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Neuro Part 2 > Final Review > Flashcards

Final Review Flashcards

1
Q

What is area 4?

A

the motor cortex

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2
Q

What features do extrapyramidal syndromes have in common?

A
  • rigid paralysis
  • involuntary movements
  • minimal impairment of voluntary movements
  • intact reflexes
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3
Q

Describe the vestibulospinal tract anatomy.

A

vestibular nucleus to ipsilateral horn cells

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4
Q

Describe the anatomy of the tectospinal tract.

A

superior colliculus projects to the LMNs in the cervical spine

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5
Q

What is the role of the tectospinal tract?

A

reflexive control of the neck to new visual stimuli

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6
Q

What is decerebrate posture?

A

excessive extension due to upper brainstem injury

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7
Q

What are the two functions of the premotor cortex?

A
  • motor set

- assembly of motor plans

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8
Q

What is the difference between parietal area 5 and 7?

A

5 controls arm movements, 7 controls eye movements

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9
Q

What does a supplementary motor area lesion cause?

A
  • speech difficulties

- alien hand syndrome

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10
Q

What is the neural pathway for voluntary saccades?

A
  • frontal eye fields
  • superior colliculus
  • reticular formation
  • oculomotor nucleus
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11
Q

What is the neural pathway for reflexive saccades?

A
  • superior colliculus
  • reticular formation
  • oculomotor nucleus
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12
Q

What is the neural pathway for smooth pursuit eye movements?

A
  • retinal ganglion cells
  • LGN
  • visual cortex
  • reticular formation
  • oculomotor nucleus
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13
Q

What is the cupulla?

A

the gelatinous mass in which vestibular hair cell stereocilia are embedded

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14
Q

Symptoms of a unilateral lesion to the vestibular nerve.

A
  • fall to ipsilateral side

- nystagmus to the contralateral side

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15
Q

Diffuse axonal injury primarily affects which structures?

A
  • diencephalon
  • midbrain
  • grey-white junctions
  • corona radiata
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16
Q

Which cranial nerves are most susceptible to injury?

A

1, 7, and 8

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17
Q

What fracture will endanger CN 7 most often?

A

transverse petrous

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18
Q

What are the symptoms of lateral and central herniation syndromes?

A
  • central: bilateral, mid-range, unresponsive pupils

- lateral: unilateral, dilated, unresponsive pupils

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19
Q

What is coloboma usually due to?

A

a PAX2 mutation

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20
Q

What are the two parts of the tympanic membrane?

A
  • pars flaccida (less)

- pars tensa (most)

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21
Q

Hemifacial microsomia is a type of what disorder?

A

1st and 2nd branchial arch anomaly

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22
Q

What are the features of hemifacial microsomia?

A
  • facial asymmetry
  • hyoid malformation
  • malformed auricle
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23
Q

What kind of defect is thyroglossal duct cyst?

A

branchial pouch 3 and 4

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24
Q

What kind of defect is a lingual thyroid?

A

branchial pouch 3 and 4

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25
Q

a sinus leading from the anterior triangle into the external auditory meatus is what kind of defect?

A

2nd branchial cleft

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26
Q

Delusional Disorder

A

a non-bizarre delusion lasting one month without other schizophrenic symptoms

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27
Q

What physical changes are associated with schizophrenia?

A
  • enlarged ventricles
  • reduced amygdala, hippocampal, and cortical volume
  • increased NE and DA in the anterior thalamus
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28
Q

How is childhood trauma thought to contribute to personality disorder?

A

it sensitizes the HPA axis and prevents synaptic pruning by increasing excitatory NT levels

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29
Q

Rejecting-fearful parenting leads to what type of personality disorder?

A

cluster C

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30
Q

Terrorizing-disorganized parenting leads to what type of personality disorder?

A

cluster B

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31
Q

What are the modules of dialectical behavioral therapy?

A
  • mindfulness
  • distress tolerance
  • emotion regulation
  • interpersonal effectiveness
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32
Q

What are the most used migraine abortive therapies?

A
  • NSAIDs/opioids
  • triptans
  • caffeine
  • antiemetics
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33
Q

What are triptans?

A

5HT agonists used for headache relief

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34
Q

What drugs are used for migraine prophylaxis?

