review Flashcards
In order to withdraw cerebrospinal fluid (CSF) from the lumbar cistern (to perform a lumbar puncture), a needle tip must pass successively through the…
… epidural space, dura mater, subdural space, and arachnoid membrane
The blood-brain barrier is created by which of the following cellular barriers?
Astrocyte tight junctions
Choroid epithelium tight junctions
Pia Mater
Capillary endothelial tight junctions
Capillary endothelial tight junctions
A 54-year-old man presents complaining of weakness. He has a difficult time pinpointing an onset. He believes he first noticed weakness in his right foot and leg about 6 months ago. He reports that he frequently trips over his toes and drags his foot. He also gets frequent cramps when he stretches in bed in the mornings. The weakness is progressing to involve both legs now. On examination, you note tongue fasciculations. Deep tendon reflexes are 3+ at the knees and ankles. Strength is 4– at the extensors and flexors of the right foot and 4+ at the left foot. Hand grip strength is also 4+. Which of the following is the suspected pathologic cause of this patient’s symptoms?
A. Degeneration of the corticospinal tracts
B. Demyelinating plaques
C. Loss of anterior horn cells in the spinal cord
D. Loss of large pyramidal cells in the precentral gyrus
E. Lymphocytic infiltrate of spinal roots and nerves
F. A and C
A. Degeneration of the corticospinal tracts
C. Loss of anterior horn cells in the spinal cord
Amyotrophic lateral sclerosis (ALS): classic findings of both upper and lower motor neuron disease in ALS. The most common presenting symptom in ALS is asymmetric weakness of insidious onset, which is most prominent in the lower extremities. Muscle wasting and atrophy may be prominent. cramping with volitional movements, such as stretching, that is most common in the early morning hours. Fasciculations may be identified. Bulbar symptoms include difficulty with chewing, swallowing, and movements of the face and tongue. Upper motor neuron symptoms may lead to spasticity with increased deep tendon reflexes.
A 45-year-old, previously healthy man has developed headaches over the past month. There are no remarkable findings on physical examination. A cerebral MR angiogram shows a 7-mm saccular aneurysm at the trifurcation of the right middle cerebral artery. Which of the following is the most likely complication from this lesion?
Cerebellar tonsillar herniation
Hydrocephalus
Epidural hematoma
Subarachnoid hemorrhage
Subdural hematoma
Subarachnoid hemorrhage
Rupture occurs into the subarachnoid space at the base of the brain, where the cerebral arterial distribution originates around the circle of Willis, and where saccular aneurysms are most likely to arise.
[Epidural hematomas arise from a tear of the middle meningeal artery, typically as a result of head trauma. Trauma also can cause a tear of bridging veins that produces a subdural hematoma.]
Information about blood gas levels is transmitted to the CNS via…
the glossopharyngeal nerve.
A patient has right-sided hypotonia and dysdiodochokinesia affecting the right arm and leg. A lesion in which of the following areas is most likely to produce these symptoms?
The left flocullonodular lobe
The right flocullonodular lobe
The vermis
The left cerebellar hemisphere
The right cerebellar hemisphere
The right cerebellar hemisphere
A patient presents with a wide, ataxic, and unsteady gait. A tumor was detected from an MRI scan. The tumor affected most profoundly which of the following structures?
Dentate nucleus of the cerebellum
Interposed nucleus of the cerebellum
Red nucleus
Fastigial nucleus of the cerebellum
Middle cerebellar peduncle
Fastigial nucleus of the cerebellum: receives direct fibers from the vermal region of cerebellum and in turn, projects to the vestibular nuclei and reticular formation
Age-related macular degeneration, or AMD, can be detected by means of…
Amsler grid: simple square containing a grid pattern and a dot in the middle. can show problem spots in your field of vision. For someone with AMD, an Amsler grid may appear to have wavy lines or blank spots.
which type of age-related macular degeneration does this describe?
a. can result in loss of the retinal pigment epithelium function
b. can be treated by anti-VEGF therapy
can result in loss of the retinal pigment epithelium function = dry AMD
can be treated by anti-VEGF therapy = wet AMD
A 65-year-old person complains of “seeing wavy lines” or “window blinds” when looking at the doorway with the right eye. The person has no pain or other ocular symptoms. Past medical history incudes hypertension and a 40-pack-year smoking history. On examination, visual acuity is 20/400 in the right eye. There is no RAPD and slit-lamp examination reveals that his anterior segment is normal. Examination of his right fundus reveals a subretinal hemorrhage involving his fovea.
What is the most likely diagnosis?
typical presentation of age-related macular degeneration (AMD)
Dry AMD is the non-neovascular form of AMD. It is characterized by drusen (yellow-white lesions in the outer retinal layers of the macula) or atrophy within the macula. Dry AMD may lead to wet (neovascular) AMD, which is associated with a choroidal neovascular membrane (CNVM). The CNVM is an abnormal growth of subretinal blood vessels, which grows in the macula or fovea and affects vision due to fluid leakage.
A 55-year-old male complains of a gradual decrease in vision in both eyes. He notes glare with oncoming headlights while night driving. Despite this, he feels that he is able to read better without his bifocals.
