First Aid Flashcards
What are Chiari I malformations associated with?
Syringomyelia
What’s a Chiari II malformation?
Herniation of low-lying cerebellar vermis and tonsils through foramen magnum?
What’s a Chiari II malformation associated with (2)?
- Hydrocephalus
2. Lumbosacral meningomyelocele
What condition involves agenesis of cerebellar vermis with cystic enlargement of 4th ventricle, filling the enlarged posterior fossa?
Dandy-Walker Syndrome
What is Dandy-Walker Syndrome associated with?
- Noncommunicating hydrocephalus
2. Spina bifida
What condition leads to a cystic cavity within the central canal of the spinal cord, leading to a “cape-like” bilateral loss of pain and temperature sensation in upper extremities, and is associated with Chiari malformations, trauma, and tumors?
Syringomyelia
What 3 cranial nerves are involved in taste?
7, 9, 10
What 3 cranial nerves are involved in tongue pain?
V3, 9, 10
What 2 cranial nerves are involved in tongue motor?
10, 12
Myelin is on which cells?
Oligodendrocytes in CNS and Schwann cells in PNS
What part of the brain is involved in thirst, water balance, hormones, circadians, temperature?
Hypothalamus
Which part of the hypothalamus synthesizes ADH and oxytocin?
Supraoptic and paraventricular nuclei
Where is ACh produced?
Basal nucleus of Meynert
Where is Dopamine produced?
Ventral tegmentum, SNc
Where is GABA produced?
Nucleus accumbens
Where is NE produced?
Locus ceruleus
Where is Serotonin produced?
Raphe nucleus
Which 2 diseases have decreased ACh?
- Alzheimer’s
2. Huntington’s
Which disease has increased ACh?
Parkinson’s
Which 2 diseases have decreased GABA?
- Anxiety
2. Huntington’s
Which EEG waveform is associated with awake eyes open?
Beta
Which EEG waveform is associated with awake eyes closed?
Alpha
“Blind people are alpha”
Which EEG waveform is associated with light sleep (N1)?
Theta
Which EEG waveform is associated with deeper sleep with bruxism (N2)?
Sleep spindles and K complexes
Which EEG waveform is associated with slow-wave sleep, nightwalking, night terrors, and bedwetting (N3)?
Delta
Which EEG waveform is associated with loss of motor tone, increased brain O2 use, variable pulse and BP, increased ACh, dreaming, nightmares, penile/clitoral tumescence, memory processing (REM)?
Beta
Depression ________ total REM sleep, but _________ REM latency?
Increases; decreases
What structure in the brain is associated with extraocular movements in REM sleep?
PPRF
Which nucleus receives input from the spinothalamic and dorsal column/medial lemniscus, and is involved in vibration, pain, pressure, proprioception, light touch, and temperature, and its destination is the primary somatosensory cortex?
Ventral Postero-lateral Nucleus (VPL)
Which nucleus receives input from the trigeminal and gustatory pathway, and is involved in face sensation and taste, and its destination is the primary somatosensory cortex?
Ventral Postero-medial Nucleus (VPM)
Which nucleus receives input from CN2 and is involved in vision, and its destination is the calcarine sulcus?
Lateral Geniculate Nucleus
Which nucleus receives input from the superior olive and inferior colliculus of tectum and is involved in hearing, and its destination is the auditory cortex of the temporal lobe?
Medial Geniculate Nucleus
Which nucleus receives input from the basal ganglia and cerebellum, is involved in motor function, and its destination is the motor cortex?
Ventral Lateral Nucleus
Which system is involved in the 5 Fs?
The limbic system
Which dopamine pathway, if its activity is decreased, leads to negative sx?
Mesocortical
Which dopamine pathway, if its activity is increased, leads to positive sx?
Mesolimbic
Which dopamine pathway, if its activity is decreased, leads to extrapyramidal sx?
Nigrostriatal
Which dopamine pathway, if its activity is decreased, leads to increased prolactin?
