Pathology-Ish

Question 1

Brodmann’s areas

1. 22
2. 44, 45

Answer 1

1. Wernicke’s

2. Broca’s

Question 2

What hemisphere is most often dominant?

Answer 2

left

Question 3

Lesion location of aphasias (most common type of lesion)

1. Broca
2. Wernicke
3. global
4. conduction
5. transcortical motor
6. transcortical sensory
7. mixed transcortical
8. anomic

Answer 3

1. Brodmann’s 44, 45 (stroke)
2. Brodmann’s 22 (stroke)
3. large area of left hemisphere (stroke)
4. supra marginal gyrus and arcuate fascicles (occlusion of angular branch of left MCA)
5. left anterior frontal lobe superior or inferior to Broca’s area (stroke)
6. between MCA and PCA (stroke, severe hypotension)
7. between ACA and MCA (stroke, severe hypotension)
8. anywhere in language area

Question 4

Lesion location of aphasias

1. Broca
2. Wernicke

Answer 4

1. Brodmann’s 44, 45

2. Brodmann’s 22

Question 5

Gerüstmann syndrome
Sx

location?

Answer 5

anomia
alexia, agraphia, acalculia, finger agnosia
right left disorientation

left angular gyrus (area 39)

Question 6

alexia without agraphia

Answer 6

can write, but not read
right homonymous hemianopsia (can’t see right visual field)

location: left medial occipital and temporal lobes involving selenium of corpus callosum

caused by: occlusion of branch of left PCA

Question 7

Sx of encephalopathy

Answer 7

1. seizures
2. altered respiration
3. acute alteration of mental status: delirium, hallucinations, coma, lethargy, stupor; decrease in: attention, memory, orientation, cognition, HIF
4. altered pupil light reactivity: symmetric and slow
5. altered ocular motility: roving, absent, dysconjugate
6. altered motor activity: alteration of strength, tone, reflexes; tremor, myoclonus, asterixis

Question 8

Sx of encephalopathy

Answer 8

1. seizures
2. altered respiration
3. acute alteration of mental status: delirium, hallucinations, coma, lethargy, stupor; decrease in: attention, memory, orientation, cognition, HIF

Question 9

Wernicke/Korsakoff encephalopathy

Sx, Dx, Tx, population, cause, location of lesions

Answer 9

B1 (thiamine) deficiency
ALCOHOL, malnutrition
ENCEPHALOPATHY
Triad: gait ataxia, ophthalmoparesis, confusion
amnesia for recent memories
peripheral neuropathy
Tx: thiamine BEFORE glucose (prevent brain damage)
Dx: clinical (reduced transketolase in blood: not readily available)
location: dorsomedial thalamus, mammillary body, periaqueductal gray
Wet/Dry Beriberi

Question 10

Niacin deficiency

Answer 10

pellagra, encephalopathy
dementia, dermatitis, diarrhea, polyneuropathy
diffuse CNS/PNS involvement

Question 11

B12 deficiency

1. causes
2. Sx
3. path
4. Dx
5. Tx

Answer 11

ENCEPHALOPATHY

1. PERNICIOUS ANEMIA, vegetarian dient, bariatric Sx, sprue, gastric CA, nitrous oxide abuse
2. pos. ROMBERG, decreased vibration/position sense; Lhermitte’s sign (electric sensation on neck flexion), distal parathesia; spastic gait, confusion/depression/dementia, visual problems, weakness
   anemia: pale, tongue atrophy
3. demyelination of dorsal columns, corticospinal tract, optic nerves, peripheral nerves, cerebral white matter
4. microcytic anemia, hyperhsegmented neutrophils, low B12, elevated methylmalonic acid and homocysteine
5. Tx underlying problem; cyanocobalamin

Question 12

B12 deficiency

Answer 12

/

Question 13

wet beriberi

Answer 13

thiamine deficiency

high output cardiac failure

Question 14

dry beriberi

Answer 14

thiamine deficiency: axonal degeneration

polyneuropathy (lower > upper), decreased pain, loss of ankle/knee reflex

Question 15

B6 (pyridoxine) deficiency

Answer 15

NO encephalopathy

Sx: seizures, polyneuropathy

Question 16

B complex deficiency

Answer 16

TOBACCO/ALCOHOL
lesion: loss of myelination of optic nerve, papillomacular bundle
bilateral
decreased visual acuity: central scotoma
optic disc pallor

