Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

► Med Notes > Principles in Neurology_2 > Flashcards

Principles in Neurology_2 Flashcards

1
Q

how does hydrocephalus ex vacuo look on imaging?

A

apparent increase in CSF observed on imaging is actually result of ↓ neural tissue due to neuronal atrophy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what type of hydrocephalus is obstructive?

A

noncommunicating hydrocephalus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

noncommunicating hydrocephalus is caused by what?

A

a structural blockage of CSF circulation within the ventricular system (e.g. stenosis of the aqueduct of Sylvius)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

how many spinal nerves are there?

A

31 spinal nerves: • 8 cervical • 12 thoracic • 5 lumbar • 5 sacral • 1 coccygeal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Nerves C1-C7 exit where?

A

above the corresponding vertebrae

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

all nerves other than C1-C7 exit where?

A

below the corresponding vertebrae

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what happens in vertebral disc herniation?

A

nucleus pulposus (soft central disc) herniates through anulus fibrosus (outer ring)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

vertebral disc herniation usually occurs where?

A

posterolaterally at L4-L5 or L5-S1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

in adults, spinal cord extends to where?

A

lower border of L1-L2 vertebrae

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

in adults, subarachnoid space extends to where?

A

lower border of S2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

lumbar puncture is usually performed at what level?

A

between L3-L4 or L4-L5 (level of cauda equina)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

how do you obtain sample of CSF without damaging spinal cord?

A

to keep the cord alive, keep the spinal needle between L3 and L5

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what info is carried by the dorsal columns?

A

pressure, vibration, touch, proprioception

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

the dorsal columns comprise which structures?

A

Fasciculus cuneatus • Fasciculus gracilis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

fasciculus cuneatus conveys what info?

A

pressure, vibration, touch, proprioception from the upper body, extremities

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

fasciculus gracilis conveys what info?

A

pressure, vibration, touch, proprioception from the lower body, extremities

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

lateral spinothalamic tract conveys what info?

A

pain, temperature

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

anterior spinothalamic tract conveys what info?

A

crude touch , pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

lateral corticospinal tract conveys what info?

A

voluntary motor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

intermediate horn sympathetics emerge at what levels?

A

T1-L2/L3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

what is important to remember as a general rule about spinal tract anatomy and functions?

A

ascending tracts synapse then cross

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

the dorsal column contributes to which tract?

A

medial lemniscal pathway

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

what is the function of the medial lemniscal pathway of the dorsal column?

A

ascending pressure, vibration, fine touch, and propioception

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

what is the 1st order neuron in the doral column medial lemniscal pathway?

A

sensory nerve ending→ cell body in dorsal root ganglion→ enters spinal cord, ascends ipsilaterally in dorsal column

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

what is synapse I of the dorsal column medial lemniscal pathway?

A

ipsilateral nucleus cuneatus or gracilis (medulla)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

what is the 2nd order neuron in the dorsal column medial lemniscal pathway?

A

decussates in medulla →ascends contralaterally in medial lemniscus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

where is synapse 2 in the dorsal column medial lemniscal pathway?

A

VPL (thalamus)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

where is the 3rd order neuron in the dorsal column medial lemniscal pathway?

A

sensory cortex

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

what is the function of the lateral spinothalamic tract?

A

pain, temperature

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

what is the function of the anterior spinothalamic tract?

A

crude touch, pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

where is the 1st order neuron in the spinothalamic tract?

A

sensory nerve ending (Aδ and C fibers) (cell body in dorsal root ganglion)→enters spinal cord

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

where is synapse 1 in the spinothalamic tract?

A

ipsilateral gray matter (spinal cord)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

where is the 2nd order neuron in the spinal thalamic tract?

A

decussates at anterior white commissure →ascends contralaterally

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

where is synapse 2 in the spinothalamic tract?

A

VPL (thalamus)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

where is the 3rd order neuron in the spinothalamic tract?

A

sensory cortex

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

what is the function of the lateral corticospinal tract?

A

descending voluntary movement of contralateral limbs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

where is the 1st order neuron in the lateral corticospinal tract?

A

UMN: cell body in 1° motor cortex→descends ipsilaterally (through internal capsule) until decussating at caudal medulla (pyramidal decussation)→descends contralaterally

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

where is synapse 1 in the lateral corticospinal tract?

A

cell body of anterior horn (spinal cord)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

what is the 2nd order neuron in lateral corticospinal tract?

A

LMN: leaves spinal cord

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

where is synapse 2 in the lateral corticospinal tract?

A

NMJ

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

when do you see weakness in motor neuron lesion?

A

UMN + • LMN+

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

when do you see atrophy in motor neuron lesion?

A

UMN - • LMN +

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

when do you see fasciculations in motor neuron lesion?

