Nervous System Flashcards by gabrielle thro

Huntington disease mode of inheritence

Autosomal dominant

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Huntington disease is caused by an increase in _______ in the gne that codes for the huntingtin protein

CAG trinucleotide repeats

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Expansion of the huntingtin protein’s polyglutamine region in huntington disease results in ________ which leads to pathological interaction with other proteins, including various transcription factors

Gain-of-function

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in huntington disease, abnormal hintingtin causes increased histone ____ which silenes the genese necessary for neuronal survival

Deacetylation

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Occlusion of the PICA results in _____ syndrome

Lateral medullary (Wallenberg)

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PICA arises from what artery

Vertebral

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What arteries course through the transverse foramina in the neck before entering the skull at the foramen magnum and therefore can be easily injured by cervical spinal trauma

Vertebral

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Oclussion of which vessel is characterized by vertigo/nystagmus, ipsilateral cerebellar signs, loss of pain/temperature sensation in the opsilateral face and contralateral body, bulbar weakness and ipsilateral horner syndrome

Posterior inferior cerebellar artery

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Blood pressure above ____ increases verebral vascular volume and blood flow, causing a corresponding increase in ICP

150 mmHg

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Blood pressure below _____ causes cerebral hypoperfuion and potential ischemia

50 mmHg

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A drop in PaCO2 whill have what effect on intercranial blood flow

Causes vasoconstriction –> decreases cerebral blood volume –> decreased ICP

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Lowering ____ is one of the measures employed to reduce ICP in mechanically ventilated patients with cerebral edema

PaCO2

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Carbon dioxide is a potent ____ of cerebral vasculature

Vasodilator

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The anterior pituitary is derived from what embryonic tissue

Surface ectoderm

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Bitemporal hemianopsia, amenorrhea, and elargement of the pituitary gland on brain imaging are suggestive of ___________

Prolactin secreting pituitary adenoma

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Prolactinomas develop from ____ cells in the anterior pituitary (adenohypophysis)

Lactotroph

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What occurs at 3 eks of embryogenesis resulting in 3 germ layers

Gastrulation

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During gastrulation, epiblast cells undergo what transition, causing them to lose their cell-to-cell adhesion properties

Epithelial-to-mesenchymal

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The anterior pituitary is derived from what structure, which is an evagination of the surface ectderm that lines the fetal oral cavity

Rathke pouch

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The posterior pituitary is derived from what embryonic cells

Neuroectoderm

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The posterior pituitary is derived from the ______ which is an extension of neuroectoderm from the diencephalon

Infundibulum

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What is the condition characterized by a sudden, involuntary contraction of a major muscle group that developes within 4 hours and 4 days of starting an antipsychotiv medication

Acute dystonic reaction

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What is the presentation of dystonia as a oculogyric crisis

Forced, sustained elevation of the eyes in an upward position

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How does opisthotonus (a dystonic reaction) present

Arching of the back with the head thrown backward

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How does spasmodic torticollis (a dystonic reaction) present

Pain and stiffness on one side of the neck

Acute dystonic reactions a theorized to result from the antipsychotic property of D2 antagonism in what pathway

Nigostriatal

Dopamanergic blockade causes excess _____ _activity in the striatum leading to extrapyramidal side effects

Cholinergic (M1)

L5 radiculopathy presents with sensory loss where?

Lateral thigh Calf Dorsal foot

L5 radiculopaty often presents with weakness where?

Great toe extension | Foot dorsiflexion, inversion, and eversion

What is pleocytosis in a CSF sample

Elevated leukocyte count

What bacteria has distinctive tumbling motililty at room temperature

Listeria monocytogenes

How is listeriosis most commonly transmitted in adults

Food ingestion (can replicate in cold (refrigerator)

Listeriosis can have what presentation in immunocompromised adults

Meningitis

Migraines are associated with cortical spreading depression and subsequent stimulation of _____ afferents in the meninges causing release of vasoactive neuropeptides

Trigeminal

Trigeminal aferents in the meninges cause release of vasoactive peptides including substance P and __________, resulting in neurogeninc inflammation, vasodilation, and plasma protein extravasation which can casue migranes

Calcitonin gene-related peptide (CGRP)

Triptans, such as sumatriptan, are ________ agonists that directly counter migraine hedaches by binding trigeminal ____ receptors and inhibiting CGRP release from trigeminal neurons

Sertonin 5-hydroxytryptamine 1B/1D

Triptans bind serotonin recepotrs on smooth muscle cells of blood vessels and result in intracranial ____

Vasodilation

Tryptans are commonly prescribed as ______ therapy for acute migraines, particularly in patients who are not responsive to analgesics

Abortive

Significant adverse effects of triptans (used aas migrain therapy) include dizziness, chest tightness, and _____

Hypertension

The extracranial portion of the facial nerve exits the skull via ______ foramen

Stylomastoid

Where does CN VII divide into 5 terminal branches

Within the parotid gland

Parotid gland tumors can compress and disrupt the ipsilateral facial nerve and its branches leading to _____

Facial droop

Parotid gland tumors that cause facial nerve paralysis are often ______

Malignant

Tetanospasmin (potent metalloprotease exotoxin) inhibits release of what neurotransmitters

Glycine and gamma-aminobutyric acid (GABA)

What is the term for lockjaw seen in C.tetani infections

Trismus

What is the term for the contractions of back muscles resulting in backward acing seen in infections with C. Tetani

Opisthotonos

all 3 opiate receptor subtypes are transmemrane receptors that are coupled to ____ G proteins

Inhibitory

Which opiate recepter exerts the strongest analgesic effects

What effects do opiates have when binding to mu receptors on the primary afferent neurons

Closure of voltage gated calcium channels --> reduced calcium influx --> decreased excitatory neurotransmitter release from presynaptic terminal

What effects do opiates binding on mu rceptors on the postsynaptc membrane have

Opens potassium channels --> potassium eflux --> hyperpolarization

Dopamine agonists in treating Parkinson disease can result in what behavior change

Impulse control disorders

Dopamine agonists, treatment for parkinsons disease, act by binding central dopamine receptors and stimulating dopamine activity in the _____ and substantia nigra

Ventral striatum

Where is the nucleus accumbens located

Ventral striatum

Nucleus accumbens is involved in motivation and the _____ pathways

Reward

Zolpidem is a short-acting nonbenzodiazepine ___ agent

Hypnotic

Mechanism of action for zolpidem

Bind GABAa receptor at benzodiapine receptor site and act as GABAa agonist

What differs nonbenzodiazepines such as zolpidem from benzos

More specific binding --> primarily hypnotics and do not produce anxiolytic, muscle relaxant, o anticonvulsant effects

Campylobacter jejuni causes guillain barre syndrome via immune mediated polyneuropathy due to _________

Cross-reacting antibodies (molecular mimicry

In guillain barre syndrome an antecedent event (typically infection) provokes an immune response that cross reacts with the ______ and ______ of peripheral nerves

Schwann cells and myelin sheath

Underlying etiology of temporomandibular disorder (TMD) is multifactoral but includes tempromandibular joint(TMJ) derangement and hypersensitivity of the _______ nerve

Mandibular

The mandibular nerve is the largest branch of what nerve

Trigeminal nerve (it is CNV3)

The mandibular nerve supplies sensation to the TMJ, floor of mouth, ______ tongue and lower part of the face

The mandibular nerve innervates the muscles of mastication, tensor veli palatini, and ________ which is in the middle ear and dampens loud sounds by tensing the tympanic membrane

Tensor tympani

Where does te herpes simplex virus 1 most commonly lay dormany

Neural sensory ganglia of trigeminal nerve

During reactivation HSV particles rely on anterograde axonal transport, carried out by ________, to reach the skin and oral mucosa

Kinesin

What motor protein, moves intracellular cargo via retrograde axonal transport

Dynein

What are two ways that critical illness can cause neuromuscular weakness

Critical illness myopathy (atrophy of myofibers) | Critical illness polyneuropathy (axonal degeneration)

What is the cause of cavernous sinus thrombosis

Contiguous spread of an infection from the medial third of face, siuses, or teeth

Methylmalonic acidemia results from complete or partial deficiency fo the enzyme ________

Methylmalonyl-coA mutase

In methylmalonic acidemia, a methylmalonyl-CoA mutase deficiency, results in a metabolic acidosis and what blood glucose status

Hypoglycemia

Why is there an anion gap metabolic acidosis present in methylmalonic acidemia (a deficiency in methylmalonyl CoA mutase)

Hypoglycemia --> increased FFA metabolism --> ketones --> anion gap

Why is there hyperammonemia in methylmalonic acidemia

There is a build up methylmalonic acid and propioinic acid. Organic acids directly inhibit urea cycle --> hyperammonemia

How is a diagnosis of methylmalonic acidemia confirmed

Elevated urine methylmalonic acid and propionic acid

Propionic acidemia is due to deficiency in what enzyme

Propionyl CoA carboxylase

How do the lab findings in propionic acidemia differ from methylmalonic acidemia

Will not have elevated levels of urine methylmalonic acid | Both have hyperammonemia, hypoglycemia, metabolic acidosis

Axillary nerve originates from the ____ cord of brachial plexus

Posterior

Axillary nerve carries fibers from what spinal nerves

C5, C6

What is the motor inervation of the axillary nerve

Deltoid and teres minor

What is the sensory inveration of the axillary nerve

Skin over lateral shoulder

What nerve injury leads to sensory loss over upper later arm and weakness on shoulder abduction due to denervation and possible atrophy of the deltoid muscle

Axillary nerve

kinesin is a microtubule associated motor protein whose funciton is anterograde transport of intracellularvesicles and organells toward the ____ end of microtrubules

Plus (rapidly growing)

What is the most common cause of cerebellopontineangle (betwen the cerebellum and lateral pons) tumors in adults

Vestibular schwannoma

Spontaneous vestibular schwannomas are usually unilateral, whereas bilateral vestibular schwannomas are associated with ___________

Neurofibromatosis type 2

What 3 nerves are in proximity at the cerebellopontine anlgle and therefore at risk of being compressed by a vestibular schwannoma

VII (facial) V (trigeminal) VIII (vestibularcochlear)

What common manifestation of multiple sclerosis is characterized by monocular visual loss with pain on eye movement and an afferent pupillary defect

Optic neuritis

MRI findings in _________ typically include white matter lesions scattered throughout the brain and/or spinal cord with a predilection for the subcortical periventricular regions

Multiple sclerosis

The pathogenesis of MS involves an autoimmue response targeting ________

Oligodendrocytes

Most patients with MS have ______ immunoglobulin bands in the cerebrospinal fluid

Oligoclonal

The auto-immune response in multiple sclerosis is __________ mediated

T cell and antibody

List the abortive medications use in migraine therapy

Triptans (sumatriptan) NSAIDs, acetaminophen Antiemetics (metoclopramide, prochlorperazine) Ergotamine

List the preventative medications used for migraine therapy

Anticonculsants (topiramate or valproate) Beta blockers (metoprolol, propranolol) Antidepressents (tricyclic: amitrptyline, or venlafaxine)

What age group is almost exclusived affected by febrile seizures

6 mo - 5 years (seizure threshold is lower during early years of brain development)

What is the treatment for most febrile seizures

Antipyretics (NSAID)

Botulinum toxin prevents the presynaptic release of _____ from the nerve terminal at the neuromuscular junction

Acetylcholine

Clostridium botulinum spore formation occurs at _______ location which allows the bacteria to survive adverse conditions such as heat and high oxygen enironments

Subterminal (between the terminal end and center of the bacteria)

Injection of _____ into the a dystonic muscle results in muscular relaxation and relief of symptoms

Botulinum toxin type B

What is hydrocephalus ex-vacuo

Normal CSF expansion following cerebral volume loss rather than abnormal CSF accumulation as seen in hyrdrocephalus

Infants with hydrocephalus typically develop macrocehaly, poor feeding and what two other musculoskeletal/neural findings

Muscle hypertonicity | Hyperreflexia

In hydrocephalus, Hypertonicicty and hyperreflexia result from upper motor neuron injury caused by stretching of the ________ tracts

Periventricular pyramidal

Treatment of hydrocephalus requires ________

Surgical placement of a shunt

Infants with hydrocephalus will show what on imaging

Enlarged ventricles

What is the characteristic presentation of paralysis in a patient with botulism

Symetric, descending paralysis that first manifests with cranial nerve abnormalities: 3 D's: diplopia, dysphagia, dysphonia

How does the botulinum toxin prevent the release of Acetylcholine

Destroys SNARE proteins

Transected nerves udergo __________ which involves axonal dissolution while activated schwann cells and macrophages degrade myelin

Wallerian degeneration

In addition to clearing cellular debris, ______ and macrophages stimulate formaiton of a growth cone from te proximal axon stump to facilitate nerve regeneration

Schwann

If regenerating axons cannot find their distal target, regeneration can result in formation of a disroganzed mass of axonal processes, Schwann cells, vascular hyalinization, and fibrosis know as a _______

Neuroma

Chronic axonal injury or inflammation induces increased expression of ___________ chanels

Voltage gated sodium chanels

To supportthe diagnosis of a neuroma, _______, is administered which will often provide immediate relief of pain

Local anesthetic (blocks sodium channels in the neuronal cell membrane --> prevents depolarization of the nerve)

What are the preferred anticonvulsants for focal onset seizures

Carbamazepie Lamotrigine Levetiracetam Phenytoin

What anticonvulsants are prefered for tonic-clonic and myoclonic seizures

Leveltiracetam | Valproic acid

What are the preffered anticonvulsants for absence seizures

Ethosuxamide | Valproic acid

What typically presents in adolscents with brief, involuntary jerking movements involving both upper extremities with preservation of consciousness and symptoms usually occring within the first hour of waking and can be provoked by sleep deprivation

Juvenille myoclonic epilepsy

Individuals who consume more than 10 times the daily value of ______ are prone to developing toxicity and may suffer hepatic injury so severe as to cause cirrhosis

Vitamin A

Signs and symptoms of acute vitamin A toxicity occur after ingestion of a single high dose of vit A and include:

Nausea, vomitting, vertigo and blurred vision

Sings and symptoms of chronic vitamin A toxicity occur after the long-term ingestion of high doses of vit A and include:

``` Alopecia Dry skin Hyperlipidemia Hepatotoxicity Hepatosplenomegly Visual difficulties ```

The cerebellar hemispheres are primarily responsible for _______ of the ipsilaeral extremities

Motor planning and coordination

Lesions in the left cerebellar hemisphere typically result in left ________(impaired rapid alternating movements), _______ (overshooting/undershooting during targeted movement), and ________ tremor

dysdiadochokinesia Limb dysmetria Intention tremor

The cerebellar vermis modulates _____ via connections with the medial descending motor systems

Axial/truncal posture and coordination

Vertigo and nystagmus may occur due to disruption of what regions of the cerebellum

Inferior vermis and flocculonodular lobe

Mechanism of action: triptans

Serotonin 1B/1D agonist

Mechanism of action: metoclopramide

Dopamine recepor blocker

Dopamine receptor blockers have both antiemetic and anaglesic effects on migraine headaches by antagonizing central dompamine ____ receptors in midbrain and striatum

Dopamne receptor bloackade in teh basal ganglila can cause excess ______ activity that manifests as significant extrapyramidal symptoms such as acute dystonic reaction

Cholinergic

What can be co-administered with metoclopramide or prochlorperazine to prvent extrapyramidal symptoms

Diphenhydramine (anticholinergic)

________ presents with vague lower extremity discomfot and an urge to move the legs that worsens at night

Restless leg syndrome

Causes of restless leg syndrome include idiopathic and 3 others:

Iron deficiency Uremia Diabetes (especially with neuropathy)

Pathophysiology of restless leg syndrom is not completely understood by likely involves CNS iron deficiency (even in patients with normal serum iron levels) and abnormalities in _______ transmission

Dopaminergic

Treatment of restless leg syndrome includes avoidance of aggravating medications, iron replacement, and ________

Dopamine agonists (ropinirole, pramipexole)

Characterisc pathologic changes associated with alzheimer disease involve acumulation of intracellulr ______ and extra cellular ______ plaques

Neurofibrillary tangles | Amyloid beta

Neurofibrillary tangles are composed of _____ protein, a primary component of intracellular microtubules

Tau

In alzheimer disease, tau protein is _____ causing microtubule structures to collapse into "tangles" that contribute to global neuronal dysfunction

Hyperphosphorylated

Amyloid beta is an abnormal fragment of ________ protein, which is normally involved in synaptic formation and repair

Amyloid precursor protein

An extra copy of ____ gene, located on chromosome 21, present in trisomy 21, is thought to lead to early onset alzheimers disease

APP (amyloid precursor protein)

______ phenomenon describes what patients with parkinson disease being treated with levodopa experience in terms of periodc flucuations in motor function

"On-off"

As parkinson disease progresses, the therapeutic windo for levodopa narrows, possibly due to natural or levodopa induced ______ degeneration

Nigrostriatal

In advanced PD, motor fluctuations can occur independently of dosing and may become _______

Unpredictable

A patien who developes prolonged muscle weakness after receiving succinylcholine could have _____________ deficiency, an autosomal recessive disorder caused by a genetic polymorphism in the BCHE gene

Pseudocholinesterase deficiency

Psuedocholinesterase deficiency is an autosomal recessive disorder caused by a genetic polymorphism in the _____ gene

BCHE

Succinylcholine is a _______ neuromuscular blocking agentused to induce skeletal muscle relaxation during intubation and surgery

Depolarizing

Succinylcholine acts as a _________ of nicotinic acetylcholine receptors of the motor endplate, where it induces persistent depolarization, leading to desensitization and skeletal muscle paralysis

Competitive agonist

Succinulcholine is rapidly hydrolyzed by plasma ________, only around 10% of the administered dose reaches the neurmuscular junction, where it typically has a duration of action of < 10 min.

Pseudocholinesterase

What is another name for neurofibomatosis type I

Recklinghausen disease

Neurofibromatosis type I is an autosomal dominant neurocutaeous disorder caused by mutations in _______ gene

NF1 (tumor supressor)

In neurofibromatosis type 1, patients typically develop _____ over the trunk

Cage au lait spots (hyperpigmented macules)

Patients with neurofibromatosis type I are at increased risk of developing ______ which can cause elevated intracranial pressure and headache

Central nervous system neoplasms (optic gliomas, pilocytic astrocytomas)

Cutaneous neurofibromas usually manifest during early adolescence as multiple, raised, fleshy tumors that often increase in size and number with age. These are benign sheath neoplasms predominantly comprised of _____ cells which are embryologically derived from _______

Schwann cells | Neural crest

Absence seizures are characteristically provoked by ______

Hyperventillation

Treatment for absence seizures

Ethosuximide (or valproate if first line is not tlerated or inneffective)

Absence seizures show _____ on electroencephalogram

3 Hz spike wave

Mechanism of action of ehosuximide

Inhibits T type calcium channels in thalamic neurons

A patient with sudden-onset confusion, memory loss, and anterograde amnsia that resolves in a couple hours is consistent with what dagnosis

Transient global amnesia

Risk factors for transient global amnesia

History of migraine | Older age

Transient global amnesia is likely due to dysfunction of what area of the brain which is responsible for formation of new memories

Hippocampus

When testing the plantar reflex, what action of the patients foot is a positive babinski sign

Dorsiflexion with or without fanning of the toes

Babinski signs indicates a _______ motor neuron lesion

Upper

Upper motor neuron injury can occur anywhere proximal to _____

The anterior hor

A sign of UMN injury includes _____reflexia, _____ paralysis, and ____ muscle tone

Hyper Spastic Increased

Describe clasp- knife rigidity

Increased muscle tension with sudden release on passive flexion

Clasp knife rigidity is present in ____ motor neuron lesions

Upper

In pyramidal weakness, a sign of upper motor neuron injury, weakness is more pronounced in lower extremity ______ and upper extremety ______

Flexors | Extensors

Pronator drift, due to upper extremity supination being weaker than pronation, is a sign of a ________ motor neuron lesion

Upper

Lower motor neuron lesion signs include ____ _paralysis, _______ tonia, and _____ reflexia

Flaccid Hypo Hypo (or absent)

Fasciculations are present in ___ motor neuron lesions

Lower

Histology of guillain barre syndrome demonstrates an inflammatory infiltrate located within the ______

Endoneurium (innermost layer of connective tisue that surrounds a nerve axon adn its corresponding blood vessels)

In guillian barre syndrome, macrophages strip the myelin sheath from the axon, and ________ macrophages are seen following the engulfment of myelin

Lipid laden

The speed of conduction down an axon depends on what two constants

Length (space) constant | Time constant

Myelin _____ the length constant by reducing charge dissipation across the membrane

Increases (allows the electrical impulse to propagate further without requiring active regeneration by ion channels)

Myelin ____ the time constant

Reduces (allows membrane potential to change faster)

Unilateral hand pain and numbness, thenar atrophy, and weakness of thumb opposition is characteristic of ________

Carpal tunnel syndrome

The carpal tunnel is an antaomic space in the wrist between the carpal bones and the ______

Transverse carpal ligament (flexor reinaculum)

What structures run through the carpal tunnel

Median nerve | 9 tendons: flexor digitorum superficialis and profundus, flexor pollicis longus

If carpal tunnel syndrome is not treatable with wrist splints and glucocorticoid injection, surgical decompression can be performed by making a longitudial incision of the ______

Transvers carpal ligament

What role do the pili on the capsular surface of N meningitidis have?

Attachment to and colonization of the nasopharyngeal epithelium as well as bacterial movement and epithelial penetration

What is the role of Opa-proteins in N. Meningitidis

Aid in endothelial attachment and invasion

What virulence factor aids N. Meningitidis by destroying mucosal antibodies that would otherwise inhbit epithelial colonization

IgA protease

Capsulr polysaccharides provide what benefit to bacterial organisms (including N. Meningitidis)

Prevent phagocytosis and phagolysisime destrution

Why are pili in N. Meningitidis a difficult target for vaccines

Significant antigenic variations

What nerve courses along the pericardium and overlies hte right atrium puting it at high risk during procedures that target structures in or near the right atrum

Right phrenic nerve

How can an injury to the right phrenic nerve be visualized on a chest xray

Elevation of the right (ipsalteral) hemidiaphragm

A patient with history of A fib presenting with isolated left lower extremety motor deficits, most likely had a carioembolic stroke in what artery

Right anterior cerebral artery

Occlusion of the ACA characteristically causes contralateral _____ limb weakness and _____ motor neuron signs

Lower | Upper

Atrial thromemboli traveling to and obstructing the middle cerebral artery characteristically has contralateral _____ extremity weakness and _____ deficits

Upper | Face

Portion of the hypothalamus that mediates satiety, and lesions --> hyperphagia

Ventromedial | Ventromedial injury makes you very massive

Portion of hypothalamus that mediates hunger, lesion --> anorexia

Lateral | Lateral injury makes you lean

Portion of hypothalamus that mediates heat dissipation, lesion --> hyperthermia

Anterior | A/C = Anterior cooling

Portion of hypothalamus that mediates head conservation, lesion --> hypothermia

Posterior | Heating controled by posterior= hot pot

Portion of hypothalamus that secretes dopamine (inhibits prolactin) and GHRH

Arcuate

Portion of hypothalamus that secretes GnRH and regulates sexual behavior

Medial preoptic

Portion of hypothalamus that secretes oxytocin, CRH, TRH, and small amounts of ADH

Paraventricular | POX = paraventricular = oxytocin

Portion of hypothalamus that secretes ADH and small amounts of oxytocin

Supraoptic | SAD= supraoptic = ADH

Portion of the hypothalamus that regulates circadian rhythm and pineal gland function

Suprachiasmatic | SCN is Sun Censing Nucleus

Musculocutaneous nerve roots

C5-C7

Musculocutaneous nerve arises from ____ cord of brachial plexus

Lateral

Motor innervation of the musculocuaneous nerve

Forearm flexors adn corachobrachialis

Sensory innervation of musculocutaneous nerve

Lateral forearm

Brown sequard syndrome (result of a spinal cord hemisection) will produce _____lateral paralysis, _____ lateral loss of vibration, proprioception, and light touch, and ____ lateral loss of pain and temperature sense

Ipsilateral paralysis Ipsilateral vibration Contralateral pain/temp

If a patient fails the romberg test with eyes open then they have ____ ataxia

Cerebellar

If a patient is steady during the romberg test with eyes open but fails when eyes are closed they have _____ ataxia

Sensory (loss of proprioception)

Tabes dorsalis causes sensory ataxia due to what infection

Syphilis

Over 95% of glioblastoma cases are associated with the overexpression of _________ on the surface of neoplastic cells

Epidermal growth factor (EGRF)

Mechanism of action: erlotinib

Inhibits EGFR/EGFR-ligand interaction

A biopsy of a tumor with hypercellular white matter with extensiveastrocytic aberration, microvascular proliferation and areas of necrosis lined with tumor cells will have what diagnosis

Glioblastoma

Right arm numbness and paresthesia caused by a focal onset seizure originates in the ____ side ____ central gyrus

Left Post (Primary somatosensory cortex)

Wernicke korsakoff syndrome is a complication of ______ defciency and most commonly occurs in patients with history of long standing alcohol abuse or other forms of malnurishment

Thiamine (B1)

Thiamine is a vitamin cofactor involved in ____ metabolism and decifiecy resultsin neuoronal damage and necrosis

Glucose

Iatrogenic wernike korsafoff an be precipitaed by the administration of ________

Glucose containing fluids which depletes the last remianing stores of thiamine

Areas of the brain with high metabolic demand are particularly susceptible to wernicke korsakoff syndrome, focal hemorrhage and atrophy of _______ is characteristic

Mammillary bodies

Neurofibromatosis type 1 gene mutation is located on chromosome ___ while NF2 gene mutation is located on chromosome ____

17 | 22

NF1 is a tumor supressor gene that codes _____

Neurofibromin

NF2 is a tumor supressor gene that codes protein ____

Merlin

Von Recklinghausen disease is associated with what gene mutation

NF1 (neurofibromatosis type 1)

Central neurofibromatosis is associated wiith what gene mutation

NF2 (neurofibromatosis type 2)

What are the main clinical features of neurofibromatosis type 1

Cafe au lait spots Multiple neurofibromas Lisch nodules

What are the main clinical features of neurofibromatosis type 2

Bilateral acoustic neuromas

A brain tumor causing cerebellar symptoms with sheets of primitive cells with many mitotic figures indicates what diagnosis

Medulloblastoma

Primitive neuroetodermal tumors are composed of sheets of small cells with deeply ____ nuclei and ____ cytoplasm

Basophilic | Scant

Primitive neuroectodermal tumors are well or poorly differentiated? And good or bad prognosis?

Poorlydifferentiated | Poor prognosis

Syringomyelia presents with loss of pain and temperature sensation in the arms and hands due to a fluid filled cavity called a _______ that damages the ________ and sometiems the ventral horns

Syrinx | Ventral white commissure

The ventral whitecommissure is the area of decussation for the fibers of the ____ tract

Lateral spinothalamic

Axons of the spinothalamic tract briefly ascend in the zone of ____ before decussating

Lissauer

The anterior 2/3 of the spinal cord is perfused by the ______ which receives blood flow form segmental arteries arising from te ______

Anterior spinal artery | Thoracic aorta

In an anterior cord syndrome how do initial changes in motor fuction progress

Initially: flaccid paralysis from spinal shock | Upper motor neuron signs devlop (spasticity, hyperreflexia) over days to weeks

Neoplastic spinal cord compression most commonly results from local extension of vertebral metastases into the ______ space

Epidural

Characteristic CT findings of ischemic stroke 6-12 hours after onset of inschemic injury include _____ of the tissue and loss of _____ differentiation within affected region

Hypoattenuation | Grey-white matter

Signs of irreversible damage during the first 24 hours after injury in ischemic stroke are ____ (microscopic finding)

Red neurons

Neutrophils move into area of ischemic stroke ____ following injury and microglial cells _____ after onset of injury

1-2 days | 3-7 days

_______ is the product of neuron disintegration and microglia phagocytosing their fragments which along w myelin breakdown products accumulate in the microglia cytoplasm

Foamy lipids

In Guillain barre syndrome, ______ demyelination and an _____ inflammatory infilttrate composed of lymphocytes and macrophages are seen on light microscopy

Segmental | Endoneurial

Fragile X syndrome mode of inheritence

X linked

Fragile x syndrome is an x linked disorder caused by ____ mutation in hat gene

Loss of function | Fragile x mental retardation 1 (FMR1)

Which arm of the x chromosome is the FMR1 gene located

Long arm

Presentation of _______ includes long, narrow face, prominent forehead and chin, large testes, hyperlaxity of joints, developmental delay, and neuropsychiatric features

Fragile x syndrome

Anxiety and agnitation are central effects of dopamine and are caused by what parkinson disease treatment

L-dopa

Why might adding carbidopa to L-dopa treatment worsen anxiety and agitation side effects

Carbidopa inhibits peripheral conversion of levodopa, making more of it availible to the brain

How long following an ischemic stroke do red neurons with eosinophiliccytoplasm, pyknotic nuclei and loss of Nissl substance appear

12-24 hours

How long following an ischemic stroke does neutrophilic infiltration occur

24-72 hours

How long after a stroke do macrophage/microglia innfiltratation and phagocyosis begin

3-7days

How long after an ischemic stroke does reactive gliosis and vascular proliferation around he necrotic area occur

1-2 weeks

How long afer an ischemic stroke does a glial scar form

>2 weeks

How long after an ischemic stroke does liquefactive necrosis occur

1 wk-1 month

How long after an ischemic stroke does a cystic area surrounded by dense glial fibers form

>1 month

Why might someone exposed to organophosphates experience wheezing

Cholinesterase inhibitor --> cholinergic overstimulation --> bronchospasms

In viral meningitis, CSF will have a WBC count of ______ with ______ cell predominance

<500 | Lymphocytic

In viral meningitis, glucose levels are _____ and protein levels are _____

Normal or slightly reduced | <150

In CSF of viral meningitis, CSF gram stain/culture will have what result

No organsism identified

In bacterial meningitis, CSF WBC count is ______ with _____ cell predominece

>1000 | Neutrophilic

In bacterial meningitis, the CSF has glucose levels of ______ and protein is _______

<45 | >250

A CSF gram stain in bacterial meningitis will often have what result

Positive for a specific organism

What is the most common viral cause of meninitis

Enterovirus (>90%)

What virus can present with the following clinical signs: fever, headache, rash, meningitis, echphalitis, acute asymmetric flaccid paralysis, parkinson symptoms

West nile virus

West nile virus is a _____ sense _____ stranded RNA virus

Positive | Single

Who is at risk for a west nile virus becoming neuroinvassive

Older Malignancy Organ transplant

What may be suspected of a patient with oral thrush and cervial and inguinal lymphadenopathy

HIV

Headache, seizures, multiple ring enhancing central nervous system lesions in a patient with HIV indicates what diagnosis

Toxoplasmic encephalitits

List two modes of transission for tocoplasmic encephalitits

``` Extensive pet (cat)exposure Contaminated food ```

Neuroleptic malignant syndrome is a life threatening adverse effect due to block of _____ receptors in the brain

Dopamine

If a patient who recently started using an antipsychotic presents with fever, confusion, muscle rigidty, and autonomic instability (abnormal vital signs, sweating) what might they be experiencing

Neuroleptic malignant syndrome

Mechanism of action: dantrolene

Atnagonizes ryanodine receptors and inhibits calcium release from sarcoplasmic reticulum

____ of inhaled anesthetic is inversly proportional to the minimal alveolar concentration

Potency

The minimal alveolar concentration referes to the percentage of anesthetic in the inspired gas mixture that renders ____ of patients unresponsive to painful stimulil

50%

What nerve innervates all of the extensor muscles of the upper limb below the shoulder and provides sensory inervation to the skin of the posterior arm, forear, and dorsal lateral hand

Radial

Radial nerve receives fibers from what nerve roots

C5-T1

The radial nerve tracks within the radial groove of the humerus, therefore it is vulnerable to tramatic injury at the ______

Humeral midshaft

Patients with proximal radial neuropathy typically have weakness during _______ and variable sensory loss over the posterior arm and forearm

Wrist and finger extension (wrist drop)

Damage to the proximal radial nerve can occur at the _____ or the midshaft of the humerus

Axilla

The blood brain barrier is formed by _____ between nonfenestrated capillary endothelial cells that prevent the paracellular pasage of fluidsand solutes

Tight junctions

L-DOPA has low lipid solubility but is able to enter brain due to _______

Its high affinity for the large neutral amino acid transporter

Liquefactive necrosis is charcteristic of irreversible CNS injury becuase of the brains high cholesterol content and lack of supporting architecture. It also occurs in other body tissues in the setting of severe infection/inflamation because of the release of _______ from reacting inflammatory cells.

