Neuro Flashcards

1
Q

vision loss described as a dark curtain falling down over eye

A

amaurosis fugax

- causes transient vision loss due to ischemia from hypoperfusion of the optic nerve, retina, or both

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2
Q

what produces CSF?

A

choroid plexus
- choroid plexus papilloma may result in increased CSF production and/or obstruction of CSF outflow, either of which can lead to hydrocephalus

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3
Q

where is the amygdala located?

A

medial temporal lobe anterior to the hippocampus and near the lateral ventricle

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4
Q

where is the lesion?

- Kluver-Bucy syndrome: characterized by a loss of fear, hyperorality, and hypersexuality

A

amygdala

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5
Q

where is the lesion?
- involuntary movements including resting tremor, sudden jerking motions called chorea, and purposeless writhing movements known as athetosis

A

basal nuclei

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6
Q

where is the lesion?

- truncal ataxia, gait ataxia, or appendicular ataxia. The latter is often associated with intention tremor

A

cerebellum

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7
Q

what brain lesion results in retrograde amnesia?

A

hippocampus

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8
Q

medial temporal lobe posterior to the amygdala and near the lateral ventricle

A

hippocampus

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9
Q

Lateral strabismus (eye rotated down and out), ptosis (drooping eyelid), and pupillary dilation

A

ocular nerve palsy

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10
Q

what is the most common site of an aneurysm causing oculomotor nerve palsy?

A

posterior communicating A

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11
Q

scanning speech, intention tremor, and nystagmus

A

Charcot triad
- can be the initial presentation of multiple sclerosis

look out for waxing/waning sx

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12
Q

young women, in 20-30’s with recurrent episodes of limb weakness, vision changes, and loss of bladder control

  • MRI lesions appear as “white” plaques, mostly near the ventricles (aka multiple ovoid, periventricular white matter lesions)
  • optic neuritis is common
A

MS

- central demyelinating autoimmune disease that targets oligodendrocytes (CNS myelin)

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13
Q

how is CSF is returned to the vascular system?

A

through arachnoid granulations at the interface of the subarachnoid space and dural venous sinuses

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14
Q

what do schwan cells produce?

A

myelin for peripheral nerves

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15
Q

microglia

A

macrophages of CNS

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16
Q

sensations of light touch, vibration, and proprioception

A

posterior column

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17
Q

pain, temperature, crude touch

A

spinothalamic tract

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18
Q

what does the lateral horn contain?

A

preganglionic sympathetic neurons lying deep to the more superficial white matter

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19
Q

roots of long thoracic nerve?

A

C5-7

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20
Q

roots of phrenic nerve?

A

C3-5

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21
Q

roots of dorsal scapular nerve?

A

C5

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22
Q

seizures, neuro-regression, decreased motor skills, neuroimaging, and cherry red retinal spots?
- hyporeflexia

A

Tay-Sachs

  • deficiency in β-hexosaminidase A
  • ultimately, patients develop seizures, blindness, and spasticity
  • less severe than Niemann-Pick
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23
Q

what is the only cranial nerve that emerges posteriorly from the brainstem and the only one to innervate structures contralateral to its exit from the brainstem?

A

CN IV: trochlear

- emerges from the midbrain just inferior to the inferior colliculus

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24
Q

eye that is abducted and depressed

A

lateral strabismus

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25
Q

what causes intention tremors?

A

damage to cerebellum
- MCC of intention tremors are stroke, multiple sclerosis of the cerebellum, or midbrain trauma that affects cerebellar outflow

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26
Q

weakness/paralysis, hyperreflexia, spasticity

A

UMN signs

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27
Q

when would you see a resting tremor?

A

Parkinsons

- damage to substantia nigra

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28
Q

buildup of amyloid plaques and neurofibrillary tangles in neurons of the cerebral cortex, thus decreasing acetylcholine transmission

A

Alzheimers

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29
Q

cerebral cortex and the epidermis are derived from what layer of the embryo?

A

ectoderm

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30
Q

what embryonic layer forms gastrointestinal tract, pancreas, liver, parathyroid, lungs, thymus, and thyroid follicular cells

A

endoderm

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31
Q

wht embryonic layer forms bone, connective tissue, muscle, and lymphatics
- organs include spleen, bladder, kidneys, vagina, adrenal cortex, testes/ovaries, urethra, and blood

A

mesoderm

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32
Q

Temporal lobe necrosis, often unilateral, in the setting of seizures and fevers is consistent with what?

