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USMLE S1 > Neurology > Flashcards

Neurology Flashcards

1
Q

cause of death from bacterial meningitis (without sepsis)

A

herniation as bacteria and pus build up in the skull

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2
Q

CSF lymphocytes, oligoclonal IgG bands on elecrophoresis, myelin basic protein

what disease?

A

multiple sclerosis

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3
Q

a round mass attached to the dura, compressing but not invading the cortex

what tumour?

A

meningioma

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4
Q

aneurysmal/tumour compression of CN III gives what symptoms first? why?

A

mydriasis first (parasympathetic fibres outside)

ptosis, down and out deviation later (somatic fibres on inside)

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5
Q

who is at increased risk of subdural haematoma and why?

A

elderly

age-related CNS atrophy draws the brain back from the skull which stretches the vessels and predisposes to haematoma formaiton

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6
Q

Berry aneurysm associations

A

PCKD

Marfan’s

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7
Q

GBM is benign or malignant?

A

malignant

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8
Q

most common CNS tumour in children?

where does it arrise?

A

pilocytic astrocytoma

subtentoral - cerebellum

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9
Q

aetiology of spongiform encephalopathy

A
  1. sporadic (bad)
  2. inherited
  3. transmitted (‘infectious’)
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10
Q

haemorrhage at the periphery of the cortex suggests what aetiology?

A

embolic stroke (e.g. AF)

probably in MCA

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11
Q

following Wernicke encephalopathy, Korsakoff syndrome persists..

2 symptoms?

A

confabulation

memory loss

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12
Q

muscle action of obturator nerve

A

adduction of thigh

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13
Q

what does Rufifni corpuscles sense?

A

deep touch, slippage of objects, joint angle change

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14
Q

xanthochromia suggests what?

A

subarachnoid haemorrhage

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15
Q

what passes through jugular foramen?

A

nerve - CN IX (glossopharyngeal), X (vagus), XI (spinal accessory)

vessel - jugular vein

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16
Q

what is the order of sensation loss with local anaesthetic?

A

pain - temperature - touch - pressure

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17
Q

meningothelial cells tumour in adults

what sex more frequently?

A

meningioma

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18
Q

Romberg test specifically tests for what?

A

distiguish between sensory or cerebellar ataxia

removal of visual input (closing eyes) means patient must rely on cerebellar integration of proprioceptive signals

Romberg +ve = sensory ataxia

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19
Q

what is entacapone/tolcapone?

A

peripheral COMT inhibitor which acts like carpidopa to increase L-DOPA availability to brain

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20
Q

what is the difference between a focal and generalised seizure?

A

focal = 1 cerebral hemisphere at onset

generalized = both hemispheres at onset

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21
Q

when are the changes of axonal reaction at their most visible during Walleriagn degeneration?

A

12 days

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22
Q

four functions of the facial nerve (affected in Bell’s palsy)

A
  1. facial muscles
  2. anterior 2/3rd of tongue
  3. autonomic innervation to lacrimal, submandibular and sublingual salivary glands
  4. somatic afferents from pinna and external auditory canal
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23
Q

thalamus medial geniculate nucleus

what sensory input/nerve?

A

hearing

superior olive and inferior colliculus of tectum

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24
Q

headache with sweating, facial flushing, nasal congestion, lacrimation and pupil changes suggests what?

A

cluster headache

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25
Q

diagnosis

A

epidural haematoma

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26
Q

astrocyte tumour in adults

A

glioblastoma multiforme

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27
Q

what are these called?

what is the tumour?

A

perivascular pseudorosette

ependymoma

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28
Q

thalamus lateral geniculate nucleus

what sensory input/nerve?

A

vision

CN II (optic)

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29
Q

what is the difference between physostigmine and other cholinesterase inhibitors?

A

physostigmine crosses BBB

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30
Q

what is cerebral pontine myelinosis?

A

demyelination of the pons leading to locked-in syndrome when hyponatraemia has been corrected too quickly

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31
Q

what are the three main muscles of the tongue and their actions?

A
  1. hypoglossus - retracts and depresses
  2. genioglossus - protrudes the tongue
  3. styloglossus - draws sides of tongue up
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32
Q

describe this and what is the diagnosis?

A

regions of necrosis surrounded by tumour cells (pseudopalisading) and endothelial cell proliferation

gliblastoma multiforme

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33
Q

what are the 3 visible changes of Wallerian degeneration?

A
  1. cellular oedema
  2. nucleus to the side
  3. Nissl staining darker and throughout the cell body
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34
Q

what is this and what are the associated conditions?

A

holoprosencephaly - monoventricle and fusion of the basal ganglia

Trisomy 13 and foetal alcohol syndrome

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35
Q

diagnosis?

A

pilocytic astrocytoma

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36
Q

diagnosis

A

spongiform encephalopathy

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37
Q

what is the inheritance pattern of Friedreich Ataxia?

A

AR

unstable trinucleotide repeat (GAA) in frataxin gene

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38
Q

where does Abeta amyloid come from?

