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500 Cards in this Set

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Parkinson's drug that selectively inhibits MAO-B
selegiline
epilepsy drug that can cause agranulocytosis
carbamazepine
what do you use to treat benzodiazepine overdose?
flumazenil (competitive antagonist at GABA receptor)
seizure drug that can cause SLE-like syndrome
phenytoin
what is the mechanism of dilantin/phenytoin?
use-dependent blockade of Na+ channels
chronic use of this anti-epileptic can cause gingival hyperplasia in kids, peripheral neuropathy, hirsutism, megaloblastic anemia, and malignant hyperthermia
phenytoin
mechanism of action of barbiturates?
facilitate GABA action by increasing duration of Cl- channel opening, thus decreasing neuron firing
what seizure drug is contraindicated in porphyria?
barbiturates
barbiturates do what to the P-450 system?
induce it
what epilepsy drug is associated with hepatotoxicity and neural tube defects?
valproic acid
what drug is used to treat neuroleptic malignant syndrome (rigidity, myoglobinuria, autonomic instability, hyperprexia)
dantrolene and dopamine agonists
tardive dyskinesia can result from long-term use of what class of drugs?
neuroleptics (antipsychotics) - thioridazine, haloperidol, fluphenazine, chlorpromazine
schizophrenia drug that can cause agranulocytosis
clozapine
side effects of lithium?
polyuria (ADH antagonist causeing nephrogenic diabetes insipidus), hypothyrodism
what is the mechanism of action of atypical antipsychotics (clozapine, olanzapine, risperidone)
block 5-HT2 and dopamine receptors
what is 'serotonin syndrome'?
can occur when SSRIs are given with MAOI's - hperthermia, muscle rigidity, CV collapse
fluoxetine, sertaline, paroxetine, and citalopram are what type of drugs?
SSRIs
how do TCAs work?
block reuptake of NE and serotonin - imipramine, amitrptyline, desipramine, nortriptyline, clomipramine, doxepin
what TCA can be used for bedwetting?
imipramine
which TCA is the least sedating?
desipramine
which class of antidepressants has convulsions, coma, arrythmias, respiratory depression as potential toxicities?
tricyclics
tricyclics can cause confusion and hallucinations in elderly due to anticholinergic side effects - what do you use?
nortriptyline
which of the SSRIs inhibits the P-450 system?
fluvoxamine
which atypical antipsychotic can also be used to treat OCD, GAD, depression, mania?
olanzapine
what is the mechanism of antipsychotic drugs?
block dopamine D2 receptors
this parkinson's drug agonizes dopamine receptors
bromocriptine
mechanism of action of amantadine? what is it used for?
increased dopamine - parkinson's
entacapone and tolcapone are parkinson's drugs that inhibit what?
COMT - prevent dopamine breakdown
this parkinson's drug curbs excess cholinergic activity
benztropine - antimuscarinic, improves tremor and rigidity but has littel effect on bradykinesia
mechanism of l-dopa
increased level of dopamine in brain
what is l-dopa administered with and why?
carbidopa - a peripheral decarboxylase inhibitor - increases the bioavailability of l-dopa in the brain and to limit peripheral side effects
what is sumatriptan and what is it used for?
5-HT1D agonist - causes vasoconstriction; used for acute migraine & cluster headache attacks
sumatriptan is contraindicated in patients with what? why?
can cause coronary vasospasm, so contraindiicated in pts. with CAD or prinzmental's angina
which 2 epilepsy drugs can cause stevens-johnson syndrome?
lamotrigine, ethosuximide
what is the first line drug for absence seizures?
ethosuximide
what is the first line drug for acute status epilepticus?
benzodiazepines (diazepam or lorazepam)
what is the first line drug for prophylaxis of status epilepticus?
phenytoin
what is the first-line seizure drug for pregnant women, children?
phenobarbital
this drug is a first-line treatment for tonic-clonic seizures and trigeminal neuralgia
carbamazepine
what is the mechanism of action of benzodiazepines?
facilitate GABAa action by increasing frequency of Cl- channel opening
this class of antidepressants can cause sedation, alpha-blocking effects, atropine-like effects (tachycardia, urinary retention)
TCAs
what is the mechanism of action of venlafaxine?
heterocyclic antidepressant - inhibits serotonin, NE, and dopamine reuptake
mechanism of action of mirtazapine?
alpha2 agonist - increases release of NE and serotonin, and potent 5-HT2 and 5-HT3 receptor antagonist
this heterocyclic antidepressant blocks NE reuptake
maprotiline
what is the clinical use of MAOIs?
atypical depression (i.e. with psychotic or phobic features(, anxiety, hypochondriasis
MAOIs are contraindicated with what two classes of drugs?
SSRIs and beta blockers (prevent serotonin syndrome)
what is a sensitive indicator of alcohol use?
serum gamma-glutamyltransferase
disinhibition, emotional lability, slurred speech, ataxia, coma, and blackout are signs of what type of intoxication?
alcohol
tremor, tachycrdia, hypertension, malaise, nausea, seizures, agitation, hallucinations are signs of withdrawal from what?
alcohol
CNS depression, nausea and vomiting, constipation, pinpoint pupils, and seizures may be signs of what type of intoxication?
opiods
anxiety, insomnia, anorexia, sweating, dilated pupils, fever, rhinorrhea, piloerection, nausea, cramps, diarrhea, yawning are signs of withdrawal from what type of drug?
opiods
psychomotor agitation, impaired judgement, pupillary dilation, hypertension, tachycardia, euphoria, prolonged wakefulness and attention, cardiac arrythmias, delusions, hallucinations, and fever may be signs of what type of intoxication?
amphetamines
post use crash, including depression, lethargy, headache, stomach cramps, hunger, and hypersomnolence are characteristic of withdrawal from what?
amphetamines
euphoria, psychomotor agitation, impaired judgment, tachycardia, pupillary dilation, hypertension, hallucinations (including tactile), paranoid ideations, angina, and sudden cardiac death may be signs of intoxication with what drug?
cocaine
post use crash, including severe depression and suicidality, hpersomnolence, fatigue, malaise, severe psychologial craving are characteristic of withdrawal from what?
cocaine
belligerence, impulsiveness, fever, pschomotor agitation, vertical and horizontal nystagmus, tachycardia, ataxia, homicidality, psychosis, and delerium are indicative of intoxication with what drug?