A

HSV encephalitis

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33
Q

what is the MCC of septic arthritis in US?

A

N. gonorrhea

- migratory polyarthritis, tenosynovitis, dermatitis

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34
Q

ptosis (drooping eyelid), miosis (constricted pupil), and anhidrosis (loss of facial sweating)

A

Horner syndrome

- PAM is NOT sympathetic!! (loss of SNS stimulation)

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35
Q

what does ocular motor nerve damage cause?

A

ptosis, mydriasis, lateral strabismus

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36
Q

cotton swab on skin tests what?

A

meissner’s corpuscles

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37
Q

deep tactile mechanoreceptors located in the dermis of the integument. They have large receptive fields and respond best to skin stretch for as long as the stimulus is present. They are important for detecting changes in finger position, movement allowing alterations in grip, and deformations within the joint capsule

A

ruffini corpuscles

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38
Q

headaches, seizures, confusion, cognitive dysfunction, focal weakness, sensory abnormalities, or aphasia

  • tumors arise in the white matter of the cerebral hemispheres, predominantly in the frontal lobes
  • fried egg appearance on bx (rounded cells with clear cytoplasm that surround a dense central nucleus)
  • vast vasculature of finely branching capillaries that give it the appearance of chicken wire
A

oligodendroglioma

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39
Q

5-10 y/o with symptoms of increased intracranial pressure, such as headaches, projectile vomiting, papilledema, a decrease in visual acuity, blurred vision, or bitemporal hemianopsia

  • both a solid and cystic component
  • microscopic examination will reveal abundant cholesterol crystals in the fluid
A

craniopharyngioma

- arise from Rathke’s pouch

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40
Q

CNS tumors that arise contiguously to the meninges

  • focal weakness, dysphasia, apathy, somnolence, and new onset seizures due to irritation and compression of the underlying cortex
  • found at the surface of the brain, either over the convexity or at the skull base
A

meningioma

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41
Q

pt in first two decades of life w/headache, nausea, vomiting, irritability, ataxia, and visual complaints

  • CT or MRI will reveal a unilocular or multilocular cyst with an associated tumor nodule
  • Rosenthal fibers which are elongated corkscrew shaped eosinophilic fibers that stain positively for GFAP
A

pilocytic astrocytoma

- benign CNS neoplasm usually in cerebellum

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42
Q

receives auditory information from the inferior colliculus and the superior olivary complex and projects to the primary auditory cortex of the temporal lobe

A

medial geniculate nucleus

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43
Q

receives input from the basal nuclei and cerebellum and projects to the primary motor cortex and the association motor cortices. It is involved in controlling and coordinating movement

A

ventral lateral nucleus

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44
Q

receives somatosensory information from the body (medial lemniscus for light touch, vibration, and position sense; spinothalamic tract for pain and temperature sensation) and projects to the primary somatosensory cortex of the parietal lobe

A

ventral posterolateral nucleus

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45
Q

receives somatosensory information from the face and projects to the primary somatosensory cortex of the parietal lobe

A

ventral posteromedial nucleus

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46
Q

receives visual information from the retina and projects to the primary visual cortex of the occipital lobe

A

lateral geniculate nucleus of the thalamus

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47
Q
  • Loss of ipsilateral upper motor neuron function below the level of the lesion
  • Loss of ipsilateral tactile discrimination, vibration, and proprioception below the level of the lesion
  • Loss of contralateral pain and temperature sensation beginning 2 to 3 levels below the level of the lesion
A

Brown-Sequard syndrome

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48
Q

pramiprexole, ropinirole

A

patients with parkinsonism who are taking levodopa and are experiencing end-of-dose akinesia or on-off phenomenon
- can also be used in patients becoming resistant to treatment with levodopa

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49
Q

what major complication is associated with Ehlers-Danlos syndrome?

A

berry aneurysm in the Circle of Wilis

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50
Q

autoantibody attacks the myelin in the sensory roots and causes often-severe weakness for days to months

A

Guillian-Barre

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51
Q

what sleep stage has sleep spindles and K complexes on EEG?

