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Neurology 1.1
UWORLD Neuro Review
| Question | Answer |
|---|---|
| Mutation of Apo E4 mutation leads to: | Late onset Alzheimer's Disease |
| APP (chromosome 21) and Presenilin 1/2 mutations | Early onset Alzheimer's disease |
| Production of A-B-amyloid is seen in __________________ onset Alzheimer's disease. | Early |
| Formation of senile plaque is seen in _________________ onset Alzheimer's disease. | Late |
| Main subdivisions of Ectoderm | Surface, Neural Tube, and Neural Crest |
| Derivatives of Surface Ectoderm | Anterior pituitary (Rathke pouch), Lens and cornea, Inner ear sensory organs, olfactory epithelium. Nasal/ oral epithelial lining and salivary glands. Epidermis, sweat and mammary glands. |
| The brain and spinal cord are derived from: | Neural Tube Ectoderm |
| Derivatives of Neural Tube Ectoderm | Brain and Spinal cord, Posterior Pituitary, Pineal gland, and Retina. |
| What type of Ectoderm do melanocytes are derived from? | Neural Crest |
| What are some structures derived from the Neural Crest? | Neural ganglia, adrenal medulla, Schwann cells, Aorticopulmonary septum and Endocardial cushions, and melanocytes. |
| Endoderm | GI tract, liver and Pancreas Lungs, Thyroid, PTH glands MIDDLE EAR epithelium, Bladder and urethra |
| Mesoderm gives rise to: | Muscles (smooth, cardiac and skeletal) Connective tissue, bone, cartilage Serosal lining Cardiovascular and lymphatic system Spleen and hematopoetic cells, adrenal cortex, and Kidneys, urethers, and internal genitalia. |
| Trigeminal Neuralgia is due to CN ______ damage or injury. | V (5) |
| Patient with episodic, severe, unilateral-electric shock-like pain in the face. | Trigeminal Neuralgia |
| What is the MC treatment for Trigeminal Neuralgia? | Carbamazepine |
| What is the MoA of Carbamazepine? | inhibition of frequency stimulation of reducing Na+ channels to recover from inactivation . |
| What is the main side effect of Carbamazepine? | Bone marrow suppression |
| What lab must be done when a patient is on Carbamazepine? | Periodic WBC counts to prevent Agranulocytosis and Aplastic Anemia |
| How long after ischemic stroke, do "red neurons" appear? | 12-24 hours. |
| _______________________ have eosinophilic cytoplasm, and the loss of NISSL substance | RED NEURONS |
| At what point (time) do Neutrophils appear after ischemic event? Macrophages? | 24-72 hours Neutrophils; 3-7 days macrophages |
| What is the first macrocytic change seen after a stroke? | Liquefactive Necrosis after 1-2 weeks |
| Myasthenia Gravis has decreased number of _________ receptors in the __________________ synaptic membrane. | ACh; Postsynaptic membrane |
| In MG, the decreased number of postsynaptic ACh receptors in the NMJ lead to a reduced ______________________ of the _____________ end-plate ____________________ and prevents muscle __________________. | AMPLITUDE; MOTOR; potential; muscle fiber DEPOLARIZATION. |
| What is the most common cause of Status Epilepticus? | Complex febrile seizures |
| What is the first part of treatment for Status Epilepticus? | IV Benzodiazepines such as Lorazepam. |
| What is the MoA of Benzodiazepines? | 1. Increase GABA effect on GABA -A receptors 2. Increase Cl- influx leading to a suppression action potential firing (decrease frequency) |
| Benzodiazepines work on GABA ______ receptors | GABA - A |
| What is the second part of the treatment of Status Epilepticus? | Phenytoin |
| Ring-enhancing brain lesions on CT of an immunocompromised patients, are most often caused by? | Toxoplasmosis |
| Toxoplasmosis lesions tend to be _______________________, contrary to Primary CNS lymphoma, which is a _____________________ lesion. | Multiple: Solitary |
| Primary CNS lymphoma is strongly associated with what viral organism? | EBV |
| At what spinal level is Lumbar puncture (LP) best done? | L3/L4 or L4/L5. space |
| Why is the L3-L5 region the best for LP? | It is just BELOW the Spinal cord termination at the L1, in most adults. |
| What anatomical landmark is important to find to identify L4, and perform an LP? | Iliac Crest |
| The Iliac Crest landmark identifies the ____________ site. | L4 |
| Mnemonic used for CN innervation of the eye muscles. | SO4 LR6 R3 |
| SO 4 | Superior Oblique innervated by CN 4 (trochlear nerve) |
| LR6 | Lateral Rectus innervated by CN 6 (Abducens nerve) |
| R3 | "Rest of Muscles" of eye innervated by CN 3 (Oculomotor) |
| Damage to CN3 causes what eye deviation and motor deficit? | "down and out" Causes inability to ADDUCT (bring in) the eye. |
| Damage to CN4 causes what eye deviation and vision problem? | The eye is deviated upward Causes --> vertical diplopia |
| Damage to abducens nerve causes what type of deviation and motor deficit? | Inward deviation of affected eye (cant bring eye out) |
