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Neurology > brain stem > Flashcards

brain stem Flashcards

0
Q

superior calliculi

A

conjugate vertical gace center

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1
Q

pineal gland

A

melatonin

circadian

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2
Q

inferior colliculi

A

auditory

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3
Q

Parinaud syndrome

A

paralysis of conjungate vertical gaze due to lesion in superior colliculi
pinealoma

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4
Q

pontocellular angle syndrome

A

acoustic neuroma
schwannoma
CNVIII
absence of long tract symptoms, only cranial signs

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5
Q

CNI

A

olfactory nerve,*sensory
smell(only CN without thalamic relay,2nd neuron, to cortex)
hyposmia: incomplete; anosia:complete
dysosmia: distorted
cribriform fracture(bipolar nasal muscosa–>cribriform–>bulb mitral cells–>olfactory tract->pyriform cortex&orbital frontal)

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6
Q

CN II

A

Optic: Sight

  1. visual field dicits, anopsia
  2. loss of light reflex with III
    * only nerve affected by MS
    * sensory
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7
Q

CNIII

A

oculomotor: eye movement, pupil constriction, accomodation, eyelid
SR, IR, MR, IO: look out and down when injured
sphincter pupillae:Edinger westphal nucleus, muscarinic receptor
levator palpebrae: ptosis
*motor

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8
Q

CN IV

A

trochlear: eye movement
SO: depress and adducts, down and out
*motor

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9
Q

CN V

A

Trigeminal: *Both

  1. Mastication: jaw deviation toward weak side
  2. Facial sensation: ophthalmic (V1, corneal reflex), maxillary, mandibular divisions
  3. somatosensation from anterior 2/3 of tongue
  4. lacrimation afferent V1
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10
Q

Cn VI

A

Abducens: eye movement *motor
LR: abducts
diplopia(internal strabisms)
loss of parallel gaze (pseudoptosis)

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11
Q

CN VII*both

A

facial movement; corner of mouth drop, cannot wrinkle forehead
taste from anterior 2/3 of tongue
lacrimation, salivation(submandibular, sublingual gland):nerve courses through the parotid gland, but do not innervate it)
eyelid closing(orbicularis oculi)
stapeidus muscle in ear

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12
Q

CN VIII

A

vestibulocochlear: hearing, balance * sensory
angular/linear acceleration
* cochlear nucleus–>superior olivary nucleus(cross trapezoid body)
–>inferior colliculus/lateral lemniscus of mid brain
–>medial geniculate body of thalamus
–>superior temporal gyrus of cerebral cortex

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13
Q

CN IX

A

Glossopharyngeal *Both
taste and somatosensation from posterior 1/3 of tongue
swallowing, salivation(parotid gland)
monitoring arotid body and sinus chemo- and baroreceptor
stylopharyngeus(elevates pharynx, larynx), 3rd arch: gag reflex

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14
Q

CN X

A 
Vagus
taste from epiglottic region swallowing
palate elevation: also gag 
midline uvula: pointing away from lesion
talking, coughing:
thoracoabdominal visera
montoring aortic arch chemo-baroreceptors
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15
Q

muscle of pharygnx and palate and glossus innervated by?

A

pharygnx: X except stylopharyngeus by IX
palate: X except tensor palatini by V3
glossus: XII except, palatoglossus: X

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16
Q

CN XI

A

accessory; motor
head turning
shoulder shrugging (SCM, trapezius)

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17
Q

CN XII

A

hypoglossal
tongue movement:tongue towards injured
styloglossus-elevation of tongue
palatoglossus by X

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18
Q

CN in midbrain

A

III, IV

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19
Q

CN in Pons

A

V, VI, VII, VIII

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20
Q

CN in medulla

A

IX, X, XII

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21
Q

spinal cord CN

A

XI

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22
Q

corneal reflex

A

afferent: V1 ophthalmic
effernet: VII

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23
Q

Lacrimation reflex

A

afferent: V1
efferent: VII

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24
Q

jaw jerks reflex

A

afferent
V3
efferent
V3

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25
Q

pupillary reflex

A

afferent: II
efferent: III

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26
Q

gag reflex:

A

afferent :IX

efferent:X

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27
Q

sneeze reflex

A

afferent: V2
efferent: X

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28
Q

cough reflex

A

afferent: X
efferent: X

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29
Q

nucleus solitarius

A

visceral sensory information
taste, baroreceptor, gut distention
VII, IX, X

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30
Q

nucleus ambiguus

A

motor innervation of pharynx, larynx, and upper esophagus
swallowing, palate elevation
IX, X

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31
Q

dorsal motor nucleus

A 
sends autonomoic(PANS)fibers to heart, luns and upper GI
X
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32
Q

CN I exits?