A

APP protein, coded for on Ch21

APP usually undergoes alpha cleavage, but beta cleavage results in Abeta and subsequent plaque formation

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39
Q

what areas of CNS are involved in ALS?

A

lower motor neurons - anterior horn

upper motor neurons - lateral cortiospinal tract

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40
Q

principles of anaesthetics

what does blood and lipid solubility equate to clinically?

A

low blood solubility = rapid onset

lipid solubility = potency

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41
Q

2 obstetric signs of anencephaly

A
  1. elevated AFP (as with all NTDs)
  2. polyhydramnios (baby cannot swallow)
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42
Q

what structure connects the lateral to the 3rd ventricles?

A

foramen of monroe

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43
Q

what is this? what vessel has ruptured?

A

subarachnoid haemorrhage

berry aneurysm in the circle of willis

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44
Q

what cranial nerve exits at the level of the middle cerebellar peduncles?

A

trigeminal (CN V)

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45
Q

what is the first area of the brain damaged by global ischaemic injury?

A

pyramidal cells of hippucampus

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46
Q

universal astrocyte marker

A

GFAP

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47
Q

where is satiety sensation regulated?

A

ventromedial hypothalamus

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48
Q

what medication can be started following SAH prophylactically? how does it work?

A

nimodepine

cerebral Ca++ channel blocker that prevents post-SAH vasospasm

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49
Q

what about the vessel of a berry aneurysm makes it likely to rupture?

A

lacks a Media layer where the vessel is branching

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50
Q

which anti-epileptic first line drug is hepatotoxic requiring LFT monitoring?

A

valproate

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51
Q

cerebellar haemangioblastoma and visceral organ cysts (esp renal) suggests what disease?

A

von hippel lindau disease

associated with (bilateral) renal clear cell carcinoma

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52
Q

pale infarction suggests what aetiology?

A

thrombotic stroke

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53
Q

what agents act centrally in PD treatment to prevent breakdown of DA?

A

COMT inhibitor - tolcapone

MAO-B inhibitor - selegiline/rasagiline

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54
Q

of all brain tumours, how many are metastatic ?

A

50%

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55
Q

what are the different neuromuscular blockade drugs?

A

depolarising - ACh receptor agonists (succinylcholine)

non-depolarising - competitive ACh antagonists (tubcurarine, rocuroniuml, vecuronium)

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56
Q

Rx normal pressure hydrocephalus

A

LP gives temporary relief of symptoms

VP shunt definitive treatment

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57
Q

what is the first line treatment for acute status epilepticus?

A

benzodiazapines

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58
Q

lighting pain

absent reflexes

ataxia

suggests what pathology?

A

neurosyphilis

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59
Q

parotid gland tumour is associated with damage to which nerve?

A

facial nerve

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60
Q

what is located at the posterior portion of superior temporal gyrus

bilateral?

A

Wernicke’s area - only on the dominant temporal lobe

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61
Q

hydrocephalus ex-vacuo is what?

A

enlargement of the ventricles caused by central neuron volume loss, rather than increased ventricular pressure

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62
Q

what CNS tumour crosses the corpus callosum?

A

GBM

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63
Q

define meningitis

A

inflammation of the leptomeninges (pia & arachnoid)

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64
Q

what is the reversal of depolarising NM block?

A

Phase I (prolonged depolarization) - no reversal possible

Phase II (repolarized but nAChR desensitized) - cholinesterase inhibitors

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65
Q

pathogenesis of normal pressure hydrocephalus?

A

gradual decrease in CSF resorption through the arachnoid granulations to the central venous sinus.

gradual increase in CSF volume allows the brain to retain function disproportionate to the degeneration visible on scan.

wet, wobbly, wacky

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66
Q

frontal blading, gonadal atrophy, muscle weakness and difficulty with doors suggests what pathology?

A

myotonic muscular dystrophy

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67
Q

diagnosis

A

subdural haematoma

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68
Q

what focal seizure

loss of consciousness & postictal state

possible automatisms (e.g. lip smacking)

A

complex focal

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69
Q

type of necrosis in ischaemic stroke

A

liquefactive necrosis

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70
Q

what is vigabatrin? indication?

A

GABA transaminase inhibitor

focal seizures

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71
Q

what is overdose treatment for barbituates?

A

supportive

maintain respiration and blood pressure

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72
Q

polio - LMN or UMN?

A

LMN

poliovirus attacks neurons in the anterior horn

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73
Q

15 year old boy with kyphoscoliosis and pes cavus has difficulty moving and walking

what is the diagnosis and what is the neuropathology?

A

Friedreich ataxia

degeneration of the spinocerebellar, lateral cortiospinal tract, and dorsal columns and DRGs

HOCM and DM 1 are associated

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74
Q

whorled pattern, psammoma bodies

diagnosis?

A

meningioma

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75
Q

adrenoleukodystrophy is cause by what?

A

inability to bind long-chain fatty acids to coenzyme A

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76
Q

what passes through foramen rotundum?

A

CN V2 - maxillary division of trigeminal

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77
Q

what is the antedote for benzo overdose?

A

flumazenil

competitive antagonist at GABA receptor

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78
Q

mutlinucleated giant cells in the brain suggest what?

