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Flashcards in Neuro Deck (305):
1

What is the Rx for ADHD?

Methylphenidate

2

What is the MOA of Methylphenidate?

Amphetamine--indirect sympathomimetic
Increases release of DA, NE

3

Name 2 S-100+ tumors.

Schwannoma
Skin, melanoma

4

What is the Rx for Restless Leg Syndrome?

Levodopa

5

What kind of stroke affects the (contralateral) upper extremity more than the lower extremity and 2/3 of the face?

MCA stroke

6

What are the findings of an MCA stroke?

Affects contralateral uppers > lowers
+ 2/3 face

7

What infarct syndrome affects ipsilateral CN III + contralateral body?

Weber's Syndrome
- Basilar or PCA

8

What are the sequelae of a stroke to the Basilar Artery or the PCA?

Weber's Syndrome:
- Ipsilateral CN III
- Contralateral body

9

What kind of brain bleed can present with symptoms minutes or months after trauma (fall) occurred?

Subdural hematoma

10

What vessels are ruptured in a subdural hematoma?

Bridging cortical veins

11

What does a subdural hematoma look like on CT?

Moon-like sliver against the skull

12

What vessels are ruptured in an epidural hematoma?

Middle Meningeal

(bleed bends towards the MIDDLE of the brain)

13

What does an epidural hematoma look like on CT?

Bleed is convex and bends towards the middle of the brain, like a lower case 'e' abutting the skull

14

What vessels are ruptured in a SAH?

Usually Berry aneurysm

15

What does a SAH look like on CT?

Spotty bleeding in anterior brain

16

What vessels are ruptured in an intracerebral (intraparenchymal) hemorrhage?

Lenticulostriate arteries of the internal capsule

(internal capsule bleeds STRAIGHT (striate) into the brain)

17

What does an intracerebral (intraparenchymal) hemorrhage look like on CT?

Big burgeoning bleed in the middle of the brain

18

What kind of bleed is caused by a Charcot Bouchard aneurysm?

Intracerebral (intraparenchymal) hemorrhage

19

What is a complication that occurs 4-12 days after SAH?

Vasospasm, causing ischemia and new deficits

20

What med can prevent vasospasm post SAH?

Nimodipine

21

What is the path of the Glossopharyngeal nerve (IX) within the brain (origin and exit)?

Medulla to Jugular Foramen

22

What muscle does the Glossopharyngeal nerve (IX) innervate?

Stylopharyngeus

23

To what gland does the Glossopharyngeal nerve (IX) carry PS fibers?

Parotid

24

What nerve provides sensory information from the inner surface of the tympanic membrane, Eustachian tube of the ear, posterior 1/3 tongue, tonsilar region, upper pharynx, and carotid body sinus?

Glossopharyngeal nerve (IX)

25

What nerve is responsible for the afferent gag reflex?

Glossopharyngeal nerve (IX)

26

What nerve is responsible for the efferent gag reflex?

Vagus nerve (X)

27

What is the MOA of phenytoin?

Inhibits neuronal high frequency firing by reducing the ability of Na+ channels to recover

Less Na+ current = less seizure

28

What is the first line Rx for status epilepticus?

Benzos

29

What Rx is used to prevent recurrence post status epilepticus?

Phenytoin

30

Keeping Schizo- Straight:

Distant

Schizoid

31

Keeping Schizo- Straight:

Odd thinking

Schizotypal

32

Keeping Schizo- Straight:

Symptoms for

Brief Psychotic Disorder

33

Keeping Schizo- Straight:

Symptoms for 1-6 mo

Schizophreniform Disorder

34

Keeping Schizo- Straight:

Symptoms > 6mo

Schizophrenia

35

Keeping Schizo- Straight:

Schizophrenic sx + psychotic sx + bipolar or depressed mood

Schizoaffective Disorder

36

Newborn is overreactive to stimuli and has a marked startle
Excessive crying and sucking

Cause?

Heroin withdrawal
- These are the opposite of opioid effects
- Rx: tincture of opium

37

What is internuclear ophthalmoplegia?

Affected eye cannot cross midline on conjugate gaze

38

Where is the lesion in internuclear opthalmoplegia?

The lesion is in the MLF, which connects CN III, IV, V, most likely to the Abducens (VI) nerve nucleus

39

CN responsible for afferent pupillary light reflex.

Optic nerve (II)

40

CN responsible for efferent pupillary light reflex

Oculomotor nerve (III), PS fibers

41

Trace the path of the pupillary light reflex.

Optic nerve >
Pretectal nucleus (ipsi) >
Edinger-Westphal nucleus (bilateral) >
Oculomotor nerve >
Ciliary ganglion>
Synapse

42

What happens to the pupillary light reflex if the Optic nerve is demyelinated (Ex. MS)?

No direct on ipsi
No consensual on contra

Constriction of both pupils w light on unaffected side

43

Patient with MS presents with:
- No constriction of L eye with light shined in L eye
- No constriction of R eye with light shined in L eye
- Constriction of both eyes with light shined in R eye

Where is the lesion?

