Neurology Flashcards
(179 cards)
1
Q
Which cervical nerve: shoulder/scapula elevation
A
C4
2
Q
Which cervical nerve: shoulder abduction
A
C5
3
Q
Which cervical nerve: elbow flexion, wrist extension
A
C5,C6
4
Q
Which cervical nerve: elbow extension, finger extension
A
C7
5
Q
Which cervical nerve controls biceps reflex?
A
C5, C6 (radial nerve)
6
Q
Which cervical nerve controls triceps reflex?
A
C7,C8
7
Q
Which nerve innervates anterior scrotum (labia majora in women); base of penis (mons pubis); medial thigh?
A
illioinguinal nerve
8
Q
Which CN originates in medulla, exits via jugular foramen and has both Somatic/motor functions?
A
CN IX glossopharyngeal
9
Q
A pure hemisensory stroke most likely occured in which brain region?
A
thalamus
10
Q
Which CN nerve controls taste in posterior 1/3 of tongue?
A
CN IX glossopharyngeal
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
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
13
Q
sciatic nerve controls which flexor
A
knee flexion
14
Q
Which nerve controls dorsiflexion and eversion of foot?
A
common fibular nerve
15
Q
Which nerve controls lateral calf and dorsal foot sensory?
A
common fibular nerve
16
Q
Which nerve controls plantar flexion and inversion of foot?
A
tibial nerve
17
Q
Which nerve controls plantar surface sensation and Achilles reflex?
A
Tibial nerve
18
Q
What peptide is involved in migraine headaches?
A
CGRP calcitonin gene related peptide
19
Q
Which medicine can block CGRP calcitonin gene related peptide release in migraine headaches?
A
triptans
20
Q
What is the MOA of erenumab migraine med?
A
antibody to CGRP (calcitonin gene related peptide)
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
22
Q
Which neurological problem can long term B12 deficiency lead to?
A
Subacute combined degeneration
23
Q
What areas of the brain are affected in subacute combined degeneration?
A
dorsal column, spinocerebellar tract, lateral corticospinal tract (spastic paresis)
24
Q
Signs of Subacute combined degeneration
A
loss of position and vibration/ +Romberg/ spastic paresis
25
ToRCHS
Toxoplasmosis
Rubella
Cytomegalovirus
HSV
Syphilis
26
Which neonatal ToRCHS presents with cataracts, heart defects, sensorineural hearing defects
Rubella
27
Which ToRCHS presents with chorioretinitis, hydroencephalus, and diffuse intracranial calcifications
Toxoplasmosis
28
Which ToRCHS presents with microencephaly, paraventricular calcification
CMV
29
Which ToRCHS presents with rhinorrhea, skeletal anomalies, rash
Syphilis
30
MOA of Phenytoin and Carbamazepine
Na channel blockers
31
MOA Valproic Acid
Na channel blocker, increase GABA
32
MOA Benzodiazepine and phenobarbital
increase GABA (benzo by activating Cl channel frequency and phenobarbital by activating Cl channel duration
33
Good med for SAH
nimodipine (CCB) up cerebral vasodilation; down Ca excitotoxicity
34
Most primary tumors in adults are supratentorial or below tentorium?
Supratentorial
35
Most primary CNS tumors in children are supratentorial or below tentorium?
below tentorium
36
Which CNS tumors are GFAP+ (glial fibrillary acidic protein)?
astrocytomas including glioblastoma multifome, oligodendroglioma, ependymomas and peripheral neural sheath tumors
37
Which neuro marker is found in presynaptic vesicles of neurons, neuroendocrine and neuroectodermal cells?
synaptophysin
38
What nerve controls motor function of tongue?
CN XII (except for palantoglussus nerve which is innervated by CN V)
39
What nerve controls sensory function of tongue's anterior 2/3?
mandibular branch of CN V
40
What nerve controls sensory function of tongue's posterior 1/3?
CN IX
41
What nerve controls posterior area of tongue root?
