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USLME Kiss my ass and pray > Neuro -Disease > Flashcards

Neuro -Disease Flashcards

1
Q

Von hippel Lindau presents w/ and increased risk of what

A

cavernous hemangionomas in the skin, mucosa, and organs;

hemangioblasoma retina, brain stem, cerebellum)

bilateral renal cell carcinoma risk

AD mutation of chromosome 3

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2
Q

Myasthenia gravis associations

A

Thymoma

Bronchogenic Carcinoma

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3
Q

Parkinsons w/ hallucinations and dementia

Location of lesion(3)

A

Lewy Body dementia
Lewy body - eosinophilic intracytoplamic inclusions

Located in
the substantial nigra
limbic cortex
subcortical nuclei

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4
Q

Werdnig Hoffman Disease

- presentation

A

LMN lesions only
due to setruciton of anterior horns ->flaccid paralysis

~polio

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5
Q

Lesions of the caudate nucleus and putamen

A

Huntingtons

  • degeneration of GABAnergic neurons
  • trinucleotide expansion of CAG on chromosome 4
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6
Q

Lewy Bodies found in (2)

A

Parkinsons

Lewy body dementia

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7
Q

Diffuse cortical atrophy sparing primary motor and sensory

A

Alzheimers

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8
Q

Selective frontal and temporal lobe atrophy

A

Picks

- silver staining cytoplasmic inclusions (pick bodies)

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9
Q

Pigmentes nodules on iris(Lisch nodules) and cafe au lair spots

-> risk of ?

Defect in ?

A

AD disease

Neurofibromatosis 1 or von Recklinhausen

optic path gliomas
sub q peripheral nerve nodules (neurofibromas)

Defect in tumor supressor NF1 on Chromosome 17

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10
Q

Low folate levels prior to conception leads to increase risk of what?

What marker may clue in

A

neural tube defects

elevated alpha fetoprotein in maternal blood and amniotic fluid

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11
Q

Maternal polyhydraminos may be due to this neuro defect

A

anecephaly(no skull or brain) - lack of cranial end to fuse

lack of swallowing mech

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12
Q

spina bifida occulta

A

dimple or patch of hair

simple failure of vertebral arch to close

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13
Q

Meningocele

A

failure of vertebral arch to close w/ protrusion of meninges

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14
Q

meningomyelocele

A

failure of vertebral arch to close w/ protrusion of meninges and spinal cord

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15
Q

3 congenital conditions that can lead to hydrocephalis

A

cerebral aqueduct stenosis
Dandy walker malformation
Arnold chiari malformation type II

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16
Q

cerebral aqueduct stenosis prevents what

A

drainage of CSF from the 3rd to the 4th ventricle -> accumulation in ventricle space

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17
Q

Foramen of monro

A

Drains lateral ventricles to 3rd ventricle

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18
Q

Foramina of magenie and Luschka

A

drians 4th ventricle to subarachnoid space

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19
Q

Massively dilated 4th ventricle congenitally called what?

Due to ?

A

Dandy walker malformation and it is due to failure of cerebellar vermis to form

  • no separation of the cerebellum and thus the space is absent on CT
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20
Q

Congenital displacement of cerebellar vermis and tonsils ->

Associated w/ (2)

A

Arnold chiari malformation type II (type 1 asymptomatic)

  • herniation of the cerebellum through the foramen magnum
  • > obstruction of CSF flow and hydrocephalus

meningomyolcele (most)
syringomyelia

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21
Q

sensory loss of pain and temp w/ sparing go fine touch and position sense in the upper extremities

What is going on and where?

Causes(2)

A

syringomyelia -

  • Usually C8 -T1, cape like distribution
  • > preferential coring out the anterior white commissure where the sensation crosses and then ascends contra laterally in the spinothalamic tract

Caused by trauma or Arnold Chiari malformation

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22
Q

Syrinx expansion of syringtomyelia

2 locations

A

initally anterior white commissure

Anterior horn -> lower motor neuron defects
Lateral horn and hypothalamospinal tract (sympathetic)-> horner syndrome

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23
Q

ptosis

A

droopy eyelid

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24
Q

miosis

A

constricted pupil

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25
Q

anhidrosis

A

lack of sweating

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26
Q

fecal oral transmission bug leading to anterior horn difficulties

Upper or lower?

A

poliomyelitis

Lower motor neuron signs
- flaccid paralysis
fasciulations
weakness
impaired reflexes
neg babinski
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27
Q

Lower motor neuron lesions (6 signs)

A 
flaccid paralysis
muscle atrophy
fasciulations
weakness
impaired reflexes
neg babinski

things go down

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28
Q

Upper motor neuron lesions(4 signs)

A

spastic paralysis
hyperreflexia
increased muscle tone
positive babinski

things go up

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29
Q

floppy baby inherited condition affects?

A

weednig hoffman disease
Auto Recessive disease; death in a few yrs

anterior horn -> LMN symptoms

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30
Q

Sporadic degeneration of the cortical spinal tract

A

amoyotrophic lateral sclerosis
(AML)

anterior horn degen-> LMN symptoms
Lateral Corticospinal Tract -> UMN symptoms

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31
Q

Atrophy and weakness of the hands w/out loss of sensory?

A

ALS

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32
Q

Zinc-Coppuer superoxide dismutase often implicated in

A

familial ALS

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33
Q

Presentation of ataxia and loss of vibratory sensation , proprioception, muscle weakness and loss of deep tendon reflexes

Due to ?

A

Friedriech ataxia
- degeneration of cerebellum and spinal cord

Autosomal recessive expansion of unstable tinucleotide repeat

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34
Q

Frataxin

A

Gene implicated in Fredriech ataxia -

  • essential for mitochondrial iron regulation -> iron buildup
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35
Q

Friedreich ataxia associated w/ what extra neuro presentation

A

hypertorphic cardiomyopathy

wheelchair bound w/in few yrs

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36
Q

inflammation of the leptomeninges

A

meningitis
specifically the pia and the arachnoid
(not dura)

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37
Q

Meningitis in neonate (3)

A

Group b strep
E Coli
Listeria monocytogenes

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38
Q

Meningitis in childen and teens

A

Nesseria meningitidis

-nasopharynx -> blood path

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39
Q

Meningitis in adults and elderly

A

Streptococcus pneumoniae

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40
Q

Nonvaccinated infants and meningitis

A

H influenza

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41
Q

Most common viral meningitis

A

Coxsackie

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42
Q

HA, nuchal regidity and fever think

If photophobia?

A

Meningitis

may be viral

Can also have altered mental status and vomitting

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43
Q

Lumbar puncture done at

A

L4 and L5 - level of the iliac crest

Spinal cord ends at L2 - just caudal equina

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44
Q

CSF of bacterial meningitis

A

neutrophils
low CSF glucose (normally 2/3 of serum)

  • more complications w/ pus and herniation -> death
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45
Q

CSF of viral meningitis

A

lymphocytes

normal CSF glucose

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46
Q

CSF of fungal meningitis

A

lymphocytes

decreased glucose

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47
Q

Sequela of meningitis

A

W/ healing and fibrosis if not dead

-hydrocephalus(obstruction), seizures(scarring) and hearing loss (nerve damage that exit)

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48
Q

Cerebrovascular disease -
2 causes and sub types w/in

6 total

A 
ischemia (85%)
- global
-Focal
--- >24 hr transient ischemic
---< 24 hr ischemic stroke
hemorrhage(15%)
- Subarachnoid
- Intracerebral
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49
Q

Etiologies of global cerebral ischemia

4

A

low perfusion - atherosclerosis
acute decreased blood flow - shock
chronic hypoxia - anemia
repeated hypoglycemia

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50
Q

transient confusion and prompt recovery seen in this CVD

A

mild global ischemia - hypglycemia

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51
Q

Diffuse necrosis and survival -> vegetative state

A

Severe global ischemia -

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52
Q

laminar necrosis of the cerebral cortex

A

layer 3,5,6 necrosis w/ moderate global ischemia

-pyramidal neurons of the cerebral cortex

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53
Q

Long term memory affected w/ this CVD

A

Pyramidal neurons of hippocampus affected w/ moderate global ischemia

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54
Q

sensory perception w/ motor control affected w/ this CVD

A

moderate global ischemia of purkinje layer of the cerebellum

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55
Q

TIA

A

Transient ischemic attack 24 hrs

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56
Q

pale infarct seen w/

point often affected?

A

thrombotic stroke - ischemic
-rupture of atherosclerotic plaque

usually at branch points ( bifurcation of internal carotid or middle cerebral artery of circle of willis)

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57
Q

hemorrhagic infarct seen w/

point often affected

A

emboli stroke - ischemic

  • maybe from the left atrium and atrial fibrillation
  • emboli lysed and reprofused area

affects middle cerebral artery often

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58
Q

Hyaline arteriosclerosis secondary to HTN or DM leads to ?

affects?

A

lacunar strokes - ischemic

lenticulostriate vessels

  • internal capsule - pute motor
  • thalamus - pure sensory
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59
Q

Ischemic stroke leads to what type of necrosis

Histology?

