Neurology Flashcards
(301 cards)
1
Q
cause of death from bacterial meningitis (without sepsis)
A
herniation as bacteria and pus build up in the skull
2
Q
CSF lymphocytes, oligoclonal IgG bands on elecrophoresis, myelin basic protein
what disease?
A
multiple sclerosis
3
Q
a round mass attached to the dura, compressing but not invading the cortex
what tumour?
A
meningioma
4
Q
aneurysmal/tumour compression of CN III gives what symptoms first? why?
A
mydriasis first (parasympathetic fibres outside)
ptosis, down and out deviation later (somatic fibres on inside)
5
Q
who is at increased risk of subdural haematoma and why?
A
elderly
age-related CNS atrophy draws the brain back from the skull which stretches the vessels and predisposes to haematoma formaiton
6
Q
Berry aneurysm associations
A
PCKD
Marfan’s
7
Q
GBM is benign or malignant?
A
malignant
8
Q
most common CNS tumour in children?
where does it arrise?
A
pilocytic astrocytoma
subtentoral - cerebellum
9
Q
aetiology of spongiform encephalopathy
A
- sporadic (bad)
- inherited
- transmitted (‘infectious’)
10
Q
haemorrhage at the periphery of the cortex suggests what aetiology?
A
embolic stroke (e.g. AF)
probably in MCA
11
Q
following Wernicke encephalopathy, Korsakoff syndrome persists..
2 symptoms?
A
confabulation
memory loss
12
Q
muscle action of obturator nerve
A
adduction of thigh
13
Q
what does Rufifni corpuscles sense?
A
deep touch, slippage of objects, joint angle change
14
Q
xanthochromia suggests what?
A
subarachnoid haemorrhage
15
Q
what passes through jugular foramen?
A
nerve - CN IX (glossopharyngeal), X (vagus), XI (spinal accessory)
vessel - jugular vein
16
Q
what is the order of sensation loss with local anaesthetic?
A
pain - temperature - touch - pressure
17
Q
meningothelial cells tumour in adults
what sex more frequently?
A
meningioma
18
Q
Romberg test specifically tests for what?
A
distiguish between sensory or cerebellar ataxia
removal of visual input (closing eyes) means patient must rely on cerebellar integration of proprioceptive signals
Romberg +ve = sensory ataxia
19
Q
what is entacapone/tolcapone?
A
peripheral COMT inhibitor which acts like carpidopa to increase L-DOPA availability to brain
20
Q
what is the difference between a focal and generalised seizure?
A
focal = 1 cerebral hemisphere at onset
generalized = both hemispheres at onset
21
Q
when are the changes of axonal reaction at their most visible during Walleriagn degeneration?
A
12 days
22
Q
four functions of the facial nerve (affected in Bell’s palsy)
A
- facial muscles
- anterior 2/3rd of tongue
- autonomic innervation to lacrimal, submandibular and sublingual salivary glands
- somatic afferents from pinna and external auditory canal
23
Q
thalamus medial geniculate nucleus
what sensory input/nerve?
A
hearing
superior olive and inferior colliculus of tectum
24
Q
headache with sweating, facial flushing, nasal congestion, lacrimation and pupil changes suggests what?
A
cluster headache
25
diagnosis
epidural haematoma
26
astrocyte tumour in adults
glioblastoma multiforme
27
what are these called?
what is the tumour?
perivascular pseudorosette
ependymoma
28
thalamus lateral geniculate nucleus
what sensory input/nerve?
vision
CN II (optic)
29
what is the difference between physostigmine and other cholinesterase inhibitors?
physostigmine crosses BBB
30
what is cerebral pontine myelinosis?
demyelination of the pons leading to *locked-in syndrome* when hyponatraemia has been corrected too quickly
31
what are the three main muscles of the tongue and their actions?
1. hypoglossus - retracts and depresses
2. genioglossus - protrudes the tongue
3. styloglossus - draws sides of tongue up
32
describe this and what is the diagnosis?
regions of necrosis surrounded by tumour cells (pseudopalisading) and endothelial cell proliferation
gliblastoma multiforme
33
what are the 3 visible changes of Wallerian degeneration?
1. cellular oedema
2. nucleus to the side
3. Nissl staining darker and throughout the cell body
34
what is this and what are the associated conditions?
holoprosencephaly - *monoventricle and fusion of the basal ganglia*
Trisomy 13 and foetal alcohol syndrome
35
diagnosis?
pilocytic astrocytoma
36
diagnosis
spongiform encephalopathy
37
what is the inheritance pattern of Friedreich Ataxia?
AR
unstable trinucleotide repeat (GAA) in frataxin gene
38
where does Abeta amyloid come from?
