Nervous System Flashcards
Huntington disease mode of inheritence
Autosomal dominant
Huntington disease is caused by an increase in _______ in the gne that codes for the huntingtin protein
CAG trinucleotide repeats
Expansion of the huntingtin protein’s polyglutamine region in huntington disease results in ________ which leads to pathological interaction with other proteins, including various transcription factors
Gain-of-function
in huntington disease, abnormal hintingtin causes increased histone ____ which silenes the genese necessary for neuronal survival
Deacetylation
Occlusion of the PICA results in _____ syndrome
Lateral medullary (Wallenberg)
PICA arises from what artery
Vertebral
What arteries course through the transverse foramina in the neck before entering the skull at the foramen magnum and therefore can be easily injured by cervical spinal trauma
Vertebral
Oclussion of which vessel is characterized by vertigo/nystagmus, ipsilateral cerebellar signs, loss of pain/temperature sensation in the opsilateral face and contralateral body, bulbar weakness and ipsilateral horner syndrome
Posterior inferior cerebellar artery
Blood pressure above ____ increases verebral vascular volume and blood flow, causing a corresponding increase in ICP
150 mmHg
Blood pressure below _____ causes cerebral hypoperfuion and potential ischemia
50 mmHg
A drop in PaCO2 whill have what effect on intercranial blood flow
Causes vasoconstriction –> decreases cerebral blood volume –> decreased ICP
Lowering ____ is one of the measures employed to reduce ICP in mechanically ventilated patients with cerebral edema
PaCO2
Carbon dioxide is a potent ____ of cerebral vasculature
Vasodilator
The anterior pituitary is derived from what embryonic tissue
Surface ectoderm
Bitemporal hemianopsia, amenorrhea, and elargement of the pituitary gland on brain imaging are suggestive of ___________
Prolactin secreting pituitary adenoma
Prolactinomas develop from ____ cells in the anterior pituitary (adenohypophysis)
Lactotroph
What occurs at 3 eks of embryogenesis resulting in 3 germ layers
Gastrulation
During gastrulation, epiblast cells undergo what transition, causing them to lose their cell-to-cell adhesion properties
Epithelial-to-mesenchymal
The anterior pituitary is derived from what structure, which is an evagination of the surface ectderm that lines the fetal oral cavity
Rathke pouch
The posterior pituitary is derived from what embryonic cells
Neuroectoderm
The posterior pituitary is derived from the ______ which is an extension of neuroectoderm from the diencephalon
Infundibulum
What is the condition characterized by a sudden, involuntary contraction of a major muscle group that developes within 4 hours and 4 days of starting an antipsychotiv medication
Acute dystonic reaction
What is the presentation of dystonia as a oculogyric crisis
Forced, sustained elevation of the eyes in an upward position
How does opisthotonus (a dystonic reaction) present
Arching of the back with the head thrown backward
How does spasmodic torticollis (a dystonic reaction) present
Pain and stiffness on one side of the neck
Acute dystonic reactions a theorized to result from the antipsychotic property of D2 antagonism in what pathway
Nigostriatal
Dopamanergic blockade causes excess _____ _activity in the striatum leading to extrapyramidal side effects
Cholinergic (M1)
L5 radiculopathy presents with sensory loss where?
Lateral thigh
Calf
Dorsal foot
L5 radiculopaty often presents with weakness where?
Great toe extension
Foot dorsiflexion, inversion, and eversion
What is pleocytosis in a CSF sample
Elevated leukocyte count
What bacteria has distinctive tumbling motililty at room temperature
Listeria monocytogenes
How is listeriosis most commonly transmitted in adults
Food ingestion (can replicate in cold (refrigerator)
Listeriosis can have what presentation in immunocompromised adults
Meningitis
Migraines are associated with cortical spreading depression and subsequent stimulation of _____ afferents in the meninges causing release of vasoactive neuropeptides
Trigeminal
Trigeminal aferents in the meninges cause release of vasoactive peptides including substance P and __________, resulting in neurogeninc inflammation, vasodilation, and plasma protein extravasation which can casue migranes
Calcitonin gene-related peptide (CGRP)
Triptans, such as sumatriptan, are ________ agonists that directly counter migraine hedaches by binding trigeminal ____ receptors and inhibiting CGRP release from trigeminal neurons
Sertonin 5-hydroxytryptamine 1B/1D
Triptans bind serotonin recepotrs on smooth muscle cells of blood vessels and result in intracranial ____
Vasodilation
Tryptans are commonly prescribed as ______ therapy for acute migraines, particularly in patients who are not responsive to analgesics
Abortive
Significant adverse effects of triptans (used aas migrain therapy) include dizziness, chest tightness, and _____
Hypertension
The extracranial portion of the facial nerve exits the skull via ______ foramen
Stylomastoid
Where does CN VII divide into 5 terminal branches
Within the parotid gland
Parotid gland tumors can compress and disrupt the ipsilateral facial nerve and its branches leading to _____
Facial droop
Parotid gland tumors that cause facial nerve paralysis are often ______
Malignant
Tetanospasmin (potent metalloprotease exotoxin) inhibits release of what neurotransmitters
Glycine and gamma-aminobutyric acid (GABA)
What is the term for lockjaw seen in C.tetani infections
Trismus
What is the term for the contractions of back muscles resulting in backward acing seen in infections with C. Tetani
Opisthotonos
all 3 opiate receptor subtypes are transmemrane receptors that are coupled to ____ G proteins
Inhibitory
Which opiate recepter exerts the strongest analgesic effects
Mu
What effects do opiates have when binding to mu receptors on the primary afferent neurons
Closure of voltage gated calcium channels –> reduced calcium influx –> decreased excitatory neurotransmitter release from presynaptic terminal
What effects do opiates binding on mu rceptors on the postsynaptc membrane have
Opens potassium channels –> potassium eflux –> hyperpolarization
Dopamine agonists in treating Parkinson disease can result in what behavior change
Impulse control disorders
Dopamine agonists, treatment for parkinsons disease, act by binding central dopamine receptors and stimulating dopamine activity in the _____ and substantia nigra
Ventral striatum
Where is the nucleus accumbens located
Ventral striatum
Nucleus accumbens is involved in motivation and the _____ pathways
Reward
Zolpidem is a short-acting nonbenzodiazepine ___ agent
Hypnotic
Mechanism of action for zolpidem
Bind GABAa receptor at benzodiapine receptor site and act as GABAa agonist
What differs nonbenzodiazepines such as zolpidem from benzos
More specific binding –> primarily hypnotics and do not produce anxiolytic, muscle relaxant, o anticonvulsant effects
Campylobacter jejuni causes guillain barre syndrome via immune mediated polyneuropathy due to _________
Cross-reacting antibodies (molecular mimicry
In guillain barre syndrome an antecedent event (typically infection) provokes an immune response that cross reacts with the ______ and ______ of peripheral nerves
Schwann cells and myelin sheath
Underlying etiology of temporomandibular disorder (TMD) is multifactoral but includes tempromandibular joint(TMJ) derangement and hypersensitivity of the _______ nerve
Mandibular
The mandibular nerve is the largest branch of what nerve
Trigeminal nerve (it is CNV3)
The mandibular nerve supplies sensation to the TMJ, floor of mouth, ______ tongue and lower part of the face
Anterior
The mandibular nerve innervates the muscles of mastication, tensor veli palatini, and ________ which is in the middle ear and dampens loud sounds by tensing the tympanic membrane
Tensor tympani
Where does te herpes simplex virus 1 most commonly lay dormany
Neural sensory ganglia of trigeminal nerve
During reactivation HSV particles rely on anterograde axonal transport, carried out by ________, to reach the skin and oral mucosa
Kinesin
What motor protein, moves intracellular cargo via retrograde axonal transport
Dynein
What are two ways that critical illness can cause neuromuscular weakness
Critical illness myopathy (atrophy of myofibers)
Critical illness polyneuropathy (axonal degeneration)
What is the cause of cavernous sinus thrombosis
Contiguous spread of an infection from the medial third of face, siuses, or teeth
Methylmalonic acidemia results from complete or partial deficiency fo the enzyme ________
Methylmalonyl-coA mutase
In methylmalonic acidemia, a methylmalonyl-CoA mutase deficiency, results in a metabolic acidosis and what blood glucose status
Hypoglycemia
Why is there an anion gap metabolic acidosis present in methylmalonic acidemia (a deficiency in methylmalonyl CoA mutase)
Hypoglycemia –> increased FFA metabolism –> ketones –> anion gap
Why is there hyperammonemia in methylmalonic acidemia
There is a build up methylmalonic acid and propioinic acid. Organic acids directly inhibit urea cycle –> hyperammonemia
How is a diagnosis of methylmalonic acidemia confirmed
Elevated urine methylmalonic acid and propionic acid
Propionic acidemia is due to deficiency in what enzyme
Propionyl CoA carboxylase
How do the lab findings in propionic acidemia differ from methylmalonic acidemia
Will not have elevated levels of urine methylmalonic acid
Both have hyperammonemia, hypoglycemia, metabolic acidosis
Axillary nerve originates from the ____ cord of brachial plexus
Posterior
Axillary nerve carries fibers from what spinal nerves
C5, C6
What is the motor inervation of the axillary nerve
Deltoid and teres minor
What is the sensory inveration of the axillary nerve
Skin over lateral shoulder
What nerve injury leads to sensory loss over upper later arm and weakness on shoulder abduction due to denervation and possible atrophy of the deltoid muscle
Axillary nerve
kinesin is a microtubule associated motor protein whose funciton is anterograde transport of intracellularvesicles and organells toward the ____ end of microtrubules
Plus (rapidly growing)
What is the most common cause of cerebellopontineangle (betwen the cerebellum and lateral pons) tumors in adults
Vestibular schwannoma
Spontaneous vestibular schwannomas are usually unilateral, whereas bilateral vestibular schwannomas are associated with ___________
Neurofibromatosis type 2
What 3 nerves are in proximity at the cerebellopontine anlgle and therefore at risk of being compressed by a vestibular schwannoma
VII (facial)
V (trigeminal)
VIII (vestibularcochlear)
What common manifestation of multiple sclerosis is characterized by monocular visual loss with pain on eye movement and an afferent pupillary defect
Optic neuritis
MRI findings in _________ typically include white matter lesions scattered throughout the brain and/or spinal cord with a predilection for the subcortical periventricular regions
Multiple sclerosis
The pathogenesis of MS involves an autoimmue response targeting ________
Oligodendrocytes
Most patients with MS have ______ immunoglobulin bands in the cerebrospinal fluid
Oligoclonal
The auto-immune response in multiple sclerosis is __________ mediated
T cell and antibody
List the abortive medications use in migraine therapy
Triptans (sumatriptan)
NSAIDs, acetaminophen
Antiemetics (metoclopramide, prochlorperazine)
Ergotamine
List the preventative medications used for migraine therapy
Anticonculsants (topiramate or valproate)
Beta blockers (metoprolol, propranolol)
Antidepressents (tricyclic: amitrptyline, or venlafaxine)
What age group is almost exclusived affected by febrile seizures
6 mo - 5 years (seizure threshold is lower during early years of brain development)
What is the treatment for most febrile seizures
Antipyretics (NSAID)
Botulinum toxin prevents the presynaptic release of _____ from the nerve terminal at the neuromuscular junction
Acetylcholine
Clostridium botulinum spore formation occurs at _______ location which allows the bacteria to survive adverse conditions such as heat and high oxygen enironments
Subterminal (between the terminal end and center of the bacteria)
Injection of _____ into the a dystonic muscle results in muscular relaxation and relief of symptoms
Botulinum toxin type B
What is hydrocephalus ex-vacuo
Normal CSF expansion following cerebral volume loss rather than abnormal CSF accumulation as seen in hyrdrocephalus
Infants with hydrocephalus typically develop macrocehaly, poor feeding and what two other musculoskeletal/neural findings
Muscle hypertonicity
Hyperreflexia
In hydrocephalus, Hypertonicicty and hyperreflexia result from upper motor neuron injury caused by stretching of the ________ tracts
Periventricular pyramidal
Treatment of hydrocephalus requires ________
Surgical placement of a shunt
Infants with hydrocephalus will show what on imaging
Enlarged ventricles
What is the characteristic presentation of paralysis in a patient with botulism
Symetric, descending paralysis that first manifests with cranial nerve abnormalities: 3 D’s: diplopia, dysphagia, dysphonia
How does the botulinum toxin prevent the release of Acetylcholine
Destroys SNARE proteins
Transected nerves udergo __________ which involves axonal dissolution while activated schwann cells and macrophages degrade myelin
Wallerian degeneration
In addition to clearing cellular debris, ______ and macrophages stimulate formaiton of a growth cone from te proximal axon stump to facilitate nerve regeneration
Schwann
If regenerating axons cannot find their distal target, regeneration can result in formation of a disroganzed mass of axonal processes, Schwann cells, vascular hyalinization, and fibrosis know as a _______
Neuroma
Chronic axonal injury or inflammation induces increased expression of ___________ chanels
Voltage gated sodium chanels
To supportthe diagnosis of a neuroma, _______, is administered which will often provide immediate relief of pain
Local anesthetic (blocks sodium channels in the neuronal cell membrane –> prevents depolarization of the nerve)
What are the preferred anticonvulsants for focal onset seizures
Carbamazepie
Lamotrigine
Levetiracetam
Phenytoin
What anticonvulsants are prefered for tonic-clonic and myoclonic seizures
Leveltiracetam
Valproic acid
What are the preffered anticonvulsants for absence seizures
Ethosuxamide
Valproic acid
What typically presents in adolscents with brief, involuntary jerking movements involving both upper extremities with preservation of consciousness and symptoms usually occring within the first hour of waking and can be provoked by sleep deprivation
Juvenille myoclonic epilepsy
Individuals who consume more than 10 times the daily value of ______ are prone to developing toxicity and may suffer hepatic injury so severe as to cause cirrhosis
Vitamin A
Signs and symptoms of acute vitamin A toxicity occur after ingestion of a single high dose of vit A and include:
Nausea, vomitting, vertigo and blurred vision
Sings and symptoms of chronic vitamin A toxicity occur after the long-term ingestion of high doses of vit A and include:
Alopecia Dry skin Hyperlipidemia Hepatotoxicity Hepatosplenomegly Visual difficulties
The cerebellar hemispheres are primarily responsible for _______ of the ipsilaeral extremities
Motor planning and coordination
Lesions in the left cerebellar hemisphere typically result in left ________(impaired rapid alternating movements), _______ (overshooting/undershooting during targeted movement), and ________ tremor
dysdiadochokinesia
Limb dysmetria
Intention tremor
The cerebellar vermis modulates _____ via connections with the medial descending motor systems
Axial/truncal posture and coordination
Vertigo and nystagmus may occur due to disruption of what regions of the cerebellum
Inferior vermis and flocculonodular lobe
Mechanism of action: triptans
Serotonin 1B/1D agonist
Mechanism of action: metoclopramide
Dopamine recepor blocker
Dopamine receptor blockers have both antiemetic and anaglesic effects on migraine headaches by antagonizing central dompamine ____ receptors in midbrain and striatum
D2
Dopamne receptor bloackade in teh basal ganglila can cause excess ______ activity that manifests as significant extrapyramidal symptoms such as acute dystonic reaction
Cholinergic
What can be co-administered with metoclopramide or prochlorperazine to prvent extrapyramidal symptoms
Diphenhydramine (anticholinergic)
________ presents with vague lower extremity discomfot and an urge to move the legs that worsens at night
Restless leg syndrome
Causes of restless leg syndrome include idiopathic and 3 others:
Iron deficiency
Uremia
Diabetes (especially with neuropathy)
Pathophysiology of restless leg syndrom is not completely understood by likely involves CNS iron deficiency (even in patients with normal serum iron levels) and abnormalities in _______ transmission
Dopaminergic
Treatment of restless leg syndrome includes avoidance of aggravating medications, iron replacement, and ________
Dopamine agonists (ropinirole, pramipexole)
Characterisc pathologic changes associated with alzheimer disease involve acumulation of intracellulr ______ and extra cellular ______ plaques
Neurofibrillary tangles
Amyloid beta
Neurofibrillary tangles are composed of _____ protein, a primary component of intracellular microtubules
Tau
In alzheimer disease, tau protein is _____ causing microtubule structures to collapse into “tangles” that contribute to global neuronal dysfunction
Hyperphosphorylated
Amyloid beta is an abnormal fragment of ________ protein, which is normally involved in synaptic formation and repair
Amyloid precursor protein
An extra copy of ____ gene, located on chromosome 21, present in trisomy 21, is thought to lead to early onset alzheimers disease
APP (amyloid precursor protein)
______ phenomenon describes what patients with parkinson disease being treated with levodopa experience in terms of periodc flucuations in motor function
“On-off”
As parkinson disease progresses, the therapeutic windo for levodopa narrows, possibly due to natural or levodopa induced ______ degeneration
Nigrostriatal
In advanced PD, motor fluctuations can occur independently of dosing and may become _______
Unpredictable
A patien who developes prolonged muscle weakness after receiving succinylcholine could have _____________ deficiency, an autosomal recessive disorder caused by a genetic polymorphism in the BCHE gene
Pseudocholinesterase deficiency
Psuedocholinesterase deficiency is an autosomal recessive disorder caused by a genetic polymorphism in the _____ gene
BCHE
Succinylcholine is a _______ neuromuscular blocking agentused to induce skeletal muscle relaxation during intubation and surgery
Depolarizing
Succinylcholine acts as a _________ of nicotinic acetylcholine receptors of the motor endplate, where it induces persistent depolarization, leading to desensitization and skeletal muscle paralysis
Competitive agonist
Succinulcholine is rapidly hydrolyzed by plasma ________, only around 10% of the administered dose reaches the neurmuscular junction, where it typically has a duration of action of < 10 min.
