Chapter 28 - Robbins Review Book - Cns

Front 1

1. What is the causative organism most likely to cause meningitis in an IV drug user if the lab findings show increased protein and decreased glucose?

Back 1

1. Increased protein and low glucose would indicate bacterial, fungal or TB meningitis (pg 178), but someone who is an IV drug user most likely is STAPH

Front 2

2. What is most common histological finding in someone w/ CJD?

Back 2

2. Spongiform encephalopathy - where the normal cellular protein (PrPc) prion protein is turned to (PrPsc) which resists degradation resulting in spongiform encephalopathy pg 176

Front 3

3. Which vitamin deficiency is seen in chronic alcoholics? What is the name of this dementia

Back 3

3. Thiamine, B1 - Wernicke - confusion, opthalmoplegia, and ataxia (wernicke's encephalopathy.)

Korsakoff if confabulation and personality change and memory problems pg 449

Front 4

4. A person w/ diabetes melliitus is most likely prone to which type of dementia?

Back 4

4. Vascular dementia - stepwise loss of cognitive function

Front 5

5. Grand mal seizure, doctors find melanoma, diagnosis?

Back 5

5. Metastases from malignant melanoma

Front 6

6. PP w/ tonic-clonic seizure from left hemorrhage in temporal lobe. Normal glucose and normal protein. What organism caused this disease?

what is seen histologically?

Back 6

6. Normal protein and normal glucose indicate a viral infection. HSV can cause hemorrhagic legions in the temporal lobe. Known as most common cause of sporadic encephalitis in the US (called temporal lobe enchelphaltis)

Cowdry A inclusions

Front 7

7. Most common cause of meningitis in 20 year old male? How would brain appear histologically?

Back 7

Neisseria meningitidis (6-60 yrs of age) -- purulent exudate on the cerebral convexities indicitve of a bacterial infection pg 178

Front 8

8. A person presenting w/ asterixis (flapping hand) is seen in what condition? What is cause?

Back 8

Liver failure w/ hepatic encephalopathy - hyperammonemia

pg 234 - asterixis is also seen in Wilsons

Front 9

9. What is most important factor in the development of alzheimers?
What are some histological findings?

Back 9

Inheritance of the e4 allele oat the ApoE4 gene - numerous plaques, amyloid in peripheral cerebral arteries

pg 422

Front 10

10. Which type of intracranial hemorrhage is most common from tripping or trauma?

what would CT scan show?

Back 10

Subdural hematoma- tearing of the bridging veins beneath the dura (mainly in elderly or children)

Crescent-shaped hemorrhage that crosses suture lines (gyr iar preserved)

pg 402

Front 11

11. What is most typical cause of aseptic or acute lymphocytic meningitis?

Back 11

11. West Nile, or an echovirus - usually self-limited

pg 178

Front 12

12. What presentation would you see w/ a saccular aneurysm in the right middle cerebral artery? How would PP?

what would you see on CT scan?

Back 12

12. lucid interval, often fracture to temporal bone, CN III palsy

biconvex disk - can cross falx, tentorium (wheras subdural cannot)
pg 402

Front 13

13. Which disease causes loss of UMN leading to progressive muscular weakness from grouped atrophy of skeletal muscle fibers -- what is the defect?

Back 13

13. ALS or Lou Gerigs disease - defect in superoxide dismutase 1 (SOD1) - commonly presents as fasiculations

pg 407

Front 14

14. A pt hits head, becomes unconscious then becomes comatose - which type of hematoma?

Back 14

14. Epidural - talk and die

Front 15

15. PP w/ decreased vision, papilledema, hyperpigmented skin which type of mass or "oma"? What is positive?

Back 15

15. Schwannoma - pt has NF1 so they have multiple skin schwannomas or neurofibromas. Basically, which type of brain tumor is found in NF2? Schwannoma bilaterally to effect CNVIII (3rd most common brain tumor) pg 425

S-100

Front 16

16. Which pathologic findings will a brain present with in Parkinson's?

Back 16

16. Loss of pigmented neurons in substantia nigra, Lewy bodies (composed of a-synuclein) pg 397

Front 17

17. Severe blunt head truama that results in death from a midbrain hemorrhage arranged in a linear ventral -to-dorsal direction and bilateral incal herniation, which artery mostly likely?

