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USMLE Step 1 > Neurology > Flashcards

Neurology Flashcards

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1
Q

What are the features of Horner Syndrome?

A
  1. Ptosis
  2. Anhidrosis
  3. Miosis

+ Flushing of the affected side of the case

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2
Q

What are the lesions that are associated with Horner Syndrome?

A
  • *Any lesion of the spinal cord located above T1 level**
  • Pancoast tumour
  • Brown-Sequard syndrome
  • Late-stage syringomyelia
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3
Q

Which cranial nerves have their nuclei in the midbrain?

A
  • CN3 (Oculomotor nerve)
  • CN4 (Trochlear nerve)
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4
Q

Which cranial nerves have their nuclei in the pons?

A
  • CN5 (Trigeminal nerve)
  • CN6 (Abducens nerve)
  • CN7 (Facial nerve)
  • CN8 (Vestibulocochlear nerve)
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5
Q

Which cranial nerves have their nuclei in the medulla?

A
  • CN9 (Glossopharyngeal nerve)
  • CN10 (Vagus nerve)
  • CN12 (Hypoglossal nerve)
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6
Q

What are the vagal nuclei and what do they supply?

A
  1. Nucleus solitarius
    • Sensory to: taste, baroreceptors, gut distension
  2. Nucleus ambiguus
    • Motor to: pharynx, larynx and upper esophagus
  3. Dorsal motor nuclei
    • Autonomic to: heart, lungs and upper GI
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7
Q

Which important structures are located in the cavernous sinus?

A

Cranial nerves

  • EOM nerves: 3, 4, 6
  • Trigeminal nerve: V1 (ophthalmic) and V2 (maxillary)

Others

  • Internal carotid artery
  • Pituitary gland

In close proximity

  • Optic chiasm
  • Sphenoidal sinuses
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8
Q

Which muscles of mastication are involved in closing the jaw?

A
  • Masseter
  • Temporalis
  • Medial pterygoid
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9
Q

Which muscles of mastication are involved in opening the jaw?

A

Lateral pterygoid

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10
Q

What diseases are associated with an increase in norepinephrine?

A
  • Anxiety
  • Mania
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11
Q

What diseases are associated with a decrease in norepinephrine?

A

Depression

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12
Q

What diseases are associated with an increase in dopamine?

A
  • Huntington disease
  • Schizophrenia
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13
Q

What diseases are associated with a decrease in dopamine?

A
  • Parkinson disease
  • Depression
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14
Q

What diseases are associated with an increase in serotonin (5-HT)?

A

Parkinson disease

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15
Q

What diseases are associated with a decrease in serotonin (5-HT)?

A
  • Anxiety
  • Depression
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16
Q

What diseases are associated with an increase of ACh?

A

Parkinson disease

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17
Q

What diseases are associated with a decrease of ACh?

A
  • Alzheimer disease
  • Huntington disease
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18
Q

What diseases are associated with a decrease in GABA?

A
  • Anxiety
  • Huntington disease
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19
Q

Where are the following neurotransmitters made?

  • Norepinephrine
  • Dopamine
  • 5-HT
  • ACh
  • GABA
A
  • Norepinephine: locus ceruleus
  • Dopamine: substantia nigra pars compact and ventral tegmentum
  • 5-HT: raphe nucleus
  • ACh: basal nucleus of Meynert
  • GABA: nucleus accumbens
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20
Q

What do muscle spindles monitor?

A

Length of the muscle

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21
Q

What do Golgi tendon organs monitor?

A

Tension of the muscle/tendon

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22
Q

What are the efferunt nerves of Golgi tendon organs called?

A

Ib fibres

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23
Q

What are the efferunt nerves of muscle spindles called?

A

Ia fibres

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24
Q

What is the gamma loop? What is its function?

A
  • CNS-regulated gamma fibres send signals to the muscle spindles
  • Causes muscle spindle contractions and thus increases the sensitivity of the reflex arc
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25
Q

Name the thalamus nucleus.

