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Systems Path > Exam II > Flashcards

Exam II Flashcards

1
Q

What are the three parts of a motor unit?

A

Peripheral axon, neuromuscular junction and innervated myocytes

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2
Q

What is the name of the cells that produce myelin in the PNS?

A

Schwann cells

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3
Q

A peripheral nerve injury that is characterized by direct injury to an axon and degeneration of peripheral segments and results in decreased amplitude and axon density.

A

Axonal neuropathy

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4
Q

Axonal neuropathy in which myelin loss is a secondary result is called:

A

Wallerian degeneration

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5
Q

A peripheral nerve injury that is characterized by damage to Schwann cells resulting in random internode demyelination and slow nerve conduction velocity.

A

Demyelinating neuropathy

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6
Q

Demyelinating neuropathy is also called:

A

Segmental demyelination

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7
Q

Carpal tunnel syndrome involves entrapment of a single nerve. This pattern of peripheral neuropathy is termed:

A

Mononeuropathy

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8
Q

“Stocking-and-glove” parasthesia and anasthetia involve diffuse and asymmetric neuronal loss. This pattern of peripheral neuropathy is termed:

A

Polyneuropathy

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9
Q

Damage that randomly affects portions of individual nerves follows which pattern of peripheral neuropathy?

A

Polyneuritis multiplex

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10
Q

The disorder that is characterized by acute motor neuron demyelination that results in ascending paralysis is termed:

A

Guillan-Barre syndrome

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11
Q

GBS is most common in:

A

Males aged 15-35 and 50-57 years

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12
Q

Which disorder is characterized by symmetric, segmental demyelination/remyelination and can relapse and progress to chronic GBS?

A

Chronic Inflammatory Demyelinating Polyneuropathy (CIDP)

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13
Q

What is the most common peripheral neuropathy?

A

Diabetic neuropathy

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14
Q

Which peripheral neuropathy is considered mixed due to its damage of both axons and myelin?

A

Diabetic neuropathy

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15
Q

What is the most highly recommended treatment option in diabetic neuropathy?

A

Daily foot inspection

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16
Q

Which cause of peripheral neuropathy results in altered axonal transport and cytoskeletal damage and is observed in the distal extremities?

A

Environmental toxins

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17
Q

Which cause of peripheral neuropathy results in damage to peripheral nerves and involves the polyneuritis multiplex?

A

Systemic vasculitis

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18
Q

Genetic disorders that result in peripheral neuropathy are attributed to mutations in which gene?

A

PMP22

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19
Q

The genetic disorder that leads to peripheral neuropathy most commonly in young adults and is slowly progressive is termed:

A

Charcot-Marie-Tooth disease

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20
Q

In myasthenia gravis, autoantibodies block:

A

Post-synaptic Ach receptors

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21
Q

MG is characterized by:

A

Thymic hyperplasia and extraocular weakness and becomes worse with e-stimulation

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22
Q

MG is most common in:

A

Females in the 3rd decade of life and males in the 5th-6th decade of life

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23
Q

Which test inhibits acetylcholinesterase (AchE)?

A

Tensilon test

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24
Q

In Lambert-Eaton syndrome, autoantibodies inhibit:

A

Pre-synaptic calcium channels

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25
Q

Which form of NMJ disorder mimics MG and Lambert-Eaton syndrome?

A

Congenital myasthenic syndrome

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26
Q

Which two bacteria cause infectious NMJ disorders?

A

C. tetani and C. botulinum

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27
Q

C. _____ increases Ach release, while C. _____ decreases Ach release.

A

tetani; botulinum

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28
Q

Which muscle fiber is characterized as slow twitch, aerobic, dark and uses fat metabolism?

A

Type I

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29
Q

Which muscle fiber is characterized as fast twitch, anaerobic, white and uses glycogen metabolism?

A

Type II

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30
Q

Disuse atrophy and glucocorticoid atrophy primarily involve which fibers?

A

Type II

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31
Q

The group of most common forms of muscular dystrophy are termed:

A

Dystrophinopathies

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32
Q

Duchenne muscular dystrophy is characterized by:

A

Absence of dystrophin

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33
Q

What is the most common dystrophinopathy?

A

DMD

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34
Q

Becker MD is characterized by:

A

Dystrophin is present but has variable function

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35
Q

DMD is most common in which population?

A

Childhood onset (Age 5), wheelchair-bound in their teens and lethal in early adulthood

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36
Q

BMD is most common in which population?

A

Delayed onset (adolescence), less severe than DMD

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37
Q

What are the features of DMD and BMD?

A

Pelvic girdle muscles primarily impacted and pseudohypertrophy of calf muscles

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38
Q

Lab values for patients with DMD/BMD include finding increased:

A

Creatine kinase

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39
Q

How do patients die from DMD/BMD?

