Neurology Flashcards
(319 cards)
1
Q
Neonatal Abstinence Syndrome
Classic Signs - 5
A
TYT Does Heroin
- Tremors
- Yawning
- Tachypnea
- Diarrhea
- High Pitched Cry
Caused by maternal opioid (Heroin) use during pregnancy
2
Q
Which Germ Layer does the ANT Pit come from?
A
Surface Ectoderm
3
Q
A: Primary CNS Lymphoma is the ___ most common cause of _____ in HIV pts
B: What virus is this associated with?
C: What WBCs would you expect to see in the brain tissue
A
A: 2nd most common cause of ring enhancing lesions in HIV pts (1st = Toxoplasmosis Gondi)
B: EBV
C: B-lymphocytes
4
Q
A: What function does the iliohypOgastric nerve have (3)
B: What happens when Surgery (Appendectomy) damages it? (2)
A
A:
- [Suprapubic Sensation]
- [Gluteal Region Sensation]
- [Anterolateral Abd Mucle Motor]
B: Loss of the above areas + [Suprapubic Burning]
5
Q
Dandy Walker Malformation
Clinical Manifestation (2)
A
(Dan - D - Walk - Er = 4 syllables = 4th Vt Dilitation (2/2 → )
+
Can’t walk with NO CEREBELLUM FORMATION!
6
Q
A: Wilson Disease MOD
B: Wilson Disease Mode of Inheritance and genetic cause
A
A: Damaged Hepatocytes leak free copper and the copper deposits in other tissues (basal ganglia / cornea)
B: [Auto Recessive ATP7B gene mutation]
7
Q
Wilson Disease Clinical Manifestation (4)
A
- Hepatic (Acute Liver Failure - Cirrhosis & Chronic Hepatitis)
- Neuro - (Gait Ataxia / Parkinsonism)
- Psych - Personality Changes
- Cornea - Kayser Fleishcer rings
8
Q
Wilson Disease
A: Dx (2)
B: Tx
A
A: DEC Ceruloplasmin and [INC Urinary Copper Excretion]
B: D-Penicillamine
9
Q
Causes of Congenital Hydrocephalus (4)
A
- Congenital Obstruction (aqueductal stenosis vs. [Chiari malformation Type 2])
- Acquired Obstruction (infection vs. posthemorrhagic)
10
Q
A: Congenital Hydrocephalus Clinical Manifestations (6)
B: Tx
A
PEDS w/ Mushy Brain
- Macrocephaly
- Bulging Fontanelle
- Enlarged Ventricles
- Poor feeding
- Developmental Delay
- [Spasticity & Hyperreflexia (from periventricular pyramidal tract stretching)]
B: Ventriculoperitoneal Shunt
11
Q
Most common [1° CNS Tumors] in PEDs (3)
A
PEDs
Pilocytic Astrocytoma = MOST COMMON
Ependymoma
meDulloblastoma (PNET tumor) = 2nd most common
12
Q
Which 2 Pediatric Brain Tumors occur in the [Cerebellar Vermis]
A
[Pilocytic Astrocytoma] and meDulloblastoma
Cerebellar Vermis = Midline POST fossa
Image shows [Pilocytic Astrocytoma]
13
Q
A: Histology for [PNET - Primitive NeuroEctodermal Tumors] (MeDulloblastoma)
B: Pgn
A
A: Sheets of [small, primitive blue cells] + [abundant mitotic figures]
B: POOR! (PNET tumors are undifferentiated and aggressive)
14
Q
A: Histology for [Pilocytic Astrocytoma] (3)
B: Pgn
A
A:
Pilocytic Astrocytes (spindle cells with hair-like glial processes)
+
Rosenthal Fibers
+
[Cerebellar Vermis Cyst]
B: (Better than MeDulloblastoma since it is well-differentiated)
15
Q
A: Describe Opsoclonus-Myoclonus Syndrome
B: What Childhood tumor is it associated with?
A
A: [Non-Rhythmic Conjugate Eye mvmnts] with myoclonus= “Dancing Eyes and Feet”
B: Neuroblastoma (onset 2 y/o)
16
Q
Neuroblastoma Histology
A
[Homer Wright Rosettes] made of [small round blue cells w/purple nuclei]
17
Q
A: Neuroblastoma Genetic cause
B: Neuroblastoma Pgn
A
A: N-myc amplifcation
B: [Better pgn for pts < 1 yo]
18
Q
Describe the Neuroblastoma metastasis process (6)
A
image
19
Q
Histology for [Acute Neuronal Injury] (AKA ___ _____) (4)
A
[Acute Neuronal Injury (AKA RED NEURON)]
- Cell Body Shrinks
- Nuclei Pyknosis
- Loss of Nissl substance
- Eosinophilic Cytoplasm
THIS IS IRREVERSIBLE INJURY that eventually –> Neuronal Degeneration!
20
Q
What causes [Acute Neuronal Injury] (AKA ___ _____) and When do the changes appear?
A
[Acute Neuronal Injury (RED NEURON)]
12-24 Hrs post [Transient Severe Insult]
21
Q
Histology for [Chromatolysis Axonal Rxn (Loss of Axon)] (4)
A
[Chromatolysis Axonal Rxn (Loss of Axon)]
- Cell Body ENLARGES
- Nucleolus ENLARGES
- Eccentric nucleus
- Dispersion of Nissl substance
22
Q
Histology for [Neuronal Atrophy 2° to Degenerative Dz] (2)
A
- Neuronal Loss eventually (compensated for by Gliosis)
- Reactive Gliosis = Astrocyte proliferation in area of neuron degeneration –> Glial Scar (compensates for volume loss)
Can come After [Acute Neuronal Injury (AKA RED NEURON)]
23
Q
A: What are Craniopharyngiomas
B: What type of tissue do they arise from
A
A: Suprasellar Pediatric tumors
B: Remnants of Rathke’s Pouch (Embryonic Precursor of ANT Pituitary)
24
Q
A: Craniopharyngiomas Composition
B: What type of tissue do they arise from
A
A: [Brownish Calcified Cyst containing cholesterol and [wet keratin]
B: Remnants of Rathke’s Pouch (Embryonic Precursor of ANT Pituitary)
25
A: Deep [**Intraparenchymal HTN Hemorrhage**] is most commonly caused by \_\_\_\_\_, which results in rupturing of \_\_\_\_\_
B: This begins as a ______ Aneurysm
A: Deep [**Intraparenchymal HTN Hemorrhage**] is most commonly caused by **HTN**, which results in rupturing of [**lenticulate** **small penetrating arteries**]
B: Charcot Bouchard Aneurysm
*Acute [Intraparenchymal HTN Hemorrhage] in image*
26
Where does **Charcot Bouchard Aneurysms** occur (4)
**C**harcot **B**ouchard **T**ears **P**ink
* **B**asal Ganglia
* **C**erebellum
* **T**halamus (shown in image below)
* **P**ons
*Acute [Intraparenchymal HTN Hemorrhage] in image*
27
1. What's the Difference in size between [Charcot Bouchard Aneurysms] and [Berry Saccular Aneurysms]?
2. Which is associated with **Subarachnoid Hemorrhage**?
1. [Charcot Bouchard Aneurysm] = \< 1 mm
vs.
[Berry Saccular Aneurysm] = 2-25 mm variable
2. [Berry Saccular Aneurysm] = Subarachnoid Hemorrhage
28
What conditions are associated with [Berry Saccular Aneurysm]? (5)
"**E**ating **A**pple*Berries* **C**an **S**ound **H**eavenly"
1. **ADPKD\*\***
2. [**E**hlers Danlos Syndrome]
3. **H**TN
4. **S**AH
5. **C**oarctation of Aorta (associated w/HTN)
29
Where do [Berry Saccular Aneurysms] occur?
Circle of Willis
30
Dx for **Multiple Sclerosis** (3)
* MRI: [**Periventricular** demyelinating plaques with lipid laden macrophages]
* CSF Oligoclonal IgG bands
* Visual Assessment (test conduction velocity)
31
A: **Syringomyelia** MOD
2. How does this manifest (2)
Formation of [CSF filled syrinx cavity] in **cervical** region of spinal cord --\> damages [Ventral white commissure (crossing fibers for STT)] --\> [**Bilateral Pain/Temp Loss in Arms & Hands**]
\*\*\*Eventually Ventral Horns are destroyed also --\> LMN signs (**FAW**) - **F**asciculations / **A**trophy & **A**reflexia / **W**eakness
32
Destructive Site for **Syringomyelia**
A
33
What **type** of Hydrocephalus is shown
Normal Pressure **Hydrocephalus**
## Footnote
*CT: _Symmetrical_ Dilation of Ventricles*
34
A; **Normal Pressure Hydrocephalus** Sx (3)
B: What causes **Normal Pressure Hydrocephalus**
Wacky, Wobbly & Wet!
## Footnote
Wacky (dementia)
Wobbly (ataxia)
Wet (Urinary Incontinence from compressing periventricular cortex white fibers traveling to sacral micturition center)
B: Idiopathic; Episodic; Occurs in Elderly. Does not INC SubArachnoid space volume.
35
Which vessels are affected by [**TUMTL**-**T**ranstentorial **U**ncal **M**edial **T**emporal **l**obe] Herniation? (5) What manifestations result from this?