APP protein, coded for on Ch21
APP usually undergoes alpha cleavage, but beta cleavage results in Abeta and subsequent plaque formation
39
what areas of CNS are involved in ALS?
lower motor neurons - anterior horn
upper motor neurons - lateral cortiospinal tract
40
principles of anaesthetics
what does blood and lipid solubility equate to clinically?
low blood solubility = rapid onset
lipid solubility = potency
41
2 obstetric signs of anencephaly
1. elevated AFP (as with all NTDs)
2. polyhydramnios (baby cannot swallow)
42
what structure connects the lateral to the 3rd ventricles?
foramen of monroe
43
what is this? what vessel has ruptured?
subarachnoid haemorrhage
berry aneurysm in the circle of willis
44
what cranial nerve exits at the level of the middle cerebellar peduncles?
trigeminal (CN V)
45
what is the first area of the brain damaged by global ischaemic injury?
pyramidal cells of hippucampus
46
universal astrocyte marker
GFAP
47
where is satiety sensation regulated?
ventromedial hypothalamus
48
what medication can be started following SAH prophylactically? how does it work?
nimodepine
cerebral Ca++ channel blocker that prevents post-SAH vasospasm
49
what about the vessel of a berry aneurysm makes it likely to rupture?
lacks a Media layer where the vessel is branching
50
which anti-epileptic first line drug is hepatotoxic requiring LFT monitoring?
valproate
51
cerebellar haemangioblastoma and visceral organ cysts (esp renal) suggests what disease?
von hippel lindau disease
associated with (bilateral) renal clear cell carcinoma
52
pale infarction suggests what aetiology?
thrombotic stroke
53
what agents act centrally in PD treatment to prevent breakdown of DA?
COMT inhibitor - tolcapone
MAO-B inhibitor - selegiline/rasagiline
54
of all brain tumours, how many are metastatic ?
50%
55
what are the different neuromuscular blockade drugs?
depolarising - ACh receptor agonists (succinylcholine)
non-depolarising - competitive ACh antagonists (tubcurarine, rocuroniuml, vecuronium)
56
Rx normal pressure hydrocephalus
LP gives temporary relief of symptoms
VP shunt definitive treatment
57
what is the first line treatment for acute status epilepticus?
benzodiazapines
58
lighting pain
absent reflexes
ataxia
suggests what pathology?
neurosyphilis
59
parotid gland tumour is associated with damage to which nerve?
facial nerve
60
what is located at the posterior portion of superior temporal gyrus
bilateral?
Wernicke's area - only on the dominant temporal lobe
61
*hydrocephalus ex-vacuo* is what?
enlargement of the ventricles caused by central neuron volume loss, rather than increased ventricular pressure
62
what CNS tumour crosses the corpus callosum?
GBM
63
define meningitis
inflammation of the leptomeninges (pia & arachnoid)
64
what is the reversal of depolarising NM block?
Phase I (prolonged depolarization) - no reversal possible
Phase II (repolarized but nAChR desensitized) - cholinesterase inhibitors
65
pathogenesis of normal pressure hydrocephalus?
gradual decrease in CSF resorption through the arachnoid granulations to the central venous sinus.
**gradual** increase in CSF volume allows the brain to retain function disproportionate to the degeneration visible on scan.
**wet, wobbly, wacky**
66
frontal blading, gonadal atrophy, muscle weakness and difficulty with doors suggests what pathology?
myotonic muscular dystrophy
67
diagnosis
subdural haematoma
68
what focal seizure
loss of consciousness & postictal state
possible automatisms (e.g. lip smacking)
complex focal
69
type of necrosis in ischaemic stroke
liquefactive necrosis
70
what is vigabatrin? indication?
GABA transaminase inhibitor
focal seizures
71
what is overdose treatment for barbituates?
supportive
maintain respiration and blood pressure
72
polio - LMN or UMN?
LMN
poliovirus attacks neurons in the anterior horn
73
15 year old boy with kyphoscoliosis and pes cavus has difficulty moving and walking
what is the diagnosis and what is the neuropathology?
Friedreich ataxia
degeneration of the spinocerebellar, lateral cortiospinal tract, and dorsal columns and DRGs
HOCM and DM 1 are associated
74
whorled pattern, psammoma bodies
diagnosis?
meningioma
75
adrenoleukodystrophy is cause by what?
inability to bind long-chain fatty acids to coenzyme A
76
what passes through foramen rotundum?
CN V2 - maxillary division of trigeminal
77
what is the antedote for benzo overdose?
flumazenil
competitive antagonist at GABA receptor
78
mutlinucleated giant cells in the brain suggest what?
