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First Aid STEP 1 - Neurology > Anatomy and Physiology 2 > Flashcards

Anatomy and Physiology 2 Flashcards

1
Q

What symptoms can be seen with severe hypotension when considering the watershed zones of the brain?

A

upper leg/upper arm weakness

higher-order visual processing deficits

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2
Q

Cerebral perfusion is primarily driven by…

A

pCO2

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3
Q

How does therapeutic hyperventilation help decrease intracranial pressure?

A

In cases of acute cerebral edema (stroke, trauma), a decrease in pCO2 will cause a decrease in cerebral perfusion and ultimately cause vasoconstriction

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4
Q

What is the MC site of a berry aneurysm?

A

the junction of the anterior communicating artery and anterior cerebral artery

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5
Q

What palsy is associated with a lesion to the posterior communicating artery?

A

CN III palsy

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6
Q

What disease are Charcot-Bouchard micro aneurysms associated with?

A

chronic HTN

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7
Q

What is the condition where a patient has neuropathic pain due to thalamic lesions following a stroke?

A

central post-stroke pain syndrome

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8
Q

What vessels are ruptured in an epidural hematoma?

A

middle meningeal arteries

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9
Q

What intracranial hemorrhage shows a biconvex (lentiform) lens shape?

A

epidural hematoma

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10
Q

What vessels are ruptured in a subdural hematoma?

A

bridging veins

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11
Q

In what population are subdural hematoma more often seen?

A

elderly
alcoholics
blunt trauma
shaken baby

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12
Q

What can be seen on CT with a subdural hematoma?

A

crescent-shaped hemorrhage

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13
Q

What vessels are ruptured in a subarachnoid hemorrhage?

A

rupture of an aneurysm

often called “worst HA of my life” –> EMERGENCY

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14
Q

What is the MCC of intraparenchymal (hypertensive) hemorrhage?

A

systemic HTN (but also seen in amyloid antipathy, vasculitis, and neoplasms)

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15
Q

What are the areas most vulnerable during an ischemic stroke?

A

hippocampus (ischemic HYPOxia = HYPOcampus)
neocortex
cerebellum
watershed areas

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16
Q

How long does a patient have before irreversible brain damage during an ischemic stroke?

A

5 minutes

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17
Q

What is one contraindication for the use of tPA that can be detected using a CT?

A

hemorrhage

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18
Q

What is the MC site of hemorrhagic stroke?

A

basal ganglia

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19
Q

What type of necrosis results from an ischemic stroke?

A

liquefactive necrosis

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20
Q

What are the 3 types of ischemic strokes?

A
  1. thrombotic
  2. embolic
  3. hypoxic
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21
Q

What is the treatment for ischemic stroke? What is the time frame within which you can use this treatment?

A

tPA if used within 3-4.5 hr of onset and no hemorrhage/risk of hemorrhage

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22
Q

What is the definition of a transient ischemic attack?

A

brief, reversible episode of focal neurologic dysfunction lasting <24 hrs without acute infarction

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23
Q

What is the pathway of CSF through the ventricles of the brain?

A

CSF made in ependymal cells of choroid plexus –> lateral ventricle –> 3rd ventricle via right and left inter ventricular foramina of Monro –> 4th ventricle via cerebral aqueduct (Sylvius) –> subarachnoid space via foramina of Luschka (lateral) and foramen of Magendie (medial)

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24
Q

What is the pathogenesis of a communicating hydrocephalus?

A

Decrease CSF absorption by arachnoid granulations –> increased intracranial pressure, papilledema, and herniation

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25
Q

What are the signs of a normal pressure hydrocephalus?

A

“Wet, wobbly, and wacky”

Urinary incontinence, ataxia, and cognitive dysfunction

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26
Q

What is the pathogenesis of a normal pressure hydrocephalus?

A
  1. increase CSF production by choroidal tumors

2. impaired CSF absorption by arachnoid granulations damaged by tumor or meningitis

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27
Q

What is the key clinical feature of normal pressure hydrocephalus?

A

enlarged ventricles

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28
Q

What is interesting about hydrocephalus ex vacuo?

