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Flashcards in Neuro/Psych Deck (93):
1

Eye's are down and out--nerve damaged?

Aneurisym of?

CN3

Posterior Cerebral Artery or Superior Cerebellar Artery

2

ANS Drug used Alzheimer's? Mechanism?

Donepezil, Rivastigmine, Galantamine

Anticholinesterases

3

What ANS modulation in?

Alzheimers

PD

What not in HD?

AD: Donezepil (increase ACh levels via AChEI)

PD: Benztropine (knock down PSNS with anticholinergic)

HD: too little ACh (like AD therefore DONT GIVE ANTICHOLINERGICS)

4

Drugs with anticholinergic effects that aren't anticholinergics per se?

H1 blockers, TCAs, Typical Neuroleptics.

Amantidine

5

Gq GCPR subunit mechanism and ANS receptors using it?

"cue-tsie" Q-->Ca-->PLC-->PKC

HAVe 1 M&M

H1, A1, V1 (vasopressin), M1, and M3***

just gotta remember M3 (bladder, eyes, exocrine secretion)

6

Gi subunit mechanism?

Receptors?

Gi inhibits AC which decreases cAMP

"MAD 2's"

M2, alpha2, D2 (dopamine)

7

1) Tyrosine Kinase Receptor?  What binds it?

2) JAK STAT pathway?

 1) "Growth Factors"

Insulin, IGF, FGF, PDGF, EGF

Think about tyrosine kinase receptor inhibitors used to stop cancer cuz you want to stop the growth factor signal

2) Prolactin, Immunomodulators (Interleukins), Growth Hormone (NOT PDGF***), EPO

8

Tinnitus Vertigo Hearing loss?

If constant: Acoustic Schwanomas associated with NF2

If periodic: Meniere's disese (defective endolymph resorption)

9

Recurrent Hemorrhagic Strokes usually result of?

Cerebral amyloid angiopathy (usually in elderly)...these strokes are less severe than ones caused by HTN.

10

  1. Epi?
  2. NE?
  3. Isoproterenol?
  4. DA?
  5. Dutamine?
  6. Phenyleprine?
  7. Alubterol?

  1. B>A (alpha wins at high doses, thus use for septic shock) EBA
  2. a1>a2>b1  Increases BP but decreases Renal Perfusion NAAB (dont use in septic shock cuz A1 agonism causes too much vasoconstriction which decreases CO)
  3. ONLY BETA IBB
  4. D1=D2>B>A DADBA
    1. Low doses: increased GFR and renal excretion (D1/D2) (good for renal's!)
    2. High doses increase inotropy (B1) and vasoconstriction (A1)
  5. B1>B2, alpha thus Ionotrophic > Chronotropic DBBA (give in acute Heart failure)
    1. Stronger inotrope than chronotrope
  6. a1>a2 Vasconstriction PAA
  7. B2>B1

11

Patient has sharp electric-like painful shocks in her jaw:

Dx? Tx? SE?

Trigenmenal Neuralgia

Carbamazepine.  Aplastic Anemia.

(lengthens Na channels time from inactivation to deinactivation).  

12

Anecphaly assocaited with? Marker?

Maternal Diabetes, AFP and ACh increased

13

Arnold Chiari Malformation (II)

Cb tonsil and vermal herniation thru foramen magnum.

Pinches cerebral aqueduct causing hydrocephalus.

14

Dandy Walker

Cb vermis agenesis w/ cystic enlargmnt of 4th ventricle ("filling the posterior fossa"): hydrocephalus and spina bifida association

"Can't walk dandy cuz your Cb isn't there"

15

Process of Guillain Barre?

Inflammatory infiltrate into the ENDONEURIUM (thus peripheral nerves)

16

NTs inc/dec in which conditions?

Anxiety

Depression

HD

PD

AD

  1. Anxiety
    1. inc NE, decreased 5-ht/Gaba
  2. Dep
    1. Dec NE, DA, 5-ht
  3. HD
    1. Inc DA, Dec ACh, GABA
  4. PD
    1. Dec DA, inc 5-ht, ACh
  5. AD
    1. dec ACh

17

Major source of ACh in brain?

