Midterm 4 Soruları Flashcards

Question

Which of the following features regarding acute hypertensive encephalopathy are correct? (Choose as many as required) A) Most of the patients have spontaneous recovery B) Can be presented with headache, confusion, vomiting and sometimes coma C) Edematous brain is heavier than normal in gross examination D) In microscopy petechiae and arteriolar necrosis in gray and white matter, fibrinoid necrosis of the vessel wall is observed E) Characterized by diffuse cerebral dysfunction

Answer 1

Everything except A is correct ( A) Most of the patients have spontaneous recovery) Diğerlerini oku ve öğren.

Answer 2

All except B are correct. Diğerlerini oku ve öğren.

Answer 3

Essential tremor is a simple kinetic tremor occurs during entire movement trajectory

Answer 4

methylation

Answer 5

Middle meningeal artery Feedback: About 70 to 80% of epidural hematomas are in the temporoparietal region. A skull fracture crosses the middle meningeal artery or its dural branches. Occipital and frontal hematomas each occur in about 10% of cases. Most epidural hematomas are arterial but one-third are venous. These usually occur at the posterior fossa or parietooccipital region. They can cause subalpine herniation or midline shift.

Answer 6

Retrochiasmal lesions mean those between chiasm and the occipital lobe in the visual system. This location causes a homonymous hemianopia (loss of vision on either right or left side of both eyes)

Answer 7

All except D is correct. D--> A frontal plane is also known as CORONAL plane

Answer 8

Extrapyramidal system Festination of gait in anteflexed posture is a characteristics of extrapyramidal disorders, specifically of parkinsonism.

Answer 9

Lidocaine Lidocaine is an amide type local anesthetic that is commonly used (combined with epinephrine) to produce a block of the brachial plexus. The other drugs are ester type LAs (notice that ester type LAs do not have “i” before “caine” suffix).

Answer 10

8 eye opening to pain 2; best motor response flexor posturing 3; best verbal response inappropriate words 3

Answer 11

Intraretinal microabnormalities

Answer 12

B and E Axons from ganglion cells cross the retina as the nerve-fiber layer and become the optic nerve. Nerve fibres from the nasal side of each retina CROSS-OVER to the opposite side. Nerve fibres from the temporal side of DO NOT CROSS but pass into optic tracts of the same side. Optic tracts originate from the postero-lateral angle of the optic chiasma and connect to the lateral geniculate body on the posterior of the thalamus. They consist of the temporal fibres of the same side and the nasal fibres of the opposite side. The fibres of the optic tracts end in the lateral geniculate bodies (LGB) and new fibres of the optic radiations originate from them. Optic radiations extend from the LGB to the visual cortex and consist of the axons of third order neurons of visual pathway. Occipital cortex are situated above and below the calcarine fissures in the occipital lobes extending up to the occipital poles.

Answer 13

Reticular formation Stimulants, such as amphetamines and caffeine, increase the activity of the reticular formation (reticulospinal pathway) and are usually used or abused to stimulate the central nervous system (CNS) and maintain wakefulness.

Answer 14

Proximal arm and proximal leg weakness Weakness is symmetrical and affects the proximal more than distal muscles of the arms and legs.

Answer 15

Oligodendroglioma Oligodendroglioma--> Calcification and sharply demarcation is generally observed in the radiology of oligodendrogliomas and the patient can be presented with epiteptic attacks. In the histological examination of the oligodendrogliomas fried egg-like cells (oligodendrocyte-like), fine anastomosing vascular structures is observed in thin fibrovascular stroma is observed Pilocytic astrocytoma--> In pylocytic astrocytoma Long thin, GFAP-positive bipolar cells with hair-like extensions, rosenthal fibrils and eosinophilic granular bodies are observed Glioblastoma--> Mitosis and necrosis are the characteristics of glioblastomas Ependymoma--> Ependymomas show ependymal tubulary like structures in the histology and dysembryoblastic neuroepithelial tumor has floathing neurons. Meningioma--> they can also have calcification but they are extraaxial tumors with meningothelial cell proliferation.

Answer 16

F) Viral meningitis is often called aseptic meningitis because routine cultures for bacterial pathogens are negative. Microbiologic diagnosis of bacterial infections is frequently made using Gram stain and culture of spinal fluid and blood. Polymerase chain reaction (PCR) assays are also useful.

