Neurology Flashcards
1
Q
Forebrain Origin? (embryology)
A
Prosencephalon
2
Q
Midbrain Origin? (embryology)
A
mesencephalon
3
Q
Hindbrain Origin? (embryology)
A
rhomboencephalon
4
Q
2 derivatives of prosencephalon? (embryology)
A
Telencephalon and Diencephalon
5
Q
2 derivatives of rhomboencephalon
A
metencephalon
myelencephalon
6
Q
Embryology origin of Medulla?
A
myelencephalon (from rhomboncephalon)
7
Q
Embryology origin of Thalamus?
A
Diencephalon (from proseencephalon)
8
Q
Embryology origin of Cerebral hemisphere?
A
Telencephalon (from proseencephalon)
9
Q
Embryology origin of Lower part of 4th ventricle?
A
myelencephalon (from rhomboncephalon)
10
Q
Embryology origin of Lower part of lateral ventricle?
A
Telencephalon (from proseencephalon)
11
Q
Embryology origin of 3rd ventricle?
A
Diencephalon (from proseencephalon)
12
Q
Embryology origin of midbrain?
A
mesencephalon
13
Q
Embryology origin of cerebral aqueduct?
A
mesencephalon
14
Q
Embryology origin of pons?
A
metencephalon (from rhomboncephalon)
15
Q
Embryology origin of cerebellum?
A
metencephalon (from rhomboncephalon)
16
Q
Embryology origin of Upper part of 4th ventricle?
A
metencephalon (from rhomboncephalon)
17
Q
Neuroectoderm Derivatives (in the brain) (name 4)
A
CNS Neurones
Ependymal Cells (inner lining of netricles)
Oligodendroglia
Astrocytes
18
Q
Neural Crest Derivatives (in the brain)
[name 2]
A
PNS neurones
Schwann Cells
19
Q
Mesoderm Derivatives (in the brain) [name 1]
A
Microglia
just like microphages, which are also from mesoderm
20
Q
Axons making up free nerve endings?
A
C (slow, unmyelinated)
A.delta (fast, myelinated)
21
Q
In which Fibers do vibration and pressure travel?
A
Pacinian Corpuscles
-found in deep skin layers (hypodermis), ligaments and joints
22
Q
In which Fibers do pressure, deep static touch (e.g. shapes, edges), and proprioception travel?
A
Merkel’s discs
23
Q
In which Fibers do Pain and Temperature travel?
A
Free nerve endings
A.delta and C fibers
24
Q
In which Fibers do dynamic, fine/light touch; proprioception travel?
A
meissner’s corpuscles
-in glaborous (hairless) skin
25
In the brain, which nucleus/nuclei produces serotonin or 5-HT?
Raphe Nucleus (pons)
26
In the brain, which nucleus/nuclei produces dopamine?
ventral tegmentum
substantia nigra (pars compacta)...in the midbrain
27
In the brain, which nucleus/nuclei produces norepinephrine?
Locus Ceruleus (pons)
28
In the brain, which nucleus/nuclei produces AcetylCholine?
Basal Nucleus of Meynert
29
In the brain, which nucleus/nuclei produces GABA?
Nucleus Accumbens
| reward center, pleasure,addiction, fear
30
Functions of the hypothalamus
| mnemonic is hypothalamus wears "TAN HATS"
T= Thirst and water balance
A= adenohypophysis (regulates anterior pituitary)
N=neurohypohysis (releases hormones made in the hypothalamus)
```
H= hunger
A= autonomic reglation
T= temperature regulation (prostaglandins cause
fever)
S= sexual drive
```
31
Cavernous Sinus Contents
CNs: III, IV, VI, V1 and V2 branches of CNV
Post-ganglionic sympathetic fibers
internal carotid sinus
32
Sinus surrounding the cavernous sinus?
Sphenoid
33
Name the blood vessels that are damaged in the 3 main types of cranial hematomas.
