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Flashcards in Neurology Deck (93):
1

What type of paralysis accompanies botulism?

Descending symmetric flaccid paralysis

As well as GI ssx - N/V, diarrhea

2

What type of paralysis accompanies Guillain-barre syndrome?

Ascending and symmetrical motor weakness

3

What are three types of cerebral aneurysms?

Saccular (berry) - MC, frequently rupture, located at branch points of major cerebral arteries

Fusiform - atherosclerotic, vertebrobasilar system, rarely rupture

Mycotic - 2ndary to infection in vessel wall, often Staph or Strep

4

What is the best imaging to ID an AVM? Hemorrhage?

AVM - MRI
Hemorrhage - CT

5

What are HA red flags?

First and worst, thunderclap HA, HA w/ fever, altered LOC, papilledema, morning HA

6

What type of paralysis does Bell's palsy cause?

Unilateral facial paralysis

7

Which chromosome is affected in familial ALS?

21

8

T/F: ALS involves both UMN and LMN.

T, both upper and lower

9

Which chromosome is affected in Huntington's?

4 - trinucleotide repeat (CAG)
Autosomal dominant

10

Which genetic marker is seen in MS?

HLA-DR2

11

What findings are indicative of MS on a spinal tap?

Inc protein
Inc leukocyte count
Inc IgG conc
Oligoclonal bands present

12

What IV treatment is used in MS to decrease inflammation?

Interferon - B

13

What type of sequelae can occur with a polio virus infection?

Asymmetrical muscle weakness, permanent weakness results from necrosis of the anterior horns cells

14

What is another term for grade 4 astrocytoma?

Glioblastoma

15

On NPLEX, what is the most sensitive imaging procedure?

MRI

16

What is the imaging often used in dementia?

SPECT - Single Positron Emission CT

17

What is the CNS imaging of choice? What is one exception?

MRI

Meningitis - do lumbar puncture before imaging

18

What is a contraindication to lumbar puncture?

Inc intracranial pressure

19

Name the neurotransmitter:

If decreased - dec memory, delirium, delusions

If increased - aggression, depression

Acetylcholine

20

Name the neurotransmitter:

If decreased - dementia, movement disorders, depression

If increased - psychosis, anxiety, confusions, aggression

Dopamine

21

Name the neurotransmitter:

If decreased - depression, aggression

If increased - Anxiety

Serotonin

22

Name the neurotransmitter:

If decreased - depression, dementia

If increased - anxiety, aggression, inattention

Norepinephrine

23

Name the neurotransmitter(s):

If decreased - anxiety

If increased - affective decrease, lethargy

GABA, glycine

24

Name the neurotransmitter:

If decreased - vasospasm, potential hyperactivity

If increased - sedation, vasodilation, visual hallucination

Nitric Oxide

25

Name the neurotransmitter:

If decreased - mania

If increased - depression

Histamine

26

Name the neurotransmitter:

If decreased - allows down regulation of GABAa receptors via a-4 subunit proliferation

If increased - potentiates GABAa receptor activity

Neurosteroids

27

What is the primary neurotransmitter modified in psychosis?

Dopamine

28

What nutrient improves membrane fluidity?

Omega-3 fatty acids

29

T/F: Phosphatidyl substances are fat based and absorbed more by fatty tissues.

T

Often combined with choline, serine, inositol

30

T/F: Phosphatidylcholine is required for phosphatidylserine formation in the brain.

T

31

What side effect can be seen with high dose B6 in individuals who don't require it?

Peripheral neuropathy

32

Why is SAMe used in depression?

Used to stimulate catecholamine.

Peripherally helps conversion of NE to Epi.

SE - can include tachycardia, HTN

33

What two amino acids are the substrate for excitatory catecholamines?

Phenylalanine and tyrosine

34

If a pt is in a stimulating medication, what amino acids would I be concerned about giving the pt?

Tyrosine or phenylalanine

35

OCD - overfocus by imbalance in serotonin and catecholamines. Which wins?

Catecholamines

36

ADD - attention deficit by imbalance in serotonin and catecholamines. Which wins?