Pseudocholinesterase
What is another name for neurofibomatosis type I
Recklinghausen disease
Neurofibromatosis type I is an autosomal dominant neurocutaeous disorder caused by mutations in _______ gene
NF1 (tumor supressor)
In neurofibromatosis type 1, patients typically develop _____ over the trunk
Cage au lait spots (hyperpigmented macules)
Patients with neurofibromatosis type I are at increased risk of developing ______ which can cause elevated intracranial pressure and headache
Central nervous system neoplasms (optic gliomas, pilocytic astrocytomas)
Cutaneous neurofibromas usually manifest during early adolescence as multiple, raised, fleshy tumors that often increase in size and number with age. These are benign sheath neoplasms predominantly comprised of _____ cells which are embryologically derived from _______
Schwann cells
Neural crest
Absence seizures are characteristically provoked by ______
Hyperventillation
Treatment for absence seizures
Ethosuximide (or valproate if first line is not tlerated or inneffective)
Absence seizures show _____ on electroencephalogram
3 Hz spike wave
Mechanism of action of ehosuximide
Inhibits T type calcium channels in thalamic neurons
A patient with sudden-onset confusion, memory loss, and anterograde amnsia that resolves in a couple hours is consistent with what dagnosis
Transient global amnesia
Risk factors for transient global amnesia
History of migraine
Older age
Transient global amnesia is likely due to dysfunction of what area of the brain which is responsible for formation of new memories
Hippocampus
When testing the plantar reflex, what action of the patients foot is a positive babinski sign
Dorsiflexion with or without fanning of the toes
Babinski signs indicates a _______ motor neuron lesion
Upper
Upper motor neuron injury can occur anywhere proximal to _____
The anterior hor
A sign of UMN injury includes _____reflexia, _____ paralysis, and ____ muscle tone
Hyper
Spastic
Increased
Describe clasp- knife rigidity
Increased muscle tension with sudden release on passive flexion
Clasp knife rigidity is present in ____ motor neuron lesions
Upper
In pyramidal weakness, a sign of upper motor neuron injury, weakness is more pronounced in lower extremity ______ and upper extremety ______
Flexors
Extensors
Pronator drift, due to upper extremity supination being weaker than pronation, is a sign of a ________ motor neuron lesion
Upper
Lower motor neuron lesion signs include ____ _paralysis, _______ tonia, and _____ reflexia
Flaccid
Hypo
Hypo (or absent)
Fasciculations are present in ___ motor neuron lesions
Lower
Histology of guillain barre syndrome demonstrates an inflammatory infiltrate located within the ______
Endoneurium (innermost layer of connective tisue that surrounds a nerve axon adn its corresponding blood vessels)
In guillian barre syndrome, macrophages strip the myelin sheath from the axon, and ________ macrophages are seen following the engulfment of myelin
Lipid laden
The speed of conduction down an axon depends on what two constants
Length (space) constant
Time constant
Myelin _____ the length constant by reducing charge dissipation across the membrane
Increases (allows the electrical impulse to propagate further without requiring active regeneration by ion channels)
Myelin ____ the time constant
Reduces (allows membrane potential to change faster)
Unilateral hand pain and numbness, thenar atrophy, and weakness of thumb opposition is characteristic of ________
Carpal tunnel syndrome
The carpal tunnel is an antaomic space in the wrist between the carpal bones and the ______
Transverse carpal ligament (flexor reinaculum)
What structures run through the carpal tunnel
Median nerve
9 tendons: flexor digitorum superficialis and profundus, flexor pollicis longus
If carpal tunnel syndrome is not treatable with wrist splints and glucocorticoid injection, surgical decompression can be performed by making a longitudial incision of the ______
Transvers carpal ligament
What role do the pili on the capsular surface of N meningitidis have?
Attachment to and colonization of the nasopharyngeal epithelium as well as bacterial movement and epithelial penetration
What is the role of Opa-proteins in N. Meningitidis
Aid in endothelial attachment and invasion
What virulence factor aids N. Meningitidis by destroying mucosal antibodies that would otherwise inhbit epithelial colonization
IgA protease
Capsulr polysaccharides provide what benefit to bacterial organisms (including N. Meningitidis)
Prevent phagocytosis and phagolysisime destrution
Why are pili in N. Meningitidis a difficult target for vaccines
Significant antigenic variations
What nerve courses along the pericardium and overlies hte right atrium puting it at high risk during procedures that target structures in or near the right atrum
Right phrenic nerve
How can an injury to the right phrenic nerve be visualized on a chest xray
Elevation of the right (ipsalteral) hemidiaphragm
A patient with history of A fib presenting with isolated left lower extremety motor deficits, most likely had a carioembolic stroke in what artery
Right anterior cerebral artery
Occlusion of the ACA characteristically causes contralateral _____ limb weakness and _____ motor neuron signs
Lower
Upper
Atrial thromemboli traveling to and obstructing the middle cerebral artery characteristically has contralateral _____ extremity weakness and _____ deficits
Upper
Face
Portion of the hypothalamus that mediates satiety, and lesions –> hyperphagia
Ventromedial
Ventromedial injury makes you very massive
Portion of hypothalamus that mediates hunger, lesion –> anorexia
Lateral
Lateral injury makes you lean
Portion of hypothalamus that mediates heat dissipation, lesion –> hyperthermia
Anterior
A/C = Anterior cooling
Portion of hypothalamus that mediates head conservation, lesion –> hypothermia
Posterior
Heating controled by posterior= hot pot
Portion of hypothalamus that secretes dopamine (inhibits prolactin) and GHRH
Arcuate
Portion of hypothalamus that secretes GnRH and regulates sexual behavior
Medial preoptic
Portion of hypothalamus that secretes oxytocin, CRH, TRH, and small amounts of ADH
Paraventricular
POX = paraventricular = oxytocin
Portion of hypothalamus that secretes ADH and small amounts of oxytocin
Supraoptic
SAD= supraoptic = ADH
Portion of the hypothalamus that regulates circadian rhythm and pineal gland function
Suprachiasmatic
SCN is Sun Censing Nucleus
Musculocutaneous nerve roots
C5-C7
Musculocutaneous nerve arises from ____ cord of brachial plexus
Lateral
Motor innervation of the musculocuaneous nerve
Forearm flexors adn corachobrachialis
Sensory innervation of musculocutaneous nerve
Lateral forearm
Brown sequard syndrome (result of a spinal cord hemisection) will produce _____lateral paralysis, _____ lateral loss of vibration, proprioception, and light touch, and ____ lateral loss of pain and temperature sense
Ipsilateral paralysis
Ipsilateral vibration
Contralateral pain/temp
If a patient fails the romberg test with eyes open then they have ____ ataxia
Cerebellar
If a patient is steady during the romberg test with eyes open but fails when eyes are closed they have _____ ataxia
Sensory (loss of proprioception)
Tabes dorsalis causes sensory ataxia due to what infection
Syphilis
Over 95% of glioblastoma cases are associated with the overexpression of _________ on the surface of neoplastic cells
Epidermal growth factor (EGRF)
Mechanism of action: erlotinib
Inhibits EGFR/EGFR-ligand interaction
A biopsy of a tumor with hypercellular white matter with extensiveastrocytic aberration, microvascular proliferation and areas of necrosis lined with tumor cells will have what diagnosis
Glioblastoma
Right arm numbness and paresthesia caused by a focal onset seizure originates in the ____ side ____ central gyrus
Left
Post
(Primary somatosensory cortex)
Wernicke korsakoff syndrome is a complication of ______ defciency and most commonly occurs in patients with history of long standing alcohol abuse or other forms of malnurishment
Thiamine (B1)
Thiamine is a vitamin cofactor involved in ____ metabolism and decifiecy resultsin neuoronal damage and necrosis
Glucose
Iatrogenic wernike korsafoff an be precipitaed by the administration of ________
Glucose containing fluids which depletes the last remianing stores of thiamine
Areas of the brain with high metabolic demand are particularly susceptible to wernicke korsakoff syndrome, focal hemorrhage and atrophy of _______ is characteristic
Mammillary bodies
Neurofibromatosis type 1 gene mutation is located on chromosome ___ while NF2 gene mutation is located on chromosome ____
17
22
NF1 is a tumor supressor gene that codes _____
Neurofibromin
NF2 is a tumor supressor gene that codes protein ____
Merlin
Von Recklinghausen disease is associated with what gene mutation
NF1 (neurofibromatosis type 1)
Central neurofibromatosis is associated wiith what gene mutation
NF2 (neurofibromatosis type 2)
What are the main clinical features of neurofibromatosis type 1
Cafe au lait spots
Multiple neurofibromas
Lisch nodules
What are the main clinical features of neurofibromatosis type 2
Bilateral acoustic neuromas
A brain tumor causing cerebellar symptoms with sheets of primitive cells with many mitotic figures indicates what diagnosis
Medulloblastoma
Primitive neuroetodermal tumors are composed of sheets of small cells with deeply ____ nuclei and ____ cytoplasm
Basophilic
Scant
Primitive neuroectodermal tumors are well or poorly differentiated? And good or bad prognosis?
Poorlydifferentiated
Poor prognosis
Syringomyelia presents with loss of pain and temperature sensation in the arms and hands due to a fluid filled cavity called a _______ that damages the ________ and sometiems the ventral horns
Syrinx
Ventral white commissure
The ventral whitecommissure is the area of decussation for the fibers of the ____ tract
Lateral spinothalamic
Axons of the spinothalamic tract briefly ascend in the zone of ____ before decussating
Lissauer
The anterior 2/3 of the spinal cord is perfused by the ______ which receives blood flow form segmental arteries arising from te ______
Anterior spinal artery
Thoracic aorta
In an anterior cord syndrome how do initial changes in motor fuction progress
Initially: flaccid paralysis from spinal shock
Upper motor neuron signs devlop (spasticity, hyperreflexia) over days to weeks
Neoplastic spinal cord compression most commonly results from local extension of vertebral metastases into the ______ space
Epidural
Characteristic CT findings of ischemic stroke 6-12 hours after onset of inschemic injury include _____ of the tissue and loss of _____ differentiation within affected region
Hypoattenuation
Grey-white matter
Signs of irreversible damage during the first 24 hours after injury in ischemic stroke are ____ (microscopic finding)
Red neurons
Neutrophils move into area of ischemic stroke ____ following injury and microglial cells _____ after onset of injury
1-2 days
3-7 days
_______ is the product of neuron disintegration and microglia phagocytosing their fragments which along w myelin breakdown products accumulate in the microglia cytoplasm
Foamy lipids
In Guillain barre syndrome, ______ demyelination and an _____ inflammatory infilttrate composed of lymphocytes and macrophages are seen on light microscopy
Segmental
Endoneurial
Fragile X syndrome mode of inheritence
X linked
Fragile x syndrome is an x linked disorder caused by ____ mutation in hat gene
Loss of function
Fragile x mental retardation 1 (FMR1)
Which arm of the x chromosome is the FMR1 gene located
Long arm
Presentation of _______ includes long, narrow face, prominent forehead and chin, large testes, hyperlaxity of joints, developmental delay, and neuropsychiatric features
Fragile x syndrome
Anxiety and agnitation are central effects of dopamine and are caused by what parkinson disease treatment
L-dopa
Why might adding carbidopa to L-dopa treatment worsen anxiety and agitation side effects
Carbidopa inhibits peripheral conversion of levodopa, making more of it availible to the brain
How long following an ischemic stroke do red neurons with eosinophiliccytoplasm, pyknotic nuclei and loss of Nissl substance appear
12-24 hours
How long following an ischemic stroke does neutrophilic infiltration occur
24-72 hours
How long after a stroke do macrophage/microglia innfiltratation and phagocyosis begin
3-7days
How long after an ischemic stroke does reactive gliosis and vascular proliferation around he necrotic area occur
1-2 weeks
How long afer an ischemic stroke does a glial scar form
> 2 weeks
How long after an ischemic stroke does liquefactive necrosis occur
1 wk-1 month
How long after an ischemic stroke does a cystic area surrounded by dense glial fibers form
> 1 month
Why might someone exposed to organophosphates experience wheezing
Cholinesterase inhibitor –> cholinergic overstimulation –> bronchospasms
In viral meningitis, CSF will have a WBC count of ______ with ______ cell predominance
<500
Lymphocytic
In viral meningitis, glucose levels are _____ and protein levels are _____
Normal or slightly reduced
<150
In CSF of viral meningitis, CSF gram stain/culture will have what result
No organsism identified
In bacterial meningitis, CSF WBC count is ______ with _____ cell predominece
> 1000
Neutrophilic
In bacterial meningitis, the CSF has glucose levels of ______ and protein is _______
<45
>250
A CSF gram stain in bacterial meningitis will often have what result
Positive for a specific organism
What is the most common viral cause of meninitis
Enterovirus (>90%)
What virus can present with the following clinical signs: fever, headache, rash, meningitis, echphalitis, acute asymmetric flaccid paralysis, parkinson symptoms
West nile virus
West nile virus is a _____ sense _____ stranded RNA virus
Positive
Single
Who is at risk for a west nile virus becoming neuroinvassive
Older
Malignancy
Organ transplant
What may be suspected of a patient with oral thrush and cervial and inguinal lymphadenopathy
HIV
Headache, seizures, multiple ring enhancing central nervous system lesions in a patient with HIV indicates what diagnosis
Toxoplasmic encephalitits
List two modes of transission for tocoplasmic encephalitits
Extensive pet (cat)exposure Contaminated food
Neuroleptic malignant syndrome is a life threatening adverse effect due to block of _____ receptors in the brain
Dopamine
If a patient who recently started using an antipsychotic presents with fever, confusion, muscle rigidty, and autonomic instability (abnormal vital signs, sweating) what might they be experiencing
Neuroleptic malignant syndrome
Mechanism of action: dantrolene
Atnagonizes ryanodine receptors and inhibits calcium release from sarcoplasmic reticulum
____ of inhaled anesthetic is inversly proportional to the minimal alveolar concentration
Potency
The minimal alveolar concentration referes to the percentage of anesthetic in the inspired gas mixture that renders ____ of patients unresponsive to painful stimulil
50%
What nerve innervates all of the extensor muscles of the upper limb below the shoulder and provides sensory inervation to the skin of the posterior arm, forear, and dorsal lateral hand
Radial
Radial nerve receives fibers from what nerve roots
C5-T1
The radial nerve tracks within the radial groove of the humerus, therefore it is vulnerable to tramatic injury at the ______
Humeral midshaft
Patients with proximal radial neuropathy typically have weakness during _______ and variable sensory loss over the posterior arm and forearm
Wrist and finger extension (wrist drop)
Damage to the proximal radial nerve can occur at the _____ or the midshaft of the humerus
Axilla
The blood brain barrier is formed by _____ between nonfenestrated capillary endothelial cells that prevent the paracellular pasage of fluidsand solutes
Tight junctions
L-DOPA has low lipid solubility but is able to enter brain due to _______
Its high affinity for the large neutral amino acid transporter
Liquefactive necrosis is charcteristic of irreversible CNS injury becuase of the brains high cholesterol content and lack of supporting architecture. It also occurs in other body tissues in the setting of severe infection/inflamation because of the release of _______ from reacting inflammatory cells.
