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Flashcards in Nervous System + Psychology Deck (171):
1

Structural pathology of Wernike Encephalopathy?

Mamillary body necrosis

2

Temporal lobe encephalitis is caused by what kind of infection?

Herpes virus infection

3

Rapidly progressive dementia + myoclonic jerks =

Creutzfeld-Jakob disease

4

4 tumors that form psamomma bodies

-Meningioma -Papillary thyroid carcinoma -Mesothelioma -Papillary serous carcinoma of the ovary or endothelium

5

Slow growing + Well circumscribed + Intracranial mass + Whorled pattern of cellular growth + Psamomma bodies =

Meningioma

6

S-100 positive tumors (2) What does it indicate?

-Schwannoma -Melanoma Indicates that it is of neural crest cell origin

7

Elongated cells + Regular oval nuclei + Biphasic growth pattern + S-100 positive =

Schwannoma

8

Relapsing and remitting ocular problems and tingling + worse after heat =

Multiple Sclerosis

-Ocular problems = optic neuritis, internuclear opthalmoplegia

-Sensory defects

9

Complication of a subarachnoid hemorrhage =

How does it present =

Arterial vasospasm

Presents as new onset confusion or focal neurological deficit. Not seen on CT.

10

Drug to prevent subarachnoid hemorrhage complication and its mechanism.

Nimodipine - selective Ca channel blocker

11

Cystic cavities in the brain are lined by =

astrocytes

12

Diagnosis of tetanus is made via

History and Physical only

13

Ascending (flaccid) paralysis after a febrile illness is what disease?

Guillain-Barre disease

14

Guillain-Barre disease microscopic pathology

Endoneurial inflammatory infiltrate of macrocytes and lymphocytes

15

Hemangioma in the retina and/or cerebellum + Congenital cysts/neoplasms in the kidney, liver or pancreas =

Von Hippel Lindau

16

Cystic tumor in the cerebellum of a child =

Pilocytic astrocytoma

17

Which kind of aneurysm rupture results in -> deep intraparenchymal hemorrhage + focal/acute neurological deficits + hypertension?

Carcot-Bouchard aneurysm

18

Rupture of _ results in a subdural (crescent shaped) hematoma + gradual onset of symptoms

cortical bridging veins

19

Wernike Syndrome triad = Reversible with _ treatment

Ocular dysfunction Ataxia Confusion Reversible with Thiamine treatment

20

Korsakoff Syndrome symptoms (2) =

Confabulation

Permanent memory loss

21

Young child + Precocious puberty + Perinaud syndrome + Obstructive hydrocephalus =

Pineal germinoma

22

Perinaud Syndrome definition

paralysis of upward gaze

23

Transtentorial (uncal) herniation symptoms (3)

-Ipsilateral CN III damage => oculomotor nerve palsy + fixed/dilated pupil

-Contralateral LCST damage/Ispislateral cerebral peduncle damage

-Ipsilateral PCA damage => occipital cortex damage

24

What is the term for: monocular vision loss + pain on eye movement + afferent pupillary defect?

Optic neuritis

25

First area damaged by global cerebral ischemia

Pyramidal cells of the hippocampus

26

Cerebellar ataxia + Loss of position/vibration + Kyphoscoliosis + Hypertrophic cardiomyopathy =

Freidrich's ataxia

27

Definition - xanthochromia

blood in the CSF

28

Definition - lissencephaly

Congenial absence of gyri on the brain. Clinically associated with severe mental retardation.

29

Definition - Hydrocephalus ex vacuo

Ventricular enlargement due to brain atrophy. Not accompanied by an increase in CSF pressure.

30

Etiology of Paraneoplastic Cerebellar Degeneration?

Autoimmune

31

Most common CNS tumor in immunocompromised patients

Primary CNS lymphoma associated with EBV infection

32

Definition - Argyll Robertson pupils

small, irregularly shaped pupils that DO NOT react to light but DO constrict with accomodation

33

Vitamin E deficiency closely resembles what neurological disease?

