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Neurology
Overall by section
| Question | Answer |
|---|---|
| What is a common cause of communicating (non-obstructive) hydrocephalus? | Meningeal scarring after meningitis |
| What are common clinical signs of Hydrocephalus, especially, in children? | Decreased feeding, behavioral changes, bulging fontanelles, and increased head circumference. |
| Which sensory fibers are responsible for the withdrawal reflex in response to pain? | Aδ-sensory nerve fibers |
| What is the composition of the Aδ fibers? | Heavily myelinated and small in diameter, which innervate the mechanoreceptors, nociceptors, and thermoreceptors |
| Which nerves roots are assessed in the Achilles tendon reflex? | S1- S2 nerve roots |
| Which important clinical reflex is assessed by stimulation of the S1-S2 nerve roots? | Achilles tendon reflex |
| Which muscles are innervated by the Musculocutaneous nerve? | Coracobrachialis, brachialis, and biceps brachii |
| What are the consequences of injury to the Musculocutaneous nerve? | Weak forearm flexion, loss of biceps tendon reflex, ands sensory loss over the lateral forearm |
| Which nerve is injured or damaged if there is loss of the bicep's tendon reflex? | Musculocutaneous nerve injury |
| Which part of the forearm losses sensitivity due to injury to the Musculocutaneous nerve? | Lateral forearm |
| If a patient arrives to ED with weakness when performing forearm flexion, is possible due to what nerve being injured? | Musculocutaneous nerve injury |
| What is the function/role of the Reticular Activating System? | Consciousness |
| What is the Reticular Activating system? | Group of neurons in the upper pons and midbrain, which extend to the cerebral cortex |
| What severe condition is due to injury to the brainstem? | Coma |
| At what approximate age does the Babinski sign usually starts to disappear in healthy babies? | 12 months of age |
| What is the Babinski sign? | Upward-moving great toe with fanning of the other toes when the bottom of the foot is stroked |
| How is the feeding development of a health 18–24-month-old child? | Use a fork and spoon to feed himself |
| What is the approximate vocabulary range for a child 18-24 months of age? | 50-200 words |
| At what age range, can we expect a child to engage in parallel play? | 18-24 months of age |
| What is the physical consequence in the brain of chronic alcohol use? | MRI showing cerebellar atrophy |
| What are some clinical features of Alcoholic cerebellar degeneration? | Initially with leg ataxia and gait impairment, later show dysarthria, upper extremity ataxia, diplopia, or blurred vision |
| What is the classic triad of NPH? | Urinary incontinence, ataxia, and dementia |
| What is the cause of NPH? | Reduced CSF absorption into the venous system |
| Which sinus participates in the pathogenesis of NPH? | Superior Sagittal sinus |
| What is the histologic appearance and description of Oligodendrocytes? | "Fried egg" |
| On which lobe of the brain are Oligodendrogliomas most located? | Frontal lobe |
| Which CNS malignancy is located in on the frontal lobe? | Oligodendroglioma |
| What is the function of Oligodendrocytes? | Myelination of multiple CNS axons |
| Which cell are known to myelinate multiple CNS axons? | Oligodendrocytes |
| What syndrome is due to occlusion of AICA? | Lateral Pontine syndrome |
| Which vascular structure is occluded in Lateral Pontine syndrome? | AICA |
| Where is the "red nucleus" located? | Midbrain, which is rostral in position to the pons |
| What CNS structure is located rostral to the pons? | Midbrain |
| Is the Red Nucleus located in the midbrain or pons? | Midbrain |
| Which nerve is affected by Bell Palsy? | Facial nerve |
| What are the clinical effects of Unilateral Bell palsy due to CN VII lesion? | Ipsilateral dry eye, dry mouth, and decreased sensation of the anterior tongue, retroarticular pain, sensitivity to noise an facial paralyses |
| What pain is often described by Bell palsy? | Retroarticular pain |
| Which part of the tongue losses sensation in Bell's palsy? | Anterior tongue |