HIV infection
forces microglial cells to fuse
79
ventral posteriolateral nucleus of thalamus
what sensory input/nerve(s)?
whole body sensation
spinothalalmic and dorsal columns, medial lemniscus
*to primary somatosensory cortex*
80
what is the target of carbidopa?
how does this help?
peripheral dopa decarboxylase, blocking conversion of L-DOPA to peripheral dopamine
increases availability of L-DOPA to cross into brain
81
lesion in the reticular activating system gives...
decreased arousal/coma
82
what is first line treatment for generalized, tonic-clonic seizures?
phenytoin or valproate
83
astrocyte tumour in kinds
pilocytic astrocytoma
84
what are the dopamine agonists in PD?
two groups
Ergot - bromocriptine
non-ergot - pramipexole, ropinirole (preferred)
85
what is levetiracitam? indications?
unknown mechanism anti-epileptic (possibly affects GABA/glutamate balance)
focal and tonic-clonic seizures
86
what is diphenoxylate?
opioid used as anti-diarrhoeal
87
where do you get an ependymoma?
wall of the 4th ventricle
88
what is sumitriptan?
cautions?
5-HT(1B/D) receptor agonist
inhibits trigeminal nerve activaiton, prevents vasodilation
treats migranes and cluster headaches
vasospasm - CAD, angina
89
what are the broad spectrum anti-epileptic drugs? (4)
levotiracitam, lamotragine, topiramate, valproate
(L-, L-, -ate, -ate)
90
what leaves the skull through optic canal?
**nerve** - CN II
**vessels** - opthalmic artery, central retinal vein
91
what is dextromethorphan?
opioid drug used as anti-tussive
92
what is the water sensing part of hypothalamus?
organum vasculosum lamina terminalis, OVLT
93
distinguishing symptoms of MCA stroke
only face and arms
parietal cortex involvement
(hemisensory neglect/aphasia depending on dominant hemisphere)
94
what is the mechanism of action for barbituates?
facilitates GABA(A) channels, keeps Cl- channel open for *longer duration* when activated by endogenous GABA.
95
what is the side effect of epinephrine used for glaucoma?
mydriasis, do not use in **closed-angle glaucoma**
96
how do cholinomimetics affect the eye and treat glaucoma?
M3 agonists
contraction of ciliary muscle, opening of trabecular meshwork and increasing outflow of aqueous humour
97
PML is caused by what and who gets it?
pattern?
JC virus
AIDS/leukaemia patients
rapidly progressive neurological signs (visual loss, weakness & dementia) leading to death
98
what are the two groups of local anaesthetic and examples of each
esters - procaine, cocaine, benzocaine
amides - lidocaine, mepivacaine, bupivacaine
99
what passes through internal auditory meatus?
CN VII (facial) and CN VIII (vestibulocochlear)
100
what is cyclobenaprine?
muscle relaxant acting centrally. similar to TCAs in structure
101
top bug for children and teenagers for meningitis
*N meningitidis*
102
'fried egg' cell appearance on biopsy
oligodendroglioma
103
medulloblastoma occurs in children. where is the most likely location for the tumour to develop?
cerebellar vermis
104
symptoms of mild global cerebral ischaemia?
transient confusion with total recovery
105
tinnitus
diagnosis? where exactly is this lesion located?
unilateral vestibulocochlear nerve schwannoma
cerebellopontine angle (between cerebellum and lateral pons)
106
where is the lesion in hemispatial neglect syndrome of a right hand dominant patient?
**nondominant** (right) **parietal** lobe
contralateral agnosia (left side neglect)
107
**GFAP** positive suggests what 5 cancers?
glial cell origin
pilocytic astrocytoma, GBM, ependymoma, oligodendroglioma, schwannoma
108
symptoms - fontal lobe lesion
disinhibition/concentration deficit
109
what is the protein structural change for spongiform encephalopathy?
prion protein going from alpha-helix to beta-sheet
110
nerve association of 2nd pharyngeal arch
facial nerve (CN VII)
111
What is brimonidine?
alpha-2 receptor agonist for use in glaucoma
112
what is Arnold Chiari malformation
what are the two types?
herniation of the cerebellar tonsils through the foramen magnum
Type 1 - no obstruction to CSF flow and no symptoms
Type 2 - vermis also heriated, obstructs drainage of the 4th ventricle so non-communicating hydrocephalus
113
what is benzotropine?
| (also trihexyphenidyl)
antimuscarinic used in PD to stop tremor and rigidity
no effect on bradykinesia
114
PathoG - rosenthal fibres
pilocytic astrocytoma
115
what passes through foramen ovale?
CN V3 - mandibular divison of trigeminal
116
how does the pH of a tissue (infected = acidic) affect local anaesthetic action?
acidic means amides will be charged so cannot cross cell membrane.
higher concentration of anaesthetic needed
117
nerve roots for all the reflexes...
sing song!