Freidrich's ataxia

34

Childhood cerebellar tumors (2)

-Medulloblastoma -Pilocytic Astrocytoma

35

Muscles most often affected in myasthenia gravis?

Extraocular muscles -> ptosis, diplopia

36

Nerve controlling hiccups?

Phrenic nerve

37

Where does the phrenic nerve arise and innervate?

Arises from C3-C5 Innervates the diaphragm ipsilaterally

38

Symptoms of Normal Pressure Hydrocephalus (NPH) (3)

"Wacky, Wobbly, Wet" -dementia -ataxic gait -urinary incontinence

39

Term for abnormally slow relaxation of muscles

myotonia

40

Alzheimer's disease: Where in the brain has markedly reduced acetylcholine levels? (2)

-Nucleus basalis of Meynert -Hippocampus

41

Acyclovir is used to treat what type of infections?

viral infections

42

Osmotic demyelination occurs in what brain structure?

central pons "Central Pontine Myelinolysis"

43

Opsoclonus-Myoclonus syndrome is associated with what tumor?

Neuroblastoma

44

How to get decerebate (extensor) posturing?

Lesion to the brainstem at/below the level of the red nucleus (rostral midbrain)

45

How to get decorticate (flexor) posturing?

Lesion to the brainstem above the level of the red nucleus (rostral midbrain) ex: cerebral hemisphere

46

"Endoneurial inflammatory infiltration" refers to what disease?

Guillain-Barre

47

"Endoneurial arteriolar hylanization" refers to what disease?

Diabetic microangiopathy of endoneurial arterioles. Leads to nerve ischemia and peripheral neuropathy.

48

Most common CN affected by diabetic mononeuropathy = Symptoms (3) =

CN III -> acute onset diplopia + down and out position of the eye + ptosis

49

Pathology of Diabetic Mononeuropathy of CN III

Ischemic nerve damage to the core of the nerve, therefore affecting only the somatic fibers, not the autonomic/parasympathetic fibers. Pupillary reflex stays intact.

50

Viruses that invade the dorsal root ganglia and their locations (3)

HSV 1 - above the waist HSV 2 - below the waist, genital region VZV - thoracic or trigeminal dermatomes

51

Waterhouse-Friderichsen Syndrome =

N. meningitidis infection leading to DIC, septic shock and hemorrhagic destruction of the adrenal glands

52

Patients with Neisseria infections have what kind of immune impairment?

C5-C9 deficiency which leads to an inability to form the MAC

53

Definition - Synaptophysin

Protein found in the synaptic vesicles of neurons, neuroendocrine cells and neuroectodermal cells. CNS tumors of neuronal origin are synaptophysin positive.

54

2 main causes of ring-enhancing lesions in HIV patients

-Toxoplasma gondii - multiple lesions

-Primary Central Nervous System Lymphoma (PCNSL) - solitary, due to EBV

55

Congenital toxoplasmosis symptom triad =

-Hydrocephalus -Intracranial calcifications -Chorioretinitis

56

1 year old full term infant brought into ED with a large and full anterior fontanelle and bilateral retinal hemorrhages. Mom says baby rolled off bed. What is the diagnosis?

Abusive head trauma.

57

Name the muscles in the ear and their innervation (2)

-Stapedius muscle - CN VII -Tensor tympani muscle - CN V

58

Sciatic nerve spinal roots

L4-S3

59

Role of axillary nerve (3)

-Motor to deltoid muscle -Motor to teres minor muscle -Sensory to skin over lateral shoulder

60

Lesion to what nerve(s) cause = contralateral spasticity + hyperreflexia + paresis?

UMN lesion

61

What nerve is at risk during an appendectomy? What does that nerve innervate?

Illiohypogastric nerve. It innervates -motor to anterolateral abdominal muscles -anterior branch - sensory to the skin above the pubic region -lateral branch - sensory to the skin of the gluteal region

62

Injury to the R temporal lobe results in what kind of visual defect?

