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MHD2 > Cumulative Exam - Semester 2 - Block 8 > Flashcards

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)

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2
Q

Process in which microglia surround a dying neuron

A

Neuronophagia

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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

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4
Q

Process of non-specific reaction to CNS injury involving glial cell hypertrophy and reactive astrocytes; CNS version of a scar

A

Gliosis

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5
Q

CNS cell type that often lines up in rows between fibers

A

Oligodendrocytes

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6
Q

Phagocytic, antigen presenting cells in the nervous system

A

Microglia

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7
Q

Specialized glial cell that lines ventricles, single layer of ciliated cells with no basement membrane

A

Ependyma

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8
Q

Specialized organ made of papillary folds of CSF-secreting ependymal cells that protrude into ventricles

A

Choroid plexus

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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)
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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
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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

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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

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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

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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

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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

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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

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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)

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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)

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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)

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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

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21
Q

Pathway carrying vibration and position sense

A

Dorsal column pathway

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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)

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23
Q

Pathway carrying pain and temperature

A

Spinothalamic tract

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24
Q

STT

A

SYNAPSE and DECUSSATE - dorsal root ganglion cells (anterior white commissure of SC)
SYNAPSE - VPL (thalamus)
SYNAPSE - 312

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25
Q

True or false - all cerebellar pathways are ultimately ipsilateral

A

True

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26
Q

CST

A

Motor cortex

Pyramidal decussation in medulla (except anterior tract, which does not cross)

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27
Q

Nuclei of the DC pathway

A

Cuneate (C1-T5)

Gracile (T6-S5)

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28
Q

Nuclei of the STT

A

Nucleus proprius

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29
Q

Nuclei of the DCT

A

Dorsal - Clark’s nucleus (C8-L2, L3 and below use gracilis to get to Clark’s)
Cuneocerebellar - C1-C7, accessory cuneate nucleus

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30
Q

Autoimmune disease against ACh receptors

A

Myasthenia Gravis

Presentation - ptosis, diplopia, dysarthria, dysphagia (can have a restricted ocular form)

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31
Q

Autoimmune disease against pre-synaptic calcium channels

A

Lambert-Eaton

Presentation - proximal weakness, muscle stretch reflex appears decreased but returns after isometric exercise, autonomic symptoms

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32
Q

Infectious toxin that prevents ACh release by impairing SNARE proteins

A

Botulinum

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33
Q

Symptoms of polyneuropathy

A

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

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34
Q

Presents as an ascending, areflexic paralysis (rapidly progressive polyneuropathy) after a virus

A

Guillain-Barre

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35
Q

Most common pathology for polyneuropathies

A

Axonal degeneration

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36
Q

Presentation of myopathy

A 
Proximal weakness and fatigue
Normal sensation
Significant atrophy
Late loss of reflexes
Pain is not prominent
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37
Q

Test the superior and inferior rectus muscles.

A

Start abducted and look up (SR) and down (IR)

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38
Q

Test the superior and inferior oblique muscles.

A

Start adducted and look down (SO) and up (IO)

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39
Q

Test the lateral and medial rectus muscles.

A

Look out (LR) and in (MR)

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40
Q

CN III lesion presentation

A

Ptosis, preserved abduction, dilated pupil, unreactive to light (direct and consensual)

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41
Q

CN IV lesion presentation

A

Impairs depression contralaterally

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42
Q

CN VI lesion presentation

A

Impairs abduction

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43
Q

Cause of intranuclear ophthalmoplegia

A

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

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44
Q

Pupillary light reflex pathway

A

Light -> optic nerve -> pretectal area -> DECUSSATES -> both EWN -> CN3 -> ciliary sphincter -> constricts both sides

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45
Q

3 components of the near reflex

A

Pupillary constriction
Lens accommodation
Eye convergence

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46
Q

Symptoms of Horner’s syndrome

A

Miosis, anhydrosis, ptosis

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47
Q

Causes of Horner’s syndrome

A
  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
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48
Q

2 major causes of trigeminal neuralgia

A

MS (younger)

Compression of tortuous vessels such as the superior cerebellar artery (older)