A

there is an apparent increase in CSF d/t neuronal atrophy (e.g. Alzheimer disease, advanced HIV, Pick disease)

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29
Q

What causes noncommunicating hydrocephalus?

A

structural blockage of CSF circulation within the ventricular system (e.g. stenosis of the aqueduct of Sylvius)

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30
Q

What many spinal nerves are there and how many for each section of the vertebral column?

A

31 spinal nerves in total

8 cervical
12 thoracic
5 lumbar
5 sacral 
1 coccygeal
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31
Q

What is the pathogenesis of a herniated disc?

A

the nucleus pulpous (soft central disc) herniates through the annulus fibrosis (outer ring)

Usually around L4-L5 or L5-S1

32
Q

At what level does the spinal cord end in an adult?

A

L1-L2

33
Q

At what level should a lumbar puncture be performed?

A

L3-L4 or L4-L5

34
Q

How is polio transmitted?

A

Fecal oral transmission

replicates in the oropharynx –> small intestine before spreading via bloodstream –> CNS –> destruction of cells in anterior horn of spinal cord

35
Q

Does poliomyelitis result in UMN or LMN lesions?

A

LMNs - weakness, hypotonia, flaccid paralysis, fasciculations, hyporeflexia, and muscle atrophy

Also include signs of infection such as fever, HA, malaise

36
Q

What is spinal muscular atrophy (Wernig- Hoffmann disease)?

A

congenital degeneration of anterior horns of spinal cord –> LMN

37
Q

What are signs of Wernig-Hoffmann disease?

A

“floppy baby” with marked hypotonia and tongue fasciculations

38
Q

What inheritance pattern is Wernig-Hoffmann disease?

A

AR

39
Q

What is the genetic cause of Friedreich ataxia?

A

AR trinucleotide repeat disorder (GAA) on chromosome 9 in gene that encodes frataxin (iron binding protein)

40
Q

What are physical findings of Friedreich ataxia?

A

staggering, frequent falling, nystagmus, dysarthria, pets cavus, hammer toes, hypertrophic cardiomyopathy

Friedreich is Fratastic (frataxin): he’s your favorite frat brother, always stumbling, staggering, and falling, but has a big heart

41
Q

What is the cause of death with those wit Friedreich ataxia?

A

hypertrophic cardiomyopathy

42
Q

In Brown-Sequard Syndrome, what are the two sensations that are CONTRALATERAL below the lesion?

A

pain and temperature sensation

43
Q

What are physical signs of Horner Syndrome?

A

Ptosis
Anhidrosis
Miosis

44
Q

What type of lesion is Horner Syndrome associated with?

A

A spinal cord lesion above T1 (e.g. Pancoast Tumor, Brown-Sequard Syndrome, late-stage syringomyelia)

45
Q

Match the appropriate nerve root to the reflex…

S1, 2
L3, 4
C5, 6
C7, 8
L1, 2
S3, 4
A

S1, 2 - achilles reflex (“buckle my shoe”)
L3, 4 - patellar reflex (“kick the door”)
C5, 6 - bicep (“pick up sticks”)
C7, 8 - tricep (“lay them straight”)
L1, 2 - cremaster reflex (“testicles move”)
S3, 4 - anal wink reflex (“winks galore”)

46
Q

A positive Babinski sign indicates what type of lesion in an adult?

A

UMN lesion

47
Q

What CNs lie medially at the brain stem?

A

III, VI, and XII

48
Q

What is the function of the pineal gland?

A

melatonin secretion, circadian rhythms

49
Q

What is the function of the superior colliculi?

A

conjugate vertical gaze center

50
Q

What is the function of the inferior colliculi?

A

auditory

51
Q

Match the following cranial nerve nuclei to its CN nerves…

midbrain
pons
medulla
spinal cord

A

midbrain - CN III, IV
pons - CN V, VI, VII, VIII
medulla - CN IX, X, XII
spinal cord - CN XI

52
Q

What CN innervates the orbicularis oculi muscle?

A

CN VII

53
Q

Name the afferent and efferent CNs responsible for the pupillary reflex

A

CN II - afferent

CN III- efferent

54
Q

Name the afferent and efferent CNs responsible for the gag reflex

A

CN IX - afferent

CN X - efferent

55
Q

What type of information is relayed to the nucleus solitarius?

