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Step 1 > Neuro > Flashcards

Neuro Flashcards

1
Q

Labs on neural tube defects?

A

Increased AFP

Increased AChE

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2
Q

What maternal disease is anencephaly associated with?

A

Maternal type 1 diabetes

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3
Q

What mutation is holoprosencephaly associated with?

A

Sonic headgehog

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4
Q

What conditions is holoprosencephaly associatd with?

A

Patau syndrome

FAS

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5
Q

How does syringomyelia present?

A

“Cape-like” bilateral loss of pain and temp sensation in UE (C8-T1)
- Ciari I malformation

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6
Q

Neuron staining?

A

Nissl (RER) - only in dendrites

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7
Q

Astrocyte staining?

A

GFAP

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8
Q

Where is Ach produced?

A

Basal nucleus of Meynert (degernation in Alzheimers)

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9
Q

Where is DA produced?

A

Ventral tegmentum

SNpc

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10
Q

Where is GABA prodcued?

A

Nucleus accumbens

- Made from glutamate and vit B6

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11
Q

Where is NE produced?

A

Locus ceruleus

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12
Q

Where is serotonin produced?

A

Raphe nucleus

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13
Q

Function of supraoptic nucleus of hypothalamus?

A

Makes ADH

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14
Q

Function of paraventricular nucleus of hypothalamus?

A

Makes oxytocin

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15
Q

Function of lateral area of hypothalamus?

A

Hunger

  • Damage –> anorexia
  • Stimulated by: ghrelin
  • Inhibited by: leptin
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16
Q

Function of ventromedial area of hypothalamus?

A
  • Satiety
  • Damage (craniopharyngioma) –> hyperphagia
  • Stimulated by: leptin
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17
Q

Function of anterior hypothalamus?

A
  • Cooling (PS)
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18
Q

Function of posterior hypothalamus?

A
  • Heating (S)
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19
Q

Function of suprachiasmatic nucleus?

A
  • Circadian rhythm

- SCN releases NE –> pineal gland –> melatonin

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20
Q

Extraocular movements during REM due to?

A

PPRF

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21
Q

Treatment for bedwedding?

A 
Oral desmopressin (1st line)
Imipramine (TCA) 2nd line
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22
Q

Treatment for night terrors and sleepwalking?

A

Benzos

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23
Q

Function of VPL of thalamus?

A

Sensory from body

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24
Q

Funciton of VML of thalamus?

A

Sensory from face

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25
Q

Function of lateral geniculate nucleus of thalamus?

A

Vision

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26
Q

Function of medial geniculate nucleus of thalamus?

A

Hearing

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27
Q

Function of ventral lateral nucleus of thalamus?

A

Motor

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28
Q

Mesocortical DA Pathway

A

Negative sx

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29
Q

Mesolimbic DA pathway

A

Positive sx

- Antipsychotics

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30
Q

Nigrostriatal DA pathway

A

EPS

- Movement disorders, antipsychotic drugs

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31
Q

Tuberoinfundibular DA Pathway

A

Prolactin –> galactorrhea, gynecomastia

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32
Q

Lateral Cerebellum Lesion

A

Fall toward injured (ipsilateral) side

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33
Q

Medial Cerebellum Lesion

A 
Truncal ataxia (wide-based cerebellar gait), nystagmus, head tilting
- Bilateral motor deficits
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34
Q

Athetosis (snake-like movement)

A

Basal ganglia (Huntington)

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35
Q

Chorea (dancing)

A

Basal ganglia (huntington)

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36
Q

Dystonia

A

Writer’s cramp, belpharospasm, spasmodic torticollis, EPS due to antipsychotic meds

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37
Q

Essential Tremor (rest + movement)

A

Familial, self-medicate with alcohol

- Rx: nonselective beta-blocker (propanolol), primidone

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38
Q

Hemiballismus

A

Contralateral STN (lacunar stroke)

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39
Q

Intention tremor (w/ movement)

A

Cerebellar dysfunction

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40
Q

Resting tremor (at rest)

A

Parkinson

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41
Q

Brain findings in Parkinsons?

A
  • Lewy bodies (alpha-synuclein - IC eosinophilic inclusions)

- Loss of DA neurons of SNPC

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42
Q

Type of gait in Parkinsons?