Answer 17

B, D and E are correct. UNUTMA--> Muscle distrophylerde ocular ve bulbar kaslar etkilenmez. Hangi hastalılarda etkilenir--> Myasthenia gravis, Guillan barre (başka varsa onları da ekle)

Answer 18

D hariç hepsi doğru Info: Multiple Sclerosis (MS), devic's disease (Neuromyelitis optica), acute disseminated encephalomyelitis (ADEM), acute necrotizing hemorrhagic encephalomyelitis, central pontine myelinosis, Marchiafava-Bignami disease and progressive massive encephalopathy are among demyelinating diseases but one of the most common form of the disease is MS.

Answer 19

Glutamate Feedback: Glutamate is an excitator neurotransmitter, both in pathways of pain and central nervous system. Glysine, GABA, alpha-2 agonists have inhibitory roles.

Answer 20

Vancomycin

Answer 21

Legs kick, cycle, dance movements This is a frontal lobe seizure feature

Answer 22

E, F hariç hepsi doğru Feedback: Since simple febrile seizures are brief and the outcome is benign, most children require no treatment. Only rectal diazepam can be administered during a seizure to abort a prolonged convulsion; it is appropriate to provide a "rescue medication" for children with a history of prolonged febrile seizures, but not a long term daily treatment with antiseizure medications. Since antiseizure medications have side effects and children with febrile seizures have an excellent prognosis, daily antiseizure medication to prevent febrile seizures is not recommended Feedback 2: Simple febrile seizures occur in otherwise healthy and normal children. Complex febrile seizures occur in children having preexisting neurological challenges.

Answer 23

Increase the dose of anticholinesterase drug being used Info: Anticholinesterase drugs will not be effective as the number of receptors remaining become insufficient to produce an adequate EPPs. Alternative approaches are to remove circulating antibodies (Abs) by plasma exchange (transiently effective) or to inhibit Ab production with immunosuppressant drugs (e.g. prednisolone, azathioprine, mycophenolate, cyclosporine and tacrolimus) or thymectomy.

Answer 24

All correct except B Penumbra--> kan akımının azaldığı ama kalıcı hasarın henüz oluşmadığı çekirdek etrafındaki bölgedir. Kurtarılabilir bölge de denebilir. Ischemic core--> Kurtarılamaz bölge, kan akışı geri gelse bile.

Answer 25

Myelomeningocele Info: Neural tube defects are a spectrum of congenital anomalies which include cranial defects and open or closed spinal dysraphism. Open spinal dysraphism or spina bifida aperta are visible lesions and include several malformations; one of them is myelomeningocele. Closed spinal dysraphism and spina bifida occulta are non visible lesions with no obvious signs recognized during physical examination. Patients often go asymptomatic with no future complications and usually do not require treatments. Myelomeningocele could be associated with other anomalies such as Type II Arnold-Chiari malformation. Dermoid cyst, terminal myelocystocele, sacral agenesis, and sacrococcygeal teratomas are another differential diagnoses of myelomeningocele.

Answer 26

Frontoparietal cortex - brain stem

Answer 27

Upper motor neuron lesion and spasticity Upper motor neuron lesion causes spasticity type increased motor tone, whilst lower motor neuron causes atrophy and decreased motor tone.

Answer 28

Paranasal sinusitis

Answer 29

Enhancement of GABA effects Info: GABA is the major inhibitory neurotransmitter (NT) in the CNS. Enhancing its effects will result in symptoms ranging from sedation to surgical anesthesia . Activation of NMDA (an excitatory NT) would not produce anesthesia, nor would blocking K channels (which would most likely increase excitablity). Blocking the effects of glycine, an inhibitory NT would also not make sense as a mechanism of general anesthesia.

Answer 30

AA and A is incorrect. Others are correct.