[**TUMTL** Hernation--\> Compression of [**C****OPP****R**- [**C**rus Cerebri CTL] / **P**CA / [**O**culomotor CN3] / **P**aramedian Pontine vessels/ **R**eticular Formation] --\>
1. [**C**rus Cerebri CTL] compression --\> CTL Hemiparesis
3. [**P**CA compression] --\> Occipital lobe infarct --\> *CTL* homonymous hemianopsia w/Macular sparing
2. **O**culomotor CN3 compression --\> [*Ipsilateral* "Down & Out" Eye + Dilated Pupil + Ptosis]
4. **P**aramedian Pontine vessel compression --\> Duret Hemorrhage
5. **R**eticular formation compression--\> Altered Mental Status
36
1. Clinical Manifestation for [**MIOS**-**M**LF **I**nternuclear **O**phthalmoplegia **S**yndrome] (3)
2: **MIOS** seen in Younger pts indicates \_\_\_\_\_
3: **MIOS** seen in OLDER pts indicates \_\_\_\_\_\_
[**MIOS**-**M**LF **I**nternuclear **O**phthalmoplegia **S**yndrome]
1.
\*[Impaired **ADD**uction of affected eye]
+
[Normal **ADD**uction of affected eye during [near reflex convergence]
+
\*[Nystagmus of **UN**affected eye when attempting to ABduct]
C:
1) Younger pts= Multiple Sclerosis
2) Older pts= Ischemic infarction
37
Clinical Manifestation of **Multiple Sclerosis** (9)
Charcot classic triad of MS is a [**SLUM** **SiiiN**] !
## Footnote
**S**ensory sx
**L**heurmitte sign = pain when chin is touched to chest
**U**hthoff phenomenon (heat sensitivity)
**M**otor sx
**S**canning Speech
[**I**nternuclear Ophthalmoplegia (MIOS) w/eye pain] / **I**ntention Tremor / **I**ncontinence
**N**euritis Optic - Loss of vision with Marcus Gunn Pupils
38
Ocular Clinical Presentation for **Diabetic Mononeuropathy** (3)
**DM --\> Oculomotor CN3 Central Ischemia**
* Ptosis (from Levator Palpebrae paralysis)
* Down & Out Eye
* **NORMAL PERRL** (since Parasympathetic fibers are spared)
39
Which part of the Cerebellum would cause **Truncal and Gait Ataxia**? What system is affected?
Upper Vermis - Medial Descending System
40
Which part of the Cerebellum would cause **Vertigo/Nystagmus (2)**? What system is affected?
Flocculonodular Lobe
+
Medial Descending System
Vestibular Nuclei
41
Which part of the Cerebellum would cause **[Limb Dysmetria & Rebound Check Response loss]**? What system is affected?
**Intermediate** Hemispheres - [Lateral Descending system]
42
Which part of the brain demonstrates the **most atrophy** in Alzheimer's Dz? (2)
Hippocampus and Temporoparietal Lobe
43
Identify
image
44
Identify
image
45
What 2 brain cells come from Neuroectoderm?
Astrocytes and Oligodendrocytes
46
Embryologically, where does Microglia originate from?
[Mesoderm - Bone Marrow Monocytes]
47
Describe Oligodendrocyte Histology
**P****ale halO** surrounding [small / round / dark nuclei] cells
48
[Creutzfeldt Jakob Dz] MOD
PrP (prion protein), normally in neurons as [a-helical structure] converts--\> [**INFECTIOUS** **Beta pleated sheets**] --\> Protease resistance --\>
Vacuoles in [**Gray** Matter Neurons & Neutrophils] develop --\> Cyst = [**Spongiform** Gray Matter]
49
Microscopic findings for [Creutzfeldt Jakob Dz]
Vacuoles in [Gray Matter Neurons & Neutrophils] develop --\> Cyst = [**Spongiform** Gray Matter]
## Footnote
*Remember: These PrP are INFECTIOUS!*
50
Facial CN7 Functions (4)
**FACE**
1. **F**acial Muscles
2. **A**fferents(Somatic) from [Ear Pinna (Pain/Temp)] & [External Auditory Canal (stapedius m.)]
3. **C**ry: Parasympathetics to [Lacrimal/Salivary/Sublingual/Submandibular/]
4. **E**at: Taste from **ANT 2/3 Tongue**
51
Clinical Manifestations for [Bells Palsy] (4)
Bells Palsy = Facial CN7 paralysis
Loss of **F** --\> Unilateral Paralysis
Loss of **A** --\> Hyperacusis
Loss of **C**--\> DEC Eye lacrimation (tearing)
Loss of **E** --\> Loss of **ANT 2/3 Tongue** Taste
**FACE**
1. **F**acial Muscles
2. **A**fferents(Somatic) from [Ear Pinna (Pain/Temp)] & [External Auditory Canal (stapedius m.)]
3. **C**ry: Parasympathetics to [Lacrimal/Salivary/Sublingual/Submandibular/]
4. **E**at: Taste from ANT 2/3 Tongue
52
What Spinal Columns are affected in [Subacute Combined Degeneration]?-3 ; How does this manifest?-3
[Su**BAC**ute Combined Degeneration]
## Footnote
[Demyelinating lesions] in 3 **Thoracic** Spinal Columns:
1. [Dorsal--\> Loss of 2TVP]
2. [Lateral CST --\> UMN *Weak MESH* + Ataxia]
3. Spinocerebellar
53
Causes of [Subacute Combined Degeneration] (3)
[Su**BAC**ute Combined Degeneration]
## Footnote
1) **B**12 Deficiency
2) **C**opper Deficiency
3) **A**IDS/HIV
* Affects Dorsal / Lateral CST / Spinocerebellar Tracts (Combined)*
54
Describe SChWannoma Histology (3)
**S****C**h**W**annoma
* **C**ellularity with Biphasic pattern (Antoni A & B areas)
* [**V**erocay Bodies within Antoni A areas]
* **S**100 positivity (indicates neural crest origin) - *also seen in melanoma*
*Verocay Bodies = Interspersing nuclear free zones within Antoni A palisading pattern: shown in image*
55
Where does SChWannomas arise from (3)
**S****C**h**W**annoma
## Footnote
Peripheral n. vs. Nerve Roots vs. [All CN except 2]
56
Most common type of Intracranial SChWannoma. Where is it located?
**S****C**h**W**annoma
Acoustic Neuroma: located at [CN8 Cerebellopontine Angle]
*Verocay Bodies = Interspersing nuclear free zones within Antoni A palisading pattern: shown in image*
57
Identify the arrow AND what Dz it's associated with
**S****C**h**W**annoma
*Verocay Bodies = Interspersing nuclear free zones within Antoni A palisading pattern: shown in image*
58
Myotonia Dystrophy Clinical Manifestation (5)
**My T**onia, **My T**oupee, **My T**V Viewers, **My T**icker, **My T**esticles,
## Footnote
**T**onia = Myo**T**onia = [sustained muscle contraction with Weakness & Atrophy]
**T**oupee = Frontal Balding
**T**V viewer = Cataracts
**T**icker = Arrhythmia
**T**esticle = Testicular Atrophy
59
Myotonia Dystrophy MOD
**My T**onia**, My T**oupee**, My T**V Viewer**, My T**icker**, My T**esticles**,**
Auto Dom [CTG repeat] on [DMPK (Dystrophy Myotonia Protein Kinase) gene] --\> Type 1 Dystrophy
60
Describe Histological finding for [Ischemic Hypoxic Encephalopathy]
Bilateral Wedge shaped strips of necrosis over the cerebral convexity, parallel & adjacent to the [longtitudinal cerebral fissure]
61
List the Location of Watershed infarcts in the Brain (2)
Between perfusion Zones of [ANT-Middle] and [Middle-POST] Cerebral a.
*Bilateral Wedge shaped strips of necrosis over the cerebral convexity, parallel & adjacent to the [longtitudinal cerebral fissure]: shown in image*
62
Chiari Malformation MOD
Congenital Underdevelopment of [POST Fossa] --\> [Cerebellar and Medulla herniation] through foramen magnum
63
Describe Chiari Malformation **Type 2**
Type 2 is *TOO* BAD:
## Footnote
SEVERE NEONATAL ONSET --\> [LUMBAR MYELOMENINGOCELE] & [CONGENITAL HYDROCEPHALUS]
64
Huntington's Dz MOD
[AUTO DOM [Chromo 4 CAG repeats]] ---\> Degeneration of (Caudate nc. inside the ((**I**)ndirect Striatum) --\> [**DEC GABA**]
## Footnote
*"Hunting **4** food is way too aggressive & dancey"*
65
Huntington's Dz Clinical Presentation (2)
*"Hunting 4 food is way too **aggressive** & **dancey**"*
## Footnote
1st: **Aggressive** Dementia w/ strange behavior
2nd: **D****ance**-like Chorea mvmnts
66
When does Huntington's Dz onset
30 - 40 y/o
67
Parkinsonism Clinical signs (7)
**PARK** & **ham**
[**P**ill Rolling Resting Tremor]
[**R**igidity Cogwheel]
Brady**K**inesia
[**A**Reflexia posturally] --\> Fall
+
- **h**ypOphonic speech
- **A**utonomic Dysfunction (constipation / bladder problems / orthostatic hypOtension)
- **m**icrographia
* PARK = primary signs*
68
Friedreich Ataxia involves Degeneration of the \_\_\_\_\_\_, [\_\_\_\_ and ____ spinal columns]
Fri**E**dreich Ataxia involves Degeneration of the [**Dorsal** and **Spinocerebellar** spinal columns]
*Fri**E**drecih is **Frat**astic! He's your fav. **twisted** **frat** brother, always **studdering** and **falling**, but has a **sweet**, **big heart***
69
A: Deficency of what Vitamin mimics Friedreich Ataxia
B: Friedreich Ataxia Mode of Inheritance
Fri**E**dreich Ataxia
A: Vitamin **E** (will also have Hemolytic anemia)
B: [Chromo 9 Auto Recessive]
70
Describe Friedreich Ataxia (8)
Fri**E**dreich is **Fratastic**! He's your fav., **twisted** **frat iHouse** brother, always **studdering** and **falling**, but has a **sweet**, **big heart**
Fri**E**dreich = [Vitamin **E** Deficiency] mimics it
**Fratastic** has 9 letters = [Chromo 9 Auto Recessive]
**twisted** = Kyphoscoliosis @ childhood
**frat** = [**frataxin** (**iron binding protein**) defect]
**iHouse** = [(iron binding protein) defect]
**studdering** = Dysarthria
**falling** = [Falls + Gait Ataxia + (Pes Cavus High Foot Arch)]
**sweet** = DM
**big heart** = Hypertrophic Cardiomyopathy
*Involves Degeneration of [Dorsal, Lateral CST & Spinocerebellar]*
71
Explain the MOD for this Dz process (2)
**Liquefactive Necrosis**
Hypoxic CNS Injury ---\> **Lysosomal** complete digestion of necrotic tissue --\> cystic cavity formation
vs.
