NMSK B

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NMSK B
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  1. Aphasia
    Trouble finding words
  2. Apraxia
    Difficulty w/ cognitive motor functions ie. butter piece of toast
  3. Agnosia
    Can't perceive; denies that they have problems
  4. Executive dysfunction
    Multi step task
  5. Metachromatic Leukodystrophy
    • Cerebroside
    • Arylsulfatase A
    • Toluidine blue - stains metachromatically
    • Cytoplasmic spherical granules
    • Astrogliosis
    • Infancy
  6. Krabbe Disease
    • Deficiency of galactocerebroside B-galactosidase
    • Globoid cells in white matter (macrophages that contain undigested galactocerebroside)
    • W/o galactocerebroside B-galactosidase there is a build up of galactocerebroside
    • Can cause glucodystrophy
    • Marbled areas of partial and total demyelination
    • Severe astrogliosis
  7. Central Pontine Myelinolysis
    • Affects tegmentum of the pons
    • Malnourished people (alcoholics)
    • Thought to be related to disturbances associated w/ rapid therapeutic correction of hyponatremia
  8. What is 85% of the body's energy stored in the form of?
    TAG
  9. What regulates GLUT 4?
    Insulin
  10. Explain what Km value is.
    Indicates concentration of substrate which is sufficient for the rate of catalysis to be 1/2 the rate of max rate
  11. What replaces 75% of glucose in the brain during starvation?
    Ketones
  12. Why is the brain undergoing exclusively aerobic metabolism?
    • B/c it requires a lot of energy to maintain ionic gradients continuously. 
    • Maintains Na/K pump
  13. What hydrolyzes 80% of the ATP in the brain?
    Maintenance of the Na/K pump
  14. What type of transporters are GLUT?
    Passive transporters
  15. Why does glucose need a transporter?
    B/c it is very hydrophilic
  16. What are the 3 types of ketone bodies produced and which ones are catabolized?
    • Acetone - body can't use; produces the fruity smell in diabetics
    • Acetoacetate - catabolized
    • 3-hydroxybutarate - catabolized (not considered a ketone structurally)
  17. What is FA bound to, to reach the liver?
    Albumin
  18. What type of oxidation is used to cleave acetyl CoA from fatty acids?
    Beta oxidation
  19. What are the 2 enzymes that make and break ketone bodies?
    HMG-CoA synthase and HMG-CoA lyase
  20. Does choline or acetate get recycled?
    Choline gets recycled
  21. How does AChE degrade ACh?
    Hydrolysis of the ester bond
  22. What is the enzyme responsible for the synthesis of ACh?
    Choline acetyltransferase
  23. How is ACh made?
    Choline acetyltransferase positions acetyl-CoA and choline so that the thioester bond of the CoA can be attacked by the choline
  24. What is serotonin derived from?
    Tryptophan
  25. How is serotonin made and what are the enzymes involved?
    • Tryptophan has a -OH added on by a tryptophan hydroxylase becoming 5-HT
    • 5-HT gets a -COO removed by the 5-HT carboxylase becoming serotonin
  26. What does Trp hydroxylase require?
    Fe2+ and tetrahydrobiopterin cofactors
  27. What deactivates serotonin and where is it located?
    MAO (monoamine oxidase) in the presynaptic neuron
  28. What does serotonin regulate?
    • BP in endothelial cells (vasoconstriction)
    • Regulates digestion
  29. What are the 4 criteria for being a neurotransmitter?
    • Synthesized in the presynaptic neuron
    • Released by the presynaptic terminal in significant amounts to produce a clear effect on the post synaptic neuron or effector organ