A

UMN - • LMN +

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

how do reflexes present in motor neuron lesion?

A

UMN ↑ • LMN ↓

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

how does tone present in motor neuron lesion?

A

UMN ↑ • LMN ↓

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

when do you see Babinski sign in motor neuron lesion?

A

UMN + • LMN -

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

when do you see spastic paralysis in motor neuron lesion?

A

UMN + • LMN -

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

when do you see flaccid paralysis in motor neuron lesion?

A

UMN - • LMN +

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

when do you see clasp knife spasticity in motor neuron lesion?

A

UMN + • LMN -

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

what do you see in lower motor neuron lesion?

A

everything lowered (less muscle mass, ↓ muscle tone, ↓ reflexes, down going toes)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

what do you see in upper motor neuron lesion?

A

everything up (tone, DTR, toes)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

What is the area of the spinal cord affected in poliomyelitis and Werdnig-Hoffman disease?

A

IMAGE pg 429

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

what are the characteristics of spinal cord lesions in poliomyelitis and Werdnig-Hoffman disease?

A

LMN lesions only, due to destruction of anterior horns; flaccid paralysis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

what area of the spinal cord is affected by Multiple Sclerosis?

A

IMAGE pg 429

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

what are the characteristics of the spinal cord lesions in multiple sclerosis?

A

mostly white matter of cervical region; random and asymmetric lesions, due to demyelination; scanning speech, intention tremor, nystagmus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

what areas of the spinal cord are affected in ALS?

A

IMAGE pg 429

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

what are the characteristics of spinal cord lesions in ALS?

A

combined UMN and LMN deficits with no sensory, cognitive, or oculomotor deficits; both UMN and LMN signs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

ALS can be caused by what?

A

defect in superoxide dismutase I

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

ALS commonly presents as what?

A

fasciculations with eventual atrophy; progressive and fatal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

what is the treatment for ALS?

A

Riluzole treatment modestly ↑ survival by ↓ presynaptic glutamate release

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

what area of the spinal cord is affected by complete occlusion of the anterior spinal artery?

A

IMAGE pg 429

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

what are the characteristics of spinal cord lesions caused by complete occlusion of the ASA?

A

spares dorsal columns and Lissauer’s tract

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

which territory of ASA is a watershed area?

A

upper thoracic territory is a watershed area, as artery of Adamkiewicz supplies ASA below T8

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

what area of the spinal cord is affected by tabes dorsalis?

A

IMAGE pg 429

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

tabes dorsalis is caused by what?

A

3° syphilis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

tabes dorsalis results from what?

A

degeneration (demyelination) of dorsal columns and roots

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

tabes dorsalis causes what?

A

impaired sensation and propioception and progressive sensory ataxia (inability to sense or feel the legs)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

tabes dorsalis is associated with what?

A

Charcot’s joints • shooting pain • Argyll robertson pupil

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

what is Argyll robertson pupil?

A

small bilateral pupils that further constrict to accommodation but not to light

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

in tabes dorsalis, exam will demonstrate what?

A

absence of DTRs and positive Romberg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

what area of the spinal cord is affected in syringomyelia?

A

IMAGE pg 429

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

what are the characteristics of the spinal cord lesion in syringomyelia?

A

syrinx expands and damages anterior white commissure of spinothalamic tract (2nd-order neurons) → bilateral loss of pain and temperature temperature sensation (usually C8-T1)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

syringomyelia is seen with what?

A

Chiari I malformation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

what area of the spine is affected by Vitamin B12 or Vitamin E deficiency?

A

IMAGE pg 429

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

what are the characteristics of the spinal lesion in Vitamin B12/E deficiencies?

A

subacute combined degeneration- demyelination of dorsal columns, lateral corticospinal tracts, and spinocerebellar tracts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

what are the symptoms caused by spinal cord lesions in VitB12/VitE deficiency?

A

ataxic gait • paresthesia • impaired position and vibration sense

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

poliomyelitis is caused by what?

A

poliovirus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

what is the transmission of poliovirus?

A

fecal-oral transmission

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

poliovirus replicates where?

A

in the oropharynx and small intestine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

how does poliovirus spread after replication in the oropharynx and small intestine?

A

by blood to CNS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

poliovirus infection causes what?

A

destruction of cells in anterior horn of spinal cord (LMN death)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

what are the LMN lesion signs of poliomyelitis?

A

weakness, hypotonia, flaccid paralysis, atrophy, fasciculations, hyporeflexia, and muscle atrophy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

what are the signs of infection of poliomyelitis?

A

malaise, HA, fever, nausea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

what are the findings in poliomyelitis?

A

CSF with ↑WBC with slight elevation of protein, no Δ in CSF glucose. virus recovered from stool or throat

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
85
Q

what is Werdnig-Hoffman disease?

