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Glossary of USMLE Neuro

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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

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