A

cribriform plate

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33
Q

CNII exits

A

optic canal, with ophthalmic artery, central retinal vein

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34
Q

CN III

A

superior orbital fissure (with IV, V1,VI, ophthalmic vein, SANS fibers)
standing room only

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35
Q

CN V2

A

Forman Rotundum

standing room only

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36
Q

CN V3

A

Foramen Ovale

standing room only

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37
Q

middle meningeal artery exits?

A

foramen spinosum

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38
Q

CN VII

A

internal auditory meatus,

with CN VIII

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39
Q

CN IX

A

jugular foramen

with CN X, XI and jugular vein

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40
Q

CN XII goes through?

A

Hypoglossal canal

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41
Q

CN XI exits

A

Foramen magum

the spinal root of CN XII, brain stem, vertebral arteries

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42
Q

nerve that pass through cavernous sinus

A

III, IV, v1, V2 and VI

postganglionic sympathetic

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43
Q

cavernous sinus syndrome

A

ophthalmoplagia and decrease corneal and maxillary sensation with normal vision

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44
Q

Jaw deviates towards side of lesion due to unopposed from the opposite pterygoid muscle

A

CN V motor lesion

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45
Q

Uvula deviates away from side of lesion, weak side collapses and uvula point away

A

CN X lesion

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46
Q

weakness turning head contralteral side of lesion

shoulder droop on side of lesion

A

CN XI

left SCM contracts to help the head to the right

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47
Q

tongue deviates towarad side of lesion

lick your wound

A

CN XII

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48
Q

conductive hearing loss

A

abnormal rinnie test(bone>air)

weber test is localized to affected ear

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49
Q

sensorineural

A

normal rinnie test (air>bone)

localized to unaffected ear

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50
Q

sudden extremely loud noise leads to?

A

hearing loss due to tympanic membrane rupture

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51
Q

prolonged noise induced hearing loss

A

damage to stereociliated cells in organ of corti

loss of high freq hearing first

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52
Q

UMN lesion on facial lesion

A

contralateral paralysis of lower face

forehead spared due to bilateral UMN innervation

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53
Q

LMN lesion on facial lesion

A

ipsilateral paralysis of upper and lower face

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54
Q

facial nerve palsy

A

destruction of facial nucleus/efferent branch(facial nerve proper)
1. peripheral ipsilateral facial paralysis with inability to close eye on involved side
2. Buccinator muscle-food and saliva drooping
gradually recovery in most cases
Bell’s palsy when idiopathic

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55
Q

mastication muscle

A 
CN V
masseter, 
temporalis
medial pterygoid
1 opening : lateral pterygoid
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56
Q

pupillary sphincter muscle is regulated by?

A

M3 receptor,PANS
CN III
constriction->mitosis
relaxation–>mydriasis

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57
Q

radial dilator muscle is regulated by?

A

alpha receptor SANS
contraction->mydriasis
relaxation->miosis

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58
Q

cillary body

A

beta receptor, SANS
secretion of aqueous humor
decrease production

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59
Q

cillary muscle

A

M3, PANS, CN III
constriction->accommodation
relaxation->focus for far vision

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60
Q

hyperopia

A

eye to short for refractive power of cornea and lens

light focus behind retina

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61
Q

Myopia

A

eye too long for refractive power of cornea and lens->light focuesed in front of retina

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62
Q

Astigmatism

A

abnormal curvature of cornea resulting in different refractive power at different axes

63
Q

presbyopia

A

decrease change in focusing ability during accommodation due to sclerosis and decrease elasticity

64
Q

accomodation

A

focusing on near objects->ciliary muscle tighten->zonular fibers relax->lens becomes more convex, occurs with convergence and miosis

65
Q

uveitis is often associated with?

