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Review / Wrong Answers > DIT review - Neurology 4 > Flashcards

DIT review - Neurology 4 Flashcards

1
Q

What is status epilepticus

A

Continous or recurring seizure that may result in brain injury; defined as > 5 min

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2
Q

Meissner corpuscle (type, location, effect)

A

♣ Rapidly adapting, superficial

♣ Dynamic, fine/light touch

♣ On hairless skin

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3
Q

Pacinian corpuscle (type, location, effect)

A

♣ Rapidly adapting, deep

♣ Vibration, pressure

♣ Deep skin layers, ligaments, joints

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4
Q

Merkel disc ((type, location, effect)

A

♣ Slowly adapting, superficial

♣ Deep static touch

♣ Fingertips, superficial skin

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5
Q

Ruffini corpuscle (type, location, effect)

A

♣ Slowly adapting, deep

♣ Pressure, slippage of objects along surface of skin

♣ Fingertips, joints, soles of feet

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6
Q

Flow of input through the cerebellum

A

Inputs (mossy fiber and climbing fibers) - cerebellar cortex - axons of purkinje fibers (always inhibitory signal) - deep nuclei of cerebellum - output targets (usually superior cerebellar peduncle - contralateral ventral lateral nucleus of the lateral thalamaus)

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7
Q

What are the deep nuclei of the cerebellum

A
  • Lateral to medial - Don’t Eat Greasy Foods
    • Dentate
    • Emboliform
      • Emboliform + Globose = Interposed
    • Globose
    • Fastigial
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8
Q

Functional units of the cerebellum and their corresponding deep nuclei

A
  • Vestibulocerebellum
    • Vermis + flocculonodular (most medial)
    • Fastigial deep nucleus
  • Spinocerebellum
    • Vermis + paravermis
    • Interposed deep nucleus
  • Cerebrocerebellum
    • Lateral hemisphere
    • Dentate deep nucleus
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9
Q

What are the most common causes of essential, intention, and resting tremor?

A

Essential (with rest and movement) - genetic

Intention - cerebellar dysfunction

Resting - Parkinson’s

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10
Q

Describe the different between Ia and Ib afferent muscle fibers

A

Ia - afferent fiber from intrafusal fiber

Synapse directly on and activate alpha motor neurons in order to stimulate the extrafusal muscle corresponding to the intrafusal fiber (e.g. opposes the stretch sensed by intrafusal fiber)

Ib - afferent fiber from golgi tendon organ

Synapses on inhibitory interneuron in spinal cord - interneuron synapses on alpha motor neuron and inhibit them - leading to relaxation of extrafusal fiber

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11
Q

What is the presentation and cause of hemiballismus

A
  • Sudden, wild flailing of half of body (1 arm +/- ipsilateral leg)
  • Seen in lesion of contralateral subthalamic nucleus
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12
Q

Define athetosis and it’s cause

A

Slow, writhing movements, especially seen in the fingers

Due to lesion of basal ganglia (Huntington’s)

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13
Q

Define chorea and its cause

A

Sudden, jerky, purposeless movements

Seen in lesion of basal ganglia (e.g. Huntington’s)

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14
Q

Define dystonia

A

Sustained, involuntary muscle contractions

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15
Q

Define akathisia and its cause

A
  • Dancing in place (voluntary) / Restlessness
  • Compulsion to move
  • Seen with neuroleptic use or in Parkinson’s
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16
Q

What disease presents with Lewy bodies and what make up Lewy bodies?

A

Intracellular eosinophillic inclusions of alpha-synuclein within neurons

Seen in Parkinsons and Lewy body dementia

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17
Q

What disease is MTPP exposure associated with?

A

Parkinsons

  • MTPP converted to MPP via COMT
  • MPP destroy dopaminergic neurons
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18
Q

Describe characteristic features of Parkinsons

A
  • Due to loss of dopaminergic neurons
  • Depigmentation of substantia nigra
  • Lewy bodies (eosinophilic inclusions of alpha-synuclein) within neurons
  • TRAPS
    • Tremor (resting)
    • Rigidity (cogwheel)
    • Akinesia (or bradykinesia)
    • Postural instability
    • Staggering gait
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19
Q

Describe characteristic features of Huntington’s

A

THINK: C’s

CAG trinucleotide repeat

On chromosome 4

Occurs in 40s

Chorea

Cognitive decline (dementia)

Caudate atrophy (and putamen)

Increased DA, decreased GABA, decreased ACh

20
Q

Identify the location of the following in the spinal cord:

Dorsal column

Spinothalamic tract

Corticospinal tract (lateral and anterior)

A
21
Q

Describe the pathway of the dorsal column/medial lemniscus

A
  • First order neurons (dorsal column) have cell bodies in dorsal root ganglion or cranial nerve ganglion and ascend ipsilaterally to the nucleus gracilis (lower body) or nucleus cuneatus (upper body) in the medulla
  • In the medulla they synapse on second order neurons which then cross the midline
  • Second order neurons (now called the medial lemniscus) ascend to the contralateral thalamus (VPL) where they synapse on 3rd order which ascend to the somatosensory cortex and synapse on 4th order
22
Q

