Neuro- FA Flashcards
(189 cards)
1
Q
Which structure does notochord give arise to?
A
nucleus pulposus of intervertebral disc
2
Q
Notochord induces ectoderm to become what subsequent structures?
A
ectoderm -> neural ectoderm and neural plate
* mediated by notochord
- neural ectoderm -> CNS neurons, astrocytes, oligodendrocytes, astrocytes
- neural plate -> neural tube and neural crest
neural tube=> spinal cord
neural crest => MOTELPASS
3
Q
Thalamus relays all information with exception of which sensory?
A
olfaction
4
Q
Which structure produces aqueous humor?
A
cilliary epithelium
5
Q
When irreversible CNS damage does happen after onset of hypoxia?
A
5 mins
6
Q
Which nerve roots are associated with cremaster reflex?
A
L1- L2
Ilioinguinal nerve
7
Q
Which nerve roots are associated with anal wink reflex?
A
S3-S4
8
Q
Where is primary auditory cortex located?
A
temporal lobe
9
Q
Describe sympathetic pathway ( hint: starting from hypothalamus, two synapses)
A
hypothalamus
- > first synapse at lateral horn at T1 level
- > second synapse at superior cervical ganglion at C2
- > Third neuron takes two pathways
- internal carotid, passing through cavernous sinus ,
- sweat gland of upper face (anhidrosis)
- pupilary dilator (CN3- meiosis)
- eye lid (CN3- ptosis) - external carotid
- sweat gland of lower face
10
Q
embryological origin of microglia?
A
mesoderm
- Mesoderm, Microglia
11
Q
Herniation syndrome: which structure is compressed in each case
- cingulate (subflacine) herniation
- transtentorial
- uncal herniation
- cerebellar tonsillar herniation
A
- cingulate (subflacine) herniation: ACA
- transtentorial: basillar artery
- uncal herniation: CN3, PCA
- cerebellar tonsillar herniation: brain stem -> may lead to death/comma due to respiratory suppression
12
Q
adverse effect of halothane?
A
hepatotoxicity
Halo, Hepato
double H yo
13
Q
Selegeline inhibits what enzyme? leading to accumulation of what?
A
MOA-B, which preferentially metabolize domapine. Thus accumulation of dopamine
MOA-A metabolizes dopamine, as well as NE, 5HT
14
Q
Describe afferent and input pathway of cerebellum
A
- input
- CL cortex -> 2. middle peduncle
or - IL spinal cord ->2. inferior peduncle
- output
1. purkinje cells -> 2. deep nuclei -> 3. CL cortex via superior peduncle
15
Q
First line for partial or generalized seizure in neonates?
A
phenobarbitol
16
Q
Phenobarbitol is contraindicated in patient with what disease?
A
porphyria
17
Q
Easy way to remember thalamic nuclei
A
- VPL, VML: sensory (two letters, after V - )
VPL: somatosensory
VML: facial/taste (Mask)
-LGN, MGN: geniculate is special sensory
LGN: visual (Light) -> occipital lobe
MGN: auditory (Music)-> temporal lobe
- VL: motor, only ONE motor, only ONE letter after V
18
Q
Compare Chiari type 1 vs. Chiari type 2
A
Chiari 1: tonsils, syringomyelia, cape-like distribution loss of PAIN/TEMP sensation (upper limbs and chest)- compression at C5-L1
- type ONE = ONE tiny hole (syringomyelia)
Chiari 2: vermis, meningomyelocele, hydrocephalus
*type TWO: TWO= more numbers= pushes TWO structures (meninges and spinal cord)
19
Q
two phases of succinylcholine?
A
phase 1: prolonged depolarization (as partial agonist), no antidote
phase 2: desensitization, progressive decrease in depolarization, may be reversed by acetylcholinesterase
20
Q
CSF analysis finding in Guian-Biarre?
A
hight protein
21
Q
What astigmatism?
A
irregular curvature of cornea, resulting in different refractive power at different axes
asigmatnism= 울퉁불퉁코니아
22
Q
Describe progression of ischemic stroke
A
- bottom line: pretty similar with MI
EXCEPTION
1. first 48 hrs is red neuron ( vs. MI- coagulative necrosis)
2. no macrophage, but microglia
3. 1-2wks has special neuron activity- reactive gliosis
first 48 hrs: red neuron (acute neuronal injury)
1-3 days: neutrophil
3-5 days: microglia
1-2 wks: reactive gliosis and vascular proliferation
>2 wks:
23
Q
Order of sensory loss by anesthetics
A
pain> temperature > touch> pressure
- pain and temperature are intense, most sensitive
touch: not that intense
pressure: not sensitive, needa press deep
24
Q
What is “wet” type age-related macular degeneration? treatment?