A

Shuffling gait (festinating gait)

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43
Q

Huntington DZ Genetics

A

AD w/ 100% penetrance
Trinucleotide CAG repeat on Chr 4
Anticipation (spermatogenesis)

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44
Q

NT in Huntington

A

Increased DA

Decreased GABA and ACh

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45
Q

Pathogenesis of Huntington

A

NMDA-R binding –> glutamate excitotoxicity –> neuronal death

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46
Q

Brain findings of Huntingtons

A

Atrophy of caudate and putamen w/ hydrocephalus ex vacuo

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47
Q

Kluver-Bucy Syndrome

- Hyperphagia, hypersexuality, hyperorality

A
  • AMYGDALA

- HSV-1 encephalitis

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48
Q

Nondominant Parietal Cortex (R) Lesion

A

Hemispatial neglect on L

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49
Q

Gerstmann Syndrome

A
  • Dominant parietal cortex lesion

Agraphia, acalculia, fingeragnosia, left-right disorientation

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50
Q

Cerebral perfusion driven by/

A

PCO2

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51
Q

ACA Stroke

A

Motor and sensory loss of LOWER LIMB (contralateral)

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52
Q

MCA Stroke

A

Motor and sensory loss of FACE and UPPER LIMB (contralateral)
Aphasia (if L hemisphere)
Hemineglect (if R hemisphere)

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53
Q

Lenticulostriate Artery Stroke

  • Lacunar infarcts
  • Secondary to unmanaged HTN
A

Motor and sensory loss of FACE and BODY

Like MCA but not aphasia/hemineglect

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54
Q

PCA Stroke

A

Contralateral hemianopia with macular sparing

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55
Q

Anterior Spinal Artery Stroke = MEDIAL MEDULLARY SYNDROME

A
  • Motor loss of UPPER and LOWER LIMBS (lateral CST)
  • Decreased contralateral proprioception (ML)
  • Tongue points ipsilateral (hypoglossal, CN XII) (caudal medulla)
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56
Q

PICA Stroke = LATERAL MEDULLARY (WALLENBERG) SYNDROME

A
  • Vomiting, vertigo, nystagmus
  • Decreased pain and temp sensation from IPSILATERAL FACE (CN V) and CONTRALATERAL BODY (STT)
  • ***DYSPHAGIA, HOARSENESS (CN X - nucleus ambiguus)
  • Decreased gag reflex
  • Ipsilateral Horner Syndrome
  • Ataxia, dysmetria
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57
Q

AICA Stroke = LATERAL PONTINE SYNDROME

A
  • Vomiting, vertigo, nystagmus
  • ***PARALYSIS OF FACE, DECREASED LACRIMATION, SALIVATION, and TASTE from anterior 2/3 of tongue (CN VII - facial nucleus)
  • Ipsilateral decreased pain and temp of face, contralateral decreased pain and temp fo body
  • Ataxia, dysmetria
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58
Q

Basilar Artery Stroke = LOCKED IN SYNDROME

A
  • Preserved consciousness, vertical eye movement, blinking
  • QUADRIPLEGIA
  • LOSS OF VOLUNTARY FACE/MOUTH/TONGUE MOVEMENT
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59
Q

Where do saccular aneurysms most commonly occur?

A

ACA

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60
Q

Rupture of saccular aneurysmleads to?

A

Subarachnoid hemorrhage

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61
Q

Epidural hematoma is rupture of which artery

A

Middle meningeal (branch of maxillary)

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62
Q

cause of epidural hematoma?

A

Skull fracture (temporal)

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63
Q

CT of epidural hematoma?

A

BICONVEX (lens shaped), doesn’t cross suture lines

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64
Q

Subdural hematoma is rupture of which vessels?

A

Bridging veins

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65
Q

What patients are subdural hematomas seen in?

A
  • Trauma
  • elderly, alcoholism
  • SHAKEN BABIES
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66
Q

Cause of subarachnoid hemorrhage?

A

Rupture of berry aneurysm of AV malformation

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67
Q

Spinal tap of subarachnoid hemorrahge?

A

Bloody or yellow xanthochromic

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68
Q

What can occur after subarachnoid hemorrhage?

A

VASOSPASM

Prevent with nimlodipine (Ca2+ channel blocker)

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69
Q

Intraparenchymal hemorrhage caused by?