Hydrolytic enzymes

How does a nicotinic receptor function

Its 2 acetylcholine binding sites must be filled and the ion channel opens, allowing sodium and calcium influx and sodium outflux ---> end plate potential

Nitrous oxide is a ____ soluble gas

Poorly

A gas that is poorly soluble, such as nitrous oxide, partial pressure will rise rapidly and plateua, indicating that the blood quickly becoems _____with the anesthetic

Saturated

Blood solubulity of an anesthetic is indicated by itsblood/gas partition coefficient, anesthetics with a higher blood slubility will have a ______ blood/gas partition coefficent

Larger

A gas with higher solubulity (thus a larger blood/gas partition coefficient) will havea partial pressure in blood that rises more _____ than a low solubilty gas

Slowly

Poorly soluble gases equilibrate with the brain ______ than highly soluble gases

Faster

Poorly soluble gases have a ______ onset than highly soluble gases

More rapide

The first pharyngeal arch is associated with what nerve

Trigeminal (V)

Bony derivatives of first pharyngeal arch

``` Maxilla Zygoma Mandible Incus Malleus ```

Muscle derivatives of first pharyngeal arch

Muscles of mastication

Second pharyngeal arcassociated with what nerve

Facial nerve (VII)

Second pharyngeal arch gives rise to what bones

Styloid process of temporal bone, lesser horn of hyoid, and stapes

Muscles derived from 2nd pharyngeal arch

Muscles of facial expression

Treacher collins syndrome is a genetic disorder resulting in abnormal development of _____

1st and 2nd pharyngeal arches

Treacher collins syndrome will preset with craniofacial abnormalities resulting in airway compromise and feeding difficulties as well as what other clinical finding

Profound conductive hearing loss

The most notable manifestaions of vitamin E deficiency are hemolysis and neurologic dysfunciton due to _____

Free radical damage of cell membranes

Neurologic symptoms of vitamin E deficiency closely mimic _______ which include ataxia ue to degeneration of spinocerebellar tracts, loss of position and vibration sense due to degeneration of the dorsal columns and loss of deep tendon reflexes due to peripheral nerve degeneration

Friedreich ataxia

Intraventricular hemorrhage in preterm infants usually originates from ______, a highly cellular and vascularized layer in the subventricular zone (source of neurons and glial cells during brain development)

Germinal mattrix

The germinal matrix contains numerous fragile, thin walled vessels that lack _____ that support other blood vessels throughout the bain, making them more susceptible to hemorrhage

Glial fibers

There is reduced risk of intraventricular hemorrhage in infants born after _____ weeks because the germinal matrix starts to become less prominent and its cellularity and vascularity decreases

Neonatal intraventricular hemorrhage occurs in infants born before 32 weeks nd/or birth weight

1,5000 g (3 lb 5o z)

Creutzfeldt-Jakob disease is a ____ disease: transmissible spongiform encephalopathy

Prion

Creutzfeldt-Jakob disease presents in previously healthy patients with ______ dementia associated with ________

Rapidly progressive | Myoclonus

Prion diseases are associated with the hange in structural confirmation of ______

Prion protein (PrPc)

The abnormal prion protein (PrPsc) in prion diseases is resistant to ______ and accumulates within neuronal and glial cells causing neural cell death

Enzymatic degredtion

Histopathology of Creutzfeldt-jakob disease shows widespread neuronal loss with small, uniform ____ in the gray matter of the brain

Vacuoles (spongiform encephalopathy)

What form of vaccine is administered for measles virus

Live attenuated

Measles genome codes for structural proteins including ____ which mediates cell surface adhesion and ____ which is important for virral assembly

Hemagglutinin | Matrix protein

______ is a rare complication of measles that occurs in children or young adults several years after the infection

Subacute sclerosing panencephalitis

Subacute sclerosing panencephailtis is caused by a form of measles virus with a mutated or absent _____ protein, allowing the virus to replicate intracellularly, evading the immune system

Matrix

Accumulation of measles viral ______ within neurons and oligodendrocytes results in the formation of intranuclear inclusions and eventually leads to inflammation, demyelination, and gliosis in manny cerebral areas (subacute sclerosing panencephalitis)

Nucleocapsids

________ of measles virus antibodies are found in the CSF of patients with subacute sclerosing panecephalitis secondary to measles infection

Oligoclonal bands

Cognitive decline and chorea along with a family history of similar symptoms are suggestive of what diagnosis

Huntingon disease

Huntington disease is due to ______ in the huntington gene leading to a gain of function mutation

Excessive number of CAG trinucleotide repeats

In Huntigton disease, the buildup of abnormal/toxic mutant huntingtin protein leads to loss of ____ in what region of the brain

Inhibitory GABA neurons | Caudate nucleus

Imaging in a patient with Huntington disease will reveal atrophy of the ___ leading to enlargement of the _____

Caudate nuclei | Lateral ventricles

The caudate nucleus and the _____ make up the striatum which is critical for movement control and coordination as well as behavior regulation

Putamen

Common manifestations of tabes dorsalis inlude sensory ataxia, absent deep tendon reflexes, and _____

Lancinating pains

Spirochetal damage to the midbrain _____ commonly results in Argyll Robertson pupil

Tectum

Positive VDRL is diagnostic of what infection

Syphilis

Normal aging leads to the following sleep changes: _______ total sleep time, slow wave sleep with _____ nighttime sleep latency

Decreased | Increased

What is the cause of isolated anosmia (leading to lack of taste) due to a head trauma

Acceleration-deacceleration forces lead to avulsion of olfactory nerve rootlets

A spinal cord disection at C7 would effect maximum insipiration or expiration more?

Expiration

Above the splenic flexure, peristalsis is controlled parasympathetic stimulation from what nerve

Vegas

Below the splenic flexure, peristalsis is controlled by parasympathetic innervation from what nerve

S2-S4 nerve roots

The external anal sphincter is controled by voluntary control (skeletal muscle) whic is innerrvated by what nerve

Pudendal nerve (S2-S4)

Decerebrate posture is due to a lesion _____ the red nucleus and results in contraction of the _______ muscles

Below | Extensor

Decorticate posture is due to a lesion ____ the red nucleus and results in contraction of the ___ muscles

Above | Flexor

Intracranial hemorrhage can cause significant mass effect and increase cranial pressure which can manifest with seizures and_________ triad (hypertension, bradycardia, bradypnea)

Cushing

Uncal herniation initially disrupts the ipsilateral occulomotor nerve (CN III) leading to _____

Fixed dilated pupil

The _____ tract regulates upper extremity flexor tone and originates from the red nucleii in the rstral midbrain

Rubrospinal tract

The rubrospinal tract is ______ by descenfing cortical output from the cerebral cortex

Inhibitted

The opthalmic nerve (CN V1) exits the skull through what foramen

Superior Orbital fissure then supraorbital foramen

The maxillary nerve (CN V2) exits the skull through what foramen

Foramen rotundum then infraorbital canal then infraorbital foramen

The mandibular nerve (CN V3) exits the skull through what foramen

Foramen oval | The alveolar nerve branch enters mandibular foramen then exits through mental foramen

what protein has apple green birefringence when stained ith congo red

Amyloid

Amyloidosis and Alzheimer disease both show apple green befringence with congo red staind but how do they differ

Alzheimer disease amyloid deposits are only seen in brain tissue

Spastic cerebral palsy may be caused by periventricular white matter necrosis which leads to loss of descending _____control from the upper motor neurons

Inhibitory

Lack of CNS inhibition leads to hyperactve ______

Stretch reflex

In the stretch reflex, muscle lengthening is sensed by _____

Muscle spindle

Afferent signal of stretch is conveyed to the spinal cord via the ____ nerve fibers

Dorsal

Efferent signals of the stretch reflex are conveyed via the ___ root of the spinal cord

Ventral

In the stretch reflex ____ muscle fibers are stimulated, causing muscle contraction

Extrafusal

The ___ reflex is responsible for deep tendon reflexes and the maintenacne of muscle tone

Stretch

A selective dorsal rhizotomy procedure destroys the ____ arm of the reflex arch, which decreses muscle tone without sacrificing motor innervation of the muscles

Afferent (sensory)

Symmetric, bilateral wedge shaped strips of necrosis over the cerebral convexity are characteristic of _____ cerebral ischemia

Global

Profound systemic hypotension diminishes blood suply to the entire brain, resulting in neuron cell death in areas that are vlnerable to hypoxia such as _____ and _____

Watershed areas and regions with high metabolic demand

______ is a group of hereditary peripheral neuropathies characterized by mutations in genes coding for peripheral nerce axonal or myelin proteins presenting with adolescent lower extremett weakness, muscle atrophy and peripheral neuropathy

Charcot marie tooth disease

The most common type of charcot marie tooth (CMT1) occurs due to autosmal dominant mutation in the ______ gene

PMP22

Sudden upward jerking of the arm at the shoulder can cause injury to the _____ trunk of the brachial plexus

Lower

the lower trunk of the brachial plexus carried nerve fibers from the C8 and T1 spinal levels that ultimately contribute to the ____ and ___ nerves

Median and ulnar

Injury to the intrinsic hand muscles leads to ______ palsy: weakness of the lumbricals --> impaired flexion of metacarpophalangeal joints and impaired extension of the interphalangeal joints: claw like deformity

Klumpke's palsy

What nerve exits the brain stem at the lateral aspect of the mid-pons at the level of the middle cerebellar peduncles

Trigeminal

What is a key neuroanatomic andmark for locating the trigeminal nerve

Middle cerebellar peduncle

Infarcts to the anterior pons can affect the ____ tracts

Corticospinal (contralateral hemiparesis) | Corticobulbar (contralateral lower facial palsy, dysarthria)

In an isolated CN III palsy, how is the eye oriented

Down and out

What eye muscles are not innervated by CN III

``` Superior oblique (CN IV) Lateral rectus (CN VI) ```

Aneurysms causing CN III palsy most often involve the ______ artery

Posterior communicating artery

Hydrocepalus (enlargement of the ventricles) caused by central neuronal volume loss (rather than excessive CSF) is called_______

Hydrocephalus ex-vacuo

In hydrocephalus ex-vacuo, the CSF pressure is____

Normal

In communicating hydrocephalus, CSF flows freely between the ventricles and subarachnoid space but there is decreased CSF absorptionin at the ________

Arachnoid granulations

Normal pressure hydrocephalus is _______ while high pressure hydrocephalus is _______

Chronic | Acute

A patient with unilateral optic neuritis is most likely to demonstrate an _____ pupillary defect due to demyelination of the right optic nerve

Afferent

The optic nerve carries the afferent limb of the puppillary light reflex, transmitting informaiton about light entering the eye to the ______ area in the midbrain

Pretectal

The pretectal area activates the ______ nuclei bilaterally which send paraympathetic efferent motor fibers down the oculomotor nerve to innervate the pupillary sphincter muscle to each iris

Edinger-westphal

Patients with an afferent pupillary defect will have what effect on pupillary constriction when light s shined in the non affected eye

Normal pupillary reflex bilaterally

What is first line therapy for essential tremor

Beta blocker (propranolol)

In patients with __________ exposure to certain anesthetic agents such as succinycholine and inhalation gasses causes unregulated passage of calcium form the sarcoplasmic reticulum into the intraacellular space

Malignant hyperthermia

In malignant hyperthermia, excessive myoplasmic _____ accumulation results in sustained muscle contraction, which is often first noted in the masseter

Calcium

What causes a high temperature in patients with malignant hperthermia

Sustained muscle contractions --> ATP consumption --> excessive heat production

Treatment for malignant hyperthermia

Dantrolene (blocks further release of calcium into the intracellular space)

Blotchy red muscle fibers on Gomori trichrome stain are characteristic of ________

Mitochondrial myopathies

In mitochondrial myopathies, abnormal mitochondria accumulate under the sarcolemma of muscle fibers causing the muscle fibers ro have irregular shape and size on cross section, for this erason mitochondrial myopathies are also known as ______

Red ragged fiber disease

Phenytoin is a ______ of p450

Inducer

_______ malformations are a group of congential disorders caused by unerdevelopment of the posterior fossa

Chiari

Chiari type I is more benign and presents when?

Adolescence/adulthood

Chiari tpe II typically presents when

Neonatal period

How does chiari type I differ from the herniation seen in chiari type II

Chiari type I only has the ccerbellar tonsils below the foramen magnum but chiari type II has downward displacement of the cerebellum and the medulla through the foramen magnum

What complications are common in type two chiari

Non communicating hydrocephalus | Lumbar myelomeningocele

Where does VZV lie dormant

(Migrates via sensory nerves to) cranial nere and dorsal spinal ganglia

What organism is a round/oval yeast surrounded by thick polysaccharide capsule

Cryptococcus neofromans

Cryptococcal diagnosis can be confirmed by cryptococcal antigens in CSF or visualiztion of encapsulated budding yeasts in CSF using what 2 specilized stains

India ink | Methenamine silver

Spinal muscular atrophy is caused by mutation in the ______ gene which encodes a protein involved in the assembly of small nuclear ribonucleoproteins (snRNPs)

Survival motor neuron gene (SMN1)

Defective snRNP assembly, as seen in spinal muscular atrophy, results in impaired _____ function and degeneration of anterior horn cells in the spinal cord

Splicesome

Non-coding RNA differs from other RNA how?

They carry out functions without first being translated into proteins

A collection of snRNPs and other proteins on a pre-RNA is referred to as a ____

A splicesome

Splicesomes remove ____ from preRNA

Introns

Infants with spinal muscular atrophy often have flaccid paralysis due to degeneration of _____ cells in the spinal cord

Anterior horn

Long standing rheumatoid arthritis frequntly involvesthe cervical spine and causes joint destruction with vertebral malalignment which is called _______

Subluxation

What is concerning about endotracheal intubation with a patient who has long standing rhuematoid arthritis

Extension of the neck can worsen subluxation leading to acute compression of the spinal cord and or vertebral arteries

Mechanism of methotrexate

Folic acid analog --> inhbits dihydrofolate reductase --> rapidly dividing cells dodnt have DNA synthesis or repair

An MRI with ventriculomegaly without sulcal enlargemnt is characteristic of ____

Normal pressure hydrocephalus

Normal pressure hydrocephalus causes lateral entrical expansion --> stretching of _______

Descending cortical fibers (corona adiata)

What is the classic triad of normal pressure hydrocephalus symptoms due to stretching of te cortical fibers

Dementia, gait disturbance, and urinary incontinence

The micturition reflex is an autononomic spinal reflex that receives inhibition from ____

Cerebral cortex

Lack of cortical inhibition on the micturition reflex results in _____ hyperactivity

Detrusor (--> urge incontinence)

The stapedius nerve, which innerates the stapes, is a brnch of what nerve

Cranial nerve VII (facial)

Paralysis of the stapedius muscle results in ______ (increased sensitivity to sound)

Hyperacusis

The pudendal nerve oriinates from ____ nerve roots

S2-S4

Pudendal nerve exits the pelvis throught hte ____ foramen

Sciatic

Motor branches of the pudendal nerve innervated the _____ and _____

Pelvic floor muscles | External urethral and anal sphincters

What is the draw back of using atropine rather than pralidoxime in organophosphate poisoning

Atropine is competitive inhibitorat muscarinic receptors only, nicotinic symptoms will persist (muscle paralysis)

How do demyelinating neuropathies differ from axonal neuropathies on a nerve conduction study

Demyelinating: delayed nerve conduction velocity Axonal: reduced signal amplitude

Ulnar neuropathy is characterized by numbness of the _____ digits, pain, and weakness

4th and 5th

___ is the most common brain tumor in children and appears as a heterogenous, well-circumscribed cerebellar mass

pilocytic astrocytoma

what are the two microscopic findings in a pilocytic astrocytoma

``` glial fibrillary acidic protein (GFAP) positive hairlike processes rosenthal fibers (eosinophilic intracytoplasmic inclusions) ```

how can a pilocytic astrocytoma be differentiated from a medulloblastoma

presence of both cystic and solid components on imaging

the neural tube is a structure that is connected to the amniotic cavity by opening at the ends know as ____ and ______

anterior and posterior neuropores

failure of neuropore closure by 4 weeks gestation leads to _____

neural tube defects

anterior nerual tube defects include ____ (absence of forebrain) and _______ (protrusion of neural tissue through the cranial defect)

anecephaly | encephalocele

what is the most mild form of a posterior neural tube defect

spina bifida occulta

a meningocele and meningomyelocele present as cystic masses at the lower spine that are sometimes covered by a tuft of hair, meningomyelocele has what difference from meningocele though