A

HIV infection

forces microglial cells to fuse

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79
Q

ventral posteriolateral nucleus of thalamus

what sensory input/nerve(s)?

A

whole body sensation

spinothalalmic and dorsal columns, medial lemniscus

to primary somatosensory cortex

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80
Q

what is the target of carbidopa?

how does this help?

A

peripheral dopa decarboxylase, blocking conversion of L-DOPA to peripheral dopamine

increases availability of L-DOPA to cross into brain

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81
Q

lesion in the reticular activating system gives…

A

decreased arousal/coma

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82
Q

what is first line treatment for generalized, tonic-clonic seizures?

A

phenytoin or valproate

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83
Q

astrocyte tumour in kinds

A

pilocytic astrocytoma

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84
Q

what are the dopamine agonists in PD?

two groups

A

Ergot - bromocriptine

non-ergot - pramipexole, ropinirole (preferred)

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85
Q

what is levetiracitam? indications?

A

unknown mechanism anti-epileptic (possibly affects GABA/glutamate balance)

focal and tonic-clonic seizures

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86
Q

what is diphenoxylate?

A

opioid used as anti-diarrhoeal

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87
Q

where do you get an ependymoma?

A

wall of the 4th ventricle

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88
Q

what is sumitriptan?

cautions?

A

5-HT(1B/D) receptor agonist

inhibits trigeminal nerve activaiton, prevents vasodilation

treats migranes and cluster headaches

vasospasm - CAD, angina

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89
Q

what are the broad spectrum anti-epileptic drugs? (4)

A

levotiracitam, lamotragine, topiramate, valproate

(L-, L-, -ate, -ate)

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90
Q

what leaves the skull through optic canal?

A

nerve - CN II

vessels - opthalmic artery, central retinal vein

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91
Q

what is dextromethorphan?

A

opioid drug used as anti-tussive

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92
Q

what is the water sensing part of hypothalamus?

A

organum vasculosum lamina terminalis, OVLT

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93
Q

distinguishing symptoms of MCA stroke

A

only face and arms

parietal cortex involvement

(hemisensory neglect/aphasia depending on dominant hemisphere)

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94
Q

what is the mechanism of action for barbituates?

A

facilitates GABA(A) channels, keeps Cl- channel open for longer duration when activated by endogenous GABA.

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95
Q

what is the side effect of epinephrine used for glaucoma?

A

mydriasis, do not use in closed-angle glaucoma

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96
Q

how do cholinomimetics affect the eye and treat glaucoma?

A

M3 agonists

contraction of ciliary muscle, opening of trabecular meshwork and increasing outflow of aqueous humour

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97
Q

PML is caused by what and who gets it?

pattern?

A

JC virus

AIDS/leukaemia patients

rapidly progressive neurological signs (visual loss, weakness & dementia) leading to death

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98
Q

what are the two groups of local anaesthetic and examples of each

A

esters - procaine, cocaine, benzocaine

amides - lidocaine, mepivacaine, bupivacaine

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99
Q

what passes through internal auditory meatus?

A

CN VII (facial) and CN VIII (vestibulocochlear)

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100
Q

what is cyclobenaprine?

A

muscle relaxant acting centrally. similar to TCAs in structure

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101
Q

top bug for children and teenagers for meningitis

A

N meningitidis

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102
Q

‘fried egg’ cell appearance on biopsy

A

oligodendroglioma

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103
Q

medulloblastoma occurs in children. where is the most likely location for the tumour to develop?

A

cerebellar vermis

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104
Q

symptoms of mild global cerebral ischaemia?

A

transient confusion with total recovery

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105
Q

tinnitus

diagnosis? where exactly is this lesion located?

A

unilateral vestibulocochlear nerve schwannoma

cerebellopontine angle (between cerebellum and lateral pons)

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106
Q

where is the lesion in hemispatial neglect syndrome of a right hand dominant patient?

A

nondominant (right) parietal lobe

contralateral agnosia (left side neglect)

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107
Q

GFAP positive suggests what 5 cancers?

A

glial cell origin

pilocytic astrocytoma, GBM, ependymoma, oligodendroglioma, schwannoma

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108
Q

symptoms - fontal lobe lesion

A

disinhibition/concentration deficit

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109
Q

what is the protein structural change for spongiform encephalopathy?

A

prion protein going from alpha-helix to beta-sheet

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110
Q

nerve association of 2nd pharyngeal arch

A

facial nerve (CN VII)

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111
Q

What is brimonidine?

A

alpha-2 receptor agonist for use in glaucoma

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112
Q

what is Arnold Chiari malformation

what are the two types?

A

herniation of the cerebellar tonsils through the foramen magnum

Type 1 - no obstruction to CSF flow and no symptoms

Type 2 - vermis also heriated, obstructs drainage of the 4th ventricle so non-communicating hydrocephalus

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113
Q

what is benzotropine?

(also trihexyphenidyl)

A

antimuscarinic used in PD to stop tremor and rigidity

no effect on bradykinesia

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114
Q

PathoG - rosenthal fibres

A

pilocytic astrocytoma

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115
Q

what passes through foramen ovale?

