Neurology

Question 1

Acute disseminated postinfectious encephalomyelitis

Answer 1

multifocal periventricular inflammation and demyelination after infection (VZV and measles common), or certain vaccinations (rabies, smallpox)

Question 2

Charcot- Marie- TOoth

Answer 2

hereditary motor AND sensory neuropathy (HMS), progressive hereditary nerve disorder due to defective neuronal proteins in volved in structure and function of peripheral nerve and/or myelin sheath. AD inhetirance, scoliosis and foot deformities are common.

Question 3

Krabbe

Answer 3

galactoverebrosidase deficiency leads to galactocerebroside build up in the myelin sheath.
findings: peripheral neuropathy, developmental delay, optic atrophy, globoid cells

Question 4

Metachromatic leukodystrophy

Answer 4

AR lysosomal storage disease, commonly due to arylsulfatase A deficiency. Sulfatides build up and impair production. destroy myelin sheath. Central and peripheral demyelination result with ataxia and dementia

Question 5

Progressive multifocal leukoencephalopathy

Answer 5

Demyelination of CNS due to destruction of oligodendrocytes. Associated with JC virus. Seen in 2-4% of AIDS patients (reactivation of latent viral infection. Rapidly progressive and usually fatal. Increased risk associated with natalizumab, rituximab.

Question 6

Pricking pain (fast, myelinated)

Answer 6

A-delta fibers

Question 7

Burning or dull pain and itch (slow, unmyelinated)

Answer 7

C- polymodal fibers

Question 8

vibration and pressure, rapid adapting

Answer 8

Pacinian corpuscle

Question 9

dynamic/ changing light, discriminatory touch, superficial

Answer 9

Meissner corpuscle

Question 10

static/ unchanging light touch, superficial

Answer 10

Merkel receptor

Question 11

propioception, muscle length monitoring

Answer 11

muscle spindle

Question 12

propioveption, muscle tension monitoring

Answer 12

Golgi tendon organ

Question 13

CSF changes in Guillain Barre

Answer 13

normal cell count with increase in protein

Question 14

Guillain Barre syndrome

Answer 14

symmetric ascending mucle weakness (Schwann cells affected), facial paralysis, preceded by infection (campylobacter usually), sensation intact

Question 15

Parkinson disease

Answer 15

tremor- resting or pill- rolling tremor
rogidity- cogwheel rigidity
akinesia or hypokinesia
postural instability
mask- like facies
festinating gait

Question 16

Neurotransmitters in Huntington

Answer 16

decreased ACh
decreased GABA
increased dopamine

Question 17

treat glaucoma

Answer 17

prostaglandins, beta blockers, alpha agonists, carbonic anhydrase inhibitors, cholinergic agonists

Question 18

alternate routes for mediation of voluntary movement

Answer 18

reticulospinal and rubrospinal tracts

Question 19

pain and temperature sensation

Answer 19

lateral spinothalamic tract

Question 20

important for postural adjustments and head movements

Answer 20

vestibulospinal tract

Question 21

propioceptive information to the cerebellum

Answer 21

dorsal and ventral spinocerebellar tracts

Question 22

BPPV

Answer 22

debris, otoliths in vestibular apparatus. Dx Hallpike, Epley for treatment

Question 23

Meniere triad

Answer 23

imbalance of fluid and electrolyte composition of endolymph. triad:
vertigo
tinnitus
hearing loss

Question 24

central vertigo

Answer 24

brainstem and cerebellar lesions damaging the vestibular nuclei. or posterior fossa tumor

Question 25

How is hair transmitted?

