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165 Cards in this Set

  • Front
  • Back
Congenital toxoplasmosis produces what brain pathology
basal ganglia calcification
mc cause of space occupying lesion in AIDS pt
toxoplasma gondii
where in brain does toxo gondii work
at junx of white and gray
dots inside toxo cyst are called what
tachyzoite
IgM in cord blood means what
congenital infection
key to CMV encephalitis diagnosis in newborn
periventricular calcifications
spleen is necessary to remove what two organisms
salmonella
streptococcus pneumonia

(pt with no spleen will get sepsis)
why is osteonyelitis caused by salmonella in sickle cell pts
autosplenectomy
handling brains gives you spngiform encephalopathy. what is eponymous disease name
C-J disease
HLA of multiple scleriosis
HLA-DR2
HLA of rheumatoid arthritis
HLA-DR4
trigger for RA in HLA-DR4 person
CMV
gender mc with MS
female
biggest path of MS
destruction of oligodendrocytes or myelin sheaths by CD8 T cells

Abs attacking oligodendrocyte protein
test question:
ID a gross picture of MS demyelination
white matter has grey spots in it
Does MS change intellect
no - no dementia
Does MS always progress into crippling disease?
no
what kind of tremor does MS pt have
intention tremor
describe MS speech pattern
scanning speech
describe gait of MS pt
ataxic
mc cause of optic neuritis
MS
pathognomonic for MS

*** high yield for board
bilateral internuclear ophthalmoplegia

demyelination of motor fasciculus
LP of MS
(1) Increased CSF leukocyte count
• Primarily T lymphocytes
(2) Increased CSF protein
• Primarily an increase in γ-globulins
(3) Increased CSF myelin basic protein
• Indicates active disease
(4) Normal CSF glucose

Increased CSF protein but no cells
• Oligoclonal bands present on high resolution electrophoresis
how do you see "oligoclonal bands" in MS
high resolution electrophoresis
Central pontine myelinolysis
due to rapid intravenous correction of hyponatremia
sign of Central pontine myelinolysis
quadriplegia
causes of dementia
hypothyroidism
lacunar infarcts
alzheimers
etc (lots)

rule out all before dx with alzheimers
key chromosome for alz
21 - makes amyloid precursor protein
3 secretases
(1) α-Secretases cleave APP into fragments that cannot produce Aβ.
(2) β followed by γ-secretases cleave APP into fragments that are converted to Aβ.
(3) Aβ deposits in neurons are neurotoxic.
• They also deposit in the walls of cerebral blood vessels.
beta amyloid protein. why is it bad
knocks off neurons
alz in 35 year old. What;s the pt's other disease
Down's
tau protein?
maintains microtubules in neurons
what if tau proteins are hyperphosphorylated?
tau protein makes fibers that make neurofibrillary tangles
Pin 1 (prolyl isomerase)
• what does it do?
normally strips excess phosphate molecules from NF restoring it to its original shape.

*****
do alz pts have Pin 1 ?
Important in preventing formation of NF tangles; often absent in AD brains

****
lobe spared atrophy in alz
occipital
Congo red stain shows what with amyloid
apple-green birefringence
what does silver stain show
"red" amyloid on yellow background

good to see senile plaques
key: how do you diagnose alz when person is alive?
purely cognitive testing.

presumptive diagnosis
voluntary muscle mov't controlled by what
striatum
main neurotransmitter in substantia nigra
DA
Grossly, what does black midbrain substantia nigra look like in parkinsonism pt
blackness disappears
type of rigidity with Parkinsonism
cogwheel
describe gait of parkinsonism
shuffling
Lewy body:
Neurons contain intracytoplasmic, eosinophilic bodies
• Ubiquinated damaged neurofilaments
ubiquitin is stress protein that marks cells for death

what is Lewy body in the liver called?
Mallory body
gas poisoning that can causes parkinsonism
CO
by product of meperidine that causes parkinsonism
MPTP
tail of caudate is atrophic. AD disease. what is it
huntington
genetic problem in Huntington's
trinucleotide repeats
"anticipation"
trinucleotide repeat tail gets longer with more generations - disease gets more severe
What disease?
1. Autosomal recessive disease
• Trinucleotide repeat disorder (GAA)
affects cerebellum
Friedreich’s ataxia
part of brain involved in Friedreich’s ataxia
dorsal columns
lateral corticospinal tract
posterior spinocerebellar tract
heart problem assoc with Friedreich's
Hypertrophic cardiomyopathy
endocrine prob assoc with Friedrich's
diabetes mellitus
desribe neuro exam in parkinsonism
normal
ALS: Popie's signs and symptoms
fasciulations all over
weakness
ALS is upper or lower motor disorder?
both
first muscles to atrophy in ALS
intrinsic muscles of hand
tongue
why do motor neurons break in ALS
free radical damage
Werdnig-Hoffmann disease
• What is it
Lower motor neuron disease that occurs in children
can't eliminate Cu in bile. Cu stays in the liver.
Ceruloplasmin is decreased
What's the disease
Wilsons
key to Wilson's: total serum Cu. 90-95% of value is bound to ceruloplasmin. The free Cu is dangerous.