A
rapid loss of vision due to bleeding (wet)
treated with Ranibizumab (anti-VEGF), which slows down neovasculization
25
Sumatriptans
- MOA
- indication
- contraindication
- 5HT-1B/1D agonist
vasoconstriction -> reducing perfusion and headache
- cluster and migraine
* intense headaches
- contraindicated in CAD and prinzmetal angina due to possible excessive vasoconstriction
26
which cranial nerves?
- lacrimation
- salivation
- eyelid closing
- eyelid opening
- coughing
- lacrimation: CN7
- salivation: CN9
- eyelid closing: CN7 (orbicularis oculi)
- eyelid opening: CN3 ( levator palpebrae)
- coughing: CN10
27
Easy way to remember hypothalamus nuceli?
LG AC (엘지 에어컨)
Lateral: Gherlin
ventroMedial (kinda opposite to lateral): leptin
Anterior: cooling
Posterior: warming
suprachiasmatic: circadian
supraoptic: ADH
paraventricular: oxytocin
28
What kind of intracranial hematoma crosses suture lines but not the falx? What kind crosses the falx but not suture lines?
epidural: does NOT cross suture lines, but crosses falx
subdural: crosses suture line, but NOT falx
* suture line: bone line. epidural hemartoma happens on top of skull, thus its spread is limited by suture line
* falx: dural structure. spread of subdrual hematoma is limited by it
29
what are primitive reflexes? which region of brain is responsible for inhibition of primitive reflexes during development?
baby's reflexes (sucking, palmar, etc)
FRONTAL LOBE is responsible for inhibition of these reflexes during normal development within the first year of life
30
xiphoid process is land mark for which dermatome?
T7
Xiphoid= Xeven
31
What are similarities and differences difference between pituitary adenoma and craniopharyngioma?
similarities: BOTH are derived from Rathke pouch (oral ectoderm), causing bitemporal hemianopia
pituitary adenoma: hyperpituitarism
craniopharyngioma: non-functional, just pituitary mass
32
What are symptoms of anterior spinal artery infarct?
medial medullary syndrome
- tongue deviation: hypoglossal
- paralysis
- loss of proprioception
* anterior spinal artery is branch of vertebral
* medial medullary syndrome is the only one that causes tongue deviation (hypoglassoal)
33
Giving what can precipitate Wernicke-Korsakoff syndrome? why?
glucose
glucose uses up B1 for metabolism
34
Which antipsychotics can cause gynecomastia? what is underlying mechanism?
Risperidone
may block tuberoinfundibular dopaminergic pathway, which normally regulates prolactin synthesis
- > more prolactin -> inhibition of LH/FSH
- > gynecomastia
35
Which part of brain is associated with executive decision making?
prefrontal association area in frontal lobe
36
knee caps are land mark for which dermatome?
L4
37
Inguinal ligament is landmark for which dermatome?
L1
* easy way to remember: Linguinal, L1
38
Which cranial nerve has nuclei in spinal cord?
CN11 (think about the ventral view FA p.477)
39
Ependymoma
- adult or kid?
- where is tumor originated from?
- histologic finding
- kid
- ependymal cells in 4th ventricle (which produce CSF)
- perivascular rossetts
40
Which neuron fiber is unmyelniated?
C fibers of free ending
| slow progression
41
Cavernous sinus syndrome: symptoms? explain symptoms based on what structures are passing through cavernous sinus
- variable ophthalmoplegia (CN3,4,6)
- Horner (sympathetic neuron)
- loss of corneal (V1) and maxillary (V2) sensation
42
What artery is passing through Cavernous sinus?
internal carotid
43
INO in MS: unilateral or bilateral or both?
bilateral
* MS fucks up broad region. so it involves both sides of MLF (medial longitudinal fasiculus)
44
Which glaucoma drug can cause browning of iris as side effect?
Iatanoprost (prostaglandin analogue)
45
ketamine
- MOA
- indication
- side effects
- NMDA blocker (phencyclidine analogue)
- IV anesthetics
- hallucination, disorientation, bad dreams
46
Parkinson
- increased neurotransmitters (2)
- decreased neurotransmitter
increased: serotonin, actylcholine (benzotropine)
decreased: dompaine
47
socially inappropriate and inattentive and has difficulty speaking. What is the likely diagnosis?
pick's disease (frontotemporal dementia)
* this is the only dementia that leads to personality change and aphasia
* easy way to remember: Pick is mean guy that he used his name for disease. He is socially messed up and can't even say word
48
What is physiologic mechanism regarding termination of barbiturates when used as anesthetics?
rapid redistribution to tissue and fat
49
Lewy body is composed of what? Lewy body can be seen in what two neuro diseases?
alpha-synuclein
- parkinson
- Lewy body dementia
50
Lewy body dementia: what is another noticeable phenotype except dementia?
visual hallucination
51
Which two drugs have increased risk for JC virus (thus PML, progressive multifocal leukoencephalopathy)?