    • When tested exogenously, it behaves as it does endogenously
    • There is a specific way that it is removed from the synaptic cleft
  30. How does tetanus interfere with NT release?
    Binds to VAMP
  31. How does botulinum toxin A, B, and C interfere with NT release?
    • A binds to Snap-25
    • B binds to VAMP
    • C binds to Syntaxin
  32. What type of transporter does Glutamate use for reuptake?
    Na/ K transporter
  33. What type of transporter does all the NT use besides glutamate for reuptake?
    Na/ Cl transporter
  34. What type of gradient does the vesicle transporter use?
    H+ gradient
  35. What is the main culprit for Multiple Sclerosis?
    Proteins - T Cell Mediated
  36. What is the main culprit for Guillain-Barre?
    Antibodies - B cell mediated
  37. What are the genetic factors for early onset of MG?
    HLA A1, B8, and DR3 (DQ2)
  38. What are the genetic factors for late onset of MG?
    HLA B7, DR2
  39. Acute or sudden unilateral dilation w/ diminished reactivity suggests...
    Uncal Herniation in pt w/ depression of consciousness or coma
  40. CN examination for pupillary light response
    CN 2, 3
  41. CN examination for occulocephalic/ caloriccs?
    CN 3, 4, 6, 8
  42. CN examination for corneal blink reflex?
    CN 5, 7
  43. CN examination for gag reflex?
    CN 9, 10
  44. Eye deviation for destructive lesion (stroke)?
    Looks toward
  45. Eye deviation for irritable lesion (tumor)?
    Looks away
  46. Eye deviation for brainstem lesion?
    Looks away
  47. Origin for vertical nystagmus?
    Central origin (posterior side or cerebellum)
  48. Origin for horizontal nystagmus?
    Peripheral or central origin (most common)
  49. Positive doll's eye?
    • Eyes deviate opposite relative to head
    • Intact reflex
  50. Negative doll's eye?
    • Eyes remain straight relative to head
    • No brainstem function
    • Impaired reflex
    • Then do VOR reflex
  51. Vestibulo-Ocular Reflex (VOR) for normal response if awake?
    Slow towards and fast away
  52. Vestibulo-Ocular Reflex (VOR) for normal response if coma and intact brainstem?
    Slow phase only intact and no fast phase
  53. Vestibulo-Ocular Reflex (VOR) for abnormal response in coma and severe brainstem dysfunction?
    No eye movement or dysconjugate response
  54. What is the decorticate posture?
    • Lesion above red nucleus
    • Lower limbs extend, upper limbs flex following stimulus
    • Activity in brainstem flexor center - red nucleus
  55. What is the decerebrate posture?
    • Lesion below red nucleus
    • Upper and lower limbs extend following stimulus (pain, startle, or auditory)
    • Normally inhibition by cortex on extensor facilitation
    • Inhibition is missing, extensors hyperactive
  56. Explain the neurogenic vasodepressor
    Too much sympathetic activity (whether it be b/c you get surprised) so heart will increase but then system will recognize that there’s too much pressure and system will respond and try to decrease the heart rate. Which will send a signal to the nucleus tractus solitaries and lead to reflexive decrease in blood pressure. It will then lead to blood rushing from the brain. At same time there could be a vagal activity going on which leads to bradycardia, which is trying to compensate.
  57. Where is DUI on the scheme?
    Cognitive Impairment --> Metabolic
  58. Who is the second victim?
    • • good people working in a flawed system
    • o 98% of these errors are due to people doing the best job they can with a variety of reasons getting in the way of doing that
    • o People that are in the process, but aren’t the people that gave or received the treatment
    • o  Ex. Nurses
  59. How does AGE damage microvasculature?
    • RAGE binding to AGE signals a proinflammatory immune response
    • Glycation and crosslinking of collagen interferes w/ the structural support of b.v.
