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Step 1 Flash Cards > Neuro Day 2 > Flashcards

Neuro Day 2 Flashcards

1
Q

communicating hydrocephalus

A
  • due to decreased CSF absorption by arachnoid granulations, which can lead to increased intracranial pressure, papilledema and herniation
  • ex: arachnoid scarring post-meningitis
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2
Q

NPH

A
  • no increase in subarachnoid space volume
  • expansion of ventricles distorts the fibers of the corona radiata and leads to clinical triad of urinary incontinence, ataxia and cognitive dysfunction
  • urinary incontinence 2/2 stretching of descending cortical fibers
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3
Q

noncommunicating hydrocephalus

A

caused by structural blockage of CSF circulation within the ventricular system (stenosis of the aqueduct of Sylvius)

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4
Q

spinal cord - lower extent

A

goes to L2, so do a LP between L3-L5 to keep the spinal cord alive

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5
Q

dorsal column orientation

A

organized the way you are, legs in the middle, arms on the outside
- decussates in the medulla

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6
Q

descending lateral corticospital tract orientation

A

Legs are Lateral, head is medial

- decussates at the caudal medulla

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7
Q

ascending lateral spinothalamic tract orientation

A

Legs are Lateral, head is medial

- decussates in the anterior white commissure and ascends contralaterally

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8
Q

polio and spinal muscular atrophy SC lesion

A
  • affects anterior horns –> flaccid paralysis

LMN lesions only

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9
Q

ALS SC lesion, pathogenesis and treatment

A
  • combined UMN and LMN lesions
  • affects the anterior horn and lateral corticospinal tract
  • can be caused by a defect of copper-zinc superoxide dismutase
  • commonly presents with fasciculations,
  • riluzole treatment modestly increases survival by increasing presynaptic GABA release
  • usually die from aspiration pneumonia
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10
Q

ASA stroke SC lesion

A
  • affects everything except the dorsal columns
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11
Q

tabes dorsalis SC lesion

A
  • affects dorsal columns and roots
  • impaired proprioception –> sensory ataxia and poor coordination
  • absence of DTRs and + Romberg
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12
Q

Vit B12 or E deficiency

A
  • subacute combined degeneration
  • demyelination of dorsal columns, lateral corticospinal tracts and spinocerebellar tracts
  • ataxic gait, paresthesias, impaired position and vibratory sense and affects voluntary movement of limbs
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13
Q

spinal muscular atrophy (Werdnig-Hoffman Disease)

A
  • congenital degeneration of anterior horns of spinal cord –> LMN lesion
  • “floppy baby” with marked hypoxia and tongue fasciculations
  • infantile type has median age of death at 7 months
  • autosomal recessive inheritance
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14
Q

friedreich ataxia

A
  • AR trinucleotide repeat (GAA) on chromosome 9
  • gene that encodes frataxin, leads to impairment of mitochondrial functioning
  • degeneration of muscle spinal cord tracts leads to muscle weakness and loss of DTRs, vibratory sense and proprioception
  • staggering gait, frequent falling, nystagmus, dysarthria, pes cavus (foot abnormality), and hypertrophic cardiomyopathy (cause of death)
  • presents in childhood with kyphoscoliosis
  • 10% get diabetes
  • “frat” brother who is always stumbling, staggering and falling, but has a big heart
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15
Q

Brown Sequard syndrome

A
  • loss of contralateral pain and temp

- loss of ipsilateral position and vibration 1-2 levels below the lesion

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16
Q

Horner syndrome

A
  • ptosis, anhydrosis and miosis
  • associated with a SC lesion above T1
  • due to Pancoast tumor, Brown-Sequard syndrome, late-stage syringomyelia
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17
Q

landmark dermatomes

A

T4 nipple, T10 umbilicus, L1 inguinal ligament, S234 keeps the penis off the floor