Based on the history given, which of the following is the most likely cause of this patient’s complaints?
A. Retinal detachment
B. Cataracts
C. Glaucoma
D. Diabetic retinopathy
E. Presbyopia
B. Cataracts
Progressive visual loss and glare from oncoming headlights while driving at night are common complaints caused by cataracts.
what are the classic symptoms of retinal detachment? (3)
- flashing lights
- visual field disruption
- floaters
majority of vision will remain intact
A 41-year-old man is brought to the Emergency Department after an accident at a construction site. The examination reveals a weakness (hemiplegia) and a loss of vibratory sensation and discriminative touch all on the left lower extremity, and a loss of pain and thermal sensations on the right lower extremity. CT shows a fracture of the vertebral column adjacent to the T8 level of the spinal cord.
Damage to which fiber bundle or tract would most likely explain the (A) loss of vibratory sensation AND (B) loss of pain and thermal sensation in this man (INCLUDE SIDE)?
a. loss of L vibratory sensation = damage to LEFT gracile fasciculus (ipsilateral tract)
b. loss of R pain/temp = damage to LEFT anterolateral system
A 27-year-old man was involved in a street brawl, and during the fight, he was stabbed in the back. He lost consciousness and was rushed to the emergency department of a local hospital. After regaining consciousness, the patient received a neurologic examination. The patient indicated to the neurologist that he could not feel any pricks of a safety pin when tested along a band approximately 4 cm wide, which included both sides of his back. The patient was able to recognize tactile stimulation when tested on his arms and legs of both sides of the body as well as on the back or chest. Motor functions appeared to be intact. The neurologist concluded that the patient had damage of the:
Substantia Gelatinosa
Dorsal Root Ganglion bilaterally
The region surrounding the central canal
The lateral funiculus of the lumbar and thoracic cord
The dorsal columns of the thoracic cord, bilaterally
The region surrounding the central canal
Bilateral segmental loss of pain is the result of damage to the region surrounding the central canal of the spinal cord. This is due to damage to the crossing fibers of the lateral spinothalamic tracts (on each side) at a specific level of the cord.
[Dorsal column lesions would not affect the pathways mediating pain but instead would affect conscious proprioception]
what is the function and location of the Substantia Gelatinosa
substantia gelatinosa is a collection of cells in the gray area (dorsal horns) of the spinal cord. Found at all levels of the cord, it receives direct input from the dorsal (sensory) nerve roots, especially those fibers from pain and thermoreceptors.
Superior cerebellar peduncles carries information from the dentate nucleus to the
Thalamic VL nucleus and red nucleus on the contralateral side
Nine year old child is seen in hospital by a neurologist. The child was hospitalized with fever and lethargic. Neurological exam showed left Sided hemiparesis, difficulty with speech and extensor plan to reflexes. Parents report patient had flu the previous week. MRI reveals areas of abnormal signal suggested of multifocal inflammation throughout the white and gray merit matter. Blood test for Lyme and anti-aquaporin4 antibodies are negative. She is diagnosed with a disease that mimics MS. What is the most likely diagnosis?
Acute disseminated encephalomyelitis (ADEM)
[anti-aquaporin 4 antibodies = neuromyelitis optica]
26-year-old patient visits neurologist after being referred by internist. Patient developed muscle weakness in both legs over last week and reports tripping over their legs and feeling clumsy while walking. No reported previous significant illnesses other than upper respiratory infection three weeks prior. Neurological exam shows depressed Achilles and patellar deep tendon reflexes, but normal reflexes in upper arms. Reduced motor conduction velocity along the nerves supplying the lower limb muscles. Sensory tests were normal. Which of the following is more likely?
A. Post polio syndrome.
B. Guillain-Barré.
B. Guillain-Barré - classic signs are distal symmetric motor loss which ascends, following infection
Post polio would include history of polio
Sensation of vibration in feet is carried by [medial/lateral] dorsal column
Medial dorsal column carries lower extremity vibration/proprioception in the fasciculus gracilis to nucleus gracilis
Which of the following receptors detect vibration?
A. Meissner’s corpuscles
B. Pacinian corpuscles
C. Golgi tendon organs
D. Merkel’s discs
E. Ruffini corpuscles
B. Pacinian corpuscles - in deep dermis
How are inner hair cells organized along the basilar membrane to detect various frequencies?
High frequency/pitch inner hair cells are at the base
Low frequency/pitch inner hair cells are at the apex
Brainstem slice shows inferior olivery nuclei and 4th ventricle - what level is it showing?
Rostral (upper) medulla
The ____ nucelus receives taste input from CN VII, IX, and X
nucleus solitarius
According to gate theory of pain, shaking your hand reduces pain sensation following injury because:
A. A-beta fibers inhibit dorsal projection neurons via interneurons
B. Descending projections from raphe nuclei inhibit C fibers
C. A-delta fibers inhibit C fibers
A. A-beta fibers inhibit dorsal projection neurons via interneurons
Large, myelinated mechanosensitive afferents (A-beta) send collateral branches in dorsal horn to synapse onto interneurons before A-beta fibers ascend in dorsal column
These interneurons send inhibitory signals to 2nd order projection neurons in spinothalamic tract