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Uworld Journal > Nervous System + Psychology > Flashcards

Nervous System + Psychology Flashcards

1
Q

Structural pathology of Wernike Encephalopathy?

A

Mamillary body necrosis

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2
Q

Temporal lobe encephalitis is caused by what kind of infection?

A

Herpes virus infection

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3
Q

Rapidly progressive dementia + myoclonic jerks =

A

Creutzfeld-Jakob disease

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4
Q

4 tumors that form psamomma bodies

A

-Meningioma -Papillary thyroid carcinoma -Mesothelioma -Papillary serous carcinoma of the ovary or endothelium

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5
Q

Slow growing + Well circumscribed + Intracranial mass + Whorled pattern of cellular growth + Psamomma bodies =

A

Meningioma

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6
Q

S-100 positive tumors (2) What does it indicate?

A

-Schwannoma -Melanoma Indicates that it is of neural crest cell origin

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7
Q

Elongated cells + Regular oval nuclei + Biphasic growth pattern + S-100 positive =

A

Schwannoma

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8
Q

Relapsing and remitting ocular problems and tingling + worse after heat =

A

Multiple Sclerosis

  • Ocular problems = optic neuritis, internuclear opthalmoplegia
  • Sensory defects
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9
Q

Complication of a subarachnoid hemorrhage =

How does it present =

A

Arterial vasospasm

Presents as new onset confusion or focal neurological deficit. Not seen on CT.

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10
Q

Drug to prevent subarachnoid hemorrhage complication and its mechanism.

A

Nimodipine - selective Ca channel blocker

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11
Q

Cystic cavities in the brain are lined by =

A

astrocytes

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12
Q

Diagnosis of tetanus is made via

A

History and Physical only

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13
Q

Ascending (flaccid) paralysis after a febrile illness is what disease?

A

Guillain-Barre disease

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14
Q

Guillain-Barre disease microscopic pathology

A

Endoneurial inflammatory infiltrate of macrocytes and lymphocytes

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15
Q

Hemangioma in the retina and/or cerebellum + Congenital cysts/neoplasms in the kidney, liver or pancreas =

A

Von Hippel Lindau

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16
Q

Cystic tumor in the cerebellum of a child =

A

Pilocytic astrocytoma

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17
Q

Which kind of aneurysm rupture results in -> deep intraparenchymal hemorrhage + focal/acute neurological deficits + hypertension?

A

Carcot-Bouchard aneurysm

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18
Q

Rupture of _ results in a subdural (crescent shaped) hematoma + gradual onset of symptoms

A

cortical bridging veins

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19
Q

Wernike Syndrome triad = Reversible with _ treatment

A

Ocular dysfunction Ataxia Confusion Reversible with Thiamine treatment

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20
Q

Korsakoff Syndrome symptoms (2) =

A

Confabulation

Permanent memory loss

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21
Q

Young child + Precocious puberty + Perinaud syndrome + Obstructive hydrocephalus =

A

Pineal germinoma

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22
Q

Perinaud Syndrome definition

A

paralysis of upward gaze

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23
Q

Transtentorial (uncal) herniation symptoms (3)

A
  • Ipsilateral CN III damage => oculomotor nerve palsy + fixed/dilated pupil
  • Contralateral LCST damage/Ispislateral cerebral peduncle damage
  • Ipsilateral PCA damage => occipital cortex damage
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24
Q

What is the term for: monocular vision loss + pain on eye movement + afferent pupillary defect?

A

Optic neuritis

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25
Q

First area damaged by global cerebral ischemia

A

Pyramidal cells of the hippocampus

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26
Q

Cerebellar ataxia + Loss of position/vibration + Kyphoscoliosis + Hypertrophic cardiomyopathy =

A

Freidrich’s ataxia

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27
Q

Definition - xanthochromia

A

blood in the CSF

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28
Q

Definition - lissencephaly

A

Congenial absence of gyri on the brain. Clinically associated with severe mental retardation.

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29
Q

Definition - Hydrocephalus ex vacuo

A

Ventricular enlargement due to brain atrophy. Not accompanied by an increase in CSF pressure.

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30
Q

Etiology of Paraneoplastic Cerebellar Degeneration?

