Kaplan- Neuro 2

Question 1

tricyclic antidepressants act on what receptor and what effect does this have on cAMP

Answer 1

TCA’s antagonize D2 receptors leading to increased cAMP

normal D2 receptor activity downregulates cAMP

Question 2

what part of the brainstem controls vertical eye movements and eyelid elevation (hint: this is why it is spared in locked-in syndrome)

Answer 2

rostral midbrain (rostral interstitial nucleus of MLF and interstitial nucleus of Cajal)

Question 3

what are intracytoplasmic eosinophilic inclusions in neurons called

Answer 3

Lewy bodies

Question 4

what are Pick bodies

Answer 4

round intracytoplasmic bodies that contain altered tau, ubiquitin and neurofilament

Question 5

what do Lewy bodies contain

Answer 5

alpha-synuclein or ubiquitin

Question 6

disruption of what brainstem structure will cause extrapyramidal symptoms

Answer 6

substantia nigra

Question 7

what hormone levels should you make sure to check in a patient on lithium?

Answer 7

TSH (Lithium causes decreased TSH and thereby decreased thyroid hormones)

Question 8

name the two streams of higher-order visual processing

Answer 8

dorsal pathway (parieto-occipital association cortex) (hair=where) relays visiospatial information

ventral pathway (temporo-occipital association cortex) (gut=what) relays information about colors, faces, symbols

Question 9

what is the most common cause of ring-enhancing lesions in HIV patients

Answer 9

toxoplasmosis

Question 10

what does CNS toxoplasmosis present like and what is seen on histology

Answer 10

CNS toxoplasmosis presents as AMS, seizures, or focal neurologic deficits;

on histology: necrotic, hemorrhagic lesions with round encysted bradyzoites (inactive) or crescent-shaped tachyzoites

Question 11

central necrosis surrounded by granulation tissue and gliosis suggests what kind of infection?

Answer 11

bacterial abscess

Question 12

what nerve provides sensation for the anatomical snuffbox

Answer 12

radial nerve

Question 13

a patient with acute onset right homonomous hemianopia and intact visual acuity most likely has an infarct in which vessel

Answer 13

left PCA (macular sparing suggests the lesion is in the occipital lobe rather than one of the nerve tracts)

Question 14

what vision defect does occlusion of the ophthalmic artery cause

Answer 14

monocular blindness

Question 15

what is the most common cause of viral encephalitis in the U.S. and what region of the brain does it most commonly affect

Answer 15

HSV-1;

temporal lobe

Question 16

what are the preferred benzos (name 3) for a patient with liver disease (i.e. alcoholics) and why are they preferred

Answer 16

“LOT” lorazepam, oxazepam and temazepam
better for patients with unhealthy livers because their metabolism is phase II rather than phase I, which starts to fail in liver disease; they also have less active metabolites

Question 17

a central scotoma is likely due to a lesion where

Answer 17

the macula

Question 18

what is the visual toxicity of ethambutol

Answer 18

optic neuropathy

Question 19

a decline in cognitive function and gait as well as hypertonicity and dysarthria and abnormal EEG waves, all of which develop over the course of several months would likely involve what pathognomonic finding on autopsy

Answer 19

spongiform change in gray matter (CJD)

-rapidly progressing dementia with abnormal EEG findings suggests CJD

Question 20

what nerve provides sensory innervation to the mucosa above the vocal cords?
below the vocal cords?

Answer 20

the internal branch of the superior laryngeal nerve supplies the mucosa above the vocal cords while the recurrent laryngeal nerve supplies the mucosa below the vocal cords

Question 21

what is Werdnig-Hoffman disease and what part of the nervous system does it affect

Answer 21

spinal muscle atrophy due to perinatal programmed cell death that continues postnatally
anterior horn is affected

Question 22

neuons of the spinal cord are myelinated by what kind of cell

Answer 22

oligodendrocytes, NOT Schwann cells (even though it’s not the brain the spinal cord is still CNS)

Question 23

which drugs tend to predispose to or cause acute angle glaucoma

Answer 23

anticholingergics and drugs with anticholinergic effects like amitryptiline, topiramate, cyclobenzaprine,

Question 24

what are some key signs and symptoms of acute angle glaucoma

Answer 24

headache, seeing halos around lights, nausea/ vomiting, severe ocular pain, corneal edema and high IOP

Question 25

what is the name of the condition in which a patient cannot recognize faces
and what kind of lesion produces this deficit

Answer 25

prosopagnosia; caused by bilateral lesion of the visual association cortex

Question 26

what is anosognosia and what lesion produces this condition

Answer 26

a lack of awareness or understanding the one is suffering from a condition; usually caused by large lesion of nondominant parietal lobe producing lack of awareness of sensory or motor deficits

Question 27

what serum marker can be used to test for myelomeningocele (either in maternal serum or amniotic fluid)

Answer 27

alfa-fetoprotein

Question 28

name all of the ventricles of the brain and their origins

Answer 28

lateral ventricles (telencephalon), third ventricle (diencephalon), cerebral aqueduct (mesencephalon), upper half of 4th ventricle (metencephalon), lower half of 4th ventricle (myelencephalon)

Question 29

what is albuminocytologic dissociation and what disease is it characteristic for

Answer 29

albuminocytologic dissociation is when there is an increase in CSF protein, but no increase in CSF cell count; characteristic of Guillan Barre syndrome (an autoimmune demyelinating disorder that causes ascending polyneuropathy, usually following GI or upper respiratory infection. It spontaneously resolves.)