A 
TB
HLA-B27
sarcoid
rheumatoid arthritis
juvenile idiopathic arthritis
66
Q

retinitis

A

retinal edema and necrosis leading to scar
often viral(CMV, HSV,HZV)
associated with immunosuppression

67
Q

central retinal artery occlusion

A

acute painless monoculear vision loss

retina whitening with cherry-red spot

68
Q

open/wide angle glaucoma

A

peripheral then central vision loss usually with increase IOP,
optic disc atrophy with cupping
associated with increase age
african-american race and family history
uvitis trauma, steriod, vasoproliferative retinopathy that block or decrease outflow at trabecular meshwork

69
Q

closed/narrow angle glaucoma

A

enlargement or forward movement of lens against central iris leads to obstruction of normal aqueous flow through pupil–>
fluid builds up behind iris, pushing peripheral iris against cornea and impeding flow through the trabecular meshwork
Chronic: asymptomatic with damage to optic nerve and peripheral
Acute:: painful !!!! sudden lost of vision, halos around lights

70
Q

Cataract

A

Painless often bilateral, opacification of lens-> decrease in vision
risk factors, age, smoking
EtOH, excessive sunlight, prolonged corticoid use, classic galactosemia, galctokinase deficiency, DM(soritol), trauma, infection

71
Q

papilledema

A

optic disc swelling(usually bilateral) due to increase intracranial pressure (secondary mass effect)
Enlarged blind spot and elevated optic disc with blurred margins seen on fundoscopic exam

72
Q

process of miosis

A

1st neuron: Edinger-Westphal nucleus to ciliary ganglion via CN III
2nd neuron: short ciliary nerves to pupillary sphincter muscles

73
Q

Mydriasis

A

1st neuron: hypothalamus to ciliospinal center of Budge(C8-T2)
2nd neuron:exits at T1 to superior cervical ganglion (travels along cervical SANS chain near lung apex, subclavian vessels)
3rd neuron: plexus along internal carotid, through cavernous sinus, enters orbit as long ciliary nerve to pupillary dilator muscle

74
Q

light reflex

A

light–>retinal cell ganglion–>
impulses travel up CN II–> pretectal nuclei in midbrain
bilateral Edinger-Westphal nucleus(preganglic PANS)–>
ciliary ganglion (postganglic PANS)–>
pupillary sphincter muscle–>miosis

75
Q

Marcus Gunn pupil

A
  • afferent pupillary defect (optic nerve damage or retinal detachment)
  • decrease bilateral pupillary constriction with light is shone in affected eye relative to unaffected eye
  • test with swinging flashlight test
76
Q

blown pupil

A

diminished or absence pupillary light reflex
CN III PANS output fibers on the periphery are 1 st affected by compression(posterior communicating artery aneurysm uncal herniation)

77
Q

out and down gaze

A

CN III, motor output to ocular muscles-affected primarily by vascular disease(DM, Glu->sorbitol) due to decrease diffusion of O2 and nutrients to the inferior fibers from compromised vasculature that resides on outside of nerve

78
Q

retinal detachment

A

separation of neurosensory layer of retina(photoreceptor layer with rods and cones) from outmost pigmented epi (normally shields excess light supports retina)->degeneration of photoreceptors–>vision loss
secondary to retinal breaks, DM, inflammtion
preceded by posterior vitrous deatchment (flashes and floaters)+myopia+moncular loss of vision->curtain drawn down

79
Q

age related macular degeneration

A 
degeneration of macula (central area of retina)
causes distortion(metamorphopsia) and loss of central vision(scotoma)
*Dry-nonexudative>80%-deposition of yellowish extracellular material, gradual loss of vision,prevent progress by vit and antioxidant
*Wet-exudative,10-15%-rapid loss of vision due to bleeding 2nd to choroidal neovascularization. treat with anti-vascular endo growth factor, anti-VEGF
80
Q

right anopia

A

right optic nerve lesion

81
Q

bitemporal hemianopia

A

A comm stroke

chiasm: pituitary adenoma(bottom), craniopharyngioma(top)

