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First Aid STEP 1 - Neurology > Anatomy and Physiology 2 > Flashcards

Anatomy and Physiology 2 Flashcards

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1
Q

What symptoms can be seen with severe hypotension when considering the watershed zones of the brain?

A

upper leg/upper arm weakness

higher-order visual processing deficits

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2
Q

Cerebral perfusion is primarily driven by…

A

pCO2

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3
Q

How does therapeutic hyperventilation help decrease intracranial pressure?

A

In cases of acute cerebral edema (stroke, trauma), a decrease in pCO2 will cause a decrease in cerebral perfusion and ultimately cause vasoconstriction

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4
Q

What is the MC site of a berry aneurysm?

A

the junction of the anterior communicating artery and anterior cerebral artery

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5
Q

What palsy is associated with a lesion to the posterior communicating artery?

A

CN III palsy

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6
Q

What disease are Charcot-Bouchard micro aneurysms associated with?

A

chronic HTN

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7
Q

What is the condition where a patient has neuropathic pain due to thalamic lesions following a stroke?

A

central post-stroke pain syndrome

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8
Q

What vessels are ruptured in an epidural hematoma?

A

middle meningeal arteries

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9
Q

What intracranial hemorrhage shows a biconvex (lentiform) lens shape?

A

epidural hematoma

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10
Q

What vessels are ruptured in a subdural hematoma?

A

bridging veins

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11
Q

In what population are subdural hematoma more often seen?

A

elderly
alcoholics
blunt trauma
shaken baby

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12
Q

What can be seen on CT with a subdural hematoma?

A

crescent-shaped hemorrhage

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13
Q

What vessels are ruptured in a subarachnoid hemorrhage?

A

rupture of an aneurysm

often called “worst HA of my life” –> EMERGENCY

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14
Q

What is the MCC of intraparenchymal (hypertensive) hemorrhage?

A

systemic HTN (but also seen in amyloid antipathy, vasculitis, and neoplasms)

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15
Q

What are the areas most vulnerable during an ischemic stroke?

A

hippocampus (ischemic HYPOxia = HYPOcampus)
neocortex
cerebellum
watershed areas

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16
Q

How long does a patient have before irreversible brain damage during an ischemic stroke?

A

5 minutes

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17
Q

What is one contraindication for the use of tPA that can be detected using a CT?

A

hemorrhage

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18
Q

What is the MC site of hemorrhagic stroke?

A

basal ganglia

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19
Q

What type of necrosis results from an ischemic stroke?

A

liquefactive necrosis

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20
Q

What are the 3 types of ischemic strokes?

A
  1. thrombotic
  2. embolic
  3. hypoxic
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21
Q

What is the treatment for ischemic stroke? What is the time frame within which you can use this treatment?

A

tPA if used within 3-4.5 hr of onset and no hemorrhage/risk of hemorrhage

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22
Q

What is the definition of a transient ischemic attack?

A

brief, reversible episode of focal neurologic dysfunction lasting <24 hrs without acute infarction

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23
Q

What is the pathway of CSF through the ventricles of the brain?

A

CSF made in ependymal cells of choroid plexus –> lateral ventricle –> 3rd ventricle via right and left inter ventricular foramina of Monro –> 4th ventricle via cerebral aqueduct (Sylvius) –> subarachnoid space via foramina of Luschka (lateral) and foramen of Magendie (medial)

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24
Q

What is the pathogenesis of a communicating hydrocephalus?

