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Neurology > Block 3 > Flashcards

Block 3 Flashcards

1
Q

what structure of the ear contains hair cells

A

organ of corti

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2
Q

when the organ of corti is wound down, the apex contains __ frequency while the base contains __ frequency
(high or low frequency)

A

apex= high frequency
base= low frequency

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3
Q

what is presbyacusis

A

lose of high frequency sound before low frequency

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4
Q

what hair cells are connected to the tectorial membrane

A

outer

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5
Q

what hair cells are connected to the tectorial membrane

A

outer

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6
Q

what is the tall hair cell in which the other hair cells bend towards or away from

A

kinocilium

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7
Q

when hair cell bend towards the kinocilium, there is depolarization or hyperpolarization and an increase or decrease in the rate of firing

A

towards= depolarization, more firing

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8
Q

when hair cell bend away the kinocilium, there is depolarization or hyperpolarization and an increase or decrease in the rate of firing

A

away= hyperpolarization, decrease

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9
Q

what is used as the depolarizing signal as hair cells bend towards the kinocilium

A

K+ influx

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10
Q

what is the function of inner hair cells

A

transform wave energy (“do the hearing”)

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11
Q

what is the function of outer hair cells

A

dampen loudness by stretching in response to signal

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12
Q

what are the contents of endolymph

A

high K+
low Na+
low Ca2+
high positive amino acids

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13
Q

what are the contents of perilymph

A

high Na+

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14
Q

what is the value of the endocochlear potential

A

150mV

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15
Q

the ventral acoustic striata is also known as what

A

trapezoid body

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16
Q

the spiral ganglion contains what class of cells

A

bipolar

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17
Q

the primary auditory cortex is composed of Broadman areas __

A

41 and 42

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18
Q

a lesion to Wernicke’s area results in __ aphasia with symptoms of

A

receptive
poor comprehension of speech, speak fluently but in “word salad”

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19
Q

interaural differences in __ and __ are used to determine lateral input direction (angle)

A

level (sound from the right is louder on the right than the left)
time (sound from the right reaches the right ear sooner than the left)

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20
Q

if the frequency for sound localization is >1600Hz, this indicates interaural level or time difference

A

level

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21
Q

if the frequency for sound localization is <800Hz, this indicates interaural level or time difference

A

time

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22
Q

what brain structure is important for localization of sound

A

superior olivary complex

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23
Q

what is needed for coincidence detectors to fire for sound localization

A

signal from left and right ear to line up at the same time on a leading neuron

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24
Q

the tensor tympani muscle which tightens the tympanic membrane is innervated by what nerve

A

trigeminal

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25
Q

the stapedius which prevents excess stapes movement is innervated by what nerve

A

facial

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26
Q

what is tinnitus sometimes caused by, although it is generally idiopathic

A

lack of loudness dampening by middle ear muscles

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27
Q

what is the mechanism in which outer hair cells dampen sound

A

movement of the basement membrane deforms outer hair cell stereocilia against the tectorial membrane. this causes K+ channels to open, outer hair cell motor proteins to shrink the cell, pulling down on the tympanic membrane and ultimately dampening the sound

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28
Q

most feedback efferent go to outer hair cells from the ___

A

superior olivary nucleus

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29
Q

conduction hearing loss is due to an issue at what location

A

before the cochlea

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30
Q

what are the 3 main causes of conduction hearing loss

A

wax
infection
cholesteatoma (skin cyst in middle ear)

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31
Q

sensorineural hearing loss is due to an issue at what location

A

past or at the cochlea

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32
Q

what are the 4 main causes of sensorineural hearing loss

A

-infection (MMR, CMV)
-drugs (NSAIDS, streptomycin, quinine, gentamycin)
-presbyacusis (esp. in elderly)
-vestibular schwannoma tumor

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33
Q

what are the 3 main drug classes that are ototoxic

A

salicylates
NSAIDS
antibiotics (aminoglycosides)

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34
Q

what type of medication leads to reversible ototoxic effects? irreversible?

A

reversible- salicylates
irreversible- antibiotics (aminoglycosides)

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35
Q

what is the process of the Weber test for conduction and sensorineural hearing loss

A

a 512 Hz tuning fork is placed on the patient’s forehead

if the sound localizes (is louder on one side), patient has either ipsilateral conductive hearing loss of contralateral sensorineural hearing loss

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36
Q

what is the process of the Rinne test for conduction and sensorineural hearing loss

A

a tuning fork is placed on the mastoid behind the patients ear until sound is no longer heard. the fork is then placed at the side of the patient’s ear and the sound should once again be heard

if no sound is heard, the test is negative

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37
Q

what is considered a normal positive test for the Rinne test

A

it indicates the ear is normal, as air conductance should be longer than bone conductance

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38
Q
A
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39
Q

what is the function of speech audiometry

A

measures the percentage of words correctly interpreted as a function of the intensity of presentation and indicates the usefulness of hearing

