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Step Uno > Neuro > Flashcards

Neuro Flashcards

1
Q

cerebral aqueduct derives from

A

mesencephalon (midbrain)

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2
Q

neural tube defect: anomaly, cause, signs

A

Anomaly: persistant connection between amnion and spinal canal.
Cause: low folate preg
Signes: elevated alpha-fetoprotein, acetylcholinesterase in amniotic

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3
Q

spina bifida occulta

A

failure of bony spine to close, no herniation, meninges intact, tuft of hair over dimple

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4
Q

meningocele

A

unclosed bony spine with herniation of the meningies

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5
Q

meningomyelocele

A

unclosed bony spine plus herniation of both meningies and spine

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6
Q

anencephaly

A

no forebrain, frog like appearance, polyhydramnios due to no swallow center, associated with maternal diabetes (folate reduces risk)

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7
Q

holoprosencephaly

A

failure of hemispheres to seperate, cleft lip/palate, cyclopia. due to HH defect

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8
Q

Arnold-Chiari Malformation

A

cerebellar tonsillar and vermian herniation from foramen magnum. aqueductal stenosis and hydrocephalus. associated with thoracic myelomeningocele.

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9
Q

Dandy-Walker formation

A

agenesis of cerebellar vermis, cystic enlargement of 4th ventricle, hydrocephalus and spina bifida

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10
Q

Syringomyelia

A

cystic enlargement of central spinal canal causeing spinothalamic tract damage -> cape-like loss of pain and temp (fine touch ok). associated with chiari formation.

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11
Q

tongue development origins

A

front 2/3 is 1st branchial arch, back 1/3 is 3rd and 4th arches.

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12
Q

tongue innervation

A

Taste: 7, 9 , 10 (solitary)
Pain: 5 (3rd), 9, 10
Motor: 12

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13
Q

wallerian degeneration

A

damage axon, degen distal/ retract proximal

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14
Q

astrocyte marker

A

GFAP

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15
Q

cells that fuse under HIV and grow when damage occurs

A

microglia

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16
Q

disease that destroys oligodendrocytes

A

MS

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17
Q

disease that destroys schwann cells

A

guillain-barre

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18
Q

ringing in the ear cancer

A

acoustic neuroma, schwann cells of the CN 8.

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19
Q

Free nerve ending sense

A

Pain temp

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20
Q

Meissner corpuscles

A

Fine touch

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21
Q

Pacinian corpuscles

A

Vibration, pressure

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22
Q

Merkels discs

A

Pressure, deep touch

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23
Q

Norepinephrine : Change in neuro disease and location of synthesis

A

High in anxiety, low in depression. Locus ceruleus (pons)

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24
Q

Dopamine: Change in neuro disease and location of synthesis

A

High in schizophrenia, low in Parkinson’s and depression. Ventral tegmentum, SNc (midbrain)

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25
Q

5-HT

A

Low in anxiety and depression. Raphe nucleus (pons)

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26
Q

Acetyl Choline: Change in neuro disease and location of synthesis

A

Low in Alzheimer’s and huntingtons, high in rem sleep. Basal nucleus of meynert.

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27
Q

GABA. Change in neuro disease and location of synthesis

A

Low in anxiety and huntingtons. Nucleus accumbens

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28
Q

three components of BBB

A

tight junctions of endothelials, basement membrane, astrocyte foot processes

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29
Q

areas where BBB is broken (and how it is opened)

A

Opened due to fenestrated endothelial cells. Area postrema- vomit after emetics/chemo, OVLT- osmotic sensing, neurohypophysis - to secrete ADH

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30
Q

Hypothalamus functions

A

TAN HATS: Thirst/water balance, Adenohypophysis (ant pituitary), Neurohypophysis (releases hormones), Hunger, Autonomic regulation, Temperature, Sexual urges

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31
Q

Lateral Area of Hypothalamus

A

hunger

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32
Q

Ventromedial area of hypothalamus

A

satiety

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33
Q

anterior hypothalamus

A

cooling/parasymp

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34
Q

posterior hypothalamus

A

heating/symp

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35
Q

suprachiasmatic

A

circadian rhythem

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36
Q

the one sense which doesn’t route through thalamus

A

olfaction

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37
Q

VPL Thalamus

A

. Body Feeling.