PCP
recurrence of intoxication symptoms due to reabsorption in GI tract, sudden onset of severe, random, homicidal violence may occur with withdrawal from what substance?
PCP
what 2 drugs are not typically associated with withdrawal symptoms?
marijuana, LSD
marked anxiety or depression, delusions, visual hallucinations, flashbacks, and pupil dilation are characteristic of intoxication with what substance?
LSD
euphoria, anxiety, paranoid delusions, perception of slowed time, impaired judgment, social withdrawal, increased appetite, dry mouth, and hallucinations are characteristics of what type of substance use?
marijuana
which has a higher safety margin: barbiturates or benzodiazepines?
benzodiazepines
anxiety, seizures, delerium, life-threatening CV collapse are potential side effects of withdrawal from what?
barbiturates
what drug inhibits opiods?
naltrexone
this drug of abuse causes pupillary constriction/pinpoint pupils
opiods
these 3 drugs of abuse can cause pupillary dilation
amphetamines, cocaine, LSD
this drug of abuse can cause vertical and horizontal nystagmus
PCP
this drug of abuse can cause angina and sudden cardiac death
cocaine
which drug of abuse is associated wtih homicidality?
PCP
which epilepsy drug can cause kidney stones?
topiramate
name two MAOIs
phenelzine, tranylcypormine
what class of benzodiazepines are the most appropriate for acute insomnia and jet lag?
short-acting, e.g. triazolam
alpazolam is what type of benzodiazepine and what is it most often used for?
intermediate-acting; panic attacks
is secobarbital short- or long-acting?
short
what is xerostomia?
dry mouth
what type of drug is benztropine?
anticholinergic - leads to anti-SLUDG side effects
how do methamphetamine/amphetamine work?
gain entrance to dopamine and NE nerve terminals, causing the release of these NTs via the uptake carriers; DA is a significant factor in the reinforcing effects of stimulants
how does supatriptan work?
serotonin1D agonist
this type of cell is important for physical support & repair, K+ metabolism, and helps to maintain BBB
astrocyte
what are microglia responsible for?
phagocytosis
where are ependymal cells found?
inner lining of ventricles
from where do microglia originate?
mesoderm (like macrophages; M)
how many axons does each oligodendrocyte myelinate?
multiple - up to 30 each
what is the predominant type of glial cell in white matter?
oligodendroglia
how many axons do Schwann cells myelinate?
only one each; also promote axonal regeneration
what fuses to form multinucleated giant cells in CNS of HIV infected patients?
HIV-infected microglia
what peripheral nerve layer serves as a permeability layer?
perineurium - must be rejoined in microsurgery for limb reattachment
what layer surrounds the entire nerve (fascicles and blood vessles)?
epineurium
what peripheral nerve layer invests single nerve fibers?
endoneurium
these are found in dermis of palms, soles, and digits
Meissner's corpuscles
what is involved in light discriminaory touch of glabrous (hairless) skin?
Meissner's corpuscles
these are large, encapsulated nerve endings found in deeper layers of skin at ligamnts, joint capsusles, serous membranes, mesnteries
pacinian corpuscles
these are involved in pressure, coarse touch, vibration, and tension
pacinian corpuscles
these are cup-shaped nerve endings (tactile disks) in dermis of fingertips, hair follicles, and hard palate that are invovled in light, crude touch
Merckel's corpuscles
perilymph is rich in what?
Na+ (peri- think outside the cell)
endolymph is rich in what?
K+ (endo-think inside the cell)
what does the bony labyrinth include?
filled with perilymph - cochlea, vestibule, semicircular canals
what does the membranous labyrinth include?
filled with endolymph - cochlear duct (within the cochlea), utricle and saccule (within the vestibule), and semicircular canals
what frequency sound does the base of the cochlea pick up?
narrow and stiff - picks up high-frequency
what frequency sounds does the apex of the cochlea pick up?
wide and flexible - picks up low-frequency
what do the ampullae detect?
angular acceleration
how does hearing loss progress in the elderly?
high frequency - low frequency
what do the utricle and saccule contain and detect?
maculae - detect linear acceleration
what produces endolymph?
stria vascularis
what 3 structures form the blood-brain barrier?
1. tight junctions between nonfenestrated capillary membranes 2. basement membrane, 3. astrocyte process
how do glucose and AA's cross the BBB?
carrier-mediated transport mechanism
which crosses the BBB more readily: nonpolar/lipid-soluble substances or polar/water-soluble substances?
nonpolar/lipid soluble substances
name 2 specialized brain regions with fenestrated capillaries and no BBB that allow molecules in the blood to affect function or neurosecretory products to enter circulation
1. area postrema- vomiting after chemo 2. neurohypophysis - ADH release
what hypothalamic nucleus is responsible for thirst and water balance?
supraoptic nucleus
the neurohypophysis releases hormones that were synthesized where?
hypothalamic nuclei
destruction of what hypothalamic nucleus leads to anorexia and starvation?
lateral nucleus
destruction of what hypothalamic nucleus leads to hyperphagia and obesity?
ventromedial (you grow ventrally and medially)
what part of the hypothalamus regulates the parasympathetic NS?
anterior
what part of the hypothalamus regulates the sympathetic nervous system?
posterior
what part of the hypothalamus regulates circadian rhythms?
suprachiasmatic nucleus
what part of the hypothalamus regulates heat conservation and production when cold?
posterior hypothalamus
what part of the hypothalamus coordinates cooling when hot?
anterior (A/C)
what part of the hypothalamus controls sexual urges and emotions? (destruction of this nucleus leads to rage)
septal nucleus (S-sexual/septal)
the posterior pituitary recieves axonal projections from where?
supraoptic (ADH) and periventricular (oxytocin) nuclei
which thalamic nucleus is responsible for relaying visual information?
lateral geniculate nucleus - (Lateral for Light)
which thalamic nucleus is responsible for relaying auditory information?
medial geniculate nucleus (M-music)
which thalamic nucleus is responsible for relaying body sensation?
VPL
which thalamic nucleus is responsible for relaying facial sensation?
VPM
which thalamic nucleus is responsible for relaying motor information?
