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Neurology Flashcards

1
Q

The ______ forms the thalamus and the third ventricle

The ______ forms the cerebral hemispheres and lateral ventricles

A

Telencephalon

Diencephalon

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2
Q

The pons and cerebellum (and upper part of 4th ventricle) are formed from the ___________
The Medulla and lower part of the 4th ventricle are formed from the ____________

A

Metencephalon

Myelencephalon

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3
Q

Holoprosencephaly
Failure of…
Related to mutations in….

A

Failure of left and right hemispheres to separate

Mutations in sonic hedgehog signaling pathway

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4
Q

What are the sensory deficits associated with syringomyelia?

A

Cape like bilateral loss of pain and temperature sensation in upper extremities (crossing anterior spinal commissural fibers damaged first)

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5
Q

Which branchial arches form the anterior 2/3 of the tongue? the posterior 1/3?

A

1st and 2nd branchial arches form anterior 2/3

3rd and 4th branchial arches form posterior 1/3

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6
Q

Oligodendrocytes are derived from _______

Schwann cells are derived from _______

A

Neuroectoderm

Neural crest

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7
Q

Meissner corpuscles sense…

Pacinian corpuscles sense…

A

Meissner: Dynamic, fine/light touch; position sense
Pacinian: Vibration, pressure

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8
Q

What neurotransmitters are increased in Parkinson disease?

A

5-HT

ACh

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9
Q

What are two areas of the brain where there is no blood-brain barrier (fenestrated capillaries)?

A 
Area postrema (vomiting after chemo)
OVLT (organum vasculosum of the lamina terminalis) - senses osmolarity and determines ADH release
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10
Q 
What are the functions of the following areas of the hypothalamus?
Lateral area:
Ventromedial area:
Anterior hypothalamus:
Posterior hypothalamus:
Suprachiasmatic nucleus:
A

Lateral area: Hunger
Ventromedial area: Satiety
Anterior hypothalamus: Cooling, parasympathetic (A/C)
Posterior hypothalamus: Heating, sympathetic
Suprachiasmatic nucleus: Circadian rhythm

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11
Q

What causes the eye movements during REM sleep?

A

PPRF (paramedian pontine reticular formation)

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12
Q 
What are the functions and inputs of the following areas of the thalamus?
VPL:
VPM:
LGN:
MGN:
VL:
A

VPL: Pain and temperature; pressure, touch, vibration, propioception (Spinothalamic and dorsal columns)
VPM: Face sensation and taste (trigeminal and gustatory pathway)
LGN: Vision (CNII)
MGN: Hearing (Superior olive and inferior colliculus of tectum)
VL: Motor (Basal ganglia, cerebellum)

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13
Q

What is the difference in presentation of a lateral lesion of the cerebellum and a medial lesion of the cerebellum?

A

Lateral: Propensity to fall toward injured side (controls voluntary movement of extremities)
Medial: Wide based gait and deficits in truncal coordination; bilateral motor deficits affecting proximal limb musculature

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14
Q

What causes neuronal death in Huntington disease?

A

Neuronal death via NMDA-R binding and glutamate toxicity

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15
Q

How is an essential tremor treated?

A

β-blockers and primidone

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16
Q

What type of tremor is due to cerebellar dysfunction?

A

Intention tremor (slow, zigzag motion when pointing/extending toward a target)

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17
Q

Anterograde amnesia is due to bilateral lesion of the ________

A

Hippocampus

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18
Q

Where is the lesion if the patient looks away from the side of the lesion?
Looks toward the lesion?

A

Away: Paramedian pontine reticular formation
Toward: Frontal eye fields

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19
Q

What are the differences between the following types of aphasia?
Transcortical motor:
Transcortical sensory:
Mixed transcortical:

A

Transcortical motor: Non-fluent aphasia with good comprehension and repetition
Transcortical sensory: Poor comprehension with fluent speech and repetition
Mixed transcortical: Non-fluent speech, poor comprehension, good repetition

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20
Q

Cerebral perfusion is proportional to PCO2 until PCO2 is >__mmHg
How can breathing rate help decrease intracranial pressure?

A

90 mmHg

Hyperventilation decreases PCO2 via decreased cerebral perfusion by vasoconstriction

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21
Q

What is Lateral Medullary syndrome (Wallenberg)?

A

Lesion of the PICA (lateral medulla/nucleus ambiguus) - Dysphagia, hoarseness, vomiting, vertigo, nystagmus

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22
Q

What is Median medullary syndrome?