What's total serum Cu level in Wilson's disease?
decreased
how does Cu hurt the liver
free radicals
end stage wilson's
cirrhosis
HCC
parkinsonism
dementia
Kayser-Fleischer ring?
brown pigment of outer cornea
lenticular degeneration?
atrophy/cavitation of basal ganglia
in Wilson's dis
endproduct of degredation of heme
bilirubin
does hemoglobin have color
no (heme does)
deficient enzyme in AIP
uroporphyrinogen I synthase
(alias porphobilinogen deaminase)
rate limiting step of heme pathway
ALA synthase (PLP)
Urine is colorless when first voided. why?
(1) Exposure to light causes oxidation of porphobilinogen to porphobilin producing port-wine color.
(2) Classic "window-sill test"
neuro problems in Pb poisoning caused by what?
δ-aminolevulinic acid (ALA)
neuro problems in AIP caused by what?
δ-aminolevulinic acid (ALA)
belly full of scars: multiple surgeries finding no cause of abdominal pain.
pt can have dementia, neuro probs (ALA), etc. What can be cause
AIP
what precipitates attacks of pain in AIP pt
alcohol

CYP450 system has heme in it. the cytochrome is heme.
ALA synthase is revved up b/c/ heme is gone
diff b/w syringomyelia and ALS
ALS is purely motor
B12 defici affects the same tracts in spinal cord as what disease
Friedrich's ataxia

Dorsal column, lateral corticospinal tract, and spinocerebellar tract demyelination
diff b/w B12 and folate defici
no neuro symps in folate defici
alcohol CNS disease

atrophy of what part of brain
cortical/cerebellar atrophy
Wernicke-Korsakoff syndrome
a. Most often due to what
thiamine deficiency

mc due to alcoholism
b. Gross and microscopic findings of
Wernicke-Korsakoff syndrome
(1) Hemorrhages with hemosiderin deposits; sites−
• Mamillary bodies, wall of the third and fourth ventricles (Slide 47)
(2) Neuronal loss, gliosis, vessel hemorrhage
thiamine is major cofactor for reactions producing what?
ATP
pyruvate --> acetyl CoA gives how many NADH
2
cofactor for pyruvate dehydrogenase
thiamine
how does gucose/saline IV induce Wernicke's encephalopathy in alcoholic
IV is given without thiamine
Wernicke's encephalopathy symptoms
confusion
ataxia
nystagmus
ophthalmoplegia
where are hemorrhages of wernicke's
Mamillary bodies, wall of the third and fourth ventricles
tumors. what do you need to know
which ones are in adults and which are in adults

locations
where are 70% of adult brain tumors
supratentorial
where are 70% of kids' brain tumors
infratentorial
primary adult brain tumor
Glioblastoma multiforme
original cell of glioblastoma multiforme
astrocyte
brain tumor in adult: In order of decreasing frequency−
• Glioblastoma multiforme, meningioma, ependymoma
brain tumors in kids In order of decreasing frequency−
• Cystic cerebellar astrocytoma, medulloblastoma, brainstem glioma
glioblastoma multiforme is famous for going across what
corpus callosum
meningioma : more commen in which gender
women

estrogen receptors
mc presentation of meningioma
focal epileptic seizure
woman
psammoma bodies? in what brain tumor
meningioma
ependymoma: where is it?
kids: 4th vent

adults: cauda equina
Malignant small cell tumor
• Primarily occurs in children
external granular cell layer of the cerebellum
Often seeds the neuraxis and invades the fourth ventricle
Medulloblastoma
40 yr old male
seizure
frontal mass w/ calcification
looks like fried eggs
Oligodendroglioma
lymphoma of the brain. mc primary or mets?
mets



Majority are metastatic high-grade B cell non-Hodgkin’s lymphomas
Primary CNS lymphomas due to what?
a. Most often associated with AIDS
b. Epstein-Barr virus–mediated B-cell lymphomas
c. Rapidly increasing due to the increase in AIDS
board question:

the rapid incr in primary CNS lymphoma in the USA is due to what
HIV
mc cancer of the brain? (not primary)
mets
a board question about mets has what clues in the stem
multiple lesions
wt loss
burning feet at night
like ant bites
peripheral neuropathy
mc genetic peripheral neuropathy
Charcot-Marie-Tooth (AD)

affects common peroneal nerve of the leg

(inverted bottle leg)
mc acute peripheral neuropathy
Guillain-Barre syndrome
mc infections that then precede to some ascending paralysis