Optic nerve (CN II) on L side
- Knocks out afferent arm of pupillary light reflex

44

What cells do tissue repair in the PNS?

Fibroblasts

45

What cells do tissue repair in the CNS?

Astrocytes (glial cells)

46

What are the 4 functions of astrocytes (glial cells)?

1. Repair
2. Structural support
3. Blood brain barrier
4. Metabolic support

47

How does Hydrochlorothiazide affect Lithium?

Increases Lithium reabsorption in the PT, along with Na+, thereby increasing potential for Lithium toxicity.

48

How do ACE-Is and NSAIDs affect Lithium?

Decrease renal clearance

49

What are signs of Lithium toxicity?

Neuromuscular excitability
Tremor
Fascicular twitch
Agitation
Ataxia
Delirium

50

What is the Rx for Lithium toxicity?

Dialysis

51

What are the 3 most common primary brain tumors in adults?

1. Glioblastoma
2. Meningioma
3. Acoustic Neuroma (Schwannoma)

52

Name that brain tumor:

- Astrocytes, large cells
- Necrosis and hemorrhage
- Found in cerebrum, crosses midline
- Poor prognosis

Glioblastoma
- Most common

53

Name that brain tumor:

- Arachnoid cells
- Well circumscribed
- Dural attachment
- Benign

Meningioma

54

Name that brain tumor:

- S-100 +
- Cerebellopontine angle

Acoustic Neuroma (Schwannoma)

55

Where is the lesion in pt. with left-sided hemibalism?

Contralateral subthalamic nuclei (of basal ganglia)

56

What stroke causes hemibalism?

Lacunar stroke, typically in pt. with HTN

57

Pt. has had multiple spontaneous hemorrhages over several months, some of which affect vision. What is the underlying cause?

Cerebral Amyloid Angiopathy
- Beta amyloid deposits in cerebral arteries

58

What lobes does Cerebra Amyloid Angiopathy most affect?

Occipital and Parietal

59

What is the MOA of Busiprone?

Selective 5HT1a agonist

60

What is the indication of Busiprone?

GAD: anti-anxiety med with less abuse potential than Benzos

- No sedative hypnotic or seizure side affects

61

What are the criteria for Major Depressive Disorder?

SIG E CAPS: 5sx x 2 wks

- Sleep disorder
- Interest decreased
- Guilt
- Energy decreased
- Concentration decreased
- Appetite change
- Psychomotor decreased
- Suicidality

62

What are the criteria for Dysthymic Disorder?

Chronic, low intensity

Depressed mood most days + 2 sx x 2 yrs

63

What are 3 drugs used in the Rx of Alzheimer's?

Donepizil: AchE-I
Vitamin E: anti-oxidant
Memantine: NMDA receptor antagonist

64

What is the indication and MOA of Donepizil?

Alzheimer's, acetylcholinesterase inhibitor

65

What is the indication and MOA of Memantine?

Alzheimer's, NMDA receptor antagonist

66

What is the first sign of uncal herniation?

Fixed, dilated pupil (ipsi) because of CN III compression

67

What are causes of uncal herniation?

Hemorrhage
Tumor

(Compression)

68

What is the cause of:
- Ipsi occulomotor paralysis
- Hemiparesis
- Contra homonymous hemianopia

Uncal herniation

(progressive sx, first one being fixed, dilated pupil)

69

What is the MOA of Carbidopa?

Prevents peripheral conversion of Levodopa
- CNS adverse effects persist, like anxiety and agitation

70

What are 2 meds used in Rx of Benign Essential Tremor?

Primidone + Propanolol

71

What is the MOA of Primidone?

Narrow spectrum anticonvulsant

(Phenobarbitol + Phenylethylmalomide)

72

What is a beta blocker used in Rx of Benign Essential Tremor?

Propanolol

73

Nerve responsible for afferent corneal reflex.

Trigeminal, V1

74

Nerve responsible for efferent corneal reflex.

Facial, VII

75

What are the 3 most common brain tumors in children?

1. Pilocytic Astrocytoma
2. Medulloblastoma
3. Ependymoma

76

Name that (kids) tumor:

- Cerebellum > cerebrum
- Cystic + protruding nodule
- Astrocytes + Rosenthal fibers
- Good prognosis

Pilocytic Astrocytoma

77

Name that (kids) tumor:

- Cerebellum only
- Solid sheets of blue cells
- Malignant

Medulloblastoma

78

Name that (kids) tumor:
- Increased CSF
- Hydrocephalus
- Rosettes

Epedymoma

79

What is the age-related eye condition caused by fatty tissue deposits in the retina +/- neovascularization?

Macular Degeneration

Dry = fatty tissue only
Wet = + new bvs

80

Where is the macula?

Central retina

81

What are two ergot-derived DA agonists?

Bromocriptine
Pergolide

- Directly stimulate DA receptor

82

What are two non-ergot DA agonists?