A

Infarct of paramedian branches of ASA and vertebral arteries - tongue deviates ipsilaterally and decreased contralateral propioception

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23
Q

What is lateral pontine syndrome?

A

AICA lesion leading to paralysis of the face, decreased taste from anterior 2/3 of tongue, and decreased lacrimation and hearing (facial nerve effects)

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24
Q

A lesion of the anterior communicating artery leads to…

A lesion of the posterior communicating artery leads to…

A

ACom: visual field defects
PCom: CNIII palsy - eye is down and out with ptosis and pupil dilation

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25
What are three associations with a Berry aneurysm?
ADPKD, Ehlers-Danlos syndrome, and Marfan syndrome
26
How do you visualize an ischemic stroke in the first 3-30 minutes? How do you visualize between 12-24 hours?
3-30 minutes: diffusion weighted MRI | 12-24 hours: dark abnormality on non-contrast CT
27
What happens in a normal pressure hydrocephalus? | What are the symptoms?
Expansion of ventricles → Distorts the fibers of the corona radiata Symptoms: Urinary incontinence, ataxia, and cognitive dysfunction ("wet, wobbly, and wacky")
28
What are the names of tracts for the following sensations... Pressure, vibration, touch, proprioception: Pain temperature: Crude touch, pressure:
Pressure, vibration, touch, proprioception: Dorsal column Pain temperature: Lateral spinothalamic tract Crude touch, pressure: Anterior spinothalamic tract
29
Which diseases cause lower motor neuron lesions due to destruction of the anterior horns (flaccid paralysis)?
Poliomyelitis and spinal muscular atrophy (Werdnig-Hoffman disease)
30
What is seen in an infant with Spinal muscular atrophy? What is the prognosis?
"Floppy baby" | Median age of death is 7 months (autosomal recessive)
31
``` Friedreich ataxia: Gene (function): Impairment in ______ function: Cause of death: Presentation: ```
Gene (function): Frataxin (iron binding protein) Impairment in mitochondrial functioning Cause of death: Hypertrophic cardiomyopathy Presentation: Staggering, falling, nystagmus, hammer toes
32
In Brown-Sequard syndrome what type of lesion is present? | What are the findings?
Hemisection of spinal cord Ipsilateral: loss of tactile, vibration, proprioception (1-2 levels below lesion), UMN signs below level of lesion Contralateral: Loss of pain and temperature below level of lesion
33
Diaphragm and gallbladder pain referred to the right shoulder via the ______ ____
Phrenic nerve
34
Which CN's lie medially at the brain stem?
CNIII, CNVI, CNXII (Motor = medial)
35
What is the function of... Superior colliculi: Inferior colliculi: Bonus: what is a lesion of the superior colliculi called?
Superior colliculi: Conjugate vertical gaze center Inferior colliculi: Auditory Bonus: Parinaud syndrome
36
Which CN causes eyelid opening? | Which CN causes eyelid closing?
Opening: Occulomotor (CNIII) Closing: Facial (CNVII)
37
The gag reflex is due to afferent input from CN__ and efferent action of CN__
CNIX; CNX
38
Vagal nuclei: What is the function of the nucleus solitarius? What is the function of the nucleus ambiguus?
Solitarius: Visceral sensory information Ambiggus: Motor innervation of pharynx, larynx, and upper esophagus
39
CNV1 exits through: CNV2 exits through: CNV3 exits through:
CNV1: Superior orbital fissure CNV2: Foramen Rotundum CNV3: Foramen Ovale
40
What structures pass through the cavernous sinus? | What happens in cavernous sinus syndrome?
CNIII, IV, V1, V2, and VI and postganglionic sympathetic fibers en route to the orbit CSS: opthalmoplegia and ↓ corneal and maxillary sensation with normal visual acuity
41
Low frequency vibrations are heard at _____ near ______ | High frequency vibrations are heard best at _____ of _____
Low frequency vibrations are heard at apex near helicotrema | High frequency vibrations are heard best at base of cochlea
42
If a Rinne test is abnormal, hearing loss is ______ | and the Weber test localizes to the ______ ear
conductive; affected
43
Noise induced hearing loss is due to damage to ________ cells in....
stereocilliated; Organ of corti
44
A UMN facial lesion causes what effect on the facial muscles? LMN facial lesion?
UMN: Contralateral paralysis of lower face LMN: Ipsilateral paralysis of upper and lower face
45