| What re the clinical features of S1 disc herniation? | Decrease sensation in the posterior leg and lateral foot, diminished ankle jerk reflex, and weak plantarflexion of the foot, and back pain radiating to the lower extremity |
| Which nerve is evaluated by the "Straight leg raise test? | Sciatic nerve |
| What test can be performed to diagnose Sciatic nerve damage or injury? | Straight Leg Raise test |
| Is plantarflexion or dorsiflexion of the foot affected in Sciatic nerve injury? | Plantarflexion |
| Which part of the foot loses sensitivity with Sciatic nerve injury? | Lateral foot |
| Is Sciatic nerve damage felt with decreased sensation in the posterior leg or anterior leg? | Posterior leg |
| How is Hereditary Spastic Paraplegia characterized? | Progressive degeneration of the lateral corticospinal tracts and subsequence lower extremity weakness and spasticity. |
| Which tracts are affected in Hereditary Spastic Paraplegia? | Lateral corticospinal tracts |
| Is NF-1 or NF-2 associated with Schwannomas? | NF-2 |
| What is the ocular characteristic of NF-2 that leads to a blurry vision? | Increase risk of developing cataracts |
| What condition is often described as a "thunderclap" headache? | Subarachnoid hemorrhage |
| What is the Cushing triad, associated with SAH? | Hypertension, bradycardia, and respiratory depression |
| What vision deficits can be expected with lesions to the right inferior temporal lobe? | Prosopagnosia and contralateral homonymous superior quadrantanopia |
| What is the non-medical way to describe Homonymous Superior Quadrantanopia? | "Pie in the sky" |
| Which skull foramina is used by CN V3? | Foramen Ovale |
| Which Cranial nerve exits the skull via the Foramen Ovale? | CN V3 |
| What is the mnemonic to remember the foramen used by Cranial Nerve V? | Standing Room Only (V1-Spinosum, V2-Rotudum, V3-Ovale) |
| What are two proteins responsible for stimulation of appetite? | Ghrelin and Neuropeptide Y |
| Is ghrelin and Neuropeptide Y decreased or increased in a fed stat? | Decreased |
| Which is the major hormone responsible for decreasing hunger and appetite? | Leptin |
| A person that just had a big meal, is expected to have low or elevated levels of Leptin? | Elevated level of Leptin |
| What is the setting in which Heat Exhaustion develops? | Exposure to elevated temperatures and vigorous exercise, which may progress into heatstroke is not properly treated |
| How is temperature regulated by palms and soles? | Decreased sympathetic nerve signaling to the sike, which cause reduced vasoconstriction, increased blood flow and increased heat dissipation |
| What is the name given to the skin of the palms and soles? | Glabrous skin |
| What are the clinical features of Medial Medullary syndrome? | Contralateral weakness of extremities and loss of proprioception and vibratory sense below the face, and ipsilateral tongue deviation |
| Is the tongue deviation in Medial Medullary syndrome, contralateral or ipsilateral? | Ipsilateral tongue deviation |
| What vascular structures engages in development of Medial Medullary syndrome? | ASA |
| At what level is the ASA occluded or infarcted leading to Medial Medullary syndrome? | Medulla Oblongata |
| What is Declarative memory? | Type of long-term memory dedicated to facts and events |
| Which lobe is responsible for strong declarative memory? | Medial temporal lobe |
| Which lobe is affected in a patient with a defective declarative memory? | Medial temporal lobe |
| What is the Limbic system? | Collection of neural structures involved in emotion, long term memory, olfaction, behavior and ANS function |
| How is Ischemic brain injury most often physically presented? | Contralateral limb weakness or numbness |
| What is the primary cell type seen in gliosis? | Reactive astrocytes |
| How long after brain ischemic injury do astrocytes (reactive astrocytes) appear ion site? | About a week after injury |
| Reactive astrocytes are responsible for which actin? | Formation of a glial scar |
| A defective glial scar formation can be due to defective ______________ (cells type). | Reactive astrocytes |
| What are the motor deficits seen in S1 radiculopathy? | Weakness of plantarflexion, leg extension, and/or knee flexion |