| Damage to CN 4 and CN 6 causes inability to _________________ the eye. | ABDUCT |
| Temporal Hemiretina, what part of the nerve is affected? | Damaged NASAL visual field. |
| Where is the lateral Geniculate body (LGB) located? | Thalamus |
| The LGB sends optic radiations to the ____________________ | Primary Visual Cortex |
| Motor deficit of adduction of the thigh | Damage to the obturator nerve |
| The lumbar plexus carries fibers? | L2 to L4. |
| Light Pupillary Test. Light shone at affected eye will cause? | No effect on either eye (affected and non affected) |
| Light Pupillary Test. Light shone at the non-affected eye, will cause? | Reaction to both eyes. |
| Changes in body of a neuron after it has been "cut" | Axonal Reaction |
| What is the histological description of Axonal Reaction? | Enlarged, rounded cells with peripherally located nuclei and dispersed finely granular Nissl substance. |
| Axonal reaction is accompanied by an increase in________ | Increase in Protein synthesis and usually is seen after 24-48 hours after event. |
| Degradation of axon and myelin distal to the point of injury | Wallerian Degeneration. |
| Where is the most common location for an Acoustic Schwannoma? | Cerebellopontine Angle |
| Acoustic ________________ arises from CN _____. | Schwannoma: 8 |
| What is the typical clinical presentation of an Acoustic Schwannoma? | Ipsilateral sensorineural hearing loss, tinnitus, an vertigo, and loss of facial sensation (V5) and Facial paralysis. |
| To what Autosomal disorder are Schwannomas associated to? | NF-2. |
| Asking patient name, location, and time | Testing for Orientation |
| Can you please fold this paper in half 3 times? | Example for assessment of COMPREHENSION |
| May, April, March..... | test to asses CONCENTRATION |
| Short-term memory assessment | Recalling 3 unrelated words after 5 mins |
| pencil, car, burger | SHORT-TERM MEMORY assessment. |
| Dates of Wedding day, first communion, birth of children. | LONG-TERM MEMORY assessment. |
| How is LANGUAGE assess by in a brief neurological physical examination? | Writing a grammatically correct sentence. |
| Two intersecting pentagons draw is used to assess the patient's? | VISUAL-SPATIAL |
| How can the executive function of a patient is assessed by doctor? | Drawing a clock with the time requested |
| What drug inhibits the conversion of L-DOPA into Dopamine? | Carbidopa/Levodopa |
| Dopamine _________________ cross the __________________. | CANNOT; blood brain barrier. |
| Common side effect of Carbidopa? | Increase in anxiety and agitation. |
| What is the mode of action of AMANTADINE in the treatment of Parkinson's Disease? | Increases the dopamine availability at the NMJ |
| Common COMT-Inhibitor | Entacapone |
| Selegiline, Rosogline | MAO-Inhibitors |
| What nerve is commonly damage as there is an injury to the Posterior Triangle of the Neck? | Spinal Accessory Nerve |
| What muscles are innervated by the Spinal Accessory Nerve? | 1. Sternocleidomastoid 2. Trapezius |
| Injury to Trapezius muscle | Drooping of shoulder, impaired abduction of the arm above the horizontal , and winging scapula |
| Deltoid injury | Impaired ABduction or arm BELOW the horizontal |
| Innervation of Deltoid muscle is by the _________________________ nerve | Axillary |
| The Latissimus dorsi is innervated by the _________________ nerve | Thoracodorsal |
| What is the function of the Latissimus dorsi muscle? | ADDUCTOR of the arm and Medial Rotation and extension of the arm. |
| Enzyme deficient in Propionic Acidemia | Propionyl-CoA carboxylase |
| How is Propionic Acidemia clinically manifested? | Metabolic Acidemia + hypotonia in babies less than 2 weeks old. |
| What is the treatment for Propionic Acidemia | Diet low on amino acids, and those precursors such as Valine, Isoleucine, Threonine, and Methionine. |
| What are the avoided 4 amino acids in Organic Acidemia? | Valine, Isoleucine, Threonine, and Methionine |
| Toxoplasmosis | 1. Associated with Hx of recurrent oral thrush, cervical and inguinal lymphadenopathy, and multiple enhancing brain lesions |
| Lesions in the brain caused by ______________________ gondii, may provoke _______________________ in HIV patients. | Toxoplasma: SEIZURES |
| What is the most common cause of CN3 palsy? | Secondary to ANEURYSM, arising from the Posterior Communicating Artery and Internal Carotid junction. |
| Saccular aneurysm of the Posterior Communicating artery commonly leads to: | Oculomotor Palsy |
| What is the eye deviation of affected eye in an Post Communicating artery aneurysm? | Down and Out, as eye losses ability of ADDuction. |
| What Cranial nerves are involved in eye ABDUCTION? | CN 4 and CN 6. |
| Mydriasis with diplopia + ptosis + "Down-and-Out" ipsilateral eye deviation | CN3 palsy |
