B & B Quiz 1

Front 1

Corticospinal tract

Back 1

Motor information. Crosses in caudal medulla. Legs originate medially, arms laterally in the precentral gyrus. Runs laterally in the spinal cord.

Front 2

Spinothalamic tract

Back 2

Pain and Temp. sensory information. Crosses immediately in the spinal cord. Ascends to the thalamus where it synapses then terminates in the postcentral gyrus. Runs anteriorly in the spinal cord.

Front 3

Posterior column medial lemniscus

Back 3

Relays sensory information about fine touch, vibration, and position sense. Originates from peripherary and Crosses in the caudal medulla. Runs posteriorly in the spinal column. Arms- Fasiculus Cuneatus. Legs- Fasiculus Gracialis.

Front 4

Infantile Reflexes

Back 4

Occur subcortically. Begin in last 4months of prenatal life and for first 4months after birth. Most of these reflexes regress by 1 year of age and/or are incorporated into adult reflexes.

Front 5

Five types of infant reflexes

Back 5

Grasping, Rooting, Sucking, Asymmetric tonic neck reflex, and Moro Reflex

Front 6

Moro reflex

Back 6

Palm of hand lifts head, then hand is suddenly removed. Arms and legs extend immediately. Disappears at 4-6mths of age. If lacking concern for cerebral birth defect

Front 7

Asymmetric Tonic Neck Reflex

Back 7

Initiated when the head is turned to the left or right causing the arm and leg on one side to exted while the opposite side flexes. "Fencing" Reflex. If lacking concern for cerebral palsy, or other neural damage.

Front 8

Palmar grasp

Back 8

appears in utero and endures through 4th month postpartum. If negative, neurological problems and spasticity present.

Front 9

Rooting

Back 9

Stroke cheek, baby turns head. Helps find food.

Front 10

Sucking

Back 10

Stimulated by touching lips, helps eat food.

Front 11

Babinski

Back 11

Stimulus to sole of foot causes toes to go up. If it persists beyond 12 months or reappears it is indicative of a UMN deficit.

Front 12

encephalopathy

Back 12

Cerebrum pathology

Front 13

myelopathy

Back 13

spinal cord pathology

Front 14

Radiculopathy

Back 14

Nerve Root injury

Front 15

neuropathy

Back 15

nerve injury

Front 16

Myopathy

Back 16

Muscle pathology

Front 17

Lesions of cerebrum produce?

Back 17

Aphasia and neglect

Front 18

Visual Field Defect lesion site?

Back 18

Eye, optic nerve, optic tract, cerebrum

Front 19

Gaze defect lesion site?

Back 19

cerebrum or pons

Front 20

If deficit is in opp. Side of face to the body

Back 20

Brain stem lesion most likely

Front 21

If deficit is bilateral and below a horizontal line in the body

Back 21

spinal cord lesion most likely

Front 22

Locations of Brocas and Wernickes

Back 22

Broca's area in anterior temporal lobe. Wernicke's in posterior temporal lobe.

Front 23

Broca's aphasia

Back 23

speech production (Motor) is impaired

Front 24

Wernicke's Aphasia

Back 24

speech comprehension is impaired.

Front 25

In parietal or frontal lobes, causes a hemineglect.

Back 25

right brain lesion

Front 26

Conductive Aphasia

Back 26

Occurs when lesions of the articulate fasiculus which connects Broca's and Wernicke's area is damaged. Patients can comprehend and speak relatively normally, but they have trouble repeating what was just said to them and make frequent mistakes and use incorrect words in conversation.

Front 27

Motor Cortex

Back 27

Gives rise to descending pathways: Corticospinal and Corticobulbar tracts. Lesions cause an UMN syndrome.

Front 28

Sensory Cortex

Back 28

Receives information from ascending STT, Trigeminal, PCML pathways. Lesions will cause a contralateral loss of touch, vibration, position sense, and pinprick localization.

Front 29

ACA

Back 29

Anterior Cerebral Artery. Supplies the motor and sensory cortex medially in the brain. Infarcts cause contralateral weakeness of LOWER extremity.

Front 30

Distal (Cortical) MCA

Back 30

Supplies motor and sensory cortex on lateral aspect of brain. Infarcts cause contralateral weakness in the UPPER extremity also to face. Can cause Hemineglect (right sided lesion) or Aphasia/Apraxia (Left sided lesion in Broca's or Wernicke's area).

Front 31

Proximal (Deep) MCA

Back 31

Supplies the Lenticulostriate branches to the Posterior Limb of Internal Capsule where the CST, STT, and PCML travel. This can cause FACE, UPPER, and LOWER extremity weakness. Visual Field defects also possible (optic radiations).

