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Neurology

FA review Round 1 2020

QuestionAnswer
What is the associated adverse effects of Enflurane? Seizures and CNS toxicity
Common inhaled anesthetic that is associated with development of seizures. Enflurane
Which inhaled anesthetic is more potent, Halothane or Enflurane? Halothane
What is the most severe adverse effect of Halothane? Malignant hyperthermia
Methoxyflurane adverse effect: Nephrotoxic
What is the adverse effect of N2O as an inhaled anesthetic? Expansion of trapped gas in the body cavity
Which receptors are involved in Miosis and Mydriasis? Alpha-1 and M-3
Miosis is caused by which type of drugs: - alpha-1 antagonists - M3 agonists
Which receptor in the pupil of the eye, when stimulated by an agonist or antagonist, causes blurred vision? M3
Miosis with blurry far vision is due to: Ciliary muscle contraction ("accommodation")
Which receptor in the pupil of the eye causes NO effect on Ciliary muscle, regardless of been agonist or antagonist effect? Alpha-1
The blurred vision caused in Mydriasis by stimulation with M3-antagonist is due to: Relaxation of ciliary muscle
Near blurred vision is seen with Mydriasis or Miosis as it is stimulated in M3-antagonist or -agonist? Mydriasis with a M3-antagonist
What are sympathomimetics? Substances (drugs) that mimic the effects of sympathetic activation on the heart and circulation
What are the stimulated (main) receptors in the use of Sympathomimetics? Alpha (1 & 2), Beta (1, 2, 3), and Dopamine (1, 2)
List of Direct Sympathomimetics: 1. Albuterol, Salmeterol, and Terbutaline 2. Dobutamine 3. Dopamine 4. Epinephrine 5. Fenoldopam 6. Isoproterenol 7. MIdodrine 8. Mirabegron 9. Norepinephrine 10. Phenylephrine
What receptors are stimulated by Epinephrine? Beta > alpha
On high or low doses, is Epinephrine alpha effect more dominant? High doses
What are the receptors targeted by Albuterol? B2> B1
Which Direct sympathomimetic has a receptor affinity of: alpha-1 > alpha-2 > Beta-1 Norepinephrine
Does epinephrine or norepinephrine has higher affinity to Beta receptors? Epinephrine
If the purpose of the treatment is to stimulate alpha-1 receptors more, which is better to use, NE or Epi? Norepinephrine
What is the receptor used and its affinity to each in relation to each other of Isoproterenol? B1 = B2
Which is a B-3 direct sympathomimetic? Mirabegron
What are the receptors targeted by Dobutamine (and affinity order)? B1 > B2, alpha
Fenoldopam is: D1 direct sympathomimetic
Which receptors are targeted by Phenylephrine? alpha-1 > alpha -2
What is a common solely alpha-1 direct sympathomimetic? Midodrine
What infectious organism is the MCC of meningitis in infants of < 6 months of age? GBS
What is the bacterial structure of GBS? Gram-positive, B-hemolytic, Bacitracin-resistant
List of MCC of Meningitis in neonates (0-6 months age): 1. GBS - #1 cause 2. E. coli 3. Listeria
What is the acute treatment for opioid toxicity? Naloxone
What is the MOA of Naloxone? Pure opioid antagonist
Naloxone is used to treat: Opioid toxicity
What are the classic findings in Opioid toxicity? Pinpoint pupils (miosis), respiratory depression, and coma
What condition is treated with Fomepizole? Alcohol toxicity
What medication is used to treat Benzodiazepine overdose? Flumazenil
What is another name for Lateral Medullary syndrome? Wallenberg syndrome
What arterial bodies are dissected, occluded or affected by thrombosis that cause Wallenberg syndrome? Vertebral or Posterior Inferior Cerebellar Artery (PICA)
Thrombosis in PICA leads to: Lateral Medullary syndrome
Lateral or Medial medullary syndrome is caused by dissection or thrombosis of PICA? Lateral Medullary syndrome
What manifestations of Wallenberg syndrome are not classified as Ipsilateral or Contralateral? Hoarseness of voice, dysphagia, decreased gag reflex, as well as, vomit, vertigo, and ataxia
What are the IPSILATERAL signs or deficits in Lateral Medullary syndrome? - Ipsilateral Horner syndrome - Ipsilateral absence of pain and temperature in the face