| Berry aneurysm arising from the Anterior Communicating artery commonly associated with? | Bilateral Hemianopsia |
| What structure is commonly compressed in a Anterior Comm Artery Berry aneurysm? | Optic Chiasm |
| Potent cerebral VASODILATOR | Carbon Dioxide (CO2) |
| Tachypnea leads to: | HypoCapnia and Vasoconstriction |
| How does VasoCONSTRICTION helps increased ICP | Reduction in cerebral blood volume lead to a decrease ICP |
| Systemic Blood Pressure that indicates possible increased ICP | > 150 mm Hg |
| Systemic BP below 50 mm Hg indicates: | 1. Cerebral Hypoperfusion 2. Potential Isquemia |
| Untreated AIDS patient, is at higher risk of contracting? | Cryptococcus Neoformans Meningitis |
| Test to identify C. Neoformans? | The polysaccharide capsule with agglutinate with Latex test |
| India ink is used to culture | C. neoformans |
| "Soap bubbles" viewed in CSF of an untreated AIDS patient, highly suggest infection by which organism? | C. neoformans |
| What is the treatment for C. neoformans meningitis? | 1. Amphotericin B + Flucytosine |
| What drug is used in maintenance treatment of C. neoformans infection? | Fluconazole |
| CD<100 | C. neoformans |
| Common way to contract C. neoformans? | Soil and bird droppings . |
| Kinesin produces: | Anterograde transport of the vesicles and organelles |
| FXN gene mutation | Friedreich Ataxia |
| Friedreich Ataxia is and _______________________ __________________ disorder. | Autosomal Recessive |
| What is the function of gene FXN? | IRON - SULFUR enzyme assembly. |
| What is the trinucleotide repeat seen in Friedreich Ataxia? | GAAn |
| What spinal cord pathways are affected in Friedreich Ataxia? | 1. Lateral corticospinal and, 2. Spinocerebellar tract |
| Kyphoscoliosis and foot abnormalities are seen in? | Friedreich Ataxia |
| Gait Ataxia, kyphoscoliosis, hypertrophic cardiomyopathy, and DM | Friedreich Ataxia |
| Atrophy of Caudate Nucleus | Huntington's Disease |
| In Huntington's Disease there is atrophy of the _______________ nucleus. | CAUDATE |
| Cerebral Cortex atrophy is seen in? | 1. Alzheimer's disease 2. Pick's disease |
| Loss of neurons in the anterior horn of the spinal cord is seen in? | 1. Poliomyelitis 2. ALS |
| Parkinson's disease | Loss of Neurons in substantia nigra |
| Damage above the Red Nucleus | DECORTICATE |
| Damage below the Red Nucleus | DECEREBRATE |
| DECORTICATE | "Flexor" posturing (hands and feet form "C" shape) |
| DECEREBRATE | "Extensor" posturing (Arms form an "E" , feet point inward but DO NOT CROSS |
| Arms in C and feet Cross | DECORTICATE |
| The demyelination seen in Multiple Sclerosis | Produces reduced saltatory conduction. |
| Young woman with vision problems, and white matter lesions. Dx? | Multiple Sclerosis |
| What is the vision problem commonly seen in MS? | INO and Optic Neuritis |
| Cells affected in Multiple Sclerosis | Oligodendrocytes. |
| What ion is important in a neurons axonal body transport of the AP to the Axon's terminal? | Na+ channels |
| The influx of __________ into the axon terminal, allows for ______ release. | Calcium (Ca2+); Neurotransmitter |
| What is the preganglionic NT-receptor pairing in all PNS? | ACh - Nicotinic |
| INDUCERS | Increase in metabolism of drugs --> decrease drug concentration |
| INHIBITORS | Decrease in metabolism of drugs --> increase drug concentration |
| Carbamazepine, Barbiturates, Phenytoin, Rifampin, Griseofulvin, St. John's wort, Modafinil, Cyclophosphamide | INDUCERS |
| Amiodarone, Cimetidine, Fluoroquinolones, Clarithromycin, Azole antifungals, Grapefruit juice, INH, and Ritonavir | INHIBITORS |
| What is the most common Neurological disorder seen in children? | Febrile seizure |
| Botulism's toxin, prevents the release of ______________ from the presynaptic nerve cells. | Acetylcholine |
| C. botulinum toxin impairs _____________________ and _______________ NT transmission, and is often seen in ______________ foods. | Muscarinic and Nicotinic; CANNED |
| Diplopia and dysphagia seen in Botulism | Nicotinic deficits |
| Dry mouth seen n Botulism | Muscarinic deficits |
| Common Peroneal nerve injury is commonly due to | Injury to lateral neck of the Fibula |
| Fracture of lateral neck of fibula, leads to ________________ nerve injury | Common Peroneal |
| What are the clinical manifestations of Common Peroneal injury? | 1. Dorsiflexion weakness. 2. weak eversion and decreased toe-extension 3. Sensory loss of lateral leg and dorsolateral foot. |
| What is another name for Idiopathic Intracranial Hypertension? | Pseudotumor Cerebri |
| What is the common type of patient characteristics seen in Pseudotumor cerebri? | Young, Obese, Female, with a daily headache, bilateral papilledema and transient visual problems. |
| Blunted disc margins with deformed marked periphery, commonly seen in fundoscopic findings? | Optic disc edema seen in Pseudomotor Cerebri |
