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2012-10-30 10:42:34

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  1. Global memory impairment with acute onset and fluctuating symptoms. Dementia or delirium
  2. Arginase deficiency
    What will be elevated or decreased?
    • Elevated: Arginine
    • Decreased: Urea and ornithine
  3. Time and length (space) constant. 
    How does myelin affect it?
    • Decreases time constant
    • Increases length constant
  4. Duration of postpartum blues
    Duration of postpartum depression
    • Blues: 10 days
    • Depression: 2 weeks - 12 months
  5. Cryptococcus neformans disseminates to what organ from the lung?
    • CNS
    • CSF has no components of the alternative pathway = impaired phagocytosis
  6. 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)
  7. 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
  8. Treatment of orotic aciduria
    Uridine (inhibits CP-II)
  9. Degeneration of posterior columns and spinocerebellar tracts
    • Friedrich's ataxia
    • Vitamin E deficiency
    • Vitamin B12 neuropathy
    • What is M?
    • M = mamillary bodies
  10. Anti-depressant drug that causes priapism
  11. Longer-acting benzos (Diazepam, Flurazepam, Clordiazepoxide) cause what adverse effects
    • Drowsiness, sedation
    • Increased risk of falls 
    • Slower clearance: low risk of dependence
  12. Function of mesolimbic-mesocortical pathway
    Dz association
    • Regulating behaviour
    • Dz: Hyperactivity causes schizophrenia
  13. Nigrostriatal pathway
    • Controls voluntary movements (dopamine inhibits Ach)
    • Parkinsonism
  14. Tuberoinfundibular dopamine pathway
    • Controls prolactin secretion (dop inhibits prl)
    • Galactorrhea
  15. Hydrocephalus associated with brain atrophy
    Hydrocephalus ex vacuo
  16. CSF flows freely and decreased CSF reabsorption secondary to subarachnoid villi inflammation. Hydrocephalus?
    • Communicating
    • (Non-obstructive)
    • Entire ventricle system is dilated
  17. Obstructed CSF flow due to Arnold Chiari malformation or aqueductal stenosis
    • Non-communicating
    • Ventricles proximal to the obstruction are dilated
  18. Appearance of substances in 12-48 hours of ischemic stroke
    Red neurons (eosinophilic cytoplasm, pyknotic nuclei, loss of Nissl substance)
  19. Ischemic stroke: 1-2 weeks
    • Liquefactive necrosis
    • Reactive gliosis and vascular proliferation
  20. Ischemic stroke (>2 weeks)
    • Glial scar 
    • Cystic area surrounded by gliosis
  21. Measles hibernate in what organ?
    • CNS
    • Antibodies are found as oligoclonal bands of immunoglobulins
  22. Liquefactive necrosis pathology
    • Complete digestion and removal of necrotic tissue with the formation of a cystic cavity
    • Degradation caused by lysosomal enzymes
  23. Cause of hemorrhagic infarcts in the brain
    Reperfusion injury
  24. Precocious puberty and upward gaze - tumor location?
    • Parinaud syndrome
    • Pineal gland: germimoma
  25. Irreversible neuronal injury causes proliferation of what cells 
    • Astrocytes (causes repair, and forms BBB)
    • Contains glial fibrils to cause glial hyperplasia
  26. 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)
  27. 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)
  28. Promoters of ALA synthase (heme pathway)
    Alcohol, barbituates, hypoxia
  29. Inhibitors of ALA synthase 
  30. Acute intermittent porphoryia
    • No photosensitivity
    • Urine darkens upon standing
    • Increased urinary ALA and porphobilinogen
  31. 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)
  32. In a study, exposure to a risk modifier and disease pathogenesis can occur years before the disease manifests
    Latent period. 
  33. Found in the temporal lobes (HSV)
  34. Treatment for acute mania
    Valproate, lithium, carbamazepine
  35. 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
  36. 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
  37. Cell receptors for CMV, Rhinovirus
    Integrins, ICAM1 (CD54)
  38. Ketamine has what effect on morphine
    • Blocks glutamate
    • Decreases tolerance development to morphine
  39. Kid presents with kyphoscolisosis, pes cavus, and lower-extremity ataxia. Dx and complications.
    • Friedrick's ataxia
    • Hypertrophic cardiomyopathy, DM, bulbar dysfunction (cannot protect airway)
  40. Aggressive behaviour, agitated, confused, vertical nystagmus, and ataxia. Drug toxicity?
    PCP (hallucinogen)
  41. Phenobarbital and carbamazepine do what to phenytoin
    Induce p450 levels and decrease phenytoin levels
  42. Cimetidine, fluconazole, omeprazole do what to phenytoin?
    Inhibit p450 levels and increase phenytoin levels
  43. Treatment for Cryptococcus (budding yeast)
    • Amphotericin B and flucytosine
    • Long term: Fluconazole
  44. Tumor composed of high cellularity pattern (antoni A) and myxoid areas of low cellularity (antoni B)
    • Schwannoma
    • S-100+
  45. Child tumor mixed with Rosenthal fibres and granular eosinophilic bodies
    Pilocytic astrocytoma
  46. Tumor with these cells surrounding a fibrillary core
    Medulloblastoma, Neuroblastoma
  47. 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)
  48. Use of valproate during pregnancy
    • Inhibits folic acid reabsorption
    • NTD
  49. 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
  50. 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)
