General Neuro Questions Flashcards
(161 cards)
1
Q
criteria when comparing different states of consciousness
A
awareness, wakefulness, brainstem/respirations, motor
2
Q
5 neurological levels assessed in comatose patients
A
LOC, respiration, pupils, oculomotor/vestibular, and motor
3
Q
cheyne-stokes happens when what level of CNS is affected
A
lower diencephalon/ upper mesencephalon
4
Q
central neurogenic hyperventilation happens when what level of CNS is affected
A
midbrain
5
Q
Apneustic breathing (ie long arrest after inhalation) occurs when what level of the CNS is affected
A
pon
6
Q
Ataxic breathing occurs when what level of the CNS is affected
A
pons/medulla
7
Q
Apnea occurs when what level of the CNS is affected
A
medulla
8
Q
decorticate posturing occurs when what level of the CNS is affected
A
upper midbrain
9
Q
decerebate occurs when what level of the CNS is affected
A
upper pontine
10
Q
are arms extended in decorticate or decerebrate posturing
A
decerebrate
11
Q
4 criteria for brain death
A
deep coma, lack of response to stimulus, lack of pupillary response, ventilator dependence
12
Q
level I brain death
A
lack of awareness, no voluntary behavioral response, no language
13
Q
level 2 brain death
A
present sleep wake cycles, preserved autonomic/hypothalamic fxn, preserved CN reflexes
14
Q
wakefulness
definition and part of CNS that is responsible
A
arousal and ability and readiness to respond to environment and stimuli
provided by reticular brainstem and its thalamic and forebrain projections
15
Q
awareness definition and part of CNS that is responsible
A
understanding of relationship to self and environment provided by thalamocortical and corticocortical circuits
16
Q
how does locked in syndrome happen?
A
large infarction/ hemorrhage in pontine tegmentum and base
17
Q
what is used to treat minimally conscious state?
A
rehab, levodopa, SSRIs, stimulants, DBS
18
Q
is wakefulness a prerequisite for awareness or is awareness a prerequisite for wakefulness
A
wakefulness is a prereq for awareness
19
Q
which areas of the brain are most sensitive to anoxia
A
hippocampus, 3rd lamina in cortex, and purkinje cells of cerebellum
20
Q
which area of the brain is sensitive to methyl alcohol
A
putamen
21
Q
which area of the brain is sensitive to mercury poisoning
A
cerebellum
22
Q
which area of the brain is sensitive to B1/ thiamine
A
Wernicke’s and mammillary bodies
23
Q
which area of the brain is sensitive to B12 deficiency
A
white matter in lateral and dorsal columns
24
Q
which area of the brain is sensitive to Wilson’s disease/ copper accumulation
A
striatum
25
Bunina bodies are associated w/ which disease
ALS
26
Wallerian degeneration
degeneration of axon distal to injury. At area of transection neuron tries to regenerate and sends out multiple endings. Myelin sheath will start to fragment as secondry effect
27
What is dying back of a neuron
degeneration of distal segments of axon due to inability of cell body to maintain adequate axoplasmic flow or provide nutrition
28
What are axonal spheroids
swellings of axons usually from sublethal injury
29
what happens to Nissl substance when motor neurons get sick
it disappears or move to the side
30
Alzheimer's type II glia occurs how?
elevated ammonia or serum electrolyte abnormalities
31
what is dysarthria
trouble speaking
32
Brown sequard
hemitransection: hemiplegia and loss of DC-ML modalities on ipsilateral side of injury , loss of ALS modalities on contralteral side
33
Which dermatome is dorsal to great toe
L5
34
Which dermatome is at lateral heel
s1
35
Which dermatome is below medial knee
L4
36
Which dermatome is near thumb
c6
37
Which dermatome is near middle finger
c7
38
Which dermatome is by pinky
c8
39
what is scale used for muscle strength
0-5
40
how is Babinksi reported
absent or present
41
what is paratonia
involuntary variable resistance during passive movement
42
flaccidity is a sign up upper or lower motor neuron disease
lower
43
a waddling gait is a sign of what
gluteal weakness
44
what does a hemiplegic gait look like
circumducting
45
what is romberg sign
tests balance/proprioception. Has person try to stand still with eyes closed
46
sympathetics come from which spinal levels
T1- L2
47
does nerve damage cause proximal or distal weakness
distal
48
does myopathic process cause proximal or distal weakness
proximal
49
What is horner's syndrom
lesions in sympathetic
50
radial nerve injury causes what kind of weakness
weakness of wrist extension
51
how is mononeuropahty multiplex treated
steroids and IVIG
52
most common cause of polyneuropathy
diabetes
53
what are fibrillations
spontaneous depolarizations which are marker of active denervation
54
Riluzole is used to treat what disease
ALS
55
does Charcot Marie Tooth/ hereditary motor sensory neuropathy affect the proximal or distal muscles more?