Epidural Hematoma = Middle Meningeal Artery
Subdural Hematoma = Bridging Veins
Subarachnoid Hematoma = Rupture of an aneurysm (e.g. berry aneurysm). Patient presents with sudden onset of headache and describes it classically as WHOML!! Treated with Nimodipine
34
Causes of Meningitis in different age group
Neonates: Group B strep (Agalactiae)
Ecoli
Listeria
Ages 1-2: S. Pneumonieae
Adolescents/Young Adults: N. Meningiditis
Older People: S. Pneumoniae
35
Name the two sources of parasympathetic outflow
Cranial Nerves: III, VII, IX, X
Pelvic Splanchnics: S2, S3, S4
36
Kluver-Bucy Syndrome?
aka Russel Brand's Condition
Caused by BILATERAL lesion of the Amygdala
- Hyperorality
- Hypersexuality
- Disinhibited Behavior
*Condition is associated with HSV-1
37
Wernicke-Korsakoff Syndrome
Caused by BILATERAL lesion to Mamillary Bodies
- memory loss (anterograde and retrograde amnesia)
- Confusion
- Opthalmoplegia
- Ataxia
- Confabulation
- Personality Changes
*Condition is associated with Thiamine deficiency (vitamin B1) and also, as a secondary factor: Alcohol Abuse
38
Where is ADH made in the brain?..be specific and precise
Made in the SUPRAOPTIC NUCLEUS of the hypothalamus...that's where the thrst centers are located to
then stored in the posterior pituitary
***NB: suprachiasmatic nucleus regulates the circardian
39
Where is oxytocin made in the brain?..be specific and precise
Made in the PARAVENTRICULAR NULCEUS
** but stored in the posterior pituitary
40
Inputs to the Hypothalamus?
1) OVLT---senses changes in osmolarity
| 2) Area Postrema---vomit center i.e. it responds to emetics
41
Functions of Hypothalamic Nuclei:
| Only the 5 major nuclei
1. Lateral= Hunger center...BILATERAL lesion
leads to anorexia. Inhibited by Leptin
2. Ventromedial= Satiety center. Stimulated by leptin
3. Anterior= Cooling and stimulating
Parasympathetic
4. Posterior= Heating and stimulating sympathetic
5. Suprachiasatic Nucleus= Circadian Rhythym
42
Name 3 common brain herniation syndromes and the structures that are affected
1. Subfalcine herniation (cingulate gyrus goes under the falx cerebri)----affects the ACA
2. Uncal herniation aka Transtentorial herniation (uncus of the medial temporal lobe goes cmpresses against the free margin of the tentorium)----affects CN III and PCA to a lesser extent
3. Tonsilar herniation (through the foramen magnum)....hugs against the brainstem/medulla and leads to cardiorespiratory arrest
43
Multiple Sclerosis symptoms
(mnemonic = S.I.I.N)
and other classic symptoms?
```
S= Scanning speech
I= Incontinence
I= internuclear opthalmoplegia i.e. MLF syndrome
N= Nystgmus
```
OTHER classic syptoms:
- optic neuritis
- relapse and remitting course
44
Treatment for Multiple Sclerosis
- B-inteferon
- immmunosuppression
- natalizumab
- symptomatic treatment for neurogenic bladder (catheterization or muscarinic antagonists)
45
Name the 4 types of refractive errors (correctable by glasses) of the eye
1. Myopia..image focuses in front of the retina
2. Hyperopia (far sightedness)..image focus behind the retina
3. Astigamatism= abnormal shape of the cornea resulting in different refractive powers at different axes
4. Presbyopia= decreasing focusing ability during accomodation
46
UVEITIS:
- definition?
- structures?
- associated disorders?
DEF:inflammation of the uveal coat of the eye
STRUCTURES: choroid (layer between retina and sclera), ciliary body, iris
ASSOC. DISORDERS: systemic iflamtion disorders: sarcoidosis, RA, juvenile idiopathic arthritis, TB, HLA-B27-assoated conditions
47
RETINITIS:
- definition?
- structures?
- associated disorders?
DEF:retinal edema and necrosis, leading to scarring
STRUCTURES: Retina
**Caused by virus usually: HSV, HZV,CMV
ASSOC. DISORDERS: Immunosuppression
48
Marcus-Gunn Pupil?