Serotonin

37

Which cofactors are important in converting amino acids into catecholamines?

B3, Fe, Biopterin

38

Cocaine, buproprion, benzatropine, and amphetamine block the reuptake of what neurotransmitter?

Dopamine

39

Tricyclics and amphetamine block reuptake of what neurotransmitter?

NE

40

NE granule storage is inactivated by which drugs/herbs.

Reserpine/Rauwolfia

41

Why is niacinamide and B6 beneficial in mild/moderate depression?

Shunt tryptophan toward serotonin production, rather than toward niacinamide.

42

What cofactors are needed for serotonin creation?

Biopterin, B3, Iron, and B6

43

What cofactors are needed for melatonin production?

B5, B12, Folate

44

Name the syndrome: Fever, hyperreflexia, BP changes, coma, death.

Serotonin Syndrome

45

How does each histamine type affect the brain?

H-1 (Stimulating)
Causes increased depolarization in hypothalamic and limbic areas

H-2 (Stimulating)
Slows potassium conductance, increasing excitation in the hipocampus, amygdala and basal nuclei

H-3 (Inhibiting)
Blocks calcium channels in the basal nuclei decreasing histamine release

“H-4” (Inhibiting)
Slows / modulates NMDA receptor complex

46

What condition is a caution of glycine supplementation?

Bipolar (esp type 1)
NMDA receptors get excited - may trigger mania

47

T/F: NMDA receptors are primarily inhibitory

F, excitatory

48

What substances inhibit NMDA receptors?

Kynurenate (Tryptophan metabolite)
Magnesium
PCP/Ketamine
Theanine

49

What substances excites NMDA receptors?

Glutamate, Glycine, Zinc

50

How does NAC affect Glutamate?

Cystine-glutamate antiporter - reduces glutamate in the brain.

500mg BID, long-term tx

51

How does Molybdenum help in Bipolar?

Takes sulfite to sulfate

Sulfites can cause migraines.

52

How does folic acid help in bipolar?

Lithium biotransformation

53

What is the MC renal effect of lithium?

Impaired conc capacity due to reduced renal response to ADH

54

What other organ can become toxic with lithium use?

Hypothyroidism

55

What mineral when added the methylphenidate (Ritalin) improved outcomes?

Zinc - 55mg daily

56

MC organisms for meningitis:
0-4wks
4-12wks
3mo - 18yrs
18-50yrs
>50yrs

0-4wks - Grp B strep, e. coli, listeria monocytogenes
4-12wks - S pneumonia, grp B strep, E. coli. L. monocytogenes
3mo - 18yrs - S pneumoniae, N. meningitidis, H. flu
18-50yrs - S pneumonia, N. meningitis
>50yrs - Strep, Neisseria, Listeria, aerobic gm neg bacilli

57

What is found in the periphery in tertiary neurosyphilis

Tabes dorsalis - spirochete destroys dorsal roots = impaired sensation & ataxia, absent DTR’s

58

Causes for encephalitis...

EEE, (Togaviridae, genus Alphavirus) arthropod borne; birds reservoir not horses
Mosquito – bird transmission / reservoir (people and horses get the disease)
35% of humans die, another 35% have residual neurological sx.

Measles, mumps, chicken pox, rubella can cause autoimmune encephalitis

CMV (MC viral CNS infxn in AIDS)

HSV I & II (why C-section for positive mothers in the past)

59

What is the most common primary brain tumor of adults? Most aggressive/highly malignant.

Glioblastoma multiforme - grade 4 astrocytoma

60

T/F: In children, tumors tend to occur below the tentorium.

T, above in the adult

61

T/F: MS affects the PNS while Guillain-Barre affects the CNS.

F. MS affects CNS and Guillain-Barre affects the PNS.

62

Term: inborn enzyme deficiencies that create abnormal myelin. Name the MC.

Leukodystrophies

Metachromic leukodystrophy

63

What vit def causes Wernicke-Korsakoff? SSX?

Thiamine - can be due to alcoholism

Confabulation, no short term memory

64

What vit def causes Pellegra? SSX?

