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AM- STEP1 > Neuro/Renal Review > Flashcards

Neuro/Renal Review Flashcards

1
Q

Neural crest derivatives

A 
Melanocytes
Aorticopulmonary septum
Ganglia 
Iris stroma
Chromaffin cells
Cranial n.
Odontoblasts/ ossicles
Parafollicular C cells
Sclerae
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2
Q

Neural tube derivatives

A

CNS

  • Neurons
  • Oligodendrocytes
  • Astrocytes
  • Ependymal cells

Pineal galnd
POSTERIOR pituitary
Retina

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3
Q

Surface Ectoderm derivatives

A 
Lens
Olfactory epithelium
Inner eat
ANTERIOR PITUITARY
Oral epithelium
PAROTID GLANDS
Enamel teeth
EPIDERMIS
SWEATGLANDS
Mammary glands
Distal anal canal
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4
Q

Mesoderm derivatives

A 
Muscle, bone, bone marrow
Blood cells
heart
Blood vessels
Lymphatics
Upper vagina
KIDNEYS
Adrenal cotex
Gonads
Dermis
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5
Q

Endoderm derivatives

A 
GI tract
Submandibular glands
Sublingual glands
Liver
GB
Pancreas
Lungs
Thymus
Thyroid follicular cells
Lower vagina
Bladder epithelium
Urethral epithelium
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6
Q

Develops at 4 weeks

A

4 chambered heart

4 limb buds

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7
Q

Develops at 8 weeks

A

Fetal movement

“8” Gait

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8
Q

Develops at 10 weeks

A

Sex specific genitalia

“TEN”italia

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9
Q

Nuclear localizing signals

A

PAL
Proline
Arginine
Lysin

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10
Q

G1 –> S regulator

A

Cyclin D CDK4 –> phosphorylates Rb
Rb released from E2F
E2F free to transcribe cyclin E
Cyclin E binds CDK2

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11
Q

G2 –> M regulator

A

Cyclin A CDK2 –> mitotic prophase

Cyclin B CDK1 –> activated by cdc25 –> breakdown nuclear lamins and initiation of mitosis

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12
Q

Which AA modified in Golgi

A

Tyrosine
Serine
Threonine
Asparagine

Tyrosine- sulfation
O’oligosaccharides to serine and threonine
Mannose-6-phosphate to asparagine

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13
Q 
Corneal clouding
Large bulging head
Saddle like nose
Hepatosplenomegaly
Restricted joint movement
A

I cell disease

- deficiency in mannose phosphorylation

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14
Q

Peroxisomes

  • fxn
  • production
A

Beta oxidation of very long chain fatty acids and branched chain fatty acids

Synthesis of plasmalogens (phospholipid found in myelin)

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15
Q

Two diseases where nuclear lamins defectvie

A

Muscular dystrophy

Progeria: advanced aging child

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16
Q

Receptor mediated endocytosis

1) Clathrin binds _____
2) Clarthin is polymerized and forms sphere
3) ______ pinches it off

A

Clathrin binds adaptin

Dynamin pinches it off

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17
Q

Inhibits pathway to leukotrienes

A

Zileuton

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18
Q

Leukotrienes effects

A

LTB4
- Neutrophil chemotaxis

LTC4, LTD4, LTE4
- Increase bronchial tone

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19
Q

Inhibits leukotrienes receptor

A

Zafirlukast

Montelukast

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20
Q

Effects of PGL2 (prostacyclins)

A

Decrease platelet aggregation
Decrease vascular tone
Decrease uterine tone

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21
Q

Effects of prostaglandins

A

Increase uterine tone (PGE2, PGF2)

Decrease vascular tone (PGE1)

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22
Q

Effects of thromboxane A2

A

Increase platelet aggregation

Increase vascular tone

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23
Q

Precursor to thromboxane, prostaglands and prostacyclins

A

Endoperoxides

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24
Q

Which arachidonic acid

1) Increases bronchial tone
2) Increases platelet aggregation
3) Decreases platelet aggregation
4) Increases uterine tone
5) Decreases uterine tone
6) Increases vascular tone
7) Decreases vascular tone

A

1) LTC4, LTE4, LTD4
2) TXA A2
3) PGI 2 (prostacyclin)
4) PGE2, PGF2
5) PGI2
6) TXA A2
7) PGI2, PGE1