Bacteria or Fungal Abscess formation also --\> Liquefactive Necrosis
72
What causes Coagulative Necrosis
Irreversible Ischemic Injury (every organ **EXCEPT BRAIN**)
73
What causes FAT Necrosis
Acute Pancreatitis
74
What causes Caseous Necrosis (5)
TB vs. Histoplasma vs. Cryptococcus vs. Coccidioides vs. Nocardia
75
Morphology for Coagulative Necrosis (2)
1. Preserved Tissue Architecture (since lytic enzymes denature b4 they have a chance to break dwn)
2. Anucleated Cells with eosinophilic cytoplasm
76
Morphology for FAT Necrosis
Release of Lipase allows fatty acids to combine with Ca+ --\> [Chalky White Saponification]
77
Morphology for Caseous Necrosis (2)
1. Cheesy Tan-White Appearance
2. Granuloma
78
What structures does the **lenticulostriate vessels** perfuse (5)
lenticulostriate vessels perfuse everything in [**B**e **TI**P**C**] EXCEPT PONS!
**B**asal Ganglia
**T**halamus = pure sensory stroke
[**I**nternal Capsule / / **C**orona Radiata] = pure motor stroke
79
Lacunar Stroke MOD
*lenticulostriate vessels perfuse [**B**e **TIPC**]*
Lacunar Stroke= [**HTN Arteriolosclerosis**] of lenticulostriate vessels --\> [cystic infarcts \< 15 mm] --\> Lacunar Syndrome
80
Describe the Lacunar **Syndrome**
*lenticulostriate vessels perfuse [**B**e **TIPC**]*
Lacunar Stroke= [**HTN Arteriolosclerosis**] of lenticulostriate vessels --\> [cystic infarcts Lacunar Syndrome (listed below)
1A: [**I**nternal Capsule/**P**ons/**C**orona Radiata] Stroke--\> pure Motor stroke (ataxia vs. clumsy hand)
1B: **T**halamu*S* Stroke --\> pure *S*ensory stroke
81
Most common [1° CNS Tumors] in Adults (3)
**GMS**
## Footnote
**G**lioblastoma (GRADE 4 - MALIGNANT - MOST COMMON)
**M**eninGioma
**S**ChWannoma
82
Glioblastoma Radiographic Findings (2)
1. Midline shift from Lateral Vt. Compression (Red arrow)
2. Butterfly lesion from crossing Corpus Collosum
83
Glioblastoma Histological Findings (5)
**CRE**E**PY**
- **C**ystic Change
- **R**eddish brown hemorrhage
- **E**ndothelial Cell Hyperplasia on *Histo*
- **P**seudopalisading Necrosis on *Histo - image*
- **Y**ellow necrosis
84
What's the marker for Glioblastoma?
**GFAP**
85
A: [**LEMS** - Lambert Eaton Myasthenic Syndrome] MOD
B: Clinical Presentation (2)
A: [Autoimmune attack against (Presynpatic Ca+ channel)--\> No ACh release]
B:
- Fatigable **Weakness of [Proximal limbs and trunk]** mimicking myopathy
- Autonomic sx (Dry mouth /Orthostasis / Impotence)
86
What other condition is [**LEMS** - Lambert Eaton Myasthenic Syndrome] associated with?
"**LEMS** has a good **SOLC**(soul)"
**SOLC**-**S**mall **O**at cell **L**ung **C**arcinoma
87
Name 3 Differentiating Factors for Myasthenia Gravis vs. [Lambert Eaton Myasthenic Syndrome]
1. [LEMS] improves with exercise/exertion during the day!
2. [LEMS] will show **no imprvmnt** with [Tensilon Edrophonium] injection
3. [LEMS] nerve testing shows **INC** muscle responses
88
What other condition is [Myasthenia Gravis] associated with?
May cause Thymoma(thymic hyperplasia)
89
[Myasthenia Gravis] MOD
Autoantibodies block and degrade [**postsynpatic** _nicotinic_ ACh Receptors]] --\> [DEC motor end plate potential]
90
[Myasthenia Gravis] Clinical Presentation (6)
Generalized= **P DDD WF**
[**P**tosis
[**D**iplopia from Disconjugate gaze]
**D**ysarthria
**D**ysphagia
[**W**eakness(Respiratory / limbs / Extraocular m.)
[**F**atigue that worsens throughout day]
91
Violent Infant Shaking ---\> \_\_\_\_\_\_\_\_. This is characterized by what 3 things?
B: How is this differentiated from similar conditions?
Violent Infant Shaking --\> [**AHT**- **Abusive Head Trauma**]! =
1. Subdural Hemorrhage (from tearing bridging veins between Dura and Arachnoid)
2. Retinal Hemorrhages Bilaterally (from congested retinal vein ruptures)
3. POST rib fractures
B: Accidental Fall is not sufficient for Subdural Hemorrhage OR Retinal Hemorrhage
*AHT is formely known as Shaken Baby Syndrome*
92
[Von Hippel Lindau Dz] Clinical Presentation (3)
[Cerebellar Hemangioblastoma]
+
[**Cyst** of Kidney vs. Liver vs. Pancreas]
+
Pheochromocytoma
93
[Von Hippel Lindau Dz] MOD
[Tumor cells lose [Chromo 3 VHL Tumor suppressor gene] --\> [INC VEGF from Hypoxia Inducible Factor]
94
Tuberous Sclerosis MOD
([Hamartin C1 9q] and [Tuberin C2 16p])--\> **HAMARTOMASSS**
95
Tuberous Sclerosis Clinical Presentation (12)
**HAMARTOMASSS**
## Footnote
[**H**amartomas benign]
[**A***ngiofibroma on Face-triad*] - *image*
**M**itral Regurgitation
[**A**sh Leaf Macules]
[**R**habdomyoma Cardiac --\> Valvular Obstruction]
**T**uberous Sclerosis
AUTO D**O**M
**M***ental Retard-triad*
[**A**ngioMyoLipoma Kidney]
**S***eizures-triad*
**S**EGA (SubEpendymal Giantcell Astrocytoma)
[**S**hagreen forehead patches]
96
Genetic Cause of Neurofibromatosis Type 1
[chromo 17 mutation]--\> [NeurofibroMin loss]. NeurofibroMin tumor suppresses (RAS GTPase activating protein
97
Characteristics of Neurofibromatosis **Type 1** (6)
**CLAP** **ON** type 1!"
1. **N**eurofibroma PLEXIFORM
2. **A**coustic Schwannoma-Unilateral (HA/Tinnitus/Vertigo)
3. [**O**ptic n. Glioma]
4. **L**isch nodules
5. [**C**afe Au Lait Spots]
6. **P**heochromocytoma
98
Neurofibromatosis **Type 2** Genetic Cause
[chromo 22 tumor suppresor gene mutation--\> (Merlin cytoskeletal protein)]
99
Neurofibromatosis **Type 2**
Clinical Manifestation (2)
- [**Bilateral** Acoustic Schwannomas] (HA/Tinnitus/Vertigo)
- Multiple Meningiomas
***Bilateral** Acoustic Schwannomas @ Cerebellopontine angle*
100
A: [HIV Encephalopathy] Histology
B: [HIV Encephalopathy] PGN
A: **Microglial Nodules** (microglial formed around necrotic areas) --\> fuse & form [multinucleated Giant Cells]
B: [Subcortical Dementia from HIV attacking gray matter] --\> Progressive cognitive decline
101
Describe Decerebrate Posturing
[d**E**c**E**r**E**brate **E**xt**E**nsor posturing]
Rigid **E**xt**E**nsion of UE and LE
102
Describe Decorticate Posturing
[De**cor**ticate Flexion Posturing] "Flex toward ur **Cor**e"
Rigid Flexion of UE
but
LE Extension
103
Describe [Cavernous Hemangiomas] and list the 2 things they put pts at risk of developing
Vascular malformations in the brain parenchyma --\> INC risk of [intracerebral hemorrhage & Seizures]
104
*This Mass is a Vascular Malformation that INC pt risk for Intracerebral hemorrhage and Seizures*
**What is this lesion and where does it occur?**
Cavernous Hemangioma occur in [Brain Parenchyma above Cerebellar Tentorium]
105
Which Fish bind to Na+ channels (Brain & Heart) and **inhibit** Na+ influx --\> prevents action potential conduction? (2)
1. [Tetrodotoxin Puffer Fish]
2. [Saxitoxin Red Tide Dinoflagellates]
## Footnote
*will have DEC Deep Tendon Reflexes*
106
Which Fish bind to Na+ channels (Brain & Heart) and **KEEP IT OPEN** --\> PERSISTENT depolarization? (2)
1. [Ciguatoxin Exotic Fish vs. Moray eel]
2. [Batrachotoxin South Amr. frog]
107
Name the Major UMN signs (5)
UMN signs = **W**eak **MESH**
## Footnote
**W**eakness
[**S**pastic Paralysis]
[**E**xaggerated Reflexes (_Babinski_)]
**M**ental Status change
**H**emipLegia
108
A: What 2 microbes is [1° CNS Lymphoma] associated with?
