Block 3 Pom Exam -- Neurology (Important Facts)

Front 1

Which muscle groups are more often involved in polymyositis?

Back 1

PROXIMAL muscles

NOTE: does NOT cause facial/ocular muscle weakness

Front 2

What is the most usual demographic for polymyositis pts.?

Back 2

50s-60s

Women twice as likely as men

Front 3

What is the most common treatment for polymyositis?

Back 3

Corticosteroids

Front 4

What do oculocephalic reflexes test?

Back 4

Integrity of the brainstem

If intact, when head moved laterally, eyes should move in OPP direction

NOTE: aka known as Doll's eye phenomenon

Front 5

What do DTRs of 2/4 mean?

Back 5

NORMAL

Front 6

Equal & reactive pupils in comatose pts. point towards what type of coma?

Back 6

Metabolic/medical coma

Front 7

Subdural is what type of bleed?
(arterial vs. venous)

Back 7

Venous

Do NOT require much trauma to begin
Present slowly
Common in elderly

Front 8

Epidural is what type of bleed?
(arterial vs. venous)

Back 8

Arterial

Usually assoc. w/ a significant trauma
Have a fairly acute onset

NOTE: may have a biphasic pattern
(pt wakes up, goes out again, etc.)

Front 9

In uncal herniation, what side is the dilated pupil on?
(relative to the herniation)

Back 9

SAME side

NOTE: weakness may be found on the contralateral side

Front 10

What two significant diseases have been assoc. w/ BILATERAL Bell's palsy?

Back 10

HIV
Lyme disease

Front 11

What nerve supplies taste to the anterior 2/3 of the tongue?

The posterior 1/3?

Back 11

CN VII (anterior)

CN V (posterior)

Front 12

How are the arms oriented in deCORTICATE posture?

Where is the lesion?

Back 12

Flexed

SUPERIOR to the red nucleus

NOTE: the rubrospinal tract is spared
(SO, overrides influence from postural pathways)

Front 13

How are the arms oriented in deCEREBRATE posture?

Where is the lesion?

Back 13

Extended
(pathways that mediate flexor activity are interrupted)

INFERIOR to the red nucleus
BUT, superior to the pontine reticular formation

NOTE: the pontine retic. formation and lat. vest. nucleus have powerful extensor effects

Front 14

What is gold standard treatment for Guillan-Barre?

Back 14

Plasmapharesis

Front 15

What do you think first w/ LP essentially nl, except for elevated PROTEIN?

Back 15

Diabetes

Front 16

What type of neuron injury are fasciculations assoc. w/?
(upper vs. lower)

Back 16

LOWER

Front 17

What part of the brain should you think of when you see CROSSED symptoms?

Back 17

BRAINSTEM

Front 18

What condition are fasciculations of the tongue a prominent sign of?

Back 18

ALS

Front 19

The vermis of the cerebellum is more assoc. w/ what?

Midline structures or extremities

Back 19

Midline structures

Front 20

What is most common sign of cerebellar disease?

How do you test for it?

Back 20

Incoordination

Test by finger-to-nose, heel-to-shin, etc.

NOTE: not always limited to distal extremities

Front 21

Do cerebellar lesions produce ipsilateral or contralateral signs?

Back 21

IPSIlateral

This is due to the double crossing of cerebellar outputs

Front 22

What is titubation?

What is it a sign of?

Back 22

Tremor of the head and trunk when erect

Sign of dysequilibrium.
In the cerebellum, could be an injury to the vermis

Front 23

Is the Romberg sign helpful in cerebellar ataxia?

Back 23

NO

Cerebellar ataxia results in the pt. not being able to stand w/ feet together
(REGARDLESS of whether or not eyes are open)

Front 24

Ataxia and nystagmus are caused by disease of what part of the cerebellum?

Back 24

Posterior, inferior vermis

NOTE: derived from same area as labyrinths

Front 25

What type of tremor is manifested by cerebellar disease?

Back 25

Intention tremor

Front 26

What are the 3 cardinal signs of cerebellar disease?