A
  • Botox
  • antiepileptics
  • antidepressants
  • beta blockers
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35
Q

What are the symptoms of pseudo tumor cerebri?

A
  • recurrent headache
  • papilledema
  • normal imaging
  • blurred vision
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36
Q

What are the symptoms of giant cell arteritis?

A
  • age over fifty
  • recurrent headaches
  • temporal artery tenderness
  • elevated ESR
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37
Q

The MD thalamic nucleus receives input from where?

A

the olfactory system

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38
Q

The MGN thalamic nucleus receives input from where?

A

the inferior colliculus

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39
Q

What is the role of the pulvinar nucleus in the thalamus?

A

alert us to new visual stimuli

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40
Q

Which thalamic nucleus is damaged in those with Korsakoff’s?

A

MD

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41
Q

Which thalamic nuclei are considered to be “motor” in nature?

A

VL and VA

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42
Q

What causes thalamic pain?

A

occlusion of the thalamogeniculate artery

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43
Q

What fibers run in the genu of the internal capsule?

A

corticobulbar fibers

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44
Q

What fibers run in the posterior limb of the internal capsule?

A
  • corticospinal fibers
  • somatosensory fibers
  • visual and auditory fibers
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45
Q

Which brainstem nuclei and cranial nerves are involved in swallowing?

A
  • CN IX brings afferent information to the solitary nucleus
  • CN X innervates laryngeal and pharyngeal muscles from the ambiguus nucleus
  • CN XII innervates the tongue muscles from the hypoglossal nucleus
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46
Q

PPV Equation

A

(sensitivity) (pretest)
- —————————————————-
(sensitivity) (pretest) + (1-pretest)(1-specificity)

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47
Q

NPV Equation

A

(specificity) (1-pretest)
- ————————————————-
(specificity) (1-pretest) + (1-sensitivity)(pretest)

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48
Q

Where are cerebral thrombi most common?

A
  • carotid bifurcation
  • MCA origin
  • top and bottom of basilar artery
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49
Q

Where are emboli most common in the cerebral vasculature?

A

the MCA

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50
Q

Where are berry aneurysms most common?

A
  • the anterior communicating artery

- the MCA (distal and proximal)

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51
Q

What microscopic changes follow brain ischemia?

A
  • 12-24 hours: red neurons
  • 12-48 hours: neutrophils
  • 2 days - 2 weeks: macrophages, necrosis
  • 1 week - 4 weeks: astrocytic proliferation
  • chronic: scar/cyst, wallerian degeneration
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52
Q

Where are lacunar infarcts most likely?

A
  • putamen/globus pallidus
  • thalamus
  • internal capsule
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53
Q

Where are intraparenchymal hemorrhages most likely?

A
  • striatum
  • thalamus
  • pons
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54
Q

What are the two major complications of a cavernoma?

A
  • hemorrhage

- seizure

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55
Q

How is HIV encephalitis diagnosed?

A

the presence of HIV p24+ multinucleate giant cells in microglial nodules

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56
Q

What are the criteria for PDD?

A

2 or more symptoms for 2 years

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57
Q

What change is believed to mediate mania?

A

changes in the phospholipid bilayer that make depolarization more likely

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58
Q

What are tricyclics?

A

drugs that block NE and 5HT reuptake

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59
Q

4 drugs used to treat bipolar disorder

A
  • lithlium
  • valproic acid
  • carbamazepine
  • lamotrigine
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60
Q

Which brainstem nuclei can be found in the medulla?

A
  • hypoglossal
  • dorsal motor of V
  • ambiguus
  • solitary
  • vestibular
  • cochlear
  • spinal trigeminal
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61
Q

Which brainstem nuclei can be found in the pons?

A
  • abducens
  • motor trigeminal
  • motor facial
  • principal sensory
  • spinal trigeminal
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62
Q

Which brainstem nuclei can be found in the midbrain?

