Neurology From Fa, Set 2

Front 1

Aneurysm causing the eye to look down and out. What artery is damaged?

Back 1

Posterior Communicating Artery (only LR and SO are functional). This is Weber Syndrome

Front 2

Aneurysm may cause a bilateral loss of lateral visual fields. What artery is damaged?

Back 2

Anterior communicating artery

Front 3

What artery is damaged if a person has Broca's or Wernicke's aphasia?

Back 3

Middle Cerebral Artery

Front 4

What artery is damaged if a patient has unilateral lower extremity sensory and/or motor loss?

Back 4

Anterior Cerebral Artery

Front 5

What artery is damaged if a patient has unilateral facial and arm sensory and/or motor loss?

Back 5

Middle Cerebral Artery

Front 6

Medial Medullary Syndrome is due to an occlusion of what artery?

Back 6

An occlusion of a paramedian branch of the Anterior Spinal Artery (see Circle of Willis, FA p.405). Aka Anterior Spinal Artery Syndrome.

Front 7

What are the unique constellation of S/S from Medial Medullary Syndrome?

Back 7

1. Damage to the pyramid/corticospinal tract leads to contralateral hemiparesis.
2. Damage to the medial lemniscus leads to decreased contralateral proprioception.
3. Damage to the hypoglossal nucleus or nerve leads to IPSILATERAL tongue paralysis; tongue deviates toward lesioned side.

Front 8

Wallenberg's syndrome is due to occlusion of which artery?

Back 8

Posterior Inferior Cerebellar arteries (PICA) leading to unilateral infarction of the lateral portion of the rostral medulla.

Front 9

What are the S/S of Wallenberg's aka laterl meduallary aka PICA syndrome?

Back 9

Contralateral: loss of pain and temp of body
Ipsilateral:
1. loss of pain and temp over face
2. hoarseness, difficulty swallowing, loss of gag reflex
3. Horner's Syndrome
4. Vertigo, nystagmus, n/v
5. cerebellar deficits (ataxia, past pointing)

Front 10

Aneurysm causing the eye to look down and out. What artery is damaged?

Back 10

Posterior Communicating Artery (only LR and SO are functional). This is Weber Syndrome

Front 11

Aneurysm may cause a bilateral loss of lateral visual fields. What artery is damaged?

Back 11

Anterior communicating artery

Front 12

What artery is damaged if a person has Broca's or Wernicke's aphasia?

Back 12

Middle Cerebral Artery

Front 13

What artery is damaged if a patient has unilateral lower extremity sensory and/or motor loss?

Back 13

Anterior Cerebral Artery

Front 14

What artery is damaged if a patient has unilateral facial and arm sensory and/or motor loss?

Back 14

Middle Cerebral Artery

Front 15

Medial Medullary Syndrome is due to an occlusion of what artery?

Back 15

An occlusion of a paramedian branch of the Anterior Spinal Artery (see Circle of Willis, FA p.405). Aka Anterior Spinal Artery Syndrome.

Front 16

What are the unique constellation of S/S from Medial Medullary Syndrome?

Back 16

1. Damage to the pyramid/corticospinal tract leads to contralateral hemiparesis.
2. Damage to the medial lemniscus leads to decreased contralateral proprioception.
3. Damage to the hypoglossal nucleus or nerve leads to IPSILATERAL tongue paralysis; tongue deviates toward lesioned side.

Front 17

Wallenberg's syndrome is due to occlusion of which artery?

Back 17

Posterior Inferior Cerebellar arteries (PICA) leading to unilateral infarction of the lateral portion of the rostral medulla.

Front 18

What are the S/S of Wallenberg's aka laterl meduallary aka PICA syndrome?

Back 18

Contralateral: loss of pain and temp of body
Ipsilateral:
1. loss of pain and temp over face
2. hoarseness, difficulty swallowing, loss of gag reflex
3. Horner's Syndrome
4. Vertigo, nystagmus, n/v
5. cerebellar deficits (ataxia, past pointing)

Front 19

Occlusion of the anterior inferior cerebellar arteries results in what syndrome?

Back 19

Lateral inferioe pontine syndrome (see FA p. 405)

Front 20

What is the most common location of a berry aneurysm?

Back 20

Bifurcation of the Anterior Communicating Artery

Front 21

What is the most common cause of a subarachnoid hemorrhage?
What is the chief complaint of SH?

Back 21

Trauma (non-traumatic: berry aneurysm or arteriovenous malformation, AVM)
CC: "Worst headache of my life"

Front 22

What conditions are associated with a subarachnoid hemorrhage (and thus we may want to screen patients with these)?

