pamhong-USMLE step 1 neuro
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200 terms
Terms | Definitions |
|---|---|
 high NE | anxiety |
| low NE | depression |
| high DA | schozphrenia |
| low DA | parkinson's and depression |
| low seratonin | anxiety and depression |
| low Ach | Alzheimer's huntington, REM sleep |
| low gaba | anxiety, huntington |
| glutamine + vit b6 | GABA |
| NE synth location | locus cerules/reticular formation/solitary tract |
| DA synth formation | ventral tegmentum, SNc |
| seratonin synth location | raphae nucleus |
| ACh synth location | basal nucleus of meynert |
| GABA synth location | nucleus accumbens |
| DA ptwy: mesocotical block | ventral tegmentum of MB to cortex. blocked: increase positive Sx of schizophrenia |
| Da ptwy: mesolimbic | ventral tegmentum of MB to limbic system. blocked: relief of pschosis (+Sx) |
| DA ptwy: nigrostriatal | substantia nigra par compacta to striatum (caudate and putamen). blocked: parkinson dz/ stimulation: extrapyramidal a/e |
| DA pwty: tuberoinfendibular: | arcuate nucleus of hypoth to pituitary blocked: increases prolactin- sx: amnorrhea, gynecomastia, galactorrhea |
| reticualr acivating system | locus cerelus, reticular formation and raphae nuclei. Mediates cosciousness and alertness bc synth 5ht,NE. Damge: coma. |
| free nerve ending | pain and temp. a-delta and c-fiber |
| c-fibers | free nerve ending. slow unmyelinated. warm temp |
| A delta fibers | free nerver ending. fast, meylinated, cold temp |
| meissner's corpuscle | large, meylinated. hairless skin (superficial skin) position and dynamic touch fast adapting |
| pacinan corpuscle | lg, meylinated (deep skin), ligaments, joints. fast adapting vibration and pressure |
| merckle's disk | hair follicle.(superficial skin)/ slow adapting position, static touch-edges, textures |
| ruffini | encapsulated/ slow adapting/ deep layers. sole of foot |
| BBB composition | 1. tight junctions b/w NON-fenestrated capillary endothelial cells (destruction- vasogenic edema) 2. BM 3. astrocyte processes |
| BBB permeability | glucose and AA cross via carriers- slow lipid-soluable and non-polar- fast via diffusion |
| non BBB, fenestrated capillaries in brain | 1. area postrema- vomiting after chemo (CZT at medulla) 2. OVLT- osmotic sensing 3. neurosecretory products- ex: ADH |
| supra optic nucleus | hypothalamus nuclei- makes ADH |
| paraventricular nucleus- | hypothalamus nuclei- makes oxytocin |
| lateral area of hypothalamus | FN- hunger. Inhibited by leptin destructionn- anorexia, failure to thrive (infants) zap lateral you shrink laterally |
| ventromedial area of hypothalamus | FN- satiety. stimulated by leptin destruction by craniopharyngioma- hyperphagia zap ventromedial you grow ventral and medial |
| antetior hypothalamus | cooling, parasymp. A/C- anterior cooling |
| posterior hypothalamus | heating, symp |
| suprachiasmatic nucleus | circadian rhythm |
| thalamus: VPL | input: spinothalmic / dorsal coums and medial lemniscus info: pain and temp (from body) output: primary somatosensory cortex. |
| thalamus: body sensation | VPL |
| thalamus: VPM | input: trigeminal and gustatory ptwy info: face sensation and taste output: primary somatosensory cortex |
| thalamus LGN | input: CN II info: vision output: calcarine sulcus (occipital lobe) |
| thalamus: MGN | input: superior olive and inferior colliculus of pons info: hearing output: auditory cortex (temporal lobe) |
| thalamus: communication w/ prefrontal cortex . damage? | mediodorsal (MD) nucleus dmaage: memory loss |
| thalamus: cerebellum (dentate n.) and basal ganglia | VL |
| thalamus: VA | basal ganglia to prefrontal, premotor, and orbital cortices |
