Cumulative Exam - Semester 2 - Block 8 Flashcards
1
Q
Nissl stain (Cresyl violet) highlights what in neurons?
A
Nissl bodies within the ER (primarily gray matter)
2
Q
Process in which microglia surround a dying neuron
A
Neuronophagia
3
Q
Process in which neuronal cell bodies shrink, become more angular, cytoplasm becomes more eosinophilic, nucleus becomes condensed and pyknotic, loss of nuclear chromatin
A
Acute neuronal injury
4
Q
Process of non-specific reaction to CNS injury involving glial cell hypertrophy and reactive astrocytes; CNS version of a scar
A
Gliosis
5
Q
CNS cell type that often lines up in rows between fibers
A
Oligodendrocytes
6
Q
Phagocytic, antigen presenting cells in the nervous system
A
Microglia
7
Q
Specialized glial cell that lines ventricles, single layer of ciliated cells with no basement membrane
A
Ependyma
8
Q
Specialized organ made of papillary folds of CSF-secreting ependymal cells that protrude into ventricles
A
Choroid plexus
9
Q
UMN lesion signs
A
Diffuse weakness Slight, general atrophy Severe weakness with relatively little atrophy NO fasciculations Hypertonia (except in spinal shock) Hyperreflexia (except in spinal shock) Clonus can be present Babinski sign present (except in spinal shock)
10
Q
UMN lesion signs
A
Focal weakness Focal, severe atrophy Some strength preserved despite severe atrophy Fasciculations Hypotonia Hyporeflexia NO clonus NO Babinski sign
11
Q
Compare the location of the lesion in LMN vs. UMN lesions.
A
LMN - at or after the anterior horn cells of the SC
UMN - prior to the anterior horn cells
12
Q
An ___ spinal cord lesion is usually associated with radicular pain and sensory impairment of pain and temperature up to the level of the lesion without sacral sparing.
A
Extramedullary
13
Q
An ___ spinal cord lesion is usually associated with diffuse or no pain, with a suspended impairment of pain and temperature sensation with sacral sparing.
A
Intramedullary
14
Q
Presentation of spinal cord transection/transverse myelopathy/myelitis + location of lesion
A
Sensory loss
LMN signs
UMN signs
Spinal shock if severe
Lesion - anywhere in the SC
15
Q
Presentation of spinal cord hemisection (Brown-Sequard) + location of lesion
A
Contralateral pain and temperature deficit
Ipsilateral vibration and position sense deficit
Ipsilateral weakness
UMN signs, LMN signs
Lesion - STT, DC, CST, anterior horn cells of half of the SC
16
Q
Presentation of syringomyelia + location of lesion
A
Suspended sensory deficit with sacral sparing (vest)
Weakness (late)
Preserved vibration and position sense
Lesion - STT
17
Q
Presentation of anterior spinal artery syndrome + location of lesion
A
Pain and temperature deficit up to thoracic level Paraplegia and UMN signs (lower libs) Back/radicular pain Acute, stroke-like onset Preserved vibration and position sense
Lesion - STT, CST (lower thoracic and upper lumbar)
18
Q
Presentation of posterolateral syndrome (subacute combined degeneration) + location of lesion
A
Vibration and position sense deficit in lower limbs
Spastic paraparesis, UMN signs
Preserved pain and temperature
Lesion - demyelination and degeneration of white matter, usually at thoracic levels (DC, CST)
19
Q
Presentation of ALS + location of lesion
A
LMN signs UMN signs Preserved sensation Diffuse fasciculations No radicular pain No affected bowel/bladder M>F, presents 40-70 y/o
Degeneration of UMN/LMN (selective and progressive)
20
Q
Presentation of Tabes Dorsalis + location of lesion
A
Severe radicular pain (lower limbs) Impaired position and vibration (+ Romberg) Eventual loss of all sensation Loss of reflexes Intact strength Charcot joinst
DC, dorsal roots
21
Q
Pathway carrying vibration and position sense
A
Dorsal column pathway
22
Q
Dorsal Column Pathway
A