Back 22

1. APKD
2. Ehlers-Danlos Syndrome
3. Marfan's Syndrome

Front 23

What might be seen on a spinal tap in a patient with a subarachnoid hemorrhage?

Back 23

Bloody or yellow (xanthochromic) fluid.

Front 24

A person gets whacked in the head and passes out. The wake up and claim they are ok. What are you concerned about? What is the problem? What can be the consequences?

Back 24

Worried about an Epidural hematoma due to rupture of the Middle Meningeal Artery.
*systemic arterial pressure causes rapid expansion. CT shows a "biconvex disk".
Consequences: transtentorial herniation, CN III palsy

Front 25

What kind of hematoma are you worried about if the patient has a history of a progressively worsening headache? Why was is progressive and why where the S/S delayed?

Back 25

Subdural Hematoma.
This is due to rupturing of the bridging veins, which have lower pressure, so this hematoma takes longer to expand and push against structures in the skull.

Front 26

What populations are at risk for a subdural hematoma?
What kind of lesion is seen on CT?

Back 26

Elderly, alcoholics, people with blunt trauma, shaken babies.
CT:crescent-shaped hemorrhage.

Front 27

What laboratory finding is diagnostic in a patient with optic neuritis (sudden vision loss), MLF syndrome, and hemiparesis?
What condition is this?

Back 27

Oligoclonal bands.
This is Multiple Sclerosis

Front 28

What is Charcot's triad of MS?

Back 28

SIN
1. Scanning speech
2. Intention tremor, Incontinence, Internuclear ophthalmoplegia (MLF)
3. Nystagmus

Front 29

Combined UMN and LMN deficits without any sensory deficit.

Back 29

Prime example is Stephen Hawkins: Amyotrophic Lateral Sclerosis (ALS)

Front 30

Viral destruction of anterior horn of the spinal cord

Back 30

Poliomyelitis (Polio)
s/s: malaise, headache fever, nausea, abdominal pain and sore throat all indicate infection. LMN signs: muscle weakness and atrophy, fasiculations, hyporeflexia

Front 31

ALS may be due to a defect in what enzyme?

Back 31

Superoxide dismutase 1 (SOD1)

Front 32

Degeneration of the dorsal columns and dorsal roots of the spinal cord is known as what condition? What is it due to?
What are some symptoms?
What will a Romberg test be?

Back 32

Tabes Dorsalis
Due to Tertiary (3) Syphilis
Symptoms: loss of proprioception and locomotor ataxia. Argyll Robertson pupils (prostitute pupils; accommodate but don't react)
Positive Romberg test

Front 33

Damaging the anterior white commisure of the spinal column results in what condition and what is it characterized by?

Back 33

Syringomyelia.
Loss of Pain and Temp sensation bilaterally.

Front 34

Sympathectomy of the face is known as...

Back 34

Horner's Syndrome

Front 35

What are the S/S of Horner's Syndrome?

Back 35

"PAM is horny"
Ptosis
Anhidrosis
Miosis

Front 36

Common cause of Horner's Syndrome?

Back 36

Pancoast tumor
Others: Brown-Sequard syndrome, late-stage syringomyelia

Front 37

Which vagal nuclei is responsible for visceral sensory information such as tast, baroreception, and gut distention?

Back 37

Nucleus Solitarius (VII, IX, X)
viscerl Sensory=Solitarius

Front 38

Which vagal nuclei is responsible for motor innervation of pharynx, larynx, and upper esophagus?

Back 38

Nucleus ambiguus (IX, X, XI)
aMbiguus=Motor

Front 39

Which vagal nuclei is responsible for sending autonomic parasympathetic fibers to the heart, lungs, and upper GI?

Back 39

Dorsal motor nucleus

Front 40

If the right vagus nerve or nuclei is damaged, then to which side will the uvula deviate?

Back 40

To the side opposite the lesion: left (because the muscles of the soft palate on the left still work to raise the left palate).

Front 41

If the portion of the right motor cortex (or right corticobulbar tract) that innvervates the soft palate is damaged, to which side with the uvula deviate?

Back 41

To the side of the lesion: right (because the lesion is after the crossing, so the right motor cortex is damaged--> cross to the left palate--> right palate still works).

Front 42

A dysfunctional hypoglossal nerve (CN XII) or nuclei will deviate the tongue to which side?
What if the lesion were from the cortex (or corticobulbar tract)?

Back 42

Side of the lesion (the working side pushes it towards the nonworking side).
If above the nuclei (corticobulbar tract to motor cortex), then tongue moves to the opposite side of the lesion. i.e. right motor cortex lesion, left deviation of tongue.

Front 43

Cataracts are cloudiness in what structure? One eye or both?

