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Neurology Flashcards

1
Q

Which cervical nerve: shoulder/scapula elevation

A

C4

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2
Q

Which cervical nerve: shoulder abduction

A

C5

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3
Q

Which cervical nerve: elbow flexion, wrist extension

A

C5,C6

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4
Q

Which cervical nerve: elbow extension, finger extension

A

C7

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5
Q

Which cervical nerve controls biceps reflex?

A

C5, C6 (radial nerve)

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6
Q

Which cervical nerve controls triceps reflex?

A

C7,C8

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7
Q

Which nerve innervates anterior scrotum (labia majora in women); base of penis (mons pubis); medial thigh?

A

illioinguinal nerve

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8
Q

Which CN originates in medulla, exits via jugular foramen and has both Somatic/motor functions?

A

CN IX glossopharyngeal

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9
Q

A pure hemisensory stroke most likely occured in which brain region?

A

thalamus

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10
Q

Which CN nerve controls taste in posterior 1/3 of tongue?

A

CN IX glossopharyngeal

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11
Q

What is it called when LFCN lateral femoral cuntaneous nerve from L2 to L3 goes under inguinal ligament and pt. has lateral thigh paresthesia

A

meralgia paresthetica

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12
Q

What is the use of therapeutic hypothermia (33-35 deg. C/92-95 deg F)?

A

decrease formation of ROS; lower ICP, reduce excitatory neurotransmitters; down inflammation and apoptosis; blocks TNF and caspase pathways

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13
Q

sciatic nerve controls which flexor

A

knee flexion

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14
Q

Which nerve controls dorsiflexion and eversion of foot?

A

common fibular nerve

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15
Q

Which nerve controls lateral calf and dorsal foot sensory?

A

common fibular nerve

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16
Q

Which nerve controls plantar flexion and inversion of foot?

A

tibial nerve

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17
Q

Which nerve controls plantar surface sensation and Achilles reflex?

A

Tibial nerve

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18
Q

What peptide is involved in migraine headaches?

A

CGRP calcitonin gene related peptide

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19
Q

Which medicine can block CGRP calcitonin gene related peptide release in migraine headaches?

A

triptans

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20
Q

What is the MOA of erenumab migraine med?

A

antibody to CGRP (calcitonin gene related peptide)

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21
Q

What is the syndrome called of a dominant parietal lobe lesion that causes finger agnosia, agraphia, acalculia, and left-right dissociation?

A

Gerstmann Syndrome

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22
Q

Which neurological problem can long term B12 deficiency lead to?

A

Subacute combined degeneration

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23
Q

What areas of the brain are affected in subacute combined degeneration?

A

dorsal column, spinocerebellar tract, lateral corticospinal tract (spastic paresis)

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24
Q

Signs of Subacute combined degeneration

A

loss of position and vibration/ +Romberg/ spastic paresis

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25
Q

ToRCHS

A

Toxoplasmosis
Rubella
Cytomegalovirus
HSV
Syphilis

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26
Q

Which neonatal ToRCHS presents with cataracts, heart defects, sensorineural hearing defects

A

Rubella

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27
Q

Which ToRCHS presents with chorioretinitis, hydroencephalus, and diffuse intracranial calcifications

A

Toxoplasmosis

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28
Q

Which ToRCHS presents with microencephaly, paraventricular calcification

A

CMV

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29
Q

Which ToRCHS presents with rhinorrhea, skeletal anomalies, rash

A

Syphilis

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30
Q

MOA of Phenytoin and Carbamazepine

A

Na channel blockers

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31
Q

MOA Valproic Acid

A

Na channel blocker, increase GABA

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32
Q

MOA Benzodiazepine and phenobarbital

A

increase GABA (benzo by activating Cl channel frequency and phenobarbital by activating Cl channel duration

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33
Q

Good med for SAH

A

nimodipine (CCB) up cerebral vasodilation; down Ca excitotoxicity

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34
Q

Most primary tumors in adults are supratentorial or below tentorium?

A

Supratentorial

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35
Q

Most primary CNS tumors in children are supratentorial or below tentorium?

