2. Neuro Flashcards Preview

Step 1 DIT > 2. Neuro > Flashcards

Flashcards in 2. Neuro Deck (131):
1

What abnormalities are often found with a Chiari malformation?

Type 1: cerebellar tonsil herniates down; syringomyelia

Type 2: lumbosacral myelomeningocele, hydrocephaly

2

What are the classic presenting sxs of a syringomyelia? (2)

- capelike dist. loss of p/t in upper extremities
- hand weakness + atrophy

3

What amniotic fluid lab abnormalities might point you to a diagnosis of anencephaly?

increased AFP (in mom's serum and amniotic fluid)

4

From which branchial pouch are each of the following structures derived?

a. middle ear and eustachian tubes
b. superior parathyroid
c. inferior parathyroids
d. epithelial lining of the palatine tonsil
e. thymus

a. 1st pouch
b. 4th pouch
c. 3rd pouch
d. 2nd pouch
e. 3rd pouch

5

Which nervous system cell looks like fried eggs under histo staining?

oligodendrocytes

6

Which nervous system cell forms multinucleated giant cells in the CNS when infected with HIV?

microglia

7

Which nervous system cell is damaged in GBS?

schwann cell

8

Which nervous system cell is the macrophages of the CNS?

microglia

9

In which neurological diseases is Ach altered? (3)

Alzheimers (decreased)
Huntington (decreased)
Parkinson (increased)

10

In which diseases are levels of GABA altered? (2)

Anxiety (decreased)
Huntington (decreased)

11

What are the components of the BBB? (3)

1. non-fenestrated capillary endothelial cells with tight junctions
2. BM
3. foot process of astrocytes

12

A lesion to which area of the brain is responsible for hemispatial neglect?

non-dominant parietal lobe

13

A lesion to which area of the brain is responsible for poor repetition?

Arcuate fasciculus (conductive aphasia)

14

A lesion to which area of the brain is responsible for poor comprehension?

Wernicke's

15

A lesion to which area of the brain is responsible for poor verbal expression?

Broca's

16

A lesion to which area of the brain is responsible for personality changes and disinhibition?

frontal lobe

17

A lesion to which area of the brain is responsible for dysarthria?

cerebellar vermis

18

A lesion to which area of the brain is responsible for agraphia and acalculia?

angular gyrus in dominant parietal lobe (Gerstmann syndrome)

19

What typically is the cause of a lesion to the mammillary bodies?

Thiamine deficiency

20

Where is the pathology located in each of the following scenarios?

a. right anopsia
b. bilateral hemianopsia
c. right homonymous hemianopsia

a. right optic nerve
b. optic chiasm
c. left optic tract

21

What 2 nerves are tested with the gag reflex?

9 (aff)
10 (eff)

22

A 19yo man presents with a furuncle on his philtrum, and the cavernous sinus becomes infected. What neurological deficits might you see in this patient?

CN 3, 4, 6 --> ophthalmoplegia, diplopia

CN5 --> pain, numbness of upper face

23

How can a stroke of the facial motor cortex be distinguished from Bell's palsy?

Facial motor cortex = contralateral paralysis of lower face, with forehead/eyebrow sparing (central)

Bell's palsy = paralysis to both upper and lower face

24

What artery supplies the medullary pyramids and the medial lemniscus in the medulla?

anterior spinal artery

25

What artery supplies the inferior cerebellar peduncle, nucleus ambiguus, and the lateral spinothalamic tract in the medulla?

PICA

26

What is the triad of Horner syndrome?

1. Ptosis
2. Anhidrosis (decreased sweating)
3. Miosis (constriction)

27

A patient comes to the ER with double vision and left-sided weakness. On p/e, she cannot abduct her right eye. In addition to motor weakness of the left arm and leg, she also has loss of fine touch, proprioception, and vibration sense in the left arm and leg. Where is the lesion and what vessel is most likely involved?

Right medial pontine syndrome

paramedian branches of basilar artery

28

A patient presents with vertigo, nystagmus, and slurred speech. P/e reveals right-sided ptosis and miosis, decreased gag reflex on the right, deviation of the uvula to the left, diminished P/T on the right side of his face, and left side of his body. Where is the lesion and what vessel is most likely involved?

Right lateral medullary syndrome (Wallenberg)

Right PICA

29

A patient presents with double vision, slurred speech, hoarse voice and acute right-sided weakness. P/e shows weakness of the right arm and leg, and left eye is depressed and abducted. Where is the lesion and what vessel is most likely involved?