GABA?

5-ht

Da

NE

Basal nucleus of meynert

Nuc Accumbens

Raphe Nuc

VTA and SNc

LC

18

DA pathways and sxs?

Mesocortical

Mesolimbic

Nigrostriatal

Tubuloinfundibular

 

  1. Mesocortical
    1. VTA-->CTX; def cause negative sxs of psycosis
  2. Mesolimbic
    1. VTA-->limbic; def/inhibition causes RELIEF of psychosis
  3. Nigrostriatal
    1. sub nigra pars compacta --.straitum (caud/put)
    2. def=PD sxs
    3. stim=extrapyramidal sxs (eg neuroleptic malignant syndrome)
  4. Tubuloinfuldibular
    1. Arcuate nuc of hypothal-->pituitary
    2. blocking causes release of Prolactin from pituitary
    3. Stimulating can be used to tx prolactinomas

19

Where is oxytocin made?

Vasopressin?

Paraventricular nucleus of hypothalamus.

"pvN make oxytoCIN"

Supraoptic Nuc for ADH

20

Parts of hypothalamus:

PSNS/Cooling center?

SNS/Heating center?

Circadian rhythm?

"controls anterior pituitary?

ADH release?

GnRH release?

Anterior hypothal (A/C: anterior cooling via PSNS); also called preoptic area

Posterior heating (SNS controlled)

Suprachiasmatic nucleus (SCN)

A-rcuate controls A-nterior pit

Supraoptic

PREOPTIC (ANTERIOR NUC)

21

REM sleep _____ during the night?

Mediated by?

ETOH, Benzos, barbs effect on REM?

EEG wave form from awake to sleep?

Increases

PPRF (paramedian pontine reticular formatoin/conjugate eye gaze center)

Decreases REM and delta sleep

Beta, Alpha, Theta, Delta (BATD) (bedwetting/night terrors occur during DELTA)

22

Parts of Thalamus?

VPM

VPL

LGN

MGN

VL

vpM for trigeM

vpL for L-eminiscus (DCMLS)

LGN for vision

MGN auditory

VL motor

 

23

STN role?

STN stims GPi to inhibit VA/VL (indirect pathway): therefore damage to STN = hemibalisms

24

Lewy Bodies associated with?

Made of?

Disease characteristics?

PD

Alpha synuclein (intracellular esoinophillic inclusions)

PD TRAPS your body: Tremors (pill rolling), cogwheel R-igidity, Akinesia, Posturual instaiblity, Shuffling gate

25

Lesion in:

Amygdala (bilateral)

Frontal Lobe

Right Parietal temporal ctx

Left parietal temporal ctx

Mammillary bodies (bilateral)

Basal Ganglia

 

Amygdala (bilateral): Kluver bucy: hypersexuality, orality, and disinhibition

Frontal Lobe: orienation, judgement, concentration, possibly primitive reflexes

Right Parietal temporal ctx: Spatial neglect (contralateral agnosia)

Left parietal temporal ctx: Agraphia, acalculia, finger agnosia, and left-right disorientation (gerstmann syndrome)

Mammillary bodies (bilateral): Wernicke korsakoff syndrome

Basal Ganglia: Termor, hcorea, athetosis

26

Cb Hemispheres

Cb vermis

STN

Hippocampus (bilateral)

Paramedian Pontine Reticular Formation

Frontal Eye fields

Cb Hemispheres: Ipsi Ataxia, fall toward side of tremor

Cb vermis: Truncal ataxia and DYARTHRIA

STN: Contralateral Hemiballismus

Hippocampus (bilateral): Antergrade amnesia

Paramedian Pontine Reticular Formation: Eyes look away from side of lesion

Frontal Eye fields: eyes look towards lesion

27

Eyes looking up and to the right? (brain lesion not CNs)

Right sided frontal eye field defect or LEFT sided paramedian pontine reticular formation lesion

28

First line treatment for + SEs of drug:

Absence seizures

Simple/Complex Partial Seizures

Myoclonic

Absence + Tonic Clonic

Trigemnal Neuralgia First line?