    • Part of the inflammatory response of RAGE involves ROS signaling 
    • ROS signaling interferes w/ NOS signaling
    • (Nitrix-oxide regulates relaxation and tension of microvasculature)
  60. Where do the plaques of MS like being around?
    Lateral ventricles
  61. What is the probably etiology of Central Pontine Myelinolysis?
    Disturbances associated w/ rapid therapeutic corrections of hyponatremia
  62. What are the vitamins for biosynthesis?
    Last 4 vitamins
  63. What are the vitamins for energy metabolism?
    First 4 vitamins
  64. Non-Polio Enteroviruses
    • Disease Manifestations: Due to virus-induced cell lysis of infected cells
    • Pathogenesis: Cytolysis and immune response
    • Dx: RT-PCR using CSF or throat swab
    • Treatment: Supportive
    • Prevention: Hand washing; bleach
    • Notes: Infects GI Tract, transmit fecal-oral route
  65. Human Herpes Virus 6
    • Pathogenesis: Viral and immune mediated; latency
    • Diagnosis: roseola, PCR or serology
    • Treatment: Foscarnet or Ganiciclovir (acyclovir won't work b/c no thymidine kinase)
    • Prevention: Hand washing
    • Notes: High fever then no fever, + rash, then recovery w/o complications
  66. Human Herpes Virus 7
    • Pathogenesis: Viral and immune mediated; latency
    • Treatment: None
    • Prevention: Hand washing
  67. Herpes Simplex type 1
    • Pathogenesis: Viral and immune mediated; latency
    • Diagnosis: cell culture to observe cytopathic effects (Cowdry cells); Tzanck smear to cell multinucleated giant cells, enzyme immunoassays and immunofluorescence, PCR using CSF for rapid dx of encephalitis or meningitis
    • Treatment: No Vaccine. Anti-viral=Acyclovir, Foscarnet to inhibit viral DNA polymerase
    • Prevention: Avoid kissing/ saliva contact if blisters present
    • Notes: linear dsDNA; 70% of adults infected; infects kids usually
  68. Herpes Simplex type 2
    • Pathogenesis: Viral and immune mediated; latency
    • Diagnosis: cell culture to observe cytopathic effects (Cowdry cells); Tzanck smear to cell multinucleated giant cells, enzyme immunoassays and immunofluorescence, PCR using CSF for rapid dx of encephalitis or meningitis
    • Treatment: No Vaccine. Anti-viral=Acyclovir, Foscarnet to inhibit viral DNA polymerase
    • Prevention: Safe sex; C-section
  69. Cytomegalovirus
    • Disease Manifestations: small head size, hearing loss, vision loss, mental disability
    • Pathogenesis: Viral and immune mediated; latency
    • Diagnosis: PCR, antigen detection, viral culture, serology; dense central "owl's eye" basophilic intranuclear inclusion body
    • Treatment: Ganciclovir, Valganciclovir, Cidofovir, or Foscarnet
    • Prevention: Safe sex; blood screening; hand-washing
  70. Varicella-Zoster Virus
    • Pathogenesis: Viral and immune mediated; latency
    • Diagnosis: Clinical symptoms, Tzanck smear for giant multinucleated cells, PCR of CSF (for encephalitis)
    • Treatment: No Vaccine; Anti-viral=Acyclovir for ICP
    • Prevention: Vaccines (chickenpox, zoster); VarZIG
  71. Eastern Equine Encephalitis Virus
    • Disease Manifestations: High morbidity and mortality; most cases are sub-clinical
    • Pathogenesis: Viral and immune mediated; latency
    • Treatment: Supportive
    • Prevention: Avoid mosquito bites
  72. Western Equine Encephalitis Virus
    • Disease Manifestations: Higher attack rate in young infants and severe disease more likely
    • Pathogenesis: Viral and immune mediated; latency
    • Treatment: Supportive
    • Prevention: Avoid mosquito bites
  73. West Nile Virus
    • Disease Manifestations: No symptoms in most
    • Pathogenesis: Viral and immune mediated; latency
    • Treatment: Supportive
    • Prevention: Avoid mosquito bites; blood-screening
  74. Saint Louis Encephalitis Virus
    • Disease Manifestations: Moderately severe encephalitis and mortality rate; more of the severe disease in adults