Injury to Meyer's loop that carries the lower retinal fibers that contain information from the upper visual field. Contralateral superior quadrantanopia = "pie in the sky defect"

63

What are the changes seen in the "axonal reaction" (4)

-Cell swelling -Nucleus moves into periphery -Nissl substance displaced throughout cell -Increased protein synthesis

64

What is a "Marcus Gunn pupil"?

-Caused by optic nerve damage or retinal injury -When light is shone into the affected eye, there is decreased bilateral light reflex (decreased pupillary constriction) -Tested with "swinging flashlight test"

65

3 D's of Botulinum Toxin ingestion?

-Diplopia -Dysphagia -Dystonia

66

Innervations of CN V =

V1 = opthalmic branch -> eye sensation V2 = maxillary -> muscles of mastication V3 = mandibular -> anterior 2/3 tongue sensation

67

What nerve is responsible for foot drop + steppage gate?

Common peroneal nerve Spinal roots L4-S2

68

What is the motor function of the obturator nerve?

Adduction of the thigh Spinal roots L2-L4

69

When preforming an interscalene nerve block to anesthetize the brachial plexus, what other nerve is involved?

The phrenic nerve also passes through the interscalene sheath

70

What two thing are measured to detect a neural tube defect?

-Alpha-fetoprotein = in the amniotic fluid and maternal serum

-Acetylcholinesterase = in the amniotic fluid

71

Vocal cords are controlled by what nerve?

CN X - Vagus nerve, Recurrent laryngeal nerve branch

72

Main antigenic component of N. meningitidis?

Pili/fimbrae

73

Most common cause of spontaneous lobar hemorrhages in the elderly?

Amyloid angiopathy - caused by A-beta amyloid deposition in the walls of vessels.

74

Common brain locations of amyloid angiopathy hemorrhages (2)

-Occipital lobe -> homonymous hemianopsia -Parietal lobe -> contralateral hemisensory loss

75

Nerve most commonly affected by ill-fitting crutches ("crutch palsy")

Radial nerve Spinal roots C5-T1

76

Rathke's pouch is derived from?

Ectoderm -> surface ectoderm

77

Posterior pituitary is derived from?

Ectoderm -> neural tube

78

What is the "length constant/space constant" of a nerve?

A measure of how far along an axon an electrical signal can propagate. Smaller constant = Less propagation distance

79

What is the "time constant" of a nerve?

A measure of the time it takes to change the membrane potential. Smaller constant = Faster membrane potential change time

80

Location of a femoral nerve block?

Inguinal crease

81

Patients with Down Syndrome are at an increased risk for what neurological disease?

Early onset Alzheimer's disease

82

Area Postrema - location and function

Location = dorsal surface of the medulla at the caudal end of the 4th ventricle Function = samples chemicals in the blood, chemoreceptor trigger zone, controls vomiting

83

Treatment for essential tremor =

Propranolol

84

What is the main distinguishing feature of Atypical depression compared to Major depression?

Mood reactivity - a positive event WILL improve mood of someone with atypical depression

85

Pellagra - cause and symptoms

Cause = Niacin deficiency Symptoms = dementia, dermatitis, diarrhea

86

Class of drug prescribed for insomnia without depressive symptoms =

Benzodiazepines

87

Definition of pica

Compulsive consumption of a non-food or non-staple food source for >1 month. Seen in pregnancy and school children. May be associated with a nutritional deficiency. Substances consumed: -earth/soil -raw starch (flour, cornstarch) -ice

88

Which antidepressant has the side effect of painful erections for >4 hours?

Trazodone "trazo-bone"

89

First line treatment for Bulimia nervosa?

Fluoxetine (SSRI)

90

First line treatment for PTSD?

SSRI

91

First line treatment for OCD?