  • Absence Seizures:
    • ethosuxsimide
    • blocks T type calcium channels in thalamus
    • GI, headahce, rash, steven johnson
  • Simple/Complex Partial Seizures
    • Carbemezipine
    • Increases Na channel inactivation
    • Risk for Agranulocytosis
  • Myoclonic
    • Valproic Acid
    • Inc Na channel inactivation and [GABA]
    • Hepatox, and Neural tube defects (teratogenic)
  • Absence + Tonic Clonic
    • Valporic >>>Ethosux
  • Trigemnal Nerulagia
    • Carbamazepine

29

Patient presents with right sides paralysis, and tongue deviates left.  Stroke of?

  • Left ASA Infarct
  • Medial Medullary Syndrome (Medial nuclei are MOTOR)
  • Contralateral Hemiparesis and proprioception issues, Ipsilateral hypoglaossal dysfunction

30

Patient presenets with Vomiting and vertigo, decreased pain and temperature on left side of body and right side of face.  The patient has dysphagia and hoarseness with decreased gag reflex. Stroke of?

  • Right PICA
  • Lateral Medullary (wallenberg) Syndrome (lateral cranial nerve nuclei are sensory)
  • Ipsi Face and contra STT of body, DYSPHAGIA AND HORSENESS (tell you medulla not pons***)

31

Paralysis and loss of pain/temp of Left Face, vertigo nystagmus, decreased corneal reflex. Stroke of?

  • Left AICA
  • Lateral Pontine Syndrome
  • Ipsi paralysis of face, cerebellar, and cranial nerve 4-7 issues

32

Patient presents with visual field defects.  Aneurisym of?

Anterior communicating artery compressing CNII

33

Patient's eye is down and out with ptosis and pupil dilation.  Aneurisym of?

Posterior Communicating Artery compressing CNIII (CN 4 and 6 still working to pull eye down and out)

34

Patient comes in with unstable gait, incoherent and has peed themselves

Normal Pressure Hydrocephalus

"Wet Wobbly and Wacky"

35

Person has troubling looking up or down?

Conjugate (both eyes) vertical gaze palsy due to a pinealoma compressing the superior colliculi.

Parinaud Syndrome

36

Brain stem nuclei for (associated CN?):

Visceral Sensory

Motor

ANS motor

  • nucleus S-olitarius (sensory)
    • CN 7, 9, 10 (taste, baroceptors, gut distention)
    • lateral=sensory
  • nucleus aMbiguus (M-motor)
    • CN 9, 10, 11
    • medial motor aMbiguus
  • Dorsal Motor Nucleus
    • CN 10 (PSNS to heart lungs, upper GI)

37

Where does CN pass thru:

2, 3, 4, 5-1/2/3, 6, Middle Meningeal A

2: Optic Canal

3, 4, 5-1, 6: Superior Orbital Fissure

5-2: Foramen Rotundum

5-3: Foramen Ovale

"SRO: Standing room only"

Middle Meningeal A: Foramen Spinosum

38

Where does CN pass thru:

CN 7, 8, 9, 10, 11, 12?

What passes thru foramen magnum?

7, 8: Internal Auditory Meatus

9, 10, 11, Jugular vein: Jugular Foramen

      "JUGs at i-XXX-i (IX, X, XI)"

12: Hypoglossal Canal

Foramen magnum: spinal roots of CN 11, brain stem, vertebral Arteries

39

Damage to Superior orbital fissure results in loss of what reflexes?

CN 3, 5

Therefore loss of ADDuction (CN3), and loss of corneal reflex (CN5)

40

Opthalmoplegia, decreased corneal and maxillary sensation with NORMAL vision?

