Usmle Neuro Flashcards by Naveed Khan

Before 32 week gestation
Weight less then 1.5 kg
Intraventricluar haemorrhage
Which place source for haemorrhage?

Germinal matrix

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Lacunar stroke
Wild flinging movement
Proximal limbs
Which disease and structure affected?

Hemiballism
Subthalamic nucleus

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Thru which mechanism tumor spread from primary tumour site to regional lymph nodes ?

Increased type 4 collagenase expression
And decreased E-cadherin expression

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Immediate flux of Calcium sodium and potassium involves which receptor?

Nicotinic cholinergic receptor (ionotropic receptor)

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Walls of brain lesion are composed of which cell after ischemic stroke?

Astrocytes

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Newborn apneic
Born before 28 weeks of gestation
Well appearing bw episodes of breathing
Apneic for more than 20 seconds
Problem where and which condition?

Central stimulatory neurons (pons and medulla )
Kid has apnea of prematurity

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DNA Polymerase and Dihydrofolate reductase activity elevated
Which step immediately precedes this in cell cycle ?

These enzymes elevated in S phase(synthesis phase)
Before this would be G-1 phase in which retinoblastoma protein phosphorylation/dephosphorylation occurs

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In which case should lamotrigine (anti seizure) should immediately be cessated if what symptom occurs?

Skin rash

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What causes wallerian degeneration in CNS?

Persistent myelin debris

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Hair tuft over lumbosacral legion
Sacral pit seen
Which condition and failure of which embryological process?

Spina bifida occulta
Failure of vertebral arch fusion

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Features of anaplastic tumor?

Giant cell (multinucleated)
Cells coalesce into sheets
Pleomorphism
Abnormal mitosis
High N/C ratio
hyperchromatism

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Features of Li-Fraumeni syndrome

TP 53 gene
Tumor or breast,brain,adrenal cortex,leukaemia and sarcoma most common

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4 Features of Abusive Head Trauma(AHT) or shaken baby syndrome in infants?

Bilateral retinal hemorrhage
Bulging anterior fontanelle
Posterior rib fracture
Subdural hematoma

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Feature of babinski sign?

Dorsiflexion of great toe and fanning out of remaining toes

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DCML features and parts affected by nucleus gracilis and cuneatus?

Vibration
Proprioception
Fine touch

Cuneatus related to upper limb and located laterally
Gracilis related to lower limb and located medially

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Febrile seizure which age group and what is cause and pathophysiology?

6 month to 5 years
Viral infection cause leading to hyperthermia-induced neuronal dysfunction

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Drugs for Alzheimer’s dementia and their side effect

Acetylcholine-esterase inhibitors (Donepezil,Rivastigmine)
Bradycardia,AV block resulting in reduced cardiac output

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Myotonic/muscular dystrophy features and which fiber involved?

Distal muscle weakness and delayed muscle relaxation after contraction(myotonia)
Early onset male pattern baldness

Type 1 fibers(slow twitch fiber)

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4 steps of wound healing

Hemostasis (fibrin clot formation)
Cellular infiltration
Angiogenesis
Maturition (collagen remodelling)

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Junction of parietal,frontal,temporal,sphenoid bones in skull is fractured.

Which artery will be severed and what is area called?

Middle meningeal branch of maxillary artery
Area is pterion

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What does tumor stage and grade mean?

Tumor stage is degree of spread
Tumor grade is how closely neoplastic cells resemble normal mature cells.

Stage include regional lymph node and distant metastasis
Grade involves pleomorphism,N/C ratio etc

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Which complication occurs in children or young adults after an RNA virus which contains hemagluttinin in tissue sample?

SSPE (Subacute Sclerosing Pan Encephalitis) occurs due to Measles virus

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Which enzyme neutralises ROS( reactive oxygen species)

SOD (Superoxide Dismutase)

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CIM and CIP features
Critical illness myopathy
Critical illness polyneuropathy

Hint-> difficulty taking off ventilator due to chest wall weakness(respiratory)
Proximal CIM and CIP rather than distal
Muscle atrophy
Axonal degeneration and decreased nerve excitability
Decreased tendon reflexes

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Oral morphine how does it act on membrane ?

Potassium efflux hyperpolarization Reduced calcium influx

Diabetic CN3 mononeuropathy is caused by?

Central nerve ischemia

Vesicular rash on forehead and side/tip of nose with visual loss caused by which nerve and condition?