VA/VL nuclei
what is the limbic system responsible for?
feeding, fighting, feeling, flight, and sex (famous 5 Fs)
premotor area is what Broadman's area?
6
principal motor area is what Broadman's area?
4
principal sensory area is what Broadman's areas?
3, 1, 2
principal visual cortex is what Broadman's area?
17
associative auditory cortex/Wernicke's area is what Broadman's area?
22
primary auditory cortex is what Broadman's area?
41, 42
motor speech/Broca's area is what Broadman's area?
44, 45
frontal eye fields are what Broadman's area?
8
what is most notable in a frontal lobe lesion?
lack of social judgment
this supplies the medial surface of the brain, leg-foot area of motor and sensory cortices
anterior cerebral artery
what artery supplies the lateral apsect of the brain, trunk-arm-face area of motor and sensory cortices, and Broca's and Wernicke's areas?
MCA
what artery is the most common circle of Willis aneurysm; lesion may cause visual field defects?
anterior communicating artery
lesion of this artery causes CN III palsy
posterior communicating artery - common area of aneurysm
these are known as the 'arteries of stroke'
lateral striate areries - divisions of MCA
what do the lateral striate arteries supply?
internal capsule, caudate, putamen, globus pallidus
a stroke of what circle leads to general sensory and motor dysfunction and aphasia?
anterior
a stroke of what circle leads to cranial nerve deficits, coma, and cerebellar deficits?
posterior
cerebral veins drain into what?
venous sinuses - internal jugular vein
what is the main location of CSF return via arachnoid granulations?
superior saggital sinus
hemisection above TI presents with what?
Horner's syndrome
what waveform is present when awake with eyes open?
beta
awake with eyes closed - what waveform?
alpha
stage 1/light sleep - what waveform?
theta
stage 2/deeper sleep - what waveform?
sleep spindles and K complexes
stage 3-4/deepest, non-REM sleep, sleepwalking, night terrors, bed-wetting (slow-wave) - what waveform?
delta - lowest frequency, highest amplitude
in what stage of sleep is there dreaming, loss of motor tone, possibly a memory processing function, erections, increased brain O2 use?
REM
what waveform is associated with REM sleep?
beta
serotonergic predominance of raphe nucleus is key to initiating what?
sleep
what neurotransmitter reduces REM sleep?
NE
what is responsible for the extraocular movements seen during REM sleep?
PPRF (paramedian pontine reticular formation/conjugate gaze center)
what drugs shorten stage 4 sleep? what are they therefore useful for?
benzodiazepines - night terrors and sleepwalking
why is imipramine used to treat enuresis?
because it decreases stage 4 sleep
what happens to pulse and BP during REM sleep?
increased and variable
how often does REM sleep occur?
every 90 minutes - duration increases throughout the night
what is the principal neurotransmitter involved in REM sleep?
ACh
where's the lesion: motor (nonfluent/expressive) aphasia with good comprehension
Broca's area
where's the lesion: sensory (fluent/receptive) aphasia with poor comprehension
Wernicke's area
where's the lesion: conduction aphasia; poor repetition with good comprehension, fluid speech
arcuate fasciculus
where's the lesion: Kluver-Bucy syndrome (hyperorality, hypersexuality, disinhibited behavior)
bilateral amygdala
where's the lesion: personality changes and deficits in concentration, orientation, and judgement; may have reemergence of primitive reflexes
frontal lobe
where's the lesion: spatial neglect syndrome (agnosia of the contralateral side of the world)
right parietal lobe
where's the lesion: coma
reticular activating system
where's the lesion: Wernicke-Korsakoff syndrome
bilateral mammilary bodies
where's the lesion: tremor at rest, chorea, or athetosis
basal ganglia
where's the lesion: intention tremor, limb ataxia
cerebellar hemisphere (laterally located, affect lateral limbs)
where's the lesion: truncal ataxia, dysarthria
cerebellar vermis (centrally located - affects central body)
where's the lesion: contralateral hemiballismus
subthalamic nucleus - loss of inhibition of thalamus through globus pallidus
what do you call slow, writhing movements, especially of fingers? what are these characteristic of?
athetosis; basal ganglia lesion
where is Broca's area?
inferior frontal gyrus
where is Wernicke's area?
superior temporal gyrus
familial form of AD (10%) is associated with genes on what chromosomes?
1, 14, 19 - APOE4 allele (ch 21 pApp gene)
intracellular, abnormally phosphorylated tau protein is associated with what?
neurofibrillary tangles in AD
dementia, aphasia, parkinsonian aspects & specificity for frontal and temporal lobes?
Pick's disease
intracellular, aggregated tau protein is associated with what?
Pick bodies
what disease is associated with Lewy bodies?
Parkinson's
what 2 degenerative diseases are associated with spinocerebellar atrophy?
olivopontocerebellar atrophy, Friedreich's ataxia
this disease is associated with degeneration of anterior horns
Werdnig-Hoffman disease
this disease presents at birth as a 'floppy baby'; tongue fasciculations are characteristic
Werdnig-Hoffman disease
how is Werdnig-Hoffman disease inherited; what is the median age of death?
AR, 7 months
polio is associated with degeneration of what?
anterior horns - LMN destruction
how is poliovirus transmitted?
fecal-oral
what are the CSF findings in poliomyelitis?
lymphocytic pleocytosis with slight elevation of protein
what is the classic triad associated with MS?
scanning speech, intention tremor, nystagmus (SIN)
what is the treatment for MS?
beta-interferon or immunosuppressant therapy
the prevalance of this disease increases with distance from equator
MS
what are periventricular plaques?
areas of oligodendrocyte loss and reactive gliosis seen in MS (preservation of axons)
patients with what disease can present with optic neuritis, MLF syndrome, hemiparesis, hemisensory symptoms, or bladder/bowel incontinence?
MS
what is progressive multifocal leukoencephalopathy associated with?
JC virus - seen in 2-4% of AIDS patients (reactivation of latent virus)
what is the treatment for Guillain Barre?
respiratory support until recovery; plasmapheresis, IVIg
symmetric ascending muscle weakness beginning in distal lower extremities is seen in what disease?