A

Respiratory insufficiency

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40
Q

The type of inflammatory myopathy that is autoimmune and is most common in males aged 45-60 years.

A

Polymyositis

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41
Q

The most common inflammatory myopathy in children is termed:

A

Dermatomyositis

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42
Q

The most common myopathy among elderly patients is termed:

A

Inclusion body myositis

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43
Q

Overproduction of thyroxine, goiter or Graves disease are characteristics of:

A

Thyrotoxic myopathy

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44
Q

Binge drinking, rhabdomyolysis and a progression into renal failure are characteristics of:

A

Ethanol myopathy

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45
Q

Drug myopathy is characterized by adverse effects by various agents, the most common being:

A

Statins

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46
Q

The peripheral nerve sheath tumor that most commonly involves CN8 is called:

A

Schwannoma (Vestibular schwannoma)

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47
Q

Multiple CNS and cutaneous schwannomas absent vestibular schwannomas is termed:

A

Schwannomatosis

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48
Q

Neurofibromatosis that exhibits pronounced neurofibromas and mutations on chromosome 17 is characteristic of:

A

Neurofibromatosis type I

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49
Q

NF1 is also called:

A

von Recklinghausen disease

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50
Q

Bilateral vestibular schwannomas and the merlin gene that most commonly result in vision and hearing problems are all characteristics of:

A

NF2

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51
Q

Swelling of the soma and displacement of the Nissl substance are characteristic of:

A

Reversible neuronal injury

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52
Q

The presence of “red neurons,” eosinophilia and axonal swelling are all characteristic of:

A

Irreversible neuronal injury

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53
Q

Minimal fibrosis occurs following CNS injury to:

A

Astrocytes

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54
Q

The presence of glial filaments sprouting is termed:

A

Gemistocytic astrocyte

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55
Q

Which cells produce myelin in the CNS?

A

Oligodendrocytes

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56
Q

Which cells are considered CNS phagocytes?

A

Microglia

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57
Q

What is the function of the choroid plexus?

A

Produces CSF

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58
Q

The rabies virus produces _____ in the cytoplasm.

A

Negri bodies

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59
Q

The presence of an “owl’s eye” is indicative of:

A

Cytomegalovirus

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60
Q

The presence of Lewy bodies is indicative of:

A

Parkinson’s disease

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61
Q

Neurofibrillary tangles and beta-amyloid plaques are indicative of:

A

Alzheimer’s

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62
Q

Accumulation of lipids in the cytoplasm or lysosomes is indicative of:

A

Lipofuscin

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63
Q

Blood-brain-barrier disruption resulting in increased permeability is termed:

A

Vasogenic cerebral edema

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64
Q

Neuronal/glial membrane injury resulting in increased intracellular fluid retention is termed:

A

Cytotoxic cerebral edema

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65
Q

What are the three distinct features of cerebral edema?

A

Flattened gyri, narrowed sulci, and ventricular compression

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66
Q

Increased CSF volume most commonly involves:

A

Altered flow or resorption

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67
Q

Hydrocephalus that occurs at

A

Cranial enlargement

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68
Q

Hydrocephalus that occurs at >2 years old results in:

A

Increased ICP and ventricular enlargement

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69
Q

What is the most common treatment for hydrocephalus?

A

Shunting

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70
Q

Hydrocephalus that occurs as a result of an infarct or neurodegeneration is termed:

A

Hydrocephalus ex vacuo

71
Q

What is the most common form of brain herniation?

A

Subfalcine (cingulate)

72
Q

Which brain hernia involves CNIII and Duret hemorrhage?

A

Transtentorial (uncinate)

73
Q

Duret hemorrhage involves vessels that enter the _____ that are then disrupted by herniation.

A

Pons

74
Q

Injury to the cortex and the red nuclei that results in extension of the legs along with internal rotation is most likely:

A

Decorticate rigidity

75
Q

Injury to the brainstem between red nuclei and vestibular nuclei that results in extension of all 4 limbs and pronation of the arms/plantar flexion is most likely:

A

Decerebrate rigidity

76
Q

What is the most common cause of neurologic morbidity?

A

Cerebrovascular disease

77
Q

Which features are all considered a “stroke?”

A

Thrombotic occlusion, embolic occlusion and vascular rupture

78
Q

Decreased O2 partial pressure and decreased O2 carrying capacity are characteristics of:

A

Functional hypoxia

79
Q

Ischemia and hypoxia are indicative of what type of necrosis?

A

Liquefactive

80
Q

A patient that exhibits severe hypotension is likely experiencing:

A

Widespread ischemic/hypoxic injury

81
Q

What is the most common focal cerebral ischemia?

A

Emboli

82
Q

Primary brain parenchymal hemorrhage is most common in:

A

Older adults (60 or older)

83
Q

What are the most common locations for primary brain parenchymal hemorrhage?

