Pretest Flashcards
(321 cards)
1
Q
+ romberg means problems in …
A
cerebellar, vestibulopathy, and posterior column
2
Q
resting tremor in parkinsons is
A
asymetric
3
Q
resting tremor vs intentional tremor anatomy
A
Resting: substaintia nigra
Intentional: cerebellum
4
Q
sensory disturbances is likely due to
A
thalamus
5
Q
what happens to pill rolling tremor during sleep
A
disappears
6
Q
phenytoin can cause what side effect
A
gaze evoked nystagmus
7
Q
problem w convergence is due to
A
midbrain
8
Q
what is the weber test and what does it inidcate
A
Vibration in the middle:
louder in the affected side: conductive hearing loss as outside voice is blocked and you hear lower on affected side
louder in unaffected side: sensisinoral hearing loss due to loss of cochlear nerve
9
Q
ocular bobbing
A
up and down of eyes even in sleep or open eyes; pons
10
Q
triad of parkinsonism
A
is asymmetric resting
tremor, rigidity, and bradykinesia.
11
Q
post viral cases are
A
ADEM or demylenating in nature
12
Q
Hyperacusis is an indication that
A
the
damage to the facial nerve is close to its origin from the brainstem, because
the nerve to the stapedius muscle is one of the first branches of the facial
nerve. Non functional stapedius muscle means undampened transmission of acustic sound
13
Q
Inappropriate slack to tympanic membrane means
A
damage to tensor tympani controlled by motor nerve of CN5
14
Q
atrophy and fasciculation of tongue means
A
denervation of 12th hypoglossal never which provides motor to tongue;
hypersensitivity to acetylcholine acting at the dener-
vated neuromuscular junction;
—brainstem disease, such as stroke or bulbar
amyotrophic lateral sclerosis (ALS), or with transection of the hypoglossal nerve.
15
Q
caloric testing tests which organ
A
medulla
16
Q
how does caloric testing normally work
A
Cold: turns off singnal in that ear, acts as if head turns in the opposite direction=> eyes towards stimulated ear but nystagmus away
warm: turns on signal in that ear, acts as if head turns in the stimulated direction=> eyes away from stimulation but nystagmus towards stimulated
Nystagmus: COWS
17
Q
how does caloric testing normally work
A
Cold: turns off singnal in that ear, acts as if head turns in the opposite direction=> eyes towards stimulated ear but nystagmus away
warm: turns on signal in that ear, acts as if head turns in the stimulated direction=> eyes away from stimulation but nystagmus towards stimulated
Nystagmus: COWS
18
Q
horner syndrome has
A
ptosis and myosis
19
Q
horner syndrome, the problem is in..
A
superior cervical ganglion
20
Q
sympathetic pathway
A
begins in the hypothala-
mus, travels down through the lateral aspect of the brainstem, synapses in the intermediolateral cell column of the spinal cord, exits the spinal cord at
the level of T1, and synapses again in the superior cervical ganglion.
21
Q
painful horner without anhidrosis after vigorous activity is a sign of what? and why
A
– Aortic dissection
- postganglionic fibers travel along the surface of the common carotid
and internal carotid arteries until branches leave along the ophthalmic artery
to the eye. Fibers of the sympathetic nervous system, which are destined
to serve the sudomotor function of the forehead, travel with the external carotid artery. Thus diseases affecting the internal carotid artery and the overlying sympathetic plexus do not produce anhidrosis, the third ele-
ment of Horner syndrome.
22
Q
how to distinguish CNS3 pstosis w horner syndrome.
How to distinguish superior cervical ganglion from T1 nerve root lesion
A
Lesions of cranial nerve (CN) III do cause ptosis, but they would also be expected to cause ipsilateral mydriasis, or pupillary enlargement, not miosis. The degree of ptosis is usually much more severe in third nerve palsy than in Horner syndrome; this is because CN III supplies the levator palpebrae, the primary levator of the lid, whereas the sympathetics supply Müller muscle, which plays an accessory role.
The sympathetic pathway does exit the spinal cord at T1, but injury at this location would not cause orbital pain, which is typical of carotid arterial dissection.
23
Q
most dense on CT
A
bone>blood
24
Q
hx of bells palsy now treated, pt he has noticed invol-
untary twitching at the left corner of the mouth each time he tries to blink the left eye. why
A
Aberrant regeneration is possible only if the nerve cell bodies survive the injury and produce axons
that find their way to neuromuscular junctions. Fibers intended for the periorbital muscles end up at the perioral muscles, and signals for eye closure induce mouth retraction.
25
hx of bells palsy now treated, pt he has noticed invol-
| untary twitching at the left corner of the mouth each time he tries to blink the left eye. why
Aberrant regeneration is possible only if the nerve cell bodies survive the injury and produce axons
that find their way to neuromuscular junctions. Fibers intended for the periorbital muscles end up at the perioral muscles, and signals for eye closure induce mouth retraction.
26
subarchnoid hemorrage can present w headache and
neck stiffness
27
suspect subarachnoid hemorrage but ct non con is neg. what next
LP to rule out SAH
28
Which of the follow-
| ing is the most definitive test for identifying intracranial aneurysms?
cerebral angiography
29
what happens to RBC in traumatic LP
RBC numbers decrease from tube 1 to 4. If not, then increased RBC
30
how to know if wbc is elevated in CSF
1 wbc: 500 RBC is appropirate. Any more WBC means infection
31
site most likely to produce non communicating hydrocephalus is...
aqueduct
| of Sylvius, which connects the third ventricle with the fourth ventricle.
32
communicating hydrocephalus vs non comm
com: problem is production vs absorption of csf
| non com: obstrcution of ventricle
33
Chiari MF 1 vs 2 vs dandywalker
1: tonsilar herniation
2: tonsilar + vermis herniation
dandywalker: enlargement of 4th ventricle w mega cisterna magna
34
Tumors common in posterior fossa
a) Meningiomas
b. Ependymomas
c. Hemangioblastomas
d. Medulloblastomas
35
tentorium cerebelli is
part of the meninges that separates the superior cerebellum from the cerebrum
36
tentorium cerebelli is the common site for
meningiomas
37
enpendymomas orgin is
choroid plexus
38
astrocytoma orignate in
glial cells + healthy brain tissues
39
distinguish vascular vs calcemic mass on CT
Calcemic: hyperdense wo contrast
vascular: hyperdense after contrast
40
posterior fossa mass without involvement of the eighth CN, seems to arise from bone, the most
probable neoplasm is
meningioma
41
tx for calcified mass in right frontal
meningioma=> resection
42
NF1 vs NF2
1) chromosomal involvement
2) chracteristics
1) NF1: deletion of chrm 17
NF2: deletion of long arm of chr 22
2) NF1: cutaneous manifestations
NF2: Meningiomas and bilateral acoustic neuromas occur
43
eeg in normal relaxed person
8-13 hertz aka alpha wave => becomes less obvious w drowsy or when eye opening and concentration on math
44
how to test wernicke aphasia
(impaired naming, com-
| prehension, and repetition with fluent speech).
