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122 Cards in this Set

  • Front
  • Back
Most common causes of meningitis:
Newborn-->6m
Group B Strep
E coli
Listeria
Most common causes of meningitis:
Children 6m-6y
Strep pneumo
Neisseria meningitides
H influenza
Enteroviruses
Most common causes of meningitis:
6y-->60y
Strep pneumo
N. meningitidies
Enteroviruses
HSV (temporal lobe encephalitis)
Most common causes of meningitis:
60+y
Strep pneumo
Gram neg rods
Listeria
What portion of the brain is supplied by the anterior cerebral artery?
Medial surface--Premotor/sensory of legs and feet
What portion of the brain is supplied by the middle cerebral artery?
Lateral surface--Broca's, Wernicke's, motor/sensory of face and arms
What group of genes is responsible for skeletal development?
Hox genes
What is the classic clinical presentation of a thyroglossal duct cyst?
Asyx mass, midline neck
Moves with swallowing
Younger than 30
Can become infected and cause abscess; must be resected
Which hepatic phase of metabolism is lost first by geriatric patients?
Phase I
Which hepatic phase of metabolism is mediated by cytochrome p450?
Phase I
What are the 4 obligate aerobic bacteria?
Nocardia
Pseudomonas aeruginosa
M. tuberculosis
Bacillus spp

(Nagging Pests Must Breathe)
Which vasculitis:
Necrotizing granulomas of lung and necrotizing glomerulonephritis
Wegener's granulomatosis
Which vasculitis:
Necrotizing immune complex inflammation of visceral/renal vessels
Polyarteritis nodosa
Which vasculitis:
Young Asian women
Takayasu's arteritis
Which vasculitis:
Young asthmatics
Churg-Strauss Syndrome
Which vasculitis:
Infants and young children; involved coronary arteries
Kawasaki's Dz
Which vasculitis:
Most common vasculitis
Temporal arteritis (Giant cell)
Which vasculitis:
a/w hepatitis B infection
Polyarteritis nodosa
What can prevent the neurotoxicity of isoniazid?
Pyridoxine (vit B6)
What is the treatment for TCA cardiotoxicity?
NaCO2 to alkalinize plasma/urine
What is the treatment for theophylline cardiotoxicity?
beta-blockers
What is the difference between malingering and facticious disorder?
Malingering--conscious creation of symptoms to conscious motivation; ex: gain disability, get free food from hospital cafeteria

Facticious--creation of symptoms but motivation is unconscious, i.e., to assume sick role
What artery is damaged:
Aneurysm causes the eye to look down and out
Posterior Communicating Artery-->CN III palsy
What artery is damaged:
Aneurysm may cause bilateral loss of lateral visual fields
Anterior Communicating Artery
What artery is damaged:
Broca's or Wernicke's aphasia
MCA
What artery is damaged:
Unilateral lower extremity sensory and/or motor loss
Anterior Cerebral Artery
What artery is damaged:
Unilateral facial and arm sensory and/or motor loss
Middle Cerebral Artery
Label.
Artery affected.
PCA
Artery affected.
MCA
Medial Medullary Syndrome:
Pathophys
AKA
Presentation
Occlusion of anterior spinal artery (from vertebral artery)-->unilateral infarct of medial portion of rostral medulla

AKA anterior spinal artery syndrome

Syx:
-Contralateral spastic hemiparesis
-Contralateral tactile and kinesthetic defects
-Tongue deviates toward side of lesion (hypoglassal nuc/nerve damage)
PAIN AND TEMP PRESERVED
What is the hallmark sign of a general brainstem lesion?q
Alternating syndromes where there are long tract symptoms on one side (hemiparalysis) and cranial nerve symptoms on other side.
Wallenberg Syndrome:
Pathophys
AKA
Presentation
AKA Lateral Medullary Syndrome

Caused by occlusion of one of the posterior inferior cerebellar arteries (PICA)-->unilateral infarct of lateral portion of rostral medulla