Cavernous sinus syndrome (mass effect or fisutal/thrombosis)

CN 3, 4, 5-1/2, 6 and post gang thru cavernous sinus

(here showing defects of 3, 5-1, and 5-2)

41

PSNS and SNS innervation of the eye

SNS: Lateral horn of SC (Ciliospinal center of buldge C8-T2)-->Superior Cervical ganglion (travels along cervical sympathetic chain)-->carodi plexus to Ciliary nerve to pupillary dilator muscles

PSNS-->Edinger westphal nucleus to ciliary ganglia via CN3 (only PSNS)-->Short ciliary nerves to upillary sphincter muscles

42

Disease associated with:

Spherical tau protein aggregates

Alpha synuclein

Spongiform cortex

 

Pick Disease (Frontotemporal Dimentia)--Pick bodies; spares pareital and posterior 2/3s of parietal. PD aspects + dimentia.

Lewy body dementia--dimentia with visual hallucinations followed by PD aspects.

Creutzfeldt-Jakob disease: Rapidly progressive. DIMENTIA WITH MYOCLONUS (startle myoclonus)---PrPsc into beta pleated shees

43

Nonautoimmune Destruction of Oligodendrocytes

Progressive Multifocal Leukoencephalopathy

JC virus in aids (BK virus in kidneys; JC=Junky Cerebrum, BK=bad kidney)

Rapidly progressive, usually fatal.

increased risk associated with Natalizumab (anti-alpha 4 integrin)

44

Patient with dark stains on face with seizures?

Sturge Weber Syndrome

STURGE: "Sporadic/Seizures, Tram track Ca2+, Unilateral, Retardation, Glaucoma, GNAQ gene, Epilepsy

Weber~port Wine

45

Glioblastoma Multiforme:

 

Adults, common, Malignant, cerebral hemispheres, Butterfly glioma ("buttergli"; crosses corpus callosum), GFAP+.

Pseudopalisading: border central areas of necrosis and hemorrhage (cuz its growing so fast) with VASCULAR PROLIFERATION

46

Meningioma

adult, Benign, common, arachnoid cell derived, dural attachment "tail", seizures or focal deficits

Psammoma bodies, spindle cells concentrically arranged in whorled pattern

Possibly Estrogen sensitive (Hormone replacement therapy increases risk)

47

Schwannoma

adults, Central type vertigo, cerebellopontine angle

S-100+

Bilateral associated with NF-2 (chromo 22)

48

Hemangioblastoma

adults, Cerebellar, can produce EPO

von Hippel Lindau (chromo 3) when found with retinal angiomas

Closely arranged thin walled capiliaries

49

Oligodendroglioma

adult, Rare, slow growing

Frontal lobe, FRIED EGG cells (round nuc w/ clear cyto---PERINUCLEAR HALO: no pink stain just around the nuc)

Chicken wire caiplary pattern

50

Pituitary Adenoma

adults, Bitemporal hemianopsia

hyper/hypo pituitary sequelae

51

Pilocytic Astrocytoma

Histological feature??

Kids, well circumscribed posterior fossa (most CNS tumors are in post. fossa in kidos)

GFAP+, benign; CYSTIC AND SOLID (two components on MRI imaging vs 1 of medullo on imaging)*****

ROSENTHAL FIBERS (eosinophilic corkscrew fibers)

52

Medulloblastoma

Malignant Cb tumor of kids

Compresses 4th ventricle causing hydrocephalus

medBLUEloblastoma=blue cells that can "drop" met to SC

HOMER-WRIGHT ROSETTES

53

Features of:

Pilocytic Astrocytoma

Medulloblastoma

Craniopharyngioma

GBM

Menignoma

Oligodendroma

 

Pilocytic Astrocytoma: Rosenthal fibers (eosinophilic corkscrew fibers)

Medulloblastoma: Homer-wrigth rosettes (solid small blue cells)

Craniopharyngioma: Calcification

GBM: butterfly glioma (buttergli)

Menignoma: Psammoma bodies

Oligodendroma: Fried egg

54

DD Pilocytic astro with Medulloblastoma

DD neuroblastoma with medulloblastoma

1) Pilocytic astrocytoma will show cystic and solid component on imaging; medullo only solid

2) Neuroblastoma: adrenal tumor, crosses midline of abdomen (WIlms doesn't), Bombesin +, produces catecholamines (HVA in urine) N-myc.  