A
  • oculomotor
  • dinger-westphal
  • trochlear
  • mesencephalic
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63
Q

Dorsal Motor Nucleus

A

preganglionic parasympathetics that exit via CN X

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64
Q

Principal Sensory Nucleus

A

secondary DCML neurons for the face that enter via CN V

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65
Q

Spinal Nucleus

A

secondary ALS neurons for the face that enter via CN V

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66
Q

Solitary Nucleus

A
  • rostral receives taste from CN VII, IX, X

- caudal receives visceral afferent from CN VII, IX, X

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67
Q

Facial Motor Nucleus

A

LMNs that exit via CN VII to supply facial muscles

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68
Q

Trigeminal Motor Nucleus

A

LMNs that exit via CN V to supply masticator muscles

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69
Q

Mesencephalic Nucleus

A

receives info for unconscious proprioception via CN V to mediate the jaw reflex

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70
Q

The medial and lateral medulla are supplied by which arteries?

A
  • medial: anterior spinal

- lateral: PICA

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71
Q

The medial and lateral pons are supplied by which arteries?

A
  • medial: paramedian branches of basilar

- lateral: long circumferential branches of basilar and AICA

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72
Q

The medial midbrain is supplied by which artery?

A

the paramedian branches of the basilar and P1 of the PCA

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73
Q

Signs of trochlear ophthalmoplegia?

A

head tilt to the contralateral side

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74
Q

Signs of oculomotor ophthalmoplegia?

A
  • eye down and out
  • mydriasis
  • ptosis
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75
Q

What is the horizontal conjugate gaze center?

A

a region in the pons that coordinates eye movements

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76
Q

The left frontal eye field directs our gaze where?

A

to the right

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77
Q

What is the medial longitudinal fasiculus?

A
  • a tract between the abducens nucleus and contralateral oculomotor nucleus that coordinates eye movements
  • damage results in inter-nuclear ophthalmoplegia
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78
Q

Name the three alternating hemiplegia.

A
  • medulla: hypoglossal
  • pons: abducens
  • midbrain: oculomotor
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79
Q

Edinger Westphal Nucleus

A

a nucleus of preganglion parasympathetics that project to the pupil

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80
Q

Where is the preganglionic sympathetic nucleus for pupil diameter located?

A

the intermediolateral column in the thoracic cord

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81
Q

What is the importance of the inferior cerebellar peduncle?

A

input from the spinocerebellar tract to the cerebellum

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82
Q

What is the importance of the superior cerebellar peduncle?

A

output from the cerebellar tract

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83
Q

Ambiguus Nucleus

A

LMNs that supply the larynx via CN IX and X

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84
Q

The PCA supplies what brain structures?

A
  • undersurface of temporal lobe
  • occipital lobe and visual cortex
  • P1 to medial midbrain
  • thalamogeniculate arteries to internal capsule
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85
Q

The internal capsule is supplied by which artery?

A

the thalamogeniculate off the PCA

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86
Q

The ophthalmic artery is a branch off what larger vessel?

A

the internal carotid

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87
Q

Tau tangles preferentially affect which brain structures?

A

amygdala, hippocampus, and LGN

88
Q

Sporadic PD is linked to what gene?

A

glucocerebrosidase

89
Q

ALS is linked to which gene?

A

C9orf72

90
Q

Name two drugs used in the treatment of AD?

A
  • memantine: an NMDA antagonist

- dopenezil: centrally acting AChE inhibitor)

91
Q

ApoE4 is a risk factor for which dementias?

A

DLB and AD

92
Q

ALS is characterized by what protein aggregate?

A

TDP-43

93
Q

AD is linked to which genes?

A

ApoE4 and presenilin-1

94
Q

Which receptor mediates LTP?

A

glutamate

95
Q

Which brain structures are particularly sensitive to thiamine deficiency?

A
  • dorsal medial thalamic nucleus

- maxillary bodies

96
Q

What are the features of Korsakoff’s?

A
  • amnesia

- confabulation

97
Q

What are the features of Wernicke’s encephalopathy?

A
  • confusion
  • truncal ataxia
  • CN VI paralysis
98
Q

Which cranial nerves mediate taste?

A

CN VII, IX, X

99
Q

What is the role of the central amygdala?

A

autonomic regulation

100
Q

What is the role of the corticomedian amygdala?

A

sex and feeding behavior

101
Q

What is the role of the basolateral amygdala?

A

assign emotional value

102
Q

Describe the neurohypophyseal system.