Somatosensory from body
>> Medial lemniscus (DCML)
>> Spinothalamic tract (STT)

A

Ventroposterolateral nucleus (VPL)

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26
Q

Name the thalamus nucleus.

Trigeminothalamic tract and taste pathways >> Somatosensory cortex

A

Ventroposteriomedial nucleus (VPM)

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27
Q

Name the thalamus nucleus.

Communications with prefrontal cortex
- Memory loss results if destroyed

A

Mediodorsal nucleus (MD)

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28
Q

Name the thalamus nucleus.

Cerebellum’s dentate nucleus and basal ganglia >> Motor cortex

A

Ventrolateral nucleus (VL)

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29
Q

Name the thalamus nucleus.

Cerebellum’s dentate nucleus and basal ganglia >> Supplementary motor cortex

A

Ventrolateral nucleus (VL)

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30
Q

Name the thalamus nucleus.

Basal ganglia >> Prefrontal, premotor and orbital cortices

A

Ventroanterior nucleus (VA)

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31
Q

Name the thalamus nucleus.

Mamillothalamic tract >> Cingulate gyrus
(Part of Papez circuit)

A

Anterior nucleus

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32
Q

Name the thalamus nucleus.

Integration of visual, auditory and somesthetic input

A

Pulvinar nucleus

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33
Q

Name the thalamus nucleus.

Retina >> Occipital lobe

A

Lateral geniculate body (LGN)

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34
Q

Name the thalamus nucleus.

Brachium of inferior colliculus (auditory information) >> Primary auditory cortex

A

Medial geniculate body (MGN)

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35
Q

What are the muscles that are innervated by the axillary nerve?

A
  • Deltoid
  • Teres minor
  • Long head of the tricpes brachii
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36
Q

What are the muscles that are innervated by the radial nerve?

A
  • All three heads (medial, lateral and long) of the triceps brachii
  • Brachioradialis
  • Supinator
  • Extensors of the wrist and fingers
  • Abductor pollicis longus
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37
Q

What are the muscles that are innervated by the median nerve?

A
  • Pronator teres
  • Flexor carpi radialis
  • Palmaris longus
  • Flexor digitorum superficialis
  • Pronator quadratum
  • Flexor pollicis longus
  • Lateral half of the flexor digitorum profundus
  • First and second lumbricals
  • Thenar muscles
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38
Q

What are the muscles that are innervated by the ulnar nerve?

A
  • Flexor carpi ulnaris
  • Medial half of the flexor digitorum profundus
  • 3rd and 4th lumbricals: IP joint extension
  • All interossei: MCP flexion, finger abduction
  • Adductor pollicis
  • Hypothenar muscles
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39
Q

What are the muscles that are innervated by the musculocutaneous nerve?

A
  • Biceps brachii
  • Brachialis
  • Coracobrachialis
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40
Q

What are the muscles that are innervated by the long thoracic nerve?

A

Serratus anterior
>> Winged scapula

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41
Q

What are the muscles that are innervated by the femoral nerve?

A

Hip flexors

  • Psoas
  • Iliacus
  • Pectineus
  • Sartorius

Knee extensors (Quadriceps)

  • Rectus femoris
  • Vastus lateralis
  • Vastus medialis
  • Vastus intermedius
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42
Q

What are the muscles that are innervated by the obturator nerve?

A

Hip adductors

  • Adductor magnus (also innervated by the sciatic nerve partially)
  • Adductor longus
  • Adductor breview

Knee flexor
- Gracilis

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43
Q

What are the muscles that are innervated by the superior gluteal nerve?

A

Hip abductors

  • Tensor fascia latae
  • Gluteus medius
  • Gluteus minimus
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44
Q

What are the muscles that are innervated by the inferior gluteal nerve?

A

Gluteus maximus

(Hip extension, hip medial rotation)

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45
Q

What are the muscles that are innervated by the tibial branch of the sciatic nerve?