distal
56
charcot marie tooth/ hereditary motor sensory neuropathy is what kind of neuromuscular diseae
hereditary neuropathy
57
pathology of CMT/ HMSN
demyelination or axonal damage
58
myotonic dystrophy pathology/ inheritance
trinucleotide repeats / AD/ Anticipation
59
type I myotonic dystrophy affects more proximal or distal muscles
distal
60
type II myotonic dystrophy affects more proximal or distal muscles
proximal
61
which muscles are most affected by mitochondiral disease
EOM
62
polymyositis treatment
prednisone, IVIG
63
Polymotositis presentation
insidious onset of proximal muscle weakness w muscle sorness
64
polymyositis etiology
autoimmune
65
dermatomyositis presentation
insidious onset of proximal muscle weakness, red/purple rash over eye lids and extensor part of joints
66
polymyositis typical onset
30-60
67
dermatomyositis typical onset
5-15 and 50-60
68
dermatomyositis can be an indicator of
malignancy
69
Lambert Eaton pathology
Abs directed against voltage gated calcium channels leads to reduced NT relase
70
does weakness w/ Lambert Eaton get worse or better w/ exercise
better
71
biceps reflex involves which nerve root and nerve
c6 musculocutaneous
72
brachioradialis reflex involves which nerve root
c6 radial
73
triceps reflex involves which nerve root and nerve
c7 radial
74
finger flexor reflex involves which nerve root and nerve
c8 median
75
patellar reflex involves which nerve root and nerve
L4 femoral
76
ankle reflex involves which nerve root and nerve
s1 sciatic
77
categories in Glasgow Coma scale
eye response, verbal response, best motor response
78
Time course in DAI
- 4-5 hours: accumulation of beta APP
- 12-24 hours: axonal varicosities
- 24hr - 2 months: axonal swelling and microglial nodules
- long term: wallerian degernation, atrophy
79
most DAI occurs where
mesencephalon and high pons
80
acceleration force from blow causes coup or contrecoup injury?
coup
81
acceleration force from fall causes coup or contrecoup injury?
countrecoup
82
medication overuse headaches usually present where?
bifrontal
83
which kind of hemorrhage can present w/ chemical meningitis and stiff neck?
subarachnoid
84
what do you see on LP of subarachnoid hemorrhage?
rbcs and xanthochromia
85
2 things that can cause thunderclap headache
SAH and cerebral venous sinus thrombosis
86
what is distinct diagnostic marker of arterial dissection
horner's
87
giant cell arteritis treated with what
steroids
88
classic patient w/ idiopathic/benign intracranial HTN
young obese women w/ polycystic ovary disease
89
mneumonic for red flags for headaches
```
S: systemic symptoms
N: neurologic symptoms
O: onset
O: older new onset/ rogressive
P: previous HA history if HA is first, different, or changing
```
90
what is meniere's disease caused by
increased pressure in endolymph of inner ear causes small ruptures in membranes and leads to mixing of endo and perilymph
91
myelin has more or less lipid and proteins than regular plasma membrane
lipid: more
protein: less
92
areas most commonly affected in MS
lateral ventricles, optic nerves, optic chiasm, along floor of 4th ventricle and adjacent to pial surface of spinal cord
93
which type of MS has conentric lesions on MRI
Balo's
94
adrenoleukodystrophy inheritance
X linked
95
ADL pathology
defect in peroxisomes so very long chain fatty acids accumulate
96
Globoid cell leukodystrophy/ Krabbe's disease pathology
deficiency of galactocerebroside B galactosidase
97
Globoid cell leukodystrophy/ Krabbe's disease inheritance
AR
98
Metachromatic Leukodystrophy inheritance
AR
99
metachromatic leukodystrophy pathology
low/ absent levels of arylsulfatase leads to accumulation of galactolipids/ sulfatides
100
which gene is involved in Pelizaeus-merzbacher disease
PLP
101
are Th1 or Th2 anti-inflammatory/ protective
Th2
102
In TNF or TGF anti-inflammatory/ protective
TGF
103
What Risk category is CIS
at risk
104
what % of people w/ CIS progress?
