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FA organs HY > Neuro > Flashcards

Neuro Flashcards

1
Q

Alar vs basal plate?

A 
Alar= sensory 
Basal = motor 
**BMR= Basal motor rate
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2
Q

What two tests can establish a neural tube defect?

A

Elevated AFP

Elevated AChE

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3
Q

Anencephaly associations?

A

Anterior neural fold defect
Elevated AFP
Polyhydramnios
Maternal T1DM

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4
Q

Pt with failure of the 2 cerebral hemispheres to fuse and One centrally located eye has what mutation?

A

Holoprosencephaly + Cyclopia == Sonic Hedgehog mutation

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5
Q

Arnold-Chiari?

A

Tonsillar and vermian herniation through foramen magnum
Thoraco-Lumbar myelomeningocele
Paralysis below defect

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6
Q

Child with cystic enlargement of the 4th ventricle, bulging fontanelle, and MRI shows lack of cerebellar vermis?

A

Dandy-walker = agenesis of cerebellar vermis

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7
Q

Where are Nissl substances located and what are they?

A

Nissl= RER –> Soma + dendrites

**NOT axon/ hillock

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8
Q

Actions associated with Astrocytes?

A 
BBB
Reactive gliosis
Removal of excess NTs
K+ metabolism
Repair
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9
Q

What two types of nerves carry pain and temp?

A

Free nerve endings –> Everywhere on body
Delta fibers –> Myelinated, Fast, First Pain
C fibers–> Unmyelinated, slow, 2nd pain

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10
Q

What fibers sense fine touch and position?

A

Meissner’s corpuscles –> Hairless areas

  • *Large Myelinated fibers–> Dorsal column
  • *Adapt quickly
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11
Q

What fibers sense vibration and pressure?

A

Pacinian corpuscles –> Deep skin, joints, ligaments

  • *Large myelinated
  • *Fast adapting
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12
Q

What fibers sense pressure, deep static touch, and position?

A

Merkels discs –> hair follicles
**Large myelinated,
Adapt SLOWLY

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13
Q

Which fibers adapt slowly and which Fast?

A

Slow –> Merkel (want to continue to feel static touch)

Fast–> Corpuscles (pressure, vibration we accommodate to)

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14
Q

Layers of a nerve fiber from inside–> out?

A

Endoneurium -> inflammed in Guillian barre
Perineurium-> permeability barrier, rejoined during microsx
Epineurium->dense CT, contains fascicles + BVs

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15
Q

NE site of synthesis? Inc/dec in what?

A

Locus ceruleus (pons)
Inc => Anxiety
Dec => Depression

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16
Q

DA site of synthesis? Inc/ dec in what?

A

Ventral tegmentum + SNc
Inc => Schizophrenia
Dec => PD + depression

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17
Q

5HT site of synthesis? Inc / dec in what?

A 
Raphe nucleus (brain stem) 
Dec => Anxiety + Depression
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18
Q

ACh site of synthesis? Inc/ dec in what?

A

Basal nucleus of Meynert (forebrain-> Neocortex)
Inc => REM
Dec => Alzh + Huntingtons

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19
Q

GABA site of synthesis? Inc and dec in what?

A

Nucleus Accumbens

Dec = Anxiety + Huntingtons

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20
Q

What nucleus is responsible for stress and panic , Reward/pleasure/ addiction?

A

Stress/panic==> Locus ceruleus

Addiction/reward ==> Accumbens / septal

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21
Q

What forms the BBB?

A

Tight junctions btwn endothelial cells
Basement membrane
Astrocyte foot processes

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22
Q

What areas do not have a BBB?

A

Area postrema -> vomiting center
OVLT –> Osmotic center (trigger ADH)
Neurohypophysis-> ADH release

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23
Q

Increased IC pressure due to infections and Neoplasms is due to?

A

Vasogenic Edema –> Destruction of Endothelial tight junctions

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24
Q

Hypothalmus actions? (TAN HATS)

A 
Thirst
Andenohypophysis
Neurohypophysis
Hunger
Autonomics
Temperature
Sex
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25
Q

What areas give input to Hypothalamus?