| thalamus: anterior nuclear group | mamillothalmic tract to cingulate gyrus part of papez circuit |
| thalamus: pulvinar | integration of vision, auditory, and somesthetic input |
| cerebellum input | contralateral cortex via middle cerebellar peduncle ipsilateral proprioception via inferior cerebellar peduncle nerves: climbing and mossy fiber |
| cerebellum output | contralateral cortex via superior cerebellar peduncle nerves: purkinje fibers modulates movement |
| spinocerebellum | vermis and paravermis via fastigial and interposed nuclei interposed n = globise and emboliform |
| vestibulocerebellum | flocculonodular lobe and vermis via fastigial nuclei |
| cerebrocerebellum | lateral hemispheres via dentate |
| cerebellum nuclei | lateral to medial: dont eat greasy food dentate, emboliform, globose, fastigial |
| lateral cerebellum | voluntary movement of extremities |
| medial cerebellum | balance, truncal coordination, ataxia injury: ipsilateral - falls to injured side bc info crosses twice |
| basal ganglia: direct ptwy | NT: dopamine receptor: D2R SNc + , + striatum, - GPi, + thalamus = movement |
| basal ganglia: indirect ptwy | NT: dopamine receptor D2R +SNc, - striatum, +GPe, -Subthalmic n.& Gpi, +thalamus = movement |
| basal ganglia: GPi | decrease/inh mov |
| basal ganglia: GPe | inhibits STN and Gpi = increases movement |
| basal ganglia: STN | stimulated GPi = inhibits movement |
| basal ganglia and PD | loss of DA= less direct ptwy , more indirect ptwy = less motion |
| basal ganglia and HD | neuronal death via NMDA-R : glutamate toxicity atrophy of striatal nuclei (main inh of mov) |
| multiple sysmtem atrophy: | parkison-like, autonomic dysFN, ataxia inclusion w/ alpha synuclein in oligodendroglia cells |
| paramedian pontie reticular formation (PPRF) lesion | eyes look away from lesion |
| frontal eye fields lesion | eyes look towards lesion |
| cerebellar hemisphere lesion | intention tremor, limb ataxia, ipsilateral |
| cerebellar vermis lesion | TRUCAL ataxia, dysarthia |
| reticular activating system (MB) lesion | reduced levels of arousal and wakefulness = coma |
| superior colliculi lesion | paralysis of upward gaze |
| left parietal lobe lesion | gerstman syndrome- agraphia, acalculia, finger agnosia, left and right disorientation |
| bilateral amygdale lesion | kluber-bucy syndrome: hyperorality, hypersexuality, disinhited behavior |
| central pointine myelinosis | acaute paralysis, dipliopia, loss consciousness. bc rapid correction of HYPO-natremia |
| broca's aphasia | nonfluent aphasia but understands INFERIOR frontral gyrus |
| wernecke's apahsia | fluent aphasia, but impaired comphrehension SUPERIOR temporal gyrus |
| global apahsia | nonfluent and impair comprehension. both broca and wernecke |
| conduction aphasia | poor repetition. pt understands and is able to speak but no connection. At arcuate fasciculus |
| non-dominant broca aphasia | expressive dysprosody- can't express emotions/inflection on speech "monotone" |
| non-dominant wernecke apahsia | receptive dysprosody- inability to comphrehend emotion or inflectionin speech |
| weber's syndrome | midbrain infarct occlusion of paramedian branches PCA contralateral hemiparesis (CST) & oculomotors CN III palsy |
| CN 3 | rostral midbrain. levator palpebrae, superior, inferiorm, and medial rectus. inferior oblique/ pupillary sphincter- ciliary muscle |
| Cn 4 | caudal midbrain- superior oblique |
| CN 6 | caudal pons- lateral rectus |
| anterior spinal art | contralat- hemiparesis (LE), ipsilateral paralysis of CN9 pain and temp are ok |
| PICA/ lateral medullary/wallenberg | contralat- pain and temp in BODY ipsilat- dysphagia, decrease gag reflex, dipliopia, nystagmus, horner's, facial tmep and pain, ataxia |