    • Pathogenesis: Viral and immune mediated; latency
    • Treatment: Supportive
    • Prevention: Avoid mosquito bites
  75. Yellow Fever Virus
    • Disease Manifestations: Liver damage or liver failure
    • Pathogenesis: Viral and immune mediated; latency
    • Treatment: Supportive
    • Prevention: Avoid mosquito bites; Vaccine
  76. Dengue Virus
    • Disease Manifestations: Hemorrhagic fever
    • Pathogenesis: Viral and immune mediated; latency
    • Treatment: Supportive
    • Prevention: Avoid mosquito bites
  77. California Encephalitis Virus Group
    • Pathogenesis: Viral and immune mediated; latency
    • Treatment: Supportive
    • Prevention: Avoid mosquito bites
  78. Colorado Tick Fever Virus
    • Pathogenesis: Viral and immune mediated; latency
    • Treatment: Supportive
    • Prevention: Avoid tick bites
  79. What are virulence factors for Cryptococcus Species?
    • Polysaccharide capsule - helps w/ dx
    • Melanin - protect against oxidative killing; made by phenol oxidase
  80. What is the diagnosis for Cryptococcus?
    • India ink stain of CSF
    • Produces white, mucoid colonies on a variety of agars
  81. What is the definite host for Taenia solium and what is definite host?
    • Humans
    • Definite host - When sexual reproduction happens
  82. What is the intermediate host of Taenia solium and what is intermediate host?
    • Swine and humans
    • Intermediate host - when asexual/ larval development happens
  83. What is Taeniasis and how does it occur?
    Sx, Tx, Dx, Prevention?
    • Tapeworm Infection
    • Eggs from human feces ingested by pigs --> eggs hatch to release hexacanth embryo which penetrates intestinal wall --> uses lymphohematogenous system to reach any tissue --> develops into cyst --> humans consume undercooked or raw pork containing cysts
    • Sx: Abdominal pain, passing of proglottids in feces
    • Tx: Antiparastitic (Praziquantel)
    • Dx: Eggs in stool sample
    • Prevention: Proper cooking of pork
  84. What is Cysticerosis and how does it occur?
    Sx, Tx, Dx, Prevention?
    • Cysts in muscles, eyes, brain
    • Due to autoinfection from vomiting or fecal-oral route
    • Most common cause of acquired epilepsy in the developing world
    • Sx: Lumps under skin or damage around the eye
    • Dx: CT scan or MRI
    • Tx: Antiparasitic and anti-inflammatory
    • Prevention: handwashing, avoiding food/ water that may be contaminated
  85. What is the MOA of Flucytosine?
    Black box warning?
    • Fungi turns 5-FC --> F-FU
    • This disrupts RNA and DNA synthesis and kills organism
    • Black box warning: Extreme caution in pts. w/ impaired renal function
  86. What is the MOA of Echinocandins? "-fungins"
    Inhibit production of Glucan on cell wall and get defective cell wall and cell will burst b/c cell wall helps w/ keeping internal osmotic pressure
  87. What is the MOA for Azole? "-conazoles"
    • Inhibit cytochrome P450 enzymes in the fungus that manufactures ergosterol (part of cell membrane)
    • Beware has lots of drug interactions!
  88. What is the MOA of Acyclovir?
    • Virus donates kinase that phosphorylates the drug
    • Triple phosphorylation to an active form and it gets incorporated into viral DNA and disrupts DNA synthesis
  89. What is the drug of choice for Listeria monocytogenes?
    Ampicillin
  90. What is the MOA for Amphotericin?
    Binds to ergosterol in the cell membrane and forms holes in the membrane and leakage of cell cytoplasmic substances which will kill the fungus
  91. Where are they found and what are characteristics of Oligodendroglioma?
    • Fried-egg Appearance
    • Calcospherites (calcifications)
    • Arises in white matter
  92. Where are they found and what are characteristics of Ependymoma?
    • Perivascular Pseudorosettes (fibrillary processes present)
    • Hydrocephalus
    • Blocks 4th ventricle
  93. Where are they found and what are characteristics of GBM?
    • Peripheral Palisading - Picket fence around tumor
    • Glomeruloid - clusters of small b.v.