A

OVLT–> Osmotic changes -> ADH release

Area postrema -> Emetics -> ANS activity

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26
Q 
Hypothalamic nuclei: actions / def 
Lateral -> 
Ventromedial -> 
Anterior -> 
Posterior-> 
Suprachiasmatic-> 
Supraoptic-> 
Paraventricular->
A

Lateral -> Hunger (def = Anorexia) *Inhibited by leptin
Ventromedial=> Satiety (def = Hyperphagia)
anterior=> Cooling (PSNS)
Posterior=> Heating (SNS)
Suprachiasmatic=> Circadian rhythm
Supraoptic -> ADH
Paravenricular=> Oxytocin

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27
Q

If you zap your Lateral hypothalamic nucleus?

A

You shrink Laterally => controls Hunger

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28
Q

If you zap ventromedial nucleus?

A

Grow Medially ==> Controls Satiety

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29
Q

Difference btwn Anterior vs Posterior hypothalamic nuclei?

A

A/C => anterior Cooling (PSNS)

Posterior => heating (SNS)

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30
Q 
Thalamic nuclei:
VPL
VPM
LGN
MGN
Ventrolateral
A

VPL => Sensory from Body–> postcentral gyrus
VPM-> sensory from FACE -> Postcentral gyrus
LGN -> Eyes (Lateral= Light)
MGN-> Hearing (Music)
VL => Motor

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31
Q

The structures and functions of Limbic system?

A

Hippo + Amygdala + Fornix + MBs + Cingulate
5 Fs = Feeding, Fleeing, Fighting, Feeling, Fucking
Emotions, Longterm Memory, Olfaction, behavior, ANS

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32
Q

What are the inputs to Cerebellum?

A

Mossy fibers => Contralateral cortex via Middle peduncle

Climbing fibers=> Ipsilateral proprioception Dorsal columns via Inferior Peduncle

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33
Q

Output from Cerebellum?

A

Purkinji fibers -> Superior Peduncle-> Contralateral Cortex
Lateral -> voluntary movement of extremities
Medial -> Balance, truncal coordination

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34
Q

Deep nuclei of cerebellum?

A

Dont Eat Greasy Foods = Lat-> med

Dentate-> Emboliform -> Globose -> Fastigial

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35
Q

What is the cause of the ACh/ GABA neuron loss on Huntingtons?

A

Excess NMDA-R binding causing GLUTAMATE toxicity

CAG=> Caudate loses ACh and GABA

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36
Q

Action tremor that is exacerbated by holding posture of limb position?

A

Essential tremor
**Pt self medicate with EtOH
Give Beta Blocker

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37
Q

Hand tremor that is alleviated by intentional movement?

A

Resting (unintentional) tremor => PD

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38
Q

SLow zigziag pointing or tremor with actions?

A

Intention tremor–> Cerebellum

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39
Q

Sudden brief uncontrolled muscle contractions?

A

Myoclonus –> Metabolic encephalopathy

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40
Q 
Consequence of losing:
Amygdala BL
Frontal lobe
Right parietal lobe
RAS  
Basal ganglia 
Subthalamic nucleus
Cerebellar vermis
Hippocampus
Paramedian Pontine reticular formation
Frontal eye fields
A

Amygdala BL => Hyperphagia, hyperoral, hypersexual
Frontal lobe-> Disinhibited, primitive reflexes, judgement
R parietal => Left sided Spatial neglect
RAS -> COMA
BG -> tremor, chorea, PD
Subthalamic=> Contralateral hemibalismus
Cerebellar vermis => Truncal ataxia, dysarthria
Hippocampus => Anterograde amnesia (No new memories)
PPRF => Eyes look AWAY from lesion
FEF => Eyes look TOWARD lesion

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41
Q

Pt with a hx of DM, HTN, and stoke presents with Right sided hemiparesis and hemiplegia. What is the most likely cause?

A

Lacunar infarct due to HTN @ L INTERNAL CAPSULE

  • stroke @ Lateral striate artery => Straitum/ IC can also cause this.
  • *
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42
Q

Pt with Left lower limb paresis, loss of proprioception, and dysarthria due to inability to move their tongue to the right. Stroke @ what Artery?

A 
Anterior Spinal Artery 
**Medial medullary syndrome=> 
contralateral Lateral corticospinal tract 
contralateral Medial lemniscus 
Ipsilateral CN XII
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43
Q

Pt with vertigo, nystagmus, dysphagia, hoarseness, horner’s syndrome, ataxia, decreased Pain + temp to Limbs and face. What artery?

