Boards - Dit - Neuro

Front 1

What EEG wave form is seen in each stage of sleep?

Back 1

1 = theta
2 = sleep spindles and K complexes
3-4 = Low freq. high Amp
REM = beta = SAME AS BEING AWAKE

Front 2

What is the key to initiating sleep? What NT is involved in REM?

Back 2

Serotonin initiates sleep

Ach involved in REM

Front 3

Pathway of melatonin release?

Back 3

Darkness --> suprachiasmis nuc releases NE -> stimulates pineal gland to release melatonin

Front 4

What areas of hypothalamus regulate autonomic nervous system (=symps and parasymps)?

Back 4

Symps = Post. hypothalamus

Parasymps = Ant. Hypothalamus

Front 5

What nerves innervate the branchial arches?

Back 5

1 = Mandibular and Maxillary nerves of Trigeminal
2 = Facial = CN 7
3 = Glossopharyngeal n
4 and 6 = Vagus = CN 10....recurrent laryngeal and superior laryngeal n.

Front 6

Risk Factors for Holoprosencephaly (=brain hemispheres fail to separate)?

Back 6

Defect in sonic Hesgehog
Pataue syndrome (=trisomy 13)
Fetal alc. syndrome

Front 7

Define Chiari II malformation

Back 7

cerebellar tosillar herniation through foramen magnum with aquaductal stenosis and hydrocephaly

Often present with Syringomyelia (enlargement of central canal of spinal cord) --> "cape-like" bilateral loss of pain and temp. sensation in upper extremities but pts KEEP touch sensation

Front 8

Define Dnady-Walker malformation

Back 8

Large posterior fossa - absent cerebellar vermis with cystic enlargement of the ventricle --> can lead to hydrocephalus and spina bifida

Front 9

Differenece between thyroglossal duct cyst and branchial cleft cyst?

Back 9

Thyroglossal duct cyst = midline = MOVES when pt swallows

Branchial Cleft cyst = lateral neck = DOES NOT move when pt swallows

Front 10

What are the branchial arch derivatives? nerves? Abnormalities?

Back 10

1 = Gives rise to M and T words like Meckel's cartilage, mandible, etc. nerve = Trigeminal (mandibular and maxillary nerves). Treacher Collins syndrome = 1st arch fails to migrate = mandibular hypoplasia --> facial abnormalities

2 = Gives rise to S words like stapes, styloid, stapedius etc. Nerve = the "Smile" nerve = Seven (facial n.)

3 = Gives rise to pharyngeal words like stylo--pharyngeus. CN IX = Glossopharyngeal

4 = Cricothyroid and Larynx. nerves = vagus (sup laryngal and recurrent laryngeal)

Front 11

What are the branchial pouch derivatives?

Back 11

1st = middle ear, eustachian tube, mastoid ari cells
2nd = epi lining of palatine tonsil
3rd = thymus
4th = sup. parathyroids

Front 12

Define DiGeorge Syndrome

Back 12

Abberrant development of 3rd and 4th pouches --> cell deficiency (thymis aplasia) and Hypocalcemia (failure of parathyroid development) = T cell's don't develop

Front 13

What CN minitors carotid body and sinus chemo and baro-receptors?

Back 13

Glossopharngeal = CN 9

Front 14

Where are the cranial nerve Nuclei located?

Back 14

3, 4 = Midbrain
5,6,7,8 = pons
9, 10, 11, 12, = medulla

Front 15

Wha tCN's go through cavernous sinus?

Back 15

3, 4,6,

Front 16

Muscles of mastication?

Back 16

Open jaw = Lateral pterygoid

Close Jaw (all have M in them)= Masseter, Temporalis, Medial Pterygoid

Front 17

Aorta is the most common site of what pathology?

Back 17

Atherosclerosis --> can lead to abd aneurysm

Front 18

Pt has poor repetition ability. Whats brain structure is affected?

Back 18

pt can't speak or comprehend so its Arcuate Fasiculas which connects Wernickes and Broca's = GLOBAL APHASIA

Front 19

Pt can't understand ie poor comprehension

Back 19

Wernicke's (word salad)

Front 20

Pt can't speak ie poor vocal expression

Back 20

Broca's

Front 21

Dysarthria = trouble speaking due to motor center of muscles

Back 21

Cerebellar vermis

Front 22

Hemispacial neglect syndrome

Back 22

Non-dominant parietal lobe, usually the Right

Front 23

Agraphia (can't write) and Acalculia (can't calculate, like balance checkbook)

Back 23

Dominant parietal lobe, usually the Left

= called Gerstman Syndrome (also presents with Finger agnosia = inability to distinguish fingers on hand)

Front 24

A pt with a cortical lesion is unaware of his neurologic deficit. Where is the lesion?