A

Autoimmune

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31
Q

Most common CNS tumor in immunocompromised patients

A

Primary CNS lymphoma associated with EBV infection

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32
Q

Definition - Argyll Robertson pupils

A

small, irregularly shaped pupils that DO NOT react to light but DO constrict with accomodation

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33
Q

Vitamin E deficiency closely resembles what neurological disease?

A

Freidrich’s ataxia

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34
Q

Childhood cerebellar tumors (2)

A

-Medulloblastoma -Pilocytic Astrocytoma

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35
Q

Muscles most often affected in myasthenia gravis?

A

Extraocular muscles -> ptosis, diplopia

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36
Q

Nerve controlling hiccups?

A

Phrenic nerve

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37
Q

Where does the phrenic nerve arise and innervate?

A

Arises from C3-C5 Innervates the diaphragm ipsilaterally

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38
Q

Symptoms of Normal Pressure Hydrocephalus (NPH) (3)

A

“Wacky, Wobbly, Wet” -dementia -ataxic gait -urinary incontinence

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39
Q

Term for abnormally slow relaxation of muscles

A

myotonia

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40
Q

Alzheimer’s disease: Where in the brain has markedly reduced acetylcholine levels? (2)

A

-Nucleus basalis of Meynert -Hippocampus

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41
Q

Acyclovir is used to treat what type of infections?

A

viral infections

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42
Q

Osmotic demyelination occurs in what brain structure?

A

central pons “Central Pontine Myelinolysis”

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43
Q

Opsoclonus-Myoclonus syndrome is associated with what tumor?

A

Neuroblastoma

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44
Q

How to get decerebate (extensor) posturing?

A

Lesion to the brainstem at/below the level of the red nucleus (rostral midbrain)

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45
Q

How to get decorticate (flexor) posturing?

A

Lesion to the brainstem above the level of the red nucleus (rostral midbrain) ex: cerebral hemisphere

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46
Q

“Endoneurial inflammatory infiltration” refers to what disease?

A

Guillain-Barre

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47
Q

“Endoneurial arteriolar hylanization” refers to what disease?

A

Diabetic microangiopathy of endoneurial arterioles. Leads to nerve ischemia and peripheral neuropathy.

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48
Q

Most common CN affected by diabetic mononeuropathy = Symptoms (3) =

A

CN III -> acute onset diplopia + down and out position of the eye + ptosis

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49
Q

Pathology of Diabetic Mononeuropathy of CN III

A

Ischemic nerve damage to the core of the nerve, therefore affecting only the somatic fibers, not the autonomic/parasympathetic fibers. Pupillary reflex stays intact.

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50
Q

Viruses that invade the dorsal root ganglia and their locations (3)

A

HSV 1 - above the waist HSV 2 - below the waist, genital region VZV - thoracic or trigeminal dermatomes

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51
Q

Waterhouse-Friderichsen Syndrome =

A

N. meningitidis infection leading to DIC, septic shock and hemorrhagic destruction of the adrenal glands

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52
Q

Patients with Neisseria infections have what kind of immune impairment?

A

C5-C9 deficiency which leads to an inability to form the MAC

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53
Q

Definition - Synaptophysin

A

Protein found in the synaptic vesicles of neurons, neuroendocrine cells and neuroectodermal cells. CNS tumors of neuronal origin are synaptophysin positive.

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54
Q

2 main causes of ring-enhancing lesions in HIV patients

A
  • Toxoplasma gondii - multiple lesions
  • Primary Central Nervous System Lymphoma (PCNSL) - solitary, due to EBV
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55
Q

Congenital toxoplasmosis symptom triad =

A

-Hydrocephalus -Intracranial calcifications -Chorioretinitis

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56
Q

1 year old full term infant brought into ED with a large and full anterior fontanelle and bilateral retinal hemorrhages. Mom says baby rolled off bed. What is the diagnosis?

A

Abusive head trauma.

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57
Q

Name the muscles in the ear and their innervation (2)

A

-Stapedius muscle - CN VII -Tensor tympani muscle - CN V

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58
Q

Sciatic nerve spinal roots

A

L4-S3

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59
Q

Role of axillary nerve (3)

A

-Motor to deltoid muscle -Motor to teres minor muscle -Sensory to skin over lateral shoulder

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60
Q

Lesion to what nerve(s) cause = contralateral spasticity + hyperreflexia + paresis?

A

UMN lesion

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61
Q

What nerve is at risk during an appendectomy? What does that nerve innervate?

