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Mind & Motion > NBME (First Aid Content) > Flashcards

NBME (First Aid Content) Flashcards

1
Q

A kind of learning where a natural response is elicited by a conditioned stimulus that was previously presented in conjunction with an unconditioned stimulus

A

Classical conditioning

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2
Q

Neurotransmitter changes in Alzheimer’s

A

Decreased ACh, increased glutamate

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3
Q

List an example of classical conditioning in PTSD

A

Something along the lines of flinching or ducking (natural response) in response to loud noises (learned stimulus) that were experienced in combat in the context of gunshots or explosions (unconditioned stimulus)

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4
Q

Learning in which an action is elicited because it produces a punishment or reward

A

Operant conditioning

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4
Q

Neurotransmitter changes in Parkinson disease

A

Decreased dopamine, increased ACh

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5
Q

List an example of negative reinforcement that might be used to convince a prisoner to speak in an interrogation situation

A

Remove the prisoner’s chains or other painful conditions every time that the prisoner speaks

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6
Q

A doctor notices that his patient reminds him of his younger brother - what is this called?

A

Countertransference

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7
Q

A teenager is angry at her sister, so she goes to kickboxing class to let out her anger. What is this called, and is it mature or immature?

A

Sublimation - mature ego defense

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8
Q

What are the four mature ego defenses?

A

Sublimation, Altruism, Suppression, Humor

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9
Q

A man feels guilty about his diet and his inability to lose weight, so he decides to donate to a charity to help people suffering from food insufficiency. What is this called, and is it mature or immature?

A

Altruism - mature ego defense

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10
Q

An 8-year-old has difficulty focusing and sitting still in school, and is fidgety and impulsive at home. His father says that he helps himself to sugary snacks even when he is told not to, and appears to not have good control over his impulses. He has been struggling in school, and has been sent to the office twice this month for acting out or acting impulsively. What diagnosis do you suspect, and how might you treat it?

A

Attention deficit hyperactivity disorder - onset before age 12, with hyperactivity, impulsivity, and/or inattention in multiple settings. Treat with stimulants (methylphenidate) and CBT, could also use atomoxetine, guanfacine, clonidine

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12
Q

Neurotransmitter changes in depression

A

Decreased norepinephrine, decreased 5-HT, decreased dopamine

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13
Q

Neurotransmitter changes in anxiety

A

Increased norepinephrine, decreased GABA, decreased 5-HT

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14
Q

Mid-line hand wringing is a key stereotyped behavior of which condition?

A

Rett Syndrome - X-linked dominant, seen almost exclusively in girls

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15
Q

Neurotransmitter changes in Huntington disease

A

Decreased GABA, decreased ACh, increased dopamine

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16
Q

Neurotransmitter changes in schizophrenia

A

Increased dopamine

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17
Q

A patient projects her feelings about her mother onto her psychiatrist - what is this called?

A

Transference

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18
Q

Decreased cognitive functioning without changes in level of consciousness, characterized by memory deficits, apraxia, aphasia, agnosia, behavior or personality changes, impaired judgment

A

Dementia

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19
Q

Treatment of delirium

A

Identify and treat underlying condition, use haloperidol as needed, use benzodiazepines for delirium tremens in alcohol withdrawal

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20
Q

List an example of how positive punishment and negative punishment might be used to teach a child not to throw food on the floor

A

Positive punishment: Say “No!” loudly every time the kid throws food
Negative punishment: Take away dessert every time the kid throws food on the floor

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21
Q

Herniation of the cerebellar vermis through the foramen magnum with aqueductal stenosis, leading to hydrocephalus

A

Chiari II malformation - often associated with lumbosacral meningomyelocele

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22
Q

Reversible causes of dementia-like symptoms

A

Hypothyroidism, depression, vitamin B12 deficiency, neurosyphilis

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23
Q

Distorted perception of reality characterized by delusions, hallucinations, and/or disorganized thinking

A

Psychosis

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24
Q

Hallucinations that can occur when waking up from sleep

A

Hypnopompic

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25
Q

How long do symptoms of schizophreniform disorder have to last in order to make a diagnosis?

A

1-6 months

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26
Q

Pain and popping sensation on internal rotation of tibia

A

Lateral meniscal tear

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27
Q

List an example of positive reinforcement that you might use to teach a child to be toilet trained

A

Child might receive a sticker or other small prize, or even just verbal praise, every time they successfully use the toilet

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28
Q

How long do symptoms of schizoaffective disorder have to last in order to make a diagnosis?

A

> 2 weeks

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29
Q

Fracture of this carpal bone in a fall on an outstretched hand can damage the ulnar nerve

A

Hook of the hamate

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30
Q

Patient with flattened deltoid, loss of shoulder abduction, loss of sensation in lateral arm

A

Axillary nerve injury - will also damage teres minor

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31
Q

Mental health complication of frequent cannabis use in teens

A

Schizophrenia and psychosis

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32
Q

Waxing and waning level of consciousness with acute onset, decreased attention span, decreased level of arousal, disorganized thinking, may have hallucinations, cognitive dysfunction

A

Delirium

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33
Q

First-line schizophrenia treatment

A

Atypical antipsychotics such as risperidone

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34
Q

Dislocation of this bone can cause carpal tunnel

A

Lunate

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35
Q

Nerve injury with fractured surgical neck of humerus

A

Axillary (C5-6)

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36
Q

Baker’s cyst location

A

Gastrocnemius-semimembranosus bursa, in the popliteal fossa

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38
Q

Positive symptoms of schizophrenia

A

Delusions, hallucinations, disorganized speech, disorganized or catatonic behavior (need at least one of the first 3 plus another or negative symptoms to make the diagnosis)

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38
Q

Pain after repetitive extension of elbow

A

Lateral epicondylitis - tennis elbow

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40
Q

Duration of symptoms necessary for classification as a manic episode

A

At least one week

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40
Q

Infant born with a tuft of hair at the L3 level of the mid-back. What is the disorder? If the mother had gotten an AFP test during pregnancy, what would the result have been?

A

Spina bifida occulta. Bony spinal canal didn’t close, but there is no herniation of the meninges or the spinal cord. SB occulta would have a normal maternal AFP, unlike the other two forms of spina bifida.

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41
Q

Widening of medial joint space of knee

A

MCL tear

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42
Q

A mother is folate-deficient and her infant is born with a neural tube closure defect on the lower mid-back. If the baby is diagnosed with a meningocele, what does that mean? What about a myelomeningocele?

A

Meningocele - meninges, but no neural tissue, herniated through the bony defect.
Myelomeningocele - meninges and neural tissue herniated through. This kid might not even have skin over the defect.

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43
Q

Hallucinations that can occur while going to sleep

A

Hypnagogic

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44
Q

4 bones that, when fractured, are probably at the highest risk of developing avascular necrosis

A

Femoral neck fracture; scaphoid fracture; navicular bone fracture, talus fracture

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45
Q

Agenesis of the cerebellar vermis with massive cystic enlargement of the 4th vesicle, such that it fills the posterior fossa, displacing the cerebellum and occipital nerve upwards

A

Dandy-Walker malformation. Often associated with non communicating hydrocephalus and spina bifida

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46
Q

Initial abduction of arm

A

Supraspinatus - suprascapular nerve

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47
Q

Widening of lateral joint space of knee

A

LCL tear

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48
Q

How long do symptoms of schizophrenia have to last in order to make a diagnosis?