Guillain Barre
what are the CSF findings in Guillain Barre?
elevated CSF protein with normal cell count - albuminocytologic dissociation; elevated protein leads to papilledema
this disease is marked by inflammation and demyelination of peripheral nerves and motor fibers of ventral roots
Guillain Barre - sensory effect is less severe than motor
what are the causes of seizures in children?
genetic, infection, congenital, trauma, metabolic
what are the causes of seizures in adults?
tumors, trauma, stroke, infection
what are the causes of seizures in elderly?
stroke, tumor, trauma, metabolic, infection
this type of seizures involves one area of the brain
partial
rupture of middle meningeal artery causing an epidural hematoma is often secondary to what?
fracture of temporal bone
what does CT show in epidural hematoma?
biconvex disk not crossing suture lines
what kind of intracranial hemorrhage is most likely to be seen in a shaken baby, elderly person, or alcoholic?
subdural hematoma - rupture of bridging veins
this type of intracranial hemorrhage is caused by hypertension, amyloid angiopathy, DM, and tumor
parenchymal hematoma
what does CT show in the case of subdural hematoma?
crescent-shaped hemorrhage that crosses suture lines
what is the drug of choice for status epilepticus?
diazepam
what is the most common site of obstruction causing hydrocephalus?
aqueduct of sylvius
what is the underlying lesion in retinopathy of prematurity?
inappropriate proliferation of vessels in the inner layers of the retina
location at the junction of cortical gray and white matter is typical for what type of tumor?
metastatic; round shape is also characteristic
progressive dementia with diffuse loss of deep hemispheric white matter?
subcortical leukoencephalopathy - Binswanger disease - one of the neurologic syndromes associated with hypertension
what degenerative disorder is characterized by ophthalmoplegia, pseudobulbar palsy, axial dystonia, and bradykinesia?
progressive supranuclear palsy - widespread neuronal loss and gliosis in subcortical sites with sparing of the cerebral and cerebellar cortices
confusion, ataxia, vestibular dysfunction, sluggish pupillary light reflexes, anisocoria, and oculomotor dysfunction are acute sympmtoms as what?
Wernicke's syndrome - thiamine deficiency usually second to chronic alcohol abuse (chornic form includes anterograde amnesia and confabulation and is called wernicke korsakoff)
syringomyelia is often associated with what?
Arnold-Chiari malformation, in which there is a congenital protrusion of the cerebellum and medulla through the foramen magnum
this type of benign tumor often involves the lateral ventricles of young boys
choroid plexus papilloma - can affect the caudate because it comprises part of the wall of the lateral ventricle
atrophy of the caudate and putamen can make what look large on imaging?
ventricles
a pituitary tumor that expands laterally will first affect what?
abducens nerve
lesion of the right parietal lobe will cause what?
sensory neglect syndrome of left side (most common pattern in right handed patients)
what is the most common primary brain tumor?
glioblastoma multiforme - grade IV astrocytoma
what stains astrocytes?
GFAP
this type of tumor has 'pseudopalisading cells' that border central areas of necrosis and hemorrhage
glioblastoma multiforme
this type of brain tumor has spindle cells concentrically arranged in a whorled pattern' psammoma bodies (laminated calcifications)
meningioma
this is the second most common type of brain tumor - most often occurs in convexities of hemispheres and parasagittal region
meningioma
from what does a meningioma arise?
arachnoid cells external to brain
this is the third most common primary brain tumor - originates from Schwann cells
Schwannoma - often localized to 8th nerve (acoustic neuroma)
this tpe of tumor contains 'fried egg' cells
oligodendroglioma - often calcified
where are oligodendrogliomas most frequently found?
frontal lobes
the majority of adult primary tumors are located where?
supratentorial
the majory of childhood primary tumors are found where?
infratentorial
this tumor has a peak incidence in childhood - diffusely infiltrating glioma, most often found in posterior fossa; benign with good prognosis
pilocytic (low-grade) astrocytoma
this type of childhood peak incidence brain tumor has Rosenthal fibers - eosinophilic, corkscrew fibers
pilocytic (low-grade) astrocytoma
this is a highly malignant cerebellar tumor & a form of primitive neuroectodermal tumor (PNET); found primarily in children; can compress the 4th ventricle to cause hydrocephalus
medulloblastoma
this type of childhood tmor contains rosettes or perivascular pseudorosete pattern of cells & is radiosensitive
medulloblastoma
where are ependymomas most commonly found? what is the prognosis?
4th ventricle; poor prognosis
foamy cells and high vascularity are characteristic of what type of childhood-predominant tumor?
hemangioblastoma
this type of brain tumor is associated with von Hippel-Lindau
hemangioblastoma
this type of tumor shows characteristic perivascular pseudorosettes; rod-shaped blepharoplasts are found near the nucleus
ependymoma
this type of child-predominant tumor can produce EPO, leading to secondary polycythemia
hemangioblastoma
this is a benign childhood tumor, confused with pituitary adenoma
craniopharyngioma
this is the most common childhood supratentorial tumor
craniopharyngioma
where does syringomyelia most commonly occur?
C8-T1
contralateral paralysis of lower face only
lesion of motor cortex or connection between cortex and facial nucleus (UMN CN VII)
cingulate herniation under falx cerebri can compress what?
anterior cerebral artery
what results with downward transtentorial (central) herniation?
coma and death - if compress brainstem
ipsilateral dilated pupil/ptosis in uncal herniation results from what?
stretching of CN III
contralateral homonymous hemianopia in uncal hernaition results from what?
compression of ipsilatearal posterior cerebral artery
ipsilateral paresis in uncal herniation results from what?
compression of contralateral crus cerebri (Kernohan's notch)
Duret hemorrhages - paraemdian artery rupture in uncal herniation results from what?
caudal displacement of brain stem
lesion in MLF results in what on attempted lateral gaze?
medial rectus palsy; nystagmus is seen in the abducting eye; convergence is normal
why are local anesthetics less effective in areas of infection?
they are weak bases and are only effective at penetrating tissue in the unprotonated form - abscesses have lower pH and thus lidocane, etc. becomes protonated and poor anesthesia results
transient global amnesia usually represents a variant of what?
TIA (typically in the posterior cerebral territory): migraine and epileptic attacks have also been implicated in some cases of transient global amnesia
what level is normal for CSF glucose?
about 2/3 of the serum value
how is the hypophysis approached transnasally?
through the spenoid sinus
what becomes atrophic in tabes dorsalis?
dorsal column
to what class of drugs does phenelzine belong?