A

Illiohypogastric nerve. It innervates -motor to anterolateral abdominal muscles -anterior branch - sensory to the skin above the pubic region -lateral branch - sensory to the skin of the gluteal region

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62
Q

Injury to the R temporal lobe results in what kind of visual defect?

A

Injury to Meyer’s loop that carries the lower retinal fibers that contain information from the upper visual field. Contralateral superior quadrantanopia = “pie in the sky defect”

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63
Q

What are the changes seen in the “axonal reaction” (4)

A

-Cell swelling -Nucleus moves into periphery -Nissl substance displaced throughout cell -Increased protein synthesis

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64
Q

What is a “Marcus Gunn pupil”?

A

-Caused by optic nerve damage or retinal injury -When light is shone into the affected eye, there is decreased bilateral light reflex (decreased pupillary constriction) -Tested with “swinging flashlight test”

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65
Q

3 D’s of Botulinum Toxin ingestion?

A

-Diplopia -Dysphagia -Dystonia

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66
Q

Innervations of CN V =

A

V1 = opthalmic branch -> eye sensation V2 = maxillary -> muscles of mastication V3 = mandibular -> anterior 2/3 tongue sensation

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67
Q

What nerve is responsible for foot drop + steppage gate?

A

Common peroneal nerve Spinal roots L4-S2

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68
Q

What is the motor function of the obturator nerve?

A

Adduction of the thigh Spinal roots L2-L4

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69
Q

When preforming an interscalene nerve block to anesthetize the brachial plexus, what other nerve is involved?

A

The phrenic nerve also passes through the interscalene sheath

70
Q

What two thing are measured to detect a neural tube defect?

A
  • Alpha-fetoprotein = in the amniotic fluid and maternal serum
  • Acetylcholinesterase = in the amniotic fluid
71
Q

Vocal cords are controlled by what nerve?

A

CN X - Vagus nerve, Recurrent laryngeal nerve branch

72
Q

Main antigenic component of N. meningitidis?

A

Pili/fimbrae

73
Q

Most common cause of spontaneous lobar hemorrhages in the elderly?

A

Amyloid angiopathy - caused by A-beta amyloid deposition in the walls of vessels.

74
Q

Common brain locations of amyloid angiopathy hemorrhages (2)

A

-Occipital lobe -> homonymous hemianopsia -Parietal lobe -> contralateral hemisensory loss

75
Q

Nerve most commonly affected by ill-fitting crutches (“crutch palsy”)

A

Radial nerve Spinal roots C5-T1

76
Q

Rathke’s pouch is derived from?

A

Ectoderm -> surface ectoderm

77
Q

Posterior pituitary is derived from?

A

Ectoderm -> neural tube

78
Q

What is the “length constant/space constant” of a nerve?

A

A measure of how far along an axon an electrical signal can propagate. Smaller constant = Less propagation distance

79
Q

What is the “time constant” of a nerve?

A

A measure of the time it takes to change the membrane potential. Smaller constant = Faster membrane potential change time

80
Q

Location of a femoral nerve block?

A

Inguinal crease

81
Q

Patients with Down Syndrome are at an increased risk for what neurological disease?

A

Early onset Alzheimer’s disease

82
Q

Area Postrema - location and function

A

Location = dorsal surface of the medulla at the caudal end of the 4th ventricle Function = samples chemicals in the blood, chemoreceptor trigger zone, controls vomiting

83
Q

Treatment for essential tremor =

A

Propranolol

84
Q

What is the main distinguishing feature of Atypical depression compared to Major depression?

A

Mood reactivity - a positive event WILL improve mood of someone with atypical depression

85
Q

Pellagra - cause and symptoms

A

Cause = Niacin deficiency Symptoms = dementia, dermatitis, diarrhea

86
Q

Class of drug prescribed for insomnia without depressive symptoms =

A

Benzodiazepines

87
Q

Definition of pica

A

Compulsive consumption of a non-food or non-staple food source for >1 month. Seen in pregnancy and school children. May be associated with a nutritional deficiency. Substances consumed: -earth/soil -raw starch (flour, cornstarch) -ice

88
Q

Which antidepressant has the side effect of painful erections for >4 hours?

A

Trazodone “trazo-bone”

89
Q

First line treatment for Bulimia nervosa?