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18
Q

clinical reflexes

A 
S1,2 - achilles - buckle my shoe
L3,4 - patellar - kick the door
T5,6 - biceps - pick up sticks
T7,8 - triceps - lay they straight
L1,2 - cremasteric - testicles move
S3,4 - anal wink
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19
Q

parinaud syndrome

A
  • paralysis of conjugate vertical gaze due to lesion in superior colliculi
  • can be due to germinoma (most common pineal tumor)
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20
Q

which colliculi are which

A

ears are below your eyes

  • superior - vision (conjugate vertical gaze center)
  • inferior - auditory
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21
Q

CN I - olfactory - S

A

smell

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22
Q

CN II - optic - S

A

vision

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23
Q

CN III - oculomotor - M

A
  • eye movement - SR, IR, MR, IO

- pupillary constriction, accomodation, eyelid opening

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24
Q

CN IV - trochlear - M

A
  • eye movement - SO
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25
Q

CN V - trigeminal - B

A
  • mastication (V3), facial sensation, somatosensation from ant 2/3 of tongue
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26
Q

CN VI - abducens - M

A
  • eye movement - LR
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27
Q

CN VII - facial - B

A
  • facial movement, taste to ant 2/3 of tongue, lacrimation, salivation, eyelid closing, stapedius (hyperacusis with palsy)
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28
Q

CN VIII - vestibulocochlear - S

A

hearing, balance

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29
Q

CN IX - glossopharyngeal - B

A
  • taste and somatosensation from post 1/3 of tongue
  • swallowing, salivation, carotid body chemo and baroreceptors
  • stylopharyngeus
30
Q

CN X - vagus - B

A
  • taste from epiglottic region
  • swallowing, soft palate elevation
  • midline uvula, talking, coughing
  • thoracoabdominal viscera, monitoring aortic arch chemo/baroreceptors
31
Q

CN XI - accessory - M

A
  • SCM, trap
32
Q

CN XII - hypoglossal - M

A
  • tongue movement
33
Q

corneal and lacrimal reflex

A
  • afferent - CN V1

- efferent - CN VII

34
Q

pupillary reflex

A
  • afferent - CN II

- efferent - CN III

35
Q

gag reflex

A
  • afferent - CN IX

- efferent CN X

36
Q

vagal nucleus solitarius

A
  • visceral Sensry information (taste, baroreceptors, gut distention)
37
Q

vagal nucleus aMbiguus

A
  • Motor innervation of pharynx, larynx, and upper esophagus
38
Q

vagal dorsal motor nucleus

A
  • sends autonomic (parasympathetic) fibers to heart, lungs, upper GI
  • bronchoconstriction
39
Q

what goes through the optic canal

A

CN III, opthalmic artery, central retinal vein

40
Q

what goes through the superior orbital fissure

A
  • CN III, IV, V1, VI, opthalmic vein and sympathetic fibers
41
Q

what goes through the foramen rotundum

A
  • V2
42
Q

what goes through the foramen ovale

A
  • V3
43
Q

what goes through the foramen spinosum

A
  • middle meningeal artery and recurrent branch of V3
44
Q

what goes through internal auditory meatus

A
  • CN VII, VIII
45
Q

what goes through the jugular foramen

A
  • CN IX, X, XI, jugular vein
46
Q

what goes through the hypoglossal canal

A

CN XII

47
Q

what goes through the foramen magnum

A

spinal roots of CN XI, brain stem, vertebral artery

48
Q

where are high/low frequency sounds heard best

A
  • low frequency at the apex near the helicotrema (wide and flexible)
  • high frequency at the base of the cochlea (thin and rigid)
49
Q

conductive hearing loss

A

Rinne test abnormal (bone > air)

Weber test localizes to the affected ear

50
Q

sensorineural hearing loss

A

Rinne test is normal
Weber test localizes to the normal ear
- in sensoriNeural, webber points to Normal

51
Q

noise induced hearing loss

A
  • damage to sterociliated cells in the organ of Corti

- loss of high frequency hearing 1st, sudden extremely loud noises can rupture tympanic membrane

