Neurology

Question 1

What brain lesion contains within it corkscrew fibers and located in the posterior fossa?

Answer 1

Piocystic Astrocytoma – solid and cystic w/ Rosenthal Fibers

Question 2

What brain lesion would present with hydrocephalus and vascular rosettes?

Answer 2

Ependymonas – lateral ventricles ependymial cell overgrown and block flow of CSF

Question 3

What brain lesion presents with solid sheets of small blue cells with hyperchromic nuclei reverting to a embryonic formation?

Answer 3

Medulloblastoma – Homer-Wright Rosettes (Pseudorosettes without vascular center)
– cerebellum location, poor prognosis

Question 4

What medication is exclusively used for absent seizures?

Answer 4

Ethosuximide

Question 5

What medication can be used for patients with both absent seizures and tonic-clonic seizures?

Answer 5

Valproic Acid

Question 6

What nuclei of the thalamus is responsible for hunger?

Answer 6

Lateral Nuclei

Question 7

What is the Paraventricular nuclei of the thalamus responsible for?

Answer 7

Production of Hormones

- ADH, GnRH, CrH, Oxytocin, TrH

Question 8

What region of the thalamus does Leptin stimulate?

Answer 8

Ventromedial

Question 9

What region of the thalamus does Leptin inhibit?

Answer 9

Lateral Nuclei

Question 10

What region of the thalamus is responsible for inhibiting release of prolactin?

Answer 10

Arcuate – produces Dopamine

Question 11

If your circadian rhythm is off, what region of thalamus is dysfunctional?

Answer 11

Supraoptic

Question 12

What neurotransmitters are dysregulated and their levels in Huntington’s Disease?

Answer 12

Decreased GABA and ACh

Increased Dopamine

Question 13

What are the physiologic changes associated with Huntington’s Disease?

Answer 13

Bilateral Caudate/Putaman (Striatum) degradation

- Dilation of the Lateral Horns

Question 14

If a patient has numerous CAG repeats on Chromosome 4, what is a likely symptom/

Answer 14

Choreiform Movement

- Depression – Suicide

Question 15

What syndrome is associated with Macrosomia, increased jaw/ear size with a long thin face and mental retardation?

Answer 15

Fragile X-Syndrome

Question 16

What syndrome is associated with CGG repeats on the X-chromosome?

Answer 16

Fragile X-syndrome

Question 17

If a patient has been experiencing chronic abdominal pain for decades and has been completely worked up without any etiology of their symptoms. The patient frequently visits ERs and the office; they are not on any addictive medications and does not seem to have any motivational force of their visits?

Answer 17

Somatic Symptom Disorder

- Need Regular scheduled frequent office visits for reassurance and improve their everyday function

Question 18

What common occurs in the internal capsule causing impaired motor function and ataxia with a normal CT Scan at onset of symptoms?

Answer 18

Lacunar Infarction
- small vessels become hylinized and occlude the internal capsule – ischemic infarction
- Hypertensive Arteriole Sclerosis
HTN Risk Factor + DM

Question 19

Where are high frequency sounds best heard in the cochlea?

Answer 19

At the base, near oval/round window

Question 20

Where are low frequency sounds best heard in the cochlea?

Answer 20

Low frequency sounds propogate further into the cochlea to the apex – helicotrema (meeting of the scala vestibuli and scala tympani)

Question 21

If the Arcuate Fasciculus is lesioned from a small stroke, what will be the problem?

Answer 21

Poor Repetition

– Good Understanding and Fluency

Question 22

What pathways are considered C-fibers?

Answer 22

Unmyelinated

• Slow Pain
• Heat Sensation
• Olfaction
• Post ganglionic

Question 23

If a child is experiencing ataxia and frequent falls and a mass is discovered in the posterior fossa, what might histology look like?

Answer 23

Medullablastoma

• • Sheets of small cells with deep basophilic nuclei and minimal cytoplasm
• • neuroectoderm origins

Question 24

If a patient is diagnosed with a mass in their lungs and develop progressive ataxia with visual disruptions, what might be occuring?

Answer 24

Paraneoplastic Cerebellar Degeneration
-- Bilateral*** symptoms due to cross reactivity of immune response damaging the Purkinje cells
(+)Anti-yo
(+)Anti-P/Q
(+)Anti-Hu

Question 25

If a patient is experiencing a change in personality and forgetfulness over the past several months and a biopsy shows vacoules between neurons - spongiform, what might be occuring?

Answer 25

Creutzfeldt-Jakob Disease

• • Prion
• • Rapid onset Dementia

Question 26

What is the difference between Avoidant and Schizoid personality disorder?

Answer 26

Avoidant – Afraid of what people think and avoid situations where people can judge them.
Schizoid – Deteched from social life and like it that way, are perfectly content. Limited intimacy.

Question 27

What would the results of testing be if a patient has conductive hearing loss?

Answer 27

Bone > Air Loudness with tuning fork

Lateralizes to THAT ear with conduction loss, due to the nerve being MORE sensitive to sound

Question 28

Which direction does the lateralizing tuning fork go if a patient has decreased hearing in the left and has neural hearing loss?

Answer 28

To the RIGHT – since that side is the one working

Question 29

What would be found in the amniotic fluid of a neonate with neural tube defect?

Answer 29

• • Elevated Alpha-Feto Protein

- - Elevated Acetylcholinesterase

Question 30

What is the underlying etiology of a patient who has had multiple stroke-like episodes with diffuse muscle weakness at the age of 35?

Answer 30

MELAS – mitocondrial encephalopathy with stroke-like episodes

Question 31

2 days after an ischemic MCA stroke, what might you expect to find histologically?

Answer 31

Infiltration of PMN/Macro cells into the tissue

Red Nuclei – within hours of ischemia

Question 32

How does morphine and other opiods work?

Answer 32

Binds Mu-receptor, via G-coupled receptor
– activated potassium channels to EFFLUX, which causes hyperpolarization of the membrane making it more difficult to depolarize (dulling pain)

Question 33

What is a side effect of Carbamazepine (other than inducing P450)?

Answer 33

Syndrome of inappropriate ADH release

Question 34

If a patient had a few days of diarrhea with intermittent blood present, then a week or two later develops a change in sensation and weakness in the right foot, what might be found in histology?

Answer 34

Guillain-Barre’

• • segmented demyelination of peripheral nerves that ascends the body
• • Endoneural inflammation infiltrate