| What is a common complication f Prematurity hemorrhage in a baby? | Intraventricular Hemorrhage (IVH) |
| What is the most common place of bleeding into, seen in Intraventricular Hemorrhage (IVH)? | Germinal Matrix |
| 5 day-old baby seen with a bulging fontanel, hypo-tension, decerebrate posturing, tonic-clonic seizures, and irregular respiration. | Intraventricular Hemorrhage (IVH) |
| Decerebrate posturing is often seen in baby with? | Intraventricular Hemorrhage (IVH) |
| CNS macrophages | Microglia |
| Which subtype of HSV causes most commonly HSV encephalitis? | HSV-1 |
| Which lobe is MC affected in HSV-1 Encephalitis? | Temporal lobe |
| HSV-1 enters the brain through the _____________________ tract. | Olfactory |
| What is the best treatment for HSV-1 Encephalitis? | IV acyclovir |
| Toxoplasmosis most commonly affects which lobes of the brain? | Parietal and Frontal lobes |
| What are the clinical manifestations of Congenital Hydrocephalus? | Macrocephaly, bulging fontanelle, poor feeding, and spasticity and Hyperreflexia. |
| Spasticity and Hyperreflexia are commonly due to | UMN lesions |
| What are the Congenital Obstruction leading to Congenital Hydrocephalus? | 1. Aqueduct Stenosis 2. Chiari malformation |
| Congenital infection and Post- hemorrhagic are causes of: | Acquired Obstruction leading to Congenital Hydrocephalus |
| Impaired deacetylation of histones, preventing transcription of neurotrophic factors, Dx? | Huntington's Disease |
| CAGn repeat | Huntington's Disease |
| CGGn repeat | Fragile "X" syndrome |
| Fragile X syndrome is an | X-linked recessive disorder |
| Prominent forehead, Large ears, Long narrow face/chin + macroorchidism. Dx? | Fragile X Syndrome |
| In Fragile X Syndrome, has a _____________ in the ______________ arm on the ________ __________________. | Gap; LONG arm: X-chromosome. |
| Failure to transport ORTHININE from the cytosol to the Mitochondria, is seen in which disorder? | Ornithine Transcarbamylase Deficiency |
| Ornithine Transcarbamylase deficiency is seen with? | Increased amounts of Ammonia Lethargy, Seizures, Cerebral Edema during infancy |
| What is the treatment for Ornithine Transcarboxylase deficiency? | Protein restriction to avoid excess amino acids, and prevent ammonia accumulation. |
| Thick polysaccharide capsule | Cryptococcus Neoformans |
| What is the MoA of Buprenorphine? | Partial Opioid receptor agonist |
| The use of _______________ along with other opioids, causes the ________________ of the other opioid, leading to a _______________ of ________________ symptoms. | BUPRENORPHINE; DISPLACEMENT; Precipitation of Withdrawal symptoms. |
| What is the most common movement disorder? | Essential Tremor |
| What area is most affected by Essential Tremor? | Arms |
| What is the most common treatment for Essential Tremor? | B-blocker, Propranolol |
| ______________________ is commonly used to treat essential tremor | Propranolol |
| ___________________________ is currently the best treatment for elderly insomnia | Ramelteon |
| What thalamic nucleus is responsible for the circadian rhythm? | Suprachiasmatic Nucleus |
| Opioid receptor | mu |
| Presynaptic mu receptor | Closes voltage gated Ca2+ channel |
| Post-synaptic mu receptor | Opens K+ channels leading to membrane HYPERpolarization. |
| What is the function of CN4 in the eye? | Intort (internal rotation) the eye |
| Injury to CN4 causes? | Vertical diplopia (upward eye deviation) |
| Patient with chin tuck-in, and head tilted away from eye that is upward deviated, Suspected CN injury? | CN4 |
| CN6 injury | Horizontal diplopia + inward eye deviation |
| Horizontal + vertical diplopia | CN3 palsy |
| What is the most common Pineal tumor? | Germinoma |
| Where is a Germinoma, that causes endocrine pathologies, MC located? | Suprasellar |
| How is a Germinoma clinically presented: | Obstructive Hydrocephalus, Dorsal midbrain (Parinaud) syndrome |
| Parinaud Syndrome is also known as: | Dorsal Midbrain Syndrome |
| Limited of upward gaze with downward preference + bilateral eyelid retraction (Coller sign) + light - near dissociation | Parinaud Syndrome |
| Which lobes are the most common to hemorrhage in elderly due to spontaneous hemorrhage? | Occipital and Parietal lobes |
| What is the MCC of Cerebral Amyloid Angiopathy? | Spontaneous lobar hemorrhage |
| Occipital hemorrhage is seen with? | Homonymous hemianopsia |
| Contralateral Hemisensory loss is due to _____________________ lobe hemorrhage. | Parietal |
| The ______________________ lobe hemorrhage causes _______________ _____________________. | FRONTAL; Contralateral Hemiparesis |
| C4 myotome function | Shoulder/Scapula elevation |
| Shoulder abduction is done by what myotome? | C5 |