- natalizumab
| - rituximab
52
What is target of natalizumab? what is its function?
alpha-4 integrin, which mediates WBC adhesion
by targeting alpha-4 integrin, WBC adhesion is reduced, thus inflammation mediated demylination in MS is reduced
=> this can induce JC virus infection / PML as it reduced WBC recruitment
53
Four Phenotypes of MS?
- spastic bladder
- intention tremor (dysmetria)
- optic neuritis, nystagmus and impaired horizontal gaze (INO)
- scanning speech: broken syllables with noticeable pause in between
* MS: young white female, who has speech with noticeable pause, whose eye motion is weird, who wants to pee all the time, and has dysmetria
* optic neuritis can present as
1. PAIN (THIS IS KEY) with ocular movements
2. sudden vision loss
54
Spinal tap finding in subarachnoid hemorrhage?
brown or yellow (xanthochromic) spinal tap due to break down of RBC (bleeding!)
55
What is first line for eclampsia seizure? second line?
first line is MgSO4, second line is BDZ
56
Retinitis pigmentosa- progressive vision loss during night driving. which cells are affected first?
rods
rods- night vision (less light), no color
cones- daytime vision (more light), color perception
57
Friedreich ataxia: which gene? which organelle is affected
Frataxin (iron binding protein), mitochondria
58
What is CT finding in VHL?
highly vascularized hamangioblastomas in brainstem, cerebellum, spine
* also RCC and Pheo
59
Effect of lumbar puncture on pseudomotor cerebri?
increased opening pressure and relief of headache
60
anterior communicating vs. posterior communicating: aneurysm leads to compression of what nerve?
anterior communicating: optic chiasm
posterior communicating: CN3
* note that this is mass effect by ANEURYSM, not stroke. these nerves don't necessarily get blood supply from these arteries
61
For each artery, which brain structure is mostly supplied? what are phenotypes of infarction?
- AICA
- PICA
- Anterior spinal
- Basilla
- AICA: lateral pons
=> facial nucleus -> facial droop
- PICA: lateral medulla
=> nucleus ambigus (CN9,10,11) -> hoarseness and dysphagia
- Anterior spinal: caudal medulla
=> hypoglossal nerve -> tongue deviation
- Basilar: lower midbrain, pons, medulla
=> locked in syndrome, only vertical gaze is intact
62
Adrenoleukodystrophy
- inheritance pattern
- what is defect and consequence of it
- X linked recessive
- defective metabolism of very long fatty acid chain
- > accumulation in CNS and adrenal gland
- > coma/death and adrenal crisis
63
What is myopia? hyperopia?
myopia: eyes too long, focus in front of retina
* myo-: muscular, eye is muscular so it is too long
hyperopia: eyes too short, focus behind retina
64
Underlying mechanism of neuronal death in Huntington?
NMDA receptor binding and glutamate excitotoxicity
65
Describe Wallerian degeneration after axonal injury
axonal degeneration DISTAL to site of injury
| -> followed by axonal regeneration (only if PNS, CNS does NOT have regeneration capacity)
66
fasiculation: defect in UMN? or LMN?
LMN
* It is kinda counterintuitive as fasiculation is sort of hyperactive continuous movement. but it is LMN
67
What is Werdnig-Hoffman disease?
- SYMMETRIC (vs. polio, which is asymmetric) loss of LMN function.
- Anterior horn defect
- "floppy baby" syndrome: tongue fasiculations and marked hypotonia
68
Huntington
- decreased neurotransmitters (2)
- increased neurotransmiter
- decreased: Ach, GABA
CAG has two meaning
- CAG repeats
- Caudate loss Ach and Gaba
- increased: dopamine (substantia nigra still intact)
69
Which inhaled anesthetic causes nephrotoxicity
methoxyflurane
70
Edinger-Westphal nuclei is involved in what signal? Lesion can cause what symptom?
visual signal connection between CN2 and CN3
CN2 -> pretectal nucleus -> EW nuclei (bilateral) -> CN3
* lesion in EW nuclei can cause ipsilateral mydriasis
71
upper body to lower body distribution in
- dorsal column (for DC/ML)
- spinothalmic tract
- corticospinal tract
- dorsal column (for DC/ML)
: medial- sacral (lower) to lateral- cervical (upper)
- spinothalmic tract
: lateral - sacral to medial- cervical
- corticospinal tract
: lateral- sacral to medial- cervical
* easy way to remember: for DC/ML remember that gracilis (lower part) is more medially located than cuneatus (upper). ALL OTHERS (spinothlamic, corticospinal) are OPPOSITE
72
which three proteins increase the risk for early-onset Alzheimer dementia?