Tuberoinfundibular
Does proprioceptive information via the inferior cerebellar peduncle from spinal cord enter the cerebellum ipsilaterally or contralaterally?
Ipsilaterally
Which input to the cerebellum is contralateral?
Contralateral cortex via medial cerebellar peduncle
What do lateral cerebellar lesions present as?
Limb voluntary movements; when injured, tendency to fall toward ipsilateral side (side of lesion)
What do medial cerebellar lesions present as?
Truncal ataxia, wide-based gait, nystagmus, head tilting
Does the excitatory dopamine pathway lead to increased motion?
Yes
Does the inhibitory dopamine pathway lead to decreased motion?
Yes
Review brain anatomy and homunculus, pg 471
Good job
From superiomedial to inferolateral, what are the body parts of the motor/sensory homunculus?
Foot Leg Shoulder Wrist Hand Thumb Face Mouth Toes
Cerebral perfusion is primarily driven by what gas?
CO2
Which surface of the brain does the ACA supply?
Anteromedial
Which surface of the brain does the MCA supply?
Lateral
Which surface of the brain does the PCA supply?
Posteroinferior
Draw the Circle of Willis
Good job
Which 4 CN are above pons?
1, 2, 3, 4
Which 4 CN are in pons?
5, 6, 7, 8
Which 4 CN are in medulla?
9, 10, 11, 12
Which 4 CN nuclei are medial?
3, 4, 6, 12 (factors of 12)
What does the pineal gland secrete?
Melatonin
What is the superior colliculi involved with?
Conjugate vertical gaze
What is the inferior colliculi involved with?
Auditory
Where are the superior colliculi?
Midbrain
Where is the nucleus of CN11?
Spinal cord
What’s the mnemonic for remembering which words are motor, sensory, or both?
Some Say Marry Money But My Brother Says Big Brains Matter Most
How many vagal nuclei are there?
3
What does the nucleus solitarius involve?
Visceral sensory information (taste, baroreceptors, gut distention) CNs 7, 8, 9
What does the nucleus ambiguus involve?
Motor innervation of pharynx, larynx, upper esophagus (swallowing, palate elevation) CNs 9, 10, 11
What CNs are involved in the corneal reflex?
V1 and 7
What CNs are involved in the lacrimation reflex?
V1 and 7
What CNs are involved in the jaw jerk reflex?
2 and 3
What CNs are involved in the gag reflex?
9 and 10
Which CN innervates the muscles of mastication?
V3
When a disc is herniated, which nerve is affected?
Usually the one below
Which nerves exit above the corresponding vertebrae?
C1-C7
How many cervical nerves are there?
8
At what level does the spinal cord end in adults?
L1/L2
What’s the function of the dorsal column?
Pressure, vibration, fine touch, proprioception
What’s the function of the spinothalamic tract?
Pain, temperature
What’s the function of the corticospinal tract?
Voluntary movement of contralateral limbs
Where do the dorsal column tracts decussate?
Medulla
Where do the spinothalamic tracts decussate?
Anterior white commissure of spinal cord at level
Where do the corticospinal tracts decussate?
Caudal medulla
What level does the Achilles reflex test?
S1
What level does the patellar reflex test?
L4
What level does the biceps and brachioradialis reflexes test?
C5
What level does the triceps reflex test?
C7
What level does the cremasteric reflex test?
L1, L2
What level does the anal wink reflex test?
S3, S4
A lesion in which area of the brain causes re-emergence of primitive reflexes?
Frontal lobe
If the lesion is in the PPRF, which direction do the eyes look?
Away from lesion
If the lesion is in the frontal eye fields, which direction do the eyes look?
Toward the lesion
Which lesion presents with agraphia, acalcula, finger agnosia, and left/right disorientation?
Dominant parietal cortex
Which lesion presents with agnosia of the contralateral side of the world?
Nondominant parietal cortex
Which lesion presents with anterograde amnesia?