A

Congenital degeneration of anterior horns of spinal cord → LMN lesion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
86
Q

what is the typical presentation of Werdnig-Hoffman syndrome?

A

‘floppy baby’ with marked hypotonia and tongue fasciculations

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
87
Q

what is the prognosis for Werdnig-Hoffman syndrome?

A

infantile type has median age of death of 7 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
88
Q

what is the inheritance of Werdnig-Hoffman syndrome?

A

autosomal recessive inheritance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
89
Q

what is Friedreich’s ataxia?

A

Autosomal-recessive trinucleotide repeat disorder (GAA) in gene that encodes frataxin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
90
Q

Friedreich’s ataxia leads to impairment in what?

A

mitochondrial functioning

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
91
Q

what are the symptoms of Friedreich’s ataxia?

A

staggering gait • frequent falling • nystagmus • dysarthria • pes cavus • hammer toes • hypertrophic cardiomyopathy (cause of death)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
92
Q

Friedreich’s ataxia presents how?

A

in childhood with kyphoscoliosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
93
Q

what is Brown-Sequard syndrome?

A

Hemisection of the spinal cord

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
94
Q

what are the findings in Brown-Sequard syndrome?

A
  1. Ipsilateral UMN signs below the level of the lesion • 2. Ipsilateral loss of tactile, vibration and propioception sense below the lesion • 3. contralateral pain and temperature loss below the level of the lesion • 4. Ipsilateral LMN signs at the level of the lesion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
95
Q

why are there ipsilateral UMN signs below the level of the lesion in Brown-Sequard?

A

due to corticospinal tract damage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
96
Q

why is there ipsilateral loss of tactile, vibration, propioception sense below the level of the lesion in Brown-Sequard syndrome?

A

dorsal column damage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
97
Q

why is there contralateral pain and temperature loss below the level of the lesion in Brown-Sequard syndrome?

A

spinothalamic tract damage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
98
Q

what happens in Brown-Sequard syndrome if the lesion occurs above T1?

A

patient may present with Horner’s syndrome due to damage of sympathetic ganglion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
99
Q

What causes Horner’s syndrome?

A

sympathectomy of face

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
100
Q

what are the symptoms of Horner’s syndrome?

A

Ptosis • Anhydrosis • Miosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
101
Q

Horner’s syndrome is associated with which conditions?

A

spinal cord lesion above T1: • Pancoast tumor • Brown-Sequard syndrome • late-stage syringomyelia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
102
Q

The 3-neuron oculosympathetic pathway pojects from where?

A

hypothalamus to the intermediolateral column of the spinal cord, then to the superior cervical (sympathetic) ganlgion, and finally to the pupil, the smooth muscle of the eyelids, and the sweat glands of the forehead and face

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
103
Q

interruption of which pathway causes horner’s syndrome?

A

3-neuron oculosympathetic pathway

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
104
Q

what is the sensory distribution of the C2 dermatome?

A

posterior half of a skull cap

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
105
Q

what is the sensory distribution of the C3 dermatome?

A

high turtleneck shirt

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
106
Q

what is the sensory distribution of the C4 dermatome?

A

low-collar shirt

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
107
Q

what is the sensory distribution of the T4 dermatome?

A

at the nipple

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
108
Q

what is the sensory distribution of the T7 dermatome?

A

at the xiphoid process

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
109
Q

what is the sensory distribution of the T10 dermatome?

A

at the umbilicus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
110
Q

why is the T10 dermatome important?

A

early appendicitis pain referral

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
111
Q

what is the sensory distribution of the L1 dermatome?

A

at the inguinal ligament

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
112
Q

what is the sensory distribution of the L4 dermatome?

A

includes the Kneecaps

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
113
Q

what is the sensory distribution of the S2,S3,S4 dermatomes?

A

erection and sensation of penile and anal zones

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
114
Q

diaphragm and gallbladder pain referred to the right shoulder via what?

A

phrenic nerve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
115
Q

biceps reflex = which nerve root?

A

C5

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
116
Q

Triceps reflex = which nerve root?

A

C7

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
117
Q

Patella reflex = which nerve root?

A

L4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
118
Q

Achilles reflex = which nerve root?

A

S1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
119
Q

what is the Babinski sign?

A

dorsiflexion of the big toe and fanning of other toes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
120
Q

Babinski reflex is a sign of what?

A

UMN lesion, but normal in 1st year of life

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
121
Q

what defines primitive reflexes?

A

CNS reflexes that are present in a healthy infant, but are absent in a neurologically intact adult

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
122
Q

when do primitive reflexes normally disappear?

A

within 1st year of life

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
123
Q

primitive reflexes are inhibited by what?

A

a mature/developing frontal lobe

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
124
Q

when can primitive reflexes reemerge in adults?