A

Lateral medullary syndrome => PICA
Vestibular nucleus = Vertigo, nystagmus
Lat spinothalamic tract => dec temp/ pain
**Nucleus ambiguus –> CN IX & X (dysphagia/ hoarseness)
SNS=> horners
Inferior cerebellar peduncle=> Ataxia, dysmetria

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44
Q

Pt with vertigo, nystagmus, decreased pain/temp to face, decreased hearing, meiosis, paralysis of face, dec lacrimation. What artery?

A 
Lateral Pons ==> AICA 
CN VIII=> vertigo, nystagmus
CNVII => facial paralysis
Spinal CN V nucleus=> Loss of pain/ temp face
SNS=> Horner's 
Middle/Inferior peduncle => Ataxia
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45
Q

pt with Right sided hemianopia with macular sparing. What artery?

A

Occipital cortex ==> PCA

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46
Q

Pt with a pure sensory deficit. What is the MCC?

A

Lacunar infarct of Thalamic nuclei (VPL/VPM)

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47
Q

Charcot-Bouchard aneurysms are MC located in?

A

Basal ganglia
Thalamus
Pons
Cerebellum

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48
Q

Hypertensive hemorrhage vs Cerebral Amyloid angiography?

A

HTN ==> Charcot aneurysms of Lenticulostriate vessels==> BG/ IC bleeds

CAA –> LOBAR/ cortex bleeds

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49
Q

During hypoxia and stroke what is the time line for brain damage/ changes?

A

Damage begins @ 5 min of hypoxia (Hippo / Cerebellum)
12-48 hrs = Red neurons
1-3d -> Liquifactive necrosis + PMNs
3-5d –> Macrophages
1-2wks -> Reactive gliosis + vascular proliferation
>2wks –> SCAR

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50
Q

What tests are done to diagnose stroke?

A

Diffusion weighted MRI => Early pickup (3-30min)

non-contrast CT –> after 24hrs

51
Q

Stroke vs TIA?

A

Stroke = Irreversible focal CNS def, with changes on imaging

TIA -> reversible focal def, < 1 hour, WITHOUT changes on Imaging

52
Q

Types of stroke:
Atherosclerotic
Hemorrhagic
Ischemic

A

Atherosclerotic => thrombi->necrosis>Cystic cavity>gliosis
Hemorrhagic-> HTN, Anticoagulants (lower BP)
Ischemic-> PFO, endocarditis, Afib, Carotid dissection, Lacunar strokes (tPA <4.5 hrs)

53
Q

Normal pressure hydrocephalus vs. Hydrocephalus ex-Vacuo?

A

Normal pressure=> Expansion of ventricles distort Corona radiate -> Wet, Wacky, Wobbly

Hydrocephalus ex-vacuo=> Inc CSF due to cerebral ATROPHY (Alzh, HIV, Picks), NO triad

**BOTH have Normal IC pressure

54
Q

Pseudotumor cerebri?

A 
Benign IC HTN >300
Obese woman + headache + blurry vison
NORMAL labs + Neuro exam 
Dec CSF absorption 
Rx: Carbonic Anhydrase inh
55
Q

Two causes of LMN lesions ONLY?

A

Poliomyelitis

Werdnig-Hoffman disease

56
Q

Pt with both LMN / UMN and no ANS defects. What is the mutation and Rx?

A

ALS –> SOD 1 mutation

**Riluzole –> dec presynaptic Glutamate release which is know to be toxic at high levels due to excess Ca+

57
Q

Pt with abdominal surgery to repair AAA begins to complain of weakness and loss of sensation. What is the cause and what is spared?

A

Loss of Artery of Adamkiewicz –> ASA

**Spares Dorsal columns & Lissauer’s tract (medial portion of spinothalamic tract)

58
Q

Pt with +Romberg and absence of DTRs complains of joint pain and blurry vision. Most likely cause?

A

Tertiary syphilis –> Tabes dorsalis

Argyll Robertson pupil-> Accommodates but Doesnt React

59
Q

What is affected in B12 def?

A

Subacute combined degeneration
Dorsal columns
Lateral corticospinal tracts
Spinocerebellar tracts

60
Q

Infant baby is “Floppy,” has marked hypotonia, and tongue fasciculations. What is the dx and seen on biopsy of Spinal cord?

