Neuro Flashcards

Question 1

Q

Neural development

differentiation initiated by
after plate
remnant of notochord
dorsal vs ventral

Answer

A

notochord, telling ectoderm to form neural plate
plate forms into neural tube and crest cells
nuc pulposus of inter vertebral disk
dorsal is sensory and ventral is motor

Question 2

Q

Regions of brain

fore brain: other name, becomes, which differentiates into
mid brain: other name, differentiates into
hind brain: other name,

Answer

A

prosencephalon, telencephalon -> cerebrum && diencephalon -> hypothal and thal
mescencepahlon -> midbrain
rhombocephalon, metencephalon -> pons and cerebellum && myelencephalon -> medulla

Question 3

Q

Central and Peripheral nervous system origin

CNS: components; origin
PNS: components; origin
Microglia: what is it, origin

Answer

A

CNS neurons, oligodendrocytes, and astrocytes; neural tube
PNS neurons, schwann cells; neural crest
marophage like cells, mesoderm

Question 4

Q

Neural tube defects

spina bifida occulta: what is it, assocaited with
meningocele: what is it
myelomeningocele: what is it
myeloschisis: what is it
anencephaly: what is it

Answer

A

failure of caudal neuropore to close, w/o herniation; tuft or hair or skin dimple at bony defect
failure of caudal neuropore to close, w/ herniation of meninges
failure of caudal neuropore to close, w/ herniation of meninges and neural tissue
exposed unfused neural tissue w/o skin/meningeal covering
failure of rostral neuropore to close; no forebrain and open calvarium

Question 5

Q

Holoproencephaly

what is it
mutation
sxs
associated w/

Answer

A

failure of forebrain to separate into 2 cerebral hemispheres
sonic hedge hog
cleft lip/palate to cyclopia
trisomy 13 and fetal EtOH syndrome
monoventricle and fusion of basal ganglia

Question 6

Q

Lissencephaly

cause
result

Answer

A

failure of neural migration

- smooth brain w/o sulci and gyri

Question 7

Q

Posterior Fossa Malformation

Chiari I: what is it; cause; sxs
Chiari II: what is it; associated w/
Dandy Walker: what is it; associated w/

Answer

A

displacement of cerebellar tonsils inferior to foramen magnum; congenital; headaches and cerebellar sxs
herniation of cerebellar vermis and tonsils through foramen magnum w/ aqueductal stenosis; lumbosacral myelomeningocele
agenesis of cerbellar vermis causing cystic enlargement of 4th ventricle; noncommunicating hydrocephalus and spina bifida

Question 8

Q

Syringomyelia

what is it
what is affected and what sxs does that cause
location

Answer

A

cystic cavity in central canal of spinal cord
fibers in anterior white commisure -> cape like symmetrical loss of pain and temp in upper extremities
cervical > thor> lumbar

Question 9

Q

Tongue Development

anterior 2/3 formed from, sensation, taste
posterior 1/3 formed from, sensation, taste
motor innervation
hyoglossus
genioglossus
styloglossus
palatoglossus, innervation

Answer

A

1st and 2nd pharyngeal arches; CN V3; CN VII
3rd and 4th pharyngeal arches; CN IX
XII
retracts and depresses tongue
protrudes tongue
draws sides of tongue up to make trough when swallowing
elevates posterior tongue during swallowing, CN X

Question 10

Q

Cells of Nervous system

Neurons: function; adult; staining
Astrocytes: function, derived from, marker
Microglia: function; activation
Ependymal cells: cell type; location; function
Myelin: function; location; produced by
Schwann cells: function
Oligodendrocyte: function, derived from; histo; involved in

Answer

A

signal transmitting cells of nervous system; do not divide; Nissl staining for dendrites and cell body
repair, remove extra NT, part of BBB, glycogen fuel reserve; neuroectoderm; GFAP
scavenger cells of CNS; line ventricles and central canal of spinal cord; response to tissue damage
ciliated simple columnar glial cells; ventricles and central canal of spinal cord; produce/ absorb/ and circulate CSF
wraps and insulates axons; nodes of ranvier; oligodendrocytes
promote axon regeneration in PNS
myelinate axons in CNS; neuroectoderm; fried egg appearance; injured in MS

Question 11

Q

Sensory Receptors

Free nerve endings: A delta, C; detect
Meissner corpuscles: time frame; detect
Pacinian corpuscles: time frame; detect
Merkel discs: time frame; detect
Ruffini corpuscles: time frame; detect

Answer

A

A: fast, myelinated; c: unmyelinated, slow; pain, temp
quick, fine light touch
quick, vibration/pressure
slow, pressure
slow, finger tips and joints; pressure, slippage of objects, joint angle change

Question 12

Q

Peripheral nerve Layers

endoneurium: function
perineurium: function
epineurium: function

Answer

A

thin, supportive CT that ensheaths and support individual myelinated nerve fiber
surrounds fasicle of nerve fibers
dense CT that surround entire nerve

Question 13

Q

Chromatolysis

what is it
changes
wallerian degeneration: what is it, compensation

Answer

A

reaction of cell body to axon injury
round cellular swelling, displacement of nuc to periphery, dispersion of nissl substance throughout cytoplasm
disintegration of axon and myelin sheath distal to site of axon injury; axon proximal to injury will retract and cell body sprouts new protrusions that grow toward other neurons for potential re-innervation

Question 14

Q

Meninges

what is it
dura: composition, derived from
arachnoid: composition, derived from
pia: composition, derived from
CSF location
epidural space

Answer

A

layers that surround and protect brain and spinal cord
thick outer layer closest to skull; mesoderm
middle, web-like; neural crest
thin, fibrous inner layer, adheres to brain/SC; neural crest
between arachnoid and pia
above dura, filled with fat and vessels

