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DIT Cards > Neuro Step 1 > Flashcards

Neuro Step 1 Flashcards

1
Q

In what disorders are dopamine levels increased?

A

schizophrenia

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2
Q

In what disorders are dopamine levels decreased?

A

depression & Parkinson disease

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3
Q

What are the four major dopaminergic pathways?

A

Mesocortical pathway, mesolimbic pathway, nigrostriatal pathway, tuberoinfundibulnar pathway

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4
Q

Describe the mesocortical pathway. What is the result of blocking this?

A

Ventral tegmental of the midbrain -> cortex

increased negative symptoms of schizophrenia

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5
Q

Describe the mesolimbic pathway. What is the result of blocking this?

A

Ventral tegmental of midbrain -> limbic system

Relieves positive symptoms of schizophrenia

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6
Q

Describe the nigrostriatal pathway. What is the result of blocking this?

A

Substantia nigra pars compacta -> neostriatum

Parkinson Disease

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7
Q

Describe the tuberoinfundibular pathway. What is the result of blocking this?

A

Arcuate nucleus of hypothalamus -> pituitary
Increased release of prolactin from anterior pituitary (hypogonadism, which manifests as amenorrhea in women and decreased libido in men)

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8
Q

In what disorders are norepinephrine levels increased?

A

anxiety/mania

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9
Q

In what disorders are norepinephrine levels decreased? Where is NEpi produced?

A

depression

locus ceruleus

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10
Q

In what disorders are serotonin levels decreased? Where is serotonin produced?

A

anxiety and depression

Raphe nucleus

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11
Q

What disorder is associated with decreased levels of ACh? Degeneration of what structure would be found?

A

Alzheimer’s Disease

basal nucleus of Meynert

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12
Q

In what disorders are GABA levels decreased? Where is it produced?

A 
anxiety & Huntington's disease
nucleus accumbens (produced from glutamate and VitB6)
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13
Q

Forebrain (prosencephalon) develops into what?

A

Telencephalon -> cerebral hemispheres, basal ganglia, hippocampus, amygdala
Diencephalon -> thalamus, hypothalamus, optic nerves, and tracts

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14
Q

Midbrain (mesencephalon) develops into what?

A

Mesencephalon -> midbrain

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15
Q

Hindbrain (rhombencephalon) develops into what?

A

Mesencephalon -> Cerebellum & pons

Myelencephalon -> medulla

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16
Q

What cartilage, muscle, and nerve structures develop from the first pharyngeal arch?

A 
M&T structures
Cartilage - 
Meckel's cartilage
     - mandibular ligament
     - mandible
     - malleus & incus
Muscle -
Muscles of Mastication
     - masseter
     - medial pterygoid and lateral pterygoid muscles
     - temporalis
mylohyoid
tensor tympani
tensor veli palatini
Anterior 2/3 of tongue
Nerves
Mandibular & Maxillary branches of the trigeminal nerve
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17
Q

What disorder happens if neural crest cells fail to migrate to the 1st pharyngeal arch?

A

Treacher Collins syndrome

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18
Q

What cartilage, muscle, and nerve structures develop from the second pharyngeal arch?

A 
S structures
Cartilage - 
Stapes
Styloid process
Stylohyoid ligament
Lesser horn of the hyoid
Muscle - 
Muscles of facial expression
Stapedius
Stylohyoid
Nerve - 
CN Seven (innervates the muscle of facial expression)
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19
Q

What cartilage, muscle, and nerve structures develop from the third pharyngeal arch?

A 
"pharyngeal"
Muscle - 
stylopharyngeus
Nerves - 
Glossopharyngeal (CN IX)
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20
Q

What cartilage, muscle, and nerve structures develop from the fourth and sixth pharyngeal arches?

A

“cricothyroid & larynx”
Cartilage -
cricoid cartilage, thyroid cartilage, cartilage of the larynx
Muscles -
cricothyroid muscle (4th)
pharyngeal muscles (swallowing) (4th)
rest of the laryngeal mm. (speech) (6th)
Nerves -
CN X
superior laryngeal (swallowing and cricothyroid m)
recurrent laryngeal nerve (6th arch) (speech)

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21
Q

Forebrain anomalies

A 
meroencephaly
anencephaly
meroanencephaly
- incompatible with life
holoprosencephaly -> hemispheres of the brain fail to separate at midline
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22
Q

What causes cycloplegia and cleft lip & palate?

A

sonic hedgehog gene mutations
severe fetal alcohol syndrome
patau syndrome (trisomy 13)

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23
Q

What is Dandy Walker syndrome?

A

enlarged posterior fossa
cerebellar vermis fails to develop
Dilation of the 4th ventricle
associated with hydrocephalus & spina bifida

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24
Q

What are Chiari malformations?