82
Q

left homonymous hemianopia

A

right optic tract

mCA

83
Q

left upper quadrantic anopia

A

right meyer’s loop, temporal lobe->lower calcarine->lingual gyrus
MCA,

84
Q

left lower quadratic anopia

A

right parietal lesion MCA

Dorsal optic->upper calcarine->cuneus

85
Q

left hemianopia with macular sparing macula

A

PCA infarct

bilateral projection to occiput

86
Q

central scotoma

A

macular degeneration
Ethambutol
MS

87
Q

MLF

A

medial longitudinal fasciculus
pair of tracts that allows for crosstalk between CN VI and CN III nuclei
coordinates both eyes to move in same horizontal direction
highly mylinated (must communicate quickly)
*lesion are seen in pt with demylination(MS)

88
Q

INO

intranuclear opthalmoplegia

A

lesion in MLF
lack communication
CN VI nucleus activates ipsilateral rectus,contralateral CN III does not respond with medial rectus
abducting eye gets nystagmus (CN VI over fires)
convergence normal,adducting both eyes

89
Q

Caloric test

Cold and warm water into ear test

A

lesion of vestibular nuclei nerve produces a vestibular nystagmus
eyes to the ices
eye track slow to ice side
nystagmus fast correction on the other side
if warm water, then nystagmus to the same side

90
Q

head turn right in INO

A 
endolymph flow +hair cell
increase nerve firing rate->VIII
\+vestibular nuclei-lateral vestibulospinal tract
MLF->MR & LR muscle move
->nystagmus(right), eyetrack slow(left)
91
Q

meniere disease

A 
abrupt recurrent attacks of vertigo
min-hrs
disruption of production of endolymph
treat with low slat diet
surgical removal of the whole system
92
Q

injury to right abducens nerve

A

right eye cannot look right

93
Q

injury o the right abducens nucleus

A

both eye cannot look right

94
Q

right PPRF injury

A

neither eye can look right

95
Q

left MLF injury

A

left eye cannot look right

96
Q

Left frontal eye field injury

A

neither can look right
slow drift to left
right lower face waekness

97
Q

syncope after stimulation of posterior external auditory canal by an ostoscop

A

vasovagal

PANS flow via vagus nerve(CNX)->decrease HR and BP

98
Q

Alzheimer disease

A

most common cause in elderly, down symdrome have increase risk
early onset: APP(21),presenilin-1(14),presenilin-2(1)
late onset: ApoE4 (19); ApoE2(19) is protective
senile plques: beta-amyloid core, angiopathy->intracranial hemorrhage
A beta is synthesized by cleaving amyloid precursor protein
Neurofibrillary tangle:intracellular, abnormal phosph tau protein
Hirano Body: ROD, crystal, eosinophilic

99
Q

Pick’s

A

Dementia+aphasia+parkinsonian aspects,change personality
spares parietal lobe and posterior 2/3 of superior temporal gyrus
spherical tau protein aggregates
Frontotemporal atrophy

100
Q

Lewy body dementia

A

parkinsonism with dementia and hallucinations

alpha-synuclein defect

101
Q

Creutzfeldt-Jakob disease (CJD)

A

Rapidly progressive(wk to month)
dementia with myoclonus(startle myoclonus)
spongiform cortex
prions: beta-pleated sheet resistant to proteases

102
Q

progressive multifocal leukoencephalopathy

A

IC, HIV
JC virus
patches of demyelination due to preferential infection of pligodendrocytes

103
Q

subacute sclerosing panencephalitis

A

progressive dementia spasticity&seizure

104
Q

MS

A

autoimmune inflammation and demyelination of CNS (brain&spine)
optic neuritis(loss of vision), MLF(internuclear opthalmoplegia)
hemiparesis, hemisensory symptoms
bladder/bowel incontinence
relapse and remit course
women in 20s, white
Charcot’s classic triad of MS is a SIN: Scanning speech, Intention tremor, Internuclear ophthalmoplegia, Nystagmus

105
Q

increase protein IgG in CSF

oligoclonal bands

A

MS

106
Q

periventricular plaques, area of oligodendrocyte loss and reactive gliosis with destructive axons