45
Neglect and left hemiparesis
would be more likely with
right brain lesion
46
Alexia without agraphia is a disconnection syndrome associated with lesions involving
left occipital lobe or splenium of corpus colosum
47
window for tpa
3 hours
48
absence seizure on eeg
3-Hz spike-
| and-wave pattern
49
elevated ESR and periungual telangiectasias in pt w proximal weakness probably has ...
dermatomyositis
50
muscle biopsies of myopahties
polymyositis: extensive necrosis of mus-
cle fiber segments is seen with macrophage and lymphocyte infiltration.
dermatomyositis: perifascicular muscle fiber atrophy, and the inflammatory infiltrate occurs in the perimy-
sial connective tissue rather than throughout the muscle fibers themselves.
Inclusion body myositis: same as polymyositis except that rimmed vacuoles are also seen.
51
muscle biopsies of myopahties
polymyositis: extensive necrosis of mus-
cle fiber segments is seen with macrophage and lymphocyte infiltration.
dermatomyositis: perifascicular muscle fiber atrophy, and the inflammatory infiltrate occurs in the perimy-
sial connective tissue rather than throughout the muscle fibers themselves.
Inclusion body myositis: same as polymyositis except that rimmed vacuoles are also seen.
52
CSF in seizure is..
normal
53
classic guimbre csf
high protein due to albumin with normal everything else
54
what is elevated in LP of SAH
RBC, WBC, opening pressure, xanthocromia (aka yellow)
55
signs of spinal cord involvment, ataxia, incontience, transient impotence CSF is
likely MS showing elevated IgG and oligoclonal bands
56
obese woman w headache csf
elevated opening pressure => pseudotumor cerebri
57
pure motor function deficit without any sensory involvement is
lacunar infarct with involvement of posterior limb of internal capsule being the site of injury
58
loss of ONLY sensation involving the entire left side of his
| body (face, arm, and leg).
right posteroventral nucleus of the lateral thalamus
59
Thalamic pain syndrome
During recovery from this thalamic stroke, paradoxical
pain may develop in the area of sensory impairment. This paradoxical pain associated with decreased pain sensitivity is referred to as the thalamic pain
syndrome.
60
Wallenberg syndrome has
ipsilateral ataxia and ipsilateral Horner syndrome. The trigeminal tract damage may produce ipsilateral loss of facial pain and temperature perception and ipsilateral impairment of the corneal reflex.
The lateral spinothalamic damage produces pain and temperature disturbances contralateral to the
injury in the limbs and trunk.
61
Wallenberg syndrome is due to interurption of which vessel
vertebral artery
62
most common cause of hemosideran deposit
in elderly patients without hypertension.
hemosiderin deposit = sign of lobar hemorrage => most common sign is
cerebral B amyloid angiopathy
63
hoarseness and dysphagia in an pt w vertebral artery dissection is due to...
The nucleus ambiguus, located in the ventrolateral medulla, contains the motor neurons that contrib-
ute to the ninth (glossopharyngeal) and tenth (vagus) cranial nerves.
motor neurons of the nucleus ambiguus innervate the striated muscles of the larynx and pharynx + preganglionic parasympa-
thetic supply to thoracic organs, including the esophagus, heart, and lungs.
64
nucleus solitarius
combines afferents from CNs VII, IX, and X responsible for visceral sensation.
Its projections are primarily to parasym-
pathetic and sympathetic preganglionic neurons in the medulla and spinal cord.
65
headache during sex or defaction
aneurysm rupture
66
lesion not enchanced by contrast on ct
bleeding
67
IV drugs + aortic valve lesion + several hemoragic lesion in the brain
endocarditis => septic emboli or mycotic aneurysm (shape) => bleeds a lot so xanthochromic
68
mycotic aneurysm
- bleeds a lot but not easily detected on imaging
| - present in gram pos or neg infection of the brain ie endocarditic septic embolism
69
todd's paralysis may last
many hours, or even days.
70
encephalofacial angiomatosis (Sturge-Weber syndrome),is associated w
leptomeningeal angiomas and seizures
71
PICA stroke produces what...
a variety
| of brainstem and cerebellar signs,
72
Anterior cerebral artery
| stroke would be expected to cause
lower extremity weakness and would
| not affect vision, although it could result in decreased speech production.
73
mca stroke
contralateral motor weakness, speech, vision (optic radiata loops arounds temporal lobe)
74
Vertebral or basilar artery occlusion would primarily affect
brainstem or cerbellar structure
75
If either posterior cerebral artery had its blood supply
| compromised, there could be
visual loss or posterior (fluent) aphasia
76
Choroidal artery occlusions might produce
focal weakness wo speech problems
77
problems w pupil dilation + oculomotor muscles dysfunction is most likely due to
compression by saccualar aneurysm; transfemoral angiogram is diagnositic
78
Hippel Lindau
Hemangioblastomas are vascular tumors seen in association with polycystic disease of the kidney
and telangiectasias of the retina
79
Charcot Buchard aneurysm ASSOCIATED W
chronic hypertension and most commonly appear in perforating
| arteries of the brain like lenticulostrial arteries
80
is especially susceptible to the formation of Charcot-
| Bouchard aneurysms.
dentate nucleus of cerebellus
81
61
k
82
TIA or amourosis fugax is due to
carotid artery disease occluding central retinal artery
83
symptomatic carotid stenois by 70%. tx is
carotid endarterectomy
84
Patients with the rare syndrome of
conduction aphasia have problems with repetition that are more obvious
than their problems with comprehension. Their speech usually does not
sound very fluent.
conduction aphasia
85
type of speech loss in brocas aphasia
Speech becomes telegraphic (ie, consisting of short phrases
with omission of small connecting words such as articles and conjunctions)
permanent loss of all ability to produce meaning-
ful language is unlikely if the area of infarction is less than a few centimeters across.
The most persistent difficulty usually exhibited by patients with this type of stroke is a permanent loss of syntax.
