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Block 9 > U-World: Neuro > Flashcards

U-World: Neuro Flashcards

1
Q

What drugs increase pupil size (dilation)?

A

Anticholinergics (atropine, TCAs, tropicamide, scopolamine, antihistamines)
Drugs of abuse- amphetamines, cocaine, LSD
Sympathomimetics

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2
Q

What drugs decrease pupil size (constriction)?

A

Sympatholytics (like alpha-2 agonists)
Drugs of abuse- heroin and opioids
Parasympathomimetics (like pilocarpine), organophosphates

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3
Q

Lady has a thick SCM and as a result, pain when turning her neck and a head tilt. She is diagnosed with idiopathic torticollis and treated with injections of a bacterial product. What kind of injections are these?

A

Botox

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4
Q

Classic triad in congenital toxoplasmosis?

A
  1. Intracranial calcifications (Sketchy: cat drinking milk and gets milk on head)
  2. Hydrocephalus (bowl of water on cat’s head)
  3. Chorioretinitis (giant flash bulb on camera of crazy cat lady that looks like a fundus)

*can also get seizures (cat shaking bowl off head) and deafness (Beethoven cat)

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5
Q

How can babies get Toxoplasmosis?

A

If mom gets infected with Toxoplasma Gondi DURING pregnancy (baby is in-utero)

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6
Q

Baby has a head in the 98th percentile, white-yellow chorioretinal lesions, and intracranial calcifications. Diagnosis?

A 
Congenital toxoplasma (mom got infected with toxoplasma Gondi while pregnant/ in-utero—> baby got the infection)
Remember, babies with congenital toxoplasma get the triad: (1) intracranial calcifications (Sketchy: cat with milk spilled on head), (2) hydrocephalus (bowl of water on cat’s head), and (3) chorioretinitis (giant flash bulb on crazy cat lady’s camera that looks like a fundus) *can also get seizures (cat shaking bowl off head) and deafness (Beethoven cat)
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7
Q

What is hydrocephalus?

A 
Increased CSF (due to blockage of CSF pathway/ non-communicating or due to decreased absorption of CSF/ communicating) 
Basically there’s more fluid in the cavities/ ventricles of the brain—> brain has less room—> enlarged head
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8
Q

Premature baby presents with prominent scalp veins, hypotonia, decreased level of consciousness. Blood is found collected in her lateral ventricles. Most likely source of the bleeding?

A

Germinal matrix

This baby has neonatal intraventricular hemorrhage

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9
Q

What is neonatal intraventricular hemorrhage? (Include definition, where it originates, why it happens, and presentation)

A

Bleeding into ventricles. Most common in premature or low birth weight babies. The bleed originates in the germinal matrix (highly vasculized layer in the subventricular zone where neurons and glial cells migrate from in brain development). It is due to reduced glial fiber support and impaired autoregulation of BP in premie babies. Can present with altered level of consciousness, bulging fontanelle, hypotension, seizures, and coma.

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10
Q

What are voltage-gated calcium channels needed for in sodium transmission?

A

Fusion and release of neurotransmitter vesicles into the synaptic cleft

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11
Q

Oral herpes (HSV-1) affects what nerve?

A

Trigeminal nerve (CN 5)

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12
Q

Clozapine is an anti-psychotic used for treatment-resistant Schizophrenia or Schizophrenia with suicidality. Not first line (more like last resort) due to a nasty side effect it has. What is this nasty side effect and how do we monitor for it?

A

Can cause life-threatening agranulocytosis

Monitor with regular (often weekly) blood tests that check for absolute neutrophil count

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13
Q

A guy recently started a new drug. 2 weeks later, he gets a stroke despite the fact that he’s on Warfarin! What type of new drug did he start?

A

Cytochrome P450 inducer
(Warfarin should prevent a stroke from occurring. But if you start a drug that causes Warfarin to metabolize/ break down/ get out of the body faster, then a stroke could happen.)

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14
Q

A kid has episodes of sudden lapse in awareness with staring, blinking, or clonic jerks. What is this called?

A

Absence seizures (Sketchy: classroom scene with ABSENT clipboard)

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15
Q

How do we treat kids with absence seizures? How do we treat kids with absence seizures + another type of seizure?