Question 17

hyperglycemic encephalopathy

Answer 17

acidosis with high sugar levels, small pupils,

no: brisk reflexes, seizures

Question 18

hyperglycemic encephalopathy

Answer 18

acidosis with high sugar levels, small pupils,

no: brisk reflexes, seizures

Question 19

hypoxic encephalopathy

Answer 19

due to: CARDIAC ARREST, CO poisoning, high altitude sickness, chronic bronchitis
Sx: stupor/coma, seizures, myoclonus, amnesia
damage to: hippocampus, watershed areas, deep cerebellum

Question 20

CO poisioning

Answer 20

cherry red skin with cyanotic hue

Tx: hyperbaric O2

Question 21

high altitude sickness

Answer 21

chronic hypoxia with compensated RBC count

Question 22

hepatic encephalopathy

Answer 22

due to: ALCOHOLIC LIVER; ACETAMINOPHEN
HIGH AMMONIA
Sx: confusion, seizures, slow EEG with triphasic waves, peripheral asterixis (flapping), myoclonus, BRISK reflexes

Question 23

hepatic encephalopathy

Answer 23

HIGH AMMONIA

Sx: confusion, seizures, slow EEG with triphasic waves, peripheral asterixis

Question 24

uremic encephalopathy

Answer 24

Sx: seizures, myoclonus, dementia, memory deficits, flapping, DECREASED reflexes, LOW Ca
DYSEQUILIBRIUM syndrome with dialysis: increased intracranial bleeds: SUBDURAL HEMORRHAGE

Question 25

Alzheimer's pathology

Answer 25

loss of cerebral cortical neurons (PARIETAL, TEMPORAL atrophy; less frontal atrophy), neurotic plaques with B-amyloid, neurofibrillary tangles

Question 26

vascular dementia

Answer 26

2nd most common dementia after AD HTN, CAD, PAD, DM same age as AD dementia within 3 months of event

Question 27

frontotemporal dementia

Answer 27

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Question 28

delirium; dementia 1. onset 2. course 3. duration 4. consciousness 5. attention 6. autonomic function 7. cognition 8. prognosis

Answer 28

1. acute; insidious 2. fluctuations; progressive 3. days/weeks; months/ years 4. altered; not impaired 5. distracted; normal 6. hyperactive; normal 7. confused; impoverished 8. reversible; irreversible

Question 29

delirium

Answer 29

clouding of consciousness with reduced capacity to shift, focus, and sustain attention to environmental stimuli

Question 30

dementia

Answer 30

impairment of intellectual/ cognitive function that interferes with social/ occupational activities

Question 31

Dx of dementia

Answer 31

1. impaired short and long term memory and/or 2. one of the following: impaired judgement, abstract thinking or other disturbance (aphasia, agnosia, etc) 3. disturbances interfere with work/ ADL 4. Sx not occurring only in delirium 5. evidence of organic cause (if no evidence then exclusion of non-organic cause (like depression))

Question 32

Dx of delirium

Answer 32

1. disorientation and memory impairment 2. two of the following: incoherent speech, disturbed sleep/wake cycle, increased/decreased psychomotor activity, or perceptual disturbance (hallucination, misinterpretations) 3. develop over short period of time and fluctuate 4. evidence of organic factor

Question 33

Alzheimer's essential criteria

Answer 33

1. confirmed dementia 2. memory deficits 3. progressive worsening of memory plus one other cognitive function (language, executive function, etc.) 4. no disturbances of consciousness 5. onset: most after 65 (btwn: 40-90) 6. absence of other brain disease other: depression, behavioral changes motor signs, seizure, gait, sensory abnormalities are ABSENT early in course

Question 34

Alzheimer's essential criteria

Answer 34

1. confirmed dementia 2. memory deficits 3. progressive worsening of memory plus one other cognitive function 4. no disturbances of consciousness 5. onset: most after 65 (btwn: 40-90) 6. absence of other brain disease