86
Mixed transcortical aphasia
can repeat but cannot spontaneously speak or comprehension aka broca and wernicke but can repeat
hypotension => watershed areas => affects brocas and wernecke
87
Anomic aphasia
Naming is impaired. Comprehension, repetition, and
fluency are relatively maintained.
--common in patients with diffuse brain dysfunction.
88
Transcortical motor aphasia
similar to Broca aphasia with the exception of preserved repetition.
-poor naming ability and is nonfluent.
Comprehension and repetition are relatively preserved.
89
Transcortical sensory aphasia
similar to Wernicke aphasia with the exception of preserved repetition.
lesion generally occupies the white matter underlying the
cortex of Wernicke area. In most cases, the prognosis for improvement is
better than that for Wernicke aphasia.
90
1-2 vs 2-3 hertz spike on EEG
3 Hz spike-and-wave pattern would confirm absence.
1-2 Hz would be consistent with severe neurological dysfunction and symptomatic generalized epilepsy.
91
preferred benzo for status
1) lorazepam: fast acting and remains in brain for long time
Past: diazapam- fast acting to reach brain, but cleared from brain in 20 min thus would need another medicine after 20 mninutes
92
side effects of
b. Diazepam
c. Phenobarbital
d. Clonazepam
e. Phenytoin
Phenytoin: if infused at greater than 50mg/min, then cardioarrythmia
Fospheytoid: if infused at greater than 150 mg/min then cardioarrythmia; IM possible
phenobarbital: hypotension and resp distress
pam: hypotension and autonomic dysfunction
93
pt comes to hospital after simple compelx seizure. now normal. What next
MRI to figure the cause of seizure.
EEg is useless as already know its seizure and it adds nothing new to information
94
timeline for alcoholic withdrawl
seizures: 1-2 days
delirious tremens: 2-4 days
symtoms resolve within 7-14 days
95
Landau-Kleffner syndrome
associated with loss of
| language function and an abnormal EEG during sleep.
96
Juvenile myoclonic epilepsy
benign epilepsy syndrome with onset in late ado-
| lescence or early adulthood.
97
LGS eeg
by mental dysfunction, multiple seizure types, and 1-to 2-Hz generalized spike-wave discharges on EEG.
98
oldfactory aura in seizure - lesion?
the mesial temporal lobe, particularly the hippocam-
| pus or parahippocampal gyrus.
99
what is given for seizure prophalaxis in traumatic head? Why?
Phenytoin - to prevent post traumatic EARLY seizure. they are not been shown to be helpful against longterm or late seizures. Preventing early seizure decreases mortality. so phenytoin given for short amount of time.
100
most common complication of temporal lobectomy
visual field defect caused by interruption of
fibers from the optic tracts passing over the temporal horn of the lateral
ventricles. Superior quadrantanopsia
101
history of febrile seizure => now intractable seizure in the last year. MRI shows
sclerotic hippocampus aka mesial temporal sclerosis
102
the most common cause of intractable complex
| partial seizures in adults.
mesial temporal sclerosis
103
tx of mesial temporal sclerosis
anterior temporal lobe may produce seizure freedom in up to 80% of cases.
104
jacksonian march
1) sequential seizure, the patient develops focal seizure activity that is primarily motor and spreads.
2) starts w hand and then generalizes w loss of consciousness
3) The face may be involved early because the thumb and the mouth are situated near each other on the motor strip of the cerebral cortex.
105
myoclonic jerks is ...
associated w....
invountary muscle jerking, no loss of consciousness
benign juvenile myoclonic epilepsy (BJME) when mycolonic jerks occur after waking up
106
general clonic tonic seizures
high risk for a variety of injuries, such as dislocated shoulders, broken bones, and head trauma.
Patients with this type of seizure always lose consciousness during the attack.
107
---- may
| be mistaken for a psychiatric problem,
complex partial seizure-- esp if uncinate (from temporal lobes uncus) features like unpleasant smell or taste
108
complications of status
include respiratory failure,
aspiration, acidosis, hypotension, rhabdomyolysis, renal failure, and cogni-
tive impairment.
109
def of status
generalized clonic tonic seizure that lasts continuously for 30 minutes or a series of
seizures over a 30-minute period without the patient regaining full con-
sciousness between them.
110
Epilepsia partialis continua
aka focal motor status elipticus
- persistent focal seizures for hours or for months. The
response to therapy is often poor.
- alert, able to follow commands, and has no gaze deviation.
111
tx for having complex
| partial seizures without secondary generalization.
levicitaram
112
tx for seizure localized to temporal lobe
levicitaram
113
west syndrome characterisitics
generalized seizure disorder of infants characterized by recurrent spasms,
the EEG pattern of hypsarrhythmia (diffuse, high-voltage, polyspike-
and-slow-wave discharges between spasms and suppression of these bursts
during the spasms.) and retardation.
114
tx of seizures in someone whose sibling died with a brainstem glioma, and the father
has several large areas of hypopigmented skin in the shape of ash leaves.
The infant had obvious psychomotor retardation even before the appear-
ance of the spasms.
its tuberous sclerosis thus ACTH
115
seizures due to west sydnrome
ACTH
116
tx for absence seizure
1) Ethusuximide is first choice
2) If side effect of GI probs in children, seizures not under control on ethusximide, then Divalproex sodium
3) If the absence seizures
are associated with generalized tonic-clonic seizure ====> divalproex sodium
117
eclampsia seizure
that magnesium sulfate (MgSO4)
118
what is unique about classic migraine
visual aura
119
classic migraine vs bibasilar migrane
Similarity: women > men, vision changes, the aura usually resolves within 10-to-30 minutes,
and the headache invariably follows, rather than precedes, the neurological deficits;
DIfference: the character and severity of neurological deficits associated with basilar migraine are distinct. The visual change may evolve to complete blindness. Irritability may develop into psychosis. Rather than
a mild hemiparesis, the patient may have a transient quadriplegia. Stupor, syncope, and even coma may appear and persist for hours.
120
trigenmnal neuralgia vs atypical facial pain
Trigeminal: praoxysmal, lancinating pains
atypical facial pain: constant, deep pain, uni or bilateral,
- -- responds to SSRI indicating may be related to depression
- --Progressive loss of sensation in the distribution of the fifth cranial nerve (CN) should prompt search for malignancy
BOTH: can be unilateral
121
trigeminal neuralgia is assocaited w
- multiple sclerosis
- basilar artery aneurysms, acoustic schwanno-
mas, and posterior fossa meningiomas => all of which cause injury to 5th nerve compression
122
Tolosa-Hunt syndrome
inflammatory disorder that produces ophthalmoplegia associated with headache and loss of sensation over the forehead.
