pathology II

Question 1

What is conduction aphasia?

Answer 1

Caused by damage to the arcuate fasciculus (connects wernickes and brocas area) - patient can’t repeat what you say

Question 2

What is global aphasia?

Answer 2

Wernickes, brocas and arcuate fasciculus are all affected

Question 3

What is transcortical motor aphasia

Answer 3

affected frontal lobe around broca area, but broca is spared

Question 4

what is transcortical senosry aphasia

Answer 4

affects temporal lobe around wenicke area but wernicke area is spared

Question 5

what is transcortical mixed aphasia?

Answer 5

broca and wernicke areas and arcuate fasciculus remain intact but surrounding watershed areas are affected

Question 6

saccular aneurysm aka

Answer 6

berry aneurysm

Question 7

most common location for a berry aneurysm

Answer 7

junction of Acomm and ACA

Question 8

how do berry aneurysms prsent

Answer 8

silent until they rupture -> subarachnoid hemorhage

Question 9

An aneurysm in the Acom may compress surrounding structure resulting in what?

Answer 9

Bitemporal hemianopia (compresses optic chiasm)

Question 10

An aneurysm in the Pcom may compress surrounding structures resulting in what?

Answer 10

CN III palsy -> mydriasis, down and out eye and ptosis

Question 11

What presents similarly to a CN III palsy?

Answer 11

Ischemic neuropathy seen in diabetes, however pupil is spared

Question 12

What are Charcot-Bouchard microaneurysms commonly found?

Answer 12

Small vessels such as lenticulostriate arteries

Question 13

What are Charcot-Bouchard microaneurysms associated with?

Answer 13

chronic hypertension

Question 14

What can Charcot-Bouchard microaneurysms result in?

Answer 14

hemorrhagic intraparenchymal strokes

Question 15

Where do most partial (focal) seizures originate?

Answer 15

medial temporal lobe

Question 16

Types of partial seizures

Answer 16

simple partial and complex partial

Question 17

How do simple partial seizures present

Answer 17

consciousness remains, may be motor, sensory, autonomic or psychic

Question 18

How do complex partial seizures present

Answer 18

impaired consciousness and automatisms

Question 19

Status epilepticus

Answer 19

continues (>5min) or recurring seizures that may result in brain injury

Question 20

types of generalized seizures

Answer 20

absence (petit mal)
Myoclonic
Tonic-clonic (grand mal)
Tonic
Atonic

Question 21

What will be seen on a EEG of an absence seizure?

Answer 21

3 Hz spike-and-wave discharges

Question 22

Atonic seizures are commonly mistaken for…

Answer 22

drop seizures

Question 23

What is Juvenile Myoclonic epilepsy?

Answer 23

characterized by absence, myoclonic and grand mal seizures. Common in children.

Absence -> myoclonic -> grand mal

Typically myoclonic jerks on awakening from sleep

Question 24

What is post-ictal state mean?

Answer 24

After a grand-mal seizure, this is a period of brain recovery that presents as confusion/lack of alterness and lasts minutes to hours

Question 25

Treatment for childhood absence epilepsy

Answer 25

Ethosuxamide

Question 26

Cause of fever

Answer 26

cytokine activation during inflammation (infection)

Question 27

Cause of heat stroke

Answer 27

the inability of body to dissipate heat (exertion)

Question 28

temperature seen in fever

Answer 28

Usually <40 C

Question 29

temperature seen in heat stroke

Answer 29

usually > 40 C

Question 30

Complications of fever

Answer 30

febrile seizures (usually benign, self-limiting)

Question 31

Complications of heat stroke

Answer 31

CNS dysfunction (confusion), end-organ damage, acute respiratory distress syndrome, rhabdomyolysis

Question 32

Management of fever

Answer 32

acetominaphen or ibuprofen for comfort and antibiotics if necessary

Question 33

Management of heat stroke

Answer 33

rapid external cooling, rehydration and electrolyte correction

Question 34

What causes headaches?

Answer 34

pain due to irritation of structures such as the dura, cranial nerves, or extracranial structures

Question 35

Which type of headache is more common in males?