A
  • supraoptic and paraventricular nuclei
  • project to the posterior pituitary
  • and release vasopressin and oxytocin
103
Q

What are the tuberoinfundibular nuclei?

A
  • arcuate nucleus

- periventricular

104
Q

What is the purpose of the anterior hypothalamic nucleus?

A

sense heat

105
Q

What is the purpose of the posterior hypothalamic nucleus?

A

sense cold

106
Q

What is the purpose of the pre-optic hypothalamic nucleus?

A

regulate the temperature set point

107
Q

What is the purpose of the lateral hypothalamic nucleus?

A

sense hunger

108
Q

What is the purpose of the ventromedial hypothalamic nucleus?

A

sense satiety

109
Q

Which hypothalamic nucleus regulates the ANS?

A

the paraventricular system

110
Q

What are the early symptoms of opioid withdrawal?

A
  • lacrimation
  • anxiety
  • pilorection
  • yawning
111
Q

What are the late symptoms of opioid withdrawal?

A
  • diarrhea
  • abdominal cramps
  • myalgia
  • insomnia
112
Q

Which alcohol dehydrogenase allele has a higher metabolic rate?

A

ADH2*3

113
Q

Name for effects alcohol has on NT systems.

A
  • reduces NMDA
  • increases opioids
  • increases GABAergic activity
  • indirectly increases DA
114
Q

What are the four criteria on which substance use disorders are diagnosed?

A
  • impaired control
  • social impairment
  • risky use
  • physical dependence
115
Q

Alcoholic Polyneuropathy

A

a vitamin B deficiency-induced peripheral neuropathy that affects the lower extremities more and is describe by many as “burning feet” sensation

116
Q

What are the elements of brief alcohol use intervention?

A
  • feedback
  • advice
  • commitment
  • tracking
117
Q

Naltrexone

A

opioid receptor antagonist use to attenuate alcohol relapses

118
Q

Acamprosate

A

a GABA agonist and NMDA antagonist used to help maintain alcohol abstinence

119
Q

Buprenorphine

A

a partial opioid agonist used to treat opioid and alcohol withdrawal

120
Q

Crista Ampullaris

A

a ridge of tissue in the semicircular canals in which vestibular hair cells are embedded

121
Q

What are three functions of the inner ear?

A
  • impedence matching
  • pressure equalization
  • gain control of vibrations reaching inner ear
122
Q

Tensor Tympani

A

dampens the tympanic membrane

123
Q

Stapedius muscle

A

dampens the stapes

124
Q

Stia Vascularis

A

part of the membranous labyrinth in the cochlea that pumps potassium ions into the scala media

125
Q

Tectorial Membrane

A

sits on and rubs auditory hair cells

126
Q

Describe the passage of sound waves through the inner ear.

A
  • stapes
  • oval window
  • scala vestibuli
  • vestibular membrane
  • scala media
  • basilar membrane
127
Q

Endolymph has high concentration of what?

A

potassium ions

128
Q

How is tonotopic organization of the cochlea achieved?

A

the basilar membrane varies in width and stiffness

129
Q

Describe the basilar membrane at the base of the cochlea.

A

narrow and stiff

130
Q

What do outer hair cells do?

A

modify the stiffness of the basilar membrane to sharpen frequency tuning

131
Q

Superior Olivary Nucleus

A

nucleus with efferent innervation of the outer hair cells

132
Q

Otoacoustic Emissions

A

generated by OHCs

133
Q

Middle ear problems contribute to what kind of hearing loss?

A

conductive

134
Q

Three common causes of conductive hearing loss

A
  • otitis media
  • otosclerosis
  • impacted cerumen
135
Q

What is otosclerosis?

A

an overgrowth of bone in the middle ear that contributes to conductive hearing loss

136
Q

What commonly used drug is ototoxic?

A

aspirin

137
Q

High intensity sound causes what kind of hearing loss?

A

sensorineural

138
Q

Meniere’s Disease

A
  • a fluctuating sensorineural hearing loss, vertigo, and tinnitis
  • caused by an excessive amount of endolymph
  • treated with diuretics and a low salt diet
139
Q

Tinnitis most commonly accompanies what?

A

auditory hair cell loss

140
Q

What is objective tinnitis?

A

tinnitis due to pulsation of a blood vessel

141
Q

Name four causes of sensorineural hearing loss.