A

Decrease CSF absorption by arachnoid granulations –> increased intracranial pressure, papilledema, and herniation

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25
What are the signs of a normal pressure hydrocephalus?
"Wet, wobbly, and wacky" Urinary incontinence, ataxia, and cognitive dysfunction
26
What is the pathogenesis of a normal pressure hydrocephalus?
1. increase CSF production by choroidal tumors | 2. impaired CSF absorption by arachnoid granulations damaged by tumor or meningitis
27
What is the key clinical feature of normal pressure hydrocephalus?
enlarged ventricles
28
What is interesting about hydrocephalus ex vacuo?
there is an apparent increase in CSF d/t neuronal atrophy (e.g. Alzheimer disease, advanced HIV, Pick disease)
29
What causes noncommunicating hydrocephalus?
structural blockage of CSF circulation within the ventricular system (e.g. stenosis of the aqueduct of Sylvius)
30
What many spinal nerves are there and how many for each section of the vertebral column?
31 spinal nerves in total ``` 8 cervical 12 thoracic 5 lumbar 5 sacral 1 coccygeal ```
31
What is the pathogenesis of a herniated disc?
the nucleus pulpous (soft central disc) herniates through the annulus fibrosis (outer ring) Usually around L4-L5 or L5-S1
32
At what level does the spinal cord end in an adult?
L1-L2
33
At what level should a lumbar puncture be performed?
L3-L4 or L4-L5
34
How is polio transmitted?
Fecal oral transmission replicates in the oropharynx --> small intestine before spreading via bloodstream --> CNS --> destruction of cells in anterior horn of spinal cord
35
Does poliomyelitis result in UMN or LMN lesions?
LMNs - weakness, hypotonia, flaccid paralysis, fasciculations, hyporeflexia, and muscle atrophy Also include signs of infection such as fever, HA, malaise
36
What is spinal muscular atrophy (Wernig- Hoffmann disease)?
congenital degeneration of anterior horns of spinal cord --> LMN
37
What are signs of Wernig-Hoffmann disease?
"floppy baby" with marked hypotonia and tongue fasciculations
38
What inheritance pattern is Wernig-Hoffmann disease?
AR
39
What is the genetic cause of Friedreich ataxia?
AR trinucleotide repeat disorder (GAA) on chromosome 9 in gene that encodes frataxin (iron binding protein)
40
What are physical findings of Friedreich ataxia?
staggering, frequent falling, nystagmus, dysarthria, pets cavus, hammer toes, hypertrophic cardiomyopathy Friedreich is Fratastic (frataxin): he's your favorite frat brother, always stumbling, staggering, and falling, but has a big heart
41
What is the cause of death with those wit Friedreich ataxia?
hypertrophic cardiomyopathy
42
In Brown-Sequard Syndrome, what are the two sensations that are CONTRALATERAL below the lesion?
pain and temperature sensation
43
What are physical signs of Horner Syndrome?
Ptosis Anhidrosis Miosis
44
What type of lesion is Horner Syndrome associated with?
A spinal cord lesion above T1 (e.g. Pancoast Tumor, Brown-Sequard Syndrome, late-stage syringomyelia)
45
Match the appropriate nerve root to the reflex... ``` S1, 2 L3, 4 C5, 6 C7, 8 L1, 2 S3, 4 ```
S1, 2 - achilles reflex ("buckle my shoe") L3, 4 - patellar reflex ("kick the door") C5, 6 - bicep ("pick up sticks") C7, 8 - tricep ("lay them straight") L1, 2 - cremaster reflex ("testicles move") S3, 4 - anal wink reflex ("winks galore")
46
A positive Babinski sign indicates what type of lesion in an adult?
UMN lesion
47
What CNs lie medially at the brain stem?
III, VI, and XII
48
What is the function of the pineal gland?
melatonin secretion, circadian rhythms
49
What is the function of the superior colliculi?
conjugate vertical gaze center
50
What is the function of the inferior colliculi?
auditory
51
Match the following cranial nerve nuclei to its CN nerves... midbrain pons medulla spinal cord
midbrain - CN III, IV pons - CN V, VI, VII, VIII medulla - CN IX, X, XII spinal cord - CN XI
52
What CN innervates the orbicularis oculi muscle?
CN VII
53
