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328 Cards in this Set

  • Front
  • Back
A patient presents w/ decreased pain nand temperature sensation over the lateral aspects of both arms
Whaere is the lesion?
Penlight in pts right eye produces bilateral pupillary constriction. When moved to the left eye, there is paradoxical dilatation. What is the defect?
Atrophy of the left optic nerve.
The patient describes a decreased prick sensation on the lateral asapect of her leg and foot. what muscular deficit can also be expected?
Dosriflexion and eversion
common peroneal
An elderly woman presents w/ arthritis and tingling over the lateral digits of her right hand. What is the Dx?
Carpal tunnel
20 y/o dancer reports dowand plantar flexion and decreaed sensation over the back of her thigh, calf, and lateral half of her foot. What spinal nerve is involved?
Tibial - L4,S3
A woman inovlved in a motor vehicle accident cannot turn her head to the lft and has a right shoulder droop. What structure is damaged?
Right XI (jugualr foramen w/ CN IX and X) innervating sternocleidomastoid and trapezius
A man presents with one wild, flailing arm, where is the lesion?
Contralateral subthalamic nucleus
A patient with cortical lesion does not know that he has a disease. Where is the lesion
Right parietal lobe
Patient cannot protrude tongue twoard left side adn has right sided spastic paralysis. Where is the lesion?
left medulla, CN XII
Teen falls while rollerblading and hurts his elbow. He can't feel the medial part of his palm. Which nerve and what injury
ulnar nerve due to broken medial condyle
Field hocky player presents to the ER after falling on her arm during practice. X-ray shows midshaft break of the humerus. Which artery and nerve were damaged?
Radial nerve and deep brachial artery
Patient cannont blink his R eye or seal his lips. Mild ptosis on the right side. What is teh Dx adn which nerve is affected?
Bells; CN VII
Pt. complains of pain, numbness, and tingling sensation. Wasiting of the thenar eminence. What is the Dx and what nerve is affected?
Carpal tunnel syndrome, median nerve
In what stage of sleep would a dude have variable bp, penile tumescence, and variable EEG?
What personality disorder would demand only the best and most famous doctor in town?
Nurse has episodes of hypoglycemia; blood analysis has no elevation in C protein
55 y/o businessman complains of lack of successful sexual contacts w/ women and lack of ability to reach a ful erection. two years ago he had a heart attack. What could be a cause of the problem?
fear of sudden death during intercourse
15 y/o girl of normal height and weight for her age has enlarged parotid glands, but no other complaints. She hides laxatives.
Woman presents w/ headache, visual disturbance, galactorrhea and amenorrhea. What's the Dx?
43y/o man w/ dizziness and tinnitis. CT has enlarged internal acoustic meatus.
25 y/o female presents w/ uniocular vision loss and slurred speech. Hx of weakness and parethesias that have resolved. What is the Dx?
10 kid spaces out in class. can be a quivering of lips.
absence seizures
man on antidepressents and other meds has mydriasis and becomes constipated. Wha tis the cause of his symps?
woman on MAOI has HTN crisis after a meal, why?
tyramine (wine or cheese)
physical support
K metab
help maintain BBB
GFAP is the marker
Ependymal cells
inner lining of ventricles
originates from mesoderm
Not readily discernible in Nissl stains
small irrecgular nuclei andd littel cytoplasm. ameboid phagocytic cells.
HIV-infected microglia fuse to form multinucleated giant cells
central myelin production
up to 30 axons myelinated.
Nissle-> small nuclei w/ dark chromatin and little cytoplasm. Predominant glial in white matter. Destroyed in MS
Schwann cells
peripheral myelin production
only 1 PNS.
promote axonal regeneration
Acoustic neuroma is an example of a schwannoma.
internal acoustic meatus CN VII, VIII
Peripheral nerve layers
Endoneurium invests single nerve fiber
Perineurium (permeability barrier) surrounds a fascicle of nerve fibers
Epineurium (dense CT) surrounds entire nerve (fascicles and blood vessels)

Perineurium- permeable barrier. must be rejoined in microsurgery for limb reattachment.
Meissner's corpuscle
Small, encapsulated nerve endings found in dermis of palms, soles, and digits of skin. Involved in light discriminatory touch of glabrous (hairless) skin
Pacinina corpuscle
Large, encapsulated nerve endings found in deeper layers of skin at ligaments, joint capules, serous memebranes, mesenteries. Involved in pressure, course touch, vibration and tension
cup shape endings in dermis of fingertips, hair follicles, hard palate. Involved in light and crude touch.
Inner Ear
series of tubes in the temporal bone filled w/ perilymph (Na rich)
- cochlea, vestibule, semicircular canals. Hair cells are the sensory elements in both vestibular apparatus and cochlea

Base of the cochlea picks up high-frequency sound. Apex of cochlea picks up low frequency sound
What is the difference between the base and the apex of the cochlea?
base- narrow and stiff (high frequency)
Apex- wide and flexible (low frequency)
what should you remember about:
samicircular canals
hearing loss
Peri- outside the cell
Endo- inside
endolymph- stria vascularis
Utricle- side to side
saccule- up down
- use maculae to detect linear acceleration
semicircular canals contain Ampullae- detect Angular acceleration
Hearing loss- lose high freqency first
What forms the blood-brain barrier?
Tight junctions between non-fenestrated capillary endothelial cells
Basement membrane
Astrocyte processes