A

> 6 months

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49
Q

Empty can test assesses this muscle

A

Supraspinatus

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51
Q

Pain after repetitive flexion of elbow

A

Medial epicondylitis - golfer’s elbow

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52
Q

Negative symptoms of schizophrenia

A

Flat affect, lack of volition, anhedonia, asociality, alogia

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52
Q

Most commonly fractured carpal bone, prone to avascular necrosis

A

Scaphoid bone

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53
Q

Loss of sensation of lateral forearm, loss of forearm flexion and supination

A

Musculocutaneous nerve injury, probably due to upper trunk compression

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54
Q

Duration of symptoms necessary for classification of a hypomanic episode

A

At least 4 consecutive days

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55
Q

Pain and popping sensation on external rotation of tibia

A

Medial meniscal tear

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56
Q

Pathophysiology and imaging of schizophrenia

A

Associated with increased dopamine, decreased dendritic branching, ventriculomegaly on brain imaging

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57
Q

Knee ligament extending from lateral femoral condyle to anterior tibia

A

ACL

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58
Q

Knee ligament extending from medial femoral condyle to posterior tibia

A

PCL

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59
Q

Pathologic finding elicited by valgus maneuver

A

MCL injury

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60
Q

Pathologic finding elicited by varus maneuver

A

LCL injury

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61
Q

Rotator cuff muscle that laterally rotates arm

A

Infraspinatus

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62
Q

Carpal bone immediately proximal to first metacarpal

A

Trapezium

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63
Q

Carpal bone immediately proximal to second metacarpal

A

Trapezoid

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64
Q

Carpal bone proximal to third metacarpal

A

Capitate

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65
Q

Carpal bone proximal to fourth and fifth metacarpals

A

Hamate

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66
Q

Radial nerve injury presentation

A

Wrist drop, decreased grip strength, loss of sensation on posterior arm/forearm and distal hand

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67
Q

Nerve injury causing wrist drop

A

Radial nerve

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68
Q

Nerve injury causing decreased grip strength

A

Radial nerve

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69
Q

Nerve injury causing thenar atrophy and inability to make a fist with first three fingers

A

Proximal Median nerve injury

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70
Q

Nerve injury causing inability to extend digits 4 and 5 in the hand

A

Distal Ulnar nerve injury

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71
Q

Nerve injury causing inability to extend digits 1-3 in the hand

A

Distal Median nerve injury

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72
Q

Nerve injury causing inability to make a fist with fingers 4 and 5

A

Proximal Ulnar nerve injury

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73
Q

Fracture of medial epicondyle of humerus

A

Proximal ulnar nerve injury -> inability to make a fist with fingers 4 and 5 (OK gesture)

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74
Q

Fractured hook of hamate

A

Distal ulnar nerve injury -> inability to extend digits 4/5 (ulnar claw)

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75
Q

Supracondylar fracture of humerus

A

Proximal median nerve injury -> can’t make a fist with first three fingers (Benediction hand)

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76
Q

Wrist laceration

A

Distal median nerve injury -> can’t extend digits 1-3 in the hand (median claw)

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77
Q

Superficial laceration of palm

A

Thenar atrophy -> inability to do opposition, flexion, or abduction of thumb, but no loss of sensation

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78
Q

Sensation to lateral half of dorsal hand (not counting digits 2 and 3)

A

Radial nerve

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79
Q

Wrist drop

A

Radial nerve injury

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80
Q

Midshaft fracture of humerus

A

Radial nerve injury

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81
Q

Using crutches that are inappropriately large

A

Radial nerve injury

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82
Q

Loss of abduction and adduction of fingers

A

Ulnar nerve injury - it innervates the interossei

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83
Q

Loss of sensation over hypothenar eminence

A

Ulnar nerve injury

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84
Q

Loss of forearm flexion and supination

A

Musculocutaneous nerve injury

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85
Q

Compression of the upper trunk of the brachial plexus

A

Musculocutaneous nerve injury -> loss of forearm flexion and supination, loss of sensation to lateral forearm

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86
Q

Arm hanging at side, medially rotated, extended, and pronated

A

Erb’s palsy - tear of upper trunk (C5-6), can occur in infants during delivery. Leads to deficits of deltoid and supraspinatus (loss of abduction), infraspinatus (loss of lateral rotation), biceps brachii (loss of flexion and supination)

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87
Q

Total claw hand

A

Klumpke palsy - tear of C8-T1/lower trunk, can occur with an upward force on a baby’s arm during delivery or due to upward forces in trauma. Leads to deficits of intrinsic hand muscles: lumbricals, interossei, thenar muscles, hypothenar muscles.

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88
Q

Atrophy of intrinsic hand muscles, and ischemia, pain, and edema in the affected arm

A

Thoracic outlet syndrome: compression of lower trunk and subclavian vessels. Will look the same as Klumpke’s palsy.

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89
Q

Patient with a claw hand and vascular insufficiency to that arm

A

Thoracic outlet syndrome

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90
Q

Winged scapula

A

Damage to long thoracic nerve, leading to serratus anterior deficit. Patient cannot abduct arm above horizontal position.

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91
Q

Function of lumbricals at MCP joints

A

flexion

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92
Q

Function of lumbricals at PIP and DIP joints

A

extension

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93
Q

Decreased sensation to medial thigh, decreased adduction at hip

A

Obturator nerve injury (L2-4 anterior division fibers)

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94
Q

Decreased thigh flexion at hip and leg extension

A

Femoral nerve injury (L2-4 posterior division fibers)

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95
Q

Inability to curl toes, loss of sensation on plantar foot, loss of inversion, loss of plantarflexion

A

Proximal injury to tibial nerve. Foot will appear everted and dorsiflexed at rest.

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96
Q

Inability to curl toes and loss of sensation to plantar foot, but inversion and plantarflexion are intact

A

Distal tibial nerve injury, probably due to tarsal tunnel syndrome

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97
Q

Fibular neck fracture resultant nerve injury

A

Common peroneal nerve injury

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98
Q

Foot drop with loss of eversion and dorsiflexion, loss of sensation on dorsum of foot

A

Common peroneal nerve injury

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99
Q

Nerve deficit from Baker cyst

A

Tibial nerve injury

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100
Q

Nerve deficit from compression of lateral leg

A

Common peroneal nerve injury

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101
Q

Trendelenburg sign

A

Pelvis tilts downward on one side. Lesion is CONTRALATERAL to the side of the hip that drops down, which is not the side the patient is standing on. Due to weakness of aBduction in the weight-bearing leg.

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102
Q

Superior gluteal nerve injury

A

Trendelenburg sign

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103
Q

Difficulty climbing stairs and rising from seated position, with loss of hip extension

A

Inferior gluteal nerve injury or problem with gluteus maximus

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104
Q

Site for IM injection in gluteal muscle in order to avoid nerve injury

A

Superior lateral gluteal quadrant

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105
Q

Direction that intervertebral discs generally herniate

A

Posterolaterally

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106
Q

Injury at disc level L3/4 affects what nerve?

A

L4

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107
Q

Injury at disc level L4/5 affects what nerve?

A

L5

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108
Q

Injury at disc level L5/S1 affects what nerve?

A

S1

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109
Q

Radiculopathy with weakness of knee extension and decreased patellar reflex

A

L4 radiculopathy

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110
Q

Radiculopathy with weakness of dorsiflexion, can’t walk on heels

A

L5 radiculopathy

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111
Q

Radiculopathy with weakness of plantarflexion, can’t walk on toes, decreased Achilles reflex

A

S1

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112
Q

Artery that runs with long thoracic nerve

A

Lateral thoracic artery

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113
Q

Artery that runs with axillary nerve

A

Posterior circumflex artery

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114
Q

Artery that runs with radial nerve

A

Deep brachial artery

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115
Q

Artery that runs with median nerve

A

Brachial artery

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116
Q

Artery that runs with tibial nerve

A

Popliteal artery in popliteal fossa -> posterior tibial artery posterior to the medial malleolus

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117
Q

Muscle fibers that do mostly oxidative phosphorylation

A

Type I - slow twitch red fibers with increased myoglobin and mitochondria

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118
Q

Muscle fibers that do mostly anaerobic glycolysis

A

Type II - fast twitch white fibers with less mitochondria and myoglobin

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119
Q

Bone formation of long and short bones

A

Endochondral ossification

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120
Q

Cartilagenous bone model then replaced with woven bone, which is then replaced with lamellar bone

