neuro Flashcards
(129 cards)
1
Q
Q
nucleus pulposus
is a remnant of ?
A
notochord.
2
Q
failure of the prosencephalon to divide into 2 cerebral hemispheres
results in?
the most likely mechanism of these findings
A
holoprosencephalon, (fused cerebral hemispheres),
seen in trisomy 13
fetal alcohol syndrome.
mechanism = field defect
3
Q
Q
pt with hyperthermia.
caused by problem with the center regulating heart.
what is the origin of this center
A
diencephalon
forms the thalmus and hypothalamus
4
Q
which chiari malformation is always associated with spina bifida (meningomyelocele)
A
type 2
bc
type 1 (adult type) is associated with syringomyelia
5
Q
dandy walker syndrome
is associated with what type of hydrocephalus
Q why hydrocephalus
A
noncommunicating hydrocephalus.
(malfunction of Luschka and Magendie)
- cystic dilation of the 4th vent –> hypoplasia of the cerebellum and absence of cerebellar vermis
6
Q
Q on the boards
neonate that survved meningtits (usually grp B strept) and started to develop enlargement of the skull?
whats the cause
A
congenital hydrocephalus
acquired after bacterial meningitis
7
Q
Q on boards
congenital hydrocephalus
(aqueduct of sylvius)
can be caused by defect in what embryolonic origin
A
mesencephalon
also can be caused by failure of the roof of the 4th ventricle to develop
8
Q
noncommunicating (obstructive hydrocephalus)
arnold chiari
dandy walker
congenital hydrocephalus
A
arnold - compression of the 4th ventricle
dandy walker syndrome - luschka and magendie malfunction
congenital hydrocephalus - stenosis of cerebral aqueduct
9
Q
Communicating (nonobstructive) hydrocephalus
kid had meningitis 1 month ago, his head is getting bigger
whats the problem
A
disoder of the arachnoid granulations
10
Q
what to know
port wine stain (nevus flammeus - birth mark) cnV1/V2
seizures
episcleral hemangioma –> glaucoma
intellectual disability
A
sturge weber syndrome
(encephalotrigeminal angiomatosis)
11
Q
what you need to know
autosomal dominant
multisystem disorder –> tumors in diff organs
brain - (cortical tubers = large white hamartomas nodules)
rhabdomyoma –> mitral regurg
hypopigmented ash leaf spots and angiofibroma
kidney: bilateral renal angioMyolipoma
A
tuberous sclerosis
12
Q
most common primary heart tumor in children and infants
A
rhabdomyoma.
13
Q
what are neurofibroma composed of
A. neural tissue
B. Schwann cells and fibroblast
A
schwann cells and fibroblasts
NOT NEURAL TISSUE
14
Q
WHAT to know
chromo 17 mut in a tumor supressor gene
Cafe au lait macules
pigmented neurofibromas
axillary freckling (crowe sign)
associated with Pheochromocytoma and wilms tumor
optic glioma
A
NF 1
15
Q
bilateral acoustic neuroma (tinnitu vertigo hearing loss)
- usually schwannoma located cerebellopontine angle
chromo 22
meningiomas
juvenile cataracts
A
NF2
16
Q
cerebellar degeneration –> ataxia (early onset)
telangiectasia (dilated blood vessels) of the eyes and skin
immunodef
low IgA and T cell deficit
recurrent infections
A
ataxia telangiectasia
17
Q
VHL gene is a
A. oncogene
B. tumor supressor gene
A
tumor supressor gene
18
Q
angiomatosis of the retina –> blindness
(hemangioblastomas (high vascularity w/ hyperchromatic nuclei) in retina, cerebellum, brain stem.