APP, presenilin-1, presenilin-2
* don't confuse with ApoE2 and ApoE4, these tell about risk not onset
73
sonic hedgehog signaling defect: what is phenotype for each?
- mild form
- severe form
- mild form: cleft lip/palate
| - severe form: cyclopia (one eye)
74
Riluzole
- MOA
- indication
- decrease glutamate excitotoxcicity
| - ALS
75
Defect in what gene is associated with ALS?
superoxide dismutase 1
76
Apart from AFP, what another molecule in amniotic fluid analysis can be used to diagnose neural tube defect?
AchE
High level of acetylcholinesterase in AMNIOTIC FLUID also indicate neural tube defect
: fetal AchE flow out from spinal cord into amniotic fluid
77
What is effect of cerebral blood flow with inhaled anagelstics?
increased (metabolite is vasodilator)
78
What is Charcot-Marie-Tooth disease?
Autosomal Dominant dismylenating disease
Defective synthesis of proteins involved in structure and function of myelin sheath
Pes cavus (high arch foot, also seen in Friedreich ataxia) and peripheral weakness
vs. Friedreich ataxia: no signs of diabetes, HCM, gait issue
79
Apart from seizure, Gabapentin can be used in what two other conditions?
- peripheral neuropathy
| - postHERPIC neuralgia (like after shingles)
80
Entacapone and tolacapone prevent L-DOPA degradation to which molecule?
3-O-Methyldopa by inhibiting COMT
* cOMt sound similar with 3OMethyldopa
81
Treatment option for essential tremor?
propanolol
82
Hemiballismus is lesion of what part of brain?
contralateral subthalamic nucleus
83
vagus mediates what tongue muscle? what motor function?
vagus mediates palatoglossus, which elevates posterior tongue during swallowing
* major tongue motor is hypoglossal
84
How different parts of tongue mediates taste sensation?
taste sensation: nucleus solitarius ( CN7 .9. 10)
- anterior 2/3: facial
- posterior 1/3: glossopharyngeal
- extreme posterior: vagus
85
phenotypes of tuberous sclerosis
*HAMARTOMAS
```
Harmatoma
Ash-leaf skin sign (hypopigmented skin lesions)
Mitral regurgitation
Angiofibroma
Rhabadomyoma
Tuberous sclerosis
O- autosomal dOminant
Mental retardation
renal Angiomyolipoma
Seizure
```
86
A pt with a Bell palsy has hyperacusis (heightened sensitivity to sound). What is causing this phenomenon?
CN7 also mediates stapedius, which tones down sound to modulate sound volume
87
Which CNS tumor can cause secondary polycythemia?
hemangioblastoma: EPO production
HEMAngioblastoma, HEMatologic
88
Neurofibroma is derived from what embryological origin?
neurofibroma is derived from Schwann cell.
| so neural crest cell is embryological origin
89
Renal angiomyolipoma is associated with?
tuberous sclerosis
one of A in HARMARTOMAS
other two As: angiofibroma, ash-leaf skin sign
90
Characteristic imaging finding in Dandy-Walker syndrome?
CYSTIC enlargement of 4th ventricle due to vermis agenesis
91
three phenotypes of normal pressure hydrocephalus (NPH) is wet, wobbly, wacky. What is wacky? what about rest?
cognitive dysfunction
- wobbly: magnetic gait
- wet: urinary incontinence
92
How to treat normal pressure hydrocephalus (NPH)?