Syx:
Loss of pain/temp over contralateral body
Loss of pain/temp over ispislateral face
Hoarsness, diff swallowing, lose gag reflex
Ipsilateral Horner's syndrome
Vertigo, nystagmus, n/v
Ipsilaterial cerebellar deficits (ataxia, past pointing)
Lateral Inferior Pontine Syndrome:
Pathophys
Presentation
Occlusin of anterior inferior cerebellar arteries (AICA)

Syx:
Ipsilateral facial nerve paralysis
Ipsilateral loss of taste from anterior 2/3 tongue
Ipsilateral deafness, tinittus
Nystagmus, vertigo, n/v
Ipsilateral limb/gait ataxia
Ipsilateral loss pain/temp from face
Contralat loss pain/temp sensation
No paralysis!
Posterior Cerebral Artery:
Lesion effects
Contralateral hemianopia (blindness) w/macular sparing; supplies occipital cortex
Weber's Syndrome:
Pathophys
Presentation
Midbrain infarct from occlusion of Posterior Cerebral Artery

Syx:
Cerebral peduncle lzn-->contralateral spastic paralysis (hemiparesis)

Oculomotor nerve (CN III) palsy-->ipsilateral ptosis, pupillary dilation, lateral strabismus (eye looks down and out)
Middle Cerebral Artery:
Lesion Effects
Contralateral face/arm paralysis, sensory loss
Aphasia (dominant sphere)
Left-sided neglect
Anterior Cerebral Artery:
Lesion Effects
Loss of motor/sensory of brain, leg-foot areas
Artery effected.
ACA
Anterior Communicating Artery:
Lesion Effects
Visual field defects--blurry, or bitemporal hemianopia (loss of lateral visual fields)
Posterior Communicating Artery:
Lesion Effects
CN III palsy; eye looks down and out (strabismus)
Watershed Zones:
When are they lesioned?
Effects
Damaged in severe hypotension-->upper leg/upper arm weakness, defects in higher-order visual processing
Basilar Artery:
Lesion Effects
Locked-in syndrome (CN III typically intact)
Stoke of Anterior Circle of Willis:
Effects
General sensory/motor dysfn, aphasia
Stroke of Posterior Circle of Willis:
Effects
CN deficits (vertigo, visual deficits), coma, cerebellar deficits (Ataxia), dominant hemisphere (ataxia), nondominant (neglect)
How can a lumbar puncture distinguish between an acute an several day old subarachnoid hemorrhage?
Acute--bloody

Several day old--xanthochromia (bilirubin present bc RBCs broken down)
Berry aneurysm
Berry aneurysm
SAH
Epidural hematoma
Subdural hematoma
Parenchymal hemorrhage
Epidural hematoma:
Pathophys
Presentation
CT findings
Rupture of middle meningeal artery (branch of maxillary artery); often 2º to fracture of temporal bone

Presents with lucid interval prior to CN III palsy (eye looks down and out) due to rapid expansion under systemic arterial pressure

CT shows biconvex disk not crossing suture lines

Can cross falx, tentorium.
Subdural hematoma:
Pathophys
Presentation
CT findings
Rupture of bridging veins

Slow venous bleedings, late onset of syx

Seen in elderly, alcoholics (tend to fall); shaken babies

Crescent-shaped hemorrhage that crosses suture liens.

Cannot cross falx, tentorium.
Subarachnoid hemorrhage:
Pathophys
Presentation
CT findings
Rupture of aneurysm (usually berry aneurysm in Marfan's, Ehlers-Danlos, APCKD).

Patient complains of "worst HA of my life"

Bloody or yellow (xanthochromic) spinal tap

Asterisk-shaped lesion on CT
Parenchymal hematoma:
Pathophys
Caused by hypertension, amyloid angiopathy--lobar strokes all over brain, DM, tumor
Brain's healing response to atherosclerotic thrombus.
Leads to ischemic stroke-->subsequent necrosis.