    • Butterfly
  94. Where are they found and what are characteristics of Colloid Cyst of Third Ventricle?
    • 3rd ventricle
    • Noncommunicating hydrocephalus
    • Gelatinous, proteinaceous material, lined w/ ciliated cuboidal epithelium
  95. Where are they found and what are characteristics of Medulloblastoma?
    Which chromosome is it associated with?
    • Exclusively in cerebellum (infiltrates vermis)
    • Small, round, blue cell tumors of childhood
    • Rosette formation
    • Radiosensitive
    • Chromosome 17p
  96. Where are they found and what are characteristics of Meningioma?
    Which chromosome is it associated with?
    • Fibroblastic, whorled pattern of "meningothelial" cells w/ Psammoma Bodies
    • Arachnoid villi
    • Parasagittal areas, olfactory groove, lateral wing of sphenoid, convexities of cerebral hemispheres
    • Chromosome 22
  97. What are characteristics of Schwannoma?
    • Antoni A pattern (mixture of fascicles of elongated spindle cells) between regions of Antoni B pattern (loosely staining, myxoid areas)
    • Attached to nerves (most commonly 8th CN)
  98. Where is Acoustic Neuroma usually located?
    Intracranial Schwannoma restricted to the 8th CN, found in the cerebellar pontine angle
  99. What are characteristics of Craniopharyngioma?
    • Arise from Rathke's pouch
    • Sella Turcica
    • Calcifications and keratin
    • Kids: Endocrine deficiences
    • Adults: visual disturbances and h/a
  100. What are characteristics of Primary Brain Lymphoma?
    • Angiocentric distribution of both small and large neoplastic lymphocytes
    • Vast majority are of B-cell origin 
    • 1000X more common in AIDS pts
  101. What are characteristics of Metastatic Brain Tumor?
    • Cannon ball lesions that seed to the gray-white junction
    • Goes through bloodstream, pts w/ advanced carcinoma
  102. What is the #1 Primary Brain Tumor?
    Glioma
  103. What is the most common benign tumor?
    Meningioma
  104. What are some malignant tumors that end in -oma?
    Lymphoma, Mesothelioma, Melanoma, Seminoma
  105. What are characteristics of a Febrile Seizure?
    • Fever
    • Child normal neurologically
    • No bacterial meningitis
    • Do lumbar puncture
    • Tx: directed at seizure, no anti-epileptics
  106. What are characteristics of a Temporal Lobe or Psychomotor Seizure?
    • Temporal lobe
    • Aura
  107. What are characteristics of a Hippocampal Sclerosis?
    • Most commonly seen w/ Complex Partial seizures
    • Hippocampal neuron cell loss
    • Segmental loss of pyramidal neurons and reactive gliosis
  108. What are characteristics of a Absence Seizures?
    • Brief staring spells by children or teens
    • No warning or postictal phase
  109. What are characteristics of a Generalized Tonic/ Clonic Phase?
    • Sudden cry, fall, momentary rigidity followed by jerking of muscles
    • No bladder control
  110. What is the principal effector target of the limbic system?
    Hypothalamus
  111. What is the intermediate effector target?
    • Amygdala
    • Hippocampus
    • Basal Forebrain (septal area, nucleus accumbens, basal nucleus of Meynert)
