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USLME Kiss my ass and pray > Neuro Phys > Flashcards

Neuro Phys Flashcards

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1
Q

Gag reflex

A

Ipsilateral glossopharyngeal (afferent) -> bilateral vagus (efferent)

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2
Q

Spinothalamic tract

Carries?
1st order neuron?

A

pain and temperature sensation

peripheral nerves to posterior horn , cell body in DRG

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3
Q

Dorsal column medial lemniscus

Carries?
1st order neuron?

A

pressure, touch vibration, proprioception

peripheral nerves to medulla via dorsal column, cell body in DRG

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4
Q

lateral corticospinal

Carries?
1st order neuron?

A

voluntary movement

Pyramidal neurons in the cortex descent, cross in medullary pyramids,
Synapse on the anterior motor horn of the cord (UMN)

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5
Q

hypothalamospinal

carries?
1st order neuron?

A

sympathetic input to the face

Arrises from hypothalamus and synapses on lateral horn at T1

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6
Q

2nd order spinothalmic tract

A

arises from posterior horn, IMMEDIATELY CROSS, in anterior white commissure and ascend in spinothalmic tract to thalamus

3rd order - thalamus to cortex

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7
Q

2nd order dorsal column medial lemniscus

A

arises from the medulla, crosses LATE and ascends via the medial lemniscus to thalamus

3rd order - thalamus to cortes

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8
Q

2nd order corticospinal

A

Arises from the anterior motor horn and synapses on muscle (LMN)

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9
Q

2nd order hypothalamospinal

A

arises from the lateral horn at T1 and synapses on the superior cervical ganglion (sympathetic)

3rd order - superior cervical ganglion to eyelids, pupil and skin of face

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10
Q

Microglial origin

A

mesoderm - like macrophages

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11
Q

Neural crest cells -> what neural structures?

A

PNS (CN, DRG, celiac ganglia, ANS) and Schwann Cells

there are other ones….

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12
Q

Neuroectoderm leads -.

A

CNS neurons, epndymal cells, oligodendrocytes, astrocytes

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13
Q

Blood brain barrier made of

A

foot process of astrocytes
BM
non fenestrated endothelia

No BBB where hypothalamus releases ADH or measures osmolarity

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14
Q

Histiologic feature defining neurons

A

Nissl cebstances in the dendrocytes

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15
Q

HIV infected multinucleate giant cells formed by

A

microglia

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16
Q

Reactive gliosis preformed by

A

astrocytes
~fibroblasts in the brain
-ID’ed by GFAP

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17
Q

Cell destroyed in MS

A

Oligodendrocyte

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18
Q

Cell destroyed in Gulliene Barrie

A

Schwann Cell

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19
Q

Fried Egg apperance on Hand E (3)

A

Oligodendrocyte
koliocyte w/ HPV
seminoma

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20
Q

Acustic nurima is

A

type of schannoma -. internal acoustic meatus of CNVIII

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21
Q

Pathways associated w/ Schizophrenia +/-

A

mesocortical pathway

mesolimbic pathway

Dopamine

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22
Q

Pathway implicated Parkinsons

A

Nigrostriatal path (substantial nigra-> neostriatum)

Dopamine

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23
Q

Tuberoinfundibular Pathway

A

Dopamine path from arcuate nucleus in hypothalamus -> Pituitary leading regulation of prolactin levels

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24
Q

What passes the BBB (4)