Question 15

Q

Blood Brain Barrier

function
formed by
damaged by
areas w/o

Answer

A

prevents circulating blood substances from reaching CSF
tight junctions between endothelial cells in capillaries, basement membrane, astrocyte foot processes
infarction/ neoplasm bc it destroys tight junctions of endo cells
vommitting center and neurohypophysis

Question 16

Q

Vomiting center

coordinated by
info from
CTZ receptors
tx of vommitting

Answer

A

nucleus tract solitarius in medulla
chemoreceptor trigger zone in area postrema in 4th ventricle
muscarinic, dopaminergic, histamin, serotonin, neurokinin
musc and histamine for motion sickness and histamine, dopamine and neurokinin for chemo

Question 17

Q

Sleep

regulated by
pathway
awake eyes open: description, waves
awake eyes closed: waves
Non Rem: N1: description, waves; N2: description, waves; N3: description, waves
Rem: what happens, when does it occur, effects of depression, waves

Answer

A

suprachiasmatic nuc of hypothal
SCN- > nor epi released -> pineal gland -> increase melatonin
alert, Beta
alpha
N1: light sleep, theta; N2: Deeper sleep, bruxism occurs, sleep splindels and K complexes; N3: deepest non REM sleep, sleepwalking/ night terrors/ and bed wetting occurs; delta
loss of motor tone; dreaming, nightmares, woody, extra-ocular movements; every 90 min and duration increases throughout night; depression increases REM and decreases N3; beta

Question 18

Q

Hypothalamus

lateral nuc
ventromedial nuc
ant nuc
post nuc
suprachiasmatic nuc
supraoptic and paraventricular nuc
preoptic nuc

Answer

A

hunger, stimulated by grehlin; anorexia; lat makes lean
satiety, stimulated by leptin; hyperphagia; ventromed makes very massive
cooling, parasympathetic; Ant -> cooling A/C
heating, sympathetic; hot pot
circadian rhythm; sun sensing nuc
synthesizes ADH and oxytocin
thermoreg, sex beahvior, releases GnRH

Question 19

Q

Thalamus

ventral-postero-lateral: senses, input, destination
ventral- postero- medial: senses, input, destination
lateral geniculate nuc: senses, input, destination
medial geniculate nuc: senses, input, destination
ventral lateral: senses, input, destination

Answer

A

sensory from body; spinothalamic and dorsal columns; cortex
sensory from trigeminal; trigeminal and gustatory pathway; cortex
vision; CN II, optic tract; calcarene sulcus
hearing; sup oliver and inferior colliculus; auditory cortex of temporal lobe
motor: cerebellum and basal ganglia; motor cortex

Question 20

Q

Limbic System

what is it
structures involved
function

Answer

A

collection of neural structures involved in emotion, long term memory, olfaction, behavior mod
hippocampus, amygdala, mammillary bodies, thalamic nuc, cingulate gyrus
feeding, feeling, fighting, fleeing, Sex

Question 21

Q

Dopamine pathways

mesocortical: decrease causes
mesolimbic: increase causes
nigrostriatal: decrease causes
tuberoinfundibular: decrease causes

Answer

A

negative sxs in schizo
positive sxs in schizo
extrapyramidal sxs
increase in prolactin -> decreased libido, sex dysfunction, galactorrhea, gynecomastia

Question 22

Q

Cerebellum

function
lateral lesion
medial lesion

Answer

A

modulated movement, aids in coordination and balance
affects voluntary movement of extremities
truncal ataxia, nystagmus, head tiliting

Question 23

Q

Basal Ganglia

function
overall pathway
direct pathway
indirect pathway

Answer

A

important in voluntary movement and adjusting posture
cortex sends info, decides whether to supress or activate and send signal back to cortex
cortex activates striatum -> signal intensified with dopamine from sub nig binding to D1 receptors-> globus pallidus is inhibited -> stop inhibiting activation of thal to cortex
cortex activates striatum -> signal intesifies with dopamine from sub nig binding to D2 receptors -> striatum inhibit subthalalmic nuc -> allows activation Globus pallidus externus which will activate globus pallidus internus to inhibit thalamus which inhibits cortex

Question 24

Q

Cerebral Cortex Locations

primary motor
premotor
frontal eye field
pre frontal
broca
limbic area
primary auditory cortex
Wernicke area
primary visual cortex
primary somatosensory

Answer

A

primary motor: frontal lobe, anterior to central sulcus
pre-motor: in front of primary motor
frontal: in front of pre motor
pre-frontal: in front of frontal eye field
broca: lateral side of frontal lobe
limbic: anterior temporal lobe
primary auditory: central temporal lobe
wernicke: posterior temporal lobe
primary visual: posterior occipital lobe
primary somatosensory: parietal lobe, right after central sulcus

Question 25

Q

Cerebral Perfusion

regulation
driven by
therapeutic hyperventilation
tx

Answer

A

on auto,
pCO2
decreases pCO2 -> vasoconstriction -> decreased cerebral blood flow -> decrease intracranial pressure
acute cerebral edema

Question 26

Q

Homunculus

sensory
motor

Answer

A

genitals, lower extremities, upper extremities, face, abdomen, pharynx
lower extremities, upper extremities, face, swallowing

Question 27

Q

Cerebral Arteries

anterior
middle
posterior

Answer

A

lower extremities, medial cortex
trunk, upper extemities, face, head (lat cortex); temporal area
occipital region

Question 28

Q

Watershed zones

location
infarct due
sxs

Answer

A

between ant and middle cerebral a and between post and middle cerebral a
severe htn
proximal upper and lower extremity weakness

Question 29

Q

circle of willis

- which vessels

Answer

A

internal carotid -> middle cerebral -> ant cerebral -> ant communicating -> middle cerebral -> posterior cerebal

Question 30

Q

dural venous sinuses

what are they
function
drain into
venous sinus thrombosis: sxs, leads to, caused by