maternal-fetal blood
How do Gcose and AAs cross the BBB?
carrier-mediated transport
what is the difference between lipid-soluble and water-soluble substances? Polar and nonpolar?
lipid and non-polar cross easier
what areas of the brain are fenestrated?
area postrema- vomiting after chemo
neurohypophysis- ADH release
What are the functions of the hypothalamus?
Thirst, water balance (supraoptic nucleus)
Hunger (lateral nucleus) and satiety (ventromedial)
Autonomic regulation (ant. hypothalamus for paras. posterior for symps), circadian (SCN)
Temperature (posterior hypo regs heat. ant regs cooling)
Sexual urges (septal nucleus-> w/o = rage)
From where do the projections of the posterios pituitary originate?
ADH from supraoptic
Oxy from paraventricular
What are the functions of the thalamus?
Major relay for ascending sensory info
LGN- visual
MGN- auditory
Ventral posterior nucleus, lateral part (VPL)- body senstaion (proprioception, pressure, pain, touch vibration, from the dorsal column and spinothalamic tract)
Ventral post nucleus, medial part (VPM)- facial sensation
Ventral ant/lateral nuclei- motor
What is the function of the limbic system?
5 Fs
What is the role of the basal ganglia?
important in voluntary movements and making postural adjustments

parkinsons is a decrease in input from the substantia nigra. (less inhibition of the inderect pathway)

Direct- facilitates movement (D1)
Indirect- inhibits (D2)
What number is the premotor area?
What number is the principal motor area?
What number is the principla sensory area?
What number is the principal visual cortex?
What number is the associative auditory cortex (wernickes)
What number is the Primary audiory cortex?
What number is the motor speech (Broca's) area?
What is the function of the frontal lobe
Executive functions- planning, inhibition, concentration, orientation, language, abstraction, judgement, motor regulation, mood.
Lack of social judgement is most notable in frontal lobe lesion
What is the homunculus
Topographical representation of sensory and motor areas in the cerebral cortex
Use to localize lesion
Lower extremities are anterior cerebral- medial
What does the anterior cerebral artery supply?
medial surface of the brain, leg-foot area of motor and sensory cortices
What does the middle cerebral artery supply?
lateral aspect of brain, trunk-arm-face area of motor and sensory cortices, Broaca and WErnickies
What does the anterior communicating artery supply?
most common aneurysm
visual field defects
What does an aneurysm of the posterior communicating artery cause?
CNIII palsy
What do the lateral striate supply?
theya re division s of the middle cerebral
they are the arteries of stroke
internal capsule, caudate, putamen, globus pallidus
What happens ina stroke of the anterior circle?
general sensory and motor dysfunction. aphasia
What happens in a stroke of the posterior circle
Cranial nerve deficits (vertigo, visual deficits, coma, cerebellar deficits
What is the function of the superior sagittal sinus?
main location of CSF return via arachnoid granulations
Where does the great cerebral veign branch off?
the inferior cerebral vein
which meet up into the straight cerebral vein
what sinuses flow on the dorsal surface of the brain?
superior ophthalmic vein
enters the cavernous sinus
which splits the superior petrosal and inferiorpetrosal to the jugular foramen.
What connects the superior sagital sinus to the cavernous sinus?
shpenoparietal sinus
How does the ventricle system connect?
the Lateral ventricle-> 3rd ventricle via foramen of Monro
3rd-> 4th via sylvius
4th-> subarachnoid via Luschka and Magendie
how many spinal nerves are there?
8 cervical
12 thoracic
5 lumbar
5 sacral
1 coccygeal

vertebral disk herniation most common between L5-S1
Where do you do the lumbar puncture?
between L4, 5
pia is not pierced
What are the layers pierced in the lumbar puncture
Ligaments (supraspinous, interspinous, ligamentum flavum)
Epidural space
Dura Mater
Subdural space
Subarachnoid space- CSF
What is the difference between the fasiculus gracilis and the fasciculus cuneatus?
gracilis=legs (medial)
cuneatus=arms (lateral)
What is the role of the Dorsal column-medial lemniscal pathway
ascending pressure, vibration, touch, and proprioception

ascends ipsilaterally
synapses in nucleus cunneatus or gracilis in the medulla
contralaterally in the medial meniscus to the VPL of the thalamus
What is the role of the Spinothalamic tract
pain and temperature
crosses after synapsing in the ipsilateral gray matter
synapses again in VPL of the thalamus
What is the lateral cotricospinal tract?
descending voluntary movements
1ry motor cortex
descends ipsilaterally to the caudal medulla and decussates in the pyramidal tracts

cell body of the ant. horn of hte spinal cord-> NMJ
How is the brachial plexus divided?
Randy Travis Drinks Cold Beer
What is the deformity of an upper trunk lesion?
Waiter's tip
What is the deformity caused by a lower trunk lesion?
Claw hand
What comes from a Posterior cord lesion?
wrist drop
What deforimity comes from a axillary nerve lesion?
deltoid paralysis
What deformity comes from a long thoracic nerve lesion?
winged scapula
What comes from a radial nerve lesion?
wrist drop
What deformity comes from a musculocutaneous lesion?
Difficulty flexing the elbow, variable sensory loss
What is the deformity that comes from a median nerve lesion?
decreased thumb fuction
pope's blessing
What is the deformity that comes from an ulnar nerve lesion?
intrinsic claw hand
What is the function of the radial nerve?
Extensors of the wrist and fingers
What is the function of the thenar and hypothenar muscles?
thenar- Opponens pollicis, Abductor pollicis brevis, Flexor pollicis brevis
Hypothenar- Oppones digiti, Abductor digiti, flexor digiti
What si the landmark for a pudendal nerve block?
ischial spine
What is the landmark for the appendix?
2/3rd of the way from the umbilicus to the ant. superior iliac spine (McBurney's point)
What is the landmark for the lumbar puncture?
iliac crest
posterior skull cap
C3 Dermatome
high turtleneck
C4 Dermatome
low collar shirt
T4 Dermatome
T7 Dermatome
T10 Dermatome
L1 Dermatome
inguinal ligament
L4 Dermatome
S2,3,4 Dermatome
penile and anal sensation
Where does gallbladder pain refer?
R shoulder via the phrenic
How is the muscle spindle controlled?
in parallel w/ muscle fibers. Muscle stretch-> intrafusal stretch-> stimulates Ia afferent-> stimulates alpha motor neuron-> reflex muscle (extrafusal) contraction
What is the gamma loop in muscle control?
CNS stims gamma-> contracts the intrafusal-> increased sensitivity of reflex arc
What is the role of the golgi tendon organ?
monitors muscle tension; makes you drop a suitcase if you've been holding it too long.
What are the reflexes?
the count up
S1,2- achilles
L3,4 - patellar
C5,6 - biceps
C7,8 - triceps