A

Werdnig hoffman –> Degeneration of Anterior horn

61
Q

young boy presents with ataxia, nystagmus, pes cavus, hammer toes, and kyphoscoliosis. Echocardiogram reveals enlarged heart. What it the molecular cause of his disease?

A

Friedreich’s ataxia–> GAA repeats

  • *Impaired MITOCHONDRIAL function
  • *Ataxia + Hypertrophic cardiomyopathy
62
Q

Conjugate vertical gaze center?

A

Superior colliculus

**Below Pineal gland –> Cancer gaze vertical gaze palsy due to compression == Perinaud syndrome

63
Q

Cranial nerve nuclei locations:
Midbrain
Pons
Medulla

A 
Midbrain= CN 3 + 4 
Pons = CN 5 + 6 + 7 + 8 
Medulla = CN 9 + 10 + 12
64
Q

Vagal nuclei functions:
Solitarius
Ambiguus
Dorsal motor nucleus

A

Solitarius –> Visceral Sensory from VII, IX, X (Taste, baroreceptors, gut distention)

aMbiguus => Motor IX, X

Dorsal => PSNS via X

65
Q

Pt with hearing difficulties has an abnormal Rinne test, and Weber test localizes to the left ear. What is the cause?

A

Conductive hearing loss in LEFT ear

**Weber localizes in Affected ear

66
Q

Pt with hearing difficulties has a normal Rinne test and Weber localizes to the Left ear?

A

Sensorineural hearing loss in the RIGHT ear

**Weber localizes in Unaffected ear

67
Q

Pt with noised induce hearing loss has damaged what? Sudden extremely loud noise can damage?

A

Noise induced=> Damaged to Stereocilliated cells in Organ of Corti-> Loss of High freq 1st

Sudden loud noise–> Tympanic membrane rupture

68
Q

LMN vs UMN lesion to facial muscles?

A

UMN -> Contralateral Lower face paralysis only (BL UMN innervation of Forehead)

LMN –> Ipsilateral Total facial paralysis

69
Q

Elderly man with decreased ability to focus during accommodation. What it the most likely cause?

A

Sclerosis and decreased Elasticity ==> AGING

70
Q

Pt with a history of back pain comes with blurry vision and pain. Eye exam shows uveitis. What parts are affected by inflammation and Rx?

A

HLA-B27 association
**Inflammation of Uveal coat (iris, ciliary body, choroid)
Rx: STEROIDS

71
Q

Retinitis associations?

A

Retinal edema and Necrosis

Immunosuppressed == CMV, HSV, HZV

72
Q

Pt comes in with acute loss of vision in one eye. Eye exam shows “whitening with cherry-red spots” and no pain is noted during exam. Dx?

A

Central Retinal artery occlusion –> Temporal arteritis

**CRVO => ischemia and edema Rx: Anti-VEGF

73
Q

What produces aqueous humor of the eye and what receptors stimulate them? Dilator & sphincter receptors?

A

Ciliary epithelium

  • *Beta 2 receptors
  • *Dilator = alpha 1
  • *Sphincter = M3
74
Q

Pt suffers from gradual painless loss of peripheral vision. What can causes this?

A

Open (wide) Angle Glaucoma = Inc IOP + CN 2 Atrophy

  • Dec Outflow through trabecular meshwork
  • Hx of uveitis, trauma, Steroids, vasoproliferative retinopathy
75
Q

What is the cause of Closed angled glaucoma?

A

Forward movement of the Lens against central iris to block aqueous flow through PUPIL

76
Q

Acute vs Chronic closed angled glaucoma?

A

Chronic=> Asymptomatic, Inc IOP, CN2 atrophy
Acute= Emergency, Inc IOP, VERY painful, sudden loss of vision, Halos around lights, frontal headache, Epi Is CI
Rx: Pilocarpin or CA inhibitor

77
Q

Pt with sudden onset of Painful vision loss, headache, and halos around lights?

A

Acute closed angled glaucoma

78
Q

What are risk factors for Painless bilateral opacifications of the lens?

A 
Cataracts:
EtOH
**Diabetes
Classic Galactosemia + Galactokinase def
**Corticosteroids
79
Q

PSNS vs SNS tracts to Eyes?