VP shunt
| ventriculoperitoneal shunt
93
Which brain region is responsible for norepinephrine synthesis?
locus ceruleus, right posterior rostral pons near 4th ventricle
94
causes, symptoms and treatment for
- serotonin syndrome
- malignant hyper
- neuroleptic malignant syndrome
- serotonin syndrome
* SSRI, TCA, ondansetron
* autonomic instability (diphoresis, palpitation), hyperthermia, CLONUS
* treated with cyproheptadine
- malignant hyperthermia
* inhaled analgestics, succinylcholine
* severe muscle CONTRACTION (vs. rigidity in NMS) and hyperthermia
* treated with dantrolene
- neuroleptic malignant syndrome
* caused by typical antipsychotics
* RIGIDITY, myoglobinuria, hyperthermia
* treated with dantrolene
95
head becomes enlarging after meningitis. What is happening?
meningitis
- > arachnoid scarring blocks CSF absorption at arachnoid granulation
- > communicating hydrocephalus
96
Which muscle mediates opening of jaw?
lateral pteryogoid
Lateral- Lower the jaw
97
Which three muscles mediate closing of jaw
Medial pterygoid
Masseter
teMporalis
closing jaw = Munching
98
bony landmark for lumbar puncture? what lumbar vertebral level?
iliac crest
| between L3-L4 or L4-L5
99
first line for prophylaxis of status epilepticus?
phenytoin
100
Kluver-Bucy syndrome
- phenotypes
- lesion in which brain structure?
- associated infection?
- hypersexuality, hyperorality (putting everything in mouth), hyperphagia (excessive hunger)
- amygdala
- associated with HSV-1 encephalopathy
101
Tramadol
- MOA
- indication
- side effects
- weak opioid agonist, inhibits uptake of 5HT and NE (like SSRI or SNRI)
: has all function= tram it all!
- chronic pain (ex: fibromyalgia)
- serotonin syndrome, opioid effects
102
A man stands on his right leg for a yoga pose. How does the cerebellum receive input about his proprioception to maintain this stance?
Right DC/ML ( proprioception)
| -> Right inferior cerebella peduncle -> Right cerebellum
103
gag reflex: sensory and motor?
sensory: CN 9
motor: CN 10
104
progressive multifocal leukoencephalopathy (PML) involves damage to what CNS cell?
oligodendrocyte
105
Two possible treatments for Guillain-Barré?
IVIG
plasmapheresis
* this makes sense: Guillain-Barré is ANTIBODY mediated demyelination.
* NO role for steroid
106
propofol
- MOA
- indication
- potentiates GABA-A
| - short procedure, rapid indcution
107
NF1 and NF2 gene on what chromosome? Each encodes what protein? Inheritance pattern for each?
NF1: 17, neurofibromin
NF2: 22, merlin
BOTH are AUTOSOMAL DOMINANT
108
A father has café-au-lait spots and neurofibromas; his son has a pheochromocytoma and an optic glioma. Explain this variation in NF1 in genetic terms
NF1 has 100% penetrance with variable expression
(variable expressivity)
vs. pleiotropy, where one gene gives multiple phenotypes (ex: PKU)
109
Which local anesthetic may cause methemoglobinemia as a side effect?
benzocaine
110
A pt presents with vertical gaze palsy, obstructive hydrocephalus, and precocious puberty. Diagnosis? Where is the lesion?
Parinaud syndrome
pineal gland tumor
* precocious is due to excess beta-hCG production
* pretty much buzzword is VERTICAL GAZE PALSY
111
Where is area postrema is located?
medulla
* area postrema does not have BBB
112
melatonin is secreted from where? what is function of melatonin?
pineal gland
circadian rhythm control
* suprichiasmatic nucleus (hypothalamus) -> NE release -> pineal gland -> melatonin
113
What tells severity of dementia in Alzheimer disease?
neurofibrillary tangles: intracellular hyperphosphorylated tau protein
* hyperphosphorylated tau protein is also seen in Pick's disease, but Pick's body is round, while AD shows tangle
114
Which antiepileptic drug manifests kidney symptom as side effect?
topiramate can cause kidney stone
* remember sketchy: kidney shaped cannon next to skinny guy (topiramate also causes weight loss)
115
Which antiepileptic drug can be used to treat bipolar disorder?
valproic acid
biPOlar, valPOric
116
Which CN is most commonly affected in cavernous sinus syndrome?
CN6
| * think how each CNs are lined up in cavernous sinus
117
What is cholesteatoma?
desquamated keratin debris within middle ear space, resulting in conductive hearing loss
* it sounds like some GI stuff, but it is ear shit
118
café-au-lait spot: what three possible diseases? give other features of each
- NF1: neurofibromas, Lisch nodules, pheocytochroma
- McCune-Albright: precocious puberty, fibrous dysplasia on bone
- Fanconi anemia: radial/thumb deviation, short stature
* café-au-lait spot is one or several big single dot (s)
(vs. Leser-Trélat sign, serraboric keratosis with multiple spots)
119
Which CNS tumor shows fried egg appearance in histology?
oligodendroglioma
* OligOdendrOgliOma: many Os like eggs
120
Damage to optic nerve can leads to damage in what two other structures?
retinal artery and vein
* both run INSIDE optic nerve
121
What part of nerve is damaged by Guillain Barré?
inflammatory infiltrates in Endoneurium
* Remember Guillain Barré as polymyositis of neuron
122
Name of two AchE inhibitors for Alzheimer drugs? What another class of drug can be used? MOA of this drug?