Answer

A

venous channels that run through periosteal and meningeal layers of dura
drain blood from cerebral v and receive CSF from arachnoid granulations
internal jugular v
signs and sxs of increased ICP, leading to venous hemorrhage; hypercoagulable state

Question 31

Q

ventricular system

- pathways

Answer

A

lat ventricles -> foramina of monro -> 3rd ventricle -> cerebral aqueduct -> 4th ventricle -> foramina of luscha and foramen of magendie -> subarachnoid space -> reabsorbed by arachnoid granulations -> drains into venous sinuses

Question 32

Q

Cranial Nerves and outlets

cribiform plate
optic canal
sup orbital fissure
foramen rotundum
foramen ovale
foramen spinosum
internal auditory meatus
jugular foramen
hypoglossal canal
foramen magnum

Answer

A

I
II
III, IV, V1, VI
V2
V3
VII, VIII
IX, X, XI
XII
brain stem

Question 33

Q

Cranial Nerves

Olfactory
Optic
Oculomotor
Trochlear
Trigeminal
Abducens
Facial
Vestibulocochlear
Glossopharyngeal
Vagus
Accessory
Hypoglossal

Answer

A

smell
sight
inferior oblique, super and inferior rectus and medial rectus
superior oblique
3 divisions: Face sensation - opthalmic, maxillary, mandibular; matication, sensory from anterior 2/3 of tongue
lateral rectus
taste from ant 2/3 of tongue, facial movement, salivation
hearing, balance
taste and sensation from post 1/3 tongue, monitor carotid body and sinus
taste, uvula, talking, parasympathetic thoracoabdominal viscera
SCM
tongue movement
some say marry money but my brother says big brains matter more

Question 34

Q

Vagal nuclei

nuc tractus solitarius
nuc ambiguus
dorsal motor nucleus

Answer

A

visceral sensory info
motor innervation of pharynx, larynx, and upper esophagus
parasympathetics to heart, lungs, upper GI

Question 35

Q

Cranial Nerve reflexes

corneal: afferent innervation, efferent innervation
lacrimation: afferent innervation, efferent innervation
jaw jerk: afferent innervation, efferent innervation
pupillary: afferent innervation, efferent innervation
gag: afferent innervation, efferent innervation

Answer

A

V1 opthalmic, VII temporal branch - orbicularis oculi
V1 opthalmic, VII
V3, V3
II, III
IX, X

Question 36

Q

Mastication muscles

muscles close
muscle opens
innervation

Answer

A

masseter, temporalis, medial pterygoid

lateral pterygoid
V3

Question 37

Q

Spinal nerves

how many: total, cervical, thoracic, lumbar, sacral, coccygeal
location of nerves
end

Answer

A

31, 8, 12, 5, 5, 1
C 1-7 above vert, C8 through T1 below vert
L2

Question 38

Q

Lumbar puncture

location
function
needle passes through

Answer

A

L3-L4 OR L4-L5
obtain sample of CSF w/o damaging spinal cord
skin, sub cu, supraspinous lig, interspinous lig, lig flavum, epidural space, dura mater, arachnoid mater, subarachnoid space

Question 39

Q

Tracts in spinal cord

sensory
motor
dorsal: function, pathway
spinothalamic: function, pathway
lateral corticospinal: function, pathway

Answer

A

dorsal medial lemniscus, lateral spinothalamic
corticospinal tracts, ant and lateral
pressure, vibration, touch; sensory nerve into spinal cord, ascends up, synapses at nucleus gracilus or cuneatus, crosses over in medulla and ascends in medial lemniscus -> VPL
lateral- pain and temp, ant - pressure; sensory nerve into spinal cord, synapses in dorsal horn, crosses over through ant white commisure ascends up contralateral side -> VPL
voluntary movement of limbs; cortex -> descends ipsi through posterior limb of internal capsule -> crosses over in medulla at pyramids -> descends contralaterally -> synapses at cell body in anterior horn

Question 40

Q

Neuro Exam Reflexes

achilles
patellar
bicep
tricep
cremasteric

Answer

A

S 1, 2
L 3, 4
C 5,6
C 6, 7
L 1-2

Question 41

Q

Primitive Reflexes

present vs asent
Moro
Rooting
Sucking
Palmar
Plantar
Galant

Answer

A

present in newborn absent in adult
startle reflex, abduct/extend arms when startled
movement of head toward side of cheek that is stroked
sucking response when roof of mouth is touched
curling of fingers if palm is stroked
curling of fingers if palm is stroked
babinski, toe dorsiflexes and fan out
lateral flexion of lower body towards side of stroked spine while pt face down

Question 42

Q

Dermatomes

C2
C3
C4
C5
C6
C7
C8
T4
T7
T10
L1
L4
S2,3,4

Answer

A

2: post half of skull
3: turtle neck
4: low collar
5: collar bones and lateral arm
6: thumb and lateral arm
7: index and middle
8: ring and pinky; medial arm
4: nipple
7: at xiphoid
10: at umbilicus
1: at inguinal lig
includes knee cap and medial leg
penis

Question 43

Q

Brain lesions

frontal lobe
fontal eye field
paramedian pontine reticular formation
medial longitudinal fasiculus
dominant parietal coretx
nondominant parietal cortex
hippocampus
basal ganglia
subthalamic nucleus
mamillary bodies
amygdala
dorsal midbrain
reticular activating system
cerebellar hemisphere
red nucleus
cerebellar vermis

