Exam II Flashcards
1
Q
What are the three parts of a motor unit?
A
Peripheral axon, neuromuscular junction and innervated myocytes
2
Q
What is the name of the cells that produce myelin in the PNS?
A
Schwann cells
3
Q
A peripheral nerve injury that is characterized by direct injury to an axon and degeneration of peripheral segments and results in decreased amplitude and axon density.
A
Axonal neuropathy
4
Q
Axonal neuropathy in which myelin loss is a secondary result is called:
A
Wallerian degeneration
5
Q
A peripheral nerve injury that is characterized by damage to Schwann cells resulting in random internode demyelination and slow nerve conduction velocity.
A
Demyelinating neuropathy
6
Q
Demyelinating neuropathy is also called:
A
Segmental demyelination
7
Q
Carpal tunnel syndrome involves entrapment of a single nerve. This pattern of peripheral neuropathy is termed:
A
Mononeuropathy
8
Q
“Stocking-and-glove” parasthesia and anasthetia involve diffuse and asymmetric neuronal loss. This pattern of peripheral neuropathy is termed:
A
Polyneuropathy
9
Q
Damage that randomly affects portions of individual nerves follows which pattern of peripheral neuropathy?
A
Polyneuritis multiplex
10
Q
The disorder that is characterized by acute motor neuron demyelination that results in ascending paralysis is termed:
A
Guillan-Barre syndrome
11
Q
GBS is most common in:
A
Males aged 15-35 and 50-57 years
12
Q
Which disorder is characterized by symmetric, segmental demyelination/remyelination and can relapse and progress to chronic GBS?
A
Chronic Inflammatory Demyelinating Polyneuropathy (CIDP)
13
Q
What is the most common peripheral neuropathy?
A
Diabetic neuropathy
14
Q
Which peripheral neuropathy is considered mixed due to its damage of both axons and myelin?
A
Diabetic neuropathy
15
Q
What is the most highly recommended treatment option in diabetic neuropathy?
A
Daily foot inspection
16
Q
Which cause of peripheral neuropathy results in altered axonal transport and cytoskeletal damage and is observed in the distal extremities?
A
Environmental toxins
17
Q
Which cause of peripheral neuropathy results in damage to peripheral nerves and involves the polyneuritis multiplex?
A
Systemic vasculitis
18
Q
Genetic disorders that result in peripheral neuropathy are attributed to mutations in which gene?
A
PMP22
19
Q
The genetic disorder that leads to peripheral neuropathy most commonly in young adults and is slowly progressive is termed:
A
Charcot-Marie-Tooth disease
20
Q
In myasthenia gravis, autoantibodies block:
A
Post-synaptic Ach receptors
21
Q
MG is characterized by:
A
Thymic hyperplasia and extraocular weakness and becomes worse with e-stimulation
22
Q
MG is most common in:
A
Females in the 3rd decade of life and males in the 5th-6th decade of life
23
Q
Which test inhibits acetylcholinesterase (AchE)?
A
Tensilon test
24
Q
In Lambert-Eaton syndrome, autoantibodies inhibit:
A
Pre-synaptic calcium channels
25
Which form of NMJ disorder mimics MG and Lambert-Eaton syndrome?
Congenital myasthenic syndrome
26
Which two bacteria cause infectious NMJ disorders?
C. tetani and C. botulinum
27
C. _____ increases Ach release, while C. _____ decreases Ach release.
tetani; botulinum
28
Which muscle fiber is characterized as slow twitch, aerobic, dark and uses fat metabolism?
Type I
29
Which muscle fiber is characterized as fast twitch, anaerobic, white and uses glycogen metabolism?
Type II
30
Disuse atrophy and glucocorticoid atrophy primarily involve which fibers?
Type II
31
The group of most common forms of muscular dystrophy are termed:
Dystrophinopathies
32
Duchenne muscular dystrophy is characterized by:
Absence of dystrophin
33
What is the most common dystrophinopathy?
DMD
34
Becker MD is characterized by:
Dystrophin is present but has variable function
35
DMD is most common in which population?
Childhood onset (Age 5), wheelchair-bound in their teens and lethal in early adulthood
36
BMD is most common in which population?
Delayed onset (adolescence), less severe than DMD
37
What are the features of DMD and BMD?