Back 24

= Hemisphere neglect = lesion in non-dominant parietal lobe

Front 25

Whats the usual cause to a lesion to mamillary bodies?

Back 25

Thiamine def. due to alcoholism --> Wernicke-Korsakoff syndrome = confusion, opthalmoplegia, ataxia, memory loss, confabulation, personality change)

Front 26

Pt is hyperoral, hypersexual and has disinhibited behavior

Back 26

Kluver Bucy Syndrome = Bilateral Amygdala lesion

Front 27

Disinhibition and deficits in concentration, orientation, judgement, may see re-emergence of primitive reflexes like babinski

Back 27

Frontal lobe

Front 28

Reduced levels of arousal and wakefulness and can lead to coma

Back 28

Reticular activating system

Front 29

tremor at rest, chrea, athetosis

Back 29

basal ganglia

Front 30

intention tremor (= only there when at rest, tremor worse as target approached), limb ataxia, and fall to side of lesion

Back 30

Cerebellar hemisphere

Front 31

Truncal Ataxia, dysarthria

Back 31

cerebellar vermis

Front 32

Hemibalismus (=flailing of arms involuntarily)

Back 32

Subthalamic nuc (contralateral to side of arm-flail)

Front 33

Anterograde amnesia = inability to make new memories

Back 33

Hippocampus

Front 34

Eyes look from side to side, AWAY from lesion

Back 34

Paramedian Pontine Reticular Formation (PPRF)

Front 35

Define central pontine myelinolysis

Back 35

due to rapid correction of Na+ (more than 10-12 in 24 hrs...)

Front 36

Pt can't look UP

Back 36

Superior calculi lesion

Front 37

Ant. cerebral a. gives blood to what?

Back 37

antero-medial surface of brain

Front 38

Middle cerebral a. gives blood to?

Back 38

lateral surface

Front 39

Post. cerebral a. gives blood to what?

Back 39

post and inf. surfaces

Front 40

Cerebral Cortex Homonculus contains motor and sensory info from dif parts of body. Describe the pattern it follows

Back 40

From Lateral --> Medial:

mouth stuff (mastication) --> Face Stuff (vocalization) --> hand stuff --> arm stuff --> shoulder stuff --> Truck stuff --> Butt stuff --> leg stuff --> feet stuff

Front 41

From top to bottom what are the arteries of the Circle of Willis?

Back 41

"AA MIPPS BAVPA"

Ant. Cerebral
Ant. communicating
Middle cerebral
Internal carotid
Post. communicating
Post. cerebral
Sup. Cerebellar
Basillar
Ant. Inf. Cerebellar
Vertebral
PICA
Ant. Spinal

Front 42

Heart defect assoc with the following?
Chromo 22q11 deletion
Downs
Congenital rubella
Turner syndrome
Marfan syndrome

Back 42

Chromo 22q11 deletion = truncus arteriosus, tetralogy of fallot
Downs = ASD, VSD, AV septal defect, (endocardial cushion defect)
Congenital rubella = septal defects, PDA, pulm. artery stenosis
Turner syndrome = Coarctation of aorta (preductal)
Marfan syndrome (Aortic insuff)

Front 43

Info communicated at nuc. solitarius? nuc. Ambiguus? Dorsal motor nuc?

Back 43

nuc. Solitarius = visceral sensory
nuc. Ambiguus = motor to pharynx, layrnx, upper esophagus
Dorsal motor nuc. = autonomic (parasymps) to heart, lungs, upper GI

Front 44

Where does the corticospinal tract decussate? Dorsal column medial lemniscus?

Back 44

corticospinal tract decussates at caudal medulla
Dorsal Column medial lemniscus decussates in medulla then ascends as medial lemniscus

Front 45

Whats the blood supply to these medullary structures: spinal thalamic tract, inf. cerebellar peduncle, nuc ambuguus, lateral spinothalamic tract?

Back 45

PICA

Front 46

Thrombus in Middle Cerebral A. leads to what deficits?

Thrombus in Ant. Cerebral a. leads to what?

Thrombus in Post. cerebral a. leads to what?

Back 46

MCA supplies Motor and Sensory to UPPER limb/face, as well as Wernicke's and Brocas

ACA supplies Motor and Sensory to Lower limb

Post. cerebral a. supplies occipital cortex and visual cortex

Front 47

The Right vagus n. or nuc is damaged, Which side will the uvula deviate to?

