Neurology 1 Flashcards
Answer: Listeria monocytogenes
Answer: Neisseria meningitidis
Important gram negative diplococci include N. meningitidis, N. gonorrhoeae, and M. catarrhalis (an important cause of bronchopneumonia in COPD patients).
Answer: Iron deficiency anaemia
A watershed stroke is a form of ischaemic stroke. They tend to be caused by insufficient blood flow to the brain (e.g. carotid artery stenosis, arrhythmia or heart failure) or a vascular blockage/restriction far upstream of the infarct. This results in an infarct of the border zones between the tissues supplied by the ACA, MCA, and PCA.
Answer: Osteoarthritis
A lumbar puncture can still be performed in patients with joint disease, but it can be more challenging due to decreased range of motion in the vertebral joints. Lumbar punctures can be performed under image guidance with the involvement of interventional radiologists.
Answer: Acetylcholine receptor antibody
Answer: Absence seizures
Answer: Trinucleotide repeat expansion
Answer: Stylomastoid foramen
Answer: Ethosuximide
Answer: Cuneate nucleus
The cuneate nucleus, one of the dorsal column nuclei, is a wedge-shaped nucleus in the closed part of the medulla oblongata. It contains cells that give rise to the cuneate tubercle, visible on the posterior aspect of the medulla. It lies laterally to the gracile nucleus and medial to the spinal trigeminal nucleus in the medulla.
Answer: Sixth nerve palsy
Answer: Fourth nerve palsy
Answer: Amygdaloid body
Answer: There is no interaction between valproate sodium and oral contraceptive pills
There is no interaction between valproate sodium and oral contraceptive pills. Some antiepileptic drugs, such as phenobarbital, primidone, phenytoin, carbamazepine, oxcarbazepine, and topiramate, are enzyme inducers and have been shown to increase the metabolism of ethinyl estradiol and progestogens. However, valproate sodium does not have this interaction and contraceptive preparations in normal doses can be used in patients taking valproate sodium.
Answer: Columns of fornix
Answer: HSV
Answer: Third nerve palsy
Answer: Vestibular nucleus
The vestibular nuclei are the cranial nuclei for the vestibular nerve.
Answer: A marked decrease in pulmonary diffusing capacity
Answer: Midazolam
This patient has status epilepticus (SE), which is traditionally defined as a single seizure or series of seizures lasting 30 minutes or more in which the patient fails to regain consciousness between the seizures. Any seizure lasting more than 5 minutes is unlikely to stop on its own, and treatment should be initiated immediately. The initial care of a patient in SE includes airway assessment, establishing an intravenous line, monitoring hemodynamic status, aggressive supportive care, and assessing and treating any underlying metabolic, toxic, and infectious etiologies.
Answer: Video electroencephalography (video EEG)
Video EEG monitoring is the criterion standard for classifying the type of seizure or syndrome or for diagnosing pseudoseizures. This study can be performed to rule out an epileptic etiology with a high degree of confidence if the patient has demonstrable impairment of consciousness during the spell in question, without abnormality on the EEG. Video EEG is also used to characterize the type of seizure and epileptic syndrome to optimize pharmacologic treatment and for presurgical workup.
Answer: Obtain an EEG and a neuroimaging study
Answer: Obtain a repeat EEG and MRI to help guide decisions on continued use of sodium valproate prior to pregnancy
Answer: Spinal trigeminal nucleus
Answer: Ethmoid
Answer: Prolongs GABA-mediated chloride channel openings
Answer: Nucleus ambiguus
The nucleus ambiguus is a group of large motor neurons, situated deep in the medullary reticular formation. The nucleus ambiguus contains the cell bodies of nerves that innervate the muscles of the soft palate, pharynx, and larynx which are strongly associated with speech and swallowing. As well as motor neurons, the nucleus ambiguus in its “external formation” contains cholinergic preganglionic parasympathetic neurons for the heart.