52
Q

facial nerve palsy

A
  • ipsilateral facial paralysis, decreased lacrimation and salivation, hyperacusis and loss of taste sensation to first 2/3 of tongue
  • idiopathic or associated with Lyme disease, HSV, herpes zoster, sarcoidosis, tumors or DM
53
Q

hyperopia

A
  • eye to short for refractive power of the cornea and lens–> light focused behind the retina
54
Q

myopia

A
  • eye too long for refractive power of the cornea, light focused in front of the retina
55
Q

astigmatism

A
  • abnormal curvature of cornea resulting in different refractive power at different axes
56
Q

presbyopia

A

decreased focusing ability during accommodation due to sclerosis and decreased elasticity

57
Q

central retinal artery occlusion

A

acute, painless monocular vision loss

  • retina cloudy with attenuated vessels and “cherry red” spot at the fovea
  • often permanent
58
Q

retinal vein occlusion

A
  • blockage of central or branch retinal vein due to compression by nearby arterial atherosclerosis
  • retinal hemorrhage and edema in affected area
59
Q

diabetic retinopathy

A
  • non-proliferative: damaged capillaries leak, lipis and fluid seep into retina leading to hemorrhages and retinal edema. treat with blood sugar control and macular laser
  • proliferative: chronic hypoxia results in new blood vessel formation with resultant traction on retina. treat with peripheral retina photocoagulation, anti-VEGF injections
60
Q

open angle glaucoma

A
  • associated with increased age, AA race, family history
  • painless, more common in US
  • primary has unclear etiology, but secondary can be due to blocked trabecular meshwork from WBCs (uveitis), RBCs (vitreous hemorrhage), retinal elements (retinal detachment)
61
Q

primary closed angle glaucoma

A
  • enlargement or forward movement of lens against central iris (pupil margin) leads to obstruction of normal aqueous flow through pupil –> fluid builds up behind the iris, pushing peripheral iris against cornea and impeding flow through trabecular meshwork
62
Q

secondary closed angle glaucoma

A
  • hypoxia from retinal disease (diabetes, vein occlusion) induces vasoproliferation in the iris that contracts the angle
63
Q

miosis (constriction) control

A
  • 1st neuron: Edinger- Westphal nucleus to ciliary ganglion via CN III
  • 2nd neuron: short ciliary nerves to pupillary sphincter muscles
64
Q

mydriasis (dilation) control

A
  • 1st neuron: hypothalamus to ciliospinal center of Budge (C8-T2)
  • 2nd neuron: exit at T1 to superior cervical ganglion (travels along cervical sympathetic chain near lung apex)
  • 3rd neuron: plexus along internal carotid, through cavernous sinus, enters orbit as long ciliary nerve to pupillary dilators
65
Q

Marcus Gunn pupil

A
  • afferent pupillary defect
  • due to optic nerve damage (optic neuritis) or severe retinal injury
  • both eyes constrict when light shone in healthy eye, neither constrict when light shone in affected eye
  • “swinging flashlight test”
66
Q

age-related macular degeneration

A
  • causes distortion and loss of central vision
  • dry –> deposition of yellowish extracellular material (fatty tissue) in and beneath Bruch membrane and retinal pigment epithelium with gradual decrease in vision. prevent progression with multivitamin and antioxidant
  • wet –> rapid loss of vision due to bleeding 2/2 choroidal neovascularization. “grey subretinal membrane”. treat with anti-VEGF
67
Q

Meyer loop lesion (temporal lobe) lesion

A

pie in the sky

68
Q

Dorsal optic radiation (parietal lobe) lesion

A

pie on the floor

69
Q

right peri-chiasmal lesion

A
  • R nasal hemianopia, can be due to calcification of the carotid artery
70
Q

INO

A

MLF lesion

  • lack of communication between CN VI and CN III nuclei
  • abducting eye gets nystagmus, convergence is normal

Step 1 Flash Cards (36 decks)

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