| What are common adverse effects of Benzodiazepines? | Sedation, respiratory depression, tolerance, and dependency |
| What are common uses for Benzodiazepine? | Anxiety, status epilepticus, insomnia, and alcohol withdrawal symptoms |
| What are the classic signs and symptoms of PCP intoxication? | Aggression, psychomotor agitation, elevated temperatures, tachycardia, hypertension, and nystagmus |
| What is an important ocular finding of PCP intoxication? | Nystagmus |
| What is Thalamic Pain syndrome? | From of central post-stroke pain syndrome that presents with hyperalgesia and allodynia contralateral to the thalamic lesion |
| What rare condition is seen with hyperalgesia week as to mothers after stroke? | Thalamic Pain syndrome |
| When the CNS does a lesion cause Thalamic Pain syndrome? | Ventro-postero-lateral thalamus |
| What is the level of AFP in maternal serum that might indicative Open NTD? | Elevated maternal serum AFP during the second trimester |
| What cause Open NTDs? | Defective primary neurulation |
| What embryologic defect is expected to occur in a defective primary neurulation process? | Open NTDs |
| What is the pathologic hallmark of Huntington disease? | Atrophy of the putamen and caudate nucleus |
| What is the advantage of use in carbidopa in treating Parkinson disease? | Carbidopa augments the action of L-DOPA by prevents its peripheral conversion to dopamine and this increases L-DOPA entry to the CNS |
| What medication is used to increase the amount of L-DOPA to reach the CNS and effectively treat Parkinson disease? | Carbidopa |
| What medication is used to prevent L-DOPA conversion to dopamine in the periphery? | Carbidopa |
| What are short-acting benzodiazepines? | Oxazepam and Alprazolam |
| Why are Oxazepam and Alprazolam preferred options over other benzodiazepines? | These are short acting, which decreases risk for developing dependency |
| What medications are causative of NMS? | Antipsychotics |
| How is NMS clinically seen? | Hyperthermia, muscle rigidity, autonomic instability (hypertension, tachycardia), and AMS |
| What is often used to treat NMS? | Dantrolene |
| What medication is known to be a skeletal muscle relaxant that antagonizes ryanodine receptors? | Dantrolene |
| What is the MOA of Dantrolene? | Antagonize ryanodine receptors to prevent the release of Calcium from the sarcoplasmic reticulum of skeletal muscle |
| Which drug is known to prevent the release of Calcium by SR in skeletal muscle? | Dantrolene |
| On which skeletal muscle receptors does Dantrolene work? | Ryanodine receptors |
| By which biochemical process does Valproic acid lead to numerous drug-drug interaction? | Glucuronidation, which may inhibit the CYP enzymes |
| Which anticonvulsant is often used safely with Valproic acid? | Levetiracetam |
| What type of anemia is due to Levodopa use? | Autoimmune hemolytic anemia, which leads to unconjugated hyperbilirubinemia |
| What nerves provides sensory innervation to the proximal interphalangeal and distal interphalangeal joints of the second digit? | Median neve |
| What is a common muscarinic receptor agonist used to treat glaucoma? | Pilocarpine |
| What ocular condition is often treated with Pilocarpine? | Glaucoma |
| How is Pilocarpine useful to treat glaucoma? | Decreases IOP by facilitating drainage of aqueous humor |
| Which medication can be used to decrease IOP by facilitating the drainage of aqueous humor? | Pilocarpine |
| What are the primitive structures of the brain? | Procephalon, Mesenphalon, and Rhombencephalon |
| Which primitive part of the brain gives rise to the midbrain eventually? | Mesencephalon |
| A defective or incomplete development of the Mesencephalon, leads to which brain structure not completed? | Midbrain |
| What embryologic condition is associated with elevated maternal serum AFP levels? | Open NTDs |
| What vitamin deficiency is can lead to Open NTD? | Folate deficiency |
| What is the serious cutaneous adverse effect of Lamotrigine? | Steven Johnson syndrome |
| What bipolar disorder drug is strongly associated with development of Steven Johnson syndrome (SJS)? | Lamotrigine |
| What are the two most common uses for Lamotrigine? | Epilepsy and to stabilize bipolar mood disorder |