A
  • perinatal infection
  • high intensity sound
  • long-standing otitis media or otosclerosis
  • ototoxic drugs
142
Q

What are climbing fibers?

A

those with direct innervate purkinje cells in the cerebellum

143
Q

Pontine Nucleus

A

relay station between cortex and cerebellum

144
Q

Red Nucleus

A

a relay station between the cerebellum and spinal cord

145
Q

The vestibulocerebellum projects to what structures outside the cerebellum?

A
  • vestibulospinal tract

- reticulospinal tract

146
Q

The vestibulocerebellum commonly has what effect on the vestibulospinal tract?

A

an inhibitory one to allow for tracking of objects with our head

147
Q

Ataxia with a normal Romberg test means what?

A

the problem is in the cerebellum

148
Q

Cerebrocerebellum lesion

A
  • dysdiadochokinesis

- decomposition of movement

149
Q

Cerebrocerebellum, Spinocerebellum, and Vestibulocerebellum

A
  • cerebro: initiation and programming of movement
  • spino: ongoing correction of movement errors
  • vestibulo: control vestibular reflexes
150
Q

Parkinson’s Disease targets which neuronal population?

A

dopaminergic neurons in the SNc

151
Q

Huntington’s chorea targets which neuronal population?

A

GABAergic neurons from the putamen to the GPe

152
Q

Parkinsonism

A
  • bradykinesia
  • postural instability
  • rigidity
153
Q

What clinical findings suggest a non-Parkinson’s disease cause of parkinsonism?

A
  • symmetry at onset
  • early autonomic dysfunction
  • abrupt onset or rapid progression
  • early dementia
154
Q

What damage leads to Shy-Drager syndrome?

A

damage to both the SNc and striatum

155
Q

What is the primary cause of vascular parkinsonism?

A

ischemic damage to the striatum

156
Q

Four pharmacologic therapies for PD

A
  • levodopa
  • COMT inhibitors
  • MAO-B inhibitors
  • dopamine agonists
157
Q

Carbidopa

A

inhibits peripheral COMT inhibitors to increase the action of levodopa

158
Q

Complications of L-DOPA

A
  • motor fluctuations
  • dyskinesias
  • mental status change
159
Q

MAO-B

A

enzyme that metabolizes DA in the synaptic cleft

160
Q

Selegiline and Rasagiline

A

MAO-B inhibitors

161
Q

Entacapone and Tolcapone

A

COMT Inhibitors

162
Q

Dystonia

A

a sustained involuntary movement

163
Q

Chorea

A

a ballistic movement (agonist, antagonist, agonist)

164
Q

Athetosis

A

a type of dystonia that appears as a writhing movement

165
Q

What causes dystonia?

A

a lack of reciprocal inhibition

166
Q

Tardive Dyskinesia

A

involuntary movements seen after the use of DA blocking agents

167
Q

Common etiologies of myoclonus

A
  • idiopathic
  • primary generalized epilepsy
  • post-anoxia
168
Q

How do we treat tardive dyskinesia?

A

anticholinergics

169
Q

How do we generally treat hyper-kinetic movement disorders?

A

anticholinergics and dopaminergics

170
Q

Describe the pathogenesis of MS

A

CD4 cells react to self-myelin and secrete cytokines

171
Q

Which genes are linked to MS?

A
  • IL-2RA
  • IL-7RA
  • HLA-DR15
172
Q

MS preferentially affects which white mater tracts?

A
  • periventricular
  • optic
  • superficial pons and spinal cord
173
Q

Marburg Variant MS

A

an acute, early onset, rapidly progressing, refractory form of MS

174
Q

Aquaporin-4

A

Neuromyelitis Optica

175
Q

Most leukodystrophies have what mode of genetic transmission??

A

autosomal recessive

176
Q

What causes Alexander’s disease?

A

a GFAP mutation

177
Q

What causes ALD?