Answer 25

tympanic membrane vibrates with sound waves, and the vibration is transmitted to the cochlea via middle ear ossicles. cholinergic signals in the olivocochlear bundles stiffen the outer hair cells, thereby sensitizing the inner hair cells to a partiular frequency. Outer hair cells are where aminoglycosides (streptomycin, gentamicin) cause damage. Hair cells and cochlea turn the sound signal into a nercous impluse, which travels from the cell body to the cochlear gangion, to cochlear nuclei in brainstem decussation to contralateral superior olivary nucleus to lateral lemniscus to inferior colliculus to medial geniculate body to primary auditory cortex in the temporal lobe

Question 26

pathogens most commonly associated with AOM

Answer 26

strep pneumo h. influenza m. catarrhalis

Question 27

most commonly associated with acute otitis externa

Answer 27

p. aeruginosa

Question 28

cholesteatoma

Answer 28

noncancer, non- cholesterol overgrowth of desquamated keratin debris within the middle ear space that may eventually erode the ossicular chain and the mastoid air cells. may be 2/2 neg middle ear pressure (chronic retraction pocket), 2/2 eustachian dysfunction or direct growth of epithelium through a TM perforation commonly associated with chronic middle ear infection Tx- surgical removal via tympanomastoidectomy and reconstruction of the ossicular chain.

Question 29

intranuclear inclusions seen in HSV encephalitis

Answer 29

Cowdry type A

Question 30

cytoplasmic inclusions pathognomonic of rabies

Answer 30

negri bodies

Question 31

neuronal inclusions characteristic of Parkinson Disease

Answer 31

Lewy bodies

Question 32

Cytoplasmic inclusion bodies associated with aging

Answer 32

Lipofuscin granules

Question 33

Dark cytoplasmic pigment in neurons of the substantia nigra and locus coruleus, not seen in patients with Parkinson

Answer 33

melanin

Question 34

Eosinophilic, rod- like inclusions in hippocampus of Alzheimer patients

Answer 34

Hirano bodies

Question 35

Diagnosis of AD

Answer 35

Neurofibrillary plaques and tangles

Question 36

Filamentous inclusions that stain with silver, do not survive neuronal death

Answer 36

Pick bodies

Question 37

Filamentous inclusions that stain with PAS and ubiquitin

Answer 37

Lewy bodies

Question 38

dementia plus visual hallucinations

Answer 38

Lewy Body dementia

Question 39

dementia plus progressive aphasia

Answer 39

FTD (Pick)

Question 40

dementia plus ataxia and loss of pupillary light reflex

Answer 40

tertiary syphilis

Question 41

dementia plus megaloblastic anemia and peripheral neuropathy

Answer 41

B12 deficiency

Question 42

dementia plus resting tremor and bradykinesia

Answer 42

LBD or Parkinson

Question 43

dementia plus uninhibited social behavior

Answer 43

frontotemporal lobe dementia

Question 44

dementia plus urinary incontinence and magnetic gait

Answer 44

NPH

Question 45

dementia plus syncopal episodes

Answer 45

LBD

Question 46

dementia plus dysarthria and liver disease

Answer 46

Wilson disease

Question 47

dementia plys myoclonus

Answer 47

CJD

Question 48

delirium

Answer 48

``` visual hallucinations fluctuating level of consciousness acute onset disturbances in sleep-wake cycle decreased attention span decreased level of arousal acute changes in mental status disorganized thinking usually reversible (unlike dementia) abnormal EEG ``` Causes: drugs especially with anticholinesterase function, UTI,

Question 49

dementia workup

Answer 49

``` RPR HIV TSH Vit B12 deficiency MRI of brain ``` CBC, etc

Question 50

Down syndrome and AD

Answer 50

Trisomy 21. APP gene on chromosome 21

Question 51

Drugs that treat AD mechanisms

Answer 51

``` Cholinesterase inhibitors (prolong ACh) Memantine is an antagonist at the NMDA glutamate receptor ```

Question 52

most common cause of dementia

Answer 52

AD

Question 53

second most common cause of dementia

Answer 53

Vascular dementia

Question 54

Extracellular amyloid deposits in the grey matter

Answer 54

AD

Question 55

Intracellular deposits of hyperphosphorylated tau protein

Answer 55

AD

Question 56

Intracellular spherical aggregates of tau protein seen on silver stain

Answer 56

These are PICK bodies, and this is FTD

Question 57

multiple sclerosis presenting symptoms

Answer 57

``` scanning speech intention tremor nystagmus bowel and bladder incontinence internuclear opthalmoplegia optic neuritis ```

Question 58

diseases that affect the anterior motor horn

Answer 58

polio, WNV, ALS, Werdnif- Hoffman disease (spinal muscle dystrophy)