From Questions- Nervous system Flashcards
What is the immune disorder characterized by inflammation of a specific segment of the spinal cord?
transverse myelitis
How can you differentiate transverse myelitis from guianne barre?
GBS is associated with LMN symptoms - flacid paralysis
transverse myelitis can present with UMN symptoms
BOTH commonly come after an infection
First-line treatment & prophylaxis cluster headache?
treatment: 100% oxygen / sumatriptan
prophylaxis: verapamil
Treatmetn & prophylaxis migraines?
treatment: triptan
prophylaxis: amitriptyline / valproate
What braincancer is associated with VHL? It secretes what cytokine?
hemangioblastoma (in cerebellum)
secreting erythropoietin - leading ot polycythemia
How can you differentiate bell’s palsy from AICA stroke?
AICA stroke - loss of pain & temp on one side of the face & opposite side of the body, vertigo, nystagmus, ataxia, ipsilateral Horner syndrome
anti-NMDA antibody syndrome is most commonly associated with what neoplasm?
What other non-malignant condition?
ovarian teratoma
HSV encephalitis
increased ammonia leads to what problems?
increased release of inhibitory neurotransmitters (GABA)
decreased release of excitatory neurotransmitters
MOA of triptans?
5-HT1B & 1D agonists - decreases the release of CRGP & substance P - therefore causing vasoconstriction and diminished transmission of pain
What are the 3 anatomic areas affected in neurosyphilis?
dorsal columns - loss vibratory & proprioception (ataxia)
cortex - dementia & behavioral changes
pretechtal area - argyll robertson pupils
What is the most common site of ependyoma?
fourth ventricle
What is the most common malignant primary bran tumor in children?
Histological findings?
medulloblastoma
rosettes - small blue tumor cells that surround a fibrotic core
Histological findings of pilocytic astrocytoma?
eosinophilic, corkscrew fibers
Glioblastoma multiorme arises from what cell type?
meningiomas?
glioblastoma: astrocyte
meningioma: arachnoid cells in the meninges
What are the dopamine agonists that are used in the treatment of parkinsons?
ergot: bromocriptine
non-ergot: pramipexole & ropinirole
both are used to treat motor symptoms in patients with parkinsons
Pattern of inheritance & chromosome affected in NFT1?
Cutaneous features?
Neurologic features?
Other features?
- 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
Pattern of inheritance & chromosome affected in NFT2?
Cutaneous features?
Neurologic features?
Other features?
- Inheritance
- chromosome 22
- cutaneous
- none
- neurologic
- bilateral acoustic neuromas
- meningiomas
- gliomas
- neurofibromas
- other
- cataracts
- scoliosis
Describe the flow of sympathetic nerve fibers fromthe spinal cord to exiting the sympathetic column
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
Location of injury for damage to the common peroneal nerve vs tibial nerve? Symptoms?
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
Clinical features & diagnostic criteria CJD?
onset 50-70, rapidly progressive dementia & myoclonus
elevated 14-3-3 protein titers & periodic sharp wave EEG
What is bruxism & what stage of sleep does it occur?
Feature of this stage of sleep?
teeth grinding
K-complexes & sleep spindles (N2)
What is the network of neurons that controls arousal & consciousness? What is its course?
reticular activatign system (RAS)
projects from midbrain, through thalamus & into cerebellum
What is the best test to confirm prior infection in a patient suspected of tertiary syphilis?
fluorescent treponemal antibody absorption (FTA-ABs)
Difference between simple & complex seizure?
complex - loss of consciousness
Laboratory finding seen in the diagnosis of Alzheimer’s disease?
diffuse atrophy of the cortex
B-amyloid plaques (apple-green birefringence on polarized light)
neurofibrillary tangles
granulovacuolar degeneration & Hirano bodies
Difference in fundoscopic examination of a patient with central retinal arteyr occlusion & retinal vein occlusion?
- CRAO:
- cloudy, pale retina
- cherry-red spot on the fovea
- RVO:
- optic disc swelling
- dilated veins
- retinal hemorrhages
- cotton wool spots
Typical presentation of a patient with giant cell (temporal) arteritis?
elderly female, presenting with new-onset and severe unilateral headache, fever, malaise, temporal tenderness & jaw claudication
elevated ESR & normal CK
Metachromatic dystrophy is due to a deficiency in what enzyme?
Symptoms?
arylsulfatase A
discrete plaques of demyelination - sparing subcoritcal (U) fibers
worsening motor fibers & intellectual disabillity
What should you give first:
glucose or thiamine?
THIAMINE FIRST
necessary for proper glucose metabolism, so if give glucose first, you can precipitate symptoms of Wernicke encephalopathy
What are the neurotransmitters affected in Huntington’s? In what direction are they affected?
decreased GAMA & ACh
Increased Dopamine
What are the neurotransmitters affected in Parkinson’s? In what direction are they affected?