B: Which lymphocytes are involved and what's pgn?
1. EBV
2. HIV/AIDS
B: B-cell lymphoma that's a high-grade tumor = POOR PGN!
109
Alzheimer's Dz MOD (3)
Alzheimers MOD = **CHA**
\*\***C**leavage, **H**emorrhage, **A**Ch \*\*
1. Cleavage of [transmembrane amyloid precursor glycoprotein] --\> Beta-**amyloid** which accumulates--\> [Neuritic Senile plaques] in temporal lobe early on.
2. Eventually Beta-**amyloid** starts to deposit in cerebral vessels --\> [**Spontaneous Occipital/Parietal hemorrhages**]
3. Beta-**amyloid** accumulation causes defective [Choline acetyltransferase] in the [Basal nc. of Meynert] & Hippocampus --\> **DEC ACh** in those areas --\> Alzheimer Sx
110
How do you diagnose Alzheimer's Dz? (2)
1. Apple Green Birefringence when stained with Congo red under polarized light
2. [Hyperphosphorylated Tau Neurofibrillary Tangles]
111
[Amyotrophic Lateral Sclerosis] (Lu Garret's) **MOD**
[Superoxide Dismutase gene mutation] --\> copper-zinc dysfunction ---\>[Upper **AND** Lower Motor Neuron Disease!]
## Footnote
*UMN Dz includes loss of neurons in motor nc. 5/9/10/12*
112
A: Tx for ALS
B: What do pts with ALS end up dying from?
ALS (AKA **Lu** Garrets Dz)
## Footnote
A: Ri**Lu**zole (DEC Glutamate release since Glutamate over excites neurons)
B: Respiratory Complications (PNA vs. failure)
113
[Carpal Tunnel Syndrome] MOD
BILATERAL Median n. Compression from the [Flexor Retinacular Transverse carpal ligament] --\> Peripheral **mono**neuropathy
## Footnote
*[Flexor Retinacular Transverse Carpal ligament] can be surgically incised for relief*
114
[Carpal Tunnel Syndrome] Clinical Manifestation (4)
1. Paresthesia vs. Pain with **Median n. Distribution** (worst at night)
2. Thenar Atrophy from motor weakness (flexion/ABduction/Opposition impairment)
3. Tinel Sign (tapping over flexor surface DEC sx)
4. Phalen Sign (flexing Wrist INC sx)
## Footnote
*CARPEL TUNNEL IS BILATERAL*
115
Which parts of the brain are the most susceptible to injury post [Global Cerebral Ischemia] (3)
1. **Hippocampus (pyramidal cells) \<---AFFECTED FIRST!**
2. [Cortex pyramidal - layers 3/5/6]
3. Cerebellar Purkinje Cells
116
What [**mini mental state exam**] do you use to test for: Concentration & Attention?
Reciting months of the year backwards
117
What [**mini mental state exam**] do you use to test for: Comprehension?
Following multistep commands
118
[Wernicke Korsakoff Syndrome] Clinical Presentation (3)
Wernicke problems come in a **CAN** of beer!
[**C**onfusion & Confabulation]
**A**taxia (Gait & Postural)
[**N**ystagmus + Oculomotor Dyf] (Opthalmoplegia)
*beer = chronic alcoholism is most common cause*
119
What **serious** finding is most likely to occur despite treatment in [Wernicke Korsakoff Syndrome]?
Memory Loss is permanent!
## Footnote
*Antero and Retrograde*
120
Causes of [Wernicke Korsakoff Syndrome] (2)
Wernicke Problems come in a **CAN** of beer!
[Thiamine B1 Deficiency] from:
1. Chronic Alcoholism = MOST COMMON
2. Giving [Glucose that doesn't have B1] to a B1-deficient pt (i.e. homeless malnutrition pt)
121
Tx for [Wernicke Korsakoff Syndrome] (2)
1. IV [Thiamine B1]
2. Glucose administration
122
A: Parkinson's Disease Histology
B: What other Dz shares this Histology and how do you tell the diff. clinically?
A: **Lewy Bodies** = [intracell eosinophilic inclusions] made of **a-synuclein**
B: [Lewy Body Dementia] (will aso have visual hallucinations and attention deficit clinically)
123
Describe the Prodromal phase of [Measles RubeOla Paramyxovirus] (4)
1st: Fever
2nd: 3 **C**'s of Measles= [**C**ough / **C**oryza / **C**onjunctivitis]
3rd: Koplik spots
4th: Maculopapular Rash starting from head then down
124
What are the dangerous potential sequelae of [Measles RubeOla Paramyxovirus] (3)
* Encephalitis (days later)
* [Acute Disseminated Encephalomyelitis] (weeks later)
* [**SSPE**- **S**ubacute **S**clerosing **P**an**E**ncephalitis] (years later)
125
Identify the Finding & Dz associated
**Koplik spots** found in [**Measles RubeOla Paramyxovirus**]
## Footnote
Prodromal phase:
1st: Fever
2nd: 3 **C**'s of Measles= [**C**ough / **C**oryza / **C**onjunctivitis]
3rd: Koplik spots
4th: Maculopapular Rash starting from head then down
126
Why does [Chromatolysis Axonal Reaction (Loss of Axon)] changes occur?
Cell body attempts to repair/regain Axon by INC protein synthesis --\> Enlargement of Cell Body
127
What syndrome occurs from **rapidly** correcting Na+ levels from low to High ?
**"Rapid Na+ From low to HIGH, your pons will DIE" =**
**[Osmotic Central Pontine Demyelination]**
Osmotic demyelination of pons white matter
128
What syndrome occurs from **rapidly** correcting Na+ levels from High to low ?
**"Rapid Na+ From HIGH to low, your brain will blow" =**
**Cerebral Edema & Herniation**
129
Clinical Manifestation of **[Osmotic Central Pontine Demyelination]** (
**"Rapid Na+ From low to HIGH, your pons will DIE" =**
**[Osmotic Central Pontine Demyelination]**
Osmotic demyelination of pons white matter
130
What vascular Dz is Polymyalgia Rheumatica associated with and does this affect vision?
Temporal Arteritis (Med. and Large vessel vasculitis) often ---\> **Monocular Vision loss!**
131
Clinical Presentation for [Polymyalgia Rheumatica] (4)
**P**oly**M**yalgia **R**heumatica
**P**ainful Stiff Shoulder & Hips
**M**alaise & **M**orning Stiffness
**R**eally Hot (Fever)
*Associated w/Giant Cell Temporal Arteritis--\>Monocular Vision loss*
132
[Paraneoplastic Cerebellar Degeneration] MOD
"Anti Yo/PQ & Hu get crazy when Seeing B/O & U"
[**Antibodies Yo, PQ and Hu**] initially target tumor cells but cross react with [Cerebellar Purkinje] by mistake---\> [**RAPID** Autoimmune Cerebellum Degeneration]
133
Which CA are associated with [Paraneoplastic Cerebellar Degeneration]? (4)
"Anti Yo/PQ & Hu get crazy when **S**eeing **B**/**O** & **U**"
1. SOLC
2. Breast
3. Ovarian
4. Uterine
134
Etx of [Frontotemporal Pick's Dementia] and manifestation-2
Prounouced Frontal & Temporal lobe atrophy --\> [**Socially inappropriate** Behavior] + aphasia
135
A: When does [Frontotemporal Pick's Dementia] onset?
B: Mode Of Inheritance
A: 50-60 (Alzheimer = 60+)
B: Auto Dominant
136
[Frontotemporal Pick's Dementia] Histology (2)
* Neuron loss in Frontotemporal lobes
* **Pick Bodies** = [microtubule tau protein] in cytoplasm of neurons
137
What is [Hydrocephalus **Ex Vacuo**] and which pts do you see it in?
Ventricular Enlargement **only because of cortical atrophy**, typically found in HIV pts (cortical atrophy is normal sequelae in HIV)
*True Hydrocephalus is actual build up of CSF (obstruction vs. hyperproduction**)*
138
What type of tumor stains positive for Synaptophysin?