| Which myotomes are in charge in elbow flexion and wrist extension? | C5 and C6 |
| Biceps and Brachioradialis is performed by ________, _________. | C5 , C6 |
| What pair or myotomes causes upon stimuli the Triceps Reflex? | C7 and C8 |
| Finger abduction is performed by _______ myotome. | T1 |
| Wrist extension + finger flexion | C8 myotome |
| C7 myotome performs | Elbow extension and Finger extension |
| Which antidepressants are associated with strong Anticholinergic properties? | TCAs |
| Confusion, Constipation, and Urinary Retention | Anticholinergic effects due to TCAs in elderly especially |
| What is a common side effect of H1-blockers? | Sedation |
| SE tremor and insomnia | 5-HT and NE reuptake inhibitors |
| Phrenic nerve arises from ________________ segments of the spinal cord. | C3-C5 |
| Phrenic nerve innervates | Ipsilateral Hemidiaphragm |
| What is a common malignancy affecting the Phrenic nerve? What symptoms are associated with such? | LUNG cancer; HICCUPS and diaphragmatic paralysis and dyspnea |
| Hoarseness of the voice is often seen with | compression of the Left Recurrent Laryngeal nerve |
| What is the MCC of intraparenchymal hemorrhage? | Aneurysm rupture |
| Progressive headache, N/V, followed by non-focal neurological deficits, such as confusion, often indicate? | Hypertensive Encephalopathy. |
| What is the main association with a Charcot-Bouchard Aneurysm? | Hypertension |
| HTN + Aneurysm at the Basal ganglia, less than 1 mm in size, that results in Intracerebral hemorrhage with progressive neurological symptoms, Dx? | Charcot-Bouchard Aneurysm |
| What conditions are often most associated with a Berry Aneurysm? | ADPKD, Ehlers-Danlo, HTN |
| Circle of Willis (most commonly the Ant Comm Artery) | Berry or Saccular Aneurysm. |
| The rupture of a Berry aneurysm most commonly results in | SUBARACHNOID HEMORRHAGE |
| Sudden and extremely severe headache | Subarachnoid Hemorrhage due to rupture of saccular aneurysm. |
| Lesions to the Jugular foramen | Vernet Syndrome |
| Vernet Syndrome causes damage to which CNs? | 09, 10 and 11 |
| Patient presents with dysphagia, hoarseness, loss of gag reflex on IPSILATERAL side, and deviation of uvula toward contralateral side of lesion. | Vernet Syndrome |
| What is the MCC of Vernet Syndrome? | Glomus Jugulare Tumor |
| What structures pass through the Cribriform Plate? | CN1 Olfactory bundles |
| the CN 1 goes through the ___________________________ | Cribiform plate |
| The Optic canal is the foramen used by: | CN2, Ophthalmic artery, and Central retinal vein |
| Optic Nerve goes through the ___________________________ | Optic canal |
| Superior Orbital Fissure provides passage to: | CN3, CN4, CN V1, CN6 and Ophthalmic Vein |
| CN V1 uses the ___________________________ to enter the CNS. | Superior Orbital fissure |
| CN3, CN4 and CN6 share the ____________________________ foramen with CN ______. | Superior Orbital fissure; V1 |
| Foramen _________________________ provides passage to CN V2 | Rotundum |
| CNV1 -_________________________, CN V2 -_________________________, and CN V3 -_________________________________ | Superior Orbital fissure; Foramen Rotundum; Foramen Ovale |
| The foramen Ovale is the hole used by CN _______ | V3 |
| Superior Orbital fissure, Foramen Rotundum and Ovale, and Foramen Spinosum are part of the: | Middle Cranial Fossa |
| The foramen Spinosum allows passage for the_________ artery | Middle Meningeal Artery (MMA) |
| What foramen is used by CN 7 and CN 8? | Internal Acoustic Meatus |
| The hypoglossal canal proves passage to: | CN 12 |
| The jugular foramen serves as the foramina proving passage to: | CN 9, 10, 11, as well to the jugular vein |
| The foramen ______________________ allows the passage of Spinal tracts of CN _______, brain stem, and vertebral arteries. | Magnum; 11. |
| Neuropathy is a common complication in ________________ patients. | Diabetic |
| Diabetic Neuropathy is due to: | Microangiopathy from nerve isquemia which leads to Hyalinization of Endoneurial arterioles. |
| Diabetic patient with feet paraesthesias, burning pain, and can't feel pain or temperature on feet. | Sensory Neuropathy from chronic diabetes |
| Cranial mononeuropathy in DM is seen clinically with: | CN3, CN7 and Optic Neuropathy |
| Bilateral involvement of Median, Ulnar, and Common Peroneal Nerve neuropathy is commonly seen in? | Somatic Diabetic Mononeuropathy |
| What are the MC areas for profound cerebral hypoperfusion leading to Hypoxic-Ischemic Encephalopathy? | The watershed areas between the ACA, MCA, and thePCA |
| Bilateral wedge-shaped strips of necrosis over cerebral convexity | Ischemic infarcts due to profound cerebral hypoperfusion. |
| Where commonly is found the primary infection of Cryptococcus Neoformans? | Lungs, as it is inhaled |