Back 26

Dyssynergia
Dysequilibrium
Altered tone

Front 27

What is dysdiadokinesia?

Back 27

Incoordination of the extremities due to cerebellar disease

Inability to do things like finger-to-nose & heel-to-shin

Front 28

Where does alcoholic degeneration affect the cerebellum?

Back 28

ANTERIOR cerebellum

Front 29

Combination of what two types of signs result from infarct of the PICA?

Back 29

CO-existence of unilateral cerebellar signs and lateral medullary signs

Front 30

What lesion is most often associated w/ neglect?

Back 30

Right parietal lesion

Neglect is usually left-sided, due to a RIGHT-sided lesion

Front 31

What is a scotoma

Back 31

A defect WITHIN the field of vision

A blind spot, or area of diminished visual acuity

NOTE: what is important, is that field of vision is NOT limited
Deficiency is WITHIN field

Front 32

Where are our optic discs located relative to our fovea?

Back 32

Medially

NOTE: because of flipping, blind spot "appears" laterally

Front 33

Junctional scotoma

Where does the responsible lesion occur?

Back 33

At the junction of the optic nerve and chiasm

NOTE: due to inferior nasal retinal fibers looping up into contralateral optic nerve

Front 34

What is an altitudinal hemianopia?

What usually causes it?

Back 34

Loss of vision in an entire upper of lower half of one or both fields

Ischemia in upper/lower half of optic nerve

Front 35

What condition is commonly assoc. w/ central scotomas?

What disease is this condition frequently a manifestation of?

Back 35

Optic neuritis

MS

Front 36

What is a centrocecal scotoma?

Back 36

Scotoma that includes BOTH central vision and the physiological blind spot

Front 37

What neuro disease are axillary freckling and cafe au lait spots assoc. w/?

Back 37

Neurofibromatosis

Front 38

What is strabismus?

Back 38

Misalignment of the eyes

Front 39

What type of brain lesions are early morning headaches assoc. w/?

Back 39

MASS lesions
Lesions that cause increased intracranial pressure

Front 40

Which cranial nerve is quickest to get damaged in increased intracranial P?

Back 40

CN VI

Has the longest path in thr brain
Unfortunately, lesion in this is least helpful in localization

Front 41

What reflex is assoc. w/ L5?

Back 41

Trick ?

There is NO reflex assoc. w/ L5

Front 42

Which reflex is associated w/ S1?

Back 42

Achilles reflex

Front 43

Which reflex is assoc. w/ L4?

Back 43

Patellar reflex

Front 44

Where does the spinal cord end?
(In terms of vertebral level)

Back 44

Between L1 and L2

Front 45

Classes of drugs used for migraine prophylaxis (5)

Back 45

Beta-blockers (propranolol)
TCAs (amitryptiline)
Calcium channel blockers (verapamil)
Anti-convulsants (valproate)

Methysergide

Front 46

Major type of drug used in abortive therapy of migraines

Back 46

Triptans (Sumatriptan)

Front 47

Types of drugs used in prophylaxis of tension headaches (2)

Back 47

SSRIs
TCAs

Front 48

Drugs used in abortive treatment of tension headaches (2)

Back 48

NSAIDs
Acetaminophen

NOTE: occasionally, narcotics are used

Front 49

What is the DOC for complex partial seizures?

Back 49

Carbamazepine

Front 50

What is the DOC for absence seizures?

Back 50

Ethosuxamide

Front 51

What is a Jacksonian March?

Back 51

Spread of a seizure to adjacent body parts

Front 52

Complex partial seizures have a predilection for which lobe?

Back 52

Temporal lobe

Front 53

Autonomic features are usually seen in seizures originating where?

Back 53

Temporal lobe

Front 54

What behavior is indicative of a complex partial seizure?

Back 54

Arrest of behavior, followed by automatisms
(ie lip smacking, chewing movements)

Front 55

Secondarily generalized seizures usually present w/ what type of features?
(w/ regards to sensory, tonic, motor, etc.)

Back 55

Tonic-clonic seizure features
(convulsive)

Front 56

What features distinguishes complex partial from absence seizures?

