Nervous system

Question 1

GBS

Answer 1

acute inflamatory demyelinating neuropathy
dec nerve conduction velocity
inc csf proteins
dec reflexes

Question 2

Chronic inflamatory demyelinating polyradiculopaty

Answer 2

2m +
recurrent de and re myelination
proliferative onion bulb schwann cells
steroid responsive

Question 3

leprosy

Answer 3

schwann cells invaded by mycobacterium
sympetric polyneuropathy, esp pain

Question 4

Diphtheria neuropathy

Answer 4

bulbar and resp dysfunction

Question 5

Vitamin eficiecy neuropaty

Answer 5

B1,6,12 folate, vitmain E, copper, zinc

Question 6

Skull ~ clasification

Answer 6

displaced if >thickness bone
diastatic if crosses suture lines

Question 7

DAI

Answer 7

asymmetrical swelling axons deep white matter
present in 50% who develop coma

Question 8

SDH time frame blood removal

Answer 8

1 week - clot lysis
2 weeks - fibroblasts from dural space into haematoma
1-3m - hyalinoid CT

Question 9

Brain CO and O2 consumption

Answer 9

15% CO 20% O2 consumption (same as skeletal muscle)

Question 10

Effect ischaemia on brain

Answer 10

dec ATP and dec membrane potential
inc Ca2+ causing cellular injury
inc glutamate release further inc ca2+ into cell (via NMDA)

Question 11

BP for global cerebral ischaemia

Answer 11

<50 systolic (autoregulation 50-150)

Question 12

morph global cerebral ischaemia

Answer 12

12-24h red neurons, eosinophilia, pyknosis
24h-2w necrosis, macrophages, reactive gliosis
2w + removal necrotic tisssue, gliosis
astrocytes from 1w

Question 13

cerebral embolism

Answer 13

most common cause focal ischaemia
main from cardiac mural then carotid

Question 14

cerebral thrombosis

Answer 14

plaque rupture
carotid bifurcation, origin mca, basilar

Question 15

gross morphology brain post thrombosis

Answer 15

48h pale
2-10d gelatinous
2-3w liquefactive

Question 16

Lacunar infarcts

Answer 16

<15mm
lenticular nucleus and thalamus and internal capsule
tissue loss surrounded by gliosis

Question 17

HTN CVD sequelae

Answer 17

lacunar infarcts
split haemorrhage
encephalopathy
ICH - mostly putamen

Question 18

Location SAH

Answer 18

90% ant circulation
- 40%ACA
- 20% branch 1 MCA
- 34% higher up MCA
4% PCA

Question 19

Meningioma

Answer 19

F>M
slow growing but faster during pregnancy

Question 20

CSF

Answer 20

volume in humans is 150mls and the rate of production is about 550ml/day
osmolality same as plasma

Question 21

Main cause atraumatic ICH

Answer 21

hypertension and cerebral amyloid angiopathy

Question 22

Retinoblastoma

Answer 22

from neural cells
most common intraoccular ca kids
spreads to brain and BM

Question 23

Meningitis organisms

Answer 23

infants - e.coli/ GBS
young adults - n meninitides
older adults - strep pneum, listeria

Question 24

CSF bacterial meningitis

Answer 24

rasied protein, WCC and opening pressure
low glucose
turbid, 90% PMNs

Question 25

viral meningitis organism

Answer 25

enterovirus, however not normally identified

Question 26

CSF viral meningitis

Answer 26

mild inc wcc and protein normal opening pressure and glucose lymphocytic pleocytosis

Question 27

Central TB

Answer 27

mainly meningioencephalitis CSF v high protein with pleocytosis and dec gluc tuberculoma - looks like CNS tumor

Question 28

HSV1 encephalitis

Answer 28

children young adults only 10% prior herpes

Question 29

HSV2 encephalotis

Answer 29

neonatal meningitis in older

Question 30

CMV encephaliti

Answer 30

foetal microcephaly immunosupressed

Question 31

Rabies

Answer 31

negri bodies pathognomonic parasthesia around bite site incubation 1-3m dependant on disctance from brain

Question 32

HIV encephalitis

Answer 32

1. during seroconversion 2. opportunistic cmv/ toxo 3. EBV +ve CNS lymphoma

Question 33

PML

Answer 33

JC plyomavirus

Question 34

MS

Answer 34

neurological episodes seperated by time, WHITE matter lesions seperated by space IgG and inc protein in CSF

Question 35

Alzheimers

Answer 35

abeta placques, tau tangles most common ementia 5-10% familial

Question 36

fontotemporal lobar degenerations dementia

Answer 36

personality, behaviour language changes pre memory loss tau inclusions and TDP43 inclusion

Question 37

Progressive supranuclear palsy

Answer 37

parkinsons plus trunkal rigidity disequelibrium with falls difficulty voluntary eye movements

Question 38

corticobasal degeneration

Answer 38

parkinsons plus extrapyramidal rigidity asymetric motor disturbance impaired higher cortical function - apraxia

Question 39

Huntingtons

Answer 39

AD chorea movement pre dementia caudate nucleus and ptamen

Question 40

friedrich ataxia

Answer 40

AR cardiomyopathy deep tendon refelx absent, plantar present

Question 41

Thiamine deficiency

Answer 41

B1 wernickes encephalopathy - psychosis and ophthalmoplegia reversible syndrome - short term memory and confabulations

Question 42

B12 deficiency

Answer 42

cobalamin subacute combined degeneration spinal cord with bilateral symetrical numbness

Question 43

Mechanism CO poisoning

Answer 43

decreased O2 carrying blood via cytochrome C oxidase blocks electron transport in mitochondria and thus tissue utilisation O2

Question 44

Acute angle closure glaucoma stages

Answer 44

in hyperopia (primary) opposition iris to ant surface lens dec flow aqueous humour inc pressure post chamber