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49
Q

Cause of facial paralysis - lower half of contralateral face paralyzed

A

UMN

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50
Q

Cause of facial paralysis - entire ipsilateral face paralyzed

A

LMN

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51
Q

Effect of UMN lesion on tongue

A

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

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52
Q

Effect of LMN lesion on tongue

A

Deviates to the affected side (lick your wounds)

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53
Q

CN involvement on one side and clinical sensory/motor deficit on the other side

A

Crossed brain stem syndrome

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54
Q

Presentation of Weber syndrome

A

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

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55
Q

Presentation of Wallenberg syndrome

A

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

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56
Q

Treat migraines

A

First line - NSAIDS

Second line - triptans

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57
Q

Headache more common in F

A

Migraines

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58
Q

Headache more common in M

A

Cluster headaches

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59
Q

Headache associated with severe eye pain, rapid onset, occur 1-4x/day for 6-12 weeks every year or two

A

Cluster headaches

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60
Q

Bilateral headache, no N/V, band-like, most common

A

Tension

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61
Q

Headache seen in young females with increased BMI, associated with increased ICP with no localizing features

A

Pseudotumor cerebri

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62
Q

These cells myelinate peripheral axons

A

Schwann

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63
Q

These cells myelinate CNS axons

A

Oligodendrocytes

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64
Q

Common causes of bacterial meningitis in neonates (<1 month)

A

E. coli
GBS
L. monocytogenes

65
Q

Common causes of bacterial meningitis in children (1 month-16 y/o)

A

H. influenza
N. meningitidis
S. pneumonia

66
Q

Common causes of bacterial meningitis in adults (>15 y/o)

A

N. meningitidis

S. pneumonia

67
Q

Common causes of bacterial meningitis in the immunocompromsied

A

GBS

L. monocytogenes

68
Q

Most common fungal meningitis

A

Cryptococcus (budding yeast, mucoid capsule, India ink, Swiss cheese basal ganglia)

69
Q

Most common brain parasite

A

Cysticercosis (SW US), pork, presents with seizures

70
Q

Most common cause of viral meningitis

A

Enteroviruses

71
Q

CSF findings of bacterial meningitis vs. viral vs. TB

A

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
Q

Cause and presentation of Wernicke-Korsakoff syndrome

A

B1 deficiency

Acute - Wernicke’s encephalopathy (nystagmus, ophthalmoplegia, gait ataxia, confusion)
Chronic - Korsakoff psychosis (amnesia with confabulation)

73
Q

When should a brain CT scan be performed prior to urgent LP in a patient suspected of meningitis?

A

High suspicion of increased ICP (LP could cause brain herniation)

74
Q

Abrupt onset of focal or global neurological symptoms caused by ischemia or hemorrhage

A

Stroke

75
Q

Describe the gross and histologic features of cerebral ischemia - acute (6-48 hours).

A

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
Q

Describe the gross and histologic features of cerebral ischemia - subacute (4 days-3 weeks)

A

Gross: gelatinous, friable, distinct border, tissue liquefaction

Histology: neutrophils early, sheets of foamy macrophages (4-7 days), vascular proliferation 92-3 weeks)

77
Q

Describe the gross and histologic features of cerebral ischemia - chronic (>3 weeks)

A

Gross: cystic +/- hemosiderin staining, secondary degeneration

Histology: astrocytic gliosis, residual macrophages

78
Q

Most common site of embolic infarction to the brain

A

MCA

79
Q

Presentation of an MCA stroke

A 
Motor/sensory cortex hemisensory loss (knocking out frontal and temporal lobes)
Contralateral hemiparesis (lower face, upper extremities)
Visual field defects
80
Q

What happens in tonsillar herniation?

A

Cerebellar tonsils drop into the foramen magnum, compress the brainstem, cause cardiopulmonary arrest

81
Q

What happens in subfalcine herniation?

A

Cingulate gyrus movies under the falx cerebri, compresses ACA, infarction infecting lower limbs

82
Q

What happens in uncal herniation?