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25
Q

Necrosis in brain

A

Liquefactive

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26
Q

Collagen lay down requires nutrient

A

Vit C

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27
Q

Tissue remodeling by ____ contain ___

A

Metalloproteinases

Which contain zinc

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28
Q

Delayed separtation of umbilical cord

A

Leukocyte adhesion deficiency

Abnormal LFA-1

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29
Q

Tall
Long fingers
Hyperelastic joints
Lens dislocation

Issues with

A

Marfan

  • defect of fibrillin (of elastin)

Aortic dissection

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30
Q

Hyperelastic skin
Flexible joints

Issues with

A

Ehlers danlos

  • Type V and I collagen for classic type
  • Type III collagen for vascular EDS

Intracranial aneurysms

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31
Q

Hearing Loss
Cataracts
Nephritis

A

Alport syndrome Type IV collagen

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32
Q

Tx for ICP

A

Mannitol

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33
Q

Holoprosencephaly

  • failure
  • when
  • mutation
  • defect type
A

Failure of left and right hemispheres to separate
5-6th weeks

Mutations in SHH

Field defect

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34
Q

Cape like bilateral loss of pain and temperature sensation in upper extremities

Hand muscle weakness and atrophy

Fine tough sensation preserved

A

Syringomyelia

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35
Q

Depression changes in NT

A

Decrease dopamine
Decrease NE
Decrease serotonin

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36
Q

Schizophrenia changes in NT

A

Increase in dopamine

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37
Q

Alzheimer changes in NT

A

Decrease ACh

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38
Q

Huntington changes in NT

A

Decrease ACh
Increase Dopamine
Decrease GABA

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39
Q

Parkinson disease changes in NT

A

Increase ACh
Decrease dopamine
Decrease serotonin

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40
Q

What is carried out by neurophysins

A

ADH and Oxytocin

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41
Q

Alcohol and benzo effect on sleep

A

Decrease REM sleep

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42
Q

Right left confusion

Difficulty with writing and mathematics

A

Gerstmann syndrome

- Dominant parietal lesion

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43
Q

Hemi-neglect of one side of body

A

Non-dominant parietal cortex

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44
Q

Apathy
Hyperorality,
Hypersexuality
Viual agnosia

A

Kluver Bucy

Dominant temporal cortex lesion

Bilateral amygdala

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45
Q

Dorsal columns senses

A

Pressure, vibration, fine touch, proprioception

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46
Q

Spinothalamic tract senses

A

Lateral: pain and temp
Anterior: crude touch and pressure

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47
Q

Lateral corticospinal tract sense

A

Descending: Voluntary movement of CL limbs

Ascending: pain and temp

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48
Q

Moro reflex

A

Infant extends and abduct arms when startled

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49
Q

Galant reflex

A

stroking one side of spine when prone causes baby to laterally flex toward stimulated side

50
Q

Rooting reflex

A

Movement of head toward one side if cheek or mouth is stroked

51
Q

Internuclear ophthalmoplegia lesion is where

A

Medial longitudinal fasciculus

52
Q

Cerebellar hemisphere lesion vs cerebellar vermis

A

Cerebellar hemisphere

  • tremor, limb ataxia, loss of balance
  • loss of rapid alternating movements

Cerebellar vermis

  • truncal ataxia, dysarthria
  • wide gait
53
Q

What is seen 12-24 hrs after ischemic event

A

Red neurons (eosinophilic cytoplasm with pyknotic nuclei)

54
Q

What is necrosis and neutrophils seen wiht ischemic brain stroke

A

24-72 hrs

55
Q

Tongue deviation to left
Hemiparesis on right
Loss of proprioception on right

A

Medial medullary syndrome

- infarct of paramedian branches of anterior spinala rtery

56
Q

Dysphagia
Hoarseness
Decrease gag refelx

A

Lateral medullary syndrome

- PICA lesion

57
Q 
Facial droop
Decrease lacrimation
Decrease salivation
Decrease taste anterior 2/3 tongue
Vomiting
Vertigo
Nystagmus
A

Lateral pontine syndrome

AICA lesion

58
Q

CL hemianopia iwth macular sparing

A

Posterior cerebral artery

59
Q

Tx cluster

A

Sumatriptan (acute)

prophylaxis: verapamil

60
Q

Dystonia

A

Sustained involuntary muscle contractions

61
Q

Sturge-Weber syndrome

A

Encephalotrigeminal angiomatosis

Sporadic

GNAQ gene mutation

Port-wine stain face
Seizures
INtellectual disability
Glaucoma early

62
Q

Associated iwt hvon Hippel LIndau disease

A

VHL chr 3

HARP
Hemangioblastomas
Angiomatosis (cavernous hemangiomas in skin, mucosa, organs)
Bilateral renal cell carcinoma
Pheochromocytomas
63
Q

