merchut handouts

Question 1

mononeuropathy vs polyneuropathy- what comes first? demyelination or axonal degeneration?

Answer 1

mono- demyelination

poly- axonal degeneration

Question 2

when sural nerve is biopsied, where is there permanent numbness?

Answer 2

along lateral foot

Question 3

in GBS, immune system attacks what?

Answer 3

peripheral nerve myelin

Question 4

are there loss of reflexes in myopathy?

Answer 4

later in the game after severe atrophy

Question 5

diagnosis of myopathy

Answer 5

CK

EMG- confirms- r/o neuropathy, motor neuron dz

muscle biopsy in some patients

Question 6

dx and tx of polymyositis

Answer 6

dx: clinical, EMG supports, muscle biopsy shows inflamm cells amidst necrotic and regenerating muscle fibers
tx: corticosteroids, immunsopressants

Question 7

myotonia

Answer 7

impaired relaxation of muscle after contraction (cant let go shaking hands)

Question 8

myotonic dystrophy 1 cause

Answer 8

aut dom- excessive trinucletodie repeats- chrom 19

–> abnl protein kinase in muscle fibers

Question 9

myotnic dystrophy presentation

Answer 9

weakness- distal limbs, neck, jaw

somatic sxs- cataracts, bald, infertile, arrythmias

Question 10

spinal muscle atrophy is a group of disorders affecting…

Answer 10

anterior horn cells (LMN weakness)

Question 11

primary lateral sclerosis is …

Answer 11

familial degeneration of CST in lateral columns

–> UMN signs

Question 12

pseudobulbar palsy presentation

Answer 12

only CBT involved- facial weakness

jaw (jaw jerk inc), , dysarthria, dysphagia, hoarse

Question 13

pseudobulbar palsy etiologies

Answer 13

infarct
tumor
MS
brain trauma

Question 14

The first REM period occurs about _____ after sleep begins, and reoccurs about every _____ thereafter, lasting only ______ at first, and subsequently lengthening in duration to _____ or so.

Answer 14

90 minutes

90 minutes

few minutes

an hour

Question 15

does REM increase or decrease with age?

Answer 15

decrease

Question 16

ascending reticular activating system (ARAS), important for arousal, arises from these 4 places

Answer 16

rostral pons,
caudal midbrain,
posterior hypothalamus
basal forebrain nuclei

Question 17

ARAS suppresses the

Answer 17

ventrolateral preoptic area of the hypothalamus- where REM and NREM are promoted

Question 18

what activates the brain stem gaze centers responsible for the characteristic rapid, conjugate eye movements during REM, and induces hypotonia and increased autonomic activity by descending reticulospinal pathways?

Answer 18

pontine REM center

Question 19

overnight sleep study includes what monitoring

Answer 19

EEG, EKG, oximetry, respiratory and videotape monitoring.

Question 20

cause of narcolepsy

Answer 20

deficiency of certain neurons in the dorsolateral hypothalamus which release the excitatory peptide hypocretin (also called orexin), and project to the locus ceruleus and cholinergic neurons of the basal forebrain.

Question 21

night terrors and sleep walking occurs in what stage of sleep?

Answer 21

stage 4

Question 22

REM behavior disorder presentation

Answer 22

older male patients lack the normal hypotonia of REM. They appear to be “acting out” their dreams, vigorously kicking, punching or running during REM, to the point of injuring themselves or their bedpartner

Question 23

REM behavior disorder often precedes the onset of

Answer 23

Parkinson’s disease or Lewy body dementia.

Question 24

where are oligodendrogliomas located?

Answer 24

frontal lobe in adults

Question 25

where are medulloblastomas located?

Answer 25

roof of 4th ventricle?

Question 26

where are ependymomas located

Answer 26

4th ventricles- kids

filum terminale- adults

Question 27

Meningeal carcinomatosis

Answer 27

where cancer cells spread throughout the CSF, depositing over different areas of cerebral cortex, cranial nerve or spinal nerve roots

Question 28

dx and tx of Meningeal carcinomatosis

Answer 28

dx: someone with known malignancy has mental status change or focal neuro deficits. confirm with CSF cytology
tx: intrathecal chemo

Question 29

whats the the most common benign brain tumor?

Answer 29

meningioma

Question 30

CNS tumors affecting the spinal cord are often which types?

Answer 30

meningiomas or ependymomas.