babinski- UMN lesion
What are the primitive reflexes?
Moro- extension of limbs
Rooting- look for the nipple
Palmar- grasp objects in palms

disappear in the 1st year
What cranial nerves lie medially at brain stem?
3, 6, 12
What cranial nerves start at the midbrain?
What cranial nerves start at the Pons
What cranial nerves start at the medulla
What is the nucleus solitarius
Vagal nucleus
Visceral Sensory infomration (tast, baroreceptors, gut distention
7, 9, 10
What is the nucleus ambiguus?
vagal nucleus
Motor innervaion of the pharynx, larynx and upper esophagus
9, 10, 11
What is the dorsal motor nucleus
vagal nucleus
atonomic to heart, lungs and GI
What CN travels through the cribiform plate?
What travels through the optic canal? (3)
II, opthalmic artery, central retinal vein
What travels through the Superior orbital fissure? (5)
CN III, IV, V1, VI, ophthlamic vein
What travels through the foramen Rotundum and Ovale
Standing Room Only
V1- S- superior orbital fissure
V2- R- Foramen Rotundum
V3- O- Ovale
What travels through the foramen spinosum?
middle meningial artery
What passes through the internal auditory meatus (2)
What passes through the jugular foramen?
IX, X, XI, jugular
what passes through the hypoglossal canal?
What passes through the foramen magnum?
spinal roots of CN XI, brain stem, vertebral arteries
What is the cavernous sinus?
collection of venous sinuses on either side of the pituitary. Blood from eye and superficial cortex drains to the cavernous which drains to the internal jugular

CN II, IV, VI, V1, V2 aond postganglionic symps pass through.
What is cavernous sinus syndrome?
ophthalmic and mandibular sensory loss
What ar ethe muscles of mastication?
Medial pterygoid

lateral pterygoid

all innervated by V3
What innervates muscles that end in glossus?
except palato- Vagus
What innervates muscles with palat in the name?
innervated by vagus
except tensor veli platini (too tense; lets V handle it)
What is the function of the superior oblique?
abducts, introverts, depresses
(down and in)
What are the functions of the eye muscles?
LR-> temporal
Obliques-> nasal, opposite
Rectus-> temporal, same (rectal sex = same sex)
What nucleus is responsible for pupillary contraction in response to light?
CNIII constricts
KLM sounds
Ka, Ka, Ka- tests palate (vagal)
La-la-la- tests tongue (glossal)
Ma, Ma, Ma- tests lip (VII)
What are the wave forms?
BATS Drink Blood
Beta- awake
Alpha- awake- eyes closed
theta- light sleep 1
sleep spindles- deep sleep 2
Delta- Deepest, non-REM; sleepwalking, night terrors, bed-wetting (slow-wave)
Beta- REM- dreaming loss of motor tone, etc
What neurotransmitter triggers sleep?
Serotonergic predominance of raphe nnucleus is the key to initiating sleep
What neurotransmitter reduces REM?
What controlse hte eye movements in REM?
paramedian pontine reticular formation
What does paradoxical sleep and desynchronized sleep refer to?
REM sleep having the same EEG waves as bein awake
What is the effect of Benzos on sleep?
shorten stage 4
night terrors and sleepwalking
What is the role of imipramine in sleep?
treats enuresis due to decreased stage 4
what are the key features of REM?
increased and variable puls, REM, increased and variable blood pressure, penile/clitoral tumescence
every 90 minutes
duration increases throughout the night
ACh is the principal neurotransmitter
decreases w/ age
Neural tube defects
elevated alpha-fetoprotein in amniotic fluid and maternal serum
Spina bifida occulta- failure of bony spiral canal to close, no structural herniation. Usually seen at lower vertebral levels.
Meningocele- meninges herniate through the spnial canal defect
Menigomyelocele- meninges and spinal cord herniate through spinal canal defect
What are the consequences of a lesion in the:
Broca's area?
Motor aphasia w/ good comprehension
What are the consequences of a lesion in the:
Wernicke's Area
Sensory aphasia w/ poor comprehension
What are the consequences of a lesion in the:
Arcuate fasciculus
Conduction aphasia: poor repetition w/ good comprehension, fluent speech
What are the consequences of a lesion in the:
Kluver-Bucy syndrome (hyperorality, hypersex, disinhibited)
What are the consequences of a lesion in the:
Frontal lobe
Personality change, deficits in concentration, orientation, and judgement; may have reemergence of primitive reflexes
What are the consequences of a lesion in the:
Right parietal lobe
Spatial neglect syndrome
(agnosia of the contralateral side of the world)
What are the consequences of a lesion in the:
Reticular activating system
What are the consequences of a lesion in the:
Maimmillary bodies
What are the consequences of a lesion in the:
Basal Ganglia
tremor at rest, chorea, athetosis
What are the consequences of a lesion in the:
Cerebral hemisphere
Intention tremor, limb ataxia
What are the consequences of a lesion in the:
Cerebellar vermis
Truncal ataxia, dysarthria
What are the consequences of a lesion in the:
Subthalamic nucleus
Contralateral hemiballismus
What is chorea?
sudden, jerky, purposeless movements
basal ganglia lesion (huntingtons)
Slow writhing movemetns of fingers
basal ganglia
What is hemiballismus?
Sudden, wild flailing of 1 arm
Characteristic of contralateral subthalamic nucleus lesion. Loss of inhibitioin of thalamus through globus pallidus
What is the difference between Broca's and Wernicke's aphasia?
Broca- nonfluent aphasia w/ intact comprehension- inferior frontal gyrus
Wernickes- fluent aphasia w/ impaired comprehension- superiro temporal gyrus