What is the difference between closed/narrow angle glaucoma and open angle glaucoma?
Open angle: Blocked trabecular meshwork from WBCs, RBCs, or retinal elements (secondary) Closed angle: Enlargement or forward movement of lens against central iris leading to obstruction of normal aqueous flow through the pupil → fluid builds up behind iris, pushing peripheral iris against cornea and impeding flow through trabecular meshwork (primary)
46
Why is epinephrine not given during acute close/narrow angle closure glaucoma?
Because of its mydriatic effect
47
What is the pathway of miosis? | What is the pathway of midriasis?
Miosis: Edinger-Westphal→ciliary ganglion (CNIII)→short ciliary nerves → pupillary sphincter muscles Mydriasis: Hypothalamus → Ciliospinal center of Budge → Superior cervical ganglion → plexus along internal carotid, through cavernous sinus → long ciliary nerve (enters orbit) → pupillary dilator muscles
48
What allows bilateral pupillary constriction when light is shone in only one eye?
Pretectal nucleus
49
What is dry ARMD? | What is wet ARMD?
Dry: deposition of drusen (yellow extracellular material) in and beneath Bruch membrane and retinal pigment epithelium Wet: Rapid loss of vision due to bleeding 2° to choroidal neovascularization
50
What is a rapidly progressive dementia with myoclonus?
Creutzfeldt-Jakob disease (spongiform cortex)
51
What finding is diagnostic of multiple sclerosis? What protein is increased?
Oligoclonal bands | Increased IgG
52
Acute disseminated encephalomyelitis is demyelination common after what infections?
Measles or VZV
53
Charcot-Marie Tooth disease is a group of nerve disorders related to... What are the clinical findings?
Related to defective production of proteins involved in the structure and function of peripheral nerves or the myelin sheath Associated with scoliosis and foot deformities (high or flat arches)
54
What proteins buildup in Krabbe disease? | What builds up in Adrenoleukodystrophy?
Krabbe: Galactocerebroside and psychosine (destroy myelin) Adrenoleukodystrophy: Very-long chain fatty acids
55
What is the difference between a simple partial seizure and a complex partial seizure?
Simple: Consciousness intact Complex: Impaired consiousness
56
What is the POUND mnemonic for migraines?
Pulsatile, One-day, Unilateral, Nausea, Disabling
57
Sturge-Weber syndrome is due to an activating mutation of the _____ gene What is the STURGE mnemonic?
``` GNAQ gene port wine Stain Tram track Ca2+ Unilateral Retardation Glaucoma Epilepsy ```
58
What is seen with Tuberous sclerosis?
``` Hamartomas in CNS and skin Angiofibromas (morgan freeman) Mitral regurgiation Ash leaf spots Rhabdomyoma ```
59
What is seen in VHL?
Cavernous hemangiomas in skin Bilateral renal cell carcinomas Pheochromocytomas Hemangioblastomas in retina, brain stem, cerebellum
60
``` Give one or two associations for each of the following adult brain tumors... Glioblastoma: Meningioma: Hemangioblastoma: Schwannoma: Oligodendroglioma: ```
Glioblastoma: Pseudopalisading; crosses corpus callosum Meningioma: Spindle cells in a whorled pattern; psammoma bodies Hemangioblastoma: Can produce erythropoietin; VHL Schwannoma: cerebellopontine angle; S-100 Oligodendroglioma: Fried egg cells, chicken wire capillary pattern
61
``` Give one or two associations for each of the following childhood brain tumors... Pilocytic astrocytoma: Medulloblastoma: Ependymoma: Craniopharyngioma: ```
Pilocytic astrocytoma: Rosenthal fibers, cystic Medulloblastoma: drop metastases, homer-wright rosettes Ependymoma: 4th ventricle, perivascular rosettes Craniopharyngioma: Rathke pouch, calcification possible
62
What is the MAC?
Minimal alveolar concentration of inhaled anesthetic required to prevent 50% of subjects from moving in response to noxious stimulus Potency = 1/MAC
63
What is a Charcot-Bouchard aneurysm?
An aneurysm in the basal ganglia, cerebellum, thalamus or pons that can rupture, leading to hemorrhage within the brain
64
What is the only bilateral type of headache? Which headache is repetitive? Which headache presents with periorbital pain and lacrimation?
Bilateral: Tension (steady pain) Repetitive: Cluster Periorbital pain: Cluster
65
How is a cluster headache differentiated from trigeminal neuralgia?
Based on duration: Trigeminal neuralgia produces shooting pain in the distribution of CN V that lasts 15 minutes)

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