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Neurology
Rx Review Round 4
| Question | Answer |
|---|---|
| Degeneration of Dopaminergic neurons in the Substantia nigra? | Parkinson disease |
| Neurons involved in Parkinson's disease have are projected into which area of the CNS? | Striatum |
| What two basal ganglia areas compose the Striatum? | Putamen and Caudate |
| Which type of Dopamine receptor is labeled as Excitatory? | D-1 receptor |
| WHich type of Dopamine receptor is labeled as Inhibitory? | D-2 receptor |
| Stimulation of the D1 and D2-receptors in the Striatum cause ---> | Facilitation of movement |
| Which nerve is commonly affected in Thyroid surgery? | Recurrent Laryngeal branch of the Vagus nerve |
| What is the most significant presentation of recurrent Laryngeal branch of the vagus nerve damage after Thyroid surgery? | Hoarseness |
| Which Pharyngeal arch gives rise to the Vagus nerve? | 6th |
| Which Laryngeal muscles are innervated by CNX? | All intrinsic laryngeal muscles except for the Cricothyroid |
| Which two type of populations are commonly affected by L. monocytogenes meningitis? | Very young and the very old |
| What is the empiric treatment for Listeria monocytogenes meningitis? | Ampicillin/amoxicillin |
| Gram-positive bacilli that grows in cold temperatures. | Listeria monocytogenes |
| What are the two food types that most commonly cause acquisition of L. monocytogenes infection? | Unpasteurized dairy products and Cold deli meats |
| What is the main function of the Cerebellum? | Coordination of movement in the IPSILATERAL side of the body |
| Lesion to the Cerebellar Hemisphere is often presented with: | Ataxia, instability, and DYSMETRIA on the ipsilateral side of the lesion |
| What condition is described by damaged neurons in the cerebellum? | Cerebellar degeneration |
| What are clinical features of LATERAL lesions to the Cerebellum? | Affection of voluntary movements of the arms and a propensity to fall to the affected side |
| What are medial structures of the Cerebellum? | Vermis, fastigial nuclei, and flocculonodular lobe |
| What are the most significant clinical features of medial lesions to the Cerebellum? | 1. Truncal ataxia (wide-based cerebellar gait) 2. Nystagmus 3. Head tilting |
| Griseofulvin is considered an CYP450 system _______________. | Inducer |
| What is the normal range of INR in a patient on Warfarin? | 2.5-3.5 |
| Common use for Griseofulvin? | Treatment of superficial fungal infections |
| Which Nervous system tracts are affected in Neurosyphilis? | Dorsal columns and Dorsal nerve roots |
| Late presentation of untreated Syphilis infection? | Neurosyphilis |
| What is the clinical presentation of Neurosyphilis? | Decreased vibration and prioception, sensory ataxia, pupillary abnormalities, neurogenic bladder disturbance, and shooting pains. |
| What is the common or distinctive pupillary abnormality seen in Neurosyphilis? | Argyll-Robertson pupil |
| Pupil that accommodates to light but does not react | Argyll-Robertson pupil |
| HSV-1 is an: | Circular, double-stranded DNA |
| What is a common neurological cause of HSV-1 infection? | Temporal Lobe Encephalitis |
| How is HSV-1 Temporal lobe encephalitis presented? | Hemiparesis of affected side, aphasia, ataxia, seizures, and increase intensity of affected area in MRI |
| What is the MCC of SAH? | Rupture of arterial aneurysms |
| What time of day accounts for 1/3 of cases of SAH? | During sleep at the middle of the night |
| What is often described as "worst headache of my life"? | SAH |
| Damage/Occlusion of the Anterior Spinal artery causes? | Medial Medullary syndrome |
| What are the main clinical features of Medial Medullary syndrome? | 1. Weakness of Contralateral body 2. Ipsilateral tongue deviation 3. Contralateral loss of proprioception and vibratory sense below the face |
| Damage to which structure accounts for ipsilateral tongue deviation upon protrusion in a patient with Medial Medullary syndrome? | Damage to Caudal medulla-- Hypoglossal nerve |
| Damage to the medial lemniscus in Medial Medullary Syndrome is manifested by: | Loss of prioception and vibratory sense in the contralateral side, below the face |
| Which artery is occluded in Wallenberg syndrome? | PICA |
| What is another term used for Wallenberg syndrome? | Lateral Medullary syndrome |
| What are the key distinctions of Wallenberg syndrome? | Dysphagia, Hoarseness, and decreased gag reflex |
| How is AICA occlusion distinctive to occlusion of PICA? | AICA causes paralysis of face, decreased lacrimation , decreased salivation, and decrease taste in the anterior 2/3 of the tongue. |
| Occlusion of the PICA causes? | Lateral Pontine syndrome |
| What is the equation for Infusion rate? | = (Css) x (CL) |
| What is another term used for Plasma concentration? | Css (steady-state concentration) |