bilateral RCC
Pheochromocytomas
A
VHL disease
19
Q
2/3 of sporadic clear renal cell carcinoma
have difinite evidence for
biallelic inactivation of VHL
A
know this
20
Q
why is carmustine and lomustine
used to treat brain tumors
A
(lipophilic)
bc they are small, lipid soluble, nonpolar,
molecules that CAN cross the BBB
21
Q
what brain tumor will you see mulltiple of in
NF2
A
meningioma
22
Q
on the boards
uniformly encircled tumor cells with psammoma bodies
presents with new onset seizures
A
meningioma
23
Q
on the boards
pt in a coma after head injury with bradycardia and ST segment elevation on EKG
A
from increased ICP
24
Q
cranial nerve palsy (VI common due to long intracranial course) –> binocular horizontal diplopia due to lateral rectus palsy
whats the cause
A
inc ICP
25
if someone is on a ventilator and a patient is suffering from increased ICP
what can you do to help
**hyperventilation**
--\> **dec co2 --\> vasoconstriction --\> dec cerebral blood flow --\> dec ICP**
26
Aids pt with CD4 count \<50
using **natalizumab**
for tx of MS or crohns disease
has deficits in **speech, memory, coordination**
**PML**
**oligodendrocytes** --\> intranuclear inclusions --\> symptoms
27
on the boards
12-15 yo hx of measles
infection early in life (before age of 2)
presents with **personility changes, seizures, myoclonus, atxia,** and **photosensitivity**
**Subacute sclerosing pancencephalitis**
28
on the boards
pt with hx of **long term corticosteroid use** who develops
pulmonary infection initially then **brain abscess**
**nocardia asteroides**
29
on the boards
**hiv infection** pt who develops signs of
encephalitis or **brain abscess** with **ring enhancement** and **calcification** on mri.
diagnosis
**protozoa**
**(Toxoplasma gondii)**
30
trick question
is CFJ prion spongiform encepholpathy
effect patchy or whole cerebral cortex
**whole cerebral cortex**
31
Q on board. 30 yo mexican immigrant healthy person visiting area from South america. has been to ER for **new onset seizures**
ct of brain shows **cystic mass**
what is the treatment
how did he acquire this infection?
**albendazole** and corticosteriods (for the edema)
through eating **pork** meat
**taenia solium (cysticercosis)**
32
when the pts thigh is flexed at the hip and knee at 90 degree angles
you see ressitance in extending the knee (painful)
what sign is this and what is it positive in
**kernig sign**
+ in **SAH, meningitis**
33
healthy middle age 30yo pt
all of sudden have increase ICP. on biopsy you see intracerebral hemorrhage formed of **numerous tortuous vessels**
what is the casue
**av malformation rupture**
34
stroke queston on boards!!!
pt with
**vertigo, N/V, nystagmus, ipsilateral limb ataxia.**
what kind of stroke?
what artery
\*\* if brainstem compression you need to do what?
**cerebellar stroke**
**Superior cerebellar A.** or
**AICA** or **PICA**
must consult neurosurgery for decompression
35
what stroke causes
dysphagia, hoarseness
dec gag refelx
**lateral medullary wallenberg syndrome**
**PICA**
36
which stroke causes **facial paralysis** (lmn lesion
(facial nucleus))
dec lacrimation
dec salivation
dec taste from anterior 2/3 tongue
AICA = **lateral pons**
37
which stroke
**ipsilateral tongue paralysis**
contralateral upper and lower limbs paralysis
loss of contralateral proprioception
**ASA**
**medial medullary syndrome**
38
on boards
conscious quadrplegic pt who is unable to move the face, mouth, and the tongue and has loss of **horizontal** eye movement (NOT the VERTICLE)
**locked in syndrome,**
involving the pons, medulla, and the midbrain.
spares the **reticular activating system (RAS)**
39
dysarthria meaning
inability to move the tongue and mouth muscles.
40
on boards
pt with conjuctival injection, edema of the eyelids with
paralysis of the cranial nerves passing through the cavernous sinus, after a **dental procedure**
diagnosis
and most likely organsim
**cavernous sinus thrombosis**
**peptostreptococcus**
41
what is the most common extraocular muscle involved in wernickes encephalopathy
lateral rectus
42
on boards
what is korsakoff psychosis due to ?
**necrosis** and **perminent damage** to the **mamillary bodies**
43
what will happen if you glucose before thiamine if pt has wernicke encephalopathy
inc anion ap **metabolic acidosis**
inc anaerobic metabolism of glucose and accumulation of lactic acid.
