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Step 1 > Neuro- Anatomy and physiology > Flashcards

Neuro- Anatomy and physiology Flashcards

1
Q

What does the Diencephalon become?

A

The thalamus

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2
Q

What does the telencephalon become?

A

the cerebral hemispheres

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3
Q

What does the mesencephalon become?

A

the midbrain

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4
Q

what does the metencephalon become?

A

The pons and the cerebellum

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5
Q

What does the myeencephalon become

A

the medulla

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6
Q

What is the origin of the ependymal cells, oligodendtroglia, astrocytes, and microglia?

A

ependymal cells, oligodendgroglia, astrocytes= neuroectoderm

microglia= mesoderm

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7
Q

What markers in the amniotic fluid indicate spina bifida?

A

AFP, AChE

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8
Q

What forebrain anomaly is associated with maternal diabetes?

A

Anencephaly

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9
Q

Often presents with lumbosacral myelomeningocele and paralysis below the defect

A

Chiari II

herniation of cerebellar tonsils and vermis through the foramen magnum

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10
Q

What presents with a dilated 4th ventricle and agenesis of the cerebellar vermis?

A

Dandy Walker

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11
Q

What neuronal cells stain positive for GFAP?

A

astrocytes

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12
Q

What electrolyte is in high concentration in the nodes of ranvier?

A

Na+

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13
Q

What presents as a cape like bilateral loss of pain and temperature sensation in upper extremities?

A

syringomyelia

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14
Q

What malformation is associated with syringomyelia?

A

Chiari I malformation

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15
Q

What levels are most often affected by syringomyelia?

A

C8-T1

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16
Q

What do multinucleated giant cells in the CNS indicate?

A

HIV-infected microglia

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17
Q

What is Wallerian degeneration?

A

Degeneration of an axon distal to the injury

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18
Q

What cells in the CNS have a “fried egg” appearance?

A

oligodendroglia

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19
Q

What are schwann cells derived from?

A

neural crest

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20
Q

What cell type is destroyed in Guillain-Barre?

A

schwann cells

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21
Q

What is the location and nerve associated with an acoustic neuroma?

A

CNVIII

internal acoustic meatus

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22
Q

What syndrome is associated with bilateral acoustic neuroma?

A

Neurofibromatosis type 2

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23
Q

Describe C nerve fibers. Where are the located and what do they sense?

A

slow, unmyelinated fibers
epidermis and some viscera
pain and temperature

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24
Q

Describe Ad fibers. Where are the located and what do they sense?

A

fast, myelinated fibers
epidermis and some viscera
pain and temperature

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25
Q

Describe meissner corpuscles. Where are the located and what do they sense?

A

large, myelinated fibers
glabrous skin
dynamic, fine/light touch; position sense

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26
Q

Describe pacinian corpuscles. Where are the located and what do they sense?

A

large, myelinated fibers
hypodermis, ligament, joint
vibration, pressure
“passionian corpuscle senses vibration)

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27
Q

Describe Merkel disc. Where are the located and what do they sense?

A

large, myelinated fibers, adapt slowly
Basal epidermal layer, hair follicle
pressure, deep static touch, position sense

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28
Q

What layer of the peripheral nerve is responsible for a permeability barrier and must be reattached in limb reattachment?

A

perineurium

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29
Q

Where is norepinephrine produced?

A

locus ceruleus (pons)

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30
Q

Where is dopamine produced?

A

ventral tegmentum and SNc (midbrain)

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31
Q

Where is 5-HT produced?

A

Raphe nucelus (pons, medulla, midbrain)

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32
Q

Where is ACh produced?

A

Basal nucleus of Meynert

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33
Q

Where is GABA produced?

A

Nucleus accumbens

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34
Q

What 3 neurotransmitters are altered in Huntington?

A

Dopamine incr

ACh, GABA decr

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35
Q

What 3 neurotransmitters are altered in Parkinson?