Back 17

17. Basilar artery branches - lead to hemorrhagic infarcts in midbrain and pons

Called "locked-in" syndrome pg 401

Front 18

18. Which neoplasm is likely to present as a mass attached to the dura of the brain w/ occasional psammoma bodies

which type of tumor? How common? what are psammoma bodies?

Back 18

18. Meingiomas - the other conditions where you would see psammoma boddies are: PSaMMoma - Papillary (thyroid), Serous (ovary), Meningioma, Mesothelioma

2ns most common primary brain tumor - spindle cells concentrically arranged in a whorled pattern w/ laminated caclifications

pg 425

Front 19

19. A person who presents w/ huntingtons and dementia, what would you find histologically in brain?

Back 19

19. Abnormal prion proteins - CAG repeats (Caudate loses ACH and Gaba) glutamate toxicity

pg 397

Front 20

20. Baby w/ anencephaly will show what lab findings

Back 20

20. Elevated maternal serum AFP levels and acetylcholinesterase pg 127

Front 21

21. If a pt has hyponatrium and it is corrected to quickly what is the negative outcome?

Back 21

21. Demyelination in the bais pontis - can lead to death or obtundation (refers to less than full mental capacity in a medical patient, typically as a result of a medical condition or trauma)

Front 22

22. Picture of whole in pt's brain after autopsy. She lost consciousness before death, what could have caused the lesion?

Back 22

22. A remote cerebral infarction - a large area resulted when macrophages had to come clean away liquifactive necrosis

Front 23

23. Cerebral atrophy and small brains weights, most likely died from which condition?

Back 23

23. Progressive dementia or alzheimers

Front 24

24. Which congenital infection is most likely to produce findings of a hydropic fetus that died of organomegaly and extensive necrosis w/ focal calcifications?

Back 24

24. CMV - one of the TORCH infections that especially effects the CNS

Toxoplasma gondii, Rubella, CMV, HIV, HSV and syphilis are other torches. pg 179

Front 25

25. What are the two most common neoplasms in children, which location of brain? How would the better prognosis present?

Back 25

25. Posterior fossa - the astrocytoma - would stain postiive for GFAP(better prognosis) and

medulloblastoma - pseudoroseette (homer-wright - or small blue cells, cause hydrocehphalus. pg 425

Front 26

26. Difficulty initiating movements, dies of pulmonary thromboembolism what are other presentations of a pt w/ a midbrain abnormality?

Back 26

26. Parkinsons - pill-roll tremors, a-synuclein,

Front 27

27. What is the most often complication of an infection that would cause a SOL w/ ring-enhancing lesions?

Back 27

27. A cerebral abscess

ring-enhancing lesions in Metastases, abscesses, toxoplasmosis, AIDS lymphoma, see pg 42 6

Front 28

Episodes of dysarthria, weakness in hands, diziness that last about 1 hour, what could explain this?

Back 28

28. Trasient ischemic attacks, generally a prodrome to stroke

pg 403

Front 29

29. Pt presents w/ paresthesias in arm, difficulty walking and then the problems will go away. Then he has problems seeing and writing. What would you find in CSF?

how else does this disease present?

how else do you diagnos?

Back 29

29. MS - you would find malignant cellsand oligoclonal bands of IgG

SIN - scanning speech, Intention tremor, incontinence, internuclear opthalmoplegia, nystagmus

MRI is gold standard but diagnostic is made on Oligoclonal bands (also periventricular plaques seen)

pg 422

Front 30

30. What would you find in CNS of a pt w/ huntingtons?

Back 30

30. Atrophy and gliosis of the caudate nuclei

Front 31

31. A child presents w/ progressive worsening of movement and mental ability and dies, myelin loss is noted.. What could cause this?