A

CN V3 - mandibular divison of trigeminal

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116
Q

how does the pH of a tissue (infected = acidic) affect local anaesthetic action?

A

acidic means amides will be charged so cannot cross cell membrane.
higher concentration of anaesthetic needed

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117
Q

nerve roots for all the reflexes…

sing song!

A

S1-2, buckle my shoe - achilles

L3-4, kick the door - patellar

C5-6, pick up the sticks - biceps

C7-8, lay them straight - triceps

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118
Q

what is a leukodystrophy?

A

inherited mutation in enzymes needed for myelination/maintenance of myelin

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119
Q

intracranial cyst filled with brown-yellow viscous fluid like machine oil

presence of protein and cholesterol crystals

diagnosis?

A

craniopharyngioma

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120
Q

foramina of Luschka and Magendie

which are located where relative to midline?

A

Luschka - bilateral

Magendie - posteriomedial

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121
Q

sudden onset unilateral hemianopia with macular spearing, visual agnosia and prosopagnosia

what’s happened? what do these words mean?

A

contralateral posterior cerebral artery infarction

visual agnosia - inability to regognise objects

prosopagnosia - inability to recognise faces

122
Q

where is the CNS centre of parasympathetic control?

A

anterior hypothalamus

123
Q

treatment for huntington’s disease?

A

tetrabenazine and reserpine - inhibit VMAT (decrease DA vesicle loading & release)

haloperidol - dopamine D2 antagonist

124
Q

define subfalcine herniation

what kills you?

A

displacement of the cingulate gyrus under the falx cerebri

compression of ACA

125
Q

what happens in diabetic III nerve palsy?

A

vasculopathic central nerver ischaemia occurs first

somatic fibres affected > autonomic fibres

eye held in down and out position, pupils are equally reactive to light and accomodation

126
Q

what is the vomiting centre of brain?

A

area postrema

127
Q

what is Dandy-Walker malformation?

A

failure of development of the cerebellar vermis

128
Q

Where exactly is a Berry aneurysm likely to form?

A

branch points of the ACA and the anterior communicating artery

129
Q

what is a familial cause of ALS

A

Zn/Cu superoxide dismutase muation

only some familial cases

130
Q

what is first line prophylactic therapy for staus epilepticus?

131
Q

what is topiramate? indications?

A

Na+ channel blocker and GABA potentiator

focal and generalized, tonic-clonic seizures

132
Q

what is the common mechanism for valproate, phenytoin and carbamazepine?

which has another action and what is it?

A

all block Na+ channels

valproate also inhibits GABA transaminase, increasing GABA availability

133
Q

diagnosis?

134
Q

first pharyngeal arch assoc with which nerve?

A

trigemminal (CN V)

135
Q

pathogenesis of metachromatic leukodystrophy

A

without arylsulphatase, sulphatides accumulate in the lysosomes of oligodendrocytes leading to cell death

lysosomal storage disease

136
Q

tensilon test is what? what diseases does it test between and what are the results?

A

edrophonium administration test for NMJ-related muscle weakness

edrophonium = AChase-I

if MG, tensilon test will relieve weakness

if Lambert-Eaton then no clinical improvement, b/c antibodies directed against presynaptic Ca++ channel

137
Q

what gene is associated with increased risk of Alzheimer’s?

A

ApoE epsilon 4 allele

epsilon 2 allele associated with decreased risk

138
Q

Kluver-Bucy syndrome

what is it and where is the lesion?

A

lesion in amygdala - disinhibited behaviour

hyperphagia, hypersexuality, hyperorality

139
Q

expansion of a midline syrinx leads to what findings?

A
  1. LMN lesion (anterior horn)
  2. Horner’s syndrome (lateral horn of hypothalamospinal tract)
140
Q

what are the neurological complications of measles virus? (3)

A
  1. acute - encephalitis
  2. subacute - acute disseminated encephalomyelitis
  3. chronic (years later) - subacute sclerosing panencephalitis
141
Q

a deficiency of arylsulphatase causes what disease?

A

metachromatic leukodystrophy

142
Q

what organ does neuroblastoma affect?

A

adrenal medulla

143
Q

what is the mechanism of action for benzos?

A

increases frequency of GABA(A) channel opening

c/o barbituates

144
Q

what is this appearance and what is the disease?

A

‘tram track’ calcifications

Sturge-Weber syndrome - facial angioma in the V1/2 (rarely V3) distribution

145
Q

estimation formula for normal CSF glucose

A

CSF(glucose) = 2/3 x blood(glucose)

146
Q

damage to what area of the brain gives rise to large-amplitude, contralateral involuntary limb movements (hemibalismus)?

A

subthalamic nucleus

147
Q

which areas of the spinal cord degenerate in neurosyphilis?

A

dorsal roots/dorcal columns

148
Q

what is the first line treatment for focal seizures?

A

carbamazepine

149
Q

what structures of the spinal cord are preferentially affected in tabes dorsalis?

A

dorsal root ganglion and dorsal columns

150
Q

what time frame of stroke is this?