SYNAPSE - dorsal root ganglion (SC)
SYNAPSE and DECUSSATE - internal arcuate (caudal medulla)
SYNAPSE - VPL (thalamus)
SYNAPSE - sensorimotor cortex (312)
23
Q
Pathway carrying pain and temperature
A
Spinothalamic tract
24
Q
STT
A
SYNAPSE and DECUSSATE - dorsal root ganglion cells (anterior white commissure of SC)
SYNAPSE - VPL (thalamus)
SYNAPSE - 312
25
True or false - all cerebellar pathways are ultimately ipsilateral
True
26
CST
Motor cortex
| Pyramidal decussation in medulla (except anterior tract, which does not cross)
27
Nuclei of the DC pathway
Cuneate (C1-T5)
| Gracile (T6-S5)
28
Nuclei of the STT
Nucleus proprius
29
Nuclei of the DCT
Dorsal - Clark's nucleus (C8-L2, L3 and below use gracilis to get to Clark's)
Cuneocerebellar - C1-C7, accessory cuneate nucleus
30
Autoimmune disease against ACh receptors
Myasthenia Gravis
Presentation - ptosis, diplopia, dysarthria, dysphagia (can have a restricted ocular form)
31
Autoimmune disease against pre-synaptic calcium channels
Lambert-Eaton
Presentation - proximal weakness, muscle stretch reflex appears decreased but returns after isometric exercise, autonomic symptoms
32
Infectious toxin that prevents ACh release by impairing SNARE proteins
Botulinum
33
Symptoms of polyneuropathy
Symmetrical and sensory loss or impairment early
Numbness and tingling, beginning distally
Stocking and glove
Paresthesia (pins and needles)
Dysesthesia (unpleasant sensation due to a non-noxious stimulus)
Distal weakness/atrophy
Early loss/decrease of reflexes
34
Presents as an ascending, areflexic paralysis (rapidly progressive polyneuropathy) after a virus
Guillain-Barre
35
Most common pathology for polyneuropathies
Axonal degeneration
36
Presentation of myopathy
```
Proximal weakness and fatigue
Normal sensation
Significant atrophy
Late loss of reflexes
Pain is not prominent
```
37
Test the superior and inferior rectus muscles.
Start abducted and look up (SR) and down (IR)
38
Test the superior and inferior oblique muscles.
Start adducted and look down (SO) and up (IO)
39
Test the lateral and medial rectus muscles.
Look out (LR) and in (MR)
40
CN III lesion presentation
Ptosis, preserved abduction, dilated pupil, unreactive to light (direct and consensual)
41
CN IV lesion presentation
Impairs depression contralaterally
42
CN VI lesion presentation
Impairs abduction
43
Cause of intranuclear ophthalmoplegia
Paralysis of EOMs due to a lesion of the ascending MLF (affects 3 and 6)
Normally, L brain -> R paramedian pontine reticular formation -> coordinates lateral gaze via the R CN6 and L CN3
Convergence is normal
44
Pupillary light reflex pathway
Light -> optic nerve -> pretectal area -> DECUSSATES -> both EWN -> CN3 -> ciliary sphincter -> constricts both sides
45
3 components of the near reflex
Pupillary constriction
Lens accommodation
Eye convergence
46
Symptoms of Horner's syndrome
Miosis, anhydrosis, ptosis
47
Causes of Horner's syndrome
1. Lateral median infarction (Wallenberg syndrome) - knocks out first order neurons
2. Apical lung tumor - knocks out second order neurons
3. Neck trauma near the superior cervical sympathetic ganglion - knocks out third order neurons
48
2 major causes of trigeminal neuralgia
MS (younger)
| Compression of tortuous vessels such as the superior cerebellar artery (older)
49
Cause of facial paralysis - lower half of contralateral face paralyzed
UMN
50
Cause of facial paralysis - entire ipsilateral face paralyzed
LMN
51
Effect of UMN lesion on tongue
No symptoms with a unilateral lesions; if a person only has contralateral innervation and this is lost, the tongue deviates away from the affected side
52
Effect of LMN lesion on tongue
Deviates to the affected side (lick your wounds)
53
CN involvement on one side and clinical sensory/motor deficit on the other side