**S1-2**, buckle my shoe - **achilles**
**L3-4**, kick the door - **patellar**
**C5-6**, pick up the sticks - **biceps**
**C7-8**, lay them straight - **triceps**
118
what is a leukodystrophy?
inherited mutation in enzymes needed for myelination/maintenance of myelin
119
intracranial cyst filled with brown-yellow viscous fluid like machine oil
presence of protein and cholesterol crystals
diagnosis?
craniopharyngioma
120
foramina of Luschka and Magendie
which are located where relative to midline?
**L**uschka - bi**l**ateral
**M**agendie - posterio**m**edial
121
sudden onset unilateral hemianopia with macular spearing, visual agnosia and prosopagnosia
what's happened? what do these words mean?
contralateral posterior cerebral artery infarction
visual agnosia - *inability to regognise objects*
prosopagnosia - *inability to recognise faces*
122
where is the CNS centre of parasympathetic control?
anterior hypothalamus
123
treatment for huntington's disease?
tetrabenazine and reserpine - inhibit VMAT (decrease DA vesicle loading & release)
haloperidol - dopamine D2 antagonist
124
# define subfalcine herniation
what kills you?
displacement of the cingulate gyrus under the falx cerebri
compression of ACA
125
what happens in diabetic III nerve palsy?
vasculopathic **central** nerver ischaemia occurs first
somatic fibres affected \> autonomic fibres
eye held in down and out position, pupils are equally reactive to light and accomodation
126
what is the vomiting centre of brain?
area postrema
127
what is Dandy-Walker malformation?
failure of development of the cerebellar vermis
128
Where exactly is a Berry aneurysm likely to form?
branch points of the ACA and the anterior communicating artery
129
what is a familial cause of ALS
Zn/Cu superoxide dismutase muation
## Footnote
*only some familial cases*
130
what is first line prophylactic therapy for staus epilepticus?
phenytoin
131
what is topiramate? indications?
Na+ channel blocker and GABA potentiator
focal and generalized, tonic-clonic seizures
132
what is the common mechanism for valproate, phenytoin and carbamazepine?
which has another action and what is it?
all block Na+ channels
valproate also inhibits GABA transaminase, increasing GABA availability
133
diagnosis?
GBM
134
first pharyngeal arch assoc with which nerve?
trigemminal (CN V)
135
pathogenesis of metachromatic leukodystrophy
without arylsulphatase, sulphatides accumulate in the lysosomes of oligodendrocytes leading to cell death
lysosomal storage disease
136
tensilon test is what? what diseases does it test between and what are the results?
edrophonium administration test for NMJ-related muscle weakness
edrophonium = AChase-I
if MG, tensilon test will relieve weakness
if Lambert-Eaton then no clinical improvement, b/c antibodies directed against presynaptic Ca++ channel
137
what gene is associated with increased risk of Alzheimer's?
ApoE epsilon 4 allele
epsilon 2 allele associated with decreased risk
138
Kluver-Bucy syndrome
what is it and where is the lesion?
lesion in amygdala - disinhibited behaviour
## Footnote
*hyperphagia, hypersexuality, hyperorality*
139
expansion of a midline syrinx leads to what findings?
1. LMN lesion (anterior horn)
2. Horner's syndrome (lateral horn of hypothalamospinal tract)
140
what are the neurological complications of measles virus? (3)
1. acute - encephalitis
2. subacute - acute disseminated encephalomyelitis
3. chronic (years later) - subacute sclerosing panencephalitis
141
a deficiency of arylsulphatase causes what disease?
metachromatic leukodystrophy
142
what organ does neuroblastoma affect?
adrenal medulla
143
what is the mechanism of action for benzos?
increases frequency of GABA(A) channel opening
c/o barbituates
144
what is this appearance and what is the disease?
'tram track' calcifications
Sturge-Weber syndrome - facial angioma in the V1/2 (rarely V3) distribution
145
estimation formula for normal CSF glucose
CSF(glucose) = 2/3 x blood(glucose)
146
damage to what area of the brain gives rise to large-amplitude, contralateral involuntary limb movements (hemibalismus)?
subthalamic nucleus
147
which areas of the spinal cord degenerate in neurosyphilis?
dorsal roots/dorcal columns
148
what is the first line treatment for focal seizures?
carbamazepine
149
what structures of the spinal cord are preferentially affected in tabes *dorsalis*?
**dorsal** root ganglion and **dorsal** columns
150
what time frame of stroke is this?
red neurons, cells currently dying
12 hours following infarction
151
oligodendrocyte tumour in adults
oligodendroglioma
152
which benzo's do not have hepatic metabolism?
