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Board questions > Misc First Aid > Flashcards

Misc First Aid Flashcards

1
Q

CL paralysis and sensory loss - lower limb

artery?

area of lesion?

A

anterior cerebral artery

motor and sensory cortices - lower limb

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2
Q

CL paralysis and sensory loss - face and upper limb; aphasia if in dominant hemisphere; hemineglect if lesion affects nondominant side

artery?

area of lesion?

A

middle cerebral artery

motor and sensory cortices - upper limb and face

temporal lobe - wernicke area; frontal lobe - broca area

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3
Q

Wernicke aphasia is a/w what visual field defect?

why?

A

right superior quadrant visual field defect due to temporal lobe involvement

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4
Q

CL paralysis and or sensory loss - face and body; absence of cortical signs (eg neglect, aphasia, visual field loss)

artery?

area of lesion?

A

lenticulostriate artery

striatum, internal capsule

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5
Q

common location of lacunar infarcts due to hyaline arteriosclerosis secondary to unmanaged HTN

A

striatum, internal capsule

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6
Q

CL paralysis - upper and lower limbs

artery?

area of lesion?

A

anterior spinal artery

lateral corticospinal tract

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7
Q

decreased CL proprioception

artery?

area of lesion?

A

anterior spinal artery

medial lemniscus

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8
Q

ipsilateral hypoglossal dysfunction (tongue deviates ipsilaterally)

artery?

area of lesion?

A

anterior spinal artery

caudal medulla - hypoglossal nerve

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9
Q

what is caused by infarct of paramedian branches of ASA and/or vertebral arteries

A

medial medullary syndrome

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10
Q

dysphagia, hoarseness, decreased gag reflex; vomiting, vertigo, nystagmus, decreased pain and temp sensation from CL body, ipsilateral face

artery?

area of lesion?

A

posterior inferior cerebellar artery

lateral medulla: Nucleus ambiguus (CN IX, X, XI), vestibular nuclei, lateral spinothalamic tract, spinal trigeminal nucleus

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11
Q

ipsilateral horner syndrome,

ataxia, dysmetria

artery?

area of lesion?

A

PICA or AICA

Lateral medulla: sympathetic fibers and inferior cerebellar peduncle

Lateral pons: sympathetic fibers and middle and inferior cerebellar peduncles

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12
Q

paralysis of face, decreased lacrimation, decreased salivation, decreased taste from anterior 2/3 tongue

artery?

area?

A

anterior inferior cerebellar artery

Lateral pons: facial nucleus

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13
Q

1)vomiting, vertigo, nystagmus 2) decreased pain and temp sensation from CL body, ipsi face

artery?

area?

A

AICA

1) lateral pons: vestibular nuc
2) lateral pons: spinothalamic tract, spinal trigeminal nuc

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14
Q

What is the area of the lesion in locked in syndrome? What tracts are affected?

A

pons, medulla, lower midbrain

corticospinal and corticobulbar tracts

ocular cranial nerve nuclei, paramedian pontine reticular formation

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15
Q

CL hemianopia with macular sparing

artery?

area?

A

posterior cerebral artery

occipital lobe

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16
Q

early changes in personality and behavior or aphasia; may have associated movement disorders;

frontotemporal lobe degeneration

dx?

what do you see on micro?

A

Pick disease

inclusions of hyperphosphorylated tau (round Pick bodies) or ubiquitinated TDP-43

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17
Q

In regard to Alzheimer disease, having ApoE2 will…

A

decrease risk of sporadic form

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18
Q

In regard to Alzheimer disease, having ApoE4 will…

A

increase risk of sporadic form

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19
Q

What genetic things would indicate potentially having a familiar form of AD with earlier onset?