Pelvic girdle muscles primarily impacted and pseudohypertrophy of calf muscles
38
Lab values for patients with DMD/BMD include finding increased:
Creatine kinase
39
How do patients die from DMD/BMD?
Respiratory insufficiency
40
The type of inflammatory myopathy that is autoimmune and is most common in males aged 45-60 years.
Polymyositis
41
The most common inflammatory myopathy in children is termed:
Dermatomyositis
42
The most common myopathy among elderly patients is termed:
Inclusion body myositis
43
Overproduction of thyroxine, goiter or Graves disease are characteristics of:
Thyrotoxic myopathy
44
Binge drinking, rhabdomyolysis and a progression into renal failure are characteristics of:
Ethanol myopathy
45
Drug myopathy is characterized by adverse effects by various agents, the most common being:
Statins
46
The peripheral nerve sheath tumor that most commonly involves CN8 is called:
Schwannoma (Vestibular schwannoma)
47
Multiple CNS and cutaneous schwannomas absent vestibular schwannomas is termed:
Schwannomatosis
48
Neurofibromatosis that exhibits pronounced neurofibromas and mutations on chromosome 17 is characteristic of:
Neurofibromatosis type I
49
NF1 is also called:
von Recklinghausen disease
50
Bilateral vestibular schwannomas and the merlin gene that most commonly result in vision and hearing problems are all characteristics of:
NF2
51
Swelling of the soma and displacement of the Nissl substance are characteristic of:
Reversible neuronal injury
52
The presence of "red neurons," eosinophilia and axonal swelling are all characteristic of:
Irreversible neuronal injury
53
Minimal fibrosis occurs following CNS injury to:
Astrocytes
54
The presence of glial filaments sprouting is termed:
Gemistocytic astrocyte
55
Which cells produce myelin in the CNS?
Oligodendrocytes
56
Which cells are considered CNS phagocytes?
Microglia
57
What is the function of the choroid plexus?
Produces CSF
58
The rabies virus produces _____ in the cytoplasm.
Negri bodies
59
The presence of an "owl's eye" is indicative of:
Cytomegalovirus
60
The presence of Lewy bodies is indicative of:
Parkinson's disease
61
Neurofibrillary tangles and beta-amyloid plaques are indicative of:
Alzheimer's
62
Accumulation of lipids in the cytoplasm or lysosomes is indicative of:
Lipofuscin
63
Blood-brain-barrier disruption resulting in increased permeability is termed:
Vasogenic cerebral edema
64
Neuronal/glial membrane injury resulting in increased intracellular fluid retention is termed:
Cytotoxic cerebral edema
65
What are the three distinct features of cerebral edema?
Flattened gyri, narrowed sulci, and ventricular compression
66
Increased CSF volume most commonly involves:
Altered flow or resorption
67
Hydrocephalus that occurs at
Cranial enlargement
68
Hydrocephalus that occurs at >2 years old results in:
Increased ICP and ventricular enlargement
69
What is the most common treatment for hydrocephalus?
Shunting
70
Hydrocephalus that occurs as a result of an infarct or neurodegeneration is termed:
Hydrocephalus ex vacuo
71
What is the most common form of brain herniation?
Subfalcine (cingulate)
72
Which brain hernia involves CNIII and Duret hemorrhage?
Transtentorial (uncinate)
73
Duret hemorrhage involves vessels that enter the _____ that are then disrupted by herniation.
Pons
74
Injury to the cortex and the red nuclei that results in extension of the legs along with internal rotation is most likely:
Decorticate rigidity
75
Injury to the brainstem between red nuclei and vestibular nuclei that results in extension of all 4 limbs and pronation of the arms/plantar flexion is most likely:
Decerebrate rigidity
76
What is the most common cause of neurologic morbidity?
Cerebrovascular disease
77
Which features are all considered a "stroke?"
Thrombotic occlusion, embolic occlusion and vascular rupture
78
Decreased O2 partial pressure and decreased O2 carrying capacity are characteristics of:
Functional hypoxia
79
Ischemia and hypoxia are indicative of what type of necrosis?
Liquefactive
80
A patient that exhibits severe hypotension is likely experiencing:
Widespread ischemic/hypoxic injury
81
What is the most common focal cerebral ischemia?