MAOI
what condition is characterized by demyelination of the central pons following overly rapid correction of severe hyponatremia
central pontine myelinolysis
coagulative necrosis of brain parenchyma with macrophage-rich chronic inlammatory infiltration mixed with microscopic cysts containing bradyzoites: ring-enhancing lesions in AIDS patient
toxoplasmosis
what drugs will reverse the paralysis of vercuronium?
neostigmine, edrophonium, and other cholinesterase inhibitors
what does the recurrent laryngeal nerve innervate?
all of the intrinsic laryngeal muscles except the cricothyroid
meningitis - encapsulated yeast, HIV patient, Mississippi/Missouri river beds
Cryptococcus
what type of fungus is cryptococcus?
monomorphic - encapsulated yeast form is found in both clinical specimens and in the environment as the infectious form
occlusion of what artery causes a lateral medullary syndrome characterized by deficits in pain and temperature sensation over contralateral body, ipsilateral dysphagia, hoarseness, diminished gag reflex, vertigo, diplopia, nystagmus, and vomiting, ipsilateral Horner's, and ipsilateral loss of pain and temperature sensation of the face?
PICA
occlusion of what artery causes ipsilateral facial paralysis, ipsilateral cochlear nucleus damage, nystagmus, and ipsilateral pain and temperature loss of face; ipsilateral dystaxia?
AICA
occlusion of what artery results in homonymous hemianopsia of the contralateral visual field?
posterior cerebral artery
fever, headache, nuchal rigidity, and low Glascow coma score along with increased neutrophils, elevated protein, and reduced glucose in the CSF indicate waht type of meningitis?
bacterial
what is the most frequent organism causing meningitis in the elderly?
strep pneumo
severe ocular pain accompanied by blurred vision associated with halos around lights; eye that is red and hard; mydriasis?
acute angle-closure glaucoma
what is the treatment for acute angle-closure glaucoma?
IV acetazolamide - inhibits carbonic anhydrase, leading to reduced production of aqueous humor and a concomitant reduction in intraocular pressure; osmotic diuretics can also be used
what nerve lies in the tonsillar fossa?
glossopharyngeal nerve - general sensory innervation to the mucosa of pharynx, and general sensory and taste sensation to the mucosa of the posterior 1/3 of the tongue
what do you call the inability to recognize, despite adequate sensation?
agnosia
what type of drug is amitryptiline? what are its side effects?
TCA - strong anticholinergic properties
what gyrus will be most affected in a subfalcine herniation?
cingulate gyrus - runs along the medial aspect of the cerebral hemisphere, just above the corpus callosum
what are the two active metabolites of primidione (an anticonvulsant used for the treatment of tonic-clonic, psychomotor, and focal epileptic seizures)?
phenobarbital and phenethylmalonamide (PEMA)
subacute sclerosing panencephalitis can follow infection with what virus?
measles
what are cortical tubers?
malformed (hemartomatous) nodules of the cortex - seen in tuberous sclerosis
supendymal giant cell astrocytoma grows from the walls of the lateral ventricles and is pathognomonic for what?
tuberous sclerosis
intracytoplasmic spherules composed of paired helical filaments seen best with silver stains
Pick bodies
paralysis of upward gaze?
lesion/ compression of the superior colliculi
aneurysm of superior cerebellar artery, posterior cerebral artery, or basilar artery can all compress what nerve?
oculomotor
tumors of what compress the vertical gaze center?
pineal gland
what does the pineal gland manufacture from serotonin?
melatonin
in what anatomic space is the middle meningeal artery located?
middle cranial fossa
lesion of what produces central scotoma?
macula
lesion of what causes ipsilateral blindness?
optic nerve
lesion of what causes bitemporal hemianopia?
optic chiasm
lesion of what causes homonymous hemianopia?
optic tract
lesion of what auses upper homonymous quadrantanopia?
temporal optic radiations
lesion of what causes lower homonymous quadrantanopia?
parietal optic radiations
what CN is responsible for the gag reflex?
CN IX
the posterior half of the ear canal receives sensory information from what?
auricular branch of vagus
naegleria fowleri crosses what to enter the brain via the olfactory nerves?
cribriform plate - trauma to nose predisposes to meningoencepalitis
on what chromosome is Rb located?
13
perivenous microglial encephalitis with demyelination is characteristic of what?
post-infectious encephalomyelitis after measles
in smaller muscles, how many muscle fibers does an alpha motor neuron innervate?
just a few - results in finer control of movement
cerebellum influences motor activity on which side?
ipsilateral - projects to contralateral motor cortex and red nuclei whose fibers cross back over
what does the anterolateral system/spinothalamic tract carry?
pain, temperature, crude touch, and pressure
what information do the dorsal columns carry?
fine touch, vibration, concious proprioception
where does the corticospinal tract deccussate?
as it descends through the inferior aspect of the medulla through the medullary pyramids
where do the dorsal columns cross over?
between their nuclei in the brainstem and the thalamus via the arcuate fibers of the medial lemniscus
where do the axons of the spinothalamic tract cross over?
almost immediately after their first-order synapes in the dorsal horn
what are the neurological deficits that occur in Brown-Sequard syndrome?
ipsilateral motor loss and loss of touch, vibration, propriceptive sense; contralateral pain and temperature loss
where do the motor and sensory deficits manifes in patients with a lesion of the internal capsule?
corticospinal tract, dorsal columns, and spinothalamic tract travel to or from the cerebral cortex through the posterior limb - contralateral hemiplegia and contralateral sensory loss
what is the primary mode of analgesic relief of opiods?
inhibition of the spinothalamic tract
what disorder is characterized by loss of pyramidal cells in the cerebral motor cortex that leads to fibrosis of the lateral corticospinal tracts
ALS
what is usually spared in ALS?
sensory tracts and cognitive function
what are signs of UMN lesions?
spastic paralysis, hyperactive deep tendon reflexes, and clonus - UMNs are tonically inhibitory to LMNs
what are signs of LMN lesions?
hporeflexia, fasciculations, flaccid paralysis
familial forms of ALS have been associated with what?
mutations in the zinc/copper superoxide dismutase gene, which plays an important role in scavenging free radicals in metabolically active cells such as neurons
periventricular plaques on MRI and oligoclonal bands in CSF are indicative of what?