Answer 35

cluster

Question 36

Location and duration of cluster headaches

Answer 36

unilateral | 15min-3 hours, repetitive

Question 37

Presentation of cluster headaches

Answer 37

excruciating perioorbital pain (suicide headache) with lacrimation and rhinorrhea May present with horner syndrome

Question 38

Treatment of cluster headaches

Answer 38

Acute: sumatriptan, 100% O2 Prophylaxis: verapamil

Question 39

Migraine location and duration

Answer 39

unilateral, 4-72 hours

Question 40

presentation of migraine

Answer 40

pulsating pain with nausia, photophobia or phonophobia. May have aura.

Question 41

Cause of migraine

Answer 41

irritation of CN V, meninges or blood vessels (release of vasoactive peptides such as substance P, calcitonin gene-related peptide).

Question 42

Acute treatment of migraines

Answer 42

NSAIDS, triptants, dihydroergotamine

Question 43

Prophylaxis treatment of migraines

Answer 43

lifestyle changes (sleep, exercise, diet), B-blockers, aitriptyline, topiramate, valproate, botox

Question 44

tension headache location and duration

Answer 44

>30 minutes, usually 4-6 hours | Bilateral in band like pattern

Question 45

Presentation of tension headaches

Answer 45

Steady band like pain with NO aura

Question 46

Acute treatment of tension headaches

Answer 46

analgesics, NSAIDs, acetominaphen

Question 47

Prophylaxis of tension headaches

Answer 47

TCAs, behavioural therapy

Question 48

Presentation of trigeminal neuralgia

Answer 48

repetitive, unilateral, shooting/shock like pain in distribution of CN V. Triggered by chewing, talking, touching certain parts of the face. Lasts seconds to minutes. Intensity and frequency increases over time.

Question 49

Treatment of trigeminal neuralgia

Answer 49

carbamazepine

Question 50

Common aura

Answer 50

scintillating scotoma

Question 51

Triptans MOA

Answer 51

5-HT agonists - inhibit trigeminal nerve and decrease vasoactive peptide release. Also cause vasoconstriction

Question 52

Triptans are contraindicated for which patients

Answer 52

coronary disease and coronary vasospasm

Question 53

Akathisia presentation

Answer 53

restlessness and intense urge to move

Question 54

asterixis

Answer 54

flapping of wrists on extension

Question 55

athetosis presentation

Answer 55

slow, snake-like, writhing movements, especially in fingers

Question 56

which disease has athetosis

Answer 56

huntingtons

Question 57

chorea

Answer 57

sudden, jerky, purposeless movements

Question 58

which disease has chorea

Answer 58

huntingtons

Question 59

dystonia

Answer 59

sudden, involuntary muscle contractions

Question 60

examples of dystonia

Answer 60

writers cramp, blepharospasm, torticollis

Question 61

what is blepharospasm

Answer 61

abnormal contraction of eyelids

Question 62

essential tremor presentation

Answer 62

high-frequency tremor with sustained posture. Worsened with movement or when anxious.

Question 63

Treatment of essential tremor

Answer 63

nonselective beta-blockers or primidone

Question 64

Hemiballismus presentation

Answer 64

sudden, wild flaing of 1 arm +- ipsilateral leg

Question 65

a lesion WHERE leads to hemiballismus

Answer 65

contralateral subthalamic nucleus

Question 66

intention tremor presentation

Answer 66

slow, zigzag motion when pointing/extending toward a target

Question 67

Myoclonus presentation

Answer 67

sudden, brief, uncontrolled muscle contraction

Question 68

Myoclonus examples

Answer 68

jerks; hiccups; common in metabolic abnormalities such as renal and liver failure

Question 69

resting tremor

Answer 69

uncontrolled movement of distal appendages seen in parkinsons

Question 70

restless legs syndrome

Answer 70

worse at rest/nighttime and releived by movement

Question 71

What is restless legs syndrome associated with?

Answer 71

iron deficiency and CKD

Question 72

treatment of restless legs syndrome?

Answer 72

dopamine agonists