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38
Q

VPM thalamus

A

Face feeling and taste

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39
Q

LGN thalamus

A

Vision

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40
Q

MGN thalamus

A

hearing

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41
Q

VL

A

Motor

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42
Q

Limbic System

A

5 F: Feeding, Fleeing, Fighting, Feeling, Fucking

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43
Q

Lateral Cerebellum

A

coordination of ipsilateral extremities (fall towards lesion)

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44
Q

Medial Cerebellum

A

balance/truncal coordination

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45
Q

causes of hemiballismus

A

contralateral subthalamic nucleus lesion due to stroke

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46
Q

essential tremor treatment

A

ethanol (self treatment), beta blockers, primidone

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47
Q

essential tremor vs parkinsons

A

essential occurs with movement, “resting tremor” is with parkinsons

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48
Q

effects of dopamine in basal ganglia (D1 vs D2)

A

Dopamine binds D1 to stimulate excitatory and D2 to inhibit inhibitory

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49
Q

Lewy Bodies

A

intracellular alpha-synuclein inclusions seen in parkinsons

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50
Q

parkinsons signs

A

TRAP: tremor (resting), Rigidity, Akinesia, Postural Instability

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51
Q

Huntingtons genetics

A

Autosomal dominant with anticipation. CAG repeat expansions.

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52
Q

Huntingtons pathophys

A

Atrophy of striatal nuclei, caudate lose of ACh and GABA, Neuronal death via NMDA-R binding and glutamate toxicity.

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53
Q

Amygdala lesion

A

Kluver-Bucy syndrome: hyperorality, hypersexuality, disinhibited behavior, associated with HSV-1.

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54
Q

reemergence of primitive reflexes

A

frontal lobe lesions

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55
Q

spatial neglect syndrome

A

lesions in parietal lobe cause agnosia of contralateral side of the world

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56
Q

reticular activating system lesion

A

midbrain lesion causes loss of arousal/wakefulness

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57
Q

Mammillary body degeneration

A

Wernicke-Kofsakoff syndrome: confusions, ophthalmoplegia, ataxia, memory loss (anterograde and retrograde), confabulation, personality changes.
Due to thiamine deficency (b1) and excess ethanol use. Can be triggered by glucose.

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58
Q

anterograde amnesia

A

no new memories, hippocampal lesion

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59
Q

Central pontine myelinolysis

A

Locked In Syndrome: acute paralysis, dysarthria, dysphagia, diplopia. Due to massive demyelination in pons. Iatrogenic or rapid resuscitation of Na levels.

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60
Q

Brocas Aphasia

A

Can comprehend but cant speak. Inferior frontal gyrus of frontal lobe.

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61
Q

Wernickes Aphasia

A

Can speak but cant comprehend. Superior temporal gyrus of temporal lobes.

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62
Q

Conduction aphasia

A

cant repeat phrases. arcuate fasiculus

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63
Q

what regulates blood flow in the brain

A

pCO2. pO2 only in very extreme conditions

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64
Q

Mca stroke

A

Motor/sense face and upper limb

Aphasia of both wernickes and brocas

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65
Q

ACA stroke

A

Motor/sensory legs

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66
Q

Lateral striate artery

A

Lacunar infarcts secondary to hypertension. Contralateral hemiparesis/hemiplegia

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67
Q

ASA

A

Lateral corticospinal tract: contralateral lower limb hemiparesis
Medial lemniscus: down contralateral proprioceprion
Caudal medulla-hypoglossal nerve: ipsilatetal hypoglossal dysfunction.

Commonly bilateral

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68
Q

PICA stroke

A

Wallenberg Syndrome due to nucleus ambiguous effects- hoarseness and dysphagia. All of lateral medulla gone- vomiting, vertigo, pain/temp, gag reflex

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69
Q

AICA stroke

A

Lateral pons gone: facial droop.

Basically a lot of the cranial nerves are gone so decreased lacrimation, taste, corneal reflex, ipsilatetal hearing, ipsilatetal horners.