``` meningocele = meninges protruding meningomyelocele= meninges and spinal cord or cauda equina protruding ```

prenantal use of what medication, used for bipolar or epilepsy, is associated with a 10 - 20 fold increased risk for NTD

valproate

lamotrigine MOA

blocks voltage gated sodium channels

most concerning side effect associated with lamotrigine use

stevens johnson syndrome, or toxic epidermal necrolysis

what is the difference between stevens-johnson syndrome and toxic epidermal necrolysis

SJS involves <10% of the body and TEN has >30% involvement

presentation of steven johnson syndrome

flu like symptoms followed by widespread mucocutaneous epidermal necrosis

the presence of nonreactive pupils to light stimulation following cardiac arrest carries a por prognosis and indicates anoxic damage to the brainstem at the level of ______

the upper midbrain

cryptococcus neoformans is a llow virulence yeast with a thick polysaccharide capsule/ . It resides in soil contaminated by bird droppings and human exposure primarily occurs due to inhalation into the ____

lungs

first line treatment for trigemnial neuralgia

carbamazepine

carbamazepine MOA

reduces ability of sodium channels to recover from inactivation

fatigable muscle weakness with restoration of strength after rest, affecting voluntary muscles, particularyl those innervated by motor nuclei of the brain stem characterizes what disease

myasthenia gravis

myasthenia gravis is most commonly caused by autoantibodies against _____

postsynaptic acetylcholine receptors

in myasthenia gravis, th reduced number of postsynaptic cation channels that can open in response to acetylcholine causes what change to the action potential

reduces the amplitude of the motor end plate potential and prevents muscle fiber depolarization

how do tricyclic antidepressents and SNRIs treat neuropathic pain

decrease of serotoninc and norepiniephrine reuptake --> inhibition of pain signals

how do anticonvullsants treat neuopathic pain

decrease depolarization of neurons in the CNS

how does Capsaicin (topical) treat neuropathic pain

loss of membrane potential in nociceptive fibers

how does lidocaine treat neuropathic pain

decreased depolarization of neurons in peripheral nerves

MOA of capsaicin

activation of TRPV1 (transmembrane cation channel) --> build up of intracellular calcium --> long lasting dysfunction of nociceptive nerve fibers (defunctionalization) it also causes release and depletion of substance P

monocular scotoma is caused by lesion where

partial lesion of retina, optic disc, optic nerve

right anopia is due to a lesion where

right optic nerve

bitemporal hemianopia is due to lesion where

optic chiasm

right nasal hemianopia is due to lesion where

right perichiasmal lesion

left homonymous hemianopia is due to lesion where

right optic tract or optic radiation

left homonymous superior quadrantanopia (pie in sky) is due to what lesion

right temporal lobe (meyers loop)

left homonnumous inferior uadrantanopia (pie on floor) is due to what lesion

right parietal lobe (dorsal optic radiation)

left homonumous hemianopia with macular sparing is due to what lesion

right primary visual cortex (occipital lobe)

what are the results of a compound muscle action potential (CMAP) and high rate repetitive nerve stimulation in a patient with clostridium botulinum

decreseased CMAP | improves as rapid depolarization rate increases

clostridium botulinum will present with the classic 3 D's : _____, ____, and ____

diplopia, dysphagia, and dysphonia

peroxisomes functions include hydrogen peroxide degredation and _____

oxidation of very long and branched-chain fatty acids

Zellweger syndrome is caused by defective ____ biogenesis

peroxisomal

x-linked adrenoleukodystrophy is characterized as defective transport of ___ into peroxisomes

VLCFAs (very long chain fatty acids)

carpal tunnel syndrome is a peripheral mononeuropathy caused by compression of the ___ nerve in the carpal tunnel

median

fragile x mental retardation 1 gene on the long arm of the X chromosome normally has 5-55 CGG trinucleotide repeats and can potentially expand during ____

meiosis in oocytes

full mutation in fragile X syndrome is characterized as > _____ CGG repeats which causes FMR1 ________

200 | hypermethylation

what test is done to anylze the degree of methylation

southern blot

occlusion of the PICA results in lateral medullary syndrome, AKA ____ syndrome

wallenburg

occlusion of the PICA/wallenburg syndrome results in what 4 symptoms

1. vertigo and nystagmus 2. ataxia 3. loss of pain and temp in ipsalateral face and contra body 4. bulbar weakness

a drug that binds to and activates GABA-A receptors will increase the conductance of ___ ions, causing pasive transport down the concentration gradient into the cell interior .

chloride

patients with _____ stroke can have both sensory and motor deficits, but most commonly have pure motor weakness affecting the contralateral arm, leg, and lower face as well as clasp knife spasticity, hyperreflexia, and positive babinski sign

internal capsule

dysfunction to what structure would cause an action tremor that increases as hand reaches target

cerebellum

a patient with history of bulbar symptoms and limb weakness and evidence of asymetric muscular atrophy is indicative of what diagnosis

amyotrophic lateral sclerosis (ALS)

what structures are affected in the pathology of amyotrophic lateral sclerosis

both upper and lower motor neurons

_____ tumors are usually non small cell lung cancers that arise near the superior sulcus

pancoast

pancoast tumors can compress the ____ which can cause ipsilateral shoulder pain/weakness and can compress the ____ which may lead to Horner's syndrome

brachial plexus | cervical sympathetic ganglia

Sympathetic first order neurons are located in the ____, their axons descend through brainstem to C8-T2 where they synapse on second order neurons found in _____ column

hypothalamus | intermedial cell

second order sympathetic neurons synapse on third order sympathetic neurons in the _________ and then travel to the their target tissues in the face and head

superior cervical ganglion

In a neural tube defect, amniotic fluid will have high levels of ______ and ______

``` Alpha fetoprotein (AFP) Acetylcholinesterase ```

What herniation type involves herniation of the cingulate gyrus underneath the falx cerebri --> contralateral leg weakness

Subfalcine

What type of herniation involves herniation of the uncus under the tentorium cerebelli --> ispalateral dilated and fixed pupil and contralateral hemiparesis and then eventually ipsilateral hemiparesis

Uncal

What type of herniation involves the caudal displacement of diencephalon and brainstem --> rupture of paramedian basilar artery branches --> bilateral midposition and fixed pupils and decroticate then decerebrate posturing

Central

What type of herniation involves herniation of th cerebellar tonsils through the foraen magnum --> coma, loss of CN reflexes, flaccid paralysis and respiraatory arrest

Tonsillar

What is the cause of osmotic demyelination syndrome (central pontine myelinolysis)

Overly rapid correction of hyponatremia

Clinical features of osmotic demyelination syndrome

Quadriplegia Pseudobulbar palsy Reduced level of consciousness

MRI of osmotic demyelination syndrome shows ____

Focal demyelination of the pons

What is the syndrome that is X linked recesive and is characterized as dstonia, choreoathetosis, self mutilation, and hyperuricemia withing the first years of life

Lesch-Nyhan syndrome

Lesch-nyhan syndrome is a condition caused by a deficiency of ______

Hypoxanthine-guanine phosphoribosyltransferase (HGPRT)

Hypozanthine-guanine phosphoribosyltransferase is an enyzme that normally functions in the purine salvage pathway, and in its absence, ____ levels increase

Uric acid

Naegleria fowleria can cause primary amebic meningoencephalitis by entering through the ____ during water activities

Nasal mucosa (it travels retrograde through the olfactory nerve to the brain)

Ethosuximide, the first line treatment for absence seizures, prevents neuronal burst firing by blocking ______

Thalamic T-type Ca chanels

Mode of inheritence for neurofibromatosis type I

Autosomal dominant

Neurofibromatosis type 1 is caused by mutation in NF1 gene located on chromosome ___

What are the most common symptoms of neurofibromatosis type 1

Cafe au lait spots Multiple neurofibromas Lisch nodules (pigmented asymptomatic hamartomas of the iris)

VZV lies dormant in the ______ ganglia

Dorsal spinal

_______ is an incomplete forebrain division into 2 hemispheres with a single lateral ventricle

Holoprosecephaly

The prosencephalon gives rise to the _____ which develops into the thalamus and third ventricle and the _____ which develops into the cerevbral hemispheres and lateral ventricles

Diencephalon | Telencephalon

Holoprosencephaly may be due to a variety of factors (ex. Hedsgehog gene mutations), the most common associated chromosomal abnormality is ________

Trisomy 13 (Patau syndrome)

Early onset familial alzheimer disease is associated with _______ gene on chromosome 21, ________ gene on chromosome 14, and ______ gene on chromosome 1

Amyloid precursor protein (APP) Presenilin 1 Presenilin 2

The APP and presenilin gene mutations in early onset alzheimers are thought to promote the production of ______

A beta amyloid

Late onset familial alzheimer disease is associated with the ____ allele of apolipoprotein E

Epsilon 4

Regardless of etiology, the initial drug of choice for treating status epilepticus is _______ due to its efficacy and rapid onset of action

IV benzodiazepine (lorazepam)

Benzodiazepines MOA

Allostericly attach to GABA-A receptors causing increased influx of Cl- --> hyper polarization of postsynaptic neuron

Diffuse axonal injury, a type of severe traumatic brain injury that can occur from direct blunt force injury or abrupt changes in acceleration-deceleration. The transfer of force can result in immediate shearing of ________ or induce secondary biochemical changes leadgn to degredatin of _____with subsequent ___ breakage

White matter tracts Axonal cytoskeleton Axon

Diffuse axonal injury inhibits normal axonl transport --> accumulation of _____ within axonal swellings at the point of injurry

Axonally transported proteins (amyloid precursor, alpha synuclein)

Diffuse axonal injury is seen on what imaging

MRI (CT may appear normal)

Diffuse axonal injury is visible as widespread axonal swelling, most pronounced at the __________

Gray-white matter junction

West nile virus is enveloped RNA virus that is found in warm climates worldwide. The virus replicates extensively within ___ and is passed to ____

Birds | Mosquitos (Culex species)

Cryptococcal neoformans can be cultured on ____ agar

Sabouraud

Initial treatment of cryptococcal meningoencephalitis

Amphotericin B and flucytosine

Long term maitenance therapy for crytpococcal meningoencephalitis

Fluconazole

Tay sachs is caused by beta hexosaminidase A deficiency which results in accululation of the cell membrane glycolipid _______ within lysosomes

GM2 ganglioside

_______ clinical presentation includes macrocephaly, abnormal startlereflex with acoustic stimuli, and cherry red macula spot

Tay sachs

Tetrodotoxin (in puffer fish) and saxitoxin (dinoflagellates in "red tide") bind to Na channels to what effect

Inhibit Na influx and prevent action potential conduction

Ciguatoxin (in exotic fish and moray eel) and batrachotoxin (in south american frogs) bind to Na channel to what effect

Keep it open and cause persitent depolarization

Treatment after tetrodotoxin exposure

Supportive care and intestinal decontamination with gut labage and charcoal

Cytotoxic (ionic) edema begins hours after ischemic injury due to ____ and failure of _______

Decreased ATP | ATP dependent ion pumps

______ edema follows 24-48 after ischeimc stroke when release of inflammatory mediators disrupts tight jnctions of blood brain barier, allowing proteins and water to enter the inerstitial space

Vasogenic

A _______ appears as a hyper dense mass on CT and almost always affects the adjacent internal capsule, leading to dysarthria, contralateral hemiparesis, and contralateral hemisensory loss

Putaminal hemorrhage

The basal ganglia are supplie by the ____ arteries which are deep, small vessel branches off the middle cerebral arteries

Lenticulostriate

Injury of what nerve can occur due to repetitive pressure/trauma caused by an ill-fitting crutch (crutch palsy) or if an individual sleeps witht he arm over a chair (saturday night palsy)

Radial

The iliohypogastric nerve arises from L1, emerges from lateral border of the upper psoas major, and passes behing the kidney. It provides motor function to ____

Anterolateral abdominal wall muscles

Damage to the anterior branch of the _______ nerve during appendectomy causes decreased sensation at the suprapubic region

Iliohypogastric

In a positive/pathologic jaw jerk reflex, Tapping on the chin with the mouth open will cause what

The jaw to briskly close

Patients with bilateral _____ lesions will have a positive jaw jerk reflex

Upper motor neuron

The jaw jerk reflex begins with afferent signals from the muscle spindles of the masseter that are carried along the ______ nerve and the efferent signals travel along the ____ nerve to the muscles of mastication

CN V3 | CN V3

What nerve is injured in tennis elbow

Median nerve

The median nerve passes between what structurs which allows it to be suseptible to compression

Humeral and ulnar heads of the pronator teres muscle

How does impaired sensation from compression of the median nerve differ in carpal tunnel syndrome and compression by pronator teres

Carpal tunnel syndrome --> impaired sensation to palmar aspects offirst 3 and 1/2 digits Compression by pronator teres --> impaired senesation to first 3 and 1/2 digits and entire lateral plm and thenar eminence (because also includes palmar branch)

In the CNS, serotonergic neurons are primarily found in the _____ nuclei of the brainstem

Raphe

What medication used in TB treatment is similar to pyridoxine (vit B6) and therefore competes with B6 in the snthesis of multiple neurotransmitters -- > defective and products

Isonizid

Isoniazid increases the urinary excretion of ___ and causes afrank deficiency in it

Pyridoxine (vit B6)

Trycyclic antidepressants modulate pain transmission by inhibitting ______ in sensory nerves and increasing ______ signaling in the CNS

Voltage gated sodium channels | Norepinephrine

SNRIs alter central transmission of pain by increasing ______ in the central synapses

Norepinephrine

What is the term for brief loss of muscle tone precipitated by strong emotion (laughter, excitement)

Cataplexy

DSM-5 diagnostic criteria of narcolepsy includes low CSF levels of ____

Hypocretin-1

Narcolepsy with cataplexy is most often caused by the lack of 2 related neuropeptides: hypocretin-1 and hypocretin-2 which are produced in neurons located in _______

Lateral hypothalamus

The ___ is a component of the basal ganglia that plays an important role in modulation of basal ganglia output. If damaged, it can decrease excitation of the globus pallidus internus --> reducing inhibition of the thalamus

Subthalamic nucleus

What is the term for a movement disorder that is characterizedby wild,involuntary, large-amplitude, fliging movements invoving the proximal limbs on ones side of the body

Hemiballism

A lacunar stroke causing damage to the _______ may result in contralateral hemiballism

Subthalamic neuclues

______ headaches are often recurrent, unilateral, and can be accompaied by ipsilateral autonomic symptoms

Cluster

thiamine (vit B1) is a cofactor in many enzymes, including _____ which converts pyruvate to acetyl co a

Pyurvate dehydrogenase

Thiamine (vit B1) isa cofactor for many enzymes including ____ which an an anzyme in the citric acid cycle

Alpha ketoglutarate dehydrogenase

Thiamine (vit B1) is a cofactor for many enzymes including _____ whch is esential for catabolism of branched chain amino acids

Branched-chain alpha ketoacid dehydrogenase

Thiamine (vit B1) is a cofactor for many enzymes including _____ which is an enzyme in the pentose phosphate pathway that help convert ribulose 5-P to glycolysis intermediates

Transketolase

Thiamine deficiency results in decreased ______ utilization which is especialy pronounced in the CNS

Glucose

Thiamine deficiency can be diagnosed if baseline erythrocyte ______ activity is low but increases after additno of thiamine pyrophosphate

Transkelotasee

The quadricalent conjugate vaccine for neisseria meningitisis moa

Capsular polysaccharide antigens are fused to a diptheroid toxin carrier -- > APCs present it to T-cells

Serogroup B vaccine for neiserria meningitidis moa

Recombinant proteins (instead f the capsular polysaccharides because too close to humn neural cell adhesion molecules --> molecular mimicry)

Women in the postpartum period are at particulary high risk of developing what condition which causes fatigable skeletal muscle weakness

Mysthenia gravis

The most common underlying cause of focal-onset seizures is a _______

Focal structural brain abnormality

____ is when an initial embryonic disturbance leads to multiple malformations by disrupting th development of adjacent tissues and structures within a particular region

Developmental field defect

______ referes to complete absence of an organ

Agenesis

______ refers to multiple anomalies without a known unifying cause that occur together more frequenly than chance alone would predict

Association

____ are fetal structural anomalies that occur due to extrinsic mechanical forces

Deformation

______ is a developmental field defect characterized by a spectrum of fetal anomalies due to incomplete division of the forebrain (prosencephalon)

Holoprosencephaly

What nerve passes posterior to the medial epicondyle of the humerus (cubital tunnel)

Ulnar nerve

The ulnar nerve innervates the _______ (wrist flexion and adduction) and medial portion of the _______

Flexor carpi ulnaris | Medial portion of flexor digitorum profundus

The ulnar nerve enters the wrist throught the ______

Guyon canal (between hook of hamate and pisiform)

The superficial branch of the ulnar nerve provides cutaneous inervation to ______, ____, and _____

5th digit Medial half of 4th digit Hypothenar eminence

Ramelteon MOA

Melatonin agonist

Neurologic damage associated with ____ dficiency classically includes subacute combined degeneration of the dorsal column, lateral corticospinal tracts, and spinocerebellar tracts

Vit B12 (cobalamin)

Patients may develop atrphic glossiis, which appears as a smooth, shiny, erythematous tongue following a gastrectomy due to what

Vit B12 deficiency

Repetitive pronation/supiination of the forearm (ex. Frequent screwdriver use) could injure the radial nerve at what location

Supinator muscle

What nerve is most frequently injured during axillary lymph node diseection and results in sensory dysfunciton in medial upper arm

Intercostobrachial nerve

Damage to what nerve results in winging of the scapula

Long thoracic

What nerve innervates the latissimu dorsi

Thoracodorsal

Opsoclonus-myoclonus syndrome: nonrhythmic conjugate eye movements and involuntary jerking movements of the trunk and limbs in a young patient should prompt evaluation for _______

Neuroblastoma

Neuroblastoma arises from _____ cells of the adrenal medula or sympathetic ganglion

Neural crest

A majority of patients with neuroblastoma have elevated _______ due to the neural crest origin

Catecholamine metabolites

Biopsy of neuroblastoma mass will reveal _____ and ______

Small round blue cells | Homer wright rosettes

Tumor tissue of a neuroblastoma is tested for _____ amplification which predicts a poor prognosis

N-myc

What are the benefits of injecting epinephrine with lidocaine

Epinephrine --> vasoconstriction--> decreased local bleeding, prolonged duration of action bc lidocaine stays in site of injection longer, and decreased systemic absorption reducing side effect risks

_____ disease can cause cystic degeneration of the putamen as well as other basal ganglia structures

Wilsons

Schwannomas appear biphasic, microscopically, with highly cellular areas: ______ pattern; intermixed with myxoid regions of low cellularity: _____ pattern

Antoni A | Antoni B

The Antoni A areas in a schwannoma is composed of _____ cells (eloongated cells with regular oval nuclei) that form palisading patterns interspercing nuclear free zones called ______

Spindle | Verocay bodies

Schwannomas and melanoma are ___ positive because they are derived from neural crest cells

S-100

Schwannomas can arise from the peripheral nerves, nerve roots, and cranil nerves except for ____

Cranial nerve II (optic nerve)

High solubility of anesthetic in the blood (blood/gas partition coefficient) has what effect on time for it to get to the brain

More anesthetic must be absorbed by the blood before it can effectively be transfered to other tissues

Solubility of an anesthetic in peripheral tissues _______ affects brain saturation

Negatively

High solubility of anesthetic in the peripheral tissues has what effect on ateriovenous concentration gradient

Increases it

Mechanism of action of erenumab (migraine treament)

Anti-CGRP antibodies

Tetrahydrobiopterin (BH4) is a cofactor in the synthesis of _____, ____, and ______

Serotonin Tyrosine DOPA (tyrosine --> DOPA)

Serotonin (5-hydroxytryptamine) is formed through hydroxylation and decarboxylation of the amino acid _____

Tryptophan

A BH4 deficiency secondary to dihydropteridine reductase deficiency can cause the build up of tryptophan and what other amino acid

Phenylalanine

Key features of congenital toxoplasmosis infection

Chorioretinitis Hydrocephalus Diffuse intracranial calcifications

Key features of congntial syphilis infection

Rhinorrhea Skeletal anomalies Desquamating rash (palms/soles)

Key features of congenital rubella infection

Cataracts Heart defects (PDA) Sensrineural hearing loss

Key features of congenital cytomegalovirus infection

Periventricular calcifications Microcephaly Sensorineural hearing loss

Key feature of congenital herpes simplex virus infection

Vesicular/ulcerative rash

What are the TORCH infections