A

following frontal lobe lesions →loss f inhibition

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
125
Q

what is the Moro reflex?

A

hang on for life reflex- abduct extend limbs when startled, and then draw together

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
126
Q

what is the rooting reflex?

A

movement of head toward one side if cheek or mouth is stroked (nipple seeking)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
127
Q

what is the sucking reflex?

A

sucking response when roof of mouth is touched

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
128
Q

what is the palmar reflex?

A

curling of fingers if pam is stroked

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
129
Q

what is the plantar reflex?

A

dorsiflexion of large toe and fanning of other toes with plantar stimulation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
130
Q

what is the Galant reflex?

A

stroking along one side of the spine while newborn is in ventral suspension causes lateral flexion of lower body toward the stimulated side

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
131
Q

which cranial nerves lie medially at the brainstem?

A

III, VI, XII • Motor=Medial

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
132
Q

what is the function of the pineal gland?

A

melatonin secretion, circadian rhythms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
133
Q

what is the function of the superior colliculi?

A

conjugate vertical gaze center

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
134
Q

what is the function of the inferior colliculi?

A

auditory

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
135
Q

what is Parinaud syndrome?

A

paralysis of conjugate vertical gaze due to lesion in superior colliculi (e.g. pinealoma)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
136
Q

what is CNI?

A

olfactory nerve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
137
Q

what is the function of the olfactory nerve?

A

smell

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
138
Q

CNI is the onlt CN without what?

A

thalamic relay to cortex

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
139
Q

what is CNII?

A

optic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
140
Q

what is the function of CNII?

A

sight

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
141
Q

what is CNIII?

A

oculomotor nerve

142
Q

what is the function of CNIII?

A

eye movement (SR, IR, MR, IO), pupillary constriction, accommodation, eyelid opening (levator palpebrae)

143
Q

what is the pathway used by CNIII to affect pupillary constriction?

A

sphincter pupillae: Edinger-Westphal nucleus, muscarinic receptors

144
Q

what is CNIV?

A

trochlear nerve

145
Q

what is the function of CNIV?

A

eye movement (SO)

146
Q

what is CNV?

A

trigeminal nerve

147
Q

what is the function of CNV?

A

mastication, facial sensation, somatosensation from the anterior 2/3 of the tongue

148
Q

what are the divisions of facial sensation by branches of CNV?

A

ophthalmic • maxillary, • mandibular

149
Q

what is CNVI?

A

abducens nerve

150
Q

what is the function of abducens nerve?

A

eye movement (LR)

151
Q

what is CNVII?

A

Facial nerve

152
Q

what is the function of CNVII?

A

facial movement • taste from anterior 2/3 of tongue • lacrimation • salivation (submandibular and sublingual glands) • eyelid closing (orbicularis oculi) • stapedius muscle in ear

153
Q

which nerve crosses through the parotid gland but does not innervate it

A

facial

154
Q

what is CNVIII?

A

vestibulocochlear

155
Q

what is the function of CNVIII?

A

hearing, balance

156
Q

what is CNIX?

A

glossopharyngeal nerve

157
Q

what is the function of CNIX?

A

taste and somatosensation from posterior 1/3 of tongue • swallowing • salivation (parotid gland) • monitoring carotid body and sinus chemo and baroreceptors • stylopharyngeous (elevates pharynx and larynx)

158
Q

what is CNX?

A

Vagus

159
Q

what is the function of CNX?

A

Taste from epiglottic region • swallowing • palate elevation • midline uvula • talking • coughing • thoracoabdiminal viscera • monitoring aortic arch chemo and baroreceptors

160
Q

what is CNXI?

A

spinal accessory nerve

161
Q

what is the function of the spinal accessory nerve?

A

head turning, shoulder shrugging (SCM, trapezius)

162
Q

what is CNXII?

A

hypoglossal nerve

163
Q

what is the function of CNXII?

A

tongue movement

164
Q

CNI is what type?

A

sensory

165
Q

CNII is what type?

A

Sensory

166
Q

CNIII is what type?

A

motor

167
Q

CNIV is what type?

A

motor

168
Q

CNV is what type?

A

Both

169
Q

CNVI is what type?

A

motor

170
Q

CNVII is what type?

A

both

171
Q

CNVIII is what type?

A

sensory

172
Q

CNIX is what type?

A

both

173
Q

CNX is what type?

A

both

174
Q

CNXI is what type?

A

motor

175
Q

CNXII is what type?

A

motor

176
Q

where are cranial nerve nuclei located?

A

tegmentum portion of brain stem between dorsal and ventral portions

177
Q

Midbrain contains the nuclei of which cranial nerves?

A

CN III • CN IV

178
Q

pons contains the nuclei of which cranial nerves?

A

CN V, VI, VII, VIII

179
Q

medulla contains the nuclei of which cranial nerves?