A

Endochondral ossification

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121
Q

Woven bone

A

bone type that occurs in endochondral bone formation, after fractures

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122
Q

Bone formation of skull, flat bones

A

Woven bone formed directly without cartilage -> intermembranous ossification

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123
Q

Bone cell that differentiates from mesenchymal stem cells in periosteum

A

Osteoblast

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124
Q

Osteoblast function

A

Build bone by secreting collagen, manage bone signaling

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125
Q

Osteoclast function

A

Resorb bone by secreting H+

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126
Q

PTH function at low, intermittent levels

A

Builds bone

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127
Q

PTH function at overly high levels

A

Leads to bone catabolism/resorption

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128
Q

Hormone that inhibits apoptosis in osteoblasts and induces apoptosis in osteoclasts

A

Estrogen

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129
Q

FGFR3 mutation

A

Achondroplasia: failure of endochondral ossification due to inhibition of chondrocyte proliferation

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130
Q

Bone mineral density with a T score of less than or equal to -2.5

A

Osteoporosis

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131
Q

Osteoporosis prophylaxis

A

Weight-bearing exercise, calcium, vitamin D

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132
Q

Acute back pain, loss of height, kyphosis

A

Vertebral compression fracture

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133
Q

Treatment of osteoporosis

A

Bisphosphonates, teriparatide, SERMS, denosumab

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134
Q

Thickened and dense bones that are prone to fracture, with pancytopenia

A

Osteopetrosis (due to defective osteoclasts with mutations in carbonic anhydrase, etc)

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135
Q

Osteopenia in adults, with defective mineralization of osteoid

A

Osteomalacia

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136
Q

Defective mineralization of cartilagenous growth plates leading to epiphyseal widening and bow-legs

A

Rickets

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137
Q

Vitamin D, calcium, PTH, phosphate, and ALP levels in osteomalacia or rickets

A

Low vitamin D, low calcium, high PTH, low phosphate, high ALP

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138
Q

Most common site of osteonecrosis

A

Femoral head

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139
Q

Causes of osteonecrosis

A

Corticosteroids, alcoholism, sickle cell, trauma, the bends, idiopathic, Gaucher disease, slipped femoral epiphysis

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140
Q

Radiographs of osteonecrosis

A

Bone looks like there’s been a bite taken out of it

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141
Q

Serum calcium, phosphate, ALP, and PTH in primary hyperparathyroidism

A

Calcium high, phosphate low, ALP high, PTH high

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142
Q

Serum calcium, phosphate, ALP, and PTH in secondary hyperparathyroidism

A

Calcium low, phosphate high, ALP high, PTH high

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143
Q

Serum calcium, phosphate, and PTH in an excess of vitamin D (oversupplementation or granulomatous disease)

A

Calcium high, phosphate high, PTH low

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144
Q

Osteoarthritis or rheumatoid arthritis: mechanical wear and tear causes it

A

Osteoarthritis

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145
Q

Osteoarthritis or rheumatoid arthritis: autoimmune mechanism

A

Rheumatoid arthritis

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146
Q

Osteoarthritis or rheumatoid arthritis: risk factors include age, being female, obesity, trauma

A

Osteoarthritis

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147
Q

Osteoarthritis or rheumatoid arthritis: risk factors include being female, HLA-DR4, smoking, RF, CCP

A

Rheumatoid arthritis

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148
Q

Osteoarthritis or rheumatoid arthritis: pain in weight-bearing joints after use

A

Osteoarthritis

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149
Q

Osteoarthritis or rheumatoid arthritis: pain and morning stiffness/swelling get better with use

A

Rheumatoid arthritis

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150
Q

Osteoarthritis or rheumatoid arthritis: osteophytes, joint space narrowing, begins medially in knee, subchondral sclerosis, low WBCs in synovial fluid

A

Osteoarthritis

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151
Q

Osteoarthritis or rheumatoid arthritis: Erosions, cysts, high WBCs in synovial fluid

A

Rheumatoid arthritis

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152
Q

Treatment for osteoarthritis

A

Acetaminophen, NSAIDs, glucocorticoid injections

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153
Q

Joints most commonly involved in osteoarthritis

A

Knee, hip, DIPs, PIPs, first carpometacarpal joint

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154
Q

Joints most commonly involved in rheumatoid arthritis of the hand

A

MCP, PIP, wrist

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155
Q

Negatively birefringent, needle-shaped, yellow under parallel light crystals

A

Uric acid -> gout

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156
Q

Positively birefringent, rhomboid, blue under parallel light crystals

A

Calcium pyrophosphate

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157
Q

Common pathogens for septic arthritis

A

S. aureus, Streptococcus, N. gonorrhoeae

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158
Q

Purulent synovial fluid, WBC > 50,000

A

Septic arthritis

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159
Q

Gonococcal arthritis presentations

A

Septic arthritis (knee) or reactive arthritis (polyarthralgias, tenosynovitis, rash)

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160
Q

Pain and stiffness in shoulders and hips in an older woman, without weakness, with high ESR and CRP, that responds quickly to low-dose corticosteroids

A

Polymyalgia rheumatica (associated with giant cell arteritis)

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161
Q

Treatment for fibromyalgia

A

Exercise, therapy, TCAs, SNRIs

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162
Q

Endomysial inflammation with CD8+ T cells, progressive symmetric proximal weakness

A

Polymyositis

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163
Q

Perimysial inflammation and atrophy, CD4+ T cells, heliotrope rash, Gottron papules, symmetric proximal weakness

A

Dermatomyositis

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164
Q

A diagnosis of dermatomyositis suggests you should do what?

A

Work patient up for an occult malignancy

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165
Q

Autoantibodies to post-synaptic ACh receptor

A

Myasthenia gravis

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166
Q

Ptosis, diplopia, and weakness that worsens with muscle use

A

Myasthenia gravis

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167
Q

Treatment for myasthenia gravis

A

Pyridostigmine

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168
Q

Pyridostigmine MOA

A

Acetylcholinesterase inhibitor

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169
Q

Proximal muscle weakness with autonomic symptoms; improves with muscle use

A

Lambert-Eaton syndrome

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170
Q

Autoantibodies to pre-synaptic Ca++ channel lead to decreased ACh release

A

Lambert-Eaton syndrome

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171
Q

Muscles affected most in Lambert-Eaton

A

proximal large muscles

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172
Q

Muscles affected most in myasthenia gravis

A

Extraocular muscles

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173
Q

Malignancy associated with Lambert-Eaton syndrome

A

small cell lung cancer

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174
Q

Reversible cyclooxygenase inhibitor that is analgesic but not anti-inflammatory and is metabolized in the liver

A

Acetaminophen

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175
Q

Irreversible COX1 and COX2 inhibitor

A

Aspirin

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176
Q

COX2-selective NSAID used in osteoarthritis and rheumatoid arthritis

A

Celecoxib

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177
Q

Adverse effects of non-aspirin NSAIDs

A

Interstitial nephritis, gastric ulcer, renal ischemia

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178
Q

MOA of bisphosphonates

A

Pyrophosphate analogs that bind hydroxyapatite and inhibit osteoclasts

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179
Q

Side effects of bisphosphonates

A

Osteonecrosis of jaw, atypical stress fractures

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180
Q

MOA of teriparatide

A

Recombinant PTH analog that increases osteoblast activity

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181
Q

Preventative gout drugs

A

Allopurinol and Febuxostat (xanthine oxidase inhibitors)

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182
Q

Acute gout drugs

A

NSAIDs (naproxen, indomethacin), glucocorticoids, colchicine

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183
Q

Sensory and motor deficits in a child with meningomyelocele

A

At/below the level of the meningomyelocele

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184
Q

Neural cells derived from neuroectoderm

A

CNS neurons, ependymal cells/choroid plexus, oligodendrocytes, astrocytes

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185
Q

Neural cells derived from neural crest

A

PNS neurons, Schwann cells

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186
Q

Neural cells derived from mesoderm

A

Microglia

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187
Q

Two markers that are elevated in amniotic fluid in spina bifida

A

AFP, fetal acetylcholinesterase

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188
Q

Mutations in sonic hedgehog signaling pathway causing a failure of left and right hemispheres to separate

A

Holoprosencephaly

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189
Q

Syndromes with holoprosencephaly

A

Patau syndrome, fetal alcohol syndrome

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190
Q

Cranial nerves that sense taste

A

CN VII, IX, X

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191
Q

Cranial nerves sensing pain to the tongue

A

CN V3, IX, X

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192
Q

Cranial nerves providing motor innervation to the tongue

A

CN, X, XII

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193
Q

Wallerian degeneration

A

An injury to an axon causes it to degenerate distal to the injury, leading to axonal retraction proximally

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194
Q

Neural cell responsible for physical support and blood-brain barrier

A

Astrocytes

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195
Q

Neural cell that serves the function of a macrophage

A

Microglia

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196
Q

How does myelin affect conduction velocity?