A

APP, presenilin-1, presenilin-2

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20
Q

autosomal dominant trinucleotide (CAG)n repeat disorder on chromosome 4

A

Huntington disease

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21
Q

step-wise decline in cognitive ability with late-onset memory impairment; second MCC of dementia in elderly

A

vascular dementia

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22
Q

Charcot triad of MS

A

scanning speech

intention tremor (also incontinence and internuclear ophthalmoplegia)

nystagmus

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23
Q

triad of urinary incontinence, ataxia, and cognitive dysfunction

A

normal pressure hydrocephalus

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24
Q

What happens when you correct Na+ too rapidly?

A
  • from low to high, your pons will die
    • osmotic demyelination syndrome
  • from high to low, your brain will blow
    • cerebral edema/herniation
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25
Q

What is Lhermitte phenomenon?

A

in MS, neck flexion causing a sensation of electric shock running down the spine

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26
Q

peripheral neuropathy, developmental delay, optic atrophy, globoid cells

dx?

deficiency of what, causing what?

A

Krabbe disease

deficiency of galactocerebrosidase causing a build up of galactocerebroside and psychosine which destroys myelin sheath

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27
Q

autosomal recessive lysosomal storage disease, MC due to arylsulfatase A deficiency

dx?

what does this cause?

findings

A

Metachromatic leukodystrophy

build up of sulfatides, impaired production and destruction of myelin sheath

central and peripheral demyelination with ataxia, dementia

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28
Q

disruption of metabolism of very long chain fatty acids causing accumulation in nervous system, adrenal glands, and testes

dx?

A

adrenoleukodystrophy

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29
Q

somatic mosaicisim for an activating mutation in one copy of GNAQ gene

dx?

acronym of ssx?

A

Sturge-Weber syndrome

  • S - sporadic, port wine stain
  • T - tram track calcifications (opposing gyri)
  • U - unilateral
  • R - retardation (intellectual disability)
  • G - glaucoma, GNAQ
  • E - epilepsy
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30
Q

TSC1/TSC2 mutation on chromosome 16; increase incidence of subependymal giant cell astrocytomas and ungual fibromas

dx?

acronym that goes with?

A

Tuberous sclerosis

  • H- hamartomas in CNS and skin
  • A - angiofibromas
  • M - mitral regurg
  • A - ash-leaf spots
  • R - cardiac Rhabdomyoma
  • T - tuberous sclerosis
  • O - autosomal dOminant
  • M - mental retardation
  • A - renal Angiolipoma
  • S - seizures, Shagreen patches
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31
Q

What disease do you find Lisch nodules in?

What are they?

A

Neurofibromatosis type I (von Recklinghausen disease)

pigmented iris hamartomas

32
Q

Hemiangioblastomas in retina, brainstem, cerebellum, and spine; angiomatosis; bilateral renal cell carcinomas; pheochromocytomas

dx?

genetics?

A

von Hippel-Lindau disease

deletion of VHL gene on chromosome 3p; autosomal dominant

33
Q

butterfly glioma

dx?

histology?

A

glioblastoma multiforme (grade IV astrocytoma)

  • astrocyte origin
  • GFAP +
  • pseudopalisading pleomorphic tumor cells border central areas of necrosis and hemorrhage
34
Q

relatively rare brain tumor, slow growing. most often in frontal lobes, “chicken-wire” capillary pattern

dx?

histology?

A

oligodendroglioma

  • oligodendrocyte origin
  • “fried-egg” cells - round nuclei with clear cytoplasm
  • often calcified
35
Q

common, typically benign primary brain tumor, most often occurs near surfaces of brain and in parasagittal region

extra-axial and may have a dural attachment (tail)

dx?

histology?

A

meningioma

  • arachnoid cell origin
  • spindle cells concentrically arranged in a whorled pattern
  • psammoma bodies (laminated calcifications)
36
Q

most of in the cerebellum, this tumor is associated with von Hippel-Lindau syndrome when found with retinal angiomas

dx?

what can this produce/cause?

histology?

A

hemangioblastoma

can produce EPO, causing secondary polycythemia

  • blood vessel origin
  • closely arranged, thin-walled capillaries with minimal intervening parenchyma
37
Q

What visual defects might be with a pituitary tumor?

