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board review > neuro > Flashcards

neuro Flashcards

1
Q

Q

nucleus pulposus

is a remnant of ?

A

notochord.

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2
Q

failure of the prosencephalon to divide into 2 cerebral hemispheres

results in?

the most likely mechanism of these findings

A

holoprosencephalon, (fused cerebral hemispheres),

seen in trisomy 13

fetal alcohol syndrome.

mechanism = field defect

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3
Q

Q

pt with hyperthermia.

caused by problem with the center regulating heart.

what is the origin of this center

A

diencephalon

forms the thalmus and hypothalamus

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4
Q

which chiari malformation is always associated with spina bifida (meningomyelocele)

A

type 2

bc

type 1 (adult type) is associated with syringomyelia

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5
Q

dandy walker syndrome

is associated with what type of hydrocephalus

Q why hydrocephalus

A

noncommunicating hydrocephalus.

(malfunction of Luschka and Magendie)

  • cystic dilation of the 4th vent –> hypoplasia of the cerebellum and absence of cerebellar vermis
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6
Q

Q on the boards

neonate that survved meningtits (usually grp B strept) and started to develop enlargement of the skull?

whats the cause

A

congenital hydrocephalus

acquired after bacterial meningitis

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7
Q

Q on boards

congenital hydrocephalus

(aqueduct of sylvius)

can be caused by defect in what embryolonic origin

A

mesencephalon

also can be caused by failure of the roof of the 4th ventricle to develop

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8
Q

noncommunicating (obstructive hydrocephalus)

arnold chiari

dandy walker

congenital hydrocephalus

A

arnold - compression of the 4th ventricle

dandy walker syndrome - luschka and magendie malfunction

congenital hydrocephalus - stenosis of cerebral aqueduct

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9
Q

Communicating (nonobstructive) hydrocephalus

kid had meningitis 1 month ago, his head is getting bigger

whats the problem

A

disoder of the arachnoid granulations

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10
Q

what to know

port wine stain (nevus flammeus - birth mark) cnV1/V2

seizures

episcleral hemangioma –> glaucoma

intellectual disability

A

sturge weber syndrome

(encephalotrigeminal angiomatosis)

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11
Q

what you need to know

autosomal dominant

multisystem disorder –> tumors in diff organs

brain - (cortical tubers = large white hamartomas nodules)

rhabdomyoma –> mitral regurg

hypopigmented ash leaf spots and angiofibroma

kidney: bilateral renal angioMyolipoma

A

tuberous sclerosis

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12
Q

most common primary heart tumor in children and infants

A

rhabdomyoma.

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13
Q

what are neurofibroma composed of

A. neural tissue

B. Schwann cells and fibroblast

A

schwann cells and fibroblasts

NOT NEURAL TISSUE

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14
Q

WHAT to know

chromo 17 mut in a tumor supressor gene

Cafe au lait macules

pigmented neurofibromas

axillary freckling (crowe sign)

associated with Pheochromocytoma and wilms tumor

optic glioma

A

NF 1

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15
Q

bilateral acoustic neuroma (tinnitu vertigo hearing loss)

  • usually schwannoma located cerebellopontine angle

chromo 22

meningiomas

juvenile cataracts

A

NF2

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16
Q

cerebellar degeneration –> ataxia (early onset)

telangiectasia (dilated blood vessels) of the eyes and skin

immunodef

low IgA and T cell deficit

recurrent infections

A

ataxia telangiectasia

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17
Q

VHL gene is a

A. oncogene

B. tumor supressor gene

A

tumor supressor gene

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18
Q

angiomatosis of the retina –> blindness

(hemangioblastomas (high vascularity w/ hyperchromatic nuclei) in retina, cerebellum, brain stem.

