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Global memory impairment with acute onset and fluctuating symptoms. Dementia or delirium
What will be elevated or decreased?
- Elevated: Arginine
- Decreased: Urea and ornithine
Time and length (space) constant.
How does myelin affect it?
- Decreases time constant
- Increases length constant
Duration of postpartum blues
Duration of postpartum depression
- Blues: 10 days
- Depression: 2 weeks - 12 months
Cryptococcus neformans disseminates to what organ from the lung?
- CSF has no components of the alternative pathway = impaired phagocytosis
The nitrogen in the urea is derived from what two sources
Rate limiting step
- Nitrogen: Asparatate and NH4+
- RLS: CP-I (activated by N-acetylglutamate)
Congenital deficiency of propionyl-coA carboxylase
- Increased levels of propionyl coA
- Decreased levels of methymalonyl coA
- Derived from:
- a) AA: Val, Ile, Met, and Thr
- b) Odd-chain fatty acids
- c) cholestrol side chains
Sx: anion gap metabolic acidosis
Treatment of orotic aciduria
Uridine (inhibits CP-II)
Degeneration of posterior columns and spinocerebellar tracts
- Friedrich's ataxia
- Vitamin E deficiency
- Vitamin B12 neuropathy
- What is M?
- M = mamillary bodies
Anti-depressant drug that causes priapism
Longer-acting benzos (Diazepam, Flurazepam, Clordiazepoxide) cause what adverse effects
- Drowsiness, sedation
- Increased risk of falls
- Slower clearance: low risk of dependence
Function of mesolimbic-mesocortical pathway
- Regulating behaviour
- Dz: Hyperactivity causes schizophrenia
- Controls voluntary movements (dopamine inhibits Ach)
Tuberoinfundibular dopamine pathway
- Controls prolactin secretion (dop inhibits prl)
Hydrocephalus associated with brain atrophy
Hydrocephalus ex vacuo
CSF flows freely and decreased CSF reabsorption secondary to subarachnoid villi inflammation. Hydrocephalus?
- Entire ventricle system is dilated
Obstructed CSF flow due to Arnold Chiari malformation or aqueductal stenosis
- Ventricles proximal to the obstruction are dilated
Appearance of substances in 12-48 hours of ischemic stroke
Red neurons (eosinophilic cytoplasm, pyknotic nuclei, loss of Nissl substance)
Ischemic stroke: 1-2 weeks
- Liquefactive necrosis
- Reactive gliosis and vascular proliferation
Ischemic stroke (>2 weeks)
- Glial scar
- Cystic area surrounded by gliosis
Measles hibernate in what organ?
- Antibodies are found as oligoclonal bands of immunoglobulins
Liquefactive necrosis pathology
- Complete digestion and removal of necrotic tissue with the formation of a cystic cavity
- Degradation caused by lysosomal enzymes
Cause of hemorrhagic infarcts in the brain
Precocious puberty and upward gaze - tumor location?
- Parinaud syndrome
- Pineal gland: germimoma
Irreversible neuronal injury causes proliferation of what cells
- Astrocytes (causes repair, and forms BBB)
- Contains glial fibrils to cause glial hyperplasia
CN III ischemic neuropathy causes damage to what fibres
Somatic only (PNS fibres are intact)
n.b cranial nerve neuropathy due to nerve compression causes loss of somatic and PNS fibres (fixed, dilated pupil and inability to accommodate)
Water-shed infarcts in the brain
- Hypoxic encephalopathy
- (initial ischemia affects purkinje cells of cerebellum and pyramidal cells of hippocampus; later, it affects watershed areas)
Promoters of ALA synthase (heme pathway)
Alcohol, barbituates, hypoxia
Inhibitors of ALA synthase
Acute intermittent porphoryia
- No photosensitivity
- Urine darkens upon standing
- Increased urinary ALA and porphobilinogen
Tremor that is autosomal-dominant and occurs with postural activities such as drinking from a glass. Tremor subsides wit alcohol. Tx
Propanolol (non-selective and has CNS affects)
In a study, exposure to a risk modifier and disease pathogenesis can occur years before the disease manifests
Found in the temporal lobes (HSV)
Treatment for acute mania
Valproate, lithium, carbamazepine
A patient is prescribed diazepam. Which drug is C/I because of its adverse effect?
- Anti-histamines (1st generation) that work peripherally and cross the CNS
- e.g. chlorpheniramine
Virulence of Rabies?
- Bullet-shaped capsule with glycoprotein spikes
- Stays in the wound for a long period of time
- Binds to nicotinic Ach receptors and travels retrograde to the CNS
Cell receptors for CMV, Rhinovirus
Integrins, ICAM1 (CD54)
Ketamine has what effect on morphine
- Blocks glutamate
- Decreases tolerance development to morphine
Kid presents with kyphoscolisosis, pes cavus, and lower-extremity ataxia. Dx and complications.