SSRI

92

Q image thumb

a=optic chiasm (CN II)

b=oculomotor nerve (CN III)

c=trochlear nerve (CN IV)

d=abducens nerve (CN VI)

e=opthalmic nerve (CN V1)

f=maxillary nerve (CN V2)

g=anterior cerebral artery

f=internal carotid artery

 

93

35 year old male, increasingly depressed, grimaces intermittently, rigid jerking and purposeless movements of the fingers, increasingly impulsive 

Huntington's disease 

94

Constipation that is not reversible with over the counter laxatives. Malfunction of which nerve = 

Pelvic splanchnic nerve innervates the anal sphincter

S2,S3, S4

“Pelvic splanchnic 2-4 keeps the shit above the floor”

95

Sudden onset R arm weakness + difficulty speaking + no other symptoms + completely resolved in 20 minutes 

TIA

96

tremor that is alleviated by intentional movement is seen in what disease

Parkinson disease 

97

slow, zig zag tremor when pointing/extending towards a target. 

problem is located where?

Intenion tremor. 

Cerebellar dysfunction.

98

Sleep terrors occur during _ sleep. 

Nightmares occur during _ sleep.

Sleep terrors - slow wave sleep (non-REM therefore no recollection)

Nightmares - REM sleep

99

Somatic symptom disorder - unconscious or conscious?

Unconscious 

100

Conversion disorder (Functional neurological symptom disorder) - unconscious or conscious?

Unconscious - patient seems indifferent to the symptoms but the symptoms are debilitating 

101

Malingering - unconscious or conscious?

Conscious - looking for secondary gains

102

Munchausen syndrome or Munchausen syndrome by proxy - unconscious or conscious?

Conscious - looking for primary gain of attention

Facticious disorders

103

Person who is preoccupied with needing things a certain way, needs to control everything around them and that is "just the way they are"

Obsessive compulsive PERSONALITY 

Ego-syntonic

104

Person with compulsions that they know are not reasonable btu they cannot help but do them (inconsistent with their own beliefs)

Obsessive Compulsive DISORDER

Ego-dystonic

105

Dysthymic disorder

Mild depression (at least 2 SIG E CAPS symptoms)

Lasts at least 2 years

106

Symptoms of Major Depressive Disorder 

SIG E CAPS - need at least 5 for at least 2 weeks

Sleep disturbance

loss of Interest (anhedonia)

Guilt/feelings of worthlessness

Energy loss/fatigue

Concentration problems

Appetite/weight changes (loss)

Psychomotor retardation or agitation

Suicidal ideation

Patient must also report depressed mood

107

Cyclothymic disorder 

Milder bipolar disorder

Fluctuates beween minor depression and hypomania

Lasts at least 2 years

108

Bipolar II

Hypomania + Depression

109

Bipolar I

At least 1 manic episode with or without hypomania or depression

Note: depressive symptoms do not have to be present for the dx to be made

110

Hypomania symptoms 

Same as mania (DIG FAST) except the mood symptoms are not severe enough to cause marked impairment

No psychotic features

Lasts 4 consecutive dasy

111

Mania symptoms 

DIG FAST - need at least 3 and needs to markedly impair functioning 

Distractibility

Irresponsibility (hedonism)

Grandiosity

Flight of ideas

increased in goal-directed Activities/Agitation

decreased need for Sleep

Talkativeness/pressured speech

112

Hallucinations or delusions without a major mood episode + periods of concurrent mood episode with schizophrenic symptoms lasting for > 2 weeks

Schizoaffective disorder 

There are no periods of time when there is just the mood disorder. There must be times when there are just schizophrenic symptoms though.

113

  • Flat affect
  • Social withdrawal
  • Lack of motivation
  • Lack of speech or thought

Negative symptoms of Schizophrenia

Treated with second generation anti-psychotics

114

  • Delusions
  • Hallucinations (auditory)
  • Disorganized speech
  • Disorganized/Catatonic behavior

Positive symptoms of Schizophrenia

Treated with both first and second generation anti-psychotics

115

Dementia ECG - normal or abnormal?