A

Absence seizures only—> Ethosuximide (Sketchy: “Ethos” on chalkboard in classroom scene)
Absence + other seizures—> Valproate, this is a broad-spectrum anti-epilepsy drug that works against absence seizures too (farm festiVAL in the lawn through the window of the classroom)

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16
Q

What are all the functions of CN 7 (facial nerve)? There are 6.

A

*both motor and sensory

  1. Facial movement (motor)
  2. Taste to anterior (front) 2/3 of tongue (chorda tympani)
  3. Lacrimation (tear production)
  4. Salivation (innervates the submandibular and sublingual saliva glands)
  5. Eye closing (orbicularis oculi)
  6. Auditory volume modulation (stapedius)
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17
Q

Why might a patient with Bell’s palsy also experience decreased tearing and decreased taste in the front (anterior 2/3) of the tongue?

A

CN 7 (facial nerve) responsible for Bell’s palsy also functions to produce tears (lacrimation) and tase to front of tongue…

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18
Q

What markers are elevated in the amniotic fluid when there are neural tube defects in baby?

A

High AFP (in maternal blood and amniotic fluid) and high acetylcholinesterase (in amniotic fluid only, confirmatory test)

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19
Q

Pregnant mom has high levels of AFP and acetylcholinesterase in her amniotic fluid. What’s wrong with baby?

A

Neural tube defect (spinda bifida)

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20
Q

MAO inhibitors can be used to treat atypical depression (MDD with atypical features). What does this mean?

A

Depression that has some not-so-typical features:

  • mood reactivity (mood improvement with positive events)
  • leaden paralysis (arms + legs feel heavy)
  • rejection sensitivity (overly sensitive to slight criticism)
  • increased sleep and appetite
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21
Q

Why can’t you just give IV dopamine to a Parkinson’s patient to eliminate their symptoms/ cure them?

A

Dopamine cannot cross the BBB

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22
Q

How can Dexamethasone help patient with bacterial meningitis from strep pneumo?

A

It decreases inflammatory response in CSF—> decreased risk of neurologic sequelae (such as seizures) and death

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23
Q

Why are Down syndrome patients at an increased risk for early-onset Alzheimer’s disease (AD)?

A

They have an extra copy of chromosome 21 and APP (amyloid precursor protein) is found on chromosome 21–> breaks down to alpha and A-beta amyloid—> inc A-beta amyloid leads to plaque deposition and AD.

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24
Q

Increased levels of epsilon 4 allele of apolipoprotein E (APOE) is associated with what condition?

A

Late-onset Alzheimer’s disease

25
Q

How do we treat Parkinson’s?

A

Give L-DOPA

Remember that Parkinson’s is a problem with lack of dopaminergic neurons in the substantia Nigra pars compacta of the basal ganglia. So you’d think to treat it by giving back that missing dopamine…but dopamine doesn’t cross the BBB, so give L-DOPA (its precursor).

26
Q

What do the Parkinson’s drugs Entacapone and Carbadopa do (administered with L-DOPA)?

A

Prevent L-DOPA from getting broken down in the periphery so that more will cross the BBB and reach the brain.

27
Q

What hypothalamic nucleus is responsible for regulation of circadian rhythm/ sleep patterns?

A

Suprachiasmatic nucleus (SCN= “Sun Censing Nucleus”)

28
Q

What hypothalamic nucleus is responsible for cooling, PNS?

A

Anterior nucelus (A/C= “Anterior Cooling”)

29
Q

What hypothalamic nucleus is responsible for hunger (stimulated by ghrelin, inhibited by leptin)?

A

Lateral nucleus (“lateral injury makes you lean” bc you won’t be hungry if it’s messed up)

30
Q

What hypothalamic nucleus is responsible for heating, sympathetic?

A

Posterior nucleus (“Hot Pot” Heating controlled by Posterior nucleus)

31
Q

What hypothalamic nucleus is responsible for satiety?

A

Ventromedial nucleus (“VentroMedial injury makes you Very Massive” bc you won’t get full so you keep eating)

32
Q

Guy has tonic-clinic seizures. Oral thrush. Brain MRI shows ring-enhancing lesions. He has not traveled and has no cats. Diagnosis?

