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75 Cards in this Set
- Front
- Back
the anterior fossa contains what parts of the brain?
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frontal lobes
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the middle fossa contains what parts of the brain?
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temporal lobes
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the posterior fossa contains what parts of the brain?
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cerebellum, brainstem
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what divides the anterior and middle fossae?
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lesser wing of sphenoid
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what divides middle fossa from posterior fossa?
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petrous ridge of temporal bone and tentorium cerebelli
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what two places is the periosteal dura separated from the meningeal dura?
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falx cerebri and tentorium cerebelli
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what structure normally passes through the tentorial notch?
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midbrain
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waht is the Virchow-Robin space?
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where the pia surrounds and is fused to the initial portion of blood vessels as they come out of the brain tissue
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what structure traverses the skull via the foramen spinosum?
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middle meningeal artery
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difference between middle meningeal artery and middle cerebral artery?
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mid meningeal is from ext carotid, supplies dura
mid cerebral is from int carotid, supplies brain |
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main route of flow of dural venous sinuses?
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drain to sigmoid sinuses then to int jugular vv.
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the major arteries of the brain travel within what space?
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subarachnoid
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the spinal cord is enveloped by the same meninges as the brain, but is also surrounded by what?
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epidural fat
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what surrounds the third ventricle?
fourth ventricle? |
diencephalon
pons, medulla, cerebellum |
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flow of CSF?
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lateral ventricles > foramen of Monro > 3rd > aqueduct of Sylvius > 4th > foramina of Luschka & Magendie > spinal cord & brain (subarachnoid space) > arachnoid granulations > dural sinuses > bloodstream
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drainage pathways of cavernous sinuses?
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sup petrosal sinus to sigmoid sinus to int jugular v
or inf petrosal sinus directly into int jugular v |
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what drains into the confluence of sinuses?
to what does it drain? |
straight sinus (drains inf sagittal sinus & great cerebral vein of Galen) and sup sagittal sinus
drains to trasnverse sinus into sigmoid sinus into int jugular v |
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what property gives the BBB its filtering power?
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zonula occludens (tight junctions) between capillary endothelial cells
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circumventricular organs of the brain (3)
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median eminence and neurohypophysis, and area postrema
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fortification scotoma is a preceding sx of what?
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migraine HA
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extremely severe, boring type of HA seen more commonly in males, may happen several times a day for weeks then remit for several months
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Cluster HA
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type of HA that responds well to O2
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cluster HA
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cluster HA is often accompanied by what other sxs?
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U/L autonomic sxs (tearing, eye redness, Horner's syndrome, flushing, sweating, nasal congestion
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mild-moderate, band-like HAs that may occur transiently or continuously for years
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tension type hA
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first step in eval of pt w/ sudden explosive onset of severe HA?
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Head CT to check for subarachnoid hemorrhage
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cause of HA that is worse when standing than when lying down?
worse when lying down than standing? |
low CSF pressure
neoplasm causing inc ICP |
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idiopathic HA and inc ICP w/o mass lesion in adolescent females?
TxOC? |
pseudotumor cerebri
acetazolamide or shunt |
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what diagnostic tests should be done early in tx of HA in elderly pt?
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ESR and temporal artery bx
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hypertension, bradycardia, and irreg respirations may indicate what?
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increased ICP
(Cushing's triad) |
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most important indicator of elevated ICP?
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irritability, depressed alertness and attention
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HA d/t intracranial mass is often worse at what time of day?
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Morning (brain edema increases overnight)
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never do a lumbar puncture on a pt w _____
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elevated ICP
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blown pupil, hemiplegia, and coma signify what?
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uncal (tentorial) herniation
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in uncal herniation, the condition producing a dilated pupil C/L to the lesion
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Kernohan's phenomenon
(midbrain pushed against opposite side of tentorial notch) |
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MCC of central herniation
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any lesion producing diffuse elevated ICP
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most common sx of mild central herniation?
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lateral rectus (abducens) palsy
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subfalcine herniation is usually asxs, but sometimes can cause what?
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occlusion of ACAs and anterior cerebral infarct
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pt who is seeing stars, followed by HA, dizziness and sometimes N/V may have what?
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concussion
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rapidly expanding hemorrhage forming lens-shaped pattern on CT, may have lucid interval
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epidural hematoma (middle meningeal a)
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brain hemorrhage not associated with trauma, w/ vague sxs like HA, cog impairment, unsteady gait, crescent shape on CT
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chronic subdural hematoma
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brain hemorrhage associated with subarachnoid hemorrhage and contusion, crescent shape on CT?