MS
what is destroyed in Parkinson's?
dopaminergic neurons in the substantia nigra
what kind of drug is bromocriptine?
dopamine receptor agonist
what is benztropine? why is it useful in PD?
anticholinergic - relative excess of Ach because of dopamine deficiency; anticholinergics can be useful in treating motor symptoms
what compound that may be found in ilicit drugs can cause PD?
MPTP - selectively destroys neurons in the substantia nigra
what is the difference between tremor in PD and tremor in cerebellar dysfunction?
PD - resting tremor, cerebellar dysfunction - tremor associated with volitional movements
what is MG often associated with?
thymoma
what is the pathophysiology of motor weakness in MG?
antibodies to the post-synaptic nicotinic ACh receptors on skeletal muscle fibers
what type of receptors are nicotinic receptors?
ligand-gated sodium channels
what kind of drug is edrophonium?
short-acting cholinesterase inhibitor - increases concentration of ACh in synaptic cleft
what are the long-acting cholinesterase inhibitors?
pyridostigmine and neostigmine
what are the side effects of cholinesterase inhibitors?
excessive PNS stimulation - diarrhea, miosis, bronchospasm, excessive urination, bradycardia, salivation, lacrimation; also sweating because SNS stimulates sweating via ACh
how do you treat organophosphate poisoning?
treatment aimed at reducing total cholinergic activity - palidoxine regenerates active cholinesterase, and anticholinergic atropine
what is Lambert-Eaton syndrome?
AI disease with antibodies to voltage-gated calcium channels located in terminal bouton of presynaptic neurons result in impaired ACh release
what is Lambert-Eaton syndrome often associated with?
paraneoplastic syndromes, particularly small cell CA of lung
bilateral loss of pain and temperature sensation?
syringomyelia
what is syringomyelia?
expanded fluid-filled cavity in spinal cord that affects the spinothalamic tract
what produces atrophy of the muscles of hands and hypoactive reflexes of the upper extremities in syringomyelia?
expansion of the syrinx to compress the ventral horns - produces LMN signs
what should you examine for masses in a patient with trigeminal neuralgia?
posterior fossa
what drug is used to treat trigeminal neuralgia?
carbamazapine - reduces rate of nerve transmission by inhibiting voltage-gated sodium channels of neurons
what are CSF findings in MS?
oligoclonal immunoglobulin bands (absent in serum), elevated IgG, and myelin basic protein
this is a disease that involves demyelination of various white matter areas of the CNS
MS
what cell type is attacked and destroyed during an exacerbation of MS?
oligodendrocytes
this syndrome is due to demyelination of peripheral nerves
Guillan-Barre
this type of stroke primarily results from atherosclerosis and subsequent thrombus/embolism or from hypercoaguability in LA (e.g. atrial fibrillation) or LV (after MI)
ischemic stroke
this type of stroke results predominantly from trauma, ruptured AV malformation, ruptured aneurysm, or vessel rupture due to hypertension
hemorrhagic
how does atrial fibrillation predispose to stroke?
makes it easier for blood to pool and clot within the atria, and the clots can then embolize to brain
what serves the motor and sensory cortex devoted to the contralateral leg?
anterior cerebral artery
what does the MCA supply?
motor and sensory cortex for contralateral upper extremity, head, neck, and face
what artery supplies Broca's and Wernicke's areas?
MCA (typically on left)
occlusion of what can cause left homonymous hemianopsia?
right posterior cerebral artery - supplies visual cortex in occipital lobe
worst headache of life, N&V, stiff neck, photophobia?
subarachnoid hemorrhage
where do you do an LP?
L3-L4 or L4-L5 (SC terminates at L1-L2)
what are the common causes of subarachnoid hemorrhage?
ruptured berry aneurysm, ruptured AVM, head trauma (most common)
patients with PKD most often have berry aneurysms in what location?
bifurcation of anterior communicating artery
almost one-half of cases of this are idiopathic; the rest develop after meningitis, subarachnoid hemorrhage, or intracranial surgery or develop as a result of a tumor
hydrocephalus
CSF flows from the lateral ventricles into the third ventricle via what?
foramen of Monroe
CSF flows from the third ventricle to the fourth ventricle via what?
cerebral aqueduct (aqueduct of Sylvius)
how is CSF reabsorbed?
empties into dural venous sinuses via arachnoid granulations
trauma that causes unconsciousness followed by lucid interval followed by confusion, lethargy, disorientation
epidural hematoma - intracranial bleeding that dissects periosteal dura away from skull
this is composed of a periosteal layer adherent to bone and a meningeal layer continuous with the arachnoid layer
dura mater
what artery is most commonly involved in an epidural hematoma?
middle meningeal artery - ruptures between dura and skull
this layer attaches directly to brain parenchyma
pia
does CSF show RBCs in an epidural bleed?
no - blood does not reach subarachnoid space where CSF is located
what structures are typically involved in a subdural hematoma?
bridging veins that interconnect the subarachnoid space and the dural (venous) sinuses - more common in elderly people whose brains have atrophied
what carries the efferent part of the corneal reflex?
facial nerve - causes contraction of the orbicularis oculi
what carries the afferent part of the corneal reflex?
V1
anticonvulsant with gingival hyperplasia, nystagmus, and ataxia as side effects?
phenytoin
anticonvulsant with hepatotoxicity as potential side effect?
valproic acid
anticonvulsants that can cause Stevens-Johnson syndrome?
lamotrigine, ethosuximide
anticonvulsants that can cause respiratory depression?
phenobarbital, diazepam
anticonvulsant that can cause agranulocytosis?
carbamazepine
anticonvulsant that can cause tremor?
gabapentin
what is the first line treatment for absence seizures?
ethosuximide
what effects do most anticonvulsants have on neuronal discharge?
decrease the frequency of neuronal discharge by increasing the threshold for neuronal discharge - most do so by blocking sodium or calcium channels, but benzos activate chloride channels to hyperpolarize neurons
how are AD and Pick's disease different?