Broca's is broken speech
Wernicke is wordy
cerebral cortex degeneration
most common cause of dementia in the elderly. Associated w/ senile plaques (extracellular, B-amyloid core) and neurofibrillary tangles (intracellular, abnormally phosphorylated tau protein)

genes- 1,14,19 APOE4; 10% familial
21 pApp gene
dementia, aphasia, parkinsonian aspects
(intracellular aggregated tau protein) specific for the frontal and temporal lobes
AD inheritance
chorea, dementia.
Atrophy of caudate nucleus (loss of GABAergic neurons)

Chromosome 4 expansion of CAG repeats
C caudate
A loses ACh
G loses Gaba
Lewy bodies
depigmentation of the substantia nigra pars compacta
Rare cases have been linked to eposure from MPTP
contaminant in illicit street drugs.

Postural instability
you are TRAPped in your body
Olivopontocerebellar atrophy
Friedreich's ataxia
Amyotrophic lateral sclerosis
associated w/ both LMN and UMN signs
No sensory deficit
Werdnig-Hoffmann disease
AR inheritance
floppy baby
tongue fasciculations
death at 7 months
degeneration of the anterior horns
LMN signs
degeneration of the ant. horns
caused by poliovirus- fecal oral
replicates in the oropharynx and small intestine before spreading through the bloodstream to the CNS where it leads to the destruction of cells in the ant. horn of the spinal cord. causes LMN destruction

Sx- Malaise, headache, fever, nausea, ab pain, sore throat

LMN lesions- muscle weakness, atrophy, fasciculations, fibrillation, and hyporeflexia

Findings- CSF w/ lymphocytic pleocytosis w/ elevation of protein. Virus recovered from stool or throat
Multiple Sclerosis
increased prevalence w/ increased distance from the equator

periventricular plaques.
oligodendrocyte loss and reactive gliosis w/ preservation of axons
increased protein in CSF
Many pts have relapsing-remitting course
Pts can present w/ optic neuritis
MLF syndrome (internuclear opthalmoplegia)
hemiparesis, hemisensory symps, or bladder/bowel incontinence

Scanning speach
Intention tremor

women in their 20s and 30s; whites

B-IFN or immunosuppressant therapy
Progressive multifocal leukoencephalopathy
JC virus, AIDS
Acute disseminated encephalomyelitis
Metachromatic leuckodystrophy
lysosomal storage disease
acute idiopathic polyneuritis
Inflamm and demyelination of peripheral nerves and motor fibers of ventral roots
- motor more severe
symmetric ascending muscle weakness in distal lower extremities
Facial diplegia in 50% of cases
Autonomic function may be severely affected- cardiac, HTN, hypotension)
recoverey after weeks to months
increased CSF protein w/ normal cell count


infections; herpes, campylobacer, inoculations, stress
Respiratory support is critical
plasmapheresis, IV immune globulines
Simple partial
retained consciousness
motor, sensory, autonomic, psychic
Complex partial
impaired consciousness
Absense seizure
blank stare
quick, repetitive jerks
alternating stiffening and movement
drop seizures
disorder of recurrent seizures

partial can 2rly generalize
What are the causes of seizures?
kids- genetic, infection, trauma, congenital, metabolic

Adults- tumors, trauma, stroke, infection
Elderly- stroke, tumor, trauma, metabolic, infection
Epidural hematoma
Rupture of the middle meningeal artery
2ry to fracture of temporal bone. Lucid interval
Biconvex disk
subdural hematoma
rupture of the bridign veins. Venous bleeding
delayed onset of symps
elderly, alcoholics, blunt trauma,
shaken baby- brain atrophy, shaking, whiplash

crescent shaped hemorrhage; crosses suture lines
Subarachnoid hemorrhage
Rupture of an aneurysm- berry
or an AVM. Worst headach of my life
Bloody or xanthochromic spinal tap
Parenchymal hematoma
HTN, amyloid angiopathy
DM and tumor
Berry aneurysms
bifurcations in the circle of willis
anterior communciating artery.
Rupture causes hemorrhagic stroke/subarachnoid hemorrhage. Adult polycystic kidney disease, Ehlers-Danlos syndrome, and marfans

RFs- age, HTn, smoking, race
What are the differences between UMN and LMN lesions?
wekness in both
atrophy, fasciculation in LMN
increased reflexes and tone in UMN; decreased in LMN
Babinski is + in UMN
What are the characteristic lesions of polio and Werdnig-Hoffmann disease?
LMN lesiosn of anterior horns-> flaccid paralysis
What are the characteristic spinal cord lesions of MS?
white matter of cervical region. random and asymmetric
demylenation; scanning speech, intention tremor, nystagmus
What are the characteristic spinal cord lesions of ALS?
combined upper and lower motor neurons signs
What are the characteristic spinal cord lesions of complete occulsion of ventral artery?
spares the dorsal columns and tract of Lissauer
What are the characteristic spinal cord lesions of Tabes Dorsalis?
degeneration of dorsal roots and dorsal columns;
impaired proprioception
locomotor ataxia
What are the characteristic spinal cord lesions of Syringomyela
crossing fibers of corticospinal tract damanged; bilateral loss of pain and temerature sensation
What are the characteristic spinal cord lesions of b12 neuropath and Friedreichs ataxia?
demyelination of dorsal columns and lateral corticospinal tracts
spinocerebellar tracts