Hydrolytic enzymes
How does a nicotinic receptor function
Its 2 acetylcholine binding sites must be filled and the ion channel opens, allowing sodium and calcium influx and sodium outflux —> end plate potential
Nitrous oxide is a ____ soluble gas
Poorly
A gas that is poorly soluble, such as nitrous oxide, partial pressure will rise rapidly and plateua, indicating that the blood quickly becoems _____with the anesthetic
Saturated
Blood solubulity of an anesthetic is indicated by itsblood/gas partition coefficient, anesthetics with a higher blood slubility will have a ______ blood/gas partition coefficent
Larger
A gas with higher solubulity (thus a larger blood/gas partition coefficient) will havea partial pressure in blood that rises more _____ than a low solubilty gas
Slowly
Poorly soluble gases equilibrate with the brain ______ than highly soluble gases
Faster
Poorly soluble gases have a ______ onset than highly soluble gases
More rapide
The first pharyngeal arch is associated with what nerve
Trigeminal (V)
Bony derivatives of first pharyngeal arch
Maxilla Zygoma Mandible Incus Malleus
Muscle derivatives of first pharyngeal arch
Muscles of mastication
Second pharyngeal arcassociated with what nerve
Facial nerve (VII)
Second pharyngeal arch gives rise to what bones
Styloid process of temporal bone, lesser horn of hyoid, and stapes
Muscles derived from 2nd pharyngeal arch
Muscles of facial expression
Treacher collins syndrome is a genetic disorder resulting in abnormal development of _____
1st and 2nd pharyngeal arches
Treacher collins syndrome will preset with craniofacial abnormalities resulting in airway compromise and feeding difficulties as well as what other clinical finding
Profound conductive hearing loss
The most notable manifestaions of vitamin E deficiency are hemolysis and neurologic dysfunciton due to _____
Free radical damage of cell membranes
Neurologic symptoms of vitamin E deficiency closely mimic _______ which include ataxia ue to degeneration of spinocerebellar tracts, loss of position and vibration sense due to degeneration of the dorsal columns and loss of deep tendon reflexes due to peripheral nerve degeneration
Friedreich ataxia
Intraventricular hemorrhage in preterm infants usually originates from ______, a highly cellular and vascularized layer in the subventricular zone (source of neurons and glial cells during brain development)
Germinal mattrix
The germinal matrix contains numerous fragile, thin walled vessels that lack _____ that support other blood vessels throughout the bain, making them more susceptible to hemorrhage
Glial fibers
There is reduced risk of intraventricular hemorrhage in infants born after _____ weeks because the germinal matrix starts to become less prominent and its cellularity and vascularity decreases
32
Neonatal intraventricular hemorrhage occurs in infants born before 32 weeks nd/or birth weight
1,5000 g (3 lb 5o z)
Creutzfeldt-Jakob disease is a ____ disease: transmissible spongiform encephalopathy
Prion
Creutzfeldt-Jakob disease presents in previously healthy patients with ______ dementia associated with ________
Rapidly progressive
Myoclonus
Prion diseases are associated with the hange in structural confirmation of ______
Prion protein (PrPc)
The abnormal prion protein (PrPsc) in prion diseases is resistant to ______ and accumulates within neuronal and glial cells causing neural cell death
Enzymatic degredtion
Histopathology of Creutzfeldt-jakob disease shows widespread neuronal loss with small, uniform ____ in the gray matter of the brain
Vacuoles (spongiform encephalopathy)
What form of vaccine is administered for measles virus
Live attenuated
Measles genome codes for structural proteins including ____ which mediates cell surface adhesion and ____ which is important for virral assembly
Hemagglutinin
Matrix protein
______ is a rare complication of measles that occurs in children or young adults several years after the infection
Subacute sclerosing panencephalitis
Subacute sclerosing panencephailtis is caused by a form of measles virus with a mutated or absent _____ protein, allowing the virus to replicate intracellularly, evading the immune system
Matrix
Accumulation of measles viral ______ within neurons and oligodendrocytes results in the formation of intranuclear inclusions and eventually leads to inflammation, demyelination, and gliosis in manny cerebral areas (subacute sclerosing panencephalitis)
Nucleocapsids
________ of measles virus antibodies are found in the CSF of patients with subacute sclerosing panecephalitis secondary to measles infection
Oligoclonal bands
Cognitive decline and chorea along with a family history of similar symptoms are suggestive of what diagnosis
Huntingon disease
Huntington disease is due to ______ in the huntington gene leading to a gain of function mutation
Excessive number of CAG trinucleotide repeats
In Huntigton disease, the buildup of abnormal/toxic mutant huntingtin protein leads to loss of ____ in what region of the brain
Inhibitory GABA neurons
Caudate nucleus
Imaging in a patient with Huntington disease will reveal atrophy of the ___ leading to enlargement of the _____
Caudate nuclei
Lateral ventricles
The caudate nucleus and the _____ make up the striatum which is critical for movement control and coordination as well as behavior regulation
Putamen
Common manifestations of tabes dorsalis inlude sensory ataxia, absent deep tendon reflexes, and _____
Lancinating pains
Spirochetal damage to the midbrain _____ commonly results in Argyll Robertson pupil
Tectum
Positive VDRL is diagnostic of what infection
Syphilis
Normal aging leads to the following sleep changes: _______ total sleep time, slow wave sleep with _____ nighttime sleep latency
Decreased
Increased
What is the cause of isolated anosmia (leading to lack of taste) due to a head trauma
Acceleration-deacceleration forces lead to avulsion of olfactory nerve rootlets
A spinal cord disection at C7 would effect maximum insipiration or expiration more?
Expiration
Above the splenic flexure, peristalsis is controlled parasympathetic stimulation from what nerve
Vegas
Below the splenic flexure, peristalsis is controlled by parasympathetic innervation from what nerve
S2-S4 nerve roots
The external anal sphincter is controled by voluntary control (skeletal muscle) whic is innerrvated by what nerve
Pudendal nerve (S2-S4)
Decerebrate posture is due to a lesion _____ the red nucleus and results in contraction of the _______ muscles
Below
Extensor
Decorticate posture is due to a lesion ____ the red nucleus and results in contraction of the ___ muscles
Above
Flexor
Intracranial hemorrhage can cause significant mass effect and increase cranial pressure which can manifest with seizures and_________ triad (hypertension, bradycardia, bradypnea)
Cushing
Uncal herniation initially disrupts the ipsilateral occulomotor nerve (CN III) leading to _____
Fixed dilated pupil
The _____ tract regulates upper extremity flexor tone and originates from the red nucleii in the rstral midbrain
Rubrospinal tract
The rubrospinal tract is ______ by descenfing cortical output from the cerebral cortex
Inhibitted
The opthalmic nerve (CN V1) exits the skull through what foramen
Superior Orbital fissure then supraorbital foramen
The maxillary nerve (CN V2) exits the skull through what foramen
Foramen rotundum then infraorbital canal then infraorbital foramen
The mandibular nerve (CN V3) exits the skull through what foramen
Foramen oval
The alveolar nerve branch enters mandibular foramen then exits through mental foramen
what protein has apple green birefringence when stained ith congo red
Amyloid
Amyloidosis and Alzheimer disease both show apple green befringence with congo red staind but how do they differ
Alzheimer disease amyloid deposits are only seen in brain tissue
Spastic cerebral palsy may be caused by periventricular white matter necrosis which leads to loss of descending _____control from the upper motor neurons
Inhibitory
Lack of CNS inhibition leads to hyperactve ______
Stretch reflex
In the stretch reflex, muscle lengthening is sensed by _____
Muscle spindle
Afferent signal of stretch is conveyed to the spinal cord via the ____ nerve fibers
Dorsal
Efferent signals of the stretch reflex are conveyed via the ___ root of the spinal cord
Ventral
In the stretch reflex ____ muscle fibers are stimulated, causing muscle contraction
Extrafusal
The ___ reflex is responsible for deep tendon reflexes and the maintenacne of muscle tone
Stretch
A selective dorsal rhizotomy procedure destroys the ____ arm of the reflex arch, which decreses muscle tone without sacrificing motor innervation of the muscles
Afferent (sensory)
Symmetric, bilateral wedge shaped strips of necrosis over the cerebral convexity are characteristic of _____ cerebral ischemia
Global
Profound systemic hypotension diminishes blood suply to the entire brain, resulting in neuron cell death in areas that are vlnerable to hypoxia such as _____ and _____
Watershed areas and regions with high metabolic demand
______ is a group of hereditary peripheral neuropathies characterized by mutations in genes coding for peripheral nerce axonal or myelin proteins presenting with adolescent lower extremett weakness, muscle atrophy and peripheral neuropathy
Charcot marie tooth disease
The most common type of charcot marie tooth (CMT1) occurs due to autosmal dominant mutation in the ______ gene
PMP22
Sudden upward jerking of the arm at the shoulder can cause injury to the _____ trunk of the brachial plexus
Lower
the lower trunk of the brachial plexus carried nerve fibers from the C8 and T1 spinal levels that ultimately contribute to the ____ and ___ nerves
Median and ulnar
Injury to the intrinsic hand muscles leads to ______ palsy: weakness of the lumbricals –> impaired flexion of metacarpophalangeal joints and impaired extension of the interphalangeal joints: claw like deformity
Klumpke’s palsy
What nerve exits the brain stem at the lateral aspect of the mid-pons at the level of the middle cerebellar peduncles
Trigeminal
What is a key neuroanatomic andmark for locating the trigeminal nerve
Middle cerebellar peduncle
Infarcts to the anterior pons can affect the ____ tracts
Corticospinal (contralateral hemiparesis)
Corticobulbar (contralateral lower facial palsy, dysarthria)
In an isolated CN III palsy, how is the eye oriented
Down and out
What eye muscles are not innervated by CN III
Superior oblique (CN IV) Lateral rectus (CN VI)
Aneurysms causing CN III palsy most often involve the ______ artery
Posterior communicating artery
Hydrocepalus (enlargement of the ventricles) caused by central neuronal volume loss (rather than excessive CSF) is called_______
Hydrocephalus ex-vacuo
In hydrocephalus ex-vacuo, the CSF pressure is____
Normal
In communicating hydrocephalus, CSF flows freely between the ventricles and subarachnoid space but there is decreased CSF absorptionin at the ________
Arachnoid granulations
Normal pressure hydrocephalus is _______ while high pressure hydrocephalus is _______
Chronic
Acute
A patient with unilateral optic neuritis is most likely to demonstrate an _____ pupillary defect due to demyelination of the right optic nerve
Afferent
The optic nerve carries the afferent limb of the puppillary light reflex, transmitting informaiton about light entering the eye to the ______ area in the midbrain
Pretectal
The pretectal area activates the ______ nuclei bilaterally which send paraympathetic efferent motor fibers down the oculomotor nerve to innervate the pupillary sphincter muscle to each iris
Edinger-westphal
Patients with an afferent pupillary defect will have what effect on pupillary constriction when light s shined in the non affected eye
Normal pupillary reflex bilaterally
What is first line therapy for essential tremor
Beta blocker (propranolol)
In patients with __________ exposure to certain anesthetic agents such as succinycholine and inhalation gasses causes unregulated passage of calcium form the sarcoplasmic reticulum into the intraacellular space
Malignant hyperthermia
In malignant hyperthermia, excessive myoplasmic _____ accumulation results in sustained muscle contraction, which is often first noted in the masseter
Calcium
What causes a high temperature in patients with malignant hperthermia
Sustained muscle contractions –> ATP consumption –> excessive heat production
Treatment for malignant hyperthermia
Dantrolene (blocks further release of calcium into the intracellular space)
Blotchy red muscle fibers on Gomori trichrome stain are characteristic of ________
Mitochondrial myopathies
In mitochondrial myopathies, abnormal mitochondria accumulate under the sarcolemma of muscle fibers causing the muscle fibers ro have irregular shape and size on cross section, for this erason mitochondrial myopathies are also known as ______
Red ragged fiber disease
Phenytoin is a ______ of p450
Inducer
_______ malformations are a group of congential disorders caused by unerdevelopment of the posterior fossa
Chiari
Chiari type I is more benign and presents when?
Adolescence/adulthood
Chiari tpe II typically presents when
Neonatal period
How does chiari type I differ from the herniation seen in chiari type II
Chiari type I only has the ccerbellar tonsils below the foramen magnum but chiari type II has downward displacement of the cerebellum and the medulla through the foramen magnum
What complications are common in type two chiari
Non communicating hydrocephalus
Lumbar myelomeningocele
Where does VZV lie dormant
(Migrates via sensory nerves to) cranial nere and dorsal spinal ganglia
What organism is a round/oval yeast surrounded by thick polysaccharide capsule
Cryptococcus neofromans
Cryptococcal diagnosis can be confirmed by cryptococcal antigens in CSF or visualiztion of encapsulated budding yeasts in CSF using what 2 specilized stains
India ink
Methenamine silver
Spinal muscular atrophy is caused by mutation in the ______ gene which encodes a protein involved in the assembly of small nuclear ribonucleoproteins (snRNPs)
Survival motor neuron gene (SMN1)
Defective snRNP assembly, as seen in spinal muscular atrophy, results in impaired _____ function and degeneration of anterior horn cells in the spinal cord
Splicesome
Non-coding RNA differs from other RNA how?