A

Hip extensors (Hamstrings)

  • Biceps femoris
  • Semimembranosus
  • Semitendinosus

+ Adductor magnus

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46
Q

What are the muscles that are innervated by the tibial nerve?

A

Plantar flexors of the foot

  • Gastronemius
  • Soleus
  • Plantaris

Unlocking the knee from the locked position
- Popliteus

Toe flexors

  • Flexor hallucis longus
  • Flexor digitorum longus

Foot inversion
- Tibialis posterior

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47
Q

What are the muscles that are innervated by the deep peroneal nerve?

A

Dorsiflexors of the foot

  • Extensor hallucis longus
  • Extensor digitorum longus
  • Tibialis anterior

Foot eversion
- Peroneus tertius

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48
Q

What are the muscles that are innervated by the superficial peroneal nerve?

A

Foot eversion

  • Peroneus longus
  • Peroneus brevis
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49
Q

What injury will lead to damage of the sciatic nerve?

A
  • Intervertebral disc herniation
  • Spinal stenosis
  • Spondylolisthesis
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50
Q

What injury will lead to damage of the femoral nerve?

A

Pelvic fracture

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51
Q

What injury will lead to damage of the obturator nerve?

A

Anterior dislocation of the hip

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52
Q

What injury will lead to damage of the superior gluteal nerve?

A

Posterior dislocation of the hip

53
Q

What injury will lead to damage of the inferior gluteal nerve?

A

Posterior dislocation of the hip

54
Q

What injury will lead to damage of the tibial nerve?

A

Any general knee injury

55
Q

What injury will lead to damage of the common peroneal nerve?

A

Lateral knee injury/Fibular neck fracture

56
Q

What injury will lead to damage of the deep peroneal nerve?

A

Usually injury to the common peroneal nerve due to lateral knee injury or fibular neck fractures

57
Q

What is the mechanism of action of dantrolene?

A

Inhibitor of ryanodine receptors in sarcomeres >> prevents release of calcium from the SR of the skeletal muscle

58
Q

What are the clinical indications for use of dantrolene?

A
  • Malignant hyperthermia (usually when inhaled GAs are used with succinylcholine in those with a RYR1 gene mutation)
  • Neuroleptic malignant syndrome
    >> Delirium
    >> Muscle rigidity/contractions leading to myoglobinuria
    >> Hyperthermia
    >> Autonomic instability
59
Q

What are the common underlying causes of cotton wool spots on the retina upon fundoscopic examination?

A
  • Hypertension
  • Diabetes mellitus
  • AIDS
60
Q

What are the underlying causes of a cherry red spot on eye examination?

A
  • Central retinal artery occlusion
  • Tay-Sachs disease
  • Niemann-Pick disease
61
Q

What are the syndromes associated with lens subluxation?

A
  • Marfan syndrome
  • Homocysteinuria
62
Q

What pathology does a white reflex upon eye examination suggest?

A

Retinoblastoma

63
Q

Describe the flow of aqueous humour.

A
  • Produced by the ciliary epithelium at the ciliary body
  • Secreted into the posterior chamber
  • Passes into the anterior chamber via the angle between the iris diaphragm and the lens
  • Secreted into the anterior chamber
  • Leaves/reabsorbed from the anterior chamber via the Canal of Schlemm
64
Q

What is the underlying pathophysiology of acute angle/closed angle/narrow angle glaucoma?

A

Obliteration/narrowing of the space between the iris diaphragm and the lens >> aqueous humour cannot pass into the anterior chamber >> accumulates in the posterior chamber

65
Q

What is the underlying pathophysiology of open angle glaucoma?

A

Unknown

  • Decreased reabsorption at the Canal of Schlemm
  • Over-production at the ciliary epithelium
66
Q

What is the function of aqueous humour?

A
  • Maintains intraocular pressure
  • Provides nutrition to cornea and lens
67
Q

What are the presenting features of open angle glaucoma?