A

mutation in ABCD1, a peroxisomal membrane transporter that yields defects in VLCFA metabolism

178
Q

Signs of an ophthalmic artery occlusion

A

transient blindness, unresponsive pupil

179
Q

Signs of an MCA superior division stroke

A
  • gaze preference
  • Broca’s aphasia
  • contralateral hemisensory loss and hemiplegia arm=face>leg
180
Q

arm=face>leg

A

MCA

181
Q

arm=face=leg

A

lenticulostriate

182
Q

leg>face=arm

A

ACA

183
Q

Signs of an MCA inferior division stroke

A
  • neglect syndrome or Wernicke’s aphasia

- superior quadrantanopsia

184
Q

Basilar artery occlusion

A

bilateral long tract and brainstem nuclei signs

185
Q

Lentinculostriate occlusion

A
  • face=arm=leg hemiparesis and hemiplegia

- contralateral ataxia

186
Q

Thalamogeniculate artery occlusion

A
  • hemiparesis
  • hemisensory loss with burning sensation
  • ataxia
  • intention tremor
187
Q

PCA cortical occlusion

A
  • contralateral homonymous hemianopia with macular sparing

- acute memory disturbance

188
Q

Bilateral ACA occlusion

A
  • paraplegia
  • frontal lobe syndrome
  • urinary incontinence
189
Q

Internal Carotid occlusion

A
  • visual disturbance
  • stupor
  • Horner syndrome
  • global aphasia
  • gaze preference
190
Q

14-3-3 protein

A

Elevated in CJD

191
Q

EEG periodic sharp waves

A

CJD

192
Q

Extremely rapid dementia

A

CJD

193
Q

Who is most affected by myasthenia gravis?

A

women in their 20s, men in their 50s

194
Q

CADASIL

A
  • an AD vascular dementia with onset between 20-30 years of age, usually beginning with migraines with aura
195
Q

Notch3 mutation

A

CADASIL

196
Q

Blood vessels stain with PAS

A

CADASIL

197
Q

Symptoms for DLB

A

fluctuating dementia, REM sleep disorder, parkinsonism, visual hallucinations

198
Q

Who is affected by Taxoplasmosis?

A

immunocompromised individuals with exposure to cats

199
Q

What is the pathophysiology of poliomyelitis?

A

neuronophagia of anterior horn cells

200
Q

Measles is associated with what encephalitis?

A

subacute sclerosing panencephalitis

201
Q

What causes Shy-Drager Syndrome?

A

damage to the striatum and substantia nigra

202
Q

Features of Shy-Drager Syndrome

A
  • early postural and speech deficits
  • autonomic dysfunction
  • peripheral neuropathy
  • parkinsonism
203
Q

Lateral brainstem syndromes have what in common?

A
  • contralateral loss of pain/temp on body
  • ipsilateral loss of pain/temp on face
  • Horner syndrome
  • ipsilateral ataxia
204
Q

What distinguishes lateral medullary syndrome from lateral pontine syndrome?

A
  • medullary: dysphagia, poor gag reflex, hoarseness

- pontine: vertigo, deafness, facial and masticatory muscle paralysis

205
Q

Medial midbrain syndrome

A
  • oculomotor alternating hemiplegia

- damage to corticobulbar tracts cause contralateral lower facial paralysis

206
Q

Symptoms of Parkinson’s disease

A
  • parkinsonism
  • autonomic dysfunction
  • neuropsychiatric signs
  • resting tremor
207
Q

How do we treat Alzheimer’s disease?

A

AChE inhibitor and NMDA antagonists

208
Q

Mucoid encapsulated yeast

A

cryptococcus neoformans

209
Q

What organism causes meningitis, thickening of the meninges, and hydrocephalus?

A

cryptococcus neoformans

210
Q

What causes Alexander’s disease?

A

a GFAP mutation

211
Q

How does Alexander’s present?

A
  • young patients: seizures, megaloencephaly, developmental delay
  • older patients: brain stem lesions
212
Q

Who does MS affect most?

A

women between 15 and 45

213
Q

How does central pontine myelinosis present?

A

with rapid onset paraplegia

214
Q

Rapid sodium correction

A

central pontine myelinosis

215
Q

Myelin disorder associated with a recent viral illness

A

ADEM and AHEM

216
Q

Lesions of the same age is a characteristic of what demyelinating disorder?

A

ADEM

217
Q

JC virus is associated with which demyelinating disease?

A

progressive multifocal leukoencephalopathy

Neuro Part 2 (18 decks)

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