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Nervous System

Pathology: Nervous System

Difference between intracellular and extracellular edema? Common causes? 1. Intra: water moves into cells. - Na/K ATPase dysfunction from hypoxia - hyponatremia causing osmotic shift 2. Extra: increased vessel permeability - inflammation - trauma - respiratory acidosis
Why is a patient with head trauma made to hyperventilate? to produce respiratory alkalosis → cerebral vessel vasoconstriction → prevent vessel permeability & cerebral edema
1. What is Pseudotumor cerebri 2. What is the most common demographic affected? 3. Most likely cause 1. idiopathic increase in intracranial pressure in the absence of tumor and obstruction to CSF flow 2. young obese women 3. obstruction at arachnoid villi
Herniation sites: 1. Subfalcine 2. Uncal 3. Tonsillar 1. cingulate gyrus under falx cerebri 2. medial temporal lobe through tentorium cerebelli 3. cerebellar tonsils herniate into foramen magnum
Complications of: 1. Subfalcine 2. Uncal 3. Tonsillar 1. compression of anterior cerebral artery 2. compression of CN III, PCA, and parasympathetic fibers 3. cardiorespiratory arrest
Presentation of uncal herniation 1. Compression of oculomotor nerve → eye deviated down and out 2. Compression of parasympathetic fibers → mydriasis 3. Compression of PCA → hemorrhagic infarction of occipital lobe
1. Communicating hydrocephalus causes 2. Noncommunicating hydrocephalus 1. ↓ CSF reabsorption by arachnoid granulations (arachnoid scarring post-meningitis) 2. obstruction to CSF flow within ventricular system
1. characteristic of Parinaud's syndrome? 2. What is the cause 1. hydrocephalus and paralysis of upward gaze 2. blockage of the aqueduct of Sylvius
1. Hydrocephalus ex Vacuo 2. Arnold Chiari malformation 1. ventricles appear dilated secondary to brain atrophy (i.e. Alzheimer's) 2. medulla and cerebellar vermis displaced through foramen magnum; can cause noncommunicating hydrocephalus
1. Neutrophils in the CSF 2. Lymphocytes in the CSF 3. Lymphocytes & monocytes in the CSF 1. bacterial meningitis 2. viral meningitis 3. fungal meningitis
1. Spina bifida occulta 2. Meningocele 3. Meningomyelocele 1. defect in closure of posterior vertebral arch 2. spina bifida with meninges protruding through vertebral defect 3. spina bifida with meninges and spinal cord protruding through defect
1. Dandy-Walker malformation 2. Syringomyelia 3. Which long tract is first affected? 1. partial or complete absence of the cerebellar vermis and dilation of the 4th ventricle 2. cystic enlargement of the cervical spinal cord central canal 3. spinothalamic → loss of pain/temp
1. Which protein is involved in Neurofibromatosis (NF) 1 and 2? 2. What is the role of these proteins? 1. NF1 - mutation in gene coding for neurofibromin; NF2 - merlin 2. both proteins act as tumor suppressors
What are the most common manifestations of Neurofibromatosis 1? 1. Cafe au lait colored macules (100%) 2. Lisch nodules (>90%) 3. axillary and inguinal freckling (70%) 4. optic glioma (2-5%)
Common manifestation of Neurofibromatosis 2? bilateral acoustic schwannoma >90%
Key findings in tuberous sclerosis 1. seizures 2. mental retardation 3. hamartomas in CNS, skin
1. Nervous system disorder associated with cardiac rhabdomyomas? 2. Incidence of epidural hematoma 1. tuberous sclerosis 2. 1% to 2% of head injuries (very low)
1. What is the inheritance pattern of neurofibromatosis and tuberous sclerosis? 2. Common cause of epidural hematomas 1. AD disorder 2. Fracture of the temporoparietal bone (at the pterion) causing severance of the middle meningeal artery
Cause of ubdural hematoma tearing of bridging veins that run through the subarachnoid space to connect the brain witht he dural sinuses
1. What are the symptoms of Horner's Syndrome? 2. Where must the spinal cord lesion be to have Horner's Syndrome? 1. Ptosis, Miosis, Anhydrosis 2. Above T1
What is autonomic dysreflexia and what is it caused by? excessive bladder or bowel distention after spinal cord injury to where massive reflexive depolarization occurs