Back 47

Opposite side of the lesion

Front 48

Damage to right motor cortex means uvula deviates where?

Back 48

Toward the lesion

Front 49

If uvula deviates left when pt says "Ah", what structures may be damaged?

Back 49

R. vagal n., Right nuc anbiguus, L. corticobulbar tract, Soft palate portion of L. motor cortex

Front 50

R. Hypoglossal n. or nuc. damage mans tongue deviates where?

Back 50

Toward lesion

Front 51

R. motor cortex that innervates tongue damaged = tongue deviates to what side?

Back 51

AWAY from lesion

Front 52

What are the 5 branches of the Facial n.

Back 52

To Zanzibar By Motor Car
Temporal, Zygomatic, Buccal, Mandibular, Cervical

Front 53

If pts tongue deviates left, what structures may be damaged?

Back 53

L hypoglossal n. or Nuc., R. corticobulbar tract, Tongue portion of Right motor cortex

Front 54

How to Lesions in motor cortex of face differ from lesions to Facial n.?

Back 54

Motor cortex = Lower HALF of face paralyzed

Facial n. = ENTIRE half of face paralyzed = Bell's palsy

Front 55

Difference between a stroke and Bell's palsy?

Back 55

stroke's only affect HALF of face while Bell's palsy affects entire SIDE of face

Front 56

Diseases with Bell's palsy as complication?

Back 56

Lyme dis, Herpes zoster, AIDS, Sarcoidosis, Tumors, Diabetes

"My Lovely Bella Had An STD"

Front 57

What should you think of immediately in pts with Bell's palsy?

Back 57

Guillan-Barre syndorme

Front 58

What is the HALLMARK of a BRAINSTEM lesion?

Back 58

Long tract symptoms on one side (for ex hemiparesis) and cranial n. symptoms on the other

Front 59

Define Weber syndrome

Back 59

Midbrain infarction due to occlusion of paramedian branches of post. cerebral a. (PCA)

Cerebral peduncle lesion --> contralateral spastic paralysis = contralateral hemiapresis

Oculomotor nerve palsy --> Ipsilateral ptosis, Pupillary dilation, lateral strabismus (eye looks down and out)

Front 60

Pt has los of pain/temp contralateral BODY, loss of pain/temp IPSILATERAL FACE, Hoarseness, difficulty swallowing, loss of gag reflex, Ipsilateral Horner's (droopng eye lid), Vertigo, Nystagmus, N/V, Ipsilateral cerebellar deficits (ataxia, past-pointing). Dx?

Back 60

Wallenberg Syndrome

= occlusion of one of the PICA's --> unilateral infarct of lateral portion of rostral medulla

Front 61

MLF Syndrome (=Medial Longitudinal Syndrome) presents? Causes?

Back 61

If pt. tries to look left, R. eye would be having nystagmus, L. eye fine

Causes: young pt = think Multiple sclerosis, older pt think Stroke

Front 62

Define Locked-in syndrome

Back 62

Where pt is aware of what's going on in environment but can't express it

DUE TO: Superior pons lesion

Front 63

Medial Inf. Pontine Syndrome cause? Symptoms?

Back 63

Cause = occlusion of paramedian branch of Basillar a. --> unilateral infarct of medial aspect of inf. pons

Symptoms:
Contra spastic hemiparesis
Contra loss of light touch/vibration/kinesthetic sensation
Paralysis of gaze to side of lesion
Ipsi paralysis of lateral rectus m.
(Pain + Temp preserved)

Front 64

Medial Medullary syndrome cause? symptoms?

Back 64

Occlusion of paramedian branch on ant. spinal a. --> unilateral infarct of medial portion of rostral medulla

Symptoms:
Contra spastic hemiparesis
Contra tactile and kinetic deficits
Tongue deviates toward lesion
(pand and temp Preserved, like in medial inf pontine syndrome = occlusion of paramedian brnach of basillar a.)

Front 65

Lateral inf. pontine syndrome - LOTS of things are wrong but whats kept?

Back 65

NO contralateral body paralysis or loss of light touch, kinesthetic/vibratory sensation

Front 66

Lateral SUPERIOR Pontine syndrome due to?

Back 66

Occlusion of AICA

Front 67

Pt can't abduct left eye on lateral gaze and convergence is normal (medial rectus working)...She also can't smile. Wheres the lesion?