ataxic gait, hyperreflexia, impaired position and vibration sense
Enlargement of the central canal of spinal cord
crossing fibers of the spinothalamic tract are damaged.
Bilateral loss of pain and temperature sensation in upper extremities w/ preservation of touch sensation

presents in pts w/ Arnold Chicari malformation
Most common at C8-T1
Tabes Dorsalis
Degeneration of the dorsal columns and dorsal roots due to 3ry syphilis, resulting in impaired proprioception and locomotor ataxia. Charcot's joints, shooting pain, Argyll Robertson pupils. No DTRs.
What is brown-Sequard syndrome
Hemisection of spinal cord
1. Ipsilateral UMN signs below lesion
2. Ipsilateral loss of tactile, vibration, proprioception sense below lesion
3. Contralateral pain and temperature loss (spinothalamic tract) below lesion
4. Ipsilateral loss of all sensation at level of lesion
5. LMN signs at level of lesion.
Horner's syndrome
PAM is horny
Ptosis- drooping of eyelid
Anhidrosis- absence of sweating and flushing of affected side
Miosis- pupil constriction
- lesion of spinal cord above T1.
What is the 3-neuron oculosympathetic pathway?
hypothalamus to the intermediolatereal column of spinal cord-> superior cervical ganglion, to teh pupil, smooth muscle of the eyelids, and the sweat glands of the forehead and face. Causes Horner's syndrome
Radial Nerve
When is the site of injury
what is the deficit in motion
what is teh deficien in sensation?
Shaft of the humerus
loss of triceps, brachioradialis, and extensor carpi radialis longus-> wrist drop

Posterior brachial cutaneous sensantion
Posterior antebrachial cutaneous (through the supinator)
Median Nerve
When is the site of injury
what is the deficit in motion
what is teh deficien in sensation?
Supracondyle of the humerus
loss of forearm pronation, writs flexion, finger flexion and several thumb movements-> thenar atrophy

passes through pronator terres
Ulnar Nerve
When is the site of injury
what is the deficit in motion
what is teh deficien in sensation?
medial epicondyle
impaired wrist flexion and adduction.
impaired addduction of the thmb and the ulnar 2 fingers
Loss of sensation over the medial palm and ulnar fingers
passes through flexor carpi ulnaris
Muculocutaneous Nerve
what is the deficit in motion
Loss of function of the coracobrachialis, biceps, and brachialis

passes through coracobrachialis
What is Erb-Duchenne Palsy
Tractio or tear o f the upper trunk of the bracheal plexus (blow to the sholder or trauma during delivery)

Limb hangs by side (paralysis of abductors)
Medially rotated (paralysis of lateral tortators
forearm is pronated (loss of biceps

Waiter's tip"
Common peroneal Nerve
When is the site of injury
what is the deficit in motion
what is teh deficien in sensation?
Loss of dorsiflexion (foot drop)
deep peroneal-> ant. compartment
superficial -> lateral compartment

peroneal everts and dorsiflexes
damage-> dropPED
Tibial Nerve
When is the site of injury
what is the deficit in motion
what is teh deficien in sensation?
Loss of plantar flexion. Tibial nerve innervates posterior compartment
can't stand on TIP toes if injured
Femoral Nerve
When is the site of injury
what is the deficit in motion
what is teh deficien in sensation?
Loss of knee extension/knee jerk
Obturator Nerve
When is the site of injury
what is the deficit in motion
what is teh deficien in sensation?
loss of hip adduction
What is thoracic outlet syndrome?
Klumke's palsy
embyologic defect
can compress subclavian artery and infereior trunk of brachial plexus
1. atrophy of thenar and hypothenar
2. Atrophy of interosseous
.3 Sensory deficits on medial forearm and hand
4. no radial pulse when moving the head to the other side.
What is the effect of a CN XII lesion?
tongue deviates towards the lesion
CN V motor lesion?
Jaw deviates towards the lesion
unilateral lesion of the cerebellum
fall toward the lesion
CN X lesion
uvula deviates away
weakness turning head to contralateral side of lesion. Shoulder droop on side of lesion
UMN lesion of the face
lesion of motor cortex or connection between cortex and facial nucleus-> contralateral paralysis of lower face
LMN lesion
Ipsilateral paralysis of upper and lower face
Bell's palsy
destruction of the facial nucleus or its branchial efferent fibers

Peripheral ipsilateral facial paralysis

idiopathic; gradual recovery

ALexander Bell with STD
What happends in a cingulate herniation?
herniates under falx cerebri
can compress ant. cerebral artery
What herniations can compress the brainstem?
Downward transtentoria
Uncal herniation
Uncus- medial temporal lobe
Cerebellar tonsillar herniation
gets pushed through the foramen magnum
What are the signs of an uncal herniation?
ipsilateral dilated pupil/ptosis from the stretching of CNIII

Contralateral homonymous hmianopia- from the compression of ipsilateral posterior cerebral artery