Brain then forms cystic cavity with reactive gliosis (line with astroglia?)
Assessment of stroke:
CT vs MRI
CT won't show ischemia until after 24 hours
MRI will identify ischemia within 3-30 mins of stroke
Describe the path of CSF. Begin with its site of production.
CSF made by choroid plexus

Absorbed by venous sinus arachnoid granulations

-->Lateral ventricle-->3rd ventricle via FORAMEN OF MONROE

-->Third ventricle-->4th ventricle via CEREBRAL AQUEDUCT

-->4th ventricle-->Subarachnoid space via:
-Foramina of Lushka (Lateral)
-Foramen of Megendie (Medial)
How does CSF enter venous circulation?
CSF-->Venous Sinus arachnoid granulations-->Superior saggital sinus
Hydrocephalus:
Communicating vs Obstructive--
Pathophys
Communicating--dec'd CSF absorption by arachnoid villi-->inc'd ICP, papilledema, herniation

Obstructive (noncommunicating)--structural blockage of CSF circulation within ventricular system (stenosis of aqueduct of Sylvius for ex)
Normal pressure hydrocephalus:
Pathophys
Presentation
Wet, wobbly, wacky

Doesn't result in inc'd subarachnoid space volume.

Expansion of ventricles distorts fibers of corona radiata and leads to dementia, ataxia, and urinary incontinence (reversible cause of dementia in elderly)
Hyrocephalus ex vacuo:
Pathophys
Appearance of inc'd CSF in atrophy.

ICP normal
Triad not seen
Which spinal nerves innervate the diaphragm?
C3, C4, C5
Which spinal nerves are responsible for erectile response?
S2, S3, S4
Which spinal tract:
Touch, vibration, and pressure sensation
Doral columns--fasciculus gracilis, cuneatues
Which spinal tract:
Voluntary motor command from motor cortex to body
Lateral/ventral corticospinal tracts
Which spinal tract:
Voluntary motor command from motor cortex to head/neck
Corticobulbar tract
Which spinal tract:
Alternate routes for the mediation of voluntary movement
Reticulospinal and rubrospinal tracts
Which spinal tract:
Pain and temperature sensation
Lateral spinothalamic tract
Which spinal tract:
Important for postural adjustments and head movements
Vestibulospinal tract
Which spinal tract:
Proprioceptive information for the cerebellum
Dorsal/ventral spinocerebellar tracts
Label
1. Fasciculus cuneatus (info from arms)
2. Fasciculus gracilis (info from legs)
3. Lisshauer's tract (pain/temp)
4. Lateral corticospino tract (movement info)
5. Vestibulospinal tract (reflexive info; postural adj)
6. Reticulospinal tract
7. Anterior/ventral corticospinal tract (motor from brain)
8. Anterior/ventral spinothalamic tract
9. Lateral spinothalamic tract (pain and temp)
10. Anterior spinocerebellar tract (info to cerebellum)
11. Posterior/drosal spinocerebellar tract (proprioception info to cerebellum)
Dorsal column:
Tract
Function
Synapses
Medial lemniscal PW

Ascending pressure, vibration, touch, proprioception, sensation

Sensory nerve ending->DRG Cell body-->Ascend in dorsal column

->Ipsilateral nucleus cuneatus or gracilis (medulla)-->Decussates in medulla-->ascends contralaterally in medial lemniscus

-->VPL of thalamus-->sensory cortex
Spinothalamic column:
Tract
Function
Synapses
Ascending pain and temperature sensation

Sensory nerve (A-delta, C fibers)-->Cell body in DRG-->ipsilateral gray matter

Decusates at anterior white commissure-->VPL of thalamus-->Sensory cortex
Lateral corticospinal tract:
Tract
Function
Synapses
Descending voluntary movement of contralateral limbs

Upper MNs--cell body in primary motor cortex-->decends ispilaterally until decussating at caudal medulla-->descends contralaterally

-->cell body of anterior horn
-->Leaves spinal cord
-->NMJ
Upper vs Lower Motor Neuron Lesions:
General
LMN: Hyporeflexia, atrophy (mm not receiving motor info)

UMN: hyperreflexive, Babinski reflex positive (spinal innervation intact, but no motor info from brain), spastic paralysis

MUSCLE WEAKNESS IN BOTH
Random, asymmetric white matter lesions-->MS
Brainw/periventricular white matter plaques of demyelination, gross.