| Aqueductal Stenosis and Chiari malformation | Congenital Obstructions causing Congenital Hydrocephalus |
| What is the treatment for Congenital Hydrocephalus? | Cerebral Shunting |
| During the first 6 hours of an ischemic stroke? | There are no evident changes |
| What is the most important appearance after 12 hours of an ischemic stroke? | Red Neurons |
| Eosinophilic cytoplasm, pinokic nucleus, and loss of Nissl Substance, describes the histology of? | Red Neurons |
| What are the characteristic muscarinic effects of Cholinergic Toxicity? | DUMBBELLS; Diarrhea/Diaphoresis, Urination, Miosis, Bronchospasm, Bronchorrhea, and Bradycardia, Emesis, Lacrimation, Salivation |
| What is a common treatment for Cholinergic intoxication's muscarinic effects? | GLYCOPYRROLATE, hyoscyamine, or Propantheline, which are selective muscarinic antagonists |
| What are some signs of Nicotinic Effects due to Cholinergic intoxication? | Muscle Weakness, Paralysis and Fasciculations |
| Arginase deficiency prevents the: | Synthesis of Urea and Ornithine from Arginine |
| What is the best treatment for Arginase deficiency? | Arginine- free and low-protein diet |
| Spastic diplegia and growth development and abnormal movements are often seen in which Urea cycle disorder? | Arginase deficiency |
| Glutamate decarboxylation produces | GABA |
| ________________________ is made from _____________________. | Serotonin: Tryptophan |
| Low Tryptophan will yield a low ________________________ production. | Serotonin |
| What is the 2nd most common children brain tumor? | Medulloblastoma |
| Where are Medulloblastomas in children most commonly located? | Cerebellum, often at the vermis |
| Small, blue cells found in brain malignancy with poor prognosis in children, Dx? | Medulloblastoma |
| Child with abnormal walk, limb ataxia and morning headaches, suspected Dx? | Medulloblastoma |
| What is the main treatment for Toxoplasmosis causing multiple ring-enhancing lesions in AIDS patients? | Pyrimethamine and Sulfadiazine, plus Leucovorin. |
| What is the MCC of infection by Toxoplasma gondii? | contaminated cat feces (oocysts) or undercooked meat (pseudocyst) |
| Schwannoma | Biphasic pattern of cellularity Positive S-100 |
| What does positive for S-100 indicate? | Neural Crest origin |
| Urea is produced by ______________________ in the ___________/__________________. | Arginine; Liver/Mitochondria |
| Accumulation of ammonia (NH3) may provoke? | Seizures and Cerebral Edema |
| How is Cerebral Edema in ammonia accumulation clinically presents? | Hyperreflexia and bad posture |
| Common disease that leads to ammonia accumulation? | Ornithine Translocase deficiency |
| Germinoma (Pineal gland tumor) has a high resemblance with? | Testicular dysgerminoma |
| What shared effects have Pineal Germinoma and a Testicular dysgerminoma? | Precocious puberty |
| Essential tremor is of _____________ inheritance and is treated with _____________________. Patients also feel relief by the intake of ________________. | Autosomal Dominant; Propranolol (beta blocker); alcohol |
| Parkinson's tremor is treated with _______________________________, while Essential tremor is treated with___________________________. | BENZTROPINE; PROPRANOLOL |
| The inhibition of ________________ on ______________-____ receptor leads to ___________ ___________ of _________, overall leading to the __________________ of the postsynaptic neuron and suppression of AP firing. | GABA; GABA-A; increased influx of Cl-; HYPERPOLARIZATION |
| Cafe-au-lait spots is strongly associated | NF type 1 |
| What are the characteristic of NF1 disorder? | 1. Numerous cutaneous Neurofibromas 2. Cafe - au - lait spots 3. Lish Nodules (brown eye coloring) |
| What is the single most important characteristic of NF1 disorder? | Lish Nodules |
| Acoustic bilateral Schwannoma | NF-2 |
| Acoustic Bilateral Schwannoma ------_____________________ Lish Nodule + Cafe-au-Spot ---------_____________________ | NF-2 NF-1 |
| Germinal Matrix hemorrhage is mostly seen in PREMATURE babies of ___________________ of gestation. | < 32 weeks |
| Which ventricles are most often associated with IVH? | Lateral Ventricles |
| Injury to the Posterior Triangle of the neck, most likely injures what muscle? | TRAPEZIUS |
| The Trapezius muscle is innervated by the | Cranial Nerve 11 |
| Impaired ABDUCTION of arm above the horizontal | Injury to Trapezius muscle |
| What is the triad of Trapezius muscle deficit due to CN 11 injury? | 1. Drooping of shoulder 2. Impaired abduction of arm above horizontal 3. Winging Scapula |
| Proximal CN 11 injury injures the _____________________________ muscle. | Sternocleidomastoid |
| Multiple ring - enhancing lesions on brain CT? | Toxoplasmosis |
| Brain Abscesses + recent travel to Mexico/South or Central America. | Neurocysticercosis |