  112. What are the regions of the Limbic Lobe?
    • Cingulate gyrus
    • Medial Orbital Frontal Gyrus 
    • Parahippocampal gyrus
    • Gyri of Temporal Lobe
  113. What are the functions of the Limbic System? (5 F's)
    Feeding, Fighting, Fleeing, Feeling, physical Fellowship
  114. What does the Hypothalamus communicate with? (Maybe test Q)
    • Limbic System
    • Autonomic Nuclei 
    • Pituitary
  115. What are the functions of the Hypothalamus?
    • Regulate autonomic and endocrine function
    • Integrates stress responses
    • Influences behavior
  116. What emotional response is the Amygdala most associated with?
    Fear
  117. What are the parts of the hippocampus?
    • Hippocampus
    • Dentate gyrus
    • Subiculum
  118. What are the steps in the Papez Circuit Pathway?
  119. What are the steps in the Perforant Pathway?
  120. What will damage to the Nucleus Accumbens cause?
    Reduce motivation to work for reward
  121. What will damage to the basal nucleus of Meynert cause?
    Create learning and recognition deficits
  122. What will damage to the septal area cause?
    Septal rage syndrome
  123. What are the 3 components of the basal forebrain?
    • Septal Area
    • Nucleus Accumbens
    • Basal nucleus of Meynert
  124. What are the pathways for Long Term Memory?
  125. What does GABA-A and Glycine do?
    • Let Cl- inward
    • Ionotropic
  126. What does GABA-B do?
    • Let K+ out 
    • Inhibit Ca2+ in
    • Metabotropic
  127. When is an MRI preferred?
    Most clinical situations especially for evaluation of intracranial lesions (soft tissue)
  128. When is a CT preferred?
    • Acute head trauma including facial fractures
    • More sensitive in finding bony fractures acute intracranial bleeds
  129. What contrast agent does MRI use?
    Gadolinium
  130. What contrast agent does CT use?
    Iodine
  131. T1 or T2?

    T1
  132. T1 or T2?

    T2
  133. What is a classic EEG for an Absence Seizure?
    3 Hz, spike/wave
  134. What are the characteristics of an absence seizure?
    • 2-15 seconds
    • Staring or blinking, upward rotation of eyes, no motor activity
    • Abrupt onset
    • No aura or warning
    • Kids, not >25 yo
  135. What are the characteristics of an generalized tonic-clonic seizure?
    • Both hemispheres affected
    • 2-5 minutes
    • Muscles rigid (tonic) - person falls, rhythmic muscle contractions (clonic), shallow breathing, incontinence, postictal drowsiness confusion amnesia
    • No aura or warning
    • No consciousness
  136. What are the characteristics of an simple partial seizure?
    • seconds to minutes
    • Involuntary muscle jerks, sensory, psychic or emotional, foul smell, metallic taste, light headed
    • Prodrome and Aura
  137. What are the characteristics of an complex partial seizure?
    • 1-3 minutes
    • MRI usually normal
    • Automatisms (smacking lips, picking at clothes, etc.)
    • Alteration of awareness but not complete loss of consciousness
  138. What are the characteristics of an partial w/ secondary generalization seizure?
    • 2-4 minutes
    • Partial seizure in onset then spreads
    • Tonic - clonic 
    • Person falls, rhythmic muscle contractions
    • Todd's postictal hemiparalysis suggests origin location
  139. What are the developmental deficits with Ohtahara Syndrome?
    Severe psychomotor prognosis
  140. What are the developmental deficits with Dravet Syndrome?
    Developmental delay and persistent gait ataxia, and cognitive and/ or behavioral impairment occur in majority of patients
  141. What are the developmental deficits with Lennox-Gastaut Syndrome?
    • Mental retardation w/ or w/o neurologic abnormality
    • Psychotic symptoms are common
    • Often, neurodevelopment is normal before the first seizure
  142. What are the developmental deficits with Landau-Kleffner Syndrome?
    • Loses language function
    • Appears deaf
  143. How does [Cl-] change with development?
    • Early in development, Cl- is moved
    • into the cell by a Na-K-Cl cotransporter

    [Cl-] becomes higher in the cell

    • When GABA-A channels are open, Cl-
    • will want to leave the cell following it’s concentration gradient so
    • essentially it is depolarizing the cell and exciting it


    • Normally, K+/Cl- cotransporter,
    • keeps the [Cl-] low in the cell

    • K+/Cl- cotransporter is not
    • expressed in early development
  144. How does Glycine provide an excitatory effect?
    • It can bind to NMDA receptors and make them more sensitive to glutamate
    • Spillover in the spinal cord can lead to enhanced pain transmission at glutamate synapses (need to clean up all the glycine so that it won't bind to NMDA receptors)
