NEUROLOGY

Question 1

subarachnoid haemorrhage
type of hydrocephalus

Answer 1

communicating
(CSF cant be absorbed via arachnoid granulations)

subarachnoid space widening
usually inflammatory or trauma cause

blood is inflammatory if leaked i.e. leaking aneurysm

Question 2

causes of communicating hydrocephalus

Answer 2

subarachnoid haemorrhage
post-meningitis
scarring

Question 3

causes of non-communicating hydrocephalus

Answer 3

Dnay Walker
Arnold Chiari II
Medulloblastoma

Question 4

chorioretinitis,
hydrocephalus
intracranial calcifications
+/− “blueberry muffin” rash

Answer 4

toxoplasma gondii

mother asymptomatic or lymphaenopathy

cat faeces or undercooked meat

Question 5

in regionalisation of the neural tube, where does basal ganglia develop from (___cephalon)

Answer 5

prosencephalon –> telencephalon

Question 6

in regionalisation of the neural tube, where does the retina develop from

Answer 6

prosencephalon –> diencephalon

Question 7

what are derived from neural crest cells

Answer 7

Melanocytes
Odontoblasts
Tracheal cartilage
Enterochromaffin cells
Laryngeal cartilage
Parafollicular (C) cells of the thyroid
Adrenal medulla & autonomic ganglia
Schwann cells
Spiral (aorticopulmonary) septum

MOTEL PASS

Question 8

what mutation is holoprosencephaly associated with

Answer 8

SHH
(sonic hedgehog)

Question 9

SHH is crucial for

Answer 9

embryonic patterning
(brain and limbs)

Holoprosencephaly (failure of forebrain division)
Midline defects (cleft lip/palate, cyclopia)
Polydactyly (abnormal limb patterning)
CNS malformations (affecting dorsal-ventral axis formation)

Question 10

what are Chiari I and II each associated with

Answer 10

I = syringomyelia
II = myleomeningocele

Question 11

what actions do these tongue muscle do
styloglossus
genioglossus

And what innervates them

Answer 11

stylo = draws sides upward
genio = protudes

XII

Question 13

what is present in cell bodies and dendrites but not axons that stains on Nissl staining

Answer 13

RER
(not present in axon)
stained by Nissl stain

Question 14

what are (2) neuron cell markers

Answer 14

neurofilament protein
synaptophysin

Question 15

neuro cell derived from mesoderm
not dissernible on nissl stain

Answer 15

microglia

Question 16

neuro cell positive for GFAP+

Answer 16

astrocyte

glial fibrillary acidic protein

Question 17

neuro cell with marker S100
injured in Guillian Barre

Answer 17

Schwann cell

Question 18

round cellular swelling
displacement nucleus to periphery
dispersion nissl substance in cytoplasm

Answer 18

chromatolysis

reaction of neuronal cell body (soma) to axonal injury

increased protein sysnthesis aimed to repair

Question 19

disintegration of axon/myelin sheath distal to site of axonal injury.

Answer 19

wallerian degeneration

macrophages remove debris

proximal to injury - axon retracts and sprouts new protrusions

Question 20

injury to middle meningial artery often bleeds into what space

Answer 20

epidural space

Question 21

lucid interval, rapid deterioration

Answer 21

epidural haematoma

haematoma expansion

Question 22

injury to bridging veins

Answer 22

subdural

shaking baby
midline shift
crosses suture lines

Question 23

conductive aphasia caused by damage to

Answer 23

arcuate fasciculus

repetition

Question 24

saccular aneurysms assocaited with

Answer 24

ADPKD
elher danlos

common site ACA, AComm

Question 25

gait instability cognitive disturbance urinary incontinence

Answer 25

normal pressure hydrocephalus “wet, wacky, and wobbly” | develops faster than vascvular dementia reversible ## Footnote mood changes, amnesia, aphasia

Question 26

seen in

Answer 26

Alzheimers disease neurofibrillary tangle | hyperphosphorylates tau protein

Question 27

area of brain critial for memory formation

Answer 27

hippocampus | medial temporal lobe affected in Alzhiemers diease

Question 28

AD early-onset alzhiemers overproduction of b-amyloid amyloid plaques | mutation causing

