Neuro 5

Question 1

HIV patient
sensory ataxia
irregularly shaped pupils that do not react to light but do constrict with accomidation

Answer 1

Tabes dorsalis

Neurosyphilis

Question 2

Cause of Argyl Robertson pupils

Answer 2

damage to the midbrain tectum

Question 3

India Ink staining of CSF is used to diagnose:

Answer 3

Cyptococcal meningitis

Caused by cryptococcus neoformans

Question 4

Treatment for cyptococcal meningitis

Answer 4

Amphotericin B and flucytosine

-> Use fluconazole for long term maitenance

Question 5

Where is the caudate found

Answer 5

inferolateral wall of the anterior horn of the lateral ventricle. Separated from the globus pallidus and putamen by the internal capsule

Question 6

In what genetic disease is the caudate atrophied?

Answer 6

Huntingtons

Question 7

Two causes of glaucoma (broad)

Answer 7

Diminished outflow

increased secretion

Question 8

MOA of timolol

Answer 8

Beta blocker

works by diminishing the secretion of aqueous humor by the ciliary epithelium

Question 9

Which two sympathetic sites are not controlled by norepinephrine?

Answer 9

Adrenal glands and sweat glands (both use acetylcholine)

Question 10

Pathway of thiopental through the body

Answer 10

IV-bloodstream-brain-muscle and adipose tissue

Question 11

Parasthesias of the thumb, index, and middle finger

Answer 11

Carpel tunnel syndrome (entrapment of median nerve)

Question 12

Causes of carpal tunnel syndrome

Answer 12

repetative movements
Fluid retention- hypothyroidism
diabetes
RA
dialysis associated amyloidosis (beta-2 microglobulin)

Question 13

Most important biochemical abnormality in Alzheimers disease

Answer 13

decrease in acetylcholine level
Occurs due to deficiency of choline acetyltranferase
Most notable in the basal nucleus of Meynert and hippocampus

Question 14

What meningococcal virulence factor allows for attachment to the nasopharynx

Answer 14

pili

Question 15

spinal nerve root whose compression would cause pain purely in the posterior thigh and leg as well as diminution of the ankle jerk reflex

Answer 15

S1

Question 16

MOA of nicotinic receptor

Answer 16

ligand gated ion channel that opens after binding acetlycholine. Results in immediate influx of Na, Ca into the cell and outflux of K+

Question 17

Damage to what nerve causes foot drop and high stepping gait

Answer 17

common peroneal

Question 18

Selegiline

Answer 18

inhibitor of MAO, type B.

Use: prevent MPTP damage to dopaminergic neurons. Delays progression of Parkinson’s disease

Question 19

Clozapine

Answer 19

Atypical antipsychotic
Useful because it treats both positive and negative psychotic symptoms
Acts on D4 receptors, less likely to cause dopaminergic side effects
AE: risk of life threatening agranulocytosis, watch CBC. Seizures

Question 20

MOA of ethosexamide

Answer 20

Decreases calcium current in thalamic neurons

Question 21

MOA of Phenytoin, carbamazepine and valproic acid

Answer 21

reduces the ability of Na channels to recover from inactivation

Question 22

Holoprosencephaly

Answer 22

failure of forebrain cleavage into cerebral hemispheres

Question 23

Malformation

Answer 23

primary abnormality in a development process

Question 24

Disruption

Answer 24

secondary destruction of a previously well-formed tissue or organ

Question 25

Uses of bethanocol

Answer 25

stimulate peristalsis in postoperative ileus and treat non-obstructive urinary retention.

Question 26

Uses of carbachol and pilocarpine

Answer 26

lower intraocular pressure in glaucoma

Question 27

Why do cholinergics work well for glaucoma

Answer 27

miosis causes iris to move further from the cornea, widens he anterior chamber angle.