A

Lipophilic substance
- small non polar

Glucose and AA w/ carrier transport

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25
Nucleus accumbens uses what Vitamin and AA
Creates GABA -LOW in huntintons Using glutamate and Vit B6
26
Locus ceruleus creates?
NE - high in anxiety - low in depression Also reticular formation and solitary tract
27
Ventral tegmentum of midbrain creates?
Dopamine Also SNc Decreased dopamine in parkinsons and depression
28
Raphe nucleus in the pons makes?
5HT
29
Basal nucleus of meynert makes?
ACh increased in REM sleep and parkinsons
30
Glycine?
inhibitory NT of the Spinal Cord
31
Glutamate?
excitatory NT of CNS
32
Arcuate nucleus | Hypothalamus
releases dopamine and GnRh
33
Lateral nucleus | hypothalamus
Hunger -inhibited by leptin Destruction -> anorexia
34
Ventromedial nucleus | hypothalamus
Satiety -stimulated by leptin Destruction -> hyperphagia - >excessive eating
35
``` Anterior hypothalamus(2) hypothalamus ```
Cooling (A/C) | parasympathetic stim
36
``` Posterior hypothalamus(2) hypothalamus ```
Heating | sympathetic stim
37
Dorsal medial nucleus | hypothalamus
Stimulates the GI | works w/ VMN
38
Suprachiasmatic nucleus | hypothalamus
master clock | circadium rhythm
39
Preoptic nucleus | hypothalamus
Secreted GnRH -> FSH and LH
40
Supraotic nucleus | hypothalamus
ADH release
41
Paraventricular nucleus | hypothalamus
Oxytocin | - give synthetic ptocin for Uterine contraction and clamping down the uterus after birth to control bleeding
42
Mammary body
in hypothalamus | contains hemorhagicc lesion of Wernicke encephalopathy
43
Melatonin
secreted by pineal gland during period of darkness also follows circadian rhythm
44
Limbic system and at the 5 Fs
``` Feeding Fleeing fighting Fucking Feeling ```
45
Anxiety is due to these changes in NTs (3)
increased NE decreased 5Ht decreased GABA
46
Stages of Sleep and EEG (6)
``` awake-beta relaxing- alpha NI- Theta NII - Sleep spindle and K complexes NIII- Delta REM - Beta ```
47
Night terrors and bed wetting found in
NIII Rx w/ benzos or imiprimine
48
Bruxism is what and where is it found
Teeth grinding in stage II sleep
49
Sleep enuresis can be treated w/
imiprimine (TCA) | Desmopressin - ADH
50
paramedian pontine reticular formation is important in sleep when?
rapid eye movement in REM
51
Depressed sleep changes (4)
decreased REM latency and increased REM early in sleep cycle repeated nighttime awakenings and early morning awakening low slow sleep
52
Narcolepsy characterized by what sleep cycle Rx:
Awake -> REM - Cateplexy and Hallucinations Tx w/ modafinil -nightime sodium oxybate
53
Insomina Rx 1st line Benzo alternative Rx? (3)
antihistamines Zolpidem Zaleplon eszopiclone - long term
54
``` Tounge nerves Anterior 2/3 taste? Anterior 2/3 sensation Posterior taste? posterior sensation ```
Facial nerve trigeminal - mandibular branch glossopharyngeal glossopharyngeal Vagus is taste in epiglotic
55
Olfactory nerve exits
cribiform plate
56
Lesions of the olfactory nerve (2)
cribiform plate frature | Kallman syndrom e9infertile as well)
57
Exits the superior orbital fissure (4)
Occulomotor Trochlear trigeminal opthalmic branch abducens
58
Trigeminal maxillary branch exits
foramen rotundum
59
Trigeminal mandibular branch exits
foramen ovale
60
2 nerves exiting internal acoustic meatus
facial | vestibularcochlear nerve
61
3 nerves exiting the jugular foramen
glossopharyngeal vagus spinal accessory nerve
62
Hypoglosseal nerve exits the
hypoglosseal canal
63
Cranial nuclei of midbrain
3 occulomotor | 4 trochlear
64
Cranial nuclei of the pons
5 trigeminal 6 abducens 7 facial 8 vestibularchochlear
65
Cranial nuclei of the medulla
9 Glossopharyngeal 10 Vagus 12 hypoglosseal
66
Cranial nuclei of spinal cord
11 accessory
67
Muscles of mastication - open - close - nerve
open - lateral petrygoid close - temporal is, masseter, medial pterygoid V3 - mandibular branch of trigeninal
68
5 branches of facial nerve
To Zanzibar By Motor Car ``` Temporal Zygomatic Buccal Marginal mandibular Cervical ```
69
Parotid gland innervation
glossopharyngeal
70
Submandibular and sublingual innervation
facial nerve
71
Lesions of the hypoglosseal see?
tounge pointing toward the lesion
72
lessons of vagus nerve see?
Uvula points away from lesion
73
Pupillary reflex
II shine in light | III constricts
74
Corneal reflex
V1 senses touch | VII temporal branch shuts
75
CNIII damage
Down and out pupil
76
CN IV damage
eyes gazes upward, hard with stairs