Back 67

Pons = b/c this is where Abducens (gaze) and Facial n. (smile) are located together

Front 68

Lesion of what artery causes locked-in syndrome?

Back 68

Basillar a.

Front 69

Where do Berry Aneurysms occur?

Back 69

Ant. communicating a. in Circle of Willis

Front 70

What conditions are assoc with Berry Aneurysms?

Back 70

Adult Polycystic Kidney Dis, Ehler's-Danlos, Marfan's

Risk factors: Advanced age, HTN, Smoking, race (blacks)

Front 71

Difference between Epidural and Subdural Hemorrhage?

Back 71

Epidural = Middle Meningeal a. rupture - seen in fracture of Temoral bone--> Lucid interval, eye looking down and out (CN III palsy). LENS shaped - DOES NOT cross suture lines

Subdural = rupture of Bridging veins (ie NOT arterial bleed) - seen in elderly, alcoholics, blunt trauma, shaken baby - CRESCENT (Lacunar) shaped - CROSSES suture lines

Front 72

Difference between Subarachnoid Hemorrhage and Intraparenchymal (HTN) Hemorrhage?

Back 72

Subarachnoid = Rupture of Aneurysm (usually Berry) Seen in Marfan's, Ehler's-Danlos, Adult polycystic kidney dis, or Arteriovenous Malformation. --> "worst headache of my life" - spider shaped. Give Nimodipine to prevent vasospasm

Intraparenchymal Hemorrhage - caused by systemic HTN, amyloid angiopathy, vasculitis, neoplasm - ex = coccaine over-dose b/c of extreme HTN

Front 73

What are the causes of ischemic brain dis?

Back 73

Hemorrhage, Clot --> Irreversible damage after 5 min.

Due to: Atherosclerosis, Hemorrhagic stroke, Ischemic stoke, Transient Ischemic attack, Stroke imaging = bright on diffusion-weighted MRI and remains bright for 3-10 days

Front 74

What are the watershed areas that are susceptible to Ischemic brain disease?

Back 74

Most terminal reaches of 3 cerebral ateries: between ant cerebral and middle cerebral

between post cerebral and middle cerebral

Damage to watershed areas results in upper arm weakening and defects in higher order visual processing

Front 75

All infants born younger than 30-32 weeks need to get US to check for what brain abnormality?

Back 75

Intraventricular hemorrhage in newborn

Front 76

List the layers you go through when you do a Lumbar Puncture

Back 76

Do between L3-L5 to keep cord alive: skin + fascia --> supraspinous lig --> infraspinous lig --> Ligamentum flavum --> Epidural space = no CSF = where Epidural goes --> Dura mater--> Subdural space --> Arachnoid membrane --> Subarachnoid space = where CSF is = where spinal Anesthesia goes

Front 77

Difference between Normal pressure Hydroephalus, Communicating Hydrocephalus, Obstructive Hydrocephalus, and Hydrocephalus ex vacuo?

Back 77

Normal pressure Hydrocephalus symptoms = "wet, wobbly, wacky" = urinary incontinence, ataxia, Dementia. Due to EXPANSION of ventricles

Communicating = due to DEC. ABSORPTION of CSF by arachnoid villi

Obstructive = due to BLOCKAGE of CSF circulation

Hydrocephalus ex vacuo = BRAIN around ventricles ATROPHIED

Front 78

Detail the route of CSF flow

Back 78

Choroid plexus of: lateral ventricle and 3rd ventricle --> 3rd ventricle --> cerebral aquaduct --> 4th ventricle --> choroid plexus of 4th ventricle --> Subarachnoid space via Foramen of Luska and Foramen of Magendi --> Reabsorbed by Arachnoid granulations back into Superior Sagital Sinus

Front 79

Define Pseudotumor cerebri = Benign intracranial HTN

Back 79

Young, Obese female with Headahces work on Am, pulsatile, worse with eye movement (maybe). Papilledema (optic disc swelling) --> VISION LOSS

Imaging = no signs of anything

CSF PRESSURE ELEVATED

Front 80

Treatment of Pseudotumor cerebri?

Back 80

Weight Loss, Acetazolamide (=diuretic), Invasive = Lumbar puncture, Optic n. sheath decompression, Lumboperitoneal shunting (CSF shunt)

Front 81

What nerve are we testing with these reflexes: biceps, triceps, patella, Achilles

Back 81

biceps = C5
Triceps = C7
Patella = L4
Achilles = S1

Front 82

HYper-reflexia = upper or lower motor neuron lesion? HypOreflexia?

