Neuro 2

Question 1

What neurons [4 locations] are involved in discriminitive touch/proprioception/vibration pathway?

Answer 1

posterior root ganglia, nucleus gracilis/cuneatus, VPL thalamus, postecentral gyrus

Question 2

Where does the posterior column/medial lemniscus pathway decussate?

Answer 2

rostral medulla [internal arcuate fibers]

Question 3

Signs of injury to posterior columns in spinal cord?

Answer 3

IL loss of discriminitive touch, proprioception and vibration

Question 4

Signs of injury to medial lemniscus?

Answer 4

CL loss of discriminitive touch, proprioception and vibration

Question 5

What is the Romberg test?

Answer 5

test of proprioceptive function [NOT cerebellum]; pt stands upright with arms abducted eyes open vs. eyes closed

Question 6

What indicates a positive Romberg test indicate?

Answer 6

a marked difference in the ability to maintain erect posture with eyes open vs. eyes closed = + Romberg

Question 7

What does a Romberg test look like in someone with cerebellar injury?

Answer 7

with cerebellar injury, pt cannot stand up even with eyes open - DON’T DO A ROMBERG TEST in a pt with cerebellar injury

Question 8

Neurons [4 locations] in pain/temperature pathway?

Answer 8

posterior root ganglia, posterior horn, VPL thalamus, postcentral gyrus

Question 9

Where does the spinothalamic tract decussate?

Answer 9

anterior white commissure, spinal cord, all levels

Question 10

Deficits in syringomyelia?

Answer 10

BL dermatomal loss of pain and temperature [usually upper limbs]

Question 11

Cause and signs of Dejerine-Roussy syndrome?

Answer 11

Extreme hypersensitivity to painful stimuli following posterior thalamic infarct

Question 12

What is the function of lower motor neurons?

Answer 12

innervate skeletal muscle

Question 13

Location of lower motor neurons?

Answer 13

spinal cord + motor cranial nerve nuclei (III, IV, V, VI, VII, IX, X, XI, XII)

Question 14

Location of upper motor neurons?

Answer 14

cerebral cortex, red nucleus, reticular formation

Question 15

Signs of injury to Upper Motor Neuron (UMN)?

Answer 15

hemiparesis, increase muscle stretch reflexes [hyper-reflexia], spasticity, clonus + Babinski sign, Hoffman sign

Question 16

Lower motor neuron (LMN) signs?

Answer 16

paralysis, decreased muscles stretch reflexes [hyporeflexia], flaccid tone, atrophy

Question 17

Motor tracts in the posterior limb of the internal capsule?

Answer 17

corticospinal [upper limb, trunk, lower limb]

Question 18

What is spasticity?

Answer 18

a velocity-dependant increase in muscle tone [injury to UMNs]

Question 19

What is rigidity?

Answer 19

a velocity-independant increase in muscle tone [damage to Basal Nuclei structures]

Question 20

The corticospinal tract decussates at what level?

Answer 20

pyramidal decussation, caudal medulla

Question 21

Motor tracts in the genu of the internal capsule?

Answer 21

corticobulbar [to cranial nerve nuclei]

Question 22

Signs of injury to the corticospinal tract in the right internal capsule?

Answer 22

left, UMN signs

Question 23

Signs of injury to the corticospinal tract in cervical spinal cord on the right?

Answer 23

right, UMN signs

Question 24

Signs of injury to the corticobulbar tract in the right internal capsule?

Answer 24

left, lower facial paralysis; tongue points away from lesion

Question 25

Location of lesion in decorticate posturing?

Answer 25

rostral midbrain or thalamus - red nucleus intact

Question 26

Location of lesion in decerebrate posturing?

Answer 26

midbrain - damage involving red nucleus or rubrospinal tract

Question 27

Signs of myopathy?

Answer 27

proximal symmetric weakness, no sensory loss

Question 28

What are the 2 most common causes of peripheral neuropathies?

Answer 28

diabetes, alcoholism

Question 29

Signs of polyneuropathy?

Answer 29

stocking/glove sensory loss

Question 30

Neurons in auditory pathway [at least 6]?