A
  • Early: asymptomatic
  • Late: gradual loss of vision, starting with the peripheral visual field and moving towards the centre
68
Q

What are the presenting features of acute angle glaucoma?

A
  • Sudden onset of pain
  • Visual changes: halos, rainbows around lights
  • Mid-dilated pupil, not responsive to light
  • Red teary eyes with hazy cornea
  • Eyeball firm on palpation

>> An emergency!!! Can damage the optic nerve by increased IOP

69
Q

What are the main drugs used for treatment of glaucoma?

A

Increased reabsorption of aqueous humour

  • Prostaglandins
  • Alpha-agonists
  • Cholinergic agonists

Decreased production of aqueous humour

  • Beta-blockers
  • Alpha-agonists
  • Acetazolamide (carbonic anhydrase inhibitor)

In acute angle glaucoma
- Mannitol

70
Q

What are the risk factors for open angle glaucoma?

A
  • Increasing age
  • African American
  • Positive family history
  • Diabetes
71
Q

What are the presenting features of cataract?

A
  • Painless gradual loss of vision, starting with difficulty in driving at night, reading signs and small print
  • Near-sightedness
  • Disabling glares
72
Q

What are the risk factors for cataract?

A
  • Diabetes mellitus
  • Long term use of steroids
  • Trauma
  • Infection
  • Galactosemia
73
Q

What are the eye problems associated wtih DM?

A
  • Cataract
  • Glaucoma
  • Retinal detachment
  • Neovascularization and proliferative diabetic retinopathy
74
Q

What are the two different types of age-related macular degeneration?

A

Dry (nonexudative) macular degeneration

  • Characterized by drusen: yellowish extracellular material deposits in and between the Bruch membrane of the choroid and the retina
  • GRADUAL loss of vision
  • Most common: 80% of all age-related macular degeneration

Wet (exudative) macular degeneration

  • Due to bleeding from neovascularization
  • RAPID loss of vision
  • 20% of all age-related macular degeneration
75
Q

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

A
  • Cessation of smoking
  • Multivitamin and antioxidant supplements
    >> Beta-carotene
    >> Vitamin C
    >> Lutein
    >> Selenium
    >> Zinc
76
Q

What is the treatment for wet age-related macular degeneration?

A
  • Anti-VEGF injection
  • Laser surgery
77
Q

What is the typical presentation of retinal detachment?

A

Sudden onset of flashing lights, immediately followed by poor vision — PAINLESS!!!

78
Q

Describe the auditory pathway.

A
  1. Tympanic membrane
  2. Middle ear ossicles: malleus, incus and stapes
  3. Auditory hair cells (outer and inner) of the cochlea
  4. Cochlear/Spiral ganglion
  5. Cochlear nuclei in the brainstem
  6. Superior olivary nucleus (decussation)
  7. Lateral meniscus
  8. Inferior colliculus (midbrain)
  9. Medial geniculate body (thalamus)
  10. Primary auditory cortex (temporal lobe)
79
Q

What are the common bacteria that cause otitis externa?

A
  • Pseudomonas aeruginosa
  • Staphylococcus aureus
80
Q

What are the common bacteria that cause acute otitis media?

A
  • Streptococcus pneumoniae
  • Non-typable Hemophilus influenzae
  • Moraxella catarrhalis
81
Q

What are the presenting features of otitis externa?

A

Pain at pulling of the pinna/manipulation of the ear

82
Q

What are the presenting features of acute otitis media?

A
  • Fever
  • Earache
  • Inspection of the tympanic membrane
    >> Bulging
    >> Erythematous
    >> Air/fluid level, pus or opacity
    >> Immotile upon positive pressure from the pneumatic otoscope – almost entirely diagnostic
83
Q

What is the treatment for otitis externa?

A
  • Irrigation
  • Topical antibiotics
84
Q

What is the treatment for acute otitis media?

A
  • Antibiotics
    >> Amoxicillin
    >> Amoxicillin + clavulanic acid
    >> Cephalosporins
  • Tympanostomy tubes (gromett)
85
Q

What is a cholesteatoma?