bilateral RCC

Pheochromocytomas

A

VHL disease

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19
Q

2/3 of sporadic clear renal cell carcinoma

have difinite evidence for

biallelic inactivation of VHL

A

know this

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20
Q

why is carmustine and lomustine

used to treat brain tumors

A

(lipophilic)

bc they are small, lipid soluble, nonpolar,

molecules that CAN cross the BBB

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21
Q

what brain tumor will you see mulltiple of in

NF2

A

meningioma

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22
Q

on the boards

uniformly encircled tumor cells with psammoma bodies

presents with new onset seizures

A

meningioma

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23
Q

on the boards

pt in a coma after head injury with bradycardia and ST segment elevation on EKG

A

from increased ICP

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24
Q

cranial nerve palsy (VI common due to long intracranial course) –> binocular horizontal diplopia due to lateral rectus palsy

whats the cause

A

inc ICP

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25
Q

if someone is on a ventilator and a patient is suffering from increased ICP

what can you do to help

A

hyperventilation

–> dec co2 –> vasoconstriction –> dec cerebral blood flow –> dec ICP

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26
Q

Aids pt with CD4 count <50

using natalizumab

for tx of MS or crohns disease

has deficits in speech, memory, coordination

A

PML

oligodendrocytes –> intranuclear inclusions –> symptoms

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27
Q

on the boards

12-15 yo hx of measles

infection early in life (before age of 2)

presents with personility changes, seizures, myoclonus, atxia, and photosensitivity

A

Subacute sclerosing pancencephalitis

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28
Q

on the boards

pt with hx of long term corticosteroid use who develops

pulmonary infection initially then brain abscess

A

nocardia asteroides

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29
Q

on the boards

hiv infection pt who develops signs of

encephalitis or brain abscess with ring enhancement and calcification on mri.

diagnosis

A

protozoa

(Toxoplasma gondii)

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30
Q

trick question

is CFJ prion spongiform encepholpathy

effect patchy or whole cerebral cortex

A

whole cerebral cortex

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31
Q

Q on board. 30 yo mexican immigrant healthy person visiting area from South america. has been to ER for new onset seizures

ct of brain shows cystic mass

what is the treatment

how did he acquire this infection?

A

albendazole and corticosteriods (for the edema)

through eating pork meat

taenia solium (cysticercosis)

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32
Q

when the pts thigh is flexed at the hip and knee at 90 degree angles

you see ressitance in extending the knee (painful)

what sign is this and what is it positive in

A

kernig sign

+ in SAH, meningitis

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33
Q

healthy middle age 30yo pt

all of sudden have increase ICP. on biopsy you see intracerebral hemorrhage formed of numerous tortuous vessels

what is the casue

A

av malformation rupture

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34
Q

stroke queston on boards!!!

pt with

vertigo, N/V, nystagmus, ipsilateral limb ataxia.

what kind of stroke?

what artery

** if brainstem compression you need to do what?

A

cerebellar stroke

Superior cerebellar A. or

AICA or PICA

must consult neurosurgery for decompression

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35
Q

what stroke causes

dysphagia, hoarseness

dec gag refelx

A

lateral medullary wallenberg syndrome

PICA

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36
Q

which stroke causes facial paralysis (lmn lesion

(facial nucleus))

dec lacrimation

dec salivation

dec taste from anterior 2/3 tongue

A

AICA = lateral pons

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37
Q

which stroke

ipsilateral tongue paralysis

contralateral upper and lower limbs paralysis

loss of contralateral proprioception

A

ASA

medial medullary syndrome

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38
Q

on boards

conscious quadrplegic pt who is unable to move the face, mouth, and the tongue and has loss of horizontal eye movement (NOT the VERTICLE)

A

locked in syndrome,

involving the pons, medulla, and the midbrain.

spares the reticular activating system (RAS)

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39
Q

dysarthria meaning

A

inability to move the tongue and mouth muscles.

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40
Q

on boards

pt with conjuctival injection, edema of the eyelids with

paralysis of the cranial nerves passing through the cavernous sinus, after a dental procedure

diagnosis

and most likely organsim

A

cavernous sinus thrombosis

peptostreptococcus

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41
Q

what is the most common extraocular muscle involved in wernickes encephalopathy

A

lateral rectus

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42
Q

on boards

what is korsakoff psychosis due to ?

A

necrosis and perminent damage to the mamillary bodies

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43
Q

what will happen if you glucose before thiamine if pt has wernicke encephalopathy

A

inc anion ap metabolic acidosis

inc anaerobic metabolism of glucose and accumulation of lactic acid.