A

bitemporal hemianopia due to pressure on optic chiasm

38
Q

What tumor is classically at the cerebellopontine angle but can be along any peripheral nerve?

A

schwannoma

schwann cell origin, S100+

39
Q
  • glial cell origin
  • GFAP +
  • Rosenthal fibers - eosinophilic, corkscrew fibers
  • cystic and solid (grossly)

dx?

description?

A

pilocytic (low-grade) astrocytoma

  • usually well circumscribed
  • in kids, most often in posterior fossa
  • may be supratentorial
  • benign, good prognosis
40
Q

form of primitive neuroectodermal tumor (PNET); Homer-Wright Rosettes, small blue cells

A

medulloblastoma

41
Q

what childhood primary brain tumor is most commonly found in the fourth ventricle, potentially causing hydrocephalus?

A

ependymoma

42
Q

characteristic perivascular rosettes; rod-shaped blepharoplasts (basal ciliary bodies) found near the nucleus

A

ependymoma

43
Q

MC childhood supratentorial tumor; may be confused with pituitary adenoma bc it also causes bitemporal hemianopia

dx?

derived from?

description?

A

craniopharyngioma

remnants of Rathke pouch

calcification is common; cholesterol crystals found in “motor oil” like fluid within the tumor

44
Q

parinaud syndrome, obstructive hydrocephalus, precocious puberty in males

A

pinealoma

45
Q

aging related sensorineural hearing loss (often higher frequencies) due to destruction of hair cells at the cochlear base (preserved low frequency hearing at the apex)

A

presbycusis

46
Q

What drugs will decrease aqueous humor production from the non-pigmented epithelium on ciliary bodies?

A

beta blockers, alpha 2 agonists, carbonic anhydrase inhibitors

47
Q

What neurons are used in the pathway of miosis in pupillary control?

A
  • parasympathetic
  • 1st neuron: Edinger-Westphal nucleus to ciliary ganglion via CN III
  • 2nd neuron: short ciliary nerves to sphincter pupillae muscles
48
Q

What nerves and brain areas are involved in the pupillary light reflex?

A

light in either retina sends a signal via CN II to pretectal nuclei in midbrain that activates bilateral Edinger-Westphal nuclei;

pupils contract bilaterally

49
Q

What neurons are inolved in the mydriasis pathway?

A
  • sympathetic
  • 1st neuron: HT to ciliospinal center of Budge (C8-T2)
  • 2nd neuron: exit at T1 to superior cervical ganglion
  • 3rd neuron: plexus along internal carotid, through cavernous sinus; enters orbit as long ciliary nerve to pupillary dilator muscles
50
Q

What are cluster A personality disorders?

(Weird)

A

Paranoid

Schizoid

Schizotypal

51
Q

What are Cluster B personality disorders?

Wild

A

Antisocial

Borderline

Histrionic

Narcisstic

52
Q

What are Cluster C personality disorders?

worried

A

Avoidant

Obesseive-Compulsive

Dependent

53
Q

glucagonoma is a tumor of…

it presents with what ssx?

A

pancreatic alpha cells

dermatitis, diabetes, DVT, declining weight, depression

54
Q

tumor of pancreatic delta cells

dx?

what does this cause physiologically?

A
  • somatostatinoma
  • decreased secretion of secretin, cholecystokinin, glucagon, insluin, gastrin, gastric inhibitory peptide (GIP)
55
Q

What is the MC malignancy in the small intestine?

A

carcinoid syndrome

56
Q

Carcinoid syndrome has neuroendocrine tumors secreting high levels of serotonin which cause this presentation of ssx…

A

recurrent diarrhea, cutaneous flushing, asthmatic wheezing, right sided valvular heart disease (tricuspid regurg, pulmonic stenosis)

increased hydroxyindoleacetic acid (5-HIAA) in urine, niacin deficiency (pellagra)

57
Q

How is Zollinger-Ellison syndrome diagnosed?

A

Positive secretin stimulation test: gastrin levels remain elevated after admin of secretin, which normally inhibits gastrin release

58
Q

MEN1 is associated with what three things and what mutation?