Name the afferent and efferent CNs responsible for the pupillary reflex
CN II - afferent | CN III- efferent
54
Name the afferent and efferent CNs responsible for the gag reflex
CN IX - afferent | CN X - efferent
55
What type of information is relayed to the nucleus solitarius?
visceral sensory information (e.g. taste, baroreceptors, gut distention) CN VII, IX, and X
56
What type of information is relayed to the nucleus ambiguous?
Motor innervation of pharynx, larynx, and upper esophagus (e.g. swallowing, palate elevation) CN IX, X, and XI (cranial portion)
57
What type of information is relayed to the dorsal motor nucleus?
sends autonomic (parasympathetic) fibers to heart, lungs, and upper GI CN X
58
Match the following opening with its appropriate nerves or vessels in the middle cranial fossa ``` optic canal superior orbital fissure foramen rotundum foramen ovale foramen spinosum ```
optic canal - CN II, ophthalmic artery, and central retinal vein superior orbital fissure - CN III, IV, V1, VI, ophthalmic vein, sympathetic fibers foramen rotundum - CN V2 foramen ovale - CN V3 foramen spinosum - middle meningeal artery
59
Match the following opening with its appropriate nerves or vessels in the posterior cranial fossa internal auditory meatus jugular foramen hypoglossal canal foramen magnum
internal auditory meatus - CN VII, VIII jugular foramen - CN IX, X, XI, jugular vein hypoglossal canal - CN XII foramen magnum - spinal roots of CN XI, brain stem, vertebral arteries
60
What is the path the blood from the eye takes to drain?
blood from eye and superficial cortex --> cavernous sinus --> internal jugular vein
61
What nerves go through the cavernous sinus?
CN III, IV, V1, V2, and VI and postganglionic sympathetic fibers
62
What will be seen with a CN V motor lesion?
jaw deviation TOWARDS the side of lesion d/t unopposed force from the opposite pterygoid muscle
63
What will be seen with a CN X lesion?
uvula deviates AWAY from side of lesion (weak side collapses and uvula points away)
64
What will be seen with a CN XI lesion?
weakness turning head to contralateral side of lesion (SCM) | shoulder droop on side of lesion (trapezius)
65
What will be seen with a CN XII lesion (LMN)?
tongue deviates TOWARDS side of lesion d/t weakened tongue muscles on affected side
66
What is the function of the 3 ossicles of the middle ear?
to conduct and amplify sound from eardrum to inner ear ossicles = malleus, incus, and stapes
67
Where in the inner ear are low frequencies heard?
at apex near helicotrema
68
Where in the inner ear are high frequencies heard?
at base of cochlea
69
What are the Rinne and Weber test results from someone with conductive hearing loss?
Rinne Test - abnormal (bone > air) | Weber Test - localizes to affected ear
70
What are the Rinne and Weber test results from someone with sensorineural hearing loss?
Rinne Test - normal (air > bone) | Weber Test - localizes to unaffected ear
71
How does noise induced hearing loss occur?
damage to the stereocilliated cells in organ of Corti
72
An UMN facial lesion would result in what clinical findings?
contralateral paralysis of lower face | forehead SPARED d/t bilateral UMN innervation
73
An LMN facial lesion would result in what clinical findings?
ipsilateral paralysis of upper AND lower face
74
What are clinical findings of a patient with facial nerve palsy?
ipsilateral facial paralysis (dropping smile) | inability to close eye on involved side
75
What are diseases associated with facial nerve palsy?
MC = idiopathic (Bell palsy) Associated diseases - Lyme disease - herpes simplex - herpes zoster (less common) - sarcoidosis - tumors - diabetes
76
What is the treatment for facial nerve palsy?
corticosteroids
77
What are the 4 muscles to mastication and what are they innervated by?
masseter (close jaw) temporalis (close jaw) medial pterygoid (close jaw) lateral pterygoid (opens jaw) All innervated by CN V3

First Aid STEP 1 - Neurology (6 decks)

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