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Step 1 High Yield > Neurology > Flashcards

Neurology Flashcards

1
Q

The ______ forms the thalamus and the third ventricle

The ______ forms the cerebral hemispheres and lateral ventricles

A

Telencephalon

Diencephalon

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2
Q

The pons and cerebellum (and upper part of 4th ventricle) are formed from the ___________
The Medulla and lower part of the 4th ventricle are formed from the ____________

A

Metencephalon

Myelencephalon

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3
Q

Holoprosencephaly
Failure of…
Related to mutations in….

A

Failure of left and right hemispheres to separate

Mutations in sonic hedgehog signaling pathway

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4
Q

What are the sensory deficits associated with syringomyelia?

A

Cape like bilateral loss of pain and temperature sensation in upper extremities (crossing anterior spinal commissural fibers damaged first)

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5
Q

Which branchial arches form the anterior 2/3 of the tongue? the posterior 1/3?

A

1st and 2nd branchial arches form anterior 2/3

3rd and 4th branchial arches form posterior 1/3

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6
Q

Oligodendrocytes are derived from _______

Schwann cells are derived from _______

A

Neuroectoderm

Neural crest

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7
Q

Meissner corpuscles sense…

Pacinian corpuscles sense…

A

Meissner: Dynamic, fine/light touch; position sense
Pacinian: Vibration, pressure

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8
Q

What neurotransmitters are increased in Parkinson disease?

A

5-HT

ACh

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9
Q

What are two areas of the brain where there is no blood-brain barrier (fenestrated capillaries)?

A 
Area postrema (vomiting after chemo)
OVLT (organum vasculosum of the lamina terminalis) - senses osmolarity and determines ADH release
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10
Q 
What are the functions of the following areas of the hypothalamus?
Lateral area:
Ventromedial area:
Anterior hypothalamus:
Posterior hypothalamus:
Suprachiasmatic nucleus:
A

Lateral area: Hunger
Ventromedial area: Satiety
Anterior hypothalamus: Cooling, parasympathetic (A/C)
Posterior hypothalamus: Heating, sympathetic
Suprachiasmatic nucleus: Circadian rhythm

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11
Q

What causes the eye movements during REM sleep?

A

PPRF (paramedian pontine reticular formation)

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12
Q 
What are the functions and inputs of the following areas of the thalamus?
VPL:
VPM:
LGN:
MGN:
VL:
A

VPL: Pain and temperature; pressure, touch, vibration, propioception (Spinothalamic and dorsal columns)
VPM: Face sensation and taste (trigeminal and gustatory pathway)
LGN: Vision (CNII)
MGN: Hearing (Superior olive and inferior colliculus of tectum)
VL: Motor (Basal ganglia, cerebellum)

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13
Q

What is the difference in presentation of a lateral lesion of the cerebellum and a medial lesion of the cerebellum?

A

Lateral: Propensity to fall toward injured side (controls voluntary movement of extremities)
Medial: Wide based gait and deficits in truncal coordination; bilateral motor deficits affecting proximal limb musculature

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14
Q

What causes neuronal death in Huntington disease?

A

Neuronal death via NMDA-R binding and glutamate toxicity

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15
Q

How is an essential tremor treated?

A

β-blockers and primidone

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16
Q

What type of tremor is due to cerebellar dysfunction?

A

Intention tremor (slow, zigzag motion when pointing/extending toward a target)

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17
Q

Anterograde amnesia is due to bilateral lesion of the ________

A

Hippocampus

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18
Q

Where is the lesion if the patient looks away from the side of the lesion?
Looks toward the lesion?

A

Away: Paramedian pontine reticular formation
Toward: Frontal eye fields

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19
Q

What are the differences between the following types of aphasia?
Transcortical motor:
Transcortical sensory:
Mixed transcortical:

A

Transcortical motor: Non-fluent aphasia with good comprehension and repetition
Transcortical sensory: Poor comprehension with fluent speech and repetition
Mixed transcortical: Non-fluent speech, poor comprehension, good repetition

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20
Q

Cerebral perfusion is proportional to PCO2 until PCO2 is >__mmHg
How can breathing rate help decrease intracranial pressure?

A

90 mmHg

Hyperventilation decreases PCO2 via decreased cerebral perfusion by vasoconstriction

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21
Q

What is Lateral Medullary syndrome (Wallenberg)?

A

Lesion of the PICA (lateral medulla/nucleus ambiguus) - Dysphagia, hoarseness, vomiting, vertigo, nystagmus

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22
Q

What is Median medullary syndrome?

A

Infarct of paramedian branches of ASA and vertebral arteries - tongue deviates ipsilaterally and decreased contralateral propioception

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23
Q

What is lateral pontine syndrome?