A

red neurons, cells currently dying

12 hours following infarction

151
Q

oligodendrocyte tumour in adults

A

oligodendroglioma

152
Q

which benzo’s do not have hepatic metabolism?

A

Out the liver

oxazepam, temazepam, lorazepam

154
Q

what is the priciple of therapeutic hyperventilation and when is it used?

A

hyperventilate, decrease PaCO2 , vasoconstriction, decrease cerebral blood flow, decrease ICP

used to treat acute cerebral oedema 2ary ischaemic stroke unresponsive to other treatment

155
Q

what generalized seizure?

loss of consciousness & postictal state

diffuse muscle contractoin of limbs followed by rhythmic jerking

A

tonic-clonic

156
Q

CNS biopsy - diagnosis?

A

oligodendroglioma

157
Q

what are the antibodies associated with paraneoplastic cerebellar degeneration?

A

anti-Yo, anti-P/Q, anti-Hu

158
Q

what is located at the posterior rostral pons near the lateral floor of the fourth ventricle?

what does it produce?

A

pigmented neurons of the locus ceruleus

norepinephrine

159
Q

when should you not use barbituates?

160
Q

how is vCJD different from CJD

A

vCJD - young patients, exposure to bovine spongiform encephalopathy

161
Q

when are the axonal reaction changes of Wallerian degeneration first visible?

162
Q

what are the two main side effects of carbamazepine?

A

bone marrow suppression and SIADH

163
Q

another word for berry aneurysm?

A

saccular aneurysm

164
Q

how does an amide anaesthetic bind to its target channel?

A

binds to inner portion of channel

crosses membrane in uncharged form, receives charge and binds to intracellular Na+ channel portion

165
Q

what is an association with Friedrich Ataxia?

A

hypertrophic cardiomyopathy

HOCM

166
Q

a ‘drop metastasis’ is what? associated with what tumour?

A

metastasis of medulloblastoma through the CSF, seeded from the 4th ventricle, down into the spinal cord…

associated with poor prognosis

167
Q

distinguishing symptoms of lacunar infarct

A

complete contralateral hemiplegia and hemianaesthesia

face, arms and legs

no cortical symptoms (neglect, aphasia, visual field loss)

168
Q

which are the short acting benzos?

A

ATOM

alprazolam, triazolam, oxazepam, midazolam

169
Q

what is the reversal of non-depolarising NM blockade?

A

cholinesterase inhibitors

  • neostigmine (must give atropine to prevent muscarinic effects, e.g. brady)
  • edrophonium
170
Q

which anaesthetics have an association with hepatotoxicity?

A

halogenated inhaled anaesthetics

(halothane most, then sevo, desflurane, enflurane etc..)

171
Q

what signalling pathway is implicated in holoprosencephaly?

172
Q

what passes through foramen magnum?

A

nerves - spinal roots of CN XI (spinal accessory, rostrally), brain stem

vessels - vertebral arteries

173
Q

boney and muscular derivatives of 1st pharyngeal arch

A

boney - mandible, maxilla, zygoma, incus & malleus

muscular - muscles of mastication

174
Q

what does ethosuxamide do?

A

block thalamic Ca++ channels, anti-absence seizures epileptic drug

175
Q

spinal accessory nerve provides innervation to which muscles?

A

trapezius and SCM

176
Q

pathologic mechanism of lacunar stroke

A

hyaline arteriolosclerosis 2ary to DM or HTN

lake-like cystic infarcts

177
Q

Define uncal herniation

what 3 things go wrong?

A

displacement of the temporal lobe uncus under the tentorium cerebelli

  1. CN III palsy, down and out
  2. compresison of PCA, ischaemia
  3. rupture of paramedian artery, brainstem (Duret) haemorrhage
178
Q

what is the first sign on temporal uncal herniation?

A

ipsilateral fixed, dilated pupil

179
Q

where is the CNS centre for sympathetic control?

A

posterior hypothalamus

180
Q

cystic lesion with mural nodule…

what CA?

A

pilocytic astrocytoma

181
Q

which subcellular proteins are responsible for retrograde and anterograde axonal transport?

A

retro - dyenin

antero - kinesin

182
Q

what is normal ICP?

A

50 - 180 mmH2O

183
Q

2 treatments for ALS

A

Riluzole - mechanism unclear but acts through glutamate and sodium channels

184
Q

classify the clinical features of friedrich ataxia

A

cerebellar degeneration - ataxia

spinal cord degeneration - LMN lesion

185
Q

what does Panician corpuscle sense?

A

vibration and pressure

186
Q

what generalized seizure?

no loss of consciousness or postictal state

brief, jerking movements

187
Q

antidote for serotonin syndrome?

A

cyproheptadine

non-specific 5-HT(1) and 5-HT(2) antagonist

188
Q

in moderate global cerebral ischaemia, what areas are likely to be damaged? (4)

A
  1. watershed areas between anterior, middle and posterior cerebral arteries
  2. pyramidal neurons of cortex (layer 3, 5 and 6; laminar necrosis)
  3. pyramidal neurons of hippocampus
  4. purkinje layer of cerebellum
189
Q

what generalized seizure?

brief loss of consciousness

may have autonomisms (lip smacking)

no postictal state

190
Q

schwannoma tumour cells show what marker?