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40
Q

how does brainstem auditory evoked response for testing conduction and sensorineural hearing loss work

A

using an EEG, scalp electrodes measure response along the entire auditory path in response to sound stimuli

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41
Q

how does otoacoustic emission for testing conduction and sensorineural hearing loss work

A

microphones are fitted into the ear canal and are used to measure response to auditory stimulation

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42
Q

acute otitis media is usually caused by __ and presents with __ and __

A

viral, sometimes bacteria

earache and fever

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43
Q

serous otitis media is caused by __ and presents with __

A

altered eustachian tube function or viral/bacterial infection

conductive hearing impairment

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44
Q

chronic suppurative otitis media is caused by __ and presents with __

A

perforation in the tympanic membrane

otorrhea (pus drainage out of ear)

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45
Q

with presbyacusis, is hearing loss ipsilateral or bilateral, symmetric or asymmetric

A

bilateral symmetric

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46
Q

with presbyacusis, does high or low frequency tone go first

A

high

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47
Q

what is otosclerosis

A

abnormal bone growth in or near the middle ear, causing the stapes to become fixed in the oval window

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48
Q

what are the symptoms of otosclerosis

A

conduction hearing loss then sensorineural hearing loss

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49
Q

what is Meniere syndrome

A

disorder of the inner ear affecting the auditory and vestibular systems (the entire labyrinth)

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50
Q

what are the symptoms of Meniere syndrome

A

deafness
sensation of profound fullness in the ears
attacks of vertigo
sometimes nystagmus

51
Q

what hearing loss do you get with Meniere syndrome

A

loss of low frequency range

52
Q

what is the cause of Meniere syndrome

A

excess endolymph buildup (endolymphatic hydrops)

53
Q

what is the treatment for Meniere syndrome

A

antihistamines

54
Q

what are the symptoms of vestibular schwannoma

A

CN 8
unilateral hearing loss
tinnitus
vertigo

CN 7
pain in facial muscles which may become paralyzed

55
Q

what is vestibular schwannoma

A

benign tumor that affects cranial nerve 8

56
Q

the ear canals, ampullae, and maculae are filled with endolymph or perilymph

A

endolymph

57
Q

when there is movement towards the kinocilium, there is depolarization and release of __

A

glutamate

58
Q

cristae respond to what type of motion

A

rotational movement

59
Q

cristae are made up of what 2 structures

A

utricle and saccule

60
Q

the utricle deals with what type of motion
the saccule deals with what type of motion

A

utricle= linear acceleration/deceleration
saccule= up/down

61
Q

maculae of the saccule respond to what and detect what

A

gravitational pull
linear acceleration/deceleration and head tilt forward and backward

62
Q

vestibular ganglia (Scarpa’s) fibers from the vestibular portion of CN VIII project where

A

lateral, medial, superior, and inferior vestibular nuclei in the caudal pons, rostral medulla, and caudal medulla

63
Q

a disorder of the craniocervical junction causes what type of nystagmus

A

downbeat

64
Q

with an upbeat nystagmus- large amplitude, this means there is a lesion where

A

anterior vermis

65
Q

with an upbeat nystagmus- small amplitude, this means there is a lesion where

A

medulla

66
Q

torsional nystagmus results due to a lesion where

A

anterior and posterior semicircular canals on the same side (or also with lateral medullary syndrome)

67
Q

pendular nystagmus occurs due to dysfunction where

A

brainstem or cerebellum

68
Q

gaze evoked nystagmus occurs due to what

A

an attempt to maintain extreme eye position

69
Q

what is benign paroxysmal positional vertigo (BPPV)

A

brief episodes of vertigo usually related to changes in positions, often accompanied by horizonto-rotary nystagmus

70
Q

how is benign paroxysmal positional vertigo (BPPV) differentiable from Meniere’s disease

A

there is no hearing loss or tinnitus in BPPV

71
Q

can symptoms of central or peripheral nystagmus be changed with head movement

A

peripheral

72
Q

nystagmus and vertigo occur when the affected or unaffected side is turned downward in the Hallpike-Dix test with benign paroxysmal positional vertigo (BPPV)

A

affected

73
Q

hyperventilation induced nystagmus occurs in __% of patients with __

A

92
vestibular schwannoma

74
Q

vestibular neuritis (neuronitis) typically presents with __ following __

A

vertigo
URI

75
Q

with caloric testing, cold water stimulates the head to turn to the same or opposite side

A

opposite

COWS
cold opposite warm same

76
Q

with nystagmus, the slow response is due to __ while the fast response is due to __

A

slow= vestibulo-ocular reflex (VOR)
fast= nystagmus- PTO response

77
Q

with caloric testing, cold water stimulates nystagmus in the same or opposite direction

A

opposite

COWS
cold opposite warm same

78
Q

what will the nystagmus response be in someone who is unconscious but has an intact brainstem

