1
Q
Most common primary cerebral neoplasm in adults
A
Glioblastoma
2
Q
Glioblastoma
A
- Typically located w/in cerebral hemispheres
- May cross midline (“Butterfly glioma”)
- Highly malignant
- Grossly: NECROSIS and HEMORRHAGE
Pts die w/in year of dx
3
Q
GAD criteria
A
- Excessive worry, anxiety for ≥6 months
- Difficult to control
- Significant distress or impairment
≥3 or more of the following:
- Restlessness
- Fatigue
- Difficulty concentrating
- Irritability
- Muscle tension
- Sleep disturbance
4
Q
Medications to avoid in elderly for tx of insomnia
A
- Benzos
- Antihistamines
- Sedating antidepressants
5
Q
Only safe anti-insomnia drug for elderly pop’n
A
Ramelteon - melatonin agonist
6
Q
Very narrow zone of beta-hemolysis on blood agar, tumbling motility at 22C, can be cultured at temps as low as 4C
A
Listeria monocytogenes
7
Q
How do you get rid of listeria?
A
Intact cell-mediated immunity is essential for elimination
That’s why neonates up to 3 months are especially vulnerable b/c they don’t have that immunity yet
8
Q
Intracellular bacteria
A
- Chlamydia
- Legionalla
- Listeria
- Mycobacteria
- N. mening
- Nocardia
- Rickettsia
- Salmonella typhi
9
Q
CN IV functions
A
Eye muscle: superior oblique
- Abduction
- Internal rotation
- Depression while abducted
10
Q
CN IV lesion findings
A
- Eye deviated upward
- Vertical and torsional diplopia (most notable when looking downwards – worsens this way)
Pts may compensate by tucking the chin and tilting the head away from affected eye
11
Q
Loss of neurons in caudate nucleus and putamen characteristic of what AD disease?
A
Huntington
Chromosome 4
12
Q
CMV cellular receptor
A
Cellular integrins
13
Q
EBV cellular receptor
A
CR2 (CD21)
14
Q
HIV cellular receptor
A
CD4 and CXCR4/CCR5
15
Q
Rabies cellular receptor
A
Nicotinic ACh receptor
16
Q
Rhinovirus cellular receptor
A
ICAM1 (CD54)
17
Q
MOA of rabies
A
- ssRNA, enveloped, bullet-shaped capsule
- Glycoprotein spikes that bind to nicotinic ACh receptors
- Deposited in wound
- Stay local for days/weeks
- Binds to ACh receptors on peripheral n. axons and travels retrograde to the CNS
18
Q
SSRIs works in which area of the CNS?
A
Raphe nuclei
Also - SNRIs and TCAs
19
Q
Ipsilateral shoulder pain, upper limb paresthesias, areflexic arm wkness due to brachial plexus involvement - potential Horner syndrome
A
Pancoast tumors
- NSCLC (any kind) that arises near superior sulcus
- If cervical sympathetic ganglia are involved => Horner syndrome
20
Q
Trigeminal neuralgia
A
- Brief episodes of sudden and severe “electric shock-like” or “stabbing” pain
- Due to stimulus of CNV (chewing, swallowing, shaving, teeth brushing)
- In distribution of CNV (specifically V2 and V3)
21
Q
Treatment of trigeminal neuralgia
A
Carbamazepine
- Effective for pain relief in up to 80% of peeps
- Inhibits neuronal high-freq firing by reducing the ability of Na channels to recover from activation
- Can cause aplastic anemia (monitor CBC)
22
Q
Inheritance of neurofibromatosis type 1
A
Single-gene AD
Chromosome 17 (there are 17 letters in neurofibromatosis)
23
Q
Common clinical symptoms of neurofibromatosis type 1
A
- Cafe au lait spots
- multiple neurofibromas
- Lisch nodules
24
Q
Most common urea cycle disoder
A
Ornithine transcarbamylase (OTC) deficiency
25
OTC deficiency findings
- Discrete episodes of vomiting, tachypnea, and confusion/coma
- All secondary to hyperammonemia
A metabolic emergency
26
Low blood/gas coefficient (think super big molecules)
Eg: N20
- Small amount needed to saturate blood
- Rapid rise in PP in blood
- Rapid equilibration w/ brain
- Rapid onset of action
27
High blood/gas coefficient (think super small molecules)
Eg: halothane
- Large amount needed to saturate blood
- Slow rise in PP in blood
- Slow equilibration w/ brain
- Slow onset of action
28
Go look up normal looking cross sections of the spinal cord for each level (C, T, L, and S)
NOWWWW
29
Mitochondrial encephalomyopathy w/ lactic acidosis and stroke-like episodes
Young boy
- History of seizure disorder
- Experiences several stroke-like episodes w/ residual neuro deficits
- Muscle wkness
- Increased serum lactate (post-exercise and at rest)
- Maternally inherited
30
Heteroplasmy
Random distribution of normal and mutated mitochondria
Some cells have healthy mitos and some shitty mitos
You see this in mitochondrial disorders like MELAS
31
Length constant in nerve stuff
- Measure of how far along an axon an electrical impulse can travel
- Myelination increases length constant
- Demyelinations shortens it
32
PCO2 function in cerebral vasculature
Potent vasodilator
33
Tachypnea causes what in the brain?
