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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
What's hydrocephalus ex-vacuo?
Appearance of high CSF (increased ventricle size) that is actually due to decreased brain tissue/neuronal atrophy (ex: HIV, AD, Pick) ICP IS NORMAL!
26
Immunoreactivity of CNS tumor for synaptophysin indicates (X) cell origin
X = neuronal
27
Almost all volatile (ex: fluorinated) anesthetics (increase/decrease) cerebral blood flow and (increase/decrease) flow to other organs
Increase; decrease
28
Huntington's is a (GOF/LOF) mutation on chromosome 4 that causes which pathological interaction with proteins?
GOF TF causes transcriptional suppression/silencing via histone deacetylation (silences genes for neuronal survival)
29
Rapidly progressive dementia with myoclonus. EEG shows periodic sharp waves and high 14-3-3 protein in CSF
Creutzfeldt-Jakob disease
30
Early personality/behavior changes (apathy, socially inappropriate behavior). Biopsy shows inclusions of hyperphosphorylated tau aka round (X) bodies. Diagnosis?
Frontotemporal dementia (Pick disease) X = Pick
31
Patients receiving GH preparation, implantable electrode, or corneal transplant at risk for which neuro disease?
Creutzfeldt-Jakob
32
Pseudotumor cerebri, aka (X), risk factors
X = idiopathic intracranial HT F, obesity, vitamin A excess, tetracycline
33
Idiopathic intracranial HT typically presents with which eye findings?
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)
34
Normal pressure hydrocephalus Sx
Triad of: urinary (urge) incontinence, ataxia, cognitive dysfunction "Wet, wobbly, and wacky"
35
MS patients experience exacerbation of symptoms with (increased/decreased) body T
Increased (exercise, hot bath) due to decreased axonal transmission with heat
36
28 yo female presenting with hemiparesis and bladder dysfunction. Reports sensation like "electric shock" running down spine when she looks down. Diagnosis?
Multiple sclerosis (with Lhermitte phenomenon)
37
CSF: oligoclonal bands diagnostic for..
Multiple sclerosis
38
Guillain-Barré: (symmetric/asymmetric), (ascending/descending) (sensory/muscle) dysfunction.
Symmetric; ascending | Muscle (weakness/paralysis; depressed reflexes)
39
Lysosomal storage disease with globoid cells on histology
Krabbe
40
Lysosomal storage disease due to arylsulfatase A deficiency
Metachromatic leukodystrophy
41
X-linked disorder disrupting metabolism of VLCFAs and leading to their buildup in multiple systems (eventual coma/death)
Adrenoleukodystrophy
42
Sturge-Weber is inherited in (X) fashion. Which gene is affected?
Not inherited (sporadic; somatic mosaicism) GNAQ (activating mutation)
43
Unilateral leptomeningeal angioma, seizures, intellectual disability, glaucoma in child
Sturge-Weber
44
Child with unilateral port-wine stain in CN V1/V2 distribution
Sturge-Weber
45
List the characteristic findings seen in Tuberous sclerosis
"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
Tuberous sclerosis patient has subependymal brain tumor, most likely to be:
Giant cell astrocytoma
47
Child with epilepsy, mental retardation and tram-track calcifications on brain imaging
Sturge-weber
48
NF1 codes for (X), which normally has what function?
X = neurofibromin Negative Ras regulator
49
Patient with Café-au-lait spots and Lisch nodules
NF1 | Lisch nodules are pigmented hamartomas in iris
50
Optic glioma is seen most often in which neurocutaneous disorder?
NF1
51
Patient with juvenile cataracts and at risk for meningiomas and ependymomas
NF2
52
Hemangioblastomas in retina, brain stem, cerebellum, and spinal cord. Which disorder?
VHL
53
Cavernous hemangiomas in skin/organs and multiple cysts (especially kidney, pancreas). Which disorder?
VHL
54
Adult brain tumor with "fired egg" cells on histology
Oligodendroglioma
55
Adult brain tumor arising in area of dural reflection and "dural tail/attachment" on imaging
Meningioma
56
Patient with VHL presents with headache and hematocrit of 55%. Diagnosis?
Hemangioblastoma (producing EPO; secondary polycythemia)
57
Adult brain tumor commonly at cerebellopontine angle
Schwannoma
58
Child brain tumor that's GFAP-positive with Rosenthal fibers
Pilocytic (grade 1) astrocytoma
59
Brain tumor similar to germ cell tumors (seminomas)
Pinealoma (can produce beta-hCG)
60
Brain tumor with "motor oil"-like fluid
Craniopharyngioma (cholesterol crystals in brown/yellow, viscous fluid)
61
"Floppy baby" with marked hypotonia and tongue fasciculations due to congenital degeneration of anterior SC horns
Werdnig-Hoffmann disease (AR inheritance)
62
At which SC level is the anterior spinal artery watershed area?