Pramipexole
Ropinerole

- Directly stimulate DA receptor

83

Hypertensive arteriolosclerosis with underlying HTN likely causes what kind of infarct?

Lacunar infarct

84

What vessels are usually involved in a lacunar infarct?

Stroke involves small penetrating vessels supplying:
- Basal ganglia
- Pons
- Internal capsule
- Corona radiata

85

What is myotonia?

Abnormally slow relaxation of muscles

86

What is myotonic dystrophy?

AD condition causing myotonia, along with:
- Cataracts
- Frontal balding
- Gonadal atrophy

Increased trinucleotide repeats

87

What are the broad spectrum anti-epileptics?

Lamotrigine, Valproate, Topiramate

88

What are the narrow spectrum anti-epileptics?

Carbamazepine, Gabapentin, Phenobarbital, Phenytoin

89

What type of seizure responds to narrow spectrum anti-epileptics?

Focal

90

What type of seizure responds to broad spectrum anti-epileptics?

Most types

91

What is the difference between schizoaffective disorder and bipolar disorder with psychotic features?

In bipolar with psychotic features, the psychoses only occur during manic/depressive episodes.

In schizoaffective, will have psychosis in the absence of mood episodes.

92

What is vasovagal syncope?

Decreased BP and HR due to vagal stimulation

93

Touching what part of the ear can result in vasovagal syncope?

External auditory canal
- Vagus innervates

94

What is a first gen. antipsychotic with low potency?

Chlorpromazine

95

What are the adverse effects of first gen. antipsychotics with low potency?

Sedation
Anticholinergic affects
Orthostatic hypotension

96

What are two first gent. antipsychotics with high potency?

Haloperidol, Fluphenazine

97

What are the adverse effects of first gen. antipsychotics with high potency?

Neuro effects
Extrapyramidal sx

98

What characterizes communicating hydrocephalus?

Free flow through ventricles

- Decreased CSF absorption
- Have abnormal arachnoid granules in TB and SAH
- All ventricles are dilated

99

What characterizes non-communicating hydrocephalus?

Obstruction of CSF flow

- Only ventricles proximal to obstruction are dilated

100

What characterizes hydrocephalus ex-vacuo?

Not true hydrocephalus; rather, ventricular enlargement secondary to brain atrophy

101

What conditions evidence hydrocephalus ex-vacuo?

Alzheimer's, Pick's, advanced HIV/AIDS

102

What is the MOA of cocaine?

Inhibits reuptake of monoamines (NE, DA, 5HT)
- Increased sympathetic stimulation (increased arousal, agitation, seizures)
- Coronary vasospasm, mucosal atrophy, septal perf

103

What is a type I Chiari malformation?

Cerebellar tonsils into vertebral canal
- Presents in adulthood with headache and cerebellar sx

104

What is a type II Chiari malformation?

Cerebellum + medulla through foramen mangum
- Presents in neonates, more severe
- Lumbar meningiocele + hydrocephalus

105

What are the symptoms of Atropine OD?

Antimuscarinic effects (opp. of DUMBELS)

106

What is the Rx for Atropine OD?

Physostigmine "phyxes Atropine OD"
- AChE-I that increases levels of acetylcholine

107

What is Rx in opioid withdrawal?

Pentazocine
- Partial agonist and antagonist at mu receptors
- May precipitate withdrawal sx if given with agonist

108

Derived from what tissue:

Rathke's pouch

Surface ectoderm

109

Derived from what tissue:

Lens and cornea

Surface ectoderm

110

Derived from what tissue:

Inner ear

Surface ectoderm

111

Derived from what tissue:

Olfactory, nasal, and oral epithelium

Surface ectoderm

112

Derived from what tissue:

Salivary, sweat, and mammary glands

Surface ectoderm

113

Derived from what tissue:

Brain and spinal cord

Neural tube

114

Derived from what tissue:

Posterior pituitary

Neural tube

115

Derived from what tissue:

Pineal gland

Neural tube

116

Derived from what tissue:

Retina

Neural tube

117

Derived from what tissue:

Autonomic, sensory, and celiac ganglia

Neural crest

118

Derived from what tissue:

Schwann cells

Neural crest

119

Derived from what tissue:

Pia and arachnoid mater

Neural crest

120

Derived from what tissue:

Aorticopulmonary septum, endocardial cushions, branchial arches

Neural crest

121

Derived from what tissue:

Skull bones

Neural crest

122

Derived from what tissue:

Melanocytes

Neural crest

123

Derived from what tissue:

Adrenal medulla

Neural crest

124

Derived from what tissue:

Muscles, CT, bone, and cartilage

Mesoderm

125

Derived from what tissue:

Blood, lymph, spleen, kidney, adrenal cortex

Mesoderm

126

Derived from what tissue:

Gi tract, liver

Endoderm

127

Derived from what tissue:

Lungs

Endoderm

128

Derived from what tissue:

Thymus, thyroid follicles, parathyroid

Endoderm

129

Derived from what tissue:

Bladder, urethra

Endoderm

130

Derived from what tissue:

Middle ear

Endoderm

131

What is the Rx for Alcohol withdrawal?