A

Dopamine decr

5-HT and ACh incr

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36
Q

What neurtransmitter is decreased in Alzheimers?

A

ACh

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37
Q

What results when the endothelial tight junctions are destroyed (eg infarction or neoplasm)?

A

vasogenic edema

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38
Q

What does the OVLT of the hypothalamus do?

A

Senses changes in osmolarity

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39
Q

What area of the brain responds to emetics?

A

area postrema of the hypothalamus

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40
Q

What nucleus of the hypothalamus makes ADH?

A

supraoptic nucleus

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41
Q

What nucleus of the hypothalamus makes oxytocin?

A

paraventricular nucleus

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42
Q

Destruction of what area of the hypothalamus results in anorexia?

A

Lateral area

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43
Q

Destruction of what area of the hypothalamus results in hyperphagia?

A

Ventromedial area

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44
Q

What is the role of the anterior hypothalamus?

A

Cooling, parasympathetic

A/C- anterior cooling

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45
Q

What is the role of the posterior hypothalamus?

A

Heating, sympathetic

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46
Q

What stage of sleep is the longest?

A

Stage N2 (45%)

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47
Q

In what stage of sleep does sleep walking, night terrors, and bedwetting occur? What type of waves are associated?

A

Stage N3

Delta waves- lowest freq, highest amplitude

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48
Q

What stage of sleep is associated with sleep spindles and K complexes?

A

Stage N2

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49
Q

What waveforms are associated with REM sleep?

A

Beta- highest frequency, lowest amlitude

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50
Q

What waveforms are associated with being awake with eyes open vs closed?

A

open- Beta

closed- Alpha

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51
Q

What are the connections of the posterior vs anterior pituitary?

A

posterior- neurohypophysis

anterior- adenohypohysis

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52
Q

What phase of sleep is associated with theta waves?

A

Stage N1- light sleep

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53
Q

What sensory modality does not relay through the hypothalamus?

A

olfaction

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54
Q

What are the inputs/ function of the VPL and VPM?

A

VPL- pain and temperature; pressure, touch vibration, proprioception
from spinothalmic and dorsal columns
VPM- face sensation and taste
trigeminal and gustatory pathway

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55
Q

What are the inputs/ function of the LGN and MGN?

A

LGN- vision, CNII

MGN- hearing, superiour olive and inferior colliculus of tectum

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56
Q

What are the inputs/ function of the VL?

A

motor

basal ganglia, cerebellum

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57
Q

What are the inputs of the cerebellum? Which peduncle?

A

Contralateral cortex– middle cerebellar peduncle

Ipsilateral proprioceptive– inferior cerebellar peduncle (from spinal cord)

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58
Q

Which side is affected for a lateral cerebellar injury?

A

fall towards side of injury

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59
Q

Presents as truncal ataxia, nystagmus, head tilting.

A

medial lesion of cerebellum

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60
Q

What makes up the striatum and lentiform?

A 
striatum= putamen (motor) and caudate (cognitive)
lentiform= putamen and globus pallidus
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61
Q

Intracellular eosinophilic inclusions composed of a-synuclein

A

Lewy bodies

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62
Q

What are the roles of the direct vs indirect pathways of the basal ganglia?

A

Direct- facilitates movement

indirect- inhibits movement

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63
Q

Describe the excitatory pathway of the BG?

A

cortical inputs– striatum—GABA release—-disinhibits thalamus via incr GPi/SNr

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64
Q

Describe the inhibitory pathway of the BG?

A

cortical inputs—striatum—disinhibits STN via GPe– stimulates GPi/SNr to inhibit thalamus

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65
Q

What part of the BG is affected in Parkinson’s?

A

substantia nigra pars compacta

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66
Q

What structure is affected in Hungtington? What is the repeat?

A

caudate nuclei atrophy, CAG (caudate loses ACh and GABA)

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67
Q

What is hemiballismus and what is underlying problem?