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70
Q

PCA stroke

A

Contralateral hemianopia with macular sparing

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71
Q

AComm stroke

A

Saccular aneurysm: visual field defects

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72
Q

PComm lesion

A

Also saccular aneurysm. CN3 palsy down and out eye with ptosis and dialation

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73
Q

Barry aneurysm association and risk

A

Associated with autosomal dominant polycystic kidney disease, ehler danlos, marfans
Risks include hypertension advanced age and race(black)

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74
Q

Rupture berry aneurysm

A

Subarachnoid hemorrhage

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75
Q

Bitemporal hemianopia

A

Compression of optic chiasm by berry aneurysm

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76
Q

Charcot Bouchard microaneurysm

A

Chronic hypertension, small vessel in basal ganglia and thalamus

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77
Q

Rupture of medial meningeal artery

A

epidural hematoma

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78
Q

epidural hematoma: vessel, symptoms, CT

A

medial meningeal artery (temporal bone fracture), rapidly developing with a lucid interval, CNIII plasy, CT is lense-shapped hematoma

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79
Q

subdural hematoma

A

bridging vein rupture, slow developing (vein), old/baby/alcoholics, crescent-shaped hemorrage that crosses suture lines, midline shift

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80
Q

subarachnoid hemorrhage

A

ruptured aneurysms or ateriovenous malformations. worste head ache of my life, exremely rapid loss of consciousness, bloodly LP

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81
Q

subarachnoid hemorrhage risk 2-3 day later

A

vasospasm (treat with nimodipine)

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82
Q

Intraparenchymal hemorrhage

A

hypertensive hemorrhage as well as amyloid angiopathy, vasculitis. Charcot-Bouchard’s are one type.

83
Q

How long till ischemic brain injury and where?

A

5 mins and most vulnerable is hippocampus, neocortex, cerebellum, and watershed areas.

84
Q

ischemic brain injury histology timeline

A

red dead neurons 12-48hrs, necrosis + neutrophils 24-72hrs, macrophages 3-5 days, reactive gliosis + vascular proliferation 1-2 weeks, glial scar after two weeks

85
Q

Ischemic stroke risks

A

a fib, carotid dissection, patent foramen ovale, endocarditis, hypertension.

86
Q

Transient ischemic attack

A

brief reversible focal neurological dysfunction without an infarction. due to focal ischemia (vasospasm)

87
Q

CSF Flow

A

Ependymal cells of choroid plexus -> lateral ventricle -> foramin of monro -> 3rd vent -> cerebral aqueduct -> 4th vent -> Luschka (lateral)/Magendie (medial) foramina -> subarachnoid space -> arachnoid granulations -> superior sagittal sinus

88
Q

communicating hydrocephalus

A

due to decreased CSF absorption -> high ICP

89
Q

normal pressure hydrocephalus

A

Wet, wobbly, wacky (incontinency, ataxia, cognitive dysfunction). due to expanded ventricle space but normal pressure

90
Q

hydrocephalus ex vacuo

A

high CSF due to brain atrophy (alzheimers, HIV, Picks) normal pressure and ventricles

91
Q

number of spinal nerves in each section

A

8 cervical, 12 thoracic, 5 lumbar, 5 sacral, 1 coccygeal. 31 total

92
Q

where do nerve roots exit?

A

C1-7 exit above their vertebra, the rest exit below.

93
Q

disc herniation

A

nucleus pulposus herniates through anulus fibrosus at L4-L5 or L5-S1

94
Q

where does spinal chord end?

A

L1-L2

95
Q

spine front and center tract

A

Anterior spinothalamic tract (crude touch, pressure)

96
Q

spine sides tract

A

Lateral corticospinal tract (motor)

97
Q

spine back side

A

lateral spinothalamic (pain temp)

98
Q

spine back center

A

dorsal column (pressure, vibration, touch, proprioception)

99
Q

dorsal column structure

A

pressure, vibration, fine touch, proprioception. dorsal root ganglia, ipsilateral spine ascending, medulla 1st synapse then 2nd neuron crosses over to VPL 2nd synapse

100
Q

spinothalamic tract structure

A

pain, temp, crude touch, pressure. 1st nerve enters spine, synapse 1 in ipsilateral gray matter, 2nd neuron crosses over immiedately then ascends to VPL

101
Q

Lateral corticospinal tract

A

motor. 1 neuron in motor cortex crosses over in medulla then decends, then synapse 1 in anterior horn, 2 neuron leaves spine (no third neuron)

102
Q

What does poliomyelitis attack?