A

Increases it

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197
Q

Cell that myelinates CNS

A

Oligodendrocytes

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198
Q

Cell that myelinates PNS

A

Schwann cells

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199
Q

How many axons can a Schwann cell myelinate?

A

Only 1

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200
Q

Cell type that may be injured in Guillain-Barre syndrome

A

Schwann cells

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201
Q

C-type free nerve endings

A

Slow, unmyelinated fibers that sense pain and temperature

202
Q

Adelta type free nerve endings

A

Fast, myelinated fibers that sense pain and temperature

203
Q

Large myelinated fibers that adapt quickly and sense light touch and position sense

A

Meissner corpuscles

204
Q

Large myelinated fibers that adapt quickly and sense vibration and pressure

A

Pacinian corpuscles

205
Q

Large myelinated fibers that adapt slowly and sense pressure, static touch (shapes, edges, etc), position sense

A

Merkel discs

206
Q

Dendritic endins with a capsule that adapt slowly and sense pressure, objects moving along the surface of skin, and joint angle changes

A

Ruffini corpuscles

207
Q

Inflammatory infiltrate is within this layer in Guillain-Barre syndrome

A

Endoneurium (at the level of single fibers)

208
Q

This layer surrounding nerves must be rejoined in microsurgery for nerve or limb repair

A

Perineurium

209
Q

This layer of tissue surrounds entire nerves - fascicles and microvasculature

A

Epineurium

210
Q

Location of ACh synthesis

A

Basal nucleus of Meynert

211
Q

Location of dopamine synthesis

A

Ventral tegmentum, SNpc (substantia nigra pars compacta)

212
Q

Location of GABA synthesis

A

Nucleus accumbens

213
Q

Location of norepinephrine synthesis

A

Locus coeruleus

214
Q

Location of serotonin synthesis

A

Raphe nucleus

215
Q

Disease states with decreased ACh

A

Alzheimer’s, Huntington’s disease

216
Q

Disease states with increased ACh

A

Parkinson’s disease

217
Q

Disease states with decreased dopamine

A

Depression, Parkinson’s disease

218
Q

Disease states with increased dopamine

A

Schizophrenia, Huntington’s disease

219
Q

Disease states with decreased GABA

A

Anxiety, Huntington’s disease

220
Q

Disease states with increased norepinephrine

A

Anxiety

221
Q

Disease states with decreased norepinephrine

A

Depression

222
Q

Disease states with increased serotonin

A

Parkinson’s disease

223
Q

Disease states with decreased serotonin

A

Anxiety, Depression

224
Q

3 structures that form the blood-brain barrier

A

Tight junctions between capillary endothelial cells; basement membrane; astrocyte foot processes

225
Q

Chemicals made by the hypothalamus

A

ADH, oxytocin

226
Q

Paraventricular nucleus of hypothalamus

A

Makes oxytocin

227
Q

Supraoptic nucleus of hypothalamus

A

Makes ADH

228
Q

Where are ADH and oxytocin stored and released?

A

Posterior pituitary

229
Q

Function of lateral area of hypothalamus

A

Sense of hunger. Stimulated by ghrelin, inhibited by leptin. If you destroy it, you starve yourself

230
Q

Function of ventromedial hypothalamus

A

Sense of satiety. Stimulated by leptin. If you destroy it, you eat too much

231
Q

Function of anterior hypothalamus

A

Cooling, parasympathetics

232
Q

Function of posterior hypothalamus

A

Heating, sympathetic

233
Q

Function of suprachiasmatic nucleus of hypothalamus

A

Circadian rhythm

234
Q

What area of the brain controls extraocular movements in REM sleep?

A

PPRF (paramedian pontine reticular formation/conjugate gaze center) in the pons

235
Q

Describe the trends in REM and NREM sleep throughout the night

A

You start by entering NREM sleep. REM sleep occurs every 90 minutes and its duration increases throughout the night.

236
Q

How is melatonin release regulated?

A

Suprachiasmatic nucleus -> NE release -> acts on pineal gland -> melatonin release, all regulated by the circadian rhythm

237
Q

Affects of alcohol, benzos, and barbiturates on sleep

A

Decreases REM sleep and delta wave sleep

238
Q

EEG waveform when awake with eyes open

A

Beta waves - highest frequency, lowest amplitude

239
Q

EEG waveform when awake with eyes closed

A

Alpha waves

240
Q

EEG waveform when in NREM stage N1

A

Theta waves

241
Q

EEG waveform in NREM stage N2

A

K complexes and sleep spindles

242
Q

EEG waveform in NREM stage N3

A

Delta waves - lowest frequency, highest amplitude

243
Q

EEG waveform in REM sleep

A

Beta waves - looks like when awake

244
Q

Disorders of NREM sleep

A

Sleepwalking, night terrors, bedwetting

245
Q

Characteristics of REM sleep

A

Loss of motor tone, increased use of O2 by brain, increased and variable pulse and blood pressure, this is when dreaming occurs

246
Q

Describe the path of neurons passing through the ventral posterolateral nucleus of the thalamus

A

These are neurons from the spinothalamic (decussates 1-2 levels above SC input) and dorsal column tracts (dorsal columns decussate at the medial lemniscus). Carrying pain and temperature (spinothal) and pressure, touch, vibration, proprioception (dorsal columns). The neurons whose cell bodies are in the thalamus synapse in the primary somatosensory cortex.

247
Q

Describe the path of neurons passing through the ventral posteromedial nucleus of the thalamus

A

These are trigeminal/taste sensation nuclei - face and taste - headed to the primary somatosensory cortex.

248
Q

Describe the path of neurons passing through the lateral geniculate nucleus of the thalamus

A

These are inputs from CN II carrying vision, destined for the calcarine sulcus.

249
Q

Describe the path of neurons passing through the medial geniculate nucleus of the thalamus

A

Inputs from the superior olive and inferior colliculus, containing information about hearing, destined for the auditory cortex.

250
Q

Describe the path of neurons passing through the ventral lateral nucleus of the thalamus

A

These are neurons from the basal ganglia and the cerebellum carrying information about motor regulation and feedback, destined for the motor cortex.