They carry out functions without first being translated into proteins
A collection of snRNPs and other proteins on a pre-RNA is referred to as a ____
A splicesome
Splicesomes remove ____ from preRNA
Introns
Infants with spinal muscular atrophy often have flaccid paralysis due to degeneration of _____ cells in the spinal cord
Anterior horn
Long standing rheumatoid arthritis frequntly involvesthe cervical spine and causes joint destruction with vertebral malalignment which is called _______
Subluxation
What is concerning about endotracheal intubation with a patient who has long standing rhuematoid arthritis
Extension of the neck can worsen subluxation leading to acute compression of the spinal cord and or vertebral arteries
Mechanism of methotrexate
Folic acid analog –> inhbits dihydrofolate reductase –> rapidly dividing cells dodnt have DNA synthesis or repair
An MRI with ventriculomegaly without sulcal enlargemnt is characteristic of ____
Normal pressure hydrocephalus
Normal pressure hydrocephalus causes lateral entrical expansion –> stretching of _______
Descending cortical fibers (corona adiata)
What is the classic triad of normal pressure hydrocephalus symptoms due to stretching of te cortical fibers
Dementia, gait disturbance, and urinary incontinence
The micturition reflex is an autononomic spinal reflex that receives inhibition from ____
Cerebral cortex
Lack of cortical inhibition on the micturition reflex results in _____ hyperactivity
Detrusor (–> urge incontinence)
The stapedius nerve, which innerates the stapes, is a brnch of what nerve
Cranial nerve VII (facial)
Paralysis of the stapedius muscle results in ______ (increased sensitivity to sound)
Hyperacusis
The pudendal nerve oriinates from ____ nerve roots
S2-S4
Pudendal nerve exits the pelvis throught hte ____ foramen
Sciatic
Motor branches of the pudendal nerve innervated the _____ and _____
Pelvic floor muscles
External urethral and anal sphincters
What is the draw back of using atropine rather than pralidoxime in organophosphate poisoning
Atropine is competitive inhibitorat muscarinic receptors only, nicotinic symptoms will persist (muscle paralysis)
How do demyelinating neuropathies differ from axonal neuropathies on a nerve conduction study
Demyelinating: delayed nerve conduction velocity
Axonal: reduced signal amplitude
Ulnar neuropathy is characterized by numbness of the _____ digits, pain, and weakness
4th and 5th
___ is the most common brain tumor in children and appears as a heterogenous, well-circumscribed cerebellar mass
pilocytic astrocytoma
what are the two microscopic findings in a pilocytic astrocytoma
glial fibrillary acidic protein (GFAP) positive hairlike processes rosenthal fibers (eosinophilic intracytoplasmic inclusions)
how can a pilocytic astrocytoma be differentiated from a medulloblastoma
presence of both cystic and solid components on imaging
the neural tube is a structure that is connected to the amniotic cavity by opening at the ends know as ____ and ______
anterior and posterior neuropores
failure of neuropore closure by 4 weeks gestation leads to _____
neural tube defects
anterior nerual tube defects include ____ (absence of forebrain) and _______ (protrusion of neural tissue through the cranial defect)
anecephaly
encephalocele
what is the most mild form of a posterior neural tube defect
spina bifida occulta
a meningocele and meningomyelocele present as cystic masses at the lower spine that are sometimes covered by a tuft of hair, meningomyelocele has what difference from meningocele though
meningocele = meninges protruding meningomyelocele= meninges and spinal cord or cauda equina protruding
prenantal use of what medication, used for bipolar or epilepsy, is associated with a 10 - 20 fold increased risk for NTD
valproate
lamotrigine MOA
blocks voltage gated sodium channels
most concerning side effect associated with lamotrigine use
stevens johnson syndrome, or toxic epidermal necrolysis
what is the difference between stevens-johnson syndrome and toxic epidermal necrolysis
SJS involves <10% of the body and TEN has >30% involvement
presentation of steven johnson syndrome
flu like symptoms followed by widespread mucocutaneous epidermal necrosis
the presence of nonreactive pupils to light stimulation following cardiac arrest carries a por prognosis and indicates anoxic damage to the brainstem at the level of ______
the upper midbrain
cryptococcus neoformans is a llow virulence yeast with a thick polysaccharide capsule/ . It resides in soil contaminated by bird droppings and human exposure primarily occurs due to inhalation into the ____
lungs
first line treatment for trigemnial neuralgia
carbamazepine
carbamazepine MOA
reduces ability of sodium channels to recover from inactivation
fatigable muscle weakness with restoration of strength after rest, affecting voluntary muscles, particularyl those innervated by motor nuclei of the brain stem characterizes what disease
myasthenia gravis
myasthenia gravis is most commonly caused by autoantibodies against _____
postsynaptic acetylcholine receptors
in myasthenia gravis, th reduced number of postsynaptic cation channels that can open in response to acetylcholine causes what change to the action potential
reduces the amplitude of the motor end plate potential and prevents muscle fiber depolarization
how do tricyclic antidepressents and SNRIs treat neuropathic pain
decrease of serotoninc and norepiniephrine reuptake –> inhibition of pain signals
how do anticonvullsants treat neuopathic pain
decrease depolarization of neurons in the CNS
how does Capsaicin (topical) treat neuropathic pain
loss of membrane potential in nociceptive fibers
how does lidocaine treat neuropathic pain
decreased depolarization of neurons in peripheral nerves
MOA of capsaicin
activation of TRPV1 (transmembrane cation channel) –> build up of intracellular calcium –> long lasting dysfunction of nociceptive nerve fibers (defunctionalization)
it also causes release and depletion of substance P
monocular scotoma is caused by lesion where
partial lesion of retina, optic disc, optic nerve
right anopia is due to a lesion where
right optic nerve
bitemporal hemianopia is due to lesion where
optic chiasm
right nasal hemianopia is due to lesion where
right perichiasmal lesion
left homonymous hemianopia is due to lesion where
right optic tract or optic radiation
left homonymous superior quadrantanopia (pie in sky) is due to what lesion
right temporal lobe (meyers loop)
left homonnumous inferior uadrantanopia (pie on floor) is due to what lesion
right parietal lobe (dorsal optic radiation)
left homonumous hemianopia with macular sparing is due to what lesion
right primary visual cortex (occipital lobe)
what are the results of a compound muscle action potential (CMAP) and high rate repetitive nerve stimulation in a patient with clostridium botulinum
decreseased CMAP
improves as rapid depolarization rate increases
clostridium botulinum will present with the classic 3 D’s : _____, ____, and ____
diplopia, dysphagia, and dysphonia
peroxisomes functions include hydrogen peroxide degredation and _____
oxidation of very long and branched-chain fatty acids
Zellweger syndrome is caused by defective ____ biogenesis
peroxisomal
x-linked adrenoleukodystrophy is characterized as defective transport of ___ into peroxisomes
VLCFAs (very long chain fatty acids)
carpal tunnel syndrome is a peripheral mononeuropathy caused by compression of the ___ nerve in the carpal tunnel
median
fragile x mental retardation 1 gene on the long arm of the X chromosome normally has 5-55 CGG trinucleotide repeats and can potentially expand during ____
meiosis in oocytes
full mutation in fragile X syndrome is characterized as > _____ CGG repeats which causes FMR1 ________
200
hypermethylation
what test is done to anylze the degree of methylation
southern blot
occlusion of the PICA results in lateral medullary syndrome, AKA ____ syndrome
wallenburg
occlusion of the PICA/wallenburg syndrome results in what 4 symptoms
- vertigo and nystagmus
- ataxia
- loss of pain and temp in ipsalateral face and contra body
- bulbar weakness
a drug that binds to and activates GABA-A receptors will increase the conductance of ___ ions, causing pasive transport down the concentration gradient into the cell interior
.
chloride
patients with _____ stroke can have both sensory and motor deficits, but most commonly have pure motor weakness affecting the contralateral arm, leg, and lower face as well as clasp knife spasticity, hyperreflexia, and positive babinski sign
internal capsule
dysfunction to what structure would cause an action tremor that increases as hand reaches target
cerebellum
a patient with history of bulbar symptoms and limb weakness and evidence of asymetric muscular atrophy is indicative of what diagnosis
amyotrophic lateral sclerosis (ALS)
what structures are affected in the pathology of amyotrophic lateral sclerosis
both upper and lower motor neurons
_____ tumors are usually non small cell lung cancers that arise near the superior sulcus
pancoast
pancoast tumors can compress the ____ which can cause ipsilateral shoulder pain/weakness and can compress the ____ which may lead to Horner’s syndrome
brachial plexus
cervical sympathetic ganglia
Sympathetic first order neurons are located in the ____, their axons descend through brainstem to C8-T2 where they synapse on second order neurons found in _____ column
hypothalamus
intermedial cell
second order sympathetic neurons synapse on third order sympathetic neurons in the _________ and then travel to the their target tissues in the face and head
superior cervical ganglion
In a neural tube defect, amniotic fluid will have high levels of ______ and ______
Alpha fetoprotein (AFP) Acetylcholinesterase
What herniation type involves herniation of the cingulate gyrus underneath the falx cerebri –> contralateral leg weakness
Subfalcine
What type of herniation involves herniation of the uncus under the tentorium cerebelli –> ispalateral dilated and fixed pupil and contralateral hemiparesis and then eventually ipsilateral hemiparesis
Uncal
What type of herniation involves the caudal displacement of diencephalon and brainstem –> rupture of paramedian basilar artery branches –> bilateral midposition and fixed pupils and decroticate then decerebrate posturing
Central
What type of herniation involves herniation of th cerebellar tonsils through the foraen magnum –> coma, loss of CN reflexes, flaccid paralysis and respiraatory arrest
Tonsillar
What is the cause of osmotic demyelination syndrome (central pontine myelinolysis)
Overly rapid correction of hyponatremia
Clinical features of osmotic demyelination syndrome
Quadriplegia
Pseudobulbar palsy
Reduced level of consciousness
MRI of osmotic demyelination syndrome shows ____
Focal demyelination of the pons
What is the syndrome that is X linked recesive and is characterized as dstonia, choreoathetosis, self mutilation, and hyperuricemia withing the first years of life
Lesch-Nyhan syndrome
Lesch-nyhan syndrome is a condition caused by a deficiency of ______
Hypoxanthine-guanine phosphoribosyltransferase (HGPRT)
Hypozanthine-guanine phosphoribosyltransferase is an enyzme that normally functions in the purine salvage pathway, and in its absence, ____ levels increase
Uric acid
Naegleria fowleria can cause primary amebic meningoencephalitis by entering through the ____ during water activities
Nasal mucosa (it travels retrograde through the olfactory nerve to the brain)
Ethosuximide, the first line treatment for absence seizures, prevents neuronal burst firing by blocking ______
Thalamic T-type Ca chanels
Mode of inheritence for neurofibromatosis type I
Autosomal dominant
Neurofibromatosis type 1 is caused by mutation in NF1 gene located on chromosome ___
17
What are the most common symptoms of neurofibromatosis type 1
Cafe au lait spots
Multiple neurofibromas
Lisch nodules (pigmented asymptomatic hamartomas of the iris)
VZV lies dormant in the ______ ganglia
Dorsal spinal
_______ is an incomplete forebrain division into 2 hemispheres with a single lateral ventricle
Holoprosecephaly
The prosencephalon gives rise to the _____ which develops into the thalamus and third ventricle and the _____ which develops into the cerevbral hemispheres and lateral ventricles
Diencephalon
Telencephalon
Holoprosencephaly may be due to a variety of factors (ex. Hedsgehog gene mutations), the most common associated chromosomal abnormality is ________
Trisomy 13 (Patau syndrome)
Early onset familial alzheimer disease is associated with _______ gene on chromosome 21, ________ gene on chromosome 14, and ______ gene on chromosome 1
Amyloid precursor protein (APP)
Presenilin 1
Presenilin 2
The APP and presenilin gene mutations in early onset alzheimers are thought to promote the production of ______
A beta amyloid
Late onset familial alzheimer disease is associated with the ____ allele of apolipoprotein E
Epsilon 4
Regardless of etiology, the initial drug of choice for treating status epilepticus is _______ due to its efficacy and rapid onset of action
IV benzodiazepine (lorazepam)
Benzodiazepines MOA
Allostericly attach to GABA-A receptors causing increased influx of Cl- –> hyper polarization of postsynaptic neuron
Diffuse axonal injury, a type of severe traumatic brain injury that can occur from direct blunt force injury or abrupt changes in acceleration-deceleration. The transfer of force can result in immediate shearing of ________ or induce secondary biochemical changes leadgn to degredatin of _____with subsequent ___ breakage
White matter tracts
Axonal cytoskeleton
Axon
Diffuse axonal injury inhibits normal axonl transport –> accumulation of _____ within axonal swellings at the point of injurry
Axonally transported proteins (amyloid precursor, alpha synuclein)
Diffuse axonal injury is seen on what imaging
MRI (CT may appear normal)
Diffuse axonal injury is visible as widespread axonal swelling, most pronounced at the __________
Gray-white matter junction
West nile virus is enveloped RNA virus that is found in warm climates worldwide. The virus replicates extensively within ___ and is passed to ____
Birds
Mosquitos (Culex species)
Cryptococcal neoformans can be cultured on ____ agar
Sabouraud
Initial treatment of cryptococcal meningoencephalitis
Amphotericin B and flucytosine
Long term maitenance therapy for crytpococcal meningoencephalitis
Fluconazole
Tay sachs is caused by beta hexosaminidase A deficiency which results in accululation of the cell membrane glycolipid _______ within lysosomes
GM2 ganglioside
_______ clinical presentation includes macrocephaly, abnormal startlereflex with acoustic stimuli, and cherry red macula spot
Tay sachs
Tetrodotoxin (in puffer fish) and saxitoxin (dinoflagellates in “red tide”) bind to Na channels to what effect
Inhibit Na influx and prevent action potential conduction
Ciguatoxin (in exotic fish and moray eel) and batrachotoxin (in south american frogs) bind to Na channel to what effect
Keep it open and cause persitent depolarization
Treatment after tetrodotoxin exposure
Supportive care and intestinal decontamination with gut labage and charcoal
Cytotoxic (ionic) edema begins hours after ischemic injury due to ____ and failure of _______
Decreased ATP
ATP dependent ion pumps
______ edema follows 24-48 after ischeimc stroke when release of inflammatory mediators disrupts tight jnctions of blood brain barier, allowing proteins and water to enter the inerstitial space
Vasogenic
A _______ appears as a hyper dense mass on CT and almost always affects the adjacent internal capsule, leading to dysarthria, contralateral hemiparesis, and contralateral hemisensory loss
Putaminal hemorrhage
The basal ganglia are supplie by the ____ arteries which are deep, small vessel branches off the middle cerebral arteries
Lenticulostriate
Injury of what nerve can occur due to repetitive pressure/trauma caused by an ill-fitting crutch (crutch palsy) or if an individual sleeps witht he arm over a chair (saturday night palsy)
Radial
The iliohypogastric nerve arises from L1, emerges from lateral border of the upper psoas major, and passes behing the kidney. It provides motor function to ____
Anterolateral abdominal wall muscles
Damage to the anterior branch of the _______ nerve during appendectomy causes decreased sensation at the suprapubic region
Iliohypogastric
In a positive/pathologic jaw jerk reflex, Tapping on the chin with the mouth open will cause what
The jaw to briskly close
Patients with bilateral _____ lesions will have a positive jaw jerk reflex
Upper motor neuron
The jaw jerk reflex begins with afferent signals from the muscle spindles of the masseter that are carried along the ______ nerve and the efferent signals travel along the ____ nerve to the muscles of mastication
CN V3
CN V3
What nerve is injured in tennis elbow
Median nerve
The median nerve passes between what structurs which allows it to be suseptible to compression
Humeral and ulnar heads of the pronator teres muscle
How does impaired sensation from compression of the median nerve differ in carpal tunnel syndrome and compression by pronator teres
Carpal tunnel syndrome –> impaired sensation to palmar aspects offirst 3 and 1/2 digits
Compression by pronator teres –> impaired senesation to first 3 and 1/2 digits and entire lateral plm and thenar eminence (because also includes palmar branch)
In the CNS, serotonergic neurons are primarily found in the _____ nuclei of the brainstem
Raphe
What medication used in TB treatment is similar to pyridoxine (vit B6) and therefore competes with B6 in the snthesis of multiple neurotransmitters – > defective and products
Isonizid
Isoniazid increases the urinary excretion of ___ and causes afrank deficiency in it
Pyridoxine (vit B6)
Trycyclic antidepressants modulate pain transmission by inhibitting ______ in sensory nerves and increasing ______ signaling in the CNS
Voltage gated sodium channels
Norepinephrine
SNRIs alter central transmission of pain by increasing ______ in the central synapses
Norepinephrine
What is the term for brief loss of muscle tone precipitated by strong emotion (laughter, excitement)
Cataplexy
DSM-5 diagnostic criteria of narcolepsy includes low CSF levels of ____
Hypocretin-1
Narcolepsy with cataplexy is most often caused by the lack of 2 related neuropeptides: hypocretin-1 and hypocretin-2 which are produced in neurons located in _______
Lateral hypothalamus