Trigeminal nerve (V1 branch) and condition is Herpes Zoster Ophthalmicus

Vesicles in external auditory canal,ear pain and facial paralysis Which nerve and condition?

Facial nerve Herpes Zoster Oticus (Ramsay Hunt syndrome )

Beta 2 receptor agonist functions?

Vasodilation Bronchodilation Decreased uterine tone (tocolysis) Hypokalemia

After radiation therapy for prostate,radiation enteritis takes place. What is primary mechanism for intestinal changes(vomiting,anorexia,diarrhea) ?

Generation of ROS (reactive oxygen species)

Fever,headache,altered mental status and seizure seen in herpes encephalitis Swelling of temporal lobe also seen What would be finding on CSF analysis?

Protein will be raised Glucose will be normal Lymphocytes raised Erythrocytes also raised( cos of haemorrhagic inflammation of temporal lobe) First 3 findings consistent with viral cos herpes is virus

Temporal lobe epilepsy What is affected and which cells increase in response to it?

Hippocampal sclerosis and consequently atrophy Astrocyte proliferation (reactive gliosis) after injury

Which parameter correlates with potency of inhaled anesthetic?

MAC (minimal alveolar concentration) MAC in inversely proportional to potency Lower the MAC , greater the potency

Head and neck cancer is predisposed by which viral genome protein?

Decreased activity of Retinoblastoma (RB) associated protein

Painful diabetic neuropathy treated by which drug?

TCA (Amytriptaline) SNRI ( duloxetine) Gabapentinoids (gabapentin)

Adenoma to carcinoma sequence of colon cancer thru gene mutations List there order

1. Normal mucosa to adenoma caused by APC gene 2. Increase in size of adenoma caused by KRAS gene 3.malignant transformation from adenoma to carcinoma caused by TP53 gene. Remember alphabetically A comes first,then K ,then T for TP53

Which area affected first by ischemic damage to brain?

1.Hippocampus 2.Cerebellar purkinje cells 3.neocortex pyramidal neurons Hippocampus is the first to be affected.

Gertsmann syndrome features and which area affected?

Agraphia (inability to write) Acalculia( inability to solve math problem) Finger agnosia (unable to recognise or distinguish fingers) Left-right disorientation Angular gyrus in parietal lobe affected.

Cytokeratin belongs wo which cell lineage?

Epithelial cells

Cytokeratin has tyrosine kinase activity in intracellular domain What is the function of this protein?

Increased cell proliferation

After ischemic stroke,what happens to cells post infarction?

First 24 hours (red neurons show signs of irreversible damage) First 1-2 days ( neutrophils move into area) 3-7 days (microglia moves into area)

Which condition resembles Freidrich Ataxia sem2sem?

Vitamin E deficiency

Which substance released from mitochondria indirectly causes cell apoptosis?

Cytochrome C

Why is diphenhydramine administered with Prochlorperazine,Metoclopromide (Dopamine receptor blocker) for migraine headaches?

Due to its anti-cholinergic effect( to prevent abnormal motor reaction)

Inferior alveolar nerve(branch of mandibular nerve)provides sensation to which area?

Chin and lower lip

Pituitary adenoma derived from which layer embryologically?

Surface ectoderm (rathke pouch)

Trendelenburg sign which nerve is affected and which muscle is innervated by it?

Superior gluteal nerve This nerve innervates glutes medius,gluteus minimus,tensor fascia latae Added info->Inferior gluteal nerve innervates gluteus maximus which is not involved in trendelenburg gait

Which drug has the lowest side effect for treating insomnia in older adults?

Ramelteon ( a melatonin agonist)

In osteosarcomas,which gene is mutated?

RB 1 and TP53

Patient returned after party Features of MI and stroke What could be reason for death?

Cocaine toxicity Impaired pre-synaptic re-uptake of neurotransmitters

Lidocaine is injected with epinephrine for what reason?

To prolong the duration of action of anesthetic cos epinephrine causes vasoconstriction hence less lidocaine washed away by bloodstream making it last longer

What is the cause of PTLD (Post Transplant Lymphoproliferative Disorder) after immunosuppressive drug administration?

Epstein Barr virus

What is cause of neurological deterioration after subarachnoid hemorrhage in patient?

Arterial vasospasm

Which nerve can be injured during radioablation of right atrium?