A

goliosis:astrocyte, Gliacyte proliferation
MS
lymphohistocytic infiltration

107
Q

Treatment for MS

A 
beta-IFN
natalizumab
symptomatic treatment for neurogenic bladder: catheterization, muscarinic anta
spasticity: baclofen, GABA
pain:opioids
108
Q

inflammatory demyelinating polyradiculopathy

A

Guillain-Barré syndrome
Autoimmune condition that destroys schwann cells–>inflammation and demyelination of peripheral nerves and motor fibers
symmetric ascending muscle weakness/paralysis beginning in lower extremeties, increase CSF protein with normal cell count, papilledema
autonomic function effected: HTN, cardiac problem
recovers wks to month

109
Q

acute disseminated(postinectious)encephalimyelitis

A

multifocal periventricular inflammation and demyelination after infection(measle/VZV)
or certain vaccination(rabies/small pox)

110
Q

metachromatic leukodystrophy

A

AR lysosomal storage disease
mmosst common due to arylsulfatase A deficiency
build up sulfatides lead to impaired production of myelin sheath

111
Q

Charcot-Marie-Tooth disease

A

Also known as hereditary motor and sensory neuropathy(HMSN)
Group of progressive hereditary nerve disorders related to the defective production of protein involved in the structure and function of peripheral nerves or myelin sheath
effect the lower limb

112
Q

Krabbe’s disease

A

AR, lysosomal storage disease, deficiency of galactocerebrosidase
built up of galactocerebroside destroys myelin sheath
neuropathy, 四肢冷，
developmental delay发育问题（横着走）
optic atrophy看不清
globoid cell吐泡泡

113
Q

partial seizure

A 
affect 1 part
usually temporal lobe, hippocampus
seizure arua:olfactory
secondary to generalize
simple
complex
114
Q

simple seizure

A

consciousness intact

motor, sensory, autonomic, psychic

115
Q

complex seizure

A

impaired comsciousness

116
Q

epilepsy

A

recurrent seizure

117
Q

status epilepticus

A

continuous seizure for>30min or recurrent seizure without regaining consciousness between seizure for 30min
medical emergency
benzo,phenytoin, valproic acid

118
Q

absence generalized seizure

A

petit mal
3Hz
no postictal confusion, blank stare

119
Q

myoclonic generalized seizure

A

quick repetitive jerks

120
Q

tonic-clonic generalized seizure

A

alternating stiffening and movement

121
Q

Tonic generalized seizure

A

tonic-stiffening

122
Q

Atonic generalized seizure

A 
drop seizures(fall to floor)
commonly mistaken for fainting
123
Q

osmotic demyelination syndrome

A

central pontine myelindysis (CPM)

osmotic movement of water moving out

124
Q

dorsal column is often damaged by.

A

B12 deficiency
NO toxicity
tertiary syphilis

125
Q

brain abscess is caused by?

A

most likely otitis media: haemophilis and Strep

HIV most likely toxoplasmosis

126
Q

family history is important in which headache?

A

migraine

127
Q

headache onset during sleep?

A

cluster

128
Q

headache onset in stress

A

tension

129
Q

bilateral headache

A

migraine and cluster headache are unilateral

tension headache is bilateral

130
Q

headache behind one eye

A 
cluster headache
with lacrimation and rhinorrhea,
sweating
facial flushing
nasal congestation
pupillary changes
131
Q

pulsatile headache

A

migraine
with nausea,
photophobia, aura
irritation of CN V mening or blood vessels(substance P, CGRP,vasoactive peptide)

132
Q

dull tight and persistent headache

A

tension
no photophobia orphonophobia
no aura
muscle tender in the neck and shoulder

133
Q

sharp and steady,

A

cluster headache

134
Q

duration of different headache

A

migraine: 4-72hr
cluster: 15-90
tention: 30-7days

135
Q

turge weber syndrome

A

congenital disorder with port-wine stain(nevus flammeus)
typically in V1 opthalmic distribution
ipsilateral leptomeningeal angiomas
pheochromocytoma
glaucoma, seizure, hemiparesis, mental retardation

136
Q

Tuberous sclerosis

A 
Hamartoma in CNS and skin
Ash-leaf spots
Mitral regurgitation
Adenoma sebacum
Rhabdomyoma
TS, ADOminant
Mental retardation
Angiomyolipoma renal
Seizure
137
Q