Left anterior midbrain (Weber syndrome)

L PCA

1. cerebral peduncle lesion leads to
- corticobulbar tract damage (dysphagia, dysphonia, dysarthria)
- corticospinal tract damage
(contralateral spastic hemiparesis)

3. CN3 palsy --> down and out

30

savage behavior and obesity result from STIMULATION of which hypothalamic nuclei?

dorsomedial (regulates hunger)

31

savage behavior and obesity result from DESTRUCTION of which hypothalamic nuclei?

ventromedial (regulates satiety; stimulated by leptin)

32

which hypothalamic nuclei is the master clock for setting circadian rhythms

suprachiasmatic nucleus

33

which hypothalamic nuclei releases hormone affecting the anterior pituitary (3)

- arcuate (secretes GnRH, dopamine, pulsatile GnRH secretion)
- preoptic (secretes GnRH)
- paraventricular (secretes oxytocin, CRH, TRH)

34

which hypothalamic nuclei is responsible for sweating and cutaneous vasodilation in hot temperature? (cooling)

anterior (thermoregulation; cooling)

damage causes hyperthermia

35

which hypothalamic nuclei is responsible for shivering and decreased cutaneous blood flow in the cold? (warming)

posterior (thermoregulation; warming)

damage causes hypothermia

36

which hypothalamic nuclei produces ADH to regulate water balance?

supraoptic

37

which hypothalamic nuclei regulates the release of gonadotropic hormones (LH, FSH)?

preoptic, arcuate

38

destruction of which hypothalamic nuclei results in inability to stay warm?

posterior

39

which hypothalamic nuclei receives input from the retina?

suprachiasmatic

40

stimulation of which hypothalamic nuclei leads to eating and destruction leads to anorexia?

lateral (regulates hunger; inhibited by leptin)

41

destruction of which hypothalamic nuclei results in diabetes insipidus?

supraoptic (secretes ADH)

42

kluver bucy syndrome is a lesion to which structure?

bilateral amygdala lesion

43

Where is CSF generated? Where is it reabsorbed?

- choroid plexus
- arachnoid granulations (in the superior sagittal sinus)

44

What is the difference b/w communicating and noncommunicating hydrocephalus?

communicating = non-obstructive (decreased absorption of CSF)

noncommunicating = obstructive

45

Drug used to treat status epilepticus?

benzo

46

What is fetal hydantoin syndrome?

- cleft lip/palate
- congenital heart disease
- mental retardation with dev delay

47

which anti-epileptics are teratogens? (3)

- phenytoin
- carbamazepine
- valproic acid

48

What drugs are known for causing Stevens-Johnson syndrome?

- anti-epileptic drugs (esp. lamotrigine)
- allopurinol
- sulfa drugs
- penicillin

"Steven Johnson has epileptic allergy to sulfa drugs and penicillin"

49

What are the toxic effects of phenytoin? (6 main, 2 additional)

1. gingival hyperplasia
2. hirsutism
3. fetal hydantoin syndrome
4. drug-induced lupus
5. Steven-Johnson
6. induces p450

7. megaloblastic anemia
8. peripheral neuropathy

50

What is the mechanism of action of sumatriptan?

5-HT (serotonin) agonist (1B, 1D receptors)

51

Contraindications to sumatriptan use? (3)

- CAD
- prinzmetal angina
- pregnancy

b/c sumatriptan causes vasoconstriction

52

What are the 3 most common primary brain tumors in adults?

1. GBM
2. Meningioma
3. Schwannoma

53

What are the 3 most common primary brain tumors in children?

1. pilocytic astrocytoma
2. medulloblastoma
3. ependymoma

54

Which primary brain tumor fits the following description?
- pseudopalisading necrosis

GBM

55

Which primary brain tumor fits the following description?
- polycythemia

hemangioblastoma

56

Which primary brain tumor fits the following description?
- NF2

schwannoma

57

Which primary brain tumor fits the following description?
- associated with von Hippel-Lindau

hemangioblastoma

58

Which primary brain tumor fits the following description?
- foamy cells, high vascularity

hemangioblastoma

59

Which primary brain tumor fits the following description?
- psammoma bodies

meningioma

60

Which primary brain tumor fits the following description?
- fried egg appearance

oligodendroglioma

61

Which primary brain tumor fits the following description?
- perivascular pseudorosettes

ependymoma

62

Which primary brain tumor fits the following description?
- bitemporal hemianopsia (2)