The ___ is a component of the basal ganglia that plays an important role in modulation of basal ganglia output. If damaged, it can decrease excitation of the globus pallidus internus –> reducing inhibition of the thalamus
Subthalamic nucleus
What is the term for a movement disorder that is characterizedby wild,involuntary, large-amplitude, fliging movements invoving the proximal limbs on ones side of the body
Hemiballism
A lacunar stroke causing damage to the _______ may result in contralateral hemiballism
Subthalamic neuclues
______ headaches are often recurrent, unilateral, and can be accompaied by ipsilateral autonomic symptoms
Cluster
thiamine (vit B1) is a cofactor in many enzymes, including _____ which converts pyruvate to acetyl co a
Pyurvate dehydrogenase
Thiamine (vit B1) isa cofactor for many enzymes including ____ which an an anzyme in the citric acid cycle
Alpha ketoglutarate dehydrogenase
Thiamine (vit B1) is a cofactor for many enzymes including _____ whch is esential for catabolism of branched chain amino acids
Branched-chain alpha ketoacid dehydrogenase
Thiamine (vit B1) is a cofactor for many enzymes including _____ which is an enzyme in the pentose phosphate pathway that help convert ribulose 5-P to glycolysis intermediates
Transketolase
Thiamine deficiency results in decreased ______ utilization which is especialy pronounced in the CNS
Glucose
Thiamine deficiency can be diagnosed if baseline erythrocyte ______ activity is low but increases after additno of thiamine pyrophosphate
Transkelotasee
The quadricalent conjugate vaccine for neisseria meningitisis moa
Capsular polysaccharide antigens are fused to a diptheroid toxin carrier – > APCs present it to T-cells
Serogroup B vaccine for neiserria meningitidis moa
Recombinant proteins (instead f the capsular polysaccharides because too close to humn neural cell adhesion molecules –> molecular mimicry)
Women in the postpartum period are at particulary high risk of developing what condition which causes fatigable skeletal muscle weakness
Mysthenia gravis
The most common underlying cause of focal-onset seizures is a _______
Focal structural brain abnormality
____ is when an initial embryonic disturbance leads to multiple malformations by disrupting th development of adjacent tissues and structures within a particular region
Developmental field defect
______ referes to complete absence of an organ
Agenesis
______ refers to multiple anomalies without a known unifying cause that occur together more frequenly than chance alone would predict
Association
____ are fetal structural anomalies that occur due to extrinsic mechanical forces
Deformation
______ is a developmental field defect characterized by a spectrum of fetal anomalies due to incomplete division of the forebrain (prosencephalon)
Holoprosencephaly
What nerve passes posterior to the medial epicondyle of the humerus (cubital tunnel)
Ulnar nerve
The ulnar nerve innervates the _______ (wrist flexion and adduction) and medial portion of the _______
Flexor carpi ulnaris
Medial portion of flexor digitorum profundus
The ulnar nerve enters the wrist throught the ______
Guyon canal (between hook of hamate and pisiform)
The superficial branch of the ulnar nerve provides cutaneous inervation to ______, ____, and _____
5th digit
Medial half of 4th digit
Hypothenar eminence
Ramelteon MOA
Melatonin agonist
Neurologic damage associated with ____ dficiency classically includes subacute combined degeneration of the dorsal column, lateral corticospinal tracts, and spinocerebellar tracts
Vit B12 (cobalamin)
Patients may develop atrphic glossiis, which appears as a smooth, shiny, erythematous tongue following a gastrectomy due to what
Vit B12 deficiency
Repetitive pronation/supiination of the forearm (ex. Frequent screwdriver use) could injure the radial nerve at what location
Supinator muscle
What nerve is most frequently injured during axillary lymph node diseection and results in sensory dysfunciton in medial upper arm
Intercostobrachial nerve
Damage to what nerve results in winging of the scapula
Long thoracic
What nerve innervates the latissimu dorsi
Thoracodorsal
Opsoclonus-myoclonus syndrome: nonrhythmic conjugate eye movements and involuntary jerking movements of the trunk and limbs in a young patient should prompt evaluation for _______
Neuroblastoma
Neuroblastoma arises from _____ cells of the adrenal medula or sympathetic ganglion
Neural crest
A majority of patients with neuroblastoma have elevated _______ due to the neural crest origin
Catecholamine metabolites
Biopsy of neuroblastoma mass will reveal _____ and ______
Small round blue cells
Homer wright rosettes
Tumor tissue of a neuroblastoma is tested for _____ amplification which predicts a poor prognosis
N-myc
What are the benefits of injecting epinephrine with lidocaine
Epinephrine –> vasoconstriction–> decreased local bleeding, prolonged duration of action bc lidocaine stays in site of injection longer, and decreased systemic absorption reducing side effect risks
_____ disease can cause cystic degeneration of the putamen as well as other basal ganglia structures
Wilsons
Schwannomas appear biphasic, microscopically, with highly cellular areas: ______ pattern; intermixed with myxoid regions of low cellularity: _____ pattern
Antoni A
Antoni B
The Antoni A areas in a schwannoma is composed of _____ cells (eloongated cells with regular oval nuclei) that form palisading patterns interspercing nuclear free zones called ______
Spindle
Verocay bodies
Schwannomas and melanoma are ___ positive because they are derived from neural crest cells
S-100
Schwannomas can arise from the peripheral nerves, nerve roots, and cranil nerves except for ____
Cranial nerve II (optic nerve)
High solubility of anesthetic in the blood (blood/gas partition coefficient) has what effect on time for it to get to the brain
More anesthetic must be absorbed by the blood before it can effectively be transfered to other tissues
Solubility of an anesthetic in peripheral tissues _______ affects brain saturation
Negatively
High solubility of anesthetic in the peripheral tissues has what effect on ateriovenous concentration gradient
Increases it
Mechanism of action of erenumab (migraine treament)
Anti-CGRP antibodies
Tetrahydrobiopterin (BH4) is a cofactor in the synthesis of _____, ____, and ______
Serotonin
Tyrosine
DOPA (tyrosine –> DOPA)
Serotonin (5-hydroxytryptamine) is formed through hydroxylation and decarboxylation of the amino acid _____
Tryptophan
A BH4 deficiency secondary to dihydropteridine reductase deficiency can cause the build up of tryptophan and what other amino acid
Phenylalanine
Key features of congenital toxoplasmosis infection
Chorioretinitis
Hydrocephalus
Diffuse intracranial calcifications
Key features of congntial syphilis infection
Rhinorrhea
Skeletal anomalies
Desquamating rash (palms/soles)
Key features of congenital rubella infection
Cataracts
Heart defects (PDA)
Sensrineural hearing loss
Key features of congenital cytomegalovirus infection
Periventricular calcifications
Microcephaly
Sensorineural hearing loss
Key feature of congenital herpes simplex virus infection
Vesicular/ulcerative rash
What are the TORCH infections
Toxoplasmosis Other infections Rubella Cytomegalovirus Herpes simplez
When are TORCH infections contracted
In utero due to transplacental transmission
What may cause new onset focal neurologic deficits 3-12 daysafter subarachnoid hemorrhage develops
Cerebral vasospasms –> delayed cerebral ischemia
Subarachnoid hemorrhage is most often caused by rupture of a ______ which occurs frequently in patients with autosomal dominant polycystic diseas
Saccular (berry) aneurysm
What can be administered to patients to improve outcomes of subarachnoid hemorrhage
Nimodipine (selective calcium chanel blocker)
How does nimodipine improve outcomes of patients with cerebral vasospasms followign a subarachnoid hemorrhagee
Induces cerebral vasodilation and decreases calcium dependent excitotoxicity
The sensor limb of the corneal reflex is mediated by CN V1 which enters the orbit through the ______
Superior orbital fissure
Globe adduction is mediated by the medial rectus muscle which is innervated by the occulomotor nerve (III) which enters the orbit through the ____
Superior orbital fissure
What nerves enter the orbit via the superior orbital fissure
Oculomotor nerve (III) Opthalamic nerve (V1) Trochlear nerve (IV) Abducens nerve (VI)
The ___ nerve is a branch of the mandibular nerve (V3) which innervated the lower teeth and is culnerable to injury during dental procedures
Inferior alveolar
The inferior alveolar nerve gives off the _____ nerve which conveys sensory information from the chin and lower lip
Mental
A history of gait dysfunction and evidence of myelin/axonal degeneration in the dorsal columns and corticospinal tract are highly suggestive of _____ deficiency
Vitamin B12
Spinal cord damage seen with vitamin B12 deficiency is called ____________
Subacute combined degeneration (combined bc degeneration of both ascending and descending pathways)
The brachial plexus originates from the ___- ___ spinal nerve roots and pass between the anterior and middle scalene
C5-T1
Interscalene nerve block, a technique used for procedures involving shoulder and upper ar, transverses along the interscalene sheath and affects the roots of the ____ nerve (C3-C5)
Phrenic nerve
Most common primary cerebral neoplasm in adults
Glioblastoma
Gliobltomas arise from ____
Atrocytes
What is a butterfly glioma
Glioblastoma tha crosses the corpus collosum
On gross examination, glioblasomas are soft and poorly defined with area of necrosis and _____
Hemorrhage
What is the prognosis of glioblastomas
Poor, they are highly malignant
Levadopa is the immediate precursor to ____
Dopamine
Dopamine is absent in the ______ of patients with Parkinson disease
Nigrostriatum
Dopamine itself cannot be administered directly due to its inability to ____
Cross the blood brain barrier
Levadopa is rapidly metabolized in the peripheral tissues to dopamine and _______
3-O-mthyldopa (via catecgol-O-methyltransferase)
Levodopa is typically administered with _______, a peripheral DOPA decarboxylase inhibitor
Carbidopa
Moa: entacapone
COMT inhibitor (inhibits peripheral methylation of levodopa)
What can be used to treat parkison patients with motor fluctuations who are experiencing end of dose wearing off periods with levodopa/carbidopa therapy
COMT inhibitors (entacapone)
Inflammation in bacterial meningitis is driven by subcapsular components, partcularyly macromolecules of bacterial cell such as ____ and ___
Teichoic acid
Peptidoglycan
_____ is the leading cause of bacterial meningitis in adults
Strep pnumoniae
For patients with strep pneumo meningitis: Pretreatment of ______ reduces levels of inflamator cytokines in the CSF and limits risk of inflammation induced morbidity
Dexamethasone
Which of the following benefit from pretreatment with dexamethasome and why: strep pneumo, h. Flu, n. Menngitidis
Strep pneumo
H. Flu and N. Meningitidis have thinner cell walls (gram negative) so have less peptidoglycan and no teichoic acid and therefore result in less inflammatory cytokine release
Creutzfeldt-jacob, fatal familial insomnia, and kuru are all examplse of ____ diseases
Prion
Prion diseases are progressive neurodegenerative disorders caused by accumulation of _____ within the brain
Abnormally folded protein
Prion diseases may be transmitted between species how?
Ingestion of tainted meat
Prion proteins are found in both neuronal and nonneruonal brain cells and normally exist in ______ structure
Alpha helical (PrPc)
Prion disease occurs after a domain in the prion protein undergoes a conformational change from the alpha helix into ____
Beta pleated sheet (PrP^Sc) (scrapie)
The beta sheet confirmation of prion proteins are resistant to ____ and form long neurotoxic fibrils which accumulate intracellularly in neurons and form extracellular deposits
Proteases
On microspcopy of prion diseases, there is a ______ degeneration of gray matter which is characterized by formation of microscopi ____ within the neuronal processes
Spongiform
Vacuoles
Extracellular prion accumulations (kuru plaques) are frequently present in prion disease and stain positive with ____ and ____ stains
Congo red
Periodic acid-Schiff
The oculomotor nerve is most susceptible to injury from ipsilateral _______ artery aneurysms
Posterior communicating artery
Classic manifestation of ______ mass include obstructive hydrocephalus from aqueductal stenosis and dorsal midbrain (Parinaud) syndrome due to direct compression of the pretectal region of the midbrain
Pineal gland mass
______ syndrome is characterized by limitation of upwrd gaze with a downward gaze preference, bilteral eyelid retraction, and light-near dissociation (pupils react to accomodation but not light
Parinaud
The most common pineal mass is a _______, a midline tumor thought to arise from embryonic germ cells
Germinoma
Suprasellar germinomas (less common site for a germinoma) do not lead to Parinaud syndrome, but they are more likely to present with _________
Endocrinopathies (central precocious puberty, diabetes insipidus)
The ____ nerve innervates the quadricepsmuscles and provides sensation for the arch of the foot, shin, and anteromedial thigh
Femoral
The optimal site for a femoral nerve block is right below the _____ at the lateral border of the femoral artery
Inguinal ligament
What nerve that passes through the cavernous sinus next to the internal carotid arter is the most likely structure to be damaged by an expanding aneurysm of the internal carotid
Abducens (VI)
Esotropia
Inward eye deviation
Occlusion of the _______ artery would affect sensory and motor function of the contralateral leg and foot while predominntly sparing contralateral arm/face
Anterior cerebral artery
Patients with bilateral ______ atery occlusions can develop significant behavioral symptoms and urinary incontinence if the frontal micturition center (medial frontal lobe/cingulate girus) is affected
Anterior Cerebral artery
Oclussion of the anterior cerebral artery would most likely impair what movements: Climbing stairs Gripping Speaking Swallowing food Whistling
Climbing stairs
The etiology of narcolepsy is believed to be due to low levels of the stimulatory neurotransmitter ______ which isinvolved in maintaining wakefulness and supressing REM sleep-related phenomena
Orexin (hypocretin)
Modafinil MOA
Nonamphetamine stumulant, may enhance dopaminergic signaling (first line agent for narcolepsy bc effective, well tolerated and misuse is rare)
Bells palsy is idiopathic paresis of ______ nerve
Facial (CN VII)
What nerve sends parasympathetic innervation to the lacrimal, submandibular, and sublingual salivary glands
Facial (VII)
What nerve sends afferent fibers for taste for anterior 2/3 of tongue
Facial
What nerve sends somatic afferents from the pina and external auditory canal
Facial
Specific findigs of bells palsy tipically include impaired eye closure, eyebrow sagging, inability to smile and frown on affected side, disappearance of the _____ fold and the mouth being drawn to the _____ side
Nasolabial
Non affected
Patients with bells palsy may experience ___ tearing, hyper____, and loss of taste sensation over the ______ of the tongue
Decreased
Acusis
Anterior 2/3
Gross examination of hemangiomas reveals a “mulberry-like” appearance due to their purple vascular clusters. Histologically they are composed of abnormal, dilatd blood vessels with a thin adventitia lacking ______ and ______
Elastic fibers
Smooth muscel
Cavernous hemanigiomas’ reduced structural suppor givesthem a tendency to leak, causing recurrent ______
Hemorrhage
_____ hematoma has a clinical manifestation of lucid interval followed by loss of consciousness
Epidural
_____ hematoma has a clinical manifestation of coma at onset and chronic gradual onset of headache and confusion
Subdural
What vessel is tpically involved in epidural hematoma
Middle meningeal artery
What vessel is typically involved in subdural hematoma
Bridging cortical veins
How is a subarachnoid hemorrahage visualized on CT? Blood in the _____
Basal cisterns
Epidural is accumulation of blood between the ____ and_____
Skull bone
Dura mater
Most cases of epidural hematoma are due to fracture of the ______
Pterion region of the skull
An ipsilateral dilated pupil can occur during an epidural hematoma due to ___ herniation and _____ nerve compression
Uncal
Oculomotor
The diagnoses of epidural hematoma can be confirmed by ______ showing a hyperdense, biconvex (lens-shaped) mass between the brain and skull
Non contrast CT
_____ are extracellular deposits often found in the medial temporal lobe and are composed of a central amyloid beta core surrounded by dystrophic neurites
Neuritic (senile) plaques
______ are found int he neuronal cytoplasm and consist of aggregates of hyperphosphorylated tau protein, which normally mediates micrtubule stabilization
Neurofibrillary tangles
Symptoms of normal pressure hydrocephalus are progressive ad occur due to disruption of periventricular _____ by the expanding ventricles
White matter tracts
Treatment for normal pressure hydrocephalus
Large volume CSF removal and longterm treatment frequently involves placement of a ventriculoperitoneal shunt
Psuedopalisading necrosis is an area of necrosis surounded by columns of ______
Tumor cells
Pseudopalisading necrosis with vascular proliferation (capillaries at the periphery) are characteristic histologic finsings of ______
Glioblastoma multiforme
Glioblastoma multiforme is usually located within the cerebral hemispheres and often presents with _______ that worsens with bending over and ____, ____, and /or _____
New onset headache
Nausea/vomiting
Focal neurological defects
Seizures
___ is the most common cause of spontaneous lobar hemorrhage, particularly in adults over age 60
Amyloid angiopathy
Amyloid angiopathy is a consequence of ____ deposition in the walls of small- to medium- sized cerebral arteries resulting in vessel wall weakening and predisposition to rupture
Beta amyloid
Dopamine agonists have a chemical structure similar to dopamine and directly stimulate the dopamine receptor. Do they need to be metabolized to be active?
No
What are the two classes of dopamine agonists
Ergot compounds (derive from ergot fungi; bromocriptine) Nonergot compounds (pramipexole, ropinirole)
MOA bromocriptine
Dopamine agonist (ergot compound)
MOA pramipexole
Dopamine agonist (nonergot compound)
MOA ropinirole
Dopamine agonist (nonergot compound)
The tetanus toxin blocksi nhibitory interneurons at what location in the body?