Answer 31

All except B is correct. Medulloblastoma is a malignant embryonal tumor of the posterior fossa (cerebellar hemispheres &vermis) so it locates at the infratentorial region. It is thought to be the most common malignant embriyonal brain tumor in children (accounts for 90% of embryonal CNS tumors) and comprises up to 20% of all pediatric brain tumors

Answer 32

Nausea, vomiting, unidirectional nystagmus, and tinnitus Info: Peripheral vertigo usually has prominent nausea and vomiting, inhibition of nystagmus by ocular fixation, and unidirectional nystagmus aggravated by head position (Hallpike maneuver). Central vertigo often has dysarthria, facial numbness, or leg weakness, which are brainstem signs. Central vertigo has minimal nausea, nystagmus not related to head position, and nystagmus which is multi-directional. Vertigo caused by a dysfunction of the vestibular system or inner ear, which is composed of the semicircular canals, the vestibule, and the vestibular nerve is called "peripheral," "otologic" or "vestibular" vertigo. The most common cause is benign paroxysmal positional vertigo. Other causes include Ménière's disease, superior canal dehiscence syndrome, labyrinthitis, and visual vertigo. The common cold, influenza, and bacterial infections may cause transient vertigo if it involves the inner ear, as may aminoglycosides, or physical trauma. Motion sickness is also a cause of peripheral vertigo. Patients with peripheral vertigo typically present with mild to moderate imbalance, nausea, vomiting, hearing loss, tinnitus, and pain in the ear. Also, lesions of the internal auditory canal may be associated with facial weakness on the same side. Acute vertigo as a result of a peripheral lesion usually improves in a short period of time (days to weeks).

Answer 33

Right pons Left hemiparesis with a Babinski sign + peripheral type Right facial paresis localize the patient's lesion to the brainstem level (crossed hemiparesis); since the facial nerve lesion is lower motor neuron type and its nucleus is placed at the level of pons, the site has to be at Right pons.

Answer 34

Cochlea Sensorineural hearing loss result from cochlear abnormalities and/or an abnormality of the vestibulocochlear nerve or central auditory pathways.

Answer 35

The first 2 are correct only. Info: Neostriatum consisting from caudate and putamen, receives cortical afferents and projects mainly to globus pallidus. Neostriatum consisting from caudate and putamen is not part of either pyramidal system or cholinergic pathway; and is not directly linked to olfactory system.

Answer 36

Pilocytic astrocytoma Long thin, GFAP-positive bipolar cells with hair-like extensions, rosenthal fibrils and eosinophilic granular bodies are the histological features of pilocytic astrocytoma which is mostly seen in young age -in cerebellum- and presented with cystic mural nodule. Mitosis and necrosis is not observed in pylocytic astrocytoma while glioblastomas have. Ependymomas also seen mostly in childhood but there is ependymal tubulary like structures in the histology and dysembryoblastic neuroepithelial tumor has floathing neurons. Meningiomas are mostly adulthood tumors with meningothelial cell proliferation.

Answer 37

S.agalactiae is the answer. The CSF shows Gram positive cocci.

Answer 38

Ataxia and dysmetria Cerebellar lesions cause ipsilateral dysmetria, hypotonus, dyssynergia, dysdiadokokinesia, ataxia. (Diğer ikisi neden olmadı bak)

Answer 39

Control of muscle tone and Coordination of movements On the other hand, extrapyramidal system does not involve in sensation of vibration or olfaction. The muscle tone increase in extrapyramidal system disorders is either leadpipe type or cogwheel type rigidity; not spastic type

Answer 40

Fever and skin rush may address to an underlying problem of menenjitis in a patient with headache

Answer 41

Left temporal Feedback: Right upper motor neuron type hemiparesis indicates a contralateral corticospinal lesion (meaning left corticospinal tract). The sensory type of aphasia (or Wernicke type) accompanies to the condition and this localizes the lesion site to neocortical level of temporal lobe. Wernicke's area on the left has specialized in comprehension of language that is among the higher cortical functions. Higher cortical function abnormality indicates a neocortical involvement in the brain.

Answer 42

Minor hemisphere (mostly right) Feedback: Neglect accompanying a left "upper motor neuron type" hemiparesis indicates a lesion in the minor hemisphere cortical lesion. A focal sign of higher cognitive impairment is indicative of neocortical lesion depending on the cortical site. For example if it is aphasia, the lesion must be in the major hemisphere which the left hemisphere in majority of people (over 90%)

Answer 43

UMN Spastic paresis LMN Flaccid paresis UMN No or very mild atrophy LMN Severe atrophy UMN Increased deep tendon reflexes LMN Absent deep tendon reflexes LMN Fasiculation and fibrilation

Answer 44

Optic tracts Feedback: Optic chiasm is a flat band-like structure lying above the pituitary fossa. Nerve fibres from the nasal side of each retina CROSS-OVER to the opposite side at this site. Nerve fibres from the temporal side of DO NOT CROSS but pass into optic tracts of the same side. Due to this crossing, visual field loss occurs in the form of hemianopsia in both optic chiasma and damage to the optic tract, which is the visual pathway that follows. However, while the damage to the optic chiasm causes heteronym hemianopsia (bitemporal half visual field loss), a homonym (half visual field loss on the same side in both eyes) occurs in the optic tract damage.