A

Hindbrain abnormality -> part of the cerebellum herniates downward through foramen magnum
Chiari I - mildest; only tonsils herniate; may cause syringomyelia
Chiari II - lombosacrale myelomeningocele, more significant herniation of tonsils and vermis; can have hydrocephalus

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25
Q

What germ layers come from the pharyngeal arches, pouches, and clefts?

A

arches - mesoderm
clefts - ectoderm
pouches - endoderm

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26
Q

What forms from the 1st pharyngeal pouch?

A

Eustachian tubes, middle ear cavity, mastoid air cells

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27
Q

What forms from the 2nd pharyngeal pouch?

A

epithelial lining of the tonsils

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28
Q

What forms from the 3rd pharyngeal pouch?

A

inferior parathyroid glands and thymus

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29
Q

What forms from the 4th pharyngeal pouch?

A

superior parathyroid glands

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30
Q

What forms from the 1st pharyngeal cleft?

A

external auditory meatus

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31
Q

What forms from the 2nd-4th pharyngeal clefts?

A

temporary cervical sinuses

If one does not obliterate, patient will have a pharyngeal cleft cyst in the lateral neck

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32
Q

What makes a thyroglossal duct cyst?

A

failure of thyroglossal duct to be obliterated

will be found midline and will move when swallowed

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33
Q

What is DiGeorge Syndrome?

A

22q11 deletion
abnormal development of the 3rd and 4th pharyngeal pouches -> absent thymus and parathyroid glands
immunodeficient and hypocalcemic

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34
Q

What does the premotor cortex do?

A

planning & guiding movement based on sensory input

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35
Q

What does the arcuate fasciculus do?

A

Connection between Broca’s and Wernicke’s areas

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36
Q

What do the frontal eye fields do?

A

eye movements and scanning

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37
Q

What structures are contained inside the carotid sheath?

A

common carotid artery, jugular vein, vagus n

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38
Q

What is expressive dysprosody?

A

inability to express emotion or inflection in speech

non dominant cortical lesion corresponding to broca’s area

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39
Q

What is receptive dysprosody?

A

inability to comprehend emotion or inflection in speech

Nondominant cortical lesion corresponding to Wernicke’s area

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40
Q

What is Gerstmann syndrome?

A

lesion of the dominant angular gyrus (usually left) (parietal lobe just posterior/superior to Wernicke’s area), resulting in:
agraphia - inability to write
acalculia - inability to do mathematical calculations
right-left disorientation
finger agnosia - inability to distinguish fingers

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41
Q

What is hemispatial neglect syndrome?

A

lesion of the non dominant angular gyrus (usually right side)
results in neglect of the body or surrounding contralateral to the lesion

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42
Q

What artery is damaged in Broca’s or Wernicke’s aphasia?

A

MCA

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43
Q

What artery is damaged in lower extremity sensory and/or motor loss?

A

ACA

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44
Q

What artery is damaged in unilateral sensory and/or motor loss in the face and arm?

A

MCA

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45
Q

What are the areas of the brain most susceptible to damage?

A

cerebellum, neocortex, hippocampus, watershed areas

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46
Q

What disorders are berry aneurysms associated with?

A

Ehlers Danlos and ADPKD

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47
Q

Where is the most common site for berry aneurysms?

A

junction of anterior communicating and ACA

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48
Q

What drug is used in a subarachnoid hemorrhage to prevent vasospasm?

A

nimodipine

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49
Q

What occurs with bilateral lesions of the hippocampus?

A

anterograde amnesia - inability to make new memories

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50
Q

What occurs with bilateral lesions of the mammillary bodies?

A

wernicke-korsakoff syndrome - confusion, ataxia, nystagmus, ophthalmoplegia, memory loss (anterograde and retrograde amnesia), confabulation, personality changes
can occur with alcoholics deficient in thiamine (Vit B1)

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51
Q

What occurs with bilateral lesions of the amygdala?

A

kluver-bucy syndrome - disinhibited behavior (hyperphagia, hypersexuality, hyperorality) - lose fear response
can occur with HSV-1 encephalitis

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52
Q

What is intraventricular hemorrhage in the newborn?

A

hemorrhage into the ventricular system
most common in premature/very low birth weight infants (<32 weeks, <1500g) within the first 72 hours of life
originates from the germinal matrix in the subependymal, sub ventricular zone that gives rise to neurons and glia during development

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53
Q

What cranial nerve deficit is associated with an epidural hematoma?

A

CN III palsy -> down and out pupil

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54
Q

Which crosses suture lines: epidural hematoma, subdural hematoma, or subarachnoid hemorrhage?

A

subdural hematoma -> subdural snakes along the skull

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55
Q

You see bloody CSF on lumbar puncture. What is it?

A

subarachnoid hemorrhage

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56
Q

What artery is commonly damaged in an epidural hematoma?