A

systemic HTN
Amyloid angiopathy (recurrent lobar hemorrhagic stroke in elderly)
Vasculitis
Neoplasm

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70
Q

CT of subdural hematoma?

A

CRESCENT SHAPED, crosses suture lines

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71
Q

Where does intraparenchymal hemorrahge usually occur?

A

Basal ganglia and internal capsule

Can be lobar

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72
Q

Charcot-Bouchard aneurysm implicated in which type of bleed?

A

Intraparenchymal hemorrhage in internal capsule

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73
Q

Flow through ventricles

A

Lateral ventricle –> foramina of Monro –> 3rd ventricle –> cerebral aqueduct of Sylvius –> 4th ventricle –> foramina of Luschka (lateral) or Magendie (medial) –> subarachnoid space

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74
Q

Pseduotumor Cerebri (Idiopathic Intracranial HTN) RF

A
  • Woman of childbearing age, Vit A excess, danazol, tetracycline
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75
Q

Pseduotumor Cerebri (Idiopathic Intracranial HTN) Rx

A
  • LP provides HA relief
  • Weight loss
  • Acetazolamide (decrease CSF production)
  • Topiramate
  • Repeat LP, CSF shunt, optic nerve fenestration
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76
Q

Communicating Hydrocephalus

A

Decreased CSF absorption by arachnoid granulations (post-meningitis)

77
Q

Normal Pressure Hydrocephalus

A
  • ELDERLY
  • Expansion of entricles –> distorts fibers of corona radiata –> triad of urinary incontinence, ataxia, and cognitive dysfunction
  • Magnetic gait (feet stuck to floor)
78
Q

Noncommunicating Hydrocephalus

A

Structural blockage (stenosis, colloid cyst, tumors)

79
Q

Ex vacuo ventriculomegaly

A
  • Looks like increased CSF on imaging but it’s actually decreased brain
  • Alzheimers, HIV, Pick DZ
80
Q

What levels is intermediate horn (sympathetic) seen?

A

T1-L2/3

81
Q

Dorsal Column

A
  • P, vibration, fine touch, proprioception
  • Decussates in medulla
  • ROMBERG
82
Q

Sinothalamic tract

A
  • Lateral: pain, temp
  • Anterior: crude touch, P
  • Decussates at anterior white commissure
83
Q

Lateral Corticospinal Tract

A
  • Voluntary movement of contralateral limb

- Decussates at caudal medulla (pyramidal decussation)

84
Q

Atrophy and fasciculations - UMN or LMN?

A

LMN lesion

85
Q

Babinski - UMN or LMN?

A

UMN lesion

86
Q

Polio - presentation and spinal cord?

A
  • ANTERIOR HORN - LMN LESION ONLY
  • Plus nonspecific sx
  • CSF: increased WBCs and protein, no change in glucose
  • ASSYMETRIC WEAKNESS
  • Fecal to oral transmission –> replicates in oropharyns and small intestine –> spreads via bloodstream into CNS
87
Q

Werdnig-Hoffman

A
  • ANTERIOR HORN - LMN LESION ONLY
  • “Floppy baby” + hypotonia + tongue fasciculations
  • AR
  • SYMMETRIC WEAKNESS
88
Q

ALS

A
  • UMN (LATERAL CORTICOSPINAL) AND LMN (ANTERIOR MOTOR HORN NEURON)
  • NO SENSORY OR BOWEL/BLADDER DEFICITS
  • Defect in superoxide dismutase 1 –> free radical injury
  • Rx: riluzole
89
Q

ALS Enzyme Defect

A

Superoxide dismutase 1 –> free radical injury

90
Q

ALS Rx

A

Riluzole extends survival (decreases glutamate)

91
Q

Tabes Dorsalis

A
  • DORSAL COLUMN
  • Tertiary syphilis
  • PROGRESSIVE SENSORY ATAXIA
  • Charcot joints, shooting pain, Argyll Robertson Pupils
  • Absence of DTRS, + Romberg
92
Q

Syringomyelia

A
  • ANTERIOR WHITE COMMISSURE OF SPINOTHALAMIC TRACT –> bilateral loss of pain and temp in “cape-like” distribution
  • Chiari I
93
Q