Ipsilateral paresis- compressio of contralateral crus cerebri

Duret hemorrhageds from paramedian artery rupture from the caudal displacement of the brain stem.
How would you get right anopia?
R optic nerve severed before the chiasm
how would you get bitemporal hemianopia
compression of the chiasm
how would you get left upper quadrantic anopsia?
temporal lobe damage- Meyer's loop
How would you get left homonymous hemianopia
optic tract lesion after the chiasm
How would you get left lower quadrantic anopia?
Right parietal lesion
dorsal optic radiation is busted
How would you get left hemianopia w/ macular sparing?
calcarine fissure lesion
What is internuclear ophthalmoplegia?
lesion in the medial longitudinal fasciculus
medial rectus plasy on attepmted lateral gaze. Nystagmus in abductin eye. Convergence is normal.
MLF seen in multiple sclerosis

reflex is usually something that drigeers the movement of the opposit eye meidal recturs
What are the neurotransmitter changes in anxiety?
increased NE
decreasaed Gaba
decreased serotonis
What are the neurotransmitter changes in depression
decreaesed NE and serotonin
What are the neurotransmitter changes in alzheimers
What are the neurotransmitter changes in hungtingtons?
decreased gaba, ACH
What are the neurotransmitter changes in schizo?
increased dopa
What are the neurotransmitter changes in parkinsons
decreased dopa
What is orientation?
whether a pt is aware of him or herself as a person
do they know their name
Anasognosia- unaware that one iss ill
Autotopagnosia- unable to locate one's own body
Depersonalization- body seems unreal or dissociated

order of loss:
1st- time
2nd- place
3rd person
What is anterograde amnesia
can't remember new things
what is Korsakoff's amnesia
anterograde amnesia of thiamine deficiency (bilateral destruction of the mammillary bodies
alcohol- confabulations
What is retrograde amnesia?
inabliitly to remember things before an insult
what are the signs of Substance dependance
Maladaptive pattern of substance - 3 of the following:
Substance taken in larger amounts or longer time than desired
Persistent desire or attempts to cut down
Significant energy spen obtaining, using, or recovering from a substance
Important social, occupational, or recreational activities reduced due to use
continued in spite of knowledge of problems.
What are the signs of substance abuse?
clinically significan impairment or distress.
1. recurrent use -> failure to fulfill obligations
2. use in physically hazardous situations
3. substance-related legal problems
4. conintued use inspide of problems caused.
What are the signs of alcohol intox?
emotional labliity
slurred speech
GGT- indicator
What are the withdrawal signs of alcohol intox?
tremor, tachycardia
delirium trememns
What are the signs of opioids intox?
CNS depression
nausea and vomiting
pupillary constriction
What are the withdrawal signs of opioid intox?
dilated pupils
stomach cramps
What are the signs of amphetamines intox?
Psychomotor agitation, imparied judgement
pupillary dilation
prolonged wakefulness and attention
cardiac arrhythmias
What are the withdrawal signs of amphetamine intox?
stomach cramps
What are the signs of Cocaine intox?
psychomotor agitation
imparied judgement
pupillary dilation
paranoid ideations
sudden death
What are the signs of cocaine withdrawal?
postuse "crash" including severe depression and suicidality
severe psychological craving
What are the signs of PCP intox?
psychomotor agitation
vertical and horizontal nystagmus
What are the signs of PCP withdrawal?
reabsorption in GI tract
sudden onset of severe random, homicidal violence
What are the signs of LSD intox?
Marked anxiety or depression, delusions, visual hallucinations, flashbacks, pupil dilation
What are the signs of Marajuana intox?
paranoid delusions
slowed time
impaired judgement
social withdrawal
increased appetitie
dry mouth
What are the signs of barbiturates intox?
Low safety margin
resp depression
What are the signs of barbituate withdrawal?
cv collapse
What are the signs of benzo intox?
Okay safety margin
minor resp depression
Addictive effects w/ alcohol
What are the signs of benzo withdrawal?
Rebound anxiety, seizures, tremor, insomnia
What are the signs of caffeine intox?
increased diuresis
muscle twitching
cardiac arrhythmias
What are the signs of caffeine withdrawal?
weight gain
What are the signs of nicotine intox?
What are the signs of nicotine withdrawal?
weight gain
what is delirium tremens?
life-threeatening alcohol w/drawal syndrome that peaks 2-5 days after last drink
Autonomic hyperactivity- tachy, tremors, anxiety
psychotic- hallucinations, delusions

Rx- benzos
What is Wernicke-korsikoff?
B1 deficiency
confusion, ophtalmoplegia, ataxia.
progresses to memory loss, confabulartion, personality change. Periventricular hemorrhage/necrosis especially in mammillary bodies
Rx- IV B1
Mallory-Weiss syndrome
longitudinal lacerations at the gastroesophageal junction from excessive vomiting
has pain
no pain in esophageal varices
what are clues to heroine addiction?
track marks
risk for hepatitis, abscesses, OD
hemorrhoids, AIDS and R-sided endocartidis
Naloxone and naltrexone inhibit
Methadone- used for heroin detox
What is delirium
Rapid decrease in attention span and level of arousal
disorganized thinking, hallucinations, illusions, pisperceptions, disturbance in sleep-wake cycle
cognitive dysfunction

Dx- waxing and waning level of consciousness
- substance use/ illniss

look for anti-ACh
Gradual decrease in cognition- memory, aphasia
apraxia, agnosia
loss of abstract though
behavioral/personality changes, imparied judgement

Dx- rule out delirium (alertness). more gradual. In elderly, depression can present as dementia

What are the Sx of a major depressive episode?
Sleep disturbance
Loss of Interest
Guilt or feelings of worthlessness
Loss of Energy
Loss of Concentration
Change in Appetite/weight
Psychomotor retardation
Suicidal idealations

prevalence- 5-12% male
10-25% female
Major depressive disorder is recurrent. 2 or more episodes
Dysthymia milder
What are the sleep patterns of depressed pts.
decreased slow wayve, REM latency
Early-morning awakening
What are the risk factors for suicide?
Previous attempt
Rational thinking
Organized plan
No spouse
Social support doesn't exist.
When is electroconvulsive therapy used?
major depressive disorder taht is refractory to other treatment
ECT is painless and produces a seizure
ECTs can cause disorientation
anterograde and retrograde amnesia
complications from anesthesia
What describes a manic episode?
Flight of idease
Activity and agitated
Sleep isn't needed
What is a hypomanic episode?
mood disturbance isn't severe enough to cause marked impairment in social or occupational functioning
manic- bipolar I
hypomanic- bipolar II
depressed episoeds