A

middle meningeal artery

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57
Q

What are the nuclei of the anterior hypothalamus?

A

Anterior, suprachiasmatic, preoptic, supraoptic, paraventricular

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58
Q

What is the function of the anterior nucleus of the hypothalamus? What happens with damage to it?

A

thermoregulation (AC = anterior cooling); damage causes hyperthermia

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59
Q

What is the function of the suprachiasmatic nucleus of the hypothalamus? Where does it receive input from?

A

Circadian rhythms; retina

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60
Q

What is the function of the prepoptic area of the hypothalamus?

A

Secretes GnRH

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61
Q

What is the function of the supraoptic nucleus of the hypothalamus? What happens with damage to it?

A

Secretes ADH (stored in posterior pituitary); damage causes central diabetes insipidus

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62
Q

What is the function of the paraventricular nucleus of the hypothalamus?

A

Secretes oxytocin (stored in posterior pituitary), secretes CRH, secretes TRH

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63
Q

What are the nuclei of the tuberal hypothalamus?

A

Arcuate, lateral, ventromedial, dorsomedial

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64
Q

What is the function of the arcuate nucleus of the hypothalamus?

A

Secretes GHRH, secretes dopamine, pulsatile GnRH secretion, regulates appetite

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65
Q

What is the function of the lateral nucleus of the hypothalamus? What happens with damage to it?

A

regulates hunger; inhibited by leptin; damage leads to anorexia and weight loss

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66
Q

What is the function of the ventromedial nucleus of the hypothalamus? What happens with damage to it?

A

Regulates satiety; stimulated by leptin; damage leads to obesity and savage behavior

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67
Q

What is the function of the dorsomedial nucleus of the hypothalamus? What occurs with stimulation of it?

A

regulates hunger; stimulation leads to obesity and savage behavior

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68
Q

What are the nuclei of the posterior hypothalamus?

A

posterior and mammillary

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69
Q

What is the function of the posterior nucleus of the hypothalamus? What happens with damage to it?

A

Thermoregulation (warming); damage causes hypothermia

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70
Q

What is the function of the mammillary nucleus of the hypothalamus? What happens with damage to it?

A

Memory; damage causes Wernicke-Korsakoff

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71
Q

What structure secretes melatonin?

A

secreted by pineal gland; produced in darkness; secretion follows circadian rhythm

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72
Q

What structures make up the limbic system?

A

cingulate gyrus, fornix, hippocampus (memory), septal nucleus, mammillary bodies, amygdala (summation of signals)

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73
Q

Deficiency of what nutrient causes damage to the mammillary bodies?

A

Vitamin B1 (thiamine)

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74
Q

What are the responsibilities of the limbic system?

A

Feeding, Fleeing, Fighting, Feeling, and Sex

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75
Q

What cranial nerve exits the skull at the cribriform plate?

A

CN I

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76
Q

What cranial nerve exits the skull at the optic canal?

A

CN II (along with the ophthalmic artery)

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77
Q

What cranial nerve exits the skull at the superior orbital fissure?

A

CN III, CN IV, CN VI, CN V1

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78
Q

What cranial nerve exits the skull at the foramen rotundum?

A

CN V2

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79
Q

What cranial nerve exits the skull at the foramen ovale?

A

CN V3

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80
Q

What structure exits the skull at the foramen spinousum?

A

middle meningeal artery

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81
Q

What cranial nerve exits the skull at the internal auditory meatus?

A

CN VII, CN VIII

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82
Q

What cranial nerve exits the skull at the jugular foramen?

A

CN IX, CN X, CN XI, and the jugular vein

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83
Q

What cranial nerve exits the skull at the hypoglossal canal?

A

CN XII

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84
Q

What structure go through the foramen magnum?

A

vertebral arteries & spinal root of CN XI (enters the skull to exit through the jugular foramen)

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85
Q

What conditions can result in facial nerve palsy?

A

Lovely Bella Had An STD (Lyme, Bell’s palsy, HSV/Zoster (#1 cause), AIDS, Sarcoidosis, Tumors, Diabetes

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86
Q

Facial nerve/nucleus lesion leads to:

A

paralysis of ipsilateral side of entire face

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87
Q

Facial motor cortex lesion leads to:

A

paralysis of contralateral side of lower face

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88
Q

What are the vagal nuclei?

A

nucleus solitarius, nucleus ambiguus, dorsal motor nucleus

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89
Q

What is the function of the nucleus ambiguus?

A

swallowing and speech; receives input from the bilateral corticobulbar tracts & bilateral motor cortices

90
Q

What is the function of the nucleus solitarius?

A

visceral sensory information (sensory from pharynx, trachea, esophagus, taste from back of tongue)

91
Q

What is the function of the dorsal motor nucleus?