Benzos
- Long acting preferred: Diazepam, Chlordiazepoxide
- Short acting if liver dysfx: Lozepam, Oxazepam

132

What is an ocular adverse effect of Atropine?

Closed angle glaucoma
- Due to increased intraocular pressure

133

Neurocutaneous syndromes:

- Hemangioblastomas in retina/cerebellum
- Pancreatic cysts (also kidney, liver)
- kidneY at risk for RCC

VHL: Von Hippel Lindau
- AD

134

Neurocutaneous syndromes:

PNS tumors
Neurofibromas
Optic nerve gliomas
Lisch nodules in the iris
Cafe au lait spots

NF 1

135

Neurocutaneous syndromes:

Bilateral acoustic neuromas
Meningiomas

NF 2
- AD

136

Neurocutaneous syndromes:

Encphalotrigeminal angtiomatosis
- Skin
- Retardation
- Skull radioopacitiies
- "Tram track" on CT

Sturge-Weber

"VVV for Weber + CN V"

137

Neurocutaneous syndromes:

Hamartomas
Cysts
Cardiac rhabdomyomas
Seizures

Tuberous Sclerosis

138

Neurocutaneous syndromes:

Hemorrhagic telangiectasias
Rupture causes bleeding
No cysts

Osler-Weber-Rendu

"Red-u blood"

139

In what part of the neuron does Wallerian Degeneration occur after injury?

Segment of the axon that lost connection to the cell body

140

In what part of the neuron does Axonal Regeneration occur after injury?

Cell body
- Edema
- Nucleus in periphery
- Dispersed Nissl
- 24-48 hrs post injury

141

Aneurysm caused by HTN
- Occurs in the ponds, thalamus, cerebellum, basal ganglia
-

Charcot-Bouchard Aneurysm

142

Aneurysm caused by ADPKD, Ehler's Danlos, HTN
- Occurs in the Circle of Willis
- 2-25 nm
- Subarachnoid hemorrhage
- Focal neuro deficits uncommon
- Sudden severe headache

Berry Aneurysm

143

What part of the ear is damaged in noise-induced hearing loss?

Sterocilia of the hair cells within the Organ of Corti

144

What is the function of the Organ of Corti?

To transduce mechanical audition from the tympanic membrane to the nerve

145

What is the function of the Mammillary Body?

Cortical control of emotion and memory
- Part of the Circuit of Papez in the Limbic System

146

What part of the brain undergoes necrosis in Wernicke-Korsakoff Syndrome?

Mammillary Bodies

147

What nerve is affected in Bell's Palsy?

CN VII

- Motor output to facial muscles > 1/2 paralysis
- PS fibers to lacrimal/submandibular/sublingual/salivary glands > lack of tearing
- Taste > anterior 2/3 of tongue
- Somatic afferents from pinna and EAM > hyperacusis

148

What is Central Pontine Myelinolysis?

Osmotic demyelination of neurons in pons
- Quadriplegia due to demyelination of corticobulbar tracts
- Pseudobulbar palsy: head and neck muscle weakness, dysphagia, dysarthria

149

What is the cause of Central Pontine Myelinolysis?

Rapid correction of hyponatremia

150

What are 2 mechanisms of diabetic peripheral neuropathy?

1) Endoneural arteriole hyalinization
2) Intracellular hyperglycemia > osmotic damage to neurons

151

What is the role of Lithium in bipolar disorder?

Manic and depressive episodes, maintenance

152

What is the role of Valproate in bipolar disorder?

Manic episodes, maintenance

153

What is the role of Carbamazepine in bipolar disorder?

Manic episodes, maintenence

154

What is the role of Lamotrigine in bipolar disorder?

Depressive episodes, maintenence

155

What drugs can be used in manic episodes of bipolar?

Lithium
Valproate
Carbamazepine

156

What drug can be used in depressive episodes of bipolar?

Lamotrigine

157

What drugs can be used in maintenance therapy of bipolar?

Lithium
Valproate
Carbamazepine
Lamotrigine

158

What are the adverse effects of Lithium?

DI
Hypothyroid
Tremor
Ebstein's anomaly

159

What are the adverse effects of Valproate?

Hepatotoxicity
Neural tube defects

160

What are the adverse effects of Carbamazepine?

Agranulocytosis
SIADH
Neural tube defects

161

What are the adverse effects of Lamotrigine?

Steven Johnson Syndrome

162

What is the Rx for Trigeminal Neuralgia?

Carbamazepine

163

Clasp-knife spasticity (initial resistance, sudden release) indicates what kind of brain lesion?

Pyramidal motor system: corticospinal tract, medulla, pons, midbrain, internal capsule, precentral gyrus

164

What area of the brain makes up the extrapyramidal motor tract?