1. What is neurogenic shock? 2. What happens during neurogenic shock? 1. loss of sympathetic innervation to the vascular smooth muscle 2. vasodilation → hypotension
1. result of lesion to the genu of the internal capsule 2. Which artery supplied the genu? 1. contralateral paralysis of lower face and tongue (contains corticobulbar fibers so motor deficit to face) 2. Middle Cerebral Artery
1. Decerebrate rigidity results from a lesion... 2. It presents with... 1. lesion below the red nucleus (intact red nucleus causes flexion of upper extremities) 2. extension of both upper and lower extremities dEcErEbratE = E for extension
1. Decorticate rigidity results from a lesion... 2. It presents with... 1. lesion above the red nucleus 2. flexion of upper extremities and extension of lower extremities deCORticate = arms protect CORE
1. What is clonus and is it seen in UMN or LMN lesion? 2. Would a ventral root lesion cause flaccid paralysis or spastic paresis? 1. involuntary muscle contractions due to sudden stretching of the muscle; UMN lesion 2. flaccid paralysis because it is where LMNs come out
1. Opthalmoplegia 2. Strabismus 1. paralysis or weakness of an ocular muscle 2. improper alignment of the eyes
1. Which nerve lesion esults in internal strabismus? 2. How can you test the trochlear nerve? 1. medial deviation of the eye results from abducens lesion 2. superior oblique function → looking down
What is the difference between sensorineural and conductive hearing loss? Conductive - external auditory canal or middle ear Sensorineural - cochlea or CN VIII
What are the results of the caloric test for patients with intact brainstems? 1. cold water = fast phase of nystagmus to opposite side 2. warm water = fast phase of nystagmus to same side
Describe the eye movements associated with nystagmus slow drift off target followed by a quick corrective saccade
Describe these movement disorders: 1. hemiballismus 2. chorea 3. athetosis 4. clonus 1. sudden, wild flailing of 1 arm and/or 1 leg 2. sudden, jerky movements 3. slow, writhing movements 4. involuntary muscle contractions
What is the usual site of lesion that results in: 1. hemiballismus 2. chorea 3. athetosis 4. clonus 1. subthalamic nucleus 2. basal ganglia 3. basal ganglia 4. upper motor neuron
1. abulia 2. prosopagnosia 1. lack of will or initiative 2. inability to recognize faces
4 Main symptoms of Parkinson's TRAP 1. resting Tremor 2. cogwheel Rigidity 3. Akinesia (can't initiate movement) 4. Postural instability
What is Myerson's sign? In what disorder is it noted? inability to suppress blinking when the forehead is tapped. Found in Parkinson's
1. What is a main component of Lewy bodies? 2. Parkinson's is characterized by degeneration of ___. 1. alpha-synuclein 2. dopamine neurons in the substantia nigra pars compacta
What is the difference between aphasia and dysarthria? 1. aphasia = higher order inability to speak 2. dysarthria = motor inability to speak
What characterizes these aphasias? 1. Broca's 2. Wernicke's 3. Global 4. Conduction aphasia 1. nonfluent aphasia with intact comprehension 2. fluent aphasia with impaired comprehension 3. nonfluent aphasia with impaired comprehension 4. poor repetition but fluent speech, intact comprehension
1. When are watershed areas subjected to stroke? 2. Where in the brain do watershed infarcts occur? 1. during severe hypotension (cardiac arrest, shock) 2. junction between anterior and middle cerebral arteries
1. Open-angle glaucoma is due to.. 2. Closed-angle glaucoma is due to... 3. Which type of glaucoma is more chronic in its onset? 1. blockade of canal of Schlem 2. obstruction between iris and lens 3. open-angle glaucoma
What are the 4 main symptoms of Gerstmann's syndrome? 1. acalculia 2. finger agnosia 3. R-L disorientation 4. agraphia
Inability to perform a task on command even though no motor weakness is present. ideomotor apraxia
1. Lack of awareness of part of one's body 2. It typically results from a lesions to 1. asomatognosia? 2. nondominant (right) parietal lobe
