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From Questions- Nervous system Flashcards

1
Q

What is the immune disorder characterized by inflammation of a specific segment of the spinal cord?

A

transverse myelitis

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2
Q

How can you differentiate transverse myelitis from guianne barre?

A

GBS is associated with LMN symptoms - flacid paralysis

transverse myelitis can present with UMN symptoms

BOTH commonly come after an infection

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3
Q

First-line treatment & prophylaxis cluster headache?

A

treatment: 100% oxygen / sumatriptan
prophylaxis: verapamil

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4
Q

Treatmetn & prophylaxis migraines?

A

treatment: triptan
prophylaxis: amitriptyline / valproate

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5
Q

What braincancer is associated with VHL? It secretes what cytokine?

A

hemangioblastoma (in cerebellum)

secreting erythropoietin - leading ot polycythemia

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6
Q

How can you differentiate bell’s palsy from AICA stroke?

A

AICA stroke - loss of pain & temp on one side of the face & opposite side of the body, vertigo, nystagmus, ataxia, ipsilateral Horner syndrome

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7
Q

anti-NMDA antibody syndrome is most commonly associated with what neoplasm?

What other non-malignant condition?

A

ovarian teratoma

HSV encephalitis

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8
Q

increased ammonia leads to what problems?

A

increased release of inhibitory neurotransmitters (GABA)

decreased release of excitatory neurotransmitters

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9
Q

MOA of triptans?

A

5-HT1B & 1D agonists - decreases the release of CRGP & substance P - therefore causing vasoconstriction and diminished transmission of pain

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10
Q

What are the 3 anatomic areas affected in neurosyphilis?

A

dorsal columns - loss vibratory & proprioception (ataxia)

cortex - dementia & behavioral changes

pretechtal area - argyll robertson pupils

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11
Q

What is the most common site of ependyoma?

A

fourth ventricle

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12
Q

What is the most common malignant primary bran tumor in children?

Histological findings?

A

medulloblastoma

rosettes - small blue tumor cells that surround a fibrotic core

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13
Q

Histological findings of pilocytic astrocytoma?

A

eosinophilic, corkscrew fibers

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14
Q

Glioblastoma multiorme arises from what cell type?

meningiomas?

A

glioblastoma: astrocyte
meningioma: arachnoid cells in the meninges

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15
Q

What are the dopamine agonists that are used in the treatment of parkinsons?

A

ergot: bromocriptine

non-ergot: pramipexole & ropinirole

both are used to treat motor symptoms in patients with parkinsons

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16
Q

Pattern of inheritance & chromosome affected in NFT1?

Cutaneous features?

Neurologic features?

Other features?

A
  • Inheritance
    • 100% penetrance
    • chromosome 17
    • variable expresivity
  • Cutaneous
    • cafe au lait
    • cutaneous neurofibromas
    • lisch nodules (pigmented hamartomas)
  • neurologic features
    • optic gliomas
    • meningiomas
    • intellectual disability
  • other
    • pheo
    • bone lesions
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17
Q

Pattern of inheritance & chromosome affected in NFT2?

Cutaneous features?

Neurologic features?

Other features?

A
  • Inheritance
    • chromosome 22
  • cutaneous
    • none
  • neurologic
    • bilateral acoustic neuromas
    • meningiomas
    • gliomas
    • neurofibromas
  • other
    • cataracts
    • scoliosis
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18
Q

Describe the flow of sympathetic nerve fibers fromthe spinal cord to exiting the sympathetic column

A

intermediolateral columns of spinal cord

exit via the ventral nerve root

enter sympathetic chain via white ramus communicans

synapse or travel up/down

exit via grey ramus communicans

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19
Q

Location of injury for damage to the common peroneal nerve vs tibial nerve? Symptoms?

A

Common peroneal - fibular head; problems w/ dorsiflexion & loss of sensation on dorsal portion of foot and lateral leg

Tibial - poplieal fossa; problems with flexing toes, inverting and plantar flexing foot + sensorly loss over sole of foot

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20
Q

Clinical features & diagnostic criteria CJD?

A

onset 50-70, rapidly progressive dementia & myoclonus

elevated 14-3-3 protein titers & periodic sharp wave EEG

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21
Q

What is bruxism & what stage of sleep does it occur?

Feature of this stage of sleep?

A

teeth grinding

K-complexes & sleep spindles (N2)

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22
Q

What is the network of neurons that controls arousal & consciousness? What is its course?

A

reticular activatign system (RAS)

projects from midbrain, through thalamus & into cerebellum

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23
Q

What is the best test to confirm prior infection in a patient suspected of tertiary syphilis?

A

fluorescent treponemal antibody absorption (FTA-ABs)

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24
Q

Difference between simple & complex seizure?

A

complex - loss of consciousness

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25
Q

Laboratory finding seen in the diagnosis of Alzheimer’s disease?

A

diffuse atrophy of the cortex

B-amyloid plaques (apple-green birefringence on polarized light)

neurofibrillary tangles

granulovacuolar degeneration & Hirano bodies

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26
Q

Difference in fundoscopic examination of a patient with central retinal arteyr occlusion & retinal vein occlusion?

A
  • CRAO:
    • cloudy, pale retina
    • cherry-red spot on the fovea
  • RVO:
    • optic disc swelling
    • dilated veins
    • retinal hemorrhages
    • cotton wool spots
27
Q

Typical presentation of a patient with giant cell (temporal) arteritis?

A

elderly female, presenting with new-onset and severe unilateral headache, fever, malaise, temporal tenderness & jaw claudication

elevated ESR & normal CK

28
Q

Metachromatic dystrophy is due to a deficiency in what enzyme?

Symptoms?