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44
Q

for the boards

pts with metabolic encephalopathy (including alcohol intoxication) will have?

whats the one exception

A

equal reactive pupils

even in the terminal conditions (cheyne-stokes breathing) except

opioid induced encephalopathy –> pinpoint pupils

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45
Q

on the boards

pt who presents with drooping eye lids, slurred speech, vomiting , and muscle weakness 6 hr.

after ingestion of contamnated food

cause?

A

botulism.

(miller-fisher syndrome)

Descending paralyses, ocular muscles first, ataxia and areflexia

it blocks release of acetylcholine from NMJ –> respiratory failure

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46
Q

C4 dermatome

A

shoulder tip

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47
Q

C6 dermatome

A

thumb

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48
Q

C5 dermatome

A

outer part of the upper arm

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49
Q

L1 dermatome

A

inguinal ligament

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50
Q

C2 occiptal and parietal area

pain in occipital area after a hit in the rear (whiplash)

A
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51
Q

diffuse hyperreflexia

generalized weakness and atrophy and fasciculations of limbs

A

compression of the cervical cord.

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52
Q

cant toe walk

A

L4-L5

53
Q

pain and sensory loss over the back of the thigh, lateral posterior calf

A

L5-S1

54
Q

cant TOE WALK

A

S1

55
Q

Hair follicle ending

A

hair displacement

56
Q

krause corpuscle

located at lip tongue and genitals

A

respond to pressure

57
Q

ruffini ending

located dermis of skin

A

pressure on skin

58
Q

meissner corpuscle

dermis of skin

A

light touch

59
Q

pacinian corpuscle

located deep dermis

A

vibration - slow and pressure

60
Q

Free nerve ending

A

mechanical , thermal

61
Q

on the boards

macrocytic anemia, smooth tongue ,

achlorhydria with hx of vitamin B12 deficiency - (prenicious anemia)

posterior column degeration -> bilateral loss of vibration and tactile sense

corticospinal tract –> bilateral spastic paresis bleow the lesions

progressive degen disease of posterior roots of the spinal cord –> bladder incontinence

A

subacute combined degeneration

62
Q

AIDS demential complex

look for pt with Subacute combined degeneration

dementia

long hx of AIDs

A
63
Q

Bilateral horners if above T2

flaccid paralysis (LMN)

spastic paresis (corticospinal treact)

pain and temp (lateral spinothalamic tract)

all impaired

A

anterior spinal artery infarction

64
Q

on the boards

fasciculations (usually tongue)

preserved ocular muscle movement

A

ALS

65
Q

mutation in superoxide dismutase 1

(SOD1 gene)

A

ALS inherited form

66
Q

what is the only nerve in nerve that regenerates in adults

A

olfactory (CN2)

67
Q

which cn has the slowest fibers in conducting action potential

A

olfactory

68
Q

fracture of the cribriform plate leads to

loos of smell (anosmia) due to injury of the olfactory bulb.

however, why can the pt still smell/have a response to ammonia.

A

noxious stimuli from the olfactory mucosa is carried by the trigeminal nerve

69
Q

on the boards

injury to geniculocalcarine tract in the temporal lobe will cause what visual field defect

A

upper visual field defect

(meyers loop)

70
Q

Q

pt with

acute glaucoma and orthostatic hypotension in a pt with DEPRESSION

what do you think the cause is

A

imipramine

71
Q

drug to give someone that has narrow angle glaucoma

(red painFUL EYE)

A

PILOCARPINE

72
Q

in the treatment of open angle glaucoma

what are the 2 main side effects of prostaglandin (latanoprost)

“PGF2)

A

darkening of the iris color (browning)

and eye lash growth

73
Q

Q

what nerve was injured when a pt had their mandibular molar extraction now causing numbness in the tip of the tongue?

A

lingual nerve ( a branch of the madibular division) passes close to the third molar

(anterior 2/3 sensation)

74
Q

what supplies innervation to the posterior scalp and the neck

A

C2-C3

NOT TRIGEMINAL NERVE

75
Q

trigeminal neurlagia

what branch

A

maxillary

76
Q

on boards

pt with levator palpebrae superioris problem

intracranial aneursym

in pt with polycystic kidney disease

can somehow effect what nerve.

