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STEP 1 > 09b: Neuro 2 > Flashcards

09b: Neuro 2 Flashcards

1
Q

How long after ischemic stroke can liquefactive necrosis be seen macroscopically?

A

1-2 weeks

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2
Q

Stroke affecting MCA: odds are, it’s what type of stroke?

A

Thombotic (ischemic)

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3
Q

Stroke affecting multiple vascular territories: odds are, it’s what type of stroke?

A

Embolic (ischemic)

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4
Q

Stroke resulting in wedge-shape area of necrosis: odds are, it’s what type of stroke?

A

Hypoxic (hypoperfusion, hypoxemia)

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5
Q

T/F: All ischemic strokes treated with tPA

A

True (if no risk of hemorrhage)

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6
Q

Most common cause of recurrent lobar hemorrhage (esp in older patients)

A

Amyloid angiopathy (beta amyloid deposits in small/med arteries, weakens walls, and ruptured vessels)

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7
Q

Intraparenchymal hemorrhage most often occurs in (X) brain regions

A

X = basal ganglia and internal capsule (Charcot-Bouchard microaneurysm of lenticulostriate vessels)

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8
Q

Wernicke’s aphasia usually associated with which visual field defect?

A

Contralateral (usually R since dominant hemisphere is L) superior quadrant defect (due to temporal lobe involvement)

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9
Q

Contralateral paralysis and sensory loss of both face and body in the absence of cortical signs. Stroke in (X) artery

A

X = lenticulostriate

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10
Q

Medial medullary syndrome: infarct of (X) arteries

A

X = Paramedian branches of anterior spinal artery/vertebral arteries

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11
Q

Contralateral paralysis of upper and lower limbs, along with tongue deviation. Stroke in (X) artery

A

X = anterior spinal (affecting lateral corticospinal tract and caudal medulla)

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12
Q

Dysphagia/hoarseness and an absent gag reflex. Stroke in (X) artery

A

X = PICA

Note: Nucleus ambiguus defects are specific to PICA lesions

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13
Q

Wallenberg syndrome, stroke in (X) artery. Which sensory defects?

A

Aka Lateral medullary syndrome
X = PICA

Decreased pain/T from contralateral body, ipsilateral face (also seen in AICA stroke)

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14
Q

Lateral pontine syndorme: stroke in (X) artery

A

X = AICA

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15
Q

Facial nucleus is compromised if stroke occurs in (X) artery.

A

X = AICA (lateral pontine syndrome)

Note: Facial nucleus defects are specific to AICA lesions

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16
Q

“Locked in” syndrome due to stroke in (X) artery and consciousness preserved due to sparing of (Y)

A 
X = basilar
Y = Reticular activating system
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17
Q

List the aphasia in which repetition is impaired

A
  1. Wernicke’s
  2. Broca’s
  3. Conduction
  4. Global
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18
Q

Conduction aphasia: damage to…

A

Arcuate fasciculus (connecting broca and wernicke’s)

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19
Q

List the aphasia in which repetition is intact

A
  1. Transcortical motor (area around Broca)
  2. Transcortical sensory (area around Wernicke’s)
  3. Transcortical mixed (watershed areas around Broca, wernicke’s, arcuate fasciculus)
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20
Q

Complex versus simple partial seizures

A

Whether or not consciousness is affected

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21
Q

Generalized versus partial seizures

A

One (partial) versus both (generalized) cerebral hemisphere(s) involved

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22
Q

Slow, snake-like writhing movements, especially of fingers/hands

A

Athetosis

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23
Q

Sustained, involuntary contraction of muscles (ex: writer’s cramp, blepharospasm, torticollis)

A

Dystonia

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24
Q

Patient with acute MI receives (X) treatment for the bradycardia and then suddenly develops severe unilateral eye pain. What’s is the cause?

A

X = atropine (blocks vagal influence on SA/AV nodes, so useful in bradycardia treatment)

Glaucoma (atropine causes mydriasis and decreased outflow of aqueous humor through anterior chamber angle)

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25
Q

What’s hydrocephalus ex-vacuo?

A

Appearance of high CSF (increased ventricle size) that is actually due to decreased brain tissue/neuronal atrophy (ex: HIV, AD, Pick)

ICP IS NORMAL!

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26
Q

Immunoreactivity of CNS tumor for synaptophysin indicates (X) cell origin

A

X = neuronal

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27
Q

Almost all volatile (ex: fluorinated) anesthetics (increase/decrease) cerebral blood flow and (increase/decrease) flow to other organs

A

Increase; decrease

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28
Q

Huntington’s is a (GOF/LOF) mutation on chromosome 4 that causes which pathological interaction with proteins?

A

GOF

TF causes transcriptional suppression/silencing via histone deacetylation (silences genes for neuronal survival)

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29
Q

Rapidly progressive dementia with myoclonus. EEG shows periodic sharp waves and high 14-3-3 protein in CSF

A

Creutzfeldt-Jakob disease

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30
Q

Early personality/behavior changes (apathy, socially inappropriate behavior). Biopsy shows inclusions of hyperphosphorylated tau aka round (X) bodies. Diagnosis?