A

Toxoplasmosis

*it doesn’t matter that he doesn’t have cats. It is easily spread (lots of people are infected with it and don’t know it/ have symptoms!) and the fact that he is immunocomprimised (oral thrush= HIV) makes this likely.

33
Q

How is toxoplasmic encephalitis transmitted?

A

Cat feces and also through contaminated foods (like a chef handles a cat litter box and does a lousy job of washing his hands and you go out to eat…)

34
Q

Ring-enhancing lesions in HIV patient is what?

A

Toxoplasmosis

35
Q

Patient has Myasthenia Gravis (MG). You treat with Pyridostigmine and their symptoms don’t improve so you give edrophonium infusion. If you see symptoms improve from this what does that mean? If you don’t see symptoms improve from this what does that mean?

A

Your are giving Pyridostigmine= AChE inhibitor (blocks the enzyme that normally degrades ACh—> more ACh in cleft to outcompete the MG antibodies against post-synaptic ACh receptors).
If you gave the right dose, the guy’s symptoms would improve. But if you undertreat or overtreat (rare) his symptoms would not improve. Undertreating doesn’t help bc it doesn’t inc ACh in the cleft enough to outcomplete MG antibodies (Myasthenia crisis). Overtreating doesn’t help bc it causes there to be so much ACh in the cleft that it constantly stimulates muscle to the point where the muscle stops responding (cholinergic crisis).
So, to tell if you under or over treated, you give Edrophonium (also an AChE inhibitor)…
-if his symptoms improve right away—> you know he was undertreated. Now you can amp up the treatment dose of Pyridostigmine.
-if his symptoms don’t get better—> you know he was overtreated. Now you can lay off the Pyridostigmine for a while.

36
Q

What nerve is responsible for the cremasteric reflex in men?

A

Genitofemoral nerve

37
Q

Low back pain that radiates down the leg is called what?

A

Sciatica
(It is due to compression of the Lumbosacral nerve roots, most commonly caused by vertebral disc herniation or spinal foramina stenosis)
*they may have worse pain during straight leg raise test

38
Q

Patient has sciatica (low back pain radiating down legs). She has pain/ sensory loss down the posterior thigh and calf to the lateral aspect of the foot. Also has weakness on thigh extension, knee flexion, and foot plantarflexion with an absent ankle jerk reflex. What nerve root is involved?

A

S1

39
Q

Damage ABOVE the red nucleus (cerebral hemispheres, internal capsule), so in the upper brainstem, results in what posturing?

Damage BELOW the red nucleus (midbrain, pons), so in the lower brainstem, results in what posturing?

*note: the red nucleus is in the midbrain/ start of pons. Options here: flexor or extensor posturing (the patient has flexed or extended extremities with the lesion).

A

Damage ABOVE red nucleus/ in upper brainstem—> decorticate FLEXOR posturing
(Remember when you FLEX your biceps your arms are ABOVE)

Damage BELOW red nucleus/ in lower brainstem—> decerebrate EXTENSOR posturing
(Remember when you EXTEND your biceps your arms are BELOW and hands are in “E’s” for decErEbrate)

40
Q

What artery supplies both Broca and Wernicke’s area of the brain?

A

MCA (middle cerebral artery)

41
Q

Broca’s vs. Wernicke’s area. State the lobe they’re at in the brain, what they do/ what happens if you have a lesion or stroke there, what artery they’re supplied by.

A

Broca’s—> frontal lobe, lesion—> can’t speak (non-fluent aphasia), supplied by superior branch of the MCA

Wernicke’s—> temporal lobe, lesion—> can’t understand (fluent aphasia aka “Wernicke’s Word salad), supplied by the inferior branch of the MCA

42
Q

A guy is speaking clearly but what he’s saying makes no sense. He cannot understand. He had a stroke that affected what area of the brain?

A

Wernicke’s

This is “Wernicke word salad” where the patient can talk but cannot understand (fluent aphasia) so when they talk it makes no sense

43
Q

What anti-seizure drug has a side effect of gingival hyperplasia?

