Neuro

Question 1

What part of N. Meningitidis is in the vaccine?

Answer 1

Capsular polysaccharide

Question 2

Describe the macroscopic findings in craniopharyngioma

Answer 2

Cysts that are derived from Rathke’s pouch and are filled with brownish-yellow, viscous fluid with cholesterol crystals

Question 3

Describe the symptoms of serotonin syndrome

Answer 3

neuromuscular excitation, autonomic stimulation, altered mental status

Question 4

From which amino acid is serotonin derived?

Answer 4

Tryptophan. Via tryptophan hydroxylase and amino acid decarboxylase

Question 5

Name the amino acid precursors for GABA, histamine, cysteine, and thyroxine/DA/Epi/NE

Answer 5

Glutamic acid, histidine, methionine, Tyrosine

Question 6

What is the treatment for serotonin syndrome?

Answer 6

supportive and cyproheptadine (histamine with nonspecific 5-HT1 and %-HT2 receptor antagonist properties)

Question 7

Which cranial nerves are affected by Cavernous sinus thrombosis

Answer 7

CNs III,IV,V,VI

Question 8

What is the classic triad of congenital toxoplasmosis?

Answer 8

Hydrocephalus
Intracranial calcifications
chorioretinitis
Can also have: hepatosplenomegaly, rash, seizures, altered mucle tone, and ocular movement defects

Question 9

What is the most common complication that can occur after subarachnoid hemorrhage?

Answer 9

secondary arterial vasospasm (50%), leading to cerebral ischemia and new-onset confusion and/or focal neurological deficit 4-12 days after initial insult

Question 10

What are the central adverse effects of L-Dopa? Peripheral?

Answer 10

Central: anxiety and agitation
Peripheral: N/V, Tachyarrhythmias, Postural hypotension, hotflashes

Question 11

What reduces the peripheral adverse effect of L Dopa?

Answer 11

Dopa decarboxylase inhibitor (Carbidopa)

Question 12

What is the pathogenesis of Guillain-Barre syndrome?

Answer 12

Antibodies cross-react with myelin and there is endoneurial inflammatory infiltrate

Question 13

What is the action of pralidoxime?

Answer 13

Used for organophosphate poisoning, it regenerates AChE in the neuromuscular junction and affects both nicotinic and muscarinic ACh receptors

Question 14

What is the most common cause of meningitis in adults of all ages? Discuss gram stain of said bacteria.

Answer 14

Strep Pneumo (lancet shaped gram + cocci in pairs)

Question 15

What is the gram stain for Listeria?

Answer 15

motile gram + rods

Question 16

What is the gram stain for H. Flu

Answer 16

non-motile gram - coccobacilli

Question 17

Name two genetic disorders associated with Berry Aneurysm

Answer 17

Ehlers-Danlos, ADPKD

Question 18

What part of the brain is supplied by the posterior cerebral artery?

Answer 18

CN III/IV, thalamus, medial temporal lobe, splenium of corpus collosum, parahippocampal gyrus, fusiform gyrus, and occipital lobe

Question 19

What type of necrosis does the CNS undergo after infarct?

Answer 19

liquefactive necrosis. Most other tissues undergo coagulative necrosis after ischemic injury

Question 20

What nerves and what is the division between the nerves that innervate the tongue?

Answer 20

Foramen cecum separates anterior 2/3rds from posterior 2/3rds
General sensory: Ant- mandibular branch of CN V, Post- CN IX
Taste: Ant- chorda tympani of CN VII, Post- CN IX

Question 21

Usually postganglionic sympathetic neurons release norepi and epi on the target organ. What are the two exceptions?

Answer 21

Adrenal Medulla- releases norepi and epi directly into the blood stream
Eccrine sweat glands: postganglionic neurons are also cholinergic

Question 22

Which anesthetics cause acute hepatitis?

Answer 22

Halogenated inhaled anesthetics
Halothane
The fluranes to a lesser degree

Question 23

Which pathogen is most commonly associated with viral meningitis?

Answer 23

Enterovirus (cocksackievirus, echovirus, poliovirus) then arboviruses, then HSV2

Question 24

Name the characteristic features of Friedrich Ataxia

Answer 24

progressive gait ataxia
impaired joint and vibration sense
spastic muscle weakness and babinski
hypertrophic cardiomyopathy (most common cause of death)
DM
skeletal abnormalities

Question 25

What is the most common cause of spontaneous lobar hemorrhage in adults over age 60?

Answer 25

Amyloid angiopathy. Recurrent hemorrhage that involves the occipital and parietal lobes.

Question 26

Where is ACh made?

Answer 26

Basal Nucleus of Meynert

Question 27

Tumor in a child with sheets of primitive cells and many mitotic figures

Answer 27

Medulloblastoma- located near cerebellum

Question 28

Signs of PKU

Answer 28

ID, gait abnormality, must odor, eczema

Question 29

What are the signs of hypocalcemia in DiGeorge syndrome?

Answer 29

Chvostek sign: twitching of the nose and lips | Trousseau sign: carpal spasm with blood pressure cuff inflation

Question 30

What causes decerebrate (extensor) posturing?

Answer 30

Damage to the brainstem at or below the red nucleus (midbrain, pons, medulla)

Question 31

What causes decorticate (flexor) posturing?

Answer 31

damage to neural structures above the red nucleus

Question 32

What is the treatment for restless leg syndrome?

Answer 32

Dopamine agonists

Question 33

What does the facial nerve control?

Answer 33

1. motor- muscles of facial expression 2. parasympathetic- lacrimal, submandibular, and sublingual glands 3. Taste- anterior 2/3rds of tongue 4. Somatic afferents from pinna and external auditory canal

Question 34

What are the treatments for Alzheimer's disease?

Answer 34

Cholinesterase inhibitors (donepizil), Antioxidants (vitamin E), NMDA receptor antagonists (memantine)

Question 35

What symptoms are associated with opioid overdose?

Answer 35

Miosis, bradycardia, hypotension, and somnolence

Question 36

What does the pudendal nerve innervate?

Answer 36

Skin around the anus and perineum pelvic floor muscles urethral and anal sphicters

Question 37

What is DRESS syndrome and with which drugs is it associated?

Answer 37

Drug Reaction with eosinophils and systemic symptoms presents with rash, fever, generalized lymphadenopathy, and facial edema. Common with Phenytoin, carbamazepine, allopurinol, sulfonamides, and antibiotics (minocycline, vanc)

Question 38

What are some systemic causes of carpal tunnel syndrome?

Answer 38

``` Pregnancy (fluid accumulation) Hypothyroid (glycosaminoglycan buildup) DM (connective tissue thickening) Dialysis (Beta2 microglobulin deposition) RA (tendon inflammation) ```

Question 39

What change are seen in the neuron during the axonal reaction?

Answer 39

It becomes swollen and rounded with the nucleus displaced to the periphery. The Nissl substance becomes fine, granular and is dispersed throughout the cytoplasm (24-48 hrs after injury)

Question 40

What is neuroleptic malignant syndrome and what is the treatment?

Answer 40

Adverse reaction to antipsychotic with muscle rigidity, high fever, and autonomic instability Rhabdo causes high CK, may lead to myoglobinuria and acute renal failure Treatment: removal of drug, supportive care, dantrolene

Question 41

What are the symptoms and histological features of HIV associated dementia?

Answer 41

Usually in CD4 count less than 200. Presents with subcortical dementia. HIV infected monocytes cross the BBB and form perivascular macrophages. These macrophages for microglial nodules around necrotic tissue and may fuse to form multinucleated giant cells.