**O**ut **t**he **l**iver
oxazepam, temazepam, lorazepam
153
154
what is the priciple of therapeutic hyperventilation and when is it used?
hyperventilate, decrease PaCO2 , vasoconstriction, decrease cerebral blood flow, decrease ICP
used to treat acute cerebral oedema 2ary ischaemic stroke unresponsive to other treatment
155
what generalized seizure?
loss of consciousness & postictal state
diffuse muscle contractoin of limbs followed by rhythmic jerking
tonic-clonic
156
CNS biopsy - diagnosis?
oligodendroglioma
157
what are the antibodies associated with paraneoplastic cerebellar degeneration?
anti-Yo, anti-P/Q, anti-Hu
158
what is located at the posterior rostral pons near the lateral floor of the fourth ventricle?
what does it produce?
pigmented neurons of the **locus ceruleus**
norepinephrine
159
when should you not use barbituates?
porphyria
160
how is vCJD different from CJD
vCJD - young patients, exposure to bovine spongiform encephalopathy
161
when are the axonal reaction changes of Wallerian degeneration first visible?
1 day
162
what are the two main side effects of carbamazepine?
bone marrow suppression and SIADH
163
another word for berry aneurysm?
saccular aneurysm
164
how does an amide anaesthetic bind to its target channel?
binds to inner portion of channel
crosses membrane in uncharged form, receives charge and binds to intracellular Na+ channel portion
165
what is an association with Friedrich Ataxia?
hypertrophic cardiomyopathy
HOCM
166
a 'drop metastasis' is what? associated with what tumour?
metastasis of medulloblastoma through the CSF, seeded from the 4th ventricle, down into the spinal cord...
associated with poor prognosis
167
distinguishing symptoms of lacunar infarct
complete contralateral hemiplegia and hemianaesthesia
*face, arms and legs*
no cortical symptoms (neglect, aphasia, visual field loss)
168
which are the short acting benzos?
ATOM
alprazolam, triazolam, oxazepam, midazolam
169
what is the reversal of non-depolarising NM blockade?
cholinesterase inhibitors
* *neostigmine (must give atropine to prevent muscarinic effects, e.g. brady)*
* *edrophonium*
170
which anaesthetics have an association with hepatotoxicity?
halogenated inhaled anaesthetics
(halothane **most**, then sevo, desflurane, enflurane etc..)
171
what signalling pathway is implicated in holoprosencephaly?
*SHH*
172
what passes through foramen magnum?
**nerves** - spinal roots of CN XI (spinal accessory, rostrally), brain stem
**vessels** - vertebral arteries
173
boney and muscular derivatives of 1st pharyngeal arch
boney - mandible, maxilla, zygoma, incus & malleus
muscular - muscles of mastication
174
what does ethosuxamide do?
block thalamic Ca++ channels, anti-**absence** **seizures** epileptic drug
175
spinal accessory nerve provides innervation to which muscles?
trapezius and SCM
176
pathologic mechanism of lacunar stroke
hyaline arteriolosclerosis 2ary to DM or HTN
lake-like cystic infarcts
177
# Define uncal herniation
what 3 things go wrong?
displacement of the temporal lobe uncus under the tentorium cerebelli
1. CN III palsy, *down and out*
2. compresison of PCA, ischaemia
3. rupture of paramedian artery, brainstem (**Duret**) haemorrhage
178
what is the first sign on temporal uncal herniation?
ipsilateral fixed, dilated pupil
179
where is the CNS centre for sympathetic control?
posterior hypothalamus
180
cystic lesion with mural nodule...
what CA?
pilocytic astrocytoma
181
which subcellular proteins are responsible for retrograde and anterograde axonal transport?
retro - dyenin
antero - kinesin
182
what is normal ICP?
50 - 180 mmH2O
183
2 treatments for ALS
**Riluzole** - mechanism unclear but acts through glutamate and sodium channels
184
classify the clinical features of friedrich ataxia
cerebellar degeneration - ataxia
spinal cord degeneration - LMN lesion
185
what does Panician corpuscle sense?
vibration and pressure
186
what generalized seizure?
no loss of consciousness or postictal state
brief, jerking movements
myoclonic
187
antidote for serotonin syndrome?
cyproheptadine
non-specific 5-HT(1) and 5-HT(2) antagonist
188
in moderate global cerebral ischaemia, what areas are likely to be damaged? (4)
1. watershed areas between anterior, middle and posterior cerebral arteries
2. pyramidal neurons of cortex (layer 3, 5 and 6; laminar necrosis)
3. pyramidal neurons of hippocampus
4. purkinje layer of cerebellum
189
what generalized seizure?
brief loss of consciousness
may have autonomisms (lip smacking)
no postictal state
absence
190
schwannoma tumour cells show what marker?