Basal ganglia

165

Dizziness + truncal atazia + dysarthria + visual changes + cancer diagnosis indicates:

Paraneoplastic Cerebellar Degeneration

166

What is the mechanism behind paraneoplastic cerebellar degeneration?

Antibodies against tumor cross reacts with Purkinje neurons
- Anti-Yo, Anti-P/Q, Anti-Hu

167

What cancers are prone to paraneoplastic cerebellar degeneration?

Small cell lung cancer
Breast, ovarian, uterine cancers

168

What is the major cause of death in TCA overdose?

Cardiac arrhythmia
- Inhibition of Na channels in cardiac myocytes (though not related to anti-depressive mechanism)

169

What type of brain bleed involves a lucid interval?

Epidural hematoma

170

What tumor is characterized by:
- Precocious puberty
- Obstructive hydrocephalus (compression)
- Paralysis of upward gaze and convergence (Parinaud's)

Germinoma, pineal gland tumor

171

What is the lesion:
- Loss of pain and temp over cape like distribution
- Uppers show LMN signs
- Lowers show UMN signs
- Setting of scoliosis

Syringomyelia

172

Where is the lesion in Syringomyelia?

Ventral White Commissure

173

What is a neuro complication of measles?

Subacute Sclerosing Panencephalitis (SSPE)

174

What are the symptoms of SSPE?

Ataxia, myoclonus, visual changes

175

What makes the diagnosis of SSPE?

Measles antibodies (oligoclonal bands) in CSF

176

Where does the virus accumulate and replicate in SSPE?

Neurons and oligodendrocytes
- Causes demyelination and gliosis

177

What antidepressants can cause mania in susceptible patients?

TCAs, Venlafaxine

178

What pathological findings are evidenced in the brain of a Huntington's patient?

Bilateral atrophy of caudate and putamen (striatum)
Dilation of frontal horns of lateral ventricles
Atrophic areas show gliosis + neuronal loss

179

What type barrier makes up the BBB?

Tight junctions/zonula occludens
- Claudins and occludins
- Limits transport to trancellular diffusion or carrier-mediated

180

Which cranial nerves are affected by acoustic neuromas?

Mainly CN VIII: sensorineural hearing loss, tinnitus, vertigo, disequilibrium, nystagmus

Also CN V (facial sensation, mastication)
and CN VII (facial muscles, taste, lacrimation, hyperacusis)

181

Valproate inhibits folate absorption from the gut, putting pregnant women at risk for...

Neural tube defects in the fetus

182

What seizures is Valproate indicated for?

Absence
Tonic clonic

183

What is the Rx for Serotonin Syndrome?

Cyproheptadine
- Antihistamine with 5HT2 antagonist properties

184

What type of receptors are mu opioid receptors?

GPCRs
- Activate various 2nd messenger pathways

185

What ist he morphine pathway?

Activate mu receptor (GPCR)
- Increase K+ efflux
- Hyperpolarization
- No pain transmission

186

What is the MOA of Thiopental?

Short acting barbiturate
Used for induction of anesthesia

187

What is the lethal side effect of Cocaine?

MI

188

What is the lethal side effect of Opioids?

Respiratory Depression

189

What is the lethal side effect of PCP?

Trauma secondary to violent behavior

190

What is the role of the cerebral cortex in urination?

Inhibits sacral nerves
(inhibition lost in NPHydrocephalus)

191

What is the role of pontine fibers in urination?

Relax external urethral sphincter

192

What is the role of sacral nerves 2-4 in urination?

Bladder contraction (PS fibers)

193

B1 (thiamine) is needed as a cofactor for:

1. Pyruvate dehydrogenase (pyruvate > acetyl CoA)
2. Alphaketoglutarate dehydrogenase (TCA cycle)
3. Transketolase (HMP hunt, pentose > G3P)

194

What are the causes of glaucoma?

Increased intraocular pressure due to:
- Increased production of aqueous humor OR
- Decreased outflow

195

What is the Rx for glaucoma?

TImolol, beta blocker that decreases aqueous production by ciliary epithelium

196

What is the MOA of Levodopa in Parkinson's?

Dopamine analog

197

What is the MOA of Carbidopa in Parkinson's

Does not cross BBB
Inhibitor of dopa-decarboxylase
Blocks peripheral effects of L-dopa

198

What is the MOA of Selegiline in Parkinson's?

MAO-I
Prevents damage to DA neurons

199

What is the MOA of Amantadine in Parkinson's

Mainly an antiviral, with dopaminergic anticholinergic action

200

What is the MOA of Pergolide in Parkinson's?

DA agonist (D2 Rs)

201

What is the initial treatment for Parkinson's?

Selegeline/Amantadine/Anticholinergics

Later, Levodopa/Carbidopa

202

What is are underlying causes to Cheyne-Stokes respiration?

Hyperventilation and apnea in alternation can be caused by CHF or can be neurogenic

(NOT due to obstructive sleep apnea)

203

What is a common adverse effect of SSRIs, including Sertraline, Paroxetine, and Velafaxine?