[**Neuronal** CNS Tumors]
## Footnote
*Also includes neuroendocrine and neuroectodermal CNS tumors*
139
Name the CNS Neoplasms that are of **Glial** Origin (i.e. Glioma) (4)
**AGE** comes from Glia
1. [**Gli**oblastoma & Oligodendro**Gli**oma]
2. **A**strocytoma
3. **E**pendymoma
*These stain positive for **GFAP***
140
[Creutzfeldt Jakob Dz] Clinical Presentation (2)
[**RAPIDLY** Progressive Dementia] + [Myoclonic Jerks] --\> DEATH
## Footnote
*Can be Acquired vs. Inherited*
141
Identify the Pathology and List the causes (3)
A: **SubDural Hemorrhage = CRESCENT SHAPED!**
B: Cortical Bridging Veins between Dura & Arachnoid are stretched by:
1. [Age related Cortical Atrophy which stretches Bridging Veins in Elderly]
2. Trauma
3. [Abusive Head Trauma] in infants
142
Identify this Dz **if it was preceded by TB meningitis**
Bilateral Symmetrical Dilation of Ventricles = [Communicating vs. Normal Pressure Hydrocephalus]
Communicating = CSF can't communicate with [Arachnoid granulation villi] --\> DEC absorption --\> INC ICP
This is **Communicating** Hydrocephalus
(only since it was preceded by [Meningitis vs. SubArachnoid/Intraventricular Hemorrhage)
143
[Communicating Hydrocephalus] cause
[Meningitis vs. SAH/Intraventricular Hemorrhage] --\>Disrupts communication of CSF with [Arachnoid Granulation Villi] ReAbsorption
144
What's the major complication of [**SubArachnoid Hemorrhage**] during recovery? How do you tx this?
Severe Cerebral Vasospasm 4-12 days post SAH onset --\> morbidity vs. mortality. Prevent with [Nimodipine CCB].
145
Describe the **Demographic** for the HA:
Migraine
Tension
Cluster
Migraine = Female
Tension = Female
Cluster = Male
146
Describe the **Onset** for the HA:
Migraine
Cluster
Tension
Migraine = Variable
Cluster = During Sleep
Tension = When Stressed "think tense"
147
Describe the **Location** for the HA:
Migraine
Cluster
Tension
Migraine = **POUND** = [**P**ulsating/**O**ne-3 Day Duration /**U**nilateral/**N**ausea/**D**isabling] + photo vs. phonophobia & aura
Cluster = Behind 1 eye
Tension = [Bilateral & Band-like around the head]
148
Describe the **Character** for the HA:
Migraine
Cluster (3)
Tension (2)
Migraine = **POUND** = [**P**ulsating/**O**ne Day-3 day Duration/**U**nilateral/**N**ausea/**D**isabling] + photo vs. phonophobia & aura
Cluster = [Excruciating, sharp & steady]
Tension = Dull & tight
149
Describe the **Duration** for the HA:
Migraine
Cluster
Tension
Migraine = **POUND** = [**P**ulsating/**O**ne-3 Day Duration /**U**nilateral/**N**ausea/**D**isabling] + photo vs. phonophobia & aura
Cluster = 15 - 90 MINUTES
Tension = 30 min to 7 DAYS!!!! (*Tammy's Entire Work Week*)
150
Describe the **Associated Sx** for the HA:
Migraine
Cluster (4)
Tension
Migraine = **POUND** = [**P**ulsating/**O**ne-3 Day Duration /**U**nilateral/**N**ausea/**D**isabling] + photo vs. phonophobia & aura
Cluster = [Sweating/Nasal Congestion/Lacrimation/Pupil changes]
Tension = [Muscle "Tension" in Head, Neck or Shoulders]
151
Identify the pathology and Describe the corresponding Histology (2)
**Liquefactive Necrosis** (occurs 1 wk.-1 mo. post ischemia)
## Footnote
Reactive Gliosis + [Vascular proliferation around necrotic area]
152
When does **Liquefactive Necrosis** appear?
[1 week to 1 mo.] post ischemic injury ( \>2 week Glial Scar will appear)
153
Identify the pathology and Describe the Clinical Presentation
**SubArachnoid Hemorrhages** will presents as "the worst HA of my life!"
## Footnote
*Typically caused by [Berry Saccular Aneurysm] vs. AVM*
154
Most common cause of [**Lobar hemorrhages**]
[**Beta**-Amyloid Angiopathy]
(pt\>60 w/Alzheimers & within Occipital/Parietal regions)
155
Identify the [CNS Tumor] and describe its Histology
**Meningioma** (**Men** are **Whorls**(whores))
**Whorled** arachnoid cells that form NEST (*RED arrow*), and then calcify into eosinophilic Psammoma Bodies (*Black arrow*)
156
Where does this [CNS Tumor] typically occur (3)
**Meningioma** (**Men** are **Whorls** (whores))
## Footnote
Dural Reflection \*(Attached to Dura & Extra-Parenchyma) at the:
1. [Falx Cerebri vs. Tentorium Cerebelli]
2. Lateral Convexity
3. Parasagittal
157
What's the Clinical Manifestation of this [CNS Tumor] (2)
**Meningioma** (**Men** are **Whorls**(whores))
1. Seizures (from compression of cerebral cortex)
2. LE Sensory Loss (+ possible hemineglect if in non-dominant hemisphere: as shown in image)
158
Trigeminal Neuralgia Tx
Carbamazepine
## Footnote
*Can cause aplastic anemia so monitor carefully*
159
Describe Trigeminal Neuralgia and what triggers it
Brief episodes of [Sudden / Severe / Shock like Stabbing Pain] with [Trigeminal CN5 -B2 & B3 distribution]
Triggered by CN5 stimulation (chewing, teeth brushing, shaving)
160
Carbamazepine MOA
**Blocks** Voltage-gated Na+ channels in neuronal membranes
161
Carbamazpine SE (5)
1. Aplastic Anemia (bone marrow suppression)
2. Agranulocytosis
3. CYP450 inducer
4. SIADH
5. Steven Johnson rash
162
Carbamazpine Indications (2)
1. Seizures (simple partial vs. complex partial vs. [GTC-Generalized Tonic Clonic])
2. Trigeminal Neuralgia
163
**Serotonin Syndrome** Clinical Presentation (8)
"Serotonin gave me the **SHIVERS**!"
***S**hivering*
[**H**yperreflexia & Myoclonus]
**I**NC Temp
*[**V**ital sign instability] (tachycardia vs. tachypnea vs. HTN)*
***E**ncephalopathy (Confusion vs. Agitation)*
**R**estlessness
**S**weating
*Italicized = Triad Sx*
164
How do you treat *Refractory* Serotonin Syndrome
Cyproheptadine
(antihistamine with anti-serotonergic properties)
165
Baclofen MOA
GABA-**B** Agonist
166
A: Baclofen Indication
B: Alternative med
[**Spasticity** 2° to Brain & Spinal Cord Dz (MS vs. low back pain)]
B: Alternative = Tizanidine
167
Physostigmine MOA
How well does it cross BBB
Reversible AChE inhibitor
READILY crosses BBB due to tertiary amine structure
168
Physostigmine Indication (2)
1. Delirium from anticholinergic drugs
2. Glaucoma
169
Difference between Physostigmine and [Neostigmine & Edrophonium]
ALL HAVE SAME MOA (AChE inhibitor)!
## Footnote
but Physostigmine = **tertiary amine** = readily crosses BBB
[Neostigmine & Edrophonium] = quaternary ammonium = limits BBB penetration
170
Donepezil MOA
How well does it cross BBB
Reversible AChE inhibitor
READILY crosses BBB
171
Tx for Alzheimer's (3)
**D**ementia is **V**ery **M**alevolent
1. **D**onepezil (Reversible AChE inhibitor)
2. **V**itamin E antioxidant
3. **M**emantine (NMDA Blocker)
172
SE of [**Inhaled** Anesthetics] (5)
1. INC Cerebral blood flow --\> INC ICP :-(
2. Myocardial Depression
3. Respiratory Depression
4. hypOtension
5. DEC Renal function
173
Parkinson's Dz Tx (5)
"Eat a **SALAD** after you Park"
## Footnote
1. [**L**evodopa (Dopamine Precursor)]
2. **A**mantidine
3. **A**nticholinergics
4. [**D**opamine Agonist Post synaptic] (NonErgot: Ropinirole vs. Pramipexole) & (Ergot:Bromocriptine)
5. **S**urgical tx vs. **S**elegiline
- Pallidotomy: Destructive of [Globus Pallidus:internal]
- SubThalamic nuc. inhibition with electrode
174
EThosuximide MOA
E**T**hosuximide
[**T**halamus **T**-type Ca+ Channel BLOCKER]
***Sux** to have **S**ilent **S**eizures*
175
A: What is the cause of **Neonatal Abstinence Syndrome**
B: Tx
A: Withdrawal from opiates
B: [Opiate Replacement Therapy]
176
Ethosuximide Indication
**Sux** to have **S**ilent **S**eizures
Silent (Absent) Seizures
177
Anesthetics that have [LARGE Arteriovenous concentrations] says what about their [Tissue Solubility] and [Onset of Action]
[LARGE Arteriovenous concentrations] of an Anesthetic will indicates:
[**High** Tissue (And blood) Solubility]
and thus
[**S**low Onset of Action (since it'll take longer to get to brain if other peripheral tissues are Absorping so much of it)]
178
Triptans MOA
[PostSynpatic 5HT1B&1D Receptor Agnoist]
--\> vasoconstriction
179
Triptans indication
**Abortive** therapy for Acute Migraines
180
List the Drugs used for Migraine Px (5)
"Prevent Migraines with a **TAB** of **VV**"
* **T**opiramate
* **A**mitriptyline
* **B**eta blcokers
* **V**enlafaxine
* **V**alproate
181
Primary Purpose of **NE** in the Autonomic Systems
Released from [PostGanglionic Sympathetic neurons] on alpha & beta receptors for most [organ/smooth m.gland stimulation] (i.e. Bladder)
182
Jimson Weed Poisoning MOD
and what other condition does it resemble?