A

liquefactive

red nueurons in 12 hrs, necrosis in 24, neutrophils invade followed by microglial cells (macrophages)

Gliosis (2-3 weeks)

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60
Q

Gliosis

A

healing stage of an ischemic stroke leading to a cystic space surrounded by microglial cells

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61
Q

Charcot bouchard microaneurisms analogous to

A

similar to lacunar strokes except there is weakening, aneurysm formation and rupture of lenticulostriate vessels

HTN predisposes again

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62
Q

Common site of intracerebral hemorage

A

basal ganglia fed by lenticulostriate vessels,

HTN risk

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63
Q

Presentation of severe HA, N/V, and eventual coma

A

Intracerebral hemorrhage -> bleeding into brain parenchyma

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64
Q

Xanthochromia w/ nucal regidity and HA

A

Subarachnoid Hemorrhage

Xanthochromia - yellow hue of CSF due to bilirubin breakdown on LP

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65
Q

Subarachnoid hemorrhage often occur where?

2 conditions the predispose?

A

Berry aneurism bleeds (lack media layer)
anterior circle of Willis branch points of the anterior communicating artery

Marfan and ADPCK

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66
Q

lens shaped lesion on CT

lesion of what vessels?

A

epidural hematoma

middle meningeal

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67
Q

Cresecent shaped lesion on CT

lesion of what vessels

A

subdural hematoma

bridging veins - stretched w/ cortical atrophy in the elderly and prone to tear

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68
Q

Lucid interval preceding neurologic signs

how long and associated w/ what

A

epidural hematoma

12-24 hrs before collapse

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69
Q

Herniation definition and 3 forms

A

displacement of brain tissue by mass effect or increased cranial pressure

Tonsillar herniation
Subfalcine herniation
Uncal herniation

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70
Q

tonsillar herniation is?

Compression of what?

A

cerebellar tonsils into the foramen magnum leading to cardio pulmonary arrest

brain stem

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71
Q

cingutate gyrus under the flax cerebra called?

Compression of what?

A

subfalcine herniation

compresses tha anterior cerebral artery ->infarction

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72
Q

eye rolling down and out w/ infarction of the occipital lobe (contralateral homonymous hemianopsia) and brain stem hemorrhage

A

Compression of cranial nerve III, posterior cerebral artery and paramedian artery

All due to Uncal herniation

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73
Q

Oligodendrocytes

A

Myelinate the CNS

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74
Q

Schwann Cells

A

myelin ate the PNS

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75
Q

deficiency or aeylsulfatase leads to?

Accumulation of what?

A

Leukodystrophy (accumulation of myelin)
auto recessive

Sulfatides cannot be degraded and accumulate in oligodendocyte lysosomes

Demylinating disorder

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76
Q

Krabbe disease is a deficiency in ?

Accumulation in?

A

Glactocerebrocidase

Accumulation of glactocerebrocide in macrophages

demylinating disorder

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77
Q

X linked defect that has impaired addition of coenzyme A to long chain fatty acids

Damage to 2 organs

A

Adrenoleukidystriophy

Adrenal glands and white matter of brain

Demylinating disorder

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78
Q

HLA DR2

A

Autoimmune destruction of CNS myeline and oligodendrocytes

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79
Q

MS is more commonly seen in in who where?

A

young adults , (20-30s), women

colder environements

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80
Q

What is internuclear opthalmoplegia and what is it associated w/

A

Lesion of the medial longitudinal fascicles leading to impaired coordination of CN3 and CN6 in eye movement (one does not move)

Seen in MS

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81
Q

Scanning speech is characteristic of

what is it?

A

MS

mimicking alcohol intoxication

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82
Q

Symptoms of MS (8)

A

Burred vision - one eye
Vertigo
Scanning speech
internuclear opthalmoplegia
Hemiparesis or unilateral loss of sensation
lower extremity weakness or loss of sensation
bowel, bladder, sexual dysfunction - sympathetics

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83
Q

Neurologic symptoms w/ periods of remission - multiple lesions separated by time and space

A

MS

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84
Q

Oligoclonal IG bands, increased lymphocytes and immunoglobulins on LP

A

MS

-also see myelin basic protein

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85
Q

Rx for acute and chronic MS

A

steroids

Chronic - interferon beta

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86
Q

MS MRI results

A

plaques - white matter demylination

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87
Q

Slowly progressing persistent infection of the brain?

due to

Characterized by

A

Subacute sclerosing PANencephalitis

Measles

Viral inclusions in the neurons AND oligodendorcytes

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88
Q

JC virus infects what neural structure causing?

Characterized by?

A

oligodendrocytes infected

causing Progressive multifocal leukoencephalopathy

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89
Q

Progressive multifocal leukoencephalopathy presentation

A

rapidly progressive nuerologic signs

-visual loss, weakness, dementia-> death

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90
Q

Rapid overcorrection of patient’s electrolytes can lead to ?

Which electrolyte in particular

A

central pontine myelinolysis

Na

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91
Q

Acute bilateral paralysis sets in a patient being treated for alcoholism or a liver transplant patient think?

A

central pontine myelinolysis

Rapid Na correction

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92
Q

Degeneration of cortex ->

A

Dementia

grey matter

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93
Q

Degeneration of the brainstem and basal ganglia

A

Movement disorders

Grey matter

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94
Q

What is the most common cause of Death in alzheimers

A

infection

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95
Q

Loss of learned motor skills and language, nut and bed ridden, no focal neuro deficits

What other symptoms

A

Alzheimers

also have slow onset memory loss short progressing to long term

Progressive disorientation

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96
Q

Increased risk of Alzeimers(2) - sporadic

A

Old age

Apo E Allele 4; Apo E Allele 2 protective

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97
Q

Early onset Alzheimers seen w/ (2)

A 
Down syndrome (APP on 21)
presenilin 1 and 2 mutations
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98
Q

Cerebral atrophy w/ narrowing of the gyri and widening of the sulci, dilated ventricles?

Also see what histological changes

A

Alzheimers

Abeta amylod

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99
Q

Amyloid precursor protein importance

A

coded on chromosome 21
- beta claevage vs normal alpha leads to accumulation

May deposit in vessels -> hemorrhage risk

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100
Q

hyperphosphoryated tau protein seen in ?

Make up what ?

A

Alzheimers

neurofibrillary tangles - tanges due to lack of organization of the microtubules

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101
Q

2nd most common cause of dementia?

Causal agents(3)

A

Vascular dementia.

HTN, Athersclerosis or vasculitis leading to multifocal infarction or injury

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102
Q

Round aggregates of tau protein

A

Pick bodies

in the neurons of the cortex of Pick’s Disease

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103
Q

Degenerative disease of the frontal and temporal cortex selectively

Symptoms(3)

A

Picks disease

Behavioral and language symptoms leading to dementia

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104
Q

Substantia nigra of the basal ganglia implicated in what disease?

what is lost?

A

Parkinsons

Lose dopaminergic neurons

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105
Q

Clinical features of Parkinsons(4)

A

TRAP

Tremor - pill rolling tremor at rest
rigidity - cogwheel rigidity
Akinesia/bradykinesia - slowing of voluntary movement- flat affect
Postural instability - shuffeling gate

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106
Q

Loss of pigmented neurons in the substantial nigra seen in what?

What are lewy bodies?

A

Parkinsons

Lewy bodies are round eosinophilic inclusions of alpha-synuclein - (LATE course vs Lewy body dementia)

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107
Q

Role of dopamine in Movement

A

D1 has a positive influence on positive movement in the cortex from the striatum of the basal ganglia
D2 inhibits the inhibition of the movement in the cortex

Both boost the signal

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108
Q

Dementia, hallucination ans parkinson like syndromes seen in less than a year is?

See what in histology?

A

Lewy body dementia

Cortical lewy bodies seen in cortex (Vs just the inner basal ganglia)

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109
Q

Huntington’s is due to loss of what where?

A

Lose GABAergic neurons in the caudate nucleus of the basal ganglia

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110
Q

The genetic component of Huntington(3)

A

AD disorder
trinucleotide repeat of CAG
expansion during spermatogenesis -> anticipation

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111
Q

Presentation of Huntingtons(2)

A

Chorea - loss of inhibition -> random movement
Athetosis - slow involuntary snake like movement of fingers

Dementia
depression

  • Age 40
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112
Q

Elderly patient w/ urinary incontenince, gait instability and dementia

caused by?

A

Normal pressure hydrocephalus

  • increase CSF -> dilated ventricles w/ arachnoid granulations not draining as well
  • Wakyness due to stretched corona radiate next to the ventricles
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113
Q

What improves normal pressure hydrocephalus?

Presentation?