What is the the CONTRALATERAL deficit seen with Lateral Medullary syndrome? Absence of pain and temperature of the body
Patient present with hoarseness of voice, decrease appetite due to pain. Also indicate no pain or temperature in right side of face, and left side of body. Suspected Dx? Right Lateral Medullary syndrome
If a patient present with Ipsilateral Horner syndrome and a decreased sensation of pain/temperature in left arm after thrombosis of right PICA. Dx? Right Lateral Medullary syndrome
Which vessels are affected in Subdural hematomas? Bridging veins
If the patient presents with rupture of Bridging veins in the brain, what is the most likely diagnosis? Subdural hematoma
What is the associated shape of the hematoma in Subdural hematoma CT? Crescent
Easy way to remember that Subdural Hematomas have Crescent -shaped hemorrhage in CT: The "S" of Subdural hematoma is formed by 2-crescnts
Lentiform-shaped hematoma. Dx? Epidural hematoma
Rupture of the MMA at the pterion. Dx? Epidural hematoma
Crescent-shaped hematoma of brain CT. Dx? Subdural hematoma
What is the main function of Oligodendrocytes? Myelinate CNS axons
Which is the most common location for Oligodendrogliomas? Frontal lobes
What is the histological view of Oligodendrocytes? "Fried egg" appearance
Class of drugs of Triptans Serotonin (5-HT) receptor agonists
What is the most common use for Triptans? As abortive treatment for migraine headaches
What drug class is most often used for acute treatment of migraine headaches? Triptans
How do Triptan mechanism of action act on treating a migraine headache? Inducing cerebral vasoconstriction, inhibiting trigeminal activation and preventing vasoactive peptide release
Serotonin receptor agonists used for migraines Triptans
What information is known to be carried by the Dorsal column/ Medial Lemniscus tract? Proprioception, vibration, and light touch
What does a (+) Romberg test indicates? Impaired proprioception, suggesting damage to the Dorsal column/Medial Lemniscus tract
Impaired proprioception is indicated by what clinical annotation or result? (+) Romberg test
What medication is used to treat Parkinsonian dyskinesias, commonly? Amantadine
What is the common use for Amantadine? Anti-parkinsonism; Decrease Parkinsonian dyskinesias, in young patients with mild symptoms
What are the two main adverse effects associated with Amantadine? 1. Ataxia 2. Livedo reticularis
What medication is often associated with Livedo reticularis? Amantadine
What causes Livedo Reticularis? Swelling of the venules due to small blood clots forming in the capillaries
What are the effects of Chronic Livedo reticularis? Permanently dilated and telangiectatic vessels
Which foramina is used by CN V3 to exit the skull? Foramen ovale
Which branch of the Trigeminal nerve exits the skull through the foramen Ovale? V3
What is the MCC of VIRAL encephalitis in HIV patients? HSV-1 infection
What lobe is most commonly affected by HSV-1 encephalitis? Temporal lobe
What medication is used to treat HSV-1 encephalitis? Acyclovir
What cells are seen in CSF of HSV-1 (viral) encephalitis sample? Lymphocytes, and RBCs
How are protein and glucose levels in CSF sample of a viral encephalitis? Normal, to mildly elevated glucose
What is the normal INR for a patient on Warfarin? 2.5 - 3.5
Common antibiotic used topically for rashes, that is known to be a CYP450 inducer. Griseofulvin
Inducers or Inhibitors of CYP450 increase the metabolism of Warfarin? Inducers
An inducer of CYP450 is known to cause what when co-administered with Warfarin? Increase metabolism of Warfarin, leading to inadequate coagulation and natural decrease in INR
What pathogen is the MCC of meningitis in college students living in the dorms? N. meningitidis
What is the most common choice for treating N. meningitis? Ceftriaxone
What generation of Cephalosporin is Ceftriaxone? 3rd generation
Why is Ceftriaxone a proper choice for treatment of Neisseria meningitidis meningitis? Can cross the BBB
What are the clinical symptoms of Progressive Multifocal Leukoencephalopathy? Subacute mental status decline, neurological deficits, visual and motor changes, and ataxia