| Vitamin B12 deficiency also known as: | Sub-acute Combined Degeneration |
| What ascending pathways are damaged in Subacute Combined Degeneration? | Dorsal Columns |
| The _________________________ tracts are ____________________ pathways affected by Vitamin B12 deficiency. | Corticospinal: DESCENDING |
| How is cobalamin deficiency clinically? | 1. loss of position and vibratory sensation 2. ataxia 3. Spastic paresis |
| Low Vitamin B12 affects nerves by | abnormal MYELIN synthesis |
| Dorsal Column Defects: | 1. Bilateral loss of position and Vibration sensation |
| 1. UMN signs; Spastic Paresis, hyperreflexia and pathological reflexes (Babinski) | Lateral Corticospinal Tracts |
| Color of calcified cyst found in children Craniopharyngiomas? | Brownish- Yellow fluid |
| Suprasellar tumor found in children? | Craniopharyngioma |
| Cysts found n Craniopharyngiomas are composed of? | Cholesterol |
| Craniopharyngiomas: | arise from Anterior Pituitary, specifically the Rathke's Pouch |
| What is a common visual complication seen in children suffering Craniopharyngiomas? | Bilateral Hemianopsia |
| What is a common complication 3 days after a Subarachnoid Hemorrhage? | Repetitive vasospasm |
| What medication is used in treatment/prevention of VASOSPASMS due to SAH? | Ca2+ channel blocker, such as NIMODIPINE |
| Spinal tap of a SAH | bloody or yellow fluid sample |
| Heteroplasmy is seen in: | Mitochondrial inherited conditions |
| Variability in clinical views in mitochondrial diseases | HETEROPLASMY |
| MELAS | Mitochondrial Inherited disease |
| Enzyme deficient in Methylmalonic Acidemia | Methylmalonyl - CoA mutase |
| Methylmalonic acidemia mostly presents in: | Newborns with lethargy, vomiting and Tachypnea. |
| Ketotic Hypoglycemia is seen in: | Methylmalonic Acidemia |
| amino acid responsible for transferring nitrogen toe the liver for disposal | ALANINE |
| The disposal of _________________ is done as ____________ transfers Nitrogen to the _______________ . | Nitrogen; Alanine; Liver |
| Catabolism of Nitrogen in liver causes the transfer of amino groups to ______________________________ to form ________________, which is ultimately converted into ________________ and finally excreted. | a-Ketoglutarate; GLUTAMATE; urea |
| Diabetic Neuropathy is caused by: | Endoneurial arteriolar hyalinization |
| The accumulation of ________________________ causes ______________ in diabetic patients. | SORBITOL; CATARACTS |
| Inducers of CYP450 cause drugs to metabolize ________________, leads to increase of risk ___________________________ events. | Faster; THROMBOTIC |
| Inhibitors of CYP450 cause drugs to metabolize _______________, which leads to increased risk of ___________________. | SLOWER; Bleeding |
| Rheumatoid Arthritis often involves the: | Cervical Spine |
| Common complication of RA causes back pain | Vertebral Subluxation |
| What is the vertebrae mostly involved in Vertebral Subluxation in RA? | C1 |
| What are the clinical manifestations of Vertebral Subluxation? | Neck pain and stiffness, neurological findings (paraesthesias). |
| PKU (Phenylketonuria) | deficiency in: 1. Phenylalanine Hydroxylase (PAH) 2. BH4 |
| Child with mental retardation, seizures, and characteristic musty body odor | PKU |
| Cathelonergic brain nuclei seen in | PKU |
| Hypopigmentation of skin, hair and eyes + dark brain spots | PKU |
| Productes dark pigment in substantia nigra, locus coeruleus, and vagal nucleus dorsalis. | Neuromelanin |
| Neuromelanin is associated with darkening of brain seen in | PKU |
| Organic Acidemia may be due to inappropriate metabolism of: | Amino acids, Pyrimidines, and Lipids |
| Microglia how long after an ischemic infarct appear? | 3-5 days |
| As the amount of myelin phagocytosis increases it also correlates with: | Increase n amount of lipids and fat. |
| What are common symptoms of HSV-1 Temporal Encephalitis? | Apnosia, changes in personality, headaches and seizures. |
| Propranolol: | contains B1 and B2 properties, |
| B-blockers prevent the interaction between: | Epinephrine and Norepinephrine |
| B-blockers cause ____________________ as an important side effect. | COUGH |
| The B-blockers work on the: | Post-synaptic cells. |
| Kinesin | Anterograde transport of NT-containing secretory vesicles down the Axons to the synaptic terminals |
| "Foot Drop" is caused by injury to the _____________________ nerve. | Common Peroneal |
| Tibial Nerve injury | 1. plantar foot flexion 2. loss sensation over the sole of the foot. |
| Recent C. jejuni infection is associated with what autoimmune disorder? | Guillain-Barre Syndrome |
| Guillain-Barre Syndrome is: | segmental demyelination of peripheral nerves and an ENDONEURIAL inflammatory infiltrate. |
| Clinical Manifestations of GB syndrome: | Ascending Paralysis with symmetrical weakness. |