A

Lumbar puncture improves symptoms
Ventriculoperitoneal shunting Rx

Wet wobbly and wacky

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114
Q

PrP c

A

normal prion protein in CNS neuron

alpha helical conformation

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115
Q

PRP sc

A

beta pleated conformation -> encephalopathy

does not degrade and conerts normal protein to pathologic protein

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116
Q

Spongiform encephalopathy is due to? (3)

A

sporadic (CJD)
inherited (familial)
transmitted (mad cow)

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117
Q

Damage to neurons and glial cells w/ intracellular vaculoles

A

Spngiform encephopathy

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118
Q

Rapidly progressive dementia w. ataxia and starle myoclonus

See what on EEG

A

Creutzfeldt Jakob disease
most common form of spongiform encephalopathy

Periodic sharp waves

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119
Q

Familial encephalopathy characterized by(2)

A

Severe insomnia

exaggerated startle response

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120
Q

well circumscribed lesion found at the grey white border of the brain

A

METS

Usually lung breast and kidney

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121
Q

Most common brain tumors of adults (3)

Seen usually

A

glioblastoma multiforme - astrocyte derived
meningioma
schwannoma

Supratentorium

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122
Q

Most common brain tumors of kids (3)

Seen usually

A

pilocytic astrocytoma
ependymoma
medulloblastoma - neuroectoderm derived

Seen infratentorium

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123
Q

Cerebral tumor that crosses the corpus collosum - butterfly lesion?

Histology you see

A

Glioblastoma multiforme

See necrosis w/ pseudopalisading and endothelial proliferation

MOST COMMON in ADULTS - Malignent

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124
Q

GFAP positive tumor cells(2)

A

Glioblastoma multiforme - adults
Pilocytic astrocytoma - kids

positive due to presence of intermediate filament in glial cells

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125
Q

Cerebral lesion presenting w/ seizures and a round mass attached to the dura

Preferentially seen in?

A

Meningioma

Seen in women

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126
Q

Histology shows whorled appearance in this benign tumor of arachnid cells

also see what on histo

A

Meningioma

psammoma bodies

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127
Q

Presentation of hearing loss and tints w/ a S100 marker

A

Schwannoma - benign

Frequently affects CN8 at the cerebrellopontine angle

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128
Q

Schawnnomas are seen bilateral in

A

Neurofibromatosis type 2

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129
Q

Calcified white matter in the front lobe presenting w/ siezures

A

Oligodendroglioma

Malignant tumor

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130
Q

Fried egg appearance on biopsy -

A

Oligodendroglioma

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131
Q

cystic lesion w/ mural nodule seen in a kid

A

pilocytic astrocytoma

Benign tumor of cerebellum

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132
Q

Rsenthal fibers are what?

A

thick eosinophilic processes of astrocytes

also are GFAP positive

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133
Q

small round blue cells -> hormer wright rosette

original cell type?

A

Medulloblastoma - malignant tumor seen in kids

Neuroectoderm derived

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134
Q

Drop METS refers to

A

medullablastoma which spreads to CSF and cauda equine due to rapid growth

poor prognosis

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135
Q

tumor along the 4th ventricle leading to hydrocephalus

Histology see?

A

ependymoma - malignant tumor in kids

perivascular psudorosettes

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136
Q

Cariopharyngiomas come from

May present w/

A

epithelial remnants of Rathke’s pouch

Supratentoral mass in a child or adult

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137
Q

Bitemporal hemianopsia due to (2)

A

pituitary adenoma

craniopharyngioms - especially if a kid

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138
Q

Calcifcation on imaging of this benign but highly recurring tumor

A

craniopharyngioma

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139
Q

unilateral facial drooping involving the forehead

A

bells palsy

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140
Q

Weber syndrome which nerve?

A

contrallateral hemiparesis and eye motor nerve palsy w/ CN3

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141
Q

Medial pontine syndrome which nerve?

A

Contralateral hemiparesis and sensation and abducens

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142
Q

Posterior infereior cerebellar arter infarct affects which nerves

A

glossopharyngeal, vagus and spinal accessory

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143
Q

Symptoms of Central Pontine myelinilysis(6)

A 
acute paralysis
dysarthias
dysphagias
diplopia
LOC
locked in syndrome
  • overly rapid correction of Na
  • also see increased signal density in the pons
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144
Q

Corticospinal tract desiccates

A

above the medullary pyramids in the caudal medulla before descending

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145
Q

Spinothalmic tract desiccates

A

early and crosses in anterior white cosmissure before ascending

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146
Q

Dorsal thalamic pathway desiccates?

A

later in the caudal medulla

after becoming the medial lemniscal

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147
Q

Lesion of the R vagus nerve or nuclei -> uvula deviates?

A

deviates to the left. (pulled to the right)

Right side is not working
- could have issues w/ the left corticobulbar tract or
soft palate portion of the left motor cortex

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148
Q

Lesion of the L hypoglosseal nuclei or nerve the young deviates

A

Pushed to the right side
-Licking your wound

-Could also have issues with the Right corticobulbar tract and higher up the tounge portion of the right motor cortex

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149
Q

Artery that supplies the medial lemniscus and medullary pyramids

A

Anterior spinal artery

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150
Q

Stroke differs from Bells palsy how

A

Stroke you have eyebrow function

  • contralateral paralysis of the lower face - UMN lesion
  • the ipsilateral side of the lesion compensates for the upper portion of the face

bells palsy is lower in the tract and thus you have ipsilateral loss of upper and lower face

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151
Q

6 diseases you see bells palsy

A

AIDS
Lymes
Herpes simplex/zoster

less common-
Sarcoidosis,
tumors
Diabetes

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152
Q

midline CN nuclei in the brainstem

A

12 divides equally

  • 3 - mid brain
  • 4 - mid brain
  • 6 - pons
  • 12 - medulla
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153
Q

lateral CN nuclei in the brainstem

A 
5 - pons
7 - pons
9 - medulla
10?
11 - spinal cord/medulla
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154
Q

berry aneurysms in the circle of will associated w/ (3)

A

ADPCKD

Ehlers Danlos

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155
Q

Weber Syndrome is due to a lesion in

Level of lesion

See(2):

CN (1)

A

Paramedian branches of posterior cerebral artery

Middle lesion (12/3) at the midbrain level

CN 3 involvement - ophtalmoplegia, ptosis, dilation and down and out

Cerebral peduncle lesion -> contralateral spastic paralysis(lesion occurs before motor cortex info coming down hits the cerebral peduncles)

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156
Q

Causes of locked in syndrome (2)

A

pontine lesions

hyponatremia rapid correction
basalir artery rupture

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157
Q

Medial inferior pontine syndrome lesion in

Symptoms?(4)

CN (1)

A

Basilar artery - paramedial branches

contralateral spastic hemiparesis -corticospinal
contralateral loss of light/touch and kinesthetic - ML
Paralysis of gaze to side of lesion (CN6 and PPRF)
Ipsilateral paralysis of Lateral rectus (CN6)

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158
Q

lateral inferior pontine syndrome lesion in

Symptoms(7)

CN (3)

A

Anterior inferior cerebellar Artery (AICA)
- Lateral lesion and a lower pontine, rule of 4

ipsilateral facial nerve palsy - CN 7
ipsilateral loss of taste anterior 2/3 - CN7
ipsilateral deafness, Nystagmus, N/V - CN8
Ipsilateral limb and gait ataxia - middle and inferior cerebral peduncles
ipsilateral loss of pain and temp from face - spinal trigeminal (CN5) tract
Contralateral loss of pain/temp body - spinothalmic
Ipsilateral horner

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159
Q

Lateral Superior pontine syndrome lesion

Symptoms(7)

CN - 2

A

Anterior inferior cerebellar artery (AICA)
lateral and upper pontine level

Ipsilateral loss of taste - anterior 2/3 -CN 7

ipsilateral limb and gait ataxia damage to middle and inferior cerebella peduncle

ipsilateral loss of pain/temp to face - spinal trigeminal nucleus (5) and nerve fiber

ipsilateral loss of light touch and vibration from face - Main sensory trigeminal nucleus

ipsilateral jaw weakness and deviation of jaw towards lesion - trigeminal motor nut

contralateral loss of pain/temp from body - spinothalamic

ipsilateral horner - descending symp

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160
Q

medial medullary syndrome lesion

Symptoms(3)

CN - 1

A

anterior spinal artery (ASA)
-medial lesion of medulla

Contralateral spastic hemiparesis - corticopinal
contralateral tactile and kinesthetic defects
-ML
Tounge deviates towards the lesion (CN12) - middle divisible by 12

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161
Q

Wallenberg syndrome lesion

Symptoms(6)

CN - 3

A

AKA Lateral medullary syndrome

Posterior inferior cerebellar artery (PICA)

Loss of pain/temp contralateral body - spinothalmic

loss of pain/temp ipsilateral face - trigeminal thalamic

hoarsness/swallowing. loss of gag - CN 9 and 10

Ipsilateral horners

Vertigo, nystagmus, N/V (Some CN 8 nuc in medulla)

ipsilateral cerebellar deficits - inferior cerebellar peduncle

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162
Q

Presentation of internuclear opthalmoplegia (2)

Lesion is where?

A

Nystagmus of affected eye lesion and pact of adduction in lateral gaze movement

Convergence is normal

Lesion is in the medial longitudinal fasiculus

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163
Q

Causes of MLF syndrome (2)

A

Stroke >50 years old
MS < 50 years old - HIGHLY myelinated

lack of communication w/ CN6 and CN III* so they do not work together

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164
Q

most common site of berry aneurisms

A

anterior communicating artery

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165
Q

Assiated risk factors in berry aneurisms in addition to congenital defects (4)

A

Race - blacks
HTN
Smoking
Advanced age

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166
Q

Complications of a epidural hematoma (2)

Presentation on CT

A

transtentorial herniation w/ CNIII palsy
lucid period -> coma

CT shows biconvex (lens hyper dense blood collection

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167
Q

CT bone looks ?