Answer

A

frontal lobe: deficits in concentration, orientation, judgement
frontal eye field: eyes look toward side of lesion
medial long: eyes look toward side of hemiplegia
dominant: impaired adduction of ipsi eye and abduction of contralateral eye
non dom parietal: agnosia of contralateral side
hippocampus: inability to make new memories
basal ganglia: tremor at rest
subthalamic: contralateral hemiballismus
mamillary: wernicke-kosakoff syndrome -> confusion, ataxia, nystagmus, opthalmoplegia
amygdala: kluver-bucy syndrome: disinhibited behavior (hyperphagia, hypersex)
dorsal mid: perinaud sndrome:
reticular: reduced level of arousal
cerebellar: intention tremor, limb ataxia, loss of balance
red nuc: decorticate if above, decerebrate if below
Vermis: truncal ataxia

Question 44

Q

Ischemic stroke

pathogenesis
types
irreversible damage
histo: 12-24 hrs, 24-72 hrs, 3-5 days, 1-2 wks, > 2 wks
procedure/ tx

Answer

A

8acute blockage of vessels -> disruption of blood flow -> ischemia -> liquefactive necrosis
thrombotic: clot forms directly at site of infection, embolic: clot formed in other part of body and traveled to brain where it got stuck, hypoxic: caused by hypoperfusion
after 5 min
12-24 hrs: eosinophilic cytoplasm and pyknotic nuclei, 24-72: necorsis and neutrophils, 3-5 days macrophages, 1-2 wks: reactive gliosis and vascular proliferation, > 2 wks: vascular scar
get CT, make sure not hemmorrhagic stroke and give TPA if sxs started within 3-4.5 hrs

Question 45

Q

Neonatal intraventricular hemorrhage

what is it
risk
starts
sxs

Answer

A

bleeding into ventricles
premature or low birth weight
germinal matrix
altered level of conciousness, bulging fontanelle, hypotension, seizure, coma

Question 46

Q

Epidural Hematoma

vessel affected
cause
sxs
CT

Answer

A

middle meningeal a
skull fracture
transient LOC and rapid deterioriation
CT does not cross suture lines

Question 47

Q

Subdural Hematoma

vessel affected
causes: acute vs chronic
CT

Answer

A

bridging veins
acute bc of trauma
chronic seen in older and infants, mild trauma
CT crosses suture lines

Question 48

Q

Subarachnoid Hemorrhage

location
cause
sxs
Dx
sequale
increased risk for

Answer

A

bleeding between pia and arachnoid
trauma or rupture of aneurysm
worst headache of life
bloody or yellow LP
vasospasm -> ischemic infarct; nimodeipine
communicating or obstuctive hydrocephalus

Question 49

Q

Intraparenchymal Hemorrhage

cause
location

Answer

A

systemic hypertension or amyloid angiopathy

- hypertensive hemm normally occur in basal ganglia, thalamus, pons

Question 50

Q

Effects of stroke

ACA: location affected and sxs
MCA: location affected and sxs
PCA
lenticulo-striate artery: location affected and sxs
ant. spinal a: location affected and sxs (2)
PICA: location affected and sxs (3)
AICA: location affected and sxs (4)
basilar: location affected and sxs

Answer

A

motor and sensory to lower limb, contralateral
motor and sensory to upper limb and face, contralateral and aphasia w/ wernicke and broca affected
occipital lobe; contralateral hemianopia
striatum and internal capsule affected, conralateral paralysis w/o cortical signs (neglect, aphasia)
lateral corticospinal tract -> contralateral paralysis and medial lemniscus -> contralateral proprioception
lateral medulla : nuc ambigus -> dysphagia, hoarseness, decreased gag reflex and vestibular nuc -> vertigo, nystagmus and lateral spinothalamic -> decreased pain and temp on contralateral side
lateral pons: facial nucleus -> paralysis of face and vestibular nuc -> vertigo, nystagmus and spinothalamic tract -> decrease pain and temp from contralateral side and labrynthine a -> ipsilateral sensorineural deafness
pons, medulla, lower mid brain -> locked in syndrome and corticospinal/bulbar tracts -> quadriplegia and loss of face, mouth, tongue movements and ocular CN nuclei -> loss of horizontal but not vertical eye movements

Question 51

Q

Central poststroke pain syndrome

what is it
sxs
how common

Answer

A

neuropathic pain bc of thalamic lesion
starts w/ paresthesia and then causes allodynia (painless stimuli cause pain)
10% stroke pts

Question 52

Q

Diffuse axonal injury

caused by
results in
MRI

Answer

A

traumatic shearing forces during rapid acceleration or deceleration
devastating neuro injury -> causing coma or veg state
multiple lesions of white matter tracts

Question 53

Q

Aphasia

broca
wernicke
conduction
gobal
transcortical motor
transcortical sensory
transcortical mixed

Answer

A

able to understand and wants to speak but cannot
able to speak but does not make sense, poor comprehension but able to speak
damage to arcuate fasiculus, good comprehension and good speech but poor repitition
everything is affected
good repetition and comprehension but no speech
good repetition and speech but no comprehension
good repetition but non fluent speech and poor comprehension

Question 54

Q

Aneursym

what is it
saccular: other name, occurs, mort common location, sxs
charcot- bouchard: associated w, type vessel, causes, agiography

Answer

A

dilation of artery due to weakening in the wall
berry; bifurcation in circle of willis, Acomm and ACA; silent until rupture -> subarachnoid bleed -> worst headache of life
chronic HTN, small vessels, hemorrhagic intraparenchymal stroke, not visible

Question 55

Q

Seizure

partial vs generalized
simple partial
complex partial
absence
myoclonic
tonic clonic
tonic
atonic
epilepsy
status epilepticus

Answer

A

partial is only one area of brain while generalized is entire brain
seizure w/ concoiusness still intact
impaired conciousness
blank stare, no postictal confusion
quick repetitive jerks
alternating between stiffness and jerking, positical confusion, incontinence, and tongue biting
stiffness
drop seizures
recurrent, unprovoked seizures
continuous seizure for >5 min

Question 56

Q

Causes of seizure

children
adult
eldery

Answer

A

genetic, infection, trauma, congenital, metabolic
tumor, trauma, stroke, infection
stoke, tumor, trauma, metabolic, infection