A

sends autonomic (parasympathetic) fibers to heart, lungs, and upper GI

92
Q

What neurologic deficits can you see with an infection of the cavernous sinus?

A

cavernous sinus contains: CN 3, 4, 5, and 6
ophthalmoplegia: CN III: eye down and out; CN VI (most susceptible): eye adducts
diplopia
pain or numbness of upper face (CN V)

93
Q

What is the function of the dorsal column? Where does it decussate? Where does it end?

A

Ascends
Function: pressure, vibration, fine touch, proprioception
Decussation: medulla -> ascends contralaterally in medial lemniscus
Ends: VPL of thalamus -> sensory cortex

94
Q

What is the function of the spinothalamic tract? Where does it decussate? Where does it end?

A

Ascends
Function: Lateral: pain and temperature; Anterior: crude touch, pressure
Decussate: anterior white commissure (1-2 levels above entrance into SC) -> ascends contralaterally
Ends: VPL of thalamus -> sensory cortex

Pain and temp to face = trigeminothalamic tract (runs with spinothalamic tract, but DOES NOT decussate

95
Q

What is the function of the lateral corticospinal tract? Where does it decussate?

A

Descends
Function: voluntary movement of contralateral limbs
Decussates: caudal medulla -> descends contralaterally

96
Q

What artery supplies the medullary pyramids and the medial lemniscus int he medulla?

A

Anterior spinal artery

97
Q

What artery supplies the inferior cerebellar peduncle, nucleus ambiguus, and lateral spinothalamic tract in the medulla?

98
Q

What spinal tract conveys light touch, proprioception, and vibration sensation?

A

Dorsal Columns

99
Q

What spinal tract conveys motor commands from he motor cortex to the body?

A

Lateral corticospinal and ventral tracts

100
Q

What spinal tract conveys pain and temp sensation?

A

Lateral spinothalamic

101
Q

What spinal tract is important for postural adjustment and head movements?

A

Vestibulospinal

102
Q

What spinal tract conveys proprioceptive information to the cerebellum?

A

Spinocerebellar (dorsal and ventral)

103
Q

What is the triad of Horner syndrome?

A

ptosis, mitosis, anhydrosis

104
Q

Which direction does vertebral disc herniation usually occur? What are the most common spinal levels? What nerve is affected?

A

posterolaterally; L4-L5 or L5-S1; nerve usually affected is below the level of herniation

105
Q

What is the dura mater derived from?

106
Q

What is the arachnoid mater derived from?

A

neural crest

107
Q

What is the Pia mater derived from?

A

neural crest

108
Q

What is Ebstein anomaly? What causes it?

A

Displacement of the septal and posterior tricuspid valve leaflets toward the apex -> atrialization of the right ventricle; lithium causes this

109
Q

What is the hallmark sign of a brainstem lesion?

A

alternating syndromes: long tract symptoms on one side (motor or sensory problems) and cranial nerve symptoms on the other side (due to interrupting CN nuclei)

110
Q

What are the four medial/midline structures of the brainstem (first rule of fours)? What happens with a deficit in each?

A

begin with M:
1. Motor pathways (corticospinal tract)
Deficit: weakness of the C/L arm and leg
2. Medial lemniscus
Deficit: loss of vibration/proprioception/fine touch (C/L arm/leg)
3. Medial longitudinal fasciculus
Deficit: ipsilateral internuclear ophthalmoplegia
4. Motor cranial nerve nuclei
Deficit: 3,4,6,12 CNs - ipsilateral defects of these CNs

111
Q

What are the four “side” (lateral) structures of the brainstem (second rule of fours)? What happens with a deficit in each?

A

begin with S:
1. Spinocerebellar tract
Deficit: ipsilateral arm & leg ataxia
2. Spinothalamic tact
Deficit: alteration of pain & temp sensation in C/L arm and leg
3. Sensory nucleus of CN V
Deficit: ipsilateral alteration of pain and temp on face
4. Sympathetic pathway
Deficit: ipsilateral Horner syndrome (ptosis, miosis, anhydrosis)

112
Q

What are the four cranial nerves that origination in the pons, four below the pons, and four above the pons (two in midbrain)? (third rule of fours)

A
  • CN III, IV - originate in the midbrain (above the pons)
  • CN V, VI, VII, VIII - originate in the pons
  • CN IX, X, XII - originate in the medulla (below the pons)
113
Q

What are the four motor cranial nerve nuclei in the midline? (fourth rule of fours)

A

CN III, IV, VI, XII (CN tracts DO NOT decussate)

114
Q

What artery supplies the lateral pons?

115
Q

What artery supplies the medial pons?

A

median and paramedic branches of the basilar artery

116
Q

What artery supplies the lateral medulla?

117
Q

What artery supplies the medial medulla?