Question 35

logic behind Alzheimer's Tx

Answer 35

AChE or BuChE inhibitor: increase ACh that is decreased due to atrophied Meynert immunotherapy to clear amyloid

Question 36

memantine

Answer 36

NMDA receptor blocker | Tx: Alzheimer's

Question 37

Dementia with Lewy bodies vs. Parkinson's Tx

Answer 37

dementia responds less well to L-DOPA

Question 38

Parkinson's disease

Answer 38

hypokinetic DA def. ASYMMETRIC onset Sx: bradykinesia, rest tremor, rigidity, postural instability (late, if falling early then something else) other Sx: Stooped, shuffle gait, MASKED face, reduced armswing, micrographic, hypokinetic dysarthria non-motor: depression, anxiety, cognitive impairment ANS: GI (constipation, dysphagia, impaired gastric emptying); low libido; CV: BP regulation; thermoregulatory: profuse sweating; bladder sleep disturbances: REM sleep behavior disorder

Question 39

Progressive Supranuclear Palsy

Answer 39

hypokinetic life expectancy: 10 yrs SYMMETRIC Sx: rigidity, bradykinesia, dysarthria; EARLY GAIT and POSTURAL problems dementia, emotional ASTONISHED face SUPRANUCLEAR GAZE PALSY: impairment of volitional downsize leading to inability to move eyes normal oculocephalic maneuver: eyes can still move when pt. fixes gaze and someone moves their head (not a muscle problem); apraxia of eyelid opening (can open spontaneously but not when asked to do so NO TREMOR BABINSKI sleep problems TAUOPATHY: GLOBOSE type neurofibrillary tangle

Question 40

Multisystems Atrophy

Answer 40

hypokinetic life expectancy: 5-10 yrs Sx: rigidity, bradykinesia, EARLY postural instability, NO TREMOR earlier and more severe ANS dysfunction ataxia, dysarthria, oculomotor abnormalities BABINSKI, SPASTICITY HYPERREFLEXIA, STRIDOR, RAYNAUD's, invountary sighing, postural myoclonus depression NO DEMENTIA GLIAL CYTOPLASMIC INCLUSION bodies that stain for alpha synuclein

Question 41

Huntington's disease

Answer 41

hyperkinetic onset: 35-45 yrs life expectancy: 15-20 yrs chorea (with progression becomes akinetic), dysarthria Behavioral: aggressive, obsessive, irritable, impulsive DEMENTIA eventually: impaired planning, organizing, reasoning, judgment WEIGHT LOSS saccades slow or difficult to initiate; difficulty maintaining gaze

Question 42

Tourette's

Answer 42

hyperkinetic YOUNG, MALE: diminishes sudden movement preceded by urge (can be suppressed temporarily), vocal or sensory tics that change overtime OCD, ADHD

Question 43

Primary Dystonia

Answer 43

AD with penetrance hyperkinetic onset: CHILD ASHKENAZI JEW twisting movement that results in abnormal postures that become fixed starts in LOWER extremities (ankle, foot) DYT1 gent, TORSIN A protein, Glu deletion

Question 44

Wilson's

Answer 44

``` mixed hyper/hypokinetic AR: ATP7B: Cu transporting ATPase onset: 10-20 Sx: hepatic, neurologic, psychiatric KAYSER-FLEISHER rings SUNFLOWER CATARACTS OPALSKI cells increased free Cu, urinary Cu, hepatic Cu decreased: serum ceruloplasmin, serum total Cu ```

Question 45

Wilson's

Answer 45

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Question 46

juvenile huntington's

Answer 46

parkinsonism rather than chorea right from onset

Question 47

focal dystonia

Answer 47

``` ADULT onset generally sporadic muscles ABOVE waist may be relieved by SENSORY TRICKS may be TASK SPECIFIC ```

Question 48

Types of focal dystonia 1. cranial 2. cervical 3. limb

Answer 48

1. Blepharospasm, oromandibular, laryngeal 2. spasmodic torticollis 3. writer's cramp, musician's dystonia