- pit adenoma, craniopharyngeoma

63

Which primary brain tumor fits the following description?
- worst prognosis of any primary brain tumor

GBM

64

Which primary brain tumor fits the following description?
- child with hydrocephalus (2)

medulloblastoma, ependymoma

65

Which primary brain tumor fits the following description?
- horner-wright pseudorosettes

medulloblastoma

66

What EEG waveforms correspond to the diff. stages of sleep?

awake
awake (relax)
N1
N2
N3
REM

awake = beta
awake (relax) = alpha
N1 = theta
N2 = sleep spindle + K complexes
N3 = delta (deepest sleep)
REM = beta

BATS Drink Blood

67

What drugs are used to shorten stage N3 sleep (2)

imipramine (TCA)
benzo

These can be given for night terrors, sleep walking, enuresis

68

What is the sleep pattern in a pt with narcolepsy?

rapidly transition from awake state --> REM

69

In what stage of sleep are night terrors found?

N3

70

Which anesthetic fits each of the following description?

- IV; associated with hallucinations and bad dreams

ketamine

71

Which anesthetic fits each of the following description?

- IV; most common drug used for conscious sedation

midazolam

72

Which anesthetic fits each of the following description?

- inhaled; side effect of hepatotoxicity

halothane

73

Which anesthetic fits each of the following description?

- IV; used for rapid anesthesia induction and short duration of action

propofol

74

Which anesthetic fits each of the following description?

- IV; decreases cerebral blood flow (important in brain surgery)

barbiturates

75

Which anesthetic fits each of the following description?

- opioid that does not induce histamine release

fentanyl

76

Which anesthetic fits each of the following description?

- high triglyceride content, increases the risk of pancreatitis with long-term use

propofol

77

What is the MoA of dantrolene?

prevents release of Ca2+ from the SR of skeletal muscle --> causes relaxation (prevents contraction)

78

What is the MoA of local anesthetics?

block Na+ channels

79

Which nerve fibers are blocked first with local anesthesia?

small myelinated > small unmyelinated > large mye > large unmyelinated

80

What drugs can be used to reverse neuromuscular blockade?

cholinesterase inhibitors (neostigmine)

*remember, only works for nondepolarizing drugs (which are competitive antagonists at ACh receptors)

81

Diff between depolarizing and nondepolarizing neuromuscular blocking drugs?

- depolarizing = strong ACh receptor agonist; produce sustained depolarization and prevents muscle contraction. no antidote for phase 1
(ex. Succinylcholine)

- non-depolarizing = competitive antagonist at ACh receptor

82

What are the 3 goals of general anesthesia?

1. amnesia - no memory
2. analgesia - no pain
3. immobilization - paralysis

83

What are the differences b/w the 1a afferent motor pathway and the 1b afferent motor pathway?

1a: comes from muscle spindle; stimulates alpha-MN --> muscle contraction

1b: comes from golgi tendo organ --> inhibits contraction

84

What is the different b/w essential tremor, resting tremor, and intention?

essential: occurs both @ rest + mvt (family hx)

resting: only at rest (Parkinson)

intention: w/ movement (lateral cerebellar hemisphere damage)

85

What is Romberg testing?

dorsal column!!! (not cerebellum)

86

a 28 yo chemist presents with MPTP exposure. What neurotransmitter is depleted?

Dopamine

[MPTP --> MPP --> destroys dopaminergic neurons in substantia nigra]

87

How do each of the following structures normally impact movement?

a. globus pallidus interna
b. subthalamic nucleus (STN)
c. substantia nigra pars compacta

a. inhib
b. inhib
c. stimulate

88

A male patient presents with involuntary flailing of one arm. Where is the lesion?

contralateral STN

89

What neurotransmitters are altered in Huntington?

glutamate toxicity

- decreased ACh
- decreased GABA
- increased dopamine

90

Which spinal tract convey voluntary motor command from motor cortex to head/neck?

corticobulbar tract

91

Which spinal tract is important for postural adjustments and head movements?

vestibulospinal tract

92

Which spinal tract convey proprioceptive information for the cerebellum?

dorsal and ventral spinocerebellar tracts

93

What are the findings of Brown-Sequard syndrome? (5)