A

below tentorium

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36
Q

Which CNS tumors are GFAP+ (glial fibrillary acidic protein)?

A

astrocytomas including glioblastoma multifome, oligodendroglioma, ependymomas and peripheral neural sheath tumors

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37
Q

Which neuro marker is found in presynaptic vesicles of neurons, neuroendocrine and neuroectodermal cells?

A

synaptophysin

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38
Q

What nerve controls motor function of tongue?

A

CN XII (except for palantoglussus nerve which is innervated by CN V)

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39
Q

What nerve controls sensory function of tongue’s anterior 2/3?

A

mandibular branch of CN V

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40
Q

What nerve controls sensory function of tongue’s posterior 1/3?

A

CN IX

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41
Q

What nerve controls posterior area of tongue root?

A

CN X

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42
Q

What nerve controls anterior 2/3 taste?

A

chorda tympani of facial nerve CN VII

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43
Q

What nerve controls posterior 1/3 taste?

A

CN IX

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44
Q

What will you find on biopsy 12-24 hours after ischemic stroke?

A

red neurons, eosinophilic cytoplasm, pyknotic nuclei, loss of Nissl substance of RER

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45
Q

What will you find on biopsy 24-72 hours after ischemic stroke?

A

neutrophic infiltration

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46
Q

What will you find on biopsy 3-7 days after ischemic stroke?

A

macrophage (microglia) phagocytosis

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47
Q

What will you find on biopsy 1-2 weeks after ischemic stroke?

A

gliosis and vascular proliferation (liquefactive necrosis 1 week to 1 month)

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48
Q

What will you find on biopsy more than 2 weeks after ischemic stroke?

A

glial scar

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49
Q

Which lobe of the brain controls personality, language, motor function and executive function?

A

frontal

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50
Q

proteins from neuronal microtubules become hyperphosphorylated and dissociate from microtubules to form paired helical filaments called….

A

tau proteins (neurofibrillary tangles) of Alzheimer’s

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51
Q

Name 5 folate antagonists used as meds (one for humans, one for bacteria, one for protozoa; one for IBD, one for diuresis)

A

Methotrexate (RA/Cancer); Trimethoprim (PCP); Pyramethamine (protozoa); Sulfasalazine (RA/IBD); Triamterene (with HTCZ, diuretic for edema/HTN)

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52
Q

In which disease is there a depletion of hypocretin 1 (orexin A) which are secretory neurons of lateral hypothalamus that maintain wakefulness? What is the treatment?

A

narcolepsy; TX: modafinil /amphetamines

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53
Q

During uncal herniation if the ipsilateral CNIII is affected, what are the signs?

A

ipsilateral fixed and dilated pupil; if continues there will be paralysis of CNIII= ptosis and down and out gaze

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54
Q

During uncal herniation if posterior communicating artery is compressed, what are the signs?

A

contralateral homonymous hemianopia with macular sparing

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55
Q

During uncal herniation if cerebral peduncle is compressed what are the signs?

A

contralateral hemiparesis; if continued pressure, it will rupture basilar artery (fatal)

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56
Q

Which virus could cause meningitis with lower limb flaccidness, fever, mibilliform rash on back and chest; parkinsonism?

A

West Nile Virus (south, southwest US)

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57
Q

Which kind of meningitis can we see thick, gelatinous exudate at basal portion of brain causing CN palsy, ventriculomegaly, multiple infarcts?

A

TB meningitis (esp. in HIV and immunocompromised)

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58
Q

most commonly tested progressive cystic neuro disease of putamen

A

Wilson’s

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59
Q

Which problem consists of sensory ataxia (+Romberg), lancinating pains, neuro urinary incontinence, and Argyl-Robertson pupils?

A

Tabes Dorsalis (Tertiary syphilis)

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60
Q

Which problem comes from abrupt acceleration/deceleration causing immediate shearing of white matter tracts which could cause accumulation of alpha synuclein and amyloid precursor proteins?

A

Diffuse Axonal Injury (traumatic brain injury)

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61
Q

Which proteins are associated with early onset familial Alzheimer’s?