``` Toxoplasmosis Other infections Rubella Cytomegalovirus Herpes simplez ```

When are TORCH infections contracted

In utero due to transplacental transmission

What may cause new onset focal neurologic deficits 3-12 daysafter subarachnoid hemorrhage develops

Cerebral vasospasms --> delayed cerebral ischemia

Subarachnoid hemorrhage is most often caused by rupture of a ______ which occurs frequently in patients with autosomal dominant polycystic diseas

Saccular (berry) aneurysm

What can be administered to patients to improve outcomes of subarachnoid hemorrhage

Nimodipine (selective calcium chanel blocker)

How does nimodipine improve outcomes of patients with cerebral vasospasms followign a subarachnoid hemorrhagee

Induces cerebral vasodilation and decreases calcium dependent excitotoxicity

The sensor limb of the corneal reflex is mediated by CN V1 which enters the orbit through the ______

Superior orbital fissure

Globe adduction is mediated by the medial rectus muscle which is innervated by the occulomotor nerve (III) which enters the orbit through the ____

Superior orbital fissure

What nerves enter the orbit via the superior orbital fissure

``` Oculomotor nerve (III) Opthalamic nerve (V1) Trochlear nerve (IV) Abducens nerve (VI) ```

The ___ nerve is a branch of the mandibular nerve (V3) which innervated the lower teeth and is culnerable to injury during dental procedures

Inferior alveolar

The inferior alveolar nerve gives off the _____ nerve which conveys sensory information from the chin and lower lip

Mental

A history of gait dysfunction and evidence of myelin/axonal degeneration in the dorsal columns and corticospinal tract are highly suggestive of _____ deficiency

Vitamin B12

Spinal cord damage seen with vitamin B12 deficiency is called ____________

Subacute combined degeneration (combined bc degeneration of both ascending and descending pathways)

The brachial plexus originates from the ___- ___ spinal nerve roots and pass between the anterior and middle scalene

C5-T1

Interscalene nerve block, a technique used for procedures involving shoulder and upper ar, transverses along the interscalene sheath and affects the roots of the ____ nerve (C3-C5)

Phrenic nerve

Most common primary cerebral neoplasm in adults

Glioblastoma

Gliobltomas arise from ____

Atrocytes

What is a butterfly glioma

Glioblastoma tha crosses the corpus collosum

On gross examination, glioblasomas are soft and poorly defined with area of necrosis and _____

Hemorrhage

What is the prognosis of glioblastomas

Poor, they are highly malignant

Levadopa is the immediate precursor to ____

Dopamine

Dopamine is absent in the ______ of patients with Parkinson disease

Nigrostriatum

Dopamine itself cannot be administered directly due to its inability to ____

Cross the blood brain barrier

Levadopa is rapidly metabolized in the peripheral tissues to dopamine and _______

3-O-mthyldopa (via catecgol-O-methyltransferase)

Levodopa is typically administered with _______, a peripheral DOPA decarboxylase inhibitor

Carbidopa

Moa: entacapone

COMT inhibitor (inhibits peripheral methylation of levodopa)

What can be used to treat parkison patients with motor fluctuations who are experiencing end of dose wearing off periods with levodopa/carbidopa therapy

COMT inhibitors (entacapone)

Inflammation in bacterial meningitis is driven by subcapsular components, partcularyly macromolecules of bacterial cell such as ____ and ___

Teichoic acid | Peptidoglycan

_____ is the leading cause of bacterial meningitis in adults

Strep pnumoniae

For patients with strep pneumo meningitis: Pretreatment of ______ reduces levels of inflamator cytokines in the CSF and limits risk of inflammation induced morbidity

Dexamethasone

Which of the following benefit from pretreatment with dexamethasome and why: strep pneumo, h. Flu, n. Menngitidis

Strep pneumo H. Flu and N. Meningitidis have thinner cell walls (gram negative) so have less peptidoglycan and no teichoic acid and therefore result in less inflammatory cytokine release

Creutzfeldt-jacob, fatal familial insomnia, and kuru are all examplse of ____ diseases

Prion

Prion diseases are progressive neurodegenerative disorders caused by accumulation of _____ within the brain

Abnormally folded protein

Prion diseases may be transmitted between species how?

Ingestion of tainted meat

Prion proteins are found in both neuronal and nonneruonal brain cells and normally exist in ______ structure

Alpha helical (PrPc)

Prion disease occurs after a domain in the prion protein undergoes a conformational change from the alpha helix into ____

Beta pleated sheet (PrP^Sc) (scrapie)

The beta sheet confirmation of prion proteins are resistant to ____ and form long neurotoxic fibrils which accumulate intracellularly in neurons and form extracellular deposits

Proteases

On microspcopy of prion diseases, there is a ______ degeneration of gray matter which is characterized by formation of microscopi ____ within the neuronal processes

Spongiform | Vacuoles

Extracellular prion accumulations (kuru plaques) are frequently present in prion disease and stain positive with ____ and ____ stains

Congo red | Periodic acid-Schiff

The oculomotor nerve is most susceptible to injury from ipsilateral _______ artery aneurysms

Posterior communicating artery

Classic manifestation of ______ mass include obstructive hydrocephalus from aqueductal stenosis and dorsal midbrain (Parinaud) syndrome due to direct compression of the pretectal region of the midbrain

Pineal gland mass

______ syndrome is characterized by limitation of upwrd gaze with a downward gaze preference, bilteral eyelid retraction, and light-near dissociation (pupils react to accomodation but not light

Parinaud

The most common pineal mass is a _______, a midline tumor thought to arise from embryonic germ cells

Germinoma

Suprasellar germinomas (less common site for a germinoma) do not lead to Parinaud syndrome, but they are more likely to present with _________

Endocrinopathies (central precocious puberty, diabetes insipidus)

The ____ nerve innervates the quadricepsmuscles and provides sensation for the arch of the foot, shin, and anteromedial thigh

Femoral

The optimal site for a femoral nerve block is right below the _____ at the lateral border of the femoral artery

Inguinal ligament

What nerve that passes through the cavernous sinus next to the internal carotid arter is the most likely structure to be damaged by an expanding aneurysm of the internal carotid

Abducens (VI)

Esotropia

Inward eye deviation

Occlusion of the _______ artery would affect sensory and motor function of the contralateral leg and foot while predominntly sparing contralateral arm/face

Anterior cerebral artery

Patients with bilateral ______ atery occlusions can develop significant behavioral symptoms and urinary incontinence if the frontal micturition center (medial frontal lobe/cingulate girus) is affected

Anterior Cerebral artery

``` Oclussion of the anterior cerebral artery would most likely impair what movements: Climbing stairs Gripping Speaking Swallowing food Whistling ```

Climbing stairs

The etiology of narcolepsy is believed to be due to low levels of the stimulatory neurotransmitter ______ which isinvolved in maintaining wakefulness and supressing REM sleep-related phenomena

Orexin (hypocretin)

Modafinil MOA

Nonamphetamine stumulant, may enhance dopaminergic signaling (first line agent for narcolepsy bc effective, well tolerated and misuse is rare)

Bells palsy is idiopathic paresis of ______ nerve

Facial (CN VII)

What nerve sends parasympathetic innervation to the lacrimal, submandibular, and sublingual salivary glands

Facial (VII)

What nerve sends afferent fibers for taste for anterior 2/3 of tongue

Facial

What nerve sends somatic afferents from the pina and external auditory canal

Facial

Specific findigs of bells palsy tipically include impaired eye closure, eyebrow sagging, inability to smile and frown on affected side, disappearance of the _____ fold and the mouth being drawn to the _____ side

Nasolabial | Non affected

Patients with bells palsy may experience ___ tearing, hyper____, and loss of taste sensation over the ______ of the tongue

Decreased Acusis Anterior 2/3

Gross examination of hemangiomas reveals a "mulberry-like" appearance due to their purple vascular clusters. Histologically they are composed of abnormal, dilatd blood vessels with a thin adventitia lacking ______ and ______

Elastic fibers | Smooth muscel

Cavernous hemanigiomas' reduced structural suppor givesthem a tendency to leak, causing recurrent ______

Hemorrhage

_____ hematoma has a clinical manifestation of lucid interval followed by loss of consciousness

Epidural

_____ hematoma has a clinical manifestation of coma at onset and chronic gradual onset of headache and confusion

Subdural

What vessel is tpically involved in epidural hematoma

Middle meningeal artery

What vessel is typically involved in subdural hematoma

Bridging cortical veins

How is a subarachnoid hemorrahage visualized on CT? Blood in the _____

Basal cisterns

Epidural is accumulation of blood between the ____ and_____

Skull bone | Dura mater

Most cases of epidural hematoma are due to fracture of the ______

Pterion region of the skull

An ipsilateral dilated pupil can occur during an epidural hematoma due to ___ herniation and _____ nerve compression

Uncal | Oculomotor

The diagnoses of epidural hematoma can be confirmed by ______ showing a hyperdense, biconvex (lens-shaped) mass between the brain and skull

Non contrast CT

_____ are extracellular deposits often found in the medial temporal lobe and are composed of a central amyloid beta core surrounded by dystrophic neurites

Neuritic (senile) plaques

______ are found int he neuronal cytoplasm and consist of aggregates of hyperphosphorylated tau protein, which normally mediates micrtubule stabilization

Neurofibrillary tangles

Symptoms of normal pressure hydrocephalus are progressive ad occur due to disruption of periventricular _____ by the expanding ventricles

White matter tracts

Treatment for normal pressure hydrocephalus

Large volume CSF removal and longterm treatment frequently involves placement of a ventriculoperitoneal shunt

Psuedopalisading necrosis is an area of necrosis surounded by columns of ______

Tumor cells

Pseudopalisading necrosis with vascular proliferation (capillaries at the periphery) are characteristic histologic finsings of ______

Glioblastoma multiforme

Glioblastoma multiforme is usually located within the cerebral hemispheres and often presents with _______ that worsens with bending over and ____, ____, and /or _____

New onset headache Nausea/vomiting Focal neurological defects Seizures

___ is the most common cause of spontaneous lobar hemorrhage, particularly in adults over age 60

Amyloid angiopathy

Amyloid angiopathy is a consequence of ____ deposition in the walls of small- to medium- sized cerebral arteries resulting in vessel wall weakening and predisposition to rupture

Beta amyloid

Dopamine agonists have a chemical structure similar to dopamine and directly stimulate the dopamine receptor. Do they need to be metabolized to be active?