Vit B12 Def

A
  • SPINOCEREBELLAR TRACTS
  • LATERAL CORTICOSPINAL TRACTS (UMN signs)
  • DORSAL COLUMNS (bilateral loss of position and vibration, gait abnormalities)
94
Q

Friedrich Ataxia Genetics

A

AR trinucleotide repeat disorder (GAA) on Chr 9

  • FRATAXIN (iron binding protein) –> impaired mt functioning
  • Staggering gait, frequent falling, nystagmus, pes cavus, hammer toes, DM, HYPERTROPHIC CARDIOMYOPATHY
  • Kyphoscoliosis in kids
95
Q

Cremaster Reflex

A

L1, 2

96
Q

Anal Wink Reflex

A

S3, S4

97
Q

Exits skull - CN I

A

Cribiform plate

98
Q

Exits skull - CN II, ophthalmic artery

A

Optic canal

99
Q

Exits skull - CN 3, 4, 6, V1

A

Superior orbital fissure

100
Q

Exits skull - CN V2

A

Foramen rotundum

101
Q

Exits skull - CN V3

A

Foramen ovale

102
Q

Exits skull - middle meningeal artery

A

Foramen spinosum

103
Q

Exits skull - CN 7, 8

A

Internal auditory meatus

104
Q

Exits skull - CN 9, 10, 11

A

Jugular foramen

105
Q

Exits skull - CN 12

A

Hypoglossal canal

106
Q

Exits skull - brainstem

A

Foramen magnum

107
Q

Which CN constricts pupil?

A
  • CN III (oculomotor) - sphincter pupillae [Edinger-Westphal nucleus, muscarinic R]
108
Q

Which CN is in charge of accommodation?

A

CN III

109
Q

Which CN in charge of eyelid opening (levator palpebra)e?

A

CN III

110
Q

Which CN in charge of lacrimation?

A

CN VII

111
Q

Which CN in charge of salivation?

A
  • CN VII *submandibular, sublingual

- CN IX *parotid

112
Q

Which CN in charge of closing eylid?

A

CN VII *orbicularis oculi

113
Q

Which CN involved with hearing?

A
  • CN VIII (hearing)

- CN VII (auditory volume modulation via stapedius)

114
Q

Which CN involved with monitoring carotid body chemo/baroreceptors?

A

CN IX

115
Q

Which CN monirots aortic arch chemo/baroreceptors?

A

CN X

116
Q

Corneal Reflex

A
  • Afferent: V1

- Efferent: VII

117
Q

Lacrimation Reflex

A
  • Afferent: V1

- Efferent: VII

118
Q

Jaw Jerk Reflex

A
  • Afferent: V3

- Efferent: V3

119
Q

Pupillary Refelx

A
  • Afferent: II

- Efferent: III

120
Q

Gag Reflex

A
  • Afferent: IX

- Efferent: X

121
Q

CN V Lesion

A

Jaw TOWARDS lesion (unopposed pterygoid)

122
Q

CN X Lesion

A

Uvula AWAY (weak side collapses)

123
Q

CN XI Lesion

A

Can’t turn head to opposite side (SCM)

Shoulder droop on side of lesion (trap)

124
Q

CN XII Lesion

A

LMN Lesion

Tongue deviates TOWARD lesion (“lick your wounds”)

125
Q

CN VII UMN Lesion (Motor Cortex)

A

CONTRALATERAL paralysis of lower facial muscles

FOREHEAD SPARED

126
Q

CN VII LMN Lesion (Nucleus/Nerve)

A

IPSILATERAL paralysis of upper and lower facial muscles, hyperacusis (stapedius), loss of taste sensation to anterior tongue

127
Q

Rx of Bells Palsy

A

Corticosteroids, acyclovir (HSV)

128
Q

Conductive Hearing Loss

A
  • Weber (top of head) –> AFFECTED EAR

- Rinne –> abnormal (bone > air) on side that Weber localized to

129
Q

Sensorineural Hearing Loss

A
  • Weber (top of head) –> UNAFFECTED EAR
  • Rinne - normal
  • Hearing loss is on side opposite of Weber
130
Q

Noise-Induced Hearing Loss

A

ORGAN OF CORTI

131
Q

Cholesteatoma

A

Desquamated keratin debris within middle ear

  • Conductive hearing loss
  • Pearly mass
  • Painless otorrhea
132
Q

What do you NOT give to someone with closed/narrow angle glaucoma?