Sexual dysfunction

204

What sense does not go through thalamic relay?

Smell

205

What tracts go through the VPL thalamic relay?

Spinothalamic tract and medial lemniscus

206

What tracts go through the VPM thalamic relay?

Trigeminal and gustatory

207

What goes through the LGN thalamic relay?

Vision (lateral = light)

208

What goes through the MGN thalamic relay?

Sound (medial = music)

209

What is an SSRI without the adverse effect of sexual dysfunction?

Buproprion

210

What are the adverse effects of Buproprion?

Agitation
Insomnia
Seizure (esp. with electrolyte imbalance)
- Contraindicated in bulimia and anorexia

211

Loss of ankle reflex in Sciatica indicates what nerve root is damaged?

S1

212

What is the MOA of inhaled anesthetics?

Increased GABA inhibition by locking K+ channels in hyperpolarization

213

What are the adverse effects of inhalation anesthetics?

Mycoardial depression (decreased CO)
Hypotension
Respiratory depression
Decreased renal fx

214

What nerve and muscle are damaged in the Trendelenberg Gait?

Superior gluteal nerve
Gluteus medius muscle

215

What is the function of the suprachiasmatic nucleus?

Regulates Circadian Rhythm

216

What is indicated by:

"Hot as a hare"
"Dry as a bone"
"Red as a beet"
"Blind as a bat"
"Mad as a hatter"

Anticholinergic Syndrome

Fever
Dry skin and mucous membranes
Flushing
Mydriasis and cycloplegia
Altered mental status

217

What are some drugs that cause anticholinergic syndrome?

Atropine
Antihistamines (diphenhydramine, hydroxizine)
Antipsychotics (cholorpromazine, olanzapine)
Antispasmodics (dicyclomine)
Tricyclic antidepressants (amitryptiline, desipramine)

218

What is sublimation?

Mature defense mechanism

Convert/channel unacceptable feelings or drives into a more socially acceptable venus

219

Diagnosis of:
- 20-30 yr old presets with headaches and papilledema
- Pituitary failure and cranial nerve dysfunction
- Bitemporal hemianopsia
- Calcified lesion on head CT

Craniopharyngeoma

220

What is a craniopharyngeoma?

Suprasellar tumor arising from remnants of Rathke's pouch

221

What is the histology of a craniopharyngeoma?

3 parts: solid, cystic, calcified
- Brownish fluid filled with cholesterol

222

What brain tumor has 3 parts: solid, cystic, and calcified?

Craniopharyngeoma, arising from remnants of Rathke's pouch

223

What is the MOA of Ethosuximide?

Blocks T-type Ca channels in thalamic neurons, keeping them hyperpolarized

224

What is the indication for Ethosuximide?

Absence seizure

225

What is the MOA of Phenytoin, Carbamazepine, Valproate?

Block Na current in cortical neurons, reducing ability to recover from inactivation

226

What additional Rs does Valproate block?

Na channels in cortical neurons AND
- NMDA Rs
- GABA Rs
- K+ channels

227

What is transference?

Shifting of emotions associated with one person to another

228

What is displacement?

Expressing emotions to/on a safer surrogate

229

What is projection?

Attributing one's own unacceptable thoughts to another

230

What does the MAC of an inhaled anesthetic indicate?

Potency

Low MAC = high potency

231

What does A/V concentration of an inhaled anesthetic indicate?

Solubility in tissues

High A/V = increased time to saturate blood

232

What does the blood/gas partition of an inhaled anesthetic indicate?

Solubility in blood

Increased blood/gas = increase time to saturate

233

What is the pathogenesis of organophosphate (insecticide) poisoning?

Acetylcholinesterase inhibition
- All of the secretions
- Muscle paralysis
- Bradycardia
- Miosis

234

What is the Rx for organophosphate poisoning?

Atropine: muscarinic antagonist
- Cannot change muscle paralysis

Pralidoxime: cholinesterase enzyme reactivator

235

What is the path of CSF circulation?

Lateral ventricles >
Interventricular Foramen of Monro >
Third Ventricle >
Cerebral Aqueduct >
Fourth Ventricle >
Luschka and Magendie >
Central Canal

236

What is the MOA of succinylcholine?

NMJ depolarizing blockade
- Ca cause flaccid paralysis

237

Poorly demarcated brain tumor with necrosis and hemorrhage and variegated appearance

Glioblastoma Multiforme

238

From what cell type does Glioblastoma Multiforme derive?

Astrocyte

239

Brain tumor with psuedopalisading necrosis, new vessel formation, small round cells, bizarre giant cells, and many mitoses

Glioblastoma multiforme

240

What is the presentation of Glioblastoma Multiforme

Headache
Seizure
Mental status change
Focus neuro sx

40-70 yo

241

What parts of the brain does Glioblastoma Multiforme affect?