Front 32

Structures involved with memory

Back 32

Cingulate gyrus, fornix, DM Thalamus, Mamillary body, Hippocampus, Amygdala, and Nucleus Basilis.

Front 33

Nucleus Basilis is involved with which disease?

Back 33

Alzheimers (Acetylcholinergic)

Front 34

Corneal Reflex

Back 34

Sensory: CN V Motor: CN VII

Front 35

Gag Reflex

Back 35

Sensory: CN IX Motor: CN X

Front 36

Tongue deviation

Back 36

Sticks out towards side of lesion

Front 37

Uvula deviation

Back 37

Contralateral to side of lesion

Front 38

CN IV Palsy

Back 38

Superior Oblique non-functional. "Double vision with reading/walking up stairs" Eye cannot look down. Eye will show superior and lateral deviation.

Front 39

CN VI Palsy

Back 39

Lateral Rectus non-functional. Affected eye cannot look laterally.

Front 40

CN III Palsy

Back 40

Eyelid drops, eye fixed laterally and down (medial rectus doesn’t work), dilated pupil. Consenual response intact in non-affected eye.

Front 41

CN III and Pupils

Back 41

Constricts (Parasympathetic)… (Dilation occurs by sympathetic action)

W/ a lesion of CN III pupil will be dilated.
W/ a lesion of sympathetics- hornet's syndrome and constricted pupil.

Front 42

UMN CN VII Lesion

Back 42

Contralateral loss of lower facial muscles

Front 43

LMN CN VII Lesion

Back 43

Hemiparesis on ipsilateral facial muscles

Front 44

Closing eye

Back 44

Facial Nerve

Front 45

Opening Eye

Back 45

Oculomotor Nerve

Front 46

Lateral Tracts in Brainstem

Back 46

STT and Sympathetic

Front 47

Medial Tracts in Brainstem

Back 47

CST and DCML

Front 48

Medial Brainstem lesions

Back 48

Contralateral body weakness. Loss of Vibration and proprioception

Front 49

Lateral Brainstem Lesions

Back 49

Contralateral loss of pain and temp. Horners syndrome b/c sympathetics run laterally.

Front 50

Horners Syndrome

Back 50

Ptosis- dropping eyelid, miosis-decreased pupillary size b.c sympathetic no longer dilates, and anhidrosis- decreased sweaing

Front 51

Taste on tongue

Back 51

Anterior 2/3rds Facial N.; Posterior 1/3 is Glossopharyngeal N.

Front 52

neuropil

Back 52

Neuronal cell bodies are surrounded by a meshwork of axons and glia that form the neuropil

Front 53

astrocytes

Back 53

Supportive cells in the CNS. Outnumber neurons 10 to 1.

Front 54

GFAP

Back 54

Glial fibrillary acidic protein. Upregulated in "activated" astrocytes when they are responding to a pathological insult.

Front 55

Oligodendrocytes

Back 55

Counterparts to PNS Schwann Cells. Form myeling sheath around neurons.

Front 56

Hallmark of oligodendrocytes on pathology

Back 56

"Perinuclear halo"

Front 57

Microglia

Back 57

Bone marrow derived phagocytes that reside in the CNS

Front 58

Ependyma

Back 58

Ciliated cuboidal to columnar simple epithelium that lines the ventricles.

Front 59

Choroid Plexus

Back 59

produces the CSF.

Front 60

Meninges

Back 60

Dura Pariteal-epidural space-Dura Visceral-Subdural Space-Arachnoid Layer-Subarchnoid space-Pia Mater- Cortex

Front 61

Cingulate Herniation

Back 61

One hemisphere is displaced below the falx cerebri compressing the Cingulate gyrus and ACA. Presents with drowsiness, confusion, lower extremity weakness

Front 62

Uncal (Transtentorial) Herniation

Back 62

Temporal Lobe mass causes the medial temporal lobe (uncus) to slip under the transtentorium dural layer. This can compress the ipsilateral CN III and lead to pupil dilation, ptosis, and cause the eye to look down and out. Crushing of the cerebral pedicle results in ipsilateral paresis due to brainstem shift causing damage to the opp. CST. False Localizing sign.

Front 63

Central Herniation

Back 63

When both hemispheres herniate transtentorially, both pupils dilate, paralysis, coma.

Front 64

Cerebellar Tonsillar Herniation

Back 64

Brainstem and cerebellum are forced through the foramen magnum.

Front 65

Cytotoxic Edema

Back 65

water is driven across an intact blood brain barrier due to osmotic forces

Front 66

Vasogenic Edema

Back 66

Most common cause of edema. When the blood brain barrier itself loosens.