A

stage 2

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52
Q

what sleep stage has dropout of alpha waves and slow rolling eye movements

A

stage 1

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53
Q

cognitive decline, gait instability, and loss of bladder function

A

normal pressure hydrocephalus

- wet, wacky, and wobbly

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54
Q

connection linking the Wernicke and Broca areas of the dominant cerebral hemisphere
- Patients are able to speak fluently and with comprehension, but have some difficulty finding specific words. Repetition ability is lost

A

arcuate fasciculus

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55
Q

lesion affecting Brodmann areas 44 and 45

- located in the inferior frontal gyrus of the dominant cerebral hemisphere

A

Broca (expressive) aphasia

- lesion in left MCA

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56
Q

lesion affecting Brodmann area 22

- posterior aspect of the superior temporal gyrus of the dominant cerebral hemisphere

A

Wernicke aphasia

- lesion in left MCA

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57
Q

lesion affecting the mammillary bodies of the hypothalamus

- triad of eye movement abnormalities, ataxia, and confusion, accompanied by profound memory loss

A

Wernicke-Korsakoff syndrome

- thiamine deficiency

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58
Q

compression of what nerve can cause weakness in elbow flexion and decreased sensation for the lateral forearm

A

musculocutaneous N

- pierces coracobrachialis m

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59
Q

when would you see CSF with an elevated protein level with a normal white blood cell count?

A

Guillian-Barre

- elevation of CSF protein is thought to be due to the presence of myelin breakdown products entering the CSF

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60
Q

when would you see red blood cells in the CSF?

A

herpes simplex virus (HSV) meningoencephalitis and subarachnoid hemorrhage (SAH)

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61
Q

young, obese female (20-40’s)

  • idiopathic elevation in CSF pressure that causes papilledema and chronic, diffuse headaches
  • elevated opening pressure with normal cell counts, protein, and glucose levels
A

pseudotumor cerebri

62
Q
  • Progressive decline with eventual Parkinson
  • Vivid visual hallucinations
  • Rapid eye movement sleep disturbances (acting out dreams)
  • Fluctuating attention and alertness
A

Lewy body dementia

63
Q

EEG shows triphasic spikes?

A

Creutzfield-Jacobs

64
Q

what does the paramedian pontine reticular formation help with?

A

it coordinates adduction movement of contralateral eye

  • to look L, L eye activates LR muscle, and the PPRF sends a signal to contralateral MR to adduct (so R eye also looks L)
  • if neither eye can look one direction, most likely a lesion in PPRF
65
Q

MC complication of solder dystocia?

A

Erb-Duchenne palsy (damage to upper trunk C5-6)

- weakness of the deltoid, biceps, and infraspinatus muscles

66
Q

MC site for Berry aneurysm?

A

junction of anterior communicating and anterior cerebral A

- look out for bitemporal hemianopsia

67
Q

microgial cells are stained with what?

A
  • silver* stain

- difficult to visualize on H&E

68
Q

what cells have several important functions in the CNS, including physical support, repair, potassium metabolism, removal of excess neurotransmitters, stimulation of glial scar formation in response to injury, and maintenance of the blood-brain barrier.

A

astrocytes

69
Q

what is the first manifestation of symptomatic hypermagnesemia?

A

loss of DTRs

- look out for in preeclampsia or HELLP, where you are giving them magnesium sulfate

70
Q

stroke of the MCA

- involves upper motor neurons with upper extremity muscles and muscles of the face

A

Damage to the lateral precentral gyrus

71
Q

pt can hear, but responds inappropriately?

A

Wernicke’s aphasia (word salad)

72
Q

good comprehension, good fluency, but repetition is poor?

A

conduction aphasia (arcuate fasciculus)

73
Q

history of blunt-force trauma to the head, transient period of regained consciousness, and subsequent oculomotor nerve palsy
- lens shaped hematoma (bubbles out)

A

epidural hematoma

- rupture of MMA

74
Q

minor bridging veins, inside the cranium and perforating the dura mater, are disrupted

  • slow bleed, delayed neuro sx
  • crescent shaped hematoma (thin, follows curve of skull)
A

subdural hematoma

75
Q

thunderclap headache?

- hyperdensity (white area) in the suprasellar cistern

A

subarachnoid hemorrhage

76
Q

loss of sensation from the right medial arm?