Blood?

Order what when ruling out ischemic vs hemorragic stroke?

A

White

Hyperdense whitish

CT w/out contrast

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168
Q

CT presentation of subdural hematoma and timeline

A

crescent shape that crosses suture lines and midline shift potentially

rupture of bridging veins leads to longer time to develop hematoma
common in alcoholics, neonates and ELDERLY post fall

169
Q

Presentation of Subdrual hematoma

A

HA
Dorwainess
focal neuro defects and dementia sometimes

170
Q

Causes of subdural hematoma

Give what to help w/ morbidity

A

Most common overall is trauma
Most common non trauma is rupture of aneurism

2nd most common is rupture of arterial venous malformation

nimodipine - Ca channel blocker - and vessel spasm

171
Q

Xanthocromic is?

A

yellow CSF seen on a spinal tap a few days after subarachnoid rupture due billirubin

172
Q

Intraparanchymal hemorrhage most often due to

Worry about damage where

A

Systemic HTN, cocaine use?

  • basal ganglia and internal capsule
  • -> lenticulostriate vessel rupture (Charcot Bouchard )
173
Q

Timeline to give a thrombolytic in a stroke

A

4.5-3 hrs

if asleep assume too long

174
Q

Most common area of damage in an ischemic stroke(4)

A 
5 minutes
hippocampus
neocortex
cerebellum
watershed areas
175
Q

Causes of ischemic stroke (2)

A 
atrial fib (L side) _. emboli
Athersclerotic emboli block or rupture (carotid)

Also
septic emboli
DVT w/ Patent foramen ovale
fat emboli

176
Q

transient ischemic attack?

A

brief reversible episode of focal neruo deficits lasting < 24 hrs

> 24 is stroke

Treat the same b/c you don’t know which is which

177
Q

Foramen of Monroe located where?

Foramen of Luschka located where?

Foramen Mefenid located where?

A

between Lateral and 3rd ventricle

(cerebral aqueduct between 3rd and 4th ventricle)

Between 4th ventricle and subarachnoid - laterally

Between 4th ventricle and subarachnoid 0 medially

178
Q

Communicating hydrocephalous due to

Symptoms

A

low CSF absorption by arachnoid granulations

Communicating:
-HA, papilledema, uncal herniation (CN3), death

Normal pressure: wet, wobbly and wacky

Hydocephales ex vacule - increase CSF in atrophy

179
Q

Noncommunicating hydrocephalis

Symptoms

A

physical blockage or stenosis - compression

HA, papilledema, uncal herniation (CN3), death

180
Q

arachnoid granulations located in

A

superior sagital sinus

Drains through sigmoid sinus -> jugular foramen -> internal jugular

181
Q

Hydrocephalous ex vacuo

A

Increase Csf in atrophy due to Alzheimers

inctracranial pressure is normal, no triad of Wet, Wobbly and wacky

182
Q

Normal pressure hydrocephalous symptoms(3)

A

Wet Wobbly and wacky

Urinary incontinence
ataxia
reversible dementia

increase in subrachnoid volume seen (meningitis or trauma maybe) but no increased pressure of CSF

183
Q

Pseudotumor Cerebri presentation

Rx

A

increased intracranial pressure w/ NO hydrocephalous

See daily HA w, papilldema and N/V, worry of vision loss

Nothing on CT(tumor or dilation) in overweight women

Rx: stop Vit A, tetracycline, corticosteriod withdrawal,

  • Weight loss and acetazolmide
  • Some invasive options as well
184
Q

Tension HA location and timing?

Associated feature -

Rx

A

Bilateral - band like HA -> frontal and occipital lobe
lasting 4-6 hrs

NO associated features

Rx - Tylenol/NSAIDS

185
Q

Cluster HA location and timing?

Associated features

Rx

A

Unilateral -retrorbital pain, piercing/nonthrobing
lasting 15 min -3 hrs; daily timing w/ month clusters

Partial horners - Myosis and ptosis, tearing, rhinnorrhea, nasal congestion

Rx: 100% O2
-Also nasal sumatripatn

186
Q

Migraine HA location and timing?

Associated Features

Rx

A

Unilateral pulsitile HA w or w/o aura (scintillating scotomat - light, smell)
lasting 4-72 hrs

Has moderate intensity prohibiting work, made worse w/ tyrosine and activity
N/V
Photo/phonophobia

Rx: Sumatriptan - > vasoconstriction by 5HT 1b and 1d agonist; take as SOON as possible

187
Q

HA seen in male smokers

A

Cluster

the rat more likely women especially migranes

188
Q

Sumatriptian contraindicated in migraine management for (3)

A

CAD
Prinzmetal angina
Pregnancy

Vasoconstriction and vasospasm worries

189
Q

obese female w/ papilledema and HA

A

pesudotumor cerebelli or hydrocephalis

190
Q

HA w/ elevated ESR and jaw muscle pain when chewing

A

Temporal arteritis

191
Q

HA w/ extraoccular muscle palsies

A

cavernous sinus thrombosis

192
Q

Sever HA w/ fever and neck stiffness

A

meningitis

193
Q

Severe HA- > constant, no wax or waining

-> develops over time

A

brain tumor
-May have seizures and focal defects

If Hx of trauma and lasts over a week could be Subdural hematoma as well

194
Q

CN nucleus responsible for?

Carotid blood pressure
Aortic blood pressure
hypoxemia aorta
muscle info for swallowing

A

10
9
9
10 and 9

195
Q

Common brain tumors in adults in order

top 4

A

Usually supratentorial
MGM Studios

METS
glioblastoma
meningioma
Schwanoma

Also oligodendroplioma, pituitary adenoma

196
Q

Common brain tumor in Kids top 3

A

Usually infratentorial

Pilocytic astrocytoma
medulloblastoma
ependymoma

also- hemangioblastoma, craniopharyngioma

197
Q

Pseudopalisading pleomophic tumor w/in the cerebral hemispheres

Stains what?

A

glioblastoma - adult

Stains astrocytes for GFAP

198
Q

cells in whirls of fascicles that grow slowly arising from the arachnoid cells

Also see what inclusions

A

meningioma - adult

psammoma bodies

199
Q

S 100 tumor that is associated w/ neruofibromatosis type 2

A

schwanoma - adult

most common CN 8 -> acoustic schanoma

200
Q

frontal lobe tumor that has fried egg appearance, chicken wire capillary pattern

A

oligodendroglioma - adults

Fried egg also: koiliocyte and seminomas

201
Q

bitemporal hemanopia w/ ammenorrhea

A

prolactinemia

202
Q

posterior fossa of the cerebella affected that is benign and has rosenthal fibers

cell affected?

A

pilocytic astrocytoma- kids
-benign

astrocytoma (remember #1 primary tumor of adults and kids involve astrocytes)

rosenthal fibers - eiosinophilic corkscrews

203
Q

Hydrocephalis seen in a kid with a brain tumor think

A

medulloblastoma - cerebellar
ependymoma - ependymal

both compress the 4th ventricle

204
Q

homer Wright rosettes are

A

circumfrential pattern surrounding fibers seen in medulloblastoma - kids brain tumor - cerebellar

  • worry about drop METS

differs from perivascular psuedorosettes in ependymoma

205
Q

perivascular pseudorosettes are

A

circumferential pattern surrounding a vessel seen in ependymoma - kids brain tumor -ependymal cells

differs from hormer Wright rosettes in medulloblastoma

206
Q

Tumor derived from rathkes pouch seen in kids

A

cranipharyngioma

pituitary adenoma-

Note:supratentoral

207
Q

Hemangioblastoma think 2 things

A

hippel lIndeau syndrome (w/ retinal angiomas)

see -> renal cell carcinoma

208
Q

foamy cells w/ high vascularity and polycythemia

A

hemagioblastoma

EPO producing tumor

Part of hippel-lindau syndrome leading to renal cell carcinoma

209
Q

cingulate subfalcine herniation under falx cerebra can compress?

A

anterior cerebral artery

210
Q

Ia afferent differs from Ib how in the muscle spindle

A

Ia delivers signal from the muscle spindle to the dorsal horn in response to stretch/∆length of the intrafuscial muscle
-> alpha motor neuron reflex leads to tightening of the extrafusal muscle fibers

Ib delivers signal from golgi tendon organ in the tendons in response to tension and inhibits alpha motor fiber contraction of extrfusial muscles if too high

211
Q

Gamma loop in the muscle spindle

A

regulates the sensitivity of the reflex arc from the CNS through a gamma motor neuron which contracts the intrafusal fiber increasing sensitivity

212
Q

Clinical reflexes tested with a hammer

Achilles
Patellar
Bicepts
Tricepts

A

S1, S2
L3, L4
C5, C6
C7 and C8

213
Q

a positive babinksi in an adult may indicate what and looks like?