What causes in HIV patients PML? Reactivation of JC virus
What conditions i associated by the reactivation of JC virus? Progressive Multifocal Leukoencephalopathy
At what CD4+ count is PML often presented in HIV patient? < 200 cells
What are the featured clinical results of PML? Neuroimaging reveal multiple, non-enhancing white matter lesions with a normal CSF profile
What is Delayed Sleep-Wake Phase disorder? Disturbance in the natural Circadian rhythm, leading to a delayed sleep onset, delated sleep offset and sleep insufficiency
List of main functions of Astrocytes: 1. Physical support and repair cells of the CNS 2. Help maintain the BBB 3. Metabolize potassium
Which CNS cells are known to serve as physical support, repair cells in CNS, and maintain the BBB? Astrocytes
What muscles are derived by the Second pharyngeal arch? 1. Muscle of facial expression 2. Stapedius 3. Stylohyoid 4. Platysma 5. Posterior belly of digastric
What branchial arch givers rise to the anterior belly of the digastric? First branchial arch
Muscles of facial expression , are derived from the ____________ branchial arch. Second
What roots convey the Musculocutaneous nerve? C5 - C7
Which reflex is lost in musculocutaneous nerve injury? Bíceps reflex
Absent biceps reflex is a common feature of: Musculocutaneous nerve injury
What motor actions are lost by injury to the Musculocutaneous nerve? Loss of flexion of forearm and loss of supination
What part of the upper extremity loses sensation by injury to the Musculocutaneous nerve? Lateral forearm
Loss sensation of the lateral forearm is commonly due to injury to which brachial plexus nerve? Musculocutaneous nerve
Which nerve is commonly affected by Upper trunk compression of the Brachial plexus? Musculocutaneous nerve
What is the motor innervation of the Vagus nerve? Palatal arches and uvula
Does a UMN or LMN injury to the CN X, causes a contralateral uvula deviation? LMN injury
Does the uvula deviate to the contralateral or ipsilateral side in LMN CNX injury? Contralateral
Broca, Wernicke, or both, have poor repetition? Both
What is the most common location affected by Wernicke aphasia? Superior Temporal gyrus of the left temporal lobe
What is affected or limited in Wernicke aphasia? Comprehension and repetition
If a person is able to complete words and sentences, but fails to respond to verbal commands, and the sentences are fluent but non-coherent. Dx? Wernicke's aphasia
What is the reversal treatment for Benzodiazepine overdose? Flumazenil
What is the mode of action of Flumazenil? Competitive antagonist of GABA receptor
What is a very common Competitive antagonist of the GABA receptor? Flumazenil
What are the clinical signs indicating probable benzodiazepine overdose? Somnolence, respirator depression, amnesia, and ataxia
Flumazenil is often used in : Acute reversal of Benzodiazepine overdose
Potent CNS stimulant that acts by inhibiting the reuptake of Dopamine, Norepinephrine,and Serotonin. Cocaine
Which hormones are prevented to be retaken by Cocaine? Dopamine, Norepinephrine, and Serotonin
How does Cocaine work? Inhibit reuptake of Dopamine, NE, and Serotonin
What are featured signs of Cocaine overdose? Psychomotor agitation, HTN, mydriasis, and at times convulsions
What is Muscarine? Toxin found in some mushrooms that agonized ACh muscarinic receptors
What type of receptors are affected by Muscarine? ACh muscarinic receptors
What is the result of agonist effect on ACh receptors by mushroom toxin, muscarine? Increased activity of PNS which leads to series of symptoms including vasodilation, sweating, salivation, GI motility, miosis, etc
Would the consumption of some toxic mushrooms will cause vasodilation or vasoconstriction, if such contains muscarine? Vasodilation
What is a more common name for Rubeola? Measles
What virus is associated with development of Subacute Sclerosing Panencephalitis? Measles
Does Rubella or Rubeola causes SSPE? Rubeola
What is the clinical profile of Subacute Sclerosing Panencephalitis? Dementia, myoclonus, and personality changes, after 2-10 years after initial Rubeola (Measles) virus infection