  145. What is the most common type of neuropathologic damage seen in individuals with Complex Partial Seizures?
    Hippocampal Sclerosis - hippocampus neuronal cell loss
  146. What are some physical findings after a seizure? (Temp, HR, BP)
    • Temp usually normal unless infection present
    • HR elevated and BP is variable
    • Maybe evidence of trauma 
    • Postictal state if seizure has occurred recently (confusion, drowsiness)
  147. What is the MOA for Ethosuximide?
    • Inhibits T-Type, low voltage gated Ca2+ channels
    • Drug of choice for Absence Seizures
  148. What is the MOA for Lorazepam?
    • Binds to specific site on GABA-A receptor and increases the frequency of channel opening
    • Drug of choice for Status Epilepticus
  149. What is the MOA for Diazepam, midazolam?
    • Binds to specific site on GABA-A receptor and increases the frequency of channel opening
    • Alternative drug of choice for Status Epilepticus
  150. What is the MOA for Flumazenil?
    • Competitive inhibitor of the GABA-A benzodiazepine receptor
    • Reverses CNS and respiratory depression caused by benzodiazepine
  151. What is the MOA for Phenytoin?
    • Inhibits voltage gated (VG) sodium channels
    • Longer acting drug used after Lorazepam in treating SE
  152. What is the MOA for Fosphenytoin?
    Same as phenytoin; Inhibits voltage gated Na+ channels
  153. What is the MOA for Phenobarbital?
    Binds to specific site on GABA-A receptor and increases the time the channel stays open
  154. What is the MOA for Valproic Acid?
    • Inhibits VG Na+ channels
    • Inhibits T-Type Ca2+ channels
    • Augments GABA synthesis
    • Inhibits GABA metabolic inactivation
  155. What is the MOA for Divalproex?
    • Same as Valproic acid; Inhibits VG Na+ channels, T-Type Ca2+ channels, augments GABA synthesis, inhibits GABA metabolic inactivation
    • Dissociates to valproic acid in GI tract
  156. What is the MOA for Levetiracetam?
    • Unclear MOA but slows release of glutamate from storage vesicles by binding to vesicle protein SV2A
    • Broad spectrum antiseizure activity including absence seizures
  157. What is dementia?
    • A general mental deterioration due
    • to organic or psychological factors; characterized by disorientation, impaired
    • memory, judgment, and intellect, and a shallow labile affect
  158. What is delirium?
    A clouded state of consciousness and confusion, marked by difficulty in sustaining attention to stimuli, disordered thinking, defective perception (illusions and hallucinations), disordered sleep-wakefulness cycles, and motor disturbances
  159. What is a coma?
    Unarousable unresponsiveness. A state of profound unconsciousness from which one cannot be aroused; may be due to the action of an ingested toxic substance or of one formed in the body, to trauma, or to disease
  160. What will a lesion in the right hemisphere of the hippocampus lead to?
    Problems with spatial orientation
  161. What will a lesion in the left hemisphere of the hippocampus lead to?
    Defects in verbal memory
  162. Where are they found and what are characteristics of Oligodendroglioma?
    • Fried-egg Appearance
    • Calcospherites (calcifications)
    • Arises in white matter
  163. Where are they found and what are characteristics of Ependymoma?
    • Perivascular Pseudorosettes (fibrillary processes present)
    • Hydrocephalus
    • Blocks 4th ventricle
  164. Where are they found and what are characteristics of GBM?
    • Peripheral Palisading - Picket fence around tumor
    • Glomeruloid - clusters of small b.v.
    • Butterfly
  165. Where are they found and what are characteristics of Colloid Cyst of Third Ventricle?
    • 3rd ventricle
    • Noncommunicating hydrocephalus
    • Gelatinous, proteinaceous material, lined w/ ciliated cuboidal epithelium
  166. Where are they found and what are characteristics of Medulloblastoma?
    Which chromosome is it associated with?
    • Exclusively in cerebellum (infiltrates vermis)
    • Small, round, blue cell tumors of childhood
    • Rosette formation
    • Radiosensitive
    • Chromosome 17p
  167. Where are they found and what are characteristics of Meningioma?
    Which chromosome is it associated with?