- Friedrick's ataxia
- Hypertrophic cardiomyopathy, DM, bulbar dysfunction (cannot protect airway)
Aggressive behaviour, agitated, confused, vertical nystagmus, and ataxia. Drug toxicity?
Phenobarbital and carbamazepine do what to phenytoin
Induce p450 levels and decrease phenytoin levels
Cimetidine, fluconazole, omeprazole do what to phenytoin?
Inhibit p450 levels and increase phenytoin levels
Treatment for Cryptococcus (budding yeast)
- Amphotericin B and flucytosine
- Long term: Fluconazole
Tumor composed of high cellularity pattern (antoni A) and myxoid areas of low cellularity (antoni B)
Child tumor mixed with Rosenthal fibres and granular eosinophilic bodies
Tumor with these cells surrounding a fibrillary core
Recurrent lobar hemmorhages that are benign due to what cause?
Hypertensive hemorrhages occur where?
- Amyloid (causes weakening of the wall and rupture)
- Due to age; located in cerebral hemispheres
Basal ganglia (and larger)
Use of valproate during pregnancy
- Inhibits folic acid reabsorption
Pathology of prion disease
- PrP (a-helical structure) becomes PrPsc (B-pleated sheet) which becomes resistant to proteases
- Accumulation of the protein in grey mater = spongioform transformation
Baby presents with rhinorrhea, diarrhea, chills, myoclonic jerks that progresses to seizures.
Drug cause? Tx?
- Opiods withdrawal
- Tx: tincture of opium (naloxone is used for patients to block opiod affects)
NE output to which organs?
Sympathetic output to the cardiac and smooth muscle, glands too (except sweat glands)
Dopanergic output to what organs?
Sympathetic output to the renal vasculature
What output reaches the skeletal muscle?
Somatic (Ach) via nicotinic receptors
What output to the adrenal medulla?
- Sympathetic (ACh via nicotinic)
- No presynaptic and post-synaptic fibres
Which enzyme has 3'-5' exonuclease activity, and 5'-3' exonuclease activity?
- DNA polymerase III
- DNA polymerase I
What fetal abnormality gives an increase in Ach-esterase?
- NTD (along with a-FP)
- Due to failed fusion of the caudal or cranial end
What branch of the radial nerve is injured with damage to the head of the radius?
- Deep branch
- weakness of the hand extensors but no sensory deficits
Pathogenesis of a disease presenting with tinnitus, vertigo, and sensorineural hearing loss
- Meniere's disease
- Decreased reabsorption of endolymph fluid
- Increased volume and pressure of the fluid in the vestibular appartus
Defects in ataxia-telangiectasia
- Defect in ATM gene that codes for DNA break repair
- IgA deficiency: infections of the upper and lower tracts
- (arise from cells of the arachnoid villi)
- Psammoma bodies: collagen-fibre bundles
- (cells of the CNS)
POMC produces what three molecules when cleaved
- endogenous opiods (b-endorphins)
Steps in the process of artherosclerosis of the cerebral arteries
- 1. 12-48 hours: red neurons (neurons die)
- 2. macrophages
- 3. necrotic area is reabsorbed and a cystic cavity forms. Astrocytes surround the cystic cavity to enlarge and proliferate (gliosis)
Mild euphoria with laughing behavior, slowed reflexes, dizziness with physical symptoms of rapid heart rate and conjuctival injection
- Marijuana abuse
- (metabolized in the liver and stored in the lipophilic tissues for upto 30 days)
Unconsciouss shifting of emotions from one person to another (positive or negative) and reminded of the former person
Transference (patient to doctor)
Shifting of emotions from one person to another (e.g. resident harrassed by attending tortues his students to destress)
Negative effect of adding carbidopa to levodopa
Increase of dopamine in the brain, worsening behavioural affects (agitation and anxiety)
Tetrahydropbiopterin cofactor is used for which two pathways
- 1. Phe - Tyr - DOPA - catecholamines
- 2. Tryptophan - serotonin
Paraneoplastic syndromes induce what kind of reaction
Autoimmune: releases substances that can damage other healthy structures/organs
Restlessness, agitation, dysphagia progressing to coma within 30-50 days after bat exploration - virus?
Patient presents with difficulty releasing a grip after a handshake, has cataracts. On LM, you see atrophy of Type 1 muscle fibres
- Myotonic dystrophy (CTG repeats)
- (myotonia = abnormal slow relaxation of muscles)
Clasp-knife rigidity (initial tension followed by sudden release of resistance) Seen in what lesions and locations?