251
Q

5 Fs of the limbic system

A

Feeding, Fleeing, Fighting, Feeling, …Sex

252
Q

Decreased activity of the nigrostriatial pathway

A

Extrapyramidal symptoms like dystonia, akasthisia, parkinsonism, tardive dyskinesia

253
Q

Major dopaminergic pathway of brain

A

Nigrostriatial pathway

254
Q

Primary therapeutic target of antipsychotic drugs

A

Mesolimbic dopaminergic pathway

255
Q

Pathway whose dysfunction is responsible for “negative” symptoms

A

Decreased activity of mesocortical pathway

256
Q

Pathway whose dysfunction is responsible for “positive” symptoms

A

Increased activity of mesolimbic pathway

257
Q

Patient presentation of a left-sided lateral cerebellar lesion

A

Will fall toward the left (ipsilateral) due to impact on voluntary movement of extremities

258
Q

Patient presentation of a medial or midline cerebellar lesion

A

Lesion involves vermis, other midline structures, and/or flocculonodular lobe, so patient will have a wide-based gait (truncal ataxia), nystagmus, head tilting, bilateral motor defects (axial and proximal limbs)

259
Q

Input from the contralateral motor cortex to the cerebellum enters the cerebellum via:

A

middle cerebellar peduncle

260
Q

Input from the spinocerebellar tracts enters the cerebellum via:

A

inferior cerebellar peduncle

261
Q

Output via Purkinje cells -> deep nuclei of cerebellum -> contralateral cortex leaves cerebellum via:

A

superior cerebellar peduncle

262
Q

Describe the excitatory pathway of the basal ganglia

A

Cortical inputs stimulate GABA release from striatum, inhibiting GABA release from GPI, which disinhibits the thalamus, leading to increased motion

263
Q

Describe the inhibitory pathway of the basal ganglia

A

Cortical inputs stimulate the striatum to release GABA that disinhibits the subthalamic nucleus by inhibiting GPe, and since the subthalamic nucleus is disinhibited, that stimulates the GPi to inhibit movement

264
Q

Dopamine binding to D1

A

stimulation of excitatory pathway

265
Q

Dopamine binding to D2

A

inhibition of inhibitory pathway

266
Q

Lesion of basal ganglia preventing the inhibitory pathway of the basal ganglia

A

Sudden jerky purposeless movements -> chorea, like in Huntington’s disease

267
Q

Contralateral subthalamic nucleus lesion

A

Hemiballismus - half of body (arm and/or leg) undergoes sudden wild flailing because there is damage to the inhibitory pathway

268
Q

Cerebellar dysfunction might produce this type of tremor

A

Intention tremor

269
Q

Intention tremor

A

Slow, zigzag motion when trying to point at a target (like in nose-finger test)

270
Q

Sudden, brief, uncontrolled muscle contraction

A

Myoclonus

271
Q

Tremor seen in Parkinson’s disease

A

Resting tremor - uncontrolled movement of distal appendages

272
Q

Dysfunction to this basal ganglia function occurs in Parkinson’s disease

A

Dysfunction of excitatory pathway, due to lack of dopamine production in the SNlc

273
Q

Intracellular eosinophilic inclusions composed of alpha-synuclein in neurons

A

Lewy bodies, seen in Parkinson’s disease and Lewy Body Dementia

274
Q

Disorder with depigmentation of substantia nigra pars compacta and Lewy bodies

A

Parkinson disease

275
Q

Presentation of Parkinson disease

A

Tremor at rest, rigidity (cogwheel sign), akinesia/bradykinesia, postural instability, shuffling gait

276
Q

Trinucleotide repeat (CAG) disorder on chromosome 4 that is autosomal dominant

A

Huntington disease

277
Q

Part of the brain impacted in Huntington disease

A

Caudate nucleus - loses ACh and GABA production, and has increased dopamine, leading to lack of the inhibitory pathway of the basal ganglia

278
Q

Pathology on autopsy or imaging in Huntington disease

A

Atrophy of caudate and putamen, hydrocephalus ex vacuo

279
Q

Patient with choreiform movements, aggression, depression, and dementia

A

Huntington disease

280
Q

Cause of neuronal death in Huntington disease

A

NMDAR binding and glutamate excitotoxicity

281
Q

Nonfluent aphasia with intact comprehension, impaired repetition

A

Broca’s aphasia

282
Q

Fluent aphasia with impaired comprehension, impaired repetition

A

Wernicke’s aphasia

283
Q

“It… hard… … talk”

A

Broca’s aphasia

284
Q

“I want to elevator because talk blue”

A

Wernicke’s aphasia

285
Q

Lesion location in Broca’s aphasia

A

inferior frontal gyrus of frontal lobe

286
Q

Lesion location in Wernicke’s aphasia

A

superior temporal gyrus of temporal lobe

287
Q

Fluent aphasia with intact comprehension but impaired repetition

A

Conduction aphasia

288
Q

Lesion location in conduction aphasia

A

Arcuate fasciculus

289
Q

Nonfluent aphasia with impaired comprehension and impaired repetition

A

Global aphasia - affects arcuate fasciculus, Broca’s area, and Wernicke’s area

290
Q

Nonfluent aphasia with intact comprehension and intact repetition

A

Transcortical motor aphasia

291
Q

Lesion location in transcortical motor aphasia

A

Frontal lobe around Broca’s area, but not Broca’s area itself

292
Q

Fluent aphasia with impaired comprehension but intact repetition

A

Transcortical sensory aphasia

293
Q

Lesion location in transcortical sensory aphasia

A

Temporal lobe around Wernicke’s area, but not Wernicke’s area itself

294
Q

Nonfluent aphasia with impaired comprehension but intact repetition

A

Transcortical mixed aphasia

295
Q

HSV encephalitis may cause disinhibited behavior as a result of damage to this structure

A

Amygdala

296
Q

Lesion to frontal lobe

A

Disinhibition, defects in concentration/orientation/judgment

297
Q

Lesion to nondominant (usually R) parietal cortex

A

Hemispatial neglect syndrome

298
Q

Lesion to dominant parietal cortex

A

Agraphia, acalculia, finger agnosia

299
Q

Lesion to reticular activating system in the midbrain

A

Coma - reduced levels of arousal and wakefulness

300
Q

Confusion, ophthalmoplegia, truncal ataxia, memory loss, personality changes

A

Wernicke-Korsakoff syndrome - associated with thiamine deficiency and excessive alcohol use

301
Q

How can you accidentally induce Wernicke encephalopathy?

A

Giving glucose without thiamine to a patient who is thiamine deficient (like a long-term alcoholic)

302
Q

Lesion to mamillary bodies

A

Wernicke-Korsakoff syndrome

303
Q

Lesion to cerebellar hemisphere

A

Intention tremor, limb ataxia, loss of balance, defects are ipsilateral to the lesion

304
Q

Lesion to cerebellar vermis

A

Truncal ataxia and dysarthria, other central body defects

305
Q

Lesion to subthalamic nucleus

A

Contralateral hemiballismus

306
Q

Lesion to hippocampus

A

Anterograde amnesia

307
Q

Lesion to paramedian pontine reticular formation

A

Eyes look away from the side of the lesion

308
Q

Lesion to frontal eye fields

A

Eyes look toward the lesion

309
Q

Normally, pressure of which gas drives cerebral perfusion?

A

PCO2

310
Q

Consequence of decreased BP or increased ICP

A

Decreased cerebral perfusion pressure

311
Q

Equation for Cerebral Perfusion Pressure

A

CPP = MAP - ICP

312
Q

CPP = 0

A

Brain death - no cerebral perfusion

313
Q

How to treat acute cerebral edema that’s unresponsive to other interventions

A

Therapeutic hyperventilation to decrease PCO2 -> vasoconstriction -> cerebral blood flow decreases -> ICP decreases

314
Q

Severe hypotension can damage which areas of the brain first?

A

Watershed areas between the territories supplied by the cerebral arteries

315
Q

Anteromedial surface of brain supplied by:

A

Anterior cerebral artery

316
Q

Lateral surface of brain supplied by:

A

Middle cerebral artery

317
Q

Posterior and inferior surface of brain supplied by:

A

Posterior cerebral artery

318
Q

A stroke producing aphasia is likely where?

A

MCA, in dominant hemisphere. Temporal lobe if fluent aphasia (Wernicke), frontal lobe if nonfluent aphasia (Broca)

319
Q

An MCA stroke in the non-dominant hemisphere could produce what finding, in addition to contralateral paralysis and sensory loss?