Patient cannot execute command to move their left arm. Patient is able to execute command to move right arm. Transcortical Apraxia from lesion to corpus callosum (usually by blockage of ACA) patient interprets command using left Wernicke's area then must send movement command to right motor cortex through corpus callosum
1. Cause of alexia without agraphia 2. Lesion resulting in truncal ataxia, dysarthria 1. severing the splenium of the corpus callosum from a left PCA infarct 2. cerebellar vermis
What is the result of a lesion at each area? 1. Amygdala 2. Mammillary bodies 3. Paramedian pontine reticular formation 1. Kluver-Bucy syndrome (hypersexuality, psychic blindness) 2. Wernicke-Korsakoff syndrome 3. Eye deviate away from lesion
What is the result of a lesion at each area? 1. Frontal eye fields 2. subthalamic nucleus 3. cerebellar vermis 4. cerebellar hemisphere 1. Eye deviate toward lesion 2. contralateral hemiballismus 3. intention tremor, ipsilateral limb ataxia
1. What are Argyll Robertson pupils? 2. Which spinal cord syndrome is associated with tertiary syphilis? 1. pupils that react to accomodation but do not constrict to light 2. Tabes Dorsalis
1. Amyotrophic lateral sclerosis is characterized by the destruction of... 2. Subacute combined degeneration is characterized by destruction of... 1. ventral horns & corticospinal tract 2. dorsal columns, spinocerebellar tracts, & corticospinal tract
1. Disease characterized by abrupt attacks of vertigo, tinnitus and hearing loss? 2. What is the cause? 1. Meniere disease 2. ↑ endolymph → distension of the fluid filled spaces in the cochlea and vestibular labyrinth
Which defect in which artery is responsible for the brain stem lesion: 1. Medial Medullary Syndrome 2. Lateral Medullary Syndrome 3. Medial Pontine Syndrome 4. Lateral Pontine Syndrome 5. Medial Midbrain Syndrome 1. Anterior Spinal Artery 2. PICA 3. Basilar Artery 4. AICA 5. PCA
All medial brainstem lesions have deficits to which long tracts? 2. Which long tract is usually effected in lateral brainstem lesions? 1. corticospinal tract and DCML 2. spinothalamic tract
Name the syndrome: contralateral paresis, contralateral tactile loss and ipsilateral tongue paralysis medial medullary syndrome (anterior spinal artery)
hydrocephalus with paralysis of upward gaze Dorsal Midbrain (Parinaud) Syndrome from Germinoma or Pineal Tumor
1. What is the genetic defect in Huntington's disease 2. How does this genetic defect lead to the pathology associated with Huntington's? 1. trinucleotide repeat on chromosome 4 2. mutant Huntingtin (mHtt) protein produced and binds Rhes in caudate leading to cytotoxicity
1. Wernicke encephalopathy usually occurs as a result of.. 2. What triad of symptoms is seen in Wernicke's encephalopathy? 3. the most notable symptoms of Korsakoff syndrome are.. 1. thiamine deficiency 2. confusion ophthalmoplegia, ataxia 3. anterograde amnesia, confabulation, personality change
1. Amyloid precursor protein is found on which chromosome? 2. Its chromosomal location makes which patient population vulnerable to Alzheimers? 1. chromosome 21 2. Down syndrome patients
What symptoms do individuals with Pick's disease exhibit that are not seen in Alzheimer's? 1. both have frontal and temporal atrophy 2. Pick's disease has parkinsonian aspects with behavioral and language symptoms early on
Most likely cause of a subarachnoid hemorrhage? ruptured berry aneurysm; AVM
Upon damage to the following cranial nerves, what would be the orientation of the eye? 1. CN III 2. CN IV 3. CN VI 1. eye looks down and out 2. eye drifts up 3. medially directed eye
1. CN III consists of a motor and parasympethetic component. Which is on the outside? 2. Which component is more vulnerable to vascular disease? 3. Which is more vulnerable to compression? 1. parasympathetic is on the outside 2. motor component 3. parasympathetic component
1. Which cerebral artery is an atherosclerotic stroke most likely to occur in? 2. What physical findings help differentiate a stroke of the ACA from that of the MCA? 1. Middle Cerebral Artery 2. MCA will have hemiparesis and sensory loss of face and upper extremities while ACA will be in lower extremities