A

anterior spinal artery

118
Q

What is the other name for lateral medullary syndrome? What deficits could you see?

A

Wallenberg syndrome

  1. loss of pain and temp sensation over C/L body (spinothalamic tract)
  2. loss of pain and temp sensation over I/L face (spinal trigeminal nucleus damage)
  3. Hoarseness, difficulty swallowing, loss of gag reflex (nucleus ambiguus: CN IX and X damage)
  4. Ipsilateral Horner syndrome (descending sympathetic tract)
  5. Vertigo, nystagmus, N/V (vestibular nuclei damage) (almost always causes these)
  6. I/L cerebellar deficits (ataxia, past pointing) (inferior cerebellar peduncle damage) - spinocerebellar tract
119
Q

What deficits could you see with medial medullary syndrome?

A
  1. C/L spastic hemiparesis (pyramid/corticospinal tract damage)
  2. C/L tactile and kinesthetic defects (medial lemniscus damage) (decreased vibration and proprioception)
  3. tongue deviation toward the side of the lesion (hypoglossal nucleus/nerve damage)
  4. Pain and temp sensation generally preserved
120
Q

What deficits could you see with lateral inferior pontine syndrome?

A
  1. I/L facial nerve paralysis (facial nucleus and nerve fiber damage)
  2. Ipsilateral limb and gait ataxia (damage to middle cerebellar peduncle) - spinocerebellar tract
  3. I/L loss of pain and temp sensation from the face (spinal trigeminal nucleus and nerve fiber damage)
  4. C/L loss of pain and temp sensation (damage to spinothalamic tract)
  5. I/L Horner syndrome (damage to descending sympathetic tract)
  6. No C/L body paralysis or loss of light touch/vibratory/proprioceptive sensation
121
Q

What deficits could you see with medial pontine syndrome?

A
  1. C/L spastic hemiparesis (corticospinal tract damage)
  2. C/L loss of light touch/vibratory/proprioceptive sensation (medial lemniscus damage)
  3. I/L internuclear ophthalmoplegia (damage to MLF)
  4. Gaze away from side of lesion (damage to pontine gaze center: PPRF)
  5. I/L paralysis of lateral rectus muscle (damage to abducens nucleus)
  6. Pain and temp sensation preserved
122
Q

What is internuclear ophthlamoplegia? What disorders could it be seen in?

A

caused by a lesion of the MLF. Horizontal nystagmus of one eye with loss of adduction in the opposite eye. Convergence is normal. Will see in MS and medial pontine strokes

123
Q

What is Weber syndrome?

A

anterior midbrain infarction resulting from occlusion of the paramedic branches of the posterior cerebral artery.

  • Cerebral peduncle lesion: dysphagia, dysphonia, dysarthria (corticobulbar tract damage); C/L spastic hemiparesis (corticospinal tract damage)
  • Oculomotor nerve palsy - ipsilateral ptosis, pupillary dilation, lateral strabismus (eye down and out)
124
Q

What is locked-in syndrome?

A

bilateral basilar artery stroke; associated with rapid correction of hyponatremia (medial pontine myelinolysis)
consciousness (RAS) spared, quadriplegia, loss of horizontal but not vertical eye movements

125
Q

What are the features of idiopathic intracranial hypertension?

A

young obese women
headaches - daily, pulsatile, worse at night or early AM, possible retroocular pain worsened by eye movements, possible N/V
Papilledema
most worrisome sequela is vision loss
Ct scan: no ventricular dilation, no tumor, no mass
elevated ICP (>200 in non obese patients, >250 in obese patients)

126
Q

How is idiopathic intracranial hypertension managed?

A

first line pharmacotherapy = acetazolamide
weight loss in obese patients
discontinue inciting agents

127
Q

What is the treatment for cluster headaches?

A

sumatriptan or 100% O2 (quickest)

verapamil for prophylaxis

128
Q

What is the treatment for tension headaches?

A

NSAIDs (ibuprofen, naproxen, acetaminophen)

129
Q

What is the treatment for migraines?

A

triptans (sumatriptan, rizatriptan, zolmitriptan)

130
Q

What are the adult brain tumors? (5)

A
  1. Glioblastoma
  2. Meningioma
  3. Schwannoma
  4. Oligodendroglioma
  5. Pituitary adenoma
131
Q

What are the pediatric brain tumors? (4)

A
  1. Pilocytic astrocytoma
  2. Medulloblastoma
  3. Ependymoma
  4. Craniopharyngioma
132
Q

Which brain tumor has pseudopalisading necrosis?

A

glioblastoma

133
Q

Which brain tumors are associated with NF2?

A

schwannoma, meningioma

134
Q

Which brain tumors are associated with hyperprolactinemia?

A

pituitary adenoma

135
Q

Which brain tumors are associated with psammoma bodies?