--pathologic site: superior orbital fissure or the cavernous sinus
123
prophalactic meds for migraine
amitriptyline hydrochloride, propranolol, verapamil, and valproate.
124
acute tx for migraine
Metoclopramide hydrochloride,
| sumatriptan, and ergotamine tartrate
125
presentation of giant cell arteritis aka temporal arteritis
persistent fevers and progres-
| sive weight loss.
126
tx for postherpetic neuralgia
imipramine hydrochloride,
127
sudden headache that prompts CT non con and LP is..
thunderclap headache
- ---even if ct and LP negative, consider angiogram as changes in aneurysm can cause that type of headache
- ------classic occurs during sex
128
MRI and LP in pseudotumor cerebri
normal MRI w increased LP opening pressure + papiledema; presents w morning headaches w vision changes and tinnitus
129
tx for pseudo tumor cerebri
include lumbar
puncture, diuretics, ventriculoperitoneal shunting, and optic nerve sheath
fenestration.
130
causes of headache worsened by standing but relieved w laying down
Intracranial hypotension due to following causes:
1) LP
2) continued leak of cerebrospinal fluid (CSF) from the subarachnoid space after head trauma, neurosurgery, or even pneumonectomy (thoracoarachnoid fistula)
3) occult pituitary tumor
4)a leak from a dural tear in the spinal root sleeves; traumatic nerve root avulsion
5) systemic illness
such as dehydration, diabetic coma, uremia, or meningoencephalitis.
131
what happens when elbow is injured
ulnar nerve runs superficially and is at high risk of damage:
- --claw hand w failure of last two fingers to extend
- --lumbricals weakness
132
gunshot wound to upper arm causing partial damage to median nerve may result in what?
Even though median nerve ws not directly hit, it can be affected through passing of energy or force
Trauma to nerves in the extremities may give rise to causalgia, a disturbance in sensory perception
characterized by hypesthesia, dysesthesia, and allodynia.
Hypesthesia: decrease in the accurate perception of stimuli.
dysesthesia: persistent discomfort, which in the situation described is likely to be an unremitting burning pain.
Allodynia: perception of pain with the application of
nonpainful stimuli.
133
Acoustic trauma may produce
| severe--- in persons who have relatively little hearing loss.
tinnitus
134
nerve damage in humerus fracture
- musculocutenaous nerve injury
--------supplies the
biceps brachii, brachialis, and coracobrachialis muscles
--------Flexion at the elbow with damage to this nerve is most impaired with the forearm supinated.
135
saturday nigth palsy is related to
radial injury: at radial groove, wrist drop and impaired extension
136
why is ct bad at dectecting bleeding several days old
because within few days, the blood will be broken down into less dense material equal in density as brain so difficult to assess at that point
137
what to do w respiratory setting in ICP
hypervenlation
138
head trauma => consciousness in and out => then coma
epidural hematoma: middle meningeal artery
139
Although subdural hemato-
| mas are often bilateral, epidural hematomas are invariably unilateral.
j
140
Chronic subdural hematoma is rel-
| atively common in
elderly and renal dialysis patients
- --often times not picked on CT as blood turns isodense after several days but MRI should pick up
- ---should not cause a shift as this is a chronic process and brain has a chance to adjust
141
most commonly involved part of brain in trauma such as car accident
temporal lobes and infe-
| rior frontal lobes
142
more common effects of TBI occurs due to..
1)anosmia --occurs due to Avulsion of olfactory rootlets. Taste sense also affected simultaneously
143
He is awake and alert, has intact cranial nerves (CNs),
and is able to move his shoulders, but he cannot move his arms or legs. He
is flaccid and has a sensory level at C5. Management?
spinal cord injury is initially flaccid then takes some time for spasticity to develop
High-dose intravenous
methylprednisolone improves outcomes in SCI
144
On examina-
| tion the abductor pollicus brevis is weak bilaterally,. think..
carpal tunnel
145
(encephalitis lethargica) aka post viral encephalitis presents w features of
features of parknsonism
146
sarcoidosis affects which cranial nerve
facial weakness aka facial paresis from CN 7 injury
147
Polio vs guimbre
Both: ascending paralysis
Polio: preceded by fever + affects anterior horn of motor neuron + elevated protein and white count on LP
Guimbre: preceded by diarrhea
148
most common causes of fungal meningitis in immunocompromised
cryptococcos and india stain
149
subacutely evolving paraparesis due to parasite
Schistosoma mansoni: The fluke deposits eggs in the valveless veins of Batson, which drain the intestines and communicate with the drainage from the lumbosacral spinal cord. The patient develops granulomas around the ova that lodge in the spinal cord, and these granulomatous lesions crush the cord.
150
The parasitic brain
lesion most likely to have a large cyst containing numerous daughter cysts
is that associated with
Echinococcus granulosa: acquired
by ingesting material contaminated with fecal matter from sheep or dogs.
children more likely than adults to have these hydatic cyts
151
82 yo w bacterial meningitis. what first
intravenous ceftriaxone plus ampicillin=> then LP
152
LP of prions disease
normal typically: if (14-3-3 proteinase
| inhibitor) it is specific to prion but not common
153
recurrent meningitis often occurs in person w
csf leak --- can have rhinohrea secondary to trauma
154
tb in brain has
caseating granuloma that makes them act like mass
155
in HIV pt w potential of bleed, abscess or mass, what is the best first test when someone presents w hemiparesis
keep it broad so ct w contrast
156
diagnosis of most common etiologies
| of rim-enhancing brain lesions in AIDS patients are
Primary CNS lymphoma: PCR EBV of CSF
Toxo: CSF
thus..LP
157
tx of toxoplasmosis
combination of sulfadiaz-
| ine and pyrimethamine
158
tx for pml
HAART is effective against JC virus
159
most common form of acute encephalitis
herpes: high lymphocytes w elveated opening pressure
160
Lyme disease affects which neurological problems?
facial weakness aka CNS 7
161
why does the mass in cerebellum not cause seziure
because you need cerebrocortical (or at least
| cerebral) lesion.
162
herpes encephalitis shows what in eeg
Bilateral, periodic epileptiform discharges
163
HIV and cyto-
| megalovirus infections in the brain characteristically produce what
microglial nodules
HIV: the microglial nodules are distributed around blood vessels throughout the brain; microglial nodules associated with syncytial cells in the brain and spinal cord,
CMV: nodules are more char-
acteristically subpial and subependymal.