Back 31

31. Metachromatic leukodystrophy - arylsulfatase deficiency w/ buildup of sulfatides- since it is an AR lysosomal storage disesase think of this if you see demylination in babies

pg 423

pg 423

Front 32

32. What could cause an 80 year old to go in and out of consciousness who has blood in subdural space?

Back 32

32. Tear of bridging vein - subdural hematoma

Front 33

33. Horrible headache that causes nuchal rigidity , CSF shows numerous RBC's -- associated w/ which conditions?

Back 33

33. Saccular/berry anerysm pg 402

marfans, ehlers danlos, APCKD****

Front 34

34. What is a common opportunistic infection that affects the CNS in pt's w/ aids?

Back 34

34. Toxoplasmosis - produces abscesses that produce bright rings on CT and MRI pg 182

Front 35

35. 5 y.o. boy complained of headache for the past week. Ataxic Gait. After sudden onset of vomitting, he is brought to the ER, where he becomes comatose. Afebrile. Head CT: 4-cm mass in cerebellar vermis and dilation of cerebral ventricles. CSF: small cells with dark blue nuclei and scant cytoplasm.

Back 35

Medulloblastoma.
Pg. 425

Front 36

36. 27 y.o. woman w/ CSF showing increased IgG levels with prominent oligoclonal bands. Additional problems?

Back 36

Optic Neuritis. This patient has M.S.
Pg. 422

Front 37

37. 60 y.o. man with sudden loss of conciousness. Examination: left hemiplegia. Did not regain conciousness and died of pneumonia. Pateint had a previous group A beta-hemolytic streptococci infection. What is the condition?

Back 37

Rheumatic heart disease with left atrial mural thrombosis.
Pg. 272

Front 38

38. 55 y.o. man suddenly loses conciousness. Examination: Bilateral Papilledema. No spontaneous movements. What underlying condition caused this?

Back 38

Systemic Hypertension. Pg. 418

Front 39

39. 49 y.o. woman has had several headaches for 2 days. Afebrile and normotensive. Fundoscopy: Papilledema on the right. One day later, patient has right pupillary dilation and impaired ocular movement. Then becomes Obtunded (less than full mental capacity in a medical patient, typically as a result of a medical condition or trauma). What's the condition?

Back 39

Transtentorial medial temporal herniation.
Pg. 426

Front 40

40. 56 y.o. man goes into see doctor after a single episode of grand mal seizure. Afebrile and Normotensive. Motor strength is intact, and there's no loss of sensation. Cranial nerves are intact. Mental Function is fine. Brain MRI: three solid, 1-3 cm mass lesions, w/o ring enhancement or surrounding edema, located at the gray-white junction in the right and left frontal lobes. Cerebral ventricles are normal in size.

Back 40

Metastatic Carcinoma.
Pg. 225

Front 41

41. Patient presents with brain tumor. Head CT: 2-cm mass in the right frontal lobe. Stereotactic biopsy: only gliosis and evidence of recent and remote hemorrhage. The mass is removed, and histologic exam: conglomerate of various-sized tortous vessels surrounded by gliosis. What is this caused from?

Back 41

AV malformation.
NFA

Front 42

42. PP Primary Brain Tumor that on microscopy looks like spindle cells concentrically arranged in a whorled pattern (psmammoma bodies: laminated calcifications). What is it?

Back 42

Meningioma.

Pg. 425.

Front 43

43. A previously healthy 16 y.o. boy has complained of headaches for the past 9 months. Enlargement of 4th Ventricle. What is it?

Back 43

Ependymoma.
Look at vignette and explanation for #60.

Pg. 425

Front 44

44. Pt. has contralateral homonymous hemianopia. What's the cause?

Back 44

Uncal Herniation that is caused from compression of ipsilateral posterior cerebral artery (PCA).
Uncus = medial temporal lobe

Pg. 426

Front 45

45. Sensorineural Hearing Loss example and explain the location?

Back 45

Schwannoma. Aka in this location is a cerebellopontine angle tumor. Schwannomas in this location arise from cranial nerve VIII (internal acoustic meatus). Also called Acoustic Neuromas.

