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COMLEX 2 > Neuro > Flashcards

Neuro Flashcards

1
Q

What causes Wallenberg Syndrome?

S&S Wallenberg Syndrome (Lateral Medullary Syndrome) RIGHT

A
  • Vertebral a. or Post. Inf. Cerebellar A. stroke
  • hoarseness

ptosis R eyelid
small R pupil
dysmetria with finger to nose testing on the R
loss of pinprick on the arm and leg L

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2
Q

What causes Wallenberg Syndrome?

S&S Wallenberg Syndrome (Lateral Medullary Syndrome) LEFT

A
  • Vertebral a. or Post. Inf. Cerebellar A. stroke
  • hoarseness

ptosis L eyelid
small L pupil
dysmetria with finger to nose testing on the L
loss of pinprick on the arm and leg R

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3
Q

Vestibular lesions cause

A

Vertigo and N&V

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4
Q

What does the Inferior cerebellar peduncle do?

What do lesions of the Inferior cerebellar peduncle cause?

A
  • Connects cerebellum to medulla

- Ataxia and dysmetria

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5
Q

What does the lateral spinothalamic tract lesion at the medulla cause?

A

Contralat loss of pain and temp

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6
Q

What does the nucleus ambiguus do?

What does a lesion in this area cause?

A
  • Brachial efferent motor neuron of the Vagus n. that controls larynx
  • Hoarseness
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7
Q

Beck’s (Ant. Spinal A.) Syndrome S&S

A

Bilat. flaccid paralysis at level of lesion

Bilat. loss pain and temp and spasms below level

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8
Q

What tracts or spinal cord areas are affected in ALS?

A

Corticospinal

Ventral Horn of spinal cord

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9
Q

Vasovagal syncope

A

triggered by physical/emotional stress
sweating, palpitations, nausea precede episode

“Posture, provoking, prodromal”

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10
Q

Lewy Body Dementia trigger words

Location?

Description?

A

round, dense cells with eosinophilia core surrounded by clear halos

in Basal Ganglia

parkinsonism with dementia and colorful hallucinations

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11
Q

Chromosome 21 encodes which Alzheimer’s gene?

A

Amyloid beta precursor protein gene

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12
Q

Most common renal lesion in Tuberous Sclerosis (Auto Dom)

A

Angiomyolipoma

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13
Q

Alzheimer Genes

A

Presenelin I, II (chrom 14, I)
APP (21)
Susceptibility (APOe4)

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14
Q

Vascular Dementia keywords

A

lacunar infarcts
stepwise deterioration
lateralizing signs (spasticity, hemiparesis, ataxia, pseudobulbar palsy)

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15
Q

Pick Disease/Frontotemporal dementia keywords

A

MAPT gene - Tau protein buildup
early onset personality changes
Frontal and Temporal lobe atrophy

Tx: Anticholinesterase inhibitors [Aricept, Tacrine, Rivastigmine]

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16
Q

Temporal Lobe epilepsy keywords

A

strange smells, lilliputian hallucinations

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17
Q

Creutzfeldt Jakob Dz. keywords

A

rapid prion accumulation
myoclonus
sharp waves on slow EEG

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18
Q

Global Aphasia (both Broca and Wernicke’s Areas affected)

A

not fluent/no spontaneous speech

no repetition/comprehension

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19
Q

Wernicke Aphasia (superior temporal gyrus of temporal lobe)

A

fluent
no repetition/comprehension

Wernicke’s wordy but makes no sense

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20
Q

Broca Aphasia (inferior frontal gyrus of frontal lobe)

A

not fluent
no repeat
intact comprehension

Broca’s broken boca

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21
Q

Guillain Barre attacks which nerves?

A

Peripheral nerves

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22
Q

Multiple sclerosis keywords

A

Multiple white matter hyperintensities
Oligoclonal bands in CSF
Tx: IgG, B-IFN, Natalizumab

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23
Q

Cerebral AutoDom Angiopathy with Subcortical Infarcts and Leukoencephalopathy (CADASIL)

A

Tetrad of: psychiatric disturbance, dementia, multiple white matter strokes, and migraines with aura

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24
Q

Bacterial Meningitis CSF findings

A

Elevated WBCs (1,000 - 20,000 cells/ml)
PMNs
Low Glucose
High Protein

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25
Q

Thalamic Hemorrhage (common site of parenchymal hypertensive hemorrhage)

A

Motor and sensory loss, eye deviation away from side of lesion
Worsening numbness opposite side of lesion
Smoking and HTN hx.
Miotic and nonreactive pupils with gaze preference to opposite side of lesion
4/5 Strength opposite side of side
may extend down to hit reticular activating system to cause coma

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26
Q

Vertebral A. Occlusion

A

leads to infarction of medulla
medial medulla –> flaccid then spastic contralateral hemiparesis, ipsilat tongue paralysis
lateral medulla –> Wallenburg syn.