Neurofibromatosis type1

von recklinghausen’s disease

A 
cafe-au-lait spots
lisch nodules:pigmented iris hamartomas
neurofibromas inskin
optic gliomas
pheochromocytomocytomas
AD Chrom 17, NF 1
138
Q

von-hippel-lindau disease

A

cavernous hemangiomas in skin, mucosa,organs
bilateral renal cell carcinoma
hemangioblastoma in retina, brain stem, cerebellum,
pheochromacytoma
VHL, chrom3 AD

139
Q

Glioblastoma multiforme

grade IV astrocytoma

A

most common primary brain tumor
malignant with<1y life-expectancy
found in cerebral hemisphere, cross corpus callosum(butterfly glioma)
stain astrocyte for GFAP
pseudopalisading:pleomorphic tumor cells-border central areas of necrosis and hemorrhage, appearance markly enlarged nuclei

140
Q

meningioma

A

2nd most common primary tumor
most often occurs in convexities of hemispheres(near surface of brain) and parasagittal region
from arachnoid cells are extra-axial(external to brain parenchyma)
dural attachment(tail)
benign and resectable, asympomatic, present with seizure
spindle cells concentrically arranged in a whorled pattern, psammoma

141
Q

Schwannoma

A

3rd most common primary tumor, Schwann cell origin
often localized to CN VIII->acoustic schwannoma(acoustic neuroma)
resectable or treat with stereotactic radiosurgery
exsert pressure on lateral part of caudal pon with CN VIII expand to V
found at cerebellopontine angle. S-100 positive
Bilateral acoustic schwannoma found in neurofibromatosis type 2

142
Q

oligodendroglioma

A 
relatively rare, slow growing
most often in frntal lobe
Chicken-wire capillary pattern
oligodendrocytes=fried egg cells-round nuclei with clear cytoplasm
often clcified in oligodendroglioma
143
Q

pituitary adenoma

A

most commonly prolactinoma
Bitemporal hemianopia(pressure on the chiasm
hyper-or hypopituitarism are sequelae)

144
Q

Pineal tumor

A

obstruction of CSF flow & increase cranial pressure
compression of upper midbrain/pretectal area->parinaud syndrome (impairment of conjugate vertical gaz& pupillary reflex abnormality)

145
Q

primary CNS lymphoma

A

AIDS patient, EBV infection:seizure, headache, cranial nerve deficits
may involve letomeninges, intermediate to high grade B cell lymphoma

146
Q

pilocytic atrocytoma

low-grade

A 
usually circumscribed, cystic+soild 
in children: posterior fossa
may be supratentorial.
GFAP +
benign, good prognosis
Rosenthal fibers-eosinophilic, cockscrew fibers
147
Q

medulloblastoma

A 
highly malignant cerebellar tumor
form of primitive neuroectodermal tumor
compress 4th ventricle causing hydrocephalus
send drop metastases to spinal cord
Homer-Wright rosettes.
Solid, small blue cell,radiosensitivity
148
Q

ependymoma

A

most commonly found in 4th ventricle
can cause hydrocephalus
poor prognosis
characteristic perivascular pseudorosettes
rod-shape blepharoplasts(basal ciliary body) found near nucleus

149
Q

hemangioblastoma

A

cerebellar
associated with VHL when found with retinal angiomas
produce EPO–>secondary polycythemia
foamy cells and high vascularity are characteristic

150
Q

Craniopharyngioma

A

benign childhood tumor,most common childhood supratentorial tumor
confused with pituitary adenoma(also cause bitemporal hemianopia)
from rathke’s pouch
calcification is common; tooth enamel-like
histo: ameloblastomas, dental epi;line with stratified epi+keratin pearls,cyst:yellow, viscous fluid rich in chol

151
Q

cingulate herniation

A

subfalcine

compress anterior cerebral artery

152
Q

transtentotial herniation

A

downward, central

optic chiasm

153
Q

uncal herniation

A

3rd nerve compression
medial temporal lobe
against tentorium cereblli

154
Q

tonsillar herniation

A

into foramen magnum

coma and death result when these herniation compress the brain stem

155
Q

Lissencephaly

A

agyria
smoth brain
lack hemispheric sulci
severe brain damage

156
Q

olfactory Neuroblastoma

A

primitive neuroectodermal tumor
small round blue cell tumor
childhood

Neurology (7 decks)

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