77
CN VI damage
medially directed eye
78
Nucleus Solitaris(3)
Vagus nuclei- Visceral sensory taste baroreceptors gut distension
79
Nucleus ambiguous (3)
Vagus nuclei -Motor pharynx larynx upper esophagus (swallowing, plate elevation)
80
Dorsal motor nucleus
Parasympathetic control of vagus heart lungs Upper Gi
81
Infection of cavernous sinus leads to what neuro defects
Ophthalmoplegia (CN 3, 4 ,6) Upper and middle face sensation change (V1 and 2)
82
Marcus gunn pupil
afferent pupillary defect - damage or retina detachment -> Bilateral constriction when light is shown in unaffected eye Neither constrict in affected
83
Bitemporal hemanopia
optic tract lesion
84
Left homonymous hemianopia
R optic tract lesion
85
Right anopia
Right optic nerve lesion
86
central scotomata - loss of central vision
macular degeneration
87
Left hemanopia w/ macular sparing
Posterior cerebral artery infarct- collateral from middle cerebral spares the macula
88
Increased AFP seen in maternal serum and amniotic (3) Down in ?
anterior abdominal wall defect Spina bifida Anencephaly Down in Down syndrome
89
Anencephaly Clues(2)?
malformation of anterior neural tube-> no forebrain, low folate of DM type 1 risk polyhydramnios - no swallowing reflex Increase AFP
90
Holoprosencephaly is ? Due to
failure of L and R hemispheres to separate sonic hedgehog signaling mutation
91
Proencephalon/Forebrain -> (2) | embryology
telencephalon -> cerebral hemispheres | Diencephalon -> thalamus
92
Mesenecephalon/Midbrain -> | embryology
mesencephalon -> midbrain
93
rhombencephalon/hindbrain -> (2)
metencephalon (Pons and cerebellum) | Myelencephalon (medulla)
94
Chiari One is at risk for? Characterized by
syringomelia - can be connected to trauma as well mild cerebellar tonsils herniate
95
Chiari type II is what ? Leads to (3)
Significant cerebellar tonsillar/vermian herniation through foramen magnum aquaductal stenosis, hydrocephalus, thoraco-lumbar myelomeningocele
96
cystic enlargement of the 4th ventricle w/ enlarged posterior fossa - Agenesis of cerebellar vermis is called
Dandy walker
97
C8-T1 lesion w/ loss of pain and temp sensation is at further risk for what neuro defects? What tract is affected 1st
Syringomyelia can have additional weakness of arms w/ progressive anterior horn involvement spinothalamic tract
98
Brachial cleft derived from
ectoderm
99
Brachial pouches derived from
Endoderm
100
Brachial arches derived from
mesoderm
101
Branchial cleft cyst characterized by Other major cleft derivative?
lateral neck location that does not move w/ swallowing -vs thyoglossal cyst(midline and moves) Cleft 1 -> external auditory meatus
102
1st brachial arch derivatives think Muscles(3) Nerves(2)
Ms and Ts Muscles of mastication(Temporalis, Maseter, lateral and medial pterygoid) Mylohyloid Tensor Tympani Tensor veli palatini Mandibular and Maxilliary branch of trigeminal
103
2nd brachial arch derivatives think Muscles(4) Nerve(1)
S's Facial expression (CN Seven) Stapedius Stylohyoid posterior belly of digastric CN VII
104
3rd brachial arch derivatives think Muscle (1) Nerve (1)
pharyngeal Stylopharyngeous glossopharyngeal
105
4-6th brachial arch derivative think Muscle(2) Nerve (1 w/ 2 branches)
thyroid and cricoid 4th swallowing muscles - cricothyroid, levator palatine and pharyngeal constrictors --enervated by superior laryngeal branch 6th Larynx/voice box (EXCEPT cricothyroid) --enervated by recurrent laryngeal branch
106
Inferior parathyroids and thymus come from
3rd brachial pouch
107
superior parathyroids come from
4th brachial pouch
108
middle ear cavity comes from
1st brachial pouch
109
palatine tonsils develop from
2nd brachial pouch
110
monitors carotid body and sinus chemoreceptors
CN 9 - glossopharyngeal
111
Unilateral lower extremity sensory and or motor loss
contra-lateral lesion of the anterior cerebral artery
112
Unilateral facial and arm sensory and/or motor loss
contra-lateral lesion of middle cerebral artery
113
vision defects
poterior cerebral artery
114
hypersexulaty, hyperorality and disinhibited behavior found in
Kluver Bucy syndrome | Bilateral amygdala lesion
115
Disinhibited behavior and problems with judgement and concentration
Lesion in the frontal lobe
116
Views/pays attention to only half the world -
contrallateral lesion of the parietal lobe (non dominant) - usually the R ignoring the L hemineglect syndrome
117
Agraphia, acalcula, finger agnosia and can't from R from L -> lesion in