OPSOCLONUS-MYOCLONUS SYNDROME: nonrhythmic conjugate eye movments (not seen in medulloblastoma***)

55

Blown pupils, vision issues, ipsilateral paralysis

UNCAL HERNIATION compressing CN3 (blown pupil can be down and out), ipsilateral PCA compression (contralateral homonmous hemianopsia), contralateral crus cerebri (ipsi paralysis: false localixation sign)

56

57

Subluxation of the Lens?

Marfans or Homocysteinuria

58

Three strategies to increase DOPA availible for the brain?

Carbidopa: peripheral dopa decarboxylase inhibitor allows more dopa to get to brain

Entcapone/Tocopone: Peripheral** COMT inhibitors allowing more DOPA to get to brain (only effective if given with Levodopa). Tocapone=heptotox.  Entacpone doesn't have tox cuz ENts are awesome.

Selegiline/Resagiline: MAO-B (b for brain specific) inhibitors preventing central DA degredation.  Selegiline has HTN crisis SEs

 

59

Chemo drug used for Brain cancers?

Nitrosureas cuz they can cross the BBB

60

Tx for ALS?

Riluzole.

Inhibits glutamate release resynaptically by blocking Na channel.

Riluzole: R-elief for Lou Gehrig disease

61

Anesthetics:

Decrease sol=?

Increase sol=?

Decrease solubility=rapid induction and recovery times

Increased solubility=increased potency=1/MAC; slower onset of action because more must be absorbed before adquate concentrates can be delivered to tissues

62

Associations?

Halothane

Methoxyflurane

Convulsions

Brain surgery

Halothane=Hepatotox (severe 80% mortality rate)

Methoxyflurane=Nephrotox (Meth for Neph)

Convulsions=Enflurane

Brain surgery=Isoflurane

63

Depolarizing NMJ blocker?

Antidote?

Describe phases and what antidote might do?

Succinylcholine

Neostigmine (AChEI)

Phase 1--shorter spikes; AChEI will POTENTIATE EFFECTS

Phase 2--tapering down of spikes (what all non-depol blockers look like)--AChEI will act as antidote

64

PD strategy?

BALSA:

Bromocriptine

Amantadine

Levodopa/carbidopa (B6 increased DA metabolism***)

Selegiline (and comt inhibitors): Entacpone (no tox, only peripheral inhibition), Tolcapone (hepatox, some CNS in addition to peripheral inibition); Selegiline=MOAB; good for MPT exposure from homemade demerol

Benztropine: antimuscarinic (improves tremor, no effect on bradykinesia)

65

AD drugs?

Memantine: NMDA receptor antagonists (dec Ca2+ excititotox)

Donepezil/Galantamine/Rivastigmine: AChEI

 

 

66

HD drug?

Haloperidol=DAR antagonist (want to knock down extra DA)

67

Personality Disorders?

"Weird, Wild, Worried" A, B, C

A: Weird (Accusatory, Aloof, Akward)-- Paranoid, Schizoid (social withdrawal), Schizotypal (magical thinking)

B: Wild (B-ad to the B-one)--Antisocial, Borderline, Histrionic, Narcissistic

C: Worried (Cowardly, Compulsive, Clingy)--Avoidant, Obsessive compulsive, Dependent

68

Schizoid Personality?

Withdrawn no interest in social interactions

69

Schizotypal Personality

Withdrawn with MAGICAL THINKING

70

Borderline Personality?

Histrionic Personality

Obsessive Complusive Personlity?

Unstable mood and relationships.  Self mutilation and impulsiveness.

Excessive Emotionality, Attention seeking, Sexually Provacative

Perfectionism; Behavior is consistent with own beliefs (compared with OCD that isn't consistent)

71

Time frame for schizophrenia?

Brief psychotic d/o < 1 month < schizophreniform < 6 months < schiophrenia

 

Schizoaffective (schizo+bp)=2 weeks of stable mood with psychotic symptoms (shows that the disease is more schizo and less Bp/MDD

72

Typical Neuroleptics:

High Potency (2) and SEs:

Low Potency (2) and SEs:

How are atypical different?