What is that possible and severe consequence of badly treated childhood Measles infection? Subacute Sclerosing Panencephalitis
What are the clinical deficits seen with MCA infarction? 1. Contralateral face and arm weakness of UMNs 2. Gaze preference toward the side of lesion and variable unilateral neglect
An MCA lesion produces a gaze preference toward or away the side of the lesion? Toward
MCA infarction causes deficits in face/arms or in legs? Face and arms
MCA infarction deficits are produced ipsilateral or contralateral? Contralateral arms and face
MCA infarction ins the dominant hemisphere produces: Aphasia
Which hemisphere is affected if the MCA occlusion produces hemineglect? Non-dominant
Which is more common to be the dominant brain hemisphere, right or left? Left
Which is most commonly the non-dominant hemisphere, right or Left? Right
Which Dopamine pathway is interrupted by Antipsychotics? Nigrostriatal pathway
What type of symptoms or effects are produced by interfering the Nigrostriatal dopaminergic pathways? EPS
What are some common EPS due to antipsychotic effects? Dystonia, akathisia, tardive dyskinesia, and Parkinsonism
A interruption or deficit to the Tuberoinfundibular dopamine pathway results in: Increased prolactin, sexual dysfunction, and galactorrhea
If the patient present with dystonia and movement disorders, is fair to assume which dompanie pathway was altered? Nigrostriatal pathway
ACA defects due to blockage or infarction will result in: Contralateral leg paresis
Does ACA infarct deficits produce contralateral or ipsilateral leg deficits? Contralateral leg paresis
What causes the Leg cortical-type sensory loss in ACA infarction? Damage to the sensory cortex
What is the most common symptom or sign of a pineal mass? Symptoms of ICP
What causes the ICP seen with penal masses? Obstruction of CSF flow by a space-occupying lesion
What is a severe complication of Pineal masses compressive effects? Parinaud syndrome
What region is compressed by a Pineal mass in order to produce Parinaud syndrome? Pretectal region of the midbrain
The compression of the Pretectal region of the midbrain may cause: Parinaud syndrome
What are the main features of Parinaud síndrome? Vertical gaze and Pupil abnormalities
What is the most common opportunistic infection in HIV/AIDS patients? Toxoplasmosis
What is Toxoplasmosis? CNS infection in HIV patients with CD4 count < 100, that leads to focal neurologic deficits and chorioretinitis
What is the MCC of focal brain lesions, comma, and death in HIV patients? Toxoplasmosis
Common cause of encephalitis in HIV-infected patients Toxoplasmosis
Disorder caharcted by degeneration of Dopaminergic neurons in the Substantia nigra par compacta. Parkinson disease
Neurons from the Substantia nigra project into the: Striatum
What are the components of the Striatum? Putamen and Caudate
Putamen + Caudate = Striatum
What part of the Basal ganglia functions by modulating activity in both direct and indirect pathways of the Dopamine effects? Striatum
Which hemisphere, left or right, has the language centers in most people? Left
Which arterial body is known to most commonly supply the Language centers in the brain? Left MCA
MCA infarction results in what type of aphasia? Broca aphasia
In which aphasia, Broca or Wernicke, does the patient get frustrated by not been able to produce words or sentences, but have good comprehension? Broca aphasia
What is the most common childhood supratentorial tumor? Craniopharyngioma
What are the associated clinical deficits seen in Craniopharyngioma in a child? Headaches and bitemporal hemianopia
From what tissue are Craniopharyngiomas derived? Remnants of the Rathke's pouch
Which childhood brain tumor is derived from remnants of the Rathke's pouch? Craniopharyngioma
A craniopharyngioma will present with increase or decrease secretion of anterior pituitary hormones? Decrease
Does a prolactinoma or craniopharyngioma, is more likely to present with low levels of GH? Craniopharyngioma