A

PSNS=> Edinger-Wesphal->CN3-> Short ciliary n

SNS->Hypothalamus->C8-T2->Sup Cerv Gang->ICA->Long ciliary nerve

80
Q

Pt presents with flashes and floaters in the left eye. Hrs later complains of acute vision loss as if “curtains were drawn down” on eyes?

A

Retinal Detachment

81
Q

Pt comes in with continuous distortion of vision and now complains of central vision loss?

A

Macular degeneration

82
Q

Dry vs Wet Macular degeneration?

A

Dry (80%)-> “drusen” (proteins) deposits beneath retinal pigment epithelium (prevent with Multivitamin/Antioxidant)

Wet-> Rapid loss of vision due to Choroidal neovascularization (Anti-VEGF)

83
Q 
Visual defect locations: 
Homonymous hemianopia
Upper quadrantic anopia 
Lower quadranic anopia
Hemianopia with macular sparing
Central scotoma
A 
Homonymous hemianopia= TRACT 
Upper => Meyers Loop 
Lower => Radiations
Hemianopia Macular sparing=> PCA/ Visual cortex infarct
Central scotoma=> MD/ Lens defect
84
Q

Highly myelinated tract in the eye that is often first to go in MS?

A

MLF –> NOT involved in convergence

85
Q

MCCs of ophthalmia neonatorum? Rx?

A
  1. Chlamydia trachamatis => Erythromycin

2. N gonorrhea => Ceftriaxone

86
Q

MCC of viral conjunctivitis?

A

Adenovirus –> pink eye

HSV1 –> Keratoconjunctivitis + dendritic ulcers

87
Q

Young patient with Loss of vision and Pain on eye movement. What are MCCs of this dz?

A

Optic Neuritis –> Rx with Steroids

  1. MS
  2. Methanol
88
Q

AIDs pt with “cotton wool exudates” and retinal hemorrhage on eye exam?

A

CMV retinitis –> MCC of blindness in AIDs pts

89
Q

MCC of “swimmers ear” and Malignant external otitis in DM?

A

Both P. aeruginosa

  1. swimmers –> Rx Polymyxin B
  2. Malignant-> Impenem-Cilastin
90
Q

Pt complains of vertigo, dizziness, and sensorineural hearing loss. What is the mechanism of her disease?

A

Meniere’s dz–> Inc Endolymph in inner ear

Rx: HCTZ + Triamtrene

91
Q

MCC of sensorineural hearing loss in the elderly is due to?

A

Presbycusis–> Degeneration of hairs in the Base of Organ of Corti
Rx: Cochlear implants

92
Q

What is the MCC of conductive hearing loss in the elderly?

A

Osteosclerosis –> Fusion of middle ear ossicles

93
Q

MCC of otitis media in kids?

A

S pneumo > H flu > Morexella

94
Q

Classical characteristic presentations of MS?

A

20-30s female
Inflammatory + demyelination of Brain& spinal cord
Optic neuritis + INO + hemiparesis/hemisensory loss
Bladder/ Bowel incontinence
Relapsing remitting
SIN (scanning speech, Intention tremor, INO, Incontinence, Nystagmus)

95
Q

Lab findings associated with MS? Rx?

A

CSF=> Inc IgG, Oligoclonal bands
MRI (goldstandard) -> “Periventricular plaques”
(Oligodendrocyte loss + Axonal destruction)

96
Q

What is the treatment of MS? spasticity associated with it?

A

Beta interferon –> Immunosuppression

Baclofen –> GABA agonist for SPASTICITY

97
Q

Characteristics of Guillian barre?

A

Destroy Schwann cells –> Inflammation/ demyelination
Inc CSF proteins + Normal cell count –> aka “albuminocytologic dissociation”
Campylobacter + CMV Molecular mimicry
Rx: IV immunoglobulins + PLASMAPHERESIS

98
Q

What is adrenoleukodystrophy?

A

XR def in enzyme for VLCFA oxidation in PEROXISOMES
Accumulation of VLCFA
Adrenal insuff + demyelination

99
Q

Rapidly progressive demyelination/ destruction of Oligodendrocytes in AIDs pt is caused by?

A

Reactivation of JC –> PML

100
Q

Lysosomal storage disease associated with build up of Sulfatides which impair production of myeline sheaths?