A

Epinephrine (mydriatic)

133
Q

Most common viral cause of conjuntivitis?

A

Adenovirus

134
Q

What is uveitis associated with?

A

Sarcoid, RA, JIA, HLA-B27 related conditions

135
Q

Dry Macular Degeneration

A

DRUSEN

Prevent with multivitamin and antioxidant

136
Q

Wet Macular Degeneration

A

Choroidal neovascularization

Rx: anti-VEGF and smoking cessation

137
Q

Nonproliferative Diabetic Retinopathy

A

Hemorrhages and macular edema

Rx: blood sugar control

138
Q

Proliferative Diabetic Retinopathy

A

Chronic hypoxia –> new blood vessel formation

Rx: peripheral retinal photocoagulation, surgery, anti-VEGF

139
Q

Retinal Vein Occlusion

A

Arterial atherosclerosis

- Retinal hemorrahge, venous engorgement, edema

140
Q

Central Retinal ARtery Occlusion

A
  • Acute, painless

CHERRY RED SPOT

141
Q

Retinitis pigmentosa

A

Night blindness

Bone spicule-shaped deposits

142
Q

Marcus Gunn pupil

A

CN II defect

143
Q

CN III Damage

A
  • Motor output (vascular DZ, DM): ptosis, “down and out” pupil
  • PS output (compression): absent pupillary light reflex, “blown pupil”
144
Q

CN IV Damage

A
  • Upward gaze
  • HEAD TILT TOWARD SIDE OF LESION
  • Problems going down stairs –> compensatory head tilt in opposite direction
145
Q

CN VI Damage

A
  • Medially directed eye

- Horizontal diplopia

146
Q

Function of MLF?

A

Coordinate VI and III –> eyes move in same horizontal direction

147
Q

Internuclear Ophthalmoplegia

A
  • Lesion in R MLF –> when you look to the L the L eye gets nystagmus (abducting eye) and the R eye looks straight ahead (impaired adduction)
148
Q

Who has an increased risk of developing Alzheimers?

A
  • Down patients (APP is on Chr 21)
  • ApoE4 (sporadic) [ApoE2 has decreased risk]
  • App, presenilin-1/2 (familial)
149
Q

Brain Findings in Alzheimers

A
  • Senile plaques (EC beta-amyloid from APP) [may cause amyloid angiopathy]
  • Neurofibrillary tangles (IC hyperphosphorylated tau)
150
Q

Frontotemporal Dementia Presentation

A

Personality/behavior probs + Aphasia

151
Q

FT Dementia Brain Findings

A
  • Hyperphosphorylated tau (round Pick bodies)

- Ubiquinated TDP-43

152
Q

Lewy Body Dementia Presentation

A

Dementia + visual hallucinations –> parkinsonian features

153
Q

Lewy Body Dementia Brain Findings

A

Lewy bodies (insoluble aggregates of alpha-synuclein)

154
Q

Vascular Dementia causes

A

HTN, atherosclerosis, vasculitis

- Elderly

155
Q

Creutzfeldt-Jakob Brain Findings:

A

Spongiform cortex

PRPc –> PRPsc (beta-pleated, resistant to proteases)

156
Q

HLA associated with MS?

A

HLA-DR2

157
Q

Presentation of MS?

A
  • Optic neuritis (sudden loss of vision, Marcus Gunn pupils)
  • INO (MLF)
  • Hemiparesis
  • Hemisensory sx
  • Bladder/bowel dysfunction
  • Women in 20-30s, relapsing/remitting, whites living further from equator
158
Q

Charcot triad of MS?

A

Scanning speech, intention tremor, nystagmus

159
Q

CSF in MS

A

Increased IgG and myelin basic protein

Oligoclonal bands

160
Q

Gold standard for MS dx

A

MRI

- Periventricular plaque (oligodendrocyte loss + reactive gliosis)

161
Q

MS Rx

A
  • Disease-modifying: beta-interferon, glatiramer, natalizumab
  • Acute flares: IV steroids
  • Neurogenic bladder: muscarinic antagonists
  • Spacticity: baclofen, GABA R antagonists
  • Pain: opioids
162
Q

Guillain Barre Syndrome cells affected?

A

Schwann cells –> PNS (endoneural)

163
Q

GBS CSF findings??