Crossed brain stem syndrome
54
Presentation of Weber syndrome
Ischemic infarction of the PCA causes CN III and the nearby peduncle to be affected - ipsilateral CN III lesion, UMN signs in contralateral face and limbs
55
Presentation of Wallenberg syndrome
Ischemic infarction of the vertebral artery or its PICA causes pain and temperature impairment in the ipsilateral face and contralateral limbs and body; DC preserved
56
Treat migraines
First line - NSAIDS
| Second line - triptans
57
Headache more common in F
Migraines
58
Headache more common in M
Cluster headaches
59
Headache associated with severe eye pain, rapid onset, occur 1-4x/day for 6-12 weeks every year or two
Cluster headaches
60
Bilateral headache, no N/V, band-like, most common
Tension
61
Headache seen in young females with increased BMI, associated with increased ICP with no localizing features
Pseudotumor cerebri
62
These cells myelinate peripheral axons
Schwann
63
These cells myelinate CNS axons
Oligodendrocytes
64
Common causes of bacterial meningitis in neonates (<1 month)
E. coli
GBS
L. monocytogenes
65
Common causes of bacterial meningitis in children (1 month-16 y/o)
H. influenza
N. meningitidis
S. pneumonia
66
Common causes of bacterial meningitis in adults (>15 y/o)
N. meningitidis
| S. pneumonia
67
Common causes of bacterial meningitis in the immunocompromsied
GBS
| L. monocytogenes
68
Most common fungal meningitis
Cryptococcus (budding yeast, mucoid capsule, India ink, Swiss cheese basal ganglia)
69
Most common brain parasite
Cysticercosis (SW US), pork, presents with seizures
70
Most common cause of viral meningitis
Enteroviruses
71
CSF findings of bacterial meningitis vs. viral vs. TB
Fluid quality
Bacterial - cloudy
Virus - clear
Cells present
Bacterial - PMNs
Virus and TB - lymphocytes
Protein
Bacterial - very high
Virus - slightly high
TB - moderately high
Glucose (relative to plasma)
Bacteria - low
Virus - normal
TB - mildly low
Opening pressure
Bacterial - high
72
Cause and presentation of Wernicke-Korsakoff syndrome
B1 deficiency
Acute - Wernicke's encephalopathy (nystagmus, ophthalmoplegia, gait ataxia, confusion)
Chronic - Korsakoff psychosis (amnesia with confabulation)
73
When should a brain CT scan be performed prior to urgent LP in a patient suspected of meningitis?
High suspicion of increased ICP (LP could cause brain herniation)
74
Abrupt onset of focal or global neurological symptoms caused by ischemia or hemorrhage
Stroke
75
Describe the gross and histologic features of cerebral ischemia - acute (6-48 hours).
Gross: pale, soft, swollen, indistinct border, blurred grey-white junction
Histology:
6-12 hours - neuronal ischemia (red dead neurons), pallor (edema)
1-3 days - infiltration by neutrophils
76
Describe the gross and histologic features of cerebral ischemia - subacute (4 days-3 weeks)
Gross: gelatinous, friable, distinct border, tissue liquefaction
Histology: neutrophils early, sheets of foamy macrophages (4-7 days), vascular proliferation 92-3 weeks)
77
Describe the gross and histologic features of cerebral ischemia - chronic (>3 weeks)
Gross: cystic +/- hemosiderin staining, secondary degeneration
Histology: astrocytic gliosis, residual macrophages
78
Most common site of embolic infarction to the brain
MCA
79
Presentation of an MCA stroke
```
Motor/sensory cortex hemisensory loss (knocking out frontal and temporal lobes)
Contralateral hemiparesis (lower face, upper extremities)
Visual field defects
```
80
What happens in tonsillar herniation?
Cerebellar tonsils drop into the foramen magnum, compress the brainstem, cause cardiopulmonary arrest
81
What happens in subfalcine herniation?
Cingulate gyrus movies under the falx cerebri, compresses ACA, infarction infecting lower limbs
82
What happens in uncal herniation?