A

May be a UMN lesion where the feet fan out and up while the big toe dorsalflexes

214
Q

Moro reflex

A

startle reflex -arms extend then abduct

215
Q

Rooting reflex

A

head turns to side of cheek

216
Q

sucking reflex

A

sucks when roof of mouth touched

217
Q

plantar reflex

A

normal in babies where toes fan out when bottom of heel stroked

218
Q

Galant reflext

A

on stomach baby laterally flexes towards side their spine is stroked

219
Q

UMN Lesion presents w?(3)

A

spastic paralysis
hyperreflexia - lost inhibiton
positive babinski

220
Q

LMN lesion presents w?(4)

A

Flaccid paralysis
hyporeflexia - lost arc
fasiculations - muscle quivers
Atrophy

221
Q

Somatosensory from the body (Medial lamiscus and spinothalamic tract) goes through what part of the thalamus

A

VPL- very painful legs

222
Q

Cerebellum (dentate nucleus) and basal ganglia goes through what part of the thalamus enrout tot the motor cortex and supplementary motor cortex

A

VL

223
Q

Trigeminalthalamic tract and taste pathway goes through what part of the thalamus enroute

A

VPM - very painful mouth

224
Q

Retina stimulation going to the occipital lobe passes through what part of the thalamus

A

Lateral geniculate nucleus

225
Q

Brachium of inferior colliculus (auditory info) enroute to the primary auditory cortex goes through what portion of the thalamus

A

medial geniculate nucleus

226
Q

What are the longitudinal zones of the cerebellum starting medial (4)

A

Vermis - central
Intermediate (paravemal zones) -arms/legs
lateral hemispheres- arms/legs

folliculonodular lobe w/in

227
Q

What are the inputs to the cerebellum and the corresponding out put fibers?

Whats in-between?

A

Mossy/climbing fibers go in

Purkinje fibers come out

the cerebellar cortex is in-between

  • deep nuclei of the cerebellum come after -> output targets
228
Q

Major output pathway of the cerebellum?

A

brachium conjunctivum (superior cerebellar peduncle) -> contralateral vental lateral nucleus of the thalamus -> motor/supplementary cortex

229
Q

3 functional regions of the cerebellar cortex that ingrates information

A

Vestibulocerebellum (flocculonodular lobe and vermis)
-balance and eye movement

Spinocerebellum ( vermis and paravermal regions)
-motor execution (medial and latera descending systems depending on nuclei)

Cerebrocerebellum (lateral hemispheres)
-motor planning to premotor and premotor cortices

230
Q

Deep nuclei of the cerebellum media to lateral (4)

A

Fastigial
Globes
Epoliform
Dentate

231
Q

Motor control on the would be effected on what side of a cerebellelar lesion?

A

Ipsilateral to the lesion

There is 2 crossings
-> movent contemplates in the contralateral motor cortex but there again is a desiccation in the cortical spinal tract on descent

232
Q

What neuro abnormalities can be attributed to damage of the spinocerebellum (vermis and paravermis)(4)

A

Postural instability
Slurred/slowed speech
Hypotonia
pendular knee jerk reflexes

233
Q

Symptoms seen in anterior lobe (Anterior vermis syndrome)?

Most common cause?

A

Ataxia/dystaxia w/ broad based staggering gait

due to chronic alcohol use -> thiamine deficiency -> cerebellar cortex degeneration

234
Q

What neuro defects can be seen in cerebrocerebellum damage (4)

A

Lack of control of voluntary movements -timing and rate(fail rapid hand movement)

delay in initiating/stopping movement

Dysmetria (impaired control of speed/distance/power)

Intention tremor

235
Q

What are the 3 types of tenors seen and how are they different?

A

Essential tremor - familial and seen in both rest and movement

Intention tremor - Seen w/ initiation of movement and sound in cerebellar defects

Resting tremor- seen at rest and disappear w/ movement (Parkinsons)

236
Q

what are the features of essential (Familal) tremor?(3)

Rx?

A

fine tremors of head/hands/arms/voice

50% familial

occurs at rest and movement

Rx w/ beta blockers or primidone (anticonvulsent)

237
Q

What neuro defects are seen in vestibulocerebellum(vermis and floculonodular) damage?(2)

A

Disequilibrium- can’t maintain balance

Abnormal eye movements (cerebellar nystagmus that are more pronounced when looking at the lesion)

238
Q

Positive rhomberg indicates what type of pathology

3 parts in balance tested

A

Problem w/ dorsal column giving proprioception from the legs

take away vision and have faulty proprioception, the vestibular apparatus has nothing to gauge against

239
Q

the basal ganglia to the prefrontal, premotor and orbital cortices traces through what part of the thalamus

A

VA

240
Q

Globus pallidus internal segment generally has what impact at on movement

A

It decreases movement through inhibiting the thalamus before signal goes to cerebral cortex

241
Q

Subthalamic nucleus generally has what impact on movement

A

it decreases movement by increasing the negative signal by the globus pallidus internus

242
Q

Substantia nigra pars compacta normally has what impact on movement

A

Generally increases movement 2 ways

  1. Direct pathway of the neostriatum w/ D1 agonist activity blocking globes pallidus negative effect
  2. Inhibits the indirect pathway w/ D2 agonist (inhibits). It inhibits the indirect pathway which normally has neg effect on globus pallidus external which has a negative effect on the sub thalamic nuclei (remember it is generally neg)
243
Q

Neurotransmitters implicated in Huntingtons(3)

A

Decreased ACh and Gaba

Increased Dopamine

244
Q

Eosinophilic inclusions in the cytoplasm of neurons

A

Lewy bodies

-parkinsons and lewy body dementia

245
Q

basil ganglias role in the brain?

A

regulates the amount of movement. Cortex controls how much

246
Q

Neostriatum made of?

A

Cuadate nucleus and putamen

247
Q

Lentiform is made of?

A

putamen and globus pallidus

248
Q

Lesions of substantial nigra pars compact leads to?

As seen in?

A

Lack of D

parkinsons- not enough movement

249
Q

Lesions of sub thalamic nucleus leads to?

As seen in?

A

hemiballismus - unilateral flailing of a limb

Lacunar stroke (contralateral to flail)

250
Q

D1 vs D2 in the basil ganglia

A

Both lead to movement

D2 agonist leads to inhibition of the indirect pathway which normally inhibits movement

D1 agonist leads to agonist of the direct pathway

251
Q

5 symptoms of parkinsons

A

Resting tremor (disappears w/ movement)- pill rolling

Cogwheel rigidity

Mask like facies

Fenestrating Gait/postural instability

akinesia

252
Q

MPTP exposure leads to?

A

Parkinson like symptoms due to chemical degradation of the substantial niga

MPTP -> MPP by MAOI which leads to lesion

253
Q

Athetosis

A

slow writhing movements especially fingers

Seen in huntingtons

254
Q

Myoclonus

A

sudden brief uncontrolled muscle contraction

-can be repetitive vs hemiballismus or chorea

255
Q

Hemiballismus

A

sudden wild flailing go 1 arm +/- the leg due to contralateral sub thalamic nuclear stroke

256
Q

Chorea

A

suddern jerky purposeles movements NON- repetative

Seen in huntingtons

257
Q

Akathisia

A

Feeling the NEED to constantly move , dance in plase

symptom of some neuroleptics

258
Q

Lesion in huntingtons?

A

caudate nucleus loses ACh and GABA lose of inhibition of movement -> chorea

259
Q

Rx for Huntingtons(3)

A

Block Dopamine receptors

  • Haloperidol
  • Olanzapin

Inhibit Dopaine release
-Tetrabenazine

260
Q

1st line in Parkinsons Rx

A

Levodopa w/ Carbidopa

crosses the BBB barrier while Carbidopa blocks peripheral decarboxylation

261
Q

Carries voluntary motor commands from the motor cortex to the head and face

A

Corticobulbar tract

262
Q

Mixed upper and lower motor neuron disease

A

ALS

263
Q

Lissauers tract

A

receives pain and temp info and ascends 2-3 segments before crossing in anterior white commissure -> spinothalamic tract

264
Q

Fasiculus cuneatus

A

Touch/Pressure/Vibration in the arms -> dorsal columns

Lateral to fasiculus gracilis

265
Q

Fasiculus gracilis

A

Touch/Pressure/Vibration in the legs -> dorsal columns

medial to the fascicles cuneatus

266
Q

Lateral corticospinal tract

A

Carries UMN signal w/ volantary muscle control.

Seen in the laterally in the grove of the Anterior and Posterior horn

267
Q

Accessory voluntary movement tracts(2)

A

Reticulospinal tract

anterior cotical spinal tract

268
Q

Vestibulospinal tract

A

reflexive bundle from vestibular apparatus responsible for making fine postural movements

Located most anterir/ventral portion of the spinal tract
- ventral spinothalamic tract found just posterior

269
Q

Ventral spinothalamic tract

A

Crossed signal of pain and temp from the lissauers tract

Just posterior to the vestibulospinal tract in the ventral portion of the spinal cord- continuous with the lateral spinal tract

270
Q

ventral spinocerebellar tract/dorsal spinocerebellar tract

A

Carries proprioception information to the the cerebellum for fine adjustments in movement correction

  • located in the lateral spinal tract adjacent to the edge
271
Q

Poliomyeolitis is spread?