1. Where do berry aneurysms form in the brain? 2. Why do they form at these locations? 3. Which location is most common? 1. junctions of communicating branches with main cerebral artery 2. junctions lack internal elastic lamina and smooth muscle 3. anterior cerebral artery and anterior communicating artery
What are the relative CSF levels in bacterial meningitis: 1. protein 2. leukocytes 3. glucose 1. ↑ 2. ↑ (neutrophils) 3. ↓
What are the relative CSF levels in viral meningitis: 1. protein 2. leukocytes 3. glucose 1. ↑ 2. ↑ (lymphocytes) 3. normal
Most common cause of: 1. viral meningitis 2. neonatal meningitis 3. meningitis in patients age 1 month ➞ 18 years 4. meningitis in patients > 18 years 1. Enteroviruses (Coxsackievirus) 2. Strep B (agalactiae) 3. Stept. pneumoniae 4. Strep. pneumoniae
Pathogenesis of multiple sclerosis 1. CD4 T cells react against self antigens in myelin sheath 2. cytokines activate macrophages that destroy myelin and oligodendrocytes
1. Slow viral encephalitis associated with measles 2. Negri bodies 3. Viral induced rapid cognitive decline in immunocompromised 1. Subacute sclerosing panencephalitis 2. Rabies 3. JC virus → progressive multifocal leukencephalopathy
1. What is internuclear opthalmoplegia? 2. Most common cause of bilateral internuclear opthalmoplegia 1. medial longitudinal fasciculus damage leading to impaired adduction 2. Multiple Sclerosis
1. Demyelination disorder caused by rapid IV correction of hyponatremia 2. Most common fungal CNS infection in AIDS? 1. central pontine myelinolysis 2. cryptococcus neoformans
1. Which genes are associated with early onset Alzheimer's disease? 2. Which genes are associated with late onset Alzheimer's disease? 1. presenilin-1, presenilin-2 2. ApoE4
Pathogenesis of neurofibrillary tangles in Alzheimer's diseases activated glycogen synthase kinase phosphorylates tau proteins causing the protein to cluster into fibers
Which sites in the brain are particularly susceptible to β-amyloid toxicity? medial temporal lobe and frontal cortex especially entorhinal cortex and hippocampus
1. Parkinsonism with dementia and visual hallucination 2. Acute muscle weakness in lower extremities following gastroenteritis 1. Lewy body dementia 2. Guillain-Barre syndrome (preceeded by Campylobacter jejuni)
Charcot's triad of Multiple Sclerosis 1. Scanning dysarthria 2. Intention tremor 3. Nystagmus
Hereditary disorder associated with sensory and motor neuropathy Charcot-Marie-Tooth disease
Difference between partial and generalized seizures 1. Partial - 1 area of the brain 2. General - diffuse
1. Where do Partial seizures commonly originate from? 2. Difference between simple partial and complex partial 1. mesial temporal lobe (hippocampus, parahippocampal gyrus, amygdala 2. simple retains consciousness; complex has impared consciousness
1. Extracellular edema due to increased vessel permeability 2. Autosomal dominant trinucleotide repeat disorder leading to chorea 1. vasogenic edema 2. Huntington's disease
Defect in Friedreich's ataxia and pathogenesis of the disease trinucleotide repeat disorder → Frataxin deficiency → impaired mitochondrial iron homeostasis → free radical damage and apoptosis
Which sites degenerate in the nervous system of those with Friedeich's ataxia? 1. dorsal root ganglia and posterior columns 2. spinocerebellar tracts 3. lateral corticospinal tracts
1. Familial cases of amyotrophic lateral sclerosis involve.. 2. Inherited lower motor neuron disease of children manifesting within the first few months of life 1. defective superoxide dismutase 1 leading to superoxide free radical injury of neurons 2. Werdnig-Hoffman disease (floppy baby)
1. What is the abnormality of Wilson's disease 2. Which spinal cord long tracts are affected by vitamin B12 deficiency? 1. defective copper excretion into bile 2. posterior columns and lateral corticospinal tract