Phrenic nerve

Jaw jerk reflex mediated by which nerve (afferent efferent both)

Trigeminal nerve( V3 mandibular division)

Raised Acetylcholine-esterase in amniotic fluid on amniocentesis suggests failure of what?

Open Neural tube defect cos of failure of fusion of neural plate edges.

Which nerve palsy when person has duplicate vision while going downstairs and difficulty reading newspaper?

Trochelar nerve (superior oblique) palsy Function is depression while eye is adducted and intort (internal rotation) of eye which is impaired. Patient presents with vertical diplopia.

Reason for prolonged paralysis after succinylcholine infusion as an anesthetic?

Decreased plasma hydrolysis of succinylcholine due to pseudocholinesterase enzyme deficiency

Excision biopsy taken from posterior triangle of neck Patient presents with shoulder drooping,weakness of arm abduction above 100 degrees and lateral displacement of scapula Which muscle paralyzed?

Accessory nerve goes thru posterior triangle of neck. Muscle with such presentation is trapezius involvment.

1.If cremesteric reflex is diminished which nerve is affected? 2. Burning sensation when upper medial thigh,anterior scrotum,base of penis touched..which nerve involved?

1.Genitofemoral nerve 2. Ilioinguinal nerve See pictures in USMLE step 1 photos in camera roll

For lumbar puncture which anatomical landmark is preferred for needle insertion?

Iliac crest

Fecal incontinence related to which nerve injury?

Pudendal nerve

Constipation related to injury to which segment of Spinal cord?

Parasympathetic impairment Sacral spinal cord (S2-S4)

Osteoblastic(sclerotic) cancer example

Prostate cancer

Osteolytic (lucent)

Multiple myeloma

Senile plaques (neuritic plaques) seen in which dementia

Alzheimer’s

Gingival hyperplasia side effect of which anti seizure?

Phenytoin

Normal epithelium of esophagus and epithelium after Metaplasia of esophagus?

Non keratizned stratified squamous epithelium is normal Ciliated columnar epithelium with goblet cell is after metaplasia

Monoocular visual loss Pelvic girdle and shoulder pain Weight loss Which arteritis?

Large vessel (temporal) arteritis

Internal carotid artery aneurysm involves the cavernous sinus Which nerves are affected?

3,4,6 and V1 and V2 branch of Trigeminal nerve

Problem on dorsiflexion,numbness on dorsum of foot,and eversion too Injury occurs where?

Injury occurs at fibular head(common peroneal nerve) Deep fibular nerve does dorsiflexion (ant compartment of leg) Superficial fibular nerve supplies dorsum of foot and does eversion (lateral compartment of leg)

Endoneural arteriole hyalinizaton seen in which disease?

Diabetes

Hereditary breast cancer associated with which gene and its function?

BRCA 1 and BRCA 2 and it does DNA repair

Cell body rounding,peripheral displacement of nuclei, and dispersion of Nissl substance seen in which reaction?

Axonal reaction

If there is pain after sensory nerve injury, which ion channel is upregulated causing pain?

Sodium ion channel cos it depolarizes the membrane hence more signal transmission hence more pain

Vomiting Center location and name

Area postrema (chemoreceptor trigger zone) Dorsal medulla,floor of 4th ventricle

First line therapy for diabetic neuropathy includes which 3 classes of medication

TCA (amitryptaline) SNRIs (Duloxetine) Gabapentin

Isoniazid-induced peripheral neuropathy results in what features in patient who’s treated for TB?

Ataxia Numbness and tingling in hands and feet Decreased pain sensation in distal extremities Isoniazid structurally similar to Vit B6 (pyridoxine) Treatment is pyridoxine supplementation

What could be reason for headache,nausea,vomiting,papilledema in absence of ventriculomegaly and intracranial mass lesion for a young patient?

Idiopathic intracranial hypertension or cerebral venous sinus thrombosis (cerebral venous hypertension) resulting in impaired CSF resorption and hence raised ICP as a result.

What are key growth factors that promote angiogenesis ?

VEGF Vascular endothelial growth factor FGF fibroblast Growth factor

Loss of gray-white matter differentiation with sulcal effacement. Injury occurs where in brain stem?

Mid brain

Methotrexate is used for Rhem.Arhritis This drug is a folate antagonist. If woman is pregnant and using this drug She is at risk for what?

Neural tube defects (anencephaly,Spina bifida occulta)

Usmle Neuro Flashcards

(82 cards)