Anterior horn cells
Cerebral spinal fluid is formed by 4 ___ found in each of the ventricles
Choroid plexuses
CSF flows from the lateral ventricles to the third ventricle via the ______
Interventricular foramina of monro
CSF travels from the 3rd ventricle to the 4th ventricle via the _____
Cerebral aqueduct (of Sylvius)
CSF exits the 4th ventricle and enters the subaracnoid space via one of the 3 foramina: the 2 lateral foramina of ________ and the single midline foramen of ______
Lushka
Magendie
CSF is returned to venous circulation from the subarachnoid space via ______
Arachnoid villi (granulations)
_________ presents with elevated ICP and classically occurs in young women who are overweight. The etiology is not well known but it is thought to be related to cerebral venous outflow abnormalities due to elevated intracranial pressure
Pseudotumor cerebri
Malignant hyperthermia is oftern due to abnormal ____ in skeletal muscle
Ryanodine receptors
______ is used to treat malignant hypertension because it directly inhibits intracellular calcium release fom the abnormal ryanodine receptor
Dantrolene
Selegiline MOA
Inhibitor of MAO type B
Clinical use of Selegiline
Delays progression of Parkinson disease (prevents damage to dopamanergic neurons)
What is the likely diagnosis: 16 yr old boy with chronic loss of upper extremity pain and temp sensation, upper extremity weakness and hyporeflexia, lower extremity weakness and hyperreflexia, and kyphoscoliosis
Syringomyelia
Name the hereditary disease that causes degeneration of spinocerebellar tracts, posterior colums and dorsal root ganglia
Friereich ataxia
What is the most common cause of death in friedreich ataxia
Hypertrophic cardiomyopathy
What skeletal anormalities are seen in friedrich ataxia
Kyphoscoliosis Pes cavus (high arches)
What inherited disease may present with behvioral abnormalities (mood changes, withdrawl), cognitive impairment, and chorea (jerky, fidgety, involuntary movements)
Huntington disease
What neurons in the caudte nuclei (striatum) are especialy vulnerable and atrophy early in the course of Huntington disease
Inhibitory GABAnergic neurons
Expanding space occupying lesions such as hemorrhage or hematoma can manifest with Cushing triad which is what
Hypertension, bradycardia, irregular respirations
Lesions in the temporal lobe tend to cause what form of herniation
Transtentorial herniation of the uncus
Transtentorial herniation of the uncus can compress the ipsilateral _____ nerve as it exits the midbrain at the same level
Oculomotor nerve (CN III)
Compression of CNIII due t trnastentorial herniation of the uncus can lead to what pupil finding
Dilated pupil
The left temporal hemiretina joins the right nasal hemiretina and travels via the left optic tract to the left _______ in the thalamus
Lateral geniculate body
Visual signals leave the lateral geniculate body and travel via optic radiations to the ipsilateral ______ for visual processing
Primary visual cortex
Herpes zoster opthalmicus is caused by viral reactivation involving what nerve
Trigeminal nucleus –> opthlmic branch of trigeminal nerve
How can herpes zoster affecting the opthalmic branch of the trigeminal nerve lead to blindness
CN V1 conveys sensory information from the cornea, if theres a lesion it can lead to blindness due to acute keratitis
What inheritable disease is characterized by initial degeneration of the prefrontal cortex that eventually progresses to include the anterior temporal cortex
Frontotemporal dementia
What subtype of demetia has these characteristic findings:
Early insidious short term memory loss
Language deficits and spatial disorientation
Later personality changes
Alzheimer disease
Wha subtype of dementia presents with:
Stepwise decline
Early executive dysfunction
Cerebral infarction and/or deep white matter changes on neuroimaging
Vascular dementia
What subtype of dementia may present with the following:
Early personality changes
Apathy, disinhibition and compulsive behavior
Frontotemporal atropthy on neuroimaging
Frontotemporal dementia
What subtype of dementia may present with the following:
Visual hallucinations
Spontaneous parkinsonism
Fluctuating cognition
Rapid eye movement sleep behavior disorder
Dementia with lewy bodies
What subtyme of dementia may present with the following
Ataxia early indisease
Urinary incontinence
Dilated ventricles on neuroimaging
Normal-presure hydrocephalus
What subtype of dementia may present with the following:
Behavioral changes
Rapid progression
Myclonus and/or seizures
Prion disease
What area of the brain is responsible for all communicative motor planning
Brocas
Damage to what part of the brain results in inability to understand spoken language or follow commands (non intact speech comprehension)
Wernickes
Brocas area is in the caudal part of the inferior ____ gyrus of the dominant hemisphere (which is usually what side?)
Frontal
Left
Vecuronium mechanism of action
Nondepolarizing agent, competitive antagonist of nicotinic acetylcholine receptor
Why do patients with myasthenia gravis have increased sensitivity to vecuronium and other nondepolarizing neuroblocking agents
They have low number of functioning receptors
How do depolarizing neuromuscular blocking agents act differently in patients with myathenia gravis
Because they have fewer funcitoning receptors, they are more resistant to these agents, larger doses are required to induce muscle relaxation
Parianal anestesia with loss of anocutaneos reflex indicates involvement of what nerve roots
S2-S4
Conus medullaris syndrome involves what spinal region
L1-L2
Cauda equina syndrome involves what spinal region
Below L2
Conus medullaris syndrome typically causes ____ (bilateral/unilateral) extremity weakness with ____ motor neuron signs
Bilateral
Upper
Cauda equina syndrome tends to cause ______(symetric/assymetric) lower extremity weakness with _____ motor neuron signs
Assymetric
Lower
What is a funciton of the frontal lobe and may be tested by asking a patient to describe the similarities between two objects
Abstraction
A patient with recurrent headaches and seiures with multiple flow voids on MRI is consitent with what diagnosis
Cerebral arteriovenous malformations
What are vascular malformations inwhich blood courses directly from arteries to veins without passing through an intervening capillary bed allowing turbulent flow which can lead to aneurysm development, bleeding, and damage to the surrounding brain
Arteriovenous malformations
Arteriovenous malformations can appear as what on angiography and what on MRI
Bag of worms
Dark flow voids(indicative of swift blood flow)
What travels through the cribiform plate
CNI olfactory bundles
What traves through the optic canal
CN II
Opthalmic artery
Central retinal vein
What travels through the superior orbital fissure
CN III, IV, V1, VI
Opthlmic vein
Sympathetic fibers
What travels through the foramen rotundum
CN V2 (maxilary)
What travels through the foramen ovale
CNV3 (mandibular)
What travels through the foramen spinosum
Middle meningeal artery and vein
What travels through the internal acoustic meatus
CN VII, VIII
What travels through the jugular foramen
CN IX, X, XI
Jugular vein
What travels through the foramen magnum
Spinal roots of CNXI
Brain stem
Vertebral arteries
What travels throught he hypoglossal canal
CN XII
What nerve innervates hte muscles of mastication
CNV3
What three muscles close the jaw
Masseter
Medial pterygoid
Temporalis
What muscle opens the jaw
Lateral pterygoid
Unilateral injury of CNV leads to deviation of the jaw to what side
Ipsilateral side (due to unopposed action of the contralateral pterygoid)
What somatic nerve function does the glossopharyngeal nerve have
Styolopharyngeus muscle (only): elevates larynx during swallowing
The sciatic nerve branches into the _____ and ___ nerve just proximal to the popliteal fossa
Common fibular (peroneal) nerve Tibial nerve
After coursing around the ______ the fibular nerve divdes into the deep and superficial branches
Neck of fibula
The ____ branch of the fibular nerve innervates the anterior compartment muscles of the leg (foot and toe dorsiflexion)and provides senstion to the webspace between the first and second toes
Deep
The ___ branch of the fibular nerve innervates the lateral compatment muscles (foot eversion) and providessensation to the dorsum of the foot and lateral shin
Superficial
The ____ nerve is frequently injured by trauma due to its superficial location at the neck of the fibula
Common fibular
Temporal lobe epilepsy is the most common type of _____ epilepsy which occur when partial seizures originate from one area of the brain and are usualy due to an underlying structural disorder which serves as an epileptogenic focus
Localiztion-related
Temporal lobe epilepsy is most commonly due to _______ which is usually visible as ______ on MRI
Hippocampal sclerosis
Hippocampal atrophy
Characteristic histopathological findings in hippocampal sclerosis includes atrophy of the hippocampal neuons with marked reactive gliosis: proliferation of ____ in response to injury
Astrocytes
The rabies virus contains a bullet shapd envelope with knob like glycoproteins that allow it to attach to the ________ at the neuromuscular junction
Nicotinic acetylcholine receptor
A patient with sudden onset explosive headache, brief loss of conscioussness and signs of menigeal irritation most likely has what type of hemmorage
Subarachnoid hemorrhage
Subarachnoid hemorrhage usually results from the spontaneous rupture of ____-
Saccular (berry) aneurysm
In subarachnoid hemorrhage, blood empties into the subarachnoid space and pools in _____ and ______
Cerebral sulci
Basal cisterns
_____ is a transmembrane glycoprotein found in the presynaptic vesicles of neurons, neuroectodermal and neuroendocrine cells
Synaptophysin
Immunoreactivity of a CNS tumor for synaptophysin indicates a ____ orgin
Neuronal
Nigrostriatal degeneration in Parkinson disease results in excessive excitation fo the _________ by the subthalamic nucleus, which in turn causes excessive inhibition of the thalamus
Globus pallidus internus
Patients with medically intactractable symptoms of parkinson disease may benefit from high frequency deep brain stimulation to the globus pallidus internus or. _____
Subthalamic nucleus
____ is a rare autosomal dominant condition characterized by the presence of capillary hemangioblastomas in the retina and or cerebellum as well as congenital cysts and or neoplasms in the kidney, liver, and pancreas
Von hippel lindau disease
Microscopically, _____ are well differentiated neoplasms comprised of spindle cells with hair-like glial processes that are associated with micrcysts. These cells are mixed with Rosenthal fibers and granular eosinophilic bodies
Pilocytic astrocytomas
A cystic tumor in the _____ of a child is most likely a pilocytic astrocytoma
Cerebellum
Interupting cortical input has what effect on bladder activity
–> bladder hyperactivity (urge incontinence)
Loss of the pontine micturition center has what effect on urination
–> neurogeni bladder
PMC coordinates detrusor contraction and sponcter relaxation
Lower spinal cord lessions in the sacral spinal cord such as cauda equina syndrome has what effect on urination
–> bladder underactivity (overflow incontinence: unable to completely empty bladder –> overflow which leaks out unexpectedly)
The pelvic floor and urinary sphincter muscles are innervated by what nerve roots
S2-S4
Neuromodulation directed toward S2-S4 nerve roots can improve continence by improving pelvic floor muscle strentgth andcontraction of the external urethral sphincter, it may also impact the ________ refex
Bladder stretch-contraction
Propofol is a highly ____ anesthetic drug used fo both induction of maintenanceof general anestesia as well as procedural sedation. Onset approximtely 30 sec and duration typically <10 min
Lipophilic
Following bolus infusion, propofol is rapidly cleared from the plasma and preferentially distributed to organs _______
Receiving high blood flow (brain)
Because the site of action for propofol is the brain, _____ acounts for the rapid termination of the drug
Redistributionn
______ is an inflammatory condition that affects the walls of medium sized and large arteries with granulomas
Temporal arteritis (aka giant cell vasculitis)
On light microscopic exam of temporal arteritis, granulomas are seen in the ____ of the arteries consisting of mononuclear infiltrates and multinucleated giant cells
Media
Commonly reported symptoms of temporal arteritis include:
Headache (focal pain over temple)
Craniofacial pain syndromes
Polymyalgia rheumatica
Sudden vision loss (may be transient or permanent)
What symptom commonly occurs in temporal arteritis and is characterized by neck, torso, shoulder, and pelvic girdle pain and morning stiffness. Fever, fatigue, and weight loss may also occur
Polymyalgia rheumatica
An indirect inguinal hernia is protrusion of abdominal contets through the abdominal wall via the _______
Deep/internal inguinal ring and inguinal canal
A direct inguinal herni is protrusion othe abdominal contents through the abdominal wall via the _______
Superficial inguinal ring
Define allodynia
Pain caused by normally nonpainful stimuli
The ____ nerve enters the inguinal canal anterior to the internal ring and follows the spermatic cord to the superficial ring
Ilioinguinal nerve
The ilioinguinal nerve gives off sensory branches to the anterior scrotum/labia majora, base of penis/mons pubis, and _____
Medial thigh
What is the Uhthoff phenomenon, seen in multiple sclerosis
Symptoms worsening with increased body temperature
What gene increases the risk of having multiple sclerosis
HLA-DRB1
What is Lhermitte sign, seen in multiple sclerosis
Electrical sensations down the back/limbs with neck flexion
In multiple sclerosis, demyelinating plaques are commonly seen as hyperintense lesions on _____ MRI
T2-weighted
In diabetic CNIII mononeuropathy, why is pupillary size and reactivity often normal while the extraocular muscles supplied by CNIII are usually affected causing a down and out positioning
It is due to ischemia predominately involving the core of CN III (where somatic nerve fibers travel) while sparing the outer regions (where autonomic component is located)
Recurrent focal impaired awareness seizures that are preceded by a distinctive aura are characteristic of ____ epilepsy
Mesial temporal lobe
Patients with arteriovenous malformations may have seizures which may be due to ____ accumulation, which is a cortical irritant, from microbleeds
Hemosiderin
What cause of headaches can also cause ipsilateral autonomic symptoms due to parasympathetic hyperactivity such as nasal congestion, lacrimation, ptosis, miosis and conjunctival injection
Cluster headaches
____ are transient episodes of focal neurologic impariment that occur due to local brain ischemia, tissue infarction does not occur, and brain imaging is normal
Transient ischemic attacks
The trochlear nerve innervates_____ muscle which causes the eye to intort and depress when adducted
Superior oblique
Patients with trochlear nerve palsy typically present with ____ which is most noticeable when the afected eye looks down and toward the nose (close up reading, going down stairs)
Vertical diplopia
People may compensat for ____ nerve palsy by tucking their chin and tilting their head away from the affected side
Trochlear
What autoimmune disorder is characterized by fatigable muscle weakness that most commonly affects the eyes, blulbar, facial, and proximal muscles
Myasthenia gravis
HIV associated dementia is due to a change of viral tropism from replicating in CD4 cells to microglil and ______ which alows the virus to penetrate deeper in the brain parenchyma
Macrophage
uncal herniation is herniation of the medial temporal lobe (uncus) through the _____
Tentorial notch
In uncal herniation, compression of the _____ leads to an ipsilateral fixed and dilated pupil
Ipsilateral occulomtor nerve
In uncal herniation, compression of ____ leads to contralateral homonymous hemianopsia with macular sparing
Isilateral posterior cerebral artery
In uncal herniation compression of the ______ of the midbrain against the tentorium may occur, damaging the descending corticospinal tracts and causing contralateral hemiparesis
Ipsilateral cerebral peduncle
______ parasomnias such as sleepwalking and sleep terrors occur during deep, slow wave sleep
Non-REM (NREM)
Most dreams occur during ____ sleep
REM
_____ waves are characteristic of deep, slow wave sleep (stage N3)
Delta (frequency up to 3.99 Hz)
Alpha and beta waves are characteristic of _______ and _____ sleep
Wakefulness and REM sleep
____ complexes and sleep _____ are characteristic of stage N2 (light, stable sleep)
K
Spindles
What stage makes up the largest amount of sleep
Non REM stage 2 (N2)
What stage of sleep is prominent in the 1st half of sleep and is when sleep walking and night terrors occur
Non REM stage 3 (N3)
What stage of sleep is prominent in the 2nd half of night and is when nightmare disorder and muscle atonia occurs
REM
REM’s EEG resembles wakefulness with ocassional _____ waves
Sawtooth
Diazepam MOA
Long acting benzo
Diazepam, a long acting benzo can be used in the following: axiolytic, sedative-hypnotic, anticonvulsant, and ___-
Muscle relaxant (can stop spasticity caused by upper motor neuron disorders and tetanus)
As a class, all benzodiazepines should be excludedfrom use in conjunction with alcohol, babituates, neuroleptics, or ________
1st generation antihistamines
Chlorpheniramine MOA
First generation antihistamine (blocks both central and peripheral H1 receptors)
____ is a heterogeneous condition characterized by permanent, nonprogressive motor dysfunction caused by damage to the developing brain
Cerebral palsy
Spastic cerebral palsy may be caused by white matter necrosis which leads to loss of ________ control from the upper motor neurons
Descending inhibitory
GABA A receptor mediates a _____ response than GABA B receptors bc it is what type of receptor
Faster
Ion gated chloride channel
GABA B receptor mediates a _____ response than GABA A becaues it is mediated by _________
Slower
G protein coupled receptor that opens pottasium channels
Baclofen MOA
Agonist of GABA B receptors (can be used to treat spasticity)
Medications used to enhance the activity of what neurotransmitter can improve spasticity in cerebral palsy
GABA
A ____ tremor is also referred to as familial treor as it often follows autosomal dominant inheritance
Essential
What is the first line treatment for essential tremor
Propranolol
MOA propranolol
Nonspecific beta adrenergic antagonist
Lidocaine MOA
Blocks sodium channels in neuronal cell membrane
Local anestetics ahve a greater effect on ___, _____ nerves, so they preferentially inhibit neurons that carry pain and temp sensation
Small myelinated nerve
Local anesthetics are weak ____ that exist in charged and uncharged forms
Bases
Why is a higher dose of local anesthetic required to achieve adequate anesthsia in infected tissue
Anesthetic crosses the cell membrane in uncharged form acidic tissues (such as infected tissues) are more acidic and result in more of the anesthetic existing in the charged form which results in less molecules able to penetrate the cells to block the sodium ion channels
Histopathologicfindings of a patients brain with HIV associated dementia includes microglial cells and macrophages clustered around small areas of necrosis (______) and fused together forming____
Microglial nodules
Multinucleated giant cells
Meningiomas are benign or malignant?