S-100
191
what is this?
Dandy Walker malformation
1. failure of the cerebellar vermis to form
2. massive dilatation of the 4th ventricle
3. non-communicating hydrocephalus
192
where is hunger senstation initiated?
lateral hypothalamus
193
symptoms of lesion in medial longitudinal fasiculus
internuclear opthalmoplegia
## Footnote
* lesion of left MLF. asked to look right.*
* R eye - abduction nystagmus, L eye - adduction paresis*
194
what does Merkel discs sense?
pressure, deep static touch (shapes and edges), position
195
where does Pick disease affect?
frontal and temporal cortex
196
from what cell dose medulloblastoma arrise?
granular cells of cerebellum
197
what drug is first line therapy for trigeminal neuralgia?
crabamazepine
198
superior quadrantanopia suggests a lesion where?
what part of the optic pathway is affected?
contralateral temporal lobe - Meyer's loop
199
what structure connects the 3rd to 4th ventricle
cerebral aqueduct
200
unilateral nasal hemianopsia on a b/g vascular disease
where is the lesion and what are the common causes?
peri-chiasmal lesion, affecting lateral fibres **only** as the medial fibres are decussating in the chiasm
calcification or aneurysm of **internal carotid artery**
3 in picture below
201
cape-like distribution along both upper limbs, loss of sensation to pain and temperature
what is the lesion and where in the cord is it?
syringomyelia
syrinx located in the anterior white commisure, lesion affects where **both** tracts cross the midline so bilateral sensory loss
202
neurochemical pathology of AD
loss of cholinergic neurons at the nucleus basalis of *Meynert*
203
bilateral schwannoma suggests what?
neurofibromatosis type II
204
what are the side effects of inhaled halogenated anaesthetics?
1. decrease cardiac output
2. decrease respiration, decrease mucociliary clearance potentially causing pos-op atelectasis
3. increase cerebral blood flow, potentially resulting in increased ICP
4. decrease GFR
5. decrease hepatic blood flow, potentially halothane hepatitis
205
tumour at the cerebellopontine angle is...
schwannoma
PNS tumour which looks like it presents in the brain
206
what CA goes to brain?
lung
kidney
breast
207
anaesthetic infiltration of the interscalene triangle (between middle and anterior scalene muscles) does what?
blocks the brachial plexus - anaesthesia of shoulder and upper arm
also affects C3-5 (phrenic nerve) so you get ipsilateral diaphragm paralysis
only muscle of the arm spared is **trapezius** - innervation from CN XI
208
what is the cause of subacute sclerosis panencephalitis?
measles virus
209
describe the path of CSF flow through the brain
generation in the lateral ventricles, foramen of monro, 3rd ventricle, cerebral aqueduct, 4th ventricle, foramina of Luschka and Magendie, subarachnoid space, venous sinuses
210
boney and muscular derivatives of 2nd pharyngeal arch
boney - styloid process of temporal bone, lesser horn of hyoid, stapes
muscular - muscles of facial expression
211
clinical features of schwannoma?
loss of hearing and tinnitus
212
what is suvorexant? indication and caution?
orexin receptor antagonist - treatment for insomnia with no/low addictive potential
narcolepsy, liver disease, CYP3A4 metabolism
213
what is a degenerative condition of upper and lower motor neurons?
ALS
214
Von Recklinghausen's disease is also known as?
clinical features?
neurofibromatosis type 1
optic nerve glioma, neurofibroma, Lisch nodules (iris), cafe au lait spots
215
ventral posteriomedial nucleus of thalamus
what sensory input/nerve(s)?
facial sensation and taste
trigemminal (CN V) and gustatory pathway
216
what is the triad of normal pressure hydrocephalus?
urinary incontinence
gait instablility
dementia
**wet, wobbly, wacky**
217
where are ADH and oxytocin synthesised?
paraventricular and supraoptic nuclei
218
amyotrophic lateral sclerosis affect motor, sensory or both?
**only motor**
219
tumour from neurons in children
medulloblastoma
220
potential consequence of orbital floor #?
infraorbital nerve damange (branch of maxillary)
numbness and parasthesia of upper lip, gingiva and cheek
221
complications of SAH
2ary arterial vasospasm
rebleeding
hydrocephalus (dysfunction of the arachnoid villi)
222
where does venous return leave the skull?
all joins at confluence of sinuses, anteriolaterally to sigmoid sinus, through jugular foramen then as internal jugular vein
223
best treatment for absence seizure?
ethosuximide
224
which muscle group predominates in decorticate posturing?
flexor muscles
rubropsinal tract intact and disinhibited
225
226
metabolic cause of global cerebral ischaemia?
hypoglycaemia
227
top bug for adults and elderly for meningitis
*Strep pneumoniae*
228
what cellular changes occur to a neuron when it's axon has been severed?