Increased ACh
Decreased Dopamine & Serotonin
What are the neurotransmitters affected in Alzheimer’s? In what direction are they affected?
decreased ACh
What are the neurotransmitters affected in Depression? In what direction are they affected?
decreased dopamine, serotonin, NE
What are the neurotransmitters affected in anxiety? In what direction are they affected?
decreased GABA & serotonin,
increased NE
Lesions in the the following lobes result in what type of visual defecits bilaterally?
parietal
temporal
occipital
parietal: interior quadrant
temporal: superior quadrant
occipital: macular sparing
What do you see in the CSF of a patient with MS?
Oligoclonal IgG bands
elevated levels myelin basic protein
Key diagnostic features of MS
worsens w/ rising body temperatuer (working out)
swelling of the optic disk w/c papilledema
eye pain worsens w/ movement
What nerve passes anteriorly to the bifurcation of the common carotid?
Posteriorly?
anterior - hypoglossal
posterior - recurrent laryngeal nerve (branch of CNX)
What is the cause of internuclear ophthalmoplegia seen in MS?
Symptoms?
d/t damage to the MLF
conjugate gaze palsy & impaired adduction of the eye ipsilateral to the site of damage
Common presentation of a patient with damage to their inferior gluteal nerve?
trouble with hip extension, climbing stairs, or rising from a seated position
MC after a fall/trauma that causes a posterior hip dislocation
What are the respective positions of the facial, vestibular & cochlear nerves within the fundus of the internal auditory meatus?
2 thin crests of bones to form 3 separate canals
facial: superior
cochlear: inferior
vestibular: posterior
How can you assess thiamine (vit B1) deficiency?
erythrocyte transketolase activity
What is Foster Kennedy Syndrome?
meningiomas arising from the olfactory groove
compression/atrophy ipsilateral optic nerve
intracranial hypertension (optic disc swelling)
olfactory degeneration
What are the 4 tumors associated with psomma bodies?
PSaMM
papillary thyroid carcinoma
serous ovarian carcinoma
mesothelioma
meningioma
Mutation in classical vs. vascular Ehlers Danlos Syndrome?
Classical - collagen type V (COL5A1, COL5A2)
vascular - collagen type III (COL3A1)
Hearing loss secondary to recurrant otitis media is what type of hearing loss?
conductive hearing loss
Spinal level of inferior glueal nerve?
L5-S2
Where is the hypoglossal canal located?
posterior fossa
superior & medial aspect of the occipital condyles
Genetic cause of Friedrich Ataxia?
Causes what mutation?
GAA repeat on chromosome 9
oxidative damage d/t mitochondrial accumulation of iron
What are the tumors seen with VHL disease?
pheochromocytoma
hemangioblastoma (retina, brain stem, cerebellum, spine)
angiostomatosis
bilateral renal cell carcinoma
Cardiac rhabdomyomas are seen in what genetic condition?
Tuberous sclerosis
chromosome 16
major complication of acyclovir?
crystaline nephropathy
(AKI)
To prevent ODS, what rate shoudl serum sodium be corrected?
not excede 0.5mEq/L/hr
Mannitol is CI in patients with what condition?
congestive heart failure
b/c it can lead to pulmonary edema b/c it causes water to move out of cells & into extracellular compartment
Why can pinealomas result in vertical gaze palsy?
they can compress the superior colliculus
What do you need to test a patient for before starting them on rituximab therapy?
JC virus -
can precipitate PML
Histopathology seen in patients with frontotemporal lobe dementia?
D/t what mutation?
hyperphosphorylated tau proteins (tau cytoplasmic inclusion bodies)
mutation MAPT gene on chromosome 17
List the correct order of penetration by a needle for a lumbar puncture
skin
subcutaneous tissue
ligamentum flavum
epidural space
dura mater
subdural space
arachnoid space
subarachnoid space
What lesions are associated with first neuron Horner syndrome?
pontine hemorrhage
lateral medullary syndromes
spinal cord lesion above T1
What lesions are associated with second neuron Horner syndrome?
compression of the stellage ganglion by a pancoast tumor (anterior to C7 transverse process)
What lesions are associated with third neuron Horner syndrome?
carotid dissection
What is the other name for Sturge-Weber synrome?
It is caused by what genetic mutation?
encephalotrigeminal angiomatosis
GNAQ- affects cappilary sized blood vessels in CNV1 & CNV2 distributions
Huntingtons has what type of anticipation?
What is the repeat?
On what chromosome?
paternal - sequence is less stable during spermatogenesis
CAG repeat on HTT gene on chromosome 4