Dominant parietal lobe. usually the Left in a Right handed person Gestman syndrome
118
Lesion in the reticular activating system leads to
decreased levels of arousal in the midbrain
119
Common lesion of the mammalary bodies due to
Thiamin - B1 deficiency - seen in alcoholics
120
Wenicke Korsakoff syndrome characterized by(5)
``` confusion opthalmoplegia ataxia memory loss confabulation personality changes ```
121
Basal ganglia lesions you may see
tremor at rest chorea athetosis Anything coordinating voluntary movement from the cortex
122
Intention tremor and limb ataxia seen in | may fall towards the lesion
cerebellar hemisphere lesion
123
truncal ataxia and dysarthia (muscles of the mouth)
Cerebellar vermis lesion
124
involuntary flailing of the limbs (contralateral hemiballismus ) seen in
lesion subthalamic nucleus
125
Inability to make new memories (anterograde amnesia causing lesion )
hippocampus
126
Lesion of paramaedian pontine reticular formation see
eyes looking away from the lesion
127
paralysis of upward gaze
Parinauds syndrome | superior colliculi lesion
128
Lesion of ? leads to inability to repeat phrases
arcuate fasciulus
129
Wernickes
Fluent aphasia - speaks but does not comprehend or make sense word salad superior temporal gyrus of temporal lobe
130
Brocas location?
nonfluent aphasia -can't speak but comprehends, very frustrating inferior frontal gyrus of frontal lobe
131
Nondominate Brocas lesion?
inability to express emotion (robot talk) | -probably a lesion on the R
132
Nondominate Wernickies lesion ?
inability to comprehend emotion (spock) | - probably a lesion on the R
133
Issue associated w/ inhaled anesthetics
hepatotoxicity especially halothane
134
Blood solubility and lipid solubility effects on anesthetics
Lipid solubility will determine how quickly it gets into the BBB and also the potency Blood solubility is the time to effect. Low blood solubility means quicker reaction to effect ex nitrous oxide is rapid in its effect (low blod solubility) but not very potent- not very lipid soluble Halothane takes longer to have effect ( more blood soluble) but not more lipid soluble and thus more potent
135
Inhaled anesthetics | 4
Halothan enflurane sevoflurane nitrous oxide Used for induction and maintenance of general anesthesia (won't remember)
136
IV anesthetics types and MOA | 4
Also some sedation seen as well barbituates - acts on GABA receptor increasing the duration of Cl channels being open (thiopental or phenobarbital) benzodiazepines- acts on GABA receptor increasing the frequency of Cl channels being open ( Diazapam and lorazepam) ketamine - dissociative anesthetic- blocking NMDA receptors Propofol - uses for sedation potentiating GABAa, rapid induction (Michael Jackson)
137
Analgesics used in surgery (2) Why might you choose one over the other?
Opioids Morphine -local histamine release side effect Fentanyl - more potent ``` Others Butorphanol dextromethorphan tramadol loeramide and diphoxylate ```
138
Blood flow concerns during brain surgery which IV anesthetic do you use
Barbituates have decreased blood flow in the brain NOTE: ketamine causes increased cerebral blood flow
139
Rx for barbituate overdose? Rx for benzodiazapine overdose
none - supportive flumazenil
140
High risk of tryglcerides levels w/ continued use of this IV anesthetic
propofol Used for rapid sedation in the ICU and short procedures
141
Barbituate examples (4)
Thiopental phenobarbital -> induces liver enzymes (Crigler Najarr Syndrome type II Rx?) phentobarbiol secobarbitol
142
Most common drug used in conscious sedation
midazolam
143
Benzodiazabine examples (6)
diazapam lorazapam alprazolam midazolam tamazapm chlordiazepoxide
144
Uses of Benzodiazapones (7)
conscious sedation anesthesia ``` alcohol withdrawal anxiety seizures night terrors insomnia ```
145
2 types of local anesthetics - both act how? examples of each (3 each)
esters - procaine, cocaine, tetracaine amides - lidocaine, mepivacaine, bupivacaine (2 Is) all act by blocking Na channels on the inner portion of the channel, prefers active channels does not work as well in acidic environments, like an infection, may need to use more
146
Given w/ local anesthetics to potentiate result
vasoconstrictors like epinephrine
147
3 things needs for general anesthesia
anesthetic analgesic immobilization - muscle paralysis
148
MAC - in anesthesia
minimal alveolar concentration which 50% of pop anesthetized - increased potency = 1/MAC highly lipid drugs
149
