NeuroExam/Dx/PathoPhys Dz Flashcards
Neuroanatomic localization to alterations in a patient sensorium is usually caused by alternation in which region?
A) Ascending reticular activating system
B) Cerebellum
C) Forebrain
D) Cranial nerve VIII
A) Ascending reticular activating system
What is pleurothotonus? A) Multiple sites of flaccid paralysis B) Multiple sites of rigid extension C) Deviation of the head and neck to one side D) Seen with decerebellate rigidity
C) Deviation of the head and neck to one side
What is the difference between decerebellate rigidity and decerebrate rigidity?
A) Decerebrate causes flexion of hips.
B) Decerebrate generally doesn’t cause change in mentation.
C) Decerebellate rigidity involves flexion of the hips.
D) Decerebellate always affects mentation
C) Decerebellate rigidity involves flexion of the hips.
Which of the following is false regarding reflexes?
a. A normal reflex requires an intact afferent (sensory) and efferent (motor) arm
b. The afferent and efferent arms tend not to enter and exit the spinal cord at the same segments
c. The afferent arm is composed of sensory receptors, sensory nerve, dorsal nerve root, and spinal cord segment
d. Sensory receptors include the muscle spindle or Golgi tendon organ
b. The afferent and efferent arms tend not to enter and exit the spinal cord at the same segments
Which of the following reflexes is not matched with the appropriate nerve segments
a. Patellar reflex – l4-l6
b. Biceps – C6-C8
c. Triceps – C7-T2
d. Withdrawal – C1-C5
d. Withdrawal – C1-C5 (C6-T2)
Patellar: femoral
Biceps: w/ musculocutaneous
Triceps: Radial n.
L6-S1 is sciatic
The menace is a learned response that may not be present until which age? 6-8 weeks 8-10 weeks 10-12 weeks 12-14 weeks
10-12 weeks
The menace response requires all these aspects of the brain to function except which? Cerebellum Medial geniculate nucleus. Occipital lobe of the cerebrum Optic nerve
Medial geniculate nucleus. (Should be lateral gen nucleus)
Describe what it means to have a negative direct but positive indirect PLR verse a negative direct and negative indirect PLR? Where are the lesions?
if the nonresponsive pupil is the result of an ocular, retinal, or optic nerve lesion, it will constrict when the light is directed into the contralateral eye (e.g., positive indirect pupillary light reflex).
If the nonresponsive eye remains dilated with light directed into the unaffected eye, a lesion involving the parasympathetic oculomotor nerve nucleus of CN III should be suspected.
Which of the following autonomous zones will have sensation if the sciatic nerve is damaged?
- Dorsal surface
- Plantar surface
- Medial surface
- Lateral surfac
Medial surface (saphaneous is a br of femoral nerve that projects to L4-L6 spinal cord segments)
Lateral surface - not an autonomous zone
Provide the localization for the following clinical signs: Normal mentation, reduced tone in the thoracic limbs, normal to exaggerated tone in pelvic limbs, hypalgesia in thoracic limbs, unilateral horner syndrome.
- C1-C5
- C6-T2
- T3-L3
- Mid to caudal brainstem
C6-T2 (T1-T3 specifically with the Horner’s syndrome)
Provide the localization for the following clinical signs: depressed mental state, vestibular ataxia, facial paresis, increased tone in all four limbs,
- Prosencephalon
- C1-C5
- Mid to caudal brainstem
- Cerebellum
- Mid to caudal brainstem (Pontine lesion)
True/false: Spinal shock is disruption of ascending inhibitory axons of border cells in the dorsolateral border of the ventral grey matter L1-L4.
False
Correct answer is schiff-sherrington
T/F Dysmetria or a disturbance in rate, range and force of movement is seen with general ataxia
False: Cerebellar ataxia
T/F reticulospinal and rubrospinal tracts function in gait generation
True
T/F Abnormal postural reactions detect a lesion functionally ipsilateral to the level of the medulla oblongata
False: midbrain
anatomic crossover at medulla oblongata
Which segments and nerves need to function for cutaneous trunci m. reflex
C8-T1 and both lateral thoracic nerves
Describe path for horner’s syndrome
Sympathetic preganglionic neurons in TL spinal cord –> T1-T3→ brachial plexus → vagosymp trunk → cranial cervical ganglia → cranial cavity + ophthalmic br of trigeminal → innervate dilator m. of pupil in iris
What is true about touching the medial aspect of nasal mucosa?
a. Tests the contralateral br of ophthalmic and maxillary n
b. Nociceptive path goes to ipsilateral thalmus
c. A Contralateral prosencephalic lesion could be localized
d. A dropped jaw could be concurrent
C
isplat ophto+max
Contralateral thalmus
dropped jaw = bilateral mandibular br of trigeminal nerve
Which is true?