Answer 45

6 Diplopia can be resulted lesion from the three possible CNs: CN 3, 4, 6.

Answer 46

Propranolol Propranolol is NOT a good choice for this patient. Propranolol would likely keep the patients’ heart rate down during exercise, and would interfere with any beta-2 bronchodilator used to treat asthma

Answer 47

B, C, E are correct. Feedback: Heliotropic erythema of the upper eyelid and Gottron papules are caused by a disease called dermatomyositis and associated autoantibodies against the endothelium of small arterioles. Inclusion body myositis effects small muscles with asymmetrical involvement and there are clear vacuoles within the sarcolemma as well as amyloid in these inclusions. Myastenia gravis is a disease which is caused by caused by antibodies to acetylcholine receptors and can be fatal due to respiratory involvement. Thymoma is seen in 15-20% of the patients with myasthenia gravis and muscle weakness is evident in the late hours of the day. While voltage-gated calcium channel (VGCC) autoantibodies are observed in Lambert-Eaton Myasthenic Syndrome an it is usually paraneoplastic.

Answer 48

The definition of allodynia is pain caused by stimuli that are usually not painful.

Answer 49

All except 3rd one are correct Feedback: The findings vary depending on the type and cause of peripheral neuropathy. For example in axonal diseases, slowly progressing symmetrical loss of sensation often spreads in the form of gloves and socks reflecting the injury of the distal axonal processes. Motor deficits are presented with weakness and reduced or absent deep tendon reflexes. Findings such as postural hypotension and constipation is observed in deficits of the autonomic system. Moreover there may be asymmetric neurological deficits. Since it may cause randomly distributed multiple nerve involvement, especially in neuropathies caused by vasculitis. In the clinical identification neuropathy is named mononeuropathy if only one

Answer 50

C) Mechanical thrombectomy is an option for recanalization.

Answer 51

Retinal blood vessels endothelium Retinal blood vessels endothelium that are similar to cerebral blood vessels maintain the inner blood-ocular barrier. The retinal pigment epithelium maintains the outer blood–retinal barrier. Choriocapillaries supply outer third of the retina Retinal nerve fibre layer consist of axons of the ganglion cell bodies

Answer 52

Metastatic adenocarcinoma Astrocytomas , medulloblastoma, ependymoma and craniopharyngioma are among the most common brain tumor types in children. Majority of brain tumors are primary tumors in children, metastatic adenocarcinoma is very rare/exceptional in pediatric age group

Answer 53

Basiller artery

Answer 54

α1-adrenergic Catecholamines include epinephrine, norepinephrine, and dopamine. All of these receptors are G protein–coupled receptors (GPCRs), but only α1-adrenergic receptors cause an increase in the intracellular calcium concentration. Stimulation of this receptor releases the Gq subunit, which in turn activates phospholipase C leading to inositol triphosphate (IP3). One of the downstream effects of IP3 is to bind calcium channels in the smooth endoplasmic reticulum to release stored calcium and raise the intracellular calcium concentration.