A

CN IX, X, XII

180
Q

spinal cord contains the nuclei of which cranial nerves?

A

XI

181
Q

Lateral nuclei=

A

Sensory (aLar plate)

182
Q

Medial Nuclei=

A

motor (basal plate)

183
Q

what separates the medial and lateral cranial nerve nuclei

A

sulcus limitans

184
Q

what is the afferent branch of the Corneal reflex?

A

V1 ophthalmic (nasociliary branch)

185
Q

what is the efferent branch of the corneal reflex?

A

VII (temporal branch; orbicularis oculi)

186
Q

what is the afferent branch of the lacrimation reflex?

A

V1 (loss of reflex does not preclude emotional tears)

187
Q

what is the efferent branch of the lacrimation reflex?

A

VII

188
Q

what is the afferent branch of the jaw jerk reflex?

A

V3 (sensory- muscle spindle from masseter)

189
Q

what is the efferent branch of the jaw jerk reflex?

A

V3 (motor- masseter)

190
Q

what is the afferent branch of the pupillary reflex?

A

CNII

191
Q

what is the efferent branch of the pupillary reflex?

A

CNIII

192
Q

what is the afferent branch of the gag reflex?

A

CNIX

193
Q

what is the efferent branch of the gag reflex?

A

CNX

194
Q

what are the 3 vagal nuclei?

A

Nucleus Solitarius • Nucleus aMbiguus • Dorsal motor nucleus

195
Q

function of nucleus solitarius?

A

Visceral Sensory information (taste, baroreceptors, gut distention)

196
Q

which CN synapse on neurons in the nucleus solitarius?

A

VII • IX • X

197
Q

function of nucleus ambiguus?

A

Motor innervation of pharynx, larynx, and upper esophagus (swallowing, palate, elevation)

198
Q

which CN synapse on neurons in the Nucleus Ambiguus?

A

IX • X

199
Q

function of the motor nucleus?

A

sends autonomic (parasympathetic) fibers to heart, lungs, and upper GI

200
Q

which CN synapse on dorsal motor nucleus?

A

X

201
Q

CN I traverses what pathway?

A

Cribriform plate

202
Q

which cranial nerves traverse the middle cranial fossa through the sphenoid bone?

A

CN II-VI

203
Q

which structures traverse the optic canal?

A

CNII • ophthalmic artery • central retinal vein

204
Q

which structures traverse the superior orbital fissure?

A

CN III, IV, V1, VI, ophthalmic vein, sympathetic fibers

205
Q

which structures traverse the foramen rotundum?

A

CNV2

206
Q

which structures traverse the foramen ovale?

A

CNV3

207
Q

which structures traverse the foramen spinosum?

A

middle meningeal artery

208
Q

Which cranial nerves traverse the posterior cranial fossa through the temporal or occipital bone?

A

CN VII- XII

209
Q

which cranial nerves traverse the internal auditory meatus?

A

CNVII, VIII

210
Q

which structures traverse the jugular foramen?

A

CNIX, X, XI jugular vein

211
Q

which structures traverse the hypoglossal canal?

A

CNXII

212
Q

which structures traverse the foramen magnum?

A

spinal roots of CN XI, brain stem, vertebral arteries

213
Q

what is the cavernous sinus?

A

a collection of venous sinuses on either side of the pituitary

214
Q

which drainage pathway goes through the cavernous sinus?

A

blood from the eye and superficial cortex → cavernous sinus → internal jugular vein

215
Q

which structures pass through the cavernous sinus?

A

CNIII, IV, V1, V2 and VI and postganglionic sympathetic fibers en route to the orbit • + cavernous portion of internal carotid artery

216
Q

what can cause cavernous sinus syndrome?

A

mass effect, fistula, thrombosis

217
Q

what are the clinical features of cavernous sinus syndrome?

A

ophthalmoplegia and ↓ corneal and maxillary sensation with normal vision

218
Q

what is the clinical presentation of a CN V motor lesion?

A

Jaw deviates toward side of lesion due to unopposed force from opposite pterygoid muscle

219
Q

what is the common clinical presentation of a CN X lesion?

A

Uvula deviates away from side of lesion. Weak side collapses and uvula points away

220
Q

what is the clinical presentation of a CN XI lesion?

A

weakness turning head to contralateral side of lesion. shoulder droop on side of lesion • left SCM contracts to help turn head to the right

221
Q

what is the clinical presentation of a CN XII (LMN) lesion?

A

tongue deviates toward side of lesion (lick your wounds) due to weakened tongue muscles on the affected side

222
Q

what are the diagnostic features of conductive hearing loss?

A

Rinne test= abnormal (bone > air) • Weber= localizes to affected ear

223
Q

what are the diagnostic features of sensorineural hearing loss?