A
  1. Amyloid precursor protein (APP) on Ch. 21
  2. Presenilin 1 gene on Ch. 14
  3. Presenilin 2 gene on Ch. 1
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62
Q

Which protein is associated with late onset (after 60) familial Alzheimer’s?

A

epsilon 4 allele of Apolipoprotein E (causing formation of senile plaques)

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63
Q

Very long chained fatty acids (VLCFA) and Branched chain fatty acids cannot go to mitochondria for beta oxidation, to which organelle must they go?

A

Peroxisome VLCFA beta ox.; branched chain, alpha ox

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64
Q

Which disease has defective peroxisomes, craniofacial abnormalities, hepatomegaly, hypotonia, and seizures?

A

Zellweger

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65
Q

Which disease is there defective transport of VLCFA to peroxisome causing neuro degeneration and adrenal insufficiency?

A

X-linked adrenoleukodystrophy

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66
Q

Which organelle: protein sorting and transport

A

Golgi apparatus

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67
Q

Which organelle: digestion of debris and pathogens

A

lysosomes

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68
Q

Which organelle: TCA cycle; fatty acid oxidation, ETC, apoptosis

A

mitochondria

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69
Q

Which organelle: oxidation of VLCFA and H2O2 degradation

A

peroxisomes

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70
Q

Which organelle: degradation of ubiquitinated proteins?

A

proteasomes

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71
Q

Which organelle: synthesis of membranous and secretory proteins?

A

RER

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72
Q

Which organelle: drug detox, lipid/phospholipid sythesis; steroid synthesis

A

SER

73
Q

Which analgesics have mu, delta, kappa and are coupled with G inhibitor proteins?

A

opiate analgesics

74
Q

MOA opiate analgesics

A

close voltage gated Ca channels, reduce Ca influx, decrease neurotransmitter release (Ach, NE, Serotonin, glutamate, substance P) from presynaptic cleft; and at the post synaptic cleft open K channels and make hyperpolarized

75
Q

Which neuromuscular blocking agents are competitive antagonists of nicotinic Ach receptors?

A

vecuronium, rocuronium

76
Q

In which patients are vecuronium and rocuronium contraindicated?

A

myasthenia gravis pts. because they have few receptors and vecuronium/rocuronium will lead to paralysis with loss of airway patency

77
Q

Name some abortive migraine therapies

A

triptans, NSAIDS, antiemetics, ergotamine

78
Q

Name some preventative migraine therapies

A

topiramate/valproate (anticonvulsives); B blockers, TCA or venlafaxine (antidepressants)

79
Q

Wallenberg syndrome usually involves which artery?

A

Posterior inferior cerebral artery PICA from vestibular artery

80
Q

In Wallenberg’s: what does lesion of inferior cerebellar penduncle cause?

A

ataxia

81
Q

In Wallenberg’s: what does lesion of vestibular nucleus cause?

A

vertigo, diplopia, nystagmus, vomiting

82
Q

In Wallenberg’s: what does lesion of spinal trigeminal nucleus cause?

A

ipsilateral facial pain and temp. sensation loss

83
Q

In Wallenberg’s: what does the lesion of nuclear ambiguus cause?

A

diminished gag reflex

84
Q

In Wallenberg’s: what does lesion of spinothalmic tract cause?

A

contralateral loss of trunk and extremity pain and temperature sensation

85
Q

+ Romberg’s defect in which nerves (central or peripheral) and what could cause + Romberg’s

A

peripheral nerve defect: tabes dorsalis, posterior column defect, or B12 deficiency

86
Q
  • Romberg’s associated with which kind of ataxia
A

cerebellar ataxia

87
Q

Which kind of diagnostic tests could you use for cerebellar ataxia?

A

rapid alternating movements; finger to nose; heel to shin

88
Q

Which problem is seen with ptosis, inability to smile or frown, disappearance of nasolabial fold, decreased tearing, and possible hyperacusis and/or loss of taste in ant. 2/3 tongue? Which CN?

A

Bell’s palsy, CN VII

89
Q

With inhaled anesthesia is there more or less perfusion to the brain? What effect does that have? What effect to other organs?

A

more perfusion to brain causing increase in intercranial pressure; decreased blood flow to other organs

90
Q

How does N. Fowleri enter the body and what are some treatments?