Answer: Valproic acid
Similar to valproic acid, carbamazepine increases the risk of neural tube defects; however, it does not increase the risk of other malformations.
- A) Coxsackie virus
- B) Cryptococcus neoformans
- C) Herpes Simplex Virus (HSV)
- D) Staphylococcus aureus
- E) Streptococcus pneumonia
Answer: Herpes simplex virus (HSV)
Answer: Decorticate rigidity
Answer: Carbamazepine
Answer: Partial seizures originating in the temporal lobe
Answer: Head trauma
Answer: Bitemporal heteronymous hemianopsia
Answer: Contralateral homonymous hemianopsia with macular sparing
What part of the brain is shown here?
Midbrain
Answer: GABA
Answer: The substantia nigra compacta
Dopamine from the substantia nigra compacta excites the direct pathway (via dopamine 1 receptors) and inhibits the indirect pathway (via dopamine 2 receptors) of the basal ganglia; resulting in net excitation of the motor cortex and thusly increased movement.
Answer: B12
What part of the brain is shown here?
Superior Colliculus
Answer: Fasciculus gracilis
Answer: Parkinson’s disease
Answer: Middle cerebral artery
Answer: Neurofibromatosis
Answer: Right lateral funiculus
Answer: Multiple sclerosis
Oligoclonal bands are an important indicator in the diagnosis of multiple sclerosis.
What part of the brain is shown here?
Hippocampus
Answer: hypertension with a wide pulse pressure, bradycardia, irregular breathing
What part of the brain is shown here?
Amygdala
What part of the brain is shown here?
Hippocampus
Answer: Glioblastoma
bilateral glioblastoma (butterfly glioma)
Answer: Oculomotor (III)
A complete oculomotor nerve palsy will result in a characteristic down and out position in the affected eye. The eye will be displaced outward “exotropia” and displaced downward “hypotropia”; outward because the lateral rectus (innervated by the sixth cranial nerve) maintains muscle tone in comparison to the paralyzed medial rectus. The eye will be displaced downward, because the superior oblique (innervated by the fourth cranial or trochlear nerve), is unantagonized by the paralyzed superior rectus, inferior rectus and inferior oblique. The affected individual will also have a ptosis, or drooping of the eyelid, and mydriasis (pupil dilation).
What part of the brain is shown here?
Left amygdala
Answer: Subfalcine herniation
Answer: Posterior spinocerebellar tract
Answer: Bleeding diathesis
Absolute contraindications for an LP include anticoagulant therapy, bleeding diathesis, and evidence of localised infection in the lumbar region. Other factors - e.g. signs of raised ICP, immunocompromise, decreased GCS - may also warrant the use of CT first.
Answer: 150 mL
What part of the brain is shown here?
Posterior Commissure
Answer: lateral, median
Cerebrospinal fluid keeps the brain buoyant, protects brain tissue from mechanical injury, prevents ischaemia, allows for homeostatic regulation of substances between cells in the brain, and removes waste products. About 500mL of CSF is produced per day, mostly by the choroid plexus in the lateral ventricles. The CSF moves from the lateral ventricles to the third ventricle via the interventricular foramina, then to the fourth ventricle via the cerebral aqueduct. It then passes into the subarachnoid space through the median aperture and the two lateral apertures.
Answer: vagus (X), away from
Answer: Anosmia
Answer: The glossopharyngeal nerve only
Answer: Chorda tympani branch of facial nerve only
Answer: Fourth nerve palsy
Answer: Its afferent nerve is the optic (CN II) and its efferent nerve is the oculomotor (CN III)
Answer: Left ophthalmic nerve (branch of trigeminal nerve)
Answer: Right cerebellum
Right cerebellum is correct. Cerebellar lesions cause a disturbance of equilibrium, muscle tone, and execution of movement. The patient’s symptoms indicate an intention tremor, which is associated with cerebellar damage. Lateral lesions of the cerebellum impair limb movements ipsilateral to the lesion. The patient’s tremor in the right hand and falling to the right suggest that the lesion is in the right side of the cerebellum.