A

Rinne= normal (air>bone) • Weber= localizes to unaffected ear

224
Q

sudden extreme loud noises can produce hearing loss due to what?

A

tympanic membrane rupture

225
Q

what causes noise induced hearing loss that begins with high frequency hearing loss?

A

damage to stereociliated cells in organ of corti

226
Q

what is the cause of an UMN facial lesion?

A

lesion of motor cortex or connection between cortex and facial nucleus

227
Q

what are the symptoms of UMN facial lesions?

A

contralateral paralysis of lower face; forehead spared due to bilateral UMN innervation

228
Q

what are the symptoms of LMN facial lesions?

A

Ipsilateral paralysis of upper and lower face

229
Q

what causes facial nerve palsy?

A

complete destruction of the facial nucleus itself or its branchial efferent fibers (facial nerve proper)

230
Q

what are the symptoms of facial nerve palsy?

A

peripheral ipsilateral facial paralysis with inability to close eye on involved side

231
Q

what is the prognosis for idiopathic facial nerve palsy?

A

gradual recovery in most cases

232
Q

facial nerve palsy is seen as a complication in what?

A

AIDS • lyme disease • herpes simplex • [less common] herpes zoster • sarcoidosis • tumors • diabetes

233
Q

what is idiopathic facial nerve palsy called?

A

Bell’s palsy

234
Q

what 3 muscles close the jaw?

A

Masseter • teMporalis • Medial pterygoid • M’s Munch

235
Q

what is the muscle that opens the jaw?

A

Lateral pterygoid • Lateral Lowers

236
Q

the muscles of mastication are innervated by what?

A

CN V3

237
Q

the ciliary body comprises which structures?

A

ciliary muscle • ciliary process

238
Q

what are the fluid filled spaces in the anterior segment of the eye?

A

anterior chamber • posterior chamber

239
Q

what is the fluid filled space in the posterior segment of the eye?

A

vitreous chamber

240
Q

refractive errors are characterized by what?

A

impaired vision that improves with glasses

241
Q

what happens in hyperopia?

A

eye too short for refractive power of cornea and lens → light focused behind retina

242
Q

what happens in myopia?

A

eye to long for refractive power of cornea and lens → light focused in front of the retina

243
Q

what happens in astigmatism?

A

abnormal curvature of cornea resulting in different refractive power at different axes

244
Q

what happens in accommodation?

A

focusing on near objects → ciliary muscles tighten → zonular fibers relax → lens becomes more convex

245
Q

accommodation occurs with what?

A

convergence and miosis

246
Q

what happens in presbyopia?

A

↓ change in focusing ability during accommodation due to sclerosis and decreased elasticity

247
Q

what is uveitis?

A

inflammation of the uveal coat

248
Q

uveal coat consists of what?

A

iris, ciliary body, choroid

249
Q

uveitis is often associated with what?

A

systemic inflammatory disorder: • sarcoid • RA • juvenile idiopathic arthritis • TB • HLA-B27

250
Q

what is retinitis?

A

retinal edema and necrosis leading to scar

251
Q

cause of retinitis is often what?

A

viral: • CMV • HSV • HZV

252
Q

retinitis is associated with what?

A

immunosuppression

253
Q

clinical features of central retinal artery occlusion?

A

acute, painless monocular vision loss • retina whitening with cherry red spot

254
Q

function of the canal of Schlemm?

A

collects aqueous humor from trabecular meshwork

255
Q

function of trabecular meshwork?

A

collects aqueous humor that flows through anterior chamber

256
Q

function of ciliary epithelium?

A

produces aqueous humor

257
Q

receptor type on ciliary muscle?

A

M

258
Q

receptor type on Ciliary epithelium?

A

β

259
Q

receptor type on eye sphincter?

A

M3

260
Q

receptor type on eye dilator muscle?

A

α1

261
Q

glaucoma is characterized by what?

A

optic neuropathy, usually with ↑ intraocular pressure • painless

262
Q

open/wide angle glaucoma is characterized by what?

A

peripheral then central vision loss usually with ↑ IOP; • optic disc atrophy with cupping

263
Q

open/wide angle glaucoma is associated with what?

A

↑age • African American • family Hx • ↑IOP

264
Q

open angle glaucoma is more common where?

A

USA

265
Q

what causes open angle glaucoma?

A

1° cause unclear • 2° causes: • uveitis • trauma • corticosteroids • vasoproliferative retinopathy that can block or ↓ outflow at the trabecular meshwork

266
Q

what happens in closed/narrow angle glaucoma?

A

enlargement or forward movement of lens against central iris leads to obstruction of normal aqueous flow through pupil → fluid builds up behind iris, pushing peripheral iris against cornea and impeding flow through the trabecular meshwork

267
Q

features of closed angle glaucoma with chronic closure?