- Galantamine and Donepezil
* sketchy: Gala is Done
-memantine: NMDA antagonist, prevents excitotoxicity (mediated by Ca2+)
123
What is molecular mechanism of opioid?
close Ca2+ and open K+ channel
-> prevents neurotransmitter release and prolongs hyperpolarization
124
Which brain structure is most susceptible to damage by ischemic hypoxia?
hippocampus
* HYPOxia, HYPOcampus
125
Locked in syndrome
- symptom
- which brain part is messed up
- infarct in which artery
- what associated condition?
- complete paralysis except vertical gaze
- pontine
- basilar artery (locked in basement)
- osmotic demyelination syndrome due to rapid correction of hyponatremic state
126
Where in the brain is serotonin synthesized
Raphe nucleus
127
Butorphanol
- MOA
- indication
- side effect
- k-opioid receptor and partial u-opioid receptor agonist
- indicated for severe pain
- withdrawal effect when taking with full opioid agonist (by competitively binding to receptor and partially working)
128
How is ICP in hydrocephalus ex vacuo?
normal ICP
| ventricles only enlarges to the same volume of atrophy. It doesn't extend beyond it, resulting in normal ICP
129
Direct vs. indirect basal ganglia pathway: bottom line? What is the one big thing I need to remember?
Direct -> decrease Gi -> increase thalamus/activity
Indirect -> increase Gi -> decrease thalamus/activity
dopamine -> stimulate direct and inhibit indirect
-> increase activity
130
Embryological origin of PNS? What about CNS?
PNS: Schwann cells. So neural crest
CNS: neural ectoderm
131
What are two lysosomal diseases that cause demyelination? which enzyme deficiency? what is accumulating?
- Krabbe disease: galactocerebrosidase is missing. Accumulation of galactocerebroside mediates demyelination
- Metachromatic leukodystrophy: arylsufase A is missing. Accumulation of sulfide mediates demyelination
132
Local anesthetics: list order that gets blocked faster
- small myelinated
- large myelinated
- small unmyelinated
- large unmyelinated
small myelinated > small unmyelinated > large myelinated > large unmyelinated
* size predominated over myelination: easy to get smaller one knock down
* myelinated nerves has more Na+ -> more target so faster knock down
* local anesthetics target Na+ channel
133
Manifestation of Horner syndrome is only seen in lesion above what vertebrae?
lesion above T1
T1 is the first synapse of sympathetic neuron. Second neuron then travels back up. So any lesion below T1 will not show symptoms
134
visual tract: Meyer loop vs. dorsal optic radiation
- where each tract project to?
- Right side lesion of each leads to what visual defect?
- Dorsal optic radiation: parietal lobe
=> Right side lesion: left side lower visual defect
- Meyer loop: temporal lobe
=> Right side lesion: left side upper visual defect
* lateral geniculate nucleus (LGN) is the branching point where Meyer loop and dorsal optic radiation branches off from optic tract
135
From which part of brain is GABA synthesized?
nucleus accumbens
136
Name the cranial nerve (CN) that innervates the parotid gland
glossopharyngeal
* remember BOTH CN7 and CN9 can do salivation
CN7-submandibular and sublingual gland
CN9- parotid gland
137
Define resting tremor
uncontrolled movement of distal appendages (mostly hands). tremor RELIEVED BY intentional movement
classic example is pill-rolling tremor in Parkinson's
138
First line for focal (partial) epilepsy?
Carbamazepine
139
How does Creutzfeldt-Jakob disease present?
RAPIDLY progressing dementia with MYOCLONUS (startle myoclonus)
140
From which artery does vertebral artery arise?
subclavian
141
Which CN is involved in phonation (talking)?
vagus
=> recurrent laryngeal is branched off from vagus
* glossopharangeal is for slowing and elevation of larynx/pharynx, but not talking
142
A pt has a Weber test finding localized to the left and
| air > bone conduction bilaterally. What type of hearing loss is this?
Sensorineural hearing loss on right
* Weber:
- sensorineural hearing defect: localizes to unaffected side
- conductive defect: localizes to affected side
* Rinnie
- Can't detect sensorineural hearing defect
- conductive defect: bone>air at affected side
* Weber alone can't not tell disease. Rinnie needs to be done together.