A

oculomotor nerve

most likely in the PCOM

also could have

77
Q

the facial nerve course

from the pons –> internal auditory meatus–> facial canal of the petrous portion of the temporal bone through the _____ foramen

A

stylomastoid foramen.

** the facial canal is Z shpaed located in temporal bone extending from internal acoustic meatus to styloidmastoid foramen.

78
Q

Q on boards

pt has hyperacusis (inc sensitivity to everyday sound)
where is the damage causing this

A

injury to the facial canal where the nerve to the stapedius originates.

stapedius n is a branch of the facial n.

79
Q

pt with bells palsy and cant close the eye lid all the way when they sleep

what nerve and muscle

A

facial nerve.

orbicularis oculi

80
Q

chorda tympani

is a branch of what nerve that supplies

taste sensation to anterior 2/3 of tongue

and parasympathetic to (submandibular and sublingual)

A

facial nerve.

81
Q

pt has eye dryness (weakness in orbicularis oculi) and increased sensitivity ot noise (hyperacusis)- know (injury in facial canal, injury to stapedius)

A

bells palsy

82
Q

horner syndrome

ipsilateral ptosis due to paresis of what muscle

A

muller muscle

smooth muscle supplied by sympathetic fibers from superior cervical ganglion help to raise upper eyelid

83
Q

Q

pt with bells palsy and acoustic neuroma

where is the injury

A

facial canal

internal auditory meatus in temporal bone

84
Q

Q

pt has difficulty of hearing low frequency sounds

think of damaged?

A

inner ear hair cells

or

menieres disease

85
Q

Q

autosomal dominant defect w/ type 1 collagen deficiency

SENSORY HEARING LOSS Is tdue to atrophy of the cochlear hair cells and abnormal bone formation in the cochlea.

what disease?

A

osteogenesis imperfecta

86
Q

ipsilateral ataxia

and

intention tremor

are due to?

A

cerebellar lesions with loss of purkinje cells

in the HEMISPHERES

not the vermis

87
Q

treatment for

essential tremor

A

B - Blocker

if b blocker is contraindicated

primidone

88
Q

asterixis

A

hepatic encephalopathy

89
Q

alcohol withdraw and

side effect of lithium

hyperthyroidism

HYPOglycemia

A

tremor

90
Q

pt bitten by a black widow spider

presents as ?

A

muscle twitching

NOT TREMOR

abdominal and chest pain

91
Q

supraoptic and paraventricular nuclei

ADH and oxytocin formation

effect of lesion

A

diabetes insipidus

92
Q

what is ghrelin

A

gut brain peptide produced by GI mucosa mainly the stomach.

acts on teh hypothalamus –> inc hunger –> wt gain – FATASS

93
Q

on the boards

a retrochiasmatic mass

or

multiple sclerosis

wiill displace the optic tract –> ?

A

contralateral homonymous hemianopsia

94
Q

in parkinsons disease you see an overproduction in ACH?

why

A

bc dopamine normally has an inhibitory effect on cholinergic neurons

no dopamine = no inhibitory effect

95
Q

the tremor in parkinsons pt is due to

A

excess ACH in the stratum

96
Q

rigidity for boards

___ is a form of increased tone –> inc muscle stiffness, fatigue, weakness

A

lead pipe rigidity

97
Q

rigidity for baords

lead pipe rigidity + tremor –> a stop and go effect during a range of motion

A

cogwheel rigidity

98
Q

rigidity for board

is seen in UMNL starts with a higher resistance to flexion ollowed by a loss of resistance

A

clasp knife response

99
Q

in huntingtons

you get atrophy of?

which leads to enlargement of the lateral ventricles (ex vacuo ventriculomegaly)

A

caudate

100
Q

on the boards

middle aged women started on a medicine for psychosis and developed dyskinesia, galactorrhea and amenorrhea.

what is the most likely cause of her symptoms

A

low potency antipyschotic drugs – phenothiazines (chlorpromazine)

cause blockade of dopamine receptors

101
Q

boards

unsteady wide based gait (staggering side to side)

whats the cause

A

cerebellar vermis lesion

long hx of alcohol abuse –> ataxia

102
Q

waxing and waning breathing followed by apnea

look for pt with

CHF, Immature newborn, or a person who moved recently to high altitude area

A

cheyne stokes respiration.