A

medial cutaneous nerve

- musculocutaneous supplies lateral forarm

77
Q
  • normal/mild high CSF opening pressure
  • mildly elevated protein
  • normal glucose
  • predominant lymphocytic infiltrates
A

viral encephalitis

78
Q
  • high CSF opening pressure
  • low glucose
  • high WBC
  • high protein
A

bacterial meningitis

79
Q

peripheral dopa decarboxylase inhibitor, reduces peripheral conversion of levodopa to dopamine
- so more levodopa can cross BBB

A

carbidopa

- levodopa + carbidopa are first line tx for Parkinsons

80
Q

what hypothalamic nuclei monitors thermoregulation?

A

anterior

81
Q

what hypothalamic nuclei produces oxytocin and antidiuretic hormone for transport to the circulatory system. Stimulation causes increased blood volume, blood pressure, and metabolism. Lesion causes diabetes insipidus

A

supraoptic

82
Q

middle-aged female, complains of vision disturbances, muscle weakness that progressively gets worse throughout the day or after use, and difficulty chewing

A

myasthenia gravis

  • ptosis, muscular weakness with sustained activity (usually chewing muscles), and normal pupillary responses
  • thymus abnormalities common (thymomas)
83
Q

drugs of choice for MG?

A

neostigmine or pyridostigmine

- prevent the actions of AChE from degrading ACh in the neuromuscular junction

84
Q

lesion in the medial longitudinal fasciculus (MLF)?

A

internuclear opthalmoplegia -> MS

85
Q

scissoring gait? hyperreflexia?

A

UMN lesion

86
Q

what nerve traverses through the spiral groove on the posterior side of the humerus?

A

radial N

87
Q

looping of single-stranded DNA that triggers the mismatch repair mechanism -> CAG repeats

A

HD (AD)

88
Q

hepatosplenomegaly, bone disease, anemia, thrombocytopenia

- abnormal macrophages

A

Gaucher dz

- lipid laden macrophages d/t a deficiency of lysosomal β-glucocerebrosidase

89
Q

accumulation of necrotic cell debris and foamy macrophages after cerebral infarction?

A

liquefactive necrosis

90
Q

Weakness in elbow extension and decreased sensation for the posterior arm and forearm

A

radial nerve injury

91
Q

what causes trendelenburg gait?

A

gluteus medius injury

- superior gluteal n supplied glut med, glut min, TFL

92
Q

what hypothalamic nucleus mediates circadian rhythm?

A

suprachiasmatic

93
Q

alternating constriction and dilation of both pupils with the swinging flashlight test is characteristic of what?

A

Marcus Gunn pupil

- When the penlight is directed into the eye on the affected side, the pupils appear to dilate

94
Q

what is the most common site of spontaneous hypertensive hemorrhage in patients with long-standing hypertension?

  • lacunar infarcts
  • hispanics and african americans
  • HTN or uncontrolled diabetes
A

lenticulostriate arteries

- supply the internal capsule and basal nuclei

95
Q

impaired vertical gaze, normal to large pupils, light-near dissociation, convergence-retraction nystagmus, and eyelid retraction

A

Perinaud syndrome
- can be caused by a pineal gland tumor (especially in the young), hydrocephalus (due to dilation of suprapineal recess), multiple sclerosis, and brainstem infarction

96
Q

congenital malformation characterized by aplasia or hypoplasia of the cerebellar vermis, cystic dilation of the fourth ventricle, and enlargement of the posterior fossa

A

Dandy Walker malformation

97
Q

Downward displacement of the cerebellar tonsils through the foramen magnum

A

Chiari malformation type I

98
Q

rapidly progressive primary brain malignancy, presenting with a single lesion. Characteristically, it is described as a butterfly-appearing lesion that crosses the midline

A

Glioblastoma multiforme

99
Q

Klumpke palsy what nerve roots?

A

C8-T1

  • falling from a tree branch
  • hyperextension of the metacarpophalangeal joints and hyperflexion of the interphalangeal joints
100
Q

Marcus Gunn pupil is typically associated with diseases of what?

A

the retina or optic nerve

101
Q

what is the one antiseizure med that inhibits CYP450?

A

valproic acid

- Carbamazepine, oxcarbazepine, and phenytoin INDUCE

102
Q

spastic paralysis or paresis, hyperreflexia, and a positive Babinski sign?

A

UMN lesion

103
Q

fasciculations, hyporeflexia?