Benign
Meningiomas typically afect adults and tend to arise near ____
Dural reflection
Parasagittal lesions compressing the medial portion of the primary somatosensory cortex in the parietal lobe can result in _________ loss with _______ hemineglect if there is also damage to the parietal association cortex (non dominant hemisphere)
Contralateral lower limb sensory
Contralateral
The thalamic ____ nucleus receives input from spinothalamic tract and dorsal comuln
Ventral posterior lateral
The thalamic _________ nucleus receives input from the trigeminal pathway
Ventral posterior medial
The thalamic ventral posterior lateral nucleus and ventral posterior medial nucleus sent ______ projections to the cortex via thalamical fibers
Somatosensory
Lacunar infarcts result from occlusion of small penetrating arteries that supply deep brin structures (ex. _______) most comonly in the setting of chronic uncontrolled hypertension or diabetes mellitus
Lenticulostriate arteries
________ , beleived to be one of the primary causes of lacunar infarcts, is characterized by hyaline thickening of the vascular wal, collaggenous sclerosis, and accumulation of mural foamy macrophages
Lipohylanosis
______, beleived to be a primary cause of lacunar infarcts, result from the atherosclerotic accumulation of lipid-laden macropahges within the intimal layer of a penetrating artery near its origin off the parent vessel
Microatheromas
CN _____ is pure motor nerve that innervates the sternocleidomastoid and _____
XI (spinal acessory nerve)
Trapezius
CNXI follows a superficial course through the ___ triangle of the neck and is vulnerable to penetrating trauma and iatrogenic injury (cervical lymphnoid node dissection)
Posterior
Symptoms of what muscle weakness include drooping of the shoulder, impaired abduction of the above 100 degrees, and lateral displacement of the scapula
Trapezius
The most common finding in PCA territory infarction is _______ often with macular sparing due to colateral circulation from the middle cerebral artery
Contralteral hemianopia
The posterior cerebral artery branches off the basilar artery and supplies cranial nerves ___ and _____ and other structures in the midbrain
III
IV
Fracture of the pterion risks lacerating the _____ artery causing an epidural hematoma
Middle meningeal
The middle meningeal artery is a branch of the ____ artery (one of the terminal branches of the external carotid artery) which enters the skull at the foramen spinosum and suppies the dura mater and periosteum
Maxillary
The middle meningeal artery enters the skull through the ____
Foramen spinosum
Fluent aphasia, characterized by speech that is fluent, well articulated, and melodic but meaningess, is often produced bylesion in the _____ area of the brain
Werkicke
What artery supplies wernickes area
Middle cerebral artery (inferior terminal)
“Wernkicke-____ salad”
Word
Wernickes area is located in the _____ cortex within the posterior portion of the superior temporal gyrus in the dominant temporal lobe
Auditory association
Motor function of obturator nerve
Adduction of the thigh
Obturator nerve arises from the lumbar plexus and carries fibers from the _____ spinal segments
L2-L4
What nerve passes throught the obturator canal
Obturator nerve
The anterior division of the obturator nerve gives off a terminal cutaneous branch that provides sensation over the ________
Distal medial thigh
Nightmares occur during REM sleep andcan be differntiated from sleep terrors, a non REM parasomnia characterized by incomplete ____ and lack of _____ of dream content
Arousal
Recall
______ typically occurs 2-8 weeks after exposure to high risk drugs and patients tyically develop fever, generalized lymphadenopathy, facial edema, diffuse skin rash, eosinophilia, and internal organ dysfunction
Drug reaction with eosinophilia and systemic symptoms (DRESS)
What nerve supplies the stapedius muscle to reuce volume by dampening ossicle movement in the middle ear
Facial nerve (CN VII)
The facial nerve provides taste to the anerior two thirds of the tongue via the ______ nerve
Chorda tympani
Facial nerve palsy results in loss of corneal reflex due to denervation of the _____ muscle
Orbiculais oculi
A non contrast CT of a subaracchnoid hemorrhage will show what
Hypersensiy within the cisterns/sulci
____ aneurysms are the most common cause of subarachnoid hemorrhages and are assocaited with ehlers danlos syndrome and autosomal dominant polycystic kidney disease
Berry (sacular)
In subarachnoid hemorrhage, blood accumlates between the ___ and ____
Pia
Arachnoid
What type of CT is diagnostic of subarachnoid hemorrhage
CT without contrast
What will a lumbar puncture reveal with a subarachnoid hemorrhage
Gross blood or xanthochromia (yellow discoloration of spinal fluid)
Histopathological findings of neurons with shrunken, basophilic nuclei and intensely eoinophilic cytoplasm (red neurons) are indicative of _______
Irreversible neuronal damage
What is seen on light microscopy of a cryptococcus neoformans infected CSF sample stained with india ink
Round or oval budding yeast
C4 can be testd with what movement
Shoulder/scapular elevation
C5 can be tested with what movement
Shoulder abduction
C5 and C6 can be tested with what movement
Elbow flexion, wrist extension
C7 can be tested with what movement
Elbow extension, finger extension
C8 can be tested with what movement
Wrist flexion, finger flexion
T1 can be tested with what movement
Finger abduction
What does the biceps and brachioradialis refelxes test
C5, C6
What nerve roots does the triceps reflex test
C7, c8
Phase 2 block durring succinylcholine adminatration is similar to a ______ blockade as the nicotinic acetylcholine receptors become gradually desensitized to the effects of succinycholine
Non depolarizing
How does succinylchoine administration lead to hyperkalemia
It acts on nicotinic acetylcholine receptors which are non selective cation channels and alow sodium influx as well as potassium release
Why are patients with crush or burn injuries, denerving injuries or diseases, and myopathies at higher risk of hyperkalemia in succinylcholine administration
These pathologic states cause up regulation of muscle nicotinic acetylcholine receptors –> large amounts of potassium released
What is myotonia
Abnormally slow relaxation of the muscles
Myotonic dystrophy is an inherited autosomal dominant trait that occurs because of an abnormal trinucleotide repeat expansion of _____
CTG
The trinucleotide expansion of CTG in myotonic dystrophy codes for what gene
Myotonia-protein kinase
What are 3 common features seen in myotonic distrophy besides myotonia
Cataracts
Frontal balding
Gonadal atrophy
Friedreich ataxia is an autosomal recessive disorder caused by a mutation in the frataxin (FXN) gene which codes for an essential mitochondrial protein involved in assembly of _____
Iron sulfur enzymes
In Friedrich ataxia, a trinucleotide repeat of what of ____ on the mutated FXN gene
GAA
In Friedreich ataxia, trinucleotide repeats of GAA lead to ______ of FXN
Decreased expression
Friedreich ataxia has decreased FXN expression which leads to decreased mitochondrial _____ production and increased _______, resulting in degeneration of neural tracts and peripheral nerves
Energy
Oxidative stress
Psammoma bodies are present in what types of tumors (4)
Meningioma
Papillary thyroid carcinoma
Meothelioma
Papillary serous carcinoma of the ovary and endometrium
_____ are well circumscribed, round masses attached to the dura and are commonly found at the falcine, parasagittal, or lateral convezity regions of the brain
Meningiomas
Median nerve injury can lead to pain and numbness in the first 3 digits and lateral half of the third digit, along with weakness of thumb ___ and ____
Flexion and opposition
Changes seen in the neuronal body after an axon is severed are called ______
Axonal reaction
What happens to the nucleus in axonal reaction
Nucleus is displaced to the periphery
The changes in the body of a neuron after the axon has been severed are called axonal reaction, this process reflect an increased ________ that facilitates axonrepair
Protein synthesis
What are telangiectasias
Abnormal dilations of capillary vessels
The risk of cancer in patients with ataxia-telaniectasia is increased significantly due to inefficient ____
DNA repair
Manifestations of _________ , an autosomal recessive disorder, manifests as cerebellar ataxia, oculocutaneous telangiectasia, repeated sinopulmonary infections, and an increased incidence of malignancy
Ataxia-telangiectasia
Ataxia-telangiectasia is characterized by DNA hypersensitivity to ______
Ionizing radiation
In __________, DNA is hypersensitive to UV radiation causing premature skin aging and increased risk of skin cancer (melanoma and squamous cell carcinoma)
Zeroderma pigmentosum
______ anemia is caused by hypersensitivity of DNA to crosslinking agents
Fanconi
____ syndrome is characterized by generlized chromosomal instability. Increased susceptibility to neoplasms is present
Bloom
hereditary nonpolyposis colorectal cancer occurs due to defect in ________ enzymes. It leads to increased susceptibility to colon cancer
DNA mismatch-repair
What is internuclear opthalmoplegia
Impaired adduction on the left eye with riht lateral gaze
What is optic neuritis
Transient blurred vision and eye pain with movement
What is saltatory conduction
Nerve impulses jumping between 2 adjacent nodes in myelinated axons
Why do some of the symptoms and signs of MS resolve to a varible extent
Overtime, sodium channels evenually redistribute across the naked axon
Sciatic nerve roots
L4-L5
What nerve is suseptible to injury during hip fracture or arthroplasty because of its proximity to the hip joint
Sciatic
The sciatic nerve motor function
Knee flexion
Sciatic nerve divides into what two nerves
Common fibular (peroneal) Tibial
What nerve controls plantar flexion and inversion and carries sensory from the plantar surface of the foot
Tibial
What nerve is tested in the ankle (achilles) reflex
Tibial
What nerve controls dorsiflexion and eversion of the foot and sensory to the lateral calf and dorsal surface of the foot
Peroneal (common fibular) (actually divides into superficial and deep)
Lambert-Eaton myathenic syndrome is a paraneoplastic syndrome to what type of cancer most commonly
Small cell lung cancer (small cells with neuroendocrine differentiation)
In approximately 50% of patients with Lambert-eaton myasthenic syndrome, ______ is present
Underlying malignancy
Lambert eaton myastenic syndrome is an autoimmune disorder with antibodies against _____
Presynaptc voltage gated calcium channel
What would you expect on an MRI of Huntington disease
Enlargement of the frontal horns of the lateral ventricles and caudate atrophy
N. Meningitidis has an outer cell membrane virulence factor called _____ which is primarily responsible for the severity of meningococcal disease
Lipo-oligosaccharide (LOS)
Endotoxins bind to ______ on monocytic and dendritic cells and trigger release of inflammatory cytokies (IL 1, IL 6 and TNF alpha) which leads to endothelial damage, capillary leak, and hemorrhagic necrosis
Toll like receptor 4
After thiamine infusion is started to treat Wernicke Korsakoff, what neurologic finding is most likely to persist despite treatment
Memory loss
_____ is when patients with korsakoff syndrome are unsure of a fact so they filll in the memory gap with a fabricated stry that they themselves believe to be true
Confabulation
The triad of Wernicke syndrome
Oculomtor dysfunction
Ataxia
Confusion
The hallmarks of korsakof syndrome are ____ and _____
Permanent memory loss
Confabulation
Narcolepsy results from the depletion of hypocretin (also known as orexin) secreting neurons in the ________ that are involved in maintaining wakefullness
Lateral hypothalamus
Patients with narcolepsy experience shortened _____ and enter REM sleep almost immediately
Sleep latency
Patients with narcolepsy commonly experience intrsions of REM sleep phenomena during sleep-wake transitions, including ____ (upon falling asleep) and ___ (upon awakening) hallucinations and sleep paralysis (inability to move immediately after wakening)
Hypnagogic
Hypnopompic
What are 2 topical agents that can be used to treat neuropathic pain
Capsaicin
Lidocaine
Name 4 non topical treatments that can be used for neropathic pain
Tricyclic antideperssants
SNRIs
Anticonvulsants (gabapentin)
Opiods (other 3 are first line, opiods are not)
How do tricyclic antidepressents modulate pain transmission
Inhibit voltage gatd sodium channelsi n sensory nerve
Increase norepinephrine signaling in CNS
The parasympathetic, preganglion neurons arise from ____ and ______
Cranial nerve nuclei (III, VII, IX, X)
Sacral spinal cord
The parasympatheitc preganglionic neurons release ____
Acetylcholine
The parasympathetic preganglionic neurons release acetylcholine on _____ receptors within the parasympathetic ganglia where?
Nicotinic
In or near the target organs
Postganglionic parasympathetic neurons release _____
Acetylcholine
Postganglionic parasympathetic neurons release acetylcholine on _____ receptors within the target organs
Muscarinic
The sympathetic preganglionic neurons arise from ______
Thoracolumbar spinal cord
The sympathetic preganglionic neurons release ____
Acetylcholine
The sympathetic preganglionic neurons arise from the thoracolumbar spinal cord and release acetylcholine which binds post ganglionic ___ receptors in the sympathetic chain and prevertebral ganglia
Nicotinic
Sympathetic postganglionic neurons release ______
Norepinephrine
Postganglionic sympathetic neurons release norepinephrine, activating alpha/beta receptors within target organs with 2 exceptions: ____ and ____
Adrenan medulla
Sweat glands
The chromaffin cells of the adrenal medulla release norepinephrine and epinephrine directly into circulation after being stimulated by the sympathetic nervous system how?
Acetylcholine release from sympathetic preganglionic neurons
The preganglionic and postganglionic sympathetic neurons that supply eccrine sweat glands are both ____
Cholinergic
In the brain, fluorinated anesthetics ____ vascular resistance and lead to a ______ in cerebral blood flow
Decrease
Increase
Donepezil MOA
Acetylcholinesterase inhibitor (alzheimer tx)
Alzheimer dementia involves dysfunction of ____ pathways in the brain
Cholinergic
Acetylcholinesterase inhibitors may cause syncope due to enhanced parasympthetic tone that leads to ____ and ____ with reduced cardiac output
Bradycardia
Atrioventricular block
Jugular foramen (________) syndrome is characterized by the dysfunction of cranial nerves IX, X, XI
Vernet
______is a paired pigmented brainstem nucleus located in the posterior rostral pons near the lateral floor of the 4th ventricle. It functions as the principal site for norepinephrine synthesis in the brain and projects to virtually all parts of the CNS.