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27
Q

Primary Progressive Aphasia

A

Variant of Frontotemporal Dementia:

Erosion of language skills (difficulty finding words and producing speech) with preservation of cognitive and behavioral function

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28
Q

CSF Findings in Viral Meningitis

A

Increase Mononuclear cells
Normal Glucose
Mildly elevated Protein

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29
Q

Tx. CNS Melanoma

A

Radiation therapy plus stereotactic radiosurgery

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30
Q

Functions of the Hypothalamus

A

TAN HATS

Thirst and water balance
Anterior pituitary
Neurohypophysis releases hypothalmic hormones

Hunger
Autonomic regulation
Temp regulation
Sexual urge

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31
Q

If the lateral cerebellum is damaged, what is usually seen?

A

Tendency to fall toward injured side

32
Q

Hemiballismus keywords

A

wild arm flailing

contralateral subthalamic nucleus lesion

33
Q

Chorea

A

dance-like, jerky, purposeless movement

lesion of basal ganglia

34
Q

Athetosis

A

slow writing snake-like movement

lesion of basal ganglia

35
Q

Dystonia

A

sustained involuntary mm. contraction

e.g. writer’s cramp, blepharospasm

36
Q

Intention tremor keywords

A

slow, zigzag motion when pointing toward a target

indicative of a cerebellar lesion

37
Q

What happens at lesion of Right Parietal lobe?

A

Spatial neglect syndrome: agnosia of contralateral side

38
Q

What happens at lesion of Reticular Activating system?

A

Decreased wakefulness

39
Q

What happens at lesion of Mammillary Bodies?

A

Wernicke-Korsakoff Syndrome

40
Q

What happens at lesion of cerebellar hemisphere?

A

Intention tremor, limb ataxia, loss of balance

41
Q

What happens at lesion of cerebellar vermis?

A

Truncal ataxia

42
Q

What happens at lesion of subthalamic nucleus?

A

Contralateral hemiballismus

43
Q

What happens at lesion of frontal eye fields?

A

Eyes look toward lesion

44
Q

What is cerebral perfusion primarily driven by?

A

PCO2

45
Q

Middle Cerebral a.

What does it supply?

S&S?

A

Supplies lateral cortex

Motor and sensory to Upper Limb and face, Wernicke’s Temporal and Broca’s Frontal

Homonymous Hemianopsia
Paralysis of Gaze
Global aphasia
Contralateral Hemispatial Neglect

46
Q

Anterior Cerebral a.

What does it supply?

A

Supplies anteromedial cortex

Motor and sensory to Lower Limb

Contralateral paralysis and loss of sensation lower limb

47
Q

Anterior Spinal A.

What does it supply?

A

Lateral Corticospinal Tract, Medial Lemniscus, Caudal medulla/Hypoglossal n.

Contralateral hemiparesis Lower Limb, proprioception, ipsilateral tongue deviation

48
Q

Posterior Inferior Cerebellar a.

What does it supply?

A

Lateral medulla

Dysphagia, hoarseness, (nucleus ambiguus lesions, essentially), ipsilateral Horner’s, decreased pain and temp contralateral limb, ipsilateral face

Lateral Medullary Wallenberg’s Syndrome. The side of the face is the side that PICA is involved.

49
Q

Anterior Inferior Cerebellar a.

What does it supply?

A

Lateral pons (Cranial n. nuclei, Vestibular nuclei, Facial Nucleus, Spinal trigeminal nucleus, cochlear nuclei, sympathetic fibers)

  • facial paralysis, dec. lacrimation, dec tongue taste ant. 2/3, decreased corneal reflex

Lateral Pontine Syndrome “Facial droop means AICA’s pooped”

50
Q

Posterior communicating a.