What are the two classes of dopamine agonists

``` Ergot compounds (derive from ergot fungi; bromocriptine) Nonergot compounds (pramipexole, ropinirole) ```

MOA bromocriptine

Dopamine agonist (ergot compound)

MOA pramipexole

Dopamine agonist (nonergot compound)

MOA ropinirole

Dopamine agonist (nonergot compound)

The tetanus toxin blocksi nhibitory interneurons at what location in the body?

Anterior horn cells

Cerebral spinal fluid is formed by 4 ___ found in each of the ventricles

Choroid plexuses

CSF flows from the lateral ventricles to the third ventricle via the ______

Interventricular foramina of monro

CSF travels from the 3rd ventricle to the 4th ventricle via the _____

Cerebral aqueduct (of Sylvius)

CSF exits the 4th ventricle and enters the subaracnoid space via one of the 3 foramina: the 2 lateral foramina of ________ and the single midline foramen of ______

Lushka | Magendie

CSF is returned to venous circulation from the subarachnoid space via ______

Arachnoid villi (granulations)

_________ presents with elevated ICP and classically occurs in young women who are overweight. The etiology is not well known but it is thought to be related to cerebral venous outflow abnormalities due to elevated intracranial pressure

Pseudotumor cerebri

Malignant hyperthermia is oftern due to abnormal ____ in skeletal muscle

Ryanodine receptors

______ is used to treat malignant hypertension because it directly inhibits intracellular calcium release fom the abnormal ryanodine receptor

Dantrolene

Selegiline MOA

Inhibitor of MAO type B

Clinical use of Selegiline

Delays progression of Parkinson disease (prevents damage to dopamanergic neurons)

What is the likely diagnosis: 16 yr old boy with chronic loss of upper extremity pain and temp sensation, upper extremity weakness and hyporeflexia, lower extremity weakness and hyperreflexia, and kyphoscoliosis

Syringomyelia

Name the hereditary disease that causes degeneration of spinocerebellar tracts, posterior colums and dorsal root ganglia

Friereich ataxia

What is the most common cause of death in friedreich ataxia

Hypertrophic cardiomyopathy

What skeletal anormalities are seen in friedrich ataxia

``` Kyphoscoliosis Pes cavus (high arches) ```

What inherited disease may present with behvioral abnormalities (mood changes, withdrawl), cognitive impairment, and chorea (jerky, fidgety, involuntary movements)

Huntington disease

What neurons in the caudte nuclei (striatum) are especialy vulnerable and atrophy early in the course of Huntington disease

Inhibitory GABAnergic neurons

Expanding space occupying lesions such as hemorrhage or hematoma can manifest with Cushing triad which is what

Hypertension, bradycardia, irregular respirations

Lesions in the temporal lobe tend to cause what form of herniation

Transtentorial herniation of the uncus

Transtentorial herniation of the uncus can compress the ipsilateral _____ nerve as it exits the midbrain at the same level

Oculomotor nerve (CN III)

Compression of CNIII due t trnastentorial herniation of the uncus can lead to what pupil finding

Dilated pupil

The left temporal hemiretina joins the right nasal hemiretina and travels via the left optic tract to the left _______ in the thalamus

Lateral geniculate body

Visual signals leave the lateral geniculate body and travel via optic radiations to the ipsilateral ______ for visual processing

Primary visual cortex

Herpes zoster opthalmicus is caused by viral reactivation involving what nerve

Trigeminal nucleus --> opthlmic branch of trigeminal nerve

How can herpes zoster affecting the opthalmic branch of the trigeminal nerve lead to blindness

CN V1 conveys sensory information from the cornea, if theres a lesion it can lead to blindness due to acute keratitis

What inheritable disease is characterized by initial degeneration of the prefrontal cortex that eventually progresses to include the anterior temporal cortex

Frontotemporal dementia

What subtype of demetia has these characteristic findings: Early insidious short term memory loss Language deficits and spatial disorientation Later personality changes

Alzheimer disease

Wha subtype of dementia presents with: Stepwise decline Early executive dysfunction Cerebral infarction and/or deep white matter changes on neuroimaging

Vascular dementia

What subtype of dementia may present with the following: Early personality changes Apathy, disinhibition and compulsive behavior Frontotemporal atropthy on neuroimaging

Frontotemporal dementia

What subtype of dementia may present with the following: Visual hallucinations Spontaneous parkinsonism Fluctuating cognition Rapid eye movement sleep behavior disorder

Dementia with lewy bodies

What subtyme of dementia may present with the following Ataxia early indisease Urinary incontinence Dilated ventricles on neuroimaging

Normal-presure hydrocephalus

What subtype of dementia may present with the following: Behavioral changes Rapid progression Myclonus and/or seizures

Prion disease

What area of the brain is responsible for all communicative motor planning

Brocas

Damage to what part of the brain results in inability to understand spoken language or follow commands (non intact speech comprehension)

Wernickes

Brocas area is in the caudal part of the inferior ____ gyrus of the dominant hemisphere (which is usually what side?)

Frontal | Left

Vecuronium mechanism of action

Nondepolarizing agent, competitive antagonist of nicotinic acetylcholine receptor

Why do patients with myasthenia gravis have increased sensitivity to vecuronium and other nondepolarizing neuroblocking agents

They have low number of functioning receptors

How do depolarizing neuromuscular blocking agents act differently in patients with myathenia gravis

Because they have fewer funcitoning receptors, they are more resistant to these agents, larger doses are required to induce muscle relaxation

Parianal anestesia with loss of anocutaneos reflex indicates involvement of what nerve roots

S2-S4

Conus medullaris syndrome involves what spinal region

L1-L2

Cauda equina syndrome involves what spinal region

Below L2

Conus medullaris syndrome typically causes ____ (bilateral/unilateral) extremity weakness with ____ motor neuron signs

Bilateral | Upper

Cauda equina syndrome tends to cause ______(symetric/assymetric) lower extremity weakness with _____ motor neuron signs

Assymetric | Lower

What is a funciton of the frontal lobe and may be tested by asking a patient to describe the similarities between two objects

Abstraction

A patient with recurrent headaches and seiures with multiple flow voids on MRI is consitent with what diagnosis

Cerebral arteriovenous malformations

What are vascular malformations inwhich blood courses directly from arteries to veins without passing through an intervening capillary bed allowing turbulent flow which can lead to aneurysm development, bleeding, and damage to the surrounding brain

Arteriovenous malformations

Arteriovenous malformations can appear as what on angiography and what on MRI

Bag of worms | Dark flow voids(indicative of swift blood flow)

What travels through the cribiform plate

CNI olfactory bundles

What traves through the optic canal

CN II Opthalmic artery Central retinal vein

What travels through the superior orbital fissure

CN III, IV, V1, VI Opthlmic vein Sympathetic fibers

What travels through the foramen rotundum

CN V2 (maxilary)

What travels through the foramen ovale

CNV3 (mandibular)

What travels through the foramen spinosum

Middle meningeal artery and vein

What travels through the internal acoustic meatus

CN VII, VIII

What travels through the jugular foramen

CN IX, X, XI | Jugular vein

What travels through the foramen magnum

Spinal roots of CNXI Brain stem Vertebral arteries

What travels throught he hypoglossal canal

CN XII

What nerve innervates hte muscles of mastication

CNV3

What three muscles close the jaw

Masseter Medial pterygoid Temporalis

What muscle opens the jaw

Lateral pterygoid

Unilateral injury of CNV leads to deviation of the jaw to what side

Ipsilateral side (due to unopposed action of the contralateral pterygoid)

What somatic nerve function does the glossopharyngeal nerve have

Styolopharyngeus muscle (only): elevates larynx during swallowing

The sciatic nerve branches into the _____ and ___ nerve just proximal to the popliteal fossa

``` Common fibular (peroneal) nerve Tibial nerve ```

After coursing around the ______ the fibular nerve divdes into the deep and superficial branches

Neck of fibula

The ____ branch of the fibular nerve innervates the anterior compartment muscles of the leg (foot and toe dorsiflexion)and provides senstion to the webspace between the first and second toes

Deep

The ___ branch of the fibular nerve innervates the lateral compatment muscles (foot eversion) and providessensation to the dorsum of the foot and lateral shin

Superficial

The ____ nerve is frequently injured by trauma due to its superficial location at the neck of the fibula

Common fibular

Temporal lobe epilepsy is the most common type of _____ epilepsy which occur when partial seizures originate from one area of the brain and are usualy due to an underlying structural disorder which serves as an epileptogenic focus

Localiztion-related

Temporal lobe epilepsy is most commonly due to _______ which is usually visible as ______ on MRI

Hippocampal sclerosis | Hippocampal atrophy

Characteristic histopathological findings in hippocampal sclerosis includes atrophy of the hippocampal neuons with marked reactive gliosis: proliferation of ____ in response to injury

Astrocytes

The rabies virus contains a bullet shapd envelope with knob like glycoproteins that allow it to attach to the ________ at the neuromuscular junction

Nicotinic acetylcholine receptor

A patient with sudden onset explosive headache, brief loss of conscioussness and signs of menigeal irritation most likely has what type of hemmorage

Subarachnoid hemorrhage

Subarachnoid hemorrhage usually results from the spontaneous rupture of ____-

Saccular (berry) aneurysm

In subarachnoid hemorrhage, blood empties into the subarachnoid space and pools in _____ and ______

Cerebral sulci | Basal cisterns

_____ is a transmembrane glycoprotein found in the presynaptic vesicles of neurons, neuroectodermal and neuroendocrine cells

Synaptophysin

Immunoreactivity of a CNS tumor for synaptophysin indicates a ____ orgin

Neuronal

Nigrostriatal degeneration in Parkinson disease results in excessive excitation fo the _________ by the subthalamic nucleus, which in turn causes excessive inhibition of the thalamus

Globus pallidus internus

Patients with medically intactractable symptoms of parkinson disease may benefit from high frequency deep brain stimulation to the globus pallidus internus or. _____

Subthalamic nucleus

____ is a rare autosomal dominant condition characterized by the presence of capillary hemangioblastomas in the retina and or cerebellum as well as congenital cysts and or neoplasms in the kidney, liver, and pancreas

Von hippel lindau disease

Microscopically, _____ are well differentiated neoplasms comprised of spindle cells with hair-like glial processes that are associated with micrcysts. These cells are mixed with Rosenthal fibers and granular eosinophilic bodies

Pilocytic astrocytomas

A cystic tumor in the _____ of a child is most likely a pilocytic astrocytoma

Cerebellum

Interupting cortical input has what effect on bladder activity

--> bladder hyperactivity (urge incontinence)

Loss of the pontine micturition center has what effect on urination

--> neurogeni bladder | PMC coordinates detrusor contraction and sponcter relaxation

Lower spinal cord lessions in the sacral spinal cord such as cauda equina syndrome has what effect on urination

--> bladder underactivity (overflow incontinence: unable to completely empty bladder --> overflow which leaks out unexpectedly)

The pelvic floor and urinary sphincter muscles are innervated by what nerve roots

S2-S4

Neuromodulation directed toward S2-S4 nerve roots can improve continence by improving pelvic floor muscle strentgth andcontraction of the external urethral sphincter, it may also impact the ________ refex

Bladder stretch-contraction

Propofol is a highly ____ anesthetic drug used fo both induction of maintenanceof general anestesia as well as procedural sedation. Onset approximtely 30 sec and duration typically <10 min

Lipophilic

Following bolus infusion, propofol is rapidly cleared from the plasma and preferentially distributed to organs _______

Receiving high blood flow (brain)

Because the site of action for propofol is the brain, _____ acounts for the rapid termination of the drug

Redistributionn

______ is an inflammatory condition that affects the walls of medium sized and large arteries with granulomas

Temporal arteritis (aka giant cell vasculitis)

On light microscopic exam of temporal arteritis, granulomas are seen in the ____ of the arteries consisting of mononuclear infiltrates and multinucleated giant cells

Media

Commonly reported symptoms of temporal arteritis include:

Headache (focal pain over temple) Craniofacial pain syndromes Polymyalgia rheumatica Sudden vision loss (may be transient or permanent)

What symptom commonly occurs in temporal arteritis and is characterized by neck, torso, shoulder, and pelvic girdle pain and morning stiffness. Fever, fatigue, and weight loss may also occur

Polymyalgia rheumatica

An indirect inguinal hernia is protrusion of abdominal contets through the abdominal wall via the _______

Deep/internal inguinal ring and inguinal canal

A direct inguinal herni is protrusion othe abdominal contents through the abdominal wall via the _______

Superficial inguinal ring

Define allodynia

Pain caused by normally nonpainful stimuli

The ____ nerve enters the inguinal canal anterior to the internal ring and follows the spermatic cord to the superficial ring

Ilioinguinal nerve

The ilioinguinal nerve gives off sensory branches to the anterior scrotum/labia majora, base of penis/mons pubis, and _____

Medial thigh

What is the Uhthoff phenomenon, seen in multiple sclerosis

Symptoms worsening with increased body temperature

What gene increases the risk of having multiple sclerosis

HLA-DRB1

What is Lhermitte sign, seen in multiple sclerosis

Electrical sensations down the back/limbs with neck flexion

In multiple sclerosis, demyelinating plaques are commonly seen as hyperintense lesions on _____ MRI

T2-weighted

In diabetic CNIII mononeuropathy, why is pupillary size and reactivity often normal while the extraocular muscles supplied by CNIII are usually affected causing a down and out positioning

It is due to ischemia predominately involving the core of CN III (where somatic nerve fibers travel) while sparing the outer regions (where autonomic component is located)

Recurrent focal impaired awareness seizures that are preceded by a distinctive aura are characteristic of ____ epilepsy

Mesial temporal lobe

Patients with arteriovenous malformations may have seizures which may be due to ____ accumulation, which is a cortical irritant, from microbleeds

Hemosiderin

What cause of headaches can also cause ipsilateral autonomic symptoms due to parasympathetic hyperactivity such as nasal congestion, lacrimation, ptosis, miosis and conjunctival injection

Cluster headaches

____ are transient episodes of focal neurologic impariment that occur due to local brain ischemia, tissue infarction does not occur, and brain imaging is normal

Transient ischemic attacks

The trochlear nerve innervates_____ muscle which causes the eye to intort and depress when adducted

Superior oblique

Patients with trochlear nerve palsy typically present with ____ which is most noticeable when the afected eye looks down and toward the nose (close up reading, going down stairs)

Vertical diplopia

People may compensat for ____ nerve palsy by tucking their chin and tilting their head away from the affected side

Trochlear

What autoimmune disorder is characterized by fatigable muscle weakness that most commonly affects the eyes, blulbar, facial, and proximal muscles

Myasthenia gravis

HIV associated dementia is due to a change of viral tropism from replicating in CD4 cells to microglil and ______ which alows the virus to penetrate deeper in the brain parenchyma

Macrophage

uncal herniation is herniation of the medial temporal lobe (uncus) through the _____

Tentorial notch

In uncal herniation, compression of the _____ leads to an ipsilateral fixed and dilated pupil

Ipsilateral occulomtor nerve

In uncal herniation, compression of ____ leads to contralateral homonymous hemianopsia with macular sparing

Isilateral posterior cerebral artery

In uncal herniation compression of the ______ of the midbrain against the tentorium may occur, damaging the descending corticospinal tracts and causing contralateral hemiparesis

Ipsilateral cerebral peduncle

______ parasomnias such as sleepwalking and sleep terrors occur during deep, slow wave sleep

Non-REM (NREM)

Most dreams occur during ____ sleep

REM

_____ waves are characteristic of deep, slow wave sleep (stage N3)

Delta (frequency up to 3.99 Hz)

Alpha and beta waves are characteristic of _______ and _____ sleep

Wakefulness and REM sleep

____ complexes and sleep _____ are characteristic of stage N2 (light, stable sleep)

K | Spindles

What stage makes up the largest amount of sleep

Non REM stage 2 (N2)

What stage of sleep is prominent in the 1st half of sleep and is when sleep walking and night terrors occur

Non REM stage 3 (N3)

What stage of sleep is prominent in the 2nd half of night and is when nightmare disorder and muscle atonia occurs

REM

REM's EEG resembles wakefulness with ocassional _____ waves

Sawtooth

Diazepam MOA

Long acting benzo

Diazepam, a long acting benzo can be used in the following: axiolytic, sedative-hypnotic, anticonvulsant, and ___-

Muscle relaxant (can stop spasticity caused by upper motor neuron disorders and tetanus)

As a class, all benzodiazepines should be excludedfrom use in conjunction with alcohol, babituates, neuroleptics, or ________

1st generation antihistamines

Chlorpheniramine MOA

First generation antihistamine (blocks both central and peripheral H1 receptors)

____ is a heterogeneous condition characterized by permanent, nonprogressive motor dysfunction caused by damage to the developing brain

Cerebral palsy

Spastic cerebral palsy may be caused by white matter necrosis which leads to loss of ________ control from the upper motor neurons

Descending inhibitory

GABA A receptor mediates a _____ response than GABA B receptors bc it is what type of receptor

Faster | Ion gated chloride channel

GABA B receptor mediates a _____ response than GABA A becaues it is mediated by _________

Slower | G protein coupled receptor that opens pottasium channels

Baclofen MOA

Agonist of GABA B receptors (can be used to treat spasticity)

Medications used to enhance the activity of what neurotransmitter can improve spasticity in cerebral palsy

GABA

A ____ tremor is also referred to as familial treor as it often follows autosomal dominant inheritance

Essential

What is the first line treatment for essential tremor

Propranolol

MOA propranolol

Nonspecific beta adrenergic antagonist

Lidocaine MOA

Blocks sodium channels in neuronal cell membrane

Local anestetics ahve a greater effect on ___, _____ nerves, so they preferentially inhibit neurons that carry pain and temp sensation

Small myelinated nerve

Local anesthetics are weak ____ that exist in charged and uncharged forms

Bases

Why is a higher dose of local anesthetic required to achieve adequate anesthsia in infected tissue

``` Anesthetic crosses the cell membrane in uncharged form acidic tissues (such as infected tissues) are more acidic and result in more of the anesthetic existing in the charged form which results in less molecules able to penetrate the cells to block the sodium ion channels ```

Histopathologicfindings of a patients brain with HIV associated dementia includes microglial cells and macrophages clustered around small areas of necrosis (______) and fused together forming____

Microglial nodules | Multinucleated giant cells

Meningiomas are benign or malignant?