Answer 55

Oligodendrocytes This patient presented with the signs and symptoms characteristic of a space-occupying lesion. This is supported by the morning headaches, focal neurological signs such as arm weakness as the new-onset seizure in a man of this age. The magnetic resonance imaging scan showed an area of hyperintensity confirming the presence of a mass lesion in the right frontal lobe. In addition, it was revealed that the mass had a chicken-wire capillary pattern and calcification, and this indicates the mass is most likely to be a brain tumor known as oligodendroglioma. This a brain tumor which presents in adulthood and is derived from the myelin-producing oligodendrocytes in the central nervous system. - Arachnoid cells are the cells from which meningiomas originate. Meningiomas are commonly benign and they may present in adulthood with symptoms of a space-occupying lesion such headaches and seizures. They are often located close to the brain surface and in the parasagittal region. Histopathology often reveals the presence of psammoma bodies. - Astrocytes are the cells from which glioblastoma multiforme originate. Glioblastoma multiforme is a highly malignant brain tumor presenting in adulthood and have a very bad prognosis. They are commonly located in the cerebral hemispheres and are referred to as butterfly glioma if they spread across the corpus callosum. Histopathology usually shows that they glial fibrillary acidic protein (GFAP) positive with pleomorphic tumor cells close to necrotic and hemorrhagic areas. - Anterior pituitary cells are the cells from which pituitary adenomas originate. Pituitary adenomas can cause various symptoms based on the type of endocrine cells affected. The hormonal symptoms can be related to elevated levels of GH, TSH or ACTH amongst others. Symptoms due to mass effect will often cause bitemporal hemianopia due to compression of the optic chiasm. - Oligodendrocytes are the cells from which oligodendrogliomas originate. Oligodendrogliomas are a brain tumor which presents in adulthood and is derived from the myelin-producing oligodendrocytes in the central nervous system. Magnetic resonance imaging will often show a chicken-wire capillary pattern and histopathology often shows cells with a clear cytoplasm and round nuclei, referred to as ‘’fried egg’’ cells. - Capillaries and blood vessels cells are the cells from which hemangioblastomas originate. Hemangioblastomas are often present in the cerebellum. If retinal angiomas are also present in the patient, they are often associated with von Hippel-Lindau cancer syndrome. Histopathology will often show capillaries with a thin wall and minimal parenchyma.

Answer 56

Migraine Migraine is generally an episodic headache with certain associated features, such as sensitivity to light, sound or movement, and often with nausea or vomiting accompanying the headache

Answer 57

Gower's sign A positive Gower’s sign is seen in children with Duchenne muscular dystrophy. Gower's sign has moderate sensitivity and high specificity and is classically seen in children with duchenne muscular dystrophy, and is due to weakness of the proximal muscles, mainly those of the lower limbs. Idiopathic toe walking may also be seen in DMD but is more classically seen in cerebral palsy, however, it is not the correct answer as it does not fit the description in the vignette. Allis sign, also known as Galeazzi's test, is used to assess for hip dislocation, primarily in order to test for developmental dysplasia of the hip. Tinel's sign is a way to detect irritated nerves. It is performed by lightly tapping (percussing) over the nerve to elicit a sensation of tingling or 'pins and needles' in the distribution of the nerve.

Answer 58

Peripheral nerves

Answer 59

Gonioscopy *Tonometry is often used as a diagnostic tool *The Tonometer is gently pressed against the eyeball, and the resistance (internal pressure) is measured. *Open-angle glaucoma, IOP is usually between 22 and 32 mm Hg *Acute angle-closure glaucoma- IOP may be over 50 mm Hg *Gonioscopy can be used to determine if the angle where the iris meets the cornea is open or closed *Visual field (Perimetry) is an essential method used to determine if there is any loss of the visual field *Measurement of Retinal Nerve Fiber Layer thickness with OCT is the most recent advancement in technology that aids in the diagnosis of glaucoma

Answer 60

Ipsilateral midriasis

Answer 61

Pyridoxine

Answer 62

B is not, but others are. Degenerative diseases involving basal ganglion and brain stem often presents with: rigidity like difficulty in walking or decrease in facial movements, abnormal posture like stooped posture, movevement disorders such as Chorea, decrease in voluntary movements, increase in involuntary movements.

Answer 63

Cerebral edema and ischemia If secondary injury is not be cured, brain edema and ischemia can devolop.

Answer 64

Median arterial pressure and intracranial pressure difference Intracranial pressure and intracranial venous pressure difference CPP = MAP – ICP CPP ≥ 60-80mmHG

Answer 65

A) Congenital myopathies tend to cause rapidly progressive clinical worsening

Answer 66

Cerebellar tremor Cerebellar tremor is intentional and usually seen with other cerebellar symptoms like dysmetria and dysdiadocokynesia

Answer 67

Gliomas Gliomas (45-50%): They are the most common brain tumors. Astrocytic tumors (75%), Oligodendroglial tumors (5%), Ependymal tumors (5-7%)

Answer 68

Parkinson’s disease

Answer 69

Medial wall of the orbit Roof of orbit Composed of the lesser wing of the sphenoid, and orbital plate of the frontal bone Lateral wall of orbit *Separated from the roof by the superior orbital fissure *Composed of the greater wing of the sphenoid and zygomatic bone Floor of orbit *Separated from the lateral wall by the inferior orbital fissure *Composed of maxillary bone, zygomatic bone and palatine bone *Orbital contents can herniate into the maxillary sinus in trauma cases Medial wall *Composed of the ethmoid bone, sphenoid bone, lacrimal bone and maxilla

Answer 70

Sumatriptan

Answer 71

Erb Duchenne Paralysis (upper part of Plexus brachialis) Erb's palsy or Erb–Duchenne palsy is a form of obstetric brachial plexus palsy. It occurs when there's an injury to the brachial plexus, specifically the upper brachial plexus at birth. The injury can either stretch, rupture or avulse the roots of the plexus from the spinal cord.

