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Neurology 1.1

UWORLD Neuro Review

QuestionAnswer
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; Post-synaptic membrane
In MG, the decreased number of post-synaptic 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 tx 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 causses? 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, adn 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 Cribiform Plate? CN1 Olfactory bundles
the CN 1 goes trough 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 CNV2 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 Sub-acute 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 (Babinsky) 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 vasospasms
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 arteriole 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 musky 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.
Created by: rakomi