Pupil with Afferent Pupillary Defect
(CNII is OK, but CN II is damaged due to either retinal detachment or optic nerve damage)
Bottomline: No pupillary constriction in both eyes when light is shone in the affected eye
49
Argyll-Robertson Pupil?
**aka Prostitute's Pupil
***Associated with Neurosyphillis
Eye does not react to light, but is able to accommodate.
50
Treatment for Age-Related Macula Degeneration (ARMD)?
1)Dry ARMD===treat with multivitamin and antioxidatives (in this form of ARMD, yellowish ECM fluid is deposited beneath the retinal epithelium and vision loss occurs gradually)
2) Wet ARMD====treat with anti-VEGF or Laser
(In this form of ARMD, there is neovascularization of the choridal layer of the eye)
51
Causes of Retinal Detachment?
| Name 3 common ones
1. Retinal Tear/break....due to vitroretinal traction
2. diabetic traction: abnormal blood vessels replaced by scar tissue. scar tissue contracts--lift retina--detachment.
3) inflammatory effusions: no visible break or tear. Inflammation leads to break or tear
52
Name the 8 'common' types of spinal cord lesions
1. Tabes Dorsalis (due to neurosyphylis)
2. Poliomyelitis or Werdnig/Hoffman Syndrome (LMN disease)
3. Anterior Spinal Artery occlusion (affects front 2/3 of spinal cord)
4. ALS- Lou Gherig Disease (both UMN and LMN affected)
5. Multiple Sclerosis (scatterd demyelianation in random spots)
6. Syringomyelia (associated with Chiari I malformation if congenital)
7. Brown-Seqard Syndrome (due to trauma)
8. Subacute Combined Degeneration -due to Vt B12 or E deficiency (Affects doral columns, spinocerebellar tracts, lateral corticospinal tracts). Also caused by AIDS or pernicious anemia
53
CMV:
Histologic Characteristics?
Brain Localization?
Presentation?
HISTOLOGIC CHARACTERISTICS: Both distinct nuclear and ill-defined cytoplasmic inclusions
BRAIN LOCALIZATION: Paraventricular subepyndymal regions
PRESENTATION:
-Encephalitis
-Occurs in imunocompromised patients.
Presn
54
HSV1:
Histologic Characteristics?
Brain Localization?
Presentation?
HISTOLOGIC CHARACTERISTICS: Cowdry Type A inclusions in the nucleus of neurons and glia
BRAIN LOCALIZATION:
- temporal lobes
- i.e. nuclei of neurones and glia
PRESENTATION: Encephalitis (its the most common cause of this) and hemorrhage of temporal lobes
55
HIV:
Histologic Characteristics?
Brain Localization?
Presentation?
HISTOLOGIC CHARACTERISTICS: Giant-multinucleated cells
--and microglial nodules
BRAIN LOCALIZATION: the subcortical white matter, diencephalon, and brainstem
PRESENTATION: Chronic HIV Encephalitis
56
TOXOPLASMOSIS:
Histologic Characteristics?
Brain Localization?
Presentation?
HISTOLOGIC CHARACTERISTICS: Ring-enhancing brain lesions--these are abscesses.
-crescentic microorganisms at edge of lesion and necrosis
BRAIN LOCALIZATION: no preference
PRESENTATION: Common in immunocompromised pts. esp HIV. Present with: seizure, altered mental status, focal deficits, necrotiing encephalitis, dysarthria If congenital, triad = chorioretinitis, hydrocephalus, intracranial calcifications
57
RABIES:
Histologic Characteristics?
Brain Localization?
Presentation?
HISTOLOGIC CHARACTERISTICS:
- Negri Bodies, which are:
- elongated eosinophilic intracytoplasmic inclusions
BRAIN LOCALIZATION: Purkinje cells of Cerebellum
PRESENTATION: Fever, Malaise, Agitation, photophobia, hydrophobia, paralysis, coma, death
58
PML:
Histologic Characteristics?
Brain Localization?
Presentation?
HISTOLOGIC CHARACTERISTICS:
Greatly enlarged oligodendrocyte nuclei with glassy amorphic viral inclusions (JC virus)
BRAIN LOCALIZATION:Preferentially infects oligodendroglia
PRESENTATION: Occurs in immunocompromised patients (es HIV) and it is a demyelinating disease
59
What are the 7 common primitive reflexes?