AD: diffuse cerebral atrophy vs. Picks: selective atrophy of frontal and temporal lobes
what class of drug is used to treat AD?
cholinesterase inhibitors - AD is associated with selective destruction of cholinergic neurons
if a patient with AD has depression, what drugs should not be prescribed?
TCAs because they have powerful anticholinergic side effects that may exacerbate the cognitive decline due to AD
what is the mechanism whereby short-term memory is consolidated into long-term memory?
long-term potentiation - occurs in hippocamus
what is the second most common cause of dementia in the elderly?
multi-infarct dementia - focal neurologic defects
what is the most common primary brain tumor?
astrocytoma
what is the worst grade of astrocytoma?
glioblastoma multiforme
what type of tumor has a characteristic pseudopaliasding arrangement of tumor cells?
glioblastoma multiforme
why are lomustine and carmustine more suitable for treating brain tumors?
belong to a class of alkylating agents - nitrosureas - can effectively penetrate the BBB
what is a meningioma?
benign tumor that arises from the arachnoid cells of the meninges - external to brain and so usually can be surgically resected
loss of dorsiflexion (foot drop) - what nerve is injured?
common peroneal nerve (L4-S2) - PED - Peroneal Everts and Dorsiflexes
loss of plantar flexion - what nerve is injured?
tibial (L4-S3) -TIP - tibial inverts and plantarflexes; if injured, can't stand on TIPtoes`
loss of knee jerk - what nerve is injured?
femoral (L2-L4)
loss of hib adduction - what nerve is injured?
obturator (L2-L4)
positive anterior drawer sign indicates what?
tearing of ACL
anterior and posterior in ACL and PCL refer to what?
sites of tibial attachment
abnormal passive abduction indicates what?
torn MCL
what are the rotator cuff muscles?
SITS: supraspinatus, infraspitatus, teres minor, subscapularis
what rotator cuff muscle helps deltiod abduct arm?
supraspinatus
what rotator cuff muscle laterally rotates arm?
infraspinatus
what rotator cuff muscle adducts and laterally rotates arm?
teres minor
what medially rotates and adducts arm?
subscapularis
what nerve injury is often secondary to injury of the shaft of the humerus?
radial
injury to what nerve results in loss of triceps brachii (triceps reflex), brachioradialis (brachioradialis reflex), and extnsor carpi radialis longus (wrist drop)?
radial nerve
what nerve is affected in an injury of the supracondyle of the humerus?
median nerve
injury to what nerve is not related to loss of power in any arm muscles but loss of forearm pronation, wrist flexion, finger flexion, and several thumb movements?
median nerve
injury to what nerve eventually results in thenar atrophy?
median nerve
injury to what nerve results in loss of sensation over the lateral palm and thumb and the radial 2 1/2 fingers?
median nerve
which nerve passes through pronator teres?
median nerve
what nerve may be affected with an injury to the medial epicondyle?
ulnar
what nerve injury is associated with impaired wrist flexion and adduction and imaired adduction of thumb and pinky and ring finger?
ulnar nerve
what nerve injury causes loss of sensation over the medial palm and the pinky and 1/2 ring fingers?
ulnar nerve
what nerve passes through the flexor carpi ulnaris?
ulnar nerve
what nerve injury is associated with a loss of function of coracobrachialis, biceps, and brachialis muscles (biceps reflex)?
musculocutaneous
what nerve passes through coracobrachialis?
musculocutaneous
waiter's tip results from what?
traction or tear of the superior trunk - C5/C6 roots, follows blow to the shoulder or trauma during delivery (aka Erb-Duchenne palsy)
limb hangs by side (paralysis of abductors), is medially rotated (paralysis of lateral rotators), and forearm is pronated (loss of biceps)
Erb-Duchenne palsy - C5/C6 injury
what does the radial nerve provide innervation to?
great extensor nerve': BEST: brachioradialis, extensors of wrist and fingers, supinator, triceps
this is the result of an embryologic defect & can compress the subclavian artery and inferior trunk of brachial plexus (C8, T1)
thoracic outlet syndrome - Klumpke's palsy
what are the results of thoracic outlet syndrome?
atrophy of thenar and hypothenar eminences, atrophy of interosseous muscles, sensory deficits on medial forearm and hand, disappearnace of radial pulse on turning head toward opposite side
what are the thenar muscles?
opponens pollicis, abductor pollicis brevis, flexor pollicis brevis
what are the hypothenar muscles?
opponens digiti minimi, abductor digiti minimi, flexor digiti minimi
what 3 muscles close the jaw?
Masseter, teMporalis, Medial pterygoid (M's munch)
what muscle opens the jaw?
lateral pterygoid (Lateral Lowers)
all muscles with root glossus (except palatoglossus - vagus) are innervated by what?
hypoglossal
all muscles with root palat are innervated by what nerve? what is the exception?
vagus (except tensor veli palatini - innervated by mandibular branch of CN V (TENSor was too TENSE)
clinical landmark for pudendal nerve block?
ischial spine
clinical landmark for lumbar puncture?
iliac crest
nerve root for biceps reflex?
C5
nerve root for triceps reflex?
C7
nerve root for patella reflex?
L4
nerve root for achilles reflex?
S1
the muscles of mastication are innervated by what CN?
V3
what dermatome includes the kneecaps?
L4 (down on L4s)
what dermatome is at the inguinal ligament?
L1 (LI is IL)
where is McBurney's point?
2/3 of the way from the umbiblicus to the anterior superior iliac spine
winged scapula is the result of an injury to what nerve?
long thoracic
claw hand results from injury to what?
lower trunk (C8/T1) - ulnar nerve
injury to what nerve causes deltoid paralysis?
axillary
injury to this nerve causes difficulty flexing elbow, variable sensory loss
musculocutaneous
decreased thumb function/Pope's blessing results from what nerve injury?
median nerve
what nerve is likely to be injured after falling asleep with arm over chair?
radial nerve - 'saturday night palsy'
what dermatome is at the xyphoid process?
T7
what dermatome is at the nipple?
T4 - T4 at the teat pore
what dermatome is a high turtleneck shirt?
C3
what dermatome is a low collar shirt?
C4
what dermatome is a posterior half of a skull cap?
C2
what cranial nerve passes through the cribriform plate?
CN I
what cranial nerve passes through the optic canal?