2 types to create neuromuscular blockade and examples of each
Depolarizing - Succinycholine Nondepolarizing - -curarine; -curium; -curonium tubocurarine, atracurium, mivacurium, pancuronium, vecuronium, rocuronium
150
Succinylcholine MOA | risk?
strong ACH receptor agonist -> fasiculations and eventual paralysis with depolarization -depolarizing vc. non depolarizing which is a competitive antagonist Worry of malignant hypertension
151
Malignant hypertension seen in (2) Gene? Rx
succinylcholine use and neuroleptic malignant syndrome Ryr1 mutation - rytanidine receptor Rx Dantrolene - blocks Ca release from sarcoplasmic reticulum
152
Non-depolarizing neuromuscular blocking drugs MOA and examples Rx?
Competitive antagonists for ACh at the neuromuscular junction Tubocurarine, atracurium, mivacurium, pancuronium, rocuronium, Rx w/ neostigmine (cholinestrase inhibitor) - less degradation -> more Ach to overcome
153
2 Types of depolarizing neuromuscular blocking and Rx
Phase I - prolonged depolarization - normal dose of succinylcholine - NO antidote, wait 10 min Phase II - depolarized but blocked - overdose of succinylcholine - antidote w/ cholinesterase inhibitors like in non depolarizing blockade (20-30 min)
154
seizure affecting only 1 area of the brain Usually what lobe?
partial or focal the temporal either simple - consciousness intact complex - LOC
155
What is the difference between a simple and complex siezure
both are partial seizures usually affecting the temporal lobe Simple - consciousness intact complex - LOC
156
Status epileptics is defined by Rx?
continuous seizure greater then 5 min or recurrent seizure w/o regaining conscious ness for >30 min Benzodiazapin 1st line - diazepam or lorazepam
157
5 types of diffuse seizures and differences
Absence - blank star myoclonic - quick repetitive jerk tonic - stiffening tonic clonic- gran maul - alters between stiff and moving atonic- drop seizure (appears to be fainting)
158
Top 3 causes of seizures in kids
congenital, developmental and infection (febrile) trauma and metabolic
159
Top 3 causes of seizures in adults
tumors, trauma and stroke maybe infection
160
Top 3 causes of seizures in elderly
stroke, tumor and trauma Maybe metabolic and infection
161
Rx for trigeminal neuralgia (1 + 3 others) usually affects which branch
Carbamazepine phenytoin, gabapentin, topiramate - maxillary - > touch leads to EXTREME pain
162
See port-wine stains (nevus flames) over the eye (V1 distribution called? Causes (3)
Sturge Weber syndrome - congenital disease - worry of ipsilateral leptomeningeal anginoma under the eye Causes Seizures, glaucoma, and mental retardation
163
Presentation of Seizures, adenoma sebaceous (cutaneous angiofibromas),mental retardation due to an autosomal Dom disease? Which gene? Associated symptoms (2) Tumors (3)
Tuberous Sclerosis - complete penetrance w/ variable expression (TSC1 or 2 gene; hamartin or tuberin protein) Ash leaf spots(hypomelaocytic macuoles), , harmatomas in CNS(retina) and skin (cortical tubers), Tumors: renal angiomyolipoma, astrocytomas, cardiac rhabdomyoma
164
5 Seizure drugs blocking Na Channels
``` Phenytoin Carbamazapine Lomotrigone topiramate valproic acid ```
165
7 seizure drugs that increase GABA activity
``` gabapentin phenobarbital valproic acid benzodiazapine tigabine vigabatrin levetiracetum ```
166
3 seizure drugs that block T type Ca channels
gabapentin ethosuximde phenytoin - at high doses
167
Rx of choice for absence seizures?
Ethosuximide -> valproic acid
168
Rx for status epilepticus
benzodiazapine - lorazepam and diazepam
169
Rx for eclampsia
Magnesium sulfate maybe a benzo
170
7 odd Side effects of phenytoin
``` gingerval hyperplasia hirsutism fetal hydrantoin syndrome (cleft lip/palat; mental retardation, congenital heart) megaloblastic anemia - low folate peripheral neuropathy drug induced lupus Steven johnson syndrome ```
171
Anti epileptics that are teratogens
phenytoin carbamazapine valproic acid - spina bifida worries
172
Hepatotoxic epileptics(2)
valproic acid | carbamazapine
173
Treatment for tonic clonic seizures (3)
Valproic acid phenytoin carbamazapine
174
3 receptors and endogenist agonists to opiod receptors
mu - beta endorphin delta - enkephalin kappa -dynorphin
175
aneurysm causes the eye to look down and out
posterior communicating artery
176
aneurysm leading to loss of peripheral vision bilaterally
anterior communicating artery

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