191
Q

what is this?

A

Dandy Walker malformation

  1. failure of the cerebellar vermis to form
  2. massive dilatation of the 4th ventricle
  3. non-communicating hydrocephalus
192
Q

where is hunger senstation initiated?

A

lateral hypothalamus

193
Q

symptoms of lesion in medial longitudinal fasiculus

A

internuclear opthalmoplegia

  • lesion of left MLF. asked to look right.*
  • R eye - abduction nystagmus, L eye - adduction paresis*
194
Q

what does Merkel discs sense?

A

pressure, deep static touch (shapes and edges), position

195
Q

where does Pick disease affect?

A

frontal and temporal cortex

196
Q

from what cell dose medulloblastoma arrise?

A

granular cells of cerebellum

197
Q

what drug is first line therapy for trigeminal neuralgia?

A

crabamazepine

198
Q

superior quadrantanopia suggests a lesion where?

what part of the optic pathway is affected?

A

contralateral temporal lobe - Meyer’s loop

199
Q

what structure connects the 3rd to 4th ventricle

A

cerebral aqueduct

200
Q

unilateral nasal hemianopsia on a b/g vascular disease

where is the lesion and what are the common causes?

A

peri-chiasmal lesion, affecting lateral fibres only as the medial fibres are decussating in the chiasm

calcification or aneurysm of internal carotid artery

3 in picture below

201
Q

cape-like distribution along both upper limbs, loss of sensation to pain and temperature

what is the lesion and where in the cord is it?

A

syringomyelia

syrinx located in the anterior white commisure, lesion affects where both tracts cross the midline so bilateral sensory loss

202
Q

neurochemical pathology of AD

A

loss of cholinergic neurons at the nucleus basalis of Meynert

203
Q

bilateral schwannoma suggests what?

A

neurofibromatosis type II

204
Q

what are the side effects of inhaled halogenated anaesthetics?

A
  1. decrease cardiac output
  2. decrease respiration, decrease mucociliary clearance potentially causing pos-op atelectasis
  3. increase cerebral blood flow, potentially resulting in increased ICP
  4. decrease GFR
  5. decrease hepatic blood flow, potentially halothane hepatitis
205
Q

tumour at the cerebellopontine angle is…

A

schwannoma

PNS tumour which looks like it presents in the brain

206
Q

what CA goes to brain?

A

lung

kidney

breast

207
Q

anaesthetic infiltration of the interscalene triangle (between middle and anterior scalene muscles) does what?

A

blocks the brachial plexus - anaesthesia of shoulder and upper arm

also affects C3-5 (phrenic nerve) so you get ipsilateral diaphragm paralysis

only muscle of the arm spared is trapezius - innervation from CN XI

208
Q

what is the cause of subacute sclerosis panencephalitis?

A

measles virus

209
Q

describe the path of CSF flow through the brain

A

generation in the lateral ventricles, foramen of monro, 3rd ventricle, cerebral aqueduct, 4th ventricle, foramina of Luschka and Magendie, subarachnoid space, venous sinuses

210
Q

boney and muscular derivatives of 2nd pharyngeal arch

A

boney - styloid process of temporal bone, lesser horn of hyoid, stapes

muscular - muscles of facial expression

211
Q

clinical features of schwannoma?

A

loss of hearing and tinnitus

212
Q

what is suvorexant? indication and caution?

A

orexin receptor antagonist - treatment for insomnia with no/low addictive potential

narcolepsy, liver disease, CYP3A4 metabolism

213
Q

what is a degenerative condition of upper and lower motor neurons?

214
Q

Von Recklinghausen’s disease is also known as?

clinical features?

A

neurofibromatosis type 1

optic nerve glioma, neurofibroma, Lisch nodules (iris), cafe au lait spots

215
Q

ventral posteriomedial nucleus of thalamus

what sensory input/nerve(s)?

A

facial sensation and taste

trigemminal (CN V) and gustatory pathway

216
Q

what is the triad of normal pressure hydrocephalus?

A

urinary incontinence

gait instablility

dementia

wet, wobbly, wacky

217
Q

where are ADH and oxytocin synthesised?

A

paraventricular and supraoptic nuclei

218
Q

amyotrophic lateral sclerosis affect motor, sensory or both?

A

only motor

219
Q

tumour from neurons in children

A

medulloblastoma

220
Q

potential consequence of orbital floor #?

A

infraorbital nerve damange (branch of maxillary)

numbness and parasthesia of upper lip, gingiva and cheek

221
Q

complications of SAH

A

2ary arterial vasospasm

rebleeding

hydrocephalus (dysfunction of the arachnoid villi)

222
Q

where does venous return leave the skull?

A

all joins at confluence of sinuses, anteriolaterally to sigmoid sinus, through jugular foramen then as internal jugular vein

223
Q

best treatment for absence seizure?

A

ethosuximide

224
Q

which muscle group predominates in decorticate posturing?

A

flexor muscles

rubropsinal tract intact and disinhibited

226
Q

metabolic cause of global cerebral ischaemia?