Benign

Meningiomas typically afect adults and tend to arise near ____

Dural reflection

Parasagittal lesions compressing the medial portion of the primary somatosensory cortex in the parietal lobe can result in _________ loss with _______ hemineglect if there is also damage to the parietal association cortex (non dominant hemisphere)

Contralateral lower limb sensory | Contralateral

The thalamic ____ nucleus receives input from spinothalamic tract and dorsal comuln

Ventral posterior lateral

The thalamic _________ nucleus receives input from the trigeminal pathway

Ventral posterior medial

The thalamic ventral posterior lateral nucleus and ventral posterior medial nucleus sent ______ projections to the cortex via thalamical fibers

Somatosensory

Lacunar infarcts result from occlusion of small penetrating arteries that supply deep brin structures (ex. _______) most comonly in the setting of chronic uncontrolled hypertension or diabetes mellitus

Lenticulostriate arteries

________ , beleived to be one of the primary causes of lacunar infarcts, is characterized by hyaline thickening of the vascular wal, collaggenous sclerosis, and accumulation of mural foamy macrophages

Lipohylanosis

______, beleived to be a primary cause of lacunar infarcts, result from the atherosclerotic accumulation of lipid-laden macropahges within the intimal layer of a penetrating artery near its origin off the parent vessel

Microatheromas

CN _____ is pure motor nerve that innervates the sternocleidomastoid and _____

XI (spinal acessory nerve) | Trapezius

CNXI follows a superficial course through the ___ triangle of the neck and is vulnerable to penetrating trauma and iatrogenic injury (cervical lymphnoid node dissection)

Posterior

Symptoms of what muscle weakness include drooping of the shoulder, impaired abduction of the above 100 degrees, and lateral displacement of the scapula

Trapezius

The most common finding in PCA territory infarction is _______ often with macular sparing due to colateral circulation from the middle cerebral artery

Contralteral hemianopia

The posterior cerebral artery branches off the basilar artery and supplies cranial nerves ___ and _____ and other structures in the midbrain

III | IV

Fracture of the pterion risks lacerating the _____ artery causing an epidural hematoma

Middle meningeal

The middle meningeal artery is a branch of the ____ artery (one of the terminal branches of the external carotid artery) which enters the skull at the foramen spinosum and suppies the dura mater and periosteum

Maxillary

The middle meningeal artery enters the skull through the ____

Foramen spinosum

Fluent aphasia, characterized by speech that is fluent, well articulated, and melodic but meaningess, is often produced bylesion in the _____ area of the brain

Werkicke

What artery supplies wernickes area

Middle cerebral artery (inferior terminal)

"Wernkicke-____ salad"

Word

Wernickes area is located in the _____ cortex within the posterior portion of the superior temporal gyrus in the dominant temporal lobe

Auditory association

Motor function of obturator nerve

Adduction of the thigh

Obturator nerve arises from the lumbar plexus and carries fibers from the _____ spinal segments

L2-L4

What nerve passes throught the obturator canal

Obturator nerve

The anterior division of the obturator nerve gives off a terminal cutaneous branch that provides sensation over the ________

Distal medial thigh

Nightmares occur during REM sleep andcan be differntiated from sleep terrors, a non REM parasomnia characterized by incomplete ____ and lack of _____ of dream content

Arousal | Recall

______ typically occurs 2-8 weeks after exposure to high risk drugs and patients tyically develop fever, generalized lymphadenopathy, facial edema, diffuse skin rash, eosinophilia, and internal organ dysfunction

Drug reaction with eosinophilia and systemic symptoms (DRESS)

What nerve supplies the stapedius muscle to reuce volume by dampening ossicle movement in the middle ear

Facial nerve (CN VII)

The facial nerve provides taste to the anerior two thirds of the tongue via the ______ nerve

Chorda tympani

Facial nerve palsy results in loss of corneal reflex due to denervation of the _____ muscle

Orbiculais oculi

A non contrast CT of a subaracchnoid hemorrhage will show what

Hypersensiy within the cisterns/sulci

____ aneurysms are the most common cause of subarachnoid hemorrhages and are assocaited with ehlers danlos syndrome and autosomal dominant polycystic kidney disease

Berry (sacular)

In subarachnoid hemorrhage, blood accumlates between the ___ and ____

Pia | Arachnoid

What type of CT is diagnostic of subarachnoid hemorrhage

CT without contrast

What will a lumbar puncture reveal with a subarachnoid hemorrhage

Gross blood or xanthochromia (yellow discoloration of spinal fluid)

Histopathological findings of neurons with shrunken, basophilic nuclei and intensely eoinophilic cytoplasm (red neurons) are indicative of _______

Irreversible neuronal damage

What is seen on light microscopy of a cryptococcus neoformans infected CSF sample stained with india ink

Round or oval budding yeast

C4 can be testd with what movement

Shoulder/scapular elevation

C5 can be tested with what movement

Shoulder abduction

C5 and C6 can be tested with what movement

Elbow flexion, wrist extension

C7 can be tested with what movement

Elbow extension, finger extension

C8 can be tested with what movement

Wrist flexion, finger flexion

T1 can be tested with what movement

Finger abduction

What does the biceps and brachioradialis refelxes test

C5, C6

What nerve roots does the triceps reflex test

C7, c8

Phase 2 block durring succinylcholine adminatration is similar to a ______ blockade as the nicotinic acetylcholine receptors become gradually desensitized to the effects of succinycholine

Non depolarizing

How does succinylchoine administration lead to hyperkalemia

It acts on nicotinic acetylcholine receptors which are non selective cation channels and alow sodium influx as well as potassium release

Why are patients with crush or burn injuries, denerving injuries or diseases, and myopathies at higher risk of hyperkalemia in succinylcholine administration

These pathologic states cause up regulation of muscle nicotinic acetylcholine receptors --> large amounts of potassium released

What is myotonia

Abnormally slow relaxation of the muscles

Myotonic dystrophy is an inherited autosomal dominant trait that occurs because of an abnormal trinucleotide repeat expansion of _____

CTG

The trinucleotide expansion of CTG in myotonic dystrophy codes for what gene

Myotonia-protein kinase

What are 3 common features seen in myotonic distrophy besides myotonia

Cataracts Frontal balding Gonadal atrophy

Friedreich ataxia is an autosomal recessive disorder caused by a mutation in the frataxin (FXN) gene which codes for an essential mitochondrial protein involved in assembly of _____

Iron sulfur enzymes

In Friedrich ataxia, a trinucleotide repeat of what of ____ on the mutated FXN gene

GAA

In Friedreich ataxia, trinucleotide repeats of GAA lead to ______ of FXN

Decreased expression

Friedreich ataxia has decreased FXN expression which leads to decreased mitochondrial _____ production and increased _______, resulting in degeneration of neural tracts and peripheral nerves

Energy | Oxidative stress

Psammoma bodies are present in what types of tumors (4)

Meningioma Papillary thyroid carcinoma Meothelioma Papillary serous carcinoma of the ovary and endometrium

_____ are well circumscribed, round masses attached to the dura and are commonly found at the falcine, parasagittal, or lateral convezity regions of the brain

Meningiomas

Median nerve injury can lead to pain and numbness in the first 3 digits and lateral half of the third digit, along with weakness of thumb ___ and ____

Flexion and opposition

Changes seen in the neuronal body after an axon is severed are called ______

Axonal reaction

What happens to the nucleus in axonal reaction

Nucleus is displaced to the periphery

The changes in the body of a neuron after the axon has been severed are called axonal reaction, this process reflect an increased ________ that facilitates axonrepair

Protein synthesis

What are telangiectasias

Abnormal dilations of capillary vessels

The risk of cancer in patients with ataxia-telaniectasia is increased significantly due to inefficient ____

DNA repair

Manifestations of _________ , an autosomal recessive disorder, manifests as cerebellar ataxia, oculocutaneous telangiectasia, repeated sinopulmonary infections, and an increased incidence of malignancy

Ataxia-telangiectasia

Ataxia-telangiectasia is characterized by DNA hypersensitivity to ______

Ionizing radiation

In __________, DNA is hypersensitive to UV radiation causing premature skin aging and increased risk of skin cancer (melanoma and squamous cell carcinoma)

Zeroderma pigmentosum

______ anemia is caused by hypersensitivity of DNA to crosslinking agents

Fanconi

____ syndrome is characterized by generlized chromosomal instability. Increased susceptibility to neoplasms is present

Bloom

hereditary nonpolyposis colorectal cancer occurs due to defect in ________ enzymes. It leads to increased susceptibility to colon cancer

DNA mismatch-repair

What is internuclear opthalmoplegia

Impaired adduction on the left eye with riht lateral gaze

What is optic neuritis

Transient blurred vision and eye pain with movement

What is saltatory conduction

Nerve impulses jumping between 2 adjacent nodes in myelinated axons

Why do some of the symptoms and signs of MS resolve to a varible extent

Overtime, sodium channels evenually redistribute across the naked axon

Sciatic nerve roots

L4-L5

What nerve is suseptible to injury during hip fracture or arthroplasty because of its proximity to the hip joint

Sciatic

The sciatic nerve motor function

Knee flexion

Sciatic nerve divides into what two nerves

``` Common fibular (peroneal) Tibial ```

What nerve controls plantar flexion and inversion and carries sensory from the plantar surface of the foot

Tibial

What nerve is tested in the ankle (achilles) reflex

Tibial

What nerve controls dorsiflexion and eversion of the foot and sensory to the lateral calf and dorsal surface of the foot

Peroneal (common fibular) (actually divides into superficial and deep)

Lambert-Eaton myathenic syndrome is a paraneoplastic syndrome to what type of cancer most commonly

Small cell lung cancer (small cells with neuroendocrine differentiation)

In approximately 50% of patients with Lambert-eaton myasthenic syndrome, ______ is present

Underlying malignancy

Lambert eaton myastenic syndrome is an autoimmune disorder with antibodies against _____

Presynaptc voltage gated calcium channel

What would you expect on an MRI of Huntington disease

Enlargement of the frontal horns of the lateral ventricles and caudate atrophy

N. Meningitidis has an outer cell membrane virulence factor called _____ which is primarily responsible for the severity of meningococcal disease

Lipo-oligosaccharide (LOS)

Endotoxins bind to ______ on monocytic and dendritic cells and trigger release of inflammatory cytokies (IL 1, IL 6 and TNF alpha) which leads to endothelial damage, capillary leak, and hemorrhagic necrosis

Toll like receptor 4

After thiamine infusion is started to treat Wernicke Korsakoff, what neurologic finding is most likely to persist despite treatment

Memory loss

_____ is when patients with korsakoff syndrome are unsure of a fact so they filll in the memory gap with a fabricated stry that they themselves believe to be true

Confabulation

The triad of Wernicke syndrome

Oculomtor dysfunction Ataxia Confusion

The hallmarks of korsakof syndrome are ____ and _____

Permanent memory loss | Confabulation

Narcolepsy results from the depletion of hypocretin (also known as orexin) secreting neurons in the ________ that are involved in maintaining wakefullness

Lateral hypothalamus

Patients with narcolepsy experience shortened _____ and enter REM sleep almost immediately

Sleep latency

Patients with narcolepsy commonly experience intrsions of REM sleep phenomena during sleep-wake transitions, including ____ (upon falling asleep) and ___ (upon awakening) hallucinations and sleep paralysis (inability to move immediately after wakening)

Hypnagogic | Hypnopompic

What are 2 topical agents that can be used to treat neuropathic pain

Capsaicin | Lidocaine

Name 4 non topical treatments that can be used for neropathic pain

Tricyclic antideperssants SNRIs Anticonvulsants (gabapentin) Opiods (other 3 are first line, opiods are not)

How do tricyclic antidepressents modulate pain transmission

Inhibit voltage gatd sodium channelsi n sensory nerve | Increase norepinephrine signaling in CNS

The parasympathetic, preganglion neurons arise from ____ and ______

Cranial nerve nuclei (III, VII, IX, X) | Sacral spinal cord

The parasympatheitc preganglionic neurons release ____

Acetylcholine

The parasympathetic preganglionic neurons release acetylcholine on _____ receptors within the parasympathetic ganglia where?

Nicotinic | In or near the target organs

Postganglionic parasympathetic neurons release _____

Acetylcholine

Postganglionic parasympathetic neurons release acetylcholine on _____ receptors within the target organs

Muscarinic

The sympathetic preganglionic neurons arise from ______

Thoracolumbar spinal cord

The sympathetic preganglionic neurons release ____

Acetylcholine

The sympathetic preganglionic neurons arise from the thoracolumbar spinal cord and release acetylcholine which binds post ganglionic ___ receptors in the sympathetic chain and prevertebral ganglia

Nicotinic

Sympathetic postganglionic neurons release ______

Norepinephrine

Postganglionic sympathetic neurons release norepinephrine, activating alpha/beta receptors within target organs with 2 exceptions: ____ and ____

Adrenan medulla | Sweat glands

The chromaffin cells of the adrenal medulla release norepinephrine and epinephrine directly into circulation after being stimulated by the sympathetic nervous system how?

Acetylcholine release from sympathetic preganglionic neurons

The preganglionic and postganglionic sympathetic neurons that supply eccrine sweat glands are both ____

Cholinergic

In the brain, fluorinated anesthetics ____ vascular resistance and lead to a ______ in cerebral blood flow

Decrease | Increase

Donepezil MOA

Acetylcholinesterase inhibitor (alzheimer tx)

Alzheimer dementia involves dysfunction of ____ pathways in the brain

Cholinergic

Acetylcholinesterase inhibitors may cause syncope due to enhanced parasympthetic tone that leads to ____ and ____ with reduced cardiac output

Bradycardia | Atrioventricular block

Jugular foramen (________) syndrome is characterized by the dysfunction of cranial nerves IX, X, XI

Vernet

______is a paired pigmented brainstem nucleus located in the posterior rostral pons near the lateral floor of the 4th ventricle. It functions as the principal site for norepinephrine synthesis in the brain and projects to virtually all parts of the CNS.

Locus ceruleus

Voluntary muscle activity is mediated by the ____ tract

Corticospinal

The _____ cortex of each hemisphere receives information about the contralateral visual field from the ipsalateral geniculate nucleus via the optic radiation

Striate

The _____ gyrus ofthe striate cortex receives information from the upper retina (lower visual field)

Cuneus

The ____ gyrus of the striate cortex receives information from the lower retina (upper visual field)

Lingual

In PCA occlussion, the macula is spared because collateral blood is supplied by the _____ to the _____ pole which processes central visual information

Middle cerebral artery | Occipital

The ____ gyrus is part of the parietal association cortex which integrates multisensory information to comprehend events and solve problems

Angular

Damage to the angular gyrus classically results in ___ syndrome: characterized by agraphia, acalculia, finger agnosia, and left-right disorientation

Gerstmann syndrome

The dorsal columns, carrying afferent vibration and proprioception fibers, are arranged topographically, medial fibers are from the ____ spinal level and lateral are from the ____ spinal levels

Lower | Higher

The ___ fasciculus of the dorsal column, located medially , carries afferentinformation that enters the spinal cord below T6

Gracile

The ____ fasciculus of the dorsal columns, located laterally, carries afferent information that enters the spinal cord above T6

Cuneate

Frontotemporal dementia results in accumualtion of different neurotoxins including _____ and _____

Tau | TDP-43

In frontotemporal dementia, abnormal ____ of TDP-43 leads to imunoreactive inclusions of TDP-43

Ubiquitination

TDP-43 normally fuctions as a ______

Transcription inhibitor or DNA repair protein

______ is a developmental anomaly characterized by hypoplasia/absence of the cerebellar vermis and cystc dilation of the 4th ventricle with posterior fossa enlargement

Dandy walker malformation

The most common complication of SAH is arterial vasospasm which occurs due to the release of vasoconstrictive factors from damaged ______ in the subarachnoid space and the inability of damaged ______ to produce vasodilators (nitric oxide)

Erythrocytes | Endothelial cells

3 neuronalpathologic features of alzheimers disease include neurodegeneration leading to neuronal loss and cerebral atrophy, extracellular ______, and intracellular ______