30-70%
105
where do most lesions in MS appear
periventricular: dawson's
juxtcortical
infratentorial
spinal cord
106
in MS T1 is used to look for
black holes/ atrophy
107
in MS T2/ Flair is used to look for
disease burden
108
in MS T1+ gad is used to look for
disruption of BBB
109
how does Glatiramer acetate work?
altered peptide ligand for MHC that acts as decoy for overactive immune cells
110
what is Ab used to treat MS and why is it second line
Natalizumab, PML
111
how do oligodendrogliomas often present
seizures
112
seizures in posterior pituitary cause what
diabetes insipidus
113
which tumor causes gigantism/ acromegaly
eosinophilic adenoma
114
which tumor causes cushing's hyperadrenalism
basophilic adenoma
115
ependymoma usually affect which age gruop
younger
116
parietal lobe = what kind of visual field deficit
inferior quadrantanopia from damage of optic raiations
117
temporal lobe damage = what kind of visual field deficit
superior quadrantanopia from damage to meyer's loops
118
what do astrocytoma cells look like histolgoically
naked nuclei, pilocytic, GFAP +
119
rosenthal material is characteristic of what kind of tumor
low grade astrocytic process
120
What is characteristic feature of oligodengolioma histology
fried egg appearance
121
What is characteristic feature of ependymoma histolgy
nuclear free zone around capillaries
122
What is characteristic feature of medulloblastoma/ primary neuroectodermal tumor?
cells w/ very little cytoplasm
| and rosettes
123
which type of rosette has a central lumen
Flexer-Witnersteiner
124
what kind of tumor has association w/ von Hippel Lindau
cerebellar hemangioblastoma
125
What is characteristic feature of meningioma histology
Psammoma bodies and whorling
126
What is characteristic feature of schwanomma histology
stream, spindle shaped cells w/ cigar shaped nuclei
| Verocay bodies
127
cafe au lait spots are associated w/
neurofibromatosis
128
hypopigmented ash leaf spots are associated w/
tuberous sclerosis
129
port wine stains are assoicated w/
Sturge Weber
130
what is most important part of pedi neuro exam
tone in motor portion
131
what is tone defined as
resistance to passive movement
132
what is moro reflex, when should it disappear
startle reflex, should disappear by 4 months
133
what is asymmetric tonic neck reflex ATNR, when should it disappear
fencer's posture appears around 6 weeks and persists until 6 months
134
when should lateral prop reflex appear
6 months
135
when should forward parachute appear
10-11 months
136
which epilepsy type is associated w/ SUDEP and SCN1A mutation
Dravet
137
spinal muscular atrophy inheritance
AR
138
What is a new, novel treatment for muscular dystrophy and how does it work
Eteplirsen = stop codon skipper
139
FT Dementia ia caused by an accumulation of what protein
amyloid
140
Pick's disease is caused by an accumulation of what protein
3R Tau
141
where does degenration occur in Pick's disease
anterior frontal lobe and anterior superior temporal gyrus
142
Parkinson's is caused by an accumulation of which protein
synuclein
143
lewy bodies are associated w/ what
parkinsons
144
Multiple System Atrophy is caused by an accumulation of hwat portein
synnuclien
145
what is characteristic histo finding of multiple system atrophy
glial cytoplasmic inclusions
146
progressive supranuclear palsy is associated w/ an accumulation of which protein
tau
147
multiple system atrophy is associated w/ atrophy in which section of the brain and which specific structure
midbrain
| putamen
148
what is histo finding in progressive supranuclear palsy
globose tangles in basal ganglia, brain stem
149
corticobasal degeneration is associated w/ accumulation of which protein
4R tau
150
what is difference b/w corticobasal degeneration and PSP
PSP has less tau
151
corticobasal degeneration affects which part of the brain
frontoparietal
152
presentation of PSP
multisystem degeneratin characterized by parkinsonism and supranuclear opthalmoplegia
153
tFDP-U is associated w/ accumulation of which protein
TD43
154
ALS is associated w/ accumulation of which protein
TD43
155
Huntington's affects which area of the brain
caudate nucelus
156
spinocerebellar ataxia inheritance
X linked
157
what kind of repeat for friedreich's ataxis
GAA
158
diagnosis of Parkinsons requries which 3 features
tremor, rigidity, bradykinesia
159
how are Parkinsons and Essential tremor different?
- when does it occur
- symmetry
- waht areas does it affect
```
parkinson= resting tremor
essential= action tremor
parkinsons= asymmetrical, unilateral at onset
essential= bilateral
parkinsons= hands/legs
essential= face, hands upper extremity more affected
```
160
list cns cells in sensitiveity to ischemia
```
neurons
oligos
astrocytes
endothelial
gial
```
161
3 major sites where hypertensive hemorrhages occur
basal ganglia, cereballar white matter, pons