44
for the boards
pts with metabolic encephalopathy (including alcohol intoxication) will have?
whats the one exception
**equal reactive pupils**
even in the terminal conditions (cheyne-stokes breathing) except
**opioid induced encephalopathy --\> pinpoint pupils**
45
on the boards
pt who presents with **drooping eye lids, slurred speech, vomiting ,** and **muscle weakness 6 hr.**
after ingestion of contamnated food
cause?
**botulism.**
**(miller-fisher syndrome)**
**Descending** paralyses, ocular muscles first, ataxia and areflexia
it blocks release of acetylcholine from NMJ --\> respiratory failure
46
C4 dermatome
shoulder tip
47
C6 dermatome
**thumb**
48
C5 dermatome
outer part of the upper arm
49
L1 dermatome
inguinal ligament
50
C2 occiptal and parietal area
pain in occipital area after a hit in the rear (**whiplash)**
51
**diffuse hyperreflexia**
generalized weakness and atrophy and fasciculations of limbs
compression of the cervical cord.
52
cant toe walk
**L4-L5**
53
pain and sensory loss over the back of the thigh, lateral posterior calf
**L5-S1**
54
**cant TOE WALK**
**S1**
55
Hair follicle ending
hair displacement
56
krause corpuscle
located at lip tongue and genitals
respond to pressure
57
ruffini ending
located dermis of skin
pressure on skin
58
meissner corpuscle
dermis of skin
light touch
59
**pacinian corpuscle**
located deep dermis
**vibration - slow** and **pressure**
60
**Free nerve ending**
**mechanical , thermal**
61
on the boards
**macrocytic anemia, smooth tongue** ,
achlorhydria with hx of vitamin **B12** deficiency - (prenicious anemia)
posterior column degeration -**\> bilateral loss** of **vibration** and **tactile sense**
corticospinal tract --\> **bilateral spastic paresis** bleow the lesions
progressive degen disease of **posterior roots of the spinal cord --\> bladder incontinence**
**subacute combined degeneration**
62
AIDS demential complex
look for pt with Subacute combined degeneration
dementia
long hx of AIDs
63
**Bilateral horners** if above T2
flaccid paralysis (LMN)
spastic paresis (corticospinal treact)
pain and temp (lateral spinothalamic tract)
all impaired
**anterior spinal artery infarction**
64
on the boards
**fasciculations** (usually tongue)
**preserved ocular muscle movement**
ALS
65
mutation in **superoxide dismutase 1**
| (SOD1 gene)
**ALS inherited form**
66
what is the only nerve in nerve that regenerates in adults
**olfactory (CN2)**
67
which cn has the slowest fibers in conducting action potential
olfactory
68
**fracture of the cribriform plate** leads to
loos of smell (anosmia) due to injury of the olfactory bulb.
however, why can the pt still smell/have a response to ammonia.
**noxious stimuli** from the olfactory mucosa is carried by the **trigeminal nerve**
69
on the boards
injury to geniculocalcarine tract in the temporal lobe will cause what visual field defect
**upper visual field defect**
**(meyers loop)**
70
Q
pt with
**acute glaucoma** and **orthostatic hypotension** in a pt with **DEPRESSION**
what do you think the cause is
**imipramine**
71
drug to give someone that has **narrow angle glaucoma**
**(red painFUL** EYE)
**PILOCARPINE**
72
in the treatment of open angle glaucoma
what are the 2 main side effects of **prostaglandin (latanoprost)**
"PGF2)
**darkening of the iris color (browning)**
and eye lash growth
73
Q
what nerve was injured when a pt had their mandibular molar extraction now causing numbness in the tip of the tongue?
**lingual nerve** ( a branch of the **madibular** division) passes close to the third molar
(anterior 2/3 sensation)
74
what supplies innervation to the **posterior scalp** and the **neck**
**C2-C3**
**NOT TRIGEMINAL NERVE**
75
trigeminal neurlagia
what branch
**maxillary**
76
on boards
pt with levator palpebrae superioris problem
**intracranial aneursym**
in pt with polycystic kidney disease
can somehow effect what nerve.