Question 57

Q

Fever vs Heat Stroke

patho phys
temp
complication
tx

Answer

A

F: cytokine activation during infection, H: inability of body to dissipate heat
F: below 104, H: above 104
F: benign, H: CNS dysfxn, ARDS, rhabdo
F: tylenol, ibuprofen, antibiotic; H: rapid coolingm rehydration

Question 58

Q

Headache

cluster: localized, duration, description, tx
migraine: localized, duration, description, tx
tension: localized, duration, description, tx

Answer

A

unilateral, 15 min to 3 hr, repetitive, excrutiating pain w/ lacrimation and rhinorrhea, sumatriptan and verapimil
unilateral; 4-72 hr; pulsating pain w/ nausea, photophobia, or phonophobia, can have aura, caused by irritation of CN V, meninges or blood vessels; NAIDS, triptans, dihydroergotamine
bilateral; less than 30 min; steady band like pain; analgesics, tricyclics

Question 59

Q

Neurodegenerative disorder

Parkinson: sxs, caused by/ histo
Huntington: cause, sxs, gross, neuro chemicals
Alzheimers: genes; gross, histo
Frontotemporal dementia: sxs, gross, histo
Lewy body dementia: sxs, histo
vascular dementia: cause; sxs; MRI
Creutzfeldt- Jakob: what is it/ sxs; gross; cause
idiopathic intracranial htn

Answer

A

pill rolling tremor, cogwheel rigidity, bradykinesia, shuffling gait; loss of dopaminergic neurons in sub nigra and lewy bodies (alpha synuclein)
auto-dom trinuc (CAG) in HTT gene on chrome 4; chorea, aggression, depression, dementia; atrophy of caudate and putamen; increase in dopamine decrease in epi and Ach
Apo E2 is protective, Apo E4 is risk for sporadic, APP causes familial which is earlier onset; widespread cortical atrophy (hippocampus), Beta amyloid plaques and neurofibrillary tangles
early changes in personality or behavior; frontotemporal degeneration and hyperphosphorylated tau or ubiquinated TDP43
visual hallucinations and dementia, get cognitive abnormalities before physical abnormalities and onsets must be greater than 1 yr apart; lewy bodies in cortex
multiple arterial infarct and chronic ischemia; step wise decline in cognitive ability w/ late onset memory impairment; MRI shows multiple cortical or subcortical infarcts
rapidly progressive dementia w/ myoclonus and ataxia; spongiform cortex, and prion
increased ICP w/o cause; female, tetracycline, obesity, excess vit A, danazol; headache, tinnitus, diplopia; impaired optic N axoplasmic flow -> papilledema; enlarged blind spot on visual field test, and increased opening pressure on LP and provides temporary headache relief

Question 60

Q

Hydrocephalus

what is it
communicating: what is it, sxs
normal pressure: affects, when does it occur, sxs, tx
noncommunicating: what is it
ex vacuo vantriculomegaly: what is it

Answer

A

increased CSF
decreased CSF absorption by arachnoid granulations -> increased ICP, papilledema, herniation
affects elderly, CSF pressure elevated only episodically; does not result in increased volume in subarachnoid space; urinary incontinence, gait apraxia, cog dysfunction; reversible with shunt placement
structural blockage of CSF circulation in ventricular system
appearance of increased CSF on imaging but due to decreased brain tissue and neuronal atrophy, ICP is normal

Question 61

Q

MS

what is it
sxs
exacerbated
clinical course
affects
dx
tx

Answer

A

AI inflammation that demyelinates CNS
acute optic neuritis (painful unilateral vision loss), brain stem syndrome (ataxia, scanning speech, intention tremor), pyramidal demylenation (weakness), spinal cord syndromes (electric shock like sensation)
increased boy temp
relapsing and remitting
women in 20s and 30s
high IgG levels and myelin basic protein in CSF, MRI is gold standard w/ multiple white matter lesions disseminated in space and time
stop relapses and halt/slow progression w/ beta interferon, glatiramer, natalizumab

Question 62

Q

Other demyelinating and dysmyelinating disorders

osmotic demyelination syndrome: what is it/ cause; sxs
acute inflammatory demyelinating: subtype, what is it, facilitated by, sxs, CSF, tx
acute disseminated encephalomyelitis: what is it, sxs
charcot-marie-tooth: what is it, genetics, sxs,
progressive multifocal leukoencephalopathy: what is it, secondary to, risk to pt, areas involved,

Answer

A

massive axonal demyelination in pontine white matter secondary to osmotic changes; iatrogenic bc of hyponatremia and rapid shifts of osmolytes; acute paralysis, dysarthria, dysphagia, diplopia; locked in syndrome
subtype of guillian-bare syndrome; AI condition that destroys schwann cells via inflammation; facilitated by molecular mimicry and triggered by innoculation or stress (campylobacter jejuni); symmetric ascending muscle weakness and depressed DTRs in LE, facial paralysis, and respiratory failure; increase in CSF protein w/ normal cell count; plamapharesis or IV Ig
multi-focal inflammation and demyelination after infection or vaccination, presents w/ rapidly progressive multifocal neuro sxs
hereditary nerve disorder relate to defective production of proteins involved in structure and function of peripheral nerves or myelin sheath; typically auto dominant; associated w/ foot deformities, LE weakness and sensory deficits; CMT1A is caused by PMP22 gene duplication
demyelination of CNS because of destruction of oligodendrocytes secondary to reactivation of JC virus, seen in 2-4% of patients w/ AIDS, rapidly progressive, involves parietal and occiptal areas, visual sxs are common

Question 63

Q

Neurocutaneous disorders

struge-weber
tuberous sclerosis
neurofibromatosis type I
neurofibromatosis type II
von hippel lindau dx