    • Fibroblastic, whorled pattern of "meningothelial" cells w/ Psammoma Bodies
    • Arachnoid villi
    • Parasagittal areas, olfactory groove, lateral wing of sphenoid, convexities of cerebral hemispheres
    • Chromosome 22
  168. What are characteristics of Schwannoma?
    • Antoni A pattern (mixture of fascicles of elongated spindle cells) between regions of Antoni B pattern (loosely staining, myxoid areas)
    • Attached to nerves (most commonly 8th CN)
  169. Where is Acoustic Neuroma usually located?
    Intracranial Schwannoma restricted to the 8th CN, found in the cerebellar pontine angle
  170. What are characteristics of Craniopharyngioma?
    • Arise from Rathke's pouch
    • Sella Turcica
    • Calcifications and keratin
    • Kids: Endocrine deficiences
    • Adults: visual disturbances and h/a
  171. What are characteristics of Primary Brain Lymphoma?
    • Angiocentric distribution of both small and large neoplastic lymphocytes
    • Vast majority are of B-cell origin 
    • 1000X more common in AIDS pts
  172. What are characteristics of Metastatic Brain Tumor?
    • Cannon ball lesions that seed to the gray-white junction
    • Goes through bloodstream, pts w/ advanced carcinoma
  173. What is the #1 Primary Brain Tumor?
    Glioma
  174. What is the most common benign tumor?
    Meningioma
  175. What are some malignant tumors that end in -oma?
    Lymphoma, Mesothelioma, Melanoma, Seminoma
  176. What are characteristics of a Febrile Seizure?
    • Fever
    • Child normal neurologically
    • No bacterial meningitis
    • Do lumbar puncture
    • Tx: directed at seizure, no anti-epileptics
  177. What are characteristics of a Temporal Lobe or Psychomotor Seizure?
    • Temporal lobe
    • Aura
  178. What are characteristics of a Hippocampal Sclerosis?
    • Most commonly seen w/ Complex Partial seizures
    • Hippocampal neuron cell loss
    • Segmental loss of pyramidal neurons and reactive gliosis
  179. What are characteristics of a Absence Seizures?
    • Brief staring spells by children or teens
    • No warning or postictal phase
  180. What are characteristics of a Generalized Tonic/ Clonic Phase?
    • Sudden cry, fall, momentary rigidity followed by jerking of muscles
    • No bladder control
  181. What are the 3 causes of seizures?
    • Increased excitability of neurons
    • Loss of local inhibition
    • Spread of excitation
  182. What kind of shift does the neurons in the seizure focus display?
    Paroxysmal depolarizing shift (PDS)
  183. What creates the inhibitory sound and how can it be broken down?
    • Inhibitory interneurons make it
    • Break down by antagonizing GABA
  184. How is the inhibition in the cerebral cortex different than in the spinal cord?
    Inhibition is stronger in the cerebral cortex
  185. What is one area prone to seizures and why is it?
    Hippocampus because it has excitatory feed forward connections
  186. How can you differentiate between an ischemic stroke and a hemorrhagic stroke?
    Non contrast CT
  187. Where does the eye gaze to concerning stroke?
    Towards the side of injury
  188. What is a significant symptoms of Intracranial Hemorrhage?
    • Sudden severe h/a
    • Associated with nausea and vomiting, decreased level of consciousness, and/ or focal neurological deficit
  189. What are 2 keys to ER care of Intracranial hemorrhage?
    • BP control and reversing coagulation 
    • Make sure BP isn't too high or too low
  190. What agent will treat thrombotic stroke?
    Antiplatelet agents (Plavix) clopidogrel, (Aggrenox) dipyridomole/ aspirin combo
  191. What agent treats embolic stroke?
    • Anticoagulant 
    • Warfarin, Coumadin (IV Heparain doesn't work except for tear of b.v.)
  192. What is there a small risk of when giving TPA?
    Hemorrhage

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