- Hypocapnia
- Cerebral vasoconstriction
- Decreases cerebral BF
- Decrease ICP
34
When you see snRNPs what do you think?
pre-mRNA splicing
35
Tonic clonic seizure + absence seizure drug of choice
Valproate
Not ethosuximide b/c it only works against absence seizure
36
Benzos MOA
- Increase freq of opening CNS GABA receptor Cl channels
| - Anxiolytic, anticonvulsant, muscle relaxant, sedative/hypnotic effects
37
Which drug do you use to prevent cerebral vascular spasm following a subarrachnoid hemorrhage?
CCB (e.g. nimodipine)
An alternative use of CCBs in general
38
Clinical findings of wilson disease
- Hepatic (ALF, chronic hep, cirrhosis)
- Neuro (parkinsonism, gait disturbance, dysarthria)
- Psych (depression, personality ∆s)
- Kayser-Fleischer rings
39
Dx of Wilson disease
- Decreased ceruloplasmin
- Increased urinary Cu excretion
- Increased Cu content on liver biopsy
40
Tx of wilson disease
D-penicillamine (Cu chelator)
41
Entacapone/tolcapone
COMT inhibitors
Increase levodopa moving across BBB
42
Atropine use and SE
Tx of bradycardia
- Decreases vagal influence on SA/AV node
SE
- Increased intraocular pressure
- Precipitates acute closed-angle glaucoma in Asians/Inuits
43
Chronic RA effects on cervical spine
- Vertebral malalignment (subluxation)
- Affects atlantoaxial joint
- Extension of neck => worsening => acute compression of spinal cord and/or vertebral arteries
44
Jugular foramen (Vernet) syndrome
Lesions at jugular foramen
- Dysfunction of CN IX, X, XI
- Dysphagia
- Hoarseness
- Loss of gag reflex (ipsilateral)
- Deviation of uvula to normal side
45
Which nerve passes through the supinator canal?
Radial n
46
How do you get a distal radial n. injury?
Repetitive pronation/supination of forearm, direct trauma, or subluxation of radius
47
Radial n injury signs w/ injury at supinator canal?
- Wkness during finger and thumb extension ("Finger drop")
| - No wrist drop or sensory deficits
48
Valproate exposed fetuses are susceptible to what?
Neural tube defects
Valproate inhibits intestinal folic acid absorption
49
Vit A overuse sx
- Intracranial HTN
- Skin changes
- Hepatosplenomegaly
50
Temporomandibular disorder
- Arises from problems involving TMJ
- Muscles of mastication
- Nerves that supply jaw
CN V (mandibular)
- Otologic sx
- Jaw pain
51
Crutches can do what at axilla?
Radial n injury
Due to repetitive pressure/trauma
52
Findings of radial n injury at axila
- Wkness of forearm, hand, finger extensors
- "Wrist drop"
- Absent triceps reflex
- Sensory loss posterior arm and forearm, dorsolateral hand, dorsal thumb
53
Coag negative staph?
Staph epidermidis
54
Staph epidermidis virulence mechanism?
Synthesis of an extracellular polysaccharide matrix
Aka adherent biofilm
55
Lacunar stroke at subthalamic nucleus MOA
Damage => decrease excitation of globus pallidus internus => reduces inhibition of thalamus
56
Lacunar stroke at subthalamic nucleus clinical presentation
Hemiballism
- Movement disorder: wild, involuntary, large amplitude, flinging movements of proximal limbs (arms/leg)
- On one side of body
Due to long-standing HTN and DM
57
AR condition, presents during childhood/teens, progressive gait ataxia, impaired joint/vibration sense
Friedrich Ataxia
Also - kyposcoliosis, pes cavus, and DM
58
Most common cause of death in Friedrich ataxia
Hypertrophic cardiomyopathy
59
Purpuric cutaneous lesions, hemorrhagic destruction of bilateral adrenals, septic shock, hyperemia and infarcts of internal organs
Waterhouse-Friderichsen syndrome
- Complication of meningococcemia
- Triad: adrenal destruction, DIC, shock
60
Long-term tx of Parkinson disease w/ levodopa
- Complicated by periodic and sometimes unpredictable flunctuations in motor function
- "On-off" phenomenon decreased therapeutic window
61
Cystic tumor in child
Pilocytic astrocytoma
Biopsy
- Spindle cells w/ hair-like glial processes
- Rosenthal fibers and granular eosinophilic bodies
62
Gliosis
- Proliferation of astrocytes in area of neuron degeneration
- Leads to formation of a glial scar
- Compensates for volume loss that occurs after neuronal death
63
Neuro sx of which vitamin deficiency mimic Friedreich ataxia?
Vitamin E
- Degeneration of spinocerebellar tracts (ataxia)
- Degen of dorsal columns (loss of position and vibration)
- Degen of peripheral nerves (loss of DTRs)
64
Changes in the body of a neuron after the axon has been severed
Axonal reaction
- Increased protein synthesis => axon repair
- Enlarged, rounded cells w/ peripherally located nuclei
- Dispersed finely granular Nissl substance
65
Go look up the brachial plexus
NOWWWWW
66
Cause of SAH
- Rupture of saccular (berry) aneurysm or arteriovenous malformations
- Saccular aneurysms of circle of Willis are associated w/ ADPKD
Dedicated Study Period
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