Question 28

Clinical presentation of excessive cholinergic stimulation

Answer 28

``` DUMBELS diarrhea urination miosis bronchospasm Emesis lacrimation salivation ```

Question 29

Effect of increased acetylcholine in nicotinic synapses of NMJ

Answer 29

fasiculations followed by paralysis

Question 30

Why does atropine only fix some of the complications of organophosphate poisioning?

Answer 30

stimulates muscarinic and nicotinic cholinergic receptors. Atropine only reverses muscarinic effects. Pralidoxime can, but is only effective early after exposure.

Question 31

How do meningiomas cause damage?

Answer 31

Benign tumors, only cause damage when they compress other brain structures

Question 32

Function of microglial cells

Answer 32

move into an area of damage after ischemic injury and phagocytize the fragments neurons, myelin and necrotic debris

Question 33

Syringomyelia

Answer 33

``` cystic dilitation in cervical spinal cord. Causes damage to ventral white commisure and anterior horns Symptoms: - chronic loss of UE pain and temp - UE weakness and hyporeflexia (LMN) - LE weakness and hyperreflexia (UMN) -kyphoscoliosis Usually at levels C8 -T1 ```

Question 34

What CN is effected by infarcts of the anterior portion of the medial pons?

Answer 34

trigeminal

Question 35

Rapid correction of what metabolite deficiency causes central pontine myelinolysis

Answer 35

chronic hyponatremia

Question 36

What are the two types of typical antipsychotics? How do their side effects differ?

Answer 36

``` Low potency (Chlorpromazine, Thioridazine): non-neurologic High potency (Haloperidol, Fluphenazine): extrapyramidal ```

Question 37

What disease causes lesions to both upper and lower motor neurons

Answer 37

AML

Question 38

What drug is used for AML? What is it's MOA?

Answer 38

Riluzole. | decreases glutamate release

Question 39

How does hydrocephalus present in early infancy? What are the long-term sequelae?

Answer 39

Irritability, poor feeding, increased head circumfrence, and enlarged ventricles on CT sequlae: lower extremity spasticity (due to stretching of the periventricular pyramidal tracts visual diturbances learning disabilites

Question 40

Two mechanisms of diabetic neuropathy

Answer 40

1. Non-enzymatic glycosylation of proteins leads to hyalinization of arteries -> ischemic nerve damage 2. Intracellular hyperclycemia (turned into sorbitol) in nerves causes osmotic damage

Question 41

What drugs are used to prevent cerebral vascular spasm after a subarachnoid hemorrhage

Answer 41

Calcium channel blockers, especially nimodipine

Question 42

Most common first manifestation of alcohol withdrawl

Answer 42

tremulousness | Also: GI distress, agitation, anxiety, autonomic disturbance

Question 43

What is the most common pathogen associated with foreign body infections. Why?

Answer 43

Staph epidermidis, because it can form biofilms.

Question 44

Essential tremor

Answer 44

``` slowly progressive symmetric postural or kinetic tremor in upper extremitites. AD inherited (familial tremor) ```

Question 45

What the first line treatment for essential tremor

Answer 45

Propranolol (nonspecific beta adernergic antagonist)

Question 46

Halothane-associated hepatitis

Answer 46

two to four days after surgery under general anathesia Liver tenderness, hepatomegaly, increase LFTs Biopsy shows widespread centrilobular hepatic necrosis. Due to direct injury by halothane metabolites

Question 47

MOA of triptans

Answer 47

abortive therapy for migraines | serotonin agonists

Question 48

What two types of drugs are used for migraine prophylaxis

Answer 48

beta blockers, TCAs, and anticonvulsants

Question 49

Meniere's disease

Answer 49

tinnitus, vertigo, sensurineural hearing loss | due to increased volume of endolymph

Question 50

What drugs can cause drug-induced parkinsonism

Answer 50

D2 receptor blockers-> Antipsychotics, antiemetics, gastric motility agents

Question 51

Treatment for drug-induced parkinsonism

Answer 51

Stop offending agent | benztropine (centrally acting antimuscarinic) and amantidine (anti-flu drug)

Question 52

Three sites of action of first generation antihistamines that cause side effects

Answer 52

1. anti-muscarininc 2. anti-alpha adernergic 3. anti-serotonergic

Question 53

What drug is used for patients with combined tonic-clonic and absence seizures?

Answer 53

Valproate