A

Thalamus, pons and cerebellum

84
Q

A patient presents with the “worst headache I’ve ever had.” You would suspect:

A

Subarachnoid hemorrhage

85
Q

Subarachnoid hemorrhaging most commonly involves the rupture of:

A

Saccular (berry) aneurysm

86
Q

In arteriovenous malformations, a tangle of arteries and veins are connected via:

A

1 or more fistula

87
Q

Arteriovenous malformations are most common in:

A

Males ages 10-30 years

88
Q

Hypertension has what effect on vessel walls?

A

Weakens vessel walls

89
Q

A single artery occlusion is termed a:

A

Lacunar stroke

90
Q

Ruptured small cerebral vessels where a “slit-like cavity” remains is termed:

A

Slit hemorrhage

91
Q

A patient presents with global cerebral dysfunction, with a diastolic BP of >130 and increased ICP. You suspect:

A

Acute hypertensive encephalopathy

92
Q

Systemic, autoimmune vasculitis with fibrinoid necrosis of small arteries is termed:

A

Polyarteritis nodosa

93
Q

Primary angiitis of the CNS is characterized by chronic inflammation of:

A

Multiple parenchymal and subarachoid vessels

94
Q

CNS trauma is most common in:

A

Males

95
Q

Silent CNS trauma is most likely associated with:

A

The frontal lobe

96
Q

CNS trauma of the spinal cord is:

A

Disabling

97
Q

If a patient has had fatal CNS trauma, which area was most likely damaged?

A

Brainstem

98
Q

What tissues are damaged in CNS trauma?

A

Parenchyma and vasculature

99
Q

How would you assess CNS trauma?

A

Airway, breathing, circulation and disability (ABCD)

100
Q

A contusion at the impact site is called a _____, while a contusion on the opposite side of impact is called a _____.

A

Coup; contrecoup

101
Q

Tearing of the cerebral parenchyma is considered a:

A

Laceration

102
Q

Tissue displacement or injury and edema are characteristics of a:

A

Contusion

103
Q

Movement of one region relative to another, commonly from angular acceleration is called:

A

Diffuse axonal injury (DAI)

104
Q

Reversible altered consciousness from head injury in the absence of a contusion is called a:

A

Concussion

105
Q

Epidural hemorrhaging is characterized by damage to _____, while subdural hemorrhaging is damage due to _____.

A

Dural artery; Rapid movement tears veins

106
Q

The most common CNS malformation is:

A

Neural tube defects

107
Q

An asymptomatic bony defect is indicative of:

A

Spina bifida occulta

108
Q

Extension of the CNS through a vertebral defect is indicative of:

A

Myelomeningocele

109
Q

Abnormal widening of the central canal is called:

A

Hydromyelia

110
Q

A cyst within the cord is called:

A

Syringomyelia (syrinx)

111
Q

Which microbe(s) is/are responsible for acute pyogenic meningitis in neonates?

A

E. coli and Group B strep.

112
Q

Which microbe(s) is/are responsible for acute pyogenic meningitis in adolescents and young adults?

A

Neisseria meningitidis

113
Q

Which microbe(s) is/are responsible for acute pyogenic meningitis in older adults?

A

Strep. pneumoniae and Listeria monocytogenes

114
Q

Which form of meningitis is self-limiting?

A

Aseptic

115
Q

Diffuse parenchymal infections are caused by _____, while localized and septic parenchymal infections are caused by _____.

A

Viruses; bacteria

116
Q

Which types of parenchymal infections are associated with meningitis?

A

Viral and fungal

117
Q

What is the most common disorder of myelin and what is the prevalence in the US?

A

Multiple sclerosis; 1 per 1000

118
Q

What are the risk factors for MS?

A

Young adults, females and a family history of MS

119
Q

What genetic antigen is well established as a predisposition for MS?

A

HLA-DR2

120
Q

Plaques associated with MS will most likely target which cranial nerve?

A

CNII (Optic)

121
Q

Wernicke-Korsakoff syndrome is associated with a deficiency of:

A

Thiamine

122
Q

Which metabolic disorder mimics hypoxia, with the hippocampus most likely susceptible?

A

Hypoglycemia

123
Q

Which metabolic disorder is associated with demyelination?

A

Vitamin B12 deficiency

124
Q

The most common cause of dementia, characterized by beta-amyloid plaques, is called:

A

Alzheimer’s disease

125
Q

Patients with Alzheimer’s disease will be most commonly disabled by _____ within _____.

A

Lethal pneumonia within 5-10 years

126
Q

What age group presents the highest risk for developing Alzheimer’s? Lowest risk?