Front 67

Edema in an Infarct

Back 67

Combo of Vasogenic and Cytotoxic

Front 68

Interstitial Edema

Back 68

Overproduction of CSF or failure to drain the CSF causes this.

Front 69

Noncommunicating Hydrocephalus

Back 69

Obstruction between ventricles. Most common site is b/w 3rd and 4th ventricle (Duct of Sylvius). Cerebral Aqueduct b/w lateral and 3rd also possible.

Front 70

Communicating Hydrocephalus

Back 70

Obstruction after the CSF has left the ventricular system.

Front 71

Normal Pressure Hydrocephalus

Back 71

Often occurs in older adults. Gradual onset of dilated ventricles with normal IOP. Causes progressive dementia, gait impairment, and urinary incontinence.

Front 72

Hydrocephalus ex vacuo

Back 72

Brain atrophy occurs, ventricles enlarge to fill space formerly occupied by brain tissue.

Front 73

Three stages of CNS development

Back 73

Neurulation, Segmentation, Proliferation/Migration

Front 74

Neurulation completed by?

Back 74

4th week

Front 75

Anencephaly

Back 75

congenital absence of all or part of the brain due to unsuccessful closure fo the anterior neuropore portion of the neural tube

Front 76

Spina Bifida

Back 76

set of Neural Tube Defects which result from failure of neural tube closure at the caudal regions.

Front 77

Spina Bifida Oculta

Back 77

Defect restricted to the vertebral arches and is usually assymptomatic. May have a dimple or small tuft of hair on the back.

Front 78

Meningocele

Back 78

Protrusion of meninges only in a fluid filled sac

Front 79

Meningomyelocele

Back 79

Protrusion of spinal cord and meninges in a fluid filled sac. Cuases nerve roots and spinal cord to be entrapped resulting in LE weakness, sensory deficits, bladder and bowel incontinence.

Front 80

Rachischisis

Back 80

Spinal column is a gapping canal with no recognizble cord.

Front 81

Arnold-Chiari Malformation I

Back 81

Herniation of the Cerebellar Tonsils through the foramen magnum

Front 82

Arnold Chiari Malformation II

Back 82

Herniation of the Cerebellar Vermis through the foramen magnum. Often associated with Meningomyelocele

Front 83

Holoprosencephaly

Back 83

Interhemispheric fissure is absent or only partially formed due to incorrect segmentation of the telencephalon.

Front 84

Alobar Holoproscencephaly

Back 84

Complete failure of segmentation/celavage of the hemispheres. Fatal.

Front 85

Lobar Holoproscencephaly

Back 85

Partial failure of cleavage of the hemispheres

Front 86

Arrhinencephaly

Back 86

Failure of Olfactory bulbs to form.

Front 87

Agenesis of Corpus Callosum

Back 87

Can be associated with Holoprosencephaly, but also a solitary lesion. Is associated with seizures.

Front 88

Congenital Atresia of the Duct of Sylvius

Back 88

Duct connecting the 3rd and 4th ventricle. Most common cause of congenital obstructive hydrocephalus.

Front 89

Lissencephaly

Back 89

migration disorder, causes a lack of Gyri and cortical surface is smooth on gross appearance.

Front 90

Periventricular Leukomalacia

Back 90

Complication of intrauterine or perinatal hypoxia that may lead to cystic white matter cavities near the ventricles.

Front 91

Wallerian Degeneration

Back 91

axonal degeneration that occurs in a nerve distal to a transection or crush injury. The Nerve may still regenerate if the lesion is not too proximal.

Front 92

Status Epilepticus

Back 92

Seizures lasting for more than 30mins. 20% mortality risk.

Front 93

First step in tx of Status Epilepticus

Back 93

Benzodiazepines such as Lorazepam. First 30mins.

Front 94

2nd step in tx of status epilepticus

Back 94

IV antiepileptic drugs phenytoin, phenobarbital, or valproate. 30-120mins

Front 95

3rd step in tx of status epilepticus

Back 95

Treat with general anasthesis propofol, etc. >120mins

Front 96

Final stage of tx for status epilepticus

Back 96

not much hope, greater than 24hrs

Front 97

EEG

Back 97

Electroencephalogram provides information about electrical activity and waveform patterns of the brain. Useful for detecting seizures or global abnormalities

Front 98

Delta Wave

Back 98

Unconsciousness or deep sleep

Front 99

Theta Wave

Back 99

Somnolence or reduced consciousness

Front 100

Alpha Wave

Back 100

Physical and mental relaxation, although aware

Front 101

Beta Wave

Back 101

Consciously alert, agitated

Front 102

Abnormal EEG with diffuse slowing indicates what?

Back 102

Encephalopathy

Front 103

Abnormal EEG with epileptiform discharges indicates what?