a. Law of electromagnetic induction = change in strength and direction of magnetic field results in electrical voltage in a coiled wire
b. Weighting = radiofrequency excitation followed by relaxation
c. Pulse sequence = accentuating variation in signal by manipulating parameters
A true
B weighting –> variation in signal
c. Pulse sequence = excitation/relaxation
Name 3 types edema of the neuro system
vasogenic, cytotoxic, interstitial
True/False: myelographic techniques use ionic contrast media iohexal or iopamidol
False: NONionic
What layers compose the subarachnoid space? A) pia and dura B) pia and arachnoid C) arachnoid and dura D) epidural and arachnoid
B pia and arachnoid
Leptomeninges = arachnoid and pia --> contains CSF Pachymeninges = dura and arachnoid
Where is csf produced? A) lateral ventricle B) third ventricle C) fourth ventricle D) all of the above
D all
Which of the following is FALSE?
a. the blood brain barrier is composed of endothelial cell tight junctions, astrocyte processes, basal lamina, pericytes, and perivascular microglia
b. Free diffusion through the blood brain barrier is dependent upon substance lipid solubility, ionization, and size
c. Substances such as glucose, amino acids, and thiamine are freely diffusible through the blood brain barrier
d. The antigen presenting cells of the blood brain barrier are the endothelial cells and perivascular microglial cells
C
Specific transport systems for glucose, amino acids, and thiamine
cytokines and certain drugs are freely diffusible through the blood brain barrie
Which of the following is true?
A. The meninges and choroid plexus do not have a blood brain barrier
B. The CNS is not immunologically privileged
C. Oligodendrocytes are the resident immune and phagocytic cell of the CNS
D. Aminoglycosides have good penetration of the blood brain barrier
A true
microglial cells = resident immune and phagocytic cells
Which of the following is FALSE?
A. Brain trauma typically causes both focal and diffuse pathologic changes
B. Diffuse brain injury is caused by brain swelling, hypoxia, and diffuse axonal injury
C. Axonal injury causes membrane damage allowing unregulated potassium entry into the cell and depolarization
D. Decrease perfusion to an area of the CNS typically leads to cytotoxic edema
C false
Axonal injury leads to membrane damage allowing unregulated SODIUM entry into the cell and subsequent depolarization
True/False
• Axonal injury is the cause of posttraumatic coma and death in patients that do not have a mass identified
True
When nerves are damaged, what neurotransmitter increases extracellularly due to increased neuronal release and decreased astrocyte uptake? • Acetylcholine • Gaba • Glutamate • Serotonin
Glutamate
What does increase in glutamate lead to an increase of inside of the cell? • Na+ • K+ • Ca2+ • Phosphorous
Sodium and Calcium
Which is FALSE about the effects of increase in calcium?
• Activates intracellular proteases such as calpains and caspase
• Leads to destruction of the cytoskeleton and chromosomes and initiate programmed cell death.
• Activates phospholipase A2, thereby producing eicosanoids and initiating an antiinflammatory response
• Binds intracellular phosphates, further depleting the cell of energy sources.
C false
phospholipase A2–> inflammatory response
Which of the following statements is FALSE?
• Leukotrienes and other inflammatory mediators have effects on ionic conductances and synaptic transmission
• Failure of ion pumps at the cell membrane may result in interstitial edema
• Genetic basis for degenerative changes have been found in humans and animals both young and old.
• Knowing the type of edema present helps direct treatment.
• Failure of ion pumps at the cell membrane may result in (cytotoxic) edema
At what age does Hansen type I degeneration peak in dogs (yrs)? • 2-7 • 5-8 • 6-9 • 3-4
B. 5-8
Characteristics of cytotoxic edema include? • Increased vascular permeability • Presence of a normal BBB • Increased intraventricular pressure • Secondary effect of Elevated PaCO2
B correct
Increased vascular permeability = vasogenic
Increased intraventricular pressure= interstitial
Elevated PaCO2 –>in vasodilation. Cytotoxic edema is from vasoconstriction → ischemia
Which is true about autoregulation of CNS perfusion?
a. Oligodendrocytes detect changes in chemical milieu
b. Very sensitive to changes in PaO2
c. Endothelial derived factors largely mediate dilation and constriction of pressure vessels
d. Metbolic is the only means of regulation
C is correct
Astrocytes: detect chemicals
PaCO2 increase –> vasodilation of cerebral vessels
metabolic AND Pressure autoregulation
true or false: hansen type II is a protrusion of the dorsal annulus and common in younger dogs
False, OLDER dogs
Which is true?
a. Oligodendrocytes and microglial cells can be regenerated readily
B. paritially denervated muscle cannot be reinervated by neighboring motor units
c. Astrocytes help axons grow/sprout
d. Myelin contains ligands that activate nogo recpetors–> growth cone collapse
D
A oligodendrocytes + astrocytes
B. can
C. Astrocytes produce inhibitory molecules
what is the normal intracranial pressure?
8-12 mmHg