Conversion disorder
motor or sensory symps that suggest neurologic or physical disorder- follows an acute stressor.
Somatoform pain disorder
prolonged pain that is not explained by illness
Body dysmorphic disorder
preoccupation w/ minor or imagined physical flaws
pts seek cosmetic surgery
false belief of being pregnant
What are the differences between 1ry, 2ry, and 3ry gain?
1ry- symptom does for patienst internal psychic economy
2ry- symptom gets teh patient (sympathy)
3ry- what the caretaker gets (MD and interesting case)
What are the signs of a panic disorder?
Recurrent periods of intese fear and discomfort- peaks in 10 mins
Abdominal distress
Intense fear of dying or losing control
lIght headedness
Chest pain
Shortness of breath
Panic is decscribed in the context
What is a phobia?
fear that is excessive or unreasonable
cued by presence or anticipation of a specific object or situation
exposure-> anxiety
Gamophobia- fear of marraige
Algophobia- fear of pain
Acrophobia- fear of heights
Agoraphobia- fear of open places
What is post-traumatic stress disorder?
person experienced or witnessed event tha tinvolved actual or threatened death or serious injury
-> intense fear, helplessness, or horror
Traumatic event is persistently re-experienced as nightmares or flashbacks
person persistently avoids stimuli associated w/ trauma and experiences persistent symps of increased arousal
Disturbance lasts more than 1 month and causes distress or social/occupational impairment
PTSD follows acute stress disoreder, which lasts 2-4 wks
What is adjustment disorder?
anxiety, depression that causes impairment after a pychosocial stressor like divorse or moving
What is generalized anxiety disorder
uncontrollable anxiety unrelated to person, situation or event.
Sleep disturbance, fatigue, adn difficulty concentrating
What is autistic disorder?
severe communication probs
difficulty forming relationships
repetitive behavior, unusual abilities, and below-normal intelligence
Rx- increase communication and social skills
What is asperger disorder
milder form of autism involving problems w/ social relationships and social behavior.
normal inteligence
what is Rett disorder
X-linked, in girls
loss of development and mental retard appearing at 4. hand-wringing
what is ADHD
limited attention span and hyperactivity
kids are emotionally labile, and impulsive
prone to accidents

Methyphenidate to treat
What is Conduct disorder
behavior that violates social norms
>18, diagnosed as antisocial personality disorder
What is Oppositional defiant disorder
child is noncompiant in the absence of criminality
motor/voal tics and involuntary profanity
< 18
haloperidol to Rx
What is seperation anxiety disorder
fear of loss of attachment figure leading to factitious complaints
Anorexia vs. Bulimia
anorexia- abnl eating habits, body iimage distortion, and increased exercise
severe weight loss, amenorrhea, anemia, and electrolyte disturbances can follow. seen in adolescent girls. Coexists w/ depression

Bulimia- binge eating and self-induced vomitign or laxatives.
Normal body weight
Parotitis, enamel erosion, electrolyte disturbances, alkalosis
dorsal hand calluses
Illusion vs. delusion vs. hallucination
Hallucination- perceptions in the absence of external stimuli
Illusions- misinterpretations of actual stimuli
Delusions- false belief not shared w/ other members of culture/subculture maintained despite obvious proof to the contrary.
Delusion vs. loose association
Delusion- disorder of thought (actual idea)

loose association is a disorder in the form of though (the way ideas are tied together)
What are the types of hallucinations?
Visual and auditory- schizo
Olfactory occurs as an aura of psychomotor epilepsy
Gustatory- rare
Tactile- formication(ants) DTs adn cocaine
HypnaGOgic- Going to sleep
Hypnapompic- waking
Sleep apnea
person stops breathing for 10 seconds
Central- no resp effort
Obstructive- lots of resp effort

Obese, snoring, systemic/pulm HTN, arrhythmias, and possible sudden death
Individuals may become chronically tired
Disordered regulation of sleep-wake cycle
Hypnagogic or hypnopompic hallucinations
nocturnal and narcoleptic sleep episodes start off w/ REM sleep
Cataplexy-> loss of all muscle tone after a strong emotional stimulus
Strong genetic component
Rx w/ stimulants
Periods of psychosis and disturbed behavior w/ a decline in functioning lasting > 6 months
1-6 monts- schizophreniform
<1 month- brief psychotic disorder, stress related

1. Delusions
2. Hallucinations
3. Disorganized though
4. Disorganized or catatonic behavior

Negative symps- flat affect, social w/drawal, lack of motivation, lack of speech or thought

Genetic outweighs environment
What are the subtypes of Schizo

Schizoaffective disorder- combined schizo and mood disorder
What is the difference between a personality trait and a disorder?
trait- enduring pattern w/ a wide range of social and personal contexts

Disorder- when these traits become inflexible or maladaptive
person is not aware of problems
Disorder patterns must be stable by early adulthood; not diagnosed in kids
What are the Cluster A disorders?
odd or eccentric- no meaningful social relationships. No psychosis
Paranoid- distrust and suspiciousness; projection is main defense mechanism
Schizoid- voluntary social w/drawal, limited emotional expression

Schizotypal- interpersonal awkwardness, odd beliefs or magical thinking, eccentric appearance
What are the cluster B personaltiy disorders
Antisocial- disregar and violatio of rights