A

enters through the nose (warm, fresh water); Tx: dexamethasone, amphotericin B, azithromycin, fluconazole, rifampin, miltefosine

91
Q

Which selective muscarinic antagonists can be used to reduce SE of cholinesterase inhibitors (diarrhea, nausea, sweating, abdominal cramp)

A

Glycopyrrolate or Hyoscyamine

92
Q

MC cause of Phenylketonuria

A

phenylalanine hydroxylase deficiency

93
Q

another cause of phenylketonuria

A

BH4 (dihydropteridine ) reductase deficiency : phenylalanine increased; serotonin decreased TX: low PHE diet and BH4 supplements

94
Q

decerebrate and decorticate postures are caused by lesions in which brain area

A

pons and red nucleus

95
Q

cause of Fragile X

A

hypermethalation on long arm of X chromosome causes inactivaton of FMR1 (Fragile X mental retardation 1) gene

96
Q

Diabetic neuropathy: what kind of symptoms do lesions on small fibers cause?

A

positive symptoms (pain, paresthesia, allodynia which is pain out of proportion)

97
Q

Diabetic neuropathy: what kind of symptoms do lesions on large fibers cause?

A

numbness, loss of proprioception and vibrational sense, + Romberg

98
Q

What is CIM (critical illness myopathy)

A

decrease muscle membrane excitability and loss of myosin (atrophy of myofiber) after critical illness

99
Q

What is CIP (critical illness polyneuropathy)

A

decreased nerve excitablitiy, axonal degeneration (injured by inflammatory mediators)

100
Q

What area of the brain does anterior cerebral artery cover?

A

inferior frontal, medial frontal, superior medial parietal, anterior 4/5 corpus callosum, olfactory bulb, anterior basal ganglia, and internal capsule

101
Q

What area of brain does MCA cover?

A

temporal lobe, deep subcortical structure like internal capsule and basal ganglia,

102
Q

What area of brain does basilar artery cover?

A

brainstem and bilateral cerebellar hemispheres

103
Q

What area of brain does the artery of Percheron cover?

A

It is a branch of PCA that supplies bilateral thalamic and dorsal midbrain

104
Q

What area of brain does anterior choroidal artery cover?

A

final branch of internal carotid that supplies posterior limb of internal capsule, optic tract, lateral geniculate; choroid plexus, hippocampus, amygdala

105
Q

What are the clinical presentation of ALS (amyotrophic lateral sclerosis) and current treatment and treatment’s MOA?

A

LMN symptoms: muscle weakness, atrophy, fasciculations
UMN symptoms: spasticity, hyperreflexia, and pathological reflex
Tx; riluzole (think riLOUzole for Lou-Gherig) MOA decrease glutamate release

106
Q

Innermost layer of connective tissue that surrounds nerve axon which is affected in Guillain Barre

A

endoneurium

107
Q

Which part of hypothalamus controls satiety?

A

ventromedial

108
Q

Which part of hypothalamus controls hunger?

A

lateral

109
Q

Which part of hypothalamus mediate heat dissipation?

A

anterior

110
Q

Which part of hypothalamus mediates heat conservation?

A

posterior

111
Q

Which part of hypothalamus secretes dopamine and GHRH ?

A

arcuate

112
Q

Which part of hypothalamus secretes GnRH and regulates sexual behavior?

A

medial preoptic

113
Q

Which part of hypothalamus secretes oxytocin, CRH, TRH and small amounts of ADH

A

paraventricular

114
Q

Which part of hypothalamus secretes ADH and small amount of oxytocin

A

supraoptic

115
Q

Which part of hypothalamus regulates circadian rhythm and pineal gland function

A

suprachiasmatic

116
Q

L2-L4 radiculopathy weakness

A

hip flexion (iliopsoas); hip adduction; knee extension (quadriceps) ; affected patellar reflex

117
Q

L5 radiculopathy weakness

A

foot dorsiflexion and inversion (tibalis anterior)
foot eversion (peronius)
toe extension (extensor hallucis and digitorium)

118
Q

S1 radiculopathy weakness

A

hip extension (gluteus maximus)
foot plantarflexion (gastrocnemius); affected Achilles reflex

119
Q

S2-S4

A

affected anocutaneous (wink); urinary or fecal incontinence; sexual dysfunction

120
Q

What kind of brain herniation occurs under the cingulate gyrus and what are the signs?