Answer 72

Myasthenia gravis (MG) Feedback: Myasthenia gravis is an autoimmune condition that is characterised by autoantibodies directed at the post-synaptic anticholinergic receptors. Thymomas are present in a subset of MG patients and CT’s are done to exclude this. The CT mass is a thymoma and local invasion of this mass is causing the patient’s dry cough and breathlessness. The increased lethargy throughout the day and dysphagia are common symptoms of MG sufferers. Anaemia and may present with some similar symptoms but would not account for the mass. Lung carcinoma is a possibility but the characteristic worsening of symptoms in the evening more likely points to MG. Sarcoidosis would reveal different CT findings such as lymphadenopathy, ground grass appearance, nodules and 0 out of 1 points granulomas. Fibromyalgia typically would present with a different picture including widespread pain, insomnia, stiffness and fatigue.

Answer 73

Extracellular amyloid plaques and intracellular fibrillary tangles

Answer 74

Gram-positive rod Listeria monocytogenes cause listeriosis, a foodborne illness. Listeria is a gram-positive, facultatively anaerobic, non-spore-forming bacillus. It is contracted by consuming prepared foods that are contaminated with L. monocytogenes. L. monocytogenes contains 0 out of 1 points several virulence factors that aid in disease progression. Actin polymerization allows the bacteria to move quickly from cell to cell.

Answer 75

Primary generalized seizure

Answer 76

All except rigidity

Answer 77

Vasogenic edema Patients suffering TBI often develop oedema, which increases ICP and impairs tissue perfusion. The result of increased vascular permeability associated with BBB disruption, (or vasogenic oedema) is the paracellular leakage of protein and ion rich fluid into the brain

Answer 78

B ve D doğru.

Answer 79

Inner blood-ocular barrier Info: Retinal blood vessels endothelium that are similar to cerebral blood vessels maintain the inner blood-ocular barrier. *The retinal pigment epithelium maintains the outer blood–retinal barrier. *The inner limiting membrane of the retina consists of the basement membrane elaborated by Müller cells. *Retinal n

Answer 80

Cerebellar Tremor Cerebellar tremor is intentional and usually seen with other cerebellar symptoms like dysmetria and dysdiadocokynesia

Answer 81

Vestibulo-ocular reflex response

Answer 82

Second afferent neuron

Answer 83

Edrophonium Edrophonium is a quaternary alcohol that is a rapidly-acting cholinesterase inhibitor with a 5-10 minute duration of action. It binds reversibly to the anionic site of cholinesterase. Historically, edrophonium has been used for the differential diagnosis of myasthenia gravis (the Tensilon test).

Answer 84

D) It inhibits the conversion of levodopa to dopamine in the periphery Carbidopa inhibits the enzyme that converts levodopa to dopamine so that more levodopa passes into the brain before being converted to dopamine. It also prevents the peripheral side effects of levodopa. Carbidopa does not cross the blood–brain barrier, and therefore, does not prevent the conversion of levodopa to dopamine in the basal ganglia

Answer 85

Propofol and etomidate Propofol, etomidate and thiopental are normally used for induction of anesthesia. Thiopental was mostly replaced by the first two agents because of its CVC and respiratory depression potential.

Answer 86

Ventral posterior hypothalamus Histamine and antihistamines have long been known to produce signifcant effects on animal behavior. Biochemical detection of histamine synthesis by neurons and direct cytochemical localization of these neurons have de ned the histaminergic system in the CNS. Most of these neurons are located in the ventral posterior hypothalamus. They give rise to long ascending and descending tracts that are typical of the patterns characteristic of other aminergic systems. The central histaminergic system is thought to affect arousal (H1 antagonists cause drowsiness), attention, feeding, thermoregulation, and vascular dynamics

Answer 87

Left Bulbus

Answer 88

Subacute sclerosing panencephalitis (SSPE) Subacute sclerosing panencephalitis (SSPE) - This is the correct answer. SSPE is a progressive, fatal neurological disorder resulting from a persistent infection with the measles virus. It typically manifests years after the initial measles infection, commonly presenting with cognitive decline, behavioral changes, and myoclonic jerks. The characteristic EEG findings of periodic complexes and MRI showing brain atrophy support the diagnosis of SSPE. The history of a rash illness likely representing measles in early childhood, especially in the context of incomplete vaccination, further points towards SSPE.