| AICA/ lateral inferior pontine synd | ipsilateral facial paralysis (cn7), cochlear n. & nystagmus (cn8), facial pain & temp |
| PCA | contralat- hemianopoa w/ MACULAR SPARING |
| MCA | contralat- face, arm paralysis/sensation, apahsia(dominant), left side neglect (non-dominant) |
| ACA | contralat- leg-foot motor and sensory |
| anterior communicating art | MC site of berry aneurysm. visual problems- bitemporal hemianopsia |
| posterior communicating art | CN 3 palsy- down and out |
| lateral striate | from MCA. pure motor hemiparesis (arms & legs) internal capsule, caudate, putamen, GP. "arteries of stroke" |
| watershed zone | b/w ACA and MCA or MCA and PCA HYPOtension,upper leg + arms weakness, high order visual process |
| basilar art | locked in syndrome. only CN3 is intact! |
| aneurysm causes | APKD, marfan, ehlers danlos |
| charcot bouchard microaneurysm | ass w/ chronic HTN- small vessel in basal ganglia and thalamus |
| stroke at thalamus | only sensory loss in cotralateral side both arms and legs. no motor defecit. but difficult to walk bc loss of proprioception |
| nimidipine | CCB used after aneurysm to decrease risk of vasospam |
| parenchymal hematoma | HTN, amyloid angiopathy- lobar stroke, DB, CA at basal ganglia and internal capsule |
| intraventricular hemorrhage | PREMES < 32 wks , low birth wgt < 1500 |
| ischemic stroke | emboli. a-fib, carotid dissection, patent foramen ovale, endocarditis, lacunar stroke-HTN. cystic cavity w/ reactive gliosis. |
| TIA | reversible. < 24 hrs |
| dural venous sinus | superior sagital sinus (main location of CSF return) --> confluence of the sinus --> transverse sinus--> sigmoid sinus --> int. jugular v. |
| where does the sigmoid sinus become IJV | jugular foramen |
| foramen of monro | latreal ventricle to 3rd ventricle |
| cerebral aqueduct | 3rd to 4th ventricle |
| CSF | made in choroid plexus/ reabsorbe by choroid sinus |
| foramen of luschka | 4th ventricle to subarachnoid space. LATERAL |
| foramen of magendie | 4th ventricle to subarachnoid space. MEDIAL |
| normal pressure hydrocephalus | wet, wobbly, wacky. NO increase in volume. dementia, ataxia, urinary incontinence |
| pseudotumorcerebri | young, obese female w/ daily HA worse in AM and papilledema N- ventricles, no tumor/masses. but HIGH csf press. tx- lose wgt, acetozolamide |
| fasciculus cuneatus | dorsal column- upper extremities |
| fasciculus gracilis | dorsal column- lower extremities. (more medial) |
| lateral CST | arms are medial, legs are lateral |
| polio & werdnig hoffmann dz | LMN lesion - destructoin anterior horns- flaccid paralysis |
| anterior spinal art and cord | lose everything but dorsal columns and tract of lissauer. (proprioception, touch and temp ok) |
| 3 syphilis | DRG and dorsal column lesion |
| vit b12, vit E def, friedreich ataxia | dorsal coumn, lateral CST, spinocerebellar tract ataxia, hyperreflexia, impair vibration. ok temp & pain |
| polio CSF | lymphocytic pleocytosis no protein. |
| SOD1 | ALS- UMN and LMN |
| friedreich ataxia | AR. repeat dz- GAA. frataxin protein. inpaired mitochondria. freq falling, nystagmus, dysarthia, hypertrophic CMP, kid- kyphoscoliosis. loss of CN8, 10, 12, cerebellum |
| brown sequad syndrome | hemisecition. ipsilateral- UMN. tactile, vibration, sensation, LMN contralat- pain and temp below lesion |
| C2 | posterior half of skull |
| C3 | turtle neck shirt |
| C4 | clavicle region. low collar shirt |
| T4 | nipple |
| T7 | xiphoid process |
| t10 | umbiicus |
| L1 | inguinal lig |
| L4 | kneecaps "down in all fours" |
| S2,3,4 | erection and sensation of penile and anal zone |
| reflex s1,2 | achilles |
| reflex L3,4 | patella |
| reflex C5.6 | bicep |