Pseudopalisading pleoorphic tumor cells

+GFAP

A

Glioblastoma

64
Q

Spindle cells in whorled pattern

location

A

Meningioma

Surface of brain and parasagittal region

65
Q

Schwannoma typically located

  • effects
  • positive for
A

Cerebellopontine angle

CN VIII

S-100

66
Q

Tumor in frontal lobes

A

Oligodenrogliomas

Slow growing
Chicken wire capillary appearance
Fried egg

67
Q

Ependymoma

  • location
  • can cause
  • histology
A

4th ventricle
Hydrocephalus

Perivascualr rosettes

68
Q

Homer wright rosettes

A

Medulloblastoma

69
Q

Cingulate herniation effects waht

A

anterior cerebral artery

70
Q

Uncal herniation effects

A 
CN III
Ipsilateral PCA (c/l homonymous hemianopia with macular sparing)
71
Q

External ear n.

A

Greater auricular
Lesser occipital
Auriculotemporal

72
Q

Supplies cerebellum and brainstem

A

Vertebral A.

73
Q

Subarachnoid hemorrage Tx

A

Surgical clip

Nimodipine (Dihydropyridine CCB)

74
Q

Wernicke-Korsakoff syndrome symptoms (6)

A

Thiamine deficiency

Nystagmus
Ophthalmoplegia
Ataxia
Encephalopathy
Anterograde and retrograde amnesia
Confabulation
75
Q

First line therapy ICP

A

Axetazolamide

76
Q

Sumatriptan MOA

Dont use in

A

Serotonin agonist 5HT 1B,1D

CAD
Prinzmetal angina
Pregnancy

77
Q

Alzheimer drugs

A

Cholinesterase inhibitors (prolong action of ACh)

  • DOnepezil
  • Galantamine
  • Rivastigmine

NMDA receptor antagonist
(Glutamate receptor type)
- Memantine
( helps prevent excitotoxicity)

78
Q

Eosinophilic rod like inclusion in hippocampus

A

Hirano bodies

Alzheimers disease

79
Q

Seizures
Angiofibromas
Intellectual diability
Hypomelanotic macrules

A

Tuberous sclerosis

AD
Incomplete penetrance and variable expressivity
TSC1 or TSC2

80
Q

Electric shock like pain triggered by even slightest touch or wind breeze

Tx

A

Trigeminal neuralgia (tic dououreux)

Carbamazepine 
or anticonvulsant (phenytoin, gabapentin, topiramate)
81
Q

Drug of choice absence seizures

A

Ethosuximide

82
Q

Tx status epilepticus

A

Persistent seizures > 5 min

Acute: Benzodiazepines
(diazepam or lorazepam)

Prophylaxis: Phenytoin

83
Q

SE of Phenytoin

A

Pheyntoin Has Given MDS Frustration

Peripheral neuropathy
Hirsutism
Gingival hyperplasia
Megaloblastic anemia
Drug induced lupus
Steven-johnsons syndrome
Fetal hydantoin syndrome
84
Q

Hepatotoxic antiepileptics

A

Valproic acid

Carbamazepine

85
Q

First line partial (focal) seizures

A

Carbamazepine

Blocks Na channels

Diplopia
Agranulocytosis
Liver toxicity
Teratogenesis
Induce P-450
86
Q

First line tonic-clonic seizures

A

Phenytoin, fosphenytoin

  • Blocks Na channel
  • Zero order kinetics
  • adverse ( nystagmus, diplopia, hirsutism, steven johnson, gingival hyperplasia, megaloblastic anemia)

Valproic acid

  • Increase Na channel inactivation
  • Increase GABA concentration by inhibiting GABA transaminase
  • GI distress, hepatotoxicty, pancratitis, tremor, WG, teratogenic
87
Q

Ethosuximide

  • MOA
  • Side effects
A

Blocks thalamic T-type Ca channels

Adverse

  • Fatigue
  • GI distress
  • Headache
  • ITCHING
  • Steven johnsons
88
Q

Benzodiazepines

  • examples
  • MOA
  • adverse
A

Diazepam
Lorazepam
Midazolam

Increase Gaba A action by increase frequency of Cl channel openings

Sedation, tolerance, dependence, respiratory depression

89
Q

Tx ALS

A

Riluzole

- Lengthens survival time

90
Q

UMN Signs
Loss of tactile vibration and proprioception one side
Loss of pain and temp other side of body