Pg. 392

Front 46

46. Pt. has mass in brain. Stereotactic biopsy of the mass shows areas of necrosis surrounded by nuclear pseudopalisading. The neoplastic cells within the mass are hyperchromatic. Neoplasm?

Back 46

Glioblastoma Multiforme. Similar to #68.
Pg. 425

Front 47

47. HIV Patient has Pneumocystis Jiroveci. Brain MRI: diffuse cerebral atrophy, and no focal lesions are identified. What would be seen in brain?

Back 47

White matter microglial nodules with multinucleate cells. Patient has AIDS dementia complex late in the course of his HIV infection.
NFA

Front 48

48. Term infant born has tuft of hair on his back. What is it?

Back 48

Spina Bifida Oculta.
Pg. 127

Front 49

49. 5 y.o. boy has meningitis. What would be seen on gram stain?

Back 49

Gram-positive cocci. Patient has acute bacterial meningitis. For his age group, the most common organism is Streptococcus Pneumoniae, which is gram-positve coccus.

Pg. 178 (Meningitis part of Strep)
Pg. 139 (Gram Stain and shape part of Strep)

Front 50

50. 55 y.o. who had been healthy all his life now has progressive, symmetric muscular weakness. What is the condition?

Back 50

Amyotropic Lateral Sclerosis aka ALS aka Lou Gehrig's Disease.
Pg. 407

Front 51

51. neonate is born prematurely at 28 weeks and becomes severely Hypoxemic 24 hours later, and seizure activity is observed. Poor neurologic development. Head CT: Symmetrically enlarged cerebral ventricles at 8 months of age. What is the cause?

Back 51

Germinal Matrix Hemmorhage.
NFA

Front 52

52. 79 y.o. woman was driving her automobile when she had a sudden, severe headache. She was taken to the ER, where she remained comatose and died 6 hours later. What was the cause?

Back 52

Rupture of Berry Aneurysm. Aneurysm in the circle of Willis and extensive subarachnoid hemmorhage.
Pg. 402

Front 53

53. Sections of brain are analyzed for red, shrunken neurons, decreased number of neurons, or absent neurons. A subset of patients are identified in which the hippocampal pyrimidal cells, the cerebellar Purkinje cells, and the superior parasagittal neocortical pyramid cells are affected. Cause of neuronal loss?

Back 53

Global Hypoxia. "Red" shrunken neurons, especially in the areas mentioned, are typically seen in the early stages of global hypoxia, as may occur in a severe hypotensive episode.

Ischemic brain disease

Front 54

54. 83 year old woman slips in the bathtub in her home and falls backwards, striking her head. Taken to the ER, and examination reveal a 3-cm reddish, slightly swollen area over the occiput. She is arousable but somnolent (drowsy). No motor or sensory deficits. No Papilledema. Head CT: acute hemmorhage where?

Back 54

Inferior Frontal Lobe. Classic "Contrecoup" type of injury, in which the moving head strikes an object, and the force is transmitted to the opposite side of the head.

NFA

Front 55

55. 56 y.o. woman is involved in MVA. Examination at ER: Multiple contusions and abrasions over the skin of the head, torso, and extremeties. No papilledema, there is no decerebrate posturing , and she has no spontaneous movements. Unconcious. Head CT: no intracranial hemmorhage or edema and no skull fractures. Remains in persistent vegetative state. Lesion?

Back 55

Diffuse axonal injury. Angular acceleration with torsional forces applied to white matter tracts can cause stretching and tearing of axons, followed by axonal swelling or "retraction balls" within hours.

NFA

Front 56

56. 4 y.o. girl developed clumsiness and difficulty ambulating over 6 months. Over the past 5 months, she developed CHF from hypertrophic cardiomyopathy. She also had hyperglycemia. Autopsy: increased perinuclear iron deposition within cardiac myocytes. Which genetic abnormalities with TNRE?