1. Recurrent bouts of abdominal pain, psychosis and peripheral neuropathy. 2. Average age of onset for Friedreich's ataxia 1. Acute intermittent prophyria 2. teenagers (always present before 20)
How does the location of primary brain tumors differ in adults and in children? 1. adults - supratentorial 2. children - infratentorial
1. Most common primary CNS tumor in adults 2. Most comon primary CNS tumor in children Both astrocytomas 1. glioblastoma multiforme 2. pilocytic astrocytoma
1. Which CNS tumor characteristically crosses the corpus callosum? 2. Common site for medulloblastoma? 3. Common site for ependymoma 1. Glioblastoma multiforme 2. cerebellum 3. fourth ventricle
1. Most common origin of brain tumor metastasis 2. Frontal lobe tumor that frequently calcifies 1. lung 2. oligodendrocytoma
1. Unilateral facial paralysis 2. Most common causes? 1. Bell's Palsy 2. herpes simplex virus
1. Periventricular plaques of demyelination 2. ↑ α-fetoprotein 1. multiple sclerosis 2. neural tube defect
65 year old man with difficulty walking, sphincter incontinence, and enlarged ventricles Normal pressure hydrocephalus (wet, wacky and wobbly)
1. Lack of which vitamin results in Wernicke-Korsakoff? 2. If the brainstem is intact in a comatose patient, which direction would the eyes deviate ofter introducing cold water in the ear? 1. B1 (thiamine) 2. eyes deviate toward the side of water
Brief, irregular foot contractions in a child with rheumatic fever Sydenham chorea
1. What is constructional apraxia 2. It is from a lesion to.. 1. inability to copy objects 2. nondominant parietal lobe (usually right)
1. Anencephaly 2. Classification of a TIA 1. absence of the skull and brain 2. symptoms of stroke last < 24 hours
Areas most susceptible to infarction during global ischemia 1. pyramidal neurons in cortical layers 3, 5 and 6 2. pyramidal neurons of the hippocampus 3. Purkinje layer of cerebellum
1. Subtype of stroke resulting in pale infarct 2. Subtype of stroke resulting in hemorrhagic infarct 3. What are lacunar stroke due to? 1. Thrombotic (no repurfusion) 2. Embolic (repurfusion occurs) 3. hyaline arteriosclerosis (diabetes or HTN) thrombus occludes vassel, emboli as a detached thrombus
What is the etiology of intracerebral hemorrhage? 1. hypertension leads to hyaline arteriosclerosis which weakens vessel walls 2. Charcot-Bouchard microaneurysms rupture
1. Head trauma with lucid interval preceeding neurologic signs 2. Head trauma with progressive neurologic signs 1. Epidural hematoma 2. Subdural hematoma
1. Lysosomal storage disease where myelin cannot be degraded and accumulates in lysosomes 2. Which enzyme is deficient? 1. Metachromatic leukodystrophy 2. Arylsulfatase
1. Which human leukocyte antigen is associated with multiple sclerosis? 2. Which T helper cell is involved in multiple sclerosis? 1. HLA-DR2 2. Th1 cells
1. First sign of Alzheimer's disease 2. Cowdry Type A Inclusion 1. short-term memory loss 2. Herpes Simplex Encephalitis
1. Most common cause of dementia 2. Second most common cause of dementia 3. Second most common neurodegenerative cause of dementia 1. Alzheimer's 2. Vascular Dementia 3. Dementia with Lewy bodies
1. Parkinsonism with impaired autonomic function. 2. Cause of hemiballismus. What is the role of this structure? 1. Shy Drager Syndrome 2. Damage to subthalamic nucleus; stimulates the GPi to inhibit the thalamus
Which conditions present as defects in the Dorsal column and lateral corticospinal tracts? 1. vitamin B12 deficiency 2. vitamin E deficiency 3. Friedreich's ataxia
Which conditions present as destruction of anterior horn of spinal cord alone? 1. poliomyelitis 2. Werdnig-Hoffmann disease
1. Rapidly progressive dementia with ataxia and myoclonus 2. What neurologic concern do you have in young patient with a port-wine stain of ophthalmic distribution? 1. Creutzfeldt-Jakob disease 2. Sturge-Weber syndrome may have leptomeningeal angioma
Compare lateralization and associaciated symptoms: 1. Migraine headache 2. Tension headache 3. Cluster headache 1. unilateral; aura, nausea, photophobia 2. bilateral; no aura, no photophobia 3. unilateral; Horner's syndrome