A

subfalcine: contralateral leg weakness (ipsilateral ACA compression)

121
Q

What kind of brain herniation happens when medial temporal lobe herniates under tentorium cerebelli and its signs?

A

uncal herniation: ipsilateral dilated and fixed pupil; early contralateral hemiparesis due to ipsilateral cerebral peduncle compression; late ipsilateral hemiparesis due to contralateral cerebral peduncle compression

122
Q

What kind of herniation involves caudal displacement of diencephalon and brainstem and what are the signs?

A

central herniation: bilateral midposition and fixed pupils (loss of sympathetic and parasympathetic innervation); decerebrate or decorticate posturing (involves red nucleus); later rupture of basilar artery branches and death

123
Q

Which nerve controls hip flexion, knee extension and sensation in anterior thigh

A

femoral nerve

124
Q

Which nerve controls sensory in medial leg and foot?

A

saphenous

125
Q

two dopa agonists used in Parkinson’s

A

Bromocriptine and Pramipexole

126
Q

What is TDP43?

A

transactive response DNA binding protein43: protein that normally transmitter inhibitor or helps in DNA repair but abnormal ubiquitination leads to immunoreactive inclusions; plays a role in frontal lobar dementia and ALS

127
Q

What is it called when you have mutation of BCHE gene and are unable to metabolize succinylcholine (have paralysis for hours)?

A

pseudocholinesterase deficiency (AR)

128
Q

Which microaneurysms occur at the basal ganglia, cerebellum, thalamus, pons, are caused by HTN and lead to progressive deficits:

A

Charcot-Bouchard aneurysms

129
Q

Possible cause of absence seizures

A

hippocampal sclerosis from childhood febrile seizures

130
Q

focal seizures that occur in a single hemisphere

A

focal aware seizures (previously known as simple partial seizures)

131
Q

focal seizures consisting of blank stares and automatisms

A

focal impaired awareness seizures

132
Q

DRESS and which drugs cause it?

A

drug reaction with eosinophila and systematic symptoms: commonly caused by anticonvulsants, allopurinol, sulfonamide, antibiotics (vancomycin)

133
Q

defect in SMN1 gene which encodes a protein involved in assembly of small nuclear ribonucleoproteins (snRNPs) in lower motor neurons; defective snRNPs=impaired spliceasome: dysfunction and degeneration of anterior horns of spinal cord: which disease?

A

Spinal Muscular Atrophy

134
Q

pharyngeal arch 1 which nerve

A

trigeminal nerve CN 5

135
Q

Pharyngeal arch 2 which nerve

A

facial nerve CN7

136
Q

pharyngeal arch 3 which nerve

A

glossopharyngeal CN9

137
Q

pharyngeal arch 4+6 which nerve

A

Vagus CN10

138
Q

Which tract controls voluntary muscle activity?

A

corticospinal tract (pyramidal)

139
Q

damage to UMN results in

A

spastic paralysis, clasp knife rigidity, hyperreflexia, Babinski+

140
Q

damage to LMN

A

flaccid paralysis; hypotonia; hyporeflexia; atrophy; fasciculations

141
Q

abnormal, dilated blood vessels with thin adventitia and lacking elastic fibers and smooth muscles (may cause seizures)

A

cavernous hemagioma

142
Q

What modulates basal ganglia output?

A

subthalmic nucleus

143
Q

lacunar stroke to subthalmic nucleus can cause

A

hemiballismus

144
Q

scapular wing found in which nerve damage

A

long thoracic n.

145
Q

nerve easily injured during mastectomy from C5-C7 and responsible for full extension and medial rotation and adduction of arm

A

thoracodorsal N

146
Q

damage to this nerve will show weakness in flexing or extending humerus

A

medial pectoral and lateral pectoral

147
Q

Which nerves are purely sensory for upper arm and axilla?