Locus ceruleus
Voluntary muscle activity is mediated by the ____ tract
Corticospinal
The _____ cortex of each hemisphere receives information about the contralateral visual field from the ipsalateral geniculate nucleus via the optic radiation
Striate
The _____ gyrus ofthe striate cortex receives information from the upper retina (lower visual field)
Cuneus
The ____ gyrus of the striate cortex receives information from the lower retina (upper visual field)
Lingual
In PCA occlussion, the macula is spared because collateral blood is supplied by the _____ to the _____ pole which processes central visual information
Middle cerebral artery
Occipital
The ____ gyrus is part of the parietal association cortex which integrates multisensory information to comprehend events and solve problems
Angular
Damage to the angular gyrus classically results in ___ syndrome: characterized by agraphia, acalculia, finger agnosia, and left-right disorientation
Gerstmann syndrome
The dorsal columns, carrying afferent vibration and proprioception fibers, are arranged topographically, medial fibers are from the ____ spinal level and lateral are from the ____ spinal levels
Lower
Higher
The ___ fasciculus of the dorsal column, located medially , carries afferentinformation that enters the spinal cord below T6
Gracile
The ____ fasciculus of the dorsal columns, located laterally, carries afferent information that enters the spinal cord above T6
Cuneate
Frontotemporal dementia results in accumualtion of different neurotoxins including _____ and _____
Tau
TDP-43
In frontotemporal dementia, abnormal ____ of TDP-43 leads to imunoreactive inclusions of TDP-43
Ubiquitination
TDP-43 normally fuctions as a ______
Transcription inhibitor or DNA repair protein
______ is a developmental anomaly characterized by hypoplasia/absence of the cerebellar vermis and cystc dilation of the 4th ventricle with posterior fossa enlargement
Dandy walker malformation
The most common complication of SAH is arterial vasospasm which occurs due to the release of vasoconstrictive factors from damaged ______ in the subarachnoid space and the inability of damaged ______ to produce vasodilators (nitric oxide)
Erythrocytes
Endothelial cells
3 neuronalpathologic features of alzheimers disease include neurodegeneration leading to neuronal loss and cerebral atrophy, extracellular ______, and intracellular ______
Beta amyloid plaques Neurofibrillary tangles (tau protein agreggates)
What are the 2 symptomtic treatment options for alzheimers (just mech of action)
NMDA receptor antagonist (memantine) Cholinesterase inhibitors (donepezil, galantamine)
Degeneration of _______ neurons in the basal forebrain contributes to memory loss and functional decline in alzheimer patients
Cholinergic
What medications should be discontinued in alzheimers patients bc they can exacerbate cognitive dysfunction
Anticholinergic (tricyclic antidepressents)
How are NMDA receptor antagonists helpful in treating alzheimers
Inhibit glutamate NMDA signaling –> prevent excitotoxicity (calclium overload) and subsequent neuronal apoptosis
Neisseria meningitidis is transmitted via aerosolized droplets and are able to colonize the _____ due to the presene of specialized surface components (dimbriae, pili)
Nasopharynx
Neisseria meningtidis causes meningitis by entering via the nasopharynx –> blood —> ______ —-> meninges
Choroid plexus
Gingival hyperplasia in phenytoin treatment is due to increased expression of ______
Platelet derived growth factor (PDGF)
When gingival _____ are exposed ot increased amounts of PDGF, they stimulate proliferation of gingval cells and alveolar bone
Macrophages
If taken during pregnancy, phenytoin may cause ____ syndrome
Fetal hydantoin syndrome
The most important biochemical abnormality noted in Alzheimers disease is decress in acetylcholine leves which occurs due to deficiency in _____
Choline acetyltransferase
In alzheimers disease, the decline in acetylcholine is most notable in the nucleus ________ which participates in memory and cognition
Basalis of meynert
Name the 3 branches directly off the aortic arch
Left common carotid
Left Subclavien
Right brachiocephalic
The right common carotid artery branches from the _____
Brachiocephalic artery
The L4 vertebral body lies on a line drawn between the highest points of the iliac _____ which can be visually identified and confirmed by palpation
Crests
Patients with _____ occlusion usually present with contralateral hemiparesis and hemisensory loss involving mainly the face and upper limb (more than leg)
Middle cerebral artery
In diabetic polyneuropathy, neuronal injury occurs due to accumulation of advanced glycosylation end products, ____, and other toxic substances that lead to derranced metabolism and increased oxidative stress
Sorbitol
Diabetic microangiopathy affecting the _____ vessels can promote nerve ischemia
Endoneurial
Length dependent axonapthy in diabetic polyneuropathy affects what nerves first
Longest nerves
Small fiber injury is characterized by predominance of ____ symptoms (pain, paresthesia, allodynia)
Positive
Large fiber inovlvemnet is characterized by predominance of ____ symproms (numbness, loss of proprioception and vibration sense, sensory ataxia, diminished ankle reflexes)
Negative
Several months-years after brain infarction, the necrotic area appears as a cystic cavity surrounded by a wall composed of dense fibers formed by what cells
Astrocytes
___ disease is a rare autosomal recessive disorder most often identfied in individual aged 5-40 with decreased secretion of copper into the biliary system resulting in movement abnormalities and psych symptoms
Wilson
Wilson diease is a autosomal recessive disorder with a mutation in ______
ATP7B
Wilson disease is an auto recessive disorder with a mutation in ATP7B which hinders intracellular hepatocyte copper transport causing reduced formation/secretion of ______ (the major extracellular copper transport protein)
Ceruloplasmin
Almost all patiens with wilson disease have ________ which are green/brown copper deposits in the Descemet membrane of the cornea and can be detected with a slit lamp examination
Kayser-Fleischer rings
Diagnosis of Wilson disease can be confirmed by presense of low serum ceruoplasmin, elevated urinary ___ excretion, and elevated hepatic ____ content on liver biopsy
Copper
Copper
How can Wilson disease be treated
Chelators (D-penicillamine, trientine)
Zinc (interferes with copper absorption)
What is the result of a charcot-bouchard aneurysm rupture
Intracerebral hemorrhage
What is the result of a saccular aneurysm rupture
Subarachnoid hemorrhage
The gag reflex is mediated by afferents predominantly from the _____ nerve and efferents from the ___ nerve
Glossopharyngeal (CN IX)
Vagus (x)
Petellar reflex tests what nerve roots
L2-l4
Sensation to anteromedial thigh and medial shin is innervated by what nerve roots
L2-L4
What nerve roots are tested in achilles reflex
S1
What nerve roots innervated sensation to perineum
S2-S4
What nerve roots innervated hip flexion (iliopsoas), hip adduction, knee extension (quadricep)
L2-L4
What nerve roots innervate hip extension (glut max) and plantarflexion (gastrcnemius)
S1
What nerve roots are tested with the anocutaneous reflex
S2-S4
What nerve roots innervated sensation to the posterior calf, sole, and lateral foot
S1
What nerve roots innervted sensation to lateral shin and dorsum of foot
L5
What nerve roots innervated foot dorsiflexion and inversion (tibialis anterior), foot eversion (peroneus), and toe extension (extensor hallucis and digitorum)
L5
Injury to what nerve roots will cause urinary or fecal incontinence and sexual dysfunction
S2-S4
What nerve innervates the glutesus medius, gluteusminimus, and tensor fasciae latae muscles
Superior gluteal nerve
The glut medius, glut minimus, and tensorfasciae latae function to stabilize th pelvis and ___ the thig
Abduct
What is a positive trendlenburg sign
Pelvis sags toward unaffected (contralateral) side when the patient stands on the affected (ipsilateral) leg
A patient with weakness to what muscles will have a positive trendelenburg sign
Gluteus medius and glutes minimus
What is a gluteus medius lurch
When a patient with gluteus medius and gluteus minimis weakness leans toward the affected side when walking to compnesate for hip drop
The temporal bone contains the vestibularochlear nerve as well as what other cranial nerve which enters at the internal auditory meatus and travels through the internal auditory canal with the vestibulocochlear nerve
CNVII (facial)
What cause of meningitis causes acute onset fever, headache, altered mental status, and focal neurologic deficits or seizures as well as temporal lobe edema
Herpes simplex virus type 1
What are the CSF findings in patients with meningitis due to herpes simplex virus 1
Normal glucose
Elevated protein
Elevated lymphocytes and erythrocytes (due to hemorrhagic inflammation in temporal lobes)
In the CNS the phagocytic macrophages/glia are recruited more slowly due to the BBB, mylein producing oligodendrocytes also beome inactive or undergo apoptosis and do not asist in phagocytosis. This results in the persistance of what for months-years following ischemic injury
Myelin debris
How is tetanus diagnosed
Clinical diagnosis
Why are blood cultures of tetanus not helpful for diagnosis
C. Tetani only grows at the inoculation site, the toxins then spread and cause the symptoms
What vascular changes result in diabetic neuropathy
Hyalinization of the endoneurial arterioles —> ischemic nerve damage
______ is a compression mononeuropathy of the lateral femoral cutaneous nerce at the inguinal ligament, typically caused by tight clothing or injury dduring surgery
Meralgia paresthetica
Meralgia paresthetica presents with pain, paresthesia and numbness over what distribution
Lateral thigh above the knee
A patient with a ring enhancing lesion in the temporal lobe who has been puling on her ear recently likely is infected with a pathogen that entered her brain through what structure
Mastoid air cells (otitismedia that spread)
Frontal lobe abscesses are generally due to direct spread of a pathogen from what structures
Ethmoid or frontal sinus
What occur as a result of compression of spinal nerve roots and typically present with neck or arm pain and motor/sensory deficits
Cervical radiculopathy
Cervical radiculopathies result from what 2 ways
Spinal sponylosis
Vertebral disc herniation
What is spinal spondylosis
Aging –> degeneration of vertebral bodies, discs, joints –> osteophye formation –> narrows neuronal formamina
A subdural hematoma is due to a rupture of _____
Cortical bridging veins
The cells that are typically affected first by hypoxia are the _____ neurons in the ____ which can be damaged by iscemia in as little as 3 min
CA1 pyramidal
Hippocampus
In addition to the hippocamus, the cerebellar ____ cells and neocortex _______ neurons are also highly susceptible to damage if ischemia lasts for 5-10 min
Purkinje
Pyramidal
Cerebellar ataxia, telangiectasia and increased risk of sinopulmonary infections constitute a characteristic triad of wha hereditary disease
Ataxia telangiectasia
Ataxia telangiectasia causes an immune deficiency that primarily manifests as a ___ deficiecy predisposing the patient to infections of the upper and lower airways
IgA
In ataxia telangiectasia, the autosomal recessive gene mutation in the ATM gene is responsible for ____
DNA break repair
In MS, activated CD8 T cells release cytotoxi granules that injure _____
Oligodendrocytes
In MS, B cell recruitment leads to the formation of antibodies that activate complement and facilitate _____ breakdown
Myelin
Diagnosis of MS is largely clinical but supported by the pressence of ____ lesions on MRI
T2
Are oligoclonal bands specific or sensitive for dx of MS
Sensitive
Blepharospasm, the second most common focal dystonia is what
Involuntary forcible closre of the eyelids
Hydrocephalus is a common complication of subarachnoid hemorrhage due to what
Blood in subarachnoid space can acutely obstruct and impair absorption of cerebral spinal fluid by the arachnoid granulations
What are 3 common findings of TB meningitis
Gelatinous exudate at basal portion of brain
Multiple bilateral brain infarcts
Hydrocephalus (can cause ventriculomegaly)
What is an autopsy likely to reveal in a patien with HSV1 encephalitis
Unilateral temporal lobe inflammation
_____ syndrome presets as a patient with quadriplegia and speechlessness with preserved consciousness and eye mvements
Locked in syndrome
Locked in syndrome can be caused by ischemic injury to ____
Bilateral ventral pons
In locked in syndrome horizontal eye movements are absent but why are vertica eye movements and eyelid elevation spared
They are controlled in rostral midbrain, not in ventral pons
Preserved conscoiusness in locked in syndrome is due to _______ being spared
Midbrain reticular formation
Neural tissu with neurons with shrunken nuclei and eosinphilic cytoplasm lacking Nissl bodies indicates what type of injury
Irreversible ischemic injury
Describe a pyknotic nucleus
Shrunk and basophilic with loss of nucleolus
Subacute cerebellar degeneration is a paraneoplastic syndrome seen in smal cell lung cancer via what mechanims which damage purkinje neurons
Anti-Yo, anti- P/Q and anti-Hu auto antibodies
On macroscopic examination, ______ are cystic or partialy solid with cyst being filled with a brownish yellow, viscocus fluid that resembles machine oil due to the presence of protein and cholesterol crystals
Adamantinomatous craniopharyngioma
Adamantinomatous craniopharyngioma are found in children and typically located in the ____
Suprasellar region
In adamantinomatous craniopharyngioma _______ of the cysts is highly characteristc and may be deteced on euroimaging
Dystrophic calcification
An adamantinomatous craniopharyngioma, on light microscopy, will reveal cysts lined with cords/nests of _____ with peripheral palisading and internal areas of lamellar ______
Stratified squamous epithelium
Wet keratine
Craniopharyngioas are derived from remnants of the _____
Rathkes pouch
Abusive head trauma (shaken baby syndrome) results in what type of hemorrage
Subdural (tearing of bridging veins)
_______ due to rupture of congested retinal veins are highly suggestive of abusive head trauma(shaken baby syndrome)
Retinal hemorrhages
Patient with progressive headaches has an enhancing ventricular mass on MRI is consistent with what diagnosis
Ventricular ependymoma
What histological finding an confirm the diagnosis of an ependymoma
Perivascular pseudorosettes
How can cocain cause myocardial infarction
Coronary artery vasospasm
Increased platelet aggregation
Cocaine MOA
Inhibits presynaptic reuptake of monoamines
An adequate antidepressant trial is generally considered to be at least how long?
4-6 weeks
What distinct features of neuroleptic syndrome differentiate it from serotinn syndrome
Diffuse rigidity (lead pipe) and hyporeflexia seen in NMS
What distinct features seen in serotonin syndrome diferentiate it from neuroleptic malignant syndrome
Clonus and hyperreflexia are seen in serotonin syndrome
What precipitates neuroleptic malignant syndrome
Dopamine antagonist
MOA: bupropion
Inhibits reuptake of norepinephrine and dopamine
What medication is contraindicated in patients with seizure disorders or current or prior diagnosis of bulimia or anorexia nervosa due to increased risk of seizures
Buproprion
Withdrawals from what substance produce symtpoms of increased apetite, hypersomnia, intense psychomotor retardation, severe depression and can be accompnied by vivid dreams
Stimulants (amphetamines, cocaine)
What dissociative disorder involves either or both: depersonalization (detachment, unreality of self) and derealization (detachment, unreality of surroundings)
Deprsonalization/derealization disorder
What dissociative disorder involves the inability to recall personal information, usually of a traumatic or stressful nature
Dissociative amnesia
What dissociative disorder involves framentation into 2 or ore distinct personalities and discontinuity in identity and personal agency
Dissociative identity disorder
Second generation antipsychotic medications are associated most with what adverse effects
Metabolic
How should patients on second generation antipsychotics be monitored
BMI
Fasting glucose and lipids
Blood pressure
Wais circumference
Within second generation antipsychotics, which medications carry the most risk for metabolic adverse effects
Olanzapine
Clozapine
Chronic ethanol use causes downregulation of _____ receptors
GABA
What is the most common initial symptom of alcohol withdrawal
Tremor (can start as early as 6 hours after last drink)
If a patient has 5 or more symptoms of major depressive disorder lasting more than 2 weeks following a precipitating event (ie losing their job) what is the diagnosis
Major depressve disorder (adjustment disorderis the diagnosis when patient does not have 5 of the symptoms meeting major depressive disorder diagnosis)
What is the diagnosis of a patient who has a pervasive pattern of distrust and suspiciousness beginning in early adulthood and occurig in a variety of settings including believes being exploited and deceived by others, interprets benign comments and events as threats, bears grudges, and questions loyalty of partner without justification (no fixed delusions and no other psychotic symptoms)
Paranoid personality disorder
A child who is previously meeting developmental milestones and now has dramatic regression of speech and motor milestones accompanied by repetitive hand movements is concerning for what dignosis
Rett syndrome
Rett syndrome is a sporadic, X-linked genetic disorder in what gene
MECP2
Does Rett syndrome cause neurodegeneration?
No, neuropathology is consitant with arrested brain development
How does bulimia nervosa differ from binge eating disorder
Bulimia nervosa involves inappropriate comensatory behavior (fasting, purging) while binge eating disorder does not
Of risk factors for suicide, what is the strongest single factor that is most predictive of a completed suicide
History of an attempted suicide
Cocaine MOA
Inhibits presynaptic reuptake of monoamines
An adequate antidepressant trial is generally considered to be at least how long?
4-6 weeks
How does bulimia nervosa differ from binge eating disorder
Bulimia nervosa involves inappropriate comensatory behavior (fasting, purging) while binge eating disorder does not
Does Rett syndrome cause neurodegeneration?
No, neuropathology is consitant with arrested brain development
Rett syndrome is a sporadic, X-linked genetic disorder in what gene
MECP2
A child who is previously meeting developmental milestones and now has dramatic regression of speech and motor milestones accompanied by repetitive hand movements is concerning for what dignosis
Rett syndrome
What is the diagnosis of a patient who has a pervasive pattern of distrust and suspiciousness beginning in early adulthood and occurig in a variety of settings including believes being exploited and deceived by others, interprets benign comments and events as threats, bears grudges, and questions loyalty of partner without justification (no fixed delusions and no other psychotic symptoms)
Paranoid personality disorder
If a patient has 5 or more symptoms of major depressive disorder lasting more than 2 weeks following a precipitating event (ie losing their job) what is the diagnosis
Major depressve disorder (adjustment disorderis the diagnosis when patient does not have 5 of the symptoms meeting major depressive disorder diagnosis)
What is the most common initial symptom of alcohol withdrawal
Tremor (can start as early as 6 hours after last drink)
Chronic ethanol use causes downregulation of _____ receptors
GABA
Within second generation antipsychotics, which medications carry the most risk for metabolic adverse effects
Olanzapine
Clozapine
How should patients on second generation antipsychotics be monitored
BMI
Fasting glucose and lipids
Blood pressure
Wais circumference
Second generation antipsychotic medications are associated most with what adverse effects
Metabolic
What dissociative disorder involves framentation into 2 or ore distinct personalities and discontinuity in identity and personal agency
Dissociative identity disorder
What dissociative disorder involves the inability to recall personal information, usually of a traumatic or stressful nature
Dissociative amnesia
What dissociative disorder involves either or both: depersonalization (detachment, unreality of self) and derealization (detachment, unreality of surroundings)
Deprsonalization/derealization disorder
Withdrawals from what substance produce symtpoms of increased apetite, hypersomnia, intense psychomotor retardation, severe depression and can be accompnied by vivid dreams
Stimulants (amphetamines, cocaine)
What medication is contraindicated in patients with seizure disorders or current or prior diagnosis of bulimia or anorexia nervosa due to increased risk of seizures
Buproprion
MOA: bupropion
Inhibits reuptake of norepinephrine and dopamine
What precipitates neuroleptic malignant syndrome
Dopamine antagonist
What distinct features seen in serotonin syndrome diferentiate it from neuroleptic malignant syndrome
Clonus and hyperreflexia are seen in serotonin syndrome
What distinct features of neuroleptic syndrome differentiate it from serotinn syndrome
Diffuse rigidity (lead pipe) and hyporeflexia seen in NMS
Of risk factors for suicide, what is the strongest single factor that is most predictive of a completed suicide
History of an attempted suicide