A

Overgrowth of desquamated keratin debris within the middle ear space that made eventually erode the ossicular chain and mastoid air cells

86
Q

What are the possible causes of cholesteatoma?

A
  • Negative pressure on the tympanic membrane due to Eustachian tube dysfunction
  • Epithelial growth through a perforated TM
87
Q

What is seen upon examination of a cholesteatoma?

A
  • Pearly grayish-white lesion behind or involving TM
  • Conductive hearing loss
  • Vertigo
88
Q

What is the treatment of cholesteatoma?

A
  • Tympanomastoidectomy
  • Reconstruction of ossicular chain
89
Q

What is the common treatment for Eustachian tube dysfunction?

A

Intranasal steroids
>> Most are due to allergic rhinitis

90
Q

What are the presenting features of Meniere disease?

A

Presentation triad

  1. Tinnitus
  2. Hearing loss
  3. Intermittent vertigo
91
Q

What are the possible causes of vertigo?

A
  1. BPPV (Benign paroxysmal positional vertigo)
  2. Vestibular neuritis
  3. Meniere disease
  4. Central vertigo: brainstem/cerebellar lesions
92
Q

What is the underlying pathophysiology of Meniere disease?

A

Imbalances of fluids and electrolytes of the endolymph

93
Q

What is the underlying pathophysiology of BPPV (Benign Paroxysmal Positional Vertigo)?

A

Debris or misplaced otoliths in the vestibular apparatus

94
Q

How does one diagnose BPPV?

A

Dix-Hallpike Test

95
Q

How does one treat BPPV?

A

Epley maneuver

96
Q

What is the cutaneous innervation of the peroneal nerves?

A
  • Superficial peroneal nerve: majority of the dorsum of the foot
  • Deep peroneal nerve: only between the first and second digitis of the foot
97
Q

Name the neuronal pigment/inclusion.

Intranuclear inclusions seen in herpes simplex encephalitis

A

Cowdry type A bodies

98
Q

Name the neuronal pigment/inclusion.

Cytoplasmic inclusions pathognomonic of rabies

A

Negri bodies

99
Q

Name the neuronal pigment/inclusion.

Neuronal inclusions characteristic of Parkinson disease

A

Lewy bodies

100
Q

Name the neuronal pigment/inclusion.

Cytoplasmic inclusion bodies associated with aging

A

Lipofuscin granules

101
Q

Name the neuronal pigment/inclusion.

Dark cytoplasmic pigment in neurons of the substantia nigra and locus coeruleus, not seen in patients with Parkinson

A

Melanin

102
Q

Name the neuronal pigment/inclusion.

Eosinophilic, rod-like inclusion in hippocampus of Alzheimer patients

A

Hirano bodies

103
Q

Name the neuronal pigment/inclusion.

Diagnostic of Alzheimer disease

A

Neurofibrillary tangles

104
Q

Name the neuronal pigment/inclusion.

Filamentous inclusions that stain with silver, do not survive neuronal death

A

Pick bodies

105
Q

Name the neuronal pigment/inclusion.

Filamentous inclusions that stain with PAS and ubiquitin

A

Lewy bodies

106
Q

Name the neuronal pigment/inclusion.

Extracellular amyloid deposits in the grey matter

A

Senile plaques of A-beta amyloid

107
Q

Name the neuronal pigment/inclusion.

Intracellular spherical aggregates of tau protein seen on silver stain

A

Pick bodies

108
Q

Name the neuronal pigment/inclusion.

Intracellular deposits of hyperphosphorylated tau protein

A

Neurofibrillary tangles of tau protein

109
Q

What genes are associated with early-onset Alzheimer’s disease?

A
  • APP gene on chromosome 21
  • Presenilin-1 gene on chromosome 14
  • Presenilin-2 gene on chromosome 1
110
Q

What genes are associated with late-onset Alzheimer’s disease?