A
  • Pituitary tumors
  • Pancreatic endocrine tumors
  • Parathyroid adenomas

mut MEN1 (menin, a tumor suppressor, chromosome 11)

59
Q

MEN2A is associated with what disorders and what mutation?

A
  • Parathyroid hyperplasia
  • Medullary thyroid carcinoma
  • Pheochromocytoma

mut in RET (codes for tyrosine receptor kinase) in cells of neural crest origin

60
Q

MEN2B is associated with what disorders and what mutation?

A
  • Medullary thyroid carcinoma
  • Pheochromocytoma
  • mucosal neuromas

marfanoid habitus, mut in RET gene

61
Q

guaifenesin (drug)

A

expectorant - thins respiratory secretions, does not suppress cough reflex

62
Q

N-acetylcysteine

A

mucolytic- liquifies mucus in chronic bronchopulmonary disease by disrupting disulfide bonds

antidote for acetaminophen overdose

63
Q

dextromethorphan

A

antitussive (antagonizes NMDA glutamate receptors); synthetic codeine analog

mild opioid effect when used in excess

may cause serotonin syndrome when used with other serotonergic agents

64
Q

alpha-adrenergic agonists, used as nasal decongestants

A

pseudoephedrine, phenylephrine

65
Q

PGI2 (prostacyclin) with direct vasodilatory effects on pulmonary and systemic arterial vascular beds; inhibits platelet aggregation

A

epoprostenol

iloprost

66
Q

5-lipoxygenase pathway inhibitor; blocks conversion of arachidonic acid to leukotrienes

A

zileuton

67
Q

What leukotriene receptors do montelukast and zafirlukast block?

What are these drugs especially good for?

A

CysLT1

especially good for aspirin-induced and exercise-induced asthma

68
Q

What drug is used in allergic asthma? What does this drug bind?

A

omalizumab

binds mostly unbound serum IgE; used in allergic asthma with increased IgE levels resistant to inhaled steroids and LABAs

69
Q

nonselective muscarinic receptor (M3) agonist

A

methacholine

70
Q

What does the drug theophylline do? Why is its use limited?

A
  • likely causes bronchodilation by inhibiting phosphodiesterase
    • increasing cAMP levels due to decreased cAMP hydrolysis
  • usage limited bc of narrow therapeutic index
    • cardiotoxicity and neurotoxicity
    • metab by P450
    • blocks action of adenosine
71
Q

generalized reabsorptive defect in PCT; associated with increased excretion;

dx?

what acid base disturbance might occur?

A

Fanconi syndrome

metabolix acidosis (proximal renal tubular acidosis)

72
Q

resorptive defect in thick ascending loop of henle

dx?

what transporter is affected?

what does this result in?

A

Bartter syndrome

affects Na/K/2Cl cotransporter

results in hypokalemia and metabolic acidosis with hypercalciuria

73
Q

reabsorptive defect of NaCl in DCT

dx?

what does this lead to?

what is it similar to (drug taking wise)?

A

Gitelman syndrome

leads to hypokalemia, hypomagnesemia, metabolic alkalosis, hypocalcicuria

similar to using life-long thiazide diuretics

74
Q

Gain of function mutation that increases Na reabsorption in collecting tubules (increase activity of Na channel)

dx?

results in?

What does this present like?

tx?

A

Liddle syndrome

results in hypertension, hypokalemia, metabolic alkalosis, decreased aldosterone

presents like hyperaldosteronism, but aldosterone is nearly undetectable

amiloride

75
Q

hereditary deficiency of 11B-hydroxysteroid dehydrogenase, normally converts cortisol to cortisone in cells containing mineralcorticoid receptors

dx?

how would one acquire this disorder?

A

syndrome of apparent mineralcorticoid excess

can acquire disorder from glycyrrhetinic acid (in licorice) which blocks activity of 11B-hydroxysteroid dehydrogenase

Board questions (24 decks)

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