Answer 30

spiral ganglion, cochlear nucleus, superior olive, inferior colliculus, medial geniculate, primary auditory cortex

Question 31

Result of Rinne test in normal ear?

Answer 31

air conduction > bone conduction

Question 32

Result of Rinne test in conductive hearing loss?

Answer 32

air conduction < bone conduction

Question 33

Result of Rinne test in sensorineuronal hearing loss?

Answer 33

air conduction > bone conduction

Question 34

Result of Weber test in normal hearing?

Answer 34

localize to midline

Question 35

Result of Weber test with sensorineuronal hearing loss in R ear?

Answer 35

localize to left

Question 36

Result of Weber test with conductive hearing loss R ear?

Answer 36

localize to right [You can verify this by sticking your finger in your ear and performing the Weber test on yourself.]

Question 37

Deficits with injury to CN VIII?

Answer 37

IL deafness, dizziness, CL nystagmus

Question 38

Deficits with injury to brainstem auditory pathways?

Answer 38

bilateral hearing loss

Question 39

What is presbycusis?

Answer 39

age-related hearing loss, high frequencies lost first

Question 40

Neurons in visual pathway [3 neurons]?

Answer 40

retinal ganglion cells, lateral geniculate, primary visual cortex

Question 41

Signs of injury to optic nerve/retina?

Answer 41

IL visual loss, can affect both temporal and nasal hemifield

Question 42

Signs of injury to optic chiasm?

Answer 42

bitemporal hemianopsia

Question 43

Signs of injury to optic tract?

Answer 43

contralateral homonymous hemianopsia

Question 44

Signs of injury to Meyer's loop?

Answer 44

upper quadrant homonymous hemianopsia

Question 45

Visual deficits in PCA stroke affecting calcarine sulcus?

Answer 45

contralateral homonymous hemianopsia, with macular sparring

Question 46

What is Marcus Gunn pupil?

Answer 46

optic nerve lesion, when light is shown into bad eye, pupil dilates (bad retina = no light)

Question 47

What structures comprise the basal ganglia [nuclei]?

Answer 47

caudate, putamen, globus pallidus, subthalamic nucleus, basal nucleus of Meynert

Question 48

Brain region affected in Parkinson disease?

Answer 48

substantia nigra, pars compacta [dopamine]

Question 49

Signs of Parkinson disease?

Answer 49

bradykinesia, pill-rolling tremor, masked facies, postural instability

Question 50

Pathological sign of Parkinson disease?

Answer 50

Loss of dopaminergic neurons in SN + Lewy bodies in SN

Question 51

Brain region affected in Huntington disease?

Answer 51

caudate nucleus

Question 52

Signs of Huntington disease?

Answer 52

choreioform movements, dementia

Question 53

Brain region injured in right hemiballismus?

Answer 53

left subthalamic nucleus

Question 54

Signs of essential tremor?

Answer 54

chronic, progressive tremor in arms, neck, larynx, chin; reduced with alcohol consumption

Question 55

What is Wilson disease?

Answer 55

inborn error of copper metabolism; Kayser-Fleischer rings; wing-beating tremor, rigidity

Question 56

What are signs of cerebellar injury?

Answer 56

ataxia, dysmetria, dysdiadokinesia, nystagmus, dysarthria

Question 57

Signs of injury to vestibulocerebellum (flocculonodular lobe)?

Answer 57

truncal ataxia, nystagmus

Question 58

Signs of injury to lateral hemisphere of cerebellum?

Answer 58

IL limb ataxia, intention tremor, dysarthria

Question 59

Signs of injury to middle cerebellar peduncle?

Answer 59

IL limb ataxia

Question 60

Results of caloric testing in normal individual?

Answer 60

COWS - cold = nystagmus to opposite side; warm = nystagmus to same side

Question 61

Signs of Arnold-Chiari I malformation?

Answer 61

extension of cerebellar tonsil below foramen magnum

Question 62

Signs of Arnold-Chiari II malformation?

Answer 62

displaced vermis + myelomeningiocele

Question 63

Signs of Dandy-Walker?

Answer 63

enlarged posterior fossa, small cerebellum, absent vermis, cystic dilation of 4th ventricle, hydrocephalus