CN X
42
What nerve controls anterior 2/3 taste?
chorda tympani of facial nerve CN VII
43
What nerve controls posterior 1/3 taste?
CN IX
44
What will you find on biopsy 12-24 hours after ischemic stroke?
red neurons, eosinophilic cytoplasm, pyknotic nuclei, loss of Nissl substance of RER
45
What will you find on biopsy 24-72 hours after ischemic stroke?
neutrophic infiltration
46
What will you find on biopsy 3-7 days after ischemic stroke?
macrophage (microglia) phagocytosis
47
What will you find on biopsy 1-2 weeks after ischemic stroke?
gliosis and vascular proliferation (liquefactive necrosis 1 week to 1 month)
48
What will you find on biopsy more than 2 weeks after ischemic stroke?
glial scar
49
Which lobe of the brain controls personality, language, motor function and executive function?
frontal
50
proteins from neuronal microtubules become hyperphosphorylated and dissociate from microtubules to form paired helical filaments called....
tau proteins (neurofibrillary tangles) of Alzheimer's
51
Name 5 folate antagonists used as meds (one for humans, one for bacteria, one for protozoa; one for IBD, one for diuresis)
Methotrexate (RA/Cancer); Trimethoprim (PCP); Pyramethamine (protozoa); Sulfasalazine (RA/IBD); Triamterene (with HTCZ, diuretic for edema/HTN)
52
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?
narcolepsy; TX: modafinil /amphetamines
53
During uncal herniation if the ipsilateral CNIII is affected, what are the signs?
ipsilateral fixed and dilated pupil; if continues there will be paralysis of CNIII= ptosis and down and out gaze
54
During uncal herniation if posterior communicating artery is compressed, what are the signs?
contralateral homonymous hemianopia with macular sparing
55
During uncal herniation if cerebral peduncle is compressed what are the signs?
contralateral hemiparesis; if continued pressure, it will rupture basilar artery (fatal)
56
Which virus could cause meningitis with lower limb flaccidness, fever, mibilliform rash on back and chest; parkinsonism?
West Nile Virus (south, southwest US)
57
Which kind of meningitis can we see thick, gelatinous exudate at basal portion of brain causing CN palsy, ventriculomegaly, multiple infarcts?
TB meningitis (esp. in HIV and immunocompromised)
58
most commonly tested progressive cystic neuro disease of putamen
Wilson's
59
Which problem consists of sensory ataxia (+Romberg), lancinating pains, neuro urinary incontinence, and Argyl-Robertson pupils?
Tabes Dorsalis (Tertiary syphilis)
60
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?
Diffuse Axonal Injury (traumatic brain injury)
61
Which proteins are associated with early onset familial Alzheimer's?
1. Amyloid precursor protein (APP) on Ch. 21
2. Presenilin 1 gene on Ch. 14
3. Presenilin 2 gene on Ch. 1
62
Which protein is associated with late onset (after 60) familial Alzheimer's?
epsilon 4 allele of Apolipoprotein E (causing formation of senile plaques)
63
Very long chained fatty acids (VLCFA) and Branched chain fatty acids cannot go to mitochondria for beta oxidation, to which organelle must they go?
Peroxisome VLCFA beta ox.; branched chain, alpha ox
64
Which disease has defective peroxisomes, craniofacial abnormalities, hepatomegaly, hypotonia, and seizures?
Zellweger
65
Which disease is there defective transport of VLCFA to peroxisome causing neuro degeneration and adrenal insufficiency?
X-linked adrenoleukodystrophy
66
Which organelle: protein sorting and transport
Golgi apparatus
67
Which organelle: digestion of debris and pathogens
lysosomes
68
Which organelle: TCA cycle; fatty acid oxidation, ETC, apoptosis
mitochondria
69
Which organelle: oxidation of VLCFA and H2O2 degradation
peroxisomes
70
Which organelle: degradation of ubiquitinated proteins?
proteasomes
71
Which organelle: synthesis of membranous and secretory proteins?