A

hypoglycaemia

227
Q

top bug for adults and elderly for meningitis

A

Strep pneumoniae

228
Q

what cellular changes occur to a neuron when it’s axon has been severed?

A
  • Wallerian degeneration* affects the axon distal to the lesion
  • Axonal reaction* affects the neuron proximal to the lesion: cell body oedema, nucleus displaced to the peirphery, Nissl substance dispersed throughout cytoplasm (visiable at 24 - 48 hours)
229
Q

a cystic degeneration of the spinal chord between C8-T1

2 causes

A

syringomyelia

  1. assoc with Arnold Chiari
  2. trauma
230
Q

what passes through hypoglossal canal?

A

CN XII (hypoglossal)

231
Q

which has a higher change of respiratory depression out of barbs or benzos?

A

barbituates

232
Q

what passes through superior orbital fissure?

A

nerves - CN III (opthalmic), IV (trochlear), V1 (opthalmic division of trigeminal), VI (ABducens)

vessels - opthalmic vein

sympathetic fibers

233
Q

biochemical sign of neuroblastoma?

A

increase urinary metanepherines

234
Q

pure motor hemiparesis suggests what?

A

lacunar infarct, possibly due to hypertensive arteriolar sclerosis

235
Q

what part of the peripheral nerve has to be joined in microsurgery when attaching a limb?

A

perineurium - membrane immediately surrounding the nerve fibres that acts as the blood-nerve barrier

236
Q

what is the mechanism of donepezil/galantamine/rivastigmine?

A

cholinesterase inhibitor

237
Q

what passes through foramen spinosum?

A

vessels - middle meningeal artery and vein

238
Q

what are the side effects of phenytoin/fosphenytoin?

A

Neuro - nystagmus, ataxia, diplopia, sedation, peripheral neuropathy

Derm - hirsuitism, SJS, DRESS syndrome, gingival hyperplasia

MSk - osteopenia

reproductive - teratogen

Other: P450 inducer

239
Q

what is the distinguishing feature between ALS and syringomyelia?

A

pain and temperature sensation change

240
Q

ependymal cell tumour in kids

A

ependymoma

241
Q

3 key ways to tell LEMS from MG

A
  1. a-/hyporeflexia
  2. autonomic symptoms (dry mouth/impotence)
  3. incremental respose to stimulation on EMS
242
Q

what is the mechanism of eszopiclone (and other nonBZD hypnotics)?

A

activate GABA(BZ1) receptor

243
Q

what is riluzole?

A

treatment for ALS

uncertain mechanism

244
Q

what is first line treatment for essential (familial) tremor?

A

propranolol

245
Q

what is the mechanism for tiagabine? indication?

A

GABA reuptake inhibitor

focal seizures

246
Q

what is located in the dorsal medulla at the caudal end of the fourth ventricle?

what does it control?

A

area postrema

‘vomiting centre’ - fenestrated capilaries so it samples chemicals circulating in the blood

247
Q

which muscle group predominates in decerebrate posturing?

A

extensor muscles

rubrospinal tract damaged, vestibulospinal tract predominates

248
Q

round aggregates of tau protein in neurons of cortex…

what disease?

A

Pick disease

249
Q

define lissencephaly

A

congenital absence of gyri

severe mental retardation and seizures, smooth appearance of brain on gross exam and imaging

250
Q

what is ramelteon?

A

melatonin receptor agonist, binds MT1 and MT2 in suprachiastmatic nucleus

251
Q

classic bone and vessel damage of epidural haematoma?

A

temporal bone

middle meningeal artery

252
Q

what nerves are damaged by ventricular swelling in NPHC?

A

corona radiata nerves that run along the edge of the ventricles

253
Q

malignant hyperthermia

trigger, inheritance

affected protein, treatment

A

triggered by inhaled anaesthetics or succinylcholine

inherited autosomal dominant

mutation in ryanodie receptor means stimulation results in much more Ca++ release

treat with dantrolene (RyR antagonist)

254
Q

what is lamotrigine? indications?

A

blocks voltage-gates Na+ channels, inhibits glutamate release

focal & generalized (all) seizures

N.B. risk of SJS, must be titrated up carefully

255
Q

what is the earliest finding of ishaemic stroke?

A

‘red neurons’

256
Q

meningitis bugs in neonate

A

GBS

  • E Coli*
  • Listeria monocytogenes*
257
Q

distinguishing symptoms of anterior cerebral artery occlusion

A

contralateral paralysis and anaesthesia only lower limb

258
Q

poliovirus transmission

A

faeco-oral route

259
Q

what does Meissner corpuscle sense?

A

fine touch, dynamic, position sense

260
Q

galactocerebrosidase deficiency is what disease?

where does galactocerebroside build up?

A

Krabbe disease

in macrophages

261
Q

brain tumour GFAP positive… diagnosis?

A

pilocytic astrocytoma

262
Q

what condition presents at poliomyelitis in children?

A

Werdnig-Hoffman disease

AR inherited degeneration of the anterior horn

floppy baby presentation, death within a few years

263
Q

what antiepileptic drugs are P450 inducers?