A

LMN

- Guillian-Bare, ALS

104
Q

40-60 y/o

- periodic episodes of vertigo, sensorineural hearing loss, and tinnitus

A

Meniers disease

  • due to hydropic dilation due to excess endolymphatic fluid in the cochlea
  • look for ear fullness or pressure
105
Q

PREcentral gyrus contains upper motor neurons, while POSTcentral gyus contains what?

A

somatosensory input

106
Q

what foramen does MMA enter the skull through?

A

foramen spinosum

- is terminal branch of maxillary A (from external carotid)

107
Q
  • ipsilateral loss of pain and temperature sensation in the face
  • contralateral loss of pain and temperature sensation in the body
  • dysarthria
  • dysphagia
  • ataxia
A
Wallenburg syndrome (lateral medullary syndrome)
- occlusion of posterior inferior cerebellar A (PICA)
108
Q
  • Ipsilateral face analgesia
  • Contralateral body analgesia
  • Ipsilateral face hemiparesis
  • Ipsilateral deafness
A

lateral pontine syndrome

- occlusion of anterior inferior cerebellar A (AICA)

109
Q

multisystem disorder from defective DNA repair

  • abnormal blood vessel formation commonly seen in the eyes and skin
  • frequent infections of the sinuses and lungs occur
  • increased risk of leukemia or lymphoma
A

ataxia telangiectasia

  • usually presents before 4 years old
  • ATM gene mutation
110
Q

5-25 year old

  • progressive ataxia, dysarthria, and abnormal eye movements
  • proprioception, vibration, and deep tendon reflexes are lost
  • hypertrophic cardiomyopathy and diabetes mellitus
  • pes cavus or scoliosis
A
freidrich ataxia (AR)
- MC ataxia
111
Q

epistaxis, gastrointestinal bleeding, iron deficiency anemia, and telangiectasia

A

Osler-Weber Rendu syndrome

112
Q

MCA -> inferior trunk vs superior trunk

A
superior = broca
inferior = wernicke
113
Q

bilateral loss of pain and temperature sensation in the upper extremities

A

syringomyelia

  • associated with Chiari malformation Type I
  • look for hydrocephalus as well
114
Q

somatosensory pathways for the face run through which thalamic nucleus?

A

ventral posteriomedial

- ventral posteriolateral is somatosensory for the body

115
Q

lateral geniculate nucleus vs medial geniculate nucleus?

A

medial: primary auditory cortex

lateral geniculate nucleus: primary visual cortex

116
Q

tumor most often in the cerebellum

  • common in von Hippel-Lindau syndrome
  • can produce erythropoietin -> secondary polycythemia.
  • histo will reveal foamy cells with a high vascularity
A

hemangioblastoma

117
Q

tumors that arise within the ependymal lining of the ventricles

  • in kids: MC near 4th ventricle
  • in adults: MC in lining of central spinal canal
  • new onset seizures, insidious onset of lethargy, headache, nausea, and vomiting
  • “toothpaste tumor” that squeezes into the ventricle
A

ependymoma

- associated w/ neurofibromatosis type II

118
Q

medial strabismus (adduction) at rest and an abduction deficit when attempting to gaze laterally

A

abducens nerve palsy
- vs internuclear opthalmoplegia (seen in MS), which is adduction weakness for one eye, with normal abduction for the other eye, while attempting lateral gaze

119
Q

weakness in the contralateral lower limb with relative sparing of the upper limb and face
- bowel/bladder incontinence

A

ACA stroke

120
Q

weakness, hemineglect in contralateral upper extremity

A

MCA stroke

- if on left side, may also see expressive aphasia

121
Q

upper extremity weakness contralateral to the lesion, and dysarthria due to damage to upper motor neurons that innervate speech muscles

A

MCA stroke affecting the primary motor cortex

122
Q

what CN provides taste sensation to the anterior tongue?

A

facial nerve

- exits skull at internal auditory meatus

123
Q

what CN causes secretion of the parotid by providing parasympathetic innervation?

A

hypoglossal nerve

124
Q

ipsilateral third nerve palsy causing “down and out” eye deviation, ptosis, mydriasis, and contralateral limb weakness/hemiparesis

A

Weber syndrome

125
Q

what CN lesion causes

  • decreased sensation/taste of the posterior third of the tongue
  • diminished sensation of the soft palate/tragus/mastoid region
  • mild dysphagia
A

CN IX palsy - glossopharyngeal

126
Q

what controls the gag reflex?