A

Hemineglect

320
Q

A stroke producing contralateral paralysis/sensory loss of the face and upper limb is likely where?

A

MCA

321
Q

A stroke producing contralateral paralysis/sensory loss of the lower limb is likely where?

A

ACA

322
Q

A stroke producing contralateral paralysis/sensory loss of the face and body without cortical signs (neglect, aphasia, visual field loss) is likely where?

A

Lenticulostriate artery

323
Q

A pure motor stroke would impact what area?

A

Internal capsule - lacunar infarct

324
Q

A stroke with contralateral hemianopia would be due to which vessel?

A

PCA

325
Q

A stroke with “locked-in syndrome” - conscious, but with vertical eye movement and blinking, and with quadriplegia and paralysis of most of the face, would be due to which vessel?

A

Basilar artery

326
Q

A stroke with facial droop, decreased lacrimation and salivation, decreased taste would likely be due to which vessel?

A

Anterior inferior cerebellar artery - facial nucleus effects are specific to AICA

327
Q

A stroke with dysphagia and hoarseness, as well as ipsilateral Horner syndrome, and decreased pain and temperature of ipsilateral face and contralateral body, would be from which vessel?

A

Posterior inferior cerebellar artery - nucleus ambiguus effects are specific to PICA

328
Q

Contralateral paralysis and decreased contralateral proprioception, with a tongue deviating ipsilaterally, would be due to a stroke in which vessel?

A

Anterior spinal artery

329
Q

Location of a berry aneurysm

A

Bifurcations in the circle of Willis, most commonly where anterior communicating artery and ACA join

330
Q

“Worst headache of my life” in a patient with ADPKD or Ehler-Danlos

A

Berry aneurysm rupture causing subarachnoid hemorrhage

331
Q

An aneurysm of the ACA might compress which structures?

A

Optic chiasm, causing visual acuity defects and bitemporal hemianopia

332
Q

An aneurysm of the PCA might compress which structures?

A

CN III - blown pupil (mydriasis), with ptosis, and eye pointing down and out. This is an ipsilateral CN III palsy.

333
Q

Lentiform area of hyperdensity on CT that does not cross suture lines

A

Epidural hematoma

334
Q

Rupture of this artery most commonly causes epidural hematoma

A

Middle meningeal

335
Q

Rupture of these vessels causes subdural hematoma

A

Bridging veins

336
Q

Intracranial hemorrhage in shaken babies

A

Subdural hematoma

337
Q

Crescent hemorrhage crossing suture lines

A

Subdural hematoma

338
Q

Brain distortion that occurs in subdural hematoma

A

Midline shift

339
Q

Rupture of what can cause a subarachnoid hemorrhage?

A

AV malformation, or aneurysm

340
Q

“Worst headache of my life”

A

Subarachnoid hemorrhage

341
Q

Star-shaped hyperdensity on CT near midline

A

Subarachnoid hemorrhage due to bursting of a saccular aneurysm

342
Q

Hemorrhagic stroke that can result from systemic hypertension

A

Intraparenchymal hemorrhage

343
Q

Areas that are typically affected by intraparenchymal hemorrhage

A

Basal ganglia, internal capsule; can be lobar

344
Q

Area of brain most vulnerable to hypoxia

A

Hippocampus

345
Q

Imaging procedure with a stroke

A

Noncontrast CT to exclude hemorrhage must be done before tPA can be given

346
Q

Conditions under which you can give tPA

A

Within 3 hours of onset of the stroke, no hemorrhage, no substantial risk of hemorrhage

347
Q

Ways to reduce risk of ischemic stroke

A

Antithrombotic medications (aspirin, clopidogrel), control blood pressure and blood sugars and lipids, treat conditions like afib that increase risk

348
Q

Headache, seizures, focal neurologic deficits in a patient with factor V Leiden disease

A

May have venous sinus thrombosis

349
Q

Main location of CSF return to venous circulation

A

Arachnoid granulations in the superior sagittal sinus

350
Q

Cells that make CSF

A

Ependymal cells of choroid plexus

351
Q

Interventricular foramen, aka foramen of Monro

A

Connections between lateral ventricles and third ventricle

352
Q

Cerebral aqueduct, aka Sylvian aqueduct

A

Connection between 3rd and 4th ventricles

353
Q

Foramina of Lushcka and Foramen of Magendie

A

Connections between the 4th ventricle and subarachnoid space (Luschka is lateral, Magendie is medial)

354
Q

Increased ICP with no apparent cause on imaging in a woman of childbearing age

A

Pseudotumor cerebri (aka idiopathic intracranial hypertension)

355
Q

Papilledema and increased opening pressure on LP

A

Pseudotumor cerebri

356
Q

What does a lumbar puncture accomplish in pseudotumor cerebri?

A

Reveals the increased opening pressure, provides headache relief, may be able to treat it

357
Q

RFs for pseudotumor cerebri

A

Female of childbearing age, vitamin A excess, danazol, tetracycline

358
Q

Headache, diplopia with CN VI palsy, papilledema, no change in mental status

A

Increased ICP… Could be pseudotumor cerebri

359
Q

Treatment for pseudotumor cerebri

A

Weight loss, acetazolamide, topiramate, shunt placement, repeat lumbar puncture

360
Q

Mechanism of communicating hydrocephalus

A

Less CSF absorption by arachnoid granulations leads to increased ICP, papilledema, herniation. Can occur with arachnoid scarring after meningitis.

361
Q

Urinary incontinence, ataxia (magnetic gait - feet stuck to floor), and cognitive dysfunction in an elderly patient with CSF pressure normal/occasionally elevated

A

Normal pressure hydrocephalus. Ventricles are expanded, distorting the corona radiata

362
Q

Structural blockage of CSF within the ventricular system

A

Noncommunicating hydrocephalus

363
Q

Vertebral level at which the spinal cord ends

A

L1-L2

364
Q

Vertebral level to which the subarachnoid space extends

A

S2

365
Q

Vertebral levels for lumbar puncture

A

L3/4 or L4/5

366
Q

Voluntary motor tract in the lateral part of the spinal cord

A

Lateral corticospinal tract (sacral most outside radially, cervical most medial)

367
Q

Voluntary motor tract in the anterior part of the spinal cord

A

Anterior corticospinal tract

368
Q

Ascending fibers for pressure, vibration, touch, and proprioception

A

Dorsal columns - fasciculus gracilis and cuneatus

369
Q

Ascending tracts for pain and temperature

A

Lateral spinothalamic tract

370
Q

Ascending tract for crude touch and pressure

A

Anterior spinothalamic tract

371
Q

Sympathetic neurons in the spinal cord

A

Lateral horn, T1-L2

372
Q

Where do the dorsal column fibers decussate?

A

Medial lemniscus

373
Q

Where do the dorsal column and spinothalamic neurons synapse in the thalamus?

A

VPL

374
Q

Where do the spinothalamic tract fibers decussate?

A

At anterior commissary

375
Q

Nerve endings whose sensations are transmitted in spinothalamic tract

A

Free nerve endings -Adelta and C fibers

376
Q

Where do descending fibers of the lateral corticospinal tract decussate?

A

Decussate on of the pyramids

377
Q

Weakness, atrophy, fasciculations, hyporeflexia, negative Babinski sign, flaccid paralysis

A

LMN signs

378
Q

Weakness, hyperreflexia, increased muscle tone, positive Babinski, spastic paralysis

A

UMN signs

379
Q

What kind of clinical signs would occur with a lesion that only affects the anterior horn bilaterally?

A

Affects LMNs only, so LMN signs -> floppy, fasciculations, hypotonia, hyporeflexia, atrophy, etc.

380
Q

Where does spinal cord damage occur in polio?

A

Anterior horn, bilaterally

381
Q

Where does spinal cord damage occur in ALS?

A

Lateral corticospinal tracts and anterior horn

382
Q

What kind of deficits are present in ALS?