A

arylsulfatase A

discrete plaques of demyelination - sparing subcoritcal (U) fibers

worsening motor fibers & intellectual disabillity

29
Q

What should you give first:

glucose or thiamine?

A

THIAMINE FIRST

necessary for proper glucose metabolism, so if give glucose first, you can precipitate symptoms of Wernicke encephalopathy

30
Q

What are the neurotransmitters affected in Huntington’s? In what direction are they affected?

A

decreased GAMA & ACh

Increased Dopamine

31
Q

What are the neurotransmitters affected in Parkinson’s? In what direction are they affected?

A

Increased ACh

Decreased Dopamine & Serotonin

32
Q

What are the neurotransmitters affected in Alzheimer’s? In what direction are they affected?

A

decreased ACh

33
Q

What are the neurotransmitters affected in Depression? In what direction are they affected?

A

decreased dopamine, serotonin, NE

34
Q

What are the neurotransmitters affected in anxiety? In what direction are they affected?

A

decreased GABA & serotonin,

increased NE

35
Q

Lesions in the the following lobes result in what type of visual defecits bilaterally?

parietal

temporal

occipital

A

parietal: interior quadrant
temporal: superior quadrant
occipital: macular sparing

36
Q

What do you see in the CSF of a patient with MS?

A

Oligoclonal IgG bands

elevated levels myelin basic protein

37
Q

Key diagnostic features of MS

A

worsens w/ rising body temperatuer (working out)

swelling of the optic disk w/c papilledema

eye pain worsens w/ movement

38
Q

What nerve passes anteriorly to the bifurcation of the common carotid?

Posteriorly?

A

anterior - hypoglossal

posterior - recurrent laryngeal nerve (branch of CNX)

39
Q

What is the cause of internuclear ophthalmoplegia seen in MS?

Symptoms?

A

d/t damage to the MLF

conjugate gaze palsy & impaired adduction of the eye ipsilateral to the site of damage

40
Q

Common presentation of a patient with damage to their inferior gluteal nerve?

A

trouble with hip extension, climbing stairs, or rising from a seated position

MC after a fall/trauma that causes a posterior hip dislocation

41
Q

What are the respective positions of the facial, vestibular & cochlear nerves within the fundus of the internal auditory meatus?

A

2 thin crests of bones to form 3 separate canals

facial: superior
cochlear: inferior
vestibular: posterior

42
Q

How can you assess thiamine (vit B1) deficiency?

A

erythrocyte transketolase activity

43
Q

What is Foster Kennedy Syndrome?

A

meningiomas arising from the olfactory groove

compression/atrophy ipsilateral optic nerve

intracranial hypertension (optic disc swelling)

olfactory degeneration

44
Q

What are the 4 tumors associated with psomma bodies?

A

PSaMM

papillary thyroid carcinoma

serous ovarian carcinoma

mesothelioma

meningioma

45
Q

Mutation in classical vs. vascular Ehlers Danlos Syndrome?

A

Classical - collagen type V (COL5A1, COL5A2)

vascular - collagen type III (COL3A1)

46
Q

Hearing loss secondary to recurrant otitis media is what type of hearing loss?

A

conductive hearing loss

47
Q

Spinal level of inferior glueal nerve?

A

L5-S2

48
Q

Where is the hypoglossal canal located?

A

posterior fossa

superior & medial aspect of the occipital condyles

49
Q

Genetic cause of Friedrich Ataxia?

Causes what mutation?

A

GAA repeat on chromosome 9

oxidative damage d/t mitochondrial accumulation of iron

50
Q

What are the tumors seen with VHL disease?

A

pheochromocytoma

hemangioblastoma (retina, brain stem, cerebellum, spine)

angiostomatosis

bilateral renal cell carcinoma

51
Q

Cardiac rhabdomyomas are seen in what genetic condition?

A

Tuberous sclerosis

chromosome 16

52
Q

major complication of acyclovir?

A

crystaline nephropathy

(AKI)

53
Q

To prevent ODS, what rate shoudl serum sodium be corrected?

A

not excede 0.5mEq/L/hr

54
Q

Mannitol is CI in patients with what condition?

A

congestive heart failure

b/c it can lead to pulmonary edema b/c it causes water to move out of cells & into extracellular compartment

55
Q

Why can pinealomas result in vertical gaze palsy?

A

they can compress the superior colliculus

56
Q

What do you need to test a patient for before starting them on rituximab therapy?

A

JC virus -

can precipitate PML

57
Q

Histopathology seen in patients with frontotemporal lobe dementia?

D/t what mutation?

A

hyperphosphorylated tau proteins (tau cytoplasmic inclusion bodies)

mutation MAPT gene on chromosome 17

58
Q

List the correct order of penetration by a needle for a lumbar puncture

A

skin

subcutaneous tissue

ligamentum flavum

epidural space

dura mater

subdural space

arachnoid space

subarachnoid space

59
Q

What lesions are associated with first neuron Horner syndrome?

A

pontine hemorrhage

lateral medullary syndromes

spinal cord lesion above T1

60
Q

What lesions are associated with second neuron Horner syndrome?

A

compression of the stellage ganglion by a pancoast tumor (anterior to C7 transverse process)

61
Q

What lesions are associated with third neuron Horner syndrome?

A

carotid dissection

62
Q

What is the other name for Sturge-Weber synrome?

It is caused by what genetic mutation?

A

encephalotrigeminal angiomatosis

GNAQ- affects cappilary sized blood vessels in CNV1 & CNV2 distributions

63
Q

Huntingtons has what type of anticipation?

What is the repeat?

On what chromosome?

A

paternal - sequence is less stable during spermatogenesis

CAG repeat on HTT gene on chromosome 4

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