A

LMN disease, destruction of anterior horns of spine causing paralysis

103
Q

Amyotrophic lateral sclerosis pathophys

A

UMN and LMN defects but no cognitive or oculomotor defects. Defective superoxide dismutase 1.

104
Q

ALS presentation

A

Fasiculations to atrophy with UMN and LMN signs. No cog defect, Stephen Hawking.

105
Q

ALS treatment

A

Riluzole helps some. Decreases presynaptic glutamate release.

106
Q

Tabes dorsalis

A

3’ syphilis demyelination of dorsal roots and column. Lose feeling and proprioception. Absence of deep tendon reflexes.

107
Q

Argyll Robertson pupils

A

Small bilateral pupils that constrict further to accommodate but not to light. 3• syphilis

108
Q

B12 or E deficiency on the spine

A

Degeneration of dorsal columns, lateral corticospinal tracts, spinocerebellar tracts

109
Q

Poliomyelitis transmission replication and test

A

Fecal-oral transmission, replicate in oropharynx and small intestine before blood spread to cns. Test for virus in stool or throat.

110
Q

Werdnig-Hoffman

A

Congenital anterior horn loss (like polio)

111
Q

Fredreich ataxia

A

Frataxin poly GAA repeat causes mitochondrial dysfunction. Causes ataxia.

112
Q

Hemisection of the spinal cord

A

Ipsilatetal motor UMN defects(corticospinal) and tactile/vibration/proprioception (dorsal column)

Contralateral pain/temp loss (spinothalamic)

Loss all sensation at the lesion level and side.

113
Q

Horners syndrome

A

Sympathectomy of face: ptosis(eye lid droop), anhidrosis(no sweat), miosis (pupil construction)

114
Q

Dermatome C3

A

High turtleneck

115
Q

Dermatome c678

A

Arms

116
Q

Dermatome t4

A

Nipple pore

117
Q

Dermatome t10

A

Belly button (butten)

118
Q

Dermatome L1

A

Ingunial ligament

119
Q

Dermatome S

A

Penis

120
Q

Dermatome knees

A

L4

121
Q

Pineal gland

A

Melatonin, circadian rhythm, seat of the soul

122
Q

Superior bs inferior colliculli

A

Vision , auditory

123
Q

Cn1

A

Olfaction. Sensory.

124
Q

CN2

A

Optic. Sensory

125
Q

CN3

A

Oculomotor

126
Q

Corneal reflex

A

V1 to VII

127
Q

Lacrimation reflex

A

V1 to VII

128
Q

Jaw jerk reflex

A

V3 to v3

129
Q

Pupillary reflex

A

2 to 3

130
Q

Gag reflex

A

9 to ten

131
Q

Bicep reflex

A

C5 root

132
Q

Tricep reflex

A

C7 root

133
Q

Patella reflex

A

L4 root

134
Q

Achilles reflex

A

S1 root

135
Q

Exit through superior orbital fissure

A

3, 4, 5.1,6

136
Q

Exits through foramen rotundum

A

5.2

137
Q

Foramen ovale

A

5.3

138
Q

Internal auditory meatus

A

7 8

139
Q

Jugular foramen

A

9, 10 , 11

140
Q

Hypoglossal canal

A

12

141
Q

Cavernous sinus syndrome

A

CN 3,4,5,6 and carotid pass through. Mass effect here disturbs all ocular movement and facial sensation (maxillary, corneal)

142
Q

Cn 5 motor lesion

A

Jaw deviates toward injury

143
Q

CN 10 lesion

A

Uvula deviates away from lesion

144
Q

CN 11 lesion

A

Weakness turning head away and shoulder drop towards

145
Q

CN12 lesion

A

Tongue deviates toward

146
Q

Causes of facial nerve palsy

A

HAT SLIDe: idiopathic, AIDS, Lyme, HSV, sarcoidosis, tumors, diabetes

147
Q

Uveitis associations

A

Systemic inflammatory diseases: sarcoidosis , rheum arth, HLA-b27

148
Q

Retinitis associations

A

Viruses: CMV, hsv, hzv. Also immunosuppression

149
Q

Retinal whitening with cherry red spot

A

Central retinal artery occlusion

150
Q

Open glaucoma

A

Aka wide angle, aqueous humor flows normally past lense. Loss peripheral then central vision. High intraoccular pressure causes damage. Primary is idiopathic, secondary can be uveitis, trauma, steroids, outflow trabecular blockage

151
Q

Closed glaucoma

A

Narrow angle. Lense blocks humor flow. Buildup causes high intraoccular pressure.