Emboli
82
Primary brain parenchymal hemorrhage is most common in:
Older adults (60 or older)
83
What are the most common locations for primary brain parenchymal hemorrhage?
Thalamus, pons and cerebellum
84
A patient presents with the "worst headache I've ever had." You would suspect:
Subarachnoid hemorrhage
85
Subarachnoid hemorrhaging most commonly involves the rupture of:
Saccular (berry) aneurysm
86
In arteriovenous malformations, a tangle of arteries and veins are connected via:
1 or more fistula
87
Arteriovenous malformations are most common in:
Males ages 10-30 years
88
Hypertension has what effect on vessel walls?
Weakens vessel walls
89
A single artery occlusion is termed a:
Lacunar stroke
90
Ruptured small cerebral vessels where a "slit-like cavity" remains is termed:
Slit hemorrhage
91
A patient presents with global cerebral dysfunction, with a diastolic BP of >130 and increased ICP. You suspect:
Acute hypertensive encephalopathy
92
Systemic, autoimmune vasculitis with fibrinoid necrosis of small arteries is termed:
Polyarteritis nodosa
93
Primary angiitis of the CNS is characterized by chronic inflammation of:
Multiple parenchymal and subarachoid vessels
94
CNS trauma is most common in:
Males
95
Silent CNS trauma is most likely associated with:
The frontal lobe
96
CNS trauma of the spinal cord is:
Disabling
97
If a patient has had fatal CNS trauma, which area was most likely damaged?
Brainstem
98
What tissues are damaged in CNS trauma?
Parenchyma and vasculature
99
How would you assess CNS trauma?
Airway, breathing, circulation and disability (ABCD)
100
A contusion at the impact site is called a _____, while a contusion on the opposite side of impact is called a _____.
Coup; contrecoup
101
Tearing of the cerebral parenchyma is considered a:
Laceration
102
Tissue displacement or injury and edema are characteristics of a:
Contusion
103
Movement of one region relative to another, commonly from angular acceleration is called:
Diffuse axonal injury (DAI)
104
Reversible altered consciousness from head injury in the absence of a contusion is called a:
Concussion
105
Epidural hemorrhaging is characterized by damage to _____, while subdural hemorrhaging is damage due to _____.
Dural artery; Rapid movement tears veins
106
The most common CNS malformation is:
Neural tube defects
107
An asymptomatic bony defect is indicative of:
Spina bifida occulta
108
Extension of the CNS through a vertebral defect is indicative of:
Myelomeningocele
109
Abnormal widening of the central canal is called:
Hydromyelia
110
A cyst within the cord is called:
Syringomyelia (syrinx)
111
Which microbe(s) is/are responsible for acute pyogenic meningitis in neonates?
E. coli and Group B strep.
112
Which microbe(s) is/are responsible for acute pyogenic meningitis in adolescents and young adults?
Neisseria meningitidis
113
Which microbe(s) is/are responsible for acute pyogenic meningitis in older adults?
Strep. pneumoniae and Listeria monocytogenes
114
Which form of meningitis is self-limiting?
Aseptic
115
Diffuse parenchymal infections are caused by _____, while localized and septic parenchymal infections are caused by _____.
Viruses; bacteria
116
Which types of parenchymal infections are associated with meningitis?
Viral and fungal
117
What is the most common disorder of myelin and what is the prevalence in the US?
Multiple sclerosis; 1 per 1000
118
What are the risk factors for MS?
Young adults, females and a family history of MS
119
What genetic antigen is well established as a predisposition for MS?
HLA-DR2
120
Plaques associated with MS will most likely target which cranial nerve?
CNII (Optic)
121
Wernicke-Korsakoff syndrome is associated with a deficiency of:
Thiamine
122
Which metabolic disorder mimics hypoxia, with the hippocampus most likely susceptible?
Hypoglycemia
123
Which metabolic disorder is associated with demyelination?
Vitamin B12 deficiency
124
The most common cause of dementia, characterized by beta-amyloid plaques, is called:
Alzheimer's disease
125
Patients with Alzheimer's disease will be most commonly disabled by _____ within _____.
Lethal pneumonia within 5-10 years
126
What age group presents the highest risk for developing Alzheimer's? Lowest risk?