RER
72
Which organelle: drug detox, lipid/phospholipid sythesis; steroid synthesis
SER
73
Which analgesics have mu, delta, kappa and are coupled with G inhibitor proteins?
opiate analgesics
74
MOA opiate analgesics
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
Which neuromuscular blocking agents are competitive antagonists of nicotinic Ach receptors?
vecuronium, rocuronium
76
In which patients are vecuronium and rocuronium contraindicated?
myasthenia gravis pts. because they have few receptors and vecuronium/rocuronium will lead to paralysis with loss of airway patency
77
Name some abortive migraine therapies
triptans, NSAIDS, antiemetics, ergotamine
78
Name some preventative migraine therapies
topiramate/valproate (anticonvulsives); B blockers, TCA or venlafaxine (antidepressants)
79
Wallenberg syndrome usually involves which artery?
Posterior inferior cerebral artery PICA from vestibular artery
80
In Wallenberg's: what does lesion of inferior cerebellar penduncle cause?
ataxia
81
In Wallenberg's: what does lesion of vestibular nucleus cause?
vertigo, diplopia, nystagmus, vomiting
82
In Wallenberg's: what does lesion of spinal trigeminal nucleus cause?
ipsilateral facial pain and temp. sensation loss
83
In Wallenberg's: what does the lesion of nuclear ambiguus cause?
diminished gag reflex
84
In Wallenberg's: what does lesion of spinothalmic tract cause?
contralateral loss of trunk and extremity pain and temperature sensation
85
+ Romberg's defect in which nerves (central or peripheral) and what could cause + Romberg's
peripheral nerve defect: tabes dorsalis, posterior column defect, or B12 deficiency
86
- Romberg's associated with which kind of ataxia
cerebellar ataxia
87
Which kind of diagnostic tests could you use for cerebellar ataxia?
rapid alternating movements; finger to nose; heel to shin
88
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?
Bell's palsy, CN VII
89
With inhaled anesthesia is there more or less perfusion to the brain? What effect does that have? What effect to other organs?
more perfusion to brain causing increase in intercranial pressure; decreased blood flow to other organs
90
How does N. Fowleri enter the body and what are some treatments?
enters through the nose (warm, fresh water); Tx: dexamethasone, amphotericin B, azithromycin, fluconazole, rifampin, miltefosine
91
Which selective muscarinic antagonists can be used to reduce SE of cholinesterase inhibitors (diarrhea, nausea, sweating, abdominal cramp)
Glycopyrrolate or Hyoscyamine
92
MC cause of Phenylketonuria
phenylalanine hydroxylase deficiency
93
another cause of phenylketonuria
BH4 (dihydropteridine ) reductase deficiency : phenylalanine increased; serotonin decreased TX: low PHE diet and BH4 supplements
94
decerebrate and decorticate postures are caused by lesions in which brain area
pons and red nucleus
95
cause of Fragile X
hypermethalation on long arm of X chromosome causes inactivaton of FMR1 (Fragile X mental retardation 1) gene
96
Diabetic neuropathy: what kind of symptoms do lesions on small fibers cause?
positive symptoms (pain, paresthesia, allodynia which is pain out of proportion)
97
Diabetic neuropathy: what kind of symptoms do lesions on large fibers cause?
numbness, loss of proprioception and vibrational sense, + Romberg
98
What is CIM (critical illness myopathy)
decrease muscle membrane excitability and loss of myosin (atrophy of myofiber) after critical illness
99
What is CIP (critical illness polyneuropathy)
decreased nerve excitablitiy, axonal degeneration (injured by inflammatory mediators)
100
What area of the brain does anterior cerebral artery cover?
inferior frontal, medial frontal, superior medial parietal, anterior 4/5 corpus callosum, olfactory bulb, anterior basal ganglia, and internal capsule
101
What area of brain does MCA cover?
temporal lobe, deep subcortical structure like internal capsule and basal ganglia,
102
What area of brain does basilar artery cover?
brainstem and bilateral cerebellar hemispheres
103
What area of brain does the artery of Percheron cover?