``` Beta amyloid plaques Neurofibrillary tangles (tau protein agreggates) ```

What are the 2 symptomtic treatment options for alzheimers (just mech of action)

``` NMDA receptor antagonist (memantine) Cholinesterase inhibitors (donepezil, galantamine) ```

Degeneration of _______ neurons in the basal forebrain contributes to memory loss and functional decline in alzheimer patients

Cholinergic

What medications should be discontinued in alzheimers patients bc they can exacerbate cognitive dysfunction

Anticholinergic (tricyclic antidepressents)

How are NMDA receptor antagonists helpful in treating alzheimers

Inhibit glutamate NMDA signaling --> prevent excitotoxicity (calclium overload) and subsequent neuronal apoptosis

Neisseria meningitidis is transmitted via aerosolized droplets and are able to colonize the _____ due to the presene of specialized surface components (dimbriae, pili)

Nasopharynx

Neisseria meningtidis causes meningitis by entering via the nasopharynx --> blood ---> ______ ----> meninges

Choroid plexus

Gingival hyperplasia in phenytoin treatment is due to increased expression of ______

Platelet derived growth factor (PDGF)

When gingival _____ are exposed ot increased amounts of PDGF, they stimulate proliferation of gingval cells and alveolar bone

Macrophages

If taken during pregnancy, phenytoin may cause ____ syndrome

Fetal hydantoin syndrome

The most important biochemical abnormality noted in Alzheimers disease is decress in acetylcholine leves which occurs due to deficiency in _____

Choline acetyltransferase

In alzheimers disease, the decline in acetylcholine is most notable in the nucleus ________ which participates in memory and cognition

Basalis of meynert

Name the 3 branches directly off the aortic arch

Left common carotid Left Subclavien Right brachiocephalic

The right common carotid artery branches from the _____

Brachiocephalic artery

The L4 vertebral body lies on a line drawn between the highest points of the iliac _____ which can be visually identified and confirmed by palpation

Crests

Patients with _____ occlusion usually present with contralateral hemiparesis and hemisensory loss involving mainly the face and upper limb (more than leg)

Middle cerebral artery

In diabetic polyneuropathy, neuronal injury occurs due to accumulation of advanced glycosylation end products, ____, and other toxic substances that lead to derranced metabolism and increased oxidative stress

Sorbitol

Diabetic microangiopathy affecting the _____ vessels can promote nerve ischemia

Endoneurial

Length dependent axonapthy in diabetic polyneuropathy affects what nerves first

Longest nerves

Small fiber injury is characterized by predominance of ____ symptoms (pain, paresthesia, allodynia)

Positive

Large fiber inovlvemnet is characterized by predominance of ____ symproms (numbness, loss of proprioception and vibration sense, sensory ataxia, diminished ankle reflexes)

Negative

Several months-years after brain infarction, the necrotic area appears as a cystic cavity surrounded by a wall composed of dense fibers formed by what cells

Astrocytes

___ disease is a rare autosomal recessive disorder most often identfied in individual aged 5-40 with decreased secretion of copper into the biliary system resulting in movement abnormalities and psych symptoms

Wilson

Wilson diease is a autosomal recessive disorder with a mutation in ______

ATP7B

Wilson disease is an auto recessive disorder with a mutation in ATP7B which hinders intracellular hepatocyte copper transport causing reduced formation/secretion of ______ (the major extracellular copper transport protein)

Ceruloplasmin

Almost all patiens with wilson disease have ________ which are green/brown copper deposits in the Descemet membrane of the cornea and can be detected with a slit lamp examination

Kayser-Fleischer rings

Diagnosis of Wilson disease can be confirmed by presense of low serum ceruoplasmin, elevated urinary ___ excretion, and elevated hepatic ____ content on liver biopsy

Copper | Copper

How can Wilson disease be treated

Chelators (D-penicillamine, trientine) | Zinc (interferes with copper absorption)

What is the result of a charcot-bouchard aneurysm rupture

Intracerebral hemorrhage

What is the result of a saccular aneurysm rupture

Subarachnoid hemorrhage

The gag reflex is mediated by afferents predominantly from the _____ nerve and efferents from the ___ nerve

Glossopharyngeal (CN IX) | Vagus (x)

Petellar reflex tests what nerve roots

L2-l4

Sensation to anteromedial thigh and medial shin is innervated by what nerve roots

L2-L4

What nerve roots are tested in achilles reflex

What nerve roots innervated sensation to perineum

S2-S4

What nerve roots innervated hip flexion (iliopsoas), hip adduction, knee extension (quadricep)

L2-L4

What nerve roots innervate hip extension (glut max) and plantarflexion (gastrcnemius)

What nerve roots are tested with the anocutaneous reflex

S2-S4

What nerve roots innervated sensation to the posterior calf, sole, and lateral foot

What nerve roots innervted sensation to lateral shin and dorsum of foot

What nerve roots innervated foot dorsiflexion and inversion (tibialis anterior), foot eversion (peroneus), and toe extension (extensor hallucis and digitorum)

Injury to what nerve roots will cause urinary or fecal incontinence and sexual dysfunction

S2-S4

What nerve innervates the glutesus medius, gluteusminimus, and tensor fasciae latae muscles

Superior gluteal nerve

The glut medius, glut minimus, and tensorfasciae latae function to stabilize th pelvis and ___ the thig

Abduct

What is a positive trendlenburg sign

Pelvis sags toward unaffected (contralateral) side when the patient stands on the affected (ipsilateral) leg

A patient with weakness to what muscles will have a positive trendelenburg sign

Gluteus medius and glutes minimus

What is a gluteus medius lurch

When a patient with gluteus medius and gluteus minimis weakness leans toward the affected side when walking to compnesate for hip drop

The temporal bone contains the vestibularochlear nerve as well as what other cranial nerve which enters at the internal auditory meatus and travels through the internal auditory canal with the vestibulocochlear nerve

CNVII (facial)

What cause of meningitis causes acute onset fever, headache, altered mental status, and focal neurologic deficits or seizures as well as temporal lobe edema

Herpes simplex virus type 1

What are the CSF findings in patients with meningitis due to herpes simplex virus 1

Normal glucose Elevated protein Elevated lymphocytes and erythrocytes (due to hemorrhagic inflammation in temporal lobes)

In the CNS the phagocytic macrophages/glia are recruited more slowly due to the BBB, mylein producing oligodendrocytes also beome inactive or undergo apoptosis and do not asist in phagocytosis. This results in the persistance of what for months-years following ischemic injury

Myelin debris

How is tetanus diagnosed

Clinical diagnosis

Why are blood cultures of tetanus not helpful for diagnosis

C. Tetani only grows at the inoculation site, the toxins then spread and cause the symptoms

What vascular changes result in diabetic neuropathy

Hyalinization of the endoneurial arterioles ---> ischemic nerve damage

______ is a compression mononeuropathy of the lateral femoral cutaneous nerce at the inguinal ligament, typically caused by tight clothing or injury dduring surgery

Meralgia paresthetica

Meralgia paresthetica presents with pain, paresthesia and numbness over what distribution

Lateral thigh above the knee

A patient with a ring enhancing lesion in the temporal lobe who has been puling on her ear recently likely is infected with a pathogen that entered her brain through what structure

Mastoid air cells (otitismedia that spread)

Frontal lobe abscesses are generally due to direct spread of a pathogen from what structures

Ethmoid or frontal sinus

What occur as a result of compression of spinal nerve roots and typically present with neck or arm pain and motor/sensory deficits

Cervical radiculopathy

Cervical radiculopathies result from what 2 ways

Spinal sponylosis | Vertebral disc herniation

What is spinal spondylosis

Aging --> degeneration of vertebral bodies, discs, joints --> osteophye formation --> narrows neuronal formamina

A subdural hematoma is due to a rupture of _____

Cortical bridging veins

The cells that are typically affected first by hypoxia are the _____ neurons in the ____ which can be damaged by iscemia in as little as 3 min

CA1 pyramidal | Hippocampus

In addition to the hippocamus, the cerebellar ____ cells and neocortex _______ neurons are also highly susceptible to damage if ischemia lasts for 5-10 min

Purkinje | Pyramidal

Cerebellar ataxia, telangiectasia and increased risk of sinopulmonary infections constitute a characteristic triad of wha hereditary disease

Ataxia telangiectasia

Ataxia telangiectasia causes an immune deficiency that primarily manifests as a ___ deficiecy predisposing the patient to infections of the upper and lower airways

IgA

In ataxia telangiectasia, the autosomal recessive gene mutation in the ATM gene is responsible for ____

DNA break repair

In MS, activated CD8 T cells release cytotoxi granules that injure _____

Oligodendrocytes

In MS, B cell recruitment leads to the formation of antibodies that activate complement and facilitate _____ breakdown

Myelin

Diagnosis of MS is largely clinical but supported by the pressence of ____ lesions on MRI

Are oligoclonal bands specific or sensitive for dx of MS

Sensitive

Blepharospasm, the second most common focal dystonia is what

Involuntary forcible closre of the eyelids

Hydrocephalus is a common complication of subarachnoid hemorrhage due to what

Blood in subarachnoid space can acutely obstruct and impair absorption of cerebral spinal fluid by the arachnoid granulations

What are 3 common findings of TB meningitis

Gelatinous exudate at basal portion of brain Multiple bilateral brain infarcts Hydrocephalus (can cause ventriculomegaly)

What is an autopsy likely to reveal in a patien with HSV1 encephalitis

Unilateral temporal lobe inflammation

_____ syndrome presets as a patient with quadriplegia and speechlessness with preserved consciousness and eye mvements

Locked in syndrome

Locked in syndrome can be caused by ischemic injury to ____

Bilateral ventral pons

In locked in syndrome horizontal eye movements are absent but why are vertica eye movements and eyelid elevation spared

They are controlled in rostral midbrain, not in ventral pons

Preserved conscoiusness in locked in syndrome is due to _______ being spared

Midbrain reticular formation

Neural tissu with neurons with shrunken nuclei and eosinphilic cytoplasm lacking Nissl bodies indicates what type of injury

Irreversible ischemic injury

Describe a pyknotic nucleus

Shrunk and basophilic with loss of nucleolus

Subacute cerebellar degeneration is a paraneoplastic syndrome seen in smal cell lung cancer via what mechanims which damage purkinje neurons

Anti-Yo, anti- P/Q and anti-Hu auto antibodies

On macroscopic examination, ______ are cystic or partialy solid with cyst being filled with a brownish yellow, viscocus fluid that resembles machine oil due to the presence of protein and cholesterol crystals

Adamantinomatous craniopharyngioma

Adamantinomatous craniopharyngioma are found in children and typically located in the ____

Suprasellar region

In adamantinomatous craniopharyngioma _______ of the cysts is highly characteristc and may be deteced on euroimaging

Dystrophic calcification

An adamantinomatous craniopharyngioma, on light microscopy, will reveal cysts lined with cords/nests of _____ with peripheral palisading and internal areas of lamellar ______

Stratified squamous epithelium | Wet keratine

Craniopharyngioas are derived from remnants of the _____

Rathkes pouch

Abusive head trauma (shaken baby syndrome) results in what type of hemorrage

Subdural (tearing of bridging veins)

_______ due to rupture of congested retinal veins are highly suggestive of abusive head trauma(shaken baby syndrome)

Retinal hemorrhages

Patient with progressive headaches has an enhancing ventricular mass on MRI is consistent with what diagnosis

Ventricular ependymoma

What histological finding an confirm the diagnosis of an ependymoma

Perivascular pseudorosettes

How can cocain cause myocardial infarction

Coronary artery vasospasm | Increased platelet aggregation

Cocaine MOA

Inhibits presynaptic reuptake of monoamines

An adequate antidepressant trial is generally considered to be at least how long?

4-6 weeks

What distinct features of neuroleptic syndrome differentiate it from serotinn syndrome

Diffuse rigidity (lead pipe) and hyporeflexia seen in NMS

What distinct features seen in serotonin syndrome diferentiate it from neuroleptic malignant syndrome

Clonus and hyperreflexia are seen in serotonin syndrome

What precipitates neuroleptic malignant syndrome

Dopamine antagonist

MOA: bupropion

Inhibits reuptake of norepinephrine and dopamine

What medication is contraindicated in patients with seizure disorders or current or prior diagnosis of bulimia or anorexia nervosa due to increased risk of seizures

Buproprion

Withdrawals from what substance produce symtpoms of increased apetite, hypersomnia, intense psychomotor retardation, severe depression and can be accompnied by vivid dreams

Stimulants (amphetamines, cocaine)

What dissociative disorder involves either or both: depersonalization (detachment, unreality of self) and derealization (detachment, unreality of surroundings)

Deprsonalization/derealization disorder

What dissociative disorder involves the inability to recall personal information, usually of a traumatic or stressful nature

Dissociative amnesia

What dissociative disorder involves framentation into 2 or ore distinct personalities and discontinuity in identity and personal agency

Dissociative identity disorder

Second generation antipsychotic medications are associated most with what adverse effects

Metabolic

How should patients on second generation antipsychotics be monitored

BMI Fasting glucose and lipids Blood pressure Wais circumference

Within second generation antipsychotics, which medications carry the most risk for metabolic adverse effects

Olanzapine | Clozapine

Chronic ethanol use causes downregulation of _____ receptors

GABA

What is the most common initial symptom of alcohol withdrawal

Tremor (can start as early as 6 hours after last drink)

If a patient has 5 or more symptoms of major depressive disorder lasting more than 2 weeks following a precipitating event (ie losing their job) what is the diagnosis

Major depressve disorder (adjustment disorderis the diagnosis when patient does not have 5 of the symptoms meeting major depressive disorder diagnosis)

What is the diagnosis of a patient who has a pervasive pattern of distrust and suspiciousness beginning in early adulthood and occurig in a variety of settings including believes being exploited and deceived by others, interprets benign comments and events as threats, bears grudges, and questions loyalty of partner without justification (no fixed delusions and no other psychotic symptoms)

Paranoid personality disorder

A child who is previously meeting developmental milestones and now has dramatic regression of speech and motor milestones accompanied by repetitive hand movements is concerning for what dignosis

Rett syndrome

Rett syndrome is a sporadic, X-linked genetic disorder in what gene

MECP2

Does Rett syndrome cause neurodegeneration?

No, neuropathology is consitant with arrested brain development

How does bulimia nervosa differ from binge eating disorder

Bulimia nervosa involves inappropriate comensatory behavior (fasting, purging) while binge eating disorder does not

Of risk factors for suicide, what is the strongest single factor that is most predictive of a completed suicide

History of an attempted suicide

Cocaine MOA

Inhibits presynaptic reuptake of monoamines

An adequate antidepressant trial is generally considered to be at least how long?

4-6 weeks

How does bulimia nervosa differ from binge eating disorder

Bulimia nervosa involves inappropriate comensatory behavior (fasting, purging) while binge eating disorder does not

Does Rett syndrome cause neurodegeneration?

No, neuropathology is consitant with arrested brain development

Rett syndrome is a sporadic, X-linked genetic disorder in what gene

MECP2

A child who is previously meeting developmental milestones and now has dramatic regression of speech and motor milestones accompanied by repetitive hand movements is concerning for what dignosis

Rett syndrome

Paranoid personality disorder

If a patient has 5 or more symptoms of major depressive disorder lasting more than 2 weeks following a precipitating event (ie losing their job) what is the diagnosis

Major depressve disorder (adjustment disorderis the diagnosis when patient does not have 5 of the symptoms meeting major depressive disorder diagnosis)

What is the most common initial symptom of alcohol withdrawal

Tremor (can start as early as 6 hours after last drink)

Chronic ethanol use causes downregulation of _____ receptors

GABA

Within second generation antipsychotics, which medications carry the most risk for metabolic adverse effects

Olanzapine | Clozapine

How should patients on second generation antipsychotics be monitored

BMI Fasting glucose and lipids Blood pressure Wais circumference

Second generation antipsychotic medications are associated most with what adverse effects

Metabolic

What dissociative disorder involves framentation into 2 or ore distinct personalities and discontinuity in identity and personal agency

Dissociative identity disorder

What dissociative disorder involves the inability to recall personal information, usually of a traumatic or stressful nature

Dissociative amnesia

What dissociative disorder involves either or both: depersonalization (detachment, unreality of self) and derealization (detachment, unreality of surroundings)

Deprsonalization/derealization disorder

Withdrawals from what substance produce symtpoms of increased apetite, hypersomnia, intense psychomotor retardation, severe depression and can be accompnied by vivid dreams

Stimulants (amphetamines, cocaine)

What medication is contraindicated in patients with seizure disorders or current or prior diagnosis of bulimia or anorexia nervosa due to increased risk of seizures

Buproprion

MOA: bupropion

Inhibits reuptake of norepinephrine and dopamine

What precipitates neuroleptic malignant syndrome

Dopamine antagonist

What distinct features seen in serotonin syndrome diferentiate it from neuroleptic malignant syndrome

Clonus and hyperreflexia are seen in serotonin syndrome

What distinct features of neuroleptic syndrome differentiate it from serotinn syndrome

Diffuse rigidity (lead pipe) and hyporeflexia seen in NMS

Of risk factors for suicide, what is the strongest single factor that is most predictive of a completed suicide

History of an attempted suicide