Affects what portion of the spinal tract leading to symptoms(4)

A

Spread fecal oral-pharnyx before CNS

Affects the LMN neurons of the anterior horn

flaccid paralysis, fasiculations, hyporeflexia,
w/ fever, HA, ab pain, sore throat

272
Q

CSF of polio has:(3)

A

lymphocytic pleotosis
slight protein elevation
No change in glucose

273
Q

Floppy baby at birth due to LMN lesion that is auto recessive

A

Werdnig Hoffman disease

Death by 7 months

274
Q

Charcots triad in MS(3)

Other symptoms?(3)

A

Damage to highly myelinated cells

Scanning speech
nystagmus
intention tremmor

intranucleat opthammoplegia
Bowel and bladder issues,
optic neuritis

275
Q

Lumbar puncture of MS -?(2)

A

Increased protein levels

  • Ig Light chains
  • Oligoclonal clonal bands on electrophoresis
276
Q

Patient w/ both upper and lower motor neuron lesions, sensory is intact

suspect a defect in what enzyme?

A

Amyolotrophic lateral sclerosis (ALS)

Defect in superoxide dismutase 1

277
Q

ALS affects what 2 spinal tracts?

Rx:

A

Lateral corticospinal tract

anterior motor horn

Riluzole - decreases presynaptic glutamate release

278
Q

Symptoms in ALS

A

Both upper and motor neuron lesions ->

Fasciulations
progressive weakness
dysarthia - speech
dysphagia - swallowing
dypsnea -> death w/ diaphragm
muscle atrophy
279
Q

Tabels dorsales is a defect in ?

Symptoms?(3)

A

Doral columns and roots

impaired sensation and proprioceptioin -> progressive sensory ataxia

Charcots joints (banging them around) argyll robbertson w/ terry syphilis

Absent DTRs and positive rhomberg

280
Q

Lesion where the dorsal column is spared but have bilateral loss of pain and temp as well as motor command

due to occlusion of what vessel

Presents as?

A

Anterior spinal artery occulusion

Presents w/ intact sensation but loss of spinothalamic and lateral corticospinal tract and anterior motor horns leads to

complete motor paralysis, loss of pain and temp, areflexia

281
Q

2 congenital ataxia lesions?

A

Freideichs ataxia

  • staggering gait
  • trinucleutid repeat - GAA in the gee frataxin

Ataxia telengiectasia

  • lowered immune
  • lymphoma risk
  • telengiectasi presenting in the sclera 1st
282
Q

Frataxin is the gene implicated in what disease?

Pathogeneisis

A

trinucleutide repeat of GAA in Friederichs ataxia

leads to mitochondrial functioning impairment

283
Q

Friedrichs ataxia presents w?(6)

A

Degeneration of sensory neurons

Staggering gait*
nystagmus*
dysarthya
pes cavus
hammer toes
hypertophic cardio myopathy*
284
Q

Brown Sequard tract defects- 5

A

Ipsilatateral loss of UMN signal w/ lateral corticospinal tract

Ipsilateral loss of LMN -> flaccid paralysis

Ipsilateral loss of tactile/pressure/vibration in w/ dorsal column

Contralateral loss of pain/temp w/ spinothalamic tract 2-3 segments below lesion (Lissaure tract ascends)

Loss of all sensation at the lesion - loss of lessor and dorsal columns

285
Q

Hemisection of the spinal cord is called?

A

Brown sequard syndrome

286
Q

5 major parts of the brachial plexus

A

Real Texans Drink Cold Beer

5 Roots
3 Trunks
2 Divisions
3 Cords
5 branches
287
Q

Brachial plexus is made from roots off of?

A

C5-T1

288
Q

Nerves off the the Upper trunk/lateral cord of significance (2)

Muscles?

A

Suprascapular nerve - infraspinatus and supraspinatus

Lateral pectoral nerve - pectoralis major

289
Q

Long thoracic nerve enervates what?

Made of

A

Serratus anterior
SALT

Made off roots of C5-C7

290
Q

extra nerves off the Medial cord(3) and muscles innervates

A

Lower subscapularis - subscapularis

Thoracodorsal nerve - latismus dorsi

Upper subscapularis - teres major

291
Q

Terminal branches of the brachial plexus and major muscle innervations (5)

A

Muscularcutaneous - bicep, coricobrachialis, brachialis, flexors of forearm

Axillary - deltoid and teres minor

Radial - extensors of the forearm and triceps

Median- thenar muslce and protinators

Ulnar - interosseous and hypothenar

292
Q

Erb duchenne palsy damages what nerve

Common presentation?(3)

Common cause?(2)

A

C5-C6

Waiters tip w/ loss of suprascapular, muscularcutaneous and axillary nerve most common -> medial rotation, pronation and limp arm

Difficult birth/landing on shoulder

293
Q

Waiters tip w/ loss of suprascapular, muscularcutaneous and axillary nerve most common -> medial rotation, pronation and limp arm

A

Erb Duchenne palsy w/ C5-C6 Damage

294
Q

Thoracic outlet syndrome is due to?

Presentation?(3)

A

Compression of the subcalvian artery and inferior brachial plexus (C8-T1) by a cervical rib

atrophy of thenar and hypothenar, interossous muscles

Loss of sensation on medial forearm and hand

Disappearance of radial pulse

295
Q

Klumpke palsy due to ?

Symptoms?(2)

A

Characterized by damage to lower brachial plexus w/ C8 and T1

Falling out of a tree and yank arm up

atrophy of thenar and hypothenar, interossous muscles

Loss of sensation on medial forearm and hand

296
Q

Radial nerve sensation(3)

A

skin of posterior arm

Superfical - lateral and posterior hand

Deep - posterior forearm

297
Q

Deep branch of the radial nerve innervates (4)

A

Supinator
brachioradialis

Extensors of the forearm

adductor pollicus longus (not main one)

298
Q

Radial nerve inervates?(4)

A

BEST

Brachioradialis
Extensores of wrist and hand
Supinator
Tricepts

299
Q

Saturday night palsy?

A

radial nerve compression against spiral groove

  • triceps ok but weak wrist and finger extension
300
Q

cannot flex the 4th and 5th DIP and unable to extend the interphalangeal joints of the 4th and 5th joint

A

Ulnar claw

loss of lateral 2 lumbricals which flex the MCP and extend the DIP and PIP

always is abnormal

301
Q

Ulnar skin sensation

A

Skin over the medial hand

302
Q

Muscles of the ulnar nerve (5)

A

Flexor carpi ulnaris
medial 1/2 of flexor digitorium profundis

Deep

  • hypothenar muscles
  • Adductor pollicis
  • Ulnar 2 lumbricles
303
Q

Median nerve skin sensation(2)

A

Lateral palm

distal 1st 3 and a half digits

304
Q

Median nerve muscles (10)

A

Pronators

  • Pronator teres
  • pronator quadratis

Wrist flexors

  • flexor carpi radialis
  • plamaris longus
  • flexor digitorium superficialis

Thumb - thenar muscles

  • Oppenens pollicis - ape hand
  • Abducto pollicis brevis
  • flexor pollicus brevis

Lateral 1/2 flexor digitoriom perfundis - benedicitine
radial 2 lumbricals

305
Q

Ape Hand

A

Loss of the recurrent branch of the median nerve -> innervates the thenar muscles

    • Oppenens pollicis - ape hand
  • Abducto pollicis brevis
  • flexor pollicus brevis
306
Q

Hand of benedictine

A

median nerve

Loss of PIP flexion in digits 1-3 and loss of DIP in digits 2-3 when making a fist

digits 2 and 3 remain extended

Lateral 1/2 flexor digitoriom perfundis - benedicitine
radial 2 lumbricles

307
Q

Carpal tunnel syndrome is trapping ow what nerve between what 2 structures

A

median nerve between

carpel bones and flexor retinaculum

308
Q

Musculocutaneous nerve sensation

A

Lateral forearm

309
Q

Musculocutaneous muscle innervation (3)

A

biceps
croacobrachialis
brachialis

310
Q

Axillary nerve muscle innervation (3)

A

teres minor and deltoid and long head of triceps brachia

311
Q

Axillary sensation

A

skin of lateral shoulder

312
Q

Fracture of surgical neck at risk of damaging what artery and nerve?

A

axillary nerve

posterior circumflex

313
Q

Femoral nerve innervates what muscles?(2 groups - 7 muslces

commonly damaged in?

A

Flexors

  • illopsoas
  • Pectineus
  • sartorius

Knee extensors (quads)

  • Vastus lateralis
  • Vastus medialis
  • Vastus intermedias
  • Rectus femoris

Damaged in pelvic fractures

314
Q

loss of sensation in anterior thigh

- nerve damaged?

A

Femoral

315
Q

Obturator nerve innervates what muscles and

Commonly damaged in?

A

Thigh Adductors **

  • adductor magnus
  • adductor longus
  • adductor brevis

Gracilus (knee flexion)

Commonly damaged in anterior hip dislocation

316
Q

Lower leg muscle innervated by both the obturator and the sciatic nerve

A

Adductor magnus

317
Q

Loss of sensation to the medial thigh thigh - nerve damage?