Answer 89

R midbrain If a patient comes with diplopia caused by an R cranial nerve 3 lesion in addition to pyramidal symptoms characterized by L hemiparesis and Babinski signs, it indicates an R midbrain lesion.

Answer 90

CT scan of the chest CT scan of the chest - This is the correct answer. The symptoms described are indicative of Myasthenia Gravis, an autoimmune disorder affecting the neuromuscular junction. Given this diagnosis and the association of Myasthenia Gravis with thymoma, particularly in male patients around middle age, a CT scan of the chest is essential to assess for the presence of a thymoma, which could be contributing to the neuromuscular symptoms.

Answer 91

α1-Adrenergic Catecholamines include epinephrine, norepinephrine, and dopamine. All o receptors are G protein–coupled receptors (GPCRs), but only a1-adrener receptors cause an increase in the intracellular calcium concentration. Sti this receptor releases the Gq subunit, which in turn activates phospholipa leading to inositol triphosphate (IP3). One of the downstream effects of IP calcium channels in the smooth endoplasmic reticulum to release stored c raise the intracellular calcium concentration.

Answer 92

Only the 3rd option is incorrect. Tumors of the optic pathway and hypothalamus region, the brainstem, and the pineal-midbrain region are MORE COMMON in children and adolescents when compared to adults. Other choices are correct

Answer 93

Cerebellar ataxic gait

Answer 94

Epidural hematoma Epidural hematoma - This is the correct answer. An epidural hematoma is likely given the lucid interval post-injury, followed by neurological deterioration, which is a classic presentation. The impact from the car accident could easily lead to arterial damage, typically the middle meningeal artery, causing blood to accumulate between the dura mater and the skull. The CT findings of a biconvex shape that does not cross suture lines aligns perfectly with an epidural hematoma. Subarachnoid hemorrhage - Typically presents with a sudden, severe headache and is characterized by bleeding into the spaces where cerebrospinal fluid circulates, often visible on CT as diffuse blood layering rather than a localized biconvex collection.

Answer 95

Mumps is the most common cause of acquired sensorineural hearing loss Info: Mumps is the most common cause of acquired sensorineural hearing loss in the childhood 50% of congenital hearing loss cases are hereditary. Non-syndromic hearing losses due to hereditary causes are widespread. 80% of non-syndromic hereditary hearing losses are autosomal recessive. Cytomegalovirus is the most common cause of congenital viral deafness.

Answer 96

Brown-Sequard Syndrome

Answer 97

Hypertensive vasculopathy Info: The correct answer is Hypertensive vasculopathy. This patient's history of poorly controlled hypertension and the location of the hemorrhage (basal ganglia) are classic for hypertensive vasculopathy leading to intraparenchymal hemorrhage. The basal ganglia is one of the most common sites of spontaneous intraparenchymal hemorrhage due to hypertension, which leads to chronic damage to the small penetrating arteries, resulting in Charcot-Bouchard microaneurysms and subsequent bleeding.

Answer 98

Cryptococcus neoformans Cryptococcus neoformans menengitis is seen in HIV/AIDS patients who cellular immunity impairment. It usually happens after pneumoniae with and the symptoms will progress slowly within weeks. The symptoms, me irritation signs that are positive and the CSF examination results show t menengitis. CSF staining with indian ink shows encapsulated yeasts wh expected as a Cryptococcus neoformans menengitis.

Answer 99

Add propranolol to the present drug regimen

Answer 100

K+ The patient was most likely receiving baclofen, a spasmolytic drug that activating GABAB receptors, a member of G-protein-coupled receptors This activation most likely opens K+ channels, causing K+ efflux, thus membrane stabilization (hyperpolarization).