**oculomotor nerve**
most likely in the PCOM
also could have
77
the facial nerve course
from the pons --\> **internal auditory meatus**--\> facial canal of the petrous portion of the temporal bone through the _____ foramen
**stylomastoid foramen.**
**\*\* the facial canal** is Z shpaed located in temporal bone extending from internal acoustic meatus to styloidmastoid foramen.
78
Q on boards
pt has **hyperacusis (inc sensitivity to everyday sound)**
where is the damage causing this
injury to the **facial canal** where the nerve to the **stapedius originates.**
**stapedius n** is a branch of the **facial n.**
79
pt with bells palsy and cant close the eye lid all the way when they sleep
what nerve and muscle
facial nerve.
## Footnote
**orbicularis oculi**
80
**chorda tympani**
is a branch of what nerve that supplies
taste sensation to anterior 2/3 of tongue
and parasympathetic to (submandibular and sublingual)
**facial nerve.**
81
pt has **eye dryness** (weakness in orbicularis oculi) and increased sensitivity ot noise (**hyperacusis)**- know (injury in facial canal, injury to stapedius)
**bells palsy**
82
horner syndrome
ipsilateral ptosis due to paresis of what muscle
**muller muscle**
smooth muscle supplied by sympathetic fibers from superior cervical ganglion help to raise upper eyelid
83
Q
pt with bells palsy and acoustic neuroma
where is the injury
**facial canal**
internal auditory meatus in temporal bone
84
Q
pt has difficulty of hearing **low frequency sounds**
think of damaged?
**inner ear hair cells**
or
**menieres disease**
85
Q
autosomal **dominant** defect w/ **type 1 collagen deficiency**
**SENSORY HEARING LOSS** Is tdue to atrophy of the **cochlear hair cells** and abnormal **bone** formation in the **cochlea.**
what disease?
**osteogenesis imperfecta**
86
**ipsilateral ataxia**
and
**intention tremor**
are due to?
**cerebellar lesions** with loss of **purkinje cells**
in the **HEMISPHERES**
not the vermis
87
treatment for
essential tremor
**B - Blocker**
if b blocker is contraindicated
**primidone**
88
asterixis
hepatic encephalopathy
89
alcohol withdraw and
side effect of lithium
hyperthyroidism
HYPOglycemia
tremor
90
pt bitten by a **black widow spider**
presents as ?
**muscle twitching**
NOT TREMOR
abdominal and chest pain
91
supraoptic and paraventricular nuclei
ADH and oxytocin formation
effect of lesion
diabetes insipidus
92
what is **ghrelin**
**gut brain peptide** produced by **GI mucosa** mainly the stomach.
acts on teh hypothalamus --\> inc hunger --\> wt gain -- FATASS
93
on the boards
**a retrochiasmatic mass**
or
multiple sclerosis
wiill displace the optic tract --\> ?
**contralateral homonymous hemianopsia**
94
in parkinsons disease you see an overproduction in ACH?
why
**bc dopamine** normally has an inhibitory effect on cholinergic neurons
no dopamine = no inhibitory effect
95
the tremor in parkinsons pt is due to
excess ACH in the stratum
96
rigidity for boards
\_\_\_ is a form of increased tone --\> inc muscle stiffness, fatigue, weakness
**lead pipe rigidity**
97
rigidity for baords
lead pipe rigidity + tremor --\> a stop and go effect during a range of motion
cogwheel rigidity
98
rigidity for board
is seen in **UMNL** starts with a higher resistance to flexion ollowed by a loss of resistance
**clasp knife response**
99
in huntingtons
you get atrophy of?
which leads to **enlargement of the lateral ventricles (ex vacuo ventriculomegaly)**
**caudate**
100
on the boards
middle aged women started on a medicine for **psychosis** and developed dyskinesia, galactorrhea and amenorrhea.