Answer

A

congenital nonhereditary anomaly of neural crest derivatives, somatic mosaicism of activating mutation; affects capillary sized blood vessels -> port wine stain in V1/2 distribution and ipsilateral leptomeningeal angioma -> seizures/epilepsy
Auto dom, TSC1 mutation on chrom 9 or TSC2 mutation on chrom 16; hamartoma in CNS, angiofibromas, mitral regurg, ash leaf spot, cardiac rhabdomyoma, mental retardation
AD, mutation in NF1 on chrom 17; cafe au lait spot, intellectual disability, cutaneous neurofibromas, lisch nodule, optic glioma
AD, mutation in NF2 on chrom 22; bilateral vestibular schwannomas, juvenile cataracts, meningiomas, ependymomas
AD, deletion of VHL on chrom 3; hemangioblastoma in retina, brain stem, cerebellum, spine, angiomatosis, bilateral renal cell carcinoma, pheochromocytoma

Question 64

Q

Adult brain tumors

glioblastoma multiforme: what is it, prognosis, location
oligodendroglioma: common, location, prognosis, x-ray
meningioma: common, prognosis, epi, location, sxs
hemangioblastoma: location, associated w/ , produces
pit adenoma: types
schwannoma: location, involves, along

Answer

A

grade IV astrocytoma, highly malignant, 1 yr survival rate, cerebral hemisphere
rare, slow growing, in frontal lobe, calcified
common, benign, common in females, parasaggital extra-axial region, asymptomatic or present w/ seizures or focal neuro sign
cerebellar, von hippel lindau when round with retinal angioma, can produce EPO -> secondary polycythemia
nonfunction (do not produce hormone) or functioning (produce hormones)
at cerebellopontine angle involving both VII and VIII but can be along any peripheral nerves, resection or radiosurgery

Answer 65

A

low grade astrocytoma, most common tumor in childhood, well circumscribed, posterior fossa, supratentorial, benign, good prognosis
malignant brain tumor in childhood, involves cerebellum, can compress 4th ventricle cauing headaches and papilledema; form of primitive neuroectodermal tumor
found in 4th ventricle, can cause hydrocephalus, poor prognosis
most common childhood supratentorial tumor, can be confused with pit adenoma
tumor of pineal gland, can cause parinaud syndrome ( compression of tectum -> vertical gaze palsy)

Answer 66

A

causes tonsillar herniation into foramen magnum

Answer 67

A

weak - UMN: +, LMN:+
atrophy - UMN: -, LMN: +
fasiculation - UMN: -, LMN: +
reflexes - UMN: increased, LMN: decreased
tone - UMN: increase, LMN: decreased
babinski - UMN: +, LMN: -
spastic - UMN: +, LMN: -
flaccid - UMN: -, LMN: +
clasp - UMN: +, LMN: -

Answer 68

A

congenital degeration of ant horn of spinal cors, symmetric weakness, floppy baby w/ marked hypotonia and tongue fasiculations, auto recessive SMN1 mutation
combined UMN and LMN degeneration, no sensory deficits; defect in superoxide dismutase 1
caused y tertiary syphilis, results from degeneration/demyelination of dorsal columns and roots -> progressive sensory ataxia, + romberg sign and absent DTR, argyll robertson pupils
syrinx expands and damages ant white commisure of spinothalamic tract -> bilateral symmetrical loss of pain and temp sensation in cape distribution, chiari I malformation
subacute demyleination of spinocerebellar tracts lateral coticospinal and dorsal columns; ataxic gait, paresthesia, impaired vibration sense

Answer 69

A

polio virus -> replicates in oropharynx and small intestine before spreading through blood into CNS
destruction of cells in anterior horn of spinal cord
signs of LMN lesion
CSF shows increased WBC and slight increase of protein

Answer 70

A

hemi-section of spinal cord
ipsilateral loss of all sensation at level oflesion, ipsi LMN signs at level and ipsi UMN signs above lesion
ipsi loss of proprioception, vibration, light touch below level of lesion
contra loss of pain, temp, and crude touch below level of lesion

Answer 71

A

auto recessive tri nuc repeat on chrom 9
impairs mito functioning
degeneration of lateral corticospinal tract, spinocerebellar tract, dorsal column; staggering gait, frequent falling, nystagmus, dysarthria, hammer toes, DM, HCM

Answer 72

A

most common cause of peripheral facial palsy
develops after HSV reactivation
corticosteroids +/- acyclovir
lyme dx, herpes zosterm sarcoidosis, tumor, DM

Answer 73

A

overgrowth of desquamated keratin debris within middle ear space,
may erode ossicles or mastoid air cells
conductive hearing loss
painless otorhea

Answer 74

A

pinna, auditory canal and TM; transfers sound waves via vibration of TM
air filled space w/ 3 bones that conduct and amplify sound from TM to inner ear
Snail shaped fluid filled cochlea; basilar membrane w/ hair cells vibrates secondary to sound waves causing the hair cells to move and send signal; low is heard at apex and high heard at base

Answer 75

A

W: equal, R: air> bone
W: localize to affected ear; R: bone>air
W: localize to unaffected ear; R: air> bone

Answer 76

A

damage to stereociliated cells in organ of Corti; Loss of high frequency hearing first; Sudden extreme loud noises can produce hearing loss due to tympanic membrane rupture
aging related progressive, bilateral sensorineural hearing loss, higher frequencies first, destruction of hair cells at cochlear base

Answer 77

A

sensation of spinning while actually stationary
inner ear etiology (semi circ canal debris, vestibular nerve infection), menniere dx (vertigo, tinnitus, hearing loss) -> low salt diet and diuretics, BPPV (otolith out of place in semi-circ canals) -> epley maneuver