A

Uncus (medial temporal lobe) -> tentorium cerebelli -> compresses CN III -> eyes down and out + dilated pupil

83
Q

Sudden focal neurologic deficit with completely resolves in 24 hours; risk factor for stroke

A

Transient ischemic attack

84
Q

Infarctions of the lenticulostriate arteries, which supply the basal ganglia, thalamus, internal capsule, and corona radiate

A

Lacunar infarction

85
Q

Type of carotid TIA to the ophthalmic artery that presents as a lowered dark shade over the eye

A

Amaurosis fugax

86
Q

When can tPA be administered in the setting of ischemic infarction?

A

Within 3 hours of the event (or risk intracranial hemorrhage)

87
Q

Prevent future strokes in patients with atrial fibrillation with what medication?

A

Warfarin (most other stroke-prone patients are treated with antiplatelet medications)

88
Q

Worst headache of your life suggests what?

A

Cerebral hemorrhage

89
Q

Cerebral hemorrhage in the striatum or thalamus are most likely from ___

A

HTN

90
Q

Causes low tone hearing loss

A

Conductive hearing loss (impaired air conduction)

91
Q

Causes high tone hearing loss

A

Nerve damage

92
Q

Explain the Weber test

A

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
Q

Explain the Rinne test

A

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
Q

Cause of L eye blindness

A

L optic nerve (or ocular/retinal cause)

95
Q

Cause of bitemporal heteronymous hemianopsia

A

Inner optic chiasm lesion

96
Q

Cause of binasal heteronymous hemianopsia

A

Outer optic chiasm lesion

97
Q

Cause of R homonymous hemianopsia

A

L optic tract lesion

98
Q

Cause of R superior homonymous quadrantanopsia

A

L INFERIOR optic radiation lesion (temporal lobe, Meyer’s loop)

99
Q

Cause of R inferior homonymous quadrantanopsia

A

L SUPERIOR optic radiation lesion (parietal lobe)

100
Q

Cause of R homonymous hemianopsia with macular sparing

A

L occipital lobe lesion

101
Q

The basal ganglia has a ___ effect on the motor cortex via the medial globus pallidus.

A

Inhibitory

102
Q

What happens to globus pallidus activity in Parkinson’s disease vs. Huntington’s disease?

A

Parkinson’s - GPm further increased

Huntington’s - GPm further decreasd

103
Q

4 primary clinical signs of Parkinson’s

A

Resting tremor (pill-rolling)
Rigidity (cog-wheeling)
Bradykinesia
Impaired postural reflexes

104
Q

Histologic finding of Parkinson’s

A 
Loss of neurons in the substantia nigra
Lewy bodies (alpha synuclein)
105
Q

Lesion - broad-based ataxic gait

A

DC, sensory nerves, cerebellum

106
Q

Lesion - hemiplegia (swinging gait + ipsilateral flexion of upper limb)

A

Stroke (1 side)

107
Q

Lesion - tabetic gait (foot slapping to feel the floor)

A

DC

108
Q

Lesion - steppage gait (foot drop)

A

Unilateral - perineal nerve or L5

Bilateral - severe neuropathy, motor neuron disease, L5 root lesion

109
Q

Lesion - waddling (swagger)

A

Myopathy

110
Q

Lesion - scissors gait

A

UMN (not compensatory)

111
Q

Clinical features of __- dysfunction: gait ataxia, dysmetria, kinetic tremor, dysdiadochokinesia, rebound phenomenon, dysarthria, nystagmus

A

Cerebellar

112
Q

Over/undershooting of a target by the hand or foot

A

Dysmetria (test with heel to shin or finger to nose)

113
Q

Uncoordinated nonrhythmic sloppy hand movements

A

Dysdiadochokinesia (uncoordinated non-rhythmic sloppy hand movements)

114
Q

Location of lesion - ipsilateral limb impairment + other cerebellar symptoms

A

Hemisphere

115
Q

Location of lesion - trunk unsteadiness, impaired balance, gait ataxia

A

Vermis

116
Q

Purposeless random non-rhythmic movements

A

Chorea

117
Q

Slow writhing continuous movements of limbs

A

Athetosis

118
Q

Rapid violent flinging movements of proximal limbs on one side (+ lesion site)

A

Hemiballismus (contralateral STN)

119
Q

Continual sustained painful muscle contractions

A

Dystonia

120
Q

Rapid shocklike jerks of the limbs and trunk

A

Myoclonus

121
Q

Disorder of previously acquired language ability due to a lesion in a critical language center