164
primary amebic meningoencephalitis.
1) caused by
2) introduced to body through
1) caused by organisms from the genera Hartmanella or
Acanthamoeba.
2) fresh water swimming: parasites enter the nervous system through: the cribriform plate at the perforations for the olfactory nerves.
165
tx of meningieal involvement of lyme disease
high-dose penicillin or ceftriaxone must be given intravenously for 10-to-14 days. Tetracycline qid for 30 days should be used for patients who are
allergic to the intravenous treatments.
166
Abscesses in the brain most often develop from
Hematogenous spread of infection
167
known infection + a rim-enhancing lesion in the left
frontal lobe. Which of the following is the most common site for formation
of this type of lesion?
Abscess; starts at grey white junction
168
symphylis affects brain in creating
A gumma is a largely or entirely
| avascular granuloma that grows and masks picture as brain tumor
169
rabies goes and resides in
animal saliva
170
cause of malignant external otitis and osteomyelitis of the
| base of the skull in HIV pt
aspergillus
171
the most common symptom in patients with
| brain abscess?
headache
172
Which of the following is the most common cause of brain abscess
in patients with AIDS?
toxo >>> fungal (crypto, aspergillus, etc)
173
General paresis eg due to symphilis
tx
early symptoms are a subtle dementia, characterized by memory loss
and impaired reasoning, with later development of dysarthria, myoclonus,
tremor, seizures, and upper motor neuron signs, leading to a bedridden
state. CHRONIC process
penecillin
174
---- of the brain are involved
| in general paresis infection.
Both the meninges and the parenchyma
175
bacterial cause of absess
#1 cause is strep; if stab wound or surgery causing abscess then staph most common
176
spongiform disease is transmitted through..
infected nervous system tissue, including dura mater grafts, and occasionally via growth hormone preparations acquired from cadaver
pituitary glands.
177
listerial meningtis tx
ampicillin and gentamicin are recommended therapy.
178
cause of meningtis in 90 yo w pleacytosis, no organism,
listeria
179
162,
x
180
Biopsy of this lesion reveals oli-
godendrocytes with abnormally large nuclei that contain darkly staining
inclusions. There is extensive demyelination, and there are giant astrocytes
in the lesion.
PML w JC virus in the large nuclei
181
tabes dorsalis is associated with
neurosyphyllis; exhibit
| abnormal (Argyll Robertson) pupils and optic atrophy.
182
SSPE produces a CSF pattern
similar to that seen with multiple sclerosis, whose features include an increase in the γ-globulin fraction and the presence of oligoclonal bands.
183
seizure. A neurologist exam-
ining the child discovers chorioretinitis, ataxia, hyperactive reflexes, and
bilateral Babinski signs. With
EEG exhibits periodic bursts of high-voltage
slow waves followed by recurrent low-voltage stretches (burst suppression
pattern).
SSPE
184
bartonella in HIV pt causes ... MRI shows
more virulent encephalitis associated with status epilepticus.
---(bacillary angiomato-
sis).
----MRI may show a characteristic increased signal intensity in the
pulvinar, suggesting a tropism of the organism or immune response to this
particular structure in the posterior thalamus.
185
Cysticercosis causes...
| Brain lesion looks like...
Cysticercal infection of
muscles produces a nonspecific myositis. Brain involvement may lead to
seizures. The lesions in the brain may calcify and often appear as multiple small cysts spread throughout the cerebrum.
186
Cysticercosis is produced by
```
the
larval form (cysticercus) of the pork tapeworm, Taenia solium=> invades gut
```
187
In adults, the most common primary brain tumor is the
gial cell tumor called astrocytoma
188
is the usual
| location for brain tumors in children.
posterior fossa aka infratentorial : Medulloblastoma, ependymomas, and cerebellar (or brainstem) gliomas
189
left hemisphere mass with an overlying hyperostosis of the skull.
meningioma
190
Several different types of germ cell tumors arise from the
| tissues in this region,
this region is called pineal gland
191
the most common source of meta-
| static tumors to the brain in patients without a known primary tumor?
lung tumor
192
brain mets usually lie in
gray-white matter junction
193
The shortest life expectancy with metastatic disease to the brain will
be found in the patient with which of the following metastatic cancers?
Malignant melanoma
194
compliation of colloid cyst
hydrocephalus: Colloid cysts may produce
| transient or persistent obstruction of the flow of cerebrospinal fluid
195
bitemporal hemianopsia. Which of the following tumors is most
likely responsible for this finding?
1) only the temporal quadrants of the field in each eye are affected.
2) Pituitary adenoma => sella turcia presses on optic chaiasm causing the #1 visual defect
196
Which of the following tumor types is common in the brain of
patients with acquired immune deficiency syndrome (AIDS), but otherwise
extremely rare?
primary CNS lymphoma
197
delayed girl has precocious puberty or excess growth harmone
and poorly controlled seizures. Her seizures are typically preceded by
episodes of uncontrollable laughter. Which of the following mass lesions
might explain her symptoms?
hypothalamic hamartomas => non malignant => surgical resection successful
198
an ependymoma. This patient is potentially at risk of dying because of
transforminal herniation. Ependymoma is in posterior fossa.
199
A 4-year-old boy presents with ataxia, lethargy, and obstructive
hydrocephalus.
Medulloblastomas (lies in posterior fossa) and are one
| of the most common CNS tumors of childhood.
200
A 16-year-old boy with café au lait spots and cutaneous nodules has
a gradual decrease of vision in his left eye.
optic glioma -NF1
201
A 55-year-old woman presents with mild unsteadiness, tinnitus, and
hearing loss.
Schwannomas usually develop
on the vestibular division of CN VIII and are pathologically derived from Schwann cells rather than nerve tissue. Although this is not the division of the nerve that carries information from the cochlea, the cochlear division is crushed as the tumor expands.
NF2
202
Pineocytomas
This patient’s symptoms and signs
constitute Parinaud syndrome, which may include loss of vertical gaze, loss of pupillary light reflex, lid retraction, and convergence–retraction nystag-
mus, in which the eyes appear to jerk back into the orbit on attempted upgaze.
203
lesion for pineocytomas
dorsal midbrain in the region of the superior colliculus.
204
paraneoplastic cerebellar dysfunction
harbor anti-Purkinje cell antibodies (called anti-Yo antibod-
ies), and these are especially commonly found in women with breast cancer
or gynecologic malignancies.