what is the most likely cause of her symptoms
low potency antipyschotic drugs -- phenothiazines **(chlorpromazine)**
cause blockade of dopamine receptors
101
boards
**unsteady wide based gait** (staggering side to side)
whats the cause
**cerebellar vermis lesion**
long hx of alcohol abuse --\> ataxia
102
waxing and waning breathing followed by apnea
look for pt with
**CHF, Immature newborn,** or a person who moved recently to high altitude area
**cheyne stokes respiration.**
103
**kussmaul sign**
increased jugular venous distention during inspiration in pt with constrictive pericarditis
104
**Erb palsy**
most comm birth related neurapraxia
upper arm paralysis **C5/ C6**
will they have intact or lost grasp
**intact grasp**
105
in erB palsy
what two nerves are involved
Axillary and musculocutaneous
106
**klumpke palsy**
**lower arm paralysis C8/T1**
grasp
**lost grasp**
107
**boards**
**common presentation**
what nerve of the arm is commonly effected in **cycylist**
**ulnar**
108
what nerve is commonly affect in these scenarios
**elbow injury**
**hematoma** in the **cubital fossa (**after IV infusion)
**median**
109
**thoracic outlet syndrome**
pain, numbness and or tingling of the upper extremity increased by overhead work caused by compression of what?
seen in painters
**brachial plexus** and **subclavian vessels**
110
**high yield on boards**
**S2-4** of the sacral plexus
innervates the structures of the **perineum** and **sensation** of the **genitalia**
pudendal nerve
111
Q
vaginal tear due to instrument delivery
can cause **pudendal nerve injury** that can cause
**urinary incontinense**
**loss of sexual sensation**
112
triptans
like **sumatriptan** moa
**selective serotonin receptor agonist**
113
triptans (sumatriptan)
the most serious side effect is ?
**coronary artery vasospasm**
114
microscopically see
**fragmentation** of the **internal elastic lamina** and **multinucleated gaint cells.**
**temporal arteritis**
115
on the boards
**old pt admitted to the hospital w/ acute illness**
**acute onset memory problem, disorganized speech, altered consciousness w/ _fluctuating_ course**
**delirium**
116
what is the highest risk for developing delirium
**dementia**
117
Q
why do alzheimers pts have early memory loss
**atrophy of hippocampus**
118
HY on the boards
alzheimer pt has dec ACH why?
loss of cholinergic neurons (acetyltransferase activity) in **nucleus basalis** of **meynert**
119
**on boards**
**hyperpohosphorylated tau protein**
is from a mutation on chromosome?
chromosome **14\*\*\***
leads to neurofibrillary tangles - **inracellular** aggregates of fibers (coreelates with the degree of dementia
120
boards
in wilsons disease
they have neuroological symptoms including psychosis and **dementia!!!!**
inc LFTs and jaundice
what iwll there alkaline phosphatase level be
**low alkaline phosphatase**
121
picks disease (frontotemporal dementia)
pt has personality changes (behavioral disturbances) and inappropriate/aggressive.
what will be seen on biopsy
**intracellular tau protein**
rounded aggregates inside cerebral neurons
122
alheimers tx
1st line
**donepezil**
123
Q
tacrine (anticholinergic) used for alheimers tx
sideeffect
**hepatotoxicity**
124
Q on boards
pt diagnosed with alzhiemers is started on a medication .
pt is getting better for 3-4 months, then her physician increases the close.
one week later pt is in ER with **syncope** why?
donepezil is a central ach esterase inhibitor that causes
## Footnote
**increased vagal tone --\> bradycardia --\> atrioventricular block**
125
alzheimers tx
for boards
know that **ginkgo biloba**
does or does not imporove the global function in pts with alzheimers
**does NOT**
126
127
inclusions bodies and pigments for the boards
alzheimers disease
**Neurofibrillary tangles**
* **=** degenerated neurofilaments
**hirano bodies**
* eosinophilic, rod like inclusion bodies in the neurons of the hippocampus
128
inclusions bodies and pigments for the boards
**dark pigments**
**neuromelanin**
* black pigments found in the cytoplasm of the neural cells of substantia nigra
* - def of neuromelanin is seen in pts with parkinsons disease
**negri bodies**
* eosinophilic, inclusion bodies, found in the **pyramidal cells** of the **hippocampus** and **purkinje cells** of the cerebellum
* know that they are pathognomonic for **rabies infection**
129