A

Highest: >85 years (47%)
Lowest: 65-74 years (3%)

127
Q

Motor disturbances, tremor, bradykinesia and damage to dopaminergic neurons are all indicative of:

A

Parkinson’s disease

128
Q

Parkinson’s disease will most likely attack the:

A

Substantia nigra

129
Q

What are the two most commonly involved structures in Huntington disease?

A

Caudate and putamen nuclei

130
Q

Huntington disease has a delayed onset, most commonly affecting ages:

A

30-40 years

131
Q

The Huntington gene is present on which chromosome?

A

Chromosome 4

132
Q

What functions are spared in ALS?

A

Sensation and extraocular motor

133
Q

Upper and lower motor neurons are commonly killed in which disease?

A

ALS

134
Q

Patients with ALS often die as a result of:

A

Respiratory paralysis

135
Q

Most CNS tumors are:

A

Primary

136
Q

Which gliomas are diffuse/infiltrative?

A

Astrocytoma and oligodendroglioma

137
Q

Which glioma is not diffuse or infiltrative?

A

Ependymoma

138
Q

What is the mean survival time for a glioblastoma?

A

15 months

139
Q

Which glioma is the most lethal and has the poorest prognosis?

A

Astrocytoma

140
Q

What is the most common embryonal neoplasm?

A

Medulloblastoma

141
Q

What is the most common CNS tumor among immunosuppressed (AIDS) patients?

A

Primary CNS lymphoma (Diffuse large B cell lymphoma)

142
Q

What is the most common benign tumor of adults?

A

Meningioma

143
Q

What is the #1 cause of morbidity and mortality in the US?

A

Vascular disease

144
Q

What are the 2 mechanisms of vascular disease?

A

Narrowing/obstruction of the lumen and Weaking of the vessel walls

145
Q

What are the 3 layers of vessel walls?

A

Intima, media and adventitia

146
Q

The inner portion of the media is supplied by:

A

Diffusion of blood from the lumen

147
Q

The outer portion of the media is supplied by:

A

Vasa vasorum

148
Q

What is the order of the vascular pathway?

A

Large elastic arteries –> Medium-sized muscular arteries –> Small arteries –> Arterioles

149
Q

What are the 3 main vascular anomalies?

A

Intracranial berry aneurysms, arteriovenous fistulas, and fibromuscular dysplasia

150
Q

What are the effects of increased blood pressure?

A

Stimulates atrial natriuretic peptide (ANP), reduced sodium resorption and vasodilation

151
Q

What are the effects of decreased BP?

A

Stimulates renin-angiotensin system (RAS), increased sodium resorption and vasoconstriction

152
Q

Blood pressure medications influence what 2 things?

A

Angiotensin II receptor blockers and diuretics

153
Q

What is the clinical BP reading to be considered hypertension?

A

> 140/90

154
Q

Percentage of HTN cases considered “essential HTN?”

A

95%

155
Q

Which race is more at risk to HTN?

A

African-Americans

156
Q

In what ways does the vascular wall respond to injury?

A

Smooth muscle cell recruitment/mitosis and irreversible intimal thickening

157
Q

Which pattern of arteriosclerosis is characterized by calcium deposits in the arteries?

A

Monckenberg medial sclerosis

158
Q

Which pattern of arteriosclerosis affects small arteries and could result in ischemic injury?

A

Arteriolosclerosis

159
Q

The tunica media is separated from the tunica adventitia by the:

A

External elastic lamina

160
Q

Atherosclerosis is most likely to involve:

A

Large elastic arteries

161
Q

Which layer of the vessel wall contains endothelial cells?

A

Tunica intima

162
Q

What percentage of the general population are hypertensive?

A

25%

163
Q

What is a standard response following vascular injury?

A

Medial thickening and intimal thickening

164
Q

Which of the following is not a category of arteriosclerosis?

A. Arteriolosclerosis
B. Monckenberg medial sclerosis
C. Endotheliosclerosis
D. Atherosclerosis

A

C. Endotheliosclerosis

165
Q

Without appropriate treatment, what percentage of hypertensive individuals will die from a stroke?

A

1/3 or 33%

166
Q

Metabolic syndrome is not associated with which of the following?

A. Dyslipidemia
B. Foam cells
C. Insulin resistance
D. Central obesity

A

B. Foam cells

167
Q

Extravasation of blood into the wall of an artery is associated with a:

A

False aneurysm

168
Q

Which type of aneurysm is associated with all 3 layers of a vessel or heart wall?

A

True aneurysm

169
Q

What are 2 key features of atherosclerotic plaques?

A

Thickening of the tunica intima and lipid accumulation

170
Q

What percent of arteriosclerosis is atherosclerosis?

A

99%

171
Q

A polyneuropathy is most likely to have a _____ distribution.

A

Symmetric

172
Q

The clinical features _____ involve ptosis and diplopia.

A

MG

173
Q

Acute renal failure may result from rhabdomyolysis secondary to:

A

Binge-drinking

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