| In action potential, which ion efflux or influx, is responsible for neuron membrane repolarization? | K+ channel opening and K+ efflux |
| K+ channel efflux is responsible for which action in a neuron action potential? | Neuron membrane repolarization |
| Neurons affected in Parkinson disease extend from what and project were? | Originate in substantia nigra pars compacta, and project to the striatum |
| What neurodegenerative condition is known to involve neurons extending from the substantia nigra to the striatum? | Parkinson disease |
| What is the MOA of Barbiturates? | Increase the DURATION of chloride channel opening by increasing the activity goes GABA-A receptor |
| If the duration of Cl- channel opening is increased, it is due to barbiturates or benzodiazepine? | Barbiturates |
| Which GABA type is inhibited by Barbiturates? | GABA-A |
| What is Pregabalin? | Antiseizure medication that binds to the α2δ subunit of voltage-gated calcium channels |
| What voltage gated channels are inhibited by Pregabalin? | Voltage-gated calcium channels to reduce the flow of Calcium into the cell, leading to decreased neuronal excitability. |
| What is the ocular effect of activation of alpha 1-receptors? | Pupillary dilator (radial) muscle cause pupil dilation (mydriasis) without affecting the ciliary muscle |
| What are the most common potential metastasize sites for Melanoma? | Liver, lungs, and brain |
| What is a common and high risk for Melanoma? | Excessive sun exposure (UV radiation) |
| What is the best way to diagnose Scoliosis? | Standing radiograph with measurement of the Cobb angle |
| Which trinucleotide condition is associated with Scoliosis development? | Friedreich ataxia |
| What is the MC primary brain tumor in childhood? | Pilocytic astrocytoma |
| Where are most Pilocytic astrocytoma most likely located? | Posterior fossa |
| Which brain tumors are most commonly presented has homogenously enhancing mass with Dural attachment? | Meningiomas |
| What is the histological description of a Meningioma? | Calcified, laminated concentric rings |
| What is the second MC type of adult brain tumor? | Meningiomas |
| What is a classic finding of a partial complex seizure? | Automatism |
| What are the most common features of a partial complex seizure? | Unilateral symptoms, such as myoclonic jerking, and impaired awareness, which can progress to full tonic-clonic jerking |
| Which brain hematoma is associated with Cushing triad? | Epidural hematoma |
| How is Epidural hematoma characterized? | 1. Cushing's triad 2. Lucid interval followed by loss of consciousness 2. Hyperdense area on CT scan |
| What is a common and severe complication seen with Epidural hematoma? | Uncal herniation |
| What gives rise to Uncal herniation in the setting of Epidural hematoma? | Pressure on the medial temporal lobe through the tentorial notch. |
| What is the most common palsy developing due to Uncal herniation? | CN III palsy |
| What is Broca aphasia? | Neurologic insult to the motor speech area of the brain, resulting in difficulty enunciating words, but patients can understand written and verbal language |
| Where the language center located in most people? | Left cerebral hemisphere |
| What artery supplies the Language center in the brain? | Superior branch of the left MCA |
| What area of the brain can be affected by occlusion of the superior branch of the left MCA? | Language center |
| What vessel structures are damaged leading the Subdural hematoma? | Low pressure Bridging veins |
| Into which sinuses do Bridging veins the subdural space drain into? | Dural venous sinuses between the dura and arachnoid layers |
| What are the ipsilateral effects of Unilateral Facial nerve lesion? | Dry eye, dry mouth, decrease taste sensation of the tone, retro-auricular pain, and sensitivity to noise |
| What are the AV blocks associated with Lyme disease? | 2 AVB type 1 and 3 AVB |
| What are common findings of neuroimaging in a patient with Huntington disease? | Caudate atrophy with widening of the lateral ventricles |
| What are the contralateral deficits of Brown-Sequard syndrome? | Loss of pain and temperature below the level of the lesion |