A

Aphasia

122
Q

Impaired fluency, preserved comprehension + lesion site

A

Broca’s aphasia

Inferior frontal lobe in dominant hemisphere

123
Q

Preserved fluency, impaired comprehension + lesion site

A

Wernicke’s aphasia

Posterior superior temporal lobe in dominant hemisphere

124
Q

Intact fluency (mostly), mild comprehension impairment, paraphasia (abnormal word substitutions) + lesion site

A

Conduction aphasia

Arcuate fasciculus (connects B and W)

125
Q

No communication, comprehension, severe hemiplegia, cannot read

A

Global aphasia

Perisylvian area

126
Q

Semantic and emotional meaning conveyed by change in pitch, inflection, melody, and tone

A

Prosody

Impaired prosody is due to non-dominant cortical lesions

127
Q

Presentation of MS

A
  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
Q

Narrowing of gyri, widening of sulci, dilated centricles

A

Gross features of AD

129
Q

Misfolded amyloid beta plaques, neurofibrillary tangles (tau)

A

Histologic feature of AD

130
Q

Lewy bodies on histology + dementia and parkinsonism

A

Lewy body disease

131
Q

Pick bodies (globose neuronal cytoplasmic inclusions made of tau)

A

Pick’s disease

132
Q

Majority of adult brain tumors occur in what region?

A

Supratentorial region

133
Q

Majority of childhood brain tumors occur in what region?

A

Infratentorial region

134
Q

Most common brain tumors in adults

A

Meningioma
Scwhannoma
Glioblastoma

135
Q

Most common brain tumors in kids

A

Pilocytic astrocytoma
Ependymoma
Medulloblastoma

136
Q

Most common glioma

A

Astrocytoma

137
Q

Hair-like tumor cells, biphasic architecture, rosenthal fibers (eosinophilic corkscrew globules)

A

Pilocytic astrocytoma

138
Q

Butterfly lesion

A

Glioblastoma

139
Q

Common location of ependymoma

A

4th ventricle (rosettes)

140
Q

Common location of medulloblastoma

A

Cerebellum

141
Q

Homer-Wright rosettes (small blue cells)

A

Medulloblastoma

142
Q

Psammoma bodies, whorls, syncytial appearance, dural tail (gross)

A

Meningioma

143
Q

Brain tumor that may cause loss of hearing and tinnitus

A

Schwannoma

144
Q

Flexner-Wintersteiner rosettes (cells arranged around an empty lumen)

A

Retinoblastoma

145
Q

Bone lesions, Cafe-au-lait spots, neurofibromas, bag of worms

A

NF 1

146
Q

Bilateral vestibular schwannomas, multiple meningiomas, gliomas

A

NF 2

147
Q

Hamartomatous lesions involving multiple organs; adenoma sebaceum, seizures, mental retardation

A

Tuberous sclerosis

148
Q

Hemangioblastoma, pheochromocytomc, RCC

A

VHL

149
Q

Mammillary body lesions

A

Wernicke Korsakoff

150
Q

Features of temporal lobe syndrome

A

Amnesia, cortical deafness, Kluver-Bucy, Wernicke’s

151
Q

Features of parietal lobe syndrome

A

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
Q

Seizure with a focal onset in the brain

A

Partial

Simple - no altered consciousness
Complex - impaired conscious
Can combine with generalized tonic clonic (focal onset evolves)

153
Q

Most common partial seizure + symptoms

A

Temporal lobe

Epigastric aura, staring, unresponsive

154
Q

Type of partial seizure that occurs at night, head and eyes turn to the side opposite the seizure

A

Frontal lobe

155
Q

Type of generalized seizure, 4-10 y/o, brief but frequent, starting spells, EEG with 3 Hz spiek and wave pattern, treat with ethosuximide

A

Absence

156
Q

Type of generalized seizure, shock-like contraction of muscle groups

A

Myoclonic

157
Q

Type of generalized seizure, sudden loss of tone

A

Atonic

158
Q

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

A

Tonic (contraction producing extension and arching) Clonic (alternating muscle contractoin-relaxation)

MHD2 (34 decks)

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