A

often asymptomatic with damage to optic nerve and peripheral vision

268
Q

which type of glaucoma is an ophthalmic emergency?

A

closed angle with acute closure

269
Q

what happens in closed angle glaucoma with acute closure?

A

↑ IOP pushes iris forward → angle closes abruptly

270
Q

clinical features of closed angle glaucoma with acute closure?

A

very painful • sudden vision loss • halos around lights • rock hard eye • frontal headache

271
Q

what is contraindicated in the treatment of closed angle glaucoma with acute closure?

A

epinephrine because of its mydriatic effect

272
Q

what are cataracts?

A

painless, often bilateral, opacification of lens → ↓ in vision

273
Q

what are the risk factors for cataracts?

A

age • smoking • EtOH • excessive sunlight • prolonged corticosteroid use • classic galactosemia • galactokinase deficiency • diabetes (sorbitol) • trauma • infection

274
Q

what is papilledema?

A

optic disc swelling (usually bilateral) due to ↑ ICP (2° to mass effect)

275
Q

fundoscopic findings in papilledema?

A

enlarged blind spot and elevated optic disc with blurred margins

276
Q

which cranial nerves innervate extraocular muscles?

A

CN VI → Lateral Rectus • CN IV → Superior Oblique • CN III → the rest • LR6SO4R3

277
Q

action of superior oblique muscle?

A

abducts, intorts, and depresses while adducted

278
Q

what happens in CNIII damage?

A

eye looks down and out; ptosis, pupillary dilation, loss of accommodation

279
Q

what happens in CN IV damage?

A

eye moves upward, particularly with contralateral gaze and ipsilateral head tilt • (problems going down stairs)

280
Q

what happens in CN VI damage?

A

medially directed eye that cannot abduct

281
Q

how do you test Superior rectus?

A

look up and out (temporal)

282
Q

how do you test lateral rectus?

A

look straight out to the side (temporal)

283
Q

how do you test inferior rectus?

A

look down and out

284
Q

how do you test superior oblique?

A

look down and in

285
Q

how do you test medial rectus?

A

look straight in (nasal)

286
Q

how do you test inferior oblique?

A

look up and in

287
Q

what is pupillary miosis?

A

constriction, parasympathetic

288
Q

what are the neurons in the control of miosis?

A

1st: Edinger-Westphal nucleus to ciliary ganglion via CN III • 2nd: short ciliary nerves to pupillary sphincter muscles

289
Q

what is mydriasis?

A

dilation, sympathetic

290
Q

what are the neurons in the control of mydriasis?

A

1st: hypothalamus to ciliospinal center of Budge (C8-T2) • 2nd: exit at T1 to superior cervical ganglion (travels along cervical sympathetic chain near lung apex, subclavian vessels) • 3rd: plexus along internal carotid, through cavernous sinus; enters as long ciliary nerve to pupillary dilator muscle

291
Q

what is the circuit activated in the pupillary light reflex?

A

light in either retina sends a signal via CN II to pretectal nuclei in midbrain that activate bilateral Edinger-Westphal nuclei; pupils contract bilaterally

292
Q

what is the result of the pupillary light reflex?

A

illumination of 1 eye results in bilateral pupillary constriction

293
Q

what is Marcus Gunn pupil?

A

afferent pupillary defect ( due to optic nerve damage or retinal detachment)

294
Q

findings in Marcus Gunn pupil?

A

↓ bilateral pupillary constriction when light is shone in affected eye relative to unaffected eye

295
Q

what are the 2 components of CN III?

A

motor = central • parasympathetic = peripheral

296
Q

center of CNIII does what?

A

motor output to ocular muscles

297
Q

center of CNIII is affected primarily by what?

A

vascular disease: • ↓diffusion of oxygen and nutrients to the interior fibers from compromised vasculature that resides on outside of nerve

298
Q

signs of center of CNIII compromise?

A

ptosis + down and out gaze

299
Q

peripheral fibers of CNIII are first affected by what?

A

compression: • posterior communicating artery aneurysm • uncal herniation

300
Q

what are the signs of compression of peripheral fibers of CN III?

A

diminished or absent pupillary light reflex • “blown pupil”

301
Q

what happens in retinal detachment?

A

separation of neurosensory layer of retina (photoreceptor layer with rods and cones) from outermost pigmented epithelium (normally shields excess light, supports retina)→degeneration of photoreceptors → vision loss

302
Q

retinal detachment may be due to what?

A

retinal breaks • diabetic traction • inflammatory effusion

303
Q

retinal breaks are more common in whom?

A

pts w/ high myopia

304
Q

retinal breaks are often preceded by what?

A

posterior vitreous detachment (flashes and floaters) and eventual monocular vision loss “curtain drawn down”

305
Q

which cause of retinal detachment presents as a surgical emergency?