| Md = | (Plasma concentration ) x CL ---------------------------------- bioavailability |
| What is the most common organism that causes bacterial meningitis in College dorm students? | Neisseria meningitis |
| What is the best option for treatment of N. meningitidis? | 3rd generation Cephalosporin such as Ceftriaxone |
| What is the mode of action of Ceftriaxone? | Bactericidal agent with B-lactam ring that inhibits cell wall synthesis via inhibition of Bacterial Transpeptidases |
| What are some key distinctions of N. meningitidis? | Photophobia, phonophobia, and a rash (petechiae) in the abdomen and lower extremities. |
| What is the area affected in Wernicke aphasia? | Superior Temporal Gyrus of the Left-temporal lobe |
| A patient with perfect wording, but no sense in what the patient is saying. Dx? | Wernicke aphasia |
| Damage to the Arcuate Fasciculus causes? | Conduction aphasia |
| Conduction aphasia? | Presents with good comprehension and fluency, but poor repetition. |
| What are the gaps in myelination along the axon of adjacent Schwann cells? | Nodes of Ranvier |
| What occurs in the nodes of Ranvier? | Influx of Na+ current and efflux of K+ current |
| Which type of myelinating cells have Nodes of Ranvier? | Schwann cells |
| Common MILD traumatic brain injury | Concussion |
| How is a concussion produced? | Due to acceleration and deceleration of the brain, which occurs after BLUNT trauma |
| What are symptoms seen in a concussion? | Headache, confusion, and amnesia with or without loss of consciousness. |
| The disruption of axonal function cause the symptoms of _____________________. | Concussion |
| What is the reason of the symptoms seen in a contusion? | Shear tear and diffuse axonal injuries |
| Which is most severe, a concussion or contusion? | Contusion |
| How is clinically characterized Hereditary Spastic Paraplegia? | Progressive degeneration of the Lateral Corticospinal tract and subsequent lower extremity weakness and spasticity (stiffness) |
| What is contained in the Lateral Corticospinal tract? | Motor neurons that control descending voluntary movements of contralateral limbs |
| What is the function of the anterior corticospinal tract? | Control of proximal muscles (trunk) |
| What is produced in the Anterior Spinothalamic tract? | Nerves corresponding to CRUDE TOUCH and Pressure |
| Which nervous tract contains the nerves responsible for pain and temperature sensations? | Lateral Spinothalamic tract |
| What is contained or composed the Dorsal column? | Fasciculus cuneatus and Fasciculus gracilis |
| What is the role or functions of the Dorsal Column? | Each fasciculus contain sensory neurons involved in pressure, vibration , fine touch, and proprioception |
| What is the most common cause of metastases to the brain? | Lung cancer |
| What is the typical presentation of brain metastases? | Multiple masses in brain |
| Which area of the nerve is rich in Purkinje cells? | Cerebellum |
| Cerebellar Purkinje cells use which inhibitory NT? | GABA |
| What are two common excitatory neurotransmitter used by Cerebellar Purkinje cells? | Acetylcholine and Glutamate |
| What are the main functions of Astrocytes? | Physical support and repair of the CNS |
| What are secondary functions of Astrocytes? | 1. Maintain the BBB 2. Metabolize Potassium |
| What is the function of Ependymal cells? | Line ventricular system and make CSF |
| What is the embryological problem seen in Lissencephaly? | Failed neuronal cell migration |
| How is Lissencephaly diagnosed? | Ultrasound in 28-week of gestation, showing a smooth surface of the cerebral hemisphere |
| Lack of both gyri and sulci in the cortex of the developing brain of an embryo? | Lissencephaly |
| Which radiculopathy reproduces weak dorsiflexion? | L5 |
| What are important S1-radiculopathy symptoms? | 1. Diminished ankle jerk reflex 2. Weak plantar flexion of the foot 3. Back pain radiating to the corresponding leg, reproduced by the straight leg raise test |
| Which kind of infection in infancy can later develop Subacute Sclerosing Panencephalitis? | Measles |
| Untreated Measles may develop _____________________________ later in life. | Subacute Sclerosing Panencephalitis |
| What is the only CSF abnormality seen in SSP? | CSF globulin |
| Chronological appearance of Neonatal Conjunctivitis | Chemical --> Gonorrhea --> Chlamydia --> HSV |
| How many days after birth is Gonorrhea-induced conjunctivitis produced? | 2-5 days |
| What is the MCC of conjunctivitis in a baby of 5-14 days old? | Chlamydia |
| Which is the latest causative organism of neonatal conjunctivitis? | HSV |
| The rupture of Bridging veins MCC --> | Subdural Hematoma |
| What is the shaped of the bleeding in Subdural Hematoma? | Crescent-shaped areas on CT scan |
| Exposure to extreme environmental heat with inappropriate dissipation of heat. | Heat stroke |
