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Dr. Mel - Neurology > UWorld 2017 > Flashcards

UWorld 2017 Flashcards

(58 cards)

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1
Q

Innervation of the 2 skeletal muscles of the middle ear

A

Stapedius muscle: CN VII

Tensor tympani muscle: CN V3

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2
Q

Highly lipophylic drugs (Propofol, …)

A

Quickly accumulating in tissues of high blood flow (rapid onset of action)
Redistribution to organs of low blood flow (short duration of action)

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3
Q

2 drugs used as monotherapy to ttt spasticity secondary to brain or spinal cord disease

A

Baclofen (GABA-B receptor agonist)

Tizanidine (alpha2-adrenergic agonist)

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4
Q

1 drug indicated + 3 to avoid in ttt of insomnia in elderly

A

Ramelteon (melatonin agonist)

Antihistamines
Sedating antidepressants
Benzodiazepines

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5
Q

Gene mutations ass w/ familial Alzheimer ds

A

Early-onset familial AD: APP (ch 21), presenilin 1, presenilin 2

Late-onset familial AD: apolipoprotein E4 genotype

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6
Q

1 ttt for acute migraine + 3 ttts for prophylaxis

A

Serotonin agonist 5HT1B/5HT1D (postsynaptic S receptor ag)

Anticonvulsivants
Antidepressants
Beta blockers

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7
Q

1 drug for absence + 1 for absence and tonic-clonic seizures

A

Sodium valproate

Ethosuximide

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8
Q

4 clinical findings in Tabes dorsalis (late form of neurosyphilis)

A

Sensory ataxia
Lancinating pains
Neurogenic urinary incontinence
Ass w/ Argyll Robertson pupils

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9
Q

Onset of action of gas anesthetic

A

Depends on its solubility in blood (blood/gas partition coefficient)
High coeff, more soluble in blood, slower equilibration with brain, longer onset time

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10
Q

MOA of opiate analgesics

A

Activation of presynaptic mu recept: closure of voltage-gated Ca2+ ch + reduced excitatory neurotransm

Binding to postsynaptic mu recept: opening of K+ ch + membrane hyperpolarization

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11
Q

Treatment of severe atropine toxicity (anticholinergic)

A

Tertiary amine: physostigmine (reverse CNS + periph symptoms) is the ttt

Quartenary ammonium: neostigmine and edrophonium (anticholinesterase) limit CNS penetration

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12
Q

Adverse effects of Levodopa/carbidopa

A 
Carbidopa reduces most of periph side eff of levodopa
Behavioral changes (anxiety, agitation) can worsen
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13
Q

MOA of ethosuximide

A

Phenytoin, carbamazepine, valproic acid: reduce Na ch recovery from inactivation
Ethosuximide: block T-type Ca ch in thalamic neurons

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14
Q

Serotonin syndrome

A

Confusion, agitation, tremor, tachycardia, HTN, clonus, hyperreflexia, hyperthermia, diaphoresis
By overdose of SSRIs esp combined w/ MAOinh
Tryptophan: precursor for serotonin
Ttt: cyproheptadine (antihistamine+antiserotoninergic)

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15
Q

Topical capsaicin

A

For neuropathic pain
Causes defunctionalization of afferent pain fibers + depletion of substance P
Initially: burning + stinging sensation
Chronic use: reduces pain transmission

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16
Q

Treatment of status epilepticus

A

Initial: IV Lorazepam then Phenytoin
Lorazepam: enhance effect on GABA-A recept, increase Cl influx
Phenytoin (long-acting, reduces Na ch recovery from inactivation, inhibits neuronal high-frequency firing)

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17
Q

Solubility of anesthetics

A

Arteriovenous concentration gradient reflects overall tissue solubility
High solubility, large AV concentration gradient + slow onset of action

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18
Q

Broad-spectrum + narrow-spectrum anticonvulsants

A

Broad: (lamotrigine, levetiracetam, topiramate, valproic acid) for most seizure types (focal or generalized)
Narrow: (carbamazepine, gabapentin, phenobarbital, phenytoin) for focal seizures or focal secondarly generalized