A

Obterator

318
Q

Superior gluteal nerve innervates? (3 muscles)

Commonly damaged in?

A

Thigh Abductors

  • Gluteal medius
  • Gluteal minimus
  • tensor fascia late

Damaged in posterior hip dislocation

also polio

319
Q

Inferior gluteal nerve innervates?(1 muscle)

Commonly damaged in?

A

Thigh extensors and lateral rotation
-Gluteus maximus

Posterior hip dislocation

320
Q

Trendelenberg gait is described as what if the lesion was on the R for example

What muscles implicated

A

The L hip would drop due to failure of the hub abductors contrallaterally to flex and old the hip up when staring on the affected leg

  • inferior gluteal nerve w/ gluteus minimus and gluteus medius
321
Q

Sciatic nerve innervates what muscles (4)

Lesion may be due to?

A

Breaks into tibial and perineal nerve later on

knee flexors and hip extendors

  • biceps femoralis - latera
  • semiteninosus
  • semimembrnous
  • adductor magnus

Lesion w/ intervertebral disk herniation, spinal stenosis , spndodylolisthesis

322
Q

Tibial nerve innervates what 7 muscles

lesion may be due to ?

A

Plantarflexors

  • gastrocnemius
  • Soleus
  • plantaris

Popliteus - unlocks knee

Toe flexion

  • Flexor hallucis longus
  • flexor digitorium longus

Tibialis posterior - inversion

Knee injury -> TIP issues

323
Q

Loss of sensation on the sole of the foot nerve injury?

A

Tibial nerve

324
Q

Common perineal nerve innervates which muscles (6)

Commonly injured w?

A 
Deep Peroneal
Dorsiflexion 
- Tibialis anterior
-extensor hallicus longus
-extensor digitorium longus

-peroneus tertius - eversion

Superfical peroneal - Eversion

  • peroneous longus
  • peroneus brevis

Lateral knee injury, fibula neck fracture -> PED

“foot drop”

325
Q

Loss sensation to the lateral foot and dorsal foot. Nerve injury?

May see what associated feature?

A

Common perineal nerve

“foot drop”

326
Q

Vasculature off the aorta leading to the foot?

A

Common iliac

  • > internal iliac
  • > external iliac

External

  • > deep femoral
  • > femoral

Femoral -> popliteal(behind the knee)

Popliteal -> tibial

Tibial

  • > posterior tibial -> fibular
  • > anterior tibial -> dorsalis pedis
327
Q

Anterior dermatome ditribution?

T10
L1
L5
S1
S2-3
A 
Umbilical
groin
L2-L3 (stripes down)
top of foot
lateral foot
genitalia
328
Q

Posterior dermatome distribution?

S5
S2
S1

A

S5 - recum
S3-4 radiates out

S2- Medial leg
S1 lateral leg

329
Q

2 muscle receptors responsible for opening the sarcoplasmic reticulum

A

dihydropiridine - volage sensitive

Ryanodine

  • mechanically coupled
  • (blocked by dantrolene)
330
Q

Sarcomere labels

A band
I band
H band

M line
Z line

A

A band is total myosin
I band - is just actin off the Z line
H band - just myosin of the M line

M line - middle of sarcomere, myosin radiates off

Z line - holds actin radiating off w/ titin filaments connection to the myosin

331
Q

Which bands change w/ sarcomere contraction

A

I band - just actin
H band - just myosin/out actin

A band- constant myosin w and w/out actin

332
Q

Binding of Ca to what causes a conformational change allowing contraction?

What moves out of the way?

A

Troponin C binds to Ca

Tropomyosins wove out of my son binding groove on actin filaments

333
Q

Type 1 muscles are found where?

A

in long acting muscles (slow twitch) like calves

High in myoglobin -> oxidative phosphorylation in mitochondria (deep red)

334
Q

Type 2 are found where?

A

in fast twitch muscles (like the pects) which contract anaerobially w/ low mitochondria and myoglobin

Body building muscles

335
Q

Rapidly adapting sensory receptors(2)

A 
Messieners (superficial)
Pacinian corpuscle (deep)
336
Q

Slowly adapting sensory receptors (2)

A

Merkels (superficial)

Ruffini (deep)

337
Q

Prickling pain is carried by?

A

A delta fibers (fast and mylinated)

338
Q

Burning or dull pain - itch is carried by?

A

C polymodal fibers (slow unmylinated)

339
Q

Vibration and pressure

Characteristic look?

A

pacinian receptor

onion in cross section

340
Q

Dynamic/changing light and discriminatory touch

Where are they found the most?

A

Messieners capsule

found in areas of skin w/out hair - fingertips, lips, eyelids

341
Q

Static unchanging light touch

On histology hard to distinguish from what cell?

A

Merkel - think of erkel awkwardly touching too long

Confused w/ melanocytes

342
Q

Propioception regarding the muscle length sensed by

A

muscle spindels

343
Q

Proprioception regarding muscle tension sensed by?

A

Golgi tendon aparatus

344
Q

Ropust spindle shape structures found on soles of feet?

A

raffinii

345
Q

Layers of peripheral nerve (3)

A

Epineurium - vessels
Perineurium - fascicle
Endoneurium - individual nerve

346
Q

Gulliane barre damages these nerves?

A

Schwann Cells

347
Q

Cells that promote axonal regeneration

A

Schwann cells

348
Q

Classic presentation of Guilliane Barre

Causal agent?

A

Ascending symetrical paralysis w/out loss of sensory

May include the face (50%)

Causal agent: Unknown - associated w/ camplobacter or CMV or herpes - post respiratory , maybe stress

349
Q

Increased CSF protein w/ NO change in the cell count?

A

Guilliane Barre

350
Q

Rx for guillaine BArre

A

Supportive

  • respiratory especially, the autoimmune attack of the schann cells eventually subsides and most recover completely
351
Q

Demylination of the CNS due to destruction of the oligodendrocytes?

Associated w/ what cause?

A

Progressive multifocal leukoencephalopathy (PML)

Reactivation of JC virus in AIDS patients -> fatal

352
Q

JC virus in AIDS patients be concerned w/ what path?

Destroys what cells?

A

progressive multifocal leukoencephalopathy

Attacks oligodendrocytes

353
Q

progressive multifocal leukoencephalopathy

A

Reactivation of JC virus in AIDS patients -> fatal

Demylination of the CNS due to destruction of the oligodendrocytes

354
Q

Acute disseminated encephalomyelitis

A

multifocal perivenular inflammation and demylination after infection (viral - measles or VSV), or vaccination

355
Q

Pathology seen after receiving a vaccine leading to symptoms of encephalitis

Pathology?

A

Acute disseminated encephalomyelitis

multifocal perivenular inflammation and demylination after infection (viral - measles or VSV), or vaccination

356
Q

Autosomal recessive lysosomal storage disease leading to demylination?

deficient in what?

A

Metachromatic leukodystophy

Arylsulfatase A
-> sulfa tide build up and impaired myelin production

357
Q

Arylsulfatase A deficiency leads to?

A

Metachromatic leukodystophy

-> sulfa tide build up and impaired myelin production

358
Q

Metachromatic leukodystophy

A

Autsomal recessive lysosomal storage disease leading to demylination

Arylsulfatase A deficiency
-> sulfa tide build up and impaired myelin production

359
Q

Charcot Marie tooth syndrome presentation

Affects (2)

A

hereditary motor AND sensory neuropathy

due to defect in production of proteins involved in the
1. function of peripheral nerves 2. myelin sheath

360
Q

hereditary motor AND sensory neuropathy

A

Charcot Marie tooth

due to defectim production of proteins involved in the function of peripheral nerves or myelin sheath

361
Q

Mcburneys point

A

Appendix

2/3 of the way from umbilicus to ASIS

362
Q

cotton wool spots seen in (3)

A

seen on the retina in
DM
HTN
AIDS

363
Q

White reflex on an infant most likely indicates

A

retinoblastoma

364
Q

Uveitis is?

Associated w?(2)

A

inflammation of the uveal coat(iris, ciliary body(anterior) and choroid (posterior)

systemic inflammatory disorders - sarcoidosis, RA
HLA b27 - PAIR associated conditions

365
Q

Flow of aqueous humor

A

Made by ciliary epithelium (B2)

  • > posterior chamber
  • > around the lens -> anterior chamber; between angle formed by lens and iris diaphragm
  • > Drains into the trabecular meshwork
  • > Drains the trabecular meshwork
366
Q

Open angle glacoma presentation(4)

A

Bilateral

insidious onset in an older patient due to either an overproduction or lack of drainage issue

loss of peripheral vision first then central

painless

367
Q

Presentation of closed narrow angle - acutely(6)

A

Emergency. Increased IOP pushes iris fotfard and angle closes abruptly

PAIN
-unilateral
sudden vision loss
halos around eyes
rock hard eye 
frontal HA
368
Q

Gaucoma medication 2 groups 6 drugs

A

Increase outflow

  • prostglandins
  • alpha agonists
  • cholinergic agonists

Decreas aqueous production

  • beta blockers
  • acetazolamide
  • alpha agonists

Mannitol in acute angle

369
Q

Catarct is?