A

glossopharyngeal (CN IX) and vagus (CN X) nerves

- also innervate the posterior pharynx, posterior 1/3 of the tongue, soft palate, and stylopharyngeus muscle

127
Q

sharp, stabbing pain in the lower jaw, teeth, and cheek

- episodes occur during chewing or brushing teeth and last for a few seconds at a time

A

trigeminal neuralgia

- tx is carbemazepine (anticonvulsant that blocks sodium channels to inhibit action potential propagation)

128
Q

cherry red fovea (center of macula) and hypotonia

  • hepatosplenomegaly , feeding difficulties, and loss of early motor skills in the first few months of life
  • areflexia
A

Niemann-Pick

  • deficiency in acid sphingomyelinase
  • NO hepatosplenomegaly in Tay-Sachs
  • hyperreflexia in Tay-Sachs
129
Q

unilateral facial weakness, facial droop, hyperacusis, and a featureless brow

A

Bell’s palsy (facial N)

130
Q

facial N exits the skull through which foramen?

A

stylomastoid foramen

131
Q

valley fever, SW US, earthquakes?

- large spherules with endospores

A

Coccidioides immitis

132
Q

involuntary hyperkinesia continuous during consciousness and diminished upon sleep

A

hemibalismus

- lesion in contralateral subthalamic nucleus (w/in basal ganglia)

133
Q

postviral symptoms of nausea, vomiting, dizziness, and vertigo with preserved hearing and ambulation

A

vestibular neuritis

- sx should start to improve in 48 hrs

134
Q

paresis or paralysis of the contralateral upper extremity and lower face due to an upper motor neuron (UMN) lesion

A

MCA stroke, superior trunk

- uvula deviates toward the strong side and the tongue toward the weak side

135
Q

what nucleus is located in the caudal pons?

A

facial motor nucleus

136
Q

bilateral weakness and loss of pain and temperature sensations below the lesion, with sparing of light touch sensation

A

occlusion of anterior spinal artery

- supplies all of the spinal cord except the posterior columns (which is why light touch is spared)

137
Q

caudate nucleus degeneration?

A

huntington (AD)

  • xsome 4
  • chorea, depression, dementia
138
Q
  1. confused
  2. ataxic gait
  3. vision problems
  4. anterograde amnesia
A

Wernicke-Korsakoff syndrome (thiamine def)

- areas most affected include the mammillary bodies, the thalamus, and the periaqueductal gray matter

139
Q

right superior quadrantanopsia, the lesion where?

A

left temporal radiation

140
Q

periventricular plaques and oligoclonal bands?

A

MS

141
Q

neurofibrillary tangles in the cerebral cortex of the brain.
- the result of β-amyloid protein deposition leading to tau protein aggregation

A

AD

  • proteins cause the destruction of cerebral neurons, and over many years, result in atrophy of the entire cortex
  • linked to Down syndrome!
142
Q

atrophy of the caudate nuclei

- enlargement of lateral ventricles

A

Huntington’s (AD)

- cognitive decline, chorea, family hx

143
Q

what cells produce aqueous humor, and are target of glaucoma meds?

A

epithelial cells of the ciliary body

144
Q

ventromedial hypothalamic nuclei?

A

mediates satiety

- destruction -> hyperphagia

145
Q

ventrolateral hypothalamic nuclei?

A

mediates hunger

- destruction -> anorexia

146
Q

anterior hypothalamic nuclei?

A

mediates heat dissipation

- destruction -> hyperthermia

147
Q

posterior hypothalamic nuclei?

A

mediates heat conservation

- destruction -> hypothermia

148
Q

arcuate hypothalamic nuclei?

A

secretion of dopamine (inhibits prolactin)

- GHRH

149
Q

medial preoptic hypothalamic nuclei?

A

secretion of GnRH

- mediates sexual behavior

150
Q

paraventricular hypothalamic nuclei?

A

secretion of oxytocin, CRH, TRH, small amounts of ADH

151
Q

supraoptic hypothalamic nuclei?

A

secretion of ADH and small amount of oxytocin

152
Q

suprachiasmatic hypothalamic nuclei?

A

regulation of circadian rhythm and pineal gland function