A

intercostobrachial n.

148
Q

muscles of inspiration

A

SCM( C1-C4), diaphragm(C3-C5phrenic n.), scalenes (C4-C8), external intercostales (T1-T11)

149
Q

muscles of expiration

A

internal intercostal T1-T11
abdominal muscles T4-L1

150
Q

trochlear nerve palsy (CN IV)

A

innervates superior oblique, causes eye to intort (up and in); seen in DM2 and microvascular nerve ischemia; usually tilt head to correct vision

151
Q

innervates forearm flexors, biceps, brachialis, and coracobrachialis and lateral forearm cutaneous innervation

A

musculocutaneous n.

152
Q

seizure med that causes gingival hyperplasia, coarse facial features and hirsutism in long term use

A

phenytoin

153
Q

Failure of repair DNA (BRCA1/BRCA2) cause mutation in FAN gene) causes aplastic anemia; AML;

A

Fanconi Anemia

154
Q

TX for Fanconi Anemia

A

bone marrow transplant (definitive)

155
Q

list some disorders caused by deficiency to repair DNA

A

1) ataxia telangiectasia
2) xeroderma pigmentosa
3) Fanconi anemia
4) Bloom syndrome (generalized chromosome instability, susceptible to neoplasms)
5)HNPCC

156
Q

MCC of spontaneous lobar hemorrhage

A

amyloid angiopathy

157
Q

MCC of spontaneous lobar hemorrhage in children

A

AVM

158
Q

Disease which manifests with lower extremity weakness, muscle atrophy, peripheral neuropathy, mutations encoding peripheral nerve axons or myelin

A

Charcot-Marie-Tooth (CMT1 gene)

159
Q

receptor when stimulated causes constriction of internal urinary sphincter, raises BP and mydriasis

A

alpha 1

160
Q

receptor when stimulated raises heart rate, and increases heart’s contractility and conductance

A

beta 1

161
Q

receptor when stimulated dilates bronchioles, relaxes uterus (tocolysis); and vasodilates (lowers BP)

A

beta 2

162
Q

Condition in which spinothalamic tract is impinged and causes loss of temperature or pain sensation

A

syringomelia

163
Q

Ataxia due to degeneration of spinocerebellar tracts; loss of vibration and position (degeneration of dorsal columns)

A

Friedrich’s ataxia

164
Q

Which vitamin deficiencies can mimic Friedrich’s ataxia?

A

Vita B12 or Vita E

165
Q

Which brain tumor is paraventricular and has pseudorosettes surrounding capillary

A

ependymoma

166
Q

Which brain tumor has eosinophilic granular bodies and hairlike processes (Rosenthal)

A

pilocytic astrocytoma

167
Q

Which brain tumor has cells with “fried egg appearance”

A

Oligodendroglioma

168
Q

Which brain tumor has small blue cells that surround neuropile ; Homer Wright rosettes

A

medulloblastoma

169
Q

Which brain tumor: hypercellular areas of atypical astrocytes bordering regions of necrosis (pseudopallisading)

A

glioblastoma

170
Q

VEGF inhibitors for age related macular degeneration

A

ranizumab, bevacizumab

171
Q

progressive dystrophy of retinal pigment and photo receptors

A

retinitis pigmentosa

172
Q

nerve that innervates SCM and trapezius

A

spinal accessory nerve CNXI

173
Q

SCLC, breast, ovarian, uterine malignancies: progressive worsening and dizziness, limb and trunk ataxia, dysarthria, visual disturbance, immune response against tumor cells that cross react with Purkinje neuron antigens: antiYo, antiHu, anti P/Q

A

paraneoplastic cerebellar degeneration

174
Q

melatonin agonist, good sedative for elderly

A

Ramelteon

175
Q

main area of sertonergic neurons

A

raphe nucleus

176
Q

cholinergic neurons that are decreased in Alzheimers causing Ach to decrease

A

nucleus basalis of Meynert

177
Q

motor coordination of upper extremities

A

red nucleus

178
Q

dopaminergic area

A

substatia nigra

179
Q

reward and pleasure area

A

nucleus accumbens

Step 2 CK (4 decks)

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