Last Cs Midterm Ever

Front 1

major output pathways for the cerebellum

Back 1

projections to motor cortex (thru the thalamus) and direct connections w/ brainstem motor pathways (rubrospinal, vestibulospinal, reticulospinal)

Front 2

Cerebellar disruption/dz is a/w what action

Back 2

precise coordination

Front 3

hallmark signs of cerebellar disruption

Back 3

intention tremor, dysdiadochokinesis, limbs ataxia/lack of balance, poor coordination in the absence of weakness

Front 4

gait of a cerebellar lesion

Back 4

wide base, swaying/ falling towards the side of dysfunction

Front 5

cerebellar diseases are more severe when they involve what?

Back 5

deep nuclei or superior cerebellar peduncle

Front 6

3 broad areas of cerebellar syndromes=

Back 6

vestibulocerebellar, spinocerebellar, pontocerebellar

Front 7

vestibulocerebellar controls

Back 7

flocculonodular lobe: equilibrium, eye muscles, axial body musculature

Front 8

Spinocerebellar controls

Back 8

posture and lower limb mostly, axial body musculature

Front 9

pontocerebellar

Back 9

upper limb movement, speech, eye movement

Front 10

lateral vs medial cerebellar lesions

Back 10

lateral: more limbs, speech and hearing (AICA); medial: axial musculature, balance, gait, eye movements + brainstem signs (PICA)

Front 11

hyperkinetic cerebellar syndromes:

Back 11

essential tremor: inherited. increased thalamic drive. Disorders related to basal ganglia. Affect is symmetrical and freq is constant. tx: propranolo, primidone & surgical manipulations

Front 12

what inhibits the normal excitatory drive to motor cortex?

Back 12

globus pallidus

Front 13

decreased postural tone d/t basal ganglia is because what?

Back 13

increased excitatory drive to the thalamus which resulted in an increased drive in motor cortex which increases the inhibition of cortex on brainstem tracts --> decreases the postural tone

Front 14

MC hypokinetic disorder

Back 14

parkinson's dz

Front 15

environmental toxin that can cause parkinsons

Back 15

manganese

Front 16

differential feature of other hypokinetic disorders vs parkinsons

Back 16

failure to respond to L-dopa

Front 17

MC hyperkinetic disorder

Back 17

Huntington's Chorea

Front 18

what is destroyed in hemiballismus?

Back 18

subthalamic nucleis

Front 19

Definition of Tourette's disorer

Back 19

hx of both motor & vocal tics > 1 yr onset before 18

Front 20

what are the 5 examples of hyperkinetic disorders?

Back 20

Huntington's Chorea, Hemiballismus, tardive-dyskinesia, Athetoid, Tourette's

Front 21

primary receptors a/w temperature detection

Back 21

transient receptor potential channels (TRPs)

Front 22

perception of temperature pathway

Back 22

DRG--> spinal cord--> brainstem --> thalamus--> insular cortex

Front 23

pathway for regulation of body temp

Back 23

ALS --> reticular formation--> hypothalamus

Front 24

anterior hypothalamus? posterior hypothalamus?

Back 24

ant: detects temp (heat sensitive)--> preoptic nuclei; post: controls "set point"

Front 25

caudolateral area of hypothalamus

Back 25

sympathetic heat conservation

Front 26

hypothermia temp

Back 26

95 or <35

Front 27

physiological responses to hypothermia based on temp

Back 27

35-32: shivering; 33: clouding of consciousness; 28-32: dec in metabolism; <28: poikilothermia, EEG slowing (<20)

Front 28

what reflexes stay normal until <82 deg F?

Back 28

respiratory and tendon reflexes

Front 29

Heat stroke vs heat exhaustion

Back 29

stroke: rapid temp increase, CNS sxs; exhaustion: inc over a couple of days, no CNS sxs

Front 30

DDX: fever & rash involving palms & soles

Back 30

erythema multiforme, coxsackie A or enterovirus, nisseria, Rickettsia rickettsii, subacute bacterial endocarditis, toxic shock syndrome, VZV, treponema pallidum

Front 31

FUO-classic

Back 31

>38.2 on several occasions for at least 3 weeks. + 3 hospital days or 3 outpt visits w/ no dx

Front 32

FUO-nosocomial

Back 32

>38.2 on several occasions, for at least 3 weeks, but starts after being admitted to the hospital, uncertain dx after 3 days including 2 day micro culture

Front 33

FUO- neutropenic

Back 33

>38.2 on several occasions for at least 3 weeks + neutrophil count <500 + 3 days including 2 day micro culture

Front 34

FUO- HIV assoc

Back 34

>38.2 several occasions for 1 months (outpt) or at leats 4 days inpt + confirmed dx of HIV + uncertain dx after 3 days including 2 day micro culture incubation

Front 35

4 categories of illnesses that account for the maj of FUO

Back 35

infections (tb MC), malignance, CT dz, misc

Front 36

SIRS criteria

Back 36

at least 2 of the following: hyperthermia (>38.5) or hypothermia (<35); tachycardia > 90; tachypnea (>20) or hypocapnia (<32); Leukocytosis (>12,000) or Leukopenia (<4000) or 10% immature bands

Front 37

Sepsis criteria

Back 37

SIRS in response to documented infection

Front 38

severe sepsis

Back 38

sepsis criteria + 1 of the following: mottled skin, capillary refill >3 secs, urinary output of <.5 ml/kg for at least 1 h, lactate > 2 mmol, abrupt change in mental status or abnormal EEG, thrombocytopenia, DIC, ARDS, cardiac dysfunction

Front 39

Septic shock

Back 39

Severe sepsis + 1 of the following: Diastolic BP <60 after fluids or pressors needed to maintain a BP >60

Front 40

goal of CVP? MAP? Central venous O2 sat?