A

sudden flailing of 1 arm (+/- ipsilateral leg)

contralateral subthalamic nucleus

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68
Q

What is chorea? What area is affected?

A 
sudden, jerky, purposeless movements
Basal ganglia (Eg huntington)
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69
Q

What is athetosis? what area is affected?

A 
slow writhing, esp fingers
basal ganglia (eg huntington)
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70
Q

What is myoclonus? what conditions are usually associated?

A

sudden, brief, uncontrolled contractions (eg hiccups)

metabolic abnormalities- renal, liver failure

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71
Q

What is a resting tremor? What condition is it associated with?

A

uncontrolled movement of distal appendages, alleviated by intentional movment

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72
Q

What is intention tremor? What structure is affected?

A

slow, zigzag motion when pointing/extending toward a target

cerebellar dysfunction

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73
Q

What is the underlying cause of neuronal death in Huntington?

A

NMDA-R binding and glutamate toxicity

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74
Q

Describe the arrangement of the body in the humunculus?

A

Toes medial, hand/face lateral

75
Q

What lobes are Broca vs Wernickes area in?

A

Broca- frontal

Wernicke- temporal

76
Q

What presents with hyperorality, hypersexuality, disinhibited behavior?

A

Kluver-Bucy syndrome

77
Q

What structure is affected by Kluver Bucy? What infection is it associated with?

A

Amygdala, HSV-1

78
Q

Presents with Agrphia, acalculia, finnger agnosia, left-right disoreintation

A

Left parietal-temporal cortex lesion

Gerstmann syndrome

79
Q

Presents with spatial neglect syndrome

A

Right parietal-temporal cortex lesion

80
Q

Presents with confusion, ophtalmoplegia, ataxia, memory loss, confabulation, personality change

A

Wernicke-Korsacoff (thiamine)

81
Q

Lesion that causes eyes to look away from side of lesion

A

paramedian pontine reticular formation

82
Q

Lesion that causes eyes to look toward lesion

A

frontal eye fields

83
Q

Acute paralysis, dysarthria, dysphagia, diplopia, loss of consciousness

A

central pontine myelinolysis (locked in)

84
Q

What is usually the cause of central pontine myelinolysis?

A

osmotic forces and edema

eg overly rapid correction of hyponatremia

85
Q

What areas are typically damaged from correcting Na+ too fast? (low to high vs high to low)

A

“From low to high, your pons will die”

“From high to low, your brain will blow” (cerebral edema/herniation)

86
Q

What are deficits seen due to hypotension/ watershed zones?

A

upper leg/ upper arm weakness, defects in higher-order visual processing

87
Q

What is the primary modulator of cerebral perfusion?

A

pCO2

88
Q

Describe therapeutic hyperventilation

A

helps decr intracranial pressure in cases of acute cerebral edema (stroke, trauma); decr via vasoconstriction due to decr CO2

89
Q

Stroke of this presents with contralateral paralysis of upper limb/face, contralateral loss of sensation of upper limb/face, aphagia or hemineglect

A

MCA stroke

90
Q

Stroke of this presents with contralateral paralysis and loss of sensation of lower limb

A

ACA

91
Q

Stroke of this presents with contralateral hemiparesis/hemiplegia

A

leniculostriate artery (striatum, internal capsule)

92
Q

Vascular defect that presents as visual field defect

A

ACom saccular aneurysm

93
Q

Vascular defect that presents as CN III palsy

A

PCom saccular aneurysm

94
Q

Stroke of this presents with contralateral hemiparesis (upper and lower), contralateral loss of proprioception, tongue deviates ipsilaterally

A

ASA

medial medullary syndrome

95
Q

Stroke of this presents with vomiting, vertigo, nystagmus; decr pain and tep of ipsilateral face and contralat body, dysphagia, hoarseness, ipsilateral Horner, ataxia

A 
PICA
lateral medullary (Wallenberg syndrome)
96
Q

What are nucelus ambiguus effects and what type of stroke causes them?