Niacin

Dementia, Dermatitis, Diarrhea, Death

65

T/F: Botulism blocks neuromuscular transmission in cholinergic nerve fibers.

T - leading to reduced salivation, constipation, hypotension

66

Symptom triad for hydrocephalus.

Incontinence, gait disturbance, dementia

67

What is the earliest MC symptom of infant botulism?

Constipation - can also see general weakness, poo head control, weak cry, poor suckling, irritability

68

What part of the hand is affected by ulnar n. palsy?

1/2 ring finger and 5th finger on palmar surface

69

Bell's palsy affects which nerve?

CN 7, no sensory loss.

Due to viral infxn.

70

When is the onset of botulism poisoning after ingestion?

18-36hrs

71

Descending or ascending paralysis:
Guillain-barre
Botulism

Ascending
Descending

72

What type of HA is often accompanied by nasal congestion and tearing eyes?

Cluster - also common at night

73

HA red flags

Sudden onset, worsening in severity and frequency, HA after 50yo, new onset in CA or HIV, HA with meningeal signs, papilledema, focal neurologic signs, head trauma

74

T/F: Trigeminal neuralgia causes sensory loss, pain, and motor weakness.

F. No sensory loss or motor weakness.

75

What labs are performed if Giant cell arteritis is suspected? What is the sequelae if untreated?

ESR over 100 and biopsy of the artery

50% untreated go blind

76

What type of imaging best shows plaques in MS?

MRI

77

What lab finding is definitive for muscular dystrophy?

Muscle biopsy

Genetic testing in Duchenne's

78

What is the only neurological dz with upper and lower motor neuron dysfunction? What functions are maintained?

Amyotrophic lateral sclerosis (ALS)

Gait and sensation

79

Term: AI disorder caused by antibodies to acetylcholine receptors in skeletal muscle

Myasthenia gravis

SSX: weakness on exertion of the proximal extremities, relieved by rest

80

T/F: Benign essential tremor increased with skilled movements and made worse with tension. Absent at rest Can occur in the head and voice.

T

81

Parkinson's involves degeneration of the _______ system.

Huntington's involves degeneration of the _____ system.

Dopamine - Substantia nigra of the basal ganglia



GABA in the basal ganglia

82

What items are included in the Mental Status Exam?

Appearance, behavior, attitude, characteristics of speech, affect and mood, thought content, thought form, concentration, memory, orientation, insight/judgment

83

What is a normal score on the MMSE? What is the MAX score?

24 or higher

30

84

What is unique about CO poisoning HA?

Waking in the morning w/ HA

85

Name the seizure:
Limited to a single part of the body or one limited aspect of behavior

Consciousness is preserved

Symptoms include focal motor (convulsive jerks) or somatosensory (paresthesia or tingling)

Simple partial

86

Name the seizure:
Spread or “march” to different parts of limb or body

Sensory symptoms: light flashes, smells, buzzing, songs

Autonomic symptoms: flushing, sweating, epigastric sensations

Jacksonian

87

Name the seizure:
S/S may change during attack (hallucinations change into complex motor acts)

Change in, or loss of, consciousness

Déjà vu (intense familiarity), fear, pleasure, anger are psychic symptoms

Complex partial

88

Name the seizure:
Usually begin from age 2-12

+ FH

Two Types:
Simple absence
Complex absence

Absence (petit mal)

Generalized

89

Name the seizure:
Most extreme form of seizure

May begin at any age

May be triggered by fatigue, fever, Ca, glucose, magnesium

May be preceded by a prodrome of mood change, apprehension, loss of appetite

Tonic-clonic (grand mal)

Generalized

90

What is always the first step in the workup for syncope?

ECG

91

What is considered the first-line treatment for trigeminal neuralgia?

Carbamazepine

92

What is the treatment for a seizure?

1) Give oxygen, don't obstruct airway
2) Role pt to the side and protect without restraining
3) Give glucose
4) Start IV with NS
5) Administer lorazepam or diazepam IV. If they do not work, administer phenytoin.

93

What imaging is MOST sensitive and specific for an acoustic neuroma?

MRI