Demyelination occurs in bilateral asymmetric distribution.

MULTIPLE SCLEROSIS
Poliomyelitis:
Method of spread
Presentation
Lab values
Poliovirus (fecal-oral)

Malaise, HA, , fever, nausea, abdominal pain, sore threat

LMN lesions--muscle weakness, atrophy, fasciculations, hyporeflexia

Findings: CSF w/lymphocytic pleocytosis with slight elevation of protein (no change in CSF glucose)

Virus recovered from stool or throat
Multiple Sclerosis:
Pathophys
Presentation
Diagnosis
Autoimmune inflammn and demyelination of CNS (brain and SC)

Presentation: optic neuritis (sudden loss of vision), MLF syndrome (internuclear ophthalmoplegia), hemiparesis, hemisensory syx, bowel/bladder incontinence

Relapsing and remitting course
Mostly affects women in 20s and 30s; more common in whites

(Classic triad of MS is SIN:
Scanning speech, INtention tremor, INcontinence, INternuclear ophthalmoplegia, and Nystagmus)

Tx: beta-IFN or immunosuppressant tx

Labs: elevated IgG in CSF; oligoclonal bands (of IgG) diagnostic (MRI is gold standard)
Internuclear ophtalmoplegia:
Pathophys
Presentation
Lesion in medial longitudinal fasiculus (MLF)-->medial rectus palsy on attempted lateral gaze

Nystagmus in abducting eye
Convergence is normal

Seen in MS!

(When looking left, left nucleus of CN VI fires, which contracts left lateral rectus and stimulates right nucleus of CNIII via right MLF to contract right medial rectus)
Amyotrophic lateral sclerosis:
Pathophys
Presentation
Combined upper and lower MN deficits with no sensory deficit. Both upper and lower MN signs.

No oculomotor deficits.

Can be caused by defect in superoxide dismutase 1 (SOD1).

Commonly presents as fasciculations and eventual atrophy; progressive and fatal.
Complete occlusion of anterior spinal artery:
Effects
Spares dorsal columns and Lissauer's tract

Lose everything except touch, vibration, proprioception, pressure info
Tabes Dorsalis:
Effects
Tertiary syphilis

Degeneration of dorsal roots and dorsal columns; impaired proprioception, locomotor ataxia

Lose joint sensation (Charcot's joint)
Syringomyelia:
Effects
Damages anterior white commissure (cervical lesion)

Results in b/l loss of pain/temp sensation of hands/arms
Vitamin B 12 Neuropathy:
Effects
What other conditions exhibit this?
Demyelination of dorsal columns, lateral corticospinal tracts, spinocerebellar tracts

Results in:
-ataxic gait
Hyperreflexia
Impaired posn and vibration sense

Also exhibited by:
Vitamin E deficiency
Friedrich's Ataxia
Friedreich's Ataxia:
Pathophys
Presentation
GAA repeat disorder (encodes frataxin)

Friedreich is Frat-tastic (frataxin):
Favorite frat brother, always stumbling, staggering, and falling

Leads to impairment in mitochondrial fn-->staggering gait, falling, nystagmus, dyarthria, hypertrophic CM (cause of death)
Brown-Sequard Syndrome:
Pathophys
Effects
Hemisection of spinal cord.

Presentation:
-ipsilateral UMN (corticospinal tract) below lesion
-ipsilateral loss of tactile, vibration, proprioception (dorsal column) below lesion
-Contralateral pain and temp loss (spinothalamic tract) below lesion
-ipsilateral loss of sensation at level of lesion
-LMN signs (flaccid paralysis) at level of lesion
Identify caudate.
What are the findings of Brown-Sequard Syndrome?
UMN signs ipsilaterally below lzn
Dorsal column loss of info ipsilaterally below lzn
Contralateral loss of pain and temp 2-3 segments below lzn
LMN signs, flaccid paralysis
All sensation lost ipsilaterally at level of lzn
What is the most common site of a berry aneurysm?