Highest: >85 years (47%)
Lowest: 65-74 years (3%)
127
Motor disturbances, tremor, bradykinesia and damage to dopaminergic neurons are all indicative of:
Parkinson's disease
128
Parkinson's disease will most likely attack the:
Substantia nigra
129
What are the two most commonly involved structures in Huntington disease?
Caudate and putamen nuclei
130
Huntington disease has a delayed onset, most commonly affecting ages:
30-40 years
131
The Huntington gene is present on which chromosome?
Chromosome 4
132
What functions are spared in ALS?
Sensation and extraocular motor
133
Upper and lower motor neurons are commonly killed in which disease?
ALS
134
Patients with ALS often die as a result of:
Respiratory paralysis
135
Most CNS tumors are:
Primary
136
Which gliomas are diffuse/infiltrative?
Astrocytoma and oligodendroglioma
137
Which glioma is not diffuse or infiltrative?
Ependymoma
138
What is the mean survival time for a glioblastoma?
15 months
139
Which glioma is the most lethal and has the poorest prognosis?
Astrocytoma
140
What is the most common embryonal neoplasm?
Medulloblastoma
141
What is the most common CNS tumor among immunosuppressed (AIDS) patients?
Primary CNS lymphoma (Diffuse large B cell lymphoma)
142
What is the most common benign tumor of adults?
Meningioma
143
What is the #1 cause of morbidity and mortality in the US?
Vascular disease
144
What are the 2 mechanisms of vascular disease?
Narrowing/obstruction of the lumen and Weaking of the vessel walls
145
What are the 3 layers of vessel walls?
Intima, media and adventitia
146
The inner portion of the media is supplied by:
Diffusion of blood from the lumen
147
The outer portion of the media is supplied by:
Vasa vasorum
148
What is the order of the vascular pathway?
Large elastic arteries --> Medium-sized muscular arteries --> Small arteries --> Arterioles
149
What are the 3 main vascular anomalies?
Intracranial berry aneurysms, arteriovenous fistulas, and fibromuscular dysplasia
150
What are the effects of increased blood pressure?
Stimulates atrial natriuretic peptide (ANP), reduced sodium resorption and vasodilation
151
What are the effects of decreased BP?
Stimulates renin-angiotensin system (RAS), increased sodium resorption and vasoconstriction
152
Blood pressure medications influence what 2 things?
Angiotensin II receptor blockers and diuretics
153
What is the clinical BP reading to be considered hypertension?
>140/90
154
Percentage of HTN cases considered "essential HTN?"
95%
155
Which race is more at risk to HTN?
African-Americans
156
In what ways does the vascular wall respond to injury?
Smooth muscle cell recruitment/mitosis and irreversible intimal thickening
157
Which pattern of arteriosclerosis is characterized by calcium deposits in the arteries?
Monckenberg medial sclerosis
158
Which pattern of arteriosclerosis affects small arteries and could result in ischemic injury?
Arteriolosclerosis
159
The tunica media is separated from the tunica adventitia by the:
External elastic lamina
160
Atherosclerosis is most likely to involve:
Large elastic arteries
161
Which layer of the vessel wall contains endothelial cells?
Tunica intima
162
What percentage of the general population are hypertensive?
25%
163
What is a standard response following vascular injury?
Medial thickening and intimal thickening
164
Which of the following is not a category of arteriosclerosis?
A. Arteriolosclerosis
B. Monckenberg medial sclerosis
C. Endotheliosclerosis
D. Atherosclerosis
C. Endotheliosclerosis
165
Without appropriate treatment, what percentage of hypertensive individuals will die from a stroke?
1/3 or 33%
166
Metabolic syndrome is not associated with which of the following?
A. Dyslipidemia
B. Foam cells
C. Insulin resistance
D. Central obesity
B. Foam cells
167
Extravasation of blood into the wall of an artery is associated with a:
False aneurysm
168
Which type of aneurysm is associated with all 3 layers of a vessel or heart wall?
True aneurysm
169
What are 2 key features of atherosclerotic plaques?
Thickening of the tunica intima and lipid accumulation
170
What percent of arteriosclerosis is atherosclerosis?
99%
171
A polyneuropathy is most likely to have a _____ distribution.
Symmetric
172
The clinical features _____ involve ptosis and diplopia.
MG
173
Acute renal failure may result from rhabdomyolysis secondary to:
Binge-drinking