Describe pathways of spinothalamic tract

A
  • Processes pain, temperature, and light touch (crude touch?)
  • First order neurons have cell bodies in dorsal horn (of gray matter) and synapse on thermoreceptors and nociceptors in the skin
  • First order nerves synapse on second order in the dorsal horn of the spinal cord, where the second order cross the midline at the anterior white commissure and ascend to the contralateral thalamus (VPL) when second order synapse on third order which ascend to somatosensory cortex and synapse on fourth order
23
Q

Describe pathway of corticospinal tract

A
  • UMN from motor cortex descend to pyramid in the medulla
  • Axons cross to contralateral side in the caudal medulla and descend via lateral cortico-spinal tract
  • Enter the spinal cord at lateral white column and travel to the anterior grey horn
  • Synapse to LMN (alpha motor neuron) which then exits via ventral spinal root to innervate muscle
24
Q

What part of the spinal cord is damaged in poliomyelitis

A

Anterior motor horn - LMN lesion with asymmetric weakness

25
Q

What part of the spinal cord is damaged in Werdnig-Hoffman disease

A

Anterior motor horn - LMN deficit with SYMMETRIC weakness

26
Q

What part of the spinal cord/presentation of occlusion of anterior spinal artery

A

Damage to everything except dorsal column

  • Spinothalamic damage = loss of bilateral pain and temperature below the lesion
  • Corticospinal damage = UMN below the lesion
  • Anterior horn damage = LMN deficit at the level of the lesion
27
Q

What part of the spinal cord/presentation of ALS

A
  • Damage to anterior motor horn and lateral corticospinal tract
  • Presents with both UMN and LMN deficits
  • Lack of sensory impairment distinguishes from syringomyelia
28
Q

What is the defect that causes ALS

A
  • Caused by defect in superoxide dismutase (O2- à H2O2)
29
Q

What part of the spinal cord is damaged/presentation of Tabes dorsalis

A
  • Due to tertiary syphilis
  • Damage to dorsal column
  • Impaired propriocepton
  • Absence of DTRs and (+) Romberg
  • Argyll Robertson pupils (accommodation but no reaction to light)
30
Q

Describe cause/presentation of Friedrich ataxia

A
  • Autosomal recessive trinucleotide repeat disorder - GAA
  • Frataxin gene of chromosome 9
  • Leads to impairment in mitochondrial function
  • Degeneration of cerebellum and spinal cord
    • Ataxia, muscle weakness, loss of vibratory sense and proprioception, diabetes mellitus, hypertrophic cardiomyopathy
    • Presents in childood with kyphoscoliosis
  • THINK: Friedreich is fratastic (frataxin): he’s your favorite frat brother, always staggering and falling but has a sweet, big heart
31
Q

Findings in Brown-Sequard syndrome

A
  • Ipsilateral UMN signs below level of lesion (corticospinal tract damage)
  • Ipsilateral loss of tactile, vibration, proprioception sense below level of lesion (dorsal column)
  • Contralateral pain and temp loss 2-3 segments below level of lesion (spinothalamic tract)
    • 2-3 segments below because remember info travelled up 2-3 segments via Lissaur’s tract
  • Ipsilateral pain and temp loss at level of lesion
  • Ipsilateral LMN signs at level of lesion
32
Q

What is the Charcot triad and what disease is it for?

A

Multiple sclerosis

  • Charcot triad of symptoms - SIN:
    • Scanning speech
    • Intention tremor, Incontinence, Internuclear ophthalmoplegia
    • Nystagmus
33
Q

Describe MRI and lumbar puncture of MS

A
  • MRI (gold standard)
    • Periventricular plaques
  • Lumbar puncture
    • Increased protein
    • Oligoclonal IgG bands
34
Q

Treatment of MS

A
  • Steroids for acute flares
  • Interferon beta slows progression
35
Q

Draw and label the branches of the brachial plexus

A
36
Q

Describe the muscles that each branch of the brachial plexus innervate

A

Also see notebook

37
Q

Lesion to what nerve gives you Saturday night palsy, and what does it present with?

A

Wrist drop

Radial nerve

38
Q

Lesion of what nerve gives you winged scapula? Due to deficit of what muscle?

A

Long thoracic (deficit of serratus anterior)

39
Q

What is the nerve damaged/presentation sometimes during delivery

A

“Waiter’s tip” aka Erb palsy

Damage to superior trunk of brachial plexus

Axillary nerve damage - deltoid - arm hangs by side

Suprascapular nerve damage - infraspinatus - arm medially rotated

Musculocutaneous damage - biceps (supination) - arm extended and pronated

40
Q

What nerve is affected in carpal tunnel?

A

Median nerve

41
Q

Pathway of aqueous humor

A
  • Aqueous humor produced by ciliary bodies posterior chamber angle of lens - anterior chamber - reabsorbed via canal of Schlemm
42
Q

What drugs decrease aqueous humor production?

A

Alpha agonists (epinephrine, brimonidine)

Beta blockers (timolol)

Diuretics (acetazolamide)

43
Q

What drugs increase aqueous flow?

A
  • Cholinomimetics
    • Direct - Pilocarpine, Carbachol
    • Indirect - Physostigmine, Echothiophate
  • Prostglandins
    • Bimatoprost, Latanoprost
44
Q
A
45
Q
A

Review / Wrong Answers (140 decks)

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