Answer: Conjugate vertical gaze
Parinaud syndrome is paralysis of conjugate vertical gaze due to a lesion (e.g. stroke, hydrocephalus, pinealoma) affecting the superior colliculus.
Answer: Option C
Answer: Pilocytic Astrocytoma
On imaging, pilocytic astrocytomas typically show a cystic lesion with an attached mural nodule.
Answer: bradycardia, hypertension with widened pulse pressure, irregular breathing
The Cushing Reflex is a late sign of raised intracranial pressure and typically indicates imminent brain herniation. When the arterial pressure is less than the ICP, the hypothalamus activates the sympathetic nervous system, causing peripheral vasoconstriction and an increase in cardiac output, which raises arterial pressure. The increased arterial blood pressure stimulates the baroreceptors in the carotid bodies, which causes bradycardia.
Answer: Middle cerebral artery
Answer: Meningioma
On imaging, meningiomas typically present as round masses attached to the dura.
Answer: Lateral corticospinal tract
Answer: Lateral reticulospinal tract
Answer: Oligodendroglioma
Micrograph of an oligodendroglioma showing the characteristic branching, small, chicken wire-like blood vessels and fried egg-like cells, with clear cytoplasm and well-defined cell borders. H&E stain.
Answer: C7
Answer: Anterior cerebral artery
Answer: Vertebral artery
Answer: Epidural haemorrhage
Epidural haemorrhage is due to rupture of the middle meningeal artery (often by trauma to the temporoparietal bone). It typically shows up on CT scans as a biconcave disk.
Answer: Pia mater
Answer: Choroid plexus papilloma
Answer: Internal carotid artery
Answer: Schwannoma
Schwannomas often present with tinnitus and loss of hearing as a result of CNVIII involvement.
Answer: Oculomotor
Oculomotor. Cranial nerves III, VII and X and S3–5 spinal nerves carry parasympathetic fibres.
Answer: the left substantia nigra
The left basal ganglia and substantia nigra influence the right side of the body.
Parkinson’s disease typically begins unilaterally, however the tremor soon becomes bilateral.
Answer: Anterior inferior cerebellar artery
Answer: Glioblastoma
On histology, glioblastomas typically show regions of necrosis surrounded by tumour cells and endothelial cell proliferation.
Answer: Oligodendroglioma
Answer: Basilar artery
Answer: S2, S3
Answer: Neisseria meningitidis
Answer: Hemangioblastomas
Answer: Skin; supraspinous ligaments; interspinous ligaments; ligamentum flavum; epidural space; dura; subarachnoid membrane into subarachnoid space
There is no such thing as the intraspinous ligament. The correct ligament is the interspinous ligaments (interspinal ligaments), which are thin membranous ligaments that connect adjoining spinous processes of the vertebra.
Answer: Vestibulospinal tracts
Answer: Craniopharyngioma
Presents as a supratentorial mass in a child or young adult; may compress the optic chiasm leading to bitemporal hemianopsia
Answer: Posterior inferior cerebellar artery
Answer: Anterior white commissure
Answer: Trisomy 21
Gene for β-APP is present on chromosome 21. Most individuals with Down syndrome (trisomy 21) develop Alzheimer disease by the age of 40 (early-onset).
Answer: Inhibits action of monoamine transporters
Answer: Vertebral artery
Answer: Facial nerve (VII)
The facial nerve passes through, but does not innervate, the parotid gland. Within the parotid gland it bifurcates into the temporofacial and cervicofacial divisions, which further subdivide.