(Autoimmune demyelination syndrome)
EBV
mycoplasma pneumonia
campylobacter jejuni
mc cause of periph neuropathy
DM
what cells have aldose reductase
lens of eye
schwann cells
pericytes around retinal vessels
what's the big deal about sorbitol
osmotically active
sucks water to it

-aneurysms of retinal vessels
-refractive change of lenses
-cataracts
toxins that produce peripheral neuropathy
heavy metal
alcohol
diphtheria toxin
nerve to close eyes
VII - orbicularis oculi
nerve to open eye
III - levator palpebri
can lower motor bell's pt wrinkle eyebrows
no
mc cause of bell's
HSV (mc)

, HIV, sarcoidosis, Lyme disease
#1 nerve involved in Lyme's
VII (bilateral)
if forehead works, where's the problem?
upper - in the brain
acoustic neuroma slide looks like what african animal
zebra

light and dark areas
is there vertigo acoustic neuroma?
no, but it's in meniere's
what is ophthalmia neonatorum
Conjunctivitis in newborn
what is time line of eye pus (ophthalmia neonatorum) in chlamydia and gono
gono - 1st week
chlamydia - 2nd week
pathogens causing bacterial conjuctivitis
Pathogens: Staphylococcus aureus (most common), Streptococcus pneumoniae, Hemophilus influenzae (aegyptius, pink eye)
symptoms of bacterial conjuctivitis
Purulent conjunctivitis. Pain but no blurry vision
sympt and cause of viral conjuctivitis
Watery exudate
Adenovirus: viral cause of pink eye, preauricular lymphadenopathy
HSV-1: keratoconjunctivitis with dendritic ulcers noted with fluorescein staining
Seasonal itching of eyes
Allergic conjunctivitis
What causes Severe keratoconjunctivitis in patients who do not clean their contact lenses properly
Acanthamoeba conjunctivitis
Stye (hordeolum) cause
staph aureus
Granulomatous inflammation involving the meibomian gland in the eyelid
Chalazion
orbital cellulitis what does it look like?
rubor, tumor of both upper/lower lids of eye

extension of sinusitis
bad sequellae of orbital cellulitis
spread from ethmoid sinus to cavernous sinus!
pterygium common in what geography
windy, dry, sandy, sunny
optic neuritis: presents with pale disc with blurry vision or loss of vision, may cause optic atrophy

mc cause
MS

other: methanol poisoning
Central retinal artery occlusion:

what are wymps
sudden, painless, complete loss of vision in one eye, pallor of optic disc, "boxcar" segmentation of blood in retinal veins
artery involved with central retinal artery occlusion
ophthalmic artery
central retinal vein occlusion
causes and symptoms
Causes: hypercoagulable state (e.g., polycythemia vera)
Clinical: sudden, painless, unilateral loss of vision, swelling of optic disc, engorged retinal veins with hemorrhage
aqueous humor maked by what
ciliary body
aqueous humor exits anterior chamber where
trabecular meshwork (schlemm)
cause of open angle glaucoma
block of treabecular meshwork
Tx of open angle glaucoma
beta blocker - decreases aqueous production
presentation of open angle glauc
bilateral eye pain
bad peripheral vision
bad night vision
why closed angle glaucoma
iris pushed anteriorly
narrow angle blocks aqueous drainage
treatment for acute closed angle glauc
pilocarpine (miotic agent = closes pupils)
mc cause of optic nerve atrophy
glaucoma
optic neuritis
uveitis: what's it look like
inflam of uveal tract:
choroid, iris, ciliary body

lots of vascularity visible, blurry vision, will go blind w/o eye specialist
disease that cause uveitis
sarcoid
mc cause of permanent vision impairmentn in old people
macular degeneration
what does dry type macular degeneration (break down of Brooks membrane of retina) look like
little droplets around macula

drusen
how do you know if it's wet MD
blood
helper T cell count of 50
blindness
cotton wool exudates
CMV retinitis
treatment of CMV retinits
ganciclovir
Foscarnet if it doesn't work
mc cause of cataract
age
other causes of cataracts
DM
systemic corticosteroids
infection (e.g., rubella),
mechanism of cataract in DM
osmotic damage (sorbitol)
mc cause of white eye reflex in new borns
retinoblastoma
too much endolymph in inner ear
fullness complaint
tinnitus
vertigo
sensorinrual hearing loss
Meniere's disease
how's Meniere's diff from acoustic neuritis
vertigo in Meniere's, not in AN
mc cause of sensorineural hearing loss in old people
Presbycusis
mc cause of conductive hearing loss in old person
otosclerosis
mc cause of conduction deafness in children
otitis media
swimmer's ear
external otitis

due to Pseudomonas aeruginosa, S. aureus, Aspergillus species
Malignant external otitis: severe infection of outer ear canal in patients with diabetes mellitus.

mc cause?
Pseudomonas aeruginosa most common cause