Frontal and temporal lobes
Basal ganglia
Crosses midline "butterfly"

242

What is the prognosis of Glioblastoma Multiforme?

High malignant
Death within 1-2 years

243

What is the presentation of hydrocephalus in infancy?

Poor feeding and irritability
Hyperreflexia and muscle hypertonicity (UMN) due to stretching of periventricular tracts
Ventricular sized enlarged on CT

244

What cell type makes up a tumor that stains with Synaptophysin?

Neurons

245

What cell type makes up a tumor that stains with GFAP?

Glial cells

246

What tumors stain for GFAP (3)?

Astrocytomas
Ependymomas
Oligodendrogliomas

247

What is the location of a pure motor or pure sensory stroke?

Internal capsule
- Will take out motor/sensation to the contralateral limbs and face

248

What is the length constant?

How far along an axon a signal can propagate

249

What is the time constant?

How long it takes to change membrane potential

250

How does MS affect the length and time constants?

Demyelination decreases the length constant (how far along an axon a signal can propagate) and increases the time constant (how long it takes to change membrane potential)

251

What are the indications of Carbamazepine?

Simple and complex, tonic-clonic seizures
Bipolar mood stabilizer
Trigeminal Neuralgia

252

What is the MOA of Carbamazepine?

Blocks voltage gated Na channels in cortical neurons

253

What are the adverse effects of Carbamazepine?

Bone marrow suppression
Hepatotoxicity
SIADH

254

Give me some tongue:

Taste anterior 2/3

Chorda Tympani of Facial Nerve (VII)

255

Give me some tongue:

Pain/temp anterior 2/3

Lingual Nerve of Trigeminal Nerve (V3)

256

Give me some tongue:

Taste posterior 1/3

Glossopharyngeal (IX)

257

Give me some tongue:

Pain/temp posterior 1/3

Glossopharyngeal (IX)

258

Give me some tongue:

Taste to epiglottis and pharynx

Vagus (X)

259

What genes (on what chromosomes) are associated with Early Onset Alzheimer's?

APP (chromo 21)
Presenillin 1 (chromo 14)
Presenillin 2 (chormo 1)

These make beta amyloid

260

What gene is associated with Late Onset Alzheimer's?

ApoE4 makes senile plaques

261

What is the inheritance pattern of NF1?

AD, 100% penetrance with pleiotropy (variable expression)

May arise spontaneously through germline mutation (germine mosaicism) in individual with no family history

262

Name the class of unmyelinated fibers.

Group C

263

What are afferent Group C (unmyelinated) fibers?

Sensory fibers for flow pain, temperature, and olfaction

264

What are efferent Group C (unmyelinated) fibers?

Post-ganglionic autonoimc

265

What is the MOA of Pilocarpine

Direct muscarinic cholinergic agnoist
- Can cause pupillary constriction in deenervated eyes because it is direct!

266

Name the disorder:

Emotional stressor becomes physical symptoms
Not reproducible on volition
Not corroborated on physical exam

Conversion Disorder

267

Name the disorder:

Many body disorders/complaints in various systems
Over-utilization of medical system
Not corroborated on physical exam

Somatization

268

What other neuro meds are contraindicated with first gen antihistamines?

Benzos, because both cause drowsiness/sedation

269

What are first generation H1 antagonists (antihistamines)?

Diphenhydramine, chlorpheniramine, promethazine, hydroxyzine

Sleep from DC to PHilly

270

Paralysis of what muscle and nerve causes hyperacusis?

Stapedius muscle, innervated by Stapedius nerve (of VII)

271

Syndrome/symptoms produced by a stroke to the:

MCA

MCA is "major"
- M1/S1

Motor and sensory to contra upper limb and face
Aphasia if dominant hemisphere (usually left)
- Broca's Area (Frontal Lobe)
- Wernicke's Area (Temporal Lobe)
Hemineglect if nondominant hemisphere

272

Syndrome/symptoms produced by a stroke to the:

ACA

Motor and sensory loss to contra lower limb

- M1/S1

273

Syndrome/symptoms produced by a stroke to the:

Lenticulostriate artery

Lacunar Infarct 2 to HTN (hyaline arteriolosclerosis)
- Internal capsule, striatum

Contralateral hemiparesis/hemiplegia

274

Syndrome/symptoms produced by a stroke to the:

ASA

Medial Medullary Syndrome
- Lateral corticospinal tract, medial lemnisucus, caudal hypoglossal nerve

Contral hemiparesis of upper and lower limbs
Ipsi hypoglossal dysfunction (togue deviates ipsi)

275

Syndrome/symptoms produced by a stroke to the:

PICA

Lateral Medullary (Walleberg) Syndrome
- Lateral medulla

Pain and temp from ipsi face and contra body
Hoarseness, dysphagia
Vomiting vertigo nystagmus

"Don't PICA horse that can't eat"

276

Syndrome/symptoms produced by a stroke to the:

AICA

Lateral Pontine Syndrome
- Lateral pons

Paralysis of face, loss of pain and temp, ipsi Horner's

"Facial droop means AICA's pooped"