What diseases are often a/w berry aneurysms?
Anterior Communicating Artery

a/w:
Ehlers-Danlos syndrome
Marfan's syndrome
ADPKD
Site of decussation:
Dorsal columns
Medulla after nuc
Site of decussation:
Lateral corticospinal tract
Medullary pyramids
Site of decussation:
Spinothalamic tract
Anterior white commissure ~3 segments above region of innervation
What is the classic presentation of syringomyelia?

What malformation is a/w syringomyelia?
b/l loss of pain and temp sensation typically in upper extremities

weakness, atrophy of hand mm
What are the cardinal features of Parkinson's disease?
TRAP

tremor
rigidity (cogwheel)
akinesia
postural instability
What are the classic signs of an upper motor neuron lesion? Of a lower motor neuron lesion?
UMN:
spastic paralysis
hyperreflexia

LMN:
flaccid paralysis
atrophy
fasciculations
A man in his 40s begins to develop early dementia and uncontrollable movements of his upper extremities.

Where in the brain do you expect to see atrophy?
Caudate (HD)
A male patient presents with involuntary flailing of one arm.

Where is the lesion?
Hemiballismus-->Contralateral subthalamic nucleus
Most common cause:
Myocarditis
Coxsackie or Echovirus
A 28 year-old chemist presents with MPTP exposure.

What neurotransmitter is depleted?
Dopamine
A patient cannot abduct her left eye on lateral gaze and convergence is normal.

She is also having difficulty smiling.

Where is the lesion?
Abducens and Facial nerve affected

must be a pontine lesion
A lesion of what artery causes locked-in syndrome?
Basilar artery
When performing a lumbar puncture for anesthesia, where is the anesthesia dosed?

Where is CSF found?
Anesthesia dosed to Epidural space, CSF in subarachnoid space
A 28-year old women is involved in an MVA. She initially feels fine, but minutes later she loses consciousness.

CT scan reveals intracranial hemorrhage that does not cross suture lines.

Which bone and vessel were injured?
Classic for epidural hematoma

RUpture of Middle Meningeal Artery caused by injury to temporal bone
A 40 year-old man with a history of Marfan's syndrome and hypertension presents with severe headache. A head CT is normal at presentation and examination of the CSF reveals numerous RBCs.

What is the cause of the man's headache?
Subarachnoid hemorrhage due to ruptured berry aneurysm
An 85 year-old man with Alzheimer's disease falls at home and presents 3 days later with severe headache and vomiting.

What is the mostly likely diagnosis? What structures were damaged?
Subdural hematoma due to rupture of bridging veins
Most common cause:
Hypoparathyroidism
Thyroidectomy
Most common cause:
Metastatic disease to brain
Lots of bad stuff kills glia

Lung
Breast
Melanome
RCC
GI tumors
Most common cause:
Lysosomal storage disease
Gaucher's Dz
Horner's Syndrome:
Pathophys
Presentation
A/w lesion of spinal cord above T1, e.g., Pancoast's tumor, Brown-Sequard syndrome (hemisection), late stage syringomyelia

PAM is horny (Horner's)

Ptosis

Anhidrosis (absence of sweating) and flushing of affected side of face

Miosis (pupils constrict)

Due to pancoast tumor
C2 dermatome
Skull cap
C3 dermatome
high turtleneck shirt
C4 dermatome
low collar shirt
T4 dermatome
Nips
T7 dermatome
Xiphoid process
T10 dermatome
umbilicus (belly butTEN)
L1 dermatome
Inguinal ligament (LI is IL)
L4 dermatome
Kneecaps, anterior thigh
Spinal nerves for penile and anal sensation.
S2, S3, S4
What spinal nerves account for clinical reflexes?
Reflexes count up in order:
Achilles: S1, S2
Patella: L3, L4
Triceps: C5, C6
Biceps: C7, C8