* Wallerian degeneration* affects the axon **distal** to the lesion
* Axonal reaction* affects the neuron **proximal** to the lesion: cell body oedema, nucleus displaced to the peirphery, Nissl substance dispersed throughout cytoplasm (visiable at 24 - 48 hours)
229
a cystic degeneration of the spinal chord between C8-T1
2 causes
syringomyelia
1. assoc with Arnold Chiari
2. trauma
230
what passes through hypoglossal canal?
CN XII (hypoglossal)
231
which has a higher change of respiratory depression out of barbs or benzos?
barbituates
232
what passes through superior orbital fissure?
**nerves** - CN III (opthalmic), IV (trochlear), V1 (opthalmic division of trigeminal), VI (ABducens)
**vessels** - opthalmic vein
sympathetic fibers
233
biochemical sign of neuroblastoma?
increase urinary metanepherines
234
pure motor hemiparesis suggests what?
lacunar infarct, possibly due to hypertensive arteriolar sclerosis
235
what part of the peripheral nerve has to be joined in microsurgery when attaching a limb?
perineurium - membrane immediately surrounding the nerve fibres that acts as the blood-nerve barrier
236
what is the mechanism of donepezil/galantamine/rivastigmine?
cholinesterase inhibitor
237
what passes through foramen spinosum?
**vessels** - middle meningeal artery and vein
238
what are the side effects of phenytoin/fosphenytoin?
Neuro - nystagmus, ataxia, diplopia, sedation, peripheral neuropathy
Derm - hirsuitism, SJS, DRESS syndrome, gingival hyperplasia
MSk - osteopenia
reproductive - teratogen
Other: P450 inducer
239
what is the distinguishing feature between ALS and syringomyelia?
pain and temperature sensation change
240
ependymal cell tumour in kids
ependymoma
241
3 key ways to tell LEMS from MG
1. a-/hyporeflexia
2. autonomic symptoms (dry mouth/impotence)
3. incremental respose to stimulation on EMS
242
what is the mechanism of eszopiclone (and other nonBZD hypnotics)?
activate GABA(BZ1) receptor
243
what is riluzole?
treatment for ALS
uncertain mechanism
244
what is first line treatment for essential (familial) tremor?
propranolol
245
what is the mechanism for tiagabine? indication?
GABA reuptake inhibitor
focal seizures
246
what is located in the dorsal medulla at the caudal end of the fourth ventricle?
what does it control?
area postrema
'vomiting centre' - fenestrated capilaries so it samples chemicals circulating in the blood
247
which muscle group predominates in decerebrate posturing?
extensor muscles
rubrospinal tract damaged, vestibulospinal tract predominates
248
round aggregates of tau protein in neurons of cortex...
what disease?
Pick disease
249
define lissencephaly
congenital absence of gyri
severe mental retardation and seizures, smooth appearance of brain on gross exam and imaging
250
what is ramelteon?
melatonin receptor agonist, binds MT1 and MT2 in suprachiastmatic nucleus
251
classic bone and vessel damage of epidural haematoma?
temporal bone
middle meningeal artery
252
what nerves are damaged by ventricular swelling in NPHC?
corona radiata nerves that run along the edge of the ventricles
253
malignant hyperthermia
trigger, inheritance
affected protein, treatment
triggered by inhaled anaesthetics or succinylcholine
inherited autosomal dominant
mutation in ryanodie receptor means stimulation results in much more Ca++ release
treat with dantrolene (RyR antagonist)
254
what is lamotrigine? indications?
blocks voltage-gates Na+ channels, inhibits glutamate release
focal & generalized (all) seizures
*N.B. risk of SJS, must be titrated up carefully*
255
what is the earliest finding of ishaemic stroke?
'red neurons'
256
meningitis bugs in neonate
GBS
## Footnote
* E Coli*
* Listeria monocytogenes*
257
distinguishing symptoms of anterior cerebral artery occlusion
contralateral paralysis and anaesthesia **only lower limb**
258
poliovirus transmission
faeco-oral route
259
what does Meissner corpuscle sense?
fine touch, dynamic, position sense
260
galactocerebrosidase deficiency is what disease?
where does galactocerebroside build up?
Krabbe disease
in macrophages
261
brain tumour GFAP positive... diagnosis?
pilocytic astrocytoma
262
what condition presents at poliomyelitis in children?