Answer 101

Cotton wool spots Background diabetic retinopathy (BDR) Signs *Microaneurysms: tiny red dots that tend to be the earliest signs *Retinal nerve fibre layer haemorrhages: superficial and flame- shaped intraretinal haemorrhages: located in the compact middle layers of the retina and have a red ‘dot/blot’configuration *Deeper dark round haemorrhages: haemorrhagic infarcts located within the middle retinal layers; risk marker for progression to retinal neovascularization *Hard exudates: waxy yellow lesions with distinct margins, often arranged in clumps and/or rings surrounding leaking microaneurysms

Answer 102

Middle Cerebral Artery contralateral gaze palsy, hemiplegia, hemisensory loss, spatial neglect, hemianopsia, global aphasia and decreased consciousness can be seen in middle cerebral artery entire territory lesions

Answer 103

All the 'system' answers are correct whereas 'nerve' answers are not.

Answer 104

Serious dermatologic reactions Info: Carbamazepine may develop potentially fatal dermatologic reactions (1 to 6 per 10,000 new users), including toxic epidermal necrolysis and Stevens-Johnson syndrome in patients with the HLA-B 1502 inherited allelic variant of the HLA-B gene.

Answer 105

Hearing loss Info: Hearing loss is a a moderate or severe sequelae seen in survivors of bacterial meningitis Peripheral neuropathy, renal impairment, myocardial infarction and osteoarthritis is not a special moderate or severe sequelae seen after bacterial menengitis

Answer 106

Candida albicans TORCH(toxoplasmosis, other, rubella, cytomegalovirus and herpes simplex)

Answer 107

'A TIA is a temporary and “non-marching” neurological deficit of sudden onset; attributed to focal ischemia of the brain, retina, or cochlea; and lasting less than half an hour' is an incorrect statement. Info: TIA is a prognostic indicator of stroke, with one-third of untreated TIA patients having a stroke within 5 years. About 1 in 10 patients with TIA experience a stroke in the next 3 months. TIA is a temporary and “non-marching” neurological deficit of sudden onset; attributed to focal ischemia of the brain, retina, or cochlea; and lasting less than 24 hours. Most TIAs last only a few minutes. Episodes that last longer than 1 hour are usually due to small infarctions

Answer 108

Sticky, yellow-green discharge

Answer 109

Inferior oblique *The orbital apex is anatomically the posterior part of the orbit where the four orbital walls converge and it is the site of origin of all extraocular muscles except the inferior oblique. *The inferior oblique originates from the orbital floor just lateral to the nasolacrimal groove. *Orbital apex syndrome (OAS) involves cranial neuropathies in associ optic nerve dysfunction. Orbital apex syndrome is symptomatically rela superior orbital fissure syndrome and cavernous sinus syndrome with etiologies. *The distinction is the precise anatomic involvement of the disease pro

Answer 110

CPP ≥ 60-80 mmHG

Answer 111

All except the second one are true

Answer 112

Herpes encephalitis The patient’s signs and symptoms suggested the presumptive diagnosis of bacterial meningitis, but the lack of efficacy of antibiotic therapy and the negative cerebrospinal fluid result raised the suspicion of herpes simplex virus (HSV) encephalitis, the most common sporadic viral infection of the CNS. Acyclovir is the first-line agent for HSV infection, and the efficacy of therapy confirms that the patient was suffering from herpes encephalitis. Toxoplasmic encephalitis and Cryptococcal meningitis are rare in patients without HIV and cannot be cured with antiviral drugs. Cytomegalovirus (CMV) infection occurs mainly in immunocompromised patients or is congenital, and acyclovir is not active against CMV.

Answer 113

Essential tremor

Answer 114

Iris and cornea The place where the outflow occurs is called the angle because it is the angle where the iris meets the cornea

Answer 115

'In patients with nasal carriage of S. aureus preoperative decolonization with nasal imipenem reduces the rate of S. aureus surgical site infections.' This statement is incorrect. In patients with nasal carriage of S. aureus preoperative decolonization with nasal mupirocin reduces the rate of S. aureus surgical site infections

Answer 116

Cervical spinal cord

Answer 117

Inferior wall *An orbital blowout fracture is a fracture of the orbital bones. Typically results from impact of a blunt object. *Inferior blowout fractures are the most common type. *Amongst the orbital walls, the medial wall takes the second place in the frequency of blow-out fractures.

Midterm 4 Soruları Flashcards

Sınav sorularını anlayıp ezberlemek (143 cards)