  51. NE output to which organs?
    Sympathetic output to the cardiac and smooth muscle, glands too (except sweat glands)
  52. Dopanergic output to what organs?
    Sympathetic output to the renal vasculature
  53. What output reaches the skeletal muscle?
    Somatic (Ach) via nicotinic receptors
  54. What output to the adrenal medulla?
    • Sympathetic (ACh via nicotinic)
    • No presynaptic and post-synaptic fibres
  55. Which enzyme has 3'-5' exonuclease activity, and 5'-3' exonuclease activity?
    • DNA polymerase III
    • DNA polymerase I
  56. What fetal abnormality gives an increase in Ach-esterase?
    • NTD (along with a-FP)
    • Due to failed fusion of the caudal or cranial end
  57. 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
  58. 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
  59. Defects in ataxia-telangiectasia
    • Defect in ATM gene that codes for DNA break repair
    • IgA deficiency: infections of the upper and lower tracts
    • Meningioma
    • (arise from cells of the arachnoid villi)
    • Psammoma bodies: collagen-fibre bundles
    • Oligodendroglioma 
    • (cells of the CNS)
    • Palisading tumor cells
    • GM
  60. POMC produces what three molecules when cleaved
    • endogenous opiods (b-endorphins)
    • ACTH
    • MSH
  61. 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)
  62. 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)
  63. Unconsciouss shifting of emotions from one person to another (positive or negative) and reminded of the former person
    Transference (patient to doctor)
  64. Shifting of emotions from one person to another (e.g. resident harrassed by attending tortues his students to destress)
  65. Negative effect of adding carbidopa to levodopa
    Increase of dopamine in the brain, worsening behavioural affects (agitation and anxiety)
  66. Tetrahydropbiopterin cofactor is used for which two pathways
    • 1. Phe - Tyr - DOPA - catecholamines
    • 2. Tryptophan - serotonin
  67. Paraneoplastic syndromes induce what kind of reaction
    Autoimmune: releases substances that can damage other healthy structures/organs
  68. Restlessness, agitation, dysphagia progressing to coma within 30-50 days after bat exploration - virus?
  69. 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)
  70. Clasp-knife rigidity (initial tension followed by sudden release of resistance) Seen in what lesions and locations?
    • UMN lesions
    • Locations:
    • a) internal capsule
    • b) corticospinal tracts
    • c) medulla, pons and midbrain
    • d) primary motor cortex
  71. 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
  72. Function of amantidine for Parkinsons
    enhances effects of endogenous dopamine
  73. 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)
  74. Cause of INO (MLF syndrome) seen in a young woman
    • MS (demyelination or axonal denudation) of the MLF
    • areas of demyelination form plaques
  75. Patient presents with sudden onset of blurred vision, difficulty swallowing, normal nerve conduction velocity but decreased compound muscle action potential. 
    • C. botulism
    • (canned goods)
  76. What happens when anti-depressants are used in the depressive phase of bipolar disorder?
    Rapid switch to mania
  77. 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)
  78. Associations with Arnold-Chiari malformation
    • 1. meningomyelocele
    • 2. hydrocephalus
  79. 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
  80. Elimination of Listeria 
    Cell-mediated immunity
  81. Patients who have cell-mediated immunity but lack humoral immunity. Increased risk of bacterial infections like Staph and Strep. Defect?
    Immunoglobulin secretion
  82. Craniopharyngomas share their developmental origin with what structure?
    • Pituitary gland (adenohypophysis)
    • Developed from remnants of the Ratke's pouch (ectoderm)
  83. 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
  84. The inability to recognize familiar objects, despite the sensation present
  85. 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)
  86. CN.XII innervates all muscles of the tongue except
  87. Immunocompromised patient develops toxoplasma. how?
    reactivation of a latent infection
  88. 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
  89. what part of the brain relays sensory information (e.g. sensation with stroke)
  90. Gag reflex involves what nerves and on what sides
    • C.N. IX on the same side (sensory)
    • CN X on the opposite side (motor)
  91. Alar plate
    Basal plate
    • Alar: dorsal (posterior) part of spinal cord, sensory
    • Basal: ventral (anterior) part of spinal cord, motor, contains anterior horn cells
  92. 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
  93. 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)
  94. Treatment for alcohol withdrawal
    • Alcohol
    • Benzos (lorazepam or chlordiazepoxide)
  95. 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.
  96. Kid has multiple episodes of sudden onset "fainting" with no warning. Type of seizure
    • Atonic
    • (absence seizures involve just staring into space with no change in position)
  97. 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
  98. What antidepressants are c/i in glaucoma (severe ocular pain, and halos seen around lights)
    • Tricyclics
    • have anti-cholinergic side effects which causes mydriasis, which can further narrow the angle in glaucoma
  99. Characteristic of Herpes and paramyxovirus family
    • Synctia formation (multinucleated giant cells)
    • Characterisitic of immunological evasion
  100. which arteries enter the posterior cranial fossa
    • composed of brain stem and cerebellum
    • vertebral arteries enter foramen magnum to form the basilar artery