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19
Q

Potency of inhaled anesthetic

A

Inversely proportional to MAC

MAC (minimal alveolar concentration) = conc. of anesth in alveoli that renders 50% of ptts unresp to pain

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20
Q

DRESS (Drug reaction + eosinophilia + systemic symptoms) syndrome

A

2-8 weeks after exposure to high-risk drugs
Phenytoin, carbamazepine, allopurinol, sulfasalazine, minocycline, vancomycin
Fever, generalized lymphadenopathy, facial edema, diffuse skin rash, eosinophilia, internal organ dysfunction

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21
Q

Vitamin E deficiency

A 
Neuro symptoms (mimic Friedreich ataxia)
Ataxia (degen of spinocerebellar T)
Loss of position + vibration sense (degen of dorsal columns)
Loss of deep tendon reflexes (periph nerve degen)
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22
Q

CN III palsy (anatomy + presentation)

A

Between post cerebral + superior cerebellar arteries
Compression from ipsilateral post communicating artery aneurysm
Injury: mydriasis (superf parasymp fiber) + diplopia, ptosis, down+out (somatic efferent fiber)

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23
Q

Alzheimer disease

A

Neurofibrillary tangles + amyloid-beta plaques

Trisomy 21: 3 copies of APP (Amyloid Precursor Protein) gene; increase amyloid-beta accumulation; high risk for Alzh

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24
Q

Mechanism of neurodegenerative disorders (Parkinson, Alzheimer)

Study These Flashcards
A

Ubiquitin undergoes ATP-dep attachment to proteins labelling them for degradation
Modified proteins enter proteasome: degraded
Impaired ubiquitin-proteasome system: neurodegen disorders