Back 82

HypER - UppER motor neuron lesion

HypO = LOwer motor neuron lesion

Front 83

What are the primitive reflexes?

Back 83

Moro, Rooting, Suckling, Palmar and Plantar reflexes, Babinski, Gallant

Dissappear by 1 year of life....=checked in adults to see if there's a frontal lobe lesion

Front 84

Cerebrum Pre-frontal cortex does what?

Back 84

Decision making capacity and allows for delayed gratification to exist = inhibits Limbic area desires and instincts

Front 85

Define Limbic system

Back 85

=cingulate gyrus, hippocampus, fornix, mamillary bodies, septal nuc.

Controls emotional behavior and motivational drives = animal portion of our brain

Does Feeding, Fleeing, Fighting, Feeling, sex

Front 86

What are the nuclei of the Cerebellum?

Back 86

From Lateral --> Medial:
Dentate --> Emboliform --> Globose --> Fastigial

(Don't Eat Greasy Foods)

Front 87

Difference between Intrafusal muscle fibers that use 1a and Golgi tendon's that use 1b afferents?

Back 87

Intrafusal muscle fiber uses 1a to cause reflex muscle contraction = EXCITATORY

Golgi tendon do inhibitor feedback via 1b = inhibits contraction= INHIBITORY

Front 88

Where do Upper motor neurons decussate?

Back 88

Upper = Caudal medulla

Front 89

Signs of Upper and Lower motor neuron lesion?

Back 89

Upper = Hyper-reflexia = Weakness, Inc reflexes, inc. tone, Babinski, Spastic paralysis, Clasp knife palsy

Lower = HypO-reflexis = Weakness, Atrophy, Fasiculations, Dec, reflexes, Dec. Tone

Front 90

Difference between Hemibalismus, Huntington's, and Chorea Tremors?

Back 90

Hemibalismus = sudden, wild flailing of 1 arm +/- leg. due to sontra subthalamic nuc. lesion and loss of inhibition of thalamus via globus pallidus

Huntington's = chorea, agression, depression, dementia due to atrophy of striatal nuc.

Chorea = suden, jerky, purposeless, movements = basal ganglia lesion

Front 91

Difference between Parkinson's, Athetosis, and Myoclonus?

Back 91

Parkinson'= degenrative disorder of CNS Assoc., with Lewey bodies and loss of dopaminergic neurons of substantia nigra pars compacta

Athetosis = slow, writhing movements esp of fingers due t obasal ganglia lesion (like chorea and huntingtons),

Myoclonus = sudden, brief muscle contraction

Front 92

Difference between Essential, Resting and Intention tremors?

Back 92

Essential = action tremor, AND at rest (Familial. Tx with Beta blocker)

Resting tremor = at REST. Parkinson's. Pill-rolling tremor

Intention tremor = With MOTION. slow, zig-zag motion while pointing at a target - assoc. with cerebellar dysfunction

Front 93

Longitudinal zones of cerebellum from Medial --> Lateral?

Back 93

Medial --> Lateral:
Vermis --> Intermediate --> Lateral

Flocculundular lobe at bottom

Front 94

What are the inputs to the cerebellum and what are their outputs?

Back 94

Inputs = Climbing and Mossy fibers --> synapse --> Purkinje fibers come out

Front 95

Motor control on what side of body is affected with a cerebellar hemisphere lesion?

Back 95

Ipsilateral b/c the nerve crosses TWICE thus it ends up ack on the same side it started on

Front 96

Cerebellum Vermis damage results in?

Back 96

Postural instability, Slurred/slowing of speech, Hypotonia, Pendular knee jerk reflexes

Front 97

Most common cause of anterior lobe (=anterior cerebellar vermis) syndrome?

Back 97

Chronic alc. abuse --> Thiamine def. --> Degeneration of cerebellar cortex starting at ant. lobe

Front 98

Damage to Lateral cerebellar lobe results in?

Back 98

lack of coordination of voluntary movement (timing and rate)

delay in initiaing movement, trouble stopping

Dysmetria = can't control speed, power)

Intention tremor

Front 99

Damage to Vestibulocerebellum = vermis and Flocculonodular lobe?

Back 99

Balance problems

Abnormal eye movement

Front 100

Most common cause of damage to Flocculonodular Lobe?

Back 100

Medulloblastoma in kids

Front 101

Where do neurons of Lateral corticospinal tract synapse before exiting spinal cord to affect movement? Diseases that damage this area?

Back 101

Ant. Horn cell body

damaged by: West Nile, Polio, ALS