A

Frontotemporal dementia (Pick disease)

X = Pick

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31
Q

Patients receiving GH preparation, implantable electrode, or corneal transplant at risk for which neuro disease?

A

Creutzfeldt-Jakob

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32
Q

Pseudotumor cerebri, aka (X), risk factors

A

X = idiopathic intracranial HT

F, obesity, vitamin A excess, tetracycline

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33
Q

Idiopathic intracranial HT typically presents with which eye findings?

A
  1. Papilledema
  2. Diplopia (CN VI palsy)

Vision changes transient when bending forward/lifting objects (valsalva) due to CSF compression of optic n (impaired axoplasmic flow)

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34
Q

Normal pressure hydrocephalus Sx

A

Triad of: urinary (urge) incontinence, ataxia, cognitive dysfunction

“Wet, wobbly, and wacky”

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35
Q

MS patients experience exacerbation of symptoms with (increased/decreased) body T

A

Increased (exercise, hot bath) due to decreased axonal transmission with heat

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36
Q

28 yo female presenting with hemiparesis and bladder dysfunction. Reports sensation like “electric shock” running down spine when she looks down. Diagnosis?

A

Multiple sclerosis (with Lhermitte phenomenon)

37
Q

CSF: oligoclonal bands diagnostic for..

A

Multiple sclerosis

38
Q

Guillain-Barré: (symmetric/asymmetric), (ascending/descending) (sensory/muscle) dysfunction.

A

Symmetric; ascending

Muscle (weakness/paralysis; depressed reflexes)

39
Q

Lysosomal storage disease with globoid cells on histology

A

Krabbe

40
Q

Lysosomal storage disease due to arylsulfatase A deficiency

A

Metachromatic leukodystrophy

41
Q

X-linked disorder disrupting metabolism of VLCFAs and leading to their buildup in multiple systems (eventual coma/death)

A

Adrenoleukodystrophy

42
Q

Sturge-Weber is inherited in (X) fashion. Which gene is affected?

A

Not inherited (sporadic; somatic mosaicism)

GNAQ (activating mutation)

43
Q

Unilateral leptomeningeal angioma, seizures, intellectual disability, glaucoma in child

A

Sturge-Weber

44
Q

Child with unilateral port-wine stain in CN V1/V2 distribution

A

Sturge-Weber

45
Q

List the characteristic findings seen in Tuberous sclerosis

A

“HAMARTOMAS”

  1. Hamartoma (skin/CNS)
  2. Angiofibroma (skin)
  3. Mitral valve regurg
  4. Ash leaf spot
  5. Rhabdomyoma (cardiac)
  6. (Tuberous Sclerosis)
  7. autosomal dOminant
  8. Mental retardation
  9. Angiomyolipoma (renal)
  10. Shagreen patches, Seizures
46
Q

Tuberous sclerosis patient has subependymal brain tumor, most likely to be:

A

Giant cell astrocytoma

47
Q

Child with epilepsy, mental retardation and tram-track calcifications on brain imaging

A

Sturge-weber

48
Q

NF1 codes for (X), which normally has what function?

A

X = neurofibromin

Negative Ras regulator

49
Q

Patient with Café-au-lait spots and Lisch nodules

A

NF1

Lisch nodules are pigmented hamartomas in iris

50
Q

Optic glioma is seen most often in which neurocutaneous disorder?

A

NF1

51
Q

Patient with juvenile cataracts and at risk for meningiomas and ependymomas

A

NF2

52
Q

Hemangioblastomas in retina, brain stem, cerebellum, and spinal cord. Which disorder?

A

VHL

53
Q

Cavernous hemangiomas in skin/organs and multiple cysts (especially kidney, pancreas). Which disorder?

A

VHL

54
Q

Adult brain tumor with “fired egg” cells on histology

A

Oligodendroglioma

55
Q

Adult brain tumor arising in area of dural reflection and “dural tail/attachment” on imaging

A

Meningioma

56
Q

Patient with VHL presents with headache and hematocrit of 55%. Diagnosis?

A

Hemangioblastoma (producing EPO; secondary polycythemia)

57
Q

Adult brain tumor commonly at cerebellopontine angle

A

Schwannoma

58
Q

Child brain tumor that’s GFAP-positive with Rosenthal fibers

A

Pilocytic (grade 1) astrocytoma

59
Q

Brain tumor similar to germ cell tumors (seminomas)

A

Pinealoma (can produce beta-hCG)

60
Q

Brain tumor with “motor oil”-like fluid

A

Craniopharyngioma (cholesterol crystals in brown/yellow, viscous fluid)

61
Q

“Floppy baby” with marked hypotonia and tongue fasciculations due to congenital degeneration of anterior SC horns

A

Werdnig-Hoffmann disease (AR inheritance)

62
Q

At which SC level is the anterior spinal artery watershed area?

