Brain and Behavior, Week 2

Question 1

Which part of the spinothalamic tract carries pain and temperature information?

Answer 1

Lateral

Question 2

Which part of the spinothalamic tract carries crude touch sensations?

Answer 2

Anterior

Question 3

Where in the brain do secondary neurons in the spinothalamic tract synapse, and where is information relayed afterwards?

Answer 3

• Synapse in the ventral posterolateral nucleus

- Third order neurons relay information to the somatosensory cortex, located in post central gyrus.

Question 4

A patient has nuchal rigidity, headache, and a CSF showing gram + rods. What is the likely etiology?

Answer 4

Listeria

Question 5

If a patient with meningeal symptoms declines very rapidly, the likely etiology is?

Answer 5

N. meningitidis

Question 6

What are the recommendations for prophylaxis of N. meningitidis?

Answer 6

Prophylax all household contact, day care contacts, and others who may be exposed to oral secretions.

Question 7

Which cancers commonly metastasize to the brain?

Answer 7

Lung, kidney, melanoma, breast

Question 8

Contrast the presentation of low vs. high grade brain tumors?

Answer 8

Low grade = seizures

High grade = headache and vomiting

Question 9

What’s a good antidepressant to use in elderly Parkinson’s patients?

Answer 9

Zoloft

Question 10

Treatment for Huntington’s disease?

Answer 10

• Antipsychotics (1st generation)

- Tetrabenazine

Question 11

Etiology of ballism:

Answer 11

Usually secondary to stroke in sub-thalamic nucleus

Question 12

Restless legs syndrome

Answer 12

• PLMD, happens when awake too
• Check thyroid, iron
• Also seen in pregnant women
• Genetic component
• Diagnosed clinically and with sleep study
• Start treatment with gabapentin

Question 13

What’s the most common type of stroke?

Answer 13

Large vessel stroke, usually due to atherosclerosis

Question 14

What’s the most likely etiology for a cardioembolic stroke?

Answer 14

A fib

Question 15

What is a lacunar stroke?

Answer 15

• Small vessel ischemic stroke
• Usually better prognosis than large vessel stroke
• DM and HTN are risk factors

Question 16

Antiplatelet treatment for stroke if patient can’t take aspirin:

Answer 16

Plavix (clopidogrel). 3rd choice: Aggrenox

Question 17

What kind of stroke is anti-coagulation therapy indicated in?

Answer 17

Cardioembolic. In other types, no advantage over aspirin.

Question 18

What’s the window for thrombolysis? For mechanical thrombectomy?

Answer 18

• 3 hrs

- 8 hrs

Question 19

What is the advantage of triptans vs. ergotamines in the treatment of migraine?

Answer 19

Ergotriptans are more likely to cause N/V due to non-selectivity of serotonin agonism

Question 20

1st line prophylaxis for migraine:

Answer 20

• Beta blockers
• Valproate
• Topiramate (1st or 2nd line)

Question 21

1st line abortive treatment for migraine:

Answer 21

NSAIDS

Question 22

A patient presents with behavioral symptoms such as personality changes, sexual aggression and a lack of a “filter” with things he says. He likely has a lesion in which part of the brain?

Answer 22

Frontal lobe

Question 23

When is hemisphere dominance usually established?

Answer 23

By the end of the first decade of life

Question 24

A lesion that affects temperature and pain sensation, as well as proprioception, is located where?

Answer 24

Parietal lobe

Question 25

Most important test to order with CSF fluid sample (if you only have a little):

Answer 25

Gram stain