Hippocampus, bilateral
Which lesion presents with resting tremor, chorea, and athetosis?
Basal ganglia
Which lesion presents with contralateral hemiballismus?
Subthalamic nucleus
“Having a ball with the subwoofer”
Which lesion presents with Wernicke-Korsakoff syndrome (confusion, ataxia, nystagmus, opthalmoplegia, memory loss, confabulation, personality changes)?
Mamillary bodies, bilateral
Which lesion presents with Kluver-Bucy syndrome (hyperphagia, hypersexuality, hyperorality)?
Amygdala, bilateral (HSV-1 encephalitis)
Which lesion presents with Parinaud syndrome (paralysis of conjugate vertical gaze)?
Superior colliculus
Which lesion presents with reduced levels of arousal and wakefulness?
Reticular activating system (midbrain)
Which lesion presents with intention tremor, limb ataxia, loss of balance, and ipsilateral deficits?
Cerebellar hemisphere (lateral)
Which lesion presents with truncal ataxia and dysarthria?
Cerebellar vermis (central)
Which region of the brain is most vulnerable to ischemic hypoxia?
Hippo
Which is the most common brain artery site of a thrombus?
MCA
When do you administer tPA?
Within 3-4.5 hours of onset
Which type of intracranial hemorrhage involves the MMA, presents with a lucid interval followed by rapid expansion that can lead to transtentorial herniation or CN 3 palsy and is biconvex and does not cross suture lines?
Epidural hematoma
Which type of intracranial hemorrhage involves the bridging veins and is due to trauma, shaken babies, or atrophy, and can cause midline shift and crosses suture lines?
Subdural hematoma
Which type of intracranial hemorrhage is often due to a berry or saccular aneurysm rupture, and presents with bloody tap, worst headache of life, vasospasm days later, and can develop hydrocephalus?
Subarachnoid hemorrage
What do you use to prevent vasospasm in subarachnoid hemorrhages?
Nimodipine
Which type of intracranial hemorrhage is usually due to systemic hypertension, vasculitis, or neoplasm and usually occurs in the basal ganglia and internal capsule?
Intraparenchymal hemorrhage
Which artery stroke can cause contralateral hemiparesis, sensory loss, hemianopia, and either aphasia or neglect?
MCA
Which artery stroke can cause contralateral leg weakness and executive dysfunction?
ACA
Which artery stroke can cause hemianopia, pure sensory infarct (thalamus), memory impairment, and decreased level of consciousness?
PCA
Which (broad) level of stroke can cause crossed sensory or motor findings, nystagmus, diplopia, vertiga, and Horner’s?
Brainstem
Which (broad) level of stroke can cause ataxia, nystagmus, vertigo, nausea, headache, or rapid deterioration in consciousness?
Cerebellar
Which type of stroke often has a characteristic pattern of pure motor, pure sensory, sensorimotor, ataxic hemiparesis, or clumsy hand dysarthria?
Lacunar
Which artery of stroke causes contralateral paralysis of face and upper limb?
MCA
“Order MCdonalds drive-thru with your face and arm”
Which artery of stroke causes contralateral paralysis of lower limb?
ACA
“Tore my ACA”
Which artery of stroke causes contralateral paralysis of face and body?
Lenticulostriate (lacunar)
“Face, bodi, lenticulostri”
Which artery of stroke causes contralateral paralysis of upper and lower limbs?
ASA
“Take ASA for upper and lower limb pain”
What’s the most common site of a saccular (berry) aneurysm?
Junction of ACom and ACA
What’s the tx for acute cluster headache?
Sumatriptan, 100% O2
What’s the preventative tx for cluster headache?
Verapamil
Lewy bodies are composed of what?
Eosinophilic inclusions (a-synuclein)
What 2 meds can cause pseudotumor cerebri?
- Danazol
2. Tetracycline
From low to high ….
Your pons will die (central pontine myelinolysis)
From high to low …
Your brain will blow (cerebral edema/herniation)
Why might Guillain-Barre cause papilledema?