Answer 78

A

sensation of spinning while actually stationary
inner ear etiology (semi circ canal debris, vestibular nerve infection), menniere dx (vertigo, tinnitus, hearing loss) -> low salt diet and diuretics, BPPV (otolith out of place in semi-circ canals) -> epley maneuver
brain stem or cerebellar lesion; directional or purely vertical nystagmus, diplopia, dysmetria and focal neuro findings

Answer 79

A

inflammation of conjunctiva
allergic: itchy eyes, bilateral
bacterial: pus, treat w/ anti biotics
viral: most common, often adenovirus, sparse mucus discharge w/ swollen pre-auricular node, self limited

Answer 80

A

cause of impaired vision, corrected with glasses
farsighted (can only see far), eye too short for refractive power of cornea and lens -> light focused behind retina, convex lenses
nearsightedness (can only see near), eye too long for refractive power of cornea and lens -> light focused in front of retina, concave lenses
abnormal curvature of cornea -> different refractive power at diff axes, cylindrical lenses

Answer 81

A

aging related impaired accomodation
decrease in lens elasticity, changes in lens curvature, decreased ciliary muscle strength
reading glasses

Answer 82

A

opacification of lens
painless, bilateral, glare and decreased vision
age, smoking, EtOH, sunlight, prolonged corticosteroid, DM, trauma, infection
galactokinase def, trisomy 21, TORCHES infections, marfans, alport syndrome

Answer 83

A

ciliary bodies produce AQH -> travels through posterior chamber between iris and lens -> into anterior chamber -> into trabecular meshwork -> into canal of shlemm to nose or drains into uvea and sclera

increased drainage into uvea and sclera increased
increased into canal of schlem
decrease formation of AQH from ciliary body

Answer 84

A

optic disk atrophy w/ cupping bc of increase intraocular pressure and progressive peripheral visual field loss
primary cause is unknown but can be caused secondarily to uveitis, vitreous hemorrhage or retinal detachment -> causes blockage of meshwork
enlargement or anterior movement of lens against iris blocking outflow of AQH -> iris pushed up against cornea -> flow impeded into trabecular meshwork; chronic- asynptomatic w/ damage to optic nerve and peripheral vision, acute- opthalmic emergency, painful red eye with sudden vision loss, frontal headache, fixed pupil, n/v

Answer 85

A

inflammation of uvea
iritis
choriditis, retinitis
accumulation of pus in ant chamber or conjunctivits
sarcoidosis, RA, juvenile idiopathic arthritis

Answer 86

A

degenration of macula
loss of central vision
depostion of drusen in between bruch membrane and retinal epi cells; multivitamin and antioxidant supplement
rapid; caused by bleeding secondary to chorioid neovascularization; anti-VEGF injection (bevacizumab)

Answer 87

A

retinal damage caused by chroni hyperglycemia
non prolif: damaged capillaries leak blood -> fluid and lipid seep into retina -> hemorrhage and macular edema; control blood sugar
prolif: chronic hypoxia results in new blood vessels; anti-vegf injection

Answer 88

A

retinal damage bc of chronic uncontrolled HTN

- flame shaped retinal hemm, cotton wool spots, papilledema

Answer 89

A

blockage of central or branch retinal v bs of compression from nearby arterial atherosclerosis
retinal hemm and venous engrogement

Answer 90

A

separation of neurosensory layer of retina from outermost pigmented epi -> degeneration of photoreceptors -> vision loss
crinkling of retinal tissue and change in vessel direction
common in patient w/ myopia or hx of head trauma
preceded by posterior vitreous detachment
monocular loss like curtain coming down

Answer 91

A

acute, painless monocular vision loss
retina cloudy w/ attenuated vessels and cherry red spot at fovea
evaluate for embolic source

Answer 92

A

inherited retinal degeration
painless, progressive vision loss beginning with night time blindness
bone spicule shaped depostis around macula

Answer 93

A

optic disc swelling due to increased ICP
enlarged blind spot
elevated optic dic w/ blurred margins

Answer 94

A

loss of red reflex

- RB, congenital cataract, toxcariasis

Answer 95

A

constricton; controlled by PS; edinger westphal nuc to ciliary gangion vic CNIII, synpase on short ciliary nerves to sphincter pupillae muscles
dilation, sympathetic; hypothal to ciliospinal center (syn)-> exit at T1 to sup cervical ganglion (synapse) travel along vessel -> onto long ciliary N to pupillary dilator muscle

Answer 96

A

light in either retina sends signal via CN II to pretectal nuc -> activated bilateral edinger-westphal nuc -> pupils constric bilaterally

Answer 97

A

when light is shined into one eye, both eyes constrict, but when light is swung to other eye both eyes dilate
impaired conduction of light signal along injured optic nerve

Answer 98

A

sympathetic denervation of face
ptosis (eyelid drops, miosis (pupil constricts), anhydrosis (no sweat)
lesions along symp chain

Answer 99

A

SR: up and lateral
IR: down and lateral
LR: lateral
MR: medial
IO: up and medial
SO: down and medial

Answer 100

A

ischemia, PCOmm aneursym, cavernous sinus thrombosis, midbrain stroke
motor primarily affected by vascular dx; ptosis, down and out gaze
paraymathetic mostly affected by compression; diminished or absent pupilary light reflex

Answer 101

A

pupil is higher in affected eye

- head tilt to contralateral side to compensate for lack of intortion of affected eye

Answer 102

A

affected eye unable to AB-duct

Answer 103

A

vision loss from entire right eye
vision loss from the lateral vision fields in both eyes; pit lesion
vision loss from the left vision fields in both eyes
vision loss from the left upper vision fields in both eyes; right temporal lesion, MCA
vision loss from the left lower vision fields in both eyes; right parietal lesion, MCA
vision loss from the left vision fields in both eyes but with central vision spared; right occipital lesion, PCA
central vision loss; macular degeneration