Back 43

Lens, bilateral

Front 44

What deficiencies are risk factors for cataracts (excluding trauma, infection, age, smoking and alcohol)?

Back 44

Galactosemia, galactokinase deficiency, diabetes (sorbitol accumulation)

Front 45

Elevated optic disk w/blurred margins, and a bigger blind spot.

Back 45

Papilledema (increase in intracranial P)
i.e. hydrocephalus

Front 46

Constriction (miosis) of the pupil is due to which muscle? Which autonomic control is it under? What nerve controls it and which nucleus is it attached to?

Back 46

Pupillary sphincter mm (circular mm)
Parasympathetics
CN III and the Edinger-Westphal nucleus--> ciliary ganglion

Front 47

Dilation (mydriasis) of the pupil is due to which muscle? Which autonomic control is it under? What nerve controls it and which nucleus is it attached to?

Back 47

Radial mm (pupillary dilator mm)
Sympathetic
T1 preganglionic sympathetic--> superior cervical ganglion--> postganglionic sympathetic--> long ciliary nerve.

Front 48

What tumor causes bitemporal hemianpoia? In kids?

Back 48

Pituitary adenoma
Kids: Craniopharyngioma

Front 49

Lewy bodies are associated with?

Back 49

Parkinson's

Front 50

Dementia + visual hallucinations + falls/syncope?

Back 50

Lewy body dementia

Front 51

Dementia + personality changes

Back 51

Pick's Disease (frontotemporal dementia)

Front 52

Rapidly progressive Dementia + myoclonus

Back 52

Creutzfeldt-Jakob disease (CJD),which is caused by prions

Front 53

Neurofibrillary tangles + Senile plaques + Dementia

Back 53

Alzheimer's Dementia

Front 54

Patient with bilateral muscle weakness that started in the feet and has progressively climbed up the legs now also has facial paralysis. What condition do they have?

Back 54

Guillain-Barre syndrome (acute inflammatory demyelinating polyradiculopathy): inflam+demyel of peripheral nerves and motor fibers of ventral roots (starts distal lower extremities)

Front 55

Infections my be associated with Guillain-Barre syndrome. By what process is this and what are common causative agents?

Back 55

Molecular mimicry (body thinks myelin protein is bug protein) causing an autoimmune attack e.g. Campylobacter jejuni, herpesvirus

Front 56

What is critical to do for a patient with Guillain-Barre syndrome?

Back 56

Respiratory support (due to potential diaphragm failure)

Front 57

Progressive multifocal leukoencephalopathy (PML) is demyelination of the CNS due to destruction of oligodendrocytes. What viruses is this condition associated with?

Back 57

JC virus, AIDS

Front 58

The classic childhood seizure characterized by a blank stare?
Treatment?

Back 58

Absence or Petit mal seizure. Treat with Ethosuximide

Front 59

What are the causes of seizures by age (children, adult, elderly)?

Back 59

1. Children: genetic, infection (febrile), trauma, congenital, metabolic.
2. Adult: tumors, trauma, stroke, infection
3. Elderly: stroke, tumor, trauma, metabolic, infection

Front 60

What is/are the drug of choice for partial (simple and complex) and tonic-clonic seizures?

Back 60

Phenytoin, Carbamazepine, Valproic Acid (p.431)

Front 61

Other than Phenytoin, Carbamazepine, and Valproic Acid, what other 4 drugs can be used for partial and tonic-clonic seizures?

Back 61

Lamotrigine, Gabapentin, Topiramate, Phenobarbital

Front 62

What do you use to treat Status Epilepticu and epilepsy?

Back 62

Benzodiazepams i.e. Diazepam, Lorazepam

Front 63

The drugs used to treat seizures, in general, work to slow down CNS activity. What are the common side-effects?

Back 63

Sedation, ataxia, dizziness, diplopia, nystagmus

Front 64

Phenytoin is one of the seizure drugs. Other than the common s/e of those drugs, what s/e are unique to Phenytoin?

Back 64

"Grow gums, hair, and a messed up baby": Gingival hyperplasia, hirsutism, etal hydanation syndrome

SLE-like syndrome, and induce cytochrome p450

Front 65

Thiopental, secobarbital, phenobarbital, and pentobarbital. What kind of drugs and MoA?

Back 65

Barbiturates
MoA: facilitate GABA(a) action by increasing the durationof Cl- channel opening (decreasing neuron firing).

Front 66

Diazepam, Lorazepam, triazolam, temazepam, oxazepam, midazolam, chlordiazepoxide, alprazolam.
MoA?

Back 66

Benzodiazepines
MoA: Facilitate GABA(a) action by increasing the Frequency of Cl- channel opening.

Front 67

Tx for Benzodiazepine toxicity?

Back 67

Flumazenil