| LM of Guillain Barre Syndrome depicts (histologically) | Lipid-Laden macrophages |
| TB causes what type of necrosis? | CASEOUS necrosis |
| Triad of Normal Pressure Hydrocephalus (NPH): | 1. Ataxia 2. Urinary incontinence 3. Dementia |
| The Neurological symptoms seen in NPH are due to: | Distention of Periventricular white matter |
| What is the cause of bladder incontinence seen in NPH? | Stretch the descending cortical fiber |
| BH4 is a cofactor to ________________________ enzymes in the synthesis of _____________, __________________, and ________________. It is highly associated with __________________________. | HYDROLASE; Tyrosine, Dopamine, and Serotonin; Phenylketonuria (PKU) |
| Carbidopa is an agent used in order to increase the levels of ____________ in order to cross the BBB. | L-DOPA |
| Abnormally high levels of Dopamine may cause: | agitation and anxiety |
| Dopamine ____________________ to cross the Blood Brain Barrier. | CANNOT |
| Charcot-Bouchard Aneurysm is the MCC of? | Deep Intraparenchymal Hemorrhage |
| Vitamin A excess may provoke: | Intracranial Hypertension (ICP), skin changes, and hepatosplenomegaly |
| Nutritional deficiency causing increased ICP? | Vitamin A |
| Alopecia is often associated with increased levels of Vitamin _____. | Vit A |
| Increased levels of CO2 detected in brain vasculature causes: | Vasodilation --> increased blood flow --> Increased ICP |
| The elevated level carbon dioxide in CNS vasculature is compensated by: | Tachypnea (get rid of excess CO2) ---> Hypocapnia |
| Decreased levels of CO2 in brain vasculature lead to: | Decrease in blood volume and eventually decrease ICP |
| Where is SYNAPTOPHYSIN is a protein found? | Presynaptic vesicles of neurons, Neuroendocrine and Neuro Endodermal cells |
| CNS tumors positive for synaptophysin account for: | 1% of all brain tumors |
| Which type of CNS tumors are GFAP +? | 1. Astrocytomas 2. Ependymomas 3. Oligodrendiomas |
| The __________________ nerve EXITS the pelvis via the Obturator foramen. | Obturator |
| Obturator Nerve injury causes: | Weakness o thigh ADDUCTION and sensory loss over the distal medial thigh. |
| Muscles of ABDUCTION of Thigh: | 1. Gluteus medius 2. Gluteus minimus 3. Tensor fasiculata |
| The Gluteus medius and minimus are innervated by the _______________________ nerve. | Superior Gluteal Nerve |
| What muscles are involved in thigh EXTENSION: | Gluteus maximus |
| The gluteus maximus is innervated by the ______________________ nerve. | Inferior Gluteal Nerve |
| The ______________, ____________________, and ____________________ muscles, are involved in the FLEXION of the thigh. | Psoas, iliopsoas, and Sartorius muscles. |
| The Psoas muscle is innervated by what nerve? Iliacus? | Lumbar plexus; Femoral nerve |
| Wallenberg Syndrome: | Occlusion on PICA |
| What is the clinical presentation of Wallenberg Syndrome? | 1. Vertigo and Nystagmus 2. IPSILATERAL cerebellar signs 3. IPSILATERAL loss of PAIN, TEMPERATURE sensation in FACE and CONTRA-LATERAL body 4. IPSILATERAL Horner Syndrome |
| Patient suffered of a cervical lesion, and complains of not feeling heat or pain in the left side of face and right side of rest of the body. Also has a right eye seems a bit droopy. | Right PICA occlusion causing Wallenberg Syndrome, due to Cervical lesion. |
| CNS disorder due to DNA-repair gene disease | Ataxia-Telangiectasia |
| Xeroderma pigmentosum, Fanconi Anemia, Bloom Syndrome, and HNPCC | DNA-repair gene diseases |
| Botulinum toxin affects the __________________ receptors for _______. | Presynaptic ; ACh |
| Low levels of CAMP are associated with: | Botulism |
| Symmetrical enlargement of the cerebral ventriculi often indicates: | Communicating Hydrocephalus |
| What is the most common cause of Communicating Hydrocephalus? | Secondary to dysfunction of Subarachnoid villi |
| Wallerian degeneration occurs: | Distal to the site of injury |
| Why does axonal regeneration does not occur in the CNS? | Due to persistence of: 1. myelin debris 2. development of dense glial scarring 3. secretion of neuronal inhibitory factors |
| Lesch-Nyhan Syndrome is due to a defect in? | HGPRT |
| The defective _____________ in Lesch-Nyhan Syndrome leads to and increase in ___________________ of ____________________ and ____________ to Uric Acid. | HGPRT; degradation; HYPOXANTHINE and GUANINE. |
| Lesch-Nyhan syndrome is due enzyme deficiency leading to increase Purine degradation, forcing what? | Increase activity by the de NOVO PURINE pathway, which means an increase in PRPP amidotransferase activity. |
| Lesch Nyhan Syndrome: | 1. Increases Purine degradation 2. Increase activity of DE NOVO PURINE synthesis pathway 3. Incrase activity of PRPP amidotransferase 4. Increase accumulation/production of Uric Acid. |
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