A

hoaresness, dysphagia

PICA

97
Q

Stroke of this presents with vomiting, vertigo, nystagmus, paralysis of face, decr lacrimation, salivagion, corneal reflex, decr ipsilateral hearing, ataxia

A

AICA

lateral pontine syndrome

98
Q

Damage of the facial nucleus is specific for what type of stroke?

A

AICA

99
Q

Stroke of this presents with contralateral hemianopia with macular sparing

A

PCA

100
Q

Stroke of this presents with preserved consciousness and blinking, quadriplegia, loss of voluntary facial, mouth, tongue movements

A

basilar artery

101
Q

Describe central post-stroke pain syndrome

A

neuropathic pain due to thalamic lesions; initially numbness and tingling, weeks to months later allodynia

102
Q

Hemorrhage associated with lucid interval and rapid decline

A

Epidural hematoma

103
Q

Hematoma that does not cross suture lines

A

epidural hematoma

104
Q

Hematoma that crosses suture lines, can cause a midline shift, cannot cross falx/tentorium

A

subdural hematoma

105
Q

What are the risks after 2-3 days for a subarachnoid hemmorrhage?

A

vasospasm (due to blood breakdown), rebleed

106
Q

Rupture of a berry aneurysm causes what kind of hemorrhage?

A

subarachnoid hemorhage

107
Q

Where are the common locations of intraparenchymal hemorrhages?

A

basal ganglia, internal capsule

108
Q

What areas are most vulnerable to ischemic strokes?

A

hippocampus, neocortex, cerebellum, watershed

109
Q

What are typical histologic features of strokes after 12-48 hours?

A

Red neurons

110
Q

What are typical histologic features of strokes after 3-5 days?

A

macrophages

111
Q

What are typical histologic features of strokes after 1-2 weeks?

A

Reactive gliosis + vascular proliferation

112
Q

What are typical histologic features of strokes after >2 weeks?

A

Glial scar

113
Q

What directions do the foramina of Luschka and Magendie empty?

A

Luschka- lateral

Magendie- medial

114
Q

Presents as urinary incontinence, ataxia, cognitive dysfunction?

A

normal pressure hydrocephalus

115
Q

What are the most common sites of vertebral disc herniation?

A

L4-L5, L5-S1

116
Q

How many spinal nerves are there?

A

31

117
Q

What level does the spinal cord extend to?

A

L1-L2

118
Q

What type of motor neuron defect is indicated by fasciculations?

A

LMN

119
Q

What spinal cord lesions are typical for MS?

A

mostly white matter of cervical region, random and asymmetric

120
Q

What region of the spinal cord is affected by poliomyelitis?

A

destruction of anterior horns

121
Q

What is used to treat ALS?

A

Riluzole (Lou Gehrig– rilouzole)

decr presynaptic glutamate release

122
Q

What is and is not affected by ALS?

A

combined UMN and LMN

no sensory, cognitive or oculomotor deficits

123
Q

What spinal cord defect presents with sparing of dorsal column sand Lissauer tract only?

A

complete occlusion of anterior spinal artery

124
Q

Where doe occlusion of the anterior spinal artery typically occur?

A

upper thoracic

125
Q

What spinal cord defect presents with impaired sensation and proprioception and progressive sensory loss?

A

Tabes dorsalis

tertiary syphilils

126
Q

What spinal cord defect presents as ataxic gait, paresthesia, impaired position and vibration sense?

A

Vitamin B12 or E deficiency

127
Q

What tracts are damaged in Vit B12 or E deficiency?

A

dorsal columns, lateral corticospinal, spinocerebellar

128
Q

What defect presents with a floppy baby with marked hypotonia and tongue fasciculations?

