Flashcards in Neurology 51% 59% 67% Deck (141):
pt with formication, agitations, and tremor has a past history of alcohol and not schizophrenia because
pt has delirium tremors due to alcohol withdrawl. schizophrenia is a associated with auditory hallucinations (not formication-feeling of insects crawling on skin)
LSD can lead to what type of hallcucinations
rod-shaped, crystal-like, and eosinophilic intracellular aggregates of actin
seen in alzheimer's. Hirano's bodies
loss of histological stain seen in cell bodies of neurons after damage to axon
two nerves that make up sciatic nerve
tibial nerve (anterior divisions of L4-S3) and common peroneal (fibular) (posterior divisions of L4-S2)
symptoms of sciatica
weakened extension of thigh, loss of knee flexion, and loss of function below the knee, pain or sensory loss on posterior thigh, lateral leg and entire foot
motor and sensory loss of femoral nerve
motor-weak hip flexion and knee extension, sensory-anterior thigh and medial leg and the foot
motor and sensory loss of obturator nerve
motor-weakness of thigh adduction and medical rotation of thigh, sensory-medial thigh
motor loss of inferior gluteal nerve
(innervates gluteus maximus) loss of hip extension and difficulty rising from seated position
motor loss of superior gluteal nerve
(supplies gluteus medius, minimus and tensor fasciae latae) loss of abduction of limb, impaired gait (Trendelenburg gait)
pt with alzheimer's and dies from a large intraparechymal hemorrhage is associated with amyloid angiopathy and not rupture Charccot-Bouchaurd aneurysm
C-B is associated with HTN, not lobar hypertension. amyloid hemorrhages can lead to weakening of vessel wall making them prone to rupture and cause large lobar hemorrhage (usually parietal)
unaware of one's disease
unaware of their own limbs
selective frontal and temporal lobe atrophy
signs of intraventricular blood
sudden severe headache and neck stiffness (meningeal irritation by blood), later pts have focal deficts from vasospam. can occur as a result of subarachnoid hemorrhage
chromosome location of pt with retinoblastoma.
chromosome 13. (13q14). mutation of tumor suppressor gene Rb.
a second somatic mutation in retinal cells leads to loss of nuclear protein and cell is stuck in G1 causing tumor growth
young child pt with bilateral foot drop gait, decreased sensation to light touch and impaired proprioception has impaired deep peroneal nerve and not obturator because
pt has Carcot-Marie-Tooth disease mc nerve affected is deep peroneal (fibular) nerve. loss of dorsiflexion (foot drop gait). obturator nerve supplies medial compartments of thigh (loss of adduction and medial rotation)
triad of Charot-Marie-Tooth dz
foot drop, pes cavus (high arched feet), stork-like appearance of legs, sensory loss of light and tough proprioception. disease damages myleininated fibers in peripheral nervous system
which nerve is a branch of peroneal nerve and has no motor function in leg
sural nerve. provides cutaneous innervation to skin on lateral leg
nerve damaged in mid-humeral fracture
muscle and action of musculocutaneous nerve (C5-C6)
all muscles of anterior compartment of arm; flex elbow and supination (biceps brachii)
muscle and action of medial nerve (C5-T1)
forearm- anterior compartment (except flexor carpi ulnaris and ulnar half of digitorum profundus); flex wrist and all digits, pronation
hand- thenar compartment; opposition of thumb. central compartment lumbricles of digits 2/3; flex MP and extend PIP and DIP of 2/3
muscle and action of ulmar nerve (C8-T1)
forearm- anterior compartment (flexor carpi ulnaris and ulnar half of flexor digitorum profundus)-flex wrist (weak) and digits 4/5
hand-hypothenar compartment, central compartment (interossei muscles palmar and dorsal)- dorsal-abduct digits 2-5; palmar adduct digits 2-5. (lumbricals digits 4/5)-flex MP and extend PIP/DIP of digits 4/5
(adductor pollicus)- adduct the thumb
muscle and action of axillary nerve (C5-C6)
teres minor-lateral rotation of shoulder
muscle and action of radial nerve (C5-T1)
posterior compartment- muscles of arm and forearm-extend MP, wrist and elbow. supination
knife touching nerve on upper border of the greater sciatic foramen injures the superior gluteal and not the pudenal because
the superior gluteal nerve artery and vein exit the greater sciatic foramen above the piriformis (muscle in greater sciatic foramen), pudendal nerve exits foramen below piriformis, as does the inferior gluteal nerve and sciatic nerve
obturator nerve exits where
pt who smells of wine, presents with confusion, disorentiation, bruises unsteady gait and horizontal nystagmus on lateral gaze and bilateral rectus palsies (CN VI palsy) has thamine deficiency and not vit B12 def because
pt has Wernicke-Korsakoff syndrome- likely to occur in setting of alcohol abuse.
vit B12 def causes anemia and subacute combined degeneration syndrome- loss of DCML spinocerebellar, and corticospinal tracts- not CN defects.
Wernicke's vs Korsakoff's
Wernicke encephalopathy (WE)- early, encephalopathy, ataxia, and oculomotor dysfunction
Korsakoff- late, confabulation, anterograde and retrograde memory loss (thalamus and mamillary bodies damage)
thiamine B1 deficiency can cause Wernicke-Korsakoff's and polyneuritis (dry beriberu) and not megaloblastic anemia b/c because
megaloblastic anemia is due to vitB12/ folate def. thiamine can also cause wet beriberi-dilated cardiomyopathy
pellagra triad and vit def
vit b3 niacin def-diarrhea, dermatitis, nd dementia
vit def in night blindness
nerve associated with injury:
-anterior dislocation of shoulder or fracture at surgical neck of humerus
-wrist (carpal tunnel)
-"Saturday night palsy", compression of spiral groove or mid-humeral shaft fracture
ulnar, axillary, median, and radial
inability to recognize faces
prosopagnosia-bilateral lesion of visual association cortex
normal perception devoid of meaning
deficit in cognition about one's illness
anosognosia-lesion in non-dominant parietal lobe
fabrication of stories and event that never happened to fill in memory gaps
confabaulation-seen in dementias
"dissociative orders not otherwise specified"
Gasner syndrome-giving approximate answers instead of exact ones, seen in prison inmates
mc location of arachnoid cysts
pt with ptosis, and mydriasis has lesion in oculomotor nerve and not superior cervical ganglion b/c
s.c.g. lesion would cause miosis, ptosis, and anhidrosis-horner's syndrome
muscle that closes eyelid/CN
orbicularis oculi and facial nerve
CN that controls afferent limb of corneal blink reflex
afferent and efferent pathway in pupilary light reflex, present in blind person?
afferent- CN II (optic) to pretenctal area. to efferent-CNIII to cilliary ganglion to pupillay sphincter muscle- miosis. yes doesn't involve visual cortex
CN III nucleus
CNIII mediates what 3 actions in eye
levator palpebrae- eyelid opening
pupillar constriction-parasympathetic fibers
embryonic connection between 3rd and 4th vent is mesencephalon and not metencephalon b/c
mes-midbrain-sylvian aqueduct, vs met- pons and cerebellum (upper part of 4th vent)
pregnant women with mumps infection can give birth to a child with
non communicating hydrocephalus-aqueductal stenosis
mitochondrial enzyme that uses thiamins B1
immigrant pt with meningitis and CSF with lymphs, plasma cells, macs, fibroblasts, and increased protein, and depressed glucose has mycobacterium tuberculosis and not neisseria meningitis b/c
pt has chronic meningitis- caused by fungus, mycobacterium, syphilus
neisseria causes acute pyogenic meningitis- increased neutrophils, and viruses cause acute lymphocytic meningitis-increase lymphocytes alone.
nucleus in CNS dies b/c of dengeneration of afferent pathway from DRG (i.e loss of gracilus and cuneatus nuclei in Friedreich's ataxia (FA))
dentate nucleus receives input and projects to
input-Purkenje fibers and output-cerebellar neocortex through middle cerebellar peduncles
gag reflex afferent and efferent arc
afferent-IX and efferent X
loss of ability to shrug shoulders and raise arms above horizontal level is cause by damage to spinal accessory and no axillary nerve b/c
s.a- innervates trapezius muscle
a.-branch of brachial plexus and innervates deltoid and teres minor muscles
surgery to reach pituitary adenoma travels through which sinus? not ethmoid b/c
sphenoid. ethmoid is related to medial wall of orbit
which is reversible delirium or dementia
pediatric tumor with evidence of both neuronal and glial differentiation
can pineal gland cause bitemporal hemianopia? why or why not? what else is found here?
no b/c it's in the posterior aspect of brain along with superior colliculus
trigeminal nerve branches are and exit the skull where?
V1 (opthalmic)-superior orbital fissure
V2 (rmaxillary)-foramen rotundum
nerves that exit skull via hypoglossal canal, jugular foramen, internal auditory meatus, stylomastoid foramen, superior orbital fissure, optic canal, cribiform plate, foramen spinosum
-chorda tympani (branch of facial nerve)
-opthalmic branch of trigeminal (V1), 3,4,6
-CN 2 and opthalamic artery
-middle meningeal artery
eyes aren't in same direction. i.e. CN III palsy- down and out
artery defect and ophthalmologic deficit
-aneurysm can cause bitemporal communicating
-cacification can cause binasal hemianopia
-homonymous hemianopia with macular sparing
-CN III palsy
-crescentic microrganisms and necrosis
-central necrosis surrounded by granulation tissue and gilosis
-encapsulated oval microorganisms
-intranuclear and and intracytoplamic inclusions
-poorly differentiating cells with pseudopalisading necrosis
toxoplasmosis (crecent shaped tachizoites)-ring enhancing and central necrosis
bacterial abcess-ring enhancing and central necrosis
-cryptococcus-clustered hyperdensities in larged virchow-robin spaces
-subacute sclerosing panencephalitis
-grade VI asrocytoma (GBM)
round brain lesion at junction of cortical gray and white matter? not astrocytoma b/c
metastatic- from breast, kidney, lung ,colorectal and melanoma. astrocytoma has a irregular shape
pt with closed angle glaucoma is caused by? not cimetidine because
amitriptyline is a tricyclic antidepressant with anticholingergic affects cimetidine is a H2 antagonist that reduces gastric acid release
Goldmann's visual test that reveals bitemporal hemianopia. pt has HA and what type of tumor and symptom? breast discharge and not tinnitus because
pt has pituitary adenoma- goldmann's test has image with dots showing where pt can see. mc type is prolactinoma=milky breast discharge. tinnitus is associated with schwannomas
pt with right homonymous hemianopsia but 20/20 vision has occlusion where? and not Acomm because
Acomm would cause bitemporal hemianopsia. PCA- leads to homonymous hemianopia and spares the macula and visual acuity is preserved.
Chiari I vs Chiari II ( age, meningomyelocele, hydrocephalus, synringomyelia, symptoms)
I- adults, no, rare, and rare, HA, neck pain, cerebellar symptoms, lower brainstem symp (dysarthia, dysphagia, nystagmus), can be asymptomatic
II-infants, always present, common, common, brainstem dsyfunction (swallowing and feeding difficulties, stridor, nystagmus) weakness of extremities, and central cord symptoms
incomplete separation of cerebral hemispheres across midline=cyclopia, associated with trisomy 13 (Patau syndrome) and 18 (Edwards)
lissencephaly vs polymicrogyria
=smooth brain, lack of brain gyri and sulci vs excessive number of small gyri on brain surface (associated with Chari II malformation)
use what to treat GAD in man worried about sex dsyfunction and not fluoxetine because
buspirone (nonbenzodiazepine anxiolytic with no sexual dysfunction problems).
fluoxetine is and SSRI (can cause sexual dsyfunction) is not used to treat GAD.
mechanism of methamphetamine. hormone that plays a role in central reinforcement. no NE because
induces dopamine release., NE, and serotnine. doapmine. NE is produces systemic side effects (HTN)
blow to the head followed by lucid (asymptomatic period) is what type of bleed? not subdural because
subdural-can be chronic but usually seen in elderly also not associated with lucid period but usually a rapid decline in consciousness also a forceful blow to head is associated with epidural
battle sign, raccoon sign, pneumocephalus
basilar skull fracture- delayed ecchymiosis over mastoid process, periorbital ecchymiosis, CSF leaking from nose
sumatriptan, buspirone, atypical antipsychotics (clozapine), ondansetron (antiemetic)
EPI is good for which type of glaucoma?
open angle, never used for closed b/c is causes mydriasis which would exacerbate the symptoms
prostaglandin F2 used to treat open angle glaucoma. reduces IOP by increasing outflow of aqueous humor
ester-type local anesthetic (along with cocaine, procaine, tetracaine)
how to you test for these nerves: (reflexes or muscle & dermatomes)
S1, L4, L5 what about L3 and L2 which don't have reflexes
-plantar reflex and exert foot against oppositions, achilles tendon reflex, dermatome is lateral aspect
-patellar reflex, dermatome is medial aspect,
-tibaialis posterior reflex- hard to illicit, to test have pt plantar flex and evert foot against opposition, dermatome is central aspect of foot
-no reflexes so use hip flexion (L2, L3, L4) and hip adductors (L2, L3, L4); dermatones are on anterior thigh
newborn ventilated with FiO2 as a premie and devleops whites puipilary reflex after 3 wks has? the underlying cause is? not pigmentated epithelium because?
severe retinopathy of prematurity (formerly known as retrolental fibroplasia), major risk factors are prematurity and intensive O2 therapy (FiO2 of 100%)
increased levels of O2 leads to vasoconstriction of retinal vessels- increase VEGF production in blood proliferation
pigmented epithelium degeneration is a feature of retinitis pigementosa and senile macular degeneration (both of these are unlikely during prego)
saturday night palsy
drunk individual's arm is draped over back of chair-damage to radial nerve
does carpal tunnel affect palm sensation
no? branch of median nerve- palmar cutaneous passes above the carpal tunnel
lesion of dorsal gray horn vs column
horn has sensory input lesion leads to loss of pain and temp signals (1st neruon in spinothalamic tract)
column has input for vibration and position sense.
ventral column vs ventral horn
horn contains LMNs- lesion cause ipsilateral flaccid paralysis
column contains anterior corticospinal tract- not as important as lateral corticospinal. contains some ipsilateral UMN
19 yr MVA pt with anisocoria, dilated right eye, hemiplegia and extensor planatr reflex on left side, with epidural hematoma the artery damaged is? not superior orbital fissure because?
middle meningeal artery-enters in middle cranial fossa, leads to epidural bleed, pressure on parasympathetics causes dilated pupil.
Not superior orbital fissure it contains the opthalmic vein, and CN III, IV, VI. pt's oculomotor movements are intact.
what structures are contained in the
-anterior cranial fossa
-inferior orbital fissure
-posterior cranial fossa
-superior orbital fissue
-vein that communicates with pterygopalatin and infratemporal space
-brain stem and cerebellum, vertebral and basilar arteries
-ophthalmic vein, CN III, IV,VI
encephalitis in HIV pt (locations of each)
-blood vessels-produces hemorrhagic infarcts
-basal surface of brain
nerves needed to say
-VII (move lips)
-XII (move tongue)
-X (raise palate)
pt on tricyclics passed away from complication due to? not respiratory depression because
lethal arrhythmia is a complication from tricyclic meds. respiratory depression in a common cause of death in sedative-hypnotic and narcotic overdoses.
drug known to cause priapism
most likely cause of fungal meningitis in an immunocompromised pt is monomorphic yeast and no septate hyphae b/c
mc is cryptoccocus meningitis and not aspergillus
pt with "locked in syndrome" has lesion where? not midbrain b/c
pon-where basillar artery travels, tegmentum is spared-pt is aware of surroundings
midbrain-lesions here can be medial-ispsilateral oculomotor nerve palsy and contra-lateral hemiplagia or lateral-leading to ipsilateral ocuomorot nerve palsy, c. cerebellar ataxia with intention tremor, and c. loss of tactlie senstation from trunk and extremities. or tectal-leading to failure of upward gaze.
loss sensation of contralateral body and face
lesion in thalamus (sensory relay center)
Intraventricular hemorrhage (IVH) in preterm infant, leading to obstruction of foramina of monro is caused by bleeding from where?
germinal matrix (vry vascular)- can bleed into lateral ventricles and clot b/f being absorbed
therapy for OCD? not busprione because
give TCAs (clomipramine) or SSRIs (fluoxetine)
Buspirone-nonbenzodiazepine anxiolytic, stimulates 5-HT1a receptors, used for GAD, no sedation, addiction, or tolerance effects
mc brain tumor? located where?
metastases (lung, breast, kidney colon, and melanoma), located at junction of cortical gray and white matter
hyperacusis seen in UMN or LMN?
LMN (close to facial nerve damage hear can lead to increased sensitivity to sound b/c of stapedius muscle paralysis) in LMN lesion in face check for loss of facial nerve function due it's proximity to the nerve.
subarachnoid hemorrhages due to berry aneursyms are associated with
marfan's Ehler's-danlos, adult polycystic kideny disease, HTN, and smoking
treatment for delirium tremens? in pts with liver dz?
benzodiazepines; LOT- lorazepam, oxazepam, temazepam
mechanisms of drugs used with pt suffering from alcohol
-discourage alcohol abuse
-methanol od ethlylene toxicity
-decrease cravings for alcohol and opiods
-benzodiazepems (LOT-lorazepame, oxazepam, temazepam if pt has liver dz)
-disulfiram (inhibit alcohol dehyrdrogenase, cause increased effects of alcohol)
-fomepizole (inhibits alcohol dehydrogenase)
-naltrexone (opioid receptor antagonist)
-thiamine (W-K is assiociated with malnutrition seen in alcoholics)
mechanism of ethylene metabolism and toxicities
eth-glycoaldehyde (via alcohol dehydrogenase); aldehyde dehydrogenase converst glycoaldehyde-glycolic acid which gets converted to oxalic acid. toxic to kidney, brain, and causes metabolic acidosis
mechanism and toxicity of methanol metabolism
-methanol to formaldehyde via alcohol dehydrogenase; aldehyde dehydrogenase converts formaldehyde to formic acid. toxic to eyes, lungs, and severe anion gap metabolic acidosis
mechanism of ethanol metabolism
ethanol to actealdehyde via alcohol dehydrogenase and acetaldehyde to acetic acid via acetaldehyde dehydrogenase (this step is inhibited by disulfiram)
toxicities of acetaldehyde
breakdown product of alcohol N&V, HA, hypotension, combines with folate and inactivates it, combines with thiamine and decreases availability (W-K syndrome)
mechanism of gout and chronic alcoholism
lactate breakdown product from muscle wasting competes with urate for excretion
role of muscle length regulators
-alpha motor neurons
-golgi tendon organs
-attach to intrafusal fibers and defect changes in tension. synpases with alpha motor neurons which innervate the muscle. (i.e. patella reflex) extrafusal fibers produce but do not modulate tension
golgi tendon organs do not participate in myotactic reflexes, the regulate muscle tension and are invovled in fine control of movement and posture.
mechanism of tPA
serine protease that bind to fibrin protein threads of a thrombus and converts the enmeshed plasminogen to plasmin allowing for fibrinolysis
naegeria fowleri vs acanthamoeba
affects heathly pts (usually divers or those in contact with freshwater)
both can infect brain and cause meningioencephalitis
aka heterotropia. when eyes do not point in same direction
increases dopamine release
inhibits monoamine oxidase (4)
MAO inhbitors (tranylcypromine, phenelzine, iproniazid, and isocarboxazid)
benzodiazepines and barbiurates
selectively inhbit reuptake of serotonin
SSRIs- fluoxetine, paroxetine, sertraline
brain stem lesion tips:
whenever lesion involves spinal trigeminal (ispilateral loss of pain on face).
-if it's bilateral loss of any 1 sense or function
-if vagus nerve is involved (hoarseness and trouble swallowing)
if toungue is deviated CN XII
-if you see olives
-it's a lateral lesion (AICA or PICA)
-it's a place where there's only 1vessel supply (basilar artery in pons)
-it's PICA (Wallenbery Syndrome)-lateral medullary syndrome
-it's in medial medulla-ASA
-you're in medulla
deficits seen in medial midbrain syndrome? aka?
Weber's syndrome-contralateral spastic hemiparesis (coticospinal tract), contralateral hemipariesis of lower half of face (corticobulbar tract-UMN), dilated pupil, ptosis, and lateral strabismus (CN III)
temporalis muscle in innervated by CN located where? not lower pons because?
CN V located in mid pons (along with 6). lower pons contains CN 7 (muscle of facial expression and stapedius muscle) and 8.
CNs in medulla
CNs in midbrain
MS autoimmune disease that presents with destruction of (2) but relative preservation of (1). initiated by what WBCs? that react against self antigens and secrete (1). why not IgG or IgGM? hypersensitivity type?
central loss of oligodendrocytes and myelin
CD4+ TH1 lymphoctytes
secrete interferon-gamma to activate macs which cause destruction
not IgG-b/c that's type II or III
not IgM b/c that's type III (i.e. rheumatoid arthritis)
interlukin-10 produced by
product of TH2 lymphocytes
transforming growth factors beta- produced by? action on?
produced by TH2 to encourage B-call type switching
gene mutation in Friedriech's ataxia? chromosome? repeeat. loss of neurons where? leads to death of nuclei in medulla. this is called?
frataxin gene, 9, (GAA). degeneration of large sensory myelinated neurons in DRG, can cause transsynaptic degeneration
2 causes of bacterial meningitis in elderly pts. most common cause and it's most important pathogenic mechanism
neisseria meningitidis and strep pneumonia.
strep pneuo- IgA polysaccharide capsule
cytolysins are produced by which (2) bacteria
staphylococcus aureus and clostridum perfringens
rapidly progressive dementia, with startle myoclonus, EEG activity is
Creutzfledt-Jacob disease (CJD)-spongiform change in gray matter
melanocytes, odontoblasts, schwann cells, para and sympa ganglia neurons, and sensory ganglia of CN V, VIII, IX, and X and leptomeninges come from what germ cell layer
neural crest cells
enterochromaffin cells are derived from? and give rise to?
stem cells that give rise to gut epithelium
haploid of G1/G0 vs G2 vs S?
G1/G0-2N (neuronal cells)
G2-4N (non-neuronal cells)
S- halfway b/t 2N and 4N (tumor cells)
hematoma caused by tearing central bridging veins vs hematoma caused by cerebral artery
both subdural-cresent shaped, doesn't cross midline, extends across sutures and dips into falx cerebi
cerebral artery-more serpetine appearnce b/c they follow exact contour of brain filling in any adjacent suci or cisterns
HTN and bradycardia in response of ICP.
polymyalgia rheumatica is associated with what vascular patholigy
temporal arteritis (can cause HA and jaw claudication) common in elderly
ligation of MCA causes most ischemic damage because
it's not a part of the circle of Willis (Acomm, ACA, internal carotid, Pcomm, PCA)
widespread neuronal loss gliosis in subcortical site
progressive supranuclear palsy, opthalmoplegiaa, pseudobulbar palsy, axil dystonia, and bradykinesia. intelligence is normal
increased ICP can lead to what CN palsy?
6-false localizing sign (b/c it has a long course)
look away from lesion vs looking towards
stroke vs seizure
two mc causes of bacterial meningitis in neonates. how to tell b/t the two? treatment?
group B strep and e. coli. gram stain. give ampicillin to GBS positive mothers during labor. give enema prior to delivery in E. coli infected women
taste from anterior 2/3 of tongue
general sensation of anterior 2/3 of tongue
V, VII, V
-crytococcoisis and histoplasmosis
-hantavirus-fatal respiratory illness-desert in SW part of US
meningioma of the parasagittal regino and falx cerebri is located where? what part of homunculus is affected?
superiorly b/t two hemispheres. motor and sensory to lower extremeties
CAMP test positive
group B strep