Answer: Tectospinal tract
Answer: Medial reticulospinal tract
Answer: Uncal transtentorial herniation
Answer: Superior cerebellar artery
Answer: Option 3
Answer: Occipital lobe
Answer: Striatum of the basal ganglia
Answer: Giant cell arteritis
Answer: Anterior communicating artery
Answer: Olfactory bulb
Answer: β-Amyloid (Aβ), Alzheimer’s disease
Alzheimer’s Disease is characterized by the formation of beta-amyloid plaques, as shown here. Senile plaques appear as small collections of dark, irregular, thread-like structures often with a brownish material in the centre. The central core is represented by amyloid and the irregular, beaded linear structures represent abnormal neurites (small dendrites and axons with degenerative changes).
Answer: Bacterial meningitis
Answer: Miosis
Opioid intoxication typically produces: miosis, confusion, obtundation, euphoria, central respiratory depression, constipation.
Answer: Subarachnoid haemorrhage
Answer: Olfactory tract
Answer: Corticospinal tract
Answer: Rubrospinal tract
Answer: facial nerve
Answer: Ependymoma
Perivascular pseudorosettes are a characteristic finding on biopsy
Answer: Neurofibrillary tangles with tau protein
Answer: Pilocytic Astrocytoma
What kind of visual field pathology would a lesion at pin 9 cause?
Left homonymous hemianopia with macular sparing
Answer: Elevation, extorsion, abduction.
Answer: ACA
Answer: Glioblastoma
Answer: Alpha-synuclein in neuronal cytoplasm
Answer: Tearing of the cerebral bridging veins
Answer: Metastases
Answer: Left medial frontal lobe
Answer: Amyotrophic lateral sclerosis - Electromyography
Answer: Fine touch, vibration, proprioception
Answer: Subdural haemorrhage
Answer: maxillary artery; external carotid artery
Answer: Ependymoma
Aqueductal stenosis is incorrect as it is a congenital disorder.
Ependymomas are malignant tumours of ependymal cells usually seen in children. They most commonly arise in the 4th ventricle and may present with hydrocephalus.
- A) All limbs of the internal capsule
- B) Anterior limb of the internal capsule
- C) Genu of the internal capsule
- D) Posterior limb of the internal capsule
- E) Thalamus
= B) Anterior limb of the internal capsule
In the anterior region, the large striatum is divided into caudate and putamen by the prominent anterior limb.
Answer: Cluster headache
This headache is most consistent with a type of neurovascular headache called cluster headache. These occur most often in young men; have a characteristic periodicity, or cluster; and cause lacrimation, nasal stuffiness, and sometimes conjunctival inflammation. Migraines tend not to come and go in this manner, are more throbbing, and are more likely to be associated with nausea and vomiting. Sinusitis is usually bilateral with associated fever and purulent discharge. Tension headaches are usually described as bandlike, without lacrimation or nasal congestion
Answer: Subarachnoid haemorrhage
Answer: Chorda tympani
The chorda tympani branch of the facial nerve passes forwards through its canaliculus into the middle ear and crosses the medial aspect of the tympanic membrane. It then passes antero-inferiorly in the infratemporal fossa. It distributes taste fibers to the anterior two-thirds of the tongue.
Answer: Schwannoma; cranial nerve Vlll
Answer: Superior orbital fissure
Answer: Epidural haemorrhage
Answer: Subarachnoid haemorrhage
Answer: Propranolol
Propranolol is highly lipid-soluble and so crosses the blood-brain barrier.
Answer: Epidural haemorrhage
Answer: Start oral aciclovir ± and oral prednisolone
Answer: A left frontal meningioma
Answer: Medulloblastoma
Answer: Meningioma
Answer: Lenticulostriate or lateral striate arteries
The lateral or lenticulostriate arteries are small branches that arise at right angles from the middle cerebral artery. They are under high pressure and vulnerable to rupture, typically into the region of the extreme or external capsule, anterior limb of the internal capsule, or striatum.
Answer: Options D and B
Answer: Subarachnoid haemorrhage
Saccular aneurysms are the most common cause of subarachnoid haemorrhage. They are thin-walled protrusions through areas of cerebral arteries with thin or absent tunica media.