Chronic asymptomatic

Acute is an emergency, very painful. DO NOT GIVE EPI

152
Q

Cataracts

A

Opacification of lens. Corticosteroids, galactosemia, galactokinase deficiency, diabetes (sorbitol), ethanol, smoking.

153
Q

Papilledema is sxm of

A

Increased intracranial pressure

154
Q

Curtains drawn down

A

Retinal detachment. Surgery indicated.

155
Q

Types of macular degeneration

A

Dry: treat with multivitamin and antioxidants
Wet: treat with laser and anti vegf

156
Q

Down syndrome associated dementia

A

Alzheimers

157
Q

Familial Alzheimers proteins/chromosomes

A

Early onset: APP (21), presenilin-1 (14), presenilin-2 (1)

Late onset: ApoE4 (19)

158
Q

Protein which protects from alzheimers

A

ApoE2 (19)

159
Q

Neurotransmitter disturbance in Alzhiemers

A

low Acetyl Choline

160
Q

Alzheimers gross and histo

A

cortical atrophy, extracellular “senile” plaques of A-beta (from APP) and intracellular neurofibrillary tangles of phospho tau

161
Q

What in alzheimers correlates with degree of dementia?

A

neurofibrillary tangles

162
Q

Frontotemporal dementia

A

Pick’s disease. Change in personality, aphasia, dementia. Spares parietal lobe, and posterior 2/3 of temporal superior gyrus. Picks bodies of spherical tau protein

163
Q

Alzheimers complications

A

intracranial bleed secondary to amyloid angiopathy

164
Q

Lewy Body dementia

A

Parkinsonism with dementia and hallucinations. Alpha-synuclein

165
Q

Creutzfeldt-Jakob Disease

A

prion spongiopathy which is rapid. “startle myoclonus”

166
Q

Causes of Mutli-infarct dementia

A

syphilis, HIV, vitamin B1/2/13 deficency, wilsons, hydrocephalus

167
Q

Classic Triad of MS

A

SIN: Scanning speech, Intention tremor (incontenience and internuclear opthalmoplegia), Nystagmus

168
Q

MS diagnostic features

A

Increase protein (IgG) in CSF that are oligoclonal. MRI is gold standard. Periventricular plaques. Demylenation with gliosis and axon destruction

169
Q

MS treatment

A

Beta-interferon, immunosuppression, natalizumab

170
Q

infectious agents responsible for guillan-bare

A

Campylobacter jejuni and CMV (molecular mimicary)

171
Q

PML

A

demyelination of cns in AIDS due to JC virus (fatal)

172
Q

Acute disseminated (post infectious) encephalomyelitis

A

multifocal perivenular inflammation and demyelination after infxn (measles and VZV) or vaccine (smallpox or rabies)

173
Q

Metachromic leukodystrophy

A

recessive lysosomal storage disease due to arylsulfatase A deficiency -> build up of sulfatides which impair myelination

174
Q

Charcot-Marie-Tooth

A

onion skin meylination

175
Q

Krabbes disease

A

autosomal recessive lysosomal storage disease with defective galactocerebrosidease (break down myelin)

176
Q

difference between Krabbes and Metachromatc leukodystrophy

A

Krabbes is defect in galactocerebrosidase

Metachromatic is defect in arylsulfatase A (sulfatides)

177
Q

simple vs complex partial seizures

A

both are focal seizures. simple = consciousness intact. complex = consciousness disrupted

178
Q

status epilepticus

A

> 30mins seizure. emergency. Children: genetic, infx. Adults: tumors, trauma, stroke, infx.