A

meningioma

136
Q

Which brain tumors have a fried egg appearance?

A

oligodendroglioma

137
Q

Which brain tumors have perivascular pseudorosettes?

A

ependymoma

138
Q

Which brain tumors are associated with bitemporal hemianopia?

A

pituitary adenoma, cranipharyngioma

139
Q

Which brain tumor has the worst prognosis of any primary brain tumor?

A

glioblastoma

140
Q

Which brain tumors are associated with a child having hydrocephalus?

A

Medulloblastoma, ependymoma

141
Q

Which brain tumor is associated with Homer-Wright pseudorosettes?

A

medulloblastoma

142
Q

Tuberous sclerosis

A

Aut Dom, mutations in TSC1 and TSC2 genes (hamartin and tuberin proteins); classic triad: seizures, intellectual disability, angiofibromas
additional findings: hypomelanotic macule (ash-leaf spots), retinal hamartomas, cortical tubers (glioneuronal hamartomas)
tumor associations: renal angiomyolipoma, cardiac rhabdomyoma, astrocytoma

143
Q

What is the treatment for trigeminal neuralgia?

A

carbamazepine

144
Q

What is the treatment for absence seizures?

A

ethosuximide (valproic acid is 2nd line)

145
Q

What is the treatment for status epilepticus?

A

benzodiazepines (diazepam or lorazepam)

146
Q

What is the treatment for eclampsia?

A

magnesium sulfate (Benzos 2nd line)

147
Q

What are the most common causes of seizures in children?

A

infections, trauma, developmental etiology, metabolic disturbances

148
Q

Which hypothalamic nucleus is responsible for regulating the sympathetic nervous system?

149
Q

Which hypothalamic nucleus is responsible for regulating the parasympathetic nervous system?

150
Q

What are the findings of Brown-Sequard syndrome?

A

At level of lesion: LMN signs & pain & temp loss
I/L below lesion: loss of pain and temp, loss of fine touch/proprioception/vibration (dorsal columns), UMN signs
C/L below lesion: loss of crude touch, pain & temp (spinothalamic tract)

151
Q

What are some of the classic presenting scenarios for MS?

A

intention tremor, nystagmus, scanning speech (also think of internuclear ophthalmoplegia, bowel/bladder incontinence, and optic neuritis)

152
Q

What are the classic presenting symptoms of syringomyelia?

A

loss of pain and temp in cape/shawl pattern bilaterally; hand muscle weakness and atrophy

153
Q

What causes degeneration of the dorsal columns?

A

tabes dorsalis

154
Q

What causes degeneration of the anterior horns of the spinal cord?

A

poliomyelitis and werdnig-hoffmann disease

155
Q

What are is spared in occlusion of the anterior spinal artery?

A

dorsal columns and medial lemniscus

156
Q

What are the deep nuclei of the cerebellum?

A 
Fast Gerbils Exercise Daily
-Fastigial
-Globose
-Emboliform
-Dentate
(globose + emboliform = interposed nuclei)
157
Q

What structure provides the major output pathway from the cerebellum?

A

superior cerebellar peduncle -> contralateral ventral lateral nucleus of the thalamus

158
Q

On which side of the body would motor control be affected by a lesion of the cerebellum?

A

motor control ipsilateral to the side of the lesion would be affected (double C/L)
output from cerebellum -> C/L thalamus -> cortex -> corticospinal tract -> body C/L to cortex (ends up I/L)

159
Q

What is the function of the vestibulocerebellum? What does a lesion here do?

A

(also called flocculonodular lobe)
Function: balance and equilibrium
Lesion: disequilibrium, difficulty with balance, truncal ataxia, nystagmus

160
Q

What is the function of the spinocerebellum? What does a lesion here do?

A

(medial with vermis)
Function: postural control of trunk, coordination of legs
Lesion: postural instability, broad-based gait

161
Q

What is the function of the cerebrocerebellum? What does a lesion here do?

A

(lateral part of hemisphere)
Function: control of extremeties
Lesion: intention tremor, loss of coordination (dysdiadokinesia, dysmetria)

162
Q

What are the features of essential (familial) tumor?

A

rapid, fine tremor of head, hands, arms, and/or voice
occurs with both movement and rest
50% of patients have a family history of tremor
Treated with beta blocker (propranolol), primidone (anticonvulsant), or clonazepam
Some patients self medicate with alcohol

163
Q

What information is relayed by the ventral lateral nucleus of the thalamus?

A

motor coordination from the cerebellum and basal ganglia -> cortex

164
Q

What information is relayed by the VPL nucleus of the thalamus?

A

somatosensory from body -> primary sensory cortex

165
Q

What information is relayed by the medial geniculate nucleus?

A

Auditory information from inferior colliculus -> auditory cortex

166
Q

A patient presents with involuntary flailing movements of one arm. Where is the lesion?