A

UMN defects due to lesions in lateral corticospinal tract

LMN defects due to lesions in anterior horn

383
Q

Treatment for ALS

A

Riluzole - not curative

384
Q

Asymmetric limb weakness, especially hands and feet, fasciculations, and progressive atrophy over time due to a defect in superoxide dismutase 1

A

ALS

385
Q

Complete occlusion of the anterior spinal artery would damage which tracts?

A

Everything except for the dorsal columns: pressure, vibration, touch, and conscious proprioception would be preserved at levels above and below the lesion, but everything else would be impaired.

386
Q

Tertiary syphilis can cause what spinal cord lesion?

A

Tabes dorsalis - demyelination of dorsal columns and dorsal nerve roots, leading to sensory ataxia due to impaired proprioception, and sensory defects for all kinds of sensory fibers at the level of the lesion.

387
Q

Charcot joints, shooting pain, abnormal pupils, no deep tendon reflexes, positive Romberg test

A

Tabes dorsalis

388
Q

What kind of a lesion is caused in syringomyelia?

A

Central lesion of the spinal cord damaging the anterior commissure, leading to bilateral loss of pain and temperature at the level of the lesion

389
Q

What kind of a lesion is present in vitamin B12 deficiency?

A

Subacute combined degeneration - demyelination of spina cerebellar, lateral corticospinal, and dorsal column tracts. Patients have impaired position and vibration sense, paresthesias, and ataxic gait.

390
Q

What kind of a lesion is present in Brown-Sequard syndrome?

A

Hemisection of the spinal cord - ipsilateral UMN signs below the level of lesion due to loss of corticospinal tracts, ipsilateral loss of tactile/vibration/proprioception sense below the level of lesion due to loss of dorsal columns, contralateral loss of pain and temperature below the lesion due to spinothalamic tract loss, ipsilateral loss of all sensation as well as presence of LMN signs at the level of the lesion itself.

391
Q

Brown-Sequard syndrome above T1 may produce what additional finding?

A

Ipsilateral Horner syndrome due to damage to oculosympathetic pathway

392
Q

Biceps reflex

A

C5 nerve root

393
Q

Triceps reflex

A

C7 nerve root

394
Q

Patellar reflex

A

L4 nerve root

395
Q

Achilles’ tendon reflex

A

S1 nerve root

396
Q

Function of superior colliculi

A

Conjugate vertical gaze center

397
Q

Function of inferior colliculi

A

Auditory signal integration

398
Q

Cranial nerves that are purely sensory

A

I, II, VIII

399
Q

Cranial nerves that are purely motor

A

III, IV, VI, XI, XII

400
Q

Cranial nerves that have both motor and sensory components

A

V, VII, IX, X

401
Q

Function of solitary nucleus

A

Viscerosensory info (taste, baroreceptors, etc) to VII, IX, X

402
Q

Function of nucleus ambiguus

A

Motor innervation of pharynx, larynx, upper esophagus (IX, X, XI)

403
Q

Corneal reflex

A

Afferent V1, efferent VII

404
Q

Lacrimation reflex

A

Afferent V1, efferent VII

405
Q

Pupillary light reflex

A

Afferent II, efferent III

406
Q

Gag reflex

A

Afferent IX, efferent X

407
Q

Cranial nerve lesion causing jaw to deviate to the right

A

CN V motor on the right side, jaw will deviate TOWARD the lesion

408
Q

Cranial nerve lesion causing uvula to deviate to the right

A

CN X lesion on the left; uvula will deviate away because the weakened side collapses

409
Q

Cranial nerve lesion causing weakness when turning head to the left, and shoulder droop on the right

A

CN XI lesion on the right side

410
Q

Cranial nerve lesion causing tongue to deviate toward the right

A

CN XII lesion on the right side

411
Q

Contralateral paralysis of lower muscles of facial expression, sparing the forehead

A

Upper motor neuron lesion of CN VII, due to destruction of motor cortex or the connection between the motor cortex and the facial nucleus in the pons. Forehead is spared because it is bilaterally innervated by CN VII UMNs.

412
Q

Ipsilateral paralysis of upper and lower muscles of facial expression with loss of taste sensation to anterior tongue.

A

Lower motor neuron lesion of CN VII, due to destruction of the facial nucleus or CN VII anywhere along its course.

413
Q

Idiopathic CN VII LMN lesion

A

Bell’s palsy (treat with corticosteroids and acyclovir)

414
Q

Structures that pass through the cavernous sinus

A

CN III, IV, VI, V1, V2, internal carotid artery

415
Q

Nerve most susceptible to injury in cavernous sinus syndrome

A

CN VI

416
Q

How does the outer ear transfer sound waves?

A

Vibration of tympanic membrane

417
Q

How does the middle ear transfer sound?

A

Ossicles conduct and amplify the sound

418
Q

How does the inner ear conduct sound?

A

Basilar membrane in the cochlea vibrates due to the sound waves, and the vibrations are transduced via hair cells into signaling along CN VII.

419
Q

Area of the cochlea that best hears low-frequency sounds

A

At the apex, near the helicotrema

420
Q

Area of the cochlea that best hears high-frequency sounds

A

At the base of the cochlea

421
Q

Abnormal Rinne test (increased conduction through the bone), and abnormal Weber test localizing sound to the affected ear

A

Conductive hearing loss

422
Q

Normal Rinne test, and Weber test localizes to the unaffected ear

A

Sensorineural hearing loss

423
Q

Where is aqueous humor produced?

A

Nonpigmented epithelium on ciliary body

424
Q

Factors that decrease aqueous humor production

A

Beta blockers, alpha-2 agonists, carbonic anhydrase inhibitors

425
Q

How does aqueous humor leave the anterior chamber?

A

Through the angle of the anterior chamber, either by passing through the trabecular mesh work or by draining into the urea and sclera

426
Q

Light is focused behind the retina due to an eye that is too short along the AP axis

A

Hyperopia (farsighted)

427
Q

Light is focused in front of the retina, due to an eye that is too long in the AP direction

A

Myopia (nearsightedness)

428
Q

Abnormal curvature of cornea causing different refractive power at different axes

A

Astigmatism

429
Q

Age-related impairment in accommodation due to decreased lens elasticity

A

Presbyopia

430
Q

Ciliary flush, sudden painful vision loss, halos, nausea and vomiting, rock-hard eye

A

Acute angle closure glaucoma

431
Q

Itchy red eyes bilaterally with clear discharge

A

Allergic conjunctivitis

432
Q

Red eye with purulent discharge

A

Bacterial conjunctivitis, treat with ABX

433
Q

Virus most responsible for viral conjunctivitis

A

Adenovirus

434
Q

Swollen preauricular LNs, sparse mucous discharge, and red eye

A

Viral conjunctivitis - self-resolving

435
Q

Accumulation of pus in anterior chamber

A

Hypopyon

436
Q

Hypopyon and/or conjunctival redness in patients with a history of systemic inflammatory disorders (think HLA-B27)

A

Uveitis/iritis

437
Q

Slowly progressive metamorphopsia and eventual loss of central vision

A

Age-related macular degeneration

438
Q

Rapid loss of vision due to bleeding beneath choroidal neovascularization

A

Wet macular degeneration - treat with anti-VEGF injections

439
Q

Retinal hemorrhages and macular edema in a diabetic patient

A

Nonproliferative diabetic retinopathy - treat with blood sugar control

440
Q

Neovascularization and chronic retinal hypoxia in a diabetic patient

A

Proliferative diabetic retinopathy

441
Q

Compression from hypertension or retinal artery atherosclerosis leads to retinal hemorrhage and venous engorgement with edema

A

Central retinal venous occlusion

442
Q

Separation of the photoreceptor layer of the retina from the outermost pigmented epithelium leading to vision loss, appearing as crinkling of retinal tissue on fundoscopic exam

A

Retinal detachment - often preceded by posterior vitreous detachment (flashes and floaters)

443
Q

Treatment of flashes/floaters/curtain

A

Emergent retinal detachment - Urgent ophtho surgery referral

444
Q

Acute painless monocular vision loss with a cloudy pale retina and a cherry-red spot at the fovea

A

Central retinal artery occlusion

445
Q

Marcus Gunn pupil

A

Afferent pupillary defect from optic nerve damage or retinal injury

446
Q

Conditions associated with Horner syndrome

A

Lesions of spinal cord above T1 - Pancoast tumor, Brown-Sequard syndrome, etc

447
Q

down and out gaze

A

CN III damage

448
Q

blown pupil

A

Damage to parasympathetics running on outside of cranial nerve III

449
Q

Eye moving upward with contralateral gaze, head tilt toward the side of the lesion (or compensatory head tilt in opposite direction)

A

CN IV damage

450
Q

Medially directed eye that cannot abduct

A

CN VI damage

451
Q

Medial longitudinal fasciculus

A

Allows for crosstalk between CN VI and III to coordinate eyes to move in the same horizontal direction. Is highly myelinated.