Risk factors?(9)

A

painless opacification of the lens leading to decreased vision (lock of night vision, can’t read fine print)

Risks

  • Smoking
  • age
  • sunlight
  • corticosteroid use
  • galacosemia
  • galatokinase deficieny
  • diabetes - sorbitol
  • trauma
  • infection - rubella in utero
370
Q

Diagnose glaucoma (2 ways)

A

tonometry test -pressure

optic cup to disc ratio greater than 50% the cup is bulging out in comparison to the disc (ganglion exit point)

371
Q

Sudden onset of plashing light followed by poor vision think of?

A

Retinal seperation

Seperation of the neurosensory layer of the retina from outermost pigmented epithelium. -> degeneration of photoreceptors

372
Q

Retinal detachment risks?(3)

A

retinal breaks - trauma
diabetic traction
inflammatory effusions

373
Q

Diabetic eye problems(4)

A

retinal detachment
neurovascularization/proliferation retinopathy
Glaucoma
cataracts

374
Q

2 types of macular degeneration and associated Rx

A

Dry - nonexudative (>80%) - deposition of “drusen” yellowish extracellular pigment

-Rx stop smoking and antioxidant vitamins

Wet- exudative - rapid loss of vision w/ bleeding secondary to choroidal neovascularization

-Rx antivascular endothelial growth factor injections (Anti VEGF)

375
Q

Outer hair cells vs Inner hair cells

Damaging Abx?

A

Outer hair cells receive signal from the olevochochlear tract causing the the outer hair cells to contract -> stiffening of the basalir membrane -> sensitization of the inner hair cells to frequencies

Aminoglycosides damage the Outer hair cells

376
Q

Pathway of hearing - 10

A 
Tympanic membrane->
middle ear ossicles (malleus, incus, stapes)->
auditory hair cells on the cochlea->
Spiral (cochlear ganglion)->
Chochlear nuclei->
lateral lemniscus->
inferior colliculus->
medial geniculate body ->
primary auditory cortex (temporal lobe)
377
Q

Weber and Rinne Tes

A

*Weber
Normal is midline
Conductive hearing loss -> lateralizes to affected ear
Sensorineural hearing loss lateralizes to the opposite ear

  • Rhinne
    Normal - Air conduction > bone
    Conductive hearing loss BC>AC
378
Q

Most common organisms implicated in Acute otitis external(2)

Rx?

A

Pseudomonas

S aureus

Irrigation and topical Abx

379
Q

Kid comes in that jumps off the table when you put in your otoscope, also does not like his pinna pulled on diagnosis

A

Acute otitis externa - pseudomonas most likely

380
Q

Diagnosis of Acute Otitis Media (4)

Rx?

A

Bulging TM
Middle ear effusion
Erythema
TM immobility under positive pressure

Amoxicillin w or W/o clauvinate

381
Q

Most common causes of otitis media (3)

A

Strep pneumonia

Hamophelis influenza - nontypable

Morexella Catarrhalis

382
Q

Patient complains post auricular swelling redness and mastoid tenderness =?

What did they have before?

A

Acute mastoiditis

Complication of Otitis media

383
Q

Difficulty maintaining inner ear pressure and due to allergic rhinitis?

Rx?

A

Eustachian tube dysfunction

Intranasal steriods Rx

384
Q

Overgrowth of desquamated keratin debris w/in the middle ear space?

Complication

A

Cholesteatoma

eventually may erode the ossicular chain and math mastoid air cells

385
Q

Causes predesposing chosteastoma (2)

Symptoms (3)

A

negative middle ear pressure - estachian tube dysfunction

direct grown of epithelium through TM perforation

Conductve hearing loss
vertigo
pearly white lesion behind the TM

386
Q

Feeling like the room is spinning is most likely due to ?

caused by(2)

A

Benigne paroxysmal positional vertigo

Cellular debris or displaced otoliths in the vestibular apparatus -> illusion of spinning

387
Q

Dx and Rx for BPPV?(2)

A

Dix hallpike procedure

Epley maneuver

388
Q

Causes of vertigo(4)

A

BPPV

Vestibular neuritis

Meniere disease - tinnitus, vertigo and hearing loss

Central vertigo - branstem/cerebellar lesion -> damaged vetibular nuclei

389
Q

Patient presents w/ tinnitus, vertigo and hearing loss Dx?

due to

A

Meniere disease

Due to imbalance in the composition of electrolytes and fluid in the endolymph

390
Q

Intranuclear inclusions seen in herpes simplex encephalitis?

A

Cowdry Type A

391
Q

Cytoplasmic inclusions pathognomonic of rabies?

A

Negri Bodies

392
Q

Neuronal inclusions characteristic of parkinsons

A

lewy bodies

393
Q

Cytoplasmic inclusions associated w/ aging

A

Lipofuscian

394
Q

Dark cytoplasmic pigment in neurons of the substantial nigra and locus coeruleus, not seen W/ Parkinsons

A

melanin

395
Q

Eosinophilic, rod like inclusions in the hippocampus of alzheimer pateints

A

Hirano bodies

396
Q

Diagnostic of alzheimers disease

A

neurofibrillary plaques or tangles (intracellular)

397
Q

Filamentous inclusions (tau proteins) that stain slier and do not survive neuronal death - spherical

A

Picks Bodies

398
Q

Filamentous inclusions that stain w/ PAS and ubiquitian

A

Lewy Bodies

399
Q

What 3 diseases have lewy bodies?

A

Parkinsons
Lewy body dementia
Rare type of alzheimers

400
Q

The difference in daily course and level of consciousness in dementia and delerium

A

Dementia is consistent w/ normal levels of consciousness

Delerium has waxing and waning levels throughout the day maybe and the has a decreased level of consciousness (taking more naps)

401
Q

intracellular deposits of hyperphosphorylated tau proteins

A

Neurofibratory tangles seen in Alzheimers

402
Q

Extracellular amyloid deposits in the grey matter?

A

Beta amyoild - senile plaques in alzheimers

403
Q

1st and 2nd most common cause of dementia

A
  1. alzheimers

2. multi infarct dementia (vascular dementia)

404
Q

Usual workup of dementia -

6 tests

A 
mini mental
HIV - encephalopathy
RPR - teriary syphilis
B12- megaloblastic anemia
MRI - vascular or hydrocephalis (NPH)
TSH - hypothyroidism
405
Q

neurotransmitter change in alzheimers and drug Rx

(2 classes)

A

decreased ACh

cholinesterase inhibitors
- domeprizol, reostigmine, galantamine

Memantine - NMDA antagonist, decreasing gluamte excitability in the brain which is toxic

406
Q

2 pathologies found in the brain w/ alzheimers and makeup and location

A

Senile plaques

  • extracellular
  • Abeta amyloid
  • from APP (amyloid precursor Protien)

Neurofibrillary tangles

  • intracellular
  • tau proteins
  • insoluble cytoskeleton elements(hyperphos)
407
Q

Dementia seen with aphasia

underlying path?

A

Pick’s Disease

  • spherical tau protein that build up in the frontal and temporal regions of the brain
  • spares the parietal and posterior superior temporal gyrus
408
Q

Dementia seen w. change in personality

underlying path?

A

Picks disease

  • spherical tau protein that build up in the frontal and temporal regions of the brain
  • spares the parietal and posterior superior temporal gyrus
409
Q

Dementia seen w/ parkinsonian like symptoms and visual hallucinations

Underlying path?

A

Lewy body dementia

alpha synuclein defect -> lewy bodies in the cortex instead of substantial nigra

410
Q

Dementia w/ syncope episodes

A

Lewy body dementia

alpha synuclein defect -> lewy bodies in the cortex instead of substantial nigra

411
Q

Lewy body dementia characterized by 3 things

A

Parkinsonain like symptoms
Syncope episodes
visual hallucinations

alpha synuclein defect -> lewy bodies in the cortex instead of substantial nigra

412
Q

alpha synuclein defect

A

-> lewy bodies in the cortex instead of substantial nigra

Lewy body dementia

413
Q

Rapidly progressive dementia w/in weeks to months

Associated finding?

A

Prion disease Creutzfield- Jacob
-> Beta pleated sheet

myoclonus (startle)

414
Q

Beta pleeted sheet buldup and myoclonus noted be worried about

A

Prion disease CJD

rapidly progressive dementia

415
Q

Other causes of dementia

A 
Multi infarct
syphilis
HIV
B12 deficiency
Wilsons
Normal press hydrocephalus
hypothyroidism
416
Q

dementia w/ urinary incontinence and magnetic gait?

A

Normal pressure hydrocephalus

-reversible

417
Q

Most common causes of delirium(2)

A

Drugs

  • Benzodiazapines
  • Anticholinergics

Infection - UTI

418
Q

Delerium characterized by(6)

What may be abnormal?

A 
acute onset
disorganized thinking
disturbance in sleep patterns
waxing and waning levels of consciousness
hallucinations

EEG abnormal

419
Q

Dementia characterized by?(7)

A

progessive/persisitent decline of intellectual ability or cognition w/out affecting consciousness (prefrontal/temporal lobe neuronal death)

memory
aphasia
apraxia
loss of abstract though
behavioral/personality changes
impaired judgement

USLME Kiss my ass and pray (33 decks)

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