205
70-year-old man with a history of lung cancer develops nausea
and vomiting and then becomes lethargic. On examination, he is lethargic
but arousable, disoriented, and inattentive. He is weak proximally and has
diminished reflexes.
hypercalcemia
206
Tay-Sachs disease,- deficiency in ..
Hexosaminidase A
207
An 8-month-old boy develops spasticity, head retraction, and diffi-
culty swallowing.
His physician discovers an abnormal accumulation of
glucosylceramide and tells the parents their child will continue to deteriorate and likely die within 3 years. This child has which of the following?
β-glucosidase deficiency
208
The cerebrospinal fluid (CSF) protein content of pt w hypertensive stroke is likely to be which of the following?
elevatedelevated but less than 100
209
A 42-year-old man presents to the emergency room with seizures,
mental status change, and vision difficulties. A magnetic resonance imag-
ing (MRI) reveals an abnormally high T2 signal in the posterior cerebral
white matter. There is proteinuria, and blood pressure is 210/120 mm Hg.
The cerebrospinal fluid (CSF) protein content of this patient is likely to be
which of the following?
elevated but less than 100
210
A patient has had progressive, chronic liver failure for the past 5 years.
At the time of death, he would be expected to exhibit changes in which
type of brain cells?
increase in Alzheimer type II astrocytes. These astrocytes are
relatively large cells.
211
An 8-month-old boy develops spasticity, head retraction, and diffi-
culty swallowing. His physician discovers an abnormal accumulation of
glucosylceramide and tells the parents their child will continue to deterio-
rate and likely die within 3 years. This child has which of the following?
1) The disease responsible for
the accumulation of glucosylceramide is Gaucher disease.
2) deficient glucocerebrosidase in fibroblasts or leukocytes.
212
the most common neurological
| complication of chronic renal failure?
Peripheral neuropathy
213
what helps restless leg syndrome
clonazepam, gabapentin, L-dopa,
dopamine agonists (eg, pramipexole or ropinirole), and opiates.
214
visual manifestation of B12 def, alcoholism -thimine def, tobacco
Centrocecal scotoma: blind spot enlarges
215
hx of alcoholism and benzodiazepine use, including diazepam, loraze-
pam, and clonazepam. Before long surgery, what should have bene given
thaimine
216
tx of alcohol and benzo withdrawl with
benxo like chlordiazepoxide
217
Her diet is strictly
| vegetarian and limited almost entirely to grains, such as corn. what deficiency
niacin or tryptophan def => causes pallegra
218
vitamin D def causes what
- rare but usually during early childhood.
| - spinocerebellar degeneration (ATAXIA), polyneuropathy, and pigmentary retinopathy.
219
korsikoff can also cause neurolgoic problems like slow mentation
k
220
hx of blood transfusions, don't forget
AIDS
221
pickwickian syndrome
obesity associated with hypersomnelence in someone with OSA.
222
trauma to brain => pt disoriented after 4 days
post ictal ---significant trauma can cause seizures esp during sleep
223
Carbon tetrachloride can cause
hepatic encephalopathy as it is a hepatic toxin=> high NH3
224
triphasic waves
hepatic encepathopathy
225
path of alzhiemers
neuronal loss, fibrillary tangles, loss of
synapses, and amyloid (or neuritic) plaque formation in hipocampus
226
eeg on alzhiemers
Generalized background slowing
227
disturbance, dementia, and incontinence.
normal pressure hydrocephalus
228
complication of VP shunts for NPH
Subdural hema-
toma occurs because the reduction in intracranial pressure brought on
by the reduction in CSF volume may cause the brain to pull away from
the covering meninges, stretching and potentially rupturing the bridging
veins.
229
Language testing is most likely to uncover which of the following
deficits in a patient with Alzheimer disease?
Transcortical sensory aphasia:which refers to a reduction in the ability to understand complex linguistic structures. Repetition of verbal material is intact.
230
transient global amnesia
TGA refers to an episode of
complete and reversible anterograde and retrograde memory loss lasting
up to 24 hours.
231
A 50-year-old woman began having double vision and blurry vision
3 months ago and has since had diminishing interaction with her family,
a paucity of thought and expression, and unsteadiness of gait. Her whole
body appears to jump in the presence of a loud noise. A magnetic reso-
nance imaging (MRI) scan and routine cerebrospinal fluid (CSF) examina-
tion are unremarkable.
CJD
232
normal development untile 2 but LOSS OF language and stereotyped movement
rhett sydnrome
233
---- is one of the manifestations of neurosyphilis. It is a chronic, often insidious meningoencephalitis that may be delayed up to 20 years after the original spirochetal infection.
General paresis
234
t whippei on neurology
seizures, myoclonus, ataxia, supra-
nuclear gaze disturbances, hypothalamic dysfunction, and dementia.
Oculomasticatory myorhythmia (pendular convergence movements of the eyes in association with contractions of the masticatory muscles) may occur
and is considered pathognomonic.
235
one hand buttons shirt while other unbuttons is called....
occurs due to lesion in...
this is seen in...
alien hand syndrome
parietal lobe
subcortical white matter, particularly in the occipital or parietal regions= > JC virus causing PML
236
dementia, delusions, dysar-
| thria, tremor, myoclonus, seizures, spasticity, and Argyll Robertson pupils.
general paresis assocaited with neurosyphillis
237
-- designates an
involuntary movement disorder that occurs during pregnancy and involves
relatively rapid and fluid, but not rhythmic, limb and trunk movements.
chorea gravidarus or estrogen use in non prego
238
A mag-
netic resonance imaging (MRI) indicates atrophy in the head of the caudate
nucleus. This MRI finding would be expected to affect the shape of which
of the following?
lateral ventricle rhomboid in shape
239
dopaminergic drugs in huntington causes
unmasking of chorea
240
1-methyl-4-phenyl-1,2,3,
6-tetrahydropyridine (MPTP). The neurological syndrome for which he is
at risk is clinically indistinguishable from which of the following?
MTP caues degenration of substantia nigra => parkinsonism symptoms
241
what is dysfunctional in parkinson?
Brainstem nuclei
242
252
ü
243
Postmortem
study of the substantia nigra of a patient with Parkinson disease is likely to
exhibit which of the following?