A

common site of berry aneurysm

CN3 palsy (eye down and out with ptosis and mydriasis)

51
Q

Werdnig Hoffman Disease

A

AR degeneration anterior horn of spinal cord –> LMN lesion

“Floppy baby”, death by 7 mo

52
Q

Friedreich’s Ataxia

A

AR GAA repeat encoding Frataxin –> impaired mitochondrial functioning –>

staggering gait, frequent falls, loss of proprioception and vibration, very high foot arch, loss of DTRs

53
Q

What nuclei are located in the midbrain?

A

CN 3, 4

54
Q

What nuclei are located in the pons?

A

CN 5 - 8

55
Q

What nuclei are located in the medulla?

A

CN 9, 10, 12

56
Q

Cavernous Sinus Syndrome S&S

What CN run through?

A

ophthalmoplegia and decrease corneal and maxillary sensation

CN 3, 4, V1, V2, 6

57
Q

What happens in a CN V motor lesion?

A

Jaw deviates toward side of lesion

58
Q

What happens in a CN X lesion?

A

Uvula deviates AWAY from side of lesion

59
Q

Conductive Hearing Loss

e.g. otitis media, cerumen impaction, osteoma, neoplasm

A

Rinne abnormal (bone>air), Weber localizes to affected ear

60
Q

Sensorineural Hearing Loss

e.g. trauma, Meniere’s, presbycusis, Ototoxicity

A

Rinne normal (air>bone), Weber localizes to UNaffected ear

61
Q

Charcot-Marie-tooth Disease (Hereditary Motor and sensory Neuropathy)

A

progressive hereditary nerve disorders d/t defective myelin sheath protein production

62
Q

Most common 1mary brain tumor?

A

Glioblastoma Multiforme (GBM): p53 mutation, crosses corpus callosum “butterfly” and “pseudopalisading” tumor cells, contrast enhancing lesion within cerebral hemispheres on MRI

63
Q

Meningioma keywords

A

whorled
psammoma bodies
near brain surface

64
Q

Oligodendroglioma keywords

A

frontal lobe
chicken-wire capillary
“fried egg”

65
Q

Most common childhood brain tumor?

A

Pilocytic astrocytoma: @ post. fossa, GFAP+, Rosenthal corkscrew fibers, benign

66
Q

Medulloblastoma keywords

A

hydrocephalus
Homer-Wright rosettes
small blue cells

Tx: Radiation

67
Q

Uncal (medial temporal lobe) Herniation keywords

A

fixed dilated pupil ipsilaterally
contralat. homonymous hemianopsia
ipsilateral hemiparesis

68
Q

S&S of Posterior Cerebral A. occlusion (LEFT)

A 
RIGHT hemianopsia
RIGHT sensory deficits
Alexia without agraphia
Difficulty forming new memories
Anomic aphasia
Gerstman's Syndrome (acalculia, agraphia, finger agnosia, right-left disorientation)
69
Q

Atypical meningitis can be caused by what immunosuppressive medication?

A

MTX: causes myelosuppression leading to neutropenia

70
Q

Empiric Tx. for Meningitis

A

“Be a life SAVeR”

Steroids
Acyclovir & Ampicillin
Vancomycin
Rocephin (Ceftriaxone)

71
Q

Ataxia-Telangiectasia

S&S

Labs

A

Ataxia (wide based gait and instability)
Telangiectasia (dilated tortuous conjunctiva) in skin, eyes
Recurrent sinopulmonary infections

Almost ZERO IgA with Elevated IgM, Normal IgG

72
Q

Dx of Benign Paroxysmal Positional Vertigo?

Tx?

A

Dx: Dix-Hallpike

Tx: Epley maneuver

73
Q

S&S of Internal Carotid A. dissection

v. Vertebral a. dissection

A

ipsilateral cranial nerve deficits (e.g. ptosis, miosis, weak shoulder raise)

while a Vertebral a. dissection will show Horner’s Syn.

74
Q

Tx. Trigeminal Neuralgia

A

Carbamazepine

75
Q

Meniere’s Disease

Ppx?

A

HCTZ + Triamterene reduce endolymph in the semicircular canals

76
Q

Common migraine

S&S

Ppx

Tx

A

Frequent constant headache that doesn’t come with flashing lights, motor weakness, aura, or dizziness

PPx: Propranolol, Verapamil

Tx: Sumatriptan

77
Q

Most common cause meningitis in people >35 y.o.

A

Strep pneumo ( G+ diplococci)

COMLEX 2 (19 decks)

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