277

Syndrome/symptoms produced by a stroke to the:

PCA

Contra hemianopia with macular sparing
- Occipital/visual cortex

278

Syndrome/symptoms produced by a stroke to the:

Basilar Artery

Locked-in Syndrome

279

Demyelinating disorder:

Caused by JC virus

Progressive multifocal leukoencephalopathy
- Reactivation of virus by immunocomp state
- Rapidly progressive, usually fatal

280

Demyelinating disorder:

Caused by measles

Subacute sclerosing panencephalitis (SSPE)
- Years after initial infection
- Ataxia, dementia

281

Demyelinating disorder:

AD disorder related to defective production of proteins involved in structure and function of peripheral nerves or myelin sheath
Associated with scoliosis and foot deformities

Charcot-Marie-Tooth

282

Demyelinating disorder:

AR lysosomal storage disease due to deficiency of galactocerebrosidase
Destroys myelin sheath
Developmental delay, optic atrophy, globoid cells

Krabbe

283

Demyelinating disorder:

AR lysososmal storage disease due to deficiency of arylsulfatase A
Build up sulfatides
Impaired production of myelin sheath
Ataxia, dementia

Metachromatic Leukodystrophy

284

Demyelinating disorder:

X-linked disorder of disrupted metabolism of VLCFA
Excessive buildup in CNS and adrenal glands
Progressive losses, adrenal crisis

Adrenoleukodystrophy

285

Demyelinating disorder:

Occurs when correcting hyponatremia too quickly
Results in locked-in syndrome

Central Pontine Myelinolysis

286

Name that tumor and its derivation:

Adult brain tumor
GFAP +
Pseudopalisading pleomorphic cells
Central necrosis and hemorrhage

GBM, derived from astrocytes

287

Name that tumor:

Adult female typically
External to brain parenchyma
May have dural attachment
May present with seizures
Spindle cells in whorled pattern
Psammoma bodies

Meningioma, derived from arachnoid cells

288

Name that tumor and its derivation:

Adult tumor typically
Cerebellopontine angle
S-100+
Bilateral in NF2

Schwannoma, derived from Schwann Cells

289

Name that tumor and its derivation:

Cerebellar
Associated with VHL
Can produce EPO and 2 polycythemia
Thin walled capillaries with interleaving parenchyma

Hemangioblastoma, derived from endothelial cells

290

Name that tumor and its derivation:

Adult tumor, slow growing
Frontal lobe
Fried egg cells and calcifications
Chicken wire capillary pattern
May present with seizure

Oligodendroglioma, derived from oligodendrocytes

291

Name that tumor and its derivation:

Adult tumor
Most commonly prolactinoma
Bitemporal hemianopsia

Pituitary adenoma, derived from pituitary

292

Name that tumor and its derivation:

Childhood tumor
Well circumscribed
Posterior fossa (cerebellum)
Solid + cystic
Eosinophilic corkscrew fibers
GFAP +

Pilocytic astrocytoma, derived from glial cells

Think: pilo-cystic

293

Name that tumor and its derivation:

Childhood tumor
Cerebellum
Hydrocephalus, compressing 4th ventricle
Drop metastases to spinal cord
Rosettes
Small blue cells

Medulloblastoma, derived from neuroectoderm

294

Name that tumor and its derivation:

Childhood tumor
4th ventricle
Perivascular rosettes

Ependymoma, from ependymal cells

295

Name that tumor and its derivation:

Childhood tumor
Bitemporal hemiaopsia
Supratentorial
Calcificiations

Craniopharyngioma, from remnants of Rathke's pouch (ectoderm)

296

What area of the brain causes acute nausea post-chemo?

Chemoreceptor Trigger Zone

297

Where is the CTZ located?

Area postrema of DORSAL MEDULLA near 4th ventricle

298

What is the mechanism of opioid tolerance?

Activation of NMDA Rs by glutamate

299

What medication decreases morphine tolerance, and what is the mechanism?

Ketamine, blocks NMDA R + actions of glutamate

300

Vertical diplopia indicates...

Trochlear Nerve Palsy

301

An increased blood gas coefficient of an inhaled anesthetic indicates (slow/rapid) onset of action?

Slow onset bc soluble in blood = slow equilibrium in brain

302

What syndrome is characterized by:
1. Pineal gland tumor
2. Upward gaze palsy, absent pupillary light reflex, failure of convergence
3. Wide based gait

Parinaud's Syndrome

303

What syndrome is characterized by:

Bilateral destruction of temporal lobe, esp. amygdala
Hypersexual, oral fixation, hyperphagia
Loss of normal anger and fear responses, placidity

Kluver Bucy Syndrome

304

What are some etiologies of Kluver Bucy?

HSV-1 encephalitis
TBI

305

What are the side effects of TCAs (ex. Amytryptiline)?

Antimuscarinic + alpha antagonistic effects
- Ex. urinary retention and sinus tachy