Borderline- unstable mood a nd interpersonal relationhsips, impulsive, empty

Histrionic- excessive emotionality, attention seeking, sexually provocative

Narcissistic- grandiosity, sense of entitlement; reacts to criticism w/ rage; may demand top physician
Cluster C personality disorders
Anxious or fearful; genetic association w/ anxiety disorders

Avoidant- sensitive to rejection

Obsessive compulsive- preoccupation w/ order

Dependant- submissive and clinging.
What drugs are used for parkinsons?
Bromocriptine- agonize dopamine receptors
Amantadine- increase dopamine release
L-dopa-> exog dopa
Selegiline- MAO type B inhib- prevents dopa breakdown
Antimuscarinic- benztropine- improves tremor and rigidity; no effect on bradykinesia
increases dopa in brain. can cross BBB
Carbidopa prevents preipheral decarboxylase to increase bioavailability

can cause arrhythmias from peripheral conversion to dopamine

can cause dyskinesea w/ long term use and akinesea between doses
selectively inhibits MAOB, increasing dopamine
adjuct w/ l-dopa
can enhance adverse effects of l-dopa
5HT1d agonist. Vasoconstriction. Half-life < 2 hrs
Acute migraine, cluster headaches

SE causes coronary vasospasm, mild tingling
can't use w/ CAD or prinzmetals
use-dependant blcok of Na channels
inhibs glutamate release from excitatory presynaptic neuron
for tonic-clonic seizures. Class IB antiarrhythmic

SE- nystagmus, ataxia, diplopia, sedation, SLE syndrome, induction of cP450
gingival hyperplasia in kids
peripheral neuropathy,
megaloblastic anemia
malignant hyperthermia
General characteristics of brain tumors
few of the spinal cord
kids- infratentorial
adults- supratentorial
1rys rarely mets
benign intracranial tumors can result in devastating clincial consequences due to compression phenomena
Metastatic tumors to the brain are foudn more frequently than primary neoplasms
1ry- glioblastoma, meningioma, acoustic neuroma

kids- cerebellar astrocytoma, medulloblastoma
Glioblastoma multiforme
most common 1ry tumor in adults
peak in late middle-age
anaplasia and pelopmorphism.
vasc changes w/ endothelial hyperplasia.
pseudopalisade arrangement of tumor cells- border central areas of necrosis and hemorrhage
- cerebral hemisphere
poor prognosis

Stain w/ GFAP
closely packed cells w/ large round nuclei w/ halo-> fried egg
site of origin in the cerebral hemisphere
tumor divides into group of cells by delecate capillary strands
Foci of calcification
4th ventricle
peak in kids and adolescence
histo by tubules or rosettes w/ cells encircling vessels or pointing toward a central lumen
tumor cells demonstrate blepharoplasts, rod-shaped structures near the nucleus representing basal bodies of cilia.
- papillary growths that obstruct flow of CSF and lead to hydrocephalus
2nd most common
benign, slow growoing
arachnoidal cells of meninges;
external to brain
cna grow into prasagittal region
falx cerebri
sphenoid ridge
olfactory area
suprasellar region
histo- whorled pattern of concentric arranged cells and laminated calcified psammoma bodies
frequently in women>men
after 30
kid neoplasm
primitive neuroectodermal tumor
malig tumor of the cerebellum
can compress the 4th
- sheeets of closely packed cells w/ scan tcytoplasm arranged in rosette or perivascular
closely related to neuroblastoma of the adrenal medulla or sympathetic ganglia
much less common than peripheral neuroblastoma
amplification of the N-myc oncogene

more amplification w/ worse prognosis
most frequently in the cerebellum
von hippel lindau
epo-> 2ry polycythemia
Foamy cells and high vascularity are characteristic
Schwannoma- benign slowly growing encapsulated tumor arising from schwann cells
intracranial is most frequently localized to the eighth CN

Antoni A- interlacing bundles
Antoni B- less cellular, looser
solitary or multiple tumors of peripheral nerves from schwann cell
von recklinghausen neurofibromatosis
mor common
lung, breast, skin, kidney, GI, thyroid
Pilocytic astrocytoma
diffulsely infiltrating glioma.
kids in posterior fossa
rosenthal fibers- eosinophilic corkscrew mofos
most common supratentorial in kids
derived from remnants of rathke's pouch
Facilitate GABAa action by increasing duration of Cl cahnnel opening, decreasing neuron firing

used as a sedative for anxiety, seizure, insomnia
Facilitate GABA action by increasing the frequency of Cl channel opening
MOst have long half-lives
and active metabolites

Clinically- anxiety, spasticity, status epilepticus (lorazepam and diazepam)
detoxification- alcohol w/drawal
night terrors, sleepwalking

Toox- dependence, additive CNS depression effects. Less risk of resp depression and coma w/ barbs
Flumazenil trates OD
Which benzos are short acting?
What are the toxicities of benzos?
sedation, tolerance, dependance
what are the toxicities of carbamazepine?
Diplopia, ataxia, blood dyscrasias, liver tox, teratogenesis
induce cP450
What are the toxicities of Ethosuximide
GI distress
stevens-johnson syndrome
What are the toxicities of Phenobarbital
induction of cP450
What are the toxicities of Phenytoin
gingival hyperplasia
megaloblasti canemia
SLE syndrome
induction of cP450
What are the toxicities of valproic acid
GI disress, rare, but fatal hepatotoxicity (measure LFTs), neural tube defects in fetus, tremor, weight gain
What are the side effects of lamotrigine
Stevens-Johnson syndrome
What are the toxicities of Gabapentin?
Sedation, ataxia
What are the toxicities of Topiramate?
Sedation, mental dulling, kidney stones, weight loss