II
what cranial nerves pass through the superior orbital fissure?
III, IV, V1, VI
what cranial nerve passes through the foramen rotundum?
V2
what cranial nerve passes through the foramen ovale?
V3
what cranial nerves pass through the internal auditory meatus?
VII, VIII
what cranial nerves pass through the jugular foramen?
IX, X, XI
what cranial nerve passes through the hypoglossal canal?
XII
muscle spindles help monitor what?
muscle length
(help you pick up a heavy suitcase when you didn't know how heavy it was)
golgi tendon organs monitor what?
muscle tension - senses tension and provides inhibitory feedback to alpha motor neurons
(make you drop a heavy suitcase you've been holding too long)
how is a muscle spindle oriented with respect to muscle fibers?
in parallel: muscle stretch - intrafusal stretch - stimulates Ia afferent - stimulates alpha motor neuron - reflex muscle (extrafusal contraction)
what is the gamma loop?
CNS stimulates gamma motor neuron - contracts intrafusal fiber - increased sensitivity of reflex arc
primitive reflex in which infant extends limbs when startled
moro reflex
primitive reflex in which infant seeks nipple
rooting reflex
primitive reflex in which infant grasps objects in palm
palmar reflex
primitive reflex in which large toe dorsiflexes with plantar stimulation
Babinski
what CNs lie medially at brainstem?
III, VI, XII
what CN is responsible for taste from anterior 2/3 of tongue, lacrimation, salivation (submaxillary & sublingual glands), eyelid closing?
facial nerve CN VII (also facial movement)
what CN is responsible for taste from posterior 1/3 of tongue, swallowing, salivation (parotid gland), monitoring carotid body and sinus chemo- and baroreceptors
CN IX (glossopharyngeal)
what CN is responsible for taste from epiglottic region, swallowing, palate elevation, talking, thoracoabdominal viscera, monitoring aortic arch and chemo- and baroreceptors?
vagus
which CN is responsible for monitoring carotid body and sinus chemo- and baroreceptors?
glossopharyngeal (IX)
which CN is responsible for monitoring aortic arch chemo- and baroreceptors?
vAgus (Aortic arch)
what cranial nerve is responsible for mastication and facial sensation?
trigeminal
where are the nuclei of CN III, IV located?
midbrain
where are the nuclei of CN V, VI, VII, VIII located?
pons
where are the nuclei of CN IX, X, XI, XII located?
medulla
which vagal nucleus carries visceral sensory information (e.g. taste, baroreceptors, gut distention)
nucleus Soliatarius (Sensory)
VII, IX, X
which vagal nucleus is responsible for motor innervation of pharynx, larynx, and upper esophagus (e.g. swallowing, palate elevation)?
nucleus aMbiguus (M-motor)
IX, X, XI
which vagal nucleus is responsible for sending autonomic (parasympathetic) fibers to heart, lungs, and upper GI?
dorsal motor nucleus
which artery passes through the foramen spinosum?
middle meningeal artery
what passes through the optic canal (3 structures)?
CN II, ophthalmic artery, central retinal vein
what passes through the foramen magnum?
spinal roots of CN XI, brain stem, vertebral arteries
what nerves pass through the cavernous sinus?
CN III, IV, V1, V2, VI and postganglionic sympathetic fibers en route to the orbit (nerves that control extraocular muscles plus V1 and V2)
among the nerves that pass through the cavernous sinus, which is the only one that is free floating?
CN VI
ophthalmoplegia, ophthalmic and mandibular sensory loss are symptoms of what?
cavernous sinus syndrome (due to mass effect)
this extraocular muscle moves the eye nasally
medial rectus (moves medial)
this extraocular muscle moves the eye temporally
lateral rectus (moves lateral)
this extraocular muscle moves the eye up and out
superior rectus
this extraocular muscle moves the eye down and out
inferior rectus
this extraocular muscle moves the eye up and in
inferior oblique
this extraocular muscle moves the eye down and in
superior oblique
how does the pupillary light reflex work?
light in either retina sends a signal via CN III to pretectal nuclei in the midbrain that activate bilateral Edinger-Westphal nuclei; pupils contract bilaterally
what does kuh-kuh-kuh test?
palate elevation - CN X
what does la la la test?
tongue CN XII
what does mi mi mi test?
CN VII - facial
what innervates the lower 1/3 of the esophagus?
splanchnic plexus - contains SM from splanchnic mesoderm
what innervates the upper 2/3 of the esophagus?
vagus
what are the order of layers that a needle passes through in an LP?
skin - superficial fascia - deep fascia - supraspinous ligament - interspinous ligament - interlaminar space - epidural space - dura - arachnoid - subarachnoid space
in a CN XII LMN lesion, which way does the tongue deviate?
toward the side of the lesion
in a CN V motor lesion, which way does the jaw deviate?
toward the side of the lesion
in a unilateral lesion of the cerebellum, which way does the patient tend to fall?
toward the side of lesion
in a CN X lesion, which way does the uvula deviate?
away from the side of the lesion
in an CN XI lesion, there is weakness turning the head which way?
to the contralateral side of the lesion
in a CN XI lesion, on which side does the shoulder droop?
on the side of the lesion
wrist flexion is dependent on what nerve roots?
C6, C7, C8, T1
elbow flexion is dependent on what nerve roots?
C5, C6, C7
elbow extension is dependent on what nerve roots?
C6, C7, C8
arm abduction is dependent on what nerve roots?
C5, C6
sensation over the deltoid is dependent on what nerve roots?
C5, C6
palmar surface of first three digits derives its sensory innervation from what?
median nerve, C6, C7, C8
where is the chemoreceptor trigger zone?
floor of 4th ventricle
what is Ki-67?
a nuclear factor whose expression correlates with neoplastic replicative activity; Ki-67 labeling correlates with a neoplasm's rate of growth and, therefore, with prognosis
facial nerve and vestibulocochlear nerve emerge from the brain stem where?
cerebellopontine angle
momentary loss of consciousness followed by lucid interval?
epidural hemorrhage
what is the most common type of herniation?
posterolateral herniation of the nucleus polposus
what spinal nerve is between vertebrae C4 and C5
C5 spinal nerve
both neuronal and glial differentiation in a brain tumor
medulloblastoma