Question 30

Flexner-Wintersteiner rosettes (cuboidal-to-columnar cells surrounding a central lumen) found in a tumor of a child’s eye suggests what disease and what chromosome association

Answer 30

retinoblastoma; chromosome 13

Question 31

mutation on what chromosome is associated with Wilm’s tumor

Answer 31

chromosome 11

Question 32

what chromosome is p53 on

Answer 32

chromosome 17

Question 33

what chromosomes are associated with BRCA-1 and BRCA-2

Answer 33

BRCA-1 is on chromosome 17

BRCA-2 is on chromosome 13

Question 34

what chromosomes are associated with NF-1 and NF-2

Answer 34

NF-1 is on chromosome 17

NF-2 is on chromosome 22

Question 35

what nerve is found along the upper border of the greater sciatic foramen above the piriformis muscle and what muscles does this nerve innervate

Answer 35

superior gluteal nerve;

it innervates the gluteus medius, gluteus minimus, tensor fascia latae muscles

Question 36

what does the inferior gluteal nerve innervate and where does it exit the pelvis

Answer 36

the inferior gluteal nerve innervates the gluteus maximus and it exits the pelvis at the inferior border of the greater sciatic foramen below the piriformis muscle

Question 37

what three nerves pass through the inferior border of the greater sciatic foramen and what nerve passes through the superior border

Answer 37

inferior gluteal, pudendal and sciatic nerves pass through the inferior border
superior gluteal passes through the superior border

Question 38

what symptom can help differentiate amphetamine use from PCP use

Answer 38

nystagmus; both drugs cause hypertension, tachycardia and diaphoresis, but PCP causes vertical and horizontal nystagmus while amphetamines do not

Question 39

what are the symptoms of PCP use

Answer 39

mental: disorientation, detachment, distortions of body image, reckless behavior, impaired judgment
somatic: horizontal and vertical nystagmus, hypertension, tachycardia, diaphoresis, lack of motor coordination and numbness

Question 40

what pathology is associated with dry beri beri

what pathology is associated with wet beri beri

Answer 40

dry beri beri involves polyneuropathy

wet beri beri involes dilated cardiomyopathy

Question 41

what visual deficit do patients with Wernicke’s aphasia commonly present with and why

Answer 41

upper quadrantanopia because Meyer’s loop (the more inferior of the optic radiations) passes near Wernicke’s area in the superior temporal lobe

Question 42

what nerve innervates the parotid glands

Answer 42

glossopharyngeal

Question 43

what nerve provides sensory input for the thoracic viscera

Answer 43

vagus

Question 44

what nerve provides taste sensation to the epiglottis

Answer 44

vagus

Question 45

how do you differentiate acute meningitis from chronic meningitis

Answer 45

acute and chronic meningitis can be differentiated by the cellular findings in the CSF

acute: either increased neutrophils (pyogenic) or increased lymphocytes (lymphocytic)
chronic: increased lymphocytes, plasma cells, macrophages and fibroblasts

Question 46

name some causes of chronic meningitis and name some causes of acute meningitis

Answer 46

chronic meningitis: TB, syphilis, brucellosis, fungal

acute meningitis: strep pneumo, neisseria meningitidis

Question 47

what disease is characterized by ophthalmoplegia, pseudobulbar palsy (difficulty chewing and speaking), axial dystonia and bradykinesia, (normal cognition)

Answer 47

progressive supranuclear palsy: a neurodegenerative condition with widespread neuron loss and gliosis in subcortical sites with sparing of cerebral and cerebellar cortices

Question 48

what are common tumors in von Hippel Lindau

Answer 48

retinal angiomas, hemangioblastomas (often of the cerebellar area), renal carcionoma, cystic or angiomatous lesions of various organs (epididymus, pancreas, lungs, liver)

Question 49

name two characteristic cancers found in Sturge-Weber disease

Answer 49

port-wine nevus of the head; leptomeningeal angiomatosis

Question 50

what does subacute sclerosing panencephalitis cause in a patient and what infection is it the result of

Answer 50

SSPE results from measles infection (usually in childhood)
patients experience cognitive decline, behavioral changes, seizures, ataxia and focal neurologic deficits leading to eventual death