Back 40

CVP: btwn 8-12; MAP >65, CVP >70%

Front 41

who is given RhAPC?

Back 41

pts w/ sepsis induced organ dysfxn & deemed high risk of death

Front 42

motor planning originates in?

Back 42

cerebral cortex

Front 43

motor coding occurs in?

Back 43

basal ganglia (learned movement)

Front 44

motor output is conducted thrus?

Back 44

motor cortex & corticospinal/ bulbar tracts

Front 45

supplemental motor cortex controls what?

Back 45

coordinating between 2 hemispheres

Front 46

Premotor cortex controls what?

Back 46

transfer between 2 hemispheres (learned movements)

Front 47

Transcortical ideomtor apraxia

Back 47

Caused by anterior cerebral artery--> loss of command to opposite side (can't send the message across the corpus callusum)

Front 48

what provides inhibition of brainstem pathways that are tonically active?

Back 48

cortex--> like rubrospinal, vestibulospinal, and reticulospinal tracts

Front 49

loss of cortical input on brainstem's tonically active tracts causes

Back 49

disinhibition (Extension)

Front 50

charcot's triad for MS

Back 50

nystagmus/intention tremor/scanning speech

Front 51

very common initial manifestation for MS?

Back 51

sensory changes: radiculitis/ radiculopathy mostly to trunk or abdomen

Front 52

lhermitte's phenomenon

Back 52

electrical shock sensation upon flexion of the neck down spine and into sacrum

Front 53

gait a/w MS

Back 53

scissor gait

Front 54

uhthoff's phenomenon

Back 54

small increase in body temp increases sxs & sns

Front 55

dawson's fingers

Back 55

plaques at centrum semiovale and at right angles to corpus in radiating manner--- MS

Front 56

tx for acute attacks of MS

Back 56

GCs (prednisone or methylprednisone)- pulsed

Front 57

dz modifying tx for MS

Back 57

interferon B and glatiramer acetate. Everyone with dx should be given INF beta or flatiramer acetat

Front 58

Glatiramer is a potent inducer of what?

Back 58

TH2 (sim structure to Myelin basic proteins)

Front 59

what two dz modifying txs for MS can cause PML? which one can cause cardiotox? ITP?

Back 59

PML= rituximab, natalizumab; cardio: mitoxantrone; ITP: alemtuzumab

Front 60

what two myopathic categories causes asymmetric weakness?

Back 60

neuropathic and infectious

Front 61

Ribonucleotide protein= marker for what AI dz?

Back 61

mixed CT dz

Front 62

myositis specific abs?

Back 62

jo-1 (anti-tRNA synthetases) syndrome--> inflammatory myopathy w/ ILD, raynaud's, arthritis & mechanics hands

Front 63

mechanics hands + raynauds + arthritis=

Back 63

jo-1: myositis

Front 64

polymyositis and dermatomyositis criteria

Back 64

PM: 4 out of the 5 = definite, 3 out of 5 = probably; DM: 3 out of 4 + rash= definite, 2 out of 4 + rash= probable. symmetric proximal muscle weakness, incr muscle enzymes, myopathic EMG abnormalities, typical changes on muscle biopsy, typical rash of dermatomyositis

Front 65

when to hospitalize your myopathic pt?

Back 65

CK > 10,000 or loss of neck flexors; dysphagia w/ aspiration, profound weakness w/ inability to care for self or walk.

Front 66

tx for dermatomyositis

Back 66

hydroxychloroquine

Front 67

statins + muscle dz

Back 67

relative contraindication.

Front 68

UMN 7th lesion=

Back 68

pt will get weak on lower part of face (contralateral)

Front 69

LMN 7th lesion=

Back 69

will affect upper & lower face so they can't close their eye. (ipsilateral)

Front 70

Stereognosis & extinction are both a/w what section of the brain?

Back 70

parietal lobe (right)

Front 71

spastic gait is seen after what 3 circumstances?

Back 71

after stroke, MS, spinal cord lesion

Front 72

cushing's triad

Back 72

HTN, bradycardia, irreg RR

Front 73

loss of pain & temp on 1 side of face and loss on opposite side of body=

Back 73

brainstem lesion

Front 74

loss of pain & temp on 1 side of body and weakness w/ or w/o vibration on opposite side=

Back 74

spinal cord lesion

Front 75

pure motor sxs=

Back 75

C/L small vessel lacunar infarct of the internal capsule, basal ganglia, pons

Front 76

pure sensory sxs=

Back 76

C/L small vessel lacunar infarct of the thalamus

Front 77

psychophysiologic sxs of vertigo

Back 77

panic attack/anxiety-- numbness & tingling around lips

Front 78

dix-hall-pike

Back 78

BPPV dx

Front 79

photophobia + > 24 hr vertigo

Back 79

migraine

Front 80

tx of bell's palsy w/ vesicles on the ear

Back 80

NOT steroids- acyclovir

Front 81

MCC if lateral medullar syndrome

Back 81

PICA--> vomiting, nystagmus, vertigo

Front 82

sudden HA + acute vertigo + inability to ambulate=

Back 82

cerebellar hemorrhage

Front 83

long term tx of MG

Back 83

Azathioprine & mycophenolate mofetil (purine antagonists)