Back 56

---Complex partial---
Post-ictal state
Focal
Last longer

---Absence---
NO post-ictal state
Generalized
Shorter

NOTE: absence also have a diagnostic 3Hz pattern on EEG

Front 57

What other name are absence seizures known by?

Back 57

Petit mal

Front 58

How does the clonic phases of GTC seizures evolve?

Back 58

Starts off low amplitude, high frequency
Becomes high amplitude, low frequency

Front 59

What is the imaging study of choice in further investigating epilepsy?

Back 59

MRI

Front 60

What is the DOC for juvenile myoclonic epilepsy?

Back 60

Valproic acid

Front 61

What type of seizures should Tiagabine NOT be used for?

Back 61

Primary generalized seizures

Front 62

How soon after a spinal cord injury must corticosteroids be given?

Back 62

Within 8 hours

Front 63

What is autotopagnosia?

Where is the corresponding lesion?

Back 63

Distorted perception of body organization and of environment

Parietal lobe

Front 64

What is anosognoia?

Where is the corresponding lesion?

Back 64

Ignorance of one's own disease, specifically of paralysis

Parietal lobe

Front 65

Limb apraxia typically corresponds to lesions where?

Back 65

Left frotnoparietal area or corpus callosum

Front 66

Which hemisphere is typically dominant for constructional and affective speech?

Back 66

RIGHT hemisphere

Front 67

What is graphestesia?

Back 67

Ability to recognize letters, etc. written on skin

Front 68

What is the dominant hemisphere for language in 95% or people?

Back 68

LEFT hemisphere

Front 69

Where is Broca's area?

Back 69

Inferior portion of the third frontal lobe

Front 70

Where is Wernicke's area?

Back 70

Posterior, superior temporal lobe

Front 71

What cerebral artery supplies the areas involved in speech?

Back 71

Middle cerebral artery

Front 72

What connects Wernicke's area and Broca's area?

Lesions here cause what type of aphasia?

Back 72

Arcuate fasciculus

Conduction aphasia

Front 73

What are the types of aphasias in which repetition is good?

Back 73

Transcortical aphasias

Front 74

What words are used to characterized Wernicke's aphasia (3)

Back 74

Fluent -- can talk fluidly, BUT words don't make sense

Receptive -- can't understand commands

Sensory

Front 75

What words are used to describe Broca's aphasia (3)?

Back 75

NON-fluent -- speech is very labored and telegraphic

Expressive -- CAN understand commands, just can't express response vocally

Motor

Front 76

A fluent aphasia w/ good comprehension is what type?

Back 76

Conduction aphasia

Front 77

What are the characteristics of a global aphasia (3)?

Back 77

Non-fluent
Poor repetition
Poor comprehension

Front 78

What two movements are good tests for L5 nerve function?

Back 78

Dorsiflexion
Eversion

Front 79

What two movements are good tests for S1 nerve function?

Back 79

Walking on tip-toes
Inversion

Front 80

The back of the calf and the lateral foot correspond to dermatome of which nerve?

Back 80

S1

Front 81

MS is a disease of what specifically?
(what structure in CNS)

Back 81

CENTRAL white matter

Front 82

What two findings in CSF are indicative of MS?

Back 82

Elevate spinal fluid IgG
Monoclonal bands

Front 83

What is the preferred type of neuroimaging for confirmation of MS?

Back 83

MRI

Should be able to see plaques in the white matter

Front 84

How are corticosteroids used to treat MS?

What are their limitations?

Back 84

Help shorten flares

Do NOTHING to modify ultimate course of disease

Front 85

What two therapies in notes for MS actually improve outcome?

Back 85

Beta-interferon
Glatiramer

Front 86

What condition is assoc. w/ dementia + myoclonus?

Back 86

Creutzfeldt-Jakob disease

Front 87

Embolic strokes often seed in which cerebral artery?

Back 87

Right Middle Cerebral artery

Front 88

What virus is by far the most common cause of aseptic/viral meningitis?

What seasonality does it show?