A

Subthalamic nucleus (hemiballismus)

167
Q

Glaucoma physical findings

A

Optic disc atrophy with cupping
Elevated Intraocular pressure
Progressive peripheral visual field loss

168
Q

Treatment for acute closure narrow-angle glaucoma if delay > 1 hour in seeing ophthalmologist

A

Timolol, apraclonidine, acetazolamide, mannitol

169
Q

What are symptoms of a lesion to the C5 and C6 nerve roots?

A 
Erb-Duchenne Palsy
- loss of UE lateral rotators
- loss of biceps m. 
- loss of UE abductors
(suprascapular n., musculocutaneous n., axillary n.
170
Q

What are the symptoms of a lesion to the inferior trunk of the brachial plexus?

A

Klumpke’s palsy

  • loss of intrinsic hand mm; claw hand
  • sensory loss of the medial arm, forearm, and hand
171
Q

What sensory area is supplied by the radial nerve?

A

posterior arm and dorsal side of hand

172
Q

What sensory area is supplied by the ulnar nerve?

A

5th digit and half of 4th digit

medial side of pam and dorsal hand

173
Q

What sensory area is supplied by the median nerve?

A

lateral palm and first 3 1/2 digits

174
Q

What sensory area is supplied by the musculocutaneous nerve?

A

lateral side of the forearm

175
Q

What sensory area is supplied by the axillary n?

A

lateral shoulder

176
Q

What sensory area is supplied by the femoral n?

A

anterior thigh and medial lower leg

177
Q

What sensory area is supplied by the obturator n?

A

medial thigh

178
Q

What sensory area is supplied by the sciatic n?

A

Posterior thigh and gluteal regions

entire lower leg except medial aspect

179
Q

What sensory area is supplied by the tibial n?

A

sole of the foot

back of the calf (sural n)

180
Q

What sensory area is supplied but the common fibular n?

A

lateral lower leg

dorsal side of the foot

181
Q

What sensory area is supplied by the deep fibular n?

A

webbing between first and second toes

182
Q

What is the adaptation, sensation, and location of Merkel receptors?

A

Adaptation: slow; sensation: static pressure; Location: superficial/hair follicles

183
Q

What is the adaptation, sensation, and location of Meissner corpuscles?

A

Adaption: rapid; sensation: light touch; location: superficial

184
Q

What is the adaptation, sensation, and location of Ruffini receptors?

A

Adaptation: slow; sensation: pressure/position sense; location: deep/spindle-shaped

185
Q

What is the adaptation, sensation, and location of Pacinian corpuscles?

A

Adaptation: rapid; sensation: vibration; location: deep/onion-shaped

186
Q

What is the adaptation, sensation, and location of free nerve endings?

A

Adaptation: A-delta: rapid; C-fiber: slow
Sensation: A-delta: sharp pain/cold; C-fiber: dull pain
Location: superficial/everywhere

187
Q

What CSF changes are present in Guillain-Barre syndrome?

A

increased protein but normal cell count

188
Q

What are the classic manifestations of Guillain-Barre syndrome?

A

ascending symmetric paralysis (w/o sensory loss), facial paralysis, preceded by infection (campylobacter jejuni

189
Q

Describe the flow of aqueous humor.

A

produced by the epithelium of the ciliary body
flows from the posterior chamber -> through the pupil -> into the anterior chamber
exits the anterior chamber via the trabecular meshwork (canal of Schlemm)

190
Q

Acute angle-closure glaucoma

A

emergency
abrupt onset of pain, headache (temporal, eyebrow), nausea, colored halos, rainbows around light
red, teary eye with hazy cornea and fixed, mid-dilated pupil (not reactive to light) that is firm to palpation

191
Q

Open-angle glaucoma

A

common, insidious form; usually bilateral
risk factors: older than 40, African American, family history of glaucoma, myopia, and diabetes
Early stage: asymptomatic, elevated intraocular pressure
Late stage: gradual loss of peripheral vision, permanent blindness if untreated

192
Q

Classic presentation of a patient with a cataract

A

usually bilateral
slowly progressive, painless decrease in vision (difficulty driving at night, reading road signs, or reading fine print)
possible disabling glare from sunlight or oncoming headlights at night
near-sightedness is often an early manifestation

193
Q

What drug classes are used in the treatment of glaucoma?

A

alpha agonists, beta blockers, cholinomimetics, diuretic, prostaglandins

194
Q

What is the treatment for dry, age-related macular degeneration?

A

smoking cessation, antioxidants

195
Q

What drugs should be used if there is >1 hour delay in seeing an ophthalmologist for acute closure narrow-angle glaucoma?

A

timolol, apraclonidine, acetazolamide, mannitol

196
Q

What infections are associated with posterior uveitis?