Answer 28

presenilin 1

Question 29

Alzhiemers characterised by loss of -? neurons

Answer 29

cholinergic | decreased Ach

Question 30

prosopagnosia can occur due to | artery

Answer 30

PCA stroke | 'face blindness'

Question 31

familial (early-onset) alzhiemers associated with | genes

Answer 31

**Presenilin** 1 (PSEN1) Ch 14 Presenilin 2 (PSEN2) Ch 1 **Amyloid precursor protein** (APP) Ch 21 ## Footnote increased Aβ (**beta**-amyloid) deposition, amyloid plaque formation

Question 32

late onset alzhiemers is associated with | gene

Answer 32

APOE (apolipoprotein E) Ch19

Question 33

Damage to the DRG disrupts -? that rely on -? input

Answer 33

reflex arcs sensory | would see hyporeflexia DTR diminished

Question 34

dorsal root gangion carries

Answer 34

afferent sensory info periphery to SC | affects reflex arc

Question 34

MDD SSRI Na 122mEq/L | what might be seen in this patient

Answer 34

**SAIDH** (adverse effect of SSRI) | hyponatremia - dilutional effect of ADH (H20 retained)

Question 35

older patient acute confusional state memory or language deficit fluctuating consciousness, lethargy disorientation, hallucinations perceptual awareness, cognition changes

Answer 35

delirium | deficient Ach signalling suggested ## Footnote causes: infection, medications, withdrawal, or electrolyte imbalances* i.e. SIADH from SSRI*

Question 36

dementia + hallucinations

Answer 36

lewy body dementia

Question 37

dementia + personality changes

Answer 37

pick disease (frontotemporal dementia) | 50yo

Question 38

huntingtons disease demonstrates what characteristic

Answer 38

anticipation | each future generation is affected at a **younger age & more severely** ## Footnote AD One copy of the mutated gene is sufficient to cause the disease CAG repeats

Question 39

**localised** motor or sensory symptoms oral/manual automatisms - lip smacking, picking auras **altered consciousness** **postictal confusion** | rhythmic slowing on EEG

Answer 39

**complex partial seizure** (focal onset impaired awareness)

Question 40

Blank stare 3Hz spike EEG no postictal confusion | rapid blinking, mouth twitching

Answer 40

absense seizure | often children

Question 41

motor or sensory symptoms **no** impaired consciousness **no** postictal confusion

Answer 41

simple partial sensory seizure | numbness, paraesthesias, pain (sensory)

Question 42

label A, C, E

Answer 42

right inferior cerebellar peduncle (vestibular) right medial lemnisci (sensation) right medullary pyrimidal tract (motor)

Question 43

identify the vessel

Answer 43

PCA | will see: contralateral visual field defecf ## Footnote contralateral homonymous hemianopsia **with** macular sparing originates rostral end, near basilar artery

Question 44

what would an anesthesiologist change to increase intracranial pressure?

Answer 44

decreasing RR | decrease RR or TV = increased CO2 = increase PaCO2 = increase CBF + ICP ## Footnote **autoregulation between 10-160mmHg** CBF increases with: increased metabolic demand hypercarbia **(biggest effect)** hypoxemia hyperthermia increased central venous pressure (CVP) CO2 combines with H2O to form carbonic acid --> disolves to H+ and HCO3 --> pH decreased (H+) --> causes vasodilation in arteries/arterioles brain --> increases blood flow to flush out co2, deliver O2

Question 45

loss of pain & temperature on Left LL. Where in SC is injured

Answer 45

(D) right spinothalamic tract | will see symptoms 2-3 levels below SC decussation (Lasseurs tract). ## Footnote see s/s **CONTRALATERLAL** *CST and DC will see ipsilateral*

Question 46

most common cause of meningitis in adults all ages

Answer 46

s. pneumo (lancet shaped gram (+) cocci) | often follows URTI ## Footnote enterovirus most comon viral (aseptic) meningitis