Back 88

Enterovirus

More prevalent in the summer time

Front 89

4 characteristics of dementia

Back 89

Memory impairment
Deficits of higher cortical functions
NORMAL alertness
Interferes with normal functioning

Front 90

2 most common meningitis causing bacterial pathogens in adults

Back 90

Strep pneumoniae
Neisseria meningitides

Front 91

DOC for herpes encephalitis

Back 91

Acyclovir

Front 92

Image test recommended in workup for herpes encephalitis

Back 92

T2-weighted MRI (focus on temporal lobes)

Front 93

How does CSF differ between bacterial meningitis and HSV encephalitis?

Back 93

HSV encephalitis typically has a NORMAL glucose
HSV encephalitis often has RBCs present in CSF

Front 94

2 most common pathogens associated w/ brain abscesses

Back 94

Strep
Staph

Front 95

What is the most frequent cause of peripheral neuropathy?

Back 95

Diabetes

Front 96

What chromosome is the mutation in Huntington's disease on?

Back 96

Chromosome 4

Causes an expansion of CAG repeats

Front 97

What is the pathological hallmark of Huntington's as seen on MRI?

Back 97

Marked caudate atrophy

Front 98

What is usually the first detectable clinical sign of Huntington's?

Back 98

Slowed eye movements

Front 99

How long after onset do Huntington's pts. usually die?

Back 99

Only 12 - 15 years

There are currently no drugs available for treating progression of HD

Front 100

Internuclear opthalmoplegia represents a lesion where?

What is the only disease that can elicit SOLELY this defect?

Back 100

Medial longitudinal fasciculus

MS
(any other condition that impacts the MLF extends beyond it, causing other symptoms)

Front 101

What does the medial longitudinal fasciculus connect?

Back 101

A PPRF w/ its contralateral oculomotor nucleus

Front 102

How do the eyes deviate w/ regards to an IRRITATIVE pre-frontal lesion?

Back 102

AWAY from it

Front 103

How do the eyes deviate w/ regards to a DESTRUCTIVE pre-frontal lesion?

Back 103

TOWARDS it

Front 104

What lobe of brain do saccades originate in?

Back 104

Frontal lobes

Front 105

What lobe of brain do pursuit movements originate in?

Back 105

Occipitoparietal lobe

Front 106

What do pursuit movements do?

Back 106

Track an already fixed, moving object

Front 107

Increased input from a labyrinth causes eyes to deviate in what direction?
(relative to the labyrinth)

Back 107

AWAY from the labyrinth

Front 108

Decreased input from a labyrinth causes eyes to deviate in what direction?
(relative to the labyrinth)

Back 108

TOWARDS the labyrinth

Front 109

What part of the brain are vertical gaze and convergence mediated by?

Back 109

Upper brainstem tectum and pretectum
Including superior colliculi

Front 110

What component is nystagmus named for?

Back 110

The FAST (corrective) component

Front 111

A lesion of the sympathetic innervation of the eye causes what condition?

Back 111

Horner's Syndrome

Front 112

How does sympathetic innervation get to the eye?

Back 112

Hypothalamus --> SC (synapse in Superior Cervical ganglion)
P-synaptic fibers ascend carotid artery back into cranium

Front 113

What are the characteristics of the Argyll Robertson pupil?

What condition is it associated w/?

Back 113

Miotic
Irregular in contour
UNresponsive to light

Neurosyphilis

Front 114

Sympathetic innervation does what to the pupil?

Back 114

DILATES it

Front 115

What are the characteristics of the Adie pupil?

Back 115

Dilated
UNresponsive to light
Assoc. w/ HYPOactive DTRs

SO, dilation represents lack of PS innervation

Front 116

Path of pupillary light reflex

Back 116

Retina --> chiasm --> tract --> pretectal brainstem

Pretectal brainstem --> EW nucleus (bilateral)

Each EW nucleus --> IPSIlateral ciliary ganglion --> IPSIlateral eye

Front 117

What fingers does the median nerve innervate?

The ulnar nerve?

Back 117

1, 2, 3, 1/2 of 4

1/2 of 4, 5