Intracytoplasmic inclusion bodies- w eosinophils
244
Trihexyphenidyl
aniticholinergic: it reduces parkinsonism when given antidopa meds like haloperidol
245
L dopa ___ haloperidol induced parkinsonism
worsens
246
in parkinsons's the decrement in
| speech that would be expected would result in
Progressively inaudible speech: low volume and speed
247
why L dopa but not dopamine as a tx for parkinson
Dopamine cannot cross the blood–brain barrier and therefore has no therapeu-
tic effect in the central nervous system (CNS).
248
why add carbidopa to l-dopa
L-dopa can be converted to dopamine in variety of tissues peripherally. Dopamine cna' tcross to brain. Carbidopa inhbits the conversion of L dopa into dopa peripherally.
Once in brain, L dopa converts to dopa.
249
tx for tourette
haloperidol
250
After several years of successful antiparkinsonian treatment, a patient
abruptly develops acute episodes of profound bradykinesia and rigidity.
Remission of these signs occurs as abruptly as the onset. Which of the fol-
lowing is the most likely etiology?
on-off phenomenon
251
Meige sydnrome
tx
blepharospasm, forceful jaw opening,
lip retraction, neck contractions, and tongue thrusting.
---also elicited by phenothiazine or butyrophenone use,
tx: botulinum injectiion
252
He breathes independently and even
swallows food when it is placed in his mouth, but he remains mute. With
painful stimuli, he exhibits semipurposeful withdrawal of his limbs. His
clinical status remains unchanged for several more months.
The vegetative state is a clini-
| cal condition in which autonomic activity is sustained with little evidence of cognitive function.
253
cause of : Consciousness is preserved in the
| locked-in syndrome, but the patient is paralyzed from the eyes down.
ischemic or hemorrhagic damage to the pons, such as that occurring with
basilar artery occlusion.
254
Hepatolenticular degeneration
| Wilson disease
- Renal tubular acidosis develops along with hepatic fibrosis=> brain and liver disease w progressive dimentia
- atrophy of putamen and globus pallidus
255
oligoclonal bands are
- limited number of bands of excess immunoglobulin indicates that the
species of IgG produced by the disease
- syphilis, Lyme, and sub-
acute sclerosis panencephalitis may also produce oligoclonal bands.
256
MS neck exam
peculiar sensory phenomenon
in which the patient feels an electrical sensation radiating down the spine
when the neck is passively flexed is called Lhermitte sign and is believed to
signify spinal cord disease.
257
Which of the following evoked response
patterns is most often abnormal in patients with early MS?
Optic neuritis occurs early
and often in many patients with MS. This involves inflammation and
demyelination of the optic nerve and slows conduction along the optic
nerve.====> slow Visual evoked response (VER)
258
pt on corticosteriod should be given what
Ranitidine: Gastric disturbances are a
possible side effect of corticosteroid use.
259
```
A papovavirus infection of the central ner-
vous system (CNS) in this person would be most likely to produce which
```
of the following?
also known as jC virus => PML
260
Canavan disease
-produce
developmental regression at about 6 months age
- extensor posturing and rigidity.
- Myoclonic seizures may develop.
- Underlying the disease is a defect in N-acetylaspartic acid metabolism.
-Elevated levels of this material can be detected in the blood and urine, but elevated
levels in the brain establish the diagnosis. Changes in brain white matter
are widespread and may result in a spongiform appearance. There is an
increase in brain volume and weight. =>MACROENCEPHALY
261
how does ms affect bladder
more spasticity => thus urinary incontinence aka inappropirate emptying of bladder
262
tx of leg spasm in ms
Baclofen is an antispasmodic
| agent that may be used in MS.
263
what worsens ms symtpoms
hot weather
264
young woman with bilateral leg weakness and
| numbness, urinary retention, and impaired bowel control.
transverse myelitis due to nmo
265
Two weeks after recovering from a febrile illness associated with a
productive cough, a 19-year-old man complains of headache and neck
stiffness. These complaints are associated with fever and are soon followed
by deteriorating cognitive function. He becomes disoriented, lethargic, and
increasingly unresponsive. MRI reveals widespread damage to the white
matter of the cerebral hemispheres.
Acute disseminated encephalomyelitis aka post viral autoimmune encephalitis affecting white matter
266
a mutation of mito-
| chondrial DNA.
A young man presenting
with centrocecal scotoma pattern of visual loss is much more likely to have Leber optic
atrophy or another cause of optic atrophy (eg, tobacco-alcohol amblyopia,
tertiary syphilis, or vitamin deficiencies)
267
ATP-binding transporter in the peroxisomal system
| responsible for long-chain fatty acid metabolism.
X lined adrenal leukodystrophy
exhibit limb ataxia, nystagmus,
and mental retardation. MRI of their brains reveals areas of abnormal signal
in the white matter. Cerebellar involvement is substantial.
268
A 3-month-old boy exhibits nystagmus and limb tremors unassoci-
ated with seizures. Over the next few years, he develops optic atrophy, choreoathetotic limb movements, seizures, and gait ataxia. He dies dur-
ing status epilepticus and at autopsy is found to have widespread myelin breakdown with myelin preservation in islands about the blood vessels.
The pathologist diagnoses a sudanophilic leukodystrophy to describe
the pattern of staining observed on slides prepared to look for myelin
breakdown products.
Pelizaeus-Merzbacher
demyelinating disorder that belongs to a group of degenerative diseases known as sudanophilic leukodystrophies.
269
rapid increase of sodium causes
Central pontine myelinolysis. quadriplegic and unre-
| sponsive
270
a mutation in the gene that encodes a subunit of the
------, which results in impaired VLDL
formation and consequent decreased vitamin E delivery to the peripheral
and central nervous system.
microsomal triglyceride transfer protein => causes ataxia
271
spinal bifida oculta
meningocele
meningomyelocele
1) spine protuding out
2) dura protuding out
3) dura+spinal cord protuding out
272
best menagement for hemangioblastoma found in von Hippel-Lindau syndrome
surgical resection
273
c1 fused to skull increases risk of
chiari malformation
274
second cervical vertebra extends above the
| level of the foramen magnum and places the patient at high risk of having
brainstem compression
275
agenesis of the corpus callosum causes what on MRI
1) Abnormally shaped lateral and third ventricles
| agenesis of the corpus callosum,
276
divalproex sodium dur-
| ing the first trimester of pregnancy.
ntd
277
A 17-month-old boy had developed normally until approximately 13
months of age, when he began having progressive gait problems. On exam-
ination, the patient is spastic, yet nerve conduction studies (NCS) reveal
slowed motor and sensory conduction velocities. Cerebrospinal fluid (CSF)
protein is elevated. MRI reveals white matter abnormalities. Leukocyte test-
ing reveals deficient arylsulfatase A activity. Which of the following tests
may also provide useful diagnostic information in this condition?
this is
metach-
romatic leukodystrophy.