452
Q

Horizontal gaze palsy where the ipsilateral lateral rectus is activated, but the contralateral medial rectus is not, leading to nystagmus in the abducting eye, with normal convergence.

A

Internuclear ophthalmoplegia

453
Q

ApoE2 association with Alzheimer’s

A

Decreases risk

454
Q

ApoE4 association with Alzheimer’s

A

Increases risk

455
Q

Risk factors for Alzheimer’s

A

Down syndrome, APP, presenilin-1, presenilin-2

456
Q

Dementia with widespread cortical atrophy, decreased ACh, and senile plaques in grey matter with beta amyloid extracellularly and neurofibrillary tangles (tau protein) intracellularly

A

Alzheimer’s disease

457
Q

Early onset changes in personality or behavior or aphasia with degeneration of frontotemporal lobe

A

Frontotemporal dementia

458
Q

Dementia and hallucinations followed by Parkinsonian features

A

Lewy body dementia

459
Q

Histological finding in Lewy body dementia

A

Intracellular Lewy bodies, made of alpha-synuclein, in the cortex

460
Q

Multiple cortical and/or subcortical infarcts on MRI or CT over an extended period of time, with dementia symptoms that have a step-wise progression

A

Vascular dementia

461
Q

Charcot triad of MS

A

Scanning speech, intention tremor/incontinence/internuclear ophthalmoplegia, nystagmus

462
Q

CSF findings in multiple sclerosis

A

Increased IgG and myelin basic protein, with oligoclonal bands

463
Q

Things that are diagnostic of multiple sclerosis

A

MRI is gold standard; oligoclonal bands are diagnostic

464
Q

Destruction of Schwann cells leads to inflammation and demyelination of peripheral nerves and motor fibers, leading to symmetric ascending muscle weakness/paralysis, maybe with autonomic dysfunction

A

Acute inflammatory demyelinating polyradiculoneuropathy (Guillain-Barre syndrome)

465
Q

Tx for Guillain-Barre syndrome

A

Plasmapheresis, IVIG

466
Q

Autosomal dominant motor and sensory neuropathy associated with foot deformities

A

Charcot-Marie-Tooth disease

467
Q

Acute unilateral headache, 15 min-3 hours in a repetitive pattern, with excruciating periorbital pain, lacrimation, and rhinorrhea, and maybe Horner syndrome

A

Cluster headache

468
Q

Bilateral headache lasting around 4-6 hours, with steady constant pain, no photophobia, and no aura

A

Tension headache

469
Q

Unilateral headache lasting 4-72 hours, with pulsating pain, nausea, photophobia, phonophobia, may have aura

A

Migraine headache

470
Q

Type of headache due to release of substance P, calcitonin gene-related peptide, vasoactive peptides (or due to irritation of CN V, meninges, or vasculature)

A

Migraine

471
Q

Acute treatment of cluster headache

A

Supplemental O2 and sumatriptan

472
Q

Acute treatment of tension headache

A

Analgesics, NSAIDs, acetaminophen, can use amitriptyline for chronic pain

473
Q

Acute treatment of migraine headache

A

NSAIDs, fluids, triptans, dihydroergotamine

474
Q

Cluster headache prophylaxis

A

Verapamil

475
Q

Migraine headache prophylaxis

A

Lifestyle changes, beta blockers, calcium channel blockers, amitriptyline, topiramate, valproate

476
Q

Positional or central vertigo: delayed horizontal nystagmus on positional testing

A

Peripheral vertigo

477
Q

Positional or central vertigo: directional change of nystagmus, skew deviation, diplopia, dysmetria

A

Central vertigo

478
Q

Most common type of highly malignant brain tumor

A

Glioblastoma multiforme (grade IV astrocytoma)

479
Q

Typically benign brain tumor arising from arachnoid cells that is often asymptomatic or may present with seizures or focal neurologic deficits

A

Meningioma

480
Q

Highly malignant cerebellar tumor in children that is a form of primitive neuroectodermal tumor

A

Medulloblastoma

481
Q

Childhood supratentorial tumor derived from remnants of Rathke pouch that can cause bitemporal hemianopia

A

Craniopharyngioma

482
Q

Ependymal cell tumor found in the 4th ventricle that can cause hydrocephalus and has a poor prognosis

A

Ependymoma

483
Q

Prognosis for a pilocytic astrocytoma in children

A

Good prognosis

484
Q

Consequence of cingulate/subfalcine herniation under the falx cerebri

A

Can compress ACA

485
Q

Consequence of transtentorial (central) herniation

A

Caudal displacement of brainstem -> rupture of basilar artery branches -> usually fatal

486
Q

Consequences of uncal herniation

A

Compression of CN III (blown pupil with down-and-out gaze), ipsilateral PCA compression leading to contralateral homonymous hemianopia, contralateral compression of crus cerebri leading to ipsilateral paresis

487
Q

MOA of opioids

A

Agonists at opioid receptors modulate synaptic transmission -> lead to opening of K channels and closing of Ca channels to decrease synaptic transmission -> decrease release of ACh, NE, 5HT, glutamate

488
Q

MOA of tramadol

A

very weak opioid agonist, inhibits 5HT and norepinephrine reuptake

489
Q

Risks associated with tramadol

A

Decrease seizure threshold, serotonin syndrome

490
Q

What side effects of opioids do people not develop tolerance to?

A

Miosis and constipation

491
Q

MOA of benzodiazepines

A

Facilitate GABA-A action by increased frequency of Cl- channel opening

492
Q

Benzo used for status epilepticus

A

Lorazepam, Diazepam

493
Q

Drug to treat benzodiazepine overdose

A

Flumenazil

494
Q

Drug that can treat malignant hyperthermia

A

Dantrolene - ryanodine receptor antagonist

495
Q

Drugs for Parkinson disease

A

Ergot (bromocriptine) or non-ergot (pramipexole, ropinirole) - dopamine agonists
Increased dopamine release and decreased dopamine reuptake: amantadine
Levodopa/carbidopa: levodopa is converted to dopamine in the CNS, and carbidopa prevents it from being coverted to dopamine in the periphery by inhibiting DOPA decarboxylase

496
Q

Alzheimer’s drugs

A

Memantine (NMDA receptor antagonist), donepezil or rivastigmine or galantamine (AChE inhibitors)

497
Q

Drug that can be used for Huntington disease

A

Haloperidol - D2 receptor antagonist

498
Q

MOA of sumatriptan

A

5HT1B/1D agonist

499
Q

Symptoms of alcohol withdrawal

A

Severe withdrawal can cause autonomic hyperactivity and delirium tremens - treat with benzos emergently

500
Q

Side effects of lithium

A

Tremor, nephrogenic diabetes insipidus, hypothyroidism, teratogenicity

Mind & Motion (7 decks)

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