- UMN lesions
- a) internal capsule
- b) corticospinal tracts
- c) medulla, pons and midbrain
- d) primary motor cortex
Degeneration of putamen = Wilson's disease
- Epidural hematoma
- (tearing of a branch of the maxillary artery)
- Sudden symptoms - lucid interval
- Subdural hematoma
- Elderly, epileptics, etc.
- Gradual onset of symptoms
- constant repeated falls
Function of amantidine for Parkinsons
enhances effects of endogenous dopamine
Thiamine treatment will not treat what sx of alcohol poisoning
- Korsakoff symptoms: permanent memory loss + confabulation
- (will treat all Wernicke's sx: opthalmoplegia, ataxia, confusion)
Cause of INO (MLF syndrome) seen in a young woman
- MS (demyelination or axonal denudation) of the MLF
- areas of demyelination form plaques
Patient presents with sudden onset of blurred vision, difficulty swallowing, normal nerve conduction velocity but decreased compound muscle action potential.
- C. botulism
- (canned goods)
What happens when anti-depressants are used in the depressive phase of bipolar disorder?
Rapid switch to mania
Patient is receiving neostigmine for her MG but still has sx. Edrophonium causes a big improvement in her muscle strength. What to do next?
Myasthenic crisis: increase her neostigmine dosage
(if no improvement in her sx, she has a cholinergic crisis - i.e. receiving too much medication that's downregulating her receptors)
Associations with Arnold-Chiari malformation
- 1. meningomyelocele
- 2. hydrocephalus
Light microscopy findings of Guillian-Barre syndrome and its complications
- Light microscopy: segmental demyelination + endoneural inflammatory infiltrate
- No deep tendon reflexes (areflexia)
- Paralysis to CN.VII (Bell's palsy)
- Paralysis of the respiratory muscles
Elimination of Listeria
Patients who have cell-mediated immunity but lack humoral immunity. Increased risk of bacterial infections like Staph and Strep. Defect?
Craniopharyngomas share their developmental origin with what structure?
- Pituitary gland (adenohypophysis)
- Developed from remnants of the Ratke's pouch (ectoderm)
Penicillins and cephalosporins function by irreversibly binding to what structure?
Mechanism of resistance for both.
Penicillin-binding proteins such as transpeptidases
Penicillin: B-lactamases will destroy the Abx by cleaving the B-lactam ring
Cephalosporins: less sensitive to B-lactamases; altered structure of PBP
The inability to recognize familiar objects, despite the sensation present
Loss of ability to carry out movements that you could once normally do (e.g. hear a phone ring but not know how to answer it)
CN.XII innervates all muscles of the tongue except
Immunocompromised patient develops toxoplasma. how?
reactivation of a latent infection
what is seen in the older plaques of MS patients?
- gliosis (inflammation and myelin breakdown have disappeared)
- axons are preserved and cause hypertrophy and hyperplasia of the area, but oligodendrocytes are dead
what part of the brain relays sensory information (e.g. sensation with stroke)
Gag reflex involves what nerves and on what sides
- C.N. IX on the same side (sensory)
- CN X on the opposite side (motor)
- Alar: dorsal (posterior) part of spinal cord, sensory
- Basal: ventral (anterior) part of spinal cord, motor, contains anterior horn cells
Retinoblastoma has a defect of what gene on what chromosome?
Contains what type of rosettes?
- Rb gene on ch 13 (also seen with osteosarcoma)
- True rosettes (Flexner-Weinster) = surrounds a central lumen
Light is shone in the left eye but does not constrict either the left or the right eye. Damage to what nerve
Left optic nerve (would travel to the CNS and cause bilateral constriction of both eyes via CN III)
Treatment for alcohol withdrawal
- Benzos (lorazepam or chlordiazepoxide)
Composition of plaques in MS and pathogenesis
- Surrounded by lymphocytes and astrocytes
- Initiated by Th1 cells which release IFN-gamma to make macrophages
- Macrophages are responsible for the demyelination
- Type IV H.S.
Kid has multiple episodes of sudden onset "fainting" with no warning. Type of seizure
- (absence seizures involve just staring into space with no change in position)
How does electric nerve stimulation relieve pain?
- Lessens chronic pain by overly stimulating the neurons
- Triggers inhibitory neurons in lamina II of the spinal cord
What antidepressants are c/i in glaucoma (severe ocular pain, and halos seen around lights)
- have anti-cholinergic side effects which causes mydriasis, which can further narrow the angle in glaucoma
Characteristic of Herpes and paramyxovirus family
- Synctia formation (multinucleated giant cells)
- Characterisitic of immunological evasion
which arteries enter the posterior cranial fossa
- composed of brain stem and cerebellum
- vertebral arteries enter foramen magnum to form the basilar artery