179
Q

General seizure types

A 
Abscence/petit mal: just blank out
Myoclonic: quick repetitive jerks
Tonic-clonic/grand mal: classic seizure
Tonic: just stiff
Atonic: drop seizure (confused for fainting)
180
Q

Cluster Headache

A

> 15mins unilateral headache that is repetitive causes running nose and crying. May cause horners.

181
Q

Tension Headache

A

Bilateral >30mins. steady pain and no photophobia/phonophobia or aura.

182
Q

Migraine

A

unilateral >4hr with photophobia/phonophobia. aura present. Substance P/CGRP

183
Q

Vertigo types and differentiation

A

Peripheral: at the ear (debris, infxn) resulting in delayed horizontal nystagmus. Central: CNS (tumor/stroke at vestibular nuclei), immediate nystagmus at all directions

184
Q

Sturge-Weber syndrome

A

Neurocutaneous: port-wine skin stains in the V1 region. ipsilateral leptomeningeal angiomas, pheochromocytomas. Causes: glaucoma, seizures, hemiparesis, and retardation.

185
Q

Tuberous sclerosis

A

HAMARTOMAS: Hamartomas in the CNS and skin, Adenoma sebaceum, mitral regurg, ash-leaf spots, cardiac Rhabdomyoma, Tuerous sclerosis, autosomal dOminant, Mental retardation, rengal Angiomyolipoma, Seizures… that was a stretch.

186
Q

Neurofibromatosis type I

A

Cafe-au-lait spots, Lisch nodules (pigmented iris hamartomas), cutaneous neurofibromas, optic gliomas, pheochromocytomas. Autosomal dominant with 100% penetrant. NF1 gene on chrom 17

187
Q

von Hipple-Lindau disease

A

Cavernous hemangiomas on visceral (skin/mucosa/organs). kidney cancers (bilateral renal cell carcinoma and pheochromocytomas), hemangioblastoma of CNS (retina/brainstem/cerebellum). autosomal dominant. VHL gene on chrom 3

188
Q

Gliblastoma multiforme

A

Grade 4 astrocytoma(GFAP). Most common primary brain cancer.

189
Q

Meningioma

A

second most common primary brain cancer. from arachnoid cells. benign. psammoma bodies (laminated calcifications)

190
Q

Schwannoma

A

3rd most common brain cancer. CN8. S100 positive. Associated with Neurofibromatosis type 2

191
Q

Oligodendroglioma

A

rare and slow. chicken wire capillary, fried egg appearance.

192
Q

Pituitary adenoma

A

commonly a prolactinoma which presses on the optic chiasm causing bilateral hemianopia.

193
Q

Pilocytic Astrocytoma

A

low grade benign, in children, posterior fossa tumor. Rosenthal fibers (eosinophilic corkscrews). Cystic +solid

194
Q

Medulloblastoma

A

Highly malignant cerebellar. primitive cells (GCPs). Compresses 4th ventricle -> hydrocephalus. “drop mets” to spinal cord. Homer-wright rosettes. Small blue (high N/C)

195
Q

Ependymoma

A

(child)Ependymal cells in the fourth ventricle. hydrocephalus. poor prognosis. perivascular pseudorosettes. Rod-shaped bleopharoplasts (basal ciliary bodies) near nuclei.

196
Q

Cingulate herniation

A

under falx cerebri, can compress ACA

197
Q

uncal herniation

A

medial temporal lobe herniation through tentorium

198
Q

Hemangioblastoma

A

(child)most often cerebellar, VHL syndrome (with rentinal angiomas). EPO increased causing polycythemia. Histo: highly vascular and foamy cells

199
Q

Craniopharyngioma

A

Rathke’s pouch childhood tumor confused with pituitary adenoma cause it also compresses optic chiasm. calcified alot to mimic tooth enamel.

200
Q

Nucleus solitarius

A

7,9,10 (taste) visceral Sensory info like taste, baro, and gut distention.

201
Q

Nucleus ambiguus

A

9, 10. Motor innervation of pharynx, larynx and esophagus

202
Q

Dorsal motor nucleus

A

the only sole vagal nuclei, autonomic to heart lungs GI

203
Q

Who gets subdural hematomas?

A

Old alcoholic babies

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