A

Metachromatic leukodystrophy –> Arylsulfatase A def

101
Q

Hereditary motor and sensory neuropathy related to defective production of Proteins involved in the function of Peripheral nerves or Myelin sheaths. Often have Orthopedic abnormalities?

A

Charcot-Mary tooth –> ARCHED feet + hamar toes

**PMPzz del **

102
Q

Partial seizures are?

Simple partial vs Complex partial?

A 
Partial = affects 1 area, MC originate in Temporal lobe, preceded by seizure aura
Partial = Consciousness intact 
Complex= Impaired consciousness
103
Q

Recurrent seizure disorder not counting Febrile seizures?

A

Epilepsy

104
Q

Status epilepticus is defined by?

A

Continuous seizure > 30 min OR
recurrent seizures without regaining consciousness btwn seizures for >30min
Causes: genetic, tumor, strokes, trauma, infections

105
Q

Characterized by 3Hz on EEG, no postictal confusion, and blank stare?

A

Absence = Petit mal seizures

106
Q

Seizures characterized by quick repetitive jerks with Normal consciousness?

A

Myoclonic

107
Q

Seizures characterized by Alternating stiffening and movement, postictal confusion, tiredness?

A

Tonic clonic –> grand mal

**Nocturnal form = Lennox Gustaut

108
Q

Tonic vs atonic seizures?

A

Tonic –> Stiffening

atonic–> Drop or loss of muscle tone (confused for fainting)

109
Q

What is thought to be the cause of Migraines? Rx and prophylactic?

A

Irritation of CN V, meninges, blood vessels via Excess release of substance P + CGRP = vasoactive peptides
Rx Triptans
Prophylactic= Propranolol + Topiramate

110
Q

What are the characteristics of BPPV?

A

Positional/ morning / laying back
Otoliths trapped in Posterior semicircular canal
Dx: Dix halpike maneuver
Rx: Epley maneuver

111
Q

Pt with broun stains around his mouth, benign vascular growths in CNS, elevated BP, seizures, and mental retardation?

A 
Sturge-Weber syndrome:
Port-wine stains V1 distribution
Leptomeningeal angiomas
Pheochromocytoma
Seizures, glaucoma, retardation
112
Q

Tuberous sclerosis associations?

A 
HAMARTOMAS 
Adenoma sebaceum (cutaneous angiofibromas) 
"Mitral regurg"
Ash-leaf spots
Rhabdomyomas
autosomal Dominant 
Mental retardation
renal Angiomyolipomas
Seizures
113
Q

NF1 associations?

A 
Lisch nodules (Pigmented iris hamartomas)
Optic gliomas
114
Q

Cavernous hemangiomas, BL renal cell carcinoma, Hemangiobalstoma?

A

VHL

115
Q

Gliobastoma multiforme associations?

A

MC overall primary

+ Necrosis + hemorrhage

116
Q

Meningioma associations?

A

Benign arising from “Arachnoid cells”
Dural tail of CT
Seizures + focal signs to compression
“spindle cells” + WHORLED + Psammomas

117
Q

What CNS tumor is S-100 positive?

A

S-100= Ca binding protein (Calmodulin like)
Schwannomas
Melanomas

118
Q

Slow growing CNS tumor with “fried egg” appearing cells and prominent delicate vasculature?

A

Oligodendrogliomas

119
Q

Benign Cerebellar tumor that is cystic and solid. What is seen on biopsy?

A

Pilocytic astrocytoma –> Rosenthal fibers (intermediate fibers)

120
Q

Medulloblastoma associations?

A 
Malignant cerebellar tumor 
Hydrocephalus by compressing 4th ventricle 
"Drop mets" to spinal cord
Homer-wright rossets + Small blue cells 
Radiosensitive due to high malignancy
121
Q

Tumor characterized by “perivascular pseudorossets?”

A

Ependymoma

122
Q

Pt with cerebellar tumor that is highly vascularized and has “Foamy cells.” Labs reveal polycythemia?

A

Hemangioblastoma ==> VHL association

123
Q 
Herniations and their associations:
Cingulate (subfalcine)
Transtentorial (Central)
Uncal 
Cerebellar tonsillar
A

Subfalcine–> Compress ACA
Central –> Compress brainstem + Duret’ hem in pons, Cheyne stokes resp
Uncal –> CN3
Tonsillar–> Coma/death compress Resp center @ BS

FA organs HY (11 decks)

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