[Belladonna Alkaloid Toxin] has **strong ANTI-cholinergic** properties and thus resembles atropine poisoning
## Footnote
*Jimson Weed Poisoning is AKA Gardener's Mydriasis*
183
[Jimson Weed Poisoning] Clinical Manifestation (7)
"Blind as a bat, mad as a hatter, red as a beet, hot as a hare, dry as a bone, the bowel & bladder lose their tone, and the heart runs alone....."
1. Blind as a bat = [**Mydriasis and [cycloplegia** (blurry vision especially when focusing on near objects)]
2. Mad as a hatter= **Agitation & Hallucinations**
3. Red as a Beet = **Cutaneous flushing** despite vasoconstriction
4. Hot as a hare = **Hyperthermia** from DEC ability to sweat
5. Dry as a bone= **DEC Secretions** (including sweat)
6. **Bladder & Bowel lose tone**
7. Heart runs alone = No vagal tone at SA --\> **Tachycardia**
184
How do you treat [Jimson Weed Poisoning]
Same as Atropine poisoning ...
Physostigmine (AChE inhibitor)
185
What is [**MAC**-**M**inimal **A**lveolar **C**oncentration] in relation to anesthetics, and what does it measure?
MAC = Minimal concentration of anesthetic in alveoli to render 50% of pts unresponsive to pain (ED50). This measures the **potency** of **inhaled anesthetics**
186
Benzodiazepine MOA
INC **frequency** of [GABA-**A** Chloride channel] opening
187
Tx for Febrile Seizures
APAP (improves fever) **but not the seizure**
188
Febrile Seizures MOD
Most common neurologic DO in children. Comes after Fever. These kids are at risk of recurrence but rarely epilepsy development
189
Describe Neuroleptic Malignant Syndrome
RARE SE of Any Dopamine Blocker (Antipsychotics vs. GI meds) that --\> **FEVER**
- [**F**ever \> 40C]
- **E**ncephalopathy (Confusion)
- **V**itals unstable (INC HR / RR / BP from autonomic dysfunction)
- **E**nzymes INC (CPK)
- **R**igitidy INC (Tremor)
190
What's the best way to approach treatment for [Neuroleptic Malignant Syndrome]
Treat Rigiditiy with Dantrolene (inhibits Ca+ release from sk. muscle sarcoplasmic reticulum)
+
supportive care
191
[Entacapone & Tolcapone] MOA
COMT inhibitor
INC Levodopa availability to brain by preventing Levodopa COMT conversion --\> 3OMD in periphery
192
[Entacapone & Tolcapone] Indication
Parkinson Dz
193
Malignant Hyperthermia MOD. Which pts are susceptible?
After giving [**inhaled anesthestics** and/or **succinylcholine**] (to genetically predisposed pts (AUTO DOM)) --\> [Fever & Muscle Rigidity soon after surgery with Unstable Vitals]
## Footnote
**M**alignant = **M**uscle Rigiditiy
**Malignant** = Unstable Vitals
**Hyperthermia** = Fever
194
Malignant Hyperthermia Tx
Dantrolene
## Footnote
*TREAT PROMPTLY! AS THIS IS LIFE THREATENING CONDITION!*
195
Describe what each letter representsfor [Neuron Action Potential]
A: Resting Potential
B: Depolarization (from Na+ influx)
C: Overshoot (+35 mV)
D: Repolarization (from [Na+ channel closure] and K+ **efflux**)
E: Hyperpolarization (K+ **efflux** remains open too long even after repolarization is done)
196
Phenytoin MOA
**Disrupts** [**propagation** & generation] of Action potentials by blocking [Voltage gated Na+ channels] at [axon hillock & proper]
197
Carbamazepine MOA
**Disrupts** [**propagation** & generation] of Action potentials by blocking [Voltage gated Na+ channels] at [axon hillock & proper]
198
Function of [Arcute hypothalamic nuclei] (3)
Secretion of
* **Dopamine** (inhibits prolactin)
* **GHRH** (growth hormone releasing hormone)
* **GnRH** (Gonadotropin-releasing Hormone)
199
Where would you inject Lidocaine to anesthetize [Skin & Muscles of ANT Thigh (Quadriceps, femur, knee)
[Inguinal Crease @ lateral border of femoral artery] (Femoral N. Block)
200
Injury to the ____ n. is most common in **Shoulder** Trauma. What is the Clinical Manifestation of this? (2)
Injury to **Axillary n.** is most common in Shoulder Trauma --\>
## Footnote
- Lateral Shoulder Sensory Loss
- Weak ABduction from (deltoid & teres minor m. denervation)
201
List perfusion areas and Clinical Manifestation of [**ACA**-ANT Cerebral Artery] occlusion (3)
ACA perfuses [**Medial** Frontal & Parietal Lobe]. If occluded --\>
1. CTL Motor and Sensory Deficits of LE
2. Behavioral change
3. Urinary Incontinence
*would have hard time climbing stairs*
202
In regards to **Carpal Tunnel**, the ______ n. courses between the _____ and ____ muscles before crossing _____ inside carpal tunnel
In regards to Carpal Tunnel, the **Median** n. courses between the [**Flexor Digitorum superficialis**] and [**Flexor Digitorum Profundus**] before crossing [**Flexor Retinaculum**] inside carpal tunnel
203
What is the Function and Dz associated with the [Meso**corticalLimbic** dopaminergic system]
Regulates Behavior ; Schizophrenia
204
What is the Function and Dz associated with the [Nigrostriatal dopaminergic system]
Voluntary mvmnt coordination ; Parkinsonism
205
What is the Function and Dz associated with the [Tuberoinfundibular dopaminergic system]
Prolactin Secretion ; Hyperprolactinemia
206
Identify
A: Basilar A. (formed by 2 vertebral arteries)
B: R PCA
C: L PCA
D: SCA (SUP cerebellar a.)
E: parapontine perforating a.
F: AICA (ANT inferior cerebellar a.)
207
What would a [**R** **Partial Retinal lesion**] manifest as
R Monocular scotoma
208
Lesion at which letter would result in [**R Nasal Hemianopia**]
D
209
Lesion at which letter would result in [**L Pie on the Floor (Homonymous INF quadrantanopia)**] lesion
G
210
Describe Hemiballismus
**Wild**, involuntary, large-amplitude flinging mvmnts of arms vs. legs on 1 side of body
211
What causes Hemiballismus
Damage (i.e. lacunar stroke) to **Subthalamic nc.**, important in modulating basal ganglia output
212
Identify
image
## Footnote
*Remember: Caudate + Putamen = Striatum*
213
Where is Wernicke's Area located?
Auditory association cortex: POST portion of [SUP temporal gyrus] within **dominant** temporal lobe
214
What neural structure is affected in [Wernicke Korsakoff Encephalopathy]?
## Footnote
*Refer to image*
B
Mamillary Bodies!
215
Damage to what nerve would cause absent Corneal Reflex (2)
[Sensory limb Corneal Reflex = CN5B1: nasociliary branch]
vs.
[Motor Limb Corneal Reflex = Facial CN7: temporal branch]
216
What all vessels & nerve enter the orbit via [SUP Orbital Fissure] (6)
1. CN3
2. CN4
3. CN5**B1**
4. CN6
5. [SUP Opthalmic Vein]
6. Sympathetics
217
Identify
image
218
Identify **C** in image and list its functions (3)
Insula
1. Emotions (limbic system)
2. Autonomic control
3. Visceral sensation consciousness
219
Describe Asociated Features of **Brocas Aphasia** (2)
Right Hemiparesis (weakness) + Impaired Repititon
## Footnote
*In addition to nonfluent/sparse speech*
220
Describe Asociated Features of **Wernickes Aphasia** (2)
[R SUP Visual field defect] + Impaired Repetition
## Footnote
*This is in addition to Comprehension problems*
221
Describe Asociated Features of **CONDUCTION** **Aphasia**
**VERY POOR** Repetition
## Footnote
*This is in addition to Fluent but many phonemic errors*
222
Which nerve is damaged from trauma to **axilla** (i.e. long term crutches) and what are the findings? (4)
Radial Nerve
1. Wrist Drop (No Wrist extension)
2. Absent Triceps Reflex (spared if lesions is distal)
3. Sensory loss of POST arm/forearm
4. Sensory loss of dorsal hand/thumb
223
A: [**MSUD**- Maple Syrup Urine Dz] MOD
B: What does the defective enzyme need to work (5)
Defective Breakdown of [isoLeucine / Leucine / Valine] due to DEC transamination to their a-ketoacids by defective [**a-ketoacid dehydrogenase**].