DO: nerve biopsy
278
phenylketonuria (PKU) have high levels of
phenelalanine
279
fragile x in men vs women
Men with the fragile X syn-
drome have hyperextensible joints and prominent thumbs, seizure but carrier women may appear quite normal.
women mostly normal but may have retardation in half of case
280
16 month old; dysarthric and mental functioning decreases, low reflexes, deficiency of arylsulfatase
metrachormatic leukodystrophy
281
Hexosaminidase deficiencies
| produce
Sandhoff and Tay-Sachs diseases.
282
Glucocerebrosidase is deficient in
gaucher
283
4-year-old previously healthy girl develops an intermittent red, scaly rash over her face, neck, hands, and legs.
+
devleopmental delay + emotional lability + episodic cerebellar ataxia.
Hartnup disease
284
tx of hartnup disease
its is inability to absorb tryptophan and other neutral aa so giving the prodruct of trpytophan aka nicotinamide provides relief
285
CT reveals calcifications in the cerebral cortex in a railroad track pattern.
Sturge-Weber syndrome
286
association of erythrocytosis with cerebellar signs, microscopic hematuria, and hepatospleno-
megaly suggests
von Hippel-Lindau syndrome.
- polycystic liver disease, polycystic kidney disease, reti-
nal angiomas (telangiectasia), and cerebellar tumors.
287
causes of retinitis pigmentosa
abetalipoproteinemai, mitochondrial diseases, Bardet-Biedl syndrome, Laurence-
Moon syndrome, Friedreich ataxia, and Refsum disease.
288
features of Abetalipoproteinemia
what helps
abnormally shaped
erythrocytes (acanthocytes), low/absent cholesterol and triglyceride, ataxia, reveals posterior column
and spinocerebellar tract degeneration, retinits pigmentosa
-----vitamin E
289
inheritance pattern of tuberous scleorsis
autosomal dominant but variable penetrance
290
Congenital hydrocepha-
lus may develop as a consequence of which of the following first-trimester
maternal disorders?
A maternal infection with
mumps or rubella virus may produce aqueductal stenosis and, as a con-
sequence, hydrocephalus.
291
uncorrected hydroencephalus leads to
macroencephaly
292
type 2 Chiari malformation. Which of
| the following defects would this child be likely to have?
spina bifida
293
Adenoma sebaceum occurs
| in about 90% of patients with
tuberous sclerosis.
294
metastatic cncer in von hippau is likely from what organ
VHL has high rate of renal cell carcinoma=> causing mets
---the cerebellar hemangioblastomas can bleed but does not have mets
295
eye finding in tuberous sclerosis
Retinal phakomas are gliomatous
tumors that require no treatment and are a principal criterion for making the
diagnosis of tuberous sclerosis.
296
Calcifications evident on the skull x-ray or CT scan of a patient with
tuberous sclerosis usually represent
subependymal glial nod-
ules that have calcified.
-----not malignant but can obstruct
297
Tay-Sachs disease develop blindness before they
die, with retinal accumulation of gangliosides that produces which of the
following?
cherry red spots
298
sign of upper motor neuron disease in child
congeni-
| tal weakness, hypotonia, and muscle atrophy
299
hyperpigmentation in 9 yo boy could be
cafe aulit sign present in NF1>2
300
a cyst occupying 50% of his posterior fossa and incomplete fusion of the cerebel-
lar elements inferiorly. Lifespan?
This is Dandy walker malformation => if obstructive hydrocephalus, death soon after birth
If no obstructive hydrocephalus, then pt will be asymtpomatic
301
having hundreds of seizures per day. The clini-
cal manifestations are somewhat subtle and consist of sit-up like movements. Interictal EEG shows multifocal, high-amplitude spikes (hypsarrhythmia) and slowing.
Adrenocorticotropic hor-
| mone is usually given as a gel intramuscularly to control infantile spasms in children with tuberous sclerosis;
302
Cerebral palsy is a static encephalopathy because
the injury to the brain does
| not progress.
303
DS brain
Smaller than normal for age and body size
304
right parietal parenchymal defect that
is continuous with the ventricle and does not appear to be lined with gray
matter. This type of lesion usually develops as a consequence
Vascular or other destructive injuries to the fetal brain
305
fetal alcohol on brain
Impaired neuronal migration causing heterotopias (collections of cortical neurons in abnormal locations),
306
type 1 and 2 Chiari malformation usually becomes symptomatic as which of the following in adults?
ataxia
307
proximal weakess in cancer pt
lung:Les=repetition helps
thymus: mg= weak w repetition
all= dermatomyositis
308
ALS: cough becomes totally ineffective for clearing his
airway- tx?
Chest physical therapy
309
A high --- in a woman
with male relatives affected by Duchenne dystrophy indicates a high prob-
ability that she is a carrier of the abnormal dystrophin gene.
cpk
310
The spontaneous mutation rate for the dystrophin gene is presumed
to be high for which of the following reasons?
Men with Duchenne dystrophy do not reproduce.
311
intellectual in dystrophy
Slightly impaired. Beckers better intelllectual than duchenne
312
pseudohypertorphy in dystrophy occurs in
limited to calves
313
exhibit problems with relaxing their grip, hypersom-
| nolence, premature baldness, testicular atrophy, and cataracts.
myotonic dystrophy
314
myotonic dystrophy eeg
Repetitive discharges with minor stimulation
315
EMG of anterior horn damage
abnormal fibrillation: conduction time normal even with extensive motor neuron disease, but the pattern of spon-
taneous and evoked muscle potentials would be abnormal.
316
The pathologist reports that there
are numerous abnormally small muscle fibers intermingled with hypertro-
phied muscle fibers. THis is due to
denervation atrophy: some groups supplied by certain nerves atropy due to denervation while other still innervated muscles do not atrophy
317
Which of the following is the
| most common manifestation of muscle weakness with myasthenia gravis?
ocular weakness
318
shortest life expectancy is associated with which clinical sign in
amyotrophic lateral sclerosis?
Fasciculations in the tongue---bulbar involvement is poor prognosis
319
alcohol affects what of cerebellum
superior vermis
320
Triorthocresyl phos-
phate is an organophosphate that may cause lethal neurological complica-
tions by which of the following means?
Causing a severe motor polyneuropathy
321
lead effect in brain
small: ataxia and tremor
large: edema=>herniation and encephalopahty