25
Amyloid Precursor Protein processing (alpha+gamma secretases)
Inappropriate processing: beta+gamma secretase Gives beta-amyloid Insufficient clearance of beta-amyloid: extracellular accumulation, neurotoxic, Alzheimer dementia
26
Cavernous sinus thrombosis
Infection of medial face, sinuses (ethmo, spheno), teeth Spread through valveless venous system into cavernous sinus: thrombosis Headache, fever, proptosis, ipsilateral deficits in CN III,IV,VI,V1,V2
27
Von Recklinghausen (NF-1)
Peripheral nervous system tumor syndrome | Neurofibromas, optic nerve gliomas, Lisch nodules (iris), café-au-lait spots
28
NF-2
Nervous system tumor syndrome Bilateral cranial nerve VIII schwannomas Multiple meningiomas
29
Sturge-Weber syndrome (encephalotrigeminal angiomatosis)
Neurocutaneous disorder Cutaneous facial angiomas (over CN V1, V2 distributions) Leptomeningeal angiomas Mental retardation, seizures, hemiplegia, skull radiopacities
30
Tuberous sclerosis
``` Kidney, liver, pancreatic cysts Cortical + subependymal hamartomas (not angiomas) - seizures Cutaneous angiofibromas Renal angiomyolipomas Cardiac rhabdomyomas ```
31
von Hippel-Lindau disease
Cerebellar hemangioblastoma | Congenital cysts of kidneys, liver, pancreas
32
Myotonic dystrophy
Increased number of trinucleotide repeat (CTG) on myotonia-protein kinase gene Sustained muscle contraction (myotonia) + weakness + atrophy (type 1 fibers) Cataracts, frontal balding, gonadal atrophy # Duchenne (necrosis of muscle fibers + fibrofatty replacement)
33
Denervation muscle atrophy, inflammatory myopathy, ion channel myopathy
Denervation: axonal destruction (trauma, ischemia, ALS); paralysis+atrophy Inflammatory: dermatomyositis, polymyositis Ion channel: myotonia, hypotonic paralysis (w/ exercise); no atrophy; PAS-positive
34
Epidural hematoma
Rare complication of epidural anesthesia After few hours to days Sudden back pain or radicular pain Progression to partial/complete paralysis of lower extremities
35
Ischemic injury in brain tissue vs other organs
Brain: liquefactive necrosis Organs: coagulative necrosis
36
Activation of GABA-A receptors
Increase conductance of Cl- ions (enter) | Hyperpolarization of membrane potential
37
Chronic opioid use
Dev of tolerance to analgesic effects + most side effects Exception of constipation + miosis Prophylaxis ttt w/ fluid intake + laxatives
38
GFAP + Synaptophysin
Synaptophysin: presynaptic vesicles of neurons, neuroendocrine, neuroectodermal cells GFAP: astrocytes, oligodendrocytes, ependymal cells (glial origin)
39
Lesions resp for decerebrate vs decorticate posturing
Decerebrate: damage to brainstem at/below red nucleus (midbrain tegmentum or pons) Decorticate: damage to structures above red nucleus (hemispheres, internal capsule)
40
Vitamin B12 and folic acid deficiencies
Similar hemato symptoms Neuro dysfunction only in vit B12 def Neuro dysfunction worsen if vit B12 def is ttt w/ folate alone
41
Neurosyphilis
Different manif Tabes dorsalis: degen of dorsal columns + dorsal roots of spinal cord (loss of proprioception + vibration, ataxia) Argyll Robertson pupils
42
Dysfunction/obliteration of subarachnoid villi
``` Communicating hydrocephalus (symmetrical enlargement of ventriculi) Sequelae of meningeal inf (tuberculosis meningitis, ...) Sequelae of subarachnoid/intraventricular hge ```
43
Activation of muscarinic receptors
Endoth cells: NO + peripheral vasodilation; smooth muscle relaxation, hypotension Other sites: smooth muscle contraction
44
Structures entering superior orbital fissure
``` CN III CN V1 CN IV CN VI Superior ophthalmic vein ```
45
Anatomy of area postrema
Dorsal medulla near 4th ventricle
46
Beta-endorphin
Endogenous opioid | Derived from POMC (like ACTH + MSH)
47
Wallerian degeneration
Axonal degen + breakdown of myelin sheath distal to injury No axonal regen in CNS bcz persistence of myelin debris, secretion of neuronal inhib factors, dev of dense glial scarring
48
Creutzfeldt-Jacob ds
Rapidly progressive dementia + myoclonic jerks | Multiple vacuoles in gray matter
49
Neuroblastoma
Extracranial, from neural crest cells of adrenal medulla Abdo mass High catecholamine breakdown products Paraneopl sd: opsoclonus-myoclonus
50
Wernicke encephalopathy + Korsakoff psychosis
Acute VitB1 def: Wernicke (mamillary body lesion, part of Papez circuit) = triad (confusion, ataxia, oculomotor dysfct) Chronic VitB1 def: Korsakoff (permanent memory loss + confabulation)
51
Locus ceruleus
Brainstem nucleus in post rostral pons near lateral floor of 4th ventricle Principle site of NE synthesis in brain Projects to all CNS parts: control mood, arousal, sleep-wake states, cognition, autonomic fct
52
Pilocytic astrocytomas vs medulloblastomas
Both: in cerebellum Piloc astr: cystic + solid components Medullobl: solid component
53
MOA of normal pressure hydrocephalus
Distortion of periventricular white matter | Bladder control: influenced by descending cortical fibers (pass in distended paraventricular area) - urge incontinence
54
Most common causes of meningitis
Viral: enteroviruses, arboviruses, HSV-2 Bacterial - adults: Strep pneumo, N meningitidis Bacterial - neonates: group B strep, G- bacilli
55
Epidural hematoma
Tear in middle meningeal artery Ass w/ bone fracture Between bone + dura mater Lucid interval before clinical presentation, then loss of consciousness
56
Idiopathic intracranial HTN (pseudotumor cerebri)
Daily headache Bilat symmetric papilledema Transient visual disturbances High intracranial pressure: optic N compression, impaired axoplasmic flow + optic disc edema
57
Fetal toxicity of Valproate
Decreases folic acid | Increases risk of neural tube def (meningoc, myelomeningoc)
58
Bell’s palsy
Unilateral facial paralysis Decreased tearing Hyperacusis Loss of taste sensation over anterior 2/3

Dr. Mel - Neurology (3 decks)

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