Back 56

GAA repeats in the frataxin gene. Patient has Friedrich's ataxia, which is autosomal recessive progressive illness that most often has an onset in the first decade of life. The frataxin gene encodes for a protein involved in iron regulation in cells.

Friedreich is Fratastic (frataxin): he's your favorite frat brother, always stumbling, staggering, and falling.
Pg. 408

Front 57

57. 63 y.o. man had increasing irritability over 3 years. Then marked memory loss. Autopsy: Frontal cortex shows extensive neoronal loss on microscopy and some remaining neurons show intracytoplasmic, faintly eosinophilic, rounded inclusions that stain IHC for tau protein.

Back 57

Pick Disease aka Frontotemporal Dementia. Has clinical features similar to Alzhemier's disease, but initially it causes less memory loss and more behavorial changes.
Pg. 422

Front 58

58. 20 y.o. mentally retarded woman saw physician because of flank pain for 1 week. Patches of leathery (shagreen patches) and hypopigmented (ash-leaf patches) skin were scattered over her body. What is it?

Back 58

Tuberous Sclerosis is one of the phakomoatoses (or "neurocutaneous syndromes").
Pg. 424

Front 59

59. 40 y.o. man, who rarely has headaches, now experiences headaches for the past 6 months. Dies. Microscopy: mass consists of cells with round nuclei with clear cytoplasm. What's the prognosis?

Back 59

Oligodendroglioma. Usually in frontal lobe. Chicken-wire capillary pattern.
Pg. 425

Front 60

60. PP with a primary brain tumor that has characteristic perivascular pseudorosettes and rod-shaped blepharoplast (basal ciliary bodies) found in nucleus. What is it?

Back 60

Ependymoma. The tumors arise in the ventricles (usually 4th ventricles) are more common in first 2 decades of life. Poor prognosis and can cause hydrocephalus.
Pg. 425

Front 61

61. AIDS patient presents with a demyelinating condition that resulted due to a latend virus. What is it?

Back 61

JC papovavirus. Patient has progressive multifocal leukoencephalopahty (PML), which is caused by JC virus and occurs in immunocompromised individuals, including people with AIDS.
Pg. 182

Front 62

62. PP w/ cell study: large cells with large nuclei and scant cytoplasm that mark CD19, but no GFAP or cytokeratin. What is it?

Back 62

Diffuse Large B-cell Lymphoma. Most common adult Non-Hogkin Lymphoma
Pg. 352

Front 63

63. 60 y.o. woman with Parkinsons. IHC stain for what type of protein is positive?

Back 63

alpha-synuclein. Pg. 397

Front 64

64. 70 y.o. pt. has acute cerebral infarction due to atherosclerosis. Risk factor?

Back 64

Hypercholesterolemia.
Pg. 266

Front 65

65. PP with cerebellar tonsillar herniation through foramen magnum with aqueductal stenosis and hydrocephaly. Brain MRI would show what malformation?

Back 65

Arnold-Chiari Type II malformation. Often presents with syringomyelia, thoraco-lumbar myelomenigocele. Pg. 127

Front 66

66. Infant born at 36 weeks gestation is suffering from cyclopia. The infant died 1 hour after birth. What did the baby have and what condition is this seen in.?

Back 66

Holoprosencephaly. Trisomy 13 (Patau's) M.C. but can be seen in maternal DM and fetal alcohol syndome as well. Pg. 127

Front 67

67. 86 y.o. man. Histological Exam of the brain: numerous neocortical neuritic plaques and neurofibirllary tangles. What is seen histologically in plaques and what is seen histologically in tangles?

Back 67

Plaques: Aggregation of AB peptide.
Tangles: tau protein

Alzheimer's disease.

Pg. 422

Front 68

68. PP with brain tumor in cerebral hemisphere. "Pseudopalisading" Pleomorphic cells positive for GFAP. Neoplasm?

Back 68

Glioblastoma Multiforme. Most common primary brain tumor. Pg. 425.