A

Fluoxetine (SSRI)

90
Q

First line treatment for PTSD?

A

SSRI

91
Q

First line treatment for OCD?

A

SSRI

92
Q
A

a=optic chiasm (CN II)

b=oculomotor nerve (CN III)

c=trochlear nerve (CN IV)

d=abducens nerve (CN VI)

e=opthalmic nerve (CN V1)

f=maxillary nerve (CN V2)

g=anterior cerebral artery

f=internal carotid artery

93
Q

35 year old male, increasingly depressed, grimaces intermittently, rigid jerking and purposeless movements of the fingers, increasingly impulsive

A

Huntington’s disease

94
Q

Constipation that is not reversible with over the counter laxatives. Malfunction of which nerve =

A

Pelvic splanchnic nerve innervates the anal sphincter

S2,S3, S4

“Pelvic splanchnic 2-4 keeps the shit above the floor”

95
Q

Sudden onset R arm weakness + difficulty speaking + no other symptoms + completely resolved in 20 minutes

A

TIA

96
Q

tremor that is alleviated by intentional movement is seen in what disease

A

Parkinson disease

97
Q

slow, zig zag tremor when pointing/extending towards a target.

problem is located where?

A

Intenion tremor.

Cerebellar dysfunction.

98
Q

Sleep terrors occur during _ sleep.

Nightmares occur during _ sleep.

A

Sleep terrors - slow wave sleep (non-REM therefore no recollection)

Nightmares - REM sleep

99
Q

Somatic symptom disorder - unconscious or conscious?

A

Unconscious

100
Q

Conversion disorder (Functional neurological symptom disorder) - unconscious or conscious?

A

Unconscious - patient seems indifferent to the symptoms but the symptoms are debilitating

101
Q

Malingering - unconscious or conscious?

A

Conscious - looking for secondary gains

102
Q

Munchausen syndrome or Munchausen syndrome by proxy - unconscious or conscious?

A

Conscious - looking for primary gain of attention

Facticious disorders

103
Q

Person who is preoccupied with needing things a certain way, needs to control everything around them and that is “just the way they are”

A

Obsessive compulsive PERSONALITY

Ego-syntonic

104
Q

Person with compulsions that they know are not reasonable btu they cannot help but do them (inconsistent with their own beliefs)

A

Obsessive Compulsive DISORDER

Ego-dystonic

105
Q

Dysthymic disorder

A

Mild depression (at least 2 SIG E CAPS symptoms)

Lasts at least 2 years

106
Q

Symptoms of Major Depressive Disorder

A

SIG E CAPS - need at least 5 for at least 2 weeks

Sleep disturbance

loss of Interest (anhedonia)

Guilt/feelings of worthlessness

Energy loss/fatigue

Concentration problems

Appetite/weight changes (loss)

Psychomotor retardation or agitation

Suicidal ideation

Patient must also report depressed mood

107
Q

Cyclothymic disorder

A

Milder bipolar disorder

Fluctuates beween minor depression and hypomania

Lasts at least 2 years

108
Q

Bipolar II

A

Hypomania + Depression

109
Q

Bipolar I

A

At least 1 manic episode with or without hypomania or depression

Note: depressive symptoms do not have to be present for the dx to be made

110
Q

Hypomania symptoms

A

Same as mania (DIG FAST) except the mood symptoms are not severe enough to cause marked impairment

No psychotic features

Lasts 4 consecutive dasy

111
Q

Mania symptoms

A

DIG FAST - need at least 3 and needs to markedly impair functioning

Distractibility

Irresponsibility (hedonism)

Grandiosity

Flight of ideas

increased in goal-directed Activities/Agitation

decreased need for Sleep

Talkativeness/pressured speech

112
Q

Hallucinations or delusions without a major mood episode + periods of concurrent mood episode with schizophrenic symptoms lasting for > 2 weeks

A

Schizoaffective disorder

There are no periods of time when there is just the mood disorder. There must be times when there are just schizophrenic symptoms though.

113
Q
  • Flat affect
  • Social withdrawal
  • Lack of motivation
  • Lack of speech or thought
A

Negative symptoms of Schizophrenia

Treated with second generation anti-psychotics

114
Q
  • Delusions
  • Hallucinations (auditory)
  • Disorganized speech
  • Disorganized/Catatonic behavior
A

Positive symptoms of Schizophrenia

Treated with both first and second generation anti-psychotics

115
Q

Dementia ECG - normal or abnormal?