Werdnig-Hoffman disease
AR inherited degeneration of the anterior horn
*floppy baby* presentation, death within a few years
263
what antiepileptic drugs are P450 inducers?
phenobarbital and carbamazepine
264
antidote for organophosphate poisoning?
pralidoxime
restores cholinesterase activity only if given soon after exposure
265
what focal seizure
no loss of consciousness or postictal state
motor, sensory, autonomic or psychic symptoms
simple
266
# define tonsilar herniation
what kills you?
displacement of the cerebella tonsils into the foramen magnum
cardiopulmonary arrest
267
what is the mechanism of opiate analgesia?
activation of mu-opioid receptor
opening of K+ channels allows efflux and depolarisation
Blockage of Ca++ stops influx and vesicle release
268
tensor tympani is innervated by which nerve?
mandibular branch of trigeminal (CN V3)
269
which 4 cranial nerve nuclei are medial?
*factors of 12, except 1 and 2*
III, IV, VI and XII
oculomotor, trochlear, abducens, hypoglossal
270
spike wave complexes on EEG
what disease?
CJD
271
what is baclofen?
GABA(B) agonist in spinal cord
muscle anti-spasmodic for low back pain/MS
272
time frame for TIA
\<24 hrs
273
degeneration of GABAergic neurons in the caudate nucleus of basal ganglia...
what disease?
Huntington's
274
a pineal gland mass will give rise to what symptoms?
1. non-communicating hydrocephalus (aqueductal stenosis)
2. dorsal midbrain (Parinaud) syndrome
## Footnote
*limitation of upward conjugate eye movement*
275
genes for familial AD?
presinilin 1 and presinilin 2
276
the flocculonodular lobe is located where and what does it control?
base of the posterior cerebellum
eye movements and balance
277
what is amantadine?
toxicity?
increase dopamine availability at the synapse
toxicity = ataxia and livedo reticularis
278
key associations with Arnold Chiari malformation (2)
meningiomyelocele, syringomyelia
279
what is ependymal cell?
cell lining the ventricles producing CSF
280
Rx MS
corticosteroids for flare
IFN-beta to slow progression of disease
281
5 branches of the facial nerve
temporal
zygomatic
buccal
mandibular
cervical
282
calcified tumour in the frontal lobe white matter is...
oligodendroglioma
283
lacunar stroke most commonly involves what blood vessels?
lenticulostriate vessels feeding deep structures of the brain
284
what is paraneoplastic cerebellar ataxia?
paraneoplastic immune response vs tumour cells cross-react with purkinje neuron antigens leading to progressive degeneration of cerebellum
285
clinical features of familial fatal insomnia
1. insomnia
2. exagerated startle response
286
treatment for wilson's disease
chelators - D-penicillamine, trientine
Zinc (interferes with Cu absorption)
287
cerebral atrophy with narrowing of the gyri, widening of the sulci and dilation of the ventricles is what disease?
alzheimer's
288
intermediolateral cell columns of the spine are found at what level?
thoracic to early lumbar (T1-L2)
289
what are the histologic findings 1 month after stroke?
fluid-filled cystic space surrounded by gliosis
290
draw the circle of willis from vertebral arteries to the anterior cerebral arteries
291
visceral organ biopsy
solid sheets of small cells with dark nuclei and scant cytoplasm
neuroblastoma
292
how does bimatoprost/latanoprost improve glaucoma?
increase outflow of aqueous humour through uveoscleral pathway
acts on PGF2alpha receptors
turns the iris more brown (darker) & eyelash growth
293
symptoms (2) and epidemiology of pseudotumor cerebri?
young, obese women - elevated ICP without ventricular enlargement
headache, papilledema, possible visual loss
294
intracerebral haemorrhage
- what vessles
- predisposing condition
- where in the brain
Charcot-Bouchard microaneurysm rupture of the lenticulostriate vessels
hypertension
basal ganglia
295
what is mechanism of memantine?
NMDA receptor antagonist, used in AD
prevents excitotoxicity (mediated by Ca++)
296
what are the non-benzo hypnotics?
zolpidem, zalepon, eszopiclone
297
genetic mechanism of anticipation in HD
expansion of the CAG trinucleotide repeat in the huntingtin gene **during spermatogenesis**
298
DBS for parkinsons involves high frequency stimulation of what areas of the brain? what is the downstream affect?
either **subthalamic nucleus** or **globlus pallidus internus**
DBS stimulation *inhibits* these areas of the brain, which usually exert an inhibitory affect on the thalamus.
*Disinhibition* of the thalamus (ergo thalamocortical pathway) restores normal motor function
299
treatment for restless leg syndrome
dopamine agonists lie pramipexole/ropinirole
300
301
what are the narrow spectrum anti-epileptic drugs? (4)
carbamazepine, gabapentin, phenobarbital, phenytoin