Back 103

Epilepsy

Front 104

Normal EEG indicates what?

Back 104

Does not exclude any diagnosis

Front 105

Evoked Potential

Back 105

derivative of EEG used for intraoperative monitoring during spine surgery

Front 106

Polysomnogram

Back 106

Useful for sleep disorders. Form of EEG.

Front 107

Arousal

Back 107

responsiveness or excitability

Front 108

Coma

Back 108

Unresponsive, absent arousal

Front 109

Stupor

Back 109

Unresponsive minimal arousal

Front 110

Delirium (Lethargic)

Back 110

Decreased arousal, decreased attention

Front 111

Delirium (Agitated)

Back 111

Increased arousal, decreased attention

Front 112

Delirium (baseline)

Back 112

Baseling arousal, decreased attention

Front 113

What causes coma?

Back 113

Lessions affecting consciousness. Must lesion that effects both hemispheres, or RAS in brainstem, or a diffuse problem.

Front 114

Most common cause of coma

Back 114

Drug poisoning, hypoxia after cardiac arrest, trauma, non-traumatic bleeding, stroke (not common unless it injures RAS or both hemisphere)

Front 115

Locked-in-syndrome

Back 115

Vertical eye movements spared, may be able to blink, caused by bilateral ventral pons with CST/CBT but not the RAS

Front 116

Glascow Coma Score

Back 116

used to evaluate level of arousal and responsiveness: includes eye opening, verbal response, motor response. Lowest score 3, Max 15.

Front 117

Withdrawal from pain vs. localizes pain

Back 117

Example given- withdrawal would be pulling arm away from painful stimuli. Localizing is swatting at the hand causing the pain

Front 118

Decorticate

Back 118

"Arms decorate" your chest. Arms flexed, legs extend and internally rotated.

Front 119

Decerebrate

Back 119

lesion extends beyond red nucleus in midbrain. Consider worse than decerebrate posture. Arms extended and internally rotated.

Front 120

Coma CN II exam

Back 120

Use a fundoscope to look for papilledema indicating increased IOP

Front 121

Coma CN III exam

Back 121

Check pupillary reflexes.

Front 122

Pupils not equal in size, two indications

Back 122

Horners or CN III palsy.

Front 123

CN III palsy and coma

Back 123

most likely uncal herniation

Front 124

Sympathetic Horner's syndrome and Coma

Back 124

lesion to sympathetic fibers as they descend in the lateral brain stem

Front 125

Pupils are equal in size but not reactive. What does this mean in coma?

Back 125

Midbrain lesion; pupillary reflexes mediated in midbrain

Front 126

Pupils are equal and reactive. What does this mean in Coma?

Back 126

Midsize reactive (normal pupils). Small reactive (opiod intoxication or pontine lesion)

Front 127

Eye deviation in coma two causes

Back 127

Frontal eye field lesion (causes ipsilateral gaze fixation) or Pontine Lesion (causes contralateral gaze fixation)

Front 128

Vestibular Ocular Reflex

Back 128

Oculocephalic (Dolls head) and Caloric Response

Front 129

Doll's Head Reflex

Back 129

eyes rotate in opposite direction of head tilt. Turn head to right, right vestib. Apparatus stimulated while left vestib. Apparatus ihibited causing eyes to turn to left.

Front 130

Caloric Response

Back 130

Stimulating the endolmph of vestibular directly. Cold water- inhibitory. Hot water- stimulatory

Front 131

Cold water in ear

Back 131

Look towards that ear

Front 132

Hot water in ear

Back 132

Look away from that ear

Front 133

Coma treatment

Back 133

ABCs: Airway, Breathing, Circulation. Naloxone (for opiod overdose), glucose, thiamine, treat specific causes

Front 134

Brain Death

Back 134

Coma of known cause w/ no hypothermia, intoxication, electrolyte imbalance, motor responses are absence, brainstem reflexes absent, and apnea

Front 135

CT- Hypodense

Back 135

Air least dense. White matter less dense than gray matter. Appears Black

Front 136

CT-Hyperdense

Back 136

Appears White. Bone most dense. Blood also very dense.

Front 137

CT routine uses

Back 137

Bleeds. Skull fractures, hydrocephalus, herniation

Front 138

CT-hyperintense

Back 138

White

Front 139

CT-hypointense

Back 139

Black

Front 140

T1 Weighted MRI

Back 140

Water is dark. Good for inflammation or oozing. Gray matter darker than white matter.

Front 141

T2 Weighted MRI

Back 141

Water appears white, good for necrosis or good image. Gray matter lighter than white matter.

Front 142

MRI routine uses

Back 142

non-emergent situations great for tumors, infection, spinal cord compression and MS. Has a higher resolution than CT