It is a branch of PCA that supplies bilateral thalamic and dorsal midbrain
104
What area of brain does anterior choroidal artery cover?
final branch of internal carotid that supplies posterior limb of internal capsule, optic tract, lateral geniculate; choroid plexus, hippocampus, amygdala
105
What are the clinical presentation of ALS (amyotrophic lateral sclerosis) and current treatment and treatment's MOA?
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
Innermost layer of connective tissue that surrounds nerve axon which is affected in Guillain Barre
endoneurium
107
Which part of hypothalamus controls satiety?
ventromedial
108
Which part of hypothalamus controls hunger?
lateral
109
Which part of hypothalamus mediate heat dissipation?
anterior
110
Which part of hypothalamus mediates heat conservation?
posterior
111
Which part of hypothalamus secretes dopamine and GHRH ?
arcuate
112
Which part of hypothalamus secretes GnRH and regulates sexual behavior?
medial preoptic
113
Which part of hypothalamus secretes oxytocin, CRH, TRH and small amounts of ADH
paraventricular
114
Which part of hypothalamus secretes ADH and small amount of oxytocin
supraoptic
115
Which part of hypothalamus regulates circadian rhythm and pineal gland function
suprachiasmatic
116
L2-L4 radiculopathy weakness
hip flexion (iliopsoas); hip adduction; knee extension (quadriceps) ; affected patellar reflex
117
L5 radiculopathy weakness
foot dorsiflexion and inversion (tibalis anterior)
foot eversion (peronius)
toe extension (extensor hallucis and digitorium)
118
S1 radiculopathy weakness
hip extension (gluteus maximus)
foot plantarflexion (gastrocnemius); affected Achilles reflex
119
S2-S4
affected anocutaneous (wink); urinary or fecal incontinence; sexual dysfunction
120
What kind of brain herniation occurs under the cingulate gyrus and what are the signs?
subfalcine: contralateral leg weakness (ipsilateral ACA compression)
121
What kind of brain herniation happens when medial temporal lobe herniates under tentorium cerebelli and its signs?
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
What kind of herniation involves caudal displacement of diencephalon and brainstem and what are the signs?
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
Which nerve controls hip flexion, knee extension and sensation in anterior thigh
femoral nerve
124
Which nerve controls sensory in medial leg and foot?
saphenous
125
two dopa agonists used in Parkinson's
Bromocriptine and Pramipexole
126
What is TDP43?
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
What is it called when you have mutation of BCHE gene and are unable to metabolize succinylcholine (have paralysis for hours)?
pseudocholinesterase deficiency (AR)
128
Which microaneurysms occur at the basal ganglia, cerebellum, thalamus, pons, are caused by HTN and lead to progressive deficits:
Charcot-Bouchard aneurysms
129
Possible cause of absence seizures
hippocampal sclerosis from childhood febrile seizures
130
focal seizures that occur in a single hemisphere
focal aware seizures (previously known as simple partial seizures)
131
focal seizures consisting of blank stares and automatisms
focal impaired awareness seizures
132
DRESS and which drugs cause it?
drug reaction with eosinophila and systematic symptoms: commonly caused by anticonvulsants, allopurinol, sulfonamide, antibiotics (vancomycin)
133
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?
Spinal Muscular Atrophy
134
pharyngeal arch 1 which nerve
trigeminal nerve CN 5
135
Pharyngeal arch 2 which nerve
facial nerve CN7
136
pharyngeal arch 3 which nerve
glossopharyngeal CN9
137
pharyngeal arch 4+6 which nerve
Vagus CN10
138
Which tract controls voluntary muscle activity?
corticospinal tract (pyramidal)
139
damage to UMN results in
spastic paralysis, clasp knife rigidity, hyperreflexia, Babinski+
140
damage to LMN
flaccid paralysis; hypotonia; hyporeflexia; atrophy; fasciculations
141
abnormal, dilated blood vessels with thin adventitia and lacking elastic fibers and smooth muscles (may cause seizures)
cavernous hemagioma
142
What modulates basal ganglia output?
subthalmic nucleus
143
lacunar stroke to subthalmic nucleus can cause
hemiballismus
144
scapular wing found in which nerve damage
long thoracic n.