B: [**a-ketoacid dehydrogenase**] requires "**T**ender **L**oving **C**are **F**or **N**ancy" to work
[(**T**hiamine B1)/**L**ipoate/**C**oenzymeA/**F**AD/**N**AD]
224
[**MSUD**- Maple Syrup Urine Dz] tx
[**a-ketoacid dehydrogenase**] requires "**T**ender **L**oving **C**are **F**or **N**ancy" to work
[**T**hiamine/**L**ipoate/**C**oenzymeA/**F**AD/**N**AD]
Tx = **T**hiamine B1
+
[Lifelone restriction of isoLeucine/Leucine/Valine]
225
[**MSUD**- Maple Syrup Urine Dz] Clinical Presentaiton (2)
1. **Burned Caramel Urine odor** (isoleucine)
2. Neurotoxicity (Leucine accumulation)
226
Conversion Disorder
Loss of sensory/motor function after acute
stressor; patient may be aware but sometimes indifferent (“la belle indifférence”)
227
Malingering
Falsifying/Exaggerating Sx in order to obtain external incentives
228
Somatic Sx Disorder
Excessive Anxiety & PreOcupation with ≥ 1 unexplained sx
229
Factitious Disorder
Falsifying or **Inducing** sx to assume the sick role
230
DSM5 Criteria For Narcolepsy (2)
[Recurrent lapses into sleep **at least (3 x/week) x 3 mo.**]
+
1 of the following:
a. Cataplexy
b. [Low CSF hypOcretin1 orexin A]
c. [REM latency ≤ 15 min]
* Cataplexy = Brief Muscle tone loss during Positive emotion*
231
Clinical Manifestations of Narcolepsy (3)
1. hypnagogic vs. Hypnopompic hallucinations
2. Sleep paralysis (excessive daytime sleepiness)
3. Cataplexy
232
Name the 3 components of **EPS**-**E**xtra**P**yramidal**S**ymptoms
EPS = **DAD**
## Footnote
[**D**rug-induced Parkinsonism]
**A**kithisia (restlessness)
**D**ystonia (Abnormal twisted posture exacerbated with activity)
233
What is **EPS** caused by, and which drugs are the most likely to cause it?
EPS (**DAD**) comes from [Nigrostriatal D2 Blocking], usually from [1st generation Antipsychotics (Haloperidol/Fluphenazine)]
234
What is Hypocretin 1 and 2 also known as, and what is their function?
[Hypocretin 1 (Orexin A)[and [Hypocretin 2 (Orexin B)] are [Lateral hypothalamus neuropeptides] that promote wakefullness & inhibit [REM sleep-related phenomena]
## Footnote
*These are deficient in Narcolepsy*
235
Clinical Presentation for [Ataxia Telangiectasia] (5)
[**A**taxia Tel**A**ngiectasia] = **A**TM gene defect
* **A**taxia (cerebellar defect)
* Tel**A**ngiectasia
* Ig**A** deficiency (recurrent sinopulmonary infections)
*Labs = INC **A**FP*
236
Lab Dx for [Ataxia Telangiectasia]
[**A**taxia Telangiectasia] = **A**TM gene defect
INC **A**FP (**A**lpha fetal protein)
237
[Ataxia Telangiectasia] MOD
[**A**taxia Telangiectasia] = **A**TM gene defect --\> Inability to repair DNA double stranded breaks --\> cell cycle arrest. These pts are highly susceptible to radiation-induced mutations!
238
Describe Telangiectasia
Superficial blancing nest of distended capillaries on sun-exposed sites
239
Name the most common pineal gland tumor and how it clinically manifest (3)
Germinoma
* Obstructive Hydrocephalus
* [Parinaud Dorsal Midbrain syndrome]
* [Pituitaryhypothalamic dysfunction (if in suprasellar region)
240
Parinaud Syndrome MOD and Clinical Manifestation (3)
"Parinaud loved his **PUP**"
Direct Compresion of [Midbrain Pretectum SUP Colliculi] (possibly from Gemrinoma) --\>
1. **P**tosis
2. **U**pward Gaze paralysis
3. **P**upil abnormalities
241
Identify
image
242
Describe the MOD of [**TMD- T**emporo**M**andibular **D**isorder] (3)
Problems involving:
* Temporomandibular joint
* Mastication m. (contracting too much)
* [Trigeminal CN5B3: **mandibular branch**] --\> Otologic sx since this also supplies mid ear
243
Clinical Manifestations of Ulnar n. Injury (2)
1. Sensory loss in medial 1.5 digits of hand
2. Ulnar claw = DEC [Wrist Flexion/ADDuction] / [4th & 5th digit flexion] and [Finger ABduction/ADDuction]
244
Which nerve enters pelvis through [Obturator Foramen]? Clinical Manifestation if this n. is compressed? (2)
**Obturator nerve** when compressed (surgery vs. trauma vs. tumor) --\>
[Weak Thigh ADDuction] + [Sensory loss of Distal Medial thigh]
245
Radial n. damage during its passage thru the **supinator canal** may be from \_\_\_\_\_(3) and ---\> \_\_\_\_\_\_\_
Radial. n. damage during its passage thru **supinator canal** may be from [forearm alternating pronation/supination (*screwdriver*)] vs. trauma vs. [radius subluxation] --\> [DEC Finger & Thumb Extension only]
246
Where would you inject anesthesia to Nerve block **Brachial Plexus**, and what m. will be affected by this?
Between [ANT Scalene] and [Middle Scalene].
This --\> [transient ipsilateral **diaphragm** paralysis] since phrenic n. roots pass through interscalene sheath
247
Identify Cerebral Blood Perfusion
in image
248
Sciatica MOD and Clinical Manifestation (3)
"Having Sciatica is like breaking **LAWS**"
* [**L**ower Back pain w/radiation down POST thigh --\> lateral foot]
* **A**nkle jerk reflex ABSENT
* **W**eak Hip Extension
* [**S**1 n. posterolateral compression at L4-5 vs. L5-S1]
249
[Cauda Equina Syndrome] Clinical Manifestation (2)
(Damage to S2 through S4 n. roots) --\>
* Saddle Anesthesia
* **Ano**cutaneous Reflex LOSS (perianal pinpoint does NOT cause anal sphincter contraction)
250
Which vessels (nerves & vasculature) go through **Jugular Foramen**
"9, 10, 11 goes through Jugular Foramen"
CN9, CN10, CN11 & Jugular Vein
*Lesion of Jugular Foramen --\> Vernet Syndrome*
251
Which vessels (nerves & vasculature) go through **Foramen Magnum**
* CN11 spinal rooots
* Brain Stem
* Vertebral a.
252
Loss of **POST 1/3 Tongue Taste** indicates what n. damage
CN9
253
Loss of **Gag Reflex** indicates what n. damage (2)
CN9 and 10
254
**Dysphagia** indicates what n. damage (2)
CN9 and 10
255
**Dysphonia/Hoarseness** indicates what n. damage
CN 10
256
# Fill in the Blank regarding Myotomes and Reflexes
in image
257
Which vessels (nerves & vasculature) go through **Foramen Ovale**
[Trigeminal CN5B3: mandibular branch]
258
Which vessels (nerves & vasculature) go through **Foramen Rotundum**
[Trigeminal CN5B2: maxillary branch]
259
Which vessels (nerves & vasculature) go through **Foramen Spinosum** (2)
[Middle meningeal Artery & Vein]
260
[Common Peroneal n.] injury is common and results from \_\_\_\_\_\_\_. What are the 2 hallmark signs?
Trauma to Fibular head region --\>
## Footnote
foot drop**PED** (**P**eroneal n. **E**verts & **D**orsiflexes) --\> Steppage Gait
261
Intraventricular Hemorrhage occurs often in ____ Infants, originating from the \_\_\_\_\_\_. Why is this?
IVH occurs often in **Preterm** Infants, originating from **Germinal Matrix**.
Germinal Matrix contain thin-walled vessels which contribute to hemorrhage risk.
These thin -walled vessels eventually migrate out, but in preterm infants, they're still there.
262
Classic Presentation for a pt with [Trochlear CN4 Palsy]
Vertical Diplopia worst when looking down and toward nose (i.e. walking downstairs vs. up close reading)
*SUP Oblique* *is responsible for moving eye Down & In*
263
Musculocutaneous n. covers sensory to what part of the body
Lateral Forearm
264
What innervates [**General Sensation of Tongue**]
[Trigeminal CN5B3: mandibular branch]
265
What type of neurological predispositions do Down syndrome pts have? (2)
1. Intellectual disability
2. Early Alzheimer Dz
266
Organophosphate poisoning MOD
ACh**E** inhibitor --\> TOO MUCH ACh in cleft
## Footnote
*Organophospahtes are used in Agricultural Pesticides*
267
Describe the [On Off Phenomenon] in Parkinson Disease Tx
Long-term tx of Parkinson Dz can **sometimes** --\> [UNPREDICTABLE MOTOR FUNCTION FLUCTUATIONS] mostly from levodopa-induced nigrostriatal neurodegeneration --\> **DEC therapeutic window** for Levodopa
## Footnote
*off = bradykinesia/rigidity vs. on=normal motor*
268
Phenytoin SE (3)
1. Gingival Hyperplasia (reversible with withdraw)
Gingival macrophage exposure to INC PDGF stimulate [gingival cell and alveolar bone proliferation]
2. Ataxia (cerebellar)
3. Nystagmus (vestibular)
269
Capsaicin MOA (2)
Topical Capsaicin [defunctionalizes afferent pain fibers] and [depletes Substance P]---\>initial stinging but w/chronic exposure --\> DEC pain
270
Clinical Manifestation of DRESS Syndrome (6)
**D**ysfunctional Internal organs
**R**eally Hot (Fever)
**E**osinophilia w/LAD
**S**kin Rash
**S**wollen Face
271
What drugs (6) causes [DRESS Syndrome] and when does this happen
2-8 weeks after taking...