A

Brown Sequard

Complete hemisection of spinal cord

91
Q

Parkinson Tx

A

Levodopa-Carbidopa

92
Q

Dopamine receptor agonist

A

Bromocriptine (Ergot)

Non-ergot (perfered)
Pramipexole
Ropinirole

93
Q

Amantadine

A

Increases dopamine release

Decrease dopamine reuptake

94
Q

Selegiline

Rasagiline

A

Inhibit Dopamine breakdown

MAO-B inhibitor

95
Q

Tolcapone

Entacapoen

A

Inhibits COMT

96
Q

Huntington’s tx

A

Tetrabenazine

  • Blocks dopamine release (tx chorea)
  • Inhibit vesicular monoamine transport (VMAT) –> decrease dopamine vesicle packagign and release

Neuroleptics
- Olanzapine
- Haloperidol
[Antigonist dopamine, tx chorea, psychosis]

97
Q

Acute angle closure glaucoma tx

A

Laser iridotamy

Eye drops
- Timolol
- Apraclonidine
(Lower intraocular pressure)

Acetazolamide
Mannitol

98
Q

Glaucoma drugs that decrease the production of aqueous humor

A

Beta blockers
- Timolol, betaxolol, carteolol

Carbonic anhydrase inhibitors
- acetazolamide

99
Q

Glaucoma drugs that increase outflow of aqueous humor

A

Prostaglandins

Alpha -agonists
- Apraclonidine

Cholinergic agonists
- Pilocarpine

100
Q

N3 and REM decreased by

A

Benzo and alcohol

101
Q

What wave

1) eyes open
2) Eyes closed
3) N1
4) N2
5) N3
6) REM

A

1) open= beta
2) closed= alpha
3) N1= theta
4) N2= sleep spindles, K complex
5) N3= Delta
6) Beta

102
Q

Restleg syndrome tx

A

Pramipexole
Ropinirole

Comorbid w/ pain

  • Gabapentin
  • Pregabalin
103
Q

Bed wetting first line

A

Desmopressin (DDAVP)
Anti diuretic

Then

  • Imipramine (TCA) reduces N3
  • Indomethacin: decrease renal blood flow
104
Q

Insomina drug safe in elderly

A

Ramelteon

Non addictive
Works at melatonin recpetors
Avoid if hepatic insufficiency

105
Q

First line tx Narcolepsy

A

Modafinil

106
Q

Barbiturates

  • examples
  • MOA
  • uses
  • adverse
A

Phenobarbital, pentobarbital, thiopental, secobarbital

Facilitate GABA A action by increasing duration of Cl channel opening

Use: anxiety, seizures, insomnia, induction of anesthesia (thiopental)

Adverse: resp/ cardio depression, DNA depression

107
Q

Orexin (hypocretin) receptor antagonist

A

Suvorexant

Use: insomnia

CNS depression
Abnormal dreams **

108
Q

IV anesthetics

A

The Might King Proposes to Oprah

Thiopentol (barbiturates)
Midazolam (benzo)
Ketamine (arylcyclohexylamines)
Propofol
Opioids
109
Q

Inhaled anesthetics with hepatotoxicity

A

Halothane

110
Q

Succinylcholine

A

Strong ACh receptor agonist

Sustained depolarization and prevents muscle contraction

Dopolarizing neuromuscular blocking drugs

111
Q

Nondepolarizing neuromuscular blocking drugs

A

Tubocurarine
Altracurium
Mivacurium
Pancuronium …

Competitive antagonists for ACh receptors

112
Q

Baclofen

A

Activates GABA receptors at spinal cord level
Inducing skeletal muscle relaxation
Use: muscle spasms, MS

113
Q

Epinephrine

A

Alpha 1 agonist

Decrease aqueous humor synthesis via vasoconstriction

Mydriasis: adverse
Blurry vision, foreign body sensation

114
Q

Brimonidine

A

Alpha 2 agonist

Decrease aqueous humor synthesis

115
Q

Propofol

A

Increases GABA in CNS
Rapidly wears off and recovery

Acute pancretitis

116
Q

Most commonly used benzodiazepine for conscious sedation

A

Midazolam

117
Q

Decreases cerebral blood flow in brain surgery

A

Thiopental (barbiturate)

118
Q

Opiod that does not induce histamine release

A

Fentanyl

119
Q

ADPKD tx

A

ACE inhibitors or ARBs

Caused by increased renin production

120
Q

Direct renin inhibitor

A

Aliskiren

HTN

121
Q

Polycystic kidney disease puts you at risk for

A

Brain aneurysm

AM- STEP1 (20 decks)

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