145
nerve easily injured during mastectomy from C5-C7 and responsible for full extension and medial rotation and adduction of arm
thoracodorsal N
146
damage to this nerve will show weakness in flexing or extending humerus
medial pectoral and lateral pectoral
147
Which nerves are purely sensory for upper arm and axilla?
intercostobrachial n.
148
muscles of inspiration
SCM( C1-C4), diaphragm(C3-C5phrenic n.), scalenes (C4-C8), external intercostales (T1-T11)
149
muscles of expiration
internal intercostal T1-T11
abdominal muscles T4-L1
150
trochlear nerve palsy (CN IV)
innervates superior oblique, causes eye to intort (up and in); seen in DM2 and microvascular nerve ischemia; usually tilt head to correct vision
151
innervates forearm flexors, biceps, brachialis, and coracobrachialis and lateral forearm cutaneous innervation
musculocutaneous n.
152
seizure med that causes gingival hyperplasia, coarse facial features and hirsutism in long term use
phenytoin
153
Failure of repair DNA (BRCA1/BRCA2) cause mutation in FAN gene) causes aplastic anemia; AML;
Fanconi Anemia
154
TX for Fanconi Anemia
bone marrow transplant (definitive)
155
list some disorders caused by deficiency to repair DNA
1) ataxia telangiectasia
2) xeroderma pigmentosa
3) Fanconi anemia
4) Bloom syndrome (generalized chromosome instability, susceptible to neoplasms)
5)HNPCC
156
MCC of spontaneous lobar hemorrhage
amyloid angiopathy
157
MCC of spontaneous lobar hemorrhage in children
AVM
158
Disease which manifests with lower extremity weakness, muscle atrophy, peripheral neuropathy, mutations encoding peripheral nerve axons or myelin
Charcot-Marie-Tooth (CMT1 gene)
159
receptor when stimulated causes constriction of internal urinary sphincter, raises BP and mydriasis
alpha 1
160
receptor when stimulated raises heart rate, and increases heart's contractility and conductance
beta 1
161
receptor when stimulated dilates bronchioles, relaxes uterus (tocolysis); and vasodilates (lowers BP)
beta 2
162
Condition in which spinothalamic tract is impinged and causes loss of temperature or pain sensation
syringomelia
163
Ataxia due to degeneration of spinocerebellar tracts; loss of vibration and position (degeneration of dorsal columns)
Friedrich's ataxia
164
Which vitamin deficiencies can mimic Friedrich's ataxia?
Vita B12 or Vita E
165
Which brain tumor is paraventricular and has pseudorosettes surrounding capillary
ependymoma
166
Which brain tumor has eosinophilic granular bodies and hairlike processes (Rosenthal)
pilocytic astrocytoma
167
Which brain tumor has cells with "fried egg appearance"
Oligodendroglioma
168
Which brain tumor has small blue cells that surround neuropile ; Homer Wright rosettes
medulloblastoma
169
Which brain tumor: hypercellular areas of atypical astrocytes bordering regions of necrosis (pseudopallisading)
glioblastoma
170
VEGF inhibitors for age related macular degeneration
ranizumab, bevacizumab
171
progressive dystrophy of retinal pigment and photo receptors
retinitis pigmentosa
172
nerve that innervates SCM and trapezius
spinal accessory nerve CNXI
173
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
paraneoplastic cerebellar degeneration
174
melatonin agonist, good sedative for elderly
Ramelteon
175
main area of sertonergic neurons
raphe nucleus
176
cholinergic neurons that are decreased in Alzheimers causing Ach to decrease
nucleus basalis of Meynert
177
motor coordination of upper extremities
red nucleus
178
dopaminergic area
substatia nigra
179
reward and pleasure area
nucleus accumbens