| reflex C7,8 | tricep |
| moro reflex "hang on for life" | baby opens arms when thinks is falling backwards |
| CN that lie medial in brain stem | CN 3-MB, CN 6- pons, CN 12- medulla. |
| CN 7 | motor- facial mov, eyelid closing, stapedius muscle in ear sensory- taste ant 2/3 tongue, lacrimation, salivation |
| Cn9 | sensory- taste post 1/3 tongue, salivation-parotid, monitoring carotid body & sinus-chemo R motor- swallowing, stylopharyngrus (elevates pharynx, larynx) |
| Cn 10 | sensory- taste epiglottic region, aortic chemo & baro-R, motor- palate elevation, midline uvula, talking, coughing thoracoabd viscera |
| corneal reflex and lacrimation | afferent- V1 efferent- cn 7 |
| jaw jerk | V3 sensory, v3 motor both via masseter |
| gag reflex | cn9 afferent, cn 9, 10 efferent |
| vagal nuclei: n. solitarius | visceral sensation- taste, baro-R, ut distantion. CN 7,9,10 |
| vagal nuceli: n. ambiguous | motor innervation pharynx, larynx, upper esophagus- Cn 9, 10, 11 |
| dorsal motor nucleus | vagal nuclei. sends autonomic (parasymp) fibers to heart, lung, GI |
| ear: webber test | turning fork in middle top head. n- hear it on both ears = midline conduction defect- ipsilateral sensory defect = contralateral |
| ear: rinne test | fork at mastoid then at ear. N- AC>BC conduction defect= AC<BC |
| ear: webber-R Rinne LE: AC>BC, RE: BC>AC | R- webber--> R-conduction or L- sensory rinne- LE ac>bc normal rinne-RE bc>ac conduction |
| cavernous sinus | CN 3,4,5 (V1, V2) ,6 internal carotid and post ganglionic symp |
| carvernous sinus syndrome | ophthalmoplegio, ophthalmic and maxillary sensory loss ass- w/ infections b/w nose and lip. |
| uvula deviation to the left | 1. Cn 10 and nucleus ambiguous on the RIGHT 2. corticobulbal tract/motor cortex on the LEFT |
| tongue deviation to the left | 1. Cn 12 Left 2. CBT / motor cortex on R |
| can't turn head to left, and should droop on R | CN 11 on R. |
| palsy of lower face | UMN lesion think of stroke. upper face is innervated by both UMN so the ipsilateral UMN still functional |
| palsy entire half of face | bell's palsy. damage at nuclei. LMN |
| causes of Bell's palsy | Lovely Bella Had An STD lyme, HSV, Aids, Sarcoidosis, Tumor, DB |
| bilateral bell's | lyme dz, guillian barre |
| open angle glaucoma | obstruction at canal of schlemn slow, oainless, bilateral |
| close angle galucoma | obstruction of flow from posterior to anterior chamber. painful, acute, rock hard eye, frontal HA, halos, raindown around lights, non-reactive pupil dont give EPI: miadriasis |
| cataracts/ congenital/ risk | opacity of lens. / congenital- rubella classical galactosemia, galactokinase def, DB |
| CN 4 damage | eye drifts upward- vertical dipliopia problems reading, going town the stairs |
| CN 6 damage | medially directed eye |
| miosis | pupilary pschincter muscle. parasymp Cn 3 from EW n. to ciliary ganglion. |
| mydriasis | radial muscle, symp. T1 preganglionic- sup cervical ganglkion- postgl. symp- long ciliary nerve. |
| marcus gunn pupil | damage in CN2. shine light in one eye- both dilated/ shine light on ok eye- both constrict. AFFERENT problem |
| macular degeneration dry vs wet | loss of central vision. dry- slow- fat deposits wet rapid. neovascularization |
| damage to optic tract on R | loss of right retina field.= loss of left visual field homonymous hemianopia |
| damage to meyer's loop on R | in temporal lobe L upper quadrant anopia. |
| damage to dorsal optic radiation R | parietal lobe MCA L lower quadrantic lesion |
| INO | lesion of MLF causes palsy of medial rectus (Cn3) when looking laterally. the normal eye moves laterally and has nystagmus. both eyes goinward on accomodation. |