A

Mid-thoracic (artery of Adamkiewicz supplies ASA below T8)

63
Q

Patient with complete occlusion of anterior spinal artery will present with (UMN/LMN) deficit (above/at/below) level of lesion. Any sensory deficits?

A

UMN deficit below lesion; LMN deficit at level of lesion

Loss of pain/T below lesion (spinothalamic tract)

64
Q

Patient with Brown-Séquard syndrome above (X) SC level may present with (ipsi/contra)-lateral Horner’s

A

X = T1

Ipsilateral (damage of oculosympathetic pathway)

65
Q

(X) inherited disease closely mimics vitamin E deficiency

A

X = Friedreich’s ataxia

66
Q

T/F: Romberg and tandem walking is normal in peripheral vertigo

A

True

67
Q

Far-sightedness aka (X) treated with (concave/convex) lens

A

X = hyperopia (eye too short)

Convex (converging)

68
Q

Near-sightedness aka (X) treated with (concave/convex) lens

A

X = myopia (eye too long)
Concave (diverging)

“My-O my I want to dive into that cave”

69
Q

Presbyopia is the result of:

A

Decreased lens elasticity and strength of ciliary muscle (impaired accommodation)
Age-related

70
Q

Diabetic with glaucoma likely has (open/closed)-angle, secondary to (X)

A

Closed;
X = hypoxia inducing vasoproliferation in iris (contracts angle between iris and cornea, impeding flow through trabecular meshwork)

71
Q

Patient presents with sudden vision loss and reports halos around lights. Eye is very painful, red. Dx?

A

Acute close-angle glaucoma (emergency!) due to high IOP

72
Q

T/F: Closed-angle glaucoma is more common in US

A

False; open-angle glaucoma more common

73
Q

55 yo F presents with rapid loss of vision. Macula sows gray discoloration with areas of adjacent hemorrhages. Dx? Rx?

A

Wet (exudative) age-related macular degeneration (bleeding secondary to choroidal neovascularization)

Rx: Smoking cessation (if smoker) and anti-VEGF injections (ranibizumab)

74
Q

Age-related macular degeneration is typically of the (dry/wet) variant and patients can be advised to prevent these changes by (X)

A

Dry (over 80%) - gradual decrease in vision due to yellow ECM deposition

X = taking multivitamins and antioxidants

75
Q

Patient presents with acute, painless vision loss in R eye. Retina appears cloudy with cherry-red spot at fovea. Dx?

A

Central retinal artery occlusion

76
Q

Inherited retinal degeneration (painless, progressive vision loss), typically beginning with (X) symptom. What would you see on eye exam?

A

Retinitis pigmentosa
X = night blindness

Bone spicule-shaped deposits around macula

77
Q

Pupillary reflex: CN II carries signal to (X) which activates (Y)

A 
X = pre-tectal nuclei
Y = bilateral Edinger-Westphal nuclei (both pupils constrict)
78
Q

Temporal aneurysm compressing L lateral retinal fibers (prior to lateral geniculate nucleus synapse). What would the patient see (visual defect)

A

L eye only, loss of nasal vision (due to compromised L temporal retinal fibers)

79
Q

Pupillary dilator muscles controlled by (X). Where does the primary neuron originate from?

A

X = sympathetics

Hypothalamus (travels down SC to synapse in lateral horn of T1)

80
Q

Pupillary dilator muscles: where does the secondary neuron originate from?

A

Lateral horn at level of T1 (travels to superior cervical ganglion, upward along sympathetic chain, to level of C2)

81
Q

Pupillary dilator muscles: where does the tertiary neuron originate from?

A

Superior cervical ganglion (travels along internal carotid and enters orbit as long ciliary nerve)

82
Q

(Motor/parasympathetic) output of CN III is most affected by vascular disease

A

Motor (more interior fibers)

Parasympathetics (peripheral fibers) first to be affected by compression

83
Q

PCA infarct: which visual defect?

A

L hemianopia with macular sparing (macular fibers transmit to separate area of visual cortex)

84
Q

Potency of anesthetic depends on its (X) solubility and onset of action depends on (Y) solubility

A 
X = lipid (high lipid solubility, high potency/low MAC and short duration of action due to quick redistribution)
Y = blood (low blood solubility, fast onset of action; like NO)
85
Q

Local anesthetics (lidocaine, procaine, etc.) work by which MOA?

A

Block Na channels (bind specific receptors on inner portion of channel)

86
Q

Local anesthetics: (charged/uncharged) form binds Na channel receptor

A

Charged

uncharged form crosses membrane

87
Q

Infected tissue will (increase/decrease) amount of local anesthetic necessary for effect

A

Increase

Infected tissue is acidic, so environment facilitates ionization of anesthetic (less effective in crossing membrane to bind channel)

88
Q

Lidocaine injected for dental procedure. What is the order in which sensations are lost in the area of injection?

A
  1. Pain
  2. T
  3. Touch
  4. Pressure

(small fibers affected before large; myelinated before unmyelinated)

STEP 1 (21 decks)

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