Normal

116

Waxing and waning consciousness + acute onset + abnormal ECG =

delerium

117

Dissociative amnesia =

Unable to recall important personal ifnormation subsequent to a severe trauma or stress

118

Girl who at age 3 begins to developmentally regress and loses verbal skills. Begins to have ataxia and wrings her hands constantly.

Rett Syndrome 

-X linked dominant- males die in utero

119

Withdrawal symptoms - hypersomnolent, hyperphagic, withdrawn, psychomotor retardation, vivid dreams =

Cocaine

120

Timeline for:

-Breif psychotic disorder

-Schizophreniform disorder

-Schizophrenia 

-Breif psychotic disorder = <1 month

-Schizophreniform disorder = 1-6 months

-Schizophrenia = >6 months

121

Q image thumb

Medulla - nuclei of CN IX, X, XII

122

Q image thumb

Pons - nuclei of V, VI, VII, VIII

123

Q image thumb

Midbrain

124

Q image thumb

Midbrain

125

The presence of what proteins increases the risk for early onset Alzheimer's?

  • APP (amyloid precursor protein, chr 21)
  • Presenilin-1
  • Presenilin-2

126

An increased amount of ApoE2 increases/decreases the risk for Alzheimer's?

Decreases risk

127

An increased amount of ApoE4 increases/decreases the risk for Alzheimer's?

Increases the risk

128

“Bright red fovea centralis that is surrounded by a contrasting white macula”

Cherry red macula spot

 

Seen in: Tay Sachs (no abdominal findings), Niemann Pick (hepatosplenomegaly)

 

129

Mechanism of phenytoin gingival hyperplasia =

Increased PDGF -> increases proliferation of gingival cells and alveolar bone

 

130

N. meningitidis endotoxin =

Outer membrane lipooligosaccharide (LOS)

Blood levels of LOS correlate with mortality

131

Oligoclonal bands of IgG seen on CSF fluid indicates a dx of

Multiple Sclerosis

132

Initial resistance to passive extension followed by a sudden release of resistance =

“Clasp knife spasticity” - seen in an UMN lesion

133

Prion transformation: _ structure to _ structure

Alpha helical

Beta pleated sheet

134

Viral esophagitis + Pneumocystis pneumonia is diagnostic for

HIV!

Esophagitis = CMV

Pneumonia = PJP

Patient is likely at risk for other immunocompromised/AIDs defining illnesses

135

Demyelination of posterior columns + LCST =

Subacute combined degeneration - vitamin B12 deficiency

“Combined” = degeneration of ascending AND descending tracts

136

Bilateral wedge shaped strips of necrosis over the cerebral convexity, parallel and adjacent to the longitudinal cerebral fissure

Hypoxic-ischemic encephalopathy (Global cerebral ischemia)

Results in watershed infarcts

137

Surgical deep brain stimulation of chronic Parkinson’s patients targets what 2 structures. Mechanism?

Structures: STN or GPi

Stimulation inhibits the nuclei therefore putting the circuitry onto the "yes movement" circuit by disinhibiting the thalamus

138

What nerve is vulnerable to injury in the posterior triangle of the neck?

CN XI -> damage causes weakness of the trapezius = impaired abduction of the arm above horizontal, drooping shoulder, winged scapula

139

Viral meningitis causes (3)

  • Enteroviruses (Polio, Coxsackie, Echo)
  • Arboviruses (Cali encephalitis, Hanta, Rift valley)
  • HSV-2

140

Bony spicule shaped deposits on retina +vision loss beginning with night blindness =

Retinitis pigmentosa

141

Fundoscopy: crinkling of retina + changes in vessel direction. Loss of vision like a curtain being drawn down.