A

phenobarbital and carbamazepine

264
Q

antidote for organophosphate poisoning?

A

pralidoxime

restores cholinesterase activity only if given soon after exposure

265
Q

what focal seizure

no loss of consciousness or postictal state

motor, sensory, autonomic or psychic symptoms

266
Q

define tonsilar herniation

what kills you?

A

displacement of the cerebella tonsils into the foramen magnum

cardiopulmonary arrest

267
Q

what is the mechanism of opiate analgesia?

A

activation of mu-opioid receptor

opening of K+ channels allows efflux and depolarisation

Blockage of Ca++ stops influx and vesicle release

268
Q

tensor tympani is innervated by which nerve?

A

mandibular branch of trigeminal (CN V3)

269
Q

which 4 cranial nerve nuclei are medial?

A

factors of 12, except 1 and 2

III, IV, VI and XII

oculomotor, trochlear, abducens, hypoglossal

270
Q

spike wave complexes on EEG

what disease?

271
Q

what is baclofen?

A

GABA(B) agonist in spinal cord

muscle anti-spasmodic for low back pain/MS

272
Q

time frame for TIA

273
Q

degeneration of GABAergic neurons in the caudate nucleus of basal ganglia…

what disease?

A

Huntington’s

274
Q

a pineal gland mass will give rise to what symptoms?

A
  1. non-communicating hydrocephalus (aqueductal stenosis)
  2. dorsal midbrain (Parinaud) syndrome

limitation of upward conjugate eye movement

275
Q

genes for familial AD?

A

presinilin 1 and presinilin 2

276
Q

the flocculonodular lobe is located where and what does it control?

A

base of the posterior cerebellum

eye movements and balance

277
Q

what is amantadine?

toxicity?

A

increase dopamine availability at the synapse

toxicity = ataxia and livedo reticularis

278
Q

key associations with Arnold Chiari malformation (2)

A

meningiomyelocele, syringomyelia

279
Q

what is ependymal cell?

A

cell lining the ventricles producing CSF

280
Q

Rx MS

A

corticosteroids for flare

IFN-beta to slow progression of disease

281
Q

5 branches of the facial nerve

A

temporal

zygomatic

buccal

mandibular

cervical

282
Q

calcified tumour in the frontal lobe white matter is…

A

oligodendroglioma

283
Q

lacunar stroke most commonly involves what blood vessels?

A

lenticulostriate vessels feeding deep structures of the brain

284
Q

what is paraneoplastic cerebellar ataxia?

A

paraneoplastic immune response vs tumour cells cross-react with purkinje neuron antigens leading to progressive degeneration of cerebellum

285
Q

clinical features of familial fatal insomnia

A
  1. insomnia
  2. exagerated startle response
286
Q

treatment for wilson’s disease

A

chelators - D-penicillamine, trientine

Zinc (interferes with Cu absorption)

287
Q

cerebral atrophy with narrowing of the gyri, widening of the sulci and dilation of the ventricles is what disease?

A

alzheimer’s

288
Q

intermediolateral cell columns of the spine are found at what level?

A

thoracic to early lumbar (T1-L2)

289
Q

what are the histologic findings 1 month after stroke?

A

fluid-filled cystic space surrounded by gliosis

290
Q

draw the circle of willis from vertebral arteries to the anterior cerebral arteries

291
Q

visceral organ biopsy

solid sheets of small cells with dark nuclei and scant cytoplasm

A

neuroblastoma

292
Q

how does bimatoprost/latanoprost improve glaucoma?

A

increase outflow of aqueous humour through uveoscleral pathway

acts on PGF2alpha receptors

turns the iris more brown (darker) & eyelash growth

293
Q

symptoms (2) and epidemiology of pseudotumor cerebri?

A

young, obese women - elevated ICP without ventricular enlargement

headache, papilledema, possible visual loss

294
Q

intracerebral haemorrhage

  • what vessles
  • predisposing condition
  • where in the brain
A

Charcot-Bouchard microaneurysm rupture of the lenticulostriate vessels

hypertension

basal ganglia

295
Q

what is mechanism of memantine?

A

NMDA receptor antagonist, used in AD

prevents excitotoxicity (mediated by Ca++)

296
Q

what are the non-benzo hypnotics?

A

zolpidem, zalepon, eszopiclone

297
Q

genetic mechanism of anticipation in HD

A

expansion of the CAG trinucleotide repeat in the huntingtin gene during spermatogenesis

298
Q

DBS for parkinsons involves high frequency stimulation of what areas of the brain? what is the downstream affect?

A

either subthalamic nucleus or globlus pallidus internus

DBS stimulation inhibits these areas of the brain, which usually exert an inhibitory affect on the thalamus.

Disinhibition of the thalamus (ergo thalamocortical pathway) restores normal motor function

299
Q

treatment for restless leg syndrome

A

dopamine agonists lie pramipexole/ropinirole

301
Q

what are the narrow spectrum anti-epileptic drugs? (4)

A

carbamazepine, gabapentin, phenobarbital, phenytoin

USMLE S1 (16 decks)

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