1. Rooting reflex=(turning head towards side that is stroked
2. Sucking Reflex= sucking if roof of mouth is stroked
3. Moro Reflex = abducting/Extending limbs and then drawing together, when startled {hang on to dear life}
4. Galant Reflex= when supine, flexing body towards the same side, when the side of the spine is stroked
5. Plantar Reflex= Positive Babinski sign
6. Palmar Reflex= curling fingers when palm is stroked
7. Glabellar Reflex= blinking in responds to tapping of the forehead
NB: Primitive reflexes reappear in adulthood if there is damage to the UMN (which normally inhibits reflexes)
60
What are the 5 clinical reflexes and their nerve roots?
1. Biceps= C5
2. Triceps= C7
3. Patellar= L4
4. Achilles=S1
5. Babinski=must be negative if no UMN lesion
61
Which disease(s) is/are associated with Hirano bodies?
Alzheimers
and
Creutzfeldt-Jakob Disease
62
Dfferences in the memory deficits in lesioning the hippocamus versus the mamillary bodies?
Mamillary lesion:
---both anterograde and retrograde amnesia e.g. as seen in Wernicke-Korsakoff syndrome caused by deficiency in Thiamine (B1)...which is also used as a co-factor by yruvate dehydrogenase
Hippocamus:
----Inability to form new memories (anetrograde amnesia)
63
Which 2 conventional drugs are prescribed for treatment of intention tremors?
And what's the UNCONVENTIONAL treatment that patients often use to self-medicate?
CONVENTIONAL:
- primidone
- B-blocker e.g. propanolol
UNCONVENTIONAL:
-sef medication with alcohol
64
Mechanism of action of FLUMAZENIL?
Use of flumazenil?
Antagoist of GABA-a chloride channel.
Used in the overdose of Benzodiazepams
65
Which drug has these properties:
1. Anxiolytic
2. Muscle Relaxant
3. Anticonvulsant
4. Amnestic Effects
Benzodiazepams!!!
Mechanism: increase frequency of opening of the Cl- channel on the GABA receptor
Overdose treated with flumazenil
66
Which drug is used to treat 1) Malignant hypothermia induced by anesthetics and 2) Neuroleptic Malignant syndrome induced by antipsychotic drugs?
What is the mechanism of this drug?
DANTROLENE!!
Mechanism: Blocks release of Ca2+ from the sarcoplasmic reticulum
NB: NMS is also treated with D2 agonists such as bromocriptine
67
Hyperthermia, Confusion, myoclonus, cardiovascular collapse, flushing, diarrhea, and seizures are side effects of which drug(s)?
What is the antidote?
SEROTONIN SYNDROME...
toxicity of SSRIs ike Fluoxetine.
Antidote= CYPROHEPTADINE (a 5-HT2 antagonist)
68
At which stage of the sleep cycle does BRUXISM occur?
Whuch wave forms are associated with this stage of sleep?
Deeper stage (N2) ie. prior to N3--the deepest
K-complexes and spindle fibers are present
69
In which stage of sleep do vivid experiences like erections, and variable BP occur?
Which wave forms are associated with this stage of sleep?
REM sleep!!
--BETA waves
70
Theta waves are associated with which stage of sleep?
Light sleep--first stage (N1)
71
During REM sleep, what gives rise/controls the rapid eye movements?
Which wave forms do we see?
The conjugate gaze center in the brain (PPRF)
-REM cycle is ~ 90min
REM has Beta waves
NB: REM is also associated with loss of motor tone and increased brain oxygen use and memory is belived to be processed in this stage too
72
When one is awake, which wave forms are seen on an EEG?
if eyes are open = beta waves
if eyes are closed= alpha waves
sleep is controlled by the circardian rhythm which is controlled by the SCN of the hypothalamus. The SCN itself is controlled by the environment--ege light
73
Drug used to treat enuresis
DDVAP (desmopressin)
| It mimics ADH
74
Which stage of sleep is associated with night terrors, sleep walking and enuresis?
Which sleep waves do you see?
Deepest stage (N3)
-associated with Delta waves
