Neurology Flashcards
Where is the insula?
Root of word means hidden within which helps with location
Which of the following instructions can enhance deep tendon reflexes in a leg?
- Clench a fist
- Elevate an arm
- Stare at a distant object
- Think of moving the limb
- Sensory stimulation of the opposite limb
Clench a fist
Maintenance of wakefulness is dependent on which of the following areas of the brain?
- Oral pontine
- Midbrain tegmentum
- Posterior hypothalamus
- Anterior cingulate parietal cortex
- Ascending reticular activating system
Ascending reticular activating system
3 lesions produce acute coma: RAS (spans midbrain and pons), bithalamic (usually due to strokes), or diffuse cortex
Histaminergic neurons that regulate sleep originate in which of the following brain nuclei?
- Raphe nucleus (serotonin)
- Locus coeruleus (norepinephrine)
- Tuberomammillary
- Ventrolateral preoptic
- Laterodorsal tegmental
Tuberomammillary
The MRI of the brain shows lateral ventricle enlargement from a 65-year-old patient with progressive cognitive decline. Lumbar puncture showed normal opening pressure and was otherwise normal. Which of the following is likely to be found on examination?
- Gait apraxia
- Cogwheeling (Parkinsonism)
- Expressive aphasia (Broca’s aphasia, dominant posterior inferior frontal gyrus)
- Alien hand syndrome
- Reduced vertical eye movements
Gait apraxia, urinary incontinence, and dementia: Normal Pressure Hydrocephalus
Which of the following neurotransmitters facilitates sexual arousal?
- GABAergic
- Glycinergic
- Serotonergic
- Dopaminergic
- Glutaminergic
Dopaminergic: nucleus accumbens, mesolimbic dopaminergic pathway
Reduction of hippocampal volume is associated with what type of memory impairment?
- Iconic
- Implicit
- Working
- Procedural
- Declarative
Declarative (the conscious, intentional recollection of factual information, previous experiences, and concepts)
Aggressive behavior in patients with Alzheimer disease is most often associated with which of the following?
- Word finding difficulty
- Concurrent psychosis
- Premorbid anxiety disorder
- Late stage Alzheimer disease
- Earlier onset of Alzheimer disease
Concurrent psychosis
A 72-year-old patient with two days of confusion and fever is evaluated in the emergency department for new onset seizure. MRI of the brain demonstrates hemorrhage and swelling of the temporal lobes. Cerebral spinal fluid shows increased lymphocytes and protein. Which of the following medications is most likely to be effective in treating the patient’s condition?
- Acyclovir
- Prednisone
- Ceftriaxone
- Amphotericin
- Pyrimethamine
Acyclovir for HSV encephalitis
A 37-year-old patient is evaluated for progressive static paraplegia. The patient also reports new onset visual loss. MRI of the spine shows longitudinal lesion in the cervical spinal cord, and MRI of the brain shows enhancement of the optic nerve. Antibodies to which of the following are associated with the syndrome?
- Lyme (neuroborreliosis)
- Ganglioside (Guillain-Barre)
- Aquaporin 4
- Acetylcholine receptor (Myasthenia gravis)
- Glutamic acid decarboxylase (stiff person syndrome, autoimmune encephalitis)
Aquaporin 4: Neuromyelitis optica (NMO, the name is in the eyes)
A clock drawing with blank left side and all numbers scrunched onto write is consistent with a lesion in which of the following areas of the brain?
- Brainstem
- Cerebellum
- Frontal lobe
- Parietal lobe
- Temporal lobe
Parietal lobe (non-dominant hemisphere, the right hemisphere in most people)
Image is of classic hemineglect (numbers are there and hands are to the right numbers, there’s nothing on one side…)
Tau staining of hippocampal tissue from a patient with progressive dementia shows ***. Which of the following is the most likely diagnosis?
- Parkinson disease (Alpha-synuclein)
- Alzheimer disease
- Huntington disease (CAG repeats in the Huntingtin gene)
- Creutzfeldt-Jakob disease (prior)
- Dementia with Lewy Bodies (Alpha-synuclein)
Alzheimer disease
A 35-year-old who was diagnosed with AIDS three years ago develops new onset headache associated with cognitive decline. MRI of the brain demonstrates multiple ring enhancing lesions. Which of the following is the most likely cause?
- Lymphoma
- CMV (CMV retinitis)
- Pneumocystis carinii
- Toxoplasmosis gondii
- Progressive multifocal leukoencephalopathy (course is usually more subacute to chronic and not a/w ring enhancing lesions)
Toxoplasmosis gondii
Ring enhancing lesion + AIDS: Toxo or lymphoma
Multiple lesions: more likely toxo
Solitary lesion: more likely CNS lymphoma
Which of the following disorders is associated with hypocretin-1 deficiency?
- Narcolepsy
- Night terrors
- Klein-Levin syndrome
- Obstructive sleep apnea
- Hypersomnolence disorder
Narcolepsy: diagnosed with multiple sleep latency test
A 25-year-old patient with seizure disorder since childhood is seen for evaluation of poorly controlled seizures. The patient has adenomas on the face, mostly around the nasal labial folds and cheeks. A fibrotic plaque is found in the lower back. The most likely diagnosis is:
- Neurofibromatosis
- Tuberous sclerosis
- Von Hippel Lindau
- Tay Sachs disease
- Sturge Weber syndrome
Tuberous sclerosis (ash leaf spots, facial angiofibromas, Shagrene patches)
