Week 6

Question 0

2 types of declarative memory

Answer 0

• episodic memory - recalls events

- semantic memory - recalls facts/information

Question 1

Guideline for Dementia Eval

Answer 1

• General cognitive Screen - MMSE
• depression screen
• structural imaging - rule out structural causes
• labs: CBC, CMP, LFT, TSH, B12
• special: RPR, FDG-PET, genetic testing

Question 2

procedural memory
working memory
prospective memory

Answer 2

procedural memory: unconsciously learned skills
working memory: manipulation of information
prospective memory: remembering to remember

Question 3

which lobe is being tested in the following assessments?
List learning (MMSE)
Copy (visual memory)
recall later (visual memory)

Answer 3

List learning (MMSE) - dominant medial temporal lobe
Copy (visual memory) - biparietal lobes
recall later (visual memory - non-dominant medial temporal lobe

Question 4

Frontal lobe function tests

Answer 4

Preservation: mnmnmnmnmn
set shifting - Trails: 1 Sunday 2 Saturday….
response inhibition - Stroop: colored words
Phonemic Fluency: F-word in 60 secs quality vs quantity

Question 5

Deferential Dx of Dementia

Answer 5

VITAMINS C D
vascular, infection, trauma, autoimmune, metabolic/toxic, inflammation, neoplastic, seizure, congenital/developmental (inherited), degenerative

Question 6

What are the 2 components of Nystagmus

Answer 6

smooth pursuit
saccade

*nystagmus is described in terms of the direction of saccade

Question 7

What are the accessory oculomotor nuclei and their functions

Answer 7

riMLF - integrator for vertical saccade
INC
PPRF - integrator for horizontal saccade
pretectal area

Question 8

All the inputs to VNC

Answer 8

vestibular input:
crista (semicircular canals) terminate in S, MVN
maculae (sacculus and utriculus) terminate in LVN

spinovestibular input:
from all level of spinal cord - proprioreceptive input

cerebellar input:
vestibulocerebellum(floccular node) –> FN –> VNC –> VST
spinocerebellum (vermis) –> fastigial nucleus –> VNC–> ReSt, VST
from bilateral fastigial via juxarestiform body

accessary oculomotor input:
from visual cortical areas via accessary oculomotor nuclei

Question 9

Cortical area that have voluntary saccade control

Answer 9

dorsolateral prefrontal cortex
FEF
posterior parietal cortex

Question 10

Cortical area that can smooth tracking moving objects

Answer 10

temporal eye field

occipital cortex

Question 11

voluntary saccade scheme

Answer 11

PPC, FEF –> superior colliculus –> PPRF –> VI –> III

Question 12

vestibulo-thalamo-cortical tract

Answer 12

cortical perception of movement (3a, 2b)

Question 13

peripheral vs central lesion on vestibular

Answer 13

peripheral lesion:
CN VIII, unilateral peripheral lesion: vertigo, nausea, unsteadiness ( fall towards the side of lesion, nystagmus opposite to lesion

central lesion:
VNC lesion, absent vertigo, Romberg (fall away from lesion), nystagmus towards lesion

Question 14

Saturday night palsy

Answer 14

• schwann cells are damaged in area of compression
• AP can’t propagate across compression site: conduction block - neuropraxia!
• requires several hours of compression
• recover by local dismantling and rebuilding of myelin sheath

Question 15

Wallerian degeneration

Answer 15

• cell body swells & RNA synthesis increases
• immediate failure of AP, but delayed loss of distal responsiveness
• myelin degeneration and axonal atrophy in 5 days
• axonotmesis/ neurotmesis

Question 16

aberrant reinnervation

Answer 16

some axons end at different destination than original during reinnervation of surviving axons

Question 17

How to fix denervation

Answer 17

• regeneration of injured axon

- sprouting : reinnervation

Question 18

Neuropathy

Answer 18

dysfunction in motor, sensory or autonomic function alone

Question 19

Define radicle

Answer 19

radicle = dorsal and ventral roots + spinal nerve

Question 20

radiculopathy

Answer 20

nerve becomes compressed in the spinal foramen by

• herniated nucleus pulposus (soft disc)
• osteophyte (hard disc)

Question 21

Radiculopathy

Answer 21

Sx corresponds to myotome/ dermatome/ sclerotome of compressed nerve

Question 22

2 types of plexopathy

Answer 22

• brachial
• lumbosacral
• pattern of involvement in a limb > individual nerve/root lesion

Question 23

Mononeuropathy

Answer 23

abnormality of individual peripheral nerve

• can be compression/ trauma
• e.g. bell’s palsy, carpal tunnel syndrome, cubital syndrome….

Question 24

Polyneuropathy

Answer 24

• bilateral, symmetric pattern
• do not correspond to a single nerve/root
• **distal segments involved initially –> move proximal if condition worsens
• reduced/absent of muscle stretch reflex
• metabolic/toxin/autoimmune/hereditary/idiopathic

Question 25

basic component of peripheral motor system

Answer 25

motor unit = neuron, axon, terminal branches, NMJs, muscle fibers

Question 26

CMAP vs MUAP

Answer 26

MUAP is the building block of recorded response

CMAP is the summation of MUAP - M wave

Question 27

patterns of abnormality of EMG on demyelinating vs axonal /motor neuron lesion

Answer 27

demyelinating: very slow conduction

axonal/ motor: mildly slow conduction

Question 28

parameters of voluntary motor unit potential (MUP) - summated activity of muscle fibers in one motor unit

Answer 28

size (amplitude & duration)
configuration
stability
firing rate (recruitment)

Question 29

2 abnormalities findings during rest activity in needle EMG

Answer 29

• positive waves & fibrillation potentials - axon to muscle fiber is damaged
• Fasciculation potential - can be normal/ abnormal

Question 30

MUP of early vs late reinnervation

Answer 30

early (2-6 months): polyphasic

late (1-2 years): large & rapid firing

Question 31

An estimate of heritability

Answer 31

H^2 = 2( C_mz - C_dz)

Question 32

Genes of MS

Answer 32

HLA - A
HLA DRB1
HLA DWB1
HLA DRA