A

Phenytoin

(Sketchy: the guy blowing bubble gum at the “seize the night” drive in anti-epileptic sketch)
*also remember the story told in lecture of soldiers who used to be given this drug as a preventative measure for seizures until they found out of side effects like their gums were swelling up (and decreased cognition)

44
Q

What’s a problematic side effect of almost every anti-epileptic drug

A

Reduced cognition/ learning because when you suppress seizures you are also suppressing normal brain activity

45
Q

What drug class is best for migraine treatment?

A

Triptans

46
Q

Boy is having tremor when writing, difficulty walking, mood changes, dietary changes, high serum transaminases, low serum ceruloplasmin. Diagnosis? Treatment?

A

Wilson disease
(Autosomal recessive mutation in ATP7B—> copper accumulates in the liver and deposits in other places too like the basal ganglia of the brain and the cornea)

47
Q

What nerve passes through the obturator canal? What is its sensory and motor function?

A

Obturator nerve
Provides sensation to medial thigh and does adduction (makes sense bc if it provides sensation to inner thigh you can assume its located in the inner thigh and inner thigh muscles to adduction/ contract to bring the legs in)

48
Q

Wernicke encephalopathy (a condition of thiamine deficiency typically seen in alcoholics) affects what area of the brain?

A

Mammillary bodies (hanging from top of brainstem)

49
Q

Cerebellar issues + mass in kidney. What neurocutaneous disorder is this?

A

Von Hippel-Lindau disease

50
Q

What is the sensory and motor function of CN 5 / trigeminal nerve?

A

Sensation to the face

Motor to muscles of mastication (chewing)

51
Q

What type of tumors stain positive for Synaptophysin? GFAP (glial fibrillation acidic protein)?

A

CNS Tumors of NEURONal origin—> stain positive for synaptophysin

Neoplasms of GLIAL origin—> stain positive for GFAP

52
Q

Extremely high BP, hemorrhagic stroke. What blood vessels were most likely stroked out?

A

Lenticulostriate arteries (little branches off the MCA)

53
Q

Man has a transverse foramina fracture. He develops dizziness, numbness of face, Horner’s syndrome, reduced pain/ temp sensation, ataxia. What artery is probably dissected?

A

Vertebral artery
(The vertebral arteries run through the transverse foramina holes of the vertebrae so a fracture there makes this likely)
**this is Wallenberg/ lateral medullary syndrome

54
Q

Why are Myasthenia Gravis (MG) patients more sensitive to nondepolarizing agents/ anesthetics like Vecuronium?

A

They are competitive antagonists of ACh receptors (block them)—> less ACh in cleft, which is already the problem in MG (due to antibodies against post-synaptic ACh receptors)—> can cause paralysis and impaired airway.

55
Q

A patient has scoliosis plus loss of pain and temperature sensation. Most likely spinal cord lesion?

A

Syringomyelia
(Central cystic dilation in cervical spinal cord that enlarges—> damage to white commissure and anterior horns where STT neurons cross)

56
Q

Guy gets in a car crash, trauma to head, and dies a little later. On autopsy, his axons were swollen and pronounced at the gray-white matter junction. Transport proteins (APP and alpha-synuclein) accumulated at the site of injury. Diagnosis?

A

Diffuse atonal injury (DAI)

Type of traumatic brain injury that disrupts white matter tracts

57
Q

What drug produces a mild euphoria (“high”) with inappropriate laughter, sedation, slowed reflexes, impaired motor coordination, distorted sensory perceptions, and cognitive impairment (decreased attention and judgement)?

A

Marijuana (cannabis w/ the active ingredient that gets you high: THC)

58
Q

What are 2 immediate symptoms of marijuana intoxication (related to the eyes and heart)?

A

Conjunctival injection (red eyes) and tachycardia (inc HR)

59
Q

A lady has hearing loss and difficulty making facial expressions. Assuming she has a brain tumor, what type is it most likely and where is it located?

A 
Schwannoma (benign tumor of Schwann cells involving CN 7 and 8, sometimes 5). 
Cerebellopontine angle (where the cerebellum meets the pons).

Block 9 (6 decks)

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