Potency refers more to the side effects that does their effectiveness/dosing

High Potency: Extrapyramidal>Anticholinergic; Fluphenazine and Haloperidol

Low Potency: Anticholinergic > Extrapyramidal

Chlorpromazine (chloro=corneal deposits), Thioridazine (thio hurts your eye-o's=retinal deposits)

ATYPICALS TREAT BOTH POSTIIVE AND NEGATIVE SXS of schizo (vs typicals only treat positve)

73

Olanzapine: drug type? SEs?

Atypical neuroleptic

Weight gain, and risk for DM

74

Clozapine: drug type? SEs?

Atypical Neuroleptic

Agranulocytosis (why its used a third line for refractory schizo despite being so effective)

75

Overdose of Tricyclics?

pramines/triptylines

"Tri-Cs": Convulsions, Coma, Cardiotox

76

PTSD vs Acute stress disorder?

3 days < Acute Stress disorder < 1 month PTSD

77

Buspirone use?

ONLY IN GENERALIZED ANXIETY DISORDER! (not for MDD etc)

78

Young woman who complains of weakness and numbness in extremeties with recent psychological stressor?

Conversion disorder

Not factitious (munchausen) or malingering (faking it for $$ gains)

79

Intraventricular hemorrhage result from damage to which artery?

Germinal Matrix Arteries

80

Result of proximal portion of neuron when distal is going thru wallerian degen? What does it look like?

Axonal Reaction

neuron because rounded, nucleus pushed to side, and RER becomes dispersed.

81

Pathways that use cAMP?

FLAT ChAMP

FSH, LH, ACH, TSH, CRH, hCG, ADH (V2), MSH, PTH

and calcitonin, GHRH, glucagon

82

Endocrine pathways that use IP3

GOAT HAG

GnRH, Oxytocin, ADH (V1), TRH, Histaimine, Angiotensin II, Gastrin

83

Steroid Receptors?

VETTT CAP

Vitamin D, Estrogen, Testo, T3, T4

Cotrisol Aldo, P4

84

S-100 positive tells you?  Two examples?

Vimentin?

Cytokeratin?

S-100 tells you neural crest derived.  Melanoma and Schwannomas are universially positive

Vimentin: Intermediate filament of mesenchymal tissues

Cytokeratin: Epitheleal cells

85

Suspected cause of narcolepsy?

Tx for Narcolepsy?

1) Decreased hypocretin (orexin)--used to stim wakefullness and inhibit REM sleep when you don't want it

2) Modafinil (non-amphetamine stimulant) "provigil"

86

Charcot - Bouchard Pseudoneruisym vs Berry Aneurism?

Associated with? Presentation?

Large Lacunar Infarcts associated with?

Charcot: Associated with HTN, patient will present with focal neruo loss, usually in basal gang. NO SUBARACHNOID SXS usually.

Berries: heridiatry syndromes (Ehrlos-Danlos, Marfans, ADPKD), resulting in Subarachnoid hemorrhage (worst headache of life).  Altered level of consciouness >> focal neuro deficits.  Usually in circle of willis.

3) Hypertensive Arteriolar Sclerosis

87

Tx for serotonin syndrome?

Cyproheptadine (first gen antihistamine with antichol and antiserotin properties)

88

Effect of timolol on glaucoma?

Inhibits aqeuous humor of the epithelial cells of cilliary body

89

Medial Anterior horn vs Lateral Anterior horn?

Lateral anterior horn is for distal muscles (eg limbs)

Medial anterior horn is for proximal limb muscles (trunk)

90

MAOI's--when to use them and what characterizes the condition?

Atypical Depression:

Mood reactivity, leaden fatigue (heavy arms/legs), rejection sensitivity, increased sleep/apetitie

91

Phentolamine?

Alpha 1 blocker

92

Insulin secretion regulation?

PSNS=stimulates thru sight and smell

SNS=Alpha 2 inhibits, Beta2 stimulates

93

Redirecting anger to something else? (2)

Sublimation: mature form--redirecting to something acceptable eg working out/sports

Displacement: redirecting to something unacceptable eg kids/pets