A

Increased CSF protein with normal cell count (albuminocytologic dissociation)

164
Q

Infections associated with GBS?

A

Campylobacter, viral

Molecular mimicry

165
Q

Charcot-Marie-Tooth DZ

A 
AD
Foot deformities (pes cavus), LE weakness, sensory deficits
166
Q

Krabbe DZ

A

AR lysosomal storage DZ - deficiency fo galactocerebrosidase –> buildup of galactocerebroside in macs and psychosine –> destroys myelin sheath

167
Q

Metachromatic Leukodystrophy

A
  • AR lysosomal storage DZ due to arylsulfatase A deficiency –> buildup of sulfatides –> impaired production and destruction of myelin sheath
168
Q

Progressive Multifocal Leukoencephalopathy

A

Destruction of oligodendrocytes
AIDS patients
Due to reactivation of JC virus
Increased risk with natalizumab, rituximab

169
Q

Adrenoleukodystrophy

A

X-linked

- Disrupted metabolism of very-long-chain FA –> build up in nervous system, adrenal glands, testes

170
Q

Rx for cluster HA

A

Acute: sumatriptan, 100% O2
Prophylaxis: verapamil

171
Q

Rx for tension HA

A

Analgesics, NSAIDs, acetaminophen, amitriptyline

172
Q

Rx for migraine

A

Acute: NSAIDs, triptans, dihyroergotamine
Prophylaxis: lifestyle changes, beta-blockers, calcium channel blockers, amitryptiline, topiramate, valproate

173
Q

Meniere DZ Presentation

A
  • Vertigo, unilateral hearing loss, tinnitus
174
Q

BPPV caused by?

A

Otoliths

175
Q

Sturge-Weber Syndrome

A
  • Activating mutation of GNAQ –> neural crest probs
  • Port-wine stain of face
  • Ipsilateral leptomeningeal angioma (seizures)
  • Intellecutal disability
  • Episcleral hemangioma (early onset glaucoma)
  • Tram track calcification
176
Q

Tuberous Sclerosis

A
  • Hamartomas
  • Angiofibromas
  • Mitral regurg
  • Ash-leaf spots
  • Cardiac rhabdomyoma
  • AD
  • Intellectual disability
  • Renal angiolypoma
  • Seizure
  • Shagreen patches
177
Q

NF 1

A
  • Cafe au lait
  • Lisch nodules (iris hamartomas)
  • Cutaneous neurofibromas
  • Optic gliomas
  • Pheochromocytomas
  • Mutated NF1 tumor suppression gene (RAS) on Chr 17
  • NEURAL CREST
178
Q

Von Hippel Lindau DZ

A
  • Hemangioblastomas in retina, brain stem, cerebellum, spin
  • Angiomatosis in skin, mucosa, organs
  • Bilateral RCC
  • Pheochromocytoma
179
Q

Glioblastoma Multiforme

A
  • Astrocytes, GFAP +

- Pseudopalisading necrosis

180
Q

Meningioma

A
  • Arachnoid cells

- Whorled pattern, psammoma bodies

181
Q

Hemangioblastoma

A
  • Von-Hippel Lindau (+ retinal angiomas)

- Secondary polycythemia (ectopic EPO)

182
Q

Schwannoma

A
  • NF-2 = bilateral vestibular schwannomas

- S-100+ (neural crest)

183
Q

Oligodendroglioma

A

Calcified, fried-egg, capillary chicken wire pattern

184
Q

Pilocytic Astrocytoma

A
  • GFAP +

- Rosenthal fibers, cystic + solid

185
Q

Medulloblastoma

A

Primitive neuroectoderm tumor

  • NOncommunicating hydrocephaus
  • Drop mets to spinal cord
  • Homer-Wright rosettes, small blue cells
186
Q

Ependyoma

A
  • Hydrocephalus (4th ventricle)
  • Pervascular rosettes
  • Rod-shaped belpharoplasts
187
Q

Craniopharyngioma

A
  • Bitemporal hemianopia
  • Supratentorial tumor
  • Rathke pouch
  • Calcifications
  • Cholesterol crystals in “motor oil” like fluid
188
Q

Pinealoma

A
  • Parinaud syndrome (vertical gaze palsy)
  • Obstructive hydrocephalus (cerebral aqueduct)
  • Precocious puberty in males (beta-hCG)

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