143
What is Parinaud syndrome?
paralysis of vertical gaze due to pinealoma
vertical gaze is impaired due to lesion in superior colliculi
144
opioid receptors: which molecules bind and what is function of each
- u
- delta
- k
- u: beta-endorphin => CNS, respiratory depression, constipation, dependence
- delta: enkephalin => anti-depressant
- k: dynorphin => meiosis
145
Where in the brain is acetylcholine synthesized?
basal nucleus of Meynert
146
Dandy-Walker malformation. What are two other associated malformations
- spina bifida occulta
| - hydrocephalus
147
Which symptoms of schizophrenia are most refractory to antipsychotics?
negative symptoms, which are mediated by mesocortical dopaminergic pathway
* mesoCortical, neCative
148
A pt with carotid artery dissection only has an issue with lower facial sweating. Where is the dissection most likely found?
EXTERNAL carotid artery, which only carries sympathetic fibers that innervate sweat glands of the lower face
* other sympathetic outlets (pupillary dilator, eyelid, forehead sweat gland) pass through INTERNAL carotid
149
What is function of intermediate lateral horn of spinal cord?
it carries sympathetic neuron
| only presents in T1-L2/L3 (thus intermediate)
150
Which cranial nerve(s) mediate(s) the sense of pain in the tongue?
V3, 9, 10
taste is 7, 9, 10 (solitary nucleus).
For pain sensation, mandibular trigeminal is replaced to facial. This also applies to area that each nerve covers
V3 and facial: 2/3 of tongue
V9: posterior 1/3
V10: extreme posterior (supraglottic)
151
How is convergence affected in INO?
normla convergence
152
Spina bifida occulta: how AFP level look like?
Normal
| * the meninges closed over the spinal cord within the canal, thus cutting off the spinal canal from the amniotic fluid
153
Effect on brain due to rapid correction of
- hypernatremia
- hyponatremia
- hypernatremia: cerebral edema and herniation
| - hyponatremia: pons die -> locked in syndrome due to osmotic demyelination
154
Which inhaled anesthetics can cause seizure (proconvulsant)?
enflurane
155
What is intention tremor?
dysmetria
| : zigzag motion when pointing toward target
156
bilateral leg paralysis, areflexia, and pain/temperature loss from T4 down. Vibration sensation is intact. Diagnosis?
Occlusion of the anterior spinal artery at the T2 level, sparing the dorsal columns because they are supplied by the posterior spinal artery
157
Lesion on which brain structure results in anterograde amnesia (learning)
hippocampus
* hippos are dumb, they cant learn.
158
Two cranial nerves (CNs) that are involved in swallowing?
CN 9 and CN 10
159
What are cutoff values for pO2 and pCO2 for noticeable change in cerebral blood flow
- pO2: no change in CBF until pO2 < 50. With pO2 <50, CBF increases
* makes sense- it is CO2 that CNS normally responds, but with really low pO2, more blood needs to flow in brain
- pCO2: proportional increase in CBF until pCO2 reaches 90. with pCO2 >90, CBF plateau
* CNS primarily responds to pCO2 (peripheral is pO2), but as pCO2 gets too high, brain is overloaded
***NOTE: do not get confused CBF with CPP. Y-axis of the graph is CEREBRAL BLOOD FLOW, not cerebral perfusion pressure. CPP actually goes opposite trend as CPP= MAP-ICP.
With more CBF, ICP goes up=> less CPP
160
Referred pain to RIGHT shoulder by phrenic nerve may indicate what two origins of pain?
- diaphragm
| - gallbladder
161
What is effect of inhaled anesthetics on
- renal blood flow
- hepatic blood flow
- cerebral blood flow
- cerebral cerebral metabolic demand
- decreased renal blood flow
- decreased hepatic blood flow
- increased cerebral blood flow
- decreased cerebral metabolic demand
* think in this way: anesthetics is knocking out brain. It only cares about brain. So by increasing blood flow only to brain, it can knock it out (decreased cerebral metabolic demand)
162
Spontaneous intracerebral hemorrhage due to uncontrolled hypertension most commonly involves which artery?
lenticulostriate artery
-> lacunar infarct involving basal ganglia or deep brain structures
* think like this: lenticulostriate is tiny vessel: easy to get ruptured due to HTN!
* this is UWORLD question
163
Histologic finding of craniopharyngioma?
- cholesterol cyst
| - dystrophic calcification around cyst
164
Which drug is choice for reducing spastic symptoms in MS?
baclofen
165
What is phenotype for damage to internal capsule?
UMN symptoms
166
Internal capsule infarction
- which artery?
- what is underlying cause?