| What are some characteristics seen with Heat stroke? | CNS dysfunction (confusion), end-organ damage, ARDS, and rhabdomyolysis |
| What is the most common of Temporal encephalitis in AIDS patients? | HSV-1 infection |
| What are the findings in lumbar puncture of HSV-1 Temporal Lobe encephalitis? | Bloody CSF in LP |
| What is the treatment of HSV-1 temporal lobe encephalitis? | IV acyclovir |
| What is the definition of a Supratentorial mass pushes the Medial Temporal lobe medially and inferiorly, compressing the ipsilateral oculomotor nerve and the contralateral crus cerebri? | Uncal herniation |
| Uncal herniation that causes contralateral hemiparesis is due to? | Contralateral crus cerebri against Kernohan's notch |
| Which notch is pushed in a Uncal herniation that causes IPSILATERAL hemiparesis? | Crus cerebri against the Tentorial notch |
| How is the CN3 palsy seen in uncal herniation? | Ipsilateral CN3 palsy |
| What are main symptoms seen in Alcoholic Cerebellar degeneration? | 1. Gait impairment (ataxia) 2. Dysarthria, diplopia and intermittent blurred vision |
| What are the symptoms of PCP intoxication? | Aggression, psychomotor agitation, increased temperature, tachycardia, HTN, and nystagmus. |
| How is the pupil size differ in cocaine and PCP intoxication? | Mydriasis --- cocaine, Normal size --- PCP |
| Which are two common conditions that produce Horner syndrome? | Pancoast tumor and PICA occlusion |
| Hoerner syndrome is seen with triad? | 1. Ptosis 2. anhidrosis 3. miosis |
| What are some SAH complications? | Rebleeding, vasospasms, seizures, hyponatremia, hydrocephalus, and increased ICP |
| What is the most common ischemic complication of SAH? | Vasospasm leading to delayed cerebral ischemia |
| What symptoms indicate vasospasm after SAH? | New-onset focal neurological deficits 4-12 days after initial event |
| What causes NPH? | Reduced CSF absorption in the venous system |
| Which sinus is damaged in the MCC of NPH? | Superior Sagittal sinus |
| What are the results of Cavernous sinus damage? | Produces visual deficits and paralysis of CN 3, 4, V1, V2, and 6. |
| What is the cause of Open-angle glaucoma? | Rise in INTRAOCULAR pressure due to increased production of aqueous humor |
| What treatment of Open-angle glaucoma causes mydriasis? | Norepinephrine |
| What drugs are used in Open-angle glaucoma causes miosis and cycloplegia? | Anti-cholinomimetic agents |
| Loss of accommodation | Cycloplegia |
| Damage to Subthalamic nucleus causes ______________________ deficits. | Contralateral |
| What is Hemiballismus? | rare movement-disorder that results in wild, flailing movement of the limbs |
| What area of the brain is damaged in Hemiballismus? | Subthalamic nucleus |
| What are common chemotherapeutic agents that may cause Cerebellar dysfunction? | Cytarabine and Fluorouracil |
| Which causes Subthalamic nucleus activity? | Directly excites the INTERNAL SEGMENT of the Globus pallidus, which then inhibits the Thalamus |
| Internal segment of the Globus Pallidus stimulation causes: | Inhibition of the Thalamus |
| What kind of infarcts are more common to cause Basal ganglia? | Lacunar |
| What is the value of the Resting membrane potential? | -60mV |
| What ion current is in charge of Depolarization? | Influx of Sodium ions into the cells |
| Efflux of K+ out of the cell in cell membrane, is involved in: | Hyperpolarization and Repolarization |
| Which negatively charged ion current is not involved in production of an Action potential? | Chloride |
| Which kind of cells use Calcium in the production of muscle AP? | Cardiac myocyte and Skeletal muscle cell |
| What mutation causes Wilson's disease? | ATP7B gene |
| What is the result of the mutation of the gene that causes Wilson disease? | Decreases the secretion of Copper into the biliary system, which leads to accumulation of Copper i the brain, liver, and cornea. |
| What is the most common cause of viral meningitis in children? | Enterovirus infection |
| What are the CSF abnormalities of Viral meningitis? | 1. Elevated WBC (lymphocytes) 2. Elevated protein 3. Normal glucose |
| What is the genomic description of Enteroviruses? | Naked, positive sense ssRNA virus |
| Essential tremor is more apparent in _________________ postures. | Sustained |
| A patient sustained posture tremor is seen more evident in which kind of tremor disorder? | Essential tremor |
| Essential tremor becomes worst during? | Movement and anxious mood |
| CNS lymphoma in often seen in which kind of patients? | Immunocompromised (AIDS) |
| CNS lymphoma is associated with which virus? | EBV |
| Which cell receptors provide possible infection of cell by EBV? | CD21+B cells |
| Mutated or damaged CD21 + receptors on B cells cause --> | Unregulated B-cell proliferation ----> lymphomas |
Created by:
rakomi
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