Brain tumor with 1. psammoma bodies 2. GFAP staining 3. pseudorosettes 4. fried egg appearance and calcifications 5. Rosenthal fibers 6. S-100 positive 7. synaptophysin staining 8. Pseudopallisading 1. meningioma 2. astrocytoma (GBM, pilocytic astrocytoma) 3. ependymoma 4. oligodendrocytoma 5. pilocytic astrocytoma 6. Schwannoma 7. neuroma 8. GBM
Genetic mutation involved in: 1. Late onset familial Parkinson disease 2. Early onset familial Parkinson disease 1. mutation in gene encoding α-synuclein (can't degrade with ubiquitin) 2. Mutaiton in 'Parkin" gene which encodes a ubiquitin ligase
1. Headache with male predominance 2. What is the penetrance and expressivity of neurofibromatosis? 1. Cluster headache 2. complete penetrance (everyone with disorder exhibits it phenotypically), variable expressivity (individuals with disease have difference degrees of symptoms)
Inheritance pattern of : 1. Neurofibromatosis 2. Tuberous sclerosis? 3. Wilson's disease 4. Sturge-Weber 1. autosomal dominant 2. autosomal dominant 3. autosomal recessive 4. somatic mosaicism or sporadic
What is ceruloplasmin? copper carrying protein found in plasma
1. Vascular dementia usually presents with what comorbidity? 2. How long until neuronal injury is visible in autopsy? 1. Alzheimer's disease 2. 12-48 hours (red neurons)
1. Which disease is known as frontotemporal dementia? 2. Which type of dementia exhibits loss of executive function and may preserve memory? 3. Which type of dementia presents with myoclonus? 1. Pick's disease 2. Vascular dementia 3. Prior disease
What is the sequence of tissue pathology following ischemic stroke 1. red neuron 2. necrosis + neutrophils 3. macrophages 4. reactive gliosis
Which neurocutaneous disorder is associated with: 1. hamartomas, cardiac rhabdomyoma 2. bilateral renal cell carcinoma 3. subependymal giant cell astrocytoma 4. retinal angiomatosis 1. tuberous sclerosis 2. von Hippel-Lindau disease 3. tuberous sclerosis 4. von Hippel-Lindau disease
New onset confusion with right arm and leg 5 days after a Subarachnoid hemorrhage. What is the problem? Vasospasm from blood breakdown products leads to ischemia of artery (treat with calcium channel blocker)
DDx for ring-enhacing lesion Toxoplasmosis, abscess, metastases, AIDS lymphoma
Ring enhanced lesion on MRI. Biopsy reveals polymorphonuclear aggregation with adjacent collagenization, gliosis and edema. Brain abscess
Causative agent of meningitis: 1. Gram positive diplococci 2. Gram negative diplococci 1. Streptococcus pneumonia 2. Neisseria meningitis
1. Atrophy of the caudate nucleus is seen in 2. Child with ataxia and hypertrophic cardiomyopathy 1. Huntington's disease 2. Friedreich's ataxia
tumor resulting in bitemporal hemianopia: 1. children 2. adults 1. craniopharyngioma 2. pituitary adenoma
Which type of neurofibromatosis: 1. optic glioma 2. vestibular schwannoma 3. higher incidence 1. NF-1 2. NF-2 3. NF-1
What is the cause of the two Age-Related Macular Degenerations: 1. Dry 2. Wet 1. fat deposits 2. neovascularization
Patient has intermittent unilateral headaches but they are always confined to the same side. Never the other. 1. Management 2. Possible cause to rule out MRI to exclude vascular malformation
Headache worse when lying down at night. possibly a space occupying lesion that can increase intracranial pressure
Headache worse in the morning associated with intracranial mass lesion, since brain edema increases overnight from the effects of gravity in the reclining position
What is Cushings triad? 1. hypertension 2. bradycardia 3. abnormal respirations
Aneurysm of which artery can cause a third-nerve palsy? posterior communicating
What is the difference between a saccular and fusiform aneurysm? 1. saccular (berry) is outpouching of a vessel wall 2. fusiform - dilation of the main vessel
Where is the site of bleed for: 1. AVMs 2. Saccular aneurysms 1. intraparenchymal 2. subarachnoid
Created by: amichael87



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