Uncus (medial temporal lobe) -> tentorium cerebelli -> compresses CN III -> eyes down and out + dilated pupil
83
Sudden focal neurologic deficit with completely resolves in 24 hours; risk factor for stroke
Transient ischemic attack
84
Infarctions of the lenticulostriate arteries, which supply the basal ganglia, thalamus, internal capsule, and corona radiate
Lacunar infarction
85
Type of carotid TIA to the ophthalmic artery that presents as a lowered dark shade over the eye
Amaurosis fugax
86
When can tPA be administered in the setting of ischemic infarction?
Within 3 hours of the event (or risk intracranial hemorrhage)
87
Prevent future strokes in patients with atrial fibrillation with what medication?
Warfarin (most other stroke-prone patients are treated with antiplatelet medications)
88
Worst headache of your life suggests what?
Cerebral hemorrhage
89
Cerebral hemorrhage in the striatum or thalamus are most likely from ___
HTN
90
Causes low tone hearing loss
Conductive hearing loss (impaired air conduction)
91
Causes high tone hearing loss
Nerve damage
92
Explain the Weber test
Top of the head
If nerve deafness - no bone or air conduction - normal ear hears better
If conduction loss - bone conduction is enhanced, affected ear hears better
93
Explain the Rinne test
Mastoid bone to the ear
If partial nerve problem (air>bone) - do hear at affected ear
If conductive - do not hear at affected ear
94
Cause of L eye blindness
L optic nerve (or ocular/retinal cause)
95
Cause of bitemporal heteronymous hemianopsia
Inner optic chiasm lesion
96
Cause of binasal heteronymous hemianopsia
Outer optic chiasm lesion
97
Cause of R homonymous hemianopsia
L optic tract lesion
98
Cause of R superior homonymous quadrantanopsia
L INFERIOR optic radiation lesion (temporal lobe, Meyer's loop)
99
Cause of R inferior homonymous quadrantanopsia
L SUPERIOR optic radiation lesion (parietal lobe)
100
Cause of R homonymous hemianopsia with macular sparing
L occipital lobe lesion
101
The basal ganglia has a ___ effect on the motor cortex via the medial globus pallidus.
Inhibitory
102
What happens to globus pallidus activity in Parkinson's disease vs. Huntington's disease?
Parkinson's - GPm further increased
Huntington's - GPm further decreasd
103
4 primary clinical signs of Parkinson's
Resting tremor (pill-rolling)
Rigidity (cog-wheeling)
Bradykinesia
Impaired postural reflexes
104
Histologic finding of Parkinson's
```
Loss of neurons in the substantia nigra
Lewy bodies (alpha synuclein)
```
105
Lesion - broad-based ataxic gait
DC, sensory nerves, cerebellum
106
Lesion - hemiplegia (swinging gait + ipsilateral flexion of upper limb)
Stroke (1 side)
107
Lesion - tabetic gait (foot slapping to feel the floor)
DC
108
Lesion - steppage gait (foot drop)
Unilateral - perineal nerve or L5
| Bilateral - severe neuropathy, motor neuron disease, L5 root lesion
109
Lesion - waddling (swagger)
Myopathy
110
Lesion - scissors gait
UMN (not compensatory)
111
Clinical features of __- dysfunction: gait ataxia, dysmetria, kinetic tremor, dysdiadochokinesia, rebound phenomenon, dysarthria, nystagmus
Cerebellar
112
Over/undershooting of a target by the hand or foot
Dysmetria (test with heel to shin or finger to nose)
113
Uncoordinated nonrhythmic sloppy hand movements
Dysdiadochokinesia (uncoordinated non-rhythmic sloppy hand movements)
114
Location of lesion - ipsilateral limb impairment + other cerebellar symptoms
Hemisphere
115
Location of lesion - trunk unsteadiness, impaired balance, gait ataxia
Vermis
116
Purposeless random non-rhythmic movements
Chorea
117
Slow writhing continuous movements of limbs
Athetosis
118
Rapid violent flinging movements of proximal limbs on one side (+ lesion site)
Hemiballismus (contralateral STN)
119
Continual sustained painful muscle contractions
Dystonia
120
Rapid shocklike jerks of the limbs and trunk
Myoclonus
121