A

AICA lesion leading to paralysis of the face, decreased taste from anterior 2/3 of tongue, and decreased lacrimation and hearing (facial nerve effects)

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24
Q

A lesion of the anterior communicating artery leads to…

A lesion of the posterior communicating artery leads to…

A

ACom: visual field defects
PCom: CNIII palsy - eye is down and out with ptosis and pupil dilation

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25
Q

What are three associations with a Berry aneurysm?

A

ADPKD, Ehlers-Danlos syndrome, and Marfan syndrome

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26
Q

How do you visualize an ischemic stroke in the first 3-30 minutes?
How do you visualize between 12-24 hours?

A

3-30 minutes: diffusion weighted MRI

12-24 hours: dark abnormality on non-contrast CT

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27
Q

What happens in a normal pressure hydrocephalus?

What are the symptoms?

A

Expansion of ventricles → Distorts the fibers of the corona radiata
Symptoms: Urinary incontinence, ataxia, and cognitive dysfunction (“wet, wobbly, and wacky”)

28
Q

What are the names of tracts for the following sensations…
Pressure, vibration, touch, proprioception:
Pain temperature:
Crude touch, pressure:

A

Pressure, vibration, touch, proprioception: Dorsal column
Pain temperature: Lateral spinothalamic tract
Crude touch, pressure: Anterior spinothalamic tract

29
Q

Which diseases cause lower motor neuron lesions due to destruction of the anterior horns (flaccid paralysis)?

A

Poliomyelitis and spinal muscular atrophy (Werdnig-Hoffman disease)

30
Q

What is seen in an infant with Spinal muscular atrophy? What is the prognosis?

A

“Floppy baby”

Median age of death is 7 months (autosomal recessive)

31
Q 
Friedreich ataxia:
Gene (function):
Impairment in \_\_\_\_\_\_ function:
Cause of death:
Presentation:
A

Gene (function): Frataxin (iron binding protein)
Impairment in mitochondrial functioning
Cause of death: Hypertrophic cardiomyopathy
Presentation: Staggering, falling, nystagmus, hammer toes

32
Q

In Brown-Sequard syndrome what type of lesion is present?

What are the findings?

A

Hemisection of spinal cord
Ipsilateral: loss of tactile, vibration, proprioception (1-2 levels below lesion), UMN signs below level of lesion
Contralateral: Loss of pain and temperature below level of lesion

33
Q

Diaphragm and gallbladder pain referred to the right shoulder via the ______ ____

A

Phrenic nerve

34
Q

Which CN’s lie medially at the brain stem?

A

CNIII, CNVI, CNXII (Motor = medial)

35
Q

What is the function of…
Superior colliculi:
Inferior colliculi:
Bonus: what is a lesion of the superior colliculi called?

A

Superior colliculi: Conjugate vertical gaze center
Inferior colliculi: Auditory
Bonus: Parinaud syndrome

36
Q

Which CN causes eyelid opening?

Which CN causes eyelid closing?

A

Opening: Occulomotor (CNIII)
Closing: Facial (CNVII)

37
Q

The gag reflex is due to afferent input from CN__ and efferent action of CN__

A

CNIX; CNX

38
Q

Vagal nuclei:
What is the function of the nucleus solitarius?
What is the function of the nucleus ambiguus?

A

Solitarius: Visceral sensory information
Ambiggus: Motor innervation of pharynx, larynx, and upper esophagus

39
Q

CNV1 exits through:
CNV2 exits through:
CNV3 exits through:

A

CNV1: Superior orbital fissure
CNV2: Foramen Rotundum
CNV3: Foramen Ovale

40
Q

What structures pass through the cavernous sinus?

What happens in cavernous sinus syndrome?

A

CNIII, IV, V1, V2, and VI and postganglionic sympathetic fibers en route to the orbit
CSS: opthalmoplegia and ↓ corneal and maxillary sensation with normal visual acuity

41
Q

Low frequency vibrations are heard at _____ near ______

High frequency vibrations are heard best at _____ of _____

A

Low frequency vibrations are heard at apex near helicotrema

High frequency vibrations are heard best at base of cochlea

42
Q

If a Rinne test is abnormal, hearing loss is ______

and the Weber test localizes to the ______ ear

A

conductive; affected

43
Q

Noise induced hearing loss is due to damage to ________ cells in….

A

stereocilliated; Organ of corti

44
Q

A UMN facial lesion causes what effect on the facial muscles?
LMN facial lesion?

A

UMN: Contralateral paralysis of lower face
LMN: Ipsilateral paralysis of upper and lower face

45
Q

What is the difference between closed/narrow angle glaucoma and open angle glaucoma?