A

Normal

116
Q

Waxing and waning consciousness + acute onset + abnormal ECG =

A

delerium

117
Q

Dissociative amnesia =

A

Unable to recall important personal ifnormation subsequent to a severe trauma or stress

118
Q

Girl who at age 3 begins to developmentally regress and loses verbal skills. Begins to have ataxia and wrings her hands constantly.

A

Rett Syndrome

-X linked dominant- males die in utero

119
Q

Withdrawal symptoms - hypersomnolent, hyperphagic, withdrawn, psychomotor retardation, vivid dreams =

A

Cocaine

120
Q

Timeline for:

  • Breif psychotic disorder
  • Schizophreniform disorder
  • Schizophrenia
A
  • Breif psychotic disorder = <1 month
  • Schizophreniform disorder = 1-6 months
  • Schizophrenia = >6 months
121
Q
A

Medulla - nuclei of CN IX, X, XII

122
Q
A

Pons - nuclei of V, VI, VII, VIII

123
Q
A

Midbrain

124
Q
A

Midbrain

125
Q

The presence of what proteins increases the risk for early onset Alzheimer’s?

A
  • APP (amyloid precursor protein, chr 21)
  • Presenilin-1
  • Presenilin-2
126
Q

An increased amount of ApoE2 increases/decreases the risk for Alzheimer’s?

A

Decreases risk

127
Q

An increased amount of ApoE4 increases/decreases the risk for Alzheimer’s?

A

Increases the risk

128
Q

“Bright red fovea centralis that is surrounded by a contrasting white macula”

A

Cherry red macula spot

Seen in: Tay Sachs (no abdominal findings), Niemann Pick (hepatosplenomegaly)

129
Q

Mechanism of phenytoin gingival hyperplasia =

A

Increased PDGF -> increases proliferation of gingival cells and alveolar bone

130
Q

N. meningitidis endotoxin =

A

Outer membrane lipooligosaccharide (LOS)

Blood levels of LOS correlate with mortality

131
Q

Oligoclonal bands of IgG seen on CSF fluid indicates a dx of

A

Multiple Sclerosis

132
Q

Initial resistance to passive extension followed by a sudden release of resistance =

A

“Clasp knife spasticity” - seen in an UMN lesion

133
Q

Prion transformation: _ structure to _ structure

A

Alpha helical

Beta pleated sheet

134
Q

Viral esophagitis + Pneumocystis pneumonia is diagnostic for

A

HIV!

Esophagitis = CMV

Pneumonia = PJP

Patient is likely at risk for other immunocompromised/AIDs defining illnesses

135
Q

Demyelination of posterior columns + LCST =

A

Subacute combined degeneration - vitamin B12 deficiency

“Combined” = degeneration of ascending AND descending tracts

136
Q

Bilateral wedge shaped strips of necrosis over the cerebral convexity, parallel and adjacent to the longitudinal cerebral fissure

A

Hypoxic-ischemic encephalopathy (Global cerebral ischemia)

Results in watershed infarcts

137
Q

Surgical deep brain stimulation of chronic Parkinson’s patients targets what 2 structures. Mechanism?

A

Structures: STN or GPi

Stimulation inhibits the nuclei therefore putting the circuitry onto the “yes movement” circuit by disinhibiting the thalamus

138
Q

What nerve is vulnerable to injury in the posterior triangle of the neck?

A

CN XI -> damage causes weakness of the trapezius = impaired abduction of the arm above horizontal, drooping shoulder, winged scapula

139
Q

Viral meningitis causes (3)

A
  • Enteroviruses (Polio, Coxsackie, Echo)
  • Arboviruses (Cali encephalitis, Hanta, Rift valley)
  • HSV-2
140
Q

Bony spicule shaped deposits on retina +vision loss beginning with night blindness =

A

Retinitis pigmentosa

141
Q

Fundoscopy: crinkling of retina + changes in vessel direction. Loss of vision like a curtain being drawn down.