A

retinal break

306
Q

what is age-related macular degeneration?

A

degeneration of central area of retina

307
Q

age related macular degeneration causes what?

A

distortion (metamorphopsia) and eventual loss of central vision (scotomas)

308
Q

what is the more common subtype of age related macular degeneration?

A

dry, nonexudative >80%

309
Q

dry ARMD is characterized by what?

A

deposition of yellowish extracellular material beneath retinal pigment epithelium (“drusen”) with gradual ↓ in vision

310
Q

prevent progression of dry ARMD with what?

A

multivitamin and antioxidant supplements

311
Q

what is the less common subtype of ARMD?

A

wet, exudative 10-15%

312
Q

wet ARMD is characterized by what?

A

rapid loss of vision due to bleeding secondary to choroidal neovascularization

313
Q

what is the treatment for wet ARMD?

A

anti-VEGF injections or laser

314
Q

what causes unilateral anopia?

A

cut optic nerve

315
Q

what cause bitemporal hemianopia?

A

lesion of optic chiasm

316
Q

what causes homonymous hemianopia?

A

lesion of optic tract

317
Q

what causes left upper quadrantic anopia?

A

right temporal lesion (meyers loop) • MCA

318
Q

what causes left lower quadrantic anopia?

A

right parietal lesion (dorsal optic radiation) • MCA

319
Q

what causes homonymous hemianopia with macular sparing?

A

PCA infarct

320
Q

what causes central scotoma?

A

macular degeneration

321
Q

path of meyers loop?

A

inferior retina; loops around inferior horn of lateral ventricle

322
Q

path of dorsal optic radiation?

A

superior retina; takes shortest path via internal capsule

323
Q

what is the medial longitudinal fasciculus?

A

pair of tracts that allows for crosstalk between CN VI and CNIII nuclei

324
Q

MLF coordinates what?

A

both eyes to move in same horizontal direction

325
Q

how much myelin in MLF?

A

highly myelinated

326
Q

MLF lesions seen in which patients?

A

demyelination: MS

327
Q

lesion in MLF causes what?

A

INO= internuclear ophthalmoplegia

328
Q

what happens in INO?

A

lack of communication such that when CNVI nucleus activates ipsilateral lateral rectus, contralateral CN III nucleus does not stimulate medial rectus to fire

329
Q

what happens to abducting eye in INO?

A

nystagmus (CN VI overfires to stimulate CN III)

330
Q

how is convergence in INO?

A

normal

331
Q

what is dementia?

A

↓ in cognitive ability, memory, or function with intact consciousness

332
Q

What are the causes of dementia?

A

AD • Pick’s disease • Lewy body dementia • CJD • Multi-infarct • Syphilis • HIV • Vit B1/B3/B12 deficiency • NPH

333
Q

what is the most common cause of dementia in the elderly?

A

Alzheimer’s disease

334
Q

what is the second most common cause of dementia in the elderly?

A

Multi-infarct

335
Q

who has an ↑ risk of developing Alzheimer’s?

A

Down syndrome patients

336
Q

what is the frequency of familial form Alzheimer’s?

A

10%

337
Q

Early onset Alzheimer’s is associated with which proteins on which chromosomes?

A

APP (21) • presenilin-1 (14) • presenilin-2 (1)

338
Q

late onset familial Alzheimers is associated with which protein on which chromosome?

A

ApoE4 (19)

339
Q

which protein on which chromosome is protective against Alzheimer’s?

A

ApoE2 (19)

340
Q

what are the histologic/gross findings in AD?

A
  1. Widespread cortical atrophy • 2. ↓ ACh • 3. Senile plaques • 4. Neurofibrillary tangles
341
Q

What are the features of senile plaques in AD?

A

extracellular β-amyloid core • may cause amyloid angiopathy → intracranial hemorrhage

342
Q

how is Aβ synthesized?

A

cleaving amyloid precursor protein

343
Q

features of neurofibrillary tangles in AD?

A

intracellular, abnormally phosphorylated tau protein= insoluble cytoskeletal elements

344
Q

tangles in AD correlate with what?

A

degree of dementia

345
Q

clinical presentation of Pick’s disease?

A

dementia, aphasia, parkinsonian aspects; • change in personality

346
Q

what structures are spared in Pick’s disease?

A

parietal lobe and posterior 2/3 of superior temporal gyrus

347
Q

other name for Pick’s disease?

A

frontotemporal dementia

348
Q

histologic/gross findings in Pick’s disease?

A

Pick Bodies: spherical tau protein aggregates • Frontotemporal atrophy

349
Q

clinical features of Lewy body dementia?

A

Parkinsonism with dementia and hallucinations

350
Q

histologic/gross findings in Lewy body dementia?

A

α-synuclein defect

► Med Notes (62 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions