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Step 1 > Neurology > Flashcards

Neurology Flashcards

1
Q

Alar and Basal plate

A

Alar (Dorsal) - Sensory
Basal (Ventral) - Motor

Separated by sulcus limitans

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2
Q

Derivatives of…
Prosencephalon
Mesencephalon
Rhombencephalon

A

Telencephalon (Cerebrum, Lateral ventricles)
Diencephalon (Thalamus/Hypothalamus, 3rd ventricle)

Mesencephalon (Midbrain, Aqueduct)

Metencephalon (Pons/Cerebellum, Upper 4th ventricle)
Myelencephalon (Medulla, Lower 4th ventricle)

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3
Q

Derivatives of…
Neuroectoderm
Neural crest
Mesoderm

A

CNS neurons, Ependymal cells, Oligodendroglia, Astrocytes

PNS neurons, Schwann cells

Microglia

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4
Q

Increased AFP

Increased AChE

A

Meningocele
Meningomyelocele

Note - In spina bifida occulta (tuft of hair, skin dimple) only bony vertebrae fails to fuse so AFP is normal

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5
Q

Increased AFP
Polyhydramnios (swallowing center)

Associated with…
Maternal T1DM
Low folate

A

ANENCEPHALY

Malformation of anterior neural tube - No forebrain and open calvarium

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6
Q

Mutation responsible for holoprosencephaly - May present anywhere from cleft lip/palate to cyclopia

Associated with…
Patau syndrome
Fetal alcohol syndrome

A

Sonic hedgehog signaling pathway - failure of left and right hemispheres to separate

example of developmental field defect (initial embryonic disturbance causes multiple malformations)

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7
Q

Cause of hydrocephalus in lumbosacral meningomyelocele

A

CHIARI II MALFORMATION

Herniation of cerebellar vermis and tonsils through foramen magnum with aqueductal stenosis

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8
Q

Cystic enlargement of 4th ventricle in posterior fossa
Noncommunicating hydrocephalus
Spina bifida

A

DANDY-WALKER SYNDROME

Agenesis of cerebellar vermis

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9
Q

Cape-like loss of pain and temperature
Fine touch preserved
loss of upper extremity pain and temperature sensation

Associated with…
Chiari I malformation (cerebellar tonsillar ectopia –> headache and cerebellar symptoms)
Trauma
Tumors

A

SYRINGOMYELIA

Fibers crossing anterior white commissure - Spinothalamic tract

damage to ventral white commissure and ventral horns

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10
Q

Taste and sensation on anterior, posterior, and base of tongue

A

Anterior (Arches 1/2):
Taste - Chorda tympani (CN VII)
Sensation - Lingual (CN V3)

Posterior (Arches 3/4)
Taste/Sensation - CN IX

Base (Arches 3/4)
Taste/Sensation - Internal Laryngeal (CN X)

Note - All motor function is by CN XII except the palatoglossus (CN X)

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11
Q

Nissl staining does not show…

A

Axon - no RER

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12
Q 
Cell marker for cell involved in...
Physical support/repair
BBB
Excess neurotransmitter removal
K+ metabolism
Glycogen fuel reserve
A

GFAP (Astrocyte)

Responsible for reactive gliosis in response to neural injury

Note - GFAP stains all Glial cells (Astrocytes, Oligodendrocytes, Ependymal cells), while Synaptophysin stains neurons

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13
Q

Fuse to form multinucleated giant cells in CNS of HIV patients - Not discernible by Nissl stain

A

MICROGLIA

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14
Q

Internal acoustic meatus tumor extending to cerebellopontine angle - GFAP+

A

VESTIBULAR (CN VIII) SCHWANNOMAS

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15
Q

Difference between oligodendrocytes and Schwann cells

A

Oligodendrocytes (CNS) can myelinate many axons, while Schwann (PNS) can only myelinate one

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16
Q

Fast adapting receptors responsible for…

Dynamic light touch
Vibration/Pressure

A

Meissner - Glabrous skin
Pacinian - Deep skin, Ligaments, Joints

Note - Both large, myelinated

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17
Q

Slow adapting receptors responsible for…

Pressure, Slippages, Joint angle change
Pressure, Static touch, Position sense

A

Ruffini - Dendritic endings with capsules

Merkel - Large, myelinated

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18
Q

Pain/Temperature receptors in skin and viscera

A

FREE NERVE ENDINGS

C (slow, unmyelinated) and Ad (fast, myelinated) fibers

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19
Q

Layer of peripheral nerve with inflammatory infiltrate in GBS

A

Endoneurium - invests single nerve fiber

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20
Q

Layer of peripheral nerve that must be attached in microsurgery

A

Perineurium - surrounds a fascicle of nerve fibers

Note - All fascicles and blood vessels surrounded by epineurium

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21
Q 
Location of synthesis of...
Acetylcholine
Dopamine
GABA
Norepinephrine
Serotonin
A

Basal Nucleus of Meynert

Ventral Tegmentum/SN pars compacta

Nucleus Accumbens

Locus Ceruleus (posterior rostral pons)

Raphe Nucleus

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22
Q

Mechanism of glucose and amino acid transfer through BBB

A

Carrier-mediated transport

Note - Nonpolar/lipid-soluble substances can cross rapidly by diffusion

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23
Q

Areas with BBB containing fenestrated capillary endothelium

A

Area postrema
OVLT (osmotic sensing)
Neurohypophysis

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24
Q

Mechanism of vasogenic edema

A

Neoplasms and infarction destroy BBB endothelial tight junctions

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25
Q

Function of locations of hypothalamus…

Lateral
Ventromedial
Anterior
Posterior
Arcuate
Paraventricular
Supraoptic
Suprachiasmatic
Tuberomammillary
A 
Hunger (Ghrelin)
Satiety (Leptin)
Cooling (Parasympathetic)
Heating (Sympathetic)
Dopamine, GnRH, GH
ADH, Oxytocin, CRH, TRH
ADH, Oxytocin
Circadian rhythm
Arousal
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26
Q

Mechanism of circadian rhythm control by light

A

SCN releases NE
NE acts on the pineal gland
Pineal gland releases Melatonin

Note - Circadian rhythm controls nocturnal release of ACTH and Prolactin as well

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27
Q

Controls extraocular movements during REM sleep

A

PPRF (Paramedian pontine reticular formation/conjugate gaze center)

Note - Increased ACh in REM

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28
Q

Substances associated with decreased REM and delta wave sleep

A

Alcohol
Benzodiazepines
Barbiturates
Norepinephrine

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29
Q 
Prominent EEG waveform during...
Awake with eyes open
Awake with eyes closed
Stage N1 Non-REM (light sleep)
Stage N2 Non-REM (deep sleep)
Stage N3 Non-REM (deepest sleep)
REM

Note - REM occurs every 90 minutes and increases in duration throughout the night

A

Beta (highest frequency, lowest amplitude)
Alpha
Theta
Sleep spindles, K complexes
Delta (lowest frequency, highest amplitude)
Beta

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30
Q 
Stage of sleep where the following occurs...
Bruxism
Sleepwalking
Night terrors
Bedwetting
Loss of motor tone
Variable pulse and blood pressure
Dreaming/Nightmares
Penile/clitral erection
Memory processing
A 
N2
N3
N3
N3
REM
REM
REM
REM
REM
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31
Q

Input to VPLN of thalamus

A

Spinothalamic
Dorsal column
Medial lemniscus

Note - To primary somatosensory cortex (postcentral gyrus)

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32
Q

Input to VPMN of thalamus

A

Trigeminal (face sensation)
Gustatory (taste)

Note - To primary somatosensory cortex (postcentral gyrus)

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33
Q

Input to LGN of thalamus

A

CN II (vision)

Note - To calcarine sulcus

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34
Q

Input to MGN of thalamus

A

Superior Olive/Inferior Colliculus of Tectum (hearing)

Note - To temporal lobe

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35
Q

Input to VLN of thalamus

A

Basal ganglia/Cerebellum

Note - To motor cortex (precentral gyrus)

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36
Q 
Function of the limbic system - includes...
Hippocampus
Amygdala
Fornix
Mamillary bodies
Cingulate gyrus

(“5 Fs”)

A 
Feeling
Feeding
Fleeing
Fighting
Sex
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37
Q 
Mechanism of Schizophrenia/Antipsychotic effects...
Mesocortical
Mesolimbic
Nigrostriatal
Tuberoinfundibular
A

Decreased in schizophrenia - Negative symptoms
Increased in schizophrenia - Positive symptoms
Decreased by antipsychotics - EPS
Decreased by antipsychotics - Hyperprolactinemia

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38
Q

Input and output of the cerebellum

A

Input:
Contralateral cortex via middle cerebellar peduncle

Ipsilateral proprioceptive information via inferior cerebellar peduncle from spinal cord

Output:
Contralateral cortex via superior cerebellar peduncle

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39
Q

Deep nuclei (lateral to medial)

“Don’t Eat Greasy Foods”

A

Dentate
Emboliform
Globose
Fastigial

Note - Deep nuclei are the connection between the Purkinje cells and the Superior cerebellar peduncle

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40
Q

Wide-based (truncal) cerebellar gait
Dysarthria
Head tilting

A

CENTRAL VERMIS (FASTIGIAL) LESION

May also develop Vertigo/Nystagmus from involvement of the Flocculonodular lobe

medial lesion affects the medial structures bilaterally

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41
Q

Basal ganglia direct pathway

A

Cortical inputs stimulate Striatum (Caudate, Putamen)
Striatum releases GABA inhibiting GPi
GPi stops releasing GABA disinhibitng the Thalamus
Increased movement

Dopamine from SNc binds D1 stimulating this pathway

Note - Motor cortex also directly modulates movement via the pedunculo-pontine nucleus

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42
Q

Basal ganglia indirect pathway

A

Cortical inputs stimulate the Striatum (Caudate, Putamen)
Striatum releases GABA inhibiting GPe
GPe stops releasing GABA disinhibiting the STN
STN stimulates GPi to inhibit Thalamus
Decreased movement

Dopamine from SNc binds D2 inhibiting this pathway

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43
Q

Treatment of…
High-frequency tremor of sustained posture
Worse with movement

A

ESSENTIAL TREMOR

Autosomal dominant

Treat with…
Propranolol
Primidone

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44
Q

Lesion resulting in hemiballismus

A

Contralateral subthalamic nucleus (STN)

Note - Usually from a lacunar stroke

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45
Q

Intracellular eosinophilic inclusions - Composed of a-synuclein

A

LEWY BODY

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46
Q

Mechanism of neuronal damage in Huntington’s

Presents as caudate atrophy and hydrocephalus ex vacuo

  • choreoathetosis
  • dementia
  • death
A

Autosomal dominant

CAG repeat

Loss of Ach and GABA in caudate leads to neuronal death via NMDA-R binding and glutamate excitotoxicity

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47
Q

Location of Broca’s area

A

Left posterior inferior frontal gyrus

Broca’s aphasia - language output deficit. Slow effortful speech that is agrammatic and telegraphic. Comprehension is largely preserved

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48
Q

Location of Wernicke’s area

A

Left posterior superior temporal gyrus

Wernicke aphasia- speech is preserved but language content is incorrect. Also have impaired comprehension and experience “word salad”, an inability to repeat, normal fluency, and are unaware of their deficits

Can be due to stroke affecting the middle cerebral artery

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49
Q

Transcortical motor aphasia

A

Broca’s aphasia with intact repetition

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50
Q

Transcortical sensory aphasia

A

Wernicke’s aphasia with intact repetition

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51
Q

Transcortical mixed aphasia

A

Global aphasia with intact repetition

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52
Q

Hyperphagia
Hypersexuality
Hyperorality

A

KLUVER-BUCY SYNDROME

Bilateral Amygdala lesions - Associated with HSV-1 encephalitis which involves the temporal lobe and limbic system

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53
Q

Agraphia
Acalculia
Finger agnosia
L/R disorientation

A

GERSTMANN SYNDROME

Dominant (L) parietal cortex lesion

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54
Q

Lesion resulting in…
Intention tremor
Loss of balance
Falling towards towards ipsilateral side

A

Cerebellar hemisphere

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55
Q

Lesion resulting in…

Anterograde amnesia

A

Bilateral hippocampal

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56
Q

Lesion resulting in…

Eyes looking away from the lesion

A

Paramedian pontine reticular formation (PPRF)

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57
Q

Lesion resulting in…

Eyes looking towards the lesion

A

Frontal eye fields

Note - Above Broca’s area

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58
Q

Equation for CPP

A

MAP - ICP

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59
Q

Regulation of CPP by CO2 and O2

A

PCO2 directly related to CPP until > 90
O2 indirectly related to CPP only when < 50

Note - Therapeutic hyperventilation (decreased PCO2) results in vasoconstriction/decreased blood flow and thus decreased ICP

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60
Q

Lesion resulting in…

Coma

A

Reticular activating system (Midbrain)

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61
Q

Upper leg weakness
Upper arm weakness
Defects in higher order visual processing

A

WATERSHED STROKE

Often due to severe hypotension

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62
Q

Contralateral face/body paralysis
Contralateral face/body sensory loss
Absence of cortical signs (neglect, aphasia, visual field loss)

Note - Embolic phenomenon most often occur in the cortex

A

LENTICULO-STRIATE LACUNAR STROKE

Arises from ICA/MCA and supplies Striatum/Internal capsule

Note - Lacunae are liquefactive necrosis from Lipohyalinosis/Microadenomas (HTN, DM)

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63
Q

Contralateral U/L limb paralysis
Contralateral proprioception deficits
Ipsilateral hypoglossal deviation

A

MEDIAL MEDULLARY SYNDROME

Stroke in paramedian branches of anterior spinal artery

Note - Anterior spinal artery arises from between both vertebral arteries

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64
Q 
Ipsilateral face pain and temperature loss
Contralateral body pain and temperature loss
Vomiting
Vertigo
Nystagmus
Dysphagia
Decreased gag reflex
Hoarseness
Ipsilateral Horner's
Ataxia
Dysmetria
A

LATERAL MEDULLARY (WALLENBERG) SYNDROME

Posterior inferior cerebellar artery stroke - Nucleus ambiguus (speech/swallow) deficits specific to this syndrome

Note - PICA arises from vertebral

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65
Q

Ipsilateral upper and lower facial paralysis
Ipsilateral face pain and temperature loss
Contralateral body pain and temperature loss
Vomiting
Vertigo
Nystagmus
Decreased lacrimation
Decreased salivation
Decreased taste (anterior tongue)
Ataxia
Dysmetria

A

LATERAL PONTINE SYNDROME

Anterior inferior cerebellar artery stroke - Upper and lower facial paralysis is specific to this syndrome

Note - AICA arises from beginning of basilar artery

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66
Q

Most common site of Saccular (berry) aneurysm

Note - Associated with ADPKD and Ehlers-Danlos

A

Junction of ACA with anterior communicating artery

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67
Q

Microaneurysm of lenticulostriate arteries resulting in internal capsule intraparenchymal hemorrhage

Note - Not seen on angiogram

A

CHARCOT-BOUCHARD ANEURYSM

Chronic hypertension

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68
Q

Mydriasis
Ptosis
“Down and out” eye

A

POSTERIOR COMMUNICATING ARTERY ANEURYSM

Compression results in CN III palsy

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69
Q

Bitemporal hemianopia

A

ANTERIOR COMMUNICATING ARTERY ANEURYSM

Compression of optic chiasm - May also be seen with Meningiomas, Pituitary adenomas, and Craniopharyngiomas

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70
Q

Lobar (not basal ganglia, internal capsule) intraparenchymal hemorrhage in elderly patient

A

Amyloid angiopathy

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71
Q

Bloody or yellow (xanthochromic) spinal tap

A

SUBARACHNOID HEMORRHAGE

Nimodipine to prevent subsequent vasospasm and ischemic infarct

May also lead to communicating or obstructive hydrocephalus

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72
Q

Regions most vulnerable to ischemia

Note - NCHCT may be normal for first 6-24 hours, but DWI will detect within first hour

A

Hippocampus (Pyramidal)
Neocortex
Cerebellum (Purkinje)
Watershed zones

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73
Q 
Histologic features of ischemic stroke at...
12 - 48 hours
1 - 3 days
3 - 5 days
1 - 2 weeks
> 2 weeks
A 
Red neurons
Necrosis + Neutrophils
Macrophages (Microglia)
Reactive gliosis + Angiogenesis
Glial scar + Myelin remnants

Note - Slow microglia recruitment due to BBB allows for myelin persistence in CNS decreasing neuronal regeneration

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74
Q

Headache
Seizures
Focal deficits

Associated with…
Pregnancy
OCP
Factor V Leiden

A

VENOUS SINUS THROMBOSIS

May progress to venous hemorrhage

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75
Q

Anatomy of dural venous sinuses

Note - Superior saggital sinus is the main location of CSF return via arachnoid granulations

A

Vein of Galen and Inferior saggital sinus form Straight sinus

Straight sinus, Superior saggital sinus, and Occipital sinus drains to Confluence of sinuses

Confluence of sinuses drains to Transverse sinuses

Transverse sinuses drain to Sigmoid sinuses and then internal Jugular

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76
Q

Anatomy of ventricular system

Note - Ependymal cells of choroid plexus make CSF, which is then drained to arachnoid granulations

A

Lateral ventricle drains to 3rd ventricle via interventricular foramina of Monro

3rd ventricle drains to 4th ventricle via cerebral (Sylvian) aqueduct

4th ventricle drains to subarachnoid space via foramina of Luschka (lateral) and foramen of Magendie (medial)

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77
Q 
Normal mental status
Headache worse in morning
Diplopia (CN VI palsy)
Loss of vision based on head position, sneezing
Papilledema
Elevated opening pressure

Note - Imaging may be normal or show slit ventricles and empty sella

A

IDIOPATHIC INTRACRANIAL HYPERTENSION

Associated with…
Vitamin A excess
Danazol
Tetracycline

Treat with...
Weight loss
Acetazolamide
Topiramate
LPs, Shunt, Optic nerve fenestration
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78
Q

Mechanism of communicating hydrocephalus - leads to increased ICP, papilledema, and herniation

A

Decreased CSF absorption by arachnoid granulation - may be due to scarring post-meningitis

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79
Q

Mechanism of NPH - communicating hydrocephalus

A

Expansion of ventricles distort fibers of corona radiata

Note – Does not result in increased subarachnoid space volume

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80
Q

Mechanism of noncommunicating hydrocephalus

A 
Structural blockage of CSF flow...
Foramen of Monro colloid cyst
Sylvian aqueduct stenosis
4th ventricle obstruction via Chiari II
Foramina of Luschka/Magendie via Dandy-Walker
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81
Q

Ventricular enlargement on imaging without triad of communicating hydrocephalus - ICP is normal

A

EX VACUO VENTRICULOMEGALY

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82
Q

Vertebral level for spinal tap

A

L3-L5

Spinal cord ends at L1/2 and subarachnoid space ends at S2 - needle should go below spinal cord but above end of subarachnoid space

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83
Q

Tract anatomy responsible for…
Fine touch
Pressure/Vibration
Proprioception

A

DORSAL COLUMN

1st order neuron (DRG) ascends ipsilaterally

Synapse in Medulla at Nucleus Cuneatus/Gracilis

2nd order neuron decussates in Medulla and ascends contralaterally via Medial Lemniscus

Synapses in VPL of Thalamus

Note - Gracilis (LE) inside, Cuneatus (UE) outside

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84
Q

Tract anatomy responsible for…
Lateral - Pain, Temperature
Anterior - Crude touch, Pressure

A

SPINOTHALAMIC TRACT

1st order neuron (DRG)

Synapse at ipsilateral gray matter of spinal cord

2nd order neuron decussates at Anterior White Commissure and ascends contralaterally

Synapse in VPL of Thalamus

Note - Cervical (inside) to Sacral (outside)

85
Q

Tract anatomy responsible for…

Voluntary movement

A

LATERAL CORTICOSPINAL TRACT

UMN descents ipsilaterally through internal capsule and decussate at pyramids (Medulla) to decent contralaterally

Synapse with cell body at Anterior Horn of spinal cord

LMN leaves spinal cord

Synapse at NMJ

Note - Cervical (inside) to Sacral (outside)

86
Q

Degeneration of anterior horns of spinal cord - LMN lesions only

A

Poliomyelitis (asymmetric)

Werdnig-Hoffmann (symmetric)

87
Q

Mutation in ALS

Note - No bowel/bladder or sensory deficits

A

Superoxide dismutase 1

88
Q

Loss of motor function below vertebral level
Loss of pain/temperature below vertebral level
Retained fine touch, proprioception, vibration

A

ANTERIOR CORD SYNDROME

Watershed at T8 - Adamkiewicz supplies ASA below this

89
Q

Ataxic gait
Paresthesia
Impaired proprioception/vibration

Note - Positive Romberg unlike Cerebellar ataxia

A

SUBACUTE COMBINED DEGENERATION

Spinocerebellar tracts
Lateral Corticospinal
Dorsal

Associated with…
Vit B12 deficiency
Pernicious anemia
Vit E deficiency

90
Q 
Begin with gait ataxia
Progress to dysarthria and dysphagia
Spastic weakness
Staggering gait/Falls
Kyphosis
Hammer toes
Pes Cavus
Diabetes
Hypertrophic cardiomyopathy
A

FRIEDREICH ATAXIA

Autosomal recessive GAA repeat on Chromosome 9 - Deficient Frataxin (iron binding protein) leads to impaired mitochondrial function due to iron overload and oxidative stress

Note - Spinal cord pattern similar to Vit B12/E deficiency

  • peripheral nerves
  • loss of tactile discrimination and of position and vibration sensation (dorsal columns)
  • spastic paresis (corticospinal tracts)
  • limb dystaxia (spinocerebellar tracts)
91
Q

Ipsilateral hemiparesis
Ipsilateral loss of position/vibration and fine touch
Contralateral loss of pain/temperature

Note - Loss of pain/temperature occurs two levels below lesion.

A

BROWN-SEQUARD SYNDROME

92
Q 
Vertebral levels for dermatomes...
Neck
Thumbs
Nipples
Umbilicus
Inguinal ligament
A 
C3/4
C6
T4
T10
L1
93
Q 
Nerve roots for reflexes...
Biceps
Triceps
Patellar
Achilles
Anal wink
A 
C5/6
C7/8
L3/4
S1/2
S3/4
94
Q

Paralysis of conjugate vertical gaze
Impaired convergence
Absent pupillary light reflex

nausea and vomiting and headache due to obstruction of cerebral aqueduct causing hydrocephalus

A

PARINAUD SYNDROME

Pinealoma (germinoma) above superior colliculus (dorsal midbrain)

Note - Inferior colliculus is auditory

Note- pineal gland is between thalamic bodies and modulates circadian rhythm by secreting melatonin in response to darkness or sympathetic stimulation

95
Q 
Location of cranial nerve nuclei...
Midbrain
Pons
Medulla
Spinal cord

Note - Lateral nuclei are sensory (alar plate) while medial nuclei are motor (basal plate)

A

CN III, IV
CN V, VI, VII, VIII
CN IX, X, XII
CN XI

96
Q 
Cranial nerve exits...
Cribriform plate
Optic canal
Superior orbital fissure
Foramen Rotundum
Foramen Ovale
Foramen Spinosum
Internal auditory meatus
Jugular foramen
Hypoglossal canal
Foramen magnum
A 
CN I
CN II
CN III, IV, V1, VI
CN V2
CN V3
Middle Meningeal Artery
CN VII, VIII
CN IX, X, XI
CN XII
Brainstem
97
Q

Only cranial nerve without thalamic relay to the cortex

A

Olfactory (CN I)

98
Q

CN responsible for salivation from…
Submandibular
Sublingual
Parotid

A

CN VII
CN VII
CN IX

99
Q

Vagal nuclei responsible for visceral sensory information

A

NUCLEUS SOLITARIUS

CN VII, IX, X

100
Q

Vagal nuclei responsible for motor innervation of swallowing

A

NUCLEUS AMBIGUUS

CN IX, X, XI

101
Q

Vagal nuclei responsible for parasythmatiecs to the thorax

A

DORSAL MOTOR NUCLEUS

CN X

102
Q

Parasympathetic innervation of the pupil

A

Preganglionic from Edinger-Westphal nucleus
Synapse in ciliary ganglion
Postganglionic short ciliary nerves to sphincter pupillae

Note - Sympathetics from Superior Cervical Ganglion

103
Q

Corneal reflex afferent and efferent

A

Afferent - Nasociliary (V1)
Efferent - VII

Note - Lacrimation reflex by same fibers

104
Q

Gag reflex afferent and efferent

A

Afferent - IX

Efferent - X

105
Q 
Physical exam presentation of...
CN V lesion
CN X lesion
CN XI lesion
CN XII lesion
A

Jaw deviates towards lesion

Uvula deviates away from lesion

Inability to turn head away from lesion (SCM), raise ipsilateral shoulder (trapezius)

Tongue deviates towards lesion

106
Q

Muscles of mastication responsible for…
Jaw opening
Jaw closing

A

Opening - Lateral pterygoid

Closing - Masseter, Temporalis, Medial pterygoid

107
Q

Contents of cavernous sinus

A

CN III, IV, V1, VI
Postganglionic sympathetic pupillary fibers
Internal carotid artery

Syndrome may result from…
Pituitary adenoma
Carotid-cavernous fistula (ICA dissection)
Cavernous sinus thrombosis (S. aureus infection)

Note - CN VI most susceptible to injury

108
Q

Tonotopy of cochlea…

A

Apex (wide, flexible) - Low frequency

Base (thin, rigid) - High frequency

109
Q

Weber test localizaiton

A

Conductive - Localizes to affected ear

Sensorineural - Localizes to unaffected ear

110
Q

Structures contained in…
Optic disc
Macula

A

Retinal vessels, optic cup
Fovea

Note - Retinal vein appears darker than retinal artery

111
Q

Drugs decreasing aqueous humor production by nonpigmented epithelium of ciliary body

Note - Ciliary body innervates zonule fibers for lens accommodation

A

b-blockers (Timolol, Betaxolol, Carteolol)
a2-agonists (Brimonidine)
Carbonic anhydrase inhibitors (Acetazolamide)

Brimonidine may cause...
Blurry vision
Hyperemia
Foreign body sensation
Allergy
112
Q

Aqueous humor pathways (2)

A

Trabecular outflow via canal of Schlemm to episcleral vasculature

Uveoscleral outflow

Note - Majority is via trabecular meshwork

113
Q

Refractive errors in…
Hyperopia
Myopia
Presbyopia

A

Short eyes focuses light behind retina - farsighted

Long eyes focuses light in front of retina - nearsighted

Age-related inelasticity of lens decreases accommodation - farsighted

114
Q

Mechanism of open-angle glaucoma

Note - Painless

A

May be primary (idiopathic)

May be secondary to blocked trabecular meshwork…
WBCs (uveitis)
RBCs (vitreous hemorrhage)
Retinal elements (retinal detachment)

115
Q

Mechanism of primary narrow-angle glaucoma

A

Forward movement of lens against central iris
Obstruction of normal aqueous flow through pupil
Fluid builds up behind iris
Peripheral iris pushed against cornea
Flow impeded through trabecular meshwork

Note - Secondary is due to hypoxia (e.g. retinal disease) inducing vaso proliferation in iris that contracts the angle

116
Q 
Painful, red eye
Sudden vision loss with halos
Poorly reactive mid-dilated pupil
Rock-hard eye (IOP)
Frontal headache
Increased cupping
Optic disc atrophy
A

ACUTE NARROW ANGLE GLAUCOMA

Ophthalmic emergency - Do not give epinephrine because of mydriatic effect

Note - Chronic is asymptomatic with gradual loss of peripheral vision

117
Q

Hypopyon - accumulation of pus in anterior chamber

A

UVEITIS

Uvea is between sclera and retina - Iris, Ciliary body, Choroid

118
Q

Gradual distortion and eventual loss of central vision (scotomas)

Yellow extracellular deposits (Drusen) in retinal pigment epithelium

A

DRY MACULAR DEGENERATION

Prevent progression with…
Antioxidants
Multivitamins

119
Q

Rapid loss of vision due to bleeding secondary to choroidal neovascularization

Distortion of straight lines
Grayish-green subretinal discoloration
Adjacent fluid/hemorrhage

A

WET MACULAR DEGENERATION

Often acute exacerbation of dry macular degeneration

Treat with…
Anti-VEGF (Ranibizumab)

120
Q 
Retinal hemorrhages
Macular edema
Cotton wool spots
Lipid deposition (granular)
Vascular proliferation
A

DIABETIC RETINOPATHY

121
Q

Retinal hemorrhage
Vessel engorgement
Edema

A

RETINAL VEIN OCCLUSION

Compression from nearby arterial atherosclerosis

122
Q

Crinkling of retinal tissue
Flashes and floaters
Monocular curtain-like vision loss

A

RETINAL DETACHMENT

Separation photoreceptor layer from pigmented epithelium

123
Q

Layers of retina

A 
Light
Ganglion cell layer
Inner plexiform layer
Inner nuclear layer (bipolar, amacrine)
Outer plexiform layer
Outer nuclear layer
Photoreceptors
Pigment epithelium/Bruch's membrane
124
Q

Acute, painless monocular vision loss
Pale retina

Cherry-red spot at fovea

A

CENTRAL RETINAL ARTERY OCCLUSION

Evaluate for carotid artery atherosclerosis or other embolic source

125
Q

Painless, progressive vision loss

Night-blindness (rods) initially

A

INHERITED RETINITIS PIGMENTOSA

Spicule shaped deposits around macula

126
Q

CMV, HSV, VZV infection followed by…
Retinal edema
Necrosis

Note - Optic disc hard to discern

A

RETINITIS

127
Q

Enlarged blind spot
Bilateral optic disc swelling
Elevated optic disc with blurred margins

A

PAPILLEDEMA

Note - Impaired axoplasmic flow

128
Q

Mechanism of pupillary light reflex

A

CN II to pretectal nucleus
Bilateral Edinger-Westphal activation
CN III to ciliary ganglion
Bilateral pupillary contraction

129
Q

Pathway for mydriasis

A

1st neuron in hypothalamus to center of Budge (C8-T2)

2nd neuron travels with cervical sympathetic ganglion near lung apices/subclavian to superior cervical ganglion

3rd neuron travels in ICA plexus and through cavernous sinus to enter the orbit as the long ciliary nerve

Note - Lesions above T1 may result in Horner’s

130
Q

Muscles and nerves responsible for ptosis

A

Superior tarsal muscle (superior cervical ganglion)

Levator palpebrae superioris (CN III)

131
Q

MARCUS GUNN PUPIL

A

Afferent pupillary defect - relative dilation when light is shone in affected eye

132
Q

Ptosis
Miosis
No anhidrosis

A

ICA DISSECTION

Sympathetics to sweat glands go from the superior cervical ganglion to ECA (not ICA)

133
Q

Function of IO and SO muscles

A

IO - Adduction/Elevation, Extortion
SO - Adduction/Depression, Intorsion

Note - When isolated from other muscles, the SO abducts the eye instead

134
Q

Mechanism of CN III palsy in ischemic and compressive lesions

A

Ischemic - Damage central motor fibers first resulting in ptosis and down/out gaze first

Compressive - Damage peripheral parasympathetics first resulting in blown pupil first

135
Q

Eye moves upward with contralateral gaze
Problems going down stairs
Head tilt away from affected eye

A

CN IV PALSY

136
Q

Left homonymous hemianopia

A

Right optic tract lesion

Note - Right side of retina (Left visual field) goes to the right lobe

137
Q

Left upper quadrantic anopia

A

Right Meyer Loop (temporal) lesion

Receives inferior retina - upper visual field

Note - MCA territory

138
Q

Left lower quadrantic anopia

A

Right Optic Radiation (parietal) lesion

Receives superior retina - lower visual field

Note - MCA territory

139
Q

Anatomy of INO

A

Frontal eye field to contralateral PPRF
PPRF to ipsilateral CN VI nuclei
CN VI nuclei connected to contralateral MLF
Contralateral MLF connected to CN III

Note - Often dorsal Pons lesion

140
Q

Altered proteins associated with…
Decreased sporadic Alzheimer’s
Increased sporadic Alzheimer’s
Early onset familial Alzheimer’s

A

ApoE2
ApoE4
APP, Presenilin-1/2

Note - Elevated APP in Trisomy 21

141
Q

Extracellular b-amyloid depositions - Dark on silver stain

Note - Formed by cleavage of APP

A

SENILE PLAQUES

Increased risk of amyloid angiopathy - lobar ICH

142
Q

Intracellular hyperphosphorylated tau protein - Insoluble cytoskeletal elements

A

NEUROFIBRILLARY TANGLES

Number correlates with degree of dementia

143
Q

Histology associated with…

Early changes in personality (behavioral) or aphasia (primary progressive aphasia)

A

FRONTOTEMPORAL DEMENTIA/PICKS disease

Inclusions of hyperphosphorylated tau (Pick bodies)
Ubiquitinated TDP-43

Note - Disinhibition is right frontal lobe, apathy and depression is left frontal lobe

144
Q 
Acute paralysis (Corticospinal)
Neck weakness, Dysarthria, Dysphagia (Pseudobulbar)
Loss of consciousness
Pons hyperintense on MRI

Note - Pseudobulbar because nuclei are intact

A

OSMOTIC DEMYELINATION SYNDROME (CENTRAL PONTINE MYELINOLYSIS)

Sudden correction of hyponatremia

(compared to cerebral edema in HYPERnatremia correction)

145
Q

CSF with…
Increased IgG
Myelin basic protein
Oligoclonal bands

A

MULTIPLE SCLEROSIS

Treat with…
IFN-b
Glatiramer
Natalizumab (a4-integrin inhibitor)

Note - Axons preserved in acute lesions

146
Q 
Ascending paralysis
Autonomic dysfunction
Mild sensory abnormalities
Albuminocytologic dissociation in CSF
Lipid laden macrophages
A

ACUTE INFLAMMATORY DEMYELINATING POLYRADICULOPATHY (GUILLAIN-BARRE)

Treat with IVIG and Plasmapheresis - Avoid steroids

Note - Associated with Campylobacter jejuni

147
Q

Viral infection or vaccination followed by…
Altered mental status
Rapidly progressive multifocal deficits

A

ACUTE DISSEMINATED ENCEPHALOMYELITIS

Multifocal periventricular inflammation and demyelination - treat with steroids

Note - No oligoclonal bands

148
Q

Pes cavus
LE weakness
LE sensory deficits

A

CHARCOT-MARIE-TOOTH

Autosomal dominant mutation results in defective myelin formation

149
Q

Globoid cells
Peripheral neuropathy
Developmental delay
Optic atrophy

A

KRABBE DISEASE

Lysosomal storage disease - Deficiency of Galactocerebrosidase causes build up of Galactocerebroside

150
Q

Central and peripheral demyelination
Ataxia
Dementia

A

METACHROMATIC LEUKODYSTROPHY

Lysosomal storage disease - Deficiency in Arylsulfatase A causes buildup of Sulfatides

151
Q

Drugs associated with PML

A

Natalizumab (a4-integrin)

Rituximab (CD-20)

152
Q 
Male with...
Progressive neurologic dysfunction
Adrenal crisis
Coma
Death
A

ADRENOLEUKODYSTROPHY

X-linked - Disrupts metabolism of very-long-chain fatty acids leading to excessive build up in CNS, adrenals, and testes

153
Q

Treatment of cluster headaches

A

Acute - O2, Sumatriptan

Prophylaxis - Verapamil

154
Q

Treatment of migraines

A

Acute - NSAIDs, Triptans, Dihydroergotamine

Prophylaxis - BBs, CCB, Topiramate, Valproate, TCA

155
Q

Sudden onset severe vertigo
Affected by position
N/V
Tinnitus

Horizontal unidirectional nystagmus - relieved by gaze fixation.

A

PERIPHERAL VERTIGO

156
Q

Intellectual disability
Port-wine stain
Seizures
Episcleral hemangioma/Glaucoma

Leptomeningeal angiomas
Unilateral tram-track calcifications

Note - Non-inherited

A

STURGE-WEBER

Sporadic activating mutation in GNAQ leading to abnormal neural crest derivatives

157
Q 
Intellectual disability
Ash-leaf spots
Hamartomas in CNS and skin
Angiofibromas
Mitral regurgitation
Cardiac rhabdomyomas
Renal angiomyolipomas

Note - Increased risk for subependymal astrocytomas

A

TUBEROUS SCLEROSIS

Autosomal dominant mutations in TSC1/2 - Hamartin/Tuberin tumor suppressor genes

158
Q 
Cafe-au-lait spots
Lisch nodules (pigmented iris hamartomas)
Cutaneous neurofibromas (GFAP+)
Optic gliomas 
Pheochromocytoma
Pseudoarthrosis

Note - Neurofibromas as neural crest derivatives

A

NEUROFIBROMATOSIS TYPE 1 (VON RECKLINGHAUSEN DISEASE)

Mutation in NF1 tumor suppressor gene on Chromosome 17 - Normally inhibits RAS

AD problem in neurofibromin

159
Q

Hemangioblastomas in CNS
Bilateral RCC
Pheochromocytoma
Angiomatosis (mucosal cavernous hemangiomas)

A

VON HIPPEL-LINDAU

VHL gene on Chromosome 3

160
Q

Pseudopalisading tumor cells
Central area of necrosis and hemorrhage
GFAP+

A

GLIOBLASTOMA (ASTROCYTOMA IV)

161
Q

Spindle cells in whorled pattern

Psammoma bodies

A

MENINGIOMA

Arachnoid cell origin

162
Q

Numerous capillaries
Minimal brain parenchyma
Elevated EPO (secondary polycythemia)

A

HEMANGIOBLASTOMA

Typically occurs in cerebellum

163
Q 
Cafe au lait spots
Cataracts
Neurofibromas
Multiple meningiomas
Spinal ependymomas
Bilateral acoustic neuromas
A

NEUROFIBROMATOSIS TYPE 2

Note - Schwannomas, Neurofibromas, and Melanomas are S-100+ (neural crest)

AD problem in merlin protein

164
Q

Calcified frontal lobe tumor
“Chicken-wire” capillaries
“Fried egg” cells
GFAP+

A

OLIGODENDROGLIOMA

165
Q

Cystic, solid posterior fossa mass in child
Well circumscribed
GAP+
Eosinophilic corkscrews (Rosenthal fibers)

A

PILOCYTIC (LOW GRADE) ASTROCYTOMA

166
Q

Solid cerebellar mass in child
Non-communicating hydrocephalus
Homer-Wright rosettes
Small blue cells

A

MEDULLOBLASTOMA

Malignant neuroectodermal tumor - Metastasizes to spine (drop metastasis)

167
Q

Responsible for detection of tension and stretch in muscle tendons

A

Tension - Golgi (Ib) in series

Length - Intrafusal (Ia, II) in parallel

168
Q

4th ventricle mass in a child
Hydrocephalus
Perivascular rosettes
GFAP+

A

EPENDYMOMA

169
Q

Calcified mass in child

Cholesterol crystals in “motor oil” like fluid

A

CRANIOPHARYNGIOMA

170
Q

Parinaud syndrome
Obstructive hydrocephalus
Precocious puberty/Elevated b-hCG

A

PINEALOMA

Obstructs Sylvian aqueduct

171
Q

Herniation resulting in ACA deficits

A

SUBFALCINE (CINGULATE) HERNIATION

172
Q

Herniation causing Duret hemorrhages - rupture of paramedian basilar artery branches

A

TRANSTENTORIAL (CENTRAL) HERNIATION

Caudal displacement of the brainstem

173
Q

Structures responsible for…

Blow, down-and-out pupil
Ipsilateral paresis
Contralateral homonymous hemianopia with macular sparing

A

UNCAL HERNIATION

Ipsilateral CN III
Contralateral crus cerebri (Kernohan notch)
Ipsilateral PCA

Note - Eventually damage to midbrain results in mid-positioned fixed pupils (pons is pinpoint)

174
Q

Herniation resulting in paralysis, coma, and death

A

CEREBELLAR TONSILLAR HERNIATION

Compression of brainstem

Note - Paralysis is initially flaccid (spinal shock) and becomes spastic days later

175
Q

Mechanism of cholinomimetics (M3) in treating glaucoma (Pilocarpine, Carbachol)

A

Increased outflow via contraction of ciliary muscles and opening of meshwork

Note - Pilocarpine is fast acting and good for emergencies (e.g. acute narrow angle glaucoma)

176
Q

Mechanism of prostaglandins (PGF2a) in treating glaucoma

A

Bimatoprost, Latanoprost - Increases uveoscleral outflow of aqueous humor

May cause…
Browning of iris
Eyelash growth

177
Q

First line for simple partial or simple complex seizure

Note - Complex is partial with LOC and post-ictal

A

Carbamazepine

178
Q

First line for generalized seizure (tonic-clonic, myoclonic)

Note - Juvenile myoclonic is worst with sleep deprivation and has no loss of consciousness or post-ictal but is still generalized

A 
Valproic acid
Phenytoin
Topiramate
Lamotrigine
Levetiracetam
179
Q

First line for acute and prophylaxis of status

A

Acute - Diazepam, Lorazepam, Midazolam

Prophylaxis - Phenytoin

180
Q

First line for seizures in neonates

A

Phenobarbital

Note - Induces Cytochrome P-450

181
Q

First line for trigeminal neuralgia

A

Carbamazepine

182
Q

Antiepileptics safest in pregnancy

A

Gabapentin
Lamotrigine
Levetiracetam

183
Q

Treatment of malignant hyperthermia

A

Dantrolene - Ryanodine receptor antagonist

184
Q

Mechanism of Tetrabenazine/Reserpine in treating Huntington’s

A

Inhibit VMAT - decreased dopamine packaging and release

185
Q

Mechanism of Riluzole in treating ALS

A

Decreasing Glutamate excitotoxicity - modest survival increase

186
Q

Mechanism of Sumatriptan in treating migraine and cluster headaches

A

5-HT1B/1D agonist…
Inhibits trigeminal nerve
Prevents vasoactive peptide release
Induces vasoconstriction

May cause…
Coronary vasospasms (CAD, Prinzmetal angina)
Mild paresthesia

187
Q

Changes in spinal cord shape moving rostrally

A

Less gray matter
More ovoid shape
Cuneate fasciculus appear at the thoracic level

Note - Low cervical cord (C7) and Lumbosacral have more ventral gray matter to innervate the limbs

Note - Thoracic cord contains lateral horn (preganglionic sympathetics)

188
Q

Inhibits REM-sleep related phenomenon and implicated in Narcolepsy

A

OREXIN (HYPOCRETIN)

Note - Treat with Modafinil

189
Q

Level of brainstem differentiating extensor and flexor posturing

A

Decerebrate (extensor) - Below red nucleus (midbrain tegmentum, pons)

Decorticate (flexor) - Above red nucleus (cerebrum, internal capsule)

Note - Red nucleus’ rubrospinal tract responsible for flexion

190
Q

Lower back pain
Saddle anesthesia
Flaccid paralysis of bladder and rectum
Impotence

A

CONUS MEDULLARIS SYNDROME

Compression at L1/L2

191
Q 
Radiating lower back pain
Saddle anesthesia
Loss of anal wink
Hyporeflexia
Weakness
A

CAUDA EQUINA SYNDROME

Disc herniation at L4/L5 or S1/S2

192
Q

Differentiation of LEMS from Myasthenia Gravis

A

In LEMS…
Autonomic symptoms
Hyporeflexia
Incremental response

Note - Associated with SCLC

193
Q

Hyperreflexia
Spasticity
Atrophy
Fasciculations

Loss of neurons in anterior horn
Atrophy of lateral corticospinal tract and precentral gyrus

A

ALS

Treat with…
Riluzole
MAOi (decreased glutamate)

194
Q

Cause of right nasal hemianopia

A

RIGHT PERI-CHIASMAL REGION

ICA calcification or aneurysm

195
Q 
Location of lacunar infarcts causing...
Pure motor hemiparesis
Pure sensory loss
Dysarthria-Clumsy hand
Ataxia-Hemiplegia
A

Posterior limb of internal capsule, Basal pons
VPL/VML thalamus
Genu of internal capsule, Basal pons
Posterior limb of internal capsule, Basal pons

196
Q

Optic tract fibers project to …

lateral geniculate nucleus
superior colliculus
pretectal area
suprachiasmatic nucleus

A
  • most fibers to LGN
  • reflex gaze
  • light reflex
  • circadian rhythms
197
Q

berry aneurysms are associated with what congenital anomaly

A

coarcation of the aorta

198
Q

First place that is damage in the brain with thiamine deficiency

A

mammillary bodies for emotion and memory

199
Q

Unilateral tremor in UE at rest and improves during purposeful movements

resting tremor
rigidity
bradykinesia
postural instability (late finding)

A

Parkinsons disease - degeneration of nigrostriatal dopamine neurons resulting in decreased levels of dopamine in the striatum. This causes an imbalance of dopamine and acetylcholine (DA is too low and ACh is too high)

tx involves increasing dopaminergic tone and decreasing cholinergic tone

200
Q

mechanism of cough syncope

A

increased intrathoracic pressure during a couching episode decreases venous return to the heart thereby transiently decreasing CO and cerebral perfusion

201
Q

The most common cause of neontatal meningitis is

A

Group B strep (GBS)

prevent by treating mother with IV ampicillin during labor

also: E. Coli

202
Q

Caused by direct trauma to the lateral aspect of the skull

Soon after the trauma, patient has a brief period of loss of consciousness which is followed by a lucid asymptomatic phase before further neurologic deterioration

A

EPIDURAL HEMATOMA

resulting in the laceration of the middle meningeal artery

classic biconvex hematoma due to cranial suture lines

203
Q

Trauma in vicinity of the petrous bone or along the sphenoid bone

A

Basilar skull fracture

  • hemotympanum (blood visible behind the tympanic membrane)
  • Battle sign (delayed ecchymosis over the mastoid process)
  • Raccoon sign (periorbital ecchymosis)
204
Q

Due to HTN, anticoagulant use, cerebral amyloid angiopathy, cocaine, and or methamphetamine abuse

CT shows intraparenchymal brightness

Focal neurologic signs

A

Intracerebral hemorrhage

205
Q

-Rupture of bridging veins between the meningeal dura and the superficial cerebral veins

A

Blood accumulates below the dura, producing symptoms of increased intracranial pressure

classically present as a cresent shaped hematoma because it can cross suture lines

206
Q

Neurological complication of middle ear infection (otitis media)

A

cerebellar and temporal lobe abscesses

CT shows a multilocular mass with ring-enhancing borders

207
Q

Isolated arcuate fasciculus lesion

note: arises in Wernicke area and travels to broca area

A

conduction aphasia characterized by a striking inability to repeat

language comprehension nd output are largely preserved

208
Q

Tricyclic antidepressant overdose

A

3 C’s:

cardiotoxicity (arrhythmias), convulsions, and coma

209
Q

Preterm infant with respiratory distress syndrome given oxygen therapy. Now has white pupillary reflex (leukocoria)

other conditions with leukocoria? retinoblastoma and cataracts in rubella

A

Retinopathy of prematurity

  • occurs almost exclusively in preterm infants
  • strong association with high partial pressure oxygen therapy
  • Oxygen causes accelerated neovascularization in the retina because high oxyen results in vasoconstriction of retinal vessels. This resulting ischemia stimulates vascular endothelial growth factor (VEGF) production to compensate

Step 1 (17 decks)

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