A

Retinal detachment

142
Q

Grayish-green subretinal membrane and subretinal hemorrhages in a 67 yo smoker who is having vision problems

A

Wet, age related macular degeneration

Treatment = VEGF inhibitors

143
Q

HTN + intracerebral bleed

A

Hypertensive vasculopathy -> lenticulostriate arteries - charcot bouchard aneurysm -> rupture -> inhibits basal ganglia -> contralateral hemiparesis + hemisensory loss + headache + nausea (symptoms are gradual)

144
Q

Lesion in the ventromedial nucleus in the hypothalamus

A

Lesion = always hungry -> hyperphagia, obesity

Ventromedial nucleus = satiety center

Stimulated by leptin

145
Q

Lesion in the lateral hypothalamus nucleus

A

Lesion = never hungry -> anorexia

Lateral nucleus = hunger center

Inhibited by leptin

146
Q

3 brain tumors that are GFAP+

A
  • Astrocytomas (adults and kids)
  • Oligodendrogliomas (adults)
  • Ependymomas (kids)
147
Q

Acute onset worst headache of my life =

A

Subarachnoid hemorrhage from a berry aneurysm

148
Q

Microglial nodules in the brain + multinucleated giant cells + dementia =

A

HIV associated dementia

149
Q

Alpha-synuclein =

A

Parkinson’s disease/Lewy body dementia

150
Q

Round circular tau proteins =

A

Frontotemporal dementia

151
Q

Tangles of tau protein =

A

Alzheimer’s disease

152
Q

Amyloid in the brain + Dementia

A

Alzheimer’s Disease

153
Q

R sided frontal lobe lesions

A

Disinhibited behavior

154
Q

L sided frontal lobe lesions

A

Apathy and depression

155
Q

Round pearly mass behind tympanic membrane + conductive hearing loss in that ear + intermittent ear discharge

A

Cholesteatoma

  • Squamous cell debris
  • Congenital or acquired
  • May erode middle ear structure
156
Q

On ophthalmoscopic exam: arteriovenous nicking, flame shaped hemorrhages, cotton-wool spots

A

HTN retinal hemorrhages

157
Q

What happens to the ciliary muscles and zonular fibers and the lens during accommodation?

A

Ciliary muscles contract -> zonular fibers relax -> lens thickens -> able to focus on near images

158
Q

Conductive Rinne and Weber test?

A

Rinne: bone > air on affected side

Weber: lateralizes to affected side

159
Q

Sensorineural Rinne and Weber test?

A

Rinne: air > bone (normal)

Weber: lateralizes to unaffected side

160
Q

What CN? Motor of submandibular and sublingual gland?

A

CN VII

161
Q

What CN? Sensation of tonsillar region, Sensation of inner surface of tympanic membrane, Motor of parotid gland?

A

CN IX

162
Q

Noise exposure induced hearing loss is caused by damage to

A

Damage to hair cells in the organ of corti

Loss of high frequency hearing first

163
Q

Lacunar infarcts in the deep brain are caused by

A

Hypertensive arteriolosclerosis

Immediate CT imaging does not show the infarct because it is so small

A few weeks later, the necrotic tissue becomes a cystic space and can now be seen

164
Q

Anterior communicating aneurysm symptoms (3)

A

Berry aneurysm

  • bitemporal hemianopsia (compression of optic chiasm)
  • visual acuity problems (compresion of optic nerves in optic chiasm)
  • rupture (thunderclap headache) -> contralateral lower extremity hemiparesis and sensory deficits
165
Q

Posterior communicating aneurysm symptoms (3)

A

Berry aneurysm

ipsilateral CN III palsy

  • mydriasis
  • ptosis
  • down & out eye
166
Q

Middle cerebral artery aneurysm

A

Berry aneurysm

MCA ischemia = contralateral upper extremity and facial hemiparesis, sensory deficits

167
Q

Acute stress disorder diagnosis timeline

A

Greater than 3 days but less than 1 month

acute stress disorder -> PTSD

168
Q

PTSD diagnosis timeline

A

Greater than one month

acute stress disorder -> PTSD

169
Q

A drop in PaCO2 does what to cerebral vasculature?

A

Vasoconstricts cerebral vasculature -> reducing cerebral blood flow -> reducing intracerebral pressure

170
Q

Afferent limb of the light reflex

A

optic nerve, optic tract (-> pretectal nucleus in midbrain)

-damage to the retina, optic nerve or optic tract will inhibit the light reflex

171
Q

Efferent limb of the light reflex

A

parasympathetic fibers of the occulomotor nerve (CN III)

Uworld Journal (12 decks)

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