## Footnote
"Summer **CAMPS** --\> bad *DRESS* game"
**C**arbamazepine
**A**llopurinol
[**M**inocycline & Vanc]
**P**henytoin
**S**ulfonamides
272
Isoniazid is structrually similar to Vitamin ___ and as a result causes what DO?
Isoniazid is structurally similar to [**P****yridoxine B6**] and as a result --\> [INC Urinary excretion of Vitamin B6 pyridoxine] + competetition to [B6 GABA binding sites]
Presents as Peripheral Neuropathy + [Potential Sideroblastic Anemia]
273
How does Vitamin [Pyridoxine B6] deficiency present (2)
Peripheral Neuropathy + [Sideroblastic Anemia]
274
Selegiline MOA
[MAO-B inhibitior]
275
Thiopental Indication
Lipid soluble barbituate used in Anesthesia for minor surgery
276
Why does Thiopental (and other lipid soluble barbituates) have rapid plasma decay?
Rapid plasma decay is due to **redistribution** to lean tissues and clearance from brain--\> allows use in minor surgery
277
Buprenorphine MOA
[partial opioid R agonist] that binds with **HIGH AFFINITY** but has low intrinsic activity--\> displaces other opioids
278
Why is Buprenorphine contraindicated with other opioids?
displaces other opioids which may --\> Withdrawal!
279
Sx of Opioid Withdrawal. When does this happen?
Dilated Pupils
Tachycardia
Diaphoresis
1-2 days post cessation
280
How can you differentiate between pediatric [Pilocytic Astrocytoma] and MeDulloblastoma?
Pilo*cytic* Astrocytoma will have **BOTH** Solid AND Cystic componenents
MeDulloblastoma only has Solid
Image shows [Pilo*cytic* Astrocytoma]
281
Describe the \_\_x\_\_ of **Delirum** in Elderly
A: onset
B: Consciousness
C: Course
D: Pgn
E: Memory impairment
282
Describe the \_\_x\_\_ of **Dementia** in Elderly
A: onset
B: Consciousness
C: Course
D: Pgn
E: Memory impairment
283
Describe the \_\_x\_\_ of **Depression** in Elderly
A: onset
B: Consciousness
C: Course
D: Pgn
E: Memory impairment
284
**Early**-onset Alzheimer's is associated with 3 gene mutations. Name them
1. Down Syndrome
2. Presenilin 1
3. Presenilin 2
285
**LATE**-onset Alzheimer's is associated with 1 gene mutations. What is it?
[ApoLipoprotein **E4**]
*Onset After 60 yo*
286
Failure of neural tube closure at __ weeks gestation --\> Neural Tube Defects. What INC risk? What DEC Risk?
Failure of neural tube closure at **4** weeks gestation --\> NTD.
\*\*[Valproate/Carbamazepine/Maternal DM] INC Risk of non-closure
\*\* [Folate B9] DEC Risk of non-closure :-)
287
Anterior [Neural Tube Defects] manifest how (2)
Anencephaly (absence of brain)
and
Encephalocele (protrusion of neural tissue thru cranial defect)
288
Posterior [Neural Tube Defects] manifest how (2)
1. Spina Bifida Occulta
2. Meningocele
3. MeningoMyelocele
## Footnote
*2 and 3 both with cystic mass @ lower spine and tuft of hair on pt*
289
Prenatal Dx for [Neural Tube Defects] (2)
Increased.....
1. [Amniotic AFP]
2. [Maternal ACh**E** (from amnion)]
*NTD occurs when NT fails to fuse/close by 4 week gestation*
290
What *Musculoskeletal* structures derive from [**1st** Pharyngeal Arch] (6)
1. Incus
2. Malleus
3. Maxilla
4. Mandible
5. Mastication m.
6. Temporalis m.
291
What *Musculoskeletal* structures derive from [**2nd** Pharyngeal Arch] (3)
1. Stapes
2. Styloid Process
3. Lesser Horn of Hyoid
292
What *Musculoskeletal* structures derive from [**4th & 6th** Pharyngeal Arch] (2)
1. [Cricoid & Thyroid Cartilage]
2. [Pharyngeal & Laryngeal m.]
293
[Treacher Collins Syndrome] MOD
Genetic disruption of [Pharyngeal Arch 1 and 2] --\> hypOplasia of mandible & Zygomatic bones
294
In [Neurofibromatosis Type 1], Fleshy cutaneous neurofibromas are made of ______ which embryologically come from \_\_\_\_\_. These pts may also have hyperpigmented spots known as \_\_\_\_
In NF1, Fleshy cutaneous neurofibromas are made of **Schwann cells**, which are embryologically from **Neural _Crest_**. May also have [**Cafe Au Lait Spots** (*image*)]
## Footnote
*Image: Cutaneous Neurofibromas & Cafe Au Lait Spots*
295
How does CO2 affect Cerebral vasculature and when is this clinically helpful?
Since pCO2 is a vaso**D**ilator of cerebral vessels, DEC pCO2 --\> vasoconstriction --\> Helps pts with cerebral edema
296
Morphine MOA
Binds to [Mu GPCR] --\> **K+ Efflux** --\> hyperpolarization
297
VitB12 deficiency presents with ____ anemia from \_\_\_\_. How can this be dx (2)
VitB12 deficiency presents with **Megaloblastic Anemia** from **Impaired DNA synthesis**.
Dx = Elevated Methylmalonic acid & Homocysteine
298
How does [Tricyclic Antidepressent] OD Manifest
Anti-Cholinergic Activity **but with no effect on NeuroMuscular Junction (normal CMAP****)**
299
Name the 3 enzymes that use [Thiamine VitB1] as a cofactor and how they're associated with [Wernicke Encephalopathy Syndrome]
* [Pyruvate Dehydrogenase]
* [A-ketoglutarate Dehydrogenase]
* [Transketolase]
Without [Thiamine VitB1] --\> No CNS Glucose Utilization with these enzymes --\> [WES]
300
[**PKU** - **P**henyl**K**eton**U**ria] MOD
[Phenylalanine Hydroxylase] or its [TetrahydrobioPterin cofactor] --\> Phe CNS accumulation --\> **DEC 50 IQ pts in 1st year of life vs. Seizures**
301
Bacterial Meningitis Sx Triad
**FAN**
1. **F**ever
2. [**A**ches (HA) + photophobia]
3. **N**uchal Rigiditiy
302
Define [Length Constant]. What Dz *Directly* affects this?
How far along the axon an electrical impulse can travel before dissipating. DEC in Multiple Sclerosis
303
Define [Time Constant]
Time it takes for a change in membrane potential to achieve 63% of the new value
MS INC Time Constant
304
[Orbital Floor] Fracture manifestations (2)
1. Paresthesia (Upper cheek, Lip, Gingiva)-*from infraorbital n. damage*
2. [Entrapment of Inferior Rectus m. --\> limited Superior Gaze]
305
Which n. is commonly stretched/injured during labor?
Pudendal n.
## Footnote
*Stretch injury from stress placed on pelvic floor during labor--\> Pudendal n. damage*
306
[Pudendal n. damage] manifestation (3)
1. Incontinence from perineal m. weakness
2. Perineal Pain
3. Sex Dysfunction
307
Where, in CNS, is the [**APCTZ -** Area Postrema Chemoreceptor Trigger Zone]?
Dorsal Medulla near 4th Ventricle
## Footnote
*D on image*
308
Identify
A: Thalamus
B: Dorsal Midbrain
C: Pons
D: Dorsal Medulla
E: Cerebellum
309
Causes of **L5** Radiculopathy (2)
Compression of L5 n. root from...
Verebral Disc Herniation
Spinal Foraminal Stenosis
310
L5 Radiculopathy Sx (4)
* [Back pain + radiation down leg]
* Sensory loss over Butt / lateral thigh / dorsal foot
* Weak Dorsiflexion
* Weak Toe extension
311
312
What's an easy way to damage the [**lower trunk** Brachial Plexus] (2) and how will this manifest (2)
1. Thoracic Outlet Syndrome (Extra Cervical Rib)
2. Sudden upward arm stretching at shoulder
[Klumpke Claw Hand] + Finger Clumsiness
313
How does [Subactue Combined Degeneration] manifest? (2)
[Su**BAC**ute Combined Degeneration]
## Footnote
[Demyelinating lesions] in 3 **Thoracic** Spinal Columns:
1. [Dorsal--\> Loss of 2TVP]
2. [Lateral CST --\> UMN *Weak MESH*]
3. Spinocerebellar
314
Describe Chiari Malformation **Type 1** (2)
Benign = adult onset occipital HA + cerebellar dysfunction
315
[Von Hippel Lindau Dz] Mode of Inheritance
AUTO DOM
316
What lesion causes Decerebrate Posturing
[d**E**c**E**r**E**brate **E**xt**E**nsor posturing]
Rigid **E**xt**E**nsion of UE and LE
[Lesion of rubrospinal tract] at or below Red Nucleus:
Pons
vs.
Midbrain-accompanied w/ vertical gaze palsy & light dissociation (pupils constrict only with accomodation)
317
What lesions cause Decorticate Posturing
[De**cor**ticate Flexion Posturing] "Flex toward ur **Cor**e"
Rigid Flexion of UE and LE
Lesion between Cerebral Cortex and Red Nucleus
318
Manifestation of [Oculomotor CN3 palsy] (2)
**DOP**
**[D**own & **O**ut eye]
+
Ptosis
*pupil dilation is determined by parasympathetic fiber involvement*
319
Which *Germ Layer* does the **POST Pit** come from?
NeuroEctoderm