A

ApoE4 in chromosome 19

111
Q

What gene is protective against Alzheimer’s disease?

A

ApoE2 on chromosome 19

112
Q

What investigations/tests are performed for diagnosis of the cause of dementia?

A
  1. Mini-mental status examination – to confirm cognitive decline
  2. Rule out organic causes/other causes
    >> RPR — neurosyphilis
    >> HIV testing
    >> TSH — hypothyroidism
    >> Vitamin B12 levels
    >> MRI brain — normal pressure hydrocephalus,
    >> +/- serum copper/ceruloplasmin — Wilson disease
113
Q

Name the major differential diagnoses for dementia.

A
  • Alzheimer’s disease
  • Vascular dementia
  • Parkinson’s disease
  • Lewy body dementia
  • Pick disease/frontotemporal dementia
  • Creutzfeldt-Jakob disease
  • Neurosyphilis
  • HIV
  • Hypothyroidism
  • Vitamin B12 deficiency
  • Depression – pseudodementia
114
Q

Name the cause of dementia.

  • Dementia
  • Parkinsonism features
  • Visual hallucinations
  • Recurrent syncopal episodes
A

Lewy body dementia

115
Q

Name the cause of dementia.

  • Dementia
  • Aphasia
  • Changes in personality
A

Frontotemporal dementia/Pick disease

116
Q

Name the cause of dementia.

  • Abrupt onset
  • Myoclonus
  • Spongiform cortex
  • Beta-pleated sheets
A

Creutzfeldt-Jakob disease

117
Q

Name the cause of dementia.

  • Resting tremor
  • Bradykinesia
  • Postural instability
  • Cogwheel rigidity
A

Parkinson’s disease

118
Q

Name the cause of dementia.

  • Urinary incontinence
  • Magnetic gait
A

Normal pressure hydrocephalus

>> Reversible dementia

119
Q

Name the cause of dementia.

  • Dysarthria
  • Liver disease
A

Wilson disease

120
Q

Name the cause of dementia.

  • Dementia
  • Ataxia
  • Loss of pupillary light reflex
A

Neurosyphilis

121
Q

Name the cause of dementia.

  • Dementia
  • Megaloblastic anemia
  • Peripheral neuropathy
A

Vitamin B12 deficiency

122
Q

What are the questions to ask for a seemingly disoriented patient?

A
  • Person: Who are you? What’s your name?
  • Place: Where are you now? Which city are you in now?
  • Time: What time is it now? What year is it now?
123
Q

What are the common causes of delirium?

A
  1. Drugs
    • Benzodiazepines
    • Drugs with anticholinergic effects
      >> Antimuscarinic agents: atropine etc.
      >> First generation H1R blockers: diphenhydramine, chlorpheniramine
      >> Neuroleptics: thioridazine, chlorpromazine, olanzapine, clozapine
      >> Tricyclic antidepressants
      >> Amantadine
  2. Urinary tract infections
124
Q

What two arteries does the oculomotor nerve run through after exiting from the midbrain?

A

Posterior cerebral artery and superior cerebellar artery

125
Q

What is the mechanism of action of opioids?

A

Agonists at opioid receptors

  • G-protein-linked receptors
  • Open K+ channels
  • Close Ca++ channels
  • Inhibit adenylate cyclase
  • Inhibit transmitter release: acetylcholine, 5-HT, epinephrine, glutamate and substance P

>> Mu = Morphine
>> Kappa = Dynorphin
>> Delta =

126
Q

Which opioid is used for cough suppression?

A

Dextromethorphan

127
Q

Which opioid is used for diarrhea treatment?

A
  • Loperamide
  • Diphenoxylate
128
Q

What is the most commonly injured nerve in the leg?

A

Common fibular nerve/Common peroneal nerve

  • Courses laterally around the neck of fibula
  • The location makes the nerve susceptible to trauma resulting from lateral blows to the knee as well as from tightly applied plaster casts and other devices.

USMLE Step 1 (14 decks)

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