- lenticulostriate artery
- uncontrolled hypertension
* basal ganglia is also common site of infarction
167
Three prophylatic agents for migraine?
- beta blocker
- CCB (amitriptyline)
- valproic acid
* bottom line: vasoconstriction -> less cerebral blood flow
- > decrease ICP
* sumatriptan is used for onset of migraine, NOT PROPHYLAXIS
168
Function of
- intrafusal muscle
- golgi tendon organ (GTO)
- Intrafusal muscle: detects static and dynamic changes in muscle length
- GTO: detects muscle tnesion
169
Two psychological symptoms in Huntington?
depression
aggression
* think patient who has corhea, depressed and angry
170
What is key difference between focal vs. generalized seizure? what are subtypes for each?
- Focal (Partial) : ONE HEMISPHERE
simple- no loss of consciousness
complex- loss of consciousness
- Generalized: BOTH SIDES OF HEMISPHERES
myoclonic-quick jerks
tonic- sustained contraction, stiffening
tonic clonic- rhythmatic alterations between stiffening and quick jerks
* In question, few things to check
- both sides? or one side?
(ie. only one side of body? or both sides of body?)
- lost consciousness?
- type of movement? => sustained contraction? jerky?
- repetitive? long duration? => status epilepticus
171
Define hemiballisums. Lesion in what brain structure?
sudden, WILD FLAILING (THROWING OBJECTS) movements of ONE arm
+/- ipsilateral leg: leg involvement is NOT NECESSARY
subthalmic nucleus
172
Compare similarities and difference between Charcot-Bouchard microaneurysm vs. lacunar infarct
BOTH result from long standing HTN
BOTH involve microvessels (lenticulostriate)
BOTH cause damage to deep brain structures
Difference
- Charcot-Bouchard: Hemorrhagic infarct, early detection in CT possible due to relatively bigger size of lesion
- lacunar infarct: Ischemic infarct, early detection may not be possible by CT due to small size of lesion (<1cm)
173
Where is GABA synthesized?
nucleus accumbens
174
Patient reports "flashes and floaters". monocular loss of vision like "curtain drawn down". What does this classical phrase mean?
Retinal detachment
*sudden mononuclear loss of vision like "curtain drawn down" can also happen in TRANSIENT ISCHEMIC ATTACK. But fundoscope will be NORMAL in this case.
175
Broca vs. Wernike: where exactly are they located in brain? right or left? what lobe?
Broca: LEFT inferior FRONTAL
Wernike: LEFT superior TEMPORAL
176
What is Korsakoff amnesia?
anterograde anemia: learning new memory
consequence of Wernicke-Korsakoff syndrome
177
Apart from bilateral schwannoma, what are three other presentations in NF2?
- juvenile cataracts
- meningoma
- ependymoma
178
Autoantibodies in Guillain-Barre targets what?
Schwann cells and peripheral myelin
* PERIPHERAL, NOT CNS
179
Which inhaled anesthetics is proconvulsant (seizure)?
enflurane
180
cerebrocerebellum: which part of cerebellum? Destruction of it results in what phenotype?
lateral part
=> fine movement of hands
- lesion in cerebrocerebellum result in dysdiadochokinesis
* cerebro-: close contact with cerebrum: lateral hemisphere
181
spinocerebellum: which part of cerebellum? Destruction of it results in what phenotype?
vermis
=> truncal ataxia
*spino-: like spine in the center: vermis
182
normal pressure hydrocephalus is under what category of hydrocephalus? (communicating? non-communicating? hydrocephalus ex-vacuo?)
communicating
183
post-meningitis: what kind of hydrocephalus?
communicating
* this makes sense: menigies are closely intact with arachnoid granulations
184
For which type of headache is 100% oxygen is indicated?
cluster
* I don't know why, but think like this: cluster is super intense headache that needs pure oxygen to clear headache
185
Chlordiazepoxide: what drug class is this?
BDZ
| chlorodiazepoxide is the only one drug that does not go with -pam or -zolam suffix
186
What neurotransmitter is increased during REM sleep?
Ach
187
How to treat Wernicke-Korsakoff syndrome?
IV fluid + vitamin B1
188
What medication is indicated for CHRONIC PAIN in tension headache?
amitryptyline (TCA)
* for acute pain control, NSAIDs are indicated. For CHRONIC pain, amitryptyline is indicated
189
Apart from sumatriptan and NSAIDs, what another medication is indicated for acute pain control of migraine? MOA? contraindication?
dihydroergotamine
: partial alpha agonist + serotonic receptor agonist
may cause vasospasm, contraindicated in angina