Disorder of previously acquired language ability due to a lesion in a critical language center
Aphasia
122
Impaired fluency, preserved comprehension + lesion site
Broca's aphasia
Inferior frontal lobe in dominant hemisphere
123
Preserved fluency, impaired comprehension + lesion site
Wernicke's aphasia
Posterior superior temporal lobe in dominant hemisphere
124
Intact fluency (mostly), mild comprehension impairment, paraphasia (abnormal word substitutions) + lesion site
Conduction aphasia
Arcuate fasciculus (connects B and W)
125
No communication, comprehension, severe hemiplegia, cannot read
Global aphasia
Perisylvian area
126
Semantic and emotional meaning conveyed by change in pitch, inflection, melody, and tone
Prosody
Impaired prosody is due to non-dominant cortical lesions
127
Presentation of MS
1. Optic neuritis (decreased monocular vision, pain with eye movements, decreased red-green color, afferent pupillary defect, heat intolerance)
2. Brainstem syndromes
3. SC syndromes
4. Romberg sign
128
Narrowing of gyri, widening of sulci, dilated centricles
Gross features of AD
129
Misfolded amyloid beta plaques, neurofibrillary tangles (tau)
Histologic feature of AD
130
Lewy bodies on histology + dementia and parkinsonism
Lewy body disease
131
Pick bodies (globose neuronal cytoplasmic inclusions made of tau)
Pick's disease
132
Majority of adult brain tumors occur in what region?
Supratentorial region
133
Majority of childhood brain tumors occur in what region?
Infratentorial region
134
Most common brain tumors in adults
Meningioma
Scwhannoma
Glioblastoma
135
Most common brain tumors in kids
Pilocytic astrocytoma
Ependymoma
Medulloblastoma
136
Most common glioma
Astrocytoma
137
Hair-like tumor cells, biphasic architecture, rosenthal fibers (eosinophilic corkscrew globules)
Pilocytic astrocytoma
138
Butterfly lesion
Glioblastoma
139
Common location of ependymoma
4th ventricle (rosettes)
140
Common location of medulloblastoma
Cerebellum
141
Homer-Wright rosettes (small blue cells)
Medulloblastoma
142
Psammoma bodies, whorls, syncytial appearance, dural tail (gross)
Meningioma
143
Brain tumor that may cause loss of hearing and tinnitus
Schwannoma
144
Flexner-Wintersteiner rosettes (cells arranged around an empty lumen)
Retinoblastoma
145
Bone lesions, Cafe-au-lait spots, neurofibromas, bag of worms
NF 1
146
Bilateral vestibular schwannomas, multiple meningiomas, gliomas
NF 2
147
Hamartomatous lesions involving multiple organs; adenoma sebaceum, seizures, mental retardation
Tuberous sclerosis
148
Hemangioblastoma, pheochromocytomc, RCC
VHL
149
Mammillary body lesions
Wernicke Korsakoff
150
Features of temporal lobe syndrome
Amnesia, cortical deafness, Kluver-Bucy, Wernicke's
151
Features of parietal lobe syndrome
Sensory cortex issues (right-left confusion, difficulty with writing (agraphia) and difficulty with mathematics (acalculia). It can also produce disorders of language (aphasia) and the inability to perceive objects normally (agnosia).)
152
Seizure with a focal onset in the brain
Partial
Simple - no altered consciousness
Complex - impaired conscious
Can combine with generalized tonic clonic (focal onset evolves)
153
Most common partial seizure + symptoms
Temporal lobe
| Epigastric aura, staring, unresponsive
154
Type of partial seizure that occurs at night, head and eyes turn to the side opposite the seizure
Frontal lobe
155
Type of generalized seizure, 4-10 y/o, brief but frequent, starting spells, EEG with 3 Hz spiek and wave pattern, treat with ethosuximide
Absence
156
Type of generalized seizure, shock-like contraction of muscle groups
Myoclonic
157
Type of generalized seizure, sudden loss of tone
Atonic
158
Type of generalized seizure - out of the blue, flexion of trunk, opening of mouth and eyelids, upward deviation of eyes, ictal cry, post-ictal confusion
Tonic (contraction producing extension and arching) Clonic (alternating muscle contractoin-relaxation)
