monocular vision loss with a cloudy pale retina and a cherry-red spot at the fovea
Central retinal artery occlusion
445
Marcus Gunn pupil
Afferent pupillary defect from optic nerve damage or retinal injury
446
Conditions associated with Horner syndrome
Lesions of spinal cord above T1 - Pancoast tumor, Brown-Sequard syndrome, etc
447
down and out gaze
CN III damage
448
blown pupil
Damage to parasympathetics running on outside of cranial nerve III
449
Eye moving upward with contralateral gaze, head tilt toward the side of the lesion (or compensatory head tilt in opposite direction)
CN IV damage
450
Medially directed eye that cannot abduct
CN VI damage
451
Medial longitudinal fasciculus
Allows for crosstalk between CN VI and III to coordinate eyes to move in the same horizontal direction. Is highly myelinated.
452
Horizontal gaze palsy where the ipsilateral lateral rectus is activated, but the contralateral medial rectus is not, leading to nystagmus in the abducting eye, with normal convergence.
Internuclear ophthalmoplegia
453
ApoE2 association with Alzheimer's
Decreases risk
454
ApoE4 association with Alzheimer's
Increases risk
455
Risk factors for Alzheimer's
Down syndrome, APP, presenilin-1, presenilin-2
456
Dementia with widespread cortical atrophy, decreased ACh, and senile plaques in grey matter with beta amyloid extracellularly and neurofibrillary tangles (tau protein) intracellularly
Alzheimer's disease
457
Early onset changes in personality or behavior or aphasia with degeneration of frontotemporal lobe
Frontotemporal dementia
458
Dementia and hallucinations followed by Parkinsonian features
Lewy body dementia
459
Histological finding in Lewy body dementia
Intracellular Lewy bodies, made of alpha-synuclein, in the cortex
460
Multiple cortical and/or subcortical infarcts on MRI or CT over an extended period of time, with dementia symptoms that have a step-wise progression
Vascular dementia
461
Charcot triad of MS
Scanning speech, intention tremor/incontinence/internuclear ophthalmoplegia, nystagmus
462
CSF findings in multiple sclerosis
Increased IgG and myelin basic protein, with oligoclonal bands
463
Things that are diagnostic of multiple sclerosis
MRI is gold standard; oligoclonal bands are diagnostic
464
Destruction of Schwann cells leads to inflammation and demyelination of peripheral nerves and motor fibers, leading to symmetric ascending muscle weakness/paralysis, maybe with autonomic dysfunction
Acute inflammatory demyelinating polyradiculoneuropathy (Guillain-Barre syndrome)
465
Tx for Guillain-Barre syndrome
Plasmapheresis, IVIG
466
Autosomal dominant motor and sensory neuropathy associated with foot deformities
Charcot-Marie-Tooth disease
467
Acute unilateral headache, 15 min-3 hours in a repetitive pattern, with excruciating periorbital pain, lacrimation, and rhinorrhea, and maybe Horner syndrome
Cluster headache
468
Bilateral headache lasting around 4-6 hours, with steady constant pain, no photophobia, and no aura
Tension headache
469
Unilateral headache lasting 4-72 hours, with pulsating pain, nausea, photophobia, phonophobia, may have aura
Migraine headache
470
Type of headache due to release of substance P, calcitonin gene-related peptide, vasoactive peptides (or due to irritation of CN V, meninges, or vasculature)
Migraine
471
Acute treatment of cluster headache
Supplemental O2 and sumatriptan
472
Acute treatment of tension headache
Analgesics, NSAIDs, acetaminophen, can use amitriptyline for chronic pain
473
Acute treatment of migraine headache
NSAIDs, fluids, triptans, dihydroergotamine
474
Cluster headache prophylaxis
Verapamil
475
Migraine headache prophylaxis
Lifestyle changes, beta blockers, calcium channel blockers, amitriptyline, topiramate, valproate
476
Positional or central vertigo: delayed horizontal nystagmus on positional testing
Peripheral vertigo
477
Positional or central vertigo: directional change of nystagmus, skew deviation, diplopia, dysmetria
Central vertigo
478
Most common type of highly malignant brain tumor
Glioblastoma multiforme (grade IV astrocytoma)
479
Typically benign brain tumor arising from arachnoid cells that is often asymptomatic or may present with seizures or focal neurologic deficits
Meningioma
480
Highly malignant cerebellar tumor in children that is a form of primitive neuroectodermal tumor
Medulloblastoma
481
Childhood supratentorial tumor derived from remnants of Rathke pouch that can cause bitemporal hemianopia
Craniopharyngioma
482
Ependymal cell tumor found in the 4th ventricle that can cause hydrocephalus and has a poor prognosis
Ependymoma
483
Prognosis for a pilocytic astrocytoma in children
Good prognosis
484
Consequence of cingulate/subfalcine herniation under the falx cerebri
Can compress ACA
485
Consequence of transtentorial (central) herniation
Caudal displacement of brainstem -> rupture of basilar artery branches -> usually fatal
486
Consequences of uncal herniation
Compression of CN III (blown pupil with down-and-out gaze), ipsilateral PCA compression leading to contralateral homonymous hemianopia, contralateral compression of crus cerebri leading to ipsilateral paresis
487
MOA of opioids
Agonists at opioid receptors modulate synaptic transmission -> lead to opening of K channels and closing of Ca channels to decrease synaptic transmission -> decrease release of ACh, NE, 5HT, glutamate
488
MOA of tramadol
very weak opioid agonist, inhibits 5HT and norepinephrine reuptake
489
Risks associated with tramadol
Decrease seizure threshold, serotonin syndrome
490
What side effects of opioids do people not develop tolerance to?
Miosis and constipation
491
MOA of benzodiazepines
Facilitate GABA-A action by increased frequency of Cl- channel opening
492
Benzo used for status epilepticus
Lorazepam, Diazepam
493
Drug to treat benzodiazepine overdose
Flumenazil
494
Drug that can treat malignant hyperthermia
Dantrolene - ryanodine receptor antagonist
495
Drugs for Parkinson disease
Ergot (bromocriptine) or non-ergot (pramipexole, ropinirole) - dopamine agonists
Increased dopamine release and decreased dopamine reuptake: amantadine
Levodopa/carbidopa: levodopa is converted to dopamine in the CNS, and carbidopa prevents it from being coverted to dopamine in the periphery by inhibiting DOPA decarboxylase
496
Alzheimer's drugs
Memantine (NMDA receptor antagonist), donepezil or rivastigmine or galantamine (AChE inhibitors)
497
Drug that can be used for Huntington disease
Haloperidol - D2 receptor antagonist
498
MOA of sumatriptan
5HT1B/1D agonist
499
Symptoms of alcohol withdrawal
Severe withdrawal can cause autonomic hyperactivity and delirium tremens - treat with benzos emergently
500
Side effects of lithium
Tremor, nephrogenic diabetes insipidus, hypothyroidism, teratogenicity