A

slow drift due to vestibulo-ocular reflex but no fast drift

cold water= same side
warm water= opposite side

79
Q

with an MLF lesion, cold water stimulates the head to turn __

A

cold= opposite
warm= same

80
Q
A
81
Q
A
82
Q

are rods or cones very sensitive to light

A

rods

83
Q

do rods or cones loss cause night blindness

A

rods

84
Q

are rods or cones in the fovea

A

cones

85
Q

are there more rods or cones in the retina

A

20x more rods

86
Q

do rods or cones confer achromatic vision

A

rods

87
Q

does loss of cones or rods cause legal blindness

A

cones

88
Q

do rods or cones have high visual acuity

A

cones

89
Q

do rods or cones have a fast response to light

A

cones

90
Q

what are the characteristics of retinitis pigmentosa

A

dying pigment epithelium is release leading to clumps of melanin
nyctalopia (night blindness)

91
Q

what is the difference between wet vs dry macular degeneration

A

wet- results in blood leakage
dry- damage to retinal pigment epithelium

92
Q

what is seen in fundoscopy of someone with hypertension

A

copper color vessels then silver wiring vessels

93
Q

what causes papilledema

A

swollen optic disc caused by increased ICP

94
Q

what is the difference between near and far sighted

A

near- difficulty with far objects
far- difficulty with near objects

95
Q

which lens, concave or convex, converges light
which diverges light

A

convex converges
concave diverges

96
Q

what is amaurosis fugax

A

loss of vision in one eye

97
Q

prednisone may cause blindness due to what effect of the drug

A

increases ocular pressure

98
Q

what causes low-tension/normal tension glaucoma

A

poor blood flow to the optic nerve or “fragile” optic nerve fibers

99
Q

how is signaling different in vision compared to typical signaling

A

hyperpolarization is the on signal

100
Q

what is achromatopsia

A

damage to V4 causes an inability to perceive color

101
Q

what is Balint’s syndrome caused by

A

lesion to the dorsal parietal lobe (how and where of vision)

102
Q

what are 3 symptoms of Balint’s syndrome

A

optic ataxia (deficit in reaching for objects)
ocular apraxia (deficit in visual scanning)
simultanagnosia (can’t perceive two objects simultaneously)

103
Q

the FFA of the inferotemporal region recognizes __
the PPA of the inferotemporal region recognizes __
the EBA of the inferotemporal region recognizes __

A

FFA= face
PPA= place
EBA= body

104
Q

what is prosopagnosia

A

face blindness

105
Q

what is Anton’s syndrome

A

denial of cortical blindness

106
Q

visual anosognosia is most commonly encountered in patients with ___ lesions

A

bilateral occipital lobe

107
Q

hemispatial neglect is usually due to lesions involving non-dominant __ cortex

A

right parietal

108
Q

what is the main blood supply to the lateral geniculate body

A

anterior choroidal artery

109
Q

what is the blood supply of the macular area of the primary visual cortex

A

posterior and middle cerebral artery

110
Q

what is anisocoria

A

unequal pupil size in the 2 eyes

111
Q

what 2 muscles control the size of the iris for the pupillary reflex

A

radial/dilator pupillae
circular/sphincter pupillae

112
Q

the radial (dilator) muscle is under the control or sympathetic or parasympathetic control

A

sympathetic

113
Q

what levels of the cell column are involved in pupillary dilation

A

T1-T4

114
Q

levator palpebrae superioris is under the control of __ while the superior tarsal is under the control of __

A

levator palpebrae superioris= CN III
superior tarsal= sympathetics

115
Q

if unequal pupils react normally to light but the anisocoria is greatest in the dark, the smaller pupil is normal or abnormal

A

abnormal (the common cause of this is Horners syndrome)

116
Q

if unequal pupils react abnormally to light and the anisocoria is greatest in the light, the smaller pupil is normal or abnormal

A

normal

117
Q

edinger westphal nucleus is used for the direct or consensual reflex

A

direct (ipsilateral)

118
Q

contralateral edinger westphal nucleus projects to the posterior commissure for the direct or consensual reflex

A

consensual

119
Q

pupillary constriction is elicited by the action of what neurotransmitter on what receptor type

A

ACh at M3 receptors

120
Q

the afferent limb of the pupillary reflex (direct and consensual) is caused by CN __ while the efferent limb is caused by CN __

A

afferent= 2
efferent= 3

121
Q

Adie’s pupil is due to a problem with what

A

ciliary ganglion

122
Q

what is the main characteristic of Adie’s pupil

A

slow accommodation to light

123
Q

what is smooth pursuit eye movement

A

foveal tracking of a small moving object opposite of the direction of vestibular ocular reflex

*maintains gaze on a stationary object

124
Q

the corneal reflex tests the integrity of what cranial nerves

A

sensory of CN V
motor of VII

Neurology (11 decks)

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