A

Werndig-Hoffman (spinal muscular atrophy)

congenital degeneration of anterior horns of spinal cord

129
Q

What presents with staggering gait, frequent falling, nysagmus, dysparthria, pes cavus, hammer toes, and hypertrophic cardiomyopathy

A

Friedrich ataxia

130
Q

What is the most common presentation and cause of death for Friedrich ataxia?

A

presents as kyphoscoliosis in kids

die of hypertrophic cardiomyopathy

131
Q

What is the underlying defect in Friedrich ataxia?

A

AR, GAA trinuc repeat on chr 9

encodes for frataxin (iron binding protein)

132
Q

What dermatomal level are the nipple and umbilicus?

A

nipple-T4

umbilicus- T10

133
Q

What dermatomal levels are the inguinal ligament and knee caps?

A

inguinal ligament- L1

knee cap- L4

134
Q

What dermatomal levels are responsible for erection and sensation of penis and anus?

A

S2,S3,S4

135
Q

Where does referred pain from the gallbladder and diaphragm go? why?

A

refer to right shoulder

phrenic nerve

136
Q

What nerve roots do the biceps, triceps, patella and achilles reflexes test?

A 
biceps- C5
triceps- C7
Patella- L4
Achilles- S1
S1, S2- buckle my shoe 
L3, L4- kick the door
C5,C6- pick up sticks
C7,C8- lay them straight
137
Q

When do primitive reflexes usually disappear? What may cause them to reappear?

A

Disappear within 1st year

reemerge with frontal lobe lesions

138
Q

What is parinaud syndrome?

A

paralysis of conjugate vertical gaze due to lesion of superior colliculi (eg pinealoma)

139
Q

What CNs lie medially at the brain stem (3)

A

CNIII, VI, XII (motor- eye, tongue)

140
Q

What cranial nerves are involved in the gag reflex?

A

Afferent: IX
Efferent: X

141
Q

What cranial nerve is responsible for tongue movement?

A

XII (hypoglossal)

142
Q

What cranial nerve provides taste for the epiglottic region?

A

X (vagus)

143
Q

What cranial nerve raises the pharynx, larynx, and soft palate?

A

pharynx, larynx- IX

soft palate- X

144
Q

What does the nucleus solitarius do and what cranial nerves does it supply?

A

visceral sensory info

VII, IX, X

145
Q

What does the nucleus ambiguus do and what cranial nerves does it supply?

A

motor innervation of pharynx, larynx, upper esophagus

IX, X, XI

146
Q

What does the dorsal motor nucleus do?

A

autonomic fibers to heart, lungs, upper GI

X

147
Q

What nerve is typically affected by cavernous sinus syndrome?

A

CN VI

148
Q

What nerves pass through the cavernous sinus?

A

CN III, IV, V1, V2, VI

149
Q

What CN lesion presents as deviation of the jaw?

A

CNV- deviates toward lesion

150
Q

What CN lesion presents as deviation of the uvula?

A

CNX- deviates away from lesion

151
Q

What CN lesion presents as weakness of head turn and shoulder drop?

A

CNXI- weakness turning head contralateral, shoulder drop on side of lesion

152
Q

What CN lesion presents as tongue deviation?

A

CNXII- tongue deviates toward side of lesion

153
Q

Where are high and low pitched sounds heard?

A

Low frequency- apex near heicotrema (wide and flexible)

High frequency- heard at base of cochlea (thin and rigid)

154
Q

Describe noise-induced damage

A

damage to stereociliated cells in organ of Cortii

loss of high-freq hearing

155
Q

Compare conductive vs sensorineural hearing loss

A

Conductive- abnormal rinne (bone>air); localizes to affected ear
Sensorineural- normal rinne, localizes to unaffected ear

156
Q

Compare UMN vs LMN lesion of face

A

UMN- contralateral, forehead spared

LMN- ipsilateral

157
Q

What are the 4 muscles of mastication? What is innervation?