Retinal detachment

142

Grayish-green subretinal membrane and subretinal hemorrhages in a 67 yo smoker who is having vision problems

Wet, age related macular degeneration

Treatment = VEGF inhibitors

143

HTN + intracerebral bleed

Hypertensive vasculopathy -> lenticulostriate arteries - charcot bouchard aneurysm -> rupture -> inhibits basal ganglia -> contralateral hemiparesis + hemisensory loss + headache + nausea  (symptoms are gradual)

144

Lesion in the ventromedial nucleus in the hypothalamus

Lesion = always hungry -> hyperphagia, obesity

Ventromedial nucleus = satiety center

Stimulated by leptin

145

Lesion in the lateral hypothalamus nucleus

Lesion = never hungry -> anorexia

Lateral nucleus = hunger center

Inhibited by leptin

146

3 brain tumors that are GFAP+

  • Astrocytomas (adults and kids)
  • Oligodendrogliomas (adults)
  • Ependymomas (kids)

147

Acute onset worst headache of my life =

Subarachnoid hemorrhage from a berry aneurysm

148

Microglial nodules in the brain + multinucleated giant cells + dementia =

HIV associated dementia 

149

Alpha-synuclein =

Parkinson's disease/Lewy body dementia

150

Round circular tau proteins =

Frontotemporal dementia

151

Tangles of tau protein =

Alzheimer's disease

152

Amyloid in the brain + Dementia

Alzheimer's Disease

153

R sided frontal lobe lesions

Disinhibited behavior

154

L sided frontal lobe lesions 

Apathy and depression

155

Round pearly mass behind tympanic membrane + conductive hearing loss in that ear + intermittent ear discharge

Cholesteatoma

-Squamous cell debris

-Congenital or acquired

-May erode middle ear structure

156

On ophthalmoscopic exam: arteriovenous nicking, flame shaped hemorrhages, cotton-wool spots

HTN retinal hemorrhages

157

What happens to the ciliary muscles and zonular fibers and the lens during accommodation?

Ciliary muscles contract -> zonular fibers relax -> lens thickens -> able to focus on near images

158

Conductive Rinne and Weber test?

Rinne: bone > air on affected side

Weber: lateralizes to affected side

159

Sensorineural Rinne and Weber test?

Rinne: air > bone (normal)

Weber: lateralizes to unaffected side

160

What CN? Motor of submandibular and sublingual gland?

CN VII

161

What CN? Sensation of tonsillar region, Sensation of inner surface of tympanic membrane, Motor of parotid gland?

CN IX

162

Noise exposure induced hearing loss is caused by damage to

Damage to hair cells in the organ of corti

Loss of high frequency hearing first

163

Lacunar infarcts in the deep brain are caused by

Hypertensive arteriolosclerosis

Immediate CT imaging does not show the infarct because it is so small

A few weeks later, the necrotic tissue becomes a cystic space and can now be seen

164

Anterior communicating aneurysm symptoms (3)

Berry aneurysm 

-bitemporal hemianopsia (compression of optic chiasm)

-visual acuity problems (compresion of optic nerves in optic chiasm)

-rupture (thunderclap headache) -> contralateral lower extremity hemiparesis and sensory deficits

 

165

Posterior communicating aneurysm symptoms (3) 

Berry aneurysm

ipsilateral CN III palsy

-mydriasis

-ptosis

-down & out eye

166

Middle cerebral artery aneurysm

Berry aneurysm

MCA ischemia = contralateral upper extremity and facial hemiparesis, sensory deficits 

167

Acute stress disorder diagnosis timeline

Greater than 3 days but less than 1 month

acute stress disorder -> PTSD

168

PTSD diagnosis timeline

Greater than one month

 

acute stress disorder -> PTSD

169

A drop in PaCO2 does what to cerebral vasculature?

Vasoconstricts cerebral vasculature -> reducing cerebral blood flow -> reducing intracerebral pressure

170

Afferent limb of the light reflex

optic nerve, optic tract (-> pretectal nucleus in midbrain)

-damage to the retina, optic nerve or optic tract will inhibit the light reflex

171

Efferent limb of the light reflex 

parasympathetic fibers of the occulomotor nerve (CN III)