| alzheimers | senile plaques: b-amyloid (dark cotton balls) neurofibrillary tangles- TAU phosphorylation (flame shape) |
| pick's dz | frontotemporal dementia dementia, aphasia, change in personality pick's body- ROUND tau, stains w/ silver |
| lewy body dementia | parkinson w/ dementia, VISUAL hallucinations, repeated falls, and syncope. alpha-synuclein defect (lewy body) |
| MS | oligoclonal bands (IgG to oligodendroglia cells) periventricular plaques |
| guillain barre' | motor fibers. symmetric. ascending/ autonomic dysFN CSF- high protien no WBC / papilledema ass w/ campylobacter |
| PML | AIDS+ JC virus - destruction of oligodentroglia |
| acute disseminated (post inf) encephalomyelitis | multifocal inflamm and demyelination after infection. no necrosis. ass w/ kids and chickenpox/measles |
| metachromatic leukodystrophy | AR lysosomal storage dz arylsulfatase A def. - impair production of myelin |
| charcot marie-tooth dz | hereditary- motor and sensory neuropathy def in protein ass w/ meylin. - palpable perineal n. but thin calfs constant demyelination/remyelination- onion bulb look |
| seizures general | 1. absence- 3hz, no postictal confusion- blank stare 2. myoclonic- jerks 3. tonic-clonic- grand mal. stiff and jerks 4. tonic- stiff 5. atonic- drop. mistaken for fainting. |
| simple vs comple sz | simple- consciousness is intact. complex- impaired consciousness |
| causes if sz by age | kids- genetic>inf>trauma adults- tumors>trauma>stroke>inf elderly- stroke> tumor>trauma>metabolic>inf |
| cluster HA | unilatral. brief HA. every day for several wks tearing, runny nose! horner's tx/; O2 +/- sumitriptan |
| tension HA | bilateral. > 30 mins. dull pain no othe associated sx frontal-occipital region |
| migraine | unilatreal- pulsating, n/v, photophobia, phonophobia, possible aura. tx: sumitriptan for acute/ BB for prophylaxis. |
| trigeminal neuralgia | lightening pain, electrical shock like w/ min stimuli- bed sheets, wind. tx- carbamezepine, |
| sturge webber syndrome | cong. port wine stain at trigeminal region (V1) ipsilateral letomeningeal angioma pheochromocytoma |
| tuberous sclerosis | hamartomas in CNS, cadiac rhabdomyomas renal angiolypomas. ashleaf spots |
| Von Hipple Lindau dz | cavernous hemangiomas in skin, mucosa BILATERAL renal cell CA- increases epo pheocrhomocytoma, hemangioblastoma in cerebellum |
| GMB | MC 1 tumor adults GFAP+ / pesudopalisading cells hemispheres. crosses corpus callosum. / necrosis. |
| meningioma | 2nd MC in adults whorled pattern. psammoma bodies - calcification rings |
| schwannoma | 3rd MC in adults. resectable S-100 + bilateral aucustic schwannoma - NF2 |
| oligodendroglyoma | slow growing. frontal lobes. GFAP + fried eggs cells and chicken wire capillary |
| pilocytic astrocytoma | kids. GFAP + usually at cerebellum - cyst and solid rosenthal fibers- eosinophilic corckscrew fibers |
| medulloblastoma | cerebellar tumors kids. PNET homer-wright rosettes. small blue cell Ca |
| epndymoma | at 4th ventricle. kids. hydrocephalous. perivascular pseudorosettes.(white area around BV) |
| hemangioblastoma | kids. cerebellum w/ foamy cells. ass w/ vHL syndrome. produces EPO- 2nd polycythemia |
| craniopharyngioma | benign kids. from rathke's pouch- calcification- enamel like bitemporal hemianopsia. |
| uncal herniation | ipsilateral- CN 3 palsy, paresis( compression crus cerebri-contralat) contralateral- homonymous hemianopia (comp ipsilat PCA) |
| cingulate herniation | subfalcine. under falx cerebri. compression ACA |
| downward transtectorial herniation | compression cerebral aqueduct- hydrocephalus |
| cerebellar tonsil herniation | into foramen magnum ass w/ arnol chiari |
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