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acute subdural hematoma
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MCC of nontraumatic subarachnoid hemorrhage
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ruptured arterial aneurysm
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risk factors for spontaneous subarach hemorrhage?
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atherosclerosis, PCKD, Marfan's (aneurysm risk)
HTN, smoking, etOH, transient high elevations in BP (aneurysmal rupture risks) |
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what complication is common in survivors of subarachnoid hemorrhage?
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delayed cerebral vasospasm (1 wk after), can lead to cerebral ischemia or infarction
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MCC of lobar hemorrhage?
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amyloid angiopathy
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MCC nontraumatic intraparenchymal hemorrhage?
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HTN
causes lipohyalinosis and Charcot-Bouchard microaneurysms of small penetrating blood vessels |
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most common locations of hypertensive hemorrhage?
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basal ganglia (putamen), thalamus, cerebellum, pons
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severe or rapidly developing cases of hydrocephalus produce what syndrome?
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Parinaud's syndrome
(setting sun sign - eyes deviate down and in d/t dilated 3rd ventricle pushing down on colliculus of midbrain) |
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elderly pt w/ gait difficulties, urinary incontinence, and mental decline may have what?
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normal pressure hydrocephalus
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two most common primary brain tumors?
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glioblastoma, meningioma
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in adults, ___ % of brain tumors are supratentorial
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70
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most common brain tumors in children? (3)
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astrocytoma, medulloblastoma, ependymoma
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d/t the common placement, brain tumors in children tend to cause what?
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hydrocephalus
(usually in posterior fossa) |
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from what do meningiomas arise?
where do they form most commonly? |
arachnoid villus cells
over lateral convexities, in the falx, and along basal regions of cranium |
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common brain tumor in children that can often be cured by surgical resection?
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cerebellar astrocytoma
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in women, meningiomas are associated with what?
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breast cancer
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CSF: high WBCs, high protein, low glucose
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Acute bact meningitis (mostly PMNs)
Tuberculous or cryptococcal meningitis (mostly lymphocytes) |
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CSF: normal to incr WBCs (lymphocytes), high protein, normal glucose
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viral (aseptic) meningitis,
herpes meningoencephalitis |
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common organisms in brain abscess?
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Strep, Bacteroides, Enterobacteriaciae, S. aureus, Nocardia
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TxOC for brain abscess smaller than 2.5cm?
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Ceftriaxone + metro
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what are common causes of meningitis in infants 0-3 mo?
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E. coli, Group B Strep and Listeria
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common causes of meningitis in children 1 mo - 7 yrs?
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H. influenzae, N. meningitidis, and S. pneumoniae
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what pathogens cause meningitis in ages 7-adult?
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Listeria, N. meningitidis, S. pneumoniae
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common cause of subdural empyema?
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direct extension from infxn of sinuses or inner ear
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aseptic meningitis w/ CN palsies, progresses to med-vessel arteritis and diffuse white matter infarcts, ends in general paresis, dementia, UMN-type weakness, and optic atrophy
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Neurosyphilis
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TxOC for neurosyphilis?
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IV pen G
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FTA-ABS or MHA-TP test for what?
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treponemal antibodies (neurosyphilis)
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IC pt presents with seizures, HA, fever, lymphocytic predominant meningitis; brain MRI shows nonenhancing nodules surrounded by a ring of enhancement. Dx?
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Toxoplasmosis
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TxOC for toxo?
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pyrimethamine and sulfadiazine
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MCCs of intracranial mass lesions in HIV pts? (2)
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Toxo, primary CNS lymphoma
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Dx: seizures, hydrocephalus, soft tissue cysts or calcifications (muscle, eye, CNS)
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cyticercosis (taenia solium)
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Dx: diabetic pt w/ ophthalmoplegia, facial numbness and weakness, visual loss, violet discoloration of tips of eyelids
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mucormycosis
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Dx: rapid onset dementia, exaggerated startle response, myoclonus, visual distortions, ataxia, periodic sharp waves on EEG
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Creutzfield-Jakob dz
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lumbar puncture needle is inserted where?
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between L4 - L5
(to avoid SC which goes down to L2; post iliac crest is landmark) |
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Dx: immunologic testing of CSF shows oligoclonal bands
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multiple sclerosis
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