Elevated CSF protein
Where are the lesions in MS on MRI?
Periventricular
Which demyelinating disease is AD inheritance and associated with hammer toe, foot drop, and sensory deficits?
Charcot-Marie-Tooth
Which demyelinating disease is AR, involves deficiency of galactocerebrosidase (lysosomal storage), developmental delay, optic atrophy, and globoid cells?
Krabbe disease
Which demyelinating disease is AR, lysosomal storage, leads to buildup of sulfatides and presents with ataxia and dementia?
Metachromatic leukodystrophy
Which demyelinating disease involves the CNS, is seen in AIDS patients due to latent JC virus infection, and the risk is increased with natalizumab and rituxumab use?
PML
Which disorder is X-linked, involves VLCFA and can lead to adrenal crisis?
Adrenoleukodystrophy
Which neurocutaneous disorder has port-wine stain of face (CN V1/V2), leptomeningeal angioma, seizures, intellectual disability, and glaucoma?
Sturge-Weber
Which neurocutaneous disorder is AD, has ash-leaf spots, angiofibromas, rhabdomyoma, intellectual disability, seizures, shagreen patches, and renal angiolipoma?
Tuberous Sclerosis
Which neurocutaneous disorder is AD, cafe-au-lait spots, cutaneous neurofibromas, pheochromocytomas, lisch nodules (on iris)?
NF1
Which neurocutaneous disorder is AD, involves bilateral acoustic schwannomas, juvenile cataracts, meningiomas, and ependymomas?
NF2
Which neurocutaneous disorder is AD, involves hemangioblastomas in retina, brainstem, cerebellum, and spine, angiomas in skin etc, pheochromocytomas, and bilateral renal cell carcinomas?
Von Hippel-Lindau
Which type of herniation can compress ACA?
Cingulate (subfalcine)
Which type of herniation can cause rupture of basilar artery branches and is usually fatal?
Transtentorial
Which type of herniation can cause down and out blown pupil?
Uncal
Which type of herniation can cause coma and death when it compresses the brainstem?
Cerebellar tonsillar
Which spinal cord lesion affects UMN and LMN but does not affect sensory or bowel/bladder function?
ALS
What disease with asymmetric weakness (LMN only) might occur in someone unvaccinated?
Poliomyelitis
What vitamin deficiency causes subacute combined degeneration of spinocerebellar tracts, lateral corticospinal tracts, and dorsal columns?
B12
What does tertiary syphilis cause?
Tabes dorsalis (argyll robertson pupils, absence of DTRs, and positive Romberg)
What’s an argyll robertson pupil?
It accommodates but does not react
Which spinal cord lesion causes ipsilateral/contralateral everything, and sometimes even Horner’s if above T1?
Brown-Sequard Syndrome
Which AR disorder causes staggering gait, falling, kyphoscoliosis, nystagmus, diabetes, hypertrophic cardiomyopathy, and loss of DTRs during adolescence?
Friedrich Ataxia
Where does the jaw deviate with CNV lesions?
Toward lesion
Where does the uvula deviate with CN10 lesions?
Away from lesion
Where does weakness occur with CN11 lesions?
Shoulder droops on side of lesion
Where does the tongue deviate with CN12 lesions?
Toward lesion
The ________ is spared in an UMN face lesion?
Forehead
In Bell’s palsy, is the forehead affected?
Yes
What mode of inheritance is the most common muscular dystrophy?
AD
What’s the most common mononeuropathy in patients on hemodialysis, often caused by dialysis-related amyloidosis?
Carpal tunnel syndrome
What part of the spinal cord contains pain/temperature and LMN?
Anterior cord
What part of the spinal cord contains light touch/proprioception and some UMN?
Posterior cord
What part of the cord is associated with arm motor function and can be damaged during whiplash?
Central cord
What’s the most common cause of spontaneous lobar hemorrhage in adults >60?
Cerebral amyloid angiopathy