A

Open angle: Blocked trabecular meshwork from WBCs, RBCs, or retinal elements (secondary)
Closed angle: Enlargement or forward movement of lens against central iris leading to obstruction of normal aqueous flow through the pupil → fluid builds up behind iris, pushing peripheral iris against cornea and impeding flow through trabecular meshwork (primary)

46
Q

Why is epinephrine not given during acute close/narrow angle closure glaucoma?

A

Because of its mydriatic effect

47
Q

What is the pathway of miosis?

What is the pathway of midriasis?

A

Miosis: Edinger-Westphal→ciliary ganglion (CNIII)→short ciliary nerves → pupillary sphincter muscles

Mydriasis: Hypothalamus → Ciliospinal center of Budge → Superior cervical ganglion → plexus along internal carotid, through cavernous sinus → long ciliary nerve (enters orbit) → pupillary dilator muscles

48
Q

What allows bilateral pupillary constriction when light is shone in only one eye?

A

Pretectal nucleus

49
Q

What is dry ARMD?

What is wet ARMD?

A

Dry: deposition of drusen (yellow extracellular material) in and beneath Bruch membrane and retinal pigment epithelium
Wet: Rapid loss of vision due to bleeding 2° to choroidal neovascularization

50
Q

What is a rapidly progressive dementia with myoclonus?

A

Creutzfeldt-Jakob disease (spongiform cortex)

51
Q

What finding is diagnostic of multiple sclerosis? What protein is increased?

A

Oligoclonal bands

Increased IgG

52
Q

Acute disseminated encephalomyelitis is demyelination common after what infections?

A

Measles or VZV

53
Q

Charcot-Marie Tooth disease is a group of nerve disorders related to…
What are the clinical findings?

A

Related to defective production of proteins involved in the structure and function of peripheral nerves or the myelin sheath
Associated with scoliosis and foot deformities (high or flat arches)

54
Q

What proteins buildup in Krabbe disease?

What builds up in Adrenoleukodystrophy?

A

Krabbe: Galactocerebroside and psychosine (destroy myelin)
Adrenoleukodystrophy: Very-long chain fatty acids

55
Q

What is the difference between a simple partial seizure and a complex partial seizure?

A

Simple: Consciousness intact
Complex: Impaired consiousness

56
Q

What is the POUND mnemonic for migraines?

A

Pulsatile, One-day, Unilateral, Nausea, Disabling

57
Q

Sturge-Weber syndrome is due to an activating mutation of the _____ gene
What is the STURGE mnemonic?

A 
GNAQ gene
port wine Stain
Tram track Ca2+
Unilateral
Retardation
Glaucoma
Epilepsy
58
Q

What is seen with Tuberous sclerosis?

A 
Hamartomas in CNS and skin
Angiofibromas (morgan freeman)
Mitral regurgiation
Ash leaf spots
Rhabdomyoma
59
Q

What is seen in VHL?

A

Cavernous hemangiomas in skin
Bilateral renal cell carcinomas
Pheochromocytomas
Hemangioblastomas in retina, brain stem, cerebellum

60
Q 
Give one or two associations for each of the following adult brain tumors...
Glioblastoma: 
Meningioma: 
Hemangioblastoma: 
Schwannoma:
Oligodendroglioma:
A

Glioblastoma: Pseudopalisading; crosses corpus callosum
Meningioma: Spindle cells in a whorled pattern; psammoma bodies
Hemangioblastoma: Can produce erythropoietin; VHL
Schwannoma: cerebellopontine angle; S-100
Oligodendroglioma: Fried egg cells, chicken wire capillary pattern

61
Q 
Give one or two associations for each of the following childhood brain tumors...
Pilocytic astrocytoma:
Medulloblastoma:
Ependymoma:
Craniopharyngioma:
A

Pilocytic astrocytoma: Rosenthal fibers, cystic
Medulloblastoma: drop metastases, homer-wright rosettes
Ependymoma: 4th ventricle, perivascular rosettes
Craniopharyngioma: Rathke pouch, calcification possible

62
Q

What is the MAC?

A

Minimal alveolar concentration of inhaled anesthetic required to prevent 50% of subjects from moving in response to noxious stimulus
Potency = 1/MAC

63
Q

What is a Charcot-Bouchard aneurysm?

A

An aneurysm in the basal ganglia, cerebellum, thalamus or pons that can rupture, leading to hemorrhage within the brain

64
Q

What is the only bilateral type of headache?
Which headache is repetitive?
Which headache presents with periorbital pain and lacrimation?

A

Bilateral: Tension (steady pain)
Repetitive: Cluster
Periorbital pain: Cluster

65
Q

How is a cluster headache differentiated from trigeminal neuralgia?

A

Based on duration: Trigeminal neuralgia produces shooting pain in the distribution of CN V that lasts 15 minutes)

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