Ryan Shared "M3: Neuro" - 228 Picmonics

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M3: Neuro

Posterior Column (Dorsal Column)
Ascending Pathway (Sensory)
Sensations
Proprioception
Deep Touch
Pressure
Vibration Sensation
Anatomy
Dorsal Root
Fasciculus Cuneatus
Arms
Fasciculus Gracilis
Lower Limbs
Lesions
Vitamin B12 Deficiency
Tabes Dorsalis
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2 mins
Cluster Headache
Presentation
More Common in Men
Unilateral Periorbital Headache
Ipsilateral Tearing
Precipitated by Alcohol
Stabbing Pain
Duration
15 min - 3 Hours
Repetitive Attacks in Clusters
Treatment
High Flow 100% O2
Ergots
Sumatriptan
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2 mins
Central cord syndrome
hyperextension
Elderly
pre-existing degenerative changes
Re-experience Traumatic Event
Trauma
central portions of the corticospinal tracts
lateral spinothalamic tract
weakness that is more pronounced in the upper extrem ities than the lower
mri without contrast
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Pseudotumor cerebri (Idiopathic intracranial hypertension)
Increased ICP (Intracranial Pressure) with no apparent cause on imaging
Risk Factors
Being a woman of childbearing age
Obesity
Excessive Vitamin A
Danazol
Tetracycline
Symptoms/Findings
Headache
Diplopia
No change in Mental Status
Papilledema
Increased Opening Pressure
Treatment
Weight loss
Acetazolamide
CSF shunt
Topiramate
Lumbar Puncture
CN II fenestration surgery
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Multiple Sclerosis Features and Mechanisms
Features
Twice as often in Women
Presents in 20's and 30's
Northern Europeans
Mechanism
Unknown mechanism, genetic factor
HLA-DRB1
Autoimmune Demyelination of CNS
White Matter of Brain and Spinal Cord
T Cell Mediated Inflammation
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2 mins
Multiple Sclerosis Symptoms and Diagnosis
Symptoms
Optic Neuritis
Internuclear Ophthalmoplegia
Scanning Speech
Urinary and Fecal Incontinence
Motor Issues (Intention Tremor, Paresis)
Numbness and Pain
Depression
Relapsing Symptoms
Diagnosis
Gold Standard = Plaques on MRI
Increased CSF Immunoglobulins (IgG)
Oligoclonal Bands
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4 mins
Progressive Multifocal Leukoencephalopathy
Progressive Multifocal Leukoencephalopathy (PML)
Demyelination of CNS due to destruction of oligodendrocytes (white matter)
Caused by JC virus
Immunosuppression (e.g., AIDS or leukemia) leads to reactivation of the latent virus
JC virus (reactivation) at CD4+ count below 200 in AIDs patients
Increased risk associated with natalizumab, rituximab
Presents with rapidly progressive neurologic signs (visual loss, weakness, dementia) leading to death
Positive babinksi
Asymmetric/focal, nonenhancing areas of demyelination on MRI
Rapidly progressive, usually fatal
Dx: PCR on CSF sample
Brain biopsy is gold standard for diagnosis
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Various recombinant immunosuppressants 2
Eculizumab
Natalizumab (Tysabri)
Denosumab
Omalizumab (Allergies)
Palivizumab (Synagis)
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Amyotrophic Lateral Sclerosis (ALS)
Assessment
Progressive Muscle Weakness
Systemic Muscle Wasting
Fasciculations
Spasticity
Fatigue
Considerations
Riluzole (Rilutek)
Moderate Exercise
No Cognitive Decline
Respiratory Support
Palliative Care
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2 mins
Motor Neuron Signs UMN and LMN
Upper Motor Neuron (Increases)
Increased DTRs
Positive Babinski
Spastic Paralysis
Clasp-Knife Reaction
Lower Motor Neuron (Decreases)
Decreased DTRs
Negative Babinski
Flaccid Paralysis
Muscle Atrophy
Fasciculations
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2 mins
Myasthenia Gravis
Mechanism
Antibodies to Acetylcholine Receptor
Symptoms
Ptosis
Diplopia
Weakness with Muscle Use
Respiratory Death
Thymus Associated
Treatment
Acetylcholinesterase Inhibitors
Plasmapheresis