What are the motor and sensory deficits seen in S1 radiculopathy? 1. Decreased sensation of Posterior Leg and Lateral foot 2. Diminished ankle-jerk reflex 3. Weak plantarflexion of the foot 4. Back pain radiating to the lower extremity 5. Positive Straight leg raise est
What is commonly herniated tint order to develop S1 radiculopathy? L5-S1 disc
Which part of the led loses sensation in S1 radiculopathy? Posterior loeg and lateral foot
Diminished ankle-jerk reflex, is commonly seen in? S1 radiculopathy
Which reflex is affected by S1 radiculopathy? Ankle-jerk reflex
Is Plantarflexion or dorsiflexion of foot affected by S1 radiculopathy? Plantarflexion of foot
A positive Straight Leg Raise test is seen with which condition? S1 radiculopathy
When does an Uncal Herniation occur? It occurs when a Supratentorial mass pushes that medial temporal lobe medially and inferiorly, compressing the Ipsilateral oculomotor nerve and contralateral crus cerebri, against the Kernohan's notch
What structures are compressed in Uncal herniations? 1. Ipsilateral Oculomotor nerve 2. Contralateral Crus cerebri against Kernohan's notch
Which nerve is commonly affected in a Left sided Uncal herniation? Left CN3
Uncal herniations will present with ipsilateral or contralateral hemiparesis? Contralateral hemiparesis
Which part of the Basal Ganglia is targeted in ablation treatment for Parkinson disease? Internal segment of the Globus Pallidus
Which is the possible condition been diagnosed in a patent schedule to have the internal segment of the Globus pallidus ablated? Parkinson disease
What is the intended result of ablation of internal segment of Globus pallidus in Parkinson disease? Decrease inhibitions of the Thalamus, leading to improvement of bradykinesia
Which date value is most affected by an outlier in a small set of data? Mean
What is the triad seen in NPH? 1. Urinary incontinence 2. Ataxia 3. Dementia
What is the cause for NPH? Decreased CSF absorption into the venous system
Which sinus is most commonly affected in NPH? Superior Sagittal sinus
What conditions is often seen with a deficit or affection to the Superior Sagittal sinus ? NPH
What is the main clinical symptom of Cerebellar hemispheres? Limb ataxia
Limb ataxia due to cerebellar hemisphere lesions causes Contralateral or Ipsilateral? Ipsilateral
What is a common type of limb ataxia? Dysmetria
What is Dysmetria? Lack of coordination
What is a clinical sign of Dysmetria? Overshoot of intended limb movement
What is Conversion disorder? Dysfunction of water or sensory symptoms without a physiological cause, often following an acute stressor
What is the associated motor effects of Conversion disorder? Normal deep tendon reflexes and normal sensation
What is a featured characteristic of Conversion disorder? La belle indifference
Which nerve is injured in Thyroid surgery that leads to hoarseness of voice? Recurrent Laryngeal branch of the Vagus nerve
What surgery may cause injury to the Recurrent Laryngeal branch of CN X? Thyroid surgery
What is the main result of damaged recurrent laryngeal branch of Vagus nerve? Hoarseness of the voice
The Recurrent Laryngeal branch of the Vagus nerve is derived from which branchial arch? 6th Branchial arch
What muscles are innervated by CN X recurrent laryngeal branch? All intrinsic muscles except for the Cricothyroid
Which muscle is not innervated by CN recurrent laryngeal nerve? Cricothyroid
Common drug that is known to stimulate muscarinic receptors M1, M2, and M3? Pilocarpine
How does Pilocarpine help in treating dryness of an eye? M3 receptor stimulation leads to increase secretion of lacrimal and salivary glands
Which G-protein-linked second messenger pathway does M3 stimulate? Gq
What is the overall effect of stimulating M3 receptor? Increase in intracellular calcium levels
What is another name for the Plantar reflex? Babinski sign
By what age is the Babinski reflex commonly lost? After 18-24 months of age
What is the Babinski sign? Primitive reflex in which an infant responds to stroking the bottom of foot with dorsiflexion of big toe and fanning out of the rest of the toes