Answer 104

A

Meyers: lower retina, loops around inferior horn of lateral ventricle
Dorsal: superior retina, takes shortest path to internal capsule

Answer 105

A

medial longitudinal fasiculus: pair of tracts that allows for cross talk between nuclei of CN III and VI; both eyes

Answer 106

A

medial longitudinal fasiculus: pair of tracts that allows for cross talk between nuclei of CN III and VI; both eyes are able to move in same horizontal direction
a conjugate horizontal gaze palsy; lack of comm so that when VI activates ipsi lateral rectus contralateral III does not stimulate medial rectus to contract
named by eye unable to adduct

Answer 107

A

benz: status epi; increased GABA action; sedation,tolerance, dependence, resp depression; eclampsia
carb: partial, and tonic clonic; blocks Na channels; diplopia, ataxia, liver tox, teratogens
etho: absence; blocks thalamic T-type Ca channels; fatigue, GI distress, headache, itching
gaba: partial, inhibits high voltage activated Ca channels, GABA analog; sedation, ataxia
lamo: partial, tonic-clonic, absence; blocks voltage gated Na channels, inhibits release of glutamate; SJS
leve: partial, tonic clonic; modulate GABA and glut release; neuro sxs
pheno: partial, tonic-clonic, status epi; increased GABA action; sedation, tolerance, dependents
pheny: partial, tonic- clonic, status epi; block Na channels; P450 induction, hirsutism, nystagmus
topira: partial, tonic-clonic; blocks Na channels and increase GABA action; sedation kidney stones, weight loss; used for migraine prophylaxis
valproic: parital, tonic-clonic, absence; Increase NA inactivation and increase GABA concentration; GI disress, hepatotox; migraine prophylaxis
viga: partial; increase GABA, irreversible; permanent visual loss

Answer 108

A

barbital
facilitate GABA action by increased durationof Cl channel opening
sedative for anxiety, seizures, insomnia, induction of anesthesia
resp and cardio depression

Answer 109

A

pam and lam
facilitate GABA action by increasing frequency of Cl channel opening, long half life
anxiety, panic disorder, status epi, detox
dependence, CNS depression

Answer 110

A

zolpidem, zaleplon, esZopiclone
insomnia
act via the BZ GABA receptor
flumazenil
ataxia, headache, confusion

Answer 111

A

insomnia
orexin receptor antagonist
CNS depression, headache

Answer 112

A

insomnia
melatonin receptor agonist, binds MT1 and 2 in suprachiasmatic nuc
dizziness, nausea, fatigue, headache

Answer 113

A

acute migraine, and cluster headache
5-HT antagonist, inhibit trigeminal N activation, prevent vasoactive peptide release, induce vasoconstriction
coronary vasospasm, mild paresthesia

Answer 114

A

bromocriptine -> ergot derivative, pramipexole, ropinirole -> non ergot derivative
amatadine
carbidopa -> inhibits DOPA decarboxylase; entacapone -> prevents peripheral L-DOPA degradation by inhibiting COMT
act centrally to inhibit breakdown of dopamine; selegiline: block coversion of dopamine into DOPAC, entacapone
benztropine: antimuscarinic, improves tremor and rigidity but has little effect on bradykinesia

Answer 115

A

donepezil; AchE inhibitor OR memantine; NMDA receptor antagonist, helps prevent excitotoxicity; used for moderate to advanved dementia
riluzole; decrease neuron glutamate excitotoxicity; only to increase survival
tetrabenazine: inhibit vesicular monoamine transporter -> decrease dopamine vesicle packaging and release

Answer 116

A

myocardial depression, respiratory depression, post op nausea and vomiting, increased cerebral blood flow
hepatotox, nephrotox, proconvulsant

Answer 117

A

barbituate; short surgical procedures; decreased cerebral blood flow, high lipid solubility
benzo; procedural sedation; cause severe post op respiratory depression
potentiates GABA; rapid anesthesia induction, ICU sedation; may cause resp depression
NMDA receptor antagonist; dissociative anesthesia, increased cerebral blood flow

Answer 118

A

block Na channels
given with vasoconstrictors to enhance local action
minor surgical procedures, spinal anesthesia

Answer 119

A

succinylcholine: strong Ach receptor agonist, procedures sustained depolarization and prevents muscle contraction; reversal of blockade; complication include hypercalcemia, hyperkalemia, malignant hyperthermia
Ach anatognist; cur

Answer 120

A

GABA receptor agonist in spinal cord, muscle spasticity dystonia; MS
acts within CNS at brainstem, muscle spasticity
prevents release of Ca from SR of skeletal muscle by inhibiting ryanodine receptor; malignant hyperthermia
alpha 2 agonist, acts centrally; muscle spasticity, MS, ALS, cerebral palsy

Answer 121

A

acts as agonist at opioid receptors to modulate synaptic transmission; close pre-synaptic Ca channels opens K channels -> decrease synaptic transmission
full agonist: morphine, codeine, heroine; partial: buprenorphine; mixed: nalbuphine, antagonist: naloxone
moderate to severe or refractory pain, acute pulm edema, maitenance for heroin addicts
nausea, vomitting, pruritis, addiction, resp depression

Answer 122

A

k opioid receptor agonist and mu opioid receptor weak atagonist or partial agonist; analgesia for moderate to severe pain
k opioid receptor agnist and mu opioid partial agonist; severe pain

Answer 123

A

very weak opioid agonist, also inhibits reuptake of norepi and serotonin
chronic pain

Answer 124

A

decrease AQH synthesis
decrease AQH synthesis and vasoconstriction; do not use in closed-angle glaucoma
acetazolamide; decrease outflow of AQH synthesis via inhibition of carbonic anhydrase
increase outflow of AQH via decrease resistance of flow through uveoscleral pathway
increase outflow of AQH via contraction of ciliary muscle and opening of trabecular meshwork