| What are the ipsilateral deficits of Brown-Sequard syndrome? | Loss of all sensation at the level of the lesion Loss of tactile, vibration, and position sense below the level of the lesion |
| Which tract is damaged in Brown-Sequard syndrome that leads to contralateral loss of pain and temperature? | Contralateral Spinothalamic tract |
| A patient with Brown Sequard syndrome has right loss sensation of pain and temperature. What is affected leading to such symptom? | Left Spinothalamic tract |
| What gives rise to ALS? | Death of UMNs and LMNs in the lateral corticospinal tracts |
| What are some less common symptoms of Facial nerve palsy? | Decreased lacrimation, hyperacusis, and difficulty closing the eye on the affected sid3e |
| Which pharyngeal arch gives rise to the nerve that supplies the muscles of facial expression? | Second pharyngeal arch |
| Which nerve innervates the second pharyngeal arch? | CN VII |
| What are some muscles derived from the second pharyngeal arch? | Posterior belly of the digastric, the platysma, the stylohyoid, and the stapedius |
| Which artery is damaged or injured in Epidural hematomas? | Middle Meningeal Artery |
| Which NF, type 1 or type 2, is associated with cafe-au-lait spots? | NF-1 |
| What are some findings of NF-1? | 1. Cafe-au-lait spots 2. Lish nodules (iris hamartomas) 3. Axillary or inguinal freckling, 4. Neurofibromas 5. Skeletal abnormalities 6. other tumors |
| Which NF, type 1 or type 2, is associated with Lisch nodules? | NF-1 |
| What would be the deficits of a Left MCA stroke? | Aphasia and right sided motor and sensory deficits that affect the face and the upper body more than the lower body |
| Pronator drift. Upper or Lower motor neuron sign? | UMN |
| What are the main two findings of a Pineal mass? | Increased ICP and Parinaud syndrome |
| How is Parinaud syndrome characterized? | Vertical gaze palsy and pupil abnormalities |
| What condition is known to produce vertical gaze palsy and other pupil abnormalities? | Parinaud syndrome |
| On which part of the CNS anatomy would a MRI of a pineal mass be located? | Posterior third ventricle |
| What is the name of the bull's-eye shaped rash associated with Lyme disease? | Erythema migrans |
| On which stage of Lyme disease is facial nerve palsy often presented? | Second stage of Lyme disease |
| Which neurodegenerative disorder is seen with resting tremor, postural instability, hypokinesia, shuffling gait, and cogwheel rigidity? | Parkinson disease |
| What are the intracellular eosinophiles inclusion of Parkison disease called? | Lewy bodies |
| Which condition is seen with Lewy bodies (intracellular inclusions)? | Parkinson disease |
| What are the Lewy bodies in PD composed of? | α-synuclein protein |
| In order to produce ataxia, which part of the brain is most likely to be damaged or affected? | Cerebellar hemisphere |
| What is the definition of dysmetria? | Lack of coordination |
| Dysmetria is caused by: | Lesion to the ipsilateral cerebellar hemisphere |
| What is a Berry aneurysm? | Thin-walled out-pouching at a cerebral artery branch point that can rupture |
| What sever condition is often due to Berry aneurysm rupture? | SAH |
| What cranial nerve palsy is associated with Berry aneurysm and SAH? | CN III palsy |
| What part of the spinal cord is affected in ALS? | Anterior horn cells and the corticospinal and corticobulbar tracts |
| What is the MC childhood brain tumor? | Craniopharyngiomas |
| What are the most important clinical findings of a child with a Craniopharyngioma? | Headaches and bitemporal hemianopia |
| What are the symptoms of Craniopharyngiomas? | Increased ICP, endocrine dysfunction, and visual changes |
| What are the endocrine changes caused by a Craniopharyngioma? | Hypopituitarism which leads to underexcretion of ADH, TSH, GH, gonadotropin, and ACTH. |
| What is a common syndrome of Apical lung tumor? | Horner syndrome |
| Besides Horner syndrome, what is another potential consequence of an Apical lung tumor? | Compression of SVC, causing facial swelling and JVD |
| What is the most common cause of IPH (intraparenchymal hemorrhage)? | Systemic hypertension |
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rakomi
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