103
Q

kussmaul sign

A

increased jugular venous distention during inspiration in pt with constrictive pericarditis

104
Q

Erb palsy

most comm birth related neurapraxia

upper arm paralysis C5/ C6

will they have intact or lost grasp

A

intact grasp

105
Q

in erB palsy

what two nerves are involved

A

Axillary and musculocutaneous

106
Q

klumpke palsy

lower arm paralysis C8/T1

grasp

A

lost grasp

107
Q

boards

common presentation

what nerve of the arm is commonly effected in cycylist

A

ulnar

108
Q

what nerve is commonly affect in these scenarios

elbow injury

hematoma in the cubital fossa (after IV infusion)

A

median

109
Q

thoracic outlet syndrome

pain, numbness and or tingling of the upper extremity increased by overhead work caused by compression of what?

seen in painters

A

brachial plexus and subclavian vessels

110
Q

high yield on boards

S2-4 of the sacral plexus

innervates the structures of the perineum and sensation of the genitalia

A

pudendal nerve

111
Q

Q

vaginal tear due to instrument delivery

can cause pudendal nerve injury that can cause

A

urinary incontinense

loss of sexual sensation

112
Q

triptans

like sumatriptan moa

A

selective serotonin receptor agonist

113
Q

triptans (sumatriptan)

the most serious side effect is ?

A

coronary artery vasospasm

114
Q

microscopically see

fragmentation of the internal elastic lamina and multinucleated gaint cells.

A

temporal arteritis

115
Q

on the boards

old pt admitted to the hospital w/ acute illness

acute onset memory problem, disorganized speech, altered consciousness w/ fluctuating course

A

delirium

116
Q

what is the highest risk for developing delirium

A

dementia

117
Q

Q

why do alzheimers pts have early memory loss

A

atrophy of hippocampus

118
Q

HY on the boards

alzheimer pt has dec ACH why?

A

loss of cholinergic neurons (acetyltransferase activity) in nucleus basalis of meynert

119
Q

on boards

hyperpohosphorylated tau protein

is from a mutation on chromosome?

A

chromosome 14***

leads to neurofibrillary tangles - inracellular aggregates of fibers (coreelates with the degree of dementia

120
Q

boards

in wilsons disease

they have neuroological symptoms including psychosis and dementia!!!!

inc LFTs and jaundice

what iwll there alkaline phosphatase level be

A

low alkaline phosphatase

121
Q

picks disease (frontotemporal dementia)

pt has personality changes (behavioral disturbances) and inappropriate/aggressive.

what will be seen on biopsy

A

intracellular tau protein

rounded aggregates inside cerebral neurons

122
Q

alheimers tx

1st line

A

donepezil

123
Q

Q

tacrine (anticholinergic) used for alheimers tx

sideeffect

A

hepatotoxicity

124
Q

Q on boards

pt diagnosed with alzhiemers is started on a medication .

pt is getting better for 3-4 months, then her physician increases the close.

one week later pt is in ER with syncope why?

A

donepezil is a central ach esterase inhibitor that causes

increased vagal tone –> bradycardia –> atrioventricular block

125
Q

alzheimers tx

for boards

know that ginkgo biloba

does or does not imporove the global function in pts with alzheimers

A

does NOT

126
Q
A
127
Q

inclusions bodies and pigments for the boards

alzheimers disease

A

Neurofibrillary tangles

  • = degenerated neurofilaments

hirano bodies

  • eosinophilic, rod like inclusion bodies in the neurons of the hippocampus
128
Q

inclusions bodies and pigments for the boards

dark pigments

A

neuromelanin

  • black pigments found in the cytoplasm of the neural cells of substantia nigra
    • def of neuromelanin is seen in pts with parkinsons disease

negri bodies

  • eosinophilic, inclusion bodies, found in the pyramidal cells of the hippocampus and purkinje cells of the cerebellum
  • know that they are pathognomonic for rabies infection
129
Q
A

board review (20 decks)

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