Mid-thoracic (artery of Adamkiewicz supplies ASA below T8)
63
Patient with complete occlusion of anterior spinal artery will present with (UMN/LMN) deficit (above/at/below) level of lesion. Any sensory deficits?
UMN deficit below lesion; LMN deficit at level of lesion Loss of pain/T below lesion (spinothalamic tract)
64
Patient with Brown-Séquard syndrome above (X) SC level may present with (ipsi/contra)-lateral Horner's
X = T1 | Ipsilateral (damage of oculosympathetic pathway)
65
(X) inherited disease closely mimics vitamin E deficiency
X = Friedreich's ataxia
66
T/F: Romberg and tandem walking is normal in peripheral vertigo
True
67
Far-sightedness aka (X) treated with (concave/convex) lens
X = hyperopia (eye too short) Convex (converging)
68
Near-sightedness aka (X) treated with (concave/convex) lens
X = myopia (eye too long) Concave (diverging) "My-O my I want to dive into that cave"
69
Presbyopia is the result of:
Decreased lens elasticity and strength of ciliary muscle (impaired accommodation) Age-related
70
Diabetic with glaucoma likely has (open/closed)-angle, secondary to (X)
Closed; X = hypoxia inducing vasoproliferation in iris (contracts angle between iris and cornea, impeding flow through trabecular meshwork)
71
Patient presents with sudden vision loss and reports halos around lights. Eye is very painful, red. Dx?
Acute close-angle glaucoma (emergency!) due to high IOP
72
T/F: Closed-angle glaucoma is more common in US
False; open-angle glaucoma more common
73
55 yo F presents with rapid loss of vision. Macula sows gray discoloration with areas of adjacent hemorrhages. Dx? Rx?
Wet (exudative) age-related macular degeneration (bleeding secondary to choroidal neovascularization) Rx: Smoking cessation (if smoker) and anti-VEGF injections (ranibizumab)
74
Age-related macular degeneration is typically of the (dry/wet) variant and patients can be advised to prevent these changes by (X)
Dry (over 80%) - gradual decrease in vision due to yellow ECM deposition X = taking multivitamins and antioxidants
75
Patient presents with acute, painless vision loss in R eye. Retina appears cloudy with cherry-red spot at fovea. Dx?
Central retinal artery occlusion
76
Inherited retinal degeneration (painless, progressive vision loss), typically beginning with (X) symptom. What would you see on eye exam?
Retinitis pigmentosa X = night blindness Bone spicule-shaped deposits around macula
77
Pupillary reflex: CN II carries signal to (X) which activates (Y)
``` X = pre-tectal nuclei Y = bilateral Edinger-Westphal nuclei (both pupils constrict) ```
78
Temporal aneurysm compressing L lateral retinal fibers (prior to lateral geniculate nucleus synapse). What would the patient see (visual defect)
L eye only, loss of nasal vision (due to compromised L temporal retinal fibers)
79
Pupillary dilator muscles controlled by (X). Where does the primary neuron originate from?
X = sympathetics | Hypothalamus (travels down SC to synapse in lateral horn of T1)
80
Pupillary dilator muscles: where does the secondary neuron originate from?
Lateral horn at level of T1 (travels to superior cervical ganglion, upward along sympathetic chain, to level of C2)
81
Pupillary dilator muscles: where does the tertiary neuron originate from?
Superior cervical ganglion (travels along internal carotid and enters orbit as long ciliary nerve)
82
(Motor/parasympathetic) output of CN III is most affected by vascular disease
Motor (more interior fibers) Parasympathetics (peripheral fibers) first to be affected by compression
83
PCA infarct: which visual defect?
L hemianopia with macular sparing (macular fibers transmit to separate area of visual cortex)
84
Potency of anesthetic depends on its (X) solubility and onset of action depends on (Y) solubility
``` 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
Local anesthetics (lidocaine, procaine, etc.) work by which MOA?
Block Na channels (bind specific receptors on inner portion of channel)
86
Local anesthetics: (charged/uncharged) form binds Na channel receptor
Charged | uncharged form crosses membrane
87
Infected tissue will (increase/decrease) amount of local anesthetic necessary for effect
Increase Infected tissue is acidic, so environment facilitates ionization of anesthetic (less effective in crossing membrane to bind channel)
88
Lidocaine injected for dental procedure. What is the order in which sensations are lost in the area of injection?
1. Pain 2. T 3. Touch 4. Pressure (small fibers affected before large; myelinated before unmyelinated)

STEP 1 (21 decks)

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