A

CMV, toxoplasmosis, cat scratch Dz, psoriatic arthritis, IBD

197
Q

What infections are associated with anterior uveitis?

A

reactive arthritis, ankylosing spondylitis, sarcoidosis, juvenile idiopathic arthritis

198
Q

Wet vs Dry Macular Degeneration

A

Dry - deposition of yellowish extracellular material in between Bruch membrane and retinal pigment epithelium with gradual decrease in vision
Wet - rapid loss of vision due to bleeding secondary to choroidal neovascularization. Treat with anti-VEGF

Can have cotton wool spots

199
Q

How is retinal detachment visualized on fundopscopic exam?

A

crinkling of retinal tissue and changes in vessel direction

200
Q

What disorders can cause a cherry red spot on the eye?

A

central retinal artery occlusion
Tay-Sachs disease
Niemann-Pick disease
Other lysosomal storage diseases

201
Q

What happens with a frontal eye field lesion?

A

eye deviates toward lesion

202
Q

What happens with a lesion of the paramedic pontine reticular formation?

A

eyes deviate away from lesion

203
Q

What happens with a lesion of the superior colliculus?

A

paralysis of upward gaze (parinaud’s syndrome)

204
Q

What will a weber and rinne test be for conductive hearing loss in the R ear?

A

Weber - lateralizes to R side

Rinne - bone > air (abnormal)

205
Q

What will a weber and rinne test be for sensorineural hearing loss in the L ear?

A

Weber - lateralizes to R side

Rinne - air > bone (normal)

206
Q

What is a cholesteatoma?

A

overgrowth of desquamated keratin debris within the middle ear space

207
Q

Acute otitis externa

A

inflammation/infection of ear canal
pain with manipulation of the ear
most commonly caused by P. aeruginosa or S. aureus
Treatment: irrigation and topical antibiotics

208
Q

Acute otitis media

A

bacterial or viral infection fo the middle ear space
diagnosis made by inspection of the tympanic membrane:
- bulging
- middle ear effusion
- erythema
- TM immobility under positive pressure with pneumatic otoscope
most common bacterial causes: S. pneumonia, nontypable H. influenzas, M. catarrhalis
Treament
- antibiotics (amoxicillin, amoxicillin + clavulanic acid, cephalosporins)
-tubes

209
Q

What is the triad of Meniere’s disease?

A

intermittent vertigo, tinnitus, and hearing loss

210
Q

What are the stages of sleep? What waves do they have?

A

Awake (beta), Relaxed (alpha), N1 (theta), N2 (sleep spindles and K complexes), N3 (delta), REM (beta)

211
Q

What stage of sleep do you grind your teeth? What stage do you dream? What stage do you have night terrors?

A

teeth grinding (bruxism): N2
dreaming: REM
night terrors: N3

212
Q

What sleep changes do you see in the elderly?

A

decreased REM and slow-wave sleep (N3), increased sleep onset latency, increased early awakenings, increased REM latency (takes longer to get there)

213
Q

What sleep changes do you see with depression?

A 
decreased slow wave sleep (N3)
decreased REM latency
increased REM early in sleep cycle
increased total REM sleep
repeated nighttime awakenings
early-morning awakening (terminal insomnia)
214
Q

What is the treatment for narcolepsy?

A

avoidance of drugs that cause sleeepiness
scheduled naps (1-2x/day for 10-20 min)
stimulants - modafinil, methylphenidate
If cataplexy, then use venlafaxine, fluoxetine, or atomoxetine

215
Q

What is the treatment for restless leg syndrome?

A

check iron levels; pramipexole, ropinirole; gabapentin or pregabalin if pain also

216
Q

Nocturnal Enuresis

A

bed-wetting
cannot be diagnosed until age 5; treatment is delayed until age 7
desmopressin (DDAVP) - ADH; enuresis starts again after discontinuation
imipramine (TCA) - decrease N3 time; short-term
Indomethacin (decrease RBF -> decrease GFR -> decrease urine production)

217
Q

What drugs are used to shorten stage N3 sleep?

A

Imipramine (TCA) & benzodiazepines

218
Q

What is the sleep pattern in a patient with narcolepsy?

A

start with REM sleep instead of N1

219
Q

Where do neurons of the lateral corticospinal tract synapse prior to exiting the spinal cord to affect movement?

A

synapse at the cell body of the anterior horn

220
Q

What information is relayed by the lateral geniculate nucleus of the thalamus?

A

visual retina -> occipital cortex

221
Q

What information is relayed by the ventral posterior medial nucleus of the thalamus?

A

somatosensory from face via trigeminal tract/medial lemniscus

222
Q

What information is relayed by the ventral anterior nucleus of the thalamus?

A

motor basal ganglia -> cortex

DIT Cards (16 decks)

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