Which lobe of the brain develops enough for the Babinski sign to disappear? Frontal lobe
What type of lesion is to be suspected with an adult with (+) Babinski sign? UMN lesion
An UMN lesion will present with what type of abnormal reflex? (+) Babinski sign
What is the most common transmission mode for a mother to contract Toxoplasmosis? Via cat feces
What are the neonatal manifestations of Congenital Toxoplasmosis? Chorioretinitis, Hydrocephalus, and intracranial calcifications
Neonate with intracranial calcifications, and hydrocephalus. Which is the most likely ToRCHES infection? Congenital Toxoplasmosis
HSV latency establishment in sensory ganglia uses what protein transport? DYENIN-dependent retrograde transport
The reactivation or recurrence of HSV infection, is due to what protein transport? Kinesin-dependent anterograde transport
Reactivation of HSV infection in lips, is due to Dynein or Kinesin transport? Kinesin-dependent anterograde transport
In which ganglia is HSV latency established? Sensory ganglia
What is the earliest symptom of Alcoholic Cerebellar degeneration? Gait impairment
What are the late manifestations of Alcoholic Cerebellar degeneration? Dysarthria, intermittent diplopia or blurred vision
What is dysarthria? Weakness in the muscles used for speech, which often causes slowed or slurred speech.
What are the clinical features of Bell palsy? Ipsilateral dry eye, dry mouth, decreased taste sensation, retroauricular pain, sensitivity to noise and facial paralysis
Which cranial nerve is involved in Bell palsy? Facial nerve
Do Bell palsy causes Ipsilateral or Contralateral deficits? Ipsilateral
What is a common result or complication of Pinealomas? Parinaud syndrome
What are the features of Parinaud syndrome? Paralysis of upward gaze
What are the common complications of Pinealomas? 1. Parinaud syndrome 2. Obstructive hydrocephalus 3. Precocious puberty in males
What are the sings and symptoms of Cerebellar dysfunction? Ataxia, dysmetria, dysarthria, and nystagmus
What are the functions of Cerebellum? 1. Modulates movement 2. Aids in coordination and balance
What are the complications of LATERAL cerebellum lesions? 1. Affect voluntary movement of extremities 2. Propensity to fall to injured side
What are signs of medial cerebellar injury? Truncal ataxia, nystagmus, and head-tilting
What are the main characteristics of NF-type 1? 1. Neurofibromas 2. Cafe-au-lait spots 3. Lisch nodules
What are Lisch nodules in NF type 1? Pigmented nodules on the iris
How are neurofibromas appear in NF1? Bumpy prominences in upper back and shoulders
What causes VHL syndrome? Deletion of VHL gene on chromosome 3
What are the tumors associated in VHL syndrome? Hemangioblastomas in cerebellum and spine, RCC, and Retinal angiomas (retinal capillary hemangioblastoma)
Which parts of nervous system have the cell bodies of UMNs? Cortex and Brainstem
Where do UMN synapse? At ganglia of LMN of the anterior horn and modulate voluntary motor and reflexes of skeletal muscle
UMN are proximal or distal to anterior horn? Proximal
LMN are proximal or distal to anterior horn? Distal
Which are Proximal to anterior horn, UNM or LMN? UMN
Which are distal to anterior horn, UMN or LMN? LMN
What is the genetic make up of HSV? Enveloped, double-stranded, linear virus
What is the MCC of Temporal encephalitis in HIV patients? HSV-2 infection
What are the actions done by alpha-1 receptor? Increase vascular smooth muscle contraction, miosis
What are some actions of Beta-2 receptor? Vasodilation and bronchodilation
Description of a Cluster headache: Severe, recurrent, and unilateral headache with conjunctival injection, lacrimation, rhinorrhea, and transient Horner syndrome
Which headache type is associated with lacrimation and unilateral location? Cluster headache
What is the MC prophylaxis medication for a Cluster headache? Verapamil
What are the treatments for acute cluster headache? Sumatriptan and 100% oxygen
Common use for Verapamil: Prophylaxis of Cluster headache
Created by: rakomi
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