A

Close: Masseter, teMporalis, Medial pterygoid
open: lateral pterygoid
all innervated by V3

158
Q

What are the typical causes of uveitis vs retinitis?

A

uveitis- usually systemic inflammatory disorder

retinitis- usually viral

159
Q

Compare hyperopia vs myopia

A

hyperopia- eye too short for refractive power of cornea + lens (light focuses behind retina)
myopia- eye too long for refractive power of cornea + lens (light focuses in front of retina)

160
Q

Describe presbyopia

A

decrease in focusing ability during accommodation due to sclerosis and decr elasticity

161
Q

Presents with cloudy retina and attenuated vessels, “cherry-red” spot on fovea

A

central retinal artery occlusion

162
Q

What is the treatment of proliferative vs nonproliferative diabetic retinopath

A

nonprolif- blood sugar control, macular laser

prolif- peripheral retinal photocoag, anti-VEGF

163
Q

Presents as retinal hemorrhage and edema

A

retinal vein occlusion

164
Q

Presents as eye looking down and out, ptosis, pupillary dilation, loss of accomodation

A

CNIII damage

165
Q

Presents as eye move upward, particularly with contralateral gaze, tilt of head

A

CNIV damage

166
Q

Presents as medially directed eye that cannot abduct

A

CNVI damage

167
Q

Presents as enlarged blind spot and elevated optic disc with blurred margins

A

papilledema (incr ICP)

168
Q

Presents as very painful, sudden vision loss, halos around lights, rock hard eye, frontal headache

A

Acute closed angle glaucoma

169
Q

Presents as often asymptomatic damage to optic nerve and peripheral vision

A

chronic closed angle glaucoma

170
Q

Describe the innervation of the ciliary muscles and epithelium?

A 
ciliary muscle- M3
ciliary epithelium (produces aq hum)- b
171
Q

Describe the innervation of the iris

A

Dilator- a1

Sphincter- M3

172
Q

Describe blockage in closed vs open angle glaucoma

A

closed- blockage btwn iris and lens

open- blockage of trabecular meshwork or retinal detachment

173
Q

Where is the canal of schlemm located? What does it do?

A

btwn cornea and sclera; collects aqueous humour from trabecular meshwork

174
Q

What are causes of Upper quadrantic vs lower quandrantic anopia?

A

Upper: contralat temporal lesion, MCA
Lower: contralat parietal lesion, MCA

175
Q

What do the meyer loop vs dorsal optic radiation supply?

A

Meyer loop- inferior retinal, lopp around inf horn of lateral ventricle
Dorsal optic radiation- superior retina; via internal capsule (shorter path)

176
Q

Compare autonomic innervation of pupillary control

A

Miosis (constriction)- parasympathetic

Mydriasis (dilation)- sympathetic

177
Q

What nucleus is involved in miosis?

A

Edinger-Westphal nucleus

178
Q

What is a Marcus Gunn pupil?

A

Decr bilateral pupillary constriction when light is shown in affected eye
optic nerve damage or severe retinal injury

179
Q

What part of the CNIII is affected by ischemia vs compression?

A

Ischemia (eg vascular disease)- motor output (centrally located)
Compression (eg PCom aneurysm, uncal herniation)- parasympathetic (peripherally located)- blown pupil, diminished pupillary light reflex

180
Q

What presents as flashes and floaters, monocular vision loss like a “curtain drawn down”

A

retinal detachment, surgical emergency

181
Q

What presents as visual distortion and loss of central vision

A

age-related macular degeneration

182
Q

What is the treatment of dry vs wet macular degen?

A

Dry- prevent progression with multivit, antiox

wet- treat with VEGF or laser

183
Q

Presents as impaired adduction of eye, nystagmus of abducting eye but normal convergence. What associated with and what structure affected?

A

internuclear opthalmoplegia
damage to MLF (comm betweeen VI, III)
common in MS, demyelinating

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