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Flashcards in Neuro UWorld Deck (41)
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1

Supplementation of which vitamin reduces risk of neural tube defects and is recommended for all women of childbearing age?

Folate (vitamin B9)

2

Folate (vitamin B9) should be give to women of childbearing age during what part of their pregnancy to prevent neural tube defects?

before they conceive

3

Which medication for bipolar disorder and epilepsy is associated with 10-20 fold increased risk of neural tube defects if taken during the first trimester of pregnancy?

Valproate/valproic acid

4

Anterograde axonal transport (moves organelles/viruses etc via microtubules, away from nucleus, down axon, toward nerve terminal) is mediated by which motor protein?

kinesin

5

Retrograde axonal transport (moves organelles/viruses etc via microtubules, toward the nucleus) is mediated by which motor protein?

dynein

6

A patient has had a subarachnoid hemorrhage. In order to prevent cerebral vasospasm with subsequent ischemia, which medication should the patient be given ?

Calcium channel blocker. 

Delayed cerebral ischemia due to vasospasm usually presents 3-12 days after the initial SAH with acute mental status and/or new focal neurological deficits. Nimodipine, a  selective calcium channel blocker, improves patient outcomes with SAH by preventing or reducing the extent of ischemic neurological deficits caused by cerebral vasospasm. This neuroprotective effect is likely due to a combination of increased cerebral vasodilation and decreased calcium dependent excitotoxicity. 

7

What neuronal property is most likely to decrease as a direct result of demyelination?

length (space) constant would decrease.

time constant would increase. 

 

The speed of conduction down an axon depends on 2 constantsL the length constant and the time constant (ie, velocity=length/time). Myelination increases th elength constant and decreases the time constant, both of which improve axonal conduciton speed. Demyelination thus impairs stimulus transmission. 

8

moving rostrally in the spinal cord, spinal levels have increasing amounts of ______, and decreasing amounts of _______.

white matter, gray matter

9

Moving rostrally in the spinal cord, the what shape does the spinal cord become?

oval

10

Spinal cord sections in the lower cervical and lumbosacral regions have large _____ horns

ventral horns.

 

these areas innervate the muscles of the arms (cervical) and legs (lumbosacral)

11

What distiguishes spinal cord section in the thoracic and early lumbar area from the other areas in the spinal cord?

lateral gray matter horns (interomediolateral cell columns), which are made up of sympathetic preganglionic neurons

12

Above which spinal level are both the gracile and cuneate fasciculi present?

T7

13

Which fasciculus is present below the leve of T7?

gracile/gracilis

14

what are the side effects of Phenytoin?

PHENYTOIN

P450 INDUCER

Hirsituism

ENLARGED GUMS

Nystagmus

Yellow-brown skin

Teratogenicity (fetal hydantoin syndrome)

Osteopenia

Inhibited folate absorption

Neuropathy

 

 

15

Phenytoin is a known P450 inducer. What types of medications are affected by this and need to be checked in patients?

Inducers of CYP450 will increase metabolism of  oral contraceptives, anticoagulants, antivirals, and HIV drugs. When the P450 oxidase system is induced, the serum concentration of such medications will decrease, thereby reducing efficacy. 

16

Phenytoin is metabolized by CYP 450. How is it influenced by CYP450 inducers? Name some examples

  • Giving phenytoin with CYP450 inducers decreases its concentration and renders it ineffective. 
  • Examples of CYP450 inducers include:
    • barbiturates
    • rifampin
    • carbamazepine
    • griseofulvin
    • chronic alcohol consumption

 

17

Phenytoin is metabolized by CYP 450. How is it influenced by CYP450 inhibitors? Name some examples

  • CYP450 inhibitors slow hepatic metabolism, which increases toxicity of phenytoin
  • Examples of CYP450 inhibitors: AMIGC (amigo without the o)
    • isoniazid
    • cimetidine
    • macrolides
    • azole antifungals
    • grapefruit juice

18

An anti-epileptic medication that selectively blocks voltage-gated claclium channels most likely affects which of the following steps of neurotransmission?

fustion and release of neurotransmitte vesicles

19

name the broad spectrum anticonvulsants and what they are used for:

Broad spectrum anticonvulsants:

  • lamotrigine, levetiracetam, topiramate, valproic acid
  • sucessfully treat most seizure types (focal or generalized at onset)

20

name the narrow spectrum anticonvulsants and what they are used for:

Narrow spectrum anticonvulsants:

  • carbamazepine, gabapentin, phenobarbital, phenytoin)
  • focal onset seizures but can be used if focal becomes bilateral

21

What are the actions of the facial nerve CN VII? 

  1. motor output to facial muscles
  2. parasympathetic innervation to the lacrimal, submandibular, and sublingual salivary glands
  3. special afferent fibers for taste from the anterior 2/3 of the tongue
  4. auditory volume modulation (stapedius)

22

What are some other sx a patient may present with in unilatera facial paralysis (Bell's Palsy)?

  • decreased tearing
  • hyperacusis (pt cannot tolerate sounds)
  • loss fo taste sensation to anterior 2/3 of tongue

23

What are 2 sx that are present in serotonin syndrome and not neuroleptic malignant syndrome?

  1. hyperreflexia
  2. myoclonus

24

describe the route of the median nerve

the median nerve courses between the humeral and ulnar heads of the pronator teres muscle and then runs bewteen the flexor digitorm superficialis  and the flexor digitorum profundus muscles before crossign the wrist within the carpal tunnel. Proximal nerve lesions may result in sensory loss over the first 3 digits and impairment of thumb flexion/opposition, flexion of the second/3rd digits, and wrist flexion/abduction. 

25

where do you give a femoral nerve block?

in the inguinal crease at the lateral border of the femoral artery

26

What areas will a femoral nerve block numb?

skin and muscles of the anterior thigh (quadriceps), femur, and knee. 

27

A patient presents with loss of touch, temperature, and vibratory sensation to one half of her body and the same side of her face. Where is the stroke?

  • Thalamus
    • The ventral posterior lateral nucleus (receives input from the spinothalamic tract and dorsal columns) and ventral posterior medial nucleus (receives input from the trigeminal pathway) of the thalamus send somatosensory projections to the cortex via thalamocortical fibers. 
      • Damage to these nuclei results in complete contralateral sensory loss

28

what 2 things increase the risk of  lacunar infarctions?

  1. diabetes
  2. HTN

Both cause lipohyalinosis and microatheroma formation

29

What higher order functions does the frontal lobes provide?

  • personality
  • language
  • motor
  • executive functions (abstraction)

Test by asking about similarities between two related objects on mental status exam (ruler vs watch)

30

stroke in the MCA on the dominant side (left) will present with what?

Broca's and Wernicke's aphasia