Thymectomy
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1 min
Alzheimer Disease
Most common cause of dementia in elderly
Down syndrome patients have an Increased risk of developing Alzheimer
Associated with the following altered proteins:
EARLY ONSET (Familial)
APP (Chr 21)
Presenilin-1
Presenilin-2
LATE ONSET (sporadic)
ApoE4 in Chr 19: Increases risk of sporadic form
ApoE2 in Chr 19: Decreases risk of sporadic form (protective) due to Increase in Ach
Findings
Decrease Acetylcholine (ACh)
Widespread cortical atrophy (Narrowing of gyri and widening of sulci)
Senile plaques (Amyloid Beta plaques)
Neurofibrillary tangles
Can lead to intracranial hemorrhage
Hyperphosphorylated tau protein
The hippocampus is the area of the brain demostrating the greatest degree of atrophy. Hippocampal atrophy in MRI is highly suggestive of the diagnosis.
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Pick's Disease (Frontotemporal dementia)
Early changes in personality and behavior (behavioral variant)
Aphasia (primary progressive aphasia) and repetition of phrases
May have associated movement disorders
Parkinsonism
UMN/LMN degeneration
Frontotemporal degeneration
Difficulty Making Own Decisions
Spares Parietal, Occipital Lobes and posterior 2/3 of superior temporal gyrus
Round Pick Bodies: Inclusions of hyperphosphorylated tau protein
Ubiquitinated TDP-43
Autosomal Dominant in 20 - 40% of the cases
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Normal Pressure Hydrocephalus
Mechanism
Elderly
Idiopathic
Decreased Absorption of CSF
Ventricular Enlargement
Symptom Triad
Urinary Incontinence
Ataxia (Gait)
Cognitive Dysfunction
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2 mins
Tick paralysis
neurotoxin present in tick saliva
Presentation
Paresthesia
Fatigue
followed by...
ascending muscle paralysis
Ataxia
Treatment
tick removal
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Status epilepticus
≥ 5 min of continuous seizures
OR ≥ 2 seizures with consciousness not being fully regained in the interictal period
Initial treatment phase
Benzodiazepines
IV lorazepam OR
IV diazepam OR
IM midazolam
Second treatment phase Non benzodiazepne antiseizure drugs
Second treatment phase Non benzodiazepne antiseizure drugs
fosphenytoin
IV valproic acid OR
IV levetiracetam OR
IV phenobarbital
Refractory status epilepticus
Refractory status epilepticus
Third treatment phase Continuous administration, anesthetic doses
Thiopental OR
Propofol OR
Midazolam OR
Pentobarbital
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Narrow vs Broad spectrum seizure medications
Narrow spectrum (in narrow part of river) are carbamazepine, gabapentin, phenobarbitol, phenytoin
Broad spectrum seizure meds include valproate, lamotrigine, levetiracetam, topiramate
levitracetam is keppra, valproate is depakote, lamotrigine is lamictal
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Seizure Workup
History of epilepsy?
Yes: Check drug/med levels
No: Actively seizing?
Yes: Abort
1) IV Benzos
2) Phenytoin
3) Midazolam + propofol
4) Phenobarbitol
No: EEG, CT
Workup (Only if new onset seizure)
Blood glucose
Serum electrolytes
LFTs
UTox
Kidney function tests
Differential
A) Syncope
Migraine/aura
Narcolepsy
Movement disorders
Psychological Disturbances
Reversible Causes
B6 deficiency (due to INH)
Eclampsia
Hyponatremia
Hypoglycemia
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Types of Seizures
Tonic-clonic
Tonic
Clonic
Absence (Petit Mal)
Myoclonic
Atonic
Partial (Focal) Seizure
Simple Partial
Complex Partial
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2 mins
Valproic Acid
Indications
First Line Tonic-Clonic Seizure Treatment
Bipolar Disorder
Migraine Prophylaxis
Mechanism of Action
Increases GABA Concentration
Blocks Voltage-Gated Na+ Channels
Side Effect
GI Distress
Contraindication
Contraindicated in Pregnancy
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1 min

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