A

visceral sensory information (e.g. taste, baroreceptors, gut distention)

CN VII, IX, and X

56
Q

What type of information is relayed to the nucleus ambiguous?

A

Motor innervation of pharynx, larynx, and upper esophagus (e.g. swallowing, palate elevation)

CN IX, X, and XI (cranial portion)

57
Q

What type of information is relayed to the dorsal motor nucleus?

A

sends autonomic (parasympathetic) fibers to heart, lungs, and upper GI

CN X

58
Q

Match the following opening with its appropriate nerves or vessels in the middle cranial fossa

optic canal 
superior orbital fissure
foramen rotundum
foramen ovale
foramen spinosum
A

optic canal - CN II, ophthalmic artery, and central retinal vein
superior orbital fissure - CN III, IV, V1, VI, ophthalmic vein, sympathetic fibers
foramen rotundum - CN V2
foramen ovale - CN V3
foramen spinosum - middle meningeal artery

59
Q

Match the following opening with its appropriate nerves or vessels in the posterior cranial fossa

internal auditory meatus
jugular foramen
hypoglossal canal
foramen magnum

A

internal auditory meatus - CN VII, VIII
jugular foramen - CN IX, X, XI, jugular vein
hypoglossal canal - CN XII
foramen magnum - spinal roots of CN XI, brain stem, vertebral arteries

60
Q

What is the path the blood from the eye takes to drain?

A

blood from eye and superficial cortex –> cavernous sinus –> internal jugular vein

61
Q

What nerves go through the cavernous sinus?

A

CN III, IV, V1, V2, and VI and postganglionic sympathetic fibers

62
Q

What will be seen with a CN V motor lesion?

A

jaw deviation TOWARDS the side of lesion d/t unopposed force from the opposite pterygoid muscle

63
Q

What will be seen with a CN X lesion?

A

uvula deviates AWAY from side of lesion (weak side collapses and uvula points away)

64
Q

What will be seen with a CN XI lesion?

A

weakness turning head to contralateral side of lesion (SCM)

shoulder droop on side of lesion (trapezius)

65
Q

What will be seen with a CN XII lesion (LMN)?

A

tongue deviates TOWARDS side of lesion d/t weakened tongue muscles on affected side

66
Q

What is the function of the 3 ossicles of the middle ear?

A

to conduct and amplify sound from eardrum to inner ear

ossicles = malleus, incus, and stapes

67
Q

Where in the inner ear are low frequencies heard?

A

at apex near helicotrema

68
Q

Where in the inner ear are high frequencies heard?

A

at base of cochlea

69
Q

What are the Rinne and Weber test results from someone with conductive hearing loss?

A

Rinne Test - abnormal (bone > air)

Weber Test - localizes to affected ear

70
Q

What are the Rinne and Weber test results from someone with sensorineural hearing loss?

A

Rinne Test - normal (air > bone)

Weber Test - localizes to unaffected ear

71
Q

How does noise induced hearing loss occur?

A

damage to the stereocilliated cells in organ of Corti

72
Q

An UMN facial lesion would result in what clinical findings?

A

contralateral paralysis of lower face

forehead SPARED d/t bilateral UMN innervation

73
Q

An LMN facial lesion would result in what clinical findings?

A

ipsilateral paralysis of upper AND lower face

74
Q

What are clinical findings of a patient with facial nerve palsy?

A

ipsilateral facial paralysis (dropping smile)

inability to close eye on involved side

75
Q

What are diseases associated with facial nerve palsy?

A

MC = idiopathic (Bell palsy)

Associated diseases

  • Lyme disease
  • herpes simplex
  • herpes zoster (less common)
  • sarcoidosis
  • tumors
  • diabetes
76
Q

What is the treatment for facial nerve palsy?

A

corticosteroids

77
Q

What are the 4 muscles to mastication and what are they innervated by?

A

masseter (close jaw)
temporalis (close jaw)
medial pterygoid (close jaw)
lateral pterygoid (opens jaw)

All innervated by CN V3

First Aid STEP 1 - Neurology (6 decks)

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