1. ipsilateral UMN signs below lesion
2. ipsi loss of p/v below lesion
3. contra p/t loss 2-3 segments below lesion
4. ipsi p/t loss @ the level of lesion
5. LMN sign @ the lesion (anterior horn)

94

What nerve is damaged when pt is unable to extend 4th and 5th fingers?

ulnar (ulnar claw)

95

What nerve is damaged when pt is unable to flex index and middle finger?

median (hand of benediction)

96

What nerve is damaged when pt has wrist drop?

radial nerve

97

What nerve is damaged when pt has scapular winging

long thoracic

SALT --> serratus anterior, long thoracic

98

What nerve is damaged when pt has loss of sensation over fingers 1-4

median

99

What nerve is damaged when pt cannot abduct or adduct fingers

ulnar

100

What nerve is damaged when pt has loss of shoulder abduction

axillary

101

What nerve is damaged when pt has loss of elbow flexion and forearm supination

musculocutaneous

102

What nerve is damaged when pt has loss of wrist extension

radial

103

What nerve is the most at risk of injury with fracture of the shaft of the humerus?

radial

104

What nerve is the most at risk of injury with fracture of the surgical neck of the humerus?

axillary

105

What nerve is the most at risk of injury with anterior shoulder dislocation

axillary

106

What artery and nerve are most at risk of being damaged with anterior dislocation of shoulder?

axillary nerve
posterior circumflex artery

107

Which nerve would most likely be damaged with pelvic fracture?

femoral nerve

108

Which nerve would most likely be damaged with anterior hip dislocation?

obturator nerve

109

Which nerve would most likely be damaged with posterior hip dislocation?

superior and inferior gluteal nerves

110

Which nerve would most likely be damaged with vertebral disc herniation

sciatic

111

Which nerve would most likely be damaged with knee injury

tibial nerve

112

Which nerve would most likely be damaged with habitual crossing of the leg

common peroneal nerve

113

Which 2 muscle receptors are responsible for opening the sarcoplasmic reticulum in response to depolarization?

dihydropyridine receptor coupled to ryanodine receptor

114

What drug prevents the release of calcium from the sarcoplasmic reticulum of skeletal muscle?

dantrolene

115

what is the difference b/w type 1 and type 2 muscle fibers?

Type 1: slow twitch, red (b/c of high levels of mitochondria and myoglobin)
- oxidative phosphorylation
- sustained contraction

Type 2: fast twitch
- anaerobic glycolysis

116

What sensory receptor communicates pricking pain (fast, myelinated)?

A-delta

117

What sensory receptor communicates burning or dull pain and itch (slow, unmyelinated)

C fibers

118

What sensory receptor communicates vibration and pressure?

Pacinian corpuscles

119

What sensory receptor communicates dynamic/changing light, discriminatory touch?

Meissner

120

What sensory receptor communicates static/unchanging light touch?

Merkel

121

What sensory receptor communicates proprioception information (muscle length monitoring)?

muscle spindle (around intrafusal muscle fibers)

122

What sensory receptor communicates proprioception information (muscle TENSION monitoring)?

golgi tendon organ

123

What initial type of vision loss is commonly seen in pts with open angle glaucoma?

peripheral vision loss

124

What drug classes are used in the treatment of glaucoma? (2 main, 3 others)

1st line
- Beta blockers
- prostaglandins

Others:
- alpha-agonist
- carbonic anhydrase inhibitors
- cholinergic agonists

125

What is the treatment for dry age-related macular degeneration? (2)

- smoking cessation
- anti-oxidant vitamins

126

A patient presents with vertigo, tinnitus, and hearing loss. What is the diagnosis?

Meniere disease (endolymphatic hydrops)

127

Which organisms are most commonly responsible for acute otitis media? (3)

S. pneumo
nontypable H. influenzae
M. catarrhalis

128

What organism is most commonly responsible for otitis externa?

Pseudomonas

129

Chronic otitis media can sometimes result in a cystic lesion that is lined by keratinizing squamous epithelium, which can be metaplastic, that is filled with amorphous debris. What is the name of this condition?

Cholesteatoma

130

Why is Alzheimer disease more common in pts with Down syndrome?

b/c of extra chromosome 21 (which has APP gene)

131

What is the MoA of the drugs used in the treatment of Alzheimer disease? (2)

- cholinesterase inhibitors
- NMDA receptor antagonist